SM-22-015 Individual Grant Awards 2022

The Substance Abuse and Mental Health Services Administration (SAMHSA) 988 State and Territory Cooperative Agreement funding opportunity will assist Alabama with capacity building and readiness efforts to ensure state originated crisis calls are properly routed and answered and sufficiently equipped to meet 988 demand. 988 Alabama Building Capacity (988 ABC) seeks to establish an interconnected statewide system to address mental health crises at optimal levels to ensure all Alabamians have access to a comprehensive crisis delivery system of Someone to CALL, Someone to RESPOND, and Somewhere to GO. Understanding the significance of the point of initial contact, the call, 988 ABC seeks to build capacity by maximizing and leveraging resources of its current Lifeline Member Center designees, onboarding new/additional Lifeline Member Center designees, and existing infrastructure to enhance and expand suicide prevention efforts and behavioral health crisis response. Alabama is located in the southeastern United States, bordered by the states of Florida, Georgia, Mississippi, and Tennessee. The capital city of Alabama is Montgomery (located in Montgomery County) and the most populous city is Birmingham (located in Jefferson County). Based on Census 2020, the State of Alabama has 4.8 million residents with a 12-17-year-old population of approximately 380,000 and an 18 and older population of approximately 3.7 million in its 67 counties. In the age group of 12-17-year-olds, males make up 50.9% of the population, while females are 49.1%. In the age group 18 and older, males make up 47.7% of the population, while females are 52.3%. Alabama is racially made up of 69.8% White, 26.6% Black, 1.3% Asian, and 0.7% American Indian/Alaska Native, and 0.1% Native Hawaiian/Other Pacific Islander. Hispanic/Latino accounted for 4.1% of the population while 1.5% of the population is made up of two or more races. Understanding that Alabama is primarily rural and land mass is vast, 50,633.2 square miles and a water area of 1,773.0 square miles, addressing the needs of all Alabamians is critical in the consideration of optimal access, reach, follow-up, and the assurance local needs are met, therefore signaling a regional response approach. Addressing health disparities and promoting health equity are essential to the success of the Alabama Crisis System of Care and service delivery will incorporate culturally relevant practices. The population of focus will be all Alabama 988 callers, texters, and chatters. 988 ABC seeks to continue efforts toward a systematic approach to crisis care that is accessible, interconnected, just, and employs best practices. The goals of 988 ABC are to: (1) Improve workforce recruitment, retention, and training efforts to ensure necessary capacity for Someone to Call, Someone to Respond, and Somewhere to Go; (2) Support existing and onboarding Lifeline Member Center designees to ensure adequate resources, coordinated efforts, necessary referrals, and linkages to care; and (3) Improve Alabama capacity to readily meet 988 implementation demand as it relates to crisis contact. The objectives of 988 ABC are: (1) By June 2022, Alabama Lifeline Member Centers will obtain a state call answer rate, chat, and text response to meet or exceed 90% of total calls received; (2) By June 2022, reduce the national backup center calls to 10% or less; (3) By June 2022, establish a monthly reporting metric for all Lifeline Member Center designees to track average speed to answer to ensure at a minimum 95% answered in 20 seconds, 90% answered in 15 seconds; and (4) By the conclusion of FY23, 100% of Alabama calls will be covered in-state. High-tech crisis call centers are a core element of transforming crisis services in Alabama and an essential component of the Alabama Crisis System of Care. 988 ABC will provide a pivotal capacity building opportunity to ensure the needs of all Alabama callers are met.

Led by the Arkansas Department of Health (ADH), the Arkansas 988 Capacity Project will enable the state to meet or exceed the expected in-state 988/Lifeline call answer rate, which will decrease wait time and increase appropriate resource advisement for callers. Additionally, it will develop the capacity for in-state chat and text response. Equally important, the project will require collaboration between current Arkansas 988/Lifeline call centers and ensure that policies are consistent, that data is appropriately collected and distributed, and that call takers are adequately trained on at-risk populations and resources available. Furthermore, the project will prioritize follow-ups for all callers. Lastly, the project will work to sustain this critical public health resource beyond the grant period. In 2017, Arkansas Legislative Act 811 mandated ADH create and maintain a suicide prevention call center, and in late 2017, staff began answering calls from the National Suicide Prevention Lifeline (NSPL) as the Arkansas Lifeline Call Center (ALCC). In addition to the ALCC, the Arkansas Crisis Center (ACC) answers calls for the northwest part of the state. Additionally, the Western Arkansas Counseling and Guidance Center (WACGC) is in the process of becoming an NSPL call center in the first quarter of 2022, also set to answer calls in the northwest part of the state. As of January 2021, the in-state call answer rate for Arkansas was 65% and therefore too many Arkansans are facing extended wait times as their calls are transferred out of state to available call centers who often lack knowledge of resources within the state. Furthermore, Arkansas currently relies on the NSPL national network for all in-state chat and text response. To meet the goals set forth, the project will: 1) Increase staffing and volunteer capacity in all three suicide prevention call centers to reach the expected answer rate of 90% in-state by July 2022. 2) Initiate an in-state chat and text response plan for all call centers to reach a 50% in-state response rate by the end of the first year and 90% by the end of the project period. 3) Establish coordinated data reporting and quality improvement plans for all in-state call centers. 4) Prioritize consistent follow-up in all in-state call centers. 5) Develop a sustainability plan to maintain capacity and key performance indicators beyond the grant period. While it is challenging to determine how many people will be impacted, a considerable number of Arkansans accessing the 988/Lifeline will benefit from shorter wait times, better advisement of local resources, texts and chats answered in-state. Lastly, the project will offer consistency across all in-state call centers, and a prioritization of follow-up from call takers.

