Welcome to Harm Reduction, a culturally responsive approach to community wellness. My name is Chiara Mattresino with Kauffman and Associates and I will be managing the logistical support for this Zoom session. At the bottom of your screen, you will find a series of icons. If you have questions throughout today's session, please use the chat function and we will address your questions either by chat or during the Q&A section at the end of the presentation. If you would like to speak aloud to ask your questions during the Q&A, please use the raise hand function under reactions. Finally, please be aware that today's session is being recorded. Closed captioning is available by clicking the CC function. If you need technical assistance during the session, please type the issue into the chat box and one of our techs will address it as soon as possible. I will now turn it over to Chelsea Kimura. Thank you, Chiara. Good morning or afternoon, everyone. Thank you all for joining us today. My name is Chelsea Kimura. I'm a Inupiaq descendant and I'm a social worker by training and I now serve as a training and technical specialist for the ORN in the Northwest region. I will be helping to facilitate the session today. Can we go to the next slide, please? Begin this presentation by opening in a good way. It's my honor to welcome Monica Super to the meeting today. Monica Super is an enrolled member of the Pitt River Tribe and a Modoc descendant. She's a tribal TA specialist who holds a strong belief that ancestral knowledge is paramount to wellness. She has spent nearly the last two decades working in the field of behavioral health in the community where she was raised. Monica has extensive experience visionizing and actualizing culturally grounded pathways across the continuum of services. With that, I will turn it over to you, Monica. Thank you for being here. Awesome. Thank you for having me. So good morning, everybody. Monica Super here. I'm really excited to be asked to provide the cultural opener for such an important topic like harm reduction. And I was thinking about this this morning about what is the cultural connection to harm reduction. And I was thinking about, you know, that we come from a people who have always sought ways to reduce harm in our communities or harm to ourselves or even prevent that harm. And in the ways in which we did that, so, you know, our questing practices or our ceremonies, doctorings, our use of our traditional medicines, or even the way that we went to war to protect our communities, you know, similar to the type of wars that we're fighting in our in our current reality, you know, our war against alcoholism or our war against opioids and how that is coming for our communities. And so, you know, we I just really am thankful for the ways that our communities, our tribal nations have always sought ways to reduce harm. That's totally in our blood. And also harm reduction has everything to do with access and non-judgmental treatment approaches. And I was thinking about this, too, this morning in that, you know, I come from a creator, you know, and in our language, we call our creator kumush or gumukums, or in our Pit River way, we refer to that creator as hey, we see. And you know, our instructions from our creator is that they that he holds favor for us as his people. And he's a really good example of care, of creating resources and supports. And you know, he created this whole natural environment for us to lean on in times of hardship. And when we come out onto our landscape, you know, all those natural resources, all those supports that were created, they're open and they're non-discriminatory. And so we have these really beautiful examples from our creation stories, from our creator, our spiritual beings that created our world. You know, we can lean on them when we think about this harm reduction approach. And so, you know, with that, I just want to say that harm reduction is almost ancestral in a way that we come from nations who have always been invested in harm reduction. And I'm going to share a song this morning. And this is a song that we created in my community a few years back. And we had several large events where we would have these big parades and we would walk through those parades and we would sing this song to our community. And this community was really calling on our people's hearts to come to the fire. So that's what the words to this mean is, changes coming people come to the fire and the fire is representing recovery. It's representing wellbriety, wellness, all of those things that we're striving for in our communities. And so I'm going to share that song with you this morning. to Narcan. We need to get that out. We need to get that to the people who are using the drugs. We need to get that out to the families. And so we worked really hard on pushing naloxone out to everyone and getting the whole community saturated. And we worked really hard on getting that access for people so they didn't actually have to go to the pharmacy. So we wanted to eliminate barriers to that. And then we did a lot of education on medication for addiction treatment and destigmatizing services. And so there's a lot of kind of groundwork has been in here to kind of set the stage. And then the hospital here became a syringe exchange program. And then we became a syringe exchange program because there was a such a need for the cultural, a culturally specific program that really met the needs of our native community. So we're very, I should say, so there's a lot of strategy here. And there's a lot of framework. And there's a lot of, I think, being transparent, and education is huge. And then making sure that we're out, out there being seen in the community. Next slide, please. And so just a little bit more on kind of program structure. You know, we work really hard to have community partnerships. We do, like I said, we were doing a lot of the naloxone training distribution. And then now, you know, the xylene test strips, fentanyl test strips, we're working towards becoming a drug testing site. And so that's one of our goals for this year is to actually help people test their narcotics. And so we're working with another program to get that set up for us here. And then, like I said, a lot of collaboration with other organizations, just to help get the word out there and working with our tribal programs as well. And then we do a lot of evaluation, and we do a lot of data collection, and we do a lot of evaluation, and we do a lot of data collection, because it's really important to be able to show people, you know, what's the difference? How has this impacted our community? Next slide, please. So here's just, I forgot to put this in, but there's the straight pipe, the hammer pipe, and then the bubble pipe. I put those in because the one thing that I have heard, you know, is people saying like, man, they give pipes out to people? Like, why? And so I get to share with them the importance of having access and how it reduces fatal overdose. And we really try to share that message that fatal overdose is actually something that can, is totally preventable, right? When we have all of the access to resources and can get the education out, nobody actually has to die. And so we really try to push that message out there and help people keep safe. And having people go from injecting to smoking, that's another way to reduce the risk of fatal overdose, to have people know which pipes they're using, so they're not sharing pipes and getting that, you know, like I said, we have had people overdose because of that. So that's why it's really important that we have those safe smoking devices. And then, next slide. And then I think one of the cool things that we really talk about, because we are a syringe exchange program, and we work so much with people that are using drugs, we have the opportunity, like