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Center Point, Inc. (CPI) is requesting $375,000 per year for up to three years from the SAMHSA CSAT to expand and enhance its comprehensive SUD continuum of care by providing job training, transitional housing/recovery residences, and recovery support services for adults who have completed an SUD treatment program and are working towards certification as a Peer Support Specialist (PSS) or Certified SUD Counselors. The populations of focus for the projects are clients of CPI's SUD treatment programs who lack access to affordable housing, recovery supports, employment and a living wage, and supportive peer network when they leave the residential treatment environment. The geographic catchment area where project services will be delivered is Marin County, CA and the participants will be Marin County residents. The goals of the project are to enhance Marin County's recovery-oriented system of care by expanding workforce development activities and recovery residence transitional housing; provide SUD and COD treatment/recovery support and; increase participants' physical and emotional well-being; and provide harm reduction services and recovery support approaches to reduce participants' risk of relapse, recidivism, drug overdose, and death. CPI's project will serve 20 unduplicated individuals per year and 60 total unduplicated individuals. As a result of project activities, 50% of participants will register for and begin field placement towards state certification as PSS or SUD Counselors; 75% of those who register will complete certification with three years. SAMSHA Special Projects funding will be utilized to enhance and expand CPI's successful Recovery Residence program by expanding recovery support opportunities and workforce development activities for project participants who are interested in pursuing careers in the SUD treatment and behavioral health workforce. CPI's Special Project will provide ""Recovery Residence"" sober housing units; SUD workforce development services, including stipends, internships, and on-the-job training; and recovery support services, including peer mentoring, outpatient counseling, and recovery support groups for people with SUD and/or COD. CPI Recovery Resident program participants will be recruited from among the population of adult men and women who have completed the CPI residential treatment program and are in need of housing and recovery support. Project participants will build relationships and connections within the targeted communities, and utilize evidence-based, trauma-informed strategies including Motivational Interviewing to engage and support people in need of harm reduction services. CPI's Recovery Residence Plus Project Director will provide program design and implementation and oversee training and supervision of interns and PSS-in-training. All participants will be provided vocational supports, case management, job and life skills building, and individualized recovery planning and will be trained to begin providing these services and supports to others in the community.

Project Lincoln University (LU) Supports Students with Substance Use Disorder (LUSS-SUD) will focus on the LU student population. LU will partner with the University of Pittsburgh Program Evaluation and Research Unit (PERU). LUSS-SUD will expand Screening, Brief Intervention, and Referral to Treatment (SBIRT) services, implement harm reduction practices, offer case management, and connect high-risk students to community partners and recovery-support services. The number of unduplicated LU students to be served will include 250 in year 1, 250 in year 2, and 250 in year 3 for a total of 750 students during the entire project period. The population of focus is LU’s undergraduate student population, which in Fall 2021 was 1,767 students, of which 84% were Black, 6% Hispanic/Latinx, 3% multiracial, and less than 4% Asian, American Indian/Alaska Native, White, and/or unknown/did not disclose. The primary language was English, with under 5% of students speaking English as a second language. Students were 67% female and 33% male with an age range of 17 to 25 years old. Students included PA residents (49%), out-of-state residents (47%), and U.S. non-residents (2%). LU estimates 24% identify as LGBTQ+ based on national prevalence. The median family income for LU students was $45,600, which equates to the 47th average income percentile. The geographic catchment area includes LU students living on campus in rural Chester County, PA. In 2021, LU students were from 28 states and nine countries; international students comprise under 10% of the student population. Chester County residents are mainly White (78%), have higher median household income ($104,161) than PA ($63,627), and a higher proportion of persons possessing a bachelor’s degree or higher (54%) than PA (32%). LUSS-SUD’s goals include: Goal 1) By Sept. 2025, increase the number of LU students screened for substance use and co-occurring mental health disorders (SUD/MH), and co-occurring physical health (e.g., HIV or Hepatitis C ID testing) by integrating SBIRT into Health and Counseling Services (HCS); Goal 2) By Sept. 2025, expand access to evidence-based harm reduction practices for LU students identified as high risk for substance use by integrating Brief Alcohol Screening Intervention for College Students (BASICS) and Cannabis Screening and Intervention for College Students (CASICS) into Counseling Services, and for LU students identified as high-risk for opioid overdose by integrating targeted naloxone distribution in Public Safety and Residence Life; Goal 3) By Sept. 2025, improve care coordination for LU students accessing or engaging in specialty SUD/MH treatment by establishing a case management department within Counseling Services; Goal 4) By Sept. 2025, address health inequities and develop a recovery-supportive environment by providing transportation services from LU to SUD/MH treatment providers, dedicating space to access telehealth treatment, if appropriate, and establishing recovery- supportive housing on campus; Goal 5) By Sept. 2025, perform a comprehensive evaluation using Government Performance and Results Act, qualitative and quantitative methodologies, and EHR encounter data to implement continuous quality improvement and health equity initiatives, promote SBIRT sustainability, and assess student outcomes; and Goal 6) By Sept. 2025, optimize program sustainability by developing a comprehensive plan to sustain activities beyond the grant period. Through these goals and associated activities, LUSS-SUD will establish a comprehensive collegiate prevention, intervention, and recovery program to address service gaps to identify and support students at-risk/with SUD/MH to increase access to SUD/MH treatment.

