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					  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 Behavioral Health
              Prevention and Treatment
                  Oregon Health and Sciences University
                           February 17, 2005


      Dale Walker, MD Patricia Silk Walker, PhD Douglas Bigelow, PhD
Bentson McFarland, MD, PhD Elizabeth Hawkins, MPH, PhD Laura Loudon, MS


                                                                          1
    For more information, contact us at
               503-494-3703
                   E-mail
              Dale Walker, MD
             onesky@ohsu.edu
Or visit our website: www.oneskycenter.org



                                             2
               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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      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
                                         6
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
                                               7
    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



                                                   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
“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
                                                      10
                    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
                                                        11
 Education     Opportunity




Consultation   Excellence




                             12
                    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


                                                             13
   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


                                               14
 One Sky Center Partners

                        Alaska Native Tribal
                        Health Consortium           Tribal Colleges
                                                    and Universities
Northwest Portland                One Sky Center
Area Indian Health                                                               Eastern
Board                                                                            U.S. Tribal
                                                                                 Consortium
      United
      American
      Indian
      Involvement

                     National
                     Indian
                     Youth
                                                   Jack Brown
                     Leadership                    Adolescent Treatment Center
                     Project




                                                                                               15
              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
                                             16
    Products

•   Website
•   Database
•   Curriculum
•   Manuals
•   Online seminars
•   Colloquia
•   Conferences
•   Funding inventory
                        17
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Definitions:

      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.



                                                  19
Definitions:

       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




                                              20
Definitions:

    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




                                                  21
Definitions:

               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




                                                  22
World Conference on Science
             A partnership begins!

• Recommended that scientific and indigenous
  knowledge be integrated in interdisciplinary
  projects dealing with culture, environment
  and chronic illness.
                                 1999




                                             23
              ID Best Practice

                    Best Practice


Clinical/Services                   Mainstream
    Research                         Practice


                     Traditional
                      Healing

                                            24
           Circle of Care
                Traditional
                Healers        Child &
Primary Care                   Adolescent
                               Programs

A&D               Best
                                   Boarding
Programs        Practices
                                   Schools

                              Colleges &
   Prevention
                              Universities
   Programs
                 Emergency
                 Rooms                        25
26 15
   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




                                               27
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

                                              28
Partnered Collaboration

Grassroots        Community-Based
Groups            Organizations




  Research-Education-Treatment


                                    29
         Recommendations
• 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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