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PROJECT ABSTRACT SUMMARY Project Name: Western Lane Mobile Crisis Response (MCR) Western Lane Fire and EMS Authority’s Mobile Crisis Response Program (MCR) is the first rural 24/7/365 mobile mental health crisis response program in Lane County, serving 19,128 residents in rural and remote areas. The proposed SAMHSA grant project will increase MCR’s capacity by establishing rural best practices staffing, improving law enforcement diversion through jointly developed protocols for response without law enforcement and by MCR providing safe, voluntary transport, and improving protocols and outreach to address suicide mortality rates that are nearly three times higher than county average. MCR serves a 980-square mile remote area bound on the east by coastal mountain range and the west by the Pacific ocean. Census data shows the project population catchment area of 19,128 residents has a disproportionately high percentage of older adults, veterans, and children < 18 living in poverty. Communities in Western Lane are high need as indicated by known factors associated with rural health disparities and its impact on mental health, including remoteness, isolation, poverty, social support and stigma. Suicide death rates in MCR service area are nearly three times higher than county average which is higher than state average. Enhanced infrastructure is needed to address gaps. Project goals are to implement a new staffing model based on SAMHSA best practices for rural mobile crisis programs whereby staff are multi-role providing crisis response to 19,128 rural service area residents, conducting community outreach to frequent users, providing voluntary transport, and collaborating with out of area resources and subject matter experts to be the rural face of suicide prevention outreach to high need audiences in the service area -veterans, children, and older adults. Measurable objectives include achieving adequate staffing levels within year one and sustaining at 80% through the end of project period; creating joint protocols with law enforcement and first responder agencies for response without law enforcement accompaniment with year one, reducing law enforcement accompaniment by 50% within year one and 60% within city limits by year 3; on-boarding eight frequent users into the community outreach program in year one, serving approximately 12 discrete frequent users per year resulting in over 44 individuals over the 4 year project period; achieving 50% reduce in 911 calls and 25% reduction in law enforcement use in Year 1. Suicide outreach measurable objectives are to conduct 12 outreach activities to each targeted audience per month, reaching a 30%, 75%, 85% of school age children in years 1,2,3 respectively; 25%, 50%, 75% of area veterans in years 1,2,3 respectively; and, reaching 75%, 90%, 90% of older adults’ liaisons in years 2,3,4 respectively.

The Indiana Innovative Community Crisis Response Partnership will create a streamlined mobile crisis response that is culturally responsive and works for and with community members. This project will operate through the 988 system in the State of Indiana and pilot in three high-need counties: St. Joseph, Lake, and Sullivan. St. Joseph, Lake, and Sullivan Counties are all high need counties due to elevated poverty rates and minimal or absent mobile crisis response. These counties have different demographic indicators: Lake County being the most urban and largest with 498,558 individuals; St. Joseph County being mostly suburban and having a population of 79,806 individuals; and Sullivan County being mostly rural with a population of about 20,758 individuals. In Lake County, approximately 5.1% of the population are veterans and 9.6% have a disability. The racial and ethnic makeup of the county is mostly White (53.8%), followed by Black (24.4%), Hispanic (19.6%), two or more races (2%), and Asian (1.7%). Native American and Native Hawaiian residents make up less than 1% of the population. In St. Joseph County 4.9% of the population are veterans and 11.3% have a disability. The racial and ethnic makeup of the county is mostly White (71.8%), followed by Black (13.8%), Hispanic (9.1), two or more races (3.1), and Asian (2.7). Native American and Native Hawaiian residents make up less than 1% of the population. In Sullivan County, approximately 6.6% of the population are veterans and 12.3% have a disability. The racial and ethnic makeup of the county is mostly White (91.6%), followed by Black (4.9), Hispanic (1.8%), and two or more races (1.4). Asian, Native American, and Native Hawaiian residents make up less than 1% of the population (CDC, n.d.). All in all, these three counties represent diverse and high-need communities where need for mobile crisis services is imminent. Project goals include: 1) create and enhance mobile crisis teams using culturally and developmentally appropriate services, 2) Implement a streamlined system with dispatch functionality through 988 and post-crisis follow-up protocols, and 3) Prioritize the use of data and evidence-based practices and measurement. These goals will be measured through key performance indicators, and this data will allow for project evaluation to identify gaps in service, and community mapping of crisis-need. This project will pilot a streamlined 988 crisis response that will allow for investment into community mental health. With a streamlined system, from the initial crisis call to the follow-up protocols, fewer individuals will fall through the cracks, and more lives will be saved. This project will serve the entire constituencies of each county, a total population of about 599,122 people.

