Access To Care

BRIDGE TO RECOVERY CCBHC - OVERVIEW: BRIDGING ACCESS TO CARE (BAC) SEEKS A CCBHC GRANT TO CREATE BRIDGE TO RECOVERY CCBHC IN BROOKLYN, NY THAT WILL PROVIDE INTEGRATED MENTAL HEALTH AND SUBSTANCE USE DISORDER TREATMENT WITH PRIMARY/PREVENTIVE HEALTH SERVICES. THE CCBHC IS DESIGNED TO REMEDY THE IMPACTS OF THE COVID PANDEMIC AND HISTORIC HEALTH INEQUITIES FOR 1,868 LOW-INCOME, PREDOMINANTLY BLACK / LATINX PEOPLE OF ALL AGES OVER THE 2-YEAR GRANT PERIOD. THE POPULATION OF FOCUS ARE PRIMARILY BLACK AND LATINX LOW-INCOME RESIDENTS, AGES 6 YEARS AND OLDER, LIVING IN WILLIAMSBURG-BUSHWICK/GREENPOINT IN BROOKLYN. TWO-THIRDS WILL HAVE SERIOUS MENTAL HEALTH CONDITIONS, SERIOUS EMOTIONAL DISTURBANCES AND/OR SERIOUS ADDICTION DISORDERS. A SIGNIFICANT NUMBER WILL BE INVOLVED OR HAVE HISTORY WITH THE JUSTICE SYSTEM. MANY WILL HAVE A HISTORY OF HOMELESSNESS AND/OR HOUSING INSTABILITY. ONE IN 3 WILL BE SEEKING TREATMENT FOR LESSER BEHAVIORAL HEALTH CONDITIONS THAT MAY HAVE BEEN TRIGGERED OR EXACERBATED BY THE COVID-19 PANDEMIC AND ITS LIFE-ALTERING IMPACTS. COMMUNITY RESIDENTS SUFFER FROM A HIGH RATE OF DEPRESSION; 23% ARE OBESE; 11% OF ADULTS HAVE BEEN DIAGNOSED WITH DIABETES; AND 25% OF ADULTS HAVE HYPERTENSION. THE COMMUNITY HAS ONE OF THE HIGHEST RATES OF OPIOID DEATHS IN NYC. GOALS/OBJECTIVES: BAC WILL SERVE 859 INDIVIDUALS IN YEAR 1 AND 1,009 IN YEAR 2, IMPROVING THEIR QUALITY OF CARE BY (1) DECREASING TOBACCO USE BY ROUTINELY SCREENING ADOLESCENTS/ADULTS AND PROVIDING APPROPRIATE FOLLOW-UP; (2) REDUCING THE BMI OF OBESE/OVERWEIGHT ADULTS THROUGH ROUTINE WEIGHT SCREENING AND FOLLOW-UP PLANS /COUNSELING; (3) IMPROVING THE DETECTION OF DIABETES/PRE-DIABETES IN ADULTS WITH SCHIZOPHRENIA AND BIPOLAR DISORDER WHO USE ANTI-PSYCHOTIC MEDICATIONS THROUGH ROUTINE SCREENING OF HEMOGLOBIN A1C LEVELS; (4) ADDRESSING SOCIAL DETERMINANTS OF HEALTH THROUGH UNIVERSAL SCREENING / MONITORING AND IMPROVED LINKAGES WITH SERVICES OFFERED BY BAC AND COMMUNITY PARTNERS; AND (5) INCREASE DEPRESSION DIAGNOSES FOR CONSUMERS AGES 12+ BY ADMINISTERING THE PHQ PER RECOMMENDED FREQUENCY AND IMPLEMENTING FOLLOW-UP PLANS AS APPROPRIATE. PROPOSED ACTIVITIES: WITH GRANT FUNDS, BAC WILL EXPAND A NEW YORK STATE-LICENSED MENTAL HEALTH CLINIC TO SERVE CHILDREN/ADOLESCENTS AGES 6-17 YEARS; CO-LOCATE A NEW NYS-CERTIFIED SUBSTANCE USE DISORDER CLINIC SATELLITE THAT OFFERS MEDICATION-ASSISTED TREATMENT; CO-LOCATE A HEALTH TEAM (PHYSICIAN’S ASSISTANT, REGISTERED NURSE, MEDICAL ASSISTANT) TO PROVIDE HEALTH SCREENINGS, MONITORING AND PHYSICALS, VACCINATIONS AND OTHER PREVENTIVE SERVICES; ADD A CRISIS TEAM FOR 24/7 IN-HOME AND COMMUNITY CRISIS STABILIZATION AND INTERVENTION SERVICES; AND BUILD ON EXISTING HCBS REHABILITATION, PEER AND EMPLOYMENT SERVICES. THE CCBHC WILL PROVIDE SIGNIFICANT OUTREACH/ENGAGEMENT SERVICES IN ITS CATCHMENT AREA TO LOW-INCOME RESIDENTS IN PUBLIC HOUSING, PUBLIC SCHOOLS, HOMELESS SHELTERS, SENIOR CENTERS AND OTHER LOCATIONS THAT ARE DISPROPORTIONATELY IMPACTED BY THE COVID-19 PANDEMIC, BEHAVIORAL HEALTH CONDITIONS AND CHRONIC MEDICAL DISORDERS.

