VA Discretionary Funding Fiscal Year 2020

To begin to address the behavioral health impacts of COVID-19 in Virginia, this project aims to 1) increase the capacity of our statewide Community Services Boards (CSBs) to provide continuity of care and decrease substance use and functional impairment for individuals with SMI/SED/SUD via telehealth treatment and supports; 2) improve wellness and decrease symptoms of stress and substance use for healthcare workers via specialized virtual supports and partnerships with hospital systems; and 3) improve the behavioral health of individuals in the community experiencing moderate mental illness and/or substance use disorder as a result of COVID-19 via telehealth treatment and supports. To meet these aims, this project will provide direct treatment services in the areas of assessment, medication management and medication assisted treatment, recovery services and recovery housing, and outpatient therapy via telehealth. The ongoing pandemic of COVID-19 has presented an alarming public health concern nationally and internationally, including at least 4,042 confirmed cases and 109 deaths in Virginia. In addition to the direct disease burden caused by the virus, the rapid behavioral, social, and operational changes required to curb the spread of COVID-19 have had severe impacts on behavioral health and the behavioral healthcare system. In the general public, these impacts include social isolation, financial strain and family stress, fear, anxiety, and increased drug and alcohol use. For individuals living with severe mental illness, serious emotional disturbance, and substance use disorders (SMI/SED/SUD), these impacts are known risk factors for the onset, relapse, or worsening of symptoms, which are compounded by the significant disruptions and compromises to treatment availability and access to care also posed by the pandemic. Healthcare workers and frontline responders are particularly vulnerable to behavioral health impacts, and unique impacts include traumatic exposures and reactions, moral distress and injury, caregiving and family strain, and burnout. This project provides direct treatment services to these three priority populations, with specialized supports and intervention modalities suited to the context of COVID-19 pandemic and associated State of Emergency.

James Madison University Substance Use Disorder Education (JMU-SUDE) is a collaborative training program designed to develop the knowledge, skills, attitudes, and aspirations required for treatment of substance use disorder across ten academic units/programs within the seven academic departments in the College of Health and Behavioral Studies (CHBS). This includes training in Nursing, Social Work, Graduate Psychology, Health Professions (i.e., Athletic Training, Dietetics, Occupational Therapy and Physician's Assistant programs), Health Sciences, Kinesiology, and Communication Sciences and Disorders. Students and faculty are the populations to be served by this program in classroom instruction, field experiences, and conference presentations. Community educational partners, who will provide student field placements and field supervision, will also be included in conference presentations. The training includes strategic and stepwise development and provision of inter-professional content for faculty, students, and local health workers to learn the necessary skills and knowledge to provide screening, brief intervention, and referral to treatment (SBIRT) for individuals who are at risk or have been identified as having a substance use disorder. In order to provide current information for a research-based understanding of substance abuse disorder (SUD), training will also include concepts of recent advances in neurobiological foundations of addictions, harm reduction, medically assisted treatment, trauma/ACEs, and motivational interviewing. Training is designed to provide knowledge and skills in interprofessional collaborative practice, reduce stigma by addressing attitudes toward addictions, and increase aspirations in health professionals for treating individuals with substance use disorders. The goal is to develop a sustainable training program that is comprehensive across the health and mental health professional programs within the CHBS. The program will draw from existing SAMHSA curriculum models that are tailored to meet the specific professional responsibilities and roles within each department as they are integrated into the standard curriculum. Where appropriate, field experiences will be expanded and developed in the community for application and supervised training of newly learned skills and knowledge. Classroom instruction will be used for increasing knowledge for screening and treating substance use disorders, field experiences for increasing students' skills, and conference presentations for development of inter-professional collaboration across professions. Input for successful implementation will be facilitated by identifying a 'champion' for each department to facilitate implementation of new instruction into current course work and programming in the most feasible manner. Input from Community partners has been provided to advise content and teaching that address the realities of substance use treatment in community settings. With the enrollment across CHBS at approximately 180 faculty and 5,000 students, the training is expected to have significant impact for expanding the number of practitioners prepared to deliver high-quality, evidence-based SUD treatment.

