Opening

JamiBartgis,Ph.D.OneFireAssociates,LLC

HonoringtheGatheringofNativeAmericans(GONA)throughEvaluation

It’sOurEvaluation!

Gratitude

• NationalCouncilofUrbanIndianHealth• CaliforniaConsortiumofUrbanIndianHealth• SacramentoNativeAmericanHealthCenter• GONAExpertsandSAMHSAConsultants• Communitymembers• Students

Objectives• IdentifymajorworldviewdifferencesandchallengestoovercomewhenimplementingevaluationinIndianCountry

• UnderstandtheCommunity-BasedParticipatoryResearch(CBPR)process

• IdentifymethodsofGONAevaluation• ListthemajoroutcomesandaccomplishmentsoftheGONAcross-sitestudy

• Accessresourcesforstrength-basedevaluationofGONAandsimilarprograms

Community-BasedParticipatoryResearch

“Ifyoulookatour data…”CommunityAdvisoryBoardMember,

Tulsa,OK

WesternMedicine/Research IndigenousMedicine/ResearchFocus/Measure pathologyandcuringdisease

Focus/Measure healthandhealingthepersonandcommunity

Reductionist:Diseasesarebiological,andtreatment/researchshouldproduce/demonstratemeasurableoutcomes

Complex:Diseasesdonothaveasimpleexplanation,andoutcomesarenotalwaysmeasurable

Investigate/research diseasewitha“divide-and-conquer”strategy,lookingformicroscopiccausethatcanbeisolatedusing statistics

Looksatthe“bigpicture”:thecausesandeffectsofdiseaseinthe physical,emotional,environmental,social,andspiritualrealmsthatmaynotbeisolatedusingstatistics

WesternMedicine/Research IndigenousMedicine/ResearchContinued

Intellectisprimary;medicalpractice/research isbasedonscientifictheory

Intuitionisprimary;healing/researchisbasedonspiritualtruthslearnedfrom,nature,elders,andspiritualvision

Thephysician/researcher isanauthority

Thehealer/researcher isahealth/research counselorandadvisor

Bartgis,2017- AdaptedfromHonoringtheMedicine,KennethCohen,2006

CurrentChallengesinConductingResearch/Evaluation

• NoAI/ANparticipationinresearchdesign/IRB• Expectedresearchoutcomesoftenconflictwithtribalinterventionsand/ordesiredoutcomes

• NationalevaluationtoolsandmethodsconflictwithIndigenousWaysofKnowing (i.e.,beliefs)

• FlawedstudieswithlimitedtonoscientificallyvalidtoolsforusewithAI/AN

• Highlytraumatizedpopulationvulnerabletoretriggeringoftraumaresponseandothernegativeoutcomes,suchasaccessbarriers

WhatisCommunity-BasedParticipatoryResearch?

• Empowers thecommunitytosolvetheirownproblemsusinglocalknowledge

• Creates equalpartnershipbetweenscientistsandthecommunity

• Buildslocalcapacityforevaluationsothecommunitycandoitthemselves

• Involves thecommunityinalllevelsofevaluation• Integrates evaluationintothecommunity’scontextand

events• Values youthandfamiliesasexpertsontheirownlives

andtheircommunity

CommonOutcomesSystem• QualityImprovement• ProcessImprovement• LeveragedFunding• Increasedsustainability

Community• WorkforceDevelopment• Youth/FamilyDrivenCare

– Confidence– PublicSpeaking– Education/Skills

• IncreasedAccesstoCare• ImprovedCultural

Competence

GatheringofNativeAmericans

• 4-DayYouthandCommunityGathering– Belonging– Mastery– Interdependence– Generosity

• Linkagestoreferralsandlocalyouthcenters

NCUIHNAHC

OaklandFAIHPFresno

SystemofCare(SOC–5years)

10YearsofGONAImplementation

RequestingEvaluationSupport

forGONA

CirclesofCare(COC–3years)

PreparingforFirstGONAEver

COCSpecialActivitiesNeedsAssessmentProcessEvaluationGONAProcess

PlanningCalls:Outcomes

MethodologyAssessmentTools

Trainings

Worldview:Strength-based

RelationalHolistic

Youth-Friendly

Cross-SiteYear1

ComponentsBelonging

– UrbanIndianHealthOrganizations– Familieswithsimilarhistoriesandchallenges

Mastery– Needtobuildcapacityinevaluation– Needtoimprovethehealthofthecommunity

Interdependence– Moreresourcestogetherthanapart– Advancementofone;advancementofall

Generosity– Sharingtoolsandresources– Sharingworkloads

StartfromtheBeginning…

• Worldview—TribalandYouthCultures–Relational vs. Individual– Strength-basedvs. Deficit-Based–Holisticvs. Segmented– Youth-friendlyvs. Adult-friendly

