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This Program will provide SVBPI Tribal members access to quality Treatment and Recovery Services. SVBPI plans to primarily utilize the professional services of Campobello, a treatment center owned and operated by the Scotts Valley Band of Pomo Indians. SVBPI will also seek the services of treatment programs that are culturally informed, offer trauma informed care and with professional staff that are caring and effective. The program will assist individuals to walk a better path that is free of addiction barriers to wellbeing.

Adventist Health System/West ("Adventist Health") proposes to use $985,000 in congressional funding to enhance services for unsheltered community members in the California counties of Lake, Yuba and Sutter. According to Partnership HealthPlan, an estimated 3,000 lives are experiencing homelessness in Lake County alone; this has exacerbated the prevalent issues these community members face, such as substance use, mental health, housing and access to care. Currently, Adventist Health offers a housing first model for medical respite and supportive housing for medically fragile, high-utilizing complex care patients. Adventist Health provides this through two locations in the City of Clearlake, the Restoration House -- a 10-bed transitional living environment -- and through the Hope Center -- a 20-bed low-barrier entry transitional housing program. Based on the successes of the Restoration House, Adventist Health aims to achieve two goals with this project: Goal 1: Respond to increased community health needs for the existing Restoration House. Goal 2: Open a Restoration House in the counties of Yuba and Sutter, using the same staffing and operating model as in Clearlake. Funding will specifically be used to support personnel expenses, furnish clinical and housing items (such as hospital beds) and offset the needed leases.

The Shingle Springs Band of Miwok Indians is a federally recognized Tribe residing in El Dorado County, California. The Shingle Springs Health and Wellness Center (SSHWC) is the tribal agency that will administer the proposed project. The SSHWC is owned and operated by the Tribe and provides direct healthcare services under the authority of a PL-638 Indian Self Determination contract with the federal Indian Health Services. Our Population of Focus is SSBMI tribal members and other American Indian/Alaska Natives (AIAN) residing within the service area of the SSHWC (El Dorado County). The Tribe currently has 530 members, with approximately 45 % of them between the ages of 0-24 years old, 45% 24 to 54 years of age and 10% 54 and older. There are 51 elders, the oldest tribal member being 83. Goals of the project include: • Treatment – Implement service delivery in primary care where MOUD is provided and linkages to psychosocial services and recovery support services centered on patient needs related to the provision of comprehensive treatment of OUD. • Recovery – Create Recovery Supportive Communities by facilitating recovery events and by designing space to support recovery group meetings and social gatherings. • Prevention – Implement prevention and education services including training Tribal staff in Adverse Childhood Experiences (ACEs) and Social Determinants of Health (SDOH). • Implement harm prevention/reduction services: Including training first responders and other key Tribal members on the recognition of opioid overdose and appropriate use of the overdose reversal medication naloxone. The project intends to serve at least 25 unduplicated people with Medication for Opioid Use Disorder in year 1 and 35 in year 2.

