The NIMH Director’s Innovation Speaker Series: Life Through a Navajo Lens Beyond the Navajo Reservation

Transcript

JOSHUA GORDON: Hello, and welcome to this NIMH Directors Innovation Series lecture. I am really excited to welcome you all here to what will be another outstanding opportunity here from a scientist, in this case, care practitioner, and others that you have heard from over time. Sometimes of direct relevance to mental health like here today and sometimes at the periphery, but always interesting and always engaging.

As you know, I am Dr. Joshua Gordon, the Director of the National Institute of Mental Health, and this series of lectures is sponsored by NIMH with an eye towards providing our community both in NIMH and elsewhere, with a diversity of perspectives on mental health research that teach us about the needs of the community and/or the opportunities for furthering the science of mental health.

In this case, today, we have an outstanding guest with us today, Dr. Glorinda Segay, who is a member of the Navajo people, the Navajo tribe, and is a behavioral health provider and is importantly responsible for directing behavioral health for the Indian Health Service. Dr. Segay comes to us having grown up on the tribal reservations of the Navajo people, having attended Arizona State and University of New Mexico, and then receiving her ate of behavioral health from Arizona State.

She has a long history of serving the Navajo people and others as a behavioral health provider and as a therapist and as a leader in the field and an administrator of the considerable efforts to try to ensure that members of the Navajo Nation and other Native American communities receive excellent, outstanding healthcare.

She has a personal journey in this as well she may comment on in terms of growing up on the reservation and interacting with the greater world outside that has lessons to teach us, but I think most of what she's going to talk to us about today are the opportunities for ensuring outstanding healthcare delivery in Native American communities that the Indian Health Service provides.

With no further ado, please welcome Dr. Segay. I am really looking forward to hearing her talk, and afterwards, we are going to do a Q&A, so just as a reminder, please use the Q&A function to enter any questions that you have, not the chat function but the Q&A function. You can enter into that at any point in the talk, and I will moderate the session asking those questions for you at the end.

One final note is there is an ASL interpreter. Make sure that if you need the services of that interpreter, please make sure that she or he is on the screen. Finally, there are closed captions available as well. Those of you who have that capacity in your Zoom, I know it varies, may want to try to use, in particular during segments were Dr. Segay will be talking to us in her native Navajo. Dr. Segay, welcome, thank you for coming, and please take it from here.

GLORINDA SEGAY: Thank you very much for that kind introduction and highlighting my background. Very much appreciated. I just want to say ya’at’eeh, meaning hello and greetings to each of you. Thank you for taking the time to be with us today. I just want to introduce myself. My name is Glorinda Segay, and I am of the Navajo tribe. My plans to my people are, in Navajo, (Navajo language). And so, greetings if I have any relatives out there. Born and raised in the Navajo Nation, Blue Canyon Arizona to be specific there. I am very happy to be here, very honored, so thank you again, Dr. Gordon.

Today, I want to talk about the Division of Behavioral Health in the Indian Health Service is. I want to highlight the importance of the Division of Behavioral Health, what our functions are, as well as the different programs we have, as well as the grants dollars. It's very important to put out there about the Division of Behavioral Health and pretty much our emphasis is to improve the healthcare of our American Indian and Alaskan Native people.

I'm going to go ahead and refer you to the PowerPoint in front of you. Here again, the Division of Behavioral Health. I am the Division Director with Behavioral Health. So it has been one year and three months. I'm very honored to serve my people in that capacity. There is my email address if you should need it there.

So here is an overview of the Division of Behavioral Health. We are housed in the Office of Clinical and Preventative Services, which is within the Indian Health Service. Our primary function is national advocacy, policy development, management and administration of behavioral health, alcohol and substance abuse, and family violence prevention programs for American Indians/Alaska Natives.

We have four functional areas. The first is alcohol and substance abuse, the second area is mental health, the third area is the Telebehavioral Health Center of Excellence, the fourth area is the behavioral health initiatives.

At DBH, we work in partnership with Tribes, Tribal Organizations, and Urban Indian Organizations. We have 12 regions across the US, and they are pretty much broken down into these different sections that are listed. We coordinate national efforts to share knowledge and also building capacity through the development and implementation of evidence-based, practice-based, and culturally based activities across Indian country.

So I want to talk about our first program that I made mention of. The Alcohol and Substance Abuse. There is the website. Please visit our website there. Right now, we do have our alcohol lead. His name is Mr. JB Kinlacheeny. Feel free to reach out to him. There is his email address.

