Transformation Transfer Initiative
In a continued effort to assist states in transforming their mental health systems of care the Substance Abuse and Mental Health Services Administration (SAMHSA) and its Center for Mental Health Services (CMHS) has created the Transformation Transfer Initiative (TTI). The TTI provides, on a competitive basis, modest funding awards to States, the District of Columbia, and the Territories not currently participating in the Mental Health Transformation State Incentive Grant* (T-SIG) program. To view the
These flexible TTI funds are to be used to identify, adopt, and strengthen transformation initiatives and activities that can be implemented in the State, either through a new initiative or expansion of one already underway, and should focus on one or multiple phases of system change. TTI recipients are chosen on the following criteria:
- Transformation readiness, demonstrated by examples of transformation initiatives already underway using State funds, Block grant funds, other identified public or private resources;
- Existing multi-agency collaboration on transformation initiatives;
- Proposed initiatives rooted in systems change with the greatest quality impact;
- Identification of other state resources and infrastructure which may leverage the TTI award funds for the proposed initiative; and
- Realistic timeframes, concrete activities, and measurable outcomes for the proposed initiative.
In FY 2020-2021, CMHS awarded 40 TTI grants, all in the amount of $150,000, to the following 28 states and territories:
- Alabama - ADMH will develop a crisis communication system that includes new crisis diversion centers, rural crisis care projects, and the Alabama Stepping Up Initiative, that will provide access to care in addition to advocacy for passage of state funding for 988 crisis line.
- Colorado - CDHS will enhance the existing Jail-Based Behavioral Health Services (JBBS) Program and provide targeted technical assistance and peer-to-peer learning for rural jails with a focus on the SMI population by linking community resources and providers, connecting individuals with their Peer Recovery Network. The University of Colorado will create and facilitate an integrated peer-to-peer community to foster successful implementation of best practices and the sharing of team successes, barriers, lessons learned, and problem solving amongst the participating jails.
- Connecticut - DMHAS will enhance Communicare mobile crisis services by including peer navigators to provide postvention follow-up services in order to divert adults from jails, increase collaboration with local police departments, and strengthen clinical staffing on the mobile crisis teams. DMHAS will employ peer navigators, replicating the success of the CARES Project, to support individuals with SMI in local jails and re-entering the community.
- Delaware - DSMAH, through the Delaware Treatment and Referral Network (DTRAN), will integrate Certified Peer Support Specialists (CPS) to serve clients with SMI and co-occurring disorders and provide additional service options through the Pre-Arrest Police Diversion Program (PDP). DSMAH will enhance the their Mobile Bridge program, which is a joint venture with the Department of Corrections, that provides recently released individuals with a myriad of services, including behavioral health screening, referral to treatment, and enrollment into State services by expanding hours, reach and public awareness of the program.
- District of Columbia - DBH will expand their existing service registry, EMResource, by engaging DC hospitals, crisis stabilization beds, inpatient and residential SUD services, and the Access HelpLine (AHL) to increase capacity of tracking the full range of acute inpatient psychiatric services and reduce unnecessary wait times.
- Florida - DCF, through culturally appropriate, evidenced-based, and best practices, will employ Forensic Peer Specialists to the new Community Forensic Liaison (CFL) Team to reduce the health and social disparities for justice-involved individuals with mental illnesses, thereby improving service access and outcomes, and strengthen collaboration between the mental health and law enforcement/criminal justice systems. DCF, using the Sequential Intercept Model, will employ Forensic Peer Specialists to colloaborate with jails to assess and coordinate treatment for individuals within the jails and upon reentry in their efforts to reduce the health and social disparities for justice-involved individuals with mental illnesses.
- Hawaii - AMHD will develop a provider and public-facing service registry and dashboard integrated with their EMR by upgrading their system to increase efficiency and include crisis, inpatient psychiatric, residential mental health, and substance abuse facilities. Data collection will enhance cross-system collaboration and identification of needs. AMHD will increase the number of Certified Forensic Peer Specialists and offer additional training to increase state capacity at pre-arraignment, arraignment, and for Hawaii State Hospital forensic patients.
- Kansas - KDADS will expand their mobile crisis competency restoration services to reduce pretrial detention times, create a best practice toolkit and guidance for judges and court officers regarding community-based competency evaluation and restoration services, and facilitate a statewide judicial training and awareness campaign.
- Kentucky - DBHDID, through the Louisville Behavioral Health Jail Diversion Initiative, will work to revolutionize and expand the crisis healthcare system in Louisville by implementing non-police jail diversion models that are trauma-informed and racially equitable for individuals in crisis, and reducing incarceration rates recidivism.
- Louisiana - OBH will research and develop a model for a crisis services registry of a triage, dispatch, and data collection/reporting to strengthen mobile crisis and crisis stabilization systems.
- Massachusetts - DMH will expand and enhance their Behavioral Health Network peer support program to assist with diversion via co-response and Community Clinical Response Team (CCRT) Clinicians, increase capacity through telehealth, and collaborate with law enforcement.
- Minnesota - MMHCF will expand and enhance FastTracker, Minnesota’s public website with two portals to track availability of mental health and substance use disorder treatment services, completing a state-level, real-time, comprehensive service registry for mental health treatment services across the continuum of care.
