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The Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS) proposes Tennessee TARGET Zero Suicide 2 (TARGET2) to reduce suicide attempts/deaths among adults ages 25 and older by expanding and enhancing suicide prevention strategies, including rapid and enhanced follow-up for 2,750 unduplicated target region adults (Yr 1: 750; Yrs 2-3: 1,000/yr) and prevention training for 300 statewide providers and stakeholders. The statewide focus population ages 25 and older is primarily white (78%), with 15% African American and 2% Hispanic/Latino. Over 13% live below poverty, 14% lack health insurance, 15% lack a high school diploma, and over 7% are unemployed. Focus population clinical characteristics (e.g., SMI, SUD, COD) are risk factors for suicide attempt/death. The focus population’s suicide rate (20.9) exceeds the U.S. rate (18), and has consistently exceeded the national rate for 15+ years. Baseline data for Tennessee reveals that 937 adults ages 25 and older died by suicide, and 6,275 were discharged (inpatient, outpatient) after non-fatal suicide attempts in 2015. The adult (25+) suicide rate among Tennessee’s minority groups other than African Americans is 11.6 versus an 8.8 national rate, and Veterans comprise 17% of state suicides. TDMHSAS will implement the following strategies/interventions throughout TARGET2 in collaboration with project partners: Centerstone of Tennessee will provide rapid enrollment and follow-up prior to/within 24 hours of discharge and weekly for one month. Follow-up will include risk assessment, crisis management plan development, means reduction counseling, and referrals/linkages to treatment services utilizing best practices Applied Suicide Intervention Skills Training, Counseling on Access to Lethal Means, and evidence-based Columbia Suicide Severity Rating Scale. TARGET2 participants will be assessed and treated according to Centerstone’s Clinical Pathway for Suicide Prevention, and Centerstone will pilot and evaluate a suicide-specific clinical treatment for those on the Pathway. The Tennessee Suicide Prevention Network will provide suicide prevention trainings for clinical providers and adult-serving systems, and will assist in establishing/implementing a Gatekeeper Surveillance Network and Call Line for training participants. TARGET2 will expand the Zero Suicide framework statewide, and an existing Advisory Council, comprising suicide attempt/loss survivors, will support TARGET2’s goals, including: (1) enhance/expand rapid follow up for adults post discharge, (2) increase follow up and care transition/coordination for high risk adults, (3) train community and clinical service providers and systems, (4) collaborate with relevant sectors and with state departments/ systems to implement comprehensive suicide prevention, and (5) implement Goals 8 and 9 of the 2012 National Suicide Prevention Strategy. Measurable objectives include reductions in suicide attempts by 35%, suicide deaths by 20%, and service/utilization costs related to suicide by 30%. TARGET2 includes a comprehensive evaluation to develop and disseminate a thoroughly documented service model for replication and adoption.

Abstract The goals of the Massachusetts Adult Suicide Prevention Program (MASSP) are to 1) create two Community Systems of Care (CSOC) integrating health, behavioral health, and suicide crisis services for the goal of Zero Suicide, 2) pilot an Engagement and Follow-up (E&F) intervention for adults transitioning after a suicide attempt, 3) promote statewide access to resources and treatment for high risk groups, and 4) institute an Adult Suicide Fatality Review Team process. The purpose of the MASPP is to reduce the rate of suicide attempts and completions among adults. Two communities will form CSOCs, led by a Zero Suicide Learning Collaborative. The first CSOC will serve adults at high risk of suicide on Cape Cod and the Islands, a region with the state’s highest rate of suicide, largest veteran population, and a significant elderly population. A second CSOC will be created in another community with high risk groups. In addition to fostering Zero Suicide standards of organizational and clinical practice within healthcare organizations, the CSOCs will link medical, behavioral health, suicide crisis, and community organizations to integrate care and coordinate transitions for at risk adults. Improved linkages should guide patients to the most appropriate services, better coordinate care, and support at risk adults during transitions, particularly those following discharge after a suicide attempt. A comprehensive training program targeted to the suicide prevention roles staff play in different CSOC organizations will enhance their skills and confidence, improving the quality of care they provide, and resulting in more effective prevention, early intervention, and follow-up care. CSOCs will each pilot an Adult Suicide Fatality Review Team, which will identify factors contributing to suicide deaths to inform system improvement. In future years, these models will be implemented statewide, community by community. Statewide activities focus on improving identification of suicide risk among high risk groups by promoting awareness of the innovative MassMen website tailored to working age men, training gatekeepers working with unemployed adults, and increasing screening and referral by perinatal care providers serving new mothers. Measurable impacts include: • Increase in identification, referral, and treatment of at-risk adults • Reduced rates of suicide deaths • Reduced rates of suicide attempts • Greater voice for adults with lived experience in strategic planning The number of people served over this three year grant is projected to be 320,874, or an annual average of 106,958.

