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, with a target population of 30,000 individuals.
Our proposed Tribal Practices program will leverage and complement an array of SAIHC programs, both existing (like our SAMHSA Strategic Framework Partnerships for Success, Zero Suicide, and Native Connections grants—and our IHS-funded Public Health Nursing grant), and several programs currently under consideration for funding by IHS (i.e., a pending Substance Abuse Prevention, Treatment and Aftercare (SAPTA) proposal, which would build on the foundations we established under past MSPI funding—and a new 4-in-1 grant program).
A key feature of SDAIHC’s patient centered medical home is the use of the PHQ-2 screening instrument with all clients, on every occasion that they present at the clinic, whatever the reason for their visit. Through this approach, we identify clients who are at risk and in potential need of behavioral health supports. All clients showing risk on PHQ-2 are given a warm handoff to our public health nurse, with whom they complete a universal screening, including multiple instruments such as PHQ-9, AUDIT-C, ACES, MAT Use, Tobacco Use, Domestic Violence, Dental Utilization, and an Activity Level Assessment. Based on the universal screening, clients are ranked as: Low Risk, Medium Risk, Medium-High Risk, and High Risk/Dependency. Our clinic has developed an excellent set of services from SBIRT, to Talking Circles, to brief courses of Therapy or Counseling, to in-patient detoxification and treatment, longer-term therapy, and intensive case management – according to the individual’s needs.
The gap that this proposal will address involves SDAIHC’s offerings of culturally competent services for clients screening low to medium risk. As the CDC has wisely noted, tribal practices that build resiliency, connections to community, family, and culture among AI/AN can prevent the American Indian clientele that we serve from progressing to medium and high risk of mental health and/or chemical dependency challenges by celebrating, validating, and reinforcing the ways in which “Culture IS Wellness.”
SDAIHC’s Tribal Practices for Wellness proposal will implement three strategies from the CDC logic model: strategies 4, 5, and 6: intergenerational learning opportunities that support wellness and resilience; cultural teachings and practices about traditional healthy foods to promote health, sustenance, and sustainability; and traditional and contemporary physical activities that strengthen well-being. Our program has been specifically designed to strengthen the future well-being of youth served through our Prevention Early Intervention Youth Center, by linking activities for elders and adults with Youth Center activities, and activities that serve entire Native American families. With CDC funding we will greatly strengthen the prevention components of our patient centered medical home. Our proposed program will cost $150,000 per year—which will provide an excellent public health value at less than $120 per AI/AN family served.