American Samoa is an unincorporated territory of the United States of America located about 2,500 miles south-southwest of Honolulu and 1,800 miles north-northeast of New Zealand, and is the only US jurisdiction that lies south of the equator. The most recent census data in American Samoa (2020) yielded a population of 49,710, where slightly more than 50% of the population are under the age of 19 and mostly males. From March 2020 to September 2021, American Samoa was impacted with a sudden increase in the number of deaths by suicide, especially amongst the youth population or individuals under the age of 20. In January 2021, the American Samoa Department of Human and Social Services (DHSS) received the 988 State Planning Grant from Vibrant for a one year period, to help prepare the territory for the 988 suicide and/or mental health crisis emergency number to go live in July 2022. To continue the efforts initiated by the 988 State Planning Grant, DHSS proposes to use SAMHSA's 988 Cooperative Agreements funding to improve and build the territory's capacity to respond to suicide/mental health crisis from its 988 crisis center. The American Samoa 988 Crisis Response Project will focus on three goals: (1) Expand the crisis response staff infrastructure, (2) Strengthen the intervention response and follow up system, and (3) Increase and expand the territory's phone coverage capacity. This project aims to target the entire population with focus on the younger individuals such as young adults, adolescents and children.

The overarching goal of this project is to enhance Lifeline center staffing and infrastructure capacity to ensure that Lifeline centers can respond to 988 contacts (including calls, chats, and texts) originating in Arizona. The project approach includes developing and supporting state, regional, and local level collaborations, and service enhancements to develop and implement best practices to comprehensively address the full continuum of care related to 988 contacts. Arizona Health Care Cost Containment System (AHCCCS) intends to work with the lifeline centers to identify the actual staffing needed to meet the projected call volume as well as continue to monitor actual performance and call volume data to adjust the plan to maintain the target answer rates. AHCCCS will also continue to partner with the Lifeline centers as an entry hub for crisis services and ensure alignment with the AHCCCS crisis system. The goal will be for lifeline callers to be seamlessly connected to the full system of care when needed, including mobile crisis teams, and facility-based stabilization, such as crisis stabilization units, and behavioral health services that may be clinically appropriate.

The State of California's Department of Health Care Services (DHCS) will partner with Didi Hirsch Mental Health Services to oversee workforce expansion, training, data collection and analysis, and collaboration among California's 13 Lifeline Crisis Centers in preparation for the launch of 988. DHCS will work with Didi Hirsch to develop plans that ensure all Lifeline Crisis Centers throughout the state have the appropriate workforce, technology, and other capacity needs to meet the anticipated increase in call, chat, and text volume. As the nation's most populous state, California experiences the largest amount of calls to the National Suicide Prevention Lifeline. In 2020, about 1 out of 8 calls to the Lifeline originated in California. Of 304,222 calls, 20% were transferred to the Veteran's Crisis Line and 8,810 were handled through the Spanish Language Line. Between 2016 and 2020, California Lifeline volume increased 67%. The anticipated demand for calls, chats, and texts from the state of California for the first year of 988 implementation is 899,100. This represents nearly a 300% increase from the 312,261 calls, chats, and texts originating throughout the state during 2021. To handle over 1.5 million individuals over expected calls, chats, and texts throughout the two-year project period, DHCS will distribute funds to each crisis center and coordinate statewide planning to ensure the adoption of consistent policies and procedures that maximize the effectiveness of suicide crisis services throughout California, including the ability of all 13 call centers to link 988 callers with 911 and relevant local mental health and substance use disorder services. By the end of the grant period, DHCS will meet the following goals and objectives with the support of Didi Hirsch as its lead partner: Goal 1: Recruit, hire, and train behavioral health workforce to staff California Lifeline centers to respond, intervene, and provide follow-up to individuals experiencing a behavioral health crisis. Objective 1.1: DHCS will directly support the workforce of state selected Lifeline crisis centers via subcontracts to ensure 100% state or territory coverage of calls and greater than 90% answer rate by end of grant. Objective 1.2: By June 2023, staff and volunteers at all 13 California Lifeline Crisis Centers will have access to a statewide directory of behavioral health resources (e.g. behavioral health Access Lines, crisis lines, warm lines, behavioral health crisis triage services, peer warm lines, and health plans) for information, linkage, and referrals when appropriate. Goal 2: Engage Lifeline crisis centers to unify 988 response across California. Objective 2.1 By April 2022, DHCS will develop and disseminate a standard data collection and analysis protocol among the 13 California Lifeline Crisis Centers. Goal 3: Expand California's crisis center staffing and response structure needed for the successful implementation of 988. Objective 3.1 By July 2022, all 13 California Lifeline Crisis Centers will answer at least 90% of NSPL calls. Objective 3.2 By July 2023, all California Lifeline Crisis Centers will provide at least 8 hours of NSPL chat/text services.

To be fully staffed to answer the projected 988 call/chat/text volume, RMCP plans to hire 190 new staff over the next year and a half. Colorado will use these funds to start to build the workforce needed at RMCP (estimated 105 staff). OBH is expecting to collect a surcharge that will fund these activities after this grant funding is spent; however, OBH will continue to collect and report data to SAMHSA throughout the duration of the grant cycle.

Connecticut has one lead NSPL provider, the United Way of Connecticut (UWC)/2-1-1, which also serves as the mobile crisis call center hub for the lifespan. At this time, UWC provides 24/7 call center services for the CT NSPL callers, but no text or chat services. However, UWC does utilize text and chat for information and referral (I&R) services which will help to inform the 988 planning to add these services for CT NSPL callers. Similar to other states across the country, Connecticut has been experiencing significant challenges with hiring and retaining staff across all agencies, programs and levels of care. This staffing shortage has also had a direct impact on UWC. There is concern about the current answer rates, which are believed to be impacted by the limited staffing. Additional staffing will be needed to meet the increase in call volume with the implementation of 988. This funding will be used by the UWC to subcontract with a vendor to be a back-up call center in order to be better equipped to meet the call demand and improve in-state answer rates.

