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Project Name: Marin County Adult Drug Court Enhancement Abstract: The Marin County Adult Drug Court will expand its capacity to provide Substance Use Disorder (SUD) and recovery support services by adding bilingual Spanish-English speaking treatment providers; enhancing trauma-informed and grief/loss treatment; providing low-income clients with material and financial assistance to support their recovery; and increasing the number of beds in recovery housing for clients with specialized needs. The Marin ADC will serve 40 clients annually and 200 clients over the life of the grant project. While the racial-ethnic composition of Marin County is 71% white, 17% Hispanic (any race), 6% Asian, 3% Black, and 3% other races and multiracial, the target population served by the ADC is disproportionately African American, Hispanic, low-income, and unhoused, and an increasing number have DUI charges. The clinical characteristics of the population to be served include adults who are diagnosed with SUD, many of whom have co-occurring mental health conditions, who have committed drug, alcohol, and certain other offenses and demonstrate a need for SUD treatment and other support services. Of clients served by the ADC to date, 56% had stimulants (methamphetamine, cocaine, amphetamine) as their primary drug, 25% had alcohol, and 18% had opiates, with many individuals reporting polysubstance use. The project goals and objectives are to increase the capacity of the ADC to serve Spanish-speaking residents; expand the capacity of the ADC to serve residents with felony DUI charges; improve the engagement of unstably housed and low-income clients in SUD treatment; increase the availability of housing for low-income clients and clients from special populations; and to increase the effectiveness of the ADC program by increasing ADC team member training and conducting a yearly evaluation of the ADC. The strategies and interventions are to contract with a bilingual Spanish-English Assessment Specialist/Psychotherapist and a bilingual Spanish-English Recovery Coach to serve Spanish-speaking clients, to create therapy groups that focus on trauma and grief/loss, to provide additional capacity to treat DUI clients; to provide low-income clients with personal and household necessities, medical supplies, transportation to appointments, and financial assistance to cover the costs of recovery housing; to contract with recovery residences to offer beds to clients with specialized needs (clients with co-occurring disorders, women who are survivors of domestic violence, perinatal women, Spanish-speaking clients, transgender clients, and transitional age youth (18-25 years old)); to provide ADC team members with additional training and attendance at state and national drug court conferences; and to contract with an Evaluator to conduct an annual comprehensive evaluation of the ADC for Continuous Quality Improvement.

The Overton County Recovery Court is an existing adult treatment court serving individuals in Overton County, Tennessee with a current misdemeanor drug or drug-related charge, no prior arrests for violent offenses within the last 10 years, and assessed as high needs/high risk for abuse alcohol and/or drugs. The Recovery Court will use its 2023 SAMHSA Treatment Drug Courts grant (TI-23-007) to expand current services for justice involved individuals with substance use disorders or co-occurring mental health disorders (SUD/COD). Enhanced screening and assessment processes, additional evidence-based services for treatment, harm reduction, and recovery support, and a more coordinated service continuum for Court participants are anticipated outcomes through this award. Building on our Recovery Court program, we are striving to break the cycle of criminal behavior, substance use, and incarceration, while simultaneously working to improve our participants' overall quality of life, including their long-term recovery. Overton County is located in the upper-middle section of Tennessee near the Kentucky border within the Appalachian Mountain range. The county's population is 22,839. Over 84% of the county is considered rural, and multiple barriers exist for residents due to that ruralness. Comparatively, demographic data show Overton County is generally older, less educated, more White, less hispanic, and more socio-economically depressed and under-resourced part of the state. The Overton County Recovery Court program is directly needed because rates of drug use, overdose deaths, crime, and poor health conditions continue to plague the county more than the rest of Tennessee in many instances. For example, Overton County experienced a 125% increase in overdose deaths from all drugs between 20-21, and federal statistics for 2020 show the county with the 25th largest opioid dispensing rate of Tennessee's 95 counties, and 401st largest rate of 3,081 counties nationwide. A corresponding lack of treatment providers worsens issues faced by the county's justice involved residents with SUD/COD. At the same time, the Recovery Court's program completion rates exceeded the state's for 2017-20. The Overton County Recovery Court's goals under this grant are to: 1) Expand SUD treatment services in the existing adult problem-solving court to reduce incarceration levels and improve recovery outcomes for people with SUD/COD; 2) Provide quality screening, assessment, case management, and program coordination to a larger number of eligible participants; and 3) Break the cycle of criminal behavior, alcohol, and/or drug use, and incarceration or other penalties. To achieve these goals, the Recovery Court will sustain a fully coordinated, multi-system approach designed to combine the sanctioning power of recovery courts with effective substance treatment services to at least 15 program participants annually and 75 over the grant period. The Court will identify and implement evidence-based tools used to screen for a wider range of factors possibly contributing to participants' substance use disorders or co-occurring mental health disorders. Augmented treatment services for program participants will include a more comprehensive outpatient program. A key component of the Recovery Court's expanded services will include closing the program's current service continuum gap for aftercare services between core treatment and graduation by offering participants additional harm reduction and recovery support services. Enhanced coordination is anticipated between the Recovery Court team and community stakeholders to increase public awareness of the court's purpose and services available to justice involved individuals with substance use disorders or co-occurring mental health disorders.

The Winnebago County Drug Court (WCDC) Expansion project seeks to expand access to (a) integrated mental health services for participants with co-occurring disorders and trauma, (b) intensive outpatient and residential treatment services, (c) medication assisted therapy and other health care services, and (d) random drug testing to monitor compliance. The overarching goal is to increase the number of participants who achieve stable recovery and graduate successfully by expanding access to evidence-based, culturally appropriate services. The population of focus for the WCDC includes adults who have (a) a diagnosed substance use disorder, (b) are high criminogenic risk and behavioral health need, (c) have a pending felony offense that is eligible for probation, (d) reside in Winnebago County and voluntarily consent to participate. Demographic characteristics of program participants are as follows: 34% women; 61.7% Caucasian, 35.3% Black/African American, with 3.0% Hispanic/Latino. Most participants (75.2%) have low levels of educational attainment (i.e., high school/GED or less) and most (58.5%) are unemployed at intake. With respect to clinical characteristics, approximately 71.9% of the individuals enrolled in the past five years were diagnosed as having severe heroin/opioid dependence and/or severe cocaine dependence. Moreover, 45.2% of current participants have co-occurring mental health diagnoses, and 59% reported exposure to traumatic/violent events at intake. Due to the high need for both mental health and substance use disorder services, many WCDC participants needing individual counseling are required to conduct walk-in assessments with local mental health providers, and all too often, they are then added to a waitlist for services. This approach to treatment often results in inconsistent delivery of care and less than optimal outcomes. The proposed expansion would allow an additional 40 WCDC participants per year (i.e., 200 additional participants over the project period) to receive integrated mental health services, including individual counseling, cognitive behavioral interventions (e.g., MRT), and intensive outpatient services through the addition of a Mental Health Clinician and a Substance Use Disorder Counselor to the WCDC team. The proposed expansion would also ensure access to Medication Assisted Treatment and other health care services for all WCDC participants, without creating additional financial burden for those in need of these services. Toxicology testing will be expanded to include standard panels for 60-70 additional participants per year (i.e., an estimated 300 additional participants over the project period), including expanded opportunities for special panels and comprehensive panels when needed to adequately monitor treatment compliance.

