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The Denver Indian Health and Family Services (DIHFS) region includes 8 counties in the Denver, CO Metro Area where there were an estimated 54,241 individuals identified as AI/AN alone or in combination with one or more races, 40 percent of which were under the age of 25. The scope of the problem includes a wide range of social determinants of health that put individuals at risk for suicide. In our catchment, these challenges and service gaps include poverty, challenges accessing health services in an overburdened system, and disproportionate impact of behavioral health issues such as substance use disorder and suicide in AI/AN communities, especially youth. The DIHFS Native Connections program will prevent suicide and substance misuse, reduce the impact of trauma, and promote mental health among American Indian-Alaska Native (AI/AN) youth through the age of 24 years by instilling protective factors and preventing the loss of cultural identity for our youth. Connection to culture is an effective prevention effort for AI/AN youth and families. We will embed opportunities to promote cultural practices into the evidence-based initiatives we implement and reach a minimum of 435 individuals over the course of the project. The project aims to serve a minimum total of 435 individuals over the five-year project, with the goals of (1) raising community knowledge of the impacts of how suicide and substance misuse impact our youth, (2) raising tribal community knowledge of the accessible prevention and intervention resources provided by DIHFS, (3) providing cultural and traditional practices as a way of embedding protective factors for Native youth, and (4) increasing cultural pride and self-awareness among youth in our catchment.

The Choctaw Nation of Oklahoma (CNO), utilized Embrace 1's funding to launch culturally focused efforts toward the prevention and reduction of suicidal behavior, substance abuse, and the impact of trauma by promoting improved mental health among the AI/AN young people, up to age 24, residing within the boundaries of CNO. It is our hope that we can continue our efforts through Project Embrace 2. Embrace 1 developed strategies that were solidly built on the voices of the youth and families in the community that: 1) reduced the impact of mental and substance use disorders; 2) established a fast and culturally based response to any suicide intent; and 3) increased the efficacy of the surveillance of suicide, suicide attempts, and mental health challenges. Using the model set forth in the prior award, Project Embrace 2 will serve and touch the lives of 6,650 individuals Postvention Services will be coordinated with the CNO 24-hr Crisis team, therapists, schools and community members to ensure needed services are provided in a timely manner using procedures set forth by the Suicide Prevention Center.

The Chunte Washake Strong Hearts-Native Connections Project of the Nebraska Minority Resource Center [NMRC] will serve 304 Native youth 13 to 24 in 4 Nebraska Panhandle Counties through building a collaborative network of public health, education, and treatment providers, initiating team-based outreach by Native Mentors and youth to at risk youth, and implementing culturally response practices in key institutions. Youth served will be at risk for suicidal behavior, substance abuse and overdose, and emotional distress related to isolation, lack of connection with Tribal heritage, historical trauma, poverty, and lack of access to supportive services. Strategies to be used include: coordination of quarterly presentations for Panhandle agencies on the Cultural Wisdom Native healing paradigm; dissemination of culturally responsive standards of care and best practice interventions for youth experiencing suicidal behavior and behavioral health conditions; community-based outreach by 4 teams consisting of an adult Native mentor and 4 Native youth exhibiting leadership qualities; tracking and reporting of key data on incidents of youth suicidal behavior, substance abuse, use of emergency services, and involvement in services; implementation of a local Native youth-led public messaging campaign for other at risk Native youth; team outreach and consultation with selected Panhandle schools. Two Native consultants familiar with the challenges experienced by Native youth in the Panhandle, Dr. Roberto Dansie and Dr. Anpo Charging Thunder, will provide expert consultation in the Native healing paradigm, based on enhancing community and traditional values, and on culturally appropriate interventions with Native youth experiencing significant crises. Project goals are: 1) Develop a Native-led evidence-based community support network in the Nebraska Panhandle for Native youth who experience risks of suicide, substance misuse, and mental health issues; 2) Improve access to and awareness of culturally appropriate prevention resources for providers serving Native youth and families in the Nebraska Panhandle. Objectives include: delivering 20 quarterly sessions and discussions on the Cultural Wisdom framework, publishing 30 email newsletters; recruiting and training 4 experienced Native Mentors and 8 Native youth leaders to provide outreach and support services; complete 3 MOUs with Panhandle institutions on information of critical incidents involving Native youth; maintain an on-line toolkit for Panhandle providers; distribute a minimum of 2 constructive messages per month via social media to Native youth served in the project; complete a minimum of 5 consultations with Panhandle school systems regarding the availability of community outreach to Native students and families demonstrating at risk behaviors. The TriWest Group, an experienced national evaluation firm, will assist NMRC staff to collect and report indicators required by SAMHSA.

The Kickapoo Tribe of Oklahoma seeks to forge a comprehensive, integrated, and trauma-informed suicide and substance misuse prevention and mental health promotion system to address suicide, underage drinking, strengthen prevention capacity, and provide intervention services to rural, non-reservation, and under-served American Indian youth and emerging adults, aged 0-24, who reside within the area of central Oklahoma served by the tribe.

Native Connections Abstract Confederated Tribes of the Chehalis Reservation The Confederated Tribes of the Chehalis Reservation’s Community and Culture department will implement a program for Chehalis youth, ages kindergarten through 24 in order to prevent suicide, substance misuse and reduce the impact of poor mental health of tribal youth. The goal of the Native Connections program is to reduce the number of youth who experience suicidal thoughts by 50% by 2026 by offering cultural and educational classes to reduce poor mental health and increase resiliency. Chehalis Native Connections will meet this goal by providing evidence-based classes for youth to teach about feelings, interpersonal relationships, the dangers of substance use and anti-bullying classes. Students may also participate in Question, Persuade, Respond classes which teach students how to help friends or family members who may be experiencing suicidal thoughts or feelings. The Chehalis governmental employees and Chehalis tribal community will also be offered QPR classes several times per year in order to have a strong support system in the community to prevent suicide. Traditional arts and plant use classes will be a major component of the program with the goal of connecting Chehalis youth to their ancestors by teaching tribal art forms such as drum making, weaving and beading. These skills are important to the survival of Chehalis culture, and in teaching the youth these skills, they will learn more about their cultural connections and discipline in perfecting their skills. The traditional plants component of the Native Connections program will teach the youth to identify native plants, understand optimal harvest time and proper storage and preservation of the plants. The plants and herbs will then be used to make traditional balms, salves and teas which were a major part of the cultural traditions of the Chehalis. The funding request of $917,239 will cover the operations of the program for five years and includes funding for a full-time project director, an evaluator at a 10% level of effort and funds for travel, training, and cultural and educational classes for youth. Funding also covers a community garden, traditional plants class and basket-weaving conference for cultural educational opportunities.

