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Harm Reduction Program: Lost Dreams Awakening - Recovery Community Organization The Lost Dreams Awakening (LDA) organization manages over 10,000 visits per year, serving 2,498 unique individuals and serves a community of people in recovery from substance use disorder who envision a world where recovery is understood and promoted. Our purpose is to increase access to care and support, and the resources needed to for long-term recovery. LDA serves multiple counties and sits on the border of and Allegheny Counties. LDA Recovery Community Center (RCC) is a Westmoreland recovery-oriented sanctuary anchored in the heart of the community. Since 2014 LDA has been a recognized resource across the state due to successes such as training over 1,000 peer recovery coaches between 2015-2021. As of February 6, 2022, Westmoreland County where LDA is located is a designated High Intensity Drug Trafficking Area (HIDTA) by the White House's Office of Drug Control Policy, making it a priority area for LDA's harm reduction program.

Mile High Council on Alcoholism and Drug Abuse, dba Mile High Behavioral Healthcare (MHBHC), a nonprofit, community-based organization in Denver, Colorado, proposes to provide harm-reduction services to prevent opioid overdose and HIV, hepatitis C (HCV), and other sexually transmitted infections (STIs) in two geographic catchment areas; 1) the Denver metro area and 2) Summit County, which is a rural mountain area. MHBHC's proposed project, Bee the Vibe (Don't get stung by your addiction), will serve a total of 240 people ages 16 and older through this three-year program (80 unduplicated individual service encounters each year of the project). MHBHC estimates that 75% of those served will live in the Denver metro area and one- quarter will live in Summit County, a medically underserved area and a rural area as designated by Office of Rural Health Policy. Bee the Vibe will serve four discrete target populations: 1) members of the underserved lesbian, gay, bisexual, transgender or queer (LGBTQ+) community of any race and gender identity; 2) people experiencing homelessness (PEH); 3) women who are at risk of an opioid overdose, specifically women who are experiencing homelessness and are pregnant or postpartum; and 4) adolescents who are at elevated risk of an overdose or STI.

Behavioral Health Services (BHS) is a division of Lakeview Center Inc. (LCI) in Escambia County FL, an organization with over 68 years of demonstrated experience providing behavioral health services to local communities. LCI proposes to build capacity for overdose and infectious disease prevention services to the populations of focus in Escambia County, FL. Over the 3-year period the proposed OPUS (Overdose Prevention & Underlying Services) Program, will extend the provision of evidence-based practices (i.e., OD prevention education, Distribution of Naloxone and Fentanyl testing strips, Mobile outreach to persons at high risk for overdose, Tracking overdose outbreaks to best target outreach services and Marketing/social media awareness campaigns) and provide rapid HIV/HCV testing and brief intervention services.

Vocational Instruction Project Community Services is committed to provide prevention activities to help control the spread of infectious diseases for individuals with, or at risk of developing SUD; distribution of opioid overdose reversal medication to individuals at risk of overdose; referrals for individuals at risk for, or with, a SUD to overdose education, counseling, and health education and treatment; referrals to treatment for infectious diseases such as HIV, STI and viral hepatitis; and education on steps they must take to reduce the negative personal and public health impacts of substance use or misuse.

CrescentCare will expand and enhance harm reduction services in four Louisiana SSPs by implementing bulk purchasing, increasing syringe and naloxone distribution, using peers to increase access to underserved PWID, intensifying testing and outreach to address high HIV, HCV, and STI prevalence and lack of access to treatment, and by forming a Harm Reduction Advisory Council.

Tarzana Treatment Centers, Inc. (TTC) will expand access to harm reduction services for residents of Los Angeles County (LAC). The population of focus will be adults ages 18+, primarily racial/ethnic minority (39% Latino; 15% Black; 4% Other/Mixed Race) males (69%) with substance use disorder (SUD) exiting TTC's publicly funded inpatient detox or residential treatment programs and/or enrolled in recovery support services as well as people who use drugs (PWUD) participating in TTC's Syringe Exchange Program (SEP), the majority (81%) of whom are homeless. Harm reduction services are critically needed in LAC to combat the negative consequences associated with drug use, especially among this vulnerable population. LAC has been grappling with twin opioid and methamphetamine epidemics alongside the rest of California and the U.S. for some time now and the COVID-19 pandemic has only exacerbated the crisis leading to a 52% increase in accidental drug overdose deaths with rates increasing most for racial/ethnic minorities. The proposed project will address these identified service gaps through capacity development and service expansion. The overall purpose of TTC's Harm Reduction Program (HRP) is to improve TTC's capacity to provide harm reduction services across all service sites, programs, and organizational levels and to expand harm reduction services, including syringe exchange and related services, overdose prevention education and naloxone distribution, and referral and linkage to behavioral healthcare, primary/specialty medical care, HIV/HCV prevention services, and other support services.

