SD Discretionary Funding Fiscal Year 2023

Summary: Ta'sunke Witko Owayawa Project AWARE will serve Native American K-12 students by implementing the trauma-informed school model and promoting a recovery-oriented, tiered system of school- and community-based mental and behavioral health interventions. The project will provide counseling, cultural mentorship, suicide awareness and prevention, and related trainings to students, school staff, families, and members of the community. Project Name: Ta'sunke Witko Owayawa Project AWARE Grantee: Crazy Horse School Additional Partnership Members: Oglala Sioux Tribe Health Administration Program, Oglala Sioux Tribe Education Agency, and Mahpiya Sinakiya Win Services. Geographic Catchment Area: Jackson County, South Dakota, and the portion of the Pine Ridge Indian Reservation contained within Jackson County’s borders. Population of Focus: Universal prevention services for Native American K-12 students, with tiered interventions for students experiencing trauma and related mental/behavioral health needs. Number of Individuals Served: 400 students, school staff, and community members annually with the total number of individuals served at 1,600. Goals & Objectives: Goals include (1) increasing child/youth access to school-based trauma-informed, culturally-informed mental and behavioral health services; (2) increasing the knowledge of children/youth and adults to recognize and report signs of at-risk behavior to promote positive personal development; and (3) decrease child/youth measures of suicidality, substance use, and disruptive behaviors. There are three objectives to help measure progress toward each goal, summarized: (1a) implementation rate of individual and small group counseling; (1b) adoption of a 24/7 on-call, crisis-response phone line; (1c) rate of completed informed consent within LEA; (2a) rate of LEA staff trained in trauma-informed model; (2b) number of community members trained annually; (2c) rate of students receiving Tier 1-level, universal prevention services, (3a) decrease in rate of student suicide attempts and completions; (3b) decrease in frequency of substance use among students with substance use disorders; and (3c) decrease in recorded instances of disruptive behavior in school. Strategies & Interventions: The Pine Ridge Indian Reservation is the poorest place in the United States, and our residents experience many historical and contemporary traumas. This project is designed to intervene in this reality and equip students with the prevention, intervention, and postvention to promote recovery and reduce the prevalence and impact of trauma-induced mental and behavioral health challenges, substance use, and suicidality. This will be accomplished through school-based mental health counseling, behavioral health counseling; substance use disorder counseling; screening, third-party service referrals, and cultural mentorship; teacher and school staff trainings; family and community member trainings. We will use evidence-based programming to promote positive behaviors among students, especially with curriculums and programs designed for use with Native American students. This includes the Reconnecting Youth program and the Healing Journey of the Canoe; both are small group-based facilitated counseling sessions to promote positive development. All students will receive universal prevention services, and students screened and determined for higher tiers of service will receive individualized counseling plans and the support of a wraparound support specialist to provide coordinated care and community connections. The project will also launch a 24/7 monitored crisis response phone line to provide immediate intervention to students in need.

South Dakota 988: Building Local Capacity is a joint venture undertaken by the state's only Lifeline crisis center, Helpline Center, and the Department of Social Services, Division of Behavioral Health to rapidly mobilize the necessary workforce for 988 call center expansion and projected ramp-up over 988's nationwide launch beginning July 2022. This cooperative agreement will serve as the foundation for which to build sustainable performance indicator monitoring that can be leveraged for years to come as 988 services expand, and as relationships are formalized between Public Safety Answering Points/911 services and referral-accepting organizations in the area of crisis response and receiving facilities. Given the fact South Dakota is a relatively population state, but with considerable geographic challenges in its frontier/rural nature, the population to be served will be all South Dakotans experiencing behavioral health crisis with specific focus on those impacted by health disparities or limited referral access to appropriate levels of care as close to their home communities as possible. South Dakota's Behavioral Health Crisis Response Stakeholder Coalition (BHCRSC, or 988 planning coalition) was formed in February 2021 and met monthly under the leadership of the South Dakota Department of Social Services, Division of Behavioral Health (DSS-DBH) to inform the development of the State's 988 implementation plan as part of the grant funded by Vibrant Emotional Health. This project builds upon the work completed and outlined by the 988 planning coalition, highlighting the need for additional workforce capacity to operationalize 988 call center capacity. The Helpline Center began serving South Dakota in 1974. Through the years, the agency was formalized with staff, grew to 24/7 services, and was the first location west of the Mississippi River to begin 211 services. The Helpline Center services thousands of people every year by connecting individuals to resources and support, connecting local agency volunteers, and offering hope to individuals with thoughts of suicide. The Helpline Center is the only entity in the state accredited by the Alliance for Information and Referral Systems, and the only entity in the state that provides a certified crisis line through the American Association of Suicidology. The Helpline Center is in the process of creating a separate division to house the 988 call center, with shared administration services provided by existing Helpline Center staff. The new 988 call center will be housed in the same location as the existing 211-based information and referral call center, but staffed separately due to the unique staff qualifications required for answering 988 calls. The implementation approach centers on four key goal areas, all of which build off of initial planning efforts outlined in the state's 988 implementation plan. Key areas of focus center around workforce capacity building, supported by additional funding through this program, along with further refinement and definition of key operational and quality improvement protocols to support and sustain 988 call center staff. The 988 planning coalition will continue to convene as an advisory resource for the Directors and Helpline Center team and will be instrumental in the development of follow up protocols that extend into local care settings as well as on identifying crisis workforce training needs across the full continuum that ultimately increases access to quality, responsive behavioral health care for South Dakotans experiencing crisis. Key performance indicators and other measure s have been identified in alignment with existing NSPL metrics, the required SAMHSA infrastructure, prevention and promotion indicators, and those that will aid the state in understanding 988 call center workforce staffing, partnership development, and the disposition of people supported by 988 call center staff as capacity expands and public awareness.

