Tribal Practices
The Good Ways of Providing
Mental Health & Substance Abuse Prevention, Treatment & Rehabilitation Services
One Sky CenterR Dale Walker, MD, Director
Doug Bigelow PhD, Deputy DirectorMichelle Singer, Indian Country Methamphetamine Initiative Director
Laura Loudon, Mentee Project Director
10 June 2009
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PROGRAMS THAT WORK
Goal of this State Initiative:
Goal of Providers of American Indian Health Services:
Goal of American Indian Communities:
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Practices that work: Continuous Quality Improvement
Panel Reviews Evidence
Site Visit: Peer Review of
Implementation
Site Visit: by Previous
Implementers
Adapt-Adopt new
Practices
Describe, evaluate, modify
existing Practices04/18/23 3
Selecting Practices that Work—
Two Routes: Imported or Home-grown
Imported
• Find proven practice
• Adopt proven practice
• Adapt proven practice for local use
Home-Grown
• Describe an unproven, existing, local practice
• Evaluate local practice
• Modify, if needed
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Select Tribal Practices that Work: The Native American
Framework for Evidence
• Approved Tribal Application form
• Review Criteria/Tribal Best Practice Principles of Native American Programming Checklist
• Review Panel
• Review Process
13 Tribal Practices
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1. Name of Tribal Practice
• Adventure Based
• Canoe Journey/Family
• Ceremonies and Rituals
• Cradle Boards
• Cultural Camp
• Domestic Violence Group Treatment for Men
• Family Unity
• Round Dance
• Sweat Lodge
• Talking Circle
• Tribal Crafts
• Tribal Family Activities
• Tribal Youth Conference
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Some Other Evidence-Based Native American Practices
• GONA
• American Indian Life Skills Curriculum
• Horse Program (Equine Therapy)
• Project Venture (service learning)
• Family Strengthening Program
• Native HOPE
• Motivational Interviewing
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2. Brief Description
• …incorporates ceremony and ritual
• …community elders…participate
• Elders (transmitters of the culture)…
• …youth relearning Indian cultural values…
• Most tribal values incongruent with AOD abuse
e.g., Ceremonies and Rituals
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3. Other examples of this Tribal
Practice (Replications)
e.g., Creek (Cheety Chapko)
e.g., Lakota (Raymond Bucko)
e.g., Yakima (J Bruchac)
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4. Evidence-basis for the Tribal Practice:Historical/Cultural Connections
Longevity (“Grandmother test”)
Teachings on which Practice is based
Values incorporated in Practice
Principles incorporated in Practice
Elder’s approval of Practice (“three elder women test”)
Community feedback/evaluation of Practice
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Historical Connections
White Bison, Sweat Lodge in Prison http://www.whitebison.org/prisons/Reentry%20Package.pdf
Coast Salish Canoe Journey 2008 USGS photo04/18/23 11
Teachings The Medicine Wheel Teachings
• Harmony
• Balance
• Polarity
• Conflict precedes clarity
• The Seen and the Unseen worlds
• All things are interconnected
• The honor of one is the honor of all
(from: White Bison, philosophy http://www.whitebison.org/about/philosophy.html )
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Values
Clan
Harmony
Holism
Acceptance
Taboos
Communal Property
Work as necessary
Now-orientation
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Principles(e.g., Treatment of Chronic Illness)
Time Healing takes time and time is healing
Relationship Healing takes place within the context of a relationship.
Intensity Achieving an energy of activation is necessary
Holism Mental/emotional/physical
Peace and Quiet The distractions of modern life "inactivate" catalysts for change
Self-awareness Self-reflection needed for healing
Rest Change often requires a break in usual daily rhythms.
Ceremony To access spiritual aid to healing
(From: Lewis Mehl-Madrona, M.D., Ph.D . Traditional (Native American) Indian MedicineTreatment of Chronic Illness: Development of an Integrated Program with Conventional American Medicine and Evaluation of Effectiveness. http://www.healing-arts.org/mehl-madrona/mmtraditionalpaper.htm )
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Elder’s Review-and-Approval(“Three elder women test”)
E.g., White Bison begins with review and approval (blessing) of elders
Coyhis Don. 1993. Meditations with the Native American Elders. Books Beyond Borders; Four Seasons.
http://www.coyhispublishing.com/store.php?crn=180&rn=387&action=show_detail
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Community Evaluation
• Cruz: “Our elders and community members will let us know if we are not doing it right.”
• “Client satisfaction” measures
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5. Basic Problems (or Goals) Addressed by this Tribal Practice
e.g., Reduce methamphetamine abuse e.g., Reduce suicide incidence e.g., Build personal identity based on culture
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6. Target Population (List the primary populations to be served)
e.g., adolescents at high risk of using methamphetamine
e.g., isolated elderly, depressed women
e.g., distributors of prohibited drugs
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7. Factors Addressed Identify the key problem/factor(s) the practice addresses (e.g., the Community Protective Factor of “high involvement in community
cultural events”, or the Individual/Peer Risk Factor of “history of prior drug use”)
Domain RISK FACTORS PROTECTIVE FACTORS
Community e.g., community
dislocation
e.g., high involvement in community events
Family e.g., family break-down e.g., strong family
dynamicsPeer
e.g., peer bullying e.g., QPR behaviorsSchool
e.g., drop-out e.g., healthy/safety policy
Individual e.g., history of drug use e.g., future vision
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8. Personnel
• Elders• Medicine people• RNs• MDs
• Counselors• Volunteers• Peer volunteers
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9. Activities e.g., recruit participants by referral from law enforcement (juvenile justice) officer
e.g., train peer volunteers to lead peer groups
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10. Materials
• Canoe • Billboards• Horses• Lodge (sweat)• Drums• School auditorium• Camp ground
Sacred or hard-to-get:
• Eagle feathers• Artifacts
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11. Optional Elements: Other items that are not necessary to implement the program but which
facilitate the Tribal Practice (e.g., food)
e.g., Prizes/awards for attendance
e.g., Food
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12. Outcomes
Longevity (vs avoidable death) e.g., rate of age-standardized mortality due to violence; specific dx;
Health (vs dx-specific morbidity) e.g., level of activity; dietary sufficiency; rate of binging; rate of underage alcohol use;
Ability (vs disability) Basic 32 measure of function
Wellbeing (vs pain and suffering)
Social/Community/Cultural Connectedness
Abstinence from/non-harmful use of AOD
Employment E.g., labor force participation; job performance
Education E.g., Recruitment; retention; grades; graduation
Healthy Family e.g., family functioning (strengths); family stability
Good Behavior (e.g., non-criminal) e.g.,
Stable Housing
Psychological e.g., attitude; beliefs; knowledge; skills; Lifestyle
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