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The Mino Bimaadiziwin Wellness Clinic Project seeks to address the overdose crisis for Native Americans (NAs) living in Minneapolis/St. Paul urban areas (including all surrounding suburban areas) by further developing our culturally responsive continuum of services, including prevention, harm reduction, treatment, and recovery support services for stimulant misuse, opioid use disorder (OUD), and co-occurring substance use disorder through the development and expansion of behavioral health integration, expanding community education & awareness of prevention activities. NAs in MN have the highest rate of death due to drug poisoning (compared to Whites); and experience overdose deaths at seven times that of White counterparts (MHD, 2019). NAs also experience disparities in mental health disorders, and lack access to and drop out of mental health treatment at high rates. Native American Community Clinic and Red Lake Nation's Medication Assisted Treatment (MAT) programs, established in 2016, prescribes FDA-approved oral Suboxone for the treatment of OUD. In order to enhance the continuum of care and help to better stabilize clients, we will add housing case management, mental health assessment and case management, and a cultural coordinator to embed cultural activities into expanded programming and ensure cultural responsibility through ongoing training. To address the goal of, Increase and enhance the culturally responsive prevention, harm reduction, and recovery services to NA community members to reduce overdose deaths in the Minneapolis/St Paul area, four objectives have been identified: Objective 1. Within the first 6 months, launch new recovery services facilitated by Case Managers and/or Cultural Coordinator. Objective 2. In year 1, provide mental health support to individuals impacted by SUD. Objective 3. Collaborate with Native American Community Clinic to increase access to harm reduction services onsite. Objective 4. Integrate cultural programming and enhance culturally responsive care throughout the spectrum of services. Key activities include but are not limited to: Create recovery support community, expand telehealth access, increased mental health support, provide overdose prevention education and Narcan supplies, coordinate cultural competency training, and document and share culturally responsive promising practices. We will serve 50 people in year one and 55 in year two for a total 105 unique individuals.

The Gila River Indian Community, is a federally recognized tribe and the population of the focus for the proposed Tribal Opioid Response Project are youth ages 10 to 17 and adults who are GRIC members and or AI AN members residing in the community. The proposed catchment area for the Tribal Opioid Response Project is the GRIC located on 372,000 acres of land south of the Phoenix Metropolitan area in both Pinal and Maricopa Counties. The tribal membership includes both the Akimel O'odam - Pima and Pee-Posh - Maricopa people. The project will be successfully implemented under the guidance and management of the Gila River Health Care. The focus of this project includes, 1 supplementing the current programming within the community with a strategic plan to advance prevention efforts through community awareness of opioid use disorder, stimulant use disorders and co-occurring substances; 2 increase treatment efforts with Medication for Opioid Use Disorder ; 3 build infrastructure to implement contingency management for stimulant use disorder; 4 enhance the strategic system of collaboration between specific community departments to identify community members needing treatment and or recovery support and finally, 5 enhance the avenue for recovery support/sober living housing. The current Indian Health Service User Population for GRIC is 34,438. Of the population, it is estimated 8,642 or 37.7 per cent do not reside within the boundaries of the community. Arizona Department Health Services reported in the 2020 Primary Care Area Statistical Profile estimated the population to be 14,260 residing in GRIC.1 GRHC will design the collaborative coalition of partners to oversee the progress of the program, regularly evaluate program data, and collaborate with a Program Evaluator to ensure continuous improvements through a process known as Plan, Do, Study, Act to ensure that the program meets its goals and objectives. A coalition of partners will consist of approximately ten members, including the Gila River Health Care Behavioral Health Services Prevention and Treatment teams, GRIC Department of Rehabilitation Services, GRIC Police Department, GRIC Tribal Social Services, and other community representatives.

The Kickapoo Tribe in Kansas (KTIK), with more than 1,600 enrolled members, is a federally recognized sovereign Indian Tribe residing on a rural reservation in Brown County, Kansas. The KTIK community face behavioral health challenges that mirror those of many indigenous communities, exacerbated by high rates of poverty and unemployment. Culture, language, community, and health are integral to KTIK and are essential to living our values, healing our community, and addressing drug misuse and recovery. KTIK has identified behavioral health service needs, including mental health and recovery programs. KTIK will develop a holistic Tribal Opioid Response program, KTIK Return to Community (R2C), that includes prevention; screening; treatment; and peer-led recovery for opioid, stimulant, and other substance use. The goals of this project include: 1) Continue providing community-based MOUD treatment services at the Kickapoo Nation Health Center established in the first TOR project and expand to support other Stimulant Use Disorder (SUD) treatment needs, including methamphetamine use; 2) Build a peer-led system of recovery inclusive of culturally responsive resources, peer mentorship programs, and intergenerational community strengthening; and 3) Increase KTIK's capacity to provide comprehensive, trauma-informed supports to community members that systematically strengthen intergenerational relationships and build community-wide trust in order to prevent future substance use disorders (SUD). R2C will build on KTIK's 2019-21 Tribal Opioid Response project and through a coordinated effort between Kickapoo Social Services, Kickapoo Nation Health Clinic, tribal and external partners, KTIK will reduce the harmful effects of substance use in the Kickapoo community for generations to come.

