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The growing opioid crisis and unending methamphetamine plague in Oklahoma has devastated individuals, families, and communities for far too long. The United Keetoowah Band of Cherokee Indians in Oklahoma wishes to develop, implement, and maintain a trauma-informed opioid and methamphetamine treatment, prevention, and recovery support system to enhance OUD and methamphetamine services to rural non-reservation American Indians (AI) who reside within the area of northeastern Oklahoma served by the tribe. Further, we wish to shape our substance abuse and mental health treatment and recovery support system to address ongoing and emerging needs during the CV19 crisis. According to the US Census, there are 42,266 American Indians (AI only) in our service area. The populations of focus shall be area adolescents and adults with or at risk for an opioid / methamphetamine use / abuse disorder. The Finding Hope TOR project is a major strategic initiative for the tribe.

The Sisseton-Wahpeton Oyate Tribal Opioid Response Project will implement public health strategies aligned with the SWO Health Plan (Tribal Action Plan), to reduce unmet treatment need and opioid overdose related deaths by connecting people to prevention, treatment, medication-assisted-treatment (MAT), and/or recovery support services that are safe, effective, evidence-based, and culturally grounded as reflected by our motto: Wou's'da Owicayakiye Kte – Help one another with compassion. Although the public health impact will benefit the entire 7,302 American Indian Sisseton Indian Health Service users residing on or near the Lake Traverse Reservation located in extreme northeast South Dakota, the TOR Nurse Care Connector will admit 25 people annually who are diagnosed with Opioid Use Disorder (OUD). TOR will also serve participants who have coexisting stimulant misuse and use disorders with OUD. Through TOR, 50 people will receive care coordination services by project end. Current TOR work has “laid the tracks” for next steps to address ongoing challenges. Care continues to be fragmented between several independently operated medical facilities serving Tribal members – all of which operate autonomously from the Tribe. Tribal substance use disorder treatment and recovery support services are not well-integrated with medical services. Added complexity occurs when patients are referred to off-Reservation specialty care referral facilities. In addition, there are multiple criminal jurisdictions involved. The result has been confusing and sometimes unsafe. The new grant will provide resources whereby the Tribe can have a role in improving timely access to MAT, urging conformity with clinical best practices, organizing workforce education, and providing ongoing community education and outreach about available services and how to access them. A major project aim will be to clarify and define relationships and processes to bridge communication and service gaps, necessary for developing a continuum of care for tribal citizens. The project will network with outside agencies and coalitions to mobilize resources, compile data and foster change to combat the opioid crisis. TOR will work with the Great Plains Tribal Epidemiology Center and local non-profit prevention agency, Alive Roberts County, to assess the impact of services. The Care Connector model is a best practice that provides integrated case management and systems access to MAT. As there is staff turnover, Narcan® training, also a best practice, will be offered to newly hired first responders; and advanced refresher training and practice applications will be developed and implemented, including a tabletop drill simulation. Evidence-based community prevention activities include Botvin Prescription Drug Abuse Prevention Lifeskills®, Narcan®, National Prescription Take-Back Day campaign, and use of materials adapted from Generation Rx. There are plans to use the results of the Medication Lock Box Dispersal Pilot Project to plan and implement a larger scale campaign. We also plan to follow-up on the Harm Reduction Community Needs and Readiness Assessment to develop and implement a community coalition public health action plan. TOR will create a calendar with hopeful and culturally resonant messaging and images that can be proudly displayed in homes to promote the Dakotah value of helping one another with compassion.

