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The abstract outlines the proposed implementation of an Assisted Outpatient Treatment (AOT) program tailored to address the pressing needs of individuals with Serious Mental Illness (SMI) in McHenry County, Illinois. The program targets residents aged 18 and above, including those experiencing homelessness, who meet the criteria for involuntary outpatient commitment as per the Illinois Mental Health and Developmental Disabilities Code. Drawing upon data from various sources including the 2022 US Census, Treatment Advocacy Center, and local healthcare providers, the AOT program aims to bridge the treatment gap for individuals with SMI. With an estimated 10,548 individuals affected by SMI in McHenry County, and only a fraction receiving treatment annually, the program seeks to provide evidence-based mental health treatment and support services to a minimum of 50 individuals each year over a four-year period. The goals of the program include establishing a multi-disciplinary AOT program within six months, reducing psychiatric hospitalizations and incarcerations, and addressing homelessness among the population of focus. Implementation strategies encompass community education, stakeholder coordination, and the development of comprehensive policies and protocols to protect participants' civil and privacy rights. Key components of the program include extensive training for stakeholders, ongoing evaluation to monitor participant progress, and inclusion of individuals with lived experience in the planning and evaluation processes. By promoting community well-being, reducing barriers to care, and fostering collaboration among local agencies, the AOT program endeavors to enhance mental health services and improve outcomes for individuals with SMI in McHenry County, ultimately contributing to a safer and healthier community.

The Centers for Youth and Families (CFYF) is a CMHC serving 1800 clients annually located in Pulaski County, AR. This project seeks to develop and deploy an AOT Program in collaboration with and AOT Management Team and Steering Committee, local courts and hospitals, and community stakeholders. The new AOT program will serve 211 unduplicated clients over 4 years. The population of focus includes adults who are: 1) SMI, 2) Involved with the Criminal Justice System, 3) COD, 4) at risk for hospitalization or have been hospitalized multiple times, living in Pulaski County. CFYF has 69 clients in the Pulaski County Detention Center (PCDC) diagnosed with SMI or COD. Of those 72% are male, 38y/o on average, 52% Black/African American and 65% have a diagnosis of schizophrenia or schizoaffective disorder/personality. Of the clients who transition out of PCDC, 25% will not be restored and many will transition to the community with minimal engagement commitment and not be medication adherent. CFYF Emergency Behavioral Health Services Department screens 45 clients per month, many of which are indigent and not engaged in consistent treatment. CFYF receives acute hospital referrals for follow-up mental health appointments of which only 20% make these appointments. Most of the acute hospital referral clients are high utilizers and are not consistently engaged in a treatment process. Pulaski County, Arkansas (AR), is primarily designated urban and the most populous county in AR (Pop 399,145). The area ranks low on indicators of Health Behaviors, Clinical Care, Social & Economic Factors, and Physical Environment. The population of the area is 50% Non-Hispanic (NH) White, 6.6% Hispanic, 38% NH Black/African American, 2.4% Asian, < 1% Native American, 4% Multiracial. About 3.3% of all Arkansans identify as LGBTQIA+. Trend data suggest the NH White population of the county is decreasing while the Hispanic and NH Black/ African American populations are increasing. Across the county, 15% are experiencing severe housing costs burdens, 16% in poverty, 15% drink alcohol excessively, 13% are food insecure, 19% are in poor to fair health, 12% experience frequent physical duress, 17% experience frequent mental duress, 11% are uninsured. County data suggest, on average, while 94% of homeless people have a bed available to them, 318 beds are empty and 386 slept outside unsheltered. Based on the identified needs of the target population and catchment area we have identified 5 main goals. Goal 1: Develop and implement collaborative AOT processes and protocols in Pulaski County catchment area by: Creating and maintaining AOT management team throughout the project, creating and maintaining AOT steering committee throughout project, creating and deploying program implementation plan, developing, and implementing AOT trainings and offered quarterly throughout the project. Goal 2: Reduce hospitalizations and re-hospitalization among the target population by: Reducing hospital admissions and readmissions among AOT clients, reducing hospital bed day use, and reducing hospitalization costs for AOT clients. Goal 3: Reduce incarceration and reincarcerations among the target population by: Transitioning 5 clients per year from Pulaski County Detention Center into the community through the AOT program and reducing criminal arrests for AOT clients. Goal 4: Increase treatment engagement and treatment usage among the target population by: Increasing medication adherence among AOT clients, reducing the number of missed appointments among AOT clients, and reducing harmful behaviors as measured by a reduction in risk assessments among AOT clients, and improving Quality Of Life Scale scores. Goal 5: Reduce homelessness and risk of homelessness among the target population by: Improving Social Determinants of Health specifically as they relate to housing security, assisting with obtain, and assisting AOT clients with maintaining stable housing.

Marquette County seeks to establish an Assisted Outpatient Treatment Program to increase support for adults with serious mental illness on Deferral or Assisted Outpatient Treatment Orders residing in Marquette County. On average, Pathways monitors 60 people on Deferral or AOT Orders at any given time. This program will establish an interdisciplinary team of professionals including Pathways Community Mental Health Authority, Marquette County Probate Court professionals and community partners assisting with social determinants of health to allow individuals living with serious mental illness to seek community-based treatment under the authority of involuntary outpatient commitment. This interdisciplinary team of professionals will work collaboratively to provide oversight in AOT cases and offer interventions including judicial supervision and targeted case management, thereby improving outcomes for individuals served including reduced frequency and duration of psychiatric hospitalization, reduced homelessness, reduced frequency and duration of incarceration, and increased treatment engagement. It is anticipated this project will serve no less than 300 Marquette County residents with serious mental illness meeting the threshold for involuntary treatment orders for the duration of the project.

