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The Tiwahe Glu Kini Pi (TGKP)System of Care on the Rosebud Reservation in South Dakota serves the Sicangu Lakota Oyate, known as the Rosebud Sioux. TGKP will expand its program to ""Bring the Family Back to Life” - Tiwahe Glu Kini Pi – through services to the LGBQTIA+ or Two-Spirit children, youth, and families and to disabled children, youth, and families; will expand opportunities for trauma-informed service and healing practices to parents, school personnel, and tribal employees; and provide training to the community to increase knowledge and positive inclusion of Two-Spirited youth in Lakota traditional and contemporary activities. TGKP will serve 185 youth, ages birth-21 in a four-year period. Within the TGKP Expansion, there are three goals and eight objectives. Goals and Objectives include: GOAL 1: Improve mental health outcomes and well-being for LGBTQIA+ children aged 3-18 and their families by enhancing access to culturally competent and affirming mental health services. GOAL 2: Improve mental health outcomes and well-being for physically disabled children aged 3-18 and their families through engagement with the Equine-Assisted Mental Health Therapy and other Lakota traditional and ceremonial practices. GOAL 3: Increase the capacity of the local school districts to use culturally relevant and trauma-informed practices to improve social and academic outcomes for LGBTQIA+ students. The TGKP Expansion Project will serve 40-50 youth each year, ages 3-21 and their families, called relatives within the TGKP. Relatives may come from any of the 20 tribal communities, may be referred from one of the TGKP partners, or may self-refer. The Year 1 federal request is $994,332. The TGKP non-federal match is $773,057.

Project Abstract Summary PACT for Families Collaborative (PACT), was established in 1993 as a Children's Mental Health and Family Services organization serving five rural Minnesota counties. PACT proposes Journey to Independence (JTI) to support youth ages 14-21 who have emerging mental health issues, or are at risk for SED/SMI diagnoses, while also offering support for their parents. PACT will employ the Transition to Independence Planning (TIP) Model® and engage in collaboration with essential community resources, mental health providers, and policymakers. JTI will provide services to 108 unduplicated youth throughout the four-year project term. With our existing JTI program operating at full capacity, this proposal will extend our services to include youth aged 14 and 15, while maintaining support for those aged 16 to 21. We will serve 27 unduplicated youth in the first year and maintain this number annually for years two through four. Project staff and collaborative partners will develop early identification protocol, providing early intervention to help prevent emerging mental health issues from progressing to SED/SMI diagnoses. Project staff will assist youth in developing greater social and emotional skills to enhance self-sufficiency and independence while emphasizing the role of parents/guardians in guiding and supporting their youth through the transition to adulthood. Using the TIP Model® and Vroon MiiWrap ® Wraparound, the project will utilize in-person coaching throughout five domains, including employment, education, housing, life skills, and wellness to enhance the youth and young adult participants coping skills and effectively prepare them for transition. Ensuring these youth receive wraparound support, JTI focuses on enhancing the skills and capacities of parents to support their youth/young adults through one-to-one support, education, and resource navigation. JTI proposes to serve 300 parents/guardians over the four years through the implementation of an educational seminar series, one to one support sessions, community outreach through correspondence and social media, and by facilitating parent networking groups and educational opportunities. We will help our participants learn about mental health and community resources that can be shared to support parents, learn about providers and staff involved with the project. This proposal will leverage PACT’s Five County Local Children’s Mental Health Advisory Council (LAC) to establish a subcommittee that will serve as the JTI Advisory Committee. This committee will be dedicated to collecting data and proposing strategies aimed at addressing service delivery gaps and funding shortfalls, with the overarching goal of enhancing the system of care across the five-county service region. Putting sustainability at the heart of this project reinforces PACT’s commitment to changing the system of care as it exists today, thereby demonstrating to rural Minnesota communities how they can support this vulnerable population. JTI represents an approach to service delivery and wraparound support aimed at reducing SED/SMI diagnoses among rural youth. By increasing resilience, strengthening parent-child bonds, and advocating for community involvement, we aim to transform the current service system model. This initiative seeks to demonstrate the value of investing resources in addressing crucial life transitions, ultimately sustaining positive system changes indefinitely.

The Brevard Behavioral Health Expansion Project (BBHE) will impact children, youth, and young adults who are currently involved in or are at risk of child welfare involvement and have behavioral health challenges. The target population of focus for direct services is children and youth ages birth through 21, along with their respective families, with priority made to individuals who are identified as neurodivergent, who are at risk with serious emotional disturbances. This includes the population that identifies as a member of the Black and Indigenous People of Color (BIPOC) and LGBTQI+. GOALS (1) Increase availability of Evidence-Based and Promising Practices by providing access to quality treatment - Obj 1: Provide EBPs for at least 100 children and youth annually; Obj 2: Will promote the expansion of Evidence-Based Practice (EBP) within the system of care; Obj 3: The BBHE project will assist in adding at least 5 new partners to the Brevard Family Partnership Preferred Provider Network annually. GOAL (2) Increase the inclusion of the child/youth and family voice by analyzing the existing use of lived experience in the System of Care - Obj 1: The BBHE project conducts a needs assessment and C.A.R.E.S. model study during the first year of the grant; Obj 2: The BBHE project will promote the expansion of advocates for children and youth within the system of care; Obj 3: The BBHE project with work with existing supports to provide resources to expand the reach by increasing participation with these groups by 10%. GOAL (3) Increase collaboration among child welfare, judicial, educational, health, behavioral health & substance abuse systems to help advocating for policy change - Obj 1: The BBHE project will work to develop or revise written guidelines to improve behavioral health delivery; Obj 2: A minimum of 100 individuals annually; Obj 3: The Project Lead Family Coordinator will provide linkage and support to community support groups for parents and children identified on the neurodiversity spectrum; Obj 4: The project will host no less than 6 hours of collaborative community conversations or focus groups annually to discuss challenges to individual and family outcomes. GOAL (4) To expand the collection and use of data for continuous system improvement - Obj 1: Quarterly report cards will be produced by FidelityEHR to evaluate the BBHE project's effectiveness; Obj 2: The BBHE Project Management Team will review quarterly report cards and maintain a Continuous Quality Improvement (CQI) Plan; Obj 3: The Project Director will work with the community partners to develop and implement a sustainability plan.

