37th Annual Meeting R Dale Walker MD July 28 2008 Coeur dAlene Reservation Idaho The Indian Country Methamphetamine Initiative A Model for Integrated Community Based Care 1 2 One Sky Center ID: 797250
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Association of American Indian Physicians37th Annual MeetingR Dale Walker, MD July 28, 2008Coeur d’Alene Reservation, Idaho
The Indian Country Methamphetamine Initiative: A Model for Integrated Community Based Care
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One Sky Center
Advisory Council / Steering Committee
Native Communities
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Jack Brown
Adolescent Treatment Center
Alaska Native Tribal Health Consortium
United American Indian Involvement
Northwest Portland Area Indian Health Board
Na'nizhoozhi Center
Tribal Colleges and Universities
One Sky Center
National Indian Youth Leadership Project
Cook Inlet Tribal Council
Tri-Ethnic Center for Prevention Research
Red Road
Prairielands ATTC
Harvard Native Health Program
One Sky Center Partners
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One Sky Center Outreach
Slide55Goals for Today
Background: The environment and the system of careThe methamphetamine problemThe methamphetamine initiativeIntegrated care approaches are best for treatment of these chronic illnessesTreatment works!
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Slide99Methamphetamine Identified as the Primary Health/Community ConcernIn 2006, Tribal Round Table sessions, HHS Regional Tribal Consultations, and numerous tribal community gatherings with SAMHSA, OMH, and IHS identified Methamphetamine abuse as the primary health concern in Indian Country.
Slide1010Young Adults (18 to
25) Reporting Past Year Methamphetamine Use: 2002 to 2005
Source: SAMHSA, 2002-2005
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Methamphetamine: Epidemiology
Slide1212 Why is Methamphetamine so Devastating?Cheap, readily available
Stimulates, gives intense pleasureDamages the user’s brainParanoid, delusional thoughtsDepression when stop usingCraving overwhelmingly powerfulBrain healing takes up to 2 yearsWe are not familiar with treating it
Slide1313The Methamphetamine Effect
Slide14“Tribal leaders unveil new meth Initiative” Indian Country TodayCreate a National outreach campaign for all Native communities.Establish and transfer community based, promising practices for prevention and treatment.Work across Federal agencies for coordinated and consistent outreach strategy.
NCAI President, Joe Garcia June 15, 2007
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Slide15ICMI Partners15
Slide16Tribes Added in Second YearChippewa Cree, MontanaSan Carlos Apache, ArizonaSalt River, ArizonaYakama, Washington Welcome!
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Slide1717Clinical Challenges for Treatment of Methamphetamine AddictionPoor treatment engagement ratesHigh dropout ratesSevere paranoiaHigh relapse rates
Ongoing episodes of psychosisSevere cravingProtracted dysphoriaMany patients may require medical/psychiatric supervision and need
ongoing treatment with antipsychotic medications
Slide1818ID Best Practice
Best Practice
Clinical/services
Research
Traditional
Healing
Mainstream
Practice
Slide1919Circle of Care
Best
Practices
Child & Adolescent Programs
Prevention Programs
Primary Care
Emergency
Rooms
Traditional
Healers
A&D
Programs
Colleges &
Universities
Boarding
Schools
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WHAT ARE SOME
PROMISING STRATEGIES?
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Slide2121An Ideal InterventionBroadly based: Includes individual, family, community, tribe and society
Comprehensive: Prevention: Universal, Selective, Indicated Treatment Maintenance
Slide2222Ecological Model
Individual
Peer/Family
Society
Community/
Tribe
Slide23Fighting Meth, Healing Families:Seven Promising Solutions1. Media Campaigns2. Expanding Permanency Options3. Interagency Collaborations4. New Supports for Grandfamilies5. Enhancing Treatment Options
6. Family Drug Courts7. Targeted Community Supports in Indian Country23
Slide24AI/AN Prevention, Treatment, and Rehabilitation InterventionsStory TellingTalking CirclesSweat LodgeCeremonies and RitualPurification
PassagesNamingGrievingDrumming, Singing, Dancing
Vision QuestFlute playing/meditationReconciliation
MentoringService LearningTraditional Experiences Preservation
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Slide25Choctaw Nation of Oklahoma Adventure Therapy“Natural Highs Program”Transformation process Experiential activitiesRelationship buildingChanging the way you
live and think Changing how you think and how you believe about life and yourselfCreation of challenge in a safe environment
Horses, Canoes, Tradition Camps
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Slide26Meth Free Crow Walk: Youth as our Warriors in Reclaiming our Nation Meth Free CrowalitionEstablish a “War Against Meth” Focus on accountability, prevention, intervention, and treatment
Combine forces for Unity.Diverse community representationYouth and Community Development: mentorship, leadership, trust, establish community norms
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Slide27Dine Nation: What Works?Community Education Age-appropriate presentations, brochures, adsEnforcement
Arrest and detainment for traffickingCaring members of the communityPartnerships
Communities, chapters, private businesses and tribal divisions and programs
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Training for best, evidence based practice, integrated public health model.
