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The Eastern Aleutian Tribes (EAT) Tribal Opioid Program will sere the adults with opioid use disorders (OUD) living in the EAT service area, located in the Eastern Aleutian Tribes borough region in southwest Alaska. The goal of our project is to decrease illicit opioid drug use and prescription opioid misuse by expanding the capacity of a a EAT's opioid outpatient treatment services, including intensive outpatient treatment (ASAM 2.1 Level of Care), peer support groups and recovery services. The outpatient treatment will include a 12-week, 9 hours per week, intensive outpatient treatment program, an evening peer support group that meets 2 to 3 times per week, and additional recovery support services provided to clients on a case-by-case basis to meet the needs of the individual transitioning back into their new healthy lifestyle in their home community, including employment and necessary social supports to maintain sobriety. In addition, our Tribal Opioid Program works in partnership with EAT's Medicated-assisted Therapy (MAT) Program as our patients receive their medical services from the MAT Program and then they receive their behavioral health services through the Tribal Opioid Program. We anticipate serving 15-20 unduplicated clients per year, and 35-40 over the 2-year grant period.

The Expanding Our Opioid Response at CRNA Project, developed by the behavioral health department at the Copper River Native Association (CRNA), will provide culturally aligned prevention, treatment and recovery support services to over 200 individuals in the Copper River Region. The two-year project will engage with other Copper River Native Association departments to provide outreach and information in the community about opioid use disorders (OUD). It will offer providers, staff, and community members training that helps to alleviate the stigma surrounding OUD and medically assisted treatment (MAT). The project will significantly enhance MAT services currently provided by integrating additional cultural elements in the program. Then, the Expanding Our Opioid Response at CRNA Project will engage a variety of stakeholders in developing a collaboratively authored plan that both provides direction for project implementation and helps indicate service and resources gaps. Over the past five years, information has been being gathered from the communities about the challenges of treatment and recovery, this project is one step in attempting to mitigate those challenges. The goal and objectives to accomplish our purpose are as follows: GOAL: The Expanding Our Opioid Response at CRNA Project will enhance efforts that provide opioid use disorder (OUD) prevention, treatment, and recovery services, including medically assisted treatment (MAT) to 200 unduplicated individuals in the communities that CRNA serves. Objective 1: The Expanding Our Opioid Response at CRNA Project, over the course of the 2-year grant, will collaborate with other programs to provide OUD prevention and outreach services for the individuals and communities that CRNA serves. Objective 2: By the end of the grant period, the Expanding Our Opioid Response at CRNA Project will significantly improve OUD treatment services at CRNA through the expansion of culturally aligned MAT services and appropriate tele-therapy. Objective 3: By 2023, the Expanding Our Opioid Response at CRNA Project, will promote recovery and community healing in the communities CRNA serves through implementing a collaboratively developed strategic plan that emphasizes evidence based practice.

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. This program will provide a comprehensive approach to serving the population of focus, Alaska Native/American Indian (AN/AI) patients diagnosed with Opioid Use Disorder (OUD) receiving 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 support 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 regularly identified as a priority health need by residents. In 2013, 2016, and 2019 behavioral health and/or substance use were all identified as the number one or two need by the Kodiak Island Community Health Needs Assessments. In addition, KANA has seen large increases in the use of opioids, moving from three patients diagnosed with OUD to more than 30 in 2020. As an accredited Patient Centered Medical Home (PCMH), KANA believes that an opioid response should encompass a comprehensive and integrated approach. The proposed project will support the expansion and strengthening of KANA’s Medication Assisted Treatment (MAT) program, enhance OUD treatment services, and serve to increase support services available for OUD clients. The KANA TOR Program goals and strategies include: (1) increase the capacity and scope of medical staff training to improve the quality of MAT services being delivered to AN/AI patients diagnosed with OUD by providing case management certification training to medical support staff associated with the MAT program and to obtain an organizational membership with the Case Management Society of America to promote ongoing education; and (2) increase capacity to provide treatment, wraparound, and other support services for AN/AI patients diagnosed with OUD by hiring and onboarding a new Case Manager who will be trained in Integrated Case Management, and increasing the certification level and skillset of several Substance Use Disorder Treatment Program staff members. Through TOR funding, KANA proposes to serve 24 AN/AI OUD patients in Year 1 and 28 in Year 2, a total of 52 unduplicated patients. These patients will be enrolled in MAT, IOP, and mental health services as appropriate and will remain in services for an average of 6-9 months, while also receiving needed support services with the assistance of the Case Manager.

