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Healthy Nations Initiative

United Indian Health Services

About the Program

The Healthy Nations Program of United Indian Health Services, Inc. (UIHS) aims to reduce substance abuse among Native Americans residing in the UIHS service area of rural Northern California, including Humboldt and Del Norte counties, a geographic area of 4,576 square miles. UIHS medical records indicate that 70% of its clients, ages 11 to 17, have substance abuse problems. Three of the five health care priorities are directly related to substance abuse for the service population, according to community surveys.

UIHS has four major goals including the community awareness campaign, multifaceted prevention programs, early detection/early intervention programs and the development of accessible treatment options and follow-up services for youth and families. UIHS utilizes The Robert Wood Johnson Foundation funding as initial start-up resources to implement the comprehensive four year plan. The following are the immediate goals for the UIHS Healthy Nations Program:

  • Goal 1: To implement a comprehensive public awareness campaign that will generate broad-based support to reduce the demand for and the use of alcohol, tobacco and other drugs.
  • Goal 2: To implement a community-wide multifaceted prevention plan to reduce the demand for the use of drugs, alcohol and tobacco, within the UIHS service area.
  • Goal 3: To implement special programs to promote early identification and early-treatment intervention of substance abuse among youth, pregnant women and other high risk tribal community members.

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Host Community/Organization

The United Indian Health Services, Inc. (UIHS) Healthy Nations Program has defined its primary target populations and communities as all Native Americans residing in Northern California’s Humboldt and Del Norte Counties -- a geographic area encompassing 4,576 square miles. The number of Native Americans in this area is estimated to be 10,000 individuals. Approximately 4,500 of these Native Americans currently live on eight different reservations in the two-county region and are descendants of four different tribes:

Reservation Tribal Group(s) Population
Bear River Mattole Band of Wiyot Indians Wiyot 129
Big Lagoon Rancheria Yurok, Tolowa 24
Blue Lake Rancheria Wiyot, Yurok 28
Elk Valley Rancheria Tolowa 260
Resighini Rancheria Yurok 73
Howonquet/Smith River Rancheria Tolowa 402
Trinidad Rancheria Yurok,Tolowa, Miwok 123
Yurok Reservation Yurok 3,433
(8 Reservations) (4 Tribes)  Total Pop: 4,472

Humboldt County is located on California’s Pacific Coast, approximately 285 miles north of San Francisco. The county is richly endowed with natural resources which support its primary industries of lumber, fisheries and tourism. The region is primarily mountainous, except for a plain surrounding Humboldt Bay where the area’s largest urban centers of Eureka and Arcata are located. Outside of this flatland zone, the county’s population is scattered among many small communities located along the river valleys which cut through the coastal mountain ranges.

Del Norte County is the northernmost coastal county of California. The 1,003 square mile county is bordered by Oregon to the north, Siskiyou County to the east, Humboldt County to the south and the Pacific Ocean to the west. Crescent City, the county seat, lies 370 miles north of San Francisco.

In addition to the Native Americans residing on reservations in the two-county area, the target population for the project includes all Native Americans and tribal organizations in neighboring counties who may wish to become involved in the project during the planning phase, and continue their efforts into the implementation phase.

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Strategy 1: Public Awareness Campaign

Through the use of modern technology UIHS' Healthy Nations Program's public awareness campaign utilized public service announcements on radio and T .V. to generate broad based support to reduce the demand for alcohol, tobacco and other drugs. The entire UIHS public awareness campaign and preventive strategies utilized the traditional healthy living practices and philosophies of the Northern California tribes (the Yurok, Hupa, Tolowa and Wyott people). The 6 PSA'S produced utilized local cultural information to reinforce and support cultural bonding.

The viewing population of more than 150,000 had the opportunity to see these PSA's. It is estimated that at least 10% of this population viewed at least one of our PSA' s. Additional PSAS also included roadside signs with culturally based no use messages for thousands of viewers to see along Highway 101, a major Northern California Highway. The two sign set remain today on this major California Highway and will be maintained by the tribes.

UIHS' public awareness campaign also included youth produced and implemented theater productions with multiple productions in each of the 4-implementation years of Healthy Nations. These productions had cultural themes and decision-making scenarios which youth and community members have every day. Tobacco, alcohol, drugs, sex, violence and other health related topics were also covered.
Other public awareness activities included a youth created and produced newsletter titled "Voices of Tomorrow" which featured culturally competent articles directed at youth on current topics, decision making and tobacco, drug, and alcohol information. Two newsletters in each year of the program were produced and distributed to over 2,000 youth in the UIHS two county Northern California service area. An additional public awareness activity included youth directed coloring books. These coloring books, two per year, utilized healthy messages and cultural symbols and ceremonial depictions to send a no use message to the community. An inter-tribal approach was taken to include all of the Northern California Tribes within UIHS' service area in the project. The depictions were to bond youth with the strengths of their culture while the coloring books reinforced a no use message.

