"It's time for a change. I need to. I have to": Substance misuse recovery turning points of unhoused Alaskans.

Substance misuse is a pernicious health concern for many unhoused people. A deep understanding of turning points - what propels someone to take concrete action toward addressing substance misuse - is needed to inform recovery policies and practices. This study sought to identify common elements in turning points among unhoused people vis-à-vis a phenomenological qualitative approach. Twenty people (Mage = 47.47, SD = 9.75; 50% female) who self-identified as being in recovery while unhoused participated in semi-structured interviews in Anchorage, Alaska, a community with high rates of both houselessness and substance misuse. Survival (life- and health-sustaining), individual (intrapersonal), and relational (interpersonal) motivations all shaped turning points. Limitations include the possible underrepresentation of individuals using a harm-reduction approach or capturing differences by housing type. Programs to address substance misuse should consider these motivations. Future research should identify and refine turning points and work to understand how they interact with change processes.

"It Was Broken Here Before": Present day impact of historical trauma in telemental health services in a rural and remote Aleutian Islands Community.

Telemental health technology is a feasible tool for providing behavioral healthcare in rural areas. However, there is scant literature about implementing this technology within Indigenous populations. The Aleutian Pribilof Islands Association is an urban-based Tribal Health Organization in Alaska tasked with providing behavioral health services to remote Unangax̂ communities. To expand telemental health services, a formative program evaluation was conducted to examine the acceptability of and barriers to implementing telemental health. Using a qualitative approach, five individuals with lived experience in the same community were interviewed using a semi-structured format. Data were analyzed using critical thematic analysis and situated within the context of historical trauma. Five themes were constructed that showed broken trust as the primary barrier to services, despite the substantial obstacles related to communications infrastructure. When situated within the context of historical trauma, the results show how colonization spurred and has maintained broken trust. The clinical, research, and policy implications resulting from this study point to the need for decolonization and integration of culture in behavioral health services. These findings can be informative for organizations and providers seeking to implement telemental health in Indigenous communities.

Implementing trauma-informed care at a non-profit human service agency in Alaska: assessing knowledge, attitudes, and readiness for change.

PURPOSE: This study assessed the critical aspect of individual staff attitudes and readiness for change within staff at a non-profit human service organization in Anchorage, Alaska, committed to adopting trauma-informed care (TIC). Organizational research has highlighted that staff attitudes and readiness impact the success of change efforts. METHOD: An online survey was used to measure staff knowledge about trauma, attitudes toward TIC, and readiness for change. RESULTS: A significant finding was that attitudes favorable toward TIC were positively associated with higher readiness for change. DISCUSSION: Human service organizations have sought to become more responsive to the needs of clients that have experienced trauma by adopting TIC. Prior to change efforts, it is critical that organizations consider staff readiness. CONCLUSION: As awareness about the prevalence and impact of trauma is increasing, these significant findings have implications for other agencies adopting TIC.