Project Abstract ReCast Baton Rouge (RCBR) proposes to serve a population of 3,800 at-risk youth and families within the City of Baton Rouge and greater East Baton Rouge Parish over a period of five (5) years. This proposal will utilize a participatory trauma-informed approach designed to promote safety, anti-violence, community and youth engagement, leadership development, peer support, and first-responder training. Through strategic planning, RCBR will focus its activities on improving governance and capacity building by convening and engaging a diverse community coalition of stakeholders. During 2016, the City of Baton Rouge was challenged with both civil trauma and natural disaster of epic proportion. On July 5, Alton Sterling, an African-American civilian, was shot and killed by two Baton Rouge City Police officers that incited questions surrounding the shooting--ultimately sparking civil unrest. Mass protests ensued when cell phone video footage was released seeming to provide evidence of questionable circumstances. These protests included a high school-led initiative referred to as “The Wave” with a reported crowd of 3,000 persons. Tensions surrounding these events were exacerbated when a lone gunman ambushed and killed Montrell Jackson, Matthew Gerald and Brad Garafola, three Baton Rouge law enforcement officers, wounded several others and caused great community harm in what appeared to be an act of retaliation. The perpetrator of this action was not a Baton Rouge native, which demonstrated the national attention these events had received. Finally, on August 12, the City and surrounding areas experienced catastrophic flooding dubbed a 1000-year event. This natural disaster displaced an estimated 500,000 persons, within East Baton Rouge Parish and neighboring parishes, when unexpected ravaging flood waters in excess of 30 inches swept the area. RCBR, led by the Office of the Mayor-President along with a coalition of stakeholders comprising the grant planning team – including the Capital Area Human Services District, the Louisiana Center for Health Equity and the Louisiana Department of Health-Office of Behavioral Health, will guide the development and implementation of a Community Resiliency strategic plan. Specifically, RCBR will 1) develop strategies to reduce the impact of trauma brought on by the events of 2016, 2) build capacity of and empower community-based organizations to implement best practices for building resilient and trauma-informed communities; 3) ensure high-risk youth and their families benefit from evidence-based youth violence prevention and youth engagement activities; 4) link the East Baton Rouge Parish School System (EBRPSS), other LEA, community-based non-profit organizations, government entities, youth leaders law enforcement, faith-based organizations, businesses, public and private institutions to create a network that improves and strengthens equitable access to behavioral health resources and services while reducing trauma and sustaining community change..

The Dallas County ReJuvenATE (Revitalize Juveniles through Acknowledgement, Training, and Empowerment) program will promote resiliency and resolve in at-risk youth in one of the most under-served areas in Dallas County. ReJuvenATE’s goal is to inspire youth and their families, first responders, and local community organizations through evidenced-based trainings to recognize those who have experienced trauma and promote healthy responses to events that can cause anxiety, aggression, and other consequential behaviors. The middle school students in the focus area are overwhelmingly minority (55% Black, 43% Hispanic) and at least 75% have been identified as “at-risk.” Curriculum involving de-escalation techniques and police interaction skills will be jointly developed by Metrocare Services and other youth mental health experts and brought directly into the schools. Pre- and post-tests will be given to 100 students at three campuses annually to measure understanding, and other indicators will be tracked to measure effectiveness. Approximately 250 students in Dallas County Juvenile Justice Alternative schools, half of the average enrollment, will receive training annually. These students have already been expelled from school or have been placed in the program by a Juvenile Court Judge. Other youth and their families will be engaged through community events and at partnering community organizations. The annual First Responders trainings will include 500 law enforcement, fire, and emergency medical professionals who will learn best practices that can be immediately implemented in the field. These trainings will be administered and evaluated by Caruth Police Institute and The University of North Texas at Dallas. Semi-annual Community Engagement Summits will allow 400 community members including workers in healthcare, education, religious, and other community organizations to receive information about responding to traumatic events, building community resilience, engaging youth, understanding and responding to community disparities, and encouraging additional training through programs like Mental Health First Aid. Finally, 300 juvenile department employees, who in their normal duties suffer emotional overload from the detained youth they oversee, will receive training on developing a healthy work-life balance from the trauma they experience. Through the life of Dallas County ReJuvenATE, more than 3,500 people will be provided the skills to appropriately respond to traumatic events in our community.

