Center for American Indian and Alaska Native Health Disparities

The initial cycle of the Center focused on health issues facing AI/AN children and youth, including quality of diabetic care for AI youth; documenting obesity among AI infants and children; increasing fitness among urban Al/AN youth; smoking cessation; understanding performance properties of a widely used health quality measure and assessing/improving the quality of mental health care for AI children; and telepsychiatry. Major accomplishments of this funding period include expanding the focus of the Special Diabetes Program for Indians to include attention to obesity and early onset type 2 diabetes among Native youth and establishing a growing network of telepsychiatry programs in rural, distant AI/AN communities, which generated clinical outcomes and cost-effectiveness data that justified its expansion to 14 clinics in South Dakota, Wyoming, Montana, and Alaska.

In this funding period, the Center turned its attention to the impact of the loss of Medicaid insurance on patient outcomes and survival among low-Income American Indians and Alaska Natives and treatment for depression in primary care. During this cycle, 66,000 AN/AI primary care patients were screened for depression using the Screening Brief Intervention and Referral for Treatment (SBIRT) protocol. Screening was followed up by co-located masters-level clinicians in primary care teams. Those patients found to be at risk were given an intervention and triaged to the appropriate level of care. 

After 3 years, the results of this study led the State of Alaska to revise its Medicaid CPT codes to fund 36 SBIRT clinicians at Southcentral Foundation, a tribally-owned and operated health care system in Anchorage, Alaska. The SBIRT protocol was expanded to address alcohol/substance abuse, suicidality, and trauma, and screening was extended to six other AI/AN primary care settings across the United States.

In the third phase of funding, the Center focused on the development, implementation, and evaluation of a culturally relevant Primary Care Screener for PTSD and an Internet-based supportive intervention. Over the course of funding, a culturally relevant screening tool for PTSD was developed and performance characteristics were established through rigorous test design. The Screener was implemented in primary care settings in healthcare systems at Southcentral Foundation in Alaska and Cherokee Nation in Oklahoma. In all, 11,298 AI/AN primary care patients were screened. Patients identified as at risk were triaged to a self-activated Internet-based psychoeducational support module, and then triaged to appropriate level of care based upon results.