Kenaitze Indian Tribe (Kenaitze) is a federally recognized tribal government reorganized in 1971 under the Indian Reorganization Act of 1934, as amended for Alaska in 1936. Kenaitze serves 1,717 Tribal members and approximately 4,410 Alaska Native/American Indian (AN/AI) residents of the central Kenai Peninsula—a geographical area spreading across more than 15,000 square miles of rural Alaska. Kenaitze’s Yinihugheltani (Dena’ina word meaning “respect for oneself and spirit”) Project seeks to improve and expand infrastructure and opportunities to prevent suicide and substance misuse among the target population of “Native Youth”, to include all AN/AI persons age 24 and younger living in our service area. Suicide rate data specific to all AN/AI youth ages 15 to 24 in Alaska suggest suicide mortality rates for Native Youth are significantly higher than the 10-year average of all service area residents, with approximately 30-35% of Tribal members reporting some degree of substance abuse. Native Youth with strong connections to their cultural identities and practices are more resilient and likely to overcome adversity; empowering Native Youth drives outreach messaging, practicing our Native culture and ways of life connects our people, working together strengthens community bonds and resilience, and fostering strong relationships among Native Youth reduces substance misuse and suicide. Project objectives include the following: 1. Develop one (1) comprehensive Suicide Prevention and Postvention Plan by the end of year 1. 2. Facilitate two (2) outreach events in year 1 and four (4) events per year in years 2 through 5 to reach and share Yinihugheltani Project opportunities with 50 unduplicated Native Youth during year 1, and 100 unduplicated Native Youth per year in years 2 through 5. 3. Design, develop, and distribute at least two (2) outreach materials in year 1, and four (4) outreach materials per year in years 2 through 5 using print and digital media. 4. Plan, coordinate, and implement ten (10) cultural activities for at least ten (10) participating Native Youth each performance year. The FY21 Yinihugheltani Project will serve 450 unduplicated Native Youth throughout the 5-year performance period, including 50 Native Youth served in year 1, and 100 Native Youth served each year in years 2 through 5. Evidence-based practices (EBPs) used by the Project will include the PHQ-9, SBIRT, the Alaska Screening Tool, C-SSRS, MI, the Matrix Model, CBT, QPR Gatekeeper, ASIST, SafeTALK, and Healing of the Canoe. Kenaitze’s integrated approach is guided by the Dene’ Philosophy of Care, a client-driven holistic approach to physical, mental, emotional, social, and spiritual health that aligns with foundational elements of the Tribal Behavioral Health Agenda (TBHA). The Yinihugheltani Project is structured as a partnership between Kenaitze’s Behavioral Health and Education Departments, utilizing authentic cultural activities to mitigate risk factors and strengthen protective factors among Native Youth to prevent and respond to substance misuse and thoughts/acts of suicide.

The Tend To Your Spirit (TTYS) Program The Tend To Your Spirit (TTYS) Program will implement effective, school-based mental health services to address the issues related to Suicide. TTYS will specifically address mental health symptoms in Muckleshoot Tribal School (MTS) students and better equip the MTS community to respond to student mental health needs. POPULATION TO BE SERVED: The primary focus for the Muckleshoot Indian Tribe’s (MIT) Tend To Your Spirit. Program are Muckleshoot Tribal Schools’ students ages 5-21 presenting mental health symptoms. STRATEGIES/INTERVENTIONS: The main strategy proposed for the TTYS Program is the formalization of mental health services at the Muckleshoot Tribal Schools. Interventions include: Prevention, Intervention and postvention services provided by the TTYS Team (Mental Health Therapists and Substance Use Disorder Professional); training school personnel, tribal leaders, community members about trauma and suicide prevention; the incorporation of a Community Advisory Board to ensure services are culturally aligned; and the utilization of a health assessment (Check Yourself©) to identify students with mental health symptoms. PROJECT GOAL (1): #1: 1. Establish an effective school- based mental health program to address mental health symptoms in MTS K-12 students Measurable Objectives: 1.1) MTS will identify and assign 3 Mental Health Therapists by the end of the 1st quarter of year 1 to address students’ mental health symptoms. 1.2) By the end of year 5, all high school grade levels will participate in a health assessment to identify students experiencing mental health symptoms. 1.3) By the end of year 5, TTYS Team will provide mental health prevention, intervention, and postvention services to 500 students. PROJECT GOAL (2): MTS community will be better equipped to respond to student mental health needs resulting in reduced incidents of crises Measurable Objectives: 2.1) By the end of year 5, activities and events will promote awareness about mental health symptoms for up to 500 school/community members. 2.2) By the end of year 5, community partners, experts and the TTYS Team will provide trainings to 120 department heads, community leaders, MTS faculty, staff, and administration. 2.3) At least 2 times per year, the Community Advisory Board (CAB) will meet with the TTYS Team to review data and recommend effective, culturally aligned strategies to promote holistic and cultural wellness.

