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Build Capacity in Underserved Regions Impacted by the Substance Use and Misuse Epidemic

Develop Models to Address the Complex and Variable Nature of Rural and Tribal Substance Use and Misuse and Increase Treatment Capacity.

Illicit substance use and misuse has both increased the demand for behavioral health services and exacerbated the behavioral health workforce shortage across the country. Treatment resource gaps are especially acute in rural communities, due to fewer treatment providers; lack of specialty substance use and misuse treatment options, including medication-assisted treatment; limited transportation resources; and greater travel distances to access care. Telehealth services are a powerful tool that can help communities close treatment gaps through electronic and telecommunication technologies that deliver substance use and misuse and recovery services. In rural communities, in particular, telehealth can help individuals access clinical services and medication-assisted treatment, learn relapse prevention skills, and receive peer recovery support services. Improving the capacity of rural communities relies on strategic partnerships and collaborations that utilize technologies and other community resources to enhance treatment capacity and quality.

American Indians and Alaska Natives have some of the highest rates of opioid overdose for all ages. However, tribal communities have limited resources for treatment and prevention and largely lack access to tribal-specific substance use and misuse treatment. Tribal service delivery issues are complicated by workforce shortages, limited behavioral health providers, and long travel distances to obtain services. Developing meaningful treatment interventions that include culturally appropriate practices that accommodate and honor tribal traditions and spiritual rituals is important to successfully addressing illicit substance use and misuse in tribal communities.

COSSUP supports activities that:

  • Implement or expand telehealth services that facilitate access to substance use and misuse treatment and recovery supports that can address community treatment gaps and reduce participant burden.
  • Develop the capacity of rural communities to address treatment and resource gaps through strategic partnerships and technologies.
  • Implement or expand tribal interventions that increase American Indian/Alaska Native access to culturally appropriate prevention, treatment, and recovery support services.

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Grantee Projects

Yurok Tribe of the Yurok Reservation


The Yurok Tribal Court’s long-term goal is to develop, implement, and enhance diversion programs to address the escalating opioid epidemic within the Yurok community. The Yurok Tribe will be implementing the Yurok Opioid Diversion to Healing (YODH) Program. YODH will complete a Yurok Tribal Action Plan and community assessment, implement a community education and outreach program and workplace opioid awareness program, develop and implement a screening process in collaboration with the Humboldt and Del Norte Sheriffs’ Offices and the Superior Courts, and establish a formalized diversion process.
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Central Council Tlingit and Haida Indian Tribes of Alaska


The Tlingit and Haida Comprehensive Opioid Abuse Prevention and Intervention Project will plan, develop, and implement a civil diversion program though the Tlingit and Haida Court that targets Native families in southeast Alaska impacted by opioid abuse. The project will utilize a stakeholder consultation model for completing assessment, capacity building, and strategic planning necessary to implement and sustain a comprehensive, culturally competent diversion program and system.
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Hoopa Valley Tribe


The Hoopa Valley Tribe will deliver customized interventions through the criminal justice system of Humboldt County and the Hoopa Valley Tribal Court. Among this project's deliverables are a full community needs assessment, an opioid diversion work plan, the implementation of data tracking systems across multiple domains, and broadened awareness of best practices for both county and tribal partners. The proposed project will be one of the first cross-jurisdictional diversion programs in Indian Country specifically designed to meet the opioid epidemic.
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