1. 1 The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services Making Best Practices Work in Native Communities Anchorage, Alaska May 5-6, 2005 Dale Walker, MD Patricia Silk Walker, PhD Douglas Bigelow, PhD Bentson McFarland, MD, PhD Elizabeth Hawkins, MPH, PhD Laura Loudon, MS

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 Best Practice = Evidence-Based + Indigenous Knowledge

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6. 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. 7 American Indians Have same health disorders as general population Greater prevalence Greater severity Much less access to Tx Cultural relevance more challenging Social context disintegrated

8. 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. 9 Disconnect Amongst Addictions, Mental Health, and Medicine Professionals are undertrained in the other two domains Patients are underdiagnosed Patients are undertreated These systems do not integrate well with social services

10. 10 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

11. 11 How are we functioning? (Carl Bell, 7/03) One size fits all Different goals Resource silos Activity-driven

12. 12 We need Synergy and an Integrated System (Carl Bell, 7/03) Culturally specific Evidence based Integrating resources Integrating resources Outcome driven

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14. 14 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

15. 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. 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 Training and education

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18. 18 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:

19. 19 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:

20. 20 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:

21. 21 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:

22. 22 World Conference on Science Recommended that scientific and indigenous knowledge be integrated in interdisciplinary projects dealing with culture, environment and chronic illness. 1999 Evidence based + community knowledge = best practice A partnership begins!

23. 23 ID Best Practice Best Practice Clinical/services Research Traditional Healing Mainstream Practice

24. 24 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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26. 26 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

27. 27 Effective Interventions for Youth Family Therapy Case Management Therapeutic Communities Community Reinforcement Circles of Care Motivational Enhancement

28. 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. 29 Partnered Collaboration Research-Education-Treatment Grassroots Groups Community-Based Organizations

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