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Project Name: Ensuring Access to High Quality Care for Patients with Substance Use Disorders: Training Advanced Practice Registered Nurses to Make a Difference Project Summary. This project will provide funding to enhance the current didactic curricula and clinical training of three Advanced Practice Registered Nurse (APRN) specialties: Nurse anesthesia (NA), nurse practitioner (NP) and clinical nurse specialist (CNS). Advanced practice registered nurses are on the front line of patient care in multiple settings and given the growing crisis related to substance abuse, they must be prepared to screen patients for substance use disorders (SUDs), assess patients, provide a brief intervention, and refer patients for treatment. The APRN students will be trained to meet both the psychosocial and medical needs of patients with a variety of SUDs. Populations to be served. This project will serve 200 APRN students from three specialty programs (NA, NP and CNS). In addition, this project will benefit the patients served by these students in their clinical training, which include vulnerable populations living in medically underserved areas of Louisiana. Strategies/Interventions. This project will begin with advanced training in SUDs for project faculty, followed by revision of the current Doctor of Nursing Practice (DNP) core courses and APRN specialty courses to include assessment, screening, pharmacological and psychosocial management of patients with SUDs. This project will involve multimodal interventions including lectures, expert speakers, high-fidelity simulation, and intraprofessional training. Project Goals and Measurable Objectives Goal One: To enhance the existing academic curricula of the NA, NP and CNS programs by providing advanced education and training in the delivery of high-quality, evidence-based care for patients with SUDs. Objective 1. By the end of year one, 200 APRN students will receive education and training on the role of the APRN in screening, brief interventions and referral to treatment; specific assessment techniques and tools; and treatment related to alcohol, marijuana, stimulants, and opioids use. Objective 2. By the end of year two, NA, NP, and CNS students will document translation of evidence-based research into practice related to SUDs in their respective specialty. Objective 3. By the end of year two, evaluation data from NA, NP, and CNS students and faculty will be used to modify curriculum and practice translation as needed. Goal Two: To collaborate with the respective APRN certification boards to promote inclusion of questions regarding SUDs on the respective certification exams. Objective 1. By the end of year one, formal correspondence will be made with five certification boards to consider including or increasing content on SUDs on future certification exams. Objective 2. By the end of year two, fifty exam questions will be developed related to SUDs (ten for each certifying body) and submitted to certification boards for beta testing and inclusion on future certification exams.

Family nurse practitioners are uniquely positioned to increase access to care for individuals and families suffering from substance use disorders, especially in rural regions of the country. This project will increase the number of primary care providers in the U.S.-Mexico border region who have advanced knowledge/training in screening for, and the evaluation and treatment of all forms of substance use disorder (SUD) with emphasis on opioid use disorder (OUD) prevention. Given the extreme shortage of mental health providers, New Mexico has a critical need for primary care providers with advanced preparation in the area of OUD and other SUD. Family nurse practitioners are also well positioned to prevention OUD by implementing evidence-based strategies for managing acute and chronic pain using non-opioid approaches. The family nurse practitioner (FNP) program at New Mexico State University (NMSU) is delivered in a distance education format so that nurses in rural New Mexico and the adjacent border region can earn their degree without relocating. Given the psychiatrist and primary care physician shortage in New Mexico, graduating FNPs with high level competencies in the identification, evaluation, and treatment of all forms of SUD with an additional focus on OUD prevention is a priority for the state and region. Project Goal 1: Increase the number of faculty at NMSU and other regional FNP programs who have the knowledge and expertise to deliver an integrated OUD/SUD curriculum with enhanced content on non-opioid alternatives for acute and chronic pain management. Project Goal 2: Increase the number of FNPs in New Mexico and the surrounding border region who are trained to effectively identify, evaluate and treat all forms of SUD and prevent OUD through acute/chronic pain assessment and management using non-opioid alternatives. Project Goal 3: Increase the number of evidence-based test questions on the topics of OUD and other SUD on the American Nurse Credentialing Center FNP certification exam. The FNP track at NMSU accepts up to 12 students per year in its 3-year DNP program and 6-12 students per year in its yearlong post graduate certificate program. The implementation of this proposed curriculum will result in an increase in the number of NMSU FNP graduates who obtain knowledge, skills and experience to holistically address the underlying causes of addiction and introduce SUD prevention, screening and treatment into their primary care practice. Seven NMSU faculty will complete a minimum of 24 hours of continuing education in SUD (including medication-assisted treatment) and/or non-opioid strategies for pain management. This project will expand the integration of SUD education into the standard FNP curriculum at NMSU and other FNP programs in New Mexico and the adjacent border region in Texas. By mainstreaming this education, NMSU will expand the number of nurse practitioners who are trained to deliver high-quality, evidence-based SUD treatment and reduce the stigma of SUD among primary care providers working in medically underserved communities.

