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Abstract The Mescalero Prevention Program has collected surveys and knows that 14.8% of the Youth and 17.9% of Adults have prescriptions for opiate painkillers. A total of 8 of our youth said they used prescription painkillers recreationally in the last 30 days and one of them said they had used them 10-19 days in the past month. We have successfully used the Strategic Prevention Framework to implement evidence-based prevention strategies. We will employ the prevention strategies and our cultural and traditional methods and knowledge to develop strategies to prevent prescription painkiller misuse All strategies will be employed at universal, selected, and indicated tiers in Mescalero by staff, Youth and Service Provider coalitions. All work will be evaluated. The MPP developed objectives to prevent prescription painkiller misuse for the on-reservation population of 3,704 people (the target population is 1021 youth aged 9-20 years) Youth, parents, other community members and Tribal leaders will be the focus of universal and selected strategies to prevent prescription painkiller misuse. Approximately 92% of children live in households that are below the poverty level and 27% of children are classified as abused or in need of intervention. Using TOR funding we will work to meet the goal of: Goal: Decrease the misuse of prescription painkillers and opiate drugs among all members of the Mescalero Tribe who live on the reservation by raising awareness of the risks associated with the use of the drugs, informing Elders, Youth and parents of ways to dispose of prescription drugs, and working together with the behavioral health treatment system to provide evidence based treatment services and the support for follow-up care essential to leading healthy drug free Mescalero life. We designed 6 objectives to focus on information dissemination and education through social and community media, problem ID and referral through our Service Provider Coalition, and use of evidence- based prevention models that are becoming NREP endorsed. All Project Performance Assessment will be completed per SAMHSA requirements.

Round Valley TOR Project Abstract The Round Valley Indian Health Center will implement a Tribal Opioid Response Grant titled the Round Valley Indian Tribes (RVIT) TOR Prevention, Intervention and Treatment Program. The Grant will serve the Tribal Members of the RVIT living on or near the RVIT Reservation land base. The primary purpose of the project is to help Tribal Members understand the full impact of Opioid Addiction and provide vital services that will help tribal members live drug free healthy lives. The project will focus on tribal members that are experiencing Opioid Use Disorder and addiction. The Project Activities will include the development of a Strategic Action Plan, Prevention Strategies, Staff and Community Education/Training, MAT Efforts and Development, Recovery and Peer Support. The TOR Project will mark the first of effort of the RVIHC to provide MAT Services and the RVIHC plans to serve up to 50 tribal members with this funding. The Round Valley Indian Health Center plans to develop a sustainable program that will serve tribal members suffering from Opioid addiction to maintain long term recovery.

The Matanuska-Susitna Borough (MSB) is the fastest growing region in the State of Alaska and covers an area of about 23,000 square miles. Since the year 2000, the MSB has doubled in population size and is the fastest growing region in the state. The Chickaloon Native Village resides within the MSB and its service area encompasses nearly half of the borough. This broad area of coverage and the rapidly increasing population present unique challenges to increasing service and resource accessibility, especially for those residing in rural communities and who are struggling with Substance Use Disorders. Currently, the Chickaloon Native Village (CNV), provides a multitude of services in an effort to connect our community and Tribal members to services they might not otherwise receive through partnerships with organizations like Southcentral Foundation (SCF) and Cook Inlet Tribal Council (CITC). The aim of this project is to again meet our Tribal and community members where they are by assisting those who are experiencing Opioid Use Disorder in accessing services and resources that are evidence-based and culturally appropriate. In order to meet this goal, CNV plans to further develop and expand current programs and partnerships within CNV and with community partners: Life House Community Health Center, SCF, and Recovery & Re-Entry Services through CITC while expanding our current service array to include additional transportation and case-management functions for our community.

ABSTRACT Project Title: Navajo Nation Opioid Response The Navajo Nation (NN) is a federally recognized tribe and proposes to lead efforts to coordinate activities and services related the possible emerging public health concern of opioid misuse and to protect the health and safety the people of the Navajo Nation. The goal is to identify the impact (morbidity and mortality) of opioid misuse and to strategize a comprehensive approach to expand the Navajo culture-based practices and evidence-based practices for opioid prevention, treatment, recovery services. In addition, opioid misuse surveillance can be developed through adequate data tracking systems. According to the 2010 U.S. Census, the total population enumeration is 332,129. During FY 2017. Navajo Area I.H.S. User Population was 241,885. The Navajo Department of Health (NDOH) is established within the Executive Branch of the NN government. The purpose of the NDOH is to ensure that quality comprehensive and culturally relevant healthcare and public health services are provided on the NN, by working with tribal leadership, NN programs, 638, federal facilities, Urban Indian Health Center, state, and schools. The project estimates to reach at least half of the total user population at 120,500 people. The NDOH proposes the three (3) priority areas: 1. Generate a Navajo Nation Opioid Response Strategic Plan 2. Coordinate appropriate activities with cultural approaches to implement evidence-based prevention, treatment, and recovery support 3. Establish an approach for data tracking and surveillance system The NDOH acknowledges and incorporates the Tribal Behavioral Health Agenda’s American Indian and Alaska Native Cultural Wisdom Declaration which elevates the importance of tribal identities, culture, spiritual beliefs, and practices for improving well-being. A promising-based practice and culture-based practice is the NWM, which is cycle interwoven practice of Nitsakahakees (Thinking), Nahata (Planning), Iina (Implementation) and Sihasin (Evaluation). The beauty of the approach is that it is specific for the Navajo people and communities. The Navajo Nation believes that through the Navajo language and cultural practices, they can restore health and wellness.

