SM-22-015 Individual Grant Awards 2022

In July of 2022, 988 will become the national three-digit code for all mental health and suicide-related crises. A 988 line that is effectively resourced and promoted has the ability to serve as the first line of defense for individuals experiencing a crisis; opening the door for access to a robust crisis care continuum available for anyone, anywhere, anytime. Following the guidance outlined in SAMHSA's National Best Practice for Behavioral Health Crisis Care Toolkit, Missouri is working towards a true "no-wrong-door" integrated crisis response system to prevent tragedies, save lives, and resources of other valuable public health and safety systems. As a grant recipient, the Missouri Department of Mental Health will ensure there is adequate capacity to provide high-quality care to every Missourian experiencing a mental health, substance use, or suicide-related crisis. Upon completion of grant activities, grantee will achieve the following goals: 1. Support the expansion of 988 center workforce capacity by determining specific quality and performance metrics for each 988 center to meet Lifeline standards, collaborating with centers to support initiatives and provide oversight and management of grant expenditures and activities, and distributing a newly created crisis specialist onboarding training curriculum; 2. Improve access to suicide prevention, behavioral healthcare, and crisis response services by enhancing follow-up services through the development of statewide protocols and data collection on follow-up contacts and developing and distributing a comprehensive resource and referral listing; 3. Improve state response rate to ensure all calls originating in-state first route to a regional 988 center by creating statewide and center-specific emergency capacity plans to respond to sudden and large spikes in call volume, initiating a routing plan that ensures 24/7 statewide primary and backup coverage for every county in Missouri, and striving for a call answer rate of 90% or higher and an average speed to answer rate of 20 seconds 95% of the time consistently. According to national volume projections, Missouri can expect to receive approximately 172,022 calls in year one of 988 implementation. This equates to approximately 143,350 calls in year one of the project period and a total of approximately 315,370 calls over the lifetime of the project period. Grantee will utilize 89% of awarded grant funds to support 988 centers with hiring crisis specialists equipped to work with individuals experiencing a crisis. The 988 Planning Grant has allowed Missouri to conduct intensive and strategic planning efforts to prepare 988 centers and the behavioral health system at large for 988 rollout. Through accomplishment of the identified goals and objectives, Grantee will expand upon preparations made during the Planning Grant to strengthen 988 center operations and enhance and integrate crisis response services available for Missourians in crisis.

CNMI CHCC CGC 988 PROJECT

The Mississippi Department of Mental Health's (DMH) FY 2022 Cooperative Agreements for States and Territories to Build Local 988 Capacity grant is designed to increase state response to 988 calls, chats, and text by ensuring all contacts originating in Mississippi are answered by an instate Lifeline crisis call center. Mississippi has 24/7 primary and backup coverage for all 82 counties in the state. The state maintained an average in-state answer rate of 90% for July - December 2021. Mississippi has continuously improved its capacity to handle Lifeline calls statewide. Over the past several years, the state has increased its answer rate percentage from 46% to now 90%. DMH's partnership with Mississippi's two Lifeline crisis centers, CONTACT The Crisis Line and CONTACT Helpline, will allow the state to achieve the following goals. (Goal 1) Increase the capacity of the Lifeline Centers to meet crisis contact demand for the projected volume of calls and follow-up for the first year of 988 implementation. (1.1) By August 31, 2022, CONTACT The Crisis Line will hire eight new staff; (1.2) By August 31, 2022, CONTACT Helpline will hire four new staff; (1.3) By August 31, 2022, CONTACT The Crisis Line will purchase technology funded by this grant to increase capacity; (1.4) By August 31, 2022, CONTACT Helpline will purchase technology funded by this grant to increase capacity. (Goal 2) Maintain 24/7 primary and backup coverage within the state to ensure all calls originating in the state are first routed to a Mississippi Lifeline Center. (2.1) By September 30, 2022, staffing and technology funded by this grant will be in place to meet the increased demand of call volume to ensure sufficient capacity to maintain 24/7 in-state coverage of all Lifeline calls originating in the state; (2.2) By the end of the first year of the grant, the Centers will have maintained an average 90% or higher in-state answer rate for Lifeline calls; (2.3) By the end of the second year of the grant, the Centers will have maintained an average 90% or higher in-state answer rate for Lifeline calls. (Goal 3) Increase collaboration among Mississippi Lifeline Centers and crisis system partners to unify 988 response. (3.1) By the end of the first year of the grant, at least 70% of the Community Mental Health Centers will enter a formal agreement with CONTACT The Crisis Line and CONTACT Helpline; (3.2) By August 31, 2022, DMH will have developed a training curriculum addressing referral protocols, resources, and crisis response; (3.3) By the end of the first year of the grant, DMH will have trained 50% of 988, Mobile Crisis Response Teams, and Crisis Stabilization Unit staff on referral protocols, resources, and crisis response; (3.4) By the end of the second year of the grant, DMH will have trained 100% of 988, Mobile Crisis Response Teams, and Crisis Stabilization Unit on referral protocols, resources, and crisis response. CONTACT Helpline and CONTACT The Crisis Line will receive funding through contracts from the Mississippi Department of Mental Health to maintain and expand the workforce to respond to increased Lifeline call volume due to 988 implementation.

