Good Mental Health Creates Sustained Wealth

We are resolving historical trauma and race based stress one person at a time. In the United States, there are over 500 Tribal nations. Here in the State of Arizona, there are 22 distinct Tribes. As members of oppressed and marginalized communities our histories are often erased, minimized and discredited. Racial trauma or race based traumatic stress (RBTS) refers to the mental and emotional injury caused by racial bias, ethnic discrimination and hate crimes (MHA, 2021) Systemic oppression has resulted in negative health outcomes for individuals, families and communities. Long standing genocidal practices committed against Indigenous people and other marginalized groups is evidenced by high suicide rates, early death rates and higher rates of poverty. Alcoholism, suicide, diabetes and depression exist in higher rates in comparison to non-Indians. In the U.S., 1 in three Native Americans lives in poverty. The unemployment rate of American Indians often hoovers at twice the national rate. (Diversity Inc, 2021) These issues contribute to the further decline of health and wellness in Native American homes and families.

Here is Arizona, American Indian residents ranked worse on 53 of 65 health indicators, had high mortality from alcohol-induced causes, chronic liver disease and cirrhosis, diabetes, septicemia, motor vehicle accidents, nephritis, assault, unintentional injuries, influenza and pneumonia, post-neonatal mortality, drowning, and sudden infant death syndrome: all contributing to the premature death rate of 77.9 percent. The Arizona Department of Health notes American Indians are 16 years younger at time of death compared to all ethnic/racial groups (ADHS, 2019). Many general health issues also have a strong co-morbidity with mental health distress. When compared to the general U.S. population Native Americans experience PTSD more than twice as often and experience psychological stress more often (APA, 2010).

For American Indians there is a noted lack of cultural competency training in mental health providers. Additionally, income barriers and geographic isolation of peoples living in rural areas have created barriers to treatment access for mental health. Rates of suicide for Native American communities is 3.5 times higher than the racial groups with the lowest suicide rate. (MHA, 2021)

Our solution is to provide direct access to trauma informed and culturally competent Telehealth mental health services. We serve populations that have been deeply impacted by genocidal practices, discrimination, active-duty service, childhood abuse and other complex traumatic experiences. By providing improved virtual access to trauma-informed mental health services in underserved communities, we envision reconciliation and sustained healing for generations to come.

We deliver HIPPA compliant confidential psychotherapy services utilizing Telehealth platforms (live synchronistic video or audio) direct to patients. Patients log into our secure Telehealth platform using a smart phone, wifi/internet connected tablet or desktop. Services can also be completed via telephone for those who do not have stable or readily accessible internet access. 

We specialize in providing Eye Movement Desensitization and Reprocessing (EMDR) therapy which is a psychotherapy method that has been proven to be effective in the treatment of addictions, depression, anxiety, OCD, chronic pain, stress and has been validated as a best practice for the treatment of Post Traumatic Stress Disorder (PTSD). EMDR can be effectively delivered via Telehealth. EMDR is a recognized as an effective treatment for PTSD by the American Psychological Association, the International Society for Traumatic Stress Studies, SAMHSA, the US Department of Defense and the World Health Organization. 

Our founder and owner, Jordanna picked EMDR therapy as the primary method of intervention due to it's inclusivity and adaptability for Indigenous and other marginalized folks and it's rapid method of intervention; EMDR therapy heals individuals and helps create healthier communities. 

Additionally we provide psychotherapy to address trauma, substance use and both mental health/substance use concerns. We do this through the use of evidence based therapies (cognitive behavioral therapy, dialectical behavioral therapy, EMDR therapy) and supports (peer support services).

TRSAZ SPECIALITIES

1.    Trauma-related depression, anxiety, suicidal ideation, stress, irritability, sleep issues and more.

2.    EMDR therapy and other cutting-edge therapies to heal communities that have been deeply impacted by genocidal practices, discrimination, active-duty service, childhood abuse and other complex traumatic experiences.

3.    Serving Indigenous communities, BIPOC, LGBTQIA+ youth and veteran individuals and families.

4.    Outpatient substance use/misuse and supportive services (peer support, etc.)

We serve Indigenous and BIPOC folks in the State of Arizona.

We serve ages 13 and up in the State of Arizona with a speciality focus on BIPOC folks, with Indigenous folks being our primary focus group. Presently there is a lack of culturally competent and EMDR trained master's level counseling providers that serve Indigenous communities. 

According to Mental Health American, a large majority of Native Americans live in Western states, with 42% in rural areas compared to 23% of whites. Twenty percent live on reservations today. Over 50% now live in urban, suburban, or rural non-reservation areas. Arizona is a large state spanning both rural and urban areas. EMDR and psychotherapy via Telehealth are solutions because they provide equitable access to a necessary and living saving mental health resources. By providing a variety of technology enabled supports (live video, telephone therapy) TRSAZ is uniquely positioned to treat Indigenous people across the spectrum in the State of Arizona. 

