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Mi’kmaq Nation, located in Maine’s northern most county (Aroostook County), will provide youth with substance abuse and suicide prevention programming, in collaboration with community partners that addresses the needs of community Native youth through the Mi'kmaq Nation Native Connections program. The Mi’kmaq Nation will focus on youth aged 10-24 because these youth are most in need of additional programming in our community. Services will be provided to 300+ Native youth annually with additional youth added throughout the lifetime of the project. The overarching goal of Mi’kmaq Nation’s SAMHSA Native Connection program is to increase awareness of and identification of youth at-risk of suicide, Serious mental illness (SMI herein after) and substance use via culturally responsive education, engagement in evidence based curriculum, resources and supports in an effort to reduce the impact of trauma and increase resilience. The program’s goal aligns with the community’s needs by addressing the lack of current prevention programming and responding to recent trauma of youth suicide. The goal fosters a culturally responsive model, which strengthens protective factors for Native youth.

The service area where the proposed project will take place St. Paul Island, AK, a remote, rural, Alaska Native village located on an island 300 miles from the Alaska mainland, 300 miles north of the Aleutian Chain, and 800 miles from Anchorage. This project will work with the youth tribal council group to improve the capacity of the Tribal Government to reduce risky behaviors in youth and young adults ages 10 – 24 by implementing evidence-based culturally centered community programs that address mental health disorders and reduce substance abuse and suicide attempts. Some of the projects we will include are an Elders and youth craft night with a talking circle, youth activities that the youth council determines and co-lead in a safe space that include an activity, an educational component, cooking classes, hikes. There will also be support for the youth dance group when they practice and perform in the community, and support for youth who want to learn how to participate in subsistence activities. We will also support youth travel for SAMHSA or tribal youth forum events, unity conferences with an adult chaperone if needed.

The Organized Village of Kake, a federally recognized Tlingit Tribe, located in Southeast Alaska has been successfully implementing a Native 5-year Connections Grant that was awarded in 2018. This initial 5-year project has been very successful at engaging Kake youth and several agency partners in creating a community supported, and youth-run Teen Center that has become a hub for recreation, education, and cultural activities in the community. This 2023 Native Connections proposal will build on the foundation that has been created, and will address the following community needs: 1. Continue to increase the Village of Kake’s readiness and capacity to prevent and reduce suicidal behavior and substance use/misuse, and reduce the impact of trauma; 2. Develop a teen mental health 1st Aid program in which youth are equipped to identify peers at-risk, and provide appropriate levels of support and referrals; 3. Assist youth in preparing for a healthy future, by providing independent living skills, job/career fairs, and access to GED instruction and testing; and 4. Provide an array of Tlingit culture and language programs and activities that are based on traditional values and life-ways. This 2023 Native Connections proposal focuses on Four Key Goals: Program Goal #1 – Increase the Village of Kake’s readiness and capacity to prevent and reduce suicidal behavior and substance use/misuse, and reduce the impact of trauma. Program Goal #2 –Create a trained youth mental health first aid team to provide peer-based, in-person prevention and intervention support for Kake youth Program Goal #3 – Assist Kake youth in preparing for a healthy future. Program Goal #4 – Build a strong foundation of language and culture through offering culturally focused prevention and intervention programs and activities. The Tribe will be partnering with several entities including the Kake School District, Southeast Alaska Regional Health Consortium, the City of Kake, and the local Teen Center Youth Board, to implement the Objectives and Activities outlined in the proposal.

The requested funding will enable the Tule River Indian Health Center, Inc. (TRIHCI) to implement the Youth Connections Expansion Project. The project will expand and enhance the organization’s Youth Connections Project and continue to establish a healthy network of systems, services, and partnerships to help prevent and reduce suicidal behavior and substance misuse, reduce the impact of trauma, and promote mental health among American Indian/Alaska Native (AI/AN) youth up to age 24 living in Tulare County, California (CA). The TRIHCI serves 2,500 Native Americans on and off the reservation. The highest percentages of AI/AN residents in Tulare County are in Porterville and Visalia. The reservation is an identified economically disadvantaged community. The per capita income on the Tule River Indian Reservation is $24,276, which is two-thirds the amount of the U.S. $37,638 per capita income; and 43% of Tule River children under 18 live in poverty. In Tulare County, 24% of AI/AN 7th graders had 3+ monthly absences from school, much higher than any other race; 26% experienced chronic sadness/hopelessness, 10% have considered suicide, and 4% use alcohol/drugs. In 2022, of the youth served by TRIHCI, no suicides, no substance overdoses, one suicide attempt, and two suicide ideations were recorded. However, TRIHCI staff are well aware that incidents of suicide, overdose, suicide attempt, and suicide ideation among youth are drastically underreported. According to post-event reports from patients/loved ones to TRIHCI staff who live on the reservation, an estimated 10-15 non-fatal, unreported overdose incidents occur monthly and many overdose deaths on the reservation are reported as “accidental” due to the stigma/shame of an overdose for tribal members. Historically, incidents related to suicide on the reservation have been reported as accidental deaths based on law enforcement policy to only identify a death as a suicide if a suicide note is present. Far too many incidences go unreported, which means youth who need intervention services are not being identified or served. TRIHCI is aware that this protocol presents a distorted impression of the growing risk of suicide among tribal youth and limits TRIHCI’s ability to identify youth and loved ones at risk of suicide clusters. Relatives and friends of suicide victims are 65% more likely to attempt suicide than if the person died from natural causes. The risk of attempted suicide is one in 10 if the relative or friend died of suicide.10 Individuals who self-injure are nine (9) times more likely to attempt suicide, and many individuals who report self-harm also describe chronic suicidal thoughts at the time of injury. Underreporting suicide puts AI/AN youth at significant risk. The goals of the project are: 1) develop and implement transparent, practical crisis protocols in an emergency, including follow-up procedures to care for at-risk youth; 2) strengthen infrastructure support in the fight against youth suicide/substance misuse; 3) expand and enhance accessible youth-focused behavioral health care, grounded in the AI/AN traditions in Tulare County; 4) enhance Protective Factors to build resilience against suicide and substance misuse among AI/AN youth up to age 24; 5) reduce the impact of risk factors for suicide and substance misuse in AI/AN youth; and 6) implement Tier III strategies to provide interventions for AI/AN youth with higher level needs related to risk of suicide and/or substance misuse. The Youth Connections Expansion Project will establish a stakeholder advisory board, establish a youth advisory board, complete a community needs assessment, complete a community readiness assessment, and develop and implement a tribal strategic action plan.