Montana's 988 capacity building project is aimed at developing crisis center capacity in order to provide in-state suicide prevention and mental health crisis services, via call, chat and text modalities to all Montanans. It utilizes evidence-based best practices in call handling and follow-up to reduce suicides and other mental health crisis. In coordination with the state's crisis resource referral network, 211, Montana 988 will improve the relationship between call centers, 911 PSAP, mobile crisis response elements, crisis stabilization resources and county crisis coordinators to achieve an "air traffic control" level of crisis response. This program will be structured and evaluated based on eight goals: 24/7 crisis call services, the development of sustainable funding streams, the addition of chat and text modalities, sustaining Lifeline operational standards, requirements and performance measures, the creation and sustainment of a 988 stakeholder coalition, the maintenance of a comprehensive, updated listing of crisis resources and referral pathways, the assurance of best practice follow-up service from call centers and the planning and implementation of 988 marketing. This project will ensure that populations at especially high risk for suicide, such as American Indian and veteran populations are served and that organizations that represent their interests are involved in the planning and development of services.

The State Mental Health Agency - the North Carolina (NC) Division of Mental Health, Developmental Disabilities, and Substance Abuse Services (DMHDDSAS) - proposes to expand implement of the single NC National Suicide Prevention Lifeline (NSPL) all Center to meet current and future 988/Lifeline response (call/chat/text/follow-up, and related functions). NC is a geographically, culturally, and demographically diverse state that is currently home to over 106 million residents (2020 US Census). NC Department of Health and Human Services (DHHS), DMHDDSAS, is partnering with the one statewide NSPL call center, REAL Crisis Intervention, INC. (REAL) in Greenville, NC. REAL is a long-standing proficient NSPL network member and accredited by the American Association of Suicidology (AAS) and International council for Helplines (ICH). Since 2012, the NC DMHDDSAS has partnered with REAL in implementing the NC NSPL call center 24/7/365 in all 100 NC counties. The three goals include: NC 988 NSPL call center operated by REAL, will respond intervene and provide follow-up to individuals experiencing a behavioral health crisis starting June 15, 2022; NC 988 NSPL call center will increase capacity to meet 988 projected call demand as a part of the unified national 988 NSPL response starting June 15, 2022 ; and NC 988 NSPL call center will meet minimum key performance indicators in coordination with NSPL/Vibrant Emotional Health an SAMSHA starting June 15, 2022. The NC DMHDDSAS seeks the funding through this grant to support the workforce development of REAL for the increased staffing needed for the implementation of 988. Vibrant has estimated a 30% increase in call volume and has reported that NC is in the top 15 states for chats/texts. REAL will need additional crisis counselors, supervisors, follow up crisis counselors, outreach coordinators, a data supervisor, and ASIST coordinator, and staff trainers to meet Key Performance Indicators (KPI's) required by the NSPL and state including but not limited to maintaining/increasing instate answer rates, times to respond to incoming call/chat/text, follow up outreach, linkage to community resources/providers.

In North Dakota, primary Lifeline call and text coverage for all of the state's 53 counties is served by a single Member crisis center, FirstLink. This funding would build capacity- to address several key gaps in service preparation for the launch of 988 in July 2022. 1) Additional staffing to answer the increase in projected call volume; 2) Integration of Vibrant's unified chat platform as well as staff and training; 3) Capacity building for follow-up services to open services for all contacts regardless of screened lethality.

Nebraska's 988 Implementation Cooperative Agreement and Enhancement project is a collaborative effort between the Nebraska Department of Health and Human Services (DHHS), Division of Behavioral Health (DBH), Boys Town National Hotline (BTNH), and University of Nebraska Public Policy Center. This project is designed to serve Nebraska's approximate 1,963,692 population. Just over half of Nebraska's population is between the ages of 19 and 64. Nebraska's landscape is both urban and rural, and is largely populated by persons who identify as white, not Hispanic or Latino. Boys Town National Hotline serves all of Nebraska's 93 counties with a 27/7/365 access to Lifeline crisis calls for all ages. In 2020, BTNH Lifeline locally offered calls totaled 9,976, with 8,894 answered for an answer rate of 89%. Call volume is projected to increase for crisis call centers when 988 is implemented. The lowest level of projected 988 call volume growth (50%) would increase the number of calls the NE Lifeline receives daily from 30 to 45 per day. Utilizing a high call volume growth projection, the number of calls daily would increase from 30 to 72 per day. In addition, BTNH is expected to receive texts and chats which they do not currently respond to. Given the increased volume projections, expanding the BTNH crisis center behavioral health workforce will allow enhanced response, intervention, and follow-up to individuals experiencing a behavioral health crisis. DHHS, BTNH, and the University will work together to build capacity of Nebraska's 988 call center to handle the increased contacts (calls, texts, chats, etc.) and meet the goal of answering 80% of instate 988 calls and respond to 75% of texts and chats during the testing phase. The team will work to establish shared protocols in place for the connection of local crisis response services to the caller, and to incorporate follow-up services for callers.