The City of Newark’s Community Crisis Response Partnerships aims to improve the City’s crisis response system by enhancing existing co-responder teams to effectively provide trauma-informed comprehensive community-based behavioral health crisis services to individuals experiencing mental health emergencies, including those who are homeless. The project is a collaborative effort of the City’s Office of Homeless Services (OHS), Office of Violence Prevention and Trauma Recovery (OVPTR), Newark Police Division (NPD), and Office of Public Safety, 988 Suicide and Crisis LifeLine Center and behavioral health care provider (Rutgers University Behavioral Health Care (R-UBHC)) and community-based organizations (Mental Health Association (MHA) and Bridges Outreach Inc (Bridges)). The project’s goals are to: 1. increase access to comprehensive community-based behavioral health crisis services across the City of Newark by enhancing the capacity of existing co-responder and mobile crisis response teams so that they are ready to respond within one hour of dispatch; 2. create a compassionate, caring, and culturally competent behavioral health crisis workforce equipped to safely diffuse mental health crises by increasing the racial/ethnic diversity of crisis responders as well as providing in-service evidence-based and cross-agency training opportunities; 3. enhance the responsiveness to homeless individuals experiencing mental health crises by increasing collaboration between Newark’s systems for crisis care and homeless services; and 4. create an integrated city-wide crisis response system across the care continuum by enhancing cross-agency collaboration through data sharing and formalized partnerships with community-based organizations, hospital emergency departments, crisis receiving, and stabilization programs as well as R-UBHC 988 Lifeline /crisis call center. The project’s objectives are: to hire three additional social workers to increase availability on co-responder teams at NPD precincts; recruit 100% racial and ethnic diverse crisis responders to deliver culturally and linguistically appropriate responsive crisis response services; provide evidence-based crisis intervention training to crisis co-responder social workers and NPD officers; provide group training and one-on-one coaching on self-care to OVPTR staff; incorporate homeless screening assessment tools and/or questions into the crisis hotline screenings; integrating a licensed clinical social worker into homeless outreach and engagement teams; provide monthly training to increase the knowledge of trauma-informed care and population-specific issues and challenges related to homelessness among OVPTR social workers, NPD officers, and Public Safety Telecommunications (PST)); educate OVPTR co-responder teams on homeless programs, resources, and services through annual and quarterly training co-led by community-based homeless service organizations; develop and implement protocols for partnering and coordinating project activities with OVPTR co-responder teams, NPD, Office of Public Safety, 911/PST, as well as the 988 and crisis hotline call center operated by R-UBHC; establish inter-departmental and external data sharing agreements; conduct a review of the crisis response and screening law to streamline local response and identify opportunities for early behavioral health intervention; develop and implement post-crisis follow-up protocols for all recipients of mobile crisis response services; create a visual crisis map of the local crisis systems; lead the development and implementation of collaborative community safety plans; and develop and launch a public and cross-agency communications campaign to increase awareness of the 988-call line. By 9/29/2026, the project anticipates screening at least 2,000 unduplicated individuals for behavioral health issues and training 1,113 professionals across the behavioral health crisis care system.

The West Virginia Bureau for Behavioral Health Cooperative Agreement for Innovative Community Response Partnerships Program will create mobile crisis response teams to serve adults, children and youth experiencing a behavioral health crisis in Kanawha County, WV. The dedicated support for the creation of these teams will propel the development of crisis services in WV allowing for greater coordination in the development of this program, alongside the rollout of 988, with local law enforcement resources and 911 Public Safety Answering Points. Progress made in the development of this program will be scalable and will influence and enhance the development of further teams across WV.

