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The Ohio Mental Health & Addiction Services (OhioMHAS) is submitting a proposal in response to SAMHSA’s System of Care Expansion and Sustainability Cooperative Agreement, which we have titled “ENGAGE 2.0.” OhioMHAS envisions this opportunity as a bold and strategic investment to “scale up” mobile response and stabilization services (MRSS), high fidelity wraparound, and intensive service coordination for children and youth ages 0 to 21 with severe emotional disturbances and their families. These services will foster a transformative widespread and sustainable system of care across Ohio. This proposal demonstrates SAMHSA’s Theory of Change, which will infiltrate and sustain a seamless children’s System of Care (SOC) focus with interest in increasing awareness and access to mental health best practices including screening and assessment. The plan will advance collaboration across systems to promote person-centered social, emotional wellness and recovery for Ohio’s children, youth, and families. Two local planning jurisdictions for children’s behavioral health will lead a multi-county region “Hub Center.” The MRSS teams will provide 24/7 hotline, on-site mobile response triage, clinical assessments, referrals and follow-up services including wraparound, for approximately 5,000 children, youth, young adults and families annually. Over the 4 years, the project will serve approximately 20,000. Primary goals and measurable outcomes for the project include: 1) Youth and Family will be the subject matter experts in the planning and implementation of the project as measured by the increased number of certified young adults and parent peer support specialists, as well as a listserv of young adult peer supporters; 2) Local system partners including schools, law enforcement, courts, hospitals, and youth-serving community organizations will be educated on and able to use mobile response appropriately as measured by the reduction in school expulsion rates, ER visits, and juvenile court involvement in the selected counties; 3) Children and families will have increased access to mobile response stabilization services in the targeted service areas as measured by the number of individuals and families served through mobile crisis.

ABSTRACT The Partners North Carolina Systems of Care Expansion Project (PNC-SOC) will expand SOC to 4 counties in West/Central NC, serving 100-410 youth annually (1,100 total) with SED/SMI or first episode psychosis and families. High Fidelity Wraparound (HFW) and Whole Person Integrated Care (WPIC) are introduced along with additional evidence-based practices. A comprehensive systems-based evaluation sets the stage for continued expansion. The systems based Collective Impact (CI) model is merged with Quadruple Aim (Q-A) as a way to build wider, deeper and more sustainable service and support networks for the SOC. This is coupled with providing the evidence-based Positive Parenting Program (Triple P), Buffering Toxic Stress (BTS) and Transitions to Independence (TIP) interventions. The project will meet 7 goals. Goal 1: To prioritize and address health disparities and social determinants of health that contribute to life adversity and toxic stress identified as key County and State level priorities for establishing healthy families and communities through implementation of the State SOC Strategic Plan and a local comprehensive needs assessment integrated with the SOC Readiness Assessment specific to this project. Goal 2: To continue to develop and implement a sustainable plan for enhancing the ability of the workforce to implement SOC infrastructure and services with fidelity in each expansion county. Goal 3: To ensure a comprehensive, modern continuum of mental health and substance use services that extends from promotion and prevention to crisis stabilization and chronic conditions, including healthcare, employment, housing, education, informal youth supports, trauma screening and trauma-informed care, is evidence-based, includes all required activities, while using Public Health approaches to address disparities in access, service use, and outcomes. Goal 4: To facilitate and support grantee communities to implement system change for SOC expansion that includes the full participation of family and youth at all stages of the process. Goal 5: To improve integration of services and a sustainable infrastructure within and between counties that is consistent with SOC through implementation and synthesis of an Integrated Model (CI, Q-A,WPIC, and HFW). Goal 6: To utilize successful engagement strategies from the state level SOC implementation to continue to develop and implement a culturally and linguistically competent Social Marketing and Strategic Communications plan designed to promote the health of and positively affect social inclusion of children and youth with SED and their families. Goal 7: To use a participatory and CI consistent evaluation model to evaluate the project and assess the performance measures specified in the FOA as well as objectives and outcomes specific to this project. Twenty-three measurable objectives along with six formative/implementation and outcome questions and six CI/systems based outcomes will ensure the program is implemented with quality. This will result in extensive documentation and development of products (e.g. Strategic Financing Plan) to continue to replicate and expand the model formulated into an Integrated System of Care Plan (ISCP).

System of Care Expansion and Sustainability Cooperative Agreements Funding Opportunity Announcement (FOA) No. SM-17-001 Transition Age Youth and Young Adults System of Care Access Initiative Abstract Massachusetts (MA) proposes to use this CMHI Cooperative Agreement to implement a Transition Age Youth and Young Adults System of Care Access Initiative (TSAI) that will create attractive and accessible gateways to system of care (SOC) services for Transition Age Youth and Young Adults (TAYA) ages 16 to 21 with mental health (MH) and co-occurring substance use disorders (SUD). These gateways will be informal, flexible, safe, welcoming to diversity, and committed to having TAYA achieve their own goals. TAYA entering this service system will be engaged in Wraparound Planning and assisted to get other needed services. The TSAI will build on the MA Medicaid (MassHealth) Children’s Behavioral Health Initiative (CBHI), a well-established high fidelity statewide SOC delivered by Community Service Agencies (CSAs). TAYA are at high risk for MH and co-occurring substance use challenges, but their unique needs are often not met within either the child or adult service systems, and they are often disconnected from any services. DMH’s current CMHI cooperative agreement, Success for Transition Age Youth (STAY), has enhanced services in 11 CSAs to better service TAYA, which has increased TAYA participation. However, MA has determined that its MH SOC needs additional TAYA engagement resources. MA will establish Access Centers focused on engaging high risk TAYA with MH and co-occurring SUD in Worcester and Springfield, the largest cities in Central and Western MA. Both cities have a greater than average share of TAYA – some who are homeless, considerable ethnic and racial diversity and substantial populations living in poverty. Both communities have TAYA-enhanced CSAs that will partner with Access Centers to serve newly engaged TAYA. Access Centers will be staffed by trained peers, provide drop-in spaces, assertively outreach to TAYA disconnected from services, teach life skills and assist TAYA to access needed SUD treatment, housing, education, and employment. The goal of the TSAI is to increase the numbers of TAYA with MH and co-occurring SUD at high risk who engage in TAYA-enhanced SOC planning and access child and adult services on their own terms and in service of their own goals. After start-up, the TSAI expects to serve 150 to 300 annually or 500 to 1,000 in total. It expects social marketing to reach 1,000-2,000 TAYA annually and 4,000-8,000 in total. Measureable objectives of TSAI include: (1) Number of TSAI engaged in services and reached through social media (2) Yearly increase in the number using TAYA-enhanced SOC services or adult MH services (3) Yearly increase in the number with a co-occurring SUD using in substance abuse treatment and recovery supports. (4) Yearly increase in the number who access adult community services. (5) Implement TAYA-friendly, trauma-informed coordination processes among community providers (6) Amplify TAYA voice to guide TAYA-serving community programs. (7) Improve coordination between child and adult services at the local and state levels. (8) Achieve a replicable, sustainable Access Center service model.

