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![Page 1: Native Adolescent Suicide: Emerging Community Based Integrative Care Models One Sky Center R Dale Walker, MD Patricia Silk Walker, PhD Michelle Singer.](https://reader036.fdocuments.net/reader036/viewer/2022062517/56649f225503460f94c3a6b8/html5/thumbnails/1.jpg)
Native Adolescent Suicide: Emerging
Community Based Integrative Care
Models
One Sky CenterR Dale Walker, MD Patricia Silk Walker, PhD Michelle Singer
AAIP 38th Annual Meeting
Alexandria, Virginia July 25, 2009
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One Sky
Center
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One Sky Center Outreach
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Goals for Today
• An Environmental Scan• Fragmentation and Integration• Gain understanding of youth health issues• Examine Native youth suicide data• Discuss suicide prevention and intervention
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How are we functioning?(Carl Bell and Dale Walker 7/03 )
One size fits allOne size fits all
Different goals Different goals Resource silosResource silos
Activity-drivenActivity-driven
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We need Synergy and an Integrated System (Carl Bell and Dale Walker 7/03)
Culturally Specific
Culturally Specific
Best Practice
Best Practice
IntegratingResources
IntegratingResources
Outcome Driven
Outcome Driven
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Age Distribution American Indians 2004
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Adolescent Problems In Schools
School
Environment
Bullying
Fighting and
Gangs
Alcohol Drug Use
Weapon Carrying
Sexual Abuse
Truancy
Domestic Violence
Drop Outs
Attacks
on Teachers
Staff
Unruly Students
Sale of Alcohol
and Drugs
1. School Admin
2. Law
3. FBI
4. DEA
5. State MH
6. State A&D
7. Courts
8. Child Services
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Key Adolescent Risk Factors
Aggressive/Impulsive
DepressionSubstance Abuse
Trauma
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Poverty Status by Race and Age 2000
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Six behaviors that contribute to serious health problems:
• Tobacco use• Poor nutrition• Alcohol and other drug abuse• Behaviors resulting in intentional or unintentional
injury• Physical inactivity• Risky sex
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Barriers to Health Care for American Indian Youth
• Waiting may be 2 to 6 months• Great distances to travel to reach facilities • Trust is difficult to establish• Some services, depending on the provider,
require the presence of a parent/adult• Lack of transportation• Lack of privacy in community health clinics
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Suicide: A Multifactorial Event
Edu., Econ., Rec.Edu., Econ., Rec.
Family Disruption/Domestic ViolenceFamily Disruption/Domestic Violence
ImpulsivenessImpulsiveness
Negative Boarding SchoolNegative Boarding School
HopelessnessHopelessness
Historical TraumaHistorical Trauma
Family HistoryFamily History
SuicidalBehaviorSuicidal
Behavior
Cultural DistressCultural Distress
Psychiatric Illness& StigmaPsychiatric Illness& Stigma
Psychodynamics/Psychological VulnerabilityPsychodynamics/Psychological Vulnerability
Substance Use/AbuseSubstance
Use/Abuse
Individual
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Suicide Decedents with BAC ≥0.08 by Ethnicity and Age
16MMWR June 19, 2009
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Suicide: A National Crisis
• In the United States, more than 30,000 people die by suicide a year.1
• Ninety percent of people who die by suicide have a diagnosable mental illness and/or substance abuse disorder.2
• The annual cost of untreated mental illness is $100 billion.3
1 The President’s New Freedom Commission on Mental Health, 2003.2 National Center for Health Statistics, 2004.3 Bazelon Center for Mental Health Law, 1999.
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Blog # 1
• I started smoking at the age of eight.Provoking my life of sin to a life of hate, drinking was what made it worse.Thinking of myself while my family hurt.Coming home at late nights with a liquored up shirt, so now I bring it home for my future isn't set in stone.
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Blog #2
• Jealousy,Frustration,Emptiness,Loneliness,Not dependable at all times,Laziness, Pain
• There Is A Boy Named xxxx. He Always Tries To Fight Me.
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Blog # 3
• My Dad Is Dead.• I Struggle With Wanting to Drink or to take
Control of My life And Do Whatever I want even if It Hurts Me Emotionally.I will Struggle When I Have Kids One Day, How They Will turn out.
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Blog #4
• There are so many deaths because of stuffLike diabetes, heart diseases, and notTaking good care of your self.And all The drugs and Alcohol…
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0
2
4
6
8
10
12
14
16
Suicide Among ages 15-17, 2001Death rate per 100,000
0
Source: National Vital Statistics System - Mortality, NCHS, CDC.
2010 Target
TotalAmeric
an
IndianAsian
HispanicBlack
White Females Males
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Suicide: A Native Crisis
Source: National Center for Health Statistics 2001
0
10
20
30
40
50
605-
9
10-1
4
15-1
9
20-2
4
25-2
9
30-3
4
35-3
9
40-4
4
45-4
9
50-5
4
55-5
9
60-6
4
65-6
9
70-7
4
75-7
9
80-8
4
85+
Age Groups
Rat
e/10
0,00
0 .