Project Abstract Summary: The purpose of the RCAC Substance Abuse Treatment Program is to expand substance use disorder (SUD) treatment services in the Richmond County Accountability Adult DUI Court by enhancing the current program, increasing access to medication-assisted treatment (MAT) services, sober living programs, extensive intensive outpatient treatment (EIOP) and intensive outpatient treatment (IOP). Richmond County Accountability Court is located in Augusta, GA. The focus area of the Accountability Court and its program efforts is the Central Savannah River Area (CSRA) and it comprises Burke, Columbia, McDuffie, and Richmond counties in Georgia, and Aiken and Edgefield counties in South Carolina. The target population are those individuals who have been diagnosed with a substance abuse disorder that have been charged with either two DUI convictions in the past five-year period or three-or more lifetime DUI convictions and are 17 years or older. The RCAC Substance Abuse Treatment Program is a multi-tiered program which includes four different treatment programs: (1) RCAC DUI program that is clinically sound, highly structured multi-phase treatment program consisting of a minimum of 64 treatment hours and consist of five phases of treatment; (2) RCAC IOP or EIOP Program, the IOP is clinically sound, highly structured multi-phase treatment program consisting of a minimum of 28 treatment hours and consist of three phases of treatment. The EIOP program that is also a clinically sound, highly structured multi-phase treatment program consisting of a minimum of 50 treatment hours and consist of four phases of treatment; (3) RCAC Sober Living Program, a residential evidence-based addiction treatment and multi-disciplinary treatment program; and (4) RCAC MAT Program, a supervised Methadone maintenance and medical withdrawal licensed Opioid Treatment Program (OTP). The goals and objectives of the RCAC Substance Abuse Treatment Program are to: • Increase participant sobriety for the purpose of reducing the recidivism rate attributable to DUI and/or drug offenses by September 29, 2028 as follows; -- provide 200 (40 participants/year) scholarships to RCAC DUI program -- enroll 50 (10 participants/year) into the RCAC IOP or EIOP programs -- recruit 35 participants (7) participants/year) into the RCAC Sober Housing Program -- enroll 15 participants (3) participants/year) into the RCAC MAT Program • Increase the number of participants that complete the RCAC EIOP. -- 90% of all participants (200 total/40 annually) will complete the 15 month DUI/EIOP Program • Increase the number of participants that meet all requirements for license reinstatement. -- 90% of participants (200 total/40 annually) will meet all requirements for license reinstatement This grant program will enhance and build upon the SAMSHA grant (1H79TI081058-01) that exceeded the target milestone set at 133 but received 164 intakes amounting to 123% of the goal. This mark outpaced the national intake target of 866,776 vs (691,203 actual) of 80%. This amounted to a 43% higher rate than the national average. Further, as of February, 2023, the RCAC Program met its goal of 80% (81.5%) of while the national average was only 48.4% for client follow-up. Again, funding of this project as outlined in the proposal, will enhance and help sustain the implementation that will continue to exceed the national average, going forward.

Project Abstract The Colorado 1st Judicial District (JD) Recovery Court (RC) is seeking $1,819,500 in funding (5-year total) to expand services in RC for adult, high-risk/high-need (HRHN), felony offenders with a Substance Use Disorder (SUD). RC will serve 200 unduplicated clients (40 new clients per year). Clients will be in the program for approximately two years. When carryover clients each year are considered, there will be 70-80 participants enrolled at a time. This project will allow RC to implement 1) residential treatment, 2) recovery housing for those entering the Program and following residential treatment, 3) attendance by the RC team at the NADCP Conference each year, 4) free bus tickets to access treatment, medical appointments (including MAT), court hearings, work, etc., 5) expanded peer recovery support services, and 6) funding to assist with the collection and reporting of data. Goal 1: Provide enhanced services (i.e., residential treatment, recovery housing, and peer recovery support services) within the first three months of funding for treatment and recovery residences to improve transitions from sentencing to treatment, from treatment to stable living, and to ultimately improve mental health outcomes. Objective (Obj.) 1.1: Ensure 80% of participants receive treatment appropriate to their ASAM level of care needed within two weeks of sentencing. Obj. 1.2: At least 50% of participants in residential treatment will complete treatment. Obj. 1.3: Provide recovery residence support to 100% of clients in need of such support. Obj. 1.4: Provide enhanced peer recovery support services, starting in the first month of funding through the end of year 5, for 100% of participants to enhance participant recovery and improve life skills and connections with the community. Obj. 1.5: Enroll 200 SUD HRHN participants in RC over five years. Obj. 1.6: At least 60% of participants will graduate from RC. Obj. 1.7: At least 65% of participants will report reduced use, improved mental health, and reduced trauma symptoms. Goal 2: Send RC staff to NADCP Conference yearly to improve competencies of staff and fidelity of programming. Obj. 2.1: NADCP will provide the latest exclusive, practical content on topics for every discipline on the RC team. The RC team will have direct access to the largest group of experts in the fields of treatment, evaluation, supervision, and law. These competencies will allow RC to improve and enhance our current practices for the benefit of our participants. Obj. 2.2: Provide treatment court team tools to ensure RC has access to evidence-based solutions (EBS) and evidence-based practices (EBP) for the Court and its participants. Goal 3: Provide transportation funds for participants to access treatment, medical appointments (including MAT), court hearings, work, and other necessary appointments. Obj 3.1: Each participant will receive one book of bus passes upon sentencing, with individual bus tickets being provided as needed. Bus passes=10 tickets, 55 passes per month. Goal 4: Collect and interpret data to help fill the gaps where services lack to further enhance success in the Program. Obj. 4.1 Required data collection per SAMHSA guidelines with hiring of an evaluation agency. Obj. 4.2 Self-Assessment observation at 6 months and years 2 and 4 and survey at all discharges to help improve procedural justice. Periodic surveys to participants throughout the Program. Obj. 4.3 Peer Review Process at end of years 1, 3, and 5.

The New York State Suicide Infrastructure Project's (NYZIP) population of focus is adults aged 18 and older served by the 13 Certified Community Behavioral Health Clinics (CCBHCs) in the NY State CCBHC Demonstration Program. NYS is seeking to use CCBHCs, vital access providers that serve an ultra-high-risk population, as a primary vehicle for increasing access to best practice suicide care across the state. NYS will soon increase the number of CCBHCs from 13 to 39, to serve approximately 200,000 individuals. The purpose of the project is twofold: 1) to reduce suicide attempts and deaths among adults aged 19 and older in the 13 CCBHCs; and 2) to establish CCBHSs as the "backbone" of the state's ZS infrastructure using a center of excellence model. Building on the strengths of CCBHCs, including peer support and targeted care management services, the approach will include universal suicide-specific screening, a comprehensive suicide risk assessment for those at-risk, and enhanced services using a suicide care management pathway with attention to health equity throughout. The proposed NYZIP project goals are: Goal 1: Create a behavioral health infrastructure within the NYS CCBHC system to improve sustainability and scalability of suicide care. Goal 2: Support CCBHCs in the full implementation of the ZS model: Lead, Train, Identify, Engage, Treat, Transition, and Improve. Goal 3: Ensure health equity principles are integrated into the ZS framework by employing culturally based engagement strategies and cultural humility in services. Goal 4: Reduce suicide ideation, attempts, and deaths among adults aged 18 and older in the 13 NYS CCBHCs by operationalizing the ZS model. Each NYZIP goal has a set of measurable objectives identified by timeframes. We estimate that approximately 50,868 unduplicated individuals will be served annually during each of the five years of the project.

