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On the evening of October 25, 2023, the City of Lewiston, Maine, experienced an incident of mass violence. In total, 18 individuals died and dozens more were injured. In the United States, the incident was the deadliest mass shooting of the year and the tenth deadliest mass shooting on record. The shooting took place in the evening hours at two separate locations: an independently owned and operated restaurant; and a bowling alley less than five miles away. A youth league was present at the bowling alley, while a cornhole tournament was ongoing at the restaurant. The deceased ranged in age from 14 to 76, and included a husband and wife, a father and son, and multiple members of Maine’s Deaf and Hard of Hearing community. As a State, we grieve for the lives lost, those whose lives are forever changed, and the sense of safety eroded. It is with a profound sense of responsibility and public service that Maine DHHS submits this application to receive resources that are vital to support the evolving behavioral health response to the tragedy. In the days and weeks after the tragedy, the Maine Department of Health and Human Services acted in partnership with the City of Lewiston, local healthcare, behavioral health and community organizations, and across Maine State Government, federal and local partners to coordinate the early response to this devastating event. In particular, Maine DHHS provided leadership to the behavioral health response critical in the aftermath of mass violence: the Office of Behavioral Health leveraged existing contracts and relationships to bolster, coordinate, and maximize available behavioral health supports; the Office of Children and Family Services provided in-person trauma-informed trainings for clinicians; the Maine CDC monitored crisis line and emergency department data to identify the impact of mass violence; and the Office of Aging and Disability Services bolstered capacity to provide spoken language / sign language interpretation services. None of these services or supports would have been possible if not for the many critical partners, including many Maine DHHS staff, who stepped forward to assist and delivered. As Maine DHHS has considered the amplified supports and resources necessary to address emerging need in the coming weeks and months, multiple stakeholders have been engaged via Listening Sessions to ensure that the response is rooted in community-identified need. This proposal reflects the input gathered across behavioral health providers, healthcare leadership, members of the Deaf and Hard of Hearing community as well as New Mainer community, school staff, home-based providers, and other valued stakeholders. The proposed framework includes a bolstered behavioral health response poised to meet the iterative needs of individuals in Lewiston and surrounding communities, a trauma-informed learning community that will ensure a ready and resilient workforce, and a communications campaign to promote mental wellbeing and access to services. The proposal also includes the necessary resources for Maine DHHS to maintain oversight over grant resources and expectations, as well as continued leadership for the behavioral health response.

SCHARP Crenshaw CCBHC Improvement & Advancement bolsters existing behavioral health services to reduce recidivism, opioid related death and return to homelessness. Black Angelenos, who represent over 70% of Crenshaw & Leimert Park residents, are at exponentially higher risk. Southern California Health and Rehabilitation Program, a Black-led organization, will close these health disparities for 450 clients experiencing serious mental illness and substance use disorders. SCHARP has been a continuous provider of Behavioral Health (BH) and related services to adults and children in Los Angeles County since 1994. The Population of Focus is unhoused and/or justice involved Black adults and young adults in South Los Angeles with serious mental illness (SMI) or substance use disorders (SUD), including veterans. Children/adolescents with serious emotional disorders (SED) are also included, and those with co-occurring disorders (COD) and a general SMI/ SUD/SED/COD population. Strategies and interventions include process improvements to enhance delivery of the nine CCBHC Core Services (Crisis mental health services; Screening, assessment, diagnosis, and risk assessment; Patient-centered treatment planning; Outpatient mental health and substance use services; Primary care screening; Targeted Case Management or TCM; Psychiatric rehabilitation; Peer support; Intensive, community-based mental health care veterans). Interventions also include Evidence Based Practices: Motivational Interviewing; Seeking Safety; Cognitive Behavioral Therapy; Assertive Community Treatment (ACT). Goal 1 is to reduce risk of opioid related deaths in POF through onsite, same day MAT/MOUD treatment. Related objectives are to train all staff in MAT/MOUD and Targeted Case Management for SUD, ensure at least one MAT prescriber is scheduled daily for walk-in treatment, establish a trigger and same-day referral in internal workflow for OUD risk, as well as quality assurance program to ensure 42 CFR Part 2 documentation. Goal 2 is to Reduce POF risk of returning to homelessness by increasing access to Targeted Case Management & Assertive Community Treatment, an Evidence Based Practice. Related objectives are to establish risk assessment for return to homelessness, 100% enrollment in of those at risk in TCM and ACT, and engage population health strategies to stratify risk and focus team efforts. Goal 3 is to reduce recidivism through peer support by ensuring 100% of clients with recent incarceration are paired with peer with lived experience of justice involvement. Target minimum number of clients served are as follows: 75 in Year 1; 125 each year for Years 2 through Year 4 (Total 450 over four years).

