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We Accountancy vacancies cheshire it becomes a resource to other tribal nations across North America, and will strengthen culturally specific responses to suicide prevention and treatment. community connections for suicidal youth is completely unique. It has great potential for public health interventions that have been disseminated across the globe. The suicide prevention work is being designed accordingly, to have relevance in populations resources. Much of the prevention and post-intervention is focused on connecting youth to caring adult family members and to community treatment resources. The latest data Native American communities have tremendous resiliency. We have survived untold adversity by blending our traditional wisdom with new technologies. Culturally appropriate research is a great example. We must harness the power of traditional understanding and rigorous scientific research to stop youth suicide. Tribal-university partnerships that are built on trust and longterm powerful means for achieving renewed health. Federal funds are well spent in the arena of our most precious assetour youthlive to full maturity and potential. In our belief system, every human life serves a purpose to maintain the health and well-being of Mother Earth. We must find the means to re-learn as a human race that life is sacred; that life is precious; that life is meant to be lived out serving our greater common purpose. DISCLAIMER: None of the opinions expressed within are those of Johns Hopkins University. No material from this site may be modified, transmitted in any way, or distributed without the owners prior approval. NOTE: Text and Photos are protected by copyright laws. Redistribution, republication, syndication, rewriting or broadcast is expressly prohibited without prior written consent. ASUS M5A88-M mATX AM3 DDR3 AMD 880G 1PCI-E16 Accountancy vacancies cheshire 1PCI USB 0 SATA3 DVI HDMI Motherboard This product can only be exchanged or replaced with the exact same item. Actual product may not be exactly as shown. Buy Selected Asus, MSI or Gigabyte AMD platform motherboards and get the all new AMD 2x4GB 1333MHz Memory Kit for only More Details Buy Selected Asus, MSI or Gigabyte AMD platform motherboards and get the all new AMD 2x4GB 1600MHz Memory Kit for only More Details Buy Selected Asus, MSI or Gigabyte AMD platform motherboards and get the all new AMD 2x2GB 1600MHz Memory Kit for only More Details This item is in stock and will ship as soon as possible. Usually ships in 1-2 business days. Add a NCIX EXTENDED SERVICE PLAN. Protect Your Investment Full parts labour coverage, surge protection, and more. Accountancy vacancies cheshire More Prices are only valid when buying a combo, and not available for price match. This motherboard supports AMD AM3 multi-core processors with unique L3 cache and delivers better overclocking capabilities with less power consumption. It features dual-channel DDR3 memory support and accelerates data transfer rate up to 5200MT/s via HyperTransport 0 based system bus. This motherboard also Accountancy vacancies cheshire AMD CPUs in the new 32nm manufacturing process.

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These behaviors include: suicidal ideation, attempts, deaths, as well as binge drinking, drug use and cutting, which are also forms of self-injury in our community. Johns Hopkins assists in managing data and In addition, with Johns Hopkins help, we have trained and employed a Accountancy vacancies of Apache case managers who follow up on every incident reported through the suicide surveillance Accountancy vacancies available care. Prior to this, very few youth who attempted suicide 25% ever received treatment due to numerous treatment barriers. This effort is the first community-based follow-up and triage system of its kind in the country. Our tribe has been fortunate to receive federal funding for our suicide prevention research. We the Native Accountancy vacancies Research Centers for Health, managed by NIH and IHS. With this support, we are now developing evidence-based prevention interventions. What has been accomplished to Accountancy vacancies is state-of-the-art, and includes the following: First, we have adapted an Emergency Department intervention for youth who attempt suicide and their Accountancy vacancies family members. Apache case managers meet directly with the youth and their families to help them Accountancy vacancies a safety plan to keep youth alive; we also help them connect to available services and follow up to ensure they go. More than anything, we teach them that their suicide attempt was very serious and taking ones life is not the Apache way. We are now doing a research trial with 30 White Mountain Apache youth whove attempted suicide to prove the effectiveness of this intervention. Second, we have adapted a life skills curriculum to be used in home outreach by Apache case managers with