ACT TEAM

TCE-HIV

WELLNESS TOGETHER: PROVIDING CO-LOCATED BH SERVICES & PRIMARY CARE

THE SAMHSA TARGETED EXPANSION - HIV PROGRAM WILL ENHANCE AND EXPAND SUBSTANCE MISUSE, MENTAL HEALTH AND HIV PREVENTION SERVICES FOR BROOKLYN YMSM/MSM.

THE NEW YORK PROJECT

ENHANCED SUPP SVCS TO FORMERLY HOMELESS CLIENTS

TREATMENT AND RECOVERY SERVICES FOR ADOLESCENTS, TRANSITIONAL AGED YOUTH, AND THEIR FAMILIES IN NYC - SUMMARY. BRIDGING ACCESS TO CARE (BAC) IS PROPOSING A PROGRAM TO ENHANCE AND EXPAND COMPREHENSIVE TREATMENT, EARLY INTERVENTION, AND RECOVERY SUPPORT SERVICES FOR TRANSITIONAL AGED YOUTH (AGES 18-25) WITH SUD AND/OR COD, AND THEIR FAMILIES/PRIMARY CAREGIVERS; THE PROJECT WILL SERVE NYC, WITH A FOCUS ON BROOKLYN. BAC PROPOSES TO SERVE 120 UNDUPLICATED INDIVIDUALS ANNUALLY AND 540 OVER THE ENTIRE PROJECT PERIOD. PROJECT NAME. BROOKLYN EXPANSION OF TREATMENT AND RECOVERY SERVICES PROGRAM POPULATIONS TO BE SERVED. BAC’S POPULATION OF FOCUS (POF) WILL BE TRANSITIONAL AGED YOUTH (AGES 18 TO 25) WITH SUBSTANCE USE DISORDERS (SUD) AND/OR CO-OCCURRING SUBSTANCE USE AND MENTAL DISORDERS (COD), AND THEIR FAMILIES/PRIMARY CAREGIVERS. BAC’S CATCHMENT AREA WHERE SERVICES WILL BE DELIVERED WILL BE THE UNDERSERVED AND HIGH-NEED COMMUNITIES IN NEW YORK CITY (NYC), WITH A FOCUS ON CENTRAL BROOKLYN, EAST NEW YORK, EAST FLATBUSH, AND BUSHWICK. STRATEGIES/INTERVENTIONS. BAC’S PROGRAM ACTIVITIES WILL INCLUDE: 1) PROVIDING A COMPREHENSIVE, FAMILY-CENTERED, TRAUMA-INFORMED, EVIDENCE-BASED, COORDINATED, AND INTEGRATED OUTPATIENT SYSTEM OF CARE, WHICH INCLUDES EARLY INTERVENTION AND RECOVERY SUPPORT SERVICES; 2) SCREENING CLIENTS FOR ALCOHOL MISUSE AND ILLICIT DRUG USE; 3) SCREENING ALL CLIENTS AND THEIR FAMILY MEMBERS FOR TOBACCO USE; 4) EDUCATION AND MESSAGING ON MAKING