Opioid misuse has reached epidemic levels in our nation, state, and communities. In order to respond to the impacts of opioid misuse locally, the Mt. Sanford Tribal Consortium is committed to both seeking and deploying resources to achieve the strategic goal of healthy community members. The Mt. Sanford Tribal Consortium Tribal Opioid Response Project utilizes both cultural and evidence-based practices to meet our goal of increasing the capacity of both Mt. Sanford Tribal Consortium providers and Chistochina and Mentasta Lake community members to reduce harm caused by opioid misuse. Strategies will include workforce training, prevention activities, community development and comprehensive messaging. The following are the objectives to be achieved by the project: Objective 1: By the end of the project period, increase awareness of opioid misuse by 80% through increasing focus on both harm reduction (Narcan) and recovery options (Medically Assistant Treatment-MAT) among both professionals and community members in Chistochina and Mentasta as measured by pre and post activity assessments. Objective 2: Through sponsoring events, training, and activities that elevate traditional Ahtna culture and lifeways in relation to generational and historical trauma, the MSTC Tribal Opioid Response Project will increase both individual and collective community (Chistochina and Mentasta) member capacity for opioid use prevention. The Mt. Sanford Tribal Consortium Tribal Opioid Response Project will serve 200 community members annually.

Project name: Harvesting Our Wellness Through Culture (HOW) The Muckleshoot Indian Tribe (MIT) proposes the following project to establish the Harvesting Our Wellness (HOW) Through Culture Program. This prevention program will include workshops to provide a cultural based training for tribal staff, an Evidence Based Program: Healing of the Canoe for MIT youth and family wellness through culture-based camps. Population to be served: The HOW Through Culture Project is focused on the prevention of opioid abuse and recovery support for OUD clients, youth and their families. Strategies/interventions: 1. Prevention Services will be provided for youth and families of OUD/MAT clients as identified by the MIT Behavioral Health Program. 2. Recovery support for OUD/MAT clients will also be provided in the HOW Through Culture Project. 3. The Project proposes to train OUD clients and their families’ service providers about cultural practices that can be used to treat and prevent opioid abuse and treat OUD disorders. The HOW Through Culture Project will launch a series of Cultural Workshops to train service providers about the traditional food, healing and concepts of the Muckleshoot People. We propose that this effort will empower service providers to promote the incorporation of traditional values and practices into the prevention of OUD among MAT clients, youth, and families. The second component of the HOW Project is the launch of Culture Camps for OUD/Medication Assisted Treatment (MAT) clients, youth, and families. The Culture Camps will be conducted four times a year to correspond with the traditional practices related to the four seasons. PROJECT GOAL: Reduce the unmet needs and opioid overdose related deaths through the use of culturally informed strategies in prevention and recovery activities for opioid use disorders (OUD) in the Muckleshoot Indian Tribal Community. Measurable Related Objectives: 1. The HOW Through Culture Project will provide 4 annual Culture Camps to prevent 50 opioid impacted families [25 per year] from participating in risky behaviors that lead to opioid abuse. 2. Through monthly workshops the Culture Department will train 40 MIT BH staff and tribal program leaders [20 per year] about cultural practices that prevent opioid abuse. 3. Support 50 OUD/MAT clients in their recovery efforts through Culture Camps infused with cultural teachings with the enhancement of family members’ healing/support (25 per year).

the Hualapai Health Education and Wellness Department will develop and implement a opioid prevention program for the Hualapai Reservation.