a really unique opportunity to have trust relations with them. But we get to talk to them about the importance of locking up their paraphernalia in their drugs, and keeping that safe and away from from kids if kids are in the home. And so we get to do safety plans with them, and we get to let them know that, hey, when whenever you're ready, we're here for you, like whenever you want to go to rehab, you know, whenever you want something different, whenever you want to talk about MAT, or can I just get you into primary care, that's another huge piece of something that we do is get people from the syringe exchange program into primary care visits, just to get physicals, just to talk to the addiction specialist. And we let them know, like, hey, it's, you don't have to be ready to quit or anything. But you can go meet with her, you can talk to her about, you know, what is tachycardia on the heart? What am I putting myself at risk for? And just get the education and kind of the resources going. Now, I give the referrals to a team of people and doctors that I know are going to treat them so incredible and so right, that they just love them. And so, and so I know that it works out, and it's a good fit. And so we actually have people, you know, who are in the syringe exchange program who are going to their primary care doctor, or they're getting established with primary care, and they're getting their physicals. And they're, you know, like really putting their health and they're still using, right. But what we really try to engage with people is that it's not, it doesn't have to be just this or that, right? Like, so much of that all or nothing thinking is part of their everyday life, right? Like, well, why do I care about my health? I put drugs in my body. Well, you can still care about your health, you can still go get your liver checked, you can still go do all those things, right? All that education is part of prevention, and it really helps getting them to make healthier choices, and they start slowing down their their use. And then here's just an example of our opioid overdose kit, we have other tags that we put on there. And it will say, this bag has been smudged and prayed over. You know, we need you here. And so we have like motivational sayings that we'll put on there, don't forget me, that will like hook to the zipper on that bag. So people remember and kind of just get back to their culture too. So some of the other things like we give these kids, but we give them out to, you know, I've heard, well, that Narcan, that's just for those people who use drugs. And we say no, actually, it's for, it's your elder who forgot they took their medication. It's for when anytime an opioid prescription is in the home, you should have it. It's for in case someone drops their medication, or it's in case, you know, one of your kids friends come over and has something with them, some kind of opiate, right. And so we really broaden that and help people think that through. And we let them know anyone could be a first responder. You know, if you have it in your house, and we've had people run to their neighbor's house, you know, for an overdose kit. And so we really just try to help people think about the bigger picture of why they would want access to Narcan. And we do a lot of the education in the schools as well to be and it was really nice because our local schools last year were finally open to getting Narcan. And we went in there, we trained staff and the educators. And, you know, they were like, well, where should the Narcan be? And I'm like, in every room, you know, don't lock it away. And then we had one school, you know, leave it out for, for the high school students. And they said, I'm going to put it right there by the condoms and overdose kits can be right there. And I thought, man, what an amazing teacher and because we have you, we have kids who literally save their parents lives. And so it is important that our youth have access know about it, that the families have safety plans as well. Let's see. Next slide, please. And so, you know, I always think of like the big picture of communities. And, you know, I have been to a lot of national gatherings. And it really, it really takes me back when I have to when I hear some of our tribal leaders crying, because they're losing people. And they are losing them so fast. And they're talking about how they go to funerals more than they go to birthday parties. And just the devastation, you know, as everyone probably knows, is that black people and indigenous people have the highest fatal overdose rate nationwide. And so, you know, that's always alarming. And I let you know, try to share that with people, not to scare them, but to say, Hey, this is, we really need to address this. And so having access to syringe exchange programs, you know, is a really crucial piece in that big picture, because they provide really important work, and they're really a bridge to that wellness. And so I, you know, there's some, some communities that struggle with even getting naloxone in there, right. And then there's, so I know, syringe exchange programs are way on the other end. And so some, some people are just challenged. And then there, there's a lot of communities, though, in tribal nations, who are actually seeing the benefits and saying, we do need syringe exchange programs, we need harm reduction programs. And the beautiful thing about, you know, about that is that we can make all of that our own, you make it make you fit it for your tribal community, right? You make it make sense for where you guys are at in that in that particular space. But you know, we have harm reduction has a place in everything, right? It's, it has its place in the MAT programs, that we're not, you know, stigmatizing people that were not being punitive when we're doing medication for addiction treatment, right? Some clinics will have a policy where you're not allowed to use any substances. And then they wonder why people aren't coming back to them, or they don't have, you know, they're not having good conversations with their patients. You know, because they're not coming from a harm reduction approach. And so, you know, that's why I share with you guys today that the harm reduction approach goes into everything. It's like really woven into all the work that we do. And so it really has its place. So yeah, it's not, it's not good to have a MOUD program, and then be super punitive. It doesn't work very well. And people don't, don't really respond. And then they, they feel ashamed. And that's the one place that they're supposed to feel safe, right? They should be able to come talk to the doctor and get the help they need. So, you know, one of the ways we always look at it is like, well, we're really, we're really happy that you're staying on your Suboxone. And yes, we can address the methamphetamine use. However, you're lower risk for overdose, you know, and we're happy that that part's getting managed. And so, you know, you're able to have those real-life conversations when you come from a harm reduction approach. Next slide, please. So, touch points and pathways. I think one of the things, you know, when we're looking at our communities is where are people showing up for help? And, and who are the people that need to know how to respond to people, particularly those who are opiate dependent, right? We had a, a story of a tribal member across the hill. And this young man went into the emergency room for an overdose. And he was a, he was a youth, right? And he got out and he went to one of the tribal, tribal leader's homes. And he talked about where the fentanyl was coming from and everything. And then that youth went home. And later on, late that afternoon, he went and had a fatal overdose. And my first thinking in response to that was, man, there was a lot of opportunities to intervene on that child's