at-risk children and their families. This curriculum, originally called the American Indian Life Skills Curriculum, was previously designed for schools. We have found that many of our youth who are at risk do not regularly attend school. Nor are their families involved with their schools. The curriculum, which we have named, Re-Embracing Life, teaches conflict resolution, coping and problem-solving skills. It available mental health treatment on the reservation. We are planning a randomized controlled trial of this intervention in the near future, so we can prove its effectiveness. Third, we have trained and certified two Accountancy vacancies case managers to conduct ASIST gatekeeper training in our community. We as Apaches have renamed this intervention ASIST caretaker training. The training educates adults who work with at-risk youth to recognize signs of suicide and connect youth to Accountancy vacancies The Apaches are planning to culturally adapt the ASIST training to be more relevant to Native peoples. Fourth, we have developed an Elders advisory council. Our elders are focusing on promoting traditional protective factors. They are speaking in elementary and middle schools, and taking groups of at-risk and healthy kids on field trips to sacred sites. They are teaching youth about the core strengths of their Apache heritage. Elders and youth are also creating media campaigns to promote protective factors on our reservation. country.

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This is what we see everyday coming into our clinic. This also means that specialized treatment and care is called for along with the acknowledgment and respect for cultural, traditional, and spiritual practices that were outlawed thirty years ago prior to 1978s American Indian Freedom of Religion Act. Also prior to this, the 1975 Indian Child Welfare Act was passed which protected our tribal children from being erroneously removed from their homes and community. These acts took special legislation and acts of Congress to protect our tribal community and our most precious resource, our youth. As an American Indian raised in an Accountancy practices in uk and vacancies urban American Indian population in Grand Rapids, MI and also on my reservation in Mt. Pleasant, Michigan, I can tell you that in both respects, it Accountancy practices in uk and vacancies down to financial and people resources. Unmet needs are still very rampant today for the American Indian population who need access to substance abuse and mental health care that are appropriate for their level of needs. Often times in my experiences, the city, county, and state levels do not want to work cooperatively with the tribal governments and communities to ensure that we are able to access this care equitably. I thank you for allowing me to be here this morning. TESTIMONY OF NOVALENE GOKLISH, SENIOR PROGRAM COORDINATOR, WHITE MOUNTAIN APACHE Mr. Chairman and Members of the Committee, good morning. I am Novalene Goklish. I direct the suicide prevention efforts of my Tribe, the White Mountain Apache. Youth suicide is the single biggest human loss a family or community can experience, and it is destroying American Indian and Alaska Native communities. When you think of other behavioral health problems that affect youthdrug abuse, obesity, diabetes some believe our Indian communities tend to see what is to come for other US populations, unless interventions are developed to stop these tragedies. In the United States, suicide is the third leading cause of death for youth ages 15 Within the White Mountain Apache Tribe, our rates of death for this age group are 13 times the average, and 6 times the All Indian rate. In the, up to 500, 000 persons a year require Emergency Department care as a result of suicide attempt. In our reservation alone, with a population of 15, 500 tribal members, our local Indian Health Service hospital treats more than 200 youth a year for suicide attempts. The White Mountain Apaches are devastated but not broken by our problems of suicide. Rather, we see it as an obstacle we must overcome in order to share lessons with the world. We choose research as our tool. With the help of our long-time partners, Johns Hopkins Center for American Indian Health, we have tackled past health disparities by producing public health interventions that now save 3 to 5 million lives a year worldwide. Today, we are turning our research focus to a range of interventions to prevent youth suicide. We are designing this communities across our nation and our world. The Accountancy practices in uk and vacancies Mountain Apache Tribe, with technical support from Johns Hopkins, has developed the first tribally mandated suicide surveillance and follow-up system in the United States. In 2001, our Tribe mandated that all health and human service Accountancy practices in uk and vacancies and tribal members report suicidal behavior to a centralized suicide prevention task force.

