The American Indian

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The American Indian/Alaska Native National Resource Center for Substance Abuse and Mental Health Services Mental Health in Native Communities: Concepts and Care Johns Hopkins University - Bloomberg School of Public Health Baltimore, Maryland January 6, 2010 Dale Walker, MD Patricia Silk Walker, PhD Douglas Bigelow, PhD Bentson McFarland, MD, PhD, Laura Loudon, MS Michelle Singer An Interdisciplinary Approach to Understanding the Health of Native Americans

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"Indian Country benefits essentially from social insurance change legislation." If medicinal services change gets to be law, so does the Indian Health Care Improvement Act. Opens up new income stream for the Indian Health framework. New cash for long haul mind, malignancy screening and better emotional well-being treatment more extensive qualification for Medicaid Higher repayment rates in provincial zones. 12-21-2009.

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Empowering Tribal Nations The President's 2010 spending plan for the BIA - $2.3 billion – 7.1% expansion. "Self-assurance, power, self-government, strengthening, and independence are not digest ideas; they are the apparatuses that empower Indian Country to shape its own particular fate." Violence, occurrences of newborn child mortality, liquor addiction, and substance mishandle are far in overabundance of whatever is left of America Ken Salazar, Secretary of the Interior November 5, 2009

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IHS Budget and Goals The President's 2010 spending plan for the IHS - $4.03 billion - 13% expansion - biggest in 20 years. To recharge and reinforce association with tribes with regards to national wellbeing change, convey change to IHS To enhance the quality and access to tend to patients served by IHS To have all that we do be straightforward, responsible, reasonable, and comprehensive Yvette Roubideaux , MD, IHS Director. Feb 4, 2010

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Native Communities Advisory Council/Steering Committee One Sky Center

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One Sky Center Partners Tribal Colleges and Universities Cook Inlet Tribal Council Alaska Native Tribal Health Consortium Prairielands ATTC Red Road Northwest Portland Area Indian Health Board One Sky Center Harvard Native Health Program United American Indian Involvement Jack Brown Adolescent Treatment Center National Indian Youth Leadership Project Tri-Ethnic Center for Prevention Research Na'nizhoozhi Center

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One Sky Center Outreach

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Goals for Today An Environmental Scan Fragmentation and Integration Behavioral Health Care Issues Best Practice = Evidence-Based + Indigenous Knowledge - You do both Treatment and counteractive action

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Native Health Problems Alcoholism 6X Tuberculosis 6X Diabetes 3.5 X Accidents 3X Poverty 3x Depression 3x Suicide 2x Violence?

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American Indians Have same issue as all inclusive community Greater predominance Greater seriousness Much less access to Tx Cultural importance all the more difficult Social setting broke down

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Agencies Involved in B.H. Conveyance 1. Indian Health Service (IHS) A. Psychological wellness B. Essential Health C. Liquor addiction/Substance Abuse 2. Agency of Indian Affairs (BIA) A. Instruction B. Professional C. Social Services D. Police 3. Tribal Health 4. Urban Indian Health State and Local Agencies Federal Agencies: SAMHSA, VAMC, Justice

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Different objectives Resource storehouses One size fits all Activity-driven How are we working? (Carl Bell and Dale Walker 7/03)

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Best Practice Culturally Specific Outcome Driven Integrating Resources We require Synergy and an Integrated System (Carl Bell and Dale Walker 7/03)

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Behavioral Health Care Issues

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Adult Serious Mental Illness By Race/Ethnicity: 2001 SAMHSA Office of Applied Studies, 2001

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Frequent Mental Distress by Race/Ethnicity and Year Percent  American Indian/Alaskan Native**  African-American**  Hispanic  White**  Asian, Pacific Islander** ** Non-Hispanic Year * Zahran HS, et al. Self-Reported Frequent Mental Distress Among Adults — United States, 1993–2001. Habitats for Disease Prevention and Control, MMWR 2004;53(41):963-966.

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Mental Illness: A Multi-factorial Event Psychiatric Illness & Stigma Edu., Econ., Rec. Social Distress Impulsiveness Substance Use/Abuse Hopelessness Family Disruption/Domestic Violence Individual Family History Negative Boarding School Psychodynamics/Psychological Vulnerability Historical Trauma Suicidal Behavior

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Adolescent Problems In Schools Alcohol Drug Use Fighting and Gangs 1. School Admin 2. Law 3. FBI 4. DEA 5. State MH 6. State A&D 7. Courts 8. Kid Services Bullying Weapon Carrying School Environment Sale of Alcohol and Drugs Sexual Abuse Unruly Students Truancy Attacks on Teachers Staff Domestic Violence Drop Outs 12

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Key Adolescent Risk Factors Aggressive/Impulsive Substance Abuse Depression Trauma

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Tobacco utilize Poor sustenance Alcohol and other medication mishandle Behaviors bringing about purposeful or accidental harm Physical dormancy Risky sex Six practices that add to genuine medical issues:

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0 Suicide Among ages 15-17, 2001 Death rate for every 100,000 2010 Target Females Males Total American Indian White Black Hispanic Asian Source: National Vital Statistics System - Mortality, NCHS, CDC.

