VIRTUAL MEETING & LISTENING SESSION – March 23, 2023 

Updating the Tribal Behavioral Health Agenda 

Convening of Tribal Nation and Community Representatives 

Meeting Notes 

WELCOME & OVERVIEW 

Joe Garcia of the Ohkay Owingeh Tribe opened the listening session with a prayer. Then Anne 

Herron, Director of SAMHSA’s Office of Intergovernmental and Public Affairs, welcomed 

participants. 

Ms. Herron acknowledged the work that had been done related to the Tribal Behavioral Health 

Agenda (TBHA) but noted that a lot has happened in the past three years and communities are 

struggling. However, she noted that the TBHA has a strength-based approach that can be further 

leveraged. 

In terms of updates, she noted two paths: updating the actual document and identifying ways to 

elevate it so that more people are aware of it’s wisdom. 

Ms. Herron noted the importance of also acknowledging the lives lost, particularly in Indian 

County which has been disproportionally impacted by health crises including COVID, suicide 

and substance use disorders. 

Don Lyons, who moderated the session, noted that there is a lot of diversity across the Tribal 

Nations as well as with urban-living Native Americans. As a result, being able to develop a 

common document is a meaningful achievement. 

A list of participants is provided in Appendix A. 

SESSION 1: TBHA AS A GUIDING BLUEPRINT FOR COLLABORATION 

Seprieono Locario, with SAMHSA’s Tribal Technical Assistance Center (TTA Center), gave an 

overview of the resources and services of the Center. Specifically, this includes support with 

curriculum development, Tribal action plans, community readiness assessments, and cultural 

competency support. Mr. Locario encouraged participants to review the resources on the TTA 

Center website as well as directly contacting the TTA Center if there are any specific technical 

assistance needs. He added that the TTA Center works collaboratively with other technical 

assistance centers so they have the capability to address very tailored requests which may go 

beyond their original expertise. 

Sara Pearson then provided an overview of the original TBHA. She noted that the TBHA is over 

90-pages long which can be a barrier for users to read and learn from. As a result, the TTA 

Center has translated the document into a Prezi presentation which provides a visual self-directed 

approach for users to review the contents. 

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In terms of key points, Ms. Pearson noted the following: 

• Three Themes – The three themes woven throughout the TBHA are “we honor,” “we 

will,” and we know.” 

• Not a Strategic Plan – Rather, the TBHA is a guiding blueprint to assist in strengthening 

policies and programs; aligning disparate resources; and supporting facilitation 

coordination. 

• Storytelling – The TBHA tells the story of resiliency and survival. 

• Authors/Ownership – The authors are the tribal community with others (e.g. Federal 

partners) contributing in a supportive role. 

• Indigenous Healing Practices – Tribes have a long history of engaging in health 

promotion and healing through practices such as community ceremonies, plants, and 

prayer. This needs to be integrated more with Western practices and accepted as an 

adaptive treatment. 

• Workforce and Infrastructure – There is not only a workforce shortage but also 

providers may lack cultural competency. In addition, infrastructure issues range from 

lack of funding and internet access to an inability to have resources to apply for and/or 

manage grant administrative requirements. 

Following are questions/comments from tribal participants: 

• SAMHSA Funding Related to the TBHA – SAMHSA has three Tribal-specific grant 

programs: the Tribal Opioid Response; Circles of Care; and Native Connections. The 

cultural declaration from the TBHA is embedded in the grant and these grants allow for 

reimbursement of cultural-specific activities. 

• Expanding Awareness of the TBHA – SAMHSA hopes to leverage the TTA Center to 

do more outreach and also to establish learning communities. This outreach will support 

updates to the TBHA, but will also serve as outlets for expanding awareness of the 

resource. 

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• Government to Government Relationships – There is a need to build trust and honor 

historical treaty obligations. In addition, it is important that US Agencies coordinate their 

funding streams and activities to minimize the administrative burden on tribes. 

• Tribal Liaisons – These positions exist in most Federal agencies and they are a great 

resource that should be leveraged better. 

• Relationships – Relationships are important in Tribal communities and, as a result, the 

isolation associated with the pandemic hit Indian country particularly hard. It is also why 

Tribal Liaisons are so important. They have credibility. Many Tribal citizens value “word 

of mouth” in adopting new ideas and judging programs. 

• Urban Natives – The needs of these communities should be incorporated more 

extensively into the TBHA conversations. 

• Awareness is Different than Adoption – There does seem to be some awareness about 

the TBHA but additional work is needed towards translating awareness into adoption 

(and understanding if there are any barriers in this translation). 

