1. 1 The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services Mental Health in Native Communities: Strengthening Our System of Care HHS Region VIII Tribal Consultation Denver, Colorado June 8-9, 2005 Dale Walker, MD Steve Sawmell Patricia Silk Walker, PhD Douglas Bigelow, PhD Laura Loudon, MS One Sky Center

2. 2 For information, contact us at 503-494-3703 E-mail Dale Walker, MD onesky@ohsu.edu Or visit our website: www.oneskycenter.org

3. 3 Overview An Environmental Scan Behavioral Health Care Issues Fragmentation and Integration Introduction to One Sky Center SAMHSA Activities

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6. 6 American Indian and Alaska Native Health Disparities Have same health disorders as general population Greater prevalence Greater severity Much less access to Tx Cultural relevance more challenging Social context disintegrated

7. 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

8. 8 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

9. 9 How is it working? One size fits all Different goals Resource silos Activity-driven (Carl Bell, 7/03)

10. 10 We need Collaboration, Integration, and Synergy : Community Mobilization Culturally specific Best Practice Integrating resources Integrating resources Outcome driven (Carl Bell, 7/03)

11. 11 One Sky Center

12. 12 Program Goals Promote and nurture effective and culturally appropriate prevention, treatment, and mental health services Identify and disseminate evidence-based prevention, treatment, and mental health practices Provide training and technical assistance Help to expand capacity

13. 13 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

14. 14 Identify Best Practice Best Practice Evidence Based Traditional Healing Mainstream Practice

15. 15 Circle of Care Best Practices Child & Adolescent Programs Prevention Programs Primary Care Emergency Rooms Traditional Healers A&D Programs Colleges & Universities Boarding Schools

16. 16 Community Mobilization Partnered Collaboration Treatment-Education-Research Grassroots Groups Community-Based Organizations

17. SAMHSA Administrator’s Policy on Tribal Eligibility Tribal entities are eligible for all grants for which States are eligible unless there is a compelling reason to the contrary. Any reason for excluding Tribal entities from grant eligibility needs to be justified and approved by the Administrator.

18. 18 SAMHSA AI/AN Grants 2005 Drug-Free Communities Support Program New Circles of Care grants New Substance Abuse Treatment Capacity grants Suicide grants, one set-aside for a tribal organization. Child and Adolescent Mental Health and Substance Abuse State Infrastructure Grants Child Mental Health Systems of Care grants Youth/Schools Violence Prevention Recovery Community Services Program

19. 19 SAMHSA National Outcomes Measures Abstinence Employment/Education Crime and criminal justice Housing stability Access/Stability Retention Social connectedness Perception of care Cost effectiveness Use evidence based practice

20. 20 Technical Assistance to Tribes and Tribal Organizations Children’s Mental Health Initiative Circles of Care FASD Center for Excellence One Sky Center

21. 21 = OSC Technical Assistance Provision

22. 22 Region VIII Behavioral Health Issues Addiction –Crow Nation Suicide –Standing Rock –Red Lake Domestic Violence –Across regions Co morbidity –Across Regions Chart indicates deaths per 1000 people. Blue = AI, Burgundy = U.S. Average

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