The Southeast Alaska Regional Health Consortium (SEARHC) is a nonprofit, Native-administered health consortium that was established in 1975 to represent the health care needs of Tlingit, Haida, Tsimshian and other Alaska Native and rural people of Southeast Alaska. SEARHC serves a patient population of 26,689 in Southeast Alaska, which is comprised of rural island communities with uniquely low access to opioid misuse prevention, treatment, and recovery support services, including Medication Assisted Treatment (MAT) services despite high demand for opioid use disorder (OUD). In most Southeast Alaska communities, SEARHC is the only provider of behavioral health and primary health care services. The state's opioid epidemic disproportionately affects certain demographics, including men, white and Alaska Native people, and people between the ages of 25 and 44. Alaska Natives made up 41% of those affected. The overall goal for the SEARHC Tribal Opioid Response (TOR) Program is to address the opioid crisis in Southeast Alaska Tribal communities by increasing access to culturally appropriate and evidence-based treatment, including MAT using one of the three FDA-approved medications for the treatment of OUD. Program objectives focus on providing evidence-based treatment and implementation of a service delivery model that strengthens and expands the existing Intensive Outpatient (IOP) MAT services for clients with OUD, including chronic pain management. SEARHC’s TOR Program will implement a service delivery Hub and Spoke model that enables the full spectrum of treatment and recovery support services that facilitate positive treatment outcomes and long-term recovery; incorporate culturally appropriate and traditional practices into program design and implementation; implement workforce development activities to ensure that individuals working in Tribal communities are well-versed in strategies to prevent and treat opioid misuse; and develop strategies to address diversion of medications. SEARHC will use the following evidence-based strategies: • Motivational Interviewing/Motivational Enhancement • Trauma-Focused Cognitive Behavioral Therapy • Twelve-Step Facilitation • Contingency Management • Matrix Model • ASAM • Cognitive Behavioral Therapy and Mindfulness for Pain • Community Recovery Support Services • Substance Use Disorder Care Coordination • Intensive Case Management

The pueblo community of Ohkay Owingeh is located in Rion Arriba County in Northern New Mexico, along the Rio Grande river. Rio Arriba County had the highest total drug overdose death rate (85.8 deaths per 1,000) among all New Mexico counties during 2011-2015. Unfortunately, because Ohkay Owingeh shares its exterior lands with seven Hispanic communities, including Espanola, NM, and has two major highways cutting through the boundaries, we have also experienced similar rates of drug overdose death rates. Overdose mortality rates in 2017 were (72 per 1,000). Ohkay Owingeh recognizes the need to take action and establish prevention initiatives and resources for treatment for our community members. The Ohkay Owingeh Na'invi Towa project, with direction from the community, will establish evidence-based practices assist those seeking opioid treatment services, while establishing strategies for marketing prevention and treatment messages for the community and strengthen the capacity of the youth by developing leadership skills and delivering early prevention education in schools. The project will target 500 community members in its first year and will reach 1000 community members by project end. We will measure our success through data collection from sign in sheets, referrals to our behavioral health programs, pre/post test and other qualitative and quantitative data. Successful outcomes include increased communication between community members increased understanding of opioid addiction as a chronic disease, increased support systems, and empowerment of community members to prevent substance abuse.

Aroostook Band of Micmacs (AMB herein after) is the most Northeasterly Federally Recognized Indian Tribe in the United Stated and is located in the most rural northern Maine; Aroostook County. ABM recognizes the limited local and culturally appropriate access to medication assisted treatment and education for the Micmac community in the substance use disorder. Since our Tribal community has 1,486 members whom 913 lives in a service area of 6,672 square miles within Aroostook County, ABM is aiming to be prepared and response to the substance use disorder within our Tribal members. Under preparation and response, we will increase access to culturally appropriate and evidence-based treatment, including medication-assisted treatment using one of the three FDA-approved medications for treatment of opioid use disorder. The addition to focusing on opioid use disorder, recipients may also address stimulant misuse and disorders, including cocaine and methamphetamine. The intent is to reduce unmet treatment need and opioid overdose-related deaths through the provision of prevention, testament and recovery support services for opioid use disorder and, if so desired, stimulant misuse and use disorders.

The Goal of the Community Reentry Project is to reduce the prevalence of opioid use and abuse, and recidivism using evidence-based interventions and therapies with Tribal Member offenders in Wisconsin County Jails. This project, which has been piloted for two years in the Vilas County Jail, has collected baseline data from evidence-based interventions and will continue to collect and analyze data to address the needs of the growing population of poly-addicted individuals with co-occurring mental health diagnoses on the Lac du Flambeau Reservation. The Community Reentry program is a partnership between the Gookomis Endaad CBRF and referring Wisconsin county jails, courts, probation and parole departments. This program will use medically assisted treatment, in the form of Vivitrol injections, in conjunction with inpatient treatment, mental health counseling, case management, intensive out-patient therapy and transitional housing. This project will run for 24 months and serve 35 clients each year for a total of 70 clients served.

The RMTLC TOR project will serve the five Urban centers in the state of Montana and The Little Shell Tribe. Services under the FOA will focus on Naloxone distribution via SSP programs, Referral to treatment to avoid duplication of services provided in each locality and workforce development. Workforce development will focus on IBH and TBHA for MAT services, DEA certification for providers and Harm reduction service provisions.

