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The Nebraska Disaster Recovery Adults 2020-21 Project will serve adults with mental health or substance abuse issues in 23 Nebraska counties with Individual Assistance Declarations under FEMA-4420-DR. This project will extend mental health access by providing trainings to recognize and respond to adults with behavioral health issues, educate the workforce on disaster related mental health issues, and provide treatment vouchers to those within impacted areas. Interventions: Access to behavioral health treatment services will be augmented through vouchers accessible through the statewide Rural Response Hotline (RRH). Experienced RRH staff will refer callers to appropriate services, and distribute vouchers. Crisis counselors working in communities will refer individuals to the RRH for access to vouchers as needed. A pool of funds for recovery support services will help reduce barriers for those receiving vouchers to access services, by providing childcare, transportation, and other services as needed. Workforce development will include training in Post-Disaster Cognitive Behavioral Therapy for treatment providers, and Adult Mental Health First Aid (MHFA) training of trainers. Crisis Counselors will work to foster community relationships and knowledge of disaster recovery processes, and to link individuals and families impacted by the disaster to community resources. Goals & Objectives: We anticipate providing 1200 adults with access to direct behavioral health treatment (800 in year 1, and 400 in the six months of year 2); 3000 adults (2000 in year 1 and 1000 in the six months of year 2) through direct crisis counseling contacts in the community; and 360 (240 in year 1 and 120 in the six months of year 2) through Mental Health First Aid trainings. Goal 1: Community members are able to recognize signs of mental illness and substance use and respond with immediate support and assistance. Objective 1.1: By September 1, 2020, hold Adult Mental Health First Aid training-of-trainers. Objective 1.2: By September 2021, hold a minimum of 12 trainings (average of one per month after training-of-trainers) in Mental Health First Aid across disaster-impacted counties (some trainings will involve multiple counties). Goal 2: Increase access to mental health and substance use treatment services throughout the catchment area. Objective 2.1: By September 2021, issue 1200 vouchers through Hotline. Goal 3: Increase ability of clinicians to provide disaster-specific treatment to individuals in order to form an appropriate plan of services. Objective 3.1: Provide training in CBT-PD to 30 clinicians by December 2020. Goal 4: Increase communities’ ability to understand disaster reactions and recovery. Objective 4.1: Region Disaster Crisis Counselors provide education and information through 3,000 outreach contacts (one-on-one education, individual crisis counseling, group counseling, public presentations).

The Northwest Florida First Responder Resiliency Project is a multi-faceted, evidence-based outreach and intervention approach to addressing the behavioral health needs of firefighters (n = approx. 2,500) in Hurricane Michael impacted areas of the Florida panhandle. The program consists of 4 primary components: linking first responders with evidence-based assessment, screening, and tele-behavioral health services; peer support capacity building; education to promote mental health literacy (MHL); and leadership coaching to address stigma and culture change. These components address the most pressing issues in linking firefighters with appropriate mental health and substance use services: shortage of local providers, providers lacking cultural competency with first responders, inadequate insurance benefits, stigma, lack of awareness and misunderstandings regarding mental health issues, and fear of employment consequences for seeking services (leadership culture). Hurricane Michael exacerbated the existing severe mental health provider shortages in the western Florida panhandle. High levels of rurality and socioeconomic challenges in this area strongly correlate with more critical and persistent mental health issues after a disaster. First responders are also at higher risk for undiagnosed and untreated mental health issues and less likely to engage in help-seeking behaviors. Given firefighters were both residents of the disaster area as well as first responders in the situation, they remain at high risk for serious mental health issues. In addition to rurality, stigma, pride, shame, misunderstandings about mental health concerns, and employment culture prohibit firefighters from accessing care locally. However, telehealth can address both proximity and cultural barriers. Telecounseling by licensed mental health providers has been demonstrated an effective technique for delivery of evidence-based trauma informed therapy modalities, which may be helpful in the repeated exposure to trauma experienced by firefighters. Evidence indicates involvement in organized peer support networks can attenuate mental health symptoms and provide protective factors among firefighters. Trained peers serve as advocates providing education and awareness so more firefighters may recognize the early signs and symptoms of mental health issues and seek treatment, decrease stigma regarding mental health and substance abuse issues, increase access and linkages to appropriate professionals. Evidence also links increases in mental health literacy with increased access to screening and treatment and reduction in stigma. Project directors will customize and deploy a wide-reaching digital campaign to improve mental health literacy among first responders. Leadership behaviors are predictive of stigma and practical barriers to mental health treatment. Given the hierarchical nature of leadership in the fire service, leaders possess a unique and powerful opportunity to create culture shifts to reduce stigma regarding mental health treatment in firefighters. Relying on the theories of planned behavior change, the program will help leaders adopt a more positive, trauma-informed perspective on mental health issues.