life. First, in the emergency department, when he got the care, you know, did someone talk to him about starting medication for addiction treatment? Did someone give him another opportunity? Did they follow up? Were, was there anyone else that they could have called? That's the other thing. So, like, if somebody doesn't want help in the emergency department and says, I don't want to start MAT, I'm not ready for that. Or they say, I'm not an addict, I don't really have a problem. Cool. Can I get you in touch with someone in harm reduction? And then you make that connection with them. And then, so then you're, you know, you're able to connect with them and talk to them about those important things. And because we know the most significant thing is that somebody who has the overdose has a 30% chance of dying within a year. That's just one of the statistics. So within the year, we know that their chance of having a fatal overdose is by 30%. That's huge. And that's more than when someone goes in for a heart attack. And so, you know, it's, it's really urgent that we're actually educating people and talking about that. And where can we have those conversations? And so the ED, you know, and I tell you, I don't know what happened, but I'm like, well, the ED could have done X, Y, and Z if they were trained or had this information. And then when he went to go talk to the tribal leader, the tribal leader, and then we're focused on where'd the fentanyl come from. And nobody was having conversations about, man, how are you feeling? Can we get you on Suboxone, your withdrawal symptoms? How are you doing? And so then later on that afternoon, when that kid is in like full withdrawal, feeling so crappy, what does he know to do? He knows to get high, to get out of that pain again. And so that's why, you know, when I talk about like the touch points and pathways, it's like, where in your community are you able to help kind of close this gap? Where are we able to help educate people that come in touch with people's lives like that, right? So, you know, hopefully our tribal leaders are open to hearing these conversations and getting this education and these resources. So people in education that are working with youth and different programs, you know, really important. Next slide, please. So one of the things that I was just talking about was the opportunity when it presents itself, right? And so it is a very short opportunity that that young man who passed away, you know, his opportunity was in that in that 24 hour mark. And so that's what I'm talking about, like we sometimes we have just a brief opportunity to be able to help somebody change, change what's going to happen, right? And so that's where that's why I said it's so crucial for harm reduction and people who are doing the syringe exchange services to be able to have those connections and resources with people. We've had people go into the emergency department and they had a fentanyl overdose and they, you know, swore they didn't have a problem. Okay, so you're not ready for MAT, so they didn't want that. Man, let's get you connected with the harm reduction services. Okay, cool. What's that? Well, here's test strips. Here's Narcan. You're safe using it, you know, or yes, it's using equipment and then building that connection out of there. And those are the those are the connections that actually save lives. With this one example, we were able to go into the home and train the whole family about Narcan and they all made a plan. And this person, because the first time the person said, I don't have a problem. And then the second time they came in a couple weeks later with another fentanyl overdose, they said they still didn't have a problem. They came in about a month later with another fentanyl overdose. Now they finally said they had a problem. And so they started, then they were open to MAT. But in the meantime, because we were able to go in there and meet with the patient, because we were able to go in there and actually work with the family, we were able to the mom saved his life the last time. And then he was able to get to the ED. And then he was able to start on medication for addiction treatment. And you know, it's such a blessing to be able to see this man walking around now who was able to keep his job he was able you know, and he's and he's still alive and the family that was a son, they still have their brother and uncle. And so that's the crucial work that you know, the harm reduction programs are actually able to do. Next slide. So a little one of the things that we did, we created the tribal overdose response navigator. Because who else goes into the home to talk about these things, right? So I'll give you an example of what happened about three weeks ago, we had a young, young lady in her 20s, was overdosed in her home. And so we were we were able to go out there with the paramedics and the tribal police and we were able to give education to the family, we were able to work with work with the person. And then the person got released from the ED, and then was going experiencing withdrawals, we were able to go back into the home and say, Hey, let's go back to the ED. And so this time, though, the navigator went with them to the to the emergency department, and then they were able to actually advocate and facilitate on their behalf that they got the right treatment and care in that moment. And so that was like a huge piece. And then we were able to work with the mom because there was two younger children in there, and let her know like, about we gave her education, but they were able to go through that whole home. And they found all these foils of where she'd been hiding foil and smoking foil. And so, you know, the important thing is, is that I know that there wasn't anyone else that was going to go in the home and do that, right? That was our job to do something about it. That was our job to say, man, there's young kids in that home. So, you know, first, the patient needs resources, the patient needs help. But also, and then the mom, you know, in the family, they don't, they were like, we didn't even know she had a problem. And we're like, wow, yeah, she's, you know, she's, she does have some things going on, right? And so we were able to educate them as well and get them and they didn't even have Narcan in the home. And so we're able to educate them about the importance of Narcan and be right there with them through that whole process. Overdose, the overdose response navigators also, you know, have been invited to go to funerals. They've been out at the camps cleaning up things when someone has overdosed. And so their role, like really takes on, you know, tribally, like this, this whole life of its own, because, and even in this like spiritual sense where they were invited to ceremony for, for someone who had passed away. And so it's such a needed piece, and it really meets the needs of people and able to, like I said, able to go into the home, able to work with them. And we make it very clear, though, because people, some people don't like calling the police, and so we make it very clear, these are not first responders, like, please don't like call the overdose response navigator and be like, someone says overdosing, come quick, like they're not the superheroes who are coming to fly down there. But that actually has happened, you know, where we've been called. And we've actually, you know, had to give Narcan because somebody was overdosing and they weren't, they weren't calling the police. And then we were able to call and get the paramedics out there. So, but they're, they're a really important piece, because they connect, they connect all these missing dots for people. And they, like I said, can go in there, get them resources, make sure that they know about, you know, why they should be starting medication, if that's the right fit for