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

阿拉斯加原住民（AN）青少年自杀是横跨阿拉斯加229个乡村的公共卫生危机。酒精和其他物质使用障碍对非洲人的影响也不成比例，是非洲成年人死亡的主要原因。作为回应，阿拉斯加土著部落健康联盟（ANTHC）在2008年建立了一个行为健康援助（BHA）项目。BHA方案的目标是为乡村辅导员提供与文化相关的培训和教育，以促进土著居民个人、家庭和社区的行为健康和保健。BHA是一名土著社区卫生工作者，具有必要的技能和相关培训，并在其部落或卫生组织中得到适当安置，以提供化学品依赖评估和咨询、卫生教育、危机管理和宣传服务。bha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培训和服务模式显示出增加获得高质量行为卫生保健机会的希望，但没有研究对其过程或结果进行检验。印第安人卫生服务（IHS）已经接受了BHA模式，以便在美国各地的部落卫生机构中复制，BHA候选人目前正在美国多个部落卫生系统中使用ANTHC课程和认证计划进行雇用和培训。该应用程序的目的是测试BHA实践的范围，以及BHA方案在解决该实践范围方面的可行性和可接受性。在农村和偏远地区，迫切需要基于地方的、符合文化的行为卫生服务，以解决目前获得护理的挑战。随着COVID-19大流行引发行为健康差异危机，这种需求只会加剧。有希望的实践，如AK的BHA模式，需要沿着转化科学途径加速，使其成为部落卫生系统的循证可报销服务模式。

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.