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The New Jersey COVID-19 Emergency Mental Health and Substance Use Disorder Project will provide and expand behavioral health treatments and supports to populations with serious mental illness and substance use disorders who are impacted by the spread of the COVID-19 virus. In addition, healthcare workers and individuals with mental health disorders, less severe than serious mental illness will also be targeted. Our project is also focusing on a special population of Hasidic and Orthodox Jews. New Jersey, the most densely populated state in the country, currently is second in the nation for COVID-19 cases according to the CDC. The United States has the highest number of COVID-19 cases in the world with 427,460 confirmed cases and NJ with 51,027 confirmed cases. In order to meet the additional demand for services as a result of this pandemic, the Division of Mental Health and Addiction Services (DMHAS), will be contracting with Rutgers University Behavioral Health Care (UBHC) to act as a COVID-19 Coordinating Entity (CCE) to provide treatment and supports, and provide a warm handoff to licensed treatment providers throughout the state that have the capability to do telehealth and accept new referrals. A series of screening tools will be used to determine mental health and substance use problems and to assess caller's level of distress and symptomology. DMHAS will also partner with the Department of Children and Families, Division of Children's System of Care (CSOC) to provide peer recovery supports. Our project will expand the use of Telehealth as a promising area to engage individuals in treatment and support services in a safe manner while mitigating opportunities for exposure for both providers and consumers. We will also increase efforts to get phones to consumers in need of them to take advantage of telehealth and virtual recovery supports. Other strategies to be utilized include the use of evidence-based practices such as Cognitive Behavioral Therapy (CBT) and Skills for Psychological Recovery (SPR). SPR is an approach to address stress and trauma in healthcare workers resulting from their work during the pandemic. We estimate serving 2,500 unduplicated individuals over the course of the project, some of whom may need multiple sessions.

In relationship to Ninilchik Traditional Council's (NTC) ongoing mission to promote access to health and education resources, the NTC Community Clinic has been providing Medically Assisted Treatment (MAT) since 2014. Together, with our partners, we have been able to provide medication and behavioral therapies to individuals experiencing Substance Use Disorder, Opioid Use Disorder, and mental illness (below the threshold of severe mental illness) throughout the Southern Kenai Peninsula. With $500,000 in Emergency COVID-19 funding, NTC will enhance and expand our telehealth capacity and ensure that recovery services are available to all individuals in the above-described client population based on diagnosis, need, risk of relapse, and assessment recommendations. According to the Center for Disease Control, Alaska's Kenai Peninsula has the highest rate in Alaska per capita of opioid prescriptions, which are higher in primarily white, rural communities with high unemployment rates. The majority of our current clients are white and Native Alaskan; male and female clients are nearly equal in representation. With the service delivery improvement and expansion made possible by this award, we anticipate that we will be able support an additional 75 impacted individuals in our service area per year and enroll 100 new clients over this project period. With Targeted Capacity Expansion funding for MAT, NTC will enhance their current addictions program to: 1) Increase access to medical and behavioral health treatments for those experiencing SUD, OUD, and mental illness through the expansion of telehealth: a. 70% of direct service funding to provide direct services to those with SUDs b. 10% of direct service funding for healthcare practitioners with mental disorders (less severe than SMI) requiring mental health care as a result of COVID-91 c. 20% of direct service funding to be used for all other individuals with mental disorders less severe than SMI 2) Mitigate risk of diversion with the transition to the Sublocade injection and Directly Observed Therapy (via emocha) for patients using Suboxone strips 3) Implement remote Blood Alcohol Content (BAC) monitoring through the purchase of Soberlink devices 4) Acquire Bridge Devices for opioid withdrawal to minimize utilization of Emergency Departments 5) Increase service access for remote villages with no access to the road system

With the third highest number of COVID-19 cases in the nation despite being the tenth most populous state, Michigan has been disproportionately affected by the COVID-19 pandemic. Unfortunately, it is estimated that Michigan's cases are still on the upswing. In response to this public health crisis, Michigan has taken significant action to reduce the spread of COVID-19 to save lives and mitigate the tremendous increase in demand for health care services. The population health and economic burden of the emergency, however, is expected to elicit mental health and substance use disorders within the general population and exacerbate these conditions within COVID-19 patients, their families/caregivers, and for the health care practitioners subject to extreme stressors associated with the provision of services during this pandemic. The toll of the pandemic has hit particularly hard in specific Michigan communities already subject to health disparities and inequities. To optimize this grant opportunity, the Michigan Department of Health and Human Services (MDHHS) created a needs assessment prioritization model to ascertain areas of specific vulnerability and need relative to the COVID-19 crisis. This model ranks county needs that utilizes per capita COVID-19 cases, percent of the low-income population, percent of the population that is uninsured, and the County Health Rankings data. As a result, MDHHS will work with five local Community Mental Health Services Program (CMHSP) provider partners in geographically and demographically diverse regions of the state in order to augment essential evidence-based behavioral health services in communities significantly impacted by and vulnerable to the effects of the COVID-19 pandemic. MDHHS' partners include Au Sable Valley Community Mental Health Authority, Detroit Wayne Integrated Health Network, Genesee Health System, HealthWest, and Saginaw County Community Mental Health Authority. Collectively, this project will provide essential behavioral health and crisis services to persons with serious mental illness, substance use disorders, mild-to-moderate mental illness, and specific disaster distress services to health care practitioners.

