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Promoting the Integration of Primary Behavioral Health Care The Indiana Department of Health (IDOH) proposes to serve 1,000 people annually and 5,000 individuals for the life of the program including 1) adults with a serious mental illness (SMI); 2) adults who have co-occurring mental illness and physical health conditions or chronic disease; 3) children and adolescents with a serious emotional disturbance (SED) who have a co-occurring physical health conditions or chronic disease, and 4) individuals with a substance use disorder (SUD) through three Federally Qualified Health Centers (FQHCs). Partners include Community HealthNet (CHN), HealthLinc, and Valley Professionals Community Health Center (VPCHC). CHN will implement the program in 4 clinics in Lake County. HealthLinc will implement the program in each of its 16 locations in Starke, St. Joseph, Porter, LaPorte, and Lake counties. VPCHC will implement the program in 10 clinics in Parke, Vermillion, and Vigo counties. The FQHCs serve both metropolitan and rural communities. Most of Indiana’s mental health patients find care at the community level as reflected in the Indiana 2020 Mental Health National Outcomes Measures: SAMHSA Uniform Reporting System, stating there were 137,963 Seriously Mentally Ill (SMI) adults and Children with Serious Emotional Disturbance (SED) served by community healthcare providers rather than in state hospitals. About 28.7% of the adults and 2.5% of children were seen in community settings who received services for co-occurring mental illness and substance abuse. This supports a strategy to expand community based mental health care in facilities like FQHCs that already exist and can provide health services integratedly. Indiana’s Behavioral Health Commission’s 2023 report states, “Primary care providers play a critical role in the overall health and well-being of individuals: Their role as first contact providers of comprehensive and continuous care makes them well-suited to treat any mental illness; they are well-trained to address mental health needs and currently provide the largest proportion of mental health care in the United States; primary care is accessible to all patients regardless of geography or ability to pay; in contrast with mental health specialists who practice mostly in urban areas, primary care physicians practice in urban and rural areas, and are more likely to take all types of insurance; primary care professionals are the major providers of care in safety-net settings and see patients of all ages, making them the first contact for patients in all demographics with mental illness.” Mental Health America’s 2022 report The State of Mental Health in America, underscores the need for increased community level access with the finding that Indiana ranks 43rd in the nation according to the prevalence of mental illness with access to care. States that are ranked 39-51 indicate that adults have higher prevalence of mental illness and lower rates of access to care. Indiana ranks 26th regarding youth prevalence and access. As access expands, an additional goal with this proposal is to provide services that will enable FQHCs to become Certified Community Behavioral Health Centers.

The Kentucky Cabinet for Health and Family Services, Department for Behavioral Health/Developmental and Intellectual Disabilities (DBHDID) will implement Kentucky Integrated Care (KIC), promoting bidirectional primary and behavioral health care integration via collaborative clinical practice, improved care models, and a comprehensive service continuum for focus populations who have physical health conditions or have/risk developing chronic diseases, including adults (18+) with mental illness, Serious Mental Illness (SMI), Substance Use Disorder (SUD), or Cooccurring Disorder (COD). Partnering Community Mental Health Centers (CMHCs) will include LifeSkills Inc. (Warren) and Pennyroyal Center (Christian). Federally Qualified Health Centers (FQHCs) will include Fairview Community Health (FCH, Warren) and Community Medical Center (CMC, Christian). Sub focus populations include women, minoritized populations including Blacks and refugees/immigrants, and military-connected individuals. Physical health conditions that will be prioritized include obesity, diabetes, hypertension, hyperlipidemia, sexually transmitted diseases, viral hepatitis, and nicotine dependence. Mental Health and physical health are interrelated and untreated mental illness can result in severe emotional, behavioral, and physical health problems (Mayo Clinic, 2015). Adults with mental illness die on average 10 years and adults with SMI, 15-25 years earlier than the general population, largely due to treatable/ preventable health conditions (e.g., cardiovascular, pulmonary, infectious diseases) (Insel, 2015; De Hert, et al., 2011; Parks, et al., 2006). Up to 68% of adults with a mental illness have one or more treatable/preventable chronic physical conditions (SAMHSA, 2014).The KCI initiative will utilize the Comprehensive Healthcare Integration Framework (CHIF) for the bidirectional integration of primary health care services in the behavioral health setting, and behavioral health care services in the primary care setting, in two Kentucky Counties (Christian and Warren). Efforts will prioritize a continuum of care for those with mental illness, SMI, SUD, or COD who have a physical health condition or have a risk of developing chronic diseases. KCI will provide co-located, integrated services, including evidence-based screening/assessment, diagnosis, prevention, and treatment according to a shared, individualized care plan, as well as outreach, engagement, and retention strategies. Total number of people to be served across the project is 450.

