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Mental & Behavioral Health Blueprint for Staten Island Children & Young Adults2024

Contents 1. Acknowledgments 2. Executive Summary 3. Statement of Need a. Demographics b. What is the Data Showing? c. The Signicance of Children’s Mental and Behavioral Well-Being d. Purpose of Our Blueprint e. Process of Creating Our Blueprint f. Solution Timeline g. Priority Recommendations h. North Star Goals and Measures 4. Collaborative Framework a. Vision b. Values c. Challenges Identied Across Systems d. Strategic Response to Organizational Challenges5. Blueprint Workgroups & Priority Recommendations a. Prevention Workgroup Recommendations b. Treatment and Crisis Workgroup Recommendations c. Community and Faith-Based Workgroup Recommendations d. Workplace, Policy and Sustainability Workgroup Recommendations e. Role of Data Technology and Data Workgroup Recommendations 6. Blueprint Important Next Steps 7. Blueprint Task Force & Partners8. Glossary9. Appendix

This Mental & Behavioral Health Blueprint for Staten Island Children is a collaborative effort led by: TheOfceoftheStatenIslandBorough President Vito Fossella JohnsHopkinsUniversity,BloombergSchoolofPublicHealthMultipleStatenIslandfocusedproviders, communityagencies,andpartnersSupported by City, State, and Federal Government partners Acknowledgements

ExecutiveSummaryIn response to the urgent mental and behavioral health crisis, the Borough President tasked his health team to work with local providers and community members to develop a comprehensive blueprint for children and young adults, pre-school through 24 years of age. The purpose of the blueprint is to support legislators, community advocates, schools, providers, and leaders, with a collaborative framework to better understand and enhance the provision of mental health services, support systems, and resources for Staten Island children and youth. The blueprint was formed through extensive community participation with educators, school leadership, treatment providers, clergy, parents, and youth. Through these meetings gaps, barriers, and priorities were identied. A North Star Goal of zero suicides was selected to guide the work. The group explored national models of integrated behavioral health. Recommendations include strengthening our existing mental & behavioral health workforce; strengthening the capacity of schools to provide universal prevention and early intervention; scaling and sustaining effective evidence-based treatment programs as well as introducing new and innovative models; and improving linkages across schools, providers and community members by using a central technology platform to integrate and enable data-driven decision making. The blueprint supports policymakers to create a paradigm shift from traditional siloed funding models to the provision of care and services for all Staten Island children regardless of their insurance status. Ultimately, it is a design for creating a resilient and supportive community that prioritizes the mental well-being of its young population.

STATEMENT OF NEED

StatenIslandDemographics

WhatistheDataShowing?Using 2019 as a reference year, data from Staten Island’s 2 largest youth serving behavioral health agencies (Richmond University Medical Center and The Jewish Board) reported: 30% increase in behavioral health acuity and suicidality starting mid/late 2020 and remaining consistent since Marked increase in suicidal ideation with 80-85% children in all treatment settings (in-patient, out- patient, mobile crisis, emergency department) reporting eeting ideation over past 12 months Increase in frequency and number of clients reporting homicidal ideations Increase in frequency, lethality and number of clients reporting suicidal attempts Increase in multiple suicidal attempts as well as completed suicides Emerging new trends (mid 2021-fall 2022) - multiple young Hispanic girls 13-17yrs attempting suicide over a short period, psychosis in young black males At the population level, surveillance data indicate: Almost 40% of Staten Island youth reporting sadness and depression (2021 YRBS and 2022 YDS) Progressive increase in bullying, anxiety, depression, and suicidality rates on YRBS and YDS over 11 years Increase in opioid overdoses (Epi data, 2022) High rates of binge drinking (2021 YRBS & 2022 YDS) Detailed data reports on slides in appendix

TheSignicanceofChildren’sMental&BehavioralWell-BeingMental well-being is central to ensuring a child’s best start and refers to a state where a child realizes their own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make contributions to their community. Addressing students’ behavioral health leads to better academic and life outcomes. As a result, students are happier, healthier and more likely to succeed. Behavioral health disorders can interfere with a child’s health outcome and cause problems at home, in schools, and in forming friendships & relationships. If not diagnosed early and addressed, can lead to severe illness and disability later in life. Addressing well-being early in school years can lead to more resilient youth with better coping skills.

