rose weahkee, ph.d. director, division of behavioral health indian health service national indian...
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Rose Weahkee, Ph.D.Director, Division of Behavioral Health
Indian Health Service
National Indian Health BoardBoard of Directors Meeting
January 23, 2012
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Federal Efforts in Suicide Prevention:
Indian Health Service
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Indian Health Service Suicide Prevention
InitiativeThe National Suicide Prevention Initiative
addresses the tragedy of suicide in American Indian and Alaska Native communities.
The IHS National Suicide Prevention Initiative builds on the foundation of the HHS “National Strategy for Suicide Prevention” and the 11 goals and objectives for the Nation to reduce suicidal behavior and its consequences, while ensuring we honor and respect Tribal traditions and practices.
Available at: www.ihs.gov/MedicalPrograms/Behavioral
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IHS Suicide Prevention Initiative
Five strategic objectives:Assist IHS, Tribal, and Urban Indian programs and
communities in addressing suicide utilizing community level cultural approaches.
Identify and share information on best and promising practices.
Improve access to behavioral health services.Strengthen and enhance IHS’ epidemiological
capabilities. Promote collaboration between Tribal and Urban
Indian communities with Federal, State, national, and local community agencies.
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Promoting Collaboration
The National Action Alliance for Suicide Prevention was launched in Sept 2010 by HHS Secretary Sebelius and Defense Secretary Gates The AI/AN Task Force, co-chaired by Dr. Yvette
Roubideaux, IHS Director, Mr. Larry Echohawk, Asst. Sec. for Indian Affairs , and McClellan Hall, private sector representative was formed to implement suicide prevention strategies to reduce the rate of suicide in AI/AN communities.
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Suicide Listening Sessions
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Listening SessionsIHS, SAMHSA, and the Department of Interior Bureau of Indian Affairs and Bureau of Indian Education held ten Tribal listening sessions across Indian Country to seek input on how the agencies can most effectively work in partnership with AI/AN communities to prevent suicide.
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Listening SessionsListening Sessions were conducted from
November 2010 to February 2011.Navajo Region – Nov. 15, 2010Rocky Mountain Region – Nov. 19, 2010Alaska Region- Nov. 30, 2010Great Plains Region – Dec. 2, 2010Southern Plains Region/ Eastern OK- Dec. 13, 2010Pacific Region – Dec. 21, 2010Southwest Region – Jan. 10, 2011Northwest Region – Jan. 12, 2011Eastern Region – Feb. 10, 2011
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Listening SessionsThe information gathered was used to
build the foundation of training and best practices program featured in the Action Summits for Suicide Prevention held in August 2011 in Scottsdale, AZ and October 2011 in Anchorage, AK
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TribalRecommendations
Address Contributing FactorsSuicide is a public health issue with
many contributing factors, including alcoholism, substance abuse, poverty, unemployment, and trauma.
Recommendation: Contributing factors should be included in overall suicide prevention planning. Additional funding is needed to address substance abuse and domestic violence.
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Tribal Recommendations
Behavioral Health StaffingThere exists a lack of culturally-competent
behavioral health professionals trained in suicide and suicide related prevention and intervention treatment modalities.
Recommendation: Increase the availability of behavioral health staff trained in suicide and suicide related prevention and interventionin Indian Country.
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Tribal Recommendations
Improvement of ServicesCurrent staffing levels, breadth of services
and hours of service do not meet the need for community-based suicide prevention and intervention activities.
Recommendation: Expansion of services are needed - Tele-psychiatry services, inpatient psychiatric services, family support, positive parenting services, safe houses, and transportation services to improve access.
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Tribal Recommendations
Communication and coordination of activities and resources between private and public sector agencies need improvement.
Recommendation: Federal partners should work to coordinate stakeholders and Tribal communities to improve communication and enhance collaboration.
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Tribal Recommendations
A Tribal Suicide Summit should be held at the national level and in Alaska that focuses on sharing best or promising practice based suicide prevention programs.
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Action Summits for Suicide Prevention
Two Action Summits for Suicide Prevention were held in Scottsdale AZ from August 1-4, 2011; and in Alaska from October 25-27, 2011
In total, over 1,000 attendees received preconference training and attended multiple workshop tracks, including suicide and substance abuse prevention, serving at risk youth, clinical practice, incident response, methamphetamine , public health communications, and many more
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Action Summits for Suicide Prevention
Focus Areas:Trainings offered in best and promising
practices in suicide preventionPrevention/Screening Focus Intervention/Treatment FocusAftercare/Postvention Focus
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Action Summits forSuicide Prevention
Objectives:To emphasize an action-focused approach
to suicide prevention. Presentation materials were combined to
produce a suicide prevention toolkit.Participants were encouraged to take
toolkits back to their communities for new program implementation or to strengthen current program sustainability.
