4. EXTENT OF THE PROBLEM The problem is all-consuming and devastating. The problem is endemic, perhaps indicative of studies that note a genetic predisposition to alcoholism. Fetal Alcohol Syndrome (FAS) is a growing problem among the targeted villages. Family violence heads the list of social service interventions. It is not unusual for entire villages, including youngsters, to be involved in binge drinking that ends either when the supply of alcohol runs out or the State Troopers are called in to restore order. State health and social service agencies have intervened in particularly difficult situations by removing children from their parents and forcing parents into treatment. A 1988 statement by Dr. John Middaugh, the State Epidemiologist characterized the present status of Alaska Natives as a "health crisis,' and a 'modern plague on our young. • The Alaska Federation of Natives (AFN)'s President, Janie Leask stated "...it is no exaggeration to say that absent timely and dramatic action, the prognosis for positive change is poor.", referring to a new report detailing the overall status of Alaska Natives. The Alaska State Troopers have reported that alcohol is involved in nearly all village violence, accidental deaths and suicides. In one targeted village over 20% of young native males aged 17-26 died in alcohol-related incidents. Throughout Alaska, 55% of all crime is estimated to be alcohol-related, and 17.5% of all felony cases are drug-related. Drinking and drugging are major factors in 14% of all child abuse cases throughout the state. Alaska's sexual abuse rate of 950 per 100,000 minor children is six times the national average. The Alaska per capita consumption rate for 1986 vas 3.51 gallons of alcohol while the U.S. average vas 2.53 gallons per person. 5. IMPORTANCE OF THE PROBLEM Tventy-five years ago there was hope that the Alaska Native would become prominent in the mainstream of Alaska's economy. Today only a few have realized this promise, as many have to combat alcohol problems that consume their lives, and many die at an abnormally young age. Suicide, accidents, homicides and diseases claim too many Native Alaskans. Alcohol abuse and co-dependency are problems that often lead to the final solution of suicide if help is not provided. Bright youngsters often commit suicide because they are the most sensitive. Accidental deaths during individual or village binge drinking exceed those by suicide, but both are far above national averages. Village isolation and denial systems helps the problem remain hidden. School age children exhibit emotional distress, reflected in poor performance. This vill preclude higher education opportunities for many. These children are unable to cope with the fragmented family situations, being unwitting victims of the family codependency. It becomes a vicious cycle, with the children becoming the losers. 6. LEVELS OF MORBIDITY AND MORTALITY - The following information is provided from Alaska State studies and statistical information: A. Nearly all suicides and homicides in the area involve alcohol. AGES 25-29 B. Accidental deaths among Alaska Natives most often involves alcohol. Local sources place the number of such deaths as over four times that from natural causes. C. Fetal Alcohol Syndrome (FAS), birth defects due to alcohol use during pregnancy costs the State of Alaska $85,000 per patient per year for institutionalization. The FAS prevalence per 1000 live births are: D. The Alaska State Troopers state that there is no serious crime in rural Alaska without alcohol. Alaska Natives account for 34% of the prison population of Alaska although they are only 16% of the population. E. The Anchorage Daily News article "A People in Peril' provides poignant stories of village conditions. Targeted villages have all demonstrated all-inclusive binge drinking and serious health problems due to alcoholism. B. Description of the program methods. 1. PROGRAM METHODOLOGY AND APPROACH Pneuma will provide intervention and treatment, attacking the symptomatic causes of dysfunction. Entire villages will be transported to St. Mary's for treatment for alcoholism, the addiction to other drugs, and codependency. The Children of Alcoholics and Adult Children of Alcoholic syndrome and Fetal Alcohol Syndrome will be addressed. Program treatment details are more specific in Pneuma's Family Life Program, but are summarized below: EDUCATION AND PREVENTION includes those activities that are designed to prevent dependency on alcohol and other drugs. OUTREACH AND INTERVENTION activity works to reverse the early stages of dysfunctional drinking. A carefully executed village intervention effort will be aided by volunteers, the schools, troopers, family services, and other agencies. FAMILY TREATMENT will be emphasized. The family of the alcoholic requires specialized co-dependency treatment. Without education about the addiction process, and treatment for co-dependency, the entire family will continue to exhibit distressing symptoms that lead to personal and familial disintegration. Group and individual counseling form the heart of the family treatment process designed to nurture each family member to wholeness, encouraging personal growth and self-worth. CONTINUING CARE OR AFTERCARE follows treatment as an aid to the process of recovery. The village aftercare component will include counselor visitations leading to an on-going, self-directed village aftercare program after six months. The appendix provides a more detailed explanation of these components. 