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HEALTH NEWS & NOTES January 2021 Behavioral Health

Publication of The Northwest Portland Area Indian Health Board

Bigfoot Sightings: Mask Up Campaign Sheila Hosner COVID Communications Lead CDC Foundation

Roger Peterson Text Messaging Specialist and Graphic Designer

Indigenous communities across the NW have had similar cultural ties to Bigfoot as a helpful partner, messenger, and protector for centuries. Bigfoot wanders in mountains and thick forests; a distant but watchful presence. For these reasons, the NPAIHB chose Bigfoot as a bearer of COVID safety messages - protecting our communities in its “Bigfoot Mask Up� campaign (and social media posts).

Bigfoot Sightings


Chair’s Notes


Indian Health Update


Consolidated Appropriations Act of 2021


Behavioral Health


LGBT Culturally Appropriate Mental Health


HNY Updates


BRAVE Intervention Updates and Impact


Springboard Campaign Recap: #IndigiLove Begins with I


Caring Message Text Intervention


THRIVE Announces: Text “Native” to 741741


49 Days of Ceremony


Losses and Love


Youth Access and Experience with Sexual Healthcare


NW Tribal Juvenile Justice


Gathering of NW Elders


Integrating Diabetes Care and Behavioral Health


New Faces


COVID-19 MH/SUD Resource List for January 2021




Nickolaus D. Lewis, Chairman, Lummi Nation Cheryle Kennedy, Vice Chair, Confederated Tribes of Grand Ronde Greg Abrahamson, Secretary, Spokane Tribe Shawna Gavin, Treasurer, Confederated Tribes of Umatilla Greg Abrahamson, Secretary, Spokane Tribe Kim Thompson, Sergeant-At-Arms, Shoalwater Bay Tribe

Laura Platero, Executive Director Sue Steward, Deputy Director Mike Feroglia, Business Manager Eugene Mostofi, Fund Accounting Manager Nancy Scott, Accounts Payable/Payroll James Fry, Information Technology Director Jamie Alongi, IT Network Administrator Jonas Greene, Communications Manager Andra Wagner, Human Resources Manager Geo.Ann Baker, Receptionist Program Operations Staff


Candice Jimenez, Health Policy Specialist Liz Coronado, Health Policy Specialist Lisa Griggs, Program Ops & Exec. Assistant Katie Johnson, EHR Intergrated Care Coordinator

Twila Teeman, Burns Paiute Tribe Denise Walker, Chehalis Tribe Matthew Stensgar, Coeur d’Alene Tribe Andy Joseph, Jr., Colville Tribe Vicki Faciane, Coos, Lower Umpqua & Siuslaw Tribes Eric Metcalf, Coquille Tribe Sharon Stanphill, Cow Creek Tribe Cassandra Sellards-Reck, Cowlitz Tribe Cheryle Kennedy, Grand Ronde Tribe Bob Smith, Hoh Tribe Brent Simcosky, Jamestown S’Klallam Tribe Darren Holmes, Kalispel Tribe Gerald Hill, Klamath Tribe Velma Bahe, Kootenai Tribe Francis Charles, Lower Elwha S’Klallam Tribe Nick Lewis, Lummi Nation Timothy J. Green, Makah Tribe Charlotte Williams, Muckleshoot Tribe Chantel Eastman, Nez Perce Tribe Samantha Phillips, Nisqually Tribe Lona Johnson, Nooksack Tribe Hunter Timbimboo, NW Band of Shoshone Indians Jeromy Sullivan, Port Gamble S’Klallam Tribe Bill Sterud, Puyallup Tribe Michele Lefebvre, Quileute Tribe Noreen Underwood, Quinault Nation Dana Matthews, Samish Tribe Cyntha Harris, Sauk-Suiattle Tribe Kim Thompson, Shoalwater Bay Tribe Ladd R. Edmo, Shoshone-Bannock Tribes Angela Ramirez, Siletz Tribe (Vacant), Skokomish Tribe


NORTHWEST TRIBAL EPIDEMIOLOGY CENTER STAFF Victoria Warren-Mears, Director Antoinette Aguirre, Environmental Health Project Specialist Ashley Hoover, Communicable Disease Epidemiologist Ashley Thomas, NW NARCH Program Manager Barbara Gladue, Oregon Tribal Public Health Improvement Manager Birdie Wermy, Behavioral Health Manager Bridget Canniff, PHIT/Injury Prevention Project Director Breastfeeding/Native CARS Project Manager Celena McCray, WYSH Project Coordinator Celeste Davis, Environmental Public Health Director Chandra Wilson, Tobacco Project Specialist Chelsea Jensen, WEAVE-NW Project Assistant Chiao-Wen Lan, IDEA-NW Epidemiologist Clarice Charging, NWTEC Project Coordinator Colbie Caughlan, RC/THRIVE/TOR Projects Director Danica Brown, Behavioral Health Program Director David Stephens, ECHO Project Director Don Head, WTD Project Specialist Eric Vinson, ECHO & TOR Project Manager Erik Kakuska, WTD Project Specialist Grazia Cunningham, NARCH Project Coordinator Heidi Lovejoy, NWTEC Substance Use Epidemiologist Itai Jeffries, Two Spirit LGBTQ Program Manager Jenine Dankovchik, MCH Opioid Biostatistician 1 Jessica Rienstra, ECHO RN Case Manager Jessica Leston, HIV/HCV/STI Clinical Services Project Director

Joshua Smith, Health Communications & Evaluation Specialist Karuna Tirumala, IDEA-NW Biostatistician Kerri Lopez, WTDP & NTCCP Director Kimberly Calloway, PHIT Project Specialist Lael Tate, THRIVE Project Coordinator Larissa Molina, TOR Project Specialist Mattie Tomeo-Palmanteer, Cancer Prevention Coordinator Meena Patil, MV Injury Data Project Biostatistician Megan Woodbury, ECHO Project Coordinator Melino Gianotti, Oregon Tribal Public Health Improvement Analyst Michelle Singer, HNY Project Manager Morgan Thomas, LGBTQ 2 Spirit Outreach & Engagement Coordinator Nancy Bennett, WA Tribal Public Health Improvement Project Manager Nick Cushman, ECHO Pharmacy Case Manager Nicole Smith, Senor Biostatistician 1 Nora Frank-Buckner, Food Sovereignty Initiative Director & WEAVE FS Project Manager Paige Smith, SASP & Response Circles Project Coordinator Reshell Livingston, Asthma Project Coordinator Roger Peterson, Text Messaging Specialist Rosa Frutos, Cancer Project Coordinator Ryan Sealy, Environmental Public Health Project Scientist Shawn Blackshear, Senior Environmental Health Scientist Stephanie Craig Rushing, PRT, MSPI, Project Director Sujata Joshi, IDEA-NW Project Director Tam Lutz, Maternal Child Health Program Director Ticey Mason, Dental Project Director Tom Becker, NARCH Project Director Tom Weiser, PAIHS, Medical Epidemiologist, assigned to NWTEC Tommy Ghost Dog, Jr., weRnative Project Coordinator NPAIHB PROJECT STAFF Christina Peters, TCHP Project Director Dove Spector, NDTI Project Specialist Kaitlyn Hunsberger, BHA Student Support Coordinator Miranda Davis, NDTI Project Director Pam Johnson, NDTI Project Manager Tanya Firemoon, TCHP Project Specialist GRANTS MANAGEMENT Amy Franco, Grants Management Specialist Tara T. Fox, Grants Management Specialist

Bigfoot Sightings: Mask Up Campaign (continued) The Bigfoot Mask Up Campaign was developed by the Board’s COVID Communications Team in the late summer and print materials were mailed to 43 Tribes and eight tribal organizations in October. Each Tribe and organization received a life-size, all weather cut-out of Bigfoot with a specially designed mask, 40 window clings, 10 yard signs, ten posters, and 15 floor stickers. Since the rollout, the Tribes have reported Bigfoot sightings all over the Pacific Northwest. He is making people smile, despite the pandemic, and encouraging community members to protect elders and to keep safe from COVID-19, through mask wearing and social distancing. Recent comments include: “Bigfoot (with mask) found a home at the Cow Creek Tribe’s Seven Feathers Truck & Travel Center in Canyonville, OR, which sees a lot of traffic since it’s right on the I-5.” (Cow Creek Band) “Bigfoot is a great conversation starter for public education.” (Kalispel Tribe) “Our employees and clients can’t get enough Bigfoot’s here in Darrington! Thank you so much for all the fun social distancing.” (Sauk-Suiattle Tribe) Thanks for all that you’re doing to keep your communities safe and help spread Bigfoot’s wise message: Mask Up! Also, please check the NPAIHB Covid webpage for customizable social media posts and articles. http://www.npaihb.org/tipsresources-for-community-messaging/

4 Northwest Portland Area Indian Health Board www.npaihb.org

Chair’s Notes Nickolaus D. Lewis Lummi Nation NPAIHB Chairman

The following is an excerpt from Chairman Lewis’ social media account. On December 18, our humble leader set off from Lummi, traveling hundreds of miles across Northwest tribal lands to deliver vaccines to Yakama and Umatilla. Eight hundred miles from Lummi to Yakama, to Umatilla, and back home, with a delivery that brought tears to those who received it. For many who haven’t been impacted by COVID, they may not know what some have gone through or still are. Our relatives in Yakama, for example, had over 1000 positive cases and over 40 deaths, which was mentioned by one of their medical doctors who received the vaccines. Within an hour of delivering the vaccines, tribal medical staff were giving them to individuals in their community. Tears filled the eyes of the medical workers who shared their experience of COVID, recalling the pain, the loss, and the hopelessness that they felt during the fight. But new feelings emerge. Feelings of hope. Of belief. Of joy. Of finally seeing a faint light at the end of the tunnel. This delivery won’t bring us all back to normal. Not yet. But we can say that this is now a start, that the vaccines are starting their deployment to Indian Country. We are all one step to being closer to that day of normal, to which we all look forward. Now that we’ve returned (back to Lummi), it’s again time to get back to work in advocating and pushing the feds to get more of these to those who need them most. The work continues. Still, it’s been an incredible past two days for our tribes in the Pacific Northwest, with these now being administered to those who need them. Nickolaus Lewis Chair, Northwest Portland Area Indian Health BoardCouncilman, Lummi Indian Business Council


