Transcript Document

Northwest Portland Area Indian
Health Board
Methamphetamine Initiative
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Dr. Linda Bane Frizzell, Ph.D.
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The Northwest Portland Area Indian Health Board (NPAIHB or
Board) is a tribal organization comprised of the forty-three federally
recognized tribes in Idaho, Oregon, and Washington. Formed in
1972, NPAIHB provides support in health promotion, disease
prevention, health research, and legislative advocacy. NPAIHB’s
mission is ”to assist Northwest tribes to improve the health status
and quality of life of member tribes and Indian people in their
delivery of culturally appropriate and holistic health care.”
The Methamphetamine Problem in Indian
Country
History of the Problem:
Methamphetamine (meth) manufacturing, trafficking,
sales, and abuse are having a significant impact on
Indian individuals, children, families, and entire
communities. Indian Country’s meth problem stems from
the drug’s origins in the central valley of California in the
1990s and its steady spread eastward across the United
States. Indian communities in state after state have
been affected. The attraction of outside interests and the
prospects of tremendous monetary profits started to find
their way to reservations.
Today
Today, a number of tribes have reported serious meth problems among their
citizenry, including the San Carlos Apache Tribe, White Mountain Apache
Tribe and Navajo Nation in Arizona, the Cherokee Nation and Chickasaw
Nation in Oklahoma, the Oglala Sioux Tribe in South Dakota, and the Eastern
Shoshone and Northern Arapaho Tribes of the Wind River Reservation in
Wyoming.
Tribal leaders have described in vivid detail the effect this dangerous and
highly addictive drug is having in their communities. One example of the
devastating impact meth has had on a tribal community was provided by San
Carlos Apache Chairwoman Kathleen Ketchiyan before the Senate Indian
Affairs Committee earlier this year. She testified that as recently as 2005
approximately 25 percent of reservation births resulted in babies born under
the influence of meth. Another tribal leader has stated that an “entire
generation in my tribe is being lost to meth.”
Very Limited Data
• The 2003 National Survey on Drug Use and Health
suggests that about 5% of the population 12 years of
age and older report lifetime use of
methamphetamine; use in the past year is about
0.7%.
• Methamphetamine prevalence is much higher in
the Western US. Reports from the Community
Epidemiology Workgroup and the Arrestee Drug
Abuse Monitoring system suggest high indicators of
use in Hawaii, California, Oregon, Washington,
Idaho, Montana, Nevada and Utah.
Data Continued
• Although, there is little empirical data on the
prevalence of methamphetamine use among
American Indians and Alaska Natives, Jan Morley,
Assistant US Attorney, speaking to a gathering of
tribal representatives stated:
"Methamphetamine has become an epidemic in
our Indian Country. The actual scope of the
effects of methamphetamine remains an
unknown for most tribal communities. But more
importantly it has become epidemic in Indian
Country” (Renee Ruble, Aug. 24, 2003, © 2003
Duluth News Tribune).
The Impact of Methamphetamine on Indian
Communities
• Meth impacts all aspects of a tribal community –
culture, people, property, land – not just a few
individuals.
• Natural resources on Indian lands such as lakes,
public areas, and open fields are at risk due to the
dumping of toxic waste that is a by–product of the
meth manufacturing process.
• Violence associated with meth production,
trafficking, sales and use, BIA and tribal law
enforcement and tribal courts personnel have been
overtaken by meth-related arrests and cases.
Impact Continued
• Meth also has an impact on every social and
economic aspect of Indian communities. It has been
closely linked to child abuse and neglect, domestic
violence, suicide, reduced employability, degraded
physical health, and reduced academic
achievement.
• As a result, meth is overwhelming Indian social,
economic, education, and health programs. Even
more troubling, Indian Country’s isolated reservation
and rural communities are viewed by foreign drug
cartels as numerous enterprise zones with limited
law enforcement and resident populations in need of
income-producing opportunities.
The Federal/Tribal Response
• The first step taken to address the meth problem in
Indian Country was to acknowledge its existence.
• In October 2005, the U.S. Attorney General’s
Advisory Committee’s Native American Issues
Subcommittee met in Coeur d’Alene, Idaho, to
discuss the problem of meth in Indian Country.
• This historic meeting was attended by over 20
United States Attorneys, the White House Office of
National Drug Control Policy, the Bureau of Indian
Affairs Office of Justice Services (formerly the Office
of Law Enforcement Services), the Drug
Enforcement Administration (DEA), the Federal
Bureau of Investigation (FBI), and over 30 tribes.
Federal/Tribal Response Continued
• Consensus was reached that a meth epidemic
existed, that it was affecting most tribes in the United
States, and that the best way to tackle the problem
from a law enforcement perspective was for federal,
tribal and state/local law enforcement to work
cooperatively together, by pooling resources and
minimizing jurisdictional conflicts, in a common effort
to combat meth in Indian Country.