NH will use 988 capacity resources to expand and enhance NSPL resources in a variety of ways. NH will hire a Crisis Center Coordinator to ensure that Lifeline Centers have a unified and uniform 988 response (service delivery, training, partnerships, data) across the state. NH will also expand staffing and infrastructure to ensure that text and chat functionality is successfully implemented. Furthermore, NH will utilize cultural brokers from various communities to ensure NSPL services are culturally relevant and accessible.

New Jersey is committed to developing a comprehensive crisis response system that will respond to 988 calls, chats and texts originating in this state. This project will build the capacity of NJ's current Lifeline centers to ensure the appropriate level of response, linkages and follow up for individuals who reach out to 988. The system is designed to serve people who are experiencing a mental health crisis or suicidal ideation as well as family and friends of these individuals. In 2020, the Lifeline received 55,068 calls from NJ and according to the Growth Model offered by Vibrant, it is expected that New Jersey will receive between 119,000 and 187,900 calls annually by year 5 of the 988 roll out. This will require a significant increase in response capacity beginning with the launch of 988 in July, 2022. In addition, NJ plans a "no wrong door" structure for the 988 system. To meet this expectation, staff will be trained to respond to contacts from or about adults, children and youth, and people with developmental and intellectual disabilities. Therefore, in addition to preparing for the anticipated increase in volume, centers must train new and existing staff regarding de-escalation skills, crisis rescue services, and comprehensive referral options. In preparation for the grant award, DMHAS will develop a Request for Letters of Intent (RLI). This RLI will offer funds to the 5 current Lifeline call/contact centers in New Jersey (NJ) with the goal of quickly building their capacity (staff and/or technology) to respond to calls, chats and texts that come into the centers through 988. Project Goals 1. Maintain contact center infrastructure and ensure 24/7/365 coverage for 988 calls. 2. Identify ongoing funding for statewide 988 crisis response system. 3. Improve statewide answer rate for mental health crisis and suicide prevention calls. 4. Expand capacity to enhance response system for coverage of 988 calls, chats and texts. Measurable Objectives 1. By May 16, 2022, New Jersey will award funding for capacity building to up to 5 (current) Lifeline contact centers. 2. By June 15, 2022, New Jersey will achieve and maintain an in-state answer-rate of 90% or higher. 3. By June 30, 2022, New Jersey will establish 24/7/365 in-state primary coverage for all counties. 4. By September 29, 2022, New Jersey will submit a plan for responding to Lifeline chat and text requests initiated within the state. 5. By March 30, 2023, New Jersey will submit a sustainability plan for long-term workforce capacity and KPI metrics. 6. By June 30, 2023, New Jersey will ensure 100% coverage of calls and more than 90% percent statewide answer rate. 7. By June 30, 2023, New Jersey will establish 24/7/365 in-state primary and backup coverage for Lifeline Calls

The purpose pf Building NM 988 Capacity is to expand the capacity of New Mexico to respond to 988 contacts originating in our state by recruiting, hiring, and training behavioral health workforce to staff local 988/Lifeline centers to respond, intervene and provide follow-up to individuals experiencing a behavioral health crisis. This project will be implemented across New Mexico (NM), which is among the most ethnically diverse states in the continental USD (48% Hispanic, 36.9% White, 9.6% Native America [NA], 13.2% Other) There are 22 federally recognized tribes in NM. including 19 Pueblos, 2 Apache reservations, and part of the Navajo Nation. Roughly half of the population are women (505.5%) , and 30% are under the age of 21. The goals of this initiative are to: (1) increase capacity for NM's call centers to respond to 988 calls, texts and chats; (2) Provide training to call center staff on suicide prevention and referral options for high risk populations; (3) Develop the infrastructure to sustain 988 call center capacity after funding ends; (4) Utilize program evaluation to ensure continuous quality improvement. Strategies include: hiring new workforce to respond to 988 calls, chat and text, ensuring training on suicide prevention and referrals options for higher care, developing a quality improvement plan, developing a sustainability plan and conducting evaluation activities. Objectives include: answering 90% of calls received, hosting annual trainings on suicide prevention and referral options, and the development of plans for the following activities: response to 50% of chats and texts, quality improvements, sustainability, and ensuring that all individuals at imminent risk of suicide are receiving follow up services. New Mexico anticipates servicing at least 18, 467 individuals through the course of this initiative.

