PA Discretionary Funding Fiscal Year 2020

The proposed COVID Suicide Prevention Project will focus on adults age 25 and older, who are transitioning back into their community and families after making a suicide attempt. Most individuals will be discharging from the hospital but they may be coming from other crisis services (e.g., emergency department [ED]). Within this population we will have a specific focus on individuals who are current or past victims of domestic violence. With suicide rates following immediately following psychiatric hospitalization discharge over 50 times greater than the national average (Chung et al., 2017) and rates for outpatient behavioral healthcare continuing to remain under 50% for those with a diagnosed psychiatric illness (SAMHSA, 2019). These data speak to the value of continuity of care, highlighted in Knesper’s (2011) seminal review. The current COVID-19 pandemic has led to noticeable stressors related to finances, food insecurity, and social isolation – all leading to an increase in psychiatric hospitalization. The project is designed after other successful statewide efforts and includes a two-tiered approach. Tier 1 includes broad efforts that support training clinical and community staff across Pennsylvania, thus providing a forum for promoting evidence-based practices to all statewide providers. Tier 2 engages 13 counties within the catchment area of the lead agency, Center for Community Resources (CCR), and brings together a comprehensive aftercare protocol for individuals following psychiatric discharge and discharge from emergency departments and medical units following suicide attempts. We have developed an intervention that includes rapid follow-up, ongoing assessment, group support for suicide attempters, family-based intervention, connection to follow-up outpatient care, crisis support, and additional evidence-based interventions, such as safety planning and caring contacts. These individuals will be offered individual group support (in-person or telehealth) and family support via telehealth. Additionally, they will be offered a web-based screening tool, the Behavioral Health Screen (BHS; Diamond et al., 2010), that assesses and monitors for risk, automatically sends follow-up assessments, provides embedded safety planning, and initiates caring contacts. Thomas Jefferson University and Drexel University will offer follow-up clinical support and evaluate outcomes. Our model exceeds national standards, providing multiple touch points to engage suicidal adults, stabilize family support, and provide follow-up assessment and crisis supports, as needed. CCR receives nearly 25,000 crisis contacts annually, with 656 annual contacts involving imminent or high risk for suicide and another 1,066 calls for domestic violence, providing a viable performance site for this project. Considering our intervention not only addresses these individual but also family members who may be at increased risk, we expect a minimum of 7,191 individuals to be served by this project (assuming an average of 2.14 family members per high risk adult [U.S. Census Bureau, 2019] and a 16-month intervention phase). By training providers statewide in Tier 1, this estimate will significantly increase.

Edinboro University's Expansion of Practitioner Education program plans to develop Certified Alcohol and Drug Counselor and Certified Advanced Alcohol and Drug Counselor credentials to increase the percentage of professionals providing high quality substance use disorder services throughout Northwest Pennsylvania by at least 150. The curriculum will be incorporated into graduate counseling coursework for current and incoming students and through continuing education to provide opportunities for professionals already working in the field. Programs will be developed in alignment with the Pennsylvania Certification Board credentials and include new field placement opportunities in rural communities. The goal of the proposed approach is to provide high quality counselor education training and increase the number of professionals prepared to deliver substance use disorder (SUD) services to reduce both the human and financial costs associated with SUD. Objectives of the program are: (1) Develop high quality, comprehensive curriculum on the identification and treatment of SUD that aligns with requirements for the Certified Alcohol and Drug Counselor credential; (2) Develop a systematic evaluation plan for grant-related data collection, performance measurement, and performance assessment as well as a loop for continuous quality improvement of the certified program for SUD identification and treatment; (3) Develop continuing education workshops for current mental health professionals who did not have addiction course work in their graduate program; (4) Implement all graduate course work, with an emphasis on SUD identification and treatment, and continuing education; (5) Increase clinical fieldwork options through partnerships with community agencies, including inpatient and outpatient treatment facilities, and; (6) Develop a systematic plan for providing undeserved, rural communities with additional SUD services. Strategies involve revising or enhancing existing courses to align with accreditation requirements; developing new courses to address advanced SUD counseling tasks; enhancing counseling program assessment planning and evaluation for quality improvement, and; establishing new field placement rotations in rural communities.