• In January 2006, the federal government followed
the lead of many states so that federal law now
requires that cold medications containing pseudoephedrine be under lock-and-key or behind
pharmacy counters.
New Challenges
• A new challenge for tribal, local, state and federal
authorities is in combating the smuggling of illegal
drugs from Mexico and Canada across tribal lands
that border or are traversed by the U.S.-Mexico and
U.S.-Canadian borders, such as the Tohono
O’odham Nation in Arizona, the St. Regis Mohawk
Reservation in New York State, and the northern
plains states (Montana, ND, MN).
• Approximately 80 percent of the current meth
supply in the U.S. is due to illegal smuggling from
Mexico.
October 4, 2006: HHS AWARDS $1.2 MILLION TO
ADDRESS METHAMPHETAMINE ABUSE IN NATIVE
AMERICAN COMMUNITIES
HHS Assistant Secretary for Health John Agwunobi today
announced the award of $1,175,100 in funds to the American
Association of Indian Physicians (AAIP) and its partners to
address the outreach and education needs of Native American
communities on methamphetamine (meth) abuse.
This initiative identifies a two-pronged approach, including a
national education and information outreach campaign and a
series of knowledge transfer activities that would help
communities understand promising practices in combating
methamphetamine abuse. It brings federal, tribal, state, and
local resources together to reach urban and rural Native
American communities and families.
Collaborators
Choctaw Nation, Crow Nation, Navajo Nation, Northern
Arapaho Tribe, and Winnebago Tribe. The five Tribes will
provide technical assistance and document promising
practices undertaken by their communities.
National Congress of American Indians, Washington, DC.
NCAI will work to provide technical assistance on a national
tribal scale.
Northwest Portland Area Indian Health Board (NPAIHB),
Portland OR. NPAIHB will contribute regional expertise and
will track data and trends within its region.
Collaborators Continued
Oregon Health and Science University-One Sky Center,
Portland, OR. (OHSU-OSC). OHSU-OSC will provide
expertise for behavioral health, mental health and substance
abuse regarding methamphetamine abuse.
United South and Eastern Tribes (USET), Nashville, TN.
USET will contribute regional expertise and will track data
and trends within its region.
NPAIHB Objectives
Objective 1: To define objective data elements available in
the IHS Resource Patient Management System (RPMS) and
similar data systems, such as Veteran’s Administration and
health maintenance organizations.
To explore data quality and identify barriers to effective
data availability.
 To develop strategies for data improvement in the
RPMS system to allow effective evaluation of
methamphetamine use/abuse in Indian Country.
NPAIHB Objectives
Objective 2: Coordinate with the United South & Eastern
Tribes (USET) organization with regard to national survey
development and implementation.
Activities: Act as lead agency to pilot questionnaire in
NPAIHB region and with NPAIHB partners in the
Methamphetamine Initiative. Test validity of questionnaire.
NPAIHB Objectives
Objective 3: To identify current treatment service
availability, referral, and use by AI/AN populations by the
end of the first
project year.
Activities: During the data collection phase of the project,
current effective prevention and treatment models will be
identified. Appropriate protocol will be followed to acquire
permission, from respective governing bodies to report these
case studies for program development/replication in other
communities. Qualitative assessment of the components of
these models will be performed using content analysis of
programmatic materials.
NPAIHB Objectives
Objective 4: To review products for methamphetamine tool
kit.
Develop a logic model for data analysis to use in Indian
Country by the end of the first year.
Develop analytical model for RPMS query and
description of RPMS for tool kit.
 Develop representative review committee of NPAIHB
board delegates to provide tribal review for tool kit.
Why is the Data So Important?
What Data do we have Now?
Literally None: National Data sets do not have American
Indian/Alaska Native samples large enough to statistically base
the size of Meth issues in our communities.
Most national surveys include AI/ANs in the “Others”
category.
Most national surveys use methods that are “not friendly”
to Indian Country, such as: telephone interviews, questions
that are not applicable to AI/Ans, no consideration of
diversity between tribes.
Universal Behavioral Health Data Issues
•Much of the data is based on paid episodic encounters.
•There are vast limitations for access to behavioral health
services.
•There are more limitations on “covered” (insurance)
services.
•There remains much stigma attached for individuals who
need behavioral health services
•Research to conduit primary epidemiological studies is
expensive.
RPMS and Methamphetamine
Coding
Wendy Wisdom, MSW
[email protected]
Phoenix Indian Medical
Center/Division of Behavioral
Health
Background
In the Spring 2005, the IHS/SAMHSA
Methamphetamine Initiative Workgroup was
established to help coordinate, collect, analyze,
and report information concerning Meth use in
Indian Country.
-Based on discussions by Service Matter
Experts across the country, the decision was
made to track with ICD-9 codes.
How are we documenting now?
Documentation of Meth Activities
by Clinicians/Data Entry


