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Terros Health CCBHC-Improvement and Enhancement (CCBHC-IA) project in Phoenix, Arizona will bring equitable care to all populations, regardless of the ability to pay for services, using the CCBHC Certification Criteria for Service Delivery. Our focus population will be children, youth, families, and adults newly accessing Terros Health’s CCBHC, who will receive person- and family-centered mental health, substance use disorder (SUD), and primary care services. As the only integrated care facility in our catchment area, our CCBHC will increase access to care and improve our ability to meet the needs of the whole person including health equity and social determinants of health (SDoH) support. Our evaluation tools and communication with participants are culturally appropriate, accessible, and provided in plain language. We hire and train our employees to interact with our participants with cultural sensitivity and we strive to have our staff be a representation of those we serve. In Phoenix, 42.7% of individuals identify as Hispanic and 36.9% of individuals ages five and older speak a language other than English at home.1 In our 2019 Terros Health needs assessment, 83% of participants were Medicaid-eligible – almost double the average for Federally Qualified Health Centers (FQHC’s) in Arizona – with 13% identifying as black and 32% identifying as Hispanic. Using our long-standing experiences providing services for those who identify as LGBTQ+, we will continue to provide equitable care and access to preventive screenings, assessments, and services for this population. With 42.8% of children (under age five) in 85017 living in poverty, our CCBHC expands our ability to serve the physical and behavioral health needs of participants. Individuals served will be 900 in year 1, 1000 in year 2, and 1100 in years 3 and 4, for a total of 4,100 individuals served during the lifetime of the grant. The project goals and accompanying objectives are: Goal 1) Improve participant health outcomes through timely access to critical care, availability of evidence-based interventions, and ongoing participant engagement with integrated, comprehensive health care. We will meet this goal by a) demonstrating a 10% improvement in participants that receive a follow-up visit within 7-days and within 30-days after a hospitalization or emergency department use (as indicated by Health Information Exchange [HIE] data), b) 75% of participants, who have been enrolled in the program for at least 90 days, will be engaged in at least 3 services – one of which will include treatment planning, c), 85% of the number of participants with active Opioid Use Disorder (OUD) will receive education about or a recommendation for Medications for Opioid Use Disorder (MOUD) services, d) 75% of participants who required a mobile crisis intervention will receive a coordinated, follow-up outreach attempt within 24-hours, and e) 85% of CCBHC participants will be offered required screenings, vaccines, or testing including HIV and viral hepatitis screens. Goal 2) Increase the number of participants who receive social SDoH resources and support by a) 60% of participants who identify housing needs on their National Outcomes Measures will receive support from case management (such as our Housing Specialist) or are engaged with housing coordinated entry, and b) 60% of participants who identify employment needs on their NOMS will receive support from case management (such as our Rehabilitation Specialist). Goal 3) Outreach and provide education to individuals and community partners by a) Providing 10 health literacy education outreach events each year of the grant (such as tobacco cessation, diabetes management, and how to access SDoH resources) to individuals who are justice involved, and b) Provide six Narcan education and distribution events in the community each year (to reduce accidental overdose) with three targeted to the Hispanic/Latino/a population.

Family Connections CCBHC-IA: Enhancing Care With a Focus on LGBTQIA+ Youth and Adults, Those at Risk for Suicide, and OUD Clients Who Would Benefit from MAT. Our CCBHC-IA will address disparities in access and BH outcomes for LGBTQIA+ youth and adults. We will respond to rising local suicide rates by engaging individuals with suicidal ideation using the Zero Suicide framework (ZS) and EBPs to rapidly identify and respond to suicide risks. Additionally, we will enhance our patient- and family-centered, culturally competent care for underserved individuals who are living in poverty with mental health (MH) and substance use disorder (SUD) diagnoses. This program will support people of all ages living with the most acute behavioral health (BH) conditions, including but not limited to adults with serious mental illness (SMI), people with opioid use disorder (OUD) who need medication assisted treatment (MAT), veterans and their families, and children and adolescents with serious emotional disturbance (SED). Our catchment area is Essex County, NJ, which has significant BH capacity gaps in evidence-based, trauma-informed, culturally competent services that address BH and physical health (PH) needs and wraparound supports - particularly in the Urban Core of Newark, East Orange, Orange, and Irvington where our CCBHC site is located. More than half (58%) of our CCBHC-IA clients will be Black; 9% White; 1% Asian; 1% American Indian/Native Alaskan; 31% either Biracial or another race. 17% will be Latinx. Most (65%) will be female, 33% will be male, and 2% will be transgender. 7.1% will identify as LGB+. 19% will be children and youth under 18, with the remainder being adults over 18. 95% will face socio-economic challenges, including living below the Federal Poverty line, being uninsured, and/or homeless. 30.3% will have co-occurring MH conditions and SUD, and 30% will have a trauma-related diagnosis. We will serve 200 unduplicated individuals in Y1, 400 in Y2, and 500 in each of years 3 and 4 for a total of 1,600 served with these grant funds. FC will 1) build program capacity to meet 2023 revised CCBHC criteria by July 1, 2024, including conducting an updated CCBHC Needs Assessment; 2) expand our CCBHC capacity by hiring an LGBTQIA+ Clinician and an Assistant CCBHC Director within four months of award; 3) offer MAT to 100% of OUD clients for whom this is clinically appropriate; 4) improve access to care, in that 90% of people entering our CCBHC with routine needs will receive services within 10 business days and 90% with urgent needs will receive services within 1 business day; 5) reduce suicide-related risks for CCBHC clients by a) screening 100% for suicide risk using the Columbia Suicide Severity Rating Scale at intake, b) developing a Safety Plan with 100% of those with suicide-related risks using the Stanley Brown safety planning protocol, c) implementing ZS within one year of award by training 100% of CCBHC staff in ZS principles, and; d) pursuing the objectives of 60% of CCBHC clients who express suicidal ideation at intake not endorsing suicidal ideation after six months of engagement; 65% of adult consumers diagnosed with Major Depressive Disorder/Dysthymia who have a score of 9+ on the PHQ-9 will reduce their score to less than 5 after 6 months of engagement; and less than 10% of clients discharged from a hospitalization and referred to our CCBHC will be re-hospitalized within 30 days of their discharge; 6) improve BH access and CCBHC outcomes for LGBTQIA+ individuals so that 70% who engage in family therapy will report improved family relations and 75% who engage in individual or group therapy will report improved social support. We will also connect 100% of middle and high school LGBTQIA+ youth to a Gender and Sexuality Alliance in their schools within 1 month of engagement with our CCBHC; train CCBHC staff in LGBTQIA+ cultural competency, and ensure 10+% of our Advisory Council self-identify as LGBTQIA+.

