Mennonite General Hospital Inc

HEP C FREE PR: INTEGRATED RAPID HCV CARE FOR PEOPLE WITH SUD, SMI, AND HOMELESSNESS ACROSS 38 HIGH-NEED MUNICIPALITIES IN PUERTO RICO - HEP C FREE PUERTO RICO INTEGRATED CARE PILOT WILL SCREEN 10,000 HIGH-RISK ADULTS, START DIRECT-ACTING ANTIVIRAL (DAA) THERAPY IN 1,150, AND CONFIRM CURE (SVR12) IN 900 PEOPLE WITH HEPATITIS C VIRUS (HCV) ACROSS 38 MEDICALLY-UNDERSERVED MUNICIPALITIES IN THREE YEARS. BY EMBEDDING OPT-OUT, POINT-OF-CARE HCV/HIV TESTING AND SAME-DAY DAAS IN EVERY MENNONITE GENERAL HOSPITAL (MGHPR) EMERGENCY DEPARTMENT (11), CERTIFIED COMMUNITY BEHAVIORAL HEALTH CLINIC (5), PSYCHIATRIC UNIT, AND FIVE OUTREACH HUBS, THE PROJECT TACKLES PUERTO RICO'S INTERTWINED EPIDEMICS OF SUBSTANCE-USE DISORDER (SUD), SERIOUS MENTAL ILLNESS (SMI), HOMELESSNESS, AND HCV. PEER SPECIALISTS, TRAUMA-INFORMED NAVIGATORS, AND A TELE-INFECTIOUS-DISEASE HUB WILL DRIVE RAPID LINKAGE, HIGH ADHERENCE, AND DURABLE CURES. PROJECT NAME & APPLICANT. HEP C FREE PUERTO RICO INTEGRATED CARE PILOT - MENNONITE GENERAL HOSPITAL, INC. (MGHPR), THE ISLAND’S LARGEST NON-PROFIT INTEGRATED HEALTH SYSTEM. POPULATION TO BE SERVED. LOW-INCOME, SPANISH-SPEAKING PUERTO RICAN ADULTS (≥ 18 YRS) WITH ELEVATED HCV RISK AND CO-OCCURRING SUD/OUD AND/OR SMI, INCLUDING 1,302 UNHOUSED PERSONS AND 28,000 PEOPLE WHO INJECT DRUGS. TWO-THIRDS ARE MEN AGED 23-49; MEDICAID COVERS ~90 %. STRATEGIES & INTERVENTIONS. • UNIVERSAL, OPT-OUT RAPID HCV/HIV TESTING WITH REFLEX RNA CONFIRMATION IN 11 EDS, 6 HOSPITALS, 5 CCBHCS, 7 PARTNER MAT CLINICS, AND STREET TEAMS. • SAME-DAY TREATMENT PROTOCOL: BEDSIDE FIB-4 STAGING AND INITIATION OF AN 8-WEEK GLECAPREVIR/PIBRENTASVIR OR 12-WEEK SOFOSBUVIR/VELPATASVIR REGIMEN, SUPPORTED BY PHARMACY STARTER PACKS AND HOME DELIVERY. • PEER NAVIGATION, PREP-C-LITE–GUIDED MOTIVATIONAL INTERVIEWING, MODIFIED DIRECTLY OBSERVED THERAPY FOR UNSTABLY HOUSED CLIENTS, AND INTEGRATION OF MOUD, PSYCHIATRIC CARE, HAV/HBV VACCINATION, NALOXONE DISTRIBUTION, AND HOUSING NAVIGATION. • PROJECT TELE-CONSULTS, CARE COMPASS EHR ALERTS, AND PREDICTIVE ANALYTICS FROM PARTNER ESTUDIOS TÉCNICOS TO