The Miami Dade College (MDC) Medical Campus will implement the SBIRT Student Training Expansion (SBIRT-X) project. The project will revise and update curriculum in programs of the MDC School of Health Sciences and the MDC Benjamin Leon School of Nursing to include substance use disorder (SUD) content focused on alcohol, marijuana, stimulants, and the growing problem posed by opioids. Over the two-year project period, SBIRT-X will engage and train 1,722 health professions students and 385 teaching faculty members from nine programs that train public-facing professionals: Nursing, Dental Hygiene, Emergency Medical Services, Emergency Medical Technician, Health Information Management, Medical Assisting, Paramedic, Physical Therapy Assistant, and Physician Assistant Studies. Eight lead faculty members from the School of Health Sciences and School of Nursing will lead the curriculum revision for their respective disciplines, adapting SAMHSA's screening, brief intervention, and referral to treatment (SBIRT) model to the needs of MDC's predominantly minority, low-income student body and service area. Students are more than 60% Hispanic; nearly 24% black, non-Hispanic; and 56% low-income, with 38% living below the poverty level. The MDC Medical Campus continues to be one of the top ten providers in the nation of degrees awarded in the health professions. The MDC School of Nursing is the largest pre-licensure nursing program in the United States. More than 40% of all registered nurses in Miami-Dade County are MDC School of Nursing graduates, with more than 20,000 graduates over the past 50 years. A current enrollment snapshot of the targeted disciplines reflects over 1,151 students in nursing programs, 99 in dental hygiene, 30 in emergency medical services, 171 in emergency medical technician, 20 in health information management, 27 in medical assisting, 100 in paramedic, 69 in physical therapist assistant, and 55 in physician assistant studies. SBIRT-X project goals are to (1) train, deploy, and support a multidisciplinary health care workforce that is competent in the use of an integrated approach to identifying, intervening, and referring for treatment persons at risk of alcohol, marijuana, stimulant, opioid, and other substance use or mental health issues; (2) develop a cadre of SUD faculty-trained champions from academia and health profession students that can impact policy change supportive of expanded use of SUD education and integration of behavioral health across all levels of health care systems at the community, regional, and statewide levels; and (3) implement a SUD training model that can be effectively replicated with ethnically diverse student populations at educational institutions nationwide, including other two-year colleges. To achieve these goals, SBIRT-X has developed the following project objectives: 1. By April 2021, lead faculty on the SUD committee, under the guidance of a co-principal investigators and the project director, will revise and deliver curriculum in the nine targeted disciplines to incorporate SUD content and will train 75% of 385 participating faculty and 1,722 participating students on the SUD curriculum. 2. By April 2022, the lead and trained faculty from the targeted disciplines will collaborate to refine, deliver to 90% of the targeted students and faculty, and assess the revised curriculum. 3. By April 2022, the project team will reach out to at least 75% of the licensing and certifying bodies for the targeted disciplines to promote the incorporation of SUD in their respective licensing examinations.

Project Title: Addiction treatment Counts: Expanding Interprofessional Training (AtCE IT!) Disciplines included: Marriage and Family Therapy (M.A.), Clinical Mental Health Counseling (M.A), Family Psychiatric Mental Health Nurse Practitioner; Social Work (MSW). A brief overview of the project as a whole: The AtCE IT! program aims to develop an innovative, high-quality, comprehensive curriculum related to interdisciplinary training and clinical practice in the use of SBIRT, assessment, and SUD treatment principles among interdisciplinary trainees in order to improve Health Professionals' use of SBIRT in clinical practice, thereby mitigating the SUD treatment gap. Additional goals for AtCE IT! include improving the educational and supervisory support structure for trainees to learn more about SBIRT throughout their coursework and within their clinical practice, developing a pipeline for trainees to pursue their Chemical Dependency Counseling (CDC) credential and to advocate licensing and certification boards about implementing examination questions related to SUD on relevant exams, and to develop training materials that can be adapted for user-friendly implementation in other Health Professions curricula. Specific, measurable objectives that the project will accomplish: A total of 120 student trainees, 10 faculty members, and 20 site supervisors will complete the AtCE IT! training, and 50 students will pursue the Chemical Dependency Counselor (CDC) license in the state of Ohio Further, 90% of trainees in clinical practice will routinely utilize the skills and knowledge learned from the training as part of their clinical practice, and 90% of trainees will demonstrate improved knowledge and perceptions regarding SUDs, SBIRT, assessment, treatment principles, and interprofessional collaboration. Additionally, all student trainees will experience at least one advocacy experience related to advocating to licensing and certification boards about implementing examination questions related to SUD on relevant exams. Finally, data review will be used to inform modifications of curriculum necessary to improve AtCE IT! and to develop a program manual outlining the training protocol to allow for user-friendly implementation in other Health Professions curricula. How the proposed project will be accomplished: To successfully implement AtCE IT!, we have developed an interdisciplinary research team with diverse content expertise to create the AtCE IT! curriculum within the context of interprofessional collaboration (see Position Descriptions). We have also devised a clear implementation plan and program evaluation plan (see Narrative). AtCE IT! will be built in as required assignments into extant courses to account for both profession-specific training needs and allowing interprofessional education across four Healthcare disciplines.

