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The District of Columbia (DC or the District) Department of Behavioral Health (DBH or the Department) intends to use the Promoting Integration of Primary and Behavioral Health Care (PIPBHC) grant to expand services for Medicaid-eligible and uninsured adults with serious mental illness (SMI) and significant co-occurring physical health conditions, particularly focusing on older adults (aged 55 or older). In Fiscal Year (FY) 2023, DBH served 43,427 individuals. Of these individuals, 11,882 (31%) were adults aged 55 or older, 67% African American, 3 percent Hispanic, 2% white, and 48% male. According to the 2021-2022 SMASHA National Survey on Drug Use and Health (NSDUH), approximately 26.6 percent of adults have any mental illness and 6.4 percent have an SMI in DC. DC also has the second-highest overdose death rate in the country. Between 2016 and 2020, 76 percent of fatal opioid overdoses occurring in adults aged 40-69, and 84 percent of these deaths were African Americans and 72 percent were males. DBH serves approximately 2,000 adults annually in its Assertive Community Treatment (ACT) program, with 100 percent of enrollees living with an SMI and approximately 80 percent also living with at least one co-occurring physical disorder. Additionally, 75 percent of the 531 individuals currently served in our Mental Health Community Residence Facilities are over the age of 55, and 80 percent of them have serious co-morbid medical conditions and DBH receives at least three requests per week for increases in bed capacity. In this project, DBH intends to partner with at least two community agencies who serve these underserved and historically marginalized populations, one of which will be a primary care provider using the Collaborative Care Model and the other will be a Community Behavioral Health Clinic (CCBHC) such as: (1) Freedman's Medicine, a primary care center currently using the Collaborative Care Model and focuses on low-income older adults and individuals with disabilities and behavioral health conditions. Freedman's Medicine indicates that the 500 people they serve reflect resource constraints and they estimate with additional funding they could increase their service population to 2,000 people per year and could more effectively address the unmet needs of the community; and (2) Hillcrest Children and Family Center (Hillcrest), a DBH-certified behavioral health provider that served 1,131 Medicaid recipients including 831 adults in FY23. In 2023, Hillcrest became a CCBHC after receiving a SAMSHA Expansion grant to build up the infrastructure needed to deliver fully integrated behavioral health and primary care services to its patients. The Department will use the funding support from this grant to support Freedman's Medicine and Hillcrest to expand their existing integrated care efforts and reach more patients in need. In the implementation of this project, DBH plans to use a minimum of three Evidence-Based Practices (EBPs): the Collaborative Care Model, ACT, and Mental Health First Aid (MHFA). Collaborative Care is a proven strategy to reduce mental health inequities and improve outcomes for racial/ethnic minority groups and older adults. The PIPBHC grant aligns well with the ACT model as ACT program participants have SMI and often have one or multiple co-occurring chronic medical conditions. Finally, this grant complements the District’s use of MHFA, which trains primary care providers and clinics on behavioral health screening, in particular for those who have older adult patients.

The Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD), established in 2009, provides extensive treatment and support services through a vast network of community providers, ensuring comprehensive care for behavioral health and developmental disabilities. Under Commissioner Kevin Tanner's leadership since January 2023, DBHDD maintains a centrally managed, functionally aligned organizational structure that enhances efficiency and accountability. Community-based and recovery-oriented services are primarily provided through a system of 22 Community Service Boards (CSBs) throughout the State. DBHDD supports a Crisis and Access Line 24/7/365 that is also the base for the National Suicide Prevention Lifeline. Mission-driven to lead an accountable and high-quality continuum of care, DBHDD is proposing to develop a novel model, Promoting the Integration of Primary and Behavioral Health Care: Georgia (PIPBHC-GA), in rural South Georgia pursuant to SAMHSA funding number SM-24-003. Most of Georgia is rural with a decreasing population. When compared to those persons living in more diverse and urban areas, there are disparities in mental health access and treatment. Given the inequities of health resources, transportation, broadband service, housing and health insurance, rural Georgians suffer from increased rates of both physical and behavioral disorder conditions. The PIPBHC-GA project will serve a 19-county area of South Georgia with a population of 390,230. Using science-based interventions, two Federally Qualified Health Centers (FQHCs) with 20 clinic sites and four CSBs in 9 locations will provide comprehensive behavior health care by screening and treating an average of nearly 40,000 persons for behavioral health problems (including substance abuse) each year, for a period of 5 years, through a bidirectional model of services integration. Serving as a gateway to care, all FQHC new and annual visit persons 6 years of age and older will be screened for high-risk behavioral health symptoms. Through a multidisciplinary Primary Care Team, the FQHC will provide immediate intervention for the most common behavioral health problems. Those persons requiring specialty care and sustained support will be referred through a “warm hand-off” to a local CSB. Severe and persistent mental illness and co-occurring disorders are special, long-term conditions that a person will be managing for life with treatment and supportive care through the CSB. Individuals needing primary care at any point in their CSB treatment will be referred back to the FQHC, which will become their Patient-Centered Medical Home. This will be an Integration Model for rural Georgians with a continuum of care from screening/prevention, assessment, diagnosis and treatment to recovery support. Co-occurring somatic and mental health conditions will be in focus and a person’s care and recovery will be managed. Over the 5-year duration of the project, PIPBHC-GA will establish reliable patterns of collaboration among major community providers (public CSBs and private FQHCs), setting a blueprint that could be used throughout the State and nationally. Beginning with Measurement-Based Care, a major cohort of the rural uninsured population will be screened thereby increasing access, identifying gaps in coverage; demonstrating how to analyze data on the Social Determinants of Health characteristics that impact health disparities; developing a behavioral health workforce relevant for rural populations; using information technology for improved quality care management, treatment, program accountability and performance measurement while re-enforcing the value of services integration among community-based providers for the best possible whole health outcomes for the individual. DBHDD is requesting $2,000,000 per year for five years.

The Illinois State Promoting Integration of Primary and Behavioral Health Care Project will bring together two providers of community care in separate areas of the state who will utilize evidence based practices to support the needs of individuals with serious mental illnesses, serious emotional disturbances, substance use disorders and/or co-occurring disorders to ensure access to physical health care that is integrated with treatment for the behavioral health conditions. These community mental health and substance use providers will coordinate with the federally qualified health care providers within their communities to ensure full integration of care for individuals in their communities in need of this care. Centerstone of Illinois, located in Alton, IL, will serve five counties that fall within designated HRSA shortage areas, and Chestnut Health Systems, Inc., located in Bloomington, IL, will serve McLean County. Both providers have significant history and expertise in providing behavioral health care to their respective communities, and have previously operated successful integrated services. This new program will allow for expansion of care and further development of expertise. As the grantee from the Substance Abuse and Mental Health Services Administration (SAMHSA), the Illinois Department of Human Services/Division of Mental Health (DMH) will provide oversight and direction of the two agencies, ensure evaluation of the initiatives, and utilize lessons learned in this project to facilitate statewide learning and potential policy changes to impact the health and well-being of all Illinoisans in need of integrated primary and behavioral health care.

