Holistic System of Care: Evidence of Effectiveness

Abstract

The Native American Health Center provides substance use and mental health services for urban American Indians and Alaska Natives (AIs/ANs) utilizing a culturally based holistic system of care (HSOC). Substance use prevention, treatment, and recovery services emphasize traditional AI/AN healing practices alongside evidence-based practices. This article describes the HSOC approach and provides preliminary findings from an outcome evaluation. Participants in outpatient and residential treatment were interviewed at baseline and 6-month follow-up with a standardized assessment tool (n = 490). The sample we composed of 86% AI/AN, 70% females, 30% males, and was entirely urban. Decreases in substance use and its related consequences were evident in both modalities but were most pronounced in residential treatment. Study's limitations and implications are included.

Keywords :

• urban
• Native American
• American Indian
• AI/AN
• substance use
• holistic system of care
• evidence-based practices
• practice-based evidence
• wellness

THE AUTHORS

Serena Wright, M.P.H., is the Director of Research and Evaluation for the Family and Child Guidance Clinic of the Native American Health Center in Oakland and San Francisco. She has 10 years of experience in public health research with an emphasis on social determinants underlying health disparities, particularly poverty, race, and gender. She has done community-based research, including international work, and is familiar with conducting research and evaluation in a range of settings. She has worked at the FCGC for the past two years and in this time has advocated for Native populations through the sound use of data, working to ensure integration of Native principles and methodologies into all evaluation components and to ensure community input into all publications to accurately reflect issues.

Ethan Nebelkopf, Ph.D., is the Director of Behavioral Health for the Family and Child Guidance Clinic of the Native American Health Center in Oakland and San Francisco. Ethan has been a licensed family therapist for 30 years and has worked in nonprofits for 40 years. Dr. Nebelkopf is Principal Investigator for Urban Trails, a CMHS-funded project in collaboration with the City of Oakland to implement a system of care for Native American children and their families. He is also Principal Investigator for One With All, a CSAP-funded project to implement the Strategic Prevention Framework for urban Native Americans in Northern California. He served as Project Director for several CSAT TCE/HIV grants. In 2007, Dr. Nebelkopf received the Award of Excellence from SAMHSA for dedication to and development of integrated HIV/AIDS prevention programs, substance abuse prevention and treatment programs, and mental health services for Native Americans. In 2008, Ethan was awarded a Certificate of Special Congressional Recognition for outstanding and invaluable service to the community.

Janet King, M.S.W., works at the Family and Child Guidance Clinic of the Native American Health Center in Oakland, California. She has been an advocate for mental health transformation and has served on many councils and forums to give voice to Native American mental health needs and the best practices to meet those needs. She has advocated for the inclusion of community-focused and other cultural interventions as the best use of mental health funds to reduce disparities for underserved populations. She has called attention to the barriers in current mental health policy that continually create disparities for many populations, leaving them underserved or inappropriately served. She is a mother, wife, sister, aunt, daughter, and a member of the Lumbee tribe in North Carolina.

Michele Maas, M.S.W., is a member of the Bad River Band of Lake Superior Chippewa Indians. She currently works as the Director of Client Services of the San Francisco Family and Child Guidance Clinic of the Native American Health Center. Michele has developed specific curriculums for Native American women that focus on the journey of discovery/recovery from substance abuse, sexual trauma, domestic violence, anxiety, grief, and depression within the context of intergenerational and historical trauma. Her work is grounded in the understanding of her traditional Anishinaabe cultural values and beliefs. Michele received her Master's of Social Work with a focus on Child Welfare from San Francisco State University (SFSU). She is currently registered with the State of California as an Associate Clinical Social Worker and working toward licensure as a Licensed Clinical Social Worker (LCSW). Michele has participated in the planning and organization of numerous events and activities that serve to educate both the Native American and non-Native American population about the socio-political, socio-cultural and socio-economic issues faced by Native Americans. She continues to advocate for the rights of Native American peoples.

Chirag Patel, M.C.P., Senior Data Manager for Family and Child Guidance Clinic, Native American Health Center has worked closely with the Bay Area Urban Native American Community for over seven years. Working closely with evaluation staff, he has successfully managed, maintained, and analyzed data for eight different SAMHSA grants. He has also spearheaded a team, along with other evaluation staff and consultants, to build a fully secured, shared, fully customized database.

Sarah Samuel, M.P.A., is an Evaluator for the Native American Health Center, with nine years of experience working with the Native American community in the San Francisco Bay Area. She is currently the evaluator for two projects, including the Native Women TCE/HIV project and Urban Trails, funded by CMHS. She also held the Project Director position for the TCE/HIV Friendship House Healing Center and Friendship House Treatment for Homeless CSAT projects. Her evaluation focus has primarily been residential and outpatient substance abuse treatment outcomes, client satisfaction, and community needs and interests.

Notes

3 The term “medicine” in this context and elsewhere in the article refers to plants or practices used as an integral component of Native American healing ceremonies, and not to medical practice or pharmacological agents in a Western sense. Guest Editor's note