Transformation Transfer Initiative
NASMHPD has proudly worked with states and territories since 1959. Since that time, one of the most impactful SAMHSA initiatives NASMHPD has had the privilege on which to work with states and territories is the Transformation Transfer Initiative (TTI). In 2007, SAMHSA, in collaboration with NASMHPD, created the TTI to assist states in transforming portions of their mental health systems of care. The TTI provides funding awards on a competitive basis to States, the District of Columbia, and the Territories to identify, adopt, and strengthen innovative behavioral health initiatives. Through the TTI, SAMHSA has invested more than 50 million dollars to over 250 innovative initiatives spanning 49 states, 5 territories, and the District of Columbia. We thank SAMHSA for their ongoing leadership and support for this dynamic project and trailblazing work.
These flexible TTI funds are used to identify, adapt, and strengthen transformation initiatives and activities that can be implemented in the state or territory, either through a new initiative or expansion of one already underway, and focus on one or multiple phases of the system change.
- American Samoa (Workforce): American Samoa is conducting workforce recruitment strategies and activities to expand the local crisis response worker resource and develop the capacity of the existing and future crisis response workers skills through the implementation of the Crisis Response Worker Development (CRWD) initiative.
- Arkansas (LGBTQ+): Arkansas is focusing their TTI on individuals who have a Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED) and self-identify as LGBTQ+.
- CNMI (Workforce): CNMI is focusing on workforce development to make all staff and key partners ready to respond to any community members experiencing a crisis. Included in the plan is the development of a Standard Operating Procedure that outlines the call and workflow of staff including required trainings that meets the standard of the National Suicide Prevention Lifeline.
- Connecticut (C&A): Connecticut is implementing significant additions to its youth Mobile Crisis Intervention Services (MCIS) training curriculum and sharing opportunities to build competencies across the child-serving system, through their Enhancing Mobile Program.
- Connecticut (Workforce): Connecticut is using TTI funding to purchase software that will allow for high-tech, GPS-enabled mobile crisis geolocation and dispatch to quickly and efficiently determine the location of the closest available mobile crisis team, track response times, provide real-time performance outcomes dashboards to monitor the quality and quantity of mobile response services, and of course, efficiently connect persons served and their families to needed resources supporting access and continuity of care.
- Delaware (C&A): Delaware’s initiative is expanding the capacity for their behavioral health crisis services to better serve children and adolescents and their families.
- Guam (C&A): Through GBHWC’s Project Agang (Chamoru word for Call), Guam is creating a mobile crisis team to respond to community needs of children, youth, and young adults with SED and the families of those experiencing crisis.
- Guam (Workforce): Guam is taking a two-pronged approach to expanding their Mobile Crisis Response Team (MCRT) through training and employment of 10 Certified Peer Support Specialists (CPSS), and engaging law enforcement with tablets to provide onsite crisis services to persons in need.
- Hawaii (AI-AN): Hawaii is strengthening existing services at their Community Mental Health Centers to offer more crisis stabilization and prevention support groups to Native Hawaiians.
- Hawaii (LGBTQ+): Hawaii is enhancing their statewide 24/7 crisis hotline/website to better address the unique needs of LGBTQ+ individuals.
- Hawaii (Workforce): Hawaii is creating a statewide training and certification program for Mental Health Emergency Workers.
- Indiana (C&A): Indiana is developing a plan for building and financing a robust youth and family crisis response and diversion continuum that links closely with the juvenile and adult criminal justice systems, identifies standardized training and certification standards for mobile teams and crisis receiving facilities, uncovers remaining legislative priorities, and explores how to make 911 and 988 more interoperable.
- Iowa (LGBTQ+): Iowa is developing two standardized training toolkits specific to serving children and LGBTQ+ individuals to be accessed by Iowa’s 988 and crisis behavioral health workforce.
- Kansas (LGBTQ+): Kansas is using funding to retain expert consultation services to develop training for all staff involved in strengthening Kansas’ 988 response and expanding crisis services throughout the state in all 3 core areas: Regional Crisis Call Centers, Crisis Mobile Team Response, and Crisis Receiving and Stabilization Facilities.
- Kansas (Workforce): KDADS is utilizing funding from the Transformation Transfer Initiative to increase efforts to recruit, train and retain individuals with lived experience to become certified as Peer Specialists, Parent Peer Support, and Peer Mentors in the State of Kansas.
- Kentucky (Workforce): Kentucky is supporting installation and initial implementation of a rural community paramedicine crisis response model that will expand the role of paramedics and emergency medical technicians (EMTs) as first responders in a behavioral health crisis and improve implementation of evidence-based programs (EBPs) among existing behavioral health crisis staff to improve client outcomes, particularly for families, children, adolescents, and transition-age youth.
- Louisiana (LGBTQ+): Louisiana is developing and implementing training related to the state’s LGBTQ+ population.
- Maryland (LGBTQ+): As part of their vision to develop a statewide integrated, comprehensive, culturally sensitive, and responsive behavioral health crisis system to serve and support all people, Maryland is launching LGBTQ-specific Training Modules.
- Maryland (Workforce): Maryland’s initiative, Special Population Training Modules, serves to ensure that Crisis Call Center Specialists have access to uniform training modules which address topics identified by Call Centers, including persons with lived experience, to ensure effective services are provided to children, youth, adults, older adults, and special populations.