Southeast Healthcare (SE) provides a comprehensive range of community-based integrated behavioral and physical health care services as a CCBHC-E grantee in eight diverse Ohio counties (Franklin, Delaware, Morrow, Belmont, Harrison, Monroe, Tuscarawas & Carroll). Through the Southeast CCBHC IA project, SE intends to improve and advance the CCBHC model throughout the organization and service area, with specific enhancements in care coordination, accessibility, trauma-informed care, and suicide risk response. SE primarily serves those living with severe mental illness (SMI), and/or substance use disorders (SUD) with low socioeconomic status and facing health disparities. The population of focus covers the lifespan, from children and youth with severe emotional disturbances through older adults with SMI, and/or SUD with a specific focus on the homeless population, those involved with the criminal justice system, and the Appalachian population in the service area. SE intends to address disparities and other barriers typically faced by these populations. SE will serve 1,500 individuals total during the four-year period (350 in years 1 and 4, and 400 in years 2 and 3).Goal 1: Enhance access to and availability of services to members of historically underserved subgroups and to those most urgently in need of care. Objectives: 1.1- 25% of enrollees will represent one or more of the four target populations. 1.2- Take immediate action on behalf of 100% of individuals who identify an emergency need, and provide services within 1 day for individuals who identify an urgent need, within 10 days for individuals who identify routine needs. Goal 2: Increase integration of comprehensive PH, BH and adjunct service delivery. Objectives: 2.1- Attendant to domains 1 (screening, referral, and follow-up) and 7 (linkages with community and social services) of the Comprehensive Healthcare Integration (CHI ) Framework, 80% of individuals in each annual enrollment cohort will be screened for SDoH. 2.2- Attendant to domains 1 and 7 of the CHI Framework, 75% of individuals who screen positive for an SDoH will receive a timely referral and follow-up. 2.3- Attendant to domain 4 (self-management support) of the CHI Framework, 45% of individuals will report increased self-efficacy to manage chronic healthcare conditions. 2.4- Attendant to domain 5 (multidisciplinary teams) of the CHI Framework, 100% of SE staff requests for multidisciplinary care conferences will be fulfilled by CCBHC staff. Goal 3: Expand and advance care coordination to achieve improved health outcomes. Objectives: 3.1- Launch a risk-stratification system to improve alignment between individual needs and care coordination services. 3.2- Implement organization-wide Case-to-Care Training for case managers and team leaders/supervisors in collaboration with a trainer affiliated with the National Council CCBHC success center. 3.3- 100% of individuals discharged from inpatient acute-care hospitals will have a contact attempt documented within 24 hours of discharge. 3.4- 100% of all individuals hospitalized for a suicide attempt will have a multi-disciplinary care team meeting within 7 days of discharge, led by an independently licensed staff member to produce an enhanced care plan. 3.5- 50% of individuals in the annual enrollment cohort will demonstrate improvement in self-reported BH symptoms, overall health and/or clinic measured PH indicators. Goal 4: Strengthen the organizational climate for integrated, wholistic, person-centered, trauma-informed care. Objectives: 4.1- SE will conduct at least one organization-wide EBP/promising practice training, which addresses one or more core IHC element and which includes an experiential component and follow-up. 4.2- During the course of each EBP/promising practice training, SE and project leadership will identify staff champions to provide in situ support and reinforcement to staff engaged in delivering the focal EBP/promising practice.