Grants Dashboard

988 Alabama Building Capacity Improvement (988 ABC Improvement) project is to assist Alabama, primarily a rural state, with the improvement of capacity building efforts to ensure state originated crisis calls are properly routed and answered and sufficiently equipped to meet 988 demand. The goals of 988 ABC Improvement are to: Improve workforce recruitment, retention, and training efforts to ensure necessary capacity for Someone to Call, Someone to Respond, and Somewhere to Go to reduce the number of jail bookings and hospital ED boarding time due to a behavioral health crisis and increase crisis support services; Implement applicable technology and security measures to ensure effective coordination across the continuum to support the Someone to Call, Someone to Respond, and Somewhere to Go framework to increase coordinated services and prevent service delays; Improve Alabama capacity to readily assess and identify 988 service need as it relates to high-risk and underserved populations to effectively address health disparities and achieve health equity; Develop and implement quality assurance plans and processes that include systematic reviews to address the identification and review of critical incidents to ensure state crisis response criteria is achieved; and Implement the comprehensive 988 communication plan and ensure Alabama communication strategies are culturally relevant and align with the 988-partner toolkit developed by SAMHSA to support local 988 needs. The objectives are to: By January 2024, Alabama Lifeline centers will be at optimal capacity to obtain a state call answer rate, chat, and text response to meet or exceed 90% of total calls received; By February 2024, the specifications of technology and security measures will be outlined to ensure effective coordination with 911, mobile crisis response or crisis stabilization services as indicated by the mobile crisis service report and the joint report to the Alabama 911 Executive Director; By December 2023, establish statewide demographic data collection methods for analysis, evidenced by the development of quantitative and qualitative tools, while ensuring safeguards of individual information that is consistent with applicable state and federal laws to address high-risk and underserved populations; By September 2024, establish quality assurance protocols, evidenced by a quality assurance plan to be submitted to SAMHSA one year after the project award, for the identification and review of critical incidents as defined by state criterion and supported by SAMHSA; and By December 2023, fully implement the 988-communication strategy and messaging, measured by analytics reports, to reach universal populations, across the lifespan, within the state through platforms such as digital billboards, indoor screens, television, radio, print and online digital ads. The goals and objectives outlined will ensure every Alabamian, 5,074,296 individuals, have access to crisis care support and services as needed. Based on Vibrant's Broad State Metrics Report from June 2022 to May 2023, Alabama received 30,577 calls through the Lifeline. Understanding that the call demand is anticipated to increase, the annual number of persons served will include a 25% increase of the current call volume which is 38,221 annually and 114,663 persons over the three years of the project period. Persons served will be reflective of the entire demographic composition of the state. Service implementation will be available to all population characteristics and will ensure meeting the needs of persons underserved or unserved and providing equitable access to crisis care services.

The Wisconsin 988 Improvement Project will work to provide needed expansion of crisis center workforce to meet current and future 988 response in Wisconsin. The Wisconsin Department of Health Services (DHS) will continue to work with our current statewide Lifeline provider to improve our in-state answer rate for calls, chats, and texts. The Wisconsin Lifeline center, operated by Family Services of Northeast Wisconsin, has been part of the Lifeline network since 2020 and has been providing coverage for all areas of the state since shortly before the launch of 988 in July 2022. While the Wisconsin Lifeline program operates 24/7/365 and provides excellent service, the current workforce has been unable to keep pace with the tremendous increase in the volume of 988 calls, chats, and texts coming from residents throughout the state. This grant opportunity will allow for integration efforts between the Wisconsin Lifeline and additional crisis services in Wisconsin. By engaging and collaborating with additional crisis providers and agencies, callers to 988 can get connected more easily to additional services. DHS has an opportunity through this grant to continue to expand and improve 988 in Wisconsin. The three primary and overarching goals of this project are: 1. Expand 988 Wisconsin Lifeline's hybrid workforce through recruiting, hiring, training, and retaining Lifeline Counselors working on-site and remotely. 2. Strengthen connections between 988 Wisconsin Lifeline, Public Safety Answering Points (PSAPs), and local crisis programs across the state. 3. Improve strategic 988 messaging to reach specific populations across the state. Personnel requirements for this project will be in kind and made up of staff within the Bureau of Prevention Treatment, and Recovery. Staff will include three Co-Project Directors. Contracted staff will include the University of Wisconsin Population Health Institute, which will provide a Project Evaluator. Additional DHS staff will offer support for the grant.

The Minnesota 988 Lifeline Capacity Improvement Project will advance the existing work to strengthen the infrastructure of the 988 Lifeline system in the state. In total, over 51,000 Minnesotans reached out to the 988 Lifeline in 2022. Data shows that there has been a notable increase in volume across calls, chats, and texts since the transition to 988. Calls have increased by 35%, chats increased by 67% and texts have risen by 658% in Minnesota. Under this cooperative agreement, Minnesota can continue to provide localized suicide, mental health, and substance use crisis support for all Minnesotans who call, chat, or text the 988 Suicide & Crisis Lifeline. At the same time, this project will allow Minnesota to strengthen statewide partnerships across the crisis care continuum. The Minnesota Department of Health (MDH) has identified five goals to further support the 988 Lifeline system in Minnesota: 1) Enhance and expand workforce capacity and service within Minnesota Lifeline Centers to achieve a 90% answer rate across calls, chats, and texts. 2) Strengthen coordination across the crisis care continuum with crisis services and public safety answering points. 3) Improve support and service for high-risk and underserved populations statewide, including partnership with Tribal Nations that share geography with Minnesota. 4) Develop a comprehensive quality assurance plan. 5) Establish and implement a comprehensive communications plan. To achieve these goals, MDH will be taking a collaborative approach partnering with 988 Lifeline Centers, Mobile Crisis Teams, Public Safety Answering Points, Tribal Nations, and other state agencies.