TRSAZ VALUES

·       Easily accessible mental health services for all

·       Community and adolescent-focused

·       Culturally-competent and inclusive practice

·       We listen, act, and transform

·       Compassion, kindness and respect

·       Fully-supported healing

·       Eliminating the stigmas of substance use and mental health

We serve the 22 Tribal Nations and urban American Indians/Indigenous folks in the State of Arizona. We work directly with individuals, couples, families and communities to determine their individual needs (via comprehensive assessment), make recommendations & deliver treatment. 

We work with them to identify their individual needs and collaborate with local and regional authorities and community members to inform our care and services. We are a members of the American Indian Chamber of Commerce, The Dine Chamber of Commerce and work regularly with other agencies and groups that work with both rural/Reservation American Indians and Urban Indians (Phoenix Indian Center, Cohoquia, etc.) 

Since the business and all of our work is viewed through an Indigenous lens, we approach common business and client concerns with the understanding that we are in community with our patients and their families. For example, we work with our clients to provide payment plans when they cannot afford their co-payments, deductibles, etc. We also run a low/no cost therapy clinic that we staff with interns and other staff to ensure folks who cannot otherwise get access to cutting edge therapies are given the chance to participate in them. 

We are the right people to do this work because we fundamentally believe that social justice is a verb, creating equitable access to top tier psychotherapies at an affordable and accessible rate/options is built into our business practices. We currently run a low/no cost clinic that is staffed by mental health interns and all staff who join the practice commit to providing 20% of their direct practice work at a low/no cost rate. We accept insurance and work to increase access to quality mental health care in our work.

EMDR and psychotherapy are fundamental interventions for mental health, yet we see that the communities that need these services are often left out of the planning, narrative and don't receive these services in equitable amounts. We are a practice of Trauma trained and informed staff that believes in social change and work towards the dismantaling of opression and genocide one person at a time. 

I (Jordanna) grew up in a Tribal community that has been negatively impacted by genocide/historical trauma and have seen and experienced first-hand what happens when healing and reconciliation doesn’t occur in a systemic and sustained manner. Indigenous and people of color/people from underserved communities experience shortened life spans, reduced quality of life. Indigenous women experience violence at much higher rates than non-Indigenous women & often deal with PTSD with little to no professional support. For these reasons and more, my work, our work focuses on improving access to trauma informed mental health services utilizing technology in Indigenous communities.

Present barriers:

1. Access to working capital/knowledge/mentorship that is non-exploitive to expand our operations (hire more staff, increase our geographic reach)
2. Lack of brand awareness in Arizona Tribal Communities: we are so focused on doing our work that we need supports in marketing and insight around business development
3. Development of evaluation methods to track our work and outcomes
4. Access to supports/knowledge in financial methods, projections, etc. As an Indigenous entrepreneur, I've utilized all available resources short of getting an MBA!
5. Connection to other Indigenous solvers to gain support, encouragement and to encourage others to continue to thrive, excel and create sustainable business/solutions to current and past problems. 
6. Connection/exploration about ways to innovate our phone services to improve EMDR access for those in rural areas without internet/stable internet access.

Yes, I am connected to my communities via my work and commitment to the work of mental health and Indigenous access to care. I grew up on the Navajo reservation in New Mexico and am a part of a cohort of other female business owners who still work to create equitable ways for Indigenous folks to thrive. 

What make our solution innovative is the combined use of culturally competent, Indigenous informed EMDR therapy and Telehealth. Because of the high rates of mental health concerns experienced by Indigenous peoples, access to quality mental health care is limited. Telehealth creates additional opportunities and reduces barriers to care. 

Broader impacts could include increased awareness of how to deliver services to rural and Reservation communities, urban communities. Telehealth is a sustainable way to deliver services as staff members of TRSAZ and clients are not required to drive or travel to sessions, thereby reducing the amount of time needed to complete essential services and reduced carbon emissions, etc.

This could change the market by providing a case study or lived example of how to integrate care into communities that have been historically underserved and marginalized. Equitable quality mental health care is a health improving practice for communities. Our hope is that with trauma resolution we would see a decrease in the amount of depression, anxiety and PTSD of our clients, which would in turn result in improved health outcomes (improved sleep, improved ability to cope with stress, decreased medical issues, decreased stressors overall) for the folks we treat and support. Since their health would improve, that would result in fewer/lessor costs to society for medical services, loss work time, loss production, loss of family connection, fewer suicides, etc. 

Year One:

• Continue to apply/integrate services for Tribal communities. 
• We recently applied to become Medicaid providers and the clinic is paneled, we are working on how we will build out this expansion.
• Continue to recruit BIPOC providers and social justice oriented providers.
• Sustain expansion efforts and pay down debt.
• Begin outreach and marketing to Arizona Tribal communities as we are able to serve many of their members.

Year Five, etc:

• Successfully integrate to provide services to Arizona Tribes and maintain active, positive working relationships.
• Expand to New Mexico and begin collaborative work with Tribes and rural communities to increase access to mental health care/EMDR therapy.
• Track outcomes and share data with funders, stakeholders and local/state/Tribal communities to demonstrate positive outcomes of our work and encourage increased access to trauma informed mental health services.
• Integrate health care specific apps/tech to reach more people who are in the contemplative stage of change to encourage engagement in mental health services.
• Establish and publish information about best practices: white paper or other method of information distribution.
• Consult with and inform Indigenous communities nation wide about our work and it's positive impacts on the communities we serve.