Indian Health Litigation Update Geoff Strommer Hobbs, Straus, Dean & Walker, LLP

Section 105(l) Leasing Chronic underfunding of facilities by IHS led to litigation and the landmark ruling in Maniilaq Association v. Burwell (2016). The court held that section 105(l) of the ISDEAA requires IHS to enter into—and fully fund—leases for tribal facilities used to carry out ISDEAA agreements. Section 105(l) leasing has proven wildly successful, with lease compensation growing from almost nothing a few years ago to an estimated $101 million in FY 2020. In recent years, this has required IHS to reprogram funds from elsewhere in the budget—primarily funding for medical inflation increases. In the Consolidated Appropriations Act, 2021, Congress provided an indefinite appropriation for “such sums as may be necessary” for lease compensation—ensuring full lease funding while protecting program funding. The appropriations act also introduces a new limitation on 105(l) lease compensation, specifying that the initial term of a lease begins no earlier than the date of receipt of the lease proposal. Finally, the appropriations act directs Interior and HHS to consult with tribes and tribal organizations on “how to implement a consistent and transparent process for the payment of [105(l)] leases.” Contract Support Cost (CSC) Claims and Policy Issues Since FY 2014, Congress has mandated full payment of CSC. But a 2016 court decision in the Sage Memorial case held that IHS owed CSC on health care services funded by third-party revenues such as Medicare, Medicaid, and private insurance. If that is so, IHS’s national CSC liability would likely more than double. Unfortunately, two other courts have ruled for IHS, in the Swinomish and San Carlos Apache cases. The Swinomish decision is currently on appeal in the D.C. Circuit, with a decision expected shortly. IHS has agreed to pay CSC on most coronavirus relief funds. But IHS has subjected the new COVID funds to the socalled “97/3 method” for avoiding duplication between the Secretarial amount and CSC. This means that IHS reduces the COVID direct cost base by 3% before applying the indirect cost rate, then offsets the 3% against the indirect CSC otherwise due. This appears to conflict with the IHS CSC Policy, which applies the 97/3 option only to “recurring service unit shares,” while the COVID funding is non-recurring. Opioid Litigation Update The Opioid multi-district litigation (MDL) involves approximately 3,000 plaintiffs—mostly government entities—seeking to hold opioid manufacturers and distributors accountable for fueling the opioid crisis. The MDL judge has designated certain “bellwether” cases to resolve legal claims and facilitate settlement. The first such case settled in October 2019, before going to trial. The Cherokee Nation’s case was selected as a tribal bellwether case and remanded to a federal district court in Oklahoma, where Defendants’ motions to dismiss are pending. Meanwhile, a handful of the opioid Defendants have filed or may be considering filing for bankruptcy—which generally halts all litigation against the filing entity while a bankruptcy plan is negotiated. A deal to resolve the Purdue Pharma bankruptcy (OxyContin) is nearly complete and includes about a set-aside for Tribes from the amount ultimately allocated to governmental plaintiffs 1 Swinomish Indian Tribal Community v. Azar, 406 F. Supp. 3d 18 (D.D.C. 2019); San Carlos Apache Tribe v. Azar, et al., 2020 WL 5111109 (D. Ariz.), Case No. 2:19-CV-05624-NVW (Aug. 31, 2020). 6 Northwest Portland Area Indian Health Board www.npaihb.org

Indian Health Litigation Update (continued) Update on Texas v. United States ACA Litigation In 2019, the Fifth Circuit agreed with Texas and some other states that the individual mandate in the Affordable Care Act (ACA) is unconstitutional. Because the Indian Health Care Improvement Act (IHCIA) was amended and reauthorized as part of the ACA in 2010, the case threatens it and other critical Indian health provisions. We filed an amicus brief in the Fifth Circuit, arguing that the individual mandate, even if unconstitutional, is “severable” and can be excised from the ACA while preserving the IHCIA and other Indian-specific provisions. The parties sought review by the U.S. Supreme Court, which agreed to hear the case. Once again, we filed a tribal amicus brief on behalf of 471 tribes, arguing that the Indian-specific provisions should be preserved. The Justices heard arguments on November 10, 2020. Questions from the Justices indicated that the Court is unlikely to strike down the entire ACA, even if it holds that the individual mandate is unconstitutional. Of course, we must await the Court’s opinion to know for sure. Tribes sue e-cigarette manufacturer JUUL Sixteen tribes, one tribal school, and one tribal health organization have sued e-cigarette maker JUUL, Philip Morris USA, and Altria Group Inc. (“Altria”) in federal court in Northern California for deceptive marketing practices targeting Native youth and costing tribes significant resources to combat vaping and related damages. The suits are part of the Multidistrict Litigation pending against JUUL and its affiliates brought by many non-tribal plaintiffs in the same federal court. The complaints allege that JUUL has deceptively marketed its products as a safe alternative to ordinary cigarettes, without disclosing the known dangers of addiction and the vaping-related illnesses that these products cause. The complaints assert that JUUL’s design, marketing, and distribution of its products to minors—specifically targeting tribal youth, despite knowing that they are more susceptible to addiction than non-Natives—have resulted in a youth vaping epidemic in many tribal communities. 340B Issues Section 340B of the Public Health Service Act (PHSA) requires that manufacturers of certain covered outpatient drugs enter pharmaceutical pricing agreements (PPAs) with HHS if the manufacturers wish to participate in the Medicaid program. These PPAs require that covered outpatient drugs be provided to covered entities, including tribal health programs, at a discount—a price not to exceed the 340B ceiling price set by HHS in accordance with a formula established by statute. Covered entities are prohibited from receiving duplicate discounts or diverting 340B drugs. The PHSA establishes an audit process that manufacturers may invoke if they believe a violation of the 340B program requirements has occurred. Additionally, last month HHS’s Health Resources and Services Administration (HRSA) established a 340B Alternative Dispute Resolution (ADR) process that either manufacturers or covered entities may use. Manufacturers must have completed an audit prior to filing a 340B ADR claim. Over the last several months, manufacturers have restricted access to 340B pricing by stating that they would no longer ship covered drugs to contract pharmacies, causing dramatic drug price increases. Drug manufacturer Eli Lilly sent a series of letters to HHS arguing that providing 340B discounted drugs through contract pharmacies violates federal law prohibiting diversion. Eli Lilly also took issue with HRSA’s past guidance authorizing distribution through contract pharmacies. On December 30, 2020, the HHS’s Office of General Counsel (OGC) issued an Advisory Opinion squarely rejecting these arguments. OGC stated that to the extent a contract pharmacy is acting as an agent for a covered entity, drug manufacturers are required to deliver covered drugs to those pharmacies and to charge the covered entity no more than the ceiling price.

2 Duplicate discounts occur when an entity receives a discount through 340B pricing at the same time as receiving drugs that are discounted because a state Medicaid program has received a rebate for the same drug. 3 HHS OGC, Advisory Op. No. 20-06, On Contract Pharmacies Under the 340B Program (Dec. 30, 2020), https://www.hhs.gov/guidance/sites/ default/files/hhs-guidance-documents/340B-AO-FINAL-12-30-2020_0.pdf. NPAIHB 7

Summary of the Consolidated Appropriations Act of 2021 Veronica Smith NPAIHB Policy Consultant

Federal funding for fiscal year 2021 was an eleventh-hour legislative struggle between divorcing parents that never got along. HR 133, Consolidated Appropriations Act of 2021, is 5,593 pages. Packaged within those pages is 2021 federal funding, COVID-19 funding, provisions impacting the Special Diabetes Program for Indians, $1 billion for tribal broadband, $1 billion to the Indian Health Service (IHS) to fight COVID-19, and a plethora of other legislation. Tribes in the Portland Area have been pushing their federal trustee for an extension in the time frames attached to the CARES Act funding received from the U.S. Treasury last spring, and thanks to your advocacy and the advocacy of countless tribal leaders across the country, that date has been moved from December 30, 2020 to December 31, 2021. Tribal consultation occurred on January 04, 2021 on two allocations to the IHS, $790 million to IHS for COVID testing/tracing, surveillance and $210 for vaccine distribution, education, and COVID related expenses. NPAIHB’s comment letter advocates for funding to flow to tribal governments through existing agreements, based on existing funding formulas, with maximum flexibility and minimal reporting. We are still looking for easter eggs within the Appropriations Act, one that just turned up yesterday is a new program through the Federal Communications Commission (FCC) that discounts broadband services and devices to low-income households. The comment period on this initiative is open until February 16, 2021. The Indian Health Service FY 2021 appropriation is found in Division G of this Appropriations Summary, and broken down below. (Original text for this table is found beginning on page 178 of this document.) Within this budget, there is also $5m for nationalization of CHAP and $2m for DHAT Training in ID, OR, WA, AK. 8 Northwest Portland Area Indian Health Board www.npaihb.org

FY 2021 Indian Health Service Appropriations (amounts in thousands) Indian Health Service

FY 2020 Final

FY 2020 Final

Clinical Services Hospitals & Clinics EHR Dental Health Mental Health Alcohol & SUDS PRC IHC Improvement Fund

2,324,606 8,000 210,590 108,933 245,603 964,819 72,280

2,238,087 34,500 214,687 115,107 251,360 975,856 72,280

<86,519> 26,500 4,097 6,174 5,757

Preventive Health Public Health Nursing Health Education Community Health Rep Community Health Immunization (AK)

91,984 20,568 62,888 0 2,127

92,736 21,034 62,892 0 2,127

752 466 4

57,684 65,314

62,684 67,314

5,000 2,000

2,465 71,538 5,806

2,465 82,456 5,806







Other Services Urban Indian health Indian Health professions Tribal Mgmt Grant Program Direct Operations Self-governance Contract Support Costs Tribal Section 105(1)leases

Increase <Decrease>

Maint & Improvement



Sanitation Facilities Construction




Healthcare Facilities Const.




