Surveillance Methods Used to Detect, Characterize, and Monitor the COVID-19 Pandemic in Rocky Mountain Tribal Communities.

OBJECTIVE: Data were essential to public health decision-making during the COVID-19 pandemic, yet no single data source was adequate for Tribes in Montana and Wyoming. We outlined data access, availability, and limitations for COVID-19 pandemic surveillance response to improve future data exchange. MATERIALS AND METHODS: The Rocky Mountain Tribal Epidemiology Center (RMTEC) used various data sources to deliver data on the number of COVID-19 cases, deaths, and vaccinations at local, state, and regional levels to inform Tribes in Montana and Wyoming. RMTEC reviewed state, federal, and public datasets and then attached a score to each dataset for completeness of demographic information, including race, geographic level, and refresh rate. RESULTS: The RMTEC COVID-19 response team shared data weekly on the number of COVID-19 cases, deaths, and vaccinations distributed and the percentage of the population vaccinated with Tribal health departments in Montana and Wyoming. The Indian Health Service Epidemiology Data Mart dataset scored the highest (24 of 30), followed by datasets from Montana (18 of 30) and Wyoming (22 of 30). Publicly available datasets scored low largely due to data aggregation across larger geographic areas and lack of demographic variables. PRACTICE IMPLICATIONS: The absence of data on race and ethnicity from publicly available data and lack of access to real-time data limited RMTEC's ability to provide Tribal-specific updates on COVID-19 cases, deaths, and vaccinations to Tribal health departments. RMTEC should be fully funded to provide the necessary resources for data management and the capacity to respond to data requests from Tribal health departments and their programs to address current and future pandemics. Federal and state agencies should also be educated on Tribal Epidemiology Centers' public health authority status to improve access to infectious disease data among those agencies.

Rethinking Recovery: A Qualitative Study of American Indian Perspectives on Peer Recovery Support.

Objectives: This qualitative evaluation was guided by two questions: 1) How does peer recovery support (PRS) support American Indian (AI) people in recovery from substance use disorders? and 2) What makes PRS effective?Methods: We utilized a descriptive qualitative study design to explore the essence of PRS. Semi-structured interviews were conducted with six AI peers to explore the perceptions and lived experiences of recovery from one urban Montana location. Data analysis involved coding all the transcripts using the priori codes developed, then identifying key themes from the coded data.Results: Themes and interview data helped us explore how PRS supports recovery and potential reasons why it is effective for AI populations. Peers indicated that the program helped them maintain their recovery, and the role of peer mentors was critical to their success. Themes of belonging, connection, and compassion were common among peers interviewed. They also felt that recovery is a spiritual process. The peers had limited recommendations for improving the program, except the need for funding sustainability.Conclusions: Understanding how people recover is the first step in addressing the current substance misuse epidemic facing our nation. This evaluation outlined the qualitative impacts of PRS, the spiritual nature of PRS, the context of PRS, and recommendations from peers involved in the program. More work is needed to explore how to sustain PRS programs and integrate PRS into existing community-based settings, like churches, social services, urban AI centers, and other locations.

The BRAVE Study: Formative Research to Design a Multimedia Intervention for American Indian and Alaska Native Young Adults.

American Indian and Alaska Native (AI/AN) young adults are strong and resilient. Interventions designed to improve their mental health and help-seeking skills are especially needed, particularly those that include culturally relevant resources and relatable role models. This paper presents formative research from the BRAVE study, a five-year community based participatory research project led by the Northwest Portland Area Indian Health Board. Formative research included three phases and more than 38 AI/AN young adults and content experts from across the United States. Results indicate that behavioral interventions can be feasibly delivered via text message to AI/AN young adults and that including Native youth in the formative research is critical to designing a comprehensive, culturally-responsive intervention. Lessons learned from this five-year process may help other youth-serving organizations, prevention programs, policymakers, researchers, and educators as they support the next generation of AI/AN leaders.

Survey Development: Community Involvement in the Design and Implementation Process.

Documenting Tribal health priorities is needed to inform research agendas, policy efforts, advocacy, and funding. However, published literature rarely documents the methods used to develop surveys in Indigenous communities. This methods paper includes two objectives: (1) increase knowledge and understanding about the importance of community involvement in public health activities; and (2) provide an example of how the Rocky Mountain Tribal Leaders Council Epidemiology Center (RMTEC) worked with one Tribal community to develop a health priorities survey. This paper describes how the RMTEC worked with a Tribal community and Tribal College students to develop, pilot, and revise a health priorities survey. Recommendations focus on the need for more culturally-responsive survey methods, the importance of building Tribal capacity for health research, and the value of piloting surveys in communities prior to implementation.