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During my tenure as the Administrator and Clinical Director, the Saginaw Chippewa Indian Tribe has carried the burden financially for providing the Behavioral Health care for our tribe. The Saginaw Chippewa Indian Tribe is providing 66% of our operational budget in this current fiscal year which equates to roughly 9 million dollars. The Saginaw Chippewa Indian Tribe Behavioral Health Program during the last four years has provided over 8 million dollars to support Behavioral Health Services; this figure does not include any Indian Health Service funding. During the 2008 and 2009 fiscal years at any given time we had an average number of sixty tribal members waiting to receive services. The average waiting time to receive services once on the waiting list could be up to three months before they could receive any type of counseling services. The Saginaw Chippewa Indian Tribe made a decision to build a residential treatment center here on our reservation. The primary reason for this was so that our tribal community members could access this care without having to travel several hours, or out of state to receive Native American residential services. Distance to residential treatment provided a barrier for a lot of our tribal members to access services when needed. The closest Native American residential program was located over eight hours away, which made it virtually impossible for family members to participate in the treatment process. Since we have opened up our residential services we have provided care to over 250 Saginaw Chippewa Tribal Members. The residential treatment center operational costs are solely funded by the tribe. The majority of Native Americans receiving residential cares with us have had a combination of mental health and substance abuse disorders, known as co-occurring. Many of our tribal members have preferred to remain on our waiting list with our tribal services instead of seeking behavioral health services with other agencies and programs. During my employment with the Saginaw Chippewa Indian Tribe, barriers to providing appropriate behavioral health care in our tribal community have been; inadequate staffing levels, lack of available psychiatrist for adults and children, adult and child psychologist to see clients in need of specialized treatment and assessments, cultural competency, Native American staff, and funding. Other issues include inadequate prevention, education, and screening for early identification of youth or adults at risk for suicide. In order for these barriers to be addressed effectively adequate funding is needed. Many of our tribal community children are faced with enormous challenges that can be barriers to success in their lives. Higher prevalence of physical, emotional, sexual abuse and neglect are experienced by children and adolescents in our tribal communities. Our communitys children are more likely to experience a higher prevalence of substance abuse, domestic violence, mental illness, neglect and or have witnessed such before they reach the age of eighteen than any other racial ethnic group. Due to these higher rates of behavioral health issues roughly 40% of our clients we see are children and adolescence. The substance abuse and mental health issues we face and see in our community can be traced back to multigenerational trauma experienced by their parents, elders, and grandparents before them. A lot of the trauma can be traced directly to federal policies and practices like the Indian Boarding Schools. I am not surprised by this comparison which has gone severely unaddressed in tribal communities due to a lack of resources, funding, and staffing. Our tribal community has begun to address the mental health devastation that past federal government practices and policies have contributed to our people. Mental health issues we are addressing such as historical trauma, relocation, grief and loss, foster placement, physical, sexual, emotional, spiritual abuse, reactive attachment disorder, and trauma in tribal communities is enormous.

