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Summary of the project: Adult & Child Health (A&C) Targeted Capacity Expansion proposal supports the organization in becoming an American Society of Addiction Medicine (ASAM) certified substance abuse treatment facility in the Greater Indianapolis area. Indiana ranks 13th in the nation for overdose related deaths while stretched provider ratios continue to leave a gap of thousands of Hoosier women in need of treatment. Within the Greater Indianapolis Metropolitan Area, A&C will expand and enhance its current substance abuse treatment model to include intensive outpatient and low-intensity residential treatment to adult women struggling with substance abuse, including women who are pregnant. A&C will increase access to integrated substance abuse treatment utilizing a strength-based, multi-disciplinary approach targeting low-income women. Adult & Child Health's approach is designed to provide a supportive environment that will offer intensive and comprehensive treatment throughout the continuum of care. Amount requested: $375,000 per year, 3 years Population to be Served: Low-income adult women, including those who are pregnant. Strategies and Interventions: A&C will enhance intensive outpatient SUD treatment to meet ASAM 2.1 criteria. A&C will begin providing Level 3.1 -Low-intensity residential treatment including a 15-bed operation providing 24-7 care. Specialized treatment offering will be available to those who are pregnant. Project Goals and Measurable Objectives: 1. Adult & Child Health will implement required policies, procedures, and programming to become certified ASAM 2.1 and 3.1. 2. Adult & Child Health will increase the number of SUD-diagnosed patients engaged in harm-reduction and recovery support services. 3. Adult & Child Health will decrease the number of patients reporting relapse within 90 days of discharge from ASAM 3.1 residential treatment. 4. Adult & Child Health will increase the number of pregnant women struggling with SUD engaged in treatment and remaining abstinent of substances during their pregnancy. Projected number served annually: Year one-120; Year two and three -144 Projected number served lifetime of project: 408

Catholic Charities Eastern Washington requests SAMHSA funds to support Rising Strong--an innovative 12-18-month program located in Spokane, WA. Rising Strong provides an intensive Substance Use Disorder (SUD) and Co-occurring Disorder (COD) treatment framework for child welfare-involved families within a transitional housing setting. Rising Strong's population of focus is families involved with the foster care system as a result of child abuse and neglect stemming from SUD/COD. The unmet needs for this population in Spokane County are significant, as 13.1% of people live in poverty (compared to 9.8% statewide), 16.5% of adults experience frequent mental distress (compared to 13.6% statewide), and 30% of adults have experienced three or more Adverse Childhood Experiences in their lifetimes. Child welfare system data also reveal significant need, with the local rate of children in Out-of-Home Care being 60% higher than the statewide rate. Finally, Child Welfare intakes of American Indian/Alaska Native children and youth are distinctly elevated compared to White children and youth, even though Spokane County is 88.9% white and 1.8% American Indian/Alaska Native, revealing a troubling disparity. Rising Strong will serve 55 unduplicated clients per year and 165 unduplicated clients over the course of the three-year grant period. Through an integrated and team-based service model providing evidence-based practice (EBP) interventions for SUD-COD and robust recovery support in a transitional housing setting, Rising Strong will increase access to treatment and recovery for the under-resourced population of focus. In alignment with identified community needs, our proposal includes the following goals and associated measurable objectives to be achieved by the end of the grant term: GOAL 1: INCREASE THE SUCCESS RATES OF SUD/COD TREATMENT THROUGH LONG-TERM EBP INTERVENTIONS. Measurable Objectives include: 85% of clients served will have completed Intensive Outpatient treatment within 15 weeks of intake; 80% of clients served will have completed Outpatient treatment within 30 weeks of intake; Under 50% of clients served will have experienced relapse; 90% of clients served will have been referred to Medication Assisted Treatment services within 4 weeks of intake; and 80% of clients served will have completed four Dialectical Behavior Therapy modules within 30 weeks of intake. GOAL 2: REDUCE AND ADDRESS ADVERSE CHILDHOOD EXPERIENCES (ACEs) BY HELPING FOSTER-INVOLVED FAMILIES REUNIFY AND DEVELOP HEALTHY FAMILY PATTERNS. Measurable Objectives include: 95% of households served will have been enrolled in Wraparound with Intensive Services (WISe) within 96 hours of child(ren) being reunified; 85% of children served will have been reunified with parent(s) within 8 weeks of intake; 95% of clients served will have completed COSP within 12 months of intake; and 70% of clients served will have graduated from RS programming within 18 months of intake. With SAMHSA support, Rising Strong will expand its capacity to reduce the impacts of family separation through whole-person/whole-family treatment that directly addresses the SUD/COD and related factors that led to child welfare involvement, helping families reunify quickly and develop pathways to stability and the ability to thrive.

CPNJ's Northeastern NJ Recovery and Individualized Support Expansion (RISE) Program will provide screening, assessment, wellness and recovery planning, linkage to specialized, developmentally appropriate services and ongoing care coordination to individuals at risk of or struggling with substance use disorders. These services will be tailored based on the Initial Assessment and outcomes of evidence-based tools such as the GRPA interview. Specialized evidence-based treatment referrals will be made, including to programming offered at CPNJ, such as Ambulatory Withdrawal Management (AWM), Medication Assisted Treatment (MAT), medication monitoring, outpatient therapy, and intensive outpatient therapy. Clients may be linked within their local community, as needed, as we have secured several partnerships and collaborative agreements to best serve individuals in need. These services will be available to individuals ages 14-35, an age demographic most vulnerable to initiate a new substance use diagnosis (SUD), in the Northern Counties of New Jersey (Bergen, Passaic, Morris, Warren, and Sussex Counties). CPNJ anticipates serving 150 individuals in year 1, and 175 individuals in years 2 and 3, for a total of 500 unduplicated individuals during the project period. The catchment area for this grant is a diverse cross section of rural counties and urban counties with many distinct differences. We aim to serve community members who may be at highest risk of harm due to demographics, including but not limited to, low socioeconomic status, ethnic minorities and/or LGBTQ+ identity. Goals: Goal 1: Provide care coordination and linkage to services to high-risk individuals to prevent or reduce the progression of a SUD. Objective 1.1: Screen 100% of individuals referred to the RISE program to assess for biopsychosocial needs utilizing an evidenced-based model. Objective 1.2: Provide outreach, monitoring, care coordination, and follow up services to 100% individuals enrolled in the RISE program. Objective 1.3: Link 100% of identified individuals to appropriate services to prevent or address the progression of a SUD. Goal 2: Provide wraparound care to individuals engaged in SUD supportive services to increase retention and improve recovery outcomes. Objective 2.1: 100% of participants will be offered peer recovery support. Objective 2.2: Actively engage and retain 65% of enrolled individuals in treatment for at least 90 days as measured by contact logs through the use of recovery support services. Objective 2.3: 100% of RISE participants will be screened for social determinants of health and assigned a case manager to address the barriers to care. Objective 2.4: Outreach and collaborate with 50 organizations annually to provide comprehensive services to recruit and engage individuals in care.