The applicant for this funding opportunity is the American Samoa Department of Health (ASDOH). ASDOH is the territory’s sole public health agency delivering programs and services that promote, protect, and address the public’s health and wellness. ASDOH also oversees the territory’s Community Health Centers (CHC) and was recently designated the Single State Authority (SSA) for substance abuse and mental health. Through this funding opportunity, ASDOH will focus on the following special populations: • Adults with a SMI • Adults who have co-occurring mental illness and physical health conditions or chronic disease • Children and adolescents with a SED who have a co-occurring physical health conditions or chronic disease; • Individuals with a SUD The integration of behavioral health care and primary care is currently not a standard of care across the territory’s healthcare delivery system. ASDOH proposes to utilize this funding opportunity to promote, develop and implement the integration of physical and behavioral health care in the American Samoa Community Health Centers and across the community. The project’s implementation plan will address the healthcare needs of the focus population through four (4) main goals: 1. Increase systematic and clinical capacity to implement evidence-based integration practices 2. Increase patient motivation and access to care through integrated screening, referral to care and follow-up practices 3. Decrease physical and behavioral health risks through preventative screening and health education 4. Enhance bi-directional care coordination and partnerships between ASDOH and community partners.

The New York State Office of Mental Health (NYS OMH) has led the nation in adoption and scale of the Psychiatric Collaborative Care Model (CoCM) and seeks to build on that success by expanding the number of youth-serving primary care practices participating in the program to address the youth mental health crisis and advance health equity. This initiative will address mental and behavioral health problems among children and adolescents with co-occurring Serious Emotional Disturbance (SED) and physical health conditions or chronic disease, such as depression, anxiety, ADHD, substance use disorders, and suicidal thoughts and behaviors, by providing integrated behavioral health services. An explicit goal of the project is to ensure equitable access of services to populations who have historically lacked access, including BIPOC, LGBTQ+, and rural youth. This project will be implemented statewide in New York, the fourth most populous state in the country. Participating providers will represent the diversity of NYS, including both urban and rural primary care settings, large public hospital clinics, and small private practices serving over 3500 youth across 15 sites. The hallmarks of the NYS CoCM implementation approach are 1) extensive technical assistance and support for participating practices and 2) robust process and outcomes metrics to ensure delivery of care that makes a difference in the lives of youth and their families. In addition to technical assistance and support for the adoption of CoCM, participating practices will also receive training in suicide prevention best practices. A significant portion of award funds will be aimed at overcoming workforce shortages, an identified barrier, and supporting development of a sustainable model by the end of the five-year project.

