Absentee Shawnee Tribal Health System: HEAL Initiative: Native Collective Research Effort to Enhance Wellness (N CREW) Program- Addressing Overdose, Substance Use, Mental Health, and Pain (OT2)

The NIH HEAL Initiative’s Native Collective Research Effort to Enhance Wellness (N CREW) Program seeks to enhance health and wellness among Native Americans by advancing research on behavioral health, particularly pain, overdose, substance use, and mental health. We aim to establish a Clinical Research Center owned by and embedded within a Native American tribe in Oklahoma, grounded in systems thinking principles, to advance holistic research on behavioral health issues impacting the tribal community - from causes to prevention and care. As a core initiative, we intend to develop and implement an Indigenous Behavioral Health Effective Coverage Care (IBHECC) Model tailored to the Absentee Shawnee Tribe (AST) community. This model leverages systems thinking approaches to disentangle the complexity underlying behavioral health challenges within Native settings. It aims to identify structural gaps and key intervention points in behavioral health services, informing coordinated, culturally aligned strategies to improve outcomes across the continuum of care. The backbone of the IBECC Model is the Native American Community Behavioral Health Systems (NACBHS) Framework, which we will develop to map the interrelated social, historical, cultural, and structural factors contributing to behavioral health challenges among the AST. This approach centers Indigenous knowledge and lived experience, ensuring that the model reflects the cultural, community, and historical contexts that shape both the roots of behavioral health issues and pathways to healing. The knowledge generated through this work will inform the next phase of our research, where we will analyze real-world care trajectories to identify critical intervention points for improving pain management and behavioral health outcomes. Guided by original instructions and grounded in Indigenous scientific knowledge systems, this work affirms that Native communities have always been researchers, observing, testing, and innovating within their own knowledge frameworks. The IBECC Model and NACBHS Framework will be tribally owned and culturally driven, serving not only as a tool to improve care within the AST, but also as a scalable framework that other Native communities can adapt to their unique contexts. Rooted in strengths and focused on positive change, this project aims to restore balance and wellness while contributing to the NIH’s HEAL Initiative through solutions that honor sovereignty, culture, and Indigenous ways of knowing. This study is part of the NIH’s Helping to End Addiction Long-term (HEAL) initiative to speed scientific solutions for the overdose epidemic, including opioid and stimulant use disorders, and the crisis of chronic pain. The NIH HEAL Initiative bolsters research across NIH to improve treatment for opioid misuse and addiction and acute and chronic pain.