Far rockaway ccbhc-IA program - catholic charities neighborhood services, INC. (ccns) is one of the largest service providers in brooklyn and queens, providing comprehensive behavioral health (BH)…

Far rockaway ccbhc-IA program - catholic charities neighborhood services, INC. (ccns) is one of the largest service providers in brooklyn and queens, providing comprehensive behavioral health (BH) services to individuals from every walk of life. With this grant, we will improve the quality of and expand the BH services offered at our ccbhc site serving far rockaway (queens). We will serve individuals of all ages impacted by BH conditions, including those with serious mental illness (SMI), substance use disorder (SUD); children with serious emotional disturbance (SED); individuals with CO-occurring mental and substance disorders (COD); and those experiencing BH crises. By promoting engagement in a comprehensive range of integrated BH, sdoh, and health services, our ccbhc will seek to address far rockaway's racial disparities in access to care and outcomes. Our target population is racially/ethnically diverse, with 51% identifying as black, 23% as white, and 24% as BI-racial. 51% of those we serve in far rockaway are latinx. We serve more females (63%) than males (37%), and 8% identify as lgbtqia+. Most individuals are adults between the ages of 25-64 (59%), while 19% are children/youth under 18, 8% are between 18 and 24, and 14% are over the age of 65. The vast majority of these individuals are impacted by a range of social drivers of health (sdoh), including poverty, unstable housing, and UN/under employment. Ccns is seeking to accomplish the following goals and objectives through our ccbhc-IA: goal #1: expand early access to needed services through integrated mental health and SUD services, including the following: 1. Serve 700 unique clients over the four-year grant; 2. Provide all required ccbhc services immediately upon award; and 3. Conduct screening for 100% of clients served at intake for suicide risk, depression, and SUD, with additional screening for these issues every 90 days during treatment as appropriate. Goal #2: reduce BH and other disparities for black and latinx individuals served by our ccbhc, including the following: 1. Conduct targeted outreach to priority populations, including those who are black and latinx; 2. Engage in targeted staff hiring, recruitment, and retention efforts, so that our ccbhc team reflects the racial/ethnic makeup of the population we serve during the entire project; and 3. Strengthen our consumer advisory board, ensuring at least 75% of participants are clients or family members who reflect our community's demographics at each meeting. Goal #3: increase access to integrated BH with physical health by CO-locating and integrating services over time, including the following: 1. Hire a registered nurse who can support ccbhc clients; 2. Offer 100% of those served an integrated array of CO-located SUD and mental health services with primary care screening; 3. Screen 100% of clients served related to BMI, blood pressure, and tobacco use, making referrals to a PCP if needed; and 4. Connect clients who do not have one to a PCP, so that 75% of our ccbhc clients will be engaged with a PCP after 6 months. Goal #4: improve access to care and support client's recovery by expanding our ccbhc's peer support and targeted case management services, including the following: 1. Hire one new TCM worker and one peer during the first four months to support access to and retention in our ccbhc; 2. 100% of clients will be offered group or individualized peer support, with the peer specialists also conducting (at least) one community outreach activity per month to engage new clients; and 3. 85% of clients living with sdoh related needs will be referred to ccns' TCM team.