This project, "Adapting and implementing opioid-sparing pain management protocols across Mount Sinai Health System Emergency Departments" will permit the creation of a new systematic approach to deliver opioid-sparing pain management across Mount Sinai Health System emergency departments (EDs). Protocols will be adapted and implemented to provide opioid-sparing pain management to ED patients with these five conditions: headache/migraine, musculoskeletal pain, renal colic, chronic abdominal pain, and extremity fracture/joint dislocation. We will adapt and implement the opioid-sparing pain management protocols through a multi-step process that involves stakeholder input, adaptation of the alternatives to opioids (ALTO) pain management pathways, formation of electronic health record (EHR) order sets, training of ED medical and nursing staff on the opioid-sparing pain management protocols and order sets, implementation of the order sets, and continuous monitoring and re-evaluation of the resulting adapted pain management protocols. The project will be conducted across the Mount Sinai Health System's eight EDs in New York City, which administer medical care to over 750,000 patients annually. Mean age among patients at these eight EDs is 45 years-old; 52% are female and 48% male; 21% self-identify as Hispanic; and 26% self-identify as Black. The goals and objectives for the project are as follows: Goal 1: Adapt opioid-sparing pain management protocols for Mount Sinai Health ED patients from the ALTO pain management pathways (for headache/migraine, musculoskeletal pain, renal colic, chronic abdominal pain, and extremity fracture/joint dislocation) with the assistance of stakeholders (ED medical staff (attending physicians, fellows, resident physicians, physician assistants (PAs)) and nursing staff at Mount Sinai). Objective 1: Preparation of pain management protocols adapted from the ALTO pain management pathways Goal 2: Prepare EHR order sets for opioid-sparing pain management protocols (headache/migraine, musculoskeletal pain, renal colic, chronic abdominal pain, and extremity fracture/joint dislocation) for Mount Sinai Health EDs with the assistance of stakeholders (ED medical staff (attending physicians, fellows, resident physicians, PAs) and nursing staff at Mount Sinai. Objective 2: Preparation of EHR order sets for the opioid-sparing pain management protocols Goal 3: Train all Mount Sinai Health ED medical and nursing staff on the opioid-sparing pain management protocols (for headache/migraine, musculoskeletal pain, renal colic, chronic abdominal pain, and extremity fracture/joint dislocation) and EHR order sets and deploy them across the Mount Sinai Health EDs. Objective 3: Training of ED medical and nursing staff on opioid-sparing protocols and EHR order sets Goal 4: Evaluate process and clinical outcomes from training Mount Sinai Health ED medical and nursing staff and deployment of the implementation strategies. Objective 4: Reduction of opioid analgesia administered during the ED visit and prescribed for after the ED visit for headache/migraine, musculoskeletal pain, renal colic, chronic abdominal pain, and extremity fracture/joint dislocation.