So we refer to this program as the ASA. I just wanted to make mention that we do have certain authorities and policies, so we also have what is known as the Indian Health Manual, so that health manual helps us as far as guidance goes in operation of the programs moving forward and what have you.

So here, Chapter 18 is the ASA, Alcohol and Substance Abuse. It is a reference for the IHS employees regarding IHS-specific policies and procedures instructions. This was published on 5/22/1991, and DBH will rewrite the Chapter in 2021. There is a link to see the Indian Health Manual there if you are curious about it.

So the objective here is to encourage, again, holistic approaches that promote healthy lifestyles, families, and communities. Keeping in mind that each community is different, so just because you hear American Indian or Native American doesn't mean that all of us are the same. We have different beliefs. We have different languages. Even our style of dressing is very different. So therefore, we have to be mindful about moving forward as far as what approaches on how we can help. I just want to make mention there.

Then, we want to also improve access to behavioral health services using our tele-behavioral health methods and providing a comprehension of array of preventative, educational, and treatment services. Also keeping in mind we are all located, some of our reservations, they are on reservations, and some are off reservations.

For example, Navajo Nation, we are about the size of West Virginia. We have at least over 400,000 members, and so the land-base is very large, so sometimes, we don't have broadband. You know, the capacity to reach across Navajo land. Again, we have to go to certain areas to be able to tap in. So right now, it's really good that telebehavioral health is there to help to provide services, especially during the pandemic.

I just wanted to put a note there for you all. Again, the land base matters. The distance matters. So far, we have tried to tailor the behavioral health needs to all of the locations.

And so within the ASA program, we have what we refer to as the Youth Regional Treatment Centers, so IHS provides funding for 12 YRTCs. Again, we provide quality holistic behavioral healthcare for the adolescents and their families in a substance-free, residential environment that integrates healing, spiritual values, and cultural identification. That is very important, especially as being an American Indian, identity in our cultural aids. It's very good that these YRTC programs can have that as part of healing.

DBH also provides program and policy guidance to the YRTCs operated by IHS and tribal programs. The way that is done is, say, for example we have meetings with the YRTC directors. They will come in and talk about their needs and what we can do and strategize, so there is a website there.

So as far as for programs and initiatives for our ASA projects, we have what we refer to as the PARD, which means Preventing Alcohol Related Deaths through Social Detoxification. This, again, is $2 million per year, so we find two areas. $1.5 million goes to the city of Gallup, New Mexico, and $500,000 goes to the Oglala Sioux tribe.

The YRTC Aftercare Pilot Project has a total amount of $1.62 million per year. And so we do have what’s called federal awardees, and then the tribal grantees. The federal award program is the Desert State Youth Wellness Center, and the tribal grantee is the Healing Lodge of the Seven Nations. So those are the names of the facilities. Currently in the extension year, this initiative is to end on December 14, 2021.

Lastly, we have our Community Opioid Intervention Pilot Project. We refer to this as COIPP. COIPP has a $16.2 million in awards, and we funded 35 grants to Tribes, Tribal Organizations, and Urban Indian Organizations for three years. The grant cycle started on April 1, 2021, so we are really happy that this was our most recent grant that went out. For more information, again, please visit the website there.

So we also have some partnerships, which is very important as far as strategy. The IHS has a committee called HOPE. This committee stands for the Heroin, Opioids, and Pain Efforts Committee. DBH supports the HOPE activities through funding and also through administrative liaison functions with IHS HQ. HOPE is made up of IHS physicians, pharmacists, behavioral health clinicians, nurses, epidemiologists, and injury prevention specialists in the field.

I'm really happy we have our chair, Captain Cynthia Gunderson. She is located at Red Lake Hospital. Our vice chair was Julianna Reece, Dr. Reese, so that just became vacant there. We are going to make some efforts to fill that. Then, we have our Secretary, LCDR Kristin Allmaras. She is located at South-Central Foundation.

Furthermore, we have the Seven Workgroups. Communications, Prescriber Support, Medication-assisted Treatment, Perinatal Substance Use, Harm Reduction, Injury Prevention, Metrics, And Technical Assistance.

What JB does is he meets with HOPE, DBH leadership, myself, and Dr. Jane, we meet with HOPE and pretty much talk about strategies and what is happening in the area, what are some of the efforts, what are some of the requests in the areas that we need to meet. So they are very vital in a lot of what we do as far as decision-making and making sure that it's appropriate across the board.

