Enhancing Carson City Community Counseling Center's CCBHC to meet the emerging needs of our rural community. - The Community Counseling Center (CCC) serves a mostly rural, high needs population in the HRSA-Designated Health Professional Shortage Areas of Carson City and Douglas County, NV. A state-certified CCBHC since 2019, CCC now seeks to improve care access and coordination for disparity populations via enhanced crisis services; onsite physicals and labs; harm reduction; a Peer-led Drop-In Center; and community education. CCC’s population of focus (POF) is people of all ages with serious emotional disturbances (SED), serious mental illness (SMI), substance use disorder (SUD), and co-occurring disorders (COD). 34% of CCC clients are homeless, with about another 30% at risk for homelessness. Many are veterans, uninsured and/or otherwise at risk of health and behavioral health (BH) disparities, with complex, inter-related challenges that complicate access to regular primary and BH care. CCC’s catchment area (CA) has a shortage of providers who accept Medicaid, as well as higher than state average rates of SUD, including rapidly rising rates of opioid use and overdoses, and of behavioral health (BH) crisis and suicide, likely exacerbated by the Covid-19 crisis. As a result, CCC’s wait times are up, and caseloads have increased to unsustainable levels. The proposed project will enable vital service expansions to increase access to BH and primary care for the CA’s most vulnerable populations: We will provide all-staff training in crisis prevention, response and de-escalation; complex trauma; harm reduction; cultural competency, including implicit bias reduction, service needs of under-served and/or vulnerable populations, with a focus on improving services for veterans and people experiencing or at risk of homelessness. Staff hiring and retention activities (including reducing caseloads) will decrease care transitions. We will streamline crisis services, with a Crisis Program Coordinator to ensure 100% of crisis contacts receive robust follow up from a case manager within 24 hours of contact and lead QI activities. We will implement a mobile crisis response team, with each response to include a qualified MH provider, a peer supporter, and a case manager, with an advanced practice nurse (APRN) or similar who can prescribe in NV instantly available via phone/telehealth. We will increase access to Targeted Case Management (TCM) for crisis contacts and disparity populations, with 30% of all CCC clients to receive TCM by month 18. Relationship building with law enforcement will ensure we are called to offsite crises; enhanced collaboration with the Carson City Jail will improve services for incarcerated individuals. Hiring more clinicians and np will reduce wait times. We will increase access to primary care among disparity populations by offering onsite physicals/wellness exams and monitoring, with targeted referrals to local federally qualified health centers for more advanced diagnostics and treatment. Onsite blood/lab testing for people who are prescribed psychotropic medication will reduce barriers to care that exist for many members of our POF. To address the CA’s increased opioid use and overdose rates, we will institute a community harm reduction program by month 12. This will include Narcan (naloxone) trainings, with Narcan and fentanyl test strips available on demand, Motivational Interviewing (MI) or Screening, Brief Intervention and Referral to Treatment (SBIRT) for those expressing readiness to care, and onsite hepatitis and HIV testing, with positive results counseled and referred to a federally qualified health center for expert HIV care. We will create a Peer-led Drop-In Center that will provide social support, harm reduction, MI/SBIRT, recovery-oriented activities, engagement and hope. The Project Director and Quality and Compliance Manager will lead QI efforts. We will serve a total of at least 525 unduplicated clients, including 100 in year 1, 125 in year 2, and 150 each in years 3 and 4.
