Tag Archive for: Culturally Informed Care

Content Analysis Informing the Development of Adapted Harm Reduction Talking Circles (HaRTC) with Urban American Indians and Alaska Natives Experiencing Alcohol Use Disorder

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Authors: Lonnie A. Nelson et al.

Publication Year: 2022

Last Updated:

Journal: International Journal of Indigenous Health

Keywords: Cultural Sensitivity and Appropriateness; Harm Reduction; Talking Circles; Alcohol Use; Qualitative Analysis

 

Short Abstract: Prior studies with Native populations have highlighted concerns about the cultural acceptability of highly directive, Eurocentric approaches, such as cognitive behavioral therapy and 12-step programs in treating alcohol use disorder (AUD).

 

Abstract: Prior studies with Native populations have highlighted concerns about the cultural acceptability of highly directive, Eurocentric approaches, such as cognitive behavioral therapy and 12-step programs in treating alcohol use disorder (AUD). When asked in a prior qualitative study how they would redesign AUD treatment, urban American Indian and Alaska Native (AI/AN) participants reported wanting more low-barrier, harm-reduction treatment options, Native treatment providers, and culturally relevant practices. Talking Circles, which are gatherings where people share what is on their hearts, were the most requested Native cultural practice. After developing and piloting its initial iteration, researchers, community members, and traditional health professionals collaborated on the present qualitative research study to further refine an adapted Harm Reduction Talking Circle (HaRTC) protocol to address AUD with urban AI/ANs. This study features a conventional content analysis of 31 patient interviews, 6 key informant interviews with management and traditional health professionals, and 5 staff and provider focus groups to inform the development of the HaRTC. Specifically, this study describes staff, management, traditional health professionals, provider, and patient participants’ a) perspectives on HaRTC, including potential benefits, risks and mitigating factors, b) preferred traditional medicines and practices, c) preferred approaches/Circle Facilitator stance for engagement and facilitation, and d) HaRTC logistics (e.g., timing, frequency). Analyses indicated a central tendency preference for 8, weekly HaRTC sessions. Although participants expressed concerns about the potential inclusion of intoxicated people in HaRTC sessions, a large majority of staff, management and patient participants felt it was important to have HaRTC be as inclusive and accepting of community members as possible. Participants provided suggestions for how to structure facilitation of the HaRTC and mitigate risks of intoxication and patient escalation. Participants preferred an approach that is acceptance-based, respects individuals’ autonomy and culture, and creates a safe space for recovery. Most participants felt the specific traditions and medicines applied in the HaRTC should be maximally inclusive to honor the diversity of tribal affiliations and backgrounds represented among urban AI/ANs. In conclusion, participants largely supported an integration of harm-reduction principles and the North American Indigenous tradition of the Talking Circle to provide a compassionate, culturally appropriate healing practice to a larger spectrum of AI/ANs with AUD. Future research is planned to test the efficacy of this community-informed approach.

 

Source: Link to Original Article.

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Source: https://jps.library.utoronto.ca/index.php/ijih/article/view/36677

Type of Resource: Peer-reviewed scientific article

Utilizing Drumming for American Indians/Alaska Natives with Substance Use Disorders: A Focus Group Study

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Authors: Daniel Dickerson et al.

Publication Year: 2012

Last Updated: September 2012

Journal:

Keywords: Cultural Sensitivity and Appropriateness; Substance Use; Drumming; Gender Roles; Tradition

 

Short Abstract: Background—Drumming has been utilized among American Indian/Alaska Native (AI/AN) tribes for centuries to promote healing and self-expression. Drum-Assisted Recovery Therapy for Native Americans (DARTNA), currently under development, is a substance abuse treatment utilizing drumming as a core component.

