TN Discretionary Funding Fiscal Year 2019

Project Summary: This project will support expanded outreach and enhanced treatment and recovery support services to pregnant and postpartum women in the state who are justice system involved or child welfare system involved through increased collaboration between community-stakeholders involved in the delivery of family-based services. Project Name: TN Coordinated Response to Pregnant/Postpartum Substance Abuse Population(s) to be Served (Demographics and Clinical Characteristics): The population of focus for this statewide project will be pregnant and postpartum (up to 12 months) women (all races, ages and ethnicities) diagnosed with a substance use or co-occurring mental health disorder who are justice involved: either incarcerated; under community supervision; or involved with the child welfare system in the State of Tennessee. Strategies/Interventions: Engagement by eight TDMHSAS Continuum of Care providers of pregnant women?s treatment services with Single Team/Single Plan (STSP) teams in six communities: Shelby, Madison, Davidson, Putnam, Knox, Washington and surrounding counties. The STSP model supports multi-agency collaborations led by the Department of Children?s Services which include TDMHSAS, the Dept. of Education, Dept. of Health, Dept. of Human Services, Health Care Finance and Administration (TennCare, CHOICES, and CoverKids), and contractors and partners of each of these agencies including Managed Care Organizations (MCOs). Treatment providers will create PPW Treatment Teams which leverage the relationships established through STSP teams to collaborate with a range of providers in their communities to offer family-based treatment and recovery support services such as: outpatient treatment services; in-home services for both individuals and family members; evidence-based parenting classes; and wrap around services such as transportation, child care, educational/vocational training, job placement, housing (not funded by the grant). Project Goals and Measurable Objectives: Goal 1: Reduce justice and child welfare system involvement for pregnant and postpartum women. Objectives: 1a - Improve early identification of target population; 1b - Increase the number of diversion programming options for the target population which are available to courts and child welfare agents; 1c- Reduce trauma exposure for target population; 1d - Increase family reunification of target population. Goal 2: Improve the quality of care for justice involved pregnant and postpartum women with substance use or co-occurring disorders. Objectives: 2a - Increase access to comprehensive services including family-based treatment and recovery support; 2b - Increase coordination and efficiency of case management services; 2c - Increase continuity of care for target population; 2d - Increase retention in treatment; 2e - Reduce substance abuse.

This project will support the expansion of formal collaborative planning efforts between team members of the Coffee County Family Treatment Court, enhance the delivery of assessment and direct care services to FTC clients, and incorporate System of Care and High Fidelity Wraparound principles into the service model of the FTC. Project Title: Coffee County Family Treatment Court Populations to be Served: Parents facing custodial removal of their children on the grounds of child abuse/neglect and their affected children and non-offending caregivers who are involved in the juvenile dependency court system of Coffee County Tennessee. Strategies and Interventions: Screening and assessment of potential FTC clients will be enhanced with project funding through the adoption of a universal rapid screening policy for juvenile dependency court clients and the introduction of a comprehensive battery of assessments to identify substance abuse and/or mental health disorders; domestic violence history, trauma history, and children?s needs and strengths. The Mental Health Cooperative (MHC) is a treatment provider whose role in the FTC will be greatly expanded to support this project. The Mental Health Cooperative?s assumption of a more prominent role in the FTC as a treatment provider will allow the court to integrate the System of Care (SOC) model, which MHC is actively implementing as a part of a statewide effort funded and supported with technical assistance by TDMHSAS. MHC staff has been trained in the High Fidelity Wraparound (HFW) process, both as supervisors and as wraparound practitioner care coordinators. Project Goals and Objectives: Goal 1: Expand the role of the Family Treatment Court (FTC) program in Coffee County. Objective 1a: Increase the number of adult juvenile dependency court clients who are screened and assessed for the presence of co-occurring substance abuse and/or mental health disorders as well as a history of domestic violence and trauma; Objective 1b: Increase the number of parents and affected children and caregivers referred and accepted in the FTC program; Objective 1c: Increase the number of formal collaboration agreements between FTC stakeholders in Coffee County. Goal 2: Improve the timeliness and quality of treatment and recovery support services available to parents, their affected children and caregivers. Objective 2a: Reduce the number of days between referral to assessment and treatment services for all participants; Objective 2b: Increase the number of parents and affected children and caregivers receiving evidence-based, trauma-focused, co-occurring treatment and recovery support services; Objective 2c: Increase retention rates in treatment for parents in the FTC. Goal 3: Reduce the rate of repeat clients served in the Coffee County Juvenile Dependency Court system. Objective 3a: Increase training for FTC team members in the areas of family-centered practices, trauma informed care, care coordination, and collaboration strategies; Objective 3b: Expand case management services and peer coaching for parents in Family Treatment Court; Objective 3c: Increase FTC staff team capacity to implement High Fidelity Wraparound services.

