II. METHODOLOGY

• In preparing the Agency's drug control budget, the Indian Health Service (IHS) includes the appropriation for Alcohol and Substance Abuse, excluding the amount designated as Adult Treatment, and the portion of the Urban Indian Health appropriation that is provided for alcohol and substance abuse prevention and treatment.



• Those items identified as primarily treatment activities include: Regional Treatment Centers, Community Rehabilitation /Aftercare, Gila River, Contract Health Service, Navajo Rehabilitation Program, Urban Clinical Services, and Expand Urban Program. The prevention activities include Community Education and Training and Wellness Beyond Abstinence.

III. PROGRAM SUMMARY

• The IHS provides health care services for American Indians and Alaska Natives while also providing the opportunity for maximum tribal involvement in developing and managing these programs.

Goal 1: Educate and enable America's youth to reject illegal drugs as well as alcohol and tobacco.

• As part of its broad mandate to provide health care services, the IHS supports substance abuse treatment and prevention services. Anti-drug abuse activities are administered by the Alcoholism and Substance Abuse Programs Branch within IHS. In addition to the development of curative, preventative, and rehabilitative services, these activities include the following:



• Data development and coordination for measuring the substance abuse and underage alcohol problems among American Indians and Alaska Natives;



• Programmatic evaluation and research toward developing effective prevention and treatment services;



• National leadership that focuses on youth treatment, community education, and prevention services for high-risk youth;



• Services for developmentally disabled.

Goal 3: Reduce health and social costs of illegal drug use to the public.

• IHS's operations support the Federal drug control priorities by working to ensure continued access to effective treatment programs for those who are in need of treatment services. In addition, IHS supports prevention and education programs that target youth, to reduce their use of illicit drugs, alcohol, and tobacco products. For instance, the Indian Health Care Improvement Act Amendments have identified funds for use by urban Indian health clinics to provide treatment, rehabilitation, and education services for Indian youth with substance abuse problems. A Memorandum of Agreement has been established between SAMHSA and IHS to coordinate activities in this regard. Urban Indians will continue to be addressed in the course of present drug control activity within IHS.



• IHS goals and objectives are also consistent with the Federal drug control priorities by focusing on community awareness, primary and secondary prevention strategies, collaboration, and services for special population groups. The Public Health Service Plan to Reduce the Demand for Illicit Drugs (June 1989) requires the IHS expand its efforts in treating intravenous drug abusers in specialty clinics and treating other drug abusing youth in federally-funded health centers and programs for the homeless. New initiatives will continue to focus on the needs of alcohol and substance abusers who have a history of sexual abuse and on a redesigned community mobilization effort that will provide innovative treatment and prevention modules targeting communities that have high rates of alcoholism and drug abuse.

IV. BUDGET SUMMARY

1997 Base Program

• The Department estimates that a total of $42.9 million will be used for drug-related activities for FY 1997. These resources are sufficient to allow IHS to continue its antidrug program at its current level of operations.

1998 Request

• The Administration requests a total of $43.1 million for FY 1998, an increase of $0.2 million over FY 1997. This increase in drug-related resources will be used for drug-related activities, including treatment, Adolescent Regional Treatment Centers, Community Rehabilitations and Aftercare Training/Community Education, Health Promotion/Disease Prevention, Navajo Rehabilitation Program, Urban Programs, and Contract Health Services. The request reflects mandatory increases for the alcohol and substance abuse and urban Indian health activities.

Goal 1: Educate and enable America's youth to reject illegal drugs as well as alcohol and tobacco.

• The total drug control request for Goal 1 activities for FY 1998 is $3.4 million. The 1998 request includes program enhancements to stem addiction in the American Indian and Alaska Native communities.

• The drug control request for Goal 3 activities for FY 1998 is $39.6 million, a net increase of $0.2 million over FY 1997. The 1998 request includes additional resources for treatment services for the chronic, hardcore population, as well as continue to provide a full array of drug-related activities.

V. PROGRAM STATISTICS

VI. PROGRAM ACCOMPLISHMENTS

• Utilizing three SAMHSA Centers for Substance Abuse Prevention (CSAP) curricula: Gathering of Native Americans, Violence Prevention, and Facilitation Skills Development, training sessions have been conducted in both the Albuquerque and Aberdeen IHS Areas. Local community based replications have been conducted in 10 communities, with additional replications being planned. A revitalization of community planning and development capabilities that focus on alcohol and substance abuse issues has occurred.



• An amendment to the Memorandum of Agreement with the BIA, that guides interagency coordination at the Headquarters, Area, and local levels was signed in August 1994. Since then, the IHS has more closely coordinated activities with the BIA, including planned meetings to review and implement items in the agreement. IHS Service Unit directors and BIA superintendents have met to determine priorities for joint activities at the local level.



• Community prevention efforts, in collaboration with the Center for Substance Abuse Prevention, have been initiated in the Aberdeen and Albuquerque IHS Areas.



• Primary Care Provider Training Workshops continue to be presented on a regular basis. This 3-day didactic and experiential training session was updated in FY 1994 to include co-dependancy, tobacco, prescription drug abuse, impaired professionals, and family issues.



• The Chemical Dependency Management Information System (CDMIS) will be fully on line by the end of FY 1996. All Areas using CDMIS, and those Areas that will be reporting CDMIS from other data systems, have received training. A user-friendly version of CDMIS was released during FY 1996, with plans for an integrated version to be released in FY 1997. The integrated version will include data collection and reporting capabilities conducive to a behavioral health model of treatment and prevention.



• In FY 1996, $1,000,000 was distributed to continue support of the Fetal Alcohol Syndrome staff at Area Offices in collaboration with the HRSA Maternal and Child Health Program. A national conference was sponsored in the spring of 1995. A conference document will be printed and distributed.



• In FY 1996, nearly $2,100,000 was distributed to continue support of the specific needs of women and their children. Each Area was required to establish a plan for use of these funds.



• The IHS began a collaborative effort with the Office of Public for Health and Science to evaluate treatment for women. This collaborative effort has completed the first two phases of four phases of evaluation.



• The IHS began an evaluation of the adolescent regional treatment centers. The evaluation project has completed several important milestones, including the completion of data collection instruments and the formation of the data collection team. The project is currently involved in the approval process which includes securing approvals from OMB, the national IHS Internal Review Board (IRB), Area IHS IRBs, tribes, and governing boards. The project will be completed in 1997.



• Clinical supervision training was sponsored to enhance local treatment capability.



• In FY 1996, the Aberdeen Area opened the tenth Youth Regional Treatment Center, located on the Standing Rock Reservation.



• An Inhalant Abuse Initiative has developed a community awareness training module, and has begun coordinating activities with the International Institutes on Inhalant Abuse to enhance treatment capabilities for both adults and adolescents.