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 view - id: 1e64a8-ZDc1Z



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:

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

Number of Views:70
Avg rating:3.0/5.0
Slides: 75
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
A Guide for Native Suicide Prevention and
Intervention Programming
Dale Walker, MD Patricia Silk Walker, PhD
Doug Bigelow, PhD Laura Loudon, MS Michelle
Singer Oregon Health and Science University
IHS/SAMHSA Conference Albuquerque, New Mexico
June 12, 2007
2
Native Communities
Advisory Council / Steering Committee
One Sky Center
3
One Sky Center Partners
Tribal Colleges and Universities
Cook Inlet Tribal Council
Alaska Native Tribal Health Consortium
Prairielands ATTC
Red Road
Northwest Portland Area Indian Health Board
One Sky Center
Harvard Native Health Program
United American Indian Involvement
Jack Brown Adolescent Treatment Center
National Indian Youth Leadership Project
Tri-Ethnic Center for Prevention Research
Na'nizhoozhi Center
4
One Sky Center Outreach
5
(No Transcript)
6
Goals for Today
  • Background The environment and the system of
    care
  • The problem
  • Contributing factors
  • Warning signs
  • Prevention strategies
  • Indigenous Knowledge Evidence Based Knowledge
    Best Practice
  • Promising programs
  • Integrated care approaches are best for treatment
    of these chronic illnesses

7
Five Missions
  • How do we define our problems?
  • 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
Most Common Emotional Disabilities Among Native
Youth
  • Learning Disabilities
  • Post Traumatic Stress Disorder (higher in girls)
  • Conduct Disorder
  • Oppositional Defiant Disorder
  • Depression
  • Anxiety Disorders
  • Substance Use/Abuse Disorders
  • Developmental Disabilities

12
Six behaviors that contribute to serious health
problems
  • Tobacco use
  • Poor nutrition
  • Alcohol and other drug abuse
  • Behaviors resulting in intentional or
    unintentional injury
  • Physical inactivity
  • Risky sex

13
Native Health Problems
  • Alcoholism 6X
  • Tuberculosis 6X
  • Diabetes 3.5 X
  • Accidents 3X
  • Poverty 3x
  • Depression 3x
  • Suicide 2x
  • Violence?

14
American Indians
  • Have same disorders as general population
  • Greater prevalence
  • Greater severity
  • Much less access to Tx
  • Cultural relevance more challenging
  • Social context disintegrated

15
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, Justice

16
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

U .S. Commission on Civil Rights
17
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

18
Different goals
Resource silos
One size fits all
Activity-driven
How are we functioning? (Carl Bell, 7/03)
19
Best Practice
Culturally Specific
Outcome Driven
Integrating Resources
We need Synergy and an Integrated System (Carl
Bell, 7/03)
20
(No Transcript)
21
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.

22
CDC
                                      Suicide
Rate per 100,000 Population19811998
23
Suicide Among ages 15-17, 2001
Death rate per 100,000
2010 Target
Females
Males
Total
American Indian
White
Black
Hispanic
Asian
Source National Vital Statistics System -
Mortality, NCHS, CDC.
24
Suicide A Native Crisis
Source National Center for Health Statistics
2001
25
Age-Adjusted Suicide Death RatesCY 1996-1998
U.S. All Races (1997) 10.6
IHS Adjusted Total - All Areas 20.2
26
(No Transcript)
27
North Dakota Teen Suicide Rates
(2000-2004 rate per 100,000 teens 13-19 years old)
28
Disaster Defined
  • 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.

