Servant Leadership and Advocacy Plan
Clinicians seeking to serve the health needs of American Indian/Alaska Native (AI/AN) communities would be most helpful by supporting existing community efforts to develop and demonstrate evidence for traditional healing-based programs. Many AI/AN communities already have well-established and effective treatment and prevention practices, but they lack the resources and funding necessary in order to fully meet community needs. This is a result of various policies which prevent these programs from implementing licensing, credentialing, and reimbursement options for traditional healers, as well as culturally appropriate research to legitimize their practices and holistic services that align with their cultural values.
These policies, written from a White, European-American, heterosexual, male perspective, are rooted in a long history of cultural oppression and suppression, and are therefore inherently restrictive in their scope of appropriate standards for research, evidence, and practice. As a result, funding and resources are often withheld and reserved for the dominant group, and AI/AN communities, among others, are prevented from practicing perfectly effective healing methods simply because they do not fit into the dominant conceptualization of health and wellness.
As clinicians with a vested interest in social justice, one of the ways we can best serve AI/AN communities is by arguing for policy changes that would allow traditional healers to practice unencumbered by systemic colonization. Creating licensure and credentialing for traditional healers who may not have a degree but who have years of experience would create a pathway for the implementation of federal, state, and local reimbursement mechanisms. Further, helping to secure funding for research with a focus on practice-based evidence would allow these programs to operate in a way that aligns with the community’s values.
With more secure funding, these programs would be able to accommodate barriers that many AI/AN individuals face when seeking traditional healing, such as providing transportation and integrating behavioral and primary health care into a holistic model. A holistic approach to health and wellness can help reduce stigma because it aligns with the AI/AN cultural value of interconnectedness. School-based health centers can be particularly effective in this regard because they are in a non-stigmatized setting and can implement prevention programs such as recreational activities and employment services. This also makes services more accessible and can increase the likelihood of their use, helping to bridge the gap for urban AI/AN who may otherwise be unable to access traditional services in tribal communities.
Beyond fighting for major policy changes that would serve the needs and interests of marginalized communities on a larger scale, clinicians can advocate for their AI/AN clients in smaller ways by becoming familiar with local cultural resources that can connect them to their roots. Research has shown that a strong sense of cultural and spiritual identity can be a major protective factor, and for many AI/AN individuals, this is interconnected with the physical, mental, and emotional aspects of wellness. Connections with tribal communities and learning the ancient ways is thought to be instrumental in AI/AN youth’s positive development, and clinicians can help meet this need by developing the ability to facilitate these connections.
Mental health agencies interested in becoming more invested in helping to meet the needs of AI/AN communities might consider a collaborative partnership with a tribal community. In this type of relationship, the agency and tribal members would work together to develop and implement effective, holistic, accessible programs that are designed specifically for the community or communities they serve. This particular approach is a much higher level of service and requires that the agency be fully culturally competent and self-aware, because a truly collaborative partnership must be based on honesty, acceptance, and mutual respect. Sadly, mental health agencies are not known for these qualities among marginalized groups, so those interested in this level of involvement must be prepared to show up to the table again and again, and they must learn to close their mouths and listen.
References
Goodkind, J. R., Ross-Toledo, K., John, S., Hall, J. L., Ross, L., Freeland, L., Coletta, E., Becenti-Fundark, T., Poola, C., Begay-Roanhorse, R., & Lee, C., (2010). Promoting healing and restoring trust: Policy recommendations for improving behavioral health care for American Indian/Alaska Native Adolescents. American Journal of Community Psychology, 46, 386-394.
Hartmann, W. E., & Gone, J. P., (2012). Incorporating traditional healing into an urban American Indian health organization: A case study of community member perspectives. Journal of Counseling Psychology, 59(4), 542-554.
Indigenous cultural and spiritual traditions represent many rich and diverse forms of human expression, and they have long served as vital sources of healing for indigenous communities across generations. The U.S. government explicitly forbade many of these traditions in the late 19th century, and American Indians/Alaska Natives (AI/AN) have had to continuously fight against systemic barriers to reclaim and revitalize their cultural and spiritual healing practices (Goodkind et al., 2010). Meanwhile, in its quest for evidence-based practices, Western psychology largely excludes both AI/AN participants and their traditional healing practices from research, resulting in the ongoing application of culturally inappropriate treatment and interventions with this population (Goodkind et al., 2010).
