TTI Through The Years

TTI 2024 Information Page

• Alaska (Rapid Access to Care): Alaska will expand their state services to families in rural Alaska where there may not be the population base or infrastructure to support services specific to children and adolescents. DBH seeks to solicit a vendor to develop a landscape assessment, cataloging and exploring specific behavioral health services in the state. This analysis will provide information necessary to help the state connect front door providers with access to care and a broader knowledge base of available services and supports.
• Alabama (Workforce Capacity): Alabama seeks to develop and deliver trauma-informed training. CCBHCs and direct care staff for adults with severe mental illness (SMI) will be trained in leading trauma-informed care models, and their organizational policies will support this work.
• CNMI (Workforce Capacity): CNMI’s Community Guidance Center seeks to enhance its Professional Pathways Project (PPP) from the FY 2023 TTI award. This enhancement project seeks to expand beyond initial coordination and implementation of the PPP to:

1. Continue with extended support of the implementation of core Behavioral Health training that leads to certification, supporting behavioral health workforce towards regional and/or international certification as Peer Specialists, Alcohol and Drug Counselors, and Prevention Specialists.
2. Expanding core training to include the Behavioral Activation (BA) Training.
3. Fully implementing, monitoring, and evaluating the Behavioral Health Aide (BHA) Program pilot launch, and
4. Collaborating with the Pacific Behavioral Health Collaborating Council/Certification Board (PBHCC/CB) to expand the BHA to other Pacific Jurisdictions and engage in heightened and sustainable local and regional workforce development efforts.

• Colorado (Workforce Capacity): Colorado plans to expand FY 2023 TTI initiative, by funding “phase two” of Colorado’s Crisis Professional Core Curriculum. This will focus on the development of additional specialized training tracks, specifically for emergency responders and youth/young adults working as peers or seeking peer certification. The overarching goal of Colorado’s Crisis Professional Core Curriculum is to provide accessible and standardized crisis training for key crisis system partners statewide.
• Connecticut (Workforce Capacity): The Connecticut Department of Children and Families will establish and implement a Performance Improvement Center (PIC) for a newly established statewide network of Urgent Crisis Centers (UCC) for youth and families.
• District of Columbia (Rapid Access to Care): The District of Columbia’s DBH proposes to award a contract through a competitive process to have a nationally recognized crisis services provider/group to complete a gap analysis and to develop a strategic plan for expansion of high-quality same day/rapid access to care (urgent care). The contractor will conduct an overall “fidelity” assessment of the District’s crisis continuum to determine how well they align with emerging best practices. Finally, they will enlist the selected offeror to guide their design of state-of-the-art geo-location tools to allow their crisis call center to track mobile teams in the field and to deploy the most appropriate resources in real time.
• Delaware (Collaboration Between 911 and 988): Delaware will expand upon a previous TTI-funded work that strengthened the partnership between the state’s Behavioral Health Crisis providers and the 911/EMS/Law Enforcement communities. DE plans to deploy new mechanisms for E911 PSAPs to transfer non-emergency behavioral health crisis calls to 988 or other crisis response services such as adult and children’s mobile crisis.
• Delaware (Workforce Capacity): Delaware has been informally piloting a successful Peer Services Liaison Program over the past few months. This project will expand on that pilot by:

1. Developing a curriculum for Certified Peer Recovery Specialists working with aging adults and adults in long-term care (LTC).
2. Developing standard operating procedures for the deployment of certified peer recovery specialists in LTC facilities.
3. Integrate Certified Peer Recovery Specialists into LTC settings.
4. This will provide a model for implementation in the public and private sectors.

• Delaware (Care for High-Risk Populations): Delaware plans to increase crisis care and suicide prevention services for veterans through peer support specialists with lived recovery experience and experience serving in the US military. The goals are to:

1. Create and maintain stakeholder resources to identify key stakeholders and recognize gaps in veterans’ services.
2. Implement a Mobile Base Program to provide a variety of peer support services that foster pathways to long-term recovery.
3. Assist with identifying sustainable funding and service resources.
4. Enhance data collection, program integrity, and quality monitoring infrastructure.

• Georgia (Care for High-Risk Populations): Georgia DBHDD proposes to recruit and train new Certified Peer Specialists (CPS) who are reflective of population groups that are historically underserved and at high risk of suicide, through partnership with community agencies. DBHDD will also collaborate with the Georgia Mental Health Consumer Network and the Georgia Council on Recovery to identify individuals interesting in working in the behavioral health system. Funding will also be used for scholarships for training.
• Georgia (Workforce Capacity): Georgia DBHDD proposes creation and implementation of a Crisis Peer Learning Collaborative which will provide training; improve communication and relationships across peers who work in the state-funded crisis system; and create a mechanism for DBHDD to get feedback from their provided network to address system challenges. Individuals selected for the Collaborative will be representative of the state’s population and include those in high-risk populations.
• Guam (Care for High-Risk Populations): Guam will enhance workforce development through training and professional development opportunities within their BH crisis service system. The goals are to provide intensive peer support services to individuals admitted to GBHWC inpatient units, reduce recidivism into highest levels of care, and provide linkage and navigation to other system support services.
• Hawai’i (Workforce Capacity): On Hawai’i Island (also known as Big Island), 220 forensically involved adults with SMI are supported by only one Forensic Supervisor Psychologist and one Secretary. HI will employ Forensic Peer Specialists (FPS) to work with the Supervisor, Secretary, and mobile crisis providers. Having at least one FPS on each side of the Island will provide this population with support at court, help with registration for needed entitlements, and transportation to and from crisis shelters.
• Iowa (Collaboration Between 911 and 988): Iowa proposes to improve interoperability between 988 and 911 by implementing a 988 Tandem Call Pilot Project, a technique that includes first responders on initial 988 callers experiencing crisis. The goal is to clear confusion around accessing the behavioral health crisis system by establishing 988 as a primary access point, while diverting people experiencing mental health and substance use-related crises from law enforcement intervention.
• Idaho (Care for High-Risk Populations): Idaho seeks to bolster their commitment to the state’s four youth crisis centers. These centers are accessible to anyone ages 12-17, with extending to ages 5-17 once the center has operated for a year, and they play a crucial role in fulfilling the “somewhere to go” aspect of SAMHSA’s three main priorities.
• Indiana (Collaboration Between 911 and 988): Indiana aims to increase the collaboration and interoperability between 988 and 911 throughout the State. Indiana is comprised of 92 counties with 121 PSAPs, supporting more than 400 law enforcement agencies. Indiana intends to hire a law enforcement liaison to solidify the strategy with their existing interoperability committee. This position will then be able to assist with mapping state and local practices throughout the PSAPs, reviewing models and data, and develop processes to best support individuals experiencing mental health crises.
• Indiana (Care for High-Risk Populations): Indiana will focus on identifying needs, barriers, and goals for mental health and suicide prevention resources for first responders in the State. Indiana intends to begin by better understanding the culture, needs, and strengths of the first responder community.  This understanding will then inform the development of resources and trainings for first responders to access, as well as outreach efforts to engage first responders in utilizing these resources.
• Kansas (Workforce Capacity): Kansas would like to further expand on the work previously started with the TTI 2022 and 2023 funds by developing a Peer Services Roadmap for peers working within the crisis response system to have greater access to toolkits and trainings that:

1. Support their own individual recovery.
2. Foster community involvement and strengthen connection within the Peer Support Guild.
3. Provide career enrichment and advancement opportunities for the peer workforce.
4. Funds would allow KDADS to connect and consult with other states for implementation support.

• Kansas (Workforce Capacity): Kansas will be expanding the first phase of their 2023 TTI project. This next phase will:

1. Build content for each competency.
2. Identify and develop agreements with training organizations.
3. Develop curriculum and training methods to prepare trainers.
4. Finalize the certifying process and authority.

• Kansas (Care for High-Risk Populations): Kansas is working with several communities to enhance local suicide prevention efforts: BIPOC, LGBTQ+, IDD, AI/AN, deaf/hard of hearing, service members, parents with lived experience, rural and frontier residents, faith-based communities, and more. The Kansas Suicide Prevention coalition (KSPC) will collaborate with Wichita State University to address suicide and crisis care for these special populations through educational and training opportunities. Both organizations include representation from community providers, community-based organizations, state agencies, and individuals with lived experience.
• Kentucky (Care for High-Risk Populations): The Kentucky DBHDID proposes to implement the Kentucky Black Youth Suicide Prevention Initiative to develop and empower a multi-disciplinary taskforce to enhance strategic engagement and collaboration with agencies and organizations that in some capacity support or serve Black youth, ages 5-24, with emphasis on entities that address SED or SMI. This coordinated approach will support organizations and agencies that play a significant role in serving Black youth most at risk for suicide in the state.
• Kentucky (Workforce Capacity): Kentucky will build on the lessons learned, job architecture, and position descriptions developed in TTI 2023 to enhance 988 crisis response capacity. The Kentucky 988 Crisis Services Workforce Expansion Initiative includes:

1. Development of evidence-based and culturally responsive workforce expansion, recruitment, and training strategies.
2. Promoting standardization across the state’s network of 988 crisis call centers as a comprehensive and statewide workforce expansion strategy.
3. The purpose is to pilot initial implementation efforts focused on transformational strategies and using non-traditional workers in the crisis workforce.

• Louisiana (Collaboration Between 911 and 988): Louisiana will identify and contract with a national expert who will be able to work with their system on the development of a training that will inform decision makers about 988 and the Louisiana Crisis Response System and the benefits of 911/988 interoperability. They will work with a consultant to develop training for Louisiana’s 911 administrators, the Sheriff’s Association, and other public safety entities, as well as crisis service providers and behavioral health staff.
• Massachusetts (Care for High-Risk Populations): Massachusetts DMH will enhance the state’s capacity to provide culturally competent mobile crisis intervention (MCI) services for Deaf individuals who use ASL. Building on their team members’ earlier work, they will expand to develop and deliver Deaf-specific trainings for ASL users in general and for BH providers (both ASL users and hearing).
• Maryland (Collaboration Between 911 and 988): Maryland will create and facilitate three technology transfer learning communities, targeted to meet the needs of urban, suburban, and rural jurisdictions and stakeholder groups. Each technology transfer learning community’s work will be facilitated by an expert consultant, engaged by Maryland BHA. Each technology transfer learning community is expected to meet several times over the course of the project. At the end of these sessions, the consultant will provide the state with themes across jurisdictions and recommendations for how the state can support its LBHAs in improving the interoperability of 988 and 911 at the local level.
• Mississippi (Transition Age Youth Supported Employment): Mississippi will implement the Individual Placement and Support (IPS) model in their Certified Community Behavioral Health Center (CCBHC)s located in three Community Mental Health Center (CMHC) regions to provide the needed supports and services to assist youth and young adults in foster care who indicate that employment is one of their goals.
• Mississippi (Rapid Access to Care): Mississippi DMH will partner with Communicare, a local CMHC, to pilot a mobile telehealth initiative with local law enforcement partners and expand access to their peer-run crisis respite program. The project will provide up to 50 tablets with access to a telehealth application that connects officers in the field with a member of Communicare’s response team. This distribution will increase the immediate assistance that crisis team members can provide.
• Montana (Workforce Capacity): Montana will improve workforce capacity by creating training opportunities for Peer Support Specialists. The state has identified in-person and virtual trainings that will support the Peer Workforce in topics such as cultural humility related to special populations (not limited to, but including, race, gender, religion, ethnicity, language, socioeconomic status, and disabilities). The Montana Peer Support Task Force will select regional leads to identify individual training needs.
• New Jersey (Collaboration Between 911 and 988): New Jersey will form a Planning Committee to initiate relationships and communication between the 911 and 988 crisis response systems. The project has 4 goals:

1. Hold meetings between 988 and 911/PSAP leadership
2. Establish a long-term Planning Committee
3. Establish an Advisory Coalition
4. Contract with a vendor to develop an interoperability plan and pilot project.

