1 / 48

Building on Success :

The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services. Building on Success : A National Strategy for Native Youth Mental Health Treatment and Prevention 2006 Juvenile Justice National Conference Washington, DC January 11, 2006.

geraldinem
Download Presentation

Building on Success :

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services Building on Success : A National Strategy for Native Youth Mental Health Treatment and Prevention 2006 Juvenile Justice National Conference Washington, DC January 11, 2006 Dale Walker, MD Patricia Silk Walker, PhD Douglas Bigelow, PhD Bentson McFarland, MD, PhD, Michelle Singer

  2. Native Communities Advisory Council / Steering Committee One Sky Center

  3. Native Aspirations!

  4. Overview • An Environmental Scan • Behavioral Health Care System Issues • Fragmentation and Integration • Discuss Suicide, Comorbidity, Disaster • Indigenous Knowledge + Evidence Based Knowledge = Best Practice • Integrated care approaches are best for treatment of these chronic illnesses

  5. Six Missions Impossible? • How do we define problems? • 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?

  6. 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%)

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

  8. 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

  9. 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

  10. 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

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

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

  13. Suicide: A National Crisis • In the United States, more than 30,000 people die by suicide a year.1 • Ninety percent of people who die by suicide have a diagnosable mental illness and/or substance abuse disorder.2 • The annual cost of untreated mental illness is $100 billion.3 1 The President’s New Freedom Commission on Mental Health, 2003. 2 National Center for Health Statistics, 2004. 3 Bazelon Center for Mental Health Law, 1999.

  14. Our Community Issue • For every suicide, at least six people are affected.4 • There are higher rates of suicide among survivors (e.g., family members and friends of a loved one who died by suicide).5 • Communities are linked to each other via a national network. • Healthy communities are stronger communities. 4 National Center for Health Statistics, 1999. 5 National Institute of Mental Health, 2003.

  15. Suicide Rates by Age, Race, and Gender 1999-2001 Source: National Center for Health Statistics

  16. SUICIDE: A MULTI-FACTORIAL EVENT Psychiatric IllnessCo-morbidity Neurobiology Personality Disorder/Traits Impulsiveness Substance Use/Abuse Hopelessness Severe Medical Illness Suicide Family History Access To Weapons Psychodynamics/ Psychological Vulnerability Life Stressors Suicidal Behavior

  17. Comorbidity Defined “Individuals who have at least one mental disorder as well as an alcohol or drug use disorder. While these disorders may interact differently in any one person….at least one disorder of each type can be diagnosed independently of the other.” - Report to Congress of the Prevention and Treatment of Co-Occurring Substance Abuser Disorders and Mental Disorders, SAMHSA, 2002

  18. Lifetime History Mental Disorder 22.5% Comorbidity 29% Alcohol Disorder 13.5% Comorbidity 45% Drug Disorder 6.1% Comorbidity 72% Regier, 1990

  19. Multiple Diagnoses Increase • Treatment seeking • Use of services • Likelihood of no services • Treatment costs • Poor outcome • Suicide risk • Dual diagnosis is an expectation, not an exception

  20. Disaster Defined • 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.

  21. The Intervention Spectrum for Behavioral Disorders T r e a t m e n t C a s e I d e n t i f i c a t i o n S t a n d a r d T r e a t m e n t n o f o r K n o w n i Indicated— Diagnosed Youth M t D i s o r d e r s n a e i n v t e r e P n C o m p l i a n c e a Selective— Health Risk Groups n w i t h L o n g - T e r m c e T r e a t m e n t ( G o a l : R e d u c t i o n i n R e l a p s e a n d R e c u r r e n c e ) A f t e r c a r e Universal— General Population ( I n c l u d i n g R e h a b i l i t a t i o n ) Source: Mrazek, P.J. and Haggerty, R.J. (eds.),Reducing Risks for Mental Disorders, Institute of Medicine, Washington, DC: National Academy Press, 1994.

  22. Ecological Model Society Community/Tribe Peer/Family Individual

  23. Environmental Interpersonal societal Stigma Community Tribal attitudes Parents Peers National attitudes Personality Attitudes beliefs Genetics Individual Cultural beliefs Schools Local legal Interpersonal State attitudes Personal situations Individual Portrayal in media

  24. Suicide: Individual FactorsRiskProtective • Cultural/religious beliefs • Coping/problem solving skills • Ongoing health and mental health care • Resiliency, self esteem, direction, mission, determination, perseverance, optimism, empathy • Intellectual competence, reasons for living • Mental illness • Age/Sex • Substance abuse • Loss • Previous suicide attempt • Personality traits Incarceration • Failure/academic problems

  25. Suicide: Peer/Family FactorsRiskProtective • Family cohesion (youth) • Sense of social support • Interconnectedness • Married/parent • Access to comprehensive health care • History of interpersonal violence/abuse/ • Bullying • Exposure to suicide • No-longer married • Barriers to health care/mental health care

  26. Suicide: Community FactorsRiskProtective • Access to healthcare and mental health care • Social support, close relationships, caring adults, participation and bond with school • Respect for help-seeking behavior • Skills to recognize and respond to signs of risk • Isolation/social withdrawal • Barriers to health care and mental health care • Stigma • Exposure to suicide • Unemployment

  27. Suicide: Societal FactorsRiskProtective • Urban/Suburban • Access to health care & mental health care • Cultural values affirming life • Media influence • Western • Rural/Remote • Cultural values and attitudes • Stigma • Media influence • Alcohol misuse and abuse • Social disintegration • Economic instability

  28. Addictions: 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

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

  30. 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.

  31. 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

  32. 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

  33. 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

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

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

  36. “Creating both vertical and horizontal partnerships at and between each level of government is essential for effective … prevention efforts; this requires overcoming traditional agency boundaries in order to focus on both broader populations and symptomatic individuals immediately in need of care.” Caine, E., Preventing Suicide, Attempted Suicide, and their antecedents Among Men in theMiddle Years of Life. Executive Summary of a Scientific Consensus Conference, 11-12 June2003, Washington, D.C.

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

  38. The good news and the bad news While there are no easy solutions to complex problems; there are complex solutions.

  39. Community Based PreventionInterventions • Public awareness and media campaigns • Youth Development Services • Social Interaction Skills Training Approaches • Mentoring Programs • Tutoring Programs • Rites of Passage Programs

  40. Effective Family Intervention Strategies: Critical Role of Families • Parent training • Family skills training • Family in-home support • Family therapy Different types of family interventions are used to modify different risk and protective factors.

  41. Suicide Prevention Resources • Suicide Prevention Resource Center http://www.sprc.org/ • Indian Health Service Director’s Initiatives http://www.ihs.gov/ • Office of Juvenile Justice Model Programs http://www.dsgonline.com/mpg2.5/mpg_index.htm • One Sky Center http://www.oneskycenter.org/ • Screening for mental health http://www.mentalhealthscreening.org/ • Jason Foundation http://www.jasonfoundation.com/home.html

  42. Addiction Resources • SAMHSA Co-occurring Disorders http://alt.samhsa.gov/Matrix/matrix_cooc.asp • National Institute of Alcohol Abuse and Alcoholism http://www.niaaa.nih.gov • National Institute of Drug Abuse http://www.nida.nih.gov • National Institute of Mental Health http://www.nimh.nih.gov • Treatment Improvement Protocol (TIP) Series • (800) 729-6686 • Monitoring the Future Study http://www.monitoringthefuture.org

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

More Related