Project Name: Improving Maine's 988 Lifeline Capacity Population Served: The project will serve the callers to Maine's statewide crisis hotline (Maine Crisis Line- MCL) and Maine's 988 Lifeline network. In 2022, Maine's Crisis Call Specialists received 129,510 calls and 2,302 chats and texts (includes both MCL and 988 Lifeline contacts). Strategies: This project will improve capacity at Maine's 988 Lifeline contact centers by increasing staffing levels and enhancing operational efficiency through implementation of national best practices and updated data tools and protections. Higher staffing levels will result in expanded services for 988 Lifeline callers, including implementations of national best practices and updated data tools and protections. Higher staffing levels will result in expanded services for 988 Lifeline callers, including implementation of the 988 Follow Up Program, answering of Maine-based chats and texts to the 988 Lifeline and at least 90% of Lifeline in-state contacts, and increased quality of care for referrals from the crisis hotline to regional mobile crisis response. Finally, this project will support marketing and messaging for Maine's behavioral health crisis system, including the 988 Lifeline, resulting in expanded awareness of confidential support and intervention services available for all Mainers experiencing behavioral health crisis. Project Goals and Measurable Objectives: Goal 1: Maine's 988 Lifeline Network will improve performance and quality of in-state response to 988 Lifeline contacts. Objectives: a. Hire and train new staff to achieve 90% answer rate b. Deploy customer service satisfaction survey to demonstrate 85% customer satisfaction c. Increase capacity on the DHHS OBH crisis data team Goal 2: Maine's 988 Lifeline contact centers will increase capacity and operational excellence by improving alignment with best practices and resources for efficient and effective crisis hotline service. Objective: a. Implement operational policy, protocols, and training curriculum in alignment with State and 988 Lifeline standards b. Maine's primary 988 Lifeline center will be 85% in compliance with SAMHSA cybersecurity recommendations. Goal 3: Individuals in Maine will improve understanding goals and access of 988 Lifeline and Maine's behavioral health continuum of crisis services Objectives: a. Engage 988 stakeholders in 988 messaging strategy and content meetings to inform statewide 988 crisis system communications and marketing efforts. b. Launch a statewide messaging campaign in alignment with SAMHSA's 988 Toolkit and Maine stakeholder input. Goal 4: Maine's behavioral health crisis system will improve access and support for post-988 contact connections with crisis intervention and stabilization services. Objectives: a. Maine's 988 Lifeline Network will provide telephonic follow up support in compliance with 988 Lifeline standards b. Enhanced Dispatch Coordination at Maine's Mobile Crisis Teams will result in 95% live connection rate for warm handoffs from Maine's 988 Contact Centers. c. Implement crisis management software capable of longitudinal tracking of individual journeys through the crisis system as well as systems-level analysis and reporting.

The state of Oregon will enhance hiring and training of the 988 and Behavioral Health Crisis System workforce, strengthen coordination and cross state partnerships, launch a statewide communication and community engagement campaign, and build a comprehensive 988 evaluation framework so that all 988 contacts, especially audiences at higher risk of behavioral health crises and suicide, receive trauma informed care during and after any crisis. Oregon's 988 and Behavioral Health Crisis System must especially reach people who live in rural areas; veterans and individuals and families who have served in the military; communities of color; Tribal communities; people who identify as LGBTQIA2S; older adults; young adults; people living with depression, anxiety or other mental health conditions; people with substance use disorders; people with disabilities; people employed in the construction industry; and people who identify as male. Through annual investments in 988 call centers and Oregon Health Authority (OHA) staff, improved coordination with Nine Federally Recognized Tribes of Oregon, Mobile Crisis Intervention Services, substance use program, Emergency services, and suicide prevention initiatives; and statewide marketing and community engagement efforts, OHA expects that 988 call, text, and chat volume will significantly rise in 2023 to 2026, potentially reaching 85,000 additional contracts through 988 directly, while also improving satisfaction with the entire Behavioral Health Crisis System through strengthened referral process and follow-up care. Understanding community needs and increasing integration among support services will ensure the experiences of populations most in need of 988 services and supports are embedded in communication and service improvement plans.

The 988 Lifeline crisis centers in Indiana have achieved remarkable success thus far, surpassing and maintaining the goal of a 90% in-state answer rate. Additional investments must be made to enhance and improve the system. The four current Lifeline crisis centers have just begun operating with a shared telephony platform and CRM, alleviating workforce challenges and promoting standardization. Soon, the fifth lifeline crisis center will be going live, answering only chats and texts. While great successes have been made, gaps remain throughout the system, specifically in integration across crisis systems, data leveraging and management, technology implementation and maintenance, and stakeholder collaboration. To address these gaps, targeted investments are needed to enhance the peer workforce and add specific roles like quality improvement specialists, technology specialists, and a law enforcement coordinator. By making these important investments, Indiana can improve the quality of services and coordinate across crisis entities, ultimately creating the best possible crisis response system.