Project Abstract Summary Project Name: The Harborview Medical Center Special Project Collaboration Opioid Use Disorder Treatment (HMC SPC-OUD) Project Summary: The Harborview Medical Center Special Projects Collaborative Opioid Use Disorder program will target high risk individuals in South King County, Washington who are seeking medication for opioid use disorder (MOUD) at two new low barrier primary care medical clinics managed by the Harborview Madison Clinic and co-located with significant behavioral health and homelessness services provided by Catholic Community Services (CCS). Building on our successful experience with a proven model of providing MOUD in urban safety net medical settings, we will expand capacity to treat more patients and enhance services for patients at two South King County Family Centers that are implementing low barrier drop-in primary care medical services for a hard to reach population. This is a collaborative clinical effort between 1) HMC, which has substantial experience implementing MOUD in primary care settings, 2) the HMC Madison Clinic, which will provide the primary care services most needed by the target population, and 3) Catholic Community Service, which manages the Family Centers and provides behavioral health, outreach, and housing programs at each site. A South King County needs assessment of the target population found that 75% had unstable housing within the last 12 months; the average age was 46 years; 64% were male; 34% were women; 1% were trans/non-binary; mean age was 46 years; 45% were white, 8% American Indian/Alaska Native, 9% Latino/Hispanic, 34% black, 6% Asian/Pacific Islander, and 6% other. Strategies and interventions include two Evidence-Based Practices (EBPs): 1) MOUD with buprenorphine-naloxone, extended-release naltrexone, or injectable buprenorphine, 2) The Massachusetts Nurse Care Manager Model for providing MOUD in medical settings. Project goals are to: 1) increase low barrier access to MOUD using a proven model for providing integrated services in in medical settings; and 2) provide enhanced on-site services for patients receiving MOUD who have high rates of experiencing homelessness as well as medical, mental health, and other substance use problems. Objectives include, but are not limited to: 1) serve 378 unduplicated patients over a three-year period, 2) provide same-day medication access to individuals with OUD, 3) assure access to comprehensive services in a culturally competent, patient-centered care manner, 4) reduce adverse OUD-related outcomes and substance use from baseline to 6-month follow-up, 5) maximize retention in MOUD, 6) reduce disparities in MOUD access, 7) collaborate with community partners to serve high risk patients, 8) provide harm reduction, recovery support, key medical screening, and tobacco cessation services, 9) seek sustainable program financing, and 10) train clinical staff in the use of EBPs, including DATA waiver training. This project will be done in collaboration with the Washington State Research and Data Analysis, which will provide technical support, ongoing evaluation, and policy support.

Cornell Scott-Hill Health Center (CS-HHC), a private 501(c)(3) non-profit organization located in New Haven, Connecticut, intends to implement targeted strategies, including the expansion of telehealth and peer recovery support services, for the provision of substance use disorder (SUD), co-occurring disorder (COD), harm reduction treatment, and recovery support services to 180 Lesbian, Gay, Bisexual, Transgender, and Queer (LGBTQ+) clients, a SAMHSA identified under-resourced population. The proposed geographic catchment area is comprised of six municipalities in Greater New Haven, Connecticut (East Haven, Hamden, Milford, New Haven, Orange, and West Haven) and three municipalities in the Lower Naugatuck Valley (Ansonia, Derby, and Seymour) with a combined population of 390,875. All nine municipalities are located within New Haven County. There are an estimated 133,000 LGBT people age 13 and over in the state of Connecticut. Substance misuse or overuse, which may be used as a coping mechanism or method of self-medication, is a significant concern for members of this community. Lesbian, Gay, and Bisexual (LGB) adults are nearly twice as likely as heterosexual adults to experience a substance use disorder. Transgender individuals are almost four times as likely as cisgender individuals to experience a substance use disorder. This is due in part to a number of societally imposed obstacles such as (a) discrimination or stigmatization based on sexual orientation; (b) hate crimes, emotional abuse, threats, public humiliation or ridicule; and/or (c) rejection or shame from family or friends after coming out. Over half of LGBTQ+ Connecticut residents age 18-24 and 30% of LGBTQ+ residents age 25-45 have indicated a need for a mental health and SUD services. The target population is also subject to considerable trauma (IPV, bullying, family shunning, outing) when compared to their heterosexual peers, as well as prone to high risk, unhealthy behaviors. CS-HHC will employ a number of evidence-based interventions, which are culturally-competent, trauma informed and designed to meet the patients where they're at. Approaches will include: integrated healthcare (primary care, behavioral health, dental, and specialties including infectious disease and women's health), engagement/outreach, outpatient treatment (MI, MET/CBT), Intensive Outpatient Programs (IOPs MATRIX Model with adaptation for LGBTQ high risk behaviors, pharmaceutical interventions (MAT), and referrals to inpatient programming as medically appropriate. Specific models include: Covington's Recovery for Men/Woman and Facing Trauma for Men and Gender Populations, Rapid Eye Movement Therapy, and TREM. For the 2022-25 project period, CS-HHC expects to serve 45, 60, and 75 clients, respectively, each year, for a total of 180 clients.

