SPTHB TOR 3.0 Program - Project Abstract Summary: As part of the Southern Plains Tribal Health Board (SPTHB) TOR Initiative project, the SPTHB will sub-award the Oklahoma City Indian Clinic (OKCIC) to partner on providing prevention, treatment and recovery support to 22,034 AIs from more than 200 tribes that the OKCIC serves. The cooperative agreement between SPTHB and OKCIC will enhance the capacity for highly effective, evidence-based interventions, by elevating the importance of tribal identity, culture, spiritual beliefs and practices for improving well-being of the AIs they serve. Goal 1: Update strategic plan with input from OKCIC staff to streamline programming and serve a higher number of MAT patients Obj. 1.1 Conduct an internal needs assessment meeting with OKCIC and SPTHB staff within 30 days of award. Obj. 1.2 Create updated strategic plan within 60 days of award Obj. 1.3 Increase intake of MAT patients in first year from 20 to 25 Goal 2: Implement increased stigma awareness messaging and training, for both providers and clinicians, in an effort to decrease stigma towards patients with OUD and encourage more providers to prescribe MAT. Obj. 2.1 At least 50% of all OKCIC Primary Care providers and clinicians will take stigma questionnaire Obj. 2.2 100% of all OKCIC primary care providers and clinicians will be exposed to stigma awareness messaging and education Obj. 2.3 Stigma questionnaire will be administered annually to track progress. Obj. 2.4 Stigma training will be included in annual de-escalation training for clinicians Goal 3: Implement effective prevention and harm reduction strategies that will increase awareness of opioid misuse and opioid use disorder, as well as increase community access to prevention and harm reduction resources. Obj. 3.1 Distribute at least 1,000 medication lock bags to community members by September 30th, 2029. Obj. 3.2 Distribute at least 5,000 medication disposal pouches to community members by September 30th, 2029 Obj. 3.3 Distribute at least 500 harm reduction kits to community members by September 30th, 2029 Obj. 3.4 Distribute Naloxone to at least 2,000 community members by September 30th, 2029 Obj. 3.5 Increase average monthly number of visits to TOR landing page (via awareness campaign messaging) from 5 to 8. Obj. 3.6 Continue universal screening for behavioral risk factors, focusing on alcohol use, with a goal of 65% patients receiving annual screenings and 10% of patients ages 9-75 who screened positive for risky/harmful behaviors receiving a Brief Negotiated Interview or Brief Intervention in ambulatory care within seven days of a positive screen. Goal 4:Continue to implement service delivery models that enable the full spectrum of treatment and recovery support services which will facilitate positive treatment outcomes and long-term recovery. Obj. 4.1 Treat a total of 125 unduplicated MAT patients by September 30th, 2029 Obj. 4.2 100% of MAT patients will be screened for benefits, and referred to wrap-around services, including but not limited to; individual and group counseling, physical therapy, and peer recovery support services by September 30th, 2029. Obj. 4.3 All Physical Therapists to undergo at least two additional chronic pain management training by Sept. 2029 Obj. 4.4 At least 50% of MAT patients with a chronic pain diagnosis will utilize either in person physical therapy or a Home Exercise Plan (HEP) assigned by a physical therapist by September 30th, 2029. Goal 5: Implement community recovery support services that incorporate input from individuals in recovery Obj. 5.1 Provide culturally relevant community recovery support training to 100% of new PRSS and Behavioral Health staff by September 30th, 2029. Obj. 5.2 Refer at least 75% of MAT patients to outside community recovery support services by September 30th, 2029. Goal 6: Assess and communicate the impact of the grant to build upon and improve programming outcomes