A Local Heroes Project was completed in the final year of UIHS' program utilizing local American Indian role models on posters with a healthy community message. These role models included ceremonial dance makers, community leaders, elders, athletes and important local figures that will be placed in classrooms and in other public locations for native children and families to see. The notion behind this activity is that there is a lack of American Indian cultural symbols and role models in the view of Indian children and families. This project will add some balance in this dilemma in order to give self-esteem, cultural pride, and a drug free health message to the community. It is estimated that 50,000 plus people will see these posters. Many of these program activities continue with UIHS and local tribes beyond Healthy Nations funding.

Tribal program staff, UIHS staff and community members have realized the potential for community change through the many positive community awareness activities implemented by our Healthy Nations program. Community awareness activities also included a monthly radio production, for two years, covering key information and events related to the UIHS Healthy Nations Program. Community presentations, workshops and other mailings also added to the awareness campaign. The listening area included all of Northern California and Southern Oregon.

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Strategy 2: Community-Wide Prevention

IHS' multi faceted prevention activities to reduce the demand for and use of drugs, alcohol and tobacco included the following positive activities: the Teen Advisory Group (TAG), which involved local American Indian youth in healthy community activities. The 70 plus TAG group members involved over the past five years were involved in creating healthy community gatherings, youth positive alternative events, recreational events, tournaments, presentations, the youth news letters, theater productions, elders gatherings, community trainings, and summer youth camps. (Over 2,000 other community members were involved in TAG sponsored activities).

Other components of the IHS multi-faceted prevention plan included multiple youth art contests and community events. These community events included at least 10 events over each of the last six years of the Healthy Nations Program. These events included an annual youth Summer Camp, Community GONAs (Gathering of Native Americans - Gatherings focused on the post-trauma and healing in the communities), sports tournaments, elder gatherings, traditional arts and craft classes, youth conferences focused on living in the modern world and retaining one’s culture, and other community events and activities that give youth and community members alternatives to using while bonding to their Native Indian culture. These events and activities involved more than 3,000 community members over the life of the program and many of these activities will be continued by UIHS and local tribes beyond Healthy Nations funding.

Additional events and positive alternative activities included youth and adult basketball, baseball and volleyball tournaments, community dinners, traditional games of cards and sticks (which require healthy lifestyles), wellness conferences, health fairs, Family Fun Days, walks, after school programs and cultural workshops. An additional community event included the painting of roadside bridges with cultural significant designs. This activity reduced graffiti while bonding the community to a positive culturally competent activity. Many members of the community have learned the power and importance of healthy alternatives and there is a start of a new norm of healthy living in the targeted urns communities. The IHS program also joined many other local cultural health projects including a new College of the Redwoods motivation program, student American Indian clubs, a plan to reconstruct a traditional village at a public school site, elder’s workshops, and an on-going training institute for public school teachers regarding American Indian issues. These programs and activities will continue beyond Healthy Nations funding.

Most of the IHS Healthy Nations staff is also involved in the cultural revival of ceremonies and healing that has been in progress for 30 years now in Northern California. The IHS Healthy Nations activities were greatly assisted by this cultural healing momentum. A revitalization of the traditional stick games was one example of the merging of these two healing processes. The traditional stick games require healthy living, a healthy attitude, and great physical training that have no room for illicit drug, alcohol or tobacco use. The Healthy Nations Program assisted in this revival of the games where youth and community participate together. The traditional stick games will continue beyond Healthy Nations funding.

Additionally, UIHS' program involved many other current health initiatives that have similar goals of the Healthy Nations program. These other programs and agencies included other UIHS agency health efforts, local tribal healing and community development, and other community based programs. This collaborative effort was developed through many community and agency committees that were started and joined over the past six years. The momentum and success of UIHS' Program was made possible through collaboration and co-mingling of resources with other UIHS programs, tribal and community efforts. These efforts will continue beyond Healthy Nations funding.

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Strategy 3: Early Identification, Intervention and Referral

UIHS' special programs to promote the early identification and early intervention of substance abuse among Native American youth, pregnant women and other high-risk tribal and community members within the Northern California region included the following: through collaborative efforts both formal and informal linkages were created and strengthened with other UIHS intervention resources, community agencies and other programs in California. Memorandums of Understanding (MOU's) supported these collaborative efforts. Early intervention with youth and other high-risk community members has increased due to training and increased awareness of problem indicators and helping resources with individuals, families and agencies. Early intervention has increase from school referrals, law enforcement, tribal programs, community agencies and families. The MODS that supported this collaboration were made with other Tribal programs, local county mental health departments, youth probation, Indian Child Welfare Programs, School Districts, and other key agencies. The referral agreements will continue beyond Healthy Nations funding.