them. There, it's just a huge piece. Next slide. And then a little bit about tribal substance use navigators. We have one right now and it is, you know, it's a huge piece of the care that we're able to provide. And like the overdose response navigators, these people are able to do so much coordination across a whole spectrum of things. And so, you know, it's really nice when we're able to engage, but they do harm reduction. So they do syringe exchange work, they work with their criminal justice system, they do the intakes, they work with the tribal programs, they're advocating for change, they're out there doing events, they're working with the schools and they help provide as like just an abundance of coordination of care and like linkage to other services too. So housing and then different like food programs. So they're able to do a lot of different things as well. Next slide. And then one of the other things that we started was a detox comfort care package. And I think part of that was to let people know like, hey, we're really proud of you for starting this process, but we wanted to be able to encourage them, give them trust and then help them like have a successful detox, right? Like nobody wants to be in the middle of that process and then just, you know, have them say, forget it. You know, fentanyl will work much better for me. And so we wanna help have that retention and then just let them know like how much we actually care about them and what they're going through. Next slide. So we just put a few different things in there, but we have like hydration, some Advil multivitamins, we have organic teas, little like masks for their eyes, journals and then some organic honey and different things like that. Just part of that, just to let them know like, hey, we are here for you, you're not alone. And so those make a huge difference with people who are going through it because they already feel so crappy. Next slide. So that was one of our last ceremonies we had, but we started a thing called the Welcome Home Ceremony, and it is just a way to honor and bring back people who are coming out of incarceration and who are coming back from rehab, who are coming back from jail. And it's so healing, and it's on so many different levels of why we're doing it. It's an amazing experience to do that, and we've had people come right from the Syringe Exchange Program, no barriers, who said, I want to change my life, or I want something different, right? And we'll get them to rehab. And then we stay connected with them, and then when we bring them back home, we have a ceremony for them. And so that's why I said that, you know, I just can't stress how important Syringe Exchange Programs really are when they're set up in such a good way. Next slide. So as part of that Welcome Home Ceremony, that was Ambrosia, and she was singing an honor song for them. But we have these tips that we made, and you know, this one says, Welcome Home, we honor you for changing your path and helping others to see it's possible. Your sobriety makes our tribe that much stronger. And then we have a card on the right hand side, and we have it done in our tribal language. And when you open the card up, it actually like has a recording of a prayer done in Nuumu. And so you can actually hear for yourself, a person speaking a prayer over you, right? And so it's a really, I think it's pretty awesome, but they're able to hear, open that card anytime they want to hear that prayer being said, and then it's shown on the other side what the words are in there as well. Next slide. And then these are just some additional photos, but the one woman is our tribal chairwoman, and then we're honoring the lady in the middle, and they bring their friends and family. We bring people, and you know, we have, they happen to be Bishop tribal members. And so, you know, I reached out to our tribe and said, Hey, we have, you know, someone coming home. You know, can you help support this? And they were, they bought the food, we did it in the tribal chambers. I said, you know, we really want the tribal council to be there. And then they invite their family and friends as well. And then we have, you know, certain people to that come. And so we have a, we do the honor song. We recognize them, we share good words, everybody, it's, you know, everybody is, there's so many tears. And it's really, it's so powerful, because the last one I watched a family get their mom back. And the, you know, she had about five children and grandkids. And they didn't think that they were ever going to get their, their mom back. And they hadn't had a relationship for 10 years. And so to see the adult children walk in, because they finally had their mom back, you know, was amazing. And this is somebody that we used to give syringes to, right, and, you know, and encourage, encourage them and uplift them. And so it's super powerful to see how full circle this actually goes. And then to get everybody involved, and then people that are in recovery involved. But we and then we do it for the incarceration piece, too, because we want to let people know, hey, how you had to survive in prison, and how you had to live in prison, you don't have to don't bring that back into our community, right? We want, we want to help them change their, their focus and realign their spirit. And so they're not just on autopilot and survival mode. And there's a lot of trauma and PTSD that can go on. And so we have to help support people that are coming back from incarceration. And this is the welcome home ceremony is another way to help reduce that because so many times they come home, and they have good intentions to stay sober. And then it starts with smoking weed, whatever. And then they they don't, they go right back to their old way of life. And then if there's violence involved, they go right back to relying on violence, right. And so this ceremony is one way to help stop that and say, hey, you get to come home, you get to be a new person. And it helps really take that stigma off of them, too. And we have other people who come who've been in prison. And they'll share their experience. And they'll say, man, I'm so proud of you, you know, like, that you're here, you're doing it, you're walking with your head high. And so it really just brings people, it just honors their whole journey and recognizes that for them. Next slide, please. And then this is just some more of the things that we will put in their kit. But oh, and this is what the prayer actually says, your journey ahead can be hard. So put forth a lot of effort, stay on your path and good things will happen. And then like I said, I shared with you that when that card opens up, you can actually hear hear him saying the prayer and then you can see the words. See next slide. One of the things that we started to do is, so I created this tool to help people understand about medication for addiction treatment and why it's so important. And it's a tool that doctors can use that the tool that, you know, non natives can use. It's a tool to use with native patients. And it really just talks about, this is just the front part of it, but it really talks about the importance of what medication for addiction treatment is doing, right? It is, it is stigmatized and people, you know, I've had, I've had parents mad because their child started MAT because they didn't understand, you know, they thought drug for a drug and all this other stuff. And so when we're able to talk to them and educate them in a different way to say, Hey, we're putting, we put the medication into the medicine wheel and man, what is Suboxone really doing for you? Like emotionally, mentally, physically, and spiritually, right? And so it helps the doctors explain it, it helps increase medication adherence. And so people, you know, our indigenous people are buying into it more for good reasons, right? Because