Montgomery Area Mental Health Authority, Inc., D/B/A Carastar Health, will implement the Carastar Health Assisted Outpatient Treatment Program for Individuals with Serious Mental Illness using a highly individualized, multi-disciplinary approach to increase engagement and reduce recidivism to hospitalization and arrest. Priority is given to individuals who are high utilizers of the crisis system of care, and in particular, services support recovery for individuals experiencing homelessness. The program seeks to empower recipients to direct their own treatment, even while court-ordered into care. Carastar recognizes that having the choice to drive one’s own change efforts can result in positive outcomes and increase the likelihood of continuing the recovery journey beyond the expiration of the outpatient commitment order. Services do not rely on targeting only behavioral health concerns but on recognizing and serving the holistic needs of the individual. Choice of services draw from an array of evidence-based, multi-modal services that address a range of psychosocial needs. The program is a collaboration of agencies with a unified goal of access to care for a complex population. So often, deficits in areas such as housing, social connectedness and employment contribute to the lack of insight and lack of resources to connect with behavioral health services. These factors contribute to poor physical health, poor support networks, increased likelihood for substance abuse, homelessness, incarceration and hospitalization. Individuals discharging from an inpatient commitment often return to the same poor support networks, triggering environments, and lack of resources. Individuals experiencing homelessness are a priority population due to their elevated risk for poor health, poor engagement, and repeated involvement with the crisis system and law enforcement with low rates of follow-through. The program links individuals under an outpatient commitment order to the services and supports that can immediately meet needs, increase support and self-reliance, and teach recipients how to manage their own recovery. Services are designed to teach recipients facts about their diagnosis and link them to components of recovery. Recipients are shown that education about their symptoms and recovery can reduce stigma so that they or their supports are more likely to stay engaged. Alabama law allows for individuals discharging from inpatient commitment to be transitioned into the community under an outpatient commitment. This program targets individuals in Montgomery, Alabama, who are at the highest risk for re-hospitalization or arrest, either those who are ordered to inpatient commitment and preparing for discharge, or individuals being evaluated as part of the petition process who might not meet criteria for inpatient treatment but will otherwise deteriorate without treatment. The success in this program will be driven by community partnerships. Just as our recipients can better recover if connected to roots within the community, Carastar’s connections provide a catalyst for change within the River Region. Three years ago, Carastar submitted for and received funding for one of the first crisis diversion centers in Alabama. Since the implementation of the center, Carastar has facilitated monthly community planning meeting that has robust involvement from such partners as local hospitals, homeless shelters, probate courts, law enforcement who are CIT-trained, and other partnering agencies. Our community has worked tirelessly to increase our crisis response for behavioral health emergencies, and this project is a natural next step. The expected outcomes of this program will show that recipients who are invested in their own treatment and are able to successfully attain goals will gain the insight, supports, and self-empowerment necessary to continue the recovery journey once the court order has lifted.

Project name: OCHN Assisted Outpatient Treatment for Individuals with Serious Mental Illness Oakland Community Health Network (OCHN) proposes the development of a comprehensive Assisted Outpatient Treatment (AOT) program in Oakland County, Michigan. OCHN aims to develop dedicated resources by building a robust program and effective multi-disciplinary team allowing for cross-system collaboration, education, and training; while closing gaps of communication between person served, the provider, and the Probate Court. Per the U.S. Census Bureau, Oakland County has an estimated population of 1,270,426 individuals with 65% of people, who are age 18 and older. It is the second largest county in the state. According to NAMI, 355,000 adults have a serious mental illness in Michigan. OCHN's AOT program will serve residents of Oakland County with severe mental illness (SMI) as defined by the Michigan Mental Health Code who meet court-ordered involuntary treatment criteria due to their inability or unwillingness to engage in voluntary care, have a demonstrated need for treatment and have a substantial risk of harm to self or others due to the SMI. Drawing on research and best practices, this initiative underscores OCHN's commitment to upholding a person’s rights and autonomy within the legal framework. By establishing an AOT program, dedicated staff assists individuals in navigating the mental health and court systems, monitors treatment, and collaborates with the court, ultimately aiming for a comprehensive program that balances patient care with individual rights. OCHNs multifaceted approach is aimed at enhancing mental health services and accessibility, beginning with the expansion of the service area to include individuals regardless of their insurance status. This initial goal is supported by a strategy to recruit and onboard staff efficiently. Secondly, the project aspires to refine its operational framework by developing comprehensive policies and procedures tailored for the AOT program and its network of providers, who provide evidence-based interventions to assist in person achieving and maintaining stability and independence. This includes the formation of management and steering committees, meticulous policy analysis, and the drafting of actionable implementation plans, with a keen focus on adherence to evidence-based practices and standardized evaluation methodologies. Other goals emphasize the importance of training, data collection, and engagement strategies. OCHN prioritizes internal and cross-system educational initiatives about AOT, aiming to elevate partner and community knowledge through targeted training programs. In parallel, it seeks to establish robust data collection to transparently showcase service impacts and areas for improvement. Finally, the project is committed to enhancing treatment engagement rates through proactive court participation, comprehensive case management, and focused efforts to reduce hospitalization instances, recidivism and increase housing and employment stability. The performance indicators range from training outreach and participation metrics to quantitative assessments of service engagement and treatment efficacy, ensuring a data-driven approach to service enhancement and accountability. Based on historical numbers provided by the Oakland County Probate Court, the number of issued orders has increased by roughly 1.1% every year. While the Oakland County Probate Court was not comfortable predicting the future volume of orders, it is expected for the number of issued orders to continue to increase. Hence, OCHN is using the court’s 2023 data as a baseline and anticipates serving a potential total of 2800 individuals over the entire grant period. The breakdown is as follows: Year 1: 700, Year 2: 700, Year 3: 700, Year 4: 700.

Cascade Community Healthcare intends to submit a proposal to the Substance Abuse and Mental Health Services Administration (SAMHSA) for the FY 2024 Assisted Outpatient Treatment (AOT) grant. This project will span at least four years and will focus on providing outpatient treatment under civil court order to individuals with severe mental illness (SMI) who have demonstrated difficulty engaging with treatment on a voluntary basis. Cascade will be partnering with Lewis County Superior Court, Providence Centralia Hospital, and our local Designated Crisis Responders to fulfill the complete scope of care necessary to meet the requirements of the AOT criteria. The target population to be served with grant funds will be adults with Serious Mental Illness (SMI), Serious Emotional Disturbance (SED), and substance use or co-occurring disorders (SUD and COD) residing in Lewis County who have demonstrated difficulty engaging with treatment on a voluntary basis. The targeted subpopulations for the project will be comprised of individuals with low English proficiency (LEP) and veterans and their families. Lewis County is designated as both a Health Professional Shortage Area (HPSA) and a Medically-Underserved Area (MUA), and as such there is a strong need for improved access to comprehensive healthcare for Medicaid recipients and uninsured or underinsured individuals of all ages. High levels of poverty and Medicaid eligibility rates have resulted in significant barriers to accessing equitable healthcare, especially behavioral health services.