Project Summary: JAMHI Health and Wellness Inc (JAMHI), founded in 1985, is a multi-service, non-profit community health center with Federally Qualified Health Center look-a-like (FQHC-LAL) status. JAMHI operates three (3) clinic sites offering integrated medical, mental health (MH), substance use disorder (SUD), and ancillary/enabling services to area residents. As a current CCBHC JAMHI desires to expand and improve its current services in compliance with CCBHC Criteria to the benefit of an isolated, despaired population. Geographic Catchment Area: The catchment area is the City and Burrough of Juneau Alaska (pop 31,534), accessible by sea or air only. Juneau has a total area of 3,255 square miles and encompasses part of Mendenhall Glacier. Project Name: JAMHI CCBHC Improvement and Advancement Project Contact: Dave Branding, CEO, 907-463-3303, dave@jamhi.org Populations to be served: The population of focus are adults and children at risk of suicide; and/or with an SUD or MH diagnosis, with emphasis to serve those with SMI, SED, SUD, and COD. Number to be served: Year 1: 90; Year 2: 120; Year 3: 150 Year 4: 180; Life of project: 540 Project strategies/interventions: JAMHI will use a combination of several evidence-based- interventions, including Individual Psychotherapy, Cognitive Behavioral Therapy, Dialectical Behavior Therapy, EMDR Therapy, Moral Reconation Therapy (MRT), Eye movement desensitization and reprocessing (EMDR) and Case Management. We provide medications for addiction treatment (MAT) in conjunction with counseling and case management. Project goals and measurable objectives: Our goals include: for each grant year, across the whole agency, screen 800 individuals for depression using the PHQ-9; for each grant year, screen 95% of CCBHC consumers for suicide risk using a combination of narrative assessment and standardized tools; for each grant year, 90% of CCBHC consumers screened at-risk for suicide using the C-SSRS, or at risk for major depression using the PHQ-9, will develop a crisis plan w/their clinician or case manager; for each grant year, 65% of CCBHC consumers will have reduced risk for suicide, and reduced symptoms of depression as indicated by improvements in C-SSRS and PHQ-9 scores between assessments; for each grant year, 65% of individuals who screen positive for alcohol issues during intake, will attend their next appointment; for each grant year, we will make 3 posts per week, to increase social media presence through an online, social media campaign to raise awareness of MH and SUD services at the JAMHI CCBHC; for each grant year, we will conduct outreach and education at appropriate, targeted venues for reaching homeless, at-risk populations at (3) community events and service-providing agencies per grant year, to reach a total of 500 individuals per year.

Greater Cincinnati Behavioral Health Services (GCB) will enhance its Certified Community Behavioral Health Clinic in Amelia, Ohio (CCBHC-A) to expand access to behavioral health treatment to support recovery in Clermont County, Ohio. CCBHC-A was established in 2020 with SAMHSA funds and meets attestation requirements. It improved service access and quality for a disparate population in the Appalachian Region which has the highest rates of economic, social and health disparities in the U.S. Primary problems grant funds will address include prescriber waiting times that average 16 days which increase suicide risk, hospitalization, and delay medication access; limited crisis receiving and stabilization services the drive local incarceration rates and emergency department (ED) utilization; limited use of peers in the crisis continuum,; lack of brief interventions and therapies (BIT) to offer immediate, short-term services for people in crisis; and health information technology (HIT) innovations needed to strengthen care management and population health management. CCBHC-A will serve 1000 clients over four years - 250 clients per year in years 1-4. The focus population will be youth and adults, to include persons with serious mental illness, substance use disorders, serious emotional disturbance, co-occurring disorders, and people in behavioral health crisis. The population is 93% White; 5% Black; 2% Hispanic/Latino. 50% are female; 49% male; 1% transgender. 94% are heterosexual. 7% are under 18; 45% are between 30-49 years. 86% are below 138% of the Federal Poverty Level. 84% have a SMI; 47% a COD. SAMHSA funds will improve psychiatric prescriber capacity, enhance crisis services and advance HIT. Goals and objectives include: 1) Improve psychiatric prescriber capacity to increase medication access by hiring an additional prescriber; 2) Enhance crisis services to reduce ED use by establishing a behavioral health urgent care aligned to the Ohio Department of Mental Health and Addiction Services standards; 3) Improve peer crisis support to reduce client distress by establishing a peer respite program; 4) Increase the availability of BITs to improve access to short-term interventions by developing Screening, Brief Intervention, and Referral to Treatment (SBIRT) protocols and training staff in Solution-Focused Brief Therapy (SFBT; and 5) Strengthen care coordination and population health management via HIT innovations and electronic health record integration to include a patient portal, health event notification, and population health management dashboards and reports. Key interventions include Critical Time Intervention, Motivational Interviewing, SBIRT, and SFBT. GCB has successfully implemented and sustained 8 SAMHSA-funded projects, including CCBHC-A. It has the capacity, experience, and partnerships to enhance CCBHC-A to continue to improve health and promote recovery for a disparate population in a disparate region.

Centerstone’s Preventing Youth Overdose Program (C-PYO) will serve 325 children/ adolescents (ages 10-18) and young adults (ages 19-25) with/at risk for opioid use disorder (OUD) and/or co-occurring disorder (COD) and their families/primary caregivers in a 12-county catchment area in southwestern Illinois (Y1: 75; Y2-3: 125/year). C-PYO will implement evidence-based treatment, including medications for opioid use disorder (MOUD); screenings/ assessments; education/community awareness; recovery support services; and linkages to care coordination. The focus population comprises an anticipated 176,850 youth whose demographics and clinical characteristics are expected to mirror those of the catchment area youth, with 51% male, 49% female, 71% White, 17% Black/African American, and 6% Hispanic/Latino individuals. Subpopulations will comprise youth from among the area’s minority groups (e.g., 39,420 racial/ethnic minority and/or 12,780 LGBT youth); systems-involved youth (e.g., 5,180 in foster care and juvenile justice); and Veteran populations (e.g., 2,300 Veterans [ages 18-25]; 1,000 Veteran households with children). Roughly 28,570 focus population youth ages 12-25 have a substance use disorder (SUD) and 2,000, OUD. Among area youth ages 12-17, 980 have a co-occurring SUD and major depressive episode. Within a Recovery-Oriented Systems of Care and using best practices from NIDA’s Principles of Adolescent SUD Treatment and TIP 59: Improving Cultural Competence, C-PYO will deliver evidence-based Teen Intervene, Teen Matrix, MDFT for Adolescent Substance Abuse, MOUD, and DIMENSIONS. The community awareness campaign will integrate best practices from the CDC’s Stop OD Campaign and HHS’ OD Prevention Strategy. The CDC’s Strategies for Preventing Opioid OD and YMHFA will inform C-PYO’s education for families and school personnel. Key C-PYO strategies/components include provider/community collaborations; outreach/engagement; an Advisory Council; prevention activities (e.g., overdose reversal education, psycho-education groups); Individual Treatment Plans; evidence-based substance use disorder (SUD)/OUD/COD treatments (e.g., MOUD); recovery support services (e.g., peer supports, relapse prevention counseling, harm reduction); and referrals (e.g., Hepatitis A/B vaccinations). C-PYO’s goals include: 1) Implement C-PYO to provide a coordinated set of prevention, treatment, and recovery support services for youth with/at risk for OUD/COD. 2) Develop an infrastructure to improve local awareness among youth of risks associated with fentanyl; increase access to MOUD; and train healthcare providers, families, and school personnel on best practices for supporting youth with OUD/taking MOUD. 3) Improve health status/outcomes for participating youth. 4) Develop/document/refine a service delivery model for replication throughout the state. C-PYO will achieve the following measurable objectives related to training, education, and community awareness: Provide accredited trainings to 30 project/agency clinicians; Reach 1,200 individuals via a community awareness campaign around the risks associated with fentanyl, emerging drugs, and drugs of interest/prevalence; and Educate/train 400 families and school personnel to improve their understanding of OUD and MOUD for youth. C-PYO will achieve the following measurable participant-related objectives: Decrease at-risk behaviors by 50%; Reduce mental health symptomatology among 60%, substance use/frequency among 40%, past 30-day unexcused absences among 30% enrolled in school, costly service utilization related to SUD/COD issues among 50%, and past 30-day criminal/juvenile justice system involvement and/or exposure to crime/violence by 80%; Improve family-functioning by 50%; Increase access to recovery-oriented treatment/services among 100%; Follow up with 100% of participants receiving linkages/referrals to supports to ensure service utilization; and Achieve an 80% participant retention rate.

