The hurt of one is the hurt of all



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  • “The hurt of one is the hurt of all”
  • Monica Roy, Ph.D. Boston
  • Daryl Fujii, Ph.D. Honolulu
  • Dellarina Garcia, Palo Alto
  • Nelupa Perera, Minneapolis
  • Melissa Corpus, Martinez
  • Samuel Wan, Ph.D. San Francisco
  • Rex Swanda Ph.D. Albuquerque

Committee 2011-2012

  • Committee 2011-2012
  •  
  • Daryl Fujii Ph.D., Honolulu (Co-Chair)
  • Rachael Guerra Ph.D., Palo Alto (Co-Chairs)
  • Angelic Chaison Ph.D., Houston
  • Jamylah Jackson Ph.D., North Texas
  • Monica Roy Ph.D., Boston
  • Melanie Scott Psy.D. West Haven
  • Rex Swanda Ph.D. Albuquerque
  • Sam Wan Ph.D., San Francisco
  • Miguel Ybarra Ph.D., San Antonio
  • Melissa Corpus, Martinez (Intern)
  • Dellanira Garcia Ph.D., Palo Alto (Postdoc)
  • India Gray-Schmiedlin Ph.D., Central Texas (Postdoc)
  • Sulani Perera, Minneapolis (Intern)
  •  

Terminology/caveats

  • Terminology/caveats
  • Heterogeneity/demographics
  • Ethnic identity
  • Health disparities
  • Clinical implications
  • Treatment implications
  • Cultural adaptations
  • Case presentation

American Indian and Alaska Native

  • American Indian and Alaska Native
    • The term often used in governmental matters
    • The term used in legal documents like the U.S. Constitution
  • Native American
    • A flexible term that is frequently used to refer to American Indians and Alaska Natives.
    • Both terms refer to the many populations groups that were living on the continent that became the United States of America

General information

  • General information
    • Numerous personal and subgroup differences
    • Great diversity within ethnic groups
  • Important to know about ethnic minority groups, more important to realize that it is limited information
    • Concerns about promoting cultural stereotypes or pigeon-holing people given ethnic group identification (Lopez, 2009)
  • Heterogeneity in the American Indian and Alaska Native Population
  • (AI/AN)

According to 2010 Census, the nation's population of American Indians and Alaska Natives, was 5.2 million, including those of more than one race (2.3 million).

  • According to 2010 Census, the nation's population of American Indians and Alaska Natives, was 5.2 million, including those of more than one race (2.3 million).
  • AI/AN account for 1.7 percent of the total population.
  • Between the 2000 and 2010 Census, the population increased by 26.7 percent compared with the 9.7 percent population growth overall.
  • The top 3 populous states are: 1) California (723,225), 2) Oklahoma (482,760), 3) Arizona (353,386)

There are 334 federal and state recognized American Indian reservations in 2010.

  • There are 334 federal and state recognized American Indian reservations in 2010.
  • 22 percent of American Indians and Alaska Natives lived in American Indian areas or Alaska Native Village Statistical Areas.
  • These American Indian areas include federal American Indian reservations and/or off-reservation trust lands, Oklahoma tribal statistical areas, tribal designated statistical areas, state American Indian reservations, and state designated American Indian statistical areas.

There are 565 federally-recognized Native American tribes.

  • There are 565 federally-recognized Native American tribes.
  • The Federally Recognized Indian Tribe List Act of 1994 provides a list of tribes that are recognized by the U.S. government
  • The following tribes reporting having 100,000+ members
    • Cherokee (819,105)
    • Navajo (332,129)
    • Choctaw (195,764)
    • Mexican American Indian (175,494)
    • Chippewa (170,742)
    • Sioux (170,110)
    • Apache (111,810)
    • Blackfeet (105,304)

There were 557,185 American Indian and Alaska Native families in 2010. 57 percent were married-couple families, including those with children.

  • There were 557,185 American Indian and Alaska Native families in 2010. 57 percent were married-couple families, including those with children.
  • The median age at first marriage for American Indian and Alaska Native for men and women (age 15 to 54) was 29.6 and 26.8 years old, respectively, in 2010.
  • For the U.S. population as a whole, the respective numbers were 28.7 and 26.7 years. The difference in the median age at first marriage between American Indian and Alaska Native women and women overall is not statistically significant.