Summary: Ohio is ranked as the sixth highest state for opioid overdose deaths in 2021 with a rate of 41.1 per 100,000 persons. Located in Northeast Ohio, UH Cleveland Medical Center (UHCMC) Emergency Department (ED) serves a broad catchment area including urban, suburban, and rural counties, and is a primary source of care for the predominantly minority and socioeconomically disadvantaged local population. In a 2022 review of 66,086 ED visits in our electronic health record (EHR), 15,546 ED visits were for patients presenting with pain and discharged home. Of these visits, over 25% received an opioid medication in the ED, representing an opportunity to reduce that percentage. The overall goal of this proposal is to decrease opioid usage in the ED by (1) increasing ED provider knowledge and (2) implementing ALTO therapies in the ED for patients presenting with pain. We will carry out this objective through a longitudinal ALTO implementation project with initial intervention in the ED and sustained follow-up in the outpatient UH Connor Whole Health (UHCWH) clinics. Specific Objectives: (1) Understand current UHCMC ED pain complaints, approaches, and potential barriers to implementation of ALTO; (2) Train ED providers on Medications for Opioid Use Disorder (MOUD) and ALTO interventions; (3) Implement acupuncture and music-assisted relaxation imagery (MARI) ALTO approaches in the UHCMC ED.; (4) Disseminate best practices through three planned publications in peer reviewed journals and numerous presentations at national/international conferences of emergency medicine and integrative medicine. Plan to Meet Objectives: Key personnel include a (1) Program Director with training and expertise in system-level project and program management, (2) Emergency Medicine physician (Co-PI) with expertise in implementation science of interventions in the ED, (3) Integrative Medicine researcher (Co-PI) with NIH-funded expertise of deploying non-pharmacologic interventions in the ED and acute care and assessing outcomes, and (4) Emergency medicine physician (Co-I) with expertise in addiction medicine. To assess and improve development and uptake of these ALTO approaches, the team will conduct a ~10 item survey of ED providers to understand their knowledge, perspectives, and potential biases regarding pain management and ALTO techniques, including barriers to ALTO implementation in the ED. The team will conduct a pre-survey (initial 3-month start-up period) and will re-assess providers’ perspectives halfway through (Year 2) and at the end (Year 3) (Obj 1). The overarching goal of this proposal is to use the combination of ED provider training on MOUD and ALTO techniques (Obj 2) to increase referrals for ALTO interventions, specifically evidence-based acupuncture and MARI in the ED (Obj 3), in order to decrease the current rate of opioids used in the ED to treat acute and chronic pain. As a novel innovation, ED providers will be able to refer patients to one of the five UH UHCWH outpatient clinics to receive ALTO interventions that are covered by Medicare, Ohio Medicaid, or by patients’ private insurance. Rationale: There is a need nationwide for emergency medicine professionals to use MOUD and ALTO interventions to safely manage acute/chronic pain. The Dept of Emergency Medicine and UHCWH successfully collaborated on a feasibility pilot of bringing acupuncture to the UHCMC in a NIH-funded trial. However, the study team contends that: (1) reduction of ED opioid use by ED providers AND (2) increased use of ALTO interventions to reduce pain in the ED would provide a unique two-pronged approach to begin to combat the opioid epidemic. With widespread dissemination of results (Obj 4), this project would provide robust evidence for a scalable intervention with the potential to readily expand to other EDs.

Meharry Medical College (MMC) has been serving underserved populations in Nashville since 1876. The Meharry Academic Medical Center is the largest HBCU medical center in the country with a mission of eliminating health disparities. We will build on this extensive experience to provide cutting edge evidence based care designed for underserved populations through the creation of the Meharry Opioid Response and Recovery (MORRE) Center. Through the MORRE we will integrate the existing near full continuum of care for people with opioid use disorder (OUD) to provide the full cascade of OUD services to people in Nashville Tennessee and surrounding counties with a focus on serving Black residents and the unhoused population. Currently, Meharry is home to the Meharry Addiction Clinic (MAC) in the Department of Family and Community Medicine, and the Elam Mental Health Center (EMHC) in the Department of Psychiatry and Behavioral Sciences. The MAC consists of a low threshold medication for opioid use disorder (MOUD) clinic that provides MOUD along with a full continuum of primary care services designed for people who use drugs (PWUD) both through a stationary and a mobile clinic. The MAC also provides harm reduction outreach and syringe service programming focusing on Black and unhoused drug using communities in the city. The EMHC has been the safety net substance use disorder provider for the city since 1976. The EMHC provides intensive outpatient, outpatient, and residential treatment, including treatment for pregnant women and women with children. The creation of the MORRE Center will further strengthen the integration of these two clinics within Meharry Medical College. Further, to complete the continuum of care we will partner with the only methadone provider in the city, as well as recovery support service providers, including recovery housing. With the requested funding we will provide a full continuum of care for people with OUD and solidify and augment the current system of care for people with OUD in Nashville. Finally, by implementing this program within an academic medical center students, residents and fellows trained through MMC will be ready to meet the challenges of the opioid epidemic in their own practices, exponentiating the impact of this important project.

