Rose Weahkee, Ph.D.
Director, Division of Behavioral Health
Indian Health Service
National Indian Health Board
Board of Directors Meeting
January 23, 2012
Federal Efforts in
Suicide Prevention:
Indian Health Service
Indian Health Service
Suicide Prevention Initiative
 The National Suicide Prevention Initiative
addresses the tragedy of suicide in American
Indian and Alaska Native communities.
 The IHS National Suicide Prevention Initiative
builds on the foundation of the HHS “National
Strategy for Suicide Prevention” and the 11 goals
and objectives for the Nation to reduce suicidal
behavior and its consequences, while ensuring we
honor and respect Tribal traditions and practices.
Available at: www.ihs.gov/MedicalPrograms/Behavioral
IHS Suicide Prevention
Initiative
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Five strategic objectives:
Assist IHS, Tribal, and Urban Indian programs and
communities in addressing suicide utilizing community
level cultural approaches.
Identify and share information on best and promising
practices.
Improve access to behavioral health services.
Strengthen and enhance IHS’ epidemiological capabilities.
Promote collaboration between Tribal and Urban Indian
communities with Federal, State, national, and local
community agencies.
Promoting Collaboration
 The National Action Alliance for Suicide
Prevention was launched in Sept 2010 by HHS
Secretary Sebelius and Defense Secretary Gates
 The AI/AN Task Force, co-chaired by Dr. Yvette
Roubideaux, IHS Director, Mr. Larry Echohawk, Asst.
Sec. for Indian Affairs , and McClellan Hall, private
sector representative was formed to implement suicide
prevention strategies to reduce the rate of suicide in
AI/AN communities.
Suicide Listening
Sessions
Listening Sessions
 IHS, SAMHSA, and the Department of
Interior Bureau of Indian Affairs and
Bureau of Indian Education held ten
Tribal listening sessions across Indian
Country to seek input on how the
agencies can most effectively work in
partnership with AI/AN communities
to prevent suicide.
Listening Sessions
 Listening Sessions were conducted from November 2010 to
February 2011.
 Navajo Region – Nov. 15, 2010
 Rocky Mountain Region – Nov. 19, 2010
 Alaska Region- Nov. 30, 2010
 Great Plains Region – Dec. 2, 2010
 Southern Plains Region/ Eastern OK- Dec. 13, 2010
 Pacific Region – Dec. 21, 2010
 Southwest Region – Jan. 10, 2011
 Northwest Region – Jan. 12, 2011
 Eastern Region – Feb. 10, 2011
Listening Sessions
 The information gathered was used to build the
foundation of training and best practices program
featured in the Action Summits for Suicide
Prevention held in August 2011 in Scottsdale, AZ
and October 2011 in Anchorage, AK
TribalRecommendations
 Address Contributing Factors
 Suicide is a public health issue with many
contributing factors, including alcoholism,
substance abuse, poverty, unemployment,
and trauma.
 Recommendation: Contributing factors
should be included in overall suicide
prevention planning. Additional funding is
needed to address substance abuse and
domestic violence.
Tribal Recommendations
 Behavioral Health Staffing
 There exists a lack of culturally-competent
behavioral health professionals trained in
suicide and suicide related prevention and
intervention treatment modalities.
 Recommendation: Increase the availability of
behavioral health staff trained in suicide and
suicide related prevention and intervention
in Indian Country.
Tribal Recommendations
 Improvement of Services
 Current staffing levels, breadth of services and
hours of service do not meet the need for
community-based suicide prevention and
intervention activities.
 Recommendation: Expansion of services are
needed - Tele-psychiatry services, inpatient
psychiatric services, family support, positive
parenting services, safe houses, and
transportation services to improve access.
Tribal Recommendations
 Communication and coordination of
activities and resources between private and
public sector agencies need improvement.
 Recommendation: Federal partners should
work to coordinate stakeholders and Tribal
communities to improve communication
and enhance collaboration.
Tribal Recommendations
A Tribal Suicide Summit should be
held at the national level and in
Alaska that focuses on sharing best
or promising practice based suicide
prevention programs.