Many of the challenges AI/AN communities face are structural and systemic, as they are primarily related to social and political factors such as oppression, racism, barriers to quality healthcare, disregard for effective indigenous practices, and historical issues of trust and power (Goodkind et al., 2010). Therefore, these communities would be better served if the Western mental health system found ways to support their cultural revitalization and traditional healing practices, rather than encouraging them to adapt within the Western understanding of wellness (Goodkind et al., 2010). In particular, the Western mental health system can shift its focus from evidence-based practice to practice-based evidence in order to recognize and honor the effectiveness of ancient healing traditions, thereby opening the door to advocate for the training, licensure, and fair reimbursement of traditional healers (Goodkind et al., 2010).
The photo above was taken at the 2017 Chumash Day Powwow and Intertribal Gathering, an annual event held in Malibu, California to celebrate native heritage, to socialize, and to heal as a community. A powwow is an ancient ceremonial gathering and includes traditional song and dance performed ritualistically for celebratory and healing purposes, although many of these dances remained illegal until very recently. The woman in the photo is performing the Fancy Shawl Dance, which is meant to symbolize tall fields of grass blowing in the wind, while the man is performing the Men’s Traditional Dance, which symbolizes a warrior preparing for battle.
I chose this photo because it visually represents the strength and resilience of AI/AN cultures, while also drawing attention to the healing power of a strong cultural and spiritual identity. Literally, the image captures a celebration of cultural revitalization and demonstrates the importance of connecting to our ancestral roots. Symbolically, it captures the power of healing through movement to the rhythmic beat of a drum, as this mirrors the beat of your heart and connects you to the nature of your existence.
This image artfully captures the systemic challenges that Native Americans have faced throughout history, and continue to struggle against today. This is a photo taken at Standing Rock Reservation on September 6, 2016, right after the water protectors had successfully halted work on the Dakota Access Pipeline (Silversmith, 2016). I chose this photo because it depicts both their struggle and their resistance, which are integrally linked throughout Native American history, as they have been fighting against the same systemic challenges, called by various names, for generations.
The Dakota Access Pipeline was to be constructed upstream from the reservation underneath the Mississippi River, posing a great threat to the reservation’s drinking water, as well as various sacred sites along the pipeline’s route (Silversmith, 2016). This is representative of ongoing systemic challenges because it illuminates the ultimate clash of values between cultures, as well as the dominant culture’s tendency to “bulldoze” over marginalized communities in the name of progress (Miranda, 2017). Construction of this pipeline threatened not only the community’s physical health and access to clean water, but also their emotional and spiritual well-being, which is intimately connected to Mother Earth and a deep respect for the sacredness of nature. The blatant disregard of native voices is just one example of the oppression they face every day, while this gathering to protect the sacred demonstrates their ongoing resilience and highlights the strength of indigenous cultures, who are still very much present in this world (Miranda, 2017).
References
Miranda, C. A. (2017). The artist who made protectors’ mirrored shields says the ‘struggle porn’ media miss point of Standing Rock. LA Times. Retrieved from: http://www.latimes.com/entertainment/arts/miranda/la-et-cam-cannupa-hanska-luger-20170112-story.html
Silversmith, S. (2016). The Standing Rock Sioux ‘know what they’re doing’ in North Dakota. PRI’s The World. Retrieved from: https://www.pri.org/stories/2016-09-12/standing-rock-sioux-know-what-theyre-doing-north-dakota
Goodkind, J. R., Ross-Toledo, K., John, S., Hall, J. L., Ross, L., Freeland, L., Coletta, E., Becenti-Fundark, T., Poola, C., Begay-Roanhorse, R., & Lee, C., (2010). Promoting healing and restoring trust: Policy recommendations for improving behavioral health care for American Indian/Alaska Native Adolescents. American Journal of Community Psychology, 46, 386-394.