UIHS is now assessing nearly all of its pregnant clients for stress and other high-risk behaviors. UIHS is interviewing at least 50% of these women for additional information related to the need for early intervention. An intensive home visiting program was secured three years ago for the most high-risk pregnant and parenting women. This program is long-term and has shown great promise toward reducing and preventing prenatal substance use by Native mothers. UIHS is doing better at tracking and detecting prenatal substance use and has formed an agency multidisciplinary (NA-AS) committee to continue to develop this critical area. Additional local and State funding is being sought to continue work in this critical area. Agency and community training has grown and the efforts will continue beyond Healthy Nations funding, through state, local and other grants, with the UIHS NA-As program.

Substance abuse training sessions, workshops and conferences occurred within schools, weekend and summer workshops, and in the training of existing UIHS and tribal program staff. Training topics included the history of substance use and American Indians, use indicators, helping resources, cultural strengths as the answer to recovery and sobriety, decision making, domestic violence, and the post traumatic stress in Native Communities. The fact that Illicit drugs, alcohol and tobacco abuse was not a part of American Indian history, was reinforced throughout the work. This awareness assisted in the early intervention. Our youth conferences, summer camps, school and community presentations and annual Success In Both Worlds Youth Conference had general awareness training within them.

UIHS fully developed the resources of school based early intervention referrals at more than 20 different public schools for Native American youth. The UIHS program utilized and expanded its counseling department through this capacity building. Community based referral resources are better utilized. UIHS reformatted its peer support groups known as the POWER groups, for youth, with expansion and training in the program. Over 300 community members were referred for early intervention during the past 5 years. Much of the school-based services will continue beyond Healthy Nations funding.

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Strategy 4: Substance Abuse Treatment and Relapse Prevention

Numerous adults and family members were referred to related support services such as family counseling, drug and alcohol intervention counseling and other social services. An additional large number of youth were referred throughout the year. Eight schools continue to receive on-site UIHS counseling resources with coordination/advocacy assistance from UIHS staff.

UIHS' Counseling Department (Child and Family Services), the same department that housed the UIHS Healthy Nations Program, continued restructuring its adult residential substance abuse treatment program, which includes a 14-bed residential treatment program for adults. The program is now contracting with other American Indian residential treatment programs in California and has bolstered local outpatient helping resources with this restructuring effort. The Healthy Nations Program built confidence in the CFS Department and UIHS to take on a restructuring project such as this. Our Healthy Nations Director also directed this adult treatment program. The restructuring is an example of building infrastructure and capacity building. It is believed that both inpatient and outpatient substance abuse services in our region will greatly improve from this restructuring effort. This effort will continue beyond the Healthy Nations funding.

A weekly Unity and Sobriety Group was started two years ago with assistance from Healthy Nations in the rural community of Weitchpec. More than 50 community members have benefited from these support meetings and healthy community events and traditional gatherings have increased due to the success of the Unity and Sobriety groups. Additional sobriety groups have started and use the Unity and Sobriety as a model. These groups will sustain beyond Healthy Nations funding.
Healthy Nations staff has successfully brokered counseling resources and social services to many rural communities and villages such as Pecwan, Klamath and Weitchpec. Helping Services have increased and maintained in these communities. Individual community members as well as tribal programs, staff and agencies have seen increased possibilities for prosperity, sobriety and wellness from the Healthy Nations Program efforts. Expectations have grown and the community norms have improved.

The UIHS program also successfully re-contracted an on-going $50,000 agreement with Humboldt County Mental Health for counseling services and an on-going yearly $75,000 contract with local Del Norte County Mental Health for counseling services. Two new counselors were hired with this new funding. These expanded capacity grants will continue yearly beyond Healthy Nations funding. Additionally UIHS submitted and was successfully funded a proposal for $25,000 to increase the domestic violence response of UIHS, a $100,000 teen pregnancy prevention program and other funding options are awaiting award.

UIHS' Healthy Nations Outreach Workers, assisted directly by the UIHS CFS counseling department and the UIHS Healthy Nations Administration, conducted multiple activities to provide access to comprehensive referral, treatment, and follow-up services and advertised the availability of culturally appropriate inpatient and outpatient treatment programs for youth, families and other tribal members. The Outreach Workers were trained on how and where to refer along with multiple other UIHS staff and community members are now more aware of referral options and procedures.

UIHS also continued participation on the IHS Task Force for the State of California to develop Youth Residential Treatment Centers (YRTC's); two centers are now operational for American Indian youth, one in Central California, one in the central region and one in Southern California. These referral options and knowledge will continue beyond Healthy Nations funding.

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United Indian Health Services

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Colorado School of Public Health

13001 E. 17th Place
Mail Stop B119
Aurora, CO 80045

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