Oglala Lakota Housing Authority/ Nisnala Sni, Yelo (You Are Not Alone) 5/13/23 Native Connections 2023 SAMHSA (NOFO) No. SM-23-021 1 Project Name: Nisnala Sni, Yelo (Neesh nah' lah Shnee Yeh lo') means "you are not alone" Summary: Nisnala Sni, Yelo (You Are Not Alone) will provide a data, coordination and planning infrastructure and implement prevention, intervention and postvention activities to combat suicide, substance abuse and mental health issues among youth between 10 and 24 on the Pine Ridge Indian Reservation (a Promise Zone). Populations to Be Served: The population to be served are youth from 10-24 including Two Spirit/LGBTQI+ who are in need of services on the Pine Ridge Indian Reservation focusing on Pine Ridge Village and Wounded Knee District. Goals The Goal of Nisnala Sni’ Yelo (You Are Not Alone) will be to provide a data, coordination, and planning infrastructure, implement prevention, intervention and postvention activities to combat suicide, substance abuse and mental health issues among youth between 10 and 24 on the Pine Ridge Indian Reservation (a Promise Zone). Objective 1 The Nisnala Sni, Yelo Project will modify, update, and implement existing data, coordination, and planning infrastructure by the end of the first year of the grant. Strategies/Activities: Develop a Community Needs Assessment within 4 months. Develop a Community Readiness Assessment within 6 months. Develop a Tribal Strategic Action Plan within 9 months including public health model multi-tiered approach. Implement effective, culturally appropriate intervention strategies. Develop policies and procedures to promote coordination among youth serving agencies. Develop or revise protocols to ensure that youth, emphasis on Two Spirit/LGBTQI+, who are at high risk for suicide, including those who attempt suicide and use substances, receive follow- up services. Update existing and create new protocols for responding to suicides, suicide attempts, or clusters. Protocols will be designed to promote community healing and reduce the possibility of contagion, these “postvention” protocols will reflect the traditions and culture of the tribe or tribal organization. Objective 2 Implement prevention activities to reach youth in the nine districts with an emphasis on Wounded Knee District and Pine Ridge Village. Strategies and Objectives. Establish and maintain a youth advisory board and include Two-Spirit youth. Ensure the involvement of community members in decisions regarding project activities. Produce PSA’s/educational carts to air on KILI radio and KOLC-TV Establish a presence on social media and internet. Hold youth meetings in the targeted districts. Objective 3 Develop and implement intervention and postvention procedures targeting high risk youth ages 10-24 residing on the Pine Ridge Reservation. Strategies/Activities: Provide effective referrals and follow-up for youth with suicide, substance abuse and mental health problems. Implement screening in the local schools to identify youth who are high risk for suicide, substance abuse, and depression. Set up alternative access to intervention and postvention procedures to include traditional and culturally based practices. Provide related resources to families dealing with suicide, attempted suicide, behavioral health disorders, substance abuse and/or identity issues with the LGBTQI+ community, living on the Pine Ridge Reservation. # to be served: We hope to serve 100 youth each year and 500 over the life of the project.

The Wiconi Wakan Health & Healing Center Expansion project will build upon the suicide prevention and behavioral health outreach work accomplished over the past 4 years of implementing the Garrett Lee Smith Suicide Prevention grant. The expansion project will focus on strengthening existing services, screening, crisis response, and outreach to youth ages 0-24. Wiconi Wakan will emphasize Lakota cultural values and teachings throughout expansion and will seek input and collaboration from local schools, the local tribal youth council, and local spiritual leaders to develop a tribal strategic action plan addressing Tiers 1-3 of suicide prevention.

