Avera Mckennan

ENVIRONMENTAL INFLUENCES ON CHILD HEALTH OUTCOMES IN THE NORTHERN PLAINS SAFE PASSAGE STUDY COHORT

ENVIRONMENTAL INFLUENCES ON CHILD HEALTH OUTCOMES IN THE NORTHERN PLAINS SAFE PASSAGE STUDY COHORT

MATERNAL AMERICAN-INDIAN RURAL COMMUNITY HEALTH (MARCH) - MATERNAL AMERICAN INDIAN RURAL COMMUNITY HEALTH RESEARCH CENTER OF EXCELLENCE | M.A.R.C.H. PROJECT SUMMARY THE PURPOSE OF THE MATERNAL AMERICAN INDIAN RURAL COMMUNITY HEALTH RESEARCH CENTER OF EXCELLENCE (M.A.R.C.H.) IS TO PROVIDE A PLATFORM FOR RESEARCHERS, TRIBAL NATIONS, RURAL COMMUNITIES AND KEY STAKEHOLDERS TO ENGAGE IN BIDIRECTIONAL COMMUNICATIONS ON MATERNAL HEALTH, IN PARTICULAR DRIVERS OF MORTALITY AND SEVERE MORBIDITY. ALL CENTER COMPONENTS REVOLVE AROUND TWO POPULATIONS WITH STARK HEALTH DISPARITIES IN OUR REGION – AMERICAN INDIAN AND RURAL RESIDENTS. NOVEL MECHANISMS FOR IMPROVING ACCESS TO CARE AND CREATING A BETTER UNDERSTANDING OF BARRIERS TO AND FACILITATORS OF ACCESSING CARE FEED INTO THE OVERARCHING THEME OF THE CENTER AND THE PROJECTS PROPOSED. THE KEY ELEMENTS OF M.A.R.C.H. INCLUDE 1) MULTI-LAYERED AND NOVEL PROJECTS THAT HAVE EMERGED FROM LONG-STANDING COMMUNITY RELATIONSHIPS WITH THE GOAL OF ADDRESSING PREVENTABLE MATERNAL MORTALITY, DECREASING SEVERE MATERNAL MORBIDITY, AND PROMOTING MATERNAL HEALTH EQUITY; 2) A COMMUNITY ENGAGEMENT CORE THAT WILL SERVE AS A CENTRAL HUB TO CONNECT M.A.R.C.H. ACTIVITIES WITH THE VAST NETWORK OF PARTNERS; AND 3) A TRAINING CORE WHICH WILL SUPPORT PROJECT-SPECIFIC TRAINING NEEDS, AS WELL AS AN OVERALL STRUCTURE OF TRAINING FOCUSED ON CULTURAL COMPETENCY AND HEALTH RESEARCH LITERACY.