The Comanche Nation is a federally recognized tribe located in Comanche County, Oklahoma. The cycle of addiction, poverty, crime, and intergenerational trauma has led to a complete breakdown of individual and family relationships extending across generations within our tribal community. A leading cause of opioid addiction and the opioid crisis has reached an all-time high, with usage prevalent in an alarming 7 out of 10 homes. With this funding, the Comanche Nation will incorporate programming that will identify tribal members who have been impacted as a result of opioid and other drug use. The Comanche Nation Prevention and Recovery Program will implement Project Standing Our Ground within the local community to provide needed services to those suffering from Opioid Use Disorder. The overarching program goal is to create an interconnected and streamlined system of care for tribal members, their families, and the local community. Concentrated efforts will be placed on prevention, workforce development, and treatment and recovery. Prevention initiatives will include safe storage and disposal. Medical and behavioral health education will encompass providing professional education and training and distribution of Naloxone to first responders. Residential treatment and wraparound services will be provided to individuals suffering from Opioid Use Disorder. The Comanche Nation will also work to identify and analyze local data sources in an effort to provide community education addressing the opioid epidemic within the local and surrounding communities. Collaborative community partnerships will be sought out and developed in order for the Comanche Nation to effectively engage within the community. Training for key stakeholders and community partners will be provided in an effort to identify and refer tribal members who have been impacted by opioid use. Training will also include components to understand the addiction of opioids and the devastating impact and consequences on the entire family. Identifying and engaging community partners will allow for appropriate and necessary referrals to be made in an effort to maximize all existing local resources. The project will serve 288 in the initial year, 320 in the second year for a total of 608 served. The first year of Project Standing Our Ground will provide the Comanche Nation the ability to combat the opioid crisis and consequential destruction of opioid use, restoring our children and families to an esteemed state.

The Yurok Tribe currently offers a full range of existing intervention/prevention services that address opioid abuse disorder. The Yurok Tribe proposes to implement a Yurok Tribal Opioid Response (YTOR) Elder's Lifeway Project to provide support, education, and referral services to Tribal elders who have been affected by the opioid epidemic. Four seasonal events will be held for elders. At these events opioid prevention / intervention information will be provided, healthy cultural lifestyle activities, and an elder's forum. The elder's forum will provide traditional lifeways knowledge to the next generations. In this safe central place elders will come together, be informed, and if needed, participate in a referral process to seek MAT services.

The Paiute Indian Tribe of Utah (PITU) is a federally recognized tribe that has served the needs of the Paiute people for more than 25 years. PITU’s Health Department, branded as FourPoints Health, provides medical, dental, and behavioral health care through four clinics in southwestern Utah (Cedar City, Kanosh, Richfield/Koosharem, and Shivwits/St. George). FourPoints Health believes that everyone should receive quality health care at a price they can afford. We choose to provide excellent care every day and take pride in our service. Although our clinics are tribally owned, we're an open door to our community - everyone is welcome here. We want our patients to be truly healthy. As a result, in addition to treating the immediate need, we also teach patients how to live a healthy life to avoid sickness. We believe that well-being includes more than treating the body and should include the mind, emotions, and spirit as well. These Four Points define health in the Paiute way of life. To address the high rate of opioid addiction and overdose related deaths in our community, the Paiute Indian Tribe of Utah (PITU) has developed the Tribal Opioid Response project. Funding will support the full spectrum of treatment and recovery support services that facilitate positive treatment outcomes and long-term recovery. The purpose of this project is to increase access to culturally appropriate and evidence-based treatment (including medication-assisted treatment or MAT) for American Indian/Alaska Native (AI/AN) youth and adults, and their families. The population of focus is AI/AN of all ages who need behavioral health services (including substance use and cooccurring disorders). The catchment area is the Tribe’s service area covering the counties of Washington, Iron, Millard, and Sevier, Utah, 1.4% of which is AI/AN. In alignment with SAMHSA’s 2019 Tribal Opioid Response grant program, PITU’s project goals are to reduce the unmet treatment need and opioid overdose related deaths by increasing access to culturally appropriate and evidence-based treatment. Health disparities among the population of focus are vast. AI/AN have the highest rate of poverty and being uninsured in Utah. AI/AN children experience posttraumatic stress disorder at triple the rate of the general population. Catchment area suicide rates are among the highest in the state. AI/AN ages 15-19 are more than twice as likely to die by suicide than their White peers. Service area AI/AN also have higher rates of poor mental health and higher rates of alcohol and drug use. Due to small sample size, there are no catchment area population of focus rates for opioid overdose related deaths. There are no IHS-funded residential substance abuse treatment Centers in Utah for adults or youth.

San Carlos Apache Healthcare Corporation (SCAHC) intends to offer medication-assisted therapy for treatment of opioid use disorder following the Medicaid Health Home Model, with psychosocial support provided by the San Carlos Apache Tribe Wellness Center, and additional technology-assisted peer support coaching provided by Ascent Powered by Sober Grid (ASG). Over a two-year period, the project will serve 160 individuals suffering from opioid use disorder, providing them with medication-assisted therapy, case management, psychosocial support, and coaching services. SCAHC intends to hire two full-time staff members (a Behavioral Health Project Director and a Psychiatric Case Manager) to operate the TOR program. These staff members will work from SCAHC's primary hospital/ clinic location in Peridot, with travel to see patients at The Wellness Center in San Carlos, the Clarence Wesley Health Center in Bylas, local schools, and other locations throughout the reservation as needed. Consortium partner ASG will provide training to peer support coaches from the tribe, and will connect participants with a social media support network as well as remote coaching sessions via a smartphone app.