To prevent youth drug overdose, WCMHS will expand services for youth with SUD by strengthening capacity, improving coordination and health management, addressing disparities in treatment access and quality, and advancing community SUD awareness of needs and services. This project will serve 300 youth directly with SUD treatment and prevention services, with 80, 100, and 120 people served in project years 1-3. The project's catchment region (Washington County, VT) has 12,500 residents aged 10-25, with 45% female, 90% white, and over 1,300 identifying as LGBTQ+. Over 12% of youth live in poverty and more than 2,700 youth have a SUD, with more than 2,400 receiving insufficient or no treatment. WCMHS's has identified key service gaps in Washington County, including a significant lack of SUD services, particularly those requiring medication assessed treatment for opioid use disorder, and a low level of awareness about drug use risks, fentanyl additives, and overdose reversal resources. To address these gaps, there is a need to enhance health professional SUD treatment skills, improve data analytic capabilities for population health management, and develop comprehensive strategies for community awareness, engagement, and expanding practices that ensure the successful implementation and awareness of new SUD services. The project's five goals and objectives are: G.1: Improve accessibility and quality of youth SUD services in the community. O.1: Within PY1 Q2, implement a universal screening process for SUD and co-occurring disorders in all agency entry points, with at least 80% of incoming youth being screened. O.2: Within PY 1, serve at least 70% of existing clients in need of SUD treatment with the new youth program, including youth in need of MOUD treatment. O.3: After PY1, annually increase the number of youth receiving SUD services by 20%. O4.: After PY1, achieve a 50% increase in referrals and transitions between services (e.g. from school based, outpatient, crisis services, to SUD services) as a result of improved care coordination. G.2: Enhance WCMHS staff capacity and expertise in youth SUD services. O.1: Be end of PY1, provide integrated dual disorder treatment training to 100% of clinicians serving youth in the outpatient SUD program. O.2: By end of PY1 establish new (internal/ external) care coordination protocols and train at least 90% of clinical staff to utilize them successfully. G. 3: Increase community awareness and understanding of youth SUD needs and services O.1: Be end of PY1, conduct at least 10 community or school-based training/ educational sessions for community stakeholders. O.2: By endo f PY2, reach at least 500 community members (including youth, parents, educators, PCP's..) through these educational initiatives. O.3: Be end of PY2, achieve a 50% increase in community referrals to the youth SUD program. G.4: Decrease youth SU in the community through evidence-based programs. O.1: By end of PY2, achieve a 10% reduction in SU among youth participating in agency SUD programming and prevention services, as measured by self report and clinical assessment. O.2: Annually, maintain a treatment dropout rate of less than 15%. G.5: Increase evidence-based SUD prevention education in schools, community, and health settings. O.1: By end of PY2, ensure 100% of health education teachers in schools, community, and health settings have been trained on an evidence-based SU prevention curriculum. O.2: Be end of PY2, WCMHS will have trained at least 75% of school social workers, counselors, and nurses on an evidence based curriculum addressing the prevention of prescription drug/ opioid overdose-related deaths. O.3: By end of PY3, school district health educators will have conducted classes on MOUD, SUD prevention for at least 90% of youth in middle/high school. O.4: By end of PY3, increase the percentage of students reporting high perceived risk of substance use, as measured by the YRBSS.

The proposed project, CHLA PYO TREAT Program (Preventing Youth Overdose: Treatment, Recovery, Education, Awareness, and Training No. TI-23-022), is a multi-level program designed to increase the target community’s understanding of SUD/OUD and related issues affecting youth and young adults (AYA) by delivering a series of specialized trainings that will address overdose prevention, fentanyl, and harm reduction practices to school personnel, parents/caregivers, youth, and healthcare workers and by increasing AYA access to substance use disorder (SUD) treatment and recovery services, including opioid use disorder and co-occurring disorder (COD) treatment and recovery services. The central/metro area of Los Angeles County (LAC) is the geographic target and is a densely populated and diverse community, marked by sharp disparities in income. LAC is the largest county in the United States, with a population greater than 10 million. The proposed program has a special focus on engaging Latinx, Indigenous and LGBTQ populations. The goals of the project are: 1) increase school and community capacity to reduce high risk behaviors of adolescents and young adults that may contribute to substance use, including opioids, fentanyl, cannabis, and prescription medications and other substances of interest; 2) increase access to substance use disorder treatment and recovery services to adolescents and young adults, and 3) increase the capacity of healthcare workers to identify and address substance use in their adolescent and young adult patients. If funded, CHLA will reach over 2700 individuals over the three years of the program through education and training, capacity building, and direct substance use treatment services. The program expects to reach 610 individuals in year 1 and 1108 each in years 2 and 3. The targets of these services will include school personnel, parents and caregivers, health care providers, students, and individuals seeking treatment. Services will be provided through parent/caregiver groups, town halls, community summits, school assemblies, professional education presentations, school clubs and leadership groups, and through individual treatment sessions.

The Great Plains Tribal Leaders Health Board’s Preventing Youth Overdose (GP PYO) program will implement an American Indian and Alaska Native-focused youth and young adult navigator program in Rapid City, South Dakota to increase access to needed resources to prevent and reduce youth overdose. GP PYO will also engage with and train service providers in harm reduction and youth substance use prevention, treatment, and recovery. According to the US Census Decennial data 2020, Rapid City, South Dakota, currently has a population of 74,703, with 12,854 self-identified as American Indian or Alaska Native (AI/AN). As of January 2023, Oyate Health Center, a tribally managed walk-in clinic, has over 22,200 active users, with 5,657 under 18. As of June 2023, there were 4,083 active users between 12-24. Our focus will be on youth ages 10 to 24 at risk of, in treatment for, or recovering from opioid use disorders (OUD). Funds are needed to increase access to improve local awareness among youth of risks associated with fentanyl, increase access to medications for opioid use disorder (OUD), and train healthcare providers, families, and school personnel on the best practices for supporting youth with OUD and those taking medications for opioid use disorder (MOUD). The GP PYO program will engage in the following objectives: Objective 1: Lead the coordination of prevention, treatment, and recovery support services by implementing a PYO Navigator program by month 4 of the grant that helps youth and young adults with OUD and co-occurring disorders with access, education, and navigation of existing community resources. Resources include MOUD for youth and young adults with OUD. Objective 2: GP PYO program will raise awareness of risks associated with fentanyl, increase access to MOUD, and support youth with OUD by offering monthly training sessions on related topics to healthcare providers, families, and school personnel. GP PYO program will target healthcare providers and prescribers most safely and effectively to prescribe MOUD to youth by offering an annual accredited training opportunity on pediatric MOUD prescription. Objective 3: Target healthcare providers and prescribers on the safest and most effective way to prescribe MOUD to youth by offering an annual accredited training opportunity on pediatric MOUD prescription. GP PYO program will serve an unduplicated number of participants, 200 each year, reaching 600 unduplicated individuals.