Project Abstract: Kansas' PIPBHC Project The Kansas Department for Aging and Disability Services (KDADS) will partner with three cohorts of four Community Mental Health Centers (CMHCs) and/or Certified Community Behavioral Health Clinics (CCBHCs) to establish an integrated care framework to be rolled out across Kansas. This framework will be based on data-driven and measurement-based, person-centered care delivered through evidence-based practices (EBPs), assessments, or evidence-informed services to comprehensively serve Kansans with comorbid behavioral and physical health conditions under its PIPBHC program. In consultation with the Kansas Department of Health and Environment (KDHE) and the Association of Community Mental Health Centers in Kansas (ACMHCK), KDADS will select a cohort four providers every two years based on a variety of factors, including behavioral health population needs, level of collaborative/integrative care infrastructure, geographic diversity, and community commitment. All PIPBHC providers will be required to have achieved and maintained CCBHC certification through KDADS to be eligible for participation. Each provider organization will serve a distinct geographic area and will utilize thorough community needs assessments to identify target populations for inclusion in this grant. The main behavioral health conditions to be served include adults with serious mental illness (SMI), children with serious emotional disturbance (SED), persons with substance use disorders (SUD), and persons with cooccurring SMI and SUD. The Kansas PIPBHC project will serve 2,100 unduplicated individuals over the project period with an average of 350 people annually. Each provider service area will represent a high need for integrated care due to insufficient workforce, lack of health coverage, and prevalence of behavioral health issues. The need for these services span urban, rural, and frontier areas across Kansas, presenting a diverse set of challenges to implementing integrated care. Per the Health Resources and Services Administration, all 105 counties in Kansas experience some type of provider shortage, with the largest disparities in primary and dental care providers. In terms of mental health prevalence, a Mental Health America analysis found the collective averages per 100,000 population for people scoring severe depression, frequent suicidal ideation, and at risk for psychosis for the selected service areas are 121.1, 126.9, and 86.1, respectively, which are higher than the national averages at 102.0, 104.4, and 64.0, respectively. From a morbidity perspective, the age adjusted suicide rate per 100,000 was over five points higher than the national average at 19.4 vs. 14.1, respectively. A greater proportion of adults in the State are documented to have some form of obesity than the national average, with the highest impacts in rural and urban Kansas. The need for integrated services is exacerbated by the lack of legislatively enacted Medicaid expansion, compromising access to care and placing additional strain on safety net providers like CMHCs and primary care provider networks. Through the Kansas PIPBHC project, and implementing integrated care within 12 CMHCs/CCBHCs, KDADS aims to accomplish 1. Improve overall access to primary and behavioral health care by increasing access points and strengthening provider relationships 2. Reduce systemic disparities and stigmas surrounding behavioral health care by enhancing the integration of behavioral health into the primary care setting 3. Enhance continual quality improvement efforts using measurement-based care, outcomes measures, and Kansas’ CCBHC program 4. Improve care coordination between primary and behavioral health care to enhance the overall individual’s care journey

As a qualified local government behavioral health authority and SAMHSA provider with 56 years of proven expertise serving the populations of focus in North Mississippi, the North Mississippi Commission on Mental Illness/Mental Retardation d.b.a. Communicare and Designated Collaborative Organizations (DCOs) will transform and advance SBIRT services by embedding SBIRT into daily treatment and training DCOs on the benefits and use of SBIRT. Name: Communicare SBIRT. Populations served: Children, youth, and young adults ages 12-21 who are at risk of a substance use disorder living in Calhoun, Lafayette, Marshall, Panola, Tate, and Yalobusha Counties. Health care access will be prioritized for racial, ethnic and LGBTQI+ underserved minorities: 50% Male; 49% Female; 1% Transgender; 50% African American; 2% Hispanic/Latinx; 1% Multiracial; 2% veterans/ armed forces; 2% HIV+/Hepatitis+ and 45% COD. Strategies: 1) Implement SBIRT screening/assessment into all aspect of health care within the agency and throughout the community 2) Provide short course and log course brief intervention to youth and young adults up to 21 when screening positive on a screener/assessment. 3) provide training to community partner about the benefits of SBIRT and how to implement them in their practice. 4) Provide recovery peer support services to individual who screen positive. 5) Provide wraparound service to individuals for appropriate resource connection. 6) Provide suicide screening and referral to treatment 7) Provide substance abuse treatment for individuals who have a substance use diagnosis from Residential level of care to outpatient level of care. 8) Work with families on harm reduction methods and abstinence education 9) Create a sustainability plan to ensure financial autonomy; EBPs: Motivational Interviewing (MI); Screening, Brief Intervention, and Referral to Treatment (SBIRT); Medications for Opioid Use Disorder (MOUD); Rx for Change: Clinician-Assisted Tobacco Cessation; Seeking Safety; Cognitive Behavioral Therapy (CBT); Peer Recovery-Oriented Support Services; Teen Intervene; The Matrix Model IOP for Teens and Young Adults, Brief Alcohol Screening and Intervention for College Students, Cannabis Screening and Intervention for College Students, SMART Recovery, 12-step Facilitation and Wellness Recovery Action Planning (WRAP). Goals: 1) Expand SBIRT Pre-screening; 2) Expand SBIRT full assessment; 3) Expand SBIRT services to primary health facilities, ERs, Urgent Cares, and Schools; 4) Expand youth mental health screening; 5) Provide brief intervention to youth and young adults; 6) Refer youth and young adults to appropriate substance abuse treatment; 7) Increase abstinence; 8) Improve educational/employment stability; 9) Improve housing stability; 10) Increase access to care; 11) Increase EBPs provided; 12) Increase treatment retention Objectives: 1) 100% of participants served using EBPS; 2) 100% of individuals who test positive on a pre-screen will be fully assessed; 3) 100% of 12 regional trainings will be completed by the end of year 5; 4) 100% of participants will be screened for co-occurring mental health needs and suicidality; 6) 100% of youth diagnosed with SUD will be referred to appropriate treatment; 7) 80% of people served will achieve abstinence; 8) 80% of participants will have an increase in employment/education stability; 9) 80% of participant will have an increase in housing stability; 10) 50% of participants will identify as racial, ethnic, and/or LGBTQIA+ minorities; 11) 80% of participants will reduce their suicide risks; 12) 80% of participants will be retained in treatment. Numbers Served: 50 in Year 1 and 100 per year in Years 2-5 = 450 total.

Through Horizon Health Services' (HHS) proposed Substance Abuse-Free Education/Intervention & Referral (SAFER) Program, HHS will expand and enhance access to the evidence-based SBIRT public health model for adolescents and young adults in middle and high schools as well as college to reduce underage drinking, opioid, and other substance use and the consequent negative health impacts. Our focus population is Western New York adolescents and young adults aged 10-25 - with the majority falling between ages 12-21 - in the Erie, Genesee, and Niagara Counties catchment area who are provided services at our New York State (NYS) Office of Mental Health-licensed school-based clinics. To reduce disparities in treatment access and outcomes, we will actively seek to engage adolescents and young adults from underserved and marginalized populations including LGBTQ+. Recent data from the NYS Youth Risk Behavioral Surveillance System shows 23% of high schoolers reported drinking alcohol in the past month and in Erie County, one district relates that >10% of their high schoolers report regularly vaping. HHS recognizes three major problems/areas of need among the focus population in our catchment area: 1) Rates of Alcohol and Other Drug use (AOD) among adolescents and young adults are rising; 2) There is a lack of access to timely AOD intervention and treatment by an adequate and culturally-aware behavioral health workforce; and 3) Rates of poor outcomes associated with adolescent and young adult AOD are increasing such as persistent alcohol and substance use disorders in adulthood. Our goals and objectives - aligned with the aforementioned areas of need - include: 1) Increase the number of adolescents and young adults who are screened with an evidence-based tool for underage drinking, opioid use, and other substance use + tobacco. 2) Improve timely access to and availability of evidence-based, culturally appropriate AOD intervention and treatment services for SAFER participants. 3) Reduce non-dependent alcohol and substance use before it results in AOD disorders that continue into adulthood, potentially causing a multitude of health and social problems. Through our SAFER Program, HHS will augment our licensed school-based clinician capacity and provide evidence-based training to support the delivery of SBIRT screenings and services to meet our catchment area's growing AOD needs. We will offer 900 adolescents and young adults over 5 years screening for AOD, and possible co-occurring mental health conditions, utilizing validated screening tools. For adolescents and young adults who screen positive, Brief Intervention will be provided which employs Motivational Interviewing techniques to increase insight and awareness about substance use to inspire behavior change. Referral to Treatment may be indicated for individuals presenting with AOD beyond what the school-based clinic can support. For adolescents and young adults referred to treatment, multiple evidence-based practices may be applied given each individual's unique diagnosis(es) and treatment plan. In addition to SBIRT services provided by clinicians, adolescents and young adults will have access to a Case Manager to coordinate wraparound supportive services, a Family Liaison to assist families as they contemplate and approach treatment as well as with their cultural/linguistic needs, and Youth Peer Support through a community-based partnership. The SAFER Program will place significant emphasis on outreaching to underserved/minority segments of our catchment area to offer SBIRT services in additional adolescent- and young adult-serving settings over the course of the program to maximize health equity. By the end of SAFER, we aim to expand the uptake of SBIRT into routine healthcare encounters at our participating sites. Data collection/measurement procedures will be delineated in a comprehensive CQI Plan, including the use of standardized instruments per an established timeline.