Grant for Expansion and Sustainability of the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances Abstract The Department of Health and Human Services (DHHS) oversees the delivery of services to youth and their families. This grant will be used to sustain current services and expand the System of Care to youth in which data shows the highest disparities in mental health and emotional disturbances, including LGBTQIA+, refugee, immigrant, youth experiencing homelessness, and youth ages 2 -11.System delivery will include the following youth serving agencies: Office of Substance Use and Mental Health (OSUMH), Child and Family Services (DCFS), Juvenile Justice and Youth Services (DJJYS), Juvenile Probation, and Services for People with Disabilities (DSPD). With the money awarded from this grant, an additional 220 unduplicated youth will receive services. Grant requirements will be met by the four following goals: Goal 1: Outreach and engagement strategies effective for LGBTQIA+ , refugee, immigrant, and youth experiencing homelessness with Severe Emotional Disturbance/Severe Mental Illness (SED/SMI) and their families by increasing access strategies to evidence based practices. Goal 2: Focus efforts on youth ages 2 -11 with SED/SMI providing earlier interventions, increased access to assessment, diagnostic services , and evidence based practices for youth and their families. Goal 3: Increase access to diagnostic, clinical mental health assessment, and evidence based practices such as Parent Child Interactive Therapy (PCIT), Safecare, Motivational Interviewing (MI), Families First (FF), Dialectical Behavioral Therapy (DBT), Functional Family Therapy (FFT), and Trauma- Focused Cognitive Behavior Therapy (TFCBT). Goal 4: Support other child/youth serving agencies by providing alternative options to keep youth with SED/SMI in their homes, school, and communities. Adherence to these goals and outcomes will be monitored by the DHHS Data, Systems and Evaluation team.

Allegheny County Department of Human Services (ACDHS) seeks to enhance and expand its Mental Health/Child Welfare Community of Practice System of Care (CoPSOC) to improve access, coordination and quality of mental health (MH) services for children, youth and families. The geographic catchment area for this project is Allegheny County (AC) in Southwestern PA. The population of focus will be families and their children/youth ages birth to 21 years who are at risk for or experiencing Serious Emotional Disturbances (SED) or Serious Mental Illness (SMI) and are 1) involved with child welfare (CW) or with both CW and Juvenile Justice (JJ), or 2) enrolled in participating schools with two or more family members at risk for or experiencing SED/SMI; CW/JJ involvement is not a requirement. In FY 2022-23, 5,074 children and youth in AC were active with CW. This cohort was 37% White and 63% People of Color (POC)—predominantly Black (60%)—and approximately 50% male and 50% female (legal sex). They ranged in age from under 1 (499 or 9.8% of the total) to 21+ (3 or 0.1%). Numbers of CW-involved children and youth remained fairly steady each year between ages 5 through 17 (between 200-300 or 5%-6%). The racial profile changed slightly in the cohort of 1455 active with both CW and MH (41% White and 56% Black). As might be expected, the numbers of dually involved children and youth increased with age, peaking at age 14 at 9% and not significantly decreasing until the ages of 18 and older. In AC, 60,755 distinct individuals (18,581 of whom were individuals under the age of 21) were active with publicly funded MH services in FY 2022-23. Of those, 2,985 (5%) individuals of any age were also active with the CW system; 1,455 (8%) of those individuals were children who were dually active with the MH and CW systems. Among youth aged 12-17 being removed from the home during 2018-2023, 57% had MH service activity in the year prior to placement; those aged 12-17 with any mental health services in the year prior to removal were placed in family settings at a rate that is 26 percentage points lower (58% vs. 84%) than youth in the same age grouping without recent MH services. Youth who are concurrently active with CW and JJ in AC also have high MH service utilization. Of the 219 crossover youth in FY 2022-23, most (92%) received MH services at some point in their lives. This project will also serve youth and families from outside the CW/JJ systems who will be referred from school districts (SDs) in low-income communities where upstream structural forces and persistent racial disparities have had an adverse effect on social determinants of health. In FY 2022-23 the student population in Sto-Rox SD, for example, was 71% POC/66% Black. Black students were overrepresented in the MH (57%), CW (69%) and JJ (86%) systems. In Pittsburgh Public SD, a statistically smaller (50%) but numerically larger Black student population was similarly overrepresented in MH (58% active) and CW (75% active), and particularly in JJ (85% active). Families that are active with CW frequently have complex needs and are involved with multiple systems, including MH. In FY 2022-23, 2,167 families were active with CW. Of these families, 1,585 (73%) had at least one family member receiving MH services in the same FY and/or in the two prior FYs. Forty percent (40%) had two or more individuals receiving MH services in the same FY; 58% had two or more individuals with MH services in the same FY and/or in the two prior FYs. The CoP SOC proposes to serve at least 240 participants over the entire project: 60 in each of the 4 years through MH Family Case Management (MHFCM). Objectives include: MHFCM involved individuals will have been referred to at least one evidence-based MH support or service; all MHFCMs will be trained in trauma-informed care; cross-system best practices; and MHFCM will be sustained through Medicaid.

