The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services

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The American Indian/Alaska Native National
Resource Center for Substance Abuse and Mental
Health Services
Disparity of Services and Research A National
Strategy for Native Behavioral Health Prevention
and Treatment Oregon Health and Sciences
University February 17, 2005
Dale Walker, MD Patricia Silk Walker, PhD
Douglas Bigelow, PhD Bentson McFarland, MD,
PhD Elizabeth Hawkins, MPH, PhD Laura Loudon,
MS
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• For more information, contact us at
• 503-494-3703
• E-mail
• Dale Walker, MD
• onesky_at_ohsu.edu
• Or visit our website www.oneskycenter.org

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Overview

• Behavioral Health Care Issues
• Introduction to One Sky Center
• Projects and Products
• Best Practice Evidence-Based Indigenous
  Knowledge
• Integration Training/Research Issues
• Technical Assistance Platform
• Recommendations

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American Indians

• Have same disorders as general population
• Greater prevalence
• Greater severity
• Much less access to Tx
• Cultural relevance more challenging
• Social context disintegrated
• Less access to research and training opportunities

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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, NIDA, NIAAA, NIMH

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Disconnect Between Drug/Alcohol/ Mental Health

• Professionals are undertrained in at least one of
  the domains
• Patients are underdiagnosed
• Patients are undertreated
• None integrates well with medical and social
  service

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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

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Envisioned as an innovative NRC dedicated to
identification and fostering of effective and
culturally appropriate substance abuse prevention
and treatment.
Charles Currie, SAMHSA, July, 2003
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Mission

• Identify and disseminate culturally appropriate
  TP
• Enhance capabilities of educators and clinicians
  serving AI/AN improve TP for AI/AN 
• Establish a resource for promotion of PT
• Build consensus and collaboration facilitate
  implementation of PT
• Build a resource network to reach AI/AN
  population nationwide (CAPT/ATTC, COE, CTN,
  consultants, subcontractors) 
• Coordinate with other agencies in provision of
  training and technical assistance in TP
• Recruit AI/AN youth into education and training

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American Indian people
Advisory Council
Steering Committee
Education
Opportunity
Consultation
Excellence
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Education

• Post Doctoral Fellowship Program- McNeil Consumer
  and Specialty Pharmaceuticals Funded
• 2. Special training programs in Medicine and
• Nursing Schools Established
• 3. Partnership with 35 AI Colleges and
  Universities
• Career Teacher Program
• Develop core curriculum for Alcohol, Drug, and
  Mental Health programs
• Mentorship Program

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Technical Assistance and Consultation

• Association of First Nations Behavioral Health
  Professionals Directory
• Provide technical assistance and consultation as
  part of the national center
• Establish study groups for emerging issues
• Expand by developing partners

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One Sky Center Partners
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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

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Products

• Website
• Database
• Curriculum
• Manuals
• Online seminars
• Colloquia
• Conferences
• Funding inventory

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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.

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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

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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

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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

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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

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ID Best Practice
Best Practice
Clinical/Services Research
Mainstream Practice
Traditional Healing
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Circle 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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Integrated Treatment

• Any mechanism by which treatment interventions
  for co-occurring disorders are combined within
  the context of a primary treatment relationship
  or service setting.
• -CSAT

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Community Mobilization What makes a partnership
work?

• Trust do away with stereotypes
• Real participation at all levels
• Build in incentives for all stakeholders
• Education and training of all stakeholders
• Dissemination of knowledge
• Enhanced communication
• Social to scientific interaction

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Partnered Collaboration

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

• Partner with SAMHSA to support a research and
  training focus for the One Sky Center
• Establish an AI/AN Clinical Research Scholars
  Fellowship Program, CTN based.
• Create a career development awards program for
  AI/AN faculty
• Establish Training Centers that attend to the
  most critical training needs behavioral
  prevention and treatment intervention science.
• Establish an Addictions Health Research
  mentorship program to train future AI/AN
  researchers. ref Jose
  Szapocznik

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