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

04/21/23 1

PROGRAMS THAT WORK

Goal of this State Initiative:

Goal of Providers of American Indian Health Services:

Goal of American Indian Communities:

04/21/23 2

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 Practices04/21/23 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

04/21/23 6

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 photo04/21/23 11

Longevity: the Grandmother Test

Grandmother approves of the fedora…

04/21/23 12

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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13. Contact person

Person

Phone

e-mail

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