Memorial Hermann Health System (MHHS) provides quality behavioral health services to children and adults across 14 hospitals and over 13 community settings, rendering over 19,000 patient encounters each year across Southeast Texas. Sadly, our region is vulnerable to natural disasters every year. Before our communities could recover from the extensive damage incurred during Hurricane Harvey, we experienced Tropical Storm Imelda (September 2019), one of the wettest tropical cyclones in US history dumping almost 43 inches of rain. We will serve Harris and Montgomery County, Texas. We focus on northern Harris County in particular as it is a highly impoverished community, had record rainfall and significant damage and also has few mental health services. Our application focuses on serving low-income, uninsured patient populations in this region. We leverage our three Mental Health Crisis Clinics (MHCCs) in northeast Harris County, west/central Harris County and southwest Harris County; these settings provide same-day, psychiatric screening, assessment, crisis counseling and safety planning for walk-in patients. In addition, we build on the expertise of our Psychiatric Response Case Management program that serves underserved patients with chronic mental illness, who repeatedly use our Emergency Departments; they have successfully reduced recidivism by 52%. During the 18-month grant period, we will: 1) screen 2,500 adults that present with mental health symptoms to understand if their symptoms are directly or indirectly related to our region’s disasters; 2) treat 300 disaster impacted adults using brief Cognitive Behavioral Therapy or Trauma Focused- Cognitive Behavioral Therapy to reduce patient symptomology by at least 20% (as determined by valid assessment tools); and 3) train 200 health and social service professionals to better detect signs and symptoms of mental distress and how to practice self-care, empowering our community to respond in future. We use grant funding to hire a full-time behavioral health clinician for screening and crisis services, who will also refer uninsured/eligible patients to a behavioral health clinician, who will perform Brief-Cognitive Behavioral Therapy or Trauma-focused CBT. One Behavioral Health Case Manager will help screen patients for social determinants of health and connect patients to community partners and services. We work with social service agencies that provide wrap around services and social support, adopting a holistic perspective to recovery and resilience. The grant team at MHHS has significant clinical, program operations, grant and program evaluation experience and is poised to be successful in helping adults achieve resilience.

The Aggie Disaster Response Mental Health Recovery Network will provide crisis counseling, mental health, vocational, and educational services for up to 250 adults who reside in North Carolina counties impacted by Hurricanes Florence and Michael. Specifically, this program will implement trauma-focused evidence-based practices to help these individuals gain a more substantial quality of life following disaster. The Department of Counseling at North Carolina Agricultural and Technical State University, a historically black college/university, is requesting funding pursuant to the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration – Disaster Response Grant Program. The proposed project directly responds to the funding opportunity FG-20-004 to provide mental and substance use disorder treatment, crisis counseling, other related supports to adults impacted by Hurricanes Florence and Michael. The proposed project will screen and assess clients for the presence of mental and substance use disorders and/or co-occurring disorders. The information will then be used to link clients to partnering organizations that provide licensed counselors who will use the information obtained from the screening and assessment to develop appropriate treatment approaches. These approaches will be trauma informed and evidenced-based. Such approaches include: Mental Health First Aid, Trauma-Focused Cognitive Behavioral Therapy, Eye Movement Desensitization and Reprocessing, and biofeedback techniques. Clients who are unemployed or underemployed will receive vocational evaluations to assist in determining viable occupational choices. Additionally, a Disaster Response educational course will be developed to provide individuals with a better understanding of how to approach mental health in the wake of disasters. This project will seek to serve 250 individuals. The goal is to recruit 250 clients in the first few months of the grant to start the process of providing the necessary services, although recruitment and treatment will be ongoing for the entire 18-month period. Each participant will be followed up every six months and at discharge for monitoring and research purposes. In sum, this project consists of the following components: (a) develop and implement a comprehensive plan of evidenced-based services; (b) screen and assess clients to better develop appropriate treatment approaches; (c) provide evidenced-based treatment services; (d) provide additional recovery support services such as vocational and educational components; (e) develop and implement a workforce development training plan; and (f) to establish relationships with local businesses, families, and community groups. In order to achieve this, measurable objectives have been set and an ongoing evaluation plan is in place to help ensure success.