The Cherokee Nation SBIRT Project will serve federally enrolled American Indian/Alaskan Native (AI/AN) tribal members aged 12-21 (youth) and those aged 22 and over (adults) residing within the Cherokee Nation (CN) Reservation, with priority commitment to serve 60% youth and 40% adults. According to the National Household Survey on Drug Use and Health, Native Americans rank highest in the nation for heavy alcohol use and second in binge alcohol use at 25.5% and illicit drug use at 31.7%.1 Cherokee Nation is experiencing negative consequences from drug use. From 2017-2021, there were 3,183 hospital discharges for nonfatal drug overdose, 530 of which were AI/AN. Between 2018 and 2022, there were 585 unintentional overdose deaths in our counties, 82 of which were AI/AN, and 74% of them had a history of substance use.2 Priority treatment admissions data in CN counties indicate opioids account for up to 40.5% of all treatment admissions and meth accounts for up to 51% of treatment admissions.3 It is estimated over 80% of Oklahoma residents in need of substance use disorder (SUD) treatment go untreated. An analysis by Cherokee Nation counties indicates unmet need at 96% for youth and 90% for adults.4 While the lack of available SUD treatment is a priority concern for CN, the need for early identification and intervention is paramount in order to bridge service gaps and reduce the impact of SUD on Cherokee individuals and families. The project seeks to address the following service gaps: Lack of system capacity to effectively implement SBIRT, lack of early identification and engagement in services for substance misuse and use disorder, especially for youth, and lack of access to culturally appropriate screening, treatment, and recovery support in rural and remote areas. The SBIRT program will fortify our healthcare system's ability to address medical and behavioral health concerns related to substance misuse and substance use disorder early and effectively. By integrating SBIRT into our existing framework, we aim to provide comprehensive care that is culturally sensitive, trauma-informed, and tailored to the needs of our historically underserved population. The Cherokee Nation SBIRT Project will serve a minimum of 55 youth and adults during Y1, 80 in Y2, 100 Y3, 114 Y4, and 120 in Y5; this over 470 people across the lifetime of the grant.

The Pascua Yaqui Tribe Health Services Division, with the Sewa U'usim Community Partnership as the lead agency, submits this application for the SAMHSA Screening, Brief Intervention, and Referral to Treatment (SBIRT) grant. The goal is to implement a screening-brief-intervention-referral-to-treatment public health model for children, adolescents, and/or adults, to include partnerships with primary care and school agencies. Partner agencies include Centered Spirit, Sewa U'usim Community Partnership, Community Health Nursing, Social Services, and Education. Partner agencies will expand to include the El Rio pediatrics clinic and Hiaki Charter High School by the beginning of year two. The focus is on youth ages 12 to 21 living on the New Pascua and Old Pascua reservations. Approximately $800,000 is requested to hire and train six staff in the SBIRT approach and utilize evidence-based screening and assessment models and EB cognitive behavioral treatment to those needing additional services. Service would begin in the fourth month following notification of the award. Four hundred individuals will receive screening brief interventions/referrals for more intensive services annually. Over 100 individuals will be trained annually on accurate aspects of the dangers of substance use and abuse and on the SBIRT approach to care. More than 1,000 persons annually will receive information related to the impacts of drugs and alcohol on our community. A health promotion specialist will provide bimonthly information flyers with accurate information on drug use locally and nationally, and monthly radio shows will be conducted to discuss the issues and offer insights and information on local community services. Sewa U'usim will partner with other tribal agencies, the pediatrics clinic, and the local schools to develop a plan for screening and referral for everyone, especially those most at risk for ongoing substance use-impacted issues in the tribal community. The program is designed to expand and enhance the uptake of SBIRT into routine healthcare and other agencies with children/adolescents for a system-level approach to reducing alcohol and other drug consumption to avoid negative outcomes. Starting with the issues surrounding underage drinking, staff will deliver early intervention screening services for individuals at risk for or involved in risky alcohol and drug use. This will include possible referral to more extensive treatment for those with substance use disorders. SAMHSA notes that American Indians, multiracial populations, and African Americans (age 12 or older) report higher rates of alcohol and drug use than white populations (36.1%, 34.6%, and 20.3%, respectively, compared to 22.5%).

The Richmond Behavioral Health Authority (RBHA) seeks funding to enhance/expand current services to youth and adults by adding SBIRT processes into current youth services (in the school setting) and adult services in our clinic. The three primary goals of the RBHA SBIRT Project include: 1) Improve overall health, wellness and recovery for youth with substance use disorders and/or behavioral health conditions by providing SBIRT, case management and wrap-around services; 2) Improve overall health, wellness and recovery for adults with substance use disorders and/or behavioral health conditions by providing SBIRT, case management and wrap-around services; and 3) Evaluate the effectiveness of the project in achieving the goals and objectives. The target population is individuals with serious emotional disturbance (SED), serious mental illness (SMI), and individuals with SMI or SED and substance use disorders, referred to as co-occurring disorder. We will serve both adults and youth. The population of focus are more than 50% youth (aged 12 to 21). Demographics of the target population include: 59% African American, 29% Caucasian; 98% speak English as their primary language; 54% male; 1% transgender; 8% identify as gay or lesbian and 73% receive Medicaid. RBHA serves 35% youth/young adults age 0-21; 6% receiving a SUD diagnosis. Co-occurring behavioral health disorders are prevalent in an estimated 42%. Opioids and cocaine are the most commonly reported drugs used among adults. For youth, marijuana use is reported by 84%; alcohol 17%; cocaine and opioids both at 7%. Nicotine use and vaping are reported as heavy use by the schools as well as using THC edibles. Common mental health disorders include: Major depressive disorder; schizoaffective disorder; and bipolar disorder. Most of the individuals served are economically dependent, have limited education and limited or nonexistent employment histories. Many were born and raised in urban neighborhoods characterized by multi-generational addiction, poverty, violence and trauma. The SBIRT Project aims to serve 1,110 individuals over the course of the five-year grant period (110 in Year 1; 250 in each of Years 2-5).

