Factors and Training Approaches that Enhance the Integration of American Indian Culture into Tele-Behavioral Substance Use/Substance Use Disorders Treatment.

项目总结 与其他群体相比，在较高的药物滥用比率方面存在明显的差异， 美国印第安人/阿拉斯加原住民的创伤应激、暴力和自杀(AI/AN)。物质的高比率 人工智能/人工智能社区的滥用与失业、低学习成绩、高风险有关 职业、暴力、家庭暴力、犯罪、缺乏医疗保险、精神疾病和死亡率 自杀、酗酒或其他物质滥用。物质使用障碍(SUD)的影响不成比例 亚利桑那州的人工智能/人工智能由于缺乏提供证据所需的基础设施和保留地人员- 以综合治疗和预防服务为主。此外，缺乏以文化为中心的治疗 是生活在农村和城市地区的人工智能/人工智能个人的障碍。新冠肺炎大流行暴露出 在服务不足的社区中，在保健机会和健康结果方面存在着广泛的种族差异。 新冠肺炎尤其对亚利桑那州的部落社区产生了毁灭性的影响。患有自闭症的人可能是 由于多种药物对呼吸系统和肺部的影响，新冠肺炎并发症的风险尤其高 健康，以及无家可归、监禁和合并健康状况的可能性比一般情况下更高 人口。鉴于在为AI/AN和农村地区提供全面护理方面存在远程保健方面的现有障碍 在社区中，新冠肺炎大流行可能会让那些有行为健康问题和肥皂水的人甚至 风险更高。培训员工以研究以文化为中心的行为健康和成瘾的交付 将远程医疗作为一种可行的选择的护理有可能减少新冠肺炎在 服务不足的人群，并防止药物使用治疗中断。母公司的总体目标 R25，以文化为中心的成瘾研究培训(C-CART)(1R25DA053805)，是为了教育临床医生， 卫生专业的提供者和博士生(职业治疗[OT]、物理治疗[PT]、 咨询、学校和临床心理学，以及跨学科健康)的研究技能，包括文化- 以实践为中心，涉及SU/SODS在跨专业实践和多样化环境中的应用。 我们建议的R25附录将考察远程行为中的土著文化和传统做法 SU/SUD治疗在我们的社区伙伴机构之一-社区行动美洲原住民组织 (NACA)-并确定在第一年对客户行为健康结果的影响 新冠肺炎大流行。该项目的具体目标是：目标1：了解土著人民的融合 NACA远程行为SU/SUD治疗中的文化和传统做法，并探讨其对 采用混合方法研究设计的新冠肺炎大流行期间的行为健康结果；以及 目标2：将目标1的发现纳入远程行为SU/SUD治疗培训模块，该模块将 与NACA SU/SUD提供商进行试点测试，并与印度卫生服务(IHS)西部地区共享。

PROJECT SUMMARY In comparison to other groups, there are clear disparities in the higher rates of substance abuse, post- traumatic stress, violence, and suicide in American Indian/Alaska Natives (AI/AN). High rates of substance misuse in AI/AN communities is associated with unemployment, low academic performance, high-risk occupations, violence, domestic abuse, delinquency, lack of health insurance, mental illness, and mortality from suicide, alcohol, or other substance abuse. Substance use disorders (SUD) disproportionately impact AI/ANs in Arizona due to the lack of infrastructure and personnel on reservations needed to deliver evidence- based comprehensive treatment and prevention services. In addition, the lack of culturally-centered treatment is a barrier to AI/AN individuals living in both rural and urban areas. The COVID-19 pandemic has exposed well-established racial disparities in health care access and health outcomes in underserved communities. COVID-19 has particularly had devastating impacts on tribal communities in Arizona. People with SUD may be particularly at-risk for COVID-19 complications due to the effect of many drugs on respiratory and pulmonary health, and higher likelihood of homelessness, incarceration, and co-morbid health conditions than the general population. Given existing barriers to telehealth in providing comprehensive care for AI/AN and rural communities, the COVID-19 pandemic may have placed those with behavioral health issues and SUDs at even higher risk. Training a workforce to research the delivery of culturally-centered behavioral health and addiction care with telehealth as a viable option has the potential to reduce the lasting impact of COVID-19 in underserved populations and prevent disruption of substance use treatment. The overall goal of the parent R25, Culturally-Centered Addictions Research Training (C-CART) (1R25DA053805), is to educate clinicians, providers, and doctoral students in health professions (occupational therapy [OT], physical therapy [PT], counseling, school, & clinical psychology, and interdisciplinary health) in research skills that include culturally- centered practices, related to SU/SUDs applied in interprofessional practice and diverse settings.This proposed Supplement to our R25 will look at Native culture and traditional practices within tele-behavioral SU/SUD treatment at one of our community partner agencies – Native Americans for Community Action (NACA) - and determine the impact on behavioral health outcomes for clients during the first year of the COVID-19 pandemic. The specific aims of this project are: Aim 1: To understand the integration of Native culture and traditional practices within tele-behavioral SU/SUD treatment at NACA and explore its impact on behavioral health outcomes during the COVID-19 pandemic employing a mixed methods research design; and Aim 2: To incorporate the findings from Aim 1 into a tele-behavioral SU/SUD treatment training module that will be pilot tested with NACA SU/SUD providers and shared with the Indian Health Service (IHS) Western Region.