National Indian Health Board
Visions: A Tribal Perspective on Methamphetamine and Suicide Prevention 
Have You Heard ...

American Indian and Alaska Native Youth Commercial Tobacco Use and the Importance of Tobacco Screening

By Chris Fore, PhD and (Chris Cooper M.Ed., Subject Matter Expert)

 Wednesday, July 1, 2015 | 3:00 pm ET


  1. Summarize how youth are targeted by commercial tobacco companies.
  2. Tell why it is important to screen for commercial tobacco use in youth.
  3. Incorporate knowledge of youth commercial tobacco use to design youth tobacco screening protocols, and assess youth for commercial tobacco use.

Click here to participate.

 Eye Movement and Desensitization and Reprocessing: An Overview

by Summer Duke, LCSW, and Rebecca Bundy, LCSW

 Tuesday, July 7, 2015 | 3:00 pm ET


  1. Cite the history of Eye Movement Desensitization & Reprocessing Therapy (EMDR).
  2. Recognize the connection between EMDR and trauma-informed care.
  3. Identify the requirements and upcoming opportunities for becoming trained to practice EMDR Therapy.

Room Code: dbh 

 Adolescent Medicine Webinar Series: Depression and Mental Health

by Aisha Mays, MD

 Wednesday, July 8, 2015 | 2:00 pm ET

passcode: health
2014 Trends in Indian Health Released


The Indian Health Service released the 2014 edition of Trends in Indian Health. The report has tables and charts that describe the health status of American Indians and Alaska Natives.


In the report, it was mentioned that, "the AI/AN age-adjusted suicide death rate (18.5) for 1979-1981 is equal to the age-adjusted rate for years 2007-2009. The highest suicide rate (19.8) was for years 2004-2006 and is 7 percent higher than the current age-adjusted rate (18.5). The 2007-2009 rate (18.5) is 1.6 times greater than the U.S. all races rate (11.6) for 2008. These AI/AN rates have been adjusted to compensate for misreporting of AI/AN race on state death certificates."


Click here to read the report. 

NIHB is hiring!

Director of Public Health Programs and Policy

For full job description and information about how to apply, please click here (PDF).


Policy Associate: Medicare, Medicaid and Health Care Reform

For full job description and information about how to apply, please click here (PDF).


Executive Assistant

For full job description and information about how to apply, please click here (PDF).


NIHB MSPI Project Management Toolkit

NIHB has updated its project management toolkit to include new tools, links and webinars.  There is now a powerpoint slide set on sustainability and sustainability planning, as well as a new sustainability readiness checklist.  There is also a powerpoint slide set on logic models, as well as two handouts for logic model.  And lastly there are two tip sheet for recruiting and retaining high quality staff for your programs.  All of these article appear in the


NIHB MSPI Webpages


NIHB tries to disseminate information to all of our Tribal partners.  We have created some mechanisms in order to do that and want to make sure that all of our MSPI Partners are able to take advantage of this.  NIHB posts new and timely information regarding topics such as: training, webinars, funding, publications, conferences, meetings, legislation, Tribal consultation, and open comment periods all on our website as Behavioral or Public Health Alerts.  NIHB operates two separate alert lists to appeal to specific audiences.  We encourage you to check these posts often to remain abreast of current information and ensure that you have access to material in a manner that is timely enough to allow you to plan for it.  

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Don't forget to visit NIHB on our Facebook page and like us.  We frequently post blurbs, updates, and pictures about important public health information, happenings, trainings, and events. 

Mission of the National Indian Health Board
One Voice affirming and empowering American Indian and Alaska Native peoples to protect and improve health and reduce health disparities.

About this Publication
This publication features information on suicide prevention, intervention, postvention and methamphetamine prevention, treatment and aftercare. We welcome your suggestions, questions and comments and invite you to submit materials for future publications.
Charting a Course for Success: Grant Writing Tips

A reality of public health work in this country is that a good amount of programming is supported by grant funding.  This means that to be an effective public health professional in this day and age it is important to have a strong skill set in grant writing.  As funding shifts and new funding becomes available, it is a good idea to brush up on those skills.  This of writing a grant as a road trip - there is a distinct starting and finishing point, and little stops along the way that will make the trip easier and more enjoyable.  And the key to a good road trip is planning and preparation, and the same is true for grant writing.  This article highlights some useful tips for you and your team to think about as you are reading through funding opportunity announcements, writing sustainability plans for your programs, and planning for the long term health and wellness of your communities. 


Is this trip worth taking?