6,047,094 6,236,279


TTL Indian Health Service

Summary of the Consolidated Appropriations Act of 2021 (continued) Other FY 2021 Funding for Indian Country Includes: • • • • • • • •

$15m at HRSA for National Health Service Corps officers in the ITU system +$1.5m Tribal set-aside Minority HIV/AIDS Prevention and Treatment Program $22m for Good Health and Wellness in Indian Country Program at the CDC $41.5m for Tribal Behavioral Health Grants through SAMHSA $50m Tribal set-aside for opioid response grants (SAMHSA) $11m for Tribal set-aside for medication assisted treatment (SAMHSA) $2.4m set-aside for American Indian/Alaska Native Zero Suicide grants $2.931m for American Indian/Alaska Native Suicide Prevention Initiative

Summary of COVID Relief Provisions • • • • • • • •

Unemployment insurance benefits will have addt’l $300/week through Mar 14, 2021 $1 billion addition to Provider Relief Fund Provider Relief Fund changes re. expenses and revenue losses New FAQ Questions $125m tribal set-aside at SAMHSA $7 million for tribal nutrition programs under the Older Americans Act $790 million to IHS for COVID testing/tracing, surveillance $210 million to IHS for vaccine distribution, education, and COVID related expense $1 billion for grants to tribes for broadband through the FCC

Division by Division Summary of Authorizing Matters is a catch-all for multiple pieces of the appropriations puzzle, including an amendment to 42 U.S.C § 254 (c) (3) that funds the Special Diabetes Program for Indians (SDPI) at $150 million/year through FY 2023. In addition to SDPI funding, we find the following: Tribal Access to Homeless Assistance Act (HR 4029) that makes tribes and tribally designated housing entities eligible for homeless grants grants A new initiative at Health and Human Services to develop evidence-based strategies for to obesity prevention Requirements for state consultation with tribes regarding suicide prevention programs Urban Indian programs are now eligible for reimbursement from the Veterans Administration for services provided to American Indian/Alaska Native Veterans. Please feel free to contact me at vsmith-contractor@npaihb.org if you have any questions or would like additional information.


Introducing Two New Behavioral Health Projects at NPAIHB Birdie Wermy Behavioral Health Project Manager

The NPAIHB has been incredibly busy this fall building programs to address the rising stress and anxiety many are experiencing in our communities, as a result of COVID. The 1803 Supplement: Suicide/ACES/IPV Prevention project and Behavioral Health Scan Opioid Response Network/Providers Clinical Support System (ORN/PCSS) project began in July 2020. Dr. Danica Brown is the Project Director and Birdie Wermy is the Behavioral Health Project Manager for both projects. These two projects are working in tandem and we are gathering information from Tribal communities during the time of COVID, to better support their needs. We hit the ground running in July and we reviewed the NPAIHB COVID-19 Survey which gathered information from Tribal Health Directors and Delegates on their needs, trainings and funding during COVID-19. From this survey we were able to develop a more in depth COVID-19 Learning Needs Assessment for Behavioral Health and Medical staff, as it pertained to suicide intervention services, interpersonal violence, mental health services, trauma prevention services and client needs during the time of COVID. We also gathered information on telehealth services, data collection, technical assistance and trainings. We sent the survey out to all Tribal Health Directors, medical and clinical staff and received 36 responses. Below are the results from the assessment. Suicide Prevention: Ninety-three percent of respondents provide suicide services. However, 44% reported they are developing or enhancing their depression screening. 44% reported having highly developed screening specific to suicide. Only 58% reported that they are either developing or enhancing the process for warm hand-offs to a behavioral health staff and 38% indicated they have a highly developed suicide specific risk assessment when someone presents with suicide. In addition, 67% reported developing or enhancing appropriate patient/family education and resources on suicide prevention and 42% provide coordinated care for patients at risk of suicide. Interpersonal Violence Prevention (IPV): Fifty-two percent of respondents provide Interpersonal Violence services. However, 55% reported they are developing or enhancing their IPV screening. 20% reported providing highly developed screening specific to IPV. 70% reported developing or enhancing warm hand-offs to a behavioral health staff when someone presents with IPV. In addition, 30% reported having highly developed appropriate patient/family education and resources on IPV and 30% indicated having coordinated care for patients at risk for IPV. Substance Use/Misuse Prevention, Treatment & Recovery (SUD/OUD): Seventy-three percent of respondents provide substance use/misuse medication assisted treatment and recovery services. 60% reported having highly developed screening for SUD/OUD, however only 36% reported providing specific screening such as SBIRT. 50% reported having a highly developed process for warm hand-offs to a behavioral health staff and 64% provide a highly developed SUD/OUD assessment when someone is at risk of SUD/OUD. In addition, 50% reported they are developing or enhancing appropriate patient/family education and resources on SUD/OUD and 50% provide having coordinated care for patients at risk for SUD/OUD.

10 Northwest Portland Area Indian Health Board www.npaihb.org

Introducing Two New Behavioral Health Projects (continued) Trauma & PTSD Prevention/Intervention: Sixty-two percent of respondents provide trauma services. However, 73% reported they are developing or enhancing their trauma or PTSD screening. Only 10% reported providing highly developed screening specific for trauma. 40% reported having a highly developed process for warm hand-offs to a behavioral health staff when someone presents with trauma or PTSD. In addition, 60% reported they are developing or enhancing appropriate patient/family education and resources on ACE’s or trauma and 30% have highly developed coordinated care for patients at risk of trauma or PTSD. Clients Current Concerns: Respondents reported clients are asking about right now, the top three concerns included mental health care, COVID-19 specific resources, and health care. When asked about potentially negative experiences, the top three included: Increase in depression, anxiety, or other mental health concerns, increase in alcohol or drug use, and being fired from their job/ becoming homeless. Successful Opportunities Despite COVID-19: Respondents reported many successful opportunities that came about despite COVID-19 including developing telehealth and social marketing, community outreach/engagement, and much more: • • • • • • • • • • •

Mental health program successfully utilizing telehealth or virtual services Patient engagement remained high QPR (Question, Persuade, Refer) training continuing for community and staff ASIST (Applied Suicide Intervention Skills Training) provided to staff Developed community support program BH2I – learn about resources and how to access them Community outreach related to COVID-19 via social media/ Rapid Testing/ Cruise by Working on social marketing to increase information sharing to the community Youth Council/ Youth Talking Circles Developed homeless response Follow-up/ Well check with clients and families Transportation assistance/ med pickup and delivery

To launch the Behavioral Health Scan ORN/PCSS project in July, we recruited Behavioral Health and Medical staff from Oregon, Washington, Idaho and Alaska to participate in a group discussion on their MAT program, current perceptions of MAT and community use during COVID-19. We completed 3 group discussions with 10 participants representing Oregon, Washington and Alaska. We completed 6 one-on-one discussions with Behavioral Health staff from our Oregon and Washington Tribes. Several themes were common in these discussions. Because staff were in the beginning of their roles at their clinic and clinics were short staffed, there appears a need for more staff and/or training. There was a gap in technology in some Tribal communities as clients were reluctant to join group meetings virtually and preferred in person meetings. Some communities also expressed a decrease in MAT services as people were relapsing, while others saw an increase in their MAT services. Overall, there is a need for more technical assistance, technology (iPads, cellphones, laptops, webcams, internet) for staff to connect with their clients and how to reach and serve the Elder populations as well as the youth. Currently, we are working on ways we can provide technology, technical assistance and trainings to these programs who’ve expressed interest. We are also in the planning process of developing an NPAIHB Behavioral Health ECHO and website which we will unveil in the upcoming months. These projects we generously funded through the Center for Disease Control (Award #6 NU38OT000255-02-03), the SAMSHA/Center for Substance Abuse Treatment/ American Academy of Addiction Psychiatry (Prime Award Number: 1H79 TI083343-01 Subaward Number: SOR-CARE-32) and the SAMHSA Garrett Lee Smith youth suicide prevention grant (Award number: SM082106) NPAIHB 11

Importance of Culturally Appropriate Mental Health Services for Two Spirit and American Indian/Alaska Native (AI/AN) LGBTQ+ Clients Itai Jeffries, PhD (Yèsah/Occaneechi) Two Spirit LGBTQ Program Manager

Jessica Leston

Morgan Thomas

HIV/HCV/STI Clinical Services Project Director

Two Spirit LGBTQ Outreach and Engagement Coordinator

The 2015 US Transgender Survey conducted by the National Center for Transgender Equality reports the following: half of all AI/AN transgender respondents have had negative experiences with a healthcare provider related to being transgender, nearly half have experienced serious psychological stress in the past thirty days, and well over half have attempted suicide in their lifetime. These disparities stand in stark contrast to the esteem with which gender-diverse and Two Spirit people were held, and the prominent roles they fulfilled, in many Nations across Turtle Island before European settlement. In fall of 2019, the Paths (Re)membered Project completed a nationally-representative survey of 223 Two Spirit and AI/ AN LGBTQ+ (2SLGBTQ+) respondents, of which 49% identified as gender-diverse (not cisgender). We found significant barriers to accessing mental healthcare, substantial need for mental health support, and emphasis on Indigenous pride and identity as central to concepts of self and wellbeing. Respondents report that there are not enough therapeutic support groups for 2SLGBTQ+ people and not enough psychologists, social workers, behavioral health aides, and mental health counselors who can help 2SLGBTQ+ people with mental health issues. Gender-diverse respondents were more likely to experience these barriers than cisgender respondents. Over 79% of gender-diverse respondents believe a lack of psychological support groups and 72% perceive a lack of mental health professionals who can help them. When participants were given the opportunity to expand on these barriers, they reported low provider knowledge of gender-affirming care, low provider knowledge of the Two Spirit community, negative or traumatic experiences with past providers, and a lack of insurance coverage for medical services with prohibitive costs. Together, these quantitative and qualitative measures suggest that the problem is not always a complete lack of mental health services, but that existing services are inaccessible or less than appropriate for 2SLGBTQ+ persons. This lack of access to appropriate mental healthcare is combined with a substantial need for mental healthcare services among 2SLGBTQ+ respondents. Within the last year, well over half (55.6%) of our respondents sometimes or usually thought about suicide, wished they were dead, or wished they would fall asleep and not wake up. Over eighty-six percent have experienced that feeling in their lifetime. Rates of attempted suicide were also high, with forty percent of cisgender respondents and more than half (53%) of gender-diverse respondents reporting having attempted in their lifetimes. These numbers are concerning and preventable. In the 2019 Journal of Adolescent Health article “Chosen Name Use Is Linked to Reduced Depressive Symptoms, Suicidal Ideation, and Suicidal Behavior Among Transgender Youth,” Stephen Russell, PhD, and colleagues demonstrate that social affirmation and transition—being referred to by correct name and pronouns, being affirmed in one’s gender—is associated with a 56% decrease in suicidal behavior in gender-diverse youth.