ABSTRACT The Pennsylvania System of Care Partnership (SOC Partnership) will build on the work of previous System of Care, and other SAMHSA Grants, to support counties in developing comprehensive Systems of Care for children, youth, and families. A Learning and Support Collaborative will support expansion, and sustainability, in the number of counties as well as in the array of services and supports, including a focus on trauma and early onset of serious illness. The SOC Partnership will involve development and enhancement of System of Care infrastructure and services at the state and county level. Two counties, Crawford and York, will serve as the initial sites for local system of care development. Two counties will be added in each of years two, three, and four of the grant. The population to be served includes youth from birth to age 21, with, or at-risk of developing, serious behavioral health challenges. Services and supports will also be developed to help families that are caring for youth with behavioral health challenges. There will be at least 25 youth served in the first year of the grant, with an increase each year in the number served so that a total of 250 youth will be served during the four years of the grant. The demographic characteristics in Pennsylvania reflect a significant and diverse population in need of a comprehensive system of care for young people who experience complex behavioral health challenges and have multi-system involvement. The SOC Partnership will serve a varied population, including Caucasian, Hispanic, African-American, and Asian youth and families, as well as youth that identify as Lesbian, Gay, Bisexual, Transgender, or Questioning. The SOC Partnership will address a wide variety of clinical needs, including first episode psychosis. A comprehensive plan will be developed during the first six months that will include plans for cross-agency collaboration, the creation of policy, and the development and implementation of evidence-based and evidence-informed services and supports. The plan will build on the work of other SOC grants and integrate the work of Safe Schools/Healthy Students, Healthy Transitions, Project LAUNCH, and Youth Suicide Prevention as part of a comprehensive System of Care. The plan will address access, service use, and outcomes among minority populations. The plan will include training and workforce development, especially for trauma and first episode psychosis. The result of the SOC Partnership will be expansion in the number of counties implementing Systems of Care, expansion in the services and supports for youth birth to age 21, and increased community understanding of the needs of youth with complex behavioral health problems, and their families. The child serving systems in the counties will coordinate their services and supports for youth and families. There will be more extensive outreach to identify youth in need, especially those who are affected by trauma or are in the early stages of a serious illness. There will be state and county youth and family organizations for self-help and advocacy.

Sustaining a Texas System of Care is a statewide initiative led by the Texas Health and Human Services Commission (HHSC) to improve behavioral health outcomes for children and youth with serious emotional disturbances and their families by expanding utilization of high-fidelity Wraparound to engage children and youth in the juvenile justice system, child welfare, and residential treatment center placement. The initiative also delivers youth peer support services. HHSC will collaborate with the Texas Institute for Excellence in Mental Health at the University of Texas at Austin and other behavioral health stakeholders for implementation of goals that were developed through a comprehensive strategic planning process. Initial local community partners for system of care expansion activities include LifePath Systems in Collin County and Burke, which serves a 12-county region in east Texas. LifePath Systems and Burke are both local mental health authorities (LMHAs) and providers of public mental health services. Two additional communities will be selected to implement expansion activities in later years of the cooperative agreement. To participate in services, children and youth must be 3 to 21 years old with a serious emotional disturbance and meet clinical eligibility for enrollment in Wraparound, an intensive, individualized care planning and management process. It is anticipated that about 40 percent of youth served will be Hispanic or Black and will be from low income families. Project activities will include referring children and youth from juvenile justice and child welfare systems to the LMHAs for diagnostic and evaluation services; engaging youth and families in the Wraparound process, including using Wraparound with youth in residential treatment center placements and their families; providing Wraparound training and coaching to achieve fidelity to the model; training youth peer support providers and their supervisors; providing outreach and education to child-serving agencies on first episode psychosis; and updating residential treatment center licensing standards to incorporate and sustain Building Bridges Initiative best practices. It is expected that 137 children and youth will be served in Year 1, followed by 238 in Year 2, 300 in Year 3, and 325 in Year 4. A total of 1000 youth and families will be served through the four-year cooperative agreement. Goals and objectives in the Sustaining a Texas System of Care initiative will facilitate access to high-fidelity Wraparound to all eligible children and youth, develop youth peer support services to improve participation in treatment and outcomes for transition-age youth, strengthen state and community system of care leadership, align fiscal strategies to support sustainable infrastructure, and promote youth and family members as leaders in system planning efforts to expand and sustain the system of care framework.

ABSTRACT The Minnesota Department of Human Services, in partnership with families and youth, the Departments of Corrections, Education and Health, 36 Minnesota counties, the Fond du Lac Band of Lake Superior Chippewa, the University of Minnesota, child serving collaboratives, and community and advocacy organizations across the state, proposes to expand the current system of mental health care for youth experiencing serious emotional disturbances and their families. The proposed transformation of Minnesota’s existing system of care will address disparities in mental health services for children ages birth to 21 who have been traditionally under served. Minnesota System of Care Expansion (MN SOC XP) will pilot and demonstrate new and enhanced services and create financing and policy reforms necessary to sustain a system of care that is family driven, youth-guided, culturally relevant and respectful, and grounded in sound scientific evidence. In year one of the initiative, the goal is to serve 3,000 youth with serious emotional disturbances and their families. These are children who receive clinical mental health services and targeted case management, and who are likely involved in multiple systems. By the end of the four-year initiative, the system of care will reach 18,129 youth annually. The Vision of the Minnesota System of Care Expansion initiative is to build healthy communities through partnership, innovation and hope for all Minnesota children and families. Measurable goals for Minnesota’s expanded system of care are 1) identify children and youth early in the emergence of SED to provide service and support that promotes full community integration, and 2) build local and state leadership to coordinate across jurisdictions for data-informed system of care development, policy reform, and financial sustainability. In order to accomplish these goals, the partners are committed to providing services that are grounded in the SAMHSA System of Care Values and Principles: clinically appropriate and individualized; provided in the least restrictive environment; family-driven, with families engaged as active participants; guided by youth; community- based with care management occurring at the community level; culturally and linguistically competent, and collaborative across child-serving systems.