The Screening, Brief Intervention, and Referral to Treatment Prevention and Access to Treatment Hubs and Services (SBIRT PATHS) initiative will serve youth ages 12-21 with substance use and/or co-occurring disorders in five Connecticut counties (Fairfield, Hartford, New Haven, New London, Windham) to ensure more youth access effective care in a timely way. The SBIRT PATHS initiative will establish a Connecticut (CT) community-based model of co-occurring care for youth and will evolve its system of care by addressing gaps in early substance use services, the progression of substance use disorders alongside other unmet social needs, and connections between levels of care. The primary goal is to provide integrated substance use, mental health, and trauma-informed services for youth with low and moderate risk substance use. Four behavioral health providers will form regional SBIRT PATHS centers to serve youth and families in Fairfield, Hartford, New Haven, New London, and Windham counties. These providers include the Child and Family Agency, Child and Family Guidance Clinic, Clifford Beers Community Care Center, and Community Health Resources. The SBIRT PATHS initiative will serve the five counties with the highest percentage of youth living below the poverty line and rank the highest for overall Social Vulnerability (socioeconomic status, household characteristics, racial and ethnic minority status, housing type, transportation). Black youth and youth with Hispanic ethnicity are served at higher rates in these counties due to behavioral health and other unmet social needs (e.g., housing, food security, transportation). In these rural and urban communities, more than one of every five youth report active substance use upon behavioral health service initiation each year. This initiative will expand three evidence-based practices (EBPs) for youth utilizing a learning community framework: SBIRT, Motivational Enhancement Therapy/Cognitive Behavioral Therapy (MET/CBT), and Wraparound services. By grant end, at least 7,000 youth will be screened and 2,700 unduplicated youth who screen positive for substance use will be served by these EBPs (300 in year one, 600 annually in years two through five). This initiative will train more than 100 staff in SBIRT, 100 clinicians in MET/CBT, 20 care coordinators in Wraparound, and ensure EBPs are delivered with fidelity. A MET/CBT train-the-trainer model will be used to build capacity and sustainability. Adaptive continuous quality improvement consultation will ensure grant services achieve equitable outcomes for all youth subpopulations. At least 60% of youth who complete MET/CBT treatment will experience clinically meaningful symptom improvement, and more than 70% of youth will increase their periods of abstinence from service start to finish. SBIRT PATHS centers will build community-based, localized partnerships to ensure youth are identified for screening and stay connected to services and care planning throughout treatment. Youth with co-occurring disorders and/or more acute substance use symptoms will receive warm handoffs to trauma-informed EBPs, specialized substance use disorder EBPs, and/or intermediate levels of care based on clinical need. This grant will have an Advisory Committee of key stakeholders, including SBIRT PATHS center leadership, CT Department of Children and Families, CT Department of Mental Health and Addiction Services, a MET/CBT national trainer, FAVOR (Connecticut's state organization for the National Federation of Families for Children’s Mental Health), and CCAR (Connecticut’s state organization for the National Alliance for Recovery Centered Organizations). FAVOR and CCAR will ensure participation from individuals with lived mental health and/or substance use experience, and/or family advocates of such individuals. The committee will help ensure initiative goals/objectives are met and more youth have access to evidence-based substance use services and treatment.

Centerstone’s Screening, Brief Intervention, and Referral to Treatment (C-SBIRT) will expand the uptake of the SBIRT model in primary care/pediatric, community health, and school settings in 14 Florida counties, with a focus on screening for underage drinking, opioid use, and other substance use. C-SBIRT will screen an unduplicated 16,000 (i.e., Y1: 1,500; Y2: 3,000; Y3: 5,000; Y4: 4,500; Y5: 2,000) via screening; of those, more than 50% will be youth ages 12-21. C-SBIRT’s focus population is expected to mirror area residents’ (12+) demographics (e.g., 49% male; 51% female, 66% White) and socioeconomics (e.g., 12% experience poverty, 12% lack health insurance). C-SBIRT will serve under-served/resourced subpopulations from among the area’s racial/ethnic and sexual/gender minority communities; Veteran/military populations, including Veteran households with children; and/or systems-involved youth populations. Low perception of risk in using substances (e.g., 50% of 12-17 year olds do not see using cocaine 1 time a month as risky) increases early initiation, risk of misuse, and likelihood of SUD for the focus population; an estimated 95.5% with SUD do not recognize the problem, impacting 570,000+ in the focus population. An estimated 46,810 youth and 550,520 adults will have SUD; of those, 3% of youth and nearly 10% of adults will have AUD and 1% of youth and 2% of adults will have OUD. Nearly 3% of youth and 8% of adults are anticipated to have COD. C-SBIRT will establish Youth and Adult Tracks for integrating SBIRT implementation protocols, including population-specific implementation sites, SBIRT teams, tools, interventions, etc. C-SBIRT’s strategies/interventions include capacity-building efforts (e.g., technology integration, annual assessment of gaps/needs); targeted outreach/education to youth- and adult-focused entities (e.g., pediatricians, schools/universities, primary care providers); expanding screenings to identify risky substance use, alcohol/other drug consumption, suicide risk, and co-occurring disorders; and initiating appropriate evidence-based response. C-SBIRT will utilize age-appropriate, validated pre-screens, such as the National Institute of Drug Abuse’s and National Institute of Alcoholism and Alcohol Abuse’s Single Question Screen, BSTAD, and PHQ-2; validated full screens such as the AUDIT, DAST-10, CRAFFT, PHQ-9/-A, C-SSRS; evidence-based brief intervention via Brief Negotiated Interview and TIP 34: Brief Interventions and Brief Therapies for Substance Abuse; and brief treatment via Cognitive Behavioral Therapy, Motivational Interviewing, and Multi-Dimensional Family Therapy. Case management for those referred to specialty treatment will be guided by TIP 27: Comprehensive Case Management for Substance Abuse Treatment and will include assessment for homelessness risk, peer supports. Project goals include: 1) Implement a project to provide comprehensive, trauma-informed SBIRT services; 2) Implement capacity building to expand and sustain SBIRT services; 3) Improve outcomes among participants receiving brief intervention, brief treatment, and treatment via referrals; and 4) Develop/disseminate a documented service model for statewide replication/adoption. Measurable participant-related objectives include: reduce reported days experiencing mental health symptoms by 40% among those with COD; reduce reported days of opioid use by 50-60% among those with risk at intake; increase abstinence from substance use among 40-60%; reduce inpatient/ER usage among 40%; reduce tobacco use among 60% with risk at intake; increase social connectedness among 70%; assess 100% referred to treatment for wraparound needs and provide 100% with case management; achieve 80% follow up among those referred to treatment. C-SBIRT has secured commitments from collaborators dedicated to the project’s success, and will collaborate with primary care providers, including pediatric providers, schools, and other key community stakeholders.

