Working with Native Americans 11.13.12


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"Students will work in teams of 3 to 4 members and lead the discussion of the readings and additional materials about one of the racial/ethnic groups covered in the course or another topic approved by the instructor. This will involve presenting a summary of the readings about assessment and treatment issues for the selected group. Disparities in mental health services for the group should also be reviewed along with solutions for resolving them. If another topic is selected, the team will be responsible for summarizing the literature on the topic. Students are encouraged to create a PowerPoint presentation on their topic and provide handouts to the class." Class Syllabus from Dr. Vida Dyson

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Working with Native Americans 11.13.12

  1. 1. Native Americans & American Indians: Considerations for Assessment & Treatment Deep Battu| Miguel Gonzalez | Kulky Nakai| Jillian Richardson 1
  2. 2. COUNSELING AMERICAN INDIANS AND ALASKA NATIVES (AI/AN) Sue, D.W. & Sue, D. (2012). Counseling the culturally diverse: theory and practice. (6th Ed). New York: John Wiley & Sons. 2
  3. 3. Historical Considerations  American Indians/Alaska Natives (AI/AN) are composed of 565 distinct tribes  AI/AN population was 2.9 million in 2010 representing 0.9% of the total U.S. population per the U.S. Census Bureau  Of the 175 Native languages once spoken in the U.S., only 20 are still passed on to younger generations 3
  4. 4. Historical Considerations (cont’d)  In 1887, the U.S. government determined Indians were incapable of managing their own land  Land was placed into a trust with the “promise” that the Indians would receive income from the land  Not until 1999 when a Federal Judge ruled that the government had breached the agreement 4
  5. 5. General Statistics  34% of AI/ANs live on reservations, where 57% reside in metropolitan areas         Many return to reservations for work in casinos or for a nurturing environment FewerAI/ANsare high school graduates as compared to the general population The poverty rate amongAI/ANsis double that of the U.S. population Mortality rate is over twice as high than that of the U.S. population Injuries and violence account for 75% of all AI/AN deaths between ages of 1 to 19 Depression and substance abuse is also disproportionately higher in this population Congress determined to have at least 25% of Indian blood to be consideredAI/AN Tribal leaders fought to develop their own criteria 5
  6. 6. Characteristics and Strengths  The tribe is a fundamental importance based on a interdependent system  Family is more than parents, extended family is part of the basic unit  Honor and respect are gained through sharing and giving such as the accumulation of material goods  AI/ANswork hard to prevent discord and believe that family and the tribe are more important than the individual  Taught not to interfere with others and to observe rather than react impulsively 6
  7. 7. Characteristics and Strengths (cont’d)  AI/NAshow greater focus on the present than on the future, therefore punctuality and planning for the future may be unimportant  Spirit, mind, and body are interconnected where illness is believed to involve disharmony with these elements  Learning occurs from listening rather than talking, hence direct eye contact with an elder may be a sign of disrespect 7
  8. 8. Cultural Implications Based on Treatment  Assessment should include tribal relationships and if any decision-making process would include the tribe  Of note, many who leave the reservation report losing a sense of identity  Because parents are not only ones responsible for raising the child, it is important to find what each family member’s role may be to determine appropriate interventions  Goals of therapy or interventions may need input from extended family or tribal leaders 8
  9. 9. Cultural Implications Based on Treatment (cont’d)  Due to emphasis on sharing, once enough money is gathered, most AI/ANs stop working and spend time focusing on ceremonial activities  Instead of going to work or school, AI/ANs may prioritize helping family, thus may be seen as unmotivated in school  Tasks are approached from a logical perspective rather than based on timelines which can develop a cultural conflict 9
  10. 10. Cultural Implications Based on Treatment (cont’d)  Due to values on Spirituality, treatment must encompass all aspects of mind, body, and spirit (i.e. sweat lodge, vision quests)  Determine what types of nonverbal communication are due to cultural values or actual problems necessitating treatment 10
  11. 11. Challenges Based on History  It is important to consider historical sociopolitical relationships between AI/ANsand the local, state, and federal government  Consideration with involving DCFS  Suspicion is often seen towards majority culture due to history of broken treaties and governmental policies 11