Early SMART (Screening, decision Making, Assessment, Referral and Treatment) for Children and Families (E-SMART) is submitted by the Carroll County Department of Health to enhance and expand the early childhood system of care by implementing a model that bridges early childhood infrastructure and supports with quality care coordination and services to meet the needs of young children experiencing serious emotional disturbances and their families. E-SMART will layer and integrate a core early childhood infrastructure with new care coordination technologies to test a model for an early childhood system of care (ECSOC) that includes improved and sustainable capacity for an expanded home- and community-based service array, inclusive of evidence-based practices and family support. Data indicate that children age 0-8 in Carroll County do not have access to a comprehensive service array. Evidenced-based practices are limited and not widely available across funding streams and other services and supports typically are designed for older children and do not translate to meet the complex needs of young children with SED and their families. Following SAMHSA’s Theory of Change and Maryland’s success in moving SOC from planning and implementation into sustainable policy and practice, E-SMART will build upon existing work in the state and the county to increase the capacity of services for children and families, build the skills and competencies of professionals, and connect efforts to the larger system development within the state. E-SMART will utilize a strengths-based, family-driven approach that engages the family as a unit while individualizing the specific interventions needed to support the child. E-SMART will enhance and expand the current early childhood system of care in Carroll County by implementing a continuous model of trauma informed, evidenced-based or promising practices to address the current gap in services. Services to be funded by this proposal include Quality Intermediate Care Coordination (QIC2), evidence-based practices (Child Parent Psychotherapy [CPP], Circle of Security-Parenting [COS-P], and Parents As Teachers [PAT]), family navigation and support, and discretionary funds to cover the cost of identified services and supports from the plan of care when there is no alternative funding source. E-SMART will support enhanced collaborations with early intervention and education providers to expand support to children, families, and professionals, strengthening families and 75the workforce simultaneously. E-SMART anticipates serving up to 75 children and families in the first year and at least 750 over the course of the 4 year cooperative agreement.

ABSTRACT - Executive Summary: The Lake County Health Department and Community Health Center (LCHD/CHC) will expand and improve a county-wide, sustainable System of Care approach to providing child and adolescent behavioral health services by both increasing capacity for services and investing in System of Care infrastructure. Project Name: Lake County System of Care Expansion Population to Be Served: The Lake County System of Care (SOC) Expansion project will target children and adolescents who have experienced serious emotional disturbances (SED), have signs of, or who are at risk of mental illness. While the project will serve children throughout Lake County, the focus will be on five communities in Lake County with significant low-income populations. Demographic and clinical characteristics: -Demographic: At least 57% of the population enrolled in services is expected to be a racial/ethnic minority or have a preferred language other than English -Clinical: All children will be screened at intake to determine eligibility for the program. In order to begin care, children must have an emotional, socio-emotional behavioral or mental disorder as diagnosable under the DSM-IV. Strategies/Interventions: The Lake County System of Care team will take a two-fold approach to improve behavioral health services in the county. First, the proposed activities will expand capacity for behavioral health services including adding staff at the local Children’s Advocacy Center and Juvenile Justice facility. Second, the proposed activities will invest in local and state infrastructure to improve the overall network of care available to youth in Lake County. This will include interaction with state SOC partners, training with local providers and coordination of care according to wrap principles. Project Goals/ Measurable Objectives: The System of Care Project has six goals. Measurable objectives are included in full application. Goal 1: Increase System Capacity; Goal 2: Improve the continuum of care; Goal 3: Increase access through social marketing and outreach; Goal 4: Raise the level of competence among community providers; Goal 5: Build a coordinated network of community-based services; Goal 6: Engage with state partners to improve state SOC services. SOC Enrollment goals: By year 4, LCHD/CHC aims to enroll at least 250 new, unduplicated consumer in evidence-based SOC services per year for a total of at least 1,000 over the life of the grant.

The School District of Osceola County, Florida aims to build local capacity to promote and protect students’ health, well-being, and learning ability by expanding the System of Care approach. Efforts will build on previous advances that emerged from the Safe Schools/Healthy Students Initiative and Project AWARE outcomes, such as creation of a centralized mental health services referral system and training of more than 400 Mental Health First Aiders. Community agency leaders realize that services offered in silos adversely impact children and families. This expansion will continue the important work of eliminating these gaps and integrating critical services. Collaboration will involve the Osceola County Children’s Cabinet, Florida Department of Children and Families (Current SAMHSA Grantee), Park Place Behavioral Health Care, and other organizations. The goal of the proposed Osceola County System of Care Expansion is to improve the outcomes and supports for children (Prekindergarten through 5th grade), including their families and caregivers, who have been diagnosed or are diagnosable SED/co-occurring disorder including early onset and/or first episode psychosis and struggling in multiple life domains. Activities will reach an estimated 15-20 families annually for a total of 60-80 families over the four-year project period. The project will aim to increase the widespread adoption of the Five Protective Factors Framework, which includes Parent Resources, Knowledge of Parenting and Child Development, Social and Emotional Competence of Children, Social Connections, Concrete Support in Time of Need. Provision of intensive wrap-around services will strengthen families who will become more self-reliant and better able to cope with chronic mental health conditions and acute mental health crises. The project objectives are to: 1. Increase availability of and access to quality mental health services and supports to children, youth and their families for mental health and/or co-occurring disorders; 2. Increase the prevalence of community providers offering services in line with evidence based or evidence-emerging practices (e.g. Wraparound Process) to ensure sustainability of OCSOC goals and widespread adoption of the values and principles of Systems of Care; 3. Increase collaboration among child-serving and adult-serving mental health and substance abuse providers and systems; 4. Increase youth and family engagement in the creation, implementation and management of the treatment plan; 5. Improve outcomes across multiple life domains; and 6. Decrease placements in restrictive or institutional settings. The intensive wrap-around services process will become the standard approach through systemic changes, training, and workforce development.