As the state agency responsible for providing prevention, intervention and treatment services and supports for children, youth, and adults with mental health and/or substance use disorders in the District of Columbia (DC), the Department of Behavioral Health (DBH) serves as the applicant for the 988 State and Territory Cooperative Agreements. The District of Columbia has only one National Suicide Prevention Lifeline (Lifeline) certified by the American Association Suicidology (AAS); Access Helpline (AHL) housed within the DBH. The AHL provides a seven-day-a-week twenty-four-hours-a-day behavioral health crisis hotline, staffed by behavioral health professionals who de-escalate caller when possible or connect callers to immediate help or ongoing care as clinically appropriate or necessary. In this capacity, the AHL Call Center answers calls to the National Suicide Prevention Lifeline for the District of Columbia. The DBH plans to expand the AHL workforce and functions to include chat, text, follow-up, and training opportunities to be better equipped to handle contacts across these modalities. The DBH and AHL will develop plans to sustain workforce capacity, adhere to Key Performance Indicators (KPIs) and to reduce the number of calls going to national backup call centers. The DBH currently serves 6,930 Lifeline callers annually. According to Vibrant Emotional Health, the projected number of contacts to be referred to DBH in Year One of the 988 implementation will be 16,100. The DBH will review internal workflows to ensure that Lifeline calls continue to take precedence over non-crisis call functions and plans to increase existing AHL staff to ensure that calls are answered promptly.

As the Single State Agency for substance abuse and mental health in the state, as well as the entity responsible for providing services to adults, DSAMH will oversee the implementation of the grant, in close partnership with the two Lifeline network call centers, ContactLifeline and Crisis Intervention Services (CIS). Using a systems-change, capacity building approach, DSAMH and Lifeline member centers will improve state response to 988 contacts by: -Maintaining a workforce to staff 988/Lifeline center to ensure calls originating from Delaware are answered in Delaware, meeting key performance indicators. -Unifying 988 response across all Lifeline centers. -Expanding the response structure needed for successful implementation of 988. With one existing Lifeline center (ContactLifeline) and one actively onboarding center (DSAMH-CIS), this Cooperative Agreement will support staffing capacity expansion for both, as well as supporting coordination and training across the two. The required activities will provide critical support for the transition from Phase 1 to Phase 2 by: (1) building new capacity within DSAMH CIS as a new Lifeline center and a future state-wide crisis response hub. (2) ensuring ContactLifeline have adequate staffing levels for maintaining an in-state answer rate above 80% and for adding text and chat service capacity.

Florida's 12 National Suicide Prevention Lifeline (NSPL) centers answer the third highest call volume in the nation. The FY 2022 Cooperative Agreement to Build 988 Capacity in Florida project will: (1) ensure all calls originating in Florida initially route to a local, regional, or state based NSPL center; (2) improve Florida's in-state response rate to meet minimum key performance indicators; and (3) increase Florida's capacity to meet 988 contact demand. The target goals and objectives of the project align with Florida's 988 Implementation Strategic Plan and the priorities of the Florida 988 Coalition. The project will support centers recruit and retain qualified behavioral health staff to improve in-state answer rates, support increases in call volume and acuity, and statewide coverage without compromising quality of service to constituents, with specific objectives designed to gradually increase center staff to achieve projected year one and 50 percent of year three contact volume needs. The project will ensure that all data used as the foundation for capacity building is consistently applied at each center to build an equitable statewide implementation plan, through objectives dedicated to improving the efficiency of the Florida NSPL routing schedule. Project efforts will identify quality assurance strategies to assure training on intervening with high-risk populations continue at routine intervals throughout center staff employment, leveraging the 988 Coalition meetings to provide cross-center collaboration for implementing and maintaining best practices and hosting an annual meeting to discuss the unification of 988 response across Florida. Driving toward a unified and coordinated response, centers will propose a glide path for callers to dispatch mobile response services or access to routine behavioral health services and formalize agreements with mobile response teams, crisis stabilization units, and other call centers focused on specific populations. This project will be available to provide crisis services to any of the approximately 22 million citizens of Florida by utilizing best practices and highly skilled, cross-trained crisis center staff providing an array of services tailored to the needs of their communities. These services will be provided to a diverse population to include Caucasians, African Americans, Latin Americans, Hispanics, Asians Americans, Native Americans, and Alaskan Natives, as well as other individuals residing in Florida. The NSPL network provides crisis services for individuals needing assistance with behavioral health and mental health issues.

The Building Georgia's 988 Capacity Project will use grant funds to expand call center workforce at the Georgia Crisis and Access Line (GCAL), Georgia's National Suicide Prevention Lifeline (NSPL) vendor, where 988 calls will be answered. NSPL calls are projected to increase from 50,000 calls per year to 240,000 calls and texts/chats. Funds will support 32 additional call center staff, resulting in an estimated 3,840 more calls per week being answered. GCAL serves both insured and uninsured individuals experiencing a mental health, substance use or intellectual and developmental disability-related crisis 24/7/365 across all 159 Georgia counties. 79.68 percent (8,645,280) of Georgia's population are age 15 years and over. 40.55 percent of Georgians live in rural areas. Behavioral Health Link, Inc., the operator of GCAL, will hire new staff, upgrade technology, and streamline processes to reduce call burden on staff and allow faster response times to individuals in crisis. These efforts will continue beyond the 988 rollout. Once fully staffed this could result in 399,000 calls being answered in the two-year lifetime of this grant. As a state participant in SAMHSA's Governor's Challenge to Prevent Suicide among Service Members, Veterans, and their Families, Georgia's continued collaboration with the Veterans Suicide Line will be an area of focus in the 988 rollout. DBHDD has set GCAL performance metrics to be aligned with the grant KPI's and are as follows: filling vacant front line staff positions within ten weeks; 1% downtime; average speed to answer (ASA) of 30 seconds, and abandonment of 5%. Follow up for suicidal individuals will be added as a metric. DBHDD's Project Evaluator and other project staff will meet with GCAL regularly to review metrics, evaluate data, and conduct continuous quality improvement. Project Goals: (1) Supporting GCAL to achieve above noted metrics through funding additional staff and identifying technological and process efficiencies. (2) Answering all 988 calls, texts, and chats that originate in Georgia (3) Achieving and maintaining a 95% call answer rate for NSPL/988 (4) Identifying long term funding strategies to support sustainable high-quality 988 service Proposed number of calls to be completed: 399,000 Federal funding request for this application is $2,927,923