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Suicide: A Native Crisis Source: National Center for Health Statistics 2001

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North Dakota Teen Suicide Rates (2000-2004 rate for each 100,000 high schoolers 13-19 years of age)

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Disaster Defined FEMA : A characteristic or man-made occasion that adversely influences life, property, work or industry frequently bringing about lasting changes to human social orders, biological communities and condition. NHTSA : Any event that causes harm, environmental demolition, loss of human lives, or crumbling of wellbeing and wellbeing administrations on a scale adequate to warrant an unprecedented reaction from outside the influenced group range. NOAA : An emergency occasion that outperforms the capacity of an individual, group, or society to control or recuperate from its results.

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ADDICTION INVOLVES MULTIPLE FACTORS Biology/Genes Environment DRUG Brain Mechanisms Addiction

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Lifetime, Annual and 30 Day Prevalence of Intoxication Among 224* Urban Indian Youth R. Dale Walker, M.D. (4/99) *100% finish test

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Changes in Lifetime Substance Use Among Urban Indian Youth * Over Nine Years Percentage ever utilized R. Dale Walker, M.D. (4/99) * 100% Completion Sample

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Age of Onset of Drug Use Among Urban An IA (Walkers, 2008)

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Models of Care

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Domains Influencing Behavioral Health: A Native Ecological Model Risk Protection Individual Peers/Family Community/Tribe Society/Cultural

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Treatment Brief Intervention Universal/Selective Prevention Spectrum of Intervention Responses Thresholds for Action No Problems Mild Problems Severe Problems Moderate Problems

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The Intervention Spectrum for Behavioral Disorders Treatment C a s e I d e n t i f i c a t i o n S t a n d a r d T r e a t m e n t f o r K n o w n Indicated—Diagnosed Youth D i s o r d e r s Prevention Maintenance C o m p l i a n c e Selective—Health Risk Groups w i t h L o n g - T e r m T r e a t m e n t ( G o a l : R e d u c t i o n i n R e l a p s e a n d R e c u r e n c e ) A f t e r c a r e Universal—General Population ( I n c l u d i n g R e h a b i l i t a t i o n ) Source: Mrazek, P.J. furthermore, Haggerty, R.J. (eds.), Reducing Risks for Mental Disorders, Institute of Medicine, Washington, DC: National Academy Press , 1994.

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Risk and Protective Factors: Individual Risk Mental ailment Age/sexual orientation Substance manhandle Loss Previous suicide endeavor Personality qualities Incarceration Failure/scholarly issues Protective Cultural/religious convictions Coping/critical thinking abilities Ongoing wellbeing and psychological wellness mind Resiliency, self regard, course, mission, assurance, diligence, hopefulness, compassion Intellectual fitness, purposes behind living

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Individual Intervention Identify hazard and defensive elements directing expertise building enhance adapting bolster bunches Increase people group mindfulness Access to hotlines other help assets

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Effective Family Intervention Strategies: Critical Role of Families Parent preparing Family aptitudes preparing Family in-home bolster Family treatment Different sorts of family mediations are utilized to change distinctive hazard and defensive elements.

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Implications for Treatment Teach young people how to adapt to challenges and affliction Increase their collection of adapting procedures Cognitive treatment is best approach

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Sources of Strength Access to Mental Health Family Support Positive Friends Access to Medical Spirituality Caring Adults Positive Activities Generosity/Leadership

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Culture-Based Interventions Story revealing to Sweat Lodge Talking circle Vision journey Wiping of tears Drumming Smudging Traditional Healers Herbal cures Traditional exercises

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Effective Interventions for Adults Cognitive/Behavioral Approaches Motivational Interventions Psychopharmacological Interventions Modified Therapeutic Communities Assertive Community Treatment Vocational Services Dual Recovery/Self-Help Programs Consumer Involvement Therapeutic Relationships

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Definition: Indigenous Knowledge Local learning special to a given culture or society; it has its own particular hypothesis, logic, logical and sensible legitimacy, utilized as a premise f