Cherokee Nation Behavioral Health Services' COVID-19 Emergency Response services will provide direct mental health and substance abuse treatment services for Native Americans residing in or near the Cherokee Nation reservation, located in northeastern Oklahoma, who have been impacted by the COVID-19 pandemic of 2020. Additionally, the comprehensive enhancement of both telehealth services for mental health and a mobile mental health crisis unit will be implemented. During the 16-month project, services will address the acute mental health, stress, and grief issues related to the pandemic's impact on our Cherokee Nation communities. The primary population of focus for this project are Native Americans residing in or near the Cherokee Nation Reservation, located in northeastern Oklahoma, who are diagnosed with severe mental illness (SMI), substance abuse disorders (SUD), and those with co-occurring SMI and SUD. At minimum, seventy percent of the level of effort of direct services will be used to serve this population. The secondary population of focus are Cherokee Nation (CN) employees and Native American healthcare professionals who require mental health services as a result of the COVID-19 pandemic. Ten percent of the level of effort of direct services will be used to serve this population. The tertiary population of focus are Native Americans residing in or near the catchment area of the Cherokee Nation Reservation with less severe mental disorders who may have experienced trauma, loss, and stress related to the COVID-19 pandemic of 2020. Twenty percent of the level of effort of direct services will be used to serve this population. We will utilize strategic and targeted use of media communications to reach each of those populations, but especially the healthcare professionals and individuals with mental disorders less severe than SMI. Outreach through media will be strategic to raise awareness of the proposed services and to reduce stigma regarding seeking and engaging in mental health services for mental disorders less severe than SMI and for trauma-related stress, grief, anxiety, and depression. The project's key strategies include: One-hundred twenty (120) Screenings (84 SMI/SUD/Co-occurring; 12 Healthcare Workers; 24 less severe SMI) Fifty (50) Assessment and intake of counseling and treatment: 36 SMI/SUD/Co-occurring; 5 Healthcare Workers; 10 less severe SMI) Six (6) Psychological First Aid Trainings One (1) Implementation of a comprehensive Mobile Mental Health Crisis Response Unit

The purpose of the Hawaii application for the SAMHSA Emergency COVID-19 funding opportunity is to bring critical mental health services directly to individuals statewide across the islands, both in person and through telehealth, amidst a pandemic. The Hawaii Department of Health (DOH) will address the increased behavioral health challenges posed by COVID-19 by tailoring responses to the needs of the three different groups: adults with severe mental illness (SMI) or co-occurring SMI and substance use disorders (SUD), homeless individuals with less severe mental illness, and healthcare practitioners requiring mental health care as a result of COVID-19. Of particular urgency is the expansion to Hawaii island of a highly promising recovery program piloted on Oahu for co-occurring SMI/SUD individuals at risk for decompensation and hospitalization at a time when hospital beds, both psychiatric and medical, may not be available, when entering a hospital facility poses a serious health risk, and when air travel to the only state psychiatric facility on Oahu entails a 14-day quarantine and jeopardizes the health of healthcare workers and other SMI patients at the locked facility. The co-occurrence of SUD among severely mentally ill individuals is very common in the state: According to the clinical judgment of their providers, 7 in 10 SMI adults served by the DOH also have SUD. Hawaii island has the highest statewide per capita rates of opioid-related poisonings, methamphetamine-related drug convictions, as well as DOH SMI consumers, making it critical for the specialized co-occurring recovery model to be brought directly to that island, particularly during this time when travel needs to minimized and currently there is no such programming available on island. The goal of the expansion is to improve the community tenure of these high-need individuals by providing intensive, evidence-based therapy and case management strategies within a cohort model. By January 31, 2021, 75 percent of the first Hawaii island cohort is expected to graduate into a lower level of care, and by June 21, 2021, 75 percent of the second cohort. Other initiatives proposed include: 1) Increasing telepsychiatry services to SMI individuals statewide through collaboration with the Department of Psychiatry at the University of Hawaii (UH) School of Medicine; 2) Increasing access to behavioral health services by homeless individuals with less severe mental illness through expanded access to homeless case management; and 3) Improving the mental well-being of healthcare professionals requiring care due to COVID-19 by partnering with the UH Department of Psychiatry to provide peer-developed and peer-implemented supports. Hawaii expects to serve approximately 650 individuals over the lifetime of the project and can leverage existing vendor agreements to begin the Hawaii island co-occurring recovery program within the first 3 months of the grant award.

Kansas COVID-19 Response proposes to meet the needs of people with SMI, SMI/SUD co-occurring issues, and people with less severe mental health issues including healthcare practitioners resulting from the current COVID-19 crisis through the creation of crisis response infrastructure which includes expansion of telehealth, expanded crisis response services, and enhanced recovery support services. We anticipate serving a total of 10,365 individuals during the grant period.