As a qualified, accredited political subdivision in Mississippi authorized as the regional behavioral health authority, Region IV Mental Health Services, with 51 years of proven expertise serving the population of focus and 14 years of experience as a SAMHSA grantee, will implement, evaluate and sustain Assisted Outpatient Treatment in full partnership with the 1st Chancery Court District MS and the 18th Chancery Court District MS and cross-agency partners to support adults with SMI who meet MS-specific criteria for AOT (involuntary outpatient commitment) and their families who are residing in 5 rural, medically underserved counties in North MS: Alcorn, DeSoto, Prentiss, Tippah, and Tishomingo to reduce disparities in access and reduce the incidence, duration of psychiatric hospitalization, homelessness, incarcerations with the criminal justice system and improve health and social outcomes. Project Name:Assisted Outpatient Treatment. Populations served:Adults ages 18+ with SMI who meet criteria for AOT under MS state law who need a civil court-ordered commitment to intensive outpatient treatment. Strategies:1) Develop strategies to reduce disparities and address social determinants of health reducing inpatient hospitalization, SUD, criminal justice involvement, homelessness, suicide fatalities and limited family/social connectedness; 2) Develop, implement and sustain the MS civil court commitment process and community-based mental health treatment with oversight from an AOT Steering Committee and AOT Management Team; 3) Provide 24/7 on-call mobile crisis response, community-based, multidisciplinary team equipped full mental health continuum of care with supportive linkages to supportive employment; supportive housing; 4) Provide quarterly workforce cross-sector training; and 5) Provide education/outreach to increase awareness of AOT program services and the civil court process-target historically underserved racial, ethnic, LGBTQIA+ communities. Evidence-based: Trauma-informed, culturally responsive and linguistically appropriate AOT, MI, Person-Centered Therapy, CBT, CTI, Hazelden's COD Program Curriculum, AMSR-SUD Treatment Professionals, Rx for Change-Clinician-Assisted Tobacco Cessation, MAT Long Acting Injectables-SMI/Suboxone OUD, WRAP and peer/family supports and CIT/MHFA. Goal: Use court intervention, systems navigation, and CQI with a harm reduction model to implement, evaluate and sustain culturally responsive, trauma-informed, multidisciplinary community-based intensive outpatient treatment, EBPs, intensive wraparound case management, peer/family recovery support linkages, in the least restrictive environment for at least 12-mo in duration. Objectives:1a) 80% of stakeholders attend AOT Steering Committee and/or AOT Mgt. Team meetings with 51% consumer/family involvement;1b) 80% of families will attend quarterly Family Advisory Committee and/or trainings; 2a) 85% of staff will attend quarterly trainings and implement EBPs with fidelity based on fidelity monitoring results;2b) Train/certify 25 first responders annually in CIT/MHFA; 3a) Facilitate 12 outreach events annually; 4a) 100% of clients will receive screening/assessment; 4b) 100% of clients receive accurate diagnosis for trauma, SUD/COD;4c) 80% of clients will improve mental health functioning; 4d) 100% of clients will receive evidence based behavioral health services; 4e) 80% of clients will reduce inpatient psychiatric admissions; 4f) 80% of clients will reduce criminal justice involvement; 4g) 80% of clients will reduce illegal substance use; 5a) 80% of clients will improve employment status;5b) 80% will improve housing stability; 5c) 80% of clients will improve social connectedness; 6a) at least 58% of clients served will be racial/ethnic/LGBTQIA+ minorities; 6b) Evaluate and monitor improvements in health and social outcomes of individuals, 100% timely reporting to SAMHSA/AOT and document AOT cost-savings. Number to serve 60 per year, 240 across 4-years.

Introduction: Metrocare’s Assisted Outpatient Treatment (AOT) Program’s population of focus is adults with severe mental illness (SMI) under civil court commitment in Dallas County, Texas. The following describes the demographic profile of the population of focus, the types of AOT available in Texas, the challenges faced in providing AOT services, partnerships established to address these challenges, and the comprehensive screening, assessment, and treatment processes implemented by Metrocare. Demographic Profile: The population of focus is comprised 47% African American, 40% White, 3% Asian, and 10% other racial backgrounds. Hispanic or Latino individuals constituted 17% of the population, with a male-to-female ratio of 57% to 43%. The average age of female clients was 46, and male clients was 41. English was the primary language for 93% of clients, while 4% spoke Spanish. Approximately 36% of participants identified as low-income, with 64% utilizing Medicaid. Types of AOT in Texas: AOT in Texas is categorized as Temporary, Extended, or By Modification, each with specific criteria and durations. Temporary AOT lasts up to 90 days, Extended AOT up to a year, and By Modification allows modification from inpatient commitment to AOT. Challenges and Disparities: Dallas County faces significant challenges in mental health care access. Underserved populations, including low-income individuals and people of color, lack access to mental health services. Limited hospitalization resources exacerbate the problem, with Texas failing to meet the recommended bed-to-population ratio. High incarceration rates, particularly among the African American population, and homelessness due to untreated mental illness further compound the challenges. Partnerships: Partner organizations, including Dallas County Probate Court #3/Mental Illness Court (MIC), the South Dallas Employment Project (SDEP), AIDS Services of Dallas (ASD), Dallas Police Department (DPD), Terrell State Hospital (TSH), and the University of Texas (UT) Southwestern, will collaborate with Metrocare. MIC will provide staffing and referrals, SDEP offers employment and wrap-around services, ASD serves as a referral source and community resource, DPD provides referrals, TSH acts as a primary referral source, and UT Southwestern will work on AOT utilization with Metrocare and the probate court. Screening, Assessment, and Treatment Processes: Metrocare conducts thorough screening and assessment upon entry into the AOT program, covering financial, mental health, and diagnostic aspects. This process involves evidence-based assessments and a diagnostic interview by a licensed practitioner. Individualized treatment plans are developed through person-centered recovery planning. Participants receive comprehensive care, including primary care screening, targeted case management, psychiatric rehabilitation, peer and counselor support, family assistance, and 24/7 access to team members. The program adopts Assertive Community Treatment (ACT) as its primary model, offering flexible services in natural settings. Integrated treatment for co-occurring disorders, along with evidence-based interventions like Seeking Safety, Motivational Interviewing, Cognitive Behavioral Therapy, and Illness Management and Recovery, are essential components of the program's approach. Impact: The program intends to serve 225 unduplicated individuals from the population of focus in Dallas County over four years as follows: year one, 51 individuals, year two, 55 individuals, year three, 59 individuals, and year four, 60 individuals. Conclusion: The implementation of AOT services in Dallas County fills a vital gap in services. Metrocare’s initiative, in partnership with various organizations, aims to reduce the incidence and duration of psychiatric hospitalization, homelessness, incarcerations, and interactions with the criminal justice system while improving the health and social outcomes of the population of focus.

