1. Does Receiving Traditional Healing as a Vocational Service Lead to More Successful Outcomes? Post Employment Training American Indian Rehabilitation Cycle VII~Researchers

2. Purpose of our Study: The purpose of this study is to determine the effect of spirituality on successful Vocational Rehabilitation (VR) outcomes. In this project the researchers examined the traditional healing component of American Indian Vocational Rehabilitation (AIVR) and how it affects consumer employment outcomes.

3. Native American Vocational Rehabilitation “The American Indian and Alaska Native people are the most underserved, misrepresented, and unknown population that require assistance in achieving employment and independence”(American Indian Vocational Rehabilitation (AIVR) History, N.D.).

4. Native American Vocational Rehabilitation According to Marshall, Johnson & Lonetree (1993), “state and federal agencies provided funds to provide vocational rehabilitation services on Tribal reservations as early as 1947, and subsequent work over the years led to a greater recognition of the psychosocial barriers facing Native Americans, generally” (p. 327). Despite this early recognition of Native Americans as an un- served or underserved population, little was done by vocational providers to include them or reach out to them.

5. Native American Vocational Rehabilitation A major addition to the Rehabilitation Act of 1973 was Section 130 which was written into Title I. This section provided for American Indian projects to serve Indian people on reservations. While this was a major achievement for Native Americans, no funding was provided to the programs.

6. Native American Vocational Rehabilitation The Navajo Nation led the movement to include a funding mandate into the Act, and finally succeeded in 1983. They were the only AIVR program until 1985. This achievement came more than forty years after the 1947 memorandum (Kelley, 2010).

7. Native American Vocational Rehabilitation A1978 Department of Education-Rehabilitation Program Annual Report sums up the failure of the State Vocational Rehabilitation to provide adequate services: The greatest problems that face VR in the effort to improve services to Native Americans are ones that relate more to the potential client’s status as an American Indian than to disability status. The Indian population on reservations, including the disabled population, is not conveniently located for easy participation in general Federal and State programs; they are usually dispersed in large rural areas. If there is a single, important step that RSA should consider in order to improve VR services to Native Americans, that step is developing ways to take VR to the reservation Indians. It is not likely that they will or even can come to VR in significant numbers. American Indians have one of the highest disability profiles in the country, yet have been identified as unserved and underserved by State Vocational Rehabilitation systems (as cited in AIVR History, N.D.)

8. Native American Vocational Rehabilitation According to the United States Department of the Interior there are currently 565 Federally Recognized Indian Tribes, Bands and Nations (TBN) (2011). In 2010 there were eighty-two AIVR Programs in 25 states (Kelley, 2010).

9. Native American Vocational Rehabilitation AIVR programs are competitive grants awarded and administered through the Rehabilitation Services Administration under the United States Department of Education. In 2008, AIVR successfully rehabilitated 1,609 American Indians with disabilities (Kelley, 2010).

10. Native American Vocational Rehabilitation The percentages of successfully rehabilitated Native Americans has held steady at 66% and over for the past 4 years (Kelley, 2010). West (2009) reports the reason for the success [of] tribal vocational rehabilitation is because “the programs are able to maintain continuous presence on the reservation, are aware of and observe tribal customs, employ primarily native staff, use non-traditional or native employment, and where possible and necessary communicate in the native language” (p.1).

11. Why is TVR Unique? The Medicine Wheel or Sacred Circle has been used in various forms and aspects in different Tribes throughout history, and it is a universally recognized symbol to most Native Americans. One aspect that makes AIVRs unique is the view of the consumer as a whole person, mind-body-spirit.

12. Spirituality is New to Many Fields In a Gallop Poll conducted in June 2011, 92% of Americans stated that they believe in God, and these numbers have held steady at over 90% since 1968 (Newport, 2011). It was only in 2000 that the American Psychological Association (APA) began to include religion in its standards for graduate school accreditation (APA, 2000). Phillips (2003) found that fields such as nursing, occupational therapy and medicine have begun to recognize the importance of r/s in patients’ lives in relation to their perceived mental and physical health.