The proposed project, Seminole Tribe of Florida (STOF) Opioid Response (TI-20-011, CFDA 93.788), will develop and implement programs to enhance the current treatment for and prevention of Opioid Use Disorders (OUD) within STOF. STOF was awarded the Tribal Opioid Response (TOR) grant in FY2019, and since that time, we have developed and implemented programs to treat and prevent OUD. Prevention programs will respond to this need by targeting children to increase their protective factors against substance use. American Indians and Alaska Natives (AI/AN) have the highest rate of substance abuse compared to any other population group in America (O’Connell, J. M., Novins, D. K., Beals, J., Whitesell, N. R., Spicer, P., & The AI-SUPERPFP Team, 2011). AI/AN comprise approximately 0.8% of the United States population and yet they account for 2.5% of substance abuse admissions. AI/AN are far more likely to require substance abuse treatment than equally matched individuals across all other ethnic groups and nearly 11% of AI/AN adolescents and young adults struggle with Substance Abuse (SA) (SAMHSA, 2020). STOF has experienced similar struggles that mirror the national averages for AI/AN. The data available show 168 STOF Members received SA services in 2019 which is believed to be an underestimation of the actual need. This has resulted in an increase in OUD treatment and mental health costs, creating a strain on the STOF resources, and more importantly placing Tribal members at greater risk for incarceration, domestic violence, and other adverse outcomes associated with OUD. The STOF clinical team will provide prevention services by following SAMHSA’s Strategic Prevention Framework. Targeting variable risk factors and increasing protective factors, STOF will employ the prevention curriculum to support Tribal youth members to increase their positive self-image, self-control, and social competence. Additionally, Center for Behavioral Health (CBH) will collaborate with the Tribal community to provide opioid antagonists as emergency treatment for opioid overdose. The proposed additional licensed clinician will provide psychotherapy services to treat symptoms of SA to reduce their interference on the member’s quality of life. A Tribal Member Recovery Liaison will also link Tribal Members with much needed services. At present, STOF CBH staff members are accessible to Tribal members at all times via an after-hours on-call system. CBH on-call staff members respond to mental health and SA crises immediately to address, deescalate, and stabilize Tribal members in order to ensure their safety. The present grant is intended to increase outpatient SA and prevention services to STOF members by providing culturally-sensitive and trauma-informed care to 30 additional members for each year of funding. Moreover, Medication Assisted Treatment (MAT) will be available to tribal members struggling with OUD. Tribal members receiving MAT will be paired with a clinician from CBH to address relapse triggers, identify recovery interfering behaviors, and increase positive coping skills. They will also be involved in the CBH Aftercare group on the reservation as they step-down from the higher level of care thus reinforcing recovery. This, in turn, will reduce relapse rates, optimize quality of life, and eliminate the unnecessary legal and medical complications associated with continued substance abuse.

Sacred Circle Healthcare (SCHC) proposes to use a hybrid MAT Program ('Medicaid Health Home Model') along with a case management program that relies on the "Accountable Health Community Model" (AHC Model) to service a minimum of 135 OUD/Methamphetamine clients who reside in the Salt Lake Valley region and in the Ibapah, UT region. We believe it ‘takes a village’ that relies on the social-ecological model (individual, family & community-systems efforts) to effectively address OUD/Methamphetamine abuse. Our MAT Program relies on evidence-based medication management, intensive outpatient mental health treatment, supportive and educational programming that uses the 'Living Room Model', and case management that focuses on addressing the clients' social service needs. Our primary health care services are integrated with behavioral health and oral health care. With regard to mental health services, our clients receive evidence-based modalities including: Culturally informed, trauma-focused cognitive behavioral therapy (particularly deconstructing the trauma narrative); Eye movement desensitization and reprocessing, to name a few. Given COVID-19, and resulting policies impacting face to face contact, SCHC has telehealth capacity to provide HIPAA compliant services. The Living Room Model provides our clients with access to a therapeutic, supportive milieu where clients can visit to receive informal peer education, programs rendered by our volunteers, and a computer lab to access self-improvement content. The premise of the AHC Model is that social service needs (i.e., food insecurity, housing & employment insecurity, transportation issues, social isolation) must be concurrently addressed to effectively reduce OUD/ Methamphetamine abuse. Failure to do so results in high risk individuals experiencing increased life stressors, which in turn, negatively impacts their sobriety. Once clients start our program, our case manager assesses and helps address their immediate unmet social service needs. The AHC Model also places importance on developing an inter-organizational network where our staff routinely contact with outside agencies to improve collaboration and our cross-referral practices. We also propose to offer workforce development quarterly trainings to our organizational partners in culturally and trauma informed services. Another component of our program is training Elders in issues related to prescription opioid use, prescription misuse and proper disposal of these medications. Once trained, our Elders will provide educational content using social media, and video-based formats on a monthly basis. Our evaluation effort involves process, formative and outcome evaluation strategies. The process evaluation provides frequency counts and percentages of project activities and characteristics about our clientele. Formative evaluation will include conducting focus groups with program participants to assess strengths, weaknesses and recommendations regarding our services. This information is shared with our program staff for the purposes of program refinement. Our outcome evaluation includes pre, mid-point (6 month), and post assessments using multiple psychometrically sound survey instruments that assess: depression/suicide risk; other psychological symptoms (anxiety, panic disorder, mood swings associated with bipolar disorder, eating disorder, alcohol/drug abuse, risk of violence); life functioning (work/school, intimate relationships, social relationships, life enjoyment); current substance abuse; and perceived social support. In case management, we will use a wiki portal allowing clients access to their electronic medicine wheel to document progress they are making on personal goals in four quadrants areas (Health Behaviors; Mental Health; Social Service Needs; Connection to Family/Community).