it does stabilize the mind, it does help people get reconnected, it reduces your chance of death, and you are able to participate in ceremonies when you're on MAT. It helps reduce your withdrawals. So and then it helps reduce craving. So it helps you in all these different areas. And I think people don't probably, well, I know people don't normally explain it this way to patients or to people about MAT. So you know, when we work with doctors, you know, I get to share this tool with them. And when they're working with native patients, they can actually use this. And so it means means a lot more. And then it's like, Oh, man, this medication really is helping me. And so I think it's one way that we're able to help reduce overdose, just because people are able to connect with that medication more, and reduce the stigma of using it too. Next slide, please. So I think about, you know, who who needs help. And then so people who use drugs, you know, they need support and all the resources to they are dealing with barriers, they're stigmatized, they're not connected in their in engaging in risky behaviors, and they need overdose prevention, outreach, right. And then we have people who want to seek help, and who will walk into a place or a facility who will say who will go sir, fill out intake packets, and all this stuff to get the help. And then we have people who need to stay in recovery, and maintain that. But what I often see is, I don't see enough attention on the people who are using drugs. And those are the people who are the most vulnerable. Those are the people who, like I said, are not walking in. We work with so many people who are encampments that other people can't go into. They're not trusting healthcare providers. They're not trusting regular social service departments, they're not trusting a whole lot of people. And so when we're able to go in there, bring them some food, bring them socks, hygiene packs, bring them clean, using supplies and building those relationships with them. We have that trust with them. And so we're able to get them resources and support. And when we find out they need something, we help them get that too. And that the whole time, you know, our message is, hey, we can get you to rehab if you want to go to rehab. Hey, we can get you to the emergency department if you wanted to start Suboxone now. Like we can do all kinds of things, or we make you a medical appointment. And so it's us actually going to them. And that's the beautiful part about the doing the syringe exchange program, is because we're working with people that don't normally walk in for services or help. And so they're really isolated from all of that. And so, and they're neglected. And people, you know, that old mentality of like, well, if they want help, they'll get it. They'll get here themselves. Well, they don't often have cars. And I tell you, the internalized stigma of carrying around so much shame and carrying around so much guilt and the compounded trauma that often goes along with people using drugs really keeps them from feeling, why am I even worth it? You know, I'm a worthless person. I don't have no self-esteem. You know, I have no power over my life. And so we start to actually go in there and change that for them and help them, you know, feel like they have power, then we're able to help connect with them and get them to the support that they actually do need. Next slide, please. And this is probably one of my most favorite things, but we created the wellness journey. And it's an indigenous contingency management program, and it's all done in the four directions. And it's only for people, the wellness journey part is only for people who use drugs. And so we go out there, we meet with them weekly, and they get weekly case management, they go through, they have a whole goal packet. And so some of that is it's really strength based, it helps them identify what their own strengths are. You know, they take a survey, and then they start setting their own goals. And like I said, none of them are, we don't tell them what to set, right? They set their own goals. And so some of it sometimes is like, yeah, I would like to be seen, I would like to know like how my liver is doing. Spiritually, you know, we get to talk to them about like, when's the last time you smudged? And they say, yeah, oh, I haven't even really smudged anymore. And then we let them know, like, we have sage here for you. And so then they're able to have that, right? And then we let them know, like, yeah, you keep praying, right? Don't lose your cultural connection. Because so many times, you know, if culture is prevention, and there's people not getting a way to engage in their culture, and a lot of that has to do with respect, and I mean, it gets even more, you know, impacted, because some people can't go to ceremonies and different things like that. But I'm talking about on a on another level of, you know, letting them, letting them smudge, giving them sage, letting reminding them that, hey, you're, you're native to like, you get to pray and do all that as well, getting them connected with their language and their culture, you know, start building them back up. And that's really the goal of the program is just to start empowering them, getting them in a better place, and they start caring more about who they are. And as they're, you know, they just feel more, more cared about. Next slide, please. So, and then you can go to the next slide. Here is just another example of that, the tool for indigenous medication. Because I think that, you know, if we're not sharing these evidence-based practices and we're not giving people access to MAT or we are running into barriers, you know, how can we eliminate that? This is such a huge piece in helping people get through the opioid crisis and stay alive. And so I think, you know, that harm reduction is huge in that whole sense. Next slide. And then just interventions and strategies. There's so much stigma out there. It's just crazy, right? Like we deal with lateral oppression and historical trauma and all of that, but man, people in recovery, sometimes the community doesn't want them to get well. They'll get sober and then people will still talk bad about them like, oh, that's just so-and-so. They're just gonna get high in a week anyways. And they really oppress them. And so, you know, there's all of that stigma that goes along with it. And so part of that, how do we help change that in our community so people aren't so stigmatized of everything, right? I get, you know, like it can be super, these are hard conversations. We have an elders healing and wellness coalition and, you know, the elders, they speak their mind, they get fired up about things and they're really set in their ways, right? And you have to be super respectful with them. At one of our meetings, you know, they were like, just get drugs off our reservation. Just do this, like get this done. And, you know, they're like, not for syringe exchange programs at first. And then, you know, getting to talk to them, I say, you know, I really wanna get the reasons why people are using drugs off the reservation. I said, cause if we, I said, it's not so simple. Like you can't just say get drugs off our reservation. You need to actually get the reasons why people are using drugs off the reservation, right? Supply and demand. And, you know, we get to have those tough conversations with the elders and then let them know like how important it is to have the Narcan. But, you know, it starts with having those conversations and letting them know like, one is that they don't even know what the drugs are like today, right? So they asked for education on what drugs and vaping and all of this looks like. And so, you know, we bring those services to our elders to help educate them, to show them like, here's what our youth and your children and