HEALTHY CHOICES; 5) HOUSING AND HOUSING PLACEMENT SERVICES; 6) TESTING FOR HIV AND VIRAL HEPATITIS; AND 7) IMPLEMENTING THE FOLLOWING EBPS: MOTIVATIONAL INTERVIEWING, COGNITIVE BEHAVIORAL THERAPY, AND CONTINGENCY MANAGEMENT. PROJECT GOALS AND MEASURABLE OBJECTIVES. THE PROGRAM’S GOAL IS TO ENHANCE AND EXPAND COMPREHENSIVE TREATMENT, EARLY INTERVENTION, AND RECOVERY SUPPORT SERVICES FOR THE POF. THE PROGRAM’S OBJECTIVES INCLUDE: PROVIDE COMPREHENSIVE, FAMILY-CENTERED, TRAUMA-INFORMED, EVIDENCE-BASED, COORDINATED, AND INTEGRATED OUTPATIENT SERVICES, INCLUDING INTERVENTION AND RECOVERY SUPPORT SERVICES, TO 60 CLIENTS IN YEAR 1 AND 120 PARTICIPANTS PER YEAR IN EACH OF THE FOLLOWING YEARS; SCREEN CLIENTS (60 IN YEAR 1, 120 IN SUBSEQUENT YEARS) AND THEIR FAMILY MEMBERS/PRIMARY CAREGIVERS, WHO ARE INCLUDED IN TREATMENT PLANNING, FOR ALCOHOL MISUSE AND ILLICIT DRUG USE, INCLUDING MARIJUANA, OPIOIDS, STIMULANTS, INHALANTS, AND BENZODIAZEPINES; PROVIDE PERSONS ENGAGED IN RISKY OR HAZARDOUS DRINKING WITH BRIEF BEHAVIORAL COUNSELING INTERVENTIONS TO REDUCE ALCOHOL MISUSE; SCREEN ALL CLIENTS (60 IN YEAR 1 AND 120 IN SUBSEQUENT YEARS) AND THEIR FAMILY MEMBERS/PRIMARY CAREGIVERS FOR TOBACCO USE AND PROVIDE TOBACCO USE COUNSELING AND INTERVENTIONS AS PART OF A STANDARD OF PRACTICE, AS APPROPRIATE. PROVIDE AUGMENTED, PREGNANCY-TAILORED COUNSELING FOR PREGNANT CLIENTS WHO USE TOBACCO PRODUCTS; PROVIDE TOBACCO CESSATION COUNSELING TO 60 CLIENTS PER YEAR; PROVIDE EDUCATION AND MESSAGING ON MAKING HEALTHY CHOICES THAT INCLUDES NO USE OF ANY SUBSTANCES THROUGH SOCIAL MEDIA AND SOCIAL MARKETING, REACHING 500 PERSONS FROM THE POF PER YEAR; PROVIDE RECOVERY HOUSING TO 2-3 CLIENTS IN YEAR ONE (3 – 5 IN SUBSEQUENT YEARS); AND PROVIDE HIV AND HCV TESTING FOR 50 CLIENTS PER YEAR.