BAY MILLS INDIAN COMMUNITY ELLEN MARSHALL-HEALTH CENTER ABSTRACT TITLE Tribal Opioid Response: Uniting together to address the opioid crisis in our community PURPOSE The Bay Mills Indian Community (BMIC), a federally recognized tribal government, is dedicated to addressing the opioid crisis within our community by increasing access to evidence based treatment in a culturally competent environment. BMIC has approximately 1,362 tribal members out of 38,000 residents within the Chippewa County service area. According to the Bay Mills Health Center Uniformed Data System, 17% of the Behavioral Health Substance Abuse population has a diagnosis of opioid use disorder. BMIC Executive Council has committed its efforts to promoting prevention and education to address the opioid use disorder within the community by the creation of Resolution No. 18-6-11-B as well as continued support as shown in Resolution No. 20-05-01B. With strong leadership influence and dedicated partnerships the BMHC will overcome the stigma and decrease opioid use. For the past two years, the Bay Mills Health Center has been working to overcome indifferences related to substance abuse issues by uniting internal agencies to focus the underlining conditions and decrease opioid use. The BMHC, with the support of BMIC Executive Council, has played an instrumental part in the implementation of the Tribal Action Plan. Within this plan, key aspects have been identified demonstrating how mental health and substance use disorders adversely and permanently affects the physical, mental, social, spiritual and economic well-being of an individual. The Tribal Opioid Response Project Director has been able to coordinate with key leadership from each socioeconomic department necessary to prioritize the design, delivery, accessibility, acceptability and effectiveness of prevention and treatment options. This comprehensive strategic plan not only has shown the broad definition of mental health or substance abuse but has addressed the significant risks of opioid use disorders. With continued collaboration, by building supportive partnerships, BMHC will began to evaluate, monitor, and analysis a historical trend within the community. This plan will also allow for the expansion of services to providing all-inclusive culturally appropriate prevention and education to our surrounding community. BMHC is determined to decrease the growing rate of substance use disorders, specifically opioid use disorder, by expanding prevention and educational services within the community. In order to continue to provide quality care to the identified population, BMHC is seeking funding from the Department of Health and Human Services Substance Abuse and Mental Health Services Administration Tribal Opioid Response Grant.

The Santee Sioux Nation will provide community membership with a structure intensive outpatient program for individuals who struggle with opioid and other substance misuse. We will continue to provide this culture based practice framework in partnership with the HEART and MAT Programs within the Health & Wellness Center setting.

Continue Wellbriety Program as first two years of funding were used to plan and implement program

The Two Feathers Youth OUD Prevention Project in Humboldt County, CA will provide substance use, including opioid and stimulant use, prevention education, mentorship and leadership development for youth ages 12-26. Two Feathers seeks to develop 30 youth leaders aged 12-26 that understand the root cause of AI youth substance use; are skilled in culturally and traditionally evidence-based interventions; and, are able to advocate for culturally responsive policies that support AI well-being in Humboldt County.

