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The purpose of this proposal, Comprehensive Treatment, Early Intervention, and Education Targeting Substance Use and Co-Occurring Trauma-Related Mental Health Problems for Adolescents and Their Families in the Charleston Tri-Country Area, is to enhance the capacity of the EMPOWERR Program in the diverse Charleston Tri-county area of South Carolina to provide a comprehensive family-centered, trauma-informed, evidence-based, coordinated, and integrated outpatient system of care, which includes early intervention and recovery support services to adolescents [12-17 years; who have substance use disorders (SUD) with and without co-occurring trauma-related mental health problems] and their families to meet currently unmet treatment needs in this catchment area. The services proposed through this grant will include screening, assessment, outpatient evidence-based treatment, case management (inclusive of wraparound services and referrals for family members), and education in school settings targeting health decision making. Specific project objectives include: (1) Implement Screening, Brief Intervention and Referral to Treatment (SBIRT) for tobacco use, alcohol, and drug use among an average of 40 adolescents and their family members presenting to an outpatient clinic specializing in trauma-related mental health (NCVC) per year across all 5 years of the grant, to include early intervention and/or linkage to evidence-based treatment as indicated by the SBIRT assessment; (2) Implement SBIRT for tobacco use, alcohol, and drug use among an average of 44 adolescents and their family members presenting to an outpatient clinic specializing in addiction behaviors (CDAP) per year across all 5 years of the grant, to include early intervention and/or linkage to evidence-based treatment as indicated by the SBIRT assessment; (3) Provide evidence-based treatment for adolescents with SUD, as well as with co-occurring SUD and trauma-related mental health problems, and their family members at the NCVC (Risk Reduction through Family Therapy/RRFT) and at CDAP (Motivational Enhancement Therapy + Cognitive Behavioral Therapy/MET + CBT; Brief Strategic Family Therapy/BSFT) via clinic-based and, to address barriers (logistical, stigma, health), via telehealth services, with an average of 35 individuals receiving these treatments per year across all 5 years of the grant; (4) Administer evidence-based education programming to students (average of 64 per year, across all 5 years of the grant) in the Charleston Tri-County community; (5) Provide wrap-around and recovery services as needed to 100% of adolescents and their family members served through this Family Tree grant. By the end of the five-year period, 463 will receive evidence-based assessments and/or interventions (93 annually), with all receiving recovery support services, and 320 (64 annually) will have received evidence-based prevention education curriculum (e.g., Catch My Breath). The overarching goal of the project is to reduce SUD and trauma-related mental health problems among adolescents and their families in the Charleston Tri-County area.

Fairbanks Native Association’s (FNA) Youth and Young Adult Services (YYA Services) division proposes to implement Preparing Our Future Leaders (PFL), a co-occurring disorder (COD) outpatient treatment project that will prepare Alaska Native transitional aged youth (21-25) (TAY) for a substance free, mentally healthy life. Without intervention, the cycle of substance use, mental illness, and trauma will likely continue for generations to come. American Indian/Alaska Native (AI/AN) ages 18-25 have the highest rate of COD (Substance Use Disorder and any mental illness) of any AI/AN adult age group. This is especially significant as Substance Use Disorder has significantly increased suicidality among AI/AN adults since 2016. Major Depressive Episodes among this group have also increased significantly since 2016. YYA Services is ideally positioned for PFL as it already meets many of the requirements for success. YYA services 1) has a strong infrastructure in place developed over the past seven years by the Interagency Transition Council (ITC), a tribal community coalition (ITC); 2) is Family-centered with a dedicated Family Services unit; 3) includes an existing outpatient treatment (OP) unit that utilizes an Evidence Base Practice with a family component (Community Reinforcement Approach); and 4) has four highly skilled consultants to provide technical assistance and fill in during key staff absences to ensure quality and timely services. Through our experience providing services to youth, TAY and adults, we have found that the needs of TAY often do not align developmentally with youth or adult populations. To achieve long term recovery, TAY need treatment designed to meet their unique needs. Our COD OP unit does not segregate treatment by age and serves ages 16-25. As a result, neither youth or TAY fit in developmentally. PFL will therefore enhance the existing COD OP unit by segregating treatment into two developmentally appropriate units (age 16-20 and ages 21-25) and expand the existing unit by serving an additional 308 unduplicated TAY over the life of the project. PFL will support existing ITC responsibilities by continuing to focus on system of care coordination and access to care improvement and it will enhance recovery support. As Alaska Native tribal organizations we serve both AI/AN by agreements initially established through the Indian Health Service. Therefore the target population is both AI/AN TAY ages 21-25 with substance abuse disorders and/or COD and their families/primary caregivers. Evidence-Based Practices will include Community Reinforcement Approach, Seeking Safety, and Contingency Management, all of which are currently in place. Additional treatment strategies will include Tobacco Counseling & Intervention, Recovery Supports, linkage to System of Care and UA/Drug Testing. PFL’s overarching goal is to enhance and expand comprehensive evidence-based treatment, early intervention, and recovery support services to transitional aged youth ages 21-25 and their families/caregivers.

