Indigenous Models of Evidence-Based Practice

1. Indigenous Models of Evidence-Based Practice Oregon’s Tribal Best Practices Initiative Indigenous Evidence-Based Practice

2. Presenters One Sky Center DHS/AMH Caroline M. Cruz, BS, CPS, CPM (Warm Springs) John Spence, MSW, PhD (Gros Ventre) Jason Yarmer, BS, CPS (Chippewa) • Douglas A Bigelow, PhD • R. Dale Walker, MD, (Cherokee) • Michelle J. Singer, BA (Navajo) The Nine Tribes of Oregon • Burns Paiute Tribe • Cow Creek Band Of Umpqua Indians • Confederated Tribes Of Coos, Lower • Umpqua & Siuslaw • Confederated Tribes Of Grand Ronde • Coquille Indian Tribe • Klamath Tribes • Confederated Tribes Of Siletz • Confederated Tribes Of Warm Springs • Confederated Tribes Of Umatilla Indigenous Evidence-Based Practice

3. The Scenario • Mandate: Evidence-based Practices • Problem: bad fit of EBP in Indian Country • Response: Tribal Best Practices Initiative • Understand Culture-Based Practice • Design Tribal Best Practice Process • Implement TBP Initiative Indigenous Evidence-Based Practice

4. Government Office of Money In God we trust, …others please provide Evidence! Indigenous Evidence-Based Practice

5. The evidence-based practice movement Indigenous Evidence-Based Practice

6. The EBP Movement Matures • What EBM is, and what it isn’t (BMJ) • Expertise plus research • Multiple streams of evidence (COCE/SAMHSA) • Experience + client factors + research • Learning healthcare system (IOM) • Continually increasing knowledge and skill • Best Practices = • Science + Service+ Indigenous knowledge Indigenous Evidence-Based Practice

7. Evaluability • Program planning and evaluation • (repertoire of techniques) • Program theory and clarification • Input-process-outcome • The Logic Model Indigenous Evidence-Based Practice

8. Service to Science: What Service Knows Best Indigenous Evidence-Based Practice

9. Service-Based Knowledge Addresses Critical Context • Rural vs. urban setting • Resources (electricity; water) • Physical condition of participants • Spiritually- vs. materially-oriented participants • Belief of participants • Belief of personnel • Context and culture Indigenous Evidence-Based Practice

10. Service-Based Knowledge Addresses Crucial Behavioral Health Variables • Choice • Self-healing belief guided by expert healer • Unique interpersonal relationships • Complex webs of inter-related and reciprocal factors Indigenous Evidence-Based Practice

11. Service-Based Evidence: The Refinement Process • Assembled experts • Published research • Practice experiences • Debate quality and meaning of info • Formal consensus process: conclusions Indigenous Evidence-Based Practice

12. Service-Based Evidence: Dissemination • Guidelines • Standards • Resource materials • Strategic plans • College curricula, courses, texts Indigenous Evidence-Based Practice

13. Culture-Based Evidence Indigenous Evidence-Based Practice

14. Why Understand Epistemology of Culture-Based Practices? • Develop new CBP • Validate proposed CBP • Culturally appropriate tests of what works • Cross-walk to EBP and PBP • Disseminate and improve CBP • Empower indigenous knowledge Indigenous Evidence-Based Practice

15. Culture-Based Prevention & Treatment: Activities • Experience, observation, listening, participating • Traditions, ceremonies, daily observances • Stories, songs, artwork • Oral, modeling, practice, animation • Language, worldview, teachings, experience Indigenous Evidence-Based Practice

16. Culture-Based Health Practices: Materials • Settings • Dress; Regalia • Symbols; Graphics; Pictures • Sensory Substances • Food • Fun Indigenous Evidence-Based Practice

17. Culture-Based Health Practices: Personnel • Enthusiasm, confidence • Caring, compassion • Vision, knowledge • Charisma • Credibility • Community status • Peer group status Indigenous Evidence-Based Practice

18. Indigenous Health Practices: Immediate (Proximal) Outcomes • Balance • Connection • family, culture, community, natural world, spiritual world • Identity • Meaning • Power and hope • Self-esteem • Community norms, adaptive capacity, sharing and support Indigenous Evidence-Based Practice