Red Lake Band of Chippewa Indians Tribal opioid Response program will serve people of Red Lake.

Lummi Nation TOR Project Abstract The Lummi Tribal Opioid Response (TOR) project is designed to add to existing chemical dependency counseling and medication assisted treatments to offer a full spectrum of treatment and recovery support services that facilitate positive treatment outcome and long-term recovery. The project has three primary goals: 1) provide outreach and case management services to tribal members returning from inpatient chemical dependency treatment and/or tribal members with a history of substance use following incarceration; 2) extend outreach and case management services to tribal members discontinuing Opioid Treatment Program (OTP) treatment against medical advice or missing OTP services for more than 5 days; 3) reduce organizational and service barriers that contribute to tribal members discontinuing OTP treatment against medical advice or missing OTP services for more than 5 days. The population of focus is Lummi tribal members and other members of federally recognized tribes that are suffering from opiate use disorder and may benefit from chemical dependency counseling and medication assisted treatment. The project proposes to utilize several empirically based practices to achieve these goals including continuing current pharmacotherapies, creating two new recovery coach positions to provide intensive case management intervention, and integrating cultural beliefs, values, and preferences into treatment. Two community members will be recruited and trained as recovery coaches. It is anticipated that 300 tribal members returning from inpatient chemical dependency treatment, and/or tribal members with a history of substance use following incarceration will receive outreach and case management services during the two years of program funding. It is anticipated that 150 tribal members discontinuing OTP treatment against medical advice, or missing OTP services for more than 5 days, will receive outreach and case management services during the two years of program funding. Program progress will be continually monitored and modified as needed to improve services to youth and families.

The Northern Cheyenne Tribal Opioid Response project will seek to provide the following to the Northern Cheyenne community members who struggle with Opioid Use Disorder (OUD): assess to out-patient medication-assisted treatment (MAT): Peer support services: weekly support groups: culturally and/or spiritually supportive activities: and a strategic plan to address gaps in prevention, treatment, and recovery for OUD. On the Northern Cheyenne Nation, substance and opioid use among youth and adult populations is markedly higher than national averages. For instance, 40% of respondents to the 2018 Northern Cheyenne Community Health Assessment indicate that a friend or close relative uses opioids. Covid has only made things worse I'm sure. There is still currently inadequate access to Opioid Use Disorder (OUD) treatment on the Northern Cheyenne Nation. Further, nearly half of patients using primary local hospital are uninsured and therefore unable to seek OUD treatment at a different facility. In 2016, Montana Healthcare Foundation provided funding to coordinate the care of pregnant women who have an identified Substance Use Disorder (SUD), but that funding is no longer available. This is our only program that addresses OUD in our area, and we are looking to grow our service. the funds from this grant will be used to prevent OUD and to improve recovery support services by adopting/ utilizing the Chronic Care Model of healthcare delivery. Goals of the Northern Cheyenne Tribal Opioid Response Program are to; 1) increase the capacity of the Northern Cheyenne Recovery Center (NCRC) to comprehensively prevent and treat opioid use disorders on the Northern Cheyenne Nation; 2) support comprehensive, evidence-based out-patient treatment to people with OUD; and 3) develop a recovery program infrastructure to support people with OUD. Interventions and measurable objectives are to : review & update a strategic plan to address gaps in prevention, treatment, and recovery care for OUD; offer at least 8 workforce development trainings; connect 28 people with OUD with out-patient MAT services utilizing FDA-approved MAT medications; determine viable, sustainable options to help people access healthcare coverage that will allow them to access MAT; develop formal understandings with the Northern Cheyenne jail and Youth Detention Center to coordinate care for people with OUD reentering the community from the criminal justice system; provide peer support to 28 people with OUD; offer weekly support groups for people with OUD; and provide at least 8 culturally and/or spiritually supportive activities to engage and support clients in sobriety. We expect to directly serve 14 people through the grant and annually 28 people over the two-year funding cycle.

