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The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services

Disparity of Health Services and Research: A National Strategy for Native Mental Health and Addictions Prevention

and Treatment

NAMI National Meeting, Washington, DC, June 30, 2006

Dale Walker, MD Patricia Silk Walker, PhD Douglas Bigelow, PhD

Bentson McFarland, MD, PhD Michelle Singer

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One Sky Center

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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

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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

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One Sky Center Partners

Jack Brown Adolescent Treatment Center

Alaska Native Tribal Health Consortium

United American Indian Involvement

Northwest Portland Area Indian Health Board

Na'nizhoozhi Center

Tribal Colleges and Universities

National Indian Youth Leadership Project

Cook Inlet Tribal Council

Tri-Ethnic Center for Prevention Research

Red Road

Prairielands ATTC

Harvard Native Health Program

One Sky Center

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One Sky Center Outreach

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What It’s All About!

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Presentation Overview

• Introduce One Sky Center• An Environmental Scan• Native Behavioral Health System Issues• Fragmentation and Integration• Integrated care approaches and interagency

coordination are best overall solutions

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Six Missions Impossible?• How do we define health, education, and

social 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?

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A Quiet Crisis: Federal Funding and Unmet Needs

in Indian Country, July 2003

Funding not sufficient to meet needs for:• Health care• Education • Public safety• Housing• Infrastructure development needed

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American Indian and Alaska Native Health Disparities

• Have same health disorders as general population

• Greater prevalence• Greater severity• Much less access to Tx• Cultural relevance more challenging• Social context disintegrated

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Agencies Involved in B.H. Delivery

1. Indian Health Service (IHS)A. Mental HealthB. Primary HealthC. Alcoholism / Substance Abuse

2. Bureau of Indian Affairs (BIA)A. EducationB. VocationalC. Social ServicesD. Police

3. Tribal Health4. Urban Indian Health5. State and Local Agencies6. Federal Agencies: SAMHSA, VAMC

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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

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How are we functioning? (Dale Walker, Carl Bell, 7/03)

One size fits allOne size fits all

Different goals Different goals Resource silosResource silos

Activity-drivenActivity-driven

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We need Synergy and an Integrated System: Community Mobilization

(Dale Walker, Carl Bell, 7/03)

Culturally Specific

Culturally Specific

Best Practice

Best Practice

IntegratingResources

IntegratingResources

Outcome Driven

Outcome Driven

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Identify Best Practice

Best Practice

Evidence Based

TraditionalHealing

MainstreamPractice

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Circle of Care

Best Practices

Child & Adolescent Programs

Prevention Programs

Primary Care

EmergencyRooms

TraditionalHealers

A&D Programs

Colleges & Universities

Boarding Schools

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Community MobilizationPartnered Collaboration

Treatment-Education-Research

Grassroots Groups

Community-BasedOrganizations

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Native Aspirations!

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Activities and Products• Motivational Interviewing Manual• Best Practices Monograph• Promising Programs Review• Suicide – Consultation List• Suicide Program Directory• Community Assessment Instrument• Traffic Safety Programs in Native Areas • School List of Native Students• Service Learning Program• Methamphetamine Treatment and Prevention• Suicide Prevention Website• Cognitive Behavior Therapy Manual• Schools/Colleges• HIV – AIDS• Tele Health• CDC

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Contact us at503-494-3703E-mail Dale Walker, MDonesky@ohsu.eduOr visit our website:www.oneskycenter.org