13. Spirituality is New to Many Fields The benefits of engaging in spirituality have been identified with advantages such as: improvement in certain relationships, increase self- esteem and confidence, promotes the awareness of values such as honesty, patience, wisdom, hope, kindness, creativity, and joy, sense of inner peace and acceptance of most problems a person is faced with, sense of optimism, and quicker recovery from certain illnesses (Cory, Gerald. 2010).

14. Spirituality is New to Many Fields Levin (2001) reviewed over 200 epidemiological studies which dealt with the impact of spirituality/religion (s/r) beliefs on individual’s mental and physical health. His results indicated the following: any religious affiliation benefits an individual’s health by promoting health and wellness behavior; participation in worship (prayer, meditation) benefits health through the physiological effects of positive emotions; having faith benefits physical and mental health relating to hope and positive expectations; and religious Americans have a longer mortality rate than nonbelievers.

15. Spirituality is New to Many Fields While consensus is emerging which supports incorporating religion/spirituality (and culture) into mental health treatment… Hansen, N.D., Randazzo, K.Y., Schwartz, A., Marshall, M., Kalis, D., Frazier, R., (2006) studied multicultural competencies among psychologists and found that their sample integrated racial/ethnic derived religious/spiritual beliefs and practices into treatment significantly less than they report they should.

16. Modern Native Spirituality To understand r/s in modern Native Americans, you must first understand Native American history. "So, Native communities experienced many generations of trauma and loss, with no traditional ways of addressing and healing them," states Beth Boyd, PhD, University of South Dakota psychologist. “In fact, it was illegal to practice traditional Native American spiritual and ceremonial forms of healing until 1978, when Congress passed the American Indian Religious Freedom Act”, she notes. (DeAngelis, 2009).

17. Modern Native Spirituality Due to the forced assimilation, boarding schools, and various laws passed that tried to “kill the Indian, save the man”, today’s modern Native Americans span the spectrum from Traditional spirituality to Christianity, and everything in between. Which begs the question, ‘What is Spirituality’?

18. What is Spirituality~ Spirituality can mean many different things to different people. Spirituality is not always associated with religion. Spirituality is a process of self discovery of the idea or a process of a journey to learn about one self. Spirituality can be connection between a person, others, or a higher power.

19. What is Spirituality~ Spirituality can be personal or with an openness with others or a person’s surroundings. Spirituality may serve as a guidance of moving forward in a direction of a purpose, meaning in a person’s life.

20. Importance of Spirituality and Counseling Some professional counselors may be aware that spiritual and religious issues matter; and have ethical views, therapeutically pertinent, and potential significant to a client problem. Counseling and Spirituality can address not only the motivation of a person, but can address the mind, body, and spirit.

21. Importance of Spirituality and Counseling Counseling and Spirituality can aid a person to gain insight into the core values and beliefs that can reflect on a person’s behavior. Clients may understand that he or she may need to re-evaluate these values. A counselor must be properly trained and ready to deal with his or her clients’ issues of the human spirit.

22. Symbolic “Symbolic forms and activities are the basic building blocks of culture…” (Bolman and Deal, 2008, p. 278). Cultural lifestyle is the behavior, beliefs, and attitudes of a Native American society; culture is the pattern of person’s thoughts, language, actions, communication, values, and beliefs. Culture is a characteristic of a person or a group of people; it defines this person or group.

23. Symbolic For Native Americans there is a cultural bond that is ethnic; there are shared beliefs, activities, and values. The influence of most Native American spiritual culture is the geographic, Tribal affiliation, and preservation of what Native people have left. The symbolic framework within Tribal communities in which this is demonstrated is taught is through traditions such as seasonal dances, sun dances, prayers, sweat lodges, the drum religion, the Native American church, as well as non-native practices.

