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25 th Annual Native Health Research Conference June 2014 Urban American Indian Elders Sharing Stories of Resilience

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Documenting and Promoting Stories of Resilience Among Urban American Indians Elders Pilot project funded by the Center for American Indian Resilience National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number P20MD006872 Partnership between University of Arizona and Tucson Indian Center

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Team Members Agnes Attakai and Kerstin M. Reinschmidt (Co-PI) Carmella Kahn-Thornbrugh (UA) Shannon Whitewater (UA) Tara Chico (UA) Marlene Jose (TIC) Phoebe Mills (TIC) Nolando Neswood (elder) Kathryn Foster (elder) Nicolette Teufel-Shone (PI- CAIR)

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CBPR Principles Tucson Indian Center-UA co-designed project Research process with elders Community Advisory Board

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Goal The purpose this qualitative pilot research project was to document and develop a youth health promotion curriculum on native elders stories of resilience. Methods Develop questionnaire based on literature Test with elders and revise Recruit 15 elder for interviews Video tape, audio tape and transcribe Code using NVIVO Develop curriculum Test, revise and finalize

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Elder Interviews 11 females, 2 males; age 55+ 1-3 hour duration; video/voice recorded Stories edited 2 nd interview to review digital story

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Analysis Process Combined consensus and thematic analysis Consensus approach to develop thematic codes NVIVO coding Coded texts shared with team for curriculum design Complete analysis and interpretation (CAB) Team consensus of final analysis

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Thematic Codes Used in NVIVO THEMESPATTERNS HISTORICAL TRAUMA Native ConceptsOppression, assimilation, fear Sense of Loss Boarding school, broken families, loss of language, loss of tradition, removal from family, removal from land, yearning Adversities Alcoholism/drugs, discrimination, generational gap, ill health, living conditions, loss of family members, lost voice, violence RESILIENCE Native ConceptsSurvival, life, get through hard times, bounce back, better myself IndividualKnow roots, participation, practicing spirituality, responsibility, strength, volunteerism Family Family members as role models, growing up, positive family relations, safe environment for kids, teaching kids Community Culture/traditions/language, economic development, TIC, other community resources, sharing stories, sovereignty, spirituality, traditional land use YouthActivities, education, get elders and youth together, know roots/know history HealthHealth now, health then, health of youth, strategies for health Strategies Non-Native Support and Connection Personal Story

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Historical Trauma Events of the past led to Loss of language, traditions and culture Disruption of family life Contemporary adversities as continuation past events Alcoholism/drugs Discrimination Loss of family members Generational gap Untold stories Strategies to overcome historical trauma Building positive identities based on culture and tradition Bringing the generations together

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Multiple, Interrelated Levels of Resilience At the community level, sources of resilience are Culture, language, traditions and sharing stories Traditional land use Tucson Indian Center and/or other community resources The family plays important cultural roles by Teaching the younger generation Creating positive family relations Providing family members as role models The individual is a source of resilience as embedded in family, community and culture/traditions by practicing spirituality practicing responsibility being strong participating/volunteering

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Resilience Strategies for Youth Education Activities Getting elders and youth together Knowing roots/history

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Resilience curriculum 4 modules with elder stories to promote resilient behaviors and strategies among American Indian youth 12-18.

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Draft Curriculum Goal 1: Build connections between elders and youth by enhancing the knowledge of the role of elders in American Indian communities Goal 2: Enhance youth identity through storytelling Goal 3: Increase knowledge among youth about American Indian resilience

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Goal 1: Build connections between elders and youth by enhancing the knowledge of the role of elders in American Indian communities Codes health generation gap spirituality values culture, tradition, language growing up/history role models volunteerism Lesson Plans Voice of Elders Volunteerism Role Models Culture, Tradition, Language and Spirituality Growing-up/History Health

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Goal 2: Enhance youth identity through storytelling Lesson Plans Storytelling What is storytelling? Telling your personal story How to share stories Codes generation gap Culture, language, tradition

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Goal 3: Increase knowledge among youth about American Indian resilience Codes Resilience Individual resilience Family resilience Role models Positive family relations Community resilience Traditions Economic development Sovereignty Spirituality Historical Trauma Adversity: alcoholism, discrimination, generational gap, ill health, living conditions, loss of family members, lost voice, violence. sense of loss: boarding school, broken families, language, traditions, removal. Native Concepts Health then and now Lessons Plans Resilience History of American Indian Resilience Personal stories of resilience Native Traditional values and teachings Personal visions Historical Trauma Specific topics: TBD Adversity: discrimination,

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Sample Lesson: Adversity Facing Adversity To have participants learn about prejudice, discrimination and how American Indians have faced adversity. Show video: Historical Trauma: Discrimination (2:03) Reflect: After viewing video, ask the students what they saw. Activity: Characteristics and Skills Discuss: definitions of prejudice, discrimination and stereotypes. Action: Write in journal how they will use their new knowledge.

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NEXT STEPS Completing Project Pilot, evaluate and revise curriculum Present final curriculum and digital stories to Tucson Indian Center

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Acknowledgements Sponsor: National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number P20MD006872. Tucson Indian Center: Jacob Bernal, Marlene Jose, Phoebe Mills-Cager, CAIR Community Advisory Board members. Contact Information: Agnes Attakai, MPA, Co-PI, agnesa@email.arizona.edu agnesa@email.arizona.edu Kerstin M. Reinschmidt, PhD, MPH, Co-PI kerstin@email.arizona.edu kerstin@email.arizona.edu

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Thank you