Skye Bass, MSW

Public Health Advisor

Office of Juvenile Justice & Delinquency Prevention (OJJDP)

Tribal Juvenile Detention & Reentry Peer-to- Peer Learning Meeting

October 7, 2011

Agenda

Need for TreatmentYouth Treatment CentersClinical ServicesTraditional Healing & Cultural PracticesAftercareFuture OutlookQuestions & Answers

Need for Substance Abuse Treatment

Substance abuse of all types is a serious problem, with AI/ANs reporting a higher rate of marijuana, cocaine, and hallucinogen abuse compared to other minority groups.

American Indians/Alaska Natives (AI/ANs) are more likely than any other race to have a past-year alcohol or illicit drug use disorder. 1

The AI/AN alcohol-related mortality rate is 519% greater than the U.S. all-races rate. 2

1 The National Survey on Drug Use & Health Report, 2007.

2 Indian Health Service/Division of Program Statistics, IHS data years 2003-2005, U.S. data year 2004.

Need for Co-Occurring Treatment Alcohol and substance abuse can co-occur with mental health

disorders (Depression, PTSD, Anxiety, etc)

There is a high rate of co-occurring substance abuse and mental health disorders within AI/AN communities. 3

When co-occurring disorders are left untreated (or if only one disorder is treated), symptoms can become acute and result in far-reaching complications.

These complications include risk for physical health problems, unemployment, homelessness, incarceration, separation from families and friends, premature death, and suicide.

3 Substance Abuse and Mental Health Administration, National Survey on Drug Use & Health

Risk Factors

Substance Abuse

Psychiatric Disorders

Poverty

Antisocial Behavior

Cultural Distress

Family Dysfunction

Historical TraumaStressful Life

Events

Impulsivity Unemployment

School Problems

Depression Anxiety

Suicidal Behavior

Personal Losses

Geographic IsolationDual Diagnosis

Stigma

HopelessnessPoor Interpersonal Communication

Behavioral Problems

Withdrawal

Family History

Limited Social Support

Domestic Violence

Child Abuse

Suicide Clusters

Need for Early Intervention

• Adolescence is a period of growth and change

• Maladaptive habits, attitudes, and behaviors that take root at this stage can have serious health repercussions

• Unhealthy behaviors that begin in adolescence can continue to affect an individual throughout adulthood

• National surveys of adolescent drug use report that AI/AN have higher rates of alcohol and drug use than any other racial-ethnic group

What does Hope Look Like?

YRTCsIndian Health Service (IHS) currently

provides recurring funding to 11 Tribal and Federally operated Youth Regional Treatment Centers (YRTCs) to address the on-going issues of substance abuse and co-occurring disorders among American Indian/Alaska Native youth.

Authorizing Legislation• Advocacy by Tribes and AI/AN organizations, combined

with support of Congress resulted in the enactment of:

• Indian Alcohol and Substance Abuse Prevention and Treatment Act of 1986 (P.L. 99-570)

• The Anti-Drug Abuse Act of 1988 reauthorized P.L. 99-570 and authorized funding for construction, renovation and staffing of treatment centers for AI/AN youth

• Section 704 of P.L. 102-573 amended the Indian Health Care Improvement Act to provide additional support for the regional treatment centers for AI/AN youth.

Establishment of YRTCs

• The original statute specified that tribes in each IHS Area would agree upon a structure and location

• The tribes were to formulate a “Tribal Action Plan” addressing their needs and plans with regard to alcohol and substance abuse

• In 1988, the first YRTCs to begin operation were New Sunrise Youth Regional Treatment Center in New Mexico, and Jack Brown Youth Regional Treatment Center in Oklahoma

• Tribes in three IHS Areas: Phoenix, Alaska and Portland chose to develop two YRTCs in their respective areas

YRTCs in Development• The Indian Health Service is purchasing land

for the development of two YRTCs in Northern and Southern California (P.L. 108-447)

• Construction is expected to begin in April 2013 to develop the first YRTC in Sage, Riverside County, California

YRTC Mission Statement

To provide quality holistic Behavioral Health care for

American Indian/Alaska Native adolescents and their families in

a substance free residential environment that integrates traditional healing, spiritual

values, and cultural identification

YRTCs

Aberdeen Area Youth Regional Treatment Center

Mobridge, SD

Desert Visions Youth Wellness CenterSacanton, AZ

Nevada Skies Youth Wellness CenterWadsworth, NV

New Sunrise Youth Regional Treatment CenterSan Fidel, NM

Unity Regional Treatment CenterCherokee, NC

Graf Rheeneerhaajii Adolescent Treatment Facility

Fairbanks, AK

The Healing Lodge of Seven NationsSpokane, WA

Jack Brown Youth Regional Treatment CenterTahlequah, OK

Klamath Falls Youth Regional Treatment CenterKlamath Falls, OR

Navajo Regional Behavioral Health CenterShiprock, NM

Raven’s Way Treatment CenterSitka, AK

YRTC Services YRTC Services

Service Population• American Indian/Alaska Native Adolescents

• Typically 12-17 years old at time of admission

• Males & Females

• Average Length of Stay of 90 days

• Admissions Process: Open Enrollment Model or Cohort Model

• Capacity: Varies, 12-24 beds depending on the YRTC

Youth Served

*Two YRTCs did not report data

• In Fiscal Year 2010, the YRTCs served 585 youth

• Of the 585 youth, 358 (61%) were court ordered

• Desert Visions Youth Regional Treatment Center reported serving 96 youth, of which 36 youth (37.5%) reported gang involvement