To address the projected increase in the number of South Carolinians experiencing mental health and/or substance use crises, the South Carolina Department of Mental Health (SCDMH) will implement the SCDMH COVID-19 Crisis Response Initiative, a three-pronged, statewide approach to expanding crisis services that will provide linkages to more intensive, integrated care, as well as financial assistance to remove barriers to care. The SCDMH COVID-19 Crisis Response Initiative consists of the following new programming: the Crisis Counseling Program (CCP), a telephone line designed to connect COVID-19 affected persons who are experiencing serious mental illness (SMI), a mental illness of lesser degree (MI), and/or a substance use disorder (SUD) to existing available resources and care (including but not limited to crisis services, assessment, therapies delivered using evidence-based models, peer support, employment assistance, care coordination/case management, suicide prevention assistance, homeless/housing assistance, nursing care, psychiatric care, primary care, deaf services, and services for non-native English speakers); a Financial Assistance Program which will assist persons suffering from SMI, MI, and/or SUD - including those in the justice-involved population facing reentry to society due to early release from detention to limit the spread of COVID-19 - in paying for treatment services and medication; and the Healthcare Outreach Team (HOT), a telehealth team that will specifically address the needs of healthcare workers experiencing crisis due to COVID-19. The department is confident that these programs will fulfill our goals of expanding access to crisis services and assisting more of our states citizens in obtaining mental health and substance abuse services. To achieve these goals, SCDMH will partner with the South Carolina Department of Alcohol and Other Drug Abuse Services (DAODAS) via SCDMHs existing Community Crisis Intervention and Response (CCRI) call line, via the new CCP call line, and via the Healthcare Outreach Team telehealth program. To monitor our progress in reaching and serving patients affected by COVID-19, we will develop a marker in our existing electronic medical records system to flag COVID-19 patients; we will track all incoming calls on the CCP and CCRI lines from COVID-19 affected patients seeking SCDMH and/or DAODAS services; we will monitor the amount of financial assistance we are able to provide to underinsured/uninsured SMI, MI, and SUD patients; and we will track the number of healthcare workers receiving telehealth services through the HOT. Once these programs are fully implemented, we expect to see an uptick in the overall number of patients served by the agency and estimate that in the first year of the program we will begin providing services to an additional 200 persons per week over our normal volume, which would result in an increase of 10,400 persons served annually and more than 13,000 persons served over the course of the grant period.

New York State (NYS) will improve accessibility of mental health and substance abuse treatment, recovery support and crisis care to racially and ethnically diverse residents of New York City (NYC) and 3 suburban counties (representing 75% of NYS COVID-19 infections) by improving the telehealth infrastructure, removing financial barriers, expanding evidence-based services, and informing healthcare workers and other New Yorkers about available services. Strengthening Mental Health and Substance Use Disorder Treatment, Recovery Support and Crisis Care to Address the Impact of the COVID-19 Pandemic on residents of NYC and Lower Hudson Valley will serve 5,000 children, adolescents, adults and families impacted by COVID-19 in NYC and the Lower Hudson Valley counties of Westchester, Rockland and Orange over the 16-month grant period. The NYS Office of Mental Health (OMH) and the Office of Addiction Support Services and Supports (OASAS) are partnering with two provider-led behavioral health (BH) Independant Practice Associations (IPAs)-Coordinated Behavioral Health Care (CBC) and Coordinated Behavioral Health Services (CBHS)--that provide a comprehensive, integrated and coordinated network of mental health (MH) and substance use disorder (SUD) services, including treatment, recovery supports and crisis-care, in the 8-county service area that is the hardest hit area in NYS and among the most impacted nationally by COVID-19. Over 100 experienced OMH-licensed and OASAS certified agencies are in the two IPA networks and will participate in this project. Proposed strategies / intervention include healthcare workers and people without serious BH conditions in brief crisis counseling and treatment services as needed using easily accessed telehealth services and by removing any financial barriers; (2) Facilitating a person-centered continuum for people with serious mental health conditions and SUD through telehealth and in-person services if necessary in order to promote and support recovery while managing BH crisis in the community; (3) Improving transitions of care for people with serious BH conditions to shorten inpatient length of stay and stabilize people with serious conditions in community settings, thereby reducing emergency department and inpatient admissions. Project Goals are to mitigate negative impacts of the COVID-19 crisis on the emotional wellbeing of New Yorkers in the most impacted NYS counties by timely addressing depression, stress, trauma, bereavement, substance abuse and other issues that undermine the ability of New Yorkers to live happy, productive lives after this crisis abates.

Yakama Nation Behavior Health Service Emergency COVID-19 program provide crisis intervention services, mental and substance use disorder treatment, and other related recovery supports for children and adults impacted by the COVID-19 pandemic. The purpose of this program is specifically to address the needs of individuals with serious mental illness, individuals with mental health disorders, and co-occurring serious mental illness and substance use disorders. We purpose to1) develop and implement a comprehensive plan of evidence-based mental health treatment services for individuals impacted by the COVID-19 pandemic. Ensure that service provision may occur in a telehealth context; 2) Screen and assess clients for the presence of mental health and co-occurring substance use disorders 3) Provide evidence-based and population appropriate treatment services via in-person and in a telemental health format; 4: Provide recovery support services. We expect to serve 300 clients over the grant period

