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The Westbrook MAT Initiative expands/enhances MOUD access by increasing Westbrook MAT Mobile Clinic capacity to serve Wood, Tyler, Pleasants, Ritchie, Wirt, Jackson, Roane & Calhoun Counties in West Virginia, thus decreasing target area illicit/improper opioid use. The target population suffers from high rates of opioid overdose deaths, poor social determinants of health & limited transportation capability. The project will serve 1,250 clients (250 clients/year). Project goals (interventions/strategies) include: (1) Expand access to MOUD for individuals with OUD by increasing comprehensive integrated MAT/OUD & mental health workforce capacity by (A) Expanding workforce capacity by hiring/training 1 Project Director, 1 Evaluator, 2 Case Managers, 2 Peer Recovery Support Specialists (PRSS), 1 LPN, 1 Therapist & 1 Physician’s Assistant; (B) Expanding WHS Medical Director time dedicated to serving MAT clients & (C) Expanding evidence based OUD training & EBP provision. (2) Expand access to MOUD for those with OUD by increasing access to the WHS MAT Mobile Unit by (A) Increasing MAT Mobile Unit availability in rural northern (Y2-Y3) & southern (Y4-Y5) counties from 1/2 day to 1 day and from 1 to 2 days in Wood county; (B) Reducing the Wood county MAT wait list time from 1-month to open access by increasing MAT provider capacity; (C) Conducting community outreach to increase community knowledge of the Mobile MAT unit & reduce stigma; (D) Partnering with culturally specific groups to identify referral pathways & (E) Partnering with rural MAT providers to deliver a robust suite of Recovery Support Services. (3) Enhance the MAT service array for individuals with OUD by (A) Expanding rural Narcan/Fentanyl test strip/kit education/provision; (B) Distributing dental kits to all agency clients being prescribed sublingual buprenorphine; (C) Expanding contingency management to clients with co-occurring OUD & meth use to Wirt, Tyler, Pleasants, Roane, Ritchie & Calhoun counties; (D) Adding a Sublocade prescription option; (E) Expanding services to criminal justice involved individuals by creating a smooth transition from incarceration to MAT treatment; (F) Providing transportation to the Mobile Unit for rural & verifiably unemployed clients & (G) Implementing a tobacco cessation program for MAT Mobile Unit clients. (4) Improve outcomes for adults with OUD receiving MAT from the Westbrook MAT Initiative by (A) Serving a total of 250 clients annually; (B) Empowering clients to achieve a statistically significant decrease in illicit opioid use & Rx opioid misuse at 6-month GPRA follow-up; (C) Empowering clients to achieve a statistically significant decrease in tobacco use at 6-month GPRA follow-up; (D) Empowering clients to achieve a statistically significant improvement in GPRA mental health outcomes at 6-month GPRA follow-up; (E) Retaining 80% of clients in treatment for 6-months & (F) Monitoring disparity group data to ensure equal access/use/outcomes/retention for all groups. (5) Sustain initiative services beyond grant funding to continue service provision to adults with OUD by initiating an Advisory Board to create a sustainability plan for each budget line item to ensure sustainability.

The American Indian and Alaskan Native population has the highest rates of substance use among all ethnicities. In response to these growing concerns, the Ponca Tribe of Nebraska is seeking to implement a Ponca Health Services Medication-Assisted Treatment program. The purpose of the PHS-MAT project is to provide whole-person focused substance use services through medication assisted treatment, an outpatient treatment program, and recovery support services. This project will provide services that are both evidence-based and culturally appropriate for the AI/AN population in the Ponca service delivery area. Over the next 5 years, our organization will focus on improving our services and work on increasing utilization of substance use services. In the 5 year period we hope to reach at least 200 individuals. The first goal of the project will be to expand and enhance access to medication for opioid use disorder by increasing access to MOUD, decreasing opioid use and misuse, and developing a medication assisted treatment program. The second goal of the PHS-MAT project will be to increase recovery support services through proving peer support and case management. The third goal will be to decrease barriers to substance use services. Data from the project will be collected and secured using the PTN's electronic health record and Smartsheet. The data will be monitored monthly by project director and quarterly by Chief Behavioral Health Officer and Data Evaluator. Data will be used to adjust project plan in order to ensure goals are being met. The overall goal of project implementation will be to improve the substance use issues of the clients in Ponca Health Services.

The Tule River MAT Project will provide the Tule River Indian Health Center, Inc. (TRIHCI) with the staffing, resources, recovery programs, tools, and data analysis strategies needed to enable TRIHCI to provide medication-assisted treatment (MAT) services at the organization’s primary and satellite clinics. The project will help to address the opioid crisis among the Tule River Indian Tribe, other indigenous individuals, and Medi-Cal patients living in Tulare County, California. The TRIHCI is poised to launch the proposed MAT services, because the organization has completed extensive planning, infrastructure creation, partner building, policy development, EHR development related to MAT services, outreach/education, staff training, and negotiating with a MAT provider during the past four planning years. As a result, it was determined that a part-time (16 hours a month) telehealth MAT physician would be the most effective strategy to provide MAT services. A full-time on-site Project Coordinator/Case Manager position will be filled by a Registered Nurse (RN) to assist the MAT physician by conducting the pre-MAT physical assessment (e.g., urinalysis/toxicology report), accompany patients during telehealth visits, and track patient understanding of and compliance with MAT protocols. Referrals to the MAT Project will be welcomed from any Reservation department (e.g., emergency medicine, public safety, education, Tribal court, family and social services, etc.) as well as from Tulare County Medi-Cal providers. Primary care physicians will be trained to conduct an opioid use risk assessment using the American Society of Addiction Medicine (ASAM) Quick Assessment, the PHQ-9, and ACEs (Adverse Childhood Experiences). The Outreach Worker will provide outreach/education (e.g., impact of trauma on opioid use, success stories of MAT patients) at tribal and non-tribal community events (e.g., health fairs) in Porterville and Visalia. MAT banners will be placed in high visibility areas on the reservation and in Visalia and will include project contact information. The Outreach Worker will post opioid use warnings and MAT-related posts on Facebook, Instagram, TikTok, and on the website to provide education and alert people to pertinent events (e.g., medication take back days, Naloxone distributions). The Tule River MAT Project will also incorporate several culturally relevant programs (e.g., Yetcha Mi Yeti – a Leadership Youth Group with male, female, and co-ed weekly support groups; Daughters of Tradition II (a character-building program for girls); and cultural craft distributions, as well as the White Bison Medicine Wheel and Wellbriety 12 Steps, a culturally-driven Tribal program that explores the historical roots of addiction within the Native population; Talking Circles, a trauma-informed cultural practice, foster positive psychology through peer support for Tribal and non-Tribal participants; and a youth Gathering of Native Americans (GONA), which will equip 100 Tribal youth per year to support each other to make positive choices for mental wellness. The Tule River MAT Project will also support important harm reduction activities -- Naloxone distribution, medication lock box distribution, and medication take-back days.