The Nevada Department of Health and Human Services (DHHS), Division of Public and Behavioral Health (DPBH), Bureau of Behavioral Health Wellness and Prevention (BHWP), which serves as the Nevadas Mental Health Authority is applying for the FY 2022 Cooperative Agreement to Build Capacity for Nevadas 988 program in collaboration with the Crisis Support Services of Nevada (CSS-NV), Nevadas only Lifeline member organization. CSSNV has been providing a crisis hotline in Nevada since 1966 and is one of only 9 National Suicide Prevention Lifeline call centers in the nation. For over 4 decades, DPBH and CSSNV have enjoyed a long-standing relationship based on the shared commitment and vision to ensure every Nevadan has the Lifeline available to them during times of crisis. Over the past several years, the relationship between DPBH and CSS-NV has included efforts to increase capacity for both in-state answer rates for call and text through additional staffing, increased awareness of the crisis line through media and messaging campaigns, enhanced data collection and reporting for CSSNV crisis lines, expanded opportunities for referral to services and follow-up with case management. Of these efforts, expansion of the CSSNV workforce has and remains a primary need to meet both current and future 988 response for crisis calls and texts and appropriate follow up. The addition of a chat feature for the crisis line is a needed feature and is addressed in the 988 implementation plan. Workforce expansion has been funded, in part through the Lifeline Capacity Expansion Grant, Crisis Counseling Assistance and Training Program (CCP), Community Mental Health Services Block Grant, state general fund. Current workforce expansion funding includes CDC Health Disparities grant, SAMHSA COVID Supplemental Block Grant, and Mental Health Block Grant. Most recently, the Vibrant 988 Planning Grant supported DPBH, CSSNV, and the statewide 988 planning coalition to evaluate CSSNVs current capacity to answer in-state crisis calls, chats, texts, project in-state calls, chats and texts over the first two years of 988 implementation and to develop an implementation plan to meet all of the 988 implementation plan requirements including key performance indicators (KPIs) such as 90% in state answer rate and speed for call answering under 20 seconds. The 988 Implementation plan identified an immediate need to address the significant shortfall of funding to address the staffing shortages needed to increase answer rates from 74.5% in 2021 to 90% and to reduce call wait times from 35 seconds to 20 seconds.

The NYS Office of Mental Health is committed to ensuring that New Yorkers experiencing a behavioral health crisis have equitable access to inclusive, high quality 988 services from NYS Lifeline crisis centers that are familiar with and dedicated to their community. This will be done by expanding workforce and Lifeline crisis center capacity through NYS. This project will serve all individuals whose calls originate from NYS that are experiencing a behavioral health crisis and contact 988. NYS estimates that 988 will receive up to 996,000 contacts in its first year of operation, with that number expected to increase the following year. Because this project will touch all facets of NY's 988 operations, we estimate that between 1-2 million people will be served through the duration of the project. Expansion of workforce and Lifeline crisis center capacity in NYS will be achieved by hiring a larger crisis center workforce, streamlining center operations, fortifying the network of backup centers, broadening the availability of chat/text services and ensuring proper connections to community services. NYS has developed seven goals for this initiative. These goals are related to access, capacity, sustainable funding, consistent standards and stakeholder involvement at the core of planning. To achieve these goals, NYS has outlined 26 objectives which set priorities and targets for progress and accountability. The themes depicted in the objectives include 24/7 geographic coverage, target percent answer rates, standardized training and governance functions, follow-up and linkage procedures, and targets for expanded crisis services. The intention of all goals and objectives is to focus on three specific areas: 1. The recruitment, hiring and training of behavioral health workforce to staff local 988 centers to respond, intervene and provide follow-up to individuals experiencing a behavioral health crisis. 2. Engagement of Lifeline crisis centers to unify 988 response across the state. 3. Expansion of crisis center staffing and response structure needed for the successful implementation of 988 in NYS. When NYS successfully achieves the goals and objectives outlined in this project, we expect that all calls originating in NY will route to a NY Lifeline crisis center, in-state response rates to 988 contacts will reach 90% and NY's capacity to meet 988 crisis contact demand for New Yorkers experiencing behavioral health crises will increase. For an in-depth review of all goals and objectives, Section B.

Ohio's 988 Capacity and Quality Improvement Development Project will be guided by two goals that align with Ohio's 988 transition needs and support and enhance Ohio's Lifeline 988 workforce, while unifying 988 responses across Ohio and improving in-state answer rates. These goals will be accomplished through a Community of Practice with Ohio's Lifeline providers, the 988 Connect planning committee, stakeholders, and the Lifetime administrator: Goal 1 is to expand Ohio's Lifeline 988 workforce through recruiting, hiring and training at the provider level, and Goal 2 is to engage Lifeline crisis centers to unify 988 responses across the state and improve rates to meet minimum key performance indicators. Additionally, Ohio will be expanding its capacity to provide chat and text services once geolocation of chats and texts is available.