19. Indigenous Health Practices: Distal Outcomes (NOMS) • Reduced morbidity; mortality • Social participation • Reduced ATOD • Employment; education • Well-functioning families • Reduced criminality • Mental health Indigenous Evidence-Based Practice

20. The Oregon Tribal Best Practices Initiative Indigenous Evidence-Based Practice

21. Problem with the EBP Mandate • Developer training & fidelity testing: alien • “Core components” concept: not adaptable • Exogenous programming: not credible • Loss of the familiar and accepted • Personnel, training, and testing capacity: non-extant • Versus sovereignty and consultation Indigenous Evidence-Based Practice

22. Items Described for Tribal Best Practice • Replications • Culture-based Evidence • Goals • Target population • Risk and protective factors • Tribal personnel • Activities • Materials • Optional Elements • Outcomes Indigenous Evidence-Based Practice

23. Evidence for Validity of TBPCriteria • Longevity • Teachings (based on) • Values (based on; incorporated) • Principles (based on; incorporated) • Elder’s approval • Community feedback/evaluation/acceptance • Contribution to advancement of the people Indigenous Evidence-Based Practice

24. Tribal Best Practices Under Review • Horse Program • Storytelling • Basketball Against Alcohol and Drugs (BAAD) • Elder-based Family Mediation • Cultural Sobriety Recognition Dinner • Powwow Indigenous Evidence-Based Practice

25. Horse ProgramCultural Evidence: Longevity of the Practice • Role of horses stretches back several hundred years • Tribal stories; old pictures of Native Americans and horses; use by plains Indians for hunting, transportation and warfare Indigenous Evidence-Based Practice

26. Horse ProgramCultural Evidence: Teachings • Native Americans learned from animals; animal characters used as teaching tools Indigenous Evidence-Based Practice

27. Horse ProgramCultural Evidence: Values • Respect • Patience • Personal responsibility • Generosity • Communication Indigenous Evidence-Based Practice

28. Horse ProgramCultural Evidence: Principles • Mentoring • Relating with the natural world • Commitment to others • Leadership skills • Being compassionate • Calmness and self-control in presence of greater power Indigenous Evidence-Based Practice

29. Horse ProgramCultural Evidence: Elders’ Approval Indigenous Evidence-Based Practice

30. Horse ProgramCultural Evidence: Community feedback/acceptance • Individual stories of youth and family • Tribes requesting program • Tribal satisfaction survey • Feedback from referring agent Indigenous Evidence-Based Practice

31. Horse ProgramReplications • Equine assisted psychotherapy (www.eagla.org) • Mustangs offering hope and renewal (www.charityblosson.org ) • Tribal horse programs in three other locations in OR. Indigenous Evidence-Based Practice

32. Horse ProgramGoals • Criminal behaviors reduced • Mental health problems reduced • Suicide ideation and attempts reduced • School tenure and academic improvement Indigenous Evidence-Based Practice

33. Horse ProgramRisk and Protective Factors • Drug free activity • Involvement in cultural practice • Bonding and positive relationships • Re-uniting with family • Learned patience, respect, personal responsibility • Academic progress • Recognition Indigenous Evidence-Based Practice

34. Horse ProgramPersonnel • Named, passionate program advocate, promoter, and implementer • Named individuals trained and experienced with horses Indigenous Evidence-Based Practice

35. Horse ProgramKey Elements (Activities) • Obtain tribal buy-in • Obtain referrals and subject’s buy-in • Incorporate into summer tribal camp • Teach horsemanship • Conduct ceremonies Indigenous Evidence-Based Practice

36. Horse Program Logic ModelMaterials • Special horses • Water, feed, and grain • Corrals, tack, and equipment • Covered arena (preferred) • Round pen Indigenous Evidence-Based Practice

37. Horse Program Logic ModelOutcomes Indigenous Evidence-Based Practice

38. Horse Program Logic ModelOutcomes Indigenous Evidence-Based Practice

39. Vision Indigenous Evidence-Based Practice

40. Lessons Learned: Plan for Advancing Culture-Based Practices Objective Action TPB form, suggestions, and instructions in logic model format Goals, activities, and outcomes in measurable terms Participation of Tribes in conceptualizing TBP in both C-B and evaluable terms • Develop a logic model • Understand evaluability • Increasing commitment to evaluation Indigenous Evidence-Based Practice