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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
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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
Goal of this State Initiative: Goal of Providers of American Indian Health Services: Goal of American Indian Communities: Programs that work
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
Selecting Practices that Work—Two Routes: Imported or Home-grown Imported • Findproven practice • Adopt proven practice • Adapt proven practice for local use Home-Grown • Describe an unproven, existing,local practice • Evaluate local practice • Modify, if needed
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
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
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
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
4. Evidence-basis for the Tribal Practice:Historical/Cultural Connections
Historical Connections Coast Salish Canoe Journey 2008 USGS photo White Bison, Sweat Lodge in Prison http://www.whitebison.org/prisons/Reentry%20Package.pdf
Longevity: the Grandmother Test Grandmother approves of the fedora…
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 )
Values • Clan • Harmony • Holism • Acceptance • Taboos • Communal Property • Work as necessary • Now-orientation
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 )
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
Community Evaluation • Cruz: “Our elders and community members will let us know if we are not doing it right.” • “Client satisfaction” measures
5. Basic Problems (or Goals) Addressed by this Tribal Practice
6. Target Population(List the primary populations to be served)
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”)
8. Personnel • Elders • Medicine people • RNs • MDs • Counselors • Volunteers • Peer volunteers
10. Materials • Canoe • Billboards • Horses • Lodge (sweat) • Drums • School auditorium • Camp ground Sacred or hard-to-get: • Eagle feathers • Artifacts
11. OptionalElements:Other items that are not necessary to implement the program but which facilitate the Tribal Practice (e.g., food)