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

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National Indian Youth Leadership Project. One Sky Center Partners. 16. Projects ... skills and practices based upon theories, beliefs and experiences indigenous to ... – PowerPoint PPT presentation

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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
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
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

3
Overview
  • An Environmental Scan
  • Behavioral Health Care Issues
  • Fragmentation and Integration
  • Introduction to One Sky Center
  • Best Practice Evidence-Based Indigenous
    Knowledge

4
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6
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)

7
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

8
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

9
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

10
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

11
Different goals
Resource silos
One size fits all
Activity-driven
How is it working?
(Carl Bell, 7/03)
12
Best Practice
Culturally specific
Outcome driven
Integrating resources
We need Collaboration, Integration, and Synergy
Community Mobilization
(Carl Bell, 7/03)
13
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14
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

15
One Sky Center Partners
16
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

17
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18
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.

19
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

20
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

21
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

22
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

23
ID Best Practice
Best Practice
Clinical/services Research
Mainstream Practice
Traditional Healing
24
Circle of Care
Traditional Healers
Child Adolescent Programs
Primary Care
Best Practices
AD Programs
Boarding Schools
Colleges Universities
Prevention Programs
Emergency Rooms
25
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26
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

27
Effective Interventions for Youth
  • Family Therapy
  • Case Management
  • Therapeutic Communities
  • Community Reinforcement
  • Circles of Care
  • Motivational Enhancement

28
Community MobilizationPartnered Collaboration

Community-Based Organizations
Grassroots Groups
Research-Education-Treatment
29
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