The U.S. territory of Guam requests funding for Project Guam 988 Lifeline Center to build local 988 capacity. The funding will be utilized to increase current Lifeline center capacity through increasing Lifeline workforce capacity and the implementation of chat/text crisis services. Guam presently has only one Lifeline Call Center, operated by the Guam Behavioral Health and Wellness Center (GBHWC), the island's only state mental health agency. Thus, the GBHWC Lifeline Center will serve the entire diverse population of 153,836 people (U.S. Census, 2020) including 10,026 veterans (U.S. Department of Veteran Affairs, 2017). In the past, the GBHWC's Hotline was staffed with Inpatient nurses and volunteers during the holiday season. However, during the COVID pandemic the need grew, and the pandemic forced the issue of having a stable, consistent 24/7 crisis hotline. In response, GBHWC established a 24/7 crisis hotline with dedicated staff that were trained in crisis intervention. The COVID pandemic has had a major impact on call volumes. Prior to the pandemic, the GBHWC Crisis Hotline, received an average of 25 calls/month. In 2020, with the advent and persistence of the COVID pandemic, call volumes rose to an average of 748 calls/month, of which approximately 15.8% were "crisis" calls, thus raising the average monthly call volume for crisis-related issues from 25 calls/month to 118 calls/month (GBHWC Crisis Hotline Data). Using the current average of 118 calls/month, we project the number of chats/texts at the initiation of Guam's 988 Lifeline to be at approximately 50%, with a progressive increase once the population becomes familiar with this mode of interaction. Data shows the increased need for 988 services, thus the major goals and objectives of this grant will be to 1) increase the capacity of the Lifeline Center to handle current and projected 988 volumes for calls, texts/chats, and follow-up services and 2) increase the capacity of the Lifeline Center to successfully launch 988 by executing the Guam 988 Implementation Plan. Project Guam 988 Lifeline Center will serve 6,000 over the life of the 2-year grant.

Project Name: 988 Behavioral Health Crisis Call Center Process Improvement The purpose of the Hawaii application for the SAMHSA 988 State Cooperative Agreement funding opportunity is to provide funding for the much needed expansion of the existing behavioral health crisis call center workforce to meet current and future 988 response for the entire State of Hawaii. Funding will also allow for expansion of crisis center services including chat and text capabilities and follow up contact, all of which are currently not available. The Adult Mental Health Division (AMHD) of the Hawaii State Department of Health is responsible for coordinating public and private human services into an integrated and responsive delivery system for mental health needs. The AMHD services promote consumer stabilization into recovery and independence and include a safety-net of crisis intervention and support services in order to effectively treat individuals in crisis. From 2002 to 2019 the AMHD was the sole provider of crisis call center services statewide. In 2019, the crisis call center service was contracted to a sole, statewide Provider and the service is currently in the final stages of the RFP process. We anticipate selecting a new behavioral health call center provider in February 2022 with a go-live date of April 15, 2022. In 2021 the crisis call center received over 100,000 calls which included over 90,000 inbound calls from the local crisis line and over 8,000 from the National Suicide Prevention Lifeline. With the implementation of 988, there is the expectation of increased volume of call. The crisis call center is 24 hours/ 7 day a week, statewide, and available to provide behavioral health crisis and suicide call center to provide telephonic crisis intervention and linkage to crisis supports and mental health resources. The goal of this project is to provide funding for the expansion of the crisis call center workforce to meet current and future 988 response for Hawaii statewide. In addition, funding will used to expand crisis center services to include chat, text, and follow up contact which is currently not available. The objectives are to have identified Provider in place and trained to respond to 988 calls, follow-up policies and procedures will be developed and implemented in accordance with Lifeline standards, will have operational chat and texting functions available, and we will meet the KPIs for the calls (90 percent of total calls answered; 95 percent answered in 20 seconds, 90 percent answered in 15 seconds). The target population for the Behavioral Health (BH) Continuum of Care (COC) services is any adult individual, adolescent individual, or families (including adults or adolescents) statewide, who meet the criteria for living with serious mental illness (SMI), or co-occurring substance use and mental health disorder; and/or b. Presents with significant functional impairment in the areas of self protection, impulse control, or social judgment, or a high risk of harm to self or others; and/or c. Presents with an emotional, behavioral, or psychological crisis, and whose immediate health and safety may be in jeopardy due to a mental health issue.

