The San Diego American Indian Health Center (SDAIHC) is an independent, nonprofit, Indian -controlled healthcare organization that was established in 1979 to provide multidisciplinary, comprehensive outpatient medical, dental, and behavioral health services to Urban American Indians and Alaskan Natives. The clinic was founded as an Urban Indian Health Organization (UIHO) under Title V of the Indian Health Care Improvement Act. SDAIHC also now operates as a Federally Qualified Health Center (FQHC) under section 330 of the Public Health Services Act. Our mission is to promote excellence in healthcare with respect to custom and tradition. Our goal is to reduce the significant health disparities of San Diego’s Urban American Indian population by increasing access to care and improving the quality of that care, resulting in increased life expectancy and improved quality of life. We are the only UIHO in the eighth largest metropolitan region in the United States.
Our proposed 4-in-1 program will leverage an array of SAIHC programs, both existing and currently under consideration for funding by IHS (like our pending SAPTA proposal, which would build on the foundations we established under MSPI funding). Existing, funded Nursing staff will support the provision of vaccines on this effort. Existing, funded Mental Health and SUD Counseling staff will provide the Behavioral Health service sessions and talking circles needed by 4-in-1 program clients. Our PHN will provide Universal Screening and warm service handoffs to all Native clients who screen at-risk on the PHQ-2 instrument (which is given to every patient, at every service entry point, at every visit) to address any indicated mental health or AOD/SUD challenge. For Native clients facing significant MH/AOD challenges, our PHN will also provide Assertive Community Treatment Intensive Case Management to promote client success. As in past 4-in-1 proposals at SDAIHC, our HP/DP component includes cultural crafting activities (advancing our philosophy that culture is health). The current proposal will a special emphasis on the crafting of Ceremonial Regalia in Year 1. Two staff will spend effort contributing to each of the 4 work areas. One is a new Outreach Education and Utilization Champion, who will assist each of the 4-1 work areas in disseminating accurate, timely HP/DP information to Native clients—and in actively engaging with those clients, and ensuring that each individual is receiving every wrap-around service required for better health. The second is a Wellness Champion, who will provide HP/DP services to clients such as nutrition assistance, personalized exercise plans, wellness circles, HIV Testing/Counseling and PrEP Navigation services (which is a growing need at our urban clinic, where nearly 6% of clients identify as Two-Spirit), and fitness-level appropriate yoga and/or gentle stretching classes.
The AOD and related mental health needs of our clientele are significant. At the time of our last 4-in-1 proposal, meth use was the most significant AOD challenge, and 3.7 individuals per 100,000 in the population suffered with it. Now there are 5.4 individuals per 100,000 – a 45% increase—and the greatest challenge is opioids, not methamphetamine. In the 92091 ZIP Code, which is part of SDAIHC’s target service area, the age-adjusted opioid overdose rate currently stands at 1,189 individuals per 100,000 and the population. In short, our clients’ and our community’s need for AOD and related mental health services has never been greater.
The program will take place in a new service context, which features enhanced patient screening designed to reliably recognize those at risk for AOD use or mental health challenges. The funding of further 4-in-1 support, and our pending SAPTA program, will enable a seamless experience for clients, of any age, needing any 4-in-1 service.