Project Abstract/Summary The proposed project will implement a Community Screening and Linkage to Substance Use Services program in Mott Haven, NYC. Our project represents a comprehensive multicomponent community-based approach that integrates (1) the scale-up of a culturally and developmentally appropriate Community SBIRT model that offers a comprehensive set of behavioral health services directly in families’ immediate context—their household; and (2) Multi-Sectoral Partnerships that leverage protective family influences to reduce the onset/progression of substance use and increase sustainable community capacity and systems trustworthiness for responding to behavioral health needs in the long term. Youth aged 12–21 years are the primary focus population for the proposed project, but we will also offer participation to all adults co-residing in households with youth. Mott Haven—one of the hardest hit localities by the overdose epidemic and the poorest congressional district in the continental US—represents a high-need community and is the catchment area for the current project. The overwhelming majority of Mott Haven residents (>95%) are Latino and/or Black and approximately half speak Spanish as their primary language. Approximately 1 in 3 residents live below the poverty line and 1 in 4 (are younger than 18 years old. With substance use-related emergency room visits and hospitalizations about three times as high as the city-wide average, Mott Haven residents face substantial challenges with the adverse consequences of untreated alcohol and drug misuse in their community. The right to access high-quality and affordable substance use and mental health-specific treatment and prevention services are core components of behavioral health (substance misuse + mental health) equity. This access is too often not a reality for Mott Haven families. The proposed project addresses this gap head on through a community-based SBIRT model, combined with multi-sectoral collective action among families, health, and social service providers to enhance substance use outcomes and care integration in Mott Haven. The proposed project has two components. Component 1, Community SBIRT, entails door-to-door community outreach, engagement, and substance use and mental health screening directly to all members of the household; culturally- and developmentally-appropriate brief intervention; and navigation to substance use/mental health treatment or prevention. Component 2, Multi-sectoral Community Partnerships, entails delivery of the family-based Linking Lives program, which supports multigenerational communication about substance use, and a community engagement component consisting of a collective action initiative that will develop a Mott Haven-focused social marketing campaign and the establishment of a sustainability and long-term capacity community committee that will co-develop and launch the project’s sustainability plan. We will conduct a comparative effectiveness trial using a two-arm group randomized trial design to evaluate the effects of the Community SBIRT intervention component alone (experimental group 1) versus the full, multilevel intervention package of Community SBIRT plus Linking Lives and engagement in the Collective Action Initiative (experimental group 2). We will recruit households, including youth aged 12–21, their adult caregivers (parents), and other adults within the household from public housing developments in Mott Haven using area sampling methods. Participants will separately complete a questionnaire (in English or Spanish) at the baseline assessments. Subsequently, households will be randomly assigned 1:1 to either of the two experimental groups. Across the entire project, we will recruit 650 households (with ~4 household members) for a total of 2,600 participants (325 households, 1,300 individuals in each experimental group). Households will complete follow-up assessments at 6- and 12-months post-baseline.

La Maestra’s Expanded Screening, Brief Intervention and Referral to Treatment (SBIRT) Services for Low-Income, Uninsured and Underinsured Transitional Age Youth (TAY) and Adults in San Diego County project will implement the SBIRT public health model for children, adolescents, and adults with a focus on screening for underage drinking, opioid use, and other substance use. The organization will serve hard-to-reach, at-risk populations, including but not limited to low-income individuals living at or below 200% of poverty, racial and ethnic minorities, LGBTQ2S+, unhoused populations, immigrants, refugees, veterans, and previously incarcerated individuals. La Maestra will place a specific focus on ensuring that 50% of the patients served are ages 12-21. The overarching goal of La Maestra’s SBIRT project is to deliver early intervention for individuals with risky alcohol and drug use, as well as the timely referral to more intensive treatment for those who have substance use disorders, with a focus on screening for underage drinking, opioid use, and other substance use. The organization expects to achieve this by fulfilling the following objectives: 1) Screen a minimum of 6,000 individuals, 50% of which will be children or adolescents, for underage drinking, opioid use, and other substance use annually (30,000 total over the five-year project period); 2) Engage a minimum of 60% of adults and 40% of youth with positive evidence-based tool screenings in brief intervention (BI), brief treatment (BT), or referral to treatment (RT); 3) Reduce alcohol and/or drug use (AOD) among program participants who participated in BI, BT, or RT by a minimum of 25% within the first six months of SBIRT enrollment; and 4) Connect at minimum of 50% of adults and/or youth participants to the full spectrum of La Maestra Circle of Care® services annually through comprehensive case management; 5) Ensure that all patients that screen positive and are referred for treatment will have a six-month follow-up rate of 80%. In 2023, La Maestra served 44,489 patients. Patients were served across the age continuum, ranging from birth to nearly 100 years old. According to 2023 clinic data, 87% of patients served were living at or below 200% of the federal poverty level, 16% of patients were uninsured, and 80% were underinsured. In addition, 79% of patients belonged to a racial or ethnic minority, and 59% were best served in a language other than English. Among all clinic patients, 6% were Asian, 16% were Black/African American, 21% were Caucasian/White, 55% were Hispanic/Latino, and 2% were undisclosed or some other race. Recent data shows that impoverished communities face significantly higher rates of addiction, with financial instability fostering stress and increasing the likelihood of addictive behaviors. Data from the University of Wisconsin Population Health Institute found that San Diego ranks among the worst places in California dealing with excessive alcohol use. In addition, the San Diego County medical examiner also noted an increase in the number of alcohol-related deaths among people ages 14-25 in 2020. Furthermore, La Maestra’s service area of central, east, and south San Diego saw opioid overdose hospitalization rates as high as 67.9 per 100,000 among Non-Hispanic Black populations and 20.4 per 100,000 among Hispanic populations, compared to the overall County average of 16.0 per 100,000. La Maestra will adhere to current Evidence Based Practices and expand its Wellness Clinic to ensure that all patients seeking SBIRT services receive the comprehensive, culturally appropriate and linguistically competent care they require to achieve recovery. In addition, performance assessment services for this program will be conducted by Dr. Andrew Sarkin, Ph.D., a third-party evaluator from the UCSD’s Health Services Research Center, established in 1991. Dr. Sarkin has over two decades of evaluation experience in behavioral health and clinical psychology.

Detroit Recovery Project (DRP), as a leading Certified Community Behavioral Health Clinic?(CCBHC) within Michigan is seeking the SAMHSA Screening, Brief Intervention, and Referral to Treatment (SBIRT) to implement screening, brief intervention, and referral to services (SBIRT) with 1,650 adolescents and young adults (ages 12 to 21) at four pediatric-serving locations throughout Detroit, Highland Park, and Hamtramck in Wayne County, Michigan over five years. These locations include an educational setting (Detroit Edison Corewell Health School Based Clinic), a community center (Durfee Innovation Society in Detroit), and two recovery centers (Calvin R. Trent Health & Wellness and the Eastside Health & Wellness Centers). DRP will also provide training to staff, peer recovery coaches, and paraprofessionals at partner organizations to conduct SBIRT, resulting in an additional 100 youth and young adults served in year 4 and 250 youth and young adults served in year 5 of the initiative, increasing DRP's reach over time. The goals of the DRP SBIRT Program are: 1) To increase the number of adolescents and young adults (ages 12-21) screened in Wayne County, who are moderate or high-risk for psychosocial or health care problems related to substance use; 2) To Increase the number of behavioral health professionals, Peer Coaches and school personnel being trained in the Detroit catchment area, to provide SBIRT Screening within their service populations, and 3) Enhance the health outcomes of youth and young adults participating in the DRP SBIRT Initiative. DRP SBIRT will provide trauma-informed SBIRT, linkage to care and, wraparound services to individuals residing in the target community with the goal of reducing the impact of substance use disorder on youth, young adults, and their families. DRP is equipped with the expertise and experience to provide services that are targeted and specific to the population, reducing barriers to care and increasing the likelihood of successful recovery.

