TIP 61 Behavioral Health Services for American
Transcript Of TIP 61 Behavioral Health Services for American
Behavioral Health Services for American Indians and Alaska Natives
For Behavioral Health Service Providers, Administrators, and Supervisors
TREATMENT IMPROVEMENT PROTOCOL
TIP 61
Please share your thoughts about this publication by completing a brief online survey at: https://www.surveymonkey.com/r/KAPPFS
The survey takes about 7 minutes to complete and is anonymous. Your feedback will help SAMHSA develop future products.
TIP 61
BEHAVIORAL HEALTH SERVICES FOR AMERICAN INDIANS AND ALASKA NATIVES
Executive Summary
For Behavioral Health Service Providers, Program Administrators, Clinical Supervisors, and Researchers
The Executive Summary of this Treatment Improvement Protocol summarizes substance use and mental illness among American Indians and Alaska Natives and discusses the importance of delivering culturally responsive, evidence-based services to address these behavioral health challenges.
TIP Navigation
Executive Summary For behavioral health service providers, program administrators, clinical supervisors, and researchers
Part 1: Practical Guide to the Provision of Behavioral Health Services for American Indians and Alaska Natives For behavioral health service providers
Part 2: Implementation Guide for Behavioral Health Program Administrators Serving American Indians and Alaska Natives For behavioral health service providers, program administrators, and clinical supervisors
Appendix and Index
Part 3: Literature Review For behavioral health service providers, program administrators, clinical supervisors, and researchers
TIP 61
Behavioral Health Services for American Indians and Alaska Natives
Contents
EXECUTIVE SUMMARY
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v Overall Key Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi Content Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .x TIP Development Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Publication Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvi
ii
Executive Summary
TIP 61
Foreword
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the U.S. Department of Health and Human Services agency that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.
The Treatment Improvement Protocol (TIP) series fulflls SAMHSA’s mission by providing science-based best-practice guidance to the behavioral health feld. TIPs refect careful consideration of all relevant clinical and health service research, demonstrated experience, and implementation requirements. Select nonfederal clinical researchers, service providers, program administrators, and client advocates comprising each TIP’s consensus panel discuss these factors, offering input on the TIP’s specifc topic in their areas of expertise to reach consensus on best practices. Field reviewers then assess draft content.
The talent, dedication, and hard work that TIP panelists and reviewers bring to this highly participatory process have helped bridge the gap between the promise of research and the needs of practicing clinicians and administrators to serve, in the most scientifcally sound and effective ways, people in need of behavioral health services. We are grateful to all who have joined with us to contribute to advances in the behavioral health feld.
Elinore F. McCance-Katz, M.D., Ph.D. Assistant Secretary for Mental Health and Substance Use SAMHSA
iii
This page intentionally left blank.
TIP 61
BEHAVIORAL HEALTH SERVICES FOR AMERICAN INDIANS AND ALASKA NATIVES
Executive Summary
This Treatment Improvement Protocol (TIP) serves as a primer for working with individuals who identify with American Indian and Alaska Native cultures. It aims to help behavioral health service providers improve their cultural competence and provide culturally responsive, engaging, holistic, trauma-informed services to American Indian and Alaska Native clients. The TIP presents culturally adapted approaches for the prevention and treatment of addiction and mental illness, as well as counselor competencies for providing behavioral health services to American Indians and Alaska Natives.
Introduction
American Indians and Alaska Natives have consistently experienced disparities in access to healthcare services, funding, and resources; quality and quantity of services; treatment outcomes; and health education and prevention services. Availability, accessibility, and acceptability of behavioral health services are major barriers to recovery for American Indians and Alaska Natives. Common factors that infuence engagement and participation in services include availability of transportation and child care, treatment infrastructure, level of social support, perceived provider effectiveness, cultural responsiveness of services, treatment settings, geographic locations, and tribal affliations.
In response to existing behavioral health disparities, this TIP illustrates strategies for facilitating American Indian and Alaska Native individuals’ access to and engagement in behavioral health services. It outlines promising practices for providers to apply in working with American Indians and Alaska Natives, and it includes tools and strategies that will help program administrators facilitate implementation of these practices.
Through this TIP, behavioral health workers will learn to identify how and to what extent a client’s cultural background affects his or her behavioral health needs and concerns. It offers practical ideas and methods for addressing the realities of service delivery to American Indian and Alaska Native clients and communities, and it provides
programmatic guidance for working with their communities to implement culturally responsive services. Throughout, the TIP emphasizes the importance of inclusivity, collaboration, and incorporation of traditional and alternative approaches to treatment and recovery support when working with American Indian and Alaska Native clients.