Community-DrivenOutcomes

• HopefortheFuture• StrongSenseofEthnicIdentity• Feelingconnectedtofamilyandcommunity

• Volunteerism

DevelopingMethodology

YouthAssessment• Pre-GONA• Post-GONA• 6-monthfollowup

ParentAssessment• 6-monthfollowup

StaffandVolunteerAssessments• 6-monthfollowup

IdentifyingMeasurementStandardizedTools

– HerthHopeIndex(HHI)– Multi-EthnicIdentityMeasure(MEIM)

Non-StandardizedTools– GONAYouthTool(pre-,post-,and6-months)

• GONAcomponents• CommunityandFamilyConnection• SatisfactionandImpact

– GONAParentTool– StaffandVolunteerTool

TrainingProtectionofHumanParticipants

– UniqueIdentifiersandMasterlist– ProtectionofData

Methodology– PreandPost

EvaluationQuality– ReliabilityandValidity– Standardization(methodsandtools)

UnderstandingDataAnalysis– T-testforDependentSamples– IntrotoANOVAandregression

StudyOutcomes• Annualevaluations• Longitudinalstudy(3years)

– Master’sThesis,CarolynKraus,Berkley– PublicationinPreparation

• Cumulativeeffectonhopeforthefuture• Increasedfeelingsofethnicidentity• Increasedfeelingsofconnectiontocommunity• Improvedpro-socialbehaviors

ProjectOutcomes

Valuingevaluation• Reducingfearanduncertainty• Identifyingusesforpositivegrowth• Increasingevaluationlanguage

CapacityBuilding• Increasingmethodologyanddatacollectionskills• ImplementingQualityImprovement/GONAtoolkit

LeveragingResources• GONAdonations,contributions,andfunding• Increasedpartnersandvolunteers

EnergyFollowsThought

Community-BasedParticipatoryResearchOutcomes

GatheringofNativeAmericansFidelityTool

• Trainingonimportanceoffidelity• UsingGONAfacilitatorstodevelopfidelitytool• Testingacross3sites

“Even[without]aresearchproject,I’mstillgoingtousethefidelitytool.”

– GONAfacilitator

FresnoNativeYouthCouncilPersonalBalanceTool

AdaptedfromAdultVersion– Strength-Based– Holistic– Youth-Friendly

PilotTested– Youthadministeredtoover100youth

– SmallFocusGroupsPublishedin2016

SAMHSAServicetoScience

• RetrospectiveStudy– DeterminedMethods– DevelopedSurveys– PilotedTools– RevisedTools

• DevelopedIRBApplication

ReplacingtheMulti-EthnicIdentityMeasure

• CulturalConnectednessScale-Revised– StandardizedonFirstNationsYouthinCanada– RevisedandtestedinCaliforniabytheNativeAmericanHealthCenter,Inc.

– Adaptabletodiversetribalcommunities

GatheringofNativeAmericansCrossSiteStudyToday

• 6YearsofLongitudinalDataCollectionfromNAHCandFAIHP,nowsupportedbyCCUIH

• FundingfromCaliforniaReducingDisparitiesActinitiativetosupportsystematicmulti-communitybaselinestudy– Adding2newGONAcommunitiesthisyear– PreparingforGONARetrospectiveStudy

EvaluatorObservations:WhatWorked• Focusingonyouth,families,andmission• Beingflexibleandjoiningthecontext• Involvingcommunitytoincreasereliability,validity,anduseofdata

• Includingstrength-basedmeasurementmadeiteasyandwasembracedbycommunity

• On-the-groundsupportindatacollectioniscritical• Ongoingtrainingisnecessaryandsignificant,butresultsinagrowingNativeworkforce

LessonsLearned• CBPRtakesmoreresourcesupfront,butrewardsaregreat

• Needadequateresearchfundingforcommunitybestpractices

• Aculturally-basedapproachmeansmakingrealchangesacrossalllevels§ Policy=Practice=Evaluation

• CBPRisaninteractiveprocessthatisitselfaninterventionthatproducesoutcomes

• Youthbringthecommunitytotheproject

Balance

• Mind• Heart• Body• Spirit

Questions/Comments?

• TorequesttoolsorresourcesfromtheGONACross-SiteStudy– drbartgis@onefireassociates.org

Presenter:JamiBartgis,Ph.D.CherokeeNationofOklahomaOneFireAssociates,LLCdrbartgis@onefireassociates.org

Facilitator:BernadetteEchoHawk,CommunicationsCoordinator,SAMHSATribalTTACenter,bcechohawk@tribaltechllc.com

Honoring the GONA through Evaluation

Tribal Training and Technical Assistance Center Website: http://www.samhsa.gov/tribal-ttac

Email: TA-Request@tribaltechllc.com

We will be sending out a brief participant feedback questionnaire shortly after the webinar. We greatly appreciate any input you are willing to provide. Thank you for attending today!