HIV PREVENTION FOR YMSM IN BROOKLYN

INTEGRATED HOUSING AND SUD TREATMENT FOR HOMELESS POPULATIONS IN BROOKLYN - SUMMARY. BRIDGING ACCESS TO CARE (BAC) IS PROPOSING A PROGRAM TO PROVIDE INTEGRATED SUD TREATMENT, HOUSING SERVICES, AND OTHER CRITICAL SERVICES; BAC TARGET WILL AFRICAN AMERICAN AND HISPANIC INDIVIDUALS (INCLUDING YOUTH) AND FAMILIES EXPERIENCING HOMELESSNESS IN BROOKLYN, NYC. BAC WILL SERVE 100 UNDUPLICATED INDIVIDUALS ANNUALLY WITH GRANT FUNDS AND 500 OVER THE ENTIRE PROJECT PERIOD. PROJECT NAME. BAC INTEGRATED HOUSING SERVICES POPULATIONS TO BE SERVED. BAC’S POPULATION OF FOCUS (POF) WILL BE AFRICAN AMERICAN AND HISPANIC INDIVIDUALS (INCLUDING YOUTH) AND FAMILIES EXPERIENCING HOMELESSNESS IN BROOKLYN, NYC. BAC’S CATCHMENT AREA WHERE SERVICES WILL BE DELIVERED WILL BE ALL OF BROOKLYN, WITH A FOCUS ON CENTRAL BROOKLYN, EAST NEW YORK, EAST FLATBUSH, AND BUSHWICK; THESE AREAS HAVE SOME OF THE HIGHEST RATES OF HOMELESSNESS, SUD, AND OVERDOSE DEATHS IN NYC. STRATEGIES/INTERVENTIONS. BAC’S PROGRAM ACTIVITIES WILL INCLUDE: 1) DIRECT ASSISTANCE TO HOMELESS INDIVIDUALS TO GAIN HOUSING; 2) DIRECT SUD TREATMENT FOR INDIVIDUALS WITH SUDS OR CO-OCCURRING MENTAL AND SUDS WHO ARE ALSO EXPERIENCING HOMELESSNESS; 3) LINKAGE AND COORDINATION TO OBTAIN PERMANENT HOUSING; 4) ENROLLMENT ASSISTANCE SERVICES; 5) RECOVERY SUPPORT SERVICES, INCLUDING EMPLOYMENT COACHING, VOCATIONAL TRAINING, RECOVERY COACHING AND OTHER SERVICES; AND 6) PROVIDE TWO EBPS: MOTIVATIONAL INTERVIEWING AND CONTINGENCY MANAGEMENT. BAC WILL ALSO IMPLEMENT SCREENING AND ASSESSMENT SERVICES AND PROVIDE ON-SITE TOBACCO CESSATION PROGRAMMING. PROJECT GOALS AND MEASURABLE OBJECTIVES. THE PROGRAM’S TWO GOALS ARE: 1) INCREASE THE NUMBER OF PERSONS FROM THE POF RECEIVING EVIDENCE-BASED SUBSTANCE USE DISORDER TREATMENT; AND 2) INCREASE THE NUMBER OF PERSONS FROM THE POF RECEIVING RECOVERY SUPPORT SERVICES. OBJECTIVES FOR THE PROPOSED PROGRAM INCLUDE: 1) CONDUCT OUTREACH AND ENGAGEMENT STRATEGIES TO ENROLL AT LEAST 100 PARTICIPANTS PER YEAR; 2) CONDUCT SCREENING AND ASSESSMENTS OF SUBSTANCE USE DISORDERS WITH 100 PERSONS FROM THE POF PER YEAR; 3) PROVIDE EVIDENCE-BASED SUD TREATMENT SERVICES TO 100 ENROLLED CLIENTS PER YEAR; 4) INCREASE ACCESS TO HOUSING SUPPORT SERVICES BY PROVIDING HOUSING SERVICES REFERRALS TO ALL ENROLLED PARTICIPANTS IN NEED OF SUCH REFERRALS; 5) RETAIN AT LEAST 50 PROGRAM PARTICIPANTS IN PERMANENT HOUSING THROUGH THE DELIVERY OF HOUSING CASE MANAGEMENT AND WRAPAROUND SERVICES (RECOVERY SUPPORT, VOCATIONAL TRAINING, ETC.); 6) PROVIDE RECOVERY SUPPORT SERVICES, INCLUDING EMPLOYMENT COACHING, VOCATIONAL TRAINING AND RECOVERY COACHING FOR AT LEAST 80% OF PROGRAM PARTICIPANTS; 7) PROVIDE ENTITLEMENT ENROLLMENT ASSISTANCE TO ALL ENROLLED PARTICIPANTS IN NEED OF ASSISTANCE; 8) PROVIDE EDUCATION, SCREENING, CARE COORDINATION, RISK REDUCTION INTERVENTIONS, AND OTHER SUPPORT SERVICES PROGRAMMING FOR AT LEAST 80% OF PARTICIPANTS; 9) AT LEAST 80% OF ENROLLED PARTICIPANTS WILL INDICATE PROGRESS TOWARD OR ACHIEVEMENT OF RECOVERY GOALS WITHIN SIX MONTHS; 10) AT LEAST 80% OF ENROLLED PARTICIPANTS WILL MAINTAIN INVOLVEMENT IN THE PROGRAM SIX MONTHS AFTER INTAKE AND WILL COMPLETE THE GPRA PRIOR TO DISCHARGE.