The Mental Health and Anti-Addiction Services Administration (MHAASA) of Puerto Rico will implement the Fiona Recovery Project to provide services to 500,000 emotionally affected survivors of Hurricane Fiona of 2022 to achieve stability/recovery through short crisis interventions in the 78 declared municipalities, screening for SMI/SUD/OUD with clinical interventions by 6 Mobile Crisis Teams (MCT) comprised of BH professionals, and harm reduction (naloxone and fentanyl strip distribution and training on use) to prevent opioid overdose. The need for the project is based on damages caused by Category I Hurricane Fiona of September 20, 2022 which impacted PR with sustained winds of up to 85 miles per hour, causing loss of electrical power and water services for over 80% of households and businesses in some areas, 35 inches of rain, sheltering of 507 refugees in 92 shelters of 31 municipalities, road destruction and 44 direct or indirect deaths. Based on the PAS Hotline's Immediate and Regular Services Projects with FEMA/SAMHSA funds, Fiona affected all ages and genders (56.5 female/43% male/0.5 transgender served) who were 85% Hispanic and Spanish-speaking. Based on the current continuing behavioral health (BH) needs of survivors, MHAASA proposes a 1-year project to achieve the following summarized goals and objectives: G1) Mitigate increases in misuse and more severe and long-lasting MH/SU conditions by providing evidence-based interventions; G2) Capacitate a broad-based workforce to address BH needs of survivors of the Fiona disaster to prevent morel serious effects such as opioid overdose or suicide. Objectives, aligned with the Needs Assessment are: O1. Achieve emotional stabilization of at least 90% of survivors intervened through six (6) 24-hours Mobile Crisis Teams (MCT) of clinicians that serve survivors in the 12 PR health regions; O2. Screen and assess needs of 100% of survivors with symptoms of emotional crisis for MA, SU, or co-occurring disorders, using SBIRT tools; O3. Link to EB treatment at least 95% of survivors assessed with SMI/SED/SUD/OUD at the most appropriate available level of care; O4. Provide opioid overdose prevention, through the SOR and PDO Projects, through the Unit for Capacitation ("UCAT") of MHAASA, training peers, first responders and community providers to recognize and use naloxone; O5. Expand harm reduction through fentanyl strip and naloxone distribution in coordination with MHAASA's SOR and PDO projects, ensuring compliance with all requirements; O6. Ensure linkage to peer, recovery, vocational, employment, housing, transportation and other support services of survivors attended by MCT's; O7. Enhance and expand BH workforce of project at state level, including trained peers; O8. Increase knowledge and skills of at least 80% of peers, first responders and other providers to recognize symptoms of MH and SU disorders in adults and children impacted by a disaster; O9. Strengthen partnerships of the PAS Hotline by signing at least 3 new MOU's to facilitate access of survivors to services; O10. Recruit and support a culturally diverse staff to serve survivors of all ages, genders, gender identities, sexual orientations, ethnicities, and races, applying CLAS; O12. Strengthen collaboration with SAMHSA supported TA Centers for T/TA. The proposed project will implement SBIRT, MI, CBT, MAT, RTSH and ACT EBPs to achieve survivors' recovery. Data collection, analysis and reporting will be supported by a 0.5 FTE Evaluator and full-time Data Entry, ensuring EBP fidelity and compliance with GPRA/SPARS data requirements. A total of about $4.3 million is requested for the project's one-year grant period.

Fairbanks Native Association (FNA), a tribal organization, proposes the “Hope for Our Children Project” (Hope Project) in response to “Grants for Expansion and Sustainability of Comprehensive Mental Health Service for Children with Serious Emotional Disturbance.” The project’s Purpose/Overarching Goal is to improve mental health outcomes for children and youth at risk for or with serious emotional disturbance (SED) and their families. The Hope Project will serve American Indian and Alaska Native (AI/AN) children and youth (birth-age 21), at risk for or with serious emotional disturbance (SED) and their families. Although an Alaska Native corporation, by mutual agreement we also serve American Indians and we do not refuse service to other race/ethnicity. Far too many AI/AN children and youth are an at-risk group with little hope for the future. They are heavily impacted by negative indicators of well-being. The Hope Project, through its comprehensive and early intervention approach, will bring new hope. While not specifically focused on clients with SED, 98.3% of youth in our co-occurring substance abuse and mental health residential treatment unit have a SED diagnosis. To provide the full complement of Required Services, the Hope Project is a collaboration of four existing Behavioral Health Service (BHS) service units and a 22 member community behavioral health coalition, the Interagency Transition Council (ITC). The service units include Early Childhood; Screening, Brief Intervention and Referral to Treatment (SBIRT); Assessment; and Suicide Prevention. Due to the complex nature of this collaboration, the Hope Project includes an Intra-Unit Service Coordinator who will streamline the intra/inter unit process and meet with Hope Project staff and allied service units monthly to ensure smooth service delivery. The Hope Project is a service expansion and will implement new treatment services, including Outpatient, Day Treatment and Home-Based Treatment, and Recovery Support. It uses an Athabascan Recovery Model that integrates culturally specific principles and groups into treatment. The Hope Project also provides 1) comprehensive outreach to reach individuals who typically fall through the cracks, 2) screening, assessment, diagnostic, and evaluation services, 3) crisis emergency services, 4) family services, 5) respite care, 6) medication administration and management, 7) therapeutic foster care, 8) training for service providers, and 8) suicide prevention services. All services will be culturally appropriate, trauma-informed and guided by evidence-based practices.

With the continued rise in the rates of substance-use, suicide, and severe mental illnesses in Native American communities, direct services are absolutely essential in assuring that our at-risk populations have the tools and resources they need to build a better future. As one of the only mental health organizations serving all Native American's, families, and communities in northern New Mexico, our goal is to continue to meet the needs of those that we serve. The mission of the Tewa Roots Society Outdoor Behavioral Health and Clinical Service Grant is to take the blueprint that was formed through our Circles of Care grant, and continue to focus on building one of the most dynamic mental health service programs, in the country.

Guam Behavioral Health and Wellness Center (GBHWC), Guam's Single State Agency for Mental Health and Substance Use, seeks funding to support the expansion and sustainability of comprehensive community mental health services. "Project Guam's System of Care (GSOC)," proposes to serve approximately 800 children and youth ages 0-21, at-risk for, or experiencing Serious Emotional Disturbances and their families. Guam received its first child mental health initiative grant between 2002-2008, which established the System of Care (SOC) "I Famagu'on-ta" (Our Children). Between 2013-2018, GBHWC began efforts to expand this SOC island-wide through the comprehensive, community-defined GSOC Expansion Strategic Plan. Although Guam has made significant strides in sustaining a few components of the 2013 strategic plan, including evidence-based and culturally appropriate outpatient, residential, and inpatient behavioral health services, the island has experiences amplified and newly emerged needs of children and families. During the pandemic, GBHWC served over 2,800 children and youth and although significant, prevalence data shows there are more children and youth on Guam that need to be served. GBHWC aims to overcome "project" mentality by focusing on "systems change" with an overall goal of achieving quality access through collaborative partnerships, in order to effectively address the concerns and needs of Guam's children, youth and families. Project GSOC proposes to accomplish this through the following three goals: 1)Increase access to treatment and support services for the target population through a 24-hour Emergency Crisis Intervention Services (Mobile Response and Stabilization Services and Crisis Intake); 2) Revive and improve connections between social support systems, community providers, and families to address challenges in the provision of support services for children, youth, and families utilizing consumer voice as the driver for decision making; 3) Address service gaps across the continuum of care with enhance services that focuses on consumer voice, multi-system stakeholder involvement, and special population services needs.

