American Indian and Alaska Native Mental Health Research

303 Pages·2016·3.47 MB·English

American Indian
and Alaska Native
Mental Health Research
Volume 23, Issue 3, 2016
American Indian and Alaska Native Mental Health Research
Copyright: Centers for American Indian and Alaska Native Health
Colorado School of Public Health/University of Colorado Anschutz Medical Campus (www.ucdenver.edu/caianh)
American Indian and Alaska Native Mental Health Research
Volume 23, Number 3, 2016
Editor-in-Chief
Spero M. Manson, PhD
Journal Manager
Natasha Floersch
Introduction
Jami Bartgis, PhD i
Indigenous youth-developed self-assessment: The Personal Balance Tool
Rachelle Barraza, Jami Bartgis, PhD, and Fresno Youth Council 1
Women finding the way: American Indian women leading intervention research in Native communities
Maria Yellow Horse Brave Heart, PhD, Josephine Chase, MSW, PhD, Jennifer Elkins, PhD, MSSW,
Jennifer Martin, BSW, Jennifer Nanez, MSW, LMSW, and Jennifer Mootz, PhD 24
The intersection of software and strengths: Using internet technology and case management software
to assist Strength-Based Practice
Michael D. Clark, MSW and Dale W. Brien 48
In their own words: Success stories from The Great Lakes Native American Research Center for Health
Matthew Dellinger, PhD, Brian Jackson, MEd, and Amy Poupart 68
Ego strengths, racial/ethnic identity, and well-being among North American Indian/First Nations
adolescents
Barbara Gfellner, PhD 87
American Indian Elders’ resilience: Sources of strength for building a healthy future for youth
Carmella B. Kahn, MPH, Kerstin Reinschmidt, PhD, Nicolette I. Teufel-Shone, PhD, Christina E. Oré,
MPH, Michele Henson, MPH, and Agnes Attakai, MPA 117
American Indian and Alaska Native resilience along the life course and across generations: A literature
review
Christina E. Oré, MPH, Nicolette I. Teufel-Shone, PhD, and Tara M. Chico-Jarillo, MPH 134
Continued on next page
ISSN 1533-7731
©2016 Centers for American Indian and Alaska Native Health
Aurora, Colorado
All Rights Reserved
American Indian and Alaska Native Mental Health Research
Copyright: Centers for American Indian and Alaska Native Health
Colorado School of Public Health/University of Colorado Anschutz Medical Campus (www.ucdenver.edu/caianh)
American Indian and Alaska Native Mental Health Research
Volume 23, Number 3, 2016
Editor-in-Chief
Spero M. Manson, PhD
Journal Manager
Natasha Floersch
Native Transformations in the Pacific Northwest: A strength-based model of protection against
substance use disorder
Stacy Rasmus, PhD, James Allen, PhD, William Connor, PhD, William Freeman, PhD,
Native Transformations Community Action Board, and Monica Skewes, PhD 158
Partnering with American Indian communities in strength-based collaborative health research: Guiding
principles from the Fort Peck Ceremony of Research Project
Elizabeth Rink, PhD, MSW, Elizabeth Ann R. Bird, PhD, Kris Fourstar, BS, Adriann Ricker, MPH,
Winona Runs-Above/Meyers, AA, and Rachel Hallum-Montes, PhD 187
Strength-based well-being indicators for Indigenous children and families: A literature review of
Indigenous communities’ identified well-being indicators
Jennifer Rountree, PhD and Addie Smith, MSW, JD 206
Perceptions and use of community- and school-based behavioral health services among urban
American Indian/Alaska Native youth and families
Julie Salvador, PhD, Jessica Goodkind, PhD, and Sarah Feldstein Ewing, PhD 221
Entrepreneurship education: A strength-based approach to substance use and suicide prevention for
American Indian adolescents
Lauren Tingey, PhD, Francene Larzelere-Hinton, BA, Novalene Goklish, BS, Allison Ingalls, MPH,
Todd Craft, Feather Sprengeler, Courtney McGuire, MPH, and Allison Barlow, PhD, MPH 248
Culturally sensitive assessments as a strength-based approach to wellness in Native communities:
A community-based participatory research project
Steven P. Verney, PhD, Magdalena Avila, PhD, Patricia Rodríguez Espinosa, MS,
Cecilia Brooke Cholka, MS, Jennifer G. Benson, MS, Aisha Baloo, BS, and
Caitlin Devin Pozernick, BS 271
ISSN 1533-7731
©2016 Centers for American Indian and Alaska Native Health
Aurora, Colorado
All Rights Reserved
We would like to extend special thanks to all the peer reviewers who read drafts of the
following articles! Your thoughtful comments and recommendations were invaluable,
and this special issue would not have been possible without you.