- Mississippi - MDMH will enhance their Crisis Intervention Team (CIT) program by employing Forensic Peer Support Specialists and establishing a Crisis Services Center (CSC) that will act as a Single Point of Entry (SPI) for the CIT program and will be accessible to any individuals experiencing psychiatric or substance abuse challenges. MDMH will promote a trauma-informed approach in the justice system by partnering with a local Community Mental Health Center to train a team of Forensic Certified Peer Support Specialists (CPSS) to work in the jail system, and train corrections officers, jail staff, and/or justice system in trauma-informed care.
- Missouri - DMH will replicate an expansion of the successful Forensic Mobile Team, a community behavioral health program, to provide services in county jails that have no medical, psychiatric, or other services available.
- Montana - AMDD will increase access to crisis and diversion services by researching and developing a Behavioral Health Crisis System Strategic Plan to inform the most relevant services in rural and frontier communities.
- New Jersey - DMHAS will support and champion peer specialists in crisis programs in two counties of the state with a focus on facilitating the diversion of legally involved individuals from involuntary hospitalization or incarceration, and expanding support for local police departments. DMHAS will strengthen services in the state by recruiting, training, and deploying forensic peer specialists (FPSs) who will work in justice-involved services (JIS) to engage individuals with a mental illness who are in county jails and local courts and support their re-entry into the community.
- New Mexico - NM BHRN will develop a Learning Collaborative to bring together and strengthen existing Crisis Triage Centers (CTCs) by bringing together service providers, their state Office of Peer Recovery and Engagement (OPRE), and law enforcement.
- New York - OMH will combine two successful peer-run county emergency programs; the 911 Diversion Program which trains 911 dispatch and emergency service personnel to screen for mental health or co-occurring issues and the Mobile Crisis Stabilization Team which is a forensic-focused mobile team that works directly with law enforcement and courts seeking diversion through alternatives to incarceration (ATI) to provide immediate crisis response and/or transitional care services to people at risk of entering the criminal justice system.
- Ohio - OMHAS will expand and enhance treatment services within jails and increase reentry coordination for treatment and recovery supports for individuals with SMI to transition into the community through crisis prevention and training staff on trauma-informed care, access to psychiatric services, and access to supportive housing and transportation.
- Oklahoma - DMHSAS, expanding upon the Sequential Intercept (SIM) Model to provide services at every level of diversion, will partner with a county jail to implement reentry support to community providers including behavioral health treatment services and other community social support such as housing, education, employment, and legal resources. They will identify a community partner network to educate about the reentry planning process and develop collaborations to make referrals and service connections. DMHSAS will work to expand reach of their County Service Engagement Project via Certified Peer Support Recovery Specialists to better screen individuals, connect them to community services, and improve jail-based behavioral health services. Multiple models of telehealth intervention are in use throughout the state and will serve as a blueprint for this project. Projects which provide tablets directly to individuals receiving services have demonstrated the success of immediate access to care and proven the effectiveness of proprietary software which protects the devices from unauthorized use. Tablets have been distributed to law enforcement to connect individuals they interact with in the public with emergency crisis care in the field have also proven successful interfaces with the criminal justice system.
- Palau - PBHAC will train providers and law enforcement on Behavioral Care and Diversion. The long-term outcome is to reduce recidivism and incarceration rates, lower the costs associated with arresting, sentencing, and jailing those with mental health issues, and more importantly, provide those experiencing a behavioral health crisis with the care and services they need.
- Pennsylvania - DHS/OMHSAS will develop a community-based forensic pilot bed registry program in the southeast region of the state building upon their Stepping Up Initiative implementation. The registry will focus on diverting individuals with mental illness involved in the criminal justice system from incarceration to community-based treatment. DHS/OMHSAS will provide specialized response training through Crisis Intervention Training (CIT) and Mental Health First Aid for law enforcement when interacting with individuals with behavioral health challenges such as mental illness and will promote collaboration at the local level. They aim to increase officer and public safety during crisis situations and enhance diversion/treatment opportunities to improve outcomes for individual with behavioral health challenges.
- Puerto Rico - ASSMCA will expand services of the Crisis Peer Support Specialists to the Integrated Crisis Intervention program of the Linea PAS Hotline by assigning Certified Peer Support Specialists to provide services to crisis programs through the ASSMCA Mutual Support Center (MSC). ASSMCA will integrate Crisis Peer Support Specialists, Recovery-Oriented Services, and their Offender Re-Entry Program to strengthen mental health treatment interventions at correctional facilities and in Forensic Psychiatric Hospitals by engaging individuals in peer-based recovery services, MH treatment, and development of personal skills.
- South Carolina - DMH will strengthen their statewide mobile crisis program to increase jail diversion practices through a Criminal Justice Coordinating Council and engagement with leaders in the local justice system to utilize data-driven, evidence-based practices to inform decision making, providing effective treatment for individuals and families, and implementing jail diversion practices. DMH will engage Certified Peer Support Specialists to increase access to mental health and substance use services for individuals released from a detention center through coordinated care and will employ mental health professionals to improve coordination of care for individuals returning to the community.
- South Dakota - DBH will create a real-time, community-based, forensic service registry of comprehensive services including but not limited to residential crisis services, mobile crisis services, outpatient mental health and substance use disorder services, residential mental health and substance use disorder services, and supported and recovery housing. They will focus on diverting individuals with mental illness involved in the criminal justice system from incarceration to community-based treatment.