The Chickahominy Circles of Grace: Healing Youth through Community Connections project will help address substance misuse and mental health challenges by building the Chickahominy Indian Tribe’s capacity to educate the community, reduce the stigma that currently prevents tribal citizens from seeking mental health services, and incorporate protective factors to safeguard tribal youth in the area surrounding the tribal headquarters in Charles City County, Virginia. The population we seek to serve is youth in the tribal community (enrolled citizens and children living with enrolled citizens), which we anticipate will consist of 50 community members between the ages of 0 and 24 during Year 1 of the project and 170 in subsequent years, for an estimated cumulative reach of approximately 220 unique individuals over the lifetime of the grant. In addition to this target population, we also expect to reach the general citizenry, as the project will widely distribute educational resources and create learning opportunities and tribal events to support community connection. Circles of Grace will employ strategies of professional development for tribal staff across departments who are in a position to bolster protective factors through existing programming and the creation and distribution of targeted mental health resources designed to educate tribal citizens and de-stigmatize mental health services. To build a foundation for durable wellness among the Chickahominy Indian Tribe’s youth, the project established the following goals: 1. To build the Chickahominy Indian Tribe’s capacity to sustainably address youth mental health needs within the tribal community. This goal’s measurable objective will be the development of deliverables including the Disparity Impact Statement, Community Needs Assessment, Community Readiness Assessment, Tribal Strategic Action Plan, Community Engagement Items (i.e., Meeting Agendas, Informational Flyers, Surveys), Youth Advisory Board (Attendance Records and Agendas), Substance Abuse and Mental Health (SAMH) Partnership Plan (Plan and Memorandums of Understanding), and Postvention Protocols. 2. To provide substance abuse and mental health education to organizational staff and tribal citizens, enabling them to recognize warning signs, and to understand prevention, intervention, and mental health care options relevant to tribal youth. This goal’s measurable objective is the number of mental health educational resources created (number of individual resource sheets created) and disseminated (number of resource sheets distributed) and the number of awareness and education activities attended (Registration and Attendance sheets). 3. To enhance protective factors through existing and new tribal programming through programs that encourage parental resilience and cultural and social connection among tribal youth. This goal’s measurable objective is the number of departments integrating protective factor programming into their project activities (e.g., number of youth cohort activities supported, number of attendees in youth cohorts, number of promotions of protective factor activities) and the number of new programs initiated that integrate and support protective factors for substance misuse and mental health.

The Houlton Band of Maliseets Boys & Girls Club ensures every youth has access to high quality youth development programming within their community, particularly during the critical afterschool and summer hours. Enhanced well-being, educational attainment, and increased confidence and self-esteem are key factors in preventing future public assistance dependency among today’s teens. Similarly, research indicates that youth who are surrounded by opportunities for positive encounters engage in less risky behavior.1 As such, Boys & Girls Clubs offer high-quality, evidence-based and -informed curricula and services that build upon youth’s strengths and help them develop skills for good decision-making for their futures. Healthy People 2020 identifies positive youth development (PYD) as an effective approach for reaching youth, in particular those from economically-disadvantaged communities,2 and is the evidenced-based model that has been selected for this proposal. The proposed project seeks to improve employment, independence, stability, health and well-being, and quality, permanent connections of youth and families in Maine. As such, the Houlton Band of Maliseets Boys & Girls Club is uniquely positioned to provide support for Tribal Teen Boys & Girls between the ages of 13-24 regardless of sexual identity through the proposed SAMHSA Native Connections program.

Pleasant Point is home to the Sipayik Nation Tribal Community and is located in Washington County, Maine with approximately 850 residents and an additional 500 Tribal Members living in the surrounding areas. Washington County, one of the most remote, rural and economically depressed areas in the United States, is plagued with limited employment opportunities, extreme poverty and a continuing growing rate of opiate addiction. Thus native youth must negotiate a complex web of interconnected social problems. While poverty, racism and isolation affect the entire community, the damaging effects often fall disproportionately on the young. Alienation from their culture, history and community has led to a sense of hopelessness and low esteem which can lead to self-destructive behavior. Native youth are in need of a safe environment with positive role models to whom they can turn for guidance, develop healthy identities, and find their rightful place in the community and world. The unemployment rates are typically 63% depending on the season and 64% of those living on the reservation live well below the poverty level. The proposed project increases prevention services and programming in Sipayik Boys & Girls Club and Cultural Center; promotes the purpose of SAMHSA Native Connections to reduce the impact of mental and substance use disorders; fosters culturally responsive models that reduce and respond to the impact of trauma in the Sipayik Passamaquoddy Community; and increases access to needed behavioral health services. Proposed work will build on the existing Club structure, which intentionally and proactively promotes protective factors and strives to reduce risk behaviors in youth. Boys & Girls Clubs are uniquely positioned to offer support to community youth and families.

Chief Leschi Schools currently serves 349 elementary and 335 secondary students, 97% of whom are Native American. We used ESSR funds to hire a Licensed Mental Health Therapist to work on campus full time in the 2022-2023 school year, and this implementation has been so successful that we are seeking funding to continue offering our students this support. In addition, we seek salary support for our Director of Student Success who maintains connections with students and their families and is often the first one aware of any issues they may be experiencing. Because of his connections to the community, he serves to connect students and families with appropriate support in a timely manner. While the implementation of our plan will be overseen by the Director of Student Services, funding will be used for the staff with direct student contact only. Data from the elementary level shows strong need for student supports: 12.6% of our students are in Foster or Kinship care 58.7% of students with chronic or absenteeism of concern 11% of students experiencing and need support with grief and loss 21.4% of students were referred to Child Protective Services 22.1% of students have been referred for support for behavioral concerns within the classroom/school 8% of students have been referred to outside counseling services 3% of students have made self-harm or statements of suicidal ideation At the secondary school, the Healthy Youth Survey shows the needs are even greater: 40% of our seniors in 2014 had attempted suicide in the 6 months prior to the survey compared to 8% in Washington State 62% of all students taking the test indicated an early age of first drug use 25% of 12th graders had used illicit drugs within 30 days of the survey and 54% had used marijuana 28% of 8th graders, 50% of 10th graders, and 66% of total students surveyed reported depressive feelings 45% of 8th graders, 70% of 10th graders, and 70% of total students reported not being able to control or stop worrying Currently, the Licensed Mental Health Therapist is working with 56 elementary and secondary students, and the number continues to grow. The Director of Student Success works primarily with our secondary students. He is often the first person to know when a student needs some support and makes multiple referrals to the therapist and other tribal resources. Together, they provide a critical safety net for our students.