In response to SAMHSA's RFP entitled FY 2023 Comprehensive Opioid Recovery Centers, NOFO No. TI-23-020, Resources for Human Development, Inc. (RHD) proposes a mobile Comprehensive Opioid Recovery Center (CORC) to primarily serve Montgomery County, PA. The mobile unit will be based out of RHD's Montgomery County Recovery Center and Center of Excellence (MCRC/COE) and named Mobile MCRC. The target population for this project are uninsured and underinsured individuals with opioid use disorder (OUD) and their families. RHD will provide the full complement of treatment, harm reduction, and recovery support services including Medication Assisted Treatment (MAT). The Mobile MCRC project aims to increase treatment access for OUD, decrease the number of opioid related deaths in the catchment area, and achieve overall consumer satisfaction with service delivery. Mobile MCRC projects serving 70 people in the first year and an additional 70 in each subsequent year. MCRC's Center of Excellence is a licensed DDAP provider of substance use disorder services including MAT. As part of implementation for the Mobile MCRC, RHD will collaborate with DDAP to expand our license to include buprenorphine and the mobile element. RHD has multiple programs licensed by DDAP and a long-standing relationship with this governing body. We are eager to collaborate with DDAP to ensure full compliance with both state and federal requirements to provide safe, effective, evidence-based treatment to people in Montgomery County. We plan to share our data with our DDAP partner to show the success and challenges of this model in the hopes that we can help support expansion of the service to other rural areas in Pennsylvania.

The North Carolina (NC) 2023 Health Transitions grant program aims to provide mental health support to youth and young adults ages 16 to 25 in the western Piedmont region of NC who have or are at risk of developing a serious mental health condition. The program aims to increase the capacity of the mental health workforce to meet the needs of transition-aged youth and improve the emotional and behavioral health functioning of these individuals. The program will engage in multiple system change activities, such as developing an IAA among departments and conducting a collaborative needs assessment process to inform the development of an Advisory Council, mental health workforce training plan, service system transition best practice protocol, and more. The program also plans to foster and sustain a Youth Advisory Council, collaborate with community providers to develop Low Barrier Engagement Groups, and develop supplemental training materials to promote youth empowerment and engagement. The program also plans to provide coordinated outreach, assessment, transition facilitation, referral and linkage, youth and family peer support, educational/vocational and behavioral health services to 260 youth and young adults over the lifetime of the grant to maximize their potential to assume adult responsibilities.

In Eddy County, Chaves County, Curry County, Roosevelt County, and Lea County in New Mexico, there is a chronic sense of hopelessness, with high rates of suicide, mental health issues, co-occurring disorders, and substance abuse with limited or non-existent networks of support for youth. Transition-age youth in these communities experience multiple barriers to developmentally, culturally, and linguistically appropriate services and supports. Until very recently, residents in our service communities were not ready to accept or discuss major problems in their community. The mission of Youth Rising (YR) is to empower vulnerable youth to use their voice and life experience to reduce youth substance abuse and improve mental health among their peers. YR’s robust model focuses on implementing mental health and wellness promotion, awareness, prevention, intervention, and resilience activities to reduce youth substance use and improve mental health outcomes for youth and whole communities over time. With support from this grant, Youth Rising will grow and strengthen our youth-led programs to increase protective factors to reduce youth substance use and improve mental health using the following strategies: 1) increase education on school campuses for mental health, suicide, and substance use prevention; 2) provide safe, alternative options for youth after school through a youth-led drop-in center; 3) increase youth leadership opportunities through youth-led wellness campaigns at the local and state levels. We have identified six activities that address SAMHSA priorities and will work to strengthen our youth-centered and youth-led grassroots program: develop youth-led drop in centers in downtown areas, implement Positive Social Norming programs in schools, implement Youth Rising Leadership Institute (YRLI) for leadership, advocacy, and policy change, promote community-based services to implement youth-led prevention education through awareness presentations and assemblies for youth, families, and school staff, provide Mental Health First Aid training to identify issues of substance use and mental health concerns including suicidality among youth, and establish a student assistance program at local middle and high schools where the need is high due to complex social and emotional constructs. YR will create a platform to amplify youth contributions and input, allowing for advocacy for systems and policy changes while sitting across the table from community stakeholders, elected officials, and decision-makers. YR is a 501c3 non-profit organization with a 6-member board of directors and is affiliated with Youth Rising National. Collaborating with regional partners and other agencies, YR will work to implement systems change and policy improvement for school districts in our service areas. Our emphasis will be on a true youth-adult partnership model where youth and adults practice equitable practices through information and resource sharing, skill development and shared decision making. YR will catalyze and energize agencies and youth-serving groups, while championing best practices and legislative policies to ensure quality opportunities for all young people. The coalition will also convene youth, youth-service professionals and community members for ongoing training, mentoring, and capacity-building. All projects and initiatives will be authentically youth-led and youth-driven.