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This project will improve treatment outcomes and reduce risk of overdose in Native American adults 18 and over by providing increased access to Medicine Assisted Treatment (MAT) and expanding substance use disorder (SUD) treatment services. Some participants travel up to 40+ miles from the community to gain access to MAT. With expansion of treatment services, including increased case management capacity, the Pueblo of Pojoaque will seek to expand enrollment in its Healing to Wellness Court to up to 30 people at one time. This will include 8-10 people with opioid use disorder. Participants who present with OUD often leave the program early due to various barriers or factors, including lack of intensive outpatient substance use disorder treatment and MAT. The proposed goals for the program will directly impact these participants and their access to treatment. We expect to increase MAT availability for an additional 45 people and enhance substance use disorder treatment for an additional 60 individuals throughout the five years of this project. Except for a few eligible non-Native self-referrals, all people served by PTW are Native American.

ABSTRACT The Washington/Madison County Adult Treatment Drug/Diversion Court and Veteran’s Treatment Court (WMCATDC) proposes to collaborate with Arkansas Community Corrections, area licensed mental health and recovery support providers, HIV education and testing services, and medical providers to facilitate a complete continuum of care with culturally appropriate and evidence based services to participants who are medium to high risk criminal offenders who have severe/complex Substance Use and/or co-occurring SUD and mental health disorders. We anticipate serving 120 participants annually for a total of 600 participants over the five year funding period. This service enhancement and expansion project is designed to improve the quality and focus of individualized treatment and recovery services available to the court’s participants and their families and to increase the number of participants from rural Madison County, as well as continue expanding our Washington County Adult Drug Court and Veterans Treatment Court. The project addresses current gaps in the continuum of care for participants and will improve the outcomes of those with the most severe/complex substance abuse and mental health problems. We will specifically target individuals with substance abuse or mental health disorders in the criminal justice system that are least likely to succeed with traditional outpatient and probation services. Participants include those with a history of trauma, problem complexity, chronicity, and fewest natural supports, including racial minorities with historically low access to drug courts. Because of the characteristics of the substance-dependent individuals targeted and the expansion to Madison County, we expect increased numbers of veterans (history of trauma), repeat offenders (legal complications as a result of drug/alcohol dependence or mental health issues), individuals with serious mental health disorders (high problem complexity) and increased Hispanic enrollment. Project goals include: Enhance and continuously improve the delivery of evidence-based and culturally appropriate services including approaches for substance abuse, co-occurring disorders, trauma, and PTSD to better serve our participants and decrease relapse and recidivism. WMCATDC also proposes to provide services that are effective for clients who are parents and have histories of Adverse Childhood Experiences (ACE) to prevent ACE in their children. The project will implement MAT, reduce HIV risk, and reduce health disparities/access through increasing Latino enrollment. Our mission is to continue to reduce the harmful impact on society of addiction and untreated mental health disorders by addressing the behavioral health needs of the criminal justice population this project will serve. The project is closely integrated with broader state-level systems of care efforts to ensure sustainability for the system and increase the likelihood for replication around the state. Quality improvement, replication, and sustainability will be guided by results from the project evaluation.

The Yellowstone (Montana) Family Recovery Court (YFRC) seeks funding through SAMHSA’s Treatment Drug Courts grant program to enhance and increase substance abuse treatment capacity for families at the intersection of substance use and child welfare. The expansion will focus on the needs of American Indians and Alaska Native (AI/AN) families including a robust partnership with the community’s Indian Child Welfare Act (ICWA) court. Specifically, YFRC will use grant funds to: (1) increase the number of families served with a focus on AI/AN families engaged in ICWA services; (2) increase the cultural competence of the court team to better understand and address the strengths and needs of families who identify as AI/AN; (3) improve parenting, child, and family services; and, (4) enhance data collection and performance monitoring. Through this grant, the YFRC will serve approximately 83 unduplicated individuals (30 parents and 53 children) each year of the grant for a total of 415 individuals over the grant period. Participants will include families living in Yellowstone County with open child neglect/abuse cases, or at risk for involvement with child welfare system, whose parents’ substance use is identified as a contributing factor to the child welfare concern. Grant funded enhancements will include evidence based practices appropriate to this population including Parent-Child Interaction Therapy, Celebrating Families!, Seeking Safety, Dialectical Behavior Therapy, White Bison Wellbriety, Medication Assisted Therapy, Love and Logic, and Motivational Interviewing among others. YFRC will work with other Native serving agencies and organizations to identify culturally responsive modifications and adaptations as necessary to meet the needs of AI/AN families. At the conclusion of 2019, Yellowstone County had 691 open dependency and neglect cases (CFSD,2019). AI/AN families are disproportionately represented in these statistics with 250 ICWA cases (36% of all cases- but only 3% of the county’s overall population identifies as AI/AN, according to the 2010 census). Based on CFSD estimates, at least 65% or 450 of those cases involved parental substance use as a contributing factor. Unfortunately, the current YFRC docket can only serve 20 families at any given time, leaving a gap of more than 400 cases. This grant will help close this gap by increasing case management, improving cultural responsiveness, increasing staff capacity, enhancing collaborative partnerships, and expanding services. Further, the YFRC will use the data collection and performance measurement embedded in these enhancements to garner community engagement, identify opportunities to improve program quality and outcomes, sustain collaborative partnerships, and provide ongoing performance monitoring.