The proposed Be Well-RVA Project by the Richmond Behavioral Health Authority (RBHA) will be delivered to adults in Richmond, VA with many components stretching beyond city limits. Services will target persons at-risk of suicide or who have attempted suicide, with specialized services for victims of domestic violence and persons with mental health and/or substance use disorders. Richmond is a diverse community of 223,787 residents, identifying as 47.8% African-American, 45.4% White, 2.1% Asian, 3.3% two or more races, and 7.1% Hispanic/Latino. Among Richmond households with children under age 18, the median household income is $39,540; half the state average. Of those households, 50% received public assistance in the last year, and 40% were at or below the federal poverty level. The city is also host to high levels of behavioral health issues. Data indicate a full 40% of Richmond residents report having poor mental health compared to 29% statewide. The city has also been affected, like many other areas, by the opioid epidemic. The past six years has seen an increase in fentanyl-related overdoses from 50 in 2012 to 813 in 2018. The Be Well-RVA Project will implement a coordinated response to the emerging issues of suicide and related behavioral health and domestic violence situations. The main purpose of the project is to prevent suicide and suicide attempts through a collaborative effort including: Direct clinical/supportive services as a rapid response and ongoing care; community/staff education and training on suicide prevention and other related topics; working across systems to implement suicide prevention efforts; community recovery supports for individuals and their families; and supports specifically for those experiencing domestic violence. The Be Well-RVA Project will serve 100 individuals over the 16 months.

Valley Health (VH) submits this proposal to establish safer suicide care by transforming its Winchester Medical Center Emergency Department (WMC ED) to more effectively identify, treat, and transition people with suicide and domestic violence (DV) risk. This project will fill critical service gaps – access to brief prevention interventions, validated risk assessment, suicide-specific treatment, transitional psychiatric care, safer care transitions, and enhanced DV services – in hopes of turning the tide of suicide risk and loss in our region post COVID-19. The WMC service region (80.8% White; 13% poverty; 17% uninsured) has among the highest suicide rates in Virginia (13.7-19.0), an alarming rate of substance-related deaths, and a documented shortage of mental health professionals. WMC will leverage grant support to better serve the target population (adults 25 and over) by improving suicide awareness and identification, expanding access to evidence-based suicide and DV care, and promoting suicide prevention (SP) throughout its region. Key project initiatives include: 1) increasing access to brief SP and DV interventions; 2) establishing an outpatient treatment service for people with suicide and DV risk; 3) enhancing suicide-specific treatment in acute care clinics; and 4) increasing psychiatric services during care transitions. WMC projects it will provide 20,000 unduplicated suicide/DV risk screens and 900 interventions/treatments over the project period. Grant funds will be used to train staff in EBPs, hire for key clinical positions, underwrite the cost of services for individuals who are under/uninsured and for services that are not reimbursable (e.g., care transition), and promote SP awareness and training to relevant community agencies. SAMHSA funding will allow WMC to meet the following goals and objectives: Goals: 1) Expand access to suicide and DV care through system transformation and workforce training to systematically identify, engage, treat, and transition people with suicide and DV risk using EBPs; 2) Raise awareness and promote a coordinated community response to SP and DV care across the service region; and 3) Use evaluation to improve project performance and impact at consumer, workforce, organizational, and local/regional levels. Objectives (summarized): 1) Improve policies and practices in support of sustainable SP and DV care; 2) Train 80% of staff in SP and DV EBPs; 3) Meet 100% adherence to risk screening, follow-up, and safe housing and 80% adherence delivering the indicated assessment/ intervention; 4) Provide SP and DV care to 900 unduplicated individuals both in-person and via telehealth; 5) Activate state and regional agencies to develop a comprehensive, coordinated response to SP; 6) Develop relationships and referral agreements with community support services leading to a community support resource guide; 7) Provide community agencies with SP training; 8) Continuous project improvement; and 9) Assess project impact on suicide attempts and deaths.

