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The Zunis are a resilient Native American tribe of 10,000 people in the high-desert plateau of Western New Mexico. Despite their rich history they face many challenges resulting from centuries of historical trauma including high suicide rates and substance dependence with over 500 emergency room visits for these issues per year. The Zuni Youth Enrichment Project (ZYEP) will implement a comprehensive program to address these issues that will focus on service coordination and multi-tiered service provision. There are many youth-involved organizations working in Zuni, but they do not currently collaborate in a coordinated and effective manner. ZYEP is a local 501c3 non-profit tribal organization that has worked to increase the resiliency, physical, and mental health of Zuni youth for the past ten years. Through this grant, ZYEP will address these gaps. Our first goal is to increase the capacity of Zuni organizations to prevent and reduce suicidal behavior and substance use, reduce the impact of trauma, and promote mental health. Our second goal is to develop a Zuni-specific model that incorporates evidence-based practices to reduce and respond to the impact of trauma and mental and substance use disorders. Third, we will develop a more efficient system of collaboration and referral between Zuni youth-involved organizations. Additionally, we have the following objectives: 80% or more of staff in Zuni youth-involved organizations will: 1) complete trainings as mental health first aid responders; 2) complete a training in trauma informed care. Other objectives include that we will convene a consortium of Zuni leaders and a Youth Tribal Council where we discuss evidence based practices and how to adapt existing models for use in Zuni. Third, we will disseminate our findings to partnering organizations and the Zuni Tribal Government and develop and implement a three-tiered action plan. Our final objectives are to hold a meeting of all partnering Zuni organizations to discuss available resources and to develop a referral path. In accomplishing these goals and objectives, we will first conduct a community system analysis, needs assessment, readiness assessment, and asset map. We will develop a set of protocols for Zuni youth involved organizations to implement standards of care, transitions of care, incorporating evidence based clinical practices, and local traditional healers and leaders and will work with local youth-involved organizations to implement these protocols. Finally, we will develop an action plan to provide three tiers of prevention strategies. These will include a first tier for all youth with year-round youth programming. The second tier for higher risk youth will consist of 12-week internship programs. The third tier will be for high-risk youth and will consist of the services provided in the other two tiers in addition to access to a comprehensive multi-disciplinary case management program that will provide highly coordinated primary care, mental health, nutrition, legal assistance, and social work services. All activities will be conducted closely with a native youth tribal council, as well as consultation with local Zuni leaders. We will serve 500 youth in year one and annually.

The Zunis are a resilient Native American tribe of 10,000 people in the high-desert plateau of Western New Mexico. Despite their rich history they face many challenges resulting from centuries of historical trauma including high suicide rates and substance dependence with over 500 emergency room visits for these issues per year. The Zuni Youth Enrichment Project (ZYEP) will implement a comprehensive program to address these issues that will focus on service coordination and multi-tiered service provision. There are many youth-involved organizations working in Zuni, but they do not currently collaborate in a coordinated and effective manner. ZYEP is a local 501c3 non-profit tribal organization that has worked to increase the resiliency, physical, and mental health of Zuni youth for the past ten years. Through this grant, ZYEP will address these gaps. Our first goal is to increase the capacity of Zuni organizations to prevent and reduce suicidal behavior and substance use, reduce the impact of trauma, and promote mental health. Our second goal is to develop a Zuni-specific model that incorporates evidence-based practices to reduce and respond to the impact of trauma and mental and substance use disorders. Third, we will develop a more efficient system of collaboration and referral between Zuni youth-involved organizations. Additionally, we have the following objectives: 80% or more of staff in Zuni youth-involved organizations will: 1) complete trainings as mental health first aid responders; 2) complete a training in trauma informed care. Other objectives include that we will convene a consortium of Zuni leaders and a Youth Tribal Council where we discuss evidence based practices and how to adapt existing models for use in Zuni. Third, we will disseminate our findings to partnering organizations and the Zuni Tribal Government and develop and implement a three-tiered action plan. Our final objectives are to hold a meeting of all partnering Zuni organizations to discuss available resources and to develop a referral path. In accomplishing these goals and objectives, we will first conduct a community system analysis, needs assessment, readiness assessment, and asset map. We will develop a set of protocols for Zuni youth involved organizations to implement standards of care, transitions of care, incorporating evidence based clinical practices, and local traditional healers and leaders and will work with local youth-involved organizations to implement these protocols. Finally, we will develop an action plan to provide three tiers of prevention strategies. These will include a first tier for all youth with year-round youth programming. The second tier for higher risk youth will consist of 12-week internship programs. The third tier will be for high-risk youth and will consist of the services provided in the other two tiers in addition to access to a comprehensive multi-disciplinary case management program that will provide highly coordinated primary care, mental health, nutrition, legal assistance, and social work services. All activities will be conducted closely with a native youth tribal council, as well as consultation with local Zuni leaders. We will serve 500 youth in year one and annually.