The Hawai'i State Child and Adolescent Mental Health Division (CAMHD) has utilized the system of care (SOC) approach for decades. The proposed grant, Workforce Activities in Action, is intended to further enhance these efforts and promote behavioral health equity through (1) infusion of evidence-based and culturally appropriate practices, (2) integration of youth and caregiver lived expertise into system design, and (3) multilevel interagency collaboration. CAMHD has longstanding experience incorporating evidence-based and culturally appropriate practices within a statewide public mental health system to serve youth with severe emotional disturbances (SED). CAMHD has made strong progress toward the early adoption and implementation of several well-known evidence-based practices (e.g., FFT, MST, TF-CBT, CBTp, MBC), and the use of a integrated knowledge management system to inform clinician decision-making yet has faced numerous provider workforce shortages in recent years. This has resulted in youth experiencing lengthy waitlists, risking a decline in functioning and an initiation of services at a higher level of care than initially necessary. Additionally, youth in the system have experienced ongoing historical trauma and cultural oppression, and significant stressors following the COVID-19 pandemic and the Maui wildfire disaster. Thus, the proposed grant is designed to (a) enhance workforce capacity (i.e., investment in the workforce via meaningful professional development, novel reimbursement strategies, and a sustainable recruitment infrastructure), (b) increase training in evidence-based practices and processes, (c) strengthen care coordination to improve family and youth engagement and practice-level interagency coordination, (d) elevate the voice of youth and caregiver peers with lived expertise, (e) increase access to evidence-informed and culturally appropriate supports that promote social, cultural, and/or environmental connectedness, (f) strengthen system-level interagency collaboration to support implementation and sustainability of the SOC approach, and (g) ensure effective dissemination and implementation of grant and SOC goals via proactive continuous quality improvement. The proposed grant will serve 25 (Year 1), 50 (Year 2), 75 (Year 3), and 100 (Year 4) multiethnic youth with SED and significant functional impairment in the East Hawai‘i and Maui Family Guidance Centers for a total of 250 youth.

The Ottawa System of Care (SOC) Expansion Grant will serve youth aged birth to 21 and their families living in Ottawa County experiencing or at risk of serious emotional disturbance and/or substance use, with an emphasis on those living in poverty, and those under-served by current community services. Ottawa SOC will continue to focus on education, dissemination, implementation, and integration of culturally competent, trauma-informed, evidence-based system of care for youth and families. The SOC will be family-driven, youth guided, trauma and grief-informed and culturally and linguistically proficient at the system, practice, and service levels. Funds will be used to maintain and expand the infrastructure for this county-wide approach, provide training and technical assistance to behavioral health providers, juvenile justice personnel, school staff, and youth and their families. Services for the target population will be enhanced through increasing mental health providers, providing transitional support, and expanding coordination with school, juvenile justice, DHHS and community agencies. Program goals are to: 1) increase parent/caregiver support; 2) increase access to crisis care for at-risk youth and reduce gaps in care; 3) increase access to care for at-risk youth; 4) decrease mental health stigma; 5) train staff, community providers and parents on mental health; 6) improve community-wide collaboration of youth-services; and, 7) coordinated approach for suicide intervention for at-risk youth. Over the course of this project, 465 youth will be served (85 in year 1; 105 in year 2; 125 in year 3; and 150 in year 4) through the System of Care Expansion.

The goal of this project is to improve the mental health outcomes for children and youth, birth through age 21, at risk for or with serious emotional disturbances, and their families, by creating sustainable infrastructure with incorporation of the system of care approach within the Connected Families NH service area. Specific infrastructure development objectives to fill service gaps include (1) the creation of a “Brief Enhanced Care Coordination” (BrECC) service to supplement other more intensive care coordination programs offered by CFNH; and (2) expanding access to high-quality, “stand alone” intensive in-home supports (IIHS). This work will be supported and continued by objective 3, assessment and sustainability planning, which encompasses administrative, outreach, capacity, and evaluation activities. Both BrECC and stand-alone IIHS can be provided more quickly and cost effectively than traditional wraparound, enhancing the service array for families who do not want or have the capacity for a long-term, intensive service. All objectives increase youth and family voice and choice, while facilitating the provision of the fewest, least intensive services necessary to meet the youth/family need and improve outcomes. The population of focus is children and youth, from birth through age 21, at risk for or with serious emotional disturbance SED, and their families. The entire project will directly serve an estimated 82 children/youth per year and 326 over four years with brief enhanced care coordination and intensive in-home supports. It will benefit all of the 185,911 people who live in the rural catchment area of west-central and southwestern part of New Hampshire, where 4.2% are people of color, about 10% live in poverty, and 41.5% are vehicle-poor in an area with practically no public transportation. The focus of Connected Families Expansion project is to broaden its programmatic scope. It will align with the state and other similar initiatives to achieve broader systems change needed to expand and sustain the SOC approach. All services provided through or in collaboration with Connected Families Expansion project will be evidence-based, culturally competent, and family-driven.

Bexar County adolescents are coming to the attention of different stakeholders with multiple, complex needs. These stakeholders include the public school system, juvenile probation and child protective services. Service capacity is not meeting the need. For example, the local Community Resource Coordinating Group (CRCG) only serves five adolescents/month and there is no local residential mental health facility for indigent adolescents; foster children are being housed in local hotels; and, there is a dearth of child clinicians. The Bexar County System of Care (SOC) will create a seamless, integrated system of care for children in which there is ""no wrong front door"" and complex adolescents are provided comprehensive, timely services. It will do so by expanding the capacity of the existing infrastructure. Specifically, the Bexar County Health Collaborative will expand its Pathways Community HUB model and Community Health Worker model to serve 600/adolescents/year. This will allow for intake, referral and service coordination for 2,400 complex adolescents over the course of the four year period. The CRCG will double its capacity from five adolescents/month to ten adolescents/month. The Continuum Outpatient Center will serve an additional 60 adolescents/year with intensive day treatment services. Hallmarks of the program will include: partnership with community-based organizations; trauma informed care; an emphasis on suicide prevention and intervention; service provider training; family and youth engagement; and outreach and engagement strategies. The Department of Behavioral Health Services and the Bexar County Health Collaborative will co-manage the grant program. A Project Director will be hired with grant funds and be answerable to the Department while the Lead Family Coordinator will be hired and answerable to the Health Collaborative. The Department of Behavioral Health Services will engage in numerous contractual relationships with the Bexar County Health Collaborative, Continuum Outpatient Center, the network of outpatient treatment providers and a university-based program evaluator.