The Two Feathers Native American Family Services of Northwest California, Making Relatives Program, serves American Indian (AI) youth ages 12-24 and their families in Humboldt County. The system-wide goal for Making Relatives is to build an effective, collaborative, and sustainable AI-focused mental health and substance use program to prevent and treat the epidemic of opioid use, and its negative impacts, in the AI community in Humboldt County. Therefore, the Two Feathers Making Relatives Program seeks to engage high risk youth by addressing current mental health gaps in tribal communities through a culturally-based home and community system of care for AI youth and their families. To meet the needs of the elevated rates of co-occurring disorders (e.g., suicide and substance use disorders) in Northwestern communities, our program will include wraparound services, intensive case management, substance abuse treatment, pro-social activities and cultural programming, to reintegrate tribal youth and their families into their communities and increase overall well-being. The Making Relatives' primary goals include: Goal 1: Continue implementation of a culturally-based substance use and intensive case management program utilizing a family focused wraparound model for 10 AI/AN youth and their families; Goal 2: Provide culturally-based, early intervention services to 10 AI/AN youth per year; and, Goal 3: Enhance the Making Relatives Program to establish efficacy and sustainability of the program.

THIS GRANT WILL SUPPLMENT CURRENT ACTIVITES FOCUSED ON REDUCING THE IMPACT OF OPIOIDS AND CONTRIBUTE TO A COMPREHENSIVE RESPONSE TO THE OPIOID EPIDEMIC. THIS PROJECT WILL HELP DEVELOP AND PROVIDE OPIOD MISUSE PREVENTION, TREATMENT, AND RECOVERY SUPPORT SERVICES FOR THE PURPOSES OF ADDRESSING THE OPIOID ABUSE AND OVERDOSE CRISIS WITHIN TRIBES. IN ADDITION TO THESE TREATMENT SERVICES, WILL BE ABLE TO EMPLOY EFFECTIVE PREVENTION ADN RECOVERY SUPPORT SERVICES TO ENSURE THAT INDIVIDUALS ARE RECEIVING A COMPREHENSIVE ARRAY OF SERVICES ACROSS THE SPECTRUM OF PREVETION, TREATMENT AND RECOVERY.

The Pleasant Point Tribal Opioid Response Initiative (PPPTOR) will provide medication assisted treatment order to address this the opioid epidemic that is plaguing Passamaquoddy citizens. In addition to MAT, this initiative will provide workforce development, education and prevention activities within the community.

Cook Inlet Tribal Council, Inc. (CITC) was established in 1983 as a private, tribal 501(c)3 social services non-profit serving Anchorage, Alaska and the neighboring Matanuska-Susitna Valley. Today, CITC provides a comprehensive array of substance use prevention, outpatient, and residential services for adults and youth. In alignment with SAMHSA’s Tribal Opioid Response Grants opportunity, CITC intends to reduce the unmet treatment need and opioid overdose-related deaths among CITC’s treatment population in Anchorage, Alaska and the neighboring Matanuska-Susitna (Mat-Su) Borough by enhancing its existing continuum of care for substance abuse treatment through implementation of two selected required or allowable activities: 1. Implement workforce development activities to ensure that individuals working in tribal communities are well versed in strategies to prevent and treat opioid misuse and 2. Address barriers to receiving MAT by reducing the cost of treatment, developing innovative systems of care to expand access to treatment, engage and retain patients in treatment, address discrimination associated with accessing treatment, including discrimination that limits access to MAT, and support long-term recovery. Our overarching goal, to reduce unmet treatment need and opioid overdose-related deaths with prevention, treatment, and recovery activities, will be achieved via the following goals and objectives. Tribal Opioid Response Grant Goals & Objectives GOAL 1: Implement a substance use clinician workforce development plan to ensure staff is trained to provide high quality, evidence-based treatment. Objective 1.1: Within three months of award, identify staff training needs. Measured by: Completed review of employee files. Objective 1.2: Between Month 4 and Month 24, 30 clinical staff complete Chemical Dependency Counselor training. Measured by: Staff certifications. GOAL 2: Increase participant access to evidence-based medication-assisted treatment for opioid use disorder. Objective 2.1: Between Month 4 and Month 24, provide 76 individuals experiencing withdrawal symptoms from opioid use with a Bridge Device. Measured by: Individual case service plans and documented outcomes. GOAL 3: Treatment participants receiving CITC TOR services will experience improvement in life domains associated with recovery, as measured by GPRA follow-up interviews. CITC TOR grant funds will directly serve 76 unduplicated individuals over 24 months through administration of the FDA-approved Bridge device to support participants through acute opioid withdrawal and will also ensure 30 CITC clinical staff receive Chemical Dependency Certification training and certification. These staff will collectively serve more than 600 participants annually.

