FLIPA Community-Based Maternal Behavioral Health Program - Forward Leading IPA (FLIPA) is proposing a project under SAMHSA’s Community-Based Maternal BHS Grant to improve access to evidence-based, culturally relevant maternal behavioral health interventions and treatment within the cities of Rochester and Syracuse, New York. The project will partner FLIPA Member Organizations, including two FQHCs, Jordan Health and Syracuse Community Health with BHOs, and social care providers to establish inter-agency collaboration in team-based care for pregnant and postpartum individuals. The target population for this project is pregnant and postpartum individuals aged 12-50 years who are patients of either Jordan Health or Syracuse Community Health. Goals and objectives will be accomplished through the establishment of inter-agency team-based care across the partner agencies that includes both the overarching, consultative Behavioral Health Team and local implementation-focused i-ACT team. The goals of the project include increased screening for behavioral health within pregnant and post-partum populations, increased access to and engagement with behavioral health care for pregnant and postpartum individuals, strengthen community referral pathways and utilization of doulas, and provide short-term mental health and substance use services to those in need to improve maternal and infant health outcomes. Key components of the project include screening and referral to the program by the FQHCs, team-based care through the establishment of a Behavioral Health Team (BHT) and local implementation-focused maternal i-ACT teams to provide care coordination, social care navigation, and mental health support. FLIPA’s structure is steeped in the role of collaboration and partnership both for member organizations and community partners and FLIPA will serve as a liaison between referring and accepting agencies, facilitating communication and collaboration among care teams. FLIPA anticipates the outcomes of this project to include universal behavioral health screening for pregnant and post-partum individuals, enhanced collaboration among care providers, successful implementation of the Behavioral Health Team and i-ACT model to support team-based care and improve access to behavioral health care for pregnant and postpartum individuals. FLIPA was founded in 2017 to support federally qualified health centers (FQHC), behavioral health organizations, and social care provider member agencies located across New York State. FLIPA supports quality standardization and improvement projects, and successful value-based payment contracting to ensure equitable, accessible health care and care coordination are available across communities served by 22 member organizations serving 27 counties. FLIPA is committed to improving maternal and child health and over the past 2 years has developed and disseminated multiple Standards of Care related to Maternal Child Health across the network. FLIPA has been working on an initiative to increase access to birthing doulas since 2023 and supported the evaluation of the Doula Program between Member Organization Finger Lakes Community Health and the Healthy Baby Network’s Black and Brown Doula Program. The program showed positive outcomes specific to prenatal care, breastfeeding initiation rates, and decreased use of unnecessary medical interventions as compared to county, regional, state, and federal metrics. Additionally, FLIPA is the lead for the Finger Lakes Region’s Social Care Network (SCN) in NYS, leading the development of a network of community-based organizations and a process for screening all Medicaid recipients for health-related social needs such as housing, transportation, and food; referring them to service providers in the region; and using a closed-loop referral platform to electronically track all referral connections.