RURAL MATERNITY AND OBSTETRICS MANAGEMENT STRATEGIES PROGRAM - APPLICANT ORGANIZATION INFORMATION: APPLICANT ORGANIZATION: AVERA MCKENNAN; ADDRESS: 1325 S. CLIFF, SIOUX FALLS, SD 57117-5045; FACILITY TYPE: HOSPITAL; WEBSITE: WWW.AVERA.ORG DESIGNATED PROJECT DIRECTOR INFORMATION: PROJECT DIRECTOR: JUANITA RUITER; PHONE NUMBER: 605-322-8945; EMAIL: JUANITA.RUITER@AVERA.ORG RMOMS PROJECT: TITLE: RMOMS SD: LEVERAGING DATA, PARTNERSHIPS AND INTEGRATED PERINATAL CARE TO IMPROVE HEALTH EQUITY AMONG BIRTHING PEOPLE IN SOUTH DAKOTA (RMOMS-SD); PROJECT GOAL: THE RMOMS-SD PROGRAM WILL LEVERAGE TELEHEALTH SOLUTIONS AND DATA-INFORMED DECISION MAKING TO CREATE A CARE PATHWAY THAT IMPROVES THE QUALITY OF CARE FOR EXPECTING PATIENTS TO DELIVER HEALTHY BABIES THROUGH A COST-NEUTRAL OR COST-SAVING AND SUSTAINABLE MODEL. FUNDS REQUESTED: Y1: $1,000,000; Y2: $1,000,000; Y3: $1,000,000; Y4: $1,000,000 NETWORK COMPOSITION: THE PROJECT WILL ESTABLISH NETWORK OF PARTNERS INCLUDING AVERA’S REGIONAL RURAL FACILITIES, AVERA@HOME, RURAL HEALTH CARE, INC. (FQHC), SOUTH DAKOTA URBAN INDIAN HEALTH (FQHC), THE STATE DEPARTMENT OF HEALTH (HOME VISITING PROGRAM) AND STATE DEPARTMENT OF SOCIAL SERVICES (STATE MEDICAID AGENCY), AS WELL AS TWO RURAL FACILITIES WITH LOW DELIVERY VOLUMES, MILBANK AREA HOSPITAL AND AVERA ST. BENEDICT HOSPITAL (CAH) AND A DATA CONSULTANT. ALL 13 NETWORK MEMBERS HAVE SIGNED AN ATTACHED MOA. TARGET SERVICE AREA: THE PRIMARY TARGET SERVICE AREA INCLUDES THE RURAL COUNTIES OF BROWN, DAVISON, GRANT, HUGHES, HUTCHINSON, AND YANKTON IN EASTERN SOUTH DAKOTA. A SECONDARY TARGET SERVICE AREA INCLUDES 47 RURAL COUNTIES COMPRISING THE REST OF AVERA’S SOUTH DAKOTA FOOTPRINT AS WELL AS THE COUNTIES THAT ARE HOME TO THE STATE’S NINE TRIBAL COMMUNITIES. TARGET POPULATION: RURAL PREGNANT PATIENTS OVER THE AGE OF 18 IN EASTERN SOUTH DAKOTA AND SURROUNDING TRIBAL COMMUNITIES WHO HAVE SIGNIFICANT BARRIERS TO OBSTETRICS SERVICES AND ACCESS CARE AT A LOCAL FACILITIES. CAPACITY TO SERVE RURAL UNDERSERVED POPULATIONS: AVERA MCK ENNAN IS THE FLAGSHIP FACILITY OF AVERA HEALTH, A NONPROFIT, REGIONAL, VERTICALLY INTEGRATED HEALTH CARE DELIVERY NETWORK ALSO BASED IN SIOUX FALLS, SD. AVERA IS A LEADER IN RURAL HEALTHCARE AND PRIORITIZES INCREASING ACCESS TO QUALITY, COST-EFFECTIVE HEALTH CARE SERVICES TO ENSURE RURAL SOUTH DAKOTANS CAN RECEIVE CARE CLOSE TO HOME. ALL NETWORK PARTNERS HAVE LOCATIONS BASED IN RURAL COUNTIES (THE PRIMARY TARGET SERVICE AREA) AND A DEMONSTRATED HISTORY OF SERVING THE STATE’S RURAL POPULATIONS. THE MAJORITY OF AVERA’S SERVICE AREA IS ENTIRELY RURAL COUNTIES. PROJECT ACTIVITY: PROGRAM INTERVENTIONS INCLUDE: REMOTE PATIENT MONITORING TELEHEALTH FOR RURAL PATIENTS AND DELIVERY CENTERS, CARE COORDINATION AND SERVICE AGGREGATION, STATEWIDE WRAPAROUND SERVICES, AND A SOCIAL DETERMINANTS OF HEALTH SCREENING PROGRAM. EXPECTED OUTCOMES INCLUDE INCREASING ACCESS TO OBSTETRICS SERVICES, IMPROVING RELATED CLINICAL OUTCOMES, AND FACILITATING THE DEVELOPMENT OF A ROBUST DATA AND EVALUATION PROGRAM THAT HELPS PARTNERS BETTER UNDERSTAND AND ADDRESS OB NEEDS IN THE REGION. FUNDING PREFERENCE: AVERA MCKENNAN IS REQUESTING A FUNDING PREFERENCE AS THE MAJORITY OF THE COUNTIES IN THE PROPOSED SERVICE AREA ARE IN A DESIGNATED HPSA. SPECIAL CONSIDERATION: AVERA MCKENNAN IS REQUESTING SPECIAL CONSIDERATION BASED ON THE INCLUSION OF A SIGNED MOU THAT INCLUDES THE STATE MEDICAID AGENCY.