This project will support the expansion of assessment treatment and recovery support services in the 25th and 22nd Judicial District Recovery Courts in southwest and southcentral Tennessee. Project Title: Tennessee Rural Recovery Court Expansion Program Populations to be Served: Non-violent felony offenders engaged in the 25th Judicial District Recovery Court program and the 22nd Judicial District Recovery Court program. Strategies and Interventions: Project funding will support the expansion of assessment, treatment and recovery support services delivered by the Grove in six counties, four in the 25th JD (Tipton, Lauderdale, Hardeman and McNairy) and two in the 22nd JD (Lawrence and Maury). This expansion of services will occur through a combination of 1) additional staff resources in the form of case managers to serve each individual county specifically, and 2) the enhanced use of telehealth technology to support the delivery of high-quality evidence-based treatment services to clients by licensed counseling staff. Project Goals and Objectives: Goal 1: Expand the client base and service area of the Recovery Courts in the 25th and 22nd Judicial Districts. Objective 1a: Increase the program caseloads for the 25th and 22nd Judicial District Recovery Courts by (100%) and (300%) respectively by year five of the project. Objective 2a: Increase the total percentage of Recovery Court clients in the 25th and 22nd Judicial Districts who can access treatment and case management services in their county of residence to (90%) by the end of the five year project. Goal 2: Improve the quality and availability of treatment and recovery support services delivered to Recovery Court clients. Objective 1b: Expand delivery of direct treatment and case management services into Tipton, Lauderdale, Hardeman, McNairy, Lawrence and Maury County. Objective 2b: Introduce mental health and primary medical care services into each targeted county by year four of the project ensuring that comprehensive clinical assessment and clinical interventions are delivered to 100% of Recovery Court participants during the final two years of the project. Objective 3b: Increase the number of family members and concerned significant others associated with Recovery Court clients who are involved in the development and implementation of case plans by (20%) in each year of the project as measured by case manager contacts. Objective 4b: Increase the percentage of Recovery Court clients completing the program successfully by (5%) in each year of the project. Objective 5b: Increase the number of Recovery Court clients reporting improved education, housing and employment status and reduced substance use by (10%) in each year of the project.