28 percent of American Indians and Alaska Natives age 5 years and older spoke a language other than English at home, compared with 21 percent for the nation as a whole.

  • 28 percent of American Indians and Alaska Natives age 5 years and older spoke a language other than English at home, compared with 21 percent for the nation as a whole.
  • 73 percent of residents of the Navajo Nation Reservation and Off-Reservation Trust Land, (AZ-NM-Utah), age 5 years and older spoke a language other than English at home.

  • Native American
  • (Age 25 years and older)
  • Overall U.S. Population
  • (Age 25 years and older)
  • 77% reported having at least a high school degree
  • 86% reported having at least a high school degree
  • 13% reported having at least a bachelors degree
  • 28% reported having at least a bachelors degree
  • 41% reported their bachelors degree is in science or engineering or related fields
  • 44% reported their bachelors degree is in science or engineering or related fields

  • Native American
  • (2010 U.S. Census)
  • Overall U.S. Population
  • (2010 U.S. Census)
  • $35, 062 was reported as the median income
  • $50, 046 was reported as the median income
  • 28.4% reported being in poverty
  • 15.3% reported being in poverty

In 2009, there were 21.9 million Veterans in the United States (Infoplease, retrieved 2011)

  • In 2009, there were 21.9 million Veterans in the United States (Infoplease, retrieved 2011)
    • Non-Hispanic White 17.7 million
    • African Americans 2.3 million
    • Hispanic 1.1 million
    • Asian-Americans 258,000
    • American Indian or Alaskan Native 153,000
    • Native Hawaii or Other Pacific Islander 30,000
    • Female Veterans 1.5 million
  • (The numbers for blacks, Asians, American Indians and Alaska Natives, Native Hawaiians and Other Pacific Islanders, and non-Hispanic whites cover only those reporting a single race.)

Native Americans have the highest military service rate of any racial group per capita.

  • Native Americans have the highest military service rate of any racial group per capita.
    • In World War II, 40% of the Cheyenne and Comanche tribes served and greater than 30% of the Apache, Crow, Kiowa, and Sioux.
    • 90% of the Native Americans that served in the Vietnam War enlisted voluntarily for service and 42% served in heavy combat areas.

It is important to understand the impact that the unique history of Native Americans can have on the therapeutic relationship.

  • It is important to understand the impact that the unique history of Native Americans can have on the therapeutic relationship.
  • It is equally important to understand the worldview of the individual before entering into the therapeutic relationship.
  • History plays a major role in the development of identity and world view for many Native Americans.
  • Be aware that the cultural history might particularly impact the level of rapport and trust in the therapeutic relationship.
  • Native Culture
  • Dominant Culture
  • Harmony with nature
  • Mastery of nature
  • Present –time orientation
  • Future-time orientation
  • Cooperation
  • Competition
  • Anonymity
  • Individuality
  • Listening
  • Speaking
  • Shared wealth
  • Saving for future
  • Humility
  • Self-recognition
  • Extended family
  • Nuclear family
  • Intuitive
  • Logical
  • Cautious
  • Risk Taking Prescott (1991)

Native American children not only face the same developmental problems experienced by other children, but they may also feel in conflict over two vastly different cultures (Reickmann, Wadsworth, & Deyhle, 2004; as cited in Sue & Sue 2008).

  • Native American children not only face the same developmental problems experienced by other children, but they may also feel in conflict over two vastly different cultures (Reickmann, Wadsworth, & Deyhle, 2004; as cited in Sue & Sue 2008).
  • One study found that Native American adolescents identified family relationships, grades, and concerns about the future as serious problems for them. This study also found that boys frequently felt that their “Indianness” was a problem, and 1/3 of the girls in the study reported that they “did not want to live” (Bee-Gates, Howard-Pitney, LaFramboise, & Rowe, 1996; as cited in Sue & Sue, 2008).

Garrett and Pichette formulated model with five cultural orientation types for Native Americans.

  • Garrett and Pichette formulated model with five cultural orientation types for Native Americans.
    • Traditional – The individual may speak little English, thinks in the native language, and practices traditional tribal customs and methods of worship.
    • Marginal – The individual may speak both languages but has lost touch with his or her cultural heritage and is not fully accepted in mainstream society.
    • Bicultural – The person is conversant with both sets of values and can communicate in a variety of contexts.
    • Assimilated – The individual embraces only the mainstream culture’s values, behaviors, and expectations.
    • Pantraditional – Although the individual has only been exposed to or adopted mainstream values, he or she has made a conscious effort to return to the “old ways.”