- Mississippi (C&A): Mississippi’s initiative partners with community providers to expand crisis services by implementing the TIP and TAMAR model.
- Mississippi (Workforce):
- Nevada (C&A): Nevada is mapping the state’s current Crisis Response System for children and adolescents, using the standardized scoring tool developed by Crisis Now to measure system readiness for 988 implementation to identify gaps and provide analysis.
- New York (LGBTQ+): New York is creating and hosting a specialized and unprecedented training for New York’s crisis workforce across the continuum of 988, mobile crisis, and crisis stabilization centers to develop competence in engaging and responding to the unique needs and risks associated with individuals who identify as LGBTQ+ across the lifespan who are in crisis.
- Oklahoma (Workforce-1): Oklahoma is developing the Clinical Training Center of Excellence, also known as The Center, to provide a centralized resource for training both new and experienced behavioral health professionals and stakeholders in the state.
- Oklahoma (Workforce-2): The Oklahoma Comprehensive Crisis Response (OCCR) serves as the state’s crisis care continuum, prioritizing community-based diversion approaches that aim to decrease unnecessary law enforcement/criminal justice engagement and prevent the need for higher levels of care.
- Oklahoma (Workforce-3): Oklahoma is partnering with the University of Oklahoma to grow the number of LPCs within the state. This project expands on similar prior successful projects which selected existing ODMHSAS employees through an application process and supported their educational cohort through the attainment of a licensed-eligible master’s degree.
- Pennsylvania (C&A): Pennsylvania is assessing current strengths and needs related to crisis services for children and adolescents and identifying best practices and opportunities for collaboration.
- Rhode Island (C&A): Rhode Island will develop a shared set of risk assessment protocols and a shared training curriculum that specifically focuses on Youth & Families.
- Rhode Island (LGBTQ+): Rhode Island is developing a shared set of risk assessment protocols and a shared training curriculum for the varied statewide workforce audiences that will be involved in the overall system of care serving those Rhode Islanders who contact 988.
- South Carolina (C&A): South Carolina’s TTI initiative, Bridges, aims to improve and expand wellness and recovery options for children and adolescents by increasing access to crisis services and other supports, assisting youth in making the transition to adulthood and self-sufficiency, providing comprehensive diversion options from the justice system, reducing racial disparities, and increasing alternatives to detention.
- Tennessee (C&A-1): Tennessee is expanding utilization of the Shield of Care curriculum, a research-informed suicide-prevention curriculum that teaches juvenile detention staff strategies to prevent suicide within youth detention settings.
- Tennessee (C&A-2): As youth are triaged by the broad continuum of the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS), two areas of concern are the use of EDs as holding facilities for mental health crises, and the perceived need for increased inpatient and residential capacity.
- Tennessee (Workforce): The Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS), in partnership with the University of Tennessee School of Social Work (UT School of SW), is launching the Tennessee Public Behavioral Health Workforce Recruitment and Outreach Initiative.
- Texas (Workforce): Texas is implementing a learning collaborative initiative, building on their existing learning collaboratives which has two tracks: One that focuses on 988 implementation workforce issues for the four urban Lifeline affiliates and the other focuses on 988 implementation workforce issues at LMHAs/LBHAs statewide.
- Washington (AI-AN): Washington supported startup activities for the Tribal 988 Line and developed an electronic resource for understanding what culture-based and culturally appropriate resources are available to AI/AN individuals.
- Washington (C&A): Washington has aligned its new children, youth, and family crisis teams established through HB1477 by incorporating Mobile Response Stabilization Services (MRSS) best practices for children and adolescent mobile response teams into its system design.
- West Virginia (C&A): West Virginia is developing formalized feedback processes for youth and families in collaboration with several relevant state groups, contracting with the University of Maryland Institute for Innovation and Implementation to become part of the Mobile Response and Stabilization Services (MRSS) Quality Learning Collaborative (QLC), and developing protocols regarding its current call lines and connections to crisis services as it launches 988 in July 2022.
In FY 2020-2021, CMHS awarded 40 TTI grants, all in the amount of $150,000, to the following 28 states and territories:
- Alabama: ADMH will develop a crisis communication system that includes new crisis diversion centers, rural crisis care projects, and the Alabama Stepping Up Initiative, that will provide access to care in addition to advocacy for passage of state funding for 988 crisis line.
- Colorado: CDHS will enhance the existing Jail-Based Behavioral Health Services (JBBS) Program and provide targeted technical assistance and peer-to-peer learning for rural jails with a focus on the SMI population by linking community resources and providers, connecting individuals with their Peer Recovery Network. The University of Colorado will create and facilitate an integrated peer-to-peer community to foster successful implementation of best practices and the sharing of team successes, barriers, lessons learned, and problem solving amongst the participating jails.
- Connecticut: DMHAS will enhance Communicare mobile crisis services by including peer navigators to provide postvention follow-up services in order to divert adults from jails, increase collaboration with local police departments, and strengthen clinical staffing on the mobile crisis teams. DMHAS will employ peer navigators, replicating the success of the CARES Project, to support individuals with SMI in local jails and re-entering the community.
- Delaware: DSMAH, through the Delaware Treatment and Referral Network (DTRAN), will integrate Certified Peer Support Specialists (CPS) to serve clients with SMI and co-occurring disorders and provide additional service options through the Pre-Arrest Police Diversion Program (PDP). DSMAH will enhance the their Mobile Bridge program, which is a joint venture with the Department of Corrections, that provides recently released individuals with a myriad of services, including behavioral health screening, referral to treatment, and enrollment into State services by expanding hours, reach and public awareness of the program.