The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) is seeking $1,047,986 in response to the FY22 Cooperative Agreements for States and Territories to Build Local 988 Capacity from the Substance Abuse and Mental Health Services Administration (SAMHSA). Following the SAMHSA 'someone to talk to, someone to respond, and somewhere to go' model, ODMHSAS proposes to utilize project funds to support this overarching crisis infrastructure goal by addressing gaps in the state's current National Suicide Prevention Lifeline (NSPL) capacity. While ODMHSAS is preparing the launch of the statewide 988 call center by July 2022, these funds will support the center in creating capacity to answer the veteran and Spanish language NSPL network lines. The ODMHSAS proposes the following project goals which complement the significant investments already made into building the capacity of Oklahoma to comprehensively address Oklahomans in crisis. ODMHSAS has released a Statewide 988 Call Center RFP which closed January 18, 2022. Received bids are currently under evaluation with a contractor to be selected and operating by July 2022. Bidders are required to either be an existing Oklahoma NSPL, receive Oklahoma NSPL accreditation, or enter into a consortium agreement with an Oklahoma NSPL. The selected vendor will be the statewide 988 call center (Center) vendor. Goal 1: Increase the Oklahoma NSPL answer rate to 100% while maintaining an average speed of answer below 90 seconds. Goal 2: Provide consistent availability of partner lines for all Oklahomans engaging the NSPL. Goal 3: Provide statewide 24/7 access to text and chat for all Oklahomans engaging the NSPL. Goal 4: Create in-state ability to answer Spanish and Veteran Crisis Network calls to the NSPL. Goal 5: Increase statewide crisis staffing knowledge and capacity. Goal 6: Develop NSPL technology capacity to provide the SAMHSA 'Air Traffic Control' type call center functions necessary for 988 success. In order to reach the project goals, the ODMHSAS will provide 85% of project funds to the Center through outcomes based incentive payments made upon establishing capacity to answer the veteran and Spanish language network line.

Oregon has two Lifeline Centers: Lines for Life which covers the entire state, and Northwest Human Services which covers two counties. Although, currently, Oregon has no coverage gaps for call, the implementation of 988 will require additional workforce capacity to meet increased demand. Oregon Health Authority (OHA) intends to use the SAMHSA grant funds to primarily help Oregon's Lifeline Centers assess, hire, and train the minimum required increased workforce to meet SAMHSA and Vibrant's projected call volume in year one of 988. Vibrant estimates that approximately 10-15% of current 911 call volume will shift to the 988 call centers. According to OHA's independent consultant, Oregon's 988 call volume is anticipated to go up to 118,000 in the first year, with gradual increase to 240,750 annually over five years. In addition, for call centers to be adequately accessible to youth, it is critical that 988 call centers include the technology and the staffing to support both texting and chat capabilities as early as possible. While OHA aims to ensure that Oregon's Lifeline Centers hire the needed workforce to meet the demand of 988 call volume no later than June 15, 2022, general workforce shortage and time needed for contract execution, hiring, and training has been identified as a risk.

Responding to an increase in call, text, and chat volume after the national transition to a 3-digit crisis number is a major priority for Pennsylvania. Through strategic increases in staffing and incentives across all 13 call centers responding to the National Suicide Prevention Lifeline, Pennsylvania aims to exceed an in-state answer rate of 90%, while responding to calls, texts, and chats within 20 seconds of contact and reaching an estimated more than 300,000 people annually with crisis response services. While Pennsylvania's goals for crisis expansion extend beyond 988 crisis call, text, and chat response and cover the full crisis continuum, the following goals and measurable objectives will drive the focus of this grant program: -Continue statewide Advisory Board, planning committees and the 911-988 subcommittee to facilitate the transition and growth of 988 call services.-Ensure statewide 24/7 service for 988 calls, texts, and chats by transitioning all centers to 24/7 coverage, collecting monthly data on calls, texts, chats; staff hiring, departures and needs; and by notifying Vibrant within 24 hours when temporary redirects are needed due to staffing, technical or demand issues affecting call centers operations. -Reach and maintain statewide metrics for 988 calls, texts, and chats, which includes maintaining in-state call, text, and chat answer rates of 90% or higher over time; answering at least 95% of calls, texts and chats within 20 seconds and maintaining an in-state abandonment rate of less than 5% for all services. -Adopt a unified platform for managing electronic health records (EHR) across all call centers and other areas of the crisis continuum, including mobile crisis and crisis stabilization; identifying an EHR platform that can be used across call centers; and adopting mobile crisis and crisis stabilization no later than January 2024. In addition to SAMHSA and Vibrant as valued partners and counsel, the department has myriad partners that enable this work to move forward efficiently, collaboratively, and effectively. Partners include: The Pennsylvania Emergency Management Agency, the Pennsylvania departments of Health, Drug and Alcohol Programs, Aging, Insurance; and an extensive advocacy and stakeholder list that reaches all demographics, including youth, seniors, those with substance use disorder, family members of those with mental health needs, vulnerable populations that include Black, Brown, and Asian American/Pacific Islanders, community members, veterans, and the LGBTQ+ community. Utilizing a data-driven approach, the project team will collaborate with all 13 call centers to identify strategies needed to increasing staffing, while being responsive to all Pennsylvanians, to ensure successful completion of the key performance indicators. While it is difficult to determine exactly how many Pennsylvanians will be impacted by these initiatives, projections offered by Vibrant suggest an annual call volume exceeding 291,000 contacts. However, with 3.12% of all calls to 988 currently originating from Pennsylvania and a 14 million medium projection of total calls to 988 by year 2, call volume may exceed 438,000.