- Texas - HHSC, through trainings, educational resources, and planning activities, will develop, publish, and implement a research-informed and evidence-based training and technical assistance (TTA) strategy to accelerate the implementation of successful diversion programs throughout the state. This project will include data collection from law enforcement, peer service providers, people with lived experience of justice involvement, including people of color, and local mental health service providers.
- Utah - DSAMH, through Forensic Peer Support Specialists (FPSS), will create a new initiative to expand diversion from incarceration into the existing crisis system. They will establish a specialized FPSS enhancement and practicum program and create a peer workforce to focus on individuals being diverted from incarceration due to behavioral health issues.
- Washington - DBHR will develop a statewide service registry by upgrading their system to increase efficiency, converting existing state hospital capacity into Forensic Centers of Excellence, and including smaller treatment facilities dispersed throughout the state to better serve individuals within or nearer their home communities and reduce institutionalization. DBHR will create a continuing education, trauma-informed curriculum for certified peer counselors to work in crisis service environments. The curriculum, created by CPCs and crisis service providers will serve the needs of behavioral health providers, and build upon the lived experience of those uniquely qualified to provide peer services. DBHR will create a specialized online curriculum focusing on Trauma Informed Approaches for jail personnel, law enforcement, and possibly forensic hospital personnel which will be delivered by co-trainers, presenters and panelists who are local tribal members, representatives of under-represented groups, youth, family, and adult content experts with lived experience.
American Samoa - ASBHSD, in collaboration with their department of Voc Rehab, is improving appointment attendance of individuals with SMI by expanding their supported employment and providing incentives of transportation and prepared meals. They have been making valiant efforts to meet with participants in parks 6 ft away to make sure that the participants receive the needed program. Find American Samoa's report here.
District of Columbia - DBH is facilitating the transition of individuals with SMI from correctional facilities to the community through a warm handoff by collaborating with and equipping community service providers and certified Peer Support Specialists with incentives. Find DC's report here.
Delaware - DSAMH is expanding the capacity built by the bed registry system initiated by TTI 2019 through leveraging technology and the funding to improve the continuum of care following the treatment and referral system. By building on their Treatment and Referral Network (DTRAN), DSAMH is improving engagement rates through direct incentives transitioning between levels of care, particularly inpatient to outpatient behavioral health settings and integration of peer support. Find Delaware's report here.
Florida - DCF developed partnerships with local and statewide entities and are offering trauma-informed family navigators and establish incentives for engagement of youth and families to improve participation in services. Find Florida's report here.
Georgia - DBHDD is partnering with service providers to reduce no-show rates and improve early engagement in treatment through its incentive system, “NICE!”. They are conducting a case control study to evaluate effectiveness of incentives. Find Georgia's report here.
Guam - GBH, through Project I Hinemlo and Guma Mami Inc., is promoting self-determination and person-centered planning for young adults experiencing FEP and/or SMI/SED by pairing them with peer navigators in their transition from psychiatric inpatient services, corrections/jails, and homeless shelters to outpatient services by providing them with incentives. Find Guam's report here.
Kansas - KDADS is fostering engagement through peer support team members and new telehealth options to encourage attendance at appointments by offering wellness recovery related activities and incentives. They are incentivizing staff to address retention challenges and are focusing on coordination and collaboration between street outreach teams, correctional facilities, hospitals, case managers, and peer supports to provide wrap-around services. They have also put into place NAMI training via ZOOM and peer staff incentives to be distributed. Find Kansas's report here.
Kentucky - DBHDID is expanding upon existing continuity of care efforts and Kentucky’s Recovery-Oriented system of care through peer support specialist, the creation and implementation of a new contingency management (CM) intervention, and incentives for individuals discharged from a state hospital. Find Kentucky's report here.
Massachusetts - DMH is innovatively utilizing Certified Older Adult Peer Specialist (COAPS) to support individuals at risk of losing their housing because of hoarding issues and pandemic-related circumstances and offering supermarket gift card incentives. Find Massachusetts' report here.
Mississippi - DMH trained and graduated 35 Certified Peer Support Specialists to act as community-based Peer Bridgers to provide incentives and support individuals in their transition from a state hospital for acute psychiatric care to community-based services. Virtual peer support trainings allowed MS to drastically increase the capacity of certified Peer Bridgers despite the pandemic. Find Mississippi's report here.
Missouri - DMH, through the Missouri Alliance for Dual Diagnosis (MOADD), designed and created an innovative mobile app for children and their families with MI and I/DD through trauma-informed clinical best practices and is providing incentives. They are assisting clinical professionals in utilizing trauma-informed clinical best practices by utilizing a mobile application and an Extension for Community Health Care Outcomes (ECHO). Find Missouri's report here.
Nevada - DPPBH designed and created innovative engagement activities by providing incentive bags described by clients as “[providing] feelings of joy and excitement [in the midst of] the economic and COVID-19 climate.” These incentives facilitated an 82% attendance rate. They are utilizing occupational therapy to support clients with leisure activities and public health education. Staff are reporting a new level of patience and ease amongst clients while waiting for their appointments following discharge from an acute psychiatric hospital. Find Nevada's report here.