Oklahoma's Emergency COVID-19 Abstract: Helping Connections Initiative The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) and our provider partners will safely deliver a full array of mental health and substance use disorder treatment for Oklahoma (OK) children and adults impacted by COVID-19. We will maximize the use of telehealth/telephone services to meet the need of current patients with SMI and substance use disorders and those patients with mental illnesses. And we will reach out to our communities, letting them know we will provide mental health services to all Oklahoma's who seek them because of COVID-related increase in their mental health symptoms. We will focus the majority of services and supports to treat OK's most vulnerable citizens, those with serious mental illness (SMI) and co-occurring substance use disorders. They are at greatest risk for increased depression, anxiety, suicidality, and decompensation into illness requiring hospitalization. Our goal is to meet their needs with the methods safest for them. Much planning has occurred to get protocols in place, and providers are mobilizing for increased telehealth/telephone services and supports. OK intends that 70% of SAMHSA resources will be utilized to serve Oklahomans with SMI and co-occurring SUDs. In addition, we are gearing up to serve additional individuals with mental health disorders that are adversely impacted. The symptoms of their mental illnesses will likely increase due to COVID-19. For adults, children, and their families, the stressors of frustration and boredom, family financial loss, increased risk of abuse and domestic violence in the home, disruption in nutrition, and decreased physical activity will result in an increase in the severity of mental illnesses. This can be ameliorated by providing telehealth/telephone services and supports. OK intends that 20% of SAMHSA resources will be utilized to serve persons with mental illness. Helping Connections will quickly mobilize SAMHSA resources to serve healthcare professionals who develop increased mental health needs. With SAMHSA support, we will effectively treat the individuals who experience high levels of stress, including traumatic stress reactions, depression, anxiety, hostility, and use of alcohol and other drugs to cope. OK intends that 10% of SAMHSA resources will be utilized to provide services and supports to these who are sacrificing so much. Helping Connections will fulfill these goals while serving a goal of 2,000 individuals: 1) complete the comprehensive plan we have started; 2) screen on the day of request. Meet immediate needs with initial assessment and treatment plan. Comprehensive assessment and integrated treatment plan will be completed over several sessions in the best interest of the person served; 3) provide evidence-based practices starting day one. Will offer EBPs by trained and coached clinicians; 4) Will provide increased recovery support services to: conduct outreach activities safely; and provide de-escalation, employment support, and linkages to housing. We will utilize telehealth/telephone/messaging for crisis diversion and initial crisis response. We will decrease the crisis center and hospital admissions.

Project Abstract: The California COVID-19 Behavioral Health Response Project will deliver treatment services to individuals affected by the COVID-19 public health emergency in Los Angeles and Santa Clara Counties with substance use disorders (SUD) and mental health disorders, youth and patients with serious emotional disturbances, and health care professionals with mental health disorders less severe than serious mental illness (SMI). As of April 7, 2020, Los Angeles had 6,910 confirmed cases and 169 deaths and Santa Clara had 1,285 confirmed cases and 43 deaths. These counties have also been significantly impacted by mental health and SUD. In 2018, Los Angeles had 497 opioid overdose deaths, 1,655 ED visits due to any opioid overdose, and 742 hospitalizations due to any opioid overdose. In 2018, Santa Clara had 60 opioid overdose deaths, 141 ED visits due to any opioid overdose, and 89 hospitalizations due to any opioid overdose. Moreover, about 1 in 5 adults experience mental illness and 1 in 25 experience SMI. These counties have a high burden of mental health and SUD treatment needs and a large percentage of the health care workforce. It is crucial to provide this funding to support behavioral health providers in these counties over the coming months. Without intervention, the disruption presented by COVID-19 will pose risks to treatment for individuals with SUD and mental health disorders. The California Department of Health Care Services will release a Request for Application on April 13, 2020, to solicit mental health and SUD treatment providers to treat up to 500 uninsured and under-insured individuals annually and through the life of the project, who have been impacted by COVID-19 in Los Angeles and Santa Clara Counties. California will undertake a dual approach by allocating $600,000 to mental health disorder treatment and $1.4 million to SUD treatment. Services will commence on or before July 31, 2020 and be completed on or before August 31, 2021. Funding will support behavioral health providers delivering SUD and mental health treatment services, with an emphasis on telehealth treatment options, during the COVID-19 public health emergency. Thirty percent of grant funds will be awarded to mental health treatment providers, with one-third of that amount specifically allocated for serving health care practitioners with mental health conditions requiring care as a result of COVID-19. Seventy percent of grant funds will be awarded to SUD treatment providers in Opioid Treatment Programs, outpatient treatment, intensive outpatient treatment, and residential treatment to individuals impacted by COVID-19. Providers must implement evidence-based mental and/or SUD treatment services that may occur through telehealth; screen and assess clients for the presence of mental health conditions or SUDs; utilize clear processes for referring individuals experiencing mental health crisis; ensure grant funds serve as the payer of last resort; be licensed, accredited, and/or certified by DHCS as of April 10, 2020; and collect GPRA and progress reporting data for submission to SAMHSA.

DHS plans to contract with counties to provide a range of expanded treatment services from intensive to community based supports to assist those with SMI, SED, SUD, health care professionals and others struggling with less than SMI impacted by COVID-19.