Project Title: Longitudinal Integration and Virtual Expansion of Rural Substance Use Disorder and Liver Disease Treatment in Iowa (LIVER-SUD-IA) Applicant Organization: University of Iowa Applicant Organization Address: 2 Gilmore Hall, 112 N Capitol St, Iowa City, Iowa 52242 Project Director: Andrea Weber, MD Project Director Contact Information: andrea-n-weber@uiowa.edu; telephone: 563-370-1919 Funding Opportunity: Targeted Capacity Expansion Grant. TI-22-002 Grant Program Funds Requested: $374,968 each year for 3-year grant term. The University of Iowa Addiction and Recovery Collaborative (UI ARC) within the University of Iowa Hospitals and Clinics (UIHC) in partnership with the UIHC Liver Clinic and Iowa Harm Reduction Coalition (IHRC) proposes the LIVER-SUD-IA project to expand access to integrated substance use treatment and recovery services to people substance use disorders (SUD) and co-morbid liver disease living in rural Iowa and seeking specialty liver services at UIHC. The project population will consist of participants living in rural Iowa, which has been identified as a Priority Population by Executive Order 13985. Over the lifetime of the project, 100 unduplicated participants will be reached with grant funds and include 30 participants in Years 1 and 3 with 40 participants in Year 2. Goals and objectives include: 1) Integrate SUD screening for patients from rural Iowa receiving care at the UIHC Liver Clinic. Utilizing a case manager integrated within the liver clinic, patients with liver disease will be screened for co-morbid high-risk substance use or use disorder. The project will also provide faculty development to both UIHC and community liver specialists on the benefits of screening and treatment of SUD. 2) Expand access, utilization, and coordination of integrated telehealth SUD treatment and peer recovery support services (PRSS) to rural patients with co-occurring liver disease and SUD. Patients with positive screens will be able to enroll in the project, which will include evaluation with an addiction medicine specialist and a substance use counselor from the UI ARC. This evaluation will create a treatment plan that will include medications for addiction treatment (MAT), individual counseling, group counseling, and access to a dedicated peer recovery support specialist. Services will be offered in-person and via telecommunications to decrease barriers associated with seeking specialty care in rural Iowa. 3) Improve treatment outcomes for patients living in rural Iowa with co-occurring liver disease and SUD receiving integrated telehealth SUD treatment and PRSS. With these enhanced and comprehensive treatment services, the project will decrease substance use, increase recovery capital protective against return to substance use, and ultimately improve outcomes related to substance-related liver disease, such as improved clinical liver function, completion of hepatitis C treatment, and successful liver transplantation listing and/or completion. A partnership will be formed with the University of Iowa Department of Psychiatry for evaluation and a partnership with IHRC to provide community-based harm reduction services and education. The project will create a research database to inform the key deliverables of the grant and to inform ongoing telehealth SUD treatment delivery models to rural Iowans.

Atlanta Harm Reduction Coalition, Inc., (AHRC) in partnership with Odyssey Family Counseling Center (OFCC) is requesting funding to support its Substance Use (SU), Co-Occurring Disorders (COD), harm reduction, and HIV/VH/STI services to help reduce adverse effects of SU, COD, overdose and HIV/VH/STI by delivering individual and group mental health and SU counseling, SU and sexual health evidence-based interventions, outpatient SU treatment services, peer support, linkage to essential, supportive, and medical services including telehealth, HIV/VH/STI screening and treatment, Medication Assisted Treatment (MAT), syringe services including Narcan and fentanyl test strip distribution, job readiness training and employment, and transportation to at-risk African American men and women ages 18-44 and partners in southwest Atlanta. Toward these ends, the seven main objectives of this project are as follows: 1. By 9/29/2023, AHRC will train 2 Peer Support Workers within the population of focus to deliver harm reduction and recovery support services to population of focus. 2. By 9/29/2023, AHRC and OFCC will increase knowledge and prevention skills of at-risk African American men and women ages 18-44 and partners within the catchment area by providing Motivational Interviewing, Matrix Model, Strengthen Based Case Management, CLEAR, PROMISE, and Trauma Informed Care to at least 75 members of population of focus. 3. By 9/29/2023, AHRC and OFCC will increase awareness of SU and COD treatment, harm reduction, recovery support services and anti-stigma campaigns through strategic media campaigns to reach at least 2500 members of population of focus per annum. 4. By 9/29/2023, AHRC will increase SU, COD, and harm reduction education and services by conducting outreach, syringe exchange, Narcan, Fentanyl test strips, safety drug using and condom kits, immunization, and linkage to essential, supportive, and medical services to at least 150 members of population of focus per annum. 5. By 9/29/2023, AHRC will increase access of HIV/VH/STI treatment services, PrEP/nPEP, and low threshold Medication Assisted Treatment for 40 members of population of focus. 6. By 9/29/2023, OFCC will increase access of outpatient SU and COD for 20 members of population of focus. 7. By 9/29/2023, AHRC will provide job readiness training and linkage to employment through First Step Staffing and to 20 members of population of focus. Our main target population are African American men and women ages 18-44 and partners who have traditionally been the most disconnected from services and the hardest to reach, including people who use/inject drugs, LGBTQ, racial/ethnic minority, and those who live in rural areas. By fully integrating our services, our program will reach and assist populations that have fallen through the cracks of traditional fragmented service delivery systems, thereby increasing system capacity to effectively prevent HIV/VH/STI, SU, COD, and overdose and provide better access to care.

Federation of Organizations (Federation) intends to deliver a mobile substance abuse program utilizing Medication Assisted Treatment (MAT), coupled with a comprehensive set of psychosocial services targeting members of the LGBTQA+ population. This program will utilize a mobile team of clinical and behavioral staff and innovative methods to serve individuals suffering with Substance Use Disorder (SUD) and other Co-Occurring Disorders (COD). Federation will target members of the LGBTQA+ population, however will serve individuals regardless of age, ethnicity, race, background, or income level who reside in either Nassau or Suffolk County, NY. These two counties make up Long Island, which has a combined population of 2.834 million. Substance abuse, including opioid related deaths have steadily risen over the course of the last decade across Long Island and this has only been exacerbated by the pandemic. According to recent CDC data, the pandemic resulted in a rise in opioid related deaths of Long Island residents; 34% increase in Nassau County and a rise of 12% in Suffolk County. Additionally, members of the LBGTQA+ population are at a greater risk for SUD. Data from the 2018 National Survey on Drug Use and Health (NSDUH), suggests that substance use patterns reported by sexual minority adults are higher compared to those reported by heterosexual adults. Federation intends to expand access to SUD services including MAT for individuals with Opioid Use Disorder (OUD) in order to help mitigate the increase in opioid and other drug use across Long Island communities. Federation will develop a robust outreach plan including strategies to identify LGBTQA+ individuals with SUD who may benefit from targeted services. This sub-population is often underserved with very few social supports, leading them to increased risky behaviors. As a major provider of health and wellness, senior, veteran and children's services, housing and support services on Long Island and in New York City, Federation has expertise in the delivery of clinical services to at risk populations. Federation operates an Article 31 Mental Health Clinic and Article 32 Sub stance Abuse Clinic as well as a myriad of mobile treatment services. Federation will utilize this expertise to benefit the development and implementation of this program. Utilizing a mobile treatment team, we will meet individuals in their homes and communities which will bolster client comfort during treatment, compared to a typical outpatient setting and will increase our program's reach and the overall access to SUD services for Long Islanders. Our team will consist of a Psychiatric Nurse Practitioner, Licensed Master's Social Worker/Credentialed Alcoholism and Substance Abuse Counselor, and a Peer Recovery Specialist who will provide treatment including MAT as well as various psychosocial services including the use of support groups and provision of access to a Harm Reduction Vending Machine. Over the course of the three-year project period, Federation expects to provide MAT to 150 individuals that identify as LGBTQA+ suffering with SUD across Long Island as we anticipate providing treatment to 50 individuals each year. Federation will provide all services with evidenced based practices, a trauma informed lens, and will utilize a harm reduction model. Through the utilization of this innovative model of care and our organization's decades of experience in direct services delivery, we expect to decrease illicit drug use and drug related deaths within the LGBTQA+ population on Long Island.