Connections Through Cultural Values- Suicide Intervention, Prevention & Recovery Knik Tribe proposes “Connections Through Cultural Values” an Intervention, Prevention & Recovery program to address the impacts of trauma, lack of mental health support, youth suicidal behavior, and substance abuse in Alaska's Matanuska-Susitna Borough. We will conduct a year-long assessment and planning process, followed by four years of indicated services implementation as designated by the community-driven plan of action. Very importantly, we will utilize the guiding principles that our ancestors followed and this opportunity to also develop youth leaders in our community. The youth are our most valued resource, and often overlooked when Native communities are seeking leadership and courage. Our program will be working with families and the community to build resilience and enhance the protective factors within the community. Much of this project will address prevention through the awareness of adverse childhood experiences, social and emotional learning, and holding each other accountable for interactions with youth. This application is seeking support to increase universal prevention through intergenerational activities and mentoring that will embrace our youth within the cultural values of the Alaska Native people, and to build the capacity to carry out the indicated prevention efforts. Youth who have already experienced adverse life issues are at higher risk of escalating risk as they transition into adulthood. Our programming will address and promote and support the community’s desire to ensure that our youth are held up and encouraged as they mature and become the future leaders of the Tribe. Information ascertained through the community assessments will become our baseline information about the population and provide qualitative and quantitative data that will inform our programming and inform our program measurement of intended outcomes. Our action plan and corresponding evaluation strategies will proceed in terms of three related goals: Our first goal is to assess community needs, readiness, and resources to address suicidal behavior, substance abuse, trauma, and mental health among AK/AI youth residing in Alaska's Matsu valley to inform strategic planning for implementation. Our second goal is to build the youth leadership capacity and infrastructure to meet such needs and to create and foster protective opportunities to prevent suicidal behavior, substance abuse, and trauma among local AN/AI youth, and promote their mental health. Our third goal is to implement and improve existing services, supports, and educational activities to prevent suicidal behavior and substance abuse, reduce the impacts of trauma, and promote healing and mental health among AN/AI youth and young adults and in the participating communities.

The Empowerment, Prevention, and Sustainability Project aims to prevent and reduce suicidal behavior, substance misuse, and the impact of trauma while promoting mental health among American Indian/Alaska Native (AI/AN) youth up to age 24. The project will use Gathering of Native Americans (GONA) services to achieve its objectives, with a focus on prevention, intervention, and trauma-informed and culturally appropriate services. The project will include a 1 FTE Education Behavioral Health Coordinator, an Education Outreach Advocate, and an Experiential Education Specialist to implement outreach programs within the CTCLUSI 5-county service area. Additionally, the project will incorporate Project Venture and ACEs services. Project Venture promotes positive youth development and leadership skills, building resilience and cultural identity to reduce substance misuse and suicidal behavior while improving mental health outcomes. ACEs services provide trauma education, support, and resources to improve well-being and promote community resilience. Together, these services can address the root cause of mental health issues, particularly historical and intergenerational trauma, promoting healing and resilience among American Indian/Alaskan Native youth.

The Friendship House Native Connections Project will address the high risk for suicide and substance misuse among Urban AI/AN youth ages 12-24 in San Francisco. The Friendship House Association of American Indians (“Friendship House”) is an Urban Indian Organization that operates a long-standing Youth Program (“FHYP”) that integrates mental health promotion, suicide prevention, and substance misuse prevention. Traditional practices, ceremonies and cultural connections through the FHYP promote self-expression, reflection, and de-stigmatization around these issues for Urban AI/AN youth. The total addressable population for this project is 1,742 AI/AN youth and young adults (ages 12-24) living in San Francisco. These groups are typically under-counted and difficult to reach. Through our partnership with the Indian Education Program of the SF Unified School District, the FHYP will expand its outreach to AI/AN students in 13 middle schools and 14 high schools (ages 12-17). AI/AN young adults ages 18-24 will be reached through their previous participation in the FHYP, younger siblings, local colleges and universities, and non-Native programs that serve transition-age youth. Through our partnership with the Native American Health Center, we will implement screenings, wellness checks and referrals to treatment for AI/AN youth and young adults. This increased access to culturally-connected programming, screenings, and interventions will directly address disparities facing Urban AI/AN youth and the higher risk factors relating to suicide, mental health and substance misuse. Our proposed project builds upon the formative work of our previous Native Connections grant from September 2017 – 2022, during which we successfully implemented many of the required activities. This new project will enable Friendship House to revisit and revise our community needs assessment, community readiness assessment, and strategic action plan by reconstituting our Community Advisory Committee. This project will further engage youth, families, systems, service providers, and community partners to elevate the need to reduce suicidal behavior and substance misuse among Urban AI/AN youth. Our community-wide public health approach that includes culturally-based interventions and practices will take root over the next 5 years. In doing so, it can be sustained in years to follow and will also serve as a model of best practices for other Urban AI/AN communities. The following are goals and measurable objectives of our proposed project: Goal 1: Increase cultural connections among Urban AI/AN youth Objective 1a: The percentage of AI/AN youth in our catchment area invited to participate in the FHYP will grow from 50% (n=870) in Year 1 to 90% (n=1570) in Year 5 Objective 1b: The percentage of AI/AN youth that enroll in the FHYP after being invited will grow from 25% (n=220) in Year 1 to 75% (n=1180) in Year 5 Objective 1c: By the end of Year 1, AI/AN youth will form a leadership council Goal 2: Increase surveillance of Urban AI/AN youth to identify risk factors that warrant early intervention Objective 2a: 100% of enrolled youth will be screened for mental health and substance misuse risks Objective 2b: 100% of youth that require behavioral health care will be referred for treatment Objective 2c: By the end of Year 1, 100% of youth will have access to a peer support groups or mentors Goal 3: Improve community care coordination for Urban AI/AN youth Objective 3a: 100% of parents and guardians of enrolled youth will provide consent and be invited to participate in youth-oriented community gatherings Objective 3b: By the end of Year 1, we will reconvene a Community Advisory Committee.