Jami Bartgis, PhD
Assistant Professor
University of Oklahoma Health Sciences Center
President/CEO
One Fire Associates, LLC
Gary Bess, PhD
Gary Bess Associates
6931 Skyway
Paradise, CA 95969
[phone], ext. 101
www.garybess.com

Cathryn Booth-LaForce, PhD
Charles & Gerda Spence Professor of Nursing
University of Washington
Lorie Wayne Chesnut, DrPH, MPH
Assistant Professor
University of Kentucky College of Public Health
Stephanie Craig Rushing, PhD, MPH
Project Director
Northwest Portland Area Indian Health Board
Rhonda Wiegman Dick, MA, CNE
Technology Director
University of Colorado Anschutz Medical Campus
Angela R. Fernandez, MSW, LICSW
Doctoral Student
University of Washington School of Social Work
Hiram E. Fitzgerald, PhD
University Distinguished Professor
Department of Psychology
Michigan State University
Rick Frey, PhD
Chief Operations Officer
Toiyabe Indian Health Project
American Indian and Alaska Native Mental Health Research
Copyright: Centers for American Indian and Alaska Native Health
Colorado School of Public Health/University of Colorado Anschutz Medical Campus (www.ucdenver.edu/caianh)
Renee Galliher, PhD
Professor
Utah State University
Susana Helm, PhD
Associate Professor, Department of Psychiatry
John A. Burns School of Medicine
University of Hawai`i at Mānoa
Vanessa Y. Hiratsuka, PhD MPH
Senior Researcher
Southcentral Foundation
Pamela Jumper Thurman, PhD
Senior Research Scientist Affiliate Faculty
Colorado State University, Fort Collins, Colorado
Jeff King, PhD
Professor
Western Washington University
Tim D. Noe, PhD
Administrator, Center for Prevention and Health Promotion,
Oregon Health Authority, Public Health Division
Dennis Norman, Ed.D., ABPP
Faculty Chair, Harvard University Native American Program
Senior Psychologist, Massachusetts General Hospital
Douglas K. Novins, M.D.
Professor, University of Colorado
Bradley Dean Morse, MA
Sr. PRA
University of Colorado Anschutz Medical Campus
Elizabeth Rink, PhD MSW
Associate Professor
Montana State University
Department of Health and Human Development
Project Leader: The Center for American Indian and Rural Health Equity (CAIRHE)
Paulette Running Wolf, PhD
Running Wolf & Associates
[phone]
103 Four Winds Lane
PO Box 345
Babb, MT 59411
American Indian and Alaska Native Mental Health Research
Copyright: Centers for American Indian and Alaska Native Health
Colorado School of Public Health/University of Colorado Anschutz Medical Campus (www.ucdenver.edu/caianh)
Julie G. Salvador, PhD
Research Assistant Professor
University of New Mexico
Katie Schultz, MSW
Doctoral Candidate
University of Washington
Linda Stanley, PhD
Senior Research Scientist
Colorado State University
Joseph E. Trimble, PhD
Distinguished University Professor
Western Washington University
Melissa L. Walls, PhD
Associate Professor
Department of Biobehavioral Health & Population Sciences
University of Minnesota Medical School, Duluth campus
American Indian and Alaska Native Mental Health Research
Copyright: Centers for American Indian and Alaska Native Health
Colorado School of Public Health/University of Colorado Anschutz Medical Campus (www.ucdenver.edu/caianh)
INTRODUCTION
Jami Bartgis, PhD
It is with great pleasure that we release the first special issue on Strength-based
Approaches to Wellness in Indian Country in the journal American Indian and Alaska Native
Mental Health Research. This issue includes a wide range of articles that address how strength-
and resilience-based approaches can support public health policy, research, and practice
improvements broadly to better serve Indigenous peoples. It is my hope that this special issue
inspires public health policy makers, researchers, and health care professionals to challenge the
current paradigm for working with Indigenous populations and to support more strength-based
and culturally congruent models. To do this, we must think outside the box and build on the
inherent strengths that lie within Indigenous communities in a number of ways.