The Vernon J. Harris East End Community Health Center, DBA as Vernon J. Harris Medical & Dental Center and Capital Area Health Network (CAHN), requests a $1,000,000 DRGP - SA grant to fund Project RESTORE (Richmond Empowerment to Support Our Recovery Effort). This innovative initiative will help the most-impacted and vulnerable residents of the City of Richmond recover from Hurricane Florence by implementing a suite of comprehensive services. This will include developing a comprehensive plan of evidence-based mental health and substance abuse treatment services; screening and assessing clients for the presence of mental and substance use disorders; providing evidence-based treatment for substance abuse disorder/opioid use disorder (SUD/OUD) and severe and persistent mental illness (SPMI); providing recovery-support services; developing and implementing a workforce development training plan; and establishing relationships. CAHN will utilize third party and other revenue realized from provision of services to the extent possible and use SAMHSA grant funds only for services to individuals who are not covered by public or commercial health insurance programs, individuals for whom coverage has been formally determined to be unaffordable, or for services that are not sufficiently covered by an individual’s health insurance plan. The proposed project will also be articulated with the coronavirus COVID-19 outbreak response; that means CAHN will prepare recovery and resilience services that may be adapted to COVID-19 as needed, and in particular for residents who are affected by Hurricane Florence and COVID-19. CAHN is a Federally Qualified Health Center (FQHC), and the target area corresponds to CAHN’s service area, which includes the City of Richmond, as well as parts of the surrounding Henrico, Chesterfield and Hanover Counties. Most CAHN patients, however, live in the inner-city East End neighborhood of Richmond, the heart of CAHN’s service area, and it will be the focus of project activities; the East End, an area that has historically experienced environmental racism and has been harmed disproportionately by Hurricane Florence and is at significant risk from COVID-19. The East End is severely economically disadvantaged and largely African American, and many persons have inadequate access to health care. The target population includes individuals and families who have been harmed or seriously affected by Hurricane Florence. About one in five residents are in poverty in the core target zip codes, compared to just one in ten in Henrico County or the Commonwealth. OUD, related to Hurricane Florence trauma, is also prevalent and must be addressed. According to data from the Virginia Department of Public Health, all parts of the project target area have seen a growing trend in OUD deaths. In Chesterfield County, there were 87 deaths in 2018, for a rate of 25.0 per 100,000 residents, while in Henrico County, there were 57 deaths, for a rate of 17.3 per 100,000 residents. In the City of Richmond in 2018, there were 54 overdoses per 10,000 ER visits: compared to 42.1 in Virginia as a whole. CAHN has seven Health Centers, including its main site in the East End.

Abstract Mount Rogers Community Services CCBHC Service Expansion Grant The Mount Rogers Community Services (MRCS) Certified Community Behavioral Health Clinic (CCBHC) Project will target adults with serious mental illness (SMI), substance use disorder (SUD), or co-occurring disorders (COD) and children with serious emotional disturbance (SED). The project seeks to expand capacity to reach the needs of six rural localities in southwest Virginia, including Assertive Community Treatment (ACT), Integrated/Primary Care, Screening, and Monitoring, and an array of Crisis Management Services. Project will also strengthen outreach through intensive care coordination for high risk populations that include our aging, and individuals and families living in poverty, with substance use issues, and/or with medical comorbidity such as Hepatitis and other key health indicators of risk. The MRCSB proposes to serve 1,500 unduplicated individuals first year and 2,000 second year in CCBHC project. Goals and objectives include: Goal 1: Increase and expand community service capacity to address the needs of individuals with chronic and/or high risk conditions. Objective 1.a: Increase outreach/engagement to high risk populations as evidenced by a 2% decrease in ED visits for psychiatric or medical treatment by high risk populations within first year. Objective 1.b: Increase capacity to serve adults with SMI and a pattern of hospital admissions by expanding our capacity to offer ACT in four additional localities within our service area within the first year. Objective 1.c: Expand the array of Crisis Management Services to include Mobile Crisis Response, with psychiatric and primary care support, and increase capacity by expanding our Crisis Care Center to five other localities, as evidenced by a 2% decrease in psychiatric hospital admissions the first year. Goal 2: Meet final CCBHC certification criteria. Objective 2.a: Hire a Medical Director within 120 days of award to ensure the medical component of care and that the integration of behavioral health and primary care are facilitated. Objective 2.b: Expand primary care screening capacity by 3% to include screening for viral Hepatitis and HIV within 120 days of award.

The Project provides a comprehensive continuum of behavioral healthcare through the CCBHC model, ensuring and expanding access to care for adults with serious mental illness (SMI), serious substance use (SUD), and youth with serious emotional disturbance (SED). Expanded capacity and capacity building will specifically target under and uninsured adults in the New River Valley of Virginia, a region with high rates of opioid use and overdose. The Project goals include reducing local rates of opioid overdose deaths and reducing state hospitalization rates for the area. To reduce the overdose death rate, the Project will reduce wait times for SUD treatment and building capacity for medication assisted treatment (MAT). To decrease state hospitalization rates, the Project will ensure capacity in Mental Health Skill Building (MHSB) and Assertive Community Treatment (ACT) to under and uninsured adults, maintain mobile crisis services availability to 24 hours per day, and utilize peer specialist services to improve engagement.