  12. 12. Educational Challenges  AI/AN children display a decline in academic performance by the 4th grade    Academic success is not perceived to be rewarding Many have the perception of no need for “White man’s education” Many AI/ANs drop out of high school  11% have Bachelor’s Degree as compared to 24% of U.S. population  Many AI/AN students feel “pushed out” of the school systems and express mistrust for the teachers and White community  Recommended to have school system to bridge the gap between NA and White cultures 12
  13. 13. Acculturation Challenges  Many youth report feeling “torn” between two cultures and fail to develop a positive selfidentity  Bee-Gates et al. (1996) found that boys frequently cited being an AI/AN as a problem, while two-thirds of girls reported not wanting to live due to self-identity stressors 13
  14. 14. Cultural Orientation Model M.T. Garret and Pichette (2000)  Traditional: the individual may speak little English and practice traditional customs  Marginal: individual may be bilingual but has lost touch with their cultural heritage, yet is not fully accepted in mainstream society  Bicultural: the individual is conversant with both sets of values and can communicate in a variety of contexts  Assimilated: the individual embraces only mainstream culture’s values, behaviors, and expectations  Pantraditional: the individual has been exposed to and adopted mainstream values but is making a conscious effort to return to the “old ways” 14
  15. 15. Cultural Model Implications  Assessment of the level of acculturation is recommended to determine the selection of therapeutic interventions  Individuals with traditional orientations may be unfamiliar with dominant culture expectations and may want to develop skills to deal with mainstream society  Assimilated or marginal individuals may want to examine possible value and self-identity conflicts  Acculturated AI/ANs have been found to have success in treatment with CBT components, whereas traditional AI/ANs are responsive to short-term focus, activity schedule, and some forms of homework assignments 15
  16. 16. Alcohol and Substance Abuse  AI/ANs have the highest weekly consumption of alcohol compared to any other ethnic group  It is common to begin drinking at an early age for AI/ANs  High use of alcohol and other drugs can be linked to cultural value of sharing, giving and togetherness  Self-identity, cultural identity, social pressures can also be linked to increase use of alcohol in this culture  Community-oriented programs that engage the entire community rather than the individual and inclusion of tribal leaders is a recommended intervention  Many tribes develop their own traditional substance abuse programs 16
  17. 17. Domestic Violence  Statistics rate AI/AN women to suffer 3.5 times higher incidences of physical, sexual, and domestic violence compared to the general population  This may be a gross underestimation due to many women not coming forth to report these incidences Due to many women remaining silent, and continued distrust for White-dominated agencies, fear of familial alienation, many will continue to remain silent  When working with abused women, inclusion of family, community, and tribal support is recommended  17
  18. 18. Suicide  There is a high incidence of suicide among AI/ANs  Thought to be result of alcohol abuse, poverty, boredom, and family breakdown Adolescence to adulthood is the time of greatest risk for suicide among AI/ANs, especially males  Recommended to include community and tribal support for those living on reservations or with ties to their tribes  Many traditionally-based AI/AN individuals believe mental illness is due to spiritual imbalance  18
  19. 19. IDENTIFYING EFFECTIVE MENTAL HEALTH INTERVENTIONS FOR AMERICAN INDIANS & ALASKA NATIVES Gone, J. P. &Alcantara, C. (2007). Identifying effective mental health interventions for American Indians and Alaska Natives: A review of the literature. Cultural Diversity and Ethnic Minority Psychology, 13 (4), 356-363. 19
  20. 20. Purpose of Article  Review of the literature pertaining to Native American (NA) mental health interventions that targeted the more prevalent psychological disorders in the community, within the EBP movement 20
  21. 21. Method  Comprehensive review of the literature using four computerized bibliographic databases encompassing English-language citations of scholarly publications in the mental health field  PsycINFO, PubMed, Social Work Abstracts, and the Social Sciences Citation Index  Proxy descriptors were used such as: treatment, and prevention and intervention to identify native-specific literature concerning treatment outcomes 21
  22. 22. Method (cont’d)  13 additional descriptors of mental health problems were used based upon epidemiological and anecdotal evidence attesting to their prevalence in and relevance for NA populations, including:  mental disorders, depression, anxiety, suicide, PTSD, emotional trauma, child abuse, sexual abuse, attention deficit hyperactivity disorder (ADHD), antisocial behavior, conduct disorder, juvenile delinquency, and “postcolonial stress disorder” Finally, “Native American”/“American Indian” and “Alaska Native” were the terms selected to limit search results  There were 312 searches that used this formula: (Computerized Database [4] × Practice Descriptor [3] × Problem Descriptor [13] × Group identifier [2])  22