The Mind the Gap project will address the national treatment gap for substance use disorders (SUDs) via rapid preservice education of 500 healthcare and behavioral healthcare students. The overarching goal of this project is to equip future providers to deliver high quality services to individuals and families suffering from SUDs. We will enhance, disseminate, implement, and evaluate SUD-related curricula across multiple health and behavioral health programs at Arizona State University (ASU) and Northern Arizona University (NAU). Despite the prevalence of SUDs, mainstream healthcare education is currently inadequate in preparing future practitioners to provide evidence-based treatment to individuals with SUDs. To address this treatment gap, the project team has secured partnerships with NAU's Physician Assistant program and ASU's Healthy Lifestyles Coaching program and the Health Education and Health Promotion program. These programs presently include only limited curricula related to SUDs. We will also expand content on SUD-related specialty topics in ASU's Addiction and Substance Use-Related Disorders online graduate certificate program, the Doctor of Nursing program, and the Doctor of Behavioral Health program. This grant will support the development and delivery of new SUDs training content for undergraduate and graduate students. We will enhance existing curricula by developing new modules in SUD assessment and treatment strategies and by expanding student access to training in SUD treatment via an online learning portal (Canvas). We will incorporate and build upon our existing, comprehensive Screening, Brief Intervention and Referral to Treatment (SBIRT) curricula - funded through the SAMHSA SBIRT Student Training Grant - and our existing specialty topic curricula (e.g., medication-assisted treatment and Motivational Interviewing). We will use a quality improvement approach to iteratively evaluate, improve, and disseminate the enhanced curricula. We will then work with licensing and certification boards overseeing the participating programs to implement questions related to SUDs in certification examinations. Our project objectives are to (1) expose a minimum of 500 students to best practices for SUDs screening and interventions by implementing curricula across six health and behavioral health disciplines within two universities over the course of two years; (2) ensure student mastery of SUDs content through average scores of 80% or higher on post-training knowledge assessments; (3) establish a student course satisfaction rate of 85% or higher through the continued adaptation and enhancement of learning materials; (4) ensure the transfer of best practice for SUDs from the university classroom to post-graduation practice settings through an implementation rate of 60% or higher for new graduates; and (5) sustain SUDs curricula content in 85% of participating programs. These project objectives will create a more comprehensive and robust curricula and will increase access to SUDS training, which will, in turn, increase patient access to evidence-based interventions for risky substance use in the southwest region of the United States.

Project Abstract Simmons SSW Expansion of Substance Use Practitioner Education (ESPE). The goal of the Simmons SSW Expansion of Substance Use Practitioner Education project is to develop and implement required curriculum to teach Master of Social Work students the knowledge, attitudes, and skills necessary to provide high quality, evidence-based identification and treatment for substance use disorders. The curriculum will include, but not be limited to, SBIRT strategies; assessment; treatment principles and their application, with particular attention to alcohol, marijuana, stimulants, and opioids. The activities proposed in this project will support the effort to build and modify the curriculum and train 1,030 MSW students over the 2-year project period. Student learning will occur through the required "Substance Use and Social Work Practice" course. This course will reach all MSW students in the campus-based and online program platforms and will be designed to train students in the identification, assessment, and treatment of substance use disorders. G1: Train social work students in the identification and treatment of SUDs to increase the number of social work practitioners who can address the needs of individuals who have SUDs and reduce barriers to accessing care. 1.1 By the end of the grant period, 1,030 MSW students will have been trained on the identification and treatment of SUDs through the required course called "Substance Use and Social Work Practice." 1.2 By the end of the grant period, 380 MSW students in the campus-based program will have completed training in brief motivational interventions for substance use through an online patient simulation system. G2: To ensure a social work practitioner workforce that is knowledgeable and skillful in the identification and treatment of SUDs, collaborate with licensing boards to aim to implement examination questions related to SUDs. 2.1 By the end of the project period, we will initiate collaborative efforts with 3 professional associations in an effort to implement examination questions related to SUDs. G3: Develop and implement an evaluation plan that continuously supports performance management and produces timely reports. 3.1 Evaluate outcomes for social work students and faculty in their acquisition of SUD identification, treatment, and recovery knowledge, attitudes, and skills.