Targeted Efficacy & Capacity Building in Opioid Treatment-TN.Expansion (TECBOT-TN.X), as proposed by the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS), will close the gap in access and delivery of evidence-based (EB), medication-assisted treatment (MAT) services for patients with opioid use disorders (OUDs) who need an MAT referral instead of an inpatient bed. Using a care-coordination model, TECBOT-TN.X will facilitate appropriate, high quality treatment for opioid addiction for 132 underserved adults receiving services in a state-funded psychiatric hospital (PH) in Blount County over a 3-year period. Acute patients with OUD will be transitioned to an outpatient MAT provider in Knox County. (Both facilities are located in the Knoxville metropolitan statistical area [MSA]). Behaviors exhibited in emergency departments (EDs), lack of disclosure about opioid/other substance use, failure of medical staff to ask about substance use, and/or lack of information about substance use treatment (SUT) options or resources all contribute to the inpatient stay. However, the result is an undertreated person with OUD. As an inpatient, withdrawal symptoms appear and hospital staff ask for additional days. Because the state-funded PH is designed to serve severely and persistently mentally ill (SPMI) at or below the poverty line, requests for extended lengths of stay (LOSs) involving substance use are denied. In addition, many of the denials show back up as readmissions. TECBOT-TN.X?s care-coordination model can enhance the quality of care for these individuals. Case management and/or care coordination staff at the PH and SUT will collaborate to successfully coordinate care for acute patients with OUD who need and express a desire for EB-MAT in the form of buprenorphine/naloxone (Suboxone) film or extended release, long-acting injectable naltrexone (Vivitrol). Veterans/military personnel will be a priority population. Case management/coordination staff at the PH will provide appropriate screening, assessment, and patient education to address any questions the patient may have regarding MAT. A standardized checklist will be used at discharge. TECBOT-TN.X picks up medication services at discharge and facilitates seamless transition to outpatient services.by providing a 3-day supply of medication and Narcan at discharge. Every reasonable effort will be undertaken to complete a coordinated transition to the SUT within 24-48 hours of discharge from the PH. Once connected to the SUT, patients will be encouraged to participate in a full range of wraparound and recovery support services, including counseling, behavioral therapy, and integrated care, along with the MAT. TECBOT-TN.X expects to: 1) increase the number receiving MAT/integrated care services; 2) decrease tobacco use, illicit/non-prescribed drug use, inpatient days, and healthcare utilization costs; and 3) increase the number of DATA-2000 waivered physicians.

Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS), Division of Substance Abuse Services (DSAS), will work to enhance current prevention, treatment, and recovery activities in response to the opioid epidemic through TN SOR: Changing Behavior, Coordinating Care, and Restoring Lives. TN SOR will increase access to medication-assisted treatment (MAT), reduce unmet treatment need, and reduce opioid overdose related deaths. The populations of focus for TN SOR are Individuals at High Risk of Overdose and Individuals with a Diagnosis of Opioid or Heroin Use Disorder. According to reports from the Centers for Disease Control (CDC), more individuals died from drug overdoses in the United States in 2016 than during any previous year. In the current National Survey on Drug Use and Health it is estimated that in Tennessee there are 82,965 Tennesseans with an OUD . In addition, a significant number of Tennesseans have no insurance or insurance with very limited coverage ? particularly coverage for substance use services. Through medication assisted treatment in combination with clinical and recovery activities, TDMHSAS estimates that it will serve 1,080 individuals annually and 2,160 individuals through the lifespan of the grant who have an OUD. TN SOR aims to: (1) increase awareness of the dangers of opioids, (2) educate key stakeholders on preventing overdose, (3) reduce the number of overdose related deaths through naloxone distribution; (4) train health professionals to assess and treat individuals with OUD, (5) implement an Opioid Overdose Rapid Response Team; and (6) expand access to MAT, clinical treatment and recovery services through a Hub and Spoke model.

