IHS Capital Financing and Health Care Reform

This document is the primary publication of a 1984-1986 management review of the Indian Health Service (IHS)-sponsored alcohol programs serving American Indians and Alaska Natives. The IHS Alcoholism/Substance Abuse Prevention Initiative: Background, Plenary Session, and Action Plan is the manifesto of the alcohol/substance abuse programs for the future. The overall purposes of the review were: 1) to define the scope of alcohol treatment and prevention efforts at all levels; 2) to identify existing program strengths; 3) to identify unique approaches to be considered for broader application; 4) to identify deficiencies; 5) to set forth the actual steps to remedy the deficiencies; and 6) to make recommendations for the mission and future direction of the IHS and alcoholism program efforts. The Background section is designed to expose the trends and issues affecting the alcoholism programs prior to 1984. The Plenary Session documents the proceedings of the second stage of the alcoholism programs management review. The Action Plan is a presentation of the recommendations developed by the contributors in the plenary session. The Action Plan was designed to address all of the relevant managerial functions, including planning, standards setting, monitoring, evaluation, resource management, operations, coordination, research, and training. The complete document provides the rationale, structures, and strategies necessary to chart a new direction that will demand enhancement of treatment program effectiveness and a realignment of resources in response to advancements in institutional knowledge and experience.This document comprises the published results of a management review of the IHS alcoholism programs that was requested by the Director of the IHS, Everett R. Rhodes, M.D., and initiated in the summer of 1984. Participants in this comprehensive program review included: 1) tribal leader representatives from each area; 2) alcohol program representatives from each area or program office; 3) IHS area alcoholism coordinators; 4) IHS line and staff officials; 5) individuals knowledgeable in the field of alcohol/substance abuse but not directly connected to IHS or tribal programs; and 6) 30 individuals from the outside who expressed interest in contributing to the process. The three major tasks of the reviewers were to: 1) develop a briefing book; 2) complete a plenary session with a set of recommendations; and 3) develop and gain the approval for an action plan based upon the recommendations coming out of the plenary session.The Director, IHS, asserted that many IHS physical plants were currently inappropriate for providing alcohol services. He concluded that these problems are solvable. In addition, he called for better horizontal and vertical communications between and within the IHS health care system and the alcohol programs. Various IHS staff, substance abuse program professionals, Federal officials, researchers, and academicians contributed their perspectives on the future direction of alcohol prevention and treatment efforts in the American Indian community. Highlights of these perspectives included: 1) community-based programs and coordination with other agencies; 2) the need for both residential and outpatient treatment services; 3) tribal leadership involvement in the recognition of alcohol as a problem; 4) good professional education for IHS doctors and nurses; 5) the importance of standardized recordkeeping for the purposes of comparison and evaluation; 6) the use of traditional healers; 7) the need to provide incentives for those programs that excel, and the continued support for those that do not function well or at all; 8) the emphasis on culture to the success and failure of different programs; 8) identification of generalizable attributes associated with the success of alcoholism prevention efforts among American Indians; and 9) the view of alcoholism as a psychosocial medical disease requiring an holistic approach to treatment.The Action Plan was developed with the assistance of the information disseminated during the Plenary Session. Specific activities, and a specific timeline for their implementation, were itemized for all nine essential management functions (listed above). Specific recommendations focused on managing scarce resources, finding additional resources, focusing on prevention, targeting youth and women for prevention activities, improving training for IHS professionals and staff to incorporate a clear understanding of alcoholism as a disease and to heighten cultural awareness. A management information system was initiated as a result of this review, and research priorities were established. Also, a plan was outlined to facilitate the monitoring of programs, and establishing a system for supporting the demands of the evaluation process. A persistent recommendation appearing throughout the review was the need to bring tribal governments into all facets of IHS involvement in alcoholism treatment and prevention, and to find ways to further involve Congressional delegates in the process