The Yakama Nation (YN) System of Care Expansion (SOC) grant will serve Native children and youth, birth through age 21, at risk for or with serious emotional disturbance (SED) and serious mental illness (SMI), and their families. The geographic catchment area will be Yakima County (YC) with a specific focus on the lands of the Confederated Tribes and Bands of YN. YNBHS will increase access to evidence-based and culturally appropriate mental health services by expanding crisis stabilization services including intensive care coordination; increasing providers' capacity to deliver culturally relevant, evidence-based services as well as trauma- and grief-informed services; coordinating with YN Tribal School; and engaging children/youth and families in all levels of the SOC. The SOC expansion grant will increase YNBHS’ capacity to deliver culturally relevant evidence-based interventions, integrate traditional healing practices into the YNBHS and YN Tribal School, and strengthen referral pathways between YNBHS and its tribal partners. The YN SOC will serve approximately 250 unduplicated children, youth, and young adults at risk for or with SED/SMI across the 4-year period. The grant will achieve the following goals. (1) Strengthen YNBHS SOC governance structure by improving coordination with the YN Behavioral Health Coalition Board. (2) Increase YNBHS SOC capacity to provide culturally appropriate intensive care management services to children/youth with SED/SMI who have experienced a mental health crisis. (3) Increase YNBHS capacity to provide culturally relevant, evidence-based/practice-based(EB/PB) or community-defined interventions to Native children/youth at risk for or experiencing SED/SMI. (4) Enhance YNBHS and YN Tribal School’s capacity to identify and address trauma (including intergenerational trauma), grief, and loss in children/youth at risk for or with SED/SMI. (5) Increase family and youth engagement and involvement in the development, implementation, and evaluation of the SOC.

The HYPED 4 Change System of Care will improve mental health outcomes for children, youth, and young adults (birth to age 21) at risk for or with serious emotional disturbance (SED) and their families by expanding access to trauma and grief-informed, culturally responsive evidence-based mental health services and related recovery support services, improved policy, practice and infrastructure, cross-agency collaboration and sustainable financing for six rural medically underserved counties in North Central MS: Calhoun, Lafayette, Marshall, Panola, Tate, and Yalobusha. The HYPED 4 Change System of Care expansion will ensure that children, youth, and young adults at risk for or with SED, and their families, receive effective services within their communities and that providers collaborate to coordinate care in a family-friendly and culturally responsive manner. EBPs will include Teen Intervene-Screening, Brief Intervention and Referral to Treatment; Trauma-Focused Cognitive Behavioral Therapy; Parent-Child Interactive Therapy; Eye Movement Desensitization and Reprocessing (EMDR); Moral Recognition Therapy; Wraparound; Crisis Intervention Team (CIT) training; Mental Health First Aid/Youth Mental Health First Aid; youth-guided peer support and family leadership. Project Name: HYPED 4 Change System of Care. Populations served: 52% Female; 47% Male; 1% Transgender; 3% LGBTQIA+; 42% African American; 4% Multiracial; 1% American Indian; 1% Asian; 7% Hispanic/Latinx/Spanish Speaking; 50% trauma/grief-involved; 45% COD; 85% below poverty level; Birth to 21: 2% birth < 5; 23% ages 5-9; 22% ages 10-12; 37% ages 13-15; and 16% ages 16-21. Strategies: The SOC expands trauma and grief-informed care, cultural and linguistically responsive evidence-based mental health services, suicide prevention and intervention, policy development with a co-serving network of agencies strengthening transitional planning, integrated mental health treatment with cross-agency care coordination coupled with wraparound recovery support services with linkages to vocational counseling, education services, primary healthcare, dental, substance abuse prevention, stable housing, including independent living. 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, and support to achieve their personal goals. The SOC expansion will include family/youth peer support, family and youth leadership development, mentoring, and youth-guided activities. Goals: 1) Expand, integrate, and sustain the SOC improving access, infrastructure and sustainable financing while ensuring a flexible, innovative CQI approach, cross-agency collaboration, and implementing trauma/grief-informed care; 2) Meaningfully involve children, youth and young adults and family/caregivers in their own care and the broader governance of the SOC; 3) Facilitate a network of co-serving providers wrapped around the system of care who use trauma and grief-informed care, evidence-based practices and programs to assess, screen, treat, and manage mental health, including suicide risk; 4) Improve mental health functioning, embedding evidence-based and evidence-informed services and supports in early childhood, youth and young adult intervention services and mental health disorders treatment; and 5) Improve health equity with targeted outreach in underserved communities to engage racial, ethnic and LGBTQIA+ minorities into SOC services. Objectives: Between 9/30/24-9/29/28: 1) 100% of 400 will improve access; 2) 80% will improve mental health functioning; 3) 80% will improve employment/education; 4) 80% will reduce criminal justice involvement; 5) 80% will improve housing stability; 6) 80% will reduce admissions to inpatient psychiatric hospitals; 7) 80% will improve social connectedness; and 8) 85% will report high client perceptions of care. # served: 100 in Year(s) 1-4, totaling 400 in four years

The Cortland County Integrated System of Care Expansion Initiative aims to improve mental health services for youth between 12-18 years old, particularly those at risk for or experiencing Serious Emotional Disturbances (SED), and their families in Cortland County, New York. Targeting a population of around 46,126, with a significant portion under 18, the project addresses the growing mental health needs in the area. The project has two main goals, each with measurable objectives to be achieved by September 2028. The first goal is to enhance the System of Care (SOC) through several strategies. These include increasing service referrals by 25% with an integrated referral system, conducting 50 training sessions for service providers to improve skills and knowledge, implementing a new data management system for more efficient case tracking, and raising community awareness about SOC programs by 25% through various outreach and marketing efforts. The second goal is to offer effective and relevant mental health services to youth. This involves training clinicians in Functional Family Therapy (FFT) and Dynamic Deconstructive Psychotherapy (DDP), aiming to provide FFT to 150 children and their families, and DDP to 96 youth. The initiative also targets a 20% reduction in emergency department visits for mental health crises and self-harm among youth and aims to deliver specialized mental health services to at least 85% of youth in foster care. The Cortland County Integrated System of Care Expansion Initiative seeks to strengthen the local mental health infrastructure for young people, focusing on improving referral systems, enhancing provider training, optimizing data management, and promoting awareness of available services. This effort is expected to foster a more effective System of Care that meets the needs of youth and families dealing with SED.

