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The proposed FRUITION System of Care will serve 7 rural underserved Northeastern Mississippi counties (Benton, Chickasaw, Itawamba, Lee, Monroe, Pontotoc and Union) to support the implementation, expansion, and integration of the SOC approach by creating sustainable infrastructure and services. The SOC will improve mental health outcomes for children and youth, birth through age 21, children and youth with serious emotional disturbance and those with early signs and symptoms of serious mental illness, including first episode psychosis and their families by focusing on mental health and related recovery support services, sustainable financing, cross-agency collaboration, EBPs: TF-CBT; Wraparound; Youth-Guided/Family Driven-Peer/Family Supports; FEP; Person Centered Planning; Active Parenting; First Episode of Psychosis: Mental Health First Aid; Youth Mental Health First Aid; QPR; ASIST; Safe Zone-LGBTQ; and enhanced policy and infrastructure with youth-guided and family driven leadership. Project Name: FRUITION System of Care. Populations served: Birth to 21 age; 45% African American; 1% Hispanic; 2% Multi-racial; 1% Native American; 1% Asian and 1% LGBTQ; 85% at, or below poverty level; 10% between (0-5); 90% 6-21 age; 50% child welfare involved. Strategies: FRUITION System of Care seeks to expand trauma-informed, cultural and linguistically appropriate EBPs, supports and policies with a cross-agency approach of coordinated service delivery and integration of mental health services, ensuring effective cross-agency expansion and the provision of mental health and related recovery support services to participants with SED and those with early signs of SMI, including FEP to include an array of non-mental health supports, i.e. vocational counseling, afterschool programming, health-related services, substance abuse prevention, stable housing, independent living skills and advocacy. Each participant will work with a care team that facilitates the identification and implementation of an individualized service plan in partnership with the child/youth, family, natural supports and professional supports to achieve their personal goals. FRUITION System of Care will develop a cross-agency infrastructure through an integrated system of care and ensure national and local evaluation and performance assessments are conducted. Goals: 1) Expand Region 3 Mental Health cross-agency collaboration to serve SED individuals and those with early signs and symptoms of SMI, including FEP; 2) Provide a broad array of accessible and coordinated services/supports; 3) Ensure individualized, managed care; Plan, deliver, and evaluate these services with the full participation of families and youth in a culturally and linguistically sensitive manner; and 4) Facilitate broad-based, sustainable systemic support for the population of focus. Objectives: Annually and over 4-years: 1) 80% of participants will improve diagnosis; 2) 80% of participants improved mental illness symptomatology; 3) 80% of participants will improve employment/education; 4) 80% of participants will reduce criminal justice involvement; 5) 80% of participants will improve stability in housing; 6) 80% of participants will reduce readmission to psychiatric hospitals; 7) 80% of participants will improve social support/social connectedness; and 8) 85% of participants will report a high client perception of care. # served: 100 in Year(s) 1-4, totaling 400 in 4 years.

The MHAASA of Puerto Rico (PR) will implement a System of Care Expansion and Sustainability Grant (SOC-ESG) Project to provide comprehensive mental health (MH) services dor children and youth. from birth through age 21, with SED and their families, and promote infrastructure development to ensure sustainable policies, legislation, financing and the integration of quality evidence-based practices in public and private service systems. The targeted areas will be local jurisdictions of Yauco in the Southern Region and Manati in the Northern MH services for children/youth. Emotional trauma in children increased recently due to severe damages from severe and continuing earthquakes impacting primarily Southern PR. The SOC-ESG will implement Required Activities to achieve the goals and objectives, including outpatient and intensive day treatment, offered in clinic in Yauco, supplemented by home visits, including to foster homes and group homes of children in protective care. Over a 4-year grant period, 350 children/youth with SED or symptoms of SMI and their families will be served. Individual, group and family counseling, with professional consultation and review and management of medications will be offered by a multi-disciplinary staff trained on the SOC and Wraparound EBP's. Arrangements will permit 24-hour/7-day a week emergency services through MHAASA's children's residential MH programs and collaborating partners, as well as intensive home-based services when the child is at imminent risk of out of home placement. The MHAASA has commitments of collaboration from the Special Education Program; Juvenile Justice System and Family Department Protective services, Foster Care and Independent Living Programs for referrals and for assisting youth in transition to MH services as adult. Collaboration through the PUEDO Project will permit other support (vocational education and employment skill development and placement) for youth with early onset of SED/SMI. The intensive wraparound strategies of the SOC-ESG will ensure services and supports sustain family participation, including peer support activities. A Governance Structure Board will be created for decision-making at the policy level, with authority and accountability for the SOC-ESG Project in both local jurisdictions, and multiple partnering agency, and family representation. To ensure that the project is sustainable, adoption by the Health Insurance Administration ("ASES" in Spanish) for treat Medicaid/CHIP eligible children, youth and families will be promoted. Using lessons learned form the pervious projects, the PR SOC-ESG will expand evidence based MH services in the Northern and Southern Regions of PR, and improve MH infrastructures through a Project Governance Body (composed by the project key staff, youth and family members) and two Interagency/Community Committees (ICC), comprised of child serving agencies in the local jurisdictions. One million per year is requested.