There are 2.9 million Native Americans (NA) in the United States. Although that population is relatively small compared with other racial/ethnic groups in the U.S., this group has been disproportionately affected by opioid and stimulant drug use. According to the most recent CDC data, NA populations had the second highest opioid overdose rates in 2017. The overall health and wellbeing of the Nation is improved to the extent the population has access to affordable and effective substance use treatment when needed. We believe we can improve long-term treatment outcomes, reduce rates of overdose, and decrease deaths from opioid and stimulant abuse by extending treatment and incorporating a chronic disease management framework into Native American Health Service Providers addiction treatment programs. To meet this need we propose designing, developing and supplying a Mobile Health App that expands access to care by enabling providers to engage patients outside of traditional treatment settings. The App will virtually collect frequent snapshots of the patient’s progress and transmit that data back to the provider to inform clinical decision making. The App will be designed, developed and implemented with a combination of culturally appropriate and traditional Native American practices and evidence-based principles. To help ensure we facilitate positive treatment outcomes and long-term recovery we will be guided by the National Institute for Health’s (NIH) best practice principles, including insuring patients remain in treatment for adequate periods of time and continuously monitoring patients for drug use throughout their years’ long recovery process. The Native American population is in need of delivery model that enables the full spectrum of treatment and recovery support services. The proposed project will directly address that need.

The Great Plains Tribal Leaders Health Board (GPTLHB, formerly Great Plains Tribal Chairmen’s Health Board) is applying for the Tribal Opioid Response grant in partnership with Trenton Indian Service Area in North Dakota, the Flandreau Santee Sioux Tribe, the Cheyenne River Sioux Tribe, the Lower Brule Sioux Tribe, and the Omaha Tribe of Nebraska. The total user population is 18,448 (Indian Health Service User Population Estimates 2019). The focus population is American Indians 10 years old and adults at risk of, in treatment for, or recovering from opioid and stimulant use disorders. The population of focus resides within the Trenton Indian Service Area, the Flandreau Santee Sioux Reservation, the Cheyenne River Reservation, the Lower Brule Reservation, and the Omaha Reservation. Tribal Opioid Response funds are needed to build opioid treatment and prevention capacity. Through a strategy of coordinating resources in prevention, treatment, and recovery, the Great Plains Tribal Opioid Response program’s goal for the 24 month grant period is to create and coordinate resources that strengthen, complement, and sustain the capacity to support the ability to prevent and treat opioid use disorder and stimulant misuse in the Trenton Indian Service Area, the Flandreau Santee Sioux Tribe, the Cheyenne River Sioux Tribe, the Lower Brule Sioux Tribe and the Omaha Tribe of Nebraska. GPTOR will engage in the following objectives: • Within the first 60 days of the grant, GPTOR will develop a tribal opioids response strategic action plan that prioritizes the delivery of medication-assisted therapy (MAT) services. • Provide educational workshops and an annual opportunity for MAT Waiver training. The program will provide educational resources to community members on opioid use disorder and stimulant misuse prevention strategies by the end of grant year 2. support or implement community recovery groups, spiritual support, and drug and alcohol-free social engagement activities. • Work with ACET, Inc. to produce an evaluation report of all grant activities. • Produce print materials that are culturally relevant and appropriate to the five tribal communities. • Create a forum and collaborative space to address methamphetamine use in the Great Plains Area tribes. Across all five tribal communities. The GPTOR project will serve at least 2,000 annually and a total of 4,000 unduplicated individuals within the 24-month time frame.

Osage Nation’s Project Wa shke (do your best) will strive to build a community which is supportive of Native Americans who are sober or seeking recovery. The MAT program will serve 35 unduplicated individuals in year 1, and add 10 more in year 2. Education and Narcan distribution will reach 500 individuals in the county. A series of cultural activities and events will be held to encourage the concept of “culture is strength”. Community based sobriety walks will be held in the three major areas of Osage County to raise awareness. A coordinated campaign of web based, digital, and print ads will work to raise awareness of opioid use/misuse and how to seek treatment. A series of billboards will do the same. The ad campaign will be culturally sensitive and Native oriented.

