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Agency Budget Summary
Department of Health and Human Services
Indian Health Service
I. Resource Summary
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 (RTCs), 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 comprehensive health services to American Indians and Alaska Natives while also providing the opportunity for maximum tribal involvement in developing and managing these programs. Approximately 95 percent of alcohol and drug abuse programs are operated by tribes under self-determination agreements. This allows tribes wide latitude to set objectives and design programs. Accordingly, while all programs are engaged in activities that are aligned with the national drug control strategies to some degree, the IHS cannot direct programs to meet federal objectives, targets, and measures. In general, the IHS-funded drug control activities fall under Goals 1 and 3 of the National Drug Control Strategy.
Goal 1: Educate and enable America's youth to reject illegal drugs as well as the use of alcohol and tobacco.
- As part of its broad mandate to provide health care services, the IHS supports substance abuse treatment and prevention services. Antidrug abuse activities are administered by the Alcoholism and Substance Abuse Program within the 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; and,
- National leadership that focuses on youth treatment, community education, and prevention services for high-risk youth.
- Many community programs are committed to the Goal 1 objectives. Some examples of community efforts that are geared towards Goal 1 are:
- The Chemical Dependency Management Information System, CDMIS. This HIM software is now available to all the Areas of the Indian Health Service.
- The Evaluation of the Adolescent Regional Treatment Centers and the Evaluation of the Effectiveness of the Indian Health Service Sponsored Alcohol and Substance Abuse Aftercare/Continuing Care Program.
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 CareImprovement 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.
IV. Budget Summary
1999 Program
Goal 1: Educate and enable America's youth to reject illegal drugs as well as the use of alcohol and tobacco.
- FY 1999 funding includes $3.6 million for Goal 1 activities. The IHS is committed to the national agenda to reduce alcohol and drug abuse using strategies that include:
- Continued development toward a comprehensive continuum of care encompassing prevention, education, treatment and rehabilitation. Workshops on American Society of Addiction Medicine Patient Placement Criteria are sponsored as part of the Clinical and Preventive Health Leadership Series.
- Supporting inhalant abuse prevention and treatment initiative training and education to tribal communities in regards to children and young adolescent use.
- Tobacco cessation activities.
- Expansion of primary prevention efforts via collaboration with the Center for Substance Abuse Prevention on the Rural and Remote Culturally Distinct population project and training.
- Continued enhancement of RTC development and effectiveness.
- Continued expansion of primary prevention efforts via collaboration with the Center for Substance Abuse Prevention curriculum on community mobilization provider training, i.e. Gathering of Native Americans, Violence Prevention, and Facilitation Skills Development.
Goal 3: Reduce health and social costs of illegal drug use to the public.
- FY 1999 funding includes $40.7 million for Goal 3 activities.
- The IHS activities under this goal are comprised primarily of its treatment activities, which includes a broad multi-discipline approach in treating and identifying interrelated mental health, social, and substance abuse related disorders and a focus on the preservation and regeneration of families. Some examples include:
- Continued enhancement of Regional Treatment Center development and effectiveness of treatment services including development of continuity of care plans for client's return to their respective community.
- Continued support to address specific needs of women and their children via recommendations from the Women's Four Phase Evaluation Report, in which two phases have been completed.
2000 Request
Goal 1: Educate and enable America's youth to reject illegal drugs as well as the use of alcohol and tobacco.
- FY 2000 funding includes $3.9 million for Goal 1 activities, a $275,000 increase over the FY 1999 level. The FY 2000 request includes the following enhancement:
- Special emphasis on including preventive or health promotion services to clients during their treatment since many clients have associated problems in the following areas: tobacco cessation, nutrition and diet, diabetes prevention, prevention of disabilities due to diabetes, parenting skills and prevention of child abuse.
Goal 3: Reduce health and social costs of illegal drug use to the public.
- FY 2000 funding includes $41.7 million for Goal 3 activities, a $1.0 million increase over the FY 1999 level. The FY 2000 request will address the following:
- The unmet alcoholism and substance abuse treatment needs of women and children and adolescents by increasing the capacity of those treatment centers who specialize in the treatment of women and children as a unit, and the Adolescent Regional Treatment Centers.
- Augmentation of the treatment centers' capacities in the areas of continuing care/case management, the continued development of multi-disciplined approaches and an increased focus on dual diagnosis issues.
V. Program Accomplishments
- Local, community based training workshops and events called "Gathering of Native Americans," GONA are being widely adapted throughout Indian country. These workshops and events have been designed, tested and evaluated in American Indian communities with the help of Indian education, social services and health professionals supported by both the Indian Health Service and the Center for Substance Abuse Prevention. As a result, there has been a revitalization of alcoholism and substance abuse awareness, community planning interest and capability.
- Over the past four years the Indian Health Service ASA Program has collaborated with the Centers for Disease Control and Prevention on several important projects. They include, a maternal alcoholism and substance abuse screening instrument for use at I/T/U prenatal clinics; a case control study on maternal characteristics of Indian mothers of FAS children; and analysis and dissemination of American Indian and Alaska Native Behavioral Risk Factor Surveillance System, (BRFSS) data.
- The IHS is in the midst of an ongoing effort to evaluate treatment for women. The first two phases of the four-phase evaluation have been completed. The final report of the first two phases described the conditions of and reasons for seeking treatment by AI/AN women who use IHS funded treatment services. The final report also emphasized need for treatment programs that provide cultural, spiritual and child care activities, and the importance of completion of individual and group therapy and participation in support groups. Phase III and IV of this evaluation have begun, and will conclude in 1999. The purpose of Phases III and IV are to assess and measure the treatment outcomes achieved by the women receiving treatment at facilities supported by the Indian Health Service. In addition, the evaluation study will attempt to relate treatment outcomes to the treatment services provided. It will also describe the organization and provision of substance abuse treatment and aftercare services available for adult AI/AN women, identifying common strengths, problems, and recommendations for improvement.
- As part of the Indian Health Service response to the results of an evaluation of the adolescent regional treatment centers, an RTC Outcomes Tracking Protocol Project has begun in FY 1998. The purpose of this protocol is to provide a quantitative means for validly and reliably documenting client progress, program outputs, program and policy outcomes, and program and policy efficiency.
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