title: A National Study of American Indian and Alaska Native Substance Abuse Treatment: Provider and Program Characteristics.
abstract: American Indians and Alaska Natives (AIANs) experience major disparities in accessing quality care for mental health and substance use disorders. There are long-standing concerns about access to and quality of care for AIANs in rural and urban areas including the influence of staff and organizational factors, and attitudes toward evidence-based treatment for addiction. We conducted the first national survey of programs serving AIAN communities and examined workforce and programmatic differences between clinics located in urban/suburban (n=50) and rural (n=142) communities. We explored the correlates of openness toward using evidence-based treatments (EBTs). Programs located in rural areas were significantly less likely to have nurses, traditional healing consultants, or ceremonial providers on staff, to consult outside evaluators, to use strategic planning to improve program quality, to offer pharmacotherapies, pipe ceremonies, and cultural activities among their services, and to participate in research or program evaluation studies. They were significantly more likely to employ elders among their traditional healers, offer AA-open group recovery services, and collect data on treatment outcomes. Greater openness toward EBTs was related to a larger clinical staff, having addiction providers, being led by directors who perceived a gap in access to EBTs, and working with key stakeholders to improve access to services. Programs that provided early intervention services (American Society of Addiction Medicine level 0.5) reported less openness. This research provides baseline workforce and program level data that can be used to better understand changes in access and quality for AIAN over time.
authors.affiliation: School of Public Health and Department of Psychiatry, Oregon Health and Science University, Portland, OR, 97239, United States. Electronic address: rieckman@ohsu.edu.
authors.forename: Traci
authors.initials: T
authors.lastname: Rieckmann
authors.affiliation: Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States.
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Moore
authors.affiliation: Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States.
authors.forename: Calvin D
authors.initials: CD
authors.lastname: Croy
authors.affiliation: Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, United States.
authors.forename: Douglas K
authors.initials: DK
authors.lastname: Novins
authors.affiliation: University of California, San Diego School of Medicine, Department of Psychiatry, 9500 Gilman Drive (0812), San Diego, CA 92093, United States.
authors.forename: Gregory
authors.initials: G
authors.lastname: Aarons
mesh_terms: D000072957:Alaska Natives; D055317:Evidence-Based Practice; D005260:Female; D019538:Health Care Surveys; D006297:Health Services Accessibility; D054625:Healthcare Disparities / Q000208:ethnology*; D006801:Humans; D007198:Indians, North American; D008297:Male; D015397:Program Evaluation; D011787:Quality of Health Care; D019035:Rural Health Services / Q000458:organization & administration / Q000592:standards; D016320:Substance Abuse Treatment Centers / Q000458:organization & administration* / Q000592:standards; D019966:Substance-Related Disorders / Q000534:rehabilitation*; D019036:Suburban Health Services / Q000458:organization & administration / Q000592:standards; D019037:Urban Health Services / Q000458:organization & administration / Q000592:standards
keywords: American Indian/Alaska Native; EBPAS; Evidence-based treatment; Organizational characteristics; Substance use disorder; Workforce