Rose Weahkee, Ph.D.Director, Division of Behavioral Health

Indian Health Service

National Indian Health BoardBoard of Directors Meeting

January 23, 2012

Federal Efforts in Suicide Prevention:

Indian Health Service

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

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.

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.

Suicide Listening Sessions

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.

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

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

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.

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.

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.

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.

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.

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

Action Summits for Suicide Prevention

Focus Areas:Trainings offered in best and promising

practices in suicide preventionPrevention/Screening Focus Intervention/Treatment FocusAftercare/Postvention Focus

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.

Action Summits forSuicide Prevention

Summit toolkits available at:http://www.ihs.gov/suicidepreventio

nsummit/http://www.ihs.gov/suicidepreventio

nsummit/alaska

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

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

Federal Efforts in Violence

Prevention:Indian Health

Service

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.

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

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;

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.

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

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.

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.

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.

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

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

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

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.

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

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.

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

MSPI Area Program

Recipients

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

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

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

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

Tele-Behavioral Health

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

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.

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.

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

65 DVPI Project Awardees

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

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.

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

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

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

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.

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: Rose.Weahkee@ihs.gov