 

Abstract: Background—Drumming has been utilized among American Indian/Alaska Native (AI/AN) tribes for centuries to promote healing and self-expression. Drum-Assisted Recovery Therapy for Native Americans (DARTNA), currently under development, is a substance abuse treatment utilizing drumming as a core component. Objectives—Focus groups were conducted to assist in the development of the DARTNA protocol. Feedback obtained from these focus groups will inform a subsequent pretest of DARTNA and an empirical study analyzing its effectiveness. Methods—Three focus groups were conducted among AIs/ANs with substance use disorders (n = 6), substance abuse treatment providers (n = 8), and a community advisory board (n = 4) to solicit feedback prior to a pretest of the DARTNA protocol. Results—Overall, participants indicated that DARTNA could be beneficial for AIs/ANs with substance use disorders. Four overarching conceptual themes emerged across the focus groups: (1) benefits of drumming, (2) importance of a culture-based focus, (3) addressing gender roles in drumming activities, and (4) providing a foundation of common AI/AN traditions. Conclusions—The DARTNA protocol is a potentially beneficial and culturally appropriate substance abuse treatment strategy for AIs/ANs. In order to optimize the potential benefits of a substance abuse treatment protocol utilizing drumming for AIs/ANs, adequate attention to tribal diversity and gender roles is needed. Scientific Significance—Due to the shortage of substance abuse treatments utilizing traditional healing activities for AIs/ANs, including drumming, results from this study provide an opportunity to develop an intervention that may meet the unique treatment needs of AIs/ANs.

 

Source: Link to Original Article.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725997/

Type of Resource: Best Practices Newsletter

Cultural Competence: What Is Needed in Working With Native American With HIV/AIDS?

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Authors: Shelley Hamill, Michael Dickey

Publication Year: 2005

Last Updated:

Journal: Journal of the Association of Nurses in AIDS Care

Keywords: Awareness; Cultural Sensitivity and Appropriateness; Health Disparities; HIV/AIDS; Misclassification of AI/AN

 

Short Abstract: American Indian and Alaskan Native (AI/AN) people have a unique culture that is misunderstood by many health care professionals. There are nearly 2.5 million AI/ANs living in the United States in 300 different tribal or language groups and governed by 569 different tribal governments (U.S. Census Bureau, 2002).

 

Abstract: American Indian and Alaskan Native (AI/AN) people have a unique culture that is misunderstood by many health care professionals. There are nearly 2.5 million AI/ANs living in the United States in 300 different tribal or language groups and governed by 569 different tribal governments (U.S. Census Bureau, 2002). The myriad of ethnicities within the population labeled AI/AN or Native American makes it difficult to identify the scope of the HIV/AIDS problem under today’s system of classification. Throughout the evolution of the health care system, AI/AN populations have experienced, as have other minorities, less than adequate attention with regard to specific and culturally appropriate treatment and prevention programs (Dickey, Tafoya, & Wirth, 2003). Perhaps nowhere is this more evident than in the area of HIV/AIDS prevention and treatment. In 2000, then-U.S. Surgeon General David Satcher issued a call for action on the HIV/AIDS crisis in AI/AN communities. He stated an urgent need among Native communities as well as federal and state organizations and community health care providers to work together in an effort to fight the HIV/AIDS epidemic and to bring awareness to community members (Satcher, 2000). According to the Centers for Disease Control and Prevention (CDC, 2002), as of December 2002, there were 2,875 AIDS cases among AI/ANs. However, although the actual number of reported HIV/AIDS cases among Native Americans is relatively low, in this small population, the number is alarming. The number of AIDS cases has doubled among this population within the last 5 years (CDC). In the period from 1996 to 2002, AIDS incidence decreased markedly among Whites, Blacks, Hispanics, and Asian/Pacific Islanders but increased among AI/ANs (CDC). During that same time period, the number of deaths from AIDS also declined among all racial groups except AI/ANs (CDC). Many health professionals estimate the number of AIDS cases among AI/ANs to be much higher than what statistics are currently reporting and that the number of HIV cases could be as much as 10-times greater (Satcher, 2002). For example, a study of drug treatment patients conducted from 1991 to 1994 in New York City showed that the number of Native Americans testing positive for HIV was comparable to that of African Americans (Walters, Simoni, & Harris, 2000). This may indicate higher rates of HIV among AI/ANs within certain geographical populations. As with other minority populations, there is still a great stigma associated with HIV/AIDS within AI/AN communities. Among AI/ANs, concerns over confidentiality are evident because of the close-knit communities in which they live and the tremendous stigma of homosexuality. Many AI/ANs are not seeking testing for HIV because of this concern. As a result, underreporting of HIV among this community remains high. In addition, many Native Americans are misclassified by health care providers as Hispanic, Caucasian, African American, or Asian. During data reporting, this misclassification skews the statistics of the AI/AN population, resulting in underreporting of HIV/AIDS cases.