Action Summits for
Suicide Prevention
 Two Action Summits for Suicide Prevention were held
in Scottsdale AZ from August 1-4, 2011; and in Alaska
from October 25-27, 2011
 In total, over 1,000 attendees received preconference
training and attended multiple workshop tracks,
including suicide and substance abuse prevention,
serving at risk youth, clinical practice, incident
response, methamphetamine , public health
communications, and many more
Action Summits for
Suicide Prevention
Focus Areas:
 Trainings offered in best and promising
practices in suicide prevention
 Prevention/Screening Focus
 Intervention/Treatment Focus
 Aftercare/Postvention Focus
Action Summits for
Suicide Prevention
Objectives:
 To emphasize an action-focused approach to
suicide prevention.
 Presentation materials were combined to produce
a suicide prevention toolkit.
 Participants were encouraged to take toolkits back
to their communities for new program
implementation or to strengthen current program
sustainability.
Action Summits for
Suicide Prevention
 Summit toolkits available at:
 http://www.ihs.gov/suicidepreventionsum
mit/
 http://www.ihs.gov/suicidepreventionsum
mit/alaska
Action Summits for
Suicide Prevention
 Three major AI/AN Suicide Prevention and Behavioral
Health documents were launched at the Action
Summits:
o AI/AN National Suicide Prevention Strategic Plan
o AI/AN National Behavioral Health Strategic Plan
o AI/AN Behavioral Health Briefing Book
Next Steps
 Continue Federal Collaborations in partnership with
Tribes in the implementation of the SP Strategic Plan
 Continue improving access to culturally competent
behavioral health care
 Provide ongoing training for health care providers as
well as community members to enable comprehensive
community-based prevention
 Promote the use of culturally-based promising and
traditional practices in prevention of suicide
 Coordinate and leverage existing resources to better
meet the need for suicide prevention activities
Federal Efforts in
Violence Prevention:
Indian Health Service
IHS Sexual Assault Policy
 The Tribal Law and Order Act requires the IHS
Director to develop sexual assault policies and
protocols based on similar protocols established by
the Department of Justice (DOJ).
 IHS established its first formal Sexual Assault Policy
on March 23, 2011.
 The IHS consulted with Tribal leaders and received
comments for incorporation in future revisions.
Tribal Comments
 Common themes for IHS SA Policy Revisions:
 Expand policy to clinics
 Clarification on utilization of victim advocates
 Adopting timelines for policy development
 Referencing Tribal codes in the policy
 Clarification of transportation section of policy
 Provision of exams on-site, by referral, or combination
of both methods
 Removing certification requirements for sexual assault
examiners
Next Steps
 IHS planning recommendations for ongoing improvements
for domestic violence and sexual assault services:
 Complete revisions of the IHS Sexual Assault Policy
based on comments received from Tribes, Urban Indian
leadership, the DOJ and the GAO;
 Develop an IHS Sexual Assault Policy Implementation
and Monitoring Plan;
 Given the focus of the current IHS Sexual Assault Policy
on hospital-based care, develop a sexual assault policy
for all IHS facilities, such as outpatient clinics and
health stations;
Next Steps cont’d
 Offer SANE-SAFE-SART training and provide forensic
examination equipment for all 28 IHS and 17 Tribal
hospitals by December 2012;
 Develop and offer domestic violence/sexual assault
training and curriculum for Indian Health System
facilities; and
 Develop new/updated IHS policies and procedures for
domestic violence, child sexual abuse, and elder abuse.
IHS Partnerships
Strategies to address domestic violence and sexual assault
include collaborations and partnerships with:
 Consumers and their families,
 Tribes and Tribal organizations,
 Urban Indian health programs,
 Federal, State, and local agencies
 Public and private organizations
IHS and ACF
 Collaborated to fund over 35 sites to identify strategies and
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develop interventions to address domestic violence in
AI/AN communities.
Trained medical and nursing staff to screen for domestic
violence and to provide safety planning for all female
patients,
Forged community partnerships,
Developed policies and procedures on domestic violence.