A/CDP has prepared this proposal in alignment with the National Tribal Behavioral Health Agenda (TBHA) published in December 2016. The mission statement of the Native Connections grant states: Iahki’nikonhrakétskwas (all of us uplift the mind) of our Akwesasró:non youth 24 and younger to work toward reducing the impact of historical, environmental, and current traumas. We will work together today to build a better tomorrow for our youth by providing quality services that focus on using culture to increase protective factors and decrease risk factors and build partnerships to support healthy youth, individuals, families and community. The Saint Regis Mohawk Tribe Health Services Alcoholism/Chemical Dependency (A/CDP) Native Connections program proposes to continue to enhance and expand culturally-relevant programs aimed at preventing and reducing suicidal behavior and substance abuse, reduce the impact of trauma and promote mental health among Akwesasró:non (The People of Akwesasne, Saint Regis Mohawk Tribe) ages 24 and younger. Continuing upon our successes and the trust gained within the community from our 2016 Native Connections grant award, this five-year program will seek to maintain and expand our critical mental health and suicide prevention services in a time of great uncertainty for our entire community, and especially among our youth. This grant will allow sustainability and expansion of the program by providing funding to serve at least 270 youth within the community, develop COVID-19 practices and protocols in support of the program and strengthen our data collection and evidence-based practices to prevent and reduce suicide among youth. We will expand the membership of the Akwesasne Suicide Prevention Committee and the Akwesasne Coalition for Community Empowerment to increase support, education and continue postvention efforts. Our guiding principle is to integrate a youth and community-driven approach to developing culturally relevant substance abuse prevention programs and suicide prevention services. The Native Connections program will support the expansion and improvement of our efforts to provide integrated training, education, and information to youth regarding mental health, substance abuse and suicide prevention, intervention and postvention. Our goals are to continue to provide, improve, and expand school-based services by offering staff training, peer-leader training, screenings, assessments, and care coordination to youth. We will also develop social marketing/media campaigns to reach our population of focus, and develop and expand services to increase our outreach to Mohawk youth who are attending area schools of higher education to address their behavioral health needs and encourage the use of community resources during a time of crisis or need. We will conduct a community readiness assessment involving our youth, their families, and community members while working closely with our partners, the Akwesasne Suicide Prevention Committee, the Akwesasne Coalition for Community Empowerment, the Suicide Prevention Center of New York State, and the Salmon River Central School District. The project will assist the A/CDP Program to implement evidence-based strategies, increase youth self-awareness and a connection to resources, and reduce the stigma of being a consumer of mental health and/or substance abuse services. Our purpose is to ensure the social, emotional, and cultural well-being of our community by focusing on the promotion of culturally informed supportive services and the development of resilience among our children and youth for a future that is free from trauma, depression, substance use, and suicide.

ABSTRACT The Thoreau Community Center seeks to continue implementing the Healing Project, a culturally responsive initiative that incorporates the values and needs of our Navajo community. The Healing Project has become a symbol of endurance as it encourages the community members to continue living and loving life. The messaging to promote suicide awareness and prevention is centered on the Navajo value of Hozho. Since 2013, the Thoreau Community Center stayed committed to the community by building a consensus amongst the members that suicide is a prevention issue that should be openly discussed. The center is currently collaborating with other local, state, and tribal partners to develop a New Mexico Suicide Prevention strategic action plan focused on the Native American population. This major effort is due to the unwavering advocacy of the community center staff to bridge the gap between at-risk individuals and accessible mental health treatment services. The Healing Project efforts are guided by the SAMHSA Strategic Prevention Framework (SPF) and the SAMHSA Native Connections Community Readiness Assessment for Native American Communities. The framework and readiness assessment will ensure that continued programming of prevention activities will be holistic, culturally appropriate, and sustainable. The mission of the Thoreau Community Center is to inspire hope, joy and progress in Thoreau and surrounding areas. Overall, we are committed to improve the health and well-being of our communities. Collectively, our proposed goals and strategies will decrease the difference in access, available services, and outcomes among our Native populations of focus.

Utilizing traditional cultural teachings, the Akiachak Native Connections Program will aim to assist our youth in overcoming the effects of generations of colonization which has taken hold of our people and enslaved them in high rates of substance use, depression, and despair which has led to high rates of suicide in our community over the past generation. Most, if not all, of our youth have experienced the loss of a close friend or relative to suicide, and a high number of our youth experience depression and suicide ideation themselves. Combined with substance use this is a lethal combination. Through this program we will serve 400 or more unduplicated youth up to age 24, with an average of 75 to 100 youth served per year, providing a combination of behavioral health services along with an array of year-round activities to engage our youth. Our community, Akiachak, population 573, is located on the banks of the Kuskokwim River in the Yukon Kuskokwim (YK) Delta in Southwest Alaska, and is made up almost entirely of Alaska Native residents at 96%. We will utilize Calricaraq, a wellness curriculum based on the traditional values and ways of the Indigenous people in the YK Delta, for our counseling and the building of coping skills for our Youth. Calricaraq incorporates ancestral traditional values, practices and teachings into prevention and treatment programs to help our Indigenous people heal from behavioral health disorders. Our Native Connections Program staff will focus on providing outreach to the community to build their knowledge of identifying youth at risk for suicide, establish protocols for responding to suicides and build up a crisis response team in our community so we have the ability to respond to behavioral health crises. Key activities of our program will include regular school presentations, the Calricaraq Gathering, a three day event that teaches participants how to get on the healthy road of life, the Calricaraq Facilitator Trainings, also three days in length, that teaches participants how to begin facilitating Calricaraq activities to help our young people, and their parents, get on the road to wellness and recovery. Program goals and objectives include the 1) review and update of our policies and procedures related to preventing and responding to youth at risk for suicide, 2) implementation of mental health awareness and substance misuse prevention trainings utilizing Calricaraq, 3) planning and facilitating a series of youth activities, such as fishing and camping trips, Native arts and crafts, and movie nights to provide healthy options for our youth, and 4) facilitate Calricaraq Gatherings and Facilitator Trainings for community members. Measurement of goals will be from surveys, key informant interviews, and the number of participants at activities.

