RI Discretionary Funding Fiscal Year 2023

Summary: Family Service of Rhode Island (FSRI) has created “Best Start RI” to address Social Determinant of Health (SDoH) challenges and mental health/substance use issues for children, adolescents and their families. At least 500 Jenks Park Pediatric (JPP) patients at critical ages of development from Central Falls, Providence and Pawtucket will be screened for SDoH inequities, along with mental health/substance use needs. Additionally, the project staff will mitigate imminent patient needs, collaborate with JPP and community providers, and coordinate appropriate referrals to address follow-up care for both the SDoH and mental health/substance use components. Population to be served: The pediatric patients of JPP, most residing in low-income minority neighborhoods in Central Falls, Providence and Pawtucket, Rhode Island. In Central Falls, 39% of residents are foreign born, with 25% living in poverty. Those numbers respectively are 31% and 22% in Providence, and 25% and 15% in Pawtucket (Census.gov). Strategies/Interventions: Best Start RI staff will 1) detect and intervene in Social Determinant of Health barriers; 2) screen, provide intervention, and linkages for children/adolescents experiencing mental health/substance use challenges. Trained staffs will provide systems navigation and coordinate care to mitigate inequities. Brief Summary of Goals and Objectives Goal 1: Increase JPP capacity to screen for SDoH challenges. Objectives: By end of October 2023, project staff will be trained in the tool deployed to screen patients, while practice staff will be oriented to project screening and referral workflow. By the end of August 2024, 500 children/adolescents (and their families) will be screened for SDoH challenges. Goal 2: Increase the capacity of JPP to support families in mitigating SDoH challenges. Objective: By the end of August 2024, 75% of families who screened positive for SDoH challenges will have been connected by staff to an appropriate community resource. Goal 3: Increase the capacity of JPP to screen patients for mental health/substance use problems. Objectives: By October 2023, project staff will be trained in PSC-17 and CRAFFT2.1+N tool, and practice staff will be oriented to all mental health/substance use project components, and aware of screening and referral workflow. By the end of August 2024, at least 500 children/adolescents will be screened. Goal 4: Increase the capacity of JPP to refer and connect patients to clinically appropriate mental health/substance use services. Objective: By the end of August 2024, 100% of children or adolescents who screened positive for mental health/substance use problems will have been referred to a clinically appropriate intervention resource. Goal 5: Decrease child/adolescent mental health problems in the community by implementing evidence-based screening tools into JPP workflow that assess anxiety, depression, and other problematic behaviors. Objective: By the end of August 2024, at least 50% of children/adolescents screened positively for mental health/substance use problems will have engaged with a clinically appropriate intervention or resource.

Rhode Island has been implementing a Behavioral Health System of Care for Children and Youth (SOC) since 2021. The SOC includes foundational, program, and connector components. The program and connector components - universal screening and prevention, Mobile Response and Stabilization Services, care coordination, home and community-based services, residential services, a single point of access, and evaluation - are all foundationally rooted in ensuring equity, workforce transformation, community and family outreach and engagement, and sustainable funding. As we note throughout this application, EOHHS is braiding funding from multiple sources to implement the entire SOC. This application focuses on MRSS funding, which is best understood as a program component of our overarching system of care.