• State Relationships – Tribal Nations should be seen as peers rather than subordinate to 

States. It would be good to have some best practices related to State-Tribe cooperative 

grants. 

• Training of Federal Staff – Federal staff would benefit from cultural humility and 

awareness trainings. 

• Components of Good Technical Assistance (TA) – TA is more than data, it should be 

inspirational and tailored to meet the needs of the requester. Sometimes having that 

“outside lens” helps to boost a project and identify challenges. The community, not the 

TA provider, should guide the conversations. TA should also be proactive rather than 

reactive. It was recommended that when requesting TA, there should be planning calls 

and clear expectations set before a site visit to the community. It is also important to 

understand the local environment as there is a lot of diversity across Tribes. 

SESSION 2: LISTENING SESSION 

Mr. Lyons then asked a series of questions for open discussion: 

What lessons have you learned through COVID-19 that could be applied to an updated TBHA? 

• Mental health is an integral part of emergency management. 

• Life expectancy for AI/AN populations dropped precipitously from 71.8 years prepandemic to only 65.2 years by the end of 2021 (21 months into the COVID-19 

pandemic). 

• One participant noted that she used the TBHA document extensively when writing grants 

and working with Tribal communities. In particular, the TBHA helped to sync the grant 

document with existing Tribal community strategic plans. 

• The document could also be produced in smaller booklets for each theme. This will 

improve awareness (easier to read). 

• The COVID-19 experience should be included in the TBHA. 

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• The TBHA should include guidance around telehealth. It is much more prevalent now 

and has mixed acceptance among various communities. 

• The updated TBHA should include a social marketing plan that spans across generations 

(e.g., virtual and "old school" approaches). 

• Community health workers (CHWs) were on the frontline during COVID-19 to help 

communities with isolation. Many in tribal communities live in multigenerational 

households. It would be good to interview CHWs to garner lessons learned from them. 

• Have the TBHA more interactive with keyword search capabilities. 

• Leverage the wisdom of the Tribal Behavioral Health Work Group which were the onthe-ground providers for IHS regions. 

• Substance use disorder is constantly changing (e.g., the growing threat of xylazine). 

• Acknowledge the importance of “collective engagement” and community for the healing 

and empowerment of human family. We aren’t meant to live in isolation. 

• Incorporate the successes/challenges of the 988 rollout in Tribes. 

• During the pandemic, community members who were in recovery sustained challenges to 

their normal spaces of recovery and support. 

• Poverty and other social determinants of health worsened under the pandemic and have 

direct impact on behavioral health. 

Have you identified other topics or areas of the TBHA that need updated? 

• High quality culturally-informed technical assistance on the grant writing process. 

• The need for US Federal agencies to be more culturally responsive. 

• The need for better access to telehealth (e.g., technology and internet infrastructure). 

• Is there something other than the community readiness model for needs assessment? 

AASTEC developed their own needs assessment that was more culturally-relevant. 

• Emphasize that indigenous communities are the experts on what they need and what 

works for them. 

• COVID-19 didn’t just “crush” physical health but also spiritual health (e.g., isolation). 

• Expand section on Indigenous healing practices. 

• Tribal communities have historical trauma and fear of pandemics. 

• The impact of isolation in our community as we are a very connected/relationship-based 

society. 

• The need to align GPRA reporting across agencies is quite burdensome. 

• A greater focus on infancy and early childhood needs (e.g., prevention/early intervention) 

as many live in multigenerational households. This could encompass the issue of 

caregivers with substance use disorders and also the issue of child welfare agencies (and 

historical impact in Indian Country of children removed from their families). 

• Review how SAMHSA’s National Registry of Evidence-Based Programs and Practices 

or (NREPP) could incorporate more culturally-centered interventions. 

• The TBHA should have more emphasis on the importance of tribal self-governance and 

self-determination. 

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• Update the data from the CDC’s Youth Risk Behavior Survey data which is referenced in 

the TBHA. 

• Reference the intersectionality of homelessness and housing instability with behavioral 

health issues. 

• Incorporate a discussion on generational resilience. 

• Funding issues ranging from the need to braid funds across Federal agencies and the issue 

of sustainability. Tribes should have self governance and Federal agencies need to lower 

administrative burdens and provide more integration/flexibility. This doesn’t happen in 

practice. And as a result, vulnerable populations may have a disruption in service. 

• Expand on Tribal culture values prevention and also holistic approaches (e.g., addressing 

the individual’s needs spiritually, emotionally, physically, and mentally). 

• Include resources for the LGBTQI+ communities. 