The Zuni Youth Enrichment Project (ZYEP) will implement Zuni Connections, a community driven, culturally responsive, and evidence-based program designed to promote mental health and prevent suicide among youth, ages 6-24, in Zuni Pueblo, New Mexico. This will be accomplished through the following project activities: 1) providing a year-round schedule of programming that promotes protective factors and adaptive behaviors and reduces risk factors and maladaptive behaviors among 500 local youth annually; 2) implement SAMHSA’s community readiness model to increase communication and collaboration on suicide prevention protocols in Zuni; 3) increase the capacity of Zuni youth serving agencies to support youth experiencing crisis by providing their staff with suicide prevention training; and 4) establish resources that increase community-wide awareness and promote the use of mental health services. Zuni Pueblo is one of the longest continuously inhabited villages in the United States and maintains one of the most intact Indigenous language and cultural systems in North America. Located in western New Mexico’s McKinley and Cibola Counties, the Zuni Reservation spans 450,000 acres, but nearly all of the 6,302 residents live in a densely populated central village. Approximately 2,531 (40%) of Zuni’s total population are under the age of 24, making youth the largest subpopulation of the Tribe (ACS 2020 5-Year Estimate for Zuni Pueblo CDP). Zuni Pueblo’s strong familial, cultural, and natural resources can make it a special place to grow up, but many youth that do face stark realities as they transition through childhood and adolescence, including high childhood poverty rates (39%), high food insecurity rates (37%), high overweight or obesity rates (43%) and suicide rates three times the national average (2022 NM Kids Count Data Book, 2019 NMDOH BMI Surveillance, 2022 ZTPP Survey). Due to intergenerational trauma, Zuni youth are exposed to adverse experiences that increase their risk of suicide. For decades, Zuni youth have reported much higher risks for depression, suicide ideation, and suicide attempts than their state and national peers (NMYRRS, 2019). Our Native Connections work gives us hope because it’s grounded in evidence and our experience that Zuni youth with a strong cultural connection report significantly lower levels of hopelessness, self-harm, suicide ideation, and suicide attempts than youth with weaker connections to culture (ZTPP Survey, 2022).

Zuni Tribal Prevention Project

The Pueblo of Zuni’s (PoZ) Prevention Project will use Tribal values, language, and culture to implement a strengths-based approach of the Strategic Prevention Framework. Prevention services will work to decrease the number of people who begin drinking before that age of 15 by offering comprehensive evidence-based programming to 10-15 year olds. PoZ anticipates accomplishing the following goals: Goal 1: Increase the capacity of the prevention team to use culturally relevant, trauma informed, outcome and evidence-based approaches to decrease the number of people who begin drinking alcohol before the age of 15. Obj 1: All staff will complete the experience and training requirements necessary to take the Certified Prevention Specialist Test within 3 years of hire. Obj 2: Staff will develop and conduct 3 trainings per year to community partners that will increase their knowledge of culturally relevant, trauma informed, outcome and evidence-based approaches to increase the age people begin drinking alcohol. Obj 3: Staff will complete training on providing trauma informed programming within the first year of funding. Goal 2: Increase the capacity of the coalition to use the SPF to decrease the number of people who begin drinking alcohol before the age of 15. Obj 1: Coalition members will be trained in a data collection protocol and will collect representative data samples per the protocol each year. Obj 2: Coalition meetings will include training sessions on culturally relevant, trauma informed, outcome and evidence-based approaches to decrease the number of people who begin drinking alcohol before the age of 15 at least 3 times per year. Obj. 3: Coalition members will review strategy level logic models to assist in the development and refinement of strategies at least 1 time per year. Obj 4: Coalition members will review process and outcome evaluation reports for each strategy at least 2 times per year. Goal 3: Decrease the number of people who begin drinking alcohol before the age of 15 by implementing comprehensive evidence-based strategies within the schools and during out of school time that are strength-based, trauma informed, culturally relevant and increase protective factors. Obj 1: 60 unduplicated 10-15-year-old girls who complete 8 sessions of relationship building program will identify and use tools to establish boundaries for healthy relationships by August 2020. Obj 2, 3, and 4 are to finalize strategic plans to implement: Positive Norms Campaign, Project Venture, School Policy Development for 10-15 year olds.