  23. 23. Results 3500 initial citations elicited 56 articles and chapters from Nativespecific mental health programs, interventions, and treatment approaches  This literature was nominally classified as follows:         (a) randomized or controlled outcome studies (n = 3) (b) nonrandomized or uncontrolled outcome studies (n = 6) (c) intervention descriptions (n = 14) (d) summary intervention overviews (n = 2) (e) clinical case studies (n = 7) (f) intervention approaches (n = 24) To summarize, the literature used the following descriptions:  prevention of maladaptive adolescent behaviors and suicide through the cultivation of coping skills and prosocial competencies; treatment of depression, trauma, and sexual abuse through both conventional and innovative therapeutic methods; application of extended family therapy, relaxation and assertiveness training, eye movement desensitization and reprocessing therapy, and stimulus fading procedures in single clinical cases; and implementation of innovative service delivery efforts within mental health treatment systems and settings in NA communities 23
  24. 24. Results(cont’d)      9 outcome studies were used to identify EBP for mental health problems Very few articles and chapters were empirical reports so their value for evidence based mental health treatments was limited Of the 9 outcome studies classified above, 6 reported pre and post intervention results for a treatment group with no untreated group for comparison, thereby rendering valid inferences about the causal relationship of intervention to outcome in these instances uncertain Beyond these 6 articles, an additional outcome study reported the efficacy of a pharmacotherapy (methylphenidate) rather than a psychological intervention for comorbid ADHD and fetal alcohol syndrome among four NA children Finally, no literature was identified through these searches that attempted an assessment of outcomes for NA traditional healing or other culturally grounded ceremonies targeted at mental health 24
  25. 25. Results(cont’d)  Only 2 controlled outcome studieshad adequate sample sizes and interpretable results:    Manson and Brenneman (1995)reported outcomes for an intervention undertaken to prevent clinical depression among olderAIsencountering health-related stressors in the Pacific Northwest LaFromboiseand Howard-Pitney (1995)reported outcomes for an intervention undertaken to prevent suicide among adolescentAIs through life skills training in a school-based program in the American Southwest These 2 studies attest that there is limited literature on EBP and is it useful in looking at this population 25
  26. 26. Discussion       Should there be more culturally relevant or sensitive practices that we use and identify and that could be more a more effective option for NA clients? The authors decided to present their findings in 2004 at the One Sky Center, a federally funded national resource centerfor AI/AN substance abuse and mental health services, in Oregon Health and Science University Policymakers, practitioners, and mental health researchers all debated and discussed the knowledge pertaining to EBP for NA populations The consensus was that there should bean adaption of mental health and substance abuse treatments in implementation withNA population Some believed that EBP movement was just another way to exercise control of mental health resources all levels and an example of arrogance on behalf of European Americans Others credited EBP with facilitating greater accountability for therapeutic efficacy and having more protection for the Native people 26
  27. 27. Discussion (cont’d)    The authors recognized the importance of empirical literature pertaining to intervention outcomes in the arena of NA mental health, but believe there is enough reasons for reconsidering the call to EBP in NA mental health service delivery There are several limitations and contradictions that have yet to be resolved within the EBP movement, especially as it prepares to assimilate mental health service delivery within NA communities One example is the limited external validity or generalizability of the outcomes of RCTs relative to actual clinical practice.   RCTsare seen as artificial and not realistic The authors proposed that the demonstration of positive therapeutic outcomes for an intervention through RCTs is the first phase in identifying EBP; a second crucial empirical endeavor is the establishment of parameters regarding the range of conditions and contexts in which the established causal relationship between intervention and outcome remains intact. Lastly, both efficacy and effectiveness studies depend on the reliable and valid assessment of psychological attributes and outcomes, an endeavor only infrequently investigated among NA respondents 27