New Jersey - DMHAS is training Certified Peer Support Specialists in Recovery-Oriented Cognitive Therapy (CT-R) and developing creative strategies and incentives to assist hospitalized patients working to remove barriers/obstacles that they have encountered within the past to move that much closer to the life they want for themselves. Find New Jersey's report here.
New York - OMH successfully engaged clients from psychiatric centers by integrating Peer Bridgers and incentives in their Sustained Engagement Support Team (SES). Cell phones were obtained for clients to more easily reach their CPS. For clients who accepted these services, 100% are regularly attending appointments. Find New York's report here.
North Carolina - MHDDSAS enhanced engagement through Certified Peers Support Specialists, telehealth services, and incentives via RICCM (Resource Intensive Comprehensive Case Management), with one participating facility achieving a 100% appointment attendance rate. Find North Carolina's report here.
Oklahoma - DMHSAS creatively and innovatively engaged individuals through a Street Outreach and Rapid Response team by offering practical items as incentives including bus passes, clothing, sleeping bags, tarps, food gift cards, and connection to housing or other services the clients have requested. They have also started working with providers using the Helping Connections and have obtained iPad’s (with separate funding) to help clients connect with their outpatient providers via technology to help with the challenges of face-to-face interactions due to COVID-19. One client that was helped with reconnecting with their outpatient provider had not engaged in services in two years and had recently lost their housing due to mental health issues. This client has now successfully completed 10 appointments with their provider, taking medication, and is working with their case manager to secure housing again. The Mental Health Association of Oklahoma, who is facilitating the project, continues to communicate with all agencies involved to improve working relationships and a more collaborative approach to serve clients better. Find Oklahoma's report here.
Puerto Rico - ASSMCA creatively and consistently facilitated client engagement through peer support specialists through incentives, support services, and telehealth services. During the lockdown period, the Peers Support Program has provided 66 digital groups and had 1,570 accesses to their mutual support services. This program has generated a great amount of interest, resulting in 218 emails requesting information about virtual groups. Find Puerto Rico's report here.
South Carolina - DMH engaged Certified Peer Support Specialists and achieved a 96% attendance rate for clients at follow-up appointments despite the challenges posed by the pandemic. Furthermore, CMHCs creatively combined incentives and community outreach for behavioral health services such as for those recently: incarcerated, leaving psychiatric hospitals, receiving mobile crisis services or youth, or young adults and their families in FEP initiatives. One center covers a very rural area where there is no public transportation. This has meant that they have had to develop contacts with businesses to provide transportation within and across county lines. Another center reported that patients have felt rewarded for not missing appointments and have responded in a positive manner. “Our Center, staff and patients, have sincerely appreciated this program and the reason it was implemented to begin with!” Find South Carolina's report here.
Utah - DSAMH actively, creatively, and thoughtfully engaged Service Navigators at distinct CMHCs, a homeless youth resource center, and a tribal organization to identify disengagement from services and effectively tailor incentives to provide appropriate support. Find Utah's report here.
Vermont - DMH creatively integrated mental health services and housing needs via outreach efforts, continuity of care, and incentives to focus on individuals who have not previously engaged in services. They have achieved a 94% attendance rate. One gentleman stated that if he had known counseling would have been so helpful, he would have gone in the first place. He is grateful to receive the cards and plans to continue counseling "for my own self”. Find Vermont's report here.
In FY 2018-2019, CMS awarded TTI grants to the following twenty-three states:
- Alabama – ADMH’s new search engine for hospital beds expands its Mental Illness Community Residential System(MICRS) and ADMH is enhancing its ability to track residential, supportive housing, and statewide crisis services by providing real-time data.
- Connecticut – DMHAS developed and launched both a public and provider facing registry that offers 1,766 inpatient, intensive residential, group homes, transitional housing, and respite sites.
- Delaware – Delaware Treatment and Referral Network (DTRAN) expanded and strengthened their array of psychiatric hospitals, detoxification facilities, crisis stabilization and respite centers, residential beds, and outpatient and support services and succeeded in reducing wait times for individuals in crisis.
- Florida – DCF is upgrading and expanding their crisis system registry into a centralized, web-enabled platform which enables real-time data of crisis stabilization units, detoxification centers, addiction-receiving facilities, inpatient psychiatric and residential treatment beds, and short-term residential settings. psychiatric and acute care beds statewide.
- Georgia – DBHDD’s Georgia Crisis and Access Line (GCAL) integrated core components of SAMHSA’s crisis care guidelines – regional crisis call center, crisis mobile team response, and crisis receiving and stabilization facilities – into its referral system, which is open to families, first responses, and providers. TTI funds worked to improve the current interface for more streamlined use and data collection, identify and place individuals in need of service in real time, and strengthen capacity to work efficiently with local emergency departments.
- Idaho – Idaho Psychiatric Bed and Seat Registry (IPBSR) grew and improved their crisis response system through expanded crisis call centers, mobile crisis teams, crisis stabilization centers, crisis respite, and inpatient beds across the state.
- Indiana – Indiana’s Treatment Connection registry expanded and improved their crisis service array through real-time tracking of available services, providing a bridge between public and private providers, and building two new crisis stabilization units.
- Maryland – Maryland Bed Availability Registry (MD-BAR) modernized their behavioral health crisis responses by building a web-based platform to broaden and enhance online updates and accuracy of service availability for crisis counselors, safe stations/walk-in centers, mobile crisis teams, detoxification centers, psychiatric hospitals, and other sites.
