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
Community Mobilization for Best Practice
Prevention and Treatment in Native
Communities Atlanta, Georgia May 25, 2005
Dale Walker, MD Patricia Silk Walker, PhD
Douglas Bigelow, PhD Bentson McFarland, MD,
PhD Elizabeth Hawkins, MPH, PhD Laura Loudon,
MS
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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

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Overview

• An Environmental Scan
• Behavioral Health Care Issues
• Fragmentation and Integration
• Introduction to One Sky Center
• 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 health 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 Amongst Addictions, Mental Health, and
Medicine

• Professionals are undertrained in the other two
  domains
• Patients are underdiagnosed
• Patients are undertreated
• These systems do not integrate well with social
  services

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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 is it working?
(Carl Bell, 7/03)
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Best Practice
Culturally specific
Outcome driven
Integrating resources
We need Collaboration, Integration, and Synergy
Community Mobilization
(Carl Bell, 7/03)
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Program Goals

• Promote and nurture effective and culturally
  appropriate prevention, treatment, and mental
  health services
• Identify and disseminate evidence-based
  prevention, treatment, and mental health
  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
• Training and education

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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
• Evidence based community knowledge best
  practice

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

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Community MobilizationPartnered Collaboration

Community-Based Organizations
Grassroots Groups
Research-Education-Treatment
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