The Hoopa Valley Tribal Court is making application for funding assistance to support ongoing operations and service expansion under its Adult Tribal Healing to Wellness Court. The population of focus are enrolled citizens, American Indian, Alaska Native(AI/AN) and AI/AN citizens enrolled in other tribes living within the jurisdictional boundaries of the Hoopa Valley Tribe. This project intends to increase and standardize services for individuals with Substance Use Disorder (SUD) and Opioid Use Disorder (OUD). While many of these individuals are court involved, services will also be made available to anyone seeking assistance with priority for special populations. The special populations include pregnant women, individuals with or at-risk of HIV/AIDS, older adults caring for a minor child due to foster care involvement, and individuals entering the community from incarceration. The Hoopa Valley Tribe and its reservations are within Humboldt County, CA. This project utilizes a hub and spoke model to centralize service delivery for Wellness Court participants and increase favorable outcomes as they journey to health. An estimated 75 adults will receive project services, with special emphasis on pregnant and postpartum (PPW) women and their estimated 15 children each year. This project will provide a trauma-informed, family-centered, culturally competent continuum of services to aid participants attain long-term recovery while reuniting and strengthening their families. In addition to providing Medically Assisted Treatment (MAT) options for participants, the Hoopa Valley Tribe and its partners, including K’ima:w Medical Center, will work with tribally operated resources to address issues of behavioral health, housing, family and children’s services, employment, crisis intervention and community and cultural education. Similarly, this project will integrate evidence-based models, such as Motivational Interviewing and Nurturing Parenting for increased responsivity in Family Wellness Court participants. Comprehensive, strength-based case management will guide participants through their services and link them to internal and external resources. These interventions support SAMHSA's goals of reducing substance use; increasing safe, healthy pregnancies; improving mental and physical of women and children; improving family functioning; and decreasing crime, violence, abuse, and neglect. An estimated 300 women, men, and children will be served over the life of the project. As required by SAMHSA, Participants will complete a 6-month follow-up assessment. This intend outcome of this project is to build personal responsibility, stabilize families and assist individuals in achieving their recovery goals – and fulfills the Family Wellness Court’s Vision to build a stronger, safer and healthier community by fostering resilience while being responsible for each other’s successes through connectedness.

Project Name: Expanding Substance Abuse Treatment Capacity in Lackawanna County Treatment Court. Populations to be served: Individuals with Substance Use Disorders (SUDs), who are at-risk for or have a history of involvement with justice system-related penalties, those with probation/parole violations related to drug/alcohol use, returning veterans, and offenders with co-occurring mental health and SUDs. Demographics and clinical characteristics of target populations: Approximately 29% are female; 71% are male; all participants reside in Lackawanna County, which has a higher percentage of driving deaths due to DUI than the rest of the nation, as well as a higher drug-induced/overdose death rate than the rest of PA or the nation. In addition to drug addiction, common clinical characteristics include co-occurring mental health disorders and PTSD. Strategies and interventions: Implement an automatic screening of all probation and parole violators for SUD and Mental Health issues to place them in Treatment Court, rather than prison. Project goals include: Promote public safety and reduce substance abuse and recidivism among non-violent adult offenders; provide timely court intervention, screening, and assessment for non-violent addicted offenders; provide treatment-based judicially supervised program for rehabilitation; provide ancillary and collateral services to help offender attain sobriety and become a productive member of the community; and establish a monitoring and evaluative measure to further demonstrate the effectiveness of Treatment Court. Measurable objectives include: 1) Over the course of this 5-year project, Lackawanna County Adult Drug Treatment Court will maintain or exceed its 81% successful program graduation rate; 2) For the duration of this 5-year grant, Lackawanna County Treatment Court will provide 100% of potential participants with intervention, screening, and assessment to non-violent drug addicted offenders within 2 weeks from application to decision; 3) During the first 12 months of this grant, Lackawanna County Treatment Court will work with Parole and Probations to develop a system for screening 100% of violations for Treatment Court eligibility; 4) Over the course of this 5-year grant period, Lackawanna County Treatment Court will provide a treatment-based judicially supervised program to more than 1,626 unduplicated individuals; 5) For the duration of this 5-year grant, Lackawanna County Treatment Court will ensure 100% of participants have reasonable access to services for attaining sobriety and becoming a productive member of the community; 6) Within the first 4 months of this grant, Lackawanna County Treatment Court will work with SAMHSA to refine monitoring and evaluation measures and processes; and 6) By the end of this 5-year grant, Lackawanna County Treatment Court will have gathered, monitored, and evaluated participant data, demonstrating its effectiveness in rehabilitating non-violent adult substance abusing offenders. Number to be served annually: 323. Number to be served over lifetime of project: 1,626.

The Brooklyn Opioid Treatment Court (BOTC) is requesting funding in the amount of $1,988,669 from the Substance Abuse and Mental Health Services Administration to enhance our existing Adult Drug Court, through the creation of a Comprehensive Opioid Intervention Network (COIN) to provide for the early identification of offenders with an opioid use disorder through telehealth screenings with an Addiction Medicine Physician (AMP) and prompt intervention utilizing opioid specific Evidence Based Practices and optional pharmacotherapeutic services for those determined to be clinically appropriate. The COIN aims to remove any barriers participants may face in accessing opioid specific treatment interventions such as Medication for Addiction Treatment (MAT) and provide Opioid Use Disorder (OUD) specific resources and supports to help sustain long term recovery. Nationally, opiates are the most commonly abused illicit drug in the United States after marijuana, with heroin use increasing among all demographic groups. According to the NYC Department of Health, in 2018, 273 Brooklyn residents died from a drug overdose, the second largest number of overdose deaths in the five boroughs. The NYC Department of Health further reported that of those 53% involved Fentanyl and 50% involved Heroin. The criminal justice system, Opioid Courts, in particular, have become an important intercept for treatment of OUD. Following the BOTC model, the COIN will include close judicial monitoring, specialized assessment and treatment services, comprehensive case management services, incentives and sanctions, and frequent and random drug and alcohol testing. Working with our proposed treatment partner Samaritan Village (SV), the COIN will provide “on-demand” medical evaluations by an AMP who can guide treatment planning and rapidly connect participants to the most appropriate MAT. In addition, the COIN will allow for on-site OUD specific clinical groups and connect participants to a Certified Recovery Peer Advocate (CRPA)for Recovery Coaching. The COIN CRPA will connect participants with community resources to help sustain recovery beyond their treatment court participation. The primary goal of the proposed project to enhance the quality, effectiveness and immediacy of opioid specific treatment services available at BOTC through the addition of coordinated resources to support participants in the recovery process and help them overcome the unique challenges BOTC participants face. This project will provide services to 40 participants each year, totaling 200 unduplicated participants over five years. Specific goals for this project include; 1) decrease illicit use of opioids by increasing access to MAT services, 2) increase participants engagement and retention in treatment by providing participants with opioid specific treatment interventions, and 3) improve access to sustainable community-based recovery support services through engagement with a Certified Recovery Peer Advocate (CRPA).

