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

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

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

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

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

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

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

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

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

The fentanyl and drug overdose public health crisis has reached epidemic proportions in our nation. American Indian and Alaska Native communities are suffering extreme costs due to the historical and ongoing impacts of systemic racism and discrimination that contribute to the current health inequities and disparities facing Tribal nations. The Northwest Indian College (NWIC) Native Connections project seeks to combat the fentanyl/drug overdose crisis by systematically building Coast Salish Indigenous strengths and protective factors in 430 transition age NWIC students (16-24 years) and among 1,000+ Coast Salish Tribal youth (13-18 years) from surrounding communities through a multi-tiered prevention service implementation of the data-driven Native Transformations Coast Salish Reef Net Wellness Model. Our overall goal aligns with SAMHSA's National Tribal Behavioral Health Agenda (TBHA) which, "elevates the importance of tribal identities, culture, spiritual beliefs, and practices for improving well-being." Through a youth- and community-driven process, our project seeks to accomplish the following goals: 1) Increase the capacity of NWIC main campus and extension sites to provide prevention services, and to promote positive behavioral health for Tribal students and Coast Salish young people from the surrounding communities. 2) Increase Coast Salish strengths in NWIC students and Tribal youth by implementing the data-driven Coast Salish Reef Net Wellness Model. 3) Decrease risk for substance abuse and overdose by implementing the Coast Salish Reef Net Wellness Model across NWIC's main campus and extension sites. 4) Increase meaning and purpose in life and decrease risk for suicide in NWIC students and Tribal youth by addressing the impacts of historical and intergenerational trauma through campus-community events that build wellness and connection. 5) Integrate the Coast Salish Reef Net Wellness Model into the NWIC Behavioral Health Aide (BHA) Certification curriculum to create a workforce change that centers culture as prevention and treatment. 6) Measure outcomes from the prevention services and gather campus-and community-level data on promotion of positive youth behavioral health and holistic well-being.

The Skokomish Behavioral Health Prevention Program will prevent and reduce suicidal behavior and substance use/misuse, reduce the impact of trauma, and promote mental health for a minimum of 50 Skokomish youth annually, up to and including age 24, by building a healthy network of systems, services and partnerships that impact youth. The Skokomish reservation is located in Washington state in rural Mason County. The Tribe has 775 members who range from newborn to 87 years old. Our April 2023 Enrollment Report shows that 155 members are 10-24 years of age. The Tribe is committed to making this trauma-informed approach program successful and sustainable. In order to do this, we will spend the first year building infrastructure and preparing staff to implement the program. Program objectives include conducting assessments; developing and implementing a strategic action plan; developing policies, protocols and procedures; attending several conferences to see if attending in subsequent years with program participants would be of value; completing a wide variety of program and topic training; identifying resources; initiating new and enhancing current partnerships; developing or improving consent forms and program information; planning and implementing outreach and awareness efforts; and planning year-two prevention activities and events. Program participants will be limited to the Skokomish tribal community serving tribal members and their families. While we do not have suicide data available for the tribe per counntyhealthrankings.org the number of deaths per 100,000 by suicide in Mason County was 21 with 16 in Washington state and 14 for the US. These numbers were consistent in 2021 and 2020. CDC WISQARS data shows that suicide was the second leading cause of death for AI/AN individuals ages 15-19 (all races 624) in Washington state at 38 as well as individuals 20-24 at 44 (all races 980). While these numbers appear to be low they are quite significant as while the AI/AN populating is less than 2% in the state the suicide rate is overrepresented at over 5%. Per the University of Washington's ADA Institute deaths involving opioids in the State have increased significantly with 1.45 per 100,000 people in 2004 to 15.95 in 2021. The AI/AN population has been consistently overrepresented at 4.5% of the deaths in 2004 to 6.3% in 2021 as compared to being less than 2% of the State's population. Of utmost concern is that Mason County has the highest number of opioid-related deaths with 3.84 per 100,000 in 2002-2004 soaring to 34.91 in 2020-2021 representing an 808.6% increase. While there are three other counties with deaths per 100,000 in the 26.23% to 31.13% range there are several with no deaths.