The Purpose of Our BlueprintTo present legislators, community advocates, schools, providers, and leaders with a shared vision that allows us to implement a stream-lined measurement-informed integrated Behavioral Health infrastructure for children and ado-lescents to thrive and have a path to success. To organize and prioritize effective communication and seamless linkages between schools, providers, community-based organizations and families along the continuum of prevention, treatment, and crisis services. To elevate and ensure we are recognizing and helping children earlier, improving their lives and reducing the need for clinical and crisis services downstream. To create a framework for continual data-based monitoring, evaluation, collective learning, and performance improvement of our Behavioral Health system. AsharedvisiontoworktogetherCreationofcommunicationandcoordinationlinkagesAsharedfocusonpreventionand early interventionAframeworkforcontinual data-basedmonitoring

This blueprint was created over a period of 18 months after a series of meetings and focus group discussions with treatment providers, educators, local school district leadership, academia, tech innovators, faith based & community-based organizations, nonprots, parents, youth as well as city, state, federal leaders and legislators. The work was rened by 5 work groups: Prevention, Treatment & Crisis; , Community & Faith-based; Data & Linkages; Workforce, Policy & Sustainability. The full group/task force convened twice to create our vision, values, and to identify our north star constellation of goals and measures. Process

Solution TimelineBorough President identies Children’s Mental Health as a priorityAssemble Visioning Team and connect with Johns HopkinsListening Sessions with providers, hospitals, schools, and other States leading Comprehen-sive MH ServicesVisioning Sessions 1 Convening Partners to review ndings and prioritize issues – Dec. 2023Vision Session 2 Convening partners to identify what’s missing, how they align with blueprint funding and sustainabilityBlueprint draft for nal review Apr. - May 2024Focus Groups and listening sessions with parents, youth, and youth-serving agencies – Dec. 2023 _ Feb. 2024Creation of Implementation Task Force – May 2024Dec. 2022Mar. 2023 Apr.-Nov. 2023Dec. 2023Jan. 2024Mar. 2024 Apr. 2024May 2024

TenPriorityRecommendations Prioritize Prevention by implementing screening and early identication in all settings Improve Linkages between schools, treatment providers and community-based supports Strengthen School Capacity to provide universal prevention and early intervention services to all children Design a mental health task-shifting model utilizing peers with lived experience and trained lay people, such as Community Health Workers, Clergy, and others to reduce barriers Scale and Sustain effective evidence-based treatment programs and implement new and promising models to treat suicidality and Opioid Use Disorders Adopt Web Tools & Data Infrastructure enabling Data Driven Decision Making (DDDM) Reduce Stigma by prioritizing behavioral health literacy and address needs of at-risk and vulnerable populations Strengthen workforce and behavioral health infrastructure Work with policy makers to expand funding for school-based behavioral health services and legislate for more comprehensive BH services Work with policy makers and leaders to move away from siloed services, regulations and funding 1.2.3.4.5.6.7.8.9.10.

North Star Goals and MeasuresNORTH STAR: ZERO SUICIDE DEATHS AGES 6-24 YEARS Reduce suicidal ideation Reduce suicidal attempts Reduce emergency department visits and hospitalizations for suicidality Improve transition to care post-hospitalization Increase self-management, connectedness, and resiliency Decrease anxiety, bullying, depression Decrease substance misuse & overdoses

COLLABORATIVEFRAMEWORK

Vision StatementValues • Cultural humility and linguistic competence • Community-based • Youth-guided • Family-driven • Equitable and inclusive • Focused outreach and strategies to address at-risk and vulnerable populations • Evidence-informed/evidence-based • Data-driven • School-centric Our vision is to create a full array of seamless-ly coordinated, integrated support structures and evidence-informed practices to ensure the mental and behavioral health and well-being of all young people and their families, to best maximize their social, emotional, behavioral, and academic functioning.

