Ohel queens ccbhc PDI - ohel children's home and family services' proposed ccbhc will expand and enhance access to comprehensive, trauma-informed, and integrated care to all individuals living…

Ohel queens ccbhc PDI - ohel children's home and family services' proposed ccbhc will expand and enhance access to comprehensive, trauma-informed, and integrated care to all individuals living experiencing behavioral health (BH) conditions and comorbid conditions in rockaway, queens (CD14). We will prioritize children and pregnant and postpartum women (PPW) from diverse backgrounds; we aim to address significant disparities among children with a disproportionate number of aces, and among PPW with peripartum depression. We anticipate that many of our ccbhc clients will be white and from the orthodox jewish community, as ohel has a particular cultural competence in serving faith-based communities. Through our geotargeted outreach based on data from the city's taskforce on racial inclusion and equity, we will actively engage individuals from diverse backgrounds, including veterans. According to US census data, CD14 is 36% white, 30% black, 29% hispanic, 2% asian, and 3% other. Ohel currently provides most of the ccbhc required services and will complete its community needs assessment by month 6, and its staffing and sustainability plans by month 12. Through the PDI grant, ohel will extend our mobile outreach to 24/7, hire 4 additional on-call clinicians, and train all crisis workers to respond to pediatric BH crises. We will begin using new evidence-based screening tools for children (pearls) and adults (rods, mast). We will hire 1 casac; 1 RN to provide onsite primary care; 1 RN with SUD experience to expand our SUD services, including mat; and 1 peer specialist with lived SUD/MH experience. We also plan to expand our cftss program to include PSR, and our TCM program to serve more individuals in the community, including uninsured and those with commercial insurance. In addition to enhancing our EHR to capture more assessment data, we will train our staff to better capture client demographic data in our EHR. With this grant, we will increase our total unduplicated individuals served annually from 647 to 1147 by the end of year 4. Our goals and measurable objectives include: (1) expand access to BH services for PPW via the following objectives: 1.a: increase number of PPW treated for SMI, SUD, or COD by 20% by year 4; 1.b: increase number of individuals, including PPW, with SUD who are receiving individual or group therapy by 20 each year of the program; and 1.c: increase number of providers prescribing mat by 2 by year 4. (2) increase BH crisis services via the following objectives: 2.a: expand mobile crisis hours to 24/7 by the end of year 1; 2.b: implement safety planning interventions for children (c-SPI) to expand crisis services to include children 6-12 years old by the end of year 1; and 2.c: increase number of crisis interventions by 20% by year 4. (3) increase community-based services for high acuity children and youth and PPW via the following objectives: 3.a: increase number of children 0-17 and transitional youth 18-21 treated for SCP, SED, or SUD by 20% by year 4; 3.b: increase enrollment in cftss for 20% by year 2; and 3.c: increase number of PPW we are treating with an EBP by 20% by year 4. (4) develop partnerships and create referral pathways for children from diverse backgrounds across the entire SA via the following objectives: 4.a: outreach to new community partners and provide children's BH educational sessions in 2 new community settings in our SA each year of the grant (8 total); and 4.b: outreach to black, hispanic/latino, and asian families (populations historically underrepresented in our client base) through culturally specific social media pages by the end of year 1. (5) improve pediatric BH outcomes and reduce health disparities via the following objectives: 5.a: improve documentation of client self-reported race, ethnicity, sexual orientation, and gender identity by 50% by the end of year 1; and 5.b: for children ages 4-17 with a high PSC-17, 25% will have a decrease of 4 points within a year across all races and ethnicities.