Aberdeen Area Tribal Chairmen

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Aberdeen Area Tribal Chairmens Health
BoardConsumers Conference

• October 26, 2005
• AAIHS Behavior Health Activities and Update Dr.
  Elaine Miller, Acting
• Director Division of Behavioral Health, AAIHS

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The State of the Behavioral Health Program

• Problems, Programs, and Plans

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•  
• Native Americans are four times more likely
  than the general population to commit
  suicide.Suicide rates were highest among 15 to
  19 year-olds. During 1997-1998, Native American
  males had suicide rates almost five times higher
  than Native American females.
• Rates remained unchanged over the
• ten year period.

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• The highest rates of youth suicide occurred in
  the Alaska, Aberdeen, and Tucson Areas. These
  Areas had rates that were six to eight times
  greater than national rates
• (11/100,000) and during clusters
• (epidemics) on some reservations, it
• is 150 times the US average.

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Behavioral Health Problems in the Aberdeen Area
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Suicide Data for the Aberdeen Area Indian
Health Service
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Disparity-Suicide

• National rate of Suicide completions is
• 11/100,000
• Aberdeen Area rate is at least 18/100,000 average
  completions 2000-2005
• (national estimates 22-55/100,000)
• Healthy people 2010 goal is 5/100,000

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Methamphetamine Use
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• Traditionally, methamphetamine users have been
  Caucasian, but use is now expanding to Hispanic
  and Asian populations, and Tribal leaders are
  reporting increased use of methamphetamines by
  Native Americans as well.

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2005 Survey of ProgramsMethamphetamine use

• 21 Indian Health Service sites
• contacted by telephone regarding patient/client
  methamphetamine use.
• Results on the average 55 male and
• 45 female 25 were age 18-24 and 75 were 24
  years or older
• As an Area, service delivery points are seeing an
  average of 105 people per month that are
  definitely using methamphetamines.

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Alcohol

• Alcohol is related to the majority of these
  problems

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Disparity-Substance Abuse

• Recent reports have shown higher rates of
  substance use among American Indians or Alaska
  Natives compared with persons from other
  racial/ethnic groups. Among American Indian or
  Alaska Native youths aged 12 to 17, the rates of
  past month cigarette use, binge drinking, and
  illicit drug use were higher than those from
  other racial/ethnic groups. Sept 4, 2004

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Behavioral Health ProgramsAlcohol and
Substance Abuse,YRTC,MH/SS,Involuntary
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Alcohol and Substance Abuse

• All alcohol programs are tribally
  operated under 638 contracts
• The Alcohol Program Directors have their own
  association
• Not well integrated into the system of care

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Youth Regional Treatment Center
(YRTC)

• Until October 1,2005, YRTC was a service unit
  operating independently
• Not well integrated into the health system of
  care
• Underutilization of resources
• Since the Aberdeen Area Tribes  recognize the
  importance of our youth , it was felt this was a
  key realignment
• YRTC is now is a program under the Behavioral
  Health Director

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Mental Health/ Social Services (MH/SS)

• At a national level, MH/SS were combined in 1990
• One half are direct service and one half are 638
  contracts
• Some are integrated into the system of care,
  others are not

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Involuntary Program

• Oct. 1 ,2005 filled the specialist position
• Since 1994, have been able to contain the cost by
  case management

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Area Behavioral Health Program

• Transitioning to the Behavioral Health Public
  Health Model formally since January 12, 2005.
• Moving toward a more integrated model.

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• Dr Grims Initiatives-

Dr. Grim's three major initiatives Behavioral
Health Chronic Disease Management Health
Promotion/Disease prevention

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Physical, Emotional,Social,Spiritual
Behavioral Health
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Change is Essential

• This has been going on for years.
• The numbers tell the story
• Suicide
• Depression
• Substance abuse
• As one study of children in 2001 states
• The results suggest an urgent need to improve
  mental health education, to screen for
  depression, and to provide necessary treatment
  for depression among Native American children.

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Area Directors Re-Alignment

• Area Directors Initiatives-Integrated the
  programs into a Behavioral Health Model-January
  12,2005
• recently established a Division of Behavioral
  Health Program at the Area level. The Mental
  Health, Alcohol and Youth Regional Treatment
  Center Program Directors all report to the
  Director of Behavioral Health.
• Area Director Elevated Behavioral Health to the
  Executive level of the organization and elevated
  the Qualifications to a medical officer.

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Area Directors Re-Alignment
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This is MONUMENTAL
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Aligning Strategic Plan and Organization to
Data and Priorities

• Area Director recognized the importance of of
  Grim's initiatives and the fact that Behavioral
  Health overlaps with the other two ( e.g.
  Depression and Alcoholism as chronic diseases and
  QPR as a suicide HP/DP activity)
• Agency Area and tribes have identified the same
  priorities
• The resources are being focused
• Trudell Commission Health Status priorities

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Accomplishments of the Area Behavioral Health
from 1994 to present that make the realignment
possible

• Initiatives
• Telemental Health
• Chargemaster -mental health billing
• Data Suicide Data Base-GPRA-RPMS-Meth
• Suicide Prevention-practice guidelines and
  toolkit
• QPR-developing Northern Plains specific
  materials-best practices
• Methamphetamine awareness and prevention
• Palliative Care Team
• CDs produced by Area
• Involuntary Program kept within budget (Sparing
  CHS dollars)

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Accomplishments of the Area Behavioral Health
from 1994to present that make the realignment
possible

• Behavioral Health-integrated services-Diabetes/dep
  ression/foot care /team
• CISM-initiative
• Collaborations
• Workforce development-collaboration with
  universities

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Accomplishments of the Area Behavioral Health
from 1994to present that make the realignment
possible

• Trainings
• Annual Behavioral Health Professional
  Development Conferences
• Meth, QPR, CISM, Gangs, Assessments ,etc.
• Collaborations e.g.. AATCHB/Region VIII Suicide
  Prevention Conference-2006, Bruce Ramsay,
  Canadian traumatologist, University Of South
  Dakota, University Of North Dakota ,V.A.,
  BIA-methamphetamine, child protection-JDC-Circle
  of care grants, First CCRF mental health
  deployment etc.

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Behavioral Health Program Plans
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Behavioral Health Program Plans

• Public Health Model
• Primary Prevention Community Directed,
  Integrated Systems-screening
• Secondary Prevention for example early referral
  to Behavioral health
• Tertiary Prevention Contract Health Service and
  White vs. Califano

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Plan

• Hire highly qualified professionals
• Collaborations
• Interventional community based research
• Overcome Stigma
• Workforce Ensure the Supply of Mental
  Health Services and Providers
• Tailor Treatment to Age, Gender, Race,
  Culture
• Reduce Barriers to Treatment

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Questions