The Sicangu Oyate (Rosebud Sioux Tribe-Lakota) seeks to utilize the Tribal Opioid Response Grant to address the opioid crisis as it affects tribal communities on the Rosebud Indian Reservation through the use of American Indian (Lakota) culture based intervention and treatment, and evidence-based methods. These funds are needed to strengthen and expand opioid treatment capacity for the Sicangu Oyate. This opportunity will be used to build on existing programs in 1) coordination between local health systems, 2) medications for opioid use disorder (MOUD), 3) peer supports and recovery coaching, and 4) harm reduction. These expanded services will ensure patients receive high- quality care. There are several reasons why these funds dedicated to responding to the opioid epidemic are critical: (1) in South Dakota, opioid use among the American Indian population continues to rise; (2) Rosebud represents a highly underserved population in which the social impact of addiction is amplified, and (3) given existing infrastructure, the Tribe is primed to successfully expand its MOUD program to meet needs. We intend to build a Sicangu Opioid Response Team of key tribal stakeholders to address the burden of opioid use disorder on the Rosebud reservation through the following goals: *Deploy evidence-based screening tools at key sites in the community (including the Rosebud Sioux Tribe Adult Correction Facility) to identify individuals who would benefit from MAT and initiate fifteen individuals annually on MAT *Support a tribally-based opiate/opioid specialized counselor position to screen, assess, treat and follow-up in continuing care, individuals receiving MAT. The Methamphetamine/Opioid Rehabilitation Unit Coordinator shall designate one counselor as the opioid use disorder (OUD)lead; the OUD lead will stay up-to-date on addiction medicine topics on opioids and recovery from opioid addiction; the OUD will organize intermittent trainings on OUD topics for the other team counselors; the OUD lead will answer OUD-related questions for and share educational materials with the other team counselors. *Support an opioid specific peer recovery coach position to coordinate, create and/or strengthen linkage between service providers, and act as an advocate for clients. This will ensure a seamless transition through the continuum of care. The peer recovery coach will also recruit and support volunteer peer recovery coaches and community-based support group activity *Collect data on patients enrolled in the program at intake, three months, and six months to improve understanding of gaps in prevention, treatment and recovery and to assess the impact of our interventions Our program will aim to align with regional- and nation-wide efforts to leverage evidence-based strategies for combating opioid-use disorder (OUD) and mortality related to overdose. We will build upon and strengthen existing resources to integrate a system of opioid prevention on the Rosebud Sioux Reservation

The Eastern Shoshone Tribe is located on the Wind River Reservation (WRR) located in central Wyoming. With more than 2.2 million acres of land, the WRR is home to the Eastern Shoshone and Northern Arapaho tribes. With separate governance structures, tribes operate independently of one another, the Eastern Shoshone Recovery (ESR) Program of the Eastern Shoshone Tribe developed this proposal. According to the 2018 tribal enrollment records, there are 4,368 enrolled Eastern Shoshone tribal members living on the WRR. A review of SPARS data from active ESR SAMHSA funded grants indicates that 32% of all clients report alcohol-related disorders, 10% opioid-related disorders, 8% cannabis-related disorders, and 10% other stimulant-related disorders. Additionally, 27% of clients experience mental health diagnoses. Marijuana is the most commonly reported drug used in the past 30-days, with 18% of clients reporting use, followed by alcohol (16%), methamphetamines (11%), and oxycontin/oxycodone (7%). Trauma and violence are shared among clients; 100% of transgender clients and 71% of female clients report lifetime trauma. Fremont County is a designated healthcare provider shortage area, and low pay, burnout, and COVID-19 have compounded issues related to OUD treatment. The proposed project will address these issues and fill gaps in services with the activities described in this proposal. The ESR MAT Program will address the opioid crisis on the WRR from the growth of opioids and OUD on the reservation. The project has two primary goals: 1. Increase access to culturally-driven evidence-based treatment on the Wind River Reservation for 30 tribal members served by ESR by August 31, 2024 2. Decrease OUD/stimulant use disorder on the Wind River Reservation by implementing culturally-centered prevention and education services that address behaviors that may lead to use or relapse The program will continue to work with TOR II partners and content experts to bring exciting, innovative, and effective evidence based prevention, treatment, and recovery practices to the Eastern Shoshone community. Through the use of social media, electronics, and alternative pain management practices, the TOR III program will be an essential piece to the healing of the community.

The Spirit Lake Tribal Opioid Program will provide for the continuation of prevention and education for the community members of the Spirit Lake Reservation and surrounding communities. The TOR program will continue to provide a registered nurse (RN) to provide and promote the prevention of opioid use disorder in community members, as well as create health care plans for clients to reach their optimal health status. The TOR program will also continue to provide one peer support specialist that will keep striving to provide the support necessary to assist clients to make lifestyle changes that lead to better whole-health outcomes.