Project Abstract The Fallon Paiute-Shoshone Tribe (FPST) will be the primary service location. In addition to Fallon, clinical services will also be provided to two additional communities: the Yomba Shoshone Tribe and the Lovelock Paiute Tribe which are part of the Fallon Tribal Health Center's service area. The Lovelock Paiute Tribe has a population of about 105 and the Yomba Shoshone Tribe has approximately 186 members. The purpose of this program is to address the opioid crisis in tribal communities by increasing access to culturally appropriate and evidence-based treatment, including medication-assisted treatment (MAT) using one of the three FDA-approved medications for the treatment of opioid use disorder (OUD). The intent is to reduce unmet treatment need and opioid overdose related deaths through the provision of prevention, treatment and/or recovery activities for OUD. Fallon Tribal Health Center (FTHC) proposes to implement MAT services utilizing Buprenorphine and Naloxone combined for the AI/AN population of the FPST service area. In addition, the FPST TOR Project will purchase and disseminate naloxone (Narcan) and provide training on its use to first responders and other tribal members. To ensure that staff working with individuals diagnosed with OUD are educated in opioid misuse treatment, workforce development training and support will be implemented. The FPST will use social marketing and public education strategies for prevention and outreach. Key staff in the project include the Behavioral Health Program Director who will serve the TOR project at .05 LOE, a Certified Pain Management Specialist/physician (contracted at .05 LOE) and the Project Evaluator, also contracted at .05 LOE. The entire Behavioral Health Team which includes a clinical psychologist, psychiatrist, clinical social worker, substance abuse counselors, recovery support coach, family support coordinator and behavioral health assistant will be available to provide services at no cost to the TOR project.

Abstract: The Southern Plains Tribal Consortium consists of six federally recognized American Indian Tribes in Central Oklahoma: Wichita and Affiliated Tribes, Apache Tribe of Oklahoma, Kiowa Tribe of Oklahoma, Fort Sill Apache and the Delaware Nation. We seek to serve about 10,100 Native people in Caddo, Kiowa, and Washita counties OK. Our goal is to prevent opioid misuse and encourage local doctors to become certified in Medication Assisted Therapy (MAT). Our three counties are classified by the Oklahoma Department of Health as medically underserved and Mental Health Professional Shortage Areas. There are no substance abuse treatment or assessment centers and no accessible practicing psychologists or psychiatrists. Native people must now travel one hour or more each way to Oklahoma City for behavioral health care. Poverty among Natives is severe and about twice that of Whites in two of our three counties including Caddo county which contains 85% of our target population. No systematic effort to assess the behavioral health of our Native people, or to provide them with substance abuse prevention or treatment services, has ever been accomplished in the three-county area. We propose to begin by conducting assessments of each counties’ readiness to support efforts to reduce opioid abuse and provide access to behavioral health care that is responsive to our cultural traditions and locally available. Based on these assessments, we will work to provide strategic opioid misuse evidence-based prevention services and begin to create Tribal partnerships with three small local hospitals to provide Medication Assisted Therapy (MAT). In addition to providing information about opioids to our Native people, we seek to provide them with increased knowledge of their language and traditions in the form of culture classes. Our culture classes will be structured to appeal to youth seeking their Native identity and elders who wish to share their traditions. Culture classes will highlight culturally appropriate wellness and a drug free lifestyle. Our grant goals are simple: Create a Strategic Plan, Develop a Native Workforce, Implement Strategies that Work, Reduce Death by Opioid Overdose, and Use Culturally Appropriate Practices. Each goal is supported by between 3 and 4 measurable objectives. We will reach over 2,000 Natives through prevention and provide face to face services for 200 individuals each year or 400 during the project’s two-year span.

Norton Sound Health Corporation’s (NSHC) Behavioral Health Services’ “Medication-Assisted Treatment Services for Rural Populations” proposes to reduce regionally-prevalent substance misuse by screening for, promoting, and providing Medication-Assisted Treatment services for up to 130 unique homeless, incarcerated, and/or substance using Alaska Native adults ages 18 and older in Year One of the project by meeting people where they present most often. These locations include NSHC’s Day Shelter, a safe environment for those who are homeless; Anvil Mountain Correctional Center and Seaside Community Residential Center, the two local correctional facilities; and NSHC’s Emergency Department. Alaska’s Bering Strait Region of 9,400 people has high rates of substance misuse interfering with basic living needs. Resultant of misuse is lack of employment and housing, and a recidivist population moving through the correctional system that is disproportionately Alaska Native. A Shelter Recovery Coach will screen guests for substance misuse and refer for assessment for Medication-Assisted Treatment (MAT). A Clinician will deliver screening, assessment, and treatment for those incarcerated and will coordinate MAT services inside the prison facilities. A Project Director will oversee activities and an Evaluator will analyze outcomes. Bridge protocols for oral Naltrexone will be developed for those people who present intoxicated at the Emergency Room of Norton Sound Regional Hospital, and medical providers will prescribe for consenting adults and refer for the extended-release injectable. To ensure patients are receiving the prescribed care necessary to enter and/or maintain recovery, project staff will develop and update a registry of patients utilizing MAT so they may be followed. A hospital case manager will maintain the registry and provide appropriate outreach for appointment reminders and coordination and for resource referral. Project staff members will coordinate and facilitate recovery support services at the Day Shelter and correctional settings through resource referrals and scheduled presentations from outside providers who may serve the needs of the guests. Presentations will include education and materials regarding OUD and MAT services descriptions, processes, and availabilities. Participation is expected to be 200 unique individuals accessing services with 120 individuals receiving MAT. At the conclusion, it is expected that participating individuals from the target populations will move into recovery, restore basic living needs (housing, employment), remain free from the prison system, and decrease dependency on emergency services