South Dakota's Rural Mobile Crisis Response project will demonstrate and evaluate innovative regional rural mobile crisis response approaches through dedicated staffing and coordinated supports for crisis care in partnership with three existing Community Mental Health Centers, providing infrastructure available to impact more than 115,000 South Dakotans residing in the three target geographic regions that presently have minimal to no mobile crisis response service availability. Each region will develop response and follow-up care protocols using a multi-tiered approach, relative to level of acuity of the individual in crisis, supported by existing crisis response resources and newly developed co-responder teams. South Dakota is uniquely positioned to capitalize on multiple strategic initiatives that, when working together, have the potential to significantly disrupt the current pathway for rural mobile crisis response services. By aligning ongoing workforce capacity building efforts around community health workers with recent telehealth capacity enhancements afforded to EMS services statewide, this project will complete the connection to appropriate regional response services delivered by local, qualified and trained behavioral health personnel. Dedicated staffing at the CMHC level will afford staff capacity and time to foster these partnerships. The project's goals center on demonstration of regional mobile crisis response and follow- up care, built on interagency partnerships across the continuum of care for dispatch, emergency response, crisis stabilization, referral to higher levels of care as needed, and follow-up services. Key staff will focus on the creation of evidence-based crisis response and follow-up protocols and define and implement crisis intervention training needs as needed to support implementation. Each region will have flexibility to define and solution opportunities that best meet the gaps in service across their catchment areas, with some opting to focus more on technological resources and others on creative workforce training and capacity building efforts. Each have the same vision: to develop and implement strategies for mobile crisis response services in rural/frontier areas that deliver the timeliest and most safe response for staff and individuals served alike. The program assessment is designed to collect information and monitor in a way that allows for continuous quality improvement at each stage of deployment, from which state and federal partners can learn from in what will hopefully be innovative, multidisciplinary, and collaborative response strategies that can be applied to other areas of the United States with similar geographic and service area challenges.

Suicide is among the top three causes of death for Native Americans between the ages of 5 and 34 in the state of South Dakota, a rate 2.5 times higher than among white South Dakotans. UIH, in collaboration with 988 Helpline and community partners, is uniquely positioned to implement community-driven, culturally appropriate, and data informed solutions aimed at addressing the needs of South Dakota’s Indigenous relatives struggling with MH and SUDs. With over forty years of experience, UIH has an established history of partnering with county, state, and private entities to bring awareness and programming to both Native and non-Native community members alike. Goal 1: Increase the long-term capacity of 988 staff to engage with our Native American relatives struggling with MH issues, suicidal ideation, and/or SUDs by integrating indigenous programing into crisis response. Goal 2: Strengthen relations between the Native American community, law enforcement, the South Dakota Helpline, and UIH, and provide an alternative for crisis response through the development of a mobile crisis response team. Goal 3: Improve case management and follow-up care for Native American clients utilizing the South Dakota Helpline and the Mobile Crisis Response Team, Wo’Okiye.