St. John's Well Child and Family Center's (DBA St. John's Community Health) TransConnect Program will integrate, enhance, and expand screening, assessment, evidence-based harm reduction, treatment and recovery support services for substance use disorder & co-occurring mental disorders (SUD/COD) among low-income transgender/gender nonconforming (TGNC) adults in South Los Angeles. More than 75% of clients will be people of color; 25% homeless/unstably housed; 40% immigrants; 27% best served in Spanish; and 10% justice-involved; 25% are transmasculine, 65% transfeminine and 10% nonbinary. TGNC experience SUD/COD at disproportionately high rates of posttraumatic stress as a result of experiences of poly-victimization, discrimination, and depression/anxiety due to struggles with gender dysphoria. TransConnect will provide an opportunity to address SUD and support clients to improve their health, functioning and stability through collaborative, comprehensive, trauma-informed, peer driven services, including implementation of the Seeking Safety EBP adapted for TGNC. Objectives include: ensuring staff/partners have all training needed to conduct services in a way that is trans-affirming and culturally competent; linking positive screens immediately into care coordination services where TGNC will work with a provider on an individual service plan; ensuring high rates of retention in Seeking Safety and clinical care; and increasing a sense of hope, functioning, self-efficacy, and social connection for participants. A total of 375 TGNC will be served (125 annually). A total of 1,500 TGNC will be screened, 300 will be enrolled in Seeking Safety, and 375 will access case management and/or recovery support services.

North Texas Addiction Counseling Education (NTACE) is proposing Stop Tarrant County Overdose Prevalence (STOP) developed due to the specific challenges of 151% increased opioid OD deaths in Tarrant County in the previous reporting year. The purpose of the program is to coordinate community resources, fill gaps and create sustainable strategies to significantly reduce opioid OD deaths among the population of focus. This will be done through the implementation and provision of SUD and/or COD treatment, recovery support services, and limited harm reduction to support the unmet need for the population of focus. The population of focus are Individuals who recently experienced nonlethal opioid overdose (OD), Individuals who are high risk for OD, and/or Families/ Support system of those at high risk for OD. Tarrant Co, TX is the geographic catchment area where services will be provided with an emphasis on the West side of Fort Worth where NTACE is located, including a cluster of smaller municipalities: Lake Worth, River Oaks, Sansom Park, Saginaw, and Azle. The project is based on the coordination of existing resources and to link the POF to these services. Direct-care services proposed to be provided through NTACE include MAT, RSS, OP Treatment, Cooccurring Psychiatric Substance Use Disorder (COPSD), Case Management, Benefits Coordination and Overdose Reversal Medication (Narcan). Goal 1: Coordinate a community overdose prevention strategy to reduce opioid-related overdose deaths in Tarrant County. Goal 2: Implement limited SBIRT to identify and retain the those at high risk for death of OD. Goal 3: Expand availability and access to integrated SUD- COD treatment and recovery support services the POF to reduce opioid overdoses/poisoning in the catchment area. Goal 4: Evaluate, review progress and report on the project to effectively establish positive outcomes and increase sustainability efforts beyond the three-year funding period to continue to end accidental opioid OD deaths in Tarrant County by 2030.

Summary of Project: The Council on Alcohol and Drug Abuse (d.b.a. CADA Prevention and Recovery Center), a substance use treatment, mental health and HIV provider with 62 years of experience and a 16-year proven track record of serving the population of focus, will implement the Reconnect & Recover project expanding trauma-informed, culturally and linguistically appropriate SUD/COD substance use and mental health disorder treatment, harm reduction and wraparound peer-led recovery support services for 150 criminal justice involved adults over the 3-year grant period. The proposed program addresses a county-identified need to expand SUD/COD treatment in Jefferson and Orleans Parishes in partnership with the New Orleans Reentry Task Force, Orleans Parrish Reentry Court, the La. Dept. of Public Safety & Corrections, New Orleans District Probation/Parole, Fit Clinic, Healthcare for the Homeless, La. Council of Resources (LACOR) and Southeast Louisiana Legal Services. Project Name: Reconnect & Recover. Populations served: Criminal justice involved adults (ages 18+) with SUD/COD treatment needs based on ASAM criteria; 40% COD and trauma; 55% African American; 4% Hispanic; 19% Female; 80% Male; 1% Transgender. Strategies/Interventions: Expands reentry systems coordination, outreach, trauma-informed harm reduction, SUD/COD treatment and enhances treatment dosage and intensity via evidence-based practices and services (in-person and telehealth videoconferencing), case management, and recovery support services. Participants will receive comprehensive screening, assessments, case management, outpatient/IOP, family therapy, parent education and recovery supports. Trauma-informed services include standardized screening/assessment, SUD/COD outpatient/IOP treatment, coupled with strengths-based case management, peer-led recovery support services, and linkages to housing, education/employment, healthcare, and social supports. EBPs: Motivational Interviewing; Seeking Safety; Matrix; SMART Recovery; MAT. Goals. 1) Strengthen criminal justice systems coordination and collaboration to expand referral pathways to SUD/COD outpatient treatment for adults with criminal justice involvement; 2) Improve SUD diagnosis for COD, trauma, HIV, hepatitis and increase substance use abstinence using harm reduction techniques; 3) Increase access and retention in SUD/COD treatment; 4) Improve vocational/education/employment stability with recovery support system linkages; 5) Improve housing stability; 6) Decrease involvement in crime; 7) Use peer-led recovery support services and care coordination to ensure social connectedness; 8) Improve access/availability to SUD/COD treatment, reducing behavioral health disparities. Objectives: Between 9/30/2022 and 9/29/25: 1) 100% of 150 participants will receive screening/assessments; 2) 100% of participants will be screened/assessed for trauma, SUD/COD, HIV, hepatitis; 65% will improve abstinence; 3) 80% of participants will increase retention in treatment; 4) 80% of participants will improve vocational/education/employment status; 5) 80% of participants in need of housing will be placed in housing; 6) 80% of participants will reduce criminal justice involvement; 7) 80% of participants will improve social connectedness; 8) 55% of adult participants served will be racial and/or ethnic populations. #Served: 50 (Year 1); 50 (Years 2-3) = 150 total.