29
(No Transcript)
30
Suicide Warning Signs
  • Changes in behavior
  • Existence of crisis
  • Changes in classroom performance
  • Changes at home
  • Changes with peers

31
SUICIDE A MULTI-FACTORIAL EVENT
Psychiatric IllnessCo-morbidity
Neurobiology
Personality Disorder/Traits
Impulsiveness
Substance Use/Abuse
Hopelessness
Severe Medical Illness
Suicide
Family History
Access To Weapons
Psychodynamics/ Psychological Vulnerability
Life Stressors
Suicidal Behavior
32
Adolescent Problems In Schools
1. School Admin 2. Law 3. FBI 4. DEA 5. State
MH 6. State AD 7. Courts 8. Child Services
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
33
Key Adolescent Risk Factors
Aggressive/Impulsive
Depression
Substance Abuse
Trauma
34
(No Transcript)
35
The Intervention Spectrum for Behavioral
Disorders
T
r
e
a
t
m
e
n
t
C
a
s
e
I
d
e
n
t
i
f
i
c
a
t
i
o
n
S
t
a
n
d
a
r
d
T
r
e
a
t
m
e
n
t
n
o
f
o
r

K
n
o
w
n
i
Indicated Diagnosed Youth
M
t
D
i
s
o
r
d
e
r
s
n
a
e
i
v
n
e
t
r
e
P
n
C
o
m
p
l
i
a
n
c
e
a
Selective Health Risk Groups
n
w
i
t
h

L
o
n
g
-
T
e
r
m
c
e
T
r
e
a
t
m
e
n
t
(
G
o
a
l


R
e
d
u
c
t
i
o
n

i
n
R
e
l
a
p
s
e

a
n
d

R
e
c
u
r
r
e
n
c
e
)
A
f
t
e
r
c
a
r
e
Universal General Population
(
I
n
c
l
u
d
i
n
g
R
e
h
a
b
i
l
i
t
a
t
i
o
n
)
Source Mrazek, P.J. and Haggerty, R.J. (eds.),
Reducing Risks for Mental Disorders, Institute of
Medicine, Washington, DC National Academy
Press, 1994.
36
Spectrum of Intervention Responses
Thresholds for Action
No Problems
Mild Problems
Severe Problems
Moderate Problems
37
Ecological Model
Individual
Peer/Family
Society
Community/ Tribe
38
Environmental
Interpersonal societal
Stigma
Community
Tribal attitudes
Parents
Peers
National attitudes
Personality
Attitudes beliefs
Individual
Genetics
Cultural beliefs
Schools
Local legal
Interpersonal
State attitudes
Personal situations
Individual
Portrayal in media
39
Individual Intervention
  • Identify risk and protective factors
  • counseling
  • skill building
  • improve coping
  • support groups
  • Increase community awareness
  • Access to hotlines other help resources

40
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.

41
Implications for Treatment
  • Teach adolescents how to cope with difficulties
    and adversity
  • Increase their repertoire of coping strategies
  • Cognitive therapy is most effective approach

42
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

43
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

44
Sources of Strength
Family Support
Access to Mental Health
Positive Friends
Access to Medical
Caring Adults
Spirituality
Positive Activities
Generosity/Leadership
45
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

46
Effective Interventions for Youth
  • Family Therapy
  • Multisystemic Therapy
  • Case Management
  • Therapeutic Communities
  • Community Reinforcement
  • Circles of Care
  • Motivational Enhancement

47
Treatment Settings - Social Support A Native
Advantage
  • Tribal
  • Community
  • Family
  • Sibs
  • Peers
  • Individual

48
Cultural Approach
  • Original Holistic Approach
  • Psychopharmacology Approach
  • The unconscious has always been there
  • Group Therapy
  • Network Therapy
  • Recreational / Outdoors
  • Traditional Interventions
  • Indian is...

49
Possible Treatment/Prevention Activities
  • The Talking Circle
  • Smudging
  • Story telling
  • Traditional Healers
  • Medicine Person
  • Herbal remedies
  • Traditional ceremonies
  • Sweat Lodge
  • Traditional Experiences Preservation

50
(No Transcript)
51
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.