First, strength-based approaches to health and wellness in tribal communities are not new,
but are embedded in diverse tribal best practices, established by systematic observation over
centuries, that have been passed down orally from generation to generation. The oral
transmission of tribal best practices results in increased supervision and fidelity through a one-
on-one mentorship model in which training typically occurs over decades. Two articles
published in this special issue identify tribal science as “Indigenous ways of knowing.” Unlike
randomized clinical trials used Western science, tribal science has collected knowledge of long-
term effects of practices that are in tune to the role of the environment. For example, Brave Heart
and colleagues address tribal best practices for healing from historical and intergenerational
trauma, and Tingey and colleagues address the potential of entrepreneurship education to
improve environmental conditions for the promotion of sobriety and life (i.e., prevention of
substance abuse and suicide). I acknowledge these diverse tribal best practices and worldviews
are an important foundation of Strength-based Approaches to Wellness in Indian Country.
Second, unlike Western health beliefs, tribal worldviews recognize the “whole” person
within the context of the environment and implement tribal best practices that are holistic in
approach, including the entire family and spirituality. In effect, health and spirituality are not
separated, but integrated. You will learn more about the holistic model in the article by Rountree
i
American Indian and Alaska Native Mental Health Research
Copyright: Centers for American Indian and Alaska Native Health
Colorado School of Public Health/University of Colorado Anschutz Medical Campus (www.ucdenver.edu/caianh)
INTRODUCTION ii
and Smith that examines the literature from a relational worldview, identifying key resilience
factors for Indigenous peoples. I acknowledge the importance of holistic medicine and healing
practices as a strength-based approach passed down using Indigenous methods for serving tribal
and urban Indian communities.
Third, inherent in many tribal worldviews is the concept that “energy follows thought.”
While the exact expressions, applications, and practices of this concept vary significantly from
tribe to tribe, it has important implications for our collective work in public health. In many tribal
cultures, the concept that energy follows thought is applied to day-to-day living in diverse ways.
As examples, one should not cook food for the family when experiencing a negative mood or the
food will taste bad; one should not speak ill of others, as doing so might make them sick; one
should not predict a negative event happening in the future or one could make it happen; and one
should not participate in dancing during a time of mourning, as doing so may pass that grief on
to others. While outsiders may consider this concept and the various applications to be
superstitions, tall tales, or myths, they actually have a basis in Western science, and the
Indigenous ways of knowing may be much more advanced than current Western science.
The first Western scientific advancement in the field of behavioral health to support this
thought energy concept is Cognitive Behavioral Therapy (CBT). CBT is the most commonly
accepted intervention for a wide range of mental and behavioral health issues; it is based on the
general idea that what a person thinks or says through self-talk will impact how that person feels,
and how the person feels will then impact how that person interacts with the world. Hence, CBT
teaches people to restructure thinking (i.e., thought) to be more positive and realistic so that it
may impact their feelings and behaviors (i.e., energy). CBT also has important implications for
family and other interpersonal relationships: if a person changes his/her behavior toward others,
then they may change their response to the person.
The second Western scientific advancement to support the concept that energy follows
thought is the self-fulfilling prophecy. In a hallmark study by Robert Rosenthal and Lenore
Jacobson, teachers actually influenced the achievements of randomly selected students just by
being led to believe that these students were “late bloomers” and were going to excel in the
classroom. Hence, teacher expectations (i.e., thought) of students actually impacted the student
performance (i.e., energy).
I propose that the energy we create in public health matters for addressing the health
disparities of tribal peoples—both for those trying to recover from mental illness or behavioral
conditions, and for the lives of all people through the expectations we set for them. You will see
American Indian and Alaska Native Mental Health Research
Copyright: Centers for American Indian and Alaska Native Health
Colorado School of Public Health/University of Colorado Anschutz Medical Campus (www.ucdenver.edu/caianh)
iii VOLUME 23, NUMBER 3
this highlighted in this special issue. For example, Clark identifies how “out of balance” current
clinical assessments are because they only assess deficits, and further hypothesizes that such
assessments may pathologize individuals. This idea is backed up by Barraza and youth
colleagues, who are publishing a youth-developed self-assessment tool; they identify that deficit-
based assessments may decrease youth motivation to get help and could negatively impact their
outlook on life. While I believe Western scientific advances have hardly begun to explore how
our thought energy can impact us and the world around us, they do provide important ideas for
us to consider about the energy we are creating in our professional lives and what impact that
might have on Indigenous peoples.