The Minnesota Department of Human Services Health Care Administration, in collaboration with the Behavioral Health Division, the Minnesota Department of Health, and Hennepin Healthcare, proposes to implement the Collaborative Care Model to expand and improve the quality of mental health and substance use disorder care in the primary care setting. Our shared interagency vision for the Substance Abuse and Mental Health Services Administration’s FY 2023 Promoting the Integration of Primary and Behavioral Health Care funding opportunity includes three goals. 1. Enhance and optimize the delivery of behavioral health services within the primary care setting. 2. Employ workforce shortage mitigation strategies to reduce the bottleneck found within behavioral health service delivery systems in Minnesota. 3. Reduce health disparities in access to quality behavioral health care services while providing recovery-oriented and trauma-informed care. As a result of the pandemic, the need for mental health services is greater than ever and the mental health workforce is in short supply. Because of these challenges, mental health-related concerns represent an increasing share of primary care visits. However, mental health outcomes in primary care are suboptimal because of barriers including inadequate mental health provider networks, a shortage of mental health providers accepting new patients, stigma, and lack of team support in primary care. The Collaborative Care Model creates a person-centered experience for individuals and families with depression, anxiety, and co-occurring physical health and substance use disorders in the primary care setting. Collaborative Care is an evidence-based model that addresses the challenges intensified by the pandemic and closes the mental health service gap by creating access to high-quality mental health and substance use services in a familiar and convenient primary care setting. The model breaks down silos between physical and behavioral healthcare, a model that all partners of this proposal are strongly committed to implementing and expanding across Minnesota. Racially and ethnically diverse populations with low-income and high levels of co-occurring mental illness and substance use disorders will be served including adolescents, patients with opioid use disorder, patients who identify as transgender, adults, and Spanish-speaking children and families. As a result of Collaborative Care, our objectives include: • 20% increase in screening rates for depression and anxiety in primary care • 4 or more points of improvement as measured by PHQ-9 at 12 months • 3 or more points of improvement as measured by the GAD-7 at 12 months • 60% or more of patients with an identified need will be referred to services and followed-up on by the behavioral health manager • 100% of enrolled patients in Collaborative Care will receive screening to determine if they meet the criteria for a special population prior to enrollment • At least 40% of enrollees will identify as Black, Indigenous, or People of Color? • At least 50% or more of enrollees will have comorbid physical health or substance use disorders Number of Unduplicated Individuals to be Served with Award Funds Year 1- 50 Year 2- 100 Year 3- 125 Year 4- 125 Year 5- 100 Total- 500 ?

The PIPBHC project in Louisiana aims to enhance integrated health care for adults with co-occurring mental and physical health disorders, serious mental illness (SMI), and substance use disorder (SUD). It focuses on marginalized populations, providing innovative solutions to reduce health disparities and improve health outcomes. PIPBHC is an ambitious initiative that aims to foster comprehensive health care delivery to the diverse population of Louisiana. Collaborating with four health organizations across the state, PIPBHC's primary mission is to bridge the gap between behavioral health care and primary physical health care. Our target populations comprise adults suffering from co-occurring mental illness and chronic disease, adults with SMI, and individuals with SUD. Special focus will be placed on five sub-populations: active-duty military service members, returning veterans, and military families; LGBTQI individuals; perinatal women; individuals with opioid use disorder, including those receiving Medication-Assisted Treatment; and severely mentally ill adults who may benefit from Assertive Community Treatment. These comprehensive care services will be deployed in clinics located in diverse geographic areas of Louisiana, namely New Orleans, Baton Rouge, and Bastrop, ensuring coverage of urban and rural residents. PIPBHC's primary goals are centered around reducing health disparities and fostering better health outcomes through the delivery of integrated care. Our six main project goals are: 1. Establish dedicated support for military families and veterans, aiding 20% more individuals by the end of year two. 2. By year one, launch an outreach program to boost health service utilization by 20% for the LGBTQ+ community. 3. By year two, raise prenatal and postnatal service utilization by 30% for perinatal women with SUD. 4. Increase patient engagement in ACT services by 10% in two years, 30%. 5. Lower the rate of opioid-related emergency department visits by 30%. 6. Increase healthcare professionals trained in integrated care by 50%. The PIPBHC project is more than just a healthcare initiative; it's our commitment to reducing health disparities and promoting a healthier future for the diverse population of Louisiana. We believe that by tackling health disparities, promoting access, and improving health outcomes, PIPBHC represents a substantial step towards a more integrated, effective, and equitable healthcare system in our state.

