OK Discretionary Funding Fiscal Year 2023

The Cherokee Nation (CN) Reservation is located within the northeast region of the State of Oklahoma. It is comprised of all or part of 14 counties which extend from Tulsa, Oklahoma, east to the Arkansas and Missouri borders and north to the Kansas border. CN is the largest federally recognized Native American tribe with approximately 420,952 registered tribal citizens nationally. The prevalence of suicide among Native Americans (NA) in Oklahoma was 10.5/100,000 between 2000 and 2021 (American Foundation for Suicide Prevention, 2021). Suicide has long been a serious problem among Oklahoma Native American populations and in CN. In Oklahoma, suicide is the 7th leading cause of death for citizens (National Center for Health Statistics 2020). Finally, there is currently no standardized reporting within Cherokee Nation to track deaths by suicide, leading to vast underestimation of the actual suicide burden, therefore showing a clear need for suicide prevention services. CN, through the 988 Tribal Response Project, will strengthen our internal referral network system to increase our ability to respond to referred crisis phone calls from the 988 Call Centers in our region. This approach will be achieved through targeted workforce development for both our system and the 988 system, community partner training, the use of collaborative workgroups for system improvements, and development of formal collaborations with other health providers, law enforcement that identify and solve capacity and knowledge gaps. CN will increase access to culturally competent, trained 988 crisis center support for Native Americans seeking assistance from the target area (CN Reservation) and enhance systems to ensure navigation and follow-up care. CN will also enhance collaborations with Tribal, state and territory health providers, law enforcement, and other first responders in a manner which respects Tribal sovereignty. To complete the above, CN will complete a readiness assessment of the capacities and competencies needed to ensure readiness to efficiently receive and serve individuals referred from the 988 call center. CN will also collaborate with 988 regional call centers to assess their staff competencies related to serving tribal populations, identify training needs, and to create formal protocols for referrals and follow-ups. CN staff will host fourteen collaborative meetings with states, territories, and local crisis centers to improve effective 988 response and linkage to local resources, including cases of emergency intervention. These collaborations will be outlined in the Strategic Plan to ensure they are action-oriented and supporting long term goals of the project. A sustainability plan will be completed to be included in the strategic plan. The CN-988 project staff, will provide training to Peer Support Specialists and Community Health Workers on tribal best practices, suicide prevention, and crisis services including recovery coaching techniques, telephone, and texting recovery check-ups, warm lines, and other supports. CN will train 1,200 Native American health care professionals and 300 individuals in crisis call centers on best practices for Native American crisis supports. CN will increase, the knowledge and confidence of 1,500 health care and crisis call center workers to provide appropriate crisis support service when working with Native populations. CN will improve referrals, and follow-ups for Native Americans calling the 988 crisis line increasing the quality of crisis response to aid in decreasing suicide in Indian Country.

The Cheyenne and Arapaho Tribes are proposing a project to implement the 988 Program for the Cheyenne and Arapaho jurisdiction. This includes planning, supportive services and partnerships. Goal: By the end of the 2nd year, the Cheyenne and Arapaho 988 Project will have implemented a system to provide culturally sensitive training for 988 personnel, developed a plan to provide supportive mental health services to individuals utilizing the 988 system, and have functioning work relationships with State and Local 988 Service Providers. Effective implementation of the proposed project will provide responsive mental health interventions for individuals residing within the Tribes jurisdiction.

Hvshi Akucha (Ha-she Ah-koh-cha) translates to the Chahta word for sunrise and symbolizes the new dawn of recovery and suicide prevention for at-risk Native American (NA) youth on the Choctaw reservation. Project Hvshi Akucha will address the emerging mental health crisis on the reservation and overwhelming demands after the McGirt v. Oklahoma Supreme Court decision’s historic jurisdictional shift. In Calendar Year (CY) 2020, CNO BH treated 554 unique tribal youth patients presenting with a PHQ9 score of 10 or higher (severe risk for suicide). In CY 2021, this number rose to 757 and in only the first three months of CY 2022 this number has already reached 329. If these rates continue, CNO can expect to treat approximately 1,316 tribal youth presenting as severe risk for suicide in CY2022. The Project will increase the Choctaw Nation of Oklahoma’s capacity to provide trauma-informed, recovery-oriented, equity- based and culturally sensitive mental health care to tribal youth at risk for suicide (Goal 1). Project Hvshi Akucha will expand collaboration and partnerships with service providers across the Tribal Service Area (TSA) to increase resources for tribal youth at risk for suicide and center suicide prevention as a core component of health care services (Goal 2). Program efforts will also center on strengthening community education on suicide prevention and care to provide a comprehensive network of support for tribal youth at risk for suicide (Goal 3). The Choctaw Nation of Oklahoma (CNO) is a federally recognized Native American (NA) Tribe located in southeastern Oklahoma. The reservation hosts a NA population of at least 52,351, of which 45,547 are Choctaw. The target population for this program is tribal youth (ages 10-18) within the TSA. The number of Choctaw Tribal members living on the reservation from ages 10-18 is 8,153 people. In the first year of this Program, two (2) new Licensed Mental Health Professionals and one (1) Peer Recovery Support Specialist will be hired (Objective 1.1). Treatment providers will also provide education to CNO Juvenile Services and Judicial Branch staff (Objectives 1.2 - 1.5). In year one, Program staff will treat 50 tribal youth at risk for suicide (Objective 1.6). The Program will partner with CNO Juvenile Services and the CNO Judicial Branch for referrals (Objectives 2.1-2.2). These partners will be trained on various methods of tracking suicidal youth (Objective 2.3). The Program will also collaborate with local school districts to coordinate virtual sessions with CNO therapists for tribal youth throughout the TSA Chahta Himmitoa Aiahli Tohnochi Program to expand referral systems (Objectives 2.4 – 2.5). To promote a fully comprehensive suicide prevention program, treatment providers will also develop familial connections and support systems around at-risk tribal youth (Objective 3.1). Education on reducing access to lethal means and increasing protective factors will be provided (Objectives 3.2 – 3.3). Guidance and information will also be provided on how to access health care, how to develop and implement crisis protocol, and how to handle crises involving suicide (Objective 3.4). Cultural wellness will also be developed through a youth-led suicide prevention task force (Objective 3.5). Peers will also establish culturally-based “talking circles.” Treatment providers will maintain consistent program quality improvement efforts through collecting and analyzing various data sources on tribal youth suicide (Objective 3.6).

