TI-16-001 Individual Grant Awards

Chestnut Health Systems proposes to enhance its capacity to provide evidence-based substance use treatment for rural adults through the use of a combination of tele-health and web-based treatment services to deliver the Community Reinforcement Approach. The population of focus is rural adults who reside in underserved areas within 11 counties located in central Illinois who are: 1) admitted to outpatient treatment for substance use disorders (SUDs); OR 2) discharged from residential treatment for SUDs and admitted to continuing care. It is anticipated that rural participants will have the following characteristics: 45% female, 3% African American, 4% Hispanic, 3% Other, average age will be 32 years old, 65% will be involved with the criminal justice system, 31% employed, 51% using alcohol weekly, 31% using marijuana weekly, 25% using cocaine weekly, 11% using heroin weekly, 70% presenting with symptoms of Major Depressive Disorder, and 50% presenting with symptoms of Generalized Anxiety Disorder. Goals of the project are to: 1) share effective treatment models and results among providers; 2) increase engagement of persons in treatment in their health care; 3) increase monitoring and tracking of the health status of individuals; and 4) improve recovery and resiliency rates. These goals will be achieved by implementing measurable objectives as defined by the Washington Circle Group: increase continuity of care after assessment and after residential discharge; increase treatment initiation and engagement. Over three years, this program will serve 261 unduplicated adults living in rural areas of central Illinois. In addition to improving the availability, accessibility, and acceptability of and rates of retention in treatment for rural populations with SUDs, this project seeks to improve compliance with national Washington Circle performance standards, as well as improve dissemination of technology-based treatment to other rural areas of the United States.

Centerstone Interactive Recovery (I-Recover) will enhance the quality of and access to treatment/recovery services via technology-assisted care (TAC), recovery/resiliency support, and wellness promotion for 130 youth/adults with substance use disorder (SUD) or co-occurring SUD and mental health disorders (COD) who are underserved and/or have special needs. I-Recover project goals include: 1) enhance infrastructure/capacity to provide TAC and treatment for clients; 2) increase functionality, access/use, and/or awareness/education of project TAC; 3) improve health status and outcomes for clients; and 4) develop/disseminate a replicable service model. I-Recover will demonstrate the ability to: share treatment models/results among providers; increase client engagement in health care; monitor/track individuals' health status; and improve recovery/resiliency rates. The evidence-based Recovery Oriented System of Care framework will be implemented to achieve the following objectives: train all clients to use TAC innovations/tools; train/educate 200 community stakeholders and Council members to identify/address/support client needs and project technologies; increase clients' recovery capital and access to services; increase utilization of primary care services among clients with no primary care provider; reduce substance use; reduce mental health symptoms among clients with mental health conditions; reduce recidivism among criminal justice-involved clients; link clients to supportive services; and achieve 80% client retention rate at six-month follow-up. I-Recover key activities are to: modify/develop and maintain project technologies (interoperable EHR, mobile application); provide recovery coaching and wraparound support linkages; train clients to use mobile application functions (e.g., Interactive Individual Treatment Plan, Daily Mood Survey, personal health information, secure communication, appointment requests/reminders); and monitor/refine service delivery.

Behavioral Health Network of Greater St. Louis proposes to implement a Technology Assisted Care Coordination for Substance Use Treatment: Text Messaging and Telecoaching for High Need/Utilization Populations project that will involve collaboration with two Substance Use (SU) treatment providers, Preferred Family Healthcare and Bridgeway Behavioral Health, to implement an interactive text messaging intervention (Epharmix) and telecoaching program. The Epharmix module for Substance Use Disorder (SUD) will expand and enhance support, treatment and referral services provided under the Missouri Department of Mental Health Alcohol and Drug Abuse - Disease Management project. The Epharmix SUD module will be partnered with existing modules to promote consumer engagement in SU treatment, improve chronic disease management, decrease medical costs and foster sustained recovery. Epharmix provider alerts and aggregated reports are driven by clinician-designed algorithms which identify consumers requiring follow-up care. Telecoaching may be accessed from Community Support Specialists (CSSs) and receive calls from CSSs triggered by the Epharmix alerts. The target population includes Medicaid eligible adults (?18 years) with a previous/presumptive SUD diagnosis, no identified Healthcare Home and over $20,000 in medical costs in the prior 12-month period. Providers will recruit consumers with a wide range of SUDs and chronic conditions, with special focus on engaging consumers participating in medical assisted treatment for opiates and other substances. Epharmix text messaging, telecoaching and community support services will be delivered to at least 240 consumers. Project goals include: (1) increasing engagement of persons in treatment in their healthcare; (2) increasing monitoring and tracking of the mental and physical health status of individuals; (3) improving recovery and resiliency rates; and (4) sharing effective treatment models and results among providers.