HEALTHY START INITIATIVE - AVERA MCKENNAN PROPOSES AVERA BRIDGING INEQUITIES REGIONALLY THROUGH HEALTHY START (AVERA BIRTHS): A COMMUNITY DRIVEN RESPONSE TO PERINATAL NEEDS FOR CARE COORDINATION AND GROUP-BASED EDUCATION IN SOUTH DAKOTA TO DIRECTLY RESPOND TO THE RISING INFANT MORTALITY RATE FOR SOUTH DAKOTA MOTHERS WITH A HIGH SCHOOL EDUCATION OR LESS (TARGET POPULATION). COMPRISED OF RURAL, IMMIGRANT, AND MARGINALIZED COMMUNITIES, THE TARGET POPULATION HAS THE HIGHEST INFANT MORTALITY RATES (IMR) IN SOUTH DAKOTA, AT 9.5 PER 1,000 BIRTHS. THESE POPULATIONS EXPERIENCE HIGHER RATES OF PRETERM BIRTH, DEPRESSION, TOBACCO OR DRUG USE, AND POVERTY, IN ADDITION TO LOWER RATES OF BREASTFEEDING, AND ACCESS TO PERINATAL CARE. ACCORDING TO THE SOUTH DAKOTA PREGNANCY RISK ASSESSMENT MONITORING (PRAMS) DATA, THE COMBINATION OF RISK FACTORS IN THIS TARGET POPULATION CREATES A STARK DISPARITY THAT LED TO ADVERSE HEALTH EFFECTS FOR BOTH MOTHER AND CHILD. AVERA BIRTHS WILL ESTABLISH A CARE COORDINATION TEAM INCLUDING COMMUNITY-BASED DOULAS, OB ADVANCED PRACTICE PROVIDER, DIETITIAN, SOCIAL WORKER, AND RN EDUCATOR TO PROVIDE DIRECT AND ENABLING SERVICES FOR THE TARGET POPULATION, AS WELL AS GROUP-BASED EDUCATION AND HEALTH PROMOTION. AVERA BIRTHS AIMS TO DELIVER PERINATAL HEALTHCARE SERVICES TO RURAL AREAS IN SOUTH DAKOTA. AS PER THE RURAL HEALTH GRANTS ELIGIBILITY ANALYZER, THE PROPOSED SERVICE AREA IS RURAL AND INCLUDES REGION 2, REGION 3, AND REGION 4 OF THE SD PRAMS REPORT, COVERING THE FOLLOWING FULL COUNTIES: AURORA, BEADLE, BON HOMME, BROOKINGS, BROWN, BRULE, BUFFALO, CAMPBELL, CHARLES MIX, CLARK, CLAY, CODINGTON, CORSON, DAVISON, DAY, DEUEL, DEWEY, DOUGLAS, EDMUNDS, FAULK, GRANT, GREGORY, HAMLIN, HAND, HANSON, HUGHES, HUTCHINSON, HYDE, JERAULD, KINGSBURY, LAKE, LINCOLN, LYMAN, MARSHALL, MCCOOK, MCPHERSON, MINER, MINNEHAHA, MOODY, POTTER, ROBERTS, SANBORN, SPINK, STANLEY, SULLY, TODD, TRIPP, TURNER, UNION, WALWORTH, YANKTON, AND ZIEBACH. FURTHER INFORMATION ABOUT THE TARGET POPULATI ON IS INCLUDED IN ATTACHMENT 1.