The Native Connections Alliance is a joint effort the between the Oklahoma Area Tribal Epidemiology Center (TEC) and the Cheyenne and Arapaho Tribes of Oklahoma. This initiative brings epidemiological expertise and the determination of a Native community to bear on Native youth suicide. The two organizations will use a combination of evidence based prevention practices and strength based traditional approaches to reduce youth suicide. We request $200,000 per year for five years of grant funds through the Substance Abuse and Mental Health Services Administration (SAMHSA) Native Connections grant SM-17-005. Native youth and young adult suicide has reached epidemic proportions. The rate of Native youth and young adult suicide is rising and, in Oklahoma, is now at its highest point ever. Recent (2015) data from the Oklahoma Department of Health’s, Violent Death Reporting System shows that Native residents over age 10 committed suicide at the rate of 43 per 100,000 population, compared with the national average for all races of 13.3 per 100,000. The physical, psychological, social and spiritual toll upon Native tribes like the Cheyenne Arapaho is great. The Native Connections Alliance will bring intensive suicide prevention to a population of about 10,000 American Indians, living in non reservation settings, within the four county Cheyenne and Arapaho Tribal Jurisdiction. The TEC brings administrative and subject matter expertise to assist the Tribe to successfully implement programs, policies, and practices that are a combination of the best clinical evidence based practices with traditional strength based approaches that resonate with Natives. The Native Connections Alliance will use school based programs such as Lifelines and Native American Life Skills combined with community based traditional healing practices including ceremonies, sweat lodge, and Native ways of knowing. In the first year, the project will complete a Cheyenne and Arapaho Suicide Prevention and Response plan. Intervention after the fact of a suicide (postvention), will be an essential part of the plan to bring aid and comfort to survivors and to reduce the possibility of additional suicide. The project will focus on building protective factors that have been shown to reduce suicide. Native Connections Alliance will measure the number of suicide attempts and completions as well as indicators of depression and substance abuse among Native youth in the target communities. The project will be evaluated by staff TEC epidemiologists and the professional evaluators of the ETEAM at the University of Oklahoma. Native Connections Alliance will serve a minimum of 800 youth and young adults per year in years 2-5 for a total of 3,200.

The Sacramento Native Connections Program will provide resources to the Sacramento Native American Health Center (SNAHC) to plan and implement culturally competent substance abuse prevention, suicide prevention, trauma reduction, and mental health promotion services for urban American Indian/Alaska Native (AI/AN) youth, birth to 24, living in Sacramento County. SNAHC is plays a major role as a part of the “safety net” in the Sacramento area; it is a Federally Qualified Health Center and Indian Health Service clinic that provides primary medical, dental and behavioral health care services to the medically underserved residing in the County. The urban AI/AN population reflects the mental and physical health disparities documented nationally. High rates of suicide among AI/AN youth is the most profound and troubling indicator of community need for Sacramento’s urban AI/ANs. At 16.93%, the suicide rate for AI/ANs of all ages is much higher than the overall U.S. rate of 12.08%. Nationally AI/AN youth are the highest suicide risk of all age and race groups. A recent community survey identified suicide as the most serious issue of concern for the local AI/AN community. One hundred percent of families in SNAHC’s home visiting program have at least one family member who has experienced an Adverse Childhood Experience, a traumatic experience that puts individuals at high risk for substance abuse, suicide and other compounded impacts of trauma. Sacramento Native Connections Program will provide services to 200 people annually and 400 over the life of the project. It will use a Community Readiness Assessment to conduct planning activities to address these issues. SNAHC expects to provide interventions in Tiers 1-3, including: provision of direct prevention services through the Gathering of Native Americans, increase of suicide and substance use risk screening in the Home Visiting program, and development of collaborative partnerships to create a more effective response to suicide attempts and completions in the community. Sacramento Native Connections Program goals are to: 1) develop capacity to implement effective community-based culturally-competent substance abuse and suicide prevention programming; 2) create a Community Resource/Asset Map that addresses suicide prevention and substance abuse; 3) implement prevention strategies the result in increased wellness for AI/AN, including decreased impact of trauma, reduced suicide and suicidality, and reduced substance use; and 4) increase organizational and community capacity to respond to suicide. The Sacramento Native Connections Program will measure its success by assessing the degree to which the community feels their concerns are addressed, establishment of policies, protocols and inter-agency agreements, establishment of an effective data assessment system, increases in screening, assessment and referral for suicide, positive impact on cultural identity and community connection, reduction in substance use, increase in sense of hope, and increase in community partners that can effectively identify, refer and treat AI/AN.

Project Name: Finding Hope Population Served: Rural non-Reservation American Indian Youth age 12-24 The College of the Muscogee Nation, seeks to fashion a comprehensive and integrated suicide prevention, substance abuse prevention, trauma-informed, and mental health promotion system to detect, prevent, and provide early intervention services to rural non-reservation American Indian youth and emerging adult students who reside within the area of central Oklahoma served by the college. This system shall both expand and enhance the current program and shall provide the foundation for establishing a prevention prepared community, data-driven management, meaningful partnerships, and delivering and sustaining effective, efficient, and culturally appropriate services for American Indian youth age 12-24. The College of the Muscogee Nation’s Finding Hope project shall define the need for services, the gaps between needed and available services, barriers to care, and other problems related to the need to implement suicide and substance abuse prevention, trauma-informed care, and early intervention services for American Indian youth and emerging adult students at risk of or currently experiencing issues that may lead to suicide. The project shall engage communities, assess needs, identify organizations, improve coordination, implement evidence-based strategies, and serve students at risk for suicide within the tribal service area. Further, the college shall enlist Muscogee (Creek) Nation, area communities, tribal members, students, area youth-serving agencies, educational institutions, health facilities, and public schools in the planning, assessment, implementation, and evaluation phases of this project. The result will raise awareness, improve the continuity of care, and save lives. Goal 1: Reduce the prevalence suicide among the youth and young adult student and perspective student population (12-24) in the area of rural Oklahoma served by the College of the Muscogee Nation. Goal 2: Increase the capacity, effectiveness, and efficiency of suicide prevention services for American Indian youth and emerging adult students, age 12-24, who reside within the area served by the College of the Muscogee Nation. Goal 3: Actively promote systems level change at the organizational level to embrace suicide prevention as a core strategy.

