1. Developing and Providing a Complementary and/or Alternative Therapy for Native
American Combat Veterans in Need of Mental Health Treatment
The White Eagle Health Center’s (WEHC) Behavioral Health Clinic (BHC) in
partnership with the Oklahoma State University (OSU) Graduate Counseling Program,
Northwestern Oklahoma State University (NWOSU) Graduate Counseling Program,
and the Americana Legion Post 38 also known as the Buffalo American Legion Post, the
members of which are all Native American, will use the poly-com systems of the WEHC
and OSU,to deliver a behavioral health service which is currently unavailable to Native
American combat Veterans in North Central Oklahoma. The project will utilize multiple
methods of delivery including current and emerging techniques.
Problem: The proposed project will address three problem areas: (1) a lack of alternate
treatment modalities specific to NA combat Veterans; (2) a lack of resources and services
specific to NA combat Veteran’s families; and (3) a lack of licensed and trained NA
professionals to deliver the services.
Need: The WEHC is the only tribal entity in the Oklahoma Area Indian Health Services’
(IHS) catchment area in North Central Oklahoma staffed with a licensed psychologist.
The psychologist provides a vast realm of services to NA people eligible for services
inclusive of individual therapy, group therapy, psychological evaluations, substance
abuse evaluations, training of graduate students affiliated with local universities (OSU
and NWOSU) and an on-line university (Capella University). The referrals for these
various services are received not only from the Ponca Tribal programs such as the WEHC
Medical clinic, the Head Start, Domestic Violence, the Social Development Center (a
residential treatment center for substance abuse), the Indian Child Welfare program, but
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2. they are also received from other tribal programs of the various tribal entities in the
surrounding area such as the Tonkawa, Pawnee, Kaw, and Otoe-Missouria. Referrals for
psychological evaluations and subsequent written reports are also received from the
Ponca City Public Schools, Frontier Public Schools, Kay County Juvenile Court, Kay
County Court for Adults, local attorneys serving NA populations, and physicians outside
of the WEHC clinic. The service area is predominantly rural. The Ponca Tribe of
Oklahoma is a federally recognized Indian tribe governed by its own constitution since
1950. The number of enrolled members is currently 3,605. The U.S. Census (2010)
indicated that approximately 3,271 (12.9%) Native American people reside within the
Ponca tribal jurisdiction. Of this number, approximately 700 are below the age of
eighteen, with approximately 1,600 ages eighteen or above, 96% claim one race (NA). A
community assessment completed by the Ponca tribal planning department in 2008
indicated an unemployment rate of 40% and also indicated that 41% of households were
single-parent families. According to the Oklahoma Kids Count agency, 100% of Ponca
Tribal youth participate in the free/reduced cost lunch program. This is a gauge for the
poverty level of this area. The number of NA combat Veterans residing in the Ponca tribe
service area is unknown. A recent article written and published by the Center for Health
Reporting (http://centerforhealthreporting.org/article/war-leaves-ptsd-scars-native-
american-
vets906) reported that nearly 30% of the nation’s 22 million Veterans live in rural areas
and for Native American Veterans the rural population is much higher. Only about 10%
of psychologists and psychiatrists and 20% of masters-level social workers or counselors,
practice in rural areas, according to the National Organization of State Officer of Rural
Health. Thus, the need for additional NA service providers inclusive of masters-level
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3. counselors and a psychologist to serve the NA Veterans and their families is
substantial. The current psychologist, whom is NA, is trained to provide Complementary
and Alternative Methods of treatment such as evidence-based Cognitive Processing
Therapy (CPT) as she had previously been employed by a local VA Medical Center and
utilized the tele-mental health services to not only provide CPT but also to train a VA
social worker in the use of tele-mental health to deliver the CPT. Although the current
psychologist has the ability and the capacity to deliver the service via tele-mental health,
a major gap will be created in the tribe’s behavioral health clinic’s ability to provide the
psychological evaluation services for the remaining population of NA whom are
currently in dire need of these services as the focus becomes geared to providing the
proposed services. There will be a need to hire a part-time psychological examiner to fill
this gap.
Several studies have been conducted on the need for utilizing tele-mental health for
Combat Veterans (Godleski, Nieves, Darkins, Lehmann, 2008; Nieves, Camdeiario,
Short & Briscoe, 2009) and their families (Dausch, Miklowitz, Nagamoto,
Adler, & Shore, 2009), in general (Darkins, 2001; Grady, Myers, Nelson, Belz, Bennett,
Carnahan, et al, 2011); and more specifically, tele-mental health services for Veterans in
rural areas(Grady & Melcer, 2005; Rabbinowitz, Brennan, Chumbler, Kobb, &
Yellowlees, 2008), to reach returning and retired combat Veterans
and their families who may not have easy access to Veteran’s Health Administration
facilities. In addition, the United States Department of Veteran Affairs has conducted
studies on the need for Complementary and/or Alternative Medicine ( Libby, Pilver, &
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4. Desai, 2012; Smith, Ryan, Smith, Reed, Riddle, Gumbs, & Gray, 2007; Williams,
Gierisch, McDuffie, & Strauss, 2011).
