Tuesday, April 29, 2025
4/29/2025
Quality Improvement Fund - Justice Involved - Target Population. Justice-involved individuals and their families in the HMS service area, primarily majority-minority Hispanic and Native American people with higher than state and national rates of unmet health-related social and behavioral health needs, with high rates of incarceration. Needs and Challenges. Incarceration rates in Grant County are 917 per 100,000. Hidalgo County has 4,801 per 100,000. (Vera Institute). Challenges include poverty rates double the national average (22% vs. 11%), with child poverty rates averaging 30%. Educational levels are lower than state and national averages. There are high rates of alcohol- and drug-related deaths, overdoses, and self-reported unmet mental health needs (NM Dept. of Health). Our very rural counties face significant transportation challenges. For decades, we have faced a loss of population, jobs, and capital (NM REAP). This creates extreme stress for families. In a recent needs assessment, which guides our work, people throughout the region shared a deep concern about the unmet needs of behavioral health, housing, access to healthcare, and health-related social needs. They had a high level of agreement on goals to expand behavioral health services to those most on the margins, including justice-involved populations and youth at risk. Those incarcerated in Grant and Hidalgo Counties face these challenges and more, with not enough support upon release, or help for their transition to community. Services. HMS services will be provided at Detention Centers and in the community, to support successful community transition for justice-involved people (1) during their final 90 days prior to release from the County Detention Centers and (2) in the community as long as needed for them to stabilize and meet goals. We will work collaboratively with Detention Center leadership, providing certified peer support workers (CPSWs) as case managers/navigators. CPSWs will meet with inmates, to help them plan their transitions to community. Any needed prescriptions will be filled and ready upon release. Inmates with previous drug use and need for MAT will receive priority access to Narcan and MAT, to reduce their risk of drug overdose during the 72 hours post-release, where risks are often highest. Each inmate enrolled in the program will complete preliminary screening; discuss priority needs and challenges; identify preference for either recovery or harm reduction; begin work with their CPSW to address challenges and goals; and develop a simple Transition Plan. The CPSW will introduce each inmate to their community-based case manager (CPSW) prior to release, and provide support during transition. Clients will meet with their community-based CPSW within 72 hours of release. Clients will be helped to address and overcome challenges with a combination of behavioral health services, wraparound supports, information and referral, skill-building classes, and coaching. CPSWs will provide intensive wraparound support for health-related social needs, driver's license renewals and other paperwork, benefits enrollment, transportation, information, and referral, and help with making required judicial and parole meetings. Issues that most justice-involved people face with behavioral health challenges, housing, employment, healthcare, family, and health-related social needs will be addressed. The CPSWs provide navigation and advocacy to assist clients in accessing resources, services, and benefits provided by local agencies, state, and federal programs. Most staff at HMS are bilingual, come from communities served, and represent them in terms of their history, understanding of community challenges, and racial and ethnic diversity. Staff provide some services at other agencies where clients gather, to support the clients and partner agencies.
HHS’ Tracking Accountability in Government Grants System (TAGGS) website provides access to detailed descriptions of grants, loans, aggregated direct payments and other types of financial assistance awarded by the HHS Operating Divisions (OPDIVs) and the Office of the Secretary Staff Divisions (STAFFDIVs).