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

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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
Honoring Heritage Traditional and Contemporary
Medicine as Partners in Healing Anchorage,
Alaska February 18, 2006
Dale Walker, MD Patricia Silk Walker, PhD
Douglas Bigelow, PhD Bentson McFarland, MD,
PhD, Michelle Singer
2
Native Communities
Advisory Council / Steering Committee
One Sky Center
3
Program Goals
  • Promote and nurture effective and culturally
    appropriate prevention and treatment
  • Identify and disseminate evidence-based
    prevention and treatment practices
  • Provide training and technical assistance
  • Help to expand capacity

4
One Sky Center Outreach
5
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6
One Sky CenterRecognizes Traditional Healer
Rita Pitka Blumenstein For Her Lifetime of
Local, National and International Service to
Native Health Care
R. Dale Walker, MD, Director
February 18, 2006
7
Native Aspirations!
8
Six Missions Impossible?
  • How do we define ourselves?
  • How do we define health care?
  • 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?

9
Overview
  • An Environmental Scan
  • Behavioral Health Care Issues
  • Fragmentation and Integration
  • Introduction to One Sky Center
  • Native Aspirations!
  • Introduce the SAMHSA Family
  • Best Practice Evidence-Based Indigenous
    Knowledge

10
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11
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12
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13
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)

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

16
Disconnect Between Addictions / Mental Health
  • Professionals are undertrained in one of two
    domains
  • Patients are underdiagnosed
  • Patients are undertreated
  • Neither integrates well with medical and social
    service

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
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21
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.

22
Knowledge is a community resource It defines
and drives the community. Its
interconnectedness, its multifaceted and
multidimensional, its revered, its language,
communication and history. Its collective
memory. Its captured and maintained for future
generations. Its a reflection of life
experience. Its acquired through listening and
being empathetic. Its wisdom, strength and
leadership. Its a strategic resource. Its the
power of a good mind. Its imperfect. Its a
gift bestowed by the Creator.

Quote from Tom
Maracle
23
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

24
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

25
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

26
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

27
ID Best Practice
Best Practice
Clinical/services Research
Mainstream Practice
Traditional Healing
28
Circle of Care
Traditional Healers
Child Adolescent Programs
Primary Care
Best Practices
AD Programs
Boarding Schools
Colleges Universities
Prevention Programs
Emergency Rooms
29
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30
Healing Concepts 1
  • Healing takes time and time is healing
  • Healing occurs within the context of a
    relationship
  • Achieving energy of activation is necessary
  • Biological systems behave similarly across all
    levels
  • Lewis Mehl-Madrona 2002

31
Healing Concepts 2
  • Distractions of modern life inactivate
    catalysts for change
  • Modern culture teaches us to ignore emotions
  • Physiological change requires a break in usual
    daily rhythms
  • Ceremony helps the spiritual dimension of healing
  • Lewis Mehl-Madrona 2002

32
Traditional and complementary medicine is widely
and increasingly used in all regions of the world
Sources Eisenberg DM et al. 1998 Fisher P
Ward A, 1994 Health Canada, 2001 World Health
Organization, 1998 and government reports
submitted to WHO.
33
What Is Integrative Medicine?
Wellness
Basic Science
CAM literacy
Patient Centered Care
Evidence Based Medicine
Cultural Sensitivity
Power Of the Mind
34
Principles of Integrative Medicine
  • It is better to prevent disease than to have to
    treat it later.
  • Recognition of the interaction between body,
    mind, spirit, and environment.
  • A desire to integrate the best of conventional
    and unconventional medicine.
  • The belief that bodies respond uniquely, so
    treatment must be customized.
  • A belief in the innate healing powers of the
    body.

35
The Intervention Spectrum for Behavioral
Disorders
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Selective Health Risk Groups
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Universal General Population
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Source Mrazek, P.J. and Haggerty, R.J. (eds.),
Reducing Risks for Mental Disorders, Institute of
Medicine, Washington, DC National Academy
Press, 1994.
36
Ecological Model
Individual
Peer/Family
Society
Community/Tribe
37
Interpersonal societal
Environmental
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
38
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39
Partnered Collaboration

Community-Based Organizations
Grassroots Groups
Research-Education-Treatment
40
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41
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42
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43
Contact us at 503-494-3703 E-mail Dale Walker,
MD onesky_at_ohsu.edu Or visit our
website www.oneskycenter.org
44
Métis Health in Canada
  • 82 - Health care programs developed to reflect
    Aboriginal culture
  • 81 - Need for better language translation
    services
  • 67 - Return to Aboriginal medicine and healing
    practices would improve health
  • 60 - Do not know where to get traditional
    medicines or have access to traditional healing
    practices
  • 67 - would use traditional health more often if
    covered by health care system
  • 66 - would use traditional health practices more
    often if available through local health centre
  • 62 - attribute poor health to experience in
    Residential School system
  • 57 - Attribute poor health to the loss of land
    and culture

45
Selected Treatment/Prevention Activities
  • The Talking Circle
  • Smudging
  • Story telling
  • Traditional healers
  • Medicine Person
  • Herbal remedies
  • Traditional ceremonies
  • Sweat Lodge
  • Traditional Experiences Preservation
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