Abstract The purpose of CONNECTing Schools to Care IV Students (CONNECT IV) is to expand and sustain the statewide infrastructure and service delivery system in Connecticut through expansion and integration of trauma-informed comprehensive school mental health supports with the existing community-based network of care to work collaboratively to provide support and services for youth with or at risk for Serious Emotional Disturbance (SED). CONNECT IV applies successes from three previous Systems of Care (SOC) awards and a current Project AWARE grant through a partnership between the statewide family organization (FAVOR), the Administrative Services Organization (Carelon), the Statewide Coordinating Center for School Mental Health and SOC (CHDI), the local evaluation team (Yale), 11 partnering state agencies, and the CT Department of Children and Families (DCF), the lead applicant who has the mandate for children’s behavioral health care. Using CT’s established framework for trauma-informed Comprehensive School Mental Health, this grant provides an opportunity to ensure that youth with and at risk of SED/behavioral health needs are linked to equitable and appropriate locally-based care across the service array by adding school mental health coaching support for implementation, supports for staff wellness, and recovery-oriented safe spaces for students, all grounded in a school-family-community partnerships approach. The population of focus for this grant includes all Connecticut (CT) youth with serious emotional disturbance (SED) with or at risk for: use of hospital emergency departments for behavioral health crisis, suicidal ideation, clinical high risk for psychosis or early/first episode psychosis, and increased school discipline sanctions (e.g., suspensions & expulsions) for behavioral health difficulties. Connecticut is the 29th most populated state with 3.6 million residents and ranks 22nd on the Diversity Index with 12% Black/African American, 69% White, and 22% Hispanic/Latino. About 20% (736,717) are under age18, with English learners at 8.3%. Children with SED are estimated at 10% (73,000). Annually, more than 1,300 children/youth receive Wraparound care, yet schools too often rely on emergency departments and other restrictive settings. There is a need to increase use of community-based services and to provide seamless transition of students needing behavioral health intervention from schools to community-based providers. Through a phased-in, tiered approach to implementation, all 206 Connecticut school districts will have universal access to prevention/early intervention resources; some schools (up to 120 in 4 years) will have access to selected supports for training, coaching, and implementation to guide service enhancement; and a few schools (up to 54 in 4 years) will receive intensive support for implementation of services and quality improvement activities to improve access and outcomes within the school mental health system and broader statewide SOC. A total of 3,200 children/youth will receive Wraparound/Care Coordination as a result of this grant (700 in years 1 and 2, 900 in years 3 and 4). With this request of $1,500,000 annually, CONNECT IV will meet the following four goals: 1) Expand the infrastructure for an integrated school- and community-based behavioral health network of care; 2) Expand school and family awareness, knowledge and access to information about behavioral health, trauma, and crisis response; 3) Build capacity of Connecticut’s schools to access and utilize community-based behavioral health resources and supports for school mental health; and 4) Implement and sustain equitable and comprehensive school mental health supports.

Milwaukee County Behavioral Health Services, Wraparound Milwaukee submits this application for $3,999,186 to address the disparity of services within the system of care (SOC) for children and young adults at risk for or with SED. The focus population are youth, 12-19 years of age, with multiple diagnosis including SED, autism, and developmental, physical, or emotional disabilities and who are co-enrolled in Wisconsin's Children's Long-Term Support (CLTS) and Comprehensive Community Services (CCS) Programs. Services will be delivered in the geographic catchment area of Milwaukee County with a population of 952,085. The project proposes to serve 50 unduplicated individuals throughout the lifetime of the project. Strategies and interventions include: conducting a needs assessment identifying racial and ethnic health disparities, specialized cultural and linguistic needs, current conditions, and desired services or outcomes for CLTS/CCS youth with complex diagnosis; modifying the evidence-informed Coordinated Specialty Care (CSC) model to provide low-barrier access to specialized clinical providers for teams CLTS/CCS youth with complex diagnosis; adapting the CSC fidelity tool to reflect the needs of CLTS/CCS youth with complex diagnosis; providing child-serving system cross-training for CCS and CLTS provider networks focusing on the integrated needs of CLTS/CCS youth with complex diagnosis; implementing an evidence-based screening tool to identify problematic substance use; providing workforce training for CCS, CLTS, and Wraparound Milwaukee HMO Provider Networks in the evidence-informed practices to better engage youth and families, and resolve complex and COD, interrelated problems; and conducting self-assessments of the strengths and needs of the SOC principles and infrastructure for CLTS/CCS youth with complex diagnosis. Project goals are to: expand the use of evidence-based practices (EBP) programs, and services; improve the SOC child-serving partnerships; focus additional attention on co-occurring mental and substance misuse, substance use disorders (COD); and promote SOC expansion and sustainability. Measurable objectives are to: conduct a needs assessment to address service delivery gaps for 101 young adults, ages 12-19, with SED and significant developmental, physical, or emotional disabilities; provide evidence-informed and culturally appropriate mental health services for teams of 14 CLTS/CCS youth with complex diagnosis; advance cross-sector system relationships to provide collaborative services for the target population; develop a well trained workforce to better engage youth and families, and resolve complex, interrelated problems; improve the identification of, and services for, youth with COD; and assess the strengths/needs of SOC principles and infrastructure for CLTS/CCS youth with complex diagnosis. Anticipated outcomes include: integration of needs assessment results into the project's overall plan and approaches; development and implementation of an integrated care coordination module for CCS/CLTS youth; CSC model fidelity; identification of youth at risk or with a SUD and referrals to services; and a well-trained workforce in mental health and related practices.

Lycoming Clinton Joinder Board Project Abstract Summary Project Name- FY 2023 Grants for Expansion and Sustainability of the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances The Lycoming-Clinton Joinder Board is a social service agency responsible for providing State-mandated services and supports to residents of Lycoming and Clinton Counties. In collaboration with system, agency, county partners, families, youth and transition-age youth, the Joinder desires to implement the System of Care (SOC) approach funded by a grant from the Department of Health and Human Services (DHS) Substance Abuse and Mental Health Services Administration (SAMHSA) in our bi-county area to create and augment a sustainable infrastructure that provides resources for children, birth to 21 who are at risk for or experiencing serious emotional disturbances (SED). Developing the SOC approach using trauma-informed evidenced- based and best practices, family-driven, multi-system integration, cultural and linguistical competence methods along with data-driven, quality, and effective outcome measures will allow the children in our counties to have the top standards available along with reducing ongoing costs associated with unmet therapeutic needs. We believe that individuals and their families have within their own power the ability to adapt and to deal with life's inevitable stresses and difficulties. The mission with which we are charged is to cultivate those adaptive skills to empower individuals and families in their community in a manner and setting which respects human dignity. Strategies/interventions: Increased EBP Trainings facilitated by SOC Lead Trainer for Providers/Agencies and Families, coordination and implementation of leadership team with 50% representation from youth and families with lived experience, development of a coordinated interagency support team that will serve 200 children and their families throughout the project and implementation of a HIPPA compliant cross-system data platform with 100% trained users to collect, monitor, analyze, and report 100% of required data and project outcomes on a quarterly basis, annually. In addition, see SMART goals. Project goals: Develop a leadership team, develop a Mission, Vision and a Plan, engage system partners, youth and families, create a strategic plan based on mapping of our community and population focus, develop a communication and social marketing plan, develop a means for evaluation, quality assurance and continual improvement, Develop ongoing and braided funding sources, Develop ongoing training and use of TA or intensive TA and use of developed SMART goals. Measurable objectives: Decrease in higher levels of care as evidenced by claims data, increased family and youth voice in treatment as evidenced by initial and ongoing youth and family satisfaction questionnaires, increased cooperation between agencies as evidenced by engagement in proper levels of care and decreased use of Crisis and Emergency Departments. Decreased justice-involved youth with an SMI, evidenced by reporting data. Increased quality of services using trauma informed, evidence-based, cultural, and linguistic competency and SOC principles, evidenced by training. Creation of cross-system information platforms to help with quality, service, and reporting, evidenced by reports generated through the platform. In addition, see SMART goals.

