Title: The American IndianAlaska Native National Resource Center for Substance Abuse and Mental Health Serv
1The 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
2Native Communities
Advisory Council / Steering Committee
One Sky Center
3Program 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
4One Sky Center Outreach
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6One 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
7Native Aspirations!
8Six 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?
9Overview
- 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
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13Health 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)
14American Indians
- Have same disorders as general population
- Greater prevalence
- Greater severity
- Much less access to Tx
- Cultural relevance more challenging
- Social context disintegrated
15Agencies 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
16Disconnect 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
17Difficulties 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
18Different goals
Resource silos
One size fits all
Activity-driven
How are we functioning? (Carl Bell, 7/03)
19Best Practice
Culturally Specific
Outcome Driven
Integrating Resources
We need Synergy and an Integrated System (Carl
Bell, 7/03)
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21Indigenous 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.
22Knowledge 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
23Traditional 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
24Evidence-based Practices
Definitions
- Interventions that show consistent scientific
evidence of improving a persons outcome of
treatment and/or prevention in controlled
settings. - SAMHSA 2003
25Best 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
26World 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
27ID Best Practice
Best Practice
Clinical/services Research
Mainstream Practice
Traditional Healing
28Circle of Care
Traditional Healers
Child Adolescent Programs
Primary Care
Best Practices
AD Programs
Boarding Schools
Colleges Universities
Prevention Programs
Emergency Rooms
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30Healing 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
31Healing 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
32Traditional 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.
33What Is Integrative Medicine?
Wellness
Basic Science
CAM literacy
Patient Centered Care
Evidence Based Medicine
Cultural Sensitivity
Power Of the Mind
34Principles 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.
35The Intervention Spectrum for Behavioral
Disorders
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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.
36Ecological Model
Individual
Peer/Family
Society
Community/Tribe
37Interpersonal 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
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39Partnered Collaboration
Community-Based Organizations
Grassroots Groups
Research-Education-Treatment
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43Contact us at 503-494-3703 E-mail Dale Walker,
MD onesky_at_ohsu.edu Or visit our
website www.oneskycenter.org
44Métis 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
45Selected Treatment/Prevention Activities
- The Talking Circle
- Smudging
- Story telling
- Traditional healers
- Medicine Person
- Herbal remedies
- Traditional ceremonies
- Sweat Lodge
- Traditional Experiences Preservation
-