The Great Plains Tribal Chairmen’s Health Board’s (GPTCHB) Great Plains Tribal Opioid Response (GPTOR) program aims to address the opioid crisis and stimulant misuse in the Great Plains Area by: • Working in collaboration with the Crow Creek Sioux Tribe to develop and strengthen their capacity to prevent and treat opioid use disorder (OUD) and stimulant misuse amongst its tribal citizens. • Increasing access to culturally appropriate and evidence-based prevention, treatment, and recovery support services for (OUD) for the American Indian (AI) population in the He Sapa (Black Hills) catchment area located in Pennington County, SD. • Establish a Great Plains Area Tribal Opioid Response (TOR) grantee Community of Practice to share challenges, successes, lessons learned and best practices in: 1) developing comprehensive strategic plans to address opioid and stimulant misuse treatment, prevention, and recovery services; 2) implement workforce development strategies to prioritize the delivery of MAT services; 3) develop culturally relevant and age appropriate community awareness, education and prevention messaging strategies to reduce stigma associated with OUD and stimulant misuse.

As part of the Southern Plains Tribal Health Board (SPTHB) TOR Initiative project, the SPTHB will contract with the Oklahoma City Indian Clinic (OKCIC) to be a sub-recipient to implement prevention, treatment and recovery support to 20,739 AIs from more than 200 tribes that the OKCIC serves. The cooperative agreement between SPTHB and OKCIC will enhance the capacity for highly effective, evidence-based interventions, by elevating the importance of tribal identity, culture, spiritual beliefs and practices for improving well-being of the AIs they serve. The SPTHB TOR Initiate project includes the following objectives and goals: Goal 1: Complete a comprehensive strategic plan, based on the most current epidemiological data to address the identified gaps in prevention, treatment, and recovery support services within 60 days of the award. Objective 1: SPTHB Provide information and technical assistance to OKCIC for creating a comprehensive strategic plan within 60 days of the grant award. Goal 2: Implement workforce development activities to increase the number of individuals working in tribal communities who are well-versed in strategies to prevent and treat opioid misuse, including the use of MAT. SPTHB Objective 2: Fund applicants to apply for Native American Behavioral Health certifications. OKCIC Objective 2: Increase healthcare professional education and training on MAT-waiver and universal annual pain management. Goal 3: Develop effective prevention strategies, including training and supplies for opioid overdose antidotes and services that address stimulant misuse and use disorders, including cocaine and methamphetamine SPTHB Objective 3a: Implement safe storage and disposal of unused or expired prescription drug medications through prescription drug supplies. Objective 3b: Launch a public awareness campaign to increase awareness of opioid misuse, reduce stigma around OUD and increase knowledge of treatment options available. OKCIC Objective 3a: Implement universal screening for behavioral risk factors. Objective 3b: Increase awareness of prevention strategies among OKCIC patients and their families. Goal 4: Implement service delivery models that enable the full spectrum of treatment and recovery support services that facilitate positive treatment outcomes and long-term recovery. OKCIC Objective 4a: Launch the OKCIC MAT Clinic and collect baseline data with which to set goals for future outcomes for enrollment and graduation. Objective 4b: Decrease the need for opioids by using alternative methods of chronic pain control. Objective 4c: Provide wrap-around social services to help address needs that support recovery from OUD or stimulant disorders. Objective 4d: To offer peer recovery support services using a life coach model. Goal 5: Implement community recovery support services that incorporate input from individuals in recovery. OKCIC Objective 5: To increase access to community support services. Goal 6: Assess and communicate the impact of the grant. Goal 6: Assess and communicate the impact of the grant.