Project Summary: Zepf Center seeks CCBHC Expansion Grant funding to increase access to and improve the quality of community mental health and substance use disorder treatment in Toledo, Ohio. The CCBHC will be located in Toledo’s historic Junction Neighborhood and will allow Zepf to expand its service offerings further into the community and offer the full array of CCBHC services to persons in need. Designated Collaborating Organizations (DCOs) include Mental Health and Recovery Services Board of Lucas County (LCMHRSB), Rescue Mental Health and Addiction Services, UTMC’s Ryan White Program, Neighborhood Health Association, and Health Partners of Western Ohio. Population of Focus: The Junction Neighborhood (zip code 43607) is home to 20,854 people, 66.3% of whom are Black, 24.2% are White, and 5.2% are Hispanic or Latino. The current unemployment rate in 43607 is 7.3%, which is higher than the current county unemployment rate, the state unemployment rate and the national unemployment rate at 6.7%. Zepf Center is one of the only service providers in this neighborhood, operating a two-building campus which provides integrated care for co-occurring disorders with co-located primary care services. Total Number Served: Y1: 400, Y2: 500; Total across grant award: 900 unduplicated persons. Goals and Objectives: Goal 1: Increase the capacity of Zepf Center to provide comprehensive, integrated behavioral health services to the target population to decrease the conditions that lead to the exacerbation of mental health, substance use, and chronic disease. Objectives: (1) Within 30 days of the NoA, ensure that the CCBHC pilot location in the Junction Neighborhood is providing 100% of services. (2) By the six-month administration of the NOMS, 50% of participants will report reductions in MH symptoms and in substance use, and improvements in physical health. Goal 2: Ensure sustainability of the CCBHC so that services remain present for the target population. Objectives: (1) By the fourth month, utilize Technical Assistance (TA) funds to consult with MTM and the National Council and the Key Project staff to ensure that all requirements are met. (2) By the end of Y1, conduct the Program Sustainability Assessment Tool (PSAT) and have a plan in place that addresses the 8 domains of sustainability. Evidence-Based Practices: Zepf will focus on the implementation of two EBPs for this project: (1) Peer Support Services and (2) EMPath Mobility Mentoring. Peer Support Services are a vital part of Recovery Support Services which help people manage their substance use disorder and mental health care successfully and can contribute to successful management of their physical health care needs. Zepf’s Peer Support Specialists are called Resiliency Coaches to emphasize their focus on resilience, asset-building, and strengths. EMPath Mobility Mentoring partners with participants to help them gain resources, skills, and sustained behavior changes necessary to attain and preserve their economic independence. This practice utilizes: (1) The Bridge to Self Sufficiency Tool, (2) Coaching, (3) Goal setting, and (4) Recognition. Contact: Deb Flores, CEO; dflores@zefpcenter.org

Zepf Center, in partnership with ProMedica Flower Hospital, Mercy Health St. Charles Hospital, Northwest Ohio Psychiatric Hospital, Bethany House, the YWCA of Northwest Ohio, OhioMeansJobs Lucas County, and the Lucas County Family and Children First Council proposes the Emergency Response for Suicide Prevention Program (ERSP) in Northwest Ohio. We anticipate serving 75 unduplicated individuals over the course of the 16 months, with an anticipated start date of June 30, 2020. This project works directly with two domestic violence shelters (Bethany House and YWCA), three hospital systems, employment services, and family services to create a cross-system approach to addressing suicide due to COVID-19.