The Peoria Tribe of Indians of Oklahoma (Peoria Tribe) is a federally recognized tribe located in Ottawa County, Oklahoma. This county and its surrounding areas have a low socioeconomic status along with high levels of intergenerational trauma. Adverse childhood experiences related to generational trauma cause an increase in health disparities and an increase in substance abuse risk. The increase in these areas results in an inundation of high-level opioid and stimulant misuse. The Peoria Tribe will utilize TOR funding to conduct assessments and the planning necessary to develop a stimulant misuse program. The project goals are to develop a successful Peer Recovery Support Specialist (PRSS) program as well as develop and implement community-based prevention services using evidence-based practices and culturally informed preventive services. The overarching program goals are to create an interconnected and streamlined system of care for Tribal Citizens, their families, and the local community. Peoria Tribe will work with evaluators to identify and analyze local data to provide community education addressing the stimulant epidemic within the local and surrounding communities. Concentrated efforts will be placed on prevention, workforce development, treatment, and recovery. Preventative initiatives will include but are not limited to outreach to children, youth, and elders, education, strategic messaging, and community prevention activities using culturally driven prevention services. Workforce development and training will include but is not limited to providing professional education and training for staff and stakeholders on culturally-based recovery and prevention services as well as cultural competency, and ensuring the staff and stakeholders are well versed in strategies related to prevention, treatment, and recovery of opioid and stimulant misuse. Concentrated efforts will also include training PRSS to work within the community to aid those in the recovery process. Peoria Tribe will prioritize the delivery of MAT services by establishing a formal referral pipeline with the two TOR-funded MAT clinics in the community. Residential recovery may be provided for up to two individuals per year following a successful completion of an inpatient treatment facility. Training will include teaching key staff and stakeholders to identify and refer Tribal Citizens who have been impacted by opioid or stimulant use or who are at high risk of using. Training will also include components to understand the addiction to stimulants and the devastating impact on the entire family. The project will serve a minimum of 24 in the first year and 37 in the second year for a minimum total of 61 served. The Peoria Tribe's intent aligns with that of the TOR grant in that it aims to reduce unmet treatment needs and opioid and stimulant overdose-related deaths through the provision of prevention, treatment, and recovery support services.

The Reno-Sparks Indian Colony (RSIC) aims to address the opioid crisis and stimulant use and misuse disorders, by implementing a systemic collaborative clinical services model of care to enhance programming for at-risk tribal populations through Reno-Sparks Tribal Health Center (RSTHC). The RSTHC is ideally situated to provide focused and culturally competent services to this target population. By increasing access to culturally appropriate and evidence-based treatment, including medication-assisted treatment (MAT) using Food and Drug Administration (FDA)-approved medications for the treatment of opioid use disorder (OUD) through contracting MAT services within the Reno/Sparks Area. In addition to focusing on OUD and/or SUD. The intent is to reduce unmet treatment need and opioid and/or stimulant related overdose deaths through the provision of prevention, treatment, and recovery support services for OUD and/or SUD. To improve services targeting opioid use and stimulant use disorders based on evidenced-based modalities as adapted for American Indian/Alaskan Native (AI/AN) populations using components of the National Tribal Behavioral Health Agenda (TBHA) and Alaska Native Cultural Wisdom Declaration (CWD), which elevates the importance of tribal identities, culture, spiritual beliefs, and practices for improving well-being. By enhancing the current infrastructure of RSTHC, the tribe will be able to mobilize existing resources and maximize patient care as it relates to this target population. The program will utilize the current TOR Project Director/Clinical Program Planner, to assist with data collection and service management. Focus of improvements includes enhanced wrap around services within the clinic utilizing systemic care model involving culturally heightened processes to improve well-being and overall health. • Purpose: The purpose of the project is to provide supplemental programming and educate current staff to improve existing clinical care focused on reducing the impact of opioid and/or stimulant use disorders and by reducing premature death associated with use. • Goals: The goal of the project is to reduce opioid use and/or stimulant use disorder, this include use of high-risk addictive medication for the treatment of chronic pain management among AI/ANs in Northern Nevada. The secondary goal is to improve the data collection to be able to forecast trends and identify gaps in services related to opioid and/or stimulant use disorders. In addition to improving the management of high-risk addictive medication for the treatment of chronic pain. • Objectives 1. To enhance clinical services by providing integrated treatment for patients with opioid use and/or stimulant use disorders, and monitoring improvements for medication management for chronic pain (targeting 30 per year), by the end of the first year of funding; 2. To decrease the number of patients diagnosed with SUDs, Chronic, and/or co-occurring mental disorders, by 25% by the end of the project period. 3. To increase the capacity of the Tribe to project program needs by improving data collection, tracking treatment success, identifying gaps in service and planning for sustainability. 4. By the 12th month of the grant period, Project Director/Clinical Program Planner will provide education/awareness and prevention services related to the negative effects of Opioid and/or Stimulant use; knowledge regarding the negative impacts of Opioid and/or Stimulant use will have increased by 30% as evidenced by pre- and post-test data 5. By the 12th month of the grant year, multiple departments will network and provide systemic culturally based program that includes education/awareness/prevention services to reduce use of high-risk medications that contribute to co-morbidities, by 35%. Target Population: 103 (current) Opioid Users, 145 (current) Stimulant Users, 115 Long term (current) use of opiate analgesics.

