Evaluation of a Behavioral Health Program Integrating Traditional and Western Medical Practices for At Risk Urban American Indian Alaska Native Youth

Heart of the Sacred Circle Evaluation of a behavioral health program integrating traditional and western medical practices for at risk urban American Indian/ Alaska Native (AI/AN) youth Problem: Urban American Indian children, youth, and their families who need services for behavioral health are not getting it at a rate that it is needed. Program purpose: Aim 1. Heart of the Sacred Circle project is to identify and treat Native American and Alaskan Native children and youth and their families, who are at risk due to negative effects of behavioral health issues. The project utilizes a dual approach to healing: The Medicine Wheel approach to wellness and healing is used to attain balance in the family circle, while psychological, psychiatric, and medical services provide a Western component. Aim 2: Address the needs of Native children and families who have been identified through diagnosis or referral as having special needs or being at risk, and to increase the resiliency of such individuals and families. Recognizing that the Native American community is a continuation of the family, the Heart of the Sacred Circle’s ultimate goal is to make a difference in the community by strengthening its members. Program: Heart of the Sacred Circle Agency: an Urban Indian Health Organization Funding Source: Indian Health Service (IHS) Critique and Program Evaluation: This program upon examination was difficult to understand through the PRECEDE/PROCEED model and use of this model uncovered many flaws and inherent design problems with the program implementation and its evaluation. The results of my work are to suggest an evaluation plan based on questions, methods and ideas for analysis. There are no “results” for me to analyze. This program was begun in 2004, and is funded through IHS grant through 2006. The question the agency wished to have ultimately answered through this evaluation was whether this program should be sustained on limited and highly demanded agency funds after the grant ends. My recommendation is that this particular program should not be sustained in its current form. While there is likely a strong need for a program to increase services and increase clients served, there is not evidence that this program increased clients served. The program alludes to the need for wrap around services to remove barriers (related to social determinants) to accessing care, however they do not describe how this will be done or measured, and are therefore unable to convince us of their success and need for continued funding. I recommend that another program be designed with greater input from the actual clients who would be served, and that the PRECEDE/PROCEED model be used to design this program, implement it and evaluate the results. by Kristi Linsenmayer Department of Health Services Coherence of Program, Agency and Funding Source Objective: To provide a culturally guided program of direct services to children and youth who have been identified by referral sources as experiencing medical and behavioral health issues as a result of stressors related to diagnosis of organicity or at risk for development of or increased severity of behavioral health issues related to stressors or imbalance with in the family system. The organizations objectives are in line with the funding agencies. The organization is concerned with needs of urban Indians. IHS serves needs of all natives. Currently IHS funds 1% of its budget to urban programs. The organization in general agreement with increasing serves to improve health status. However, the main focus of the organization is on urban Indians. Over 61% of AI/ AN reside in urban areas. (US Census 2000) *The underlying social, educational, and cultural issues related to mental illness and behavioral health problems include poverty, lack of economic opportunity, limited educational alternatives, community breakdown, familial disruption, and stigma. *Key health indicators for behavioral health issues are homicide, suicide, alcohol and drug abuse. Violent deaths, unintentional injuries, homicide and suicide account for 75% of all mortality in the second decade of life for AI/AN. (Trends in Indian Health 2000-2001)