WI Discretionary Funding Fiscal Year 2020

The Gerald L. Ignace Indian Health Center (GLIIHC), the only Urban Indian Health Center in Wisconsin, will implement the Milwaukee Emergency COVID-19 Response Program to meet the needs of new and existing patients of all ages with serious mental illness, less serious mental illness and substance use disorders, serving at least 1,000 patients and an estimated 30 staff during the 16-month life of the program. The only Urban Indian Health Center in Wisconsin, GLIIHC is located just south of downtown Milwaukee, Wisconsin, which has a population of 595,351 (2017, est.). GLIIHC is located in the urban community where most American Indian/Alaska Natives (AI/AN)in the area reside. The community surrounding GLIIHC is a mixture of lower- and middle-income families. Measurable objectives will focus on tracking the number of existing and new patients who receive telehealth individual or group therapy, the number of referrals for enabling/supportive services, and additional treatment-related goals at the individual levels. Goals include: Goal 1) All existing GLIIHC patients with SMI, SUD, or LSMI diagnoses will have the opportunity to be connected to a therapist via telehealth, with continued monitoring of prescription access and utilization where needed, with 24-hour crisis response also available. Goal 2) All existing patients with SUD will have assistance with medical, individual and group therapy services to support their ongoing recovery, including the opportunity to participate in virtual Talking Circles to ensure access to the social supports necessary to remain sober and prevent relapse. Goal 3) All new behavioral health patients with diagnoses of SMI, SUD or LSMI will have the opportunity to be served via a telehealth platform during the COVID-19 pandemic. Goal 4) All GLIIHC providers will have the opportunity to access mental health care in support of their needs during the added stress of the pandemic. Goal 5) All SMI, SUD or LSMI patients and GLIIHC staff will have the opportunity to connect to additional services that can help support them with daily needs like housing, food, family violence prevention or other needs that may arise.

The St. Croix Chippewa Indians of Wisconsin Emergency COVID-19 Mental Health and Substance Abuse Project will expand access to mental health and substance abuse treatment to individuals and families living in the reservation communities of the St. Croix Chippewa Indians of Wisconsin Tribe. Mental health and substance abuse on the reservation is expected to increase due to the impact of COVID-19. The St. Croix Tribal Emergency COVID-19 Project will provide access, support and connection to resources for tribal community members, children, families, and healthcare providers. This program will provide direct mental healthcare assistance, treatment and referral to treatment for individuals suffering from addiction and mental illness due to or made worse by the COVID-19 pandemic. This program will connect clients to care providers, community agencies and support resources for culturally appropriate, evidence based, professional mental health care and sobriety support. Services will be provided via telehealth, or virtually where possible. The St. Croix Tribal Emergency COVID-19 Project will use grant funds to serve an estimated 40-60 unduplicated individuals. This project will reduce incidence of mental health crisis and addiction due to COVID-19 in the tribal community by 80% in 16 months. The St. Croix Tribal Emergency COVID-19 Project will expand access to substance abuse disorder treatment for and estimated 20 individuals in 16 months.

DHS plans to contract with counties to provide a range of expanded treatment services from intensive to community based supports to assist those with SMI, SED, SUD, health care professionals and others struggling with less than SMI impacted by COVID-19.

Circles of Care Milwaukee will have four overarching goals. Goal 1: Create a Community Advisory Board that guides Circles of Care Milwaukee through the planning, implementation, and evaluation phases of project activities, ensuring a culturally appropriate program and high community accountability. Objective 1: Identify local individuals and organizations with which GLIIHC will partner on an ongoing basis to provide oversight and culturally relevant input into the Circles of Care Program. Objective 1: Identify local individuals and organizations with which GLIIHC will partner on an ongoing basis to provide oversight and culturally relevant input into the Circles of Care Program. Goal 2: Identify needs, gaps in local care systems for AI/AN children, youth and families. Address these needs through increased cross-training, interagency collaboration and referrals, and family-centered educational events. Objective 1: Engage in ongoing meetings with individuals and organizations to gauge the level of readiness to address existing and anticipated mental health and substance abuse prevention needs in AI/AN children, youth and families. Goal 3: Using lessons learned from needs/gaps analysis and community input, create a model that addresses a broad range of mental health and substance abuse/misuse prevention and treatment for AI/AN children, youth and families. Objective 1: Increase screening, referral, and treatment referrals and build capacity to accommodate increased numbers of patients across the life span. Goal 4: Pilot the care model at the Indian Community School during the 2021-2022 school year, analyze and improve the model in the interim summer months, and re-implement the program during the 2022-2023 school year. Objective 1: Pilot a care model focused on the primary and secondary prevention of mental health and substance abuse/misuse in the AI/AN community, with a special focus on youth at the Indian Community School. Over three years, 5,340 people will be served.