Ohio's 988 Improvement Project will be guided by two goals that align with Ohio's 988 needs and support and enhance Ohio's 988 workforce, while unifying 988 resources across Ohio and improving in-state answer rates. These goals will be accomplished through a Community of Practice (COP) with Ohio's 988 providers, the 988 Connect planning committee, stakeholders, and the 988 Administrator. Goal 1: Expand Ohio's 988 workforce through recruiting, hiring, and training at the provider level. Objective 1A: To utilize funding from this cooperative agreement to maintain and expand the workforce to answer at least 90 percent of total calls, chats, and texts to 988 by Ohioans. Objective 1B: To convene a COP among Ohio's 19 988 providers to facilitate collaboration, coordination, sharing, and utilization of workforce development resources. Goal 2: Engage 988 crisis centers to unify 988 responses across the state and improve response rates to meet minimum key performance indicators. Objective 2A: To create referral and follow-up procedures that are unified across all Ohio 988 providers. Objective 2B: To expand capacity for agencies to collect, analyze, and understand Key Performance Indicator (KPI) data and use KPI to make real-time operational decisions to improve answer rates and follow-up. Objective 2C: To utilize formal written/intra- and inter-organizational agreements such as MOUs and MOAs to improve 988 system performance and to ensure use of best practice referral and follow-up practices. Objective 2D: To monitor implementation of the state's primary and backup coverage map, along with he performance of the statewide backup provider. Ohio's 988 COP also will allow each of Ohio's 988 providers to share workforce development strategies and will build capacity to collect and report monthly data on contacts that were screened for suicide ideation, referred to mental health services, linked to mental health or related services, result in an emergency rescue, suicide attempts in progress, substance use crisis, mobile crisis outreach referrals, and individuals who died by suicide. While in FY2022, 63,613 Lifeline calls were attributed to Ohio, according to Vibrant, the total demand for Ohio's 988 services since launch was 110,749 calls/chats/texts. Based on the trend that Ohio's total calls have increased over the last nine months, and by increasing coverage and capacity to answer calls by Ohio providers, Ohio hopes to consistently meet at a minimum 90 percent Ohio call demand during all three years of the grant. Additionally, Ohio will be expanding its capacity to provide chat and text services for Ohioans and hopes to answer more than 50 percent of state demand for grant year one and 90 percent for year two and three. Age, gender, and race all are related to suicide in Ohio, with 44 percent of Ohioans who died by suicide in 2019 being 50 or older, 80 percent being male, and 86 percent being white. 2021 data from Ohio's Careline shows that 34.5 percent of callers are seeking information, 21.4 percent present with a mental health issue, 22.1 percent with stress and anxiety, 9.8 percent feel lonely or isolated, and 3.7 percent report substance use issues. A greater percentage of females (53.5 percent) contacted the Ohio CareLine compared to males (30.3 percent). A large percentage of callers declined to provide their age (50.3 percent) and race (63.3 percent).

The Mental Health and Anti-Addiction Services Administration (MHAASA) of Puerto Rico (PR) will implement the PR 988 Improvement Project to improve response to 988 contacts, including calls, chats, and texts originating within PR. The PAS Line, as the only call center/988 in PR, attended 211,323 calls, including 506 calls through the 988/Lifeline, in SFY 2022. Through April of 2023 in the current fiscal year, a total of 134,440 persons have been attended by the PAS Line, of which 8,998 were related to suicide behavior. The PAS/988 Lifeline became one of the National Spanish-Speaking Lines in November of 2022, and ahs received support and collaboration from VIbrant and SAMHSA. Most recent data of May of 2023 from the Spanish Crisis Line reflected 2,924 calls received, with 2,388 calls answered (82%), with an average speed to answer of 00.19 seconds, and an abandonment rate of 18%. In April of 2023, 2,389 of 2,877 total calls (83%) were answered with an abandonment rate of 17%. The PR Crisis Continuum of Services currently guarantees access to crisis services from all of PR through one Crisis Call Center (CC), 5 Mobile Crisis Teams (MCT), and coordination of services to Crisis Stabilization Facilities. Based on the increase in calls received by the CC through the addition of 988 contacts, and the continuing needs to serve individuals at risk of suicide, the MHAASA proposes a 3-year 988 Improvement Project to achieve the following summarized Goals and Objectives: G.1) Ensure statewide and National coverage for 9-8-8 calls, chats, and texts through the PAS Line; G.2) Enhance national initiatives directed to public messaging for 988; G.3) Enhance the PR-PAS Line's data collection infrastructure to improve 988 services and communication; and G.4) Ensure that the PR-PAS Line/Lifeline crisis center can provide follow-up services to 9-8-8 users according to Lifeline best practices. Aligned with the needs, the objectives will be directed to ensure that: the total number of received calls answered is greater than 90% during YR 01; and at least 95% in YR03; meet a minimum of 90% of state chats and texts demand; that 95% of the contacts received are answered (speed to answer) in 20 seconds, with 90% answered in 15 seconds; that the abandonment rate is less than 5%; direct/rollover calls to backup centers is less than 10%; and that at least one (1) communication strategy is directed to promoting the 988/PAS Line services; that a report is developed with community-based leadership input to meet 988 connection and support needs; and that 100% of the data collection instruments are assessed and updated to ensure the addition of 988 guideline requirements; that policies and procedures specific for populations identified at risk of suicide are established; and that 100% of the population served by the crisis case managers of the PAS Line/988 Lifeline are registered in the "Respond" database; at least one new MCT is added to improve connection in currently underserved geographic area of PR; and at least three MOU's for crisis support or crisis stabilization services are established to ensure referral connections post-988 contact; and at least 85% of the contacts requiring substance use crisis care are connected to specialized services. The proposed project will ensure Nationwide coverage for 9-8-8 calls, chats, and texts through the PAS Line/988 Lifeline. Primary services EBP's will include SBIRT, Applied Suicide Intervention Skills Training (ASIST), Mental Health First Aid, and Rapid Response in Suicidal Behavior. Data collection, analysis and reporting will be supported by a 0.28 FTE Evaluator to ensure fidelity to EBPs and compliance with GPRA/SPARS requirements. A total of $869,503 per year is requested for the 3-year grant period.

