American Indian/Alaskan Native - Opioid Response Workgroup
Agenda 2:00 p.m. Welcome, Blessing and Introductions 2:15 p.m. State Opioid Response Plan and Structure 2:45 p.m. SAMHSA Tribal-State Opioid Academy Highlights 3:30 p.m. Discussion of American Indian Alaskan Native Opioid Response Workgroup (AI/AN ORW) – Deliverables 4:15 p.m. Workgroup structure, membership and meeting dates 4:45 p.m. Closing
2018 Washington State Opioid Response Plan GOALS, STRATEGIES AND ACTIVITIES
Goal 1: Prevent Opioid Misuse and Abuse STRATEGY 1: Implement strategies to prevent misuse of opioid and other substances in communities, particularly among youth. 2: Promote use of best opioid prescribing practices among health care providers. 3: Increase the use of the Prescription Drug Monitoring Program to encourage safe prescribing practices. 4: Educate the public about the risks of opioid use, including overdose. 5: Promote safe home storage and appropriate disposal of prescription pain medication to prevent misuse. 6: Decrease the supply of illegal opioids.
Goal 2: Identify and Treat Opioid Use Disorder STRATEGY 1: Build capacity of health care providers to recognize signs of opioid misuse, effectively identify patients misusing opioids and other substances, and link patients to appropriate treatment resources in a non-stigmatizing way. 2: Establish access in every region of the state to the full continuum of care for persons with opioid use disorder to include low barrier access to medication, office-based opioid treatment services, Opioid Treatment Programs (OTPs), substance use disorder treatment programs, mental health services, pain management, healthcare and recovery support services. 3: Identify, treat and support pregnant and parenting women with opioid use disorder. Improve management of infants born with neonatal abstinence syndrome. 4: Expand access to and utilization of opioid use disorder medications in the juvenile and adult criminal justice system and transition those with opioid use disorder to treatment in the community upon release.
Goal 3: Reduce Morbidity and Morality in those with Opioid Use Disorder STRATEGY 1: Provide overdose education and distribute naloxone to individuals who use opioids and those mostly likely to witness an overdose. 2: Make system-level improvements to increase availability and use of naloxone. 3: Support and increase capacity of syringe services programs (SSPs) to provide infectious disease screening services and overdose education and naloxone, and engage clients in health and support services, including housing.
Goal 4: Use data and information to detect opioid misuse/abuse, monitor morbidity, and evaluate interventions. STRATEGY 1: Improve Prescription Monitoring Program data quality, timeliness, completeness, access and functionality. 2: Utilize the Prescription Monitoring Program data for public health surveillance and evaluation. 3: Enhance efforts to monitor opioid use and opioid-related morbidity and mortality. 4: Monitor progress towards goals and strategies and evaluate the effectiveness of our interventions.
Presenter Michael Langer Acting Division Director Division of Behavioral Health and Recovery Michael.Langer@hca.wa.gov (360) 725-9821
Sarah Sullivan, Health Policy Analyst, Northwest Portland Area Indian Health Board Presentation: SAMHSA Tribal-State Policy Academy (TSPA) Tribal Priorities
SAMHSA Tribal-State Policy Academy (TSPA) Tribal Priorities HCA Tribal Opioid Response Workgroup January 15, 2019
Tribal-State Policy Academy Discussion Overview 1. TSPA Purpose and TBHA 2. Washington Tribal-State Policy Team 3. Priorities 4. Collaboration 5. Treatment 6. Prevention 7. Recovery Supports 8. Cross-Cutting Priorities
SAMHSA TSPA • PURPOSE: States and Tribes brought together to work collaboratively to develop opioid and substance use priorities around culturally-based prevention activities, treatment and recovery supports for tribal communities. • OBJECTIVES: (1) Improve/strengthen tribal-state relationships; and (2) establish mutual behavioral health priorities to collaboratively improve the well-being of tribal communities. • Round 1 of 3. • Held August 20-21 at the Santa Ana Pueblo, New Mexico. • 15 State-Tribal Teams attended.