- District of Columbia: DBH will expand their existing service registry, EMResource, by engaging DC hospitals, crisis stabilization beds, inpatient and residential SUD services, and the Access HelpLine (AHL) to increase capacity of tracking the full range of acute inpatient psychiatric services and reduce unnecessary wait times.
- Florida: DCF, through culturally appropriate, evidenced-based, and best practices, will employ Forensic Peer Specialists to the new Community Forensic Liaison (CFL) Team to reduce the health and social disparities for justice-involved individuals with mental illnesses, thereby improving service access and outcomes, and strengthen collaboration between the mental health and law enforcement/criminal justice systems. DCF, using the Sequential Intercept Model, will employ Forensic Peer Specialists to colloaborate with jails to assess and coordinate treatment for individuals within the jails and upon reentry in their efforts to reduce the health and social disparities for justice-involved individuals with mental illnesses.
- Hawaii: AMHD will develop a provider and public-facing service registry and dashboard integrated with their EMR by upgrading their system to increase efficiency and include crisis, inpatient psychiatric, residential mental health, and substance abuse facilities. Data collection will enhance cross-system collaboration and identification of needs. AMHD will increase the number of Certified Forensic Peer Specialists and offer additional training to increase state capacity at pre-arraignment, arraignment, and for Hawaii State Hospital forensic patients.
- Kansas: KDADS will expand their mobile crisis competency restoration services to reduce pretrial detention times, create a best practice toolkit and guidance for judges and court officers regarding community-based competency evaluation and restoration services, and facilitate a statewide judicial training and awareness campaign.
- Kentucky: DBHDID, through the Louisville Behavioral Health Jail Diversion Initiative, will work to revolutionize and expand the crisis healthcare system in Louisville by implementing non-police jail diversion models that are trauma-informed and racially equitable for individuals in crisis, and reducing incarceration rates recidivism.
- Louisiana: OBH will research and develop a model for a crisis services registry of a triage, dispatch, and data collection/reporting to strengthen mobile crisis and crisis stabilization systems.
- Massachusetts: DMH will expand and enhance their Behavioral Health Network peer support program to assist with diversion via co-response and Community Clinical Response Team (CCRT) Clinicians, increase capacity through telehealth, and collaborate with law enforcement.
- Minnesota: MMHCF will expand and enhance FastTracker, Minnesota’s public website with two portals to track availability of mental health and substance use disorder treatment services, completing a state-level, real-time, comprehensive service registry for mental health treatment services across the continuum of care.
- Mississippi: MDMH will enhance their Crisis Intervention Team (CIT) program by employing Forensic Peer Support Specialists and establishing a Crisis Services Center (CSC) that will act as a Single Point of Entry (SPI) for the CIT program and will be accessible to any individuals experiencing psychiatric or substance abuse challenges. MDMH will promote a trauma-informed approach in the justice system by partnering with a local Community Mental Health Center to train a team of Forensic Certified Peer Support Specialists (CPSS) to work in the jail system, and train corrections officers, jail staff, and/or justice system in trauma-informed care.
- Missouri: DMH will replicate an expansion of the successful Forensic Mobile Team, a community behavioral health program, to provide services in county jails that have no medical, psychiatric, or other services available.
- Montana: AMDD will increase access to crisis and diversion services by researching and developing a Behavioral Health Crisis System Strategic Plan to inform the most relevant services in rural and frontier communities.
- New Jersey: DMHAS will support and champion peer specialists in crisis programs in two counties of the state with a focus on facilitating the diversion of legally involved individuals from involuntary hospitalization or incarceration, and expanding support for local police departments. DMHAS will strengthen services in the state by recruiting, training, and deploying forensic peer specialists (FPSs) who will work in justice-involved services (JIS) to engage individuals with a mental illness who are in county jails and local courts and support their re-entry into the community.
- New Mexico: NM BHRN will develop a Learning Collaborative to bring together and strengthen existing Crisis Triage Centers (CTCs) by bringing together service providers, their state Office of Peer Recovery and Engagement (OPRE), and law enforcement.
- New York: OMH will combine two successful peer-run county emergency programs; the 911 Diversion Program which trains 911 dispatch and emergency service personnel to screen for mental health or co-occurring issues and the Mobile Crisis Stabilization Team which is a forensic-focused mobile team that works directly with law enforcement and courts seeking diversion through alternatives to incarceration (ATI) to provide immediate crisis response and/or transitional care services to people at risk of entering the criminal justice system.
- Ohio: OMHAS will expand and enhance treatment services within jails and increase reentry coordination for treatment and recovery supports for individuals with SMI to transition into the community through crisis prevention and training staff on trauma-informed care, access to psychiatric services, and access to supportive housing and transportation.
- Oklahoma: DMHSAS, expanding upon the Sequential Intercept (SIM) Model to provide services at every level of diversion, will partner with a county jail to implement reentry support to community providers including behavioral health treatment services and other community social support such as housing, education, employment, and legal resources. They will identify a community partner network to educate about the reentry planning process and develop collaborations to make referrals and service connections. DMHSAS will work to expand reach of their County Service Engagement Project via Certified Peer Support Recovery Specialists to better screen individuals, connect them to community services, and improve jail-based behavioral health services. Multiple models of telehealth intervention are in use throughout the state and will serve as a blueprint for this project. Projects which provide tablets directly to individuals receiving services have demonstrated the success of immediate access to care and proven the effectiveness of proprietary software which protects the devices from unauthorized use. Tablets have been distributed to law enforcement to connect individuals they interact with in the public with emergency crisis care in the field have also proven successful interfaces with the criminal justice system.
