RI Discretionary Funding Fiscal Year 2018

Gateway Healthcare, Inc. proposes the Enhanced Care Team project to deliver evidence-based, individualized, and integrated services to engage individuals who have chronic homelessness and co-morbidities of substance use or mental health issues. The project anticipates assessing 300 individuals and enrolling 120 in year one. The population of focus are adults over the age of 18 who have co-morbidities including chronic homelessness and substance use disorders (SUDs), serious mental illness (SMI), serious emotional disturbance (SED), and/or co-occurring disorders (CODs). The project goal is to ensure that participants receive access to or placement in sustainable permanent housing, treatment, recovery supports, and/or Medicaid and other benefit programs. Strategies and interventions to meet this goal include: 1) delivery of coordinated mental health and substance use treatment, housing support, and other recovery-oriented services; 2) engagement and enrollment of eligible individuals in health insurance, Medicaid, and other benefit programs; and 3) establishment of a forum to collaborate and coordinate existing area services to complement different organization's strengths, provide better access to services, and address gaps in the system. Measurable objectives include: 100% of all project participants qualifying for HUD will have applications submitted through the HUD Coordinated Entry System; 100% of participants needing assistance with benefits will meet with Benefit Specialists and 75% of those individuals will secure benefits within 6 months; participants will show measurable improvement compared to the baseline regarding improved access to mental health, substance use, and/or support services through the work of the Enhanced Care Team and its Steering Committee; and participants will show measurable improvements compared to the baseline in functioning at the 6 month reassessment.

The Statewide Family Network Project, Strengths of Diversity, at Parent Support Network of Rhode Island (PSN) will engage families, youth, policy makers, and system of care partners statewide with a special focus on culturally and linguistically diverse children and youth with serious emotional disturbance (SED) and their families in Rhode Island. PSN seeks to address behavioral health disparities and decrease the challenges of access, service use, and achieve positive outcomes among special populations living in poverty; racial and ethnic minorities; grandparents; veterans and military families; and parents who have mental illness or substance use disorders. The SFN Project Will achieve three goals by implementing clear objectives and strategies: Goal 1: Organize and train a committed team of 25 diverse family, youth, and consumer leaders representing children and youth SED and special populations to participate on state and local planning and policy boards and healthcare reform activities to increase children and youth access to home and community based behavioral services and supports and address social determinants impacting children's mental health. (25 annually and 50 unduplicated by the end of year 3). This will include starting our strengths of diversity advisory board, Youth MOVE RI Chapter, Grandparent Support Group, and holding a Children's Behavioral Health Family and Consumer Leadership Policy Academy. Goal 2: Expand workforce development training and technical assistance opportunities to increase the skills and knowledge of 100 mental health and related workforce, including family and young adult peer support providers annually (200 unduplicated by the end of year 3) and to increase by 25% the children and youth with SED and their families served by PSN each year. Trainings will include Children's Behavioral Health Peer Support Provider training, National Standards for Culturally and Linguistic Appropriate Services (CLAS), Health Equity, and working with Military Families. Goal 3: Have 50 physicians representing state organizations of physicians, primary healthcare providers, and schools participate in trainings to learn new strategies for the promotion of mental health and strategies for prevention, screening, and early identification. (100 updated by the end of year 3).

