Challenges to providing quality substance abuse treatment services for American Indian and Alaska native communities: perspectives of staff from 18 treatment centers

Legha, Rupinder; Raleigh-Cohn, Ashley; Fickenscher, Alexandra; Novins, Douglas K.

doi:10.1186/1471-244x-14-181

Cited by 23 publications

(20 citation statements)

References 41 publications

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“…Hartmann and Gone (2012) noted, "On one hand, many of these (urban) agencies wish to provide both standard Western and traditional healing services, but on the other hand, they lack concrete guidance for the design and integration of such services" (p. 543). Moreover, Legha et al (2014) pointed out that chemical dependency treatment programs for AI/ANs must deal with "pressure to use Evidence-Based Treatments (EBTs)" (p. 7). However, in a recent survey of chiefly rural substance abuse treatment programs for AI/ANs, Novins et al (2016) found that "only two of the commonly implemented psychosocial EBTs (Motivational Interviewing and Relapse Prevention Therapy) were endorsed as culturally appropriate by a majority of programs that had implemented them" (p. 214).…”

Section: Discussionmentioning

confidence: 99%

Integrated Care with Indigenous Populations: A Systematic Review of the Literature

Lewis¹,

Myhra²

2017

AIANMHR

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Integrated care appears to be an intervention that can ameliorate these disparities by reducing stigma for those seeking care and providing coordinated care to prevent or reduce health care disparities in this population. While integrated care appears to be an effective system of care for Indigenous people, it must be noted that integration of local Indigenous health beliefs and practices is equally necessary.

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Section: Discussionmentioning

confidence: 99%

Integrated Care with Indigenous Populations: A Systematic Review of the Literature

Lewis¹,

Myhra²

2017

AIANMHR

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“…These include challenges related to delivering clinical services (e.g., client trauma history and mistrust of service system, socioeconomic barriers faced by clients), limitations of the infrastructure of treatment settings (e.g., provider turnover, fatigue and burnout, lack of resources in the treatment setting), and the shortfalls of the greater service/treatment system (e.g., lack of sufficient aftercare resources, the employment of treatments inappropriate to the population). 41 Providers also express concern that many of the current evidence-based practices conflict with American Indian traditions and healing practices. 42…”

Section: Discussionmentioning

confidence: 99%

Disparities in the Treatment of Substance Use Disorders: Does Where You Live Matter?

Acevedo

Panas

Garnick

et al. 2018

J Behav Health Serv Res

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This study focused on (1) whether disparities in timely receipt of substance use services can be explained in part by the characteristics of the community in which the clients reside and (2) whether the effect of community characteristics on timely receipt of services was similar across racial/ethnic groups. The sample was composed of adults receiving publicly funded outpatient treatment in Washington State. Treatment data were linked to data from the US census. The outcome studied was "Initiation and Engagement" in treatment (IET), a measure noting timely receipt of services at the beginning of treatment. Community characteristics studied included community level economic disadvantage and concentration of American Indian, Latino, and Black residents in the community. Black and American Indian clients were less likely to initiate or engage in treatment compared to non-Latino white clients, and American Indian clients living in economically disadvantaged communities were at even greater risk of not initiating treatment. Community economic disadvantage and racial/ethnic makeup of the community were associated with treatment initiation, but not engagement, although they did not entirely explain the disparities found in IET.

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“…This project consisted of three phases: 1) convening an advisory board to identify key issues in the dissemination and implementation process and to develop study measures and methods (Novins et al, 2011), 2) completion of qualitative case studies of 18 substance abuse treatment programs serving AI/AN communities (Legha et al, 2014; Legha and Novins, 2012; Moore et al, 2015), and 3) conducting a national survey of AI/AN substance abuse treatment programs to explore their use of EBTs (Novins et al, 2012). This paper draws on the data collected during this final phase.…”

Section: Methodsmentioning

confidence: 99%

Use of evidence-based treatments in substance abuse treatment programs serving American Indian and Alaska Native communities

Novins

Croy

Moore

et al. 2016

Drug and Alcohol Dependence

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Background Research and health surveillance activities continue to document the substantial disparities in the impacts of substance abuse on the health of American Indian and Alaska Native (AI/AN) people. While Evidence-Based Treatments (EBTs) hold substantial promise for improving treatment for AI/ANs with substance use problems (as they do for non-AI/ANs), anecdotal reports suggest that their use is limited. In this study, we examine the awareness of, attitudes towards, and use of EBTs in substance abuse treatment programs serving AI/AN communities. Methods Data are drawn from the first national survey of tribal substance abuse treatment programs. Clinicians or clinical administrators from 192 programs completed the survey. Participants were queried about their awareness of, attitudes towards, and use of 9 psychosocial and 3 medication EBTs. Results Cognitive Behavioral Therapy (82.2%), Motivational Interviewing (68.6%), and Relapse Prevention Therapy (66.8%) were the most commonly implemented psychosocial EBTs; medications for psychiatric comorbidity was the most commonly implemented medication treatment (43.2%). Greater EBT knowledge and use were associated with both program (e.g., funding) and staff (e.g., educational attainment) characteristics. Only two of the commonly implemented psychosocial EBTs (Motivational Interviewing and Relapse Prevention Therapy) were endorsed as culturally appropriate by a majority of programs that had implemented them (55.9% and 58.1%, respectively). Conclusions EBT knowledge and use is higher in substance abuse treatment programs serving AI/AN communities than has been previously estimated. However, many users of these EBTs continue to have concerns about their cultural appropriateness, which likely limits their further dissemination.

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Challenges to providing quality substance abuse treatment services for American Indian and Alaska native communities: perspectives of staff from 18 treatment centers

Cited by 23 publications

References 41 publications

Integrated Care with Indigenous Populations: A Systematic Review of the Literature

Integrated Care with Indigenous Populations: A Systematic Review of the Literature

Disparities in the Treatment of Substance Use Disorders: Does Where You Live Matter?

Use of evidence-based treatments in substance abuse treatment programs serving American Indian and Alaska Native communities

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