Sites developed:
 culturally sensitive screening tools,
 policies and procedures,
 informational brochures.
IHS and DOJ
 The IHS and the DOJ Office for Victims of Crime (OVC)
entered into a partnership involving the Federal Bureau of
Investigation and the Department of the Interior to
develop the AI/AN SANE-SART Initiative.
 The goal of the SANE/SART Initiative is to address the
needs of sexual assault victims in Indian Country.
 To address this overall goal, the project will identify, assess,
and support existing SANE and SART efforts by providing
training and technical assistance resources for all of the
IHS and OVC funded SANE/SART programs, and through
the development of comprehensive SANE/SART
demonstration projects.
OVC SANE-SART AI/AN Initiative
Three tribal communities funded:
 Mississippi Band of Choctaw Indians
 Tuba City Health Care Corporation
 Southern Indian Health Council, Inc.
Three sites funded to:
 Identify a SANE-SART Coordinator
 Establish a framework for a SANE-SART Team
 Involve community stakeholders
 Conduct comprehensive needs assessment
 Develop a strategic plan to enhance and/or
create a sustainable, culturally relevant, victim
centered SANE/SART program.
IHS Priorities In Action
• National Tribal Advisory Committee on
Behavioral Health
• National Behavioral Health Work Group
• Methamphetamine and Suicide Prevention
Initiative
• Domestic Violence Prevention Initiative
National Tribal Advisory
Committee (NTAC) on
Behavioral Health
 The IHS National Tribal Advisory Committee on
Behavioral Health embodies all of the IHS priorities
 Elected Tribal officials from each IHS Area provide
recommendations and advice on the range of behavioral
health issues in Indian Country
 NTAC is the principal Tribal advisory group for all
behavioral health services to the IHS Director
 Provide recommendations on significant funding
allocations and service programs
 Develop long term strategic plans for Tribal and
Federal behavioral health programs
National Behavioral Health
Work Group (BHWG)
The IHS National Behavioral Health Work Group
works very closely with the NTAC to provide
collaborative links between the professional
community and national Tribal leadership:
• National technical advisory group to the NTAC and the
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Division of Behavioral Health
Comprised of mental health professionals from across the
country
Strengthen partnerships
Improve quality and access to care
Direct collaboration across Tribal and Federal behavioral
health system
What is the Methamphetamine and
Suicide Prevention Initiative (MSPI)
 Demonstration pilot program
 Provides $16.4 million annually to existing or
innovative Tribal, Tribal organizations,
Federally-Operated, and Urban Indian
health programs to provide
methamphetamine and/or suicide
prevention and treatment services.
NTAC MSPI Consultation
 Consultation and Collaboration over one year
 NTAC developed program and funding
distribution recommendations
 Director accepted those recommendations without
alteration
 Together developed innovative funding
mechanisms
 Together endorsed community developed and
delivered programs
MSPI
 Establish evidence based or practice based
methamphetamine and suicide prevention and
intervention pilot projects.
 Represent innovative partnerships with IHS to deliver
services by and for the communities themselves,
with a national support network for ongoing program
development and evaluation.
MSPI
 127 IHS, Tribal, Youth, Urban Pilot
Projects
 112 Tribal and IHS awardees
 Includes 3 Youth Regional
Treatment Centers (YRTCs)
 12 Urban grantees
 3 Tribal Youth grantees
MSPI Area Program
Recipients
Number of MSPI Recipients by Area
Number of MSPI Funded Recipients
25
22
20
17
15
15
11
10
11
9
8
8
6
9
7
5
2
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2
Year One Activities
Of those MSPI programs who have reported to date,
a total of 289,066 persons have been served through
both prevention and treatment activities. Prevention
activities include, but are not limited to:
 Evidence-based practice training
 Knowledge dissemination
 Development of public service announcements and
publications
 Coalition development
 Crisis hotline enhancement
Baseline Measures
Outcome Measure # 4: (66%)
The proportion of youth who participate in evidencebased and/or promising practice prevention or
intervention programs.