Northeastern Health System (NHS), a nonprofit regional health system in rural northeastern Oklahoma (OK), proposes to implement the Northeastern OK Medication Assisted Treatment (MAT) program to expand access to treatment for people with prescription drug and opioid addiction. NHS Addiction Resource Center (NHS-ARC), a federally and state licensed opioid treatment program, will build a comprehensive Hub-and-Spoke addiction treatment system emanating from our Hub clinic in Tahlequah in Cherokee County. Five Spoke clinics in Adair, Delaware, Mayes, Muskogee and Wagoner counties will bring access to a comprehensive system of addiction and behavioral health treatment services, close to home, for a rural population of approximately 246,258. Our target population is rural and entirely located within federally recognized tribal areas, and includes underserved and high need communities. Northeastern OK MAT will expand access to MAT, medications for opioid use disorder, mental health services and peer recovery supports for rural residents including people from diverse racial, ethnic, sexual, gender minority and tribal communities. Our proven, evidence-based Hub-and-Spoke model will alleviate structural, transportation, insurance and economic barriers to initiating and sustaining engagement in addiction treatment. We will expand the addiction treatment and recovery provider workforce, and build capacity to deliver comprehensive, person-centered, trauma-informed evidence-based care for people with substance use disorder and opioid use disorder. Our measurable objectives are to increase the number of opioid treatment programs in rural northeastern OK; increase the number of individuals receiving MAT and medications for opioid use disorder; and increase the number of medical, mental health and peer recovery support specialists available to rural residents. We will serve an additional 50 to 250 people per year, and an additional 750 individuals over the five years of the project. At the end of the project, we will have expanded capacity to continue serving 350 rural residents per year.

The Washoe Tribe of Nevada and California (herein Wašiw Nation – WN) is a federally recognized tribe residing at the base of the foothills of the Sierra Nevada Mountains. The WN Health Center’s (herein HC) service population is Washoe Tribal Members and their descendants and other federally recognized American Indian/Alaska Native (herein AI/AN) people and their descendants. HC’s geographic catchment area includes the four tribal colonies/communities of Stewart, Carson, Dresslerville, and Woodfords (California). Some travel over 100 miles to receive services. The Washoe Tribal Healing Center (Healing Center) has been working toward establishing a Medication Assisted Treatment (MAT) program, but progress has been slow due to limited funding. Our implementation approach for the MAT program is based on successful programs previously implemented, experience with our target population, and relies heavily on community, stakeholder, and tribal department engagement. The Healing Center, is a clinical outpatient agency providing a wide range of culturally appropriate mental health and substance abuse services, including community outreach services, outpatient services, consultation and liaison services, suicide prevention and awareness, case management services, crisis intervention, individual, couples and family counseling, group counseling, grief counseling, mental health assessments and psychological evaluation, psychiatric evaluation, inpatient placement supports, referrals, substance abuse evaluation and assessment, child play therapy, and wellness groups. The Washoe Tribal Health Center and Healing Center’s goal for SAMHSA’s Medication-Assisted Treatment – Prescription Drug and Opioid Addition (MAT-PDOA) are: To develop a Medication Assisted Treatment program for individuals struggling with opioid use disorder. To assist with the reduction and elimination of the use and misuse of prescription and illicit opioids. (1) By the end of Year One: The Medication Assisted Treatment (MAT) program will be developed and sustainably operating with a minimum of five individuals utilizing the MAT program.

Friendship House will develop and lead the Northern California Tribal MAT Consortium in response to the goals articulated by the MAT-PDOA program. Through this project, we will increase access to MOUD for American Indians and Alaska Natives (AI/ANs) living in urban, rural and tribal areas of Northern California. As a direct service provider, Friendship House will lead a consortium of tribal health programs operated by the Indian Health Service and urban Indian health programs in Northern California. In doing so, we will create a more coordinated continuum of referral, treatment and recovery support services for AI/ANs experiencing opioid use disorder. The epidemic of opioid use disorder has disproportionately impacted AI/ANs, who experience the second highest rate of opioid overdose of all racial/ethnic populations. Unfortunately, AI/ANs have poor access to treatment. Nationally 71% of AI/ANs now live in urban areas, with that percentage closer to 90% in California. These urban areas lack culturally-informed systems and services. For AI/ANs in rural or tribal areas, they often live hours away from a tribal clinic or pharmacy, preventing access to OUD treatment. These access gaps are not unique to Northern California. By addressing access gaps for AI/ANs in urban, rural and tribal areas, the Northern California Tribal MAT Consortium can serve as a national model, and a roadmap for other regions to create their own Tribal MAT Consortium. As the lead direct service provider, Friendship House will expand screening across a sprawling Northern California region and increase the number of AI/ANs receiving residential treatment at our San Francisco facility. This project will make our existing treatment program more accessible to AI/ANs living in more remote areas, establish recovery support services for AI/ANs when they return to their communities, and coordinate long-term MOUD and behavioral health care with tribal health programs. Friendship House will provide residential treatment and MOUD to 675 people throughout the 5 years of the project. Our recovery support services will reach an additional 433 unduplicated people over this period. The following are goals and measurable objectives of our proposed project: Goal 1: Increase access to medication-assisted treatment for individuals with OUD Objective 1a: By the end of Year 1, Friendship House will have increased the number of annual individuals screened for OUD by 75% (from 500 to 875). Objective 1b: By the end of Year 1, Friendship House will have increased the number of annual individuals admitted for residential OUD treatment by 50% (from 70 to 105). Goal 2: Improve care coordination for individuals with OUD from rural or tribal areas Objective 2a: Friendship House will have increased the number of annual referrals by tribal health programs and county courts by 50% (from 300 to 450). Objective 2b: 90% of individuals exiting residential OUD treatment will have stable housing and access to local behavioral and medical health care. Objective 2c: Friendship House will have engaged with each IHS clinic to collaborate on care coordination. Goal 3: Reduce relapse rates among individuals receiving MAT Objective 3a: 90% of individuals in residential treatment program will have co-created an individualized recovery plan before discharge from residential treatment. Objective 3b: 75% of individuals in recovery will participate regularly in peer-based recovery support services for at least 3 months after discharge from residential treatment. Objective 3c: 90% of individuals in recovery will have successfully continued their prescribed MAT for at least 3 months after discharge from residential treatment.