The Nez Perce Tribe propose the Native Connections effort to address the problem of suicide and substance use among Native American youth and young adults ages ten through twenty-four years on our remote rural reservation. The Nez Perce Reservation is in north central Idaho and represents the geographic catchment area. The Native Connections initiative facilitates integration of Universal and Targeted Prevention into a comprehensive public health effort that currently focuses on treatment. Native Connections supports bringing Tier 1-Universal Prevention and Tier 2-Targeted Prevention to scale to serve half of the youth and young adults on the Nez Perce Reservation approximately three-hundred and twenty-eight individuals over the 5-year funding period which is approximately sixty-five unduplicated youth and young adults per year. Native Connections is guided by a tribal youth advisory board (Native America Hear Our Voices Arise-NAHOVA). The NAHOVA youth advisory board was established three years ago and meets monthly and continues to grow. NAHOVA members are trained in suicide prevention. Through a Participatory Action Research -PAR- process recently NAHOVA generated a substance use hot spot and resource analysis for the Nez Perce Reservation and developed infographics about contributors to alcohol and marijuana use. The PAR process will expand on the current assessment to address community needs and existing resources supportive of suicide prevention and behavioral health. NAHOVA will conduct focus groups with their peers. NAHOVA members are trained in focus group facilitation training and will facilitate focus groups at the upcoming GONA. Focus group input will inform development of the Tribal Strategic Action Plan. The Nez Perce Tribe Native Connections program goals. Goal 1 is to increase awareness about suicide and substance use through educational in-person and social media outreach to Native Americans on and near the reservation. Goal 2 is to build public health capacity within the tribe by designing and implementing a public health effort encompassing the three prevention tiers. Goal 3 is to develop resiliency among Native youth and young adults on the reservation by supporting youth leadership activities. Goal 4 is to increase the capacity of the tribe to respond to suicide and attempts and to prevent contagion by developing and implementing tribal postvention procedures-protocols-policies. Goal 5 is to increase community gatekeeper capacity to prevent and respond to suicide and overdoses by providing evidence-based training and CEUs.

Project Name: FPT Native Connections Program Population(s) to be served (demographics and clinical characteristics): As of January 2023, the Fort Peck Tribes Enrollment Office estimates the total enrollment as 13,129, with 6,408 members living on or adjacent to the Reservation. Of these 6,408 Tribal members, 34% of Tribal members living on or adjacent to the Reservation are between the ages of 0 to 17 and 36% are between the ages of 18-39. 70% of the Tribal membership is below the age of 39. The main spoken language is English, with some people speaking Nakoda or Dakota. “The median age is 29, per capita income is $18,301, 31% are below the poverty line, 55% of children under 5 years of age live below the poverty line, 74% have a High School degree but no College degree, 14% have a bachelor’s degree or higher, 46% are not in the labor force, and 46% are in the labor force and employed, 8% are in the labor force and unemployed. (Fort Peck Tribes Community Economic Development Strategy 2021).” Strategies/interventions: Our strategy is to engage youth ages 0-24 living on the Reservation to participate in cultural activities that express connection to culture and family and provide a sober and balanced environment. Project goals and measurable objectives, including the number of people to be served annually and throughout the lifetime of the project, etc.: The GOAL of the FPT Native Connections is “to prevent and reduce suicidal behavior and substance abuse, reduce the impact of trauma, and promote behavioral health among American Indian youth on the Fort Peck Indian Reservation.” To achieve this goal, we have developed the following measurable objectives: Objective 1 Required – By the end of Month 4 the Native Connections team will update its behavioral health Disparity Impact Statement (DIS). Objective 2 Required – By the end of Month 4 the Native Connections team will conduct a Community Needs Assessment (CNA) Objective 3 Required – By the end of Month 6 the Native Connections team will update its Community Readiness Assessment (CRA) Objective 4 Required – By the end of Month 9 of the project period, the Native Connections team will develop a Tribal Strategic Action Plan (TSAP) Objective 5 Required – Establish a Youth Advisory Group that provides guidance and feedback about the project and whose contributions and recommendations are addressed by the project – (The Notice of Funding Opportunity (NOFO) does not specify a required date). -Completed and Ongoing- Objective 6 Required – Develop and/or revise “postvention”6 protocols that reflect the traditions and culture of the community while also addressing coordination of care and intervention among youth-serving agencies for both immediate and follow-up care for AI/AN youth. (The Notice of Funding Opportunity (NOFO) does not specify a required date). – Ongoing - Objective 7 By the end of Month 36, the Native Connections team will conduct a Youth Needs Assessment (Ages 0-24). Objective 8 By the end of Month 60, 11 Youth will have attended the Native Pride Youth Conference in Billings, MT Objective 9 By the end of the Project Period (60 Months), at least 1,000 American Indian Youth will participate in cultural activities and events sponsored by, co-sponsored by, coordinated with or supported by the Native Connections program on the Fort Peck Indian Reservation. Objective 10 By the end of the Project Period (60 Months), Native Connections staff will have conducted 48 suicide prevention trainings (ASSIST, SafeTALK, QPR) to approximately 200 American Indian Youth and Adults per year living on the Fort Peck Indian Reservation.