Vision, Objectives, and Activities
Vision: To continue to develop a collaborative relationship between the WEHC BHC,
OSU counseling program, NWOSU counseling program, and the American Legion Post
38 to implement, and evaluate a complementary and/or alternative modality of treatment
that will be accessible for NA combat Veterans and their families. To be able to
simultaneously train NA counselors and/or interested non-Native counselors on the use of
tele-mental health modality, Cognitive Processing Therapy, and a curriculum geared
specifically to the combat Veterans, Coming Home: A Warrior’s Guide. After
implementation of the service, disseminate information regarding the outcomes achieved
in the delivering of the service to the Ponca Tribal Council, the Indian Health Service,
Oklahoma State University, Northwestern Oklahoma State University, and the American
Legion Post 38.
Objectives:
1. To continue to develop a collaborative relationship between the WEHC BHC,
OSU counseling program, NWOSU counseling program, and the American
Legion Post 38 to allow for a unique population to be served.
2. To utilize a comprehensive, integrated and culturally aligned curriculum to
improve access to mental health services and treatment outcomes for NA combat
Veterans and their families.
3. To align and articulate a comprehensive curriculum with NA counselors and
graduate-students-in-training.
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5. 4. To implement the comprehensive, integrated and articulated curriculum into
treatment modalities for NA combat Veterans and their families via the WEHC
poly com system.
5. Evaluate the impact of the curriculum and use of the tele-mental health modality
of treatment upon the mental health of NA combat Veterans and their families.
6. To disseminate information regarding the outcomes in delivering the service to
the Ponca Tribal Council, IHS, OSU counseling program, NWOSU counseling
program, American Legion Post 38, electronic or print newsletters, State,
Regional and National Conferences.
Activities:
Information Activities: Discuss and present to OSU and NWOSU counseling program
administrators, tribal entities inclusive of the tribal council, community organizations,
civic organizations about the benefits of developing professional relationships and
implementing evidenced-based complementary and/or alternative mental health
treatments for NA combat Veterans and their families.
Leadership Activities: Each grant year identify and recruit two to three cohorts (NA
counselors and/or psychologists-in-training or interested non-Native counselors/or
psychologists-in-training) from each of the institutes of higher education, OSU and
NWOSU, who are committed to training in a facility that provides mental health services
to NA people. Each successive year, the incoming cohort of students along with the
Psychologist(s) will review the evaluation information from the previous year and will
make modifications if needed.
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6. Training and Planning Activities: (1) Provide counselors, newly hired professional
staff, and graduate-students-in-training the use of the poly com system for the delivering
of tele-mental health services; (2) Provide counselors, newly hired professional staff, and
graduate-students-in-training use of the various evidence-based treatment models to be
utilized such as CPT and Coming Home: A Warrior’s Guide; and, (3) Provide counselors,
newly hired professional staff, and graduate-students-in-training with continued support
for their individual training requirements of their universities.
Disseminating Activities: (1) Provide partners the opportunity to interact, share, and to
promote community coherence and connections between and among all cohort groups
through on-going meetings, workshops, and conferences that focus on sharing successful
implementation strategies and networking with partners in all other cohort groups;
(2) Provide regional, State, and Federal entities with requested information regarding the
evaluation and outcomes of the program; and, (3) Partners will design and implement
locally conducted symposia and seminars; publish articles and present papers at
conferences to disseminate successful development and implementation strategies and
evaluation data.
Administration: The WEHC’s BHC will serve as the primary applicant and grant
recipient. Daily administrative management operations of the project as well as
curriculum coordination of the project goals and objectives are the primary
responsibilities of the Project Director, Dr. Lahoma Schultz, WEHC Behavioral Health
Clinic Director. Jake Roberts, Licensed Professional Counselor (LPC) and NA tribal
member; Candice Kemble, Licensed Professional Counselor (LPC) candidate and NA
tribal member; and Jennifer Inciarte, Licensed Marriage and Family Therapist (LMFT)
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7. and Sergeant in the U.S. Army Reserves (served in Afghanistan) will serve as Co-
Directors of the project. Together, the project co-directors have over 11 years of training
and working in the mental health field. The Project Director will primarily be
responsible for (1) the daily operations of the project; (2) recruitment of participants for
the project; (3) hiring and coordinating the administrative assistant; (4) assisting with the
curriculum for the project; (5) coordinating the schedule of events and activities; (6)
planning and implementing the evaluation component of the project; (7) supervising the
follow-up components; and, (8) completing all reports and paper work associated with
the implementation of the project. The Project Co-Directors will be responsible for
assisting the Project Director in (1) setting up the poly com system for each treatment
session;; (2) facilitating the treatment curriculum; (3) inputting required appointments
and notes into the Electronic Health Records (EHR) system; (4) facilitating evaluation of
the project; and (5) dissemination of project information.