Choctaw Nation of Oklahoma seeks to improve and preserve the lives of Choctaw people through expanded access to care and enhanced quality of multidisciplinary MOUD services offered within the Choctaw Nation Family Medicine Residency (CNFMR) Clinic. By training resident physicians to confidently and competently provide MOUD services, we aim to address the workforce shortage experienced across Oklahoma and the Choctaw Nation. The goals of the project include: 1. Increasing access to MOUD for individuals with Opioid Use Disorder among the tribal population of the Choctaw Nation of Oklahoma using a multidisciplinary approach to SUD/OUD treatment. 2. Decreasing illicit opioid use and prescription opioid misuse among the tribal population of the Choctaw Nation of Oklahoma through a multidisciplinary MOUD program. 3. Improving the workforce shortage of MOUD treatment providers by training resident physicians in multidisciplinary MOUD care. Goals will be accomplished through objectives including the establishment of a multidisciplinary MOUD treatment team including resident and attending physicians, a decentralized pharmacist, a registered nurse case manager, and a licensed professional counselor. The team will establish care plans for the enhancement of existing MOUD services to treat at least 6 new, unduplicated patients with opioid use disorder (OUD) per year, while simultaneously training at least 15 resident physicians to provide MOUD services independently by completion of the project period. With a proven history of success, CNFMR intends to retain at least 25% of residency graduates for service across Choctaw Nation and 75% for service in rural or medically underserved populations/areas. These physicians will be fully trained to provide MOUD services when practicing independently, including within Choctaw Nation Health Services Authority satellite clinics. The American Academy of Family Physicians affirms that primary care physicians are uniquely positioned to address the needs of patients with OUD through the delivery of patient-centered and compassionate care to the diverse populations they serve. An Office-Based Opioid Treatment (OBOT) approach will be used to overcome barriers to MOUD treatment in the rural, tribal target population. OBOT within an existing primary care clinic providing culturally-competent care presents an opportunity for MOUD treatment in a setting with established trust in patient-physician and patient-staff relationships. This care will be further enhanced by interprofessional teaming to fully support recovery and sustained remission of OUD. Knowledge gained from the project will promote overall quality improvement of SUD/OUD treatment, access to MOUD services, and overall health and quality of life of Native American families and communities.

The Standing Rock Sioux Tribe (SRST) through treatment program proposes the ""Tribal Opioid Treatment and Prevention 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); decrease illicit opioid use and prescription opioid misuse; and reduce unmet treatment need and opioid overdose-related deaths through the provisions of prevention, treatment, and recovery support services for OUD. The goals of the opioid treatment and prevention 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, including MAT and supports for opioid, prescription drug and other drug misuse; facilitate education of the Tribal labor force & Community members to increase knowledge of strategies for prevention, treatment & recovery from opioid and prescription drug misuse; strengthen the capacity of SRST tribal health and tribal systems to improve & implement systematic referral mechanisms for Tribal members needing opioid misuse treatment; prevent the initiation and progression of youth substance misuse (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 prescriptions) 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 opioids, prescription drugs and other drug misuse training; improve patient tracking system among providers both on and outside the reservation; utilize IHS behavioral health to provide MAT services; utilize telehealth services to reach, engage and retain patients in treatment; provide harm reduction services, including opioid misuse education, naloxone distribution, syringe services, and other services across the Tribe's 8 districts; 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 125 over the 5-year project period. Additionally, we hope to reach the reservation population of 8,612 through community education and media messages.