The Gun Lake Tribe (GLT) will strengthen its opioid programming by identifying community response readiness, developing recommendations for an action plan to address the opioid crisis in the community, and by expanding access directly and through referrals to opioid response services. The project will serve 100 individuals who are at risk for opioid/drug misuse over the course of the two (2)-year project. The target population are those who use Gun Lake Tribal Health Center (GLTHC) programs and services; this includes GLT staff, GLT Citizens, Native Americans from other tribes, and household members of Tribal Citizens. The geographic catchment area where services are delivered is rural with limited access to hospitals and health centers. In order to address the needs identified in this project, staff will accomplish two (2) goals: Goal 1 – Identify gaps in existing services to reduce opioid misuse, addiction, and risk factors in the community and increase efforts to support those affected by the opioid epidemic. Objective 1 – Work with key stakeholders to draft a response/strategic plan and fine tune the Community Readiness Assessment to further identify the impact of the opioid crisis in the GLT Community. Objective 2 – Draft and administer pre and post mini-surveys to identified focus groups by the end of January 2020. Goal 2 – Expand access to prevention, treatment, and recovery services by advancing existing GLTHC programs and services in coordination with other federally-supported efforts. Objective 1 – By the end the end of January 2021,work with the Grand Rapids Red Project to provide Naloxone training to key GLT Health and Human Services (HHS) staff and purchase/obtain Naloxone kits and distribute as needed. Objective 2 – Reduce the stigma of addition by providing training and education to the Tribal Community on opioid/drug misuse. Objective 3 – Support the ability of the Gun Lake Tribe Behavioral Health Program to provide effective treatment and services to patients by providing staff with relevant training and education. The GLT will use Medication-Assisted Treatment (MAT) directly through its HHS medical clinic and Behavioral Health programs or by referral to appropriately credentialed agencies, Screening, Brief Intervention and Referral to Treatment (SBIRT), Motivational Interviewing (MI), Trauma-Informed Care, and Auricular Acupuncture (or Acudetox) to complete the goals outlined in this project. The GLT will also leverage funding in this project to complete SMART Recovery facilitator training, MAT training, and strengthen prevention, intervention, and recovery efforts. Patient data and community feedback through surveys will be used to make recommendations to the HHS Director to advance opioid response programming.

The Kodiak Area Native Association (KANA) is requesting Substance Abuse and Mental Health Services Administration (SAMHSA) funding for the KANA Tribal Opioid Response (TOR) Program. KANA TOR Program will provide a comprehensive and multifaceted approach serving the population of focus, all Alaska Native/American Indian (AN/AI) patients receiving opioid use disorder (OUD) treatment at KANA, to address the opioid epidemic in Kodiak, Alaska. Kodiak Island is a 100-mile long island on the south coast of Alaska, separated from the Alaska mainland by the roughly 30-mile wide Shelikof Strait; it is surrounded by smaller islands of various sizes in the Kodiak Archipelago. KANA provides comprehensive services to over 2,500 AN/AI residents in the Kodiak region, and operates through resolutions from nine regional Tribal Governments under P.L. 93-638, the Indian Self-Determination Act. KANA provides primary medical, dental, and behavioral health services, as well as wrap-around services to families who struggle for resources to all AN/AI population of Kodiak and the surrounding villages. In the Kodiak region, behavioral health, including substance use, has been identified as the priority health need by residents. KANA has seen large increases of opioid use, especially heroin, with our patients in recent years. In 2015, KANA provided services to three OUD patients, which increased to 37 OUD patients in 2018, 32 of whom reported heroin as the primary substance. As an accredited Patient Centered Medical Home (PCMH), KANA believes that an opioid response should encompass a comprehensive and integrated approach. The proposed project includes Medication Assisted Treatment (MAT), OUD treatment, physical therapy, as well as alcohol and drug free social activities for OUD prevention, treatment, and recovery in the City of Kodiak and the predominately Alaska Native villages of Akhiok, Larsen Bay, Old Harbor, Ouzinkie, and Port Lions. KANA TOR Program goals and strategies include: (1) increasing the capacity and scope of medical and SUD providers to improve recovery outcomes of AN/AI patients diagnosed with OUD by allocating a SUD Counselor to the TOR Program, training MAT, substance use disorder (SUD), and village-based providers, enhancing village OUD treatment, and providing Naloxone kits; (2) improve long-term recovery outcomes of AN/AI OUD patients by providing drug and alcohol free social engagement; and (3) provide alternative pain management for OUD prevention with the inclusion of a Physical Therapy Assistant and purchasing physical therapy supplies. Through TOR funding, KANA proposes to serve 20 AN/AI patients with a primary OUD diagnosis in year 1, and 23 patients in year 2. These patients will be enrolled in IOP, MAT, and mental health services, as appropriate, and will remain involved in services for an average of 6-9 months. This is a total of 43 unduplicated patients who will receive OUD services over the entire project period.

