Appendix_B_Specifc_Programs.pdf

RFP No: 19-250-SOL-00045

APPENDIX B

Specific HRSA-funded programs that support the integration of behavioral health with primary care:

Federal Office of Rural Health Policy (Rural) - has the department-wide responsibility for analyzing the possible effects of current policies and proposed statutory, regulatory, administrative, and budgetary changes on the 57 million residents of rural communities. The

Office provides grant funding at the state and local levels to improve access, quality and financing for rural health care, including behavioral health.

In line with the mission of HRSA, FORHP helps increase access to care for underserved populations and build health care capacity through several programs:1 1) The Community-

Based Division provides support to community organizations to improve health service delivery and strengthen health networks, and encourages collaboration among rural health providers; 2) The Hospital-State Division (HSD) supports ongoing improvements in care to

50 State Offices of Rural Health (SORH) and to rural hospitals through the Medicare Rural

Hospital Flexibility Program. HSD also supports technical assistance for small rural hospitals, including Critical Access Hospitals; 3) Office for the Advancement of Telehealth provides funding for telehealth grants and resource centers, as well as supporting efforts to align licensing and portability activities across states; 4) Policy Research Division coordinates the review of proposed regulations to assess the potential impact on rural health care delivery and financing. The division also supports eight Rural Health Research Centers across the country and staffs the National Advisory Committee on Rural Health and Human services; and 5) Rural Communities Opioid Response supports the prevention and treatment of substance use disorder, including opioid use disorder, in rural communities through grant programs and cooperative agreements.

Additionally, FORHP funds the Rural Health Information Hub (RHIhub), a national clearinghouse on rural healthcare and population health issues. This site has information about evidence-based models on rural health interventions, as well as innovative approaches to behavioral health service delivery, often spotlighting champion grantees.

The Health Center Program (Health Centers) - For more than 50 years, the Health

Resources and Services Administration’s Bureau of Primary Health Care (BPHC) has administered the Health Center Program which provides affordable, accessible, quality and cost-effective care to America’s most vulnerable populations. In 2018, nearly 1,400 health centers operated approximately 12,000 service delivery sites to provide care to more than 27 million people in every U.S. state, the District of Columbia, Puerto Rico, the U.S. Virgin

Islands and the Pacific Basin.2 Health centers advance a model of coordinated, comprehensive, and patient-centered care, and coordinate a wide range of medical, dental, mental health, substance use disorder, and patient support services. Overall Nearly 90 percent of our health centers provide mental health counseling and treatment and 69% of health centers provide substance abuse services.

1 https://www.hrsa.gov/rural-health/about-us/index.html 2 https://bphc.hrsa.gov/sites/default/files/bphc/about/healthcenterfactsheet.pdf https://bphc.hrsa.gov/sites/default/files/bphc/about/healthcenterfactsheet.pdf

In FY17, HRSA awarded $200 million to health centers to expand services related to mental health and the prevention, treatment, and awareness of opioid abuse at existing health centers. In 2018, HRSA awarded $350 million to health centers to expand access to quality substance use disorder and mental health services with a focus on OUD. This funding supports health centers in enhancing mental health and substance abuse services by increasing staff and leveraging health information technology and training to support the expansion of mental health and substance abuse services and their integration into primary care.

Through this initiative, HRSA-supported health centers will have the opportunity to receive science-driven T/TA through a Learning Health System integrated into the Center of

Excellence (COE). For BPHC, this initiative will develop a T/TA model that builds the capacity of regions and health centers to advance and sustain T/TA in order to accomplish their ongoing primary care integration goals in the following four areas:

1. Primary care, innovative integrated care models that translate research on evidence-based behavioral health and substance use disorder interventions into effective clinical and public health practice;

2. Clinical Workflow and Informatics for Process and Quality Improvement;

3. Health Center Workforce Training and Knowledge Enhancement;

4. Service to System Coordination and Financial Sustainability.

Health Workforce Training Programs (Health Professions)- The Graduate Psychology

Education (GPE) and Behavioral Health Workforce Education and Training (BHWET) programs work to close the gap in access to behavioral health services by increasing the number and distribution of adequately trained behavioral health professionals and paraprofessionals. These programs fund schools to develop and operate clinical training programs for psychologists, psychiatrists, social workers, licensed professional counselors, occupational therapists, community health workers and peers focused on underserved and/or rural communities serving diverse populations. Our programs foster the transformation of the health care system by supporting integrated and interprofessional training and practice. Area

Health Education Centers work across disciplines to improve the health of underserved communities through provider education. BHW’s FY19 programs include the Opioid

Workforce Expansion Program- Professionals (OWEP-Pro), Opioid Workforce Expansion

Programs- Paraprofessionals (OWEP-Para), and GPE. These programs are intended to build upon existing HRSA investments to enhance community-based experiential training focused on Opioid Use Disorder (OUD) and other Substance Use Disorders (SUD) for students preparing to become behavioral health professionals and paraprofessionals by training them in the provision of OUD and other SUD prevention, treatment, and recovery services in high need and high demand areas. Programs are required to collaborate with two or more health disciplines focused on integrated and/or interprofessional, team-based care.

