The overarching goal of the Cocopah Tribal Opioid Response (TOR) Project is to increase access to treatment, including FDA-approved medications for Opioid Use Disorder (MOUD), substance use treatment (SUD), and co-occurring mental health and substance use disorder treatment (COD) and culturally relevant recovery support and care coordination services for adult tribal members. The program will also increase access to harm reduction services including overdose education and naloxone and Fentanyl testing strip distribution across the community to reduce overdose rates. The Cocopah TOR Project will expand outreach and harm reduction services to 200 (40 per year) individuals and provide direct treatment services to an unduplicated total of 125 (25 per year) eligible individuals over the entire project period. Cocopah TOR will outreach, assess, and coordinate care for MOUD, SUD, and COD, services for eligible Cocopah members by partnering with two community based Opioid Treatment Programs (OTPs), one of which provides residential treatment. The Cocopah TOR Project in collaboration with treatment providers will coordinate care and provide recovery support, case management, and harm reduction services. The Cocopah Alcohol Drug Abuse and Prevention Program (ADAPP) provides substance use prevention and adult outpatient treatment services using the Native focused Wellbriety program, hosts peer support groups (e.g. talking circles, Narcotics Anonymous, Alcoholics Anonymous), and provides transportation. Cocopah TOR will utilize ADAPP’s existing outpatient treatment infrastructure, experienced at serving the target population and providing culturally relevant services, to support outreach, harm reduction, engagement in treatment, recovery support, and case management services. The Cocopah TOR Project goals and abbreviated objectives include: Goal 1: Increase access culturally competent and client centered outreach, engagement, and harm reduction services for Cocopah tribal members. Objective 1.1. increase access to treatment, recovery support, and case management services through outreach and harm reductions services. Objective 1.2. increase access to harm reduction practices including rapid fentanyl test strip distribution, overdose education, naloxone, and other FDA approved overdose reversal medications. Goal 2: Increase access to culturally competent, recovery-oriented evidence based, and client centered MOUD, substance use treatment, and co-occurring mental health and substance use treatment services to 125 individuals over the course of the project. Objective 2.1: increase the percentage of enrolled individuals reporting abstinence from substance use. Objective 2.2: decrease criminal justice involvement for enrolled individuals. Objective 2.3: increase the percentage of enrolled individuals who are employed. Objective 2.4: increase the percentage of enrolled individuals who are housed. Objective 2.5: increase the percentage of enrolled individuals who report social connectedness. Objective 2.6: decrease the percentage of enrolled individuals who report psychological issues. Objective 2.7: maintain a 70% engagement and retention rate for enrolled individuals in treatment by providing recovery support services. The target population for the grant includes adults living on or near the Cocopah Indian Reservation. According to the U.S. Census (2022) five-year estimate, the Cocopah Tribe Region had a total population of 1,158, the recorded population of focus, 18+ years of age, represents 78% of all Cocopah Tribe members with a median age of 42.3. Most residents in the Cocopah Tribe Region are American Indian (58%), 17% are Hispanic or Latino, 56% are female, 7% are Veterans, and 16% of the adults in the community are living with a disability. Almost one-third (30%) of persons living in families on the Cocopah Indian Tribe live in poverty, 19% of adults over 25 did not finish high school diploma.