Puerto Rico's Mental Health and Anti-Addiction Services Administration (MHAASA) will ensure statewide coverage for 9-8-8 calls, chats and texts through the PAS Line (First Psychosocial Help Line), under the Integrated Crisis Intervention Program (ICIP) of the MHAASA, the government agency in charge for the mental health and substance abuse (MH/US) disorder in PR, and for state crisis counseling services in situations of natural disaster, and now COVID-19. Through the FY 2022 Cooperative Agreements for States and Territories to Build Local 988 Capacity, the PAS Line will achieve capacity building for current and projected 9-8-8 volume for calls, texts, chats and follow-up services. Currently, there are no centers in PR members of the National Suicide Prevention Lifeline (Lifeline) 9-8- 8. Operating since 2001, the Pas Line provides crisis hotline services, 24/7, for the population of the 78 municipalities of PR and will be the site of the 9-8-8 implementation. Forty-six (46) case managers work as telephone counselors of the crisis hotline, working under three (3) supervisors. The services are available for teens and/or college aged youth (13-24), older adults (55+), the deaf and hard of hearing, domestics violence survivors, and the LGBTTQ community, among others. It is a member of the Suicide Prevention Commission which is the key stakeholder coalition of 12 government agencies, the federation of Majors, four (4) private sector representatives, and two (2) community organizations' representatives that provide services to persons at risk of suicide, plus one (1) family member of a suicide case. This coalition will be invited to serve as the 9-8-8 implementation/key stakeholders' coalition of the Puerto Rico 988 Cooperative Agreement. While there is no Lifeline center at this time, the PAS Line of the MHAASA will sustain a contact center capacity to maintain a 90% in-state answer rate 9-8-8 contacts. Due to consistent federal funding sources, the PAS Hotline has the capacity to meet all Lifeline project requirements. A total of 22,008 calls were received from people with suicidal behavior in 2021, when calls related to COVID-19 and the natural disasters impacting Puerto Rico were more prevalent. The PAS Line has a current answer rate of 97%. The MHAASA is willing to make a commitment to make a good faith effort to work collaboratively with Lifeline member call centers to continue to exceed an 90% answer rate by the end of the Project. A project director will oversee the implementation of the project and an evaluator will measure process aspects and outcomes, with resulting data, including GPRA, to be submitted in SAMHSA reports and use to improve procedures and services over the 2-year grant period. A total of $250,000 is requested for the grant period, to cover the project required and allowed activities implementation and data collection and evaluation.

The SC 988 Comprehensive System of CARE (SC 988) Cooperative Agreement will further build SC mental health crisis intervention infrastructure, with 988 being the central piece in response, intervention, and follow-up during a mental health crisis. This infrastructure will result in increased in-state answer rates, improved key performance indicators, and increased capacity to meet 988 crisis contact demand. These activities will ensure SC is part of the unified 988 response across the US. The COVID-19 pandemic is predicted to not only worsen mental health symptoms for those living with serious mental illness but may also lead to an increase in new mental health patients. SC EMS call volume for self-harm has increased 53% when comparing 2020 vs. 2021. Other major issues include identifying a decision tree between 988, SCDMH, 911, and other partners such SC Department of Alcohol and Other Drugs (DAODAS) for continuity of care. Aim 1: Enhance workforce capacity through recruitment, hiring, and training of local 988 staff and adding an additional call center in SC The SC 988 grant will help reach the goal of at least 90% of total 988 calls answered in SC by June 15, 2022 by: 1. Expanding the 988 crisis center workforce by hiring more MHAGC Call Center staff for 988 operations. 2. Developing an additional 988 call center for SC to increase capacity in SC through SCDMH. 3. Building text and message answer capacity. Aim 2: Build SC's 988 Crisis Center's response infrastructure that is needed for the successful implementation of 988, including areas around crisis response, intervention, and follow-up. In order to build SC's capacity to implement 988, the following infrastructure activities will occur: 1. Train 8 new MHAGC and 5 MC workforce staff members to better prepare them to work with high-risk populations. 2. Facilitate a 988 Advisory Board to coordinate infrastructure development between all partners. 3 Evaluate current activities and develop a plan for implementing referral and follow-up services. 4. The Program Director (PD), Project Coordinator (PC) and Evaluator will immediately start work with the 988 Advisory Board partners to ensure required data is collected. 5. The 988 Advisory Board will work with the PD and PC to develop a sustainability plan.