 

Source: Link to Original Article.

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Source: http://www.asph.sc.edu/news/cultural.pdf

Type of Resource: Peer-reviewed scientific article

A Gathering of Native American Healers: Exploring the Interface of Indigenous Tradition and Professional Practice

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Authors: Virgil D. Moorehead Jr., Joseph P. Gone, Damia December

Publication Year: 2015

Last Updated:

Journal: American Journal of Community Psychology

Keywords: Cultural Sensitivity and Appropriateness; Mental and Behavioral Health; Psychology; Traditional Healing; Multicultural Counseling; Alternative Medicine

 

Short Abstract: This article reports insights from a 4-day Gathering of Native American Healers at the University of Michigan in October of 2010.

 

Abstract: This article reports insights from a 4-day Gathering of Native American Healers at the University of Michigan in October of 2010. This event convened 18 traditional healers, clinically trained service providers, and cross-cultural mental health researchers for a structured group dialogue to advance professional knowledge about the integration of Indigenous healing practices and conventional mental health treatments in community-based mental health services for Native Americans. Our thematic analysis of transcripts from five Roundtable sessions afforded several key insights and understandings pertaining to the integration of Indigenous healing and conventional mental health services. First, with reference to traditional healing, the importance of a rampant relationality, various personal qualities, Indigenous spirituality, and maintenance of traditional life and culture were accentuated by Roundtable participants. Second, for traditional healers to practice effectively, Roundtable participants posited that these individuals must maintain personal wellness, cultivate profound knowledge of healing practices, recognize the intrinsic healing potential within all human beings, and work for the community rather than themselves. In speaking to the possibilities and challenges of collaboration between Indigenous and conventional biomedical therapeutic approaches, Roundtable participants recommended the implementation of cultural programming, the observance of mutuality and respect, the importance of clear and honest communication, and the need for awareness of cultural differences as unique challenges that must be collaboratively overcome.

 

Source: Link to Original Article.

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Source: http://gonetowar.com/wp-content/uploads/2015/12/Healers-Gathering.pdf

Type of Resource: Peer-reviewed scientific article

Holistic system of care: a ten-year perspective.

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Authors: Ethan Nebelkopf and Serena Wright

Publication Year: 2011

Last Updated:

Journal: Journal of Psychoactive Drugs

Keywords: Cultural Sensitivity and Appropriateness; HIV/AIDS; Mental and Behavioral Health; Violence; Prevention; Intervention; Recovery

 

Short Abstract: The Holistic System of Care for Native Americans in an Urban Environment is a community-focused intervention that provides behavioral health care, promotes health, and prevents disease.

 

Abstract: The Holistic System of Care for Native Americans in an Urban Environment is a community-focused intervention that provides behavioral health care, promotes health, and prevents disease. This approach is based on a community strategic planning process that honored Native American culture and relationships. Substance abuse, mental illness, homelessness, poverty, crime, physical illness, and violence are symptoms of historical trauma, family dysfunction, and spiritual imbalance. The holistic model links treatment, prevention, and recovery. The link between prevention and treatment is early intervention. Peer support is the link between treatment and recovery. Recovering individuals serve as role models linking recovery to prevention. Culture and spirituality build a strong and resilient foundation for recovery. This article documents the effectiveness of the holistic model over a ten-year period that it has been implemented at the Family & Child Guidance Clinic of the Native American Health Center in the San Francisco Bay Area. The holistic model has produced statistically significant reductions in substance abuse among adult Native American women, men, reentry, and homeless populations; reductions in substance abuse among Native American adolescents; reductions in HIV/AIDS high-risk behavior among Native American men, women, and adolescents; and decreases in acting out behavior among Native American severely emotionally disturbed children.

 

Source: Link to Original Article.

