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Opioid misuse is a national health crisis that requires sustained treatment, prevention, and recovery efforts. This study evaluates the innovative treatment approaches that two states - Kentucky and Missouri - implemented in their states using State Targeted Response to the Opioid Crisis Grant (Opioid STR) program funds from the Substance Abuse Mental Health and Services Administration (SAMHSA), as well as preliminary findings from the Opioid STR national, cross-site evaluation that is funded and managed by SAMHSA. The Kentucky approach discusses the Emergency Department (ED) bridge model, which links patients discharged from EDs to appropriate professional treatment and recovery services. Missouri implemented the Medication First (MedFirst) model, an evidence-based treatment for individuals with opioid use disorder (OUD). These states highlight novel approaches likely being implemented throughout the country to combat the opioid epidemic. Findings from the case studies and supported by the national evaluation indicate that key factors to successful program implementation - supportive state policies, partnerships and collaborations, and sustainability - facilitated the implementation of planned interventions. The novel approaches discussed combined with care across the continuum (prevention, treatment and recovery) and continued federal support is likely to have an impact on reducing opioid misuse across the U.S.

As part of Preventing Suicide: Kentucky's Plan, a gatekeeper training was implemented. The implementation of this brief educational intervention and changes in participants' suicide prevention attitudes were examined. Data were collected from 3,958 people in 213 sessions from May 2004 to August 2006. Participants reported high levels of satisfaction with the trainings. Immediately following the training, participants showed substantial increases in their perception of their suicide knowledge and their perceived efficacy to help someone who displays signs of suicide. QPR was widely disseminated across the state and shows promise to change immediate beliefs and feelings of efficacy.

The inverse relationship between economic status and mental illness is well established. Less is known, however, about the nature of this relationship. A comparison of poor suburban and rural youth receiving services for their emotional and behavioral problems revealed more similarities than differences. Family income increased during the first year of service for a small percentage of families. A small but significant relationship was found between increased income and caregiver strain as well as child outcomes. For families who are poor and have a child with a disability, highly individualized services and support that reduce caregiver strain are necessary to improve child outcomes.

One state's efforts to assess school readiness to implement a comprehensive mental health innovation are described. To determine the likelihood of achieving success with positive behavioral supports (PBS), a process to identify school buildings ready for planned organizational change was designed and implemented within a large-scale system of care initiative in southeastern Kentucky. The salient features of the innovation are discussed, the process used to design and implement the approach is delineated, and limitations and implications of this method are considered. This multi-systemic intervention can serve as an example of the practice of organizational school psychology.

We present selected initial results from a study investigating the effects of school restructuring and reform activities on outcomes for students who are identified as having serious emotional and behavioral disabilities. A review of the literature revealed six key areas of reform for investigation: accountability, governance, parent involvement, “includedness,” curriculum and instruction, and pro-social discipline. Ten schools (five elementary, two K-8, one middle, and two high schools) actively engaged in school restructuring and reform efforts were selected to participate in the study, and their status related to these six areas is presented. Characteristics of the students identified as having emotional and behavioral disabilities and served in these schools in special education settings (N = 116) are described. Results from the administration of standardized assessments revealed that these students have significant levels of emotional and behavioral disabilities that impair their functioning at school and at home. Further, school staff are providing the majority of counseling services to these students during the school day, with non-school professionals providing services to 25% of the students.

This article presents the results of a survey of all state directors of mental health programs for children on the agreement with and use of financial policies and practices which promote home- and community-based mental health care for children and adolescents and their families. Whereas only five states reported the implementation of all the financial mechanisms feasible in their states, a majority of states reported the use of mechanisms such as federal funds, state resources and incentives, and flexible funds to encourage the development of community-based care. Results also indicated that states with a local form of government or local district or board that served as the local mental health authority tended to have more of the community-based financial practices in place than did states that contracted directly with providers at the local level.