Using Native Values and Strengths to Help People Heal

Victor Joseph became a Robert Wood Johnson Foundation Community Health Leader in 2001. The Foundation selected him for leading an innovative drug and alcohol addiction recovery program that combines the best of Western science with Alaska Native values and traditions. Today, as director of the Health Services Division for the Tanana Chiefs Conference, Joseph works to expand access to health care for some 26 communities spread over 180,000 square miles in the interior of Alaska.

The problem. Alaska Natives suffer disproportionately from a range of chronic illnesses. High on the list is drug and alcohol abuse, a complex problem that some researchers believe stems in part from cultural and economic changes that have undermined the Native way of life. How could the use of traditional tribal values and strengths promote greater well-being for Alaska Natives struggling with addictions and other illnesses?

Leader’s background. Victor Joseph was born in Anchorage and raised in Fairbanks, but his family traces its roots to Tanana Village, a tiny tribal community near where the Tanana and Yukon Rivers meet.

His mother and grandparents instilled in him the value of hard work, Joseph says—“never say you can’t” were his mother’s bywords. Those words became a comfort and a guide when in 1985 Joseph began in earnest to get sober after years of drug and alcohol abuse.

“There was a lot of dysfunction happening in my world at that time,” Joseph recalls, and his first few attempts at recovery ended in relapse. He recalls a moment sitting on the couch in his mother’s home when “I knew a decision had to be made. I wanted to be healthy, and I knew that when I used drugs I was unhealthy.”

Getting back in touch with his identity as an Alaskan Native man helped him give up substances for good. He learned the traditional Native skills of hunting and fishing, which brought him closer to the land and to his heritage. And his grandfather taught him how to put on a potlatch—an important ceremonial gathering of family and members of his larger Athabascan tribe.

Leading the Old Minto Recovery Camp. Joseph wanted to pass on what had worked for him to other Alaska Natives struggling with addiction. In 1990, he took over the leadership of Old Minto Family Recovery Camp, an Athabascan alternative to substance abuse treatment.

Located 40 miles west of Fairbanks on the Tanana River, the camp is accessible only by boat, plane, dog sled, or snowmobile. Clients and family members spend 35 days at Old Minto, living in cabins heated by wood stoves and lit by kerosene lamps. There is no indoor plumbing and no electricity. The program’s emphasis on subsistence living and traditional hunting and gathering provides families and individuals with the skills to live healthy, substance-free lives within their own communities.

Several generations of family members and other tribal members often become involved in the recovery process at Old Minto. “The Native family is not only your immediate family members,” Joseph says, “it is basically the whole tribe.... We are feeding back into the value of the way our people used to be. We always had to work in a group and be unified to survive. Part of this environment is how do you deal with 60-below temperatures when you are low on wood and that is your only heat source? How are you going to get that wood?”

Over the years, Joseph has fine-tuned the Old Minto program, adding other modalities from Western substance abuse recovery programs, including formal groups that take clients through the stages of recovery—“so that people could understand what was going on with them in their mind and body.” In 2005, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) recognized Old Minto Recovery Camp as an example of a “best practice” substance abuse treatment program for Native populations.

Becoming a Community Health Leader. In 2001, RWJF named Joseph an RWJF Community Health Leader in recognition of his work with the Old Minto Recovery Camp. Joseph used part of the award to expand follow-up care for people graduating from the program. For more on the program, read the Program Results Report.

The recognition of the Community Health Leader award “helped my self-image and my understanding of what I had actually accomplished,” Joseph says. “When you’re in it, it becomes day-to-day stuff to you. It is helpful when someone from the outside says, ‘Wow.’”

The award also got Joseph thinking about what more he could achieve for his people. “It created questions for me,” Joseph recalls. “What’s next? What will be my legacy here?“

The answers to those questions came much sooner than Joseph anticipated. In 2003, the Cook Inlet Tribal Council asked him to run substance programs in Anchorage. Then in 2005, he returned to Fairbanks to become deputy health director of the Health Services Division for Tanana Chiefs Conference—a position he expected to hold for about five years in order to polish his managerial skills. Instead, he was quickly promoted to health director, first in an acting capacity and then as a permanent appointment.

Expanding health care and access. The Health Services Division, which cares for some 26 tribal communities that stretch across the state’s vast interior, faced serious challenges when Joseph became its permanent health director in 2007. A deficit of several million dollars and layoffs of 22 health staff meant patients were waiting up to wait three months for a medical appointment. Regular dental appointments involved an 18-month wait.

“We were having to outsource more of the care than we wanted to,” Joseph recalls. “That was money going out and not money coming in, and when you have that happening, it is impossible to expand care.”

Beyond that, the location of the health clinics was not meeting the communities’ needs. Services were scattered across Fairbanks, with the main clinic in one location, and behavioral health, dental, and optical services elsewhere. “Our tribal population has a high unemployment rate...and they don’t have the financial capability to come to Fairbanks and take cabs all over,” Joseph said. “We needed to help our tribal members access care.”

He began by leading an effort to improve the health center’s business practices, which increased third-party revenues by 110 percent over five years. The clinic also adopted a patient-centered care model and by 2012, the wait time for a primary care doctor’s appointment averaged three days. By renovating the dental department and adding three more dental chairs, the center was able to shave six months off the long wait for appointments.

The culmination of the health care expansion came in December 2012, when Tanana Chiefs Conference opened a new 95,000 square foot state-of-the-art health facility in Fairbanks, bringing all of its services together under one roof. Chief Andrew Isaac Health Center, named after a beloved tribal leader, blends the history of the Athabascan lands and culture with modern medicine.

A river design theme runs through the center, with river stone inlays at the entrance and winding walkways mimicking the rivers of interior Alaska. Islands of tables, chairs, and benches provide comfortable places for people to gather. True to tribal family values, the new design includes not only exam suites, but “talking rooms” where a patient, family members, and friends can meet with a provider to discuss treatment options.

Patients living in rural areas now benefit from technology that enables them to access care through videoconferencing. “Some patients are even receiving cardiology services in their own villages,” Joseph wrote in a newsletter announcing the new center. “Gone are the days when people must travel into Fairbanks and beyond for advanced health care.”

A lease arrangement with the federal Indian Health Service paid for the construction and includes funds for staffing—a key component in the center’s plans to expand care. The U.S. Congress must appropriate continued funds, and in early 2013, Joseph made several trips to Washington to educate key congressional leaders about the importance of health care for Alaska Natives.

New projects for addiction recovery. With the opening of the new health center, Joseph is now applying his management skills to new endeavors. His next step is Housing First, a model program in Fairbanks that provides stable, supportive housing for homeless people with mental illness or chronic addictions. Tenants are responsible for paying 30 percent of the rent, with the remaining 70 percent paid through housing vouchers or other sources.

The program operates under the belief that, once housed, tenants are better able to address their underlying disorders, thereby easing public costs for crisis emergency services. In 2012, an evaluator documented some $700,000 in savings over 10 months for 10 tenants of the Housing First program (based on what the city did not have to spend on ER visits, detox visits, police contact, and community service patrol pick-ups).

RWJF perspective. RWJF recognized the first 10 Community Health Leaders in 1993. They are unsung and inspiring individuals who work in their communities—often among the most disenfranchised populations—to address some of the nation’s most intractable health care problems. The formal recognition of these Robert Wood Johnson Foundation Community Health Leaders and their work often launches them to greater levels of influence and extends their reach to serve more populations that are vulnerable. See the Program Results Report for more information on the program.

Under the Community Health Leaders program, each year RWJF has provided a $125,000 award to 10 individuals and their organizations ($105,000 supports a project at the organization, and $20,000 goes directly to the leader for personal development). RWJF has also connected the Community Health Leaders with one another so they can build their programs upon the wisdom and experience of their peers and previous award winners.

Community Health Leaders are characterized by three specific traits—they are courageous, they are creative, and they are committed,” says National Program Director Janice Ford-Griffin. "The Foundation recognizes the tremendous resource of experiences among the leaders, and we look forward to mining that resource as we consider future initiatives."

“Through the Robert Wood Johnson Foundation Community Health Leaders award, we at the Foundation have the opportunity to recognize innovative and courageous local leaders behind groundbreaking efforts in communities across the United States,” said Sallie George, MPH, a program officer at RWJF. “These individuals remind us that one person can have a powerful impact on health and health care within their communities.”

The most recent round of leaders was chosen in the fall of 2012.