EmergyCare will impact the PA EMS Crisis by increasing the number of functioning providers and limiting the loss of providers by providing high quality, blended virtual training opportunities for EMT, AEMT, and continuing education within the catchment area of the grant. Additionally, EmergyCare will increase the competency of career and volunteer EMS providers to deal with mental health and substance abuse disorders and the care of such disorders through continuing education programs.

The Fayetteville Volunteer Fire and Ambulance Department’s Training Institute’s (FVFDTI) project entitled “Bringing EMT Training into the 21st Century” (BET21C) is intended to reverse the 5-year downward trend of Emergency Medical Technician (EMT) class enrollments. The project involves of the listed percentages of the following counties within the 13th Congressional District in Pennsylvania (100% of Franklin, 45% of Adams, and 20% of Cumberland Counties). This encompasses a total geographic area of 1471.4 square miles and a total population of 195,330. The demographics of the area that we provide training for are as follows: Average median income is $47,420.74 and the per capita income is $20,754,86. There are 5.5% of families and 8.9% of the population living below the poverty line. According to the 2010 US Census the ethnic breakdown of races are as follows: 95.8% = White; 2.1% African American; .4% = Asian; 1.9% = Hispanic; and .8% = Multi-race: Project Goals of the project were determined via polling of past and prospective students: 1. Increase the enrollment in EMT classes in this region. 2. Reduced the number of individuals failing the state EMT certification test. 3. Make practical training scenarios as realistic as possible. 4. Increase the knowledge and skills of emergency responders to recognize the signs of mental disorders and substance abuse through educational seminars. 5. Provide opportunities for EMTs to maintain their certification. Objectives: 1. Provide three 220 hour EMT classes, through virtual and classroom training, to train approximately 80 people as EMTS by the end of the project year. 2. Provide quarterly Mental Health & Substance Abuse educational seminars to over 400 individuals by the end of the project period. 3. Purchase 2 sets of new CPR Mannequins, 4 new AED Trainers, and a state of the art Rescue Mannequin for use in each class. 4. Offer Continuing Education classes monthly, to allow individuals to attend and meet the training requirements of the Department of Health. 5. Purchase an Audience Participant Response System to provide immediate feedback to both the students and the instructors on the comprehension of the material being covered. When we started the development of this project it was our original intention was to extend the goals beyond 4 years, which was the original performance period. Now that the performance period has been reduced to one year, we are confident this project’s cost benefit ratio will extend for several years.

Social workers are uniquely positioned to reach people with substance use disorders (SUD) across diverse service settings, including primary care, hospitals, schools, senior centers, housing programs, mental health centers, child welfare agencies, jails, prisons, community centers, domestic violence programs, substance use treatment, and other health, legal, and social service organizations. However, most social workers do not receive specialized training in substance use-related services during their professional education. This project's proposed activities will ensure that 100% of MSW students at the University of Pennsylvania gain specialized training in evidence-supported SUD practices, including SBIRT, assessment, and treatment to address alcohol, marijuana, stimulants and opioids, in particular, by infusing it across all sections of our required, first-year foundation practice course (N=approximately 165 students/year). This content will draw upon evidence-supported pedagogical strategies to enhance SUD practice knowledge and skills and to ensure that regardless of the setting in which a person with SUD engages, high-quality, evidence-supported care can be provided. In Year 1, a multimodal curriculum including video, online, and standardized client trainings will be developed by the project team and then implemented and evaluated with all first-year MSW students (N=approximately 165 students). Pre- and post-test evaluations for MSW students and satisfaction surveys for both MSW students and foundation practice course instructors will be developed in Year 1 and then implemented and analyzed in Years 1 and 2. A minimum of 85% of participants will receive a minimum score of 85% on post-test evaluation of SBIRT and SUD assessment and treatment knowledge. In Year 2, the curriculum will be further refined, implemented, and evaluated with all new first-year MSW students (N=approximately 165 students in Year 2; N=approximately 330 students across both years). In Year 1 and Year 2, the project team will collaborate with the Pennsylvania State Board of Social Workers, Marriage and Family Therapists and Professional Counselors and the Association of Social Work Boards to expand SUD questions on state licensure exams for social workers (Licensed Social Worker-LSW and Licensed Clinical Social Worker-LCSW). Throughout the curriculum development and infusion in the required foundation practice sequence, the project team will act to support the sustainability of the SUD curriculum, including collaboration with foundation practice instructors, inclusion in the course syllabus, and provision of online and video training materials at no cost and with easy access in future years. The overarching goals of the project include the development, implementation, and evaluation of evidence-supported training in SUD practices among MSW students to ensure people have consistent access to high quality SUD services across diverse service settings and to reduce the gap between SUD treatment need and access.