Hél daa sá a yáanáx? x??adudlitseen haa yátx?i Nothing is More Cherished Than Our Children is a Tlingit Cultural Identity Development for Emotional Well-Being and Suicide Risk Reduction initiative by the Goldbelt Heritage Foundation (GHF) serving Alaska Native Youth ages 7-19. The Indigenous youth in Alaska are growing up in a fractured society, apart from their culture, and suicide is the leading cause of death among Alaska Native young people ages 15-24. The goals of this project are to (1) Reduce and prevent suicidal behavior and substance abuse among Alaska Native youth from ages 7 to age 19. (2) Ease the impacts of substance use, mental illness, and trauma in our community, through a lens of Tlingit culture, partnerships, and sustaining safe welcoming spaces for youth. (3) Support AN/AI youth as they transition into adulthood by providing information and education for mental health and empowerment. (4) Teach AN/AI youth how to advocate for themselves as we connect them to resources for their mental health and wellness and for them to understand some of the structural-societal factors contributing to mental illness and trauma. (5) Provide culturally responsive suicide prevention and awareness training to youth and community mental health providers in collaboration with Tlingit & Haida (T&H) and the Juneau Suicide Prevention Coalition (JSPC). (6) Celebrate the cultural identities and belonging of Alaska Native youth through cultural gatherings. To make progress toward these goals, GHF will conduct a Community Needs Assessment (Objective 1), Community Readiness Assessment (Objective 2), and complete a Strategic Action Plan that encompasses three tiers of suicide reduction and prevention strategies that are Universal, Selected/Targeted, and Indicated Prevention Strategies (Objective 3).GHF will partner with local agencies committed to serving on a Youth Advisory and AN/AI Students Board (YAB) in order to develop a written online manual for suicide prevention and postvention (Objective 4). GHF staff will deliver a culturally relevant suicide prevention and self-advocacy curriculum to at-risk AN/AI youth. The curriculum will address Tier 2 Selected and Targeted Prevention Strategies and include empowerment for self-advocacy and information supporting transitions to adulthood and mental health policy (Objective 5) to serve 50 AN AI youth annually. GHF staff and the Juneau Suicide Prevention Coalition (JSPC) will co-develop and deliver culturally informed training for adult responders (Objective 6) to serve 50 adult community responders annually. Additionally, GHF staff will promote spiritual and cultural identity development and youth social connectedness by conducting three community events over the award period 1. a GOAN, 2. the Alaska Blanket Exercise, and 3. a traditional Tlingit ?u.eex with adoption and naming ceremonies (Objective 7) to serve 100 youth during the project award period (and 100 guests for ?u.eex GHF has more than 15 years of experience writing and teaching curriculum that is based on our cultural values and supports youth in identity affirming ways forward grounded in Tlingit culture. This implementation strategies approach is supported by NTBHA, Foundational Element 1 Historical and Intergenerational Trauma (HIT). The literature shows that an individuals sense of his or her own belonging, and connection to the communities he or she lives in, is a strong protective factor against many behavioral health issues, including suicide, depression, and substance use. This project will serve 350 youth and 250 adults during the project award period.

