The American IndianAlaska Native National Resource Center for Substance Abuse and Mental Health Serv - PowerPoint PPT Presentation

Loading...

PPT – The American IndianAlaska Native National Resource Center for Substance Abuse and Mental Health Serv PowerPoint presentation | free to download - id: 1c3940-YjQzN



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

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

Description:

Dale Walker, MD Laura Loudon, MS Patricia Silk Walker, PhD Douglas Bigelow, PhD ... Unruly Students. Sale of Alcohol. and Drugs. 12. 22. Emergency situation ... – PowerPoint PPT presentation

Number of Views:74
Avg rating:3.0/5.0
Slides: 60
Provided by: ohsu9
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

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


1
The American Indian/Alaska Native National
Resource Center for Substance Abuse and Mental
Health Services
Native Adolescent Substance Use and Mental
Illness A Catalyst for Disaster Denver,
Colorado May 11, 2006
Dale Walker, MD Laura Loudon, MS Patricia Silk
Walker, PhD Douglas Bigelow, PhD Denise
Middlebrook, PhD Michelle Singer
2
Native Communities
Advisory Council / Steering Committee
One Sky Center
3
One Sky Center Partners
4
One Sky Center Outreach
5
(No Transcript)
6
Presentation Overview
  • An Environmental Scan
  • Behavioral Health and Education System Issues
  • Fragmentation and Integration
  • Discuss Behavioral Health, Suicide, Disaster
  • Integrated care approaches and interagency
    coordination are best overall solutions

7
Six Missions Impossible?
  • How do we define health, education, and social
    problems?
  • 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?

8
(No Transcript)
9
(No Transcript)
10
(No Transcript)
11
A Quiet Crisis Federal Funding and Unmet Needs
in Indian Country, July 2003
  • Funding not sufficient to meet needs for
  • Health care
  • Education
  • Public safety
  • Housing
  • Infrastructure development needed

12
Native Health/ Educational Problems
  • Alcoholism 6X
  • Tuberculosis 6X
  • Diabetes 3.5X
  • Accidents 3X
  • Suicide 1.7 to 4x
  • Health care access -3x
  • Poverty 3x
  • Poor educational achievement
  • Substandard housing

13
American Indians
  • Have same disorders as general population
  • Greater prevalence
  • Greater severity
  • Much less access to Tx
  • Cultural relevance more challenging
  • Social context disintegrated

14
Agencies Involved in Edn. B.H.
  • 1. Bureau of Indian Affairs (BIA)
  • A. Education
  • B. Vocational
  • C. Social Services
  • D. Police
  • 2. Indian Health Service (IHS)
  • A. Mental Health
  • B. Primary Health
  • C. Alcoholism / Substance Abuse
  • 3. Tribal Education/Health
  • 4. Urban Indian Education/Health
  • State and Local Agencies
  • Federal Agencies SAMHSA, Edn

15
Disconnect Between Education/Behavioral Health
  • Professionals are undertrained in one of the two
    domains
  • Students as patients are under diagnosed and
    under treated
  • Students have less opportunity for education
  • Neither system integrates well with medical,
    emergency, legal, and social services

16
Difficulties of System Integration
  • Separate funding streams and coverage gaps
  • Agency turf issues
  • Different philosophies
  • Lack of resources
  • Poor cross training
  • Consumer and family barriers

17
Different goals
Resource silos
One size fits all
Activity-driven
How are we functioning?
(Dale Walker,
Carl Bell, 7/03)
18
Best Practice
Culturally Specific
Outcome Driven
Integrating Resources
We need Synergy and an Integrated System
(Dale Walker, Carl Bell, 7/03)
19
BIA Schools
  • 184 elementary and secondary schools and
    dormitories (55) as well as 27 colleges
  • In 23 states
  • 60,000 total students
  • 238 different tribes
  • Majority of the schools are located in Arizona
    and New Mexico
  • Second greatest number of schools in the states
    of North Dakota and South Dakota
  • Third greatest lie in the northwest

20
Why should schools be involved?
  • Schools cannot achieve their mission of education
    when students problems are barriers to learning
    and development. From Carnegie Task Force on
    Education.
  • Schools are at times a source of the problem and
    need to take steps to minimize factors that lead
    to student alienation and despair.
  • Schools also are in a unique position to promote
    healthy development and protective buffers, offer
    risk prevention programs, and help to identify
    and guide students in need of special assistance.

