Title: The American IndianAlaska Native National Resource Center for Substance Abuse and Mental Health Serv
1The American Indian/Alaska Native National
Resource Center for Substance Abuse and Mental
Health Services
Exploring New Frontiers A National Strategy for
Native Behavioral Health Sioux Falls, South
Dakota August 9-11, 2005
Dale Walker, MD Patricia Silk Walker, PhD
Douglas Bigelow, PhD Bentson McFarland, MD,
PhD Laura Loudon, MS Michelle Singer
2- For information, contact us at
- 503-494-3703
- E-mail
- Dale Walker, MD
- onesky_at_ohsu.edu
- Or visit our website
- www.oneskycenter.org
3Overview
- An Environmental Scan
- Behavioral Health Care Issues
- Fragmentation and Integration
- Introduction to One Sky Center
- Introduce the SAMHSA Family
- Best Practice Evidence-Based Indigenous
Knowledge
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6Health Problems
- Alcoholism 6X
- Tuberculosis 6X
- Diabetes 3.5 X
- Accidents 3X
- Physicians 72/100,000 (US 242)
- 60 Over 65 live in poverty
(US 27)
7American Indians
- Have same disorders as general population
- Greater prevalence
- Greater severity
- Much less access to Tx
- Cultural relevance more challenging
- Social context disintegrated
8Agencies Involved in B.H. Delivery
- 1. Indian Health Service (IHS)
- A. Mental Health
- B. Primary Health
- C. Alcoholism / Substance Abuse
- 2. Bureau of Indian Affairs (BIA)
- A. Education
- B. Vocational
- C. Social Services
- D. Police
- 3. Tribal Health
- 4. Urban Indian Health
- State and Local Agencies
- Federal Agencies SAMHSA, VAMC
9Different goals
Resource silos
One size fits all
Activity-driven
How are we functioning? (Carl Bell, 7/03)
10Evidence based
Culturally specific
Outcome driven
Integrating resources
We need Synergy and an Integrated System (Carl
Bell, 7/03)
11Disconnect Between Addictions / Mental Health
- Professionals are undertrained in one of two
domains - Patients are underdiagnosed
- Patients are undertreated
- Neither integrates well with medical and social
service
12Difficulties of Program Integration
- Separate funding streams and coverage gaps
- Agency turf issues
- Different treatment philosophies
- Different training philosophies
- Lack of resources
- Poor cross training
- Consumer and family barriers
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14Program Goals
- Promote and nurture effective and culturally
appropriate prevention and treatment - Identify and disseminate evidence-based
prevention and treatment practices - Provide training and technical assistance
- Help to expand capacity
15One Sky Center Partners
16Projects
- Review SAMHSA portfolio 134 projects
- Mental health liaison SAMHSA/ IHS
- Medicaid, state, Indian funding
- Best practices consensus project
- National traffic safety drivers training
- Suicide and substance abuse
- Suicide prevention
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19Indigenous Knowledge
Definitions
- Is local knowledge unique to a given culture or
society it has its own theory, philosophy,
scientific and logical validity, which is used as
a basis for decision-making for all of lifes
needs.
20Traditional Medicine
Definitions
- The sum total of health knowledge, skills and
practices based upon theories, beliefs and
experiences indigenous to different culturesused
in the maintenance of health. - WHO 2002
21Evidence-based Practices
Definitions
- Interventions that show consistent scientific
evidence of improving a persons outcome of
treatment and/or prevention in controlled
settings. - SAMHSA 2003
22Best Practices
Definitions
- Examples and cases that illustrate the use of
community knowledge and science in developing
cost effective and sustainable survival
strategies to overcome a chronic illness. - WHO 2002
23World Conference on Science
A partnership begins!