Native Connections Project Abstract Quartz Valley Indian Health Native Connection's purpose is to increase access to culturally responsive behavioral health services (e.g., substance abuse and mental health), and suicide prevention programs for American Indian/Alaska Native (AI/NA) youth and young people living in Siskiyou County. The majority of the population of focus reside on the Quartz Valley Indian Reservation (QVIR). The initiative will also increase community engagement and strengthen service delivery. A minimum of 125 youth will be served each year. The Anav Tribal Health Center (ATHC) provides medical, dental, mental health counseling, equine therapy, and a range of community/culture-based services and activities. Our philosophy is that culture is prevention strategy that creates resiliency factors to prevent young AIAN from becoming at-risk. Even more important is the belief that each individual may need a different level of care and engagement. ATHC currently serves ages youth from newborns to age 24 in Siskiyou County. While the program has been successful in reaching at-risk youth, staff continuously report the need for more resources and a stronger collaborative system. The proposed project goal is to expand and strengthen the ATHC's integrated service capacity and community support systems that will a) reduce the impact of trauma; b) prevents suicide/suicidal ideation and substance use; and 3) integrate mental health promotion for AI/AN youth and transitional aged youth ages up to 24 years. Project components include a) planning and building community engagement capacity in response to specific community needs and level of readiness; b) address gaps in service and strengthening current service delivery systems by developing and implementing youth and transitional aged youth programs; c) engage staff clinicians to participate in youth care coordination activities and programs; and d) engage community voice in vetting programs and services. The Native Connections project will thus enhance the ATHC's current suicide and substance abuse and mental health service infrastructure for our youth by adding the following additional components: a) support for youth services and outreach activities; b) support for annual youth GONA (85 youth attend GONA last year); c) develop and implement a transitional aged youth program and outreach; d) support youth-based trauma-informed care coordination, screening, assessment, and treatment. Native Connections will increase community voice and engagement through a variety of resource building and readiness activities that will increase the overall effectives of the ATHC's suicide/substance abuse prevention and mental health programs, as well as identify needs and gaps in service. ATHC will proactively target challenges and disparities within current programs and services through member identification and assessment, enhanced outreach, and integration of traditional healing practices with evidence-based practices.

Native American young adults, aged 18-24, are at higher risk than their peers to use opioids, experience an overdose, and die by overdose or die by suicide. This program is taking an innovative and practical approach to increase the protective factors for preventing death. The Healing Circle and Native Internship Program at Indigenous Peoples Task Force is a long-term intervention building capacity among this high-risk group. The participants will be trained in QPR, NARCAN, the Mending Broken Hearts curriculum, and as Peer Recovery Support Specialists. Additionally, the capacity of 25 Native American specific organizations in the Twin Cities Metro area will be increased. The Healing Circle and Native Internship Program at Indigenous Peoples Task Force will decrease risk factors for suicide and substance use among Twin Cities Metro area Native American adults 18-24 years old through developing cultural strengths, education on dangers of opioid use, connection to resources for treatment, mental health, and financial well-being through job training, paid internship, and connection to sustained employment opportunity in the Native American community. At least 75 Native American young adults will complete 237 hours of training, and internship over 5 years. The 75 participants will refer at least 225 other peers to treatment and or resources for suicide prevention and substance abuse prevention. The 75 program participants will move closer to financial wellness and managing their mental health will positively impact an estimated 300 family members (siblings, children, relatives) within their homes. Accurate and current information will be collected about the Twin Cities Metro area Native American community members on current needs assessment, development of a strategic action plan. Throughout the project a postvention protocol will be developed and implemented.

The purpose of the Blossom Wellness Services is to implement a culturally appropriate community change model among the Long Island Native American community, specifically the Shinnecock Indian Nation to strengthen the capacity of tribal and local, health, and wellness organizations to delivery services. This model serves to remove barriers to care by providing a point of entry and helping families and their loved ones impacted by mental health disorders and substance abuse to navigate the behavioral health system. Blossom’s vision it to welcome those with the desire to live life both well and sober into the safe space where they will have access to a vast network of behavioral health services including direct and indirect prevention services, wrap around support services, peer recovery group, and referrals to treatment. Blossom Wellness Services will take the view that the community has the strengths and resiliencies within it reduce substance abuse and mental health challenges and activities will be informed by community knowledge. Blossom’s role is to help facilitate the community change model by providing case management, counseling services and prevention services to tribal youth and their families.