The LSF Zero Suicide Project will support the scaling of our Zero Suicide Initiative which began in 2020 in Duval County, (Duval) Florida. The project will focus on adults ages 18 and older, with emphasis on underserved and minority populations, specifically individuals identifying as Black, Hispanic, LGBTQ or Veteran. The LSF Zero Suicide Project will implement the Zero Suicide framework through its network of 17 nonprofit mental health service providers in Duval to ensure an integrated system of suicide care, referral, suicide prevention gatekeeper training, suicide prevention therapies training, linkages to treatment and transition services to effectively intervene in the lives of individuals at risk of suicide. LSF was one of the first to adopt and introduce the Zero Suicide model to providers in the area and through this grant will bring to scale a suicide care management system for all providers in the county. This project will develop and implement relevant trainings for both the non-clinical and clinical healthcare workforce in Duval with an emphasis on collaborating and highlighting best practices, case studies, and care models from providers that are further along in applying the framework. The successful Link to Life suicide prevention team piloted in 2020 through a SAMHSA Covid-19 Emergency Response Suicide Prevention Grant with grant partner Mental Health Recourse Center (MHRC) will continue under this grant as a best practice model for intervention and care coordination. Project goals include 1) Lead a system-wide culture change in Duval committed to reducing suicides by establishing the Duval County Zero Suicide Oversight Steering Council and completing the Zero Suicide Organizational Self-study and Workforce Survey across the system of care; 2) Train Duval’s clinical and non-clinical healthcare workforce using data from the Workforce Survey to ensure providers have access to the evidence-based trainings needed to incorporate the Zero Suicide framework across their organization; 3) Identify and assess individuals who have been determined to be at medium or high risk for suicide within 1 business day of referral; 4) Engage 100% of screened individuals at risk for suicide and develop a Safety Plan with lethal means counseling at time of assessment; 5) Treat individuals at risk with the most effective evidence-based practices, ensuring 80% of clients attend a minimum of 80% of each EBT service recommended for their treatment and that 85% of individuals enrolled in services receive at least one contact weekly during the first 30 days of enrollment.; 6) Transition individuals using safety plans that will be monitored monthly to achieve a reduction in suicide risks after participating for at least 180 days; and 7) Improve the system of care by developing a strategic plan, implementing quality improvement protocols across the system, and reviewing quarterly performance and outcome data to identify gaps, disparities, and barriers experienced by minority and vulnerable populations. Based on best practices from the Duval project, the Zero Suicide Oversight Steering Council will oversee the development of a manual detailing how to implement the Zero Suicide framework system-wide (i.e. across a county) and a Link to Life suicide prevention care team, facilitating replication in the other 22 counties served by LSF in North Florida.

The Horizon Health Zero Suicide Program will provide suicide intervention and prevention services based on the Zero Suicide Method to rural Pinal County Arizona. Over the course of the grant we will serve 1800 individuals offering both direct intervention, follow up and ongoing services as well as trainings to community leaders and community members with the goal of identifying at risk individuals and preventing suicide attempts. The goals of this program are: 1. Increase the number of Pinal County residents that are screened and evaluated for suicide potential 2. Connect individuals to treatment with intake occurring within 24 hours of risk assessment 3. Increase the workforce and community experience, education, and training regarding suicide prevention. Horizon will utilize several evidence-based practices for this program, including ASIST and safeTalk trainings, several screening and risk assessment tools and the treatment modalities of DBT, CBT-SP and peer support. All services and trainings will be provided in a trauma informed care approach with a focus and effort on closing both the service gaps as well as the gaps of inequity in the rural population of focus.

Burrell Behavioral Health (Burrell) requests $2,000,000 to improve and enhance implementation of our existing system wide Zero Suicide Model and partner with Preferred Family Healthcare (PFH) to improve their suicide response as joint venture health system. Chosen subpopulations of focus will include men over 18 years and the LGBTQIA+ population across the geographic catchment area. Burrell's internal data indicates possible barriers to men and minorities being enrolled on the Supportive Care Pathway implemented in 2022; studies show this is due to lack of understanding about to access professional services, a lack of education around self-help and coping mechanisms and stigma around mental illness. This project is expected to serve 400 individuals annually for a total of 2,000 individuals throughout the life of the project. Burrell's Zero Suicide Cooperative will use the following strategies to implement the required activities: 1) Utilize current processes, procedures and historical knowledge to improve upon the existing seven elements of the Zero Suicide Framework; 2) Utilize evidence based informed communication and safe messaging throughout Burrell and PFH to build Zero Suicide culture and buy-in; 3) Work alongside SAMHSA in a cooperative agreement to make changes in our joint health system. The project objectives include: 1) Utilize the organizational and workforce survey to improve Burrell's Zero Suicide Framework taking systematic steps across our organization to create a culture that no longer finds suicide acceptable; 2) Improve Burrell's Supportive Care Pathway so that all individuals at risk of suicide are engaged using a suicide care management plan; 3) Develop and implement a training program, that includes EBP's for the clinical workforce who are in frequent contact with individuals who are at risk or suicidal; 4) Improve overall engagement of clients who are on the Supportive Care Pathway while working with Suicide Prevention Liaisons. As Missouri's second-largest Certified Community Behavioral Health Organization, Burrell serves three distinct geographic catchment areas encompassing 18 counties in southwest, central and western Missouri. The project GCA population exceeds 1,500,000, or over one in four Missourians. 100% of the counties are designated mental health and primary care professional shortage areas and 72% are designated Medically Underserved Areas and Communities. Congressional districts benefitting are Missouri's districts MO-004-MO-007. The top 10 languages spoken in this area include: English, Spanish, German, Chinese, African Languages, Vietnamese, Other Germanic Languages, French, Russian and Tagalog.

