“Don’t Forget Us”

 

Project Overview

 

 

      

 

 

A collaborative initiative of

 

Native American LifeLines, Inc.

and

Friends Research Institute, Inc.

 

 

 

OVERVIEW

 

            The Don’t Forget Us project is an initiative to prevent substance abuse, HIV/AIDS, and hepatitis among American Indians living in Baltimore City, Maryland. Funded by the Substance Abuse and Mental Health Services Administration’s Center for Substance Abuse Prevention (CSAP) under the Minority AIDS Initiative, Don’t Forget Us represents a multi-pronged effort to reach one of Baltimore’s most vulnerable minority communities. The ultimate goals of the five-year project are to:

 

  • Determine the risk and protective factors for substance abuse, HIV/AIDS, and hepatitis among American Indians in Baltimore.

 

  • Raise awareness of American Indian health needs among local service providers

 

  • Build project, organizational, and community capacity to address American Indian service needs

 

  • Strengthen collaborations between the community and local service providers concerned with Native American health, and

 

  • Deliver innovative and culturally responsive substance abuse, HIV/AIDS, and hepatitis health education and prevention programming.

 

PROJECT EVOLUTION

 

            The planning and implementation of Don’t Forget Us has been based on state-of-the-art approaches for health risk prevention programming. The project is guided by SAMHSA’s Strategic Prevention Framework, which is comprised of five major steps:

 

STEP 1:         Profile population, needs, resources, and readiness to address                                                needs and gaps

 

STEP 2:         Mobilize and/or build capacity to address needs

 

STEP 3:         Develop a comprehensive Strategic Plan


STEP 4:         Implement evidence-based prevention programs, policies,

                        and practices

 

STEP 5:         Monitor, evaluate, sustain, and improve or replace those that fail

 

 

            The Strategic Prevention Framework has functioned as a roadmap for the project. The first year of the project focused on assessing the needs, challenges, and strengths of the American Indian population in Baltimore. A comprehensive community needs assessment was conducted using multiple scientific methodologies and relying on a community participatory framework. The needs assessment was very successful, providing rich and detailed information which was then used to identify service barriers, map community assets, and delineate the interaction between American Indian culture and the local urban environment. This crucial information was used to carefully design services tailored specifically to Native Americans in Baltimore.

 

            Concurrently with the needs assessment phase of the project, Native American LifeLines and Friends Research Institute have worked diligently to mobilize the community and other service providers with the goal of strengthening local capacity to effectively address Native American health needs. Multiple presentations have been made at conferences, special lectures have been given, project staff have attended trainings on service delivery and cultural competence, and we are now in the beginning stages of forming a coalition dedicated to improving health services for Native Americans in the State of Maryland.

 

            A Strategic Plan was formulated in which evidence-based programmatic approaches and practices for American Indians were identified, and integrated with data from the local needs assessment. The result was the construction of a culturally-specific health education and prevention program for substance abuse, HIV/AIDS, and hepatitis. Don’t Forget Us officially began serving clients in February of 2007. To date, two cohorts of clients have participated in the Don’t Forget Us Curriculum. Friends Research Institute is evaluating the intervention for effectiveness.

 

 

COLLABORATION AS A GUIDING PRINCIPLE

 

            The true strength of the Don’t Forget Us project is that it fosters collaboration with the community. Native American LifeLines has demonstrated clear leadership in linking with other service providers and community collaborators on this and other projects. This has resulted in a strengthening of referral networks between providers and the ability to connect with more hidden and at-risk segments of the local Native American community (e.g. injection drug users).

 

            The Strategic Prevention Framework, Participatory Involvement from the community, Cultural Competence, and Continuous Quality Improvement are the guiding principles of the Don’t Forget Us project. The emphasis on collaboration and strengthening relationships with both the target population and the service provider network also serves to enhance program sustainability. The model of program sustainability used by the Don’t Forget Us project is shown in Figure 1.

 

 

Figure 1: Sustainability Model

 

 

 

 

 

 

 

 

 

 

SERVICE DELIVERY

 

            The prevention program and health education component of Don’t Forget Us consists of four weekly sessions lasting approximately 90 minutes, in addition to a guided-discussion social period where a meal is served. Many of the American Indians receiving services live in poverty, and the inclusion of a meal in program activities has helped disadvantaged individuals and families get nutritious sustenance, while simultaneously aiding recruitment efforts. The program takes place at Native American LifeLines.

 

            The cornerstone of the intervention is culturally competent service delivery. Our needs assessment revealed that many American Indians in Baltimore experienced distress because they felt isolated from their culture and traditions. Therefore, this program offers health information within a community-building and culture-celebrating framework. Native American symbols from different tribes are used to illustrate core concepts. Above all, a holistic approach to health and prevention is emphasized. The program uses a Native American facilitator who has many years of experience in advocacy and outreach work with various socio-economically disadvantaged groups in Baltimore City. This facilitator also has linkages to Chase Brexton Health Services, a community-based AIDS treatment provider in Baltimore. This arrangement offers the benefits of fast and easy referral and follow-up for screening, treatment, and other health services which are (for now) beyond the capacity of LifeLines to offer on-site, all while maintaining cultural sensitivity and understanding. The four topical sessions of the Don’t Forget Us curriculum are detailed below:

 

            Session 1: Our Indian Selves and Holistic Health

 

·        The Native American Approach to Prevention

·        Holistic Concepts of Health

·        The Importance of Identity

·        The Circle

·        The Medicine Wheel

·        Native American History and Intergenerational Trauma

 

            Session 2: Hepatitis – The Liver and Liver Disease

 

·        Overview of the Liver from a Medical Standpoint

·        What Happens when the Liver is Damaged

·        Introduction to Viral Hepatitis

·        What is Hepatitis A and how can I prevent it?

·        What is Hepatitis B and how can I prevent it?

·        What is Hepatitis C and how can I prevent it?

·        Treatments for Hepatitis A, B, and C

·        Living with Hepatitis C

·        Co-Infection

·        Ways to Protect Yourself

 

            Session 3: Sexually Transmitted Disease and HIV

 

·        Introduction to the Common Sexually Transmitted Infections

·        Preventing Sexually Transmitted Infections

·        HIV: What It Is and What It Isn’t

·        Busting HIV Myths

·        HIV Transmission

·        Treatment Options

·        Prevention

 

            Session 4: Putting It All Together

 

·        Review of Holistic Health Concepts

·        Review Sessions 1-3

·        Participant Questions and Discussion

·        How to Get HIV and STI testing at Chase Brexton

·        How to Get Case Management and Services at LifeLines

 

 

            The content of the prevention program is based on an evidence-based intervention specifically for American Indians: the Native American Prevention Project Against Substance Abuse and AIDS (NAPPASSA). However, some modifications were made to better address the unique needs of American Indians in Baltimore which were discovered during the needs assessment phase of the project.

 

            At the time of this writing, two full cohorts of participants have received the Don’t Forget Us curriculum. This translates to 19 individuals who have completed the prevention program. While it is too early to determine program effectiveness, process evaluation has revealed that participants are highly satisfied with the program. The Don’t Forget Us program is planned to continue through 2010, and will ultimately deliver prevention and health education services to over 160 American Indians in Baltimore.

 

            The Don’t Forget Us program is an excellent example of how community partnerships can translate into action and improved service capacity. Thanks to the steadfast commitment of Native American LifeLines, Friends Research Institute, and all of the community collaborators and service agency partners involved in the initiative, the project has great potential – not only to prevent substance abuse, HIV, and hepatitis among American Indians in Baltimore, but to create a more responsive system-of-care for all American Indians in the city.