Abstract Southcentral Foundation (SCF) is a successful Tribally-owned and -operated healthcare organization in southcentral Alaska, a region spanning 104,713 square miles, 55 rural villages, and serving 70,000 ANAI peoples representing 229 federally-recognized tribes. In 2018, SCF completed a community health needs assessment (CHNA) with the intention to improve existing services and develop new programs. The CHNA included quantitative and qualitative methods to gather cross-sectional information about the health needs of the AN/AI peoples served by SCF to assess performance and identify any gaps across seven domains (manuscript in preparation). Participants included healthcare system leadership, staff, and customer-owners. Two of the top three health needs identified through the CHNA were substance use (alcohol, drug, and tobacco misuse) and behavioral health. More specifically, participants reported needs for more prevention, addiction awareness, and both short-term and long-term treatment for SUD. Behavioral health needs included increased access to services, expanded treatment for behavioral health issues (e.g., depression, anxiety) and suicide prevention, awareness, and support. Since these results were shared with SCF key stakeholders, leadership has made significant efforts to improve access to services and address some of the needs identified by CHNA participants. However, since the COVID-19 pandemic led to an increase in the use of telemedicine for all services, there is a need to engage the AN/AI community served by SCF to better understand whether attempts to improve access and address the specified needs have been met, or if additional needs been identified since the pandemic. The goal of the proposed project is to complete a CHNA focused on substance use treatment services offered to SCF customer-owners, both urban and rural. While the literature suggest that co-occurring substance use and mental health disorders can impact service utilization, and this is a component of interest of the investigative team, the design and scope of this CHNA will be established in collaboration with the proposed project’s steering committee. Our Specific Aims are to: 1. Assess the needs for substance use treatment services at Southcentral Foundation. This will be achieved through 20 interviews with clinicians and leadership, 250 customer-owner surveys, and 4 focus groups with rural clinics and one community- based treatment program external to SCF. 2. Build capacity of one Alaska Native investigator (Ms. Aliassa Shane) with ongoing mentorship by local and academic investigators with expertise in substance use disorders. This will be achieved through monthly mentoring meetings, annual attendance at one professional conference, and one training focused on development of substance use disorder or indigenous methods. 3. Draft health system recommendations and conceptual framework for a Phase II study. This will be achieved through a report and meetings with the steering committee for Southcentral Foundation leadership. These aims will contribute to the limited knowledge about effective treatment and recovery services among AN/AI peoples in a real-world environment. These activities have potential applicability in other tribal health systems across the nation and other health systems that seek to provide culturally grounded treatment and recovery services.