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Santa Cruz County Behavioral Health Services will launch Building Hope & Safety-Santa Cruz to serve community members experiencing domestic violence and/or who are at-risk of suicide. The project includes a partnership with Monarch Services that will provide emergency housing support for people experiencing domestic violence and at-risk of suicide, and other related services. A collaborative partnership with Suicide Prevention Services of the Central Coast will also provide large-scale suicide prevention programming to county residents at increased risk of suicide, especially due to increased stress related to the COVID-19 pandemic. The implications of the COVID-19 pandemic for community behavioral health are far reaching. The risk of suicide and potential for negative mental health outcomes in both our target populations and in the general population with a parallel need for enhanced and expanded services is escalated by the following key trends: economic instability, high unemployment rates, increased social isolation due to shelter in place orders, decreased access to community and religious supports, exacerbated illness and medical issues, drastic increases in firearms sales and access to means for suicide, variation in seasonal suicide rates, projected increase in child abuse and domestic violence, increased national anxiety, and other factors. Given the current pandemic, our target population of people at-risk of suicide is expanded to potentially include all community members, particularly those at risk of domestic abuse, as well as healthcare workers experiencing intense secondary trauma, throughout the county of Santa Cruz. The behavioral health impacts, including increased substance abuse and higher rate of child abuse and domestic violence are unpredictable in their length of impact and negative effects. Building Hope & Safety-Santa Cruz will provide the following services for the entire 16-month grant term: emergency housing vouchers for people at-risk of suicide and experiencing domestic violence for a minimum of 150 individuals; clinical and community training in suicide prevention and safety planning for a minimum of 1,190 people; direct crisis services and behavioral health counseling for a minimum of 2,500 residents; a minimum of 1,000 residents in an active post intervention Local Outreach to Suicide Survivors model (LOSS); over 20,000 people will receive a newly created behavioral health resource pocket guide, including suicide prevention services; and another 45,000 will be targeted by a public education campaign with an emphasis on means management and people at-risk of domestic violence.

Prevent suicides in adult patients age 25 years and older, in Suffolk County, NY by implementing the evidence-based Zero Suicide program across five hospitals, two domestic violence treatment programs, and ten FSL clinical sites. The SCSP program will serve patients discharged from emergency departments and inpatient hospital units, as well as patients referred from domestic violence treatment programs. Suffolk County, a 912 square mile region east of New York City, sits at the epicenter of the COVID-19 pandemic in the U.S., with 1,840 confirmed COVID-19 deaths at the time of this submission, and has reported more than 120 suicides in each of the past two years. Suffolk County is also in the midst of the national opioid epidemic, with the highest rate of overdose deaths and overdose-related hospital admissions in the New York City metropolitan area. FSL has already seen a 7.8% increase in patients and a 22% increase in units of service since the start of the COVID-19 pandemic. The stay-at-home orders in response to the pandemic, as well as the financial instability that has resulted from businesses being closed, have also resulted in increased rates of domestic violence in Suffolk County. The SCSP program will provide additional resources to meet this increased need among Suffolk County residents. The SCSP program will build on the existing relationship between FSL, local hospitals, and domestic violence treatment programs, increasing the capacity of all providers to prevent suicide in adult patients age 25 and older, including those with psychiatric comorbidities, substance use disorders, and victims of domestic violence. This project will also identify individuals with precursors to these disorders, such as social isolation and financial instability, through extensive screening of at-risk populations. We propose to link four local hospitals and two domestic violence treatment programs with an integrated FSL program that will comprehensively screen, assess and intervene to identify and treat individuals at risk of suicide, including those who have made recent suicide attempts, those with active suicidal ideation or plans, and those with underlying conditions such as depression, anxiety disorders (including Acute Stress Disorder and Post-traumatic Stress Disorder), psychotic disorders and substance use disorders. Embedded in the proposed program are the use of evidence-based assessment instruments, evidence-based interventions to address suicidality, as well as related mental health and chemical dependency issues, and extensive staff training for all providers in the referral network. These activities will ensure that patients will be assessed quickly and accurately, referred to effective services, treated and followed over time by a group of integrated care providers who share a common understanding of effective strategies to address their needs. The development of assessment, referral and treatment protocols, along with the extensive provider training, will result in a sustainable network of care providers in Suffolk County.

American Health Center, Inc. (NAHC), located in Oakland, California, proposes the implementation of COVID-19 Emergency Response for Suicide Prevention for adults ages 25 and older that are: 1. Urban American Indian/ Alaska Native (AIAN) and other underserved member living with or at-risk for mental health including suicidality and/or substance use disorders; and 2. Urban AIAN and other underserved members that are victims of domestic violence or are at-risk for exposure to violence and their dependents. The proposed project will serve 500 members over the 16-month project period. Goals and objectives are as follows: 1. Develop and implement a plan for rapid follow-up of adults who have attempted suicide or experienced a suicidal crisis after discharge from emergency departments and inpatient psychiatric facilities including care transition and care coordination services. 2. Establish follow-up and care transition protocols to help ensure patient safety, especially among high risk adults in health or behavioral health care settings who have attempted suicide or experienced a suicidal crisis, including those with serious mental illnesses and/or substance use disorder(s). 3. Provide, or assure provision of, suicide prevention training to community and clinical service providers and systems serving adults at risk including Question, Persuade, Refer (QPR) gatekeeper training and clinical training related to selected evidence based practices. As a result, 20 staff and 50 community members/ partners will be trained. 4. Work across relevant or community departments and systems in order to implement comprehensive suicide prevention such as recovery and social support and crisis intervention. 5. Provide suicide screening and assessment and appropriate clinical treatment services required as a result of the assessment, including options for tele-health. As a result, 100 members will be screened/ assessed and 80 members will receive appropriate treatment. 6. Provide Traditional Health activities and community recovery supports to assist individuals who have attempted or are at risk for attempting suicide, including supports for impacted household members. As a result, 300 members will receive recovery community support. 8. Provide enhanced services for victims of domestic violence and their dependents including appropriate treatment, care coordination, and emergency linkages. As a result, 125 domestic violence victims or members at- risk for domestic violence will be served. As indicated, NAHC will coordinate with state or local health agencies as appropriate in order to provide comprehensive suicide prevention programming for the target population.