Here is the committee background. This was chartered back in 2017 as a Permanent Committee of the IHS National Combined Councils. There is a circular there, and you can go ahead and click that link. There are five strategies here. We extend access to culturally relevant substance use disorders. We refer to that as the SUD prevention, treatment and recovery services.

Number two, we expand harm reduction interventions to include enhancing education and improving access to opioid overdose reversal medication. Three, develop competence of an interdisciplinary approaches to improve the management of acute and chronic pain. Reduce the impact of perinatal substance exposure on future generations. Better data-extraction methods and metrics to support informed decision-making surrounding pain management and opioid use disorders.

Perhaps through social media and perhaps through watching the news, during dinnertime, there is always topics on opioids, so opioid use is on a lot of the reservations. It is a crisis across Indian country. That is where we work with tribes through IHS partnership. We try to help what needs to be done. How should it be done. That is just an example of how vital the HOPE committee is to the Division of Behavioral Health.

The next program is mental health. There is our website. Right now we do have an acting mental health point of contact who is Stephen Whitehorn. I apologize, I forgot to make that change there. We also have our national suicide prevention consultant, her name is Pamela End of Horn, and there is her email address.

The authority policy for mental health comes out of our Indian Health Manual. This is part three, chapter 14. This is the mental health program. Again, this is reference for IHS employees, regarding IHS specific policy and procedure instruction. This was published back in 7-19-1994. DBH will rewrite the chapter in 2021. Secondly, the Indian Health Manual part three, chapter 34, which covers the suicide prevention and care, this was published on February 6, 2019.

So, the objective here is we offer a wide range of clinical and community mental health services. We promote positive mental health services including efforts aimed at primary prevention of mental and emotional disorders. Promote broad social and health goals to enhance the emotional security of AI/AN individuals and groups. Again, that is American Indians and Alaska Natives.

Also, early intervention at the onset of mental, emotional and behavioral disorders to restore and improve patient, client level of functioning. Assist rehabilitation and stabilization of advanced emotional disorders or pathology to prevent further patient/client disorganization. Offer educational, consultative, research and other supportive services focus on AI/AN mental health issue to a full range of tribal, governmental, educational, legal, institutional, and health agencies.

So, the mental health programs, pretty much, IHS operates 38 federally operated mental health programs for direct service tribes. In conjunction with HIS Area Offices, local ideas service units provide a variety of behavioral health services.

So, here are some programs and initiatives for the mental health. So, one that is very important is the Trauma Informed Care. So, Trauma Informed Care is basically from the Indian Health Manual. Part three, Chapter 37. This was published May 7, 2020. It promotes the delivery of Trauma Informed Care services, training the workforce to be trauma informed and promoting self-care for providers. So there is the website.

This is very important right now. In the media, I am sure that you heard about the boarding schools and what is happening there. We try to think about all of that, about our people, what can we do, how can we help them, those that are victims or may become other survivors. And we talk to our partners at the tribal level, we use our behavioral health consultants. So, they're all there at the local level. There are boots on the ground and they come to us and let us know.

And of course, the brilliant team with the Division of Behavioral Health, where we are talking about what is Trauma Informed Care. So, for our native people, a lot of us went through some sort of trauma. If it was at boarding schools, it was probably a childhood trauma that we went through. How do we work through that? What do we do? How do we make an awareness for our providers so that our people can get the most effective, compassionate care moving forward, in hopes that they can recover and live a beautiful and healthy lifestyle? That is always the goal. So, we also have interagency task force on Trauma Informed Care. There is the website.

And so, we also have the Behavioral Health Integration Initiative. We reference this as the BH2I. This project is to improve the physical and mental health status of people with behavioral health issues by developing an integrative, coordinated system of care between behavioral health and primary care providers.

For example, integrated healthcare. So, there are $6 million per year in awards of $500,000 per project. There are 12 current projects that began back in 2017. They have been extended through September 29, 2021. So we have one IHS award, eight tribal guarantees, and three urban grantees. There is more information on the website.

So, the suicide prevention and care. This is the one that Ms. End of Horn leads. The role of the DBH National Suicide Prevention Consultant. This person is very vital. They lead the effort to improve access to behavioral health services and address suicide in culturally appropriate ways. So, again, as I had alluded to earlier, we all have different customs, including the views of suicide. So, this is where we have to be mindful of how we talk about suicide, how is it viewed or what are the perspectives, moving in in the most culturally sensitive way.

