PROJECT SUMMARY In comparison to other groups, there are clear disparities in the higher rates of substance abuse, post- traumatic stress, violence, and suicide in American Indian/Alaska Natives (AI/AN). High rates of substance misuse in AI/AN communities is associated with unemployment, low academic performance, high-risk occupations, violence, domestic abuse, delinquency, lack of health insurance, mental illness, and mortality from suicide, alcohol, or other substance abuse. Substance use disorders (SUD) disproportionately impact AI/ANs in Arizona due to the lack of infrastructure and personnel on reservations needed to deliver evidence- based comprehensive treatment and prevention services. In addition, the lack of culturally-centered treatment is a barrier to AI/AN individuals living in both rural and urban areas. The COVID-19 pandemic has exposed well-established racial disparities in health care access and health outcomes in underserved communities. COVID-19 has particularly had devastating impacts on tribal communities in Arizona. People with SUD may be particularly at-risk for COVID-19 complications due to the effect of many drugs on respiratory and pulmonary health, and higher likelihood of homelessness, incarceration, and co-morbid health conditions than the general population. Given existing barriers to telehealth in providing comprehensive care for AI/AN and rural communities, the COVID-19 pandemic may have placed those with behavioral health issues and SUDs at even higher risk. Training a workforce to research the delivery of culturally-centered behavioral health and addiction care with telehealth as a viable option has the potential to reduce the lasting impact of COVID-19 in underserved populations and prevent disruption of substance use treatment. The overall goal of the parent R25, Culturally-Centered Addictions Research Training (C-CART) (1R25DA053805), is to educate clinicians, providers, and doctoral students in health professions (occupational therapy [OT], physical therapy [PT], counseling, school, & clinical psychology, and interdisciplinary health) in research skills that include culturally- centered practices, related to SU/SUDs applied in interprofessional practice and diverse settings.This proposed Supplement to our R25 will look at Native culture and traditional practices within tele-behavioral SU/SUD treatment at one of our community partner agencies – Native Americans for Community Action (NACA) - and determine the impact on behavioral health outcomes for clients during the first year of the COVID-19 pandemic. The specific aims of this project are: Aim 1: To understand the integration of Native culture and traditional practices within tele-behavioral SU/SUD treatment at NACA and explore its impact on behavioral health outcomes during the COVID-19 pandemic employing a mixed methods research design; and Aim 2: To incorporate the findings from Aim 1 into a tele-behavioral SU/SUD treatment training module that will be pi...