The Absentee Shawnee Tribe of Indians of Oklahoma in partnership with area schools and community events will work to lower substance abuse and suicide rates in American Indians/Alaska Natives between the ages of 12 and 24. Utilizing ""Zero Suicide"", one on one counseling services, and promoting community education to recognize the signs of substance abuse and/or suicide, and prevent and intervene in substance abuse and suicides and suicide ideation. The AST-Strength of Tradition Project will serve Native youth, ages 12 to 24. Both male and female will be served through this project. The project will include after school programs, community events, health fairs, and other events that include the age population. The program hopes to serve over 300 youth per year, for a minimum of 1,500 youth served through the life of the program. The goals and objectives of the program are to decrease the number of youth who are active substance abusers, decrease the number of participants experiencing suicidal thoughts, and improve the overall morale of the communities members that fit the criteria for this program.

Friendship House Native Connections Project Abstract The Friendship House Native Connections Project(FHNCP) provides direct suicide and substance abuse prevention services to American Indian/Alaska Native (AI/AN) youth that mitigate trauma and promote mental wellness. FHNCP will engage a community-based process to assess strengths and needs, create protocols for suicide assessment, intervention, and postvention, and train staff and community in this area. Friendship House Association of American Indian (FH) serves AI/AN youth under 25 in the San Francisco Bay Area through 3 mechanisms: 1)a community-based prevention program that serves youth 10-25 that live in the local community; 2)a culturally-based residential substance abuse program that serves adults, including those 18-25; and 3)a specialized residential program that serves mothers with children 0-5. FHNCP will provide collaborative community planning processes and direct prevention services to 80 per year and 200 over the life of the grant. FHNCP’s goals are to: 1) Improve the capacity at FH to identify high risk youth engaged with existing programming; 2) Improve community capacity to offer cooperative and collaborative services for high risk youth up to age 24; and, 3) Improve the internal capacity of FH to contribute and assess surveillance and tracking data for mental health, substance use and suicide measures for youth in the community. FHNCP will conduct a community needs assessment to inform decision making and assist an Advisory Group to identify current unmet needs and gaps in service. FHNCP will train AI/AN youth-serving staff on culturally competent assessment of suicide risk, awareness and screening. FHNCP will engage a collaborative process with community service partners, traditional healers. An Advisory Group will develop suicide assessment, intervention, and postvention protocols and procedures for all youth under age 25 in FH, which are strengths-based, and guided by indigenous culture, knowledge and approaches. These protocols will include linkages to mental health support and intervening with individuals at high risk, coordinating care, and following up on connection and impact of services. In Years 2-5 FHNCP will provide youth culturally-based traditional health services from Traditional Healers. These services will include one-to-one and group healing practices, and cultural education and ancestral ceremonies, like the Sweat Lodge and The Wiping of Tears. FHNCP will be built on the values and experiences of American Indian people: love, tolerance, reciprocity, humility, and respect for all life. The focus of FH and FHNCP is to assist youth to develop a strong sense of place, the sacred, the beautiful, and of humanity, so that an individual may stand in the “center of life” and in good relation to all points and directions of the world circle.

Suicide and substance abuse has had a significant impact on the Fresno community as a whole, as well as the Native American community in and around Fresno. According to the California Department of Public Health, Fresno County’s average death rate from suicide was 9.2 per year from 2005 to 2007, with a total of 84 deaths (for all ages, races/ethnicities). For the three-year period spanning 2013 to 2015, Fresno County had 10 teen suicides. But there were eleven youth suicides in 2016 alone. In fact, one local high school had three student suicides in a three month period. In addition, one of the local area tribes have had two youth suicides in the past year, indicating the community may be experiencing suicide contagion. The Fresno American Indian Health Project (FAIHP) submits this proposal for the Fresno Native Connections Project (FNCP) Cooperative Agreement. FAIHP seeks five years, $200,000 a year, to serve 200 children and families, over the course of the project, using culturally based indicated interventions (tier 3) targeted to reach American Indian and Alaska Native (AIAN) transitional age adolescents and young adults ages 15-24 in Fresno County. In year one, FNCP will work with the GPO and the Tribal Training and Technical Assistance Center to develop a plan to support the agency’s work which will be completed and approved by the GPO and will establish the plan for years 2-5. FAIHP will collaborate with our community advisory board, and youth council to conduct a community systems analysis, community needs assessment, readiness assessment, and create a community resource asset map that specifically addresses substance abuse prevention and suicide prevention. The assessments will be conducted utilizing the SAMHSA Strategic Prevention Framework (SPF) model, to expand community comprehension of the specific needs of at-risk AIAN transitional age youth, and facilitate the development of a prevention strategy that appropriately engages community members and organizations, at-risk youth, and the project in meeting the needs of transitional age youth. The goals of the project include: • Goal #1: Prevent and reduce suicidal behavior among AI/AN youth. • Goal #2: Reduce the Impact of mental and substance use disorders on the Fresno AI/AN Community by fostering culturally responsive models to reduce and respond to the impact of trauma. • Goal #3: Support AI/AN youth and young adults transition to adulthood by facilitating collaboration among agencies.

ABSTRACT American Indian and Alaska Natives (AI/AN) that live in urban areas suffer from the highest health disparity rates of mental health issues, however this racial group only composes 1.7% of the total U.S. population. These same disparities affect the youth and young adults in those communities at an astounding rate. Urban AI/AN youth suffer higher rates of depression, which can be attributed to isolation from tribal lands and identity, lack of adequate mental health care, and poverty. They are also often geographically dispersed and disconnected from other urban AI/AN youth. Overcome with a high prevalence of alcoholism, and increased risk for mental health issues and suicide the need for better systems of care and improved community capacity to assist in recovery is high priority. The National Council of Urban Indian Health’s (NCUIH) Supporting Urban Native Youth (SUNY) proposes to build the capacity of urban communities to assist urban youth to live healthy lives through community support. The goal of this project is to develop a community-driven comprehensive urban youth suicide and substance abuse response plan for urban Indian communities to address the needs to provide prevention and recovery supports to AI/AN young people up to 24 years of age. Through the creation of a National Urban Youth and Young Adult Advisory Council for youth living in urban areas, NCUIH hopes to engage youth to become active in their communities as ‘gatekeepers’ to promote mental health among AI/AN young people living in urban areas. NCUIH will select youth champions from their urban community to spearhead this endeavor, and provide training on trauma, mental health best practices, and ways to open communication with friends. Through the assistance of a National Behavioral Health Advisory Council, made up of experts from the urban community, a social media campaign on awareness and prevention will be developed for a national release to the urban community. This ongoing relationship will lead to better equipped youth in urban settings to respond to community crisis. As the youth are helped to develop as leaders, the SUNY Project will also provide guidance to two Urban Indian Health Organizations (UIHOs) to assist in the facilitation of a community assessment and service assessment, in order to build the capacity of these two urban communities in order to reduce and respond to the impact of suicide and substance abuse in their communities. It is hoped that through this community-driven project to provide support for youth mental health, a more sustainable system of care will see reduced barriers to mental health screening and reduction in the number of Native youth suicides and suicidal ideations. Overall, the SUNY Project will proved better access to health care, improve health equity, and sustain services for AI/AN transitional youth.