The Pawnee Nation Tribal Opioid Response (TOR) Program aims to provide a community based, culturally focused opioid and stimulant addiction services that promote positive health habits and drug free lifestyle for our clients, their families, and their communities. In order to so, TOR plans to do the following: Create a community wide opioid and stimulant abuse program that implements preventative, outreach, and recovery support services; Develop and implement evidence based, cultural related activities/methods; and Develop and implement community recovery services to enhance a better understanding of effective treatment and post-treatment strategies. Pawnee Nation TOR will help provide much needed resources to aid in the reduction of opioid/stimulant usage and production in our community. In addition, TOR will encourage behavior changes by concentrating on the individual, social, and environmental determinants. TOR Program staff intends to work with additional city, tribal, and county programs in a collaborative effort. Combining our rich Pawnee culture with treatment and prevention has been lacking in the recovery process. Cultural activities featuring inter-generational bridging can have favorable outcomes that include improved learning experiences. The desired outcomes are for long-term improvements in decision making that will result in reduced chance of opioid/stimulant misuse. With the emphasis placed on culture and collaborative approaches to treatment and prevention, there should be a greater opportunity to identify underlying reasons for substance misuse. This ability to identify the root causes will allow for further approaches and treatment availability to be accessed and to continue the reduction in misuse and addiction of opioids/stimulants. The target population will be adults (age 18 and up) in the Pawnee service area. During the two-year project period, TOR plans to reach (1000) people.

The Standing Rock Sioux Tribe (SRST) through their Tribal treatment program proposes the "Tribal Opioid Response (TOR)" project to address the opioid crisis in Standing Rock by increasing access to culturally appropriate and evidence-based treatment, including medication-assisted treatment (MAT) using Food and Drug Administration (FDA)-approved medications for the treatment of opioid use disorder (OUD); address stimulant misuse and use disorders, including cocaine and methamphetamine; reduce unmet treatment need and opioid overdose-related deaths through the provision of prevention, treatment, and recovery support services for OUD. The goals of the TOR project include: Strengthen program services capacity by hiring staff; strengthen the capacity of SRST treatment program, and tribal systems to increase utilization of culturally relevant evidence-based and evidence-informed programs for providing clinical services and supports to opioid and stimulant misuse; facilitate education of the Tribal labor force & community members to increase knowledge of strategies for prevention, treatment & recovery from opioid and stimulant misuse; strengthen the capacity of SRST tribal health and tribal systems to improve & implement systematic referral mechanisms; prevent the initiation and progression of youth substance abuse (including tobacco use) in the community by implementing promotion and prevention strategies with school age youth; increase awareness of available resources, supports, written and electronic materials for community members on substance (including opioids and stimulants) misuse, prevention, treatment and recovery; and promote family and community support. To achieve these goals the project team will increase staff members; plan and organize culturally relevant and cross-cultural substance (including opioids and stimulants) misuse training; improve patient tracking system among providers both on and outside the reservation; utilize the Approved Assessments online assessment tool to increase reach; compile existing/or revise/or develop policies and procedures for behavioral health for service coordination among partnering organizations; utilize social media, social marketing and awareness campaigns to provide electronic information and access to substance misuse resources; promote healthy lifestyle choices, positive communication, personal success and cultural involvement; and regularly assess and monitor collaboration among participating organizations. The project is slated to serve twenty-five unduplicated individuals in each year for a total of 50 over the 2-year project period. Additionally, we hope to reach the reservation population of 8,612 through community education and media messages.

