AK Discretionary Funding Fiscal Year 2023

The Alaska Native Tribal Health Consortium (ANTHC) 988 Tribal Response project will focus on providing systems and resources to improve response to 988 contacts in multiple Alaskan communities. ANTHC will partner with Aleutian Pribilof Island Association, Maniilaq Association, Norton Sound Health Corporation, and ANTHC’s Behavioral Health Wellness Clinic to develop resources that will improve existing resources and outcomes for 988 contacts originating in Tribal communities. ANTHC will also work closely with the Alaska Careline to develop a Quality Improvement plan focused on connecting individuals at risk of suicide to local tribal behavioral health care services.

Population to be served: All Alaskans, Alaskans calling the 988 Suicide and Crisis Lifeline Number of people to be served: 40,000 Summary of project: Alaska’s need for improved suicide prevention and early interventions like the 988 Lifeline is tragically evident. In 2019, suicide was the leading overall cause of death for youth and young adults in Alaska aged 15-24. In addition to the high rates of suicide across all age groups, Alaska faces further challenges in the delivery of behavioral health services and the implementation of programming. Outside of the three largest cities (Anchorage, Fairbanks, and Juneau), all of Alaska’s boroughs/census areas are considered frontier by the state, with access to behavioral health services often only possible by boat, plane, or telehealth. Many of these rural communities experience significant health disparities, are historically underserved, and have populations that are majority Alaska Native. They suffer disproportionately from suicide, with Native Alaskan youth in these communities currently experiencing the highest rate of suicide in the nation.1 While the current 988 Lifeline response system in Alaska has made substantial progress since it was initiated, challenges to implementation on a statewide level remain. In Alaska there is only one accredited Crisis Call Center that is a member of the National Suicide Prevention Lifeline and from January-March 2021, there were 2,081 Lifeline calls attempted. Only 61% of those calls were answered. Increasing our Lifeline call answer rates to 90% is dependent upon an increase in staffing and capacity. Part of the 988-expansion plan outlined in this proposal includes increasing the call answer rate for Lifeline/988 calls. Another gap in services is the lack of 24/7 coverage for 988 text and chat, which is a priority under this proposal. A further need addressed under this funding is to add to our landscape analysis of the programmatic needs and costs associated with dispatching mobile crisis teams and building capacity to make referrals to tribal health organizations. The goals that will be guiding the objectives and activities proposed in this project are as follows: • GOAL 1: Increase the Capacity of Alaska’s 988 Response to Achieve a Call Answer Rate of 90% and Ensure Future Sustainability: • GOAL 2: Strengthen Partnerships for an Improved and Coordinated Response Across the Crisis Continuum • GOAL 3: Improve the Analysis and Use of Statewide Suicide Data to Better Inform Priorities, Policy, and Programming • GOAL 4: Develop an updated Alaska 988 Communications Plan that is Aligned with the 988 Partner Toolkit • GOAL 5: Improve The Continuous Quality Assurance Capacity For Alaska’s Crisis Call Center • GOAL 6: Improve Coordination With Tribal Health Organizations to Facilitate Community Engagement and Increase Referrals to Available Services • GOAL 7: Build a Comprehensive Network of 988 Referral Resources and Increase Post-988 Follow-up Capacity to Ensure Clients are Connected to Service 1 Wexler, L., Apala Flaherty, A., Begum, F., White, L., Kouassi, L., Wisnieski, D., Davis, A., & Ewell Foster, C. (2023). Describing meanings and practices related to firearms, safety, and household storage in rural Alaska Native communities. Journal of Rural Mental Health, 47(1), 30–40. https://doi.org/10.1037/rmh0000207.