With Restoring Balance to Our Youth II, the Indian Health Center of Santa Clara Valley (IHC) will provide suicide and substance use and abuse prevention work to urban American Indian/Alaska Native (AI/AN) youth under 25, and their families, by providing subject-specific trainings and services, traditional and cultural programs, strengthening early intervention capacity, and revising suicide prevention, intervention, and postvention policies and procedures. The target population for this grant is AI/AN youth under the age of 25, their families, the prevention staff who serve them, IHC staff agency-wide and partner organizations who work with the same community. Restoring Balance to Our Youth II will serve a minimum of 110 unique individuals over the course of 5 years, approximately 22 per year. The first goal of the program is to increase the capacity of IHC staff to identify and intervene with AI/AN youth and their families in order to reduce substance use and suicide risk. The second goal of the program is to decrease youth substance use and suicide risk by implementing culturally-based and evidence-based programs in IHC's AI/AN youth-serving program that address behaviors that may lead to initiation of use and development of substance use and suicide risk. This will be achieved with an array of approaches including prevention trainings and evidence/community-based interventions, early intervention training with prevention staff, mental health screenings for youth, and culturally-based community outreach and services. IHC will employ the following strategies and interventions: 1) training youth, family, community and staff training in Question, Persuade, Respond and Mental Health First Aid; 2) in-depth early intervention training and ongoing consultation to prevention staff; 3) policy work focused on suicide intervention and postvention, cultural practices and approaches and social media; 4) direct prevention using Photovoice, Gathering of Native Americans and other culturally-based activities (Round Dance, Wiping of the Tears Ceremony, Talking Circles, Spiritual Support); 5) development of social marketing materials for outreach, education and stigma reduction; and 6) implementation of a suicide screening processes for the prevention environment. All activities will occur in a virtual environment until such time as IHC receives guidance that it is safe to re-open and gather in-person. Any physical gatherings will follow safety guidelines to minimize the spread of COVID-19. The impact of this program will be measured by 1) staff capacity to assess and intervene on suicide risk and to prevent youth substance use and suicide, and 2) prevalence rates of substance use and suicidal ideation and risk. It is anticipated that youth served by the project will experience increased resiliency and coping skills resulting in reduced substance use, delayed onset of first use of substances, reduced suicidal ideation, reduced ER visit due to either, and prevention of hospitalizations for self-inflicted injury over time and ultimately, reducing the youth suicide rate among AI/AN in Santa Clara County.

Thunder Valley CDC is a community-based organization and our mission is to empower Lakota youth and families to improve the health, culture, and environment of our communities through the healing and strengthening of cultural identity. Our work in the Youth Leadership Development Initiative (YLDI) pursues a multifaceted approach grounded in theories and evidence based perspectives focused on promoting protective factors in youth. Positive Youth Development theory is used to design youth programs that optimize developmental progress and strengthen cultural identity. Thunder Valley CDC is located on the 11,000-square mile Pine Ridge Reservation in South Dakota, which is the second-largest Native American Reservation within the United States and is home to about 32,000 mostly Oglala Lakota residents. Lakota youth have a high rate of Adverse Childhood Effects and there is a substantially high suicide completion and attempts rate. Mental illness and emotional disturbances including depression among youth are also common. There is a lack of community based outreach, prevention, and post-interventions that address suicide and substance use among youth up to age 19. There are many strategic plans which include collecting and sharing data to improve service coordination and delivery, however there is a lack of strategic plan implementation, collaboration between agencies, and sharing of data results and findings with each other. Our YLDI program goals are intended to prevent suicide and substance misuse, reduce the impact of trauma, and promote mental health among youth through the age of 19 years on the Pine Ridge Reservation. Our project will focus on youth up to age 19 and serve at least 550 children. Programming will provide holistic, culturally relevant services for families to increase suicide protective and resiliency factors, and provide traditional teachings on parenting to reduce the impact of trauma among our target population. Participants will receive training in ACEs through community outreach, cultural activities, events, and/or workshops. We will create a parenting curriculum based on the traditional Lakota Life Course model. Programming will also provide holistic and culturally relevant suicide outreach services using a positive youth development theory framework to reduce suicide ideation, attempts and completions in our target population. Staff will receive facilitator training for Youth and Adult Mental Health First Aid. Staff will then host community trainings for schools, parents, youth, and public. During summer months, staff will host four suicide prevention social activities for 10-15 youth recruits ages 13-18 and community. Lastly, programming will provide holistic and culturally relevant substance use services using a positive youth development theory framework to decrease substance use for our target population. Youth and community members will receive monthly supplemental educational services related to substance use. Youth will also receive weekly prevention activities and cultural interventions to youth during the school year. Through designated youth programming, children will show a 50% decrease in substance use.