your grandchildren are dealing with, right? And so we have to make space for them. And this is why I love harm reduction is because I get to meet the elders where they're at, right? Like I get to use harm reduction on our elders now. And so, you know, you can put a harm reduction into everything that you do. So, next slide. So harm reduction in the community, what it looks like is helping people get access to housing and really get those social determinants met. It's working on finding those points of entry where people need help. It's getting people connected to their culture and helping people who are in the justice system. It's helping people with prevention. I mean, it's just, it's in everything that we do. So I, you know, that's why I really, I love harm reduction. I love how it it heals communities, and I love how you can put your own culture into it. Next slide. So what does giving syringes to people actually look like or do? Next slide. So for us last year, it meant that 22 people got to stay alive because of our syringe exchange program. It also meant that we were able to test, you know, 33 people for HIV. We also have like since and since November, we had 42 people engage in substance use services. We had 14 people go to inpatient programs from the syringe exchange program, and we had 22 people that are now participating in weekly groups. Now, these are all people that would not be involved in any other services. However, because they were part of our syringe program and part of the trust that we had built with them, these people all are on the recovery side now. So when I say like giving syringes to participants is like the smallest part of what we actually do in a syringe exchange program for us because we just created more services and a whole program of care around that because people need it. Like our community needs it. We cannot we can't ignore the people who are using drugs. That doesn't that approach doesn't work. And so that's why I really love what we get to do here. Next slide, please. And then Native, our National Harm Reduction Coalition created a Native harm reduction toolkit. And so how to talk with elders, how to harm reduction principles are on there. And it's a really neat it's a really awesome thing that a national organization, you know. Took a minute and said, who who doesn't have a voice at the table? And they realized, you know, a few years back that they didn't have very good representation for Native Americans. And this is National Harm Reduction Coalition. And so they did a survey and they found out that they did a survey in California and they found out several themes of what people said were missing from tribal. They did urban, rural communities and found out that, you know, people said there is too much stigma around Narcan, that the tribal elders and leaders needed education. They needed more Narcan out there. And so this toolkit was really based on that and it's on their website. And I seen that someone put the link in there and then there's more links in there as well. So that's a really great resource. And then anyone who's wanting certificates, you know, and they live in California, I know it's free, but they do overdose prevention and like three other certificates from an HRC. And so that's a really good way to get people kind of the fundamentals of what harm reduction is and kind of build their knowledge on that if they're not too familiar. Next slide, please. And then also we do weekly free TA for people who are wanting support with de-stigmatizing, starting programs, doing outreach events or working with their elders. And that's every Wednesday at 1 Pacific Standard Time. And then that ends in March, but that's every Wednesday at 1 and that correlates with the toolkit as well. And then next slide. And then harm reduction can be part of all the work we do and is a service on its own in the community, just like a syringe exchange program. And then next slide. And this is like my favorite thing, though, that I think about harm reduction, is that it really is the bridge that connects all of us and stigma is the wall that separates us. So I always have to anything that I'm ever doing projects or whatever, it always has to be centered in harm reduction and in how we're doing it and how we're making it work for our tribal communities. So thank you guys very much. And I know we're going to do some questions at the end. So appreciate it. Thank you so much, Arlene. You're doing such amazing, impactful and powerful work. Thank you so much for sharing with us. Like Arlene mentioned, we will have a Q&A in just a moment here. But before we do that, I'm going to introduce Philomena Quebec, who's going to share a little bit more about her work with harm reduction as well. So Philomena Quebec belongs to the Bad River Band of Lake Superior Chippewa. She's an attorney and judge licensed to practice law and tribal and state courts. Philomena currently serves as the economic development coordinator for the band, where she's focused on community empowerment through harm reduction and overdose prevention, tribal health care optimization, access to capital and improving access to local and traditional foods. Prior to joining the band's planning department, Philomena and co-founder Aurora Conley spent years building a startup syringe services and harm reduction program to reduce drug related morbidity and mortality on the Bad River Reservation. And with that, I will go ahead and turn it over to you, Philomena. Thank you. Hey, bonjour. It's really good to see everyone here today. Arlene, I just feel like you covered it all. It's it was great to hear your presentation and all the amazing things that Skodan is doing. I have a few minutes. I'm going to cover some other topics. Could you forward to the next slide, please? OK, and then the one after that. So just like Arlene talked about, our program started because our leadership and the traditional public health entities weren't addressing the drug overdose deaths. It was like, we're just going to let this happen. You know, there's nothing we can do kind of throwing up our hands in despair. And Aurora and I and Aurora was in the picture with me, my little, you know, the snapshot that they had me send over. So Aurora and I, we were working in the legal department at the time. We were both working with a lot of parents who had child welfare cases. And we decided that we wanted to figure out some way to do something other than nothing. And so we started learning about harm reduction. We started learning about naloxone. And we thought that this might be a really good intervention to start addressing some of the problems that we were seeing in our community. So, you know, harm reduction is an amazing community. There's there's all kinds of people who have been doing this for years. It's not just a public health thing. It's a social movement. And there's there's a lot of organizations that are out there that are really great to work with, interested in helping tribes and, you know, just helping everyone. So we we started our program in 20. We started researching and and doing the pre work and all the community work that you need to do before you start a syringe program. We started that in 2014. About, you know, eight months into 2015 is when we had our first our first syringe exchange event in the community. And it and it didn't go really well. So it was a failure. You know, we've had lots of failures. Don't be afraid to fail. And after that, we were able to learn some more and revise our communication strategy. What we've done from the beginning is that we serve everyone in the community and more more participants than not have been native. A majority of our participants have been women. And that's kind of interesting. But our demographics have shifted for a long time. This is just an all volunteer effort. But slowly but surely, we've