DRIVE REAL-TIME COORDINATION AND QUALITY IMPROVEMENT. GOALS & MEASURABLE OBJECTIVES (FY 2026–2028). GOAL 1 – IDENTIFY. SCREEN 10,000 UNDUPLICATED ADULTS ACROSS ALL MGHPR EMERGENCY DEPARTMENTS, CCBHCS, AND COMMUNITIES; DELIVER ≥ 95 % SAME-DAY ANTIBODY RESULTS AND REFLEX RNA CONFIRMATION WITHIN 24 HOURS. GOAL 2 – TREAT. INITIATE PANGENOTYPIC DAAS WITHIN SEVEN DAYS FOR 1,150 RNA-POSITIVE CLIENTS; EMBED PEER-LED READINESS COACHING AND ACHIEVE ≥ 90 % TREATMENT COMPLETION. GOAL 3 – CURE. CONFIRM SUSTAINED VIROLOGIC RESPONSE (SVR12) IN 900 PATIENTS-AN ≥ 85 % CURE RATE THAT SURPASSES SAMHSA TIER 3 (> 100 CURES / YEAR); RETEST HIGH-RISK CLIENTS AT 12 MONTHS AND HOLD REINFECTION TO ≤ 5 %. GOAL 4 – SUSTAIN. TRAIN 300 FRONTLINE STAFF THROUGH PROJECT ECHO, ACTIVATE REAL-TIME HCV DASHBOARDS IN EVERY SERVICE SITE, AND SECURE MEDICAID/340B REIMBURSEMENT FOR DAAS AND PEER SERVICES BY YEAR 3 TO INSTITUTIONALIZE THE MODEL POST-GRANT. PEOPLE TO BE SERVED. ANNUALLY THE PROJECT WILL REACH 3,250–3,950 INDIVIDUALS ACROSS SCREENING, TREATMENT, NAVIGATION, AND SUPPORTIVE SERVICES; OVER ITS LIFETIME IT WILL SERVE APPROXIMATELY 11,000 UNDUPLICATED RESIDENTS AND ACHIEVE 900 CURES—MEETING SAMHSA TIER 3 (> 100 CURES/YR) MICRO-ELIMINATION BENCHMARKS WHILE STRENGTHENING PUERTO RICO’S PUBLIC-HEALTH INFRASTRUCTURE.

CIMA CCBHC FOR THE RURAL CATCHMENT AREA - HOSPITAL MENONITA CIMA (CIMA), THE LARGEST NON-PROFIT SPECIALTY MENTAL HEALTH ORGANIZATION IN PUERTO RICO (PR) AND AN OPERATING DIVISION OF MENNONITE GENERAL HOSPITAL, INC. (MGHPR), THE LARGEST NON-PROFIT ORGANIZATION IN PR, WILL PLAN, DEVELOP, AND IMPLEMENT A CERTIFIED COMMUNITY BEHAVIORAL CLINIC (CCBHC) TO SERVE 2,000 INDIVIDUALS OVER FOUR YEARS IN 11 MUNICIPALITIES IN PR. THE CIMA CCBHC PROGRAM WILL PROVIDE COMPREHENSIVE AND COORDINATED BEHAVIORAL HEALTH SERVICES FOR ADULTS WITH SERIOUS MENTAL ILLNESS (SMI), SUBSTANCE USE DISORDER (SUD), INCLUDING OPIOID USE; CHILDREN AND ADOLESCENTS WITH SERIOUS EMOTIONAL DISTURBANCE (SED); INDIVIDUALS WITH CO-OCCURRING MENTAL AND SUBSTANCE DISORDERS (COD); AND INDIVIDUALS EXPERIENCING A MENTAL HEALTH OR SUBSTANCE USE-RELATED