24. Spirituality & Native Americans Many people may believe that Native Americans and spirituality go hand in hand; many followers of Native American spirituality do not regard his or her spiritual practices and beliefs as a “religion” as a Catholic or Christian. Native American spirituality is not evangelistic; to walk the way of a true Native American in a spiritual understanding is a cultural lifestyle always.

25. Spirituality & Native Americans Most Native Americans spirituality practices and beliefs form an essential and flawless part of his or her being. A Native Americans spiritual/cultural life-style is the belief of promoting and preserving what is mother earth has given everyone; from the air that he or she breaths to ground that he or she walk on; mother earth is always giving so a person can survive.

26. Spirituality & Native Americans Cultural life style is the behavior, beliefs, and attitudes of a Native American society; culture is the pattern of person’s thoughts, language, actions, communication, values, and beliefs. Spirituality is simply being Native American, a reflection of his or her self in a good way.

27. Spiritual Leaders/Helpers Laverne Haag, MSW, Treasurer for Native American Church Chapter in Kansas, member of the Ponca Tribe. a. Dawn interviewed Mrs. Haag on 9/21/11. b. Grew up knowing the positive effects of the Native American church ceremony. c. Family members were and continue to advocate and educate others on the American Indian Religious Freedom Act.

28. Spiritual Leaders/Helpers Mary Webster, spiritual helper, member of the Menominee Tribe. a. Carey interviewed Ms. Webster on 9/16/11. b. Plays an important role in helping clients connect to other spiritual leaders in the community. c. Has worked in the human service field for over 20 years.

29. Spiritual Leaders/Helpers Angie Merrill, tribal elder and member of the St. Croix Chippewa Tribe. a. Director of the Ojibwa Language program. b. Served as the coordinator of the Johnson O’Malley(JOM) and Trails Youth Program. c. Born and raised on the reservation and brought up in the traditional way.

30. Native American Vocational Rehabilitation~Spiritual Leaders/Helpers Questions for our Spiritual leaders/Helper 1.Is the community at large aware of the spiritual leaders in the community and the types of services they offer? a. Mrs. Haag replied as follows: …that if individuals have been brought up in knowing traditional ways then they would be aware of the traditional leaders in the community. However, on the other hand the opposite is true that if community members have not been brought up this way then these leaders would not be familiar to them. In Mrs. Haag’s experience, she said unless a client specifically asked for spiritual help then it is not really addressed or offered. (L. Haag, personal communication, September 21, 2011)

31. Native American Vocational Rehabilitation~Spiritual Leaders/Helpers 1. Is the community at large aware of the spiritual leaders in the community and the types of services they offer? b. Angie Merrill responded by saying that “Most of the Community who practice the traditional way [is] aware of the spiritual leaders and healers. Most of the community also know who to ask (elders) if they need advice, guidance, or to be directed to a healer” (A. Merrill, personal communication, September 22, 2011).

32. Native American Vocational Rehabilitation~Spiritual Leaders/Helpers 1. Is the community at large aware of the spiritual leaders in the community and the types of services they offer? c. Mary Webster preferred to be called a helper. She said a healer is a medicine man. She also went onto say that “[A] helper… can find people that can do sweat lodges, pipe carrier ceremonies, and naming ceremonies.” One common practice that is used in Native communities is the offering of tobacco when asking others for help. Ms. Webster practices this and when she is approached by community members enquiring about the services of other spiritual leaders in her community she first gives them tobacco and asks permission to give out their information. The Indian way for the releasing of information in the form of offering tobacco is unknown and is not practiced in both Native and non- native social service agencies. (M. Webster, personal interview, September 16, 2011).