Northwest Health Services, Inc. (NHS), located in rural northwest Missouri, proposes to dramatically expand medications for opioid use disorder (MOUD) services across 15 counties in northwest Missouri. The ""Northwest Missouri MOUD Expansion"" project will engage 375 – 450 individuals with an opioid use disorder annually in MOUD, increasing the number of unique patients served gradually over five years, to ultimately reach 2,100 individuals. NHS is requesting $744,938 in year 1 to initiate the project. Patients will be recruited across a mixture of rural, suburban, and urban communities. Demographics are expected to be similar to NHS’s patient pool: Asian - 0.71%, Native Hawaiian/Pacific islander - 0.3%, Black - 3.95%, American Indian/Alaska Native - 1.15%, White - 86.2%, More than one race - 3.37%, and unreported - 4.32%. Of patients accessing NHS for substance use last year, over 8% were uninsured initially. Approximately 16% are expected to have co-occurring conditions alongside an OUD diagnosis. Strategies and interventions for the project include all required activities within the SAMHSA MAT-PDOA scope of work. These include providing MOUD with FDA-approved medications, conducting DSM-5 diagnostic criteria screenings to identify care level and treatment, checking the state prescription drug monitoring program (PDMP), conducting screenings for co-occurring disorders, implementing outreach strategies to engage diverse populations, ensuring all practitioners have DATA waivers to prescribe MOUD to at least 30 patients, and building funding models and a Collaborative Care Model (CoCM) to deliver quality services across resource-limited communities. The project will also use telehealth services, expand formal partnerships to deliver recovery support services, and provide harm reduction services. SAMHSA allowable activities will include linkage to two HRSA funded initiatives administered by NHS—integrating MOUD within a primary care mobile unit, coordinating closely with services supporting populations with or at-risk for HIV/AIDS/infectious diseases, enhancing care to NHS’ homeless population, and improving oral health care for all participants. GOAL 1: Expand ACCESS to MOUD in northwest Missouri by (a) increasing the number of unique service delivery sites and (b) increasing the staff overseeing coordinated response. Primary Objectives: (a) Increase from one (1) to ten (10) primary care clinic sites providing MOUD; (b) expanding from one (1) to seven (7) counties); (c) integrate MOUD evidence-based services into the recently launched primary care mobile unit; (d) launch a telehealth counseling program with behavioral health student providers (overseen by a preceptor) to address staffing shortages in the catchment area; and (e) increase regional awareness of the availability of MOUD services and access points through targeted media messaging to reach a minimum of 20,000 views. GOAL 2: Enhance MOUD service QUALITY through team-based and evidence-based care in primary care clinics. Primary Objectives: (a) Engage the PI/Behavioral Health Coordinator as the dedicated staff “hub” to coordinate the Collaborative Care Model serving patients with OUD; (b) add two Community Health Worker/Navigators that holistically support MOUD services; (c) add 1.0 Peer Support Specialist (PSS) to collaborate with schools and community partners in OUD response; (d) provide technical assistance training to 40 NHS staff on evidence based practices and technical needs to improve MOUD services; (e) introduce financial assistance for patients to reduce social determinant of health barriers (e.g., transportation, food, clothing); (f) annually distribute 200 units of naloxone to patients AND ALSO to community members supporting friends and/or family members with OUD; and (g) ensure at least 80% of patients beginning MOUD services persist in treatment for at least six months.

The project will provide evidence-based services for 100 individuals with OUD or stimulant use disorder living within the Pueblo of Pojoaque, the Hispanic communities in Pojoaque Valley, and the surrounding tribal communities. The population of the service area is primarily Native American (21%) and Hispanic (63%) (U.S. Census Bureau, 2020). Clients that receive services at the Pueblo of Pojoaque Behavioral Health are American Indian at 74% followed by Hispanic at 21%. Clients speak English and Spanish. The project will serve all clients, including sexual gender minorities (SGM) and individuals of all ages and socioeconomic backgrounds. According to the 2020 Census data, 18% of the population of Pojoaque live below the federal poverty line, and in 2019 the median household income was $46,481, a 3% decline from the year prior (NM-IBIS, 2020). The median age in Pojoaque is 35.4 years, with 23% of the population under 18 (U.S. Census Bureau, 2020). Local data shows that between Rio Arriba County and Santa Fe County, 13% of the population are uninsured, and there is limited access to primary health care or behavioral health services outside of Santa Fe. These factors, coupled with rurality, discrimination, and stigma, make it difficult for tribal members to access effective substance abuse prevention and treatment services. The Pueblo of Pojoaque Behavioral Health will address the local opioid crisis and impact of opioids within Pojoaque Valley through the MAT program. The project has one primary goal and three objectives. The overall goal of the MAT program is to increase the number of individuals with OUD receiving medication for opioid use disorder (MOUD) and decrease illicit opioid use and prescription opioid use. The three objectives are: Objective 1. By the end of month three, the Pueblo of Pojoaque Behavioral Health will hire, contract with, and provide orientation to one Project Director, one licensed clinician, one peer recovery support specialists, and a MAT provider. Objective 2. During the project period of September 30, 2022, to September 29, 2027, the ESR MAT will provide access to MAT and mental health services to at least 20 individuals with OUD per year (100 total) with at least 80% (16 per year) who will successfully complete the MAT program and a variety of culturally-based recovery support services. This will be measured by the GPRA core client outcome measures data elements at baseline, 6-month follow-up, and discharge. Objective 3. The Pueblo of Pojoaque Behavioral Health will provide evidence-based services to participants and their families, to reach 20 unduplicated individuals per year impacted by OUD. The Pueblo of Pojoaque will utilize three locations to reach participants including the Annex Building, Tapia Building, and a mobile service unit.

The Three Affiliated tribes (Mandan, Hidatsa, & Arikara Nation) is located on the Fort Berthold Reservation in rural North Dakota. The Three Affiliated Tribes is a Title 1 P.L. 93-638 Program which is seeking support from the U.S. Department of Health & Human Services, Substance Abuse and Mental Health Service Administration (SAMHSA)to establish the Mandan, Hidatsa, and Arikara Medication Assisted Treatment- Prescription Drug and Opioid Addiction (MHA Nation MAT-PDOA) Model of Care Throughout the Elbowoods Memorial Health Care System. There are six segments that make up the reservation. The Three Affiliated tribes currently has 17,145 enrolled members with 5,503 tribal members living and working on the reservation. 8,274 or 48.259% of the tribal members are male and 8,871 or 51.741% are females. The tribe has 5,349 members that are under the age of 17 years old and 10,093 between the ages of 18-59. The tribe's overall average life expectancy is 51.11 years with females having 57.96 years and males coming in at 50.11 years (Tribes 2022 Enrollment Report) The main goals are to: 1. To continue making MAT accessible to members of the Three Affiliated Tribes. a. Continue training staff in Medication Assisted Treatment and training of the Behavioral health personnel in evidence-based practices in the Five A Model for Tobacco Cessation (Ask, Advise, Assess, Assist, and Arrange). b. Continue educating the EMHC staff as well as community members on protocols for the administration of Naloxone. c. Develop protocol for case management and track of clients who request or require MAT. 2. develop referral processes from primary care providers to behavioral health staff for those at high risk of substance abuse as pertains to opioid and mental health and wellness. a. Increase the knowledge and confidence in the following referral processes and workflow by annually assessing our workforce by using the referred care system and Icare EHR RPMS. 3. Improve care and outcomes for individuals who are at risk for overdose and death associated with the opioid epidemic with case managing MAT and assisting patients with support services. a. Outcomes will be tracked via case management through the development of an Opioid specific patient registry 4. Sustainability a. Enrolling clients in clients in private, state, and/or federally funded insurance programs will help in the sustainability of tribal organizational MAT Program. Elbowoods Memorial Health Center will assess our objectives at regular intervals (i.e. every 3 months) and utilize the implementation team to create continued advocacy and longevity for the project. EMHC has experience with operating a SAMHSA funded grant and are currently operating a SAMHSA MAT/TOR program which is due to expire before the start of the new proposed grant funded program. Additionally, as of January 12, 2023, the previously stringent requirement of obtaining an x-waiver to prescribe this buprenorphine has been removed. Without this requirement there should be increased ordering from more diverse sources, which will increase access to treatment and increase the need for maintenance treatment. Since 2018, when the MAT program in Elbowoods was first started, there has been an increase in facilities surrounding the Fort Berthold Reservation that also provide MAT services. As of the time of this application, with these changes mentioned above, EMHC is in the process of shifting the focus of the program to allow for more patients to have access to this treatment to decrease the financial strain on obtaining the treatment (No cost to the patient through the EMHC pharmacy).

