PR Discretionary Funding Fiscal Year 2023

Puerto Rico's Mental Health and Anti-Addiction Services Administration (MHAASA) will ensure statewide coverage for 9-8-8 calls, chats and texts through the PAS Line (First Psychosocial Help Line), under the Integrated Crisis Intervention Program (ICIP) of the MHAASA, the government agency in charge for the mental health and substance abuse (MH/US) disorder in PR, and for state crisis counseling services in situations of natural disaster, and now COVID-19. Through the FY 2022 Cooperative Agreements for States and Territories to Build Local 988 Capacity, the PAS Line will achieve capacity building for current and projected 9-8-8 volume for calls, texts, chats and follow-up services. Currently, there are no centers in PR members of the National Suicide Prevention Lifeline (Lifeline) 9-8- 8. Operating since 2001, the Pas Line provides crisis hotline services, 24/7, for the population of the 78 municipalities of PR and will be the site of the 9-8-8 implementation. Forty-six (46) case managers work as telephone counselors of the crisis hotline, working under three (3) supervisors. The services are available for teens and/or college aged youth (13-24), older adults (55+), the deaf and hard of hearing, domestics violence survivors, and the LGBTTQ community, among others. It is a member of the Suicide Prevention Commission which is the key stakeholder coalition of 12 government agencies, the federation of Majors, four (4) private sector representatives, and two (2) community organizations' representatives that provide services to persons at risk of suicide, plus one (1) family member of a suicide case. This coalition will be invited to serve as the 9-8-8 implementation/key stakeholders' coalition of the Puerto Rico 988 Cooperative Agreement. While there is no Lifeline center at this time, the PAS Line of the MHAASA will sustain a contact center capacity to maintain a 90% in-state answer rate 9-8-8 contacts. Due to consistent federal funding sources, the PAS Hotline has the capacity to meet all Lifeline project requirements. A total of 22,008 calls were received from people with suicidal behavior in 2021, when calls related to COVID-19 and the natural disasters impacting Puerto Rico were more prevalent. The PAS Line has a current answer rate of 97%. The MHAASA is willing to make a commitment to make a good faith effort to work collaboratively with Lifeline member call centers to continue to exceed an 90% answer rate by the end of the Project. A project director will oversee the implementation of the project and an evaluator will measure process aspects and outcomes, with resulting data, including GPRA, to be submitted in SAMHSA reports and use to improve procedures and services over the 2-year grant period. A total of $250,000 is requested for the grant period, to cover the project required and allowed activities implementation and data collection and evaluation.

The goal of REHACE’s Mental Health Awareness Training Project is to increase mental health awareness and knowledge in 3,500 Spanish speaking Puerto Ricans over the course of five years. After participants complete an evidence-based training called, Mental Health First Aid (MHFA) participants will recognize symptoms of mental disorders, particularly SMI and SED, and will appropriately respond to individuals experiencing mental health crisis through de-escalation techniques, and available resources in the community. Mental health in Puerto Rico is a public health matter. According to the Health Insurance Administration (ASES), Puerto Rico is the third jurisdiction in the United States with the most considerable mental health problems. Data from the Commission for the Prevention of Suicide indicates that suicide is the third leading cause of violent deaths in Puerto Rico (CyberNews, 2018). On top of Puerto Rico's fragile mental health condition, traumatic events such as hurricanes, earthquakes, and now the COVID-19 pandemic continue to affect the emotional state of our population and exacerbate the existing conditions. To reach the target goal of 3,500 individuals, each year REHACE will train 700 members of the following populations: 100 first responders’ members of Voluntary Organizations Active in Disaster (PRVOAD); 500 faith leaders from 8 major denominations in Puerto Rico; 50 care providers of a rehabilitation hospital, and 50 providers of veteran services. Measurable objectives include: (1) By September 30, 2022, REHACE staff will have trained 100 PRVOAD members, 500 Faith Leaders, 50 Trauma health care providers, and 50 providers of veterans in Puerto Rico with Mental Health First Aid which represents 100% of participants. (2) By September 30, 2022, project 700 participants will recognize signs and symptoms of Mental Health, particularly with SMI and SED.  (3) By September 30, 2022, project 700 participants will develop the competencies to employ de-escalation techniques to address a crisis.   (4) By September 30, 2022, project 700 participants will demonstrate knowledge about Mental Health available resources in the community to refer individuals with a mental health need to appropriate service. For potential referrals that result from the project, REHACE has established an agreement of collaboration with INSPIRA, one of the leading mental health providers in Puerto Rico having an experience of more than 30 years and more than 400 licenses providers around the island. Referrals will be track through a monthly electronic questionnaire each participant will receive. REHACE instructors are clinical psychologists, that besides of training providers, also will be consultants to participants on applying de-escalation techniques, provide guidance on potential referrals, and follow up on referrals made by participants according to the appropriate level of care. As an added value REHACE will develop a year-round evidence-based mental health awareness social marketing campaign.

Guara Bi, Inc. a subsidiary of WestCare Foundation, Inc. (Guara Bi) proposes the project Puerto Rico Youth and Family TREE (TREE) to provide early intervention, recovery support services, and comprehensive SUD/COD outpatient treatment to traditionally under-served, primarily minority youth and their families/primary caregivers throughout Puerto Rico. Guara Bi will provide project services to 50 unduplicated clients in year 1, and 100 unduplicated clients in years 2-4 (450 across the five-year funding period). Goals include: 1) increase access to care by providing culturally competent and youth-centered evidenced-based SUD/COD treatment to primarily minority youth (ages 12-25) and their families; and 2) Enhance the social and behavioral health functioning of primarily minority youth (12-25) and their families. Objectives include: 1) Provide A-CRA/ACC to 450 unduplicated youth; 2) provide Seeking Safety to 80% of the youth having trauma-related symptoms; 3) refer 85% of youth and their family members for additional services as needed; 4) 75% of the youth will complete A-CRA/ACC; 5) 80% of youth completing treatment will be alcohol and drug free during the 30 days prior to discharge, and 70% of those will be alcohol and drug free at 3/6-months post admission; 6) 80% of youth completing treatment will exhibit decreased depression and anxiety symptoms at discharge, and 70% of those will maintain improvements/show additional decreases at 3/6-months post admission; 7) 70% of youth completing Seeking Safety will report reduced trauma symptoms at discharge, and 70% of those will maintain the improvements/show additional decreases at 3/6-months post admission assessed by the PCL-5; 8) 80% of youth successfully completing treatment who did not have stable living arrangement at admission will have stable living arrangements at discharge, and 70% of those will maintain their living arrangements at 3/6-months post admission; 9) 80% of youth completing treatment will be in an educational/vocational program, be seeking employment actively, or be employed at discharge, and 70% will continue to remain enrolled, complete their education/training, or remain employed at 3/6-months post admission; 10) 80% of youth completing treatment will not engage in new criminal activity at discharge, and 70% will not recidivate at 3/6-months post admission; 11) 80% of youth completing treatment will have improved social connectedness at discharge, and 70% will maintain these improvements at 3/6-months post admission; 12) 80% of youth will utilize ER services less and have fewer hospitalizations for SUD and Mental Health at discharge, and 70% of those will maintain this reduction/show increased reductions at 3/6-months post admission.