South Dakota 988: Building Local Capacity is a joint venture undertaken by the state's only Lifeline crisis center, Helpline Center, and the Department of Social Services, Division of Behavioral Health to rapidly mobilize the necessary workforce for 988 call center expansion and projected ramp-up over 988's nationwide launch beginning July 2022. This cooperative agreement will serve as the foundation for which to build sustainable performance indicator monitoring that can be leveraged for years to come as 988 services expand, and as relationships are formalized between Public Safety Answering Points/911 services and referral-accepting organizations in the area of crisis response and receiving facilities. Given the fact South Dakota is a relatively population state, but with considerable geographic challenges in its frontier/rural nature, the population to be served will be all South Dakotans experiencing behavioral health crisis with specific focus on those impacted by health disparities or limited referral access to appropriate levels of care as close to their home communities as possible. South Dakota's Behavioral Health Crisis Response Stakeholder Coalition (BHCRSC, or 988 planning coalition) was formed in February 2021 and met monthly under the leadership of the South Dakota Department of Social Services, Division of Behavioral Health (DSS-DBH) to inform the development of the State's 988 implementation plan as part of the grant funded by Vibrant Emotional Health. This project builds upon the work completed and outlined by the 988 planning coalition, highlighting the need for additional workforce capacity to operationalize 988 call center capacity. The Helpline Center began serving South Dakota in 1974. Through the years, the agency was formalized with staff, grew to 24/7 services, and was the first location west of the Mississippi River to begin 211 services. The Helpline Center services thousands of people every year by connecting individuals to resources and support, connecting local agency volunteers, and offering hope to individuals with thoughts of suicide. The Helpline Center is the only entity in the state accredited by the Alliance for Information and Referral Systems, and the only entity in the state that provides a certified crisis line through the American Association of Suicidology. The Helpline Center is in the process of creating a separate division to house the 988 call center, with shared administration services provided by existing Helpline Center staff. The new 988 call center will be housed in the same location as the existing 211-based information and referral call center, but staffed separately due to the unique staff qualifications required for answering 988 calls. The implementation approach centers on four key goal areas, all of which build off of initial planning efforts outlined in the state's 988 implementation plan. Key areas of focus center around workforce capacity building, supported by additional funding through this program, along with further refinement and definition of key operational and quality improvement protocols to support and sustain 988 call center staff. The 988 planning coalition will continue to convene as an advisory resource for the Directors and Helpline Center team and will be instrumental in the development of follow up protocols that extend into local care settings as well as on identifying crisis workforce training needs across the full continuum that ultimately increases access to quality, responsive behavioral health care for South Dakotans experiencing crisis. Key performance indicators and other measure s have been identified in alignment with existing NSPL metrics, the required SAMHSA infrastructure, prevention and promotion indicators, and those that will aid the state in understanding 988 call center workforce staffing, partnership development, and the disposition of people supported by 988 call center staff as capacity expands and public awareness.

The proposal for the Tennessee 988 State and Territory Cooperative Agreements Grant provides justification for the funding necessary to support enhancement of Tennessee's NSPL infrastructure for crisis calls, texts, and chats. Additionally, through this work, data will be collected to inform downstream impact to the current crisis continuum for both current and future calls, chats, and texts that originate in Tennessee as a part of the NSPL network. Provision of effective services to these individuals is essential in ensuring they relate to services that are, very often, lifesaving. Utilizers of 988 to call, text or chat in Tennessee will receive effective and efficient screening, triage, intervention, and referral services to ensure that they are met with appropriate resources in diffusing the crisis and normalize behavioral health concerns, along with the resources to assist in navigating these. The Tennessee Department of Mental Health and Substance Abuse Services has a long-established partnership with the six Tennessee based NSPL providers, ensuring that services are available to individuals in all 95 counties across the state. Through the implementation of this grant project, it is the goal to enhance capacity and data collection efforts to ensure the Tennessee meets or exceeds 90% total contact handle rate. Additionally, TDMHSAS will utilize data to identify needed capacity downstream as a result of potential increase post July 2022, along with utilization for quality assurance measures and overall program development.

The Texas Health and Human Services Commission (HHSC) is applying for the 988 State and Territory Cooperative Agreement in order to improve Texas' response to 988 contacts originating in Texas. If awarded, HHSC plans to implement a multi-pronged approach to improve its 988 response, including the in-state answer rate, and take meaningful steps towards achieving key SAMHSA funding targets and performance indicators. In order to achieve these goals, HHSC will continue to leverage its existing robust crisis continuum and conduct a comprehensive review of current statewide capabilities to inform future direction during the project period which may include, but not be limited to, contracting or subcontracting with entities to expand in-state Lifeline services capacity. HHSC plans to continue building off the work accomplished through the National Suicide Prevention Lifeline Capacity Building Grant SAMHSA awarded to HHSC for federal fiscal years 2020 and 2021. At the start of the grant period (October 2019), Texas' in-state answer rate was 30 percent and at the close of the grant period (September 2021), the in-state answer rate increased to 39 percent. Throughout the grant period, MHMR Tarrant answered 12,460 Lifeline calls, Emergence answered 9,497 calls, Integral Care answered 22,889 calls, and The Harris Center answered 35,689 calls. Additionally, through the work of the 988 Planning Grant, coalition members representing various agencies vested in the interest of reducing suicide and mental health crises in Texas, convened over several months to develop a roadmap for Texas' implementation of 988/Lifeline services. HHSC has already begun implementing the coalition's recommendations, which will further increase Texas' footprint in ensuring 988/Lifeline service calls originating in Texas are answered locally and resources are made available to any person who contacts 988/Lifeline. HHSC and its partners are strongly committed to working towards the minimum required in-state answer rate of 90 percent by the end of the fiscal year 2024. HHSC will contract with partners to ensure efforts are increased in recruiting, hiring, training, and expanding the behavioral health workforce in Texas to uniformly respond locally to persons who call, chat, or text into 988/Lifeline services. Based on Vibrant's 2021 Lifeline data of actual number of calls offered to Texas Lifeline centers, the anticipated number of calls answered during the grant term is 329,108; the number of persons served as a result of the award of this grant may vary to account for multiple contacts to the Lifeline per person served and any increase in contacts to the Lifeline after the 988 rollout.

