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Certified Community Behavioral Health Clinic, ACMHS Abstract: Anchorage Community Mental Health Services seeks SAMHSA support to become a Certified Community Behavioral Health Clinic (CCBHC) providing comprehensive services to children, youth and adults experiencing severe emotional disturbance (SED), severe mental illness (SMI), substance use disorders (SUD) and co-occurring disorders (COD.) Services will reduce symptoms, improve functioning and improve health outcomes. As a CCBHC, ACMHS will serve Alaska’s metropolitan area as defined by the U.S. Census Bureau, 2019: the Anchorage Municipality and Fairbanks/North Star Borough. This catchment area is 9,042 square miles (larger than New Jersey) and has a population of 390,509 (US Census Bureau estimate, 2018). 53.4% of Alaska’s population resides within this catchment area. Data identify critical shortages of services for children, transition age youth and adults who experience SED, SMI, SUD and COD, with acute shortages in available SUD and COD treatment. ACMHS will improve outcomes (symptom reduction, functional improvement, improved health outcomes) for children and youth who experience SED by improving access to services and expanding wrap around services. ACMHS will improve outcomes for adults experiencing SMI (symptom reduction, functional improvement, physical health improvement, maintain population in community setting) by improving access to services and implementing and expanding available evidence-based practices. ACMHS will improve outcomes (symptom reduction, substance use reduction, functional improvement) for transition age youth and adults experiencing SUD and (COD), expanding treatment capacity at ACMHS by training providers in SUD and COD treatment. ACMHS will improve client health outcomes by integrating primary care and by implementing best practices in psychiatric medical care. ACMHS will expand and develop the current workforce to support the above activities and obtain certification as a CCBHC. ACMHS will use four strategies, make improvements and expand existing services, develop services to address the acute shortage of SUD and COD services, expand and develop our workforce, and implement improvements in primary care integration and psychiatric medical practices. Unduplicated to be served using grant funds: Year 1 (8/30/2020-8/29/2021) 500 SED children and youth unduplicated, 2,200 SMI/SUD/COD adults unduplicated. Year 2 (8/30/2021-8/29/2021) 600 SED children and youth 2,400 SMI/SUD/COD adult unduplicated. Total to be served during project, unduplicated, current served plus new admissions: 4,300 SMI/SUD/COD adults, 1,360 SED/SUD/COD children and youth.

The Alaska Native Tribal Health Consortium (ANTHC) and the Lower Yukon School District’s (LYSD) FY 2020 Tribal Behavioral Health Grant Program project, entitled “Yupiit Ikayuat (Yup’iks Help)”, is focused on decreasing the suicide and substance misuse rates of Alaska Native youth ages 14-18 in the 10 villages in southwestern Alaska that are served by LYSD through social, economic and intergenerational-based development opportunities. These 10 villages are significantly isolated and poverty-stricken. Research shows that this combination of isolation and poverty is a perfect concoction for decreased access to food, increased mental health disorders and increased rates of drug and alcohol use among youth, all of which are precursors to suicide ideation. According to the Youth Risk Behavior Surveillance System (2013-2017), 23.6% of 14-18 year older in the Lower Yukon School District seriously considered attempting suicide within the past year. This project is focused on addressing the causes of such high suicide and substance misuse rates through the incorporation of community-based social, economic and intergenerational youth development opportunities. The intent of this project is to provide this next generation with the social, emotional and career skills they need in order to be successful and resilient. Additionally, this project is designed to strengthen Alaska Native families, preserve Alaska Native culture and increase self-sufficiency and community well-being.