The Vermont Family Centered Healthcare Home Project (VFCHP) is an integrated care delivery system that addresses the primary care, behavioral health and social support needs of children and their families who are at risk of, or have been diagnosed with, severe emotional disturbance (SED), and/or for youth and young adults transitioning to adult services. VFCHP service integration occurs between federally qualified health centers and community mental health centers. Vermont is the second most rural state in the nation and public transportation is largely non-existent. Nearly 30% of Vermont children and youth live below the federal poverty level, and 12.4 out of every 100 children have two or more chronic health conditions. More children in Vermont experience early adversity than the national average: 50.6% of Vermont children had one or more Adverse Family Experiences (AFEs) in 2012, vs. 47.9% of children nationally, and 23.3% of Vermont children had experienced two or more AFEs, vs. 22.6% nationally. The Vermont Department of Mental Health conservatively estimates that there are 12,000 children who have, or are at risk of, SED yet the percentage of Vermonters accessing behavioral health treatment is low. The VFCHP provides services in a person/family centered and directed manner with intensive care coordination that incorporates High Fidelity Wraparound. The VFCHP framework will involve core elements of the Chronic Care Model, the Improving Mood: Providing Access to Collaborative Treatment model, Managing and Adapting Practice System, the Attachment, Regulation and Competency model, Strengthening Families and the Four Quadrant Model. The VFCHP aims to: provide a safe, accessible and family-centered healthcare home for children, youth and families to receive comprehensive, integrated pediatric and behavioral health care services in a bidirectional manner; develop a model that truly invites and engages the family into the process of owning and directing their own healthcare through increased knowledge; clarity around options, risks and benefits; and support in making their own decisions; incorporate regular care plan meetings to allow for shared decision making and an increase in the development and implementation of shared care plans; improve health outcomes; and address social determinants of health. Children who are struggling with severe emotional disturbance are most likely to improve when their caregivers are actively engaged in their treatment and when they have a highly-coordinated treatment team. For example, children with, or at risk of, SED will enhance their resilience and their physical activity and their family’s nutritional practices will improve as their healthcare and the social context in which they live/work/attend school improves. The VFCHP will expand from two regions to four regions in year three. The unduplicated number of individuals to be served in the first two regions will be 5,400. It is estimated that this number will double making the total approximately 10,800 over the five-year period.

The Kentucky Department for Behavioral Health/Developmental and Intellectual Disabilities will implement Kentucky Care Integration (KCI), promoting primary and behavioral health care integration between selected providers, Centerstone of Kentucky and Mountain Comprehensive Care Center (MCCC), and federally qualified health centers, Family Health Centers and HomePlace Clinics. KCI will serve Kentucky focus populations who have behavioral health conditions and physical health conditions or chronic diseases. Centerstone will serve a total of 625 adults (Yr 1: 75; Yrs 2-3: 125, annually; Yrs 4-5: 150, annually) with substance use disorder (SUD) who have/are at risk for co-occurring physical health conditions/chronic diseases in Bullitt, Henry, Jefferson, Oldham, Shelby, Spencer, and Trimble counties. The focus population is predominately male (52%) and white (84%), with 67% unemployed and 27% acquiring less than a high school education. Nearly 70% of clients with SUD use opioids; prevalent physical health conditions include hypertension (21%). MCCC will serve a total of 500 individuals (Yrs 1-5: 100, annually), including adults with mental illness, serious mental illness, and SUD, and children/adolescents with serious emotional disturbance who have/are at risk for physical health conditions/chronic diseases in Floyd, Johnson, and Pike counties. MCCC’s focus populations are primarily white (99%) and disproportionately impacted by poverty. Among those with SUD, 58% are male, 89% live below poverty, 35% are unemployed, and 38% have less than a high school education. The focus population with mental illness is 51% female, and 77% live in poverty, 14% are unemployed, and 25% have attained less than a high school education. Among the focus population with SMI, 60% are female, 82% live in poverty, and 42% have less than a high school education. The focus population with SED is 61% female and 78% live in poverty. Approximately 34% of MCCC clients experience anxiety disorders, 36%, hypertension, and 16%, diabetes. KCI will provide bidirectional and co-located integrated services related to the screening, diagnosis, prevention and treatment for the focus populations, implementing the Chronic Care Model and the following evidence-based/informed practice strategies/interventions: Integrated Dual Disorders Treatment, Twelve-Step Facilitation, The 4 R’s and 2 S’s for Strengthening Families Program, Whole Action Health Management, Nutrition and Exercise for Wellness and Recovery, and DIMENSIONS. Project goals include: establishing comprehensive health homes and wellness services; enhancing infrastructure/capacity to sustain services; improving client health status/outcomes; and developing/disseminating a replicable service model. Measurable objectives include: decreased risk factors related to hypertension, diabetes, hyperlipidemia, nicotine dependence, obesity, etc. for 30% of clients; decreased mental health symptomatology by 35% for SMI, 60% for mental illness, and 45% for SED clients; substance use abstinence by 45% for clients with SUD; and improved functional outcomes for 80% of clients with SMI and SUD. A multidisciplinary, integrated care team, including an integrated care manager, primary care provider, care coordinators, counselors/clinicians, peer wellness specialists, etc., will help clients develop/implement individualized care plans. KCI will utilize a meaningful-use certified EHR, population management tools, and data-sharing protocols across providers. KCI has obtained and will continue to pursue key community partnerships with other behavioral/primary health care providers and supports, nonprofits, and faith-based organizations.

