RI Discretionary Funding Fiscal Year 2020

The Newport County (RI) System of Care (NCSOC) COVID-19 Emergency Suicide Prevention Program will be led by Newport County Community Mental Health Center (NCCMHC), in collaboration with Newport Hospital, East Bay Community Action Program, CODAC Behavioral Health, and the Women’s Resource Center. These collaborators currently work together in a local System of Care that utilizes a No Wrong Door approach for individuals and families with complex needs. The proposed program seeks to implement a Zero Suicide program that will be embedded within the NCSOC. The population of focus for this grant includes all adults aged 25 and older who are at risk for suicide in Newport County, RI, which has a population of 83,204. The racial makeup of the county is 92% White, 5.5% Black, 1.2% Native American/Alaska Native, and 2.5% Asian. 5.6% is Hispanic or Latino of any race. The median household income is $75,463. 9.0% of the population is below the poverty line. The mental health effects of the coronavirus disease 2019 (COVID-19) pandemic are profound and suicide has become a major concern as the pandemic spreads and has longer-term effects on the general population, the economy, and vulnerable groups. Specific sub-populations at increased risk include frontline healthcare workers, first responders, those who develop the illness, those with mental health issues, those who become unemployed, and victims of domestic violence. The program will provide many entry points into care for patients at imminent risk for suicide. Staff at the collaborating agencies will receive evidence-based training and practices to enhance their skill sets and change the culture to empower them to better address the behavioral health needs of the county’s population. Under the proposed program, all individuals who seek care at one of the partner sites will be screened for mental health and suicide issues using the Columbia Suicide Severity Rating Scale (C-SSR). Anyone identified at risk for suicide will receive immediate treatment or referral, a Suicide Care management Plan, and follow-up care. Specialized interventions to be utilized will include Cognitive Behavioral Therapy for Suicidal Prevention (CBT-SP), Dialectical Behavior Therapy (DBT), and Collaborative Assessment and Management of Suicidality (CAMS). Project goals include: 1) Reduce the incidence of deaths by suicide in Newport County. 2) Create a leadership-driven, safety oriented culture committed to reducing suicide among people under care. 3) Train and develop a competent, confident, and caring workforce. 4) Identify and assess suicide risk among people receiving care. 5) Engage individuals in ensuring that they have a pathway to care that is timely, adequately meets their needs, and includes a collaborative safety plan and means restriction. 6) Treat those assessed to be at risk of suicide with evidence-based treatments, and 7) Provide patients to continuous contact and support, especially after acute care. The project will seek to achieve a 40% reduction in suicides in the county and will serve 10,000 individuals by the end of the 16-month project.

The RI Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) will implement the 2020 Mental Health and Substance Use Disorders Emergency COVID-19 project statewide. The population of focus will be adults with Serious Mental Illness (SMI), those with Substance Use Disorder (SUD), and/or those with co-occurring SMI and SUD; children with Serious Emotional Disturbances (SED) and individuals with mental health conditions less severe than SMI requiring mental health care as a result of COVID-19 including those in the health care profession. Recent data from BHDDH's Behavioral Health Online Database reveals 2,316 unique admissions in calendar year 2019 across 5 Community Mental Health Centers for individuals with high acuity SMI and youth with SED. Of these admissions, 2,079 are adults and 237 are children. 4% of youth had a co-occurring SUD diagnosis as did 59% of adults. We project that individuals with conditions less severe than SMI currently seen in general outpatient programs may rise to higher levels of care given increased symptomatic response associated with COVID-19. Based on these projections, we will target 700 of these individuals (approximately 30% of a typical year's admissions) to newly engaged or re-engage with COVID-19 resources and completion of the required data collection. Our targeted subpopulations who may have less severe conditions than SMI will include those experiencing homelessness, behavioral and physical healthcare professionals, and immigrant, refugee, and non-English speaking populations and will complete required data collection should they enroll in services. Rhode Island's overall goal is to improve outcomes among the targeted populations experiencing mental health and substance use conditions as a result of COVID-19.To address the needs of these individuals, we will focus these grant resources on investments in: technical and clinical infrastructure for telehealth at our licensed Community Mental Health Centers, creating remote access to DATA-waived prescribers; and supporting organizations in delivering treatment and making linkages to recovery support services in a telehealth context in the language preferred by the client. Specific strategies include: 1) Issuance of a delegated authority request for proposals to expand the telehealth capacity of Community Mental Health Centers 2) Provision of interpreter and translation support services for phone, video and computer-based materials used by behavioral health providers 3) Establishment of a Buprenorphine Tele-Induction (assessment and prescribing) hotline and connection to outpatient maintenance treatment It is our belief that these investments are sustainable as the service delivery environment shifts toward a more favorable context for telehealth service policy and reimbursement.

