• persistence of Tribal leaders and concerned Navajo leaders and community members;
  • training and education of younger Navajo community members to participate actively in the administration and operation of a complex research endeavor;
  • collaboration of Dr. Phillip May, a researcher with two decades of research experience with substance abuse among Native American people (see for example, May, 1992; May and Dizmang, 1974);
  • the interest and flexibility of government officials in working with the tribe and local academics to bring about a funded project; and
  • the capability to undertake convincing research across languages and cultures in a largely rural population, many of whom were unfamiliar with research methods or suspicious of the uses to which research might be put.

Academicians, Navajo leaders, and Navajo collaborators in the research project had to cooperate in a variety of complex tasks to establish a state-of-the-art-and-science project. For example, materials had to be translated into Navajo using a standard, yet time-consuming and costly method of initial translation, back-translation, pilot study, renorming and restandardizing, and final acceptance (Brislin, 1986).

Negotiations regarding data access were also important. Data that might result from such a study has the potential for embarrassing tribal officials, leaders, or members at large, while reputable researchers engage in such projects to foster the expansion of knowledge and understanding. Funding organizations wanted assurances that the findings would benefit the people for whom the project was intended, and not languish unused because they were unpalatable to one of the parties involved. After these issues were worked out to each party's satisfaction, projects were undertaken.

Drug Outcome Monitoring System

Two large community-based drug abuse treatment providers in Illinois designed and implemented a performance measurement system to monitor client outcomes and enhance their accountability with purchasers and consumers. Chestnut Health Systems and Interventions, operating 49 facilities, collaborated on a field trial of the Drug Outcome Monitoring System (DOMS). Clinical records, administrative information, and service utilization data are integrated and used for quality improvement and outcome monitoring initiatives. The system includes an assessment tool (Global Appraisal of Individual Needs—GAIN) that facilitates a diagnosis based on



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