Serving Children and Adults in Need (SCAN), Inc. proposes to implement Technology Assisted Border Expansion and Enhancement Project (TA-BEEP) to expand and enhance substance abuse treatment services for adolescents (aged 12 to 17) and adults who live in rural and underserved areas of Webb County Texas through the use of web-based services, tablets/smart phones, and behavioral health electronic applications. This will allow SCAN to recruit and communicate with clients in remote areas and to ensure that services are available. TA-BEEP will provide pre-treatment services; screening and assessment; access to treatment with linkages to residential services; transportation; recovery support services; case management; continuing care, and care monitoring. Project goals are to: 1) expand and enhance behavioral health treatment capacity in Webb County's underserved areas and rural Colonias through the use of Technology Assisted Care (TAC); 2) strengthen technology infrastructure that will allow clients to access TAC Tools: 3) increase SCAN's staff capacity to use and implement TAC Tools; 4) have participants show improvements in abstinence from substance use, employment/school performance, housing stability, criminal justice involvement, social connectedness, risk behaviors, and mental health.; 5) develop trauma- informed programming to identify participants suffering from traumatic stress, lessen the impact of trauma, and coordinate trauma specific interventions in person or through the use of TAC tools; 6) achieve high follow-up rates to provide evidence-based treatment interventions with a high degree of fidelity using a mixture of in-person interactions and TAC tools; and 7) develop a cultural and linguistically informed project utilizing feedback collected from participants and significant others to address the specific needs of participants. Over three years, TA-BEEP will expand and enhance services to serve 225 participants.

St. John Providence Health System proposes a Multi-Region Population Access Initiative (MRPAI) that will utilize telehealth technology to provide combined alcohol and mental health disorder treatment to underserved populations in eastern Michigan. Over the three year grant period, MRPAI anticipates serving 11,136 individuals from three rural counties located in northeastern Michigan and the city of Detroit. These counties, as well as many areas in Detroit, are designated Health Professional Shortage Areas and Medically Underserved Areas/Populations for mental health providers, and have inadequate access to public transportation. A large proportion of this population is at risk for heavy drinking, binge drinking, depression, and other mental health issues. MRPAI's primary strategy is to provide prompt behavioral health screening, assessment and treatment for those presenting in the emergency rooms of four participating providers via telehealth technology. Project goals include: 1) effectively sharing treatment models and results among providers; 2) meaningfully engage persons in treatment in their health care; 3) monitor and track the health status of individuals; and 4) achieve improvement in recovery and resiliency rates. Project objectives include documenting training sessions and presentations on this mode both regionally and nationally; comparing patient engagement among several variables; screening patients for alcohol risk/dependency; tracking impact on health status; reducing risky and binge drinking; and reducing alcohol-related consequences and risk among participants. Data collection and reporting will be led by the Project Evaluator who will be supported in overall data collection by our Health Information Management Department. This department also participates in facilitating data and information requirements by outside agencies, including Centers for Medicare & Medicaid Services and the Centers for Disease Control.

The CASA-CHESS: Smartphone Technology to Enhance Engagement with Behavioral and Primary Care Services Among Latinos with Mental Health and Substance Abuse Disorders project will provide expanded care coordination using Health Information Technology through an enhanced bilingual CASA-CHESS Smartphone application, provider dashboard, and mobile client portal. The target population is 110 newly enrolled Spanish-Speaking Casa Esperanza Latino/a adult clients with co-occurring alcohol and/or other drug and mental health disorders receiving integrated primary and behavioral health care services. The project proposes to purchase Smartphones to equip with an enhanced version of CASA-CHESS, adapted and translated into Spanish. Boston University and CHESS developed and tested CASA-CHESS in collaboration with Casa Esperanza, demonstrating feasibility and acceptability among Spanish- speaking clients who completed residential treatment. Care coordination will be expanded by: (1) enhancing the CASA-CHESS Smartphone app (2) broadening the availability of this enhanced app to the target population and the expanded network of bilingual staff who serve them; (3) providing a mobile client portal to increase client engagement in health care; and (4) adding a provider dashboard to improve the timely management and quality of interactions with CASA-CHESS clients. An outcome evaluation will include GPRA, local performance assessment questions, and a comparison group of Latina/o integrated care clients who had not received CASA-CHESS during the previous 2-years of the integrated care program. The evaluation will examine the following outcomes: (1) reduced risk of alcohol/drug relapse, (2) increased engagement in integrated care services, (3) increased knowledge about overdose risk and prevention, and use of naloxone; reduced rates of OD; (4) increased access of client portal, (5) improved mental well-being, and (6) improved social connectedness.