Newport County Community Mental Health Center’s (NCCMHC) current CCBHC seeks to enhance and expand evidence based practices to individuals with serious mental illness (SMI), children and adolescents with serious emotional disturbances (SED) young adults with emerging SMI, and chronically homeless adults with SMI. With three collaborators (Thrive, Inc., Community Care Alliance, and CODAC Behavioral Health), NCCHMC will provide expanded and enhanced CCBHC services to 9,000 people across the State of Rhode Island in the first year of the project. A total of 10,000 (unduplicated) people will be served over two years. The project will expand evidence based behavioral health practices to over 495 adults, children and families who currently do not have access to these services in the first year and over 1,125 over the two year grant period. Covering an area of 1,212 square miles and a population of 1,059,639 (72.5% white, 15.5% Hispanic,8.2% Black, and 7.7% Other, Rhode Island has the highest adult rate of mental illness nationally (24%) and 34% of Rhode Island children who needed mental health treatment or counseling in the past 12 months did not receive it. Older adults are admitted to mental health and substance abuse facilities at much higher rates than the national average. Psychiatric hospitalization rates for children and adults exceed those for other New England states and the needs assessment indicates a serious lack of availability of intensive in-home behavioral healthcare. Rates of attempted suicide and opioid overdose are above the national average. Young adults with first episode serious mental illness have had limited early access to research based treatment to increase recovery and reduce disability. The project has three main goals: 1.) NCCMHC will maintain its current fully operational Certified Community Behavioral Health Clinic providing a complete scope of CCBHC services to individuals eligible for Medicaid as well as those who are uninsured or under insured; 2.) NCCMHC together with its contract partners will enhance existing CCBHC services by expanding/initiating by maintaining/expanding its current array of four evidence based practices (EBP), Assertive Community Treatment, Individual Placement Services (Supportive Employment), Consolidated Specialty Care (young adult RAISE/Healthy Transitions), and Positive Parenting Program (Triple P). The following new EBPs will be added: Integrated Health Homes, Permanent Supportive Housing, and Dialectical Behavioral Therapy. 3.) NCCMHC and its DCO partners will implement infrastructure enhancements to improve the overall quality and coordination of care. Additional workforce development and infrastructure improvements (training in recovery/person-centered care, Motivational Interviewing, CLAS standards), and infrastructure for telemedicine, implementation of a recovery-oriented, person-centered EHR with a measurement-based care component, and provision of free mobile phones to vulnerable clients, to improve both behavioral health and health outcomes of the people served.

“Healthy Transitions RI” will address the needs of 555 youth and young adults ages 16-25 with Serious Emotional Disturbance (SED), Severe Mental Illness (SMI), First Episode Psychosis, and/or Co-Occurring Disorders (COD) at two sites in seven Rhode Island communities. Responsibility for these young people is divided between state agencies, schools, service providers, families, and others. This proposal seeks to create new and expand on existing partnerships responsible for their successful care. It proposes an interdepartmental administrative body, the Transition Team, advised by a Statewide Advisory Council composed of young adults, families, advocacy groups, state departments and service providers. Seven communities: Providence, Newport, Jamestown, Middletown, Portsmouth, Tiverton and Little Compton Rhode Island, have committed to working with the behavioral health organizations providing RI HT. These providers, known as “Labs” will work with their communities and expand on existing partnerships with youth and family representatives, local service provider agencies, education, veteran, employment, recreational, faith-based, advocacy organizations, and other community stakeholders to meet the treatment goals of program participants. Each Lab will have a local advisory group that will guide the local development of the project, learning about the needs of their youth and young adults, collaborate to help identify, engage, and screen those at risk for developing SMI and/or COD. The two Labs will provide RI HT, a modification to coordinated specialty care as the primary evidenced based practice. Teams will also use Shared Decision Making, Motivational Interviewing, Cognitive Behavior Therapy and Dialectic Behavior Therapy as a complement to our modified CSC. The two state agencies responsible for mental health: the Department of Behavioral Healthcare, Developmental Disabilities and Hospitals for adults and Department of Children Youth and Families for children, will oversee a transition team that will identify policy areas that need to be modified or created for the improvement of transitioning children into adult services. These changes will be measured in terms of the numbers of service agreements, policy and practice changes made at the state and city level and by the implementation of funding arrangements that can sustain this effort beyond the life of the grant. The proposal’s other objective, the transformation of the service delivery system, will be measured by the total numbers identified through the outreach and engagement services as being at risk for SMI/COD and the total numbers served by RI Healthy Transition services. The program will provide outreach to 2100 individuals and screen 665 individuals over the five years of the grant. Of these, 585 will receive a clinical assessment and, of these, 555 will receive RI HT services over the five-year period.