Project RISE (Recovery Interventions and Service Enhancements) will address the 29% increase in parents with foster home placements and 21% increase in parents of maltreated children who remained "in-home" in Bay County, Florida. The 18 month project will serve 180 diverse individuals who are: 1) parents whose behavior health disorder is a contributing factor to child welfare system involvement (especially those with children at risk of removal); and 2) young adults with past and or current trauma exposure who have "aged" out of the local foster-care system and have no family support or any supportive network and are now in independent living status.

We know that natural disasters disproportionately impact lower income populations and recovery can be more challenging when access to resources is often determined by socio-economic status. Our primary goal is to support the mental health and long-term recovery of domestic labor and working populations in Malibu, whose jobs, businesses and livelihoods were adversely impacted by the Woolsey fire. The Boys and Girls Club of Malibu (BGCM) has been supporting the fire relief and recovery efforts by providing financial aid based on economic need to 540 individuals and families, crisis counseling to 80 individuals within 1 month of the fire and workforce development programs for 127. What has made our previous relief efforts effective is that we already cater to the most vulnerable groups within our overall population. We are already serving the target population and know that they would benefit from additional mental health and case management services. We are proposing to provide case management and mental health services to at least 300 low to moderate income adults. We will be employing Trauma Focused Cognitive Behavioral Therapy (TF-CBT) and Somatic Experiencing (SE) as our primary Evidence Based Practices (EBP’s) for treatment. Outcomes will be assessed with 2 psychometrically sound measures. The UCLA PTSD Reaction Index will allow us to accurately evaluate the prevalence and intensity of PTSD symptoms and will assist in providing diagnoses. The Outcome Questionnaire (OQ 30.2) will allow us to assess overall mental health. When both measures are combined, with the demographic profiles and BGCM program participation data, it will provide a high fidelity picture of our populations mental health, and what effect fire related trauma is having on particular subpopulations. Seasonal fires appear to be the new norm for our community. How we organize as a community and support our most vulnerable members will determine our resilience and ability to cope with the next disaster.