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Action Summits forSuicide Prevention
Summit toolkits available at:http://www.ihs.gov/suicidepreventio
nsummit/http://www.ihs.gov/suicidepreventio
nsummit/alaska
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Action Summits for Suicide Prevention
Three major AI/AN Suicide Prevention and Behavioral Health documents were launched at the Action Summits:oAI/AN National Suicide Prevention
Strategic PlanoAI/AN National Behavioral Health Strategic
PlanoAI/AN Behavioral Health Briefing Book
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Next StepsContinue Federal Collaborations in partnership with
Tribes in the implementation of the SP Strategic Plan
Continue improving access to culturally competent behavioral health care
Provide ongoing training for health care providers as well as community members to enable comprehensive community-based prevention
Promote the use of culturally-based promising and traditional practices in prevention of suicide
Coordinate and leverage existing resources to better meet the need for suicide prevention activities
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Federal Efforts in Violence
Prevention:Indian Health
Service
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IHS Sexual Assault Policy
The Tribal Law and Order Act requires the IHS Director to develop sexual assault policies and protocols based on similar protocols established by the Department of Justice (DOJ).
IHS established its first formal Sexual Assault Policy on March 23, 2011.
The IHS consulted with Tribal leaders and received comments for incorporation in future revisions.
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Tribal CommentsCommon themes for IHS SA Policy Revisions:
Expand policy to clinicsClarification on utilization of victim advocatesAdopting timelines for policy development Referencing Tribal codes in the policyClarification of transportation section of policyProvision of exams on-site, by referral, or
combination of both methodsRemoving certification requirements for sexual
assault examiners
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Next StepsIHS planning recommendations for ongoing
improvements for domestic violence and sexual assault services:Complete revisions of the IHS Sexual Assault
Policy based on comments received from Tribes, Urban Indian leadership, the DOJ and the GAO;
Develop an IHS Sexual Assault Policy Implementation and Monitoring Plan;
Given the focus of the current IHS Sexual Assault Policy on hospital-based care, develop a sexual assault policy for all IHS facilities, such as outpatient clinics and health stations;
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Next Steps cont’dOffer SANE-SAFE-SART training and provide
forensic examination equipment for all 28 IHS and 17 Tribal hospitals by December 2012;
Develop and offer domestic violence/sexual assault training and curriculum for Indian Health System facilities; and
Develop new/updated IHS policies and procedures for domestic violence, child sexual abuse, and elder abuse.
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IHS PartnershipsStrategies to address domestic violence and sexual
assault include collaborations and partnerships with:
Consumers and their families, Tribes and Tribal organizations, Urban Indian health programs, Federal, State, and local agenciesPublic and private organizations
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IHS and ACFCollaborated to fund over 35 sites to identify
strategies and develop interventions to address domestic violence in AI/AN communities.
Trained medical and nursing staff to screen for domestic violence and to provide safety planning for all female patients,
Forged community partnerships, Developed policies and procedures on domestic
violence. Sites developed:
culturally sensitive screening tools, policies and procedures, informational brochures.
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IHS and DOJThe IHS and the DOJ Office for Victims of Crime (OVC)
entered into a partnership involving the Federal Bureau of Investigation and the Department of the Interior to develop the AI/AN SANE-SART Initiative.
The goal of the SANE/SART Initiative is to address the needs of sexual assault victims in Indian Country.
To address this overall goal, the project will identify, assess, and support existing SANE and SART efforts by providing training and technical assistance resources for all of the IHS and OVC funded SANE/SART programs, and through the development of comprehensive SANE/SART demonstration projects.
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OVC SANE-SART AI/AN InitiativeThree tribal communities funded: Mississippi Band of Choctaw Indians Tuba City Health Care Corporation Southern Indian Health Council, Inc.Three sites funded to: Identify a SANE-SART Coordinator Establish a framework for a SANE-SART Team Involve community stakeholders Conduct comprehensive needs assessment Develop a strategic plan to enhance and/or create a sustainable, culturally relevant, victim centered SANE/SART program.
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IHS Priorities In Action
• National Tribal Advisory Committee on Behavioral Health• National Behavioral Health Work
Group• Methamphetamine and Suicide
Prevention Initiative• Domestic Violence Prevention
Initiative
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National Tribal Advisory Committee (NTAC) on
Behavioral HealthThe IHS National Tribal Advisory Committee on
Behavioral Health embodies all of the IHS priorities
Elected Tribal officials from each IHS Area provide recommendations and advice on the range of behavioral health issues in Indian Country
NTAC is the principal Tribal advisory group for all behavioral health services to the IHS Director Provide recommendations on significant
funding allocations and service programs Develop long term strategic plans for Tribal
and Federal behavioral health programs
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National Behavioral HealthWork Group (BHWG)
The IHS National Behavioral Health Work Group works very closely with the NTAC to
provide collaborative links between the professional community and national Tribal
leadership:
• National technical advisory group to the NTAC and the Division of Behavioral Health
• Comprised of mental health professionals from across the country
• Strengthen partnerships• Improve quality and access to care• Direct collaboration across Tribal and Federal
behavioral health system
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What is the Methamphetamine and Suicide Prevention Initiative (MSPI)
Demonstration pilot programProvides $16.4 million annually to
existing or innovative Tribal, Tribal organizations, Federally-Operated, and Urban Indian health programs to provide methamphetamine and/or suicide prevention and treatment services.
