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Through a TCE-Special Projects grant, Hope House will double its capacity to deliver medication assisted treatment (MAT) by increasing medical and counseling staffing and by acquiring the necessary supplies for a clinical setting to administer MAT. Over the three year grant, Hope House will establish the RISE (Recovery, Inclusive Support & Empowerment) program to increase access to evidence-based mental health and substance use residential and intensive outpatient treatment services, intensive case management, and linkages to other supportive services for 150 low-income women (including heterosexual and LGBTQ women) having substance use disorders (SUD), specifically opioid use disorders (OUD) and co-occurring mental health disorders (COD) in the Augusta-Richmond County, Georgia Metropolitan Statistical Area (MSA). The Augusta-Richmond County MSA is the second largest metropolitan area in Georgia and includes Richmond and adjacent Columbia County and experienced a 33% increase in drug overdose deaths year to year in the pandemic. In 2021, 1,000 women applied for treatment services at Hope House, a 52% increase over 2018 pre-pandemic applications and greatly exceeding Hope House current capacity. Of the total applicant pool for treatment, 75% indicated that they had no source of income upon applying for treatment. Women, particularly women who identify as LGBTQ, in the Augusta-Richmond County MSA face significant economic and social barriers to treatment of SUD and COD. 16.4% of Augusta-Richmond County residents live below the poverty line compared to 12.3% US, with the largest demographic living in poverty in Richmond County being females age 25-34. Over one-quarter (27.6%) of Georgia women avoid healthcare due to costs compared to 18.8% US. In January 2022, Richmond County ranked second for highest drug overdose Emergency Department visits. Only 2 out of the last 12 months did Richmond and/or Columbia County not rank in the top 5 counties for highest drug overdose Emergency Department visits. Georgia overdose deaths for females increased by 30% from 2019 to 2020. While MAT is the most effective intervention to treat OUD, access to MAT is limited especially for low-income and homeless populations because of inadequate funding for treatment programs and a lack of qualified providers who can deliver these therapies. There are no other, no-cost MAT programs that support the use of buprenorphine-naloxone treatment in the Augusta-Richmond County MSA. The closest programs are over 120 miles away in Savannah and Atlanta, which are transportation and housing prohibitive for the proposed target population. Hope House’s primary goal for the TCE project is to reduce SUD and overdose deaths among Augusta-Richmond County low income and homeless women, including those identifying as LGBTQ, and to help those individuals sustain recovery. Measurable objectives for the program are: (1) expand access to MAT to 50 individuals annually with SUD/COD, primarily OUD; (2) 70% of participants will secure or increase monthly income through employment or permanent benefit programs; (3) 80% of program participants will self-report abstinence from alcohol and/or illegal drug use; (4) 80% of program participants will self-report no arrests in the past 30 days; (5) improve mental health as measured by decreasing the instance of program participants self-reporting past 30 day experience of serious depression and/or anxiety; (6) at least 50% of program participants who successfully complete the program will self-report housing stability at six-month follow-up; (7) at least 80% of program participants who successfully complete the program will self-report improved social connectedness at six-month follow-up.

