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Native Center for Alcohol Research & Education (NCARE)
Webinar Series
Agenda
• Welcome, Overview of Initiative for Research and Education to
Advance Community Health (IREACH) and Partnerships for Native
Health (5 minutes)
• Native CARE Presentation: Harm Reduction Talking Circles (HaRTC)
for Urban American Indians and Alaska Natives with Alcohol Use
Disorder (45 minutes)
• Question and Answer, Closing (10 minutes)
• Post-webinar survey link
This research is supported by the National Institute on Alcohol Abuse and Alcoholism under Award Number P60AA026112
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Initiative for Research and Education to Advance
Community Health
(IREACH)
“We challenge the status quo and advance community health
through partnerships and collaboration.”
This research is supported by the National Institute on Alcohol Abuse and Alcoholism under Award Number P60AA026112
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IREACH Structure
Native Hawaiian and Pacific Islander Health
Ka imi Sinclair (Western Cherokee)
Partnerships forNative Health
Lonnie Nelson (Eastern Band
Cherokee)
Rural Health and Health Networks
Justin Denney
Latino Health
Anna Zamora-Kapoor
Addictions
Michael McDonell
College ofMedicine
College ofNursing
College ofPharmacy
College ofEngineering & Architecture College of
CommunicationCollege ofVeterinary
Medicine
This research is supported by the National Institute on Alcohol Abuse and Alcoholism under Award Number P60AA026112
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Partnerships for Native Health
• Community-based research and education
to improve health and reduce health
disparities among American Indians, Alaska
Natives, Native Hawaiians, and Pacific
Islanders
• Prototype for program development for new
and novel programs at Washington State
University
• Focus on achieving health equity
• Community outreach and engagement
• Training and education
• ~160 partners: tribal colleges, Native
organizations, tribes, and universities
This research is supported by the National Institute on Alcohol Abuse and Alcoholism under Award Number P60AA026112
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Satellite Centers
This research is supported by the National Institute on Alcohol Abuse and Alcoholism under Award Number P60AA026112
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• Alcohol dependence
• Substance abuse prevention
• Smoking and nicotine
dependence
• Suicide prevention
• Mental and behavioral health
• Homelessness
• High blood pressure
• Diabetes
• Stroke risk reduction
• Cervical cancer prevention
• Colorectal cancer screening
• Cognitive impairment and
Alzheimer’s disease
Research Topics
This research is supported by the National Institute on Alcohol Abuse and Alcoholism under Award Number P60AA026112
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Native Center for Alcohol Research Education (NCARE)
NCARE aims to optimize alcohol intervention research for public
health in general and our Native community partners in particular.
We accomplish this goal by collaboratively engaging with
Research Project teams and the Pilot Projects to conduct
research that yields high-quality data while simultaneously
meeting the unique needs of our partners.
This research is supported by the National Institute on Alcohol Abuse and Alcoholism under Award Number P60AA026112
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Randomized Clinical Trial of
Harm Reduction Talking Circles (HaRTC)
for Urban American Indians and Alaska
Natives with Alcohol Use Disorders
Lonnie A. Nelson, Ph.D. (Washington State University)
Susan E. Collins, Ph.D. (University of Washington)
together with our Community Consultants and
the Seattle Indian Health Board
This research is supported by the National Institute On Alcohol Abuse And Alcoholism of the National Institutes of Health
under Award Number P60AA026112
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Presentation Overview
Origin story
HaRTC operationalization
Pilot experience
Current Study Plan
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Origin Story
UW Life Enhancing Alcohol-management Program (LEAP)
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1811 Eastlake Housing First Program
“Harm-reduction housing”
Owned and operated by DESC
Houses 75 of King County’s top
utilizers of publicly funded services
Chronically homeless
individuals with severe alcohol use
disorders
Residents permitted to drink in their units
No treatment or abstinence
requirements
www.desc.org/1811.html
Malone, Collins & Clifasefi (2015)
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Housing First was associated with…
Over $4m in tax-payer savings over the first year (Larimer et al., 2009)
Significant decreases in alcohol use and related problems (Collins et al. 2012)
Significant reductions in jail days and jail bookings (Clifasefi, Collins & Malone, 2013)
Significant reductions in EMS use (Mackelprang, Collins & Clifasefi, 2015)
There were no significant differences in outcomes between AI/ANs and non AI/ANs.
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Despite the clear positive effects of Housing First…
…many residents still experienced alcohol-related problems.
23.34
19.1217.94 17.85
19.39 19.31
14.55
26.03
21.83 21.72 21.17
23.15
21.39
18.1
0
5
10
15
20
25
30
0 3 6 9 12 18 24
ME
AN
SIP
SC
OR
ES
MONTHS
Full sample AI/AN heritage
Adapted from Collins et al (2012)
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Housing First!
What comes second?
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Strengths
Humor
Storytelling
Sense of community
Cultural identity
PragmatismResourcefulness
Mental toughness
Physical hardiness
Survival against all odds
How can honor the
wisdom, strength
and lived experience
in this community?
Collins, Clifasefi, Andrasik et al (2012)
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Researching
topics of
importance to
the community
Involving community
stakeholders in
research design and
implementation
Capitalizing on
all stakeholders’
unique strengths
Combining
knowledge and
action to
achieve social
change
Community based participatory research (CBPR)
Pragmatic in practice,
Transformative in spirit.