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Source: https://www.thefreelibrary.com/Holistic+system+of+care%3A+a+ten-year+perspective-a0278880917

Type of Resource: Peer-reviewed scientific article

A Collaborative and Trauma-Informed Practice Model for Urban Indian Child Welfare

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Authors: Nancy M. Lucero, Marian Bussey

Publication Year: 2012

Last Updated:

Journal: Child Welfare

Keywords: Childcare; Cultural Sensitivity and Appropriateness; Family; Indian Child Welfare Act (ICWA); Trauma; Case Management

 

Short Abstract: Preventing the breakup of the American Indian family is the fundamental goal of the Indian Child Welfare Act (ICWA). However, few models exist to provide CPS workers and other practitioners with effective and practical strategies to help achieve this goal.

 

Abstract: Preventing the breakup of the American Indian family is the fundamental goal of the Indian Child Welfare Act (ICWA). However, few models exist to provide CPS workers and other practitioners with effective and practical strategies to help achieve this goal. This article presents a collaborative and trauma-informed family preservation practice model for Indian Child Welfare services with urban-based American Indian families. The model encompasses both systemic and direct practice efforts that assist families facing multiple challenges in creating a nurturing and more stable family life. System-level interventions improve the cultural responsiveness of providers, encourage partnerships between CPS and community-based providers, and support ICWA compliance. Direct practice interventions, in the form of intensive case management and treatment services, help parents/caregivers become more capable of meeting their own and their children's needs by addressing challenges such as substance abuse, trauma and other mental health challenges, domestic violence, and housing instability. Evaluation of the practice model suggests that it shows promise in preventing out-of-home placement of Native children, while at the same time improving parental capacity, family safety, child well-being, and family environment.

 

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Source: https://tribalinformationexchange.org/files/resources/ACollaborativeandTrauma-InformedPracticeModelforUrbanIndianChildWelfare.pdf

Type of Resource: Peer-reviewed scientific article

Development and evaluation of an enhanced diabetes prevention program with psychosocial support for urban American Indians and Alaska natives: A randomized controlled trial

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Authors: Lisa G. Rosas et al.

Publication Year: 2016

Last Updated: September 2016

Journal: Contemporary Clinical Trials

Keywords: Cultural Sensitivity and Appropriateness; Diabetes; Nutrition; Population Information; Weight Management and Obesity; Prevention; Prediabetes; Community-based Participatory Research

 

Short Abstract: Diabetes is highly prevalent, affecting over 25 million adults in the US, yet it can be effectively prevented through lifestyle interventions, including the well-tested Diabetes Prevention Program (DPP).

 

Abstract: Diabetes is highly prevalent, affecting over 25 million adults in the US, yet it can be effectively prevented through lifestyle interventions, including the well-tested Diabetes Prevention Program (DPP). American Indian/Alaska Native (AIAN) adults, the majority of whom live in urban settings, are more than twice as likely to develop diabetes as non-Hispanic whites. Additionally, prevalent mental health issues and psychosocial stressors may facilitate progression to diabetes and hinder successful implementation of lifestyle interventions for AIAN adults. This 2-phased study first engaged community stakeholders to develop culturally-tailored strategies to address mental health concerns and psychosocial stressors. Pilot testing (completed) refined those strategies that increase engagement in an enhanced DPP for urban AIAN adults. Second, the enhanced DPP will be compared to a standard DPP in a randomized controlled trial (ongoing) with a primary outcome of body mass index (BMI) and a secondary outcome of quality of life (QoL) over 12 months. Obese self-identified AIAN adults residing in an urban setting with one or more components of the metabolic syndrome (excluding waist circumference) will be randomized to the enhanced or standard DPP (n = 204). They hypothesized that addressing psychosocial barriers within a culturally-tailored DPP will result in clinical (BMI) and superior patient-centered (QoL) outcomes as compared to a standard DPP. Exploratory outcomes will include cardiometabolic risk factors (e.g., waist circumference, blood pressure, fasting glucose) and health behaviors (e.g., diet, physical activity). Results of this trial may be applicable to other urban AIAN or minority communities or even diabetes prevention in general.