Washington TSPA Team • Tribal Representatives: – Jolene George, THD Port Gamble S’Klallam Tribe – Lori Hartelius, Stillaguamish – Marilyn Scott, Upper Skagit Indian Tribe – John Stephens, Swinomish Indian Tribal Community – Sarah Sullivan, NW Portland Area Indian Health Board • State Representatives: – Jessie Dean, Health Care Authority – Kathryn Lofy, Department of Health – Lucilla Mendoza, Health Care Authority – Cheryl Wilcox, Health Care Authority – Myra Parker, University of Washington
National Tribal Behavioral Health Agenda (2016) Foundational Elements 1) Historical and Intergenerational Trauma 2) Socio-Cultural Ecological Approach 3) Prevention and Recovery Support 4) Behavioral Health Systems and Support 5) National Awareness and Visibility
Collaboration Discussion • Prevention, Treatment and Recovery need to be more informed by AI/AN population and the community. • Educate legislators to align the state with the federal trust obligation to fulfill tribal needs. • Family and community are key, need more input from tribal communities. • Need to review Substance Abuse Prevention and Treatment Block Grant (SABG) model and need to look at tribal equity. • Tribal governments establish priorities of funding. • Need improved access for detox and mental health services. • Limited staff capacity. • Little research of tribal best practices as evidence- based practices.
Tribal Cultural Models Discussion • Healing of the Canoe • Gathering of Wisdoms • Gathering of Native Americans (GONAS) • Sweat Lodge • Paraprofessionals • Wellbriety- people in recovery become the greatest advocates • Peer-based Recovery Coaching • EXAMPLES: Port Gamble THOR Prevention Program and Swinomish D idgʷálič Wellness Center.
Collaboration Priorities • Information sharing of tribal best practices. • Tribes as credible experts from the beginning. • True government-to-government relationship • Reduce administrative burden. • Improve coordination between tribes and state agencies and federal agencies.
Treatment Challenges • Lack of treatment and treatment resources available at the local level. • Tribal government and community stigma with MAT. • Lack of providers. • Licensure of CDP services (agency, not person). • Lack of culturally appropriate treatment. • Lack of transportation to treatment. • Electronic Health Record (EHR) obstacles. • Workforce development- CDPs and MHPs. • 12 step meetings are not always accepting of MAT. • Difficult to include a culture balance in recovery programs along with all state and federal treatment requirements.
Treatment Priorities • Reduce regulatory barriers, need for inclusion of all regulatory players (DEA, DOJ, HUD, HHS, DOC). • Simplify and coordinate multi — jurisdictional approval for MAT facilities. • Dissemination of best practices for integrated care.
Prevention Challenges • Need for sharing and strategizing of successful preventative interventions in tribal communities. • The majority of federal funds are dedicated to treatment, only 20% can be used for prevention. • Lack of sustainable prevention program funding. • Use of evidence-based practice requirements are increasing (does not include tribal-best practices).
Prevention Priorities • Funding cultural practices as prevention. • Include equity in re-distribution methodology (Substance Abuse Block Grant). • Sustainable funding.
Recovery Supports Challenges • Ask peers to support peers, but most peers have difficulty passing the background check to become recovery coaches. • 250 Oxford Houses (peer run), but tribes and tribal members are usually left out/voted out. • Only 2 options for certified recovery housing: – Oxford House Model; and – National Alliance for Recovery Residences.
Recovery Supports Priorities • Expansion and consistency of implantation of peer programs. • Establish requirements for integration of Behavioral Health Aides (BHAs), Recovery Coaches, and Peer Supports. • Tribal recovery housing without signing away tribal sovereignty immunity. • Recovery cafes model for tribes.
Cross-Cutting Priorities • Develop pipeline for healthcare workforce from tribal communities. • Tailoring services for subgroups. • Holistic and integrated approach to care.
Discussion
Vicki Lowe, Executive Director, American Indian Health Commission Lisa Rey Thomas, PhD, Consultant, American Indian Health Commission Lucilla Mendoza, Tribal Behavioral Health Administrator, Health Care Authority AI/AN Opioid Response Workgroup - Deliverables and Structure
Workgroup’s Purpose Engage tribal leaders and providers in developing goals, objectives, and strategies to address the Opioid Crisis in Indian Country. The workgroup goals, objectives and strategies will inform the Statewide AIAN Opioid Response Plan to strengthen our efforts to prevent and treat opioid use disorder in our communities.
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