Cook Inlet Tribal Council, Inc. (CITC) proposes its Tribal Behavioral Health Grant Program (aka Native Connections) project to the Substance Abuse and Mental Health Services Administration (SAMHSA). With the proposed project, CITC will reduce the prevalence of suicidal behaviors and the impacts of substance use disorders (SUDs), co-occurring disorders (CODs), and other mental health disorders among members of the population of focus (i.e., participants). Those members are Alaska Native and American Indian (AN/AI) youths who reside in the Anchorage Metropolitan Statistical Area (MSA) (the Municipality of Anchorage city-borough and the Matanuska-Susitna borough combined) in southcentral Alaska. Currently, the Anchorage MSA has a significant lack of culturally appropriate (for AN/AI people) programming that adequately addresses its increasingly severe suicide, substance use, and mental health challenges. Because the Anchorage MSA is very heterogeneous in terms of population density, demographics, and available infrastructure, residents of Tribal and/or rural communities are often the last people to receive assistance and resources. Those residents are also disproportionately more likely to experience and to be affected by suicidal behaviors, substance dependencies, poverty, and unemployment. The proposed project will incorporate 5 goals and 8 SMART objectives, which are closely aligned with the purposes of the Native Connections grant. The goals of the proposed project, which is designed for a 5-year project period, are provided below. Goal 1. Develop, revise, and disseminate (i) protocols for identifying and screening high-risk participants (especially those who have already attempted suicide and/or actively use substances), (ii) protocols for providing intervention, recovery, and follow-up services to those participants, and (iii) policies and procedures for coordinating more effectively with youth-serving organizations and agencies in the Anchorage MSA. Goal 2. Provide psychosocial screenings, intensive case management services, and referrals for mental health disorder (including SUD and COD) treatment to participants in the Anchorage MSA. Goal 3. Provide trauma-informed and culturally competent trainings on suicide and substance use prevention to youth-serving staff in the Anchorage MSA. Goal 4. Conduct trauma-informed, prevention-focused, and culturally appropriate wellness activities that strengthen positive Tribal cultural identity and provide mental health education for AN/AI youths and their families in the Anchorage MSA. Goal 5. Create and implement an enduring social norms campaign that promotes positive behaviors and encourages building strengths and developing resilience for AN/AI youth audiences in the Anchorage MSA. CITC expects that its proposed project will have numerous positive outcomes for its participants and for the Anchorage MSA’s AN/AI Tribal communities in general. By the end of the 5-year project period, specifically, relevant protocols will be established between CITC and 3 partnering organizations, 250 unduplicated participants will receive direct intervention and recovery services, 30 internal and external youth-serving staff members will receive trainings on suicide and substance use prevention, 50 AN/AI youths (and their families) will attend wellness activities, and potentially hundreds of AN/AI youths will engage with an enduring social norms campaign. In total, 650 unduplicated individuals are expected to benefit from the grant funds. The proposed project will be administered by CITC’s Recovery Services (RS) department and will utilize an existing Suicide Prevention Coordinator (1.0 FTE), who will also be the Project Director, and an existing Transition to Independence Process (TIP) Coordinator (1.0 FTE).

The mission of NARA is to provide education, physical and mental health services and substance abuse treatment that is culturally appropriate to American Indians, Alaska Natives and anyone in need. Through the Native Connections project, NARA’s aim is to prevent suicide and substance abuse, reduce the impact of trauma, and promote mental health among American Indian/Alaska Native (AIAN) youth through the ages of 24 years in the Portland Metro area. NARA proposes the following goals to achieve this aim: 1) Implement trauma informed care and culturally centered strategies that address behaviors towards decreasing suicidal ideation and attempts, and substance abuse by AI/AN youth ages 10 to 24 in the Portland Metro AI/AN community, and 2) Increase collaboration among AI/AN-serving organizations to improve the cohesive communication and collaboration of a culturally-responsive network responding to mental health and behavioral health needs of the Portland Metro AI/AN community. NARA will achieve these goals through the following eight measurable objectives over the course of five years: 1.1) By the end of project year 1, NARA will examine and revise policies and procedures to enhance transition to treatment, follow-up care services, and culturally adapt postvention protocols with input from AI/AN-serving organizations, youth serving agencies, and schools to meet quarterly during the length of the project; 1.2) By June 2022, NARA will deliver a culturally centered substance abuse/suicide prevention curriculum, Healing of the Canoe’s Culturally Grounded Life Skills for Youth, via a drop-in model to at least 40 youth annually adhering to COVID-19 protocols by the CDC and Oregon Health Authority; 1.3) By February 2022, NARA will deliver Question Persuade and Refer (QPR) trainings in-person or virtually for 30 NARA staff members annually; 1.4) By February 2022, NARA will deliver Applied Suicide Intervention Skills Training (ASIST) trainings in-person or virtually to at 10 least collaborating professionals annually; 2.1) By the end of project year 1, NARA will convene a Tribal Evidence Based and Cultural Best Practices Conference to share inter-organizational knowledge about health promotion with a strong focus on suicide prevention and behavioral health to a minimum of 50 participants annually during the length of the project; 2.2) By September 2021, NARA will utilize the National American Indian/Alaska Native Hope for Life Day Toolkit as part of a series of public messaging to at least 500 community members during the length of the project; 2.3) By September 2022, conduct suicide prevention NARA community events monthly for at least 50 community members during the length of the project.; 2.4) By September 2022, NARA will utilize the National American Indian/Alaska Native Hope for Life Day Toolkit during National Suicide Prevention Awareness Month as part of a series of public messaging to at least 500 community members annually during the length of the project.

The UKB wishes to create an inclusive, integrated, and trauma-informed suicide and substance misuse prevention and mental health promotion system to address suicide, underage drinking, strengthen prevention capacity, and provide intervention services to rural, non-reservation, and under-served American Indian youth and emerging adults, aged 0-24, in our northeastern Oklahoma tribal area.

Seattle Indian Health Board (SIHB)'s Native Connections Project, titled All My Relations, is designed to reduce suicide and the impact of mental and substance use disorders among urban American Indians and Alaska Natives (AI/AN) aged 12-24 living in King County, Washington. The project will increase protective factors by strengthening AI/AN youth cultural identity, and improve access to Indigenous-knowledge informed behavioral health care, especially for justice-involved youth and youth experiencing homelessness. King County's AI/AN youth relatives, a group of 7,900 people, experience devastating health disparities as a result of generational trauma. Illicit substance use rates are an average of 36% for AI/AN youth compared with 27% for all youth. Almost a quarter of our youth population has experienced suicidal ideation, the highest rate of any race or ethnicity. This project's goals are to (1) increase access to evidence-based and Indigenous knowledge-centered behavioral health treatment and support for AI/AN youth by coordinating systems of care; and (2) increase the protective factors that mitigate trauma and prevent suicide and substance misuse by strengthening urban AI/AN cultural identity, leadership opportunities and connection to community. The project will serve 100 youth annually. The project's objectives are for 200 individuals to have received evidence-based mental health or related services after referral; and serve 500 unduplicated youth across all project activities by the end of Year 5. To coordinate systems of behavioral health care, SIHB will reach out to systems partners to create pathways to Indigenous knowledge-informed evidence treatment for youth leaving Emergency Departments, youth experiencing homelessness, and youth leaving juvenile detention facilities. The project will also screen all relatives aged 14-24 with SBIRT+ to identify and address substance misuse and mental health concerns. To build protective factors, SIHB and partners UNEA and Native Wellness Institute will carry out: (1) youth-led Kiis Youth Council and its youth-driven activities and outreach; (2) Gathering of Native Americans (GONA); (3) Traditional Indian Medicine and intergenerational Elders' Care Projects; and (4) Power Hour online presentations. We will train community members with the evidence-based practice Question, Persuade, Refer (QPR) suicide prevention trainings.

