Behavioral Health Services and Staff Perceptions in Urban Indian Health Organizations

Abstract

Three studies were conducted to determine how urban American Indian health organizations deliver behavioral health services. The first study, Behavioral Health Services in Urban Indian Health Organizations: Results of Survey and Observational Research, presents a survey of the offered services at fourteen UIHOs, and summaries drawn from in-person visits to six UIHOs. The aim of this study was to document the extent to which typical behavioral health services are being offered at UIHOs and to observe how the services these sites offer may differ from other settings. The results of the first study indicated that UIHOs report offering services similar to national outpatient clinics, but that their offering of American Indian cultural education and traditional healing is a crucial difference in terms of what services they offer. The second study, Behavioral Health Services Offered at Urban Indian Health Organizations: A Thematic Analysis, presents a thematic analysis drawn from interviews with ten directors of behavioral health at UIHOs. The aim of this study was to further document through interviews what services are offered in behavioral health and what resources are used to offer them. The results of the second study indicated that behavioral health services at these UIHOs goes beyond psychotherapeutic treatment of psychological disorders and includes significant amounts of case management to address clients’ basic living needs, as well as the coordination of cultural and traditional healing programming. While funding was identified by participants as a primary barrier to offering adequate services, they also noted additional challenges due to the lack of psychiatrists, and a lack of American Indian therapists. The third study, American Indian Behavioral Health Treatment Preferences as Perceived by Staff at Urban Indian Health Organizations, presents a thematic analysis drawn from interviews with twenty-eight behavioral health staff at six UIHOs along with focus groups with twenty-three staff from five UIHOs. The aim was to better understand how therapists at UIHOs manage demands for evidence-based practice and culturally relevant behavioral health care for American Indian clients. The results of the third study suggested that these therapists attempt to blend and tailor empirically-supported treatments with American Indian cultural values and practices (where possible and appropriate), while trying simultaneously to honor the client’s specific preferences and needs and to encourage clients to seek cultural practices and connection outside the therapy room. These three studies together suggest that UIHOs offer a wide array of behavioral health services, but variation from UIHO to UIHO is noteworthy. A lack of resources, both financially and in terms of the availability of particular types of clinicians, were reported to limit the amount and type of behavioral health services offered. Cultural education and traditional ceremonial practice are commonly employed in both theorization and implementation of behavioral health treatment in service to wellbeing and healing for American Indian clients. Staff at all UIHO sites in these studies utilized some form of cultural education, traditional practice, or both in their approach to offering behavioral health services. Participants described how these practices may be incorporated in treatment, provided to clients outside of treatment, or referred out for client active engagement. These findings suggest UIHO staff blend theories of empirically-supported treatments with cultural programming to promote American Indian wellbeing, while consciously aware of the limitations of the evidence base and the lack of research with American Indian clients.