SAMSHA FY 2022 Cooperative Agreements for Innovative Community Crisis Response Partnerships Genesee Health System’s Abstract Summary This program will serve residents of Genesee County, Michigan with behavioral health care needs that experience acute crises and escalation of symptoms. Genesee County Michigan has a population of approximately 400,000 individuals. Residents of Genesee County have experienced varying levels of personal and environmental trauma from the Flint Water Crisis, an increase in community violence, and the lingering impact of the covid-19 pandemic. The intended goal of this project is to provide comprehensive mobile crisis care in Genesee County, increase jail and hospital diversion and improve access to mental health treatment, by ensuring adequate post-crisis care. The target population is those that are most under resourced in Genesee County, such as individuals who are uninsured or underinsured, veterans, and those that are most disconnected from midtown; which is also home to the county government, the majority of social service organizations, and the county hospital which is the region’s only Level 1 Trauma center. GHS has just launched a mental health co-response program in partnership with Genesee County Sheriff’s Dept. This program needs further development. One of the goals of this project would be to partner with the County 911 communications center to develop a mental health-specific dispatch code to flag mental health-related calls. Law enforcement will be utilized when a call comes through dispatch indicating there may be imminent safety risks. GHS has already began to work with 988 (miCal) to receive referrals for behavioral health crisis care. We aspire to use this avenue to further provide mobile crisis services. We anticipate these calls will come into GHS’s main phone line or directly to the urgent care itself. Staff will be trained to utilize a decision tree to indicate whether crisis calls warrant law enforcement co-response or simply a mobile crisis call. Goals include: Improved access to behavioral health services, improve the proper disposition of mental health calls, hospital/jail diversion, timely access to crisis services as well as enhancing Genesee County’s crisis continuum. GHS cannot independently accomplish the goals listed above. GHS currently works with mental health providers in the community through an existing provider network. Further, GHS has an existing Memorandum of Understanding with several local law enforcement agencies, as well as an established relationship with the Genesee County 911 Consortium. Given the geographic expanse of Genesee County, and the reported 5,000 mental health-related calls that come through the service center. There is a need to centralize the current crisis service offerings, as this fragmented approach, generally confuses community members and results in low service utilization and heavy dependence on law enforcement or the hospital emergency department.

Texoma Community Center (TCC) is the Local Mental Health Authority in North Central Texas bordering Oklahoma. TCC has forged collaborative relationship with the law enforcement agencies for the counties in this catchment area and propose to strengthen and expand that relationship and improve the full continuum of crisis care in this area. TCC’s Mobile Crisis Outreach Team (MCOT) has been operating since 2007 and has been involved with jail diversion activities since that year, but has also been expanding into cross-training, participated in the sequential intercept mapping, the 988 initiative and cross-site evaluations. TCC seeks to improve and expand those activities to reduce the burden on area law enforcement. TCC will use this grant to work with the City of Sherman to develop a co-responder program since Sherman showed to have the highest area of need, and to also work with other towns in this primarily rural area to work toward that same co-responder model for effective crisis response. TCC has the infrastructure to capture and report the essential data and has a proven history of highly successful metric compliance.

South Dakota's Rural Mobile Crisis Response project will demonstrate and evaluate innovative regional rural mobile crisis response approaches through dedicated staffing and coordinated supports for crisis care in partnership with three existing Community Mental Health Centers, providing infrastructure available to impact more than 115,000 South Dakotans residing in the three target geographic regions that presently have minimal to no mobile crisis response service availability. Each region will develop response and follow-up care protocols using a multi-tiered approach, relative to level of acuity of the individual in crisis, supported by existing crisis response resources and newly developed co-responder teams. South Dakota is uniquely positioned to capitalize on multiple strategic initiatives that, when working together, have the potential to significantly disrupt the current pathway for rural mobile crisis response services. By aligning ongoing workforce capacity building efforts around community health workers with recent telehealth capacity enhancements afforded to EMS services statewide, this project will complete the connection to appropriate regional response services delivered by local, qualified and trained behavioral health personnel. Dedicated staffing at the CMHC level will afford staff capacity and time to foster these partnerships. The project's goals center on demonstration of regional mobile crisis response and follow- up care, built on interagency partnerships across the continuum of care for dispatch, emergency response, crisis stabilization, referral to higher levels of care as needed, and follow-up services. Key staff will focus on the creation of evidence-based crisis response and follow-up protocols and define and implement crisis intervention training needs as needed to support implementation. Each region will have flexibility to define and solution opportunities that best meet the gaps in service across their catchment areas, with some opting to focus more on technological resources and others on creative workforce training and capacity building efforts. Each have the same vision: to develop and implement strategies for mobile crisis response services in rural/frontier areas that deliver the timeliest and most safe response for staff and individuals served alike. The program assessment is designed to collect information and monitor in a way that allows for continuous quality improvement at each stage of deployment, from which state and federal partners can learn from in what will hopefully be innovative, multidisciplinary, and collaborative response strategies that can be applied to other areas of the United States with similar geographic and service area challenges.