Our project, WAT TOR 2020, will deliver culturally appropriate Telehealth services, recovery support, substance abuse prevention, and medication assisted therapy to reduce drug use and overdose. The Wichita and Affiliated Tribes (WAT), working in partnership with the Kiowa Tribe of Oklahoma, will provide behavioral health services to over 10,000 American Indians in three counties of SW Oklahoma, using or at risk of misusing, opioids and stimulants. The catchment area is rural, and the largest town is Anadarko in Caddo County with about 6,600 population. Our area includes all of Caddo, Kiowa, and Washita counties, over 3,000 square miles. The total population of all three counties is 38,823 and approximately 10,176 are American Indian. Six federally recognized Tribes are headquartered in Caddo county. Natives live in racially mixed communities not reservations. Economic, social, and health disparities for Natives are great. There are no substance abuse treatment centers or behavioral health therapists. Overdose deaths are four times state average in Washita County and all three counties have high rates of Native poverty and low rates of health insurance. Although opioids are widely misused, methamphetamine abuse is epidemic due to the importation of high-grade meth from Mexico to the area. Methamphetamine is a serious and worsening problem in all three counties and is the number one substance for treatment admissions statewide. Our goal is to reduce the number of Natives needing behavioral health treatment as well as mortality from overdose and to prevent the initiation of drug use among our youth. We will use culturally appropriate treatment and prevention strategies throughout the project to reduce overdose and the number of Natives needing treatment. WAT TOR 2020 will continue prioritizing opioid misuse but will also address methamphetamine misuse. Up to now transportation and lack of behavioral health services has been a major barrier to providing prevention or treatment services to Natives. Recently, due to the use Telehealth as a result of the Covid 19 Pandemic, Telehealth has become affordable and is now familiar to most Natives. We will utilize Telehealth as a major vehicle to conduct clinical assessments of Natives and provide them counseling and treatment services. The availability of these services will be widely promoted through social media and Tribal newsletters as well as word of mouth. All Natives, regardless of Tribal affiliation will be offered recovery support services such as housing, access to health care, and counseling to maintain abstinence. At the same time we will continue our prevention efforts to eliminate the nonmedical use of prescription drugs among our youth utilizing a program called “Culture and Drugs Don’t Mix that shows great promise. Adults and youth will receive culturally appropriates services through the White Bison Wellbriety program WAT TOR 2020 will serve approximately 200 Natives in prevention and 80 Natives in treatment modalities over two years. 8,000 more Natives will be reached by PSA’s or social media.

The goal of the Tribal Opioid Response (TOR) initiative is to provide service to 100+ individuals annually and 200+ individuals over the entire project period. The TOR Project Team completed a comprehensive strategic plan based on the most current epidemiologist data for the tribe. The strategic plan was used to identify and address the gaps in prevention, treatment and recovery identified by the Tribe. The Project Team will expand service delivery models enabling the full spectrum of treatment and recovery. These efforts will aid in meeting the project's first goal of conducting appropriate clinical assessments and second goal of building a culture of evidence-based, integrated care for Opioid Use Disorder (OUD). The Project team will continue to implement evidence-based treatment interventions adapted for Native American populations.

Pit River Health Service is a 501(c)3 non profit corporation providing primary care medical, dental, mental health and substance abuse services to the federally recognized Pit River Tribe of northeast California. As is common with many Native American tribes Pit River has experienced significant historical trauma resulting in high levels of poverty, substance abuse and violence within the tribe. We were rewarded a TOR grant in the last phase and have made significant progress in decreasing the number of community members using Opioids. However, due to the complexity of the problem and our unique situation we are requesting another round of funding to allow us to complete all of our original goals and expand our prevention activities and possible integrate a MAT option into the services we offer.

NHBP shall implement the TOR Project within the Tribal community.

Kenaitze Indian Tribe (Kenaitze) requests federal funding for the “Tribal Opioid Response Enhancement Project” to increase investments in outreach, clinical treatment, peer-based recovery support services, and strategic planning related to methamphetamine and stimulant misuse, and for those struggling with substance use disorder (SUD) more broadly, including opioid use disorder (OUD). Kenaitze is a federally recognized tribal government reorganized in 1971 under the statutes of the Indian Reorganization Act of 1934, as amended for Alaska in 1936. The Tribe’s service area comprises the communities of Kenai, Soldotna, Sterling, Nikiski, Salamatof, Ridgeway, Cohoe, Kalifornsky, Cooper Landing, Funny River, and Kasilof—a geographical area that spreads across more than 15,000 square miles of rural Alaska. Kenaitze serves 1,684 Tribal members and approximately 4,410 Alaska Native/ American Indian (AN/AI) residents of the central Kenai Peninsula, where the total population is 35,943 people. Local AN/AI community members are more likely to have lower incomes and/or be unemployed, and less likely to be educated than non-Natives; approximately 30-35% of the 300 Kenaitze Tribal members residing in our service area report experiencing substance abuse. To reach and treat our service area population, this project will pursue the following goal and objectives: Goal: Expand awareness of and access to substance use treatment and recovery support services. Objective 1: Develop one (1) Comprehensive Strategic Plan Addressing Methamphetamine and Stimulant Misuse among participants by the end of two (2) months. Objective 2: Design at least three (3) outreach materials, and print and distribute at least 2000 copies of each designed document by the end of Year 2. Objective 3: Increase treatment capacity to serve at least 40 unique participants who report using methamphetamine and/or other stimulants by the end of Year 2. Objective 4: Facilitate at least eight (8) peer-based recovery support group meetings in Year 1 and twelve (12) meetings in Year 2 for 18 participants each meeting. At least forty (40) unique participants will benefit from expanded clinical treatment services, and 360 participants (some of whom will ideally be returning more than once) will benefit from the peer-based recovery support group meetings; in total, up to 400 participants will benefit from grant-funded activities over the 2-year performance period. Evidence-based practices include tools such as Screening, Brief Intervention, and Referral to Treatment (SBIRT) and the Alaska Screening Tool (AST); and clinical treatment approaches include Motivational Interviewing (MI), Cognitive Behavioral Therapy (CBT), and the Matrix Model. Data collection interviews will be conducted at intake, at 3-month intervals thereafter, and at discharge using the CSAT GPRA “Client Outcome Measures for Discretionary Programs” interview tool to assess, measure, and track individual treatment outcomes over time; and to evaluate the results of project performance.