SOUTH DAKOTA PEDIATRIC CLINICAL TRIALS NETWORK (SODAKPCTN)

PRIMARY CARE TRAINING AND ENHANCEMENT-COMMUNITY PREVENTION AND MATERNAL HEALTH

INTEGRATED SUBSTANCE USE DISORDER (SUD) TRAINING PROGRAM

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION

AMERICAN INDIAN MHEALTH SMOKING DEPENDENCE STUDY (PQ4)

CBPR INITIATIVE IN REDUCING INFANT MORTALITY IN AMERICAN INDIAN COMMUNITIES

COMMUNITY BASED SYSTEM DYNAMICS MODELS OF ALCOHOL AND SUBSTANCE EXPOSED PREGNANCY IN NORTHERN PLAINS AMERICAN INDIAN WOMEN

THE MEDICARE CHRONIC CARE PRACTICE RESEARCH NETWORK (MCCPRN)

BEHAVIORAL HEALTH WORKFORCE EDUCATION AND TRAINING PROGRAM - SOUTH DAKOTA FACES A SEVERE SHORTAGE OF BEHAVIORAL HEALTH PROFESSIONALS, PARTICULARLY IN RURAL AND UNDERSERVED AREAS, WHERE ACCESS TO MENTAL HEALTH AND ADDICTION SERVICES IS CRITICALLY LIMITED. AVERA BRIGHT: BUILDING RURAL INNOVATION AND GROWTH IN BEHAVIORAL HEALTH TEAMS ADDRESSES THIS CRISIS BY CREATING A SUSTAINABLE PIPELINE OF HIGHLY TRAINED PROFESSIONALS WHO SERVE THESE HIGH-NEED COMMUNITIES. FOCUSING ON CHILDREN, ADOLESCENTS, AND YOUNG ADULTS AT RISK FOR MENTAL HEALTH DISORDERS, TRAUMA, AND SUBSTANCE USE CHALLENGES, AVERA BRIGHT INTEGRATES RECRUITMENT, TRAINING, AND RETENTION STRATEGIES TO EXPAND AND ENHANCE SOUTH DAKOTA’S BEHAVIORAL HEALTH WORKFORCE. OVER ITS FOUR-YEAR SPAN, THE PROGRAM WILL TRAIN 12 STUDENTS PER GRANT YEAR. PARTICIPANTS WILL INCLUDE MASTER OF SOCIAL WORK (MSW), MASTER OF ARTS IN COUNSELING (MA), AND MASTER OF ADDICTION COUNSELING (MAC) TRAINEES, PRIORITIZING CANDIDATES FROM RURAL AND UNDERSERVED BACKGROUNDS. THESE STUDENTS WILL GAIN HANDS-ON EXPERIENCE IN DIVERSE CLINICAL SETTINGS, INCLUDING SCHOOL-BASED PROGRAMS, ADDICTION TREATMENT FACILITIES, AND TELEHEALTH ENVIRONMENTS. CULTURALLY RESPONSIVE AND TRAUMA-INFORMED CARE MODULES, PARTICULARLY THOSE ADDRESSING THE NEEDS OF NATIVE AMERICAN COMMUNITIES, WILL EQUIP TRAINEES TO MEET THE UNIQUE CHALLENGES OF RURAL PRACTICE. AVERA BRIGHT ADDRESSES BARRIERS TO WORKFORCE SUSTAINABILITY BY PROVIDING STIPENDS, LICENSURE SUPPORT, AND PROFESSIONAL MENTORSHIP, EASING FINANCIAL AND LOGISTICAL BURDENS FOR TRAINEES. TELEHEALTH TRAINING AND PARTNERSHIPS WITH TRIBAL COUNCILS AND RURAL CLINICS ENHANCE ACCESS TO CARE IN REMOTE AREAS, ADDRESSING GEOGRAPHIC AND SYSTEMIC BARRIERS. AVERA BRIGHT EMPHASIZES HEALTH EQUITY AND CULTURALLY COMPETENT CARE BY ADHERING TO THE NATIONAL STANDARDS FOR CULTURALLY AND LINGUISTICALLY APPROPRIATE SERVICES (CLAS). THIS PROGRAM ENSURES UNDERSERVED COMMUNITIES RECEIVE HIGH-QUALITY, COMPASSIONATE CARE WHILE FOSTERING A RESILIENT AND COMMITTED BEHAVIORAL HEALTH WORKFORCE TO TRANSFORM SOUTH DAKOTA’S MENTAL HEALTH AND ADDICTION TREATMENT LANDSCAPE.

