1. Methamphetamine and Suicide Prevention Initiative (MSPI) 101 KIMBERLY FOWLER, PHD AND WHITNEY HEWLETT NATIONAL COUNCIL OF URBAN INDIAN HEALTH

2. Session Objectives 1. To become aware of the impact of suicide and methamphetamine use in Indian Country with a special focus on Urban communities. 2. To understand the purpose and goals of the Methamphetamine and Suicide Prevention Initiative (MSPI) for Urban programs. 3. To become aware of MSPI best practices and lesson learned. 4. To gain strategies for community engagement and overcoming program challenges for developing and implementing culturally adapted programs. 5. To learn about resources for program support, evaluation, technical assistance and training opportunities.

3. Suicide and Methamphetamine Use: An Overview  Suicide impacts AI/AN communities at a greater rate than the overall U.S. population (16.93 vs 12.08 per 100,000) (3)  AI/AN youth, ages 10-24, are especially at risk for suicide compared to the overall AI/AN population (2 nd vs 8 th leading cause of death)  Suicide generally decreases with age among AI/AN which is in contrast to the overall U.S. population  Suicide has had a greater impact in recent years on AI/AN adults age 35 – 64  Lifetime rates of suicide attempts among AI/AN youth on reservations are slightly higher than among urban AI/AN youth (17.6% vs 14.3%)  Lifetime rates of suicidal ideation are significantly higher for AI/AN youth on reservations as compared to urban AI/AN youth: (32.6% vs 21%) Suicide among American Indians and Alaska Natives

4. Suicide and Methamphetamine Use: An Overview (continued) Risk Factors (Across Populations)  Prior suicide attempt(s)  Alcohol and drug abuse  Mood and anxiety disorders  Access to lethal means Risk Factors (Specific to AI/AN Populations)  Alcohol and drug use  Historical trauma  Alienation  Acculturation  Discrimination  Community violence  Mental health services access and use  Suicide contagion Risk Factors for Suicide

5. Suicide and Methamphetamine Use: An Overview (continued) Protective Factors (Across all Populations)  Effective mental health care  Connectedness to individuals, family, community, and social institutions  Problem-solving skills  Contacts with caregivers Protective Factors for AI/AN Populations  Community control  Cultural identification  Spirituality  Family connectedness Strengthening Protective Factors vs. Reducing Risk Factors

6. Suicide and Methamphetamine Use: An Overview (continued)  Meth is ranked as the most widely used illicit drug in the world after cannabis  Meth use is frequently associated with high risk sexual behavior (UCLA Report)  Meth usage among AI/AN is under-researched  Most data is anecdotal  Usage varies by region, age, gender, and tribe  According to NSDUH data for 2002 – 2006, AI/AN experience higher past year rates as compared to the overall U.S. population (1.4% vs 0.6%) (Forcehimes et al., 2011)  As of 2007, 40% of all AI/AN substance abuse treatment facilities were located in urban areas (UIHI, Sobriety Report)  Less than 1/5 of alcohol and other drug abuse treatment programs nationwide offer specialized services for AI/AN (UIHI, Sobriety Report) Methamphetamine Use among American Indians and Alaska Natives

7. Issues and Challenges: for Urban American Indians/Alaska Natives  Historical Trauma  Mental Health Disparities  Access to Care  Lack of licensed AI/AN providers  Perspectives on Mental Health Issues  Western approaches to medicine  Stigma around Mental Health

8. MSPI: An Introduction  The Methamphetamine and Suicide Prevention Initiative (1)  Authorized under the Synder Act of 1921(Indian Citizenship Act)  A 5-year demonstration project housed under IHS for IHS, Tribal, and Urban Indian Health Programs  Funds 130 projects across the U.S.  111 (MSPI-T) Tribal and IHS awardees  12 (MSPI-U) Urban grantees  2 (MSPI-Y) Youth services grantees  5 IHS Area Office Projects

9. MSPI Purpose and Goals  Purpose of MSPI-U (2):  To expand community-level access to effective, Urban AI/AN methamphetamine and/or suicide prevention and treatment programs  Goals of MSPI (1)  Prevent, reduce or delay the use and/or spread of methamphetamine abuse;  Build on the foundation of prior methamphetamine and suicide prevention and treatment efforts  Support the IHS, Tribes, and Urban Indian health organizations in developing and implementing Tribal and/or culturally appropriate methamphetamine and suicide prevention and early intervention strategies;  Increase access to methamphetamine and suicide prevention services;  Improve services for behavioral health issues associated with methamphetamine use and suicide prevention;  Promote the development of new and promising services that are culturally and community relevant; and  Demonstrate efficacy and impact