Title - Northwest Portland Area Indian Health Board (NPAIHB) Tribal Opioid Response Consortium Phase 2 (TOR2) The aim of the Northwest Portland Area Indian Health Board (NPAIHB) Tribal Opioid Response Consortium Phase (TOR2) is to significantly expand the capacity for Tribal Opioid Response to at least the participating six NW Tribes in TOR2. The overarching goal of the NPAIHB TOR2 is to develop a comprehensive and strategic approach to assist Tribes in developing capacity to address the complex factors associated with a comprehensive opioid response. This includes expanding access to culturally appropriate prevention, treatment, and recovery activities to reduce unmet treatment need and opioid-related deaths through a strategic opioid response plan. The current TOR strategic plan includes, but is not limited to accomplishing the following objectives: Objective 1-The NPAIHB TOR2 Consortium will review the existing TOR strategic plan and update as necessary based on TOT2 tribal input. Objective 2-Increase awareness of tribal opioid response in AI/AN communities. Objective 3-Prevent Opioid Use Disorder (OUD) in AI/AN communities by increasing use of evidence and culture-based interventions and innovative community-based strategies. Objective 4-Increase access to treatment and recovery services and overdose reversal capacity by increasing access to evidence-based interventions. Objective 5-Reduce the health consequences of opioid use disorder in tribal communities using evidence-and-culture based interventions, and innovative community-based strategies. NPAIHB's primary role in the Consortium Phase 2, is to provide leadership, coordination, data management and analytic support, and training and technical assistance to participating tribes in goth the application and administration of the SAMHSA TOR 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 TOR2 will expand access to integrated health services, thus reaching critically underserved AI/AN people living in the United States.

The Ponca Tribe of Oklahoma proposes to address the opioid crisis in tribal communities by completing a comprehensive strategic plan to identify service gaps in the six (6) county catchment area of Kay, Noble, Pawnee, Grant, Garfield, and Payne counties. The Ponca Tribe Opioid Response Program will provide medication-assisted treatment (MAT) through the Ponca Tribe’s White Eagle Health Center. The program will implement evidence-based prevention strategies inclusive of community outreach and in-service training to prevent opioid abuse/misuse. The Ponca Tribe Opioid Response Program intends to serve approximately 25 unduplicated AI/AN people ages 18-years-old and older annually and approximately 50 unduplicated AI/AN people ages 18-years-old and older over the two (2) year grant project period.

Mathiesen Memoria Health Clinic’s (MMHC) MAT Program Overarching Goal: MMHC will enhance and expand its existing Medication Assistance Treatment (MAT) program in order to see an additional 60 unduplicated patients (tribal members and low-income individuals). In order to move forward in our MAT program we are compelled to start with a strategic program planning and development process. This program planning process would help us identify levels of need, access barriers, loss opportunities and gaps in care (prevention, treatment and recovery), our capacity, workforce requirements and training needs and likely community partners. We will assess the economics of the program, financial support available for patients, attitudes and workforce issue. With this comprehensive information we would then develop a sustainable, well-received MAT program that is evidence-based and inclusive of tribal culture and believes for improving well-being. MMHC has integrated behavioral health services within the four walls of our health clinic as well as a hepatitis C 340B program. Thus, MMHC can offer the combination of primary care, medication management and behavioral therapies. As part of the strategic program planning and development process, we would develop measurable outcomes and evaluate our MAT program on an ongoing basis by using the chronic care model - plan, do, study, act (PDSAs). Service Area: MMHC’s service area is the city of Jamestown, a national designated historic town located in western Tuolumne County, California and the surrounding area. Jamestown is a rural and somewhat remote area with minimal services located in the Sierra Nevada mountain foothills. Target Population: The target population is the Chicken Ranch Rancheria tribal membership of 32 members, 840 unaffiliated Native American Indians who reside in Tuolumne County, and the low-income population that reside in and around Jamestown. Expected Outcomes: 1) Strategic MAT planning and development including policies and procedures and increase staff capacity; 2) Hire a MAT Care Navigator to support patient coordination, tracking and outreach; 3) Expect to provide MAT services to 60 unduplicated patients; 4) 80 percent of patients are retained in the program after a six month period of beginning the program.