The purpose of Georgia’s Outreach and Intervention Program for Youth and Young Adults at Clinical High Risk for Psychosis (CHR-P) is to serve youth and young adults (Y/YA) at risk of developing psychotic disorders, through community outreach and education, screening, detection, assessment, treatment, and recovery services provided through a comprehensive, coordinated, and stepped-care approach. In partnership with key stakeholders, the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) will implement this initiative by focusing on the following goals: (1) developing a primary and secondary outreach network to identify CHR-P Y/YA; (2) building the capacity of the mental health treatment provider communities to meet the unique needs of CHR-P Y/YA and their families; and (3) creating an assessment hub and implementing a stepped-care CSC model for Y/YA meeting criteria for CHR-P with the capacity to provide ongoing monitoring, treatment, and referral to appropriate services. DBHDD has selected a partner with unique and highly relevant expertise: Grady Health System, in downtown Atlanta, has extensive experience working with Y/YA with first-episode psychosis and serves a predominantly underserved, uninsured population. Grady will target Y/YA ages 14- 25 at CHR-P, and the CHR-P program will be co-located with their Coordinated Specialty Care for First Episode Psychosis program, Project Arrow. Through proven screening and detection strategies and the provision of a variety of evidence based treatments and services, including Clinical Monitoring, Psychoeducation, Cognitive Behavioral Therapy, CBT/MET5, Open Dialogue, peer support, and the IPS model of Supported Employment/Supported Education for young adults, Grady Health System will leverage their experience, proven track record, and numerous community partnerships to meet the needs of the individuals and families they will serve. Approximately 75 Y/YA will be screened in the CHR-P program in the first year. In subsequent years, this number will increase to 150, for a total of approximately 525 individuals screened over the four-year period of the project. Of these 525 individuals, we anticipate that a total of approximately 80 will meet criteria for inclusion in the CHR-P program. Expected outcomes include early identification of Y/YA at CHR-P through high-quality diagnostic assessment conducted by professionals with specialized training in CHR-P; careful monitoring of symptoms; treatment tailored to the needs and preferences of Y/YA at CHR-P; and referral to appropriate services when these cannot be provided by the CHR-P team. Ultimately, through a reduction in the duration of untreated illness, we anticipate seeing improved clinical, occupational, and social functioning, as evidenced by reductions in rates of hospitalization and legal system involvement and increased participation and success in academic, social, and vocational pursuits.

To prevent the onset of psychosis and lessen the severity of psychotic disorders among American Indian and Alaska Native (AI/AN) youth and young adults at clinical high risk for psychosis, Fairbanks Native Association (FNA) has developed the Athabascan Outreach and Resilience program (AOR). AOR will provide trauma-informed, culturally resonant, evidence-based interventions using a stepped-care model and the Coordinated Specialty Care approach. Disparity data indicates AI/AN are one of the highest at-risk populations for Clinical High Risk for psychosis (CHR-P), which refers to a state in which an individual shows early signs or symptoms that suggest an increased likelihood of developing a psychotic disorder. AI/AN youth and young adults experience high rates of multiple risk factors for CHR-P including disproportionate mental illness, substance use, trauma, violence, poor maternal health, poverty, child abuse and neglect, and incarceration. Given these disproportionate risk factors, there is a critical need to prevent the onset of psychosis and lessen the severity of psychotic disorders among the target population. To accomplish this, AOR uses a stepped-care model for early psychosis that features lower intensity/lower-risk treatments as first-line interventions, with decisions regarding treatment completion, maintenance therapy, or step-up to more intensive care based on objective measures of treatment response. It also uses Coordinated Specialty Care, an evidence-based, multi-disciplinary approach that integrates medication management, psychotherapy, case management, family support, and educational and vocational support tailored to the individual needs of young people experiencing early symptoms of psychosis to improve outcomes and promote recovery. The goals of AOR are 1) implement a stepped-care model, 2) improve symptomatic and behavioral functioning; 3) enable youth and young adults to resume age-appropriate social, academic, and/or vocational activities; 4) delay or prevent the onset of psychosis; and 5) minimize the duration of untreated psychosis for those who develop psychotic symptoms. Objectives include 50% fewer psychiatric hospitalizations or use of emergency services for mental health crises annually from baseline and a 50% improvement annually from baseline in the following Infrastructure Development, Prevention, and Mental Health Promotion indicators: number of individuals screened for mental health or related interventions, number of individuals referred to mental health or related services, number of individuals contacted through outreach efforts, and number of people in the mental health and related workforce trained in mental health. Objectives also include 50% improvement from baseline to discharge in the following National Outcome Measurements: criminal and criminal justice status, perception of care, functioning in everyday life, stability in housing, severity and frequency of CHR-P symptoms, education and employment, and social connectedness. Due to the rigorous and specialized nature of AOR, which prioritizes the delivery of evidence-based, culturally resonant, trauma-informed care tailored to the complex needs inherent in CHR-P and psychosis treatment, we have kept the number of youth and young adults (Y/YA) served low. Fewer clients are seen in year one due to implementation activities, with services beginning by month four. Individuals served include youth and young adults (Y/YA) enrolled in AOR, their family members, and providers trained through AOR activities. It does not include the broader community or providers reached through the AOR Outreach Plan. At a minimum, AOR will serve four Y/YA in year one and six per year in years two through four for a total of 22 Y/YA. It will serve eight family members in year one and 10 per year in years two through four for a total of 38 family members. It will provide training/workforce development to 20 providers in year one and 10 per year in years

Psychosis is a debilitating condition with negative impacts on quality of life and functioning. Clinical high risk for psychosis (CHR-P) is an identifiable and treatable state in adolescents and young adults. The state of Mississippi currently has no specialized services for those at CHR-P. The proposed program will fill that gap and establish the Center for Behavioral Health Screening, Outreach, Assessment, and Resilience (CBH-SOAR) Clinic at the University of Southern Mississippi (USM). The CBH-SOAR Clinic will fill a crucial role in Mississippi regarding early identification of those at risk for psychosis, serving aims both in preventing onset of psychosis as well as reducing duration of untreated psychosis (DUP) among those who convert to psychosis. The CHB-SOAR Clinic will be a specialty clinic housed under the umbrella of the CBH at USM, an established community clinic serving a complex population at low cost. As Mississippi is largely a rural state, the CBH-SOAR Clinic will partner with the Department of Mental Health and Mississippi State University to develop state-wide outreach and employ primarily a telehealth model to promote broad accessibility of services. The proposed program has three main goals. Goal #1 is to implement a robust outreach program focused on reaching young people and their parents, through partnership with Open Up Mississippi, a NAMI-affiliated organization that provides education and training to youth, their parents, and providers throughout the state. Goal #2 is to assess CHR-P and implement a stepped care model of CHR-P services at the CBH-SOAR Clinic. The CBH-SOAR Clinic will serve adolescents and young adults aged 14-25 from diverse backgrounds across the state of Mississippi. We propose to enroll 20 unique CHR-P clients in the first year and 30 in each subsequent year, for a total of 110 unique clients served during the four-year project period. We anticipate assessing (with the PRIME Screen and Structured Interview for Psychosis Risk Syndromes [SIPS]) a much higher number of potential clients, with the expectation that approximately 40% of those screened will meet criteria for CHR-P. Enrolled CHR-P clients will be provided with psychoeducation and offered (within a stepped care framework) psychotherapy (Cognitive Behavioral Therapy for Psychosis if CHR-P is the primary concern), substance use psychoeducation or treatment, family services, and supported education and employment. Referrals will be made to our partner organization, the University of Mississippi Medical Center (UMMC) Center for Telehealth, if pharmacotherapy is needed. Goal #3 is to provide referrals and resources to clients not meeting eligibility for CHR-P to promote positive outcomes. We will work with state NAVIGATE programs to develop reciprocal referral processes, build referral partnerships with local organizations in addition to existing partners, and provide appropriate psychoeducation and referrals for common comorbidities or substance misuse to clients not eligible for CHR-P services. In the case that a client has full psychosis (either having converted from CHR-P or screening positive during initial eligibility assessment) but is not able to access NAVIGATE programming, they may be seen at the CBH-SOAR Clinic or a partner agency. The CBH-SOAR Clinic will be the first of its kind in the state of Mississippi and will help clients with CHR-P live fulfilling and meaningful lives while promoting positive mental health outcomes.

The Commonwealth Healthcare Corporation (CHCC) aims to strengthen youth and young adult mental health services in the Commonwealth of the Northern Mariana Islands (CNMI) by establishing the Youth & Young Adult Outreach & Intervention Project (YYA-OIP). The project will serve youth and young adults, up to age 25, who are at clinical high risk for psychosis on Saipan, Tinian, and Rota.