DHHS Definition: Differences in health outcomes that are closely linked with social, economic, and environmental disadvantage - are often driven by the social conditions in which individuals live, learn, work and play.”

  • DHHS Definition: Differences in health outcomes that are closely linked with social, economic, and environmental disadvantage - are often driven by the social conditions in which individuals live, learn, work and play.”
  • “Even more than other areas of health and medicine, the mental health field is plagued by disparities in the availability of and access to its services. These disparities are viewed readily through the lenses of racial and cultural diversity, age, and gender” (DHHS, 1999, p.vi).

“Oppression, discrimination, and removal from traditional lands have contributed to Native peoples’ current lack of educational and economic opportunities and their significant representation among populations with high need for mental health care” (excerpt from Manson p. 11; U.S. DHHS, 2001).

  • “Oppression, discrimination, and removal from traditional lands have contributed to Native peoples’ current lack of educational and economic opportunities and their significant representation among populations with high need for mental health care” (excerpt from Manson p. 11; U.S. DHHS, 2001).
  • AI/AN populations show disproportionate rates of depression, trauma, substance use, suicide, and violent death (Gone 2007).
  • AI/AN populations face multiple social and economic risk factors that negatively impact their mental health and access to care, including homelessness, stigma, low education levels, extreme poverty, inadequate health care, and discrimination (Gone, 2004; U.S. DHHS, 2001)

From 1979 to 1992, the suicide rate of Native Americans was 1.5 times the national rate (U.S. DHHS, 1999)

  • From 1979 to 1992, the suicide rate of Native Americans was 1.5 times the national rate (U.S. DHHS, 1999)
  • Suicide is particularly common among young Native males ages 15 to 24 years old, accounting for 64% of all suicides by Native Americans. This rate is 2 to 3 times higher than the general U.S. rate (Kettle & Bixler, 1991)

Although Native Americans comprise less than 1% of the general population, they constitute 8% of the U.S. Homeless Population (U.S. Census Bureau, 1999).

  • Although Native Americans comprise less than 1% of the general population, they constitute 8% of the U.S. Homeless Population (U.S. Census Bureau, 1999).

Mental health services are severely lacking. Gone (2004) indicated that a large majority of the AI/AN population rely on the Indian Health Services (IHS) for mental health treatment. He further estimated that IHS employs approximately 2 psychiatrists and 4 psychologists per 100,000 people.

  • Mental health services are severely lacking. Gone (2004) indicated that a large majority of the AI/AN population rely on the Indian Health Services (IHS) for mental health treatment. He further estimated that IHS employs approximately 2 psychiatrists and 4 psychologists per 100,000 people.
  • Removal of children from their homes, which continues today, is a major risk factor for mental illness;
  • A study conducted in the 1970’s by the Association on Indian Affairs found that between 25 percent and 35 percent of all Indian children had been separated from their families (George, 1997).

In a study examining healthcare coverage and access disparities Johnson et al. (2010) found that AI/AN veterans have 1.9 times higher odds of being uninsured compared with non-Hispanic white veterans. Additionally, barriers to treatment are primarily due to inefficiencies in navigating the healthcare system and lack of transportation.

  • In a study examining healthcare coverage and access disparities Johnson et al. (2010) found that AI/AN veterans have 1.9 times higher odds of being uninsured compared with non-Hispanic white veterans. Additionally, barriers to treatment are primarily due to inefficiencies in navigating the healthcare system and lack of transportation.
  • When barriers to care in a low-income insured population were examined Call and colleagues (2006) found that compared to non-Hispanic White adults AI/AN adults were more likely to report problems accessing care due to racial discrimination, cultural misunderstandings, family/work responsibilities, and transportation difficulties (Call et al., 2006).

In a national study of Vietnam Veterans (Friedman et al., 1997) ethnicity greatly affected the lifetime rate of PTSD. Compared to Whites, the highest rates of PTSD were found among two Native American groups, one from the Southwest (45.3%) and one from the Northern Plains (57.2%).