The Vernon J. Harris East End Community Health Center, DBA as Vernon J. Harris Medical & Dental Center and Capital Area Health Network (CAHN), requests a $1,000,000 DRGP - SA grant to fund Project RESTORE (Richmond Empowerment to Support Our Recovery Effort). This innovative initiative will help the most-impacted and vulnerable residents of the City of Richmond recover from Hurricane Florence by implementing a suite of comprehensive services. This will include developing a comprehensive plan of evidence-based mental health and substance abuse treatment services; screening and assessing clients for the presence of mental and substance use disorders; providing evidence-based treatment for substance abuse disorder/opioid use disorder (SUD/OUD) and severe and persistent mental illness (SPMI); providing recovery-support services; developing and implementing a workforce development training plan; and establishing relationships. CAHN will utilize third party and other revenue realized from provision of services to the extent possible and use SAMHSA grant funds only for services to individuals who are not covered by public or commercial health insurance programs, individuals for whom coverage has been formally determined to be unaffordable, or for services that are not sufficiently covered by an individual’s health insurance plan. The proposed project will also be articulated with the coronavirus COVID-19 outbreak response; that means CAHN will prepare recovery and resilience services that may be adapted to COVID-19 as needed, and in particular for residents who are affected by Hurricane Florence and COVID-19. CAHN is a Federally Qualified Health Center (FQHC), and the target area corresponds to CAHN’s service area, which includes the City of Richmond, as well as parts of the surrounding Henrico, Chesterfield and Hanover Counties. Most CAHN patients, however, live in the inner-city East End neighborhood of Richmond, the heart of CAHN’s service area, and it will be the focus of project activities; the East End, an area that has historically experienced environmental racism and has been harmed disproportionately by Hurricane Florence and is at significant risk from COVID-19. The East End is severely economically disadvantaged and largely African American, and many persons have inadequate access to health care. The target population includes individuals and families who have been harmed or seriously affected by Hurricane Florence. About one in five residents are in poverty in the core target zip codes, compared to just one in ten in Henrico County or the Commonwealth. OUD, related to Hurricane Florence trauma, is also prevalent and must be addressed. According to data from the Virginia Department of Public Health, all parts of the project target area have seen a growing trend in OUD deaths. In Chesterfield County, there were 87 deaths in 2018, for a rate of 25.0 per 100,000 residents, while in Henrico County, there were 57 deaths, for a rate of 17.3 per 100,000 residents. In the City of Richmond in 2018, there were 54 overdoses per 10,000 ER visits: compared to 42.1 in Virginia as a whole. CAHN has seven Health Centers, including its main site in the East End.

The Ponca Disaster Behavioral Health Project will address the response needs resulting from the 2019 floods impacting the Ponca Service Delivery Area. The Project will develop the Tribe's capacity to deliver disaster-focused professional and supportive services, with an emphasis on distance technology as a mode of delivery for the broad geographical area served. The project will also build from exiting social networks to assist with communication, recruitment, and resource sharing assistance.

The Modoc Tribe Disaster Response Grant will seek to provide an immediate plan of treatment for mental and substance use disorders, crisis counseling, recovery support services as well as outpatient services to adults who may have behavioral health issues as a result of the major disaster flooding that occurred in May 2019 in Northeast Oklahoma. The Tribe will contract with Grand Lake Mental Health Center an established mental health provider to provide these relevant services. Services include operating a crisis recovery program that will provide treatment services for individuals who are struggling with substance abuse, co-occurring disorders, and behavioral health disparities as a result of the impact from the natural disaster flooding event declared under section 401 of the Robert T. Stafford Disaster Relief and Emergency Assistance Act. The Tribe’s service area for its existing outpatient treatment program Lost River Treatment Center (LRTC), spans in a 50-mile radius from the central point of the Tribe’s headquarter office in Miami, OK. This location provides outpatient Medication Assisted Treatment and Substance Use Counseling treatment access in the four-state area of Oklahoma, Kansas, Missouri, and Arkansas. The immediate county of service provided impact is Ottawa County, Oklahoma, with the adjacent counties of Cherokee, Kansas; Jasper, McDonald and Newton Counties in Missouri; Delaware, Craig, Mayes and Cherokee Counties in Oklahoma; and Benton County, Arkansas. This treatment service area includes a total of 533,909 adults over the age of 18 as of 2017. The Modoc Tribe will embed LRTC Licensed Counselor(s) within the Grand Lake Mental Health Center (GLMHC) Crisis Stabilization Units at Intensive Outpatient Center located in Vinita, OK and the Grand Recovery Center located in Pryor, OK. The agreement with GLMHC for 24/Crisis Intervention Services and Crisis Unit will be to provide mental health and substance abuse treatment services, and crisis intervention for individuals identifying being impacted by the natural flooding disaster occurring in Ottawa County, Oklahoma, May 2019. Initial patient assessment will take place at Grand Lake Mental Health Centers with a licensed mental health professional. Individuals will be assessed to qualify services by answering a brief questionnaire identifying place of residency during the time period of the major flooding disaster, as well as, the ways in which it impacted them. The project start date will be April 1, 2020 with anticipated service delivery date to be through September 30, 2021 and serve 100 clients. To achieve our desired project start date, the Modoc Tribe will receive program consultation and collaborate with an established mental health/substance abuse treatment provider organization, Grand Lake Mental Health Center. Through the power of partnership, GLMHC and LRTC are able to effectively provide wraparound services including but not limited to psychotropic medications, Subutex based medication, methadone and other Medication Assisted Therapies traditionally associated with substance use disorder treatment. Although there is a degree of overlap in this partnership, the two organization work in a complimentary manner by referring based on client needs. The organizations are effectively leveraging the strengths of each other to facilitate the best outcome for each consumer. GLMHC has a full array of services available including Medication Assisted Treatment, Intensive Outpatient services for both mental health and substance abuse, IPS Employment services, housing services, screening for residential treatment, IMR (illness management and recovery) groups, 24 hour crisis services and integrated health services.