In recent years Tennessee treatment admission for opioids have surpassed even those for alcohol and 1,631 Tennesseans died of overdose in 2016 a rise from 2015, making finding innovative solutions to the opioid crisis a top priority for the state. We intend to use this funding to develop an opioid specific approach to Screening Brief Intervention and Referral to Treatment (SBIRT) built upon our robust foundation of SBIRT for alcohol and other drugs. We will build on our previous success with the SBIRT implementation grant as well as our partner institution, Meharry Medical College's, SBIRT training grant to expand screening and enhance our referral to treatment efforts. This project will be a complement to the TN Together initiative to address the burgeoning opioid crisis in our state, and resultantly the receipt of this award will have an exponential effect on our state's ability to address substance use disorder (SUD) and OUD specifically. Through our previous SBIRT implementation grant we were able to screen thousands of Tennesseans, and provide brief intervention and referral to treatment to hundreds respectively, and these efforts have been sustained in our partner institutions. Meharry Medical College has also trained over 2,000 practicing physicians, medical residents and students in SBIRT and continues to provide this service as standard care in all of the family medicine clinics, we will combine this implementation and training experience to effectively combat substance use disorder on a wide scale while also tailoring the intervention to OUD. We will partner with both Eastern Tennessee State University, another previous partner that continues to utilize SBIRT as standard care, Meharry Medical College, and the University of Tennessee Health Science Center's Center for Addiction Science to adapt a statewide opioid focused approach to SBIRT. Our approach utilizes the frame work of SBIRT and adds the innovations that have been so effective in Rhode Island through the AnchorED intervention and the Yale ED Health study. We will use five primary strategies to adapt SBIRT to our current opioid crisis: (1) add universal opioid screening to extant protocols in primary care clinics, continuing to provide brief advice and intervention in clinic; and (2) partner with emergency departments and emergency medical services to identify non-fatal overdoses, in essence a second form of screening; and (3) utilize Advanced Peer Recovery Specialist (APRS) to provide brief negation interviews with these patients and provide either brief treatment using a form of cognitive therapy known as Seeking Safety in combination with MAT; or (4) utilize the APRS to shepherd the patients in need of treatment referral to one of our partner providers that offer behavioral as well as buprenorphine, naltrexone, and/or methadone treatments; and (5) utilize an ECHO training model to rapidly disseminate this approach across the state multiplying the effect of this funding.

The Tennessee HIV/AIDS, Related Substance Use Disorders, and Mental Disorders Services Program, a joint venture between The University of Tennessee College of Social Work and the Helen Ross McNabb Center, a Regional Behavioral Health System, expands and enhances culturally competent services in minority (predominately African-American) and Hispanics/Latinos communities for persons with great risk for HIV/AIDS and having mental health needs, and to others linked to the clients? Individual Treatment Plan (ITP), e.g., parents, partners, and dependents. The program addresses the epidemic of minority persons who: a) are HIV positive and have a DSM diagnosis, or b) are HIV positive and have mental health problems that do not reach the criteria for DSM diagnosis; and parents, partners, dependents, and others linked to the client?s Individual Treatment Plan (ITP). The program is intended to alleviate significant unmet needs of this population based on the data to indicate the small percentage of clients with HIV/AIDS currently receiving mental health services (?12.5%), and of those 12.5%, the very few (?1.47%) who receive additional substance abuse services. These clients will receive direct services that consist of outreach, decision to pursue treatment, case management, mental health and substance abuse screening and HIV/VH assessment, mental health and substance abuse treatment, and aftercare. This proposed project seeks to expand and enhance the intensive outpatient services of the Regional Behavioral Health System in East Tennessee to provide a specialized continuum of care to the target population, i.e. outreach, pre-treatment, and mental health treatment services and in-patient and outpatient substance abuse treatment (ASAM Levels I and II.1). We further seek to improve the infrastructure to support service delivery expansion through: ? Building partnerships to ensure the success of the project and entering into service delivery and other agreements. ? Developing or changing the infrastructure to expand treatment or prevention services. ? Training to assist treatment or prevention providers and community support systems to identify and address mental health or substance abuse issues, HIV and Hepatitis care, and screenings for viral hepatitis. ? Increase services for black young men who have sex with men (YMSM) (ages 18-29), and other high-risk populations such as Latino YMSM and men who have sex with men (MSM) (ages 30 years and older), and gay, bisexual, and transgender individuals who have a SUD and/or COD who are HIV positive or at risk for HIV/AIDS. One-hundred individuals will be served each year for outreach, 80 for case management and 60 for treatment services (in conjunction with their parents, partners, dependents). Staff from the College of Social Work Behavioral Health Services Research Center will conduct the project evaluation. The College of Social Work will be responsible for collecting the GPRA data and for disseminating evaluation findings. The affiliated agencies of the Helen Ross McNabb Center (HRMC) Regional Mental Health System, Incorporated, will serve as the sites for the provision of services.