The Jefferson County Commission is requesting SAMHSA Treatment Drug Court funds to enhance and expand its Family Wellness (Treatment) Drug Court. The population of focus is parents with a substance use disorder who have lost or are at risk of losing custody of their children within Jefferson County, Alabama. Demographics of the population are 91% female, 62% African American and mean age of 29 years. Proposed program components include: (1) enhanced peer integrated substance use assessment process, (2) enhanced treatment services, (3) expanded recovery support services, (4) integrated family preservation services, (5) expanded access to recovery housing. The program proposes to serve 50-75 parents each year for a total of 350 over the 5-year project cycle. Project performance will be assessed for its ability to (1) expand access to the population of focus, (2) integrate Family Wellness Court recovery support services with substance use treatment interventions, (3) expand access to recovery housing, and (4) positively impact the drug court family. The initiative will adhere to the Family Drug Court Guidelines and evidence-based practice. It will be implemented in conjunction with the University of Alabama at Birmingham and The Foundry.

Summary. The North Mississippi Commission on MI/MR (d.b.a. Communicare/Region 2 Mental Health) and the Third District Drug Court of Mississippi will implement the Addiction Counseling Health Integration Education Vitality Enforcements project expanding IOP treatment capacity and providing trauma-informed service enhancements and peer recovery supports to improve recovery and successful reintegration into communities and reduce recidivism. Name of the project: ACHIEVES. Populations served: High risk/high need adults 18+ (40% female; 59% male; 1% transgender); 14% African American, 2% Hispanic/Latino; 2% American Indian; 1% Multi-Racial; 1% LGB; 100% trauma-involved; 100% Co-occurring Disorders; 1% HIV positive and 1% viral hepatitis positive. Goal. To provide gender affirming, trauma-informed and culturally and linguistically appropriate behavioral health services reducing crime, co-occurring substance use and mental disorders among high risk/high need, nonviolent offenders who are in need of residential treatment. Strategies/Interventions: ACHIEVES expands IOP treatment capacity and enhances treatment dosage and intensity adding state-of-the-science approaches and recovery support services all to meet the individualized needs of drug court participants. The Risk and Needs Triage (RANT) is used to match each participant's level and intensity of services to his/her level of risk and relative to his/her needs. Services include standardized screening/assessment, trauma-informed SUD/MH co-occurring disorders residential treatment coupled with strength-based case management, HIV, viral Hepatitis screening and linkage, and peer recovery support services (ensuring linkages to housing, employment, healthcare and social supports). Use of EBPs will help to achieve the measurable objectives yielding optimal results. EBPs: (Motivational Interviewing (MI), IOP Matrix Model, Medication Assisted Treatment (MAT), Moral Reconation Therapy (MRT), Accelerated Resolution Therapy, (ART) Eye Movement Desensitization and Reprocessing (EMDR) and My Ongoing Recovery Experience (MORE). Objectives. Of the 250 participants served, 80% will improve abstinence; 80% will reduce criminal justice involvement; 80% will improve education/employment; 80% will improve housing stability; and 80% will improve social connectivity via peer recovery support services. # to be served. 50 per year, totaling 250 across a five-year project period.

Project Abstract Summary – SAMHSA Grants to Expand Substance Abuse Treatment Capacity in Family Treatment Courts The proposed project, Southern Ute Indian Family Treatment Court (SUIFTC), will enhance and strengthen the Southern Ute Indian Tribe’s existing efforts to ameliorate the negative impact of alcohol and other substance abuse, including the use of opioids, and co-occurring disorders affecting 80 parents, 80 children, and 8 caregivers within the jurisdiction of the Southern Ute Indian Tribal Court. The Tribal Court in collaboration with Tribal Social Services, and Tribal Health, which includes the Health Clinic and Behavioral Health will implement comprehensive trauma-informed case management for referred families that will include evaluation, assessment, treatment, and wrap- around services. Vocational Rehabilitation and the Tribal Education Department will also be involved in the program. These Tribal Departments have, since inception, shared a long-term working relationship focused on addressing historical trauma and the generational cycles of violence, mental health issues and substance abuse that continue to negatively pervade the culture, families, and community. The Southern Ute Family Treatment Court will address the following: 1)reduce the rate and severity of substance misuse and co-occurring disorders among parents; 2) increase access to extensive and comprehensive treatment and recovery services for parents; 3) increase access to socio-emotional, behavioral and developmental services for their children; 4) provide trauma informed practices and training; 5) increase family reunification and preservation; and 6) improve family functioning through the provision of comprehensive wrap- around services. This effort will address existing gaps in the system for court involved parents who need treatment and provide comprehensive services for impacted children and extended family caregivers. The program will include an exploratory pilot program engaging families with dependency and neglect investigations that have not been filed in the Tribal Court in a preventative approach with court accountability. Based on the successful Tribal Healing to Wellness Court evidence-based model, the SUIFTC integrates case management, co-occurring disorders treatment, peer support, vocational supports, and trauma informed practices into one coordinated delivery approach. In addition to the existing supports with the Southern Ute Indian Tribe, the SUIFTC will connect with and leverage existing evidence-based community treatment and support services to support resiliency, and “protect the safety and welfare of children while giving parents the tools they need to become sober, responsible caregivers” (Bureau of Justice Assistance & Center for Substance Abuse Treatment [BJA & CSAT], 2004, p. 4). The Southern Ute Tribal Court will serve as the lead for the Southern Ute Indian Family Treatment Court program. The program will expend $1,953,451.27 during the five-year grant period to development and implement the evidence-based family treatment court program. This effort is aligned with the Justice Strategic Initiative and the OJJDP Guidance to States for Family Drug Courts. Estimated number of people to be served as a result of this grant award: 168 (five year grant period)

