1 Pammie R. Crawford, PhD CandidateAdvisors: Drs. Robert Lawrence & Harold LehmannTelehealth Providing Mental Health and Addiction Care forNative Populations: Best Practices Gleaned from the US and Canadian ExperiencesIntroduction/Importance: There is a profound need to deal with mental illness andaddiction epidemics for American Indian, Alaskan Native and Canadian First Nationpopulations (to be referred to as Native populations) throughout North America. High rates ofpsychiatric problems with related co-morbidities affect approximately 20-63% of Nativepopulations.1 Depression is the most prevalent psychiatric disorder affecting thesepopulations, often strongly correlated with substance abuse.2,3 Suicide plagues Nativepopulations throughout North America at a greater extent than non-Native populations.4 USNative youth suicide rates can be up to 10 times the US average and Canadian aboriginalyouth commit suicide at a rate 3-6 times higher than the Canadian average.5 Co-occurrencerates of substance abuse/mental health problems are estimated to affect up to 80% of Nativepopulations.6 Disentangling mental health and addiction issues is challenging for both Nativecommunities and health providers but improvements in health care provisions for theseillnesses can be dramatically helpful.7 For most of these communities’ access to care on-reserve is extremely limited8 and medical transportation costs can be prohibitive consideringoverall budget for care.9 Telehealth services are a useful and practical option filling a gap ofmuch needed healthcare access for many Native communities.10 The overarching goal of theproposed study is to determine telehealth best practice(s) of mental health/addiction careservices provided to Native communities in Canada and the US. Specific aims of this studyinclude:1. Summarize health provider experience mental health/addiction care via telehealth througha. USA’s Indian Health Services b. Canada’s First Nation and Inuit Health Branch2. Summarize Native experience receiving mental health/addiction care via telehealth in both Canada and the US3. Determine gaps between IHS/HC provision of mental health/addiction care via telehealth and Native needs4. Compare and contrast the Canadian and US experiences to determine best practice(s) of telehealth for mental health/addiction care for Native communities in both the USA and CanadaMethods: This project will utilize qualitative research methodologies and result withAmerican and Canadian case-studies on telehealth experiences for mental health/addictioncare for Native communities. The case-study method will be used as this research will answer“why” and “how” telehealth can be best used to deal with Native mental health/addictionepidemics11 when limited health care options exist. There will be two phases of the data collection. Phase 1 will entail reviewing governmentdocuments and data to establish the current telehealth provision models used in bothcountries at the various levels of telehealth delivery. Telehealth services provided throughHC’s First Nation and Inuit Health Branch include the 1) Hospital level; 2) Health center(mainly for public health/community health programs in non-isolated sites); 3) Health station(semi-isolated Native communities) and 4) Health clinic (isolated Native communities). TheUSA’s IHS provides telehealth through the five following levels: 1) Hospital level; 2) Majormedical center (where experts provide telehealth services for semi- and isolated communities);2 Pammie R. Crawford, PhD CandidateAdvisors: Drs. Robert Lawrence & Harold Lehmann3) Rural health station (isolated Native communities); 4) Health clinic (semi-isolated Nativecommunities) and 5) Urban Native clinical center (due to the fact many Native populations aremigrating to cities and telehealth care where telehealth care is still used for cost-effectivenessreasons).12 The information collected on telehealth use and models at each level of deliverywill help shape field guides and structured content for interviews and focus groups. Phase 2 will include in-depth interviews and focus-groups for data collection which will beperformed using videoconferencing when possible (strongly supported as data collectionmethod by both IHS/HC to better understand the technology). Purposive sampling will beperformed to create samples of health providers and Native community members at each levelof telehealth delivery. Inclusion criteria will be: 1) Native community members who havereceived mental health/addiction care via telehealth for at least one year and 2) at 16-18months).13 Field/interview guides of questions will be developed and refined with theassistance of contacts at IHS/HC and Johns Hopkins advisors. Approximately 20 healthproviders will be interviewed in Canada (five health providers at each level of providers withone year’s experience providing telehealth mental health/addiction care to Native populations(staff turnover usually occurs Canada’s 4-level health system) and 25 in the US (five healthproviders at each level of USA’s 5-level health system) resulting with (n=45) primary data onthe health system level of telehealth provision. In order to understand the most appropriate and effective telehealth use from a Nativeperspectives focus groups will be conducted with Native telehealth recipients in each countryat each of the health system levels (4 focus groups in Canada (one per each level of delivery)and 5 focus groups in the US (one per each level of delivery). It is expected there will be 6-10participants in each focus group for a total of 24-40 Canadian Native participants and 30-50American Natives (n=54-90). Data will be analyzed, coded and integrative memos/conceptualframework will be created to determine themes for defining best practices of telehealthprovision to deal with Native mental health/addiction care. It is expected this research willresult with best telehealth practice(s) for Native mental health/addiction care, streamliningtelehealth services provision in the US and Canada by making it more effective and