  • Ask yourself if this funding opportunity fits within the mission or strategic plan of the Tribal program or organization.  If it does not, then it may not be worth going for.
  • If this grant represents a foray into a new realm for your department, then consider partnering with an experienced organization or hiring a consultant.  This will help to demonstrate needed capacity to work on the issue.
  • Look at eligibility criteria.  Don't waste your time with planning if your program or organization is not even eligible to apply for the funds.  There is oftentimes some leeway for organizations within Indian Country, as grants are often eligible to Tribal governments, Tribal organizations and/or non-profit organizations - and organizations within Indian Country often fall into one or more of these categories.  If your program or organization is ineligible, then look for an organization or a fiscal agent that is eligible with whom you can partner on the application.
  • Ask yourself if your program/organization has the capacity to do what is being asked.  No matter how promising, the funding may look and how closely aligned it is to the purpose of your program, if your Tribe or program does have the capacity or resources (i.e., staff, space, community support, infrastructure, history), then you are setting yourself up for failure should you choose to compete for funds. 


Making Plans

  • Take plenty of time to read and review the grant - highlight important components of the guidelines - such as the intended goal, required activities, due dates, page limits and required components.  Highlight any questions that the funder would like answered within your application.  And be sure to take note of the rules of the application, such as mandatory page margins, font size, pagination, spacing, and required attachments.
  • Distribute the funding opportunity announcement to your colleagues and team members.  Ask them to review it, and then gather everybody for a group brainstorming session.  Use the time to lay out ideas for activities, collaborators, frameworks, evaluation processes.  Honor everybody's input, and use it to construct an approach your team together and take Group brainstorm - honor everybody's thoughts.
  • Do a literature review and internet to find out if anything relevant or similar has already been done in the field.  Either you could change your plan to avoid proposing work that has already been undertaken, or you could take those lessons already learned and apply them to your proposal. 
  • Try to make assignments to divvy up the work. For example, have one person in charge of gathering the attachments, one person gathering letters of support, while another person starts writing a statement of need.  Create an electronic filing system where everything can be shared and saved.  Assign one person to take lead on the entire application - who will be in charge in putting all of the pieces together.
  • Set deadlines for completion of each component.  Do not wait to the last minute - especially if you are thinking about collaborating with partners. 

Filling the Gas Tank

  • When starting to write the narrative components, feel free to use language from older grant applications or reports (this is especially true when talking about organization structure, internal capacity, or community need).  However, do not just cut and paste the language.  Take time to update and tailor it to this proposal.
  • Be very clear about what you want to accomplish with a solid goal for your proposed program.  Remember a goal is generally broad and lofty.  Your goal should seek to address an identified problem or issue within the community.  All components of the proposal should relate to achieving the goal. A simple and clear goal states what you want to do, and then the rest of your application explains how you are going to reach your goal.
  • You should begin by writing a logic model for your program.  This will sketch out the problem, what you will need to address the problem, what activities you will undertake, and what changes you want to accomplish.  From there, you can write a workplan to explain the journey you will take to achieve the goal and operationalize the logic model.  Then you can write an evaluation plan from the workplan, and finally you should have all of the components to write a draft budget.
  • Use charts and diagrams - especially the in planning phase to understand all of the moving parts in your proposed program.  Feel free to add charts and diagrams to your application, as well.

Hitting the Road

  • When it actually comes to start writing the portions of the application, cut and paste components of the funding opportunity announcement right into your own documents.  Pieces likes questions that need to be answered or very specific language that they use to describe a component are very helpful to guide and include in the narrative component of your application. 
  • Write a clear workplan that explains step by step what you are going to do.  A workplan usually includes a goal, objectives, activities, responsible parties, timelines (or deadlines), and may include other elements like deliverables or approval processes.  Feel free to use a table or a chart for your workplan and not just a narrative.
  • Measure your results.  Create a work plan with outcomes that are feasible to measure.  Then ensure that you explain how you will measure all aspects of the project to promote project improvement, effectiveness and efficiency. 
  • Timing is everything.  Let the reviewers know WHEN you will be doing the things you plan to do.  A detailed timetable lets them know that you have given this work some thought and that you have a clear idea of the time it will take.  A Gantt chart
  • Staffing to match the work proposed.

Don't Get Lost

  • Keep checking back to make sure that you are not exceeding the page length and that what you are proposing is in line with what they are asking
  • If you are submitting the application online, about one month prior to submitting, check to make sure that all online government accounts, paperwork, passwords, etc. are up to date and functional.  This includes, FedBizOpps, DUNS, and SAM (which has now combined ORCA, FedReg and EPLS into one site).
  • Develop a realistic budget.  Itemize and justify all project expenses carefully.  Do not budget for extraneous things that are not in your workplan.  The staffing plan should reflect what is necessary to accomplish the workplan.  Reviewers can tell when a budget has been inflated, so don't pad the budget. 

Almost There

  • Make sure that program staff's resumes or bio sketches are up to date.
  • Do not include a lot of attachments that are not requested or directly related to your proposal. Use your attachment/appendices to make a case, and supply evidence of what you state in the narrative. 

