The Bridge of Central Massachusetts, Inc., (The Bridge), DBA Open Sky Community Services, proposes to implement a transformative approach to service delivery called the Open Sky Rapid Response HUB (OSRRH) which will provide real time access to integrated behavioral health treatment services and rehabilitative supports. Services will be accessible 24/7 and delivered by an interdisciplinary team. Service delivery is not bound to the four walls of the clinic and will be delivered flexibly in a variety of settings. As a housing authority, the OSRRH will employ Housing First and Rapid Rehousing models as vehicles for stabilization and engagement in CCBHC services. The Bridge will be the lead agency in partnership with its DCO’s: Family Health Center of Worcester, Edward M Kennedy Community Health Center and LUK, Inc., who will provide primary care and specialized services for youth and families.
Over two years, the OSRRH will serve 800 individuals and families with known and chronic conditions (SMI, SED, SUD, COD) as well as those whose wellbeing has been negatively impacted by the COVID-19 pandemic. Populations of focus will include the homeless, justice-involved, veterans, LGBTQIA+ youth and young adults, and seniors. Worcester County is one of the MA counties hardest hit by the opioid epidemic, accounting for over 13% of MA overdoses in 2019 (www.mass.gov). Among the County’s justice-involved and homeless populations there is high prevalence of mental health conditions and overdose, as well as lack of follow-up care following an overdose (UMASS Medical, 2020). In Massachusetts, LGBT youth report having considered suicide at five times the rate of non-LGBT youth. Prior to the pandemic, undomiciled Worcester County residents totaled nearly1,600 (2019 PIT Count).
The Bridge’s mission aligns with that of SAMHSA’s and reads: Blending best practices with the power of community, we partner with individuals and families to see beyond and live beyond perceived limitations to pursue fulfilling lives. We have identified three overarching outcomes for the individuals and families we support that are tied to our agency’s Theory of Change: Wellness, Opportunities, and Relationships. The goals of the OSRRH are to empower individuals and families to achieve wellness, build relationships, and realize opportunity. Wellness objectives involve expanding open access and outreach models for delivering evidence-based clinical interventions that equip participants with the skills to improve their near and long-term behavioral and physical health. By adding capacity for integrated peer services, the OSRRH will create connections, natural supports, and recovery capital that will lead to lasting relationships. To enable participants to realize opportunity, the OSRRH will integrate housing, education, employment, and case management services into person-centered care plans, opening pathways to self-determination and self-sufficiency.