Meta House's Housing, Overdose Prevention, and Engagement (HOPE) program will provide recovery housing, treatment, and overdose prevention services for a diverse population of women in early recovery from substance use disorders and co-occurring disorders and their children and address the unmet need of recovery housing in the Milwaukee County area. Based on recent statistics for clients served at Meta House and Milwaukee County demographics, we expect to serve a population that is English-speaking and racially diverse, approximately 50% White, 30% Black/African American, 10% Native American, and 10% multiracial/other. Ethnically, we expect our population to be approximately 15% Hispanic/Latinx. Most clients will be 20 to 44 years old. Based on past data, we expect that 85% of the clients served will be heterosexual, 10% bisexual, and 5% lesbian. Meta House's programs are welcoming to transgender clients, although typically transgender women make up only about 1% of our client population. Families served by HOPE will be low-income and have multiple special needs in addition to their substance use disorders and co-occurring disorders, such as unstable housing, trauma histories, low literacy, and employability concerns. A significant number of women served will be parenting minor children. Most will be involved in multiple systems, including child welfare, TANF, and criminal justice. Meta House, a treatment provider with over 50 years of experience serving the population of focus, will provide recovery housing and outpatient treatment for women with substance use disorders and co-occurring disorders and their children, expand peer support services, implement overdose prevention strategies with women in recovery housing and their family members/supports, and collaborate with community partners to improve access to housing and comprehensive care for diverse populations. All women enrolled in the HOPE program will be admitted to Meta House's outpatient treatment program and living in Meta House recovery housing, which provides 26 units of integrated substance use disorder/co-occurring disorder treatment for women and children in a gender-responsive, culturally competent, trauma-informed context. The HOPE program will integrate the following EBPs: 1) Recovery Housing for housing stability, maintaining reduced substance use, and improvements in self-sufficiency and quality of life; 2) Motivational Interviewing for treating substance use disorders and co-occurring disorders; 3) Peer Recovery Support Services for providing recovery support and engaging clients in treatment; and 4) Naloxone and Fentanyl Test Strip Distribution for harm reduction and overdose prevention. The goals of the program are: advocate for expanding and supporting quality recovery housing in our community; serve 132 women (40 in Year 1, 44 in Year 2, and 48 in Year 3) with substance use disorders/co-occurring disorders and their children (20 in Year 1, 22 in Year 2, and 24 in Year 3) who are in need of recovery housing; provide services to women and families to support recovery and housing stability; support women in maintaining their recovery and improve their quality of life; provide harm reduction services for overdose prevention; increase housing stability for families; and minimize subpopulation disparities in access to, use of, and outcomes of project services. In collaboration with IMPACT, the experienced external evaluator for the project, a program evaluation will be implemented that will measure how the project meets all program goals and objectives as well as additional process evaluation questions.

The overall purpose of New Dawn-Warrior Women is to enhance and expand access to affirming culturally tailored substance use disorder (SUD) and co-occurring disorder (COD) harm reduction, treatment, and recovery support services for under-resourced Indigenous women from across the state of Arizona and Hispanic women from Southern Arizona-primarily in Pima County. The University of Arizona's Southwest Institute for Research on Women (SIROW), The Haven, and the Pima County Health Department will collaborate on New Dawn-Warrior Women to achieve this purpose. New Dawn-Warrior Women will provide culturally-tailored comprehensive residential, intensive outpatient, and outpatient SUD and COD harm reduction, treatment, and recovery support services to 135 unduplicated under-resourced Indigenous and Hispanic women who have SUD or COD (Year 1=35; Year 2=45; Year3=55). The majority of these participants are expected to be ages 18-45, to have dependent children, to be living at or below the poverty line, and to be homeless or near-homeless. The culturally-tailored treatment and services will include substance use and relapse prevention, family therapy and parenting classes; evidence-based practices to address substance use and mental health issues; primary and family care services; an array of recovery support services; active case management; as well as housing, vocational, and job placement support adapted to meet the unique needs of Indigenous and Hispanic women. In addition, the services will include the women-centered, culturally-tailored SIROW Health Education for Women sexual and relationship health intervention (SIROW-HEW), which includes an educational and motivational curriculum, sexual risk preventive behavioral skill development, and Viral Hepatitis, sexually transmitted infection, and HIV testing, counseling, and treatment. In addition, New Dawn-Warrior Women will expand activities for The Haven's Native Ways, an award-winning program that offers culturally supportive treatment options for Indigenous women with SUD or COD. The New Dawn-Warrior Women project team will utilize ongoing monitoring and evaluation to inform ongoing quality improvement and to examine the effectiveness of SUD and COD treatment, SIROW-HEW, and related services in decreasing substance use and related risk behavior and improving health-related well-being among Indigenous and Hispanic women. Throughout the duration of New Dawn-Warrior Women, the project team will regularly engage stakeholders to provide project support; will reinforce capacity by providing ongoing trainings; and will disseminate SUD, COD, and health risk relevant information and resources to practitioners and the public.