The Alakanuk Native Connections Program will serve our youth of Alakanuk, a Yup’ik Eskimo community located on the banks of the lower Yukon River in Southwest Alaska. We will serve youth up to age 24, providing behavioral health (BH) services using Calricaraq, a holistic, Alaska Native wellness program, to help our youth heal from past traumas, and help any youth suffering from BH disorders, and to prevent any future suicides from occurring. Calricaraq, translated “the way to be healthy”, is a curriculum based on the traditional values and ways of the people in the Y-K Delta region of southwest Alaska, and involves the incorporation of the ancestral traditional values, practices and teachings into prevention and treatment programs to help our Indigenous people heal from BH 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 (BH) crises. An Action Plan will also be developed to provide a guide for the strategies and activities to be completed during the five-year grant period. At the heart of our intervention will be the Annual Calricaraq Gathering, a 3-day event that teaches participants how to get on the healthy road of life, and the Calricaraq Facilitator Trainings, also 3-days in length, that teach participants how to begin facilitating Calricaraq activities to help our community members get on the road to wellness and recovery. In addition, we will hold weekly talking circles for the youth as well as a talking circle for parents, and we will have a strong presence in the school where we will give weekly presentations and instruction on how to live a healthy Yup’ik lifestyle. Our measurable goals and objectives include the 1) Development, review and update of our policies and procedures related to preventing and responding to youth at risk for suicide, 2) development and implementation of mental health awareness and substance misuse prevention trainings utilizing Calricaraq teachings for the school and community, 3) planning and facilitating a series of youth activities, such as fishing and camping trips, Native arts and crafts taught by elders, and movie nights and lock ins to provide healthy options for our youth to engage in, and 4) facilitate Calricaraq Gatherings and Calricaraq Facilitator Trainings for the community members. The measurement of goal one will be from the documents that are created or updated, and goals 2 through 4 will be based on the number of participants and their survey responses. It is anticipated we will serve 200 youth per year, and 1,000 in the five-year grant cycle.

Native Village of Tyonek (NVT), a federal recognized tribe in Alaska, will serve a population of 373 community members and other residents in the area by providing timely responses to emergency medical incidents in the area by increasing the capacity of rural emergency responders. A responder trained and competent will provide any emergency aid necessary to sustain life and minimize impact of physical and behavioral conditions. The strategy is: 1) to assure adequate 24/7/365 coverage by increasing the pool of EMS responders by 3 locally trained personnel; 2) to assure competent personnel respond to all EMS calls, six personnel lacking formal certification will be trained to EMT level 1; 3) to assure competent emergency medical response to opioid overdose, all EMS staff will be trained to recognize overdose and administer Narcon (naloxone); 4) to assure emergency responders in this isolated village area trained to the highest level of proficiency possible, existing certified EMS responders will receive upgraded training resulting in an additional three EMS personnel certified as EMT-2 or EMT-3; 5) to assure that people in the village having a mental health crisis are provided best practice emergency care, all EMTS will received Mental Health First Aid Training. Because Tyonek is a small, close knit Tribal community, recruitment methods focus on "word of mouth" dissemination within the village. Each Tribal Leader and other staff will also participate in spreading the word. Training will be conducted using several resources such as state training materials and trainers as well as approved curriculum. Each trained EMT is also commissioned to keep on training each other and other tribal members as the need for more EMTs becomes evident. With the high rate of suicide as well as impacts of the most recent Coronavirus (COVID-19) pandemic overwhelm the NVT health system, more people may need to get training in Mental Health First Aid. This project, as does other NVT projects, include a strong partnership with Southcentral Foundation, the Nikiski Fire Department, and the Cook Inlet Tribal Council.