PROJECT ABSTRACT The lead applicant, Pasco County government, on behalf of, and in collaboration with, the Sixth Judicial Circuit of Florida, is requesting Treatment Drug Courts funding from SAMHSA in response to FOA No. TI-20-003, to increase the number of drug-involved offenders (adults) participating in the Pasco County Adult Drug Court (PADC) over five years (2020-2025). The proposed Pasco ADC Expansion Project focuses on drug-involved offenders residing in Pasco County (adults 18+) that meet American Society of Addiction Medicine (ASAM) criteria for outpatient substance use disorder (SUD) treatment and The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) criteria for SUD. The expansion will also prioritize voluntary admissions of drug-involved offenders who are negatively affected by trauma-related symptoms, and may also be experiencing co-occurring disorders (COD). Furthermore, in alignment with the goals of the local Opioid Task Force and the Florida Department of Health, the drug court expansion also emphasizes the recruitment of individuals using opioids, methamphetamines and at-risk of overdose. The primary goal of the proposed project is to expand services in the existing PADC to offer more drug-involved offenders (adults) in Pasco County a treatment drug court model and community-based SUD treatment and recovery support services (RSS). The PADC will reduce recidivism and SUDs among the population of focus and increase the possibility of successful habilitation through early, continuous, and intense judicially supervised treatment, mandatory periodic drug testing, and use of appropriate sanctions and other habilitation services. Over the life of the grant (2020-2025), the PADC will serve 245 more unduplicated drug-involved offenders in Pasco County. In the shortened first and fifth years of the project, the PADC will serve 40 unduplicated participants annually; and 50 unduplicated participants in the second, third and fourth years of the project. In alignment with guidance from SAMHSA, the National Institute on Drug Abuse (NIDA) and the NADCP, the treatment provider, WestCare GulfCoast-Florida, Inc., will incorporate evidence-based programs and practices within the delivery of comprehensive SUD treatment services, including: Cognitive Behavioral Therapy (CBT), Motivational Interviewing (MI), Motivational Enhancement Therapy (MET), Relapse Prevention (RP), The Matrix Model, Seeking Safety and Thinking for a Change. The project partners have the ability to offer Medication-assisted treatment (MAT and recovery housing to PADC participants when appropriate and at no cost to SAMHSA. The PADC maintains fidelity to the ten key components established by the National Association of Drug Court Professionals (NADCP) in collaboration with the Bureau of Justice Assistance (BJA) as described in the publication, Defining Drug Courts: The Key Components. Also, the PADC utilizes many of the NADCP’s Adult Drug Court Best Practice Standards.

The Judiciary of Guam submits this FY 2020 SAMHSA Adult Drug Court Enhancement Project for enhancement of an Adult Treatment Drug Court (ADC). The goal is to reduce substance abuse and criminal activities related to substance use among judicially involved clients. The implementation approach involves the expansion of participant slots in the ADC and enhancements to address emerging substance use trends and needs of the clients in the program. The population of focus is current ADC participants and probationers adjudicated with drug charges pending admission upon availability of program slots. Pretrial detainees with primary charges of drug offenses will also be considered for the program after case adjudication or deferred plea. ADC is a judicially-supervised program that allows eligible defendants the opportunity to engage in treatment while on probationary status. The primary treatment program is the Matrix Model, a curriculum proven as effective with stimulant-based addictions like methamphetamines, the current drug of choice for a majority of probationers. In 2019, ADC’s current capacity of 20 participants annually was exceeded, resulting in a 180% intake rate. The rise in intake and increased referrals to ADC equate to the need for expanding ADC slots to serve the population in most need. The project proposes to serve 20 current and 20 new participants by the end of Year 1; adding 40 new participants each year thereafter, for an unduplicated total of 200 participants served by the end of the project period (Objective 1). This enhancement project seeks to address emerging substance use trends and needs of the target population through the addition of opioid-focused treatment, addressing co-occurring disorders, and increasing access to residential treatment services. By the end of the fourth month and throughout the project, enhancements to the ADC treatment services will include the implementation of Helping Men Recover, Moral Reconation Therapy, Cognitive Behavioral Interventions programs and residential treatment services (Objective 2). ADC recognizes the need to enhance the capacity of treatment providers to address the rise of opioid use and addiction on Guam. As a proactive measure to prevent an opioid crisis, the project proposes to expand ADC services by implementing at least one substance use treatment focused on opioid use and/or co-occurring disorders (Objective 3). Guam’s ADC addresses the National Association of Drug Court Professionals 10 Key Components of Drug Courts. The project proposes that by the end of the fourth month and throughout the life of the project, ADC will procure the resources and supplies needed to ensure fidelity to the drug court model (Objective 4). The proposed project will enable additional participants to benefit from immediate access to evidence-based services, treatment planning, and increased monitoring that is responsive to their treatment needs while program enhancements will address current program gaps and assist less advantaged participants with barriers to treatment such as the need for additional support.