TITLE BMIC: Tribal Opioid Response Expansion Program PURPOSE The Bay Mills Indian Community (BMIC), a federally recognized tribal government, is dedicated to addressing the opioid crisis within our community by increasing access to evidence-based treatment in a culturally competent environment. BMIC has approximately 2,342 tribal members, with 705 tribal members living on the BMIC reservation. According to the Bay Mills Health Center Uniformed Data System (UDS) FY 2020, the total universal patient population was 2,843. Of the total patient population, 740, or 26% of patients, received Behavioral Health Services. Additionally, 15% of the Behavioral Health Substance Abuse population has a diagnosis of opioid use disorder. BMHC is determined to decrease the growing rate of substance use disorders, specifically opioid use disorder, by expanding community prevention, educational, and recovery support services. To continue to provide quality care to the identified population, BMHC is seeking funding in the amount of $250,000 from the Department of Health and Human Services (DHHS)-Substance Abuse and Mental Health Services Administration (SAMSHA) Tribal Opioid Response (TOR) Grant NOFO: TI-22-006. The Tribal Opioid Response Project Director will coordinate with key leadership and personnel from each socioeconomic department in order to prioritize the design, delivery, accessibility, and effectiveness of prevention, treatment, and recovery support services. With continued collaboration and by building supportive partnerships, BMHC will begin to evaluate, monitor, and modify the historical trend within the community. This proposed plan will also allow for the expansion of services to provide all-inclusive culturally appropriate prevention and education to our patients, families, and community. In 2018, the BMIC Executive Council publically committed to the promotion of prevention and education to address the opioid pandemic within the Bay Mills Indian Community and surrounding area. With strong leadership influence and dedicated partnerships, the BMHC will continue to overcome the stigma associated and decrease opioid use within the community. For several years, BMHC has been working to overcome indifferences and underlining conditions from the opioid epidemic. Within this proposed plan, key aspects have been identified. They will be utilized to promote the adverse and permanent effects on an individual concerning the physical, mental, social, spiritual, and economic well-being after opioid use/abuse. Aside from prevention and education, BMHC will expand the current therapeutic treatment models and recovery support services offered. This effort is greatly needed and has been identified by the patient population.

Project Summary: Pit River Health Service, Inc., which is the healthcare services system of the federally recognized Pit River Tribe of Northeast California, will conduct a two year project aimed at addressing opioid and stimulate use issues in our community. The Project Coordinator is a full time position that is responsible for the day to day program operations. This position will coordinate eight required activity types which will include planning, outreach, education, treatment, and other assistance to Native community members who are affected by opioid and stimulant issues. Work will be coordinated interdepartmentally between our Medical and Behavioral Health departments. The requests for services increased significantly in the last year as has the need for additional resources including a case manager to work with the most at risk community members. We will hire a consultant to provide technical assistance to medical staff and to the clinical staff working directly with clients. Our activities are showing positive results and we are excited to continue and expand treatment and prevention activities.

Na'invi Towa Hekhaa- My peoples Healing is a Prevention Project aimed at addressing Opioid and Substance Abuse Prevention utilizing Culture and traditional practices as a way of seeking wellness in our peoples walk in life.

The Kiowa Tribe's Tribal Opioid Response Recovery Response will initiate and create the medication-assisted treatment (MAT) services for Tribal Citizens and members of surrounding communities who are diagnosed with opioid use disorder (OUD) and are seeking or receiving MAT. Our Tribal jurisdiction is not located on a traditional reservation but spans bicultural communities under shared jurisdictions with Oklahoma governmental systems & other Tribal governments. The Kiowa Tribe is a federally recognized tribe with tribal enrollment numbers totaling 10, 600 with the large population residing in the Anadarko area in Southwest Oklahoma. To reach our project goals of increasing the number of individuals with OUD receiving MAT and seeing a decrease in illicit opioid use and prescription drug misuse at 6-month follow-up our treatment regimen will provide outpatient treatment services, we will provide classes, & refer individuals with necessary resources for those suffering from UOD. The Kiowa Tribe will utilize the 2016 RAND Corporation's MAT Guidebook for Health Center's four phases of Assessment, Induction, Stabilization, & Maintenance. To increase the capacity of our Tribe to address our opioid crisis long-term we will adopt a Recovery Oriented System of Care (ROSC) approach. These efforts will support our MAT goals with added components of outreach, expansion of recovery supportive services, formal collaborations, community education to reduce stigma, and professional workforce development. The evidence-based modalities we will use include Quick Screen (QS) from the National Institute for Drug Awareness, which is an evidence-based practice appropriate for all adult populations, including our population of focus: Native Americans. It is used to increase identification of patients risk of substance abuse disorder and to determine the depth of the substance abuse. We will also use the Brief Negotiation Interview (BNI) model, to increase the identification of candidates and the readiness for MAT services and is appropriate for all adult populations, including Native Americans.