The Puerto Rico MHAASA will implement a PR-PIPBHC 2023 Project for 2024-2028 for the Metro, Northeastern, Central Eastern, Eastern and Western Health Regions in areas classified as HPSA to improve PC/BH levels in 5 subrecipient CMHCs, addressing needs of SMI or co-occurring SUD patients. Goals are 1. Accelerate integrated PC/BH in 5 CMHC's to increase access to treatment/recovery of patients; 2. Strengthen CMHCs' infrastructure to support full PC/BH integration; 3. Achieve documented improvements in PC and BH indicators of SMI/SUD adults; and 4. Demonstrate improvements in dimensions of Wellness through use of WSM+ EBP. A total of 834 unique Hispanic clients are to be served over a 5 year grant period. Objectives are directed to increasing levels of PC/BH integration in all 5 CMHS. An integrated care steering committee with persons with lived experience will exercise project leadership. A 2016 PR needs assessment showed 18.7% of adults in PR meeting criteria for SMI, with an estimated increase due to repeated natural disasters in recent years. The population of focus will be that of municipalities of the Salud San Juan (San Juan), HealthproMed (Guaynabo/Cataño, Vieques, Culebra), CSILO (Rio Grande, Ceiba), NeoMed (Gurabo, Juncos, Naguabo) and Costa Salud (Rincon, Moca, Aguada). Required integrated services will be implemented in CMHCs, including physical, MH, SU, including ATOD with SBIRT tools, dental, nutritional, and other screenings; development of plans for integrated services leadership and sustainability; training and technical assistance for workforce on SBIRT, WSM+, and MI EBPs; and policy and procedural modifications to CMHCs' clinical and administrative infrastructure to support integrated care, all considering CLAS for Hispanic environment. Central and key staff includes PD, Administrative Coordinator, Clinical Coordinator, Lead Evaluator and Finance Technician. Data collection and performance measurement at subrecipient level will be done at baseline, 6-month post baseline and discharge, and includes submission in SPARS, GPRA and other SAMHSA formats for CQI, with MHAASA support from Office of Federal Funds and Planning, Training, Finance, and IT units.

The FY 2023 PIPBHC opportunity from the Substance Abuse and Mental Health Services Administration (SAMHSA) will target funding to strengthen collaborative care model (CoCM) infrastructure in primary care practices across Maryland. PIPBHC will allow the Maryland Department of Health (MDH) to implement a grants-based infrastructure development program focused on staff training, workflow and policy development, and patient registry or integration of a patient registry into an electronic health record (EHR) system. To foster payer alignment, MDH will set Medicaid CoCM rates to equal Medicare and will mandate that practices implementing CoCM in Maryland comply with the SAMHSA reporting requirements. Populations to be Served MDH will use the funding to issue grants to primary care practices and providers to ensure access to collaborative care model services beginning October 1, 2023. The Maryland Primary Care Program (MDPCP), a tenet of Maryland’s Total Cost of Care Model, works with 538 providers, 121 of which already offer CoCM services to Medicare participants. Medicaid and Medicare participants with a mild or moderate depression, anxiety, or substance use disorder (SUD) diagnosis, including individuals with co-occurring diagnoses, will be the primary population of focus for services. Strategies and Interventions MDH will target primary care providers who either already offer or are interested in delivering CoCM services through a patient-centered, evidence-based approach for integrating physical and behavioral health services in primary care settings that includes: (1) care coordination and management; (2) systematic monitoring and treatment using a validated clinical rating scale; and (3) regular psychiatric caseload reviews and consultation for patients who do not show clinical improvement. Project Goals and Measurable Objectives MDH aims to improve health outcomes by expanding access to integrated care models and increase capacity for data collection across the state by: - Providing grants to up to eighteen practices annually for the next five years for staff training and infrastructure development to implement CoCM models; - Enabling all grantees to operationalize EHRs to optimize data collection for a minimum of 1,000 CoCM participants a year; - Working with CRISP to develop necessary data reporting tools and at least one dashboard for participating providers by the end of year 1 of the grant; and - Building internal capacity to evaluate implementation by adding one contractual position to serve as a data lead under the supervision of the evaluator. MDH anticipates using $1.8 million per year to provide grants to up to 18 practices annually. Within those grants MDH will work with providers to ensure that they spend no more than 20 percent on IT systems and infrastructure. The remaining 80 percent will be used for workforce development, including hiring staff and training. MDH estimates that these grants will facilitate Medicaid providers serving participants across the five-year grant period.

