PR Discretionary Funding Fiscal Year 2018

The proposed Puerto Rico Assisted Outpatient Treatment (AOT) Project is directed to implementing and evaluating a new AOT program in partnership with behavioral health entities that provide an array of evidence-based treatment and the criminal justice system, including the mental health courts. The principal purpose of the project is to provide access to Individuals with Serious Mental Illness residents of the Western Region of Puerto Rico to evidence based services that reduce the incidence and duration of psychiatric hospitalizations, homelessness and interactions with the criminal justice system while improving their health and social outcomes. By improving the quality and effectiveness of outpatient treatment services, the proposed project will be directed to accomplishing the following goals: (1) Improve the quality and effectiveness of assisted outpatient treatment services through the implementation of two strategies: a) implement EBPs for individuals with SMI who are processed by Mayaguez MH Court as a pilot project; and b) develop a wraparound services system to ensure a comprehensive MH services delivery; (2) Reduce the incidence and duration of psychiatric hospitalization, homelessness, incarcerations and interactions with criminal justice system of individuals with SMI; (3) Improve the PR -AOT participant's health and social outcomes through their participation in an array of services provided by multiple agencies, including the MH court of the PR Courts Administration, the MHAASA Mayaguez Services Center, substance abuse treatment providers, primary health care providers, temporary and permanent shelter and permanent housing providers, public and private social services providers, training and employment services providers, and entities offering family and peer supports. MHAASA will serve 75 individuals with SMI and their families for the first year and 300 individuals through the lifetime of the project.

The MHAASA PR-MHAT Project will provide training to create awareness for early and correct identification and interventions with individuals showing signs and symptoms of mental illness. The need for the project is based on the vulnerability of the PR population to MH conditions post 2017 natural disasters (Hurricanes Maria and Irma) and the need for skill development in First Responders from varied systems related to crisis management and identification and intervention with persons showing signs of MH conditions. Using the Mental Health First aid (MHFA) EBP, over 3 years, 1,500 First Responders (600 from public education and 900 from law enforcement, veterans services and other systems) will be trained to recognize signs/symptoms of mental disorders, particularly SMI or SED. Linkages will be established with school and community-based agencies to refer those identified for appropriate treatment and other services. Training on appropriate crisis de-escalation techniques and available community resources for persons with MH conditions will be included. The IRESA Project of the University of Central Caribbean (UCC), using trainers certified in the MHFA EB Model, will be contracted as the primary training resource. The project will expand MHAASA's crisis and disaster mitigation and response efforts. Collaboration with public education, MH public and private treatment systems, Public Security (Police, Firemen, Emergency Management) and the VA healthcare will permit identification and recruitment of First Responders to be trained on the MHFA EBP, helping these responders to identify and intervene with potential MH patients and engage them in treatment with support services. The project will be directed to training participants Island wide, with the exception of the municipalities of Bayamon, Orocovis, Barranquitas, Naranjito, Vega Baja, Toa Alta, Cataño, Vega Alta, Comerio and Corozal, these being served through IRESE under another grant. For MH treatment, the MHAASA San Patricio Center for adults and Rio Piedras MH Center for Children and Adolescents, and Medicaid providers such as APS (all licensed and experienced) will be used. Under the MHFA, an 8-hour training will focus on identification and intervention with persons showing signs of mental illness, appropriate de-escalation techniques in crisis situations, appropriate engagement and referral procedures and resources that are available. Project goals/objectives include training 1,500 school, security and veterans staff; establishment of a bank of resources for referrals of populations of focus with which First Responders come in contact, or serve; development of follow-up tracking mechanisms related to referrals of populations of focus; utilization of the MH Advisory Council of MHAASA for input to the project; and awareness created on the importance of early identification and referral to reduce PTSD or other consequences and stigma toward persons with MH conditions. All training logistics will be carried out by the MHAASA T/TA Unit, the director of which will serve as Project Director with a full-time Coordinator for logistical training aspects. A Data Analyst will collect required data on process and statistical outcomes of trainings and on fidelity to the selected MHFA EBP, using standardized instruments of the model and those developed by training resources. A total of $125,000 per year is requested over the 3-year grant period, including funds for training, data collection, and evaluation.