The Gerald L. Ignace Indian Health Center in Milwaukee, Wisconsin will work to prevent the high rates of suicides in local Native American and Alaska Native (AI/AN) communities through the implementation of Native Connections Milwaukee. About 1/3 of the state’s AI/AN population lives in the Milwaukee area, or about 18,239 people. The local AI/AN population is younger than the population at large: about 36% of the local population is under age 25. They experience health disparities related to mental health and substance misuse, which can contribute to suicide risk. Native Connections Milwaukee will use a number of evidence-based and promising practices supported with highly effective screening and clinical intervention tools to reach more deeply and broadly into the AI/AN community that is under age 25. Through prevention education, screenings, outreach at local colleges/universities and through local AI/AN agencies, the program will reach 1,780 people annually, or 8,900 people over five years. Native Connections Milwaukee five goals are: Goal 1) Increase the capacity of local agencies to identify risk factors and implement prevention strategies for suicides in AI/AN communities. Obj. 1) Between June and December 2020, GLIIHC will provide best practices trainings to staff from at least four (4) colleges and universities and three (3) AI/AN specific organizations to increase their knowledge and understanding of suicide prevention. Goal 2) Formalize relationships with organizations that work with AI/AN communities to better support and serve AI/AN youth at risk of suicide. Obj. 1) Before the end of 2020, GLIIHC will finalize memoranda of understanding (MOU) with at least three (3) local universities and colleges and three (3) AI/AN specific organizations to formally set up referral protocols/processes. Goal 3) Implement evidence-base practices to address suicide prevention in AI/AN communities. Obj. 1) Between October and December 2020, train all GLIIHC clinical staff and key partner representatives in the Zero Suicide in Indian Country implementation model, and continue implementing existing evidence-based practices demonstrated to support and promote mental health in a culturally competent way. Goal 4) Increase opportunities for AI/AN families and young adults to participate in protective, culturally-specific and culturally relevant prevention activities. Obj. 1) Offer at least one on-site and one off-site opportunity each month for AI/AN youth, families and young adults to participate in protective, culturally-specific and culturally relevant prevention activities. Goal 5) Create a broader system for tracking AI/AN youth at risk of self-harm, AODA misuse, suicidal ideation, and/or attempts to complete suicide. Objective 1) Implement universal screening and tracking at GLIIHC starting in 2021. Objective 2) Work with local inpatient and outpatient providers and hospital systems to create a tracking process that will enable better tracking of AI/AN youth at risk, youth who have made attempts at suicide.