The Harm Reduction Coalition of Kansas City (The Coalition) is a partnership of KC CARE Health Center (KC CARE), First Call (FC), and the University of Missouri Kansas City (UMKC) designed to increase the availability and scope of harm reduction services throughout the Kansas City (KC) metropolitan area. Through these expanded harm reduction services, The Coalition aims to decrease the number of overdoses and associated hospitalizations and deaths in the region; reduce the spread of transmissible illnesses associated with substance use disorder (SUD) and consequences thereof; and reduce harm caused by SUD in the Greater KC community. Data from the Missouri Department of Health and Human Services reveals that in the first half of 2021, overdose deaths increased 40% in KC. This data also reveals that Black residents are increasingly more likely to experience overdose deaths compared to their white counterparts. The partnership has determined a clear need for expanded harm reduction services in the region as a result of these alarming trends.

IMPACT Life proposes Project OPS (Overdose Prevention Services) to implement a community- based outreach and education program throughout Delaware to reduce overdose deaths, increase awareness of the risk of opioid use and overdose, increase knowledge of safe prescribing and safe disposal, reduce stigma related to SUD, increase harm reduction activities and increase access to behavioral health treatment, prevention, and navigation to services.

HRP will address the dearth in harm reduction services and health inequities by providing evidence-based harm reduction activities/services that include: trauma-informed substance use/mental health treatment with medication assisted treatment, peer outreach, broad distribution of over dose reversal medication and fentanyl testing strips, targeted distribution of medication lock boxes, referral/warm handoff to community health centers for screening/treatment for HIV and other infectious diseases; family-based case management; community health/resource fair; youth prevention activities; communication campaign that will include information on Florida's Good Samaritan Act, provide education and awareness, and reduce stigma. Over the life of the grant HRP is proposing to provide 7,000 service encounters, 2,000 referrals to support services, and 6,000 linkages to support services.

New York Harm Reduction Educators (NYHRE) will provide harm reduction services to people who use drugs (PWUD) in Manhattan and the Bronx, including overdose prevention; syringe services; HIV/HCV and other STI prevention, testing, and treatment; vaccination services; holistic health; mental health and substance use treatment; and connection to primary health care, housing assistance, food/nutrition, and other supportive services they need. The proposed program's target population is racial and ethnic minorities in New York City, NY. All activities will focus on meeting people where they're at and integrating trauma-informed care and peer support workers. The proposed service area consists of the following Northern Manhattan and South Bronx zip codes: 10027, 10029, 10030, 10031, 10032, 10033, 10034, 10035, 10451, 10452, 10453, 10454, 10455, 10457, 10458, 10459, 10460, 10468, 10472, and 10474. These specific Bronx and Manhattan neighborhoods have the highest rates of overdose death of all areas in New York City, NY. At least 80% of program participants will be Black or Latino (with over 20% hailing from Puerto Rico or Dominican Republic). We expect that over 70% of participants will be men, our target population includes adults of any gender.

PILLAR proposes to implement Project PAW (Positive Affirmation at Work) to enhance the current overdose and prevention activities and to help control the spread of infectious diseases and the consequences of such diseases for individuals with, or at risk of developing, a substance use disorders (SUD). PROJECT PAW will effectively distribute FDA-approved overdose reversal medication; overdose education, counseling, and health education; and linkage to infectious diseases treatment. The goals of this program are to increase the number of persons receiving overdose prevention services and decrease illicit drug use and prescription opioid misuse among individuals receiving harm reduction services from PILLAR. PROJECT PAW will reach its goal by increasing the number of persons receiving MAT services; screening for Fentanyl as part of routine clinical visits from their community health clinic; increasing HIV, STI, and hepatitis screenings; and develop a naloxone distribution program to include placing a harm reduction vending machine at their primary location. PROJECT PAW will also establish Border Harm Reduction Action Committee which will be integral with the planning, implementation, and evaluation of the Project.

As Cherokee, we are called to itsehv detsadasdelisgesdi, meaning "live and exist as a help to one another." Development of a full culturally informed continuum of care, that starts with prevention and harm reduction services, will ensure that our citizens and families affected by substance use disorders are not left behind as we build a stronger and healthier Cherokee Nation for the next Seven Generations. The Cherokee Nation Harm Reduction Program will provide early intervention policies, programs, and practices designed to minimize the negative health, social, and legal impacts associated with drug use, policies, and laws. Our program design is grounded in a compassionate service delivery model without judgment, coercion, discrimination, or requirement of abstinence as a precondition of support. Our program design will involve three components: Syringe Support Services, Case Management and Service Navigation, and Community Outreach and Advocacy. We will serve a minimum of 525 unduplicated persons over the course of the project.