The Behavioral Health Information Technology Enhancement (B-HITE) Initiative will strengthen Community Mental Health Center, Inc.'s ability to provide substance use services through the enhancement of the electronic health record (EHR) infrastructure, implementation of evidence-based practices (EBPs), and adoption of a mobile application to promote substance use recovery. The project will focus on individuals enrolled in the intensive outpatient program (IOP). By utilizing a population health approach, data will be used to identify additional subpopulations of individuals in need of process improvement changes to increase treatment engagement. Program goals include: 1) improve EHR infrastructure and create an environment of data driven decision making agency wide; 2) improve treatment provision through the implementation of EBPs; 3) enhance treatment engagement and recovery support for child welfare involved individuals; 4) increase primary care integration; and 5) increase inter-agency collaboration focused on reducing substance abuse. B-HITE objectives are to: a) hire a Director of Evaluation and Quality; b) train a staff member as a Motivational Interviewing Train the Trainer; c) train providers in Cognitive Behavioral Intervention for Substance Abuse; d) provide primary care screening to IOP participants; e) provide technology enhanced treatment to child welfare involved individuals; f) provide an evidence-based IOP program to 1,050 participants; g) establish shared decision making between clinicians and clients utilizing the EHR; h) exchange data with primary care providers using an inter-operable EHR; and i) establish cross system data sharing with the Department of Child Services and Probation to increase outcome tracking.

The Northern Ohio Recovery Association, Inc., (NORA), has been providing technologically enhanced treatment services for the past 6 years. NORA purposes of to create a technology supported intervention designed to promote engagement, provide peer support, and support the recovery of opiate abusing and dependent women in rural and medically underserved areas in Northern Ohio. These rural counties have been designated as Medically Underserved Populations and as both Mental Health and Dental Health Professional Shortage Areas. Over the three year grant period, in collaboration with community Health Centers and Health Departments, the Circle of Care (CoC) project will increase access and availability of outpatient substance abuse treatment services to 400 women with histories of opiate misuse, abuse or dependence through the use of a patient communication portal that, in addition to a Recovery Coach, will assist with enhancing motivation for treatment and provide tools for self- management. In treatment, web-based and electronic applications including e- therapy and tele-support accessed from mobile devices (e.g., smart phone, tablet), will enhance treatment attendance and effectiveness through the use of self-management reminders and educational prompts, and access to personal health records. Information within the patient portal will be developed utilizing the principles Motivational Interviewing and Recovery Support philosophy. CoC will allow NORA's current telemedicine capacity to be expanded to include a Certified Behavioral Health Record that will provide interoperability capacity to share records and facilitate coordination of care with other health care organizations and provide consumers with access to patient health records.

The Clinic for Education, Treatment and Prevention of Addiction (CETPA), Inc. proposes to improve and expand treatment and communication to persons who may not have access to treatment and a full range of health services due to language barriers (Spanish), geographic, socioeconomic and/or psychosocial issues that can impact negatively on their living conditions, financial situation and family responsibilities. Through technology that can be accessed from home or from smart phones and other portable technology and related e-therapy tools, CETPA will be able to address the needs of individuals living in rural areas and those with special needs such as the elderly, LGBT individuals, persons with co-occurring disorders, and ethnic and racial minorities. Service will be provided to new clients, current clients identified to do well in a virtual environment, and clients who may have stopped coming to or are having a difficult time completing treatment due to problems with transportation, childcare, economic/financial constraints or other barriers. Over three years, CETPA anticipates serving 65 individuals. Recovery Support Staff and/or Certified Peer Specialists will be trained to perform community outreach programs to introduce the proposed technology to individuals admitted to this program. CETPA will provide culturally sensitive, bilingual, evidence-based treatment services aimed at: reducing alcohol use, substance use and mental health problems; increasing access, compliance and retention of Latino clients to and in care; and enhancing and expanding the capacity of and access to substance abuse treatment and co-occurring disorders care for underserved Latinos in the State of Georgia by using technology assisted care to address cultural, linguistic, financial, geographic and transportation, barriers, as well as a lack of adequate licensed, Latino service providers.

Volunteers of America of Los Angeles (VOALA) will address the needs of veterans (with a focus on post-9/11 veterans) with substance use disorders or co-occurring substance use and mental health disorders through integration of POS REP, a mobile, proximity-based social network designed for the military veteran community, and the WRAP app to promote treatment and recovery. Participants will be able to directly access behavioral health treatment, health care, case management, and wraparound services as well as support ongoing recovery and resiliency efforts. VOALA will utilize an evidence-based treatment approach consistent with the disease model that portrays addiction as a treatable disease and the problem-solving model which involves breaking down the challenge of rehabilitation into smaller, more manageable steps. The project will serve 260 participants over the three-year project period. Project goals for the targeted population include: 1) increase the use of technology for effective communication; 2) increase access to and service utilization of behavioral health treatment, health care and wraparound supportive services; and 3) ensure that project implementation and evaluation adhere to objectives, proposed outcomes and facilitate continuous quality improvement. Project outcomes for the targeted population include: 1) increase monitoring and tracking of health status by 70%; 2) increase engagement in health status by 60%; 3) improve recovery and resiliency rates by 60%; 4) increase the sharing of effective treatment models and results among 75% of referral agencies; and 5) maintain operational integrity of the program by completing 100% of required tasks on time and within SAMHSA requirements. Morehead State University will conduct an independent evaluation to ensure achievement of targeted performance measures as well as ongoing high quality services.