  • In a national study of Vietnam Veterans (Friedman et al., 1997) ethnicity greatly affected the lifetime rate of PTSD. Compared to Whites, the highest rates of PTSD were found among two Native American groups, one from the Southwest (45.3%) and one from the Northern Plains (57.2%).
    • Rates of PTSD were also higher among Hispanics and African Americans compared to Whites.
  • Brinker et al. (2007) found that male American Indian and Hispanic Veterans who had combat-related PTSD delayed seeking treatment compared to Veterans with non-combat related PTSD.

Given the historical, sociopolitical, cultural, educational, and economic diversity among Native American tribes, it would be ideal – but not always feasible - for clinicians to research the veteran's tribe to familiarize him/herself with the veteran's background.

  • Given the historical, sociopolitical, cultural, educational, and economic diversity among Native American tribes, it would be ideal – but not always feasible - for clinicians to research the veteran's tribe to familiarize him/herself with the veteran's background.
  • Consider alternative sources of information beyond psychological journals, books, or literature.
    • Information from other disciplines such as anthropology, sociology, history, medicine, and religion can be valuable resources.
    • For those in close proximity, contact with Native American community and spiritual leaders could also be an important resource.
    • When in doubt, remember that it is usually OK to seek additional information from the client that might yield information about his or her unique cultural perspective.

A great general resource is the SAMHSA Culture Card for American Indian and Alaska Native. This free information can be downloaded for review before working with Native American clients:

  • A great general resource is the SAMHSA Culture Card for American Indian and Alaska Native. This free information can be downloaded for review before working with Native American clients:
  •  
  • http://store.samhsa.gov/product/American-Indian-and-Alaska-Native-Culture-Card/SMA08-4354
  •  
  • Among important information for clinicians provided on the card include:
    • communication styles,
    • self-awareness
    • etiquette.
  •  

 

  •  
  • The following are websites that describe more specific characteristics of Native
  • American tribes:
  •  
  • http://indiancountrytodaymedianetwork.com/native-american-healing
  • http://www.42explore2.com/native4.htm
  • http://nace.samhsa.gov/index.aspx
  • http://www.everyculture.com/
  • http://www.iwri.org
  •  

Worldview is how one views the larger world around them and their relationship to it.

  • Worldview is how one views the larger world around them and their relationship to it.
  • The worldview of Native Americans may be markedly different than the worldview of the larger dominant western culture.
  • The client’s views regarding God, a Higher Power, or spirituality, people, nature, the universe, and the phenomenon of life can provide a helpful way of understanding the client’s fundamental worldview.
  • Exploring “Creation” beliefs may help to begin exploring a client’s worldview
    • Ex: “What are your views about how the planet earth and life came into being?”
  • Native Culture
  • Dominant Culture
  • Harmony with nature
  • Mastery of nature
  • Present –time orientation
  • Future-time orientation
  • Cooperation
  • Competition
  • Anonymity
  • Individuality
  • Listening
  • Speaking
  • Shared wealth
  • Saving for future
  • Humility
  • Self-recognition
  • Extended family
  • Nuclear family
  • Intuitive
  • Logical
  • Cautious
  • Risk Taking Prescott (1991)

Tribes and their constituent programs are typically organized around these four core values:

  • Tribes and their constituent programs are typically organized around these four core values:
  • Being a good relative: Tribal communities govern and function through inclusive relational webs of mutual reciprocal exchange obligations based on kinship principles.
  • Inclusive Sharing: Good, resources, opportunities are redistributed throughout the community by sharing.
  • Contributing: The social system and its various components are designed so that each person can participate in as well as contribute to the community.
  • Non-Coercive Leadership: Leadership – and consequently influence and authority – springs from an assumption of responsibility for others rather than the ability to coerce or control.

Cultural self-awareness is "absolutely mandatory" for working with Native American veterans (Gone, 2004).