The Missoula County System of Care (MCSOC) will serve children, youth, and young adults ages 0 - 21 at risk for or with serious emotional disturbances (SED) or serious mental illness (SMI) and their families. We will place an emphasis on children, youth, and young adults with multi-system involvement and in need of crisis stabilization and intensive home and community-based services. Our geographic area is Missoula County in Montana and incudes a portion of the Flathead Reservation. MCSOC providers will identify and assess children, youth and young adults and connect them to a fully integrated continuum of coordinated behavioral health services, including crisis stabilization services. These activities align with Missoula County's Strategic Alliance for Improved Behavioral Health’s 2024 Goals and Success Measures of developing a coordinated crisis response system for children and youth experiencing a behavioral health crisis and providing increased support services for youth transitioning from restrictive placements. The MCSOC will serve 325 unduplicated children, youth, and young adults over the course of the four-year grant. The MCSOC activities are centered on the following goals (1) increasing coordination between child-serving agencies by establishing a Strategic Alliance Children’s sub-committee (SACS) to oversee and sustain the MCSOC, (2) decreasing unnecessary emergency room encounters and inpatient admissions by strengthening and coordinating the behavioral health crisis services continuum for children, youth and young adults, (3) reducing the length of stay in inpatient settings by increasing access to community-based transition services, including culturally relevant crisis stabilization services, intensive home-based services and targeted case management, (4) decreasing the number of youth at risk for or with SED/SMI that are involved in the juvenile justice system by strengthening the partnership between juvenile justice and behavioral health and enhancing school-based behavioral supports, and (5) increasing family and youth engagement and involvement in all levels of the system of care. The MCSOC will complete these goals by hiring a project director to implement all SOC requirements and support the SACS, oversee the SOC expansion, implementation, and sustainability, oversee the needs assessment, and develop a training plan. The project director, evaluators and children’s crisis providers will complete a Sequential Intercept Model and a map of the current crisis continuum. Children’s crisis providers will develop and adopt formal referral pathways and polices that increase coordination between crisis services for children, youth, and young adults. The SACS and SOC will develop a cross-system approach to deliver crisis stabilization step down services. The MCSOC, youth court, Missoula County Public Schools and School Resource Officers will develop a formal partnership to develop and oversee a coordinated response to disrupt the school to prison pipeline for youth at risk of or with SED or SMI. The Lead Family Coordinator and a Community Health Worker will be hired and will recruit family members to serve on the Strategic Alliance Peer Advisory Committee and the SACS. They will work with providers to identify the number of families in leadership roles and peer support roles and develop a plan to build capacity.

This project will facilitate the development of the Center for Appalachian Community Prevention to provide support for the enhancement and expansion of youth behavioral health prevention activities across Ohio’s 32-county Appalachian region. The Center will serve as a facilitator of support for and promoter of collaboration across local prevention coalitions, schools, governments, and organizations focusing on prevention activities. This project will 1) enable the development of a strategic operational plan for the center built on community assessment, audits of local programs, and evaluation of a number of pilot strategies in specific locations, 2) expand and enhance youth-led prevention programs through training for youth leaders and engagement with schools not currently offering such programs, 3) provide prevention program training to educators, practitioners, and community members, and 4) evaluate the efficacy of a number of local pilot projects. The Center for Appalachian Community Prevention will provide services and supports across Ohio’s 32 Appalachian counties with deeper focus in eight target counties across the region. These eight counties will serve as sites for pilot projects, initial targets for youth-led prevention supports, and locations for training activities. The Appalachian region exhibits higher poverty rates, less economic opportunity, and lower access to behavioral health services than other regions in the State. Substance abuse, teen depression, and suicide ideation are elevated in the region compared to other regions. These patterns create a unique opportunity for a supportive entity such as the Center to be developed as a result of this project.

Rise Above, a Native-led nonprofit organization based in Washington State, proposes a 12-month project to strengthen its organizational capacity and develop a scalable, replicable model for delivering culturally competent, evidence-based interventions to Native youth and underserved communities of color. The project aims to prevent at-risk indigenous youth from entering the juvenile justice system by providing pro-social, multigenerational, and culturally oriented prevention programs. The project will build upon Rise Above's existing partnerships with tribal communities, urban Native organizations, and community-based organizations serving underserved communities of color. Key activities include: 1. Recruiting and training 4 Regional Program Directors to oversee program implementation across various locations 2. Developing and implementing a comprehensive professional development plan for all staff members 3. Conducting a comprehensive assessment of current programs to identify core components, best practices, and areas for improvement 4. Creating a program manual and training curriculum that outlines the key elements of Rise Above's intervention model, including cultural adaptations, implementation guidelines, and evaluation protocols 5. Piloting the intervention model in at least 2 new communities, directly serving a minimum of 2,000 youth (1,600 Native youth and 400 youth from underserved communities of color) 6. Establishing formal partnerships with at least 5 tribal communities, 3 urban Native organizations, and 2 community-based organizations serving underserved communities of color Rise Above's approach to change is based on the cultural adaptation of the evidence-based Behavior-Image Model (BIM), which incorporates art, culture, music, and sports mentoring to promote healthy behaviors. By building Rise Above's capacity to implement the culturally adapted BIM model in a replicable and scalable manner, the project will enhance the organization's ability to effectively serve Native youth and underserved communities of color, ultimately contributing to the evidence base on culturally competent, evidence-based interventions for these populations. By the end of the grant period, Rise Above expects to have a robust, scalable, and replicable model for delivering culturally competent, evidence-based interventions that can be adapted to serve diverse Native youth populations and underserved communities of color across the country. The project will contribute to the prevention of juvenile justice system involvement, the promotion of health equity, and the overall well-being of Native youth and underserved communities.