12 Northwest Portland Area Indian Health Board www.npaihb.org

Importance of Culturally Appropriate Mental Health Services (continued)

Despite the barriers to accessing mental health services and substantial need for those services, 2SLGBTQ+ respondents to our survey demonstrate incredible resiliency, pride, community connectedness, and culture. Seventy-eight percent report participating in at least one traditional cultural activity. Ninetyfive percent believe that it is mostly or extremely important to follow Indigenous ways of thinking. When asked how important various aspects of identity were, 97% of our gender-diverse respondents ranked Indigenous identity as extremely important, compared to just 78% who ranked their gender identity as extremely important. Among our gender-diverse Indigenous respondents, Indigenous identity was more likely to be ranked extremely important than gender identity or sexual orientation. While we cannot yet speak to the direct impacts of such strong cultural pride and community connection on health, we do know that to better meet the needs of our people, appropriate mental health care for 2SLGBTQ+ people must engage a strengths-based approach that supports clientsâ&#x20AC;&#x2122; Indigenous identities and promotes cultural pride.


Healthy Native Youth Updates and Community of Practice Michelle Singer Healthy Native Youth Project Manager

If you haven’t visited the Healthy Native Youth website in a while – we encourage you to check it out! HealthyNativeYouth.org contains health promotion curricula and resources for American Indian and Alaska Native youth. The site is designed for tribal health educators, teachers, and parents – providing the training and tools needed to access and deliver effective, age-appropriate programs. You will find several new Curricula and Lesson Enhancement Activities! In 2021, HNY will be updating and modernizing several curricula favorites, including: Native It’s Your Game (NIYG) and Native Students Together Against Negative Decisions (STAND). You will also notice several new curricula that have been added to the site, including: Positive Indian Parenting, First Nations Youth Suicide Prevention Curriculum, and the BRAVE Facilitator’s manual.

Community of Practice Healthy Native Youth’s Community of Practice virtual gatherings are held the second Wednesday of every month from 10:00-11:30 am PST. The sessions are chalk full of tips, tools, resources, and examples, and open to all who support and engage youth: • 2/10/21: Connecting our Past to our Present Re-traumatization – Add To Calendar • 3/10/21: Culture as Prevention – Add To Calendar To connect with us and join future sessions text HEALTHY to 97779

14 Northwest Portland Area Indian Health Board www.npaihb.org

BRAVE Intervention Updates and Impact Stephanie Craig Rushing, PhD, MPH PRT, MSPI, Project Director

American Indian and Alaska Native 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. To meet this need, the BRAVE intervention was designed by our THRIVE and Adolescent Health teams at the Northwest Portland Area Indian Health Board over five-years, using community based participatory research activities. The formative research process included three phases and more than 38 AI/AN teens and young adults, as well as content experts from across the U.S. The multi-media BRAVE intervention was designed for Native teens and young adults to amplify and reinforce healthy social norms and cultural values, teach suicide warning signs, prepare youth to initiate difficult conversations with peers and trusted adults, encourage youth to access mental health resources (i.e. tribal clinics, chat lines), de-stigmatize mental health services, and connect youth to trusted adults. The intervention builds on traditional teaching strategies and community values and connects AI/AN teens and young adults to people, stories, resources, and teachings that demonstrate what it means to be strong and resilient. Last year, the team conducted a randomized controlled trial to test the efficacy of the intervention with over 1,000 AI/ AN teens and young adults (15-24 years old) nationwide. Participants experienced improvements in mental health, reductions in alcohol & drug misuse, improvements in resilience and coping skills, and better self-esteem – even as it was delivered in the midst of a pandemic. To sign up for the text message intervention, youth can text BRAVE to 97779. A facilitator’s manual is available on the Healthy Native Youth website. Health educators can deliver the curriculum in person or virtually in one of three ways: • Option 1: Self-Reflection Activity + Youth Sign Up to receive the video series and Text Message Series (total activity time = 10-30 minutes) • Option 2: Facilitator shows the full-length video beginning to end, followed by a 35-minute individual activity and discussion (45 minutes) • Option 3: Facilitator shows one of the 7 episodes of the BRAVE video, followed by a 30-minute group activity (45 minutes each, 7 lessons) Please sign-up to check it out yourself or share it with a young adult in your life.


#IndigiLOVE Begins with I: Virtual Springboard Lab and Social Media Campaign Lael Tate THRIVE Project Coordinator

During July 2020, We R Native (WRN) and THRIVE hosted the first virtual Springboard Lab for Native youth. The Springboard Lab was a multi-day, virtual event where 23 Tribal youth came together to collaboratively design and produce a multimedia campaign to destigmatize mental health, normalize getting help, and share mental health and wellness skills. The inspiration for the lab came two summers ago when WRN team members traveled to Boston to attend the Headstream Springboard Innovation Challenge to draft technology solutions for youth mental health. The event was engaging, but there was limited space to address the specific interests and needs of Native youth. WRN team members left the event with ideas to host their own Native-focused Springboard Lab.

Springboard facilitators youth waving on Zoom The Native youth Springboard Lab originally was planned to be in-person but due to COVID-19 it was moved to a virtual platform. Going into the event team members were cognizant of the stressful climate youth were living in. Young people were experiencing a pandemic, school closures, and the passing of relatives, and also witnessing the murders of Breonna Taylor and George Floyd and the nationwide uprisings that followed. Facilitators were mindful about how these factors affected the mental health of Native youth and were intentional about creating a space of comfort, trust, and creativity. With this in mind, they invited several guests committed to social justice and mental health. Jeremy Fields, a descendent of the Pawnee, Crow, and Chickasaw tribes, founder of Thrive Unltd., and a muralist, served as the lead facilitator. Shelby Rowe, a citizen of the Chickasaw Nation and a suicide prevention expert, gave the keynote presentation. Kinsale Hueston, a DinĂŠ, youth poet, led the poetry workshop. These guests helped shape the lab and grounded the experience in processing emotions through art and creative expression. The Lab kicked off on July 9th with a presentation by Shelby Rowe, where she talked about historical traumas that Native people have experienced, and the incredible resilience and the incredible resilience and strength of Native communities. Her presentation set the tone for the event. The Springboard Lab was a space to be honest, vulnerable, and share experiences. 16 Northwest Portland Area Indian Health Board www.npaihb.org

#IndigiLOVE Begins with I (continued) During the lab, participants rotated through three different art workshops: Poetry with Kinsale Hueston and Celena McCray; Filmmaking with Skybear Media and Thomas Ghost Dog, and Visual Art with Jeremy Fields, Corey Begay, and Roger Peterson. Youth were given space to share their experiences with mental health and reflect on their emotions through artistic mediums. One participant shared, “I’ve never shared a poem of mine with people before so it’s a great feeling that it got positive feedback.” At the end of each day there was time for reflection and participants expressed how important it was to be connected, even over a virtual platform. “One of my highlights from today was truly emotionally connecting with the amazing individuals in my group and growing close” stated one youth, another person shared how “the feeling of being connected as a group even from a distance,” was very impactful. Youth also learned mental health strategies from each other. One participant shared that “seeing everyone’s different ways of self-care helped me and gave me new ideas on how to take care of myself.” Art and discussion from the workshops revealed that self-love and cultural pride were important to youth. The group created the campaign slogan: “#IndigiLOVE Begins with I” and Jeremy Fields designed a logo to reflect artwork from participants (left). The #IndigiLOVE social media campaign was created to spread positivity, encourage youth to reach out for help, and share self-care tips. The campaign launched on social media in September 2020 for Suicide Prevention Awareness Month and went through November. Poems, artwork, and videos made by youth were released on the WRN Facebook, Instagram, Twitter, and YouTube channels. In total, the #IndigiLOVE campaign had a wide reach, with 213,910 total impressions on social media. Readers can view the content on WRN’s social media pages and it will be available on the website soon. The Springboard Lab and #IndigiLOVE social media campaign showed the importance of staying connected, even when physically distanced. “My favorite part about yesterday was connecting with new people,” one young person shared and continued with, “I also was moved by knowing that other Native youth around me struggle with the same things as I do.”

Caring Text Message Intervention Lael Tate THRIVE Project Coordinator Sometimes when we are feeling sad or lonely, a message from a friend is all we need to help turn our mood around. A text as simple as “I’m thinking of you,” or a link to a song helps remind us we are cared for and important. The THRIVE project’s new Caring Text Message Intervention is meant to feel like a message from a friend. Launched in October 2020, it is a text service for American Indian and Alaska Native teens and young adults that provides expressions of care, concern and interest. Previous studies around caring contacts have defined them as brief, periodic messages that express unconditional care, ask nothing in return, and provide behavioral and crisis service resources. They have been previously shown to prevent suicide deaths, attempts, ideation and hospitalizations, and are simple to implement, low cost, and scalable. NPAIHB 17

Caring Text Message Intervention (continued) THRIVE developed this intervention last summer and recruited Native youth to write and submit caring messages. Participants sent encouraging messages, such as: “I hope you’re having a good day. I just wanted to remind you how much you are loved. You are so important to me!” Other messages acknowledged struggles that young people may be facing: “I know it is late and things might be getting hard. I just wanted to let you know I am here for you. Please believe you are not alone.” In addition to messages received from youth, the THRIVE team developed messages with links to funny videos, resources, songs, and playlists. The messages were written from the perspectives of elders, cousins, friends, and Two Spirit relatives. They were culturally tailored with messages like: “You are a blessing to your ancestors. We need you and who you are becoming,” and “I wish you well and I wish you peace and I hope your life turns into a masterpiece” – from the song “Rize” by Ray Viktoria, a Native singer. THRIVE worked with an artist to develop new Native avatars to deliver the messages. THRIVE launched the Caring Message Text Campaign over the We R Native social media channels and users were encouraged to text the word “CARING” to 65664 to opt in to the text intervention. Upon texting, users were greeted with a warm welcome message and enrolled in the campaign to receive two messages per week for 15 weeks. Currently, there are 84 subscribers. THRIVE plans to follow the youth caring messages with texts specifically tailored for Native college students and Native Veterans. We can all use support when we are feeling down, and any form of a caring message can give youth, and us all, that extra boost to get through the lows.