  • Cultural self-awareness is "absolutely mandatory" for working with Native American veterans (Gone, 2004).
    • Psychological interventions are "cultural artifacts" and based upon western cultural assumptions, world view, and values.
    • Western notions of "wellness, distress, disorder, and healing" may not fit those of Native American veterans, thus may not make sense to, or be accepted by the Native American veteran.
    • When working with a Native American veteran, clinicians need to be aware of their assumptions and personal biases (e.g. western values and treatments are superior and more effective than nonwestern traditions)
    • Gone, J. (2004). Mental health services for Native Americans in the 21st century United States. Professional Psychology: Research and Practice, 35, 10-18.
  • Native Culture
  • Clinical Implications
  • Anonymity
  • May be less likely to complain when not satisfied
  • Shared wealth
  • May utilize resources to help others in need, particularly family members, despite apparent personal imposition/paucity of resources
  • Family may look to share veteran’s benefits
  • Humility
  • Mild self-deprecating statements normal and not necessarily sign of low self-esteem
  • Extended family
  • Veteran may prefer to live with family vs. other independent/assisted living facility despite apparent better living condition/medical care
  • Native Culture
  • Clinical Implications
  • Harmony with nature
  • Allow things to proceed according to the idea that “things happen when they are supposed to happen”
  • Present –time orientation
  • Avoid frequently looking at watch and do not rush things
  • Emphasis on relieving distress in current situation
  • Less motivated by achieving long-term goals
  • Cooperation
  • Veteran may agree and passively not comply vs. openly disagree with treatment recommendations which conflict with values and beliefs

Clinicians should be aware of the concept and implications of historical trauma (Brave Heart, 2011).

  • Clinicians should be aware of the concept and implications of historical trauma (Brave Heart, 2011).
    • Historical trauma (HT) is defined as "cumulative emotional and psychological wounding across generations, including the lifespan, which emanates from massive group trauma"
    • HT has been associated with emotional distress, specifically depression and anger, and may impact risk for alcohol abuse
    • Related experiences to HT include the prohibition of indigenous burial practices and ceremonies until 1978 and compulsory Indian boarding school education that separated children from their parents
    • Brave Heart, M. Y. H., et al., (2001). Historical trauma among Indigenous Peoples of America: Concepts, research, and clinical considerations. Journal of Psychoactive Drugs, 43, 282-290.

Awareness that client suffers from emotional burdens due to past pain and trauma. Recognizes that addiction is a chief consequence of pain.

  • Awareness that client suffers from emotional burdens due to past pain and trauma. Recognizes that addiction is a chief consequence of pain.
  • Cathartic disclosure is an important aspect of recovery.
  • Initiate a life-long process of introspection to better understand self, one’s life, and behavior.
  • Reconceptualize life and experiences as an Aboriginal person in the context of European colonization.
  • Healing involves reclaiming Aboriginal identity through participation in indigenous cultural and spiritual practices.

Level of acculturation gleaned from past and current exposure to mainstream culture, living situation, and lifestyle.

  • Level of acculturation gleaned from past and current exposure to mainstream culture, living situation, and lifestyle.
  • Experience with, belief and trust in, and acceptance of, western forms of medical and psychological interventions.
  • Perception and beliefs pertaining to mental health issues including causes, distress, and effective treatments including beliefs about the role of traditional healers.
  • Current living situation and availability of familial or tribal social supports, and feelings about this situation.

Definitions of the self vary along a continuum between “egocentric” and “sociocentric.” Native Americans may relate more to the latter.

  • Definitions of the self vary along a continuum between “egocentric” and “sociocentric.” Native Americans may relate more to the latter.
  • Implication: Emotions might not be generated only from within oneself but reflect a Native American’s relationship to other elements of his/her universe.
  • Implication: It may be challenging to elicit individualistically oriented self-statements (e.g. “I feel blue” or “I fear things that I do not normally fear.”)
  • Shweder, R., & Bourne, E. (1984). Does the concept of the person vary cross-culturally? In Shweder, R. & LeVine, R. Culture theory: Essays on mind, self, and emotion. Cambridge, MA: Cambridge University Press, pp. 47-71.

Clinicians should consider potential differences in nonverbal communication among some Native Americans.

