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Integrating Best Practices in Native Communities for Behavioral Health Care

This conference explores the challenges in delivering behavioral health care to Native communities and focuses on integrating evidence-based practices with indigenous knowledge. Topics include alcoholism, tuberculosis, diabetes, and accidents, and the need for an integrated system. The conference aims to promote effective prevention, treatment, and mental health services, identify and disseminate evidence-based practices, and provide training and technical assistance.

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Integrating Best Practices in Native Communities for Behavioral Health Care

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

  3. Overview • An Environmental Scan • Behavioral Health Care Issues • Fragmentation and Integration • Introduction to One Sky Center • Best Practice = Evidence-Based + Indigenous Knowledge

  4. 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%)

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

  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 • State and Local Agencies • Federal Agencies: SAMHSA, VAMC

  7. 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

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

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

  11. 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

  12. 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

  13. 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

  14. 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.

  15. 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

  16. 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

  17. 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

  18. 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 Evidence based + community knowledge = best practice

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

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

  21. 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

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

  23. 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

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

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