Current treatment models for opioid addiction treatment are not effective in American Indian and Alaska Native (AI/AN) populations. The Billings Urban Indian Health and Wellness Center (BUIHWC) is seeking to disrupt the standard method of treatment through this pilot program in order to achieve improved outcomes for individuals, families, communities, and health care networks. This is not a solution based solely on an individual’s treatment and recovery needs, but rather a strategy that embraces a comprehensive and coordinated approach to address and mitigate the impacts on the family and community as a result of the individual’s choices.
BUIHWC’s overall goal is to create a replicable model that will mitigate key vulnerabilities of the AI/AN population and address the gaps in culturally-appropriate patient care. Using a systems of care approach, we intend to work collaboratively across the micro (individual), meso (family/peers) and macro (healthcare network/community partners) system. Our relationship-based continuum of care model focuses on health promotion, prevention education, intervention, treatment, and recovery; each of which is vital to the integration and progression of care received by participants.
Current treatment models often retain patients within an active maintenance stage, (trading one drug for another), failing to move to aftercare & complete recovery. For these reasons, BUIHWC seeks funding to implement an innovative and transformative treatment model designed to a) increase public awareness, health education/disease prevention, treatment, and recovery using a cultural and family centered framework; b) engage and empower support mechanisms for AI/AN individuals, families, and communities to effectively mitigate opioid abuse; and c) efficiently respond to the treatment, aftercare, and recovery needs of AI/AN individuals, families, and communities to reduce opioid consequences and overdose risks.
Addressing substance use prevention, treatment and aftercare from a community-driven integrative approach will ensure wraparound care to participants involved in different levels of care/treatment and increase the capacity of the community to prevent, and treat opioid addition. We believe that this community-driven framework that includes the AI/AN patient, their family, and community network supports and integrates traditional, holistic and Western medicine will improve outcomes and potentially reduce the social determinants of health that contribute to the opioid crisis being experienced in far too many AI/AN communities.
Rather than deliver MAT through internal medicine (primary care) or opioid dispense clinics, BUIHWC intends to deliver MAT by facilitating a psychiatric evaluation and treatment plan through behavioral health and medicine. Should Medication Assisted Treatment be deemed medically appropriate and necessary, patient induction will follow. From induction, a coordinated care team approach will follow in which patients assume a level of accountability within their care plan and progress.
According to the Indian Health Service:
“The American Indian and Alaska Native people have long experienced lower health status when compared with other Americans. Lower life expectancy and the disproportionate disease burden exist perhaps because of inadequate education, disproportionate poverty, discrimination in the delivery of health services, and cultural differences. These are broad quality of life issues rooted in economic adversity and poor social conditions.” This pilot project could aid in reducing this grim health status by generating cross-system collaboration, improving community awareness and education and supporting the community as a whole to better understand and serve the AI/AN population.