Wallerstein, Duran, Oetzel & Minkler (2017); Collins et al (2018)
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Multiphase CBPR Approach
Phase I:Listening to the community
Phase II:Developing approaches with the community
Phase III:Testing effectiveness of the approach
Phase IV: Disseminating & Implementing programs sustainably
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Phase I sample description
21%
43%
11%
2%
21%
2%
Self-reported racial identity
American Indian/Alaska Native/First Nation
White/European American
Black/African American
Native Hawaiian/ Pacific Islander
More than one race
Other
•44 1811 resident
participants
•22% (n=8) women
•Mean age 53.15 yrs
•9% Latinx
Clifasefi et al (2016)
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Phase I Findings
“Harm reduction is
the only thing that works…”
“There’s a lot of Natives here, and Natives
understand Natives…”
Culturally appropriate
programming through LEAP
Clifasefi et al (2016), Collins et al (2016)
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Harm reduction approaches provide alternate
pathways to recovery
Harm reduction refers to a low-threshold and “user-driven” set of
compassionate and pragmatic approaches to reduce substance-
related harm and improve quality of life for affected individuals and
their communities without requiring abstinence or use reduction.
Collins et al (2011); Marlatt (1998)
Compassion PragmatismHarm
reduction
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What is LEAP?
LEAP Advisory Board, 1 x month: voted upon and appointed members (UW, DESC residents, staff and management)
LEAP Researcher Meetings 1 x month: UW + all 1811 residents
Welcoming Committee: 1811 residents helping other residents, more structured orientation for new residents
Collaborative hiring through LAB of Meaningful Activity Coordinator
Harm Reduction training (theory & practice): DESC Staff + LAB members
Cultural humility training (DESC Staff + LAB members)
Leadership Opportunities
•LEAP Art Collective: Artist collective to support residents expressing themselves through visual arts, writing and music (2 x week: facilitated by a Meaningful Activities Coordinator that LAB hired)
•Community Garden
•LEAP Speakers Series, 1 x month (speakers/topics identified by the community)
Meaningful activities
•“Pongo Poetry” Writing Sessions, Weekly
•Harm Reduction one on one counseling - helping people with their own goals (development of a 4 session weekly one on one intervention)
•Harm-reduction groups--helping people learn how to reduce alcohol problems (2x month)
•Talking Circle (2 x month)
•Mindfulness Based Harm Reduction(8 week pilot program)
Recovery and healing
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Talking Circles
Based on Traditions of Plains Indians, Widely Embraced Across
Different Native Cultures
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Harm Reduction Talking Circles (HaRTC)
Harm reduction approach
Native tradition
of Talking Circles
HaRTC
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Pilot HaRTC at 1811 Eastlake
Participants’ responses to
HaRTC
It was “beautiful”
It gave them “a connection to [their tribal]
culture”
That “it can be used in
communities where there is
conflict”
It gets people “involved so
they don’t just sit around and
drink”
It is “a hell of a lot more useful
than an AA meeting”
• We conducted 8 HaRTC
sessions
• 23% of residents attended
at least once
• Mean of 6 participants per
HaRTC session
• Topics included:
• Shaping your
future/What do you
want to see happen
for yourself?
• Protecting yourself
and your community
• Taking care of your
health
• Living in a good way
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Current Study Plan
In Partnership with the Seattle Indian Health Board
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Multi-Phase Structure
Phase I:Listening to the community
Phase II:Developing approaches with the community
Phase III:Testing effectiveness of the approach
Summer/Fall 2018 Winter 2018 Spring 2019 - 2022
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Phase I: Identifying points for adaptation
Individual interviews with SIHB leadership
Individual interviews with SIHB patients
with AUDs
Focus groups with SIHB staff members
Conduct conventional content analysis to identify points for optimal
adaptation
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Phase II: Adapting and finalizing HaRTC
Assemble CABReview
qualitative findings with CAB
Refine and finalize
intervention manual with CAB
Pilot HaRTC
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Phase III: Testing HaRTC Effectiveness
• Evaluate HaRTC effectiveness compared to services-as-usual control groupAim
• 2-arm, partially nested, longitudinal RCT of HaRTCvs services-as-usual arms with baseline, posttest,1-, 3- and 6-month follow-up assessments
• Multilevel structural equation models will test group effects on pre-post difference scores
Design
• 280 SIHB patients meeting criteria for current AUDParticipants
• Alcohol outcomes (peak quantity, frequency, alcohol-related harm, EtG/creatinine ratio)
• Quality of life (QOLS, EQ-5D-5L)
• Cost-effectiveness
Measures
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Current Status – Year 1
Completed 30 individual patient
interviews
Currently conducting phase 1 key informant interviews and focus
groups with SIHB management and staff
Assembling community advisory board at SIHB
Beginning Phase 1 qualitative analysis
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Perspectives of HaRTC Community Partners
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Thank You!
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NCARE Webinar Series
Thank you for your participation!
Our next webinar will be January 31st, 2019 12pm-1pm PST
Topic: Contingency Management
Presenter: Michael McDonell, PhD. Washington State
University
Please send your webinar ideas to [email protected]
This research is supported by the National Institute on Alcohol Abuse and Alcoholism under Award Number P60AA026112