- Palau: PBHAC will train providers and law enforcement on Behavioral Care and Diversion. The long-term outcome is to reduce recidivism and incarceration rates, lower the costs associated with arresting, sentencing, and jailing those with mental health issues, and more importantly, provide those experiencing a behavioral health crisis with the care and services they need.
- Pennsylvania: DHS/OMHSAS will develop a community-based forensic pilot bed registry program in the southeast region of the state building upon their Stepping Up Initiative implementation. The registry will focus on diverting individuals with mental illness involved in the criminal justice system from incarceration to community-based treatment. DHS/OMHSAS will provide specialized response training through Crisis Intervention Training (CIT) and Mental Health First Aid for law enforcement when interacting with individuals with behavioral health challenges such as mental illness and will promote collaboration at the local level. They aim to increase officer and public safety during crisis situations and enhance diversion/treatment opportunities to improve outcomes for individual with behavioral health challenges.
- Puerto Rico: ASSMCA will expand services of the Crisis Peer Support Specialists to the Integrated Crisis Intervention program of the Linea PAS Hotline by assigning Certified Peer Support Specialists to provide services to crisis programs through the ASSMCA Mutual Support Center (MSC). ASSMCA will integrate Crisis Peer Support Specialists, Recovery-Oriented Services, and their Offender Re-Entry Program to strengthen mental health treatment interventions at correctional facilities and in Forensic Psychiatric Hospitals by engaging individuals in peer-based recovery services, MH treatment, and development of personal skills.
- South Carolina: DMH will strengthen their statewide mobile crisis program to increase jail diversion practices through a Criminal Justice Coordinating Council and engagement with leaders in the local justice system to utilize data-driven, evidence-based practices to inform decision making, providing effective treatment for individuals and families, and implementing jail diversion practices. DMH will engage Certified Peer Support Specialists to increase access to mental health and substance use services for individuals released from a detention center through coordinated care and will employ mental health professionals to improve coordination of care for individuals returning to the community.
- South Dakota: DBH will create a real-time, community-based, forensic service registry of comprehensive services including but not limited to residential crisis services, mobile crisis services, outpatient mental health and substance use disorder services, residential mental health and substance use disorder services, and supported and recovery housing. They will focus on diverting individuals with mental illness involved in the criminal justice system from incarceration to community-based treatment.
- Texas: HHSC, through trainings, educational resources, and planning activities, will develop, publish, and implement a research-informed and evidence-based training and technical assistance (TTA) strategy to accelerate the implementation of successful diversion programs throughout the state. This project will include data collection from law enforcement, peer service providers, people with lived experience of justice involvement, including people of color, and local mental health service providers.
- Utah: DSAMH, through Forensic Peer Support Specialists (FPSS), will create a new initiative to expand diversion from incarceration into the existing crisis system. They will establish a specialized FPSS enhancement and practicum program and create a peer workforce to focus on individuals being diverted from incarceration due to behavioral health issues.
- Washington: DBHR will develop a statewide service registry by upgrading their system to increase efficiency, converting existing state hospital capacity into Forensic Centers of Excellence, and including smaller treatment facilities dispersed throughout the state to better serve individuals within or nearer their home communities and reduce institutionalization. DBHR will create a continuing education, trauma-informed curriculum for certified peer counselors to work in crisis service environments. The curriculum, created by CPCs and crisis service providers will serve the needs of behavioral health providers, and build upon the lived experience of those uniquely qualified to provide peer services. DBHR will create a specialized online curriculum focusing on Trauma Informed Approaches for jail personnel, law enforcement, and possibly forensic hospital personnel which will be delivered by co-trainers, presenters and panelists who are local tribal members, representatives of under-represented groups, youth, family, and adult content experts with lived experience.
American Samoa: ASBHSD, in collaboration with their department of Voc Rehab, is improving appointment attendance of individuals with SMI by expanding their supported employment and providing incentives of transportation and prepared meals. They have been making valiant efforts to meet with participants in parks 6 ft away to make sure that the participants receive the needed program. Find American Samoa's report here.
District of Columbia: DBH is facilitating the transition of individuals with SMI from correctional facilities to the community through a warm handoff by collaborating with and equipping community service providers and certified Peer Support Specialists with incentives. Find DC's report here.
Delaware: DSAMH is expanding the capacity built by the bed registry system initiated by TTI 2019 through leveraging technology and the funding to improve the continuum of care following the treatment and referral system. By building on their Treatment and Referral Network (DTRAN), DSAMH is improving engagement rates through direct incentives transitioning between levels of care, particularly inpatient to outpatient behavioral health settings and integration of peer support. Find Delaware's report here.
Florida: DCF developed partnerships with local and statewide entities and are offering trauma-informed family navigators and establish incentives for engagement of youth and families to improve participation in services. Find Florida's report here.
Georgia: DBHDD is partnering with service providers to reduce no-show rates and improve early engagement in treatment through its incentive system, “NICE!”. They are conducting a case control study to evaluate effectiveness of incentives. Find Georgia's report here.
