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TIP 61 Behavioral Health Services for American Indians and Alaska Natives

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TIP 61 Behavioral Health Services for American Indians and Alaska Natives Behavioral Health Services for American Indians and Alaska Natives For Behavioral Health Service Providers, Administrators, and Supervisors TREATMENT IMPROVEMENT PROTOCOL TIP 61 Please share your thoughts about this publication by completing a brief online survey at: https://www.surveymonkey.com/r/KAPPFS The survey takes about 7 minutes to complete and is anonymous. Your feedback will help SAMHSA develop future products. BEHAVIORAL HEALTH SERVICES FOR TIP 61 AMERICAN INDIANS AND ALASKA NATIVES Executive Summary For Behavioral Health Service Providers, Program Administrators, Clinical Supervisors, and Researchers The Executive Summary of this Treatment Improvement Protocol summarizes substance use and mental illness among American Indians and Alaska Natives and discusses the importance of delivering culturally responsive, evidence-based services to address these behavioral health challenges. TIP Navigation Executive Summary For behavioral health service providers, program administrators, clinical supervisors, and researchers Part 1: Pr actical Guide to the Provision of Behavioral Health Services for American Indians and Alaska Natives For behavioral health service providers Part 2: Imple mentation Guide for Behavioral Health Program Administrators Serving American Indians and Alaska Natives For behavioral health service providers, program administrators, and clinical supervisors Appendix and Index Part 3: Lit erature Review For behavioral health service providers, program administrators, clinical supervisors, and researchers TIP 61 Behavioral Health Services for American Indians and Alaska Natives Contents EXECUTIVE SUMMARY Foreword .................................................................. iii Introduction .................................................................v Overall Key Messages ......................................................... vi Content Overview .......................................................... viii Terminology .................................................................x TIP Development Participants ................................................. xiii Publication Information ...................................................... xvi ii Executive Summary TIP 61 Foreword The Substance Abuse and Mental Health Services Administration (SAMHSA) is the U.S. Department of Health and Human Services agency that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities. The Treatment Improvement Protocol (TIP) series fulflls SAMHSA’s mission by providing science-based best-practice guidance to the behavioral health feld. TIPs refect careful consideration of all relevant clinical and health service research, demonstrated experience, and implementation requirements. Select nonfederal clinical researchers, service providers, program administrators, and client advocates comprising each TIP’s consensus panel discuss these factors, offering input on the TIP’s specifc topic in their areas of expertise to reach consensus on best practices. Field reviewers then assess draft content. The talent, dedication, and hard work that TIP panelists and reviewers bring to this highly participatory process have helped bridge the gap between the promise of research and the needs of practicing clinicians and administrators to serve, in the most scientifcally sound and effective ways, people in need of behavioral health services. We are grateful to all who have joined with us to contribute to advances in the behavioral health feld. Elinore F. McCance-Katz, M.D., Ph.D. Assistant Secretary for Mental Health and Substance Use SAMHSA iii This page intentionally left blank. BEHAVIORAL HEALTH SERVICES FOR TIP 61 AMERICAN INDIANS AND ALASKA NATIVES Executive Summary This Treatment Improvement Protocol (TIP) serves as a primer for working with individuals who identify with American Indian and Alaska Native cultures. It aims to help behavioral health service providers improve their cultural competence and provide culturally responsive, engaging, holistic, trauma-informed services to American Indian and Alaska Native clients. The TIP presents culturally adapted approaches for the prevention and treatment of addiction and mental illness, as well as counselor competencies for providing behavioral health services to American Indians and Alaska Natives. Introduction programmatic guidance for working with their communities to implement culturally responsive American Indians and Alaska Natives have services. Throughout, the TIP emphasizes the consistently experienced disparities in access to importance of inclusivity, collaboration, and incor- healthcare services, funding, and resources; quality poration of traditional and alternative approaches and quantity of services; treatment outcomes; to treatment and recovery support when working and health education and prevention services. with American Indian and Alaska Native clients. Availability, accessibility, and acceptability of behavioral health services are major barriers to This TIP was developed through a consensus-based recovery for American Indians and Alaska Natives. process that refected intensive collaboration with Common factors that infuence engagement and American Indian and Alaska Native professionals. participation in services include availability of These professionals, who represented diverse transportation and child care, treatment infrastruc- tribes and native cultures, carefully considered ture, level of social support, perceived provider all relevant clinical and research fndings, tradi- effectiveness, cultural responsiveness of services, tional and culturally adapted best practices, and treatment settings, geographic locations, and tribal implementation strategies. American Indian and affliations. Alaska Native contributors shared their behavioral health-related experiences and stories through- In response to existing behavioral health disparities, out the process, thereby greatly enriching this this TIP illustrates strategies for facilitating American important resource. Indian and Alaska Native individuals’ access to and engagement in behavioral health services. It outlines promising practices for providers to Audience apply in working with American Indians and Alaska This TIP can serve as a resource to both native and Natives, and it includes tools and strategies that non-native behavioral health professionals who will help program administrators facilitate imple- wish to provide culturally appropriate and respon- mentation of these practices. sive services. This TIP is for: Through this TIP, behavioral health workers will • Addiction treatment/prevention professionals. learn to identify how and to what extent a client’s • Mental health service providers. cultural background affects his or her behavioral • Peer support specialists. health needs and concerns. It offers practical • Behavioral health program managers and ideas and methods for addressing the realities of administrators. service delivery to American Indian and Alaska Clinical supervisors. Native clients and communities, and it provides • v TIP 61 Behavioral Health Services for American Indians and Alaska Natives • Traditional healers. Role of culture and cultural identity. Providers • Tribal leaders of governance. need to understand how clients perceive their • Other behavioral health professionals (e.g., own cultural identity and how they view the role of social workers, psychologists). traditional practices in treatment. Not all American Indian and Alaska Native clients recognize the Researchers and policymakers. • importance of culture or perceive a need for traditional practices in their recovery. Nonetheless, Objectives providers and administrators must be ready to Addiction and mental health professionals will address their clients’ cultural identity and related improve their understanding of: needs. Helping clients maintain ties to their native cultures can help prevent and treat substance use American Indian and Alaska Native demograph- • and mental disorders. Through reconnection to ics, history, and behavioral health. American Indian and Alaska Native communities • The importance of cultural awareness, cultural and traditional healing practices, an individual identity, and culture-specifc knowledge when may reclaim the strengths inherent in traditional working with clients from diverse American teachings, practices, and beliefs and begin to walk Indian and Alaska Native communities. in balance and harmony. • The role of native culture in health beliefs, help-seeking behavior, and healing practices. Recognition of sovereignty. Tribal governments • Prevention and treatment interventions based are sovereign nations. Each nation adopts its own on culturally adapted, evidence-based best tribal codes and has a unique history with the practices. U.S. federal government. Providers in native and non-native programs need to understand the role Methods for achieving program-level cultural • of tribal sovereignty and governance systems in responsiveness, such as incorporating American treatment referrals, planning, cooperative agree- Indian and Alaska Native beliefs and heritage ments, and program development. in program design, environment, and staff development. Signifcance of community. American Indian and Alaska Native clients and their communities must Overall Key Messages be given opportunities to offer input on the types Importance of historical trauma. Providers
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