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The impact of state behavioral health reform on native American individuals, families, and communities

机译：州行为健康改革对美国原住民个人，家庭和社区的影响

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In 2005, the State of New Mexico undertook a sweeping transformation of all publicly funded behavioral health services. The reform was intended to enhance the cultural responsiveness and appropriateness of these services. To examine achievement of this objective, we conducted a qualitative study of the involvement of Native Americans in reform efforts and the subsequent impacts of reform on services for Native Americans. We found that the reform was relatively unsuccessful at creating mechanisms for genuine community input or improving behavioral health care for this population. These shortcomings were related to limited understandings of administrators concerning how tribal governments and health care systems operate, and the structural limitations of a managed care system that does not allow flexibility for culturally appropriate utilization review, screening, or treatment. However, interaction between the State and tribes increased, and we conclude that aspects of the reform could be strengthened to achieve more meaningful involvement and service improvements.
机译：2005年，新墨西哥州对所有公共资助的行为健康服务进行了彻底的改革。该改革旨在增强这些服务的文化响应能力和适当性。为了检验该目标的实现情况，我们对美国原住民参与改革工作以及改革对美国原住民服务的后续影响进行了定性研究。我们发现，这项改革在建立真正的社区投入机制或改善该人群的行为保健方面相对没有成功。这些缺点与管理人员对部落政府和卫生保健系统的运作方式的了解有限，以及管理式医疗保健系统的结构局限性有关，这种结构性局限性使得无法灵活地进行文化上适当的利用审查，筛查或治疗。但是，国家与部落之间的互动增加了，我们得出的结论是，可以加强改革的各个方面，以实现更有意义的参与和服务改善。

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