Wellstar Health System (Wellstar) will implement Zero Suicide at Wellstar: Expanding Access, Delivering Care, Saving Lives (ZSW), serving a focus population of 2,870,557 Georgia adults ages who reside in Bartow, Cherokee, Cobb, Douglas, Forsyth, Fulton, Harris, Paulding, Polk, and Troupe counties, comprising 48% male, 52% female, and a racially and culturally diverse population (see below). Services will be delivered across a multi-county geographic catchment area in six Wellstar hospital and emergency departments, including suicide prevention organizational change, identification, treatment, care transitions, workforce training, and quality improvement. Wellstar proposes to provide direct suicide-specific services (including but not limited to screening, assessment, treatment, and care transitions) to at least 5,000 adults across the catchment area. Despite successes of Wellstar’s implementation of the Zero Suicide model across its health system to date, the catchment area remains subject to significant behavioral health disparities, including care specifically for persons at risk for suicide. Behavioral health, primary care, and emergency care (i.e., ambulatory services, first responders, etc.) providers lack a statewide surveillance and referral system that could promote timely, continuous care in their communities. Comprehensive screening, assessment, care planning and management, and treatment are all critical components of effective and evidence-based suicide prevention, but are often conducted (when they are conducted) by service providers who work in different health systems without efficient or effective strategies for sharing suicide-specific patient information; leading to patients who “fall through the cracks” of the overall healthcare system. Further, needs exist in the development of a competent and caring workforce who are trained in evidence-based suicide prevention strategies that align with their job roles, qualifications, and personal needs (i.e., vicarious trauma, compassion fatigue, moral injury). Purpose: To reduce suicide attempt and suicide death rates among adult Georgians ages 18 and older by building on the existing Wellstar Zero Suicide Initiative’s community suicide prevention strategies, including upstream community-based and downstream treatment-focused strategies, to enhance/expand health system wide and community collaborations, training, and service provision. Goal 1: Lead a system-wide culture change committed to reducing suicides through the convening of a Zero Suicide Oversight Steering Council that will oversee the development, implementation, and quality improvement of the Zero Suicide program. Goal 2: Enhance/Expand provision of evidence-based suicide risk screening and assessment across the Wellstar Health System. Goal 3: Enhance/expand provision of treatment upon intake and rapid follow up after discharge from emergency departments (EDs) and inpatient psychiatric units for focus region adults in who have experienced a suicidal crisis and/or attempt. Goal 4: Provide follow up and care transition/coordination for high risk adults who have experienced a suicide crisis/attempt (including those with SMI). Goal 5: Enhanced/expand training to clinical and non-clinical team members serving at-risk adults in topics including assessment of suicide risk/protective factors, evidence-based/best practice implementation (e.g., QPR, CALM, CT-SP, CAMS, C-SSRS, RRSR, MHFA), suicide risk treatment, and follow-up to ensure care continuity. Goal 6: Implement Goals 8 and 9 of the 2012 National Suicide Prevention Strategy to reduce rates of suicide attempts and deaths among Georgia adults ages 18-64. Goal 7: Conduct a comprehensive evaluation and develop/disseminate a thoroughly documented service model for replication/adoption across the state and nation.

The Webb County Adult Drug Court (DCP) is proposing to expand the program's capacity for felony and misdemeanor participants from a baseline of 360 participants to 460 by adding 100 clients who are primarily alcohol and opiate dependent and who have co-occurring psychiatric and substance disorders during the 5 year grant period beginning in FY'24. The DCP will not only provide services to participants from Webb County, but also will expand DCP services to the adjacent rural counties within a 100 mile catchment area of Webb County, which includes Zapata, Jim Hogg, and Starr Counties and that are not being serviced due to lack of treatment resources in those communities. The DCP is proposing to incrementally increase the number of clients receiving expanded services from 70 in FY24 to 85 in FY'25, 95 in FY26', and 105 in FY '27 and 28' totaling 460 participants. The DCP is a problem-solving court which uses the treatment drug-court model in order to provide services supporting co-occurring psychiatric and substance treatment, screening, assessment, case management, and program coordination to adult defendants/offenders. The DCP under the administration of the Honorable County Judge Tano E. Tijerina is adjudicated by the Honorable Associate District Court Judge David E. Garcia, and is the only felony DWI court in Webb County. PILLAR, a TXDSHS Licensed Provider supports the DCP goals by providing comprehensive screenings, assessment, and treatment planning as well as a comprehensive therapeutic milieu of individual and group counseling to 100% of participants which includes the following evidenced based models Dialectical Behavior Therapy (DBT), Solution-Focused Group Therapy (SFGT), and Seeking Safety to specifically treat co-occurring psychiatric and substance use disorders, address trauma, personality disorders and suicidal ideations which are commonly presented in DCP, Medication Assisted Treatment (MAT), Broad Spectrum Treatment (BST-Vivitrol) in order to reduce relapse, improve abstinence rates, reduce recidivism, and improve treatment retention for opiate alcohol dependent participants, Motivational Enhancement Therapy (MET), the Matrix Model, and Relapse Prevention therapy (RPT) to build self efficacy in recovery, and Thinking for a Change (T4C) to reframe distorted thinking patterns. Goals and objectives are to 1) promote self-sufficiency by reducing drug use through Drug Court treatment; 2) provide a comprehensive integrated program for co-occurring psychiatric and substance treatment; 3) promote public safety by reducing recidivism; 4) improve mental health and health including prevention and treatment of infectious diseases; and 5) evaluate the DCP's cost-effectiveness to promote future funding and development. The target population for the DCP includes felony and misdemeanors drug offenders over the age of 17 who primarily reside in Webb County, have drug-related crimes, or history of drug use, and who are not felony assault offenders, violent offenders or have weapons offenses. Demographics are: 1) 95% Hispanic; 2) 65% male; 3) majority live below the federal poverty level; 4) average age is 29; 5) average of 12 years of drug use; 6) less than 50% are high school graduates; 7) less than 40% are employed; 8) 25% are married; 9) primary drugs of addiction includes alcohol. heroin, marijuana, and cocaine; 10) 100% have co-occurring psychiatric and substance use disorders.

The Webb County DWI Court will serve 280 participants in its five-year project period. The population of focus (POF) consists of adult males and females 18 years of age and older from Webb County, Texas who have had one or more DWI offenses and who meet the criteria for an alcohol use disorder/substance use disorder and/or co-occurring substance use and mental health disorder. The proposed area is Webb County, situated along the Texas-Mexico border. The purpose of the project is to expand substance use disorder (SUD) treatment and recovery support services through a continuum of care. Webb county will provide an efficiently coordinated, multi-system approach that is integrated to the sanctioning power of DWI Court with effective treatment services to break the cycle of criminal behavior, alcohol and/or drug use, and incarceration or other penalties. The Court will utilize the leverage of the court to motivate DWI Court participants to access comprehensive substance abuse treatment services including Medication Assisted Treatment and will coordinate mental health and trauma services for those participants with co-occurring disorders. The Court will also utilize case management and wraparound approaches to link participants to community resources. The Court will integrate Recovery Support Services to ensure participants are engage in ongoing recovery opportunities. The Court will have certified recovery coaches who will coordinate all recovery activities with the support of project staff. The project's goals are to: provide a continuum of care that includes prevention, harm reduction, treatment, and recovery services for individuals with alcohol use disorders and/or other co-occurring substance use or mental health disorders; implement evidence-based and population-appropriate treatment services that meet the unique needs of the population of focus; continue implementing the 10 Guiding Principles of the DWI Court Model to reduce recidivism and engage clients in ongoing recovery efforts; provide effective treatment that facilitates recovery efforts and lead clients to experience significant improvements in overall health and wellness as demonstrated by positive outcome; and ensure the drug court continues to meet the cultural and linguistic needs of participants from the border region. The project will utilize the following evidence-based practices: Evidence-based Assessment; Motivational Interviewing (MI); Acceptance and Commitment Therapy (ACT); Seeking Safety (SS); The Matrix Model for Criminal Justice Settings (Matrix CJ); and Medication Assisted Treatment.