COMMUNITY PROJECT FUNDING/CONGRESSIONALLY DIRECTED SPENDING - CONSTRUCTION - THE AVERA VIRTUAL PATIENT CARE PROGRAM AIMS TO INCREASE VIRTUAL NURSING INFRASTRUCTURE ACROSS THE AVERA MCKENNAN REGION, AND BY EXTENSION, INCREASE ACCESS TO VIRTUAL NURSING RESOURCES THROUGHOUT AVERA’S RURAL FACILITIES IN SOUTH DAKOTA. THE PROJECT WILL SOLVE MANY BARRIERS THAT CLINICIANS WITHIN THE HEALTH SYSTEM FACE DUE TO STAFFING SHORTAGES BY UTILIZING ARTIFICIAL INTELLIGENCE VIA A PLATFORM THAT INCLUDES NETWORK SENSORS, CAMERAS, SPEAKERS, AND MICROPHONES, TO GATHER DATA AND BUILD ALGORITHMS TO AUTOMATE SPECIFIC WORKFLOWS. THE INCREASED ACCESS TO QUALITY AND SPECIALTY HEALTHCARE PROVIDED THROUGH THE AVERA VIRTUAL PATIENT CARE PROGRAM HAS THE POTENTIAL TO REDUCE HEALTH DISPARITIES FACED THROUGHOUT AVERA’S RURAL FOOTPRINT IN SOUTH DAKOTA AND HELP CLINICIANS DELIVER THE PROPER CARE AT THE RIGHT TIME TO IMPROVE PATIENT OUTCOMES AND THE OVERALL QUALITY OF CARE IN RURAL AREAS. THE PROPOSED FUNDING WILL ENABLE THE ORGANIZATION TO PURCHASE CAMERAS, SPEAKERS, ARTISIGHT CONNECT, AND MOBILE CARTS AT AVERA MCKENNAN HOSPITAL & UNIVERSITY HEALTH CENTER, AVERA BEHAVIORAL HEALTH HOSPITAL, AVERA SPECIALTY HOSPITAL, AVERA MEDICAL GROUP FAMILY HEALTH CENTER EMERGENCY DEPARTMENT – MARION, AND AVERA MEDICAL GROUP FAMILY HEALTH CENTER EMERGENCY DEPARTMENT – DAWLEY FARMS. EACH FACILITY WILL RECEIVE TELEMEDICINE UNITS THAT PROVIDE ACCESS TO VIRTUAL PATIENT CARE. THIS TECHNOLOGY, WITH ITS ADVANCED AUDIO-VISUAL CAPABILITIES, WILL CONNECT THEM WITH HIGHLY TRAINED NURSES AND TECHNICIANS, ENSURING EFFICIENT AND QUALITY HEALTHCARE.

2/5 THE CUMULATIVE RISK OF SUBSTANCE EXPOSURE AND EARLY LIFE ADVERSITY ON CHILD HEALTH DEVELOPMENT AND OUTCOMES

**AWARDS ISSUED PRIOR TO JANUARY 20, 2025, WERE FUNDED UNDER PREVIOUS ADMINISTRATIONS AND MAY NOT REFLECT THE PRIORITIES AND POLICIES OF THE CURRENT ADMINISTRATION.** AVERA MCKENNAN-FOOD AS MEDICINE (FAM): A HOSPITAL-BASED APPROACH TO INCREASE ACCESS AND INTAKE OF FRUITS AND VEGETABLES TO REDUCE THE RISK OF CHRONIC DISEASE IN RURAL AMERICA