• Nevada (Care for High-Risk Populations): Nevada strives to improve access to crisis services for indigenous populations and the Deaf/Hard of Hearing communities in rural and frontier Nevada, with a focus on youth. Multiple state and local entities will collaborate and host Youth focus groups to inform the development of reports with recommendations from both Indigenous communities and Deaf/Hard of Hearing communities. The goals are to increase crisis calls from these communities, as well as improve relationships with local Tribal Nations.
• New York (Workforce Capacity): New York plans to create and implement a targeted training series that supports a racially and culturally diverse workforce in the behavioral health crisis response system, which serves diverse individuals across the state. This initiative will build on OMH’s commitment to supporting diverse and inclusive workplaces in the mental health system and providing a robust training infrastructure for staff members delivering crisis services.
• New York (Rapid Access to Care): New York strives to enhance Same day/Rapid Access to Care for Crisis Prevention and Follow-up Care. The goal is to provide access for adult high risk high-need individuals with mental illness to resources to support mental health service connection. This includes individuals who are disengaged from treatment, high utilizers of psychiatric inpatient and emergency department services, and those identified as high risk due to mental health symptoms or co-occurring disorders. NY will develop an implementation plan to increase the use of mobile devices and technology to support individuals in service access, engagement, crisis management, and wellness.
• Ohio (Transition Age Youth Supported Employment): Ohio’s team from the Supported Employment for Transition-Age Youth (SE-TAY) Policy Academy will work to build a workforce pathway for Certified Youth Peer Specialists (CYPS) to be prepared and successful on a Supported Employment (SE) team. This will include offering CYPS trainings, targeting marketing to state and community partners, adding CYPS to several SE teams, and creating an advisory and support group for these CYPS.
• Oklahoma (Rapid Access to Care): The Oklahoma DMHSAS will support the creation of a toolkit and provide technical assistance to replicate the success of the Oklahoma County Court Outpatient Program (CO-OP), which is used to provide immediate access to crisis care and dismissal of criminal charges for individuals with serious mental illness facing low level criminal charges.
• Oregon (Care for High-Risk Populations): Oregon plans on increasing Latinx/e trainers in Big River programs and support for Big River trainings in and for the Latinx/e community, particularly for rural areas of Oregon. This project supports the Oregon Health Authority’s goal to eliminate health inequities in Oregon by 2030, outlined in the Equity Advancement Plan.
• Oregon (Care for High-Risk Populations): Oregon will support their Black Youth Suicide prevention project (the Life Sustaining Practices Fellowship Program) by compensating Black leaders, staff, and Black youth coalition members, holding community town halls, developing a Green Book for culturally relevant resources, and funding pilot interventions that the Fellows develop during the project. These pilot interventions will be rooted in culture and connection.
• Pennsylvania (Workforce Capacity): Pennsylvania’s OMHSAS will work with the Department of Corrections and the Pennsylvania Peer Support Coalition (PaPSC) to create a bridge program for Certified Peer Specialists (CPSs) reentering into communities from incarceration. The initiative will provide them with access to information, support, and resources that will prepare them to secure employment within the behavioral health system.
• Pennsylvania (Care for High-Risk Populations): Pennsylvania’s robust workgroup from the Black Youth Suicide Policy Academy will work with the local NAMI chapter and PA 988 Advisory Board to engage people from LGBTQ+ and Black Youth communities to inform state suicide prevention strategies and workgroups.
• Palau (Transition Age Youth Supported Employment): Palau will partner with various agencies to implement several evidence-based programs for Transition-Age Youth on the island: Supported Employment (SE), Supported Education (SEd), Multisystemic Therapy (MST), and Family Functional Therapy (FTT).
• South Carolina (Rapid Access to Care): South Carolina will build on their previous TTI work with its Roads of Independence (ROI) initiative, which is focused on alternative education settings. They plan to work with the Sumter School District to implement the Safe Place Project, which will pilot the use of a crisis triage center that provides immediate in-person attention to students referred by their school district. The center will provide same-day access to mental health services, evidence-based therapies, and family support from a multidisciplinary team.
• South Carolina (Transition Age Youth Supported Employment): South Carolina strives to increase access to Individual Placement and Support (IPS) services for Transition-Age Youth experiencing SMI in up to seven rural, under-resourced counties in the state. The new program, in tandem with the Beckman Center for Mental Health Services (BCMHS, one of the state’s CMHCs), will provide career opportunities for youth with SMI ranging from 16-25 years in high schools, technical schools, and colleges. BCMHS will hire two new full-time IPS Transition Employment Specialists to support these youth and young adults.
• South Dakota (Care for High-Risk Populations): South Dakota’s initiative aims to support services for youth experiencing SMI/SED. They will work with a subject matter expert to assess their available services and develop a training plan to implement national best practices of children’s crisis care. This training plan will be developed for existing and new staff across the crisis continuum, including emergency departments, child protective services, law enforcement, first responders, and other behavioral health staff.
• Texas (Care for High-Risk Populations): Texas plans to conduct the following activities:

1. Create youth and young adult focus groups to better understand youth/young adult suicide, youth help-seeking behavior, preferred recovery services and supports, and helpful suicide postvention strategies.
2. Develop a suicide prevention toolkit focused on children, youth and young adults for training and technical assistance efforts.
3. Develop video messaging aimed at strengthening crisis supports such as community and behavioral healthcare providers who treat children, adolescents, and young adults who may be at risk for suicide.

• Texas (Workforce Capacity): Texas strives to support informal caregivers of people with Serious Mental Illness (SMI) by providing the caregivers with evidence-based training and tools for daily living with SMI. This initiative will support the development, testing, and refinement of their Cognitive Adaptation Training (CAT) and tools specifically designed for informal caregivers. CAT is a motivational, evidence-based psychosocial intervention designed to help people with SMI bypass challenges in daily living and enables them to live more independently in their communities.
• Texas (Care for High-Risk Populations): Texas will pilot placing Certified Mental Health Peer Specialists (CPS) with specialized training to serve youths (Youth and Young Adult Peer Support) in addition to adults and Certified Family Partners (CFP) in Community Resource Centers (CRCs) in Bastrop and Burnet counties. These two rural counties are in Central Texas within the local service area of Bluebonnet Trails Community Services (BTCS), an LMHA.
• Vermont (Care for High-Risk Populations): Vermont will work to increase access to crisis services and improve relations between the state agency and local marginalized communities. This initiative will support the training of Mobile Crisis Teams on working with marginalized populations. The project will also facilitate engagement with peers from marginalized populations, such as Abenaki (indigenous) people, People of Color, and those experiencing SMI/SED. They will analyze 988 data to identify gaps and methods to improve demographic data collection practices.
• Washington (Rapid Access to Care): As Washington state invests in the enhancement of their crisis call center platform and technology-enabled behavioral health client referral systems, they plan to gather information and develop TA materials on the use and importance of bed registry and referral tools. They plan to increase behavioral health providers’ meaningful use of these tools by learning from providers, people with lived experience, first responders, and other states. TA products developed will be piloted and enhanced in selected regions.
• Washington (Collaboration Between 911 and 988): Washington plans to support 911 callers experiencing behavioral health crises by:

1. Developing clear and consistent screening criteria for 911 call takers around behavioral health crises and 988 Lifeline services.
2. Developing, implementing, and evaluating training for 911 call takers on the role of the 988 Lifeline and how to conduct adequate screening for behavioral health crises.
3. Analyzing current 911 Computer-Aided Dispatch (CAD) processes and identifying opportunities to initiate transfers to 988.

• Wisconsin (Care for High-Risk Populations): Wisconsin proposes to improve crisis care and suicide prevention for children and adolescents and their families who are experiencing Serious Mental Illness and/or Serious Emotional Disturbance, while also improving the capacity of the behavioral health workforce and improving same day/rapid access to behavioral health care for crisis prevention and follow up care by imbedding supports and parent peer supports into county crisis systems and tribal behavioral health system.
• West Virginia (Workforce Capacity): West Virginia will build on their 2023 TTI, which allowed the state to engage with existing WV agencies, leaders, and champions to increase new pathways to entry-level behavioral health workforce supply. WV will develop a strategic plan for their workforce, expand funding for in-state subject matter expertise, and facilitate state-to-state peer learning to enhance data analysis and reporting on the impact of behavioral health workforce vacancies on the state’s programs.