We have created an expanded version of SBIRT training, SBIRT-Plus, which focuses on building students’ knowledge, skills, and attitudes to identify individuals with or at risk for marijuana, stimulants, or opioid usage. The SBIRT-Plus project uses an interdisciplinary approach to expand, transform, and strengthen the capacity of the University of Pittsburgh’s (PITT) School of Health and Rehabilitation Sciences (SHRS) Occupational Therapy (OT) and Clinical Rehabilitation and Mental Health Counseling (Counseling) educational programs to address the critical need for well-trained rehabilitation professionals to screen, refer, and provide preventative treatment to those with or at risk for developing SUDs. The goal of the SBIRT-Plus program is to implement an interdisciplinary, sustainable, replicable training within PITT SHRS. In collaboration with experts from PITT’s School of Nursing (SON) and the Institute for Research, Education, and Training in Addictions (IRETA), we will train 250 rehabilitation students in PITT’s Departments of OT and Counseling to have the knowledge, skills, and attitudes to successfully implement SBIRT-Plus as rehabilitation professionals in the workforce. We hypothesize that participation in SBIRT-Plus modules and workshops will increase knowledge and skills while improving attitudes of OT and counseling students’ to work with clients with SUDs by building confidence and reducing stigma associated with SUDs. Healthcare professionals such as occupational therapists and counselors, who address psychosocial aspects of rehabilitation, need to be poised from the very first point of contact to meet the needs of clients who are at risk for misusing substances. Despite the exposure and need to treat people at risk for SUDs, occupational therapy and counseling graduate students may learn general knowledge of SUDs but lack training on screening and prevention treatment for individuals at moderate and high risk for SUDs. Training occupational therapy and counseling students on SUDs screening, preventative treatment, and referral will ultimately address this treatment gap by elevating the services rehabilitation clinicians are able to provide individuals at risk for SUDs

The proposed University of Pittsburgh School of Social Work (PITT SSW) Substance Use Disorder (SUD) and Co-Occurring Mental Health Disorder (CO-MH) Training and Integration Program will develop and integrate 18-hours of comprehensive education on SUD and CO-MH into the Bachelor of Arts (BA) and Master of Social Work (MSW) curricula at PITT SSW. This is an application in response to Funding Opportunity Announcement (FOA) FG-20-001 from the Substance Abuse and Mental Health Services Administration (SAMHSA). The population of focus includes 400 BA and MSW students at PITT SSW. PITT SSW will be collaborating with the University of Pittsburgh School of Pharmacy Program Evaluation and Research Unit (PERU), the applicant organization, on this proposed initiative. PERU will lead curriculum development and integration, train faculty champions, organize continuing education (CE) events, and lead all program evaluation activities. PITT SSW will integrate the SUD and CO-MH curriculum into the current BA and MSW curricula, facilitate in-class lecture and discussion on the curriculum’s learning objectives, work with the Administration of Social Work Boards (AWSB) to implement examination questions related to SUD, and sustain the program within the curricula following the completion of the grant. Key goals of this project are to develop a comprehensive SUD and CO-MH curriculum for BA and MSW students, integrate the curriculum into the current BA and MSW curricula, increase the number of questions related to SUD on the AWSB licensing exams, and increase the number of social workers who are trained on SUD and CO-MH to inform and improve clinical work with clients diagnosed with any SUD and/or CO-MH through the developed curriculum and CE events. To achieve these objectives, the program will do the following: (1) develop a comprehensive curriculum on best practices related to screening, brief intervention, and referral to treatment (SBIRT) strategies, assessing clients for SUD and CO-MH, treatment principles and their application to alcohol, marijuana, stimulant, and opioid use and misuse, strategies to decrease stigma in healthcare, and managing clients with CO-MH; (2) integrate the curriculum into the current BA and MSW curricula; (3) perform a comprehensive evaluation in years’ one and two of the program via interviews and surveys and according to all SAMHSA Government Performance and Results Act (GPRA) requirements to continuously improve the content and delivery of the curriculum and to evaluate the overall utility; (4) work with AWSB to implement questions related to SUD identification, treatment, and prevention by providing AWSB with potential questions based on evaluations measuring knowledge acquisition developed during the program; (5) sponsoring CE events for students, faculty, and graduates; and (6) sustain the full SUD and CO-MH curriculum beyond the life of the grant funding. The program will span April 2020 to April 2022. This training and education program will expand access to SUD and CO-MH education and increase the number of social workers trained and educated on best practices related to SUD and CO-MH identification, treatment, and prevention.

