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Disparity of Services and Research:

A national strategy to improve prevention and treatment of behavioral health issues among American Indian/Alaska Native populations, with a focus on integrating evidence-based practices and indigenous knowledge.

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Disparity of Services and Research:

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  1. 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

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

  3. 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

  4. AmericanIndians • 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

  5. 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 • State and Local Agencies • Federal Agencies: SAMHSA, VAMC, NIDA, NIAAA, NIMH

  6. 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

  7. 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

  8. “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

  9. 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

  10. American Indian people Advisory Council Steering Committee Education Opportunity Consultation Excellence

  11. Education • 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

  12. 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

  13. Alaska Native Tribal Health Consortium Tribal Colleges and Universities Northwest Portland Area Indian Health Board One Sky Center Eastern U.S. Tribal Consortium United American Indian Involvement National Indian Youth Leadership Project Jack Brown Adolescent Treatment Center One Sky Center Partners

  14. 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

  15. Products • Website • Database • Curriculum • Manuals • Online seminars • Colloquia • Conferences • Funding inventory

  16. 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.

  17. 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

  18. 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

  19. 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

  20. 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

  21. ID Best Practice Best Practice Clinical/Services Research Mainstream Practice Traditional Healing

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

  23. 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

  24. 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

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

  26. 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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