Horizon Behavioral Health intends to expand its current Family Treatment Drug Court in Bedford County Virginia. Our population focus are adults who have involvement with the Department of Social Services due to abuse, neglect and substance use.

The purpose of the Circuit Court of Cook County's Rehabilitation Alternative Probation/Women's Rehabilitation Alternative Probation Program (RAP/WRAP) Substance Abuse Treatment Capacity Expansion Program is to increase the number of drug court participant who successfully graduate from the program and achieve stable recovery, and affect the long-term health and safety needs of these individuals and their community. This will be accomplished by expanding the existing drug courts current substance use disorder (SUD) treatment services, particularly residential treatment, medication-assisted treatment (MAT), and long-term recovery housing. The SUD expansion will be implemented in the Illinois Circuit Court of Cook County's RAP/WRAP Felony Drug Court operating the Criminal Division. This Division services the residents of the city of Chicago. The populate of focus high-risk/high-need adult men and women (age 18 and older) who are arrested/charged with a new non-violent drug-related felony offense who have been diagnosed with substance use disorders and have accepted that they have a drug problem, and are willing to participate in treatment and have not been convicted of a violent crime within the past 10 years. The demographic background of the target population will likely reflect that of the current RAP/WRAP Drug Court Program. Among all participants admitted between 2017 and 2019, over 77% were African American and 6% were Hispanic/Latino. Seventy-one percent were male and 29% were female. Seventy-five percent of participants were 40 years of age or older at admission. Ninety-one percent of the population had less than a high school education, 68% were unemployed, and 63% reported unstable housing in the past 30 days. Heroin remains the most common primary drug of choice (78%), followed by cocaine (17%) among participants admitted to the program and 72% of those admitted indicated that they were poly-drug users. All eligible drug court participants have, on average, three prior felony convictions, thus making them eligible for a sentence to the penitentiary. The goal of the program is expanded substance use disorder (SUD) treatment service capacity in the existing RAP/WRAP Drug Court, particularly residential, medication-assisted treatment (MAT) and recovery housing to address the needs of opiate-addicted participants. The proposed expansion will serve 305 unduplicated drug court participants during the five-year project period (45 in Year 1 and 65 per year in Years 2-5).

By adding a dedicated therapist, case manager, peer support specialist, and vocational specialist to create an Assertive Community Treatment (ACT) team to treat eligible high risk/high needs participants, the McCracken County Specialty Court (MCSC) will better serve the unique treatment needs of participants and apply effective and evidence based treatment and services to increase successful outcomes and avoid recidivism and incarceration. The Kentucky (KY) Administrative Office of the Courts (AOC), on behalf of MCSC, is submitting this proposal in response to the Substance Abuse and Mental Health Services Administration (SAMHSA) Funding Opportunity Announcement (FOA TI-20-003) Grants to Expand Substance Abuse Treatment Capacity in Adult Treatment Drug Courts and Adult Tribal Healing to Wellness Courts (SAMHSA Treatment Drug Courts). McCracken County is a jurisdiction in far western KY where the substance use disorder (SUD) and co-occurring disorders (COD) needs are great and where vocational and educational opportunities are minimal. Four Rivers Behavioral Health (FRBH), a community mental health center for the region, serves MCSC and is a provider in this project. Morehead State University will provide the outcome and process measurement, including GPRA/SPARS data collection. West Kentucky Workforce Board (WKWB) will provide vocational services. This project will create a more comprehensive rehabilitative opportunity by enhancing the quantity, quality and intensity of targeted treatment for MCSC participants with SUD and for those with COD. Thorough clinical assessments, ongoing treatment planning, and weekly ACT meetings will identify needs and provide rapid access to targeted treatment, recovery supports, and vocational/educational services. Wraparound services will provide access to services that include but are not limited to: recovery housing; transportation; medical services including Hepatitis B/C and HIV/AIDS screening and treatment; medication assisted treatment (MAT); child daycare; life skills training; education and job training; and a continuum of SUD and MH services and recovery supports. Reasons for selecting this site include: 1) the current opioid and methamphetamine epidemics have ravaged the area, and there are limited resources to meet the comprehensive needs caused by this problem; 2) Specialty Court funding is limited, and with current levels of state funding, many individuals cannot receive services they need. Utilizing an evidence-based modification of the ACT model, this grant will address participant needs and improve chances for long term recovery. Goals for the project are 1) to enhance and strengthen treatment services for 52 persons annually (260 over the 5 years of the project which will increase current numbers by 10.63% to develop an effective, comprehensive system of care to help individuals with SUD involved with the criminal justice system become higher functioning; 2) to increase abstinence and decrease recidivism among program participants; and 3) to ensure that project implementation and evaluation adhere to objectives and facilitate continuous quality improvement (CQI).