Project Name: Assisted Outpatient Treatment: A Pathway to Community Care At present, the Assisted Outpatient Treatment (AOT) pathway to mental health care in Illinois is widely considered to be severely “underutilized.” Therefore, the purpose of this program is to develop and operationalize a replicable and effective structure to increase the utilization of AOT as a step-down transition from inpatient to community-based care. A host of reasons including lack of familiarity with the statutorily established process, fragmented communication amongst key stakeholders, inadequate process coordination, and limited case management resources have all been cited as reasons for this current underuse. Consequently, many individuals end up cycling through emergency medicine settings, inpatient units, and even the criminal justice system. In response, the proposed project seeks to improve the coordination of care between respondents, courts, hospital systems, and community providers through AOT. The project focuses on two Illinois Counties; Cook County and McLean County. Cook County is the largest county in the State of Illinois with a population of 5.2 million people and includes the City of Chicago, the third largest city in the nation with 2.7 million residents. In comparison, McLean County is largely rural, with a population estimated at 173,000. Despite the variations in population, each county has identified a need to regularize AOT as a key strategy to improving continuity of care for individuals living with serious mental illnesses. Through establishing local project teams including the Courts, the Illinois Department of Human Services, County Officials, Healthcare Systems, Community Mental Health Centers, and Social Service Providers, along with a dedicated Project Director, Attorneys, Coordinator/Case Managers, and Peer Support resources, the project intends to serve a minimum of 231 individuals within the AOT program. Secondarily, the project aims to create an “AOT in Illinois Toolkit” to assist communities and courts across the state in establishing and operationalizing AOT as a strategy to improve continuity of care and treatment adherence for individuals living with serious mental illnesses. In doing so, the following project goals have been identified: • Goal 1: Strengthen the existing infrastructure in Cook and McLean Counties that are responsible for managing, coordinating, developing, planning, and supporting the effective administration of AOT processes and programming. • Goal 2: Reduce reliance on institutional settings through increased use of AOT as a pathway to community care. • Goal 3: Conduct ongoing quantitative and qualitative program assessment to inform operational best practices and respondent outcomes. • Goal 4: Increase statewide education on AOT through outreach and training for court, treatment, and community members.

South Central Louisiana Human Services Authority (SCLHSA), a political subdivision of Louisiana Department of Health and Hospitals (LDH), Office of Behavioral Health (OBH) in partnership with the 32nd Judicial District Court and Terrebonne Parish stakeholders will create, implement and evaluate the first Assisted Outpatient Treatment (AOT), Terrebonne AOT, in the SCLHSA region. SCLHSA will also create an additional Assertive Community Treatment team, SCLHSA ACT, to meet the need for increased capacity and for participants of Terrebonne AOT. Project Name: Terrebonne AOT. Population to be served: Adult residents, age 18 and older, of Terrebonne Parish diagnosed with a severe mental illness (SMI) and who meet the criteria for a civil commitment sited in Louisiana state law R.S. 28:66. Strategies/Interventions: (1) Build a sustainable, replicable AOT infrastructure and program for neighboring parishes to emulate; (2) Reduce behavioral health disparities by offering recovery focused, culturally competent, trauma-informed approaches to participants in the Terrebonne AOT using the ACT model. Goal 1: Create, implement and evaluate the first AOT program in the SCLSHA catchment area by partnering and collaborating with the local judicial system, hospitals, criminal justice and behavioral health treatment agencies. Objectives: (1) Establish infrastructure to develop AOT program by aligning with key stakeholders in Terrebonne parish, creating the AOT Management Team, and AOT Steering Committee and hiring qualified staff to work with SCLHSA within 3 months of obtaining grant funding. (2) By December 31, 2024, Terrebonne AOT will develop and approve all policies, procedures, and referral forms and accept its first participant into the program. (3) By the end of year 4, the AOT Management Team will create a replicable model for AOT implementation that considers the unique culture and disparities of south Louisiana for neighboring parishes in the catchment area. Goal 2: Promote self-efficacy and social connectedness in the lives of individuals living with SMI who have historically been unable or unwilling to obtain/maintain outpatient behavioral health treatment. Objectives: (1) At termination of the civil commitment, the participant will have reduced the number of arrests by 40%. (2) At termination of the civil commitment, the participant will reduce the frequency and duration of inpatient visits by 50%. (3) At termination of the civil commitment, participants will have been compliant or had improved compliance with the civil ordered treatment plan (medication adherence and compliance with plan) as indicated in the NOMS collected data at baseline (admission), follow-up and discharge, increasing each year to reach 65% compliance by Year 4. (4) At 6 months post discharge participants will have maintained compliance with discharge treatment recommendations by 60% as evidenced by treatment provider and client self-report. Goal 3: SCLHSA will meet the need for increased capacity to individuals with SMI in the AOT program by creating an additional Assertive Community Treatment (ACT) team. Objectives: (1) By the end of Year 1, become certified and credentialed as an agency to provide ACT community based services. (2) By Sept. 2025, hire, train and credential the required number (currently 10) and type of staff required to implement ACT as an EBP. Number served: 185 individuals over 4 years.

