Project Grant H79SM087038

FLATLANDS 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 EXPAND ACCESS TO AND IMPROVE THE QUALITY OF COMMUNITY BH SERVICES OFFERED AT OUR CCBHC IN CENTRAL BROOKLYN. 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 WHO ARE LIVING IN THE CENTRAL BROOKLYN NEIGHBORHOODS OF FLATLANDS, MIDWOOD, KENSINGTON, FLATBUSH, EAST FLATBUSH, DITMAS PARK, AND CROWN HEIGHTS. OUR TARGET POPULATION IS RACIALLY/ETHNICALLY DIVERSE, WITH 60% IDENTIFYING AS BLACK, 21% AS WHITE, AND 17% AS BI-RACIAL. 24% OF THOSE WE SERVE ARE LATINX. WE SERVE SLIGHTLY MORE FEMALES (58%) THAN MALES (42%), AND 4.5% IDENTIFY AS LGBTQIA+. MOST INDIVIDUALS ARE ADULTS BETWEEN 25-64 (70%), WHILE 19% ARE CHILDREN/YOUTH, 6% ARE BETWEEN 18 AND 24, AND 5% ARE OVER 65. THE VAST MAJORITY ARE IMPACTED BY A RANGE OF SOCIAL DRIVERS OF HEALTH (SDOH), INCLUDING POVERTY, UNSTABLE HOUSING, AND UN/UNDER EMPLOYMENT. BY PROMOTING A COMPREHENSIVE RANGE OF INTEGRATED BH, SDOH, AND HEALTH SERVICES, OUR CCBHC WILL SEEK TO MITIGATE DISPARITIES IN ACCESS TO BH CARE AND OUTCOMES EXPERIENCED IN CENTRAL BROOKLYN. WE ARE SEEKING TO ACCOMPLISH THE FOLLOWING GOALS AND OBJECTIVES THROUGH OUR CCBHC: GOAL #1: EXPAND EARLY ACCESS TO NEEDED SERVICES THROUGH INTEGRATED MENTAL HEALTH AND SUD SERVICES, INCLUDING: 1. SERVE 1,800 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: 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 (CAB), 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: 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 THE CAPACITY OF OUR CCBHC'S PEER SUPPORT AND TARGETED CASE MANAGEMENT SERVICES, INCLUDING: 1. EXPAND TARGETED CASE MANAGEMENT (TCM) AND PEER SUPPORT TO SUPPORT ACCESS AND RETENTION, BY HIRING ONE NEW TCM WORKER AND ONE PEER DURING THE FIRST FOUR MONTHS; 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.