1 The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services Exploring New Frontiers: A National Strategy for Native Behavioral Health Sioux Falls, South Dakota August 9-11, 2005 Dale Walker, MD Patricia Silk Walker, PhD Douglas Bigelow, PhD Bentson McFarland, MD, PhD Laura Loudon, MS Michelle Singer

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

3 Overview An Environmental Scan Behavioral Health Care Issues Fragmentation and Integration Introduction to One Sky Center Introduce the SAMHSA Family Best Practice = Evidence-Based + Indigenous Knowledge

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Health Problems 1.Alcoholism 6X 2.Tuberculosis 6X 3.Diabetes 3.5 X 4.Accidents 3X 5.Physicians 72/100,000 (US 242) 6.60% Over 65 live in poverty (US 27%)

7 American Indians Have same disorders as general population Greater prevalence Greater severity Much less access to Tx Cultural relevance more challenging Social context disintegrated

8 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

9 How are we functioning? (Carl Bell, 7/03) One size fits all Different goals Resource silos Activity-driven

10 We need Synergy and an Integrated System (Carl Bell, 7/03) Culturally specific Evidence based Integrating resources Integrating resources Outcome driven

11 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

12 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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14 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

15 One Sky Center Partners Jack Brown Adolescent Treatment Center Alaska Native Tribal Health Consortium United American Indian Involvement Northwest Portland Area Indian Health Board Na'nizhoozhi Center Tribal Colleges and Universities One Sky Center National Indian Youth Leadership Project Cook Inlet Tribal Council

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

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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 Lifetime, Annual and 30 Day Prevalence of Intoxication Among 224* Urban Indian Youth R. Dale Walker, M.D. *100% completion sample

28 Changes in Lifetime Substance Use Among Urban Indian Youth * Over Nine Years R. Dale Walker, M.D. * 100% Completion Sample Percentage ever used

29 Age of Onset of Substance Use Among Urban American Indian Adolescents, by Substance Used R. Dale Walker, M.D. (5/2000) *Cohorts 4 & 5 were sampled every third year; recall and sampling bias apply

30 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

31 Effective Interventions for Adults Cognitive/Behavioral Approaches Motivational Interventions Psychopharmacological Interventions Modified Therapeutic Communities Assertive Community Treatment Vocational Services Dual Recovery/Self-Help Programs Consumer Involvement Therapeutic Relationships

32 Effective Interventions for Youth Family Therapy Multisystemic Therapy Case Management Therapeutic Communities Community Reinforcement Circles of Care Motivational Enhancement

33 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

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

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SUBSTANCE ABUSE AND MENTAL HEALTH SERVICE ADMINISTRATION (SAMHSA) Grant Opportunities, Website links, Publications (TDD)

37 SAMHSAs’ Strategic Plan E FFECTIVENESS VISION A Life in the Community for Everyone Measure and report program performance Increase service availability Improve service quality A CCOUNTABILITY C APACITY MISSION Building Resilience and Facilitating Recovery

38 The SAMHSA Matrix

39 SAMHSA’s Strategic Prevention Framework Steps Sustainability & Cultural Competence Profile population needs, resources, and readiness to address needs and gaps Monitor, evaluate, sustain, and improve or replace those that fail Implement evidence- based prevention programs and activities Develop a Comprehensive Strategic Plan Mobilize and/or build capacity to address needs

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41 Comprehensive Community Strategies Primary Prevention Intervention Drug Court Recovery Support Relapse Prevention SPF, Coalitions & Drug Courts

42 The State Incentive Grants Implements SAMHSA’s Strategic Prevention Framework to: –24 States, 2 Territories, million per year; –Prevent onset and reduce progression of substance abuse –Reduce community substance abuse problems; –Build State and community prevention capacity and infrastructure; –Uses National Outcome Measures and builds Epidemiological Workgroups at the State and Community level. –Places emphasis on Underage Drinking

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44 Drug-Free Communities Program The GOALS are to: –Reduce substance abuse among youth and adults by addressing the factors in a community that increase the risk of substance abuse and promoting the protective factors that reduce risk of substance abuse. –Establish and strengthen collaboration among communities, drug courts, private nonprofit agencies, and federal, state, local and tribal governments to support the efforts of community coalitions to prevent and reduce substance abuse among youth. The Drug-Free Communities Act (Pub. L. No ) was signed into law on June 27, On December 14, 2001, Public Law , 115 Stat. 814 (2001), reauthorized the program for 5 years.

45 Fetal Alcohol Spectrum Disorders (FASD) Center for Excellence The FASD Center For Excellence builds FASD State systems through: –Drug Courts and Family Courts –Training and technical assistance –Women in recovery summit –Birth mothers video –Materials/ resources for SA treatment systems –Public education materials for general audiences –Data analysis of SAMHSA’s national survey on drug use and health (NSDUH) –Inventory of prevention and treatment programs –State system meetings –Web site:

46 Centers for the Application of Prevention Technologies (CAPTs)

47 Addiction Technology Transfer Centers (ATTC)

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