The Gulf Coast Region AOT Program (GCR-AOT), comprised of community partners from the Gulf Coast Center, Sun Behavioral Health, Galveston County Probate Court, and the Galveston County Mental Health Court, will reduce the incidence and duration of psychiatric hospitalization, emergency healthcare service usage, homelessness, incarceration, and other interactions with the criminal justice system by improving sustained treatment engagement, treatment adherence, and functional outcomes for adults age 18 years and older with serious mental illness (SMI) residing in Galveston and Brazoria Counties (Gulf Coast Region) Texas; thus, decreasing taxpayer burden related to justice system involvement and repeat emergency healthcare service usage. Located within the Gulf Coast area, this region is one of the largest, most diverse and rapidly growing metropolitan areas in the U.S., Galveston and Brazoria county's mental healthcare systems have been struggling to keep pace with the expanding demand for services post pandemic, particularly for those who are high need service consumers with minoritized identities from historically under resourced communities. During the course of this 4-year project, The GCR-AOT Program will serve a total of 125 (20 in Year 1, 30 in Years 2-3, and 35 in Year 4) unique uninsured/underinsured English and Spanish speaking residents with SMI in Galveston and Brazoria Counties, who have consistently demonstrated significant barriers to sustained voluntary treatment engagement and behavioral health treatment adherence. The GCR-AOT Program will leverage existing relationships between The Gulf Coast Center, SUN Behavioral Health and Galveston County Probate Court to build a regional coalition of stakeholders involved in the civil commitment process, thereby expanding existing collaborations between behavioral health entities and the criminal justice system to develop and fully implement an adult AOT program that holistically addresses the behavioral health needs of individuals with SMI in the greater Gulf Coast Regional area. Potential candidates for the GCR-AOT Program will be identified from individuals diagnosed with SMI admitted to SUN Behavioral. Also, the GCR-AOT Program's Care Coordination Liaison will identify additional potential program candidates by reviewing inpatient admissions at other area psychiatric hospitals in conjunction with The Gulf Coast Center’s list of patients who struggle with adherence with outpatient services and frequently use emergency psychiatric services or are frequently involved with the justice systems in the Gulf Coast area. Individuals civilly committed to the GCR-AOT program will receive individualized treatment planning based on assessment of substance misuse and trauma, in addition to their existing mental health issues. Furthermore, comprehensive evidence-based trauma-informed behavioral health and psychosocial services will be provided, such as case management, motivational interviewing (MI), psychosocial rehabilitation, cognitive behavioral therapy (CBT), Illness Management Recovery (IRM), Wellness Recovery Action Planning (WRAP), Person-Centered Recovery Planning (PCRP), supported employment, and medication management as indicated. Implementation and outcomes of the GCR-AOT Program will be evaluated by an independent, university-based evaluation team through both formative and summative evaluation components to 1) ensure its congruence with program participants’ needs, applicable state laws, and program goals and 2) inform continual program improvement and quality assurance efforts.

Regional Health Systems (RHS) is applying for the FY2024 Assisted Outpatient Treatment (AOT) Program for Individuals with Serious Mental Illness Grant to develop an AOT program for our service population. The focus population for the AOT Program are persons living with Serious Mental Illness (SMI) and/or co-occurring disorders that are under outpatient civil commitment who meet Indiana's AOT criteria. These individuals will be involved in local civil, criminal, and/or drug courts, who are at risk for psychiatric hospitalization, incarceration or homelessness without this commitment. RHS will use this grant funding to develop an AOT program for our service population, and intends to offer community and office-based treatment and support to individuals in need at any time. In alignment with the development of the AOT Program, RHS will utilize both the Forensic Assertive Community Treatment (FACT) and the Adult Intensive Rehabilitation Services (AIRS) treatment models. These models will allow RHS to offer integrated care through structured and intensive rehabilitation services, including but not limited to case management, psychiatric care, medical and nursing care, therapy and substance use services. RHS will be able to effectively triage incoming requests for services, based on assessment of clinical need, violence, suicide and safety risk, and possible need for stabilization treatment through our inpatient psychiatric unit or residential substance abuse units. A critical task for the AOT staff will be to effectively engage persons who are under commitment, who have struggled with voluntary treatment adherence in the past, to take an active role in their treatment, as well as engagement with families or persons providing support to the identified patient. Another proponent of the AOT Program will be maintaining communication between the courts and treatment team, ensuring both sides are apprised of the client's legal and treatment status. Each AOT participant will be evaluated at the end of the commitment period to determine whether the commitment will be extended, or if the client will be released and transitioned to voluntary outpatient treatment, where RHS will monitor client to ensure that they remain stable and treatment-compliant. The goals of this project include maximizing the use of our resources and partnering with local court administrators, law enforcement and community partners to serve as a resource for SMI individuals who are facing criminal and/or civil charges without treatment adherence. With the development of our AOT program, RHS will increase the rate of treatment compliance among adults with SMI under civil commitment, and will monitor participant outcomes, including rates of homelessness, recidivism and hospitalization. To track the success and sustainability of the AOT program, we will measure the following objectives: medication compliance, treatment plan compliance, active service utilization, and referrals to community partners. We anticipate serving 204 unduplicated clients over the award period: Year 1 (51 clients), Year 2 (51 clients), Year 3 (51 clients) and Year 4 (51 clients).

The Behavioral Wellness (BWell) Assisted Outpatient Treatment program will focus on under- and unserved individuals in Santa Barbara County (California) who have a severe mental illness, are not engaged in behavioral health services, are significantly decompensating or deteriorating without intervention, have a history of not complying with treatment, and/or have a lack of insight into the need for treatment. In addition, the program will support individuals who have failed to engage in services and are likely to relapse or be subject to a psychiatric hold without AOT intervention.

The Oregon Health Authority is seeking funding to implement two community-based programs in a rural county in Southern Oregon. The local community mental health program (CMHP), the circuit court, and the sole emergency room for the county will partner to implement outpatient civil commitment and assisted outpatient treatment (AOT), both serving adults with serious mental illness. These court-ordered mental health treatment programs are designed for individuals unwilling to engage in treatment voluntarily and who experience either a level of dangerousness or inability to meet their own basic needs severely enough to put themselves or others at risk of harm. The court and civil commitment investigators will refer people into these programs by way of civil commitment proceedings, starting either at the hospital or as a diversion from competency restoration orders. The CMHP will offer and provide peer support services to every participant and, if eligible, participants will be enrolled in ACT or EASA. The project will utilize the START and CSSR-S as a standardized risk assessment tools and help participants complete Declarations for Mental Health Treatment to prevent inpatient hospitalizations when in distress and preserve choice. The project will serve approximately 40 adults with serious mental illness in one year. For this population of focus, it aims to reduce incidence of inpatient hospitalizations, reduce incidence of homelessness, reduce incidence of incarceration, and reduce contacts with law enforcement. It also seeks to increase the number of community-based monitoring and reduce the number of individuals remaining in competency restoration for 12 or more months. Project staff will utilize tools specific to Oregon like the Measures and Outcomes Tracking System and the Acute Care Reporting system, and data available in the state's Behavioral Health Data Warehouse, along with the IPP and NOMs from SAMHSA, to assess the project’s progress, revise and refine over time, and report outcomes.