Florida Pediatric Behavioral Health Collaborative The Florida Pediatric Behavioral Health Collaborative increases child/adolescent access to behavioral/mental health services by integrating these services into pediatric primary care. This project transforms the knowledge, skills, and ability of providers to better screen, identify, treat, and refer children with behavioral/mental health needs. It addresses critical geographic gaps in care through skills training and the Collaborative Care Model (CoCM) in target counties. With six existing CoCMs, known as behavioral health hubs (BH-HUBS), we propose to add two BH-HUBS to serve in Palm Beach and Duval counties, and their surrounding catchment. Palm Beach has 281,000 children. Population estimates indicate 50,000 have a mental health (MH) condition, and 28,200 a Serious Emotional Disturbance (SED). The school district’s minority enrollment is 70%, and 47% are poor. Palm Beach has 315 pediatricians, and a severe shortage of child and adolescent psychiatrists (CAPs). Duval has 225,343 children. With 273 pediatricians to serve the area, and a severe shortage of CAPs, for 52,000 children with a MH diagnosis, and 30,000 with an SED. Duval’s school district’s minority enrollment is 70%, and 40% are poor. Alarming is Duval’s Health Zone One data with the highest minority percentage >83%, lowest incomes, highest population density, highest rates of ER visits with intentional injuries, and highest suicides. Strategies: BH-HUBS partner with pediatric primary care providers (PCPs) to conduct program readiness reviews and provide evidence-based skill-building training to PCPs to augment their ability to screen, identify, treat, and refer children with mental health (MH) needs. The BH-HUBSs provide access to care coordination, case consultation with CAPs, and utilize patient registries to document status and outcomes. Quality improvement activities are facilitated through a learning action network, utilizing small tests of change with the plan, do, study, act to then scale up accordingly. Fiscal sustainability is being explored through partnerships with Medicaid and its Managed Medical Assistance plans and the Patient Centered Medical Home (PCMH) BH accreditation model. Project Goals include: 1) Augment PCPs ability to provide integrative BH services through skills training and the CoCM. 2) Improve outcomes in child and adolescent psychosocial functioning, through the provision of integrated BH in the pediatric primary care setting. 3) Address sustainability of integrated BH services in the primary care setting, including adequate reimbursement and payment methodologies. Objectives: By September 2028, 90% of participating PCPs will report advanced skill in providing integrated BH services; 100% of children/adolescents served will be screened with a validated MH or substance use screening tool; 90% of children/adolescents that screen positive for a MH concern receive referral services; 75% of children/adolescents that screen positive for a MH concern receive treatment from PCP or MH provider. Unduplicated Children and Adolescents to be Served: Year 1: 1,000; Year 2: 1,200; Year 3: 1,440; Year 4: 1,728; Year 5: 2,074; Total: 7,442

The Connecticut Department of Mental Health and Addiction Services (DMHAS), in partnership with primary care and behavioral health treatment providers in two Connecticut communities with large populations of underserved adults with co-morbid behavioral health and medical conditions, proposes to continue Promoting Integrated Care in Connecticut (PIC-CT) to fill major gaps both in the integration of behavioral health into primary care as well as the integration of primary care into behavioral health. We plan to engage 1500 individuals over the course of the 5-year grant period into primary care, behavioral health care including medication assisted treatment, care coordination including nurse care management, and peer health navigation services for health promotion, referrals and support. Connecticut has considerable momentum to implement this project. We were recipients of PIPBHC funding in 2018 and utilized it to create PIC-CT, a program that has greatly improved the lives of individuals in three of our largest cities. For over eight years we have implemented and sustained the Behavioral Health Home model, authorized under Section 2703 of the Patient Protection and Affordable Care Act. This model served individuals with serious mental illness (SMI) and co-occurring disorders who have Medicaid and spend in excess of $10,000 in a calendar year, typically as a result of chronic, co-morbid medical conditions. The core services articulated in SAMHSA's NOFO perfectly align with Connecticut's CMS-approved State Plan Amendment for Health Homes. Lessons learned from BHH implementation will frame out best practices for this project. Two urban areas have been identified that have high rates of individuals who have high Medicaid spend, a behavioral health diagnosis, and are currently not being served by an integrated model of care: Bridgeport and Waterbury. Finally, the Commissioner of the Department of Mental Health and Addiction Services has made integrated care a central focus of the Department with regular conferences, trainings, and webinars dedicated to this critical issue. The overarching goal of the project is to increase access to integrated care for individuals with substance use, mental health, and/or co-occurring disorders with a special focus on increasing health literacy, promoting health behavior change, and increasing access to medication-assisted treatment. We will accomplish these goals by: 1) improving integrated care; 2) implementing evidence-based practices in the context of integrated primary and behavioral health care; and 3) improving overall wellness and physical health status for individuals. Through this project, we anticipate incremental improvement in health outcome indicators, co-occurring mental health and substance use disorders, including tobacco use. This measurement will contribute to an improvement in the overall health of people with SMIs and substance use disorders by addressing the basic risk factors related to high morbidity and mortality rates of individuals with SMIs and substance use disorders. In addition, patients will have increased immediate access to care, reduction of health disparities, and increased services linkage through care coordination.