White Male AI Male Black Male AI Female
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Suicide Rate per 100,000 Population1981–1998
CDC Suicide Rate 1981-1998
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Denise Middlebrook 1-5-2006R. Dale Walker, M.D., 2003
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North Dakota Teen Suicide Rates
(2000-2004 rate per 100,000 teens 13-19 years old)
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Disaster Defined• FEMA: A natural or man-made event that negatively
affects life, property, livelihood or industry often resulting in permanent changes to human societies, ecosystems and environment.
• NHTSA: Any occurrence that causes damage, ecological destruction, loss of human lives, or deterioration of health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community area.
• NOAA: A crisis event that surpasses the ability of an individual, community, or society to control or recover from its consequences.
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Models of Care
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Suicide Prevention Programs Among American Indian Youth :
Three Main Approaches – Do them All
• Adoption of mental health focus on Risk and Protection factors across life span
• Adaptation of public-health based interventions that promote opportunities for youth to gain self-esteem and avoid substance abuse/risky behavior
• Incorporation of traditional tribal responses as effective prevention strategies
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Domains Influencing Suicidal Behavior: A Native Ecological
Model
Individual Peers/Family Society/Cultural
Community/Tribe
Risk
Protection
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Risk
Mental illnessAge/genderSubstance abuseLossPrevious suicide attemptPersonality traitsIncarcerationFailure/academic problems
Protective
Cultural/religious beliefsCoping/problem solving skillsOngoing health and mental health care Resiliency, self esteem, direction, mission, determination, perseverance, optimism, empathyIntellectual competence, reasons for living
Risk and Protective Factors: Individual
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Individual Intervention
• Identify risk and protective factors counseling skill building improve coping support groups • Increase community awareness• Access to hotlines other help resources
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80%80% No No
ProblemsProblems
Universal/Selective Universal/Selective PreventionPrevention
Brief InterventionBrief Intervention
TreatmentTreatment
Mild Mild ProblemsProblems
Moderate Moderate ProblemsProblems
5% Severe 5% Severe ProblemsProblems
Thresholds for ActionThresholds for Action
Spectrum of Intervention Responses
15%15%
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Sources of Strength
Family Support
Positive Friends
Caring Adults
Positive ActivitiesGenerosity/Leadership
Spirituality
Access to Medical
Access to Mental Health
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Indigenous Knowledge
• Is local knowledge unique to a given culture or society; it has its own theory, philosophy, scientific and logical validity, which is used as a basis for decision-making for all of life’s needs.
Definitions:
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ID Best Practice
Best Practice
Clinical/servicesResearch
TraditionalMedicine
MainstreamPractice
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What are some promising strategies?
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AI/AN Prevention, Treatment, and
Rehabilitation Interventions• Story Telling• Talking Circles• Sweat Lodge• Ceremonies and Ritual
– Purification– Passages– Naming– Grieving
• Drumming, singing, dancing
• Vision Quest
• Flute playing/meditation
• Reconciliation
• Mentoring
• Service learning
• Traditional Experiences
Preservation38
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Adapted Interventions
• American Indian Life Skills• Canoe Journey• Gathering of Native Americans• Project Venture• Helping Our People Endure (HOPE)
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Native Interventions
• American Indian Life Skills• Gathering of Native Americans (GONA)• Native Helping Our People Endure (HOPE)• Crisis Response Teams• Family Canoe Journey• Community Readiness Model• Peer Counselors• Mentoring• Suicide Prevention Camp• Contests/races/special events
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Integrated Treatment
Premise: treatment at a single site, featuring coordination of treatment philosophy, services and timing of intervention will be more effective than a mix of discrete and loosely coordinated services
Findings:• decrease in hospitalization• lessening of psychiatric and substance abuse
severity• better engagement and retention
(Rosenthal et al, 1992, 1995, 1997; Hellerstein et al 1995.)
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Partnered Collaboration
Research-Education-Treatment
Grassroots Groups
Community-BasedOrganizations
State/Federal
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Reasons for Not Seeking Formal Help When Suicidal
REASON % Example
Did not perceive needfor help
28.8 Nothing really happened
Stigma, embarrassment 23.7 Care what people think
Had other support 23.7 went to friends for help
Self-reliance 15.3 figured it out on my own
Felt hopeless, alone 15.2 didn’t think they could help
Fear of consequences 11.9 someone might put mein a hospital
Costs 3.4 No money
No services available 1.7 No help around43
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Reasons for Not Seeking Informal Help When Suicidal
Reason % Example
Stigma, embarrassment
34.8 Think I was weird
Felt hopeless, alone 16.6 Felt no one cared
Fear of consequences 16.6 They might lock me up
Did not perceive needfor help
10.8 Didn’t need them
Self-reliance 10.8 It was my problem
Had other support 2.7 All alone. Find someone whose job it is to help
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Common Characteristics of Successful Native Programs
• Leadership
• Mobilization Community driven
• Public health approach
• Strength based
• Culturally informed
• Proactive
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Five Key PrinciplesEvidence-based predictors of
change
• Understand & Involve the Community
• Focus on major problems
• Select the right change agent
• Seek ideas from outside the field and
organization
• Do evaluation47
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Contact us at503-494-3703
E-mail Dale Walker, [email protected]
Or visit our website:www.oneskycenter.or
g