Abstract: Approximately 640 people live in our remote village, Supai, AZ, located in a slot canyon in the bottom of the Grand Canyon. The Havasupai people are a strong and resilient people, possessing deep cultural and familial roots with our home in the Grand Canyon. Historical injustices and limited educational and economic opportunities have had negative effects on our people. Many have preserved but some have turned to unhealthy coping strategies, abusing drugs and alcohol and attempting and carrying out suicide to block the psycho-social pain and intergenerational trauma. This pain is juxtaposed by the beauty and culture of our community. Substance use and substance abuse-related deaths have been increasing in our community over the past two decades. Prevention services and mental health and behavioral health services are inconsistent and often not available to those who need them. Through this project, we hope to conduct a community needs assessment, community readiness assessment, and create a community resource map to guide intervention development to decrease gaps in substance use and mental health services and increase mental health wellness among the Havasupai people.

Chugachmiut Iguillrrapet Lumacerpet “Our Kids, Our Culture” Project Abstract Chugachmiut’s Native Connections Project, Iguillrrapet, Lumacerpet “Our Kids, Our Culture,” is intended to reduce the impact of mental and substance use disorders, foster culturally responsive models that reduce and respond to the impact of trauma in our communities, and allow Chugachmiut, through the Chugach Region communities to facilitate collaboration and develop long-term partnerships among region-wide agencies to support youth as they transition into adulthood. We seek to pair nationally recognized evidence-based best practices from the Brief Strategic Family Therapy (BSFT) within the homes with parents and siblings with community and school-based activities to promote acceptance of healing, to remove stigmas, and to educate on the many paths out of family troubles such as depression, suicidality, alcohol experimentation (including necessary detoxification and interventions), and substance use disorders. Our itinerating Brief Strategic Family Therapy (BSFT) clinician will travel out to each of the four village communities, as possible, throughout the Chugachmiut catchment region (Tatitlek, Chenega, Nanwalek, and Port Graham) on a constant and rotating basis. This position performs behavioral health and addictions assessments and works with other counselors to ensure continuity of services. In efforts to reach the youth, we provide services in the homes, the schools, and within the community (Tier 1 Universal Prevention Strategies). We engage our regional youth with entire family involvement (to the greatest extent possible and allowable). We help to remove existing problems such as home-based substance addictions and familial depression (Tier 3 Indicated Prevention Strategies) within siblings and parents in order to (1) show “problem-solving in action” and (2) to remove the basis for home-based unhealthy modeling. During village visits, our Brief Strategic Family Therapy clinician and other clinical providers will provide community psycho-educational presentations on communications, fending off depression and suicidality, breaking the cycle of addictions, promoting positive parenting skills, and other topics with heart-connected stories, humor, and real approaches to the matters that affect them most (Tier 2 Selective and Targeted Prevention Strategies). And we work within the schools (again, as possible), giving presentations, gaining familiarity, hearing from the teachers as to whom they have greatest concerns for, and reaching out to the broadest swath of youth possible. Also, once per year and as possible, Chugachmiut hosts a regional Tribal Retreat addressing primarily men’s issues of family connectedness, healthy parenting, substance uses, and how to support upcoming generations of future tribal leaders (our youth) through strengthening tribal culture and reaffirming our healthy tribal values.

A grant proposal in response to SM-23-021 to support suicide prevention, substance misuse prevention and mental health promotion within the Blackfeet Nation, Montana. More specifically, the purpose of this proposal is to; 1) prevent and reduce suicidal behavior and substance use, 2) reduce the impact of trauma, and 3) promote mental health among Blackfeet young people up to and including age 24. This will be done by; 1) reducing the impact of mental and substance use disorders with culturally responsive and evidence based models that will reduce and respond to the impact of trauma (both historical and current), and 2) fostering community support for youth and young adults through the facilitation of collaboration among local agencies. This grant application is following 5 years of a current successful Native Connections grant. Though we have poured an incredible amount of education, training and support into our community our youth is still suffering greatly. One of our communities is currently in a state of crisis with a youth suicide cluster. In lieu of these events we are requesting additional support through another Native Connections grant to continue the work we started. We hope to continue to provide education around mental health through the distribution of wellness and crisis packets, increase our communities capacity to respond to mental health illnesses through trainings, awareness building, and improved collaboration between our programs and with our protocols, and direct support to our community with our culturally resonant activities. We will focus on the continual improvement of all of these activities through another Community Needs and Readiness Assessment, ongoing program evaluation and direct communication with a youth advisory board. Our program will meld western and traditional Blackfeet ways of healing to provide the most opportunity for wellness as possible.

