Southern Highlands Community Mental Health Center

COVID SUPPORT IN RURAL APPALACHIA (CSIRA) - THE CSIRA INITIATIVE FOCUSES ON SUPPORTING & RESTORING THE DELIVERY OF CLINICAL SERVICES THAT WERE IMPACTED BY COVID-19 AND TO EFFECTIVELY ADDRESS THE NEEDS OF THOSE WITH SED/SMI/COD LOCATED IN MERCER, MCDOWELL & WYOMING COUNTIES IN RURAL SOUTHERN WEST VIRGINIA ALL OF WHICH SUFFER FROM COVID-MAGNIFIED GRIEF, TRAUMA, OVERDOSE, POVERTY, POOR MENTAL HEALTH AND A BROKEN MENTAL HYGIENE PROCESS. CSIRA WILL SERVE 1,000 CLIENTS (500-Y1, 500-Y2). PROJECT GOALS (INTERVENTIONS/STRATEGIES) ARE TO: SUPPORT/RESTORE THE DELIVERY OF CLINICAL SERVICES IMPACTED BY THE COVID-19 PANDEMIC & EFFECTIVELY ADDRESS THE NEEDS OF THOSE WITH SED/SMI/COD BY (1) EXPANDING CRISIS SERVICES VIA (A) HIRING A COMMUNITY CRISIS SYSTEM EVALUATOR TO RESTORE THE CRISIS SYSTEM & MENTAL HYGIENE PROCESS; (B) HIRING 8 COVID CRISIS COMMUNITY NAVIGATORS TO LINK THE COMMUNITY W/ CRISIS RESOURCES; (C) TRAINING 9 CRISIS STAFF IN GRIEF COUNSELING AND MENTAL HEALTH FIRST AID, ETC.; (D) HIRING AN ASSISTANT CHILDRENS CLINICAL SERVICES DIRECTOR TO INCREASE YOUTH CRISIS OUTREACH; (E) ADDING CHILDRENS CLINIC FNP TIME TO INCREASE CAPACITY TO SERVE YOUTH IN CRISIS, (2) EMPOWERING LAW ENFORCEMENT TO SERVE THOSE WITH SED/SMI/COD VIA (A) CONTRACTING WITH COUNTY COMMISSIONS TO HIRE MENTAL HEALTH DEPUTIES; (B) HIRING 3 LAW ENFORCEMENT CASE MANAGERS TO SUPPORT MENTAL HEALTH DEPUTIES; (C) TRAINING MENTAL HEALTH DEPUTIES & LAW ENFORCEMENT CASE MANAGERS IN MENTAL HEALTH, CIT, QUICK RESPONSE DE-ESCALATION & HANDLE WITH CARE; (D) SENDING CSIRA STAFF TO THE INTERNATIONAL CIT CONFERENCE; (3) EXPANDING SOUTHERN HIGHLAND SERVICES TO ADDRESS THE MENTAL HEALTH COVID FALLOUT VIA (A) EXPANDING THERAPIST & THERAPIST SUPERVISION TIME TO REDUCE WAIT LIST TIMES; (B) EXPANDING MEDICAL PROVIDER & DIRECTOR TIME TO REDUCE WAIT LIST TIMES; (C) HIRING A TELEHEALTH COORDINATOR; (D) EXPANDING ADMINISTRATIVE CAPACITY TO FACILITATE INCREASED MENTAL HEALTH SERVICE NEEDS; (E) TRAINING DIRECT STAFF IN EVIDENCE-BASED MENTAL HEALTH FIRST AID & EMDR; (F) HIRING A PR COORDINATOR TO FURTHER EXPAND KNOWLEDGE OF SHCMHC SERVICES INTO THE COMMUNITY & REDUCE STIGMA; (G) INITIATING ANNUAL REQUIRED LGBTQ+ TRAININGS; (4) SUPPORTING STAFF MENTAL HEALTH VIA (A) INITIATING AN EMPLOYEE ASSISTANCE PROGRAM; (B) PROVIDING STAFF LEADERSHIP TRAINING; (C) REIMBURSING STAFF FOR EXERCISE MEMBERSHIPS; (D) INITIATING WELLNESS FUNDS FOR DIRECTORS TO SUPPORT SPECIFIC TEAM NEEDS; (E) INITIATING A STAFF RECOGNITION PROGRAM; (5) IMPROVING CLIENT OUTCOMES TO INCLUDE (A) SERVING 1,000 CLIENTS; (B) SIGNIFICANTLY IMPROVING MENTAL HEALTH OUTCOMES; (B) REDUCING SUBSTANCE USE & INCARCERATION DAYS; (C) RETAINING CLIENTS IN TREATMENT; (D) ENSURING THAT DISPARITY GROUP CLIENTS HAVE EQUAL SERVICE ACCESS, USE & OUTCOMES; (6) SUSTAINING CSIRA SERVICES VIA (A) CREATING A SUSTAINABILITY PLAN; (B) HIRING AN EVALUATION SPECIALIST TO SUPPORT DATA-DRIVEN SERVICE SUSTAINABILITY; (C) INITIATING AN ADVISORY BOARD; (D) MAXIMIZING THE AGENCY EHR.