The project titled Rural West Texas Covid-19 Relief Suicide Prevention aims to benefit residents of Coke, Concho, Crocket, Irion, Reagan, Sterling, and Tom Green Counties, that are experiencing suicidal thoughts as a result of the COVID-19 pandemic and measures implemented to slow down its spread. The proposed project focuses on domestic violence victims and their dependents as a population with a higher risk of suicide. MHMR services for the Concho Valley, in conjunction with the Intellectual and Developmental Disabilities Authority, will lead the project in partnership with West Texas Counseling & Guidance providing outpatient behavioral support and the Institute of Cognitive Development providing agency support to victims of domestic violence. The area of service for the Rural West Texas Covid-19 Relief Suicide Prevention project is largely rural and located at the edge of the Permian Basin, which serves as the world's second most valuable oil field. The geographic catchment area equates to approximately 3.5% of Texas's landmass, representing about 0.45% of Texas's population. The reported race categories are Caucasian, 93.5%; African American, 2.3%; Hispanic, 45.6%. Additionally, 14.6% identify as low income, and 18.3% of the adult population under 65 are uninsured (U.S. Census Bureau). Stakeholders in the area worry about the effects of Covid-19 on declining mental health trends and increased domestic violence victims. Since the outbreak, there has been an increase of 35-40% in local domestic violence calls to support hotlines. Furthermore, Tom Green County consistently has had suicide rates above the national and state averages. This focus area has a shortage of mental health providers and residents rely heavily on resources located in Tom Green County. The Rural West Texas Covid-19 Relief Suicide Prevention Project aims to prevent suicides in the area, as a result of the pandemic, by strengthening current suicide prevention efforts. Through the project, the partnership will develop a Care Management Plan to provide the needed support and services to individuals with suicidal crisis upon discharge of emergency rooms and psychiatric facilities. If granted, area community groups and providers will have access to necessary evidenced-based screening and suicide prevention training. Also, partner agencies will have standardized screening protocols, guaranteeing that those clients most at risk of systematic disenfranchisement receive consistent and competent access-to-care. If granted, a portion of the funds will support hiring additional staff to serve the increased number of individuals expected as a result of enhanced screening measures. Additional funds will be utilized to provide direct services to those at risk, including domestic violence victims and their families. Services provided include increased mental health counseling access, telepsychiatry, medication assistance, and emergency housing. 39% of the funds will be use to provide direct support to domestic violence victims.

The Spirit Lake Tribe COVID-19 Emergency Response for Suicide Prevention will utilize Safety Planning Intervention (SPI+) to conduct suicide risk assessment and treatment plans with individuals experiencing suicidal crisis, substance abuse and/or domestic violence and discharging from an emergency room or inpatient psychiatric facility. The project will provide follow-up after discharge and Indigenous Support Groups/group therapy for individuals having experienced suicidal crisis, substance abuse, or domestic violence,

The Rosebud Sioux Tribe will use resources available through SAMHSA-20-007 to mitigate the impact of the COVID-19 epidemic in terms of rates and number of suicide and in support for victims of domestic violence. Suicide and domestic violence are top tribal priorities, with height rates matching a pattern of disparities in American Indian communities. Annual rates of death by suicide in Todd and Mellette County between 2010-2014 was 24 per 10,000, compared to 1.45 per 10,000 in the total US population in 2017. Rosebud's reservation seat of Todd County has the second highest age-adjusted mortality rate for suicide in the continental U.S., second only to another Lakota county. Those with histories of suicidal behavior or ideation have higher mental healthcare utilization overall, and access to in-person care presents challenges even under usual circumstances. Our gaps in care access align with national trends; like ours, 65 percent of non-metropolitan counties in the Unites States lack a psychiatrist. We will conduct activities to support individuals with a recent behavioral health crisis as well as victims of domestic violence and their dependents or families. Activities will include a planning phase, growth of a collaborative care network, crisis intervention services, telebehavioral health, training of reservation-based health providers, enhanced referral and treatment networks for individuals in crisis, and improved access to care. Wherever possible, traditional medicine will be integrated into our approach through the support of spiritual leaders. We will work with existing clinical and community support systems to enhance access to telebehavioral health services and prompt, appropriate behavioral health care. A key strategy will be to bring telebehavioral health services to clients' homes, as our community has deep gaps in broadband access and telephone service access. The program's director will be based at a leading women's shelter, the White Buffalo Calf Woman Society, based in our community. During the lifetime of the project we aim to facilitate more than 1000 clinical encounters for over 200 individuals. This challenging time will be a strain on our health systems, and we feel it is critical to expand services for those in our community with behavioral health needs. By leveraging telehealth, this program will deliver evidence based care in the places where it is needed most.

Preventing Suicide in the Rural Mountain West is a highly collaborative project leveraging multiple evidence-based programs and strategies to respond to the acute risk of increased suicide resulting from the COVID-19 pandemic across a broad rural and frontier region of the Colorado Rocky Mountains, with specific focus on victims of domestic violence and their dependents. Solvista Health, a Community Behavioral Health Center, leads a dynamic partnership with regional Critical Access Hospitals, domestic violence victims' advocacy organizations, Local Public Health Agencies, Offices of Emergency Management, and multiple State Agencies. The project will implement community and provider training utilizing the evidence-based Collaborative Assessment and Management of Suicidality (CAMS) therapeutic framework of care. CAMS training will be implemented with 10 individuals serving a four county region covering 4,000 square miles with a total population of over 80,000. This region is disproportionately impacted by both COVID-19 and the prevailing suicide epidemic. In addition, extensive training on evidence based Dialectic Behavioral Therapy (DBT) will occur with approximately 26 treatment providers across the region in concert with the CAMS framework. Providers will offer intensive, evidence based individual treatment, therapy groups, and psychiatric services available in-person and via tele-health to those experiencing acute behavioral health symptoms. Complementing widespread training efforts and clinical services, the project will deploy certified Peer Specialists and Case Managers in a comprehensive approach to decrease suicide risk, promote stability, enhance social connection, increase engagement with outpatient services, and reduce the frequency of inpatient hospitalization among domestic violence victims and other at risk, rural community members.