Crisis Counseling -Disaster Relief Program

Emergency Response

MHAASA proposes the "PUEDO", meaning "I can" Project, directed to youth of 16-25 years of age with SED/SMI, including moderate intellectual disability, and their families/caregivers from the San Juan and Ponce, Puerto Rico catchment areas. Using the Wraparound Strategies EBP and trauma-informed approaches, 500 participants will be given expanded access to quality treatment and support services to promote their self-sufficiency and recovery through this 5-year grant. Outreach will be done through promotion and awareness campaigns and strengthened collaboration with the Juvenile Justice, Child Welfare, Special Education systems and community support services providers and support groups, representatives of which will participate in an Advisory Council with youth/family peers to guide project planning and implementation. The two catchment areas are urban with about 500,000 total populations, 14% unemployment, 40-50% poverty rates, high criminal and family/youth violence, poor transportation, limited professionals to meet demands, and other barriers. Two licensed and experienced treatment providers are the MHAASA Rio Piedras MH Center for Children and Adolescents in San Juan and the Ponce Behavioral Health Clinic in Ponce, which will maximize third-party resources for treatment. Training will be given to project and collaborating partner entities' staff on SED/SMI, the Wraparound EBP with System of Care values and principles, referral procedures and related topics. The Spanish Traumatic Events Screening Inventory-Parent Report screening will be administered to identify youth who have trauma experiences. The Wraparound EBP has four phases of assessment, individualized planning, plan implementation and transition to recovery. Project goals include expanded access to EB treatment and support services for healthy transition to adulthood; improved cross-system collaboration, for increased service capacity related to transition aged youth with SED/SMI through infrastructure and organizational improvements at state and local levels; and planning and implementing public awareness and cross-system training to reduce stigma and increase support for SED/SMI youth/young adults by community, business and education leaders. Objectives include achieving self-management of behaviors, improved social relations and functioning, and self-sufficiency through education/employment in at least 85% of participants completing the EBP, as well as reducing risky and unhealthy ATOD use and sexual practices for a healthy transition to adult life. These will be achieved by integrating family and community support, linking youth/families to housing, basic living, education, vocational, peer support, social/economic benefits, legal and other service needs based on Individualized Care Plans. An experienced Project Director will lead the professional team to implement the Action Plan. A local Evaluator will carry out process, outcome and EB fidelity evaluations, results used to improve project operations. A total of $1 million per year is requested.

The Mental Health and Anti-Addiction Services Administration (MHAASA) is the Single State Agency (SSA) for mental health (MH) and substance abuse (SA) prevention and treatment services in Puerto Rico (PR), and is herein submitting this application for funding under the Funding Opportunity Announcement (FOA) No. SM-17-008 to promote the Integration of Primary and Behavioral Health Care (PR-PIPBHC). The PR-PIPBHC Project will be implemented by the MHAASA, which is the Single State Agency (SSA) for the Mental Health and Substance Abuse Block Grants in Puerto Rico, through the collaboration with Federally Qualified Health Centers geographically located within the Western, Northern and Eastern Regions of PR. Lack of specialized PC and BH services beyond Health care services and access vary outside of the San Juan metro area. The greatest concern has been limited access to physicians. Seventy-two of Puerto Rico’s 78 Municipalities have been deemed medically underserved areas by the US Health Resources and Services Administration (HRSA). Within these areas, HRSA has identified 32 primary care health professional shortage areas (HPSAs) with a population-to–primary care provider ratio of 3,500:1 or higher. Additionally, 23 percent of municipalities had a shortage of pediatricians, 68 percent had a shortage of Ob-Gyn’s, and 64 percent had a shortage of psychiatrists, according to HRSA guidelines. The proposed PR-PIPBHC Project is directed to (1) Promote full integration and collaboration in clinical practices between primary and behavioral health care; (2)Support the improvement of integrated care models for primary care and behavioral health care to improve the overall wellness and physical health status of adults with a serious mental illness and (3) Promote integrated care services related to screening, diagnosis, prevention, and treatment of mental and substance use disorders, and co-occurring physical health conditions and chronic diseases.