The Milwaukee Center for Independence (MCFI) proposed Whole Health CCBHC (WH-CCBHC) project will significantly expand capacity to serve residents of Milwaukee County with serious mental illness (SMI) or substance use disorders (SUD), including opioid use disorders; children and adolescents with serious emotional disturbance (SED); and individuals with co-occurring mental and substance disorders (COD). The MCFI clinic will qualify for certification as a CCBHC. Grant funds will help MCFI address the critical shortfall in capacity of Milwaukee’s behavioral health (BH) care system to meet the needs of its most vulnerable citizens, particularly those in crisis. The problem is evidenced by the fact that more than two-thirds of those admitted to County and private hospital emergency rooms with a primary BH diagnosis in 2017, were unable to access timely outpatient psychiatric rehabilitation services post-discharge, if at all, because of both limited funding and provider shortage (long wait times). MCFI will use grant funds to address this situation by expanding its existing service array to include outpatient SUD/COD and SED services, while enhancing its existing SMI and emergency crisis services with additional EBPs. Care coordination will be provided to every participant. The WH-CCBHC project will serve 225 individuals in Year 1 and 375 in year two. Services will be provided within MCFIs integrated primary care/ behavioral health clinic. It will subcontract with the National Council for Behavioral Health for technical assistance to meet all CCBHC criteria by the 4th month subsequent to grant award. MCFI will also contract with the Center for Evidence-Based Practices (CEBP) at Case Western Reserve University to provide training in Integrated Dual Disorder Treatment (IDDT) and related EBPs to project staff. Serving as DCOs will be 1) Milwaukee County Behavioral Health Division, which will provide mobile crisis teams, the Milwaukee VA Medical Center, which will accept referrals of veterans for treatment, and the National Association for the Mentally Ill, which will provide evidence-based family support groups. Project Goals are: 1) Achieve full compliance with CCBHC Standards; 2) Expand and enhance access to behavioral health services; 3) Expand delivery of its behavioral health services to serve more people; 4) Fill in identified gaps in professional staff capacity to serve the needs of the target populations; 5) Expand programming to serve new treatment populations; 6) Provide care coordination for every individual/family assessed to benefit from this service. 7) Improve participants' mental; 8) Decrease participants’ substance use, and 9) Foster participant satisfaction with their care.

The Milwaukee County Behavioral Health Division (BHD) submits this application for $3,996,143 (over four years) to enhance crisis treatment services by implementing a new Assisted Outpatient Treatment (AOT) program using the Assertive Community Treatment (ACT) model for individuals with severe mental illness (SMI), high utilization rates of acute adult inpatient services (AIS), and under involuntary commitment for treatment. Services will be delivered in the geographic catchment area of Milwaukee County with a population of 952,085 and encompassing areas of extreme poverty and high racial segregation. The projected number of unique consumers to be served through the AOT program are 30 consumers per year; 120 consumers throughout the lifetime of the project. The focus population is predominantly African American with diagnoses of Schizophrenia and Other Psychotic Disorders, unemployed, undereducated, on Medicare or Medicaid, and requiring four times longer average lengths of stay than their national counterparts. Strategies and interventions include: the implementation of an AOT program that provides access to, and continuity of care with, a full fidelity ACT team for civilly committed SMI consumers; full fidelity ACT Team staffing and services; training for ACT team members, AOT Implementation Team, ACT Stakeholder Advisory Board, and consumer advocates in AOT and ACT evidence-based practices (EBP) such as Enhanced Illness Management and Recovery (psychosocial rehabilitation intervention that combines Illness Management and Recovery and Integrated Dual Disorder Treatment, Social/Natural Supports), Family Psychoeducation, and Cognitive Behavioral Therapy; rigorous AOT program evaluation and ACT model fidelity; and sustainable funding streams and the role of Managed Care, Medicaid, and other insurance programs to ensure AOT program continuation when federal funding ends. Project goals: enhance crisis treatment services for individuals unable to adhere to treatment and who cycle repeatedly from tenuous stability to psychiatric crisis; provide more effective and comprehensive EBP services for individuals with complex clinical and social needs; and sustain the AOT program through ongoing EBP training for the ACT Team, third party revenue, and mentorship. Measurable objectives are to: create the foundation for AOT Program implementation using a full fidelity ACT Team Model; establish and operate a formal AOT program to motivate and engage individuals with SMI who struggle with voluntary treatment adherence; train in core ACT services and educate stakeholders and community on the AOT process the ACT model; admit 4 consumers with an AOT Court Order to the full fidelity ACT Team per month; monitor and assess ACT fidelity; provide ongoing training and consultation in intensive skills (secondary ACT services) and complementary EBPs; and build access to core ACT and secondary services for individuals with SMI in Milwaukee County. Anticipated outcomes include fewer psychiatric hospitalizations, increase in medication adherence, cost savings from less readmissions, decrease in harmful behaviors, reduced likelihood to perpetrate violence, and fewer arrests and incarceration among AOT participants.

