American Indian/Alaska Native Behavioral Health Briefing Book

deficit, in 2009 the State cut reimbursements through MediCal, California‘s Medicaid program, to Tribal
and urban Indian health clinics unless the clinic was designated as a Federally qualified health center,
which the majority of Indian health clinics are not. The results of this change have been devastating
because programs may no longer bill for mental health services provided by the LCSW or LMFC. These
reimbursement barriers have increased the rationale to advocate to CMS to standardize and expand billing
for telemedicine services. Using tele-health is one option for the Tribal and urban ambulatory clinics to
seek reimbursement as the patient actually sees the specialist using tele-video and receives appropriate
mental healthcare. This is extremely beneficial to the patients and to the overall clinic budgets.
Program Spotlight: Toiyabe Indian Health Project
Toiyabe Indian Health Project is a nonprofit organization providing behavioral health, primary care,
diabetes prevention, a dialysis unit, and dental services to the AI/AN people living in the Eastern Sierra
region of California. Toiyabe represents seven Federally recognized Tribes and two Indian communities.
The geographic service area is very rural and isolated including 13,277 square miles of mountainous,
narrow valleys and desert terrain.
Substance abuse continues to be a significant concern to Toiyabe Indian Health Project. Receiving MSPI
funding from the IHS has allowed the program to enhance and expand the capacity of several of their
prevention and treatment programs. They now operate an intensive outpatient program (IOP) for alcohol
and substance abuse treatment programs based on the Matrix Model. To create a more culturally relevant
IOP, Toiyabe Indian Health Project includes talking circles and has integrated Red Road to Wellbriety 12-
Step Groups into their approach. Infusing their IOP with these and other culturally appropriate practices
like sweat lodges and family groups creates a recovery environment that is focused on a Native tradition
of healing.
The MSPI grant also supports their Warrior Down program, which provides community-based support to
individuals coming out of treatment and jail. This culturally based mentor program helps people stay
clean and sober as they re-integrate back into the community by linking them with social services, job
opportunities, and other recovery supports they need to remain in a spirit of healing.
To address suicide prevention, Toiyabe Indian Health works closely with the schools to present the
American Indian Life Skills curriculum. Behavioral health staff have also been trained in ASIST and are
working toward training other agencies, including school personnel, on the ASIST model. They are also
working on a protocol within the community to address suicide, including creating a crisis response team.
Toiyabe Indian Health Project continues to face challenges related to the stigma of drug and alcohol
abuse, mental health issues, and suicide. They work with their community to raise awareness and to get
people to talk about the pain and trauma so that healing can begin. They try to host a Gathering of Native
Americans (GONA) for their community every year, during which the community works together on
healing so that people in recovery have the support of a community that is getting well along with them.
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AI/AN Beh avioral Health Briefin g Boo k