ABSTRACT Hennepin County 911 Alternative Mental Health Response Project (ALT) SAMHSA Community Crisis Response Partnerships Grant NOFO No. SM-22-016 Hennepin County Behavioral Health will implement a 911 Alternative Mental Health Response (ALT) pilot in Brooklyn Park, Minnesota. ALT teams consisting of a senior social worker and a community paramedic will respond to low-risk 911 behavioral health calls for service instead of BPPD officers, reducing disparities in justice system involvement for people with mental health disorders and connecting them to stabilizing mental health and social services. ALT teams will assess and respond to urgent behavioral health and medical needs at the scene and stabilize the person in the community or via voluntary transport to Hennepin County’s walk-in / drop-off behavioral health clinic. ALT will also work closely with BPPD’s existing embedded social workers to provide follow-up stabilization services. Over a 45-month implementation period, ALT teams will respond to 4,500 911 mental health calls, reducing the number of mental health calls currently responded to by BPPD officers by 95%, and perform an estimated 3,000 field assessments. The targeted benefits are a 30% increase in connections to stabilizing services for residents involved in 911 mental health calls and a 30% decrease in repeat 911 mental health calls. The lead applicant is Hennepin County’s Behavioral Health Division and the partnering applicant is the Brooklyn Park Police Department (BPPD). Additional partners include the Hennepin County Sheriff’s Office, which operates 911 dispatch, and North Memorial Health, a Level 1 Trauma Center that will provide the community paramedic. A Hennepin County 911 Mental Health Reform Task Force consisting of mental health and justice partners, youth and adults with lived experience of mental health disorders, and BIPOC residents invested in police reform will serve as the project advisory board. Brooklyn Park (population 86,478) is the fourth largest city in the Twin Cities, Minnesota metro area and part of Hennepin County (Minneapolis and its suburbs). It is significantly more racially diverse than the city of Minneapolis, with 60% of residents identifying as BIPOC (30% African American, 20% Asian, 5% Hispanic, and 5% as multi-racial or other identities). Twenty-four percent of residents are foreign-born and 9.2% percent have income below the federal poverty line (2020 US Census data). Brooklyn Park has the highest crime rate in Hennepin County, with 7,820 total crimes in 2020 (90 crimes per 1,000 residents vs. 59.7 for Minneapolis). Brooklyn Park also has over 300 group homes that serve people living with mental illness and/or additional disabilities in congregate care settings. Having police officers respond to 911 mental health calls is contributing to racial disparities in justice system involvement, increasing the potential for escalation, and failing to provide needed mental health, primary care, and stabilizing services. By dispatching ALT teams to 95% of 911 mental health calls in Brooklyn Park, the Hennepin County 911 Alternative Mental Health Response project will produce better outcomes for both public safety and residents with mental health disorders in Brooklyn Park.