Fairbanks Native Association (FNA), a tribal organization, is applying for the SAMHSA 988 Tribal Response opportunity. Our project, the Athabascan Suicide Response Project will serve American Indians and Alaska Natives (AI/AN) in our tribal service area, the Fairbanks North Star Borough (FNSB), an area geographically the size of the New Jersey. By joint agreement we serve both Alaska Natives and American Indians. Our response is a cultural response. On July 16, 2022, the 988-dialing code (988 Suicide and Crisis Lifeline) came on-line in Alaska. The prior 911 call line wasn’t set up to address mental health needs. The intent of 988 dialing is to reduce confrontations with law enforcement and connect people in crisis to the right help right away. People who call or text the number are connected to a trained counselor at the crisis center closest to them. This system has yet to develop a culturally specific strategy for responding to a suicide crisis for AI/AN people. As AI/AN have the highest incidence of suicide both statewide and nationally, a culturally specific suicide crisis response is critical. As AI/AN culture is community and family-based, the Athabascan Suicide Response Project is framed around the concepts of community, family and culture and integrates elements of each into its suicide response following referral. For AI/AN, healing from the effects of intergenerational trauma and other social issues – including suicide – require a cultural response. Key to the community response is the FNA-sponsored 22 member Behavioral Health Community Coalition (BHCC), which provides infrastructure development and behavioral health leadership in the FNSB. FNA’s Behavioral Health Services department (BHS) partners with the BHCC in all projects. The Athabascan Suicide Response Project will include the following required activities: A) Train 988 staff to be more culturally resonant, B) Form three three-person Community Response Teams, C) Provide screening, assessment, treatment, and recovery supports, D) Provide group therapy through Talking Circles, and E) Inform the community about 988. Cultural elements of this project will include the following: 1) project activities led by the community (BHCC) include the development of Community Response Teams, led by a Therapist. The teams may include an Elder, AI/AN community leader, BHCC member, and/or BHCC Youth Council member if client is a youth. The team will be convened upon referral from the call line. 2) A family member of the person referred will identified by the client to provide 3 month support and follow-up post treatment discharge. 3) Meeting in a community versus office setting. 4) Culturally specific suicide prevention materials. 5) Guiding Good Choices, an Evidence Based Practice that BHS has tested for cultural relevance over three years for family training. 6) Culturally specific screening, assessment, treatment, and recovery support services. 7) Training 988 staff in culturally specific communication techniques. 8) Client Participation in a weekly Talking Circles. 9) A culturally specific marketing campaign to inform the community of the change from 911 to 988 and to explain how responses will be culturally specific.

Santo Domingo Pueblo will implement a Mobile Crisis Team initiative that targets reform at the tribal level, as well as delivering direct services to vulnerable community members. This proposal requests funding for a Mobile Crisis Team (MCT) that would increase and sustain access to behavioral health services for tribal members of Santo Domingo Pueblo. The MCT will provide crisis stabilization services to community members at home or in the community to address suicidal ideation, escalating mental health needs, and substance use issues. Santo Domingo Kewa Family Wellness Center is the right agency to oversee the implementation of these services as individuals from Santo Domingo are the most equipped to provide culturally sensitive and appropriate services to this population. Service provision will be impactful because it is grounded in evidence-based practices in crisis intervention that include motivational interviewing, trauma informed care, and harm reduction approaches. Current relationships with our community partners and a fully staffed team will ensure we can provide real time coordinated crisis interventions. Community partners will include law enforcement, EMS, emergency services, faith-based organizations, and other tribal departments. If awarded Kewa Family Wellness Center will enter into a formal agreement with our local health center, our EMS responders, our local BIA service provider, and our Tribal Official team.

Project Abstract The Eastern Shoshone 988 Tribal Response program will increase awareness and use of the 988 Lifeline on the Wind River Reservation located in central Wyoming. The program will train at least 20 individuals over the course of two years along with serving the Eastern Shoshone tribal members with an enrollment of 4,368 members. Access to mental health services, substance use treatment and behavioral health therapies is limited on the WRR due to rural location, limited transportation, stigma, digital inequality, and long-wait times. Foundational guidance from needs assessments, quality improvement plans, and linkage to local, state, and national resources are needed. These gaps directly impact tribal members in crisis. Data from the WRR Indian Health Service indicate that 246 individuals were treated at the clinic due to intentional self-harm diagnosis from 2016 - 2020. In 2021 there were 17 deaths by suicide in Fremont County, this was three times greater than the national average. A 2022 WRR community survey reported that the number one health concern was opioid use followed by unresolved trauma. This same survey reported that 22% do not have access to the internet and 19% are not aware of the telehealth services available (like 988), and 9% do not have access to a phone. Tribal members feel that most providers could benefit from cultural competency training. The overall goal of the ESR 988 project is to save lives through the 988 Lifeline on the WRR. Though the implementation of six specific objectives, ESR will: • Assist local 988 crisis centers with a quality improvement plan focusing on policies, first contact, assessment, referral, and access to local care to ensure there is a comprehensive and coordinated response to individuals at imminent risk for suicide. • Establish collaborations with states, territories, and local crisis centers to improve effective 988 response and linkage to local resources, including cases of emergency intervention. This will result in 20 individuals referred to ESR for services from the 988 Lifeline. • Provide training for two crisis call center staff per year that specifically addresses the needs of the WRR and tribes in Wyoming. • Develop and implement a plan for sustainability which includes ongoing collaboration with the Wyoming DOH 988 Lifeline team. • Partner with Lifeline 988 crisis centers to identify contacts and provide follow-up • Train peer support specialists and community health workers on suicide prevention and crisis response • Develop a culturally appropriate and culturally responsive curriculum for individuals in crisis The ESR 988 project will continue to work with existing partners, current SAMHSA grants, and the Indian Health Services to offer evidence-based prevention, treatment, and recovery practices to the Eastern Shoshone community.