Centerstone’s Treatment and Recovery Court (C-TRC) will expand substance use disorder (SUD) treatment and recovery support services in existing drug courts for an unduplicated 200 adults (i.e., Yrs. 1-5: 40, annually) diagnosed with SUD as their primary condition participating in partnering courts, the 17th Judicial District Misdemeanor and Felony Recovery Courts and Lincoln County Recovery Court, within the catchment area of Bedford, Lincoln, Marshall, and Moore counties, Tennessee. Focus population demographics are expected to mirror those of current drug court program participants, with 57% male; 43% female; 95% White; and 5% Black individuals. An estimated 310 in the local criminal justice system will be eligible for drug court participation; of those, up to 30% (93) are anticipated to have opioid use disorder (OUD) and up to 40% (124), co-occurring SUD and mental health disorders (COD). Of the 120+ with COD; an estimated 74% will experience anxiety and 68.5%, depression; up to 49% with COD are expected to be unstably housed. In 2020, 12% of HIV cases in Bedford were attributed to injection drug use vs. 7% of the state’s; per public health surveillance, the focus population in Lincoln and Marshall experience increased risk of HIV/hepatitis C virus due to injection drug use. C-TRC’s evidence-based strategies/interventions include NADCP’s Defining Drug Courts: The Key Components, NHRC’s Harm Reduction Principles, and SAMHSA’s TIP 59: Improving Cultural Competence to guide activities; Hazelden’s Matrix Model and COD Program, Moral Reconation Therapy, Dialectical Behavior Therapy, Seeking Safety, and Medication Assisted Treatment according to SAMHSA’s TIP 63: Medications for OUD and TIP 49: Incorporating Alcohol Pharmacotherapies Into Medical Practice to treat SUD/COD; TASC Case Management Model to guide case management; and SAMHSA’s Opioid Overdose Prevention Toolkit to guide/inform harm reduction services and education. C-TRC’s goals include: (1) Implement a comprehensive project to expand access to SUD treatment and recovery support services, including harm reduction services; (2) Develop a sound infrastructure/capacity to expand, enhance, and sustain services; (3) Use evidence-based/best practice Treatment & Case Management Planning to address behavioral health disparities; social determinants of health; and diversity equity, inclusion, and accessibility; (4) Improve client health status and outcomes via evidence-based, population appropriate treatment services; and (5) Develop/disseminate a documented service model for agency replication/adoption throughout the state. As a result of these goals, C-TRC will achieve the following measurable objectives: train 5 project staff and 50 other providers in SUD/COD identification, culturally-/linguistically-appropriate care, harm reduction, and relapse prevention; provide/facilitate comprehensive screening/assessment, drug testing, treatment and case management plans, and evidence-based SUD treatment for an unduplicated 200 focus population adults; establish an Advisory Council comprising 20% focus population/families, court staff, etc.; conduct 5 policy/procedure reviews with partnering courts; outreach to 200 community organizations/stakeholders; develop a sustainability plan with linkages to 2 funding mechanisms; link 100% of those in need to appropriate resources (e.g., housing/recovery housing, employment/skills training, transportation, language access services); increase substance use abstinence among 70%; reduce consequence of substance use among 75%; reduce mental health symptoms among 60% with COD; reduce tobacco/nicotine use among 50% with such goals; improve employment/education status among 60% who received such services; improve housing stability among 60% who received such supports; reduce past 30-day criminal justice involvement among 60%; improve individual/family functioning among 70%; increase social connectedness among 70%; and achieve an 80% follow-up rate.

Bordered by the Appalachian Mountains on the east and Mississippi River to the West This Kentucky communities are rural and white yet diverse in community culture. More than 90% of those counties are designated rural and 55% of the state population lives in a rural community. Those living in rural communities have disparate suicide risk compared to urban residents. In the northeast corner of the state comprising 10 of Kentucky's most rural communities, Pathways incorporated provides behavioral health services to more than 14,000 unduplicated clients annually and nearly 7% of the region's population. This application to SAMHSA by the Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities is in response to SAMHSA announcement SM-23-011, Cooperative. Agreements to Implement Zero Suicide in Health Systems (Zero Suicide). Frequent mental health distress has increased in KY by more than 22% since 2017 and the state is ranked 45th for this indicator. COVID-19 exasperated an existing deficit in mental health providers in the state with every Community Mental Health Center (CMHC) reporting in early 2021 issues with recruitment and retention of staff. Those issues continue more than two years later. Kentucky is ranked 28th.in available mental health providers with 285.3 per 100,000 population. All counties in Pathways region are Appalachian. All 10 are designed by HRSA as having a mental health provider shortfall. Efforts will focus on those over the age of 18, who visit a PC or ED, with risks of suicide. and substance use. The KDBHDID proposes to use a combination of evidence-based practices: QPR, ASIST, AMSR, CAMS, and CBT-SP to increase the capacity of the workforce to adequately support those at risk of suicide attempts and death. DBHDID will partners with Pathways, St. Claire Healthcare, Mental Health America Kentucky, and REACH Evaluation

Native American Health Center (NAHC) proposes the implementation of Zero Suicide at its clinic neighborhoods located in the Fruitvale/ San Antonio neighborhoods of East Oakland located in the San Francisco (SF) Bay Area. The populations of focus include 1. Urban American Indian/ Alaska Native (AIAN) and Indigenous adults that experience suicidal thoughts and urges that reside in and around NAHC clinics; and 2. Other underserved adult community members that experience suicidal thoughts and urges with specific emphasis on those that are uninsured or underinsured, Veterans, and LGBTQI+ that reside in and around NAHC clinics. The purpose of this project is to implement the Zero Suicide framework throughout NAHC’s healthcare system. The goals of the project are as follows: GOAL 1. Increase agency and community-wide capacity efforts to implement a coordinated strength-based suicide prevention and mental health support system for adults living in and around NAHC clinic neighborhood in Oakland. GOAL 2. Reduce the onset and progression of suicidal ideation through the implementation of an accessible, culturally responsive prevention model for adults living in and around NAHC clinic neighborhoods in Oakland. This project will serve 5,000 unduplicated clients by the end of the 5-year project period.