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NTAC MSPI Consultation
Consultation and Collaboration over one year
NTAC developed program and funding distribution recommendations
Director accepted those recommendations without alteration
Together developed innovative funding mechanisms
Together endorsed community developed and delivered programs
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MSPIEstablish evidence based or practice based
methamphetamine and suicide prevention and intervention pilot projects.
Represent innovative partnerships with IHS
to deliver services by and for the communities themselves, with a national support network for ongoing program development and evaluation.
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MSPI127 IHS, Tribal, Youth, Urban Pilot Projects
112 Tribal and IHS awardees Includes 3 Youth Regional Treatment Centers (YRTCs)
12 Urban grantees3 Tribal Youth grantees
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MSPI Area Program
Recipients
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Year One ActivitiesOf those MSPI programs who have reported to date,a total of 289,066 persons have been served through both prevention and treatment activities. Prevention activities include, but are not limited to:Evidence-based practice trainingKnowledge disseminationDevelopment of public service announcements and
publicationsCoalition developmentCrisis hotline enhancement
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Baseline MeasuresOutcome Measure # 4: (66%)
The proportion of youth who participate in evidence-based and/or promising practice prevention or intervention programs.
42,895 youth participating in EBP/PBE program
Outcome Measure # 5: (50%)Establishment of trained suicide crisis response teams.
674 persons trained
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Baseline MeasuresOutcome Measure # 3: (44%) Reduce the incidence of methamphetamine abuse in AI/AN communities through prevention, training, surveillance, & intervention programs.
4,370 persons with a methamphetamine disorder
Outcome Measure # 1: (38%) The proportion of methamphetamine-using patients who enter a methamphetamine treatment program.
1,240 persons entering treatment
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Baseline MeasuresOutcome Measure # 2: (80%)Reduce the incidence of suicidal activities (ideation, attempts) in AI/AN communities through prevention, training, surveillance, & intervention programs.
14,242 persons reporting suicide-related activity
Outcome Measure # 6 (21%)Tele-behavioral health encounters.
617 tele-behavioral health encounters
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Tele-Behavioral Health
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Program Highlights
One program is using MSPI funds to renovate a “safe room,” within their emergency department for suicidal patients
One program is establishing a peer-to-peer suicide prevention program in 4 area high schools
One program is implementing the only Tribal operated residential methamphetamine treatment facility in the Nation
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Domestic ViolencePrevention Initiative
(DVPI)The IHS Domestic Violence Prevention
Initiative (DVPI) is a nationally-coordinated demonstration program aimed at addressing domestic violence (DV), sexual assault (SA), and family violence within American Indian and Alaska Native communities.
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NTAC and DVPI • As it did with MSPI, the NTAC provided
recommendations on spending allocations and program development.
• As with the MSPI, the IHS Director accepted the NTAC recommendations without alteration.
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DVPI Funding FY 2009 – funding for the amount of
$7,500,000 was provided for the DVPI
FY 2010 – Congress appropriated an additional $2,500,000 for a total of $10,000,000 for FY10
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65 DVPI Project Awardees
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Preliminary FindingsAugust 2010 – January 2011
• 56 programs reported data• Over 220 project-affiliated positions
created• 21 interdisciplinary Sexual Assault
Response Teams (SARTs)• Over 2,100 clients served
• 1,602 received DV services • 177 received SA services • 395 received both DV/SA services
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Services Provided• Over 9,100 patients screened for DV. • Over 3,300 referrals made for DV/SA
services, culturally-based services, & clinical behavioral health services. • Over 140 individuals received shelter
services.• 48 adult and 18 child SAFE kits were
completed and submitted to Federal, State, and Tribal law enforcement.
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Sexual Assault Examiner Training
2011:4 Regional Sexual Assault Examiner Trainings
conducted; including SART Training
2012:Sexual Assault Examiner (SAE) Training will be offered
to all 24/7 IHS and Tribal hospitals 7 Regional Trainings
Multidisciplinary/SART/Community response Training will be provided
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SART TrainingTraining in 2012
12 regional training sessionsOffered to all 45 hospitals in 2012Will be provided prior to Sexual Assault
Examiner TrainingCore members for training:
Sexual Assault AdvocatesMedical personnelLaw EnforcementProsecution
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Forensic EquipmentForensic equipment will be purchased for
IHS & Tribal hospitals in 2012
Needs assessment is currently being conducted for all IHS & Tribal hospitals Will determine:
Training needs Forensic equipment needs
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Federal Partners and Federal Partners and
Tribal Nations are Tribal Nations are
working together to working together to
eliminate health eliminate health
disparities among disparities among
American Indian and American Indian and
Alaska Native people.Alaska Native people.
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For More Information
General IHS InformationGeneral IHS Information::www.ihs.gov
Rose Weahkee, Ph.D.Director, Division of Behavioral HealthIndian Health Service801 Thompson Avenue, Suite 300Rockville, MD 20852Phone: (301) 443-2038Email address: [email protected]