Targeted Capacity Expansion: Special Projects (TCE) No. TI-22-002 (2022-2025) This project will address the fentanyl overdose crisis in Tennessee (TN) by expanding access to treatment and psychosocial services for 240 rural clients who have recently experienced overdose in a 21-county catchment area of rural middle Tennessee. Using a comprehensive continuum-of-care model that integrates an array of evidence-based approaches to provide substance use treatment, psychosocial therapies, recovery support services, and harm reduction with a strong peer-support network, this project will facilitate long term recovery for this under-resourced population. These rural communities already have a critical gap in treatment services for substance use disorders as well as a severe lack of behavioral health providers, and are currently experiencing a surge of fatal and non-fatal overdoses, largely due to the increasing prevalence of fentanyl. In 2019, the TN Department of Health's Office of Information and Analytics reported 23,910 overdose-related hospital discharges, representing a sizeable stress on a system already struggling with the COVID-19 pandemic in the state. This project will divert people experiencing overdose from emergency departments and hospitals into long-term treatment, thus easing the burden on local medical infrastructure. In 2020, 66.4% of overdose deaths were fentanyl related in Tennessee and fentanyl was associated with 69.6% of overdose deaths in the catchment area. Preliminary data suggest that this figure will increase in 2021 and 2022. The rural poor are especially vulnerable to overdose, as local hospital closures have made it increasingly difficult to access full-service medical facilities. Elevated poverty rates (14.8%) and low education levels in the catchment area parallel closely with the numbers of fatal and non-fatal overdose. Buffalo Valley Inc. (BVI) will provide assessment for opioid use disorder, illicit drug use, alcohol dependence, and co-occurring mental health disorders. Based on these assessments and by engaging Assertive Community Treatment (ACT) as the guiding evidence-based practice, BVI will deliver a full continuum of services to eligible clients, including integrated treatment with mental and physical healthcare, medication, psychotherapy, case management, and transitional and permanent housing in rural middle Tennessee. Clients will be offered comprehensive residential and outpatient treatment, relapse prevention, Narcan training, peer support, vocational training, and transportation services. In order to render this broad spectrum of services, BVI will partner with other experienced service providers: Recovery Navigators, hospitals, ERs, law enforcement, faith-based entities, and employment agencies. BVI has extensive treatment infrastructure in the heart of the project catchment area, Hohenwald, TN, as well as seven satellite facilities, two mobile health clinics to serve remote, distressed counties, and over 650 housing units in the area, and is well positioned to serve the POF. The project's specific goals are: 1. To develop and implement outreach and engagement strategies for recruiting 240 rural clients who have recently experienced overdose to treatment (80 per year); 2. To conduct screening and assessments to identify 240 rural overdose clients (80 per year) with SUD, OUD, and/or and co-occurring disorders eligible for SUD/COD treatment and other services; 3. To provide evidence-based treatment, including medication, counseling, psychosocial, peer and recovery support services, case management, and harm reduction services to 240 rural clients (80 per year); and 4. To decrease OUD, SUD, and COD at six-month follow-up for 240 rural clients in the catchment area (80 per year).

Mental Health Care, Inc. (d/b/a Gracepoint) proposes an integrated evidenced-based program, Gracepoint's Access Point (GAP), to bridge the gap and serve individuals who are homeless or chronically homeless with co-occurring disorders (COD) and support the integration of behavioral health treatment and services, permanent housing and critical services, including health care, for individuals and families experiencing homelessness. This application requests $291,678 a year for each of three years, totaling $875,034. The purpose of the proposed program is to provide a familiar place (access point) to support those individuals who have lived on the streets or a place not meant for human habitat for over one year or three episodes in a four year period and have substance use disorders, serious mental illness, serious emotional disturbance, or co-occurring mental and substance use disorders. GAP is a means of empowering consumers to take control of their own recovery; provide a safe place where individuals receive respect, encouragement, and hope that encourages and strengthens their recovery with mental illness, addiction and / or trauma. GAP will provide: 1) behavioral health and other recovery-oriented services; 2) linkage to housing and services that support the implementation and/or enhance the long-term sustainability of integrated community systems that provide permanent housing and supportive services to the target population; and 3) efforts to engage and connect clients who experience SUDs or CODs to enrollment resources for health insurance, Medicaid, and mainstream benefits programs. Participants will be identified through the homeless services intake system and prioritized through the needs assessment and severity ranking system incorporated into the Tampa Hillsborough Homeless Initiatives (THHI) Homeless Management Information System. This program will serve 400 individuals annually who are homeless or chronically homeless on the path to housing. The program participants will be engaged in supportive employment, developing and implementing their own Wellness Recovery Action Plan and participate in recovery activities. The individual will be engaged for up to a year or more as program participant and/ or volunteers. GAP is a community-driven resource that will promote recovery, increase independence, and encourage community inclusion for persons with co-occurring disorders through education, consumer-run programming, support, and empowerment. Gracepoint will serve as grant administrator and provider and provide data collection and mandatory contract reporting.

The CARE Project (Critical Access to Recovery Expanded) Project Abstract Summary The Restoration Recovery Center's CARE Project (Critical Access to Recovery Expanded) will improve recovery outcomes for underserved communities in North Central Massachusetts, including individuals who are limited English-speaking, have experienced domestic violence, and/or have experienced sex trafficking. The CARE Project will provide: 1) timely identification of need, 2) harm reduction access, and 3) culturally-reflective peer recovery support services. The Restoration Recovery Center (RRC) will work in partnership with Community Health Connections (CHC), the Aids Project Worcester (APW), and the Spanish American Center (SAC) to support high-risk individuals to seek and sustain recovery. The CARE Project will do this through the following goals and measurable objectives: Goal 1. The RRC will link at-risk adults to coordinated primary health, behavioral health, and SUD treatment to enhance the health and wellbeing of 30 percent of the individuals supported. 1.a. By Year 1/ Quarter 1, the RRC will partner with CHC to identify individuals at-risk, provide linkages to mobile and telehealth screening, assessment, and treatment, and provide PRSS. 1.b. By Year 1/ Quarter 1, the RRC will partner with CHC to educate individuals accessing early recovery support services on how to access MOUD and polysubstance treatment. 1.c. By Year 1/ Quarter 1, the RRC will provide Opioid Overdose Prevention Education and Naloxone Distribution (OEND) to high-risk individuals, their networks, and high-risk venues. Goal 2. The RRC will provide peer support recovery groups and resources to underserved adults who are seeking post treatment PRSS to reduce substance use among individuals by 50 percent. 2.a. By Year 1/ Quarter 3, the RRC will partner with CHC and the SAC to tailor and implement our PRSS for underserved adults recently discharged from treatment and at risk for relapse. 2.b. By Year 1/ Quarter 4, the RRC will partner with the SAC to tailor and implement our PRSS for individuals who are limited English-speaking and who have experienced domestic violence and sex trafficking. Goal 3. The RRC will link underserved adults in early recovery to educational programs and/or professional development opportunities to advance recovery capital among 50 percent of the individuals supported. 3.a. By Year 2/ Quarter 1, the RRC will partner with the SAC to tailor RRC's education and employment programming to meet the needs of limited English-speaking individuals and conduct outreach through social media and community events. 3.b. By Year 2/ Quarter 1, the RRC will partner with the SAC to provide culturally-reflective and person-centered volunteer, training, education, and income generating opportunities through peer-driven recovery plan assessment and goal setting. By the third year of the CARE Project, the RRC and our partners will serve 600 individuals through our community outreach, harm reduction, and peer recovery support services (150 individuals in year one, 200 year two, and 250 year three).