PREVENTION NAVIGATION FOR RACIAL/ETHNIC MINORITIES IN BROOKLYN - SUMMARY. BRIDGING ACCESS TO CARE (BAC) IS PROPOSING A PROGRAM TO PROVIDE SERVICES TO THOSE AT HIGHEST RISK FOR HIV AND SUBSTANCE USE DISORDERS IN BROOKLYN, NY. BAC WILL PROVIDE TRAINING AND EDUCATION AROUND THE RISKS OF SUBSTANCE MISUSE, EDUCATION ON HIV/AIDS, AND NEEDED LINKAGES TO SERVICE PROVISION FOR INDIVIDUALS WITH HIV. BAC PROPOSES TO SERVE 150 UNDUPLICATED INDIVIDUALS ANNUALLY AND 750 OVER THE ENTIRE PROJECT PERIOD. PROJECT NAME. BROOKLYN PREVENTION NAVIGATOR PROGRAM POPULATIONS TO BE SERVED. BAC’S POPULATION OF FOCUS (POF) WILL BE THOSE AT HIGHEST RISK FOR HIV AND SUBSTANCE USE DISORDERS. THE CATCHMENT AREA WILL BE BROOKLYN, NY, WITH A FOCUS ON THE HIGH-NEED AREAS OF CENTRAL BROOKLYN, EAST NEW YORK, EAST FLATBUSH, AND BUSHWICK. STRATEGIES/INTERVENTIONS. BAC’S PROGRAM ACTIVITIES WILL INCLUDE: 1) IMPLEMENT COMMUNITY-BASED SUBSTANCE MISUSE AND HIV PREVENTION STRATEGIES; 2) DEVELOP AND IMPLEMENT PUBLIC MESSAGING AND AWARENESS CAMPAIGNS ON SUBSTANCE MISUSE AMONG PLWH AND THE IMPORTANCE OF SEEKING CARE AND TREATMENT; 3) PROVIDE OPPORTUNITIES FOR SCREENING AND TESTING FOR HIV AND VIRAL HEPATITIS; 4) PROVIDE NAVIGATION SERVICES TO LINK INDIVIDUALS TO CARE FOR HIV AND SUBSTANCE MISUSE; 5) PROVIDE EDUCATION AND TRAINING TO SUD TREATMENT AND HEALTHCARE PROVIDERS ON THE IMPORTANCE OF SCREENING FOR HIV; 4) AND 6) IMPLEMENT THE FOLLOWING EBPS: MOTIVATIONAL INTERVIEWING, CONTINGENCY MANAGEMENT WITH LIFE SKILLS, TOO GOOD FOR DRUGS AND VIOLENCE, AND SPORT. PROJECT GOALS AND MEASURABLE OBJECTIVES. THE PROGRAM’S 3 GOALS ARE 1) IMPROVE LOCAL SERVICE PROVIDERS’ UNDERSTANDING OF NEEDS AND ISSUES IN THE COMMUNITY RELATED TO SUBSTANCE ABUSE AND HIV, 2) INCREASE THE NUMBER OF AT-RISK INDIVIDUALS WHO ARE IDENTIFIED, TESTED FOR HIV, AND LINKED WITH HIV CARE, HOUSING AND SUPPORT SERVICES, AND 3) INCREASE THE NUMBER OF AT-RISK INDIVIDUALS