Project Name: Integrated MAT for Families affected by Opioid Use Disorder. Summary: The Oasis Center of the Rogue Valley (Oasis) proposes a family-centered program of integrated primary care, behavioral health, and recovery support services for parenting adults with opioid use disorder (OUD) and their children in Southern Oregon. Targeted outreach will be provided to high-risk populations including unhoused, hospitalized, and recently incarcerated individuals. A majority of Oasis families live in poverty, and approximately one-third are child welfare involved and one-third are community justice involved. Oregon is ranked first nationally for illicit drug abuse in the past year, and last in the nation in residents needing, but not receiving, substance use disorder treatment (MHACBO). 18.6% of Oasis clients identify ethnicity as other than white. OUD and overdose deaths are severe problems in Oregon and in the Oasis service area in particular. The Oregon Health Authority (OHA) reports (2018, the most recent county-specific data) overdose hospitalizations in Jackson and Josephine counties were 112.0 and 136.2 per 100,000 compared to 97.0 per 100,000 for the state. The 3-year (2016-2018) drug overdose death rates for the counties were 30.5 and 27.5 per 100,000 residents respectively, almost three times higher than the statewide rate of 13.2 per 100,000. There is a spike in overdose deaths attributed to greater danger from fentanyl in the drug supply. In Jackson County Fatal overdoses increased 115% from 2020 to 2021 (JCME). This project responds to urgent needs in Jackson County: to increase community OUD recovery capacity, mitigate the impacts of substance use and overdose on individuals and families, support children’s healthy development, and reduce the negative intergenerational impacts of OUD. The project goals are 1) Decrease illicit opioid use, 2) Increase access and engagement with medication for opioid use disorder (MOUD), 3) Reduce overdose and diversion risk by adults with OUD, 4) Reduce the impact of addiction on family members of clients with OUD, 5) Increase treatment retention through integrated primary and behavioral health care, wellness activities, and employment and housing support, 6) Increase long-term funding mechanisms for clinic sustainability. Strategies and Inventions include hiring an additional physician to manage medication and to support patients with opioid use disorder (MOUD for OUD) and their young children, hire a community health coordinator to support harm reduction activities, care coordinate for large Oasis Hepatitis C cohort, and facilitate a high-system involved multi-disciplinary team (MDT) of community partners. Additionally, Oasis proposes hiring a children’s coordinator to provide targeted parenting support and to ensure children of parents with OUD receive full array of supportive and health-related services. Oasis will also hire a bilingual peer support specialist for outreach, engagement, and recovery support and will embed an employment support specialist within the clinic to support parents with barriers to employment. This five-year project will serve 50 unduplicated adults and their families during each year of the project for a total unduplicated number served of 250 adults. This proposal has a strong focus on improving access to diverse populations, providing trauma-informed care, and working closely with community partners to serve families impacted by OUD. Services will be provided by Oasis or onsite through embedded providers from OnTrack Rogue Valley, Nathan Beard Job Development, Max’s Mission, and other community providers.

Fairbanks Native Association (FNA), a non-profit urban tribal organization, developed the Medication Assisted Treatment (MAT) New Hope project to address the opioid epidemic in the American Indian and Alaska Native (AI/AN) community in the Interior region of Alaska. New Hope’s MAT Day Treatment Center will provide the hope and impetus necessary for opioid disorder users to achieve a life free of opioid abuse and one of overall wellbeing. AI/AN have been hit the hardest of any ethnic group by the opioid epidemic (Bedrock Recovery, n.d.). Discrimination, historical trauma, stigma, a lack of resources, and workforce shortages have all contributed to this crisis (National Institute of Health, 2018-2019). New Hope will serve two diverse populations; racial and gender minorities (AI/AN) and AI/AN who identify as LGBTQ. By mutual agreement FNA serves both American Indian and Alaska Natives. Services will be provided in the Fairbanks North Star Borough (FNSB). The FNSB has extreme temperatures including winter temperatures as low as -50 degrees Fahrenheit, presenting challenges to both consumers and service providers. The Purpose/Overarching Goal of New Hope is to expand and enhance access to medications and treatment for Opioid use Disorder (OUD). It will serve a total of 114 clients over the five-year life of the project. New Hope fills a specific service gap; while medication for OUD is provided by project partner Interior AIDS Association (IAA), there are no MAT programs serving AI/AN in the FNSB. The project is a partnership between IAA and FNA. It is supported through the 22-member Interagency Transition Council (ITC), the community behavioral health coalition that comprises the AI/AN FNSB behavioral health system of care. This partnership streamlines the service system, provides collaboration in and among member organizations, ensures continuity in and among services, and increases access to care. MAT Day Treatment will consist of a three-month length of stay for six clients per treatment cycle. It will offer Treatment Planning and Follow-Up, Behavioral Therapy, Group Therapy, Education, Talking Circle, Employment Education, Gender Education, Medications for Opioid Use Disorder Education, Trauma Treatment, Drug Monitoring and Testing and Transportation and Transition Planning followed by three months of Recovery Support Services. These services will be evidence-based, trauma-informed and culturally specific.