The Cherokee Nation's Native Connections project will service the reservation's 14-counties focusing on youth (Ages 10-24), their parents and extended family members. The project seeks to address the high prevalence of psychological distress. A barrier is that most communities are rural, resulting in many individuals feeling isolated geographically, socially, and economically. Mental health and substance use disorders are frequently seen as the consequences of culture loss among American Indian and Alaskan Native communities. There is growing research to support that maintaining ties to one's culture can help to prevent and treat substance use and mental disorders; thus, healing can come from reconnecting. Cherokee Nation's project will provide an innovative solution by providing access to evidence-based, culturally grounded programming to each county within the tribe's jurisdiction. It will utilize the Tribal Behavioral health Agenda (3) as a tool to help instill protective factors and prevent the loss of cultural identity for our youth, despite the challenging dynamics they face within the home. Our mission is "Culture as Prevention: Building Bridges Between Generations" - and our intention is to embed opportunity within each community so that cultural practices can serve as protective factors that are carried forward into future generations. For Cherokee Nation, we envision a community that can live free of suicide, substance abuse and its related harms, and a youth community that is proud of its history, can overcome the impact of historical trauma, and views mental health as key to overall health and well-being. The project aims to serve 1600 individuals over the course of five years, with the goals of: 1) Raising community knowledge of how suicide and alcohol/drug misuse impact our youth family systems, community systems and school systems. 2) Raising community knowledge of the accessible suicide prevention and intervention resources within tribal rural areas by promoting our departmental services and collaborating with the local communities and organizations to promote resources. 3) Providing opportunities throughout Cherokee Nation territory to learn from/participate in culture and traditional practices as a way of embedding protective factors within youth and their families. 4) Increasing cultural pride and self-awareness amongst youth in Cherokee Nation by facilitating youth group meetings and events which teach traditions and promote a sense of self, community, and well-being.

Healing and Empowering Apache Youth will serve the San Carlos Apache Indian reservation and community. The San Carlos Apache Tribe has approximately 16,874 enrolled members, and has a 1.8-million-acre reservation located in Gila, Graham and Pinal counties in southern Arizona. The goal of the program is to highlight and advance the mental health resources in a culturally-specific manner that will draw from our ancestral knowledge to build resilience, prevent and reduce suicidality and substance misuse in Apache youth. The Wellness Center, the Tribe’s behavioral health provider, seeks to do so through partnership, policy development, and linking evidence-based practices to ancestral knowledge and cultural activities. Through community engagement, Suicide Prevention Task Force, and mental health awareness training the Team will incorporate and ensure that the Evidence Based Practices will be culturally and developmentally appropriate as the community sees fit. The project will utilize QPR, Youth Mental Health First Aide, Mental Health First Aid and Cognitive Behavioral Psychotherapy for Suicide Prevention (CBT-SP). The project will provide direct services to up to 150 communities members per year. This will include members of the stakeholder team, staff and other community member trained in EBPs, and community/youth trained in YMHDA. Total people served is 875. The project will also train Wellness Center staff, who will in turn train 3 stakeholder agencies, and provide community trainings annually. The project further seeks to develop and implement 5 new policies and protocols dealing with follow up services, early identification, and a tobacco free workplace policy.

Title: Mashantucket Pequot Skeehch Wuyeekan (Pequot for "Good Medicine") Project This application proposes focus on preventing suicide and substance misuse, reduce the impact of trauma, and promote mental health among MPTN community youth ages 8-24. The Good Medicine Project (GMP) will increase the general awareness of substance abuse and suicide as preventable public health issues and decrease MPTN youth substance abuse and suicide rates through the provision of local prevention activities. The goals and activities in this application will provide objectives focused on enhancing widespread use of culturally relevant evidence-based best practices in prevention for youth (age 8-17) and young adults (age 18-24). The GMP’s goal will be to reduce the progression of suicidal ideation, substance misuse and its related problems while strengthening the capacity and infrastructure for prevention at the community level, through Tier 1 interventions. These Tier 1 interventions are specific strategies that are positive and proactive, not reactive and consequence based. Tier I (universal) prevention activities are given priority because it is an effective way to minimize the prevalence of substance abuse and suicide attempts in rural areas, particularly since the proposed program is focused on adolescents. It is important given the social and economic events of the last 12 to 14 months that the community needs to become aware of latest contributing factors to increased reports of suicidal ideation and substance misuse issues, which is best accomplished through universal (Tier I) interventions. Develop a culturally responsive curriculum centered around oral traditions and lessons. Involve humor, art, photos, and language with trainers familiar with our tribal community as well as harm reduction and substance abuse Evidence-Based Programs (EBPs). Cultivate responsive leadership and develop strong partnerships with internal and external partners to build a whole community support system. Encourage clients to participate in Indigenous healing practices and cultural traditions to support their overall health and wellness.