Guam: GBH, through Project I Hinemlo and Guma Mami Inc., is promoting self-determination and person-centered planning for young adults experiencing FEP and/or SMI/SED by pairing them with peer navigators in their transition from psychiatric inpatient services, corrections/jails, and homeless shelters to outpatient services by providing them with incentives. Find Guam's report here.
Kansas: KDADS is fostering engagement through peer support team members and new telehealth options to encourage attendance at appointments by offering wellness recovery related activities and incentives. They are incentivizing staff to address retention challenges and are focusing on coordination and collaboration between street outreach teams, correctional facilities, hospitals, case managers, and peer supports to provide wrap-around services. They have also put into place NAMI training via ZOOM and peer staff incentives to be distributed. Find Kansas's report here.
Kentucky: DBHDID is expanding upon existing continuity of care efforts and Kentucky’s Recovery-Oriented system of care through peer support specialist, the creation and implementation of a new contingency management (CM) intervention, and incentives for individuals discharged from a state hospital. Find Kentucky's report here.
Massachusetts: DMH is innovatively utilizing Certified Older Adult Peer Specialist (COAPS) to support individuals at risk of losing their housing because of hoarding issues and pandemic-related circumstances and offering supermarket gift card incentives. Find Massachusetts' report here.
Mississippi: DMH trained and graduated 35 Certified Peer Support Specialists to act as community-based Peer Bridgers to provide incentives and support individuals in their transition from a state hospital for acute psychiatric care to community-based services. Virtual peer support trainings allowed MS to drastically increase the capacity of certified Peer Bridgers despite the pandemic. Find Mississippi's report here.
Missouri: DMH, through the Missouri Alliance for Dual Diagnosis (MOADD), designed and created an innovative mobile app for children and their families with MI and I/DD through trauma-informed clinical best practices and is providing incentives. They are assisting clinical professionals in utilizing trauma-informed clinical best practices by utilizing a mobile application and an Extension for Community Health Care Outcomes (ECHO). Find Missouri's report here.
Nevada: DPPBH designed and created innovative engagement activities by providing incentive bags described by clients as “[providing] feelings of joy and excitement [in the midst of] the economic and COVID-19 climate.” These incentives facilitated an 82% attendance rate. They are utilizing occupational therapy to support clients with leisure activities and public health education. Staff are reporting a new level of patience and ease amongst clients while waiting for their appointments following discharge from an acute psychiatric hospital. Find Nevada's report here.
New Jersey: DMHAS is training Certified Peer Support Specialists in Recovery-Oriented Cognitive Therapy (CT-R) and developing creative strategies and incentives to assist hospitalized patients working to remove barriers/obstacles that they have encountered within the past to move that much closer to the life they want for themselves. Find New Jersey's report here.
New York: OMH successfully engaged clients from psychiatric centers by integrating Peer Bridgers and incentives in their Sustained Engagement Support Team (SES). Cell phones were obtained for clients to more easily reach their CPS. For clients who accepted these services, 100% are regularly attending appointments. Find New York's report here.
North Carolina: MHDDSAS enhanced engagement through Certified Peers Support Specialists, telehealth services, and incentives via RICCM (Resource Intensive Comprehensive Case Management), with one participating facility achieving a 100% appointment attendance rate. Find North Carolina's report here.
Oklahoma: DMHSAS creatively and innovatively engaged individuals through a Street Outreach and Rapid Response team by offering practical items as incentives including bus passes, clothing, sleeping bags, tarps, food gift cards, and connection to housing or other services the clients have requested. They have also started working with providers using the Helping Connections and have obtained iPad’s (with separate funding) to help clients connect with their outpatient providers via technology to help with the challenges of face-to-face interactions due to COVID-19. One client that was helped with reconnecting with their outpatient provider had not engaged in services in two years and had recently lost their housing due to mental health issues. This client has now successfully completed 10 appointments with their provider, taking medication, and is working with their case manager to secure housing again. The Mental Health Association of Oklahoma, who is facilitating the project, continues to communicate with all agencies involved to improve working relationships and a more collaborative approach to serve clients better. Find Oklahoma's report here.
Puerto Rico: ASSMCA creatively and consistently facilitated client engagement through peer support specialists through incentives, support services, and telehealth services. During the lockdown period, the Peers Support Program has provided 66 digital groups and had 1,570 accesses to their mutual support services. This program has generated a great amount of interest, resulting in 218 emails requesting information about virtual groups. Find Puerto Rico's report here.
South Carolina: DMH engaged Certified Peer Support Specialists and achieved a 96% attendance rate for clients at follow-up appointments despite the challenges posed by the pandemic. Furthermore, CMHCs creatively combined incentives and community outreach for behavioral health services such as for those recently: incarcerated, leaving psychiatric hospitals, receiving mobile crisis services or youth, or young adults and their families in FEP initiatives. One center covers a very rural area where there is no public transportation. This has meant that they have had to develop contacts with businesses to provide transportation within and across county lines. Another center reported that patients have felt rewarded for not missing appointments and have responded in a positive manner. “Our Center, staff and patients, have sincerely appreciated this program and the reason it was implemented to begin with!” Find South Carolina's report here.
Utah: DSAMH actively, creatively, and thoughtfully engaged Service Navigators at distinct CMHCs, a homeless youth resource center, and a tribal organization to identify disengagement from services and effectively tailor incentives to provide appropriate support. Find Utah's report here.