Summary. Abounding Prosperity, Inc. (AP, Inc.) is proposing a program to support and enhance SUD treatment and recovery support services. AP, Inc. will primarily target Black persons, including the high-risk MSM and transgender populations. The catchment area where services will be delivered will be in Dallas County, TX. AP, Inc. will serve 100 unduplicated individuals annually with grant funds and 300 over the entire project period. Project name. Treatment and Recovery Support Populations to be served. AP, Inc.'s populations of focus (POF) will be AP, Inc. will be Black persons, including the high-risk MSM and transgender populations. The catchment area where services will be delivered will be in Dallas County, TX. Strategies/interventions. Program activities will include: 1) screen and assess clients for the presence of SUD and/or COD and use the information obtained to develop appropriate harm reduction, treatment and/or recovery approaches; 2) provide evidence-based and population-appropriate harm reduction, treatment, and recovery approaches, including medications for SUD, counseling sessions, contingency management therapy and recovery support services; 3) provide a range of recovery support services on-site to improve access and retention in services, including transportation services, case management, harm reduction counseling and education, a Safe Space Drop-in-Center; 4) develop and implement strategies that are inclusive and used to recruit and engage diverse people in care; 5) coordinate with other organizations and municipal agencies to ensure coordination of care and increase access to services; and 6) provide education, screening, care coordination, risk reduction interventions, testing, and counseling for HIV/AIDS, hepatitis, and other infectious diseases. AP, Inc. will implement a number of evidence-based practices (EBPs), including Motivational Interviewing (MI) and Seeking Safety. Project goals and measurable objectives. The proposed goal is to increase AP, Inc.'s capacity to provide SUD treatment and recovery support for MSM and transgender persons of color in Dallas. Objectives for the proposed program include: Conduct outreach and recruitment activities, reaching at least 200 persons from the population of focus per year; Assess 100 clients for the presence of SUD per year; Provide HIV and hepatitis screening to at least 90% of clients pear year; Provide substance use counseling services to 100 program participants per year; Provide referrals to health care and other services to at least 90% of program participants per year; Provide recovery support services to at least 90% of program participants per year; Provide comprehensive harm reduction education, services and supplies, reaching 100 members of the POF per year; Collaborate with at least three other service providers reaching the POF to coordinate care and ensure access to services; Provide Motivational Interviewing to 100 members of the POF per year; Provide Seeking Safety to 50 members of the POF per year.

The proposed program, Teen Solutions: Transforming Family Recovery, is addressing unmet substance use treatment needs of youth whose risk factors for substance use have increased during Covid-19. The goal of the program is to interrupt teenagers progression of substance use through the application of both, youth and family, recovery support services in partnership with evidenced based treatment services of Motivational Enhancement Therapy and Contingency Management Interventions. CARE will implement the following required activities to offer motivational-based therapeutic approaches to youth in partnership with RSS that are population specific by: 1) providing screening and assessment for substance use and/or co-occurring disorders through both telehealth and an in-person evidenced based models, 2) provide age appropriate evidenced-based (motivational enhancement therapy and contingency management) outpatient therapy for youth and families, 3) provide recovery support (RSS) for both youth and families via a youth peer recovery coach and family recovery coach respectively, 4) increase access to care by streamlining the intake process to treatment and customizing RSS services to those with the greatest need in the community and 5) enhance diversity, inclusion, equity (DEI) initiatives through a robust action plan in order to provide culturally competent services, including population specific RSS and staff that reflect the people served.

Team Management 2000, Inc., a community behavioral health center, will implement the Peer Recovery Imitative to implement peer recovery support for individuals living with HIV who have substance use disorder and/or mental illness, with a focus on the growing population of older adults, individuals 45 years old and older. The primary goal of this project is to improve outcomes for older HIV+ individuals with substance use and/or co-occurring disorders, including abstinence, employment, health, viral suppression, reduction in criminal justice involvement, and social connections, through the provision of new peer support services. We anticipate serving 200 individuals over the course of the three-year grant. For this project, we anticipate 85% will be minority. We anticipate 55% of clients will be homeless or unstably housed. 80% will be low income. We anticipate at least 60% of the clients being age 45 or older. We expect 75% to be dually diagnosed, with primary diagnoses being alcohol, cocaine, and opiate use disorder, along with major depressive disorder, bipolar disorder, anxiety disorders, and schizophrenia. There are significant gaps in services for substance use disorder (SUD), mental illness and HIV in New Jersey. The COVID-19 pandemic exacerbated those gaps, as people living with HIV/AIDS (PLWHA) and SUD have increased illicit substance use and contact with other substance-using individuals and decreased their confidence to stay sober and attend recovery meetings. HIV medication and follow up compliance has also decreased during the pandemic. Older adults living with HIV/AIDS (whose number are increasing) have been particularly vulnerable during the pandemic. A major barrier to these individuals receiving services has been identified as stigma. Peer support has been demonstrated to reduce stigma, as well as to reduce hospitalizations and overall costs. Peer support further improves outcomes by improving social functioning, qualify of life, treatment compliance, and community engagement. By sharing their own lived experience and practical guidance, peer workers help people to develop their own goals, create strategies for self-empowerment, and take concrete steps towards building self-determined lives. Implementing active peer support will improve outcomes for these at-risk individuals. Comprehensive evidence-based outpatient treatment and case management will ensure clients have needed resources for sustained recovery. This project will recruit and engage diverse people in care, screen individuals for SUD and/or COD. TM2K will implement strategies that are inclusive and used to recruit and ensure those with the greatest need are being served. TM2K will provide evidence-based and population appropriate harm reduction, treatment, and recovery approaches to meet the unique needs of diverse populations. These will include medications for SUD, outpatient day treatment (including outreach-based services), intensive outpatient treatment, and recovery support services. Recovery support services will include vocational, educational, and transportation services designed to improve access and retention. TM2K will collaborate with several community partners noted below that are trained and can serve diverse populations to provide comprehensive services.