The Southern Ute Behavioral Health Department aims to utilize funding from the Tribal Opioid Response grant to increase our capacity to provide harm reduction for the estimated 3,579 Native Americans that live on and near the Southern Ute Reservation in Southwest Colorado. Our interventions include: - Medication-Assisted Treatment, with expanding access to MAT to inmates at the detention center: - Widespread naloxone training and distribution - An anti-stigma social marketing campaign - Implementation of a contingency management program - Development of a Recovery Housing program We anticipate providing MAT to 50 discreet individuals annually and providing naloxone training and distributing naloxone to approximately 250 individuals. We are currently undergoing a comprehensive assessment and planning process for our strategic approach to substance use that will include collecting baseline data, developing an ongoing evaluation model, and creating a roadmap.

The Match-E-Be-Nash-She-Wish Band of Pottawatomi Indians (d.b.a. Gun Lake Tribe) is requesting $249,981 in federal funding for year 1 of the FY2022 Tribal Opioid Response (TOR) Grant. FY2021 Tribal Needs Assessment data indicate that substance use is an issue in the community. 81% of respondents 18 and older had used substances at some point in their life. The assessment also found youth are using substances at an earlier age. Gun Lake Tribe HHS FY2023-FY2027 Strategic Plan supports the project and further identified the need for additional prevention services and programming. The overall goal for the Sober is Sacred Project is to expand existing, and establish new, prevention, treatment, and recovery support services for opioid use disorder (OUD), and co-occurring substance use disorders. Over the course of the two-year project, the Tribe will complete the following two objectives: Objective 1: Provide appropriate substance use disorder treatment levels of care and coverage for individuals and/or clients including those reentering the Tribal Community from criminal justice or other rehabilitative settings. Objective 2: In coordination with other efforts, update and continue the youth substance abuse prevention program.

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 adults ages 18-years-old and older, in the Tribe's jurisdiction and surrounding area. The program looks to serve at minimum 30 adults annually and 105 throughout the lifetime of the project. The wide-spread use of opioids, stimulants and other drugs of abuse pose additional threats to the physical and emotional wellness of the Ponca Tribe of Oklahoma. In the 2020-2021 Annual Report submitted to the Ponca Tribal Business Committee, the White Eagle Health Center-Behavioral Health Department (WEHC-BH) saw an increase of 20% in clients seeking services for opioid and stimulant treatment. Treatment outcomes are further complicated by the lack of transportation, employment, housing, detox, and aftercare. Additionally, the Ponca Tribe of Oklahoma Business Committee has identified methamphetamine as a significant drug threat for the community. These gaps in services have been partially addressed by federal funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) but additional funding is required to produce optimum outcomes. The proposed project seeks to strengthen the recovery support services, treatment options, and prevention activities for the Ponca Tribe of Oklahoma catchment area. The goals of the project are too: 1)Increase the capacity of recovery support services designed to assist individuals and families to initiate, stabilize, and maintain long-term substance abuse recovery, 2)Maximize the accessibility of evidence-based treatment practices for American Indian/Alaskan Natives (AI/AN) clients diagnosed with Opioid use disorder (OUD) or co-occurring disorder (COD), and 3)Initiate awareness and increase understanding of historical trauma and internalized oppression as contributing factors to current trauma, violence, criminal activity, and substance abuse.

The Northwest Portland Area Indian Health Board's Tribal Opioid Response Consortium Phase 5 will facilitate the expansion of Northwest Tribes capacity for tribal substance use response. The overarching mission is to develop a comprehensive and strategic approach to assist Tribes in addressing the complex factors associated with a comprehensive substance use response by utilizing strategies outlined in the Tribal Opioid Response Strategic Agenda. This includes expanding access to culturally appropriate prevention, treatment, and recovery activities to reduce unmet treatment needs and substance-related deaths through a strategic response plan. TOR5 has the opportunity to reach at least 50,000 tribal members annually (100,000 over 2 years) through outreach, education, social marketing and media messages, and treatment and recovery services. SUD prevention, education, and treatment for this TOR5 grant are inclusive of opioid and stimulant use and misuse disorders. The goals and objectives for the grant are: Goal 1: Prevent new cases of substance use disorder in AI/AN communities by increasing the use of evidence and culture-based interventions and innovative community-based strategies. The three objectives are 1) Include culture and tradition into SUD prevention strategies; 2) Increase awareness of tribal substance use response in AI/AN communities through social marketing & media materials and messaging and; 3) Educate community members, healthcare providers, and/or healers about opioids and stimulants. Goal 2: Increase overdose reversal capacity and access to tribal, evidence- and practice-based training, treatment, and recovery services. The five objectives are 1) Incorporate harm reduction into tribal treatment and recovery services; 2) Develop programs for sub-populations affected by SUD (i.e. pregnant mothers and babies, active military and veterans, those incarcerated); 3) Develop an integrated and inclusive treatment model of care; 4) Develop comprehensive and inclusive recovery services and; 5) Offer ongoing training to providers. Goal 3: Increase capacity building within the Tribes for the sustainability of SUD prevention, care, and services. The two objectives are 1) Cultivate responsive leadership and; 2) Cultivate responsive communities. NPAIHB's primary role in the TOR5 is to provide leadership, coordination, data management, analytic support, and training and technical assistance to participating Tribes in both the application and administration of the SAMHSA TOR 2022 grant. Our proposed activities will strengthen our partnerships with Northwest Tribes, the Substance Abuse and Mental Health Services Administration (SAMHSA), the Indian Health Service (IHS), and the states of Idaho, Oregon, and Washington. The NPAIHB TOR5 will expand access to integrated health services, thus reaching critically underserved American Indian/Alaska Native (AI/AN) people living in the United States.