American Indian Health and Family Services (AIHFS) was established in 1978 with a mission to enhance the physical, spiritual, emotional and mental well-being of Native American families and other underserved populations in Southeast Michigan (SE-MI). We serve American Indian and Alaskan Native (AI/AN) urban populations relocated due to federal relocation policies and many are unemployed, poor and have high incidences of heart disease, diabetes, depression, substance abuse, and suicide. With funding from the Native Connections Grant, AIHFS will strengthen its programming to reduce and prevent prevalence of substance abuse and suicide among urban AI/AN youth in Metro Detroit. Based on the results of the systems analysis, the needs assessment, the CRA and Resource/Asset Map, we will take a Three-Tiered approach to assess needs, and develop and implement an ACTION plan with at-risk youth age 10-24 to prevent and reduce suicide, substance abuse, the impact of trauma, and promote mental health. This includes Hope & Wellness suicide and substance use screenings with youth in our BH department, and at community venues; utilizing evidence-based methods including traditional healing, that target suicide and substance abuse to keep youth safe and sober; coordinating care, and follow-up through all care transitions, that include safe hand-offs to service providers; and increased emphasis on follow-up via face-to-face meetings and/or phone calls.

The Southern Plains Tribal Health Board’s (SPTHB) Tribal Epidemiology Center (TEC) is one of 12 TECs in the nation and supports 43 federally recognized tribes in Oklahoma, Kansas, and Texas. Our agency has long history of providing training and technical assistance (TTA), guidance, and consulting services to public health professionals, nurses, doctors, community health representatives, community members, tribes, state and local agencies, non-profits, and many other organizations, as well as acting as the fiscal agent responsible for multiple funding opportunities. Disparities exist in Caddo County at several levels: rural, racial (as it relates to AI/ANs), and socio-economic. In addition, the data illustrate Caddo County as a medically underserved area and a health professional shortage area with regards to rural health clinics, community mental health centers, and being a low-income mental health catchment area. There is a clear need for suicide prevention and other mental health interventions and treatment options in the catchment. Data reported from the Violent Death Reporting System and the Oklahoma Youth Risk Behavior Survey indicate the Oklahoma youth suicide rate increased 41% since 2006, compared to a 33% increase in the youth suicide rate nationally for the same time period. The Oklahoma youth male suicide rate increased 23% since 2006, and the youth female suicide rate increased 79% in the same time frame. In the 10-24-year-old age group, the male suicide rate was nearly three times that of the female rate in Oklahoma. American Indian/Alaska Native youth had the second highest rate of suicide among the 10-14 age group. In the 10-24 age group, AI/ANs had the highest suicide rate among all gender, race, and ethnic groups, with a 39% higher rate than white males who had the second highest rates among all groups. Goal 1- Increase the capacity of the local tribal community to provide tools, services, and resources that promote the mental health of AI/AN youth. Goal 2: Increase access to mental health services for AI/AN youth by enhancing cross-system collaboration within and across tribes, as well as among various non-tribal sectors. Goal 3: Decrease suicide among AI/AN students and their peers by implementing an evidence-based, peer-to-peer, school-based program that provides knowledge, skills, and resources in suicide prevention. Goal 4: Decrease substance use among AI/AN youth by conducting activities that address substance misuse and overdose.

The College of the Muscogee Nation seeks to forge a comprehensive, integrated, and trauma-informed suicide and substance misuse prevention and mental health promotion system to address suicide, underage drinking, strengthen prevention capacity, and provide intervention services to rural, non-reservation (McGirt), and under-served American Indian youth and emerging adults, aged 0-24, who reside within the area of northeastern Oklahoma served by the college. This shared vision shall expand and enhance the continuum of care, reduce suicides and suicidal behaviors, promote mental health, and reduce the progression of substance abuse and related problems and their negative influences. The project will reduce the impact of trauma, improve public health, and demonstrate community change while increasing prevention capacity.

The Akwesasne Boys & Girls Club will work in partnership with the St. Regis Mohawk Tribe to provide youth with substance abuse and suicide prevention programming with our focus being on Mohawk youth ages 6-18 years of age.

The Spirit Lake Suicide Prevention Program (SLSP) and its project partners—including, the Spirit Lake Recovery and Wellness Center, Spirit Lake Health Center, Behavioral Health Department, Tiwahe Initiative, Cankdeska Cikana Community College, and Four Winds High School—are in the Fort Totten district in Fort Totten, North Dakota. The Spirit Lake Tribe Enrollment Office reported approximately 7,574 total Tribal Members with approximately 3,783 residing on the Reservation in Fort Totten, Crow Hill, Mission District, and Woodlake, and 3,697 residing off the Reservation. 248 Tribal youth are enrolled in the Cankdeska Cikana Community College, 181 in Four Winds High School, 66 in Warwick High School, 78 in Minnewaukan High School, and 127 in New Rockford High School. Current barriers to proper and effective intervention include transportation, lack of capacity of parents or guardians, lack of providers, no hospital beds or overnight housing for temporary homeless, low buy-in from youth over 18 years of age, and an inability to follow up with at-risk youth. The goal of this grant is to enable the Spirit Lake Suicide Prevention Department to create and codify an efficient system of programs, policies, and capacity building for the Spirit Lake Tribal Health Department, Tribal Behavioral Health Clinic, and Educational Institutions to effectively prevent suicide and mitigate suicide risk among the youth of the Spirit Lake Tribe. The objectives of the grant are: 1. Determine the community’s needs by gathering data from 80 – 100 Tribal youth, 40 Tribal parents and guardians, 10 Tribal community service providers, 5 Tribal cultural leaders, 10 Tribal Elders, and up to 20 Tribal and Non-Tribal regional youth advocates and service providers in Year 1. 2. Draft and obtain feedback from the youth advisory council for a comprehensive Spirit Lake Youth Suicide Prevention Program and Policy document through a minimum of 3 phased feedback sessions in Year 1, 3, and 5. 3. Draft and obtain feedback from the youth advisory council on the Performance Report through a minimum of 3 phased feedback sessions conducted at the end of each year. Number of Unduplicated Individuals to be Served with Award Funds Year 1 - 36 Year 2 - 48 Year 3 - 60 Year 4 - 60 Year 5 - 60 Total - 264 Previously the suicide prevention activities were done in a hub and spoke model with the Behavioral Health Clinic and the Recovery and Wellness department as the hub and Social Services, Vocational Rehab, Victims Services, Tribal Health and Public Health Nursing, Veterans Services serving as spokes. The proposed model shifts to the concentric model to ensure active and focused engagement by critical stakeholders and reduce their burden to perform program coordination, management, and reporting. Instead, the program will be managed and monitored by the SLSP (center). The Behavioral Health Clinic, Schools and College, Recovery and Wellness Center, and Tiwahe (middle) will be primary collaborators. The Language Programs, Tribal Employers, Vocational Rehab, Victims Services, Justice Department, and Social Services (outer) will be informed and will have the opportunity to provide feedback on the program but will not be active participants in decision making or program design. These changes will be codified and operationalized through the proposed grant.