Our programs prevent the onset of illegal drug use, prescription drug misuse and abuse, and alcohol misuse and abuse. Our programs provide pregnant and parenting mothers with education and prevention tools around drug use and abuse. They provide them with resources and support to remain sober, and if necessary, seek treatment. They connect them to culture and ceremony. Support is provided before, during and after delivery both one-on-one with doulas and in the Women of Traditional Birthing groups. They can also access other supports at DIW such as our food shelf. Participation in our programs is low barrier. We are located in the heart of the urban American Indian Community in the East Philips/Powderhorn neighborhood and are on a bus line. We have passenger vans for transporting clients. All of our programs are free to community. As an American Indian-led and American Indian-serving organization, DIW is inherently representative of the population we serve. Our leadership team is comprised of the Executive Director, Director of Programs, and Development Officer-all of whom are American Indian. Of the 35 DIW employees (including the leadership team), 86% are American Indian. DIW is governed by a 13-member board of directors, 62% of whom are American Indian

The ""#IRiseAbove Positive Social Norming and Opioid Education Project"" is a substance use prevention initiative that enables Rise Above Colorado (RAC) to maintain and grow its infrastructure, messaging and resources to coordinate and support a statewide network of partners committed to supporting a Positive Community Norms approach to prevention. The project will promote messaging and programming to middle and high school-aged students (ages 12-17) emphasizing that most Colorado youth are not using drugs and alcohol. It will also amplify specific opioid misuse prevention with messaging, educational resources and local implementation activities that increase knowledge and perceived risk of opioids and the presence of fentanyl, thereby increasing action-oriented attitudes and behaviors among youth to help prevent overdoses among their peers through positive social norming and the ability to deploy naloxone. As such, youth peer-to-peer leadership is central to this proposal. This proposal is comprised of several interrelated projects upon which RAC staff will engage with partners, youth and contractors, directly serving more than 5,028 youth participants. Activities include: • Pilot substance use prevention programming in 4 rural Colorado schools in the eastern and western parts of the state • Delivery of educational resource to support increased knowledge, skills & perception of harm about the dangers of prescription drug misuse, fentanyl and other contaminants to 4,500 youth across a 23-county rural footprint • Paid digital advertising for RAC's social norming campaign Fill Your World With Good statewide, with specific saturation-level geotargeting in the 23-county rural footprint identified above. • Facilitation of RAC’s 2024-2025 Teen Action Council (comprised of 28 youth) to support statewide peer delivery of RAC’s educational resources (e.g. Not Prescribed) and social norming messaging (e.g. Connect Effect, Fill Your World With Good) • Updated platforms for youth and adult access to RAC educational resources through the redevelopment of RAC’s adult and youth facing websites (www.riseaboveco.org and www.IRiseAboveCO.org) • Through focus group testing with youth and educators, develop up to 4 updated content modules within the Not Prescribed lesson • Supporting the Community-Based Process work of RAC’s Colorado Constellation Project network of prevention partners, including planning and delivery of its annual Constellation Partner Summit.

Fentanyl abuse has become a pervasive issue in our state, affecting communities across the board. One of the major challenges associated with fentanyl use is the lack of concern from criminal groups regarding the potency of the substance and the absence of warnings about fentanyl content in illegal drugs, thereby increasing the risk of accidental overdoses. In response to this pressing issue, the Pueblo of Laguna is proposing a comprehensive project aimed at employing community health workers and first responders to identify and reach out to vulnerable populations. This outreach effort will be coupled with the procurement of essential resources such as fentanyl test products, naloxone, and other opiate overdose treatment items. The primary goal of this initiative is to provide timely assistance and support to individuals at risk of fentanyl abuse and overdose. By focusing on early identification, targeted outreach, and the provision of necessary resources, the project endeavors to mitigate the impact of fentanyl abuse and save lives within our community.

Implementation and Expansion of Outreach Education Utilizing Original GameChanger Film You Have What It Takes to Elementary and Middle School Students in West Virginia. Background: The GameChanger film and supportive educational materials were developed with the primary goal of reaching elementary and middle school students in West Virginia to provide appropriate prevention education regarding opioid and fentanyl dangers that are prevalent within their communities. Objective: Promote and support proactive, preventative education within a health-based model to encourage substance free schools and communities. Methods: We selected and established partnerships with Elementary and Middle School locations throughout West Virginia to begin implementation of You Have What It Takes film and educational materials. In an effort to bridge community and school, a parent toolkit and educator toolkit will be disseminated along with opioid and fentanyl fact sheets. Data: Established GameChanger schools include an estimated 7,000 elementary school students and 5,000 Middle School students that will have the opportunity to utilize the GameChanger film and educational materials that will be provided by GameChanger Prevention Specialists and Coaches.

Preventing Tobacco Addiction, Baldwin Wallace University, and Ohio State University will embark on the implementation of developing a comprehensive program aimed at reducing youth access to tobacco/vaping products through education, advocacy and the promotion of policies aimed at creating healthier communities. The program will aim to accomplish this mission through education, collaboration and advocacy materials development. From its onset the goal will be to expand upon the current tobacco control efforts in OH by increasing awareness of the current gaps in existing laws while targeting advocacy for the passing of local tobacco retail licenses in 7 municipalities - Athens, Barberton, Cleveland, North Ridgeville, Oberlin, Toledo, and Upper Arlington. Resources produced within this program will include toolkits for advocacy, adoption and implementation of tobacco control laws. We envision this toolkit to include (1) detailed process outline; (2) staffing needs and structure; (3) sample letters to retailers; (4) informational video for retailers about enforcement of current laws; (5) decoy training presentation; and (6) compliance check protocols. In addition to the policy toolkit, we hope these resources will be widely available to Ohio communities by utilizing multiple forms of media produced for the dissemination of information and training. Additionally, the program will include a tobacco enforcement pilot program by conducing 6,000 undercover ""secret shopper"" compliance checks at tobacco retailers across Ohio. At the completion of the program, the Principal Investigators will produce a summary and research publication of the program's success, policy findings, implications, next steps.