10. MSPI Funding Allocation: What can funds be used for?  Provide community-focused responses that enhance evidence-based or practice based methamphetamine and/or suicide prevention or treatment services or education programming  Coordinate services for communities to respond to their local methamphetamine and/or suicide crises  Participate in a nationally coordinated program focusing specifically on increasing access to methamphetamine and/or suicide prevention or treatment related activities among the Federal partners, Areas, Tribes, States, and academic or not-for-profit programs  Provide communities with needed resources to develop their own community-focused programs with preference for coordinated programming that maximizes the impact across communities and Tribal groups  Establish baseline data information related to methamphetamine abuse/suicides in the local communities  Adequately document the level of need for the community  Promote programs that will ensure measureable impact

11. Outcome Measures 1. The proportion of methamphetamine-using patients who enter a methamphetamine treatment program. 2. Reduce the incidence of suicidal activities (ideation, attempts) in AI/AN communities through prevention, training, surveillance, and intervention programs. 3. Reduce the incidence of methamphetamine abuse in AI/AN communities through prevention, training, surveillance, and intervention programs. 4. The proportion of youth who participate in evidence-based and/or promising practice prevention or intervention programs. 5. Establishment of trained suicide crisis response teams. 6. Increase tele-behavioral health encounters.

12. MSPI Urban Grantees Cohort 1Cohort 2 San Francisco, CA: Friendship House Association of American Indians, Inc. Santa Barbara, CA: American Indian Health and Service, Santa Barbara Minneapolis, MN: Indian Health Board of Minneapolis, Inc. Albuquerque, NM: First Nations Community Health Source Portland, OR: Native American Rehabilitation Association Fresno, CA: Fresno American Indian Health Project Omaha, NE: Nebraska Urban Indian Health Coalition, Inc. Reno, NV: Nevada Urban Indians, Inc. Sioux Falls, SD: South Dakota Urban Indian Health, Inc.San Diego, CA: San Diego American Indian Health Center Los Angeles, CA: United American Indian Involvement, Inc., Los Angeles Tucson, AZ: Tucson Indian Center, Inc. **Tulsa, OK: Indian Health Care Resource Center of Tulsa **Oklahoma City, OK: Oklahoma City Indian Clinic

13. MSPI Community Partners National Council of Urban Indian Health National Indian Health Board

14. NCUIH MSPI Roles  Provides Technical Assistance support to the 12 UIHP MSPI Grantees:  Collecting and Disseminating Information relevant to methamphetamine and suicide prevention, treatment, or recovery support.  Developing Resources Tools for MSPI including the development and implementation of a National Social Marketing Campaign on Meth/Suicide Prevention  One-on-One Individualized Technical Assistance Support to 12 grantees which includes direct consultation, coordination of national experts, and linking to other communities who are experts from experience

15. Tools and Trainings  Providing and coordinating trainings  Web-ex trainings in 2013-2014  Social Media & Suicide Prevention: Engaging our Urban American Indian Community  Building Evaluation Capacity  Integrated Behavioral Health & Primary Care Records: Myth or Reality?  How to Develop and Establish an Effective Program: One Year Planning Phases as a Key to Success (NIHB) **All Webinars are archived on the NCUIH website and/ or YouTube Page

16. Tools and Trainings – cont’d  Providing and coordinating trainings – cont’d  In-person Training in 2013-2014  Coordinating Urban presentations at National Meetings and Conferences  ACA/IHCIA in Urban Indian Communities- BH focus  NCUIH Annual Leadership Conference

17. Tools and Trainings – cont’d  Developing and coordinating Tools to Support  Tools for local evaluation and assessment (Evaluating Data Toolkit)  Community training materials  Training materials for engaging local partners  Sharing successful grant applications  Behavioral Health Community of Learning Sharepoint  Resources and Toolkits  BH Director’s COL monthly call (SPRC) for Peer-to-Peer sharing

18. NCUIH 2014-15 Main Objectives  Provide MSPI informational webinar/training to all Urban Indian Health Programs.  Develop suicide awareness day toolkit for American Indian/Alaska Native (AI/AN) communities and health organizations.  Develop and implement an annual national AI/AN suicide awareness day.  Serve as an active partner in the Action Alliance for Suicide Prevention, AI/AN Task Force.  Develop an online suicide crisis response training module to be launched on the IHS MSPI website.  Provide technical assistance to MSPI Urban pilot projects.