Boys & Girls Clubs of Southcentral Alaska proposes to develop and provide behavioral health support and services to children and youth, including those exposed to trauma through the following strategies: a. Trauma-informed staff development – with 100 staff and 200 volunteers providing skills to reduce behavioral incidents, reduce stigma, and foster connections with other support services; b. Partnerships with families and other caregivers – to build connections and skills with parents and widen their support network; c. Active networking with other human service agencies and health providers – to ensure children and youth receive appropriate services in a timely manner rather to combat “refer and wait” challenges; d. Aligning agency policy with trauma informed practice – through an assessment, development, implementation, and consultation process developed by Boys & Girls Clubs of America to ensure Club organizations are truly operating in a trauma informed manner; and, e. Proactively addressing trauma-informed improvements through a refined continuous quality improvement process. Boys & Girls Club of Southcentral Alaska has over 55 years of experience providing positive youth development services to children and youth since 1966. The Clubs’ statewide reach includes twenty-three (23) Clubhouse programs in Alaska’s urban corridor of Anchorage, Mat-Su, and Fairbanks, as well as rural and remote settings throughout Alaska. Fifteen (15) of these Clubs currently serve predominantly Alaska Native communities and include all major indigenous groups in Alaska, including Tlingit, Haida, Tsimshian, Athabascan, Iñupiaq, Yup’ik, Cup’ik, Unangax, and Sugpiaq peoples. These Clubs are in Metlakatla, Saxman, Klawock, Kake, Utqiagvik, Kotzebue, Noorvik, Selawik, Nome, Brevig Mission, Saint Mary’s, Naknek, Togiak, Sand Point, and Tyonek. In Anchorage, the Clubs operate a Child Development Center for children as young as six weeks old. In 2022, the population of focus in the Clubs’ statewide reach served over 4,000 youth, ages 6 six weeks – 18 years. About 33% of these youth are teens. About 46% are girls; 54% boys; 37% Alaska Native or American Indian; 8% African American or Black; 5% Hispanic or Latino; 3% Native Hawaiian or other Pacific Islander; 27% Caucasian or White; 14% Multiracial; and 2% Other or Unknown. Poverty is pervasive in these communities, which limits opportunity to services health and education. Six (6) communities qualify for 100% free and reduced-price meals, seven (7) are between 75% and 99%, with the remaining Clubs above one third. The project will have a particular impact in that Clubs also need to be part of the continuum of services for youth who need behavioral support. The extreme geographic isolation, harsh climate, and limited technology mean there are limited services available for high-need children and youth. Building stronger supports in the continuum of care allows children and youth to receive appropriate levels of service in a timely manner and help keep them with their families and communities. When agencies are truly Trauma-Informed they are part of a support network that gets children and youth help early in their lives and provides positive support when it is needed.

The Central Council of the Tlingit & Haida Indian Tribes of Alaska is a federally recognized tribe with a Community and Behavioral Health Services division that proposes a $1 million project under the Department of Health and Human Services Substance Abuse and Mental Health Services Administration's 988 Tribal Response Cooperative Agreements. This project will enable the tribe to provide culturally responsive and culturally appropriate methods of addressing behavioral health issues. This will include a critical and essential ongoing partnership with Careline (Alaska 988 Crisis Line Provider).

Fairbanks Native Association (FNA), a tribal organization, is applying for the SAMHSA 988 Tribal Response opportunity. Our project, the Athabascan Suicide Response Project will serve American Indians and Alaska Natives (AI/AN) in our tribal service area, the Fairbanks North Star Borough (FNSB), an area geographically the size of the New Jersey. By joint agreement we serve both Alaska Natives and American Indians. Our response is a cultural response. On July 16, 2022, the 988-dialing code (988 Suicide and Crisis Lifeline) came on-line in Alaska. The prior 911 call line wasn’t set up to address mental health needs. The intent of 988 dialing is to reduce confrontations with law enforcement and connect people in crisis to the right help right away. People who call or text the number are connected to a trained counselor at the crisis center closest to them. This system has yet to develop a culturally specific strategy for responding to a suicide crisis for AI/AN people. As AI/AN have the highest incidence of suicide both statewide and nationally, a culturally specific suicide crisis response is critical. As AI/AN culture is community and family-based, the Athabascan Suicide Response Project is framed around the concepts of community, family and culture and integrates elements of each into its suicide response following referral. For AI/AN, healing from the effects of intergenerational trauma and other social issues – including suicide – require a cultural response. Key to the community response is the FNA-sponsored 22 member Behavioral Health Community Coalition (BHCC), which provides infrastructure development and behavioral health leadership in the FNSB. FNA’s Behavioral Health Services department (BHS) partners with the BHCC in all projects. The Athabascan Suicide Response Project will include the following required activities: A) Train 988 staff to be more culturally resonant, B) Form three three-person Community Response Teams, C) Provide screening, assessment, treatment, and recovery supports, D) Provide group therapy through Talking Circles, and E) Inform the community about 988. Cultural elements of this project will include the following: 1) project activities led by the community (BHCC) include the development of Community Response Teams, led by a Therapist. The teams may include an Elder, AI/AN community leader, BHCC member, and/or BHCC Youth Council member if client is a youth. The team will be convened upon referral from the call line. 2) A family member of the person referred will identified by the client to provide 3 month support and follow-up post treatment discharge. 3) Meeting in a community versus office setting. 4) Culturally specific suicide prevention materials. 5) Guiding Good Choices, an Evidence Based Practice that BHS has tested for cultural relevance over three years for family training. 6) Culturally specific screening, assessment, treatment, and recovery support services. 7) Training 988 staff in culturally specific communication techniques. 8) Client Participation in a weekly Talking Circles. 9) A culturally specific marketing campaign to inform the community of the change from 911 to 988 and to explain how responses will be culturally specific.