Women in Leadership (WIL) will launch a one-year project starting in September 2024, aimed at supporting 150 participants through comprehensive programs that focus on mental health, substance use disorder, domestic violence, recidivism reduction, and family unity. The project targets detained women awaiting release, recently released women in early reentry, and high school students at risk. Project Description: The Women in Leadership (WIL) Empowerment and Support Program will serve 150 participants: 50 adult women detained and awaiting release, 50 adult women recently released or in early reentry, and 50 high-risk students/youth from local high schools. These participants come from diverse backgrounds, including African American, Hispanic, Indigenous, Immigrant, and Asian Pacific Islander communities, and face significant challenges such as displacement, income insecurity, domestic violence, sexual assault, substance abuse, and mental health issues. Strategies/Interventions: The project will implement bi-weekly teleECHO sessions, weekly life skills and job readiness classes, overdose prevention training, and one-on-one peer case management. Specific interventions for youth include suicide and gun prevention programs at five local high schools: Del Norte, Highland, La Cueva, Highland, and West Mesa. For the female incarcerated population, the program will provide weekly in-person training sessions (subject to Covid-19 restrictions) and monthly teleconference meetings over 36 weeks. Project Goals and Measurable Objectives: • Improve Mental Health and Well-being of Participants: Conduct 24 bi-weekly teleECHO sessions annually with at least 75% attendance and 80% positive feedback. Distribute 500 mental health educational materials. • Enhance Life Skills and Job Readiness: Develop two life skills and job readiness curricula, conduct 52 workshops annually with a 70% attendance rate and 80% positive feedback. Establish 10 partnerships to achieve a 30% employment rate among participants post-program. • Reduce Substance Abuse and Overdose Incidents: Conduct 52 overdose prevention and harm reduction training sessions annually, distribute 300 naloxone kits, and reduce overdose incidents by 10%. • Support Incarcerated Women with Reentry and Transition: Implement 36 weekly in-person training sessions and 12 monthly teleconferences annually, ensuring a 70% attendance rate. Provide reentry support to 50 participants, with 70% showing improvement in housing stability. • Provide Comprehensive Peer Case Management: Conduct at least 150 case management sessions annually, with 5 additional case managers trained and hired. • Increase Awareness and Advocacy Skills: Distribute 500 advocacy training materials and conduct 12 advocacy workshops annually with 80% positive feedback. • Strengthen Team Cohesion and Effectiveness: Conduct 4 team building sessions annually with a 90% staff satisfaction rate. Provide 12 professional development opportunities with 80% staff participation. • Ensure Project Accountability and Continuous Improvement: Hold 4 quarterly evaluation meetings annually, ensure 100% on-time submission of reports, and implement a data management system within 3 months with 90% accuracy in data tracking. By addressing these measurable objectives, the Women in Leadership project aims to provide comprehensive support that bridges existing service gaps, enhances participant outcomes, and fosters community well-being in Southwest New Mexico.

Thrive Mat-Su, a multi-sector Alaskan community coalition, seeks to prevent and reduce youth substance use, increase protective factors, and improve community wellness in the Mat-Su Borough. Thrive Mat-Su will serve youth and young adults 12-20 amounting to approximately 25,000 unduplicated individuals. The coalition is committed to building healthy environments and ensuring youth can access safe, supportive spaces and positive relationships with adults and peers in their community. Thrive Mat-Su uses the Strategic Prevention Framework and CADCA's seven strategies to guide its work as it seeks to address preventing youth substance use through a public health approach. The coalition's strategies involve supporting youth-serving organizations, providing opportunities for youth, sharing information, encouraging the adoption of policies that support youth and their families, and building a strong prevention network in the Mat-Su. Thrive commits to the following strategies to improve community wellness and reduce youth substance use in the Mat-Su Borough: *Enhance Positive Youth Development*Amplify Youth Voice*Advocate and Communicate*Grow Community Prevention Capacity.

The Martinsburg Initiative (TMI) is a police, school, community, health, and education partnership working to prevent substance use disorders, build strong families, and empower the community. TMI utilizes a tiered prevention model aimed to increase awareness, identify risk factors, intervene, and mitigate negative effects of trauma or substance use. TMI will use strategies to screen for Adverse Childhood Events (ACEs) and trauma among youth and connect them to case management and behavioral health services. Employing long-standing, strong collaborative efforts, TMI will ncrease youths’ perception of risk, reduces substance use through educational activities, addresses root-causes of addiction, and reduces exposure to ACEs among youth. TMI will build strong families through resiliency building in-home parenting programs and supports for social determinants of health. TMI will empower the community with skills to recognize ACEs and trauma which enhances all tiers of the prevention model. TMI services the residents of Berkeley County, WV, population approximately 122,000. The geographic area served is Martinsburg, West Virginia, including Berkeley County Schools. The racial makeup of the county is 80.52% white, 7.76% black or African American, 1.23% Asian, 3.33% American Indian, and 2.6% from other races. Hispanic or Latino make up 5.65% of the population. 30% of the population in Martinsburg, WV (5.04k out of 17.1k people) live below the poverty line, a number higher than the national average of 12.3 From 2019-2022, Berkeley County EMS reports 177 overdoses among individuals aged 0-19 with 3% dead on scene. During the same period, Emergency Department reports 157 visits related to overdoses among individuals aged 0-19 with 1.5% deceased in ED. TMI utilizes a multi-tiered system of supports including primary, secondary, and tertiary prevention of ACEs. Tier 1 supports include increasing awareness and knowledge of ACEs and SUDs in the community. Tier 1 activities work towards building a trauma-informed community. Tier 2 supports include identifying and intervening for those at risk for ACEs and SUD by providing resources and services through screenings and risk stratification. Tier 3 supports primarily focus on providing mitigation methodologies that increase protective factors and address Social Determinants of Health (SDoH). Goal 1: Increase awareness of how to prevent substance use disorder through outreach, education, and training Sub Goal 1:1 Increase community awareness of ACEs and addiction prevention. Sub Goal 1.2: Build resilience and enhance protective factors by fostering safe, stable, and nurturing relationships/environments Goal 2: Identify, risk stratify, and offer interventions for individuals experiencing risk factors of trauma or substance misuse Sub Goal 2.1: Identify children and families that have experienced trauma. Sub Goal 2.2: Identify the level of risk for trauma. Sub Goal 2.3: Offer support and resiliency-building activities for at-risk children referred to TMI Goal 3: Mitigate negative consequences resulting from substance misuse or trauma through community interventions Goal 3: Mitigate negative consequences through community interventions Sub Goal 3.1: Provide wraparound services for children experiencing complex trauma.