Iowa 988 Capacity Building Project The Iowa Department of Human Services (DHS), Division of Mental Health and Disability Services—Community (MHDS-C) is the applicant agency for the FY2022 Cooperative Agreement for States and Territories to Build Local 988 Capacity in Iowa. Iowa's 988 State Planning Team, comprised of DHS and Iowa Department of Public Health (IDPH) staff, will collaborate with Iowa's two Lifeline Network Centers (Lifeline Centers), CommUnity Crisis Services and Food Bank (CommUnity) and Foundation 2 Crisis Services (Foundation 2) to implement 988 in Iowa. Increasing Iowa's capacity to answer 988 contacts originating from Iowa will improve answer rates in Iowa, ensure Iowa contacts are first routed to Iowa's Lifeline Centers, and increase access to local behavioral health services. DHS will work with Iowa's two Lifeline Centers to identify, recruit, hire, and train the needed behavioral health workforce for the successful implementation of 988. Iowa's target population is any Iowan experiencing a behavioral health crisis. Iowa anticipates 77,056 clients to be served through this grant, 30,100 during year one and 46,956 during year 2. During SFY2021, Iowa answered 10,975 calls originating from Iowa, for an answer rate of 67%. During FFY2021, Iowa answered 2,356 chats and 1,009 texts. Since chats and texts are not routed by location, it is unknown the number of chats and texts Iowa answered that were from Iowa. Vibrant Emotional Health estimates Iowa will handle 71,800 contacts including follow-up contacts between July 15, 2022, and June 30, 2023. Iowa has been building a mental health crisis system for many years. Iowa's 14 Mental Health and Disability Services Regions (MHDS Regions) develop and provide access to the following crisis services for adults: access centers, crisis evaluation, crisis stabilization community-based and residential services, mobile response, subacute services, 24-hour access to crisis response, and 23-hour crisis observation and holding; and the following crisis services for children: crisis stabilization community-based and residential services, and mobile response. Iowa's 988 State Planning Team facilitates ongoing communication with stakeholders on the development of the implementation of 988 in Iowa. Iowa's 988 State Planning Team has received stakeholder feedback on areas to consider and focus on throughout 988 implementation. Iowa will review contact metrics monthly, quarterly, and annually to continually assess in-state answer rate and identify areas of need (i.e., additional staff). During this review process, Iowa will also review contacts resulting in emergency rescue, suicide attempts in progress, and mobile crisis outreach referrals. This review of contact metrics will support the longevity of successful implementation and sustainability of 988 in Iowa. Iowa's Lifeline Centers work closely with the Department of Veteran's Affairs to ensure appropriate linkage to the Veterans Crisis Line occurs for veterans, service members, or their families upon request. Iowa will also provide attention to development of appropriate policies on intervention and follow-up through 988 for American Indians/Alaskan Natives (AI/AN). State-specific behavioral health data is not available for these populations, but nationally, have a higher-than-average suicide rate. Iowa received a Transformation Transfer Initiative (TTI) award in December 2021 which will be used to provide two standardized training toolkits for Iowa's 988 and behavioral health crisis workforce specific to serving children and LGBTQ+ individuals.

Idaho Department of Health and Welfare, Division of Public Health FY 2022 Cooperative Agreements to Build Local 988 Capacity The universal mental health and suicide prevention crisis number (988) will greatly improve access to services for Idahoans in crisis and reduce the stigma associated with mental health and suicide. With support from SAMHSA, Idaho will build capacity for 988 service delivery through workforce expansion and continuous quality improvement. Additional investments in staff and crisis response training are necessary to adequately serve Idahoans experiencing a behavioral health crisis. Nationally, Idaho ranks among the top ten states for suicide with a suicide rate of 22.9 deaths per 100,000 population in 2020. Challenges in reaching Idahoans residents with behavioral health services relate to rapid population growth, high rurality, geographic isolation, and a shortage of clinical health providers. All Idaho counties are federally designated Health Professional Shortage Areas for mental health services. The Idaho Suicide Prevention Hotline (ISPH) serves as the state's Lifeline crisis center. As a member of the National Suicide Prevention Lifeline network, ISPH provides support to Idahoans in behavioral health crises via text, chat, and call capabilities which are available 24/7, 365 days per year. Call referrals are made to the Veteran's Crisis line and real-time language translation services. Trained crisis responders evaluate a caller's situation, conduct a suicide and homicide risk assessment, and when needed, assist in creating a safety plan. In 2021, ISPH responded to 19,018 total contacts from all counties of the state, representing an increase of 34% over 2020. Despite COVID related challenges such as historically high call volume and staffing constraints, ISPH achieved the National Lifeline's annual performance standards. The proposed implementation plan for this project focuses expanding capacity to respond to 988 callers while improving Key Performance Indicators (KPIs). Planned activities center around four (4) main goals: Goal 1: Promote the emotional well-being of Idahoans through enhanced crisis care access. Goal 2: Expand workforce capacity at Lifeline crisis center to prepare for 988 Goal 3: Increase workforce training at Lifeline crisis center to prepare for 988 Goal 4: Implement a quality improvement program at Lifeline crisis center Throughout the project period, Idaho Department Health and Welfare's Suicide Prevention Program (SPP) will foster clear communication between all stakeholders to ensure success in crisis center outcomes. One Project Director and one Evaluator from SPP will be responsible for data reporting, monitoring KPI requirements, and resolving any performance shortfalls. Idaho will develop a sustainability plan to ensure that advances made in crisis response capacity building have a lasting impact.

The Illinois Department of Human Services/Division of Mental Health (DMH) will utilize the Illinois 988 Capacity Building Grant to expand capacity of Illinois Lifeline Call Centers (LCCs) to respond to calls, texts and chats from Illinoisans to the National Suicide Prevention Lifeline in preparation for the roll out of the three digit 988 dialing code on July 16, 2022. Through the development of cooperative agreements with LCCs, DMH will support the recruitment, hiring and training of the necessary workforce staff of the LCCs, enabling them to respond, intervene and provide follow-up services to individuals in Illinois who are experiencing a mental health crisis. In addition, DMH will engage the LCCs in Illinois' efforts to participate in system planning for a unified 988 response, and continued expansion of staffing and the structure of the crisis response system to fulfill the vision of the 988 initiative. By providing adequate levels of funding to the LCCs, DMH will work to ensure that all calls originating from Illinoisans receive a response from a center located within Illinois, while monitoring key performance indicators for each participating LCC and analyzing rates of response to determine any increases needed for the capacity of centers to meet 988 crisis contact demand. Illinois is a large state geographically with a total of 102 counties across 57,915 square miles and a population estimated at 12.85 million people. Only 35 counties have any contracted coverage by an LCC, with only 17 being primary coverage. This significant lack of statewide Lifeline coverage has resulted in a low rate of response by Illinois-based LCCs to Illinoisans contacting the Lifeline for assistance. The most recent quarter of response rate data from Vibrant ranked Illinois last among all states, at 19% of calls from Illinoisans being answered in state. There are currently six LCCs doing this work in Illinois. The characteristics of these centers vary widely, with two operated by county health departments, two by community mental health providers, and two as stand-alone centers. Hours of operation vary, as do the staffing patterns and credentials of staff, technology supports and funding streams. DMH has recently funded one of the six to develop a statewide call center, but DMH lacks regulatory or contractual authority over the remaining centers, which creates a significant disadvantage to ensuring consistency in accountability and regulatory oversight across the system. An adequately funded network of call centers is needed to increase the response rate, with an ultimate goal of 100% of calls, texts and chats from Illinoisans being handled by Illinois LCCs. With the award of this grant, DMH is confident we can achieve this goal, and provide all Illinoisans experiencing a mental health crisis with the immediate and effective responses needed, from call takers who are familiar with the state's unique culture. Based on the most recent data provided by Vibrant on contacts from Illinoisans, it is estimated that a total of 96,600 Illinoisans will benefit from this program on an annual basis.