Riverside San-Bernardino County Indian Health, Inc. (RSBCIHI) is the largest tribal health care organization in California. Our MAT-PDOA program will screen 20,000 American Indian/Alaska Native (AI/AN) youth and adult patients, and non-AI/AN family members for non-medical drug. We will deliver MAT services to 160 patients. We will disseminate naloxone and provide training on its use to 750 individuals and deliver culturally appropriate education, prevention, and engagement activities to 5,000 community members. We deliver comprehensive outpatient medical, pharmacy, laboratory, eye care, dental, behavioral health, outreach, and support services. Our U.S. Indian Health Service geographic catchment area covers Riverside and San Bernardino Counties in Southern California and nine (9) federally recognized Indian reservations. This area is home to 85,471 American Indian/Alaska Native (AI/AN) youth and adults (U.S. Census Bureau, 2020). We have 37,463 registered AI/AN patients. To serve this population of focus, we operate six (6) health centers located on Indian reservations (Cahuilla, Morongo, Pechanga, Santa Rosa, Soboba, and Torres-Martinez), and two (2) located in urban areas (Barstow and San Manuel). We will expand and enhance our existing MAT program, professional training, peers support, harm reduction, and community education and prevention services. We will 1) increase access to Medications for Opioid Use Disorder (MOUD) for individuals with OUD; and 2) decrease illicit opioid use and prescription opioid misuse. To improve our MAT services, we need to solve eight (8) gaps, which is causing an inequity in access to MOUD and a disparity in our care. Our objectives are to: • Screen 4,000 individuals each year for non-medical drug use with the DAST-10. • Deliver MAT service to 32 patients with OUD each year. • Make telehealth services available to phase 2 and 3 patients. • Deliver MAT in-service training to 19 professional staff members each year. • Train and California State Certify three (3) Peer Recovery Support staff members. • Deliver effective and culturally appropriate education, outreach, engagement, and messaging at schools, COVID vaccination clinics, food drives, youth groups/talking circles, conferences, and other community events/gatherings to 1,000 youth and adult community members each year. • Purchase and disseminate naloxone and provide training on its use to 150 first responders and people in key sectors each year. • Conduct weekly MAT Case Conference meetings. • Meet monthly with our Integrated Care Committee.

Summary: LIVE FREE expands MAT and related psychosocial services within NH’s largest city of Manchester, known as the epicenter of the state’s drug crisis. Targeting justice-involved individuals with OUD or those at-risk of incarceration, LIVE FREE includes a robust community education campaign that focuses on reducing stigma and disparities in treatment to improve recovery results. Population of Focus (PoF): Justice-involved individuals with an opioid use disorder (OUD) who are: (1) within 90 days of release from incarceration; or 2) currently on parole or probation; or (3) drug court participants; or (4) identified as at risk of incarceration due to previous or current altercations with law enforcement; and those presenting with OUD-related health crises at the Emergency Department who are more likely to become justice-involved based on current demographic disparities that are prevalent within the incarcerated population (including LGBTQIA+, Racial/Ethnic Minorities, & Homeless/Living in Poverty). Strategies/Interventions: To attack capacity gaps and disparities in access to treatment for the PoF, LIVE FREE will implement a comprehensive recovery team approach – providing a cohesive unit to provide MAT (buprenorphine, naloxone, suboxone, vivitrol, etc.) and the related psychosocial treatment interventions and wraparound support services needed to prevent relapse/overdose, reduce recidivism, and help these vulnerable individuals be successful on their recovery path. LIVE FREE’s direct services team will include an Advanced Registered Nurse Practitioner to administer MAT, a Licensed Mental Health Counselor/Clinical Social Worker to provide mental health and substance use assessments, counseling and concurrent treatment referrals; a Nurse Care Coordinator (NCC) to provide “case management” and patient coordination/referral to resources addressing other medical/health needs and social determinants of health, and a Peer Recovery Coach/Resource Navigator to support clients and accompany them through all phases of their recovery journey, including helping to identify and secure fundamental needs necessary to recovery success, such as employment and safe housing. To improve systemic services relative to OUD, the project partners with Makin’ It Happen to provide educational forums and outreach targeted toward various community sectors (healthcare, justice system, business, housing/landlords, etc.) to reduce stigma associated with the POF and improve understanding of MAT and OUD. A Sequential Intercept Model Mapping event will bring different sectors together to identify diversion opportunities to steer those with OUD into treatment vs. incarceration, and a robust “Live Free” campaign and mentorship program will encourage, train, mentor, and award doctors and practitioners willing to expand or introduce MAT within their practices, to result in increased MAT access points throughout the city. Project Goals/Measurable Objectives: To increase availability & access to MAT treatment; Increase participant retention in MAT treatment; Increase recovery sustainability; Reduce Stigma/bias and achieve buy-in through MAT Education and awareness of disparities. Measurable objectives include: actively target, recruit, and enroll a minimum of 675 highly vulnerable marginalized individuals (LGBTQIA+, Racial/Ethnic Minorities, & Homeless/Living in Poverty) to receive MAT during 5-yr. project period, to address disparities/ensure equitable access by meeting or exceeding 62% of total participants; achieve re-arrest rate 6-months post-release which is 20% lower than those not using MOUD, 100% of participants will receive case management and wraparound services support, 80% of participants will participate in evidence-based Cognitive Behavioral Therapies, and others. Total Number Served: 1,085 unduplicated people over 5-year project; Annual Average Served: 217