Tropical Texas Behavioral Health (TTBH) Zero Suicide Program proposes to implement the Zero Suicide and prevention model for adults throughout our integrated system of care. The TTBH Zero Suicide Program will provide support for the Suicide Safer Care Pathway. The target population will be adults with a serious mental illness (SMI) or serious emotional disturbance (SED) at risk for suicidal ideation and/or suicidal behavior in an outpatient behavioral health setting. TTBH has 55 years in operation as the Local Mental Health Authority (LMHA) for the region in South Texas known as the Rio Grande Valley (RGV) composed of 1.3 million residents with about 90% Hispanic population. TTBH serves residents of Hidalgo, Cameron, and Willacy Counties with poverty levels of 23.9%, 24.4% and 24.7%, respectively, almost double of the state at 13.4% and the U.S. at 11.4%, based on 2020 US Census. HRSA identifies our counties as Medically Underserved Areas and Health Professional Shortage Area for Primary Care, Psychiatrist, Psychologists, Licensed Professional Counselors and Licensed Chemical Dependency Counselors. Additionally, our 2021 internal data indicates 24.50% of all clients assessed by TTBH outpatient services were considered low income and/or uninsured. From the TTBH adult population served, 6% identify as LGBT and of individuals experiencing homeless or displacement, 11% reported SUD/COD. Also, TTBH veterans account for 5% of all clients served. TTBH serves an average of 34,000 persons annually with serious mentally illness and/or substance use disorders (SUD) with gold standard person-centered care. The region's rapidly growing population, pervasive poverty, high rates of unemployment and low educational attainment, high numbers of uninsured, and profound shortages of healthcare providers place the general population of the region at elevated risk for poor health outcomes. TTBH is committed to implement the TTBH Zero Suicide Program with fidelity through a service array of evidenced-based services which includes initial and ongoing assessments, case management, psychiatric services, psychosocial rehabilitation, natural supports and education, primary care services, substance use services and other services and supports critical to an individual's ability to live successfully in the community. Individuals that are placed on the Pathway will be assigned to a Pathway Navigator that will assist the client in navigating their care during high-risk periods. Suicide is the 16th leading cause of death in the TTBH catchment area. The area has experienced an 87.9% increase in suicide mortality rate per 100,000 population since 1999. Between 2001 to 2020, TTBH area experienced a 154.8% increase in suicide attempt inpatient hospitalizations per 100,000 population, which is 1.11x higher than the state of Texas. With the implementation of this program, TTBH anticipates that annually at least 500 unduplicated clients from the overall number of clients served throughout the organization will receive a suicide risk screening for a total of 2,500 for the term of this program. Furthermore, at least 90% of clients that screen positive for suicide risk will have a comprehensive crisis risk assessment and a safety plan completed within the same day. Additionally, individuals that receive services through the Suicide Safe Care Pathway will receive face-to face contact at least every 7 days with a suicide risk screening completed at every contact. TTBH also proposes to continue staff development by providing AS+K About Suicide to Save a Life Gatekeeper training, Counseling on Access to Lethal Means (CALM) training, Safety Plan Intervention (SPI) training, and Risk Formulation training.

WestCare Tennessee, Inc. Zero Suicide project will benefit 130 adults over 5 years with crisis treatment and train 200 professionals and community members with suicide awareness, prevention, intervention, and treatment skill depending on their role. WCTN proposes Cocke and Jefferson Counties as the geographical area for delivering Zero Suicide services, but the surrounding counties will benefit from this project, too. WCTN chose this area due to the high rates of suicide in this primarily rural, underserved area. Goal 1: Increase access to and quality of services by implementing the Zero Suicide intervention and prevention models in Cocke and Jefferson Counties to reduce suicide ideation, suicide attempts, and deaths due to suicide. Objectives: 1.1: By September 29, 2028, provide services to 130 unduplicated adults using the Zero Suicide models Y1 & 5=20, Y2-4=30). 1.2: By September 29, 2028, link 80% of clients to crisis or other mental health services as documented in the WestCare CDS (Clinical Data System). 1.3: By September 29, 2028, 75% of the clients will complete services as evidenced by the NOMS and the WestCare CDS. 1.4: By September 29, 2028, 80% of clients completing services will exhibit reduced suicide risk and decreased mental health symptoms at discharge, and 70% of those will maintain improvements/ show additional decreases at 6-months post admission assessed by the Columbia Suicide Severity Rating Scale (C-SSRS), PCL-5, the Modified Mini Screen (MMS), and the Beck Scale for Suicide Ideation (BSS). 1.5: By September 29, 2028, train 80 individuals in suicide risk assessment measured by the training logs and pre/post-tests. Goal 2: Improve the mental health and behavioral health functioning of adults (18+) successfully completing suicide intervention and prevention services. Objectives: 2.1: By September 29, 2028, 80% of clients successfully completing services will have stable living arrangements at discharge, and 70% of those will maintain their living arrangements at 6-months post admission as evidenced by the NOMS. 2.2: By September 29, 2028, 80% of clients completing services will be in an educational/vocational program, be seeking employment actively, or be employed at discharge, and 70% will continue to remain enrolled, complete their education/training, or remain employed at 6-months post admission as evidenced by the NOMS. 2.3: By September 29, 2028, 80% of clients completing services will not engage in new criminal activity at discharge, and 70% will not recidivate at 6-months post admission as evidenced by the NOMS. 2.4: By September 29, 2028, 80% of clients completing services will have improved social connectedness at discharge, and 70% will maintain these improvements at 6-months post admission as evidenced by the NOMS. WestCare Tennessee makes a system-wide commitment to safer suicide care throughout its behavioral health care system by including all required activities. WCTN will use the seven elements of the Zero Suicide framework to reduce suicide ideation, suicide attempts, and deaths due to suicide. WestCare programs and services are person-centered, respectful, and responsive to each individual receiving services. WestCare programs tailor services (using an individualized treatment plan) to best respond to the individual needs of each client, building on the strengths of each client and celebrating the elements that make each client unique: ethnicity, culture, language, gender identity and expression, sexual orientation, age, experience and history, strengths, skills, talents, geographic location, education, and other factors. WestCare programs provide culturally and linguistically appropriate services informed by the National Standards for Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care.

CNBH Zero Suicide-23 Project Abstract The Cherokee Nation’s (CN) Zero Suicide-23 Project will implement the Zero Suicide intervention and prevention model throughout the Cherokee Nation healthcare system in a sustained effort to reduce suicide ideation, suicide attempts, and deaths due to suicide. The project goals are to; (1) sustain a well-trained and supported workforce that effectively identifies individuals at risk for suicide throughout the healthcare system, (2) create and maintain a culture of care that includes universal screening for suicidality across the CN health system and rapid and continuous access to behavioral health service support, and (3) expand and improve evidence-based interventions and supportive services for individuals under a suicide care management plan, and to equip the healthcare system with a data-driven continuous improvement processes aimed at reducing suicide. The project will serve 2,000 American Indian individuals over the course of the five year project while creating a sustainable and collaborative system committed to eliminating suicide in our communities.