  28. 28. Discussion (cont’d)      Another critique looks at how the mental health EBP movement asserts that the designation of the RCT as the gold standard for the evaluation of pharmacological interventions in medicine cannot be meaningfully extended to the evaluation of psychotherapeutic interventions in the mental health professions Finally, critics argue that mental health professionals should pursue EBP by prescribing empirically supported therapeutic relationships (ESTRs) instead of specific clinical techniques, and place emphasis on healing relationships The culture of the mental health clinic is not the culture of the reservation community In many Native communities, the contemporary status of AI “mental health” remains significantly caught up in history, culture, identity, and (especially) spirituality, all within the devastating context of European American colonialism Return to sacred tradition and practice from which a renewed sense of purpose, source of coherence, and semblance of continuity might be fashioned 28
  29. 29. Discussion (cont’d) The role of EBP seems to have little relevance in the NA community  New roles which advocate more for community psychology might be more appropriate  There could be more traditional clinical services and community mental health approaches and service delivery  Looking at reaching larger numbers of people through brief consultations and crisis intervention; instead of the clinician's office, the location of intervention is practice in the community; instead of assuming an intrapsychic cause of disorder, the etiological factors of interest are the environmental causes of maladaptation; instead of rehabilitative services or “treatments,” the type of service delivery is often preventative in nature; instead of professional control of mental health services, the locus of decision making is shared responsibility between professionals and community members; and so on  29
  30. 30. Conclusion • The NA population may need a different type of service that no one has yet thought of • More empirical research needs to be done on the population 30
  31. 31. HONORING THEIR WAY: COUNSELING AMERICAN INDIAN WOMEN Rayle, D. A., Chee, C., & Sand, J. K. (2006). Honoring their way: Counseling American Indian women. Journal of Multicultural Counseling and Development, 34(2), 66-79. 31
  32. 32. American Indian (AI) Women Throughout U.S. history, multiple assaults of racism, sexism, and sociopolitical and economic disadvantages compound the discrimination and injustices against AI women  Contributes to higher levels of poverty, school drop outs, unemployment, substance abuse, alcohol-related mortality, domestic violence, suicide, gang-related violence, poor physical health, and other mental health problems (e.g., depression and feelings of hopelessness)  32
  33. 33. AI Stigma  Historical incidents of the past may have negatively affected AI’s view of their cultural values that differ from those of mainstream America (i.e., cultural dissonance)  Led to have considerable distrust of European American counselors  AI’s do not feel liberated or free enough to seek help  Indian Health Service (IHS) serves over 500K 33
  34. 34. Experience of AI Women Today Crucial to consider in counseling: History and values of females in the U.S. (especially women of color who face forms of racism, sexism, inequality, and stereotyping)  Experiences with the acculturation process (often varies in identity development and level of acceptance of and commitment to tribal values, beliefs, and practices)  Gender-neutral behaviors, or psychologically androgynous, is viewed as a strength  34
  35. 35. Core AI Values              Harmony Unity Noninterference Respect for elders and all others Sharing Being Cooperation Collectivism Reservation life Matriarchal systems Present-time living and orientation Traditional spiritual beliefs and healing methods Harmony with nature, oppression, and racism 35
  36. 36. Counseling Needs of AI Women Historical Effects:  18th-19th Century: Battle of Wounded Knee and the Indian Removal/Trail of Tears where AI women were beaten, raped, and killed because they were considered “savages”  20th Century: AI women were forced to leave their families and attend nonreservation boarding schools that influenced their worldviews, experiences, and trust levels (especially with the government) 36
  37. 37. Counseling Needs of AI Women (cont’d) Cultural Values:  Political, social, and cultural histories, in addition to personal, gender, familial, and cultural values and beliefs  A sense of connection to the land is primary in the psychological makeup of all AI women, as this is intertwined with AI’s religion, values, culture, and complete life experience  5 Levels of acculturation: 1) traditional, 2) marginal, 3) bicultural, 4) assimilated, and 5) pantraditional 37
  38. 38. Counseling Needs of AI Women (cont’d) Physical and Mental Health:  Health irregularities did not exist prior to colonization  Most vital mental and physical health concerns are the effects from alcoholism and substance abuse  Higher alcoholism rates than any other women of color in U.S. society  Increased emotional and psychological disturbance, such as depression, which affects 79% of AI women who use IHS mental health services (IHS, 2000)  Suicide rates are four times greater than all other U.S. women 38
