WA Discretionary Funding Fiscal Year 2020

Yakama Nation Behavior Health Service Emergency COVID-19 program provide crisis intervention services, mental and substance use disorder treatment, and other related recovery supports for children and adults impacted by the COVID-19 pandemic. The purpose of this program is specifically to address the needs of individuals with serious mental illness, individuals with mental health disorders, and co-occurring serious mental illness and substance use disorders. We purpose to1) develop and implement a comprehensive plan of evidence-based mental health treatment services for individuals impacted by the COVID-19 pandemic. Ensure that service provision may occur in a telehealth context; 2) Screen and assess clients for the presence of mental health and co-occurring substance use disorders 3) Provide evidence-based and population appropriate treatment services via in-person and in a telemental health format; 4: Provide recovery support services. We expect to serve 300 clients over the grant period

Washington State Health Care Authority (HCA), Division of Behavioral Health and Recovery (DBHR), Emergency COVID-19 grant application is designed to increase treatment access, particularly to low-income and underinsured Washington State residents, and to swiftly provide services to healthcare workers who may have experienced trauma, anxiety, or exacerbated pre-existing mental health issues working on the front lines to support the initial COVID-19 pandemic efforts in the highest impacted county within Washington State. Similar services may also be provided in other hot zones as they develop; simultaneously provide increased Recovery Support Systems within the newest community health care recovery facilities located in King County that is focused on individuals that have been isolated due to residing in the highest COVID-19 impacted county in Washington State. Grant activities will include: The BH-ASO's Grants Program- Each of Washington State's 7 regional Behavioral Health Administrative Service Organizations (BH-ASO's) will receive funding to expand access to mental and substance use disorder (SUD) treatment for low-income and underinsured individuals that have lost access to, or were previously unable to receive treatment services. The Healthcare Worker Services Program- The Healthcare Worker Services Program will provide mental health (MH) and SUD outreach services to individuals working on the front lines in the COVID-19 pandemic efforts in the highest impacted county within Washington State. Similar services may also be provided in other hot zones as the develop. The Recovery Supports System Program- Recovery support services will be provided to individuals residing in the highest COVID-19 impacted county in Washington State who may need emotional support and who are temporarily housed in Isolation & Quarantine Facilities, at-home, or within the newest community health care recovery facilities located in King County. They will have access to telehealth or telephonic services delivered by a network of peers. The overall objective of this project is to provide increased access to MH and SUD treatment services for low-income and underinsured Washington State residents and healthcare workers that have supported the COVID-19 pandemic efforts in the highest impacted county who may have experienced post-traumatic stress disorder, trauma, and anxiety, and provide increased Recovery Support Systems within the newest community healthcare recovery facilities in King County for individuals experiencing SMI/MI that have been isolated due to residing in the highest COVID-19 zone. Washington is well positioned to swiftly implement these programs and disseminate grant funding to the identified entities within the required 4 months after receiving funding. These programs will be used to further Washington's effort to expand, integrate, and sustain culturally relevant and developmentally appropriate services and supports statewide.

