Aberdeen Area Tribal Chairmen’s Health Board Consumer’s Conference

1. Aberdeen Area Tribal Chairmen’s Health BoardConsumer’s Conference October 26, 2005 AAIHS Behavior Health Activities and Update: Dr. Elaine Miller, Acting Director Division of Behavioral Health, AAIHS

2. The State of the Behavioral Health Program Problems, Programs, and Plans

3. Native Americans are four times more likely than the general population to commit suicide.Suicide rates were highest among 15 to 19 year-olds. During 1997-1998, Native American males had suicide rates almost five times higher than Native American females. • Rates remained unchanged over the • ten year period.

4. The highest rates of youth suicide occurred in the Alaska, Aberdeen, and Tucson Areas. These Areas had rates that were six to eight times greater than national rates • (11/100,000) and during clusters • (epidemics) on some reservations, it • is 150 times the US average.

5. Behavioral Health Problems in the Aberdeen Area

7. Suicide Data for the Aberdeen Area Indian Health Service

11. Disparity-Suicide • National rate of Suicide completions is: • 11/100,000 • Aberdeen Area rate is at least 18/100,000 average completions 2000-2005 • (national estimates 22-55/100,000) • Healthy people 2010 goal is 5/100,000

12. Methamphetamine Use

13. Traditionally, methamphetamine users have been Caucasian, but use is now expanding to Hispanic and Asian populations, and Tribal leaders are reporting increased use of methamphetamines by Native Americans as well.

14. 2005 Survey of ProgramsMethamphetamine use • 21 Indian Health Service sites • contacted by telephone regarding patient/client methamphetamine use. • Results : on the average 55% male and • 45% female : 25% were age 18-24 and 75% were 24 years or older • As an Area, service delivery points are seeing an average of 105 people per month that are definitely using methamphetamines.

15. Alcohol • Alcohol is related to the majority of these problems

16. Disparity-Substance Abuse • Recent reports have shown higher rates of substance use among American Indians or Alaska Natives compared with persons from other racial/ethnic groups. Among American Indian or Alaska Native youths aged 12 to 17, the rates of past month cigarette use, binge drinking, and illicit drug use were higher than those from other racial/ethnic groups. Sept 4, 2004

17. Behavioral Health Programs:Alcohol and Substance Abuse,YRTC,MH/SS,Involuntary

18. Alcohol and Substance Abuse • All alcohol programs are tribally operated under 638 contracts • The Alcohol Program Directors have their own association • Not well integrated into the system of care

19. Youth Regional Treatment Center (YRTC) • Until October 1,2005, YRTC was a service unit operating independently • Not well integrated into the health system of care • Underutilization of resources • Since the Aberdeen Area Tribes  recognize the importance of our youth , it was felt this was a key realignment • YRTC is now is a program under the Behavioral Health Director

20. Mental Health/ Social Services (MH/SS) • At a national level, MH/SS were combined in 1990 • One half are direct service and one half are 638 contracts • Some are integrated into the system of care, others are not

21. Involuntary Program • Oct. 1 ,2005 filled the specialist position • Since 1994, have been able to contain the cost by case management

22. Area Behavioral Health Program • Transitioning to the Behavioral Health Public Health Model formally since January 12, 2005. • Moving toward a more integrated model.

23. Dr Grims Initiatives- Dr. Grim's three major initiatives: Behavioral Health Chronic Disease Management Health Promotion/Disease prevention

24. Physical, Emotional,Social,Spiritual Behavioral Health

25. Change is Essential • This has been going on for years. • The numbers tell the story : • Suicide • Depression • Substance abuse • As one study of children in 2001 states: • “The results suggest an urgent need to improve mental health education, to screen for depression, and to provide necessary treatment for depression among Native American children.”

26. Area Director’s Re-Alignment • Area Director’s Initiatives-Integrated the programs into a Behavioral Health Model-January 12,2005 • …recently established a Division of Behavioral Health Program at the Area level. The Mental Health, Alcohol and Youth Regional Treatment Center Program Directors all report to the Director of Behavioral Health. • Area Director Elevated Behavioral Health to the Executive level of the organization and elevated the Qualifications to a medical officer.

27. Area Director’s Re-Alignment

28. This is MONUMENTAL

29. Aligning Strategic Plan and Organization to Data and Priorities • Area Director recognized the importance of of Grim's initiatives and the fact that Behavioral Health overlaps with the other two ( e.g. Depression and Alcoholism as chronic diseases and QPR as a suicide HP/DP activity) • Agency Area and tribes have identified the same priorities • The resources are being focused • Trudell Commission Health Status priorities

30. Accomplishments of the Area Behavioral Health from 1994 to present that make the realignment possible: • Initiatives: • Telemental Health • Chargemaster -mental health billing • Data: Suicide Data Base-GPRA-RPMS-Meth • Suicide Prevention-practice guidelines and toolkit • QPR-developing Northern Plains specific materials-best practices • Methamphetamine awareness and prevention • Palliative Care Team • CDs produced by Area • Involuntary Program kept within budget (Sparing CHS dollars)

31. Accomplishments of the Area Behavioral Health from 1994to present that make the realignment possible: • Behavioral Health-integrated services-Diabetes/depression/foot care /team • CISM-initiative • Collaborations • Workforce development-collaboration with universities

32. Accomplishments of the Area Behavioral Health from 1994to present that make the realignment possible: • Trainings: • Annual Behavioral Health Professional Development Conferences • Meth, QPR, CISM, Gangs, Assessments ,etc. • Collaborations: e.g.. AATCHB/Region VIII Suicide Prevention Conference-2006, Bruce Ramsay, Canadian traumatologist, University Of South Dakota, University Of North Dakota ,V.A., BIA-methamphetamine, child protection-JDC-Circle of care grants, First CCRF mental health deployment etc.

33. Behavioral Health Program Plans

34. Behavioral Health Program Plans • Public Health Model • Primary Prevention : Community Directed, Integrated Systems-screening • Secondary Prevention: for example early referral to Behavioral health • Tertiary Prevention: Contract Health Service and White vs. Califano

35. Plan • Hire highly qualified professionals • Collaborations • Interventional community based research • Overcome Stigma • Workforce: Ensure the Supply of Mental Health Services and Providers • Tailor Treatment to Age, Gender, Race, Culture • Reduce Barriers to Treatment

36. Questions