Compared to all other racial and ethnic groups in the U.S., Alaska Natives and Native Americans have the highest rates of suicide in the nation. As demonstrated by the Suicide Prevention Resource Center in 2020 and Center for American Indian Health in 2021, among others, locally informed and culturally based approaches that leverage strengths within Alaska Native and or Native American communities can significantly protect youth against suicide. The Rural Alaska Community Action Program, Inc., (RurAL CAP) Peer Mentor and Mental Health First Aide in Rural Alaska Project will build community capacity to support mental health and workforce development initiatives for young people, encouraging skill development to create a pipeline to needed community roles such as Behavioral Health Aids, Village Police Officers, school staff, and Tribal Government leaders. The project will support a cohort of approximately 10 Youth Peer Mentors and up to five Adult Mentors from up to seven rural Alaska communities to complete culturally responsive suicide prevention and mental health training. These trainings benefit each Mentor’s ability to create and facilitate safe places for difficult conversations with peers in their respective communities and refer community members to certified, professional health care providers if and as needed. The project pairs each Youth Peer Mentor with an Adult Mentor to ensure that youth have necessary support and processing mechanisms needed to be safe and supported. An estimated 100 people in rural Alaska will receive direct support from Mentors during this one-year project. The project goals are to 1) increase the capacity of the local community to reduce high-risk behaviors of youth that may contribute to self-harm and/or suicide and 2) decrease instances of youth self-harm and/or suicide by implementing a locally informed and peer-based program that addresses behaviors that may lead to harmful actions. Objectives to reach these goals include, but are not limited to, the following: develop formal agreements about capacity building with up to seven rural communities; train up to 10 rural youth and five rural adults on suicide prevention and mental health frameworks; Peer Mentors host up to 20 events to promote mental health awareness in their communities; Youth Peer Mentors successfully connect up to 100 peers in total across their communities to supportive mental health resources and/or methods. The Peer Mentor and Mental Health First Aide in Rural Alaska Project will benefit rural Alaska communities’ ability to create and sustain a healthy youth culture that will contribute to the reduction of self-harm and suicide rates. The project will go further by generating paths for youth and adults to advance from schooling into vital, high-demand workforce positions within their communities, contributing to social, mental, and emotional health as well as community-wide economic development across rural communities.

Over the next five years, the CRNA Creating Conditions for Community Healing Project will support the training of over 300 community members in various positions, both professional and community-based, who reside in the Copper River Region of Alaska. The Copper River Native Association, using evidence based practices, will implement programming to train service professionals, first responders, education professionals and community members to recognize and support individuals in the community with serious mental health challenges. The project will support Ahtna people who are affiliated with the Copper River Native Association. The project will train between 50-100 individuals annually. The goal of the project is: by the end of the five-year MHAT grant program, the CRNA Creating Conditions for Community Healing Project will substantially increase the capacity of service providers and community members in the Copper River Region to respond effectively to our tribal community members who struggle with serious mental illness. The project will accomplish this through consistent training of service providers using evidence based methods, through resource development and referral services, and through promoting community mental health awareness.