SOUTHERN HIGHLANDS CCBHC-IA INITIATIVE - THE SOUTHERN HIGHLANDS CCBHC-IA INITIATIVE WILL PROVIDE COMPREHENSIVE, COORDINATED BEHAVIORAL HEALTH CARE FOR ALL PEOPLE IN NEED OF BEHAVIORAL HEALTH SERVICES AT SOUTHERN HIGHLANDS’ MERCER COUNTY CLINIC WHICH SERVES MERCER, MCDOWELL & WYOMING COUNTIES IN WV. THE TARGET POPULATION SUFFERS FROM SUD, POOR MENTAL HEALTH, LOW MENTAL HEALTH WORKFORCE CAPACITY, POOR SDOH & POOR DISPARITY GROUP OUTCOMES. THE INITIATIVE WILL SERVE 4,000 CLIENTS (1,000/YEAR). PROJECT GOALS (INTERVENTIONS/STRATEGIES) INCLUDE: (1) PROVIDE A COMPREHENSIVE SUITE OF CCBHC SERVICES FOR THE TARGET POPULATION WITH FIDELITY TO THE CCBHC CERTIFICATION CRITERIA AND BASED ON REGULAR NEEDS ASSESSMENTS BY (A) INITIATING A PROJECT DIRECTOR & COORDINATOR TO MANAGE THE CCBHC INITIATIVE; (B) ENSURING AGENCY COMPLIANCE WITH THE CCBHC CERTIFICATION CRITERIA; (C) COLLABORATING WITH THE STATE TO OBTAIN CCBHC CERTIFICATION; (D) CONDUCTING THE REQUIRED NEEDS ASSESSMENT; (E) COMPLETING THE CCBHC ATTESTATION POST NEEDS ASSESSMENT; (F) IMPLEMENTING THE NEEDS ASSESSMENT DRIVEN TRAINING PLAN; (G) SUPPORTING PROCESSES & PROCEDURES FOR COLLECTING, REPORTING & TRACKING ENCOUNTER, OUTCOME, AND QUALITY DATA; AND (H) ENSURING AGENCY PARTICIPATION IN THE CCBHC TECHNICAL ASSISTANCE CENTER ACTIVITIES. (2) ENHANCE SHCMHC’S MERCER COUNTY CCBHC SERVICE PROVISION FOR THE TARGET POPULATION BY (A) ENHANCING CRISIS SERVICES BY HIRING 3 MOBILE CRISIS CASE MANAGERS, 2 CASE MANAGERS, 3 MOBILE CRISIS PEERS, A MOBILE CRISIS COORDINATOR & ASSISTANT CRISIS EVALUATOR TO PROVIDE 24 HOUR MOBILE CRISIS AND FOLLOW-UP SERVICES; (B) ENHANCING SCREENING/ASSESSMENT SERVICES BY ADDING THE COLUMBIA SUICIDE SCREENER AND A CRISIS ASSESSMENT; (C) ENHANCING SUD SERVICE VIA ENHANCEMENT OF AN ACT-LIKE INTENSIVE PROGRAM FOR TREATMENT RESISTANT SUD CLIENTS; (D) EXPANDING TELEHEALTH SERVICES VIA HIRING A TELEHEALTH COORDINATOR; (E) ENHANCING PEER SERVICES VIA ADDITION OF 3 MOBILE CRISIS PEERS AND ONE SUD PEER; (F) CREATING & INITIATING A TOBACCO CESSATION PROGRAM; (G) WORKING TO OBTAIN MOUS WITH VETERAN SERVING ORGANIZATIONS; (H) ENHANCING TREATMENT/CRISIS PLANNING & TARGETED CASE MANAGEMENT; (I) CONTINUING TO PARTNER WITH TUG RIVER FOR PRIMARY CARE SERVICE PROVISION; AND (J) CONTINUING TO PROVIDE PSYCHIATRIC REHABILITATION SERVICES. (3) ENHANCE CCBHC INFRASTRUCTURE DEVELOPMENT AT SHCMHC’S MERCER COUNTY CCBHC CLINIC BY (A) MAINTAINING HEALTH INFORMATION TECHNOLOGY (HIT) SYSTEMS TO FACILITATE CARE COORDINATION; (B) BUILDING PARTNERSHIPS TO SUPPORT ELECTRONIC HEALTH INFORMATION EXCHANGE & CARE COORDINATION; AND (C) UPDATING AND IMPLEMENTING A CCBHC-WIDE DATA-DRIVEN CONTINUOUS QUALITY IMPROVEMENT (CQI) PLAN. (4) SUPPORT RECOVERY FROM MENTAL ILLNESS AND OR SUBSTANCE USE DISORDERS BY PROVIDING ACCESS TO HIGH-QUALITY MENTAL HEALTH AND SUBSTANCE USE SERVICES TO THE TARGET POPULATION BY (A) COORDINATING OUTREACH EFFORTS; (B) SERVING A TOTAL OF 1,000 CLIENTS ANNUALLY; (C) CLIENTS HAVING A STATISTICALLY SIGNIFICANT DECREASE IN ILLICIT SUBSTANCE USE AT 6-MONTH NOMS FOLLOW-UP; (D) CLIENTS HAVING STATISTICALLY SIGNIFICANT IMPROVEMENT IN MENTAL HEALTH OUTCOMES AT 6-MONTH FOLLOW-UP; (E) CLIENTS HAVING STATISTICALLY SIGNIFICANT IMPROVEMENT IN SOCIAL CONNECTEDNESS AT 6-MONTH FOLLOW-UP; (F) CLIENTS HAVING STATISTICALLY SIGNIFICANT DECREASE IN TOBACCO USE AT 6-MONTH NOMS FOLLOW-UP; (G) HAVING 80% OF CLIENTS REMAIN IN TREATMENT FOR AT LEAST 6-MONTHS THROUGHOUT THE LIFE OF THE GRANT; (H) MONITORING DISPARITY GROUP DATA TO ENSURE EQUAL ACCESS/USE/OUTCOMES/RETENTION; (I) SUPPORTING ANNUAL CRISIS INTERVENTION TRAINING (CIT) TRAINING FOR LAW ENFORCEMENT PARTNERS; AND (J) DEVELOPING OUTREACH/REFERRAL PATHWAYS THAT ENGAGE/TARGET ALL DISPARITY GROUPS. (5) SUSTAIN CCBHC SERVICES BEYOND GRANT FUNDING TO SERVE THE FOCUS POPULATION BY (A) HAVING THE PROJECT DIRECTOR LEAD THE PEER-DRIVEN CCBHC ADVISORY BOARD; AND (B) CREATING A SUSTAINABILITY PLAN FOR EACH BUDGET LINE ITEM TO ENSURE SERVICE SUSTAINABILITY.