NARA (Native American Rehabilitation Association of the Northwest), an Urban Indian Organization and Federally Qualified Health Care Center (FQHC), located in Portland, Oregon will continue to adapt its current strategies to provide telehealth services according to the guidelines provided by the Center for Disease Control in response to the COVID-19 virus. NARA serves primarily American Indian/Alaska Native (AI/AN) populations who have shown higher rates of substance abuse, mental health conditions, suicidality, homelessness, disabling conditions, and domestic violence when compared to other ethnicities (Lewis, Myhra, 2018). The SAMHSA 2020 COVID-19 Emergency Response for Suicide Prevention (COVID-19 ERSP) funding will reduce the impact of disparities that limit access to prevention and intervention programs, substance use and mental health services, increase screening, assessment, crisis stabilization, referral processes and prevention activities with the overall goal of continuing care during pandemic, as well as improving outcomes (e.g., C-SSRS, etc.), suicidality, and domestic violence (DV) for individuals and/or families over the period of 16 months. The primary focus is on adults, 25 years and older, who are at high risk for suicidal behaviors, as well as DV victims including their dependents who are at greater risk related to COVID-19 virus and the shelter in place order. This project will allow NARA, with the support of community partners (Cascadia’s Project Respond, The Gateway Center, and Unity Psychiatric Hospital), to continue to provide crisis intervention, prevention services, DV treatment/supports, mental and substance use disorder treatment, care coordination, case management, as well as recovery supports for 3000+ low income or underinsured individuals/families impacted by the COVID-19 pandemic. With the use of telehealth, this project brings much needed access to cultural activities, case management services, addiction and mental health services during the duration of the pandemic and beyond. Through system adaptation that aligns with the recommendations put in place by the CDC, NARA commits to goals focused on reducing barriers to care, using evidence based practices, promoting behaviors and activities that promote recovery, safety, as well, as overall well-being through the use of telehealth with the gradual integration to in person services. Key interventions and strategies are: 1. Create a leadership committee that is committed to prevention services specific to suicide and domestic violence by reducing disparities caused by limited access to direct treatment services and cultural activities during the COVID-19 pandemic; 2. Develop and implement a plan for rapid follow-up following hospitalization of suicidal patients; 3. Establish follow-up and care transition protocols to ensure patient safety among high risk suicidal adults in primary care or mental health, and substance treatment settings; 4. Provide suicide prevention training to community and clinical service providers; 5. Collaborate with community organizations and systems to implement comprehensive suicide prevention (e.g., Cascadia’s Project Respond, The Gateway Center, Unity Hospital, etc.); 6. Provide suicide screening, assessment and appropriate clinical treatment services based on assessment; 7. Provide community recovery supports to assist individuals and their family members who attempted or are at risk for attempting suicide; 8. Develop protocol for enhanced screening of individuals at risk for domestic violence; 9. Provide enhanced services for victims and dependents of domestic violence based upon screening and assessment treatment services; 10. Provide patient supports that promote safety and well-being of domestic violence victims and those at risk for suicide.

On March 18, 2020, the Eastern Shoshone Tribe declared a state of emergency and there are 209 COVID-19 cases confirmed in Freemont County, the location of the WRR. This emergency and the relatively high number of cases dictated a stay-at-home-order for all residents. COVID-19 has impacted how individuals in our community access and receive services, with veterans, domestic violence victims, and the elderly placed at high risk for suicide. Before the COVID 19 pandemic, direct services to these groups were extremely limited. COVID-19 threatens our ability to reach these high-risk populations because direct service providers are not open, transportation resources are closed or limited, and many in this population lack access to the internet or have limited computer skills to access virtual services. In sum, the current conditions fail to fully support these high-risk populations, resulting in a high risk for suicide, domestic violence, and other behavioral health problems. The purpose of the project is to develop and implement a plan for rapid follow-up of adults who have attempted suicide or experienced a suicidal crisis after discharge from emergency departments and inpatient psychiatric facilities. In addition, this project will establish follow-up care and transition protocols, provide suicide prevention training, screening and assessment, recovery support, telehealth, and enhance services for domestic violence victims and their dependents as a result of COVID-19. This project will increase access to services using evidence-based services, recovery support services, and crisis mental health services on the WRR. This will be accomplished by the following two goals: 1. Goal One: Develop and implement plans, protocols, and training opportunities to support direct services providers and adults over age 25 impacted by the COVID-19 pandemic. 2. Goal Two: Expand access to community recovery supports, telehealth services, and enhanced services for victims of domestic violence. Eastern Shoshone Recovery program will support these two goals through a variety of evidence and practice-based services including implementing the Zero Suicide Model. Suicide and domestic violence response protocols will be developed and revised to better serve victims. Additionally, cultural implementation of services such as sweats, talking circles, and community gatherings will also be used for the overall success and sustainability of the program.

Catholic Charities Neighborhood Services, Inc. (CCNS) is seeking funding to support the creation of a dedicated, specialized team of behavioral health professionals to address a potential suicide crisis in our community, which is expected to be exacerbated by the COVID-19 pandemic. The proposed CCNS Suicide Prevention, Response, and Recovery (SPRR) Initiative will leverage our established and successful network of programs which include crisis, mental health, substance use treatment and social support services across Brooklyn and Queens, NY. The SPRR Initiative will serve adults age 25 and older who have attempted suicide or experienced a suicidal crisis after discharge from emergency departments and inpatient psychiatric facilities, or are otherwise at-risk for suicide, as well as impacted household members. As part of the SPRR Initiative, individuals will receive a comprehensive and focused suite of services that includes supportive outreach and engagement, risk assessment, intensive care transitioning and care coordination to facilitate successful engagement in recovery supports, as well as targeted treatment that uses evidence-based practices to build resiliency. CCNS is well positioned to offer the SPRR Initiative to individuals in need. We are one of the largest behavioral health and social service providers in Brooklyn and Queens. Our primary service area includes 23 zip codes across the two boroughs, and the area is home to 1.48 million people with a wide range of socioeconomic and health disparities. The area also has the highest rates of domestic violence homicides and suicide deaths in NYC. Multiple sources indicate that COVID-19 has exacerbated socioeconomic and health disparities in NY. As the national epicenter of the crisis, NYC has manifested over half of COVID-19 cases in NYS. Together, Brooklyn and Queens make up nearly half of the cases and death rate across the entire city. The area with the most COVID-related deaths in the city is Corona, Queens, where 369 people to date have died of the virus, or 1 of every 302 people. CCNS has been embedded in Corona Queens for decades. We have community relationships as a longstanding mental health provider and will be able to start serving the community immediately upon award. Publications have cited the strains that the COVID pandemic is having on the general public, especially front line health workers and mental health, exacerbating substance use disorder, suicidal risk, and domestic violence and we are positioned to help. Based on the available data and our deep ties to the community we serve, we anticipate that a behavioral health crisis is imminent. Funding from this grant will allow us to add six behavioral health professionals specializing in suicide prevention, treatment, and recovery to expand access to much-needed services to our high-risk, high-need population. Further, funding will support the creation of a specialized Domestic Violence team who will be experienced in providing care to individuals who exhibit suicidality and are also victims of domestic violence. As a result of this funding, we will serve 1700 unduplicated individuals that meet program criteria during the grant period. We have also established multiple goals to ensure that individuals effectively engage in treatment and care to ultimately reduce the overall suicide rate and number of suicides in our area.

