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

The WI 988 Cooperative Agreement project will work to provide Wisconsin residents with in-state crisis phone, chat, and text counseling and intervention services. The State of Wisconsin Department of Health Services (DHS) plans to work with our current statewide Lifeline provider to meet or exceed a 90% in-state answer rate and improve response times to Wisconsinites using 988 through call, chat, or text. Wisconsin maintains its focus on a July 2022 rollout and the subsequent projected call volume increase. Therefore, the goals of this project are reflective of the need to support the existing Lifeline center and expand capacity. DHS will provide technical and monetary support from this grant to our established statewide Lifeline Center. This will provide resources to enhance the recruitment, hiring, and training of qualified behavioral health staff and provide a unified response to consumers. Successful implementation of 988 in Wisconsin will help to ensure that all Wisconsin residents, regardless of geographical area, have access to immediate communication with a trained counselor and connections to local crisis services. Wisconsin is home to approximately 5.9 million people. Wisconsin's overall population is 88% white, 7% African American, 3% Asian, and 1% American Indian/Alaska Native. Of that overall population, 7% is Hispanic, 22% is under the age of 18, and 18% is over the age of 65. Of Wisconsin's 72 counties, 65% are considered rural (non-metro). In addition, 10% of the population lives below the poverty line. In 2021, 36,497 calls were routed to Lifeline Centers in Wisconsin. Based on reports by Vibrant, the Lifeline administrator, Wisconsin has an impressively high in-state answer rate averaging between 85-90%. This grant will allow Wisconsin to maintain this high standard and prepare for and respond to the projected call, chat, and text increases expected in the coming years. DHS has an opportunity through this grant to set the stage for a successful 988 rollout in Wisconsin. Three primary and overarching goals of this project are: 1. Increase the capacity of the existing statewide Lifeline center to meet the projected volume increase by recruiting, hiring, and training behavioral health workers to respond and provide follow-up services to individuals experiencing a behavioral health crisis. 2. Improve coordination between the statewide Lifeline center and the larger crisis system, including county-based crisis programs and Public Safety Answering Points (PSAPs). 3. Assist the Lifeline center in the implementation of the Unified Platform. Personnel requirements for this project will be in kind and made up of staff within the Bureau of Prevention Treatment, and Recovery. Staff will include a Project Director, Project Supervisor, and Project Coordinator. Contracted staff will include the University of Wisconsin Population Health Institute, which will provide a Project Evaluator.

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

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

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

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

The Washington National Suicide Prevention Lifeline (NSPL) crisis center capacity expansion project will provide behavioral health workforce capacity and services that are culturally, geographically, and linguistically specialized and relevant for people in Washington who experience a behavioral health crisis. Data-driven efforts have led to the creation of the first Washington Indian Behavioral Health Hub and Tribal Crisis Line and chat/text service provision in Washington state; however, additional capacity is needed to provide additional relevant services to the communities we serve, and to ensure capacity can scale at the same rate as call, chat and text volume due to 9-8-8 implementation. Although Washington provides full geographic primary coverage, we rely on out-of-state NSPL centers to provide backup. With a projected (per Vibrant, medium call estimates) of 156,100 calls handled in year 1 and up to 424,600 calls handled in year 5, and significant behavioral health provider shortages, Washington must be creative in order to fund and sustain capacity. With this funding, Washington NSPL member centers will work to increase their staffing capacity to 100.0 FTE, establish a student intern program and follow-up program, and develop in-house training capacity to help develop the Behavioral Health workforce and recruit and retain employees. The project team, which includes members from the Department of Health, all three Washington NSPL member centers, Health Care Authority and Washington 911, will work together to plan for capacity building, sustaining, and service coordination. Over the course of the project years the team will submit Washington's quality improvement plan, plan for chat/text service expansion, sustainability plan for member center workforce capacity and meeting key performance indicators, and the centers will develop their follow-up programs, student intern programs, and training and professional development plans. The team will evaluate monthly, quarterly and annual data including the Network's key performance indicator data to identify solutions to address capacity challenges. This team has strong working relationships and has collaborated on initial technology planning and previous preparation efforts for 9-8-8 implementation (ie. via a coalition funded by Vibrant Emotional Health). The Washington state team is prepared to initiate work, if funded, without delay. Contract amendments are ready to pass at minimum 85% of the funding allocation to the three NSPL member centers. The Department of Health is prepared to shift staffing FTE to ensure no delays occur due to hiring. Team members have laid important groundwork for planning efforts thus far and if funded, are excited to support capacity building efforts immediately.

CNMI CHCC CGC 988 PROJECT

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

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

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

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

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

The West Virginia Bureau for Behavioral Health (BBH) will use 85% or more of this 988 Cooperative Agreement for subgrant award to First Choice Services (FCS), the state's single 24/7 call center for the National Suicide Prevention Lifeline, to build its workforce in preparation for the national launch of 988 in July 2022; increase its in-state call answer rate to 90% or more by June 15, 2022; add in-state chat and text responses in 2022; and meet other key performance indicators (KPIs). The remaining 15% or less of this grant will provide funding for a combined .3 FTE Project Director and .2 FTE Evaluator at BBH to ensure 988 grant goals, objectives, KPIs, and reporting requirements are met, including quality improvement, follow-up services, and sustainability planning for the call center and behavioral health crisis continuum of care.

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

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

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

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

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

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

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

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

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

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

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