been able to raise funding to support harm reduction. We now have paid staff and the paid staff started working in 2022. Now we have three paid staff members and about six contractors that go out in the field. We're serving four counties with delivery based services. And and we also have a mail order program that's serving the whole state of Wisconsin. Next slide, please. So these are some of the things that we do really similar to what Arlene was talking about. Because we work in rural areas, people are so very concerned with anonymity and protecting their identity. So we make sure that the way that we're interacting with people feels comfortable to them, because we're not going to have an effective program if we make them give us all their information and come out in this public place in order to do have, you know, in order for them to get their supplies. So we take a lot of measures to protect their identity. We people interact with us on a free text app. It's kind of like a little party line where all of our contractors and staff can respond to somebody's request. But they just end up oftentimes they end up meeting with the same person over and over and maybe they have their cell phone and they just text that person. Trauma informed design is is really critical. So thinking through how that person is going to feel when they're accessing services is really is really important. And sometimes what what you need to do in order to get to that trauma informed design is work with your participants to figure out how they what would make them feel comfortable and what are the things that make them feel uncomfortable. So a real best practice in that field is to engage in some community based participatory research. So we've done some of that that involves compensating people and for their time and their participation and again conducting a survey in a way that makes them feel safe. Next slide please. So this is our mail order program. We work with an organization called Next Distro. And we have focused our outreach efforts to Native Americans and others in rural counties in Wisconsin. But again, we serve everyone in the state. So there's a QR code and a link that you can go to. You can check it out even if you're not from Wisconsin. But if you're from Wisconsin, place an order, order something from us. Next slide please. So how the mail order process works is that you can either go to nextdistro.org slash Wisconsin, or there's also a toll free number I should have put that in there, shoot. If anybody wants a toll free number let me know and I'll dig it up. And then you just complete a little video training on how to administer Naloxone and then a questionnaire. If you're going to order by mail, people are going to have to provide some information, your address and your name. But if somebody is unhoused, they can also get a package delivered to a general, just to a post office. And then they can go pick it up from the post office. And so, once Next Distro gets the data, they send it over to Bad River in a spreadsheet, we fulfill orders, we're like Amazon for Next Distro. And then the orders are filled in nondescript packaging within 72 hours. So all the data that we have is maintained confidentially. We absolutely do not share our data with anyone. Next slide please. And really we want to, one of the things that we've done, because we want to be good neighbors. And certainly our program participants also want to be good neighbors, is focusing on environmental safety. So, everybody who gets a kit also gets a sharks container and we're always request that people return, provide returns if they have a reorder. There's a discussion on that, if people can't, sometimes people have a real difficulty in doing that. And we're not a one to one exchange, because that's a really bad idea. So, you know, we talk about safety a lot with the people that we work with. Next slide please. You know, overdose, or naloxone saturation, really great idea. You know, we do have the Emergent Biotech product, the Narcan product, but we distribute a lot more injectable naloxone. And our supplier for injectable naloxone is Remedy Alliance. Remedy Alliance offers probably the best pricing on both nasal and injectable naloxone. And just as a caveat, I am a board member of Remedy Alliance. So, I'm not pushing the product or anything, but certainly if you are doing procurement, you want to look at their pricing. Next slide please. And, you know, there's been a lot of real transformation and changes from having a syringe program in our community. So, we've had thousands of overdose reversals. We're preventing HIV and hepatitis C. We're keeping syringes and syringe waste off the street. And we're celebrating and supporting the pro-social actions of people who use drugs. Next slide please. And that's it. Thank you so much. Miigwetch. God bless you all. There's our website, my email address. Feel free to drop me a line. I'll put my phone number in the chat too if you want to text. Really glad to see you all here today and thank you for your time. Awesome. Thank you so much Philomena for being here and for sharing with us. Both of these presentations are just really good reminders of how important harm reduction is. I think in all aspects of our work. So, thank you both so much. Before we get into our question and answer section of the presentation, I want to take just a minute here to talk a little bit about the services that the ORN can offer to help assist with harm reduction related TA requests. So, we can provide consultation for harm reduction program implementation. We can also provide community and workforce trainings about harm reduction and stigma. Trainings on the benefit of a harm reduction approach and the recovery process. Trainings about reducing barriers to medications for addiction treatment. There are a lot of different trainings related to harm reduction that the ORN can offer. These are good examples of retraining requests that we get asked for more frequently from our grantees and communities. We can also provide consultation for media campaigns and awareness. Consultation for determining community readiness for harm reduction services. And consultation and review for harm reduction policies and procedures. If you have an idea for a TA request and you don't see it represented here on this list, we do encourage you to submit a request online anyways. Part of our jobs as TTSs are to meet with you and talk through your requests and see how we can best support your efforts. Next slide, please. You can submit a TA request online at opioidresponsenetwork.org and your local TTS will respond to your request within one business day. You can also email us at ORN at AAAP.org. Next slide, please. And finally, we are at the Q&A section. So we'd love to open it up now for questions and answers. If there were any questions added to the chat during the presentations, we can take those now. If you have questions that you'd like to add, please do that. Chelsea, I had one question that came through direct for me. So I'm actually going to push this back out to the presenters and maybe just kind of see what steps maybe Arlene, you might have taken. So we had someone reach out to just ask what type of education or training does one need to become a tribal substance use navigator? That is a great question. And I would come. And so, I mean, it's a unique position, but it could be implemented in any type of capacity, right? Community based organization or like tribal health clinics. But I think the most foundational piece is the education in harm reduction. And so really understanding the fundamentals of harm reduction and then also getting the navigation training. California Bridge did an amazing job on substance use navigation. And so like motivational interviewing is a piece of that. Understanding the different types of substances, working