Fairbanks Native Association (FNA) is seeking support to implement the Bridges to Recovery project (Bridges). Bridges will reduce unmet treatment needs in the Fairbanks North Star Borough (FNSB) of Alaska by improving Medically Assisted Treatment (MAT) and Opioid Use Disorder (OUD) services and ensuring prevention, treatment, and recovery support services for stimulant (specifically methamphetamines) misuse and use disorders. The population to be served is American Indian/Alaska Native (AI/AN) adults (18+) in the Fairbanks North Star Borough (FNSB) of Alaska. With support from SAMHSA, the applicant, Fairbanks Native Association (FNA) developed a culturally appropriate continuum of care to address our tribal community’s opioid crisis, including a Medically Assisted Treatment (MAT) OUD Outpatient Treatment program. Evaluation demonstrates this program is succeeding in treating OUD, as the percentage of FNA Behavioral Health clients in treatment for OUD has dropped dramatically from 2017 to 2020. The treatment completion rate, however, is below national rates. Bridges will allow FNA to increase treatment completion rates and improve long term recovery from OUD. In addition, the FNSB is experiencing a surge in AI/AN methamphetamine (meth) use and meth-related overdose mortality. At present, 60% of FNA Behavioral Health Department adult clients are in treatment for meth abuse. Bridges strategies/interventions include improving long-term recovery by implementing the Continuous Quality Management Model to increase MAT/OUD treatment completion rates, meth prevention and treatment services that include a strategic plan to address stimulants, three new Evidence-Based Practices, a Meth Counselor, and five Recovery Coaches providing Recovery Supports through Peer Support. The Overarching Goal of Bridges is to enhance the existing continuum of care for OUD through performance improvement while meeting the unmet treatment need for meth misuse and use disorders. Goal 1: is to address the tribal opioid crisis by improving the quality of the existing OUD continuum of care. Goal 1 Outcome Objectives are 1) OUD use and abuse will be decreased from existing outcome by 20%, 2) quality improvement will double the treatment completion rate for MAT/OUD Outpatient Treatment from baseline (19%) to 38%; and 3) Quality Improvement of Recovery Support will result in a 20% improvement in housing and employment status and a 20% reduction in justice involvement from enrollment to 6 month follow-up for MAT/OUD Outpatient Treatment clients. Goal 2: is to address the meth service gap by adding meth treatment and recovery support services. Goal 2 Outcome Objectives are 1) a reduction of 40% in meth use and abuse, and 2) 45% of clients will sustain recovery at 6 month follow-up. Bridges will serve 45 unduplicated clients in Year 1 and 60 in year 2 for a total of 105 unduplicated clients over the 2 year life of the project.

