Alaska Behavioral Health Aide Program: Formative research to evaluate a rural training and service delivery model to reduce disparities in AN/AI mental health and substance use disorders

节目摘要阿拉斯加原住民青年自杀是阿拉斯加229个农村地区的公共卫生危机。酒精和其他物质使用障碍对人的影响也不成比例，是成年人死亡的主要原因。为此，阿拉斯加原住民部落健康联盟(ANTHC)于2008年建立了行为健康助手(BHA)计划。BHA计划的目标是为驻村顾问提供与文化相关的培训和教育，以促进个人、家庭和社区的行为健康和健康。BHA是一名土著社区卫生工作者，具有必要的技能、相关培训和在其部落或卫生组织中的适当安置，以提供化学品依赖评估和咨询、健康教育、危机管理和宣传服务。BHAS帮助解决个人和社区的行为健康需求，包括悲伤、创伤、抑郁、自杀和药物滥用。虽然BHA的培训和服务模式显示出增加获得高质量行为卫生保健的机会的前景，但还没有研究检查其过程或结果。印度卫生服务机构(IHS)已经在全美的部落卫生环境中采用了BHA模式进行复制，BHA候选人目前正在美国各地的多个部落卫生系统利用ANTHC课程和认证计划进行聘用和培训。这项申请的目标是测试钻具组合实践的范围，以及解决这一实践范围的钻具组合计划的可行性和可接受性。在农村和偏远的AIAN环境中，迫切需要基于地点的、文化上一致的行为健康服务，以应对当前获得护理的挑战。随着行为健康差距随着新冠肺炎大流行的危机而加剧，这种需求只会加剧。有希望的做法，如AK的BHA模式，需要沿着转化科学的道路加速，以达到部落卫生系统基于证据的有偿服务模式地位。

Program Summary Alaska Native (AN) youth suicide is a public health crisis across the 229 rural villages of Alaska. Alcohol and other substance use disorders also disproportionately impact AN people and are a leading cause of death among AN adults. In response, the Alaska Native Tribal Health Consortium (ANTHC) established a Behavioral Health Aide (BHA) Program in 2008. The goals of the BHA Program are to provide culturally relevant training and education for village-based counselors to promote behavioral health and wellness in AN individuals, families and communities. A BHA is an Indigenous community health worker with the requisite skills, relevant training and appropriate placement within their Tribe or health organization to provide chemical dependency assessment and counseling, health education, crisis management and advocacy services. BHAs help address individual and community behavioral health needs, including grief, trauma, depression, suicide and substance misuse. While the BHA training and service model shows promise for increasing access to quality behavioral health care, no research has examined its process or outcomes. The Indian Health Service (IHS) has embraced the BHA model for replication in Tribal health settings across the U.S., and BHA candidates are currently being employed and trained in multiple Tribal health systems across the U.S. utilizing the ANTHC curriculum and certification program. The objective for this application is to test the scope of BHA practice, and the feasibility and acceptability of the BHA program in addressing this practice scope. There is a critical need for place-based, culturally congruent behavioral health services in rural and remote AIAN settings to address current access to care challenges. This need has only intensified as the behavioral health disparities crises with the COVID-19 pandemic. Promising practices such as the BHA model in AK need to be accelerated along the translational science pathway to evidence-based reimbursable service model status for tribal health systems.