Funds for this project will enable the Substance Abuse Prevention Coalition of Alexandria (SAPCA) to continue focusing on reducing underage drinking in the City of Alexandria, Virginia through a culturally appropriate lens by allowing the coalition to reach middle school youth and focus more on engaging Latino students and the 18-20 population attending the local community college. To meet the needs of the diverse population represented in our public schools and across the City, SAPCA will create a culturally appropriate prevention campaign to effectively prevent underage drinking among these populations. SAPCA will also create an effective campaign that speaks to Latino youth and their parents. Additionally, SAPCA will tailor its messages to a community it has not previously reached: community college students. The feedback solicited from this diverse array of groups will inform the creation of campaigns aimed at preventing underage drinking among community college students and the Latino community. Once the middle school campaign is created, campaign materials will be translated into Spanish, Amharic and Arabic, the three primary languages spoken by ACPS students other than English, to most effectively reach these target populations. All of these materials will be reviewed by the Alexandria Department of Community and Human Services’ Culturally Competent and Linguistic Committee. The goals of this project are to reduce the number of Alexandria City Public Schools middle school students reporting regular alcohol use by 2024 through the delivery of evidence-informed prevention programming; the number of Alexandria City Public Schools Latino students reporting regular alcohol use by 2024 through the design and implementation of culturally appropriate resources that promote the importance of abstaining from underage alcohol use; and the number of Northern Virginia Community College students, below the age of 21, reporting regular alcohol use by 2024 through the design and implementation of a community-led campaign focused on preventing underage drinking among Alexandria youth and young adults. SAPCA will accomplish these goals by increasing the number of middle school students participating in evidence-based seminars about the facts and consequences of alcohol use and the number of Latino and community college students reporting drinking alcohol before age 21 is harmful to their health and against their values. Through this project, SAPCA plans to serve 2,450 middle school students, 1,000 Hispanic high school students, and 2,000 community college students.

The Central Virginia Addiction and Recovery (CVARR) proposes to utilize the Drug Free Communities (DFC) funding to work with leaders in the Lynchburg Community to identify and address local youth substance use problems and create sustainable community-level change in reducing youth substance use through the use of the Seven Strategies for Community Level Change. This project will impact youth under age 18 residing in the City of Lynchburg.

In 2009, the substance abuse coalition One Care of Southwest Virginia began a collaborative, region-wide approach to address addiction concerns affecting the 22 rural cities and counties of rural Southwest Virginia. One Care has coalesced around a goal of achieving significant reductions in substance abuse and related social, economic, and health factors in their service area through the formation of a “Southwest Virginia Prevention Network”, which will enhance existing prevention programming and expand resources related to addiction and recovery. To fulfill this goal, an extensive strategic planning process was conducted and led to the development of the following objectives: Objective 1: Increase evidence-based prevention efforts in the One Care service area to prevent, delay, and identify the risk factors of SUD/OUD by August 2025 Objective 2: Increase access to the whole continuum of care, from early intervention through sustained recovery, in the One Care service area by August 2025 Objective 3: Increased access to non-treatment resources in the One Care service area to support long-term resilience by August 2025 Objective 4: Reduce stigma and increase community awareness surrounding SUD/OUD in the One Care service area by August 2025 If funded, these objectives will be accomplished through a number of specific strategies and interventions, to include: development of a drop-in day treatment Center that also provides housing and job training assistance, provision of continuing education opportunities for healthcare professionals, community outreach for education and training on responding to an opioid overdose emergency, expansion of two existing evidence-based youth prevention programs, first responder substance abuse continuing education, completion of a community needs assessment and gap analysis, development of a Substance Exposed Youth Toolkit, an analytical assessment of community stigma, and implementation of a stigma education campaign. The proposed activities will greatly expand prevention and behavioral health services in the target community and provide additional capacity for recovery treatment, with an estimated reach of 102,341 individuals per year, over a period of 5 years, for a total reach of 511,705 rural residents. The proposed programs will serve a diverse array of residents, across a spectrum of ages, levels of education, and exposure to opioid and stimulant substances, from the earliest prevention to supporting individuals currently living in recovery.