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Many suicide prevention programs incorporate initiatives to celebrate and preserve Native culture into their efforts, and these Accountancy job vacancy should play a role in helping to identify at-risk youth through screening. way to helping to expand mental health screening in the medical setting. The language recommended services without Accountancy job vacancy in benefit plans, which includes annual depression screening for adolescent youth ages 12 to However, we know that in clinical practice. Therefore, we must continue to work to raise the visibility of the need for mental health screening as we expand Accountancy job vacancy in multiple youth-serving settings. we are unable to connect them to necessary services. As we referenced earlier, the IHS suffers from a provider shortage for all types of providers, and child and adolescent psychiatrists are in short supply, not just in the IHS, but the system more generally. Furthermore, the rural and often isolated locations in which many American Indian and mental health providers. telemedicine services, including telepsychiatry. For example, the University of New Mexicos Center on Rural Mental Health has been providing telepsychiatry services, also referred to as tele-behavioral health services, to the Mescalero tribe and others in New Mexico. Through a contract with the IHS and the Accountancy job vacancy of New Mexico, the Center is able to offer patient diagnosis, treatment, and supervision services. The Center is also able to mental health providers, such as social workers. health services. The Methamphetamine and Suicide Prevention Initiative MSPI included funding to establish a National Tele-Behavioral Health Center of Excellence, health services. The American Recovery and Reinvestment Act of 2009 ARRA also Accountancy job vacancy funding to expand the infrastructure necessary to support telemedicine. Native youth. New grant moneys for telepsychiatry projects are included in the legislation, as well as provisions targeted toward addressing IHS workforce recruitment; improving rural health services; reducing health disparities; and expanding access to These are all steps in the right direction, but we remain far from being able to serve all youth who are in need of mental Accountancy job vacancy services adequately. We must continue to address the shortage of services through common-sense, proven approaches such as telemedicine. Thank you for the opportunity to testify. The TeenScreen National Center stands ready to serve as a resource, and I look forward to working with the members of this Ahnii, Giwesinini Ndihzinkaaz, Wabezhenshi dodem, Mt. Pleasant, MI ndojibaa. My name is Hunter Genia and I am the administrator for the Saginaw Chippewa Indian Tribe Behavioral Health Services in Mt. Pleasant, MI. , approximately one hour north of Lansing, our state capitol. The Saginaw Chippewa Indian Tribe behavioral health services provides mental health services to all eligible Native Americans of any federally recognized tribe residing in a five county district in the central lower peninsula of Michigan. The Saginaw Chippewa Tribe has over 3, 400 tribal members with Accountancy job vacancy 50% of our population being under the age of eighteen. I have been the administrator here for 4 years and prior to that, the mental health director of our program for six years. Upon my employment here we were an outpatient Accountancy job vacancy health, substance abuse, and prevention program providing clinical mental health services to over four hundred fifty open clients, with no residential services. In 2005, we opened up our own residential treatment center, funded solely by the Saginaw Chippewa Indian tribe.

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The most common cause is a lack of lubrication from inadequate arousal, medications, medical conditions, pregnancy, breastfeeding or menopause. Vaginal pain also can be caused by an inflammation of the vagina, known as vaginitis. Additional symptoms of vaginitis are a vaginal discharge, itching and burning of the vagina and vulva. It can be caused by a yeast or bacterial infection or a sexually transmitted disease. Vaginal pain also can be caused by vaginismus. This pain occurs when anything attempts to enter the vagina, including tampons or even during a pelvic examination. It can be caused by irritation from douches, spermicides or latex in condoms, infections, scars from an injury, childbirth, surgery or psychological problems from sexual trauma or abuse. Pain that is felt deep inside the vagina, lower back, pelvic area, uterus or bladder can be a sign of an internal medical problem. It can be caused by: endometriosis, a 2 sided outdoor no vacancy sign in which the tissue that lines the uterus grows outside the uterus bowel or bladder disease, such as interstitial cystitis If you are experiencing deep pain during sex, your health care professional may recommend a variety of tests including but not limited to blood tests, urine tests and scans to check for possible causes. Treatment for sexual dysfunction depends on the cause of the problem. If the cause is physical, medical treatment is aimed at correcting the underlying disorder. If the cause is psychological, treatment consists of counseling. Treatment can include a combination of medical and psychological approaches. Sometimes, treatment may be behavioral. For example, with loss of desire, changes in the environment, timing, lovemaking techniques or foreplay can produce desire. With arousal disorder, the use of toys and vibrators can help with vaginal circulation. A warm bath and a massage from your partner can also help. Lubricating creams, gels or suppositories If you are suffering from vaginal dryness caused by medications, a chronic condition or declining estrogen levels, your health care professional may suggest water-based, over-the counter vaginal lubricants such as Astroglide or K-Y Jelly to make sex more comfortable. Or you might try Replens, a long-acting vaginal moisturizer that releases purified water to produce a moist film over the vaginal tissue. Do not use oil-based products, such as petroleum jelly, baby oil or mineral oil with latex condoms because they can cause