The RI Department of Behavioral Healthcare, Developmental Disabilities and Hospitals (BHDDH) will implement the 2020 Mental Health and Substance Use Disorders Emergency COVID-19 project statewide. The population of focus will be adults with Serious Mental Illness (SMI), those with Substance Use Disorder (SUD), and/or those with co-occurring SMI and SUD; children with Serious Emotional Disturbances (SED) and individuals with mental health conditions less severe than SMI requiring mental health care as a result of COVID-19 including those in the health care profession. Recent data from BHDDH's Behavioral Health Online Database reveals 2,316 unique admissions in calendar year 2019 across 5 Community Mental Health Centers for individuals with high acuity SMI and youth with SED. Of these admissions, 2,079 are adults and 237 are children. 4% of youth had a co-occurring SUD diagnosis as did 59% of adults. We project that individuals with conditions less severe than SMI currently seen in general outpatient programs may rise to higher levels of care given increased symptomatic response associated with COVID-19. Based on these projections, we will target 700 of these individuals (approximately 30% of a typical year's admissions) to newly engaged or re-engage with COVID-19 resources and completion of the required data collection. Our targeted subpopulations who may have less severe conditions than SMI will include those experiencing homelessness, behavioral and physical healthcare professionals, and immigrant, refugee, and non-English speaking populations and will complete required data collection should they enroll in services. Rhode Island's overall goal is to improve outcomes among the targeted populations experiencing mental health and substance use conditions as a result of COVID-19.To address the needs of these individuals, we will focus these grant resources on investments in: technical and clinical infrastructure for telehealth at our licensed Community Mental Health Centers, creating remote access to DATA-waived prescribers; and supporting organizations in delivering treatment and making linkages to recovery support services in a telehealth context in the language preferred by the client. Specific strategies include: 1) Issuance of a delegated authority request for proposals to expand the telehealth capacity of Community Mental Health Centers 2) Provision of interpreter and translation support services for phone, video and computer-based materials used by behavioral health providers 3) Establishment of a Buprenorphine Tele-Induction (assessment and prescribing) hotline and connection to outpatient maintenance treatment It is our belief that these investments are sustainable as the service delivery environment shifts toward a more favorable context for telehealth service policy and reimbursement.

The overarching goal of the Cocopah COVID-19 Emergency Behavioral Health Project is to increase access to mental health /substance use treatment and recovery support services by developing a system of telehealth services to serve at least 63 members of the Cocopah Indian Tribe, a federally recognized, sovereign tribe located in the southwestern corner of Arizona in Yuma County, and 7 health practitioners from Indian Health Services Fort Yuma Health Center. The 70 individuals to be served annually will include young adults over 18 and adults with serious mental illness (SMI), substance use disorders (SUD), and/or co-occurring SMI and SUD and those with mental disorders that are less severe than SMI from the Cocopah Indian Tribe and healthcare professionals from FHYC identifying with mental disorders less severe than SMI. The objectives include developing and implementing a comprehensive plan to provide mental health and substance abuse treatment, education, and recovery support services through telehealth services; screening and assessing at least 70 clients for the presence of mental and substance use disorders and/or co-occurring disorders; enrolling and providing evidence-based & population appropriate treatment telehealth services; conducting intake and six-month follow-up GPRA interviews with an 80% follow-up rate; increasing change in the preferred direction for GPRA performance measures by at least 20% for at least 70% of enrollees in treatment services; increasing the number of participants receiving recovery support services within telehealth context by at least 50%; and improving retention in treatment services for at least 70% of the enrolled participants through provision of case management. Project staff will utilize the ASAM Criteria 3rd edition dimensions and philosophy of assessment when assessing individuals enrolled in the project. Cognitive Behavior Therapy (CBT), a form of psychotherapy, will be used by the counseling staff under this project. Another evidenced based practice that will be used is Motivational Interviewing, an evidenced-based counseling approach that is used to help clients adhere to treatment recommendations. Wellbriety is currently used by the Cocopah Tribe for outpatient substance abuse treatment and is considered a practice-based evidence/promising practice for suicide and substance abuse specifically for American Indians/Alaska Native (National Indian Health Board). Wellbriety concentrates on the whole person, supporting personal awareness, growth and development, positive self-image and talk, and incorporates the teachings of Native culture into everyday life. Wellbriety is a way of life and involves committing to a life of wellness and healing every day. The program consists of 24-36 sessions, held twice a week for 1.5 hours and includes support groups (e.g. talking circles, Narcotics Anonymous, Alcoholics Anonymous). The Cocopah COVID-19 Emergency Behavioral Health Project will also develop and implement crisis mental health services staffed by the project's counselors and in collaboration with Tribal Police and existing tribal warm line providers and Arizona Complete Health.

The Hualapai Health Education and Wellness Department is seeking funds to provide additional mental health services during after regular hours via a telehealth option. The program will have at least two licensed counselors available to be contacted during hours in which the HHEW is closed.

Seattle Indian Health Board's project, COVID-19 Behavioral Health Response, will focus on reaching American Indians and Alaska Natives, including those experiencing homelessness, in Seattle/King County, Washington State. Services will include culturally-attuned evidence-based practices embedded within our agency's Indigenous Knowledge-Informed Systems of Care, which combines skills, services, and cultures to holistically integrate primary care, behavioral health care, dental care, Traditional Indian Medicine, housing, nutrition, and other social services. Seventy percent of participants will have SUD, SMI, or co-occurring SMI/SUD. To remove barriers to safe, COVID-era care among members of our target population who are unhoused, our project will use social distancing therapy rooms and safe therapy rooms with our clinic location. Social distancing therapy rooms allows people to see providers face-to-face from a safer distance, and safe therapy rooms connect people to telehealth through a phone or tablet to reach a physician in a separate location within our clinic or from a confidential space in their home. We plan to develop other safe therapy rooms at our satellite clinics and with community partners who serve our clients, such as King County Work Release. We also plan to identify HIPAA-compliant technology to facilitate access to group therapy. People served through COVID-19 Behavioral Health Response will access culturally attuned MH and SUD counseling, a new Level 2 Intensive Outpatient Program, Medication Assisted Treatment, Traditional Indian Medicine, and Recovery Support Services. Case managers will help our clients access the services that will support them in their SUD recovery goals and to manage SMI. This project will ensure that urban AI/ANs in Seattle/King County may access the behavioral health services necessary to their wellbeing during this crucial time. It will also reach our catchment area's healthcare professionals, who have been on the frontlines of COVID-19 response since patient zero was identified in the greater Seattle are in January 2020.