This project will expand The Hawaii Health & Harm Reduction (HHHRC’s) capacity to provide behavioral health services, including mental health services and treatment for substance use disorder, to persons of transgender experience served by HHHRC’s gender-affirming care and peer program clinic in Honolulu County. HHHRC’s clinical services team for this project includes an Addiction Medicine Specialist, Medical Director (APRN-Rx), Certified Substance Abuse Counselor (LCSW), Peer Specialist Behavioral Health Navigator, Program Director, Medical Receptionist, and Program . Additionally HHHRC’s transgender services program will provide referrals to needed behavioral health services. The clinical team will work with the Kua`ana team (meaning – big sister to littler sister) which is a peer-run program by and for people of trans experience to provide these integrated services. Preliminary work for the project will begin prior to funding and will include conducting a needs assessment and starting to identify members of the trans community who would benefit from participating. With staff trained up and workflows developed by end of November, the first clients would be seen in December 2024. The mobile component of the program will be launched in early 2025, with a six month reassessment of the program (with HHHRC evaluator and client surveys) to determine any changes. Once clients are assessed, they will have a treatment plan (based on the GPRA or similar tool) that will include onsite addiction treatment (all but residential), skills-based groups and mental health support.

The Compassionate Outreach for Recovery (COR) Project creates an opportunity to interact with individuals experiencing substance use disorder and offer them a bag which includes Narcan, test strips, basic first aid, education on the dangers of drug use and most importantly the 24/7 access phone number to treatment. By offering continued education credits to First Responders, Healthcare Workers and Social Service Personnel, the COR Project aims offer the COR Ambassador Training to distribute COR Bags. In collaboration with partner agencies, community events and loved ones of those living in active substance use.

The Virginia Hospital Research and Education Foundation, in partnership with three member health systems, will develop and implement Hospital-based Substance Use Intervention Programs which utilize the evidence-based best practice of connecting patients identified with Substance Use Disorder to a Peer Recovery Specialist (PRS). These Peer Recovery Specialists will undergo training and certification to facilitate the improvement of patient outcomes, starting when a patient presents in the emergency department and continuing by guiding the patient to community resources and through the stages of recovery. Peers are uniquely suited to provide this crucial support as they are personally familiar with the struggles of addiction and recovery. By providing these three health systems with the initial funding to establish these programs and hire and train PRS and other needed support staff, the systems will be able to sustain the work after the grant period ends by utilizing the Virginia Medicaid Addiction and Recovery Treatment Services (ARTS) waiver along with other funding opportunities. It is the goal of the Foundation that these early adopters will assist in establishing a Peer Recovery Support model that can be easily duplicated by other hospitals which are experiencing a growing rate of opioid related emergency department admissions. The health systems committed to establishing Hospital-based Substance Use Intervention Programs include Valley Heath, Augusta Health, and Centra Health which serve the populations of Winchester, Staunton, Fishersville, Farmville, and Lynchburg. All these areas are considered rural and have similar demographics including a less than 40% bachelor's degree rate, an average 29% minority population, and increasing rates of emergency department visits related to overdose and substance use related co-morbidities. In 2023, the participating health systems recorded a combined total of 2,161 emergency department visits that recognized Substance Use-related admission codes. Of those, 459 visits were for the treatment of drug overdose. This represents, on average, a 64% increase in overdose-related visits across all the participating hospitals since 2019, with Centra Southside Community Hospital reporting a 125% increase in the past 5 years. It is the goal of this project to provide support for at least 100 program participants over the course of the grant year. This allows necessary time for hiring, onboarding and training seven Peer Recovery Specialists, and a gradual ramp-up to a full caseload which may be achieved in the year following grant funding. Although this represents a small number of the total patients presenting to the ED annually, it will significantly impact the survival rate of patients who enter the program and allow for additional data collection that will assist other health systems in developing similar programs. Peer Recovery Specialists will be expected to complete the Virginia Department of Behavioral Health and Developmental Services 72-Hour PRS training program and work with their supervisors to accumulate the 500 hours of experience required for Virginia PRS Certification. After receiving certification and registering with the Board of Counseling, the Peer Recovery services will qualify for reimbursement through the ARTS waiver, ensuring fiscal sustainability for the program. Legitimizing the role of peer support in the recovery process not only increases positive outcomes for those in active addiction, but also gives hope to those in active recovery that there are opportunities for them to give back to their communities in a measurable way.

Lauren's Wish Addiction Triage Center is dedicated to providing vital support to individuals seeking recovery from addiction in Monongalia County, WV, and the surrounding tri-state area. Through three stages of care, including temporary housing, sober living assistance, and ongoing follow-up support, we empower clients to navigate their journey to recovery with dignity and respect. Our comprehensive approach, which includes case management, transportation assistance, peer services, and community resource connections, aims to address the complex needs of individuals in recovery. With a commitment to serving a minimum of 350 clients annually while maintaining and achieving a 80% successful placement rate into treatment or sober living programs, Lauren's Wish strives to make a meaningful impact on the lives of those affected by addiction. The population to be served by Lauren's Wish Addiction Triage Center consists of individuals seeking recovery from addiction in Monongalia County, WV, the State of West Virginia, and the surrounding tri-state area. This region has been significantly affected by substance abuse issues, including opioid misuse and overdose deaths. Demographically, individuals seeking recovery may come from various age groups, ranging from young adults to older individuals. They may represent different ethnicities, socioeconomic backgrounds, and educational levels. Additionally, this population may include individuals from urban, suburban, and rural communities within the region. Clinically, individuals seeking recovery may present with a range of substance use disorders, including but not limited to opioid addiction, alcohol dependence, stimulant misuse, and polysubstance abuse. Co-occurring mental health disorders, such as depression, anxiety, and trauma-related conditions, are also prevalent among this population. Moreover, individuals may have experienced various life challenges, including homelessness, unemployment, involvement with the criminal justice system, and interpersonal conflicts, which can complicate their recovery journey. Strategies and interventions to support the individuals requiring our service include temporary housing and case management services to individuals awaiting placement in inpatient treatment or sober living facilities to address the immediate needs of each client such as health insurance enrollment, identification procurement, transportation coordination for medical appointments/court hearings, and providing peer support from our staff to help these individuals navigate their recovery journey. Assisting individuals who have completed inpatient treatment in securing residency in sober living programs by facilitating the application process for sober living facilities and expanding geographical search areas to ensure suitable placement options. Conducting regular follow-up calls and local visits to past clients to assess their progress in recovery and provide additional support as needed. With these follow up calls and visits we are able to obtain information such as employment status and housing status and compare the information collected during their initial intake and see the individuals progress. Facilitating group and individual peer services focused on recovery-based topics, including relapse prevention plans, wellness plans, coping skills, and addiction education, we can help the i begin their recovery journey. We utilize a centralized database platform to streamline data collection, track client progress, and access treatment service options around the state. Leveraging data insights to improve program efficiency, identify areas for enhancement, and measure the effectiveness of our services to achieve desired outcomes. From October 25, 2022, to June 19, 2024, we have accepted 594 clients into our care and have successfully placed 490 of our clients with 85 clients leaving before they were placed for various reasons, and 19 clients being administratively discharged.