Norton Sound Health Corporation’s (NSHC) Behavioral Health Services’ (BHS) “Rural Implementation of Early Identification and Prevention Activities for Youth” proposes to reduce suicidal behavior and substance misuse by screening for and promoting behavioral health among regional Alaska Native youth ages 12-24 years. Through a combination of early intervention and prevention activities, youth and adults will access skills contributing to individual and community wellness. The Norton Sound Region, home to 9,865 people and comprised of 15 largely Alaska Native villages and the City of Nome, has high rates of suicide and substance misuse prevalent among youth and adults, and historical trauma has a significant impact on overall wellness. This project seeks to collaborate with stakeholders to conduct Community Assessments culminating in an Action Plan designed to address service gaps in the region. An Advisory Group and staff members will utilize information gained to revise protocols with youth-serving agencies for collaborative approaches to prevention, intervention, and postvention. A Project Director will oversee the activities with a Prevention Specialist and an Evaluator with oversight from the NSHC BHS Administrative Director. Project staff members propose to implement Evidence Based training for the Nome Public School and Bering Strait School Districts. Both staff members and students will receive the training with emphasis on developing peer leaders through the model. Project staff members will further offer the program to regional communities as the project progresses. Training will include, but not limited to, Providing Community Conversations About Research to End Suicide (PC CARES), Mental Health First Aid, and SafeTALK or Lifeskills. Project activities include the revision and deployment of a Depression Screener for early identification and intervention of behavioral concerns among the target population. By project’s end, the Screener will be implemented in all regional primary care and clinic settings. Project staff will collaborate with stakeholders to develop culturally-attuned crisis response and postvention plans for targeted communities. Project members will provide accessibility outreach in the communities and offer youth activities outside of the office setting. Activities will focus on strengthening the family core by reinforcing communication and engagement supports. At the conclusion of the project, it is expected that youth suicide attempts and completions in addition to chronic substance use will decrease as a result of community training and education, family engagement, and protocol development.

The Qissunaq Native Connections Program will serve our youth of Chevak, a Cup'ik Eskimo community located on the banks of the Ninglikvak River in Southwest Alaska. We serve youth up to age 24, providing behavioral health (BH) services using Canricaraq, a holistic, Alaska Native wellness program, to help our youth heal from past traumas, and help any youth suffering from BH disorders, and to prevent any future suicides from occurring. Canricaraq, translated "the way to be healthy", is a curriculum based on the traditional values and ways of the people in the YK Delta region of Southwest Alaska, and involves the incorporation of the ancestral traditional values, practices and teachings into prevention and treatment programs to help our Indigenous people heal from BH disorders. Our Native Connections Program staff will focus on providing outreach to the community to build their knowledge of identifying youth at risk for suicide, establish protocols for responding to suicides and establish a first responder protocol for BH emergencies in our community so we have the ability to respond to BH crises. A Tribal Strategic Action Plan will also be developed to provide a guide for the strategies and activities to be completed during the five-year grant. At the heart of our intervention will be the annual Canricaraq Gathering, a three day event that teaches participants how to get on the healthy road of life, and the Canricaraq Facilitator Trainings, also three days in length, that teach participants how to begin facilitating Canricaraq activities to help our community members get onto the road to wellness and recovery. In addition, we will have a strong presence in the school, where we will give weekly presentations and instruction on how to live a healthy Cup'ik lifestyle. Finally, our NC staff will promote healthy and safe activities for our youth to participate in. Our measurable goals and objectives include the 1) development, review and update of our policies and procedures related to preventing and responding to youth at risk for suicide, 2) trainings utilizing Canricaraq teachings for the school and community, 3) planning and facilitating a series of youth activities, such as fishing and camping trips, Native arts and crafts taught by elders, and movie nights and lock ins to provide healthy options for our youth to engage in, and 4) facilitate Canricaraq Gatherings and Canricaraq Facilitator Trainings for the community members. The measurement of goal one will be from the documents that are created or updated, and goals 2 through 4 will be based on the number of participants and their survey responses. It is anticipated we will serve at minimum 100 youth per year, and 500 in the five-year grant cycle.

