The health of families is one of Florida's most important priorities. The foundation of a family begins with the health of the parents. The Florida Department of Health (Department) recognizes that mental health is a key component to overall health. To address the need for behavioral and mental health services in Florida, the Maternal and Child Health (MCH) Section applied for, and was awarded, a five-year grant from the Health Resources and Services Administration: The Development of a Sustainable Screening and Treatment Model to Improve Maternal Mental Health Outcomes in Florida. During the reporting year, Florida implemented year three of the grant.

The goal of this grant, known as BH IMPACT: Improving Maternal and Pediatric Access to Care and Treatment for Behavioral Health, is to increase routine screening and referral by prenatal care providers. The project team developed and implemented a perinatal screening and treatment model to directly train health care providers in prenatal health care practices and birthing hospitals. Community mental health providers will be trained in evidence-based management of perinatal mental health disorders and have access to a professional perinatal psychiatrist for consultation to increase the use of evidence-based therapeutic interventions for perinatal depression. Mental health and substance abuse referral networks have grown through provider outreach, development of community resource guides, and expansion of the Moving Beyond Depression program in statewide home visiting programs. BH IMPACT’s ongoing Florida’s Moms Mental Health Resource Directory has been updated. The Directory has an enhanced search capability for users and improved ability to capture detailed analytics for reporting purposes. Additional Service types were added to the listings, including housing authorities and supporting entities, employment resources, food and diaper banks, and more to address the social needs of the patient’s providers are serving. The Directory also has a member login interface for returning users to save search history.

The Department had a Maternal and Neonatal Opioid Prevention Coordinator who continued to work with state teams and counties to learn challenges in addressing Opioid Use Disorder among pregnant women. Outcomes continued to provide a foundation for our collaborative work and have been integrated into the State Health Improvement Plan (SHIP). One of the SHIP objectives centers on increasing the number of pregnant women who receive Screening, Brief Intervention, and Referral to Treatment. The Department is working closely with the Agency for Health Care Administration (AHCA) and other partners to educate health care providers and promote comprehensive screening with ongoing support from partners. The Department also co-led a workgroup of agency leaders in partnership with the Florida Hospital Association (FHA) that is focused on increasing access to medication assisted treatment for pregnant women. This workgroup includes partners from the FHA, Florida Perinatal Quality Collaborative, and AHCA. Another Department led workgroup focuses on expanding access to free naloxone kits for anyone at risk of overdose prior to hospital discharge. This effort, in partnership with the Florida Society of Health System Pharmacists, the FHA, and AHCA has led to an expansion of the Department of Children and Families (DCF) Overdose Prevention Program, which makes free kits available for hospitals to dispense.

The Department’s Violence and Injury Prevention (VIP) Section plays a key role in the development of the state’s suicide prevention plan; the Governor’s Challenge action plan to address suicide among services members, veterans, and their families; and the SHIP’s Mental Well Being and Substance Abuse Prevention and the Injury, Safety, and Violence Priority Area Workgroup goals and objectives. Currently, there are several behavioral health initiatives that are supported through the State Health Improvement Plan’s Mental Well-being and Substance Abuse Prevention priority area. Partners are working to reduce the impact of mental, emotional, and behavioral health disorders among adults and youth. There are also efforts to reduce substance use disorders and drug overdose deaths and goals to reduce suicide behaviors and death. Under these goals, products have been developed to help raise awareness such as a youth suicide prevention toolkit, public service announcements reaching at-risk populations such as veterans, and data briefs focused on increasing public knowledge of suicide among youth and aging adults.

VIP works closely with DCF, home to the Statewide Office of Suicide Prevention (SOSP) and the state’s lead designated agency for Substance Abuse Mental Health Services Administration funding. DCF works with the Florida Association of Managing Entities (FAME), a system-wide behavioral health network. Managing Entities (MEs) contract regionally with providers on behalf of DCF. The MEs do not provide direct services; rather, ME’s contract with local, direct service providers, tailoring to the specific behavioral health needs in communities. DCF and FAME coordinate efforts with Florida Suicide Prevention Coalition, the nonprofit organization representing local suicide prevention coalitions throughout the state. The Florida Suicide Prevention Coalition is responsible for the annual statewide suicide prevention conference, held in the Spring.  In addition to increasing the state’s ability to collect relevant data on behavioral health indicators, partners are also involved in suicide prevention and interventions with the youth population under the Florida Suicide Prevention Interagency Action Plan (Action Plan). Under the Action Plan, school mental health professionals are offered training in the appropriate application of suicide risk screening tools such as the Colombia Suicide Severity Rating Scale (C-SSRS) assessment tool. School staff are offered training in Youth Mental Health First Aid. Finally, mock suicide drills are being implemented in the state’s juvenile detention centers and juvenile residential programs.

CMS continued implementation and facilitation to increase system integration through collaboration and engagement across medical and behavioral health organization, academic institutions, and families. The Behavioral Health Hubs (BH-Hubs) promoted integration of the BH and physical health systems by connecting pediatric providers from more than nine disciplines to consultation, care coordination and trainings on common and uncommon BH conditions, screening and assessment tools, treatment modalities, and family support techniques. Analysis by third party evaluation team indicated that providers engaged with a BH-Hub self-reported feeling more skilled and trained than in the past year. BH-Hubs also facilitated over 1000 services referrals connecting families and primary care providers to community-based services.

The Collaboratives’ sixth BH-Hub was the first to be established with a health system partner. The Clinical Director also serves as the Co-chair for Florida's State Health Improvement Plan Mental Health Priority Area Workgroup. This leadership and CMS's participation in multiple priority area workgroups has facilitated the new partnerships with Florida Behavioral Health Association (FBHA) and Medicaid Managed Medical Assistance (MMA) Plans. Partnership with the FBHA has led to the creation of a track and townhall at FBHA's annual conference on behavioral health integration. The State Health Improvement Plan and collaborative participation with Medicaid have also led to increased opportunity for BH-Hub's to partner with an MMA Plan to promote program sustainability.