Department of Public Health (DPH) Substance Abuse Prevention and Control (SAPC) and Department of Health Services (DHS) Office of Diversion and Reentry (ODR) propose Community Informed Harm Reduction Expansion (CIHRE) to enhance overdose prevention, safer drug use, and safer sex work services to people who use drugs (PWUD) and uplift their voices to inform programming countywide. CIHRE will serve PWUD across Los Angeles County (LAC) who are experiencing homelessness, for whom overdose fatalities remain the leading cause of death, and bolster harm reduction resources available in areas of higher concentrations of people of color (POC) and/or people who identify as LGBTQ+ who are experiencing homelessness. Between 2017 to 2019, PEH were more than 35 times more likely to die of an overdose in comparison to LAC's general population. PEH in LAC are predominantly POC, with only a quarter reporting being White. Approximately 10.5% of PEH in LAC identify as either non-conforming or LGBTQ+.

Project DHARMA (Distribution of Harm reduction Access in Rural Maine Areas) will serve syringe service program (SSP) clients in all sixteen counties of Maine. Being the most rural state in the nation, this grant will focus on clients in rural counties, particularly those deemed high risk for HIV/hepatitis outbreaks, as well as underserved populations such as LGBTQ+ individuals and unhoused individuals who use drugs. Developed through an unprecedented collaboration between syringe service programs, MaineHealth (the largest health system in Maine), and community organizations across the state, Project DHARMA will involve the delivery of evidence-based harm reduction strategies across the state, with a focus on utilizing Peer Support Workers embedded in SSPs to facilitate harm reduction supply distribution and linkage to care for infectious disease prevention and treatment, wound care, and substance use.

In response to high opioid burden rates in portions of Dutchess, Orange, and Ulster Counties in New York State (NYS), Planned Parenthood of Greater New York (PPGNY) proposes Project Street Beat - Region 2 (PSB-R2). Through PSB-R2, PPGNY seeks to expand its existing harm reduction model operating in New York City since 1988 to additional NYS communities in which we are already embedded as a trusted sexual and reproductive health care provider. During the three year period of 5/30/22-5/29/25, PSB-R2 will provide harm reduction outreach and services in ZIP codes within these three counties where opioid burden rates exceed rates for NYS as a whole.

As part of the trauma-informed continuum of care, University Health's South Texas Opioid Prevention (STOP) project will enhance and expand overdose prevention and other harm reduction services and activities for minority individuals with, or at risk of developing substance use disorders (SUD). Using an online platform increase reach and access to underserved populations, STOP staff will implement evidence-based practices to screen, provide brief SUD education/intervention, distribute harm reduction supplies (e.g. Naloxone kits, HIV test kits, Safer Sex kits, etc.), and referral to treatment. Population: 5000 (1000 Y1; 2000 Y2; 2000 Y3) racial/ethnic minority adults (ages 18+) at risk for or with substance use disorders (SUD) living in South Texas Region 8, with special focus on individuals from rural or LGBTQ+ communities.

Victory Programs, a Boston-area nonprofit serving 3,800 homeless or precariously housed individuals in crisis with housing, health, prevention, and recovery programs, is launching the Victory Connector, a low-threshold drop-in center designed to provide evidence-based harm reduction services and supports to Boston's service-resistant, street-based homeless individuals at great risk for opioid overdose and infectious disease acquisition. The Victory Connector expands upon five years of efforts by the agency's Mobile Prevention Team by creating a brick and mortar site to implement person-centered, coordinated interventions that are based in research and respond to the urgent needs of individuals at high risk. This site will be located in the area surrounding the intersection of Massachusetts Avenue and Melnea Cass Blvd., often referred to as Mass. and Cass, which, since 2014, has been a magnet for a growing homeless population and the epicenter of Boston's opioid epidemic.

Overdose is the leading cause of death among New York City (NYC) Department of Homeless Service (DHS) clients. The NYC Harm Reduction in Shelters Project will build DHS capacity to prevent overdose by developing a Harm Reduction Strategic Plan, training staff in Harm Reduction approaches, and implementing a Peer Program to deliver harm reduction education and referrals, evidenced based interventions and linkage to care for at least 2400 clients at risk during the project period.

