Shakopee Mdewakanton Sioux Community Building Blocks to a Healthy Life

July 21, 2008Prior Lake, Minnesota

Healing Families, Finding

Solutions

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One Sky

Center

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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

One Sky Center

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 Partners

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One Sky Center Outreach

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Goals for Today

• An Environmental Scan• Behavioral Health Care Issues• Fragmentation and Integration• Best Practice = Evidence-Based + Indigenous

Knowledge • You do both• Treatment and prevention

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Six Missions Impossible?How do we:

• Define ourselves?

• Define health care?

• Ask for help?

• Get Federal and State agencies to work together and with us?

• Build our communities?

• Restore what is lost?

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Native Health Problems

1. Alcoholism 6X

2. Tuberculosis 6X

3. Diabetes 3.5 X

4. Accidents 3X

5. Poverty 3x

6. Depression 3x

7. Suicide 2x

8. Violence?

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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

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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,

Justice

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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?(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 (Carl Bell, 7/03)

Culturally Specific

Culturally Specific

Best Practice

Best Practice

IntegratingResources

IntegratingResources

Outcome Driven

Outcome Driven

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Mental Illness: A Multi-factorial Event

Edu., Econ., Rec.Edu., Econ., Rec.

Family Disruption/Domestic ViolenceFamily Disruption/Domestic Violence

ImpulsivenessImpulsiveness

Negative Boarding SchoolNegative Boarding School

HopelessnessHopelessness

Historical TraumaHistorical Trauma

Family HistoryFamily History

SuicidalBehaviorSuicidal

Behavior

Cultural DistressCultural Distress

Psychiatric Illness& StigmaPsychiatric Illness& Stigma

Psychodynamics/Psychological VulnerabilityPsychodynamics/Psychological Vulnerability

Substance Use/AbuseSubstance

Use/Abuse

Individual

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Adolescent Problems In Schools

School

Environment

Bullying

Fighting and

Gangs

Alcohol Drug Use

Weapon Carrying

Sexual Abuse

Truancy

Domestic Violence

Drop Outs

Attacks

on Teachers

Staff

Unruly Students

Sale of Alcohol

and Drugs

1. School Admin

2. Law

3. FBI

4. DEA

5. State MH

6. State A&D

7. Courts

8. Child Services

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Key Adolescent Risk Factors

Aggressive/Impulsive

DepressionSubstance Abuse

Trauma

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Most Common Emotional Disabilities Among Native

Youth• Learning Disabilities• Post Traumatic Stress Disorder • Conduct Disorder• Oppositional Defiant Disorder• Depression Disorders• Anxiety Disorders• Substance Use/Abuse Disorders• Developmental Disabilities

Six behaviors that contribute to serious health problems:

• Tobacco use• Poor nutrition• Alcohol and other drug abuse• Behaviors resulting in intentional or unintentional

injury• Physical inactivity• Risky sex

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Suicide: A Native Crisis

Source: National Center for Health Statistics 2001

0

10

20

30

40

50

605-

9

10-1

4

15-1

9

20-2

4

25-2

9

30-3

4

35-3

9

40-4

4

45-4

9

50-5

4

55-5

9

60-6

4

65-6

9

70-7

4

75-7

9

80-8

4

85+

Age Groups

Rat

e/10

0,00

0 .

White Male AI Male Black Male AI Female

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Methamphetamine: Epidemiology

Past Month Illicit Drug Use among Youths Aged 12 to 17, by Race/Ethnicity: 2002

Methamphetamine: Epidemiology

24SAMHSA Office of Applied Studies, 2001

Adult Serious Mental Illness By Race/Ethnicity: 2001

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Models of Care

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Ecological Model

IndividualPeer/FamilySociety Community/Tribe

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Risk

Mental illnessAge/genderSubstance abuseLossPrevious suicide attemptPersonality traitsIncarcerationFailure/academic problems

Protective

Cultural/religious beliefsCoping/problem solving skillsOngoing health and mental health care Resiliency, self esteem, direction, mission, determination, perseverance, optimism, empathyIntellectual competence, reasons for living

Risk and Protective Factors: Individual

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The Intervention Spectrum for Behavioral Disorders

CaseIdentification Standard

Treatmentfor KnownDisorders

Compliancewith Long-TermTreatment(Goal: Reduction inRelapse and Recurrence)

Aftercare(Including

Rehabilitation)

Source: Mrazek, P.J. and Haggerty, R.J. (eds.), Reducing Risks for Mental Disorders, Institute of Medicine, Washington, DC: National Academy Press, 1994.

Indicated—Diagnosed Youth

Selective—Health RiskGroups

Universal—General Population

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Individual Intervention

• Identify risk and protective factors counseling skill building improve coping support groups • Increase community awareness• Access to hotlines other help resources

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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.

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Sources of Strength

Family Support

Positive Friends

Caring Adults

Positive ActivitiesGenerosity/Leadership

Spirituality

Access to Medical

Access to Mental Health

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Treatment Settings - Social Support:

A Native Advantage

• Tribal

• Community

• Family

• Siblings

• Peers

• Individual

AI/AN Prevention, Treatment, and Rehabilitation Interventions• Story Telling

• Talking Circles• Sweat Lodge• Ceremonies and Ritual

– Purification– Passages– Naming– Grieving

• Drumming, Singing, Dancing

• Vision Quest

• Flute playing/meditation

• Reconciliation

• Mentoring

• Service Learning

• Traditional Experiences

Preservation33

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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.

Definitions:

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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

Definitions:

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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

Definitions:

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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

Definitions:

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ID Best Practice

Best Practice

Clinical/servicesResearch

TraditionalMedicine

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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What are some promising strategies?

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Integrated Treatment

Premise: treatment at a single site, featuring coordination of treatment philosophy, services and timing of intervention will be more effective than a mix of discrete and loosely coordinated services

Findings:• decrease in hospitalization• lessening of psychiatric and substance abuse

severity• better engagement and retention

(Rosenthal et al, 1992, 1995, 1997; Hellerstein et al 1995.)

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Comprehensive school planning

• Prevention and behavioral health programs/services on site

• Handling behavioral health crises• Responding appropriately and effectively

after an event occurs

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Community Driven/School Based Prevention Interventions

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

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Unified Services PlanCase management should

address:• Mental health• Education/vocation• Leisure/social• Parenting/family• Housing• Financial• Daily living skills• Physical health

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Partnered Collaboration

Research-Education-Treatment

Grassroots Groups

Community-BasedOrganizations

State/Federal

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– Albert Einstein

“We cannot solve problems by using

the same kind of thinking we used when we created

them.”

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Contact us at503-494-3703

E-mailDale Walker, MDonesky@ohsu.edu

Or visit our website:www.oneskycenter.org