Broward County, Florida (The County), Broward Behavioral Health Coalition (BBHC), Broward County Public Schools (BCPS), the Children's Services Council of Broward County, the Broward County Child Welfare lead agency (ChildNet), and South Florida Wellness Network (SFWN) continue a long standing partnership for the One Community Partnership 4 (OCP4) Initiative to build sustainable cross-systems infrastructure and evidence-based services capacity to improve mental health outcomes for children ages 4 through 11 years, at risk for and with serious emotional disturbances (SED), and their families, with emphasis on underserved and minority populations, specifically Black and Hispanic children and families. OCP4 will serve 25 children and their families in year 1, 58 in year 2, 57 in year 3, and 58 in year 4, with a total of 200 unduplicated children and families served. OCP4 will focus on pre and elementary school-age children to facilitate early identification and intervention, necessary for optimizing outcomes. OCP4 will bring universal mental health and trauma screening to Broward's Voluntary Prekindergarten Education Program (VPK) and elementary schools (k-5), using the Strengths and Difficulties Questionnaire (SDQ) and the Adverse Childhood Experiences (ACE) screening instrument. Mental Health Screeners will partner with VPK and elementary schools, prioritizing and starting in designated underserved and predominantly minority population areas within Broward County. Partnerships with schools will include engaging and training school personnel in the screening process, to establish sustainable universal mental health and trauma screening throughout Broward County's VPK and elementary schools. OCP4 will screen 360 children in year 1, 1,000 in year 2, 1,000 in year 3, and 1,000 in year 4, with total of 3,360 children screened. OCP4 will also create a referral pathway and will expand and enhance Broward's children and families System of Care to facilitate provision of trauma-informed and culturally and linguistically responsive evidence-based interventions. For further assessment, children at risk for SED will be referred to BBHC'S System-Level Care Coordination Program that will facilitate service linkage using the Child and Adolescents Needs and Strengths (CANS), a comprehensive assessment with components to assess both trauma and suicide risk. The CANS will be utilized to determine appropriate and least restrictive levels of care. Children presenting with SED will be placed in High Fidelity Wraparound, through which children and families will be engaged in evidence-based child and family treatment, services, and supports, tailored to each family's unique needs and strengths, health beliefs, language, and customs. OCP4's core service array will include Parent Child Interaction Therapy, the Triple P Positive Parenting Program, Trauma-Focused Cognitive Behavioral and Equestrian Trauma Therapies, and family peer support. Families will be linked with SFWN, Broward's recovery-focused support network run and fully staffed by youth, adult, and family peers and home to Broward's Chapters for Federation of Families and Youth M.O.V.E., to access educational and social recovery-oriented activities. OCP's primary goals are to improve child and family functioning while reducing school absenteeism and utilization of acute/institutional levels of care. The OCP4 Children's Mental Health Initiative grant will provide Broward the opportunity to expand the existing System of Care into a younger population of focus, building capacity for early identification of children at risk for and with serious emotional disturbances, ensuring equitable access to and benefit from needed services and supports by supporting systems level change.

The City of Houston Mayor's Office of Education with the collaboration with the Baylor College of Medicine are proposing a four-year initiative, titled The Next Day Project (NDP) to effectively address the epidemic of youth suicide, within the Greater Houston Area, through evidence, trauma, and culturally informed processes. Children, youth and families will receive screening, assessment, referral to care, and intensive direct services for those in most need. The project is named the Next Day Project (NDP) because that is the identified gap for youth who are struggle with suicide thoughts and behaviors. The NDP initiative will serve school-age youth (6-17 years) at risk for serious emotional disturbance (SED) who are presenting suicidal ideation, have attempted to commit suicide or are presenting non-suicidal self-injury. It aims to fill a need in the area to assess and treat suicidal youths given that there is a lack of a comprehensive approach to the screening, development of an appropriate safety planning and linkage for treatment. The initiative will implement effective detection, assessment, monitoring, referral, tracking, and appropriate treatment by coordinating these processes under the auspices of the Baylor College of Medicine - Department of Psychiatry and Behavioral Sciences, emergency centers and clinics of the Texas Children's Hospital, pediatricians and primary care providers, independent schools districts and charter schools, local community organizations including Mental Health America of Greater Houston, Houston Area Suicide Prevention Coalition and National Alliance on Mental Illness of Greater Houston, and state-funded programs such as Texas Child Health Access Thru Telemedicine (TCHATT) and the Child Psychiatry Access Network (CPAN). The initiative will provide a stepped level of care for youth through (a) screening protocols for at-risk youth, (b) assessing youth presenting suicidal attempts or serious crisis, (c) providing first-hand interventions, (d) connecting to appropriate level of care within the community based on these screenings and assessments, (e) increasing the knowledge, skills and resources on providers through specialized training, and importantly, (f) expanding the clinical capacity within the community to provide intensive care management and multi-agency treatment planning and follow up. In the four-year span, the project aims to screen 40,000 youths, provide direct mental health services to 4,500 participants and their families, attend and provide guidance consultations to 400 primary care providers and pediatricians, and deliver training to 300 mental health providers and school counselors in the area, among other goals.

NC DHHS' Division of Child and Family Well-being (DCFW) is applying to fund the "NC System of Care Expansion: Focus on Governance Development and High-Fidelity Wraparound (HFW) Utilization." We are applying to address specific needs related to Comprehensive Community Mental Health Services (CCMHS) through strengthening the System of Care (SOC) approach at the state, county, and provider levels. Building a better system for all young people with SED is the priority, with emphasis on target populations including: 1) youth at high risk for placement in residential services, mental health crisis units and Emergency Departments (ED), 2) minority populations, 3) young people in foster care and 4) with exposure to trauma. We plan to start two new HFW teams in four NC counties with large African-American populations. African-American youth (22% of the population) are disproportionately represented in NC EDs for behavioral health crises (46%) and represent 29% of youth in DSS custody. We will develop and implement a three-level model. The 1) Service Level will ensure that at least 650 youth with a range of 100-195 per year are served with EBPs (HFW and others). We will also put in place a statewide screening process to screen 6,000 children. In addition, 4 established HFW teams that are struggling will be supported to improve recruitment, fidelity, and impact. The 2) Collaborative Level will engage 60 County SOC Collaboratives (CSC) throughout NC. CSCs will receive training and help to apply for scholarship dollars that will improve SOC and Results Based Accountability (RBA) knowledge and capacity. 12 CSCs struggling with RBA and data management will be provided with intense support to increase infrastructure, data management, and RBA capacity through community projects that raise awareness of HFW teams. The 3) Policy Level will engage a SOC Advisory Council (SOCAC) to address grant goals and objectives and will become a permanent governing body on SOC/CCMHS for the state. The preliminary SOCAC structure will prioritize Youth and Family Voice identified problems, generate proposed solutions, develop data-informed projections of proposed solution impact on outcomes, cost, and youth/family satisfaction. The process will be entirely youth/family-guided. With this approach, we will 1) ensure policy and legislative support; 2) improve community support via CSC-led projects raising awareness of services for youth with SED; 3) routinely assess for, identify and work with local stakeholders to meet resource needs; 4) increase service delivery to include HFW and needed services to at-need regions; 5) and, ensure that direct services for youth and families are of the highest quality. Implementation and Evaluation support will 1) collect, manage, and report data for performance measurements and Continuous Quality Improvement; 2) complete all documentation outlined in application; 3) provide sustainability planning and needs assessments; and 4) complete an integrated systems, process, and outcome evaluation. Four goals, each with multiple measurable objectives will be targeted to meet identified needs: 1) Expand and formalize the screening to service continuum for CCMHS through screening, linkage, and service delivery while using data to identify common and emergent mental health, substance use, and resource needs, and tailor interventions accordingly; 2) Establish and support sustainability of two new HFW teams and improve performance of four established HFW teams; 3) Assess, engage, and support county CSCs to conduct effective projects to raise community awareness of services for youth with SED; and 4) Establish an SOCAC as a permanent statewide body by the end of the grant period to improve the effectiveness and efficiency of NC's SOC to care for young people with SED.