Providence College will establish a comprehensive, integrated wellness promotion and suicide prevention program, offering a full spectrum of preventative interventions, ranging from the individual to the ecological. The multi-systemic array of evidence-based strategies includes gatekeeper training (online and in-person), crisis response planning, family engagement, network building, mental health screening, community-building, promoting hotlines, and facilitating access to mental health services. We will identify and support individuals at high risk as well as bring resources and access to vulnerable groups. A public health approach will be used to establish a new level of knowledge and understanding about suicide prevention for the entire community and enhance our readiness to support those who are most vulnerable. We will introduce the Kognito online gatekeeper training module in order to build skills and help students effectively engage and refer peers who are experiencing distress. We will build on the gatekeeper paradigm by developing a new in-person gatekeeper training curriculum named PC Lifelines. PC-Lifelines will use current research to increase effectiveness of current gatekeeper models. Integrating faith-based values is a unique component of PC-Lifelines which is appropriate to Providence College, and may also be of particular interest to the hundreds of faith-based colleges and universities in the United States. The online and in-person training will be evaluated to determine possible advantages to combined training. Outcomes of this evaluation and development initiative will be widely disseminated. Consistent with the College mission, we are determined to promote ?the human flourishing of each member of the campus community.? Outreach initiatives and interventions will specifically seek out those groups most at risk for suicide and most likely to experience disparities in access to health services. These include students with mental health challenges as well as students of color, Native American students, first generation students, LGBTQ students, international students, and veterans. Our project will involve these groups as partners to build trust and to help develop suitable educational and intervention approaches. We will engage persons from diverse backgrounds with lived experience to share their stories, model recovery, reduce stigma, increase help-seeking, and inspire hope. This project will bring multiple campus resources to a new level of integration and collaboration. It will also be undertaken in partnership with off-campus organizations such as the National Association of Mental Illness/Rhode Island Chapter and the Rhode Island Department of Health. Providence area hospitals, mental health practices, and substance abuse clinics will be brought into our network of resources so we can offer coordinated and integrated care for our students. We will establish protocols, networks, training programs, and practices that will bring our suicide prevention capacity to a new level. It will become part of the culture at Providence College, a sustainable and meaningful confirmation of our commitment to health and safety.

"Healthy Transitions Rl" will address the needs of youth and young adults ages 16-25 with Serious Emotional Disturbance (SED), Severe Mental Illness (SMI) and/or Co-Occurring Disorders (COD) in two Rhode Island communities, Warwick and Woonsocket. These cities will build on existing partnerships with youth and family representatives, local service provider agencies, educational, recreational, church and other community stakeholders. They will build local advisory structures to guide the local development of the project, make the communities aware of the needs of these young people, collaborate to help identify, engage and screen those at risk for developing, SMI and/or COD. The cities' two Community Mental Health Organizations will provide specialized intensive services to those who are experiencing SMI/COD. These services will involve a number of Evidence Based Practices delivered within the Coordinated Specialty Care (CSC) model. Additionally, an interdepartmental administrative body, the Transition Team will develop a shared "locus of responsibility". The goal is to transform a divided service system that provides different types of services, using different eligibility criteria, to youth/young adults of different ages. This will involve making structural changes at both state and local community levels and the transformation of the service delivery system.

Over three years, the Rhode Island Department of Health (RIDOH) will work to implement a comprehensive and sustainable training program to increase the ability of Emergency Medical Technicians (EMTs) to respond to individuals experiencing a mental health crisis. In addition to training the primary target population the project will also train family members of current or former military service members to recognize and respond to signs of mental distress. In implementing the Rhode Island First Responders Training Project (RIFRTP), RIDOH will complete four project goals. Goal 1: Establish and maintain the RI First Responder Training Project infrastructure in order to ensure fulfillment of all stated project goals and objectives; Goal 2: Provide evidence based mental health awareness training to targeted populations throughout Rhode Island; Goal 3: Create a sustainable structure within Rhode Island’s Emergency Medical Services training programs for all future emergency medical technicians to receive the Public Safety version of Mental Health First Aid (MHFA) training; and Goal 4: Create and maintain a system of mental health referrals from targeted first-responders to qualified local mental health providers. By completing each of these goals and their associated measurable objectives the following results are expected: • Approximately 1,000 Rhode Island EMTs will be trained in the Public Safety version of the MHFA curriculum • Approximately 250 family members of current or former Rhode Island military service members will receive MHFA training • Over 7,000 Rhode Island EMTs will be trained in the U.S Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) “Creating Safe Scenes” curriculum • A sustainable infrastructure to support training future Rhode Island EMTs in principles of recognizing and responding to mental health crises • A mechanism for EMTs to refer individuals to mental health resources The RIFRTP will leverage multiple resources and partners from relevant stakeholders throughout Rhode Island to create a program that is both immediately impactful and sustainable. By including mechanisms to continue training EMTs after funding ceases, project staff will ensure that mental health awareness continues to be a key part of first responder training moving forward. By including family members of current or former military service members as a targeted training population the RIFRTP will explore a new method to preventing serious negative outcomes associated with mental crises among military personnel.