Berks Counseling Center (BCC) expansion project will address trauma and fully implement an integrated system of trauma informed care inclusive of its services, staff, policies and procedures and work space. In addition, BCC will improve integrated care for limited English proficiency (LEP) clients by implementing additional bilingual services and devices to improve diagnosis, treatment, and understanding and achieve greater client satisfaction. BCC will address social determinants of health, as they impact patient outcomes, with emphasis on food insecurity and transportation to further reduce disparities in health care for BCC clients. BCC is located in Reading, Berks County, PA. The population (420,152) is a diverse population with 21% (88,508) residing in the city of Reading. In 2011, Reading was designated the poorest city in the United States. The city no longer claims that title but it is the third poorest city in PA; 32.1% of its residents live at or below the poverty line; children living in poverty in the city is at 43% Both percentages are above PA state percentages. In addition, Reading is classified as a medically undeserved area (MUA). Reading has higher concentrations of specific sub-groups of people facing economic, cultural and linguistic barriers to healthcare. Since the SAMHSA demonstration and first expansion grant, BCC has consistently provided integrated care to over 4,000 men, women and children. In the current expansion grant opportunity, BCC will address barriers to care we have identified. In the U.S. 90% of clients in public behavioral health care settings have experienced trauma. BCC has done an outstanding job around trauma informed care through the services we provide. As we move forward in improving trauma care, we need to infuse understanding of trauma and resilience in all areas of BCC. BCC is encountering rising number of clients with limited English proficiency (LEP) as well as clients who are deaf or hard of hearing. U.S. Census data shows between 2009-2012, twenty percent of Americans (older than 5 years) spoke a language other than English at home. Language/cultural barriers result in poor understanding of diagnosis and treatment, and lower client satisfaction. In addition, social determinants of health lead to health disparities. Reading Hospital 2019 Community Needs Report found 20% of our community were food insecure and found it difficult to purchase fresh, healthy foods. All of these barriers lead to disengagement in health and wellness. Through this project BCC will breakdown these barriers and better serve their clients. We propose to serve 300 clients in year one of the grant and 400 clients in year two.