Mt. Sanford Tribal Consortium serves approximately 217 tribal members. The Tribal Opioid Response: Tele-Therapy at MSTC project will serve approximately 70 individuals who struggle with various substance misuse disorders. The project emphasizes tele-health strategies to increase clients’ access to licensed health providers. The project will support creating two tele-therapy centers in two different villages in Alaska, Chistochina and Mentasta. The Tribal Opioid Response: Tele-Therapy at MSTC project will also enhance existing healing networks in order to increase the availability of services throughout the Copper River Region of Alaska. A project case-worker will recruit clients into the project and then support their process of recovery. The goals and objectives of the project are as follows: GOAL: Utilize tele-health strategies to provide mental health treatment services to Mt. Sanford Tribal Consortium beneficiaries. Objective 1: By the end of the project period, Mt. Sanford Tribal Consortium will implement systems to provide tele-health treatment options to tribal beneficiaries and other Alaska Natives/American Indians who struggle with substance misuse. Objective 2: Through developing culturally integrated, innovative approaches to healing networks, within 24 months, Mt. Sanford Tribal Consortium will enhance its capacity as a behavioral health provider offering substance abuse treatment within the region.

The Absentee Shawnee of Oklahoma seeks to fashion a inclusive and integrated opioid and methamphetamine treatment, prevention, and recovery support system to strengthen OUD and methamphetamine services to rural non-reservation American Indians who reside within the area of central Oklahoma served by the tribe.

Sault Tribe Opioid Prevention and Recovery (STOPR) program funded by SAMHSA’s Tribal Opioid Response Grant (TOR) includes youth opioid prevention, community prevention, and recovery services/housing. This program responds to the Sault Tribe - Tribal Action Plan (addressing substance abuse) that identifies a need for prevention and recovery resources. STOPR will fund two Prevention Specialists to provide evidence-based prevention resources in select schools and prevention activities across our Tribe’s 7-county service area. Recovery housing and 1 full time recovery coach and two part time recovery coach will assist patients to adjust to sober living. The Prevention Specialists will also engage in standard workforce development activities and opioid prevention training staying current on drug related problems and trends. Prevention Specialists will be implementing Positive Action Prevention Programming to 1500 3rd-5th grade students in our service area. Total unduplicated individuals 21,982 per year will be served. Pre and post-tests will be delivered to measure effectiveness. Prevention activities will also be held across the seven-county service area. The Prevention Specialists will have compiled prevention materials and Public Service Announcement (PSA) materials and will have delivered them at health fairs, health centers, and elder centers. Radio and tribal paper PSA’s will educate hard to reach individuals about the harm of opioids. At the health fairs, training will be provided on the use of nasal spray naloxone (provided by Sault Tribe Health). Recovery services and recovery housing will be made available to the Tribal membership. Two furnished recovery houses will be leased that houses a total of 6 people. Anticipating 12 people with people completing housing services. The Chronic Care Model will establish recovery support services that identify barriers to recovery and establish self-advocacy care plans in order to promote long-term recovery. Contracted Recovery Coaches will provide help to establish long-term recovery plans. Recovery Coaches along with Sault Tribe Behavioral Health Staff will implement the data collection of demographics, progress, outcomes, and employment of the recovering members to shape future services and report on progress. The TOR grant and Sault Tribe will have worked together to help (7,606 per year X 2 =15,212 individuals) with face-to-face services if funded for the next 2 years. This work will also service up to 24 individuals in recovery.

The Pokagon Band Tribal Opioid and Stimulant Response Project serves adult Native Americans eligible for services through the Pokagon Health Services Clinic in southwest Michigan. Currently, 6 percent of patients using the Pokagon Band’s behavioral health services present with opioid use disorder (OUD) and 12 percent present with a stimulant use disorder, particularly methamphetamine. Requested funds will support medication-assisted treatment (MAT) for patients with OUD as well as peer recovery services for patients with OUD and/or stimulant use disorders. The Project seeks to achieve the following goals and objectives by serving a total of 30 individuals annually: Goal 1: To eliminate the number of deaths caused by Opioid Use Disorders (OUD) through increased prevention, treatment, and peer recovery services. Objective 1: Provide access to MAT and peer recovery services for at least 15 patients annually presenting with OUD to improve recovery. Objective 2: Continue to provide training to community outreach staff to help identify those in the community who are at greatest risk of opioid misuse/abuse or those who are actively misusing/abusing opioids. Goal 2: To identify and reduce by 50 percent the number of individuals with stimulant use disorder, particularly methamphetamine, by the end of Year 2. Objective 1: Engage at least 15 individuals annually with stimulant use disorders, particularly methamphetamine, in individual treatment services including peer recovery. Objective 2: Intervene effectively to prevent, reduce, and/or delay the use of methamphetamine abuse.