33. Native American Vocational Rehabilitation~Spiritual Leaders/Helpers 2. Are Spiritual leaders easily accessible to community members? a. Mrs. Haag replied by the following: “yes they are easily accessible to those who are familiar to them so if they attend ceremonies and they see the leaders that stand up and talk they see the person taking charge, and leading the ceremonies, leading prayers…then those are familiar faces to them.” However, on the other hand she goes onto say that “no, these spiritual leaders are not easily accessible to community members that [do not] go around [those] ceremonies that are not familiar with these people that wouldn’t know this person, the spiritual leader, if they seen them in the grocery store or around the community somewhere or in the clinic … because they have not been exposed to that familiar face” (L. Haag, personal interview, September 21, 2011).

34. Native American Vocational Rehabilitation~Spiritual Leaders/Helpers 2. Are Spiritual leaders easily accessible to community members? b.Ms. Merrill replied “the tribe doesn’t have their own medicine man, but the elders and traditional Natives know how to get a hold of the healer if needed.” Ms. Merrill’s goes onto say that “most of the Traditional Natives also attend Traditional ceremonies, such as big drum, so finding a spiritual leader or elder is relatively easy” (A. Merrill, personal interview, September 22, 2011). c. Ms. Webster responds by saying that “When I am approached by a community member, the spiritual need is asked. I go to the person that can help with tobacco at hand to give to the spiritual person I am asking for help.” (M. Webster, personal interview, September 16, 2011)

35. Native American Vocational Rehabilitation~Spiritual Leaders/Helpers 3. Is spirituality incorporated into individual plans of employment (IPEs) and service plans for spiritual leaders who have to document their teachings, and how is it documented? a. Ms. Haag said that she “did not believe spirituality is really incorporated into the treatment plans …it is only a suggestion, it might be a suggestion of a VR counselor of a drug and alcohol counselor or a social worker. She also goes on to say that “you can make those suggestions all day long and now whether or not the individual takes that upon themselves to incorporate that willingly or whatever unless it is mandated or kind of like court ordered.” A tribal drug court might recommend that clients do this. She went onto acknowledge that “Mainstream society like even Indian Health Service [do not] recognize yet though it’s changing but yet [do not] recognize cultural and traditional ceremonies as a part of a person’s treatment plan.” She did agree that “for spiritual leaders who have to document their teachings...it probably should be documented somewhere in case notes and it should be required.” (L. Haag, personal interview, September 21, 2011)

36. Native American Vocational Rehabilitation~Spiritual Leaders/Helpers 3. Is spirituality incorporated into individual plans of employment (IPEs) and service plans for spiritual leaders who have to document their teachings, and how is it documented? b. Ms. Merrill said that “Most of the western treatments are separate from Traditional. It is thought (by this leader/elder) that living in the Traditional way would preclude need for western medicine, such as AODA counseling. The creator will help, and show you the path, so the need for treatment will likely not be needed.” (A. Merrill, personal interview, September 17, 2011) c. Ms. Webster reports that “She will annotate that she [discussed] this holistic healing of what the topic is and place it in her monthly report and she will also “pass a rock around [and] I ask the people I am speaking to what they have learned today.” She watches body language and feels good in knowing if a person learned one thing then she did her part.

37. Native American Vocational Rehabilitation~Spiritual Leaders/Helpers 4. When do you refer people seeking healing to other resources (like a medical doctor or AODA treatment)? a. Mrs. Haag replied that “The methods of treatment they are so varied they enhance one another.” She considers “traditional cultural events or activities like sweat lodges, Native American Church, drum doings, as…those things are part of our spirituality that enhance [and] they are resources. Mrs. Haag makes a valid point in adding that “they’re our church, they’re the support system, [and] they’re the cushion around our lives that hold us safe.” A resource book would be helpful for consumers because these activities and events could be made available to consumers. She goes onto add that there are “people that do merely just the clinical piece and [do not] do the traditional/cultural piece and …somehow some people walk on both spectrums, one foot’s on this clinical side and one foot is on the traditional/spiritual side.” (L. Haag, personal interview, September 21, 2011)