The City of Poteau, Oklahoma proposes to implement Community Programs for Outreach and Intervention with youth and young adults at Clinical High Risk for Psychosis to enhance and expand comprehensive treatment, early intervention, and recovery support services for youth and young adults at high risk of psychosis. Poteau is the county seat and largest city in LeFlore County and serves as a hub for the rural communities across the county. Poteau will partner with Carl Albert State College, LeFlore County Youth Services, Carl Albert Community Mental Health Center, Evolution Foundation, Choctaw Nation of Oklahoma, Cherokee Nation, the Boys and Girls Club of LeFlore County, and the Pervasive Parenting Center to implement a stepped care model for early psychosis with lower- intensity/lower-risk treatments with stepped up intensive treatments as dictated by treatment response and objective measures of outcomes. We will deliver a continuum of care with trauma-informed, evidence-based, integrated services and supports that comprehensively address the needs of our target population-youth and young adults aged 16 through 25 living in the city of Poteau and the surrounding LeFlore County. We will improve symptomatic and behavioral functioning; enable youth and young adults to resume age-appropriate social, academic, and/or vocational activities; delay or prevent the onset of psychosis; and minimize the duration of untreated psychosis for those who develop psychotic symptoms. The National Institute of Mental Health reports that approximately 100,000 youth and young adults in the United States experience a First Episode Psychosis every year and across Oklahoma from 2019-2022, the Medicaid data system documents that 8.1% of all admissions for those aged 16 - 25 had psychosis symptoms. Based on a 2021 Mental Health America Report, Oklahoma had one of the highest percentages (82%) of individuals to score at risk for psychotic-like experiences of those who were screened. Across LeFlore County, 27.5% of all admissions for those aged 16 – 25 had psychosis symptoms. The Oklahoma Youth Crisis Mobile Response documented 314 crisis calls in LeFlore County during Fiscal Year 2022, with 100 (32%) resulting in inpatient hospitalization of youth and young adults. This is the highest rate of inpatient hospitalization during crisis mobile response in the entire state. In addition, of those youth and young adults experiencing a crisis mobile response at school, only 67% returned to class. This is the lowest rate in the entire state. More than half of high school-age to young adult calls pertain to crises associated with depression as an underlying cause (usually also connected with suicidal behaviors). We will serve a total of 250 youth and young adults over the project period. Project goals include: increase awareness of how to identify warning signs of CHR-P and how to refer youth and young adults for early identification; increase access to services for youth and young adults who may be at risk of CHR-P by implementing screenings specifically developed to assess the risk of CHR-P; and increase access to treatment services for youth and young adults with CHR-P.

The Louisiana Department of Health, Office of Behavioral Health proposes to expand the existing partnership with Tulane University's Early Psychosis Intervention Clinic in New Orleans (EPIC NOLA) to serve youth and young adults who are at clinical high risk for psychosis (CHR). This includes establishing a CHR treatment track focused on young people who exhibit changes in perception, thinking, and functioning typically preceding the first episode of psychosis (FEP). This grant project would support the expansion of the EPIC NOLA coordinated Specialty Care services (CSC) to target those at clinical high-risk (CHR) for psychosis. This will be approached through the implementation of a CHR treatment team, Clinical High-Risk Program (EPIC-CHRP) and a CHR community early detection campaign in New Orleans. The CHR population of focus includes young people, up to 25 years of age. The target area for this project is the New Orleans area, which is the area currently served by the Tulane EPIC-NOLA clinic. New Orleans is a vibrant and diverse community with a total population of 389,6171 made up of 60% African American, 31% White, and about 6% Hispanic residents. New Orleans, in Orleans Parish, is designated a low-income population of a Health Professional Shortage Area.2 The median household income is $36,792 (U.S. median, $56,516). Nearly 27% live in poverty,3 with high prevalence of several measures of social stress that increase risk for psychosis onset (exposure to violence, child abuse and discrimination, and history of migration).4 These overlap with prognostic factors such as poverty, low educational and occupational achievement, and poor access to health services. Louisiana ranks 50th for per-capita funding for community mental health services and 46th in access to general medical services. Strategies & Intervention: Primary, secondary, and tertiary prevention strategies are being utilized to address the purposes of this grant which are to provide treatment and improve functioning of the CHR population, to reduce duration of untreated psychosis and/or to delay or prevent psychosis. EPIC NOLA CSC services will be offered for the CHR population and adapted based on evidence-informed practices. Workforce development strategies will build capacity for CHR assessment. Current community wide FEP early detection strategies will be adapted to CHR early detection. Goals and objectives: A goal of this project is to increase the capacity of the current early psychosis program to provide evidence-based care for those at clinical high-risk for psychosis through establishing a dedicated CHR team. 290 individuals will be directly served in the 4-year grant period (Year 1-20, Year 2-90, Year 3-90, and Year 4-90). Another goal is to enhance the capacity of workforce development in CHR assessment and treatment, achieved through trainings in standardized assessments and interventions. The 3rd goal is to increase capacity of key community stakeholders interfacing with the at-risk population to identify those experiencing clinical high-risk psychosis symptoms, achieved by community CHR education sessions. The 4th goal is streamlining local pathways to care to early psychosis treatment to delay or prevent psychosis and reduce duration of untreated psychosis through psychosis early detection strategies.

Strategic Prevention Framework - Partnerships for Success La Casa Community Behavioral Health – Chaves County, New Mexico Abstract 2024 La Casa Community Behavioral Health in Roswell proposes to implement the SPF-PFS across Chaves County, New Mexico using universal evidence-based initiatives focused on preventing the onset and progression of substance abuse, specifically alcohol, nicotine, and marijuana, among youth. La Casa will partner with the Roswell Independent School District to implement universal, evidence-based curriculum, and to design campaigns promoting attendance. The SPF-PFS program would greatly enhance prevention capacity across the county, especially in these targeted systems and agencies: schools, community service providers, and law enforcement agencies. For example, prevention infrastructure will be strengthened by working on school policies and practices to identify, support, and refer students at risk for substance misuse, adding direct services for substance abuse prevention, selected prevention programming for students caught in violation of substance use policies, and increasing local law enforcement's coordination of underage drinking enforcement activities. Program goals include: • Increasing substance abuse prevention infrastructure and capacity to collect and use local data to assess needs and readiness, develop a data-driven strategic plan, and implement evidence-based substance abuse prevention approaches. • Reducing behavioral health disparities in Chaves County, particularly related to access to care, use, and outcomes of service; • Reducing underage drinking, and nicotine and marijuana use among youth. • Increasing the age of initiation of alcohol, nicotine, and marijuana use among youth. The proposed activities will reach the entire county population of 65,000, and at least 400 youth will receive prevention curriculum annually, or 2,000 students over the course of the grant. An additional subset of 100 adults will receive prevention training and information through forums or other events each year, reaching at least 500 community members over the course of the five-year grant. Media and messaging are expected to reach the entire community through radio, newspaper, billboards, and social media. This comprehensive approach will prevent the onset and reduce the progression of substance abuse and its related problems while strengthening prevention capacity and infrastructure at the community level.