SOUTHERN HIGHLANDS COMMUNITY BEHAVIORAL HEALTH CENTER CCBHC EXPANSION INITIATIVE - SHCMHC CCBHC EXPANSION INITIATIVE FOCUSES ON STRENGTHENING COMPREHENSIVE BEHAVIORAL HEALTH SERVICES TO THOSE W/SERIOUS MENTAL ILLNESS, SUBSTANCE USE DISORDER (INCLUDING OPIOID DISORDER); CHILDREN W/SERIOUS EMOTIONAL DISTURBANCE, AND THOSE WITH CO-OCCURRING MENTAL & SUD LOCATED IN MERCER CO. WEST VIRGINIA WHILE INCREASING SERVICES TO RURAL WYOMING & MCDOWELL COUNTIES, ALL OF WHICH SUFFER FROM HIGH OVERDOSE RATES, POVERTY & LACK OF TRANSPORTATION/SERVICES. THE INITIATIVE WILL SERVE 2,000 INDIVIDUALS (1,000-Y1, 1,000-Y2). PROJECT GOALS (INTERVENTIONS/ STRATEGIES) ARE TO (1) INCREASE ACCESS TO COMMUNITY MENTAL/SUD TREATMENT SERVICES FOR THE FOCUS POPULATION VIA (A) FINALIZING A STAFFING PLAN BASED ON A NEEDS ASSESSMENT FOCUSED ON POPULATION CULTURAL, LINGUISTIC & TREATMENT NEEDS; (B) HIRING A TELEHEALTH COORDINATOR IN TO COORDINATE SERVICES, TRAIN STAFF & TROUBLESHOOT TECHNOLOGY; (C) EXPANDING PSYCHIATRIST TIME TO INCREASE MENTAL HEALTH SERVICES AVAILABLE TO THE FOCUS POPULATION; (D) INITIATING AN ACT-SUD PROGRAM TO ENSURE THAT CLIENTS ACCESS THE APPROPRIATE LEVEL OF CARE; (E) INITIATING A MOBILE CLINIC WHICH WILL ENHANCE SERVICE ACCESS IN RURAL AREAS; (F) EXPANDING AFTER HOURS SERVICES IN ALL CLINICS TO INCREASE SERVICE ACCESS; (G) HIRING AN INFECTION CONTROL SPECIALIST TO REFER/EDUCATE CLIENTS RE DISEASES; (H) EXPANDING THERAPY, PSYCH & RX SERVICES IN MCDOWELL COUNTY; (I) HIRING A FINANCIAL SERVICES SPECIALIST TO ASSIST CLIENTS & STAFF WITH NAVIGATING THE FINANCES; (2) IMPROVE THE QUALITY OF COMMUNITY MENTAL & SUD TREATMENT SERVICES FOR THE FOCUS POPULATION VIA (A) IMPLEMENTING A STAFF TRAINING PLAN DETERMINED BY THE NEEDS ASSESSMENT; (B) IMPLEMENTING TECHNICAL ASSISTANCE TRAINING FOR INTEGRATING MENTAL & PHYSICAL HEALTHCARE; (C) PROVIDING FOR STAFF LICENSES & SUSTAINABLY INCREASED COMPENSATION NEEDED FOR SERVICE EXPANSION; (3) IMPROVE CLIENT OUTCOMES AS A RESULT OF THE CCBHC EXPANSION VIA (A) SERVING 1K CLIENTS IN Y1 & 1K CLIENTS IN Y2; (B) MEASURING OUTCOMES FOR ALL IMPLEMENTED SCREENERS; (C) CLIENTS IMPROVING AT LEAST ONE MENTAL HEALTH STATUS OR FUNCTIONING OUTCOME/YEAR; (D) CLIENTS IMPROVING AT LEAST ONE PHYSICAL HEALTH INDICATOR/YEAR; (E) CLIENTS REDUCING ILLICIT SUBSTANCE USE BY 10% AT 6-MO INTERVIEW; (F) CLIENTS REMAINING IN TREATMENT FOR AT LEAST 6-MO; (G) MONITORING DISPARITY GROUP (RURAL, LGBT+, AFRICAN AMERICAN, VETERAN, UNABLE TO PAY) OUTCOMES TO ENSURE EQUAL ACCESS/USE/OUTCOMES; (4) IMPROVE COMMUNITY CRISIS RESPONSE/SERVICES TO ENSURE INDIVIDUALS IN CRISIS RECEIVE THE APPROPRIATE CARE LEVEL VIA (A) HIRING A COMMUNITY CRISIS SYSTEM EVALUATOR TO EDIT THE CRISIS SYSTEM & MENTAL HYGIENE PROCESS THAT HAS ERODED DUE TO COVID; (B) FUNDING A SOCIAL WORKER TO WORK WITH LAW ENFORCEMENT TO HANDLE MENTAL HEALTH & SUD RELATED INCIDENTS; (5) SUSTAIN CCBHC EXPANSION SERVICES FOR THE FOCUS POPULATION VIA (A) HIRING AN EVALUATION SPECIALIST IN TO INITIATE MOVING FROM FEE FOR SERVICE TO VALUE-BASED REIMBURSEMENT; (B) WORKING TO MAXIMIZE THE AGENCY EHR; (C) WORKING TO CREATE CCBHC FRIENDLY POLICY REVISIONS; (C) INITIATING A SUSTAINABLE TUITION REIMBURSEMENT PROGRAM; (D) JOINING OTHER WV STATE CCBHC EXPANSION GRANTEES IN WORKING WITH THE STATE TO ACHIEVE FORMAL CCBHC STATUS; (E) CREATING A SUSTAINABILITY PLAN.

