Commitment to Recovery: Alaska Native Community Needs for Substance Use Treatment - Southcentral Foundation (SCF) is a successful Tribally-owned and -operated healthcare organization in southcentral Alaska, a region spanning 104,713 square miles, 55 rural villages, and serving 70,000 ANAI peoples representing 229 federally-recognized tribes. In 2018, SCF completed a community health needs assessment (CHNA) with the intention to improve existing services and develop new programs. The CHNA included quantitative and qualitative methods to gather cross-sectional information about the health needs of the AN/AI peoples served by SCF to assess performance and identify any gaps across seven domains. Participants included healthcare system leadership, staff, and customer-owners. Two of the top three health needs identified through the CHNA were substance use (alcohol, drug, and tobacco misuse) and behavioral health. More specifically, participants reported needs for more prevention, addiction awareness, and both short-term and long-term treatment for substance use disorder (SUD). Behavioral health needs included increased access to services, expanded treatment for behavioral health issues (e.g., depression, anxiety) and suicide prevention, awareness, and support. Since these results were shared with SCF key stakeholders, leadership has made significant efforts to improve access to services and address some of the needs identified by CHNA participants. However, overdose remains a high priority for the healthcare system: AN/AI people experienced the highest rates of overdose death in the US in both 2020 and 2021, representing a year-over-year increase of 20%. In 2023, the overdose death rate among AN/AI people was 36% higher than that of non-Hispanic White people. The goal of the proposed project is to complete a CHNA focused on substance use treatment services offered to SCF customer-owners, both urban and rural. While the literature suggests that co-occurring substance use and mental health disorders can impact service utilization, and this is a component of interest of the investigative team, the design and scope of this CHNA will be established in collaboration with the proposed project’s steering committee. Our Specific Aims are to: Assess the needs for substance use treatment services at Southcentral Foundation. This will be achieved through up to 20 interviews with clinicians and leadership, 500 customer-owner surveys, and 4 focus groups with rural clinics and one community-based treatment program external to SCF. Build capacity of a masters-trained Alaska Native investigator, Ms. Aliassa Shane, with ongoing mentoring by academic partners. This will be achieved through monthly mentoring meetings, annual attendance at one professional conference, and one training focused on development of substance use disorder interventions or Indigenous research methodologies. Develop a detailed logic model for an intervention which will outline inputs, activities, and outputs for short-term and long-term impacts on reducing opioid overdose morbidity and mortality rates. This will be achieved through a review of the literature and theoretical frameworks relevant to the substance misuse research and engagement with the steering committee to ensure the intervention will be inclusive of all factors that contribute to improving Alaska Native/American Indian health. These aims will contribute to the limited knowledge about effective treatment and recovery services among AN/AI peoples in a real-world environment. These activities have potential applicability in other tribal health systems across the nation and other health systems that seek to provide culturally grounded treatment and recovery services.
