1 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 Addictions Prevention and Treatment Oklahoma City, Oklahoma February 2-3, 2004 Dale Walker, MD Patricia Silk Walker, PhD Douglas Bigelow, PhD Bentson McFarland, MD, PhD Elizabeth Hawkins, MPH, PhD Laura Loudon, MS

2 For more information, contact us at Dale Walker, MD Or visit our website:

3 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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6 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

7 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 5.State and Local Agencies 6.Federal Agencies: SAMHSA, VAMC, NIDA, NIAAA, NIMH

8 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

9 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

10 “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

11 Mission Identify and disseminate culturally appropriate T&P Enhance capabilities of educators and clinicians serving AI/AN; improve T&P for AI/AN Establish a resource for promotion of P&T Build consensus and collaboration; facilitate implementation of P&T 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 T&P Recruit AI/AN youth into education and training

12 Education ConsultationExcellence Opportunity

13 Education 1.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

14 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

15 Jack Brown Adolescent Treatment Center Alaska Native Tribal Health Consortium United American Indian Involvement Northwest Portland Area Indian Health Board Eastern U.S. Tribal Consortium Tribal Colleges and Universities One Sky Center National Indian Youth Leadership Project One Sky Center Partners

16 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

17 Products Website Database Curriculum Manuals Online seminars Colloquia Conferences Funding inventory

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19 Indigenous Knowledge 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 life’s needs. Definitions:

20 Traditional Medicine The sum total of health knowledge, skills and practices based upon theories, beliefs and experiences indigenous to different cultures…used in the maintenance of health. WHO 2002 Definitions:

21 Evidence-based Practices Interventions that show consistent scientific evidence of improving a person’s outcome of treatment and/or prevention in controlled settings. SAMHSA 2003 Definitions:

22 Best Practices 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 Definitions:

23 World Conference on Science Recommended that scientific and indigenous knowledge be integrated in interdisciplinary projects dealing with culture, environment and chronic illness A partnership begins!

24 ID Best Practice Best Practice Clinical/Services Research Traditional Healing Mainstream Practice

25 Circle of Care Best Practices Child & Adolescent Programs Prevention Programs Primary Care Emergency Rooms Traditional Healers A&D Programs Colleges & Universities Boarding Schools

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27 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

28 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

29 Partnered Collaboration Research-Education-Treatment Grassroots Groups Community-Based Organizations

30Recommendations 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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