The H.A.T. (Healing After Trauma) Center will serve as the single entry point trauma therapy center for children and adolescents age 0-17 in Clearfield and Jefferson Counties, PA who have experienced a traumatic event. Both counties are largely rural. Clearfield County (1,145 sq. miles) has a population density of only 71 persons, and Jefferson County (652 sq. miles) has 69 persons per square mile. There will be two populations of focus. The first are those children, adolescents and their families who are victims of physical or sexual abuse, other forms of child maltreatment, or have experienced other traumatic life events. The second are children and adolescents with Problematic Sexual Behaviors. These populations of focus experience social and economic risk factors, which increase likelihood for trauma and related mental health problems. CenClear will have a dedicated team comprised of the Project Director, a Clinical Supervisor, 5 Licensed Mental Health Therapists, a Mental Health Assessor, a Mental Health Navigator, a Departmental Assistant, and a Mental Health Data Reports Manager to cohesively operate the H.A.T. Center and provide trauma services to consumers in both counties. CenClear has also contracted with a Professor from the Prevention Research Center at The Pennsylvania State University to provide services under the Lead Evaluator role. This contractor will provide data collection, performance measurement, program evaluation, and analyze and evaluate the overall performance of the project. The H.A.T Center planning team considered utilizing a number of Evidence Based Programs (EBPs), but determined that the ones listed below are the most relevant to the population of focus and outcomes to be achieved: • Trauma-Focused Cognitive Behavioral Therapy (TF-CBT): This is an evidence-based intervention that addresses the multiple domains of trauma impact including, but not limited to, Posttraumatic Stress Disorder, depression, anxiety, externalizing behavior problems, relationship and attachment problems, school problems and cognitive problems. TF-CBT includes skills for regulating affect, behavior, thoughts and relationships, trauma processing, and enhancing safety, trust, parenting skills and family communication. TF-CBT is an effective intervention that targets trauma victims from ages 3-17, which falls within the age range of our population of focus. • Eye Movement Desensitization and Reprocessing (EMDR): This is an evidence-based intervention that is an integrative psychotherapeutic approach that emphasizes the role of the brains information processing system in improving the somatic and psychological consequences of distressing events. This intervention is effective for a variety of traumas, including trauma stemming from sexual abuse. • Problematic Sexual Behavior – Cognitive Behavioral Therapy for School-Age Children (PSB-CBT): A therapeutic intervention approach that is used on children and adolescents who are identified with problematic sexual behaviors geared toward other children and adolescents. Children with problematic sexual behavior may have a history of trauma to include sexual abuse, physical abuse, and/or witnessing domestic violence. CenClear has established and defined goals and objectives for the H.A.T. Center. Through the implementation of this project, CenClear will have the ability to expand access to evidence-based trauma focused treatment and trauma-informed services to children, adolescents and families who are in dire need in both counties; provide an array of evidence-based trauma-focused treatment services for those children, adolescents, and families; enhance the capacity of the child-serving systems and local and regional infrastructures to develop a trauma-informed systems of care across agencies; and, further CenClear will be able to greatly reduce the overall trauma symptoms for clients receiving services at the H.A.T. Center by utilizing the stated evidence based programs.

Allegheny County Department of Human Services (ACDHS) seeks to enhance and expand its successful pilot of the Mental Health/Child Welfare Community of Practice System of Care (CoP SOC) to improve access, coordination and quality of mental health (MH) services for youth and families involved in the child welfare (CW) system. The population of focus will be families and their children/youth experiencing a Serious Emotional Disturbance (SED) or early onset Serious Mental Illness (SMI), ages 5 to 21, who are also involved with CW or with both CW and Juvenile Justice (JJ). ACDHS data demonstrates that families active with CW are frequently involved with multiple systems, including MH and JJ, and have complex needs. In fiscal year (FY) 18/19, 59,142 individuals received MH services in Allegheny County (AC); of those, 2,142 children were dually active with the MH and CW systems. Also in FY 18/19, there were 3,539 families active with CW. For 73% (2,571) of these families, at least one family member received MH services during that year, and 40% of families had more than one family member who received MH services. Youth who are concurrently active with CW and JJ, commonly referred to as “crossover youth,” also have high MH service utilization. Of the 501 crossover youth in 2018, nearly all (93%) received MH services at some point in their lives. Children and youth involved with systems such as CW, MH, and JJ not only face disproportionately high rates of emotional or behavioral disorders and developmental delays, but also often experience out-of-home placement and lower rates of being placed in a family setting or achieving placement stability. The primary goal of the CoP SOC is to improve the access, coordination and quality of MH services for youth and families experiencing SED or early onset SMI who are also involved in CW or CW/JJ. The CoP SOC proposes to serve at least 250 participants over the entire project: 30 in year 1, 50 in year 2, and 60 in years 3 and 4 through the MH referral pathway; and 10 in year 1 and 20 in years 3 and 4 through a new model of MH Family Case Management (MHFCM). Objectives include: competitively procuring an MH CoP provider to implement the MHFCM model; full implementation of the previously piloted MH referral pathway across CYF regional offices for multi-system involved youth and families; cross-system best practice training; attaining Medicaid reimbursement for the MH Family Case Management model; and identification, testing, and implementation of best practices for serving multi-system youth who are transition age.