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This project is titled Copper River Native Association expansion of telemedicine in response to COVID-19. The project goals are to expand our existing telehealth services to serve a population the geographic size of Ohio through Zoom, telephonic and Social Media to provide substance abuse treatment, recovery support services that directly address the substance abuse crisis that is currently in our region. With COVID-19 we are seeing a rise in substance use that is leading to an increase in domestic violence, child abuse and neglect.

Ketchikan Indian Community (KIC) is a Federally Recognized Tribe that serves over 6,000 Tribal Members. Since the first Novel Corona Virus (COVID-19) case was reported in Ketchikan, Alaska on March, 17, 2020 the KIC Behavioral Health Department has experienced a daily increase of 1-2 new clients per day seeking behavioral health assistance with depression, isolation, anxiety, and suicidal ideation. Clients have been struggling with increased levels of stress, fear, trauma and uncertainty because of the sudden and hazardous arrival of COVID-19. Moreover, the growing number of social distancing mandates has had a negative impact on the social environment in Ketchikan, particularly for people with a Substance Use Disorder (SUD) . KIC plans to use Emergency COVID-19 grant funds to evaluate, refine and enhance the overall delivery of treatment services for clients with substance use disorders and/or mental health illness. Emergency COVID-19 grant funds would assist the behavioral health staff develop and implement healthier changes to treatment programs and services in order to respond COVID-19 and assist the increased needs of SUD and/or mental health illness clients this pandemic has created. COVID-19 has reduced the ability of the KIC Behavioral Health Department to provide services for existing clients during an increased time of behavioral health need. Client access to health care has been significantly impacted by COVID-19 causing a negative impact on revenues the Tribe depends on to operate. Until the threat of COVID-19 is significantly mitigated or eliminated the KIC Behavioral Health Department estimates serving 75 new clients in Ketchikan over the next 16 months while simultaneously developing new telehealth pandemic protocol and processes.

Knik Tribe proposes the Emergency COVID Response Project for the Emergency COVID Grant. The project will focus on caring for individuals presenting with mental health and/or substance use disorders in the Matanuska-Susitna (Mat-Su) Borough of Alaska. The Mat-Su Borough is home to over 106,000 residents and covers over 25,000 square miles. Knik Tribe is the only AN/AI tribe in the service area, where roughly 18% of the population is AN/AI.Due to the Mat-Su Borough's high population and massive size, the COVID-19 pandemic has been uniquely harsh to the Mat-Su Borough's residents. It is for this reason Knik Tribe proposes the Emergency COVID Response Project as a way to connect Mat-Su Borough residents with mental health and substance use disorder treatment services. In addition to this, Knik Tribe will bridge the gap for direct support services by linking residents to transportation, nutrition/food, childcare assistance, vocational, and education support services.

Tlingit and Haida COVID-19 Mental Health and Substance Abuse Response Initiative Abstract The Tlingit & Haida COVID-19 Mental Health and Substance Abuse Response Initiative will provide crisis intervention services, mental and substance use disorder treatment, and other related recovery supports for Native families impacted by the COVID-19 pandemic. The Project will target more than 200 Native families in Southeast Alaska who have been identified as impacted by, or at risk for, serious emotional disturbance and/or substance abuse disorder, exacerbated by the COVID-19 crisis. The project catchment area will include the Juneau urban area, and the following southeast Alaska Native villages and communities: Craig, Klawock and Kasaan. Native families in Southeast Alaska are already at extreme risk for mental health problems and related substance abuse problems. Many families in the urban areas have relocated from village settings in an effort to escape extreme poverty and gain employment. When the impacts of the COVID-19 pandemic are added to other at risk factors, these families find themselves faced with overwhelming mental health and substance abuse challenges due to the isolation and economic disruption caused by the COVID-19 pandemic. The stresses and pressures on already overburdened Native families has been drastically increased as a result of the COVID-19 crisis. Families that have been experiencing domestic violence or child endangerment issues are forced together in a 24 hour lockdown situation, which acts as an absolute powder keg for further violence and abuse. This is especially true for smaller rural Native villages where there is simply no place to run and hide. COVID-19 lockdown produces nothing less than a living nightmare for vulnerable Native women and children. OBJECTIVE 1/YEAR 1 (MONTHS 1-4): Community Readiness/Strategic Planning: By the end of Month Four, the Tlingit and Haida TFYS Department, in consultation with project partners, will complete a planning, consultation, and service model development effort in preparation for delivery of comprehensive mental health and substance abuse services. Initial assessment of need and severity of conditions will be a simultaneous focus. OBJECTIVE 2/YEAR 1 (MONTHS 4-12): By the end of Year One, the TFYS Department, in consultation with project partners, will complete pilot implementation efforts for delivery of comprehensive mental health and substance abuse treatment services under the Tlingit and Haida Covid-19 Mental Health and Substance Abuse Response Initiative; delivery of comprehensive, culturally appropriate care to a minimum of 50 Native families will occur. OBJECTIVE 3/(MONTHS 12-16): By the end of the 16th month, the TFYS Department, in consultation with project partners, will achieve full program implementation of delivery of comprehensive mental health and substance abuse treatment services to a minimum 100 targeted Native families most in need of care due to the pandemic, and will develop a sustainability model for the future, drawing on federal, state, tribal and private funding streams.