At the policy level, federally funded grant programs typically create silos by requiring an
often exclusive focus on an illness, disease, or problem. Clark refers to this as the “stranglehold
that silos and categorical financing have wrought on [Indigenous] communities.” Grants often
require the measurement of a disease or illness and, more often, require the use of evidence-
based practices that have not been created or tested for diverse tribal peoples. As policy makers
we must ask ourselves: What energy are we creating when we silo a person’s health by requiring
exclusive focus on substance abuse within federal grant programs for Indian Country, without
attending to the underlying current and historical trauma driving many addictions? What energy
are we creating when we require measurement of negative experiences exclusively? How did we
get to the place where we would impose practices on a community for whom the evidence base
does not exist?
At the research level, we develop standardized screenings, assessment tools, and
research methods that tend to be similar. While there are many measures of depression and
hopelessness, it is much more difficult to find measures of happiness and hopefulness. How did
it happen that, in our expert research opinions, we thought it was more valid and meaningful to
measure the worst side of life than the best? What energy might that create for a behavioral
health patient on a first visit filling out the assessment packet, in a profession where a significant
number of patients drop out after the first session?
At the practice level, we implement evidence-based interventions that are normed on a
few populations. We make a diagnosis and develop a treatment plan that is focused on
addressing the problem/illness/condition. Unless a system of care is being implemented, the
treatment and interventions are distinctly separate and there is generally a failure to include
spirituality as a part of holistic health. Rarely do practitioners attend to the whole person within

American Indian and Alaska Native Mental Health Research
Copyright: Centers for American Indian and Alaska Native Health
Colorado School of Public Health/University of Colorado Anschutz Medical Campus (www.ucdenver.edu/caianh)
INTRODUCTION iv
their environment through the coordination of comprehensive services. What kind of energy do
our intake processes and treatment interventions bring to patients? Does this energy impact
people’s willingness to seek care? Does this energy impact the outcomes patients achieve?
While the U.S. public health model has given some attention to the importance of
strength-based approaches like those inherent within Indigenous worldviews, the current
initiatives being rolled out to Indian Country continue to be focused primarily on problems,
illness, and disease and to emphasize these as “real outcomes” over health promotion and well-
being. Because the current federal initiatives separate physical health, mental health, and
substance abuse, and create other silos based on a linear worldview, they are often in opposition
to the worldviews of local tribal communities and may be contributing to ongoing health
disparities. As an example, tribal communities have been experiencing youth suicide disparities
for over 40 years and have continually struggled to be allowed to use tribal best practices as an
intervention for a number of reasons (e.g., historical prohibition of tribal religious health
practices, requirements to use evidence-based practices, lack of acceptance of Indigenous ways
of knowing in Western science).
As we work to implement culturally appropriate models of care, it is critical that policy,
practice, and research consistently support tribes and urban Indian organizations to implement
strength-based strategies that are grounded in local community beliefs about health and well-
being if we are ever to improve health disparities. Brave Heart and colleagues call on us to stop
“pathologizing explanations for disparities.” We believe that this special issue will allow us to
raise the visibility of strength-based wellness approaches in Indian Country and highlight the
great work that is already being done in policy, research, and practice. We also believe that this
special issue will begin to raise challenges of the current public health approach toward
Indigenous communities and to generate solutions that will better fit diverse tribal worldviews
while improving the health and well-being of tribal populations.
I am very thankful for the dedication and commitment of the Journal Manager at
American Indian and Alaska Native Mental Health Research who worked tirelessly to publish
this special issue. Without her this special issue would not have been possible. I am also thankful
to Dr. Spero M. Manson, Editor in Chief, for the commitment to publishing an online peer-
reviewed journal to support access and learning for Indigenous communities. Most importantly, I
am thankful for all of the incredible scholars who submitted and are publishing articles in this
issue as they are leading the way in improving the conditions of tribal populations.
American Indian and Alaska Native Mental Health Research
Copyright: Centers for American Indian and Alaska Native Health
Colorado School of Public Health/University of Colorado Anschutz Medical Campus (www.ucdenver.edu/caianh)