Leads suicide prevention standards of care policy. Identifies and shares best practices. Strengthens data capabilities around suicide surveillance. Promotes collaboration between AI and AN communities, national, federal, state and local agencies and organizations. Provides subject matter consultation to I/T/Us and DBH program leads.

Getting information from the ground up and basically dissecting it and bringing in all the appropriate people and having discussions on what are ways, when we talk to the states, talk to the tribes, this is what is happening, how can we strategize? There is always a lot of robust, fast and fierce discussion, trying to find a resolution and what is most effective.

And so, as far as screenings go, we do have the ASQ, which is Ask Suicide-Screening Questions pilot projects in two sites. We also have the Community Crisis Response Guidelines. So, there is the link. And then, the QPR, which is Question, Persuade, Refer Gatekeeper Training for IHS staff. We contract with who we refer to as Sister Sky, this began in November 2020, to develop and provide training on a culturally adapted version of the QPR.

I want to talk about the QPR little bit more. Whether we are in our professional lives or our personal lives, suicide basically is there, whether it is our immediate family members or relatives or friends, or even yourself.

So, when somebody approaches you and tells you that they are contemplating suicide, how do you help them? In our upbringing, at least for me, there was no such thing as suicide. Being born and raised on Navajo. My parents kept us isolated. We used to live in the deep mountains, where we still live. We were cut up from the outside world. We only had a radio. But the radio was basically to the local Navajo station. So, we did not know about suicide.

When I was studying in my training here, being a provider, I had to learn about this. And that is where I started to see that people do come forward, they do ask for help. I am feeling this way. I do not feel good about my future. However they decide to say it. That is where, when you take a training, when you have some sort of basic understanding, you are able to help the person tap into the resource that they need to get some help.

That is where it is so important to have these types of training, to have these types of screenings that are available to everybody. So, I am really happy that we can provide that to everybody. The IHS staff, across the country, giving them that competence, preparing them, if they should and up in that type of predicament. I just wanted to make mention of that.

We also have the Zero Suicide Initiative, the ZSI. This one is a cooperative agreement to implement a model comprehensive healthcare system approach to suicide care which aims to reduce the risk of suicide.

So, we do get $2 million per year in awards at $400,000 per project. There are eight current projects that began back in 2018 and extended throughout October 31, 2021. There is the website. Lieutenant Commander Richards is our ZSI lead. You can also email her there if you have any questions or inquiries.

So, the partnership that we have is IHS/BIE/BIA, Bureau of Indian Education, Bureau of Indian Affairs, memorandum of agreement. So, this was signed in December 2016 to implement behavioral health services in federally funded BIA juvenile centers and BIE schools.

Five completed local agreements between IHS and BIE to provide mental health counselling to BIE operated schools. For example, Havasupai Tribe has successfully implemented telehealth counselling for BIE students. And so although this is the mental health program, telebehavioral health is a separate program within Division of Behavioral Health, but with that collaboration that I was talking about earlier, we are able to have successes such as the Havasupai Tribe, with their students there, making sure that these children get the services that they need.

The mental health lead represents IHS on Federal Interagency Task Force on Trauma Informed Care, the IHS/BIE/BIA Memorandum of Agreement, Interagency Autism Coordinating Committee, and the Crisis Text Line.

I wanted to make mention that we have such a wonderful team, that at least everybody sits on one workforce or task force or committee so, I want to make mention of that overall. But, for mental health, this is the lead tasks and responsibilities.

Here is a continuation of our partnerships. So, as far as the National Suicide Prevention Consultant, it represents on the National Action Alliance for Suicide Prevention. The AI/AN Native Task Force. The National Suicide Prevention Lifeline. The Crisis Text Line. IHS/VA Memorandum of Understanding. PREVENTS Taskforce, and the WETA Advisory Board.

So as you can see, earlier, when I made mention of Ms. End of Horn, we are happy to have her on our team. She fits on all of these various task forces, representing IHS and strategizing and letting them know what is happening at our level.

Here is our other program, THBCE, Tele-Behavioral Health Center of Excellence, and there is the website. This is led by Dr. Chris Fore. He is wonderful and a great leader, always leading our team in an effective and efficient direction.

Again, here is the authority in the policy. This is the federal registry, December 12, 2018. It states that DBH manages the operation of direct behavioral health services provided through the Tele-Behavioral Health Center of Excellence. There is the website there.