Fairbanks Native Association (FNA) is applying for SAMHSA COVID-19 ERSP funding. Our proposed project will expand our existing Alaska Native Pandemic Project (ANPP). The focus of ANPP-2 is to provide prevention training, case management, and Recovery Support services for American Indians and Alaska Natives (AI/AN) adults (25+) who have attempted or are at-risk of suicide and/or domestic violence from the effects of the COVID-19 crisis. AI/AN suicide and domestic violence rates far exceed the national average. AI/AN face disproportionately high financial, health, and behavioral health challenges, all of which are exacerbated by the pandemic. Stay-at-home orders increase the risk of domestic violence, substance misuse, poverty, and disconnection from social and cultural supports. ANPP-2 will serve 120 unduplicated clients over the 16 month period. Existing FNA Behavioral Health (BH) ANPP-1 services include 1) a comprehensive community-wide plan of evidence-based substance use disorder and co-occurring SUD and mental health disorder treatment services for individuals impacted by the pandemic; 2) Recovery Support services for all for residential and outpatient individuals with Chronic Mental Illness or Serious Mental Illness, or mental health and/or alcohol disorders; 3) Crisis Mental Health Services (including a 24 hour on-call crisis team and Crisis Intervention, Stabilization, and Therapy); and 4) a plan for rapid follow-up and protocols following crisis. New services to enhance and expand the ANPP include the addition of 1) suicide and domestic violence prevention training for community members at large, community coalition members, and clinical providers; 2) a social media campaign to raise community awareness of new services and recruitment mechanism, 3) case management for Recovery Support services for individuals who have attempted or are at-risk for suicide and are exiting the emergency room or treatment and victims of domestic violence. The existing 17 member community coalition, the Interagency Transition Council (ITC) will play a key role in the project. During its six year tenure it has provided leadership, planning, and rapid access to behavioral health service and Recovery Support providers to FNA projects for the past six years. The ITC is the BH System of Care for this service area. It includes representatives in the following service domains and individuals: Mental Health, Substance Abuse, Juvenile and Criminal Justice, Education & Employment, Spiritual/Cultural, Housing, Health and Emergency Care, Child Welfare, a suicide victim survivor, a veteran, youth, an AI/AN Elder, and members of the community-at-large. Formal agreements are in place for most of the ITC providers, with the remainder to be updated or formalized within three months of project funding. The ITC is responsible for the social media campaign, identification and recruitment of clients, rapid access to care, and assisting in the identification of suicide and domestic violence curriculum.

The Gerald L. Ignace Indian Health Center in Milwaukee, Wisconsin will address the high rates of mental illness and/or substance abuse/misuse in Native American and Alaska Native (AI/AN) communities, as well as the increase in domestic violence during the time of COVID-19, through the implementation of the Milwaukee Emergency Response for Suicide Prevention (MKE ERSP). MKE ERSP will use evidence-based practices supported with highly effective screening and clinical intervention tools to reach more deeply and broadly into the AI/AN community. About 1/3 of the state’s AI/AN population lives in the Milwaukee area, or about 18,239 people. Through prevention education, screenings, community events, outreach and through local AI/AN agencies, the program will reach 1,530 people between June 30, 2020 and October 30, 2021. MKE ERSP will have four overarching goals. Goal 1) Increase the capacity of GLIIHC staff to respond rapidly to attempted suicides or suicidal crises using a Zero Suicide in Indian Country framework. Obj. 1) Between August and September 2020, GLIIHC will review and improve care transition protocols to ensure patient safety for patients at all risk levels for suicide attempts or crises. Obj. 2) Between September and December 2020, train all GLIIHC clinical staff and offer key partner representatives (as COVID-allowable in a telehealth/ video based platform) in the Zero Suicide in Indian Country implementation model, and continue implementing existing evidence-based practices demonstrated to support and promote mental health in a culturally competent way. Goal 2) Ensure that all existing and new GLIIHC Behavioral Health Department (BHD) hires are familiar with and proficient at using the in-house suicide risk rating tools, and that any high-risk patients receive ongoing monitoring. Obj. 1) Provide training in and monitor usage of suicide risk rating tools used at GLIIHC, ensuring consistent usage for all relevant providers in the BHD. Goal 3) Offer ongoing telehealth opportunities for all BHD patients (regardless of suicide risk but providing ongoing monitoring) to receive evidence-based mental health and substance misuse treatment on an outpatient basis, connecting patients to inpatient treatment when indicated. Obj. 1) Offer evidence-based and culturally relevant services ranging from outpatient (telehealth) services to group therapy (telehealth) to family services as well as connections to inpatient treatment resources. Services will be provided virtually by video conference or by telephone. Goal 4) Implement screening tools that will allow GLIIHC staff to better assess patients in the BHD for exposure to family violence/domestic violence, including connecting them to safe shelter when indicated. Objective 1) Update intake/screening tools to screen for family/domestic violence. Objective 2) Identify situations where referrals to safe shelter/housing may become necessary.