Project Summary: Our project responds to the needs of individuals with SMI and SUD who are also impacted by the mental health stresses caused by the Covid-19 pandemic. We will develop a comprehensive plan of evidence based mental and substance use disorder treatments for individuals with SMI and SUD impacted by the COVID-19 pandemic. Project Name: St. Paul Island Emergency COVID-19 Population(s) to be served: The Pribilof Islands Aleut Community of St. Paul Island (ACSPI) is a federally recognized tribe. Out of a population of 425 (Census 2014-2018) 410 (85.6%) are all/ part Alaska Native. We estimate that there are 50 individuals with SMI, 50 individuals with SUD, 20 individuals with both SMI and SUD, 20 individuals with mental disorders that are less severe than serious mental illness, including 5 in the healthcare profession and first responders. Strategies/interventions: The program services for St. Paul Island community members meets three critical needs: (1) A need to expand outpatient treatment capacity as a result of COVID-19; (2) A need to implement an evidenced-based treatment model and (3) A need to implement the Global Appraisal of Individual Needs -1. Project Goals and Measurable Objectives: Project Goal: Develop and implement a comprehensive plan of evidence-based mental and/or substance use disorder treatment services for individuals impacted by the COVID-19 pandemic. Objective 1: Screen and assess customers for the presence of mental and substance use disorders and/or co-occurring disorders, and use the information obtained from the screening and assessment to develop appropriate treatment approaches Objective 2: Provide evidence-based and population appropriate treatment services. Objective 3: Provide recovery support services Objective 4: Develop and implement Crisis mental health services Number of people to be served annually and throughout the lifetime of the project: Target population: 50 individuals with SMI, 50 Individuals with SUD, 20 individuals, with both. In addition, the total population of 425 will benefit from some of our activities.

Native Village of Eklutna is a small rural native village about 25 miles north of Anchorage, Alaska. The Village is the only original Dena’ina village left in Anchorage. The traditional borders of the Dena’ina area overlap with present day Anchorage, Joint Elmendorf/Richardson Military Base, and the Matanuska-Susitna Borough. The Eklutna Tribe consists of approximately 400 members, with the majority living in the greater Anchorage area, with the Village housing the tribal offices and being considered the ‘capitol’ of the tribe. The Native Village of Eklutna, with support of SAMHSA, will work to bring culturally appropriate prevention and education services to our Tribal members and their loved ones. With this two-year grant opportunity, we will work on reducing the impact of opioid related overdoses and death within our families by creating healthy prevention activities and services. Our overarching goal is to identify and reduce opioid related activity within our community by implementing prevention, outreach, and assessment activities. This will be achieved via the following goals; GOAL 1: NVE will develop and implement a culturally appropriate outreach and awareness program. Objective 1.1: NVE will conduct a needs assessment and strategic plan based on the most current epidemiological data for the tribe to address the gaps in prevention, treatment, and recovery support services identified by the tribe. Objective 1.2: NVE will develop and implement educational materials that increases awareness of opioid related activity within our community. Objective 1.3: Establish a repository of referral sources for Tribal members in the Anchorage and Matanuska Susitna service area and develop a resource packet. GOAL 2: Provide workforce development activities to ensure that partners working in our communities are providing culturally sensitive prevention and treatment services. Objective 2.1: Provide education and prevention opportunities for community partners and Tribal members that increases awareness and shares resources. Objective 2.2: Provide specialized classes to community members on how to access and administer NARCAN kits and other MAT strategies. Objective 2.3: Offer activities in the Native Village of Eklutna for First Responders to build partnership and awareness. GOAL 3: Provide culturally appropriate referral services regarding client intake and referral. Objective 3.1: Develop policies and processes for substance abuse related intake process Objective 3.2: Provide continued education for TOR staff member to build capacity in substance abuse related services. Objective 3.3: Facilitate monthly team meetings as needed to address system improvements and processes.

