MODELS FOR PRACTICE
FOCUS
AREA: SUBSTANCE ABUSE
Location:
Healthy People 2010 Objective: 18
Web Address: http://www.searhc.org
Blueprint: The Community Family Services Program is part of SEARHC (Southeast Alaska
Regional Health Consortium), the third largest Native health organization in
The
program is staffed by 18 paid employees including nine village providers, four
licensed mental health clinicians, one clinical director, two administrative
personnel, one health systems technician, and one health systems specialist.
The village providers are cross-trained to work with both mental health issues
and substance abuse disorders. Professional staff supervise the village
providers by visiting each community every six to eight weeks and by providing
day-to-day support via telephone.
The
program’s clientele is mostly Native Alaskan with substance abuse disorders.
Specifically, the program provides outreach, prevention, assessment services, early intervention,
education, emergency and crisis intervention, outpatient counseling,
aftercare/continuing care, relapse prevention, community development, and telepsychiatry/telehealth for
individuals with substance use disorders, mental illness, or co-occurring
disorders.
The
services are delivered in a variety of ways. Village-based counselors and
itinerant clinicians offer services to individuals, couples, families, and
groups. The services are offered primarily in counseling offices but can be
offered in homes, schools, and medical offices. These services employ various
technologies including telephones, fax, e-mail, computers, polycom units, and
palm pilots.
SEARHC developed its own
program to combat substance abuse and suicide. The program assesses individual
needs and tailors treatment to the individual. All counselors are cross-trained
in the treatment of substance use disorders and mental health disorders, such
as motivational interviewing and culturally relevant interventions such as the Red
Road to Recovery curricula. A key element of the program’s success is the
philosophy of identifying natural helpers from the villages and training them
as counselors, which: 1) increases the odds of provider longevity, 2) promotes culturally
competent providers for this unique underserved population, and 3) provides
career development in isolated economically depressed areas.
Making
a Difference: Since the program began, information has been gathered and assessed based
on the number of people served. Factors considered in the follow-up include
client satisfaction, improvement in productive activity for clients, decrease
in the use of alcohol, and increase in support from others. The program
expanded its focus to include more prevention and early intervention and
training concerning these issues. Initially, this may be more difficult to
evaluate, but it is thought that in the long run, longitudinal studies will
prove the efficacy of this direction. Additionally, prevention and early
intervention are more cost-effective than treatment.
In 2000, 71 percent of the clients were treated for
substance use disorders, 20 percent for mental health disorders, and 9 percent
for co-occurring disorders. In 2001, 51 percent of the clients were treated for
substance use disorders, 16 percent for mental health disorders, and 33 percent
for co-occurring disorders. In 2001, of the 222 discharged clients, 155
completed their treatment plans compared to 104 of the 144 discharged clients
in 2000. The substance abuse program does pre- and post-assessments to
determine program effectiveness, as well. In 2000, 65 percent of program
clients contacted for follow-up reported they had not relapsed at the six-month
mark, and 59 percent of the contacted clients had not relapsed at the 12-month
mark. In 2000, 90 percent of follow-up contacts rated their relationships as
good or above average at the six-month mark and 97 percent as good or above
average at the 12-month mark. In 2000, 83 percent of respondents rated family
support as above average at the six-month mark and 88 percent as above average
at the 12-month mark. In 2001, 81 percent of respondents rated family support
as above average at the six-month mark and 81 percent above average at the 12-month
mark.
The program received accreditation for its work,
including CARF (Commission on Accreditation of Rehabilitation Facilities)
accreditation for outpatient services for children and adolescents; and State
of
Beginnings: The
program began in 1989 in response to the need to address suicide and alcohol
problems. Seven years later, in 1996, the program was fully implemented. The program began with the cooperation of
the Native villages of Klukwan, Haines, Kake, Angoon, Pelican, Hydaburg,
Hoonah, and Yakutat. Since the program began, Hoonah and Yakutat have
withdrawn, and a new village, Klawock, joined. These villages range in size
from 160 in Klukwan to 1,429 in Haines.
Challenges and Solutions: The funding for sustaining
this program is through grants; the depressed economy in southeast
Geographical
and cultural barriers present major challenges in accessing and delivering
mental health services in this part of
Community
Family Services Program
Phone:
(907) 966-8776
Fax:
(907) 966-2489
E-mail:
ivag@searhc.org