The Evidence Based Substance Use Disorder Curriculum for Social Work Students project is a multi-university initiative aimed at developing a new substance use disorder (SUD) curriculum for undergraduate and graduate social work students. For that purpose, Florida State University (FSU) Center for the Study and Promotion of Communities, Families and Children created the Florida Higher Education Substance Use Disorder Consortium ('the Florida Consortium') of 11 university social work programs at Barry University, Florida Agricultural and Mechanical University, Florida Atlantic University, Florida Gulf Coast University, Florida Memorial University, Florida State University, Saint Leo's University, University of North Florida, University of South Florida, University of West Florida, and Warner University. The Florida Consortium universities are more diverse than the national average; and consortium member universities are located in rural and urban areas. This cooperative network of Florida universities has the goal of collectively developing a SUD curriculum, piloting the curriculum at the FSU College of Social Work during the first year of the project and then rolling out the curriculum in the other 10 universities during the second year of the project. The basic requirements for the new SUD curriculum include 15 key content areas ranging from concepts of SUDs, screening, assessment, the application of evidence-based practices in treatment and recovery, cultural competency in SUD services, ethics, prevention, and clinical supervision. FSU and the Florida Consortium universities will be able to integrate content areas from the curriculum into their core courses in addition to developing electives specifically dedicated to SUDs. The curriculum will address population-specific competencies for elderly, homeless, pregnant women, veterans, and adolescent clients paying attention to alcohol, marijuana, stimulants and opioid misuse. The project will also include working with the Association of Social Work Boards (ASWB), a project partner, to develop an evidence-based set of examination items on substance use disorders to be recommended for inclusion in licensure exams in social work across the U.S. and Canada. In addition to the universities, Citrus Health Network and the National Association of Social Work - Florida, have partnered with the FSU and the Florida Consortium for the curriculum project. SUD have important implications for the health and well-being of individuals, families, and communities in the United States. Social workers are likely to encounter clients with SUD in a wide array of settings, suggesting that social workers need to have a solid understanding and conceptual foundation in substance use disorder treatment practices and concepts.

The proposed project, titled Undergraduate Training in Addictions Intervention, will implement a two-tiered approach intended to expand practitioner education, help relieve the practitioner shortage, increase treatment availability, and reduce substance use disorders (SUD) treatment stigma by moving SUD training further into the educational mainstream. Nearly 92% of those with SUDs in the United States fail to receive treatment, a situation made worse by an acute shortage of qualified mental health and SUD practitioners. Prevention Insights (PI), a translational research organization at Indiana University, Bloomington, IN, proposes to develop a 45-hour educational curriculum for a new online course, Principles of Substance Abuse Assessment and Treatment, designed to educate undergraduate students in screening, brief intervention, and referral to treatment (SBIRT) as well as principles of SUD assessment, and treatment. Second, this class will serve as the capstone course of a newly proposed 12-credit certificate, the Online Undergraduate Certificate Program in Addiction Intervention. Completion of the certificate will also qualify students for the Certificate in Addiction Intervention, Practitioner Rank from the Indiana Credentialing Association on Alcohol & Drug Abuse (ICAADA). Anyone who enrolls at Indiana University will be eligible to complete this certification or any of the constituent courses. Subject matter experts and educational professionals at PI will complete the following goals and objectives in the course of this project: (1) Create a 12-credit-hour Online Undergraduate Certificate Program in Addiction Intervention; (1a) Create a new 45-contact-hour online course, Principles of Substance Abuse Assessment and Treatment; (1b) Prepare and adapt three existing undergraduate courses to meet Quality Matters standards for online education; (2) Gain approval for the certificate across the university; (2a) Prepare all justification documents for review; (2b) Promote the new certificate and courses; (3) Implement the new certificate and courses; (3a) Formally identify faculty who are experts to teach courses; (3b) Offer each course at least once annually, with the capstone course offered twice annually; (4) Conduct evaluations of the certificate and course; (4a) Conduct pre-test surveys of the capstone class; (4b) Conduct post-test surveys of the capstone class; (4c) Conduct an overall evaluation of the certificate program; (5) User evaluation data to modify the program; (5a) Prepare a revised curriculum for the capstone class; (5b) Implement the revised class in the second year of the project; (6) Develop sustainability of the certificate and capstone class; (6a) Gain approval from the PI Executive Director to support staffing of the program; (6b) Gain approval for the program content from the Indiana Commission for Higher Education. The number of people served annually by the proposed course and certificate will vary based on enrollment. However, the potential exists to serve any number Indiana University's nearly 88,000 undergraduates.

Tennessee and other southeastern states are best described as experiencing an epidemic of substance abuse, particularly opioid abuse. The Tennessee Expansion of Social Work Practitioner Education program is intended to expand substance use disorder (SUD) education into the standard curriculum of relevant healthcare and health services education programs, beginning with the University of Tennessee Knoxville and Nashville campuses. Through the mainstreaming of this education, the ultimate goal is to expand the number of practitioners who will deliver high-quality, evidence-based SUD treatment and thus reduce the stigma associated with SUD. A comprehensive, evidence-based SUD-SBIRT curriculum will be developed, implemented and evaluated. The curriculum will include SBIRT screening, assessment and treatment strategies and their application, particularly with regard to alcohol, marijuana, stimulants, and opioids. Electronic modes of teaching, i.e., websites, chat rooms, CD ROM presentations, and electronic newsletters will be used in training social work students in the appropriate interventions and will allow for rapid and efficient dissemination of information to stakeholders. Upon completion, the SUD-SBIRT curriculum will be made available to other schools/colleges of social work in the Southeast and to healthcare professionals throughout the nation. The state-of-the-art electronic services provision will enable access to a significantly higher percentage of the population who currently lack such access to treatment services. The experiences and success of our five previous SAMHSA-funded e-therapy grants that have utilized SBIRT have paved the way for the implementation of the proposed program.