in treatments for medication for addiction treatment, right? And then knowing services and how to navigate navigate all of those. And so that's a good foundation for it. I think, you know, for me, when I created it, it was playing all those pieces, giving people the. When I did, I did a training for 15 community members to become like tribal community navigators. And it was when I gave them the foundation of harm reduction. I gave them an overview of addiction and what that actually looks like. And I had when I had a really awesome doctor who's. Who is an addiction doctor, sorry, and so she facilitated a great training on what that looks like on the medication piece. And then we did a thing on wraparound services and how you actually engage and work with other agencies and provide actual wrap services. And so we just did a small training like that for the community. And it was really neat because they we did our last one in person and we did like some virtual ones. And we had we had people who were currently using drugs and we had people. We had the sheriffs on there. We trained two sheriff officers and we trained nurses. And so we had a really neat mix, a mixture of people. And then for like the tribal piece, though, like when when I hired a tribal substance use navigator or created that position, it was that they they really knew and understood our tribal community as well. And so there are some real specific things besides the navigator piece that they would have to understand. You for that information. There's one more question that came through, but I want to just see if there's anyone else who's on the line that maybe has any questions. You can either raise your hand or just drop it in the chat and we'd be happy to read that off. We do have LaVonna, I know she mentioned she'd just like to have more information on harm reduction programs, just so that they can set up more informational education outreaches there in the Northern Cheyenne Reservation and Lame Deer, Montana. We did drop in that link to the Native Harm Reduction Toolkit. It is a little bit probably further up in the chat. And, you know, maybe that's a good resource to have and to review. And also, like Carrie mentioned here, the Opioid Response Network, we can provide various different types of trainings on many of the topics that were discussed. So even if you're unsure, you know, we definitely encourage you to, you know, take advantage of that, that no cost option, you know, click that link and maybe even just keep it there in one of your tabs and then, you know, submitting that request and we can really help you determine what your needs might be. Well, the other question I had, and maybe this is for both Philomena and Arlene, was just, you know, someone had mentioned something about recovery burnout. And the question specifically was those who have been in recovery for, you know, a long time and then experiencing recovery burnout and just how have you maybe mitigated through some of those challenges that might come up because sometimes those are maybe your champions, right, that might be involved in your program, maybe as a peer support or, you know, they're just there in community. And so let me just turn it over to maybe you, maybe see what you have to say, if you've ever experienced any of your relatives who might be kind of dealing with that right now. I have, I've experienced that myself, and it's deadly, like burnout is really dangerous. I think, you know, I said that our program was unfunded for many years, and it was a volunteer effort. And it was, that was unsustainable. So we need to have harm reduction services that are sustainably funded, and we need federal agencies to provide the support as part of their federal trust responsibilities to make sure that there is appropriate levels of community care, including harm reduction services available within all tribal communities that want one. What we've done since 2022 is we have a staffing model that provides for redundancy, so that means that everyone is cross trained on everyone else's, you know, position description. So this means that staff, when they have to take a break, or go on funeral leave, or go on vacation with their family, that they're able to do that without having to worry about people not being taken care of, not getting the naloxone they need, and potentially being at risk. So we, you know, that staff redundancy is really key. The other piece that we've, you know, the other pieces that we've implemented are, it's pretty much mandatory that everybody goes to therapy. So everyone has their own therapeutic relationships outside of work. We also have a lot of, you know, we do things within our own harm reduction program that are supportive to each other, and we're always trying to be kind to each other, maintain really good avenues of communication, avoid toxic workplace, because that's another driver for stress. As a supervisor, I protect my staff, I make sure that, you know, I'm kind of running interference if there is somebody like politically out to get them or whatever. You all know, if you're working with tribal governments, what I'm talking about. And, you know, and then, I don't know, I mean, we try to infuse our culture in our staffing model as well. And so we begin our meetings, we smudge, you know, we talk about what's going on. And when we do lose someone, when we have an event that happens, I'm running to tribal council, and I'm talking to my supervisor about making sure that my staff get enough break time so that they're able to properly grieve. Because that's a reality of what we're dealing with in this work. It's really, it can be really hard work. It's also really satisfying work. You know, we're keeping people alive. We're doing amazing things. We're seeing people recover all the time. We're celebrating wins, all of that, right? So those are some of the things that we do around here to address and reduce the burnout risk. Thank you, Philomena. Thank you, Krista, for that question. We are just about at time now, so I think we will move ahead. We have a couple of closing slides here. But thank you, Philomena and Arlene, for chiming in and sharing your insights. And I think you both shared your email addresses, so we'll make sure that people have access to ask you any questions afterwards if something comes up. But thank you again. All right, so closing out today, our next webinar will be in March, March 28th, from 2 to 3 p.m. Eastern. You can register with this QR code here. We will also be sending out registration emails, as we have for past sessions. So do keep an eye out for those. Next slide, please. Future webinar topics. So in March, we'll be talking about what is naloxone saturation mapping for tribal communities. In April, what to do, pregnant people, and substance use. And May 30th, we'll be talking about nurturing brilliance of Native youth, community, and cultural connection as prevention. Next slide, please. All right, please do take just a minute, if you can, to complete this survey here before you leave the session. These surveys really help us make sure that these sessions that we're providing are helpful to you and the work that you're doing in your communities. And with that, we are at the end of the session today. So I would like to thank you all for taking time out of your day to be here with us. Thank you again to Monica, Arlene, and Philomena for sharing with us today. We very much appreciate all of you. And I hope you all have a great rest of your day. We look forward to seeing you for our next session in March. Thank you all. Take care.

harm reduction

culturally responsive approach

community wellness

ancestral practices

Native communities

naloxone distribution

safe smoking practices

MAT programs

tribal communities

overdose interventions

rehabilitation support

sustainable funding

staff training