Vermont: DMH creatively integrated mental health services and housing needs via outreach efforts, continuity of care, and incentives to focus on individuals who have not previously engaged in services. They have achieved a 94% attendance rate. One gentleman stated that if he had known counseling would have been so helpful, he would have gone in the first place. He is grateful to receive the cards and plans to continue counseling "for my own self”. Find Vermont's report here.
In FY 2018-2019, CMS awarded TTI grants to the following twenty-three states:
- Alabama: ADMH’s new search engine for hospital beds expands its Mental Illness Community Residential System(MICRS) and ADMH is enhancing its ability to track residential, supportive housing, and statewide crisis services by providing real-time data.
- Connecticut: DMHAS developed and launched both a public and provider facing registry that offers 1,766 inpatient, intensive residential, group homes, transitional housing, and respite sites.
- Delaware: Delaware Treatment and Referral Network (DTRAN) expanded and strengthened their array of psychiatric hospitals, detoxification facilities, crisis stabilization and respite centers, residential beds, and outpatient and support services and succeeded in reducing wait times for individuals in crisis.
- Florida: DCF is upgrading and expanding their crisis system registry into a centralized, web-enabled platform which enables real-time data of crisis stabilization units, detoxification centers, addiction-receiving facilities, inpatient psychiatric and residential treatment beds, and short-term residential settings. psychiatric and acute care beds statewide.
- Georgia: DBHDD’s Georgia Crisis and Access Line (GCAL) integrated core components of SAMHSA’s crisis care guidelines – regional crisis call center, crisis mobile team response, and crisis receiving and stabilization facilities – into its referral system, which is open to families, first responses, and providers. TTI funds worked to improve the current interface for more streamlined use and data collection, identify and place individuals in need of service in real time, and strengthen capacity to work efficiently with local emergency departments.
- Idaho: Idaho Psychiatric Bed and Seat Registry (IPBSR) grew and improved their crisis response system through expanded crisis call centers, mobile crisis teams, crisis stabilization centers, crisis respite, and inpatient beds across the state.
- Indiana: Indiana’s Treatment Connection registry expanded and improved their crisis service array through real-time tracking of available services, providing a bridge between public and private providers, and building two new crisis stabilization units.
- Maryland: Maryland Bed Availability Registry (MD-BAR) modernized their behavioral health crisis responses by building a web-based platform to broaden and enhance online updates and accuracy of service availability for crisis counselors, safe stations/walk-in centers, mobile crisis teams, detoxification centers, psychiatric hospitals, and other sites.
- Massachusetts: Massachusetts Behavioral Health Access (MABHA) website broadly expanded its service array both for providers and the public such as mobile crisis teams and crisis stabilization units, inpatient beds for both mental health and substance use-related crises for adults and children, and preventive and aftercare services, and increased access during the pandemic to further facilitate access to crisis services. and capture critical data on wait times.
- Mississippi: MDMH Bed Registry expanded capacity for crisis stabilization unit beds and services close to home, as well as tracking for CSUs, state hospital beds, community living facilities (long-term residential), IDD crisis units, and child/adolescent facilities, and were able to adjust and accommodate new admissions more safely during the pandemic.
- Nebraska: NDBH successfully expanded their largest metropolitan area’s crisis services by providing first responders with transportation options and referrals through effectively tracking availability daily and reducing boarding of individuals in crisis. The registry will include a new, 24-hour crisis stabilization unit, public and private psychiatric hospitals and units, as well as western Iowa collaboration.
- Nevada: DBPH exponentially improved their continuum of crisis care based on the Crisis Now model by integrating crisis call centers, mobile crisis teams, peer-run respite settings, and crisis stabilization units to improve resilience, reduce treatment costs, relieve emergency room crowding and make judicious use of inpatient beds through a referral network for providers and a public website, Treatment Connection. Despite the pandemic, Nevada successfully recruited 75% of providers and ensured the growth and continuity of their crisis continuum of care.
- New Jersey: DMHAS expanded their Bed Enrollment Data System (BEDS) to strengthen relationships with and use of short-term care by including psychiatric beds in community hospitals and peer-run respite facilities to provide a critical integration into their existing system.
- New Mexico: The New Mexico Behavioral Health Referral Network (NM BHRN) strengthened hospital, first responder, and public-facing access to crisis services by expanding integration with their substance use treatment registry, adding two new 24-hour crisis triage centers, and utilizing the New Mexico Crisis and Access Line to facilitate access to the appropriate level of care.
- New York: OMH improved and expanded access to care through the Bed Availability System (BAS) so mobile crisis teams could quickly identify available beds statewide by enhancing hospital reporting to BAS, improving on-time updates by 24% statewide and aiming for 80% of hospitals reporting daily.
- North Carolina: The Behavioral Health Crisis Referral System (BH-CRSys) integrated the feedback of providers to upgrade their platform system to simplify use, expand information captured in the network, and facilitate patient transportation to care. Provider facilities as well as hospital emergency departments, mobile crisis providers, and 24/7 behavioral health urgent care centers are able to access the registry. NC DHHS used relationships strengthened as a result of the registry to ensure providers had relevant information and assistance related to COVID-19 needs.