Safe Refuge proposes to implement the Tele- Health Recovery Interventions for Vulnerable and Economically-disadvantaged adults (THRIVE) Project. THRIVE will enhance substance abuse treatment services through the implementation of an electronically-based treatment continuum, beginning with 90-day Residential treatment services, embedded with online treatment programming, and followed with "stepped-down" services through the use of a web and mobile-based support tool, MyStrength, for ongoing aftercare services. MyStrength is a web and mobile platform with evidence-based, self-help resources for addressing substance use problems, as well as co-occurring depression and anxiety. These tools enable participants and providers to extend care for these chronic health conditions. MyStrength staff will provide on-site training services in order to ensure maximum benefits and fidelity to evidence based approaches used within this platform The project goal is to expand and enhance access to treatment services with integrated telehealth technology. The population of focus is vulnerable, economically-disadvantaged adults ineligible for funding sources to cover substance abuse treatment, including co-occurring mental health disorder. Over three years, THRIVE will serve 120 adult (ages 18+) participants as well as their family members and significant others. THRIVE will provide services to participants without access to funding for treatment services, including, but not limited to, persons who may be experiencing homelessness or other barriers to accessing treatment and adults with a criminal justice history without post-release supervision. THRIVE will also: 1) increase access to quality, coordinated residential substance abuse treatment programming, with integrated telehealth services; 2) increase telehealth training services to improve quality of care for participants enrolled in THRIVE; and 3) expand and enhance aftercare services to THRIVE participants.

Pine Rest Christian Mental Health Services' (Pine Rest) Telehealth in Rural Northern Michigan will expand outpatient treatment for substance use disorders (SUDs) and co-occurring conditions to adults in underserved rural areas in the northern Lower Peninsula of Michigan through use of telehealth to provide assessment and group and individual therapy. Over three years, the project will serve 300 patients. Project goals are to: 1) provide outpatient treatment for SUDs to adults living in rural areas where there is a shortage of behavioral health providers; 2) increase participant engagement in their health care to address co-occurring disorders; 3) increase monitoring and tracking of the health status of participants; 4) improve recovery and resiliency rates; 5) enhance Pine Rest's capacity to provide technology assisted care; and 6) share effective treatment models and results of the program with other providers. Pine Rest will employ the following Evidence-Based Practices: American Society of Addiction Medicine Patient Placement Criteria for screening and assessment; telehealth; and individual and group therapy using Cognitive Behavioral Therapy, Motivational Enhancement Therapy, 12-Step Facilitation Therapy, and Motivational Interviewing. Recovery support and care management will be provided by recovery coaches both in person and through tele-communication. Pine Rest will use its Traverse City Outpatient Clinic as a base of operation to administer the telehealth program. Therapists at Traverse City will conduct evidenced-based assessment and therapy through a videoconferencing platform. Locally-based recovery coaches will help to recruit and retain participants in the program, assist with recovery, provide care management, and collect data from participants for program evaluation. Pine Rest will also partner with two Health Care Organizations with several different locations in northern Michigan that will serve as hubs for providing telehealth services.

Brandywine Counseling and Community Services (BCCS) is proposing to implement an enhancement of existing mental health, substance abuse, and co-occurring disorders outpatient treatment programs in Wilmington, Delaware by incorporating the use of technology assisted care (TAC) through the use of myStrength, an interactive mobile and web-based resource which acts as a clinician extender for many managing substance use disorders as well as mental health issues through a range of self-care applications and activities. This project will work as a clinical extension and serve 450 diverse individuals over three years by providing clients with an opportunity to engage in self-guided, treatment-on-demand services outside of their therapists' office. Due to the extensive needs of those with co-occurring disorders or mental health or substance us disorders, the overarching goal of the TCE-TAC program is to enhance participants' treatment success and experience, through the use of person-centered technology-assisted care, outside of a traditional therapy setting, as a way to engage participants in continuous treatment and/or treatment-on-demand which promotes overall well-being including decreases in alcohol and drug use, mental health symptoms, criminal activity, and increases in housing stability. Those participants who are experiencing a co-occurring disorder often need more treatment (more frequent, more intensive) than what is available to them; the use of myStrength will enhance services at BCCS and will assist the agency in overcoming that obstacle and promote recovery through empowering participants to take full responsibility for their treatment and recovery.