The WA COVID 19 ERSP will implement best practice care transitions for individuals with suicide risk from emergency departments and inpatient psychiatric facilities to outpatient care. Community and service providers and systems serving adults at risk, including domestic violence providers, will receive suicide training in assessment of risk and protective factors, best practice interventions and treatment (including lethal means), and follow up care. The Project's target population is adults 25 years of age or older, high risk individuals in health and behavioral health care settings, victims of domestic violence and their dependents, and who have also attempted suicide or experienced a suicidal crisis after discharge from an emergency department or inpatient psychiatric facility. The WA COVID 19 ERSP is a statewide collaboration between the Washington State Health Care Authority, Harborview Medical Center's Behavioral Health Institute (BHI), New Beginnings' domestic violence program, and emergency departments and inpatient psychiatric facilities located in the greater Seattle area and NE Washington to implement evidence based digital strategies for caring for individuals with a history of suicide risk during the critical transition from inpatient to outpatient care. In the month after patients leave inpatient psychiatric care, their suicide death rate is 300 times higher in the first week and 200 times higher in the first month than the general population's (Chunt et al., 2019). Hospital emergency departments and inpatient psychiatric facilities are the front lines. We will use this grant opportunity to advance findings from the Washington State Bree Collaborative Suicide Care Report and Recommendations, which includes risk assessment and screening, clinical protocols for timely and adequate care, lethal means reduction, collaborative safety planning interventions, and evidence based treatment and follow up care. Through consultation and training with our states leading experts in suicide prevention we will implement Caring Contacts (CC), an intervention that involves sending patients who are suicidal brief, non demanding expressions of care and concern following discharge. Our goals and objectives include: 1) serve 202 patients in year 1 and 300 by the end of the Project), 2) train 4,640 professionals in year 1 and 6,500 by the end of the Project, 3) reduce suicide related deaths through use of evidenced based practices, 4) serve patients in a culturally competent, patient centered care manner, and 5) seek sustainable program financing.

Seattle Indian Health Board's project, COVID-19 Behavioral Health Response, will focus on reaching American Indians and Alaska Natives, including those experiencing homelessness, in Seattle/King County, Washington State. Services will include culturally-attuned evidence-based practices embedded within our agency's Indigenous Knowledge-Informed Systems of Care, which combines skills, services, and cultures to holistically integrate primary care, behavioral health care, dental care, Traditional Indian Medicine, housing, nutrition, and other social services. Seventy percent of participants will have SUD, SMI, or co-occurring SMI/SUD. To remove barriers to safe, COVID-era care among members of our target population who are unhoused, our project will use social distancing therapy rooms and safe therapy rooms with our clinic location. Social distancing therapy rooms allows people to see providers face-to-face from a safer distance, and safe therapy rooms connect people to telehealth through a phone or tablet to reach a physician in a separate location within our clinic or from a confidential space in their home. We plan to develop other safe therapy rooms at our satellite clinics and with community partners who serve our clients, such as King County Work Release. We also plan to identify HIPAA-compliant technology to facilitate access to group therapy. People served through COVID-19 Behavioral Health Response will access culturally attuned MH and SUD counseling, a new Level 2 Intensive Outpatient Program, Medication Assisted Treatment, Traditional Indian Medicine, and Recovery Support Services. Case managers will help our clients access the services that will support them in their SUD recovery goals and to manage SMI. This project will ensure that urban AI/ANs in Seattle/King County may access the behavioral health services necessary to their wellbeing during this crucial time. It will also reach our catchment area's healthcare professionals, who have been on the frontlines of COVID-19 response since patient zero was identified in the greater Seattle are in January 2020.

Due to the very limited Wi-Fi coverage on the Spokane Reservation, the Spokane Tribe of Indians Behavioral Health program plans to create a mesh network to provide Wi-Fi coverage for its patients. In order to ensure that their clientele can still receive proper health care, HHS will provide Wi-Fi coverage throughout the parking lot outside of its facility in Wellpinit, WA. The parking lot will serve as a virtual facility throughout the COVID-19 emergency. The Spokane Reservation is a large, rural reservation located in northeastern Washington State along the Spokane River. There are just under 2,200 individuals that reside on the 237 square mile reservation. Around 80% of the total on-Reservation population is American Indian. Approximately two thirds of the population do not have access to adequate Wi-Fi or cell phone coverage. The Spokane Tribe created the HHS Behavioral Health department in order to address the Tribe's overwhelming substance abuse and mental health disorders. In order to ensure that the Spokane Tribe of Indians Behavioral Health Program continues to provide adequate services to its clientele throughout the COVID-19's emergency, the mesh network in the parking lot will allow for clientele to continue meeting with caseworkers and mental health counselors. HHS's behavioral electronic health record system, InSync, has a built-in, fully-integrated, Zoom-based, HIPAA-compliant, telehealth solution that allows for both individual and group therapy sessions. Additionally, laptops, tablets, and cellphones will be purchased to allow for telehealth solutions that are necessary in order to continue addressing the Spokane Tribe's substance abuse and mental health disorders, as well as complying with the social distancing regulations in place during the COVID-19 pandemic. Data will be captured on a day-to-day basis through the intake process, as patients reach six months of therapy, and upon completion of therapy. The Washington State assessment, the PHQ9, the GAD7, Beck's Depression Inventory, and the ASAM Assessment tool will be used to capture data after six months of therapy and at discharge by the patient's assigned therapist. It will be compiled and analyzed on a quarterly basis by HHS's Clinical Applications Coordinator. It will be reviewed periodically by a case review team that will include all six licensed therapists, the Project Director/Behavioral Health Director and the Director of Health and Human Services to identify opportunities for improvement. Areas of improvement will be determined by key performance metrics established jointly by the clinical review team, the Behavioral Health Director and the Director of Health and Human Services. For example, if one key performance indicator is time from intake to first counseling session, the Project Director may be asked to conduct a process map to find opportunities for improvement.