The Standing Rock Sioux Tribe (SRST) through their Tribal health program proposes the "Addressing Mental and Substance Use Disorders (Emergency COVID-19) project to provide treatment on the Standing Rock Indian Reservation, North Dakota, for 1). Tribal members with Substance Use Disorders (SUDs), Serious Mental Illness (SMI), and co-occurring SMI and SUDs; 2). Health care practitioners with mental disorders requiring mental health care as a result of COVID-19; and 3). All other Tribal members with mental disorders. The goals of the "Emergency COVID-19" project include: strengthening the capacity of SRST tribal health and tribal systems to increase utilization of evidence-based programs for providing clinical services and supports to address SMI and/or SUD among Tribal Members, including health care providers impacted by COVID-19; improving patient tracking systems among providers both on and outside the reservation; improving client access to treatment through use of telehealth; identifying signs and severity of SUDs and/or SMIs, planning and providing culturally appropriate evidence-based and population appropriate treatment services; helping treatment clients become and stay engaged in the recovery process; and activating the Crisis Response Team to implement a mental health crisis intervention plan on the Reservation. To achieve these goals the project team will utilize the following strategies: increase staff capacity by hiring a Project Director, evaluator, a licensed professional mental health counselor, and 3 peer recovery specialists; develop a systematic network of communication channels for improved coordination of care by creating a well written and agreed upon plan between partner agencies; improve integrated data capturing capabilities of the electronic systems used on the reservation so that no patients are lost through either system; use tools like Zoom, Skype and Facetime to conduct telehealth; utilize culturally appropriate treatment for Tribal members with SMI/SUDs; implement curricula and training that help clients through recovery and provide community with knowledge on mental health risks, how to identify and respond; and revise the existing Tribal strategic plan for crisis responses to provide 24-hour mobile crisis services, emergency crisis intervention services including psychiatric/medical assessment and where indicated, medication administration, and crisis stabilization. The project is scheduled to serve the entire population of 8,612 Tribal community members, including healthcare professionals with SMI/SUDs treatment needs through the sixteen months of the project.

Comparable to the rest of the nation, Idaho is combating the COVID-19 pandemic, with the number of contaminated Idahoans rising significantly daily. As these numbers increase and the economy simultaneously crashes, Idaho is realizing a subsequent upsurge in the need for crisis and on-going behavioral health supports and treatment. Additionally, hospital beds currently used to serve individuals with psychiatric needs are now needed for COVID-19 patients, creating a gap in services for Seriously Mentally Ill (SMI) population. The Idaho Department of Health and Welfare, Division of Behavioral Health (DBH) intends to help mitigate this gap by providing an alternative for this population. DBH plans to implement a 3-pronged approach to bring needed resources to Idahoans during this time of crisis: Emergency Department Behavioral Health Diversion and Triage: Idaho will stand up a Diversion and Triage unit to provide emergency services to patients with psychiatric conditions, but do not have critical medical health needs. This includes the establishment and utilization of a COVID19 Behavioral Health Distress Line, emergency department diversion and triage, and utilization of crisis centers to provide subacute care for patients not requiring acute inpatient psychiatric hospitalization. Access to Substance Use Disorder (SUD) Treatment: Idahoans uninsured due to the economic devastation resulting from COVID-19 will be provided access to SUD treatment. Target population includes individuals with SUD and those co-occurring individuals with either SMI or less than SMI symptoms and who fall between 138-200% of FPG. Services include residential and out-patient treatment, and recovery support services. Access Behavioral Health Services for Professionals: Professionals of all types currently on the front lines of the COVID-19 crisis, including medical professionals, as well as other behavioral health providers, are often in need of services themselves. Those needing assistance will be offered five (5) free sessions of evidence-based counseling or assistance in accessing services if already insured.

The "Omaha Crisis Intervention Project" is to serve as the tribal centerpiece to provide crisis intervention services, mental and substance use disorder treatment, and other related recovery supports for Native American population impacted by the COVID-19 pandemic. The COVID-19 pandemic crisis comes on the heels of a rash of completed suicides and numerous attempted suicides as well as a homicide that has left the community shattered and little time to heal. A comprehensive planning and implementation approach will be developed to improve the Tribe's current community health system to respond to current condition of our community. This includes addressing emotional and mental stress created by COVID-19 and meeting the immediate need for accessing mental health and substance abuse services.