New York State Office of Alcoholism and Substance Abuse services (OASAS)in partnership with Acacia Networks and The National Center on Addiction and Substance Abuse (The Center) proposes to develop models for integrated care for individuals with opiate use disorders (OUDs). The PIPBHC project has five specific goals: (1) to build comprehensive, integrated care models into three Opioid Treatment Programs (OTPs); (2) build practices for identification, intervention, and MAT for OUD into three FQHCs and three mental health clinics; (3) provide whole person care to 2,280 people with OUD in order to improve physical and behavioral health outcomes; (4) document key elements of program implementation barriers and successes and disseminate throughout the State; and (5) make changes in infrastructure and policies in order to increase prevention, health promotion, and integrated care in OTPs, FQHCs, and MHCs. NYS OASAS oversees one of the nation’s largest substance use disorder services systems comprising nearly 1,600 prevention, treatment, and recovery programs, most of which are community-based and acutely aware of the demographic, cultural, and language characteristics of the local populations of focus. OASAS currently oversees 104 OTPs who serve over 41,000 individuals. Acacia Network, the leading Latino integrated care nonprofit in the nation, offers the community, from children to seniors, a pathway to behavioral and primary healthcare, housing, and empowerment. With roots in the Bronx since 1969, Acacia Network is the largest community based, Latino-led health and human services agency in NYS and serves as the holding company for 20 affiliates, including Promesa. The Network’s visionary leaders are transforming the organization to address the triple aim of high quality, great experience at a lower cost through triple integration-health care, housing and community impact. These leaders champion a collaborative environment to deliver vital health, housing and community building services The National Center on Addiction and Substance Abuse (The Center) is a non-profit research, policy, and practice improvement center that is at the forefront of improving substance use disorder treatment in New York. The Center has a strong track record in conducting scientifically rigorous evaluation and providing training and technical assistance. The team has conducted many projects with government partners in New York on topics such as care management for welfare populations, medication assisted treatment for disenfranchised injection drug users, supportive housing using Housing First models, and care management for high needs/high cost SUD treatment clients covered by Medicaid. The Center has extensive expertise in implementation science, system-level change strategies, implementation of evidence-based practices, evaluation of Statewide programs, advanced data analysis as well as collecting and analyzing GPRA data.

The Choctaw Nation of Oklahoma is committed to integrating the Zero Suicide Model firmly into the tribal health system. If funded, Choctaw Nation Health Services Authority (CNHSA) will implement Project Zero in an integrated health care system so that we can provide prevention and intervention for individuals who are 25 years of age or older, with the aim of raising awareness of suicide, establishing stronger referral processes, and improving the care and outcomes for individuals who are at risk for suicide. The target populations for Project Zero will be 1) approximately 1,200 American Indians age 25+ and their family members, who live within the 10½ county jurisdictional boundaries of the Choctaw Nation; 2) approximately 125 health providers who serve this population; and 3) 50 partner health providers in other county and state facilities. A nurse will serve as project director to train the hospital medical professionals in QPR for Physicians, Physicians Assistants, Nurse Practitioners and Nurses. These trainings will build the capacity of the CNHSA to better identify and address patients who present with suicidal ideation/behaviors. He/She will be available to travel to the nine other clinic sites for oversight, training and collaboration purposes, ensuring that all 10½ counties served by the CNO will benefit from increased suicide awareness, support services and that integration of Zero Suicide is implemented. Services of two Integrated therapists will be offered as well, increasing the therapeutic response to suicide. They will be based out of the two counties, LeFlore, the location of the CNHSA hospital, and Pittsburg, which houses the second largest CNHSA Behavioral Health unit. They will operate out of Poteau and McAlester, Oklahoma. Choctaw Nation of Oklahoma is well positioned to launch Project Zero, having already implemented some components that have been very well received. The Zero Suicide model, a comprehensive, multi-setting approach to suicide prevention and intervention in health systems will be the driving force of this project. CNO’s Project Zero will be inclusive of all elements of the Zero Suicide Model throughout the five year funding cycle. We expect that the long-term impact will be the complete transformation of the Choctaw Nation Medical and Behavioral Health system to enhance our ability to identify, treat, refer, and ensure continuity of care for individuals at risk for suicide and suicidal behaviors. This project will follow the Choctaw concept of Achchukmali Imabachi Sa Banna, which describes a special caring – “teaching to make better”. This is the basis for the Project Zero. Caring and teaching/training are woven throughout as we build a system wide embrace of our people, our families, our providers and our community to intervene in, and reduce suicide.

Zero Suicide Program Summary: The University Health System Zero Suicide program will implement a comprehensive, multi-setting suicide prevention and intervention approach under the framework of the seven essential elements of the Zero Suicide Model. In partnership with University Medicine Associates (UMA), the Health System aims to reduce suicide attempts and deaths among adults, 25 years and older, especially veterans and individuals with serious mental illness. Population: The Zero Suicide Program will screen 300,000 adults, 25 years and older, including veterans and individuals with serious mental illness, who are at-risk for suicide across 21 ambulatory clinics, including specialty care clinics, in five regional areas. Of these 300,000 it is estimated 5,400 will screen positive for suicidality. Zero Suicide Model: To ensure the successful implementation of the Zero Suicide model, an implementation team, including survivors of suicide, will build upon the strengths and weakness identified by the Zero Suicide Organizational Self-study and embed the seven elements of the Zero Suicide Model across the five regional clinic areas in yearly phases. In conjunction, the Zero Suicide Data Elements Worksheet will be utilizing to develop a data-driven, quality improvement approach to maintain fidelity and improve care, training, and policies. Goals and Objectives: The overall purpose of the Health System’s Zero Suicide program is to raise awareness, establish referral processes, and improve care and outcomes for patients at-risk for suicide by creating a leadership-driven, safety oriented culture. Measurable objectives are to (a) To transform the health system by implementing the Zero Suicide model, establishing an implementation team, and providing training to all UMA staff; (b) Improve care and outcomes for patients at risk for suicide by enhancing the EMR and providing evidence-based treatment; (c) Identify and engage patients at risk for suicide by increasing screening, comprehensive assessment, and safety planning; and (d) ensure continuity of care by increasing formal agreements with community behavioral health