Through Horizon Health Services' (HHS') MATConnect program, we will expand and enhance access to Medications for Opioid Use Disorder (MOUD) treatment and Recovery Support Services (RSS) for individuals with opioid use disorder (OUD) who are living in Niagara and Genesee Counties, NY, where - according to the New York State Department of Health - opioid burden is among the highest in the state. We will prioritize engagement of individuals living in rural areas in the two counties, as well as those with a history of criminal justice system involvement. Our focus population includes people living with OUD from diverse backgrounds. We anticipate that 81% of our MATConnect patients will be white, 7% black, and the remainder either biracial or of other races. We anticipate 4% of patients will be Hispanic. We have initiated outreach to the Tonawanda Indian Reservation of the Tonawanda Seneca Nation, and are carefully assessing how we can work together to support their OUD needs in a culturally sensitive and appropriate way. As such, we expect a small percentage of our patients will be from this community. Through our MATConnect program, HHS will hire three prescribers who will provide MOUD, including buprenorphine, suboxone, and vivitrol. We will offer same-day induction assessments, MOUD prescriptions, and instructions for a home induction, as well as serve as a resource for ongoing MOUD treatment. Our prescribers will work collaboratively with each patient, along with HHS' counseling staff and state-certified peer specialist to integrate MOUD with comprehensive psychosocial services, counseling, behavioral therapies, RSS, and other clinically appropriate services that are provided in alignment with each patient's needs and recovery goals. Overall, our program will offer MOUD and individualized RSS to 950 individuals living with OUD in our two-county region, including 100 in Year 1, 175 in Year 2, 200 in Year 3, 225 in Year 4, and 250 in Year 5. Our goals and measurable objectives include: (1) Increase access to MOUD and RSS for individuals in Niagara and Genesee Counties via the following objectives: 1.1: Engage 950 individuals in our program over the five year grant period; 1.2: 80% of individuals will receive MOUD services within five business days after referral; 1.3: 80% of individuals served will meet with the Peer Specialist within 48 business hours of MATConnect engagement; and 1.4: 75% of patients who engage in MOUD will also be engaged in HHS' individual, group, and/or family counseling services within two weeks of enrollment. (2) Decrease illicit opioid use and prescription opioid misuse among individuals we serve through the provision of evidence-based, FDA-approved MOUD via the following: 2.1: 80% of individuals served will improve their quality of life and recovery capital after 3 months of engagement; and 2.2: 75% of people served will reduce their misuse of opioids after six months. (3) Reduce accidental overdose events from illicit opioid use and prescription opioid misuse among patients through the following objectives: 3.1: 100% of patients served will be offered training in overdose response, along with naloxone and fentanyl test strips, within 2 weeks of engagement; 3.2: When an accidental overdose occurs, HHS will engage our Incident Response policy 100% of the time; and 3.3: 65% of patients who indicate in their baseline GPRA interview that they experienced an overdose in the past 30 days will not report experiencing an overdose in the last 30 days at their 6-month or discharge GPRA interview, whichever comes first. Data collection and measurement procedures will be delineated in a comprehensive CQI Plan, including the use of standardized instruments per an established timeline.

Southeast Alaska Regional Health Consortium (SEARHC) is a nonprofit, Native-administered health consortium established in 1975 to represent the health care needs of Alaska Native and rural people of Southeast Alaska, providing culturally and linguistically appropriate, comprehensive, medical, dental, vision, behavioral health, community-based prevention and outreach services, and urgent and emergent care services in one of the most isolated regions of the country. Southeast Alaska’s challenging geographic terrain contributes to its need for unique systems of health care delivery and the drastic lack of Medication Assisted Treatment (MAT) services for rural communities facing high rates of substance misuse. The impact is highest for populations like those on Prince of Wales island who are isolated and largely unresourced. SEARHC proposes to pilot expanding dedicated opioid treatment services to the Prince of Wales community of Klawock following a Hub and Spoke model with Juneau being the hub and Klawock one of a growing number of spokes targeting remote communities in the region. Prince of Wales Island, located in the Southeast region of Alaska, is the fourth largest island in the United States. The island is in the heart of the homeland of the Indigenous Tlingit tribes. The program SEARHC is proposing to expand will be delivered from the Southeast Alaska Regional Health Consortium Alicia Roberts Medical Center located on Lingít Aaní (Tlingit land) and will enhance access to services through a dedicated transportation service for patients seeking care who would otherwise have no help.

SUMMARY: Amity Medical Group, Inc. (AMG) is a non-profit medical practice with extensive experience providing affordable, culturally competent, integrated medical services, HIV services, opioid use disorder (OUD) services, including Medication-Assisted Treatment (MAT) services, and mental health services to vulnerable residents. AMG is proposing to use grant funding to expand and enhance access to Medications for Opioid Use Disorder (MOUD) in the Charlotte area of North Carolina, regardless of an individual’s ability to pay. PROJECT NAME: Expanding Access to Medication-Assisted Treatment – Prescription Drug and Opioid Addiction (MAT-PDOA) and Addressing Social Determinants of Health in the Charlotte Metropolitan Area of North Carolina POPULATIONS TO BE SERVED: Any individuals with OUD, including individuals from diverse racial, ethnic, sexual and gender minority communities. There is a strong need for improved access to these services in the Charlotte area where according to the Uniform Data System Mapper Report, 29% of the population (315,436 residents) are below 200% of the federal poverty level, 12% live in poverty, and 12% are uninsured. According to the NC Injury & Violence Prevention Branch, in Mecklenburg County, there were 44 opioid poisoning deaths in 2010, and this number escalated by 300% to 176 opioid poisoning deaths in 2020. Also, the number of opioid poisoning emergency department visits drastically increased by 566% from 116 in 2010 to 772 in 2020. STRATEGIES & INTERVENTIONS: AMG will utilize existing staff, hire staff, and collaborate with partners to provide MOUD services in combination with comprehensive psychosocial services, counseling, behavioral therapies, recovery support services, and harm reduction services. AMG will also conduct screenings and assessments; develop and implement outreach and engagement strategies to increase access to MOUD and related services for diverse populations with OUD; build funding mechanisms and service delivery models with organizations to effectively identify, engage, and retain individuals in OUD treatment and facilitate long-term recovery; use telehealth services to reach, engage, and retain patients in treatment; provide de-escalation/crisis prevention and Trauma-Informed Care training to staff; and assess individuals and families who are at risk for or experiencing homelessness and refer them for services. GOALS & OBJECTIVES Goal 1: To expand and enhance access to MOUD for individuals with OUD in the Charlotte area of North Carolina. Objectives: 1) Provide MOUD to 600 new unduplicated individuals in Year 1; 2) Provide MOUD to 350 new unduplicated individuals in each additional year; 3) By the end of Year 5, AMG will have provided MOUD to 2,000 unduplicated individuals total. Goal 2: To decrease illicit opioid use and prescription opioid misuse in the Charlotte area of North Carolina. Objectives: 1) By the end of each program year, 80% of program participants will have self-reported a reduction in recreational opioid use and prescription opioid misuse since starting the program; 2) By the end of each program year, 95% of participants will have received a psychosocial assessment; 3) By the end of each program year, 80% of program participants will have continued their retention in services; 4) By the end of each program year, the number of ER visits and hospitalizations for program participants will have decreased by 75% from their year prior to program entry; 5) By the end of each program year, 80% of participants will be engaged in primary care via visiting a primary care provider at least once in the past year; 6) By the end of each program year, 80% of participants that had scores of 10 or greater on the PHQ-9/GAD7 prior to program entry will show improvement in these scores; and 7) By the end of each program year, 80% of participants will have reported an increase in the quality of their life compared to surveys conducted prior to entry in the program.