THRIVE Announces: Text “NATIVE” to 741741 Lael Tate THRIVE Project Coordinator In 2020 our Tribal communities faced crises on many fronts, from anxiety around COVID-19 to grief over the loss of relatives. During times of crisis, it is more important than ever to have trusted and accessible support like the Crisis Text Line, a free 24/7 text line where trained counselors support individuals in crisis. The THRIVE project is excited to share a new collaboration with the Crisis Text Line, the Indian Health Service, and Suicidologists across Indian Country! Starting now, individuals can text the word “NATIVE” or “INDIGENOUS” to 741741 to connect with a trained Crisis Counselor. This collaboration will allow the NPAIHB, member Tribes, and Tribes across the country to learn about challenging topics and crises that Tribal communities are struggling with so that we can identify the best ways to support those who need it. Additionally, the NPAIHB is working with the Crisis Text Line to develop an American Indian and Alaska Native Tip Sheet for Crisis Counselors to reference and use when working with AI/AN texters. Texting the word “Native” or “Indigenous” will help counselors connect texters with appropriate support and resources. THRIVE is hopeful that this collaboration will help Tribal members connect to supportive resources when they need it. 18 Northwest Portland Area Indian Health Board www.npaihb.org


49 Days of Ceremony: Accessing Traditional Indigenous Knowledge to Heal Trauma and Improve Health and Wellbeing in Tribal Communities Dr. Danica Love Brown Project Director

The Northwest Portland Area Indian Health Board (NPAIHB) - in collaboration with the Alaska Native Tribal Health Research Consortium (ANTHC), Good Medicine Tribal Public Health Consulting Services (Good Medicine), and Tribal Elders - is working to develop a public health intervention for AI/AN adults designed to heal trauma and promote optimal health and well-being through accessing traditional Indigenous ways of knowing. This intervention, called the 49 Days of Ceremony, applies an Indigenous framework for conceptualizing health and encourages individuals to live full and balanced lives through engaging in traditional Indigenous wellness and healing practices, applying ancestral knowledge, and reflecting on Indigenous teachings. 49 Days of Ceremony is the life’s work of Alaska Native Elders Doug and Amy Modig, both are experienced community organizers who have supported countless individuals through long-term behavior change using traditional methods. Through collaborating with staff from NPAIHB, ANTHC, and Good Medicine, Doug and Amy’s knowledge is being accessed to create the framework for the 49 Days of Ceremony intervention. As such, the framework is based directly on our workgroup’s collective lived experiences. It is also informed by a substantial body of research that indicates that for AI/ AN peoples, our traditional life ways are often inherently wellness-based and protective against negative health outcomes.


49 Days of Ceremony (continued) Through engaging in group-based learning, 49 Days of Ceremony participants will receive support from facilitators and peers as they take steps to nurture their individual health and the health of their communities through applying traditional Indigenous healing and life practices. By encouraging participants to reconnect with sacred foods and medicines, movement, nurturing their relationships to all living beings, and other beliefs and practices that have sustained our tribal communities for millennia, we believe 49 Days of Ceremony will help mitigate the effects of trauma and holistically address the breadth of health inequities experienced by AI/AN people. It is not surprising then that the 49 Days of Ceremony framework is based on the medicine wheel, which has been used to conceptualize and facilitate healing, wellness, and life balance for many Indigenous peoples across the globe. Although ideas about wellness vary across different Indigenous communities, many of us have shared concepts about what wellness is. For example, for many Indigenous communities, wellness is understood as a mental, emotional, physical, and spiritual state of being, where components are in balance. The 49 Days of Ceremony model contains three additional components to the traditional medicine wheel that we believe are essential to Indigenous wellness. In addition to the mental, emotional, physical, and spiritual components, the 49 Days of Ceremony model also contains Mother Earth (representing our connection to all living things), Father Sky (representing our connection to our ancestors and the spiritual realm), and the Sacred Fire (representing the fire within ourselves and our communities that propels us forward on the path to healing and wellness).

When asked “Why should someone participate in 49 Days of Ceremony,” Doug Modig replied “because 49 Days of Ceremony offers a way to think about how to live successfully that’s helped people recover from substance misuse, heal their relationships, get out of prison, and maintain stable employment. It’s helped our young people live successfully in the modern world.” In this time where our personal health and well-being and that of our communities is being challenged, it is our hope that an intervention, like 49 Days of Ceremony, may offer an opportunity to achieve a connection to the intrinsically wellnessbased elements of our cultures. For more information about this project, please contact Dr. Danica Love Brown, Project Director at the Northwest Portland Area Indian Health Board at dbrown@npaihb.org. This work is generously funded by the CDC’s Tribal Public Health Capacity Building and Quality Improvement Umbrella Agreement, Federal Award: 5 NU38OT000255-02-00. 20 Northwest Portland Area Indian Health Board www.npaihb.org

Losses and Love: Staying Healthy for our Families Mattie Tomeo-Palmanteer, BSW (Confederated Tribes of Colville & Yakama Nation) Cancer Prevention Coordinator

Happy New Year everyone! As we reflect on the tremendous losses our families and tribal communities have endured this past year, I want to continue the important conversation concerning the harmful effects of commercial tobacco on Native families and communities. American Indians/Alaska Natives (AI/ANs) have a higher prevalence of cigarette smoking than other racial/ethnic groups in the United States. The tobacco industry has specifically targeted Native people to use commercial products by using AI/AN images in marketing materials since the early 1900â&#x20AC;&#x2122;s. My intentions are to plant a seed that grows into decreased use or quitting and to provide culturally-tailored support resources (developed in partnership with the Nine Tribes of Oregon, Chemawa, NARA, NAYA, NPAIHB, Metropolitan Group, Buffalo Nickle and Oregon Health Authority.) As a younger family member who unfortunately has lost many family members from preventable illnesses and dealt with so much grief as a result, I would like to share my story. I have never been a commercial cigarette smoker, however my mother and grandmother both smoked commercial tobacco and suffered from different forms of cancer. My kuthla (maternal grandmother and our familyâ&#x20AC;&#x2122;s matriarch) atwai Agnes Goudy-Lopez smoked while working in the shipyards during the Great Depression. Her life centered around family. She was a talented seamstress and storyteller; she spoke her traditional tongue (dialect) and a few other tribal languages from the NW region. She raised her eight children for most of her life as a widow, as well as many grandchildren before leaving this earth - myself included.


Losses and Love (continued) In the Spring of 2003, I was concerned about my kuthla’s deteriorating health. One sleepless night, I wrote a page and a half of life questions that I wanted to ask her. The next day, I took the day off from my college classes and work and traveled out of state to spend time with her. Armed with my list, notepad, and pen, I sat at her table with her. I told her that I knew that she would be leaving us and that I couldn’t go on in this life if she was not able to share one more birthday celebration with my cousins and me, as we shared the same birthday month (September) as her. I asked my kuthla if I could ask her some questions. She looked at me calmly through her glasses and nodded yes. She laughed a little bit when I pulled out my list. During lunch together, she took the time to answer each question patiently and, for that, I am forever grateful. The next time I saw her was in September when we shared our birthday cake and celebrated one more year of life together. When we got the call in October that she was in the Hospital and that she would be leaving us soon, I visited her with my mother. In the hospital bed, her body was fragile, her strength and breath nearly exhausted. Reflecting back, I feel blessed that we had that last birthday together and that I had the opportunity to ask my questions before she made her journey. In my circumstance, my grandmother’s deterioration was gradual so we had time to prepare. For many other family members, the loss of a parent or grandparent may be abrupt, leaving no time to share last celebrations or learn important lessons. Sadly, there are many families with similar loss of life stories. I wonder what coping methods helped relieve their family’s heartache and if there was an opportunity to mentally prepare for loss of their loved one. I wonder, dear reader, what life story your children and grandchildren will hold in their hearts when your health declines and you leave this earth. I ask each of you to take a moment, pause & reflect on the losses in your family. As we start 2021 as individuals and family members, let’s work together to support better overall health and wellness, cleaner air, and healthy stress-relief activities. Overcoming an addiction to tobacco is a challenge, but worth the effort. With support and resources, such as cessation medication education, self-help materials, and referrals to tribal cessation programs, it is an achievable goal. Please, consider this opportunity to cut back, or quit and replace daily smoking patterns with healthy stress-relief alternatives. For example, try chewing gum, running in place, meditation, or yoga. It is more important now than ever to take steps to stay healthy for our families. 1 https://www.cdc.gov/tobacco/disparities/american-indians/index.htm

Ready to Quit? Call the National Quitline at 1-800- Quit-Now (1-800-784-8669) for support. Press “7” if you smoke commercial tobacco and are ready to take the first step to better health!