This TIP was developed through a consensus-based process that refected intensive collaboration with American Indian and Alaska Native professionals. These professionals, who represented diverse tribes and native cultures, carefully considered all relevant clinical and research fndings, traditional and culturally adapted best practices, and implementation strategies. American Indian and Alaska Native contributors shared their behavioral health-related experiences and stories throughout the process, thereby greatly enriching this important resource.
Audience
This TIP can serve as a resource to both native and non-native behavioral health professionals who wish to provide culturally appropriate and responsive services. This TIP is for:
• Addiction treatment/prevention professionals. • Mental health service providers. • Peer support specialists. • Behavioral health program managers and
administrators.
• Clinical supervisors.
v
TIP 61
Behavioral Health Services for American Indians and Alaska Natives
• Traditional healers. • Tribal leaders of governance. • Other behavioral health professionals (e.g.,
social workers, psychologists).
• Researchers and policymakers.
Objectives
Addiction and mental health professionals will improve their understanding of:
• American Indian and Alaska Native demograph-
ics, history, and behavioral health.
• The importance of cultural awareness, cultural
identity, and culture-specifc knowledge when working with clients from diverse American Indian and Alaska Native communities.
• The role of native culture in health beliefs,
help-seeking behavior, and healing practices.
• Prevention and treatment interventions based
on culturally adapted, evidence-based best practices.
• Methods for achieving program-level cultural
responsiveness, such as incorporating American Indian and Alaska Native beliefs and heritage in program design, environment, and staff development.
Overall Key Messages
Importance of historical trauma. Providers should learn about, acknowledge, and address the effects of historical trauma when working with American Indian and Alaska Native clients. Most American Indians and Alaska Natives believe that historical trauma, including the loss of culture, lies at the heart of substance use and mental illness within their communities.
Acceptance of a holistic view of behavioral health. Among many American Indian and Alaska Native cultures, substance use and mental illness are not defned as diseases, diagnoses, or moral maladies, nor are they viewed as physical or character faws. Instead, they are seen as symptoms of imbalance in the individual’s relationship with the world. Thus, healing and treatment approaches must be inclusive of all aspects of life—spiritual, emotional, physical, social, behavioral, and cognitive.
Role of culture and cultural identity. Providers need to understand how clients perceive their own cultural identity and how they view the role of traditional practices in treatment. Not all American Indian and Alaska Native clients recognize the importance of culture or perceive a need for traditional practices in their recovery. Nonetheless, providers and administrators must be ready to address their clients’ cultural identity and related needs. Helping clients maintain ties to their native cultures can help prevent and treat substance use and mental disorders. Through reconnection to American Indian and Alaska Native communities and traditional healing practices, an individual may reclaim the strengths inherent in traditional teachings, practices, and beliefs and begin to walk in balance and harmony.
Recognition of sovereignty. Tribal governments are sovereign nations. Each nation adopts its own tribal codes and has a unique history with the U.S. federal government. Providers in native and non-native programs need to understand the role of tribal sovereignty and governance systems in treatment referrals, planning, cooperative agreements, and program development.
Signifcance of community. American Indian and Alaska Native clients and their communities must be given opportunities to offer input on the types of services they need and how they receive them. Such input helps match services to clients, increase community use of services, and use agency and tribal fnancial resources effciently. Providers must involve themselves in native community events and encourage native community involvement in treatment services.
Value of cultural awareness. If providers are aware of their own cultural backgrounds, they will be more likely to acknowledge and explore how culture affects their interactions, particularly their relationships with clients of all backgrounds. Without cultural awareness, providers may discount the infuence of their own cultural contexts— including beliefs, values, and attitudes—on their initial and diagnostic impressions of clients and selection of healing interventions.
vi
Executive Summary
Cultural Perspective on Behavioral
Health (West)
Culturally Specifc and Responsive Skills and Practices
(North)
Part 1: Providers
Part 2: Administrators
Part 3: Researchers
TIP 61
Cultural Knowledge
(East)
Cultural Awareness and Competence (South)
Commitment to culturally responsive services. Organizations have an obligation to deliver high-quality, culturally responsive care across the behavioral health service continuum at all levels— individual, programmatic, and organizational. Not all American Indian or Alaska Native clients identify or want to connect with their cultures, but culturally responsive services offer those who do a chance to explore the impact of culture, history (including historical trauma), acculturation, discrimination, and bias on their behavioral health.