So the objective is to provide, promote, and support the delivery of high-quality, culturally sensitive telebehavioral health services to AI/AN people. TBHCE tele-education program mission is to equip, connect, and encourage healthcare providers working in the IHS, Tribal, and Urban Indian Health System and those serving AI/AN people and communities.

It's so wonderful to see Dr. Chris Fore and his team, they have a lot of webinars and tele-ECHOs, Dr. Fore even goes all the way out on how do you set up such a system, what broadband do you use, what's the best platform. Providing that kind of information to Indian country.

The Telebehavioral Health Program provides direct, ongoing care via tele-video at 24 IHS/Tribal/Urban Indian operated facilities across the country. So far 5437 hours of behavioral healthcare was provided in FY20. The types of services provided were adult psychiatry, addiction psychiatry, geriatric psychiatry, child/adolescent psychiatry, adult therapy, family, couples, and group therapy, child/adolescent therapy, trauma/PTSD therapy. Those are the services, again, that Dr. Fore's team provides, and we are very happy that we can provide advanced services to our native people and help them to get into a healthy lifestyle. So they have also developed a telebehavioral health toolkit.

So here, I just wanted to give you a visual about the locations of our telebehavioral health sites. As you can see, all the way from North Carolina, Tennessee, and then you go to the Southwest, New Mexico, San Diego, all the way to Seattle, Washington and down to Montana and Wisconsin. That's just an idea of the services provided.

So the Tele-Education Program is also part of our telebehavioral health. They are equipped healthcare providers, again serving Indian country and communities with the culturally sensitive education and training they need to provide excellent patient care. So, connecting healthcare providers by providing a space to learn from one another and share best practices and solutions to challenges, encouraging healthcare providers by celebrating and sharing successes. There is a link for more information.

So here is a diagram of our tele-education. There is the Telebehavioral Health Center of Excellence tele-education, so what we have what are called ECHO Clinics. We also have on-demand training, conference streaming, and meeting support. We also have live webinars, and the live webinars are also archived, and recorded webinars are available. Some topics are on autism. One that is coming up is the pediatric immunization. There is just a variety of topics, so I am really pleased and happy with our team and what they put out there, you know, for everybody basically to get educated on, especially to the providers.

And so here are the tele-ed participant locations. I just wanted to map it out there and give you a visual. This time, it expands into Alaska. If you see that, it's so wonderful what technology can do and how far it can reach out so that they can get the information and education that's needed and implement that in their local areas.

So, 436 programs altogether. Within the TBHCE, we do have some initiatives. One of them is the Indian Children's Program. DBH has responsibility under the 12/6/2018 Federal Registry, and basically this indicated financial resources and programmatic oversight for complying with the Americans with Disabilities Act through the programs such as the Indian Children's Program that focuses on autism spectrum disorders, fetal alcohol spectrum disorders, and other neurobiological disorders. TBHCE provides education and individual provider consultation on neurodevelopment issues impacting AI/AN youth. Like I said, they do provide the autism ECHOs. They are very, very helpful.

The partnerships that we have, again, are the BIE, the school-based telebehavioral health pilot project. And then with the University of New Mexico, we have contracts to provide telebehavioral health services, the ECHOs, and the educational webinars.

And so, here is our last program that I wanted to provide an overview of, the Behavioral Health Initiative. Our lead there is Audrey Solimon. There is her address and her contact information.

So the authority and the policy for this program: DBH funds and manages several behavioral health initiatives to meet the mission of IHS by developing promising practices and pilot projects across the country. Grant awards are for tribes, tribal organizations, and Urban Indian Organizations under authority of the HHS Grants Policy Statement. Transfer/allocation of funds to IHS Service Units or Area Offices, also known as federal awards under authority of the IHS fiscal management policy

Here are the programs and initiatives that we have. We have the Substance Abuse and Suicide Prevention Program. We call this SASP. This was formerly known as the MSPI, which was the Methamphetamine and Suicide Prevention Initiative. This began as a demonstration project back in 2008 to 2015. There was an official name change in 2016 and a full transition to the new SASP program name that was done in 2019. There is a link for more information.

So the SASP has four purpose areas. The Community and Organizational Needs Assessment and Strategic Planning, three awards were given there. Then, the Suicide Prevention, Intervention, And Postvention with 45 awards. The Substance Use Prevention, Treatment and Aftercare with 19 awards. And then the Generation Indigenous Initiative Support with 107 awards.

