MODELS FOR PRACTICE

FOCUS AREA: SUBSTANCE ABUSE

 

 

Program Name: Community Family Services Program

Location: Sitka, Alaska

Problem Addressed: Substance Abuse and Mental Health

Healthy People 2010 Objective: 18

Web Address: http://www.searhc.org

 

 

SNAPSHOT

 

The Community Family Services Program is a non-profit health consortium of several Native groups to pool resources for health care. The program delivers mental health and substance abuse services on site at several remote villages in southeast Alaska through the use of lay providers certified as chemical dependency counselors by the state of Alaska.

 

THE MODEL

 

Blueprint: The Community Family Services Program is part of SEARHC (Southeast Alaska Regional Health Consortium), the third largest Native health organization in Alaska. The program serves the Native and non-Native people in rural southeast Alaska. Southeast Alaska consists primarily of remote island communities ranging from population 30,000 in Juneau to 19 in Port Alice. Most of the funding for the program is provided through contracts by the Indian Health Service and State of Alaska grants.

 

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 programís 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 programís 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 Alaska accreditation for outpatient care, aftercare/continuing care, and Alcohol Drug Information School (ADIS).

 

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 Alaska makes support through fees for services unrealistic. Currently, the program receives funding from federal monies and four state grants. The program reaches out to its consumers through the use of the media, brochures, radio public service announcements, CB announcements, newspaper articles, and its website. The program reaches prospective clients through presentations and trainings; reaches the community through media, presentations, and trainings; and reaches the state through reports and involvement on committees.

 

Geographical and cultural barriers present major challenges in accessing and delivering mental health services in this part of Alaska. Most of the villages are accessible only by plane or ferry. Extreme weather conditions in this area inhibit site visits and access to training, and cultural differences complicate the approach to providing care. The Community Family Services Program is investigating the use of a secure on-line client record-keeping system for use as a tool to strengthen its treatment component. The program training emphasis is on increasing provider competence in treating co-occurring disorders.

 

PROGRAM CONTACT INFORMATION

 

Iva Greywolf, Ph.D., MAC

Community Family Services Program

222 Tongass Drive

Sitka, AK 99835

Phone: (907) 966-8776

Fax: (907) 966-2489

E-mail: ivag@searhc.org