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

项目摘要 与其他群体相比，在吸毒后的较高药物滥用率方面存在着明显的差异。 美国印第安人/阿拉斯加原住民（AI/AN）的创伤应激，暴力和自杀。物质的高比率 AI/AN社区的滥用与失业，低学业成绩，高风险 职业、暴力、家庭虐待、犯罪、缺乏健康保险、精神疾病和死亡率 自杀酗酒或其他药物滥用物质使用障碍（SUD）不成比例地影响 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的人员- 综合治疗和预防服务。此外，缺乏以文化为中心的治疗 这对居住在农村和城市地区的AI/AN个人来说是一个障碍。2019冠状病毒病疫情暴露了 在服务不足的社区，在获得医疗保健和健康结果方面存在着根深蒂固的种族差异。 COVID-19尤其对亚利桑那州的部落社区造成了毁灭性的影响。SUD患者可能 由于许多药物对呼吸和肺的影响， 健康，无家可归的可能性更高，监禁，以及比一般健康状况 人口鉴于远程保健在为人工流产/人工流产和农村地区提供全面护理方面存在的障碍， 社区，COVID-19大流行可能使那些有行为健康问题和SUD的人甚至 更高的风险。培训工作人员，研究以文化为中心的行为健康和成瘾的交付 作为一种可行的选择，远程医疗护理有可能减少COVID-19的持久影响， 服务不足的人群，防止药物使用治疗中断。家长的总体目标 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， 提供者和卫生专业的博士生（职业治疗[OT]，物理治疗[PT]， 咨询，学校，临床心理学和跨学科健康）的研究技能，包括文化- 以实践为中心，与跨专业实践和不同环境中应用的SU/SUD相关。 建议补充我们的R25将着眼于本土文化和传统做法，在远程行为 SU/SUD治疗在我们的社区合作伙伴机构之一-美洲原住民社区行动 （NACA）-并确定在第一年期间对客户行为健康结果的影响， 2019冠状病毒病疫情。该项目的具体目标是：目标1：了解原生 在NACA的远程行为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COVID-19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， 与NACA SU/SUD供应商进行试点测试，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.