The purpose of this project is to prepare physicians to address substance use disorders, especially in rural and underserved populations. The project's three goals target the education of medical students, the training of family medicine residents at three residency programs, and the enhancement of faculty and community physician resources. Specific objectives include education in substance abuse for medical students in each year of the curriculum; screening, brief intervention, and referral to treatment certification, medically assisted treatment training, and comprehensive didactic and clinical education in substance abuse and related disorders for family medicine residents; and didactics and practical training for faculty and community physicians. This project will serve more than 500 medical students, residents, and practicing physicians per year, and potentially twice than many over the life of the project. The project will quickly improve access to high-quality care, focused on patients with substance abuse disorders and their families, for the vulnerable populations served by physicians in the State of Kansas. The substantial long-term impact is the provision of access to substance abuse care for populations served by graduates. As these medical students and residency graduates have some of the highest national rates of practicing in rural and underserved areas, the project should make substantial contributions to SAMHSA clinical priorities. This impact will be increased by dissemination of outcomes and model projects to other educators. The project team will be responsible for conduct of activities and achievement of outcomes. This team will monitor and adjust activities using a Rapid Cycle Quality Improvement process and will be responsible for all required reporting to SAMHSA. The project is designed to increase education and training opportunities for medical students, family medicine residents, and practicing physicians. This is a proposed project of the Department of Family and Community Medicine of the University of Kansas School of Medicine-Wichita. The project will use the resources of the hosting institution, partnering community organizations, and State and Federal agencies; and education and clinical activities will be led by a family physician with fellowship training in addiction medicine.

Individuals attending opioid treatment programs (OTPs) and syringe support programs (SSPs) have many complex substance-related medical concerns (e.g., skin and bacterial infections, respiratory and cardiovascular disease, etc.). People who inject drugs (PWIDs) also make up almost all of the new cases of hepatitis C virus (HCV) infections and substantial numbers of cases of HIV in the U.S. This grant proposal submitted by the NJ Division of Mental Health and Addiction Services (DMHAS) for a Collaborative HIV/HCV Opioid care (CHHOC) initiative will address barriers to medical services and related care for PWIDs at risk for HIV and HCV by developing an integrated system of care between participating OTPs and primary care providers. SSPs providing harm reduction interventions and HIV/HCV screening of PWIDs will make referrals to the OTPs and primary care providers. In the CHHOC, the services of the providers will be integrated on two different levels, thus allowing comparison of their effectiveness. One level is a collaboration between an OTP and a federally qualified healthcare clinic (FQHC), while the other is a single provider that has a co-located OTP and primary care clinic. The grant would allow the OTPs to hire nurse care managers and peer navigators. The FQHC/primary care clinic will be funded to hire peer navigators and behavioral health clinician staff support patient self-direction and adherence to treatment. These health clinics will conduct mental health screenings and treatment will be provided or facilitated by the behavioral health clinician. The OTPS will conduct medical and mental health screenings and coordinate referrals to care. Both the FQHC/primary care clinic and the OTPs will provide smoking cessation treatment. The CHHOC will employ a chronic disease model that will ensure that clients are monitored and supported, especially while receiving antiretroviral therapy and/or direct- acting antiviral treatment for HCV. Primary care providers in the initiative are enrolled in 340B programs to allow more affordable access to high-cost antiviral medications for the individuals served. In addition, NJ will provide state funding to support medications for the uninsured. A part-time infectious disease specialist consultant and use of telehealth case conferencing will further enhance care coordination of HIV/HCV seropositive clients. An addiction expert will train the partnering programs to implement smoking cessation treatment services. As PWIDs will be educated about risk reduction strategies while receiving antiviral therapy that is coordinated with treatment for their substance use disorder, the goal is to eliminate HCV and slow the progression of HIV in those treated, thus helping to prevent the transmission of these diseases and decrease deaths in PWIDs. The number of individuals who will receive coordinated care through the CHHOC is estimated at 1,786 per year.

Project Rural Recovery is a proposal to respond to the need of service accessibility and Governor Lee’s executive order #1 to ensure resources are available to Tennesseans living in distressed rural communities. Through the implementation of integrated mobile health clinics in four (4) Tennessee distressed rural counties and their surrounding counties, Project Rural Recovery will break down barriers of access associated with traditional health care. These counties have been identified as having higher rates of premature death, poor reported mental and physical health, and low infant birth weights (Robert Wood Johnson Foundation County Health Rankings 2019; https://www.countyhealthrankings.org/sites/default/files/media/document…). Mobile clinics implemented by two community partners, will meet adults and children with or at-risk of, physical and serious mental health, substance use disorder conditions where they live, work and recover and provide care in their communities of origin and when needed, referrals to more intensive care. The initiative plans to have two thousand four hundred (2,400) encounters per bus per year, for a total of four thousand eight hundred (4,800) encounters annually and to serve one thousand (1,000) patients per bus, per year for a total of two thousand (2,000) patients to be served per year once implementation is in place. Project Rural Recovery has two goals. 1) To create a model of integration between primary care and mental health/substance use disorder providers to serve as a template for reproduction across the State of Tennessee and 2) To engage and treat the rural populations who are currently underserved in order to improve their health status. Patients seen by the interdisciplinary teams on the mobile health clinics will be assessed for medical, mental health, and substance use needs. Individualized treatment plans will be put in place with the consent and willingness of each individual patient. Through the implementation of the integrated mobile health care clinics the State of Tennessee proposes to replace episodic care with coordinated care for all life stages; make the access to whole-person care easy for the patients of rural Tennessee; and implement state-wide policy changes that build a reimbursement structure for unique integrated care programs.