52
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

53
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

54
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

55
ID Best Practice
Best Practice
Clinical/services Research
Mainstream Practice
Traditional Healing
56
Circle of Care
Traditional Healers
Child Adolescent Programs
Primary Care
Best Practices
AD Programs
Boarding Schools
Colleges Universities
Prevention Programs
Emergency Rooms
57
What Is Integrative Medicine?
Wellness
Basic Science
CAM literacy
Patient Centered Care
Evidence Based Medicine
Cultural Sensitivity
Power Of the Mind
58
Principles of Integrative Medicine
  • It is better to prevent than to treat later.
  • Recognition of the interaction between body,
    mind, spirit, and environment.
  • Integrate the best of conventional and
    traditional medicine.
  • Belief that bodies respond uniquely, so treatment
    must be customized.
  • Belief in innate healing powers of the body.

59
WHAT ARE SOME PROMISING STRATEGIES?
60
Promising Practices for Suicide Prevention
  • ASIST
  • C-CARE/CAST
  • Columbia University Teen Screen
  • Means Reduction
  • Lifelines
  • Reconnecting Youth
  • ER intervention for attempters
  • Signs of Suicide
  • US Air Force program
  • Yellow Ribbon Suicide Prevention
  • American Indian Life Skills

http//www.sprc.org/featured_resources/ebpp/ebpp_f
actsheets.asp
61
Promising Strategies
  • Home visitation
  • Parent training
  • Mentoring
  • Heroes
  • Social cognitive
  • Cultural

62
Integrated Treatment
  • Premise treatment at a single site, featuring
    coordination of treatment philosophy, services
    and timing of intervention will be more effective
    than a mix of discrete and loosely coordinated
    services
  • Findings
  • decrease in hospitalization
  • lessening of psychiatric and substance abuse
    severity
  • better engagement and retention
  • (Rosenthal et al,
    1992, 1995, 1997 Hellerstein et al 1995.)

63
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

64
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.

65
Comprehensive school planning
  • Prevention and behavioral health
    programs/services on site
  • Handling behavioral health crises
  • Responding appropriately and effectively after an
    event occurs

66
(No Transcript)
67
Community Driven/School Based Prevention
Interventions
  • Public awareness and media campaigns
  • Youth Development Services
  • Social Interaction Skills Training Approaches
  • Mentoring Programs
  • Tutoring Programs
  • Rites of Passage Programs

68
Unified Services Plan
  • Mental health
  • Education/vocation
  • Justice/safety
  • Leisure/social
  • Parenting/family
  • Housing
  • Financial
  • Daily living skills
  • Physical health

69
Potential Organizational Partners
  • Education
  • Family Survivors
  • Health/Public Health
  • Mental Health
  • Substance Abuse
  • Traditional Healers
  • Elders
  • Law Enforcement
  • Juvenile Justice
  • Medical Examiner
  • Faith-Based
  • County, State, and Federal Agencies
  • Girls/Boys Clubs

70
Tribal Crisis Intervention Team
  • Tribal Council
  • Tribal Health Department
  • Community Health Representative
  • Indian Health Service
  • Behavioral Health Department
  • Emergency Room (a physician and nurse)
  • Ambulance team
  • Police Department
  • Fire Department
  • Middle and High School (Administrator, teacher,
    counselor)
  • Spiritual leaders
  • Alcohol and Drug Abuse Prevention programs
  • Youth Centers or other Youth programs
  • Peer Counselors
  • Parents known and trusted by the young people

71
Partnered Collaboration
State/Federal

Community-Based Organizations
Grassroots Groups
Research-Education-Treatment
72
Recommendations
  • Develop interagency task forces
  • Bring in supportive/interested state partners
  • Reach out to bring in new resources
  • Be clear, positive, and direct
  • Remember what this effort is all about

73
Coordination Strategies
  • formal agreements amongst behavioral health,
    primary health, schools, and justice
  • case management of behavioral health, justice,
    and primary health care
  • co-location of behavioral health, and primary
    health care services, access to school sites
  • delivery of mental, substance-use, and primary
    health care through clinically integrated
    practices of primary care providers.

74
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