Westfield State University requests funding to implement the Resilience Rising: Uniting for Suicide Prevention and Mental Wellness project. This project aligns with the objectives outlined in both the federal government's National Strategy for Suicide Prevention (Goal 7) and the Massachusetts Strategic Plan for Suicide Prevention. The need for evidence-based training in suicide-specific assessments, management, and the delivery of effective clinical care is critical. Suicide is the second leading cause of death among young adults aged 10 to 24 and the 15th leading cause of death overall in Massachusetts. The goal of our project is to 1) prevent and reduce instances of suicide, mental health, and substance use disorders while promoting help-seeking behavior and reducing stigma, and 2) improve the identification and treatment of at-risk WSU students, so they can successfully complete their studies and thrive academically, emotionally, and socially. Objectives include: Objective 1. Establish a dedicated Behavioral Health Coordinator position to oversee the development and implementation of comprehensive behavioral health services. This position will be a clinician who can provide case management and conduct assessments. It will increase the capacity of the Counseling Center to treat more students, conduct drug and alcohol assessments, and work with stakeholders to provide comprehensive educational and prevention programming. Objective 2. Reduce the counseling hours-to-staffing ratio from 405 hours per staff member to 365 hours per staff member, to provide a more sustainable and effective mental health service delivery model, benefiting both counselors and clients alike. Objective 3. Improve coordination of education and outreach of mental health services by working with a team of stakeholders including LGBTQIA+ student groups, Office of Veteran Services, Residential Life, and others. This group will hold one meeting per semester with stakeholders to coordinate events, messaging, and resources to promote mental health. Objective 4. Train a group of individuals through a Clover.edu train-the-trainer program. Trainers will conduct training sessions for at least 300 additional faculty, staff, and students over the grant period. This program will be designed specifically for suicide prevention training for college students. By implementing these strategies and fostering collaboration with key stakeholders, WSU will create a comprehensive and inclusive approach to mental health promotion and suicide prevention. This will help create a supportive and inclusive campus environment where all students, including LGBTQIA+ students and veteran students, feel valued, supported, and empowered to seek help when needed.

Stanford University's National Center for Mental Health: Dissemination, Implementation, and Sustainment (MHDIS) will develop pragmatic, accessible implementation science-based resources and provide high-impact technical assistance (TA) to build the capacity of SAMHSA recipients and mental health providers to disseminate, implement, and sustain effective practices, thereby increasing access to effective mental health services for people in need. Housed in the Stanford University School of Medicine’s Center for Dissemination and Implementation, the MHDIS brings together national leaders in dissemination and implementation (D&I) science, five bi-regional centers with long-standing expertise in delivering targeted and intensive TA, and a network of national, state, and local partners. People at risk for or with mental health disorders have difficulty accessing any care, effective treatments, or treatments delivered effectively (with high fidelity to original models), especially underserved and historically minoritized populations. These issues reflect gaps that the mental health field faces in dissemination, implementation, and sustainment of evidence-based practices (EBPs). D&I science is the study of how to successfully integrate effective interventions in settings. Current, non-research based TA relies on light touch strategies, such as webinars and one-time training, that have little to no impact on practice change, whereas mental health providers need intensive support to embed new, often complex or organization-level interventions. The MHDIS will provide targeted and intensive TA that is more likely to lead to practice change. Also, the MHDIS will have a unique focus on "the how'' or process of practice change, translating findings from D&I science into pragmatic resources and targeted and intensive TA services to address national gaps, barriers, and problems faced by CMHS recipients and mental health-related organizations. The MHDIS has two goals and associated objectives. A) Increase availability of D&I science-based resources on how to disseminate, implement, and sustain effective practices. A Consultative Monitoring Board will provide guidance on MHDIS priorities and workplans. A Technical Expert Panel will work with MHDIS staff, regional partners including CMHS recipients and organizations that oversee or provide mental health services, and communications and marketing experts to identify, develop, and disseminate resources in eight core D&I science topic areas. B) Increase the capability of CMHS recipients and organizations that oversee or directly provide mental health services to disseminate, implement, and sustain effective practices. Five bi-regional Mental Health TA Centers (MHTACs) will be established and provide targeted and intensive TA, leveraging the eight core resource areas. They will work closely with SAMHSA-funded TA centers to provide them TA on how to design more effective services, and coordinate with them to provide TA (e.g., with the MHDIS/MHTACs providing expertise on the 'how’ of change management and the TA centers providing EBP-specific expertise). Our evaluation plan uses D&I science-based evaluation strategies to ensure that our resources and services have utility and acceptability and lead to practice change. Based on our focus on more resource-intensive, high impact TA and our audience of CMHS recipients and organizations that oversee or directly provide mental health services, we anticipate serving the following number of organizations: Y1-555; Y2-1,125; Y3-1,175; Y4-1,225; Y5-1,275; for a total-5,355.