The SASP program overview has $27.7 million per year in awards, 174 projects with funding ranging from $50,000-$425,000. The project period began in 2016, extended through September 29, 2021.

So here is a snapshot of the funding there. It's broken down into purpose areas, and each purpose area has a dollar amount and also how many projects there are within a purpose area. Furthermore, if you look down to the left, there is a legend there. It's basically pointing out the tribes and tribal organizations, which ones are the federal facilities, and which ones are the urban Indian organizations. When you look at the map there, basically it just points out how many, a number is given for each area there moving forward as far as awards go.

And so the DVP, which is the Domestic Violence Prevention Program, previously known as the DVPI during the demonstration phase between 2008-2015. Again, this underwent a name change, so the full transition to use the new DVP name occurred in 2019. There is a link there for more information.

So the DVP program has two purpose areas. The DV Prevention, Advocacy, and Coordinated Community Responses with 75 projects. Then we also have the forensic Healthcare Services, with eight projects.

So here is a program overview. There is $11.7 million per year in awards, and 83 awards range from $50,000-$200,000 that are given. The project began in 2015 and has been extended through September 29, 2021.

I just want to make a side note that a lot of our grants were extended due to the pandemic, so we just want to make sure we gave the time that's needed to close and what have you.

So here's a snapshot again, similar to the DVPI. Purpose area 1, the dollar amount, and also the project and how it is spread out there across the map.

And so, each program funded through DVP and SASP is assigned to an area project officer. The APOs are pretty much spread across the US, so they monitor the programmatic progress. They provide direct support, guidance, and technical assistance to grantees or awardees on programmatic issues.

This is daily for them. They will get an inquiry or a question, especially now that we are closing out a lot of our grants, and you know reports are due, so they are very busy. Here is just a map of a breakdown of who is where. So for example, we have Mr. Scott Zander, who is in the Billings area. He does have four DVP projects and 10 SASP projects, and so he assists as far as what was mentioned earlier with the responsibilities.

We have a person in Alaska, Portland, California, Navajo, Phoenix, Tucson, Oklahoma. Just to give you an idea, these individuals are so, so brilliant, they’re hard workers providing the services that are needed to awardees and grantees.

Programs and initiatives. So we do have the Forensic Healthcare. This was established back in 2011 to address sexual violence and later expanded to include intimate partner violence, child maltreatment, and elder maltreatment. There is a link there for more information. This one came from the Indian Health Manual Part Three, Chapter 29: Sexual Assault which was published back in February 6 of 2018. There is another link there.

We do have our forensic nurse consultant, Erica Gourneau. Erica is so wonderful. She provides training to nurses and healthcare providers as far as sexual assault and getting everybody involved. She also has a seat at a lot of the table in these taskforces speaking about the issues that are happening in Indian country that are relevant to sexual violence and also intimate partner violence, child maltreatment, and what have you.

Erica also provides technical assistance, again, with policy creation, legislative review, and also clinical practice in forensic healthcare. She also leads the Intimate Partner Violence GPRAMA Measure. She manages IHS forensic examiner list serves and manages contracts supporting forensic examiner education. She does a lot. She is so wonderful as far as the services she provides and all of her responsibilities and tasks.

 Furthermore, the forensic healthcare, we do have a contract with the International Association of Forensic Nurses. There is a link there. Here again like I have said earlier, we train providers in forensic medical examinations, evidence collection techniques, and in coordinated community response to address violence. Adult adolescent sexual assault examiner theory courses, pediatric SAE courses, intimate partner violence SAE course, webinars, live clinical experiences, monthly pediatric peer review, and the Sexual Assault Examiner program. Just to name a few.

Here is the AI/AN SANE-SART initiative. I want to make mention that we do have the sexual assault response team. There's a partnership between IHS, Department of Justice Office for Victims of Crime, FBI, and the Department of the Interior. Address the needs of sexual assault victims in Indian country, with the ultimate goal of institutionalizing sustainable and evidence-based practices that meet the needs of the tribal communities. There is a link there.

So, thank you, again, for additional information, you are free to contact me. There is my contact information, as well as our website, with Division of Behavioral Health. If you have a question, or trying to find resources, feel free to log on and also share resources that we have. That is for everybody there.

