Behavioral Health Services in Urban American Indian Health Organizations: A Descriptive Portrait

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The federal Indian Health Service (IHS) is the primary funding source for health services designated for American Indians (AIs; Gone & Trimble, 2012). Urban Indian health organizations (UIHOs), funded in part by IHS, are typically the only sites in large metropolitan settings offering treatments tailored to AI health needs. This is a first look at how mental health treatment is structured at UIHOs. UIHO staff at 17 of 34 UIHOs responded to our request to participate (50%), 14 employed behavioral health program directors who could complete the survey on behalf of their programs, and 11 of these submitted complete data regarding their current treatment practices and personal attitudes toward empirically supported treatments. Reported treatment profiles differed less than expected from available data on national outpatient clinics from the National Mental Health Services Survey (Substance Abuse and Mental Health Services Administration [SAMHSA], 2014), and program director attitudes toward empirically supported treatments were similar to national norms reported by Aarons et al. (2010). One way in which treatment differed was in the reported use of traditional AI healing services. All program directors indicated that traditional AI healing services were available within their behavioral health programs in some form. These findings seem promising for the development of new empirically supported treatments for AI clients, but also raise concerns, given what is known about AI treatment preferences and mental health disparities. For example, traditional healing services are often considered “alternative medicine,” outside the purview of evidence-based practice as typically construed by mental health services researchers. This potential conflict is a subject for future research.

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