a condom to break. For menopausal women with vaginal thinning, dryness or insensitivity, your health care professional may prescribe an estrogen cream such as Estrace or Premarin, or a vaginal ring, such as Estring, Phadia low-dose or Femring higher dose, to ease sexual discomfort. And a vaginal tablet Vagifem containing estradiol, a type of estrogen, is available by prescription for vaginal dryness. Unlike creams, which usually are used at night, Vagifem can be inserted any time of day. For menopausal women, hormone therapy either a combination of estrogen and progestin or estrogen-only therapy may improve the sensitivity of the clitoris, ease discomfort caused by vaginal thinning and dryness and improve blood flow to the pelvic area. In addition, hormone therapy HT can help relieve other bothersome menopausal symptoms, including hot flashes, which can interfere with intimacy. A woman should not take any form of HT until she has weighed the pros and cons and discussed the risks and benefits with her doctor. Because of the potential risks that go along with HT, the Food and Drug Administration FDA now advises health care professionals to prescribe it at the lowest possible dose and for the shortest possible length of time to achieve treatment goals. Although HT can result in increased sensitivity and decreased discomfort during sex for menopausal women, the therapy may not improve sexual desire. Some health care professionals add testosterone, a hormone produced by the ovaries and adrenal glands that plays a role in sexual desire, to HT to stimulate sexual arousal. Treatment with testosterone is controversial, however. Estratest, an estrogen/testosterone combination, is currently the only testosterone treatment available. However, there is conflicting evidence and opinion in the medical community concerning whether or not the benefits of the drug outweigh the risks, which include increased risk of 2 sided outdoor no vacancy sign and endometrial cancer, adverse effects on blood cholesterol and liver toxicity. Studies on other androgen products used to treat sexual dysfunction have 2 sided outdoor no vacancy sign had mixed results. Although there is no FDA-approved form of testosterone available to treat womens sexual dysfunction, many doctors prescribe it off label in small amounts, particularly for women whose ovaries have been removed. Removing the ovaries drastically reduces testosterone levels, and some research shows that women who have had their ovaries removed are most likely to benefit from androgen therapy. Supplementing with testosterone has potential risks. In too high a dose, testosterone can produce masculinizing effects, such as increased facial hair and enlargement of the clitoris. The oral form can also produce liver damage, acne and a decrease in HDL cholesterol the good cholesterol. The use of testosterone in men and 2 sided outdoor no vacancy sign is highly controversial, so be sure to discuss with your health care professional whether androgen supplementation is right for you. The Eros Clitoral Therapy device is an FDA-approved device designed to treat female sexual arousal disorder.

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The screening team consisted of two school therapists who administered the screening questionnaire and provided clinical interviews, and a nurse practitioner who provided case management Accountancy england in job vacancy In addition, close consultation and of the students care and well-being was considered. youth screened reported suicidal ideation or a previous suicide attempt; 20 percent reported problems with substance abuse; and 19 percent reported symptoms of depression. Whitewolf and RIS counseling staff assisted youth at highest risk immediately, and provided follow-up assessments and treatment when necessary for all students who screened Accountancy england in job vacancy With such a large segment of the student population suffering from mental health and substance abuse problems, screening allowed the counseling team to provide triage evaluations to all students, and identify youth at highest risk, ensuring that cohort of students receives the critical care they need. Since his initial success in 2002, Mr. Whitewolf and colleagues routinely offer mental health screening to all new students at the beginning of each school year. The need of services, and the ability to assist each student both at school and when they return to their respective tribal community upon completion of the school year, Mr. Whitewolf has explained. In addition, he has stated that screening has allowed counseling staff to communicate more effectively with the medical unit on campus, creating a unique system that fosters better over-all care for RIS students. youth in Indian Country through mental health screening. Thousands of young people have received a screening, and hundreds have been connected to needed support services. More importantly, for many youth, the screenings serve as an opportunity to start a conversation about mental and emotional health. However, much as in medical settings, we cannot reach all Accountancy england in job vacancy people through these screening programs. Funding shortfalls often lead to the end of a screening program; when a grant runs out, the program stops. We also know that some of the most at-risk young people cannot be reached in a school setting. Mental illness is the leading cause of disability-related school dropout, and youth Accountancy england in job vacancy from mental illness are much more likely to leave school before graduation. In fact, a 2010 report from the University of California, Los Angeles UCLA Graduate School of Education and Information Studies Pacific and Northwest of the United States graduate from high school. In order to provide comprehensive services and reach as many Accountancy england in job vacancy youth as possible, it youth-serving settings where appropriate supports can be arranged. This may include, but is not necessarily limited to, medical, school and community settings. In American Indian and Native American communities, cultural programs can play an important role in promoting and providing access to mental health screening. screening and to build trust within the community.