Summary: Leveraging best practices from Dakota lifeways, research in mentoring, and the National Tribal Behavioral Health Agenda strategies, Lower Sioux will establish a new tribal network referring and mentoring children of OUD and other addicted patients being treated in the tribe's CD Programs, Behavioral Health, and Clinic. Forty (40) children, ages 6-17 years, will engage in cultural and healthy physical activities led by small group mentors to promote protective factors and reduce risk factors to help prevent generational alcohol and drug addiction. Population & Characteristics: This project will serve 40 indigenous youth ages 6-17 years living on or within the 10-mile federally designated service area of the Lower Sioux Indian Community. One-third of Lower Sioux's enrolled tribal population, nearly 400 youth, is under 18 years of age. All or 100% live in families impacted by addiction and historic trauma. A 2018 Lower Sioux youth survey revealed that the average age of first substance use is 11.1 years. Strategies & Interventions: Project youth will engage in a minimum of 24 weeks of evidence-based and culturally grounded out-of-school time small group activities led by two Mentor Leaders. Through relationship building and increasing access to cultural traditions and healthy activities, youth will strengthen protective factors to deter the onset of and reduce the levels of substance use. Youth will self-select and/or be referred to the project through the Lower Sioux CD & Behavioral Health Department and/or the Clinic as the children of tribal members undergoing addiction treatment. This project meets Lower Sioux's tribal-wide strategic plan, TOR community prevention strategies, and the National Behavioral Health Agenda for Advancing Prevention & Recovery Priorities. It also strengthens the prevention, intervention, and recovery network across the tribe. Goal & Objectives: The goal of the Dakota Youth Wawokiya (Mentoring) to Promote Generational Recovery Project is to increase protective factors among youth with families facing addiction that can decrease the likelihood of multi-generational substance use among 40 indigenous youth, 6-17 years. To achieve this goal, Lower Sioux will undertake and achieve two SMART objectives. Objective 1: By the end of September 2023, Lower Sioux will establish and implement a new tribal-wide referral network for youth prevention services, resulting in at least 20 new referrals from Human Services and/or the Clinic to the Wawokiya Youth Prevention Project. Objective 2: By the end of September 2023, at least 40 tribal youth ages 6-17 will strengthen protective factors against alcohol and drug use by participating in a minimum of 24 weeks of small group mentoring on Dakota cultural traditions, healthy physical activities, and arts learning activities.

The Mille Lacs Band of Ojibwe (MLBO), a constituent of the federally recognized Minnesota Chippewa Tribe has three main goals moving forward in order to address Substance Use Disorder in the community which include, 1. Improving upon and continuing current successful TOR programming 2. Addressing stimulant misuse within the community and, 3. Providing opportunities for sober enrichment. With the completion of these goals, MLBO hopes to reach 15 more clients per year totaling 30 clines over the course of the granting period.

The Ponca Tribe of Nebraska's Opioid Response Program aims to implement and integrate Medication Assisted Treatment (MAT) into the outpatient substance abuse program. Funds will also be utilized to expand outpatient services, case management, youth prevention programming, and education surrounding substance misuse.