New Yorkers Advancing Suicide Safer Care (NYASSC) The New Yorkers Advancing Suicide Safer Care (NYASSC) project will reduce suicide attempts and deaths by implementing Zero Suicide (ZS) in health systems across all five mental health service regions in New York. The project will also create a Suicide Safer Care Network in a high-risk county by linking emergency departments, inpatient psychiatric units, outpatient mental health and substance use disorder treatment settings, and primary care practices to create a local zero suicide safety net. The project anticipates assessing 281,596 individuals served by the project sites for suicide risk over five years, and projects that of those assessed, 197,116 will receive suicide-specific interventions. The Office of Mental Health will partner with the Center for Practice Innovations at Columbia University and the University of Rochester to advance implementation of Zero Suicide across the state. Providers will develop competency in the NYS Suicide Safer Care Model which includes screening and assessing for suicide risk, developing a prevention-oriented risk formulation, suicide care management plan, providing suicide specific evidence-based treatment and brief interventions, and protocols for transition of care and follow up when patients move to a different level of care. The four goals of the project are to 1) implement Zero Suicide in health systems in each of the five regions of NYS, 2) develop a Suicide Safer Care Network across all health systems in one high risk county, 3) disseminate statewide implementation of Zero Suicide based on lessons learned at project sites in the first 3 years of the grant, and 4) evaluate the project’s impact on clinical service delivery and utilization and on suicide attempts and deaths. With input and guidance from individuals with lived experience and members of the NYS Suicide Prevention Council, project goals will be accomplished by accomplishing the following objectives: engaging health systems leadership, conducting learning collaboratives, training providers, developing and implementing site-specific protocols, developing and conducting fidelity checks for clinical components, developing and disseminating materials and trainings, creating a robust suicide surveillance infrastructure, and by conducting an outcome evaluation to assess impact of the project on suicide attempts and deaths. In Year 4, the NYS Suicide Prevention Conference will be devoted to introducing health systems, county leadership, and providers across the state to Zero Suicide, to the NYS Suicide Safer Care Model, and to lessons learned from a county’s development of a Suicide Safer Care Network of Health Systems to create a local zero suicide safety net.

The goals of the Coalition are: (1) establish and strengthen collaboration among Chemical Health Initiative of Goodhue County's partner organizations in support of the community's effort to prevent and reduce substance abuse among youth; and (2) reduce substance abuse among youth in Goodhue County, MN, and, over time, reduce substance abuse among adults by addressing the issues in our community that increase the risk of substance abuse and promoting the factors that minimize the risk of substance abuse. The Coalition will achieve its goals by implementing these strategies: (1) Create a local community-supported Chemical Health Council in Red Wing, Goodhue, Cannon Falls, Zumbrota, and Kenyon-Wanamingo and assist these community CHI Councils in the development of strategic plans for implementing evidenced-based policies and practices that will create environmental and population-level changes within the community. (2) Institutionalize and embed best practices in health promotion into the policies and procedures of the County's organizations and agencies working with youth, to wit, churches, sports and recreation, schools, civic clubs, local government, healthcare, mental health/social services, law enforcement, student groups, and parent groups.

The goals of the Coalition are: (1) establish and strengthen collaboration among The BEACON Coalition's partner organizations in support of the community's effort to prevent and reduce substance abuse among youth; and (2) reduce substance abuse among youth in Newburyport, MA, and, over time, reduce substance abuse among adults by addressing the issues in our community that increase the risk of substance abuse and promoting the factors that minimize the risk of substance abuse. The Coalition will achieve its goals by implementing these strategies: (1) Decrease access to alcohol by minors from social sources. (2) Increase parental involvement in activities and resources. (3) Identify and decrease barriers to prevention and social services to teenagers.

The 21 Reasons Coalition services Portland, ME, an urban area with a population of 64,249. The goals of the Coalition are: (1) establish and strengthen collaboration among 21 Reasons Coalition's partner organizations in support of the community's effort to prevent and reduce substance abuse among youth; and (2) reduce substance abuse among youth in Portland, ME, and, over time, reduce substance abuse among adults by addressing the issues in our community that increase the risk of substance abuse and promoting the factors that minimize the risk of substance abuse. The Coalition will achieve its goals by implementing these strategies: (1) Outreach, training, and collaboration to strengthen Coalition membership and leadership. (2) Marketing and information dissemination to strengthen parental monitoring attitudes and behaviors. (3) Policy change, education, and collaboration to strengthen enforcement and sentencing related to violations of alcohol and marijuana laws. (4) Education and collaboration with key decision makers to decrease availability of alcohol and marijuana to youth.