The Washington InterProfessional Education for Substance Use Disorders (WIPEout-SUDs) project will facilitate interprofessional training in the screening, assessment, and treatment of substance use disorders (SUDs) for health professional students at the University of Washington (UW). To accomplish this goal, we will leverage our institution's robust infrastructure for interprofessional education as well as the depth of faculty with experience in the clinical management of patients with SUDs. Specific project goals include 1) developing learners' confidence with screening, assessment, and treatment of SUDs; 2) cultivating learners' use of interdisciplinary methods to screening, assessment, and treatment of SUDs; 3) improve learners' recognition of the unique contributions other professionals provide in the care continuum for patients with SUDs; 4) enhance learners' use of non-stigmatizing approaches when working with patients with SUDs; and 5) to familiarize learners' with harm reduction approaches as a means of engaging patients with SUDs who are not seeking treatment. By adapting existing interprofessional SUD curricula to the unique needs of our learners, we anticipate being able to rapidly develop and implement a targeted curriculum. Project objectives will include 1) ensuring >75% of learners express confidence in their ability to use an evidence-based strategy to screen, assess, or treat SUDs; 2) having learner participation from all six UW health sciences schools (medicine, nursing, pharmacy, social work, dentistry, and public health); 3) facilitating learners' reflection on interprofessional roles and unique skills; 4) supporting >75% of learners to recognize non-stigmatizing approaches at the conclusion of the training; and 5) securing >75% of learners recognizing common harm reduction approaches used in the care of patients with SUDs. This project will support our interprofessional team including the project director, other key personnel, and administrative staff. The project team includes staff from multiple UW health sciences school as well as the UW Center for Health Sciences Interprofessional Education, Research and Practice. To identify opportunities for improving the curriculum and monitoring our objectives, we will complete regular assessments of trainees and meet at consistent intervals to review project data. As part of our project, we will also work with local experts to identify opportunities to include questions related to SUDs on licensing and certification exams for the relevant health professions.

