The relevance of cultural activities in ethnic identity among California Native American youth

This study analyzed data from a large statewide sample of Native American adolescents throughout California to determine whether participation in cultural practices was associated with stronger ethnic identity. The Multigroup Ethnic Identity Measure (MEIM) scale was used to measure the ethnic identity of 945 Native American adolescents (416 male, 529 female) aged 13 - 19 across California. Respondents who participated in cultural activities including pow-wows, sweat lodge, drum group and roundhouse dance reported significantly higher Native American ethnic identity than their counterparts who did not take part in cultural activities. The association between cultural activities and ethnic identity was only significant among urban youth and not among reservation youth. Higher grades in school were associated with ethnic identity among females but not among males. Findings from this study show a strong association between cultural activities and traditional practices with tribal enculturation among Native American youth in California. Cultural-based practices to enhance Native identity could be useful to improve mental and behavioral health among Native American youth.     

From tradition to evidence: decolonization of the evidence-based practice system

Culture counts in the prevention and treatment of behavioral ailments. The Native American Health Center (NAHC) has successfully developed a model that incorporates cultural adaptations into EBPs, yet also believes community-defined and practice-based evidence are relevant in the validation of traditional practices. American Indian/Alaska Native (AI/AN) traditional practices are more than complementary forms of healing. They are stand-alone methods, developed and used by tribal people long before the concept of EBPs existed. There is a need for funders to respect these practices as autonomous mental health strategies. The reasons for promoting change are explained through an understanding of key dimensions of AI/AN behavioral health issues. These key dimensions were identified in the 2001 Surgeon General's Report and an extensive literature review of Indigenous research methodologies. Recommendations are made based upon their ability to promote AI/AN empowerment, to support movement toward self-determination using the Indigenous Research Agenda model. This model honors fluid movement of Indigenous people through states of survival, recovery, development and self-determination through four categories for action: decolonization, mobilization, transformation, and healing. The end results are options for holistic approaches to influence policy changes in the EBP system.     

“This is the way we were raised”: Alcohol beliefs and acculturation in relation to alcohol consumption among Native Americans

Native Americans have the highest rates of alcohol use in comparison to other ethnic groups, placing them at risk for experiencing alcohol-related problems. The present study examined the beliefs that some Native Americans may have related to alcohol use; specifically, the belief that alcohol is a key component in Native American cultures. To assess these beliefs, we developed the Stereotypical Alcohol Beliefs Scale for Native Americans (SABSNA). The new 20-item measure was administered to 144 individuals who identified as Native American along with a measure of acculturation and other drinking-related measures, including perceived norms, alcohol expectancies, and drinking motives. An exploratory factor analysis revealed that the measure is unidimensional in structure and has excellent internal consistency. SABSNA scores were found to be positively associated with typical week drinking, alcohol expectancies, and drinking motives (social, coping, enhancement, and conformity). Hierarchical regression analyses revealed that level of acculturation moderated the association between alcohol beliefs and weekly drinking. Native Americans who identified less with mainstream culture demonstrated a positive association between their cultural alcohol beliefs and their weekly drinking. The findings suggest that alcohol beliefs would be an appropriate additional target for interventions for individuals who are not oriented to the mainstream culture.     

Holistic System of Care: a ten-year perspective

The Holistic System of Care for Native Americans in an Urban Environment is a community-focused intervention that provides behavioral health care, promotes health, and prevents disease. This approach is based on a community strategic planning process that honored Native American culture and relationships. Substance abuse, mental illness, homelessness, poverty, crime, physical illness, and violence are symptoms of historical trauma, family dysfunction, and spiritual imbalance. The holistic model links treatment, prevention, and recovery. The link between prevention and treatment is early intervention. Peer support is the link between treatment and recovery. Recovering individuals serve as role models linking recovery to prevention. Culture and spirituality build a strong and resilient foundation for recovery. This article documents the effectiveness of the holistic model over a ten-year period that it has been implemented at the Family & Child Guidance Clinic of the Native American Health Center in the San Francisco Bay Area. The holistic model has produced statistically significant reductions in substance abuse among adult Native American women, men, reentry, and homeless populations; reductions in substance abuse among Native American adolescents; reductions in HIV/AIDS high-risk behavior among Native American men, women, and adolescents; and decreases in acting out behavior among Native American severely emotionally disturbed children.     