The Comanche Nation “Native Spirit Project” would like to fill a service gap by forging a comprehensive family driven, community and youth guided services to reduce suicide and promote and expand the safety net of suicide prevention and intervention for urban and rural Native Americans. Native Spirit’s goal is to identify and connect the behavioral health service organizations that exist within our community; decrease the stigma of suicide, substance abuse prevention, address trauma and promote mental health. Native Spirit Project will improve and implement evidenced based approaches and strategies to reach the native community. By integrating suicide prevention into the values, culture and leadership the following will foster culturally responsive models to reduce the impact of target population of 10-24 years by: Native Spirit Project will: 1) Improve culturally appropriate behavioral health care to meet these goals and outcomes. 2) Extend an Outreach to develop collaborative relationships with community members (State and tribal), 3) increase the services of educational institutions (College and Public schools) and youth serving organizations to expand training to mental health, professionals, gatekeepers, community members and tribal affiliations. 4) Create a sustainability plan for the communities to ensure the ongoing mental health and well-being of our youth that would go beyond the grant cycle. The Native Spirit will utilize The National Suicide Prevention Lifeline on various media projects. Also various media avenues and expressive arts will be used to reduce the stigma of suicide within the native community. Clinical service providers will be trained to manage, assess and treat native youth at risk for suicide. These four measurable outcomes will include: 1) Increased Outreach for suicide awareness and reduce suicide stigma 2) Expanding training and technical assistance to improve ability of local and tribal/community members and to provide training to professionals to identify, manage and treat youth at risk 3) and continue screening to increase identification of at-risk youth 4) Improved and expanded treatment measured by an increase of at-risk youth. To successfully meet these goals and outcomes.

The Pala Band of Mission Indians proposes to plan and design a comprehensive model to deliver improved mental health and substance abuse prevention services for tribal children and adolescents age 25 and under who have serious mental health needs. The length of the project will be 36 months and will serve approximately 1,260 tribal members. The program, entitled “Building Bridges to Promote Mental Health and Wellness for Pala Youth and Families” (“Pala Bridges”) will address the current fragmentation in the system of care on the Pala reservation. We will develop a comprehensive mental health service delivery model which draws on the principles, traditions and values of the Pala tribe. The model will be developed in collaboration with a cross-disciplinary team of other youth-serving tribal agencies including mental health, law enforcement, education and health care, in consultation with elected tribal leaders. We will bring together these and other agencies in a series of meetings to plan and design the model, supported by research, assessments and other activities. Cultural advisors from the tribe will play a critical role in the planning process, as well as youth and families themselves. At the conclusion of the planning grant Pala Social Services will deliver a culturally appropriate system of care model grounded in Pala’s rich cultural traditions, involving coordinated case management that improves the mental health, substance abuse prevention and wellness services for the tribe’s children and youth who have serious mental health challenges.

Population: It is proposed that the Strengthening Our Nets (SONs) project will take place among urban and rural Unangax̂ (Aleut) populations specifically targeting young men ages 12-24 years old. This project, however, will not exclude individuals interested in addressing the wellness of Unangax̂ communities. Furthermore, this project will rely on traditional wisdom bearers, including Elders and other adults who have mastered or are mastering a traditional and/or subsistence lifestyle. Therefore, in the rural settings this project has the potential to reach up to 100% of the population, if not directly, then indirectly through positive impacts within family networks. We propose to partner with rural communities: Atka, Nikolski, Unalaska, St. George, and Belkofski tribal members residing in King Cove; in addition to working with Unangax̂ individuals who have relocated to the urban hub community of Anchorage. Strategies/interventions: Aleutian Pribilof Islands Association, Inc. (APIA) is invested in the health and wellness of Unangax̂ communities. In the fall of 2014, APIA partnered with a wide variety of for-profit and not-for-profit industries including law enforcement, travel, health organizations, fishing, and economic development agencies to host a summit addressing substance abuse in the region. From that summit, a strengths, weakness, opportunities, and threats (SWOT) analysis was conducted specifically to assess services for individuals struggling with substance abuse disorders. Regional specific intervention and postvention needs were identified as areas of needed growth. Also, the stigma in the region related to behavioral health services was identified as a barrier to care. There are passionate, vocal community members APIA can rely on to provide feedback and guidance. Year One strategy is to focus on hearing the less vocal community members, namely young men. The goal is to capture their input on prevention, intervention, and post-vention services for their peer group. Rather than completing a typical community needs assessment, a skilled iqyax̂ (kayak) maker will travel to three of the four communities and present at the Urban Unangax̂ Culture Camp model iqyax̂ making “train the trainer” classes. During these week-long classes, targeted conversations will take place to inform the following four years of this project. Project goals and measurable objectives: The overall goal of this project is to reduce feelings of hopelessness and despair, which lead to substance abuse disorders and/or thoughts of suicide among young Unangax̂ men. In Year One, each model iqyax̂ making “train the trainer” class can have up to 10 participants. The goal of this class will be to transform the participants into future iqyax̂ instructors. Four classes will take place. The following years it is anticipated that up to 40 young men will be served by this project through services identified from the activity based inquiry sessions. This will be a total of 200 individuals with direct services. This does not include indirect figures, which in small communities reaching one person has exponential impacts.

