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IV. Agency Budget Summaries

INDIAN HEALTH SERVICE


  1. RESOURCE SUMMARY

  2. 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.

  3. PROGRAM SUMMARY

    • The IHS provides health care services for American Indians and Alaska Natives (AI/AN) 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 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. 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; and,

      • Services for the developmentally disabled.

    • IHS's operations also support Goal 1 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.

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

    • 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.

  4. BUDGET SUMMARY

    1998 Program

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

    • FY 1998 funding for Goal 1 activities totals $3.5 million. IHS uses these resources to reduce alcohol and drug abuse. Some approaches IHS uses in support of Goal 1 are:

      • on-going development toward a comprehensive continuum of care encompassing prevention, education, treatment and rehabilitation;

      • supporting inhalant abuse prevention and treatment training and education to tribal communities with regard to children and adolescent use;

      • tobacco cessation activities;

      • expansion of primary prevention efforts through collaboration with the CSAP on the Rural and Remote Culturally Distinct population project and training;

      • continued enhancement of RTC development and effectiveness; and,

      • continued expansion of primary prevention efforts via collaboration with CSAP 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 to the public of illegal drug use.

    • FY 1998 funding for Goal 3 activities totals $39.4 million. These resources support IHS' treatment activities, which include a multi-discipline approach in treating and identifying inter-related mental health, social, and substance abuse related disorder and a focus on the preservation and regeneration of families. Some examples include:

      • continued enhancement of RTC development and effectiveness of treatment services inducing development of continuity of care plans for the return to the community; and,

      • continued support to address specific needs of women and their children through recommendation from the Women's Four Phase Evaluation Report, in which two phases have been completed.

    1999 Request

    • The total drug control request for FY 1999 is $51.9 million, a net increase of $9 million over the FY 1998 enacted level.

    • Nearly all the effort designed and carried out for the prevention of alcoholism and substance abuse has focused on individual-based strategies. In recent years there has been a growing interest in environmental prevention strategies; addressing social, economic and political issues at both the global and community levels (e.g. family systems, schools, workplace, etc.) that might affect alcohol and other drug use behavior.

    • Many Indian communities face multiple risk factors for alcohol and other drug problems, making them high-risk environments for violence and alcohol and other drug problems. This requires attention to broad economic political and social forces, as well as the need to develop viable, community-based social support systems.

    • We propose to build on environmental prevention strategies already taking place on some reservations. Among the strategies already being tested are: zoning regulations for the sale of alcohol and efforts to encourage women of childbearing age to prevent the use and abuse of alcohol during pregnancy. The aim is to provide assistance to Indian communities to develop and carry out prevention strategies in their communities and/or to join and collaborate with other agencies to effect environmental change.

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

    • The drug control request for Goal 1 activities for FY 1999 is $11.483 million, a net increase of $8 million over FY 1998. The 1999 request includes the following enhancements:

      • The focus of environmental prevention strategies for Indian communities will be on American Indian/Alaska Native Women's Treatment Centers by broadening the scope of traditional treatment, and by facilitating the collaboration and connection of women in treatment and after treatment with their communities.

      • Within this focus, special emphasis will be placed on the following: Women and children; tobacco cessation; parenting skills; prevention of child abuse; fetal alcohol screening; appropriate intervention and follow-up; and, community development.

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

    • The drug control request for Goal 3 activities for FY 1999 is $40.411 million, a net increase of $1 million over FY 1998. The FY 1999 request includes the following enhancements:

      • The focus of this goal will be to augment adolescent treatment capacities including continuing care/case management at the RTC, and in the home communities of clients who have completed treatment.

      • Special emphasis will be placed on upgrading staff positions through appropriate training designed to address comprehensive care needs, dual diagnoses, inhalant abuse, FAS and tobacco cessation.

  5. PROGRAM ACCOMPLISHMENTS

    • Local, community based training workshops and events have been conducted in 16 communities, utilizing three CSAP curricula. Additional replications have been planned and will take place in FY 1998 and FY 1999.

    • Continued primary care provider training workshops to enhance professional skills in addiction, prevention, intervention, and treatment skills. A special module has been developed for public health nurses. Activities include the development of a lending library (video and slide materials) designed to improve provider in service capability and community presentations. Training for 55 physician and other primary care providers was conducted in Phoenix, Arizona and Albuquerque, New Mexico. Prevention training for Nurses was offered in collaboration with CSAP.

    • The Chemical Dependency Management Information System (CDMIS) is now fully on line. 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. An integrated version which incorporates both commercial and RPMS data conducive to a behavioral health model of treatment is currently being tested in the Billings Area. The ASAP is supporting two software enhancement projects which further integrate and coordinate assessment, treatment planning, and case management utilizing the ASAM Patient Placement criteria and the CSAT Alcohol Severity Index (ASI) are being tested with 10 youth RTCs and the Billings area.

    • A maternal Alcoholism and Substance Abuse screening instrument was developed with the CDC for prenatal clinics in Aberdeen, Md. A companion curriculum for training providers was also developed, utilized, and implemented in three additional pilot sites: Shiprock, San Xavier, and the Chicago Urban Clinic in FY 1997. There were 25 participants at the Shiprock site which included the Chicago Urban Clinic and 12 participants at the San Xavier site.

    • Clinical supervision training will continue to be supported as in the previous 3 fiscal years to enhance the competency of counseling efforts.

    • As part of the IHS 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 validity and reliably documenting client progress, program outputs, program and policy outcomes and program and policy efficiency.