ChallengesIdentiedAcrossSystemsPOLICYSchool-based student BH data difcult to access; not always tracked or reviewed; condentiality challenges; lack of meaningful mental health dataBH data should include comprehensive risk factor domainsUniversal BH screening needed Current policies do not hold Managed Care Organizations accountablePolicies don’t allow for reimbursement of BH servicesAGENCIES/BOROUGHSI based behavioral health partners have limited way to support schoolsLack of support from outside agen-cies and funding sources; geographic challengeLack of the resources to meet the special needs populationNeuropsychic needs; waitlists for proper evalsUnmet health-related social needsWorkforce challenges including retentionLack of diversity of clinical providersSITES/SCHOOLS/PROVIDERLack of formal process for screening and linkagesLack of evidence-based screening; identifying students with behavioral health challengesNo guidence on SEL programsChallenges with connecting students to outside providersReactive mode vs. a more proactive approachStaff burnoutLack of school support servcices and mental health providersINDIVIDUALS/TEAMSPoor understanding of complex be-havioral health systemInability to identify students with behavioral health challengesStaff lack of knowledge of system, resources and toolsLack of condence in respondingLack of BH literacy/training for stu-dents, teachers and parents

StrategicResponsetoOrganizationalChallenges

BLUEPRINT WORKGROUPS & PRIORITY RECOMMENDATIONSFor full set of workgroup recommendations, please scan QR code at the end of the document

Blueprint Important Next Steps1. Create an Implementation Team to move the work forward :Create an advisory and evaluation sub-committee Develop unied buy-in from all partners Partners on SI need to agree to operating principles and Governance Share information across providers and child-serving systems Share grant applications Seek “braided” funding opportunities Fund an infrastructure to support blueprint effort2. Develop and strengthen interagency local, City and State support 3. Work towards alignment Each agency partnered in the blueprint begins to work towards alignment4. Begin collecting data to track blueprint North Star Goals and measures5. Create a Staten Island School System Improve-ment and Evaluation ofce (see appendix)

Meet Our Taskforce & Blueprint PartnersOur Partners

GlossaryMH- Mental Health BH – Behavioral Health SUD – Substance Use Disorder QPR – Question, Persuade, Refer CDAP - Congregational Depression Awareness ProgramCARE - Cultivating Awareness and Resiliency in Education PTE - Pathways to EmpowerProject TRIUMPH - TReatIng YoUr Mental Health Through Prayer and HealingProject ENGAGE - Engaging Communities to Gain Mental Wellbeing and EquityCFTSS - Community and Family Treatment and Support ServicesYOUTH ACT - Assertive Community Treatment CCBHC - Comprehensive Community Behavioral Health Clinic HBCI – Home-Based Crisis InterventionTHI Model – The Hope Institute Model CAMS – Collaborative Assessment and Management of Suicide DBT – Dialectical Behavior Therapy CBT – Cognitive Behavioral Therapy ABFT – Attachment-Based Family Therapy AWARE – Advancing Wellness and Resiliency in Schools SBIRT – Screening Brief Intervention, Referral to Treatment Triple P – Positive Parenting Program MTSS – Multi-Tier Systems Support SEL – Social Emotional Learning PPP – Positive Pathway to Parenting tMHFA – teen Mental Health First AideSBHC – School-Based Health Center SBMHC – School-Based Mental Health Clinic

AppendixOurStrategicVisioning&ImplementationTeamsOurBlueprintReviewTeamResearchKeyResourcesEvidenceBasedTherapies&StrategiesEmergingPracticesLessonsLearnedfromOtherDistrictsModelsforSISchoolSystemImprovementandEvaluationOfceSI Behavioral Health DataScan for full set of workgroup recommendations