WHS CCBHC-PDI INITIATIVE - THE WESTBROOK CCBHC-PDI INITIATIVE WILL PROVIDE COMPREHENSIVE, COORDINATED BEHAVIORAL HEALTH CARE FOR ALL PEOPLE IN NEED OF BEHAVIORAL HEALTH SERVICES AT WESTBROOK'S JACKSON COUNTY CLINIC WHICH SERVES JACKSON, CALHOUN & ROANE COUNTIES IN WEST VIRGINIA. THE FOCUS POPULATION SUFFERS SUD, POOR MENTAL HEALTH, LOW MENTAL HEALTH WORKFORCE CAPACITY, POOR SOCIAL DETERMINANTS OF HEALTH & POOR DISPARITY GROUP OUTCOMES. THE INITIATIVE WILL SERVE 1,600 CLIENTS (400/YEAR). PROJECT GOALS (INTERVENTIONS/STRATEGIES) INCLUDE: (1) PLAN, DEVELOP & IMPLEMENT THE JACKSON COUNTY CLINIC CCBHC TO MEET THE CCBHC CERTIFICATION CRITERIA BY (A) INITIATING A PROJECT DIRECTOR TO MANAGE THE CCBHC INITIATIVE; (B) HIRING AN EVALUATOR TO SUPPORT PROCESSES & PROCEDURES FOR COLLECTING, REPORTING & TRACKING REQUIRED CCBHC ENCOUNTER, OUTCOME & QUALITY DATA; (C) ENSURING AGENCY PARTICIPATION IN CCBHC TECHNICAL ASSISTANCE CENTER ACTIVITIES; (D) IMPLEMENTING HEALTH INFORMATION TECHNOLOGY TO SUPPORT CARE COORDINATION; (E) WORKING WITH WEST VIRGINIA UNIVERSITY TO GAIN ACCESS TO THE WVU MEDICINE EHR; (F) DEVELOPING COMMUNITY PARTNERSHIPS; AND (G) IMPLEMENTING THE WESTBROOK CCBHC-WIDE DATA-DRIVEN CONTINUOUS QUALITY IMPROVEMENT (CQI) PLAN FOR CLINICAL SERVICES AND CLINICAL MANAGEMENT. (2) DESIGN THE JACKSON COUNTY CLINIC CCBHC TO ADDRESS COMMUNITY NEEDS OF THE TARGET POPULATION BY (A) CONTRACTING WITH A CONSULTANT TO CONDUCT THE REQUIRED NEEDS ASSESSMENT; (B) IMPLEMENTING THE NEEDS ASSESSMENT DRIVEN CCBHC STAFFING PLAN; (C) IMPLEMENTING THE NEEDS ASSESSMENT DRIVEN CCBHC TRAINING PLAN; (D) IMPLEMENTING THE NEEDS ASSESSMENT DRIVEN CCBHC SERVICE DELIVERY PLAN; AND (E) COMPLETING THE CCBHC ATTESTATION AFTER EACH NEEDS ASSESSMENT. (3) PROVIDE A COMPREHENSIVE RANGE OF OUTREACH, SCREENING, ASSESSMENT, TREATMENT, CARE COORDINATION, AND RECOVERY SUPPORTS TO THE TARGET POPULATION BASED ON A NEEDS ASSESSMENT THAT ALIGNS WITH THE CCBHC CERTIFICATION CRITERIA BY (A) ENSURING THAT THE JACKSON CLINIC PROVIDES ALL 9 CORE CCBHC SERVICES; (B) ENSURING THAT THE JACKSON CLINIC OPERATES IN COMPLIANCE WITH THE CCBHC CRITERIA; (C) HIRING CARE COORDINATORS TO COORDINATE THE NINE CORE CCBHC SERVICES; (D) HIRING A MENTAL HEALTH PEER TO SERVE CLIENTS DISCHARGING FROM THE CRISIS UNIT; (E) DESIGNATING A VETERAN'S CARE COORDINATOR TO SERVE THE VETERAN POPULATION; (F) DESIGNATING A TOBACCO CESSATION CARE COORDINATOR TO INITIATE A CLINIC-WIDE TOBACCO CESSATION PROGRAM; (G) EXPANDING MEDICAL DIRECTOR & NURSE PRACTITIONER TIME; AND (H) INITIATING AN SDOH SCREENER TO BE CONDUCTED & ADDRESSED BY THE CARE COORDINATORS. (4) SUPPORT RECOVERY FROM MENTAL ILLNESS & SUD FOR THE TARGET POPULATION BY PROVIDING ACCESS TO HIGH-QUALITY MENTAL HEALTH AND SUD SERVICES BY (A) SERVING A TOTAL OF 400 CLIENTS ANNUALLY; (B) CLIENTS HAVING A STATISTICALLY SIGNIFICANT DECREASE IN ILLICIT SUBSTANCE USE AT 6-MONTH NOMS FOLLOW-UP; (C) CLIENTS HAVING STATISTICALLY SIGNIFICANT IMPROVEMENT IN MENTAL HEALTH OUTCOMES AT 6-MONTH NOMS FOLLOW-UP; (D) CLIENTS HAVING STATISTICALLY SIGNIFICANT IMPROVEMENT IN SOCIAL CONNECTEDNESS AT 6-MONTH NOMS FOLLOW-UP; (E) HAVING 100 CLIENTS ENGAGE IN THE SMOKING CESSATION PROGRAM THROUGHOUT THE DURATION OF THE GRANT; (F) HAVING 80% OF CLIENTS REMAIN IN TREATMENT FOR AT LEAST 6-MONTHS THROUGHOUT THE LIFE OF THE GRANT; (G) MONITORING DISPARITY GROUP DATA TO ENSURE EQUAL ACCESS/USE/OUTCOMES/RETENTION; AND (H) IDENTIFYING CULTURALLY COMPETENT REFERRAL PATHWAYS FOR DISPARITY GROUP COMMUNITIES. (5) SUSTAIN JACKSON COUNTY CLINIC CCBHC SERVICES POST GRANT FUNDING TO SERVE THE TARGET POPULATION BY (A) HAVING THE PEER-LED BOARD OF DIRECTORS SERVE AS THE CCBHC BOARD; AND (B) CREATING A SUSTAINABILITY PLAN.