- Massachusetts – Massachusetts Behavioral Health Access (MABHA) website broadly expanded its service array both for providers and the public such as mobile crisis teams and crisis stabilization units, inpatient beds for both mental health and substance use-related crises for adults and children, and preventive and aftercare services, and increased access during the pandemic to further facilitate access to crisis services. and capture critical data on wait times.
- Mississippi – MDMH Bed Registry expanded capacity for crisis stabilization unit beds and services close to home, as well as tracking for CSUs, state hospital beds, community living facilities (long-term residential), IDD crisis units, and child/adolescent facilities, and were able to adjust and accommodate new admissions more safely during the pandemic.
- Nebraska – NDBH successfully expanded their largest metropolitan area’s crisis services by providing first responders with transportation options and referrals through effectively tracking availability daily and reducing boarding of individuals in crisis. The registry will include a new, 24-hour crisis stabilization unit, public and private psychiatric hospitals and units, as well as western Iowa collaboration.
- Nevada – DBPH exponentially improved their continuum of crisis care based on the Crisis Now model by integrating crisis call centers, mobile crisis teams, peer-run respite settings, and crisis stabilization units to improve resilience, reduce treatment costs, relieve emergency room crowding and make judicious use of inpatient beds through a referral network for providers and a public website, Treatment Connection. Despite the pandemic, Nevada successfully recruited 75% of providers and ensured the growth and continuity of their crisis continuum of care.
- New Jersey – DMHAS expanded their Bed Enrollment Data System (BEDS) to strengthen relationships with and use of short-term care by including psychiatric beds in community hospitals and peer-run respite facilities to provide a critical integration into their existing system.
- New Mexico – The New Mexico Behavioral Health Referral Network (NM BHRN) strengthened hospital, first responder, and public-facing access to crisis services by expanding integration with their substance use treatment registry, adding two new 24-hour crisis triage centers, and utilizing the New Mexico Crisis and Access Line to facilitate access to the appropriate level of care.
- New York – OMH improved and expanded access to care through the Bed Availability System (BAS) so mobile crisis teams could quickly identify available beds statewide by enhancing hospital reporting to BAS, improving on-time updates by 24% statewide and aiming for 80% of hospitals reporting daily.
- North Carolina – The Behavioral Health Crisis Referral System (BH-CRSys) integrated the feedback of providers to upgrade their platform system to simplify use, expand information captured in the network, and facilitate patient transportation to care. Provider facilities as well as hospital emergency departments, mobile crisis providers, and 24/7 behavioral health urgent care centers are able to access the registry. NC DHHS used relationships strengthened as a result of the registry to ensure providers had relevant information and assistance related to COVID-19 needs.
- Ohio – OMHAS improved and expanded their registry to integrate crisis services including mobile crisis teams, crisis stabilization units, and inpatient hospital beds in seven counties, which will be expanded statewide and will include community-based services such as organizations that provide transportation, food, shelter, rehabilitation, and entitlement assistance.
- Oklahoma – ODMHSAS improved their “Bed Board” system by adding new functionality to the electronic health records system to ensure consistent, timely, and reliable information by providing quarterly hour updates for participating agencies, crisis bed providers, call-centers, and mobile crisis teams.
- Rhode Island – BHDDH created a public-facing, real-time website to help people find help when they or a loved one is in crisis. Rhode Island built out and greatly improved their crisis care continuum through a semi-automated bed registry including mobile crisis teams, central statewide call center, and crisis stabilization unit for triage.
- Tennessee – The Hospital Resource Tracking System (HRTS) developed an electronic communication bridge to allow for inform their entire crisis services array including mobile crisis, crisis stabilization units, and hospital providers to view availability in real time, in addition to developing the Patient Bed Matching System (PBMS) to improve communication between referral sources and inpatient facilities.
- Utah – DSAMH is expanding their crisis care continuum by creating an enhanced call center that would serve as a 911 for behavioral health and include a triage process to get people to the right care at the right time. The Utah Behavioral Health Availability Platform is expanding from mental health inpatient beds to include substance use disorder residential programs and social detoxification centers along.
- Vermont – DMH upgraded their current E-Bed Board by improving user interface and enhanced access to information on service availability including crisis stabilization, inpatient, residential, and intensive residential beds, as well children’s inpatient and crisis beds throughout the state.
- West Virginia – BBH strengthened their continuum of care by identifying and integrating call centers, mobile crisis teams, and wraparound services for children, youth and families. A later expansion will include psychiatric hospitals and units, psychiatric units, crisis triage centers, outpatient, substance abuse care, children’s respite, and residential care.
In FY 2017-2018, CMHS awarded TTI grants, all in the amount of $220,000, to the following six states:
- Georgia – DBHDD targeted specific groups of providers for training and increased capacity of staff certified in sustaining Recovery-Oriented Cognitive Therapy (CT-R) and expanded the treatment reach to a larger variety of consumers (children, youth, young adults, individuals in recovery). Find Georgia Summary Here.
- Massachusetts – DMH partnered with The Bridge of Central MA, Inc. to develop in-state capacity for the CT-R trainers to expand delivery of this evidence-based practice within the community-based service delivery system for people with severe mental illness. This treatment has been successful in helping people shift the direction of their energy towards meaningful recovery as well as energizing staff that had been working at sites for years by breathing new life into treatment teams. Find Massachusetts Summary Here.
