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Provider and State Perspectives on Implementing Cultural-Based Models of Care for American Indian and Alaska Native Patients with Substance Use Disorders

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Abstract

American Indians/Alaska Natives (AI/ANs) suffer disproportionate rates of substance use disorders compared to Americans overall. Providers serving AI/AN communities are drawing from a diverse toolkit of treatment strategies that incorporate Native worldviews and community-shared values in order to improve outcomes. This paper describes findings from interviews with 22 program directors and 18 representatives from Single State Authorities on substance abuse. Interviews assessed provider and state efforts to increase AI/AN client engagement and to improve the quality of care through culturally relevant interventions. Results suggested that providers employed flexibility and originality to cultural-based programs by broadening established practices, adopting outside traditions, and creating new ones to fit client needs. However, gaps in state–tribal collaborations and inter-group complexities such as staff-based tensions, a widening generational divide, and blurred consensus of “tradition” affect service delivery. Overall, respondents underlined the critical role culturally relevant care plays in individual and community healing.

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Conflict of Interest Statement

The authors have no financial ties, academic commitments, personal relationships, political or religious association, or institutional affiliations with the state agencies, treatment providers, or tribal communities participating in this study.

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Authors and Affiliations

  1. Department of Public Health and Preventive Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, CSB 670, Portland, OR, 97239, USA

    Raina L. Croff PhD & Traci R. Rieckmann PhD

  2. NW Indian Training Associates, P.O. Box 561, Sherwood, OR, 97140, USA

    John Doug Spence PhD

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  1. Raina L. Croff PhD
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  2. Traci R. Rieckmann PhD
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  3. John Doug Spence PhD
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Correspondence to Raina L. Croff PhD.

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Croff, R.L., Rieckmann, T.R. & Spence, J.D. Provider and State Perspectives on Implementing Cultural-Based Models of Care for American Indian and Alaska Native Patients with Substance Use Disorders. J Behav Health Serv Res 41, 64–79 (2014). https://doi.org/10.1007/s11414-013-9322-6

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