Project Name: Expanding Access to Medication Assisted Treatment for Opioid Use Disorder (MOUD) for Arkansas Native American Communities and Non-Native Communities Population: Native American and Non-Native American individuals residing in Arkansas, with a focus on the major population centers for active tribal members including Crawford Sebastian, Franklin, Pulaski, Madison, Montgomery, Garland, Grant, Phillips, and Union counties. AICA primarily serves members of Chickasaw/Mississippi Choctaw, Yurok/Karuk, Cherokee, Yup’ik, and Pawnee Tribes. Additionally, the center provides services to members of other federally recognized tribes and non-tribal citizens in Arkansas. Statement of Need: The opioid epidemic has been a public health crisis for decades, claiming the lives of thousands of Americans each year. The COVID-19 pandemic has further exacerbated the crisis, particularly among Native American and Alaska Native populations. Arkansas has been significantly impacted by the opioid epidemic, with a high opioid dispensing rate per 100 people in 2020 (82.59) compared to the national average (43.3). In addition, several counties in Arkansas had high opioid dispensing rates in 2020, including Crawford, Montgomery, and Ouachita. Strategies/Interventions: The American Indian Center of Arkansas (AICA) seeks funding to expand and enhance access to MOUD for Native American and Non-Native American individuals in Arkansas. AICA will provide resources for MAT programs, mentoring, and job opportunities to decrease illicit opioid use and prescription opioid misuse. The project will involve outreach and education efforts to increase awareness of MOUD resources and treatment options. Goals and Measurable Objectives: The goal of this project is to decrease opioid use and opioid-related deaths among Native American and Non-Native American individuals in Arkansas by expanding access to MOUD resources. The project aims to serve a total of 100 people annually and 675 people throughout the lifetime of the project. The measurable objectives include: (1) increase the number of individuals receiving MOUD by 20% annually; (2) decrease the number of opioid-related deaths by 20% annually; and (3) increase awareness of MOUD resources and treatment options among the target population by 30% annually. Impact: Expanding access to MOUD resources in Arkansas will have a significant impact on the lives of Native American and Non-Native American individuals affected by the opioid epidemic. The project will provide crucial resources for MAT programs, mentoring, housing, and job opportunities to decrease illicit opioid use and prescription opioid misuse. By increasing access to MOUD resources and treatment options, the project will save lives, improve health outcomes, and contribute to the overall well-being of the Arkansas community. Conclusion: The American Indian Center of Arkansas seeks funding to expand access to MOUD resources and decrease opioid use and opioid-related deaths among Native American and Non-Native American individuals in Arkansas. The project will provide crucial resources for MAT programs, mentoring, housing, and job opportunities and increase awareness of MOUD resources and treatment options. By addressing the opioid epidemic in Arkansas, the project will save lives, improve health outcomes, and contribute to the overall well-being of the community.

The five tribal communities in Maine, Micmac Nation; Houlton Band of Maliseet Indians; Passamaquoddy at Pleasant Point; Passamaquoddy at Indian Township; and Penobscot Nation, are known as the Wabanaki, the People of the First Light. The Bangor area is the ancestral homeland of the Penobscot Nation, and home to Wabanaki Public Health and Wellness (WPHW). WPHW is a tribal non-profit organization whose mission is to provide high-quality, culturally relevant services to the Wabanaki communities and Indigenous peoples in Maine whom this grant will serve. The primary goal of the proposed grant activities is to support the expansion and accessibility of MAT services to Wabanaki People in response to service gaps, by connecting individuals to services that incorporate culture, language, and tradition, offering behavioral health treatment and supportive services while reducing barriers to treatment. Funding will be used to ensure appropriate staffing levels are in place for the provision of MOUD treatment and recovery services in Millinocket, Maine, and the transition of a contracted MAT provider to in-house capacity and licensure in Bangor, Maine. Additional proposed activities include offsetting client transportation costs and reducing barriers to treatment, increasing delivery of harm reduction and telehealth activities in recovery homes, providing dental kits and oral health education to individuals receiving treatment services, and creating preparedness packets for incoming patients.

Population to be served: The Maniilaq Service area includes the 12 communities of the Northwest Arctic Borough and Point Hope, AK. The population is primarily Alaska Native. A remote and roadless region of the arctic, residents face compounded stresses on social determinants of health: economic distress, minimal infrastructure (physical and social), as well as legacies of intergenerational trauma and high incidents of adverse childhood experiences. The project builds on previous SAMHSA support in order to expand access to Maniilaq Association's comprehensive addiction services which now include intensive outpatient therapy and medication assisted therapy (MAT), as well as piloting low-threshold services and expanded peer supports. The project has three goals: 1) expand village-based access to MA-SUD services; 2) improve MA-SUD services through coordination of MA SUD service providers across MA Administrative divisions; and 3) expand awareness of, and perceived efficacy of MA-SUD services. The project is anticipated to increase participation in services growing additional client numbers over the life of the project and accounting for a total project increase in clients served of 120 after 5 years.