21
Adolescent Problems In Schools
Alcohol Drug Use
Fighting and Gangs
Bullying
Weapon Carrying
School Environment
Sale of Alcohol and Drugs
Sexual Abuse
Unruly Students
Truancy
Attacks on Teachers Staff
Domestic Violence
Drop Outs
12
22
Emergency situation
  • Event where, in order to protect the people,
    goods and the environment, requires a quick
    response for which the normal procedures and
    resources of an organisation are adequate.

23
Disaster
  • Event, endangering the safety of people, goods
    and the environment, that exceeds the
    organisations normal response capabilities
    (resources or procedures)

24
When Does an Emergency Become a Disaster?
  • A disaster depends largely on the community
    itself. What is its size, its resources, its
    experience in dealing with a certain hazard.

25
Suicide A National Crisis
  • In the United States, more than 30,000 people die
    by suicide a year.1
  • Ninety percent of people who die by suicide have
    a diagnosable mental illness and/or substance
    abuse disorder.2
  • The annual cost of untreated mental illness is
    100 billion.3
  • 1 The Presidents New Freedom Commission on
    Mental Health, 2003.
  • 2 National Center for Health Statistics, 2004.
  • 3 Bazelon Center for Mental Health Law, 1999.

26
Our Native Community Issue
  • For every suicide, at least six people are
    affected.4
  • There are higher rates of suicide among survivors
    (e.g., family members and friends of a loved one
    who died by suicide).5
  • Communities are closely linked to each other,
    increasing the risk of cluster suicide.
  • 4 National Center for Health Statistics, 1999.
  • 5 National Institute of Mental Health, 2003.

27
(No Transcript)
28
Suicide Rates by Age, Race, and Gender 1999-2001
Source National Center for Health Statistics
29
Native Suicide A Multi-factorial Event
Psychiatric Illness Stigma
-Edn,-Econ,-Rec
Cultural Distress
Impulsiveness
Substance Use/Abuse
Hopelessness
Family Disruption Domestic Violence
Suicide
Family History
Negative Boarding School
Psychodynamics/ Psychological Vulnerability
Historical Trauma
Suicidal Behavior
30
Current Cluster Suicide Crisis in a Tribal
Community
  • 300 attempts in last 12 months
  • 70 attempts since November
  • 13 completions in 12 months
  • 8 completions in 3 months
  • 4 to 5 attempts per week
  • Some attempts are adult
  • Age range of completions 14-24 years of age
  • Most completed suicides are female
  • 80 Alcohol related
  • All hanging

31
Ecological Model
Individual
Peer/Family
Society
Community/Tribe
32
Suicide Individual FactorsRisk Protective
  • Mental illness
  • Age/Sex
  • Substance abuse
  • Loss
  • Previous suicide attempt
  • Personality traits Incarceration
  • Failure/academic problems
  • Cultural/religious beliefs
  • Coping/problem solving skills
  • Ongoing health and mental health care
  • Resiliency, self esteem, direction, mission,
    determination, perseverance, optimism, empathy
  • Intellectual competence, reasons for living

33
Suicide Peer/Family FactorsRisk Protective
  • History of interpersonal violence/abuse/
  • Bullying
  • Exposure to suicide
  • No-longer married
  • Barriers to health care/mental health care
  • Family cohesion (youth)
  • Sense of social support
  • Interconnectedness
  • Married/parent
  • Access to comprehensive health care

34
Suicide Community FactorsRisk
Protective
  • Isolation/social withdrawal
  • Barriers to health care and mental health care
  • Stigma
  • Exposure to suicide
  • Unemployment
  • Access to healthcare and mental health care
  • Social support, close relationships, caring
    adults, participation and bond with school
  • Respect for help-seeking behavior
  • Skills to recognize and respond to signs of risk

35
Suicide Societal FactorsRisk Protective
  • Western
  • Rural/Remote
  • Cultural values and attitudes
  • Stigma
  • Media influence
  • Alcohol misuse and abuse
  • Social disintegration
  • Economic instability
  • Urban/Suburban
  • Access to health care mental health care
  • Cultural values affirming life
  • Media influence

36
Four Phases of Emergency Management
  • Mitigation
  • Preparedness
  • Response
  • Recovery

37
Tips for talking to children after a disaster
  • Provide opportunities to talk about what they are
    seeing on television and to ask ?
  • Dont be afraid to admit you dont know all the
    answers
  • Answer ? At a level the child can understand
  • Establish a family emergency plan (Sense of doing
    something is helpful)
  • Monitor childrens TV watching..dont need to see
    event over over) Watch with children
  • Help kids to understand there are no bad emotions
  • Try to not focus on blame
  • In addition to tragic things seen, also help kids
    focus on good things such as heroic actions,
    reuniting of families, assistance offered by
    people throughout the world