Judiciary Courts of the State of Michigan proposes to expand the treatment & recovery support services provided by the Adult Treatment Court (ATC) Program to non-violent, men & women, age 17 years & older, currently involved with the 9th Circuit Court, diagnosed substance use disorder (SUD), identified as high-risk/need, & residing in (or employed within) Kalamazoo County. Eligible participants enter the ATC on one of two tracks. Diversion participants (track 1) voluntarily enter the ATC after pleading guilty to 1 or more felony offenses. Track 2 participants are sentenced to participate in the ATC after being convicted of one or more felony offenses or a probation/parole violation. ATC provides participants with access to clinical, evidenced-based practices such as: outpatient therapy, IOP, trauma-informed therapy (i.e., Seeking Safety and Helping Men Recover), gender-specific group therapy, Moral Reconation Therapy (MRT), Dialectical Behavioral Therapy (DBT), Cognitive Behavioral Therapy (CBT), Eye Movement Desensitization Reprocessing (EMDR), & Medication Assisted Treatment (MAT). Through this expansion project, participants will have access to a comprehensive, coordinated, & structured aftercare model. Specific elements of this model include: continued support from ATC case manager, referrals to appropriate evidenced-based treatment services noted above, assistance with vocational, educational, & employment goals, housing resources, additional pro-social activities & transportation assistance. A life skills coordinator will provide a life skills curriculum and provide support to participants with referrals to services. Lastly, a community liaison will expand drug/alcohol screens to evening hours with home visits and provide transportation assistance. The proposed project has four goals: 1) Expand & enhance evidence-based treatment services available to the population of focus; 2) Enhance the ability of all participants to improve their quality of life by providing them with the opportunity to develop to their fullest potential the four dimensions of recovery identified by SAMHSA in its working definition of recovery: health & wellness, a sense of purpose (e.g. having a job), housing stability, & interconnectedness (community); 3) Reduce recidivism among project participants by decreasing alcohol/drug use & thus increase the safety of the community; & 4) Evaluate the project. The proposed project will serve 75 individuals annually & thus, a total of 375 adults will be served during the 5-year project period.

The Brooklyn Misdemeanor Veterans Treatment Court (BMVTC) in collaboration with EAC Network’s Treatment Alternatives for Safer Communities (TASC) clinical case management program proposes to enhance services for 200 adult men and women veterans (Yr1: 40, Yr2:40 Yr3:40 Yr4: 40 Yr5:40) who have been charged with misdemeanor offenses in Kings County who are eligible for local jail diversion. An overwhelming large number of the veteran/military population suffer from posttraumatic stress disorder (PTSD) and substance use disorders (SUD). This comorbidity presents a serious challenge to many clinicians and there is growing evidence that addressing both conditions concurrently is the most effective approach. The Brooklyn Veteran’s Resource Engagement Project will seek to: (1) enhance the current screening and assessment process to include an initial screening for trauma to assist in expediting the referrals to existing Veteran Administration services (2) for Veterans who have been other than honorably discharged and are not eligible for services thru the Veteran’s Administration the engagement project would hire staff to conduct a structured clinical interview, develop a comprehensive treatment plan and conduct evidence based Seeking Safety sessions focusing on psychoeducation and coping skills (3) enhance the integration of Peer Mentors to help support client reintegration and recovery by providing specific training to the Peer Mentors and Case Management staff and (4) incorporate vocational services.

The Sebastian County Veterans Drug Treatment Court Expansion Project aims to increase the capacity of this court to serve justice-involved Veterans. Currently, the Sebastian County VTC is unable to serve Veterans without access to Department of Veterans Affairs (VA) healthcare benefits. Local experts estimate that approximately 50% of the justice-involved Veterans in the catchment area lack such VA benefits. To address this gap, we intend to use grant funds to provide evidence-based interventions (EBIs) for substance use disorder (SUDs) and co-morbid conditions prevalent among justice-involved Veterans. We anticipate this will more than double the current capacity of the VTC by the end of the five-year grant. We project serving 125 Veterans with grant funds as follows: Year-1: 15 Veterans, Year-2: 20 Veterans, Year-3: 25 Veterans, Year-4: 30 Veterans, and Year-5: 35 Veterans. The VTC is currently serving 28 Veterans. Recognizing the complex needs of justice-involved Veterans and the relative lack of available behavioral health services in the catchment area, we are proposing a diverse array of services to meet individual recovery goals, including: medication assisted treatment, motivational enhancement therapy, CBT-SUD, residential SUD treatment, intensive outpatient treatment for SUD, 3 EBIs for PTSD, EBIs for other co-morbid mental health disorders, Moral Reconation Therapy for criminogenic risk, tobacco/nicotine cessation, psychoeducation, transportation, and case management. We have explicated performance objectives for all interventions within the narrative. Expected participant outcomes include reductions in criminal behavior, substance use and emotional distress/psychiatric symptoms as well as increases in quality of life, relationship satisfaction, income, satisfaction with living situation, and access to mainstream benefits to support on-going self-sufficiency.

