ADOLESCENT AMERICAN INDIAN MULTISECTOR HELP INQUIRY

尽管在美国印第安人青年中毒品和其他共同发生的精神健康问题的比率很高，但我们对他们的服务利用情况知之甚少。他们的医疗保健系统(印度健康服务)与其他联邦和州计划分开发展。尽管他们有资格获得国家资助的服务，但政治阻力、难以获得医疗补助报销以及缺乏预约服务，阻碍了城市青年和预约青年获得不同程度的服务。AIM-HI(青少年美国印第安人多部门帮助调查)研究将在4年内(从青春期到成年)收集城市和保留地的美国印第安人青年的服务使用和药物使用信息。这两个样本都来自亚利桑那州，在国家资助的服务中提供稳定的服务，但一个住在盐河皮马-马里科帕部落的土地上，另一个住在凤凰城。该项目将在第一年访问1000名青年，从1000名青年中抽取400名进行密集纵向访谈，并对其中600名青年的门户服务提供商进行调查。将在毒品/酒精和精神健康等专业部门；儿童福利、教育、少年司法和初级卫生等非专业部门；由父母、亲戚和朋友组成的非正规部门；以及土著治疗师的传统部门，研究多部门服务的使用。这项研究将达到三个目标：1.检验两个服务使用假设：a)青少年使用服务解决毒品或共病问题取决于他们的需要、他们的易感特征和服务使能特征；他们的需要是由网关提供商感知的；以及这些网关提供商的资源、服务联系和服务知识。B)在控制了基线环境因素和需求后，因吸毒和相关行为问题而获得和利用更广泛和更密集的服务的美国印第安人青年将不太可能出现功能受损和药物滥用、滥用或依赖。2.检验关于服务报销后果的假设：特殊物质使用服务的使用与这些服务的医疗补助和管理保健报销的可得性和可及性呈正相关。3.记录：a)药物滥用和其他问题的流行率、严重性和持续时间，以及保护性因素和风险因素；b)服务的多部门结构及其互补或补充关系；c)障碍和服务结构变化之间的关系。AIM-HI的影响因美国印第安人社区代表的参与、其个人投资者与乔治·沃伦·布朗社会工作学院精神健康服务研究中心和巴德美国印第安人研究中心的联合以及该领域主要研究人员的合作而加速。

Despite high rates of drug and other co-occurring mental health problems among American Indian youths, we know little about their service utilization. Their health care system (The Indian Health Service) developed separately from other federal and state programs. Although they are eligible to receive state-funded services, political resistance, difficulty in accessing Medicaid reimbursement, and lack of on-reservation services impede access differentially for urban and reservation-based youths. The AIM- HI (Adolescent American Indian Multisector Help Inquiry) study will collect service use and drug-use information over a 4-year period (from adolescence to young adulthood) on urban and reservation-based American Indian youths. The samples are both from Arizona, providing stability in state financed services, yet one lives on the Salt River Pima-Maricopa Tribal lands and the other in urban Phoenix. The project will interview 1,000 youths in Year 1, sample 400 of the 1,000 for intensive longitudinal interviewing, and survey 600 of these youths' gateway service providers. Multisector service use will be studied in the specialty sectors of drug/alcohol and mental health; the nonspecialty sectors of child welfare, education, juvenile justice, and primary health; the informal sector comprised of parents, relatives and friends; and the traditional sector of Native healers. The study will achieve three aims: 1. To test two service use hypotheses: a) Youths' use of services for their drug or comorbid problems is determined by their need, their predisposing characteristics, and service enabling characteristics; their need as perceived by gateway providers; and those gateway providers' resources, service connections, and service knowledge. and b) After controlling for baseline environmental factors and needs, American Indian youths who have accessed and utilized more extensive and intensive services for their drug use and related behavioral problems will be less likely to have impaired functioning and substance misuse, abuse or dependence. 2. To test a hypothesis concerning the consequences of service reimbursement: The use of specialty substance-use services is positively associated with the availability and accessibility of Medicaid and managed care reimbursement to those services. 3. To document: a) the prevalence, severity and duration of substance abuse and other problems, as well as the protective and risk factors, b) The multisector configurations of services and their complementary or supplementary relationships; and c) The relationship between barriers and changes in the configurations of services. AIM-HI's impact is accelerated by the participation of American Indian community representatives; the association of its PIs with the George Warren Brown School of Social Work's Center for Mental Health Services Research, and the Buder Center for American Indian Studies; and the collaboration of key researchers in the field.