The Tanana Chiefs Conference (TCC) is the traditional tribal consortium of the 42 tribes of Interior Alaska. Our region spans three Census areas (Southeast Fairbanks Census Area; Yukon Koyukuk Census Area; and the Fairbanks North Star Borough) and covers almost one-fourth the entire state of Alaska. The TCC region is divided into six sub-regions and the Fairbanks North Star Borough. Our service area for the Tribal Opioid Response Grant (TOR) project will be four of the rural sub-regions: Upper Tanana, Yukon Flats, Yukon Tanana, and Yukon Koyukuk. We will implement MAT in the regional hubs of Fairbanks, Galena, and Tok. Within these four sub-regions there are 30 villages with populations ranging from 20 in Alatna and 1,246 in Tok. TCC serves 16,797 Indian Health Service beneficiaries each year. While we do not have an exact estimate of the number of individuals with opioid use disorder in the TCC region, several indicators suggest that around two percent of our population currently has an opioid use disorder; most are polysubstance users. Our goals are to 1) increase awareness about the risks of opioid use (prescription opioids and heroin) among youth and adults in the TCC region; and 2) increase the number of individuals with OUD who receive evidence-based MAT. TCC will implement three activities incorporating culturally appropriate and traditional practices: 1) complete a comprehensive strategic plan to address the gaps in prevention, treatment and recovery identified by our tribes; 2) develop and implement effective prevention strategies, including elder education, outreach and engagement of youth, and promotion of drug disposal; 3) Implement service delivery models that enable the full spectrum of treatment and recovery support services that facilitate positive treatment outcomes and long-term recovery. Primary care or other clinical practice settings where MAT is provided and linkages to psycho-social services and recovery services in support of patient needs related to the provision of comprehensive treatment of OUD may also qualify as evidence-based programs/practices. In implementing these activities we will use several evidence-based programs. For prevention efforts, TCC will integrate opioid misuse prevention in its Talk. They Hear You. framework which is currently being used in our broader substance abuse prevention efforts. The approach was selected due to its positive and inter-generational focus, a cultural value, as well as the flexibility to adapt it to TCC’s expanded conversations, and easily adaptable with images and language. TCC will follow the Clinical Guidelines for the Use of Buprenorphine in the Treatment of Opioid Addiction and Incorporating Alcohol Pharmacotherapies into Medical Practices to develop its evidence-based medically assisted treatment program using naltrexone and buprenorphine. TCC will use the evidence-based Matrix Model of Intensive Outpatient Treatment to provide individual and group counseling to patients with opioid use disorder. The Matrix Model is a multi-element package of therapeutic strategies that complement each other and combine to produce an integrated outpatient treatment experience. As a result of these activities we will reach at least 3,000 youth and adults with prevention information and 1,000 adults and particularly elders with information to safely dispose of or store prescription opioids; distribute at least 1,000 lockboxes and opioid disposal bags; train TCC physicians and behavioral health staff to implement policies and procedures to use MAT and provide linkages to psycho-social services and recovery services; and treat at least 34 individuals with MAT.

CITC was established by Cook Inlet Region, Inc. (CIRI) in 1983 as a Tribal 501(c)(3) social services nonprofit organization. Each year, CITC provides services to approximately 9,000 people, who are predominately (but not exclusively) Alaska Native, in the Cook Inlet region, as defined by the Alaska Native Claims Settlement Act (ANCSA) of 1971. With its proposed Tribal Opioid Response (TOR) project for FY 2020, CITC intends to reduce the unmet need for substance use disorder (SUD) and co-occurring disorder (COD) treatment services and the significant harms (e.g., overdose deaths, acute and chronic injuries) that are caused by opioids and stimulants in the Cook Inlet region. With the proposed project, CITC will conduct the opportunity’s required and allowed activities that are listed below. o Required Activity #2. “Implement workforce development activities to ensure that individuals working in tribal communities are well versed in strategies to prevent and treat opioid misuse.” o Required Activity #4. “Implement service delivery models that enable the full spectrum of treatment and recovery support services that facilitate positive treatment outcomes and long-term recovery.” o Required Activity #5. “Implement community recovery support services such as peer supports, recovery coaches, spiritual support, drug and alcohol free social engagement, and recovery housing.” o Required Activity #7. “Assess the impact of the grant [with a tribal epidemiology center or an external evaluator].” o Allowed Activity #1. “Incorporate culturally appropriate and traditional practices into your program design and implementation.” o Allowed Activity #2. “Provide prevention, treatment, and recovery support services to address stimulant misuse and use disorders, including cocaine and methamphetamine, in your community, including the use of contingency management strategies.” CITC’s proposed TOR project will serve 126 unduplicated participants with expanded SUD and COD treatment slots and more resources for supportive services. The proposed project will fulfill the goals and objectives that are listed below. Tribal Opioid Response Grant (FY 2020) Goals & Objectives GOAL 1: Expand the continuum of care for opioid and stimulant use disorders available for adults in Alaska’s Cook Inlet region through the provision of ASAM 3.1 residential treatment. Objective 1.1: Between Month 3 and 24, provide culturally appropriate treatment meeting ASAM 3.1 criteria for 126 adults. Objective 1.2: Between Month 3 and 24, 100% of participants with appropriate diagnoses will have access to medication assisted treatment. Objective 1.3: Between Month 3 and 24, 100% of participants will be offered workforce development training. GOAL 2: Treatment participants receiving CITC TOR services will experience improvement in life domains associated with recovery, as measured by GPRA follow-up interviews. Objective 2.1: Increase participant retention in recovery treatment services. Objective 2.2: Reduce substance use at 6-month and 12-month follow-ups. Objective 2.3: Increase participant employment. Objective 2.4: Increase participant housing stability. Objective 2.5: Decrease participant crime and criminal justice involvement. Objective 2.6: Decrease participant recidivism rate. Objective 2.7: Increase participant social connectedness.