The Indiana 988 Workforce Expansion Project will expand 988 center workforce to meet the needs of improving communication and increasing 988 center capacities. Over 30,000 calls were received in 2021 with Vibrant projecting a 300% increase in 988 contacts over the initial year of 988 implementation. This project will ensure that Indiana can provide 988 call services 24/7 to Hoosiers across all 92 counties while building on the success of past Vibrant/Lifeline grants to further increase our in-state answer rate to 90 percent or higher. In addition, this project will expand our capacity through the development of multiple strategic plans which will help us respond to sudden volume increases, provide best practice follow-up services, expand all 988 centers in order to offer call, chat, and text services, and sustain our progress into the future. We will also identify comprehensive, standardized training which will be developed collaboratively between 988 and 911 PSAP centers to increase the interoperability of these emergency lines. Finally, this project will closely examine the quality of 988 services and identify ways to build off current strengths and maintain Lifeline key performance indicators

KDADS is applying for the 988 Capacity Grant to build Kansas' capacity to improve our response to 988 contacts. Kansas currently partners with Johnson County Mental Health Center, COMCARE of Sedgwick County and Kansas Suicide Prevention HQ as the three certified NSPL contact centers. The existing network of contact centers will benefit from additional funding to improve their ability to respond to the increase of crisis demands as a result of the 988 crisis line implementation on July 16, 2022. These funds will increase the ability of the contact centers to be able to reach the goal of answering 90 percent of calls in-state as well as increasing recruiting, hiring and training staff to meet the increased call demands from 988.

Funding from the Kentucky 988 Capacity Infrastructure Project will support increased/retention of staffing to ensure the target of 90% of calls, texts and chats are answered in state, and within 20 seconds, with fewer than 5% of calls abandoned is essential in closing the gaps within Kentucky's public behavioral health safety net. An additional 40,000 callers are expected to be served over a two-year period with 20,000 served in year one. A minimum of 14 FTE will be hired into the CMHC crisis call system to respond to crisis calls from Kentucky residents. Goals of the project include increasing: 1) the number of people trained in mental health-related practices; 2) number of individual referred to mental health services; 3) number of individuals screened for mental health issues; 4) number of people receiving follow-up care after referral; 5) number of organizations who enter into formal agreement to improve mental health care; and achieving or maintaining: 1) a 90% answer rate for all calls that originate in the state; 2) a 20-second or less answer speed; 3) a 5% or lower abandonment rate; and 4) a 10% rate or lower of calls that go directly or roll over to the national back-up centers. In 2020, behavioral health needs skyrocketed as Kentucky and the rest of the world struggled with the trauma of social isolation, fear, unemployment, loss of homes and closing of schools from the COVID-19 pandemic. Coupled with racial injustice highlighted by the traumatic deaths of George Floyd, Breonna Taylor, Michael Brown, and countless others at the hands of police officers, crisis call centers reported they were receiving more calls, especially from people who had never reached out for mental health care in the past; that the calls were more acute in nature resulting in a significant increase in time to resolve the crisis. Overall, suicide rates in Kentucky increased about 4% from 2019 to 2020, the latest year for which data is available, however, significant increases were noted for those who are male (12%); under the age of 24 (18%) and Black (20%). Comparatively, the rate of drug overdoses jumped by 49% from 2019 to 2020 propelling Kentucky to the number two spot among states in the U.S. for increases. Preliminary data from the Kentucky Incentives for Prevention (KIP) survey conducted in the fall of 2021, found that 26% of middle schoolers and 39% of high schoolers reported poor mental health most or all the time during the pandemic. Between 20% and 40% of students who used substances before the pandemic, reported their usage increased during COVID. Similarly, since 2016, Kentucky has seen a nearly 70% increase in initiated call volume to the National Suicide Prevention Lifeline, highlighting the increasing mental health needs of Kentucky residents. Funding for crisis centers is limited but growing with the awareness of the need for crisis call services, and the state does not have sufficient capacity to answer anticipated call volume. Only 10 crisis centers, located within the Community Mental Health Center system, are providing 24/7 primary coverage for all 120 counties and backup coverage for 37 of those counties, leaving 83 counties without back-up coverage. Three centers are in the onboarding process and will be accredited before 988 goes live in July, covering with in-region services all but five of the 120 counties in Kentucky. Since January 2019, the state has significantly increased the average annual in-state answer rate from 48% in 2018 to 75% for the one-year period that ended November 30, 2021. That percentage is still significantly below the expected goal of 90% of calls originating in Kentucky being answered in Kentucky. Additionally, deficits exist in workforce to answer the anticipate call volume. Staffing projections call for 170 call takers and 34 supervisors in year one. Kentucky's crisis call system currently numbers about half that in workforce capacity, without considering