Health Services Center, Inc. (HSC) proposes Project STAR (Strategies to Advance Recovery) to provide LGBTQ+ focused, peer engaged substance use disorder(SUD) and HIV linkage and risk reduction services to reduce substance-and related harm in an underserved rural, high poverty area of the rural Deep South that experiences significant negative consequences related to substance use, including overdose, poor health outcomes, family disruption, and legal system involvement. The target service area is large, covering 9,000 square miles and 14 Alabama counties (Blount, Calhoun, Coosa, Cleburne, Chambers, Calhoun, DeKalb, Etowah, Randolph, Shelby, St. Clair, Tallapoosa, Talladega, Clay Counties, AL). HSC has provided SUD, HIV and harm reduction services in the target area for over 25 years and has the cultural knowledge, infrastructure, and community partnerships necessary to expand and enhance services for LGBTQ+ populations. Project STAR will implement the evidence-based practice, Cognitive Behavioral Therapy (CBT) to serve the priority population of LGBTQ+ rural/non-urban populations. The STAR Project will particularly focus on LGBTQ+ young adults and populations of color, as these groups are perennially underserved in the target area. Project STAR has three main goals: 1. increase access to substance disorder and behavioral health services for LGBTQ+ populations through targeted individual and group behavioral health and case management services, 2. provide HIV/harm reduction services to at risk LGBTQ+ populations through HIV counseling, testing, referral (HIV CTR), linkage to HIV medical and supportive services, PrEP services, HIV education, and access to prevention supplies, and 3. increase peer support and recovery community building services, and community awareness activities. Annually, Project STAR will serve 1,150 persons through SUD, harm reduction, and community awareness/outreach activities (3,450 over course of project). Measurable outcomes include reduction in service area substance-related overdoses and incarcerations, numbers of persons receiving harm reduction education and awareness activities, persons receiving HIV testing and PrEP services, and screening/referrals for harm reduction needs. Innovative service provision components include incorporation of telehealth approaches to reduce barriers to treatment access for low-income rural persons, trauma-informed care, peer support and linkage services, leverage of a ""mobile safe space"" to enhance rural recovery communities, and an area-wide LGBTQ+ focused mini-conference to increase area competence and capacity for service provision. The proposed Project STAR will provide critical substance use service expansion and enhancement for a population that faces significant stigma, discrimination, and lack of access to services in the rural South.

GCASA is requesting $375,000 per year for 3 years for $1.125 Million total in SAMHSA TCE: Special Projects funding to increase access to Harm Reduction and recovery services in Genesee and Orleans Counties in New York. The goals of the project are: to support community-based overdose prevention, syringe exchange services programs, and other harm reduction services to reduce overdose, engage people in harm reduction activities, and support people self-identifying and pursuing their paths to recovery. Funding will be used employ staff for case management, peer recovery support, harm reduction-focused treatment; establish processes for referral to and patient access for appropriate harm reduction, recovery support services, and treatment including expansion of Open Access hours; purchase of syringe exchange and harm reduction supplies; training for staff; and community education to reduce stigma. In 2020—the last year for which data is available--there were 32.5 opioid overdose deaths per 100,000 population in Genesee County compared to 21.8 statewide and marking a 26.7% increase over 2018. Genesee County saw 56.4 hospital emergency department (ED) visits for opioid overdoses per 100,000 compared to 55.0 statewide, including 37.6 opioid overdose ED visits involving opioids other than heroin per 100,000 compared to 22.7 statewide. There were 353 treatment admissions for opioids alone. Orleans County saw 62.9 hospital emergency department visits per 100,000 population compared to 55.0 statewide and 228 admissions to treatment for opioids alone. Work under this project will involve utilizing and expanding existing partnerships with public health and mental health departments in Genesee and Orleans Counties. Partners will provide referrals to GCASA, share information on services offered under this project with the people they serve, communicate the project to the broader community through one-on-one and group communications that occur during the course of their normal operations and/or through the use of their website and social media platforms, etc., assist with data gathering tracking referrals made, and offer feedback for program improvement. The county health departments will provide harm reduction supplies such as safe sex supplies to the project at no cost when available to them at no cost through the state health department. The project will serve 30 people in Year 1 and then 75 people per year in Years 2 and 3 for a total of 180 people served over the 5-year project period. The project will result in measurable: increases Open Access hours and services in the service area; increases in people receiving harm reduction supplies and support; decreases in social determinant of health risk scores; decreases in illicit drug use, alcohol use, and prescription opioid misuse; increases in positive sober engagement (e.g. participation in education, employment, sober recreational and/or enrichment activities, and/or increased sober supports); increases in housing stability; and decreases in criminal justice involvement and re-involvement.