Tides Family Services’ is requesting funds to support the Intensive Outpatient Program (IOP). This program was developed to address the treatment needs of youth who had historically been unsuccessful in being maintained in their homes. The IOP is a structured treatment program designed to provide intensive support and therapy for youth struggling with truancy, substance abuse, addiction, or certain behavioral health issues. The description provided here is based on the American Society of Addiction Medicine criteria, specifically version 2.1. IOP services are located in Pawtucket, RI, and are available to youth and families throughout the state. The IOP program serves youth from a variety of cultural and socioeconomic backgrounds experiencing a wide range of behavioral, social, health/mental health, educational/vocational, and family problems.

The issue of Opioid-Use Disorder (OUD) is prevalent within the criminal justice system. Addressing the underlying causes of OUD is a key strategy in reducing recidivism and the associated financial strain on local government resources. Efforts to manage OUD often involve a combination of treatment programs, support services, and policy initiatives. Clark County, a government agency located in southern Nevada, which funds the Clark County Detention Center, the largest jail in the state, operated by Las Vegas Metropolitan Police Department’s Detention Services Division (DSD), has embarked on efforts to manage OUD using a combination of treatment and support programs for inmates. Clark County seeks to implement a Medication-Assisted Treatment (“MAT”) program in phased increments, initially targeting incarcerated individuals who have an OUD. The purpose of this program is to provide access to DSD’s underserved OUD population to reduce the proliferation of OUD within DSD. The MAT program will be jail-based and have initial capabilities to provide services to 50 inmates. Key elements of the MAT program, administered by DSD’s medical services provider, Wellpath, will include screening and assessment of all inmates at intake to identify individuals who suffer from OUD and other comorbidities, behavioral health counseling, access to FDA approved, evidenced based medications and methodologies to assist with treatment of the whole patient for improved outcomes upon re-entry. The primary goal of the MAT program is to support individuals in their journey toward full recovery from OUD to improve patient outcomes and reduce recidivism. The jail-based MAT program provides the time and resources to facilitate safe withdrawal from opioids and the ability to stabilize individuals prior to release in the community. The program focuses on an evidence-based holistic approach to the treatment of OUD.

AIDS Service Center of Lower Manhattan, Inc., d/b/a Alliance for Positive Change (Alliance) seeks funding to support Women Accessing Options for Opioid Management (Options) in the geographic catchment area of New York City. The population of focus is cisgender and transgender women with substance use disorder (SUD); Alliance has served this population since our founding in 1990. Options is a high impact women-centric service model specifically designed to reach and engage low-income cisgender and transgender women living with substance use disorder (SUD) and other mental health diagnoses in comprehensive and integrated prevention, treatment, and supportive services. Since the onset of COVID-19, SUD has continued to become more prevalent in NYC and the crisis has taken a toll on Black and Latina female residents. Options is an individual and group level service program consisting of groups that address polysubstance use, harm reduction strategies, and treatment options that will also facilitate socialization activities that promote expanding social networks. Individual services will include referrals and one-on-one recovery support services by individuals with lived experience. Through this program design, participants will increase knowledge related to substance use, SUD treatment options such as buprenorphine, building coping skills, and overdose prevention to improve quality of life, health and wellness. Alliance’s Options leverages peer-to-peer learning among program participants and staff to create a safe space in which women can receive support and resources that will result in improved access, reduced barriers, and promotion of high quality, effective treatment and recovery services for women in New York. At Alliance’s Options program, no woman in need is turned away. The Options team will develop individualized service plans for each participant to promote healthy behavioral change and linkage to substance use treatment. Alliance will serve at least 100 unduplicated women with Options services during the program year.

Wisconsin Opioid Overdose Response Center and Pharmacy Resource Network Fentanyl-related harms, including overdoses, morbidity, and mortality, represent a major public health crisis in Wisconsin. Specifically, illicitly manufactured fentanyl contributed to 90% of opioid-related deaths and 70% of all drug-related deaths. Furthermore, rates of opioid misuse in military populations, especially combat wounded veterans, are 46.2 %, ten times larger than that in the civilian population. Deaths due to opioid overdoses have increased by 65% among veterans in recent years representing a significant risk to military recruiting, readiness, and national security. These concerns are further enhanced by the proliferation of additional fentanyl analogues and novel synthetic opioid molecules for which effective detection and treatment approaches are not yet available. Efforts to close treatment gaps through evidence-based interventions, such as access to medications, are often fragmented. In addition, these efforts are often targeted on only one part of the infrastructure necessary to address this systemic issue. If effective interventions are not sustained, the benefits or improved outcomes are lost to future patients and the community. More importantly, interventions targeting the opioid epidemic often eschew the role of community pharmacists, who are well-positioned to offer fentanyl specific prevention and treatment services. As such, it is essential to create a sustainable infrastructure that supports a community pharmacy network focused on the development and implementation of evidence-based interventions to combat opioid overdose. The Wisconsin Opioid Overdose Response Center will focus on a systematic effort to build a sustainable and resilient community pharmacy-centric infrastructure that can change the trajectory of the opioid epidemic in communities across Wisconsin. The center will establish a distributed Wisconsin Opioid Overdose Pharmacy Resource Network involving patients, prescribers, veterans, and community leaders from across the state. Working closely with network members, we will leverage our expertise to optimize use of existing tools and develop the next generation of approaches used to combat fentanyl and synthetic opioid overdoses, and to deliver these interventions to citizens across the state through community pharmacies. Specific projects pursued by the center will include efforts to accomplish four goals: • Goal #1 – Establish a pharmacy-focused center at UW-Madison that is capable of developing, implementing, and communicating successful strategies to combat the opioid and fentanyl crisis in Wisconsin. • Goal #2 – Increase patient access to evidence-based treatments for opioid use disorder and opioid overdose through expansion of community pharmacy-based services in Wisconsin. • Goal #3 – Increase the capacity of pharmacies and pharmacists in Wisconsin to access and deploy evidence-based educational materials and programs focused on opioid misuse and overdose risk mitigation strategies. • Goal #4 – Develop new technologies suitable for use by Wisconsin pharmacists and pharmacies to prevent overdose from existing and emerging synthetic opioid molecules. Scaling these projects by deploying them across multiple sites within an improved resource network will both immediately support community efforts to adopt pharmacy-centric evidence-based interventions that deliver medications to individuals not otherwise being reached, disseminate fentanyl specific prevention and treatment services, and build toward long-term resilience by creating conditions and the infrastructure to enable rapid uptake of new detection and overdose reversal approaches.