Substances UsedMost Common

Substances ReportedDiagnosis

1) Alcohol • Alcohol Dependence 303.90

• Alcohol Abuse 305.00

2) Marijuana • Cannabis Dependence 304.30

• Cannabis Abuse 305.20

3) Multiple Drugs • Polysubstance Dependence : 304.80

4) Opioids Opioid Abuse: 305.50

ServicesPsychosocial

AssessmentsSubstance Abuse

EducationAcademic EducationIndividual, Group,

PsychotherapyFamily Counseling &

EducationOnline Education

ServicesHealth, Nutrition, & Life

Skills InstructionSupport GroupsNarcotics Anonymous and

Alcoholics Anonymous Meetings

Medication and Health Monitoring

Job Interview Practice

Life Skill LessonsParenting Skills

ServicesAdventure Based

TherapyRecreationEquine/Animal Assisted

TherapyWilderness Expedition

Rock Climbing Equine Therapy

Hiking

Evidence- and Practice- Based Models In Use

Cognitive Behavioral TherapyDialectical Behavior TherapyMotivational InterviewingTeen Matrix ModelProject Venture, National Indian Youth

Leadership ProjectWhite Bison: Red Road to WellbrietyAcceptance and Commitment TherapyMoral Recognition Therapy

Co-Occurring DisordersMajor Depressive DisorderAnxiety DisorderPost Traumatic Stress Disorder (PTSD)Attention Deficit/Hyperactivity Disorder

(AD/HD)Bipolar DisorderDisruptive Behavioral DisorderConduct DisorderOppositional Defiant Disorder

Cultural-Spiritual Orientation

Some of the most effective prevention and treatment programs for AI/AN youth and families are rooted in culturally-based models which are aligned with local traditional beliefs, practices and norms.

Strong identification with culture, therefore, is preventative in many tribal communities and may be critical for developing and implementing successful prevention and treatment intervention.

Traditional HealingA life in imbalance, i.e. caused when one suffers

from mental health challenges, addictions, unresolved grief, theft of ancestral lands, environmental racism, loss of culture and spirituality, etc., requires a restoration of balance to the individual through various culturally- and spiritually-based ceremonies.

These may include prayer, talking circles, healing ceremonies, or a number of procedures and protocols rooted in ancient wisdom.

Traditional Healing & Cultural Services

• Drum Making• Sweat Lodge Ceremonies• Talking Circles• Traditional Drumming• Story Telling• Beading• Spiritual Gardening• Stick Ball• Hide Tanning• Rites of Passage Ceremonies

Traditional Healing

Spiritual Gardening

Sweat Lodge Ceremonies

Talking Circles

Cultural Activities

Traditional Drumming

Medicine Wheel Teaching

Cultural Activities

Hide TanningStick Ball

Teepee Ceremonies

Expressive Arts

Traditional Murals

Traditional Murals

Traditional Arts & Crafts

Expressive Arts: Music• The Healing Lodge of Seven Nations received the national iAward, presented by the National Institute for Addictions Treatment for innovation in addictions recovery programs.

• The Healing Lodge was recognized for its Expressive Arts therapy program, which engages youth in recovery through poetry and music.

U:\youtube\720p 152 kbit HL7N Music Program.mp4

Aftercare Services• AI/AN youth are referred from numerous Tribes/States

across the U.S. & throughout Indian Country.

• YRTCs provide discharge planning, referral services, and relapse prevention skills/planning.

• YRTCs all provide follow up services, some at 72 hours, 1 month, 6 months, and 12 months post-discharge.

• Some YRTCs provide tele-behavioral health aftercare services.

Impacting Future GenerationsThrough education and

culture based prevention initiatives, evidence- and practice-based models of treatment, family strengthening, and recreational activities,

The Indian Health Service funded YRTCS believe youth can overcome their challenges and recover their lives to become healthy, strong, and resilient leaders in their communities.

Contact Skye Bass, MSWPublic Health AdvisorIndian Health Service Headquarters801 Thompson Avenue, Suite 300Rockville, MD 20852Phone: (301) 443-2038Fax: (301) 443-7623Skye.Bass@ihs.gov

References

1 The NSDUH Report. (2007) Substance use and substance use disorders among American Indians and Alaska Natives. Office of Applied Statistics. Retrieved from http://www.osa.samhsa.gov/2k7/AmIndians.htm

2 Indian Health Service. Office of Public Health Support. Division of Program Statistics. (n.d.). Trends in Indian Health, 2003-2005. Unpublished data.

3 The NSDUH Report. (2007) Substance use and substance use disorders among American Indians and Alaska Natives. Office of Applied Statistics. Retrieved from http://www.osa.samhsa.gov/2k7/AmIndians.htm