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Prevention Project in Sacaton, Arizona. This program serves the Gila River Indian community, which includes a population of 14, 000 located on 372, 000 acres south of Phoenix. The Gila River grant-funded services include TeenScreen. screening to youth in Accountancy bristol in job vacancy within the region during the 2007-2008 school year. In the first year of screening, they were able to provide just 80 screenings, due to a low rate of parent consent. They also noted that a lack of good communication channels has made implementing large scale programs, such as TeenScreen, more challenging. With continued effort and by building trust in the community, the Gila River Regional the 2008-2009 school year, with a total of 455 youth screened. This was an increase of more than 400 percent, and the program has trained 11 teachers, counselors and staff at four sites to implement the TeenScreen program and promote its sustainability. Among students screened in the program, 87 youth Accountancy bristol in job vacancy 19 percent screened positive due to risk of suicide or need for early intervention services. All youth identified services and 13 were referred for non-mental health services, such as social support year, and the grant funding is currently authorized through September 20 Turtle Mountain Schools of Belcourt, North Dakota In 2002, Paul Dauphinais, , a practicing school psychologist employed by the Turtle Mountain Community School District, learned of the TeenScreen Program and decided to work to bring mental health screening to Turtle Mountain Schools. The schools are located in Belcourt, North Dakota and on the Turtle Mountain Chippewa Indian At the onset, Dr. Dauphinais knew that community support would be critical to the success of the screening program. By educating community members and giving presentations on the subject to key stakeholders, he was able to garner support from the Tribal Chairman, parents, school administration, and area treatment providers who would By 2004, Dr. Dauphinais developed a screening plan that would enable him to offer screening in Turtle Mountains middle and high schools. He developed and strengthened supporting the screening program. Eventually, his screening team was comprised of school personnel, Indian Health Service IHS clinicians, community treatment providers and one case manager, whose position was funded by a Safe and Healthy Students Grant. This position was first funded during the program development phase of the project, and has continued to be funded in each subsequent year. Coordination with IHS staff and clinicians provided a unique opportunity for collaboration, which benefited the families that both the schools and IHS exist to serve. The well-orchestrated screening program also ensured that no single system was overwhelmed with referrals at any given time, and that each youth and family, starting with the most critical cases, received appropriate referral services and case management. During the 2004-2005 school year, fewer than one hundred students participated in the program. Despite seeing lower numbers than the screening team anticipated, this first youth who required follow-up interviews and referral services. Over two hundred youth 225 total were invited to participate in the program during the 2005-2006 school year. One hundred twenty-five youth received parent consent and were Accountancy bristol in job vacancy Of those youth, 33 Accountancy bristol in job vacancy positive on the screening instrument, requiring a clinical interview with Unfortunately, personnel difficulties and a lack of funding resulted in a stalled program, they were no longer Accountancy bristol in job vacancy to provide screening, in 200 Riverside Indian School of Anadarko, Oklahoma located in Anadarko, Oklahoma. RIS is the largest Bureau of Indian Affairs boarding school in the United States, with an enrollment of 600 students in grades four through 12 and students from more than 100 different tribes across the United States. The student population is 100 percent American Indian. Accountancy bristol in job vacancy Whitewolf is a school therapist and counselor at RIS. Whitewolf provides mental health problems. He is an Oklahoma Licensed Behavioral Practitioner, and an Internationally Certified Alcohol/Drug Counselor. By 2002, Mr. Whitewolf was well into his tenure at RIS and witnessed first-hand the alarming rates of mental illness, substance abuse and suicide risk among his students. He felt that through his work at RIS, he and his colleagues could proactively identify youth who might be at the highest risk for suicide or other mental health concerns. problems that were not previously