Transcript Healing Families, Finding Solutions

Healing Families, Finding
Solutions
Shakopee Mdewakanton Sioux Community
Building Blocks to a Healthy Life
July 21, 2008
Prior Lake, Minnesota
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One Sky
Center
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One Sky Center Partners
Cook Inlet Tribal Council
Alaska Native Tribal
Health Consortium
Northwest Portland Area
Indian Health Board
Tribal Colleges
and Universities
Prairielands ATTC
Red Road
One Sky
Center
United American
Indian Involvement
Harvard Native
Health Program
Jack Brown
Adolescent
Treatment Center
National Indian Youth
Leadership Project
Tri-Ethnic Center for
Na'nizhoozhi Center Prevention Research
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One Sky Center Outreach
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Goals for Today
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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
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Alcoholism 6X
Tuberculosis 6X
Diabetes 3.5 X
Accidents 3X
Poverty 3x
Depression 3x
Suicide 2x
Violence?
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 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,
Justice
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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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Different goals
Resource silos
One size fits all
Activity-driven
How are we functioning?
(Carl Bell, 7/03)
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Culturally
Specific
Best
Practice
Outcome
Driven
Integrating
Resources
We need Synergy and an Integrated
System (Carl Bell, 7/03)
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Mental Illness: A Multi-factorial Event
Psychiatric Illness
& Stigma
Edu., Econ., Rec.
Cultural Distress
Impulsiveness
Substance
Use/Abuse
Family Disruption/
Domestic Violence
Individual
Negative Boarding School
Historical Trauma
Hopelessness
Family History
Psychodynamics/
Psychological Vulnerability
Suicidal
Behavior
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Adolescent Problems In Schools
Fighting
and
Gangs
1. School Admin
2. Law
Alcohol
Drug
Use
Weapon
Carrying
Bullying
3. FBI
4. DEA
7. Courts
8. Child Services
Sexual
Abuse
Environment
5. State MH
6. State A&D
School
Sale of
Alcohol
and Drugs
Unruly
Students
Truancy
Attacks
on Teachers
Staff
Drop
Outs
Domestic
Violence
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Key Adolescent Risk Factors
Aggressive/Impulsive
Substance Abuse
Depression
Trauma
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Most Common Emotional
Disabilities Among Native Youth
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Learning Disabilities
Post Traumatic Stress Disorder
Conduct Disorder
Oppositional Defiant Disorder
Depression Disorders
Anxiety Disorders
Substance Use/Abuse Disorders
Developmental Disabilities
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Six behaviors that contribute to
serious health problems:
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Tobacco use
Poor nutrition
Alcohol and other drug abuse
Behaviors resulting in intentional or unintentional
injury
• Physical inactivity
• Risky sex
Suicide: A Native Crisis
AI Male
Black Male
AI Female
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Age Groups
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Source: National Center for Health Statistics 2001
85+
80-84
75-79
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
0
10-14
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5-9
Rate/100,000 .
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White Male
Methamphetamine:
Epidemiology
Methamphetamine:
Epidemiology
Past Month Illicit Drug Use among Youths Aged 12 to 17, by
Race/Ethnicity: 2002
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Adult Serious Mental Illness
By Race/Ethnicity: 2001
SAMHSA Office of Applied Studies, 2001
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Models of Care
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Ecological Model
Society
Community/
Tribe
Peer/Family Individual
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Risk and Protective Factors:
Individual
Risk
Mental illness
Age/gender
Substance abuse
Loss
Previous suicide attempt
Personality traits
Incarceration
Failure/academic problems
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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
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The Intervention Spectrum for
Behavioral Disorders
Case
Identification Standard
Treatment
for Known
Indicated—
Disorders
Diagnosed
Youth
Selective—
Health Risk
Groups
Universal—
General Population
Compliance
with Long-Term
Treatment
(Goal:Reduction in
Relapse 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.
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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
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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
Access to Mental Health
Access to Medical
Spirituality
Generosity/Leadership
Family Support
Positive Friends
Caring Adults
Positive Activities
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Treatment Settings - Social Support:
A Native Advantage
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Tribal
Community
Family
Siblings
Peers
Individual
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AI/AN Prevention,
Treatment, and Rehabilitation
Interventions
Story Telling
Talking Circles
Sweat Lodge
Ceremonies and Ritual
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Purification
Passages
Naming
Grieving
• Drumming, Singing,
Dancing
• Vision Quest
• Flute playing/meditation
• Reconciliation
• Mentoring
• Service Learning
• Traditional Experiences
Preservation
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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 decisionmaking 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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ID Best Practice
Best Practice
Clinical/services
Research
Mainstream
Practice
Traditional
Medicine
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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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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
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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 Plan
Case management should
address:
• Mental health
• Education/vocation
• Leisure/social
• Parenting/family
• Housing
• Financial
• Daily living skills
• Physical health
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Partnered Collaboration
State/Federal
Grassroots
Groups
Community-Based
Organizations
Research-Education-Treatment
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“We cannot solve
problems by using
the same kind
of thinking we used
when we created
them.”
– Albert Einstein
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Contact us at
503-494-3703
E-mail
Dale Walker, MD
[email protected]
Or visit our website:
www.oneskycenter.org 48