 

Source: Link to Original Article.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691492/pdf/nihms-1044257.pdf

Type of Resource: Peer-reviewed scientific article

Indigenous Evaluation Toolkit: An Actionable Guide for Organizations Serving American Indian / Alaska Native Communities through Opioid Prevention Programming

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Authors: Seven Directions: A Center for Indigenous Public Health

Publication Year: 2023

Last Updated:

Journal:

Keywords: Awareness; Cultural Sensitivity and Appropriateness; Data Collection; Ethnicity; Mental and Behavioral Health; Race; Substance Use; Data Collection; Research Methodology; Toolkit

 

Short Abstract: Indigenous communities have always engaged in review and reflection. Western research and evaluation frameworks may not align with ancestral and cultural wisdom, and we hope to address this through our Indigenous Evaluation Toolkit.

 

Abstract: Indigenous communities have always engaged in review and reflection. Western research and evaluation frameworks may not align with ancestral and cultural wisdom, and we hope to address this through our Indigenous Evaluation Toolkit. As Indigenous communities continue to shape programming to reflect their own stories, ways of knowing, and cultural perspectives, there is a growing need for frameworks that support the infusion of this knowledge into the evaluation of their programs focused on substance use prevention, treatment, and recovery support. Through step-by-step guidance, worksheets, and storytelling, this toolkit offers communities an iterative, reflective, continuous learning process for beginning or incorporating Indigenous evaluation.

 

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Source: https://www.indigenousphi.org/tribal-opioid-use-disorders-prevention/indigenous-evaluation-toolkit

Type of Resource: Toolkit

Social Determinants of Cancer Risk Among American Indian and Alaska Native Populations: An Evidence Review and Map

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Authors: Stephanie Melkonian, Jolie Crowder, Emily Adam, Mary White, Lucy Peipins

Publication Year: 2022

Last Updated: September 21, 2022

Journal: Health Equity

Keywords: Cancer; Health Disparities; Social Determinants of Health

 

Short Abstract: Objectives: To explore current literature on social determinants of health (SDOH) and cancer among American Indian and Alaska Native (AI/AN) populations.

 

Abstract: Objectives: To explore current literature on social determinants of health (SDOH) and cancer among American Indian and Alaska Native (AI/AN) populations. Methods: We searched Ovid MEDLINE®️, CINAHL, and PsycINFO databases for articles published during 2000 to 2020, which included terms for SDOH and cancer occurrence in AI/AN populations. We derived the data extraction elements from the PROGRESS-Plus framework. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA)-Equity extension guided the evidence map. Results: From 2180 screened articles, 297 were included. Most were observational (93.9%), employed a cross-sectional design (83.2%), were categorized as cancer occurrence and surveillance research (62%), and included no cancer-related risk factors (70.7%). Race, gender, and place were the most frequently included PROGRESS-Plus categories. Religion, relationship features, and characteristics of discrimination were least common. Only 12% of articles mentioned historical/current trauma or historical context. Conclusions: Gaps exist in our understanding of SDOH as drivers of cancer disparities in AI/AN populations. Future studies in health equity science may incorporate historical and cultural factors into SDOH frameworks tailored for AI/AN populations.

 

Source: Link to Original Article.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9536331/#!po=1.19048

Type of Resource: Best Practices Newsletter

The Three Sisters Garden: A Cultural Approach to Cultivating American Indian/Alaska Native (AI/AN) Psychological Service Providers.

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Authors: Gray, J. S., Wheeler, M. J., & Bender, N. M.

Publication Year: 2021

Journal: American Psychological Association

Keywords: Cultural Sensitivity and Appropriateness; Health Disparities; Psychology; Social Determinants of Health

 

Short Abstract: With the current emphasis on diversity, equity, and inclusion (DEI) in education and psychological services, it is important to understand the culturally important issues for American Indian/Alaska Native students training of psychological services providers.

 

Abstract: With the current emphasis on diversity, equity, and inclusion (DEI) in education and psychological services, it is important to understand the culturally important issues for American Indian/Alaska Native students training of psychological services providers. The Three Sisters Model can provide the necessary guidance and supports to provide the important DEI aspects for the development of culturally sensitive and humble psychological service providers while retaining AI/AN ones.

 

Source: https://psycnet.apa.org/record/2022-53783-001

Type of Resource: Peer-reviewed scientific article

 

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