The Dunn County Partnership for Youth (DCPFY) is a county-wide coalition that a prevention program of Arbor Place, Inc. in Menomonie, Wisconsin. Concern about increasing rates of e-cigs/vaping and Rx drug abuse by teens is mobilizing the coalition to join schools, law enforcement, medical providers, youth serving organizations, and other stakeholder groups to develop and implement programming to decrease the growing use and related problems. DCPFY's mission statement is "Collaborate with Dunn County resources developing dynamic programming to serve youth and families. Efforts focus on ATOD (alcohol, tobacco, and other drug) related issues, parenting, mental health, youth engagement, and emerging concerns." The goals of the coalition are to establish and strengthen collaboration between key stakeholders in communities across that county that can help to prevent youth substance use. The coalition will achieve its goals by implementing several strategies to impact identified needs: In the most recent student survey, tobacco use by teens Dunn County is higher than the state rate and over triple the national rate of underage tobacco use. And, these figures don’t even include e-cigs as questions related to vaping nicotine products were just added to the states student surveys. One reason for this high use is that, in underage teens were able to purchase cigarettes, chewing tobacco and e-juice nearly 21.9% of the time in the county, which is much higher than the state rate of 5.8% and also higher than the surrounding counties. Our strategies to reduce teen tobacco use involve working with court elected officials and schools to reduce access to tobacco and/or increase negative consequences for using tobacco and nicotine products (i.e. required attendance at tobacco education class in lieu of school suspension, increased fine for underage use, etc.) Student use of prescription drugs in Dunn County is also noticeably higher than the national average (3.5% vs. 2%). Our strategies to reduce teen Rx use is to increase the awareness of community members, especially adults, about the importance of monitoring and securing prescriptions to prevent teen access to medications. We will also increase the number of Rx disposal events, such as the DEA Drug Take Back days, in Dunn County Communities and provide educational sessions on Rx misuse/abuse in High School Health classes. Underage alcohol and teen marijuana use will also be addressed by working with key stakeholders in Dunn County Communities to increase awareness of risks, reduce access to the substances, and educate adults in the community of local resources. We anticipate that our efforts during the first year of funding will engage 200-300 adults, and impact 500-600 youth. In time, impact of the programming, classes and events we offer should increase as our efforts expand across the county, at least tripling the number of parents/adults who learn how to talk with children the dangers of these substance and be provided with resources to seek help if needed.

Burnett County Prevention Coalition

“Drink Wisconsinbly™” The Alliance for Substance Abuse Prevention (Alliance) is a community-driven coalition focused on preventing youth substance use to improve the lives of children, youth and adults in the Eau Claire community. The Alliance has made a positive impact on youth substance abuse prevention in their initial years of work and this grant will support the needed epidemiology capacity to use data effectively and to focus on specific populations at risk. In addition, this grant will support the needed infrastructure to strengthen effective partnerships, utilize evidence-based prevention strategies and new best and promising practices, and focus on eliminating behavioral health disparities. The goals of this project are to 1) sustain and strengthen current community capacity and infrastructure through the Alliance to advance substance abuse prevention in Eau Claire County and 2) enhance and expand current Alliance initiatives to address underage drinking and reduce marijuana and e-cigarette use among youth aged 9 to 20. This includes working on objectives to 1.1) sustain and strengthen Alliance infrastructure and partnerships by maintaining representation and active involvement of all 12 sectors in the Alliance, 1.2) enhance and build capacity of the Alliance network to address substance abuse prevention by engaging at least 3 new community partners and collaborating with at least 3 new organizations working on substance use or mental health by the end of the second year of the grant, 2.1) use the SPF to complete a needs assessment by the end of year 1 to identify, select, and implement comprehensive, data-driven substance abuse prevention strategies to target youth in the county at highest risk for alcohol and substance misuse and address behavioral health disparities in the subsequent years of the grant, 2.2) decrease the percentage of 30-day use of alcohol, marijuana, and tobacco by the end of year five by changing social norms and access of substances in the community, and 2.3) increase the percentage of middle and high school youth reporting their peers feel it’s wrong for them to drink, use marijuana, or use tobacco by 1% each year. The population of focus for this grant will be middle and high school youth and families in the all Eau Claire public and private school districts. For the first year of the project, 11,442 middle and high school youth and their parents will be served, and 6,570 sixth graders and their parents will be served annually for the following 4 years of the grant. The total amount of unduplicated people served in this project will be approximately 37,722.