Rhode Island's (RI) 988 Connect to Care project is designed to serve the entire state, by expanding the RI 988 Lifeline Center ability to answer calls, texts, and chats to the 988 Suicide and Crisis Lifeline. Goals of the project focus on increased access, workforce development, education, and data collection quality improvement. Project planning efforts will rely on stakeholder collaboration, coordination throughout the statewide crisis care continuum, and integration into the buildout of the Certified Community Behavioral Health Clinic (CCBHC) model in Rhode Island. Since 2019, the RI 988 contact center has served over 10,000 Rhode Islanders through call, text, and chat services, an average of 2,200 individuals annually. Almost half (45%) of these contacts occurred after the July 2022 launch of 988. We aim to serve a total of 20,000 Rhode Islanders during this grant period. Individuals experiencing a mental health or substance use crisis, seeking a referral for behavioral health services, or seeking other information/resources make up a majority of 988 contacts, 77%, 2%, and 8%, respectively. Additionally, target populations include people of color, individuals identifying as LGBTQ+, men, and middle-aged individuals, all of whom experience a greater risk of suicide in RI. In order to promote cultural competency, an enhanced training program will be offered to 988 crisis counselors. This training program includes trainings relating to working with special populations such as LGBTQ+groups, Indigenous/Tribal affiliated individuals, and various other populations. Strategies to achieve our goals of increasing access and capacity to serve through 988 focus on workforce augmentation, formalized recruitment and retention program building, and enhanced training initiatives. Communications strategies include launching a community-reviewed campaign, and community engagement grass-roots efforts that can enhance the reputation of 988 and build trust with hard-to-reach populations. Improved data collection efforts will allow for enhanced service levels and inform quality assurance and improvement measures. Goal 1. Provide immediate access to crisis intervention and support. 1.1) By the end of Y3, 90% of texts will be routed and answered in-state; 1.2) By the end of Y3, 90% of chats will be routed and answered in-state 1.3) By the end of Y3, less than 20% of individuals enrolled in follow-up services will report a suicide attempt since their initial contact. Goal 2: Expand workforce capacity through improved recruitment, retention, and training. 2.1) Within two weeks of hiring, 100% of crisis counselors will complete the required Lifeline counselor training 2.2) By the end of Y1, 80% of counselors will complete at least one cultural competency training 2.3) By end of Y1, perform at least 6 employee retention activities 2.4) By the end of Y3, onboard at least one contact center intern. Goal 3: Educate Rhode Islanders on 988, what services it provides, and when to call 988. 3.1) By the end of Y3, launch a statewide public awareness campaign that reaches 75% of Rhode Islanders 3.2) By the end of Y3, conduct at least 360 outreach activities. Goal 4: Enhance contact center data collection and quality improvement. 4.1) By the end of Y1, 100% of eligible contacts will be asked to complete the end-of-call demographic survey 4.2) By the end of Y3, 90% of eligible contacts will receive three follow-up attempts.

The populations of focus for this project include: individuals with serious mental illness; children and adolescents with serious emotional disturbance involved with substance and opioid use disorders. Higher percentages of blacks (16.4%) and Hispanics (18.8%) report mental distress than whites (14.1%). NEXO Behavioral and Mental Health Center delivers outpatient mental health services to children and adults. Clients can access these services even if they don't have insurance and aren't able to pay. We use evidence-based treatments to provide integrated care that addresses chronic and toxic stress. The program is designed culturally and linguistically competent staff to address mental health issues, eliminate stigma and reduce barriers faced by low-income minority populations.

CCA will continue to improve and advance to be certified as a fully operational CCBHC, providing the complete scope of CCBHC services to individuals regardless of ability to pay. CCA will implement infrastructure enhancements to improve overall quality and coordination of care. CCA will advance four program areas: Peer Specialist Services, Complex Care Management Services, MedTeam Programming, and Emergency Services Prescriber access. These projects will address the needs of a wide range of clients across the lifespan, including individuals with: 1) a mental or substance use disorder who seeks care, including those with a serious mental illness (SMI), substance use disorders (SUD), including opioid use disorder; 2) children and adolescents with a serious emotional disturbance (SED); 3) individuals with a cooccurring disorder (COD); and 4) individuals experiencing a mental health or substance use related crisis. A priority will be placed on serving underserved populations (homeless, veterans, BIPOC, etc.). The program will serve people who reside in a five-town area in the northern and eastern Providence County (RI) that covers an area of 131 sq. mi. and a population of 130,845.