From 1999 to 2019, opioid-only mortality rates increased from 2.8 to 15.8 per 100,000 (p< 0.001) for American Indian/Alaska Native (AI/AN) women and 4.6 to 25.6 per 100,000 (p< 0.001) for AI/AN men in the U.S. During the same time period, the AI/AN population also exhibited significant increases in mortality rates due to opioids in combination with other substances (i.e., alcohol, benzodiazepines, and methamphetamine), where all opioid-related mortality rates increased significantly (p< 0.001) from 5.2 to 33.9 per 100,000 AI/AN persons. Similar behavioral health disparities are witnessed among the AI/AN population in New Mexico. The AAIHB TOR Project has been designed to address the opioid overdose crisis in tribal communities via a collaboration of a tribally designated organization, the Albuquerque Area Indian Health Board, Inc. (AAIHB), and four of its six Consortium Tribes; Jicarilla Apache, Mescalero Apache, Ramah Navajo, and To'hajiilee Navajo. The overarching purpose of the AAIHB TOR Project is to support the continuum of prevention, recovery, and harm reduction services for opioid use disorder (OUD) and co-occurring substance use disorders among AI/AN youth and adults. Project goals and measurable objectives are aligned with the foundational elements, priorities and strategies of the National Tribal Behavioral Health Agenda, and include the following core components: 1) training, certification a mobilizing a cadre of AI/AN peer support workers in all 4 participating tribes; 2) developing and disseminating culturally centered strategic messaging products; 3) facilitating community trainings on naloxone use, Mental Health First Aid (MHFA), Question Persuade Refer (QPR), Trauma-Informed Care, Adverse Childhood Experiences (ACE), and/or Social Determinants of Health (SDOH); 4) facilitating Project Venture courses with AI/AN youth; 5) disseminating naloxone within the participating tribes; and 6) reviewing and enhancing existing tribal harm reduction policies/practices in all four participating communities. At least three Evidence Based Practices into this effort, Project Venture (PV), Mental Health First Aid (MHFA), and Question, Persuade and Refer (QPR). These selected EBPs are appropriate for the proposed outcomes, have strong evidence, and have a history of successful implementation with diverse communities in New Mexico, including tribal communities. The AAIHB TOR Project is therefore well positioned to strengthen prevention, recovery, and harm reduction activities among AI/AN youth and adults throughout our region to engage tribes, create awareness of OUD and prevention pathways, increase access to harm reduction practices, and enhance recovery support for affected individuals and families that are currently experiencing substantial behavioral health disparities.

Tewa Roots Society's (TRS) Sustainable Wraparound Service Initiative is geared toward providing Native American Individuals and families with better quality resources and evidence-based services that focus on treating the root cause of substance-use, mental health, domestic violence, and suicide for our community and surrounding eight northern pueblos. Our unique service offerings could help bridge the gaps between services, while creating a more authentic and applicable approach to ongoing wellness.

2022 Tribal Opioid Response Project: Indian Health Council, Inc. (IHC) will serve American Indians in and around nine federally recognized tribes located in North San Diego County, in which overdoses by American Indians have been occurring at higher rates than in other populations in this county. The Treatment and Prevention activities include Medically Assisted Treatment (MAT) plus counseling, community events focusing on opioid prevention, and strategic marketing in support of these activities. There are three primary goals for this project: the first is a Treatment activity: MAT and Counseling Together for 10 unduplicated clients served per year in a coordinated response to the local opioid epidemic. The Measurable Objectives of this Goal 1: each year, ten eligible individuals will be recruited, induced or transferred from an outside induction facility, and get on a regular administration of MAT in the Medical Department while they participate in regularly scheduled one-on-one counseling sessions with Behavioral Health Department staff. Additionally, IHC proposes to offer aftercare/supportive housing to a subset of these individuals who could benefit from supportive housing. Goal 2. includes Prevention activities: IHC will aim to serve 400 unduplicated Individuals served per year in two large community prevention events per year: the Opioid Awareness Walk and the Family Opioid Prevention Summit. Finally, Goal 3 consists of Strategic Marketing (External and Internal) Strategic marketing of both MAT/Counseling and the community awareness events will be supported through IHC's social media channels, including Facebook, Instagram. Also, we propose to collaborate with partners and the established IHC Tribal Opioid Response Coalition to create print media such as billboards, posters and banners in Tribal Halls and other physical locations through the catchment area for this project. Internal marketing to IHC Staff will be an important part of boosting the 2022 Tribal Opioid Response program elements (including explaining acronyms and collaborative efforts; and sharing the understanding that we are making strides and the clinic has the capacity to help with OUD recovery). For all three of these goals, surveys and other measures of reach and effectiveness will serve to evaluate the program in support of quality improvement. Between 10 individuals per year to be served in MAT+Counseling and 400 people per year in the prevention events, we anticipate 410 people served per year and 820 total for the two year.