Signifcance of the environment. An environment that refects American Indian and Alaska Native culture is more engaging for, and shows respect to, clients who identify with this culture. Programs can
create a more culturally responsive ethos through adapted business practices, such as using native community vendors, hiring a workforce that refects local diversity, and offering professional development activities (e.g., supervision, training) that highlight culturally specifc American Indian and Alaska Native client and community needs.
Respect for many paths. There is no one right way. Providing direction on how something should be done is not a comfortable or customary practice for American Indians and Alaska Natives. For them, healing is often intuitive; it is interconnected with others and comes from within, from ancestry, from stories, and from the environment. There are many paths to healing.
vii
TIP 61
Behavioral Health Services for American Indians and Alaska Natives
Content Overview
Through this TIP, providers can explore how they interact with American Indian and Alaska Native clients and how they can incorporate culturally responsive ways of healing into their work. First, the TIP explores the basic elements of American Indian and Alaska Native cultures. Second, it emphasizes the importance of becoming aware of and identifying cultural differences between providers and clients. Third, it highlights native cultural beliefs about illness, help seeking, and health. Fourth, it offers culturally adapted, practice-based approaches and activities informed by science and the restorative power of native traditions, healers, and recovery groups.
Part 1: Practical Guide to the Provision of Behavioral Health Services for American Indians and Alaska Natives
Part 1 is for behavioral health service providers who work with American Indian and Alaska Native clients and communities to support their mental health and drug and alcohol recovery.
Part 1 consists of two chapters. Part 1, Chapter 1, explains the background and context for Chapter 2, so it is strongly recommended that readers examine it frst. Part 1, Chapter 1, includes:
• A summary of American Indian and Alaska
Native history, historical trauma, and critical cultural perspectives on such key topics as health beliefs and help-seeking behaviors.
• An overview of American Indian and Alaska
Native demographics, social challenges, and behavioral health issues.
• Strategies to expand providers’ cultural
awareness/competence and culture-specifc knowledge.
• Specifc treatment interventions, including
traditional American Indian and Alaska Native interventions and cultural adaptations of standard treatment/prevention strategies.
Part 1, Chapter 2, content provides:
• Several case histories in the form of story-based
vignettes that demonstrate specifc knowledge and clinical skills necessary for providing effective counseling to American Indians and Alaska Natives across behavioral health settings.
viii
• For each vignette, an outline of the client’s
presenting concerns and treatment needs, provider–client dialog, and master provider notes.
• Practical suggestions and guidance for key
stages in the provider–client relationship.
In Part 1, readers will learn that:
• Not all native cultures are the same. Similarities
across native nations exist, but not all American Indian and Alaska Native people have the same beliefs or traditions.
• The use of diagnostic terminology in clinical
work with American Indian and Alaska Native clients can be problematic, because the process of “naming” can have signifcant spiritual meaning and may infuence individual and community beliefs about outcome.
• For hundreds of years and into the present,
American Indians and Alaska Natives have endured traumatic events resulting from colonization. They and their communities continue to experience repercussions (i.e., historical trauma) from these events.
• American Indian and Alaska Native clients
experience grief for unique reasons, such as loss of their communities, freedom, land, life, self-determination, traditional cultural and religious practices, and native languages, as well as the removal of American Indian and Alaska Native children from their families.
• Among American Indians and Alaska Natives,
historical loss is associated with greater risk for substance abuse and depressive symptoms.
• Genes that increase risk of substance misuse
and related factors (e.g., tolerance, craving) are no more common in American Indians and Alaska Natives than in White Americans.
• Alcohol is the most misused substance among
American Indians and Alaska Natives, as well as among the general population. Many American Indians and Alaska Natives do not drink at all, but binge drinking and alcohol use disorder occur among native populations at relatively high rates.
• American Indians and Alaska Natives start
drinking and using other substances at a younger age than do members of other major racial or ethnic groups. Early use of substances has been linked with greater risk for developing substance use disorders.
For Behavioral Health Service Providers, Administrators, and Supervisors
TREATMENT IMPROVEMENT PROTOCOL
TIP 61
Please share your thoughts about this publication by completing a brief online survey at: https://www.surveymonkey.com/r/KAPPFS
The survey takes about 7 minutes to complete and is anonymous. Your feedback will help SAMHSA develop future products.
TIP 61
BEHAVIORAL HEALTH SERVICES FOR AMERICAN INDIANS AND ALASKA NATIVES
Executive Summary
For Behavioral Health Service Providers, Program Administrators, Clinical Supervisors, and Researchers
The Executive Summary of this Treatment Improvement Protocol summarizes substance use and mental illness among American Indians and Alaska Natives and discusses the importance of delivering culturally responsive, evidence-based services to address these behavioral health challenges.
