University of Washington

Background A ccording to a 2006 census report, there are approximately 93,000 American Indian/Alaska Native (AIAN) people in the state of Washington, or 1.5% of the total population. The state is home to 29 federally recognized AIAN tribes, 7 state recognized tribes, 6 Recognized American Indian Organizations (RAIOs) (N.A.T.I.V.E. Project, Seattle Indian Health Board, American Indian Community Center, Small Indian Tribes of Western Washington, South Puget Sound Intertribal Planning Agency, and the United Indians of All Tribes) as well as AIAN urban health care centers and other AIAN organizations. AIAN individuals and communities are distributed across the state ranging from small, rural reservations to urban, inter-tribal communities. worked together to convene three Tribal Mental Health Conferences held consecutively May 5-6, 2008, September 8-11, 2009, and April 6-7, 2010. As a result of this series of conferences, OIP is working with tribes and RAIOs in collaboration with the Northwest Portland Area Indian Health Board to survey existing tribal program best practices and develop a Tribal-Centric Mental Health System. Reports from all of these related conferences are available at adai. uw.edu/tribal/conferencereports. While collaborating with a federally recognized tribe in the Pacific Northwest on a National Institute on Minority Health and Health Disparities (NIMHD) Community Based Participatory Research project ("Healing of the Canoe," 5R24MD001764), the Alcohol and Drug Abuse Institute's research team observed several important tribal/RAIO health disparity issues. Due to complex relationships between tribes, RAIOs and local, state and federal agencies, healthcare may be provided either by the tribe, local service providers, the state, an Indian Health Service facility, a regional Native Health Board, or by some combination of the above. Because of this, there are very little comprehensive, empirical data describing health disparities as they are experienced by AIAN communities in Washington State. In fact, a recent review of psychosocial interventions for ethnic minorities was unable to find any studies evaluating outcomes of mental health interventions for AIANs. Similarly, a recent joint review by the University of Washington Alcohol and Drug Abuse Institute and Northwest Frontier Addiction Technology Transfer Center reported that there were no evidence-based practices shown to be effective with AIANs. The Washington Tribes and Recognized American Indian Organizations Health Priorities Summit held April 4-5, 2012 built on the success and momentum of these three previous conferences, and extended the breadth, scope and purpose in tribal and RAIO communities more broadly. The Summit facilitated a critical dialogue to foster sharing of ideas, best practices and lessons learned between tribes and RAIOs rather than in response to funder-generated initiatives. In addition to the voices of tribal leaders, tribal health workers and service providers could share their direct experiences and resulting priorities for programs, and University of Washington attendees served to identify opportunities for evaluating best practices and find innovative ways to measure impact and sustainability. Tribal leaders have additionally indicated that insufficient funding and overburdened resources often prevent service providers from receiving adequate training in the provision of effective and culturally appropriate services to tribal communities. This lack of access to ongoing training contributes to the health disparities experienced by AIANs who are in need of culturally appropriate and effective interventions. Meanwhile, little is also known about the many communitydeveloped programs that often incorporate tribal values, practices and beliefs, and have anecdotal evidence of effectiveness. There is ample testimony from tribal leaders in Washington State that these community-developed and tribally-grounded programs are effective, as well as crucial to the health of AIAN individuals and communities. However, there is currently very little empirical evidence to support their efficacy. To address this gap and promote knowledge transfer across tribal programs, the University of Washington Alcohol and Drug Abuse Institute (ADAI) and the Washington State Department of Social and Health Services Office of Indian Policy (OIP) The Summit planning committee remains committed to mentoring and nurturing future AIAN leaders. It therefore invited 5 AIAN student interns to assist with the planning and implementation of the Summit, and to assist with summarizing findings and recommendations. In addition to their potential as future healthcare providers, community-based researchers, and tribal/RAIO health leadership, AIAN high school and college students serve as ambassadors and coalition-builders between their institutions and local communities. Their participation in this summit promoted a key element to realizing tribal sovereignty; nurturing the development and training of AIANs to lead tribally/RAIO-directed health initiatives now and in the future. This summit is part of an ongoing effort to promote sharing and dialogue to inform behavioral and health policy and practice that is culturally grounded, appropriate and effective for AIAN people. We are building on outcomes achieved from prior conferences where we began to address the scope of services available to AIANs, and the need for Indigenous1-directed capacity to document and evaluate promising practices. Recognizing the reality that achieving consensus and inclusivity with diverse tribal and Urban Indian needs and perspectives requires continued dialogue over time, outcomes for this summit include discussion of next steps, and suggestions for identifying collective priority setting and assessment strategies. To be inclusive of both tribal and Urban Indian perspectives, we use the terms "Native" and "Indigenous" where appropriate 1 Summary Report: April 4-5, 2012 1

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