In an effort to address the service gaps in the Crisis Continuum of Care, ICBHS proposes the establishment of the Mobile Triage Response Team (MTRT) program. The program will serve individuals experiencing psychiatric emergencies within Imperial County. The County of Imperial is located on the southern border of California and encompasses 4,175 square miles adjacent to the United States-Mexico International Border. The community is a primarily agriculture driven and is comprised of 17 population centers surrounded by 500,000+ acres of land dedicated to agricultural production. The awarding of the Community Crisis Response Partnerships grant would allow ICBHS to develop new mobile crisis response team that will address service gaps for individuals experiencing psychiatric emergencies within Imperial County, mitigate the unnecessary use of law enforcement, shorten response times within the community and further strengthen the continuum of care model. The MTRT program will bring increased service capacity by integrating an additional mental health professional staff that will provide crisis call de-escalation, respond to dispatch requests and provide continuum of care resources to individuals during post-crisis, follow-up. As part of discharge planning and post crisis follow up, the MTRT program will offer referrals to the ICBHS outpatient clinics, social services to secure health and safety net benefits, and provide client with supports to ensure there access barrier to services are mitigated. It is estimated this program will provide services to 150 individuals annually and 600 thought the lifetime of the project. The goals of MTRT include the following: Goal #1: Reduce the percentage of individuals requiring a 5150 application by emergency responders. Goal #2: Reduce the percentage of cancelled crisis response requests by community agencies. Goal #3: Increase community agency outreach, engagement, and education about behavioral health services. Goal #4: Decrease the number of clients transferred from the MHTU to an inpatient psychiatric hospital due to a psychiatric condition. Goal #5: Establish a behavioral health conscious approach to the joint response model and decrease the average response time for urgent condition requests.

535,000 individuals. Current services will be expanded to a second location and further strengthened by the addition of four clinical and behavioral health professionals. Call response rates and community resolved rates will be improved with capacity expansion. Residents in Montgomery County have a variety of compounding risk factors that place them at extreme danger for mental distress, mental illness, developing Substance Use Disorders (SUD), and experiencing unintentional drug overdoses. The Mayo Clinic identifies key risk factors that can increase risk of mental illness including stressors like financial issues stemming from lack of education or employment, chronic medical conditions, trauma including military combat or assault. According to the latest 2022 U.S. Census, Montgomery County has a poverty rate of 14.7% with that increasing to 29% in Dayton. This is exacerbated by a 9.5% high school dropout rate and a 12.6% unemployment rate for the county. Data USA reports that 7% of residents do not have health insurance and the county is home to over 38,800 veterans. Based on these statistics, risk factors for mental illness in the geographic catchment area are concerning for the Montgomery County Alcohol, Drug Addiction, & Mental Health Services (ADAMHS), elected officials, health care providers, and the community at large. Through expansion of services, the current 24/7 crisis care services will reduce call response times, increase the community resolved rate, decrease justice involvement, and train community members in crisis intervention. Fully staffed after March 2023, the response rate will remain or decrease from the current 20 minutes, significantly less than 1hour national goal; Increase the community resolved rate from the current 85% to 90% by year two; and implement updated referral policies in the first year. Within the first 90 days, an updated protocol for crisis care will be implemented. Evaluation services will be conducted by Wright State University who has been responsible for evaluating millions of dollars in grant funds.

The Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS) is seeking $750,000.00 in response to the FY22 Cooperative Agreements for Innovative Community Crisis Response Partnerships from the Substance Abuse and Mental Health Services Administration (SAMHSA). Following the SAMHSA someone to talk to, someone to respond, and somewhere to go model, ODMHSAS proposes to utilize project funds to support this overarching crisis infrastructure goal by addressing gaps in the state current mobile crisis team capacity within two of the most populous counties within the State of Oklahoma, Oklahoma County and Tulsa County. Mobile crisis response teams are a part of the Oklahoma Comprehensive Crisis Response (OCCR), which is a behavioral health crisis continuum of care, developed by the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS), serving individuals in the least restrictive means possible and prioritizing community-based diversion approaches to prevent the need for higher levels of care and to avoid unnecessary law enforcement and criminal justice involvement for people in behavioral health crisis. The ODMHSAS proposes the following project goals which complement the significant investments already made into building the capacity of Oklahoma to comprehensively address Oklahomans in crisis. ODMHSAS released RFPs to invest in a statewide network of 988 dedicated mobile crisis teams. These teams became operational statewide on July 5, 2022- in alignment with the 988 call center launch. Each region of the state has at least one team which operates 24/7 and meets the requirements of the RFP, which was developed to align with guidance provided by the SAMHSA Best Practice Toolkit. Additionally, ODMHSAS has invested in five additional flexible teams which can respond across regions to assist in surging or unanticipated demand. These flexible teams will begin operation in the late summer of 2022. The expansion of these mobile crisis team services within Oklahoma and Tulsa Counties are the focus of this project application. Goal 1: Increase the capacity of 988 dispatching mobile crisis teams in Oklahoma and Tulsa County. Goal 2: Provide ongoing technical assistance, training, and evaluation of mobile crisis teams. This project will support the investments already made including the purchase of a single, statewide 988 call center, two back up centers, expansion of technology, creation of emergency transportation, and expansion of community-based URCs and CCs.