This article is a literature review on the mental health of AI/AN youth. The authors identify seven distinct causes of the behavioral health disparities and challenges AI/AN youth currently face, as well as recommend seven policy changes that seek to transform the current systems in order to meet their needs. The disparities and challenges discussed are widely supported, and the solutions proposed are relevant and practical, offering guidance on how professionals can really make a difference for this underserved population. The authors cite a number of Native researchers and providers, including relevant literature and a plethora of Native voices to demonstrate both the needs of AI/AN communities, as well as effective solutions to the ongoing systemic challenges they face. There are several citations that warrant further exploration:
- Goodkind, et al., (2008) Project TRUST: Report and recommendations for enhancing the well-being of Native American youth, families, and communities. New Mexico: Department of Health, Office of School and Adolescent Health.
- White Bison (2001). Developing culturally-based promising practices for Native American communities.
- Cruz & Spence (2005). Oregon tribal evidence-based and cultural best practices. Oregon Department of Human Services.
- Alaska Native Tribal Health Consortium, Behavioral Health Aide Program to train, certify, and supervise local behavioral health workers to address concerns in remote Alaska Native Villages. (Being adapted for New Mexico as well)
The author’s main argument is that AI/AN are disproportionately affected by systemic problems within western behavioral health care, such as fragmented, underfunded, and culturally inappropriate services, as well as a lack of access to additional resources necessary for youth, families, and communities to thrive. Due to past and current, structural and political oppression, racism, and discrimination, AI/AN communities face tremendous barriers to practicing or accessing the healing traditions of their ancestors. Rather than integrating Native American cultural teachings and practices into Western behavioral health systems, the current systems must find ways to support Native healing practices and cultural reclamation programs. There is ample evidence, both ancient and modern, that suggests the efficacy of traditional cultural and spiritual healing practices. It is time to allow these practices to be legitimized so that Native American communities across the U.S may benefit from them. For the purposes of this assignment, each of the seven policy changes recommended are clear action steps toward serving this population. Further, these recommendations are based on Native research and voices, meaning that they are not only doable, but meaningful.
Hartmann, W. E., & Gone, J. P., (2012). Incorporating traditional healing into an urban American Indian health organization: A case study of community member perspectives. Journal of Counseling Psychology, 59(4), 542-554.
The purpose of this study was to explore community member perspectives regarding the integration of traditional healing practices into current services offered by the Urban Indian Health Organization (UIHO) in their community, particularly because urban communities have distinct needs from reservation communities. The second author facilitated four focus groups, each with 6 – 8 community members: 17 females and 9 males, ranging in age from early 20’s to early 60’s, and representing many tribes. Open-ended questions focused on participants familiarity with, experiences with, and attitudes toward traditional healing, as well as the specific healing activities of interest and the conditions under which they are deemed helpful. The author’s chose a qualitative approach in order to allow for the accurate representation of participants’ knowledge and life experiences, including differences held among them. Conversations were transcribed and subject to multiple layers of analysis and revision, involving several different people and continuous reflection on potential biases, in order to determine the coding and categorization of the information obtained.
Community members indicated four ways they would like to see traditional healing practices integrated into existing services: (1) ceremonies from a variety of tribal backgrounds (2) education on cultural practices and traditions from varying tribal backgrounds, (3) culture keepers who both provide education and practice traditional healing, and (4) community cohesion to ensure effective and safe integration. Their conversations also illuminated four distinct tensions that must be considered before incorporating these components: (1) traditional healing protocols versus realities of impoverished urban living, (2) multitribal representation versus relational consistency with culture keepers, (3) enthusiasm for traditional healing versus uncertainty about who is trustworthy, and (4) the integrity of traditional healing versus the appeal of alternative medicine. The authors suggest that mental health agencies and professionals research nearby cultural resources for their AI clients as a simple and effective solution to help meet this need, as the training and competence required to provide traditional services may be impractical. For those agencies and professionals willing and able to modify their services to better serve urban AI clients, the results indicate the importance of involving community members and becoming familiar with local discourses of identity, culture, tradition, and healing.
Running Bear, U., Garroutte, E. M., Beals, J., Kaufman, C. E., & Manson, S. M., (2018). Spirituality and mental health status among Northern Plain tribes. Mental Health, Religion, & Culture, 1-14.