  39. 39. Counseling Needs of AI Women (cont’d) Traditional Responsibilities and Education:  27% of AI households are headed by women, which requires women to stay at home  1% of AI women have obtained higher education and formal training, but often experience barriers that interfere with or hinder their success in professional careers (also consider gender variations in educational attainment)  Consider an intentional decision for traditional AI women to refuse leaving their reservations and families, losing their cultural heritage, and trusting others from outside reservation life 39
  40. 40. Considerations for Counseling AI Women (cont’d) Acculturation and Identities:  Openly address acculturation and life experiences as a woman, as an indigenous AI person, and as an AI woman  Encourage the beginning process of therapy using selfdisclosure and initiating conversation about the scope of counseling and how the process is likely to unfold  Inquire about comfort level in bridging both cultural experiences of traditional healing (i.e., songs, herbs, sand paintings) and nontraditional approaches to healing  Encourage her to visit the reservation to reinforce her identity and mainstream connections with extended family in order to navigate both worlds 40
  41. 41. Considerations for Counseling AI Women (cont’d) Tribal and Clan Membership and Values:  Inquire about her tribal affiliation, clan membership, and values  Common AI values:  Humility  Cooperation over competition  Silence over words  Respect for elders (only speak when asked)  Preference for matriarchal society 41
  42. 42. Considerations for Counseling AI Women (cont’d) Culturally Specific Counseling Approaches:  Definition of “sick” is being unbalanced or losing the path of beauty  Religion = Medicine  Honor values by redefining or rediscovering harmony and balance to build loyalty, respect, and trust in therapeutic relationship  Interact and consult with elders in the community, and be aware of urban community resources  Empower her regarding abilities and selfconfidence 42
  43. 43. Counselor Cultural Awareness & Techniques: Build credibility with AI women by having the knowledge and awareness of AI culture  Weave Western counseling techniques with elements of AI culture, beliefs, and philosophy  Traditional AI learning processes emphasize a narrative approach (i.e., legends, stories, metaphors) to create symbolic meanings and share tribal histories to convey complex concepts  Humor brings people together and reaffirms bonds of kinship, therefore laughter relieves stress and creates an atmosphere of sharing and connectedness (often used to deal with painful and oppressive experiences)  43
  44. 44. Counseling Implications  Acquire basic knowledge of AI women’s historical and current challenges (etic) and their cultural values and individual personal beliefs (emic), in order to understand worldviews and to integrate culturally appropriate counseling interventions  Approach AI females as individuals first  Evaluate personal ideas, beliefs, and traditions regarding her role as a woman in her respective tribe, family, society, and workplace, as well as the influences of AI women’s multiple identities 44
  45. 45. Acculturation Assessment       Personal and tribal definitions of traditional and nontraditional activities, beliefs, and values Beliefs regarding family roles and religion Level of traditionalism, acculturation, or assimilation Reactions to and experiences with mainstream society Preferences for daily language use, meals, clothing, and music and reading selections Overall cultural identity (e.g., race/ethnicity, gender, religious/spiritual, etc.) Bidirectional Assessment: Building Rapport with AI Clients Counselors encouraged to self-disclose about themselves 45
  46. 46. Communication Styles with AI Women Both nonverbal body language (e.g., eye contact, body space preference, body posture) and verbal language clarifies AI individual’s worldview and level of acculturation or assimilation  More traditional AI women may use less direct eye contact or may display contact at short glances as a way to maintain privacy in order to show respect for counselors  Counselors should allow for silence and allow AI women to tell their life stories in their time frame (especially if struggling from depression and loneliness)   Silence helps build trust and rapport, and also allows for peaceful, culturally appropriate, and non-rushed counseling sessions 46
  47. 47. Holistic, Wellness-Based Approach  Strengths-based  Mirrors cultural values of balance and harmony  Assess childhood and family structures and systems  Involve families and/or a Shaman (tribal medicine person/healer) may help AI women feel honored in the healing environment 47
  48. 48. Strengths-Based Encouragers Use open-ended, non-intrusive questions about:  Where they are from  Their strengths  Their areas of wellness  Their family and tribal systems  Their cultural and gender identities  Their personal and ethnic beliefs and values  Their spiritual beliefs  Their experiences with power and oppression  Their lives on and of reservation land  Their experiences as AI women living in the U.S.  Their counseling needs 48