COMAT: COMMUNITY OUTREACH MAT INITIATIVE - COMAT INCREASES THE NUMBER OF PEOPLE WITH OUD RECEIVING MOUD & DECREASES ILLICIT OPIOID DRUG USE/RX OPIOID MISUSE IN ADULTS WITH OPIOID USE DISORDER (OUD) SEEKING/RECEIVING MAT WHO ARE LIVING/BEING TREATED IN RURAL MERCER, MCDOWELL & WYOMING COUNTIES, WV. THE FOCUS POP. SUFFERS HIGH OPIOID OVERDOSE DEATHS, POOR SOCIAL DETERMINANTS OF HEALTH, HIGH INFECTIOUS DISEASE RATES & MULTIGENERATIONAL DRUG USE. COMAT SERVES 200 CLIENTS/YEAR (1,000 TOTAL). PROJECT GOALS & MEASURABLE OBJECTIVES (INTERVENTIONS/STRATEGIES) ARE TO (1) INCREASE THE NUMBER OF INDIVIDUALS WITH OUD RECEIVING MOUD BY INCREASING WORKFORCE CAPACITY BY (A) EXPANDING WORKFORCE CAPACITY BY HIRING & TRAINING 3 CASE MANAGERS, 3 PEER RECOVERY SUPPORT SPECIALISTS (PRSS), 1 PROJECT DIRECTOR, AN EVALUATION TEAM & INCREASING MED. PROVIDER/DIRECTOR TIME; (B) INCREASING MAT SERVICE CAPACITY TO INCREASE THE NUMBER AND SPEED OF PSYCHIATRIC EVALUATIONS, THUS REDUCING CLIENT WAIT TIMES BY 10% BY THE END OF THE 5-YEAR GRANT PERIOD; (C) EXPANDING THE PRESCRIPTION DRUG MONITORING PROGRAM (PDMP) USE BY ENSURING THAT THREE SHCMHC DELEGATES ARE TRAINED TO USE THE PDMP & (D) ENSURING THAT THE NEWLY HIRED MEDICAL PROVIDER OBTAINS A DATA WAIVER TO PRESCRIBE BUPRENORPHINE TO MORE THAN 30 PATIENTS. (2) INCREASE THE # OF INDIVIDUALS WITH OUD RECEIVING MOUD BY EXPANDING COMMUNITY OUTREACH BY (A) CONDUCTING A 5-YEAR OVERDOSE FATALITY ANALYSIS WITH THE PURPOSE OF DEVELOPING A TARGETED OUTREACH STRATEGY TO REDUCE COMMUNITY OVERDOSE; (B) PARTNERING WITH THE QRT TO APPLY THE RING IMMUNIZATION MODEL TO OVERDOSE VICTIMS; (C) CONDUCTING TWO CULTURALLY COMPETENT OUTREACH ACTIVITIES IN EACH COUNTY IN EACH QUARTER; (D) CONDUCTING QUARTERLY SPECIALIZED DISPARITY GROUP OUTREACH EVENTS TO ENGAGE THE DISPARITY POPULATIONS (LGBT+, AFRICAN AMERICAN, VETERANS & THOSE IN POVERTY); (E) PROVIDING TRANSPORTATION SERVICES TO CLIENTS WHO LACK TRANSPORTATION OR BROADBAND SERVICES; (F) PROVIDING SERVICES TO COMAT CLIENT FAMILY MEMBERS; (G) SCREENING LOCAL INMATES FOR OUD, PROVIDE SERVICE REFERRALS, INTAKES & TRANSPORTATION TO APPROPRIATE SERVICES UPON RELEASE; (H) PURCHASING AVATAR CARE ROUTING SOFTWARE TO MAXIMIZE ON-CALL WORKFORCE CAPACITY & (I) CONTINUING PARTNERING WITH ONE VOICE AND COMMUNITY CONNECTIONS IN SUPPORT OF HARM REDUCTION. (3) IMPROVE OUTCOMES FOR ADULTS WITH OUD SEEKING OR RECEIVING MAT BY (A) SERVING 200 CLIENTS EACH YEAR; (B) DECREASING ILLICIT OPIOID DRUG USE AND RX OPIOID MISUSE AT 6-MONTH FOLLOW-UP; (C) EMPOWERING CLIENTS TO EXPERIENCE SIGNIFICANT IMPROVEMENT IN NOMS MENTAL HEALTH OUTCOMES AT 6-MONTH FOLLOW-UP; (D) EMPOWERING 80% OF CLIENTS TO REMAIN IN TREATMENT FOR AT LEAST 6-MONTHS THROUGHOUT THE LIFE OF THE GRANT; (E) MONITORING DISPARITY GROUP OUTCOMES TO ENSURE EQUAL ACCESS/OUTCOMES; (F) PARTNERING WITH TUG RIVER TO PROVIDE INFECTIOUS DISEASE SERVICES & (G) IDENTIFYING A STAFF MEMBER TO BE TRAINED IN RX FOR CHANGE AND TO DEVELOP/IMPLEMENT A TOBACCO CESSATION PROGRAM FOR CLIENTS WITH OUD WHO ARE RECEIVING MOUD. (4) SUSTAIN COMAT SERVICES BEYOND GRANT FUNDING BY (A) CREATING A SUSTAINABILITY PLAN FOR EACH COMAT BUDGET LINE ITEM TO ENSURE SUSTAINABILITY & (B) SUSTAINING CLIENT/FAMILY MEMBER ENGAGEMENT IN THE PROGRAM BY INVOLVING CLIENTS/FAMILY MEMBERS IN THE COMAT ADVISORY BOARD.

SOUTHERN BLUESTONE HEALTH CENTER

MAT ACCESS FOR RURAL APPALACHIANS (MARA)

RURAL COMMUNITIES OPIOID RESPONSE PROGRAM ? NEONATAL ABSTINENCE SYNDROME - RURAL COMMUNITIES OPIOID RESPONSE PROGRAM – NEONATAL ABSTINENCE SYNDROME

RURAL COMMUNITIES OPIOID RESPONSE PROGRAM ? NEONATAL ABSTINENCE SYNDROME

HEALTHCARE ACCESS

WYOMING COUNTY PREVENTION COALITION

SOUTHERN BLUESTONE HEALTH CENTER