Abstract: The Blackfeet TOR project will provide prevention, treatment, and recovery services to people with Opioid Use Disorder (OUD), fentanyl, and or stimulate use disorder in the Blackfeet Community within the boundaries of the Blackfeet Nation. This includes access to Medication Assisted Treatment (MAT), contingency management, counseling, care coordination, peer support, and cultural wisdom services that were unavailable to approximately 11,000 Blackfeet residents prior to TOR funding. In 2019, the Blackfeet Tribe launched an outpatient substance use disorder facility, the Journey to Recover Center (JTRC), under the umbrella of the Blackfeet Tribal Health Department BTHD reorganized and is now the Health Systems (BTHS). BTHS includes the services of Crystal Creek Lodge Treatment Center, BTHS Behavior Health Programs, BTHS Clinics and Public Health Services for Youth and Adults. In 2019 and 20230 JTRC partnered with Community Medical Services (CMS), an established SAMSHA-certified Opioid Treatment Program, to set up a medication unit within the JTRC to provide FDA-approved OUD treatment medications such as methadone, buprenorphine, and naloxone. This partnership was on hold due to the COVID epidemic. This service will begin again starting September 1, 2022. Clients of the JTRC receive medication from CMS, they also receive services such as drug and alcohol counseling, mental health counseling, care coordination, peer support and cultural connection directly from JTRC. While the first and second round of funding established these services, the JTRC required continued funding to expand the current services to the large population experiencing OUD and create a sustainable array of services for those experiencing fentanyl and stimulant disorders, also. Statistics indicate extremely prominent levels of substance use on the Blackfeet Nation. March of 2022 the Blackfeet Tribe released a press release and resolution declaring the Blackfeet Nation a State of Emergency on Fentanyl and drug overdose. In the second week of March there were seventeen overdoses; four of these ended in death. The goals of this grant will be to (1) Increase the BTHS's Opioid and Stimulant Use Disorder prevention and treatment capacity; (2) Provide comprehensive, evidence based outpatient Opioid and Stimulant Use Disorder treatment to the people of the Blackfeet Nation; (3) Develop an Opioid and Stimulant Use Disorder recovery program infrastructure. With funds from this grant, we plan to serve sixty people each funding year, for a total of 120 people over the two year funding cycle.

Substance and Mental Health Services Administration Center for Substance Abuse Treatment Yavapai-Apache Nation Tribal Opioid Response Grants 2022 Application Program Abstract Funds will be used to continue further support and build on the Wellbriety Program for the Yavapai-Apache Nation by adding a youth component. This program will support and aid the medical prevention and treatment of Substance Abuse and Addiction within the Yavapai-Apache Nation Tribal Communities. The Yavapai-Apache Nation received its first funding from the Tribal Opioid Response Program 1918. Those funds were used to determine the extent of opioid abuse within the Yavapai-Apache Nation and to develop a plan to address the issue and implementation of the plan by the end of the 2nd year. Steps needed: Tracking.

Kenaitze Indian Tribe (Kenaitze, the Tribe) 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, Ridgeway, Kalifornsky, Cooper Landing, and Kasilof a geographical area that spreads across more than 15,000 square miles of rural Alaska. Kenaitze serves 1,809 Tribal Members and approximately 4,410 Alaska Native/American Indian (AN/AI) residents of the central Kenai Peninsula. The purpose of Kenaitze's proposal to the SAMHSA Tribal Opioid Response (TOR) Grants Program (TI-22-06) is to enhance the availability of medication-assisted treatment (MAT) case management services to support Tribal/AN/AI populations diagnosed with opioid use disorder (OUD) and co-occurring mental health conditions in the Kenaitze service area. Substance use is a perennial problem for the region, especially among AN/AI populations, with opioids becoming a more frequent cause for concern and minimal access to substantive, coordinated coordination for those seeking assistance with OUD. Since 2017 Kenaitze has served populations diagnosed with OUD and/or seeking treatment for opioid-related concerns, with many more afflicted with SUD for whom opioids may not be the primary diagnosis. Initially funded via an FY19 TOR award, the DWC currently offers MAT to participating Tribal/AN/AI populations diagnosed with OUD who would benefit from such approaches; non-Native populations must be referred to other local/regional providers who are outside the Tribal health system. Kenaitze will provide MAT and required complementary case management, counseling, and related supports to at least fifteen (15) eligible populations during each year of program implementation; by the end of the 2-year grant-funded performance period, Kenaitze will have provided these services to thirty (30) unduplicated populations. populations MAT cohorts consist of five (5) individuals over a period of four (4) months. In support of ongoing and enhanced MAT services, Kenaitze will use evidence-based practices (EPBs) including the Matrix Model, Motivational Interviewing, Cognitive Behavioral Therapy, strengths-based case management, and traditional approaches to: - Continue to implement a service delivery model that balances MAT with evidence-based chemical dependency counseling approaches, with an emphasis on case management, supplemental referrals, and additional resources to support populations in long-term recovery. - Strengthen and refine linkages with effective prevention programs and engagement strategies offered by the Tribe. To support full operation of this service delivery model, Kenaitze will solicit qualified candidates for a 1.0 full-time equivalent (FTE) MAT Case Manager position specifically funded by this SAMHSA opportunity to enhance our integrated service delivery model and guide populations through barriers to long-term recovery that arise throughout the OUD treatment process. This includes development of goals, objectives, and treatment interventions; community referrals, connections to community resources, and skills development; data collection, maintenance of case records, appointments, and required paperwork; and coordination of local transportation where applicable based on individual need. Ancillary support for MAT-specific services and requirements is available, each participating populations will have access to additional, substantial case management services that provide individually relevant referrals to parallel Tribal programs and resources.