  • Clinicians should consider potential differences in nonverbal communication among some Native Americans.
    • NA may look down to show respect or deference to elders.
    • Ignoring an individual may indicate disagreement or displeasure
    • A gentle handshake is a sign of respect and not weakness
    • Body language, personal space, and speech patterns (e.g. tone, volume, rate, length of pauses) vary among tribes, thus the clinician should be vigilant and adapt behaviors appropriately
    • SAMHSA. (January, 2009). Culture card: A guide to build cultural awareness American Indian and Alaska Native . Retrieved December 1, 2011. http://store.samhsa.gov/product/American-Indian-and-Alaska-Native-Culture-Card/SMA08-4354

Native American clients may use humor to convey truths, difficult messages

  • Native American clients may use humor to convey truths, difficult messages
  • Smiles or jokes may be used to cover pain
  • Teasing the clinician may be a sign of rapport building or correcting in appropriate behaviors of the clinician. It is important to learn to laugh at yourself.
    • SAMHSA. (January, 2009). Culture card: A guide to build cultural awareness American Indian and Alaska Native . Retrieved December 1, 2011. http://store.samhsa.gov/product/American-Indian-and-Alaska-Native-Culture-Card/SMA08-4354

It is unacceptable for a NA to criticize another directly as it is considered disloyal or disrespectful.

  • It is unacceptable for a NA to criticize another directly as it is considered disloyal or disrespectful.
  • NA often communicate through telling a story (traditional and personal) which is in contrast to western “get to the point” mindset.
  • Allow NA client to tell their story before engaging in specific questioning.
  • Learn to be comfortable with long pauses in conversation
    • SAMHSA. (January, 2009). Culture card: A guide to build cultural awareness American Indian and Alaska Native . Retrieved December 1, 2011. http://store.samhsa.gov/product/American-Indian-and-Alaska-Native-Culture-Card/SMA08-4354

Given the potential for significant cultural differences in treatment, a collaborative approach is recommended (Gone, 2004), in which clinicians strive to respect and incorporate the client’s treatment preferences and goals.

  • Given the potential for significant cultural differences in treatment, a collaborative approach is recommended (Gone, 2004), in which clinicians strive to respect and incorporate the client’s treatment preferences and goals.
    • Many Native Americans "view disorders and healing in the context of spirituality and religious practice." Thus if possible, key members in the Native American community such as medicine persons and ritual leaders should be consulted.
    • Consider asking the client to help you understand how the symptoms might be treated within his or her traditional community.
  • Both therapeutic and counter-therapeutic effects of treatment should be assessed throughout the course of therapy.
    • Gone, J. (2004). Mental health services for Native Americans in the 21st century United States. Professional Psychology: Research and Practice, 35, 10-18.

Traditional healing and traditional medicine are an important part of treatment for Native Americans and are consistent with Native American beliefs.

  • Traditional healing and traditional medicine are an important part of treatment for Native Americans and are consistent with Native American beliefs.
  • The Department of Veterans Affairs National Chaplain Center developed a traditional healing policy that facilitated the incorporation of Native American healing practices and Medicine Men into the VA Healthcare System.
  • The National Center for PTSD (NCPTSD) created The Wounded Spirits, Ailing Hearts Training Manual in 2000, to help practitioners understand and address the unique needs that may be present when dealing with Native American Veterans.
    • http://www.ptsd.va.gov/professional/manuals/wounded-spirits-ailing-hearts.asp

In 2003, the Indian Health Service (IHS) and the Veterans Health Administration (VHA) entered into a Memorandum-Of-Understanding (MOU) that allowed for the local creation of policies whereby joint sharing can occur between the two separate federal agencies (VA/VHA-HHS/HIS MOU, 2003).

  • In 2003, the Indian Health Service (IHS) and the Veterans Health Administration (VHA) entered into a Memorandum-Of-Understanding (MOU) that allowed for the local creation of policies whereby joint sharing can occur between the two separate federal agencies (VA/VHA-HHS/HIS MOU, 2003).
  • Readjustment Counseling Services(RCS) are offered through more than 200 field-based Veteran’s Centers with 6 established on or immediately adjacent to reservation communities to increase outreach to this population.

Many Tribal Nations have their own programs and/or dedicate positions that cover Tribal Veteran Issues

  • Many Tribal Nations have their own programs and/or dedicate positions that cover Tribal Veteran Issues
  • Most pow-wows have a color guard made up of tribal veterans that lead the first dance
  • Many tribal communities have a Veteran’s Day/Weekend Pow-wow in honor of their tribal veterans

Native American Motivational Interviewing: Weaving Native American and Western Practices (Venner, Feldstein, & Tafoya, 2006)

  • Native American Motivational Interviewing: Weaving Native American and Western Practices (Venner, Feldstein, & Tafoya, 2006)
  • Adapts Motivational Interviewing (Miller & Rollnick, 1995) for treating substance use disorders when working with Native Americans
  • Incorporates Native American language, prayer, and practice to be able to motivate clients to moderate or abstain from alcohol use.
  • http://casaa.unm.edu/download/nami.pdf

