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Tribal Practices The Good Ways of Providing Mental Health & Substance Abuse Prevention, Treatment & Rehabilitation Services One Sky Center R Dale Walker,

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Presentation on theme: "Tribal Practices The Good Ways of Providing Mental Health & Substance Abuse Prevention, Treatment & Rehabilitation Services One Sky Center R Dale Walker,"— Presentation transcript:

1 Tribal Practices The Good Ways of Providing Mental Health & Substance Abuse Prevention, Treatment & Rehabilitation Services One Sky Center R Dale Walker, MD, Director Doug Bigelow PhD, Deputy Director Michelle Singer, Indian Country Methamphetamine Initiative Director Laura Loudon, Mentee Project Director 10 June 2009 5/5/20151

2 PROGRAMS THAT WORK Goal of this State Initiative: Goal of Providers of American Indian Health Services: Goal of American Indian Communities: 5/5/20152

3 Select Practices that work Evaluate Implementation (Quality Assurance) Technical Assistance for existing practices 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 Practices 5/5/20153

4 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 5/5/20154

5 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 5/5/20155

6 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  5/5/20156

7 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 5/5/20157

8 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 5/5/20158

9 3. Other examples of this Tribal Practice (Replications)  e.g., Creek (Cheety Chapko)  e.g., Lakota (Raymond Bucko)  e.g., Yakima (J Bruchac) 5/5/20159

10 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  5/5/201510

11 Historical Connections White Bison, Sweat Lodge in Prison df df Coast Salish Canoe Journey 2008 USGS photo 5/5/201511

12 Longevity: the Grandmother Test  Grandmother approves of the fedora… 5/5/201512

13 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 ) 5/5/201513

14 Values  Clan  Harmony  Holism  Acceptance  Taboos  Communal Property  Work as necessary  Now-orientation 5/5/201514

15 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 Medicine Treatment of Chronic Illness: Development of an Integrated Program with Conventional American Medicine and Evaluation of Effectiveness. )Lewis Mehl-Madrona, M.D., Ph.D 5/5/201515

16 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. 5/5/201516

17 Community Evaluation Cruz: “Our elders and community members will let us know if we are not doing it right.” “Client satisfaction” measures 5/5/201517

18 5. Basic Problems (or Goals) Addressed by this Tribal Practice Problem/Goal Program Activity Outcome  e.g., Reduce methamphetamine abuse  e.g., Reduce suicide incidence  e.g., Build personal identity based on culture 5/5/201518

19 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 5/5/201519

20 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”) DomainR ISK F ACTORS P ROTECTIVE F ACTORS Community  e.g., community dislocation  e.g., high involvement in community events Family  e.g., family break-down  e.g., strong family dynamics Peer  e.g., peer bullying  e.g., QPR behaviors School  e.g., drop-out  e.g., healthy/safety policy Individual  e.g., history of drug use  e.g., future vision 5/5/201520

21 8. Personnel Elders Medicine people RNs MDs Counselors Volunteers Peer volunteers 5/5/201521   

22 9. Activities  e.g., recruit participants by referral from law enforcement (juvenile justice) officer  e.g., train peer volunteers to lead peer groups      5/5/201522

23 10. Materials Canoe Billboards Horses Lodge (sweat) Drums School auditorium Camp ground Sacred or hard-to-get: Eagle feathers Artifacts 5/5/201523   

24 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  5/5/201524

25 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 5/5/201525

26 13. Contact person Person  Phone  e-mail  5/5/201526

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