Friday, April 4, 2025
4/4/2025
Quality Improvement Fund - Justice Involved - H80CS04287 Project Vida Health Center (PVHC) is a Federally Qualified Health Center incorporated in 2003 and serving the low-income and homeless residents in El Paso, TX. PVHC has 25 years’ experience providing relationship-based, recovery-oriented trauma and culturally informed integrated medical, behavioral, and oral healthcare. PVHC proposes to mitigate ongoing barriers and challenges that JI-R individuals have after release from the West Texas Behavioral Health Residential Treatment Center (WTBHRTC). PVHC will provide a continuum of medical, behavioral, and substance use disorder care for acute and chronic conditions and access to peer recovery support services. The focus population is those jailed at WTBHRTC due to substance use-related charges serving 2 years or less, of which 88% are minorities. Unmet needs include no health insurance, substance use and mental health disorders with high risk of drug overdose, lack of stable/affordable housing, frayed relationships, little/no income, employment, or transportation. PVHC proposes to use evidence-informed strategies and several innovations to achieve positive results. PVHC’s objectives are to avert accidental overdose, stabilize health and basic needs, enhance patients’ recovery environment, and reduce the chance of recidivism with the following elements: 1. Pre- and post-release access to PVHC’s Peer Recovery Support Specialists 2. Collaborative continuity of care transition planning across jail, health center, and other health systems 3. Access to healthcare, including overdose prevention, assessment and treatment of medical and behavioral health conditions, and access to medications for opioid or alcohol use disorders, Narcan, insulin, hypertension, and psychotropic medications 4. Within the first 2 weeks, health evaluations by PVHC medical and behavioral providers to identify acute and chronic physical, behavioral, and oral health issues, including screening for sexually transmitted infections, including HIV and hepatitis A, B, C; diagnoses, treatment, and access to medications 5. Access to stable housing, bus passes, and medications for MOUD and mental health conditions PVHC gathered input from internal and external stakeholders, including people with lived experience in the justice system, determining the opioid/fentanyl crisis is a precipitating factor and recovery is probable with the proposed model. PVHC will form a Recovery Team Advisory Board with 51% of the membership having lived experience in the justice system and include patients, community members, the carceral authority, community partners, and PVHC staff. The goal is to review data and make course corrections while empowering people in recovery. PVHC is working with a collaborative that includes four universities to reduce overdose in El Paso’s homeless population, which developed a unique comprehensive assessment and GeoMapping tool, still in beta format, called ATLAS. PVHC will use this new tool that allows peer recovery specialists, PVHC team members, and researchers to access geo-map at the census-tract level of high-risk overdose sections of the city to deploy PVHC resources with the goal of averting overdoses. Goals of the project: 1. Reduce the rate of fatal overdoses from 80% to 20% in people released from WTBHRTC in the first 2 weeks after release with PVHC’s education and harm reduction and recovery support 2. Offer pre-release care planning to 100% of participants 3. Within two weeks of release, link 100% of participants with comprehensive screening and assessment and integrated healthcare and recovery services 4. Mitigate social determinants of health by offering supportive housing options to 100% of individuals as clinically indicated post-release and bus passes to 100% of participants 5. Utilize peer recovery support specialists as point persons for the transition from incarceration to release, including ongoing screenings, assessments, and care management 6. Serve 300 individuals
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).