  49. 49. Holistic, Wellness-Based Approach (con’t) Respect from the counselor allows access to information about:  Ceremonies and spiritual beliefs to include in therapy  Extended family or elders to be involved in the healing process  Their histories and presenting issues  Their previous attempts at resolving dilemmas  The ways in which they define their identities  Their roles as individuals, immediate and extended family members, and as members of their tribe/clan 49
  50. 50. Therapy Goals  Reestablish harmony between physical, emotional, and spiritual selves  Honor traditions, families, tribes, values and beliefs, histories, needs for harmony and balance, and their roles as women and AIs  Aim for holistic, intentional wellness-based collaboration, awareness, understanding, and education 50
  51. 51. Words of Wisdom         Remain aware of cultural and political events that affect AI women’s identities and worldviews Be cautious when prescribing your own internalized gender constructs and stereotypes that might be influenced by history and media Physical and mental health may reflect longstanding traditions of mindbody dualism in Western health care (Miresco & Kirmayer, 2006) Physical or mental illnesses effectively treated by traditional Shaman or “medicine men” or “spiritual healers” may have somaticized forms of relational and interpersonal distress Counselors can use cultural awareness as a means to empower their clients Acknowledge feelings, perceptions, and interpretations of AI woman’s experiences in an urban setting that might be molded by her expectations before arriving to counseling AI individuals strongly discourage boasting about themselves and is considered disrespectful to make oneself look better at the expense of others Do not elicit or use forms of humor that are painful or oppressive in nature with AI clients 51
  52. 52. BEST PRACTICES IN COUNSELING NATIVE AMERICANS Thomason, T. (2011). Best practices in counseling Native Americans. Journal of Indigenous Research, 1(1), Art. 3 52
  53. 53. Survey Study Pilot-test on Counseling NAs using a group of AI/NA/ANpsychologists and counselors  Most members of the listserv of the Society of Indian Psychologists or were experts who have extensive experience  Internet administration  30-questions (both closed and open)  1-hour completion time  Offered financial stipend to compensate  53
  54. 54. Participants  N=68  Demographics:  57% Native American and 43% non-Native  68% Female and 32% Male  42% Psychologists, 27% Counselors, 16% Teachers, 16% Researchers, 10% Social Workers, 25% More than one profession  73% worked in counseling center or mental health clinic working with Native American clients 54
  55. 55. Building Rapport in the st 1 Session Warm welcome  Refreshments (water, coffee, tea)  Minimize intake paperwork  Story telling from client’s point of view  Self-disclosure of counselor  Address role of culture in client’s life  Discuss confidentiality and expectations for counseling  Collaborate with client about the content of and goals for counseling sessions  55
  56. 56. Significant Barriers to Help-Seeking  Stigma, mistrust, or fear of being judged  Lack of money  Shortage of providers  Long wait lists  Dysfunctional systems of care  Racial discrimination 56
  57. 57. Increase Comfort in Help-Seeking  Counselors are encouraged to build relationships with the local Native communities and speak with tribal elders  Ask what counselors should know or how they can help  Display Native art on the walls or with books/magazines  Offer refreshments 57
  58. 58. Results 60% do not agree with using Native health practices such as talking circles, purification ceremonies, etc., as this may be seen as patronizing and may be harmful (unless professionally trained and competent)  50% of Native American counselors are more effective with Native American clients than non-Native counselors (20% said no difference, 18% depends on cultural competence of counselor)  55% feel that spirituality is important to incorporate in the counseling process (41% said depends on the client)  73% approve of psychological testing, but are cautious of potential bias and lack of adequate norms due to consideration of how the client’s culture affects the test results  58
  60. 60. Alcohol Consumption (Henry, et al., 2011) Alcohol use is considered a problem within the population, even in urban areas  Early onset alcohol use (prior to 14) is strongly correlated with alcohol problems throughout life   Heavy use during adolescents, specifically between the ages of 16-18  Experienced more alcohol related problems between the ages of 16-18  Higher rate of alcohol related diagnoses by the age of 18  Three times the risk for life long alcohol related issues 60
  61. 61. Alcohol Consumption (cont’d) (Henry, et al., 2011)  Factors that contribute to early alcohol consumption:  Delinquency  Family history of alcohol abuse or dependence  Poverty  Broken family structure  Limited family cohesiveness  Family conflict 61