19. MSPI Achievements  Over 7,500 individuals initiated treatment for methamphetamine abuse  15,000 substance abuse and mental health encounters via telehealth  10,000 professionals and community members trained in suicide crisis response  400,000 encounters with youth provided as part of evidence-based and practice-based prevention activities

20. Examples from Urban MSPI Grantees  Nebraska Urban Indian Health Center (NUIHC) – Soaring over Meth and Suicide Program (SOMS)  Wellbriety Group Meetings  Hoops for Life Event  Fresno American Indian Health Project (FAIHP)  Phone App Development: Youth Suicide Prevention App  Substance Abuse Assessment, Treatment Referrals, and Outpatient Counseling  Indian Health Board of Minneapolis (IHB)  Bullying Prevention Programs  Here4areason Project

21. Issues and Challenges: Program Implementation  Program Recruitment and Retention  Transportation and Outreach  Coordination of Care  Integration of Care/Services  Evaluation

22. Resources and Best Practices  Curriculums and Tools:  Gathering of Native Americans (GONA) Curriculum (substance abuse prevention)  Positive Indian Parenting Curriculum  Mending Broken Hearts Curriculums (intergenerational trauma healing)  White Bison Sons and Daughters of Tradition Curriculums (substance abuse prevention)  The Native H.O.P.E Curriculum (youth suicide and substance abuse prevention)  American Indian Life Skills Curriculum (suicide prevention)  Motivational Interviewing

23. Resources and Best Practices (continued)  Training Programs and Guides  Umatter for Schools Youth Suicide Prevention (gatekeeper training)  Question, Persuade, Refer (QPR) (gatekeeper training)  To Live to See the Great Day that Dawns (suicide prevention plan development guide)  Agencies and Organizations:  Administration for Children and Families (https://www.acf.hhs.gov/)https://www.acf.hhs.gov/  Suicide Prevention Resource Center (http://www.sprc.org/)http://www.sprc.org/  White Bison (http://www.whitebison.org/)http://www.whitebison.org/  Native Wellness Institute  One Sky Center  SAMHSA’s Tribal Training and Technical Assistance Center (http://www.samhsa.gov/tribal-ttac)http://www.samhsa.gov/tribal-ttac  Strategies: Strengthening Organizations to Support Families & Communities  Urban Indian Health Institute (http://www.uihi.org/)http://www.uihi.org/

24. Resources and Best Practices (continued)  Evaluation (Screening Tools and Assistance):  Addiction Severity Index (ASI)  Steps for Conducting Research and Evaluation in Native Communities (SAMHSA paper)  Where’s the Logic in Logic Modeling? (NIHB archived presentation)  UIHI Evaluation Resource Page (http://www.uihi.org/projects/health-equity/evaluation/)http://www.uihi.org/projects/health-equity/evaluation/  Funding and Sustainability Resources  Healthy Native Communities Partnerships (http://www.hncpartners.org/HNCP/Home.html)http://www.hncpartners.org/HNCP/Home.html  Tribal Youth Program Finance Resource Page  Resources for Establishing Community Partnerships  Resources for Partnerships, UIHI (http://www.uihi.org/projects/health-equity/partnership/)http://www.uihi.org/projects/health-equity/partnership/  Community-Campus Partnerships for Health

25. IHS MSPI Website

26. Urban Grantee Page

27. Project Spotlight Page

28. Resources Page

29. Evaluation Toolkit

30. National Suicide Prevention Lifeline

31. MSPI Program Officer- Urban Ais Murray, MD, MHA (Shoshone/Ute) Public Health Advisor Division of Behavioral Health Office of Clinical & Preventive Services Indian Health Service Phone: 301-443-1539 Email: ais.murray@ihs.gov

32. NCUIH Contacts  Whitney Hewlett, MSPI Coordinator  whewlett@ncuih.org whewlett@ncuih.org  Kimberly Fowler, TARC Director  kfowler@ncuih.org kfowler@ncuih.org

33. Thank You!  QUESTIONS???