• Expand upon trauma-informed care practices. 

• Discuss how tribes can leverage the 988 local call centers. 

• Incorporate discussions on culturally-based parenting practices. 

• In terms of resource funding, it would be better to have Federal Agencies partner with 

IHS through funding agreements to reduce the burden on Tribes. 

• The TBHA needs to discuss workforce models and allow tribes to adopt their own 

models with their workforce that is reimbursable. The supervision requirement is a 

barrier and takes staff away from direct services. 

• Funding should align with the actual work. 

• Update social determinants of health discussion. Need was exacerbated by the pandemic. 

• Reference the “vicious” intergenerational cycle and systemic racist issues. 

• Provide resources for tribal schools since youth as young as preschool age are impacted. 

• Rather than SAMHSA directing practices, it is better for SAMHSA to work with tribal 

communities to learn, understand and support reimbursement for tribal-based practices 

that are proven to work. 

• There is a disconnect between services provided/needed and what is funded. 

• Discussions around the TBHA need to be based on deeper discussions with community 

members. There are promising practices and delivery methods that have been learned in 

Western Washington, for example, following discussions with community members who 

were able to maintain their recovery through the pandemic. 

• The TBHA should empower and support communities across the nation through 

opportunities of community storytelling. 

• Subject matter experts from within Indian Country should be incorporated into the 

discussion and also compensated for their input in updating the agenda. 

• Provide a high-level version that is youth-focused, Many youth are re-learning their 

culture and language. 

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How can information and resources within the TBHA best be shared and utilized? 

• There needs to be a strong intentional dissemination of the agenda to get the resource to 

Tribal programs. 

• SAMHSA has regional offices. When the TBHA is updated, SAMHSA might host 

regional meetings for Tribal and urban programs as modes of engagement and outreach. 

• Leverage the Indian County Echo, both as a resource as well as a dissemination 

mechanism. 

• Use social marketing techniques. 

CLOSING 

Mr. Lyons gave a recap of salient points. It was noted that the TBHA will be discussed during 

the August National Tribal Opioid Summit as well as other national gatherings. 

Kim Beniquez then thanked participants and noted that SAMHSA will be reaching out to 

participants inviting them to be part of the learning communities related to the TBHA. SAMHSA 

will also provide the interactive Prezi presentation on the TBHA to participants. 

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APPENDIX A - PARTICIPANTS 

Contractors 

Nickole Fox, M.A., CPC-R 

Tribal Tech LLC 

Don Lyons, M.S.W. 

Tribal Tech LLC 

Sara Pearson, M.Ed. 

Tribal Tech LLC 

Seprieono Locario, M.S. 

Tribal Tech LLC 

SAMHSA 

Kimberly Beniquez, M.S. 

Office of Tribal Affairs and Policy 

Irene Darko, M.P.H. 

Public Health Advisor 

CAPT Karen Hearod, M.S.W., LCSW 

Director, Office of Tribal Affairs and Policy 

Anne Herron 

Director, Office of Intergovernmental and 

Public Affairs 

Sharon Hester 

Office of Tribal Affairs and Policy 

Intern 

Jenna Meyer, M.P.H., RN, BSN-C, CPH 

Office of Tribal Affairs and Policy 

Jared Stokes, Ed.D., M.A. M.P.H., CHES 

Office of Tribal Affairs and Policy 

Angela Wright, J.D. 

Senior Project Associate 

Service Members, Veterans, and their 

Families (SMVF) Technical Assistance 

Center 

Department of Justice 

Julius Dupree 

Policy Advisor 

Jennifer Marsh 

Grants Management Specialist 

Food and Drug Administration 

Veronica Uzoebo, Ed.D. 

Science Policy Advisor 

Health and Human Services 

Anna Leonard, M.P.H. 

Budget Analyst 

Assistant Secretary for Financial Resources 

Mona Lewandoski, J.D. 

Program Analyst 

Melinda Golub 

Senior Counsel 

Office of the Inspector General 

Health Resources and Services 

Administration 

LCDR Venus Uttchin 

Public Health Analyst 

Indian Health Service 

JB Kinlacheeny, M.P.H. 

Public Health Advisor 

Teddi Penland 

Management Analyst 

Alcohol and Substance Prevention Branch 

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National Institute on Drug Abuse 

Barbara Oudekerk, Ph.D. 

Social and Behavioral Sciences 

Administrator 

Office of National Drug Control Policy 

Sarah Sdringola 

Intern 

Veterans Administration 

Amy Deloyski, M.D. 