During the past two years Alaska has experienced a decrease in opioid misuse related overdose deaths while simultaneously seeing a dramatic increase in stimulant misuse. This project will help Alaska to combat the opioid/stimulant misuse by enriching prevention efforts, enhancing recovery support efforts for individuals experiencing opioid or stimulant use disorders, and the expansion of the addiction treatment workforce to increase the number of Alaskan served. The purpose of the Alaska State Opioid Response project is to reduce opioid overdose-related deaths through the provision of prevention activities for Opioid and or Stimulant Use Disorders; increase access to treatment and recovery supports for those with opioid and stimulant use disorders and to further enhance the Addiction Treatment workforce's proficiency using evidence based practices. To meet these goals Alaska will undertake the following objectives: 1) conduct educational outreach and distribution of Naloxone, 2) screen newborns for substance exposure, 3) enhance the functions of the Prescription Drug Monitoring Program, 4) establish ASAM level 3.3 capabilities within the State, 5) continue development of credentialing standards for peer support specialists, 6) strengthen recovery residences through adding two to rural areas and continue funding for current residences, 7) begin certification of recovery residencies to national standards, 8) increase number of peer support specialists through provided training, 9) provide access to supported employment/education specialists, 10) link providers to Project Echo Opioid and other educational opportunities, 11) host trainings on Evidence Based practices for Addiction Treatment, and 12) publish Medication Assisted Treatment Guide. To achieve these goals and objectives, this project will work in tandem with current state efforts to develop a coordinated recovery-oriented system of care and utilizing several evidence-based practices. Project Echoes as well as other provider educational opportunities, will enhance Alaska's addiction treatment and recovery workforce. Alaska is working to integrate peer supports into multiple environments as it is proven practice to boost recovery capital. Employment is an important part of recovery and this project will utilize Individual Placement and Supports to help the targeted population find employment of their choice. This project will provide recovery services to 195 clients in Year 1 and 212 clients in Year 2 (overall project total for treatment and recovery = 404). Workforce enhancement opportunities will be offered to 440 providers in Year 1 and 500 providers in Year 2 (overall project total for workforce development= 940). Overall individuals served as result of grant 1,344.

The Central Council Tlingit and Haida Indian Tribes of Alaska (Tlingit & Haida) is proposing a 4 year “Rural Set Aside” project to train Village Public Safety Officers (VPSO’s) to administer approved drugs and/or devices for emergency treatment of known or suspected opioid overdose. The project will serve the City and Borough of Juneau, Alaska, and seven rural southeast Alaska Native communities in which opioid abuse is an issue, and the VPSO program has a presence. The Office of Management and Budget confirms that the City and Borough of Juneau, and these seven village areas, as being outside of any Alaska Metropolitan Statistical Area. (See Attachment 5) The overall goal of the First Responders-Comprehensive Addiction and Recovery Opioid Overdose Response Proposal is to increase the capacity of the VPSO program to respond to opioid overdose situations with effective emergency treatment through administration of approved drugs or devises. The First Responders-Comprehensive Addiction and Recovery Opioid Overdose Response Proposal is an important part of this effort. The project will serve over 25 Native individuals per year, (100 over the project period) for overdose intervention services, and 200 individuals per year, (800 over the project period) for training & community education services. The project model will: *VPSO Community training: Train and provide resources for VPSO first responders and members of other key community sectors on carrying and administering a drug or device approved or cleared under the Federal Food, Drug, and Cosmetic Act for emergency treatment of known or suspected opioid overdose; *VPSO Drug Exposure Safety: Train and provide resources for first responders and members of other key community sectors on safety around fentanyl, carfentanil, and other dangerous licit and illicit drugs to protect themselves from exposure to such drugs and respond appropriately when exposure occurs; *Referral Protocols VPSO/TFYS/Tribal Court/SEARHC: Establish processes, protocols, and mechanisms for referral to appropriate treatment and recovery communities, and safety around fentanyl, carfentanil, and other dangerous licit and illicit drugs. * Village Advisory Stakeholder Team: Form an advisory council that comprised of members who are currently engaged in efforts to prevent prescription drug/opioid overdose-related deaths meets the requirements of the grant. *Clinical Support to VPSO: Collaborate with health care providers to educate them on overdose dangers, and recommend that they consider providing resources to overdose victims and families, including information on treatment and recovery. *Village and Stakeholder Education: Provide public education on any state “Good Samaritan” laws, such as those that permit bystanders to alert emergency responders to an overdose or to administer FDA approved overdose reversal drugs without fear of civil or criminal penalties.