The goals of the Coalition are: (1) establish and strengthen collaboration among Jackson County Substance Abuse Prevention Coalition's partner organizations in support of the community's effort to prevent and reduce substance abuse among youth; and (2) reduce substance abuse among youth in Jackson County, MI, and, over time, reduce substance abuse among adults by addressing the issues in our community that increase the risk of substance abuse and promoting the factors that minimize the risk of substance abuse. The Coalition will achieve its goals by implementing these strategies: (1) Perform alcohol and tobacco vendor compliance checks throughout the county to ensure compliance. (2) Receive responsible alcohol server training and provide said training to Jackson County vendors. (3) Host a cultural competency training for the Coalition and community stakeholders. (4) Through social marketing, positively impact misperceived community norms involving alcohol, tobacco, and marijuana use by youth. (5) Advocate for and implement a 24/7 school tobacco-free campus policy at all county schools. (6) Attend CADCA's National Leadership Forum to increase community collaborations and capacity around substance abuse prevention. (7) Conduct evaluation and incorporate results into future Coalition planning.

The goals of the Coalition are: (1) establish and strengthen collaboration among Healthy Communities Healthy Youth's partner organizations in support of the community's effort to prevent and reduce substance abuse among youth; and (2) reduce substance abuse among youth in Marquette County, WI, and, over time, reduce substance abuse among adults by addressing the issues in our community that increase the risk of substance abuse and promoting the factors that minimize the risk of substance abuse. The Coalition will achieve its goals by implementing these strategies: (1) Conduct a comprehensive assessment of community readiness to reduce underage social and commercial access of alcohol and tobacco through one on one interviews, surveys, and environmental scans. (2) Implement beverage server training in conjunction with comprehensive alcohol and tobacco compliance checks to reduce commercial underage access to alcohol and tobacco. (3) Develop Parent Information Exchange Networks in three communities within Marquette County to support increased parental monitoring and provide support for enforcement of family policies related to underage access and use of tobacco and alcohol. The Healthy Communities Healthy Youth coalition services Marquette County, WI, a rural area with a population of 15,423.

The Coalition services Castle Rock, WA, a rural area with a population of 12,150. The Coalition will achieve the DFC goals by implementing these strategies: (1) Develop strong partnerships with all community stakeholders, including youth and parents. (2) Increase awareness in the community on the dangers and risk of underage drinking and prescription drug use. (3) Focus activities and Coalition efforts on decreasing alcohol, tobacco, marijuana, and prescription drug use among youth in Castle Rock.

The Coalition services Orting, WA, a rural area with a population of 6,000. The Coalition will achieve the DFC goals by implementing these strategies: (1) Develop knowledge and skills of Coalition members to effectively address alcohol and prescription drug abuse among youth as well as develop the cultural competency of the Coalition through training and community outreach. (2) Set clear consequences for alcohol use by youth and routinely apply consequences and set clear consequences for adults supplying alcohol to youth by conducting Party Intervention Patrols and working with city council to develop and adopt a social hosting ordinance. (3)Enhance barriers to alcohol access by youth and reduce access and enhance barriers to prescription drugs by conducting compliance checks at local stores, bars, and restaurants and setting up prescription drop-off centers.

The goals of the Coalition are: (1) establish and strengthen collaboration among Catalyst Coalition's partner organizations in support of the community's effort to prevent and reduce substance abuse among youth; and (2) reduce substance abuse among youth in Napa, CA, and, over time, reduce substance abuse among adults by addressing the issues in our community that increase the risk of substance abuse and promoting the factors that minimize the risk of substance abuse. The Coalition will achieve its goals by implementing these strategies: (1) Expand Coalition membership and capacity, provide trainings and outreach to engage the entire community, and revise and publish the countywide Strategic Prevention Plan. (2) Review and improve local policies to limit youth alcohol access including social host ordinances, responsible beverage service ordinances and school policies, support internal policy development for families and organizations to discourage youth use at home and at community events, and support the enforcement of underage drinking laws. (3) Discourage youth marijuana use by discussing and creating boundaries at school, in the community, and at home, and limit youth access to marijuana by improving policies at school and in the community.

Early Trauma Treatment Network: Improving Access and Standard of Care for Young/Preschool Children. The Early Trauma Treatment Network (ETTN) will address the needs of traumatized young/preschool children by increasing access to evidence-based trauma treatment and raising the standard of care in key service systems. ETTN will build capacity and competence in early trauma services in pediatrics, home visiting, childcare, mental health, child welfare, and the military system. Young/preschool children are most vulnerable to trauma due to statistically higher exposure, developmental vulnerability, and dependence on parents or caregivers. Among military families, young children are at risk due to the impact of deployment and parental injury or death on family functioning. ETTN will address training and service gaps by activities that promote workforce development; create culturally informed products, training protocols and resources; and build cross-system linkages to promote collaboration among the key systems of care. ETTN is a collaborative of four leading national programs in early childhood trauma treatment, training, and dissemination. The lead agency is the UCSF Child Trauma Research Program, a multicultural program engaged in developing evidence-based treatments/interventions, training, clinical research, and direct service; the other sites are Child Violence Exposure Program at Louisiana State University Health Sciences Center, Child Witness to Violence Project at Boston Medical Center, and Infant Team at Tulane University Medical Center. All ETTN sites provide training in Child-Parent Psychotherapy (CPP), a manualized treatment for young children listed as evidence-based in the SAMHSA National Registry of Evidence-Based Programs and Practices. To enhance access and standards of care, ETTN will create products and conduct activities that increase agency readiness and promote sustainability of evidence-based and promising interventions; conduct 4 CPP Learning Co