The Modoc Nation Treatment and Recovery Services for Adolescents, Transitional Aged Youth, and their Families (TREE) program will serve adolescents and transitional age youth (12-25) with Substance Use Disorder (SUD) and/or Co-occurring Disorders (COD) and their families/primary caregivers within the Ottawa County area of Northeastern Oklahoma. The program will utilize equine-assisted psychotherapy and other evidence-based interventions to address local challenges like the varying social determinants of health, insufficient culturally informed behavioral health providers and services, and the need for increased access to evidence-based services. In addition to Equine-Assisted Psychotherapy, Modoc’s TREE program will provide Trauma Focused-Cognitive Behavioral Therapy (TF-CBT) and Eye Movement Desensitization and Reprocessing (EMDR) to the target population. This program aims to serve 450 youth and their families over the five years of the project, with the goals of: 1) Improve treatment and prevention program participation rates for youth & their families experiencing trauma and other risk factors that may contribute to substance misuse, suicidal ideation, or mental health instability. 2) Establish a standard process for youth-serving agencies (including schools, justice system, after school programs, etc.) to refer youth to evidence-based trained treatment providers. 3) Increase access, engagement, and retention in Equine-Assisted Therapy and nature-based treatment through the implementation of culturally grounded trauma-informed care models for at-risk youth and their families in need of treatment for substance use disorders/co-occurring mental disorders and substance use. 4) Increase awareness of available health services for underserved populations. We are confident that our culturally mindful approach will result in improving knowledge and access to mental health treatment and resources, thus supporting our efforts to reduce the incidence of substance misuse for youth and their families throughout Northeastern Oklahoma.

The UKB seeks to fashion a comprehensive and integrated substance abuse and co-occurring treatment, early intervention, and recovery support system to better serve the 19,480 rural non-reservation American Indian youth and emerging adults, age 12-25, in our service area.

The purpose of Strengthening Youth Through Empowerment (SYTE) is to establish an expanded system of integrated, coordinated treatment, and community-based services that is family-centered, trauma-informed, and evidence-based. Specifically, this program will provide a coordinated multi-system, family-centered approach that will enhance and expand holistic or comprehensive evidence-based treatment, including early intervention, and recovery support services. Tarrant County, the third-most populous county in Texas and the nation's 16th largest urban area, will serve as the geographic catchment area for SYTE. The program will target a combination of adolescents age 12-17 with a specific emphasis on Transitional Aged Youth age 16-25, with substance use disorders (SUD) and co-occurring psychiatric and substance use disorders (COPSD) and their families and primary caregivers. The Tarrant County Drug Impact Index noted that 24% of adolescents reported using alcohol, 12% marijuana, and 12% any drug use. The onset of substance use during adolescence or emerging adulthood increases the likelihood of severe substance abuse in adulthood and can have negative consequences on interpersonal relationships, employment, and overall well-being. . To address the substance use concerns in the community, MHMR of Tarrant County serves more than 3,700 youth in outpatient behavioral health services and nearly 800 youth in outpatient and intensive residential SUD and recovery services; other analyses suggest that nearly 50 have dual concerns. Internal data indicates 1,011 unique youth sought admission to services in 2020, 10.9% of which were age 16-17. The children's substance use system serves youth from age 3 to 17 with eligibility ending at 18 years. Funding is appropriated but separated by each qualifying system, which means children, youth, and adults are served at different clinics, programs, and by different staff. STYE will bridge the gap by providing the staff and services necessary to help youth successfully transition into adult services, thereby increasing the likelihood of a successful continuity of care with needed services. The project has been designed to provide an array of comprehensive services to 450 youth through the implementation Adolescent Community Reinforcement, Multi Dimensional Family Therapy, and Seeking Safety EBPs, which will compromise of Cannabis Youth Treatment.

