University of Southern California Keck School of Medicine, Department of Preventive Medicine, United States of America.
University of Southern California, Keck School of Medicine, Department of Pediatrics, Children's Hospital Los Angeles, United States of America.
J Subst Abuse Treat. 2020 Jan;108:9-19. doi: 10.1016/j.jsat.2019.04.003. Epub 2019 Apr 10.
American Indian and Alaska Native (AI/AN) communities have disproportionately been impacted by the opioid epidemic with the second highest opioid-related overdose death rates compared to other ethnic groups. The diversity among California AI/AN tribes, including regional differences in economic opportunities, tribal affiliation and organization, resources and infrastructure, requires a strong community-based partnership approach to assess global statewide patterns in service availability, acceptability, and utilization, as well as capturing the unique challenges and service needs within each region. This article describes a statewide community-based needs assessment of strengths and weakness among key informants in CA to identify facilitators and barriers to treatment of substance use disorders (SUD) and opioid use disorders (OUD). We conducted structured interviews of 21 healthcare professionals from Urban Indian Health Programs, Tribal clinics and community-based organizations throughout California. The interview assessed (1) barriers to accessing services; (2) risk factors; (3) protective factors; (4) community substance use description; (5) SUD and OUD services available; and (6) service system needs. Findings indicate an overall increase in SUD and OUD in AI/AN communities. Key informants discussed the importance of comprehensive and culturally centered care, wrap-around services, such as treatment of mental health issues alongside substance abuse, and the need for AI/AN-specific treatment facilities that integrate traditional and cultural activities into western health services.
美国印第安人和阿拉斯加原住民(AI/AN)社区受到阿片类药物流行的不成比例的影响,与其他族裔群体相比,阿片类药物相关的过量死亡率第二高。加利福尼亚州 AI/AN 部落之间存在多样性,包括经济机会、部落隶属关系和组织、资源和基础设施方面的区域差异,这需要采取强有力的基于社区的伙伴关系方法来评估全州范围内服务的可用性、可接受性和利用率,并了解每个地区的独特挑战和服务需求。本文描述了一项全州范围内的基于社区的需求评估,以了解加利福尼亚州关键信息提供者的优势和劣势,以确定治疗物质使用障碍(SUD)和阿片类药物使用障碍(OUD)的促进因素和障碍。我们对来自加利福尼亚州城市印第安人健康计划、部落诊所和社区组织的 21 名医疗保健专业人员进行了结构化访谈。访谈评估了(1)获取服务的障碍;(2)风险因素;(3)保护因素;(4)社区物质使用描述;(5)SUD 和 OUD 服务的可用性;(6)服务系统需求。调查结果表明,AI/AN 社区中的 SUD 和 OUD 总体上有所增加。关键信息提供者讨论了综合和以文化为中心的护理、全面服务(如同时治疗心理健康问题和药物滥用)的重要性,以及需要针对 AI/AN 的特定治疗设施,将传统和文化活动融入西方卫生服务的重要性。