VHA- VISN 23 Suicide Prevention Program 

Manager 

Jamison Hild 

Homeless Program Manager 

Veterans Administration 

Marianne Schumacher, Ph.D. 

Chief Mental Health Officer 

VHA - VISN 23 

Tribal, State and Community 

Representatives 

Michael Ashley 

Patient Services Coordinator 

F.A.I.T.H. Behavioral 

Lyz Best, M.A., M.P.H. 

Technical Assistance Manager 

National Council of Urban Indian Health 

Cheryl Bighorn-Savior, R.N. 

Fort Peck Tribal Health 

Jennifer Boardman 

Regional Transit Coordinator 

Oregon Department of Transportation 

Sherea Burnett, J.D. 

Continuum of Care Engagement Specialist 

North Carolina 

Estefanita Calabaza 

Native Connections Coordinator 

Kewa Family Wellness Center 

Jose Castillo 

Veterans Advocate 

Arizona Complete Health 

Nicole Coleman, MA 

988 Project Manager 

Idaho Division of Behavioral Health 

Janet Cornell 

Federal Block Grant Administrator 

Washington State Health Care Authority 

Sondra Cosgrove, Ph.D. 

Executive Director 

Vote Nevada 

Gail Crane 

Carmelita Cruz, J.D. 

Equity Officer 

Office of Addiction Services and Support 

New York State 

Kay Culbertson, M.P.A. 

Health Services Director 

Squaxin Island Tribe 

Mercia Cummings, LCPC 

Clinical Director 

Native American LifeLines 

Robin Davis, Ph.D. 

Vice President, Research Science 

ICF 

Josh DeBartolo, M.A. 

Tribal and Multicultural Liaison 

Oklahoma Department of Mental Health and 

Substance Abuse Services 

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Michelle Eggers, M.S.N. 

Data & Program Analyst 

St. Joseph’s Indian School 

Marie Erb 

Grants and Communications 

Margaret Clark Foundation 

Teagan Escarcega 

Fort Peck Tribes 

Bessie Evans, LPN 

Life Health Center 

Alan Faulkner 

Program Manager 

Dot Lake Village 

Alisha Fletcher, M.A. 

Project Assistant 

Policy Research Associates 

Walter Flores 

Care Coordinator 

Nueces Center for Mental Health and 

Intellectual Disabilities 

Cary Fremin 

Director of Health and Social Services 

Dot Lake Village 

Karen Friend, Ph.D. 

Senior Evaluator 

Pacific Institute for Research and Evaluation 

Maya Fountain 

Joe Garcia 

Ohkay Owingeh Nation 

SAMHSA TTAC Representative 

Helen Gomez 

Jacqueline Gray, Ph.D. 

Co-Director 

NAI/ANPTTC 

Angela Greene, M.S. 

Senior Study Director 

Westat 

Carla Hawkins 

Compliance Manager 

The Chickasaw Nation 

Ashley Hesse 

Vice President of Policy 

Indigenous Pact PBC, Inc. 

Sandra Hiebert, M.S. 

Education Coordinator 

Poarch Band of Creek Indians 

Margot Holmes, M.A. 

Blue Heron Nonprofit Consulting 

Katie Houle, M.S.W. 

Clinical Administrator 

North Dakota Department of Human 

Services 

Rueben Howard 

Health Director 

Pascua Yaqui Tribe of Arizona 

Rochelle Hubbell-Spencer 

Deputy Director 

Navajo County Public Health Services 

District 

Samantha Huddleston 

Program Manager 

Choctaw Nation of Oklahoma 

Ashley Hupchick 

Director of Therapeutic Services 

Wholistic Perspectives 

Felipita Jacks 

Tribal Liaison 

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Candice Jimenez, M.P.H. 

Health Policy Analyst 

Northwest Portland Area Indian Health 

Board 

Angie Jones 

Regional Transit Coordinator 

Public Transportation Division, Oregon 

Kari Jones 

Health Equity Director 

Indiana Division of Mental Health and 

Addiction 

Lawanda Jones 

Health Program Specialist 

State of Nevada 

Amanda Karla 

Project Director 

Helio Health 

Kathryn Kaniewski, M.S. 

Guardianship Administrator 

Illinois Guardianship Advocacy Council 

Glenn Kazan 

Senior Care Coordinator 

Easterseals NH 

Amber Kidder 

Pines Behavioral Health 

Larry Kinread 

Executive Director of Special Education 

Office of Superintendent of Public 

Instruction 

Washington State 

Abigail Kirkman, M.A. 

Assistant Director 

SAMHSA SOAR Grant 

Policy Research Associates, Inc 

Sebouh Kouyoumijian, M.P.A. 