Given the current COVID-19 crisis and the potential of mental health challenges and suicide that comes with isolation, the Choctaw Nation of Oklahoma (CNO) proposes to launch Project Native Strong, an effort to deliver immediate action by providing evidence based efforts to address the mental health needs of Natives adversely impacted by COVID-19 and who reside within the tribal boundaries of the CNO and who make up the target population. The CNO catchment area is comprised of 10 ½ counties in southeastern Oklahoma, it is bordered by Arkansas to the east and Texas to the south. Due to the elevated rates of diabetes, asthma, cardiovascular disease, kidney and liver issues among Native Americans, it is widely accepted that Natives are at a higher risk for fatality if they acquire the COVID-19 virus. With the rates of the virus rising daily and Oklahoma ranking 47th in all states testing for the virus, it is difficult to determine the number of patients that will be encountered. CNO anticipates serving as few as 50 and as many as 200+ positive for COVID-19 and as many as 400 unduplicated patients for mental health or substance use issues. In addition, Native Strong will provide all federally recognized tribes within the State of Oklahoma educational opportunities to benefit the mental health of their tribal members. The proposed activities include launching an opportunity for tribes to participate in the transformative work of the Zero Suicide (ZS) framework. The Choctaw and Chickasaw Nations participated in past Zero Suicide Academies and CNO will utilize COVID-19 Emergency funds to share this educational opportunity with other tribes within the State of Oklahoma. A Licensed Mental Health Professional (LMHP) will be positioned in the Emergency Department to work alongside doctors and nurses to address the increased mental illness concerns related to COVID-19. By increasing access, screening, intervention, immediate appointments and referral at this critical location, patient outcomes related to depression, anxiety, suicide intervention, and other mental health issues are expected to improve. The LMHP will also conduct tele-health behavioral health sessions. Screening and assessment efforts will be increased throughout all CNO clinics to determine the presence of mental and domestic violence issues and appropriate care plans will be established. Training and resources will be provided to community members who are survivors of suicide or have lived experience to train them to facilitate support groups throughout the state of Oklahoma. The established CNO Zero Suicide Initiative will expand by incorporating State and Tribal Law Enforcement, Child Welfare Services, Domestic Violence Advocates, and other community partners and provide them with education for safety planning, means safety, and non-demand caring contacts. Partnerships with domestic violence shelters throughout the CNO will be established so that the shelters can expand their capacities to meet victim needs. Education on the support of survivors of domestic violence will be provided throughout the state for tribes and their partners. A focused Training of Trainers will be provided to CNO staff/partners to further address domestic violence victim needs throughout the CNO.

Through technology, Aleutian Pribilof Islands Association aims foster connectivity with adults 25 years and older by developing accessible resources in effort to prevent suicides and domestic violence. APIA’s mission is to promote self-sufficiency and independence of the people by advocacy, training, technical assistance and economic enhancement; to assist in meeting the health, safety, and well-being needs of each Unangax community; to promote, strengthen and ensure the unity of the Unangax?; and, to strengthen and preserve the Unangax cultural heritage. The Substance Abuse and Mental Health Services Administration award COVID-19 Emergency Response for Suicide Prevention Grant (COVID-19 ERSP) aligns with APIA’s mission to meet the health, safety, and well-being needs of Unangax communities. The Unangax region is comprised of sparsely populated archipelago islands. The rugged beauty and rich history are in stark contrast to the ruthless weather (fog, wind, rain, repeat). Residents are a hardy group. They have had to rely on each other to survive, which the task of daily living can take a toll. The rate of suicide among all Alaskans in 2017, 26.9 per 100,000, was nearly 2 times higher than the national rate. For Alaska Native people in 2017, the rate was more than 3 times higher than the national rate, 51.9 per 100,000 (U.S. Centers for Disease Control and Prevention (CDC). Suicide mortality by state: 2016). More than 4 in 5 American Indian and Alaska Native (AI/AN) women (84.3 percent) have experienced violence in their lifetime (Rosay, 2016). The COVID-19 pandemic impacts this at-risk population disproportionally (https://www.cdc.gov/coronavirus/2019-ncov/community/health-equity/race-…). There is a high potential for an increase in suicides and domestic violence in both the region and in the urban center, within a state that already faces such high numbers in these areas, it is a public health concern. The goal of this project is to increase the capacity of APIA’s Behavioral Health Services Program and the Healthy Relationships Program in order to increase support and communication with at-risk adults age 25 years or older who are at greater risk of domestic violence and suicide due to COVID-19. The following objectives will be implemented to reach our goal: Objective 1: By November 15, 2020, APIA Healthy Relationships Program will have three public services announcements focused on domestic violence prevention and resources completed and ready for release in Atka, Nikolski, St. George, and Unalaska via public radio and VHF (in communities without radio). We will also post the PSAs on Facebook for a wider audience to raise awareness and promote services during times of social isolation due to COVID-19. Objective 2: By January 30, 2021, APIA will have an app and patient portal with 24-hour access. This will increase resources available to adults who may be isolated due to COVID-19. The app and patient portal will have evidenced based resources such as video clips (e.g., mindfulness exercises), worksheets (CBT and DBT activity sheets), and culturally relevant content (e.g., APIA’s Unangam Tunuu word of the day). National suicide and domestic violence numbers will be on the app and portal along with the state wide AA call in number.

The Central Oklahoma American Indian (AI) Health Center, Inc., doing business as Oklahoma City Indian Clinic (OKCIC) is the nation’s largest urban Indian clinic, with more than 20,000 active patients. The population of focus is AIs age 25+. The geographic focus is central Oklahoma (OK). According to the US Census, nearly 100,000 AIs live in this area. OK has the second-largest concentration of AIs in the nation, with nine percent identifying as AIs (compared to one percent nationally). Like AIs nationally, they face serious challenges, including the highest suicide rate of any race or ethnicity. OKCIC proposes this COVID-19 ERSP project to improve its capacity to help reduce the number of suicides among AI adults in central Oklahoma. This grant funding will allow OKCIC to improve follow-up for AIs being discharged after a suicidal crisis, ensuring they transition immediately into a coordinated care program that is culturally appropriate and based on evidence-based practices. OKCIC will establish protocols for follow-up and care transition to ensure patient safety, especially among high risk adults who have attempted suicide, experienced a suicidal crisis, have a severe mental illness or substance abuse disorder. As a respected medical home model in the central Oklahoma community, with extensive expertise in caring for the AI community, OKCIC will provide training to community and clinical service providers that serve adults at risk of suicide. OKCIC will utilize the skills of a Ph.D.-level health professional to serve as a liaison between OKCIC and community systems to increase collaborations in the community related to suicide prevention. This grant will also allow OKCIC to increase and improve suicide screening, assessment and treatment services within the Clinic, including outpatient services, intensive outpatient services, referral to residential care, group therapy and family services. OKCIC staff will provide community recovery supports to both adults who are at risk for suicide and their household members. Services will be available both onsite at the OKCIC clinic and through expanded telehealth services. A key component of this grant program will be the expansion and enhancement for victims of domestic violence and dependents, including a safe place to stay if needed. OKCIC will also provide patients with an assessment of their eligibility for benefits coverage and provide technical assistance to apply for any coverage for which they may be eligible. All programs will focus on using evidence-based practices and progress will be monitored by both OKCIC leadership and an on-staff epidemiologist as well as oversight of the finances by the Department of Finance. OKCIC has the capacity and experience to successfully manage this grant and measure its impact.