2. PROGRAM STAFFING - A specialized staff will be retained for this project, headed by a Pneuma Rural Program Director. Professional, culturally-sensitive counselors will provide group and individual counseling and therapy sessions assisted by a support staff. The project can be expected to attract extremely qualified and culturally sensitive counselors due to its unique and professionally challenging characteristics. Stable and vell-adjusted native couples will be involved as role models and aides. With a maximum counselor/patient ratio of 1:12, ten primary counselors are required since up to 110 villagers are expected to be treated at one time. Five program aides are required; four will provide round-the-clock patient monitoring duties in the two residential patient buildings, and the fifth will assist in the treatment program. The program vill serve three villages the first year, five the second, and seven thereafter. The budget provides additional details regarding the project personnel. 3. AVAILABLE RESOURCES The people want this project and have confidence in Pneuma's professionally directed program. The people are available to carry out this project as targeted villages involved in treatment; as support personnel who will provide village security during treatment; as village network personnel to assist in aftercare; as school districts who will support the transfer of schooling during treatment; as churches, village councils, local industries, and law enforcement systems. The 69,000 sf physical facilities of the old St. Mary's boarding school will be utilized. The facilities and equipment, provided as an in-kind donation by the owner. Tvo dormitory buildings will be used to house up to 110 villagers during residential treatment. Food service, classrooms and other programs will be housed in the main building. The worker's dorm will house professional staff. State and federal agencies have support resources available that will be used as required. The Department of Education vill assist with the school transfer during treatment. Health and Social Services vill assist in the intervention and aftercare. The State Troopers and justice system vill assist in the village intervention. individuals throughout the State have also volunteered assistance. Yukon-Kuskokwim Health Corporation's services will be utilized as appropriate. Other 4. OTHER REQUIRED RESOURCES - Money is the most needed resource. The major project expense will be for qualified personnel. Specialized talents will be required for child, adolescent, and adult treatments. Money is needed to pay for personnel, support expenses, and transportation costs as detailed in the budget narrative. If one organization cannot fully fund this program, Pneuma vill seek shared 、 participation for this vital project. Without proper funding, this program cannot be implemented. 5. PROJECT TIMELINES AND LOCATION -_The project will begin at St. Mary's in August 1989. The first village residential treatment is expected in October 1989, a time of freeze-up, when activities are at a lull in the targeted villages. In the first year, two additional village projects will be completed before summer. If the program vere funded for additional years, in the second year three would be planned for fall, and two for spring. In the third year, seven villages will be treated in succession. This phased approach will ensure time for staff training and program evaluation. A six to eight week residential program will be followed by intensive aftercare vork for a minimum of six months. Three counselors are expected to return to the village with the patients after treatment for one week, followed by a weekend trip every two veeks for three months, followed by a veekend trip every month for three months. 6. PNEUMA'S RELATIONSHIP WITH THE COMMUNITIES Pneuma has an excellent relationship with, and demonstrated support from the Alaska Native community. Pneuma is a community organization, with the majority of the Board of Directors being Alaska Natives, and a 100% Alaska Native Director's Advisory Board that is responsible for program activities. Pneuma is the final result of an evaluation process begun in the late 1970's which involved meetings with the native people throughout Western Alaska. They requested that the devastating problem of alcoholism be seriously approached with an effective, comprehensive, and professionally directed program. Thus, Pneuma's relationship to the native people is one of creative assistance to insure the best help possible for a problem identified by them as one that needs priority attention and one they are unable to deal with themselves appropriately, 7. ACCESS TO THE TARGETED PEOPLE Sponsors, associates, advisory boards, and administrative personnel, and a network of volunteer village representatives provide input and assistance. Most groups and all churches will assist. Other access come from referrals from the schools, the court system, other State agencies, the native councils, and the direct requests for help from village people themselves. 