Holistic Native network: integrated HIV/AIDS, substance abuse, and mental health services for Native Americans in San Francisco

The Holistic Native Network provides a model for integrated HIV/AIDS, substance abuse and mental health services in a cultural context. Funded in 2002 by a grant from the Health Resources and Services Administration (HRSA) Special Projects of National Significance (SPNS) initiative, the Holistic Native Network is a collaboration of the Native American Health Center and Friendship House Association of American Indians, two community-based organizations with facilities in San Francisco and Oakland. Substance abuse and mental health services are integrated into primary HIV/AIDS medical care. San Francisco has the largest population of Native Americans with HIV/AIDS in the country. Since its inception, 45 Native Americans with HIV/AIDS have been enrolled in the Holistic Native Network. These clients were surveyed upon admission and at three months in treatment. The results indicated positive changes in quality of life. The success of this program lies in the way that culture and community is included at every stage of service provision. From outreach to case management to substance abuse and mental health services, the Holistic Native Network meets the spiritual, medical and psychosocial needs of HIV+ Native Americans.     

Culturally appropriate HIV/AIDS and substance abuse prevention programs for urban Native youth

This article will examine HIV/AIDS and substance abuse prevention for urban Native youth in Oakland, California. It will highlight the Native American Health Center's Youth Services programs. These programs incorporate solutions based on a traditional value system rooted in Native culture and consisting of youth empowerment, leadership training, prevention activities, traditional cultural activities and wellness and life skills education. They aim to reduce HIV/AIDS and substance abuse risk for American Indian/Alaska Native (AI/AN) youth through structured, community-based interventions. The Youth Services Program's events, such as the Seventh Native American Generation and the Gathering of Native Americans, offer effective and culturally relevant ways of teaching youth about American Indian/Alaska Native history, intergenerational trauma, and traditional Native culture. Satisfaction surveys gathered from these youth provide invaluable data on the positive effects of these prevention efforts. The need for culturally relevant and culturally appropriate HIV/AIDS and substance abuse prevention programs for urban AI/AN youth is apparent. These prevention efforts must be creatively integrated into the multidimensional and complex social structures of Native American youth.     

Evolution of San Francisco Bay Area urban trails

The Family and Child Guidance Clinic of the Native American Health Center (NAHC) has developed strong working relationships with San Francisco Bay Area system partners in order to serve the mental health needs of American Indian/Alaska Native children and families. NAHC worked relentlessly with stakeholders to pave the Urban Trails that urban Indigenous community members utilize to access culturally competent care. These Urban Trails have been grounded in a community-based system of care model and cultural framework that links substance abuse and mental health through a holistic approach congruent with Indigenous values and traditions. This article describes how NAHC has partnered with community members and organizational stakeholders to develop and sustain an effective holistic system for serving urban Indigenous people.     

Indigenous communities and evidence building

Indigenous populations in the U.S. and Pacific Islands are underrepresented in mental health and substance abuse research, are underserved, and have limited access to mainstream providers. Often, they receive care that is low quality and culturally inappropriate, resulting in compromised service outcomes. The First Nations Behavioral Health Association (U.S.) and the Pacific Substance Abuse and Mental Health Collaborating Council (Pacific Jurisdictions), have developed a Compendium of Best Practices for American Indian/Alaska Native and Pacific Island Populations. The private and public sector's increasing reliance on evidence-based practices (EBP) leaves many Indigenous communities at a disadvantage. For example, funding sources may require the use of EBP without awareness of its cultural usefulness to the local Indigenous population. Indigenous communities are then faced with having to select an EBP that is rooted in non-native social and cultural contexts with no known effectiveness in an Indigenous community. The field of cultural competence has tried to influence mainstream research, and the escalating requirement of EBP use. These efforts have given rise to the practice-based evidence (PBE) and the community-defined evidence (CDE) fields. All of these efforts, ranging from evidence-based practice to community-defined evidence, have a shared goal: practice improvement.     

Traditional and Western Healing Practices for Alcoholism in American Indians and Alaska Natives

The American Indian and Alaska Native population is a culturally diverse population with a current census of 1,959,000. Prior to White contact, there was historically little use of alcoholic beverages except for American Indians in the Southwest. After White contact, use and misuse of alcohol escalated rapidly; however, the prevalence, patterns, and problems of drinking alcoholic beverages vary enormously even in tribes closely linked geographically. American Indians and Alaska Natives have preserved and revitalized a number of traditional healing practices and applied these to the treatment of alcohol-related problems. These healing practices include the following: nativistic movements, sacred dances, sweat lodges, talking circle, four circles, and cultural enhancement programs. Additionally, Western treatment approaches have been applied in the treatment of problems related to alcohol, such as medication for detoxification, disulfiram (Antabuse), Alcoholics Anonymous, and behavioral interventions. Several investigators have completed a small number of naturalistic follow-up studies, but no one has undertaken a randomized controlled trial looking at specific methods of alcohol treatment in American Indians or Alaska Natives. American Indian and Alaska Native communities have adapted and integrated both Traditional and Western approaches to fit their own unique sociocultural needs.     