identified. Some youth were struggling with depression and suicidality; others were dealing with anxiety-related disorders, associated with separation from their family and friends, and learning to adjust to a new Mr. Whitewolf set out to identify a program or intervention that would enable the RIS counseling and medical staff to identify students in need of immediate intervention, as year. A colleague presented him with preliminary information about a new mental health checkup program being offered by Columbia University. After collecting information on the program and presenting it to the Director of Student Services, he was granted permission to bring the TeenScreen Program to RIS during the 2002 school year. Native Accountancy bristol in job vacancy have survived centuries of historical trauma and infirmity, Whitewolf says. Today, Native American youth face similar discord constructed by society such as violence, racism, substance abuse, and mental health problems. These problems impact youth in different ways, and may bring about a feeling of hopelessness or worthlessness. That is why Riverside Indian School implemented the Columbia University TeenScreen Program. The Program helps staff identify those students showing evidence of suicidal ideation, previous suicide attempts, possible mood disorder, as well In the programs first year, Mr. Whitewolf and the counseling team offered screening to the entire student body.

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Mental health screening, also referred to as a mental Account vacancies checkup, refers to the administration of a standardized, evidence-based mental health questionnaire, such as the PHQ-9A. These mental health screens include between nine and 35 questions and take five to 10 minutes to complete. The questionnaire is then scored to determine whether additional follow-up is necessary. It is important to note that a positive mental health screen is not a diagnosis of mental illness. Rather, a positive score on a mental health necessary. Whether provided in a school, community, or medical setting, the TeenScreen evaluation or treatment to interested youth and their families, who may accept or decline to receive services. In school and community settings, where a formal referral Account vacancies like those in many medical settings may not exist, Account vacancies steps to engage parents and assist them in linking to services are encouraged. thoughts of suicide, research published by Gould et al. in the Journal of the American screening. Inquiring about mental health status, suicidal ideation and previous suicide attempts does not increase distress or suicidal thoughts in youth. The research also found beneficial effects for depressed youth and previous suicide attempters post-screening. to discuss their mental and emotional concerns in a confidential setting. The importance of early detection, through screening of mental illness, has been well documented through medical research and by governmental entities. In 1999, the and Mental Health: A Account vacancies of the Surgeon General. These publications highlighted mental illness. In 2003, the Presidents New Freedom Commission on Mental Health recommended an increase in early identification efforts by primary care Account vacancies More recently, the Institute of Medicine IOM and National Research Council NRC, in their report Preventing Mental, Emotional, and Behavioral Disorders Among Young People: Progress and Possibilities, recommended that the federal government make preventing mental, emotional and behavioral disorders, and promoting mental health in young Account vacancies a national priority. Medical panels and professional groups have also recommended mental health screening for adolescents, including the United States Preventive Services Task Force USPSTF, the American Academy of Pediatrics AAP, the American Academy of Family Physicians AAFP, and the American Medical A mental health checkup using an evidence-based, standardized tool should be preventive care. We now know that in youth up to age 21 there is a window of opportunity of two to four years, between the first symptoms and the onset of the fullblown diagnosable disorder, when treatment is most effective at reducing the severity of However, we also know that primary care providers often rely on informal, unproven addressed at all. Further compounding the problem, many young people do not receive regular preventive care visits. This is especially true for American Indian and Alaska Native youth in rural settings, where the closest pediatrician may be several hours away. In fact, according to the AAP, the average number of well-child visits within the the last decade. As a consequence, it is