38. Native American Vocational Rehabilitation~Spiritual Leaders/Helpers 4. When do you refer people seeking healing to other resources (like a medical doctor or AODA treatment)? b.Ms. Webster replies by saying that she does not refer a client to an AODA counselor anymore but instead replies by saying “I work with a cultural spiritual group. If someone [wants] AODA and [it is] brought to my attention, I give this information to my supervisor, or tell them how to get started, or refer them to the front desk to get started.” She also reports that “A community in Canada works with traditional people that work with the clinics. Even the clinic refers people to the traditional people and …have brought this up to the Menominee Clinic but it did not get far” (M. Webster, personal interview, September 16, 2011) c. Mrs. Merrill contends and believes that “the creator should help with all of these things. If you are sincere and walk in the Traditional way, the creator will give you help and guidance to deal with your issues.” (A. Merrill, personal interview, September 22, 2011)

39. Native American Vocational Rehabilitation~Spiritual Leaders/Helpers 5. As a spiritual leader, how does the healing affect anyone, in a positive or negative manner? a. Mrs. Haag replied that she “has heard from other individuals, acquaintances, family members attest to what the healing does to them but a lot of times they don’t understand from just one sweat lodge ceremony…you have to keep going until you begin to understand from sitting still, being quiet, listening … and there’s a time when you also get to express yourself. Whether it physical, mental, psychological, emotional pain that they need healing from, how it affects them is just a sense of how they perceive… the healing or how somebody can help them. For example, she explains that a person with arthritis could use the heat from the sweat lodge as a type of physical healing and if a person were suffering emotionally they might cry in a sweat lodge.” (L. Haag, personal interview, September 21, 2011)

40. Native American Vocational Rehabilitation~Spiritual Leaders/Helpers 5. As a spiritual leader, how does the healing affect anyone, in a positive or negative manner? b.Ms. Webster said to “work with your heart, body and mind [it] will make you well. It is up to the individual, if you are open if you want that healing it will happen…if you send out positive energy it will come back and if you send out negative energy it is going to come back. Some people have [selective] hearing or selective thought. It is also up to that person wanting to receive that healing, if they want it or not to get to the place to get better” (M. Webster, personal interview, September 16, 2011). c. Mrs. Merrill’s reply to the question was that “It is all positive” (A. Merrill, personal interview, September 22, 2011).

41. Native American Vocational Rehabilitation~Spiritual Leaders/Helpers 6. As a spiritual leader do you feel that your efforts in Native Healing have had any effectiveness on people you serve? a. Mrs. Haag replied that “yes, and that’s just from the individuals that have come to me prior to a healing ceremony… and saying I really need this or I really want to do this and they actually come and then have that experience and they get there and get to benefit from the ceremony. After that they come back to you and say I really slept good last night or they say I figured something out while you were talking… or say I really feel good. There’s always something somebody says and appreciates these types of events and ceremonies. She further acknowledges that [she] gets to feel the positive effects of the things that we do as Indian people and the tools that were left here for us that were given to us by the creator.” (L. Haag, personal interview, September 21, 2011)

42. Native American Vocational Rehabilitation~Spiritual Leaders/Helpers 6. As a spiritual leader do you feel that your efforts in Native Healing have had any effectiveness on people you serve? b. Ms. Webster replied by saying that “I rely on my spirituality [and] I rely on the Creator to direct me... [to] help me say something to somebody today that [is]going to help them.” She also goes onto comment that she “[gets] direction from my higher power…it is not of the ego it is of the heart. When you have the mind and the heart to work together it is a good place, ego doesn’t exist.” Ms. Webster feels happy when she has been able to help someone “in the healing process” (M. Webster, personal interview, September 16, 2011). c. Ms. Merrill replied that “Getting the advice of an elder, spiritual leader or healer has positive effects on those who walk in the Traditional way… she agrees with the concept of the mind-body-spirit connection, and that you cannot neglect one part of that, because we are all mind-body and spiritual people.” (A. Merrill, personal interview, September 22, 2011)

43. Native American Vocational Rehabilitation~Spiritual Leaders/Helpers A positive outcome that came about as a result of this interview was that Ms. Webster had asked Ms. Waubanascum “to start having a resource for Spiritual communication, because there are people in our community that are looking for what clan they are, where to go for sweat lodge, and who they are” (M. Webster, personal interview, September 16, 2011).