South Carolina Zero Suicide Initiative's (SCZSI) focus is to implement the Zero Suicide intervention and prevention model for adults throughout mental health systems. Partners to achieve this goal include the South Carolina Department of Mental Health's (SCDMH) Lexington County Community Mental Health Center (LCCMHC), SC Department of Corrections (SCDC), and SCDMH's Department of Inpatient Services (DIS), including their forensic program. These mental health care systems provide treatment and support to thousands of people throughout SC. They will work on addressing concerns regarding the increasing rates of self-harm, increasing need for policies and procedures regarding collaborative care transitions, and the increasing need to address social determinants of health (SDOH). Highlights of this project include training for both clinical and non-clinical staff in population of focus (POF), increasing collaboration through Zero Suicide Task Force (ZDTF) participation, developing policies and procedures related to discharge and transitions, and sharing of data addressing behavioral health disparities and SDOH. It is estimated that roughly 50,000 individuals will be served each year of the project through training, outreach, presentations, and treatment. Training that will be implemented throughout this project include LivingWorks, ASSIST, safeTALK, Talk Saves Lives for Corrections, Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP), CBT for Anxiety, DBT for Prolonged Exposure to PTSD, Assessing and Managing Suicide Risk (AMSR), NAMI New Hampshire Survivor Voices- Sharing the Story of Suicide Loss, and Collaborative Assessment and Management of Suicidality (CAMS). SCZSI hopes to apply lessons learned from this grant, as it did with the successful 2018-2023 SCZSI, to statewide systems of care to have SC become as ZS state.

Project Life Worth Living, led by Maine Behavioral Healthcare (MBH), will reduce suicide ideation, suicide attempts, and deaths due to suicide among adults residing in eight rural counties across southern, western, and coastal Maine. MBH will leverage progress made to implement elements of the Zero Suicide framework—developing a leadership council, completing an organizational self-study and workforce survey, implementing C-SSRS and CASE assessments, and training an initial cohort of clinicians in CBT-SP—to fully implement the ZS framework across eight outpatient clinics and seven emergency departments. The project will serve approximately 12,500 unduplicated individuals per year. The target region includes 56% of Maine’s population, approximately 625,000 individuals 18 years and older, including 51% female; 94% white; and approximately 5% LGBTQ+. The suicide rate within the region is significantly higher and rising much more quickly than the national average. Five of the eight targeted counties have among the highest per 100,000 rates in the state (Oxford 31.5; Sagadahoc 28; Knox 28.4; Lincoln 27.5, and York 25.1). Suicide ranks higher as a cause of death for virtually every age group in our target area when compared to the rest of the country. For 35-44 year olds, suicide is the 2nd leading cause of death, compared to the 5th leading cause of death nationally. For those aged 45-54 years, suicide is the 4th leading cause of death, versus the 7th leading cause of death nationally. Exacerbating this issue, Maine has 19.7% of the psychiatrists it needs, ranking 37th nationally in percent of need met. Five counties in the target area are among Maine’s most underserved for mental health providers, with population to mental health provider ratios as high as 484:1 in Lincoln and 441:1 in Sagadahoc County (compared to the state 190:1 and the nation 350:1). The project will pursue the following Zero Suicide goals: (1) lead a system-wide culture change committed to reducing suicides; (2) develop and implement training programs for clinical and non-clinical healthcare workforce; (3) develop and implement a plan to screen all individuals via comprehensive screening, assessment, and re-assessment (as appropriate); (4) design suicide care management guidelines and implement suicide care management policies so individuals at risk of suicide are engaged using a suicide care management plan; (5) implement effective evidence-based treatments that directly address suicidal thoughts and behaviors; (6) develop and implement policies and procedures to transition individuals through care with warm hand-offs and supportive contacts; (7) develop and implement a strategic plan to improve policies and procedures through a continuous quality improvement plan. The project will utilize five evidence-based screening and assessment tools and three evidence-based treatment models: (1) Chronological Assessment of Suicide Events (CASE); (2) Columbia-Suicide Severity Rating Scale (C-SSRS); (3) Question, Persuade, Refer (QPR); (4) Stanley-Brown Safety Plan; (5) Suicide Assessment Five-Step Evaluation and Triage (SAFE-T); (6) Cognitive Behavioral Therapy (CBT); (7) Cognitive Behavioral Therapy for Suicide Prevention (CBT-SP); (8) Collaborative Assessment and Management of Suicidality (CAMS). The Project Director and Lead Evaluator will provide training and technical assistance for all providers using EBPs, ensuring fidelity through learning collaboratives, checklists, and interviews.

St. Peter’s Health (SPH) Foundation and our committed partners seek to implement the Zero Suicide model for adults across the health system with the aim of reducing suicide ideation, attempts, and deaths. SPH is an independent, rural health system located in Helena, Montana, serving five rural counties in southwestern Montana. Suicide is the leading cause of death for Montanans aged 10-44; Montana has one of the highest suicide rates in the country, with a rate of 25.9 per 100,000 people, which is nearly twice the national average. SPH has made addressing suicide prevention a priority as it is a major concern for our health system. Total Emergency Department (ED) visits at SPH with a mental health diagnosis were 3197 in 2019, 4025 in 2020, and 3780 in 2021, with an average of weekly ED visits with mental health diagnosis of 61.5, 77.4, and 72.7, respectively. The SPH Mobile Crisis Team has completed 752 crisis visits in the community over the past two years, avoiding 592 additional emergency room visits. In 2021, we provided 882 acute visits, as an aggregated number of ER and inpatient visits, where patients were seen specifically for suicide attempts and/or active suicidal ideation; and in 2022, that number rose to 1,195 visits, a 35% increase. The Zero Suicide Grant from SAMHSA will allow SPH to implement the Zero Suicide model at SPH and emphasize the need for systematic and continuous care for those at risk of suicide. Fully implementing the framework, particularly in light of the increased functionality of our new Electronic Health Record (EHR), would provide the consistent support and trained resources necessary to address the service gaps and disparities in our community, and it would help us better capture data for and serve the population of focus, including those suffering from depression and other mental health issues. The implementation plan will follow the Zero Suicide Framework, focusing on leadership support through the establishment of a formal Zero Suicide Steering Committee, robust training, systematic identification of suicide risk, patient engagement in care planning, ongoing contact and support through transitions, and continuous process monitoring. Implementation goals will include: Establish and implement a multidisciplinary collaborative approach to create a sustainable system level culture change that leads to a significant reduction in suicides for the SPH service area; Develop a culturally competent, skilled, and confident workforce that understands their role in suicide reduction; Implement a consistent and comprehensive screening, assessment, and treatment for suicide risk in all individuals in care, using standardized tools and clear policies and procedures; Develop a comprehensive and collaborative pathway to suicide care that prioritizes recovery, saves lives, and ensures safe hand-offs between different levels of care through standardized and continuous contact and support for patients; and Implement a comprehensive continuous quality improvement plan that ensures fidelity to evidence-based practices and the components of the Zero Suicide model, while continually evaluating policies and procedures, patient care outcomes, and implementation metrics. Over the lifetime of the five-year grant, we anticipate serving a total of 64,338 unduplicated individuals with standardized screening and appropriate treatment. In year 1, we will serve 35,629 individuals, or 60% of the population, increasing to 100% by year 2 and continuing this level through the remaining grant years.