Project Summary: California Rural Indian Health Board, Inc. (CRIHB) will implement the California Rural Tribal Opioid Response (TOR) project in rural Tribal communities in Northern California to address opioid use disorder by incorporating culturally appropriate and traditional indigenous practices in prevention and public awareness, intervention, and treatment programming, as well as provide services to address stimulant misuse and use disorders as part of prevention activities. Populations to be Served: CRIHB will partner with five consortium member Tribal Health Programs (THPs): Anav Tribal Health Clinic in Siskiyou County; Sonoma County Indian Health Project, Inc. in Sonoma, Mendocino, and Marin Counties; Toiyabe Indian Health Project, Inc. in Inyo and Mono Counties; Tule River Indian Health Center, Inc. in Tulare County; and Warner Mountain Indian Health Program in Modoc County. The TOR project will enhance relevant THP staff qualifications and improve health and quality of life for 200 unduplicated American Indian Alaska Native (AIAN) residents annually. Project Goals and Objectives: The CRIHB TOR project has the following goals: increase medication-assisted treatment (MAT) services at participating THPs; partner with CRIHB workforce development programs to implement relevant Opioid Use Disorder (OUD) prevention training for Tribal health care workers; utilize an intergenerational, multifaceted approach in the prevention of OUD and overdose for elders, youth, and other vulnerable populations; implement Tribal Youth Council public awareness campaign addressing opioids, stimulant use, and related risk factors; enable participating THPS to administer a full spectrum of treatment and recovery services; provide assistance to patients with treatment costs and develop strategies to eliminate or reduce treatment costs for under and uninsured AIAN patients; work with the Program Evaluator to assess the impact of the project activities. To meet its TOR objectives, CRIHB will implement the following activities: all five participating THPs will continue to provide MAT services, or have agreements with local MAT providers for referral; provide at least four relevant trainings to the participants of the CRIHB workforce development program; provide at least six training courses at CRIHB's Research and Public Health Department-sponsored training courses; provide at least six activities targeted at elder education; modify existing OUD education campaign materials to match strategic messaging needs for participating THPs; partner with at least five organizations to help increase education and services for specific vulnerable populations within rural, Tribal communities; partner with CRIHB's Tribal MAT project and naloxone-distributing programs to ensure the medication's availability. In addition, all participating THPs Tribal Youth Council will lead two opioid and stimulant use prevention meetings for youth in their community. All participating THPs will collaborate with CRIHB's Youth Board to create opioid safety and prevention messaging to be shared on CRIHB's social media. The five participating THPs will be designated hubs or continue to have agreements with their local hub in the California Hub and Spoke System. The hubs will provide at least two (one per year) training courses to participating THP staff on youth-specific service delivery and discharge planning. They will provide at least two (one per year) x-waiver training courses for participating THPs and qualified practitioners. CRIHB will create a peer support group schedule for each of the five participating THPs. CRIHB will inform participating THPs how subcontract funds can be utilized for patient treatment costs. CRIHB will complete eight quarterly reports (four per year) to track and report on the impact of the grant.

Mathiesen Memorial Health Clinic (MMHC) service area is located in and around Jamestown, California, (zip code 95327) and expands into the north-eastern Sierra foothills (zip code 95370) in Tuolumne County. This community has been greatly affected by the economic downturn to the COVID pandemic. We are seeing and experience an influx use of illicit drugs and overindulgence of opioids resulting in high numbers of overdoses in our emergency departments. MMHC was fortunate to had begun providing Medication Assistance Treatment (MAT) and substance use counseling services just prior to the pandemic, thanks to our first TOR grant. At first, we began a small program with a few patients. As the pandemic raged, we began caring for a higher number of patients than anticipated. Within a year we had to move our MAT services to a larger dedicated space, which we now call the Red Feather Clinic. By the end of last year, we had 345% more patients than we originally anticipated. Thus, MMHC will need to continue to be a strong source of care for our Tribal members and community at large. MMHC will continue to enhance and expand our existing MAT and substance use counseling program provided by highly experienced and passionate staff. Over the next year we expect to care for 180 new patients and 40 the following year. We have been outreaching to schools and noticed the need for a youth treatment program, which there are none in our area. Our plan with the 2022 TOR funding is to begin a more aggressive outreach campaign, seeking and educating youth on drug use and prevention of overdose. We plan to do 10 educational community events; at which time we will distribute overdose kits containing Naloxone. Over the two years we hope to distribute at least 500. MMHC's MAT/SUD Counselors have taken basic training in contingency management this last year. All agree it is a promising care modality for positive reinforcement which will support pathways to recovery. This next year, with the TOR funding, MMHC will develop a contingency management implementation plan, and take the guided steps in providing the evidence-based program that includes protocols, staff training, developing tracking a system for incentives, patient education and evaluation plan. We hope to have the program available mid-year. MMHC is committed to delivering best practices, evidence based and trauma-informed care for our clients diagnosed with opioid use/substance use disorders. We have dedicated individuals that provide needed services and are open to anyone in need, no matter how they enter: self-referred, walk-in or referral. Thus, we need to add an addition certified substance use counselor to our family of clinicians. With this funding we would immediately begin the recruitment. Service Area: MMHC’s service area is the city of Jamestown, a national designated historic town located in western Tuolumne County, California, and the surrounding area. Jamestown is a rural and somewhat remote area with minimal services located in the Sierra Nevada Mountain foothills. Target Population: The target population is the Chicken Ranch Rancheria tribal membership of 32 members, 840 unaffiliated Native American Indians who reside in Tuolumne County, and the low-income population that reside in and around Jamestown. Expected Outcomes: MMHC expect outcomes are: 1) provide 220 patients in the two years 2) hire another part time substance abuse counselor; 3) increase outreach to high-risk youth proving care to at least 20 teens, and 4) develop and implement a contingency management program.