Resources: Please visit https://smokefreeoregon.com/native-quit-line for tribal specific resources. If you are outside of Oregon state, please visit the quit line support and resources for Washington and Idaho. Washington State Quitline Calling 1-800-QUIT-NOW (1-800-784-8669); Visiting quitline.com; or. Text READY to 200-400. Idaho: The Tips® campaign connects smokers with resources to help them quit, including a quitline number (1-800-QUIT-NOW) which routes callers to their state quitline. The Idaho quitline provides free cessation services, including counseling and medication. 22 Northwest Portland Area Indian Health Board www.npaihb.org

Improving Youth Access and Experience with Sexual Healthcare in Washington State Celena McCray (Navajo), MPH WYSH Project Coordinator

The Northwest Portland Area Indian Health Board’s Washington Youth Sexual Healthcare (WYSH) Project is partnering with the Washington State Department of Health’s (DOH) Youth Sexual Health Innovation Network to improve youth’s access to and experience with sexual health care in I/T/U (Indian Health Service, Tribal and Urban) clinic settings, including sexual health services for 2SLGBTQ teens and young adults. NPAIHB’s WYSH project is recruiting 4-6 Washington State Tribes to work together to support the design, delivery and promotion of youth-friendly sexual health services. The project is funded by the Department of Health and Human Services (DHHS) Public Health Service Grant. Tribal subcontracts will range from $65,000 - $100,000 per year for 3 years. Our goal will be to engage Tribal Health Departments, school-based health programs, local I/T/U clinics, and youth engagement programs who have a bi-directional impact on youth and their access to and experience with sexual healthcare. Selected sites will work with the NPAIHB to: • Carryout local needs assessments that include youth, caregiver, and clinical perspectives; • Select local goals and priorities to improve youth’s access to and experience with sexual health services; • Implement selected clinical trainings, sexual health messaging campaigns, culturally-relevant curricula, quality improvement initiatives, and referral services (if selected); • Offer youth-friendly, gender affirming preventive health screenings for youth, including sexual health services for straight and 2SLGBTQ teens and young adults; • Improve communication and linkages between youth-serving programs and local health services, to improve youth engagement in clinical services; and, • Engage youth throughout the project to guide the selection of sexual health services, project goals, interventions, and activities. NPAIHB staff will select recipients based on their organizations’ capacity to develop, implement, and test user-centered interventions inclusive of youth voice, with the involvement of clinical stakeholders. To learn more about this opportunity and request an application, please contact the WYSH Project Coordinator, Celena McCray, at cmccray@npaihb.org. Applications will be reviewed on a rolling basis, the last week of each month. Applications will be accepted until all funds have been disbursed to WA Tribes/sites (a total of $400,000 per year). Subcontracts will be renewed annually for three years, contingent on approved DOH funding and completion of project deliverables.


Northwest Tribal Juvenile Justice Alliance: Project Review Dr. Danica Love Brown Project Director In 2019, the Northwest Portland Area Indian Health Board established a new inter-tribal workgroup —the NW Tribal Juvenile Justice Alliance (NW TJJA) — to collaboratively design a research study to evaluate and disseminate juvenile justice best practices for AI/AN youth in the Pacific Northwest. While AI/AN youth in the region experience disproportionate rates of juvenile justice involvement, prior to the formation of the Alliance, there were no planning bodies working to elevate these important health and safety research agendas in AI/AN communities. NW Tribal Juvenile Justice Alliance: To fulfill our proposed aims, NPAIHB—with support of NPC Research—formed this collaborative inter-tribal workgroup, which comprised 43 stakeholders, including juvenile justice professionals from state agencies (including probation, corrections, youth and family and rehabilitative services), Tribal law enforcement, and human services from Washington, Oregon, and Idaho. Additionally, the Alliance included Tribal youth. The NW TJJA convened to identify culturally relevant juvenile justice interventions, best practices, and sources of available data (to improve local decision-making). Informed by this material, Alliance members guided the design of a study to assess and share juvenile justice best practices to assist AI/ AN youth in the Pacific Northwest. Research Priorities: The 18-month planning process identified several programming and research gaps, including the need to develop protocols for data surveillance, policy analysis, and implementation of cultural practices and Tribal Best Practices throughout the juvenile justice system. Additionally, findings suggested that Tribal communities in the Pacific Northwest are supportive of and prepared to engage in the NW TJJA to better serve AI/AN youth involved in the juvenile justice system. We conducted 4 focus groups, including the 2019 NPAIHB THRIVE Conference Stakeholder Focus Group, a Quarterly NPAIHB Board Meeting, a Northwest Portland Area Indian Health Board Youth Delegate Focus Group, and the Oregon Nine Tribes Prevention Focus Group. These participants have specific experience supporting youth in their respective Tribal communities and have localized knowledge about the extent and nature of Tribal juvenile justice issues and needs. We also took the opportunity to conduct adult and youth surveys at the Native American Rehabilitation Association of the Northwest (NARA) Annual Conference, a conference focused on substance abuse and dependency treatment and recovery. Surveys were collected between November 13 and 15, 2019. Forty-one adult and 10 youth surveys were collected to gather information about people’s perspectives related to Tribal juvenile justice issues. Finally, we conducted Key Informant Interviews of stakeholders who work with both Tribal communities and the juvenile justice systems in the three-state region. Additionally, we connected with Dr. Sujata Joshi, who is a data surveillance specialist at the NPAIHB. Data gathered through this project identified two needs to be addressed that impact AI/AN youth involved in the juvenile justice system: 1) data surveillance and a need to improve inter-agency coordination with Tribes to support the needs of AI/AN youth involved with and transitioning out of corrections; and 2) the need for Tribal Best Practices (TBP) and cultural activities to be made available for AI/AN youth who are involved in the justice system. This project highlighted the need to expand data collection and communication efforts between juvenile justice agencies and Tribes in the Pacific Northwest, and to help juvenile justice agencies develop better systems for monitoring AI/AN youth they are serving.

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Northwest Tribal Juvenile Justice Alliance (continued) Recommendations for Improving NW Juvenile Justice Research and Programs: A primary need identified was for TBP and cultural activities to be made available for AI/AN youth who are involved in the justice system. “Culture as prevention,” i.e., access to culturally responsive treatment and activities, was a consistent theme that was identified throughout this project. The NARA conference survey respondents, youth and adults, shared thoughtful perspectives on AI/AN youth in the juvenile justice system. There were two themes that were very strong throughout the responses: access to cultural knowledge and access to treatment services. During the NPAIHB Youth Delegate focus group, NW TJJA meetings, and the Oregon Nine Tribes meetings, participants shared concerns that AI/AN youth do not have access to treatment options or activities that include their culture. Culture was noted in the context of prevention and intervention. Interestingly, it was also stated that the criminal justice system could be improved for AI/AN youth by implementing Tribal courts and having more American Indian staff; cultural activities such as powwows, sweats, and drumming; and more overall support from Elders or “Cultural Advocates.” The key informants echoed this finding and suggested that the Oregon Youth Authority and the Washington Youth and Family Rehabilitation Department fund and support efforts to develop policy and hire staff to ensure that AI/AN youth involved in the juvenile justice system have access to culturally responsive treatment, cultural activities, and cultural advocates. Additionally, participants identified the need for more culturally relevant assessments, and highlighted the adaptation of the Screening, Brief Intervention, and Referral to Treatment (SBIRT) to AI/AN youth as a successful example. SBIRT represents an innovative, evidence-based approach to addressing substance use with medical patients. Reclaiming Futures is an organization that works with local jurisdictions to implement developmentally appropriate and evidence-based treatment responses sustained by community supports. Reclaiming Futures has adapted SBIRT with two Tribal communities, Yurok and Southern Ute Tribes, and is open to continuing to work with Tribal communities to adapt SBIRT to their specific cultural needs. For more information about these opportunities please contact Evan Elkin at Reclaiming Futures at eelkin@ pdx.edu. NPAIHB is currently seeking future funding opportunities to continue with the NW TJJA project. We encourage Tribes to use these findings and this report to support program development in their Tribal communities. If you have any questions about this research or would like a copy of the final research report, please contact Danica Love Brown, Project Director at dbrown@npaihb.org or Stephanie Craig Rushing, Principal Investigator, at SCraig@npaihb.org. This project was generously funded through Department of Justice, National Institute of Justice Funding Opportunity Number: NIJ-2018-13840.


Gathering of NW Elders: Knowledge Holders & Culture Keepers Tanya Firemoon (Nakoda) Tribal Community Health Provider Project Specialist

The Behavioral Health Aide (BHA) Advisory Workgroup was created in 2018 with the purpose of informing and supporting the strategic direction and development of a Portland Area Behavioral Health Aide Program (BHAP), in accordance with Community Health Aide Program (CHAP) expansion. Behavioral Health Aides (BHAs) are community grown members pursuing a career in healthcare who are both culturally informed and residentially based tribal health service providers. They understand the history, culture, and traditions of their tribal communities and are employed by a tribe or tribal organization, will receive on-the-job training, customized online distance learning curriculum, and face-to-face sessions. They will be involved with behavioral health screenings, initial intake processes, prevention and intervention for our elders, youth, families and others under clinical supervision, in accordance with the Portland Area Community Health Aide Program Certification Board (PACCB). One important goal for the BHA Advisory Workgroup for 2020 was to launch and create an elder’s gathering to support our current and new BHA students in their learning journeys. COVID and summer fires consumed workloads and communities; organizing this event seemed unobtainable. However, a planning member commented that it was perfect timing and that our communities need this healing and we persevered. Fortunately, with the support of Sue Steward, CHAP Program Director and Marilyn Scott, Advisory Chair, we assembled a Planning Committee and collected the necessities to launch. As a result, we hosted our first virtual gathering of NW Elders, Knowledge Holders, and Culture Keepers on October 15-16, 2020 through ZOOM. I did not know how many people would participate because it was going to be conducted virtually versus our customary in-person event, but all presenters graciously made themselves available, even when some of their communities were dealing with an influx of COVID19 cases and shutdowns. Ultimately, we hosted 60 participants from Oregon, Washington and Idaho, including guest speakers from Alaska. Listening to our elders, our youth, our healers, and our advocates while getting student’s perspectives was the inspiration we needed to find our path for the next phase of identifying mentors and instructors for the education program. It caught me off guard because even though we weren’t in the same physical space, through ZOOM, we still found connection by weaving songs, prayer offerings, and the sound of the drum. Everyone received a meeting packet filled with material and swag in appreciation of their time with us.

