Preliminary findings from a formative evaluation of the Indigenous peer support specialist train-the-trainer manual: a culturally grounded approach to recovery in American Indian and Alaska Native communities

Introduction American Indians and Alaska Natives (AIANs) are rich in culture, heritage, language, and resilience. Chronic underfunding, limited healthcare infrastructure, and barriers to quality health services contribute to some of the most severe health disparities in mental health and substance use disorders among AIAN populations. Methods This formative evaluation aims to document the process and early implementation feedback on an Indigenous Peer Support Specialist Train-the-Trainer Manual (IPSSTTM) designed for use across Indigenous, community, clinical, and university settings. The curriculum was piloted from 2024 to 2026 in collaboration with the University of New Mexico Center for Native American Health (UNM CNAH), a peer recovery support worker, and an external community-based recovery organization (AKA). Initial drafts were developed, reviewed for content, culture, and applicability, and compiled into a 143-page manual. A culturally centered, Indigenous, mixed-method, Two-Eyed seeing approach was employed to gather and analyze pilot feedback on the curriculum. Various data types were used to explore meaning and identify areas for improvement within Indigenous contexts. Results This formative evaluation suggests the curriculum is an innovative, culturally grounded intervention that combines Indigenous healing practices with recovery needs. By centering Indigenous worldviews, building local capacity and workforce, and promoting sustainable knowledge transfer, this initiative may support behavioral and mental health equity. It strengthens Indigenous communities to address substance use and mental health challenges with resilience, cultural reverence, and sustainability. Discussion/Conclusion Early feedback from participants underscores the importance and urgency of providing culturally constructed recovery support services in Indian Country and that the IPSSTTM is a promising approach.