Ann & Robert H. Lurie Children's Hospital of Chicago's Potocsnak Family Division of Adolescent & Young Adult Medicine (LCH) seeks a three-year grant of $375,000/year for Reaching Every Adolescent in Chicago through Harm reduction (REACH), a trauma-informed, evidence-based outreach intervention that delivers harm reduction education and supplies, SUD/COD screenings, and referrals to treatment and recovery supports to Chicagoans ages 16-25 in community settings. While all Chicago youth ages 16-25 will be eligible, REACH focuses on low-income, Black, Indigenous, and People of Color (BIPOC), and/or sexual minority (LGBTQ+) populations in under-resourced community areas experiencing a high prevalence of substance use/misuse disorders, mental health disorders, and trauma. REACH leverages LCH's Mobile Health Unit (MHU) to reduce barriers specific to youth engagement (e.g., lack of familiarity with available behavioral health resources, lack of knowledge around accessing SUD/COD diagnosis and treatment, and/or lack of transportation to clinic locations). In partnership with four community-based providers of youth services Lawrence Hall (South Side), Youth Outreach Services (South and/or West sides), Ignite (South Side), and Phalanx Family Services (Far South Side) LCH will deploy the MHU to partner agency sites to engage youth populations already accessing other services via these providers. Throughout the project, REACH staff will use Motivational Interviewing, Contingency Management, and Text-Messaging Interventions to encourage uptake of REACH services and adoption of healthier behaviors. Goals/Objectives: 1) Decrease incidence of opioid-related overdoses and fatalities among Chicagoans ages 16-25 by distributing opioid harm-reduction supplies to youth and providing related overdose prevention education to youth and youth-service providers. Objective 1a: REACH will provide Overdose and Disease Prevention Kits (including Narcan [naloxone] and fentanyl test strips) and related training to at least 45 unduplicated youth in Year 1 (Y1) and at least 60 unduplicated youth annually in Year 2 (Y2) and Year 3 (Y3), serving at least 165 unduplicated youth in Y1-Y3. Objective 1b: REACH will train staff at partner agencies to identify opioid substances, recognize an opioid overdose, and administer Narcan. LCH will train a minimum 30 unduplicated provider staff in Y1 and a minimum 10 unduplicated provider staff annually in Y2 and Y3, training at least 50 unduplicated provider staff in Y1-Y3. 2) Increase local capacity to identify Chicagoans ages 16-25 in need of SUD and/or COD treatment and recovery supports. REACH will offer SUD, COD, and recovery support screenings to participating youth. Objective 2a) REACH will provide screenings for SUD, COD, and recovery supports to at least 19 participating youth in Y1 and at least 25 participating youth annually in Y2 and Y3, screening a minimum 69 participants in Y1-Y3. Objective 2b) By the conclusion of Y3, 62 REACH youth (90%) will screen positive for SUD/COD and needed recovery supports.3) Strengthen access to SUD/COD treatment and recovery supports for Chicagoans ages 16-25. LCH will refer REACH youth screening positive for SUD/COD to applicable clinical services at LCH or another preferred provider, as well as to any needed recovery supports (e.g. transportation assistance, housing services) to promote engagement/retention in care. Objective 3a: LCH will refer at least 17 REACH youth to treatment and recovery supports in Y1 and at least 22 REACH youth annually in Y2 and Y3, referring a minimum 61 participating youth to individualized clinical care and wraparound supports in Y1-Y3. Approximately 50% of youth screening positive will initiate treatment/recovery supports. Objective 3b: Nine (9) participating youth in Y1, and 10 participating youth annually in Y2 and Y3, will initiate care, for a total 29 REACH youth initiating SUD/COD treatment and/or recovery supports by the conclusion of the project

Steppingstone, Inc. (SS) is applying to SAMHSA's TCE-Special Projects solicitation for $1,125,000 to expand our Fall River Outpatient Clinic to become a MassHealth qualified behavioral health urgent care (BHUC) provider and offer Integrated Treatment for Co-Occurring Disorders (ITCD) and Medication for Opioid Use Disorders (MOUD). The population of focus is individuals with opioid use disorders who have chosen to receive medication-assisted treatment (MAT). The Project will enroll 240 individuals over the 3-year grant term. The project will prioritize under-resourced populations including Hispanics, individuals with co-occurring mental health disorders (COD), and individuals who identify as LGBTQ+. To address the gap for timely treatment for persons who present with urgent needs, access to screening and diagnostic evaluation will be available within 24 hours, medication and psychopharmacology appointments within 72 hours, and treatment and follow-up within 14 days. Staff will be trained in the provision of ITCD and MOUD. Once enrolled, the OCE Nurse Practitioner and Clinicians will provide ongoing treatment and interventions to reduce risk, support treatment engagement and retention and promote an improved quality of life. Patients will be screened for both opioid use disorders and MHDs. They will be evaluated and inducted on buprenorphine/naloxone or another type of MOUD and begin treatment for CODs. Nurse Practitioners will closely monitor and regularly meet with each OCE participant to ensure effectiveness of treatment. OCE clinicians will provide comprehensive OUD psychosocial services utilizing evidence-based practices such as Cognitive Behavioral Therapy and Motivational Interviewing. OCE will utilize Steppingstone's expansive continuum of care, as well as linkage agreements with a variety of local organizations, to provide comprehensive recovery support services such as referral to permanent housing, employment, education, childcare, primary medical care, and other services as needed. The goals of OCE are to: -Build capacity to provide BH urgent care (BHUC) and implement strategies to address the need for integrated MOUD & COD treatment for high-risk, under-resourced populations in Fall River, MA. -Reduce substance use and increase number of individuals w/OUD or CODs receiving MOUD and and ITCD in Fall River, MA -Minimize risks associated with OUD and COD and promote treatment engagement. -Promote other positive outcomes by integrating treatment with recovery support services. OCE staff will also include a .5 FTE Project Director, a .5 FTE Assistant Clinical Director, Evaluator, 2 FTE Clinicians and 1 FTE Recovery Support Navigator. Other services will include peer services, crisis care, recovery planning, independent living skills training, discharge planning, and assistance obtaining entitlements and employment.

This project aims to (1) expand and improve community access to treatment services for Opioid Use Disorder (OUD) and Methamphetamine (MAP) use, (2) decrease opioid overdoses in the community through comprehensive evidence-based harm reduction strategies and (3) decrease MAP use in the population served by implementing evidence based interventions. Imperial Beach Community Clinic (IBCC) is a fully integrated federally qualified health center that provides behavioral, dental, and primary care services to low income and uninsured residents of Southwest San Diego County. Its geographic service area falls within the County's South Region, which is bordered by Mexico to the south, the Pacific Ocean to the west, the Otay Mountains to the east, and the city of San Diego to the north. IBCC's Behavioral Health Department, the direct service provider for this project, provides substance use disorder (SUD), medication assisted treatment (MAT), and comprehensive counseling and psychiatric services. Sustained in-service training has ensured participation and credentialing of primary care providers and increased capacity in the use of MAT for SUDs among providers throughout the clinic system. A strong team of care managers ensures that care is coordinated and timely. IBCC's overall patient population is comprised primarily of low-income and uninsured Latinx residents of southwest San Diego County. The population of focus for this program are those individuals in Southwest San Diego County struggling with any combination of opioid use disorder (OUD), methamphetamine (MAP) use, and Any Mental Illness (AMI). Overlap among these conditions is prevalent among individuals in our community and patients diagnosed with one or more have complex needs requiring a whole-person approach to healthcare. This includes the identification and amelioration of underlying determinants of health that pose a barrier to good patient outcomes.