A STUDY TO MEASURE THE EFFECT OF THE ADDITION OF A COMPREHENSIVE

DOCUMENTING AND ARCHIVING THE SAFE PASSAGE STUDY IN NICHD DATA AND SPECIMEN HUB (DASH) - PROJECT ABSTRACT THE SAFE PASSAGE STUDY IS THE FIRST PROSPECTIVE, OBSERVATIONAL, LARGE-SCALE COHORT STUDY TO INVESTIGATE THE EFFECT OF PRENATAL EXPOSURE TO ALCOHOL, TOBACCO AND DRUGS ON THE RISK FOR SUDDEN INFANT DEATH SYNDROME (SIDS), STILLBIRTH, AND FETAL ALCOHOL SPECTRUM DISORDERS (FASD). PARTICIPANTS WERE RECRUITED FROM TWO SITES IN CAPE TOWN, SOUTH AFRICA, AND FIVE SITES IN THE NORTHERN PLAINS, UNITED STATES, INCLUDING TWO AMERICAN INDIAN RESERVATIONS BETWEEN 2007 AND 2015. IN TOTAL, THE STUDY ENROLLED 10,088 WOMEN, 11,892 PREGNANCIES, AND 12,029 FETUSES, FOLLOWED TO 1-YEAR POST-DELIVERY. EXTENSIVE LONGITUDINAL DATA HAVE BEEN COLLECTED DURING PRENATAL, DELIVERY/NEWBORN, AND POSTNATAL STAGES. AS SUCH, THE SAFE PASSAGE STUDY IS AN IMPORTANT RESOURCE FOR RESEARCHERS INTERESTED IN PRENATAL EXPOSURES, CHILD PHYSIOLOGICAL AND NEUROLOGICAL DEVELOPMENT, AND PATHOLOGICAL ASSESSMENTS OF SIDS, STILLBIRTH, AND FASD. THE SAFE PASSAGE STUDY WAS INITIATED PRIOR TO THE NIH DATA SHARING MANDATE, THUS FUNDS WERE NOT AVAILABLE FOR PREPARATION AND ARCHIVING OF A DE-IDENTIFIED DATASET. TO FACILITATE THE USE OF THIS VALUABLE RESOURCE, WE PROPOSE TO MAKE PUBLICLY AVAILABLE THE SAFE PASSAGE STUDY DATASETS VIA NICHD DATA AND SPECIMEN HUB (DASH). WE WILL ARCHIVE AND DOCUMENT THE EXISTING DATASETS OF SAFE PASSAGE STUDY, WHICH NICHD SPONSORED ALONG WITH NIAAA AND NIDCD. MORE SPECIFICALLY, WE WILL 1.) PREPARE AND SUBMIT PASS SELF-REPORTED AND MEDICAL CHART ABSTRACTION DATA, SUCH AS MATERNAL AND INFANT CHARACTERISTICS, PSYCHOSOCIAL AND DIETARY INFORMATION, AND EXPOSURE ASSESSMENTS, TO THE DASH PORTAL; AND 2.) PREPARE AND SUBMIT PASS PHYSIOLOGY AND PATHOLOGY DATA, SUCH AS AUTONOMIC, RESPIRATORY, AND BRAIN FUNCTION IN THE FETUS AND INFANT, PATHOLOGY ASSESSMENTS FROM AUTOPSY AND PLACENTAL EVALUATION, AND NEUROLOGIC ASSESSMENTS OF THE INFANT TO THE DASH PORTAL. WE WILL PERFORM DATA DE-IDENTIFICATION, CREATE A VARIABLE DICTIONARY, PREPARE DATASETS AND ANNOTATION FILES USING THE DATA PREPARATION TOOL, AND SUBMIT THE SAFE PASSAGE STUDY TO NICHD DASH. DE-IDENTIFIED DATA SETS PRODUCED WITH SUPPORT FROM THIS GRANT WILL BE AVAILABLE WITHOUT RESTRICTION TO RESEARCHERS WITH THE EXCEPTION OF DATA COLLECTED ON TRIBAL LANDS, DUE TO SHARING RESTRICTIONS NEGOTIATED AT THE ONSET OF THE STUDY. THE SHARED DATASETS WILL ENABLE SECONDARY ANALYSIS BY THE SCIENTIFIC COMMUNITY INTERESTED IN THE LINK BETWEEN PRENATAL EXPOSURES AND CHILD DEVELOPMENT.