The Aani: Choosing the Right Trail Program utilizes a culturally aligned, invitational approach to community healing. Based on lessons learned, we will ensure that our Elders’ wisdom guides our process, that we train our youth to be the leaders our communities need, that we will hold space for recovery as our communities heal, and that we acknowledge that speaking about mental health is necessary to healing. Over the five years of the project period Aani: Choosing the Right Trail will impact 200 community members in the two communities, Chistochina and Mentasta, that the Mt. Sanford Tribal Consortium serves. Youth, ages 13-24 are our primary focus for the program. The goals and objectives to accomplish our purpose are as follows: GOAL: Over the course of the five years of the grant project, members of the communities served by MSTC accept the Aani: Choosing the Right Trail Program as an invitation to community healing and subsequently choose to join the effort. Objective 1: By the end of the Aani: Choosing the Right Trail Program grant period, 20 community members will be trained in both evidence based practices and culturally aligned protocols for suicide prevention and treatment. Objective 2: Annually, the Aani: Choosing the Right Trail Program will support 5-10 youth (ages 13-24) in cultural, leadership, and workforce skills development. Objective 3: By 2026, the Aani: Choosing the Right Trail Program will increase the capacity for community healing in the communities that MSTC serves.

The Hannahville Native Connections program understands that historical trauma and grief in Native American communities have manifested in a myriad of maladaptive coping techniques including substance abuse, depression, domestic violence, and suicide. Our plan is to help facilitate restoration in the community by providing opportunities to resolve grief, heal, build resiliency, forgive, and embrace a spirit of gratitude and generosity. We will work with Hannahville community members, specifically targeting youth and young adults up to the age of 24. We will also provide some prevention programs universally so that they will include individuals of all ages. What benefits the community as a whole will benefit youth and young adults. That being said, we will specifically target policy making and revising that will impact youth and young adults at risk of substance abuse or suicide. We will work with our community partners, including our Native Connections Advisory Board, to identify policies and procedures that need to be created or changed to ensure that these individuals can effectively access needed services. The goals we will focus on will help guide the community through the grief process on a macro level. For the first year, we will increase understanding of grief and trauma by providing at least four experiential activities that address grief, such as the youth round dance and ghost feed. In the second year, we will help illuminate the connection between community grief and individual problems. We will create opportunities for community members to share about their losses in a safe place with people on hand to provide teachings and support. In the third year, we will focus on building adaptive coping skills in youth and young adults, through experiences such as the mental toughness basketball camp and connecting with cultural practices like maple syrup making. By year four, we will focus on addressing underlying feelings of grief and loss and accepting responsibility to change through the act of forgiveness. We will promote feelings of mastery and awareness of interdependence through activities like a Gathering of Native Americans (GONA). In the fifth year, we will focus on increasing gratitude and generosity. We will provide events that will allow participants to explore and develop gratitude and find ways to give back to the community through activities like the traditional Thanksgiving feast. Throughout the course of the grant we will be offering gatekeeper trainings for suicide prevention and culturally specific classes on interpersonal relationships. We will also collaborate with our community partners on initiatives like the Youth Council and trauma-informed care at the school. We will maintain our social media connection to the community and utilize those channels to provide education and support. We plan to serve 150 unduplicated individuals in the first year, and then add at least 50, 25, 25, and 15, respectively in years two through five, for a total of 265 served cumulatively. This is a realistic goal for a small community with a great deal of duplication in participation.

Fairbanks Native Association (FNA) Youth and Young Adult Services (YYA) seeks support to implement Reconnecting Youth, a project that will reconnect American Indian and Alaska Native (AI/AN) at-risk youth (up to 24 years of age) to services and supports needed to achieve overall mental health and a substance-free lifestyle. Reconnecting Youth will prevent suicide and substance misuse, reduce the impact of trauma, and promote mental health. Through multiple new services, Reconnecting Youth will reduce the impact of mental and substance use disorders, foster culturally responsive models that reduce and respond to the impact of trauma in AI/AN communities, and allow our community to facilitate collaboration among our community coalition - the Interagency Transition Council (ITC) - to support youth as they transition into adulthood. At its conclusion, Reconnecting Youth will have developed and implemented an array of integrated services and supports to enhance and expand our existing continuum of care. An ITC representative has been involved in the development of this project and the entire body will be involved in implementation and evaluation. New services responding to the required activities of the proposed project will include 1) policy/procedure development to promote coordination among youth serving agencies for standards of care for youth at-risk of suicide, procedures to address the transition of youth from one agency to another, the role of evidence based clinical health practices in supporting suicide prevention, substance misuse prevention interventions, mental health promotion strategies among youth and their families, and the role of local traditional healing/helping practices in combination with evidence-based suicide and substance use prevention among youth, and youth suicide follow-up services and postvention protocols. 2) Development and/or revision of protocols to ensure that youth at risk for suicide, including those who attempt suicide and use substances, receive follow-up services to ease their transition into treatment. 3) Development and implementation of mental health awareness training in our community including activities to raise awareness of the importance of suicide prevention strategies, including screening for suicide. 3) Implementation of community substance misuse prevention strategies, including public messaging, training on the risk of substance use, and education in school settings. 4) Implementation of prevention/intervention evidence-based practices (EBP). Existing continuum of care services will augment this project and project participants will be able to participate in all existing services. Existing youth services include the following EBP: Seeking Safety (trauma prevention), Screening, Brief Intervention and Referral to Treatment (SBIRT), Guiding Good Choices (family prevention training), Coping and Support Training (youth training), and Community Reinforcement approach (co-occurring outpatient treatment). Other existing services that will be available to project participants include street outreach, an annual marketing campaign, a community coalition (the ITC), a Strategic Prevention Framework, short-term transitional living, residential treatment, and community kiosks that provide system of care agency information throughout the community. Reconnecting Youth will serve 588 unduplicated participants over the five year life of the project.