Tropical Texas Behavioral Health (TTBH) is proposing to establish the TTBH-Edinburg Police Department (PD) Mental Health Unit (MHU) in Edinburg, Texas under the TTBH-Edinburg PD Community Crisis Response Program. The goals of this program are to increase the capacity of mobile crisis response teams while expanding access in high-need communities; increase collaboration to improve crisis stabilization in the community for adults, children, and youth; and improve equity in the continuity of care and post-crisis follow-up, including for those with suicidal ideation and/or a previous suicide attempt. This program will also benefit individuals in crisis, who come in contact with law enforcement, who may be appropriate for diversion from the justice system and into routine behavioral health care services. TTBH's target population are individuals residing in Edinburg, Texas in Hidalgo County. Our service area is designated High-Poverty Areas or Persistent-Poverty County. Based on the U.S. Census Bureau, Hidalgo county's poverty rate was 41.9% in 1990, 35.9% in 2000 and 23.9% in 2020. Edinburg has a poverty with a rate of 22.6%, an average rate almost twice of Texas at 13.4% and twice of the U.S. at 11.4%. The area is predominantly Hispanic population at 87.7%. Our population rate of individuals without medical insurance is 26.7%, higher than Texas at 20.8% and two and a half times higher than the U.S. at 10.2%. Challenges in our service area also includes identification as a Medically Underserved Area (MUD ID 1489644651) and a Health Professional Shortage Area (HPSA ID 7481397026) for Primary Care, Psychiatrist, Psychologists, Licensed Professional Counselors and Licensed Chemical Dependency Counselors by Health Resources and Services Administration (HRSA). The TTBH-Edinburg PD MHU will be a community-based, ride along-respond service model targeting the delivery of immediate screening, assessment, and brief intensive intervention services to adults and adolescents who may be experiencing a mental health crisis. Collaboratively, the team will identify the best approach to assist the individuals with the least restrictive methods. The MHU will engage in evidence-based techniques to promote effective strategies by law enforcement to identify and reduce the risk of harm to individuals with mental health crisis and to the public's safety. TTBH will provide triage services to individuals 24 hours per day 7 days per week, including holidays, for the purpose of gathering information to determine the need for further assessment and immediate treatment. Triage services will be provided by a Qualified Mental health Professional (QMHP), who has the capabilities to make appropriate clinical decisions to determine an appropriate course of action and to stabilize the situations as quickly as possible. The MHU intends to continue outreach efforts with community partners by forming a Mental Health Alliance to identify resources to appropriately serve the community. If awarded, this will be the first collaborative crisis responder team developed with the Edinburg P.D. TTBH proposes to serve 500 persons (as referred by police department: service calls) with an indication of behavioral health needs per year for a total of 2,000 persons for the four years of this grant. We anticipate that 60% of those service calls maybe suicide/crisis incidents requiring screening and from those incidents 90% will require assessment and treatment. This program will adapt the goals to increase the capacity of mobile crisis response in our community, increase collaboration to improve crisis stabilization of individuals in our community and to improve equity. Crises follow up services are provided to individuals who are not in imminent danger of harm to self or others but require additional assistance to avoid reoccurrence of the crisis event.

This project focuses on partnering with an Indian tribe to pilot implementation of Mobile Crisis Team (MCR) within a tribal community in Washington and document best practices to determine how the state can further support the expansion of tribal MCR teams. Additionally, this pilot will demonstrate the positive impacts and relief that Tribal MCR may have on the regional and statewide crisis system. As part of this project, the HCA identified the Tulalip Tribes (Tribes) as a partner to develop one 24/7 tribal MCR program.