The Rhode Island Early Diversion project will implement a direct transfer approach for law enforcement to divert individuals affected by mental health or cooccurring substance use disorders from arrest to services. Police may transport individuals to the Behavioral Health Link (BH Link) assessment and triage center or request on-site assistance. BH Link will provide short term crisis stabilization services and make connections to treatment and recovery services. The Law Enforcement and Behavioral Health Partnership comprised of stakeholders and consumers will be convened by BHDDH to provide input on approaches and strategies for achieving the goals of the project which are to: (1) Improve partnerships and policies that support law enforcement to respond to individuals with mental illness and co-occurring disorders (2) Increase knowledge and skills of local law enforcement to respond to individuals with mental illness and co-occurring disorders and conduct warm handoffs to the treatment and recovery support system of care (3) Increase appropriate health care referrals of persons with mental illness and co-occurring disorders that are encountered by police and referred to the state’s assessment and triage center, BH Link Clinical and support services to be provided include Assertive Community Treatment, Medication Treatment, Evaluation and Management, Integrated Treatment for Co-Occurring Disorders, Illness Management and Recovery Support services including case management and peer support services. Engagement in services will be monitored at 3 months, 6 months, and one year after diversion. A Law Enforcement Liaison will be contracted to engage police departments to refer to BH Link and to take the One Mind pledge to implement 4 promising practices over a 12-36 month period that includes formalizing partnerships with mental health organizations, developing model policy to respond to persons affected by mental illness, training officers and other staff in mental health first aid and crisis intervention training. The Rhode Island Early Diversion statewide project proposes to serve 100 unduplicated individuals in Year 1 of the project, 200 on an annual basis thereafter and a total of 900 individuals affected by mental illness or cooccurring substance use disorders with a priority to Veterans over the five-year project period.

The Rhode Island Department of Health’s Violence & Injury Prevention Program proposes continued implementation of the Rhode Island Youth Suicide Prevention Project (RIYSPP) to maintain and expand an innovative, comprehensive, and coordinated youth suicide prevention program for RI youth ages 10-24 that builds upon the successes of the past five years. The public health approach presented in this application is informed by the 2012 National Strategy for Suicide Prevention and the Social Ecological Model (SEM). The Social Ecological Suicide Prevention Model is a four-tier framework that guides the planned activities of the RIYSPP, with corresponding evidence-based suicide prevention strategies implemented statewide and at community, relational and individual levels. Goal 1: Provide early intervention and assessment services and timely referrals to appropriate community-based mental health services for youth at risk for suicidal behaviors by enhancing the current Suicide Prevention Initiative (SPI) and evaluating annually. Goal 2. Train professional staff and individuals in diverse community settings to identify youth who are at risk for suicide and evaluate annually. Goal 3. Work with child-serving professionals and providers to ensure they are trained in youth suicide early intervention and prevention strategies and timely response systems, including SAMHSA-sponsored technology and training resources, and evaluate annually. Goal 4. Work with external partners to provide post-suicide intervention services, care, and information to individuals, programs, organizations and statewide systems, solicit input from individuals with lived experiences, and evaluate annually. Goal 5. Conduct a broad public awareness campaign to improve the public’s knowledge of mental health and awareness of available suicide prevention resources in RI. Goal 6. Collect and analyze data on statewide youth suicide early intervention and prevention strategies to monitor program effectiveness throughout the 5-year grant cycle. The unduplicated number of individuals projected to be served annually over the project period is estimated at 6,000 individuals ages 10-24 or 30,000 throughout the lifetime of the project. The numbers are based on individuals directly served by project activities that link school districts and the RI juvenile justice system with community- and hospital-based mental health services. The estimated number of individuals served does not include individuals who will benefit from project activities through gatekeeper trainings, technical assistance/support from RIYSPP funded staff or the statewide media campaign. Over the past 5 years, the RIYSPP has demonstrated the ability to leverage support and resources from other state agencies, private/public organizations, and community stakeholders to meet the stated goals and objectives of SAMHSA’s grant funding. The RIYSPP will build on and expand this work to meet the six goals presented above.