The Catawba Indian Nation (CIN) proposes continued implementation of the Catawba Nation Tribal Opioid Response (TOR) Grant, a tribal behavioral health intervention program for tribal citizens experiencing substance-related challenges. This funding will support the Behavioral Health Department and community partners as an evidence-based and culturally driven behavioral health program answering these critical challenges facing Catawba citizens. Tribal community members charged with substance misuse often struggle in all areas of their lives. As it is throughout Indian Country, these challenges intersect in the Catawba tribal community. Catawba citizens experience high rates of substance use on and beyond the Reservation. To provide support, mitigate, and prevent these challenges, CIN provides behavioral health programs that promote the physical, social, emotional mental, and cultural healing for every citizen. Catawba Nation TOR focuses on these challenges by providing access to culturally informed, evidence-based services through cultivating partnerships and following an integrated care model. In addition, implementing sound data collection and analysis practices ensures effective and efficient behavioral health services for tribal citizens on a lifelong continuum. Our overarching goal is to address the unique challenges of substance misuse including and not limited to assisting tribal families impacted due to substance misuse.

The Confederated Tribes of Siletz Indians runs a Medically Assisted Treatment Program from their Siletz Community Health Clinic, with the program's primary function is to address Opioid Use Disorder. While the Siletz MAT program has grown with the TOR funding awards, the program has also continued to grow in patient size, and so has the needs of clients. If funded, this grant will continue to sustain personnel positions that serve current MAT clients and allow for the programmatic growth needed to meet current service demands. These funds will expand current programming, identify and work to remedy service gaps for clients and make the program more comprehensive. This grant will sustain personnel positions and contracted professionals that are needed to respond to the growth and ever changing needs as the MAT program evolves and responds to what we know about the services our clients are most responsive to. Goal 1: Contract counselors for direct SUD and mental health outpatient treatment for 100 individuals to address the overdose crisis in the Siletz tribal community. Objective: Contract counselors will provide treatment both individually and in groups offer by contracted providers to increase access and options for SUD treatment to 100 patients by September 29,2024. Goal 2: Provide 1 full time Peer Mentor position to meet 75 MAT patient's biggest treatment recovery support needs which are transportation, identifying and accessing resourced, accompaniment to social service appointments, and help receiving wrap around services to ensure the full continuum of services and combat the barriers of being in a rural community. Objective: The MAT Peer Mentor will provide 75 MAT patients support services to increase support services for those seeking a form of treatment for SUD, decrease the likelihood of overdoses, and increase the continuum of services available in Siletz/Lincoln County for SUD by September 29, 2024. Goal 3: Increase capacity for MAT clients to receive recovery support through creating a Recovery Support Community through facilitated events around major holidays, culturally relevant team activities such as Run to the Rogue, Pow Wow sacred space tent for recovery during Pow Wow gatherings and wellness retreats to enhance recovery support and honor the tribal value of connection as a vital aspect of recovery. Objective: The MAT program will utilize its Peer Support and partner with tribal and county programs to provide 20 events by September 29, 2024 to establish a Recovery Supportive Community which will also increase prevention through outreach around the space and activities. Goal 4: Partner with CTSI Prevention, Harm Reduction, and Tobacco Cessation program to provide prevention activities that utilize culturally specific strategic messaging at the high schools in Lincoln County and Siletz Youth Programming. Objective: The MAT program will partner on 6 prevention events that focus on and highlight the dangers and negative health outcomes of Opioid and Stimulant Use Disorder by September 29th, 2024. Goal 5: Siletz MAT program staff/providers will be sent to training on Contingency Management Training to then design and deploy a Contingency Management Program for the Siletz MAT clients to increase treatment engagement and recovery. Objective: 5 MAT program staff/providers will be sent to Contingency Management Training by April 30, 2023 to provide contingency management services to 75 individuals by September 29,2024. Goal 6: Partner with Siletz Harm Reduction to provide 50 patients Harm Reduction services on site and within the community to combat the overdose crisis. Objective: By September 29, 2024 50 MAT clients will engage in Harm Reduction services by being educated and given Naloxone kits to access free rapid testing for hepatitis and Human Immunodeficiency Virus (HIV) and homelessness resources by September 29, 2024.