- Recommended that scientific and indigenous
knowledge be integrated in interdisciplinary
projects dealing with culture, environment and
chronic illness. - 1999
24ID Best Practice
Best Practice
Clinical/services Research
Mainstream Practice
Traditional Healing
25Circle of Care
Traditional Healers
Child Adolescent Programs
Primary Care
Best Practices
AD Programs
Boarding Schools
Colleges Universities
Prevention Programs
Emergency Rooms
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27Lifetime, Annual and 30 Day Prevalence of
Intoxication Among 224 Urban Indian Youth
R. Dale Walker, M.D. 100 completion sample
28Changes in Lifetime Substance Use Among Urban
Indian Youth Over Nine Years
Percentage ever used
R. Dale Walker, M.D.
100 Completion Sample
29Age of Onset of Substance Use Among Urban
American Indian Adolescents, by Substance Used
R. Dale Walker, M.D. (5/2000) Cohorts 4 5
were sampled every third year recall and
sampling bias apply
30Integrated Treatment
- Any mechanism by which treatment interventions
for co-occurring disorders are combined within
the context of a primary treatment relationship
or service setting. - -CSAT
31Effective Interventions for Adults
- Cognitive/Behavioral Approaches
- Motivational Interventions
- Psychopharmacological Interventions
- Modified Therapeutic Communities
- Assertive Community Treatment
- Vocational Services
- Dual Recovery/Self-Help Programs
- Consumer Involvement
- Therapeutic Relationships
32Effective Interventions for Youth
- Family Therapy
- Multisystemic Therapy
- Case Management
- Therapeutic Communities
- Community Reinforcement
- Circles of Care
- Motivational Enhancement
33What makes a partnership work?
- Trust do away with stereotypes
- Real participation at all levels
- Build in incentives for all stakeholders
- Education and training of all stakeholders
- Dissemination of knowledge
- Enhanced communication
- Social to scientific interaction
34Partnered Collaboration
Community-Based Organizations
Grassroots Groups
Research-Education-Treatment
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36SUBSTANCE ABUSE AND MENTAL HEALTH SERVICE
ADMINISTRATION (SAMHSA) www.samhsa.gov
- Grant Opportunities, Website links, Publications
- 1-800-729-6686
- 1-800-487-4889 (TDD)
37SAMHSAs Strategic Plan
VISION A Life in the Community for Everyone
MISSION Building Resilience and Facilitating
Recovery
EFFECTIVENESS
ACCOUNTABILITY
CAPACITY
Measure and report program performance
Increase service availability
Improve service quality
38The SAMHSA Matrix
39SAMHSAs Strategic Prevention Framework Steps
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41SPF, Coalitions Drug Courts
Comprehensive Community Strategies
Recovery Support Relapse Prevention
Primary Prevention
Intervention Drug Court
42The State Incentive Grants
- Implements SAMHSAs Strategic Prevention
Framework to - 24 States, 2 Territories, 5 years _at_ 2.3 million
per year - Prevent onset and reduce progression of substance
abuse - Reduce community substance abuse problems
- Build State and community prevention capacity and
infrastructure - Uses National Outcome Measures and builds
Epidemiological Workgroups at the State and
Community level. - Places emphasis on Underage Drinking
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44Drug-Free Communities Program
- The GOALS are to
- Reduce substance abuse among youth and adults by
addressing the factors in a community that
increase the risk of substance abuse and
promoting the protective factors that reduce risk
of substance abuse. - Establish and strengthen collaboration among
communities, drug courts, private nonprofit
agencies, and federal, state, local and tribal
governments to support the efforts of community
coalitions to prevent and reduce substance abuse
among youth. - The Drug-Free Communities Act (Pub. L. No.
105-20) was signed into law on June 27, 1997. On
December 14, 2001, Public Law 107-82, 115 Stat.
814 (2001), reauthorized the program for 5 years.
45Fetal Alcohol Spectrum Disorders (FASD) Center
for Excellence
- The FASD Center For Excellence builds FASD State
systems through - Drug Courts and Family Courts
- Training and technical assistance
- Women in recovery summit
- Birth mothers video
- Materials/ resources for SA treatment systems
- Public education materials for general audiences
- Data analysis of SAMHSAs national survey on drug
use and health (NSDUH) - Inventory of prevention and treatment programs
- State system meetings
- Web site www.fascenter.samhsa.gov
46Centers for the Application of Prevention
Technologies (CAPTs)
47Addiction Technology Transfer Centers (ATTC)
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