TTI 2023 Information Page

• Alaska (Building Crisis Services that Serve Under-Resourced Minority Communities): Alaska is working on increasing tribal citizen utilization of crisis call services, enhancing tribal input in the development and expansion of crisis line services, and increasing the capacity of the 988 Suicide and Crisis Lifeline accredited call center to offer culturally grounded crisis services and coordinate referrals to Tribal Health Organizations. 
• Alaska (Workforce): Alaska is addressing workforce development by increasing training for peer support specialists in crisis services to include youth/family navigators, and to develop universal crisis intervention trainings for paraprofessionals and professionals in the crisis system.  
• American Samoa (Crisis and Community Trauma): American Samoa is coordinating the integration of trauma-informed care across the territory’s crisis response service delivery system and in the community through collaboration with key stakeholders and the development of peer support services to engage any individual, including individuals with a serious mental illness or serious emotional disturbance, experiencing trauma/crisis. 
• Arkansas (Building Crisis Services that Serve Under-Resourced Minority Communities): Arkansas is following up on its 2022 TTI focusing on individuals with a serious mental illness or serious emotional disturbance who self-identify as LGBTQ+. Initiatives include the Arkansas Inclusive Network/Focus group, professional training development for first responders/providers/law enforcement/educational professionals, and train-the-trainer programs.  
• Colorado (Workforce): Colorado is focusing on supporting the development of a Crisis Professional Core Curriculum, which would be offered at no cost to individuals serving those in crisis throughout the state. The goal is to standardize training and supervision for all crisis workers, regardless of background and prior education. 
• Connecticut (Workforce): Connecticut is utilizing funds to address notable data collection voids and to investigate new and innovative initiatives to assess the effectiveness of current crisis-related services through data collection initiatives that inform the improvement and expansion of their crisis services and to examine the viability of a regional crisis response structure designed to expand the continuum of care and to encourage coalition-building and collaboration among community partners. 
• Delaware (Building Crisis Services that Serve Under-Resourced Minority Communities): Delaware is strengthening the capacity for their behavioral health crisis continuum to serve neurodivergent individuals, especially those with intellectual and developmental disabilities (IDD) or dual IDD and behavioral health conditions. Initiatives include collaborative learning system mapping, developing training curriculums and public resources, and partnering with first responder communities. 
• Delaware (Workforce): Delaware is expanding the peer recovery specialist workforce pipeline for their behavioral health crisis services. Activities include reviewing current curriculum and certification pathways, growing the peer recovery specialist workforce pipeline, creating professional development pathways, and developing a youth and family crisis peer training program. 
• Georgia (Building Crisis Services that Serve Under-Resourced Minority Communities/Workforce): Georgia is creating a Crisis System Learning Collaborative with two cohorts that will provide training, improve communication and relationships across the state-funded crisis system, and create a mechanism for DBHDD to get feedback from its provider network. The two are Cultural and Linguistic Competence and Improving Inpatient Diversion.  
• Guam (Workforce): Guam is supporting the following goals: Provide training to behavioral health staff providing services, such as crisis response, provide virtual professional development opportunities for more immediate means of accessing information, education, and trends in behavioral health, and build on-demand professional development capacity for staff seeking to improve clinical and direct service practices to retain staff.  
• Hawaii (Crisis and Community Trauma): Hawaii is developing and implementing a standard 3-part program curriculum for their mental health/substance use disorder workers statewide: introduction to trauma and how it impacts care, the role of cultural historical trauma and avenues to healing, and workforce support and trauma in individuals’ own lives, including secondary traumatic stress impacts providers.  
• Indiana (Building Crisis Services that Serve Under-Resourced Minority Communities): Indiana is supporting activities to address mental health crises more equitably in Black youth across Indiana. This includes focus groups that will inform a report outlining recommendations for improving connectedness and quality of life for Hoosier Black youth. They will identify evidence-based and community/peer-based practices to contribute to the prevention and resolution of risk in Black youth communities in collaboration with the Mobile Response and Stabilization Services model for serving youth and families in crisis.  
• Indiana (Workforce): Indiana is launching a new communication and recruitment campaign around systemic behavioral health workforce development, the first phase of which will be completed with this award.  
• Iowa (Facilitating Timely Access to Community-Based Mental Health Services): Iowa is contracting with a consultant with proven experience in crisis system change who will update and add to the landscape analysis done for IA's 2021 TTI project. They will conduct focused stakeholder engagement activities with individuals with lived experience of serious mental illness and co-occurring mental health and substance use disorders, and family members of children with serious emotional disturbance.  They will then make recommendations to IA HHS to reimagine IA's front door (with a focus on diversion) and develop processes to increase coordination between all components of the behavioral health system.  
• Kansas (Facilitating Timely Access to Community-Based Mental Health Services): Kansas is increasing the collaboration between community services and the community mental health centers (CMHCs) through the training, collaboration, and strengthening of system development of the CMHC liaison staff. 
• Kansas (Workforce): Kansas is expanding upon KDADS’s work previously started with the TTI 2022 funds. They plan to develop additional training to be made available to peer support professionals. Through the Peer Support Guild, KDADS intends to ensure that peer support professionals have access to trauma-informed, culturally, and linguistically competent training for special populations, including, but not limited to, veterans, individuals with intellectual and developmental disabilities, individuals who are BIPOC, and individuals who identify as LGBTQ+. 
• Kentucky (Workforce): Kentucky is focusing on the Kentucky 988 Dedicated Call Taker Workforce Development Initiative which is to design, implement and evaluate a workforce development package for statewide dissemination. 
• Louisiana (Facilitating Timely Access to Community-Based Mental Health Services): Louisiana is identifying a national consultant to provide tailored technical assistance to LDH/OBH with the development and implementation of the Certified Community Behavioral Health Clinic (CCBHC) model as a Medicaid service that is specific to the culture and needs of Louisiana. The consultant will facilitate the establishment of a learning collaborative comprised of the five organizations awarded SAMHSA CCBHC grants and LDH/OBH. 
• Minnesota (Building Crisis Services that Serve Under-Resourced Minority Communities/Workforce): Minnesota is supporting and strengthening workforce development trainings for 988 Lifeline centers and crisis service staff, including CCBHC crisis response staff. This will include training on substance use and serious mental illness and serious emotional disturbance crisis response and intervention, as well as developing a cultural humility and awareness training focused on American Indian communities in Minnesota in collaboration with tribal partners. 
• Mississippi (C&A): Mississippi is contacting the crisis line of the two 988 centers in the state, adding three additional Open Up MS chapters throughout the state, and continuing to partner with Pine Belt Mental Healthcare resources to offer training to current Crisis Intervention Team officers on how to effectively connect to children and their families during crisis situations. NAMI is partnering with parents/guardians of Open Up MS council members in educating other parents regarding 988 and designating Open Up MS members to consistently participate in DMH’s 988 Planning and Implementation Coalition to ensure children and families’ crisis needs are addressed.  
• Mississippi (Workforce): Mississippi is hosting an in-person event to kick off the year of training and partnership among crisis system employees. The event will aim to address proactive planning, system collaboration, and best practices for crisis treatment. The selected consultant will also provide virtual monthly trainings to crisis workers, relying heavily on individuals with lived experience for input on needed training topics. 
• Nebraska (Workforce): Nebraska is formalizing a workforce development plan for supporting a Crisis Response Team (CRT). A team of stakeholders will review research and standard guidelines to make recommendations for curriculum development, training modalities, and skill verification. Outcomes will include a plan for the development, implementation, and sustainability of CRT trainings. This may include the development of a pilot cohort to complete the training and provide feedback. 
• Nevada (Workforce): Nevada is focusing on two initiatives that aim to enhance their mental health crisis system for adults in rural and frontier NV. These plans include providing incentives for current clinicians who administer crisis services in rural NV. This is intended to help with workforce retention and strengthen Nevada's current Immediate Mental Health CARE Team to improve crisis access for individuals in rural and frontier NV.   
• Nevada (Workforce): NV is providing an annual stipend of $5,000 to 20 current board-approved clinical site supervisors who choose to oversee post-graduate internships in rural and frontier counties in Nevada that are identified as mental health professional shortage areas starting in Quarter 4 of 2023. 
• New Jersey (Workforce): New Jersey is building upon past TTI successes in enhancing and expanding the peer role. Activities include a mentorship program for peers working in their existing and emerging crisis settings as specified in the Best Practice Toolkit, a needs and gap assessment, development and delivery of advanced level training curricula, delivery of the training to experienced peers acquiring these additional competencies, assessment of the outcomes of this new educational endeavor, and a learning community of peers and their supervisors will be established. 
• New Jersey (Workforce): New Jersey is developing a Crisis Services Community of Practice (CSCoP) that will build a capable and resilient workforce that is well-trained in utilizing best practice approaches. The entity contracted to provide the CSCoP will develop webinars and training series with subject matter experts and support listserv and networking amongst crisis service agencies. 
• New York (Building Crisis Services that Serve Under-Resourced Minority Communities): New York is developing ECHOMH/intellectual and developmental disabilities (IDD), a project that is conceptualized to provide free tele-mentoring and didactic trainings for 988 counselors and mental health providers. These providers will give information regarding the treatment of individuals with co-occurring mental health challenges and IDD. The interdisciplinary hub team will cover topics such as cultural and linguistic competency, interventions for minimally verbal individuals, considerations in crisis response for dually diagnosed youth and adults, and sensory integration issues contributing to behavioral crises. 
• New York (Facilitating Timely Access to Community-Based Mental Health Services): New York is creating an implementation plan for a mobile outreach unit. This mobile outreach unit will provide crisis stabilization services in the East Flatbush neighborhood in Brooklyn, NY through a community-based planning process.  
• North Carolina (Building Crisis Services that Serve Under-Resourced Minority Communities): North Carolina will be supporting a Needs Assessment, Resource Toolkit, and trainings for the deaf and hard of hearing community in the state.   
• North Carolina (Building Crisis Services that Serve Under-Resourced Minority Communities): North Carolina is focusing on improving the quality of emergency department (ED) data to strategically identify Behavioral Health holds. They will do this by enhancing the quality of existing NC DETECT ED visit data and using ED data to perform a deep dive and investigate BH hold prevalence ED length of stay across the following dimensions: race, ethnicity, age, insurance coverage, geographic region, and rurality. 
• Northern Mariana Islands (Facilitating Timely Access to Community-Based Mental Health Services): Northern Mariana Islands is planning, implementing, and evaluating Mobile Crisis Response services as part of comprehensive CNMI CHCC Behavioral Health Crisis Care services. 
• Northern Mariana Islands (Facilitating Timely Access to Community-Based Mental Health Services): Northern Mariana Islands is developing a Professional Pathways Project to increase the number of CNMI Behavioral Health certified professionals, and to implement a CNMI Behavioral Health Aide Program. 
• Oklahoma (Building Crisis Services that Serve Under-Resourced Minority Communities): Oklahoma is expanding upon their comprehensive crisis response system by engaging special populations: people with English as a second language, the deaf and hard of hearing community, and individuals living in OK tribal nations. ODMHSAS intends to develop a more inclusive 988 marketing campaign, strengthen warm handoffs between the Oklahoma Crisis Continuum of Care and Oklahoma tribal nations, and have sensory kits available to anyone interacting with mobile crisis teams. 
• Oklahoma (Workforce): Oklahoma is building upon a partnership with local colleges and universities to support the growing number of RNs among existing staff seeking career advancement opportunities. ODMHSAS proposes to partner with local colleges and the Oklahoma State University (OSU) nursing program to pilot an LPN to RN training cohort. ODMHSAS has identified local colleges for candidates to complete the requirements to enter the OSU LPN to RN pathway program. 
• Oregon (Workforce): Oregon is focusing on the development and initiation of a consistent, streamlined, and centralized source: Behavioral Health Crisis Response Training Academy. For the workforce in phone crisis intervention, Community Based Mobile Crisis Intervention Services (CBMCIS), Mobile Response and Stabilization Services, and facility-based stabilization services in the community. 
• Pennsylvania (Workforce): Pennsylvania is focusing on utilizing PA's existing online learning system to provide crisis intervention workers with the necessary orientation and onboarding training. They Partnership with Temple University Harrisburg to create the modules necessary to meet both the pre-service and onboarding training requirements. Upon completion of these additional 22 hours of coursework, an individual will earn a certification as a Crisis Intervention Worker that will be valid for 2 years.  
• Palau (Workforce): Palau is providing training to 100 providers on suicide prevention, intervention, and postvention. Subtopics include Training in Zero Suicide, mental health first aid (adult/youth), training in postvention, and training in psychosocial autopsy. 
• Rhode Island (Facilitating Timely Access to Community-Based Mental Health Services): Rhode Island is increasing access to higher levels of services via mobile crisis teams (MCTs) through MCT dispatch software concentrated in the 988-call center - thus connecting those that need more intense community-based services with our established CMHC and CCBHC partners 
• South Carolina (C&A): South Carolina is collaborating with Sumter School District to address unmet needs and mental health concerns present among this population of youth. Project Connect will pilot the use of Certified Peer Support Specialists, Mental Health Professionals, and Behavioral Interventionists working together in an alternative educational setting. They will provide youth and parent peer support services, mentorship, care coordination, life skills training, and mental health services with connection to telepsychiatry and additional family supports.  
• South Carolina (C&A): South Carolina is enhancing the availability of early intervention for suicide and SMI in youth. Goals include providing early intervention and assessment services, including screening programs, to minors under the age of 18 and their caregivers as well as partnering with NAMI Piedmont TriCounty to develop a resource app to provide immediate support and resources to parents/caregivers of minors who are in crisis/at risk for suicide. 
• Tennessee (Workforce): Tennessee is enhancing the crisis continuum by providing the latest evidence-based practices that will promote improving client/patient care as well as self-care concepts/skills for staff that is directly providing crisis services. TN will use DBT and Compassion Science to address workforce retention and development. 
• Tennessee (Workforce): Tennessee is supporting five peer program enhancements: public awareness and education about services and workforce opportunities, widespread dissemination of the CADRE system, stable training hours to ensure availability, scholarships to ensure access for potential qualifying peers, and development of an employer toolkit including free ongoing training and technical assistance.  
• Texas (C&A): Texas is modifying the Zero-Suicide framework for the juvenile justice system, implementing a learning collaborative for juvenile justice system stakeholders, and facilitating a train-the-trainer trainer series to increase suicide prevention trainings. 
• Texas (Facilitating Timely Access to Community-Based Mental Health Services): Texas is establishing a learning collaborative for criminal justice, behavioral health, and community stakeholders to improve re-entry planning for people with serious mental illness who are exiting jail, including after forensic hospitalization. 
• Vermont (Building Crisis Services that Serve Under-Resourced Minority Communities): Vermont is co-sponsoring a pilot program to establish a proven model of mobile crisis intervention, Crisis Assistance Helping Out on the Streets (CAHOOTS), assist community-based mental health first response for crisis support and establishing a trauma-informed approach to alleviate pressures on other components of the system (police and EMS). 
• Washington (Building Crisis Services that Serve Under-Resourced Minority Communities): Washington is standing up a Tribal Mobile Crisis Response (TMCR) team that will provide cultural-based crisis services to their tribal community. This includes supporting hiring a TMCR project manager, completing MCR training and identifying appropriate cultural adaptations needed, and developing a community map of services and workflows to serve individuals in crisis. 
• Washington (C&A): Washington is purchasing participation in the MRSS Quality Learning Collaborative. Topics to be covered include leadership, financing, data, workforce development, capacity building, policy development, implementation barriers single point of access, community engagement, systems engagement, and service array.  
• West Virginia (Building Crisis Services that Serve Under-Resourced Minority Communities): West Virginia is focusing on the guiding principles of building on existing engagement efforts while continuing outreach to new partners is critical for sustainable community engagement, and both require cultural humility. This request for intensive technical assistance is to support the subject matter expertise both within and external to West Virginia for BBH to support culturally appropriate outreach and crisis service. 
• West Virginia (Workforce): West Virginia is focusing on the BBH Statewide Therapist Loan Repayment (STLR) project that focuses on recruitment and retention of the most needed MA-level early career behavioral health professionals, specific to WV. BBH collaborations with WV Medicaid which include a review of mental health crisis service funding mechanisms, and BBH partnerships with K-12 and higher education.  
• Wisconsin (Workforce): Wisconsin is assessing the training needs of crisis-related positions across the state; identifying the core competencies required for these positions; developing or contracting for training on these core competencies; delivering the training on a pilot basis to select agencies; assessing the effectiveness of these trainings; make recommendations for scaling up the trainings so they can be provided state-wide and on an on-demand basis whether this be in person or virtually; and make recommendations for the sustainability of the initiative. 