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Gathering of NW Elders (continued) We owe a special thank you to each of the following presenters: • • • • • • •

Behavioral Health Aide (BHA) Student Perspective by Amy Redner (Lower Elwha Klallam) Healing Words by Natosha Gobin (Tulalip) Trauma-Informed Care in the Time of Crisis by Danica Brown (Choctaw) Advocacy by Colleen F. Cawston (Colville) Elder Mentor Perspective in the Alaska BHA Program by Amy Modig (Deg Xi’tan Athabascan) and Doug Modig (Tsimshian of the Eagle Clan) Dental Health Aide Therapist Perspective by Kari Douglass (Chickasaw) This Has to Stop, March Against Addiction by Huge Edwards (Swinomish)

We couldn’t have done it without all our participants, partners, funders, opening and closing blessings, Swinomish Canoe Family (drum & singers), our planning committee members (Danica Brown, Amy Redner, Marilyn Scott, Kari Douglass, Barbara Juarez, Andrew Shogren, Sue Steward, and Tanya Firemoon), and our event hostess (Marilyn Scott), each of you provided your own healing medicine. We are hoping our second gathering will grow much more. For those who may be interested, we are seeking your leadership and experience to help guide how BHA’s learn, share, and sustain culture within their communities. In this collaboration, we hope to weave your indigenous knowledge with students in the development of the education curriculum. Students and mentors will share in this learning journey using this knowledge to both increase access to quality behavioral healthcare, and to help create a wraparound system of care that is unique to their tribes and communities. Community members of Oregon, Washington, and Idaho who hold a deep appreciation of their communities and trade, those who are dedicated to being of service, recognized keepers, instructors/teachers, storytellers, artists, and many more who want to invest by offering their experience and be a cultural guide for your community/tribal health organization are welcomed to participate. The anticipated education program launch date is Fall of 2021, with Northwest Indian College in Bellingham, WA and Heritage University in Toppenish, WA. Per the BHA Advisory Workgroup, this is the beginning of our students and their mentors’ journey in how they develop their recipe based on culture, traditions, and ceremonies to identify our communities’ strengths and resiliency by providing the appropriate cultural response. For those who would like to be involved in the next planning committee; apply to become a BHA student; become a mentor; and/or have interest in becoming an instructor for the education program. All are welcome to attend and we would like to extend a special invitation to communities where individuals are experiencing substance misuse, as we hope they attend as well in hopes of creating plans of community engagement and developing partnerships. Please email tfiremoon@npaihb.org for more information.


Integrating Diabetes Care and Behavioral Health for Improved Outcomes Don Head WTD Project Specialist

Like most chronic health issues, successfully managing diabetes is often the result of teamwork between the patient, the provider, friends, and family. An effective team works together to address what’s happening with the patient’s blood sugars, the patient’s awareness and communication of any symptoms they feel, and the general well-being experienced by the patient. When the team is working well, the quality of life of the patient is usually improved. Important facets of diabetes management and care that can sometimes be overlooked are the mental and emotional health of the patient. In this article, we’ll take a look at how some of the clinics in the Pacific Northwest address this issue, and the successes and challenges that they’ve encountered. NATIVE Project NATIVE Project’s integrated system of health includes Open Access to in-house behavioral health providers, a robust referral system, and linkages to local community resources and providers. The Open Access basically means that when a provider is conducting a visit with a patient, and they feel the patient would benefit from a visit to a behavioral health provider, that provider can refer the patient themselves. This allows for on-thespot referrals for patients that may need to talk to someone as soon as possible. The in-house behavioral health providers are dually-trained in behavioral health and substance use disorders, or are in the process of getting certified in both areas. In the case of patients with diabetes, NATIVE Project employs a behavioral health provider that is knowledgeable about the disease and its associated complications, so patients with diabetes are able to talk with someone that understands the disease and the management thereof. The NATIVE Project also recognizes that access to behavioral health providers is an important part of the integrated care model. The clinic is divided into working pods, and each of these pods has a focus. Initially, the Behavioral Health providers were housed within the medical pod, since this helped medical providers with utilizing and referring patients for Behavioral Health visits. However, with expansion came the need for more room, and so the Behavioral Health providers were moved out of the medical pod, but kept close within the same building for continued ease of access. The medical providers have since gotten used to the Open Access and wraparound services available at the NATIVE Project in the last eight years, and are more likely to offer referrals to Behavioral Health. The clinic also provides linkages through referrals to mental health providers within Lincoln County, WA. The NATIVE Project employs Care Coordinators, or case managers, that work to identify services and resources for patients needing Behavioral Health services outside of the clinic. The Care Coordinators work with the Behavioral Health providers to find the resources and services that best fit the patient’s needs.

28 Northwest Portland Area Indian Health Board www.npaihb.org

Integrating Diabetes Care and Behavioral Health (continued) Claire Aberasturi, the Director of the Behavioral Health Services at the NATIVE Project, has indicated that one of the biggest challenges to overcome with Open Access was the communication between different types of providers regarding patients. “When we’re trained in one discipline, we tend to see it from that perspective. Medical providers were in one silo, while mental health providers were in another. The onsite integration of care between the two was challenging, because we had different focuses, and it made communication difficult. It’s improved over the last few years. It helps that the patient is the priority. We always ask, ‘what can we do to improve the life of that patient?’ This leads to better outcomes for the patient, which is our goal.”

Tulalip Veronica Leahy, the Diabetes Program Manager for the Tulalip Health Systems, works closely with the Behavioral Health providers at the Tulalip Tribe. The clinic at Tulalip recently underwent a reorganization, and the Diabetes Program was moved over to clinical services from community health. This was due mainly in part to the bulk of the Special Diabetes Program for Indians grant money going towards treatment and care for patients with diabetes. While the prevention of diabetes is part of the grant, and is more widely evident in the community due to its activities, the treatment and care of patients with diabetes is the main focus of the grant.

Claire Aberasturi, Director of the Behavioral Health Services at the NATIVE Project

In the reorganization, the Diabetes Program was physically placed within the Well Care Lobby. This area also houses services for Pharmacy, Behavioral Health, Nutrition Education, and Massage Therapy. Patients access all of these services from the Well Care Lobby, which can help with breaking down the stigma that is often associated with Behavioral Health and Substance Use Disorder. In the Well Care Lobby, the services the patients are accessing are not identified. Behavioral Health providers and staff are directly involved in the team meetings of the Well Care Lobby, and assist with the strategic planning. In addition, Behavioral Health providers often participate in the outreach and prevention activities organized by the Diabetes Program, allowing patients with diabetes to become familiar with and use to seeing these providers outside the clinical setting. Working alongside providers in the community garden can go a long way towards the alleviating the trepidation that sometimes arises in accessing Behavioral Health services. The Well Care team understands that healthy outcomes for patients involve more than the physical health, but also the mental, emotional, and spiritual health, and strive to integrate all of these aspects together in one place. “We want the patients to see us in the clinic as one health program, all working together. When you talk about the word team, it really is exactly that,” Veronica Leahy remarked. “We bring our best as a team, and it directly benefits the patients.” NPAIHB 29

Integrating Diabetes Care and Behavioral Health (continued) Nooksack Tribe When Dr. Aamer Khan arrived at the Nooksack Clinic nine years ago, he saw that the confidence level that the community had in the Behavioral Health program was pretty low. Patients seemed to be leery of accessing their services, possibly because of the stigma involved in behavioral health or data confidentiality security. He decided he needed to revamp the Behavioral Health service model, and to do so required aggressive community outreach. He wanted to make accessing Behavioral Health services routine, so he conducted outreach to the Head Start Program. The thinking was to target people as early as possible, and to offer services so they’d continue to access Behavioral Health throughout their lives. “Basically, we wanted people to get used to accessing services from a young age, all the way through to their 70s and older,” Dr. Khan said. “To that end, I have also reached out to the public school districts in our community, and we are able to send providers to those schools to offer services for their Native students.” The program currently offers individual counseling to students in eight public schools attended by Nooksack children. The program also regularly engages in community education programs, where providers are able to discuss depression, suicidal behaviors and ideation, and other mental health issues in a forum that helps to lessen the impact and stigma of these problems. “It is the responsibility of the community to participate in its own health, and this includes accessing mental health services if needed,” Dr. Khan observed. “Discussing the issues that a community faces helps integrate Behavioral Health into the community, so that these services are more readily accessed.” This ongoing outreach is in conjunction with services that the Behavioral Health Program continues to offer. The Heart Smart program was developed to help people recognize and express their emotions in a healthy way. The Behavioral Health team also conducts a regular clinical meeting, to identify high risk clientele within the system. The providers for these high risk clientele are notified, so that everyone is on the same page with respect to delivering medical care that observes patient’s mental health. The program also conducts regular screening for depression and intergenerational trauma. Due to the relationship between diabetes and depression, patients newly diagnosed with diabetes are also screened for depression regularly. The Behavioral Health program offers these patients with diabetes services so that they can address the depression, in order to better manage their diabetes. Psychiatric services are also offered, with a psychologist visiting the clinic every month. The psychologist was previously at the medical clinic, but has since been moved to the Behavioral Health offices, for better access to the providers there who see the patients on a more regular basis. To raise the confidence level in the Behavioral Health patient confidentiality, Dr. Khan worked with tribal leadership, and has instituted systems that ensure the patients’ data is safe. He also designed the layout of the Behavioral Health offices to ensure patient confidentiality, while also making it a welcoming environment. Also, when people are hired to work in Behavioral Health, they undergo training in culturally appropriate practices in working with Native communities. Finally, when hiring the receptionist for the Behavioral Health program, he decided against hiring anybody from within the community itself. Dr. Khan asked me, “would you access behavioral health if you had to go to your cousin to make an appointment? I would not, because some of the issues discussed in visits, people would not even share with their own mother.” The integration of behavioral health services in these three programs demonstrates success in addressing the mental health aspects that coincide with chronic diseases. The active and robust nature of the behavioral health services offered in these communities can lead to better health outcomes for their patients, and their community. I would like to thank Candy Jackson, Claire Abersasturi, Veronica Leahy, Dr. Aamer Khan, and Grayce Hein. They were enthusiastic and generous with their time in completing this survey of their programs.