The EMHC Native Connection program over five years will work to reduce the number of suicide attempts, completions, ideations, substance abuse and increase the access to mental health services. Activities will include talking circles, hosting community awareness events, creating a postvention protocol, establishing a youth advisory board, and collaborating with other community stakeholders. The target population is Native American youths age 12 -24 years old on the rural Fort Berthold reservation. The Fort Berthold reservation is home to the Mandan, Hidatsa and Arikara Nations (MHAN) also known as the Three Affiliated Tribes (TAT). The TAT is located in rural western North Dakota on the Bakken Oil field. The reservation covers an estimate 988,000 acres and is broken up into 6 segments. The reservation has seen a major increase in development thanks to the oil field which a part of the reservation sits upon. The reservation has seen a major increase in population, economic activity and development, crime, drug use, and more. The community is taken steps to fight the increase in drug use in both a law enforcement way and recovery. From 2018 to 2022 the MHA has seen the average life expectancies drop by 11.79% over the time frame. A large contributing factor for the decline has been the increase numbers of young drug over dosages and an increase in suicidal situations of the young members. This trauma that the members of the tribe face, have a profound effect on the quality of life that they live after the situation. The EMHC Native Connection project aims to address the growing cases of suicidal incidents, substance abuse cases, and general access to mental health that the Native American youth age 12 – 24 years old are facing on the Fort Berthold reservation. The program will work with the local schools to help schedule and organize QPR and other mental health crisis training for the staff members so that they may be better prepared for an emergency. Along with the local school staff members, members of the Native Connection program will undergo similar training so that they too might be better prepared to handle mental health crisis and assist someone who is battling a substance use disorder (SUD). The Native Connection program is working to reduce the number of suicidal situations, substance abuse and to increase the access to mental health services for the youth and young adults living on the reservation. The program is working to establish youth talking circles that can be used to inform participants about health ways to deal with situations, what services they can access, and more. The program seeks to continue offering the classes to the general youth and the youths in the probation system. The staff members are working to establish a youth advisory board as well as a youth board. The two groups would be made up of program representatives that service the youth and youth leaders. The board will discuss common issues youth experience and discuss ways the issues could be addressed. The issues and suggestions will be taken to the youth advisory board where the representatives will discuss ways to implemented the proposed ideas. The program will look to collaborate with fellow tribal and non-tribal programs in developing a community wide Postvention protocol for a youth suicide incident. The development of the protocol will allow for the programs operating on the reservation to better communicate with each other and to ensure a warm handoff between programs. The protocol will help reduce the number of patients that fall between the cracks of the different programs on the reservation. The NC program will look to help host and to host community wide events to help inform the community of the importance of mental health and the danger of substance abuse. The events will largely be based around GONA style events with additional community walks, informational booths and attending local pow wow and other cultural events.

Through this Native Connections Prevent Youth Suicide, Mental Illness, and Substance Misuse grant, Wabanaki Public Health and Wellness (WPHW) will be working with the Penobscot and Motahkomikuk tribal areas to increase awareness and prevention of youth suicide, mental health issues, and substance misuse. Across those two areas there are more than 1300 residents and over 10,000 living in close proximity to those tribal reservations. The people impacted by this grant have greater instances of youth suicide, substance misuse, and mental health diagnoses, lower standards of living, educational completion, and life expectancy. This funding will allow us to break the cycle of despair that Wabanaki youth are too used to. The interventions we propose are both clinical and cultural. This grant will allow WPHW to train more call agents for WabCare, a warmline offering referrals and outreach specifically to youth. It will allow more youth specific training for crisis intervention and postvention within the community through our Critical Incident Stress Management (CISM) team. Part of the funding will also be used to fund awareness campaigns of the presence of WabCare and CISM as resources for our youth. Additionally, we are in the process of building a network that will offer Intensive Outpatient Programs through a telehealth model to increase accessibility for those in need. Wabanaki feel the culture handed down from our ancestors is medicine. To this end, we recognize that connecting our youth back to our culture allows them to call on the supports our culture brings to the challenges of modern life. This grant will help us bring people together in ways desperately needed after the isolation of the pandemic. Using the Gathering of Native Americans model we intend to hold youth specific gatherings that incorporate our Wabanaki traditions. These gatherings are inclusive and open to all. 2023 and 2024 will see our Youth Cultural Center come to fruition in downtown Bangor. This will be a hub for Project Venture experiences but also arts classes taught by local native artists and language classes that had transitioned to the web due to the pandemic. To track and evaluate the success of these and other efforts we will build data management into our youth programming. Working with the Center for Wabanaki Research, Knowledge, and Innovation and the Public Health Research Institute we have already begun this process through data collection on those participating in our Project Venture after-school programming and WabCare but anticipate building out our data collection to other programs and gatherings.