I wanted to share a very brief and general overview for what we do at the Division of Behavioral Health. Like I said, we have a wonderful team. I am so happy and honored to be part of the team. As far as what they do every day. It is a lot of work, but like I said, they are very wonderful. The work is done, we move forward. We always think about our AI/AN, their well-being, is very important to us. We want them to be healthy, we want them to be happy. We want them to be strong. So, that is always our main goal each day.

So, as a leader, I always encourage my colleagues, what can I do? What can I do to help you? Let me know about recommendations. I always tried to be an effective leader. Honoring what they have, so, the creativity level is just out of this world. The type of development that comes moving forward, what can we provide to the tribes, like I was saying. Just want to say thank you for taking the time to listen to the presentation. I will go ahead and turn it over to Dr. Gordon. Sir?

JOSHUA GORDON: Thank you for that comprehensive and wonderful talk. Note that in addition to the several questions in the Q&A, which we will get to in a moment, there was also a comment that it is a lot of really wonderful information and very helpful. It is clear that you are doing a lot of work on behalf of Native American communities across the United States. We thank you for doing what you do. Thank you for telling us about it today.

There are a few questions in the Q&A box. I have some of own that I want to ask you as well. One relates to the last comment, I think you said that you will make the slides available to the folks, is that right? Should they contact you directly about that? If not, you can reach out to NIMH, and we get it to you as well.

GLORINDA SEGAY: They can reach out, either way, whatever works. Thank you.

JOSHUA GORDON: That is the first one, that is an easy one. The next one was a question about suicide in Native American communities. Of course, you and I know that unfortunately, Native Americans die by suicide at a higher rate than the general population. Can you say something about whether that differs depending on whether someone lives on reservation or lives in urban communities? What do we know about the demographics about suicide in the Native American population?

GLORINDA SEGAY: Anecdotally, I don’t have any data. Anecdotally I just want to say that suicide exists in Indian country, whether it is on the reservation, off the reservation, in urban areas. So, that has always been a monster in Indian country that we are always trying to battle, through education, through services, basically again trying to restore harmony among our people, to let them know how important they are and that their lives matter. But it is there, it does exist in Indian country.

JOSHUA GORDON: A related question relates to crisis responses in general. What is IHS's role in handling crisis responses? Are those done mostly through law enforcement or IHS or others send out mobile units? And how is IHS preparing for 988 implementation?

GLORINDA SEGAY: Basically, with crisis response what normally happens is that they would get an inquiry or a request, so just depending upon the request we pretty much strategize on what needs to happen. At the same time, just having that close communication with where the request is coming from, and also, our federal partners such as SAMSA, what are you all doing, what can we do together?

That is pretty much how we try to assist there at local areas there. Right now, we do not have a crisis response team. So, there is discussion about that. As far as 988, that is going to roll out I believe, July of 2022. Do not quote me on that.

What we are doing is that we are pretty much, there is a concern about how 988 will work out, just for an example, on Navajo Reservations. We do not always have cell phone signals. In cases like that, what can be done? We speak to our tribal sectors, our leaders, and we asked them what their input is. What are other concerns that we are not aware of, that we can put forth as we sit on these task forces, as we answer legislations, how can we let them know? That is just one example of the 988. But, we are very happy that that is coming out. We are excited to get that rolled out in Indian country.

JOSHUA GORDON: One related comment from Dr. Lisa Horowitz, who is one of our intramural investigators, they're working on the ASQ questionnaire that you mentioned on one of your slides. Dr. Harwood says, just a shout out to the team at Chinle, led by Dr. Nurit Harari who is testing and validating the ASQ Suicide Risk Screening Tool in the Navajo language, along with colleagues Drs. Mary Quick and Emily Haroz. It is really wonderful to see tools that can help reduce suicide being studied, and hopefully be able to have significant impacts in Native American communities.

GLORINDA SEGAY: If I can comment on that, it is wonderful to hear about the creativity that is happening in a lot of these areas. So, again, we are all so mindful of the traditional, practical natives. On Navajo land, let’s use my mother as an example, she lives in a secluded area. So, being so far, and her education status, you know, she does not have the health literacy and understanding. So, keeping her in mind and also my grandfather, he cannot speak English.

So, my grandfather recently lost his wife, my grandmother. So, these feelings that came upon him, he did not know what it was. That is where I came in. I had to translate. I even asked my grandpa, are you suicidal? It was done in Navajo. That just triggered a discussion.