- Ohio: OMHAS improved and expanded their registry to integrate crisis services including mobile crisis teams, crisis stabilization units, and inpatient hospital beds in seven counties, which will be expanded statewide and will include community-based services such as organizations that provide transportation, food, shelter, rehabilitation, and entitlement assistance.
- Oklahoma: ODMHSAS improved their “Bed Board” system by adding new functionality to the electronic health records system to ensure consistent, timely, and reliable information by providing quarterly hour updates for participating agencies, crisis bed providers, call-centers, and mobile crisis teams.
- Rhode Island: BHDDH created a public-facing, real-time website to help people find help when they or a loved one is in crisis. Rhode Island built out and greatly improved their crisis care continuum through a semi-automated bed registry including mobile crisis teams, central statewide call center, and crisis stabilization unit for triage.
- Tennessee: The Hospital Resource Tracking System (HRTS) developed an electronic communication bridge to allow for inform their entire crisis services array including mobile crisis, crisis stabilization units, and hospital providers to view availability in real time, in addition to developing the Patient Bed Matching System (PBMS) to improve communication between referral sources and inpatient facilities.
- Utah: DSAMH is expanding their crisis care continuum by creating an enhanced call center that would serve as a 911 for behavioral health and include a triage process to get people to the right care at the right time. The Utah Behavioral Health Availability Platform is expanding from mental health inpatient beds to include substance use disorder residential programs and social detoxification centers along.
- Vermont: DMH upgraded their current E-Bed Board by improving user interface and enhanced access to information on service availability including crisis stabilization, inpatient, residential, and intensive residential beds, as well children’s inpatient and crisis beds throughout the state.
- West Virginia: BBH strengthened their continuum of care by identifying and integrating call centers, mobile crisis teams, and wraparound services for children, youth and families. A later expansion will include psychiatric hospitals and units, psychiatric units, crisis triage centers, outpatient, substance abuse care, children’s respite, and residential care.
In FY 2017-2018, CMHS awarded TTI grants, all in the amount of $220,000, to the following six states:
- Georgia – DBHDD targeted specific groups of providers for training and increased capacity of staff certified in sustaining Recovery-Oriented Cognitive Therapy (CT-R) and expanded the treatment reach to a larger variety of consumers (children, youth, young adults, individuals in recovery). Find Georgia Summary Here.
- Massachusetts – DMH partnered with The Bridge of Central MA, Inc. to develop in-state capacity for the CT-R trainers to expand delivery of this evidence-based practice within the community-based service delivery system for people with severe mental illness. This treatment has been successful in helping people shift the direction of their energy towards meaningful recovery as well as energizing staff that had been working at sites for years by breathing new life into treatment teams. Find Massachusetts Summary Here.
- Montana – AMDD introduced CT-R into state MH services, enhanced the skill set of MSH and community staff at various levels of training and experience, improved outcomes of individuals with serious mental illness, and promoted and improved continuity of care. Find Montana Summary Here.
- New Jersey – DMHAS focused on health integration and culminated into the hosting of a CT-R consumer outcome Summit as well as the development of a Behavioral Health Home Toolkit featuring the integration of CT-R in integrated settings, and peer-delivered CT-R within clinical teams. The CT-R competencies enabled the staff to assist individuals attending the BHH with building relationships, developing trust, and identifying and moving forward with their life aspirations by providing them with practical recovery-oriented, strengths-based, hopeful strategies and techniques. Find New Jersey Summary Here.
- New York – OMH provided immersive CT-R training and expanded the use and availability of CT-R provided to individuals with serious mental illness to assist their transition from inpatient hospitalization to be fully integrated in their communities and to explore their aspirations in relation to work, education, independent housing, and expanded social networks. Find New York Summary Here.
- Vermont – DMH provided intensive CT-R training for staff and strengthened the promotion of recovery by implementing and sustaining CT-R strategies for adults with serious mental illness (SMI) enrolled in Community Mental Health Centers (CMHC). The grant has assisted with systems change at the program and state levels. CT-R has supported Vermont in systematically and intentionally creating successful and positive experiences for people to build confidence and resilience, as well as helping shape conversations around how to support people’s fundamental wellbeing and sense of self. Find Vermont Summary Here.
In FY 2016-2017, CMHS awarded TTI grants, all in the amount of $221,000, to the following six states:
- District of Columbia: DBH developed an innovative screening and support tool to address the needs of Transitional Age Youth (TAY) with co-occurring disorders (MI, DD, and trauma history) to enhance capacity of providers serving this population. Find District of Columbia Summary Here.
- Kentucky: DBHDID, recognizing the growing diversity among the youth population with co-occurring SED and I/DD, created and disseminated a bilingual parent survey including a Spanish language parent/caregiver advocate. The survey culminated in change teams to address the diverse needs of these communities. Following the implementation the change teams, data resulted in identification of and strategies to overcome barriers and build action plans. Find Kentucky Summary Here.
- Louisiana: OBH, in order to expand understanding and system-wide collaboration, developed and implemented an intensive cross-system training and technical assistance/mentoring program to infuse expertise in DD across all levels of the child and adolescent behavioral health system. Find Louisiana Summary Here.
- Missouri: DMH created the Missouri IDD-BH Center of Excellence initiative model to strengthen collaboration between developmental disabilities and behavioral health systems by increasing community awareness of co-occurring diagnosis; increasing family support; and implementing with sustainability standards of care. This work connects to MO’s TTI 2020 mobile app project. Find Missouri Summary Here.