Volunteers of American Western Washington (VOAWW) proposes a COVID-19 Emergency Response for Suicide Prevention (ERSP) project to expand follow-up, care coordination, and aftercare support services for an adult population who are aged 25 and older experiencing emotional issues identified through the 24/7 Care Crisis Response Services (CCRS) and links with the National Suicide Prevention Lifeline (NSPL). Within the population are adults at risk of domestic violence (DV), in crisis and present in emergency departments (ED), and whose mental health (MH) has been adversely affected by the COVID-19 pandemic. The project will focus on service delivery for an eight counties Snohomish, Skagit, Whatcom, Island, San Juan, Clallam, Jefferson, and Kitsap in the western region of Washington state. Two hospitals in the catchment area have received an increase of ED visits related to suicidal ideation, depression, domestic violence, overdose, and alcoholism during the pandemic. Criminal justice reports indicate a reduction of domestic violence call volume and the calls they do receive are from concerned neighbors and family. DV advocates suggest sheltering-in-place has minimize the ability of victims to call for help and statistics do not reflect what is transpiring in homes. VOAWW’s COVID-19 ERSP project goal is to reduce the number of repeat visits to ED from individuals with suicidality and risks of domestic violence through follow-up, care coordination, and aftercare. Crisis Line Specialists will forward consent from crisis line callers to a team of Behavioral Health Navigators (BHNs) who will contact the client by phone or telehealth platforms. BHNs will (1) conduct a client needs assessment, (2) develop a client service plan (CSP) with the client’s input, documenting a safety plan and specific support services, (3) coordinate linkage between the client and service provider, (4) provide an aftercare plan designed with graduated follow-up to maintain client contact, ensure ongoing safety, reconnect them with resources if circumstances change, and preserve the client-BHN relationship for an authentic six-month follow-up interview. Client contact during aftercare will include the use of telehealth, text, chat, and visual communication. Five BHNs will serve 672 clients over the grant period; two BHNs will provide specialized case management to DV clients. Specifically, BHNs will offer hotel vouchers to provide safety for DV victims who need safe, emergency shelter until the BHN can link the client with DV services. ED contacts will request follow-up through the crisis line for individuals who present in the ED with suicidality, substance abuse, or other emotional distress prior to discharge and following a medical clearance and consent. VOAWW’s certified Living Works safeTalk trainers will deliver no cost suicide prevention training along with trauma informed care training for 150 clinical service providers to increase their confidence and competency when working with at-risk adults. To contribute to the prevention of suicide and suicide attempts, VOAWW respectfully requests $800,000 to implement the proposed COVID-19 ERSP project.

Rethinking Education on Substance Use with Inter-Professional Education and Collaborative Teams using Medication-Assisted Treatment (RESPECT-MAT) is a 2-year project to enhance an existing substance use disorder curriculum by expanding content to include medications for addiction treatment (MAT). An interprofessional education (IPE) course will focus on future prescribing practitioners (medical and nurse practitioner students) who are preparing to enter the experiential phase of their education in Washington State and the team that will collaborate with them. Together, they will learn to provide care for clients with substance use disorders (SUD) along with pharmacy, social work, and addiction studies students. The project aims to increase expertise in treating SUDs, specifically focusing on content related to medications to treat opioid use disorder (e.g. methadone, buprenorphine) and alcohol use disorder (e.g. naltrexone, disulfiram). The existing curriculum includes use of an interprofessional team-based facilitated simulation using video vignettes and/or standardized patients. The simulation's patient case focuses on screening and assessment of an adult with chronic pain and potential opioid use disorder while demonstrating a team approach to integrating behavioral health into primary care practices. The infrastructure for delivery of the existing training program is established and will be completed by an estimated 1700 student learners over the next 5 years. For the proposed project, we will build on the existing IPE training by expanding the patient case to follow the same patient through initiation and management of medications to assist SUD treatment. The goal in year 1 will be to modify the patient case to include evidence-based treatment principles that apply to all SUDs and develop new content specifically targeting medications for opioid and alcohol use disorders. Program evaluation and student learning assessment data will be collected from students and educators in order to make improvements. In year 2, the goal will be to modify the training based on evaluation data and provide the revised training to approximately 320 Washington State health science students. We will continuously evaluate and enhance the training for interprofessional teams using student and faculty feedback. The refined training will be added to our existing IPE website that provides publicly-available educational materials including facilitators' guide and student learning materials for widespread dissemination. Sustainability planning will begin at the project's onset to embed this training into annual IPE training for health professions students. In addition, the project team will pursue existing relationships with local, state, and national organizations to facilitate processes for inclusion of SUD examination questions on exams for health professions.