TIP Navigation
Executive Summary For behavioral health service providers, program administrators, clinical supervisors, and researchers
Part 1: Practical Guide to the Provision of Behavioral Health Services for American Indians and Alaska Natives For behavioral health service providers
Part 2: Implementation Guide for Behavioral Health Program Administrators Serving American Indians and Alaska Natives For behavioral health service providers, program administrators, and clinical supervisors
Appendix and Index
Part 3: Literature Review For behavioral health service providers, program administrators, clinical supervisors, and researchers
TIP 61
Behavioral Health Services for American Indians and Alaska Natives
Contents
EXECUTIVE SUMMARY
Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . iii Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .v Overall Key Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vi Content Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . viii Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .x TIP Development Participants . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Publication Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvi
ii
Executive Summary
TIP 61
Foreword
The Substance Abuse and Mental Health Services Administration (SAMHSA) is the U.S. Department of Health and Human Services agency that leads public health efforts to advance the behavioral health of the nation. SAMHSA’s mission is to reduce the impact of substance abuse and mental illness on America’s communities.
The Treatment Improvement Protocol (TIP) series fulflls SAMHSA’s mission by providing science-based best-practice guidance to the behavioral health feld. TIPs refect careful consideration of all relevant clinical and health service research, demonstrated experience, and implementation requirements. Select nonfederal clinical researchers, service providers, program administrators, and client advocates comprising each TIP’s consensus panel discuss these factors, offering input on the TIP’s specifc topic in their areas of expertise to reach consensus on best practices. Field reviewers then assess draft content.
The talent, dedication, and hard work that TIP panelists and reviewers bring to this highly participatory process have helped bridge the gap between the promise of research and the needs of practicing clinicians and administrators to serve, in the most scientifcally sound and effective ways, people in need of behavioral health services. We are grateful to all who have joined with us to contribute to advances in the behavioral health feld.
Elinore F. McCance-Katz, M.D., Ph.D. Assistant Secretary for Mental Health and Substance Use SAMHSA
iii
This page intentionally left blank.
TIP 61
BEHAVIORAL HEALTH SERVICES FOR AMERICAN INDIANS AND ALASKA NATIVES
Executive Summary
This Treatment Improvement Protocol (TIP) serves as a primer for working with individuals who identify with American Indian and Alaska Native cultures. It aims to help behavioral health service providers improve their cultural competence and provide culturally responsive, engaging, holistic, trauma-informed services to American Indian and Alaska Native clients. The TIP presents culturally adapted approaches for the prevention and treatment of addiction and mental illness, as well as counselor competencies for providing behavioral health services to American Indians and Alaska Natives.
Introduction
American Indians and Alaska Natives have consistently experienced disparities in access to healthcare services, funding, and resources; quality and quantity of services; treatment outcomes; and health education and prevention services. Availability, accessibility, and acceptability of behavioral health services are major barriers to recovery for American Indians and Alaska Natives. Common factors that infuence engagement and participation in services include availability of transportation and child care, treatment infrastructure, level of social support, perceived provider effectiveness, cultural responsiveness of services, treatment settings, geographic locations, and tribal affliations.
In response to existing behavioral health disparities, this TIP illustrates strategies for facilitating American Indian and Alaska Native individuals’ access to and engagement in behavioral health services. It outlines promising practices for providers to apply in working with American Indians and Alaska Natives, and it includes tools and strategies that will help program administrators facilitate implementation of these practices.
Through this TIP, behavioral health workers will learn to identify how and to what extent a client’s cultural background affects his or her behavioral health needs and concerns. It offers practical ideas and methods for addressing the realities of service delivery to American Indian and Alaska Native clients and communities, and it provides
programmatic guidance for working with their communities to implement culturally responsive services. Throughout, the TIP emphasizes the importance of inclusivity, collaboration, and incorporation of traditional and alternative approaches to treatment and recovery support when working with American Indian and Alaska Native clients.
This TIP was developed through a consensus-based process that refected intensive collaboration with American Indian and Alaska Native professionals. These professionals, who represented diverse tribes and native cultures, carefully considered all relevant clinical and research fndings, traditional and culturally adapted best practices, and implementation strategies. American Indian and Alaska Native contributors shared their behavioral health-related experiences and stories throughout the process, thereby greatly enriching this important resource.
Audience
This TIP can serve as a resource to both native and non-native behavioral health professionals who wish to provide culturally appropriate and responsive services. This TIP is for:
• Addiction treatment/prevention professionals. • Mental health service providers. • Peer support specialists. • Behavioral health program managers and
administrators.