The ALEUTIAN PRIBILOF ISLANDS ASSOCIATION, INC regional MAT Program will continue to provide culturally and caring medication assisted treatment to everyone in our service area. We have the only DEA Waivered provider in the Region. We propose to expand our services to establish a first ever tele-MAT program. Our team consists of DEA Waivered, FNP, a licensed RN, and local providers in each of our four sites. These services will extend from Unalaska/Dutch Harbor to Atka, Nikolski, and St. George Islands in Alaska. We will perform these services utilizing best practices and keeping with cultural and caring values of the Unangan people.

Opioid use and misuse are on the rise in the Yukon Kuskokwim (Y-K) Delta of southwest Alaska. The popularity of opioids is on the rise due to its low cost of production, ease of transportation and affordability for the user. The Yukon Kuskokwim Health Corporation’s (YKHC) Tribal Opioid Response Grant (TOG) Program provides residential and outpatient opioid treatment, and community outreach and education to our many tribal communities. The Y-K Delta region in southwest Alaska is home to 58 Federally recognized tribal communities, more than 10% of the 566 Federally recognized tribes in the United States. Our region is in a very rural setting where no road system exists, and air travel is the standard method of transportation. The population of 27,000 residents is scattered over 75,000 square miles, an area larger than the state of Washington state. YKHC, a consortium of tribes, is the sole direct service provider for the communities in the Y-K Delta region, which is one of the economically poorest regions in the state. YKHC is a member of the Alaska Tribal Health Compact, which is made up of the 12 region tribal health organizations that serve the state of Alaska. The communities of the Y-K Delta were once health and self-sufficient, free from alcohol, drugs and diabetes, but today they suffer a highly disproportionate rate of substance abuse, suicide and depression, domestic violence, STDs, and poverty. Our history of oppression, colonization, epidemics and boarding schools devastated our villages, and resulted in severe social issues that are destroying our people. Now it is the Opioid epidemic that threatens our people, our families and our children. The YKHC TOG Program will 1) enhance the current Opioid Treatment Program to serve up to 40 clients per year, 2) expand existing treatment services available to the patient, and 3) increase our community outreach and education program that travels out to the villages to teach young people and adults about the dangers and realities of opioid abuse, and also get to know and build a network of community-based providers and advocates who can refer clients in for treatment. The clients we serve can be broken down into two categories: Inpatient Opioid Treatment and Community Outreach and Education. During year 1 of the grant we will serve 35 inpatient opioid treatment clients, and 175 participants in the Opioid Outreach and Education activities. In year 2 we will increase to 40 inpatient treatment clients, and Outreach and Education will increase to 200.