All new clients/patients complete an intake process with the practice (this happens annually for ongoing patients). The intake includes the following: a biopsychosocial background, an evidence- based depression screening tool (PHQ-9), an evidence-based anxiety screening tool (GAD-7), a PTSD screen tool (PTSD-5). Patients meet with licensed mental health professionals via secure HIPPA compliant Telehealth (live video, telephone or other qualified Telehealth interventions), to determine the following: presenting symptoms, assessment of the breath and scope of impairment/level of symptoms (via self-identification and the outcomes of the aforementioned clinical screening tools) & a proposed treatment plan is created to determine the next steps and method(s) of intervention.

We would like to create a better tracking system to measure our outcomes to determine our efficacy in treating mental health concerns. We also use evidenced based and validated tools taking into account the World Health Organizations recommendations and our owners experience managing Tribal healthcare and general mental health/substance abuse intake and screening experiences. 

Our theory of change is that by providing quality accessible mental health services to Arizona residents we will: (actions: providing mental health services, mental health awareness/education via social media and community education and engagement efforts, interventions: psychotherapy, peer support services, etc.)

Changes/results/outcomes

• increase access to affordable care
• increase access to trauma informed care
• destigmatized mental health treatment and symptoms
• awareness of mental health symptoms and treatments
• improved health/wellness
• reduced mental health symptoms.
• increased functioning at work, home and other core areas of connection for individuals, couples and families

Actions/changes: objectives, accomplishments, measures, metrics  

• Observe decrease in mental health symptoms as evidenced by remission or reduction in mental health symptoms as reported by therapy attendees via evidence based screening tool completion (PHQ-9, GAD-7, etc.)
• Additional measures will be determined via participation in MIT Solve. 

Trauma Recovery Services of Arizona (TRSAZ) is a mental and health counseling practice that provides Mental Health Services via Telehealth in the State of Arizona. Our services include professional counseling via Synchronous Telehealth. Synchronous Telehealth is real-time interactive video teleconferencing that involves communication between the patient and a master’s level licensed mental health practitioner who is performing the behavioral health service. The practitioner sees the patient throughout the communication, so that two-way communication (sight and sound) can take place.  These services are performed through a HIPAA compliant & secure video-conferencing software. Additional services provided by TRSAZ include: clinical supervision, peer support services, professional mentorship, internships and education/training to other companies. 

All TRSAZ services are envisioned and implemented through an Indigenous world view which takes into account individual needs, strengths, goals and connection to one another. 

Our leadership team is led by an Indigenous woman who was born and raised on the Navajo Reservation in the United States. Our focus is to include and incorporate diverse voices, lived experiences and access to opportunity for our staff, contractors and clients. We employ serval Indigenous women (CEO, biller, practice manager), have a bi-lingual male (Spanish speaking) therapist and our CEO also speaks Navajo. We target underserved groups because we come from the underserved. To put it simply, we serve the people who represent who we are and who we aspire to continue to serve.

Our key customers are the patients that we serve, our secondary customers are the communities that are positively impacted by our work and efforts. We operate on a fee for service model and recently obtained a new contract to provide mental health expansion for a local City in Arizona.

The business began as an in-person solo private practice in 2017. In 2021, during the Covid-19 pandemic, due to an influx of therapy requests, the business transitioned into a group practice and began employing several contractors to provide Telehealth based mental health services.  The sales for 2020 were $14,000 The projected sales for 2021 were $30,000 with a profit of approximately $10,000.  The actual sales for 2021 were $58.898; profit was $6,900. Sales for 2022 were $196,790 with a loss of 2k-as the company focused on expansion, established the low/no cost therapy clinic and added its first full-time employees.

The year-to-date collected sales as of May 9, 2023 are $74,261 with a profit of 4k. Revenue for the company is expected to continue to increase over time as the caseloads of the practitioners is increasing on a daily basis due to high demand for Telehealth therapy. Additionally, all but one practitioner in the practice is trained in Eye Movement Desensitization and Reprocessing (EMDR) therapy which is a cutting-edge psychotherapy that is endorsed by the World Health Organization, the American Psychological Association and the US Department of Defense as an effective therapy to treat PTSD; as well as depression, anxiety and many other common mental health concerns.

The business is female Native American owned and operated.  Jordanna Saunders is an enrolled member of the Navajo Tribe.  According to the SBA, only 29% of businesses are majority-owned by minorities. 

Our goals are to improve our profits to further expand our reach and provide more pro bono/low cost services. 

We will continue to provide fee for service mental health services as well as continue to apply for grants. We have initial meetings scheduled later this month to begin raising capital. Additionally, we are working on our registration to provide service contracts to governments. We will also begin a concentrated effort to market our services to Arizona Tribes and other rural communities as those communities may be most positively impacted by engagement in our services. 

We have successfully navigated our first few rounds of development and transition to stabilize our business and revenue continues to increase.