44. Traditional Values The ceremonies offered and practices for Traditional Healing are as varied as the Tribes, Bands, Nations. Most have Medicine Men that can be called upon for healing. Most have sweat lodges or some form of hot house used for healing and harmony of mind-body-spirit.

45. Traditional Values Carey’s helper (healer) was very open and asked her to help get a resource list together for Natives who are looking for their healing or path. Dawn’s leader was open and gave us a lot of good information and understanding of the Traditional ways and reasons behind different ceremonies. Mollie’s leader was reserved in her information – many things are taboo to speak of in regard to Traditional Spirituality for this Tribe.

46. Results Conducted a survey to the 9 Regional TVRs, with 5 responses returned. Data was for the 2010 and 2011 fiscal years. Surveys were received from: Great Lakes Inter Tribal Council-Pat Lerch Inupiat Community-Dallas Lee Drower Menominee Nation-Norman Shawanokasic Oneida Nation-Micah Nickey Yakama Nation-Leah Smartlowit.

47. Spiritual Healing-Findings 1.How many consumers total were served under an Individualized Plan for Employment (IPE)? 701 2.How many of these consumers were closed as successful (employed)? 227 3.How many of these consumers were closed as unsuccessful (not employed or other)? 123

48. Spiritual Healing-Findings 4. How many of these consumers had as their primary disability: a)Substance dependency 340 b)Mental Health Disorder 278 c)Physical Disability 160

49. Spiritual Healing-Findings 5. Of these consumers, how many received Traditional healing as a service? A.For those consumers who did receive Traditional healing as a service, how many were: 18-40 years old 42 41-70 years old 29 B. For those consumers who did receive traditional healing as a service, how many were: Closed as successful (employed) 24 Closed as unsuccessful (other) 4

50. Spiritual Healing-Findings 6.Of these consumers, how many did not receive Traditional Healing as a service? A.For those consumers who did not receive Traditional healing as a service, how many were: 18-40 years old 227 41-70 years old 264 B.For those consumers who did not receive Traditional healing as a service, how many were: Closed as successful (employed)201 Closed as unsuccessful (other) 109

51. Results Consumers who have received traditional healing: 10% Consumers who have not received traditional healing: 70% Successful closures that did receive traditional healing service: 33% Successful closures did not receive traditional healing service: 40%

52. Discussion and Recommendations In developing this paper the researchers have discovered that most, if not all TVR application paperwork does not ask the consumer if he or she has or needs religion and spirituality (r/s) or Traditional Healing in his or her life. The researchers believe that our results could have had a different outcome if r/s and/or traditional healing was addressed on the application or during the introduction of VR services.

53. Discussion and Recommendations Furthermore, the interviews with the spiritual leaders and helper indicated that the role they play in their communities is important and they all felt that traditional healing has made positive effects in the lives of those they serve. Are traditional healing practices not addressed during the VR process? This was indicated by Mrs. Haag’s response when she said that in her experience that it is not addressed and that it is only a suggestion.

54. Discussion and Recommendations Another reason why r/s may not be addressed during the VR process is that rehabilitation counselors historically do not discuss this with their consumers, because it is seen as a private matter and some counselors may be fearful of imposing their own beliefs and values on consumers (Green, Benshoff, and Harris-Forbes 2001).

55. Conclusion Though our survey results did not support our hypothesis, through the research and interviews the researchers feel that r/s are very important to Native people and to AIVR. Future studies may wish to address the question of whether spirituality is uniformly addressed during the application, intake, or when developing a plan for employment, and whether or not this may have some significance in successful outcomes.

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