Tribal Practices The Good Ways of Providing Mental Health

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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, MD, Director
• Doug Bigelow PhD, Deputy Director
• Michelle Singer, Indian Country Methamphetamine
  Initiative Director
• Laura Loudon, Mentee Project Director
• 10 June 2009

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Programs that work

• Goal of this State Initiative
• Goal of Providers of American Indian Health
  Services
• Goal of American Indian Communities

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Practices that work Continuous Quality
Improvement
Adapt-Adopt new Practices
Panel Reviews Evidence
Site Visit by Previous Implementers
Site Visit Peer Review of Implementation
Describe, evaluate, modify existing Practices
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Selecting Practices that WorkTwo 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

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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 eldersparticipate
• Elders (transmitters of the culture)
• youth relearning Indian cultural values
• Most tribal values incongruent with AOD abuse

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 3. Other examples of this Tribal Practice
(Replications)
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4. Evidence-basis for the Tribal
PracticeHistorical/Cultural Connections
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Historical Connections
Coast Salish Canoe Journey 2008 USGS photo
White Bison, Sweat Lodge in Prison
http//www.whitebison.org/prisons/Reentry20Packag
e.pdf
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Longevity the Grandmother Test

• Grandmother approves of the fedora

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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.whitebis
  on.org/about/philosophy.html )

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Values

• Communal Property
• Work as necessary
• Now-orientation 

• Clan
• Harmony
• Holism
• Acceptance
• Taboos

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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-ma
  drona/mmtraditionalpaper.htm )

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Elders 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?crn180
rn387actionshow_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
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6. Target Population (List the primary
populations to be served)
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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)
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8. Personnel

• Counselors
• Volunteers
• Peer volunteers

• Elders
• Medicine people
• RNs
• MDs

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9. Activities
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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) 
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12. Outcomes
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13. Contact person