So, it is wonderful that we can have brilliant people like this to translate. Not just Navajo, but maybe other native languages, so that we can reach these populations. So that we can help them understand and let them know that we are here to help them, and we are here to provide somewhat of a comfort, of a relief, because we care. Thank you so much. Shout out to Chinle.

JOSHUA GORDON: Thank you. There are a number of questions here that all deal with whether and how to provide resources or training for those working with Native Americans, whether it is from Navajo or other tribes. How they can work with them, appreciate cultural differences, learn how to deliver mental healthcare in the context of these differences. That’s just by way of background. I have a couple of specific questions. One of which is one that I think we all wonder about sometimes. I think there are different opinions about this in the Native American communities.

I’ve noticed the use of American Indian, Native American, and Native interchangeably, but are they? What is the most appropriate phrase to use if the specific tribe is unknown, or if one is trying to discuss things more generally? Do you have a thought about that? I know that is not really behavioral health, but it’s a question and someone is asking, I thought I would forward it on to you.

GLORINDA SEGAY:  I’ll take that as being a Navajo person. It depends on the contextual conversation and where you are coming from. Like, for myself, being born and raised on Navajo, I am very tribal minded. I would not even know the difference between American Indian and Native or Native American. So, that is where I come in with Navajo. That is to be specific.

Say, I am in the local area, I would say Navajo or Dine’. When I go out to Washington, DC, or somewhere, Germany, I would say American Indian, because when you explain to the Germans or whoever your audience is, they are not going to know what Navajo means. But they might have an idea on what American Indian, or Native, or Native American. It is used interchangeably. It depends like I said on who you are talking to, what the discussion is about. I hope that’s helpful. I would say, learn about the tribes, the customs. So, that kind of helps you. Thank you.

JOSHUA GORDON:  No, thank you. There was a related question which is how to best learn about mental health issues amongst Native Americans who are in specific tribes. Are there resources available? Are there places one can go to learn about these issues and how best to address them in these contexts? In tribal context?

GLORINDA SEGAY: Within IHS we do have some webinars and ECHOs like I had made mention of, and so those are very specific subject matters there. But overall, in general, I am answering for me again, the best way to learn is to be around it. That is just in general, for anything. Be around the people, get familiar with their style, their customs. Be observant in the community. Are you seeing individuals meeting up in one area or who are you seeing on a daily basis?

For example, I live in Blue Canyon, Arizona, and the nearest town is Fort Defiance and Window Rock. When I go to Window Rock, I see a variety of people. I see some of my people who are intoxicated, unfortunately. I see some of my people who are hungry. And so when you can put yourself there at the ground level in learning anything that is the best teacher.

So, asking questions, too. My elders always told me that there is no wrong way to ask a question. If you want to know, ask a question, and then you will learn. That’s just my advice to you all. Ask the question. And when it’s sincere, it is just so wonderful, you get a lot of knowledge in return. Thank you.

JOSHUA GORDON: Thank you. There are a couple more questions in this realm of resources for people. One of them is rather interesting, or specific. As a tribal employee, this person asks, where can they receive culturally appropriate interventions and training? Can you do that at the IHS level? This person notes that she is a therapist.

GLORINDA SEGAY: Thank you for that, therapist, for your services. Again, we do have a lot of resources there on our website, as far as from the webinars all the way down to say, for example, the National Suicide Hotline. So, feel free to reach out to me. I will be happy to put you in contact with an individual based on your needs.

So, again, always very different needs, always different wants. We just want to pinpoint you. So, I want to say, go to our website. Go through there, if you cannot find what you're looking for, then feel free to reach out.

JOSHUA GORDON: Great, I will note your email address. Glorinda.segay@ihs.gov is there on the slides for people who want to jot it down when they have a chance.

We have come to the close of our hour. It was a wonderful hour, thank you very much for the talk, and for answering our questions so patiently. And for your service to this country and to the Native American communities across this country that rely on IHS.

It is fantastic to learn about the plethora of programs that IHS has to help ensure that members of Native American communities get outstanding behavioral health treatment. We have a lot of work to do to try to make up for many of the disparities in mental health outcomes that exist in Native American communities. I know that NIMH is going to do its part from a research perspective, and I know that you are doing your part from a care perspective. So thank you very much.

GLORINDA SEGAY: Thank you very much.

JOSHUA GORDON: We’ll sign off for now. I hope everyone enjoyed and found this talk to be informative. We will see you at the next NIMH Innovation Directors Talk, at some point in the future. Goodbye everyone.