CRISIS. THESE 11 MUNICIPALITIES, WHICH EXPERIENCE SOME OF THE POOREST SOCIAL, ECONOMIC, AND HEALTH CONDITIONS IN PR, ARE AIBONITO, ARROYO, BARRANQUITAS, COAMO, COMERIO, GUAYAMA, MAUNABO, OROCOVIS, PATILLAS, SANTA ISABEL, AND SALINAS. OVERALL, 99% OF THE POPULATION IS HISPANIC AND PRIMARILY SPANISH-SPEAKING. HRSA CLASSIFIES THE ENTIRE ZONE AS MEDICALLY UNDERSERVED AND A HEALTH PROFESSIONAL SHORTAGE AREA FOR MENTAL HEALTH CARE PROVIDERS. OVER THE FOUR-YEAR PROGRAM, CIMA WILL ACHIEVE THE FOLLOWING: - OBJECTIVE 1: WITHIN 150 DAYS, COMPLETE A NEED ASSESSMENT IN THE CATCHMENT AREA THAT ADDRESSES CULTURAL, LINGUISTIC, TREATMENT, CULTURE, STAFFING NEEDS, TRANSPORTATION, INCOME, AND OTHER BARRIERS TO BE SERVED BY THE CCBHC. - OBJECTIVE 2: WITHIN 60 DAYS, COMPLETE A READINESS REVIEW USING THE CCBHC CERTIFICATION CRITERIA WITH AN EXTERNAL ORGANIZATION. - OBJECTIVE 3: WITHIN SIX MONTHS, COMPLY WITH 100% OF THE CCBHC CERTIFICATION CRITERIA. - OBJECTIVE 4: BY THE END OF THE PROGRAM, COMPLY WITH A 100% ANNUAL READINESS REVIEW USING THE CCBHC CERTIFICATION CRITERIA. - OBJECTIVE 5: BY THE END OF THE PROGRAM, REDUCE BY 15% THE SUICIDES IN THE CATCHMENT AREA (FROM BASELINE). - OBJECTIVE 6: BY THE END OF THE PROGRAM, INCREASE BY 25% THE NUMBER OF CONSUMERS INITIATED MEDICATION-ASSISTED TREATMENT (MAT) (FROM BASELINE). - OBJECTIVE 7: BY THE END OF THE PROGRAM, INCREASE THE NUMBER OF CONSUMERS WHO INITIATED THE SUD YOUTH PROGRAM BY 25% (FROM BASELINE). - OBJECTIVE 8: BY THE END OF THE PROGRAM, INCREASE THE NUMBER OF CONSUMERS RECEIVING PRIMARY CARE SCREENING BY 20% (FROM BASELINE). - OBJECTIVE 9: BY THE END OF THE PROGRAM, INCREASE THE NUMBER OF CONSUMERS WHO RECEIVE VOCATIONAL COUNSELING BY 15% (FROM BASELINE). - OBJECTIVE 10: BY THE END OF THE PROGRAM, CIMA EXPECTS TO REDUCE HOSPITAL UTILIZATION OF HIGH-UTILIZER INDIVIDUALS WITH SMI AND COD BY 25% (FROM THE BASELINE). - OBJECTIVE 11: BY THE END OF THE PROGRAM, CIMA ANTICIPATES AN INCREASE OF 15% IN THE REFERRALS TO THE FIRST PSYCHOSIS EPISODE PROGRAM (FROM THE BASELINE). THE PROGRAM WILL ENROLL 400 CLIENTS IN YEAR 1, 500 YEAR 2, 550 YEAR 3, AND 550 YEAR 4.