On October 10, 2018 the Florida Panhandle was struck by a Category 5 Hurricane that caused unprecedented and wide-spread catastrophic devastation to the counties of Bay and Gulf which are located in the FL-002 district of northwestern Florida. As a result of this storm, a large percentage of the population was made homeless, jobless, and struggling to access basic needs and medical care. Life Management Center of NW FL, Inc. has an extensive history of providing mental health and substance use treatment services to these affected counties and was an integral part of Project Hope as part of Hurricane Michael community-based recovery efforts and was providing service to the impacted communities in shelters, parking lots, another other unconventional sites during and immediately after the storm. The goal of the Bay/Gulf Recovery Project is to identify those individuals who continue to struggle with recovery and to utilize evidence-based treatment approaches such as Trauma Focused Cognitive Behavioral Therapy and Integrated Dual Disorder Treatment to address the continuing mental health and substance use crisis which has also had negative impacts on victims' ability to maintain stable housing, access to medical care, educational advancement, and employment stability.

The 2018 wildfire season in California was the most devastating on record, with the Camp Fire in Butte County being the deadliest and most destructive wildfire in California history. BCDBH is applying for SAMHSA Disaster Response funding to significantly increase access to mental health and substance use disorder services to the older adult population (ages 60+) throughout the County. The collaboration seeks to enhance current outreach teams utilizing staff specially trained in serving older adults, focusing on trauma related to the Camp Fire and its coinciding emotional, social, physical, and economic health related challenges.

Disaster Response to Hurricane Florence-Adults: The proposed project plans to develop and implement a comprehensive plan of treatment and recovery support services to decrease the impact of Hurricane Florence on adults residing in Brunswick, New Hanover, and Pender, counties in North Carolina which were severely damaged by the hurricane. Our goals and objectives are the following: Goal 1. To increase the ability of individuals who interact with people who were affected by Hurricane Florence to detect mental and substance use issues and respond to the issues detected. Objective 1. Develop a workforce training plan. Objective 2. Provide training on evidence-based practices that increase mental health and substance use awareness and literacy and respond appropriately to the issues detected. Goal 2. To connect individuals who have behavioral health issues to needed services. Objective 1. Provide coordinated referrals, services, and follow-up to adults for evidence-based community based mental health practices and services. Objective 2. Establish relationships with local businesses and community groups to broaden and link all community resources available for adults impacted by disaster. Goal 3. To provide direct treatment and recovery support services. Objective 1. Develop a comprehensive plan of community-based mental health services, including crisis counseling, that utilize evidence-based practices. Objective 2. Screen and assess clients for the presence of mental and substance use disorders and/or co-occurring disorders, and use the information obtained from the screening and assessment to develop appropriate treatment approaches. Objective 3. To treat participants. Objective 4. Provide recovery support services. Project duration is 18 months.

The Commonwealth of the Northern Mariana Islands (CNMI) Disaster Response Program (DRP) will engage key stakeholders to collaboratively implement a comprehensive plan of treatment and recovery support services aimed at decreasing the behavioral health impact of the Typhoon Mangkhut and Super Typhoon Yutu disasters on adults. The project will target adults and their families on Saipan, Tinian, and Rota.