ABSTRACT
Purpose: The COVID-19 pandemic has disrupted rural American Indian populations disproportionately in terms of elevated infection rates, economic hardship and psychosocial stressors. As Kirsch et al. (2020), Dumas et al. (2020) and others have noted, social distancing efforts to contain the spread of the virus exacerbate risk factors for substance use in youth, including social isolation, boredom and depression. Historical trauma, socioeconomic inequalities and geographic isolation already challenge Tribal-community-partnered interventions to reduce and prevent underage substance use in rural California Native communities. We describe innovative ways one program addressed the additional challenges of pandemic conditions. Methods and Data: Tribal clinic providers and partnering research scientist met weekly to design, implement, and evaluate a multilevel intervention which combined clinic-based behavioral programs to reduce individual demand for alcohol and other drugs with community-based environmental strategies to reduce social supply of alcohol and other drugs. Research staff meetings were recorded in written logs. Using an extended case study approach, we conducted thematic review of weekly activity logs for the period of March through December 2020. Results: Recurring themes included responding to community emergency concerns, leveraging prior relationships, and creatively expanding technological capabilities while adhering to the underlying model of the multilevel intervention. Staff participated in drive-through medication pick-ups, virtual and drive-through events promoting resources and mental health as well as informal wellness checks with community partners and study participants through virtual outreach. The intervention's clinic component was shifted from in-person to online meetings on a secure web-based platform using Tribal IRB-approved digital signatures for parental consent and youth assent. The environmental prevention component enhanced educational messaging in lieu of in-person presentations. Conclusions: Transitioning to virtual intervention activities to reduce underage drinking and drug use among American Indian youth facilitated deeper relationship-building within the community. Expanded technology applications enabled the project to continue serving remote communities. These innovations present novel ways for clinics serving rural, reservation-dwelling, Tribal youth to treat, reduce, and prevent underage substance use and other tribal health disparities in the time of a pandemic health emergency and otherwise.