Maryland's Alliance for Suicide Prevention, Intervention, Recovery, and Education (MD-ASPIRE) establishes a network for rapid response to crisis and transition to care, particularly for victims of domestic violence, individuals experiencing unemployment, and adults ages 25 and older who have recently been seen in the emergency department (ED) or impatient psychiatric facility for suicidal ideation or attempt. By assessing suicide risk and connecting at-risk adults to essential services, MD-ASPIRE aims to reduce the incidence of suicide and suicide-related behaviors with a focus on groups heavily impacted by the COVID-19 response. Led by the state Behavioral Health Administration and in partnership with 211 Maryland, United Way of Central Maryland, the Life Crisis Center, the American Association of Suicidology, the Maryland Chapter of the National Alliance on Mental Illness, and the Maryland Department of Labor, MD-ASPIRE will serve 1,000 adults ages 25 and older throughout the state (51.5% White, 30.7% Black, 10.4% Hispanic, and 7.0% Asian). Over the past two years, Maryland's suicide rate has increased. Many of the impacts of COVID-19 - including an unprecedented increase in sudden unemployment, restrictions forcing many victims of domestic violence to shelter in place with abusers, facing a changing behavioral health system as a recent discharge from an EDs and/or inpatient psychiatric facility - amplify existing suicide risk. The goals of MD-ASPIRE are: 1) Establish a caring transitions programs that will rapidly follow up with adults who have been discharged recently from EDs and inpatient psychiatric facilities, assess suicide risk, and connect them to outpatient care, 2) Ensure patient safety by providing caring contacts, continued risk assessment, and connection to behavioral health resources for 9 months after discharge, 3) Provide suicide risk and response training for behavioral health clinicians, 4) Develop screening capacity in sectors that interact with individuals experiencing unemployment, 5) Provide community support services for individuals with mental illness or lived experience of suicide, 6) Expand telehealth and virtual options for case management, training, and support groups , and 7) Connect victims of domestic violence with specialized risk assessment and expanded resources.

NADC in partnership Sunburst Mental Health and Cedar Creek Integrated Health’s project population of focus includes Native American individuals, families, and healthcare practitioners experiencing increased levels of stress, anxiety, depression and trauma associated with mass stay-at-home and quarantine orders due to the COVID-19 pandemic. These conditions, especially in conjunction with higher incidents of domestic violence are primary contributing factors of suicide if left unaddressed. Addressing and mitigating these conditions are the purpose of the project. 2019 Novel Coronavirus (COVID-19) cases in Montana continue to increase. Present numbers of confirmed cases are 332 with 6 deaths in the previous three-weeks, which is of concern with a state that is remote and very sparsely populated. Within the initial three-week shelter at home period, the Montana Suicide Call line received 700 calls, averaging 39 per day. Immediate actions initiated within the state left outpatient mental health and substance use providers ill-equipped to handle shelter in place directives as agencies lacked telemedicine/health capabilities. Montana witnessed a 70% decrease in treatment access within the first seven (7) days of declared emergency. Billings is the largest population center within a 500-mile radius and houses one of the largest hospital networks in the state with Billings Clinic, Riverstone Health and St. Vincent Healthcare. Surrounding communities often seek care through Billings area providers due to the rural expanses of Montana, Wyoming, North Dakota and South Dakota. Immediate actions initiated within the state left outpatient mental health and substance use providers ill-equipped to handle shelter in place directives as agencies lacked telemedicine/health capabilities. Montana witnessed a 70% decrease in treatment access within the first seven (7) days of declared emergency. Emergency COVID-19 funding would permit NADC to shift the disproportionate impacts from lacking telemedicine/health access across our service area. Such an access point would decrease emergency room impacts from mental health crises and emergencies due to shelter in place directives. The overarching goal of this project is to develop a comprehensive, coordinated, and collaborative system of care designed to meet various health care needs associated with the recent impacts of COVID-19 for Native American individuals, families, and healthcare providers seeking care in the Billings area. The project team will coordinate care and provide supportive services through a regional coordination plan designed to ensure good outcomes for clients served during, and beyond, the project period.

First Nations Community HealthSource (FNCH), an Urban Indian Organization and Federally Qualified Health Center, will conduct the Emergency Response for Suicide Project (ERSP) to provide suicide screenings, education, and comprehensive clinical care to a minimum of 500 high-risk individuals at the end of 16 months. The target population will consist of the most vulnerable suicide-risk populations impacted by COVID-19 in the geographic catchment area of Albuquerque, New Mexico. The target population will be low-income, minority, and homeless community adult members that include subpopulations of American Indians and individuals who experience homelessness/precariously housed, victims of domestic violence, lack health insurance or are on Medicaid, live at or below the federal provider's levels and/or are essential service workers. The target population experiences high rates of poverty, unemployment, lack of housing, no health insurance, low levels of education, and a high rate of chronic health conditions. The onset of the COVID-19 pandemic significantly increases their risks for substance use, depression, and suicide. ERSP will offer a full continuum of suicide prevention and clinical treatments ranging from education, suicide screenings, brief intervention, brief treatment, clinical care, rapid follow up from inpatient/emergency facilities, follow up from health/behavioral health programs, and/or linkages to higher levels of care. ERSP will incorporate evidence-based practices including SBIRT, cognitive behavior therapy, EMDR, moral reconation therapy, Medication Assisted Treatment, Seeking Safety, trauma-informed care, and Matrix Model, to name a few. ERSP's goal is to increase FNCH's capacity to reduce/prevent suicide and suicide attempts during the COVID-19 pandemic. Measurable outcomes will be aligned with SAMHSA's GPRA measures and will include the number of individuals served, types of services provided, the number of individuals who received case management services, the number of individuals who experienced improvements in their depression and suicide risks, and the number and outcomes of the suicide trainings provided. ERSP will partner with community collaborators to support community-wide suicide awareness and prevention.