Sacramento Native American Health Center (SNAHC) is a 501(c)3 non-profit Urban Indian Organization (UIO) and Federally Qualified Health Center (FQHC) established in 2006. SNAHC’s service area includes 19 zip codes with a total population of 575,882 residents and 38,000 AI/AN in Sacramento County. SNAHC serves over 12,000 patients per year, approximately 30% of which are American Indian and Alaska Native (AI/AN). SNAHC anticipates doubling its patient population and provide access to over 24,000 individuals per year by opening a second site in 2023, further establishing SNAHC as the largest-serving UIO. SNAHC’s vision for a Sacramento Native Connections Program is to focus on three levels of prevention activities to reduce impacts of trauma, risk for suicide, and any existing silos of uncoordinated care across partner organizations for AI/AN within Sacramento County. The program will also promote mental health among urban American Indian/Alaska Native (AI/AN) youth 0-24 and their families. SNAHC will employ multiple methods towards engaging partners and community. Goals of the program include: Complete Preliminary and Ongoing Organizational Assessment, Planning, and Procedure Development; Implement Universal Prevention Strategies (Tier 1) to Promote Cultural Connectedness and Prevent Mental Health and Suicide Concerns among Youth; Engage in Selective and Targeted Prevention Strategies (Tier 2) to Intervene with At-Risk AI/AN Youth; Implement Clinical Intervention (Tier 3) with AI/AN who have Additional Mental Health or Substance Use Needs; Complete Reporting and Evaluation.

The Native Connections (NC) project will focus on suicide prevention including mental health crises and substance misuse. The project will promote mental heath and alleviate the impact of trauma among American Indian/Alaska Native (AI/AN) youth through age 24 by building a system of service and partnerships that impact youth and transitional aged youth. The NC project will operate from the Fallon Tribal Health Center's Behavioral Health Program (BHP). Staff under this grant includes the Project Manager and Prevention Specialist. In Year 1, NC will conduct and use the results of a Community Needs Assessment and a Community Readiness Assessment to engage partners in developing a Strategic Action Plan. The Strategic Action Plan will address suicide prevention and substance misuse utilizing universal, selective and indicated prevention strategies. The NC will update the BHP's policies, protocols, and procedures for responding to mental health crises, suicide ideation, suicide attempts and suicide clusters; update existing, re-establish, and/or establish new memoranda or understandings (MOUs) with at least three AI/AN-serving programs to enhance collaborative relationships and formally set up referral protocols and procedures. The NC will collaborate with other tribal programs and agencies that serve youth and families, such as FPST Cultural Learning Center, Social Services, Law Enforcement, Tribal Court, Victim Services and the Housing Department. The NC will collaborate with the Churchill Community Coalition on at least three yearly projects related to suicide prevention and substance misuse. The NC will collaborate with the Cultural Learning Center in at least three projects annually that promote mental health through the Paiute and Shoshone culture, language identity and traditions. Activities include gatekeeper training to 5 adults in year 1 and 10 adults in Years 2 through 5; collaboration with local high school and middle schools to provide a school-based suicide awareness campaign targeting AI/AN students; establish a tribal youth advisory board; develop a public education campaign focusing on suicide prevention, substance misuse prevention and mental health promotion with public messaging on at least 5 occasions a year; conduct trainings for FTHC staff on a suicide screening tool; training FPST employees and community members on Youth Mental Health First Aid, QPR (Question, Persuade & Refer), SafeTALK and/or ASIST; and collaborate with the Office of Justice/Bureau of Justice Assistance's Connect and Protect project to follow up on all mental health referrals from the C&P Behavioral Health Liaison.