Over 5 years, Family Service of Rhode Island will trauma-screen 3,000 at-risk diverse children; provide evidence-based/informed practices (EBPs) to 1000+ children, with 250+ families receiving help with care barriers; add 64 therapists certified in EBPs; educate 3000 child-serving workers statewide on trauma-focused care/referrals; adapt/innovate 3 EBPs to improve outcomes; measure effectiveness; and sustain treatment. Project Name: Children’s Treatment and Recovery Center. Populations Served: 3,000 at-risk children (particularly victims of or witnesses to abuse, violent crimes, etc.) ages 2 to 18 and their families, particularly from Latinx and Communities of Color with a focus on low-income high-crime cities Providence, Centrals Falls and Pawtucket. In addition, 3000 child serving professionals statewide will be educated to foster understanding and referrals to trauma-focused evidence-based practices (EBPs) and increase the number of clinical providers certified in these treatments. Strategies/Interventions: EBPs will be Trauma-Focused Cognitive Behavioral Therapy (TF-CBT); Parent Child Interaction Therapy (PCIT); Trauma Systems Therapy (TST, evidence-informed). TF-CBT to be adapted to improve outcomes. Other interventions: measuring clinical effectiveness with Child Stress Disorder Checklist; assisting populations overcome care barriers; Resources provided to increase understanding of child-serving professionals of EBPs; Goals: 1) Expanded access to EBPs for diverse at-risk children and their families. 2) Providing direct services of aforementioned therapies; 3) Educate child-serving systems about trauma-informed resources and services to increase access and referrals to EBPs 4) Collaborate with Category II and III sites to adapt EBPs. 5) Measure treatment effectiveness. Overview of Objectives: 1) Trauma-screen 3000 children/youth for exposure to traumatic events; 2) Increase number of certified PCIT therapists by 4; TF-CBT by 60 (focus on bilingual, bi-cultural staff); 3) Treat 1000 children with EBPs; 4) Identify funding beyond SAMHSA for sustainability; 5) Outreach and care management for 250 families; 6) Emergency services for 100 youngsters; 7) Implement clinical measure Child Stress Disorder Checklist; 8) Deliver trauma-focused education/resources to 3000 child-serving professionals and measure knowledge gain; 9) With NCTSN Category IIs and IIIs, adapt TF-CBT, and foster increased number of PCIT clinicians and improve TST implementation;10) Measure effectiveness of Children’s Treatment and Recovery Center. Total People Served Annually: Year 1: 1200; Year 2: 1300; Year 3: 1500; Year 4: 1700; Year 5: 1800 Total People Served At End of 5 Years: 7500.

Family Service of Rhode Island, the Roger Williams University Justice System Training and Research Institute and the Institute for Intergovernmental Research will create a Center for Trauma-Informed Policing to improve outcomes for traumatized children encountered on crime scenes. A state-of-the-art, virtual law enforcement training program will be developed and the FSRI Go Team police/mental health partnership program will be formally evaluated. A Project Advisory Committee including child trauma experts, law enforcement, clinicians, and family with lived experience will advise on all project activities. Following a New England-based pilot to test the initial training and technical assistance program and two Learning Communities involving police departments across the country to improve upon and refine the program and related intervention products, the final trauma-informed law enforcement Learning Management System (LMS) will be launched and broadly disseminated. Project goals and objectives: 1. Develop a best practice Trauma-Informed Policing training curriculum for law enforcement to respond to the needs of children impacted by traumatic stress (informed by a nationwide law enforcement survey, LMS design and build out, pilot testing, and two Learning Communities. 2. Evaluating FSRI's Go Team program to assess its efficacy in reducing child trauma symptomology as a promising addition to the inventory of evidence-based practices (including a point-in-time-self study, stakeholder survey, key informant interviews, Go Team service recipient focus groups, service utilization data, and measures for post intervention child trauma symptomology synthesized into a comprehensive evaluative report for journal publication. 3. Evaluation of overall project impact resulting in a Project Evaluation Report. 4. Dissemination of the Trauma-Informed Policing training program, LMS, intervention products, and evaluative findings (as promoted through project partner, SAMHSA, and NCTSN networks and presented at regional and national law enforcement and child mental health conferences, regional meetings, and other relevant venues. The Center for Trauma-Informed Policing or "TIP Center" will serve as an ongoing resource for law enforcement interested in becoming trauma-informed, implementing best practice response approaches, and developing or enhancing partnerships with community-based mental health organizations to mitigate the short- and long-term effects of childhood trauma exposure and reduce the risk of revictimization. Ten diverse police departments at various stages of trauma-informed readiness are expected to participate in the Year two pilot and 20 are expected to participate in the Year three and four Learning Communities. A total of 3,000 law enforcement professionals, community-based mental health professionals, and other key stakeholders are expected to benefit from TIP Center training, technical assistance, consultation, and intervention products across the five year project period.