Indian Health Service (IHS) Funded Youth Regional Treatment Centers

1. Indian Health Service (IHS) Funded Youth Regional Treatment Centers 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

2. Agenda • Need for Treatment • Youth Treatment Centers • Clinical Services • Traditional Healing & Cultural Practices • Aftercare • Future Outlook • Questions & Answers

3. 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 IndianHealthService/Division of Program Statistics, IHS data years 2003-2005, U.S. data year 2004.

4. 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. 3Substance Abuse and Mental Health Administration, National Survey on Drug Use & Health

5. Risk Factors Antisocial Behavior Poverty Impulsivity Unemployment Hopelessness Withdrawal School Problems Poor Interpersonal Communication Cultural Distress PsychiatricDisorders Limited Social Support Stigma Depression Anxiety Family History Suicidal Behavior Family Dysfunction Substance Abuse Domestic Violence Dual Diagnosis Geographic Isolation Child Abuse Historical Trauma Stressful Life Events Personal Losses Suicide Clusters Behavioral Problems

6. 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

7. What does Hope Look Like?

8. YRTCs • Indian 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.

9. 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.

10. 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

11. 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

12. 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

13. YRTCs

14. Federally Operated Facilities

15. Aberdeen Area Youth Regional Treatment CenterMobridge, SD

16. Desert Visions Youth Wellness CenterSacanton, AZ

17. Nevada Skies Youth Wellness CenterWadsworth, NV

18. New Sunrise Youth Regional Treatment CenterSan Fidel, NM

19. Unity Regional Treatment CenterCherokee, NC

20. Tribal Operated Facilities

21. Graf Rheeneerhaajii Adolescent Treatment FacilityFairbanks, AK

22. The Healing Lodge of Seven NationsSpokane, WA

23. Jack Brown Youth Regional Treatment CenterTahlequah, OK

24. Klamath Falls Youth Regional Treatment CenterKlamath Falls, OR

25. Navajo Regional Behavioral Health CenterShiprock, NM

26. Raven’s Way Treatment CenterSitka, AK

27. YRTC Services

28. 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

29. Youth Served • 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 *Two YRTCs did not report data

30. Substances Used

31. Services • Psychosocial Assessments • Substance Abuse Education • Academic Education • Individual, Group, Psychotherapy • Family Counseling & Education Online Education

32. Services • Health, Nutrition, & Life Skills Instruction • Support Groups • Narcotics Anonymous and Alcoholics Anonymous Meetings • Medication and Health Monitoring Job Interview Practice Life Skill Lessons Parenting Skills

33. Services • Adventure Based Therapy • Recreation • Equine/Animal Assisted Therapy • Wilderness Expedition Hiking Rock Climbing Equine Therapy

34. Evidence- and Practice- Based Models In Use • Cognitive Behavioral Therapy • Dialectical Behavior Therapy • Motivational Interviewing • Teen Matrix Model • Project Venture, National Indian Youth Leadership Project • White Bison: Red Road to Wellbriety • Acceptance and Commitment Therapy • Moral Recognition Therapy

35. Co-Occurring Disorders • Major Depressive Disorder • Anxiety Disorder • Post Traumatic Stress Disorder (PTSD) • Attention Deficit/Hyperactivity Disorder (AD/HD) • Bipolar Disorder • Disruptive Behavioral Disorder • Conduct Disorder • Oppositional Defiant Disorder

36. 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.

37. Traditional Healing • A 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.

38. 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

39. Traditional Healing Talking Circles Spiritual Gardening Sweat Lodge Ceremonies

40. Cultural Activities Traditional Drumming Medicine Wheel Teaching

41. Cultural Activities Stick Ball Hide Tanning Teepee Ceremonies

42. Expressive Arts Traditional Murals Traditional Murals Traditional Arts & Crafts

43. 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

44. 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.

45. Impacting Future Generations • Through 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.

46. Contact Skye Bass, MSW Public Health Advisor Indian Health Service Headquarters 801 Thompson Avenue, Suite 300 Rockville, MD 20852 Phone: (301) 443-2038 Fax: (301) 443-7623 Skye.Bass@ihs.gov

47. 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. 3The 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