American Indian culture as substance abuse treatment: pursuing evidence for a local intervention

Contemporary tribal commitments to traditional cultural reclamation and revitalization find continued expression by recent generational cohorts of American Indians who, when it comes to matters of recovery, healing, and wellness in the context of substance abuse, routinely assert that "our culture is our treatment." And yet, empirical investigations of this culture-as-treatment hypothesis--namely, that a (post)colonial return to indigenous cultural orientations and practices is sufficient for effecting abstinence and recovery from substance use disorders for many American Indians--have yet to appear in the scientific literature. Preliminary activities of a research partnership dedicated to the empirical exploration of this hypothesis for reducing Native American substance use disorders are summarized. Specifically, collaboration between a university-based research psychologist and a reservation-based substance abuse treatment program staff has thus far resulted in a detailed blueprint for a radically alternative, culturally-grounded intervention developed for reservation residents. This proposed alternative intervention--a seasonal cultural immersion camp designed to approximate the day-to-day experiences of prereservation ancestors--was designed for eventual implementation and evaluation with adult clients referred for residential treatment on the Blackfeet Indian reservation. It is anticipated that the proposed intervention will eventually afford empirical evaluation of the culture-as-treatment hypothesis.     

Walking on: celebrating the journeys of Native American adolescents with substance use problems on the winding road to healing

High rates of substance use and related problems have been long recognized as critical health issues for Native American adolescents. Unfortunately, no manualized interventions address the specific needs of Native American adolescents in a culturally appropriate manner. In 2006, the Cherokee Nation partnered with the University of Colorado to employ a community-based participatory research process to develop an intervention for Native American adolescents with substance use problems. The resulting intervention, Walking On, is an explicit blend of traditional Cherokee healing and spirituality with science-based practices such as cognitive behavioral therapy and contingency management and is designed to address the specific needs and worldviews of Native American adolescents with substance use problems and their families. Each individual and family session includes a brief assessment, a skill-building component, and a ceremony. A Weekly Circle (multifamily group) promotes sobriety and builds a community of healing. Early pilot study results suggest that Walking On is feasible for use in tribal substance abuse treatment programs. While Walking On shows early promise, the intervention will require further study to examine its efficacy.     

The Sustained,Positive Impact of a Native American Cultures and Health Course on Students’ Education and Practice-Related Choices

Objective. To encourage pharmacy students to elect education and practice opportunities in Native American communities, including careers with the Indian Health Service (IHS).Methods. Students in 2 elective courses were educated on various aspects of contemporary Native American life in urban and reservation environments, including cultural traditions, social and health-related challenges, health access disparities, and cultural approaches to health and wellness. The teachers were Native American leaders and healers primarily from Plains tribes, as well as non-Native American practitioners affiliated with IHS hospitals and tribal health facilities. Students kept reflective journals, and a subset spent 5 days immersed in a rural Navajo community where they lived and worked alongside IHS practitioners and Community Health Representatives.Results. Student engagement with IHS opportunities was tracked for 11 years. Of the 69 pharmacy students who completed the electives, 11 applied for a Junior Commissioned Officer Student Training and Externship Program (Jr. COSTEP) (8 accepted, 6 completed), 43 requested one or more IHS APPEs (43 accepted, 32 completed, 8 in progress), 17 applied for an IHS residency (1 pending, 8 accepted, 5 completed), and 5 became IHS Commissioned Corps officers. Five additional students accepted an IHS or tribal position, with 3 pursuing a USPHS commission.Conclusion. Since the first report on the impact of this elective experience was published, the course continues to meet its primary objective of promoting interest in IHS/tribal education experiences and pharmacy practice careers.     

A holistic system of care for Native Americans in an urban environment

The Native American Health Center has implemented a holistic system of care in the San Francisco Bay Area as a result of a multiyear strategic planning process that included a needs assessment based on the community-readiness model. The strategic plan links substance abuse, mental health, HIV/AIDS, and social services in a holistic approach congruent with Native American values and traditions. The plan also links prevention with treatment in a continuum of care. Based on a collaboration of Native American nonprofit community-based organizations and public agencies, the plan has resulted in bringing significant resources to the community.     

Design of a behavioral health program for urban American Indian/Alaska Native youths: a community informed approach

American Indian/Alaska Native (AI/AN) urban youths experience significant mental health and substance use problems. However, culturally relevant treatment approaches that incorporate community perspectives within the urban setting are limited. This study analyzes community perspectives from AI/AN parents, AI/AN youths, and services providers within Los Angeles County. Information gathered was utilized to develop a needs assessment for AI/AN youths with mental health and substance use problems and to design a community-informed treatment approach. Nine focus groups and key informant interviews were conducted. The Los Angeles County community strongly expressed the need for providing urban AI/AN youths with traditional healing services and cultural activities within their treatment program. However, various barriers to accessing mental health and substance abuse treatment services were identified. An integrated treatment approach was subsequently designed as a result of input derived from community perspectives. The community believed that providing urban AI/AN youths with an integrated treatment approach has the potential to decrease the risk of mental health and substance abuse problems in addition to enhancing their cultural identity and self esteem.     

