Abstract:

Alcoholism continues to be the specific disability most needing attention, according to surveys and medical statistics.  In order for VR counselors to deal more effectively with clients who have this disability, they need to know more abut effective treatment for American Indians and Alaska Natives who have alcoholism (so they can make more effective referrals), and more about the special needs of American Indians and Alaska Natives during the early stages of abstinence and recover, as their IPEs are being developed and implemented.  American Indians and Alaska Natives who have alcohol dependency who are helped to achieve stability during this process are more likely to be rehabilitated and achieve successful employment outcomes than those whose special needs are ignored.  The proposed project will conduct research that addresses these needs.

Purpose:

To identify and promote best practices for American Indians and Alaska Natives with alcohol dependency, to improve the employment outcomes of these consumers.

Progress to Date:

Objective 1: Data from RSA and NHIS was analyzed and summarized in the draft of our Final Report. Objective 2: Completed in previous grant year. In addition, P.I. has collaborated with the RRTC on Drugs and Disability, the Arizona Practice Improvement Collaborative, and the Northern Arizona Regional Behavioral Health Authority and has received training in …Dual Diagnosis …Motivational Interviewing …Community Reinforcement Approach Objective 3: Completed in previous grant year. Objective 5: Re-assessment and redesign of project goals completed by Drs. Spero Manson & Candice Fleming, 5/02/2001. Objectives 6-7: In progress: Substantial draft of Final Report has been written. 1.Publication of a Directory of Alcoholism Treatment Programs with special programs for American Indians and Alaska Natives in 2000 2.Searchable research bibliography database [Experimental version online at http://www3.nau.edu/ihd/airrtc/pubsearch.cfm will be linked from the AIRRTC R-51 web pages and ready to use by July 23.] Objective 4 has been a problem because Activity 4.1 Originally, we had planned to obtain information about successful AI VR clients from participating VR agencies, and interview them, but it proved much more difficult than expected to identify participants in this way. Objective 4: Progress towards this objective, as well as all others, was reviewed by Spero M. Manson, Ph.D., and Candace M. Fleming, Ph.D., American Indian and Alaska Native Programs, Department of Psychiatry, University of Colorado Health Sciences Center. Their recommendations were as follows:

The fourth objective involves identifying culturally relevant components of the VR process that should be incorporated into an AI/AN client?s IPE. The team approached this objective by crafting a questionnaire for administration to AI/AN VR clients. As of June 2000 only 2 AI VR clients had been interviewed, with difficulty noted in recruiting additional interviewees.

Anticipating that the recruitment process has proven and/or will continue to prove difficult, we propose an alternative strategy for the team to consider. Specifically, after carefully reviewing the recent, relevant literature, we have developed a schematic representation of the analogous stages in the vocational rehabilitation process and in the behavioral health treatment process (see Table 1). The former is represented in the left-hand column; the latter is depicted in the right-hand margin. We then indicate, in the center column, those elements of culturally competent care that apply to both. In doing so, we drew heavily upon two documents: 1) Cultural Competence Guidelines in Managed Care Behavioral Health Services for American Indians and Alaska Natives, a volume published in 1999 by the Center for Mental Health Services, SAMHSA, which is a product of a task force chaired by Dr. Fleming, and 2) Appendix I, Diagnostic and Statistical Manual-IV, published in 1994 by the American Psychiatric Association, which is a product of the NIMH-sponsored Committee on Diagnosis, Culture, and Care, on which Dr. Manson served. Our experience suggests that VR counselors and behavioral health treatment providers can profitably consider both the corresponding points in the intervention process as well as matters of cultural competence specific to their own efforts. Further, we suggest that the team?s efforts might be better invested in elaborating this framework with materials from case examples to illustrate their overlap and respective contributions to the client?s care. The resulting product could then directly inform continuing education targeted to either set of practitioners, for whom cultural competence is an equally important goal.

Note: This Project has been endorsed by the Consortia of Administrators for Native American Rehabilitation (CANAR).

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