Utah's greatest need is to expand capacity to respond to 988 calls, texts, and chats. Through the use of State General Funds as appropriated by the State Legislature, Utah's funding supported 113,685 contacts in 2021, 18,845 being calls answered as routed through the National Suicide Prevention Lifeline. Capacity challenges are primarily related to the massive workforce shortages within the state, with the public mental health sector reporting over 650 vacancies of qualified professionals. Utah's emphasized priorities are to enhance in-state answer rates to 90% and beyond, while preparing for increased volumes related to 988 and the assumption of text and chat contacts. Utah shall offer distribution of funds to statewide crisis center to maintain and expand the workforce to respond to an increase in lifeline call volume due to 988 implementation; Expand the ability of local, regional and/or statewide/territorial Lifeline crisis centers to respond to sudden and large spikes in call volumes following a public service announcement, disaster, or other type of traumatic event; work to ensure that the state targets to answer at least 90 percent of total calls received, potentially reducing the amount that goes to the national backup centers to 10 percent or less by June 15, 2022; work to ensure crisis workforce receives training on working with populations at higher risk of suicide in their communities, including awareness of referral options for high risk population-specific services. Key performance indicators will be monitored and used to inform practice, quality improvement initiatives, and hiring efforts.

There is a need to increase capacity at each participating call center to meet the expected increased demand. The goals in this area are statewide, and include: increase our in-state answer rate to 90% by the end of the grant period, answer 95% of calls within 20 seconds and 90% of calls within 15 seconds by the end of the grant period, and achieve an abandonment rate of less than 5% and a rollover rate less than 10%. In the interim, these investments will focus on decreasing our national rollover rate to 15% by July, 2022. To reach these goals, a range of capacity building activities will be required at the call center level. Thus, DBHDS will enter into subrecipient funding agreements with the regional call centers as well as all other NSPL call centers in the state. The focus of partnerships with call centers who are not directly contracted for a region will be to build collaborative relationships and assess call patterns and build capacity to serve as a back up call center. Each call center (regional as well as back up) will submit a detailed plan in terms of the specific approach to increasing capacity, and will be required to participate in monthly Crisis Workforce Innovations meetings with partners across the state. Plans will include activities designed to ensure responses during times of spikes in call volumes or public events.

The Virgin Islands Division of Behavioral Health and Drug Dependency Services (BHADDS) is a division within DOH's Public Health Services charged by Act 4039, Title IXX, V. I. Code with establishing, administering and regulating programs designed to offer prevention, treatment and recovery intervention in the areas of substance abuse prevention, substance abuse treatment, behavioral health and residential services to our territory's adults and children. Health care, public education and social services are provided as entitlements, by the United States Virgin Islands (USVI) Government, to all residents of the USVI. The Virgin Islands Department of Health Division of BHADDS is the Single State Authority (SSA) for the Substance Abuse Prevention and Treatment Block Grant (SAPT BG) and Mental Health Block Grant, which is administered by the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration (SAMHSA), Center for Substance Abuse Treatment (CSAT) and Center for Substance Abuse Prevention (CSAP). BHADDS serves as the lead organization in a continuum of services to support prevention, early intervention, treatment and recovery support services for youth and adults with behavioral health needs. BHADDS prioritize services that meet the needs of the individual, family, and community. Unlike many US states, BHADDS not only establishes, administers, and regulates behavioral health services in the Territory but also functions as a direct provider of several services in the service delivery continuum. The Territory leverages partnerships and local funding as key components in building a broad system of treatment, prevention and recovery support that meets the behavioral health needs of its residents.

According to the Suicide Prevention Recommendations 2020 Report to the Legislature, Suicide is the eighth leading cause of death in Vermont overall and the second leading cause of death for Vermonters age 15 to 34. Rates of death from suicide in Vermont are higher than- and increasing at a faster rate than- the national average. The funding from this opportunity will enable Vermont to increase capacity across both primary Lifeline Centers to meet established target rates for chat and text services while not affecting call coverage and capacity, coordinate efforts with stakeholders, develop quality improvement and sustainability plans, and assess training opportunities around high-risk populations.