  62. 62. Reproductive Health Needs (Ravello, Tulloch, & Taylor, 2012)  STD rates among AI/AN youth (15-24 years of age) are the second highest in the U.S.  4.5 times more likely to be diagnosed with chlamydia  3 times more likely to be diagnosed with gonorrhea  2 times more likely to be diagnosed with syphilis  HIV rates are difficult to assess due to limited testing  Account for 20% of new cases in the U.S. 62
  63. 63. Reproductive Health Needs (cont’d) (Ravello, Tulloch, & Taylor, 2012) Teen birth rates have increased 12% over two years  1 in 5 AI/AN girls will give birth before 20th birthday  30% had parental care later in pregnancy or no prenatal care (U.S. population 16%)  AI/AN mothers experience higher rates of:   Low birth weight  Preterm birth  Post neonatal mortality  Infant mortality (SIDS) 63
  64. 64. Reproductive Health Needs (cont’d) (Ravello, Tulloch, & Taylor, 2012)  AI/AN gay, lesbian, bisexual, transgender, and questioning youth experience more physical and sexual abuse  Gay and bisexual youth:  17.8% reported sexual abuse  26.7% reported physical abuse  23.3% reported running away  Lesbian and bisexual youth:  42.4% reported sexual abuse  51.5% reported physical abuse  32% reported running away  Alarming rate of sexual and physical abuse for AI/AN girls  31.1% reported sexual abuse  33.6% reported physical abuse  AI/AN girls are believed to make up a large percentage of human trafficking and sexual exploitation 64
  65. 65. Suicidality (Dorgan, 2010)  AI/AN population’s suicide rate is 70% higher than the US general population  AI/AN individuals between the ages of 10-24 have the highest suicide rate of any racial group  Suicide is the second leading cause of death for AI/AN between that ages of 10-34  AI/AN suicide rates are highest between the ages of 15-19  AI/AN males are 5 times more likely to take their own lives than AI/AN females 65
  66. 66. Suicidality (cont’d) (Range, et al., 1999; US Commission on Civil Rights, 2003; Gone, 2004) Risk factors:  High rates of poverty  Limited and/or poor education  Substandard housing  High rates of disease  Weakening parental influence  Dislocation from native lands  Weakening tribal unity  Limited and/or no access to mental health professionals  Underutilization of mental health services and discontinuation of services during treatment 66
  67. 67. Prevention  Focus on psychoeducation      Target reservations and tribes Raise awareness of the long term effects of alcohol use and the trajectory individuals are likely to take with early consumption Discuss the importance of reproductive health needs Discuss resources available for suicidal individuals Explain steps to reduce factors that contribute to alcohol use, reproductive issues, suicidality Make resources available to the community without pushing medical model of assessment and treatment  Work within the goals or “dreams” of the population  Alcohol can be included in natural healing and can help spirituality/faith  Cultural considerations of reproductive health and contraception  67
  69. 69. Video Discussion  What are your personal beliefs of the concept of “Natural Healing”?  How would you discuss ancestral situations with your clients?  How can we encourage and facilitate treatment with clients who opposed modern medicine?  What do you think of Gayokla’s explanation and treatment of mental illness?  What challenges have you faced in working with this population?  What are your concerns in working with this population? 69
  70. 70. References Gone, J. P. (2004). Mental health services for Native Americans in the 21st century United States. Professional Psychology: Research and Practice, 35, 10-18. Gone, J. P. & Alcantara, C. (2007). Identifying effective mental health interventions for American Indians and Alaska Natives: A review of the literature.Cultural Diversity and Ethnic Minority Psychology, 13 (4), 356-363. Henry, K. L., McDonald, J. N., Oetting, E. R., Walker, P. S., Walker, R. D., &Beausvais. F. (2011). Age of Onset of First Alcohol Intoxication and Subsequent Alcohol Use Among Urban American Indian Adolescents. Psychology of Addictive Behaviors, 25(1), 48-56. doi:10.1037/a0021710. Range, L. M., Leach, M. M., McIntyre, D., Posey-Deters, P. B., Marion, M. S., Kovac, S. H., et al. (1999). Multicultural perspectives on suicide. Aggression and Violent Behavior, 4(4), 413-30. Ravello, L., Tulloch, S., & Taylor, M. (2012). We will be known forever by the tracks we leave: Rising up to meet the reproductive health needs of American Indian/Alaska Native Youth. American Indian and Alaska Native Mental Health Research, 19(1), i-x. doi: 10.5820/aian.1901.2012.i. Rayle, D. A., Chee, C., & Sand, J. K. (2006). Honoring their way: Counseling American Indian women. Journal of Multicultural Counseling and Development, 34(2), 66-79. Sue, D.W. & Sue, D. (2012). Counseling the culturally diverse: theory and practice. (6th Ed). New York: John Wiley & Sons. Thomason, T. (2011). Best practices in counseling Native Americans. Journal of Indigenous Research, 1(1), Art. 3 U.S. Commission on Civil Rights. (2003). A quiet crisis: Federal funding and unmet needs in Indian Country. Washington D.C.: Manuel Alba and MireilleZieseniss, 70