The United Keetoowah Band of the Cherokee Indians in Oklahoma (UKB), a federally recognized American Indian (AI) tribe, seeks to fashion a comprehensive, integrated, and trauma-informed suicide and domestic violence prevention and mental health promotion system to detect, prevent, and provide early intervention services to rural non-reservation American Indians age 25 and older who reside within the area of northeastern Oklahoma served by the tribe. This system shall both expand and enhance the current initiatives to combat CV19 consequences and shall provide the foundation for creating prevention prepared communities, data-driven management, meaningful partnerships, and delivering and sustaining effective, efficient, and culturally appropriate suicide and domestic violence prevention services.

Project Resiliency, led by Community Alliance Rehabilitation Services (CA) will expand community capacity to respond to suicide risk among adults, 25 or older, who have been affected by the COVID-19 pandemic, with special attention to victims of domestic violence, those living with serious mental illness or substance use disorder, and people who have experienced trauma, anxiety, grief, loss or attenuated behavioral health needs as a consequence of COVID-19. CA will strengthen its integrated physical and behavioral health services and partner with the Women’s Center for Advancement (WCA) to increase suicide risk identification, rapid response and access to prevention, treatment, care coordination and recovery services for those at risk for or who have attempted suicide, who are referred by health care, domestic violence or other community partners, or who self-refer. With the Nebraska Chapter of the American Foundation for Suicide Prevention (AFSP-NE), CA and WCA will provide training on suicide prevention and risk assessment for clinicians and general audiences as well as cross training on suicide prevention and domestic violence. The project will serve Nebraska’s Behavioral Health Region 6 which encompasses a 5 county area surrounding metro Omaha, encompasses 40% of the State’s population, and has incurred the largest number of confirmed COVID-19 cases in Nebraska. Grant funding will add the following strategic resources: A full time CA trainer to offer AFSP education and training modules, both virtually and face-to-face, on evidence-based suicide risk identification, rapid response and prevention to more than 420 community health and behavioral health providers and community groups connected to people at risk, including hospital emergency rooms and primary care practices, behavioral health and domestic violence professionals, churches, senior centers, the LGBTQ community, and organizations serving racial, ethnic and linguistic minorities; a full time Licensed Mental Health Professional (LMHP) and full time Care Coordinator to join CA’s Integrated Care Team and provide specialized support for people at heightened suicide risk and/or experiencing domestic violence; a WCA Advocate to provide added support to individuals affected by domestic violence including coordinating legal, financial, and support services vital to affected individuals and, with CAs LMHP, co-leading group therapy for domestic violence victims and community cross training in suicide prevention and domestic violence; and a full-time Project Director to lead the multi-agency effort, engage community stakeholders and oversee the achievement of program objectives and evaluation. Service access and responsiveness is further enhanced through the ability to purchase safe housing for those seeking safety and telephone, tablet and internet resources for client use. Evidence based practices employed include: National Institutes of Health Zero Suicide Framework, Columbia Suicide Severity Rating Scale, Cognitive-Behavioral Therapy, Trauma Informed Care, Motivational Interviewing, Seeking Safety, and the AFSP tools ICAR2E for suicide assessment in hospital emergency rooms, and SafeSide in primary care practices.

The goal of the COVID-19 ERSP project is to create a healthy and empowered community by providing culturally-based, trauma-informed suicide intervention, treatment, and prevention across the Oneida healthcare system as well as the entire community. The objectives are: (1) develop and implement a plan for rapid follow-up of adults and adolescents who have attempted suicide or at high risk for suicide; (2) Establish follow-up and care transition protocols to help ensure patient safety among high risk community members in health or behavioral health care settings who have attempted suicide or experienced a suicidal crisis; (3) Provide, or assure provision of, suicide prevention training to community and clinical service providers and systems serving adults at risk; (4) Work across Tribal community departments and systems to implement comprehensive suicide prevention plan; (5) Provide suicide screening, assessment, referral and appropriate clinical treatment services; (6) Provide community recovery supports to assist individuals and household members who have attempted or are at risk for attempting suicide; (7) Provide telehealth options given the current pandemic situation; and (8) Provide enhanced services for community members experiencing domestic violence and their dependents. The Oneida Nation is a federally-recognized tribe located on a semi-rural reservation outside the city limits of Green Bay in northeastern Wisconsin. The City of Green Bay, WI is located at the Reservations' eastern border and lies diagonally in two counties, as well as several local municipalities. The Native American population living on or near the Oneida Reservation is one of the largest in the state of Wisconsin. As of April 2020, there are 17,386 enrolled Oneida members with 7,927 members living on or near the Oneida reservation. For many Native American communities throughout the United States, including Oneida Nation, suicide is a significant health and social concern. According to the Suicide Prevention Research Center (2013), the suicide rate for Native Americans is much greater than the overall U.S. suicide rate. The 2018 National Center for Health Statistics reported that in Wisconsin, suicide is the eighth leading cause of death among American Indian/Alaskan Natives and the second leading cause of death among individuals between the ages of 10 and 34. The Oneida Nation Comprehensive Health Division is a tribally run organization comprised of Medical, Dental Pharmacy, Behavioral Health, Optical, Employee Health, Public Health, Environment Health, Skilled Nursing Facility and Purchased and Referred Care. Oneida Comprehensive Health employs 343 staff. Oneida Behavioral Health (OBH) data from April 2018 showed that 66% of OBH patients have co-occurring medical issues and seek services at the Oneida Community Health Center (OCHC).

