The American IndianAlaska Native National Resource Center for Substance Abuse and Mental Health Serv

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The American Indian/Alaska Native National
Resource Center for Substance Abuse and Mental
Health Services
Honoring Heritage Strengthening Our Nations
Spirits Los Angeles, California November 17, 2005
Dale Walker, MD Patricia Silk Walker, PhD
Douglas Bigelow, PhD Bentson McFarland, MD,
PhD, Michelle Singer
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Native Aspirations!
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Six Missions Impossible?

• How do we define ourselves?
• How do we define disaster?
• How do we ask for help?
• How do we get Federal and State agencies to work
  together and with us?
• How do we build our communities?
• How do we restore what is lost?

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Disaster

• FEMA A natural or man-made event that
  negatively affects life, property, livelihood or
  industry often resulting in permanent changes to
  human societies, ecosystems and environment.
• NHTSA Any occurrence that causes damage,
  ecological destruction, loss of human lives, or
  deterioration of health and health services on a
  scale sufficient to warrant an extraordinary
  response from outside the affected community
  area.
• NOAA A crisis event that surpasses the ability
  of an individual, community, or society to
  control or recover from its consequences.

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Overview

• An Environmental Scan
• Behavioral Health Care Issues
• Fragmentation and Integration
• Introduction to One Sky Center
• Native Aspirations!
• Introduce the SAMHSA Family
• Best Practice Evidence-Based Indigenous
  Knowledge

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Health 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)

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American Indians

• Have same disorders as general population
• Greater prevalence
• Greater severity
• Much less access to Tx
• Cultural relevance more challenging
• Social context disintegrated

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Agencies 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

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Disconnect 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

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Difficulties 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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Different goals
Resource silos
One size fits all
Activity-driven
How are we functioning? (Carl Bell, 7/03)
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Best Practice
Culturally Specific
Outcome Driven
Integrating Resources
We need Synergy and an Integrated System (Carl
Bell, 7/03)
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Program 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

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One Sky Center Partners
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Projects

• 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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Native Aspirations!
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Indigenous 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.

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Traditional 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

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Evidence-based Practices
Definitions

• Interventions that show consistent scientific
  evidence of improving a persons outcome of
  treatment and/or prevention in controlled
  settings.
• SAMHSA 2003

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Best 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

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World 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

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ID Best Practice
Best Practice
Clinical/services Research
Mainstream Practice
Traditional Healing
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Circle 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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Lifetime, Annual and 30 Day Prevalence of
Intoxication Among 224 Urban Indian Youth
R. Dale Walker, M.D. 100 completion sample
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Changes in Lifetime Substance Use Among Urban
Indian Youth Over Nine Years
Percentage ever used
R. Dale Walker, M.D.
100 Completion Sample
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Age 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
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Integrated 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

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Effective 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

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Effective Interventions for Youth

• Family Therapy
• Multisystemic Therapy
• Case Management
• Therapeutic Communities
• Community Reinforcement
• Circles of Care
• Motivational Enhancement

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What 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

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Partnered Collaboration

Community-Based Organizations
Grassroots Groups
Research-Education-Treatment
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SUBSTANCE ABUSE AND MENTAL HEALTH SERVICE
ADMINISTRATION (SAMHSA) www.samhsa.gov

• Grant Opportunities, Website links, Publications
• 1-800-729-6686
• 1-800-487-4889 (TDD)

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Fetal 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

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Centers for the Application of Prevention
Technologies (CAPTs)http//www.captus.org/
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Addiction Technology Transfer Centers (ATTC)
http//www.nattc.org/contactUs.html
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• For information, contact us at
• 503-494-3703
• E-mail
• Dale Walker, MD
• onesky_at_ohsu.edu
• Or visit our website
• www.oneskycenter.org