Public Health Associate 

National Council of Urban Indian Health 

Garrett Lankford, M.P.P. 

Federal Relations Analyst 

National Indian Health Board 

Byron Larson, M.H.A. 

Principal 

Xanovea 

Fergus Laughridge 

Health Director 

Ft McDermitt Paiute Shoshone Tribe 

Tawny Lavell 

ICWA Representative 

North Fork Rancheria of Mono Indians 

Angela Lockhart, M.A. 

Statewide Coordinator 

VR Counseling Support & Employment 

Services 

State of New York 

Lachyna Locklear 

National Indian Health Board 

A.C. Locklear, J.D. 

Federal Relations Manager 

National Indian Health Board 

Hyacinth Logan, R.N. 

Children’s Rehabilitation Network 

Stacy Lookout, M.S. 

Director 

Osage Nation Counseling Center 

Maria Lourdes 

Co-Director of Programming and Projects 

Alianza Indigena sin Fronteras 

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Jeramie Martin, DSL.c 

Behavioral Health Administrator 

Confederated Tribes of Siletz Indians 

Richard McDuffe, MNM 

Grants Administrator 

Seminole Tribe of Florida 

Stephanie Miller, R.N. 

Nurse Coordinator 

Pines Behavioral Health Services 

Cristee Miner, LPN 

Case Manager 

Dubuque Visiting Nurse Association 

Megan Mitchell 

Melissa Mohammad, CNA 

Fort Peck Tribal Health 

Javier Moreno, M.B.A. 

Director of California Government Relations 

Aegis Treatment Centers 

Mary Mummaw 

Grants Management Specialist 

Tribal Affairs Division 

Office of Violence Against Women 

Lena Nachand, M.A. 

Tribal Liaison for Medicaid Transformation 

Washington 

Jennifer Nanez, M.S.W. 

Senior Program Therapist 

Division of Community Behavioral Health 

University of New Mexico 

Sarina Oden, M.B.A. 

Program Director 

Elmhurst Home, Inc. 

Rose Olmsted 

University of Regina 

Carmen O’Leary 

Director 

Native Women’s Society of the Great Plains 

Cynthia Ortiz 

Coordinator 

Intermountain Centers 

Denise Peroune, Ph.D. 

Executive Director of Population Health 

Nirvana Healthcare Management Services 

Hanno Petras, Ph.D. 

Senior Research Scientist 

Pacific Institute for Research and Evaluation 

Kendra Pountney 

Behavioral Health Administrator Services 

Central Council of the Tlingit & Haida 

Indian Tribes of Alaska 

Tony Quintana 

Program Coordinator 

Albuquerque Area Indian Health Board 

Kathryn Redhorse 

Executive Director 

Colorado Commission of Indian Affairs 

Office of the Lt. Governor 

Samantha Renfrow 

Mental Health Services Advisor 

Chickasaw Nation Department of Family 

Services 

Angela Roberts 

Department for Behavioral Health, 

Developmental and Intellectual Disabilities 

Kentucky 

Joanette Robertson, M.S.W. 

Supervisor of Mental Health Services 

Wisconsin Department of Health Services 

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Craig Sandoval 

Tribal Liaison 

Western Sky Community Care – Medicaid 

Marilyn Scott 

Vice Chairperson 

Upper Skagit -Tribal Council 

Tanya Sheperd 

Senior Programs & Projects Specialist 

Navajo Nation 

Margaret Shirley 

Contract Specialist 

Navajo Area Indian Health Service 

Leslie Short, M.P.H. 

Integrated Services Administrator 

Arizona Health Care Cost Containment 

System 

Molly Siegel, M.P.H. 

Public Health Associate 

National Council of Urban Indian Health 

Regina Sisneros 

Director of Equity Initiatives 

National Association of State Directors of 

Developmental Disabilities 

Ann Tarpy 

Executive Director 

Arizona Governor's Council on Spinal and 

Head Injuries 

Patience Sumner 

Shawn Terrell, M.S. 

Health Information Specialist 

Administration for Community Living 

Jerry Ware 

Quality and Compliance 

Colorado Health Care Policy and Financing 

Elizabeth Watanbe, M.P.A., RD 

Health and Wellness Director 

Snoqualmie Tribe 

Kaitlyn Waters, LMFT 

NextGen HealthCare 

Renee Watters, LCSW 

Birchwoodwellness PLLC 

Jean Weber, LMSW ACSW CAADC CCBT 

ADS Ch.t 

CCBHC Coordinator 

Pines Behavioral Health 

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