Youth Environmental Services, Inc. (YES) – a NYS OASAS licensed substance abuse and prevention treatment provider – is targeting Nassau County, Long Island, NY, while simultaneously increasing/expanding target populations across Long Island into Suffolk County with a program of enhanced and expanded Treatment and Recovery Services for transitional aged youth from 17 to 25 years old. This project, called BRIDGES – “Building Resources for Individuals to Develop, Guide, Encourage, and Support” – was designed based on a recent data analysis that revealed patterns of substance abuse escalation as local youth encounter post-secondary challenges and attempt to manage them as young adults and college students. Through collaboration with this project’s partners, we will develop ways to overcome barriers identified by college administrators to promote the sustainable growth of collegiate recovery programs on Long Island campuses. Confirmed by 11 signed MOUs, BRIDGES will also address disparities in access and treatment among non-college students and underserved populations, including the justice-involved, veterans, Latinx populations, and LGBTQ transitional aged youth. YES proposes to launch BRIDGES as a comprehensive evidence-based approach providing intervention, treatment, and recovery support services in an outpatient setting as well as critical wraparound services with the following goal: To increase the unduplicated number of individuals served with Evidenced Based Services/Practices through a family-centered, trauma-informed, comprehensive and coordinated outpatient system of care. The program’s integrated EBPs will include SBIRT tools/protocols for screening and assessment, Trauma-Focused Cognitive Behavioral Therapy, Motivational Enhancement Therapy, Moral Reconation Therapy, early intervention EBPs (BASICS and Teen Intervene), and family-centered EBPs through the CRAFT model to help families support their loved ones. MAT clients and those with co-morbidity issues that require psychiatric evaluation and monitoring will have access to a psychiatrist specializing in addiction medicine at YES. The Program Director will ensure that the goals of the grant are carried out as intended, and a Grant Coordinator will oversee the day-to-day functions of all program staff. As a licensed drug treatment facility, YES will ensure that the confidentiality of participants is protected in accordance with federal and state law. A contracted Data Coordinator will assist in determining the effectiveness of the program, establishing data outcomes, and sustainability planning. Data will be collected and analyzed to complete required reports and to inform continuous quality improvement (CQI) efforts. Trainings will be made available to partner staff, including university personnel, regarding how to support transitional aged youth in recovery.

The Indiana Adolescent & Family Recovery and Intervention Services Expansion (RISE) is a proposed outpatient family-based screening, consultation, treatment and referral program that would serve adolescent/transition age youth (ages 12-18) with substance use disorders or co-occurring mental health/substance use disorders across the state. This application pulls together an already robust urban, academic Adolescent Dual Diagnosis Program with full telemedicine capabilities and an established statewide primary care/emergency room consultation infrastructure, amplifying those services with additional providers and care coordination in order to achieve the following project goals: (1) expand program reach to youth in underserved, rural counties; (2) impact a much larger number of youth and caregivers than at present; (3) extend the adolescent treatment team's mission to include caregiver assessment, brief intervention and referral to treatment (4) enhance access to recovery coaches who are competent at supporting adolescents; (5) expand our youth behavioral health access program for pediatricians/primary care providers to include support for adolescent and caregiver SUDs (objective: n=200 consultations annually, 1,000 over project period); and (6) provide community messaging and education around adolescent addiction assessment and treatment. The State of Indiana is among the most underserved in terms of youth addiction treatment workforce, hence the need for the statewide approach. For adolescents, the proposed program will utilize well-established, evidenced based screening (i.e., S2BI, BSTAD, AUDIT), assessment (i.e., TLFB, KSADS), and treatment modalities (i.e., MET/CBT, pharmacotherapies, contingency management) that are packaged together in the ENCOMPASS model for adolescents with co-occurring disorders. Our team has been learning and refining our competence with this model for >10 years and are now one of a small group certified to train others on this model. Therefore, aside from onboarding some new team members, our team will be able to immediately assess and treat adolescents and caregivers without a lengthy training or implementation period. All adolescents and caregivers will be offered screening (objective: n=2,000 annually, 10,000 over project period), and some will need a brief intervention (objective: n=200 annually, 1,000 over project period), or treatment (MET/CBT, pharmacotherapy; objective: n=100 adolescents/25 caregivers annually, 625 over project period). Our team is well-situated to accomplish the project goals and greatly expand our capacity to provide substance use disorder risk screening, provider consultation, and treatment to Indiana adolescents and their caregivers who have yet to access this needed care.