- Montana – AMDD introduced CT-R into state MH services, enhanced the skill set of MSH and community staff at various levels of training and experience, improved outcomes of individuals with serious mental illness, and promoted and improved continuity of care. Find Montana Summary Here.
- New Jersey – DMHAS focused on health integration and culminated into the hosting of a CT-R consumer outcome Summit as well as the development of a Behavioral Health Home Toolkit featuring the integration of CT-R in integrated settings, and peer-delivered CT-R within clinical teams. The CT-R competencies enabled the staff to assist individuals attending the BHH with building relationships, developing trust, and identifying and moving forward with their life aspirations by providing them with practical recovery-oriented, strengths-based, hopeful strategies and techniques. Find New Jersey Summary Here.
- New York – OMH provided immersive CT-R training and expanded the use and availability of CT-R provided to individuals with serious mental illness to assist their transition from inpatient hospitalization to be fully integrated in their communities and to explore their aspirations in relation to work, education, independent housing, and expanded social networks. Find New York Summary Here.
- Vermont – DMH provided intensive CT-R training for staff and strengthened the promotion of recovery by implementing and sustaining CT-R strategies for adults with serious mental illness (SMI) enrolled in Community Mental Health Centers (CMHC). The grant has assisted with systems change at the program and state levels. CT-R has supported Vermont in systematically and intentionally creating successful and positive experiences for people to build confidence and resilience, as well as helping shape conversations around how to support people’s fundamental wellbeing and sense of self. Find Vermont Summary Here.
In FY 2016-2017, CMHS awarded TTI grants, all in the amount of $221,000, to the following six states:
- District of Columbia –DBH developed an innovative screening and support tool to address the needs of Transitional Age Youth (TAY) with co-occurring disorders (MI, DD, and trauma history) to enhance capacity of providers serving this population. Find District of Columbia Summary Here.
- Kentucky – DBHDID, recognizing the growing diversity among the youth population with co-occurring SED and I/DD, created and disseminated a bilingual parent survey including a Spanish language parent/caregiver advocate. The survey culminated in change teams to address the diverse needs of these communities. Following the implementation the change teams, data resulted in identification of and strategies to overcome barriers and build action plans. Find Kentucky Summary Here.
- Louisiana – OBH, in order to expand understanding and system-wide collaboration, developed and implemented an intensive cross-system training and technical assistance/mentoring program to infuse expertise in DD across all levels of the child and adolescent behavioral health system. Find Louisiana Summary Here.
- Missouri – DMH created the Missouri IDD-BH Center of Excellence initiative model to strengthen collaboration between developmental disabilities and behavioral health systems by increasing community awareness of co-occurring diagnosis; increasing family support; and implementing with sustainability standards of care. This work connects to MO’s TTI 2020 mobile app project. Find Missouri Summary Here.
- New Jersey – DMHAS developed pilot based on direct feedback from family caregivers of persons living with co-occurring DD and MI to create a self-care program which included interactive education and practice program relevant to caregiving skills, resiliency, coping, and wellness, with an integrated yoga-based protocol and mindfulness practice. Find New Jersey Summary Here.
- Utah – DSAMH strengthened family supports statewide, designed a family curriculum, and initiated family peer support for children and youth with co-occurring DD and SED to increase access to care and implement a community focus and strengths-based approach. Find Utah Summary Here.
In FY 2015-2016, CMHS awarded TTI grants, all in the amount of $221,000, to the following two states:
- Illinois - Developed and strengthened the use of Health Information Technology (HIT) in crisis prevention, intervention, and management. Collaborated with Northwestern University Center for Behavioral Intervention Technologies (CBITs) to refine and expand the use of a smartphone app which will help connect homeless youth, and potentially other populations, to services. Recruited and trained peer volunteers for the Crisis Text Line and/or other peer support services.
- New York – Improved the clinical informatics infrastructure of the NYS Crisis Intervention System by funding the addition of a crisis suite to the Psychiatric Services and Clinical Knowledge Enhancement System for Medicaid (PSYCKES) web application, which consists of measures and functions designed to support people experiencing behavioral health crises. The crisis suite provides access to key clinical information, including safety plans and psychiatric advance directives, for recipients and crisis service providers. Access to this information improves crisis assessment and service planning and helps reduce unnecessary emergency room visits and inpatient hospitalizations.
In FY 2014-2015, CMHS awarded TTI grants, all in the amount of $221,000, to the following six states:
- Idaho – Built three specialty certifications that CPS may obtain as part of their ongoing training and entered into a specialty system that required additional training to work within a specific population/facility. These specialty certificates were obtained in face-to-face trainings (2 day each) and the curriculum customized to Idaho’s specific needs and available for other states to evaluate and adopt. Each specialty certificate follows a similar process for development, financial mapping, publication, training, train-the-trainer, and ownership.
- Kentucky – Built an infrastructure around peer support services for individuals being discharged from any of the four state operated psychiatric hospitals, with the priority population being young adults 30 years old or younger, particularly those who have been admitted due to a first episode of psychosis. Development of an implementation team responsible for initiative management and accountability assisted in coordinating the effort. Kentucky’s four state operated psychiatric hospitals are eager to provide more targeted support to individuals and understand the huge gap in services for young adults being discharged from the hospital as well as the need to fill that gap with peer support services.