Toiyabe Indian Health Project (TIHP) and the seven federally recognized tribes in the consortium are challenged due to its rural California location with limited available services and public/private entities who work inconsistently with Native Americans at risk of suicide. TIHP aims to create a cohesive public/private partnership (PPP) program with local entities and 998 Suicide & Crisis Centers to work together to serve Native Americans who are at risk of suicide. • Project Name: Toiyabe Indian Health Project 988 Public/Private Partnership • Population(s) and number of people to be served annually and throughout the project: From among the 3,950 Native Americans (youth, adults, and Elders) who are members of the seven federally recognized tribes under the TIHP consortium and the 10 Public/Private entities to be included in the task force, 100 tribal members and 100 employees, respectively, will be trained with 50% trained by Year 2 and 50% trained in Year 3. • Project Goals & Measurable Objectives: Goal #1: Secure public/private partnerships to work together to develop effective and culturally informed suicide risk response services for Native Americans. . Objective: By 1/31/24, TIHP will have secured at least four tribal leaders and 10 public/private entities (healthcare, educational, and law enforcement entities, 988 crisis centers, mental and behavioral health centers, and Mono and Inyo County officials) through MOUs and will have initiated monthly meetings to develop the common purposes of serving Native Americans at risk of suicide. Goal #2: Create professional development training plans/ activities to: a) address issues affecting Native American suicidal ideation, and b) enable a culturally competent training program for PPP task force members and their employees to identify and refer Native Americans at risk of suicide to TIHP. Objective: By 8/31/24, the TIHP PPP team will have identified, tested, assessed, and amended a culturally and linguistically developed curriculum and training program that improves the competency of team members and their employees to refer at-risk Native Americans to TIHP and will have started full-scale training to all team entities and TIHP tribal nations 9/1/24. Goal #3: Create methods for collecting, analyzing, and using data to assess and improve the effectiveness of the programs employed by the PPP task force. Objective: Quarterly and annually, using benchmarks prepared by 1/31/24 and tested by 6/30/24, the PPP team and each of their organizations will have been evaluated to determine the program’s effectiveness in identifying and referring Native Americans at risk of suicide to TIHP. • Strategies/Interventions: 1) Partners Program: Create and format the SRT task force. Include local hospital districts, 988 crisis centers, law enforcement, school districts, county behavioral health officials, tribal leaders, and mental health centers. Activities include task force development and purpose, scheduled meetings, Native American cultural knowledge learning, and how to identify and support at-risk Native Americans. 2) Curriculum Development: Develop Native American culturally and linguistically sensitive curriculum on suicidal awareness, prevention, and intervention. Activities include needs assessments, Tribal leader consultations, identifying the curriculum, developing pamphlets, flyers, videos, etc., adapted to the various entities and Native American youth, adults, and Elders. 3) Curriculum Activities and Delivery: In-person, virtual, and hybrid training for each entity and TIHP tribal nations, training to improve knowledge to facilitate referrals, tribal community education sessions. 4) Data Collection: Determine methods to collect, analyze, and improve the TIHP program through monthly and quarterly qualitative and quantitative methods. 5) Sustainability Planning: Extend the TIHP program through new funding and local and regional sources through SRT task force members.

The Peoria Crisis Response Program will serve tribal citizens across Ottawa County, Oklahoma. Administered through the Peoria Tribe of Indians of Oklahoma, the grant will help grow regional partnerships to provide increased access to community-based resources for suicide prevention and substance use disorders and overdose prevention education. Regionally, there has been an increase in suicides and substance misuse coupled with low treatment rates which highlights the need for increased awareness of the 988 Lifeline in Oklahoma. The purpose of the project is to educate and equip the community and healthcare practitioners how best to respond to suicide and substance misuse by increasing regional knowledge of 988 and access to treatment, raising awareness of existing resources, and encouraging sustainable, trauma-informed recovery networks and referral processes. The proposed multi-year program will be heavily informed by strategic partnerships and engagement with behavioral health partners which will be imperative to its success and sustainability. For the duration of the grant, staff will work closely with the evaluation team to gather data, evaluate efficacy of trainings, and provide reports to illustrate impact and utilize the Process Improvement Model to ensure metrics are being met.

The "Arizona 988 State and Territory Improvement" project will address the urgent need to strengthen crisis response and support systems in the state for 988 generated contacts. With a focus on reducing suicide rates and improving mental health outcomes, our interventions aim to enhance access to timely and effective care for individuals experiencing mental health emergencies. By leveraging evidence-based strategies, fostering collaboration among stakeholders, and implementing comprehensive prevention measures, we strive to save lives and improve the overall well-being of Arizonans. The project will focus on three key strategies: Lifeline Expansion and Enhancement: We will expand the capacity and accessibility of the state's suicide prevention helpline, ensuring that individuals in crisis have immediate access to trained professionals and resources. By increasing the helpline's coverage and availability, we aim to reduce the barriers to seeking help and provide critical support to those in need. Community Education and Awareness: Through targeted education campaigns, workshops, and training programs, we will raise awareness about suicide prevention, mental health, and the available support services. By empowering communities with knowledge and resources, we seek to reduce stigma, promote early intervention, and encourage help-seeking behavior among at-risk populations. Strengthening Post-988 Supports: We will strengthen partnerships among mental health providers, crisis centers, community organizations, and other stakeholders. These collaborations will facilitate a coordinated response to mental health emergencies, ensuring seamless transitions of care and comprehensive support for individuals in crisis. Our measurable objectives include: Increasing the capacity of the suicide prevention helpline, resulting in continued achievement of unanswered calls and wait times expectations. Executing mental health communications strategies reaching a minimum of 100 community organizations annually, leading to an increase in knowledge about suicide prevention and available resources. Training a network of community gatekeepers, including teachers, healthcare providers, and law enforcement officers, with the goal of reaching 300 individuals per year and improving their ability to identify and support individuals at risk of mental health emergencies. Throughout the lifetime of the project, we aim to serve the diverse population of Arizona, with a particular focus on vulnerable groups such as LGBTQIA2S+, Veterans, Older Adults (65+), Adolescents, American Indians, and Suicide Attempt Survivors/Survivors of Suicide Loss. By providing targeted interventions and support, we strive to reduce the state's suicide rates and create a culture of mental wellness and resilience. Through rigorous data collection and evaluation, we will assess the project's impact on suicide rates, help-seeking behavior, and the accessibility of mental health services. The findings will guide ongoing improvements and enable the replication of successful strategies in other regions. By investing in the "Arizona 988 State and Territory Improvement" project, we have a unique opportunity to save lives, strengthen communities, and create a statewide model for effective crisis response and support. This project aligns with Arizona's commitment to the well-being of its residents and its dedication to reducing the devastating impact of mental health emergencies. Estimated number of people to be served as a result of the award of this grant: 183600.