TTI 2022 Information Page

• American Samoa (Workforce): American Samoa is conducting workforce recruitment strategies and activities to expand the local crisis response worker resource and develop the capacity of the existing and future crisis response workers skills through the implementation of the Crisis Response Worker Development (CRWD) initiative.
• Arkansas (LGBTQ+): Arkansas is focusing their TTI on individuals who have a Serious Mental Illness (SMI) or Serious Emotional Disturbance (SED) and self-identify as LGBTQ+.       
• CNMI (Workforce): CNMI is focusing on workforce development to make all staff and key partners ready to respond to any community members experiencing a crisis. Included in the plan is the development of a Standard Operating Procedure that outlines the call and workflow of staff including required trainings that meets the standard of the National Suicide Prevention Lifeline. 
• Connecticut (C&A): Connecticut is implementing significant additions to its youth Mobile Crisis Intervention Services (MCIS) training curriculum and sharing opportunities to build competencies across the child-serving system, through their Enhancing Mobile Program.
• Connecticut (Workforce): Connecticut is using TTI funding to purchase software that will allow for high-tech, GPS-enabled mobile crisis geolocation and dispatch to quickly and efficiently determine the location of the closest available mobile crisis team, track response times, provide real-time performance outcomes dashboards to monitor the quality and quantity of mobile response services, and of course, efficiently connect persons served and their families to needed resources supporting access and continuity of care.
• Delaware (C&A): Delaware’s initiative is expanding the capacity for their behavioral health crisis services to better serve children and adolescents and their families.
• Guam (C&A): Through GBHWC’s Project Agang (Chamoru word for Call), Guam is creating a mobile crisis team to respond to community needs of children, youth, and young adults with SED and the families of those experiencing crisis.
• Guam (Workforce): Guam is taking a two-pronged approach to expanding their Mobile Crisis Response Team (MCRT) through training and employment of 10 Certified Peer Support Specialists (CPSS), and engaging law enforcement with tablets to provide onsite crisis services to persons in need. 
• Hawaii (AI-AN): Hawaii is strengthening existing services at their Community Mental Health Centers to offer more crisis stabilization and prevention support groups to Native Hawaiians.
• Hawaii (LGBTQ+): Hawaii is enhancing their statewide 24/7 crisis hotline/website to better address the unique needs of LGBTQ+ individuals.
• Hawaii (Workforce): Hawaii is creating a statewide training and certification program for Mental Health Emergency Workers.
• Indiana (C&A): Indiana is developing a plan for building and financing a robust youth and family crisis response and diversion continuum that links closely with the juvenile and adult criminal justice systems, identifies standardized training and certification standards for mobile teams and crisis receiving facilities, uncovers remaining legislative priorities, and explores how to make 911 and 988 more interoperable.
• Iowa (LGBTQ+): Iowa is developing two standardized training toolkits specific to serving children and LGBTQ+ individuals to be accessed by Iowa’s 988 and crisis behavioral health workforce.
• Kansas (LGBTQ+): Kansas is using funding to retain expert consultation services to develop training for all staff involved in strengthening Kansas’ 988 response and expanding crisis services throughout the state in all 3 core areas: Regional Crisis Call Centers, Crisis Mobile Team Response, and Crisis Receiving and Stabilization Facilities.
• Kansas (Workforce): KDADS is utilizing funding from the Transformation Transfer Initiative to increase efforts to recruit, train and retain individuals with lived experience to become certified as Peer Specialists, Parent Peer Support, and Peer Mentors in the State of Kansas.
• Kentucky (Workforce): Kentucky is supporting installation and initial implementation of a rural community paramedicine crisis response model that will expand the role of paramedics and emergency medical technicians (EMTs) as first responders in a behavioral health crisis and improve implementation of evidence-based programs (EBPs) among existing behavioral health crisis staff to improve client outcomes, particularly for families, children, adolescents, and transition-age youth.
• Louisiana (LGBTQ+): Louisiana is developing and implementing training related to the state’s LGBTQ+ population.
• Maryland (LGBTQ+): As part of their vision to develop a statewide integrated, comprehensive, culturally sensitive, and responsive behavioral health crisis system to serve and support all people, Maryland is launching LGBTQ-specific Training Modules.
• Maryland (Workforce): Maryland’s initiative, Special Population Training Modules, serves to ensure that Crisis Call Center Specialists have access to uniform training modules which address topics identified by Call Centers, including persons with lived experience, to ensure effective services are provided to children, youth, adults, older adults, and special populations.
• Mississippi (C&A): Mississippi’s initiative partners with community providers to expand crisis services by implementing the TIP and TAMAR model.
• Mississippi (Workforce): Mississippi’s initiative is enhancing the crisis support system throughout the state by partnering with community providers to pilot a court and law enforcement liaison program to connect people with community-based services and decrease the number of commitments to acute inpatient psychiatric services.
• Nevada (C&A): Nevada is mapping the state’s current Crisis Response System for children and adolescents, using the standardized scoring tool developed by Crisis Now to measure system readiness for 988 implementation to identify gaps and provide analysis.
• New York (LGBTQ+): New York is creating and hosting a specialized and unprecedented training for New York’s crisis workforce across the continuum of 988, mobile crisis, and crisis stabilization centers to develop competence in engaging and responding to the unique needs and risks associated with individuals who identify as LGBTQ+ across the lifespan who are in crisis.
• Oklahoma (Workforce-1): Oklahoma is developing the Clinical Training Center of Excellence, also known as The Center, to provide a centralized resource for training both new and experienced behavioral health professionals and stakeholders in the state.
• Oklahoma (Workforce-2): The Oklahoma Comprehensive Crisis Response (OCCR) serves as the state’s crisis care continuum, prioritizing community-based diversion approaches that aim to decrease unnecessary law enforcement/criminal justice engagement and prevent the need for higher levels of care.
• Oklahoma (Workforce-3): Oklahoma is partnering with the University of Oklahoma to grow the number of LPCs within the state. This project expands on similar prior successful projects which selected existing ODMHSAS employees through an application process and supported their educational cohort through the attainment of a licensed-eligible master’s degree.
• Pennsylvania (C&A): Pennsylvania is assessing current strengths and needs related to crisis services for children and adolescents and identifying best practices and opportunities for collaboration.
• Rhode Island (C&A): Rhode Island will develop a shared set of risk assessment protocols and a shared training curriculum that specifically focuses on Youth & Families.
• Rhode Island (LGBTQ+): Rhode Island is developing a shared set of risk assessment protocols and a shared training curriculum for the varied statewide workforce audiences that will be involved in the overall system of care serving those Rhode Islanders who contact 988.
• South Carolina (C&A): South Carolina’s TTI initiative, Bridges, aims to improve and expand wellness and recovery options for children and adolescents by increasing access to crisis services and other supports, assisting youth in making the transition to adulthood and self-sufficiency, providing comprehensive diversion options from the justice system, reducing racial disparities, and increasing alternatives to detention.
• Tennessee (C&A-1): Tennessee is expanding utilization of the Shield of Care curriculum, a research-informed suicide-prevention curriculum that teaches juvenile detention staff strategies to prevent suicide within youth detention settings.
• Tennessee (C&A-2): As youth are triaged by the broad continuum of the Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS), two areas of concern are the use of EDs as holding facilities for mental health crises, and the perceived need for increased inpatient and residential capacity.
• Tennessee (Workforce): The Tennessee Department of Mental Health and Substance Abuse Services (TDMHSAS), in partnership with the University of Tennessee School of Social Work (UT School of SW), is launching the Tennessee Public Behavioral Health Workforce Recruitment and Outreach Initiative.
• Texas (Workforce): Texas is implementing a learning collaborative initiative, building on their existing learning collaboratives which has two tracks:  One that focuses on 988 implementation workforce issues for the four urban Lifeline affiliates and the other focuses on 988 implementation workforce issues at LMHAs/LBHAs statewide.
• Washington (AI-AN): Washington supported startup activities for the Tribal 988 Line and developed an electronic resource for understanding what culture-based and culturally appropriate resources are available to AI/AN individuals.
• Washington (C&A): Washington has aligned its new children, youth, and family crisis teams established through HB1477 by incorporating Mobile Response Stabilization Services (MRSS) best practices for children and adolescent mobile response teams into its system design.
• West Virginia (C&A): West Virginia is developing formalized feedback processes for youth and families in collaboration with several relevant state groups, contracting with the University of Maryland Institute for Innovation and Implementation to become part of the Mobile Response and Stabilization Services (MRSS) Quality Learning Collaborative (QLC), and developing protocols regarding its current call lines and connections to crisis services as it launches 988 in July 2022.

TTI 2021 Information Page

In FY 2020-2021, CMHS awarded 40 TTI grants, all in the amount of $150,000, to the following 28 states and territories:

• Alabama: ADMH will develop a crisis communication system that includes new crisis diversion centers, rural crisis care projects, and the Alabama Stepping Up Initiative, that will provide access to care in addition to advocacy for passage of state funding for 988 crisis line. 
• Colorado: CDHS will enhance the existing Jail-Based Behavioral Health Services (JBBS) Program and provide targeted technical assistance and peer-to-peer learning for rural jails with a focus on  the SMI population by linking community resources and providers, connecting individuals with their Peer Recovery Network. The University of Colorado will create and facilitate an integrated peer-to-peer community to foster successful implementation of best practices and the sharing of team successes, barriers, lessons learned, and problem solving amongst the participating jails.
• Connecticut: DMHAS will enhance Communicare mobile crisis services by including peer navigators to provide postvention follow-up services in order to divert adults from jails, increase collaboration with local police departments, and strengthen clinical staffing on the mobile crisis teams. DMHAS will employ peer navigators, replicating the success of the CARES Project, to support individuals with SMI in local jails and re-entering the community. 
• Delaware: DSMAH, through the Delaware Treatment and Referral Network (DTRAN), will integrate Certified Peer Support Specialists (CPS) to serve clients with SMI and co-occurring disorders and provide additional service options through the Pre-Arrest Police Diversion Program (PDP). DSMAH will enhance the  their Mobile Bridge program, which is a joint venture with the Department of Corrections, that provides recently released individuals with a myriad of services, including behavioral health screening, referral to treatment, and enrollment into State services by expanding hours, reach and public awareness of the program.  
• District of Columbia: DBH will expand their existing service registry, EMResource, by engaging DC hospitals, crisis stabilization beds, inpatient and residential SUD services, and the Access HelpLine (AHL) to increase capacity of tracking the full range of acute inpatient psychiatric services and reduce unnecessary wait times.
• Florida: DCF, through culturally appropriate, evidenced-based, and best practices, will employ Forensic Peer Specialists to the new Community Forensic Liaison (CFL) Team to reduce the health and social disparities for justice-involved individuals with mental illnesses, thereby improving service access and outcomes, and strengthen collaboration between the mental health and law enforcement/criminal justice systems. DCF, using the Sequential Intercept Model, will employ Forensic Peer Specialists to colloaborate with jails to assess and coordinate treatment for individuals within the jails and upon reentry in their efforts to reduce the health and social disparities for justice-involved individuals with mental illnesses.
• Hawaii: AMHD will develop a provider and public-facing service registry and dashboard integrated with their EMR by upgrading their system to increase efficiency and include crisis, inpatient psychiatric, residential mental health, and substance abuse facilities. Data collection will enhance cross-system collaboration and identification of needs. AMHD will increase the number of Certified Forensic Peer Specialists and offer additional training to increase state capacity at pre-arraignment, arraignment, and for Hawaii State Hospital forensic patients.
• Kansas: KDADS will expand their mobile crisis competency restoration services to reduce pretrial detention times, create a best practice toolkit and guidance for judges and court officers regarding community-based competency evaluation and restoration services, and facilitate a statewide judicial training and awareness campaign. 
• Kentucky: DBHDID, through the Louisville Behavioral Health Jail Diversion Initiative, will work to revolutionize and expand the crisis healthcare system in Louisville by implementing non-police jail diversion models that are trauma-informed and racially equitable for individuals in crisis, and reducing incarceration rates recidivism.
• Louisiana: OBH will research and develop a model for a crisis services registry of a triage, dispatch, and data collection/reporting to strengthen  mobile crisis and crisis stabilization systems.
• Massachusetts: DMH will expand and enhance their Behavioral Health Network peer support program to assist with diversion via co-response and Community Clinical Response Team (CCRT) Clinicians, increase capacity through telehealth, and collaborate with law enforcement.  
• Minnesota: MMHCF will expand and enhance FastTracker, Minnesota’s public website with two portals to track availability of mental health and substance use disorder treatment services, completing a state-level, real-time, comprehensive service registry for mental health treatment services across the continuum of care. 
• Mississippi: MDMH will enhance their Crisis Intervention Team (CIT) program by employing Forensic Peer Support Specialists and establishing a Crisis Services Center (CSC)  that will act as a Single Point of Entry (SPI) for the CIT program and will be accessible to any individuals experiencing psychiatric or substance abuse challenges. MDMH will promote a trauma-informed approach in the justice system by partnering with a local Community Mental Health Center to train a team of Forensic Certified Peer Support Specialists (CPSS) to work in the jail system, and train corrections officers, jail staff, and/or justice system in trauma-informed care.
• Missouri: DMH will replicate an expansion of the successful Forensic Mobile Team, a community behavioral health program, to provide services in county jails that have no medical, psychiatric, or other services available. 
• Montana: AMDD will increase access to crisis and diversion services by researching and developing a Behavioral Health Crisis System Strategic Plan to inform the most relevant services in rural and frontier communities.
• New Jersey: DMHAS will support and champion peer specialists in crisis programs in two counties of the state with a focus on facilitating the diversion of legally involved individuals from involuntary hospitalization or incarceration, and expanding support for local police departments. DMHAS will strengthen services in the state by recruiting, training, and deploying forensic peer specialists (FPSs) who will work in justice-involved services (JIS) to engage individuals with a mental illness who are in county jails and local courts and support their re-entry into the community.
• New Mexico: NM BHRN will develop a Learning Collaborative to bring together and strengthen existing Crisis Triage Centers (CTCs) by bringing together service providers, their state Office of Peer Recovery and Engagement (OPRE), and law enforcement.
• New York: OMH will combine two successful peer-run county emergency programs; the 911 Diversion Program which trains 911 dispatch and emergency service personnel to screen for mental health or co-occurring issues and the Mobile Crisis Stabilization Team which is a forensic-focused mobile team that works directly with law enforcement and courts seeking diversion through alternatives to incarceration (ATI) to provide immediate crisis response and/or transitional care services to people at risk of entering the criminal justice system.
• Ohio: OMHAS will expand and enhance treatment services within jails and increase reentry coordination for treatment and recovery supports for individuals with SMI to transition into the community through crisis prevention and training staff on trauma-informed care, access to psychiatric services, and access to supportive housing and transportation.
• Oklahoma: DMHSAS, expanding upon the Sequential Intercept (SIM) Model to provide services at every level of diversion, will partner with a county jail to implement reentry support to community providers including behavioral health treatment services and other community social support such as housing, education, employment, and legal resources. They will identify a community partner network to educate about the reentry planning process and develop collaborations to make referrals and service connections. DMHSAS will work to expand reach of their County Service Engagement Project via Certified Peer Support Recovery Specialists to better screen individuals, connect them to community services, and improve jail-based behavioral health services. Multiple  models  of  telehealth  intervention  are  in  use  throughout  the  state  and  will  serve  as a blueprint for this project.   Projects which provide tablets directly to individuals receiving services have  demonstrated  the  success  of  immediate  access  to  care  and  proven  the  effectiveness  of proprietary  software  which  protects  the  devices  from  unauthorized  use. Tablets  have  been distributed  to  law  enforcement  to  connect  individuals  they  interact  with  in  the  public  with emergency crisis care in the field have also proven successful interfaces with the criminal justice system.
• Palau: PBHAC will train providers and law enforcement on Behavioral Care and Diversion. The long-term outcome is to reduce recidivism and incarceration rates, lower the costs associated with arresting, sentencing, and jailing those with mental health issues, and more importantly, provide those experiencing a behavioral health crisis with the care and services they need.
• Pennsylvania: DHS/OMHSAS will develop a community-based forensic pilot bed registry program in the southeast region of the state building upon their Stepping Up Initiative implementation. The registry will focus on diverting individuals with mental illness involved in the criminal justice system from incarceration to community-based treatment. DHS/OMHSAS will provide specialized response training through Crisis Intervention Training (CIT) and Mental Health First Aid for law enforcement when interacting with individuals with behavioral health challenges such as mental illness and will promote collaboration at the local level. They aim to increase officer and public safety during crisis situations and enhance diversion/treatment opportunities to improve outcomes for individual with behavioral health challenges.
• Puerto Rico: ASSMCA will expand services of the Crisis Peer Support Specialists to the Integrated Crisis Intervention program of the Linea PAS Hotline by assigning Certified Peer Support Specialists to provide services to crisis programs through the ASSMCA Mutual Support Center (MSC). ASSMCA will integrate Crisis Peer Support Specialists, Recovery-Oriented Services, and their Offender Re-Entry Program to strengthen mental health treatment interventions at correctional facilities and in Forensic Psychiatric Hospitals by engaging individuals in peer-based recovery services, MH treatment, and development of personal skills.
• South Carolina: DMH will strengthen their statewide mobile crisis program to increase jail diversion practices through a  Criminal Justice Coordinating Council and engagement with leaders in the local justice system to utilize data-driven, evidence-based practices to inform decision making, providing effective treatment for individuals and families, and implementing jail diversion practices. DMH will engage Certified Peer Support Specialists to increase access to mental health and substance use services for individuals released from a detention center through coordinated care and will employ mental health professionals to improve coordination of care for individuals returning to the community.
• South Dakota: DBH will create a real-time, community-based, forensic service registry of comprehensive services including but not limited to residential crisis services, mobile crisis services, outpatient mental health and substance use disorder services, residential mental health and substance use disorder services, and supported and recovery housing. They will focus on diverting individuals with mental illness involved in the criminal justice system from incarceration to community-based treatment.
• Texas: HHSC, through trainings, educational resources, and planning activities, will develop, publish, and implement a research-informed and evidence-based training and technical assistance (TTA) strategy to accelerate the implementation of successful diversion programs throughout the state. This project will include data collection from law enforcement, peer service providers, people with lived experience of justice involvement, including people of color, and local mental health service providers.
• Utah: DSAMH, through Forensic Peer Support Specialists (FPSS), will create a new initiative to expand diversion from incarceration into the existing crisis system. They will establish a specialized FPSS enhancement and practicum program and create a peer workforce to focus on individuals being diverted from incarceration due to behavioral health issues.
• Washington: DBHR will develop a statewide service registry by upgrading their system to increase efficiency, converting existing state hospital capacity into Forensic Centers of Excellence, and  including smaller treatment facilities dispersed throughout the state to better serve individuals within or nearer their home communities and reduce institutionalization. DBHR will create a continuing education, trauma-informed curriculum for certified peer counselors to work in crisis service environments. The curriculum, created by CPCs and crisis service providers will serve the needs of behavioral health providers, and build upon the lived experience of those uniquely qualified to provide peer services. DBHR will create a specialized online curriculum focusing on Trauma Informed Approaches for jail personnel, law enforcement, and possibly forensic hospital personnel which will be delivered by co-trainers, presenters and panelists who are local tribal members, representatives of under-represented groups, youth, family, and adult content experts with lived experience. 

TTI 2020 Information Page

 In FY 2019-2020, CMHS awarded TTI grants to the following twenty states & territories:

• American Samoa: ASBHSD, in collaboration with their department of Voc Rehab, is improving appointment attendance of individuals with SMI by expanding their supported employment and providing incentives of transportation and prepared meals. They have been making valiant efforts to meet with participants in parks 6 ft away to make sure that the participants receive the needed program. Find American Samoa's report here.

• District of Columbia: DBH is facilitating the transition of individuals with SMI from correctional facilities to the community through a warm handoff by collaborating with and equipping community service providers and certified Peer Support Specialists with incentives. Find DC's report here.

• Delaware: DSAMH is expanding the capacity built by the bed registry system initiated by TTI 2019 through leveraging technology and the funding to improve the continuum of care following the treatment and referral system. By building on their Treatment and Referral Network (DTRAN), DSAMH is improving engagement rates through direct incentives transitioning between levels of care, particularly inpatient to outpatient behavioral health settings and integration of peer support. Find Delaware's report here.

• Florida: DCF developed partnerships with local and statewide entities and are offering trauma-informed family navigators and establish incentives for engagement of youth and families to improve participation in services. Find Florida's report here.

• Georgia: DBHDD is partnering with service providers to reduce no-show rates and improve early engagement in treatment through its incentive system, “NICE!”. They are conducting a case control study to evaluate effectiveness of incentives. Find Georgia's report here.

• Guam: GBH, through Project I Hinemlo and Guma Mami Inc., is promoting self-determination and person-centered planning for young adults experiencing FEP and/or SMI/SED by pairing them with peer navigators in their transition from psychiatric inpatient services, corrections/jails, and homeless shelters to outpatient services by providing them with incentives. Find Guam's report here.

• Kansas: KDADS is fostering engagement through peer support team members and new telehealth options to encourage attendance at appointments by offering wellness recovery related activities and incentives. They are incentivizing staff to address retention challenges and are focusing on coordination and collaboration between street outreach teams, correctional facilities, hospitals, case managers, and peer supports to provide wrap-around services. They have also put into place NAMI training via ZOOM and peer staff incentives to be distributed. Find Kansas's report here.

• Kentucky: DBHDID is expanding upon existing continuity of care efforts and Kentucky’s Recovery-Oriented system of care through peer support specialist, the creation and implementation of a new contingency management (CM) intervention, and incentives for individuals discharged from a state hospital. Find Kentucky's report here.

• Massachusetts: DMH is innovatively utilizing Certified Older Adult Peer Specialist (COAPS) to support individuals at risk of losing their housing because of hoarding issues and pandemic-related circumstances and offering supermarket gift card incentives. Find Massachusetts' report here.

• Mississippi: DMH trained and graduated 35 Certified Peer Support Specialists to act as community-based Peer Bridgers to provide incentives and support individuals in their transition from a state hospital for acute psychiatric care to community-based services. Virtual peer support trainings allowed MS to drastically increase the capacity of certified Peer Bridgers despite the pandemic. Find Mississippi's report here.

• Missouri: DMH, through the Missouri Alliance for Dual Diagnosis (MOADD), designed and created an innovative mobile app for children and their families with MI and I/DD through trauma-informed clinical best practices and is providing incentives. They are assisting clinical professionals in utilizing trauma-informed clinical best practices by utilizing a mobile application and an Extension for Community Health Care Outcomes (ECHO). Find Missouri's report here.

• Nevada: DPPBH designed and created innovative engagement activities by providing incentive bags described by clients as “[providing] feelings of joy and excitement [in the midst of] the economic and COVID-19 climate.” These incentives facilitated an 82% attendance rate. They are utilizing occupational therapy to support clients with leisure activities and public health education. Staff are reporting a new level of patience and ease amongst clients while waiting for their appointments following discharge from an acute psychiatric hospital. Find Nevada's report here.

• New Jersey: DMHAS is training Certified Peer Support Specialists in Recovery-Oriented Cognitive Therapy (CT-R) and developing creative strategies and  incentives to assist hospitalized patients working to remove barriers/obstacles that they have encountered within the past to move that much closer to the life they want for themselves. Find New Jersey's report here.

• New York: OMH successfully engaged clients from psychiatric centers by integrating Peer Bridgers and incentives in their Sustained Engagement Support Team (SES). Cell phones were obtained for clients to more easily reach their CPS. For clients who accepted these services, 100% are regularly attending appointments. Find New York's report here.

• North Carolina: MHDDSAS enhanced engagement through Certified Peers Support Specialists, telehealth services, and incentives via RICCM (Resource Intensive Comprehensive Case Management), with one participating facility achieving a 100% appointment attendance rate. Find North Carolina's report here.

• Oklahoma: DMHSAS creatively and innovatively engaged individuals through a Street Outreach and Rapid Response team by offering practical items as incentives including bus passes, clothing, sleeping bags, tarps, food gift cards, and connection to housing or other services the clients have requested. They have also started working with providers using the Helping Connections and have obtained iPad’s (with separate funding) to help clients connect with their outpatient providers via technology to help with the challenges of face-to-face interactions due to COVID-19. One client that was helped with reconnecting with their outpatient provider had not engaged in services in two years and had recently lost their housing due to mental health issues. This client has now successfully completed 10 appointments with their provider, taking medication, and is working with their case manager to secure housing again. The Mental Health Association of Oklahoma, who is facilitating the project, continues to communicate with all agencies involved to improve working relationships and a more collaborative approach to serve clients better. Find Oklahoma's report here.

• Puerto Rico: ASSMCA creatively and consistently facilitated client engagement through peer support specialists through incentives, support services, and telehealth services. During the lockdown period, the Peers Support Program has provided 66 digital groups and had 1,570 accesses to their mutual support services. This program has generated a great amount of interest, resulting in 218 emails requesting information about virtual groups. Find Puerto Rico's report here.

• South Carolina: DMH engaged Certified Peer Support Specialists and achieved a 96% attendance rate for clients at follow-up appointments despite the challenges posed by the pandemic. Furthermore, CMHCs creatively combined incentives and community outreach for behavioral health services such as for those recently: incarcerated, leaving psychiatric hospitals, receiving mobile crisis services or youth, or young adults and their families in FEP initiatives. One center covers a very rural area where there is no public transportation. This has meant that they have had to develop contacts with businesses to provide transportation within and across county lines. Another center reported that patients have felt rewarded for not missing appointments and have responded in a positive manner. “Our Center, staff and patients, have sincerely appreciated this program and the reason it was implemented to begin with!” Find South Carolina's report here.

