Interview and Talking Circle Evaluation Results From An Urban American Indian Health Center Needs Assessment Study

Background and Purpose: This project entitled Gda'shkitoomi We are Able!, is a three year “Circles of Care” Substance Abuse and Mental Health Services Administration (SAMHSA) funded project whose purpose is to assist in the infrastructure development of an integrated children's mental health systems of care for American Indian Health and Family Services (AIHFS) in Michigan. AIHFS community members and academic social work researchers collaboratively conducted a comprehensive qualitative needs assessment of the physical and behavioral health service needs of American Indian (AI) children, youth, and families. The goal is to create a culturally relevant integrative system of behavioral and physical health care based upon input from youth, adults, elders and providers in this urban AI community. Methods: Between April of 2008 and October of 2009 an Advisory Board of community members (children, adults, elders and providers) was created. The Advisory Board aided in the development of a methodology to assess the availability, and appropriateness of behavioral and physical health services from the view of providers and community members via semi-structured interviews (N=38) and talking circles (N=12). Additionally data was gathered on traditional healing. Talking circles consisted of elders, women, men, and youth (N=89). Transcripts of the interviews and talking circles were analyzed using content analysis. The interview transcripts were read by 3 team members, manually coded separately, and then we met to concur on the codes and later developed the themes. For the talking circles the transcripts were read by 3 team members, manually coded separately, concurred on by team members and then cross checked via NVivo, a qualitative software program. From these processes themes were developed and reported to the team members for concurrence. Results: The interview emergent themes with respect to service needs were: 1) transportation to access care, 2) marketing of activities and available services, 3) specialty services (e.g. dental care, x rays, emergency care), 4) integration of physical and behavioral health care, 5) holistic and traditional Native services and 6) opportunities to learn about traditional Native healing/culture. Talking circles emergent themes were similar: 1) transportation, 2) knowledge of available services, 3) specialized services (e.g. comprehensive care, dental and vision care, substance abuse services, parenting education, language, powwows, sweats), and 4) assistance for emotional stress (mental health counseling). Conclusions and Implications: Results indicate that providers and community members want more services that meet their needs for behavioral services (emotional and substance abuse) and want to be able to access services more easily, as lack of transportation is an issue. Moreover, participants supported the integration of services for behavioral and physical health with an emphasis on traditional healing. Also of note was the community members' desire to learn more about their culture and traditional healing. More research on traditional AI healing is needed so that researchers and practitioners become aware that AIs value and want traditional healing.

This research was supported by SAMHSA Grant # (1HS5 SM05 8836-01). Thank you to all community members/providers who were willing to share stories with us.