The Four County Systems of Strength and Wellness (4SOSW) provides infrastructure for care management and service coordination plus an array of behavioral health services across a four-county rural region of Ohio.

Alaska's Children's Mental Health Initiative (CMHI) aims to help fill a need for resources to improve the mental health outcomes for children/youth, birth to age 21, at risk for or with serious emotional disturbances (SED), and their families. The geographic region/population for this proposed project represents the full state of Alaska, including larger as well as smaller communities. Alaska faces many challenges in service delivery/implementation; the state is geographically the nation's largest, though its population is only about 3/4 million, ranked 48th lowest nationally. A range of data sources and reports indicate the gaps and needs for Alaska's System of Care for child/youth mental health. Thus, Alaska plans a multifaceted approach that supports the implementation, expansion, and integration of the System of Care by working towards creating sustainable infrastructure and services. Such efforts aim to prepare children and youth with or risk of SED for successful transition to adulthood. Examples of the required activities Alaska will implement are a needs assessment and sustainability plan, training to service providers, enhancing collaborative partnerships, board, and family participation, provision of evidence based mental health services, such as diagnostic/evaluation and outpatient services, including trauma/grief informed care, including service to those from diverse populations (e.g. LGBTQAI+, racial/ethnic groups) and rural areas. DBH will also endeavor to work towards care coordination, and appropriate integration with existing services, such as other suicide prevention, recovery support services, and crisis services, to avoid both duplication of services and gaps in coverage. Alaska's CMHI goals and measurable objectives aim to address and monitor progress towards filling the needs and gaps in Alaska's System of Care across the state for such children and their families and align with SAMHSA required activities. The goals include: decreasing reliance on out of state residential behavioral health services for youth; increasing opportunities for agencies to provide early intervention and outpatient services to help prevent out-of-home placement away from youth and children's communities; increasing education regarding mental health and the benefit of mental health services, with a focus on behavioral health equity and reaching under-served populations; and expanding the implementation of additional crisis services and short-term respite placement opportunities. Measurable objectives are linked to each of these goals, and complement additional data and reporting, and these measures include tracking counts of out of state youth placements, tracking numbers of tribal and community-based organizations with under-served populations who receive materials and education regarding mental health and available services, and tracking the number of technical assistance sessions offered on the development and implementation of different crisis support services. Over the four years of anticipated SAMHSA funding, Alaska will gradually increase number of persons served annually, beginning in year 1 with 250 persons, 400 persons in year 2, and concluding with 500 persons in year 3 and in year 4, for a total planned number of 1,650 served over the project's lifetime.

The population of focus for the Boston Children’s Mental Health Initiative (CMHI) are Black and Latinx children up to age 4 who are diagnosed or at risk of serious emotional disturbances (SED). Led by the Boston Public Health Commission (BPHC, Boston’s health department), the project focuses on serving families who are either involved with the state child welfare system (Massachusetts Department of Children and Families (DCF) or connected to family support services through BPHC’s home visiting program (Healthy Baby Healthy Child) and HRSA-funded family partnership program (The Boston Healthy Start Initiative). The goals of Boston CMHI are to: (1) improve access to evidence-based and culturally competent behavioral health services for over 275 children ages 0-48 months experiencing or at high risk of severe emotional disturbance through a novel dyadic model that incorporates a family partner and behavioral health clinician. (2) Institutionalize early childhood mental health screening and mental health service provision in municipal and community-based child health and child welfare agencies through provider training. (3) Sustain and expand project methods and results by disseminating learnings from this project to the child welfare system. child service agencies, caregivers and providers statewide. To reach these goals this proposal proposes the following objectives: Objective 1. Training: Over the 4-year project period, train a minimum of 37 Family Partners (lay health workers), public health nurses, social workers and case workers on evidence-based behavioral health frameworks (DC:0–5™, Circle of Security, SMART) to ensure the well-being of children receiving services with the Boston Public Health Commission and Department of Children and Families (state child welfare agency). Objective 2. Screening: Screen at least 90% of children in families receiving BPHC home visit and family partner services for social and emotional wellness. Objective 3. Behavioral health services: Provide evidenced-based behavioral health services to families in Boston receiving child health services or involved in the welfare system; whose children are experiencing or are at significant risk of SED—for a total of 275 children served over the project period. Objective 4. Caregiver and community awareness: Increase awareness of early childhood mental health, including behavioral health screening and services, through monthly convenings and a variety of community activities reaching engaging, 4,000 community members over the project period.

The Clark County Department of Family Services (CCDFS) proposes filling identified gaps and implementing enhanced direct therapeutic and clinical care coordination services for children, youth, and families suffering from or affected by a serious emotional disturbance. The project aims to serve children and youth ages 0-21 across Clark County, Nevada, the 14th largest county in the nation, covering the entire southern region of Nevada, including Las Vegas, home of the world-famous Las Vegas Strip. Meeting the needs of individuals requiring mental health assistance has been challenging. Nevada has ranked last in the nation overall, indicating a high prevalence of mental illness and low access to care. Throughout the COVID-19 pandemic, Nevada has felt the devastation of disease, job loss, and poor mental health outcomes. For younger children, being in out-of-home foster care can lead to disparities in health and development, including brain formation and development that can impact a child’s future learning, behavior, mental and physical health (Casey.org). By addressing mental health and substance use issues in those with severe emotional disturbances, we can improve outcomes for children, youth, and families, especially underserved populations. Although the Medicaid expansion has allowed a more substantial proportion of individuals to receive insurance coverage, many qualified mental health providers do not accept Medicaid patients due to low reimbursement rates leaving marginalized patients without adequate care options. These patients are frequently the same clients in child welfare and social services settings. This project proposes to offer a full range of clinical health services to children, youth, and their families referred to child welfare. It supports the mental health needs of this population by increasing access to services where identified gaps and lack of availability have been identified. Two of these gaps include providing therapeutic respite support to caregivers and intensive day treatment services for children assessed with high mental health and behavioral challenges. Caregivers of this population often experience burnout. Post-adoption, guardianship, and fictive kin placements often feel left without adequate support services. CCDFS has partnered with The Therapeutic Solution to provide specialized therapeutic respite to this population and prevent caregiver burnout and child relinquishment. Intensive day treatment services allow for a higher level of care to be delivered to our pediatric population (0-12 years of age) and those requiring direct therapeutic and mental health services. Healthy Minds has committed to supporting this project by providing Intensive Outpatient and Partial Hospitalization Programs. The Clark County Mental Health Expansion Project proposes expanding the Nevada System of Care and providing augmented resources to improve the behavioral, mental health, intellectual, and developmental needs of children, youth, and families who suffer from serious emotional disturbances.