Alaska Project AWARE (APA) Project summary: APA will build upon the seminal work toward statewide school-based mental health services and broad-based mental health literacy created under its previous Project AWARE grant by piloting its successful alternative school model in traditional schools, including the first rural school. Upon completion, Alaska will have a comprehensive school-based mental health system of care model that can be implemented by any school in the state. Population(s) to be served: K-12 students in 8 schools (3 LEAs: Juneau, Fairbanks, and Bering Strait) with SED/SMI or at-risk, particularly AI/AN students and students from military families Strategies/interventions: (1) school-based behavioral health specialists; (2) Cognitive Behavioral Therapy; (3) Solution Focused Behavioral Therapy; (4) Support for Students Exposed to Trauma; (5) Restorative Justice training, with name modified to “restorative practices” for cultural reasons; (6) CASEL Social Emotional Learning (SEL); and (7) Youth Mental Health First Aid Goals/measurable objectives: APA will serve approximately 2,500 unduplicated students annually/12,500 throughout the lifetime of the project. Goal 1. Increase access to and use of school- and community-based mental health services to meet the needs of more students. Obj. 1.1: One school-based behavioral health specialist (counselor) hired and trained in each of the 8 participating schools. Obj. 1.2: All 3 participating LEAs will identify and establish partnerships with community providers. Obj. 1.3: Conduct 18 outreach and education sessions per LEA for students, families and staff, to reduce stigma and increase help-seeking, incorporating cultural considerations such as the values of AI/AN, military and other cultural groups. Obj. 1.4: Increase the number of students receiving school-based mental health programming/services in each LEA to 25%. Obj. 1.5: Increase community-based service referrals by 10%, with at least 25% of referrals leading to accessing services. Goal 2. Increase the use of EBPs and other tools to improve student mental health outcomes. Obj. 2.1: Train families, community members and 100% of staff at all 8 participating LEAs, as well as school districts statewide, to increase the overall number of YMHFA “first aiders” by 3,000. Obj. 2.2: 100% of participating schools will implement at least 2 EBPs to improve school climate, safety, and the mental health of school-aged youth. Obj. 2.3: Conduct 35 monthly outreach and education sessions with school-based counselors to improve early identification and intervention. Goal 3. Build system infrastructure and capacity through interagency collaboration to increase sustainability of mental health services for students. Obj. 3.1: Conduct training and technical assistance to 100% of participating schools and leadership from all 3 districts in the expanded definition of child and youth services under Alaska’s 1115 Medicaid Waiver. Obj. 3.2: Provide samples and templates to 100% of participating schools and districts for use in developing partnerships with community providers. Obj. 3.3: Adopt at least one statewide policy for districts to implement that supports mental health and school safety.

Over two years, through a curriculum of modularized best treatment practices, the proposed project seeks to educate 300 students of diverse cultural, ethnic and racial backgrounds enrolled in human services, social work, behavioral health and nursing programs in five campuses in Alaska to increase awareness, understanding, and knowledge of best treatment practices and their use to reduce substance and alcohol use of people in clinical care. Population Served: The project will educate students of diverse cultural, ethnic, and/or racial backgrounds involving Alaska Native, Hawaiian, Pacific Islands, Asian, African American, Hispanic Latino, or Caucasian. Strategies and Interventions: The project will incorporate state of the art distance electronic methods of education and training involving on-line delivery of modules addressing professional use of best treatment practices. In the first year, the project staff will work with faculty from 9 universities or colleges within the University of Alaska system, and the only tribal college in Alaska to incorporate online and digital substance use treatment education content. The project will incorporate those modules within the curricula of existing social work, human service, and nursing programs at associate, bachelors, masters, and doctoral levels (in the case of nursing). In the first year, the project will move systematically through multiple revisions of the curriculum, build 5 modules, deliver, test, and assess those modules across Alaska universities and colleges, and revise them based on systematic data obtained from students and instructors. In the second year, continue to move through iterations of the curriculum and prepare an additional cohort of faculty to use the modules within designated courses. In the second year, the project will continue to test the curriculum and its modules, revise them based on instructor and student feedback, and finalize a new version of the modularized curriculum as the principal product. Project Goals and Measurable Objectives: The project will increase the capacity of students across multiple degree and workforce levels to gain comprehensive understanding of substance use disorders (Goal 1), develop a hierarchical, sequential and coherent SUD/AUD modularized curriculum for distance delivery (Goal 2), increase student self-efficacy and proficiency in SUD/AUD treatment and recovery practices (Goal 3), ensure that students have the attitudes, knowledge and skills to engage in responsive and effective SUD/AUD treatment (Goal 4), and enhance student eligibility for certification/licensure in their designated professional degree areas and/or in chemical dependency (Goal 5). A full 80% of students will increase their knowledge and understanding of prevention and treatment of SUD/AUD disorders and gain awareness of key best treatment practices. A full 70% will demonstrate increases in their treatment self-efficacy.