The Rhode Island Veterans Treatment Court (RIVTC) proposes a five-year project aimed at expanding Rhode Island’s statewide pre-plea, pre-sentence treatment court program to meet the growing needs of justice-involved veterans presenting with substance use, mental health disorder, or co-occurring disorders. RIVTC serves both veterans with high criminogenic risk/high clinical need and those with low criminogenic risk/high clinical need. Successful completion of the RIVTC program results in jail diversion, reduction of charges, or alternate sentencing, including dismissal of all charges related to the offense. The RIVTC aims to expand our ability to meet the needs of veterans by providing access to a more comprehensive range of evidence-based practices that are appropriate and consistent with the Ten Key Components of Veterans Courts as well as with the Adult Drug Court Best Practice Standards. The RIVTC intends to serve 115 unduplicated clients annually with a total of 575 unduplicated clients served throughout the grant. Proposed services will begin within four months of contract start date. RIVTC referrals have almost tripled from 51 referrals in 2014 to 139 referrals in 2019. RIVTC is struggling to meet the growing service demand and increasing numbers of justice-involved veterans presenting with substance use, mental health, or co-occurring disorder. The RIVTC program has grown from serving a weekly docket of 25 participants to splitting the docket into two tracks and serving an average of 45 high risk/high need and low-risk/high need participants weekly. The previous caseload of 60 to 75 participants at any given time throughout the year has risen to approximately 85 to 90 participants. Using Veteran Justice Outreach referrals, the RIVTC will increase access to benefits through the Veterans Administration. Ensuring all veterans using Medication-Assisted Treatment are linked to a licensed clinician and medication management through a licensed prescriber will increase the potential for treatment success. By expanding evidence-based programming services to include Moral Reconation Therapy and Seeking Safety, the RIVTC will decrease recidivism while treating mental health and substance use issues for at least 275 clients. The increase in case management services, including drug testing and alcohol monitoring, will allow proper therapeutic adjustment for indications of substance use, increasing the success rate of treatment. By hiring a Recovery Support Service Specialist and expanding existing recovery service offering, the RIVTC will offer services and referrals to at least 60 veterans and their families per year.

The Northern California Co-Occurring Drug Court Program (CODC) is a comprehensive Adult Treatment Drug Court program in good standing with SAMHSA that addresses the unique needs of substance-abusing adult offenders with co-occurring mental health disorders who are involved in Tehama County's criminal justice system. The CODC population of focus is exclusively high risk, high-need adult offenders diagnosed with co-occurring substance abuse and mental health disorders. These adults have a substance abuse disorder as their primary condition, as well as a severe and persistent mental health diagnosis. This funding opportunity expands the substance abuse treatment capacity be expanding outreach to referral sources targeting potential participants who are engaged in law enforcement supervision, and by providing services that specifically address the needs of CODC participants and their family members who suffer from Adverse Childhood experiences (ACE's) related to parental substance use and co-occurring mental health disorders. CODC''s primary goals are to reduce substance use//dependence and subsequent recidivism among adult offenders with co-occurring disorders. These goals are accomplished through a) evidenced based, immediate, continuous, and intensive judicially-supervised treatment, b)regular random computerized drug testing, c)inter-agency supervision and monitoring, d) graduated sanctions, incentives and restitution, and e) mental health services for co-occurring disorders. Service Gap 1: Adult offenders who commit state prison eligible offenses within the community are underrepresented in the CODE program. In 2011 California's 'Realignment' law Assembly Bill 109 (AB 109) created community supervision under which adult offenders are monitored by county probation departments instead of state parole. Many of these adult offenders who commit state prison eligible offenses fit the CODC population profile as substance abusing adult offenders with co-occurring mental health disorders, however they have been underrepresented in the CODC program. Under this proposal, the service gap will be addressed through the implementation of the intentional strategies designed to screen all potential participants who are engaged in law enforcement supervision for CODC program suitability. Service Gap 2 : Adult offenders with addiction are frequently in families that deal with multiple ACE's including substance abuse, neglect, family violence and emotional , physical, and sexual abuse. Commonly there is parental separation or divorce and often one or both parents are dealing with addiction, mental health illness, and incarceration. Their children are among those at highest risk for future physical and ta health problems. Treatment that focuses on these children offers a solution to the inter generational cycle of substance use and related consequences by helping adult offenders reduce their substance use and be an engaged contributor to improving their children's health and safety Under this proposal, the service gap will be addressed by the implementation of specific ACEs evidenced based strategies. CODC's design embodies the Adult Drug Court Best Practice Standards and Ten Key Components. The measurable outcomes include: a) abstinence from substance use; b) program graduation rates; c)employment rates; d) housing stability; 3) individual and family functioning and well-being; 4) social contentedness; and g) decreased number of re-arrests post graduation. These positive changes in individuals and their families will lead to prolonged recover, decreased risky behaviors, decreased criminal justice involvement, and ultimately significant decreases in recidivism rates.

The City of Phoenix Veterans Court in partnership with its primary partners La Frontera Arizona EMPACT-SPC and University of Arkansas, will reduce incarceration/recidivism for justice involved veterans by expanding and enhancing the access to evidence-based substance use disorder (SUD) treatment services for justice involved veterans who are otherwise unable to access services through the Veterans Administration or other mainstream benefits. By working together, this multi-agency project seeks to level the playing field for veterans in "Veterans Court" and greatly increase the likelihood of every veteran's success regardless of the veteran's ability to pay for treatment. This program, the City of Phoenix and EMPACT Veterans court Service Enhanced Expansion Project, requests $2,000,000 to increase access to treatment for justice involved veterans to address the primary issue of substance use disorder along with co-occurring disorders, as well as health, medical, and other basic needs. Between 10-25% of veterans in Veterans Court experience gaps in treatment either because they are ineligible for treatment from the VA or they cannot afford treatment. Oftentimes these costs can be crippling to the veteran's recovery and success in the program. Some veterans opt to leave Veterans Court because they are unable to pay for treatment. This program will address this gap by providing Medication Assisted Treatment, Intensive Outpatient Treatment, Intensive Case Management, Forensic-based Cognitive Behavioral Therapy, Peer Support and Residential Treatment and/or Recovery Housing to those veterans in Veterans Court without access to treatment otherwise. Over the five-year project period, the Phoenix Veterans Court Project will provide: - 400 participants with Peer Support "Navigator" Services (Year 1-60, Year 2-85, Year 3-85, Year 4-85, Year 5-85) - 280 participants with Case Management Support (Year 1-40, Year 2-60, Year 3-60, Year 4-60, Year 5-60) - 280 participants with EBP treatment modalities (Year 1-40, Year 2-60, Year 3-60, Year 4-60, Year 5-60) While each participant's services will be tailored to their specific needs, the following are projected annual treatment objectives: - 10 participants will receive Medication Assisted Treatment (MAT) Services - 25 participants will receive Substance Use Outpatient Treatment Services - 15 participants will receive Forensic-based CBT Services - 5 participants will receive Intensive Case Management (for those with significant mental health/PTSD/COD needs) - 5 participants will receive slots in residential treatment and/or recovery housing.