URBAN CCBHC IN THE CIMA AREA - HOSPITAL MENONITA CIMA (CIMA), THE LARGEST NON-PROFIT SPECIALTY MENTAL HEALTH ORGANIZATION IN PUERTO RICO (PR) AND AN OPERATING DIVISION OF MENNONITE GENERAL HOSPITAL, INC. (MGHPR), THE LARGEST NON-PROFIT ORGANIZATION IN PR, WILL PLAN, DEVELOP, AND IMPLEMENT A CERTIFIED COMMUNITY BEHAVIORAL CLINIC (CCBHC) TO SERVE 2,000 INDIVIDUALS OVER FOUR YEARS IN 11 MUNICIPALITIES IN PR. THE CIMA CCBHC PROGRAM WILL PROVIDE COMPREHENSIVE AND COORDINATED BEHAVIORAL HEALTH SERVICES FOR ADULTS WITH SERIOUS MENTAL ILLNESS (SMI), SUBSTANCE USE DISORDER (SUD), INCLUDING OPIOID USE; CHILDREN AND ADOLESCENTS WITH SERIOUS EMOTIONAL DISTURBANCE (SED); INDIVIDUALS WITH CO-OCCURRING MENTAL AND SUBSTANCE DISORDERS (COD); AND INDIVIDUALS EXPERIENCING A MENTAL HEALTH OR SUBSTANCE USE-RELATED CRISIS. THESE 11 MUNICIPALITIES, WHICH EXPERIENCE SOME OF THE POOREST SOCIAL, ECONOMIC, AND HEALTH CONDITIONS IN PR, ARE AGUAS BUENAS, CAGUAS, CAYEY, CIDRA, GURABO, HUMACAO, JUNCOS, NAGUABO, LAS PIEDRAS, SAN LORENZO, AND YABUCOA. OVERALL, 99% OF THE POPULATION IS HISPANIC AND PRIMARILY SPANISH-SPEAKING. HRSA CLASSIFIES THE ENTIRE ZONE AS MEDICALLY UNDERSERVED AND A HEALTH PROFESSIONAL SHORTAGE AREA FOR MENTAL HEALTH CARE PROVIDERS. OVER THE FOUR-YEAR PROGRAM, CIMA WILL ACHIEVE THE FOLLOWING: - OBJECTIVE 1: WITHIN 150 DAYS, COMPLETE A NEED ASSESSMENT IN THE CATCHMENT AREA THAT ADDRESSES CULTURAL, LINGUISTIC, TREATMENT, CULTURE, STAFFING NEEDS, TRANSPORTATION, INCOME, AND OTHER BARRIERS TO BE SERVED BY THE CCBHC. - OBJECTIVE 2: WITHIN 60 DAYS, COMPLETE A READINESS REVIEW USING THE CCBHC CERTIFICATION CRITERIA WITH AN EXTERNAL ORGANIZATION. - OBJECTIVE 3: WITHIN SIX MONTHS, COMPLY WITH 100% OF THE CCBHC CERTIFICATION CRITERIA. - OBJECTIVE 4: BY THE END OF THE PROGRAM, COMPLY WITH A 100% ANNUAL READINESS REVIEW USING THE CCBHC CERTIFICATION CRITERIA. - OBJECTIVE 5: BY THE END OF THE PROGRAM, REDUCE BY 15% THE SUICIDES IN THE CATCHMENT AREA (FROM BASELINE). - OBJECTIVE 6: BY THE END OF THE PROGRAM, INCREASE BY 25% THE NUMBER OF CONSUMERS WHO INITIATED MEDICATION-ASSISTED TREATMENT (MAT) (FROM BASELINE). - OBJECTIVE 7: BY THE END OF THE PROGRAM, INCREASE THE NUMBER OF CONSUMERS WHO INITIATED THE SUD YOUTH PROGRAM BY 25% (FROM BASELINE). - OBJECTIVE 8: BY THE END OF THE PROGRAM, INCREASE THE NUMBER OF CONSUMERS RECEIVING PRIMARY CARE SCREENING BY 20% (FROM BASELINE). - OBJECTIVE 9: BY THE END OF THE PROGRAM, INCREASE THE NUMBER OF CONSUMERS WHO RECEIVE VOCATIONAL COUNSELING BY 15% (FROM BASELINE). - OBJECTIVE 10: BY THE END OF THE PROGRAM, CIMA EXPECTS TO REDUCE HOSPITAL UTILIZATION OF HIGH-UTILIZER INDIVIDUALS WITH SMI AND COD BY 25% (FROM THE BASELINE). - OBJECTIVE 11: BY THE END OF THE PROGRAM, CIMA ANTICIPATES AN INCREASE OF 15% IN THE REFERRALS TO THE FIRST PSYCHOSIS EPISODE PROGRAM (FROM THE BASELINE). THE PROGRAM WILL ENROLL 400 CLIENTS IN YEAR 1, 500 YEAR 2, 550 YEAR 3, AND 550 YEAR 4.