Kenaitze Indian Tribe (Kenaitze) is a federally recognized Tribal Government reorganized in 1971 under the statutes of the Indian Reorganization Act of 1934, as amended for Alaska in 1936. Kenaitze serves 1,670 Tribal members and approximately 4,410 Alaska Native/American Indian (AN/AI) residents. The Tribe’s service area spreads across more than 15,000 square miles of rural Alaska, where heroin use in particular has reached epidemic proportions in recent years. Kenaitze’s health programs do not currently offer medication-assisted treatment (MAT) for opioid use disorder (OUD), so patients who would benefit from such approaches must be referred to other local/regional providers outside the Tribal health system. The population of focus is limited to Kenaitze Tribal and other AN/AI adult (18 years and older) community members who are diagnosed with OUD because Primary Care services are available only to IHS beneficiaries, which include the prescription of FDA-approved MAT; non-IHS beneficiary patients who are encountered by this program will continue to be referred to outside providers to receive MAT. This proposal is intended to achieve the following goal and objectives: Goal: Improve the availability of evidence-based treatment options for Tribal/AN/AI un’ina within the Kenaitze service area. Objective 1: By the end of program year 1, provide MAT to at least fifteen (15) Tribal/AN/AI patients diagnosed with OUD as measured by program enrollments. Objective 2: By the end of program year 2, provide MAT to at least thirty (30) Tribal/AN/AI patients diagnosed with OUD as measured by program enrollments. Grant-funded services will be provided at Kenaitze’s Dena’ina Wellness Center (DWC), a state-of-the-art health facility. Participants’ MAT will be provided in this clinical practice setting as a collaboration between the Primary Care and Behavioral Health Departments, ensuring that OUD-diagnosed patients receive FDA-approved MAT from a licensed prescribing physician and are linked to psychosocial services via a Chemical Dependency Counselor (CDC) that are intended to support sustained recovery; those admitted to the program will be administered Suboxone (buprenorphine) in weekly treatment increments in conjunction with required individual and group counseling sessions conducted by the CDC, utilizing Motivational Interviewing (MI), the Matrix Model, and Cognitive Behavioral Therapy (CBT) as evidence-based practices that demonstrate effectiveness with the population of focus. To ensure accountability, the CDC will also perform weekly “dipstick” urinalysis testing that can be used in-office to determine whether patients are using substances other than that prescribed. Used Suboxone strips will be collected to ensure the patient is using the MAT as it has been prescribed. The CDC will also be responsible for conducting face-to-face interviews with all patients who are accepted into the MAT program at initial intake, at the 3- and 6-month marks of service delivery, and at discharge.

Wampanoag Tribe of Gay Head (Aquinnah) SAMHSA - FY 2019 Tribal Opioid Response Grant (TOR) Funding Opportunity Number: TI-19-012 – Project Abstract Summary Massachusetts ranked among the top ten states with the highest rates of drug overdose deaths involving opioids. In 2017, there were 1,913 drug overdose deaths involving opioids in Massachusetts—a rate of 28.2 deaths per 100,000 persons, which is twofold higher than the national rate of 14.6 deaths per 100,000 persons. American Indian and Alaska Native (AI/AN) populations are disproportionately impacted by public health & safety issue. Therefore, the goal of this project two-year project is to increase the capacity of the Wampanoag Tribe of Gay Head (Aquinnah) to address the opioid crisis in its jurisdictional boundaries increasing access to culturally appropriate and evidence-based treatment and prevention programming. The outputs of this project include the development of three actionable documents 1) a comprehensive, current needs assessment, 2) and capacity assessment of the tribal court and 3) a Strategic Plan to identify gaps and resources to build prevention and community-based recovery support services that are culturally relevant for marginalized AI/AN community members. This project’s target population are AI/AN individuals affected by substance abuse, including heroin, opium, oxycodone, fentanyl and the like. The age group of interest are ages 8-65, with specific attention to teenage males, pregnant women affected by opioids, and the children born to chemically dependent mothers misusing opioids. This project will leverage the existing programs operating within the Tribe’s administration. The outcome of this project is increased tribal capacity to document and manage client needs, provide holistic care to individuals and families affected by opioids, and better integrate related support services. Objective One: Complete a comprehensive strategic plan, based on the most current epidemiological data for the tribe, to address the gaps in prevention, treatment, and recovery identified by the tribe. Objective Two: Complete a system analysis of the Tribal Courts capacity to operate a Wellness Court that is interlinked with the Social Service Programs of the Tribe Objective Three: Define workforce development needs to ensure that individuals working in tribal communities are well versed in strategies to prevent and treat OUD Objective Four: Develop effective prevention strategies which include outreach and engagement of youth, strategic messaging, and community prevention activities – particularly for breastfeeding mothers and caregivers of infants exposed to drugs These objectives directly link with the National Tribal Behavioral Health Agenda supporting priorities HIT 1.3, HIT 1.4, HIT 3.2, SCE 3.2, PR 1.1, PR1.6; and PR 2.1. The estimated unduplicated number of individuals this project intends to serve annual is 10 individuals in year one and 15 individuals in year two. During the full two-year project an estimated 25 to 30 adult individuals will be served with SAMHSA grant funds.