CIRCLE is a clinical research and outreach partnership between the Healing Lodge of the Seven Nations and the Division on Addiction, Cambridge Health Alliance, a Harvard Medical School teaching affiliate. Launched in 2013 with cross-national visits between HL7N and the Division on Addiction., their goal was to develop a strategic plan.

The vision of CIRCLE is to be the leading innovator and resource center for cooperative learning and research opportunities that facilitate healthy indigenous communities across the United States. The team also developed a clear mission for the collaboration to promote healthy indigenous communities across the United States by promoting and participating in cooperative learning and research related to addiction and other mental health treatment and outreach.

CIRCLE has five goals including:

  • Relationship Building
    • Building a mutually beneficial relationship through creating programmatic links and bridges
  • Community Involvement
    • Supporting and advancing existing and new community outreach and assessment partnerships
  • Treatment Program Evaluation
    • Supporting and advancing existing and new treatment assessment efforts
  • Visibility & Influence
    • Developing visibility and influence as a source for cooperative research and learning
  • Independent Infrastructure
    • Building an independent research and training infrastructure for CIRCLE

NARCH – Native American Research Centers for Health

NARCH is a joint highly selective center grant program between NIH and HIS. HL7N, along with Division on Addiction, Cambridge Health Alliance, had a successful proposal for the NARCH VIII grant entitled "Promoting cultures of recovery in tribal communities" in 2014. The grant had two goals:

  • Immediate Goal: to work collaboratively with the seven tribal nations to identify tribal communities' existing and needed resources for recovery support.
  • Long-term Goal: to facilitate the future development of interventions designed to promote tribal adolescents' long-term recovery from chemical dependency.

The research purpose of the NARCH VIII grant was focused on tribal youth returning home from residential or inpatient treatment, realizing that they are vulnerable to relapse, especially if they encounter the same environmental triggers in which their substance misuse developed. This study sought to learn about community stakeholder perceptions of existing strengths and needs for supporting recovering adolescents among six tribal communities of the Inland Northwest.

The research strategy included Group Level Assessment involving the Coeur d'Alene Tribe, the Nez Perce Tribe, the Confederated Tribes of the Colville Reservation, the Kalispel Tribe of Indians, the Spokane Tribe of Indians, and the Confederated Tribes of the Umatilla Reservation and had a total of 166 stakeholders who participated.

NARCH VIII had specific aims to develop lasting partnerships between the Healing Lodge, the Division on Addiction, and the Seven Nations through Tribal Participatory Research (TPR) methods, Increase capacity by training and involving local native college students as Student Researchers, and assess and summarize critical informants' perceptions of available and potential post-recovery support systems within each of seven tribal nations.

The findings included results based on youth feedback and the work with the seven tribes.


In creating their action plans, youth participants identified strategies their communities could use to help them avoid relapse. These included:

  • Youth indicated a need for positive sober activities, particularly sporting opportunities. Using sports and music to help them develop a greater connection to sober activities and support systems.
  • The youth indicated the importance of developing new friendships with more positive and sober individuals.
  • It was clear that family support is the most desired support; however, it was important for the family to be sober.


Produced Youth Recovery Guides for each of the Seven Tribes
based on five themes discovered through NARCH XII focus groups and tribal outreach:

  • The importance of providing wraparound/supportive services
  • Community Education
  • Youth services and events
  • Communication and collaboration among tribal departments/agencies
  • Recovery coaching model

NARCH VIII's findings grew the need for Mental Health training, which was the focus of the NARCH X grant. The initiative is funded by continued NARCH funding to CIRCLE. The NARCH X grant's goal was to produce a training that can be used to train x̌aʔtu̓s/First Face individuals within the tribes, including youth and adults. x̌aʔtu̓s means First Face; it describes an individual who steps forward to help a person in a crisis or need. x̌aʔtu̓s for Mental Health will be a culturally sensitive, community-based mental health first response system. x̌aʔtu̓s will equip community members to respond empathically and effectively to an individual experiencing a mental health crisis. First responders will serve as a bridge between the individual in need and professional healthcare.

First Face Training

The First Face Training is built with and for tribal communities with special considerations for self-care, especially in Tribal communities, but with a specific focus on Tribal teens. There are five main topics covered in the training 1) trauma, 2) addiction, 3) depression & anxiety, 4) self-harm, and 5) violence. In addition to these five core topics, there is a particular focus on understanding intergenerational trauma, typical and atypical adolescent behavior, and self-care.

Healing Hands is the specific strategy that First Face individuals can use to help someone who is experiencing a mental health or addiction crisis. First Face is built around five themes or steps that can be used to guide assistance.

  • Safety First: Start with the thumb. The thumb is the strongest finger. Ensure your safety, including practicing self-care and the one you seek to help.
  • Listen Openly: The pointer finger placed in front of the mouth reminds us to observe and listen before speaking. Assess before acting.
  • Guide to Help: The middle finger, our tallest finger, reminds us of leaders and guides. Be a practical guide to professionals in your area who can provide support.
  • Influence with Compassion: The ring finger is the weakest but has power. Moving the ring finger moves other fingers. This reminds us to act compassionately because what you do can affect others.
  • Provide Hope: The pinky is the smallest finger and easiest to hurt. People who are injured often feel small. This finger reminds us to provide hope and reassurance, not judgment.