CIMA CCBHC - EASTERN AREA OF PUERTO RICO - AS A CCBHC-PDI GRANT AWARDEE, HOSPITAL MENONITA CIMA (CIMA) WILL PROVIDE CCBHC SERVICES TO THE MUNICIPALITIES OF JUNCOS, LAS PIEDRAS, YABUCOA, HUMACAO, NAGUABO, CEIBA, AND CULEBRA IN SOUTHEASTERN PUERTO RICO. CIMA WILL SERVE ALL INDIVIDUALS ACROSS THE LIFESPAN IN NEED OF BEHAVIORAL HEALTH (BH) CARE, WITH A PARTICULAR FOCUS ON ADDRESSING BH DISPARITIES FOR INDIVIDUALS OVER 65 YEARS OLD WITH BH DISORDERS AND YOUTH WITH SUBSTANCE USE DISORDERS (SUD). CIMA'S PROJECT GOALS ARE TO: 1. INCREASE CAPACITY TO PROVIDE MENTAL HEALTH TREATMENT TO OLDER INDIVIDUALS (AGE 65 AND ABOVE); 2. IMPROVE AND EXPAND MENTAL HEALTH AND TRAUMA-RELATED EVIDENCE-BASED SCREENINGS AND PRACTICES; 3. INCREASE ACCESS TO EVIDENCE-BASED SUD SERVICES; AND 4. INCREASE ACCESS TO WRAP-AROUND SERVICES TO ADDRESS CLIENTS' PHYSICAL HEALTH AND SOCIAL NEEDS. WE WILL ADDRESS THESE GOALS BY: (1) INCORPORATING CLINICAL PATHWAYS FOR ELDERLY POPULATION-RELATED DIAGNOSES AND FOR DEPRESSION, PTSD, AND ANXIETY, IMPLEMENTED WITH AT LEAST 80% FIDELITY ON THE FIDELITY SCALE; (2) SCREENING AT LEAST 75% OF CCBHC CLIENTS FOR SUICIDE USING THE COLUMBIA SUICIDE SEVERITY RATING SCALE (C-SSRS) ANNUALLY; (3) SCREENING AT LEAST 75% OF CCBHC CLIENTS BH DISORDERS ANNUALLY USING STANDARDIZED AND VALIDATED INSTRUMENTS (E.G., PHQ-9, GAD-7, CRAFFT, AUDIT, C-SSRS, FTND, CAST, TSQ, S2BI, CAGE); (4) INCREASING REFERRALS TO OUR FIRST EPISODE PSYCHOSIS (FEP) PROGRAM BY 15% OVER BASELINE; (5) REDUCING ASSERTIVE COMMUNITY TREATMENT (ACT) PARTICIPANTS' EMERGENCY DEPARTMENT (ED) USE BY 50%; (6) INCREASING THE NUMBER OF CLIENTS WHO INITIATED MEDICATION-ASSISTED TREATMENT (MAT) AND THE SUD YOUTH PROGRAM BY 25% FROM BASELINE OVER THE GRANT PERIOD; (7) INCREASING THE NUMBER OF CLIENTS WHO RECEIVE VOCATIONAL COUNSELING BY 15% FROM BASELINE; AND (8) INCREASING THE NUMBER OF CLIENTS RECEIVING PRIMARY CARE SCREENING BY 20% FROM BASELINE. WE WILL COLLABORATE WITH THE MENTAL HEALTH AND ANTI-ADDICTION SERVICES ADMINISTRATION (MHAASA), THE GOVERNMENT ENTITY RESPONSIBLE FOR MENTAL HEALTH AND SUD IN PUERTO RICO, TO PROVIDE 988 CRISIS HOTLINE AND MOBILE CRISIS SERVICES. WE WILL