National statistics illustrate the multi-layered challenges under-resourced families face including higher risk of exposure to victimization and multiple stressors often resulting in major behavioral health disparities. Growing awareness of trauma’s impact on these families – including the critical roles families play in helping children recover – necessitates further development, evaluation, training on and dissemination of Family Interventions. In response to RFA SM-16-008, the Family-Informed Trauma Treatment (FITT) Center, an active and productive NCTSN member since 2007, proposes to 1) lead national efforts to raise awareness of the impact of complex trauma, poverty and inequity on families; 2) elaborate the multi-tiered family interventions and resources needed to optimize healing; 3) train the workforce on family trauma interventions and resources that effectively support healing; and 4) enhance the role of peers by recognizing and empowering families and communities as central to promoting resiliency and positive outcomes for children. The FITT Center will employ ecological and power sharing approaches to improve engagement, effectiveness, and acceptability of family intervention for families who are disenfranchised and living in highly under-resourced communities. We will convene three Breakthrough Series Collaboratives in partnership with three communities highly impacted by trauma, poverty and violence to increase resources for families. We will improve access to, impact and sustainability of three effective family trauma treatments, Strengthening Families Coping Resources (SFCR), Trauma Adapted Family Connections (TA-FC), and a family based assessment and treatment planning tool, Family Assessment of Needs and Strengths-Trauma (FANS-Trauma) through collaborations with 20 CTCs and other organizations that support large numbers of minority families living in poverty. We will increase availability of training and tools for the workforce to enhance knowledge

The National Child Trauma Workforce Development Institute at the Silberman School of Social Work at Hunter College will expand the trauma-informed workforce by widely disseminating the NCTSN Core Concepts Curriculum (CCC) in the higher education systems that train clinical psychologists, child psychiatrists, social workers, licensed clinical mental health and marriage and family counselors both In and Beyond the Network. The Institute’s In Network strategy that disseminates the CCC to NSTCN Cat II & III sites throughout SAMHSA’s 10 regions reaches our population during their field practicums before graduation. It also builds the site’s CCC facilitator capacity needed to train 3 of the 5 mental health disciplines. Our Beyond the Network strategy reaches the 2 other disciplines, with CCC integration in their classroom curriculum and by partner agency and post-graduate CEU training. Trainee and NCTSN staff demographic information is not collected, however proxy data shows that they will serve multiply traumatized male and female clients 0-18 without regard to race, socioeconomic status, ethnicity, religion, gender identity, sexual orientation, geography, disability or language and literacy. GOALS: (1) (In Network) Build a national organizational infrastructure: Obj. 1. Establish a leadership team (meets at least monthly). Obj. 2. Develop 3 discipline specific planning teams (meets at least 4 time/year) Obj. 3. Develop a minimum of 3 regional work group teams (meets at least twice/year) Obj. 4. Develop a CCC training team (“the College”)-to expand CCC capacity by training 60 facilitators of different experience levels. Obj. 5. Develop an Advisory Board of trauma experts and consumers; (2) (In Network) Launch CCC dissemination within the system of higher education. Obj. 1. Recruit 28 staff from CAT II & III sites to attend a CCC College Obj. 2. Train 30 clinical psychology interns in at least five sites with APA approved internships.

COMPLEX TRAUMA TREATMENT NETWORK (CTTN) Suffolk U, Justice Resource Institute, Adelphi U, Los Angeles Children’s Hospital, U Chicago, ACMHS NATIONAL CHILD TRAUMATIC STRESS INITIATIVE CAT II TSA Track: Complex Trauma: Residential Treatment Settings, Shelters & Juvenile Justice Detention Centers The project proposes the continuation/expansion of the Complex Trauma Treatment Network (CTTN), a Category II NCTSN Center established in 2009 to develop, adapt, and disseminate trauma-informed systems interventions and evidence-based practices (EBPs) for agencies and programs nationwide serving youth and families with complex trauma (CT), including residential treatment settings (RTS), homeless shelters (HS) and juvenile justice detention centers (JDC). During the 2016-21 cycle, the CTTN will provide intensive training and technical assistance (T/TA) to over 190 RTS, HS and JDC programs operated by 43 governmental agencies and nonprofit organizations participating in 2 Learning Communities (LCAs), 17 Learning Collaboratives (LCs) and 3 CT EBP Consortia (CTCs) from 15 states and 4 US territories that collectively span all 10 HHS/SAMHSA service regions. The CTTN will train over 40,000 multidisciplinary providers, impacting over 200,000 US children and families. Goals for 2016 cycle: (1) establish CT-informed infrastructure across high-need systems of care; (2) increase national dissemination of EBPs for CT (ARC, SPARCS, and Think Trauma) in RTS, JDC, and HS; and (3) achieve regional sustainability of CT EBPs through establishment of inter-agency consortium addressing CT within large metropolitan regions, multistate urban corridors, and national service organizations. Implementation science-driven objectives will address goals based on three levels of system readiness. Level 1 will continue CTTN’s work of enhancing CT-informed infrastructure across the care continuum addressing behavioral health disparities in regions of the US with history of limited access to N