Health Professions Scholarship and Loan Repayment Programs - The National Health

Service Corps (NHSC) builds healthy communities by providing financial support to health care providers dedicated to working in areas with limited access to care. The NHSC Loan

Repayment Program supports behavioral health practitioners, including psychiatrists, clinical psychologists, clinical social workers, licensed professional counselors, marriage and family therapists, psychiatric physician assistants, and psychiatric nurse specialists. The NHSC

Substance Use Disorder Workforce Loan Repayment Program supports the recruitment and retention of health professionals needed in underserved areas to expand access to SUD treatment and prevent overdose deaths. The Nurse Corps awards scholarships and loan repayment to nurses, nursing students, and nurse faculty. By supporting these nurses, BHW builds healthier communities across the country, especially in areas of greatest need.

Maternal and Child Health Programs (MCH) - HRSA’s MCH programs fundamentally promote mental health and well-being for maternal and child populations across the lifespan. This aligns with HRSA’s Maternal and Child Health Bureau’s (MCHB) mission to improve the health of America’s mothers, children, and families. Our programs Promote, Prevent, Screen, Intervene, Refer, Treat, Train and Support. MCHB programs work on multiple levels.

Provider level grantee programs include Healthy Start and Home Visiting, evidence-based approaches to screen perinatal women and parents of young children, and referals to treatment and support for mental and substance use disorders. At the systems level, MCHB funds States and Territories through the Title V Maternal and Child Health Block Grant to address gaps in direct services, and support through enabling public health services and systems. MCHB provides funds to states for two tele-psychiatric consultation and provider training programs that improve the mental health and well-being of mothers and children.

At the policy level, the Supporting State MCH Policy Innovation Program encrouages innovative state policy initiatives that improve access to quality health care, including behavioral health, for MCH populations. MCHB also funds the development and dissemination of clinical guidelines such as the Women’s Preventive Services Guidelines, Bright Futures pediatric guidelines, and a maternal safety bundle (sets of evidence-based practices) for hospitals and providers on the obstetric management of women with opioid dependence. For workforce training, MCHB supports interdisciplinary graduate training such as the Developmental Behavioral Pediatrics Training Program and continuing education for the practicing workforce around pediatric mental and behavioral health through the

Collaborative Office Rounds program.

Ryan White HIV/AIDS Program (HIV/AIDS) - Provides a comprehensive system of human immunodeficiency virus3(HIV) medical care, medication4, and essential support services for low-income people living with HIV (PLWH) who are uninsured or underserved.

The Ryan White HIV/AIDS Program (RWHAP) funds grants to states, cities/counties, and local community-based organizations to provide HIV care and treatment services to people living with HIV to improve health outcomes and reduce HIV transmission among hard to reach populations. RWHAP understands the critical need for behavioral health services.

From its HIV surveillance, the Centers for Disease Control and Prevention (CDC) has determined that SUD involving crack cocaine, methamphetamine, amyl nitrite, opioids, and heroin are closely associated with HIV and other sexually transmitted diseases, and that in

PLWH, SUDs “can hasten disease progression, affect adherence to antiretroviral therapy

3 https://www.cdc.gov/hiv/risk/substanceuse.html 4 https://www.nimh.nih.gov/health/topics/hiv-aids/index.shtml https://mchb.hrsa.gov/maternal-child-health-initiatives/healthy-start https://mchb.hrsa.gov/maternal-child-health-initiatives/home-visiting-overview https://mchb.hrsa.gov/maternal-child-health-initiatives/title-v-maternal-and-child-health-services-block-grant-program http://www.hrsa.gov/about/news/press-releases/hrsa-awards-12-million-maternal-child-mental-health-programs http://www.hrsa.gov/about/news/press-releases/hrsa-awards-12-million-maternal-child-mental-health-programs https://mchb.hrsa.gov/fundingopportunities/?id=3379c46e-d6d9-4155-bfa5-c7bb85609764 https://mchb.hrsa.gov/maternal-child-health-topics/recommended-preventive-services.html https://mchb.hrsa.gov/maternal-child-health-initiatives/mchb-programs#preventive https://mchb.hrsa.gov/maternal-child-health-topics/child-health/bright-futures.html https://mchb.hrsa.gov/maternal-child-health-topics/maternal-and-womens-health/#AIM https://mchb.hrsa.gov/training/projects.asp?program=6 https://mchb.hrsa.gov/training/projects.asp?program=3 https://www.cdc.gov/hiv/risk/substanceuse.html https://www.nimh.nih.gov/health/topics/hiv-aids/index.shtml

(HIV medicine), and worsen the overall consequences of HIV infection with an estimated 10 to 28 percent of PLWH having co-occurring substance abuse disorders and mental illnesses.

In 2016, 16 percent (nearly 89,000) of RWHAP clients received mental health or substance abuse services from RWHAP providers. In that same year, the RWHAP provided 353,896 mental health visits and 173,926 substance abuse service visits in outpatient settings.

RWHAP ensures that clients have access to behavioral health services either directly or through coordination with recipients providing these services. In addition, through the

RWHAP Part F - Special Projects of National Significance Program, innovative models of

HIV care and treatment are developed, including those that integrate behavioral health approaches with HIV primary care to respond to emerging needs PLWH.