SUMMARY: WestCare Tennessee's Breaking the Cycle program will provide evidence-based behavioral health treatment and recovery support services to help citizens reintegrate into the community post-incarceration. PROJECT NAME: Breaking the Cycle POPULATION: The proposed program will serve adult (men and women 18+) offenders & ex-offenders who are returning to the community from incarceration in Morgan County Jail or Roane County Jail in Tennessee. Participants must: 1) be assessed or diagnosed as having a moderate to severe substance use disorder (SUD) and/or co-occurring mental health disorder (COD); 2) have been sentenced to & serving at least 3 months in jail, or have violated parole & serving at least 1 month in jail; & 3) be within 4 months of scheduled release. INTERVENTIONS: The program will provide direct treatment services & systems linkages through an interconnected network of direct service provider partners. As the lead applicant, WC-TN will provide direct SUD and/or COD outpatient and intensive outpatient treatment services, as well as recovery support services (employment services, case management, relapse prevention, referrals & assistance in locating housing, life skills, education, parent education & child development, & substance use education). The program will also link participants to direct service provider partners for other recovery support services, including primary medical care, HIV testing, Hepatitis testing, & transportation to and from services. GOALS & OBJECTIVES: Goal 1-Foster a stable & manageable transition from incarceration to community-based living for reentering citizens. Objective 1.1-Strengthen & expand the existing partnership between WC-TN & Morgan & Roane County Jails. Objective 1.2-Provide pre- & post-release reentry services to 45 participants annually (225 over 5-years). Objective 1.2.1-100% of participants will have a transition plan. Objective 1.3-90% of participants who received medical testing will effectively manage their own health. Goal 2-Avert relapse & support sustained recovery. Objective 2.1-Provide SUD treatment to 45 participants annually (225 over 5-years). Objective 2.1.1-75% of persons enrolled in treatment will successfully complete the program. Objective 2.2-Conduct random urinalysis for 100% of participants. Objective 2.2.1-70% of participants will be substance free for 6 months post intake & remainder will reduce use. Objective 2.3-90% of participants completing Seeking Safety will report reduced trauma symptoms at discharge and 6 months post intake. Goal 3-Promote community and family safety through the prevention of criminal recidivism, and enhance social, mental health, and behavioral health functioning among participants reintegrating into the community. Objective 3.1-Provide case management services to 45 participants annually (225 over 5-years). Objective 3.1.1-100% of participants identified as needing housing support will receive targeted case management. Objective 3.1.2-At least 80% of completers will have improved relationships at discharge and at 6 months post intake. Objective 3.2.1-80% of completers will not engage in new criminal activity at discharge, and 70% will not recidivate at 6 months post intake. Objective 3.3- Provide vocational/employment services to 100% of participants identified as needing this service. Objective 3.3.1-80% of completers will be in an educational/vocational program, seeking employment, or employed at discharge, and 70% at 6 months post-intake. Objective 3.4-100% of completers will complete an anger management class. Objective 3.5-80% of completers who are parents will complete a parenting class.