30 Northwest Portland Area Indian Health Board www.npaihb.org

New Faces Elizabeth Coronado Health Policy Specialist

Elizabeth (Liz) Coronado is admitted to practice in the states of Washington and Arizona. Prior to accepting the Health Policy Specialist position with the NPAIHB, she was the Health and Human Services Attorney with the Lummi Nation and an attorney within the Economic and Community Development Unit of the Navajo Nation Department of Justice. She graduated cum laude from Suffolk University Law School in 2016 where she was the President of the Native American Law Student Association. While in law school, she interned with the Office of Tribal Justice with the U.S. Department of Justice and the Mashpee Wampanoag Tribe. Nick Cushman ECHO Pharmacy Case Manager

I was born and raised in northern Michigan and I am an enrolled member of the Sault Ste. Marie Tribe of Chippewa Indians. I earned a BS and PharmD at the University of Michigan, and I am also board certified in ambulatory care pharmacy. I graduated as an IHS Health Professions Scholar and have been with the Indian Health Service since 2016. I spent my first two years at the Albuquerque Service Unit, as a Staff Pharmacist and later, PGY-1 Pharmacy Practice Resident. After successful completion of the residency program, I transferred to the Ute Mountain Ute Health Center, where I served as Deputy Chief Pharmacist prior to joining the NPAIHB. Larissa Molina TOR Project Specialist

Hello, my name is Larissa and I’m the new TOR project specialist! Here’s a little bit about my background: I was born in Guatemala and moved to Portland when I was little, so my first language is Spanish. I went to school at Seattle Pacific University and graduated with my BA in psychology. I really love doing research and being a part of new upcoming studies, so I did that for a bit working at Microsoft and then at Seattle Children’s Hospital. Fun fact, when I was little I was in a PGE commercial dancing with Larry the Lightbulb. Unfortunately, my child stardom started and stopped there. Anyways, I’m really excited to be a part of the TOR project and collaborating with you all!


New Faces (continued) Carrie Simpson CHAP Project Director

Carrie Sampson-Samuels is an enrolled member of the Confederated Tribes of the Umatilla Indian Reservation (CTUIR) in Eastern Oregon. Her Indian name is Tsusunmy and she is the daughter of Trisha Sampson and Atway (the late) Curtis Sampson. She is the granddaughter of Atway Chief Carl Sampson, Peo Peo Mox Mox, Chief of the Walla Walla Tribe. Carrie is also a descendent of the Nez Perce and Palouse peoples’. Carrie has an early background in nursing and later earned a bachelor’s degree from Portland State University in Health Sciences and Community Health Education. In 2019, she completed a graduate certificate in healthcare management from Oregon Health and Sciences University and plans to complete her master’s in the same program. Carrie has worked in Public Health for the last 10 years, serving the Tribes of the Oregon, Washington, and Idaho through various projects at the Northwest Portland Area Indian Health Board and the Blackfeet Nation in Browning, Montana. Additionally, she had the opportunity to serve Treaty 7 Tribes in Alberta, Canada assisting with survey development and outreach through the Alberta First Nations Information Governance Center. For the last five years, Carrie worked at Yellowhawk Tribal Health Center as the Community Wellness Director. During her time at Yellowhawk, she restructured the department and focused on integrated approaches that bridged CTUIR values and culture with public health, health promotion and disease prevention. Carrie lives in Pendleton with her husband Austin and daughters Avery (13), Fallyn (8), Hayden (7), and Symone (7 months). Carrie enjoys connecting with her family regularly, especially her aunties, which are constantly sharing historical teachings of First Foods and often heading to the mountains to gather. She looks forward to serving the 43 member Tribes to advance health policy priorities. Samantha Wells Temp Legislative Field Organizer

Samantha is a recent graduate of the University of Washington’s School of Social Work. Samantha is a fierce advocate for her community and holds a deep belief that all people deserve strong access to culturally relevant and high-quality healthcare. In her free time, you can find her celebrating her friends and family, finding solitude and healing within nature and music, and enjoying a craft beverage or two. She resides on land that has long been tended to by the Costal Salish people; specifically, the Suquamish and Duwamish tribes. During her time in graduate school, she worked on the Washington Dental Access Campaign and was thrilled to be able to accept this position and continue the work of expanding oral healthcare access in Washington and Oregon by following the leadership of our Northwest Tribes and the Native Dental Therapy Initiative.” She is committed to ensuring that the government honors its obligations to the Tribal Nations, particularly the elevation of the health status of American Indian/Alaska Native people. She looks forward to serving the 43 member Tribes to advance health policy priorities. 32 Northwest Portland Area Indian Health Board www.npaihb.org

Washington Tribal Public Health Improvement Data Partners Meeting

Save the Date! Wednesday, February 3, 2021 10AM - 1PM The WA Tribal Public Heal th Improvement Project is pleased to offer this virtual meeting to bring together tribal, state, and regional data partners.  Join us to review data and support available f rom NPAIHB projects and explore tribal public heal th data needs.

Registration Link

Aud ie n ce: Tribal Heal th Directors Tribal Heal th Program Staff Other Tribal Leaders and Staff who collect, analyze, or use heal th data for decision making

Top ic s: Introduction to the WA Tribal Public Heal th Improvement Program Data Linkage presentation Communicable Disease Data Briefs overview Facilitated discussions

Or scan QR code with your smart device

Lo c at i on : This is a virtual event, a Zoom link will be sent to registrants

Q u e s t i on s? Contact Nancy Bennett at nbennett@npaihb.org

Sponsored by NPAIHB’s WA Tribal Public Health Improvement Project and IDEA-NW. Funding provided by Washington State Department of Health. 

COVID-19 MENTAL HEALTH RESOURCE LIST Compiled by the Northwest Portland Area Indian Health Board (NPAIHB) NPAIHB COVID-19 Updates CHAT WITH A SUPPORTIVE LISTENER • • • •

• • • •

Crisis Text Line - Text “NATIVE” to 741741 to connect with a crisis counselor Disaster Distress Helpline - Call or text 1-800-985-5990 National Suicide Prevention Lifeline - Call 1-800-273-8255 Lines for Life - 24/7 free, confidential and anonymous help ○ Alcohol and Drug Helpline - 800-923-4357 ○ Senior Loneliness Line - 503-200-1633 ○ Youthline - 877-968-8491 Idaho’s COVID Help Now Line - Call or text (986) 867-1073 Washington Listens - Call 1-833-691-0211 for support with COVID-19 related stress The Trevor Project - Call 1-866-488-7385 or text “START” to 678-678 Trans Lifeline - Call 877-565-8860


Centers for Disease Control and Prevention (CDC) - Stress and Coping National Alliance on Mental Illness - COVID-19 Information and Resources Crisis Text Line - How to Handle Coronavirus American Foundation for Suicide Prevention (AFSP) - Mental Health and COVID-19 American Psychological Association - COVID-19 Information and Resources National Indian Health Board (NIHB) - COVID-19 Community Health Tools John Hopkins Center for American Indian Health - COVID-19 Tribal Materials National Center on Domestic Violence, Trauma and Mental Health Suicide Prevention Lifeline - Coping during COVID-19 The Trevor Project - LGBTQ Youth Mental Health and Suicide Prevention

34 Northwest Portland Area Indian Health Board www.npaihb.org

SUBSTANCE USE DISORDER • Recovery Speakers - pre-recorded speeches • In the Rooms - COVID-19 Online Recovery Resources • Harm Reduction Coalition - Guidance for people who use drugs and harm reduction programs • Connections App - A free app to support people in recovery during COVID-19

RESOURCES FOR ELDERS • CDC - Older Adults and Coronavirus • NIHB - Tips for Health and Wellness for Elders • AFSP - Caring for Elders


Urban Indian Health Institute Talking with Children Center for American Indian Health A children’s storybook for COVID-19 CDC Helping Children Cope with Emergencies Child Mind Institute Talking to Kids about the Coronavirus Be Strong Families Daily Webinars for Parents and Families: COVID-19 Seize the Awkward Maintaining Mental Health During Coronavirus

RESOURCES BY STATE • Washington ○ Washington State Coronavirus Response - Mental and emotional well-being ○ Care Connect Washington • Oregon ○ Oregon Health Authority - COVID-19 Community Resources ○ Native American Youth and Family Center - COVID-19 Resources • Idaho ○ Empower Idaho- COVID-19 Mental Health Resources ○ Idaho Official Resources for the Novel Coronavirus NPAIHB 35




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NORTHWEST PORTLAND AREA INDIAN HEALTH BOARD OCTOBER 2020 RESOLUTIONS 21-01-01 National Congress of American Indian’s Native Vote Grant

21-01-06 Community Catalyst Funding Opportunity to Support Native Dental Therapy Initiative

21-01-02 COVID-19 Food Security Survey for Washington State Tribes With Potential Expansion to Idaho and Oregon State Tribes

21-01-06 Community Catalyst Funding Opportunity to Support Native Dental Therapy Initiative

21-01-03 Injury Prevention Program; Tribal Injury Prevention Cooperative Agreement Program 21-01-04 Revision to the NPAIHB Program Operations Manual 21-01-05 COVID-19 Funding to Tribes and IHS/Tribal Health Clinics

21-01-07 Lead Testing in School and Child Care Program Drinking Water Tribal Grant 21-01-08 Tribal Epidemiology Center Consortium to Increase Vaccination Coverage Across American Indian and Alaska Native (AI/AN) Adult Populations Currently Experiencing Disparities (TEC-IAVC) - CDC-RFA-IP21-2106

Next Quarterly Boarding Tentative dates April 20-22, 2021 | Location TBD Photo credit: E. Kakuska Dancing in the Square Powwow 2018

Profile for npaihb

Health News & Notes  

Quarterly publication of the Northwest Portland Area Indian Health Board.

Health News & Notes  

Quarterly publication of the Northwest Portland Area Indian Health Board.

Profile for npaihb