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Shakopee Mdewakanton Sioux Community Building Blocks to a Healthy Life July 21, 2008

Shakopee Mdewakanton Sioux Community Building Blocks to a Healthy Life July 21, 2008 Prior Lake, Minnesota. Healing Families, Finding Solutions. Native Communities. Advisory Council / Steering Committee. One Sky Center. One Sky Center Partners. Tribal Colleges and Universities.

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Shakopee Mdewakanton Sioux Community Building Blocks to a Healthy Life July 21, 2008

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  1. Shakopee Mdewakanton Sioux Community Building Blocks to a Healthy Life July 21, 2008 Prior Lake, Minnesota Healing Families, Finding Solutions

  2. Native Communities Advisory Council / Steering Committee One Sky Center

  3. 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

  4. One Sky Center Outreach

  5. 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

  6. 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?

  7. I491 Indian Country!

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

  9. AmericanIndians • Have same disorders as general population • Greater prevalence • Greater severity • Much less access to Tx • Cultural relevance more challenging • Social context disintegrated

  10. 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 • State and Local Agencies • Federal Agencies: SAMHSA, VAMC, Justice

  11. 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

  12. Different goals Resource silos One size fits all Activity-driven How are we functioning? (Carl Bell, 7/03)

  13. Best Practice Culturally Specific Outcome Driven Integrating Resources We need Synergy and an Integrated System (Carl Bell, 7/03)

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

  15. 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. Child 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

  16. Key Adolescent Risk Factors Aggressive/Impulsive Substance Abuse Depression Trauma

  17. 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

  18. Tobacco use • Poor nutrition • Alcohol and other drug abuse • Behaviors resulting in intentional or unintentional injury • Physical inactivity • Risky sex Six behaviors that contribute to serious health problems:

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

  20. Methamphetamine: Epidemiology

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

  22. Models of Care

  23. Ecological Model Society Community/ Tribe Peer/Family Individual

  24. Risk and Protective Factors: Individual • Risk • Mental illness • Age/gender • Substance abuse • Loss • Previous suicide attempt • Personality traits • Incarceration • Failure/academic problems • Protective • Cultural/religious beliefs • Coping/problem solving skills • Ongoing health and mental health care • Resiliency, self esteem, direction, mission, determination, perseverance, optimism, empathy • Intellectual competence, reasons for living

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

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

  27. 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.

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

  29. Treatment Settings - Social Support: A Native Advantage • Tribal • Community • Family • Siblings • Peers • Individual

  30. 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 Preservation AI/AN Prevention, Treatment, and Rehabilitation Interventions

  31. 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.

  32. 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

  33. 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

  34. 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

  35. ID Best Practice Best Practice Clinical/services Research Mainstream Practice Traditional Medicine

  36. Circle of Care Traditional Healers Child & Adolescent Programs Primary Care Best Practices A&D Programs Boarding Schools Colleges & Universities Prevention Programs Emergency Rooms

  37. What are some promising strategies?

  38. 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.)

  39. Comprehensive school planning • Prevention and behavioral health programs/services on site • Handling behavioral health crises • Responding appropriately and effectively after an event occurs

  40. 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

  41. Unified Services Plan • Case management should address: • Mental health • Education/vocation • Leisure/social • Parenting/family • Housing • Financial • Daily living skills • Physical health

  42. Partnered Collaboration State/Federal Community-Based Organizations Grassroots Groups Research-Education-Treatment

  43. – Albert Einstein “We cannot solve problems by using the same kind of thinking we used when we created them.”

  44. 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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