The geographic catchment area for our Native Village of Tyonek’s TOR project will include the village of Tyonek (Qaggeyshlat in Dena’ina Athabascan) and surrounding 68 square mile region with a population of 3731. The village is located 40 air miles southwest of Alaska’s largest city, Anchorage, along the west bank of the Cook Inlet. The village is only accessible by air or water and as a result access depends on weather conditions. In our current TOR grant, there is a service gap as there is no worker who can help connect these individuals for treatment. The grant will fill that gap. There are currently no programs that provide drug prevention, intervention and postvention services in Tyonek. The lack of steady behavioral health services in the village of Tyonek means that the majority of at-risk members with identified substance use issues are unable to access treatment and services designed to promote mental health and reduce the risk. The Native Village of Tyonek is currently experiencing prescription pain medications and methamphetamine problems. While we have had a TOR grant for a year and half, our funding was small (54,537.00), and it only allows community education and we are now going to expand to add an outreach specialist, who can create direct referrals for treatment. Our population of focus will be adults 18 and over with opioid or stimulant use disorders. The evidence based medication we will use in our TOR program is Buprenorphine (suboxone). Buprenorphine in its sublingual form retains patients in treatment and reduces illicit opioid use more effectively than placebo. It also reduces HIV risk behaviors. One evidence based way we will address healthcare disparities among AI/AN communities and members is through increasing access to quality behavioral health services through telehealth/telemental health in ways that are holistic, cost-effective, and culturally respectful. The Tyonek Tribal Opioid Response program will promote and increase substance abuse prevention activities in the community by expanding the current tribal health center capacity and implementing the following evidence-based practices: Screening, Brief Intervention, and Referral to Treatment (SBIRT), Drum-Assisted Recovery Therapy for Native Americans, and Learning Circles. All are evidenced-based practices included in SAMHSA’s National Registry of Evidence-based Programs & Practices (NREPP). The unduplicated number of individuals we propose to serve (annually and over the entire project period) with grant funds is: Prevention/education/cultural and traditional practices = 25 in year 1 and 25 in year 2. Engagement and treatment - given our small village we anticipate 5 in year one and 5 in year two. Because of our small population size and our small proposed budget our three staff will include; a part-time project director, a 70 percent program coordinator and a 70 percent outreach specialist. Our whole Tyonek TOR team will work together to review any data we collect, identify any barriers and any improvements that are needed and will make every effort to implement those improvements going forward. 1 United States Census Bureau, American FactFinder.

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

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

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

The project responds to the increasing occurrence of opioid and stimulant abuse in the region by providing medically assisted treatment (MAT) as appropriate and outpatient substance use disorder therapy to the 12 tribal communities of Northwest Arctic Alaska. Direct therapeutic and MAT services will serve an estimated 10 unduplicated individuals each year with approximately a higher number taking part in either therapeutic or MAT services (estimated 25 per year). Additional 4,000 youth and adults will be served by the prevention services. Goal 1 is to Use strategic planning and project reporting to improve OUD/SUD services. Objective 1.1. Within 60 days, complete strategic plan for opioid and stimulant use disorder services. Objective 1.2. Within 3 months, coordinate ongoing regional efforts for crisis response to OUD/SUD (including NARCAN availability and training). Objective 1.3. Use project performance data collected and reported to periodically review project implementation and address improvements (ongoing periodic reporting). Goal 2: Prevent expansion of opioid and stimulant abuse in the Maniilaq Association service area. Objective 2.1. Within 6 months of award, work with Maniilaq Departments and Programs to leverage community prevention outreach. Objective 2.2. Within 10 months of award, work with Maniilaq programs and departments to design and produce locally and culturally responsive prevention media. Goal 3: Continue implementation of OUD/SUD Service Delivery developed under previous TOR project. Objective 3.1. By the first month of project period, continue delivery of MAT to clients who wish to participate in these services. Objective 3.2. By 6th month of project period Train Community Health Aides on use of MAT Objective 3.3. By 6th month of project period, review integration of Behavioral Health Services outpatient clinical services with MAT services.

The Matanuska-Susitna Borough (MSB) is the fastest growing region in the State of Alaska and covers an area of about 23,000 square miles. Since the year 2000, the MSB has doubled in population size and is the fastest growing region in the state. The Chickaloon Native Village resides within the MSB and its service area encompasses nearly half of the borough. This broad area of coverage and the rapidly increasing population present unique challenges to increasing service and resource accessibility, especially for those residing in rural communities and who are struggling with Substance Use Disorders. Currently, the Chickaloon Native Village (CNV), has implemented a Tribal Opioid Response Program in an effort to connect our community and Tribal members to services they might not otherwise receive through partnerships with organizations like Southcentral Foundation (SCF) and Cook Inlet Tribal Council (CITC). The aim of this project is to again meet our Tribal and community members where they are by assisting those who are experiencing Opioid Use Disorder and Stimulant Use Disorder in accessing services and resources that are evidence-based and culturally appropriate while remaining in their community. In order to meet this goal, CNV plans to further develop and expand current TOR programming while maintaining current partnerships between CNV and existing community partners. Chickaloon Native Village plans to use this additional funding to expand the current service array to include substance use counseling services, outreach, education, and preventative activities, within the Chickaloon Native Village community for all community members that are evidence based and culturally appropriate to the CNV community.