Dr. Carrie Winterowd, Training Director for the OSU counseling program masters-level
graduate students, Dr. Julie Koch, Training Director for the OSU counseling program
doctorate-level graduate students, and Leigh Kirby, Training Director for the
NWOSU counseling program masters-level graduate students, will serve as the site
administrators for the project. They will lend support to the project by coordinating
student placements for training at the WEHC BHC. Mr. Pete Buffalohead, Commander
of the American Legion Post 38 will serve to assist in recruiting NA Veterans to
participate in treatment.
Evaluation: Both qualitative and quantitative data will be obtained from the project
participants, students-in-training, and group facilitators relevant for the evaluation plan
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8. for the project. Formative and summative evaluation procedures will be employed
throughout the duration of the project including the follow-up. Data from the evaluations
will be used to inform revision decisions and the implementation of future needs of the
project. Summative evaluations will be conducted each year and at the end of the three-
year period. Data will be collected from program participants and administrators of the
participating institutions to determine how the curriculum and treatment modalities
impacted the mental health of the NA combat Veterans and their families. The data
collected for the formative evaluation will focus on continued improvement,
dissemination, and implementation. Improvements to participants’ mental health will be a
continuous focus for gauging the success of the project throughout the three-year project.
Anticipated outcomes for the project include the following:
(1) Increased positive attitudes of participants toward mental health services.
(2) Removal of stigmatization associated with seeking mental health services.
(3) Demonstrated knowledge by professional staff and students-in-training of the use
of the poly com system used to deliver tele-mental health services.
(4) Demonstrated knowledge by professional staff and students-in-training of the use
(5) of Complementary and/or Alternate Methods of treatment with NA combat
Veterans and their families.
(6) Increased awareness by the community of viable mental services that are
available for NA combat Veterans and their families.
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9. References
Darkins, A. W. (2001). Telemedicine grows throughout VHA. Telemedicine News,
April, Vol. 1 (1).
Dausch, B.M., Miklowitz, D.J., Nagamoto, H.T., Adler, L.E.,& Shore, J.H. (2009).
Family-focused therapy via videoconferencing. Journal of Telemed Telecare,
15 (4): 211-4.
Freed, D. ( 2012). War leaves PTSD scars on Native American vets. Center for Health
Reporting, May. Retrieved on 02/23/2014
http://centerforhealthreporting.org/article/war-leaves-ptsd-scars-native-american-
Godleski, L., Nieves, J.E., Darkins, A. & Lehman, L. (2006). VA telemental health
suicide assessment. National Frontier and Rural ATTC Telehealth Foundation
Presentation (ppt).
Grady, B.J., Melcer, T. (2005). A retrospective evaluation of TeleMental Healthcare
services for female military populations. Telemedicine Jounral and e-Health, October,
11 (5): 551-8.
Libby, D.J., Pilver, C.E., & Desai, R. (2012). Complementary and alternative medicine
in
VA specialized PTSD treatment programs. Psychiatryonline.org, November,
Vol. 63 (11).
Rabinowitz, T., Brennan, D., Cumbler, N., Kobb, R., & Yellowlees, P. (2008). New
directions for telemental health research. Telemedicine Journal and E-Health.
November, 14 (9): 972-6.
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10. References (continued)
Smith, T.C., Ryan, M. A., Smith, B., Reed, R.J., Riddle, J.R., Gumbs, G.R., & Gray, G.C.
(2007). Complementary and alternative medicine use among US Navy and Marine
Corps personnel. BMC Complementary and Alternative Medicine, 7:16.
U.S. Census Bureau American Fact Finder (2010). Demographic profile data for Ponca
City, OK. Retrieved on 02/23/2014
http://factfinder2.census.gov/faces/tableservices/jsf/pages//productview
Williams, J.W., Jr., Gierisch, J.M., McDuffie, J., and Strauss, J.L. (2011). An overview of
complementary and alternative medicine therapies for anxiety and depressive
disorders. Supplement to Efficacy of Complementary and Alternative Medicine
Therapies for Post-Traumatic Stress Disorder. VA-ESP Project #09-010; 2011.