• Utah: DSAMH actively, creatively, and thoughtfully engaged Service Navigators at distinct CMHCs, a homeless youth resource center, and a tribal organization to identify disengagement from services and effectively tailor incentives to provide appropriate support. Find Utah's report here.

• Vermont: DMH creatively integrated mental health services and housing needs via outreach efforts, continuity of care, and incentives to focus on individuals who have not previously engaged in services. They have achieved a 94% attendance rate. One gentleman stated that if he had known counseling would have been so helpful, he would have gone in the first place. He is grateful to receive the cards and plans to continue counseling "for my own self”. Find Vermont's report here.

   

In FY 2018-2019, CMS awarded TTI grants to the following twenty-three states:

• Alabama: ADMH’s new search engine for hospital beds expands its Mental Illness Community Residential System(MICRS) and ADMH is enhancing its ability to track residential, supportive housing, and statewide crisis services by providing real-time data. 
• Connecticut: DMHAS developed and launched both a public and provider facing registry that offers 1,766 inpatient, intensive residential, group homes, transitional housing, and respite sites.

• Delaware: Delaware Treatment and Referral Network (DTRAN) expanded and strengthened their array of psychiatric hospitals, detoxification facilities, crisis stabilization and respite centers, residential beds, and outpatient and support services and succeeded in reducing wait times for individuals in crisis.
• Florida: DCF is upgrading and expanding their crisis system registry into a centralized, web-enabled platform which enables real-time data of crisis stabilization units, detoxification centers, addiction-receiving facilities, inpatient psychiatric and residential treatment beds, and short-term residential settings. psychiatric and acute care beds statewide.
• Georgia: DBHDD’s Georgia Crisis and Access Line (GCAL) integrated core components of SAMHSA’s crisis care guidelines – regional crisis call center, crisis mobile team response, and crisis receiving and stabilization facilities – into its referral system, which is open to families, first responses, and providers. TTI funds worked to improve the current interface for more streamlined use and data collection, identify and place individuals in need of service in real time, and strengthen capacity to work efficiently with local emergency departments.  
• Idaho: Idaho Psychiatric Bed and Seat Registry (IPBSR) grew and improved their crisis response system through expanded crisis call centers, mobile crisis teams, crisis stabilization centers, crisis respite, and inpatient beds across the state.
• Indiana: Indiana’s Treatment Connection registry expanded and improved their crisis service array through real-time tracking of available services, providing a bridge between public and private providers, and building two new crisis stabilization units.
• Maryland: Maryland Bed Availability Registry (MD-BAR) modernized their behavioral health crisis responses by building a web-based platform to broaden and enhance online updates and accuracy of service availability for crisis counselors, safe stations/walk-in centers, mobile crisis teams, detoxification centers, psychiatric hospitals, and other sites.
• Massachusetts: Massachusetts Behavioral Health Access (MABHA) website broadly expanded its service array both for providers and the public such as mobile crisis teams and crisis stabilization units, inpatient beds for both mental health and substance use-related crises for adults and children, and preventive and aftercare services, and increased access during the pandemic to further facilitate access to crisis services. and capture critical data on wait times.
• Mississippi: MDMH Bed Registry expanded capacity for crisis stabilization unit beds and services close to home, as well as tracking for CSUs, state hospital beds, community living facilities (long-term residential), IDD crisis units, and child/adolescent facilities, and were able to adjust and accommodate new admissions more safely during the pandemic.
• Nebraska: NDBH successfully expanded their largest metropolitan area’s crisis services by providing first responders with transportation options and referrals through effectively tracking availability daily and reducing boarding of individuals in crisis. The registry will include a new, 24-hour crisis stabilization unit, public and private psychiatric hospitals and units, as well as western Iowa collaboration.
• Nevada: DBPH exponentially improved their continuum of crisis care based on the Crisis Now model by integrating crisis call centers, mobile crisis teams, peer-run respite settings, and crisis stabilization units to improve resilience, reduce treatment costs, relieve emergency room crowding and make judicious use of inpatient beds through a referral network for providers and a public website, Treatment Connection. Despite the pandemic, Nevada successfully recruited 75% of providers and ensured the growth and continuity of their crisis continuum of care.
• New Jersey: DMHAS expanded their Bed Enrollment Data System (BEDS) to strengthen relationships with and use of short-term care by including psychiatric beds in community hospitals and peer-run respite facilities to provide a critical integration into their existing system.
• New Mexico: The New Mexico Behavioral Health Referral Network (NM BHRN) strengthened hospital, first responder, and public-facing access to crisis services by expanding integration with their substance use treatment registry, adding two new 24-hour crisis triage centers, and utilizing the New Mexico Crisis and Access Line to facilitate access to the appropriate level of care.
• New York: OMH improved and expanded access to care through the Bed Availability System (BAS) so mobile crisis teams could quickly identify available beds statewide by enhancing hospital reporting to BAS, improving on-time updates by 24% statewide and aiming for 80% of hospitals reporting daily.
• North Carolina: The Behavioral Health Crisis Referral System (BH-CRSys) integrated the feedback of providers to upgrade their platform system to simplify use, expand information captured in the network, and facilitate patient transportation to care. Provider facilities as well as hospital emergency departments, mobile crisis providers, and 24/7 behavioral health urgent care centers are able to access the registry. NC DHHS used relationships strengthened as a result of the registry to ensure providers had relevant information and assistance related to COVID-19 needs.
• Ohio: OMHAS improved and expanded their registry to integrate crisis services including mobile crisis teams, crisis stabilization units, and inpatient hospital beds in seven counties, which will be expanded statewide and will include community-based services such as organizations that provide transportation, food, shelter, rehabilitation, and entitlement assistance. 
• Oklahoma: ODMHSAS improved their “Bed Board” system by adding new functionality to the electronic health records system to ensure consistent, timely, and reliable information by providing quarterly hour updates for participating agencies, crisis bed providers, call-centers, and mobile crisis teams.
• Rhode Island: BHDDH created a public-facing, real-time website to help people find help when they or a loved one is in crisis. Rhode Island built out and greatly improved their crisis care continuum through a semi-automated bed registry including mobile crisis teams, central statewide call center, and crisis stabilization unit for triage. 
• Tennessee: The Hospital Resource Tracking System (HRTS) developed an electronic communication bridge to allow for inform their entire crisis services array including mobile crisis, crisis stabilization units, and hospital providers to view availability in real time, in addition to developing the Patient Bed Matching System (PBMS) to improve communication between referral sources and inpatient facilities.
• Utah: DSAMH is expanding their crisis care continuum by  creating an enhanced call center that would serve as a 911 for behavioral health and include a triage process to get people to the right care at the right time. The Utah Behavioral Health Availability Platform is expanding from mental health inpatient beds to include substance use disorder residential programs and social detoxification centers along.
• Vermont: DMH upgraded their current E-Bed Board by improving user interface and enhanced access to information on service availability including crisis stabilization, inpatient, residential, and intensive residential beds, as well children’s inpatient and crisis beds throughout the state.
• West Virginia: BBH strengthened their continuum of care by identifying and integrating call centers, mobile crisis teams, and wraparound services for children, youth and families. A later expansion will include psychiatric hospitals and units, psychiatric units, crisis triage centers, outpatient, substance abuse care, children’s respite, and residential care.

In FY 2017-2018, CMHS awarded TTI grants, all in the amount of $220,000, to the following six states: 

• Georgia – DBHDD targeted specific groups of providers for training and increased capacity of staff certified in sustaining Recovery-Oriented Cognitive Therapy (CT-R) and expanded the treatment reach to a larger variety of consumers (children, youth, young adults, individuals in recovery). Find Georgia Summary Here. 
• Massachusetts – DMH partnered with The Bridge of Central MA, Inc. to develop in-state capacity for the CT-R trainers to expand delivery of this evidence-based practice within the community-based service delivery system for people with severe mental illness. This treatment has been successful in helping people shift the direction of their energy towards meaningful recovery as well as energizing staff that had been working at sites for years by breathing new life into treatment teams. Find Massachusetts Summary Here.
• Montana – AMDD introduced CT-R into state MH services, enhanced the skill set of MSH and community staff at various levels of training and experience, improved outcomes of individuals with serious mental illness, and promoted and improved continuity of care. Find Montana Summary Here. 
• New Jersey – DMHAS focused on health integration and culminated into the hosting of a CT-R consumer outcome Summit as well as the development of a Behavioral Health Home Toolkit featuring the integration of CT-R in integrated settings, and peer-delivered CT-R within clinical teams. The CT-R competencies enabled the staff to assist individuals attending the BHH with building relationships, developing trust, and identifying and moving forward with their life aspirations by providing them with practical recovery-oriented, strengths-based, hopeful strategies and techniques. Find New Jersey Summary Here. 
• New York – OMH provided immersive CT-R training and expanded the use and availability of CT-R provided to individuals with serious mental illness to assist their transition from inpatient hospitalization to be fully integrated in their communities and to explore their aspirations in relation to work, education, independent housing, and expanded social networks. Find New York Summary Here. 
• Vermont – DMH provided intensive CT-R training for staff and  strengthened the promotion of recovery by implementing and sustaining CT-R strategies for adults with serious mental illness (SMI) enrolled in Community Mental Health Centers (CMHC). The grant has assisted with systems change at the program and state levels. CT-R has supported Vermont in systematically and intentionally creating successful and positive experiences for people to build confidence and resilience, as well as helping shape conversations around how to support people’s fundamental wellbeing and sense of self. Find Vermont Summary Here. 

In FY 2016-2017, CMHS awarded TTI grants, all in the amount of $221,000, to the following six states: 

• District of Columbia: DBH developed an innovative screening and support tool to address the needs of Transitional Age Youth (TAY) with co-occurring disorders (MI, DD, and trauma history) to enhance capacity of providers serving this population. Find District of Columbia Summary Here. 
• Kentucky: DBHDID, recognizing the growing diversity among the youth population with co-occurring SED and I/DD, created and disseminated a bilingual parent survey including a Spanish language parent/caregiver advocate. The survey culminated in change teams to address the diverse needs of these communities. Following the implementation the change teams, data resulted in identification of and strategies to overcome barriers and build action plans. Find Kentucky Summary Here. 
• Louisiana: OBH, in order to expand understanding and system-wide collaboration, developed and implemented an intensive cross-system training and technical assistance/mentoring program to infuse expertise in DD across all levels of the child and adolescent behavioral health system. Find Louisiana Summary Here.
• Missouri: DMH created the Missouri IDD-BH Center of Excellence initiative model to strengthen collaboration between developmental disabilities and behavioral health systems by increasing community awareness of co-occurring diagnosis; increasing family support; and implementing with sustainability standards of care.  This work connects to MO’s TTI 2020 mobile app project. Find Missouri Summary Here. 
• New Jersey: DMHAS developed pilot based on direct feedback from family caregivers of persons living with co-occurring DD and MI to create a self-care program  which included interactive education and practice program relevant to caregiving skills, resiliency, coping, and wellness, with an integrated yoga-based protocol and mindfulness practice. Find New Jersey Summary Here. 
• Utah: DSAMH strengthened family supports statewide, designed a family curriculum, and initiated family peer support for children and youth with co-occurring DD and SED to increase access to care and implement a community focus and strengths-based approach. Find Utah Summary Here. 

In FY 2015-2016, CMHS awarded TTI grants, all in the amount of $221,000, to the following two states: 

• Illinois - Developed and strengthened the use of Health Information Technology (HIT) in crisis prevention, intervention, and management. Collaborated with Northwestern University Center for Behavioral Intervention Technologies (CBITs) to refine and expand the use of a smartphone app which will help connect homeless youth, and potentially other populations, to services. Recruited and trained peer volunteers for the Crisis Text Line and/or other peer support services.
• New York – Improved the clinical informatics infrastructure of the NYS Crisis Intervention System by funding the addition of a crisis suite to the Psychiatric Services and Clinical Knowledge Enhancement System for Medicaid (PSYCKES) web application, which consists of measures and functions designed to support people experiencing behavioral health crises. The crisis suite provides access to key clinical information, including safety plans and psychiatric advance directives, for recipients and crisis service providers. Access to this information improves crisis assessment and service planning and helps reduce unnecessary emergency room visits and inpatient hospitalizations. 