The Childhood Violent Trauma Center (CVTC) of the Child Study Center at the Yale School of Medicine proposes to serve as the lead Treatment and Service Adaption (TSA) Center in the area of acute/early/brief intervention, providing national expertise for early/acute responses to traumatic experiences, and supporting the specialized adaptation of effective early evidence-based treatments and service approaches following recent potentially traumatic events. The proposed project will: 1) expand implementation of acute/early/brief trauma interventions – including the specialized adaptation of the Child and Family Traumatic Stress Intervention (CFTSI) and Law Enforcement Responses to Children Exposed to Violence (LE CEV). CFTSI is currently the only evidence-based brief, early mental health treatment for children 7-18 who have experienced a recent traumatic event and will be expanded to new populations including Young Children ages 3-6, Military Families and Medically/Physically Injured Children. This will include a focus on service systems where children can be identified in the early phase of traumatic response, including in Emergency Departments and in Child Advocacy Centers. The LE CEV initiative is based on the innovative Child Development Community Policing (CD-CP) program developed in New Haven. The CD-CP program is a groundbreaking model of law enforcement-mental health collaboration which forms the basis for strategies and approaches to enhance the capacity of law enforcement to respond to children and families exposed violence; 2) increase capacity of child-serving systems, including law enforcement, to support identification, referral, access and utilization of evidence-based trauma informed approaches, by developing engagement strategies designed specifically to engage families in the early/acute phase of trauma response that have not yet reached out for mental health treatment and other services; 3) develop, train, implement, and evaluate acute/early/brief

The Chadwick Center for Children and Families at Rady Children’s Hospital-San Diego, in close cooperation with the Child and Adolescent Services Research Center (CASRC), proposes to create the Center for Child Welfare Trauma-Informed Practice and Systems Change (Center) to support child welfare (CW) system efforts across the nation. The objective is to further evolve toward being truly trauma-informed (TI) and to better meet the needs of victims of child abuse and neglect. Expanding on work advanced through the currently funded Substance Abuse and Mental Health Services Administration (SAMHSA) Chadwick Trauma-Informed Systems Dissemination and Implementation Project (CTISP-DI), the Center will develop and evaluate a system of comprehensive training and consultation/coaching for the full CW workforce to support communities seeking to become more TI. This National Child Traumatic Stress Network (NCTSN) Treatment and Services Adaptation (TSA) Center, in cooperation with the National Center for Child Traumatic Stress, other select TSA and Community Treatment and Services (CTS) Centers across the country, appropriate NCTSN committees, and public CW organizations nationwide, will continue to lead the transformation of public CW agencies into TI systems. Specifically, the Center will build on lessons of implementation science and experience with current efforts to support CW systems and expand upon the existing Child Welfare Trauma Training Toolkit (CWTTT). Developed by the Chadwick Center-led NCTSN CW Committee and revised and refined under the formerly SAMHSA-funded Chadwick Trauma-Informed Systems Project (CTISP), the CWTTT will be adapted into four new curricula for use with specific targeted segments of the CW system workforce including caseworkers, supervisors, leaders (directors and managers), and support staff (receptionists, case aides, etc.). Each curriculum will provide information on how culture and trauma intersect and all four of these curricula will

The Center for Trauma-Informed Adolescent Suicide, Self-Harm, and Substance Abuse Treatment and Prevention will provide national expertise on adolescents affected by trauma, emphasizing services for suicide/self-harm and substance abuse. By supporting trauma-informed adaptation of effective evidence-based care for these problems, the Center will provide a resource with potential to decrease morbidity and mortality associated with suicidal/self-harm behavior and substance abuse in adolescents suffering the effects of trauma. Due to the potential life-threatening consequences of suicidal and self-harm behavior, and substance abuse, we prioritize services for emergency/acute care and brief time-limited treatments with evidence supporting effectiveness. These include: 1) emergency/acute care for suicidal/self-harm behavior using the Specialized Emergency/Family Intervention for Suicide Prevention (FISP), and Screening and Motivational Interviewing for substance using adolescents; and 2) treatment after the emergency/acute episode using SAFETY, a cognitive-behavioral family intervention that includes dialectical behavior therapy skills for adolescents presenting with suicidal/self-harm behavior, and motivational interviewing plus cognitive-behavior therapy (with optional contingency management) for substance using adolescents. Combining effective emergency care and brief outpatient treatments aimed at establishing safety has potential for reducing high-cost emergency department and hospital care. To facilitate national reach, the Center is structured with hubs in California and North Carolina with the goal of serving health and behavioral health care sites across the nation. Based on the numbers of clients seen at partnering sites, the Center has potential to improve care for over 180,000 youths across four states located across the nation and 400 providers. Sites were recruited with the goal of serving a high proportion of underserved and minority youths, with the goal