Abstract Keep the Fire Alive For over a quarter of a century the Indigenous Peoples Task Force (IPTF), an urban non-profit Native organization, has been vital to providing access to traditional and western health services. Our programs are aimed at improving the quality of life for our clients, families, and partner tribal communities. The efforts proposed in this Native Connection project will go far in building the needed support to serve Native youth and young adults through the age of 24 who are living in the IPTF service area. The project will directly serve/educate/train approximately 500 youth per year or a total of 2,000 youth. IPTF proposes to launch Keep the Fire Alive, a Native Connections project aimed at developing strategies built on the voices of the youth and families in the community to: 1) reduce the impact of mental and substance use disorders; 2) establish a swift and culturally based response to any suicide intent; and 3) increase the inclusion of Native data in state suicide surveillance reports, which will then increase the potential for funding for Native programs; and 4) increase the efficacy of the local surveillance of suicide, suicide attempts, and mental health challenges. IPTF provides culturally grounded programs addressing women’s health, tobacco cessation, teen pregnancy, and childhood diabetes, as well as culturally appropriate programs to prevent further transmission of HIV - programs that include both education and direct services. IPTF weaves theater, experiential learning and traditional knowledge, and arts and crafts into its work, especially in programs designed for Indigenous youth. The service area defined for this project is the metropolitan area that encompasses a fourteen-county area of Minnesota, and includes the Twin Cities of Minneapolis and St. Paul, the Mille Lac Band of Ojibwe and the White Earth Nation. Year one will consist of a planning period in which we intend to build new relationships and enhance current partnerships, establish and improve local surveillance, determine what services are most needed, identify the gaps between existing services, identify the barriers youth have to accessing care, and examine other issues surrounding the implementation of an effective and receptive system wide response to suicide attempts. Years two through five strategies will rely on the information gathered in year one to implement a Strategic Action Plan that is consistent with the scores obtained through year one’s Community Readiness assessment. Keep the Fire Alive will also be grounded in the concepts of Readiness. Mikwanedun Audisookon means ""remember our teachings"" in Ojibwe. IPTF bases its programs in Native values and traditional ways of knowing. We are committed to the wellness of our youth and our community and follow the directive to “strengthen the health and education of Native people”. Caring and teaching are woven throughout all of our projects as we build the project for our youth, their families, the providers and the community. The earth has a fire within and like the fire, we each have a fire within too. We need to fan those flames to keep our fire burning.

Suicide is an issue in that haunts the Wabanaki people. Coming from the belief that the youth are our future; these losses undermine the community’s sense of hope and exacerbates chronic anxiety and despair. Much like circles in a pond, the traumatic effects are seen at multiple levels. Our vision for the Native Connections grant program is to increase the capacity of youth and young adult (up to age 24)-serving agencies to provide a holistic approach to suicide prevention. This will be accomplished by increasing community knowledge and support, providing culturally and linguistically appropriate substance abuse, mental health, and suicide prevention services, and empowering youth through engagement in cultural activities and leadership opportunity. Wabanaki Health and Wellness will engage community-level public and private non-profit entities, tribes and tribal organizations collaboratively to prevent and reduce the onset of substance abuse and mental health issues among Tribal youth up to age 24.

The name of our project is, Santa Clara Pueblo Behavioral Health Connections. We are applying for Tier 2, Selective Prevention Strategies for addressing the needs of at-risk young tribal members up to 24 years old. Our rationale for prioritizing this tier in our community is based on the fact that we do not know additional specific mental health issues that exist in our community. In order for our Pueblo to effectively respond to an overall mental health promotion approach as well substance and misuse among the community, we need additional data. We believe that the Tier 2 requirements will allow us to target a prevention strategy with specific target population, especially since we do have data from 2012 that can strongly support our request to SAMHSA. We also believe that an assessment and SAMHSA technical support can assist us in developing, administering, and analyzing data we receive from a community assessment. The outcome of a community assessment will also allow us to identify additional mental health issues and needed resources from community, that we otherwise do not know at this time due limited data collection and newly established collaborations. We have identified 4 goals of our project, and they are the following: • Goal 1: Establish Santa Clara Pueblo services and support for youth and young adults to reduce the impact of mental health, substance abuse, and prevent suicide. Objective 1: To identify current services and support that exist and serve Santa Clara Pueblo members who are identified as youth and young adults. Objective 2: Create a community resource guide that identifies metal health services, substance abuse, and suicide prevention for youth and young adults. • Goal 2: Create a community driven array of services to support at-risk youth and young adults and their families. Objective 1: Develop a service map that identifies where services exist within our community. Objective 2: Develop a tribal action plan. • Goal 3: Establish a community assessment process that can be used as a foundation to develop and/or enhance services. Objective 1: Develop and administer a community assessment to be used in our community. Objective 2: Analyze community assessment feedback. Objective 3: Develop a report for tribal council and community members that reflect assessment results. • Goal 4: Establish a youth and young adult wrap-around service delivery system that includes community stakeholder input and community service collaboration. Objective 1: Create an advisory team based on commitment letters and stakeholders to ensure continuity of team function. Objective 2: Develop wrap-around services focused on youth and young adults for our community that includes Pueblo resources for mind, body, and spirit wellness. Objective 3: Develop brochures that educate community members about our service to ensure appropriate amounts of outreach. The Pueblo believes that in order to create a path of wellness and resiliency for our youth – we must find ways to not only support our youth, but establish grounded learning through culture and tradition. Despite our historical trauma, we believe that it is our responsibility to preserve our culture and tradition by taking control of all of our programs and services to ensure that we not only prevent illnesses that impact a healthy person but also intervene in the early stages of growing trends in mental health, including the factors and indicators related to suicide. Our Pueblo community population is approximately 2,500 tribal community members, but that does not mean that we do not experience mental health and suicidal behaviors at any less than a larger community, per capita. Our goal would include to serve 200 community members per year during the 5 year project.