- Missouri – Strengthened and enhanced the peer crisis services being provided at the St. Louis Empowerment Center while creating a peer liaison positon to connect peer services and the traditional crisis intervention system.
- New Jersey – Developed capacity to deliver Peer Bridging services to “forensically involved” individuals with serious mental illness transitioning to the community. “Forensically involved” individuals include persons who have been civilly committed due to: 1) a provision of sex offender law, 2) have been ruled by a court to be currently “incompetent to stand trial”, or 3) have been found “not guilty by reason of insanity”.
- Pennsylvania – Strengthened and sustained a more robust use of Certified Peer Support Specialists (CPPSs) within Pennsylvania’s county-based network of behavioral health crisis services and supports. This project included the development and delivery of a comprehensive training program for CPPSs and provided technical assistance to county behavioral health administrators and the crisis providers to clarify the potential roles of CPPSs.
- Tennessee – Implemented an innovative pilot peer bridger program called PeerLink in the state’s Crisis Stabilization Units (CSUs). The CSU PeerLink program in Tennessee will help individuals admitted to a CSU engage with a CSU PeerLink Peer Bridger and make successful transitions back into their home communities.
In FY 2013-2014, CMHS awarded TTI grants, all in the amount of $221,000 to the following five states:
- Michigan – Employed Certified Peer Support Specialists (CPSS) as independent support brokers. The role of the CPSS included brokering an array of services that incorporated person centered planning and linking and coordinating services. They also assisted with employment and financial management services, and advocated for the needs of individuals with long-term mental health, chronic conditions, and substance use disorders. They also created several documents and training initiatives related to self-directed care and other development and implementation materials.
- New York – Designed a model Self-Directed Care (SDC) for individuals with SMI. Designed a pilot program that could be tested in multiple sites in the state and then be brought up to scale in a managed behavioral health delivery system.
- Pennsylvania – Enhanced the Self-Directed Care program in one county by contracting with the state’s leading consumer-based provider organization (Mental Health Association of Southeastern PA) and Temple University. They developed and delivered a self-directed care manual to promote replication of the initiative in other counties across the commonwealth, provide technical assistance to these other counties, and determine an avenue for financial sustainability statewide for these initiatives.
- Texas – Documented the elements of a sustainable Self-Directed Care (SDC) Program for people with serious mental illness. Building on experience gained from pilot programs in the Dallas and Houston metro areas, they convened stakeholder community meetings to lay the groundwork and began planning for future SDC pilot programs.
- Utah – Designed a system to increase self-directed care opportunities for adults with serious mental illness and youth with severe emotional disturbances who could have their needs better met through self-directed services. “Support Brokers” assessed participating individuals for their own personal needs toward budget development, and peer support was confirmed as a critical element of self-directed care and success of the program. Ensuring peer support resources was an increasing focus as this program was rolled out across the state.
Summaries of FY 2013-2014 Projects:
In FY 2012-13, CMHS awarded TTI grants, all in the amount of $221,000, to the following eleven states:
- Guam - Built local capacity with locally-based trained trainers and improve services delivery by skilled services providers and consumer coaches/peer specialists. The five areas addressed included (1) Self-directed care; (2) mental health first aid; (3) suicide prevention; (4) trauma informed care; and (5) enhanced collaboration among stakeholders.
- Idaho - Created a recovery coaching training program for adults in recovery from substance use disorders. Facilitated a number of trainings and established recovery coaches in each of the seven regions of the state. Idaho also now has its own recovery coach trainers located around the state to support the sustainability of this effort, and worked toward certification for recovery coaches. The state also began conversations on community-driven recovery centers, including specifically for tribal communities.
- Illinois - Addressed several critical issues in Illinois that include information tracking in problem solving courts, the statewide forensic waiting list for DMH hospital admissions, the enhancement of community provider and DMH hospital workers therapeutic skills towards more effectiveness in their work with justice involved consumers and patients, and facilitation of justice involved consumers access to health benefits.
- Indiana - Planned and delivered eight trainings and technical assistance events to increase levels of knowledge, program evaluations, and recommendations to identify additional training and/or resources needed to bring Integrated Primary and Behavioral Health Care (IPBHC) to scale, in addition to developing a module to continue training opportunities for sustainability. Indiana has an ongoing Primary Care and Behavioral Health Integration Initiative.
- Kentucky - Implemented evidence-based screening in six child care settings in Central Kentucky through the Expanding Access to evidence-based practices for Kentucky’s Young Children in Child Care project. Children who screened positive in any of the developmental domain were referred for further assessment to the appropriate agency, and families in these child care settings had access to the evidence-based Nurturing Parenting Program, a 16-week parenting group, as well as one-on-one peer support, upon request.
- Louisiana - Established Louisiana's first mental health court (MHC) program that specialized in problem solving, using a collaborative team approach with judicial leadership. Through discussions with stakeholders, the program involved (1) the diversion of individuals charged with probation and parole violators (and possibly misdemeanors) from jail time; and (2) the provision of re-entry services and treatment to appropriate offenders leaving the state prison system through “good time” andparole and returning to the community.