HIV/AIDS and Native Americans: the health departments' response

For some time, state health department HIV/AIDS programs have worked with communities of color to address their unmet needs. Because of the need for a holistic approach to the multiple issues impacting these communities, efforts to address HIV/AIDS in Native American communities are often integrated into programs addressing related issues, such as substance abuse, mental health and other STDs. Building upon a recent report from the National Alliance of State and Territorial AIDS Directors (NASTAD), this article will review the numerous challenges state and local health departments face in supporting HIV/AIDS-focused health and human services in Native American communities and how some health departments have worked with Native American communities to respond to these challenges. A series of recommendations and next steps for health departments seeking to improve services in Native American communities will be offered.     

Chapter 5: Results: Part II Comparing Findings in Alaska: 1983 and 1988

SUMMARY

American Indian and Alaskan Native communities illustrate the great diversity found among the rural populations of the United States. These communities are marked by cultural, socioeconomic, and historical patterns that differ from other rural groups and that lead to a distinctive set of social problems. When compared to a national sample of youth, American Indian and Alaskan Native youth show exceptionally high levels of drug use. Because they share a number of similar cultural characteristics, it could be hypothesized that the rates of drug use among these Native groups are related to cultural traits. However, non-Native Alaskan youth also have high rates of drug use, indicating that there are factors in the social environment other than culture that account for this behavior. Possible explanatory factors include uncertain economic conditions, family instability, and lack of access to cultural values. Although rural living in itself is not necessarily a contributing factor to drug use, it does place some constraints on intervention efforts. Geographic isolation and lack of adequate health and social service resources make it difficult to develop adequate prevention and treatment services.     

A Service-Learning Elective in Native American Culture, Health and Professional Practice

Objectives

To evaluate the success of an elective course in Native American culture, health, and service-learning in fostering interest in experiences and careers with the USPHS Indian Health Service (IHS), and in shaping reflective practitioners.

Design

Students conducted readings, kept reflective journals, and engaged in discussions with Native American and non-Native American speakers. Students orally presented a Native American health issue and spent their fall break in Chinle, Ariz, providing social and healthcare services to the Diné under the supervision of IHS pharmacists. Opportunities for additional IHS experiences were discussed, as was discerning the Creator''s call to a professional life of service.

Assessment

Thirteen of 15 students who had completed the service-learning course by January 2007 responded to a brief survey indicating that not only were the course objectives met, but the experiences had a lasting impact on professional mindset and career plans.

Conclusion

The course had a lasting impact on students'' understanding of Native American social and health care issues, and on how they will practice their profession and live their lives.     

Treatment for substance use disorders in a privately insured population under managed care: costs and services use

The study investigated the relationship of substance use disorders, concurrent psychiatric disorders, and patient demographics to patterns of treatment use and spending in behavioral health and medical treatment sectors. We examined claims data for individuals covered by the same organization. Services spending and use were examined for 1899 individuals who received substance use disorder treatment in 1997. Medical and pharmacy spending was assessed for 590 individuals (31.1%). The most prevalent services were outpatient, intensive outpatient, residential, and detoxification. Average mental health/substance abuse (MHSA) care spending conditional on use was highest for those with concurrent alcohol and drug disorders ($5235) compared to those with alcohol ($2507) or drugs ($3360) alone; other psychiatric illness ($4463) compared to those without ($1837); and employees’ dependents ($4138) compared to employees ($2875) or their spouses ($2744). A significant minority also sought MHSA services in the medical sector. Understanding services use and associated costs can best be achieved by examining services use across treatment sectors.     

Alcoholism Treatment and the Relationship of Native American Cultural Values to Recovery

Native American alcoholics, Native American nonalcoholics, Anglo alcoholics, and Anglo staff were compared on demographics and the Rokeach Value Survey. The subjects were from an inpatient alcohol treatment program of a rural community mental health center located 1 mile from the boundary of a large southwestern Indian reservation. Results from this study provide evidence which supports the poorer prognostic rates of alcoholism recovery for Native American alcoholics. Evidence is also presented which suggests that Native Americans’ values are measurable and significantly different from Anglo values. While the relationship between values and recovery was difficult to discern, it is suggested that the disparity in values between the two cultures is one reason why so few Native American alcoholics remained in treatment.