Aroostook Band of Micmacs (AMB herein after) is the most Northeasterly Federally Recognized Indian Tribe in the United Stated and is located in the most rural northern Maine; Aroostook County. ABM recognizes the limited local and culturally appropriate access to medication assisted treatment and education for the Micmac community in the substance use disorder. Since our Tribal community has 1,486 members whom 913 lives in a service area of 6,672 square miles within Aroostook County, ABM is aiming to be prepared and response to the substance use disorder within our Tribal members. Under preparation and response, we will increase access to culturally appropriate and evidence-based treatment, including medication-assisted treatment using one of the three FDA-approved medications for treatment of opioid use disorder. The addition to focusing on opioid use disorder, recipients may also address stimulant misuse and disorders, including cocaine and methamphetamine. The intent is to reduce unmet treatment need and opioid overdose- related deaths through the provision of prevention, testament and recovery support services for opioid use disorder and, if so desired, stimulant misuse and use disorders.

The Great Plains Tribal Leaders Health Board is applying for the Tribal Opioid Response grant in partnership with the Crow Creek Sioux Tribe. The total population is 19,165 (Indian Health Service User Population Estimates 2019). The focus population is American Indians 10 years old and adults at risk of, in treatment for, or recovering from opioid and stimulant use disorders. The population of focus resides within the Crow Creek Sioux Reservation and the He Sapa (Pennington County and Meade County) catchment area. Tribal Opioid Response funds are needed to build opioid treatment and prevention capacity. Through a strategy of coordinating resources in prevention, treatment, and recovery, the Great Plains Tribal Opioid Response program's goal for the 24-month grant period is to create and coordinate resources that strengthen, complement, and sustain the capacity to support the ability to prevent and treat opioid use disorder and stimulant misuse on the Crow Creek Sioux Reservation and the He Sapa catchment area. The program will engage in the following goals & objectives: GPTOR will expand resources to strengthen the capacity of Crow Creek Sioux Tribe to prevent, treat and recover from opioid use disorder (OUD) and stimulant use disorder (SUD). GPTOR will provide educational resources to 1,000 CCST community members GPTOR will provide training opportunities to social services and behavioral health-related staff on the Crow Creek Reservation. These opportunities will include opioid misuse prevention, opioid medication management, and medication-assisted treatment (MAT) information. GPTOR will provide transportation cost assistance to OUD or SUD treatment to 5 American Indians on the CCST reservation. Provide ongoing recovery support services to individuals recovering from OUD/SUD. GPTOR will support two individuals to become certified as peer recovery specialists. GPTOR will train 200 individuals in harm reduction strategies to include administration of the overdose antidote, Naloxone, education on fentanyl test strips, and education on the use of medication lock boxes. Goal 2: Set the foundation of resource referral and development for culturally appropriate OUD and SUD prevention, intervention, and recovery support resources in the He Sapa catchment area. Provide educational resources on OUD and SUD prevention strategies. Provide training on opioid misuse prevention, opioid medication management, and medication-assisted treatment (MAT) information. Provide ongoing recovery support services that normalize sobriety. Provide transportation costs and essential needs such as childcare assistance to OUD or SUD with poly-substance misuse treatment attending inpatient treatment facilities. Train individuals in harm reduction strategies, including the administration of the overdose antidote, Naloxone, education on fentanyl test strips, and education on the use of medication lock boxes. Goal 3: Facilitate the Great Plains Area Tribal Opioid Response, "So That the People May Live" Community of Practice by hosting quarterly peer-to-peer virtual and in-person meetings to share best practices, resources, and networks among tribal communities stakeholders.

Taos Pueblo has been operating a TOR program for four years, and would like to expand programming for the Taos Pueblo community. Taos Pueblo is seeing an increase in Fentanyl use, and needs to increase education and awareness for community, tribal programs, and vulnerable populations. Taos Pueblo would like to re-establish the "Tiwa Time" programming, a highly successful community-based prevention and intervention program that was greatly interrupted during the pandemic. Taos Pueblo would also like to address the challenge that OUD clients have when they are returning from inpatient treatment, or are in substandard (or no) housing. Many individuals are relapsing when they return home from treatment, or can not escape the living conditions that encourage substance misuse. Providing supportive and supervised Recovery Housing would greatly support people in their recovery. Taos Pueblo will also continue to provide group and individual counseling sessions for OUD clients. With the network of Public Health programming provided through the Division of Health and Community Services at Taos Pueblo, the TOR program will continue to be an integral part of the movement to address OUD, but not the sole programming. There is strength in numbers.