FARNHAM, INC, and community partners will implement COMMUNITY NEXUS: CULTIVATING BONDS TO FORTIFY SUBSTANCE MISUSE PREVENTION INITIATIVES in Oswego County, NY, serving those aged 60 and older and those with Intellectual & Developmental Disabilities (ID/DD) by enhancing the prevention capabilities of providers and community prevention services to better serve two underserved populations in Oswego County. The POPULATIONS of focus on this project - those aged 60 and older and those with ID/DD- are underserved populations significantly affected by substance use disorder (SUD), who are at risk of or already diagnosed with SUD and Co-Occurring Disorders (COD), specifically tobacco use, electronic cigarette use, and opioid use disorder. The CLINICAL CHARACTERISTICS highlighted in the Oswego County Community Health Assessment (2022) show that adult smoking contributes to elevated premature death rates and that smoking rates in Oswego County surpass the state average, with 22% of adults identified as smokers. The assessment highlights a 14.8% disability rate in Oswego County, slightly exceeding the state average. COD is a notable concern, with SAMHSA reporting that around 9.2 million U.S adults with COD. Adults aged 60 and above face vulnerability to substance and prescription misuse. The Center for Disease Control (2023) indicated about 1 in 5 (18.5%) U.S. adults who have disabilities smokes cigarettes compared with 10.9% of adults without disabilities. Farnham & the Oswego County Prevention Coalition (OCPC) will employ various STRATEGIES AND INTERVENTIONS, combining their prevention expertise to partner with population experts to serve the target population, involving ARISE and the Oswego County Office for the Aging. The project adopts a comprehensive approach, including the delivery of Evidenced-Based Programming -Wellness Initiative for Senior Education (WISE) and Contingency Management. The Farnham Training Institute will organize specialized Continuing Education Unit (CEU) COD coursework for Social Work, CASAC, and Mental Health Counselors and will extend community-based training to the targeted population and their families, addressing topics such as substance use, prescription misuse, and safe medication disposal. Dyads consisting of ARISE Advocates & Farnham's Care Coordination Specialist will facilitate community-based prevention services within the ID/DD population. Additional elements include Social Media campaigns, the establishment of a Prevention Advisory Committee, and the implementation of Strategic Prevention Framework Environmental strategies. PROJECT GOALS: Goal 1: Broaden and fortify the capacity of community providers to mitigate substance misuse and its associated issues Goal 2: Increase the number of people in the target population receiving prevention EBPs. Goal 3: Reduce medication theft and prescription misuse Goal 4: Increase professional development and community-based training. MEASURABLE OBJECTIVES: 1) 100% of individuals with Tobacco Use Disorder referred for CM 2) Increase OCPC member capacity by 15% population of focus membership 3) Increase community knowledge of older adult substance use signs and symptoms 4) Enhance workforce by offering CEUs for Social Work, CASAC, and Mental Health Counselors 5) Decrease medication theft in vulnerable populations through Deterra bag distribution 6) Install drug-disposal dropboxes that are accessible to individuals over 60. NUMBER OF PEOPLE SERVED: this project will serve a range of 175 to 250 individuals annually and 1,125 unduplicated individuals in 5 years.

The Prevention Partnership Coalition of Sandusky County will utilize coalition building strategies to increase the regional capacity across five county regions in rural Northwest Ohio. The Enhancing Prevention Initiative and Infrastructure Consortium, EPIIC, will utilize the SPF to ensure cross-disciplinary, inter-agency understanding of the substance abuse issues in the region and leverage new and existing prevention resources to ensure a comprehensive response. This regional framework will ensure the provision of evidence-based, prevention services and supports that strengthen resiliency and prevent or impede the development of vaping nicotine and marijuana abuse related problems among youth ages 9 to 18 across the region. The catchment area for the proposed project is Sandusky, Seneca, Ottawa, Wyandot, and Huron Counties in rural Northern Ohio. The population to be served is all youth ages 9-18 who reside in the identified counties. There are 232,882 residents in the region and 49,623 youth under the age of 18 youth, will be impacted throughout the life of the project. The population within the region is relatively homogeneous, however, there are vast disparities based on geography, income, and other social characteristics. The proposed project will assess the disparities and implement universal, selective and indicated prevention strategies, that target both environmental and individual outcomes, to meet the divergent needs of the youth across the region. The primary goals of the project are Prevent the onset and reduce the progression of substance abuse in youth ages 9-18 in our 5-county region and Increase the prevention capacity and infrastructure at both the community level and in NW Ohio. The EPIIC consortium will achieve the following objectives: Prevent the onset and reduce the progression of vaping nicotine and marijuana use in youth ages 9-18 in our 5-county region. Increase the prevention capacity and infrastructure at both the community level and in NW Ohio. Develop and implement a comprehensive regional substance abuse prevention media campaign in response to Ohio's recent passing of recreational marijuana. The leadership Team will identify TA and training needs and develop responsive activities; local communities will have the capacity to collect and share adolescent substance abuse data across disciplines involved in youth well-being and utilize the data for regional decision making; all 5 counties will have a prevention coalition in place with members representing the cross disciplinary partners who work with youth; increase the capacity of local communities to implement effective prevention.

The Oregon City School District/Oregon City Together is partnering with the smaller Gladstone School District to reduce and prevent youth substance misuse. The Gladstone School District school has been struggling to establish a community prevention coalition for several years. Oregon City Together is a 10-year Drug Free Community Grant recipient ready to expand its capacity. The adjacent communities share similar youth substance use risk factors as well as common protective factors. The two school districts serve 9,943 students. Our collaborative approach will serve all youth and their families in a catchment area that includes two school districts with both suburban and rural areas. Prioritizing youth ages 9 to 18, underserved youth, Latino youth and LGBTQI+ youth, we aspire to foster a more equitable and supportive environment for youth, promoting their mental health well-being and preventing substance misuse. The proposed initiative uses a data-driven systematic approach. The Oregon City/Gladstone Partnership for Youth Success will increase and strengthen community-level capacity by working with Communities that Care, a program based out of the University of Washington rated as a Certified Promising Program by Blueprints for Healthy Youth Development. It brings stakeholders together to implement evidence-based practices to reduce risk factors and increase protective factors related to youth substance misuse. The steps in the Communities that Care process mirror the Strategic Prevention Framework. Oregon is among the worst states in the nation regarding a high rates of drug use and low rates of addiction and mental health treatment services for all ages but especially youth. Voters legalized recreational marijuana in 2014 and approved the decriminalization of small amounts of drugs, like heroin and cocaine, in 2020. The availability of fentanyl in our state and communities has greatly exacerbated the situation. The Oregon City/Gladstone Partnership for Youth Success will address these challenges on the local community level. Our goals include addressing the normalization of drugs, increasing e youth perception of harm of using substances like marijuana and alcohol, promoting youth mental health and reducing the stigma of asking for help.

Union County, Arkansas, has resilient leaders and various community resources available to assist residents in removing barriers and improving their quality of life. Although these are very helpful, many adults still struggle with mental health issues, substance use disorder (SUD), alcoholism, substance-related criminal offenses, access to care, and lack of support. SUD treatment and recovery options are available, but they are under-utilized by those in need. Additionally, there is an identified gap and lack of prevention services for adults regarding substance use disorder, alcoholism, and related substance abuse problems. Therefore, the community can only assist these individuals after SUD becomes a problem. SHARE Foundation will provide community-led prevention services to Union County adults, specifically underserved populations, by developing and implementing the Union County Prevention Plan. The first goal is to establish partnerships at the state level and with various community levels to increase awareness about prevention. The objective will be to increase community collaboration by partnering with the Arkansas SPF-PFS State recipient, South Arkansas Regional Hospital, Newhaven Counseling and Health Services, 100 Families, and other partners within 45 days of the project start date. The second goal is to develop and implement a community-led Union County Prevention Plan to address the Social Determinant of Health, social and community context, by providing comprehensive prevention services to reduce the onset of SUD, substance-related criminal activity, behavioral and mental health problems, and other related problems associated with substance use and abuse. The objective will be to utilize the SPF model to develop and implement the plan by identifying the project's direction of prevention goals, focused efforts, partnership roles, actions, services, gaps, and timelines. Through data tracking and reports, SHARE Foundation will create a baseline for Union County's data on substance use and prevention results in adults. The results will assist the community and partners to build on future goals, outcomes, and strategies.