ALSO ESTABLISH A REFERRAL AGREEMENT WITH NEOMED, A LOCAL FQHC PROVIDING PRIMARY AND HIV CARE, AND ESTANCIA SERENA, A RESIDENTIAL DETOXIFICATION CENTER THAT PROVIDES MAT FOR INDIVIDUALS WITH SUD. WE WILL PARTNER WITH THE UNIVERSITY OF PUERTO RICO - MEDICAL SCIENCES CAMPUS (RCM) TO ADAPT OUR EVIDENCE-BASED PRACTICES TO ENSURE THEY ARE CULTURALLY AND LINGUISTICALLY APPROPRIATE FOR OUR POPULATION AND PROVIDE TRAINING IN MEASUREMENT-BASED CARE TO OUR STAFF. FINALLY, WE WILL PARTNER WITH PLAN DE SALUD MENONITA (PSM), AN OPERATING DIVISION OF MENNONITE GENERAL HOSPITAL, INC. (MGHPR) AND A HEALTH INSURANCE PLAN THAT PROVIDES COVERAGE FOR 200,000+ COMMERCIAL AND MEDICAID BENEFICIARIES IN PUERTO RICO, TO IDENTIFY INDIVIDUALS WITH SERIOUS MENTAL ILLNESS (SMI), SERIOUS EMOTIONAL DISTURBANCE (SED), SUD, AND CO-OCCURRING DISORDERS (COD) TO REFER THEM TO OUR CCBHC AND GATHER BENEFICIARY DATA TO IDENTIFY HIGH-UTILIZING PATIENTS FOR TCM ENGAGEMENT. THE PROJECT WILL SERVE 400 UNDUPLICATED INDIVIDUALS IN THE FIRST TWO YEARS OF THE PROJECT AND 600 INDIVIDUALS IN THE LAST TWO YEARS OF THE PROJECT, FOR A TOTAL 2,000 INDIVIDUALS OVER THE COURSE OF THE PROJECT.

MENNONITE HEALTH SYSTEM ZERO SUICIDE IMPLEMENTATION PROJECT - MENNONITE GENERAL HOSPITAL (MGHPR), THE LARGEST HEALTH SERVICE ORGANIZATION IN PUERTO RICO (PR), WILL IMPLEMENT THE SEVEN ELEMENTS OF THE ZERO SUICIDE FRAMEWORK (ZSF) TO REDUCE SUICIDE IDEATION, ATTEMPTS, AND DEATHS IN 27 COUNTIES ON THE ISLAND. THE ORGANIZATION, AS AN INTEGRATED HEALTH SYSTEM, OPERATES SIX GENERAL HOSPITALS, 11 EDS, CARE MANAGEMENT, HEALTH INSURANCE, A HOME HEALTH AGENCY, AND A HOSPICE. CIMA, AN OPERATING DIVISION OF MGHPR, IS THE LARGEST NON-PROFIT SPECIALTY BH ORGANIZATION IN PR. IT MANAGES FIVE CERTIFIED COMMUNITY BEHAVIORAL CLINICS (CCBHC), A PSYCHIATRIC HOSPITAL, A STABILIZATION UNIT, AND FIVE PARTIAL HOSPITALIZATION PROGRAMS. ALL THESE SERVICES ARE AVAILABLE, SITUATED, AND COORDINATED IN THE CA USING THE HUB AND SPOKES MODEL. THE ORGANIZATION IS THE ONLY ONE IN PR WITH ALL LEVELS OF SERVICES (BH AND PHYSICAL HEALTH) TO PROVIDE INTEGRATED CARE SERVICES AND TRANSITIONS FOR INDIVIDUALS AT RISK OF SUICIDE WITHIN