Project Title: Promoting Integration of Primary and Behavioral Health Care Description: Integrating primary care services into behavioral health for adults with serious mental illness and children with serious emotional disturbance through a Community Mental Health Center that is also a Federally Qualified Health Center. Population of Focus: The populations of focus for this project are children and adolescents with serious emotional disturbance and adults with serious mental illness with physical health comorbidities. Individuals will be enrolled in AltaPointe Health Systems, Inc. (AHS) programs in Mobile, Alabama that serve these populations, Childrens Outpatient Program (COP) and Zeigler Adult Outpatient Program (ZOP). COP serves children and teens ages 3-19 with emotional and behavioral needs, and ZOP is AHSs hub for individuals with severe mental illness who reside in AHSs housing continuum. In the COP, 91% are insured through Medicaid, 3.7% insured commercially, and 4.9% indigent. African-Americans are the largest race served, making up nearly 49% of the patients with 45% being Caucasian. Just under 5% of the patients identify as Hispanic. ZOP serves a patient population with similar racial and payor breakdowns as the child patients served by COP. Goal 1: Promote full integration and collaboration in clinical practice between primary and behavioral healthcare. Objective A: AHS will provide integrated primary care and behavioral health services to 2500 adults with serious mental health or children with serious emotional disturbance in Year 1 and 4000 annually thereafter, for a total of 6,700 patients over five years. Objective B: Department of Mental Health (DMH) will develop a workgroup to identify policy solution(s) to capture the bundled community mental health center (CMHC) services delivered under the AHS FQHC to address the complexity of the funding environment. Goal 2: Support the improvement of integrated care models for primary care and behavioral health care to improve the overall wellness and physical health status within the population of focus. Objective A: AHS shall integrate patient centered primary care services into the Zeigler Campus Adult Outpatient Program and the Childrens Outpatient Program within four months of funding. Objective B: AHS shall secure Joint Commission Patient Centered Medical Home recognition for both sites within one year of funding. Goal 3: Promote and offer integrated care services. Objective A: AHS will screen (and treat as needed) all patients within the population of focus for depression and substance use disorder by the end of Year 1. Objective B: AHS will implement screening protocols during Year 1 (and treat/refer as needed) for all clients for the presence of co-occurring chronic physical conditions including HIV, Hepatitis, and tuberculosis. Objective C: AHS will implement chronic disease and prevention protocols and clinical performance measures by the end of Year 1.

The Nebraska Department of Health and Human Services, in partnership with Community Alliance Rehabilitation Services, will test and refine an evidence based and trauma informed model of planning and care that fully integrates health, mental health, substance abuse, and recovery oriented care and treatment to 160 unduplicated adults in Region 6 in the first year and 240 unduplicated in years 2-5 for a total of 1120. Applicability of lessons learned statewide is assured because Region 6 contains urban, suburban and rural areas and further, because it is home to the state’s most diverse population. In addition, a representative, statewide Integrated Care Taskforce will meet quarterly to review evaluation data and provide constant feedback on project activities. The Project will utilize grant funds to add and test strategic functionalities necessary for SAMHSA/HRSA Level 6 fully merged practice but currently not supported by Medicaid in Nebraska: (1) staff training on population-focused, evidence based practice; (2) engagement from the point of contact via a Rapid Response Team (RRT) consisting of a Licensed Mental Health Professional (LMHP), Peer Specialists (PS) and Care Coordinators (CC) to address urgent needs through a Mini-Plan; (3) timely, integrated clinical response through a daily huddle of project staff, ongoing team based treatment planning, and a client specific Integrated Care Team (ICT); (4) rapid access to in depth assessments in mental health (by a LMHP) and chemical dependency (by a Licensed Alcohol and Drug Counselor (LADC) necessary to plan treatment and establish a diagnosis for third party reimbursement; (5) sufficient clinical time within treatment encounters to address complex needs and, with respect for client privacy, provision of real time information through an Integrated Care Dashboard updated automatically as changes are made in the CA certified EHR; and (6) expanding numbers served and therapeutic functionalities delivered via Telehealth. The project will implement the following mutually reinforcing evidence based practices without modification: the SAMHSA/ HRSA Center for Integrated Health Solutions rubric for standardized assessment of levels of integration and functionalities for achieving Level 6 fully merged practice; Motivational Interviewing, Wellness Self-Management, Seeking Safety, Supported Employment, SOAR, Peer Support (through state certified peer specialists); Cognitive Behavioral Therapy; ACT; Culturally and Linguistically Appropriate Services standards of US DHHS, and the American Telemedicine Association Practice Guidelines (in expanding telehealth services). The evaluation will include assessment of both cost and programmatic effectiveness and will drive full alignment with the CMS Collaborative Care codes (currently in the Nebraska Medicaid Plan) for project sustainment. This fully integrated model will produce measureable and sustained improvement in client outcomes including clinically significant improvements in decreased behavioral health symptomology and hospitalizations, blood pressure, BMI, waist circumference, breath CO, plasma glucose and lipid profile that match or exceed SAMHSA grantee benchmarks.