Through the Louisiana 988 Cooperative Agreement, the Louisiana Department of Health, Office of Behavioral Health (OBH) will improve Louisiana's response to 988 crisis calls, chats, and texts originating in the state. The goals of this project are to: (1) ensure statewide 24/7 coverage for 988 calls, chats and texts, (2) strengthen OBH's oversight of Louisiana's 988/Lifeline services, and (3) ensure strong coordination between Louisiana's crisis response system, 988/Lifeline contact centers and 911 administrators. To achieve these goals, OBH will work closely with Louisiana's two Lifeline contact centers, VIA LINK and the Louisiana Association on Compulsive Gambling (LACG), who will expand their capacity to ensure the in-state answer rate for Lifeline calls is maintained at 90% or higher. The contact centers will ensure their workforce receives training on working with populations at risk of suicide and awareness of referral options. Contact centers will also link veterans, service members, or their families to the Veterans Crisis Line. OBH will also form a unified platform workgroup to address responding to Lifeline chat and text requests by creating and adopting a timeline that includes costs, analysis of barriers, and addressing state-specific needs. This coordinated approach will ensure the state of Louisiana has the systems in place to respond to crisis calls, texts and chats statewide when 988 goes live on July 16, 2022

The MA988 Project will reside within the Massachusetts Department of Public Health (MDPH) Suicide Prevention Program (SPP). MDPH SPP funds five crisis call centers that handle Lifeline responses, including Samaritans Inc., Mass211/Call2Talk, Samaritans on Cape Cod and the Islands, Samaritans Southcoast, and Samaritans of Merrimack Valley. All Lifeline calls are routed on a county-level basis to one of these centers, with geographic coverage in all 14 MA counties. In FY21, MA was routed approximately 46,285 National Suicide Prevention Lifeline (NSPL) calls; 32,729 (71%) were answered in-state. The MA 988 project has three broad goals to effect meaningful systemic change by building statewide and crisis call center capacity to provide comprehensive and coordinated crisis care to Lifeline callers. MDPH SPP aims to increase MA in-state answer rate on the National Suicide Prevention Lifeline to a minimum of 90%. Goal 1 objectives: Centers will develop and begin implementing hiring plans to expand staff capacity to respond to calls; hiring plans will incorporate flexible staffing models to respond to increased demand upon the 988 program launch; by July 1, 2022, MDPH increase the number of local crisis centers that operate on a 24/7/365 basis from two centers to five centers; by September 1, 2022, all five crisis centers will develop surge capacity response plans following a public service announcement, disaster, or other traumatic events; by July 1, 2022, centers will develop the capacity to collect, report, and analyze core universal metrics; quarterly throughout the grant period, MDPH will meet with centers to discuss performance, progress, policies, and procedures; and every six months, MDPH will monitor the routing coverage map and adjust based on capacity and response structure. Second, MDPH will ensure MA 988 callers receive a comprehensive, coordinated, and appropriate level of care and follow-up across the statewide crisis services continuum. Goal 2 objectives: MDPH will continue to convene the 988 Implementation Team to engage crisis services continuum partners across the state to establish uniform policies and procedures; on-demand training modules for centers on policies, procedures, transfer logistics, and resources for high-risk populations, including veterans will be developed; and by July 1, 2022, the 988 Implementation Team will develop a quality improvement plan for implementing referral emergency interventions and follow-up services for those callers identified at imminent risk of suicide. A state plan to sustain a 90% in-state answer rate of MA-initiated 988 calls and build capacity to respond to chat and text-based contacts will be developed. Goal 3 objectives: Develop a sustainability plan to maintain center capacity and Lifeline metrics beyond the grant period; and develop a plan to expand the response to Lifeline chat and text requests. MDPH will implement all 988 required activities related to distributing SAMHSA funds, expanding surge capacity, data collection and reporting, ongoing communication. supporting staff expansion, aligning national, state and local performance measures, quality improvement, veteran and service member support, strengthening outreach and follow-up for at-risk callers, expanding capacity to respond to chat and text requests, sustainability, and workforce training. MDPH will partner with the University of Massachusetts to conduct an independent evaluation. The evaluation team will work closely with the 988 Implementation Team throughout the two-year grant period monitoring all grant activities and providing regular feedback on the Key Performance Indicators.

The Maryland Department of Health's Behavioral Administration (BHA), in partnership with jurisdictions and Maryland Lifeline crisis centers, will build local 988 capacity with the two-year, $1,972,989 988 State and Territory Cooperative Agreement funds (SAMHSA 22-015). This project will increase staff capacity at eight Lifeline centers, allowing them to respond, intervene, and provide follow-up to individuals experiencing a behavioral health crisis. Maryland's life line call volume is projected to increase to 101,700 handled contacts in the first year of 988 implementation. Grant funds will be used by Maryland Lifeline crisis centers to maintain and expand their workforce to respond to this expected increase in Lifeline call, chat, and text volume. During the project, BHA will be working with Lifeline crisis centers and other stakeholders to: Monitor and improve: crisis call, chat, and text answer rates; Increase follow-up services; Ensure appropriate linkages for veterans; Train the workforce on engaging with populations at higher risk of suicide in our communities; Monitoring and improving the handling of contacts that require emergency rescue, involve suicide attempts in progress, and mobile crisis outreach referrals. Ensuring strong linkages between 988 services and the state's suicide prevention plan; and Improving coordination between 988 and 911 services. The state will measure its project success using the following key performance targets: 90% or more of calls, chats, and texts originating in Maryland will be answered by Maryland Lifeline crisis centers. 95% of Maryland 988 calls will be answered within 20 seconds, with 90% of these calls answered within 15 seconds. Less than 5% of calls received are disconnected prior to answer by a Maryland Lifeline crisis center.