Thrive Behavioral Health, Inc.'s CCBHC Expansion Project seeks to enhance and expand evidence based practices to adults with serious mental illness (SMI) and serious and persistent mental illness (SPMI), children and adolescents with serious emotional disturbances (SED), young adults with emerging SMI, and chronically homeless adults with SMI. Thrive received its CCBHC certification in May of 2019. It is a DCO of a current CCBHC grant. With three collaborators (Newport County Community Mental Health Center, Community Care Alliance and CODAC Behavioral Health), Thrive will provide expanded and enhanced CCBHC services to 9,000 people across the State of Rhode Island in the first year of the project. A total of 10,000 (non-duplicated) people will be served over two years. The project will expand evidence based behavioral health practices to over 300 adults, children and families who currently do not have access to these services in the first year and over 675 over the two year grant period. Covering an area of 1,212 square miles and a population of 1,059,639 (72.5% White, 15.5% Hispanic, 8.2% Black and 7.7% Other), Rhode Island has the highest adult rate of mental illness nationally (24%) and 34% of Rhode Island children who needed mental health treatment or counseling in the past 12 months did not receive it. Older adults are admitted to mental health and substance abuse facilities at much higher rates than the national average. Psychiatric hospitalization rates for children and adults exceed those for other New England states and the needs assessment indicates a serious lack of availability of intensive in-home behavioral healthcare. Rates of attempted suicide and opioid overdose are above the national average.Young adults with first episode serious mental illness have had limited early access to research based treatment to increase recovery and reduce disability. The three main goals of Thrive's CCBHC project include: 1) Enhancement of existing CCBHC services it provides as a DCO of a current CCBHC project of which Newport County Community Mental Health Center is the lead agency. These include four evidence based practices (EBP): Assertive Community Treatment, Individual Placement Services (Supportive Employment), Consolidated Specialty Care/Healthy Transitions, and Positive Parenting Program (Triple P). 2) Implement three additional EBPs will be added: Integrated Health Homes, Permanent Supportive Housing, and Dialectical Behavioral Therapy. 3) Implementation of infrastructure enhancements to improve the overall quality and coordination of care. Enhancements include workforce development (training for 200 staff in recovery/person-centered care, Motivational Interviewing, and CLAS standards), and a recovery-oriented, person-centered electronic health record (EHR) with a measurement-based care component and a language line.

The proposed project aims to expand the content and delivery of an evidence-based intervention for mental and behavioral health that is designed to increase knowledge, decrease stigma, and encourage help-seeking behavior. By infusing this initiative into the academic and professional standards, this project has the potential to significantly improve mental/behavioral health outcomes and services at the University of Rhode Island. Advancing Mental Health First Aid makes broadly available training to identify, approach, and support individuals who may be struggling with mental/behavioral health concerns. The proposed initiative will develop and implement strategies to centralize and institutionalize the Advanced Mental Health First Aid curriculum through required matriculation and employment trainings, and developing a standing series of open trainings for those individuals who self-select for participation. Implementation of the core Mental Health First Aid curriculum (including the Higher Education module) will be conducted in concert with the development of 6 additional content modules aimed to more directly address the specific risk-factors that disproportionately affect vulnerable populations on college/University campuses, including: the LGBTQ community, international/multicultural student groups, student veterans, members of the Greek system, student Athletes, and students struggling with eating disorders or body image concerns. It is expected that a minimum of 600 participants will be trained during each of the first two years of the proposed project (1200), and an additional 800-900 participants will be trained during the final year (totaling a minimum of 2000-2500 trained participant over the course of the funding cycle). Participants for these trainings will include faculty/staff, and students (undergraduate and graduate) from across University campuses, colleges, and disciplines. Each training will involve self-report measures of participant knowledge of and confidence to use key Mental Health First Aid strategies to identify, approach, and support individuals struggling with mental/behavioral health concerns, including depression, anxiety, substance use/abuse, and suicidal ideation. Additional information will be gathered to evaluate participant awareness of mental/behavioral health resources on campus, as well as their confidence to refer individuals to key service providers at the University. These same constructs will be measured at 3, 6, and 12 months post-training and are expected to demonstrate increased knowledge of and confidence using skills and strategies to intervene on potential mental/behavioral health concerns, as well as increased awareness of and utilization of appropriate campus-based mental/behavioral health resources.