Homeless Outreach Person-Centered Engagement (HOPE) Project

Overview and Target Population: Zepf Center, in partnership with Health Partners of Western Ohio (HPWO; a federally qualified health center), Mercy Health: St. Vincent Medical Center and St. Charles, The University of Toledo Medical Center’s Ryan White Program, and Alvis present the MATTER Project, targeting 100 unduplicated individuals in need of medication-assisted treatment (MAT) for opioid use disorder (OUD) in Year One; 580 individuals over the five-year grant period. Clinical and Demographic Considerations: Ohio is still in the midst of an opioid epidemic, rising rates of suicide, and like everywhere else, is still battling through COVID-19. Ohio is grappling with the fourth highest overdose death rate in the United States (Ohio Dept. of Health, April 2018), and Lucas County is in the second-highest tier with 24.1 deaths per 100,000 people. Health is affected by bio-psycho-social factors, including poverty, chronic disease, environmental stress, acute crisis, and access to care. Income inequality may further perpetuate or exacerbate health disparities. The nature of the problem as it relates to access to MAT continues to be related to poverty levels, continued stigma surrounding substance use disorder and mental health disorder treatment, little to no insurance coverage for the target population, and low education levels which are barriers to needed services for residents in the catchment area. Experience with providing MAT: Zepf Center offers Methadone, Sublocade, Vivitrol, Subutex, and Zubsolv as forms of MAT through its OTP program. This expansion will create an OBOT (Office Based Opioid Treatment Program) in the Junction Neighborhood of Toledo. Zepf Center utilizes several regimens for MAT, including those that are less susceptible for diversion. Zepf employs strict oversight practices of all medications to minimize diversion. Project Goals and Objectives: The goal of The MATTER Project is to expand access to MAT services for persons with an OUD seeking or receiving MAT. Outcomes include:(1) Increase the number of individuals with OUD receiving MAT; and (2) Decrease in illicit opioid drug use and prescription opioid misuse at six-month follow-up. Objective 1: 50% of program participants receiving MAT will complete their assigned level of care (e.g. IOP or OP), per recommendations from the clinical assessment. Objective 2: 50% program participants will who complete treatment will report no illicit opiate use at their six- month follow up. Objective 3: 10% of participants who do not complete treatment will report no illicit opiate use at their six-month follow up. Objective 4: 60% of participants will work with a peer support specialist, recovery coach or sponsor to assist them with maintaining their recovery; Objective 5: 90% of eligible participants will enroll in benefits and improve their resources; Objective 6: 75% of participants will report improvement in mental health symptoms and MH recovery. Objective 7: 50% of participants who express a need for recovery housing (RH) will be linked within 30 days of admission to treatment.

Project Overview and Evidence-Based Practices: Zepf Center, in collaboration with partners in Lucas, and Wood counties (Northwest Ohio), proposes REACT: Responsive Education, Awareness and Community Treatment. Zepf will provide multiple training opportunities in the evidence-based practice, Mental Health First Aid (MHFA) for Adults and MHFA for Youth, and will coordinate Crisis Intervention Training (CIT) for first responders and law enforcement. REACT will create a Speakers Bureau of trainers that will be deployed across Northwest Ohio, including the use of Certified Peer Recovery Supporters as part of the training team. Zepf proposes to provide these trainings across Northwest Ohio to maximize the reach of the education offered through REACT. In addition to training, Zepf Center will work to establish referral mechanisms that increase the ability of the individuals trained through REACT to refer and link people in need of mental health services to those resources. Purpose and Objectives: The purpose of this program is to: (1) Train individuals working in schools, emergency response, law enforcement, veterans, armed services personnel and their families, local employers, and students in targeted vocational and post-secondary education settings to recognize the signs and symptoms of mental disorders. (2) Establish linkages with school-based and/or community-based mental health agencies to refer individuals with the signs or symptoms of mental illness to appropriate services; (3) Train emergency services personnel, veterans, law enforcement, fire department personnel, and others to identify persons with a mental disorder and employ crisis de-escalation techniques; and (4) Educate individuals about resources that are available in the community for individuals with a mental disorder. Number of People Served: We anticipate many of the individuals being between 18 to 65 years of age. This population was selected because of their professional reach in the community and their connection to persons who may be experiencing mental illness or a mental health crisis. We anticipate training up to 500 individuals per year or 1,500 over the three years of the grant. The catchment area for this project is Toledo, Ohio (Lucas County) and Bowling Green, Ohio (Wood County). Toledo is the fourth largest city in Ohio with 287, 208 residents; Bowling Green has 31,591 residents. Lucas County’s population is 433,689 and Wood County is 130,492 (US Census Data Quick Facts, 2015). Both cities are home to mid-size universities with student bodies of between 15,000 and 19,000 (Bowling Green State University and The University of Toledo, respectively). Toledo is considered an urban area, while Bowling Green is rural. Lead Organization: The Zepf Center; Project Director: Craig Gebers, cgebers@zepfcenter.org