38
Tips for children closer to disaster
  • Disasters often reawaken a childs fear of loss
    of own parents when parents are preoccupied with
    own fears consider family counseling
  • Families may permit some regressive behavior
    weaning off by leaving bedroom door open, night
    lights, extra time with parents
  • Parents may have trouble leaving child after a
    disaster,,,may be able to use childs problem as
    a way of asking for help themselves
  • Get the children into some sense of routine of
    school and play even if displaced
  • Teachers can help kids with art, and play
    activities, encouraging group discussions and
    presentations about the disaster

39
Stress Management
  • Mental health professionals with child/family
    training
  • Information, information, information
  • Provide energy outlets for kids
  • Provide parents with time away from kids
  • Provide best possible sleep environment
  • Therapeutic play (drawing, role play)

40
(No Transcript)
41
Lifetime, Annual and 30 Day Prevalence of
Intoxication Among 224 Urban Indian Youth
R. Dale Walker, M.D. (4/99) 100 completion
sample
42
Changes in Lifetime Substance Use Among Urban
Indian Youth Over Nine Years
Percentage ever used
Percentage ever used
R. Dale Walker, M.D. (4/99)

100 Completion
Sample
43
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
44
Reasons for Use
  • Momentary power
  • Freedom
  • Love
  • Euphoria
  • Peer acceptance
  • Alleviate pain
  • Boredom
  • Self concept problems
  • Loneliness
  • Loss
  • Nothingness
  • Depression
  • Shame

45
How Teens View Counseling
  • Witch Hunt
  • Helpless
  • Target
  • Danger
  • Waste of time

What to do
  • Non - judgmental
  • Honesty
  • Consistency
  • Confidentiality
  • Always a ? of accuracy

46
Prevention Programs Should . . . .
Target all Forms of Drug Use
. . .and be Culturally Sensitive
47
Prevention Programs Reduce Risk Factors
  • ineffective parenting
  • chaotic home environment
  • lack of mutual attachments/nurturing
  • inappropriate behavior in the classroom
  • failure in school performance
  • poor social coping skills
  • affiliations with deviant peers
  • perceptions of approval of drug-using behaviors

48
Prevention Programs Enhance Protective Factors
  • strong family bonds
  • parental monitoring
  • parental involvement
  • success in school performance
  • pro social institutions (e.g. such as family,
  • school, and religious organizations)
  • conventional norms about
  • drug use

49
Implications for Treatment
  • Teach adolescents how to cope with difficulties
    and adversity
  • Increase their repertoire of coping strategies
  • Cognitive therapy is most effective approach

50
WHAT ARE SOME PROMISING SCHOOL-BASED STRATEGIES?
51
Comprehensive school planning
  • Prevention and behavioral health
    programs/services on site
  • Handling behavioral health crises
  • Responding appropriately and effectively after an
    event occurs

52
American Indian Life Skills Curriculum
  • Build self-esteem
  • Identify emotions and stress
  • Increase communication, problem-solving skills
  • Recognize and eliminate self-destructive
    behaviors
  • Receive suicide information
  • Receive suicide intervention training
  • Set personal and community goals
  • Curriculum three times a week for 30 weeks in a
    required language arts class

53
Community Driven/School Based PreventionIntervent
ions
  • Public awareness and media campaigns
  • Youth Development Services
  • Social Interaction Skills Training Approaches
  • Mentoring Programs
  • Tutoring Programs
  • Rites of Passage Programs

54
Promising Strategies
  • Home visitation
  • Parent training
  • Mentoring
  • Social cognitive
  • Cultural

55
Effective Family Intervention Strategies
Critical Role of Families
  • Parent training
  • Family skills training
  • Family in-home support
  • Family therapy
  • Different types of family interventions are used
    to modify different risk and protective factors.

56
Its a Fact !
  • School officials must link to the larger
    community during all phases of emergency
    management.

57
Potential Organizational Partners
  • Education
  • Family Survivors
  • Health/Public Health
  • Mental Health
  • Substance Abuse
  • Law Enforcement
  • Juvenile Justice
  • Medical Examiner
  • Faith-Based
  • County, State, and Federal Agencies

58
Partnered Collaboration

Community-Based Organizations
Grassroots Groups
Research-Education-Treatment
59
Contact us at 503-494-3703 E-mail Dale Walker,
MD onesky_at_ohsu.edu Or visit our
website www.oneskycenter.org
About PowerShow.com