The name of our project is, Santa Clara Pueblo Behavioral Health Connections-2023. We are applying for Tier 2, Selective Prevention Strategies for addressing the needs of at-risk young tribal members up to 24 years old. Our rationale for prioritizing this tier in our community is based on the fact that we do not know additional specific mental health issues that exist in our community. In order for our Pueblo to effectively respond to an overall mental health promotion approach as well substance and misuse among the community, we need additional data. We believe that the Tier 2 requirements will allow us to target a prevention strategy with specific target population, especially since we do have data from 2012 that can strongly support our request to SAMHSA. We also believe that an assessment and SAMHSA technical support can assist us in fostering, administering, and analyzing data we receive from a community assessment. The outcome of a community assessment will also allow us to identify additional mental health issues and needed resources from community, that we otherwise do not know at this time due limited data collection and newly established collaborations. The four goals we have identified for our project are as follows: Goa1: Expand Santa Clara Pueblo services and support for youth and young adults to reduce the impact of mental health, substance abuse, and prevent suicide. Objective 1: To identify current services and support that exist and serve Santa Clara Pueblo members who are identified as youth and young adults with a focus on LGBTQI (Lesbian, Gay, Bisexual, Transgender, Queer and Intersex individuals). Objective 2: Update and distribute a community resource guide that identifies metal health services, substance abuse, and suicide prevention for youth and young adults. Goal 2: Continue to provide community driven array of services to support at-risk youth and young adults and their families. Objective 1: Update and distribute a service map that identifies where services exist within our community. Objective 2: Finalize a tribal action plan. Goal 3: Establish a community assessment process that can be used as a foundation to develop and/or enhance services. Objective 1: Develop and administer a follow-up community assessment to be used in our community. Objective 2: Analyze community assessment feedback. Objective 3: Develop a report for tribal council and community members that reflect assessment results. Goal 4: Expand our youth and young adult wrap-around service delivery system that includes community stakeholder input and community service collaboration. Objective 1: Create an advisory team based on commitment letters and stakeholders to ensure continuity of team function. Objective 2: Continue to develop wrap-around services focused on youth and young adults for our community that includes Pueblo resources for mind, body, and spirit wellness. Objective 3: Create and distribute brochures that educate community members about our service to ensure appropriate amounts of outreach. The Pueblo believes that in order to create a path of wellness and resiliency for our youth, we must find ways to not only support our youth, but establish grounded learning through culture and tradition. Despite our historical trauma, we believe that it is our responsibility to preserve our culture and tradition by taking control of all our programs and services to ensure that we not only prevent illnesses that impact a healthy person but also intervene in the early stages of growing trends in mental health, including the factors and indicators related to suicide. Our Pueblo community population is approximately 2,500 tribal community members, but that does not mean that we do not experience mental health and suicidal behaviors at any less than a larger community, per capita. Our goal would include to serve 250 community members per year during the 5-year project.

The Northern Arapaho Tribe seeks the FY2023 Tribal Behavioral Health Short Title: Native Connections (Standing Funding Announcement) for Hinono’eino’ Heetoxnenii3i’ Cee’kohei3i’- Arapaho Families Rising, The Healing Village within the Traditional Practices to Wellness Office of the Wind River Family and Community Healthcare System (WRFCHCS), Northern Arapaho Tribe proposes to enhance Traditional Practices to Wellness Office intergenerational family wellness focused group work. Hinono’eino’ Heetoxnenii3i’ Cee’kohei3i’ and The Healing Village will strengthen tribal youth members Arapaho (Hinono’ei) identity and resilience against suicide and substance misuse in an integrated public health model approach to improve behavioral health disparities and lay the foundations for a coordinated network of health professionals, tribal programs, and community partners such as law enforcement, hospitals, and court systems serving tribal youth. Through a community needs assessment and community readiness assessment and leadership support, a tribal strategic action plan for universal prevention, selective and targeted prevention, and indicated prevention strategies and postvention protocols. The Traditional Practices to Wellness Office within WRFCHCS will coordinate all service providers around culture and language and strong connection to tribal elders, Beesneeniteeno (old people) to increase cultural humility, healing and braid traditional practices to wellness with evidence based practices. The Wind River Family and Community Health Care System is the Public Health Authority of the Northern Arapaho Tribe and the provider of direct health care services through an Indian Self-Determination and Education Act contract with the Indian Health Care Services. The Traditional Practices to Wellness Office at WRFCHCS will partner with all the WRFCHCS service providers and with the other tribal programs of the Northern Arapaho Tribe including the Northern Arapaho Language and Cultural Commission, whose members will also serve on the Advisory Council. The behavioral health disparities faced by the Northern Arapaho Tribe are significant, higher that national figures and highest in the State of Wyoming. The Wind River Indian Reservation (WRIR), home to the Northern Arapaho Tribe, has the lowest average of death in all of Indian Country at age 53. Those who abuse drugs and alcohol die even younger with an average age of death of 32 despite the WRIR having the lowest consumption of alcohol in the state of Wyoming. Adverse Childhood Experiences (ACE) scores rank at the top end of the scale due to this mortality and the trauma of early death within families and the reason those deaths occur. Trauma is a major cause of addiction and substance misuse as is the poverty found at Wind River where the health disparities of diabetes, heart disease, stroke and cancer strike down those who do not die due to the injuries that are a major cause of death (homicide, suicide, and substance involved motor vehicle crashes.) Research has shown that Tribal practices that build resiliency and connections American Indians to community, family, and culture, can over time, reduce risk factors for suicide and substance misuse. However, many youth for whom alcohol/drugs has become their culture are unfamiliar with who they really are. Many others have lost family over time who did not or could not convey the strength and healing that our culture, language and traditions contain. This Tribal Practices approach provides for shared knowledge between western providers of health care and traditional and ceremonial Elders. Through consultation, peer group, family heritage and language learning activities, they will connect cultural teachings to health, resilience, strengthen cultural connectedness, wellbeing, and enable intergenerational learning that supports wellbeing and resilience. $250,000 per year is being requested for a five-year program total of $1,250,000.