Goals, objectives and activities are aligned with the 2012 National Strategy for Suicide Prevention.
Goal 1: Enhance state agency infrastructure and capacity required to successfully execute all aspects of the proposed project, including program implementation and evaluation, for grant period 2014-2019 and beyond.
Goal 2: Implement and evaluate RI's first multifaceted youth suicide prevention program, using a combination of universal, selective and indicated strategies.
Goal 3: Implement a novel streamlined crisis evaluation assessment tool and selective intervention strategies for at-risk youth ages 10-24 in multiple settings.
Goa1 4: Implement RI's first systematic linkage of health and non-health organizations to improve continuity of care and follow-up for youth aged 10-24 at risk for suicide.
Expected outcomes:
Increased numbers of persons trained to identify and refer at risk youth.
Increased number of clinicians trained to assess, manage and treat at risk youth.
Increased identification of risk, referral and utilization of behavioral health services.
Improved continuity of care, follow-up and accountability for youth with suicidal ideation, substance abuse disorders and/or depression, or identified as at risk for suicide seen in outpatient mental health centers, hospital EDs and inpatient psychiatric units.
Reduced ED use for mental health evaluations.
Increased promotion of utilization of the National Suicide Prevention Lifeline.

RI Project LAUNCH 2015 will build on its prior LAUNCH project successes to expand four activities in four identified communities in need. The activities are (1) mental health consultation within early care and education, (2) parent education and support for children and their families age 3-8 (including 0-3 as needed), (3) screening response and referral, and (4) systems alignment related to programs and policies.

The four identified communities have a combined population of about 113,000, with almost 12,000 being age birth to eight years. Based on multiple risks identified at birth, approximately 30% of the children in the four communities are at high risk for poor developmental outcomes. Furthermore, approximately 20% of the residents of these communities are members of identified subpopulations (racial minority, ethnic minority, language minority) subject to demonstrable disparities in access to services. Needs assessments further document that these communities do not have the service capacity to meet the needs of the children birth to eight years who are at high risk. The specific LAUNCH 2015 activities will provide direct services to 298 children and families on an annual basis (less in the first year, owing to start-up activities). LAUNCH 2015 will provide indirect services to 510 children annually, as part of program-level mental health consultation to early care and education settings. LAUNCH 2015 has a goal of providing 40% of its services to the identified subpopulations, which would provide some amelioration of disparities.

Rhode Island Project AWARE The Rhode Island Department of Education (RIDE), in partnership with their Department of Children Youth and Families (DCYF), proposes to work with: Providence, Pawtucket and Woonsocket school districts, impacting 38,795 students, to increase awareness of MH issues among school-aged youth; provide training for school personnel and other adults who interact with school aged youth to detect and respond to MH issues, and connect their families to needed services. In Rhode Island, one in five (19%) children ages 6-17 has a diagnosable mental health problem and one in 10 (10%) has a significant functional impairment. RIDE, DCYF, and its partners will build strong collaborative partnerships to oversee BH efforts in LEAs who serve school-aged youth with mental disorders. The collective impact of our state partnership will be mirrored by a similar partnership within the three LEAs, in partnership with local community MH treatment provider agencies, to ensure that school prevention and intervention programs and services are linked to existing resources and/or new capacity to support students is created. The following goals will support the process: Goal 1 Through programs, policies and system changes RIDE, DCYF and its partners will increase access to culturally competent and developmentally appropriate school- and community-based BH services, particularly for children and youth with Serious Emotional Disturbance (SED) or Serious Mental Illness (SMI) for the 38,795 students and ultimately the 142,949 RI school aged youth statewide. Goal 2 RIDE, DCYF, the 3 LEAs, along with partners, will have school-based MH programs staffed by behavioral health specialists to screen, provide early intervention, and address any ongoing MH needs of children with symptoms consistent with a SMI or SED. Goal 3 RIDE, DCYF, the 3 LEAs, along with partners, will see an increase in awareness and identification of MH issues and the promotion of positive MH. Goal 4 RIDE, DCYF, the 3 LEAs, along with partners, will have the capacity to connect families, schools, and communities to increase engagement and involvement in planning and implementing school and community BH and prevention programs for school-aged youth. Goal 5 RIDE, DCYF and partners will have the capacity to support LEAs in helping school-aged youth develop skills that will promote resilience and promote pro-social behaviors; avert development of mental and behavioral health disorders; and prevent youth violence. Goal 6 Schools will have the ability to immediately identify students and respond to their needs if they exhibit behavioral/psychological signs of a severity indicating the need for clinical intervention. Goal 7 Systems will be established to expand and sustain BH services and supports for school-aged youth beyond the Project AWARE funding period.