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11. White Eagle Health Center/Ponca Tribe of Oklahoma – Native American Veterans
Mental Health Treatment Budget for National Prevention Partnership Awards
Project Budget
Line Items Requested NPPA Total Project Budget
1/ Salaries/Personnel
Project Director (50%) $43,250.00 $43,250.00
Benefits/Fringe 25% 10,813.00 10,813.00
Project Co-Director (25%) 12,000.00 12,000.00
Benefits/Fringe 25% 3,000.00 3,000.00
Project Co-Director (100%) 30,000.00 30,000.00
Benefits/Fringe 25% 7,500.00 7,500.00
Project Co-Director (100%) 30,000.00 30,000.00
Benefits/Fringe 25% 7,500.00 7,500.00
Administrative Assistant 18,000.00 18,000.00
Benefits/Fringe 25% 4,700.00 4,700.00
2/ Travel
Local Mileage 2,400.00 2,400.00
Conferences/Symposiums 10,000.00 10,000.00
3/ Program Supplies/Equipment
Computer 1,600.00 1,600.00
Printer 400.00 400.00
Paper 2,000.00 2,000.00
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13. White Eagle Health Center/Ponca Tribe of Oklahoma/NPPA Project - Budget Page 2
Budget Narrative Justification:
1// Personnel – Project Director – individual’s base salary is $93,000 per year plus
fringe benefits of 25% ($23,250) and this individual is devoting 50% of her time to this
project. The Project Director will be responsible for the daily operations of the project,
recruitment of project participants, hiring staff, planning and implementing the evaluation
components of the project, and completing all reports associated with the implementation
of the project. Co-Project Director (3) – one individual’s current base salary is $48,000
per year plus fringe benefits of 25% ($12,000) and this individual is devoting 25% of his
time to this project. Two additional Co-Project Directors will be hired at a base salary of
$30,000 per year plus fringe benefits of 25% ($7,500) and they will each devote 100% of
their time to this project. The Project Co-Directors will primarily be responsible for
setting up the poly-com system for each session, facilitating treatment curriculum,
inputting progress notes into the EHR system, facilitating evaluation of the project, and
disseminating project information. An Administrative Assistant will be hired to
schedule and monitor appointments for the staff, input appointments into the EHR
system, ensure that No Shows and Cancellation of appointments are entered into the EHR
system. This person will be proficient in the use of computer inclusive of Microsoft
Word, Excel, and the Electronic Health Record system. This person will also be
responsible for answering phone calls and taking messages in an appropriate manner.
This person will be responsible for ensuring that staff members are made aware of phone
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14. messages directly after receiving the message(s). This person will be responsible for
additional clerical duties as needed as the project develops. This person will be
responsible for ensuring that clients are greeted and treated in a dignified and caring
manner. The salary per year for this position will be $18,00 plus fringe benefits of 25%
($4,700) per year.
2/ Travel Local mileage is estimated at $100 per week to visit the various partners
committed to the implementation of the project. The OSU partner is approximately 60
miles (round trip) in distance from the WEHC BHC and the NWOSU partner is 120
miles (round trip) in distance from the clinic. Mileage logs will be kept and destinations
will be documented. Travel to a national conference such as the annual National IHS
conference is estimated to cover travel costs for the Project Director and the three
Co-Directors ($2,500 x 4 = $10,000) per year.
3/ Program Supplies/Equipment – A computer and printer that are compatible with the
IHS network will be needed for the Administrative Assistant. Replacement cartridges
estimated at a yearly cost of $1,200 will be needed for the printer. This will be a one-time
cost over the three-year period.The curriculum, Coming Home: A Warrior’s Guide, cost
$6.25 x 100 = $625 per year. Postage will be utilized to disseminate via U. S. mail
service information regarding the mental health services and other information necessary
to the project.
4/ Other Costs – Consultant and Psychological Examiner – the Commander of American
Legion Post 38 will be paid a small stipend ($3,600) each year for his consultation
services to help in recruitment of participants. A part-time psychological examiner will
be paid a stipend of $40 per hour for each 40 hours of work completed toward the
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15. completion of psychological evaluations that may be requested by various entities to
close the gap that will be created as the Project Director/Psychologist devotes an
increased amount of time to the NPPA project; thus, lessening the time available to
conduct psychological evaluations, score the evaluations, analyze the results, write a
report of findings and meet with the client to review the results. This cost is per each year
of the project.
5/ Indirect Costs – this line item cost will be used to pay for services such as Information
Technology support, conference room, and maintenance. These are services not
directly related to the day to day operations of the project.
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