MCNDH BH2I Project - The Muscogee (Creek) Nation, acting through the Department of Health (MCNDH) under the Behavioral Health Services (BHS) program will utilize grant funding to advance movement toward integrated care that was built upon a previous System of Care initiative that was focused on promoting comprehensive, integrated services and supports that were community-based, youth/family driven, and culturally competent. MCNDH BHS will complete the goals below to reduce a wide range of mental/behavioral health issues among American Indian/Alaskan Native (AI/AN) youth and families residing within the MCN reservation. The overall goal of this project is to provide 1,200 diverse screenings and services to patients and families within the reservation, initially beginning at the Sapulpa location. The project will be successfully achieved through the following goals and objectives. Goal 1: To expand an integrated and coordinated system of care between primary care and behavioral health providers within the MCN service area, initially beginning at the Sapulpa location. Objective 1.1- Organize the project, tailor, and implement existing procedures into expansion location. Objective 1.2- Provide necessary trainings on behavioral health integration, mental health, and wellness to current and new providers/staff. Objective 1.3- Plan and conduct project-wide process, outcome evaluation activities, and quality improvement measures. Goal 2: Provide services and ultimately improve the overall quality of life for AI/AN individuals and families with behavioral health issues. Objective 2.1- Utilize the evidenced based integrated care model SBIRT to identify, screen, assess, treat, and refer patients, especially adolescents and children. Objective2.2- Endeavor to infuse the language, culture, and spirit of good health and wellness into the project as it evolves. Objective 2.3- Increase collaborations, partnerships, and community linkages with tribal, state, and federal agencies to support services and goals. Objective 2.4- Provide outreach and education about health disparities to patients and their families. Objective 2.5- Expand and advance on the existing Mvskoke Wellness Model. Goal 3: Improve access to care by building on existing integration efforts by implementing and monitoring a Family Support/Peer Recovery model. Objective 3.1- Implement a family recovery model for patients and families to assist in navigating tribal/state/federal systems to increase access to social services and other forms of care. Objective 3.2- Improve lives by offering support and education, advocacy, mentorship on the various mental and behavioral issues.