The Knik Tribe is a federally recognized tribe providing state and federal contracted social, educational, and economic development services to tribal members in the Upper Cook Inlet region of Alaska. Knik Tribe has the largest Alaska Native Village Service Area (ANVASA) for a single tribal government covering 25,000 sq. miles and serving over 10,000 Alaska Native and Indian people residing within the tribal service area. Knik Tribe has served its people for over 30 years through such services as Housing/Community Services, Tribal Development, Tribal Transportation, Financial Assistance, and Information Technology. Knik Tribe is also a Tribal Health Organization (THO) that has recently established the Benteh Wellness Center (BWC) behavioral health program. BWC provides psychosocial and behavioral health services to the Matanuska-Susitna Valley community. BWC offers compassionate, individualized clinical, peer support, prevention, and case management services in-clinic and through Tele-Behavioral Health (video conference) to youth, young adults, and families in the Mat-Su Valley community These services also include youth and family support programs and activities and culturally informed participant data collection. Knik Tribe’s proposed Tribal Opioid Response (TOR) project for FY 2021 intends to (1) increase access to Medication-Assisted Treatment and recovery services and to (2) provide clinical and prevention services for the opioid use disorder (OUD), substance use disorder (SUD), and co-occurring disorder (COD) through the BWC program. Knik Tribe will focus on these required and allowed activities under the TOR grant opportunity: • Required Activity #5. “Implement community recovery support services such as peer supports, recovery coaches, spiritual support, drug, and alcohol-free social engagement, and recovery housing.” • Allowed Activity #1. “Incorporate culturally appropriate and traditional practices into your program design and implementation.” Tribal Opioid Response Grant (FY 2021) Goals & Objectives: GOAL 1: Increase access to MAT and recovery services. Objective 1.1: Assess BWC participants for OUD and SUD. Objective 1.2: Refer BWC participants in need of MAT and recovery services to the Southcentral Foundation. Objective 1.3: Follow-up on BWC participants treatment progress. GOAL 2: Provide support and prevention services to the participants through Knik Tribe’s BWC behavioral health program. Objective 2.1: Provide clinical services to the BWC participants. Objective 2.2: Provide peer-support services to the BWC participants. Objective 2.3: Provide prevention services to the BWC participants. Objective 2.4: Provide case management to the BWC participants. Objective 2.5: Increase participant retention in treatment. Objective 2.6: Increase participant recovery. Objective 2.7: Reduce substance use at case follow-ups. Objective 2.8: Increase participant cultural connectedness.

Prevention Opioid Abuse within the Oglala Lakota Nation The Oglala Sioux Tribe has prioritized the need to combat the abuse of alcohol and illicit drugs associated with the myriad of health and economic consequences. SAMHSA’s Tribal Opioid Response mechanism presents an excellent opportunity for the Oglala Sioux Tribe to improve both the quality and coordination of behavioral health services that aim to prevention, treat, and support those in recovery from an opioid use disorder. The introduction of medication-assisted treatment (MAT) will substantially expand the treatment options among those who struggle with addiction. This initiative will dovetail on the Tribe’s current strategic plan for reducing alcohol and substance abuse in order to deliver the following outputs: • Implement medication-assisted treatment (MAT) services among ALO clients actively participating in inpatient and outpatient services. • Implement a recovery support service model in order to increase the quality of client follow-up and MAT compliance. • Implement population level public health education campaign to increase knowledge of the health and economic consequences of opioid abuse as well as tribal resource for treatment and recovery. • Increase recovery support services for clients throughout the reservation.

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 2021 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.

The Two Feathers Native American Family Services of Humboldt County, CA, Making Relatives Project, serves American Indian (AI) youth ages 12-24 and their families in Humboldt County with a focus on the Southern Humboldt region. The project 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 Southern Humboldt 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 15 AI/AN youth and their families each year; Goal 2: Provide culturally-based, early intervention services to 15 AI/AN youth per year; and, Goal 3: Enhance the Making Relatives Program to establish efficacy and sustainability of the program.

A program to provide culturally appropriate prevention, medicated-assisted treatment, and coordinated recovery support services for tribal members diagnosed with opioid use disorder (OUD).