In FY 2014-2015, CMHS awarded TTI grants, all in the amount of $221,000, to the following six states: 

• Idaho – Built three specialty certifications that CPS may obtain as part of their ongoing training and entered into a specialty system that required additional training to work within a specific population/facility. These specialty certificates were obtained in face-to-face trainings (2 day each) and the curriculum customized to Idaho’s specific needs and available for other states to evaluate and adopt. Each specialty certificate follows a similar process for development, financial mapping, publication, training, train-the-trainer, and ownership.
• Kentucky – Built an infrastructure around peer support services for individuals being discharged from any of the four state operated psychiatric hospitals, with the priority population being young adults 30 years old or younger, particularly those who have been admitted due to a first episode of psychosis. Development of an implementation team responsible for initiative management and accountability assisted in coordinating the effort. Kentucky’s four state operated psychiatric hospitals are eager to provide more targeted support to individuals and understand the huge gap in services for young adults being discharged from the hospital as well as the need to fill that gap with peer support services.
• Missouri – Strengthened and enhanced the peer crisis services being provided at the St. Louis Empowerment Center while creating a peer liaison positon to connect peer services and the traditional crisis intervention system.
• New Jersey – Developed capacity to deliver Peer Bridging services to “forensically involved” individuals with serious mental illness transitioning to the community. “Forensically involved” individuals include persons who have been civilly committed due to: 1) a provision of sex offender law, 2) have been ruled by a court to be currently “incompetent to stand trial”, or 3) have been found “not guilty by reason of insanity”.
• Pennsylvania – Strengthened and sustained a more robust use of Certified Peer Support Specialists (CPPSs) within Pennsylvania’s county-based network of behavioral health crisis services and supports.  This project included the development and delivery of a comprehensive training program for CPPSs and provided technical assistance to county behavioral health administrators and the crisis providers to clarify the potential roles of CPPSs.
• Tennessee – Implemented an innovative pilot peer bridger program called PeerLink in the state’s Crisis Stabilization Units (CSUs). The CSU PeerLink program in Tennessee will help individuals admitted to a CSU engage with a CSU PeerLink Peer Bridger and make successful transitions back into their home communities. 

In FY 2013-2014, CMHS awarded TTI grants, all in the amount of $221,000 to the following five states: 

• Michigan – Employed Certified Peer Support Specialists (CPSS) as independent support brokers. The role of the CPSS included brokering an array of services that incorporated person centered planning and linking and coordinating services. They also assisted with employment and financial management services, and advocated for the needs of individuals with long-term mental health, chronic conditions, and substance use disorders. They also created several documents and training initiatives related to self-directed care and other development and implementation materials.
• New York – Designed a model Self-Directed Care (SDC) for individuals with SMI. Designed a pilot program that could be tested in multiple sites in the state and then be brought up to scale in a managed behavioral health delivery system. 
• Pennsylvania – Enhanced the Self-Directed Care program in one county by contracting with the state’s leading consumer-based provider organization (Mental Health Association of Southeastern PA) and Temple University. They developed and delivered a self-directed care manual to promote replication of the initiative in other counties across the commonwealth, provide technical assistance to these other counties, and determine an avenue for financial sustainability statewide for these initiatives.
• Texas – Documented the elements of a sustainable Self-Directed Care (SDC) Program for people with serious mental illness. Building on experience gained from pilot programs in the Dallas and Houston metro areas, they convened stakeholder community meetings to lay the groundwork and began planning for future SDC pilot programs. 
• Utah – Designed a system to increase self-directed care opportunities for adults with serious mental illness and youth with severe emotional disturbances who could have their needs better met through self-directed services. “Support Brokers” assessed participating individuals for their own personal needs toward budget development, and peer support was confirmed as a critical element of self-directed care and success of the program. Ensuring peer support resources was an increasing focus as this program was rolled out across the state.

Summaries of FY 2013-2014 Projects:

• Michigan
• New York
• Pennsylvania
• Texas
• Utah

In FY 2012-13, CMHS awarded TTI grants, all in the amount of $221,000, to the following eleven states:

• Guam - Built local capacity with locally-based trained trainers and improve services delivery by skilled services providers and consumer coaches/peer specialists. The five areas addressed included (1) Self-directed care; (2) mental health first aid; (3) suicide prevention; (4) trauma informed care; and (5) enhanced collaboration among stakeholders.
• Idaho - Created a recovery coaching training program for adults in recovery from substance use disorders. Facilitated a number of trainings and established recovery coaches in each of the seven regions of the state. Idaho also now has its own recovery coach trainers located around the state to support the sustainability of this effort, and worked toward certification for recovery coaches. The state also began conversations on community-driven recovery centers, including specifically for tribal communities.
• Illinois - Addressed several critical issues in Illinois that include information tracking in problem solving courts, the statewide forensic waiting list for DMH hospital admissions, the enhancement of community provider and DMH hospital workers therapeutic skills towards more effectiveness in their work with justice involved consumers and patients, and facilitation of justice involved consumers access to health benefits.
• Indiana - Planned and delivered eight trainings and technical assistance events to increase levels of knowledge, program evaluations, and recommendations to identify additional training and/or resources needed to bring Integrated Primary and Behavioral Health Care (IPBHC) to scale, in addition to developing a module to continue training opportunities for sustainability. Indiana has an ongoing Primary Care and Behavioral Health Integration Initiative.
• Kentucky - Implemented evidence-based screening in six child care settings in Central Kentucky through the Expanding Access to evidence-based practices for Kentucky’s Young Children in Child Care project. Children who screened positive in any of the developmental domain were referred for further assessment to the appropriate agency, and families in these child care settings had access to the evidence-based Nurturing Parenting Program, a 16-week parenting group, as well as one-on-one peer support, upon request.
• Louisiana - Established Louisiana's first mental health court (MHC) program that specialized in problem solving, using a collaborative team approach with judicial leadership. Through discussions with stakeholders, the program involved (1) the diversion of individuals charged with probation and parole violators (and possibly misdemeanors) from jail time; and (2) the provision of re-entry services and treatment to appropriate offenders leaving the state prison system through “good time” andparole and returning to the community.
• Massachusetts - Explored the barriers and opportunities to encouraging culturally and linguistically understandable and relevant peer support and avenues to recovery within the Deaf community. The department engaged a team including peer-run agencies, providers of Deaf and Hard of Hearing behavioral health services, and members of the Deaf community self-identified as having a mental illness and working on their recovery, to inform the project.
• Minnesota - Partnered with the Mental Health Consumer/Survivor Network of Minnesota (CSN) to develop relationships with other organizations serving veterans. Partnership examples include the HUD Veteran's Housing Assistance Project offering CSN resources, and the St. Cloud VA Medical Center offering Wellness Recovery Action Plan (WRAP) to veterans. They also participated in public awareness events and meetings related to veterans' needs, and coached local mental health authorities to identify clients who served in the military so their unique needs could be considered when planning and implementing services.
• Nebraska - Implemented programs and training to further trauma-informed peer support within family systems with a focus on how trauma impacts consumers of mental health services across the lifespan and how to promote healing that is developmentally specific. These goals were accomplished through activities such as educational opportunities, peer support train-the-trainer, and materials created by family peer support providers.
• Tennessee - Transformed juvenile court services by expanding the use of screening for mental health, substance abuse, and family service needs of youth referred to juvenile courts as unruly or delinquent; provide family peer support services to the families of these youth; and increased the use of evidence-based therapeutic practices for the juvenile justice population.
• Virginia - Furthered efforts to incorporate the use of Psychiatric Advanced Directives (ADs) into routine clinical practice throughout its system of care to promote individual self-determination, reduce coercion, and reduce the need for expensive crisis care including inpatient treatment and incarceration. They also provided much needed cross-systems education about the behavioral health system to Virginia’s legal community, including judges, clerks, magistrates, commonwealth’s attorneys and defense attorneys.

Summaries of FY 2012-13 projects are located here

In FY 2011-2012, CMHS awarded TTI grants, all in the amount of $221,000 to the following eleven states: 

• Alabama – Provided an opportunity for all of Alabama's mental illness and substance abuse providers to gain clear understanding of how healthcare reform will change the delivery and financing of behavioral health services. The focus was to stress to providers the importance of adopting a recovery orientation system of care and provider integrated care.
• Arizona – Increased self-management of chronic illnesses among Arizona peer-based workforce, peers and their family members (with focus on population with SMI). As well as created the process and mechanisms to identify and refer peers into workshops and an educational module to train providers in recruitment and referral.
• Arkansas – Began a core consumer group monthly teleconference among staff of the CMHCs, consumer members of the councils, Division Advocate, and Staff at the Mental Health Council. This meeting is used to coordinate initiatives and to elicit and give support for strengthening the councils.
• Colorado – Assisted the Governor’s Behavioral Health Cabinet in facilitating the integration of Colorado’s public behavioral health system. This project established a planning and implementation process for this transformation that included the Behavioral Health Cabinet (Corrections, Medicaid, Human Services, Employment, Local Affairs, Public Health, and Public Safety), and a Behavioral Health Transformation Council comprised of departmental staff, consumers and stakeholders.
• Georgia – Integrated whole health concepts into Georgia’s peer workforce with the development of peer support whole health services.
• Kentucky – Supported the initiation of statewide efforts in the implementation of trauma-informed care across the state, including: the formation of a statewide interagency Trauma- Informed Care Steering Committee; eight Regional Interagency Trauma-Informed Care Community Forums; and support to provide follow-up to the Regional Forum communities.
• Michigan – Demonstrated the effectiveness of Peer Support Specialists as health coaches and system’s navigators in Federally Qualified Health Centers (FQHC). Two areas of the state in both urban and rural settings that serve a significant population of persons with serious mental illness and/or co-occurring chronic conditions were chosen as pilot sites. 
• Montana – Built, expanded, and enhanced system transformation by developing strong partnerships across all levels of the criminal justice and behavioral health continuum. Utilizing the Sequential Intercept Model, they created new initiatives at Intercepts 2 & 3, with reinforcement of existing programs at Intercept 1, through pre-trial services programs that have been demonstrated as best practices in diversion from detention. Program elements included court training, attorney education, crisis intervention team training, and mental illness intervention. 
• New Jersey & Pennsylvania (Joint) – Built upon the successes of previous TTI funds by collaborating to prepare a peer workforce to meet the health and wellness needs of older adults with mental health and substance use disorders. This joint effort strengthened the capacity of the workforce of both states. In NJ, peer wellness coaches were utilized to help clients manage chronic health conditions and achieve their lifestyle goals. PA developed a curriculum for peer support specialists to address older adult whole health issues. In addition to bridging the gap between physical and behavioral health, these initiatives have increased employment opportunities for Certified Peer Specialists.
• Wisconsin – Provided trauma-informed care (TIC) training to a juvenile justice facility for young men with substance use issues. Specific training themes included TIC culture change, the role of Parent Peer Specialists (PPS) and Family Driven Care, vicarious trauma/staff self-care, trauma screening/assessment, and the trauma specific intervention ‘Seeking Safety’. Outcomes from these trainings and culture shift included creation of a comfort room, development of youth TIC profiles and corresponding case plans, creation of a database tracking youth triggers, development of a ‘good behavior’ program to reinforce positive behavior, and the administration of Seeking Safety pre and post-tests to evaluate youths’ use of coping skills.

Summaries of FY 2011-2012 projects can be found here.