Zepf Center, in collaboration with Neighborhood Properties, Inc. (NPI) present the HOPE Project (Homeless Outreach and Person-Centered Engagement) targeting individuals with serious mental illness (SMI), serious emotional disturbance (SED), or co-occurring disorders (CoD) experiencing homelessness living in Lucas County. The purpose of HOPE is to provide comprehensive, coordinated and evidence-based services for the target population. Zepf and NPI are long-term partners, having TIEH funding in 2018.

Project Overview and Evidence-Based Practices: Zepf Center, in collaboration with partners in Lucas and Wood counties (Northwest Ohio), proposes REACT: Responsive Education, Awareness and Community Treatment. Zepf will provide multiple training opportunities in the evidence-based practices, Mental Health First Aid (MHFA) for Adults, tMFHA for high school aged students, and MHFA for Youth, and will coordinate Crisis Intervention Training (CIT) for first responders and law enforcement. REACT will utilize its trained staff and Certified Recovery Peer Supporters to deploy these trainings. Zepf proposes to provide these trainings across Northwest Ohio to maximize the reach of the education offered through REACT. In addition to training, Zepf will work to establish referral mechanisms that increase the ability of the individuals trained through REACT to refer and link people in need of mental health services to those resources. Purpose and Objectives: The purpose of this program is to: (1) Train individuals working in schools, emergency response, law enforcement, veterans, armed services personnel and their families, local employers, and students in targeted vocational and post-secondary education settings to recognize the signs and symptoms of mental disorders. (2) Establish linkages with school-based and/or community-based mental health agencies to refer individuals with the signs or symptoms of mental illness to appropriate services; (3) Train emergency services personnel, veterans, law enforcement, fire department personnel, and others to identify persons with a mental disorder and employ crisis de-escalation techniques; and (4) Educate individuals about resources that are available in the community for individuals with a mental disorder. Number of People Served: We anticipate many of the individuals being between 18 to 65 years of age. This population was selected because of their professional reach in the community and their connection to persons who may be experiencing mental illness or a mental health crisis. We anticipate training up to 250 individuals in year one, then up to 350 for the next three years, and up to 300 in the final year, for a total of 1,600 over the five years of the grant. The catchment area for this project is Toledo, Ohio (Lucas County) and Bowling Green, Ohio (Wood County). Toledo is the fourth largest city in Ohio with 271,689 residents; Bowling Green has 31,504 residents. Lucas County’s population is 428,348 and Wood County is 130,817 (US Census Data Quick Facts, 2019). Both cities are home to mid-size universities with student bodies of between 15,000 and 19,000 (Bowling Green State University and The University of Toledo, respectively). Toledo is considered an urban area, while Bowling Green is rural. Lead Organization: The Zepf Center; Project Director: Craig Gebers, cgebers@zepfcenter.org

Overview: Zepf Center, in partnership with Neighborhood Properties, Inc., the Toledo Lucas County Homelessness Board, Lucas County Metropolitan Housing, and the Mental Health and Recovery Services board of Lucas County, proposes the HOPE project. Target Populations: (1) Families with children who have at least one member of the family with a CoD; (2) Homeless veterans and their families who have a CoD; and (3) Single individuals who are identified as chronically homeless with CoD. The HOPE project will serve 60 unduplicated individuals and their children each year, for total of 300 unduplicated individuals across five years. Clinical and Demographic Considerations: This population was selected because of their complex needs related to maintaining housing while addressing mental health and substance use disorders while parenting, or are averse to utilizing services because they are younger and feel uncomfortable in traditional shelter settings. HOPE is in alignment with the local Continuum of Care’s Housing First Model and the Two Generational Model for addressing the needs of families. Project Goals and Objectives: The goal of The Hope Project is to increase capacity and provide accessible, effective, comprehensive, coordinated, integrated, and evidence-based treatment services, peer support and other recovery support services, and linkages to sustainable permanent housing. Objective 1: 80% of participants will maintain stable, permanent housing after one year of being in the program; Objective 2: 80% of participants will engage in treatment and follow their integrated service plan; Objective 3: 80% of participants will receive requested services made through linkage and referral; Objective 4: 75% of participants will work with a peer support specialist, recovery coach or sponsor to assist them with maintaining their recovery; Objective 5: 90% of participants will enroll in benefits and improve their resources; Objective 6: 75% of participants will reduce substance use, with the goal of sobriety and stability and Objective 7: 75% of participants will report improvement in mental health symptoms. Evidence-Based Practices: This project will allow Zepf to implement a new EBP within substance use treatment and mental health services, as well as building collective impact with LMHA who is piloting the same EBP. The selected EBP is known as “2Gen.” 2Gen is an antipoverty initiative that provides support for both children and their parents in an integrated manner. The 2Gen approach helps children and families get the education and workforce training, social supports like parenting skills, and health care they need to create a legacy of economic stability and overall well-being that passes from one generation to the next. NPI’s staff are trained in the EBP Critical Time Intervention (CTI). The goal of CTI is to get the individual housed, and that time is the critical factor for that individual to make the positive changes necessary to maintain housing. Lead Organization: The Zepf Center; Project Director: Craig Gebers, cgebers@zepfcenter.org

Overview: Zepf Center, in partnership with Neighborhood Properties, Inc., the Toledo Lucas County Homelessness Board, Lucas County Metropolitan Housing, and the Mental Health and Recovery Services board of Lucas County, proposes the HOPE project. Target Populations: (1) Families with children who have at least one member of the family with a CoD; (2) Homeless veterans and their families who have a CoD; and (3) Single individuals who are identified as chronically homeless with CoD. The HOPE project will serve 60 unduplicated individuals and their children each year, for total of 300 unduplicated individuals across five years. Clinical and Demographic Considerations: This population was selected because of their complex needs related to maintaining housing while addressing mental health and substance use disorders while parenting, or are averse to utilizing services because they are younger and feel uncomfortable in traditional shelter settings. HOPE is in alignment with the local Continuum of Care?s Housing First Model and the Two Generational Model for addressing the needs of families. Project Goals and Objectives: The goal of The Hope Project is to increase capacity and provide accessible, effective, comprehensive, coordinated, integrated, and evidence-based treatment services, peer support and other recovery support services, and linkages to sustainable permanent housing. Objective 1: 80% of participants will maintain stable, permanent housing after one year of being in the program; Objective 2: 80% of participants will engage in treatment and follow their integrated service plan; Objective 3: 80% of participants will receive requested services made through linkage and referral; Objective 4: 75% of participants will work with a peer support specialist, recovery coach or sponsor to assist them with maintaining their recovery; Objective 5: 90% of participants will enroll in benefits and improve their resources; Objective 6: 75% of participants will reduce substance use, with the goal of sobriety and stability and Objective 7: 75% of participants will report improvement in mental health symptoms. Evidence-Based Practices: This project will allow Zepf to implement a new EBP within substance use treatment and mental health services, as well as building collective impact with LMHA who is piloting the same EBP. The selected EBP is known as ?2Gen.? 2Gen is an antipoverty initiative that provides support for both children and their parents in an integrated manner. The 2Gen approach helps children and families get the education and workforce training, social supports like parenting skills, and health care they need to create a legacy of economic stability and overall well-being that passes from one generation to the next. NPI?s staff are trained in the EBP Critical Time Intervention (CTI). The goal of CTI is to get the individual housed, and that time is the critical factor for that individual to make the positive changes necessary to maintain housing. Lead Organization: The Zepf Center; Project Director: Craig Gebers, cgebers@zepfcenter.org

Project Overview and Evidence-Based Practices: Zepf Center, in collaboration with partners in Lucas, and Wood counties (Northwest Ohio), proposes REACT: Responsive Education, Awareness and Community Treatment. Zepf will provide multiple training opportunities in the evidence-based practice, Mental Health First Aid (MHFA) for Adults and MHFA for Youth, and will coordinate Crisis Intervention Training (CIT) for first responders and law enforcement. REACT will create a Speakers Bureau of trainers that will be deployed across Northwest Ohio, including the use of Certified Peer Recovery Supporters as part of the training team. Zepf proposes to provide these trainings across Northwest Ohio to maximize the reach of the education offered through REACT. In addition to training, Zepf Center will work to establish referral mechanisms that increase the ability of the individuals trained through REACT to refer and link people in need of mental health services to those resources. Purpose and Objectives: The purpose of this program is to: (1) Train individuals working in schools, emergency response, law enforcement, veterans, armed services personnel and their families, local employers, and students in targeted vocational and post-secondary education settings to recognize the signs and symptoms of mental disorders. (2) Establish linkages with school-based and/or community-based mental health agencies to refer individuals with the signs or symptoms of mental illness to appropriate services; (3) Train emergency services personnel, veterans, law enforcement, fire department personnel, and others to identify persons with a mental disorder and employ crisis de-escalation techniques; and (4) Educate individuals about resources that are available in the community for individuals with a mental disorder. Number of People Served: We anticipate many of the individuals being between 18 to 65 years of age. This population was selected because of their professional reach in the community and their connection to persons who may be experiencing mental illness or a mental health crisis. We anticipate training up to 500 individuals per year or 1,500 over the three years of the grant. The catchment area for this project is Toledo, Ohio (Lucas County) and Bowling Green, Ohio (Wood County). Toledo is the fourth largest city in Ohio with 287, 208 residents; Bowling Green has 31,591 residents. Lucas County?s population is 433,689 and Wood County is 130,492 (US Census Data Quick Facts, 2015). Both cities are home to mid-size universities with student bodies of between 15,000 and 19,000 (Bowling Green State University and The University of Toledo, respectively). Toledo is considered an urban area, while Bowling Green is rural. Lead Organization: The Zepf Center; Project Director: Craig Gebers, cgebers@zepfcenter.org

Project Summary: Zepf Center seeks CCBHC-IA Grant funding to improve upon its existing CCBHC services by increasing access to and improving the quality of community mental health and substance use disorder treatment in Toledo ,Ohio. The CCBHC is located in Toledo's historic Junction Neighborhood and has allowed Zepf to expand its service offerings further into the community to offer the full array of CCBHC services to persons in need. Zepf Center was awarded a previous CCBHC-E grant through SAMHSA in 2021. The Designated Collaborating Organization (DCO) for this project is the UTMC Ryan White Program. Population of Focus: The Junction Neighborhood (zip code 43607) is home to 20,854 people, 66.3% of whom are Black, 24.2% are White, and 5.2% are Hispanic or Latino. The current unemployment rate in 43607 is 7.3%, which is higher than the current county unemployment rate of 4.9%, the state unemployment rate of 5.2%, and the national unemployment rate of 6.7%. Zepf Center is one of the only service providers in this neighborhood, operating a two-building campus which provides integrated care for co-occurring disorders with co-located primary care services. The most common diagnoses amongst the target population served through Zepf's CCBHC were major depressive disorder, bipolar disorder, and anxiety disorders. Goals and Objectives: Goal 1: Improve access to and availability of high-quality services that are responsive to the needs of the community and continually work to measure and improve the quality of services. Objectives: (1) 100% of individuals seeking services through Zepf's CCBHC will be screened and assessed within 10 days of initial inquiry. (2) Within 5 working days of an assessment at Zepf Center, ensure that 90% of interested individuals are enrolled in the CCBHC to increase access to care. Goal 2: Use evidence-based practices that address the needs of the individuals the CCBHC serves. Objectives: (1) By the end of Y1, ensure that the fidelity assessments for the EBPs of Peer Support Services and EMPath Mobility Mentoring are conducted to ensure that quality services proposed by the CCBHC are being delivered to fidelity. (2) On an annual basis, review the EBPs offered at Zepf Center to CCBHC participants and compare them to the needs assessment to ensure that the needs of those served are reflected in the practices. (3) Ensure that ongoing training is provided to staff on EBPs in conjunction with the CCBHC requirements for 100% of CCBHC staff who provide clinical services on an annual basis. Total Number Serves: Y1: 200, Y2: 250; Total: 850 unduplicated persons. Contact: Deb Flores, CEO; dflores@zepfcenter.org.

Overview: Therapeutic Services encapsulates the YWCA Pierce County’s Children’s Program and Counseling program. Both programs provide support to survivors of domestic violence and their children to allow every individual in the family to process the trauma they have experienced, and to build on the resilience of each person. This therapeutic support ensures that clients we work with can develop the skills needed to safely navigate their lives and to access the resources they need to thrive. A multi-faceted approach offers tangible support and advocacy coupled with therapeutic interventions to strategically eliminate barriers and to meet the needs, wants, and priorities as determined by everyone with whom we partner. All services offered are completely free to access for our clients and do not require any qualifying proof of income or insurance. This holistic, client-centered approach fortifies one’s ability to strengthen oneself and their ability to effectively and safely navigate their lives. Populations of focus: Our services support the needs of a wide population of children, adults, and families that have experienced domestic violence as one aspect of their experience. Our main client population is those individuals residing within Pierce County, Washington. Based on Fiscal Year 2021-2022 service numbers, our Counseling Program will serve 50 individuals, comprising 17% African American/Black; 4% Asian/Asian American; 2% Pacific Islander; 48% White/Caucasian; 13% Latinx/Hispanic; 10% Multi-ethnic; 85% Female; 8% Male; 6% Transgender. Based on Fiscal Year 2021-2022 service numbers, our Children’s Program will serve 170 individuals, comprising 33% African American/Black; 2% Asian/Asian American; 31% White/Caucasian; 5% Latinx/Hispanic; 1% Native American/Alaskan Native; 24% Multi-ethnic; 53% Female; 46% Male; 28% 0–4 years old; 49% 5–12 years old; 19% 13–17 years old; 3% 18–21 years old. Strategies/interventions: The YWCA Pierce Therapeutic Service Department exists to serve the social-emotional and mental health needs of children, adults, and families impacted by intimate partner violence in our community with best practices of holistic, trauma-specific care to promote lasting emotional resiliency, skill-building, and community change. Both programs aim to provide support to survivors of domestic violence and their children to allow every individual in the family to process, healing from, and understanding the trauma they have experienced, and to identify and build on the holistic resilience of each person. These interventions are consistently provided within trusting relationships and spaces that are predictable, safe, and beautiful. This therapeutic support ensures that clients with whom we work can develop the skills needed to safely navigate their lives in self-determined, healthy, and non-violent ways, and to have access to the resources they need to move forward and thrive. Mental health services include systemic assessment, diagnosis, and psychotherapy for children, adults, and families focusing on trauma-specific treatment and support. This program uses both evidence-based and trauma-informed practices to support healing in families through art therapy, play therapy, skill-building, and talk therapy. We also offer comprehensive support for clients to engage with other related behavioral health supports in the community such as substance use treatment, medication evaluation and management, and peer counseling. The methods of the YWCA Children’s Program are guided by elements of Trauma-Focused—Cognitive Behavior Therapy and are grounded in research of practices that build resilience. In groups for children/youth of all ages, we teach emotion regulation skills or “Cool-Down Skills” which are adapted from the TF-CBT sessions related to psychoeducation.

The Skuy soo hue-nem-oh Initiative