The Pascua Yaqui Tribe's Health Services Department is requesting funding from the Health and Human Services, Substance Abuse and Mental Health Services Administration, under the Native Connections grant project. The department is requesting $250,000 a year over a five-year grant cycle in order to bring suicide prevention and substance use-misuse services to tribal youth up to age 24. The grant calls for the development of the necessary groundwork and infrastructure to build an effective community behavioral health system that changes the tribal approach to services for youth at risk for suicidal ideation and substance abuse. The shared goal for the project is to prevent and reduce suicidal behavior and substance abuse. The shared goal impact of trauma, while promoting mental health among our tribal youth. Sewa U'usim Community Partnership will again be the lead agency for our Native Connections project. They will bring together the three key health service departments: The Department of Nursing for primary care, Centered Spirit for mental health, and Sewa U'usim for community development and public health services, as noted in the letter of commitment from the Executive Director of the Health Services Division. In addition, once funded, several of the original providers from the 2016 project. Education, Social Services and CPS will develop MOU in order to provide services under the project. Our Native Connections project will serve youth 12 to 24 who are members of the New Pascua Reservation located southwest of Tucson, Arizona, approximately 50 miles from the border with Mexico. At the completion of the assessments and the strategic plan, final recommendations of the interventions to be used will be finalized. At this point, we look to our previous effective suicide prevention services, which include a tribal-wide Be Kind anti-bullying initiative and a positive youth program for youth and families. The campaign will include various activities and events highlighting positive peer interaction, positive communication skills, and self-respect, along with tribal norms and beliefs, to help children and families address the issue of violence which impacts our communities. The project will allow the partnering agencies to come together to create an Advisory Committee composed of youth, parents, and individuals who have experienced violence in their lives, along with partner agency representatives to help in the planning development, and implementation of the project goals. An Advisory Committee, in tandem with program staff, will provide the required needs assessment, community readiness assessment, and the tribal strategic action plan as required. They will also address all three tiers of prevention strategies in order to impact the entire youth community and their need for prevention services, based on a public health approach. The project will also develop postconvention protocols reflective of the tribe's traditions and culture which will address coordination of care and intervention among youth service agencies for both immediate and follow-up care. The postconvention protocols will address suicides, suicide attempts, suicide clusters, substance misuse, and substance overdose. The plan will include up-to-date protocols and policies, points of contact and procedures for crisis management, instruction on safe messaging, and identification of follow-up care linkage to resources for grief counseling that includes family, friends, colleagues, and community members. The protocols will set up steps to be taken to include youth in the planning and follow-up for the community. Our Native Connections program will work with SAMHSA for guidance and technical support in the completion of reports and activities under the project. We will complete all required reports and work with the federal department in providing SPARS data as requested and information on the required performance measures.

Abstract The Absentee Shawnee Tribe (AST) understands and recognizes the issues plaguing AI/AN youth regarding suicide, mental health illness, and substance abuse. Our tribal catchment area may be vast. However, through coalitions and partnerships, AST can begin to address these detrimental issues. Our Native Youth are imperative to the sustainability of many tribal entities. They are the future and the AST tribe has an obligation to ensure that future will be a positive one.