Cayuga County Community Mental Health Center (CCCMHC), in collaboration with system of care partners in Cayuga County, plans to expand the ability of family-serving organizations with a focus on rural school districts to support youth, ages 5-21, with mental health needs; challenging behavior; and poor academic functioning. The plan includes providing training with a focus on improving understanding of emotional dysregulation and the development of strategies to effectively intervene and improving youth functioning at home, school and in the community. The number of youth experiencing mental health challenges including anxiety, depression, and suicidal thinking, have dramatically increased over the last 10 years. Feedback from families has often focused on frustration with schools, believing they are not responding to the needs of their children. Schools express frustration that children in their buildings are becoming more challenging to manage and impacting teachers' ability to teach. Over the last several years, CCCMHC has partnered with several county schools and providers to provide staff training and consultation to help identify and intervene with behavioral health challenges. However, due to limited staff resources, it has been difficult to meet the increasing requests for support. SAMHSA funds will allow the county's system of care to continue to build collaborative relationships in the county and make meaningful change so county-wide organizations, particularly schools, are better able to meet the needs of families and their children. Dialectical Behavior Therapy (DBT) is an evidenced-based model with a focus on teaching four core skills: mindfulness, distress tolerance, interpersonal relationship effectiveness and emotional regulation. Although DBT was originally developed to address serious problems in people with extreme emotional dysregulation, DBT skills are now recognized as essential life skills that are useful for everyone who wants to strengthen emotional wellness and resilience skills. Using a trauma-informed framework, Cayuga County intends to support schools to establish a universal approach in schools in which DBT skills are taught to all students as part of the school curriculum as well as provide a continuum of DBT treatment options within the school setting to students identified as needing more intensive support. The plan includes creating a public health approach through teaching the use of DBT skills to providers, school staff, students and parents/caregivers throughout the county to improve social and emotional well-being for all.

A structured, integrated and evidence-based System of Care (SOC) is urgently needed in Dallas County to further improve outcomes for transitional age youth and their families and expand access to mental health support to promote “Healthy Transitions” to adulthood. Metrocare’s Healthy Transitions Program is a System of Care (SOC) that focuses on preparing transitional age youth (ages 15-21) in Dallas County, Texas, with or at risk of Serious Emotional Disturbances (SED) and/or Serious Mental Illness (SMI) for a healthy transition to adulthood. Transitional age youth with SED/SMI often experience challenges transitioning from children services to the adult serving system. This is the period when many youth/young adults make long-term goals about careers, family, relationships, finances, and obtain independent living environments. The philosophy of Healthy Transitions is the development and implementation of a comprehensive community of care for transitional age youth with or at risk of SED/SMI in Dallas County with the goal of providing cultural and linguistically appropriate, evidence-based, trauma informed, person-centered services organized into a coordinated system. Healthy Transitions is a transitional age youth-guided program where youth and young adults actively impact every level of the environment including the development/modification and active participation in the planning when policies or decisions will affect their lives. Healthy Transitions targets individuals involved in various systems, such as the juvenile justice system, foster care, and/or alternative education programs. Transitional services include mental health treatment, education, GED, vocational, and housing assistance. The goals of Metrocare’s Healthy Transitions Program are: 1) develop a Healthy Transitions governance board; 2) develop and implement a comprehensive referral and continuum of care process; 3) increase access to treatment and healing for transitional age youth; 4) increase community engagement of transitional age youth and stakeholders; 5) increase youth/young adult’s life skills and overall knowledge in daily living; and 6) educate, assess and provide treatment/intervention for substance use disorder in transitional age youth. A community needs assessment will be conducted within the first four months following award to address gaps in service delivery for the transitional age youth and young adults to be served by this project in Dallas County. The needs assessment will seek to identify racial and ethnic health disparities, and specialized cultural and linguistic needs. Metrocare’s Health Transitions Program will serve 375 unduplicated transitional age youth over four years. In year one, 50 individuals will be served; in year two, 75 individuals will be served; in year three, 100 individuals will be served; and in year four, 150 individuals will be served.

Prince William County Community Services (PWC) of Virginia will implement a Children's Mental Health Initiative (CMHI) to screen 2,000 youth (250-550/year), serving all youth with individualized treatment plans, with special emphasis on 400 youth (65-125/year) with complex mental health conditions. PWC is an over 60% majority minority county with Hispanic (25.4%), Black (22.1%), Asian (10.2%) or Other (2.4%) residents. Staff will use culturally informed practices to implement the CMHI consistent with youth enrolled for services. Target groups include (1) minority populations (2) co-occurring SED and substance use disorder (SUD), emphasis on youth with opioid/fentanyl use as this is the fastest growing subgroup in care from 2019 to present, and (3) suicidal ideation and behavior of youth which is also increasing rapidly in PWC. Resource generation, sustainability planning, and the use of collaborative and integrated systems interventions will target two overall aims: (1) Strengthen the System of Care by improving understanding and implementation of SOC principles; offer training linked to clearly identified needs; expand trauma informed approaches to community organizations and businesses; improve policies; and increase youth and family engagement from planning, service delivery and service selection to evaluation. (2) Improve the Service Delivery System to increase access to Evidence-Based Practices (EBP), reduce wait times, increase trust and satisfaction, and improved retention in treatment. Four goals with 3-6 measurable objectives will be addressed: Goal 1. Expand capacity and access for youth/families with complex mental health needs with emphasis on minority, co-occurring SUD/OUD disorders and depression/suicidality to EBPs through systematic screening, treatment planning, and provision of EBPs with fidelity. Goal 2. Improve youth, family, engaged service/resource stakeholders, and community capacity to detect, refer and support youth with SED through improving trainings (mental health, SUD, trauma/resilience, suicide) and the use of technology to improve engagement in treatment, reinforcement of improvement, data collection, and micro-communications. Goal 3. Integrate system improvement activities and objectives via Network Analysis at the community and organization levels. Increase engagement of stakeholders to improve access and quality of services, resources, equity, and voice for minority populations. Goal 4. Incorporate the Connected County Care (C3) app platform for youth, caregivers, treatment providers and key stakeholder agencies to increase feedback, resource support and data collection targeting daily living skills, symptoms, social support, coping skills, and agency of youth and caregivers. To accomplish all goals a Governance Board of local key stakeholders that represent the diversity of the County will support a comprehensive and ongoing Needs Assessment, integrating recovery support services, trauma-informed approaches, and promoting and sustaining family and youth involvement. The process will be data-driven and evidence-based and will incorporate three strategic documents that will guide implementation and evaluation of the SOC: (1) Implementation Plan, (2) Sustainability Plan and, (3) Evaluation Plan. EBPs will be incorporated with a comprehensive evaluation process and system of care development activities to solidify a sustainable SOC. A Continuous Quality Improvement (CQI) model merged with Clinical Process Improvement (CPI) will identify gaps and successes and will be used to introduce frequent, small reviews and changes. The CMHI team has completed an interaction comparison for specific EBPs that will be introduced or expanded with SAMHSA seed dollars. These include Intensive Care Coordination, Collaborative Assessment and Management of Suicidality, Trauma-Focused Cognitive Behavioral Therapy, Eye Movement Desensitization and Reprocessing, and Seeking Safety.