The 2012 National Strategy for Suicide Prevention (NSSP) identifies the need to promote suicide prevention as an essential element of health care services, and the importance of implementing effective practices for assessing and treating individuals at risk of suicide. In support of national efforts to reduce suicide deaths among adults, the Maine Center for Disease Control and Prevention Maine Suicide Prevention Program (MSPP) will implement the Communities of Care (CoC) Project, with the goals of increasing access to suicide-safer care for individuals served by primary care and behavioral health services; implementing comprehensive systems change to support suicide screening, assessment, treatment, and follow-up within major community mental health agencies; and developing shared discharge protocols between hospitals, emergency rooms, and regional crisis service providers to ensure rapid follow-up and transition of care for individuals after a suicide attempt or suicidal crisis. Specifically, the MSPP CoC Project will focus efforts in three areas: • Goal 1: Increase the number of providers within Maine’s Behavioral Health Homes who use evidence-based practices to assess, treat, and manage suicide risk among patients and clients. • Goal 2: Increase the number of behavioral health systems that implement evidence-based protocols and clinical pathways, using the Zero Suicide framework (Zero Suicide Practice Transformation), for suicide risk screening, intervention, treatment, and follow-up. • Goal 3: Increase the number of hospitals, emergency rooms, and inpatient behavioral health programs that have developed shared protocols with regional crisis service providers that include procedures for rapid follow-up and care connections for individuals following a suicide attempt or suicidal crisis (Strengthening Supports). To increase health and behavioral health providers’ skills in evidence-based suicide screening and treatment, MSPP CoC Project staff will partner with the Sweetser Training Institute to create a web-based training portal that provides access to best-practice educational resources in suicide prevention. The MSPP will expand upon these trainings by partnering with two additional major community mental health providers to implement the Zero Suicide model, a quality improvement process that focuses on creating organizational systems and policies to support screening, intervention, treatment, and ongoing follow-up for all clients at risk of suicide. The CoC Project will increase community supports for individuals at high risk by engaging hospitals, emergency rooms, and local crisis service programs to ensure rapid follow-up and supported care transitions for individuals following a suicide attempt or suicidal crisis. The Maine Suicide Prevention Program has a long history of engaging with community partners to provide innovative suicide-prevention interventions across many sectors. The MSPP takes a data-driven approach to implementing high-quality services. As part of the Communities of Care Project, the MSPP will train over 650 health and behavioral health providers in evidence-based suicide prevention practices, and support high-quality suicide-safer care and community follow-up for over 3500 Maine adults. The MSPP believes that these efforts will have a positive impact on the well-being of our communities by reducing Maine’s rate of suicide deaths and suicide attempts.

Utah will develop and implement the Utah Zero Suicide Project in order to strive towards the aspirational goal of suicide as a never event for people in care. The purpose of the project is to reduce non-fatal suicide attempts and suicide deaths for adults 25+ in Utah. We propose to do this through the following goals: · Increase access to and quality of physical and behavioral health care for those at risk for suicide · Improve rapid follow up and care transition services for individuals at risk for suicide statewide · Reduce access to lethal means among those identified at risk for suicide. The Utah Division of Substance Abuse and Mental Health (DSAMH) is committed to the adoption of the ‘Zero Suicide’ approach to behavioral health care and promotion of the approach within all health and behavioral health care settings statewide. The provision of follow-up and care coordination services for individuals discharged from emergency departments and inpatient hospital settings following a suicidal crisis will be piloted by two Local Mental Health Authorities (LMHAs), in an urban and rural community. This project will result in the improved ability of physical health providers, behavioral health providers, first responders, and other community and clinical service providers to respond to individuals at risk for suicide through assessment, intervention, and effective clinical care through a series of training initiatives. Annual Zero Suicide Leadership Summit, clinical training on safety planning/crisis response planning, screening and assessment of suicide risk training using the Columbia Suicide Severity Rating Scale, Counseling on Access to Lethal Means and other lethal means restriction activities, Brief-Cognitive Behavioral Therapy for Suicide Prevention clinician training, Collaborative Assessment and Management of Suicidality clinician training, develop and distribute model follow-up and care transition protocols that outline best practices for ensuring patient safety for individuals at risk for suicide and best practices for communicating and referring between medical providers and behavioral health organizations; develop online enduring Continuing Medical Education training on best practices for follow-up and care transitions based on model protocols; and develop and train on suicide prevention/intervention training for Certified Peer Support Specialists. Utah has a demonstrated need to improve the skills, training, and support of the workforce to effectively respond to someone at risk for suicide and these initiatives will result in that improvement. The Utah Zero Suicide Project will result in a coordinated, sustained effort to help our state substantially reduce the suicide rates for those in care.

The Florida Implementation of the National Strategy for Suicide Prevention (FINS) Project is a partnership of the state suicide prevention infrastructure, the Inter-Agency Dissemination and Collaborative Network, which consists of the Florida Statewide Office of Suicide Prevention (SOSP), the University of Central Florida (UCF) and the University of South Florida (USF) with the Florida Hospital. Utilizing a sustainable mentorship model, FINS will adopt and integrate the National Strategy for Suicide Prevention (NSSP) to ensure that health and behavioral health settings and adult serving systems (crisis centers, VA centers, correctional facilities, housing and employment centers, grass root organizations, faith-based, and other social services) are adequately prepared to identify, engage, and treat at-risk adults with culturally competent evidence-based/best-practice (EB/BP) suicide prevention, treatment, safety planning, and care coordination services. The goals/measurable objectives are to (a) transform health and behavioral health system infrastructure through the development of ZS advisory committees, suicide prevention policies and procedures, and the integration of EB/BP measures and mechanisms to monitor suicide care; (b) enhance the collaboration of local and state-level partnerships to promote ZS and NSPL utilization; (c) develop workforce training capacity to utilize EB/BP suicide prevention strategies; (d) enhance care coordination strategies to increase the number of referrals and sustainable treatment, recovery and support linkages for at-risk adults; and, (e) improve the coordination, sharing, and tracking of suicide-related indicators (suicide ideation, attempts, deaths, service utilization) via regional and state-level data surveillance systems. Over 3 years, the project will prevent adult suicide morbidity and mortality rates by (1) assisting partnering systems to adopt EB/BP screening, suicide risk assessment, safety planning, and care coordination tools via ZS workshops [155 agency administrators/directors trained]; (2) conducting EB adult gatekeeper skills training to non-clinical staff [QPR, 1,500 gatekeepers]; (3) training clinical and medical staff in EB/BP strategies to increase capacity to conduct suicide risk assessments, safety plans, and care coordination services [QPRT (230 trained), LINC (150 trained), LINC to Life Safety Planning/CALM (430 trained)]; (4) providing EB clinical training to treat suicidal clients [DBT, 50 trained]; (5) promoting the ZS initiative and FINS project via participation in community events/meetings and dissemination of suicide prevention materials, including NSPL materials [144 community events/meetings; 7,200 promotional materials, 3,600 NSPL materials]; and, (6) providing long-term care coordination services to high risk adults to ensure rapid follow-up, smooth care transitions, and sustained engagement in services [1,620 adult clients]. Quality assurance and overall program direction will be conducted by UCF and evaluation efforts will be conducted by USF. The FINS Project will pilot the model in central Florida in order to guide future suicide prevention initiatives which are planned throughout Florida.