Region 6 Behavioral Healthcare proposes to expand and enhance services in the rural Nebraska counties of Cass and Washington, with special focus on school-based mental health services in eight school districts that serve 7,578 birth-21 children/youth. Region 6 System of Care proposes a hybrid approach of infrastructure development and delivery of services to ultimately connect 450 children/youth (birth-21) with severe emotional disturbances (SED) and their families to mental health services (75 in Y1 and 125/year thereafter). The proposal features a school-based single point of access for mental health services for the children/youth with SED and their families. Two districts within this rural geographic catchment have over 40% of students eligible for Free and Reduced Lunch. The area is experiencing a shortage of mental health professionals, fragmented services, and challenging 50-mile drives to services in urban Omaha. Once infrastructure has been established to increase capacity for population access and service use, activities will focus on connecting the population to services/interventions through early identification, so access and use can occur in the least restrictive, most normative environments that are clinically appropriate. Licensed personnel will screen 90% of the geographic catchment's school-age children and refer 100% of those identified through screening to appropriate Multi-Tiered System of Support tiers or community-based services. Continuous accountability and assessment activities will not only ensure sustainability of service integration, but also strengthen the cross-system infrastructure. Capacity for improved mental health outcomes is further boosted via a cadre of 8 Parent Mentors matched with 145 families with children facing SED challenges. In addition, 400 teachers, school personnel/administration, families and other stakeholders will participate in training on evidence-based practices and/or awareness regarding children's behavioral health. Workforce capacity for mental health services will be increased by integrating at least 6 post-doctoral fellows into the rural schools.

The Standing Rock Sioux Tribe (SRST) through their Tribal Substance Abuse Treatment Program, the Wellness Program and the Child Protective Services (CPS) proposes the Systems of Care (SOC) project to improve the mental health outcomes for children and youth, birth through 21 years, with Serious Emotional Disturbances (SED), and their families/primary caregivers, residing on the Standing Rock Indian Reservation, North Dakota by bolstering the current infrastructure to assure tribal-wide access to evidence based assessment, treatment modalities and recovery services. The goals of the SOC project include strengthening program services capacity by hiring the lead family coordinator, parent aides, case managers, licensed supervisory social workers, business manager, and project evaluator; strengthening the capacity of SRST treatment program and tribal systems to increase utilization of culturally relevant evidence-based programs for providing clinical services and supports to address SED; increasing collaborations among Tribal and non-Tribal agencies to increase early access to behavioral health care; preventing the initiation and progression of youth substance abuse (including tobacco use) in the community by implementing promotion and prevention strategies with school age youth in educational settings; and promoting family and community support for individuals with behavioral health issues and their families. To achieve these goals the project team will increase staff capacity through new hires; develop a systematic network of communication channels for improved coordination of care for clients by creating a well written and agreed upon plan between partner agencies and family members; develop guidelines for integration of information technology functions in the behavioral health workflow; develop a High Fidelity Wraparound team; utilize online assessments to increase client reach; compile/revise existing policies and procedures for behavioral health; improve patient tracking systems among providers both on and outside the reservation by improving integrated data capturing capabilities; partner with the North and South Dakota DHS; partner with Sitting Bull College School of Social work to recruit local interns; plan and organize culturally relevant and cross-cultural training of primary care, behavioral health providers, and all departments of Indian Health Service (IHS) serving Standing Rock Tribal members; implement substance use prevention education within the tribal school systems; and promote healthy lifestyle choices, positive communication, personal success and cultural involvement to support strong family relationships. The project is slated to serve fifty unduplicated youth and their families in the first year, and an additional one hundred in each subsequent year for a total of 350 over the life of the project. Additionally, we hope to reach the reservation population of 8,612 through community education and media messages.