Rhode Island experiences high rates of mental illness and substance use among underserved populations. The focus of the project “Primary and Behavioral Health Care Integration: Expanding Access for Underserved Communities” is to implement integrated care services for the lesbian, gay, bisexual, transgender and queer (LGBTQ+) community with a focus on individuals who identify as Hispanic/Latinx and other underserved populations (i.e., those who experience unstable housing). Specific populations will include adults with serious mental illness (SMI), adults who have a co-occurring mental illness and physical health condition or chronic disease, individuals with a substance use disorder (SUD), and individuals with co-occurring disorders (COD). The overall goal of the proposed program is to implement bidirectional integrated care services, including evidence-based screening, assessment, diagnosis, prevention, treatment, and recovery services for mental health and substance use disorders, and co-occurring physical health conditions and chronic diseases such as HIV, sexually transmitted infections (STIs), and chronic hepatitis C virus (HCV) infection. The proposed project will aim to develop culturally congruent approaches to providing these comprehensive services for the LGBTQ+ community in Providence, Rhode Island, the epicenter of mental illness, substance use, HIV and other chronic diseases in the state. At the present time, there are no integrated programs for mental health, substance use, and primary care for the LGBTQ+ community in Rhode Island. In response to this unmet need and to address disparities among LGBTQ+, Hispanic/Latinx, and unstably housed individuals, the Rhode Island Department of Health (RIDOH) is partnering with Rhode Island Public Health Institute (RIPHI), Open Door Health (the only community-based LGBTQ+ clinic in the state), The Providence Center (the main and largest community-based behavioral health center in Providence) and The Miriam Hospital, a major Brown University affiliate. The goals of the project include providing clinic- and community-based health screenings for LGBTQ+, Hispanic/Latinx, and other underserved communities (Goal 1), providing comprehensive community-based mental health and substance use services for LGBTQ+, Hispanic/Latinx, and other underserved communities (Goal 2), and providing community-based primary care and other specialty care for LGBTQ+, Hispanic/Latinx, and other underserved communities (Goal 3). We aim to screen over 1,000+ unique individuals annually (5,000+ total during the project) and enroll approximately 125 at-risk individuals annually (625 total during the project).

The need for integrated care for pediatric patients in Washington state arises from the recognition that children have unique healthcare needs that require comprehensive and coordinated services. The integrated care program seeks to enhance the overall well-being and physical health of children and adolescents with serious emotional disturbances and co-occurring physical health conditions in eastern Washington State. By fostering integration and collaboration between primary healthcare and behavioral healthcare, implementing evidence-based practices, and improving care coordination, the program aims to provide comprehensive and coordinated care to this specific population. The project strives to achieve sustainable system improvements, expand integrated care services, and enhance health outcomes for children and adolescents in need. The program targets children and adolescents, ages 0-25, residing in six counties in eastern Washington State, specifically in and around Spokane, WA. The focus is on individuals with serious emotional disturbances (SED) and co-occurring physical health conditions or chronic diseases. The program's strategies and interventions include promoting integration and collaboration, between primary healthcare and behavioral healthcare, implementing evidence-based practices in treatment plans, providing culturally responsive services, enhancing care coordination, and reinforce our interventions with infrastructure approaches that support new value-based payment pathways. The number of people to be served annually: 300 individuals in the first year, gradually increasing to 1500 individuals in the fifth year. Over the lifetime of the project, approximately 4,400 individuals will benefit from the program. Project Goals: • Improve the overall wellness and physical health status of children and adolescents with SED and co-occurring physical health conditions. • Create sustainable system improvements to support an integrated model of care. • Increase the offering of integrated care services for mental and substance use disorders, as well as co-occurring physical health conditions and chronic diseases. • Create sustainable culture and administrative advancements to organizational infrastructure to support integrated care. A Sample of our Measurable Objectives include: • Increase the percentage of children and adolescents receiving evidence-based practices in their treatment plans from 17% to 54%. • Reduce the number of ED/ER visits and hospitalizations by 15% each year. • Reduce the prevalence of depression among teens from 38.3% to a lower rate. • Enhance referral facilitation by 20% per year to co-located BH/PC office • Implement electronic data sharing and accountability practices for engagement of all providers and patients. • Increase the number of children and youth with SED and co-occurring physical health conditions served by this program in the first year by 20% • Reduce or mitigate general health risk factors by 10% per year • Improve access to care for racially and ethnically underserved communities and LGBTQIA+ youth and adults.