Abstract-Hamilton County Drug Court Expanded Treatment Grant The proposed project, Hamilton County Drug Court Expanded Treatment Grant, is a collaboration between the Hamilton County Mental Health and Recovery Services Board (MHRSB), the Hamilton County Court of Common Pleas Drug Court (HCDC), and Talbert House. MHRSB has acted on behalf of HCDC since 1995 to provide a continuum of treatment for drug court clients through Talbert House's Alcohol & Drug Addiction Partnership Treatment (ADAPT) program. This project requests funding to expand substance use disorder treatment services for residential drug court clients. Significant gaps impede ADAPT's ability to provide comprehensive treatment services that facilitate recovery. These gaps include lack of funding for medication-assisted treatment (MAT) for uninsured clients, deficient screening data, limited treatment services for clients with co-occurring disorders (CODs), and intermittent access to employment services. To address these issues the program will serve 270 residential treatment clients over five years and will achieve the following goals/objectives: Goal 1: Expand data collection at screening to improve assessment, treatment planning, and outcome monitoring. Obj. 1.1: Develop data-sharing protocols between HCDC and Talbert House. Obj. 1.2: Collect drug court docket and client data per Ohio Supreme Court requirements. Obj. 1.3: Identify and collect joint criminal and clinical performance measures. Obj. 1.4: Screen 1,250 clients (250/year) for CODs and Adverse Childhood Experiences (ACEs). Obj. 1.5: Conduct 5,000 urinary drug tests - 2,500 point-of-care +2,500 confirmation (1,000/year). Goal 2: Increase access to integrated COD treatment to reduce substance use, improve psychological functioning, and reduce recidivism. Obj. 2.1: Revise residential treatment protocols for the delivery of integrated COD services. Obj. 2.2: Provide COD training to residential treatment staff. Obj. 2.4: Provide integrated COD treatment to 270 residential clients (40 in yr. 1, 50 in yr. 2, 60/year in years. 3-5), Goal3: Increase access to MAT to reduce substance use and recidivism. Obj. 3.1: Provide MAT to 25 uninsured clients (5/year in yrs. 1-5). Goal 4: Provide employment services to increase employment rates. Obj. 4.1: Provide employment services to 270 residential clients (40 in yr. 1, 50 in yr. 2, 60/year in yrs. 3-5) Key interventions include standardized screening for CODs and ACEs, MAT, Integrated Treatment for CODs, and Employment Services. The population of focus is F4/F5, non-violent, felony drug offenders in need of residential treatment. The majority are male (54%), White (87%), and between 20-39 years (78%). Primary diagnoses include opioid (78%), cannabis (26%), and cocaine (25%), 49% have a COD, mainly post-traumatic stress and adjustment disorders. The project will address critical treatment gaps, expand needed services to HCDC clients, and improve clinical and criminal justice outcomes.

Co-occurring substance use and mental health disorders are common among drug court participants and a great need exists for enhanced care coordination between the court and treatment systems. The Massachusetts Trial Court, in collaboration with the evaluator (University of Massachusetts), the provider (BHN), the state substance use and mental health authorities, and other local partners, propose to enhance the Springfield Drug Court (SDC) by embedding an evidence-based co-occurring disorders wrap-around treatment model called Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Criminal Justice (MISSION-CJ). This model which has been cited in SAMHSA’s National Registry of Evidence-based Programs and Practices (NREPP) and used in a number of other SAMHSA grants, systematically integrates case management, co-occurring disorders treatment, peer support, vocational supports, and trauma informed care into a single, coordinated service delivery approach. The goals of the proposed project are to reduce criminal recidivism, improve mental health and substance use disorder outcomes, and increase linkage and engagement to wraparound services and supports (e.g. MAT) among drug court participants by offering MISSION-CJ to facilitate care between the Springfield Drug Court and community providers. In this proposed project, which we will call Maintaining Independence and Sobriety Through Systems Integration, Outreach, and Networking-Springfield, we intend to serve 40 clients a year, and a total of 200 clients over 5 years, in the SDC who have a co-occurring mental health and substance use disorders. Clients will receive one year of MISSION-CJ services delivered by a case manager and peer team, which also will link program participants to other needed community based services, including medical benefits and medication-assisted treatments. The University of Massachusetts Medical School, developer of the MISSION-CJ model, will provide staff training, project coordination, and perform the evaluation. The Executive Office of the Massachusetts Trial Court will be the grant recipient, and the Springfield Drug Court will be the site embedding the services within the court. BHN, an experienced provider, will deliver these new MISSION-CJ services within the court. Representatives from the Executive Office of the Massachusetts Trial Court, Department of Mental Health, the Department of Public Health, Probation, and MassHealth, our state Medicaid Authority, will serve in a leadership capacity on this grant, and assist with sustainability planning. This project received input during the planning phase from district court judges, state agencies, community treatment providers, and is consistent with the 10 key components of the drug court model. This project is innovative in that it will embed peer and case management teams that will use an evidence-based, wrap-around model previously developed with SAMHSA funding to specifically improve coordination between the court, clients, and community-based treatment providers.