Blossom Sustainable Development is a non profit organization located on the Shinnecock Indian Reservation in Suffolk County, NY. Blossom’s mission is to promote the health and wellbeing of the Long Island Native American community. Blossom is fiscally and managerially a separate entity from the Shinnecock Indian Nation’s government structure. Blossom is as adjunct provider of health and wellness services to the Shinnecock Indian Nation and located on the Shinnecock Indian Reservation. Blossom seeks to address this gap by providing on territory social work services to assist families learning about and connecting to various services, navigating the healthcare, social services, community based, and educational systems, enhancing coordination of care, providing case management, counseling, and traditional wellness services. The overarching purpose of the Shinnecock 988 Tribal Response Project is to 1) improve response to 988 contacts originating in Tribal communities and/or activated by AIs in the Shinnecock service area; 2) improve integration to ensure there is navigation and follow-up care; and (3) facilitate collaborations with tribal/state health providers, tribal organizations, law enforcement, and other first responders in a manner which respects Tribal sovereignty.

The American Indian Center of Arkansas (AICA) is seeking funding under Substance Abuse and Mental Health Administration (SAMHSA) FY2023 Support for 988 Tribal Response Cooperative Agreements. AICA is a non-profit Urban Indian Organization based in Little Rock, Arkansas and serves Native Americans in Arkansas. For this project, AICA will have one key partner that will serve as a sub-grantee: Inter-Tribal Council of Louisiana (ITCLA). Through these key partnerships, AICA catchment area will include Arkansas, Louisiana, and Polk County in the state of Texas. Over the last several years, the need for improved services for mental health and suicide prevention has become a top priority for tribal communities in our catchment area due to the extremely high suicide rates in our state. In Arkansas, the 2022 suicide rate was 20.6 individuals per 100,000 individuals and 15.26 individuals per 100,000 individuals in Louisiana versus 14.21 per 100,000 individuals nationally (Centers for Disease Control). With a suicide rate 30% higher than the national average, suicide is the second-leading cause of death for ages 10-34, the fourth leading cause of death for ages 35-44, and the fifth leading cause of death for ages 45-55 in Arkansas. (CDC WONDER Online Database, Underlying Cause of Death, Multiple Cause of Death and CDC 2021 Fatal Injury Report). Mental health disorders have proven to be a major issue among tribal members in our area. Goal 1. Increase the number of 988 emergency staff that are trained in providing culturally appropriate emergency response to Native Americans in Arkansas, Louisiana, and Polk County. Goal 2. Improve the integration of 988 crisis centers with tribal organizations and tribal treatment providers in the catchment area to assist tribal members in navigating mental/behavioral health resources to ensure comprehensive wrap-around care including case management and follow-up care. Goal 3. Develop formal partnerships, that align with tribal sovereignty, with key stakeholders including tribal service providers, local non-tribal service providers, state agencies, local agencies, and first responders that will result in improved access and treatment for tribal members with mental health issues and/or co-occurring mental health/substance abuse issues including those at risk of suicide.

Through the Tribal 988 Response funding, the Iowa Tribe of Oklahoma, Perkins Family Clinic will work with State 988 Crisis Response teams to increase cultural competency for Crisis Call center staff and provide resources for Native American individuals who contact the 988 Hotline that include traditional and cultural services provided in the state. PFC-BH will increase clinical staff by hiring a licensed mental health professional who will offer same day or next business day appointments for individuals who do not meet criteria for entering a crisis or urgent care behavioral health center. Key personnel will provide in school counseling services to reduce the barriers for seeking mental health services as well as provide suicide prevention curriculum in the school setting. Providing a systems advocate will also improve follow up and warm handoffs for individuals who seek resources and referral from the 988 Crisis Line. By increasing project staff, PFC-BH will increase mental health awareness, suicide prevention and improve advocacy and referral for individuals and families working through mental health complications. The Iowa Tribe of Oklahoma, Perkins Family Clinic Behavioral Health, continues to grow and service the rural communities of Lincoln, Logan and Payne Counties in Oklahoma with medical, dental, behavioral health and substance use treatment to Iowa Tribal Members, clients with any Tribal affiliation and non-Native clients. Perkins Family Clinic and Perkins Family Clinic Behavioral Health have worked to improve capacity and increase integrated medical and behavioral health and substance use services since 2018. PFC-BH has increased capacity for individual, family and group counseling, peer recovery support services, case management, mediation assisted treatment, 12 Step and Wellbriety groups, and Positive Indian Parenting groups over the past two years. Throughout the life of the grant, key personnel will train 62 individuals who are working at the State 988 Crisis Call center in Motivational Interviewing, cultural competency, and address the gap in mental health and substance use services provided to Native American individuals in Payne, Lincoln, and Logan Counties in Oklahoma.

The Wichita and Affiliated Tribes, a federally recognized Indian Tribe in SW Oklahoma, proposes to assist all the Native people of the Indian Health Services Lawton Service area through the 988 Tribal Response Cooperative for the Crisis Lifeline for three (3) years. At this time, suicide, particularly among young male Natives has reached near epidemic levels. The grant will help provide expanded services through the development of a mobile crisis unit to help supplement early identification of suicide risk and culturally appropriate help to all Natives of any Tribe. The Lawton Service Area is slightly larger than that of the state of New Jersey and comprises ten counties of over 9,000 square miles. There are approximately 26,000 Native people within the ten-county service area. Seven (7) Tribal Nations have their headquarters within the Lawton Service Area (Apache Tribe of Oklahoma, Caddo, Comanche, Delaware, Kiowa, Wichita and Affiliated and Fort Sill Apache. The Native population has poverty rates greater than Whites in seven of ten counties and many Native people are without health insurance. About 50% of the population is female. Natives in Oklahoma have higher rates of suicide than any race and Native males age 15-34 have approximately four times the rate of suicide as females and almost double the rate of their White male counterparts. The CDC reports that Native suicide of both males and females had greater increases during the first year of Covid 19 compared to all other races. In reality, suicide among our Native people is actually much higher than is reported as studies by the Southern Plains Tribal Health Board have shown that about 30% of Native suicides are unreported, likely due to stigma. In less than a year, the 988 Crisis Lifeline has had excellent results. Callers to the 988 Crisis Lifeline have much shorter wait times which allows more persons to be served with the addition of a mobile crisis unit. The Wichita and Affiliated will initially expand upon the screening of all Natives within the service areas and workplaces and continue to train teachers and staff on interventions. The project will provide culturally appropriate training to behavioral health professionals throughout the service area. To date, the most widely used interventions include: Asist, safeTALK, and Mental Health First Aid. The grant will also explore innovative ways of calling 988 including on line chats and phone to phone texting. The grant has four broad goals and seventeen measurable Objectives. Approximately 150 stakeholders per year will receive face to face trainings and over 8,000 Natives each year will be reached through Tribal Newsletters, social media, earned media and radio and TV. Over 350 stakeholders (including 988 personnel) and approximately 15,000 Native will be reached in the two-year project.