In this Program track 2 proposal, the state of Arkansas will partner with the University of Arkansas for Medical Sciences (15 clinics) and two federally qualified health centers (FQHC – 21 clinics) and the Arkansas Behavioral Health Integration Network (ABHIN). This partnership, named the Behavioral Health Integration Hub (BHI-Hub) will implement the behavioral health collaborative care model (CoCM) among rural residents with chronic medical and co-occurring behavioral health conditions. It will also help family and internal medicine and psychiatry residents learn how to work in an integrated behavioral health model. The geographic catchment area is the entire State of Arkansas. The BHI-Hub provides funding for personnel and a patient registry to track progress of patients and to facilitate the use of measurement based care. It will provide training to new and existing personnel about integrated behavioral health care as well as create enduring resources that can be use by other clinics when they implement integrated care. The project includes a state planning council will be a state-wide entity involving key stakeholders. The state planning council will be co-chaired by state leadership and facilitated by Dr. Hudson and Smith. It will meet no less than quarterly to accomplish its work. Goal Implement integrated behavioral health into 145 UAMS primary care and at 21 FQHC clinic locations for patients suffering from multiple chronic physical and behavioral health conditions. Objective 1: Conduct a Program Readiness review This review will identify barriers and current or potential facilitators to providing integrated care in UAMS and FQHC primary care clinics. Objective 2: Develop a detailed, integration program plan. A program planning team will develop a detailed plan (BHI-Hub Manual) describing procedures for identifying and meeting behavioral health needs for patients identified in objective 1. . Objective 3: Develop formal collaborative agreements between the State of Arkansas and all clinical partners. Objective 4: Sustainability plan: create a sustainability plan to continue integrated behavioral health care after the end of federal funding. This will include identifying barriers to sustainability and strategies to address each barrier. Objective 5: Create a State planning Council for Integrated Care. This council will utilize the materials developed during this project to increase the number of primary care clinics providing integrated behavioral healthcare. Objective 6: When clinically appropriate, implement additional screenings and referrals. This includes conditions such as HIV, sexually transmitted diseases, viral hepatitis, tobacco/nicotine use, opioid and alcohol use disorders, oral health resources and support for provision of care via telehealth.