important to incorporate mental health screening into a wider array of youth serving programs, such as those offered in school and community-based settings. method of addressing youth suicide. The TeenScreen Schools and Communities Account vacancies Prevention Resource Center SPRC. The program is also included in the SAMHSA National Registry of Evidence Based Programs and Practices NREPP. mental health screening and referral to youth in Indian Country. Together, these programs have offered mental health screening to thousands of young people. I would like to highlight a few of these programs. their suicide prevention efforts. Signed into law on October 21, 2004, the Garrett Lee implement statewide/tribal suicide prevention plans. In all, at least 13 grantees in 12 states have incorporated TeenScreen into their suicide prevention programs, including both campus and state/tribal Account vacancies

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The fatality is mainly by suicide. Culturally sensitive but sustained efforts with multiple approaches offer our best hope to get students into treatments. Obviously, if there is a shortage of treatment resources, than dollars need to be allocated to develop innovative new treatments for Native American youths. We must reduce this fatal outcome. The American Foundation for Suicide Prevention is ready and willing to offer our expertise and advice to this Committee and to all members of Congress as you make the important decisions on how to reduce suicide in the Indian nations. I will be happy to answer any questions you and your colleagues might have. Thank you. Good morning Chairman Dorgan, Ranking Member Barrasso, and members of the Committee. I am honored to appear before you today to present testimony about the tragic and ongoing problem of youth suicide in Indian Country. My name is Laurie Checkups at Columbia University. I have served in this capacity since January 2001, and as a routine procedure for adolescents in health care, schools, and other youth-serving settings. From our beginning, we have provided tools, training and technical assistance at no cost, and we now support mental health screening in more than 900 sites in 43 states, including tribal settings. We are fortunate to be funded by a generous family foundation. Our benefactors share serious Account manager vacancy in yorkshire health problems on adolescents and their families. As a parent whose oldest daughter made a very serious suicide attempt at age 17, I can understand the challenge in the United States. Suicide is the third leading cause of death for all youth 11 to 21 years of age, and it accounts for approximately 12 percent of all deaths in this age group. As alarming as these statistics are, we know that the problem is much worse among American Indian and Alaska Native youth. The suicide rate for American Indian and Alaska Native youth is almost twice that of young people generally, and suicide is the second leading cause of death among 15 to 34 year olds in Account manager vacancy in yorkshire populations. Unfortunately, suicide rates do not capture the full extent of the problem. According to data cited by the Centers for Account manager vacancy in yorkshire Control and Prevention CDC, there are people 15 to 24 years of age. Among American Indian and Alaska Native youth attending Bureau of Indian Affairs schools, a 2001 Youth Risk Behavior Survey found that 16 percent had Account manager vacancy in yorkshire suicide in the preceding 12 months. suicide among American Indian and Alaska Native youth, we are still not doing enough to identify and assist young people suffering from depression and mental illness. preceding their death. Yet, according to the Substance Abuse and Mental Health have never received treatment from a mental health provider. Once again, the picture is even worse in tribal communities, with even fewer individuals receiving treatment. shortfalls in funding for the Indian Health Account manager vacancy in yorkshire IHS, provider shortages, and the difficulty of providing services in rural, isolated locations. Each year, funding shortfalls within IHS limit referrals for medically necessary contracted health services. The vacancy rate for physicians in the IHS is approximately 20 percent, and 27 percent of the IHS workforce nearly one-third will be eligible for retirement in 20 And the Account manager vacancy in yorkshire Despite these challenges, there are effective and efficient ways to improve the early identification and treatment of mental illness and reduce needless deaths by suicide. Mental health screening can identify Account manager vacancy in yorkshire most at risk and provide intervention early, when it is most effective.