Rural Oklahoma Critical Access Service Array (ROCASA): Mobile Crisis, Health Home Teams, Supported Employment, and Primary Care, Prioritizing Veterans and Welfare/Juvenile Justice Involved Children - The "Rurual Oklahoma Critical Access Service Array (ROCASA): Mobile Crisis, Health Home Teams, Supported Employment, and Primary Care, Prioritizing Veterans and Welfare/Juvenile Justice Involved Children" addresses unmet behavioral and medical needs for seven rural counties with an area population over 310,000 that have suicide rates twice the national average, drug overdose deaths 33% higher, and death due to coronary artery disease three times higher. The populations of focus for ROCASA are adults with severe mental illness (SMI), adults with substance use disorders (SUD), including opioid use disorders; children and adolescents with serious emotional disturbance (SED); individuals with co-occurring mental health and substance use disorders (COD); and will prioritize veterans and Welfare/Juvenile Justice (WJJ) involved children. The goals of the project are: (1) increase the engagement and participation of persons with high suicidal/behavioral risk in formal services that will reduce suicide rates and contribute to successful community tenure; (2) decrease behavioral health symptoms/behaviors for adults and children that lead to hospitalization or law enforcement/welfare involvement through the provision of behavioral health services using multidisciplinary teams; (3) increase recovery capital for adults with SMI/SUD/COD by assisting them with supported employment to promote their independence and graduation from formal service systems; and (4) increase effective metabolic syndrome control of persons with behavioral health and chronic medical conditions to improve overall health and reduce early mortality. ROCASA employs mobile crisis teams to engage people in the community who need services and follow-up to ensure engagement in outpatient treatment. Services have been augmented to provide for Health Home teams. These interdisciplinary teams offer wraparound supports that can address psychiatric, substance use, and medical needs at the same time. Supported employment is also given to accelerate recovery. ROCASA places an emphasis on detection and early intervention. The project conducts a variety of screens to identify substance use, depression, metabolic syndrome, and other risk factors for treatment. Primary care screening and monitoring of key health indicators and health risk are offered to all persons and medications are made available for diabetes, hypertension, and coronary artery disease. Outcomes are measured in documented follow-up within seven days post-discharge from an inpatient/crisis facility, percent of persons reaching 30 and 180 days of community tenure post-discharge, percent of persons having four documented services on four separate occasions within 45 days post-discharge, reduction in PHQ-9/GAD-7/TCU Drug Screen II scores, reduction in school days missed, reduction in law enforcement contact, reduction in self-harm, controlling HbA1c <9%, controlling blood pressure <140/90, and maintaining LDL-C levels <100 mg/dL. ROCASA will serve 600 adults and children a year and 1,050 over the course of the two year project.