Diagnosis/Purpose of Visit-ICD9 codes
-only the Amphetamine codes
-discourage clinicians from using Drug Abuse
and/or Poly-substance Abuse codes
For local data collections within the BH
applications:
-Personal History Factors
-Patient and/or visit flags
What is RPMS?

RPMS is an integrated Public Health
information system




Composed of over 50 component applications
Patient and Population based clinical applications
Patient and Population based administrative
applications
Financially-oriented administrative applications
www.ihs.gov/CIO/RPMS
Resource Patient Management System
Case
Management
RCIS
Surgery
PCC Data Entry
Behavioral
Health System
Elder Care
Patient
Registration
PCC
Patient
Database
Laboratory
Dental
Women’s
Health
Emergency
Room
Immunization
Public Health
Nursing
Pharmacy
Radiology
Appointment
System
CHR
BHS Data Movement
Data Entry
Local RPMS
BHS
Database
Third Party
Billing
Site-selected
links to PCC
PCC
Database
Area
National BHS
Database
BHS
Export
Reports
Web-based
Reports
How representative are
these reports?
Multiple Data Sources


Data electronically exported to IHS National
Data Warehouse
Resource Patient Management System (RPMS)
clinical application exports



Behavioral Health System (continue to track per site)
Mental Health/Social Service (“old” application; all
sites should be using BHS)
Patient Care Component
Alaska
4
RPMS BH Sites by Area
Portland
12
California
41
Billings
29
Bemidji
25
Aberdeen
13
Navajo
23
Phoenix
Oklahoma
37 Albuquerque 20
24
Tucson
3
Nashville
23
Programs Using RPMS BHS
IHS
41%
Tribal
53%
Urban
6%
Monitoring your own BH export
Wendy encourages sites to check the
website to make sure their BH exports are
being received.
www.ihs.gov/cio/bh/ibh-bhs-v3-exports.asp
Data Issues in IHS




In the future, ICD-10 standard code set will include specific
codes for methamphetamine-related disorders and death. It will
not be adopted until at least 2011.
Funding and reporting are centralized, but administration and
governance are decentralized
Over half of Indian health programs are administered
autonomously by tribes. Submission of health data from tribes is
voluntary
We (IHS) must provide tools for quality care and data collection
that are attractive and meet the needs of all constituents, Tribal
and Federal. Various needs and priorities by all.
More Information
Northwest Portland Area Indian
Health Board
www.npaihb.org
Project Director-Dr. Linda Bane Frizzell, Ph.D.
[email protected]
527 SW Hall Street Suite 300 Portland, OR 97201
Phone: 218-821-6774 cell
Phone: 503-416-3270 Portland Office
Phone: 218-224-2639 MN Office
Fax: 503-228-8182
Safe Travels Home
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