The Arizona Emergency COVID-19 Project is to address the increased need for substance use, mental health, and crisis support services to Arizonans that have been impacted by the COVID-19 pandemic. The Arizona Emergency COVID-19 Project will meet the required activities of the grant by meeting the following proposed goals and objectives: Goal 1: Develop and implement a comprehensive plan of evidence-based mental and/or substance use disorder treatment services for individuals impacted by the COVID-19 pandemic. Goal 2: Improve access and connection to services for Arizonans that are at greater risk for developing substance use disorders, mental health disorders (including individuals diagnosed with a Serious Mental Illness (SMI)), and/or co-occurring disorders due to the COVID-19 pandemic. Goal 3: Increase evidence-based practice (EBP) and population appropriate practices and service utilization for Arizonans that are experiencing substance use disorders, mental health disorders, and/or co-occurring disorders due to the COVID pandemic. The first phase of the project will be a planning phase to inventory resources available to Arizonans, which will include the appropriated funding for Emergency COVID-19 allocated to Arizona, to ensure service gaps, barriers, and potential overlap has been addressed before project implementation. Once planning has concluded, Arizona will be in a better place to address identified priorities with these funds, which may include, but is not limited to, the following items: increase infrastructure of current crisis services (e.g. crisis phone lines) in Arizona through additional services and/or both licensed and non-licensed staff substance use and mental health professionals to address the increased need for crisis services, identify Arizona service providers who are in need of telehealth or teleconference software to address the needs of the target populations, and appropriate, and deliver recovery support services, including rapid re-housing, to improve access to, and retention in services. Project outcomes will include, but is not limited to, the following: increased collaboration and partnerships across service providers, increased access and connection to services, increase identification of service providers experiencing greatest need related to COVID-19, increased utilization of evidence-based treatment services, increased number participants referred to recovery support services, increased access to crisis mental health services, and increased number of participants receiving services within telehealth context.

The Montana Emergency COVID-19 project will strengthen the capacity of nine counties and four tribal behavioral health programs to provide mental health and substance use services, including crisis services, during COVID-19 pandemic to individuals with serious emotional disturbance (SED) for youth, serious mental illness (SMI) for adults, and substance use disorder (SUD) for youth and adults. Funding will also be utilized to support healthcare workers and others with less severe mental disorders who are impacted by the COVID-19 pandemic. Our state strategy involves contracting with nine counties who work through their existing partnership networks to fund licensed / state approved mental health and substance abuse treatment programs who will provide direct services identified most critical and needed in their community. The nine counties who will participate in this initiative are: Yellowstone, Missoula, Gallatin, Sanders, Ravalli, Silver Bow, Flathead, Lake, and Lewis and Clark. Collectively, these counties represent 62% of Montana's overall population and are home to an estimated 178,000 adults in the target population. As of April 8,2020, 78% of the COVID-19 cases in Montana were in one of these 9 counties. Our second strategy involves funding four tribally operated state approved substance abuse treatment facilities, located in four American Indian Reservations. White Sky Hope on the Rocky Boy Reservation, Spotted Bull on the Fort Peck Reservation, Fort Belknap Chemical Dependency Program on the Fort Belknap Reservation, and Crystal Creek on the Blackfeet Reservation. American Indians compromise the largest racial minority in Montana with 6.4% of residents identifying as American Indian / Alaska Native. American Indians in Montana are disproportionately impacted by behavioral health issues including substance misuse and abuse. The goal of this project is to increase Montana's capacity to provide behavioral health crisis services, including telehealth services, along with assessment, treatment and recovery support services to individuals impacted by COVID-19 pandemic. Our measurable objectives include documenting behavioral health crisis service provision to at least 1,000 individuals in Montana supported by this funding over the course of the project period and document behavioral health assessment, treatment and recovery service provision supported by the funding to at least 400 individuals over the course of this project period. We anticipate at least 1000 individuals will be served in the first year of the project and 1,400 will be served over the course of the project period.

Florida intends to use $1,800,000 in grant funds to purchase an array of behavioral health services for the target populations identified in the Request for Application. Specifically, $600,000 will be allocated to IMPOWER (through the Central Florida Cares Health Systems managing entity) to provide psychiatric and therapeutic services via telehealth for healthcare practitioners and individuals experiencing mental health and/or substance use issues as a result of COVID-19. The remaining $1,200,000 will be allocated to managing entities based on highest impact of COVID-19 in their service area to serve individuals with serious mental illness and/or substance use disorders. These funds will purchase crisis intervention, behavioral health treatment, and recovery support services.

SAMHSA Emergency Grants to Address Mental and Substance Use Disorders During COVID-19 Nez Perce Tribe Abstract Summary Funding assistance is requested from the SAMHSA Emergency COVID-19 program to help the Nez Perce Tribe conduct an effective public health emergency response to COVID-19 on the 1,208 sq. mile Nez Perce Reservation in north central Idaho. SAMHSA funding will be used for the Nez Perce Tribe Health Authority, Nimiipuu Health and its Behavioral Health Department, to contract with qualified public health professionals over one year to assist the two Nimiipuu Health centers in identification, treatment, and monitoring of the COVID-19 epidemic among the Tribe's 3,650 members and 4,780 Nimiipuu Health clients who are engaged in or at risk of SUD and/or co-occurring mental disorders. Funding will help cover an additional 25% increase in hours needed by the Nimiipuu Health Behavioral Health Director in addressing the pandemic and will pay for the department to hire a data specialist at 50% full time employment to monitor data regarding behavioral health cases impacted by the pandemic. Direct services will enable Nimiipuu Health Behavioral Health to obtain sobriety housing for the equivalent of 12 individuals in recover from SUD to obtain sobriety housing for 12 months and for 12 clients with SUD or co-occurring mental health disorders to obtain 30-45 in-patient residential treatment services as needed. Additionally, funding will enable Nimiipuu Health Behavioral Health to contract with outside qualified mental health professionals to provide up to 750 hours in contract services to help alleviate the increased demand for mental health evaluations and counseling services for Nimiipuu Health Behavioral Health clients, as well as 80 hours of contract counseling as needed to help medical staff cope with extreme stress resulting from the pandemic. Our funding request is in the amount of $453,467.