8. WHY THIS PROGRAM WILL WORK Past efforts to solve the alcohol problems in rural Alaska have failed, in part, because they have not addressed all facets of the problem, or have done so on a fragmented basis, or have lacked professional guidance, or lacked sufficient physical facilities to carry out a comprehensive program. None have attempted a family-oriented, community approach that includes residential treatment. None have had Pneuma's vide volunteer support system. Pneuma's program will work because it draws on past experiences and has the support of the people served, building on their rich cultural heritage. 9. SUCCESS EVALUATION The project should yield a measurable reduction in abuse, violence, accidents, homicides, and suicides. It should yield a measurable improvement in school performance, employment, and participation in community affairs. Evaluation will also monitor improved family situations and cohesiveness, community concern and improved adult/youth interaction. The "Handbook for Evaluating Drug and Alcohol Prevention Programs published by the U.S. DHHS, Public Health Service, will be used as an evaluation guide. A debriefing evaluation will be performed after each village residential project. Initial evaluations will be done after the first treated village returns home, expected in early December 1989. Follow-up evaluations will be regularly accomplished. Social service agencies will report on progress they observe. The native people themselves have asked for this program, and are integral elements of its operation. The chances of success are increased with dedicated professionals working in a culturally suitable, innovative program among the people who have asked for this help and recognize the need for it. 11. HAS THIS PROJECT BEEN ATTEMPTED BEFORE? - No! No one has attempted intensive residential treatment of an entire village. The location change effectively breaks the cycle of current village behavior. No Alaskan programs have had the combination of available facilities, family orientation, vision and support from the people as does this project. C. Assessment of potential problem areas affecting management and implementation of the project, and how such problems or barriers might be overcome. A project of this scope vill undoubtedly encounter difficulties and barriers to success. Treatment of 110 people at a time is difficult, and all the village's problems will be transported to treatment with the people. Pneuma's organization uses a statevide Board of Directors, local operational advisory boards, and groups of other concerned individuals who will provide expertize to overcome obstacles as presented. The broad contacts available to Pneuma provide resources that should be able to appropriately address problems as they develop. The professional challenges of this program can be expected to attract the required staff and volunteer supporters. The major barrier will be sufficient funding. The high cost of operations in Alaska discourages many supporters, so there is a need for a long term commitment for reliable funding for the program to succeed. If this obstacle is overcome by the award of this grant request, other difficulties or barriers will be easily surmounted with our diversified resources. Pneuma General Statement of Purpose APPENDIX 1. Pneuma has been formed to assist the people in their efforts to combat alcohol abuse/alcoholism/co-dependency. Pneuma will provide a family-oriented, professional, culturally sensitive, and comprehensive program of education, prevention, and treatment for entire villages, addressing the physical, psychological, social and spiritual conditions of each individual. This program supplements other Pneuma prevention and treatment programs. General Program Features 1. EDUCATION Provide education programs that expose opinions as opinions, building prevention and treatment efforts on a factual rather than opinionated foundation. Education and training efforts will respond to the need for an understanding of 1) the Agent alcohol and other drugs; 2) the Host those most susceptible to substance abuse and dependency; and 3) the Environment those conditions conducive to interaction of the host with the agent. 2. PREVENTION Provide those activities designed to prevent dependency on alcohol and other drugs. Primary prevention will forestall the unhealthy use of alcohol or other drugs. Secondary prevention will interrupt unhealthy use of such substances. Tertiary prevention will provide treatment and rehabilitation. 3. OUTREACH AND INTERVENTION works within the community to identify persons in need of services, alerts people to the availability of services, locates such services, and enables people to enter such programs and accept the services available, seeking to reverse the early stages of dysfunctional drinking and prevent substance abuse. 4. NON-MEDICAL DETOXIFICATION safely sees the patient through the first few days of residential treatment. Patients at risk or in need of medical detoxification will be referred to an appropriate medical facility. |