The proposed project will serve the Confederated Tribes of Grand Ronde’s (CTGR) youth, parents, and young adults in Grand Ronde and the adjacent, overlapping Willamina School District in Polk County. In the 2021-22 school year, 22% of the Willamina School District was Native American, most of whom were enrolled Grand Ronde tribal members. Through this grant, our Youth Empowerment & Prevention Program (YEP) will implement, improve, and sustain effective services that will both prevent and reduce prevalent issues among our youth, including suicide prevention and awareness, substance use, and mental health issues. This will be completed through education, training, and equine-assisted therapy. The Tribe will focus on two populations. Our first population set is Tribal member youth ages 10-17 within Grand Ronde, Willamina, Sheridan, Dallas, McMinnville, and Salem. Our second population is Tribal member young adults ages 18-24. The total population we will serve through this grant is 400 tribal youth and their families. The Tribe is proposing three enhancements: 1) to work toward sustainable programming by providing Conscious Discipline training to new youth-serving program staff and expanding and deepening Conscious Discipline training for staff with an existing Conscious Discipline foundation; 2) to obtain further training and create more opportunities for Equine Assisted Therapy for our youth and young adults; and 3) to ensure training the wider Grand Ronde Community through annual suicide prevention trainings by using train the trainer trainings and staff trainings in Trauma Assisted Care, QPR, and ASIST. The four Goals and Objectives that the Tribe is proposing to focus on through this grant are: (1) to set a solid foundation for the CTGR Native Connections Program through a comprehensive planning year by conducting a community systems analysis and community readiness assessment to address suicide prevention, substance use, and mental health issues, develop an asset map, and then a strategic action plan including evidence-based programming, policies, and protocols; (2) to build youth resilience, connection to culture, and behavioral health using equine-assisted programming by retaining training and cooperative agreements that provide services to ensure the whole CTGR community is prepared to support youth hope and wellness through strategic awareness messaging and trainings related to trauma, suicide prevention, intervention, and postvention; (3) use a social-ecological approach to building youth's (and adults) social and emotional well-being through Conscious Discipline curriculum wherever youth are: home, school and community; and, (4) build youth and community resilience through training of staff, youth, young adults and parents in trauma-informed and suicide prevention, by creating connection to culture, and by optimizing behavioral health using Oregon Tribal Best Practices (TBP), QPR, and ASIST.

The Zuni Youth Enrichment Project (ZYEP) will implement Zuni Connections, a community driven, culturally responsive, and evidence-based program designed to promote mental health and prevent suicide among youth, ages 6-24, in Zuni Pueblo, New Mexico. This will be accomplished through the following project activities: 1) providing a year-round schedule of programming that promotes protective factors and adaptive behaviors and reduces risk factors and maladaptive behaviors among 500 local youth annually; 2) implement SAMHSA’s community readiness model to increase communication and collaboration on suicide prevention protocols in Zuni; 3) increase the capacity of Zuni youth serving agencies to support youth experiencing crisis by providing their staff with suicide prevention training; and 4) establish resources that increase community-wide awareness and promote the use of mental health services. Zuni Pueblo is one of the longest continuously inhabited villages in the United States and maintains one of the most intact Indigenous language and cultural systems in North America. Located in western New Mexico’s McKinley and Cibola Counties, the Zuni Reservation spans 450,000 acres, but nearly all of the 6,302 residents live in a densely populated central village. Approximately 2,531 (40%) of Zuni’s total population are under the age of 24, making youth the largest subpopulation of the Tribe (ACS 2020 5-Year Estimate for Zuni Pueblo CDP). Zuni Pueblo’s strong familial, cultural, and natural resources can make it a special place to grow up, but many youth that do face stark realities as they transition through childhood and adolescence, including high childhood poverty rates (39%), high food insecurity rates (37%), high overweight or obesity rates (43%) and suicide rates three times the national average (2022 NM Kids Count Data Book, 2019 NMDOH BMI Surveillance, 2022 ZTPP Survey). Due to intergenerational trauma, Zuni youth are exposed to adverse experiences that increase their risk of suicide. For decades, Zuni youth have reported much higher risks for depression, suicide ideation, and suicide attempts than their state and national peers (NMYRRS, 2019). Our Native Connections work gives us hope because it’s grounded in evidence and our experience that Zuni youth with a strong cultural connection report significantly lower levels of hopelessness, self-harm, suicide ideation, and suicide attempts than youth with weaker connections to culture (ZTPP Survey, 2022).