The Healthy Communities Office represents the urban catchment area of the city of Providence in Rhode Island. The Providence Partnerships for Success grant will focus on citywide underage alcohol and tobacco/nicotine use with an anticipated reach of at least 13,243 individuals ages 12-17 with a focus on youth in out-of-schooltime settings. With over 178,000 residents, Providence is the capital of Rhode Island and the second largest city in New England. Providence is the home to a large concentration of RI’s communities of color. Nearly 21% of Providence residents are non-native English speaking, compared to only 8% statewide. The proportion of foreign-born people in Providence (29%) is more than twice that of the whole state (13.6%). Approximately 26% of the City’s total population is living below the federal poverty level. Providence has the largest youth population in RI with 13,050 public school youth in grades 6-12. Ninety-one percent of the total public-school population is children of color and 86% qualify for free/reduced lunch. Alcohol is the most prevalent substance used by youth and young adults in RI. In 2017, half of RI high school students reported that they have ever drank alcohol. According to the National Study on Drug Use and Health, RI has a higher percentage of youth and young adults who use alcohol and binge use alcohol, and a lower youth perception of great risk, compared to the Northeast region and national averages. Over the past few decades, RI has seen significant decline in underage cigarette use. However, the proliferation of electronic nicotine delivery systems (ENDS), is of concern in RI. Recent RI Youth Risk Behavior Survey (YRBS) data show a ten-percentage point increase in current high school ENDS youth from 2017 to 2019. The goal of the Providence Partnerships for Success project is to utilize the Strategic Prevention Framework to implement a comprehensive approach to continue progress in reducing alcohol, tobacco, and ENDS use for youth, ages 12-17. To meet this goal, the Healthy Communities Office proposes implementing a comprehensive set of evidence-based strategies including: education and communication strategies such as delivering evidence-based programs in out-of-schooltime and family settings; environmental strategies addressing social and retail access; and enhanced enforcement of underage alcohol and tobacco laws. Providence expects to see a 5-percentage point decrease in alcohol and tobacco/nicotine use each, for youth ages 12-17. The evidence-based strategies will create measurable city-level changes in social access, retail access, family and community norms, and perception of risk and harm.

The Warren Substance Abuse Prevention Coalition will establish and strengthen the collaboration of community members in Warren, RI. Together, we will prevent and reduce the abuse of alcohol among youth in grades 6-12. The award of the Sober Truth on Preventing Underage Drinking Act grant will allow the Warren Coalition to partner with community members and others to reach the 10,490 residents of this under serviced community.(1)The Warren Prevention Coalition will work with youth to mobilize the large number of youth leaders in our community. These youth will lead the information and educational efforts of the coalition to help change underage alcohol use, perception of risk/harm and the society norms that prevail in our communities. By the end of project year one, all youth leaders will have been trained by MADD/SAC counselor on communication skills and knowledge skills to present to grades 6-12. These youth leadership groups will also lead the effort in enhancing skills in an educational effort at both the middle and high schools. (2)The youth coalition will also work toward changing Social Norms by using the media to specifically address underage alcohol use. We will focus this effort around holidays, proms, school vacations, and an Alcohol Awareness month. (3) By the end of year two of the project, all youth leaders in grades 6-12 will have received training in assertiveness skills and knowledge skills on the risk/harm of underage drinking. We will meet our objectives of increasing the perception of alcohol risk/harm by 20% in grades 6-12 by 2023, as well are decrease youth approval by 20% by 2023. Our youth will play an increasingly critical role in the community as they partner with law enforcement efforts, local media, information dissemination and skill enhancement to change practices and norms. (4) We will also increase youth participation in schools and community to provide information and enhance skills surrounding underage alcohol use, developing and distributing culturally sensitive underage drinking literature.(5) By the end of year 2 of this grant, the number of youth that participate in the youth leadership in the Middle (STAND) and High schools (VAASA) will have increased by 10%. The Coalition membership will also partner with our youth to develop an underage media campaign for the community as well. By the end of year one of this grant we will have formed our committee and begun to place signage around the community. By year 2 the Coalition will have developed the culturally appropriate underage drinking brochure and 100% of all parents will have received this information. (6) We will also look to meet our objectives of increasing parent disapproval 20% in grades 6-12 by 2023.The Warren Substance Abuse Prevention Coalition will serve over 10,000 community members annually, as well as over the entire 4-year grant, reaching our community members with increased signage, brochures, advertisements, etc. The Coalition will reach over 2,100 students each year (900 from the middle school, 1,200 from the high school) as well as participating college students. Over the entire project period, the Warren coalition will have reached over 4,800 students, grades 6- 12, as new students enter into the Middle school. The Warren Substance Abuse Prevention Coalition and its partners will work together to make our community safe and Alcohol abuse free place to live, work and enjoy our coast.