Tribally-led mobile outreach: improving access to harm reduction services in one rural reservation community.

American Indian and Alaska Native populations in the United States face significant disparities related to opioid use disorder and opioid-related mortality. Inequitable access to medications and harm reduction strategies due to structural, societal, and geographical factors prevent Tribal communities from obtaining needed services, and further contribute to the opioid epidemic. One Tribal Healing Center in the Rocky Mountain region identified mobile outreach to build upon existing opioid prevention, treatment, and harm reduction efforts. The Healing Center purchased a mobile outreach vehicle and worked with a combination of clinical staff, peer recovery support specialists, and Tribal elders to reach identified high-risk areas on the reservation. As of December 2023, the mobile outreach vehicle has disseminated 150 Narcan kits, 150 Fentanyl testing strips, 20 self-care kits, and 500 brochures detailing Healing Center services. Preliminary results from this formative evaluation demonstrate the success of MOV efforts and the process required to purchase and launch an MOV campaign.

Documenting tribal community readiness to support substance abuse prevention.

Documenting community readiness to support substance abuse prevention in tribal communities is needed to maximize the impact of prevention programming. Semi-structured interviews with 26 tribal community members from Montana and Wyoming served as the primary data source for this evaluation. The Community Readiness Assessment was used to guide the interview process, analysis, and results. This evaluation found that community readiness was vague, meaning most community members recognize it as a problem, but there is little motivation to do anything about it. There was a significant increase in overall community readiness between 2017 (pre) and 2019 (post). Findings underscore the need for continued prevention efforts targeted at a community's readiness to address the problem and move them to the next change stage.

A Feasibility Evaluation of the Urban Native Youth Leaders Program.

Urban American Indian and Alaska Native (AI/AN) youth represent a unique and growing population in the United States. Culture and participation in cultural activities is associated with resilience; however, urban AI/AN youth often report limited access to their culture. This paper presents results from a mixed-method feasibility evaluation of the Native Youth Leaders (NYL) program, a culturally-grounded youth program for urban AI youth. The NYL feasibility evaluation sought to answer two questions: (1) is the NYL program feasible and appropriate and (2) what are urban AI youth perspectives on the NYL program? Results indicate the NYL program was feasible and appropriate for urban AI youth. Recommendations may be useful to other tribal organizations as they design and implement culture-based programs for urban AI youth.

A review of tribal best practices in substance abuse prevention.

American Indian youth experience higher rates of substance use than non-American Indian youth. Researchers, clinicians, and treatment programs embrace evidence-based practices (EBPs) and practice based evidence (PBE) as a primary method for addressing substance abuse and advancing behavioral health. However, less is known about the use of tribal best practices (TBPs) and how they are implemented in American Indian substance use prevention contexts. OBJECTIVE: The main objective of this systematic review was to determine how TBPs are implemented and shared in the context of tribal substance use prevention. The second objective was to document TBP examples from three tribal communities involved in a 5-year substance use prevention initiative. METHODS: A systematic review of published and grey literature was conducted using funding agencies websites, EBSCO Host and national registries. Three tribal communities involved in the initiative documented current TBPs to highlight characteristics of TBPs, costs, and approval processes. RESULTS: TBPs are very limited in the literature. Despite tribal use for thousands of years, TBPs are underrepresented and misunderstood. This review found that the terminology used to describe TBPs is not consistent across agencies, publications, websites, or reports. There is also variation in how TBPs originate in substance use prevention contexts and there is not a primary resource or protocol for sharing TBPs. Continued efforts are needed to support the use and dissemination of TBPs in substance use prevention.

Preventing Substance Use in American Indian Youth: The Case for Social Support and Community Connections.

AIMS: This study explored the relationship between social support, community connections, self-esteem, and culture on misuse in American Indian youth. METHODS: The study team developed a culturally-responsive 16-question survey for American Indian youth ages 12-20 living in six American Indian communities in the Great Plains Region of the United States. The study was grounded in primary socialization theory and variables were explored using regression models. RESULTS: A total of 565 American Indian youth completed the participant survey between January 2016 and August 2017. The present study found that community connections were negatively associated with marijuana use in American Indian youth. Higher community connection scores were associated with higher social support and self-esteem scores. CONCLUSIONS: Tribally-led prevention initiatives can fill an important socio-behavioral prevention gap by facilitating social support opportunities for American Indian youth who may not have adequate support from immediate family or friends.

Is culturally based prevention effective? Results from a 3-year tribal substance use prevention program.

American Indian youth substance use is a major public health concern. To date, there has been limited evaluation of American Indian youth substance use prevention programs. Evaluation of prevention programs is necessary to understand the aspects of programming that are effective or not effective. This mixed-methods evaluation focuses on select outcomes of a 3-year culturally-based prevention program located in six American Indian communities in the Rocky Mountain Region. The goals of the prevention program are to reduce binge drinking by 30% and increase community readiness by 1-point over a 5- year period. In the first year of the program, community members worked with program staff to develop an evaluation plan that would measure the following outcomes: lowering substance use, increasing community readiness, and increasing the reach of prevention messaging through culturally based prevention. The primary research questions this outcome evaluation sought to answer were as follows: 1) Are there differences in American Indian youth who participate in culturally-based prevention activities compared with American Indian youth who do not participate in these activities? 2) Was the prevention program effective in increasing community readiness over a 3-year period? 3) Did community involvement in prevention activities increase overtime? Results from this evaluation indicate that substance use was similar among intervention (n = 200) and non-intervention youth (n = 369). This was somewhat surprising because Intervention youth reported higher levels of social support and community connections than non-intervention group youth. Community readiness decreased -.81 point from 2015 to 2017. The reach of prevention activities increased 365% from 2015 to 2017. We provide lessons learned that may help other communities as they document outcomes related to prevention efforts. Substance use is a multi-faceted problem facing our communities, families, schools, and nation. Innovative, effective, culturally-based prevention programs like the one highlighted in this paper underscore the need for primary prevention strategies.