For fiscal year 2010-2011, CMHS awarded TTI grants ranging from $115,000 (designated by a *** as a repeat recipient) or $221,000 (as a first time awardee) to the following twelve states:

• Delaware – Created a recovery-oriented system by providing support and direction to the “budding” Delaware state consumer network as well as building on the initial integration of the employed Peer Specialists at the state hospital to provide hospital onsite services as well as bridge peer services that follow individuals upon their discharge from the hospital to assist them in their re-entry, as well as to identify gaps in services.
• Idaho – Created a data warehouse to collect and process data from multiple state systems to allow reporting across systems within the Division of Behavioral Health for the first time ever.
• Kansas – Improved health and wellness and coordination of physical and mental health treatment for persons with severe and persistent mental illness, provided training and technical assistance to mental health treatment providers and peer support organizers and advanced existing efforts in the development of an effective behavioral health home and care coordination model to inform policy decisions in Kansas.
• Kentucky*** – Serviced enhancement with the co-occurring providers through NIATx and mini-grants and facilitated the establishment of Double Trouble in Recovery groups.
• Minnesota*** – Jump-started a statewide public-private campaign known as the Minnesota 10x10 Initiative by focusing initially on assertive community treatment (ACT), strengthened the work of Minnesota’s 26 ACT teams in the goal area of physical health and wellness and extended the lessons learned in ACT to our entire state system.
• New Hampshire – Implemented statewide client level outcome measures for adults and children/adolescents.
• Pennsylvania*** – Implemented 6 goals in efforts to reduce barriers to treatment. Those goals are: train-the-trainer curriculum development, recruitment, pilot the train the trainer approach, follow-up evaluations, on-going COAPS training, and following up date collection and consultation. The Office of Mental Health and Substance Abuse Services (OMHSAS) has developed a cadre of older adult peer specialists to provide recovery services to older adults.
• Rhode Island – Integrated behavioral health into rural primary care settings by increasing knowledge in the physical health professionals, increasing access to integrated physical and mental health services, early detection, increasing satisfaction of the integrated health team members, and reduced ER visits of patients with co-morbid disorders. 
• South Carolina – Initiated a partnership and planning process with the South Carolina Primary Health Care Association: to identify, adapt or develop bidirectional models of integrated care for both Community Health Centers (CHC) and Community Mental Health Centers (CMHC); and provide statewide training forums.
• Tennessee*** – Deployed a public health approach of early intervention to improve access to mental health and substance abuse services for youth in juvenile courts as well as to support follow-through with and participation in available services which contribute to diversion from the juvenile justice system and reduce recidivism.
• Vermont – Established an independent, cooperative organization focused on mental health practice improvement and workforce development. This new organization will work with mental health providers, consumers, family members, and other service organizations to support the adoption of promising, evidence-based, and recovery-oriented practices within the state’s community mental health system and improve the quality of life outcomes for individuals receiving services from that system. The cooperative will also focus on establishing and supporting core competency training for Vermont’s community mental health providers to ensure that our workforce has the core values, skills and knowledge to meet the needs of the consumers they are working with.
• Virginia – Embedded CIT within Virginia Communitiesand empower peers and families by overlapping and supporting NAMI Virginia’s annualstatewide conference with the CIT International and Statewide Conferences. Brought Virginia's consumers, family members, law enforcement personnel and mental health stakeholders together and provided a unique opportunity to focus on Virginia's behavioral health and criminal justice transformation challenges and opportunities.

Summaries of FY 2010-2011 projects can be found here. 

In FY 2009-10, CMHS awarded TTI grants ranging from $115,000 (designated by a *** as a repeat recipient) or $221,000 to the following twelve states and the District of Columbia:

• Alabama*** – Improved collaboration with primary care providers through: 1) local planning grants to support collaboration between Community Mental Health Centers (CMHCs) and Federally Qualified Health Centers (FQHCs), 2) convening expert panels to address barriers and challenges to collaboration from the physician's perspective, and 3) a joint meeting between pediatricians and public mental health center psychiatrists to address improved collaboration.
• Alaska – The Alaska Psychiatric Institute’s (API) Telebehavioral Health Open Access Clinic commenced January 2010 with the goal of providing immediate access to psychiatric, psychological, and behavioral health services for Alaskans living in rural and remote-rural locations throughout the state.
• Arizona – Implemented a peer-based whole health program in the two largest metropolitan areas in Arizona, Maricopa and Pima Counties, to transform the behavioral health system into one that applies a holistic approach to health to increase longevity and quality of life, increase coordination of care between primary care and behavioral health, and increase participation in recovery through medical autonomy.
• Arkansas – Strengthened their existing mental health sytem through the creation of a statewide consumer network. The state accomplished an active consumer council in each of the state’s fourteen Community Mental Health Centers and three specialty clinics along with a statewide Consumer Conference.
• DC – Improved access to primary health care for individuals with chronic mental illness by expanding an existing project to co-locate primary health care practitioners with community mental health providers and also by incorporating Peer Specialists as "health navigators" to help consumers to take advantage of primary health care services.
• Florida*** – Had 2059 participants attend six regional seminars on trauma-informed care (TIC) throughout Florida. Seminar participants included mental health consumers, family members, advocates, executive and clinical staff of mental health provider agencies, other mental health professionals, staff of other social service and advocacy organizations, department staff, and staff of other state agencies.
• Illinois*** – Implemented a statewide mental health justice and advisory group, piloted an integrated mental health court database, and hosted a mental health and justice consumer conference.
• Indiana – Increased and improved recovery-based care at the community level by providing community mental health centers (CMHCs) and state operated psychiatric hospitals needed training for transformation initiatives and align them to a recovery-based philosophy and model clinical care and a media campaign designed to increase recovery awareness.
• Maine – Worked with a group of consumers and providers to develop and implement a system of measures (in the form of a toolkit) focused on individual outcomes and recovery. The selected toolkit includes four measurement instruments: the OQ, the Recovery Assessment Scale (RAS), the Data Infrastructure Grant Survey, and the LOCUS. The TTI grant also assisted Maine to define “recovery”, create a draft of “Recovery Guidelines for Mental Health”, develop a recovery-focused clinical training module for the administration of the toolkit, test Maine’s assumptions about whether the toolkit works to measure both individual and system outcomes, and create a training model for the implementation of the toolkit with providers and consumers.
• Massachusetts – (1) a statewide training effort on person-centered planning; and (2) initiation of a program for a shared decision-making model to foster the reduction in the use of psychiatric medications. The team worked with each of the state’s geographic “Areas” to determine the manner, schedule and attendees for the trainings in each area. A hallmark of this project at all stages was the inclusion of peers in all aspects of its execution.
• Mississippi – A group of 35+ transportation stakeholders 1) Trained 17 staff of the Life Help CMHC on the Coalition’s transportation needs assessment. 2) The trained Life Help staff administered the needs assessment to 130 Life Help customers to determine their transportation needs and then worked with them to prioritize these needs. 3) Transportation service providers were identified.
• Montana – Fostered behavioral health and corrections collaborations, including training for law enforcement, criminal defense attorneys, and 911 data collection. Training on mental illness and crisis intervention has been provided to 200+ law enforcement officers & criminal justice professionals. Local providers, advocates, consumers and health care professionals have participated in the training. This Mental Illness Intervention curriculum has also been incorporated into Montana Law Enforcement Basic Training.
• North Dakota*** – Provided a pilot project to address the needs of transition-aged youth at risk. The TTI Project at North Central Human Service Center targeted transitionaged youth ages 14 -24 and built upon current transformation services as well as Bill 1044. This project collaborated and worked intensively with multiple community resources to provide the necessary supports to youth in transition.

Summaries of FY 2009-2010 projects are located here. 

In FY 2008-2009, CMHS awarded TTI grants, all in the amount of $221,000 to the following eleven states: 

• Colorado - Provided assistance to the Governor’s Behavioral Health Cabinet in facilitating the integration of Colorado’s public behavioral health system. This project established a planning and implementation process for this transformation that included the Behavioral Health Cabinet (Corrections, Medicaid, Human Services, Employment, Local Affairs, Public Health, and Public Safety), and a Behavioral Health Transformation Council comprised of departmental staff, consumers, and stakeholders.
• Georgia - Integrated whole health concepts into Georgia’s peer workforce with the development of peer support whole health services. This was accomplished through a Peer Support Whole Health Pilot Project Training (PSHW) program that included 33 participants. A detailed audit report of the program was also created.
• Louisiana - Provided training, through the Early Childhood Supports and Services (ECSS) program, for public and private sector clinicians in specific evidence-based practices in order to achieve improved clinical and functional outcomes in preschool children (birth through five years). The trainings, created in partnership with Tulane University, were free to clinicians.
• Michigan - Integrated physical and mental health care in selected Community Mental Health Services Programs (CMHSPs) by providing a comprehensive peer-led whole health initiative. Participating CMHSPs used funding to hire Certified Peer Support Specialists (CPSSs). Additionally, over 100 CPSSs in Michigan attended leader training as part of the state's Personal Action Toward Health (PATH) program rooted in evidence-based practice models developed by Stanford University.
• Nebraska - Developed a statewide Peer Support Training plan. This included the creation of a steering commitee to develop training curriculum and the execution of 7 town hall meetings across the state with a combined attendence of over 300 people. The state planned peer support trainings, and train-the-trainer sessions to take place in 2010.   
• New Jersey - Created a system of Peer Specialist Wellness Coaches and a State Medicaid Plan Amendment to allow for reimbursement of peer specialist services. Outcomes included the execution of a statewide wellness and recovery conference attended by over 400 participants, 42-hour trainings completed by 22 Peer Support Specialists and, 96 hour trainings completed by 20 Peer Support Specialists, now designated as Peer Support Coaches. 
• New York - Used recovery centers focused on consumer/family education, peer support and assistance with treatment planning to restructure care in New York State. Partnered with Dartmouth University to conduct research on the development of recovery centers and enhance the use of supported employment.
• South Dakota - Strengthened rural mental health transformation through the development of family-voice in implementation efforts. South Dakota also expanded an existing System of Care Pilot Project by implementing wraparound training in two regions of South Dakota that are actively working toward the creation of an integrated services system for children and their families.
• West Virginia - Integrated physical and mental health at CMHCs and rural primary health care clinics. A Statewide “Call to Action” conference was attended by over 100 primary care physicians, nurse practitioners, psychiatrists, CMHC staff, state leaders, and consumers/ families.
• Wisconsin - Integrated trauma-informed care into the state system via Trauma Care Champions. The Department of Health Services (DHS) Trauma Services Coordinator worked successfully with the Department of Children and Family (DCF) staff to participate in parallel to develop trauma-informed care (TIC) within Child Welfare programs.    
• Wyoming - Developed a statewide housing network across Wyoming’s five regions designed to build a regional provider system for consumers and bolstered that effort with statewide SOAR training.

Summaries of FY 2008-2009 Outcomes can be found here.

In FY 2007-2008, CMHS awarded TTI grants, all in the amount of $105,000 to the following ten states and one territory: 

• Alabama - Coordinated public mental health and primary care through one large Adult Psychiatric Conference followed by regional roundtable discussions between family practice physicians and mental health clinicians to develop regional plans of action.
• Florida - Developed a recovery and resiliency task force. The task force conducted 12 two-day recovery and resiliency trainings (two in each region) with over 500 participants, one statewide advanced leadership training for 34 participants, two Certified Peer Specialist Trainings producing fifty new Peer Support Specialists, and a statewide Certified Peer Specialist train-the-trainer three-day training for fourteen participants, including one person from each region.
• Illinois - Created a co-occurring strategic plan and developed a criminal justice workgroup with regional sessions to develop regional system mapping to identify service gaps and barriers. This workgroup helped to identify gaps in services and develop work plans for each of the five participating regions.
• Iowa - Developed emergency mental health crisis services through Iowa’s CMHCs by conducting Mental Health First Aid (MHFA) train-the-trainer sessions for 22 participants. Iowa also  improved their children’s mental health system through CAFAS Child & Adolescent Functional Assessment Scale (CAFAS) "train the trainer" sessions that totaled 39 participants.
• Kentucky - Created a Peer Support Initiative with the State Medical Office. This resulted in, amongst other initiatives, two pilot sites for Medicaid Peer Reimbursement and 50 additional trained peer specialists. Kentucky also developed a plan to support statewide high fidelity implementation of wraparound. This included the development of training curiculums and the State Wraparound Implementation Fidelity Team (the “SWIFT”).
• Minnesota - Developed a mechanism for multiple reviewers to simultaneously conduct the Illness Management and Recovery (IMR) and Integrated Dual Disorder Treatment (IDDT) evidence-based practice rating scale reviews while maintaining the integrity of the individual scale. 
• North Carolina - Provided training and support to the Local Management Entities (LMEs) to learn from each other and foster evidence-based practices. Licensed clinical social workers, masters level psychiatric nurses, and certified clinical addictions specialists were trained to conduct the initial (first-level) examinations of individuals to determine if they meet criteria for involuntary commitment under North Carolina law.
• North Dakota - Provided Peer Support Training and collaboration with State Medicaid Office in a statewide peer support initiative. This included participation from over 80 individuals at each of the work group's three meetings resulting in the development of a Peer Support Certification Curriculum. 
• Pennsylvania - Created an Older Adult Peer Support Services Initiative. This initiative developed one day and three day curriculums designed to help peers specialize in working with older populations. 72 Certified Peer Specialists completed these trainings. 
• Puerto Rico - Integrated behavioral health services into rural primary care settings. This included increased knowledge in the physical health professionals of signs and symptoms of emotional illness and procedures for referral, increased access to integrated physical and mental health services for patients of the Northwestern Region, and increased access to integrated physical and mental health services for patients of the Northwestern Region.
• Tennessee - Transformed their juvenile forensic mental health services by providing courts with alternatives through a program of outpatient screening and forensic evaluation. This was accomplished by engaging judicial leadership and other essential departments, and supplying training and technical assistance to community providers.

Summaries of FY 2007-2008 projects are located here.