Cascade Community Healthcare proposes a two-year project to become a Certified Community Behavioral Health Clinic (CCBHC) to enhance the standard of behavioral health services available to Lewis, Thurston, and Pacific county residents in Washington state of all ages who have or are at risk for a behavioral health condition. As a CCBHC, Cascade will enhance care coordination to ensure that clients have access to a broad range of services, including primary care and vaccinations. Furthermore, the project will focus on expanding capacity for outpatient SUD treatment, social support, community-based treatment modalities, and training in evidence-based practices (EBPs). The population of focus includes children and adults experiencing serious emotional disturbance (SED), serious mental illness (SMI), substance-use disorders (SUD), and co-occurring disorders (COD). Targeted subpopulations for this project include Low-English Proficiency (LEP) individuals and members of the Latinx community in addition to veterans and their families. Our goals and measurable objectives for the two-year project include: Goal 1. Raise the standard of care by achieving 100% of CCBHC standards for staffing, access, care coordination, scope of services, quality and other reporting, organizational authority, governance and accreditation by establishing policies and procedures consistent with those standards and developing strategic plans for sustainability in partnership with state authorities and other stakeholders and hiring new staff to oversee and evaluate the project; Goal 2. Increase staff capacity to treat clients according to their needs through person and family-centered treatment planning by enhancing training and credentialing in a number of EBPs, including Motivational Interviewing, trauma-informed care, SBIRT, Matrix, DBT, and EMDR; Goal 3. Increase access to comprehensive health care along a continuum of prevention, early intervention, and treatment by implementing sliding-scale fees, increasing outreach efforts, and providing access to new, community-based programs; finally, Goal 4. Expand care coordination with the addition of a care coordination team to monitor and assist high-risk clients in accessing services within and beyond the CCBHC. The targeted number of people to be served is 500 new clients each year in addition to the 5,000 that we already serve annually, for a total of 1,000 new clients over the course of two years.

Comprehensive Healthcare (CHC), an organization with 48 years of experience, will increase access to and quality of services to individuals with serious mental illness, substance use disorders, including opiates, children and adolescents with serious emotional disturbance, and individuals with co-occurring mental health and substance use disorders throughout Yakima County. CHC will serve an additional 710 unique individuals over the two-year project. Yakima County is home to a population with significant behavioral healthcare needs, social determinants of health challenges, and ranks 32nd out of 39 counties for overall health. Yakima has a diverse group of residents including 10,000 migrant seasonal farmworkers and is home to the Confederated Tribes and Bands of the Yakama Nation. Comprehensive Healthcare has an extensive history of providing high quality, evidence-based care to individuals throughout the county and seeks to expand and improve these services to populations that have previously had limited access to care. Examples of program expansion includes increasing access to Medication Assisted Treatment (MAT) for Methadone and adding Buprenorphine and Naltrexone MAT services. In response to the significant methamphetamine abuse prevalent in Yakima County, peer support specialists will be hired to assist individuals to successfully transition from inpatient treatment back into the community. Quality of care will be improved through enhanced specialty training in provision of culturally appropriate services to subpopulations including veterans, the LGBTQ community, and adolescents with co-occurring mental health and substance use disorders. To promote a community approach to improved mental health, and reduce stigma, Comprehensive will provide four Mental Health First Aid trainings, free of charge, to community members, as well as train five (5) staff to provide Critical Incident Stress Debriefings to community organizations and first responders following traumatic events. In a specific effort to provide more culturally appropriate behavioral healthcare to American Indian/Alaska Natives (AI/AN) CHC will hire a liaison to provide direction on evidence-based treatment options and strengthen relationships. CHC will improve capacity to serve AI/AN and will increase services provided by 20% within two years. Additional counselors and peer support specialists will be hired to provide services in the schools, including those located on the Yakama Nation, with the goal of increasing school-based services by 50%. Goals will be monitored through external professionals from Pacific Northwest University to ensure that all the objectives identified in this project are successfully accomplished. CHC will also report measures on 21-quality indicators to ensure that whole person healthcare is being delivered consistently to all individuals, regardless of residence or ability to pay.