CAST to tackle big issues on path to regional wellness

Last week, the Community Alcohol Safety Team gathered at Kawerak’s Talialuk boardroom for two days to hear data presented by Dr. Brian Saylor that was to help the group make community-based decisions on how to tackle underage drinking, binge drinking and to begin charting a path towards behavioral health and wellness in Nome and the region.

Dr. Saylor, a former director of University of Alaska’s Institute of Circumpolar Health studies and now independent health services researcher, presented data from a 2015 survey and several focus groups.

The team, CAST for short, was born through a state grant to RuralCap and was administered by Kawerak to address and improve wellness in Nome and the region through a concept that is called “Strategic Prevention Framework.” Unlike other grants, the concept allows for the community to make its own data-informed and culturally appropriate decisions. A second grant uses the same process and is to continue the work.

Kawerak’s Lisa Ellanna said that the first community assessment results indicated that the real concerns were the negative effects of alcohol on the community and the region. But it also became clear that alcohol abuse is only the symptom of much deeper underlying problems. “We utilized the same process to go through another grant of identifying other areas that we need to focus on that address behavioral health,” Ellanna said. “The coalition identified that there are concerns around the issue of behavioral health, that relate to racial equity, recognizing history and how difficult that has been for the Alaska Native population.” Ellanna said the results of this difficult history requires an assessment of the present in order to be able to work towards wellness. “You can’t really chart a path to the future unless you know where you are and we are just now recognizing where we are,” Elanna said. She said that people’s personal histories were validated in the data that addressed racial inequity and historical trauma experienced by Alaska Native people. “Being in a place where its safe to have a discussion as to what we’ve been through as a community of Alaska Natives has allowed us to say, ok, this is where we are, this is what happened to us and this is why we are where we are, now we can chart a path to a brighter future,” she said.

Dr. Saylor presented data to the group that consisted of members of Kawerak, the Nome Youth Facility, the Office of Child and Family Services, Public Health nurses, a correction officer, the Nome Public School District, Bering Sea Women’s Group, the UAF’s Extension Service, the Nome Community Center and private persons.

One of the more surprising trends that the data revealed was that people of mixed race have a harder time and experience more physical and mental hardship than people of full-blooded ethnicity. “Adults of mixed race – mostly Alaska Native and Caucasian — had a higher average number of days of limited physical health days and bad mental health days than other ethnic groups,” concludes the survey.

Lisa Ellanna said it was a surprise to her. “We could see it in the data that people of mixed race identity have a very difficult time with their mental health some days. They have more days that they experience reduced mental health than people of non-Native ethnicity or full Native ethnicity. I knew that for myself to be true, but it was rattling to see how large a demographic is experiencing the same thing,” she said.

“Those mixed race people who are easily criticized by one or the other group are with a foot in both camps. They are in a very awkward position – it is shows up in their mental health status,” Dr. Saylor added.

Data showed that mixed race adults in Nome have far higher depression levels than other ethnic groups. Compared to other places in Alaska and the northern region of Alaska, there is more depression among Alaska Native people and mixed race people in Nome.

Also, Dr. Saylor had good news to report: data revealed a slight decrease in people drinking at all or in the last 30 days of the survey taken in April 2015. The survey showed a statistically insignificant decrease in adult binge drinking, but there was no change in underage drinking.

This data was put in the context of what it means for mental health or behavioral health in Nome. How does parental alcohol or substance abuse affect children? Effects on children of alcoholics include that they are exposed to higher risk for emotional, physical and mental health problems; they are exposed to more violence in the home; are more likely to experience depression, anxiety, eating disorders and are more likely to become alcohol or drug addicts themselves.

Dr. Saylor walked the group through data that showed that maltreatment of children is passed along – 70 percent of parents abusing their kids have experienced maltreatment themselves as children. In focus group discussions, the researchers could glean information about the identity crises of mixed race individuals, who struggle with a sense of belonging; and about the lingering effects of historical trauma.

After pouring over the data sheets and having group discussions, the coalition concluded that improvements are needed in the justice system; also improvements are needed to better train behavioral health providers as to an understanding of Native history and cultural practices and to improve cultural awareness in the school system.

“There was nothing in the data that said anything about the justice system,” said Dr. Saylor. He explained that this is the beauty of the process, that CAST took the data and drew its own conclusions from it. “But as a community, we have decided that the justice system needs improvement and that providers need to be more effectively trained facing the patients they serve,” he said. “Now we descend on that.”

The researcher is now waiting for further questions from the CAST team to direct his focus on the next survey with the overarching goal to improve behavioral health in Nome and the region. “This is the very beginning of a very deliberate and intensive community decision making process,” Dr. Saylor said. “This is not a bunch of people being told what to do. This is a community coming to an understanding what it has to do.”

Lisa Ellanna said that the CAST group holds quarterly meetings in Nome and invites anybody interested to participate. “If people want to get involved and help guide to steer the direction, they are very welcome,” she said.