NARA (Native American Rehabilitation Association of the Northwest), an Urban Indian Organization and Federally Qualified Health Care Center (FQHC), located in Portland, Oregon will adapt its current strategies to provide telehealth services according to the guidelines provided by the Center for Disease Control in response to the COVID-19 virus. NARA serves primarily American Indian/Alaska Native (AI/AN) populations in the area, who have shown higher rates of substance abuse, and mental health conditions, homelessness, disabling conditions, and domestic violence when compared to other ethnicities (Lewis, Myhra, 2018). The SAMHSA Emergency COVID-19 funding will reduce the impact of disparities that limit access to substance use and mental health services, increase screening, assessment, crisis stabilization, and referral processes with the overall goal of continuing care during pandemic, as well as improving evidence based patient outcomes (e.g., PHQ-9, etc.) for at least over 400 low income, uninsured, or homeless individuals and/or families over the period of 16 months; the primary focus is on individuals with substance use disorders, mental illness of a reduced severity, as well as health care workers who seek treatment for mood symptoms related to COVID-19. This project will allow NARA, with the support of community partners (Cascadia's Project Respond, JOIN, and Unity Psychiatric Hospital), to continue to provide crisis intervention services, mental and substance use disorder treatment for both children and adults, as well as recovery supports for those individuals impacted by the COVID-19 pandemic. With the use of telehealth, this project brings much needed access to addiction services, as well as behavioral health services during the duration of the pandemic and through recovery. Through system adaptation that aligns with the recommendations put in place by the CDC, NARA commits to goals focused on reducing barriers to care, using evidence based practices, promoting behaviors and activities that promote recovery as well, as overall well-being through the use of telehealth with the gradual integration to in person services. Key interventions and strategies are: 1. Create a leadership committee that is committed to reducing disparities caused by limited access to mental health services during the COVID-19 pandemic at NARA; 2. Develop a method to screen individuals for mental health symptoms and need for treatment through telehealth. 3. Develop a strategy to identify need for patient supports during this time of limited access; 4. Assess and monitor mental health symptoms during this time of pandemic; 5. Develop a systematic monitoring strategy for streamlining individuals identified as high risk or with severe mood symptoms into treatment rapidly; 6. Provide responsive patient, family, and community support to those at risk through outreach as well as referral to supportive resources.

Due to the very limited Wi-Fi coverage on the Spokane Reservation, the Spokane Tribe of Indians Behavioral Health program plans to create a mesh network to provide Wi-Fi coverage for its patients. In order to ensure that their clientele can still receive proper health care, HHS will provide Wi-Fi coverage throughout the parking lot outside of its facility in Wellpinit, WA. The parking lot will serve as a virtual facility throughout the COVID-19 emergency. The Spokane Reservation is a large, rural reservation located in northeastern Washington State along the Spokane River. There are just under 2,200 individuals that reside on the 237 square mile reservation. Around 80% of the total on-Reservation population is American Indian. Approximately two thirds of the population do not have access to adequate Wi-Fi or cell phone coverage. The Spokane Tribe created the HHS Behavioral Health department in order to address the Tribe's overwhelming substance abuse and mental health disorders. In order to ensure that the Spokane Tribe of Indians Behavioral Health Program continues to provide adequate services to its clientele throughout the COVID-19's emergency, the mesh network in the parking lot will allow for clientele to continue meeting with caseworkers and mental health counselors. HHS's behavioral electronic health record system, InSync, has a built-in, fully-integrated, Zoom-based, HIPAA-compliant, telehealth solution that allows for both individual and group therapy sessions. Additionally, laptops, tablets, and cellphones will be purchased to allow for telehealth solutions that are necessary in order to continue addressing the Spokane Tribe's substance abuse and mental health disorders, as well as complying with the social distancing regulations in place during the COVID-19 pandemic. Data will be captured on a day-to-day basis through the intake process, as patients reach six months of therapy, and upon completion of therapy. The Washington State assessment, the PHQ9, the GAD7, Beck's Depression Inventory, and the ASAM Assessment tool will be used to capture data after six months of therapy and at discharge by the patient's assigned therapist. It will be compiled and analyzed on a quarterly basis by HHS's Clinical Applications Coordinator. It will be reviewed periodically by a case review team that will include all six licensed therapists, the Project Director/Behavioral Health Director and the Director of Health and Human Services to identify opportunities for improvement. Areas of improvement will be determined by key performance metrics established jointly by the clinical review team, the Behavioral Health Director and the Director of Health and Human Services. For example, if one key performance indicator is time from intake to first counseling session, the Project Director may be asked to conduct a process map to find opportunities for improvement.