The Mental Health and Anti-Addiction Services Administration (MHAASA) is the SSA for Puerto Rico and is proposing a System of Care Initiative (PR-SOCI) to expand the SOC and the Wraparound Strategy for SED children/youth/families to the Western Region of PR, to serve 300 clients in the 4-year grant period, in collaboration with the Health Insurance Administration, APS provider, PR Department of Family, CBO's and other partnering entities. The proposed catchment area is comprised of 15 municipalities: Mayaguez, Aguada, Aguadilla, Anasco, Hormigueros, Las Marias, Moca, Rincon, San German, Cabo Rojo, Lajas, Maricao, Rincon, Isabela, and San Sebastian. The principal purpose of the PR SOC Initiative (PR-SOCI) Project is to expand the family-driven and youth guided system of care (SOC) to populations in need in the Western Health Region. The second purpose is to sustain systemic changes by achieving the adoption of the SOC as the service-delivery model for MH services to children and youth in PR's public health system. The expected outcomes at territory level include changes in policies and procedures, development of financing structures that work in the current healthcare environment and development of a blueprint that can be used throughout the territory to expand the use of the SOC Model for treatment of children with SED.

Our project will increase and improve access to culturally competent and developmentally appropriate mental health services, for children and youth with emotional disturbance or mental illness, caregivers and school staff in three communities. The Puerto Rico Department of Education has established a Consortium Agreement with Mental Health and Anti-Addiction Services Administration (MHAASA) and Albizu University (CAU)- Instituto Tercera Misión (IM3) to implement Project AWARE in our jurisdiction.

The purpose of the Puerto Rico's Project Launch project is to promote wellness of young children from birth to 8 years of age by addressing the physical, social, emotional, cognitive and behavioral aspects of their development. The goal is to create a shared vision for the wellness of young children that drives the development of alliances for the coordination of services and the integration of behavioral and physical health services at the Fajardo Region by October, 2014. The objectives to achieve the goal are: 1) Develop a profile of needs within the first five months of the grant, 2) Develop a local level strategic plan in the first seven months of Project Launch; 3) To offer developmental and cognitive assessments to children from Head Start to 2nd grade at the school community and pediatric centers at the Fajardo Region, 4)Integrate behavioral health into primary care settings through training of professionals on early childhood needs and parenting skills, health screenings at the day care and school settings and referrals to health clinics; 5) Offer mental health consultation through school counseling and Incredible Years curricula; 6) Offer education and early screening as a primary prevention strategy to high risk families through a home visiting nurse initiative; 7) Strengthen family relationships through parenting skills curricula; 8) Develop interpersonal skills at the school community through the Incredible Years curricula from pre-school to second grade, and offer education to students, parents and teachers using the curricula "Incredible Years" and 9) Integrate a Task Force for the Launch Project within ongoing Committees at the Executive Office and local (regional) level to develop policies and alliances to promote child wellness at the Fajardo Region.

The HL-MHTTC will serve at least 2,500 front-line staff, clinical directors/supervisors, pre-service staff, community workers, leaders, stakeholders, and specialists (Y1=500; Y2=520; Y3=520; Y4=520; Y5=500) by delivering at least 18 educational training events (in-person), two synchronous/virtual technical assistance and five webinars yearly to impact at least 80 organizations serving the Latino communities during proposed funding period. The proposed actions will support the center in building collaborative relationships, developing diverse and culturally competent workforce, and promoting the adoption and implementation of evidence-based and promising practices to reduce health disparities in the provision of training opportunities, thus improving quality and provision of services for our Hispanic and Latino communities in need of mental health and recovery support services.