Bear River Band of the Rohnerville Rancheria proposes culturally-based prevention events targeted at tribal elders (ages 55+). The Bear River Elder Prevention Program will focus on expanding the capacity of the social services department to target at-risk elders and increase referrals for obtaining opioid and stimulant abuse Medication-Assisted Treatments. In order to help prevent opioid overdose, a training on how to administer naloxone will be held for the community. There will be three Elder Wellness Events in order to promote discussion, healing, and community building around the topic of preventing opioid and stimulant abuse. The goal of the project is: Increase the capacity of the Bear River Social Services Department to prevent and intervene in opioid abuse and misuse (and stimulant use disorder) in tribal elders. The objectives are: 1) By the end of year two, the Social Services Department will have increased elder-targeted outreach on opioid use and misuse/stimulant use disorders by 17 materials; 2) By the end of year two, the Social Services Department will have increased prevention-based events for elders by three events; 3) By the end of month six of year two, the Social Services Department will increase the number of elder referrals for treatment of opioid and/or stimulant abuse from zero to five; 4) By the end of month nine of year two, the Social Services Department will build capacity for data sharing, screening, diversion, and referral programs within a minimum of two other Bear River departments. Throughout the two-year project period, 20 unduplicated elders living in the service area will be served by attending the prevention events and/or by receiving treatment referrals--this number is roughly 5% of the Tribe's total population living in the service area of Humboldt County, CA.

The Red Cliff Band of Lake Superior Chippewa continues to see the increase of substance abuse addiction throughout the tribal community and surrounding communities. The Red Cliff Tribal Opioid Response (RCTOR) grant project will strengthen collaboration across tribal divisions to increase the full spectrum of substance abuse services. The project will enhance the tribal continuum of care within the community to expand substance abuse services and early integration of comprehensive and coordinated services to meet the complex needs of individual and families struggling with addiction.

The Mashpee Wampanoag Tribal Opioid Project will provide substance abuse prevention and intervention programming to the 1,812 Tribal members who reside in the IHS Contract Health Service Delivery Area (CHSDA) in Massachusetts. The project will provide culturally tailored evidence based practices including peer recovery services, enhancement of our MAT services, culturally-based prevention activities, recovery housing support and increased community outreach. We believe this combination will ultimately result in fewer losses to opioids in the community. Massachusetts is designated as one of the top 10 states in the US with the highest rate of opiate addiction and MWT members have a substance abuse rate 4 times higher than that of other MA residents. Our proposed project will reduce unmet needs related to opioid use disorder and overdose related deaths by connecting Tribal members to lifesaving resources and programs. As a result of integrating culture and tradition, we believe there will be an increase in the physical, spiritual, mental, and emotional wellness in a way that tribal members can respect and engage. Funding will support our Peer Recovery Specialist who works one on one with Tribal members connecting them to services, addressing unmet needs and providing support as they progress on their journey to recovery. Funding will also be used to connect Tribal members to MAT services and will support stays at local residential programs. Culturally tailored prevention activities will also be held throughout the year to foster community and prevent Tribal members from turning to substance abuse in the first place. Lastly, this project will increase strategic messaging and outreach to the community on substance abuse programming and services to target those Tribal members who may be unaware of or hesitant to reach out for support. The goals for the number of people served by direct substance abuse prevention and intervention programming in the first year is 145 and 190 for the second year. An additional 1,812 will be outreached to each year via electronic and mailed communications to inform the entire community on available services and dates for activities. The goals leading this project are: 1. To increase the number of Mashpee Wampanoag tribal members connected to treatment and recovery programs and supports, 2. To increase number of cultural and prevention activities that support holistic health for Mashpee Wampanoag Tribal members, 3. To increase strategic messaging and outreach to community on substance abuse programming and services.

Hunkpapa Development is a Tribal entity of the Standing Rock Sioux Tribe., which has been providing services to Tribal Communities for the last seven years. For the last five years we have been working on a Native Connection grant which works towards decreasing Adolescent suicide, suicide attempts and to decrease methamphetamine use all of which were at alarming rates before the Epidemic arrived, now the rates have risen even further. Our program will address the opioid crisis in our identified service areas by bringing awareness, education, and outreach to the communities. We will work towards addressing the unmet treatment need and the opioid overdoses. The number of people to be served annually will be 300 individuals, and 600 over the lifetime of this project. Project goals for year one are to develop the program with policies and procedures, as well as protocols. The project will use a collaboration of different evidenced based program, a prevention program, a treatment modality and an education program for our Suicide prevention, substance abuse prevention, addressing trauma, and mental health promotion. By using collaboration of programs, our community will benefit in numerous ways and we will be able to accommodate different learning types and several levels of wellness. It is our communities’ vision to provide our community members with the skills to become stable adults in all areas of their lives.