WHO ARE IDENTIFIED, TESTED FOR HIV, AND LINKED TO HIV CARE AND OTHER SUPPORT SERVICES. THE PROGRAM’S OBJECTIVES INCLUDE: OFFER TRAININGS AND WORKSHOPS FOR AT LEAST 12 AGENCIES REGARDING THE RISKS OF SUBSTANCE AND HIV IN THE POF AND BEST PRACTICES FOR SERVING THE POF; CONDUCT OUTREACH AND RECRUITMENT ACTIVITIES FOR 400 PERSONS PER YEAR; CONDUCT PUBLIC MESSAGING AND AWARENESS CAMPAIGNS VIA SOCIAL MEDIA AND COMMUNITY EVENTS FOR 4,500 PERSONS PER YEAR; PROVIDE REFERRALS TO HIV, STD, AND HCV TESTING FOR 150 PERSONS PER YEAR; PROVIDE 24 GROUP PREVENTION EDUCATION SESSIONS PER YEAR FOR AT LEAST 240 PROGRAM PARTICIPANTS PER YEAR ON SUBSTANCE MISUSE PREVENTION EDUCATION AND HIV RISK REDUCTION SERVICES; SCREEN AT LEAST 150 PERSONS FROM THE POF PER YEAR FOR SUBSTANCE MISUSE USING EVIDENCE-BASED SCREENING TOOLS; PROVIDE NAVIGATION TO SUD TREATMENT FOR 95% OF PARTICIPANTS; PROVIDE HIV COUNSELING, TESTING, AND REFERRAL SERVICES TO AT LEAST 150 PERSONS IN THE POF EACH YEAR; PROVIDE HCV AND STI SCREENING FOR AT LEAST 150 PERSONS IN THE POF EACH YEAR; PROVIDE NAVIGATION TO HIV CARE SERVICES TO 95% OF PERSONS TESTING HIV POSITIVE PER YEAR; PROVIDE NAVIGATION TO HCV AND STI CARE TO 95% OF PERSONS TESTING POSITIVE PER YEAR; AND PROVIDE ONGOING SUPPORT TO 95% OF HIV-POSITIVE CLIENTS TO ENSURE RETENTION IN CARE.

SAMHSA CBI PROJECT

SAMHSA CBI PROJECT

THE SAMHSA TARGETED EXPANSION - HIV PROGRAM WILL ENHANCE AND EXPAND SUBSTANCE MISUSE, MENTAL HEALTH AND HIV PREVENTION SERVICES FOR BROOKLYN YMSM/MSM

CONTINUUM OF CARE PROGRAM

CONTINUUM OF CARE PROGRAM

CONTINUUM OF CARE PROGRAM

CONTINUUM OF CARE PROGRAM

CONTINUUM OF CARE PROGRAM

CONTINUUM OF CARE PROGRAM

CONTINUUM OF CARE PROGRAM

CONTINUUM OF CARE PROGRAM

CONTINUUM OF CARE PROGRAM

RYAN WHITE TITLE III HIV CAPACITY DEVELOPMENT AND PLANNING GRANTS

HIV PREVENTION FOR YMSM IN BROOKLYN

WELLNESS TOGETHER: PROVIDING CO-LOCATED BH SERVICES & PRIMARY CARE