- New Jersey: DMHAS developed pilot based on direct feedback from family caregivers of persons living with co-occurring DD and MI to create a self-care program which included interactive education and practice program relevant to caregiving skills, resiliency, coping, and wellness, with an integrated yoga-based protocol and mindfulness practice. Find New Jersey Summary Here.
- Utah: DSAMH strengthened family supports statewide, designed a family curriculum, and initiated family peer support for children and youth with co-occurring DD and SED to increase access to care and implement a community focus and strengths-based approach. Find Utah Summary Here.
In FY 2015-2016, CMHS awarded TTI grants, all in the amount of $221,000, to the following two states:
- Illinois - Developed and strengthened the use of Health Information Technology (HIT) in crisis prevention, intervention, and management. Collaborated with Northwestern University Center for Behavioral Intervention Technologies (CBITs) to refine and expand the use of a smartphone app which will help connect homeless youth, and potentially other populations, to services. Recruited and trained peer volunteers for the Crisis Text Line and/or other peer support services.
- New York – Improved the clinical informatics infrastructure of the NYS Crisis Intervention System by funding the addition of a crisis suite to the Psychiatric Services and Clinical Knowledge Enhancement System for Medicaid (PSYCKES) web application, which consists of measures and functions designed to support people experiencing behavioral health crises. The crisis suite provides access to key clinical information, including safety plans and psychiatric advance directives, for recipients and crisis service providers. Access to this information improves crisis assessment and service planning and helps reduce unnecessary emergency room visits and inpatient hospitalizations.
In FY 2014-2015, CMHS awarded TTI grants, all in the amount of $221,000, to the following six states:
- Idaho – Built three specialty certifications that CPS may obtain as part of their ongoing training and entered into a specialty system that required additional training to work within a specific population/facility. These specialty certificates were obtained in face-to-face trainings (2 day each) and the curriculum customized to Idaho’s specific needs and available for other states to evaluate and adopt. Each specialty certificate follows a similar process for development, financial mapping, publication, training, train-the-trainer, and ownership.
- Kentucky – Built an infrastructure around peer support services for individuals being discharged from any of the four state operated psychiatric hospitals, with the priority population being young adults 30 years old or younger, particularly those who have been admitted due to a first episode of psychosis. Development of an implementation team responsible for initiative management and accountability assisted in coordinating the effort. Kentucky’s four state operated psychiatric hospitals are eager to provide more targeted support to individuals and understand the huge gap in services for young adults being discharged from the hospital as well as the need to fill that gap with peer support services.
- Missouri – Strengthened and enhanced the peer crisis services being provided at the St. Louis Empowerment Center while creating a peer liaison positon to connect peer services and the traditional crisis intervention system.
- New Jersey – Developed capacity to deliver Peer Bridging services to “forensically involved” individuals with serious mental illness transitioning to the community. “Forensically involved” individuals include persons who have been civilly committed due to: 1) a provision of sex offender law, 2) have been ruled by a court to be currently “incompetent to stand trial”, or 3) have been found “not guilty by reason of insanity”.
- Pennsylvania – Strengthened and sustained a more robust use of Certified Peer Support Specialists (CPPSs) within Pennsylvania’s county-based network of behavioral health crisis services and supports. This project included the development and delivery of a comprehensive training program for CPPSs and provided technical assistance to county behavioral health administrators and the crisis providers to clarify the potential roles of CPPSs.
- Tennessee – Implemented an innovative pilot peer bridger program called PeerLink in the state’s Crisis Stabilization Units (CSUs). The CSU PeerLink program in Tennessee will help individuals admitted to a CSU engage with a CSU PeerLink Peer Bridger and make successful transitions back into their home communities.
In FY 2013-2014, CMHS awarded TTI grants, all in the amount of $221,000 to the following five states:
- Michigan – Employed Certified Peer Support Specialists (CPSS) as independent support brokers. The role of the CPSS included brokering an array of services that incorporated person centered planning and linking and coordinating services. They also assisted with employment and financial management services, and advocated for the needs of individuals with long-term mental health, chronic conditions, and substance use disorders. They also created several documents and training initiatives related to self-directed care and other development and implementation materials.
- New York – Designed a model Self-Directed Care (SDC) for individuals with SMI. Designed a pilot program that could be tested in multiple sites in the state and then be brought up to scale in a managed behavioral health delivery system.
- Pennsylvania – Enhanced the Self-Directed Care program in one county by contracting with the state’s leading consumer-based provider organization (Mental Health Association of Southeastern PA) and Temple University. They developed and delivered a self-directed care manual to promote replication of the initiative in other counties across the commonwealth, provide technical assistance to these other counties, and determine an avenue for financial sustainability statewide for these initiatives.
- Texas – Documented the elements of a sustainable Self-Directed Care (SDC) Program for people with serious mental illness. Building on experience gained from pilot programs in the Dallas and Houston metro areas, they convened stakeholder community meetings to lay the groundwork and began planning for future SDC pilot programs.
- Utah – Designed a system to increase self-directed care opportunities for adults with serious mental illness and youth with severe emotional disturbances who could have their needs better met through self-directed services. “Support Brokers” assessed participating individuals for their own personal needs toward budget development, and peer support was confirmed as a critical element of self-directed care and success of the program. Ensuring peer support resources was an increasing focus as this program was rolled out across the state.
Summaries of FY 2013-2014 Projects: