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Mountain Comprehensive Care Center (MCCC), in partnership with the Big Sandy Regional Detention Center (BSRDC), will provide an evidence-based, culturally and gender-appropriate outpatient substance abuse treatment program with integrated trauma-informed approaches, mental health care, case management, wraparound reentry/recovery supports, and aftercare to meet the underserved needs of the targeted rural population in Johnson, Magoffin, Martin, and Lawrence Counties in KY. MCCC will expand and enhance treatment services for adults who: 1) are sentenced adult offenders ages 18 and older; 2) are assessed as substance using/abusing or diagnosed as having a substance use and/or co-occurring mental disorder; 3) have been sentenced to and serving at least three months; 4) are within 4 months of scheduled release to the community; and 5) upon immediate release will be referred to community-based treatment. Men comprise upwards of 80% of offenders and women 20%. All clients admitted to treatment will be screened for the presence of co-occurring substance use and mental health disorders and provided referrals for hepatitis B/C and HIV testing and other health issues. MCCC client interaction will be conducted through Motivational Interviewing, Seeking Safety for trauma-informed care, cognitive behavioral therapy including selected modules of RDAP as well as peer support. MCCC will also provide clients mental health care, housing, employment and educational supports and any other identified resource per their Transition Plan. MCCC anticipates that an estimated program completion rate will be 70% (retention). Of those that complete: 1) 70% will decrease their use of alcohol or other illicit drugs; 2) 70% will increase stability and self sufficiency; 3) 60% will be employed or qualified for disability benefits; 4) 70% will increase social connectedness; and 5) 65% will reduce their involvement in the criminal justice system (i.e., no recidivism).

The coalition will prevent and reduce youth substance abuse by implementing the following strategies: The goals of the coalition are two- fold: to establish and strengthen collaboration among Knox County communities, private nonprofit agencies, and federal, state, local and governments to support the efforts of the Knox County Coalition to prevent and reduce substance abuse among our youth, and to reduce substance abuse among Knox County youth and over time reduce substance abuse among Knox County adults by addressing community factors that increase the risk of substance abuse and promote the factors that minimize the risk of substance abuse.

The coalition will prevent and reduce youth substance use by implementing the following strategies: (1) Provide education and training along with skill enhancement to promote greater collaboration and effectiveness as a coalition. (2) Provide information to the community about the Pulaski County KY-ASAP Board for the purpose of increasing collaborative efforts to address youth substance use. (3) Provide information/support to youth and adults to reduce the likelihood of youth alcohol use. (4) Provide information/support to youth and adults to reduce the likelihood of youth marijuana use. (5) Increase enforcement of existing laws/policies, modify/change existing laws and policies, and assist with the development and implementation of new laws and policies.

The coalition will prevent and reduce youth substance use by implementing the following strategies: For provide information, participate in health fairs and festivals, public service announcements and provide information on prescription bags; ror enhance skills, provide curriculum such as TEG/TEP, youth conferences, and adult trainings such as Accidental Dealer and Meth Watch; for provide support, partner with events such Truth and Consequences and conduct a mentoring program; for enhancing access/reducing barriers, work with school system on accessing programs and bus runs as well as work with partners on grant applications; for changing consequences, conduct Reward and Remind, Court Watch and Early Intervention Program; ror physical design, increase signage in community and school regarding tobacco, accidental dealer, Meth Watch and alcohol; and for modifying/changing policies work with school district on policies such as student drug testing, work with fiscal court on social host and responsible beverage server training ordinances and work with retailers on the Meth Watch program.

Mountain Comprehensive Care Center will implement the Big Sandy Region Youth Mental Health Literacy Project in Floyd, Johnson, Magoffin, Martin and Pike Counties in eastern Kentucky. With high rates of poverty, high numbers of adverse childhood experiences (exceeding national rates), suicide as the leading cause of death for adolescents, high rates of mental illness across the region, and continuing trauma from devastating weather-related events, MCCC has identified the greatest need for intervention is for adolescents ages 12-18. Coupled with this is the need to train parents and other adults throughout the community to break cultural bias and stereotypes regarding behavioral health issues, so they can be critical First Aiders for their children and other youth. The project will certify the Project Coordinator and 29 School-based Therapists to receive and conduct YMHFA training. The project will target a diverse group of persons to be trained as First Aiders to ensure broad community representation. Based on the current adolescent population, the project will train 30 YMHFA Instructors who in turn will train 1,125 First Aiders annually and 3,375 over the three-year project period. The primary outcomes for clients are decreased rates of depression and other mental health issues. For the community/population, outcome measures will focus on training and maintaining 30 YMHFA Instructors; providing a minimum of 45 workshops annually; developing collaborative community partnerships; and providing YMHFA training to a minimum of 1,125 First Aiders. For the provision of behavioral health services, the project will increase the number of youth ages 12-18 referred to behavioral health service screening, assessment, or treatment. Morehead State University will conduct an independent evaluation which will track required performance measures, outcomes, fidelity, cultural competence, and quality improvement.

Mountain Comprehensive Care Center, in partnership with Big Sandy Health Care, Inc., Pike County Health Department, and Pikeville Medical Center, will provide the Pikeville Integrated Care Clinic offering coordinated and integrated services through the co-location of primary and specialty care medical services in MCCC's community-based behavioral health center for the benefit of adults with serious mental illness in Pike County, Kentucky. Services will target adults with SMI and those with co-occurring substance use disorders who have or are at risk for co-morbid primary care conditions and chronic diseases. The targeted population will reflect many of the same characteristic of this rural, homogenous population including high rates of poverty and unemployment, low educational attainment and half of participants who identify as "disabled." Primary diagnosis reflect a high rate of mood disorders followed by schizophrenia/other psychotic disorders, anxiety disorders and a smaller rate of co-occurring SMI and substance use disorders.

Morehead State University seeks to create a Suicide Prevention Program that will systematically create a campus environment that is safer for all students, staff, and faculty, to intervene and assist those at risk for suicide, and to create an enhanced infrastructure to promote a cultural change regarding the perception of mental health. This will be accomplished using a public health model, expanding programs and services, and targeting 25% of all MSU students. QPR training will be provided to help everyone recognize and respond to those identified as at risk for suicide. The success of this model on college campuses rests on the ability to detect students at risk for suicide, effectively referring them for a professional evaluation, and providing access to meaningful and appropriate mental health treatment. Program goals and objectives: develop momentum among campus administrators and leadership through presentations and discussion on the importance of suicide prevention activities to the MSU campus; educate the community of students and stakeholders in suicide prevention indicators by providing QPR Gatekeeper training with targeted groups of students, staff, faculty, and community stakeholders; to provide information to parents of MSU students during student orientation on identification of depression and other mental health issues, specifically warning signs of suicide, and the intervention process; to develop and build infrastructure for MSU Suicide Prevention Plan, including a written protocol for the behavioral intervention team; to establish campus advisory groups and main campus and 4 regional campuses; to build community networks and establish partnerships between MSU and community mental and physical health providers; to develop a protocol for postvention and establish policies and procedures to serve as a guide for managing situations when there has been a suicide attempt.

Mountain Comprehensive Care Center (MCCC) will target children and adolescents, birth to age 17, along with their parents/caregivers. The program proposes to serve 160 participants in year 1, 225 annually in years 2 and 3, and 200 in year 4 for a total of 810 unduplicated participants over the four-year project period. MCCC will prioritize services for children and adolescents of military families with a secondary population of those who have primarily experienced neglect and physical and sexual abuse. MCCC will utilize three key evidence-based practices including Trauma-Focused Cognitive Behavioral Therapy, Adapted Dialectical Behavior Therapy for Special Populations and Child-Parent Psychotherapy. MCCC will conduct comprehensive, culturally and gender-appropriate outreach to increase access to trauma-informed care as well as improve outpatient trauma-focused treatment and services through implementation of the three evidence-based interventions.