Strengthening Native Communities: Disaster Response and Mental Health Support

1. The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services Honoring Heritage: Strengthening Our Nations’ Spirits Los Angeles, California November 17, 2005 Dale Walker, MD Patricia Silk Walker, PhD Douglas Bigelow, PhD Bentson McFarland, MD, PhD, Michelle Singer

2. Native Aspirations!

3. Six Missions Impossible? • How do we define ourselves? • How do we define disaster? • How do we ask for help? • How do we get Federal and State agencies to work together and with us? • How do we build our communities? • How do we restore what is lost?

4. Disaster • FEMA: A natural or man-made event that negatively affects life, property, livelihood or industry often resulting in permanent changes to human societies, ecosystems and environment. • NHTSA: Any occurrence that causes damage, ecological destruction, loss of human lives, or deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community area. • NOAA: A crisis event that surpasses the ability of an individual, community, or society to control or recover from its consequences.

5. Overview • An Environmental Scan • Behavioral Health Care Issues • Fragmentation and Integration • Introduction to One Sky Center • Native Aspirations! • Introduce the SAMHSA Family • Best Practice = Evidence-Based + Indigenous Knowledge

9. Health Problems Alcoholism 6X Tuberculosis 6X Diabetes 3.5 X Accidents 3X Physicians 72/100,000 (US 242) 60% Over 65 live in poverty (US 27%)

10. AmericanIndians • Have same disorders as general population • Greater prevalence • Greater severity • Much less access to Tx • Cultural relevance more challenging • Social context disintegrated

11. 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

12. Disconnect Between Addictions / Mental Health • Professionals are undertrained in one of two domains • Patients are underdiagnosed • Patients are undertreated • Neither integrates well with medical and social service

13. 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

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

15. Best Practice Culturally Specific Outcome Driven Integrating Resources We need Synergy and an Integrated System (Carl Bell, 7/03)

17. Program Goals • Promote and nurture effective and culturally appropriate prevention and treatment • Identify and disseminate evidence-based prevention and treatment practices • Provide training and technical assistance • Help to expand capacity

18. Cook Inlet Tribal Council Alaska Native Tribal Health Consortium Tribal Colleges and Universities Northwest Portland Area Indian Health Board One Sky Center United American Indian Involvement National Indian Youth Leadership Project Jack Brown Adolescent Treatment Center Na'nizhoozhi Center One Sky Center Partners

19. 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

20. Native Aspirations!

23. 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.

24. 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

25. 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

26. 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

27. 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

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

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

31. Lifetime, Annual and 30 Day Prevalence of Intoxication Among 224* Urban Indian Youth R. Dale Walker, M.D. *100% completion sample

32. Changes in Lifetime Substance Use Among Urban Indian Youth * Over Nine Years Percentage ever used R. Dale Walker, M.D. * 100% Completion Sample

33. Age of Onset of Substance Use Among Urban American Indian Adolescents, by Substance Used R. Dale Walker, M.D. (5/2000) *Cohorts 4 & 5 were sampled every third year; recall and sampling bias apply

34. 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

35. 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

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

37. 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

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

40. SUBSTANCE ABUSE AND MENTAL HEALTH SERVICE ADMINISTRATION (SAMHSA)www.samhsa.gov Grant Opportunities, Website links, Publications 1-800-729-6686 1-800-487-4889 (TDD)

41. Fetal Alcohol Spectrum Disorders (FASD) Center for Excellence • The FASD Center For Excellence builds FASD State systems through: • Drug Courts and Family Courts • Training and technical assistance • Women in recovery summit • Birth mothers video • Materials/ resources for SA treatment systems • Public education materials for general audiences • Data analysis of SAMHSA’s national survey on drug use and health (NSDUH) • Inventory of prevention and treatment programs • State system meetings • Web site: www.fascenter.samhsa.gov

42. Centers for the Application of Prevention Technologies (CAPTs)http://www.captus.org/

43. Addiction Technology Transfer Centers (ATTC) http://www.nattc.org/contactUs.html

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