Consult with others when you have questions or concerns

  • Consult with others when you have questions or concerns
  • Culture is fluid, seeking someone with knowledge of the culture (a cultural broker) is important for consultation and understanding your client
  • Consultation may assist in selection of interventions or testing
    • May also assist with what questions to ask and how to gather more information
  • Joseph is a 65 year-old American Indian male, born and raised in Alaska. He is an elder in his community and is well respected. He is a Vietnam War Combat Veteran.
  • Presenting Problems:
  • Chronic PTSD and Depression
  • Joseph’s 36 year old son is living with him and his wife and is both physically and verbal abusive.
  • Joseph voices distrust of white men and recalls discrimination during his military service.
  • He reports increased marital distress.
  • Joseph recently got into a physical fight with his son who is abusing alcohol and other illicit drugs. His son threatened to kill him after he asked him to leave. Things had never been this bad and Joseph doesn’t know what to do or how to respond and feels numb. His wife is very concerned for both of them and indicated that over the last several years Joseph has been more irritable and distant.

What may be initial impressions on Joseph’s case and how might you approach the initial session?

  • What may be initial impressions on Joseph’s case and how might you approach the initial session?
  • What are some potential salient issues to explore in conceptualizing the family problems? Community problems?
  • What would be some cultural considerations/adaptations to consider?

“We have to honor the wisdom in the client and then to be able to not see a person that’s an alcoholic, but see the person in the community that’s a grandmother or grandfather, honoring them for who they are, and everyone has wisdom, to bring that honor to them and (to allow) their wisdom to come out.”

  • “We have to honor the wisdom in the client and then to be able to not see a person that’s an alcoholic, but see the person in the community that’s a grandmother or grandfather, honoring them for who they are, and everyone has wisdom, to bring that honor to them and (to allow) their wisdom to come out.”
  • ~ As stated by a Navajo female participant taken from Venner & Tafoya (2006)

Call, K. T., McAlpine, D. D., Johnson, P.J., et al. (2006). Barriers to care among American Indians in public health care programs. Med Care, 44, 595–600.

  • Call, K. T., McAlpine, D. D., Johnson, P.J., et al. (2006). Barriers to care among American Indians in public health care programs. Med Care, 44, 595–600.
  • George, L.J. (1997). Why the need for the Indian Child Welfare Act? Journal of Multi-Cultural Social Work, 5, 165-175.
    • Gone, J. (2004). Mental health services for Native Americans in the 21st century United States. Professional Psychology: Research and Practice, 35, 10-18.
  • Gone, J. P. (2007). “We never was happy living like a Whiteman”: Mental health disparities and the postcolonial predicament in American Indian communities. American Journal of Community Psychology, 40(3– 4), 290–300.
  • Johnson, P. J., Carlson, K. F., & Hearst, M.O. (2010). Healthcare disparities for American Indian Veterans in the United States: A population-based study. Med Care, 48(6), 563–569.
  • U.S. Department of Health and Human Services. (2001). Mental health: Culture, race, and ethnicity, A supplement to mental health: A report of the Surgeon General (SMA01-3613). Office of the Surgeon General, Public Health Service. Washington, DC: U.S. Government Printing Office.
  • Venner, K. L. Feldstein, S. W., & Tafoya, N. (2006). Native American Motivation Interviewing: Weaving Native American Practices. http://casaa.unm.edu/download/nami.pdf
  • Harris, LaDonna, and Jacqueline Wasilewski. “This Is What We Want to Share: Core Cultural Values.” Contemporary Tribal Government Series. Bernalillo, NM: Americans for Indian Opportunity, 1992.
  • Prescott, S. (1991). The American Indian: Yesterday, Today, & Tomorrow. A Handbook for Educators. Bureau of Publications, Sales Unit, California State Dept. of Education, PO Box 271, Sacramento, CA 95802-0271.
  • Shweder, R., & Bourne, E. (1984). Does the concept of the person vary cross-culturally? In Shweder, R. & Levine, R. Culture theory: Essays on mind, self, and emotion. Cambridge, MA: Cambridge University Press, pp. 47-71.


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