AVERA RESEARCH INTEGRITY CONFERENCE: CREATING AND PROMOTING A CULTURE OF RESEARCH INTEGRITY

AVERA MCKENNAN PROPOSES "ADAPTED STAFFING MODELS FOR NO WRONG DOOR: LINKING RESOURCES FOR INCREASED ACCESS TO COMMUNITY SERVICES IN A MID-SIZED METRO IN THE MIDWEST" TO RESEARCH THE IMPACT OF WORKFORCE DEVELOPMENT TACTICS, INCLUDING TRAINING, STAFFING RATIOS, AND SCOPE OF WORK IN A NOW WRONG DOOR SETTING AT A COMMUNITY-BASED TRIAGE CENTER IN SIOUX FALLS, SD. THIS PROJECT WOULD TAKE PLACE AT THE LINK IN SIOUX FALLS, SD, WHICH IS A COMMUNITY TRIAGE CENTER FOR PEOPLE EXPERIENCING A NON-VIOLENT BEHAVIOR HEALTH CRISIS OR NEEDING CARE FOR SUBSTANCE USE OR MENTAL HEALTH DISORDER BY PROVIDING THE REQUIRED CARE WITHOUT UTILIZATION OF JAIL OR AN EMERGENCY DEPARTMENT. PRIMARY ACTIVITIES INCLUDE 1) DEPLOYING EVIDENCE-BASED TRAINING PRACTICES FOR COMMUNITY-BASED LEVELS OF STAFF, 2) HIRING PEER SUPPORT SPECIALISTS, 3) LINKING TO COMMUNITY-BASED SERVICES, AND 4) INCREASING TRANSPORTATION TO RESEARCH BEST PRACTICES AND CARE TEAM MODELS FOR WORKFORCE DEVELOPMENT AND STAFF RETENTION. THE SERVICE AREA WILL FOCUS ON THE FIVE-COUNTY AREA AROUND SIOUX FALLS, SD INCLUDING MINNEHAHA, LINCOLN, TURNER, MCCOOK, AND ROCK COUNTIES. THE INTENDED BENEFICIARIES ARE NON-VIOLENT, 18 YEARS OLD OR OLDER INDIVIDUALS WITH A SUBSTANCE USE OR MENTAL HEALTH DISORDER SEEKING SERVICES IN THE SERVICE AREA. THE KEY RESEARCH PARTNER IS THE UNIVERSITY OF SOUTH DAKOTA CENTER FOR RURAL HEALTH IMPROVEMENT, WHICH HAS EXTENSIVE EXPERIENCE RESEARCHING COMMUNITY-BASED SERVICES IMPACT ON THE CRIMINAL JUSTICE SYSTEM. KEY OUTCOMES INCLUDE: IMPROVED WELLBEING FOR CLIENTS AT THE LINK, FEWER DEATHS ASSOCIATED WITH SUBSTANCE USE DISORDER/MENTAL HEALTH (SUD/MH); A REDUCTION IN ARRESTS AND CHARGES ASSOCIATED WITH BEHAVIORAL HEALTH ISSUES; A REDUCTION IN RECIDIVISM IN STAKEHOLDER PROGRAMS; COST SAVINGS FOR KEY STAKEHOLDERS; SUSTAINABLE INVESTMENTS IN THE LINK ENSURING FUTURE FUNDING; AND TOOLKITS FOR REPLICABLE STAFF TRAINING AND CARE TEAM MODELS.