Cherokee Nation Tribal Behavioral Health - Substance Use Prevention Project - The Cherokee Nation Behavioral Health (CNBH) Tribal Behavioral Health- Substance Use Prevention (TBH-SUP) project will serve Native American youth, young adults, and families across Adair County, Oklahoma, a predominantly Cherokee, federally designated rural county of approximately 19,575 residents located entirely within the Cherokee Nation Reservation, where 66% of residents are Cherokee Nation citizens. The primary population of focus is American Indian/Alaska Native (AI/AN) youth and young adults through age 24 who are tribal citizens, with an emphasis on 10th graders; CNBH estimates 5,050 tribal citizen youth and young adults reside in the catchment area. The secondary population of focus is the parents, non-parent caregivers, coaches, mentors, and community members who surround these young people and shape their exposure to risks and protections. Adair County is a federally designated Mental Health Professional Shortage Area with no coordinated screening and referral system linking schools and community partners to services and inconsistent naloxone access and training; building this infrastructure is foundational to the grant. Data from the Oklahoma Prevention Needs Assessment and CNBH's own community indicators confirm that Adair County's AI/AN youth and young adults experience substance use and overdose risk disproportionate to the surrounding population: lifetime use rates among secondary students reach 18% for alcohol, 13% for marijuana, and 8% for nonmedical prescription drugs, and the county's unintentional overdose death rate for the AI/AN population, 100.8 per 100,000, is more than double the rate of 50.5 for the total population. Rural geography, long emergency response times, and hesitancy to call 911 or 988 further compound the county's exposure to overdose harm. Over the five-year project period, CNBH will build organizational and community prevention capacity, strengthen early identification and referral pathways (Goal 1), and build rural communities' readiness and trust to engage with crisis response systems (Goal 3), while directly delivering prevention education (Goal 5) and overdose response training (Goal 4). CNBH will launch the project with a Year 1 Gathering of Native Americans (GONA) or comparable strategic planning event and community listening sessions to build a community-driven strategic plan (Goal 2), then develop a Training-of-Trainers pool of local prevention and naloxone trainers, finalize written screening and referral protocols with Adair County's high schools and the Indian Capital Technology Center (Goal 1), and deliver evidence-based prevention programming, including the Connect Brief Intervention, Connect Kits for Family Action, and Alternatives programming grounded in Cherokee traditional practices such as beading, basket weaving, and stickball (Goal 5). CNBH will also establish community-informed overdose response protocols, expand naloxone access points countywide, and deliver community education on emerging substances such as fentanyl (Goal 4). Within 12 months of the award date, CNBH will submit a written strategic plan and overdose response protocols through SPARS, supporting SAMHSA's priorities of preventing substance misuse, abuse, and addiction (Goals 1, 4, and 5) and expanding crisis intervention care and services (Goal 3), and will track and report progress quarterly and annually as its trained community workforce, referral pathways, and reach grow each year of the project period. At least 4312 unduplicated people will be served over the life of the grant (YR1- 565, YR2- 698, YR3- 838, YR4- 1005, YR5- 1206).