Integral Care's "Advancing Zero Suicide as Integral to Care" will fully implement the Zero Suicide intervention and prevention model throughout our system of care. The goal is to reduce suicide ideation, attempts and deaths for adults in Travis County. Interventions will be based on evidence-based practices that have been shown to reduce suicide risk and will be used and delivered to sub-populations where gaps and disparities exist. This includes racial, ethnic, LGBTQIA+, and individuals of Limited English Proficiency (LEP). Research shows that the rate of suicide in Travis County has fluctuated over the past ten years, with a 22% increase in the rate of suicide between 2018 and 2019 and a 40% increase in the rate of suicide from 2020 to 2021. This project will reach 550 individuals over the course of 5 years - Year 1=75. Year 2=100. Year 3=125. Year 4=125. Year 5=125. We will achieve the following goals and objectives: Goal 1 - Reduce the risk of suicide ideation, attempts, and self-harm among individuals living in Travis County by implementing the Zero Suicide Framework within the Integral Care System. Objective A: By January 2024, Integral Care will have recruited and hired 3 Suicide Care Specialists and the Project Evaluator. Objective B: By January 2024, Integral Care will design and implement suicide care management guidelines and policies. Objective C: By September 2028, Integral Care will reduce suicide ideation, attempts and self-harm for participants service by the Suicide Care Specialists as evidenced by 40% improvement C-SSRS scores. Objective D: By April 2024, Integral Care will develop outreach and referral pathways with 3 partnering organizations - APD Victim Services, Travis County Jail Behavioral Health services, Dell Medical and Behavioral Health services. Goal 2 - Reduce measurable disparity gaps in sub-populations at risk of suicide in Travis County. Objective A: By March 2024, Integral Care will complete review of all plans and trainings to ensure health equity and CLAS Standards are incorporated. Objective B: By September 2024, Integral Care will have implemented targeted interventions to address disparity gaps for 50% of identified sub-populations. Objective C: By September 2028, Integral Care will have reduced disparity gaps in sub-populations at risk of suicide served by 50% as reflected in the annual internal Population Health analysis reports. Goal 3- Increase Integral Care's capacity to deliver evidence-based treatments to clinical and non-clinical staff serving populations with increased risk of suicide. Objective A: By January 2024, Integral Care will train the 3 clinical staff Suicide Care Specialists in evidence based trainings which include: Applied Suicide Intervention Sills Trainings, Counseling on Access to Lethal Means, Columbia-Suicide Severity Rating Scale, Safety Planning Intervention and Chronological Assessment of Suicide Events. Objective B: By Septembers 2028, Integral Care will have trained 50% of non-clinical staff in Suicide Alertness for Everyone: Tell, Ask, Listen, and Keep Safe. Objective C: By December 2023, Integral Care will have developed a training for tobacco cessation programs, activities and/or strategies.

The Colorado Office of Suicide Prevention (OSP) leverages the national Zero Suicide quality improvement framework to propel forward comprehensive suicide prevention strategies for adults in key Colorado community mental health centers and health systems. Participating health systems: prioritize suicide prevention as a core component of care; create robust suicide care management plans and protocols for patients screened and assess as at some level of risk for suicide; train staff in culturally responsive, trauma-informed care; and collect and analyze data to identify any areas for improving care for suicidal patients. The purpose of Zero Suicide Colorado (ZSC) is to support full implementation of the framework in 16 priority counties: 5 rural counties (Delta, La Plata, Montezuma, Montrose, Ouray), 3 frontier counties (Gunnison, Hinsdale, San Miguel), and 8 urban counties (Clear Creek, Denver, El Paso, Gilpin, Jefferson, Larimer, Mesa, Pueblo). OSP will support priority populations with this project, particularly those disproportionately affected by suicidal despair, attempts, and death, including Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, Two Spirit, and other sexual orientations (LGTBQIA2S+), veterans, Black, Indigenous, and communities of Color (BIPOC), including American Indian / Alaska Native (AIAN) adults, and adults in rural communities. From 2017-2021, while comprising 51% of Colorado's population, the 16 priority counties represent 54.3% of Colorado's adult suicide deaths, 57.3% of hospital discharges, and 56.2% of emergency department (ED) visits for suicide-related behaviors. Through OSP-funded training, 7,550 staff between 2023-2028 will receive education on suicide-specific interventions relevant to their role, and patients at risk will access care in system better equipped to manage their suicidal despair and/or intent. OSP assists health systems in using a data-driven quality improvement approach to improve their suicide care policies, workflows, and protocols; in doing so, participating systems in priority counties will reduce the number of suicide-related behaviors, hospital discharges, and ED visits among their patient populations.

Corewell Health East’s (CHE) Project S.A.F.E.-T. (Suicide Awareness for Everyone and Treatment) is designed reduce ideation, attempts, and deaths due to suicide in individuals aged 25 and older in Michigan’s Wayne, Macomb, and Oakland counties by raising awareness, providing job-related training in suicide prevention, and by standardizing the assessment tools in screening for suicide risk. Project SAFE-T will focus on particularly high-risk populations, including individuals who are LGBTQI+, of Arab or Middle Eastern descent, African American, American Indian, unemployed, or those living in poverty within its 596 locations. Through Project SAFE-T, CHE will promote a system-wide cultural shift around issues of behavioral health and suicide, and bridge cultural gaps to address three core issues: 1) Lack of system-wide behavioral health approach to mental health and suicide; 2) Lack of personnel and culturally responsive training and development to deal with special populations and suicide risk; 3). Lack of cohesive data collection and analysis to inform communication & strategic decision making. Project SAFE-T is an evidence-based, trauma-informed, recovery-focused, and equitable and accessible. Through Project SAFE-T, CHE will achieve the following objectives: 1) To decrease the number of suicide deaths of individuals age 25 and older served in the CHE system by 10% over the baseline by the end of year one, and by an additional 2% over the previous year each subsequent year by the end of year five. 2) To reduce the number of non-fatal suicide attempts by individuals 25 and older served in the CHE system by 10% over the baseline by the end of year one, and by an additional 2% over the previous year each subsequent year by the end of year five. 3) To hire all key personnel to implement the creation and development of the CHE Behavioral Health Department by the end of first year. 4) To support the sustainability of the Zero Suicide model and other mental health care activities within the 596 CHE system location general operating budgets by the end of year five. 5) To train 165 healthcare professionals within the CHE system in the Zero Suicide model and other mental health support initiatives by the end of year two. 6) To screen at least 3,800 individuals age 25 and older for suicide risk and mental health needs each year for five years as a measurable result of the Zero Suicide initiative. 7) To deliver evidence-based mental health services to at least 3,800 individuals age 25 and older each year for five years as a measurable result of the Zero Suicide initiative. 8) To refer at least 300 individuals in identified, high-risk sub-populations of Arab/Middle Eastern, African American/Black, American Indian, LGBTQI+, poverty, and unemployed for mental health and related services as a measurable result of the Zero Suicide initiative to CHE’s “Bridge the Gap” Program and CMH partners. 9) To decrease time from admission to disposition by 10% in the first year and 2% in subsequent years for 100% of individuals who screen positive for suicide risk. 10) To ensure the composition of a diverse, equitable, and inclusive Zero Suicide Implementation Team, including at least two individuals who have attempted suicide or family members who have lost a loved one to suicide. 11) To complete annual evaluations as a part of an ongoing project improvement plan and for CHE leadership to communicate their findings and recommendations each year for five years.

Project Abstract is attached under 'Other Narrative Attachments' as 'Abstract'.