Experienced at mobilizing communities across large area for interventions.
Slide28Northern Arapaho Tribe: a Comprehensive Systems PlanThe Problem: “turf”
gaps duplications crossed purposesFragmented Service System
The Solution: “Works”client-centered
multi-agencycomprehensivecoordinatedEfficient
Implement Best Practice
Treatment
1.Multi-Systemic
Family Therapy
2.Critical
Incident Counseling
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Slide29Winnebago Tribe: Meth Task Force Goals and Objectives Develop/maintain a Comprehensive Meth Prevention Strategy Collectively plan and implement Use Proactive measuresUse available funds - take immediate action
Working together to determine what fits Broad based, multi-agency, systematic, family/community focused prevention- Will it reduce treatment need?
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Slide3030How to Use the Toolkit
Leadership and decision makingOverview of each moduleSpecific topics, issue pagesPromising Practice approachesWhat the culture and science says
Training, technical assistance, and consultationReference documents Toolkit webpage
Slide3131Toolkit Essentials
Leadership InformationMethamphetamine BasicsTribal Code-Policy MediaEducational Materials and Presentations Prevention and Treatment Educational for Students, Parents, Community Community Organizing Fun Youth Items Additional Resources
Slide32“Best Practices”Families and Schools Together (Rural Wisconsin Res)Parenting WiselyPreparing for Drug Free YearsProject AlertProject Venture (NIYLP)Promoting Alternative Thinking StrategiesAmerican Indian Life Skills
(Zuni Pueblo)32
Slide33“Best Practices”Cultural Enhancement Through Story Telling (Tohono O’odham Res)AI Strengthening Families Program (U UT)Creating Lasting Family ConnectionsDare to Be You (Ute Res)
With Eagles Wings (N. Arapaho Nat)Families That Care—Guiding Good ChoicesAcross Ages (Mentoring) (Temple U)Across Ages (Mentoring) (Temple U)
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Slide3434Effective Treatment Approaches For Methamphetamine Use DisorderMotivational Interviewing
Therapeutic Use of Urine TestingContingency Management ( motivational incentive based) Cognitive Behavioral Therapy - CBTCommunity Reinforcement ApproachMatrix Model (combination of above)
Slide3535Matrix ModelIs a manualized, 16-week, non-residential, psychosocial approach used for the treatment of drug dependence
Designed to integrate several interventions into a comprehensive approach. Elements include:Individual counselingCognitive behavioral therapyMotivational interviewingFamily education groupsUrine testingParticipation in 12-step programs
Slide3636Contingency ManagementKey conceptsBehavior to be modified must be objectively measuredBehavior to be modified (eg urine test results) must be monitored frequently
Reinforcement must be immediatePenalties for unsuccessful behavior (eg positive UA) can reduce voucher amountVouchers may be applied to a wide range of prosocial alternative behaviors
Slide3737Is Treatment for Methamphetamine Effective?Analysis of:Drop out ratesRetention in treatment ratesRe-incarceration ratesOther measures of outcome
All these measures indicate that Meth users respond in an equivalent manner as do individuals admitted for other drug abuse problems.
Slide3838Youth Treatment Completion: WA State
Slide3939Comprehensive School and Behavioral Health PartnershipPrevention and behavioral health programs/services on siteHandling behavioral health crisesResponding appropriately and effectively after an event occurs
Slide4040Integrated TreatmentPremise: 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 hospitalizationlessening of psychiatric and substance abuse severitybetter engagement and retention (Rosenthal et al, 1992, 1995, 1997; Hellerstein et al 1995.)
Slide4141Partnered Collaboration
Research-Education-Treatment
Grassroots Groups
Community-Based
Organizations
State/Federal
Slide4242Potential Organizational PartnersEducationFamily Survivors Health/Public Health
Mental Health Substance AbuseElders, traditionalLaw EnforcementJuvenile Justice Medical Examiner
Faith-BasedStudent GroupsCounty, State, and Federal Agencies
Slide43Problem is bigger, broader and more complex than current solutionsBroad-based, integrated, interagency changes are neededState, county, and city relationships to be developed with tribes and communitiesTraining and tribal leadership developmentA Marshall Plan for all Native America that effects: economics, housing, social services, education, law/governance, and health
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Slide4444Contact us
at:503-494-3703E-mail: Dale Walker, MDonesky@ohsu.eduOr visit our website:
www.oneskycenter.org
Rachel Crawford, Association of American Indian Physicians405-946-7072 E-mail: rcrawford@aaip.org
One Sky Center