Neighborhood Healthcare's Southern California Harm Reduction program will add harm reduction strategies to its substance use program to reduce the negative consequences associated with drug use and improve health outcomes. Informed by people who use drugs and evidence-based practices, program activities will include community outreach to meet people where they are, overdose prevention education, a syringe exchange program, distribution of opioid overdose reversal medications, expanded access to HIV and Hepatitis C testing, and PrEP, and linkages to resources to address social determinants of health. Over the project period, 500 individuals will receive services: 100 in Year 1, 200 in Year 2, and 200 in Year 3, and at least 58% will be Hispanic/Latinx.

With funding from SAMHSA's Harm Reduction Program, St. John's Community Health (SJCH) proposes to establish comprehensive harm reduction services for low-income Latinx and Black/African American people (? 98% of population of focus) who use drugs (PWUD) residing in South Los Angeles. Many of our participants will be uninsured, undocumented, homeless/housing insecure, LGBTQ+, reentry, and have a substance use disorder (SUD) with co- occurring mental disorder (COD), HIV, and/or viral hepatitis. Our multi-modality, trauma- informed, peer-driven harm reduction program (HRP) will delivered by expertly trained staff at Avalon Health and Access Center, on our Homeless Services Mobile Clinic, during street-based outreach, and integrated into our continuum of programs that target similar populations. Services will include: overdose prevention education/naloxone distribution, syringe services, support services, and linkage to comprehensive services that address medical, behavioral health, and other social determinants of health-driven needs.

Harlem United (HU) proposes a project to strengthen harm reduction programs as part of the continuum of care for individuals from racial/ethnic minority communities, particularly those with or at risk of developing substance use disorders. Services will include street-based medicine, overdose prevention education, and linkage to care. The project will conduct 300 monthly field encounters and 204 monthly field referrals, establish 144 monthly linkages, and serve 9,600 people over three years.

The Streetwork Project will implement a three-year program to enhance access to critical harm reduction services among homeless young people ages 16-25 in New York City. Youth in this population are among the highest risk of developing substance use disorders (SUDs) and co-occurring disorders, including PTSD, major depression, and anxiety. At least 39% of target youth experience SUDs, which is at least twice the rate of stably housed young people individuals and 4x the rate of the general population. The program's priority populations include LGBTQ+ youth and youth of color, with a focus on enhancing access and addressing behavioral health disparities experienced by transgender and gender non- conforming young people. Based on needs across multiple socioeconomic indicators of health, these youth experience multiple barriers in accessing harm reduction services to prevent SUDs and other infectious diseases.

The Detroit Recovery Project (DRP) proposes the "SQUAD" (Safe, Quick, Understanding, Accessible and Dynamic) Outreach Initiative to provide community-based overdose prevention, syringe services, and harm reduction to enhance overdose prevention, reduce the consequences of substance use disorder (SUD) and provide a continuum of care for racial and ethnic minorities and individuals. The area of focus for this initiative is the City of Detroit, which is in Southeast Michigan, within Wayne County. The target population for this initiative is racial and ethnic minority groups, primarily People who inject drugs (PWID) and People who use drugs (PWUD).

Franklin and Pickaway Counties in Ohio continue to experience overdose deaths at disproportionate rates, and Ohio has experienced a significant increase of injection drug-related infectious diseases. To address these issues and the racial inequities that are prevalent within them, PrimaryOne Health's Harm Reduction Integrated Care project will integrate enhanced screening protocols and evidence based harm reduction activities across its continuum of care. PrimaryOne Health (P1H) values meeting its patients where they are and funding to support a comprehensive harm reduction strategy is critical next step to meet the needs of its underserved target population in Central Ohio. As an FQHC, P1H serves a diverse, underserved population of individuals whose social determinants of health (SDoH) cause them to be at a higher risk for SUD, infectious diseases and other health consequences. While participants will primarily be identified from P1H's health care and behavioral health system - which served 1,091 patients with an SUD diagnosis in 2021 - the organization will serve individuals at risk of or living with SUD who are self-referred and referred from partner organizations. The organization's community health centers are located within neighborhoods which are historically underserved; of the 12 health centers, 9 are located in qualified census tracts with low incomes.

Proyecto Sanaremos will serve persons who use drugs in El Paso County who are; 70% Hispanic, 2% tribal, 8% LGBTQ and 5% rural from an opioid and other drug Walk-In Center located in a community with high levels of substance use activity using experience from its successful harm reduction programs. PS will seek to reduce the harmful consequences of substance misuse, to de-crease morbidity and mortality for those for whom abstinence is not an immediate or feasible goal. Proyecto Sanaremos will serve 8,000 residents of El Paso County in three years.