The Comanche Nation is a federally recognized tribe located in Comanche County, Oklahoma. The impact of historical and intergenerational trauma has created cycles of mental health problems, addiction, poverty, and crime has led to a complete breakdown of individual and family relationships extending across generations within our tribal community. Lack of access to culturally-competent and responsive care has had a devastating impact on the mental health stability of American Indian and Alaskan Natives (AI/AN) within our community. With this funding, the Comanche Nation will collaborate with local 988 crisis centers to improve the quality of response, care, and follow-up for tribal youth, teens, and young adults experiencing mental health crises and utilizing 988/lifeline call centers. The overarching program goals are to ensure culturally-responsive services, improve access to care, and improve effective 988 response and follow-up for AI/AN youth, teen, young adults and their respective family systems. The Comanche Nation will implement a mobile crisis program to provide crisis intervention, stabilization, and management to tribal youth, teen, and young adults callers utilizing 988/lifeline systems. We will also work to identify and analyze local data sources in an effort to provide community education addressing suicide awareness, education, and prevention within the local and surrounding communities. Collaborative community partnerships with local area schools and service providers will be sought out and developed in order for the Comanche Nation to effectively engage within the community. Training for key stakeholders and community partners will be provided in an effort to identify and refer AI/AN youth, teens, and young adults who are experiencing mental health crises. Funding for Comanche Nation FY 2023 988 Tribal Response Project will provide the Comanche Nation the ability to provide mental health services and continue the healing process from the effects historical and intergenerational trauma.

The cultural/social stigma associated with behavioral health issues, including suicide and illegal drug use, and reluctance within the tribal community to expose themselves and family members to legal, child welfare, and social repercussions, prevents self-reporting and referrals of persons involved in substance abuse or high-risk/suicidal behaviors. IHC aims to ensure all IHC patients are aware and have access to culturally competent, trained 988 crisis center support; to improve integration and support of 988 crisis centers, Consortium Tribes, and IHC to ensure there is timely navigation and follow-up care; and to facilitate collaborations with Tribal, state and local health providers, law enforcement, and other first responders in a manner which respects Tribal sovereignty.

Over 3 years, the NPAIHB 988 Tribal Response project will facilitate increased access to behavioral health on-call crisis services through the 988 Suicide & Crisis Lifeline call centers in the NW & increase the connection & support felt by Tribes when engaging with these call centers. The NW Tribes & partnering call centers are deeply committed to completing this scope of work & sustaining partnerships to assist in improving the response to mental health & substance use emergencies for tribal people. The NPAIHB is a tribally designated non-profit organization representing the 43 federally-recognized tribes in WA, OR, & ID. Housed at the NPAIHB, the THRIVE project has worked with the NW Tribes to prevent suicide since 2009 & the TOR team has worked to prevent substance misuse since 2018. In collaboration with NW Tribes, regional partners, & 988 call centers, the NPAIHB will build regional suicide & substance use disorder (SUD) crisis response partnerships to prevent & improve the response of suicide & SUD emergencies among AI/AN ppl. Our approach builds upon our strong tribal network & expertise in culturally-relevant behavioral health strategies as well as on strategies to promote suicide & SUD resources. The project will reach at least 10,000 ppl. annually & 30,000 throughout the life of the grant. Our goals and objectives are to: G1 Improve intertribal & interagency collaboration & communication about the 988 Suicide & Crisis Lifeline, suicide prevention, & treatment to share & maximize limited resources, by collaborating with local, regional, & state partners. 1.1 Coordinate qtly. partner calls with local 988 call centers, Tribes, & State representatives to improve effective 988 response & linkage to tribal resources. 1.2 Create 1 opportunity in each State for Tribal staff and community members to meet call center staff & learn how the call center operates. 1.3 Review current 988 crisis call center training & continuing education curricula/materials to ensure they are culturally appropriate and trauma-informed. 1.4 Work with partners to create 988 response documents which will assist with continued partnership & sustainability after funding concludes. G2 Promote mental health & improve social acceptability of mental health services for AI/AN ppl. 2.1 Develop, update, print, & disseminate suicide prevention social marketing & media campaign materials tailored to AI/AN ppl., reaching at least 10,000 ppl. across Indian Country. 2.2 Across the 43 NW Tribes, staff will promote local crisis call centers with relationships with Tribes in their area to increase the usability of the 988 call line. G3 Through partnerships, increase capacity of local 988 centers to implement a comprehensive & coordinated response to AI/AN ppl. at risk for suicide. 3.1 Fund 2-5 Tribes & 3-5 NW Crisis Call centers to facilitate partnerships & work to improve call center response for tribal members calling in. 3.2 Host qtly. partner calls with local 988 call centers & Tribes to improve linkage to tribal resources & develop necessary documents, policies, and/or procedures for partnerships. 3.3 Assist all sub-awarded 988 crisis centers with creating a plan to identify & track referrals & develop a response for staff to establish follow-up contact protocols for AI/ANs after crisis encounters. 3.4 Develop quality improvement plan focusing on procedures, policies, assessment, referral, & access to local care to ensure a comprehensive & coordinated response to AI/AN ppl. at imminent risk of suicide. G4 Increase tribal capacity & expand their delivery of suicide & SUD prevention/early intervention/crisis intervention strategies in NW tribal settings. 4.1 Provide TA to 15 NW Tribes to improve & expand their delivery of suicide and/or SUD prevention/screening/intervention/recovery strategies in their community. 4.2 Host a SUD & a suicide prevention, intervention and/or crisis training for those working with or at NW Tribe & include 988 call center information.