A SINGLE SYSTEM. THESE 27 MUNICIPALITIES, WHICH EXPERIENCE SOME OF THE POOREST SOCIAL, ECONOMIC, AND HEALTH CONDITIONS IN PR, ARE AIBONITO, COAMO, LAS PIEDRAS, AGUAS BUENAS, COMERIO, MAUNABO, ARROYO, GUAYAMA, NAGUABO, BARRANQUITAS, GURABO, OROCOVIS, CAGUAS, HUMACAO, PATILLAS, CAYEY, JAYUYA, SAN LORENZO, VILLALBA, CEIBA, JUANA DIAZ, SANTA ISABEL, YABUCOA, CIDRA, JUNCOS, SALINAS, AND PONCE. OVERALL, 98% OF THE POPULATION IS HISPANIC AND PRIMARILY SPANISH-SPEAKING. HRSA CLASSIFIES THE ENTIRE ZONE AS MEDICALLY UNDERSERVED AND A HEALTH PROFESSIONAL SHORTAGE AREA FOR MENTAL HEALTH CARE PROVIDERS. TWO SUBGROUPS ARE HIGHLIGHTED AND ATTENDED TO WITH THE PROJECT. THE CATCHMENT POPULATION IS DECLINING, PRIMARILY DUE TO THE OUTMIGRATION OF WORKING-AGE ADULTS, WHILE THE NUMBER OF ADULTS OVER AGE 65 IS GROWING, THE ONLY AGE GROUP TO DO SO, LEAVING THEM WITHOUT SOCIAL SUPPORT. ON THE OTHER HAND, THE INCIDENCE OF SUICIDE AMONG VETERANS IS 16.9 PER 100,000, MORE THAN DOUBLE THE AVERAGE RATE IN PR. IN ADDITION, MEN ACCOUNT FOR 80% OF SUICIDES IN PR, WITH A RATE THAT HAS BEEN CONSISTENTLY ABOVE 15 PER 100,000 IN RECENT YEARS. OVER THE FIVE-YEAR PROGRAM, MGHPR WILL ACHIEVE THE FOLLOWING: GOAL 1 IMPLEMENT THE SEVEN ELEMENTS OF THE ZSF AT MGHPR 1.A WITHIN 90 DAYS, COMPLETE AND OPERATIONALIZE CLINICAL PATHWAYS FOR PERSONS WITH NATURAL DISASTER TRAUMA AND OLDER ADULTS. 1.B WITHIN 90 DAYS, COMPLETE AND OPERATIONALIZE A CLINICAL AND REFERRAL PATHWAY FOR VETERANS TO VA. 1.C WITHIN 120 DAYS, ADAPT THE ZSF TO SPANISH AND BEGIN IMPLEMENTING THE SEVEN ELEMENTS OF THE ZSF, INCLUDING THE STAFF EDUCATION PROGRAM. GOAL 2 REDUCE THE SUICIDE RATE IN THE CA. 2.A BY THE END OF THE PROGRAM, INCREASE THE NUMBER OF CONSUMERS IDENTIFIED IN THE MGHPR EDS AND REFER THEM TO ITS CCCBHC BY 25%, FROM THE BASELINE. 2.B BY THE END OF THE PROGRAM, ACHIEVE 75% ENGAGEMENT OF SUICIDE TREATMENT PARTICIPANTS. 2.C BY THE END OF THE PROGRAM, 90% OF SUICIDE TREATMENT PARTICIPANTS WILL REDUCE THEIR SUICIDAL THOUGHTS. 2.D BY THE END OF THE PROGRAM, REDUCE THE SUICIDE RATE IN THE CA BY 25%. THE PROGRAM WILL ENROLL 400 CLIENTS IN YEAR 1, 1000 YEAR 2, 1000 YEAR 3, 1000 YEAR 4, AND 1000 YEAR 5.