Transformation Transfer Initiative

In a continued effort to assist states in transforming their mental health systems of care, the Substance Abuse and Mental Health Services Administration (SAMHSA) and its Center for Mental Health Services (CMHS) created the Transformation Transfer Initiative (TTI). The TTI provides, on a competitive basis, modest funding awards to States, the District of Columbia, and the Territories not currently participating in the Mental Health Transformation State Incentive Grant* (T-SIG) program.

These flexible TTI funds are to be used to identify, adapt, and strengthen transformation initiatives and activities that can be implemented in the State, either through a new initiative or expansion of one already underway and should focus on one or multiple phases of the system change. TTI recipients are chosen on the following criteria:


  • Transformation readiness, demonstrated by examples of transformation initiatives already underway using State funds, Block grant funds, other identified public or private resources.
  • Existing multi-agency collaboration on transformation initiatives.
  • Proposed initiatives rooted in systems change with the greatest quality impact.
  • Identification of other state resources and infrastructure which may leverage the TTI award funds for the proposed initiative.
  • Realistic timeframes, concrete activities, and measurable outcomes for the proposed initiative.

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.