The purpose of this study was to examine the relationship between American Indians mental health status and two measures of spirituality: one conventional measure developed for use with the general population, and one tribal cultural spirituality measure developed in consultation with AI community members. Previous research has long shown that spirituality is associated with positive mental health outcomes, but most of this research has excluded AIs and does not focus on their unique spiritual values and beliefs. This study hypothesized that the conventional measure would not show a significant association with AI mental health status, whereas the tribal measure would.
Secondary data analysis was performed on data collected from the AI-SUPERPFP, which assessed the prevalence of alcohol, drugs, and mental disorders as well as service utilization in two distinct AI populations located in the Northern Plains and Southwest, and included the two measures of spirituality. Results of this analysis confirmed each of the proposed hypotheses, and suggest the importance of conceptualizing spirituality in a way that is meaningful to AI people when attempting to measure its relationship with mental health status.
Implications for the purposes of this assignment include the emphasis placed on traditional spiritual beliefs and their importance to the mental health and well-being of American Indian individuals and communities. It will be important to consider the wide variation in spiritual beliefs across tribes, and to understand that a measure developed for one community may not be appropriate for another community. This article further stresses the importance of involving AI community members in the development of measures and research practices.
West, A. E., Williams, E., Suzukovich, E., Strangeman, K., Novins, D., (2012). A mental health needs assessment of urban American Indian youth and families. American Journal of Community Psychology, 49, 441-453.
The purpose of this study was to examine community mental health needs in an urban population of AI youth and families as part of the planning process for a sustainable system of care. Using relevant literature, the authors demonstrate a need for systems/policy changes to support behavioral health care in AI communities while ensuring that they are consistent with core values and philosophies across all communities.
Using the Community Story Framework (The Four Worlds Centre for Development Learning, 2000) as a tool for participatory analysis in AI communities, researchers conducted 16 focus groups assessing three main domains: (1) the mental health/positive development needs of urban AI youth in Chicago, (2) the available support systems, mental health services, and service utilization, and (3) potential cultural and historical parameters that might drive the development of innovative service approaches to meet community needs. Each group had 6-12 participants, including 107 youth and families organized by age group and mixed genders (66% female), with 41% under the age of 25, 14% under the age of 18, and 18% community elders.
Eight core domains of interest were selected for analysis, including community characteristics, community demographics, indicators of health and mental health, risk and protective factors, definitions of mental illness, service system needs, barriers to accessing services, and acceptability of existing services (see Table 1, pg 445 for themes that emerged). Based on these analyses, the authors discuss four themes relevant to systems change for AI communities, and go on to suggest practical ways of implementing these changes: (1) the need to address the role of historical trauma and internalized oppression in shaping divisions within community and affecting a community’s readiness for change, (2) the importance of extensive community mobilization efforts to address community politics, factions of the community, and organizational alliances, (3) the need to honor locally-meaningful conceptualizations of mental health and wellness, and (4) the need for community-based and culturally-relevant clinical services and programs.
Yellow Horse Brave Heart, M., Chase, J., Elkins, J., Martin, J., Nanez, J., & Mootz, J. J., (XXXX). Women finding the way: American Indian women leading intervention research in native communities. American Indian and Alaska Native Mental Health Research, 23(3), 24-47.
This article, written by leading American Indian female researchers, addresses the ways in which traditional roles and modern challenges for AI women impact their federally funded and culturally grounded behavioral health intervention research in Native communities. It details the authors’ collaborative processes with both the Native communities for whom they are developing the interventions, as well as the often-competing demands of mainstream academic environments. The article discusses the challenges they face in negotiating and implementing culturally grounded research practices, likening it to whitewater rafting. It ends with recommended strategies for successful engagement with AI/AN communities to support and enhance resilience (pg 35).
- E.g. practice cultural humility, recognize and respect traditional knowledge and wisdom, have contingency plans, be prepared to play multiple roles, patience and flexibility, know that ongoing trauma and loss will impact research, and focus on sustainability as much as possible.
Note: pg 34 addresses voices of non-AI/AN women allies who support the research, and stresses the value their perspectives add to both methodological processes and outcomes.