The Choctaw Nation of Oklahoma (CNO) proposes improving response to 988 contacts from Native Americans living within the CNO reservation. According to the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS), total call volume has more than doubled since the July launch of Oklahoma's 988 crisis line. ODMHSAS provided data to CNO that 1,565 Native Americans living within the CNO reservation received crisis service (crisis center, service, mobile crisis, or UMC). Current service gaps addressed with this funding include: 1) strengthening CNO, ODMHSAS, local crisis units, and 988-operator Salari collaborations, 2) Continuing to ensure that the 988 staff receive culturally relevant training. 3) increasing mental health professional resources for mental health services, mobile crisis response, and case management, 4) Maintaining and expanding upon the CNO warm line for 988 transfers and follow-up to improve crisis response for Native Americans living within the CNO reservation, and 5) ensure a comprehensive and coordinated response to Adults and Youth at imminent risk for suicide and/or other mental health crisis.

The Alaska Native Tribal Health Consortium (ANTHC) 988 Tribal Response project will focus on providing systems and resources to improve response to 988 contacts in multiple Alaskan communities. ANTHC will partner with Aleutian Pribilof Island Association, Maniilaq Association, Norton Sound Health Corporation, and ANTHC’s Behavioral Health Wellness Clinic to develop resources that will improve existing resources and outcomes for 988 contacts originating in Tribal communities. ANTHC will also work closely with the Alaska Careline to develop a Quality Improvement plan focused on connecting individuals at risk of suicide to local tribal behavioral health care services.

The Great Plains 988 Tribal Response program was developed to increase the awareness and utilization of the 988 as a first step to addressing the mental health crisis through intervention and response. The population of focus is American Indians and Alaska Natives (AI/AN) people living in the He Sapa area and statewide South Dakota. 988 data dashboards captured that the counties in tribal communities underutilized the lifeline call center despite the suicide rate from American Indians/Alaska Natives (AI/AN) being notably higher, 2.6 times than the majority in the State of South Dakota. The Great Plains 988 Tribal Response program aims to service AI/AN children, youth, and families in the He Sapa area (Rapid City, South Dakota) and tribal communities while using culturally relevant approaches. The program's primary objective is to build the capacity of 988 Suicide and Crisis Lifeline and improve integration and implementation of AI/AN and tribal crisis response. Goal One: To ensure AI/AN have access to culturally competent, trained 988 Suicide and Crisis Lifeline support. Goal Two: Improve integration and support of 988 crisis centers with tribal nations to ensure navigation and follow-up care of AI/AN callers. Goal Three: Facilitate collaborations with tribal, state, health providers, urban Indian organizations, law enforcement, and first responders in a manner that respects tribal sovereignty. Strategies include partnerships with the Helpline Center and South Dakota Department of Social Services Division of Behavioral Health (SD DSS DBH) and the collaborative efforts of tribal entities to identify and track referrals and establish follow-up contact protocols for AI/AN callers after all crisis encounters. The program plans to offer training opportunities on trauma-informed, culturally relevant approaches, suicide prevention awareness, and crisis response resources to providers, partners, and tribal communities to service 200 unduplicated participants.

Riverside San-Bernardino County Indian Health, Inc. (RSBCIHI) is the largest tribal health care organization in California. We will partner with six (6) other Indian health care organizations, the Indian Health Service, and California State Assemblyman James Ramos. We will create a California 988 Tribal Response Taskforce to improve crisis center services to the tribal and urban Indian communities served by Did Hirsch Mental Health and WellSpace Health. Our Indian health programs directly serve 17 federally recognized California tribes. We also serve the urban Indian populations in Riverside, San-Bernardino, Los Angeles, and Sacramento counties. Our health record data shows that our AI/AN patients represent 44 California tribes and 128 out of state tribes. We operate 21 health center locations that deliver medical, laboratory, pharmacy, dental, behavioral health, social services, and/or other support services. We have 94,665 registered patients and 50,514 active patients. Our program will be implemented in 11 counties and two (2) California Lifeline Network Crisis Center regions. These are the two (2) largest regions in Southern and Northern California with the largest AI/AN populations. Our organizations are in counties with the highest rates and highest number of deaths by suicide (California Department of Public Health, 2020). To prevent suicide in our tribal and urban Indian communities, we need to improve our 988 Tribal Response. We will achieve the following objectives: • Hire a 988 Tribal Response Coordinator at each of our tribal and urban Indian health organizations. • Create a California 988 Tribal Response Taskforce made-up of five (5) tribal health organizations, two (2) urban Indian Health organizations, the Indian Health Service, and California State Assemblyman James C. Ramos. • Partner with Did Hirsch Mental Health and WellSpace Health to create a quality improvement plan that focuses on procedures, policies, assessment, referral, and access to local care to ensure there is a comprehensive and coordinated response to AI/AN individuals at imminent risk for suicide. • Develop a training plan for 988 crisis center staff members based on tribal preferences and beliefs and meet Culturally and Linguistically Appropriate Service (CLAS) standards. • Create a procedure for identifying AI/AN individuals who use the crisis centers. The goal is to identify callers who are AI/AN and then provide counseling by individuals who are fully trained in crisis intervention and support, with special emphasis on cultural and traditional practices related to healing. • Create a linkage between the 988 crisis centers and our tribal and urban Indian health care centers. • Plan the 2024 California 988 Tribal Response Summit. • Train 600 people in the mental health and related workforce. • Screen 5,000 individuals at our health centers for depression, anxiety, and suicidal ideation. • Deliver mental health and related services to 670 unique individuals at our health centers • Promote the 988 Tribal Response Program in our tribal and urban Indian communities. • Develop a sustainability plan.