The Washington County (Rhode Island) Zero Suicide Program (WCZSP) will be led by South County Hospital Healthcare System's (SCH) Emergency Department (ED), drawing on the strong collaboration that SCH leads for the county's Healthy Bodies, Healthy Minds program. The effort will begin in our local hospital EDs since the ED is a typical entry point for patients at imminent risk for suicide. The EDs will receive evidence-based training and practices to enhance their skill sets and change their culture to empower them to better address the behavioral health needs of the county's population. During the project period, we will expand to other parts of the hospitals as well as to other health care organizations in our region. All individuals age 25 or older who seek health care at one of the partner sites will be screened for mental health issues using the PHQ-9, as many partners now do. Anyone identified at risk for suicide will receive immediate treatment or referral, a care management plan, and follow-up for one year post care. The Washington County population, per the US Census Bureau (2016), includes 84,360 individuals age 25 or older. Of these, 47.2% are male; 52.3% are female; 0.5% are transgender. The county is predominantly White (92.9%), with 2% Asian, 1.3% Black or African American, and 3.2% identifying as Hispanic or Latino. Washington County has the highest suicide rate in RI: 13.9 per 100,000 individuals (2015), higher than the national rate of 13 deaths per 100,000 population and increased from a rate of 11.5 in 2013, a more than 20% increase over two years compared to the national increase of 2% per year since 2006. Three of the five RI towns with the highest suicide rates are in the county, 23.8, 26.6, and 31.8 per 100,000 population, respectively. The WCZSP will apply a High Reliability Organization strategy to create a wide-spread ZS leadership-driven safety culture, using extensive evidence-based trainings and practices to provide all staff at partner organizations with the skills and confidence to take responsibility for suicide prevention to achieve zero suicides in the county by the end of the project's fifth year. We will track the number of patients who screen positive for a suicide risk, patients evaluated in our hospital EDs for psychiatric inpatient admissions, patients seen by peer recovery specialists, patients referred to any form of support who do not keep their appointments, and patients who die by suicide. We will use qualitative methods to assess changes in attitudes toward zero suicide prevention by leadership and all staff who have patient contact, in provider confidence to effectively treat at-risk patients, and in patient and family perceptions regarding the efficacy of care and support received. We will use a suicide review board to investigate all suicides for root cause analysis and use rigorous data collection and analysis to create an ongoing quality improvement environment for the program. The number of individuals to be served each year: Year 1 - 9,789; Year 2 - 9,881; Year 3 - 9,913; Year 4 - 9,996; Year 5 - 10,107. The total population to be served over 5 years is 49,686.

Over the next 3 years, we will undertake a multi-pronged, comprehensive plan to increase mental health awareness in Washington County using evidence-based curriculum and strategies, including: 1) Continue Youth Mental Health First Aid training of school communities across Washington County – expanding trainings to include parents and ancillary staff/officials (such as coaches, afterschool program staff, school committee members, etc.) and Mental Health First Aid training for health care providers, including hospital staff 2) Partner with local municipalities to conduct Youth Mental Health First Aid (YMHFA) or Mental Health First Aid (MHFA) with town staff (i.e. park and recreation, town clerks, housing officials, etc.) with the goal of meeting the national standard of 1:10 Americans trained (beginning with the towns of Narragansett and Westerly) 3) Train all area first responders (who are not currently trained) in Mental Health First Aid: Specifically, training all local law enforcement staff as required by state law in Mental Health First Aid for Public Safety and career and volunteer first responders and local EMS and fire depts. as recommended in Mental Health First Aid for Fire/EMS 4) Develop a regional CIT (Crisis Intervention Team) Program, based on the Memphis model, for advanced training and community collaboration to address the needs of those living with severe and persistent mental illness (SMI population) 5) Conduct outreach to veterans organizations and veteran owned businesses to conduct trainings in Mental Health First Aid for Veterans Using a population health approach, our targets for training include those sectors with the greatest opportunities to interact with people struggling with mental health challenges: schools, law enforcement, fire/EMS, municipal staff, and hospitals, as well as those at highest risk due to trauma: veterans and first responders. Our project builds on our successes to date (816 individuals in Washington County have been trained in YMHFA and 150 trained in MHFA) and helps take our efforts to the next level in not only providing mental health awareness training to individuals, but instituting policy and systems changes to create a safer and more compassionate community.