Evaluation of the Chemical Misuse Treatment and Recovery Services (CMTRS) Program Institute for Circumpolar Health Studies University of Alaska Anchorage 3211 Providence Drive Anchorage, Alaska 99508 January 2000 The CMTRS Evaluation is supported by a contract with the State of Alaska, Division of Alcohol and Drug Abuse. CMTRS is supported through CSAT RRCD Grant #5U94 TI00883 PROJECT TEAM YKHC Directors Gene Peltola, CEO/President Mary Anarak, VP, Community Services CMTRS Staff Joan Hamilton, Director, CMTRS Alice Abraham, Director, CMTRS State of Alaska Division of Alcohol and Drug Abuse Kay Klose, State Project Coordinator Pete Kinney, Research Analyst Institute for Circumpolar Health Studies Evaluation Team Brian Saylor, PhD, MPH Brad Kehoe, MA Stacy Lynn Smith, MFA Gary Hughes, EdD Kate Heitkamp, BS Beth Landon, MBA, MHA Patricia E. Starratt, BA Mary Ellen Gordian, MD, MPH Consultants David Marshall, MA Beth Kersey, MS, MRA, Former RSAS Program Director Larry Emerson, PhD Candidate Consultant Services Robert Pond, MA Pacific Production Services Table of Contents Table of Contents ......................................................................................................................i I. Introduction......................................................................................................................... 1 A. Background.................................................................................................................1 B. Setting ........................................................................................................................ 1 C. Description of Villages ................................................................................................ 2 1. CMTRS Villages ................................................................................................... 2 2. VAEC Comparison Villages .................................................................................. 3 3. Village Hub City .................................................................................................... 5 D. Program Description ................................................................................................... 5 1. Initial Program Vision ............................................................................................ 5 a. Local Policy Steering Committees................................................................... 6 b. Local Providers................................................................................................ 7 c. Traditional Treatment Modalities...................................................................... 7 2. Program Values.................................................................................................... 8 E. Evolution of Cmtrs....................................................................................................... 8 F. Services...................................................................................................................... 9 1. Western Substance Abuse Treatment................................................................... 9 2. Traditional Treatment Modalities......................................................................... 10 3. Local Hiring......................................................................................................... 11 G. Training .................................................................................................................... 11 H. Governance.............................................................................................................. 12 1. YKHC Board of Directors .................................................................................... 12 2. CMTRS Policy Steering Committees................................................................... 12 3. Mental Health and Substance Abuse Advisory Board ......................................... 12 I. Administration ............................................................................................................ 13 1. Center for Substance Abuse Treatment RRCD Program .................................... 13 2. Regional Substance Abuse Treatment System................................................... 13 3. State of Alaska Division of Alcoholism and Drug Abuse...................................... 13 4. Summary ............................................................................................................ 14 II. Evaluation Design............................................................................................................ 15 A. Evaluation Questions................................................................................................ 15 B. Comparison Groups.................................................................................................. 16 C. Selection of Quantitative and Qualitative Techniques ............................................... 18 1. Initial Effort of Using Quantitative Data................................................................ 18 2. Decision to Incorporate Qualitative Evaluation.................................................... 19 a. Conditions Influencing the Decision to Use Qualitative Methods ................... 19 b. Evaluation Plan Revisions............................................................................. 19 c. Summary....................................................................................................... 20 3. Flow chart on choice of Evaluation Method......................................................... 22 III. Qualitative Findings ........................................................................................................ 23 A. Focus Groups ............................................................................................................ 23 1. CMTRS Focus Groups........................................................................................ 24 a. Introduction ................................................................................................... 24 b. Thematic Analysis ......................................................................................... 24 c. Conclusion..................................................................................................... 28 i 2. VAEC Focus Groups........................................................................................... 29 a. Introduction ................................................................................................... 29 b. Thematic Analysis ......................................................................................... 29 c. Conclusion..................................................................................................... 38 3. Comparison of CMTRS and VAEC Focus Groups .............................................. 38 a. Introduction ................................................................................................... 38 b. Thematic Analysis ......................................................................................... 39 c. Conclusion..................................................................................................... 42 B. Video Taped Key Informant Interviews...................................................................... 42 1. Introduction......................................................................................................... 42 2. The Key Informant Interview Evaluation Process ................................................ 42 3. Planning, Instrument Design, and Execution....................................................... 43 4. Conclusion.......................................................................................................... 44 IV. Use of Yup'ik/Cup'ik Traditional Modalities ..................................................................... 46 A. Introduction............................................................................................................... 46 B. Implementation of Traditional Modalities ................................................................... 47 1. Mission Statement .............................................................................................. 47 2. Basic Assumptions.............................................................................................. 47 3. Traditional Modalities for Wellness Goals and Outcomes.................................... 48 C. Yup’ik/Cup'ik Standards of Care ............................................................................... 48 1. Definition of Standards........................................................................................ 48 2. Yup'ik Standards and Alcohol Programs ............................................................. 49 3. The Need for Yup’ik Standards of Care............................................................... 50 4. How Standards are Developed ........................................................................... 50 5. Yup'ik Standards and Treatment Planning and Clinical Supervision.................... 50 6. Ethical Considerations in Standards.................................................................... 51 D. Issues in Treating Native Peoples............................................................................. 51 1. Choice ................................................................................................................ 52 2. Confidentiality ....................................................................................................