Through the "Mental Health Treatment Training and Integration Project," the National Empowerment Center Technical Assistance Center (NEC TAC) will develop and deliver a variety of trainings and educational materials that will enhance vocational opportunities and integrate consumers into the treatment delivery system, improve access and coordination of services, and improve mental health outcomes, and will serve 20,000 people (4,000 annually). NEC TAC will identify and develop in-person and online trainings to improve the integration and employment opportunities of consumers working in the treatment system. Consumers will also be trained to assist other consumers with their medication visits, crisis services, and returning to work. In addition, mental health providers will be trained on how to identify and support peers working in provider agencies, engage families, and support youth leadership. Run by persons with severe mental illness, NEC TAC is uniquely qualified to carry out the mandate of the President's New Freedom Commission to engage consumers and families in service delivery. Because peers understand firsthand the use and value of medications and crisis services, they are well suited to these activities. NEC TAC will work with the National Council for Behavioral Health to develop training needed to improve peers' understanding of how they can best integrate as peer specialists into clinical, healthcare, and addiction services. To prepare them to provide services to consumers in crisis, peers find it valuable to be trained in Emotional CPR. With the help of our partners, NEC TAC will provide other training to clinical and related services staff either in-person or online on the value of recovery-based practices, person-centered planning, shared decision making, crisis alternatives, and peer support. NEC TAC will work closely with the National Association of State Mental Health Program Directors (NASMHPD) and the National Association of County Behavioral Health Developmental Disability Directors (NACBHDD) to improve opportunities for peers to be hired and reimbursed adequately by state and county providers. To assist with the transition of consumers form receiving benefits to being employed, NEC TAC will provide training in job seeking, job retention, and financial literacy. Consumer self-sufficiency will be improved by the creation of a national database of supported education programs, as well as a webinar and supplemental materials, which will enable them to have success in school. NEC TAC will foster and improve youth leadership skills in the delivery of peer services through the creation of a Youth Advisory Committee and developing its "Finding Our Voice" training (as well as other trainings) in collaboration with our partners. Too often families are left out of service delivery. To address this need, NEC TAC will engage families in the care of their family member with mental illness. To improve the collaboration with more traditional services, NEC TAC has entered into cooperative agreements with SAMHSA supported topic focused centers such as the Clinical Support System for Serious Mental Illness and the Mental Health Technology Transfer Centers of Regions 1 and 4.

Doors to Wellbeing (D2W), a project of the Copeland Center for Wellness & Recovery, will focus on three core program areas during the five-year grant period serving 50,000 individuals annually: 1) integration of people with lived experience into the U.S. mental healthcare workplace; 2) empowerment of individuals with Serious Mental Illness (SMI) through supported education and employment and 3) educating individuals with SMI and mental health practitioners about Psychiatric Advance Directives. Doors to Wellbeing is one of the most creative, effective, and productive National Consumer Technical Assistance Centers currently operating in the United States.

The Youth MOVE National Consumer TA Center is designed to provide technical assistance to the mental health workforce, inclusive of peer providers, system administrators, consumer run organizations, and the mental health field at large, to support the adaption, implementation, and enhancement of recovery oriented services, peer provided services, and evidence based practices to promote the recovery of individuals living with serious mental illness. The goals of this TA effort are to increase awareness and implementation of evidence based practices by educating and training the mental health workforce; increasing the capacity, knowledge, and skills of the peer provider workforce by providing training; improving the integration of peer and recovery orientated supports into the mental health service area through intensive technical assistance, training, and product development; increasing the peer provider workforce through training; and improving the mental health service array through improved policies and practices at the agency and system levels. The technical assistance approach of the TA Center braids the lived experiences of youth adults, adult consumers, and family members of navigating the mental health system, throughout all Center activities. The technical assistance array includes the offering of tiered support including a) intensive support including ongoing coaching, onsite training, and facilitation, b) specialized support including webinars, peer co-hort calls, and group coaching, and c) generalized support through the maintenance of a toll free phone line, website, email newsletter list, and resource databases. Additional strategies include product development of both implementation guides and issue briefs, on relevant and time sensitive topics, as identified through field driven technical assistance requests and the delivery of both virtual and in person training for individuals with lived experience, peer providers, consumer run organizations, mental health agencies, mental health providers, and system administrators. The TA Center, through dissemination, training, and technical assistance strategies, will reach an average of 5,150 individuals annually, with 25,750 reached over the course of the five years of funding.