The Kansas Department for Aging and Disability Services (KDADS) will partner with five primary care provider organizations to implement the Collaborative Care Model (CoCM) and other evidence based practices (EBPs) to comprehensively serve Kansans with comorbid behavioral and physical health conditions under its PIPBHC program. In consultation with the Kansas Department of Health and Environment (KDHE) and the Community Cares Network of Kansas (CCNK), KDADS selected the five providers based on a variety of factors, including behavioral health population needs, level of collaborative/integrative care infrastructure, geographic diversity, and community commitment. The PIPBHC provider partners are comprised of three federally qualified health centers (FQHCs), one FQHC look-alike, and one nonprofit rural health clinic (RHC). Each provider organization will serve a distinct geographic area and provide services to a particular population of focus under the CoCM. The main behavioral health conditions to be served include adults with serious mental illness (SMI), children with serious emotional disturbance (SED), persons with substance use disorders (SUD), and persons with cooccurring SMI and SUD. The Kansas PIPBHC project will serve 8,850 unduplicated individuals over the project period with an average of 1,770 people annually. Each provider service area reflects a high need for integrated care due to insufficient workforce, lack of health coverage, and prevalence of behavioral health issues. These service areas span urban, rural, and frontier areas across Kansas, presenting a diverse set of challenges to implementing integrated care. Per the Health Resources and Services Administration, the five chosen providers reside in or are designated as a Mental Health Professional Shortage Area. In terms of mental health prevalence, a Mental Health America analysis found the collective averages per 100,000 population for people scoring severe depression, frequent suicidal ideation, and at risk for psychosis for the selected service areas are 121.1, 126.9, and 86.1, respectively, which are higher than the national averages at 102.0, 104.4, and 64.0, respectively. From a morbidity perspective, the age adjusted suicide rate per 100,000 was over five points higher than the national average at 19.4 vs. 14.1, respectively. A greater proportion of adults in the provider service areas are also smokers and binge drinkers compared to the state and national averages. The need for integrated services is exacerbated by the lack of legislatively enacted Medicaid expansion, compromising access to care and placing additional strain on safety net providers like FQHCs, FQHC Look Alikes, and RHCs. Through implementation of the CoCM and select EBPs, the Kansas PIPBHC project will address the key needs for integrated care and achieve the following 1. Reduce barriers to accessing integrated physical and behavioral healthcare by embedding the CoCM in all five provider organizations. 2. Increase the capacity for integrated care by implementing evidence based practices to reduce the proportion of adults and youth with nicotine use disorder and other SUD. 3. Decrease the frequency of suicidal ideation through collaborative supports and services that address physical, behavioral, and health related social needs. 4. Improve access to oral health care services through screening and referrals. 5. Develop a robust State infrastructure to implement and establish the CoCM model across the State of Kansas

In Texas, behavioral health services - which encompass both mental health and substance use disorders (SUD) - have evolved over the last decade. Statewide implementation of the Certified Community Behavioral Health Clinic (CCBHC) model in conjunction with a movement toward managed care, and improved psychiatric crisis system, as well as enhanced community collaboration, have all contributed to significant advancement in behavioral health care in Texas. As a current SAMHSA Promoting Integration of Primary and Behavioral Health Care (PIPBHC) grantee, Texas Health and Human Services Commission (HHSC) has identified key elements essential to providing integrated care with meaningful outcomes. This grant opportunity allows Texas HHSC to continue building a sustainable model for promoting integration of primary care and behavioral health services in an underserved part of the state. Through a two-part approach - enhancing service delivery through care coordination between services and increasing access points through co-location and innovative partnerships - Texas plans to continue building systems capacity related to integrated health. Texas HHSC will work with four provider sites to improve access to behavioral health, primary care, and specialty care thereby improving health outcomes. The four community health centers participating in this project cover 26 counties in East Texas, which include some of the most rural and urban counties in the state and border three states (Oklahoma, Arkansas, and Louisiana) and the Gulf of Mexico. The region has been designated as medically underserved, with some counties having this designation as far back as 1978. Given the variation between population, resources, and geographic area, Texas' healthcare system must function differently in each community. To best serve East Texans with mental health, substance use, and physical health needs, Texas HHSC will work with the four selected providers across 25 rural counties and one urban county to identify integrated care models that work in each community. Behavioral health providers will collaborate with primary care providers in a variety of ways to identify best practices for the people in their counties. Through the project, Texas will focus on four key populations who would benefit from the PIPBHC model: 1) adults with serious mental illness (SMI), 2) individuals with co-occurring mental illness and physical health conditions and chronic diseases, 3) children and adolescents with serious emotional disturbances (SED) who have co-occurring physical health and chronic conditions, and 4) individuals with substance use disorders. The Texas strategy for success will focus on building capacity of targeted clinic partnerships in select service areas to provide effective, evidence-based integrated healthcare. The partnerships will be supported at the state level through learning collaboratives, partnerships with managed care and integration experts, and community network building. Through these partnerships Texas HHSC will also examine the elements required to implement true bi-directional integration and collaborative care models. Texas is ideally positioned to leverage this grant to transform service delivery and align incentives to improve the lives and health outcomes of vulnerable populations by creating a more efficient and coordinated system.