The American Indian/Alaska Native National Resource Center
for Substance Abuse and Mental Health Services
Disparity of Services and Research:
A National Strategy for Native Addictions
Prevention and Treatment
Oklahoma City, Oklahoma
February 2-3, 2004
Dale Walker, MD Patricia Silk Walker, PhD Douglas Bigelow, PhD
Bentson McFarland, MD, PhD Elizabeth Hawkins, MPH, PhD Laura Loudon, MS
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For more information, contact us at
503-494-3703
E-mail
Dale Walker, MD
onesky@ohsu.edu
Or visit our website: www.oneskycenter.org
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Overview
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Behavioral Health Care Issues
Introduction to One Sky Center
Projects and Products
Best Practice = Evidence-Based + Indigenous
Knowledge
• Integration: Training/Research Issues
• Technical Assistance Platform
• Recommendations
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American Indians
• Have same disorders as general
population
• Greater prevalence
• Greater severity
• Much less access to Tx
• Cultural relevance more challenging
• Social context disintegrated
• Less access to research and training
opportunities
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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
5. State and Local Agencies
6. Federal Agencies: SAMHSA, VAMC,
NIDA, NIAAA, NIMH
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Disconnect Between
Drug/Alcohol/ Mental Health
• Professionals are undertrained in at least one
of the domains
• Patients are underdiagnosed
• Patients are undertreated
• None integrates well with medical and social
service
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Difficulties of Program
Integration
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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
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“Envisioned as an innovative NRC
dedicated to identification and
fostering of effective and culturally
appropriate substance abuse
prevention and treatment.”
Charles Currie, SAMHSA, July, 2003
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Mission
• Identify and disseminate culturally appropriate T&P
• Enhance capabilities of educators and clinicians
serving AI/AN; improve T&P for AI/AN
• Establish a resource for promotion of P&T
• Build consensus and collaboration; facilitate
implementation of P&T
• Build a resource network to reach AI/AN population
nationwide (CAPT/ATTC, COE, CTN, consultants,
subcontractors)
• Coordinate with other agencies in provision of
training and technical assistance in T&P
• Recruit AI/AN youth into education and training
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Education
Consultation
Opportunity
Excellence
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Education
1. Post Doctoral Fellowship Program- McNeil
Consumer and Specialty Pharmaceuticals Funded
2. Special training programs in Medicine and
Nursing Schools Established
3. Partnership with 35 AI Colleges and Universities
– Career Teacher Program
– Develop core curriculum for Alcohol, Drug, and Mental
Health programs
– Mentorship Program
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Technical Assistance and
Consultation
• Association of First Nations Behavioral Health
Professionals Directory
• Provide technical assistance and
consultation as part of the national center
• Establish study groups for emerging issues
• Expand by developing partners
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One Sky Center Partners
Alaska Native Tribal
Health Consortium
Northwest Portland
Area Indian Health
Board
Tribal Colleges
and Universities
One Sky Center
Eastern
U.S. Tribal
Consortium
United
American
Indian
Involvement
National
Indian
Youth
Leadership
Project
Jack Brown
Adolescent Treatment Center
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Projects
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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
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Products
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Website
Database
Curriculum
Manuals
Online seminars
Colloquia
Conferences
Funding inventory
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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.
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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
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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
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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
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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
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ID Best Practice
Best Practice
Clinical/Services
Research
Mainstream
Practice
Traditional
Healing
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Circle of Care
Traditional
Healers
Primary Care
A&D
Programs
Best
Practices
Child &
Adolescent
Programs
Boarding
Schools
Colleges &
Universities
Prevention
Programs
Emergency
Rooms
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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
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Community Mobilization: What
makes a partnership work?
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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
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Partnered Collaboration
Grassroots
Groups
Community-Based
Organizations
Research-Education-Treatment
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Recommendations
• Partner with SAMHSA to support a research
and training focus for the One Sky Center
• Establish an AI/AN Clinical Research
Scholars Fellowship Program, CTN based.
• Create a career development awards
program for AI/AN faculty
• Establish Training Centers that attend to the
most critical training needs: behavioral
prevention and treatment intervention
science.
• Establish an Addictions Health Research
mentorship program to train future AI/AN
researchers.
ref Jose Szapocznik
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