Development and Implementation of a Community-Led Research Program in the Utah Navajo Health System

The Navajo Nation represents the largest Tribal community in the U.S. and experiences high rates of morbidity and mortality attributable to substance use. Rates of alcohol-associated mortality exceed the national rate by more than five times, and specific prevalence rates for substance use disorders (SUDs) such as stimulants and opioids among the Dine (Navajo), while not currently well-defmed, represent a growing concern.

Characterizing the burden of SUDs and the responsiveness of healthcare systems to meet that burden within the Dine community is a critical step toward advancing healthcare access, improving healthcare quality, and increasing overall wellness for Dine people. The Utah Navajo Health System is a nonprofit healthcare system in Southeast Utah servicing more than 15,000 patients across seven chapters of the Navajo Nation.

As both a Federally Qualified Health Center and Tribal healthcare system, UNHS provides behavioral health care to thousands of Dine patients each year. Over a 23-year period, UNHS has developed a robust composition of behavioral health services, including medication treatment, addiction treatment services, western medicine-based therapy, traditional counseling, sweat lodges, hogans, telepsychiatry, peer support, domestic violence shelters, crisis intervention, and a community wellness program.

UNHS' s success has garnered support, collaboration, and partnership from neighboring organizations, including the Navajo Nation, San Juan County Public Health Department, and Navajo Nation. Despite UNHS' s success in clinical care, its ability to assess needs, evaluate performance, and improve care through empirical data and research has been limited.

UNHS currently maintains an electronic medical record, data warehouse, and grants manager primarily for operational needs, including data reporting for the Uniform Data System and applying for and processing service grants to support clinical operations. In contrast, UNHS has not previously initiated a research program or applied for NIH

Research funding. Given its unique, influential, and trusted position within the Dine community, UNHS has great potential to be a leader in healthcare evaluation and research-especially for culturally aligned SUD care. UNHS also has a longstanding partnership with the University of Utah that provides an opportunity to develop research by drawing upon the strengths of each organization.

Collaboration between UNHS and UU grew out of a shared commitment to serve Tribal communities and represents a close partnership spanning nearly a decade that is focused on improving the lives and wellbeing of the Dine people. As project partners, UNHS and UU will work toward a single overall ob;ective, which is to develop a sustainable, community-led, culturally aligned SUD research infrastructure housed at UNHS that will benefit the Dine community and other Tribal communities by improving healthcare access, quality, and

outcomes. UNHS and UU will achieve requisite preliminary milestones toward that overall objective by (1) conducting a needs assessment among UNHS stakeholders relating to SUD identification, treatment, and research capacity; (2) implementing an SUD research and evaluation program at UNHS, using a model of facilitated implementation; and (3) developing a three-way study cohort of Dine patients with SUDs who (a) receive traditional counseling (b) receive other SUD treatment, and (c) receive no SUD treatment.

The aims of the project will be completed in accordance with key guiding principles, including assurance of cultural alignment, a focus on developing inter-organizational and community partnerships, and a plan for

long-term sustainability. As part of the N CREW Program (OTA-23-007), UNHS will build on its history of leadership in Tribal healthcare delivery, unwavering mission to meet the needs of the Dine community, and commitment to partner with organizations who share a similar vision for improving SUD care in Tribal communities.

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.