Project Grant H79SM089684

SAYAQAGVIK SYSTEM OF CARE COMMUNITY EXPANSION INITIATIVE FOR ALASKA NATIVE CHILD, YOUTH, AND FAMILY BEHAVIORAL HEALTH EQUITY - THE SAYAQAGVIK SYSTEM OF CARE WAS DEVELOPED OVER EIGHT YEARS BY MANIILAQ ASSOCIATION AND THE 12 FEDERALLY-RECOGNIZED INUPIAT TRIBES WITHIN ITS NORTHWEST ALASKA SERVICE AREA. SAYAQAGVIK (INUPIAQ, MEANING 'A PLACE TO HEAL') EMPLOYS A PRIMARY CARE MEDICAL HOME MODEL TO BRING EVIDENCE-BASED AND CULTURALLY-GROUNDED MENTAL HEALTH SERVICES TO ESTABLISHED, TRUSTED, AND HIGHLY-UTILIZED POINTS OF CARE, INCLUDING PEDIATRIC PRIMARY CARE, WOMEN'S HEALTH, COMMUNITY CLINICS, ASSISTED LIVING, AND HOSPITAL SETTINGS. SAYAQAGVIK ENCOMPASSES FOUR CORE INITIATIVES, EACH CORRESPONDING TO A POPULATION OF FOCUS, HEALTH CARE TEAM, AND SITE OF CARE: 1) MIQLIQTUURAQ (INFANT AND EARLY CHILDHOOD MENTAL HEALTH SERVICES), MIQLIQTUQ (CHILD AND ADOLESCENT WRAPAROUND SERVICES), ILILGAAGIIT (FAMILY CARE), AND NANIRVIK (PROVIDER AND HEALTH SYSTEM CAPACITY-BUILDING). GOALS AND OBJECTIVES UNDER THIS AWARD FOCUS ON EXTENDING PREVENTION, EARLY INTERVENTION, AND TREATMENT SERVICES EQUITABLY THROUGHOUT ALL 12 SERVICE AREA VILLAGES THROUGH COMMUNITY FIELD CLINICS AND TELEMEDICINE. THIS AWARD WILL SERVE 1,240 UNDUPLICATED CHILDREN, YOUTH, AND FAMILY CAREGIVERS OVER FOUR YEARS, INCLUDING 340 IN YEAR 1, 320 IN YEAR 2, 280 IN YEAR 3, AND 300 IN YEAR 4. MANIILAQ ASSOCIATION IS A DESIGNATED TRIBAL HEALTH ORGANIZATION SERVING 38,000 SQUARE MILES OF THE ALASKAN ARCTIC AND SUBARCTIC. THE AREA POPULATION IS 8,467, 83% OF WHOM ARE ALASKA NATIVE (AN) AND 45% OF WHOM ARE UNDER THE AGE OF 22. NORTHWEST ALASKA COMMUNITIES ARE UNIFIED BY STRONG CULTURAL TRADITIONS AND A DEEP CONNECTION TO THE LAND, WHICH HAS BEEN INHABITED CONTINUOUSLY BY INUPIAT FOR THOUSANDS OF YEARS. OUR REGION'S CHILDREN, YOUTH, AND FAMILIES ALSO FACE SIGNIFICANT CHALLENGES. MORE PROXIMATE SOCIAL DETERMINANTS OF MENTAL HEALTH (SDMH) REFLECT OUR REGION'S HISTORY OF COLONIAL SETTLEMENT, DISPLACEMENT TO BOARDING SCHOOLS, EPIDEMIC DISEASE, AND OTHER FORMS OF HISTORICAL TRAUMA. ADVERSE SDMH EXPERIENCED BY AN CHILDREN AND YOUTH WITHIN A ONE-YEAR SPAN INCLUDE CHILD POVERTY (30%), CHILDHOOD WITNESS TO VIOLENCE (10%), LACK OF TRUSTED ADULT SOCIAL SUPPORT (54%), AND ADULT BINGE DRINKING (19%). ONE- THIRD OF AN ADULTS EXPERIENCED FOUR OR MORE ADVERSE CHILDHOOD EXPERIENCES CUMULATIVELY. AS A RESULT, NORTHWEST ALASKA CHILDREN, YOUTH, AND FAMILIES FACE A RANGE OF BEHAVIORAL HEALTH AND HEALTH CARE DISPARITIES. COMMON BEHAVIORAL AND SUBSTANCE USE CONCERNS AMONG ALASKA NATIVE YOUTH, DESCRIBED AS A PERCENTAGE OF ADOLESCENTS WHO EXPERIENCE THE CONDITION IN A ONE-YEAR PERIOD, INCLUDE DEPRESSION (43%), SUICIDE ATTEMPT (24%), PRESCRIPTION PAIN MEDICINE MISUSE (14%) AND BINGE DRINKING (11%). THE AGE-ADJUSTED SUICIDE RATE IN OUR REGION IS EIGHT TIMES THE U.S. AVERAGE, WHILE RATES OF DEPRESSION, ADOLESCENT INTIMATE PARTNER VIOLENCE, AND SUBSTANCE MISUSE MARK ADDITIONAL DISPARITY AREAS. TAKEN TOGETHER, THESE CONDITIONS SIGNAL A DEEP LEVEL OF SOCIAL SUFFERING THAT REQUIRES A COMPREHENSIVE, CULTURALLY-GROUNDED, EVIDENCE-BASED APPROACH TO CARE, AS WELL AS COORDINATED, COMMUNITY-LED EFFORTS TO ADDRESS THE UPSTREAM CAUSES OF DISTRESS. SAYAQAGVIK GOALS AND OBJECTIVES CENTER ON 1) IMPROVING DEVELOPMENTAL CONDITIONS AMONG INFANTS AND CHILDREN AT RISK FOR SED THROUGH COMMUNITY-BASED SCREENING, PREVENTION, AND EARLY INTERVENTION SERVICES; 2) IMPROVING SOCIAL AND BEHAVIORAL OUTCOMES FOR CHILDREN AND YOUTH WITH SED THROUGH COMMUNITY-BASED WRAPAROUND CARE; 3) ADDRESSING THE SOCIAL DETERMINANTS OF SED BY CONNECTING FAMILIES TO CULTURAL, CLINICAL, AND COMMUNITY RESOURCES; AND 4) INCREASING THE CAPACITY OF FIRST-CONTACT CAREGIVERS TO PROVIDE CULTURALLY-GROUNDED AND EVIDENCE-BASED MENTAL HEALTH SERVICES. CORE SERVICE LINES INCLUDE COMPETENCY-BASED INFANT AND EARLY CHILDHOOD MENTAL HEALTH SERVICES, TRAUMA-FOCUSED COGNITIVE-BEHAVIORAL THERAPY AND DIALECTIC BEHAVIOR THERAPY, CHILD AND ADOLESCENT PSYCHIATRIC EMERGENCY SERVICES, AND PRIMARY CARE-INTEGRATED PSYCHIATRY, ADDICTION MEDICINE, AND CULTURE-BASED PARENTING AND FAMILY SUPPORT SERVICES.