The current national COVID-19 crisis will certainly contribute to the growth in the number of tribal community members needing urgent care to address mental health needs. Tribal citizens will likely experience increases in depression, anxiety, trauma, grief, isolation, substance use, loss of employment, financial instability and other challenges, which can lead to suicide and suicide attempts. The purpose of this program is to support the tribal communities in Michigan during the COVID-19 pandemic in their efforts to prevent suicide and suicide attempts among adults age 25 and older. The Inter-Tribal Council of Michigan, Anishnaabek COVID-19 Emergency Response for Suicide Initiative will provide evidence based and culturally responsive suicide prevention services to American Indians residing in the combined tribal service areas of four Michigan tribes. Over the sixteen-month project period, 200 individuals will receive screening, assessment treatment and rapid follow-up in a suicidal crisis. Given that the stay-at-home and quarantine orders may contribute to a rise in domestic violence, the project will also implement strategies to address the special needs of victims of domestic violence. Clients will be members of federally recognized tribes. Non-native family members and descendants will also be eligible, in a manner consistent with local tribal policy. The project will also support telehealth options and training and technical assistance to enhance the capacity of the collaborating tribal communities to develop, implement and sustain effective culturally responsive local suicide prevention initiatives during the current pandemic and beyond. Funding and Project Period: June 30, 2020 thru October 31, 2021. (16-months)

Through the proposed COVID-19 Emergency Response for Suicide Prevention (ERSP) project, Cook Inlet Tribal Council, Inc. (CITC) will provide behavioral health services and direct assistance, and advance comprehensive community efforts such as training and cross-referral, to address heightened risk for suicide related to impacts of the COVID-19 pandemic. The population to be served include Alaskan adults (age 25 and up) of all genders and ethnicities assessed as at risk for self harm or possible suicide attempts, particularly those who are victims of domestic violence. CITC is a mature, tribally-operated social services agency with an extensive history providing recovery and other behavioral health services to individuals at heightened risk for suicide throughout Alaska’s Cook Inlet region. There is a profound need for the proposed project. Even prior to the appearance of COVID-19, the demand for behavioral services in Alaska far outweighs provider availability and the virus is clarifying – as well as exacerbating – the entrenched disparities in socioeconomic, physical, and behavioral health conditions that influence experiences of suicidality in Alaska. Few people in our communities have escaped the personal impact of self-harm or suicide. State data released in 2019 tells us that Alaska’s suicide rate has been the first or second highest in the nation since 2012. It is the leading cause of death among Alaskans ages 10–64 years, and the sixth leading cause of death overall – compared with tenth in the U.S. as a whole. In 2017, Alaska’s age-adjusted suicide mortality rate was nearly twice the national rate. The rate among AN/AI Alaskans was nearly three times the nation’s, up 19% since 2008. In alignment with SAMHSA’s funding opportunity, CITC will conduct and report on all required activities, including developing or updating rapid follow-up plans and care transition protocols, facilitating suicide prevention trainings for community members and providers, collaborating with regional partners for comprehensive suicide prevention efforts, providing screening, assessment, and treatment referrals, telehealth, and community-based recovery supports, and by offering victims of domestic violence enhanced services and direct assistance with emergent housing, transportation, and other safety needs.

The COVID-19 Pandemic has caused increased stress and anxiety on the residents of the Yukon Kuskokwim (Y-K) Delta in southwest Alaska. With over 85% of our residents Alaska Native it is critical our suicide prevention and behavioral health programs provide culturally responsive services to the population. Combining our traditional Yup’ik Eskimo wellness program, Calricaraq, and our western-based behavioral health (BH) clinical services, we are able to respond to BH emergencies and provide follow up treatment services that connect with our clients, meeting them where they are culturally and emotionally. The Y-K Delta region in southwest Alaska is home to 58 Federally recognized Tribal communities, more than 10% of the 566 Federally recognized Tribes in the entire United States. Our region is in a very rural setting where no road system exists, and air travel is the standard method of transportation. At 75,000 square miles in size, our region’s land area is larger than Oklahoma, the 19th largest state, and our 27,000 residents, in which almost every community is over 90% Alaska Native, makes this region one of the highest concentrations of indigenous Native Americans in Alaska or the Lower 48 states. For the purposes of this proposal the population of focus to be served are individuals 25 years of age and older who are at risk for suicide and suicide ideation. During the increased stress, anxiety and depression associated with the COVID-19 Pandemic, these individuals are at increased risk for suicide. In addition, individuals without previous BH diagnoses experiencing acute stress and anxiety as a result of the Pandemic are also at risk, and this project will also target these individuals. Through the COVID-19 ERSP Project our goals and objectives remain much the same as the standard of care we provide to our clients. This includes a milieu of traditional Indigenous wellness services through our Calricaraq Program in partnership with our western clinical treatment methods. Clients have a choice to utilize one or the other, or both, and services may include such modalities as motivational interviewing and family systems therapy. Measurable objectives include tracking BH Emergency Services (ES) admissions, monitoring utilization of BH treatment services for those diagnosed with depression and anxiety and patient satisfaction as a result of these life-saving services. We anticipate at minimum we will serve 150 clients. The greatest risk we are currently facing, however, is the inability to pay for these services. During this Pandemic our 3rd party/Medicaid revenue has decreased by 90% over the past 3 months. This has put our BH ES department at risk for layoffs and furloughs resulting in a decrease in available services for suicide prevention. The funding provided by the COVID-19 ERSP program will ensure our BH ES department will remain funded and able to continue to provide these life-saving services so important to our families and communities who continue to suffer greatly from the effects of suicide.

The County of San Luis Obispo Behavioral Health Department (SLOBHD) will use SAMHSA’s 2020 COVID-19 Emergency Response for Suicide Prevention grant funds primarily to support direct services for adults 25 years and older impacted by suicide crisis in the behavioral health system, veterans community, and those affected by domestic violence.. The project will center on the establishment of a Suicide Triage and Response Team (START). Activities will include enhanced system improvements to rapidly follow-up with adults who have attempted suicide or experienced a suicidal crisis, expanded training to establish follow-up and care transition protocols, improve screening, assessment, and treatment protocols across the behavioral health system, enhance wellness and recovery supports, and provide enhanced services for victims of domestic violence and their dependents. In response to the COVID-19 emergency, all project activities will utilize telehealth capacity when possible, distancing requirements, and all safety standards to protect patients and providers.