This SAMHSA Tribal Opioid Response Grant proposal is submitted by the Hydaburg Cooperative Association (HCA). HCA was chartered in 1938 as a Federally Recognized Tribe in accordance with and by authority of the Indian Reorganization Act of June 18, 1934 (48 Stat. 984). A 20-year community plan, the community safety survey, regional and statewide data, and existing gaps in programs and services all point to the need for developing a continuum of community-based and culturally-grounded prevention, treatment and aftercare support. The overall goal of this Tribal Opioid Response Project is to supplement and expand access to evidence-based prevention, treatment, and recovery support services that will result in a reduction of the misuse and use of opiates and methamphetamines in Hydaburg, Alaska. Five project objectives have been identified that are driven in large part from the community planning and data collection efforts that have taken place. The project objectives and related activities outlined in the proposal include several of the required and allowable activities outlined in the Funding Opportunity Announcement.

Ninilchik Tribal Opioid Response. Ninilchik Traditional Council's Ninilchik Community Clinic (NCC) has been developing an addictions program since 2014. NTC has provided MAT using buprenorphine since 2016. NTC's Addition Program will continue to enhance and expand their addiction clinic to make MAT recovery services available to the entire Ninilchik Village Tribe area, with service to Kenai, Soldotna, and continued service to Anchor Point, Homer, Seldovia, and Nanwalek. Current service gaps include: 1.) outreach and engagement activities to increase positive outcomes in recovery services 2) screening, care coordination, risk reduction education, testing, and services for community members 3.) offering diverse services and delivery models to greater support recovery, 4.) peer recovery support services (PRSS). Our user population is 652, however, the clinic is open to non-IHS beneficiaries as well. Based on demographic data, we anticipate most of our patients to be low income, white, and Alaska Native. NTC will target individuals who are active drug users, and those who are not actively in our Medication Assisted Treatment Program. NTC also has the MAT-PDOA grant which is utilized to provide services to patients who are actively on medication assisted treatment. Goals and Objectives: Goal 1: Implement workforce development activities to ensure that individuals working in tribal communities are well versed in strategies to prevent and treat opioid misuse. Objective 1:1: By November 2020, NTC will continue outreach to increase knowledge of recovery services among the Southern Kenai Peninsula healthcare providers, behavioral health providers, Department of Corrections, probation officers, the Reentry Coalition, Change for the Kenai, and the South Peninsula Opioid Task Force. Objective 1:2: By November 2020, NTC will create an outreach campaign to address overdose prevention and substance use stigma within our tribal community. Goal 2: Implement service delivery models that enable the full spectrum of treatment and recovery support services that facilitate positive treatment outcomes and long-term recovery. Objective 2:1: By September 2020, NTC will utilize its TOR Project Director to continue to provide services in our integrated MAT program. They will be the linkage when a participant is willing to engage in MAT, peer support, case management and behavioral health services. Objective 2:2: By September 2020, NTC will provide peer recovery support services twice a week to people with OUD and polysubstance use disorder. Goal 3: Implement community recovery support services such as peer support, recovery coaches, spiritual support, drug and alcohol-free social engagement, and recovery housing. Objective 3:1: By November 2020, NTC will offer varied activities to be able to engage participants at any stage of recovery Objective 3:2: By September 2020, NTC will provide case management one day a week to people with OUD and polysubstance use disorder who are not receiving medication assisted treatment. Goal 4: Provide prevention, treatment, and recovery support services to address stimulant misuse and use disorders, including cocaine and methamphetamine, in your community, including the use of contingency management strategies. Objective 4:1: By September 2020, NTC will have developed an outreach strategy to engage community members who may still be actively using opioids or stimulants and need services. Objective 4:2: By November 2020, NTC will be able to provide fentanyl testing strips and other overdose prevention tools to be able to provide education about drug use and overdose prevention. Objective 4:3: By November 2020, NTC will be able to provide support services to those still not engaged in our MAT program or who are actively using. NTC Project Director will connect with this population through outreach at the Homer and Anchor Point Food Pantry, our local syringe exchange, and through networking.

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

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.