The purpose of this project, Substance Use Prevention and Treatment Services, is to sustain and expand WVU Medicine Addictions Program’s efforts to increase access to medication for opioid use disorder (MOUD) treatment, stigma and harm reduction, provider and community education, and peer recovery support services within the hospital and community-based setting. Berkeley and Jefferson Counties in West Virginia have been disproportionately affected by the Opioid Crisis. In 2021, there were a reported 81 fatal drug overdoses per 100,000 in Berkeley County which was almost triple the national average in the same year (32.4 per 100,000); respectively Jefferson County experienced 42 per 100,000 in 2021. The highly potent, synthetic opioid fentanyl is the primary cause of overdose in the Eastern Panhandle and West Virginia overall. The proposed project will increase access to treatment and harm reduction services to reduce mortality and secondary harms associated with opioid use disorder and substance use disorder and increase the likelihood of sustained recovery. The project will provide an Addictions Program Coordinator and Program Supervisor to oversee and expand current addiction services within Berkeley and Jefferson Medical Centers and the community setting. Both will conduct regular needs assessments and lead the expansion of Peer Recovery Services to outpatient clinics and the community. They will work towards the creation of a fully mobile harm reduction and rural health unit to provide treatment and harm reduction to underserved areas. These roles will track program data and share findings via publications and national conferences. They will serve as liaison to community partners and physician practices and provide academic detailing to medical providers. They will also facilitate the creation of a tri-state consortium including diverse community sectors and representatives from Virginia and Maryland hospital systems for better regional coordination of care. The project will work toward the following goals: 1: To increase capacity of WVU Medicine Eastern Division’s Addictions Program to identify and treat Opioid Use Disorder among patients. 2: To reduce overdose fatalities in Berkeley and Jefferson Counties by 10%. 3: Lead Tri-State Collaborative between West Virginia, Virginia, and Maryland to coordinate efforts around addiction treatment

Implementing SBIRT Statewide in School-Based Health Centers (SBHCs) aims to increase the effectiveness of New Mexico's state-funded school-based health centers in preventing and treating adolescent substance use through the systematic adoption of screening, brief interventions, and referral to treatment (SBIRT). Project Goals: Goal 1 is to increase the capacity of the state-funded school-based health centers (SBHCs) to deliver SBIRT (screening, brief intervention, and referral to treatment) effectively and consistently for students using those SBHCs. Goal 2 is to create a lasting system for the ongoing monitoring and evaluation of SBIRT trainings and SBIRT services provided in NM SBHCs. We will provide SBIRT training to at least 80 unduplicated NM SBHC providers and staff by the end of the project.

Federal Funding Helps Infants in rural New Mexico get Cutting Edge Care New congressional funds allocated to a program aimed at helping healthcare providers across the state manage complex health issues during an infant's earliest stages of life is expected to support community hospitals and care-teams, especially rural, underserved areas with implementing best-practices for care of neonates with Neonatal Opioid Withdrawal Syndrome (NOWS). The NOWS?NM Quality Improvement (QI) Program provides training and QI coaching to optimize care and aims to reduce unnecessary infant transports to tertiary hospitals for NOWS, support observation of uncomplicated infants with NOWS, and improve non? pharmacologic care for infants with NOWS. This program has a foundation of non-judgmental, trauma-informed care and supporting providers and care-systems in addressing barriers and reducing stigmatization for pregnant people and new parents with substance use disorder and complex trauma who are seeking care. With this grant funding, the goal is to expand the NOWS-NM QI capacity and evaluate the outcomes. We will be providing training to the providers and nursing staff on labor and delivery units at 2-3 hospitals. We expect to train up to 20 or 30 unduplicated individuals. We will share previously developed online educational materials, in-person didactic teaching, and hands-on trainings to support medical best-practices, including instruction in implementation of the Eat Sleep Console (ESC) program. This approach to care is emerging as the best practice and has the benefit of emphasizing non-pharmacological care for neonates with NOWS. This grant will also support the development of lasting educational and training materials, including 3 new online modules that will reflect the most current knowledge in NOWS care. The team will also host an educational UNM Symposium to disseminate best practices, updates and trainings developed through this program. Pratt-Chavez co-leads the NOWS-NM Program with fellow directors Dr. Alberta Kong and Dr. Jessie Maxwell. Together, this triad worked with Sen. Martin Heinrich to secure $3.9 million in congressionally directed funding, specifically to increase care for infants with NOWS. ""Sen. Heinrich pushed through the funding and his team really advocated for this program,"" said Pratt- Chavez. “It’s a testament to the work that we all are doing at UNM and how important it is.” The funding will come from the Substance Abuse and Mental Health Services Administration (SAMHSA). Envision New Mexico (ENM) has nearly 20 years of experience in offering Quality Improvement Initiatives (QI), and education and training for health care providers in New Mexico (NM) through in person, on site programs and with our Telehealth Program. All of our programs and initiatives reflect our commitment to implementation and dissemination of best practices and active scholarship in child and adolescent health. We work with children’s healthcare providers to make sustainable changes in healthcare service delivery to improve the quality of care for children and families in New Mexico. For Pratt-Chavez, the journey of doing this work continues to be among the most fulfilling of her career. “It's some of the most satisfying work that I've been able to do, because it's just such an important opportunity to collaborate with families, and it is an honor to take care of these little people,” said Pratt-Chavez. “I’m a general pediatrician; I specialize in coordination of care for young children with more complex health needs, and care of babies in the hospital who have opiate exposure. I developed this niche to ensure these infants with prenatal substance exposure get the best care possible,” said Pratt-Chavez.