The Ponca Tribe of Oklahoma headquartered in White Eagle (5 miles south of Ponca City, Oklahoma) with Tribal jurisdiction extending to parts of Kay and Noble counties has a membership of 3,522. The Tribe operates a small, ambulatory health clinic, White Eagle Health Center (WEHC), with a user population approaching 5,000 consisting of infants, children, adolescent, adults, and elders. The WEHC service area encompasses four (4) additional counties (Grant, Garfield, Payne, and Pawnee). These six (6) counties are resident to four (4) other rural tribes, Otoe-Missouria, Tonkawa, Kaw, and Pawnee, each with limited access to mental health and substance abuse services. The proposed project will focus on the youth and young adult population, ages 10-24-years-old, in the Tribe’s jurisdiction and surrounding area. The program looks to serve at minimum 50 youth and young adults annually and 500 throughout the lifetime of the project. The Ponca Tribe Native Connections proposes to continue expanding its Native Connections program to develop policies and procedures to promote coordination of inter and intra tribal youth serving agencies to ease transition from one agency to another; to increase the role of evidence based clinical health practices to support the prevention of suicide and substance misuse; to promote mental health strategies for youth and their families and to promote the role of traditional healers in conjunction with empirically validated western medicine practices. The tribe proposes the expansion of ‘postvention’ protocols for responding to suicide completions, attempts, and clusters. These protocols will reflect the traditions and culture of the tribe or consortia of area tribes to promote healing and reduce the possible contagion of further suicides. The Ponca Tribe proposes to create a comprehensive surveillance system by creating a consortium between the five-tribe area to increase awareness of the importance of suicide and substance misuse prevention strategies to include screening across various settings and offering a variety of mental health awareness trainings across the catchment area. Strategies within the consortia will include public messaging, trainings on risk of substance misuse and identification of suicidal ideation behaviors, and partnering with educational settings (i.e., public schools, vo-tech, two-year college(s)/university center) within the consortia that serve the 10–24-year-old population. Because substance misuse and suicidal ideation are often fueled by a complex set of circumstances frequently unique to Native American communities, the Ponca Tribe proposes to reduce behaviors that may contribute to substance abuse/use and mental health issues by offering a triad of culturally based courses that are designed to increase family engagement and relationship skills. The activities proposed for year 1 are: 1) Hire Staff, 2) Strengthen D.R.U.M. coalition, 3) update referral process for at-risk youth and young adults, 4) Create prevention video campaign, initiate outreach program, and provide suicide prevention trainings 5) Develop Policies and Procedures to Promote Coordination across Youth-Serving Agencies, 6) Conduct weekly NAFFA classes designed to promote family engagement and skill building.

Ninilchik Traditional Council’s Youth Outreach Program is designed to protect the present, foster the future, and strengthen our tribal youth with the lessons and traditions of the past through education and prevention. We have proposed a comprehensive prevention plan that will implement an array of integrated services and supports for youths to prevent suicide and substance use in our community. Studies consistently show that the negative cognitive, behavioral, and social impacts of growing up in poverty and exposure to adverse childhood experiences can be reversed by youth participating in prevention programs and having a positive relationship with a mentor. By utilizing the elements of positive youth development, we are able to help outreach participants develop their personal, social, emotional, and intellectual characteristics and increase favorable outcomes and behaviors among our youth. Similar research conducted in Alaska indicates that there is a 32% reduction of risk factors when youth are engaged in activities that strengthen the cultural values and promote social growth. Our priority is to provide a safe environment to promote educational excellence and facilitate engaging activities which encourage character-building, self-awareness, and the development of strong interpersonal communication skills. We aim to serve every youth in Ninilchik through the life of the grant. In the first year we will serve 100 youths and train a group of peer mentors who will create community wide change that impacts the wellness of our tribe and our neighbors. Local data suggests substance use, lack of community connection, and lack of adult supports are a high risk to young Alaska Natives in our community. The Ninilchik Traditional Council’s Youth Outreach Program seeks additional support for our successful prevention efforts through the continued expansion of intergenerational activities and mentorship opportunities to help our youth embrace the cultural values of the Alaska Native people. This investment in our youth will benefit the Tribe and the community for years to come as we prepare the next generation of tribal leaders to meet the challenges of the future, while maintaining a solid connection to their past. As indicated in extensive research, investing in our youth is the best possible investment we could make in the future development and success of our community. Our vision is to create a community where healthy lifestyles provide safe environments for families, promote resilience among youth, and facilitate support from community members and leadership. Our mission is to promote safe and healthy environments that foster development through early intervention and education focusing on upstream suicide and substance use prevention.

The Washoe Tribal Health Clinic-Healing Center’s Native Connections- 2021 Washoe Tribe Resiliency Project will be a continuation of the 2016 Resiliency Project which has been focused on nurturing community resiliency through the improvement/expanding upon strategies in behavioral health programs. The Resiliency Project has been focused on increasing a sense of belonging and sense of culture for American Indian/Alaskan Native (AI/AN) youth ages 0-24 and their families through the collaboration of tribal programs such as educational institutions, juvenile justice systems, and other child- and youth-serving organizations. The program services target Washoe and American Indian/Alaska Native youth and their family members in the community setting through modern and traditional activities. Our goal is to implement a process of change through which individuals ages 0-24 years will improve their health and wellness, live a self-directed life, and strive to be resilient and reach their full potential. Our objectives in Year One include: (1) Implementation of a community readiness assessment of the mental health and suicide awareness of all four Washoe reservation communities within the first six months of the grant (2) Organization of a task force representative of partners and communities to work with the Healing Center to identify the best approach to services/programming that will focus on and address trauma as it triggers suicide attempts and drug and alcohol abuse (3) Continue to development and revise the suicide protocols including Prevention, Intervention, and Postvention (4) Training in and utilization of culturally appropriate activities and approved curriculum including Gathering of Native Americans (GONA) and Indian Life Skills (5) Coordination of White Bison Wellbriety, Native Wellness Institute and other culturally appropriate wellness activities to encourage inclusivity of all supporting tribal departments and to ensure understanding of the goal and objective of the project. It is estimated that 500 people living in the four Washoe communities and the surrounding areas are ages 0-24; who will be the target population over the 5 years of the grant. Our goal is to continue the 2016 implementation and execution of a process of change through which Washoe Tribal community youth ages 0-24 years will effectively and successfully address trauma, suicide, and substance abuse to improve their health and wellness, live a self-directed life, and strive to be resilient and reach their full potential.