Arriving at Your Destination

  • Have somebody review the final draft for you - for grammar, flow, and most importantly - how does it line up with the funding opportunity announcement.
  • Double check the budget using a calculator.
  • Double check that page numbers are continuous, and that smaller components (like a table of contents and abstract) have been completed.
  • Set aside a good chunk of time to move through the online submission process.  There are often times other online documents to complete as well, and uploading large documents (like appendices) may take time. 
  • Print or save a copy of any confirmation that you received from the submission. 
  • Notify all collaborators that the application was submitted and let them know of any future follow-up that will take place. 

Some of the above tips for the content of the application and others are for the process.  These tips won't guarantee a successful grant application, but they will help to create a smoother and more streamlined process, and hopefully a stronger and more competitive application.  Grant writing is a skill and with all skills, practice makes perfect.  So seek out opportunities within your Tribe to work on grant applications - start off with smaller assignments (e.g., statements of need) and move up to more challenging and complex components (e.g., an evaluation plan). With time, your Tribe and team will develop their own process that works for them. 

SAMHSA Releases Revised Federal Guidelines for Opioid Treatment Programs


The Substance Abuse and Mental Health Services Administration (SAMHSA) released the revised Federal Guidelines for Opioid Treatment Programs in March, 2015. This is the first revision of the guidelines since 2007. The guidelines were designed to be the primary reference and measure for opioid treatment program (OTP) staff, accreditation bodies, and other stakeholders.


For the first time, SAMHSA has included guidelines for telemedicine. SAMHSA recommends that any OTP interested in telemedicine should proceed with a profound understanding of state or licensing boards, and that special care should be taken with the security and privacy of data. It is also important to note that OTPs should not expand their practice to a jurisdiction that falls outside of the provider's area. For instance, if a provider is located in California, they should not be providing services to a patient in Arizona. This is an important consideration for Tribes whose lands straddle state lines, and whose facilities may have service populations in multiple states. 


Another change in technology, electronic health records, was also endorsed by SAMHSA in the guidelines. Though they do not provide concrete guidelines, they do advise to take measures to ensure the protection and security of the records, similar to telemedicine.


Also for the first time, SAMHSA introduced guidelines for prescription drug monitoring programs (PDMPs). Most states have PDMPs in response to the rising misuse of prescription drugs. SAMHSA recommends that OTP healthcare providers register with their state's PDMP. Providers are encourage to check the PDMP regularly, from the initial visit with a client through the course of the treatment plan, to ensure that common drug seeking behaviors such as "doctor hopping" is not taking place. Accessing the PDMP will allow providers to see other prescriptions, including those that a client does not disclose. This helps identify when substances may be misused.


While much of the guidelines remains the same, there were other significant differences between the 2007 and 2015 Guidelines, including:

  • Nursing scope of practice
  • The role of non-physician authorized prescribers
  • Benzodiazepine misuse in the context of opioid agonist therapy
  • The rule that went into effect January 7, 2013, removing the "time in treatment" requirement for patients receiving buprenorphine or take-home use from OTPs.
It is important to note that some states have additional regulations, on top of the federal guidelines. Health program and clinical staff should take that into consideration when verifying compliance or creating their own standards of care. Tribes should examine the guidelines, as well as any other regulations that exist and explore how they can be adopted adapted into their practices to assist with the battle against opioid abuse. To read the Federal Guidelines for Opioid Treatment Programs, click here.
The Influence of Past Experiences on the Present: Eye Movement Desensitization and Reprocessing (EMDR)
While walking through a park in 1987, Dr. Francine Shapiro realized that moving her eyes back and forth while thinking a distressing thought caused the thought to be less distressing. A couple short years later, after completing initial research studies, Eye Movement Desensitization and Reprocessing (EMDR) was recognized as a promising treatment for posttraumatic stress disorder (PTSD). Though the therapy celebrated its 25th anniversary last year, it is still new, or unfamiliar to many people.


What is EMDR?

EMDR is a clinical therapy that addresses clinical complaints by processing components that lead to distressing memories. Like other systems in the body, humans have an information processing system. This system stores memories and experiences. These stored memories are linked in a network that has other similar thoughts, emotions, and sensations. Humans learn when new experiences, thoughts, emotions, images, etc. are combined with already stored items in the memory.


When traumatic events occur, the information processing is adversely affected. The memories are stalled from processing by strong negative feelings, or dissociation. Instead of memories combining, they are disconnected. These disconnected memories lead to dysfunctional and unprocessed memories, in turn causing the person to be triggered when in similar situations.


EMDR processes memories by targeting the memories and linking them with adaptive information. This process helps learning occur, essentially reorganizing the experience and storing it in the appropriate place.   