- Massachusetts - Explored the barriers and opportunities to encouraging culturally and linguistically understandable and relevant peer support and avenues to recovery within the Deaf community. The department engaged a team including peer-run agencies, providers of Deaf and Hard of Hearing behavioral health services, and members of the Deaf community self-identified as having a mental illness and working on their recovery, to inform the project.
- Minnesota - Partnered with the Mental Health Consumer/Survivor Network of Minnesota (CSN) to develop relationships with other organizations serving veterans. Partnership examples include the HUD Veteran's Housing Assistance Project offering CSN resources, and the St. Cloud VA Medical Center offering Wellness Recovery Action Plan (WRAP) to veterans. They also participated in public awareness events and meetings related to veterans' needs, and coached local mental health authorities to identify clients who served in the military so their unique needs could be considered when planning and implementing services.
- Nebraska - Implemented programs and training to further trauma-informed peer support within family systems with a focus on how trauma impacts consumers of mental health services across the lifespan and how to promote healing that is developmentally specific. These goals were accomplished through activities such as educational opportunities, peer support train-the-trainer, and materials created by family peer support providers.
- Tennessee - Transformed juvenile court services by expanding the use of screening for mental health, substance abuse, and family service needs of youth referred to juvenile courts as unruly or delinquent; provide family peer support services to the families of these youth; and increased the use of evidence-based therapeutic practices for the juvenile justice population.
- Virginia - Furthered efforts to incorporate the use of Psychiatric Advanced Directives (ADs) into routine clinical practice throughout its system of care to promote individual self-determination, reduce coercion, and reduce the need for expensive crisis care including inpatient treatment and incarceration. They also provided much needed cross-systems education about the behavioral health system to Virginia’s legal community, including judges, clerks, magistrates, commonwealth’s attorneys and defense attorneys.
Summaries of FY 2012-13 projects are located here
In FY 2011-2012, CMHS awarded TTI grants, all in the amount of $221,000 to the following eleven states:
- Alabama – Provided an opportunity for all of Alabama's mental illness and substance abuse providers to gain clear understanding of how healthcare reform will change the delivery and financing of behavioral health services. The focus was to stress to providers the importance of adopting a recovery orientation system of care and provider integrated care.
- Arizona – Increased self-management of chronic illnesses among Arizona peer-based workforce, peers and their family members (with focus on population with SMI). As well as created the process and mechanisms to identify and refer peers into workshops and an educational module to train providers in recruitment and referral.
- Arkansas – Began a core consumer group monthly teleconference among staff of the CMHCs, consumer members of the councils, Division Advocate, and Staff at the Mental Health Council. This meeting is used to coordinate initiatives and to elicit and give support for strengthening the councils.
- Colorado – Assisted the Governor’s Behavioral Health Cabinet in facilitating the integration of Colorado’s public behavioral health system. This project established a planning and implementation process for this transformation that included the Behavioral Health Cabinet (Corrections, Medicaid, Human Services, Employment, Local Affairs, Public Health, and Public Safety), and a Behavioral Health Transformation Council comprised of departmental staff, consumers and stakeholders.
- Georgia – Integrated whole health concepts into Georgia’s peer workforce with the development of peer support whole health services.
- Kentucky – Supported the initiation of statewide efforts in the implementation of trauma-informed care across the state, including: the formation of a statewide interagency Trauma- Informed Care Steering Committee; eight Regional Interagency Trauma-Informed Care Community Forums; and support to provide follow-up to the Regional Forum communities.
- Michigan – Demonstrated the effectiveness of Peer Support Specialists as health coaches and system’s navigators in Federally Qualified Health Centers (FQHC). Two areas of the state in both urban and rural settings that serve a significant population of persons with serious mental illness and/or co-occurring chronic conditions were chosen as pilot sites.
- Montana – Built, expanded, and enhanced system transformation by developing strong partnerships across all levels of the criminal justice and behavioral health continuum. Utilizing the Sequential Intercept Model, they created new initiatives at Intercepts 2 & 3, with reinforcement of existing programs at Intercept 1, through pre-trial services programs that have been demonstrated as best practices in diversion from detention. Program elements included court training, attorney education, crisis intervention team training, and mental illness intervention.
- New Jersey & Pennsylvania (Joint) – Built upon the successes of previous TTI funds by collaborating to prepare a peer workforce to meet the health and wellness needs of older adults with mental health and substance use disorders. This joint effort strengthened the capacity of the workforce of both states. In NJ, peer wellness coaches were utilized to help clients manage chronic health conditions and achieve their lifestyle goals. PA developed a curriculum for peer support specialists to address older adult whole health issues. In addition to bridging the gap between physical and behavioral health, these initiatives have increased employment opportunities for Certified Peer Specialists.
- Wisconsin – Provided trauma-informed care (TIC) training to a juvenile justice facility for young men with substance use issues. Specific training themes included TIC culture change, the role of Parent Peer Specialists (PPS) and Family Driven Care, vicarious trauma/staff self-care, trauma screening/assessment, and the trauma specific intervention ‘Seeking Safety’. Outcomes from these trainings and culture shift included creation of a comfort room, development of youth TIC profiles and corresponding case plans, creation of a database tracking youth triggers, development of a ‘good behavior’ program to reinforce positive behavior, and the administration of Seeking Safety pre and post-tests to evaluate youths’ use of coping skills.
Summaries of FY 2011-2012 projects can be found here.