Transcript Document

The American Indian/Alaska Native National Resource Center
for Substance Abuse and Mental Health Services
Mini-summit: Alcohol and Native Children
CWAG 2005 Annual meeting
Kapalua, Maui, Hawaii
August 1-4, 2005
Dale Walker, MD Patricia Silk Walker, PhD Douglas Bigelow, PhD
Bentson McFarland, MD, PhD Laura Loudon, MS Michelle Singer
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For information, contact us at
503-494-3703
E-mail
Dale Walker, MD
[email protected]
Or visit our website:
www.oneskycenter.org
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Overview
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An Environmental Scan
Behavioral Health Care Issues
Fragmentation and Integration
Introduction to One Sky Center
Our Children
Introduce the SAMHSA Family
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Health Problems
1.
2.
3.
4.
5.
Alcoholism 6X
Tuberculosis 6X
Diabetes 3.5 X
Accidents 3X
60% Over 65 live in poverty
(US 27%)
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
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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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Program Goals
• Promote and nurture effective and culturally
appropriate prevention and treatment
• Identify and disseminate evidence-based
prevention and treatment practices
• Provide training and technical assistance
• Help to expand capacity
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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
One Sky Center
United
American
Indian
Involvement
National Indian Youth
Leadership Project
Na'nizhoozhi Center
Jack Brown
Adolescent Treatment Center
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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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Lifetime, Annual and 30 Day Prevalence of
Intoxication Among 224* Urban Indian Youth
100
Percentage
80
60
40
20
0
T1
T2
T3
T4
T5
T6
T7
T8
T9
(n=224) (n=221) (n=215) (n=213) (n=206) (n=203) (n=199) (n=195) (n=186)
Ever intoxicated
R. Dale Walker, M.D.
Intoxicated past year
Intoxicated past 30 days
*100% completion sample
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Changes in Lifetime Substance Use Among
Urban Indian Youth * Over Nine Years
Chewing Tobacco
T1
T2
T3
T4
T5
T6
T7
T8
T9
Marijuana
Smoking Tobacco
Alcohol
0
20
40
60
80
(n=224)
(n=221)
(n=215)
(n=213)
(n=206)
(n=203)
(n=199)
(n=195)
(n=186)
100
Percentage ever used
R. Dale Walker, M.D.
* 100% Completion Sample
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Age of Onset of Substance Use Among Urban
American Indian Adolescents, by Substance Used
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14
12
10
Age 8
6
4
2
0
Alcohol
Smokeless
Cigarettes
Marijuana
Age Range
Cohort 1 (n=224)
13.64
13.29
13.05
14.30
1.25
Cohort 2 (n=66)
13.89
13.81
13.21
14.60
1.39
Cohort 3 (n=78)
12.99
13.97
13.64
13.84
0.98
Cohort 4*(n=72)
13.32
14.88
14.12
15.14
1.82
Cohort 5*(n=79)
13.64
12.17
12.75
13.20
1.47
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R. Dale Walker, M.D. (5/2000) *Cohorts 4 & 5 were sampled every third year; recall and
sampling bias apply
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SUBSTANCE ABUSE AND
MENTAL HEALTH SERVICE
ADMINISTRATION (SAMHSA)
www.samhsa.gov
Grant Opportunities, Website links, Publications
1-800-729-6686
1-800-487-4889 (TDD)
The SAMHSA Matrix
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The State Incentive Grants
• Implements SAMHSA’s Strategic
Prevention Framework to:
– 24 States, 2 Territories, 5 years @ 2.3 million per
year;
– Prevent onset and reduce progression of
substance abuse
– Reduce community substance abuse problems;
– Build State and community prevention capacity
and infrastructure;
– Uses National Outcome Measures and builds
Epidemiological Workgroups at the State and
Community level.
– Places emphasis on Underage Drinking
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Drug-Free Communities Program
• The GOALS are to:
– Reduce substance abuse among youth and adults by
addressing the factors in a community that increase the risk
of substance abuse and promoting the protective factors that
reduce risk of substance abuse.
– Establish and strengthen collaboration among communities,
drug courts, private nonprofit agencies, and federal, state,
local and tribal governments to support the efforts of
community coalitions to prevent and reduce substance
abuse among youth.
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The Drug-Free Communities Act (Pub. L. No. 105-20) was signed into law
on June 27, 1997. On December 14, 2001, Public Law 107-82, 115 Stat. 814
(2001), reauthorized the program for 5 years.
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Fetal Alcohol Spectrum Disorders
(FASD) Center for Excellence
• The FASD Center For Excellence builds
FASD State systems through:
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Drug Courts and Family Courts
Training and technical assistance
Women in recovery summit
Birth mothers video
Materials/ resources for SA treatment systems
Public education materials for general audiences
Data analysis of SAMHSA’s national survey on drug
use and health (NSDUH)
– Inventory of prevention and treatment programs
– State system meetings
– Web site: www.fascenter.samhsa.gov
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Centers for the Application of
Prevention Technologies (CAPTs)
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Addiction Technology Transfer
Centers (ATTC)
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Prevention Technology
Platform
• Web-based Application To Help Communities:
• Assess their needs, readiness and resources;
• Plan strategically to develop infrastructure and
sustainability;
• Select & implement evidence-based prevention
approaches; and
• Conduct evaluations measuring progress, impact, &
outcomes.
• Regularly updated database of on-line training curricula;
• A readiness roadmap and user-paths customized to individual
responses;
• Geo-mapping resources
• Access to national databases; and
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• Access to SAMHSA’s National Outcome Measures.
National Registry of Effective
Programs and Practices
(NREPP)
• SAMHSA’s new and improved NREPP:
• Will establish review criteria for the
identification and rating of strategies,
programs, policies, and activities; and
• Will expand to include community
coalitions, which will be rated by criteria
that will be developed by a panel of
leading researchers, evaluators and
coalition experts.
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