42,895 youth participating in EBP/PBE program
Outcome Measure # 5: (50%)
Establishment of trained suicide crisis response teams.
674 persons trained
Baseline Measures
Outcome Measure # 3: (44%) Reduce the incidence of
methamphetamine abuse in AI/AN communities
through prevention, training, surveillance, &
intervention programs.
4,370 persons with a methamphetamine disorder
Outcome Measure # 1: (38%) The proportion of
methamphetamine-using patients who enter a
methamphetamine treatment program.
1,240 persons entering treatment
Baseline Measures
Outcome Measure # 2: (80%)
Reduce the incidence of suicidal activities (ideation,
attempts) in AI/AN communities through prevention,
training, surveillance, & intervention programs.
14,242 persons reporting suicide-related activity
Outcome Measure # 6 (21%)
Tele-behavioral health encounters.
617 tele-behavioral health encounters
Tele-Behavioral Health
Program Highlights
 One program is using MSPI funds to renovate a “safe
room,” within their emergency department for suicidal
patients
 One program is establishing a peer-to-peer suicide
prevention program in 4 area high schools
 One program is implementing the only Tribal
operated residential methamphetamine treatment
facility in the Nation
Domestic Violence
Prevention Initiative (DVPI)
 The IHS Domestic Violence Prevention Initiative
(DVPI) is a nationally-coordinated demonstration
program aimed at addressing domestic violence
(DV), sexual assault (SA), and family violence
within American Indian and Alaska Native
communities.
NTAC and DVPI
• As it did with MSPI, the NTAC provided
recommendations on spending allocations and
program development.
• As with the MSPI, the IHS Director accepted the
NTAC recommendations without alteration.
DVPI Funding
 FY 2009 – funding for the amount of
$7,500,000 was provided for the DVPI
 FY 2010 – Congress appropriated an
additional $2,500,000 for a total of
$10,000,000 for FY10
65 DVPI Project Awardees
44 Tribal
8 SANE/ SAFE/SART
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4 Domestic Violence/Sexual Assault Projects
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14 Sexual Assault Prevention Projects
39 Domestic Violence Prevention Projects
13 Federal
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26
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Preliminary Findings
August 2010 – January 2011
• 56 programs reported data
• Over 220 project-affiliated positions created
• 21 interdisciplinary Sexual Assault Response
Teams (SARTs)
• Over 2,100 clients served
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1,602 received DV services
177 received SA services
395 received both DV/SA services
Services Provided
• Over 9,100 patients screened for DV.
• Over 3,300 referrals made for DV/SA
services, culturally-based services, & clinical
behavioral health services.
• Over 140 individuals received shelter
services.
• 48 adult and 18 child SAFE kits were
completed and submitted to Federal, State,
and Tribal law enforcement.
Sexual Assault Examiner Training
 2011:
 4 Regional Sexual Assault Examiner Trainings conducted; including
SART Training
 2012:
 Sexual Assault Examiner (SAE) Training will be offered to all 24/7
IHS and Tribal hospitals
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7 Regional Trainings
 Multidisciplinary/SART/Community response Training will be
provided
SART Training
 Training in 2012
 12 regional training sessions
 Offered to all 45 hospitals in 2012
 Will be provided prior to Sexual Assault Examiner
Training
 Core members for training:
 Sexual Assault Advocates
 Medical personnel
 Law Enforcement
 Prosecution
Forensic Equipment
 Forensic equipment will be purchased for IHS & Tribal
hospitals in 2012
 Needs assessment is currently being conducted for all
IHS & Tribal hospitals
 Will determine:
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Training needs
Forensic equipment needs
Federal Partners and Tribal
Nations are working
together to eliminate health
disparities among American
Indian and Alaska Native
people.
For More
Information
General IHS Information:
www.ihs.gov
Rose Weahkee, Ph.D.
Director, Division of Behavioral Health
Indian Health Service
801 Thompson Avenue, Suite 300
Rockville, MD 20852
Phone: (301) 443-2038
Email address: Rose.Weahkee@ihs.gov