Peer Experience National Technical Assistance Center (Peer Experience NTAC), a program of Peer Support Coalition of Florida, Inc. (PSCFL) is proposing to provide TA to promote evidence-based care for adults with serious mental illnesses, through SAMHSA's National Consumer and Consumer Supporter TA Centers. Peer Experience NTAC will be designed on a collaborative operating infrastructure to allow for innovative approaches that leverage existing efficiencies and maximize the impact of federal dollars allotted for TA. In providing TA as a Statewide peer network, PSCFL has experienced the wealth of information that is available on the peer and consumer movement. PSCFL's efforts have been made less effective by the inability to find a concentration of guiding materials on one platform in a strategically coordinated system. Further as the nation shifts focus to recovery-oriented systems of care, providers of consumer guided TA must also prepare the underpinnings of a sustainable recovery community that is infused with the learning gained though lived experience. In so doing, the program will focus on the foundational structures that support the occupational and financial dimensions of wellness. Finally, to promote self-determination and inclusion practices into future generations, it is imperative that youth are provided the opportunity to capture and continue the vision and values embedded in the consumer recovery movement. Generational sustainability must be a priority. To address the needs identified, the five goals of Peer Experience NTAC are: 1) Develop project operating infrastructure and conduct outreach and collaboration with SAMHSA's established topic focused TA and other Consumer TA centers. 2) Develop and implement TA on the integration of peers in treatment delivery systems. 3) Identify effective approaches to supported education programs, develop training approaches for employers to hire and retain consumers and explore alternate routes for consumer financial and occupational wellness development. 4) Provide TA on development of positive youth leadership skills and the critical role of family engagement in recovery. Peer Experience NTAC has a goal to reach a minimum of 5,000 individuals with universal TA during the first year and 25,000 over the life of the grant through various outreach modes. However, we expect the numbers to exponentially expand through collaboration and harnessing the infrastructure of SAMHSA's existing TA centers. Peer Experience NTAC will provide targeted TA on-demand and through development and presentation of learning materials. Finally, Peer Experience NTAC will conduct a replicable intensive TA pilot to educate a minimum of 50 employers and up to 250 participants annually on hiring and retaining consumers. Using the principles of implementation science, Peer Experience NTAC will bring lived-experience infused, evidence-based practices to scale through the direction and provision of multiple levels of TA, diffusing sustainable change throughout recovery communities.

The CAFE Mental Health TA Center (CAFE TAC) is designed to support the recovery and independence of individuals with serious mental illness (SMI) and promote their integration into the nation's MH system of care. It is a national program, intended to serve people with SMI, their families, providers and agencies that employ people with SMI within the system of care, and other stakeholders. Its goals and objectives are: 1. Individuals with SMI will become an integral part of the MH system of care, as consumers, agencies, and providers recognize the evidence base for their effectiveness and understand the roles in which they excel. 1.1: At least 250 participants will receive training on the integration of peers in the MH system, including information on the evidence base for peer support and the roles peers can fulfill, on an annual basis. 1.2: At least 250 participants will receive training on how lived experience of MH conditions can be leveraged to positively impact people in the community with similar experiences through peer support on an annual basis. 1.3: At least 75 representatives of State Agencies and/or local organizations will receive training on recruiting and retaining individuals with lived experience, financing mechanisms, and the integration of recovery-based practices in multiple settings on an annual basis. 2. Individuals with lived experience of SMI will grow and thrive in their recovery through access to education, connection with family and natural supports, and linkages to resources on employment and economic self-sufficiency. 2.1: At least 250 individuals with lived experience will receive training on supported education and educational accommodations and success strategies on an annual basis. 2.2: The project will create a database of supported education resources, with at least 50 new resources added annually. 2.3: At least 250 individuals with lived experience and/or family members will receive training on the role of families in supporting the recovery of family members with lived experience on an annual basis. 2.4: At least 75 youth with SMI will participate in training on leadership skills, advocacy, and self-direction on an annual basis. 2.5: At least 250 individuals with lived experience will receive training on job seeking and financial self-sufficiency on an annual basis. 2.6: The project will develop at least two guides for employers on hiring and employing individuals with lived experience of SMI on an annual basis. 3. Stakeholders will benefit from access to a wealth of nationally-relevant resources and information through information and referral, collaboration with partner SAMHSA TA efforts, and marketing of project activities. 3.1: The project will share a minimum of 25 resources from partner SAMHSA TA centers on an annual basis. 3.2: The project will establish an information and referral network through a toll-free telephone line, project website, email list serve, and social media accounts, and will develop engagement with at least three posts weekly. 3.3: The project will develop and disseminate a quarterly newsletter featuring resources and information to promote evidence-based care for adults with SMI and the role of those with lived experience as a component of the treatment system.