This project will establish a new 988 coordinating position embedded in Maine's statewide crisis call center the Maine Crisis Line (MCL). The MCL 988 Coordinator will actively partner with Maine's Office of Behavioral Health to build the foundational collaborations and cross-sector connections being forged across the crisis system as Maine plans for 988 implementation. As an integral part of the state and local 988 Community of Practice, the 988 MCL Coordinator will play a pivotal role in the success of 988 by strengthening state and local efforts to effectively leverage 988 as a catalyst for Maine's broader crisis system transformation. Additionally, as 988 is activated and marketed locally and nationally, the corresponding projected rise in call volume will necessitate increased staffing infrastructure in order to achieve SAMHSA's national standard of a 90% in-state call answer rate. The MCL 988 Coordinator will be fully trained to serve as auxiliary crisis call answering staff, enhancing MCL's ability to maintain effective operations in the case of an unexpected surge in demand or a workforce shortage. This enhanced staffing capacity and resilience will serve to ensure effective and appropriate care for those in crisis, and to enhance and accelerate coordination of Maine's 988 crisis system. Goals and objectives: Goal 1 - Enhance and strengthen coordination between state and local entities for the implementation of 988 crisis response system to ensure successful launch and ongoing development of 988 crisis call center in the context of broader crisis system development. Objective 1 - A robust system of collaboration, planning and reporting between DHHS-OBH, Maine's crisis call center, and crisis system stakeholders. Objective 2 - A dynamic, issue-focused 988 Crisis Response Community of Practice (988 COP), holding monthly meetings to strategize efficient and effective cross-sector crisis response. Goal 2 - Increase integration and interoperability of crisis call center with key elements of the crisis response system to ensure seamless and appropriate crisis response. Objective 1 - Define 3-5 priority issues to solve, starting with 911/988 interoperability. Objective 2 - Develop proposals, implementation plans and trainings for operational and policy changes required to solve the identified priority issues, starting with 911/988 interoperability. Goal 3 - Expand 988 crisis call center capacity to meet national operational standards. Objective 1 - Increase staffing capacity. Objective 2 - Achieve target answer rate of 90% Objective 3 - Develop chat/text and follow-up plans. Objective 4 - Support adoption of real-time service locator tool.

Over the past year, MDHHS engaged in an intense 988 planning process with key stakeholder groups, elucidating several gaps in resources and programming needed for successful implementation of 988. This cooperative agreement will provide Michigan with critical resources to increase staffing for 988 call, text, and chat coverage. The funding will also be used to support staffing for coordination between 911 centers, 988 centers, crisis services providers, and others. In addition, the funding will afford the development and implementation of follow-up programs for high-risk populations who seek crisis care through emergency departments or encounter law enforcement. As part of its 988-planning grant, MDHHS developed a 988-implementation plan that integrates 988 as part of a unified crisis services system. This aligns with Michigan's work on the development of a three-component crisis services system, consistent with SAMHSA recommendations, for all Michiganders: a centralized crisis line, mobile crisis, and crisis stabilization units. Michigan Crisis and Access Line (MiCAL), staffed by MDHHS vendor Common Ground, will provide primary text and chat coverage statewide and primary call coverage in all areas of the state except Kent and Macomb Counties, where MiCAL will provide backup coverage. Network 180 and Macomb County Community Mental Health, current NSPL providers and publicly funded community mental health service programs (CMHSPs), primarily serve these respective counties. While there is funding for current contact volume, resources will be needed to cover the anticipated significant increase in demand. Michigan received over 57,000 calls in 2021 and is expecting over 90,000 calls in the first year 988 goes live (in addition to chat and text). Finally, Michigan will utilize funding to institute in-state back up coverage as recommended by Vibrant. Through the 988-planning process, stakeholders emphasized the importance of 988 offering geographically and culturally equitable services across Michigan. Coordination services provided through this grant will focus on Michigan 988 centers providing services that meet all Vibrant standards. This will also facilitate the development of a two-phase follow-up program: 1) Phase 1 in which 988 Centers offer follow up calls to all high-risk individuals who contact 988; and 2) Phase 2, which will develop culturally sensitive and regionally tailored follow-up service program to high-risk individuals who seek crisis care at emergency departments or encounter law enforcement. This program will be designed with feedback from stakeholders, including people with lived experience, 911 centers, law enforcement, emergency departments, and others. Another focus of this grant is to build formal coordination processes between 911 and 988 so that Michiganders are served by the system that best meets their needs. Stakeholders will remain imperative to 988 implementation through identification and prioritization of high-risk populations, marketing 988, sharing resources, and system feedback. MDHHS will also utilize partnerships to help identify continued resources supported by this initiative.

In 2021, 33,887 calls from across Minnesota were made to the National Suicide Prevention Lifeline. This demonstrates a critical need to ensure that Minnesota is equipped to continue providing localized suicide and mental health crisis support for all Minnesotans under 988. With this funding opportunity, the Minnesota Department of Health (MDH) and the Minnesota Lifeline Centers will actively partner together to build the local workforce capacity to respond to 988 contacts including calls, chats, and texts. MDH has identified three overarching goals for this project period. Goal one support Lifeline Centers in increasing their workforce capacity to build and expand response to all 988 contacts (including calls, chats, texts, and follow-up services). To meet goal one, MDH will support Lifeline Centers in achieving a 90 percent in-state answer rate of total 988 calls, chats, and texts received, designating an in-state backup call center, and offering follow-up services more consistently. Goal two establishes aligned policies and practices among Lifeline Centers. Aligning policies and practices under goal two will be a collaborative effort between MDH, Lifeline Centers, the Minnesota Department of Human Service (DHS), and the Minnesota Department of Public Safety (DPS). The objectives under this goal will address aligning follow-up service protocol, collecting Key Performance Indicators (KPIs), Lifeline Centers training curriculum on high-risk populations and specific cultural communities, coordinating with mobile crisis teams and the 911 system. Goal three is focused on maintaining and sustaining workforce capacity at the Lifeline Centers through continuous quality improvement. Objectives will emphasize on quality improvement monitoring of KPI metrics and the policies and procedures at Lifeline Centers. With the launch of 988, MDH expects to see an increase in the call, chat, and text volume. Strengthening the capacity of Lifeline Centers will improve access to confidential suicide and mental health support and increase collaboration and coordination of crisis services in Minnesota. Expansion of 988 services to include chat, text, and follow-up will ensure that Minnesotans can reach the Lifeline using their preferred communication.