The eight-phase therapy seeks to eliminate suffering and symptoms, to create a healthy adult that is able to self-soothe, feel a range of healthy emotions, and able to maintain a sense of self and general awareness. It also seeks to help individuals be members of the larger society by learning how to interact and bond, be resilient, cope, and able to set boundaries, empathize, and contribute. While EMDR has been proven effective for PTSD, it has also seen success with panic attacks, dissociate disorders, stress reduction, addiction, and disturbing memories, to name a few.


What does EMDR entail?

When undergoing EMDR as a treatment plan, clients go through eight phases. The process is frequently cyclical as sometimes new specific problems are revealed.

  1. Client history and treatment planning. During this phase, the therapist conducts a thorough history of the client. This includes discussing why the client is seeking therapy, what specific problems they'd like to focus on, and what potential symptoms may be. After completing the history, the therapist develops a plan for treatment.
  2. Client preparation. During the client preparation phase, the therapist explains the process for treatment and builds a rapport with the client. The therapist introduces the client to coping techniques for times when the client is experiencing stress.
  3. Assessment. During the assessment phase, the therapist asks the client to associate an image or scene with one of the targeted problem areas. The therapist asks the client to choose a statement to express negative self-beliefs and, alternatively, the client also chooses a positive statement they want to believe. The therapist will ask the client how true they feel the positive statement is, based on the Validity of Cognition (VOC) scale. On this scale, a score of 1 indicates "completely false," while a score of 7 indicates "completely true". The client also rates the disturbance using the Subjective Unites of Disturbance (SUD) scale. On this scale, a score of 0 indicates no disturbance, while a score of 10 indicates "the worst feeling you've ever had".
  4. Desensitization. During the desensitization phase, the therapist leads the client with sets of eye movements, or other types of stimulation. The therapist starts with the specific problem, but also targets other associations that may go along with the specific problem.
  5. Installation. During installation, the client focuses on the positive belief they previously identified. This positive belief is first strengthened, then "installed". The therapist measures how much the person believes the positive statement using the VOC scale.
  6. Body scan. After the installation, the therapist will bring the client back to the original specific problem being targeted. The therapist observes the client to see if there are any residual physical reactions to the problem. If there are any residual reactions, these reactions are targeted for reprocessing.
  7. Closure. Closure occurs at the end of each session. It makes sure that clients are leaving the session in a good place, even if processing trauma has to be split between sessions. This involves teaching the client techniques to cope, and self-calm.
  8. Re-evaluation. Each new session begins with re-evaluation. The therapist ensures that the positive results from previous sessions have been maintained, while identifying new areas that need treatment, and areas that need reprocessing.


Common Misconceptions

As many people are unfamiliar with EMDR, there are also quite a few misconceptions. It can be viewed as a somewhat "magical" approach to some people, thereby fueling misconceptions. Below are three very common misconceptions.


EMDR is not research-based.

There have been over twenty randomized controlled trials on a wide variety of trauma populations. Many organizations recommend the therapy for treatment of PTSD, including the World Health Organization, the American Psychiatric Association, the Veterans Administration, and the Substance Abuse and Mental Health Services Administration.


EMDR is like hypnosis, or is simply moving your fingers back and forth.

EMDR is not hypnosis, and does not inducing a hypnotic state. As described above, EDMR has multiple stages. An EDMR therapist has studied EDMR and understands the distinct stages. Skipping the steps would lead to skipping essential stages of trauma recovery.


EMDR is a quick therapy.

The therapy has worked quickly for some clients (1-5 sessions), however this is not necessarily the norm. The amount of sessions required varies from client to client. Some clients are able to process a traumatic event quickly, while others need longer (especially when multiple traumatic events have occurred). For instance, person A could have experienced a one-time traumatic event, while person B could have experienced trauma as a child, abused substances as an adult, and possibly experienced additional trauma as an adult. Person A is likely to recover in fewer sessions, than person B.


For more detailed information about Eye Movement Desensitization and Reprocessing, visit


The National Indian Health Board's third installment of its MSPI webinar series will cover the topic of EDMR. Please join us on Tuesday, July 7, 2015 at 3:00 pm ET. The free webinar will take place here, passcode: dbh. No preregistration is required.




EMDR Institute, Inc. - Theory. (2011). Retrieved from
EMDR Network. (n.d.). Retrieved from

Jenkins, S. (2014, March 6). EMDR Therapy: Separating Fact from Fiction. Retrieved from

What kind of problems can EMDR treat? - EMDR International Association. (2014). Retrieved from

The National Indian Health Board welcomes your input!  If you would like to submit materials for consideration, please contact the NIHB Public Health Department through Acting Director of Public Health Programs and Policy, Robert Foley at or (202) 355-5494.