The Choctaw Nation of Oklahoma (CNO) proposes to improve response to 988 contacts originating from Native Americans living within the CNO reservation. According to the Oklahoma Department of Mental Health and Substance Abuse Services (ODMHSAS), total call volume has more than doubled since the July launch of Oklahoma’s 988 crisis line. ODMHSAS provided data to CNO that 1,565 Native Americans living within the CNO reservation received crisis service (crisis center, service, mobile crisis or URC) in FY21-22. Current service gaps addressed with this funding include: 1) strengthening CNO, ODMHSAS, and 988-operator Solari collaborations, 2) providing culturally relevant training for 988 operators, 3) increasing mental health professional resources for mental health services, mobile crisis response, and case management, and 4) establish a CNO warm line for 988 transfers and follow to improve crisis response for Native Americans living within the CNO reservation.

The Comanche Nation is a federally recognized tribe located in Comanche County, Oklahoma. The impact of historical and intergenerational trauma has created cycles of mental health problems, addiction, poverty, and crime has led to a complete breakdown of individual and family relationships extending across generations within our tribal community. Lack of access to culturally-competent and responsive care has had a devastating impact on the mental health stability of American Indian and Alaskan Natives (AI/AN) within our community. With this funding, the Comanche Nation will collaborate with local 988 crisis centers to improve the quality of response, care, and follow-up for tribal citizens experiencing mental health crises and utilizing 988/lifeline call centers. The overarching program goals are to insure culturally-responsive services, improve access to care, and improve effective 988 response and follow-up for AI/AN individuals. The Comanche Nation will implement a mobile crisis program to provide crisis intervention, stabilization, and management to tribal callers utilizing 988/lifeline systems. We will also work to identify and analyze local data sources in an effort to provide community education addressing suicide awareness, education, and prevention within the local and surrounding communities. Collaborative community partnerships will be sought out and developed in order for the Comanche Nation to effectively engage within the community. Training for key stakeholders and community partners will be provided in an effort to identify and refer AI/AN individuals who are experiencing mental health crises. Funding for CN 988 Tribal Response Project will provide the Comanche Nation the ability to provide mental health services and continue the healing process from the effects historical and intergenerational trauma.

The Iowa Tribe of Oklahoma, Perkins Family Clinic Behavioral Health, continues to grow and service the rural communities of Lincoln, Logan and Payne Counties in Oklahoma with medical, dental, behavioral health and substance use treatment to Iowa Tribal Members, clients with any Tribal affiliation and non-Native clients. Perkins Family Clinic and Perkins Family Clinic Behavioral Health have worked to improve capacity and increase integrated medical and behavioral health and substance use services since 2018. PFC-BH has increased capacity for individual, family and group counseling, peer recovery support services, case management, mediation assisted treatment, 12 Step and Wellbriety groups, and Positive Indian Parenting groups over the past two years. Through the Tribal 988 Response funding, the Iowa Tribe of Oklahoma, Perkins Family Clinic will work with State 988 Crisis Response teams to increase cultural competency for Crisis Call center staff and provide resources for Native American individuals who contact the 988 Hotline that include traditional and cultural services provided in the state. PFC-BH will increase clinical staff by hiring a licensed mental health professional who will offer same day or next business day appointments for individuals who do not meet criteria for entering a crisis or urgent care behavioral health center. Throughout the life of the grant (two years), grant key personnel will train 62 individuals who are working at the State 988 Crisis Call center in Motivational Interviewing, cultural competency, and address the gap in mental health and substance use services provided to Native American individuals in Payne, Lincoln, and Logan Counties in Oklahoma.