PROJECT ABSTRACT SUMMARY: WestCare Tennessee (WC-TN) provides evidence-based, medication assisted treatment (MAT) using FDA-approved medications & recovery support services (RSS). The program decreases prescription drug and illicit opioid misuse for 210 clients over three years, reducing overdose mortality and addiction in Eastern TN. PROJECT NAME: TN MATTERS (Tennessee Medication Assisted Treatment - Together Eradicating Reliance on Substances) POPULATION: TN MATTERS serves male and female adults (18 and over) who are prescription drug and opioid abusers (PDOA) in the rural Roane and Morgan counties of TN. Clients are offenders referred by the jails and drug courts; family and self-referred addicts, veterans and the homeless; and, primarily White, poverty-level clients. Clients have a moderate to severe opiate use disorder and co-occurring mental health disorders. . INTERVENTIONS: TN MATTERS will provide MAT services and RSS. MAT will offer FDA-approved medications, Vivitrol and Suboxone, prescribed and maintained by an APRN who will adjust and reduce frequency and dosage as needed. Medical withdrawal and abstinence will be managed by the APRN, treatment team and client. As the lead applicant and treatment provider, WC-TN will provide direct outpatient MAT services, as well as recovery support services including employment services, case management, relapse prevention, housing assistance, life skills, formal and substance use education. Provider partners offer medical care, HIV testing, Hepatitis testing, tobacco cessation and transportation to and from services. GOALS & OBJECTIVES: TN MATTERS will serve 60 unduplicated clients annually (Year 1), 70 (Year 2) and 80 (Year 3), serving 210 clients over the entire project period). Goals are: (1) Increase numbers receiving MAT services; (2) Decrease PDOA; and, (3) Provide FDA-approved medications for the treatment of PDOA using RSS. Objectives include: (1.1) Strong outreach strategies; (1.2) provide MAT services in rural, resource-limited counties; (1.2.1) individualized treatment plan (90%); (1.3) self-sufficiency and abstinence from opiates (80%); (2.1) Outpatient MAT to 60, 70 and 80 clients in Years 1-3 (210 across three-year funding period); (2.1.1.) Successful program completion (80%, GPRA); (2.2.) client-free illicit drug abuse, prescription misuse and diversion of medication six months post intake (80%, GPRA); (2.2.1) clients adjust or reduce their dosage (70%, COWS); (2.3) clients receive needed COD services (90%); (3.1) case management to 210 clients; (3.1.1) stable living situations (80%); (3.1.2) decreased mental health symptoms (80%), improved mental health functioning (70%, GPRA); (3.1.3) No new criminal activity (80%), and no recidivism (70%. GPRA); (3.1.4) clients who smoke, with HIV/AIDS, hepatitis and other infectious diseases referred for tobacco cessation, testing and counseling.

Williamson County (TN) General Sessions DUI Court will use funding from SAMHSA to increase by 180% the number of DUI offenders it serves annually and expand recovery services to include medication-assisted treatment and technology assisted care. Building on eight years of proven success, the DUI Court enhances public safety in Middle Tennessee using evidence-based practices that reduce impaired driving among members of a high-risk population. Participants have been convicted of multiple Driving Under the Influence offenses and meet Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria for moderate to severe substance use disorder. The population of focus is comprised of offenders who live in one of ten Middle Tennessee counties that all reported ""Excessive Drinking"" rates above State average and in which 24.9% of ""Known Alcohol Related Traffic Crashes"" in Tennessee occurred. Williamson County DUI Court addresses core behavioral health issues, unhealthy lifestyle choices, and unique needs to elicit personality changes while providing the resources and tools a participant needs to sustain long-term sobriety. With the research-driven ""Guiding Principles of DWI Courts"" at its cornerstone, the program empowers participants to demonstrate changes throughout 11 months and 29 days of intensive supervision and accountability. Excluding current, 94% of participants have graduated after fulfilling all expectations including completion of ""How to Escape Your Prison"" and ""Prime for Life"". Recognized on the National Registry of Evidence-based Programs and Practices, these programs reduce recidivism among those involved with the justice system who demonstrated behaviors of substance abuse. Of the 80 graduates, 70 (88%) have not again been convicted of a DUI-related offense. While individual treatment plans may vary to include residential treatment, intensive outpatient, or mental health counseling, all participants demonstrate progress via multiple points of contact with Court Team members each week. In particular, they attend group sessions with the Treatment Provider and self-help meetings, meet one-on-one with the Presiding Judge, meet with Case Manager, and undergo two urine screenings among other expectations. During the life of this project, the DUI Court program will annually provide life-changing services to 42 unduplicated participants as opposed to an average of 15 the previous five years. A total of 210 unduplicated participants will be accepted and enter into the DUI Court program whereas the previous five-year sum is 75, which represents a 180% increase.