• Clinical supervisors.
v
TIP 61
Behavioral Health Services for American Indians and Alaska Natives
• Traditional healers. • Tribal leaders of governance. • Other behavioral health professionals (e.g.,
social workers, psychologists).
• Researchers and policymakers.
Objectives
Addiction and mental health professionals will improve their understanding of:
• American Indian and Alaska Native demograph-
ics, history, and behavioral health.
• The importance of cultural awareness, cultural
identity, and culture-specifc knowledge when working with clients from diverse American Indian and Alaska Native communities.
• The role of native culture in health beliefs,
help-seeking behavior, and healing practices.
• Prevention and treatment interventions based
on culturally adapted, evidence-based best practices.
• Methods for achieving program-level cultural
responsiveness, such as incorporating American Indian and Alaska Native beliefs and heritage in program design, environment, and staff development.
Overall Key Messages
Importance of historical trauma. Providers should learn about, acknowledge, and address the effects of historical trauma when working with American Indian and Alaska Native clients. Most American Indians and Alaska Natives believe that historical trauma, including the loss of culture, lies at the heart of substance use and mental illness within their communities.
Acceptance of a holistic view of behavioral health. Among many American Indian and Alaska Native cultures, substance use and mental illness are not defned as diseases, diagnoses, or moral maladies, nor are they viewed as physical or character faws. Instead, they are seen as symptoms of imbalance in the individual’s relationship with the world. Thus, healing and treatment approaches must be inclusive of all aspects of life—spiritual, emotional, physical, social, behavioral, and cognitive.
Role of culture and cultural identity. Providers need to understand how clients perceive their own cultural identity and how they view the role of traditional practices in treatment. Not all American Indian and Alaska Native clients recognize the importance of culture or perceive a need for traditional practices in their recovery. Nonetheless, providers and administrators must be ready to address their clients’ cultural identity and related needs. Helping clients maintain ties to their native cultures can help prevent and treat substance use and mental disorders. Through reconnection to American Indian and Alaska Native communities and traditional healing practices, an individual may reclaim the strengths inherent in traditional teachings, practices, and beliefs and begin to walk in balance and harmony.
Recognition of sovereignty. Tribal governments are sovereign nations. Each nation adopts its own tribal codes and has a unique history with the U.S. federal government. Providers in native and non-native programs need to understand the role of tribal sovereignty and governance systems in treatment referrals, planning, cooperative agreements, and program development.
Signifcance of community. American Indian and Alaska Native clients and their communities must be given opportunities to offer input on the types of services they need and how they receive them. Such input helps match services to clients, increase community use of services, and use agency and tribal fnancial resources effciently. Providers must involve themselves in native community events and encourage native community involvement in treatment services.
Value of cultural awareness. If providers are aware of their own cultural backgrounds, they will be more likely to acknowledge and explore how culture affects their interactions, particularly their relationships with clients of all backgrounds. Without cultural awareness, providers may discount the infuence of their own cultural contexts— including beliefs, values, and attitudes—on their initial and diagnostic impressions of clients and selection of healing interventions.
vi
Executive Summary
Cultural Perspective on Behavioral
Health (West)
Culturally Specifc and Responsive Skills and Practices
(North)
Part 1: Providers
Part 2: Administrators
Part 3: Researchers
TIP 61
Cultural Knowledge
(East)
Cultural Awareness and Competence (South)
Commitment to culturally responsive services. Organizations have an obligation to deliver high-quality, culturally responsive care across the behavioral health service continuum at all levels— individual, programmatic, and organizational. Not all American Indian or Alaska Native clients identify or want to connect with their cultures, but culturally responsive services offer those who do a chance to explore the impact of culture, history (including historical trauma), acculturation, discrimination, and bias on their behavioral health.
Signifcance of the environment. An environment that refects American Indian and Alaska Native culture is more engaging for, and shows respect to, clients who identify with this culture. Programs can
create a more culturally responsive ethos through adapted business practices, such as using native community vendors, hiring a workforce that refects local diversity, and offering professional development activities (e.g., supervision, training) that highlight culturally specifc American Indian and Alaska Native client and community needs.
Respect for many paths. There is no one right way. Providing direction on how something should be done is not a comfortable or customary practice for American Indians and Alaska Natives. For them, healing is often intuitive; it is interconnected with others and comes from within, from ancestry, from stories, and from the environment. There are many paths to healing.
vii
TIP 61
Behavioral Health Services for American Indians and Alaska Natives
Content Overview
Through this TIP, providers can explore how they interact with American Indian and Alaska Native clients and how they can incorporate culturally responsive ways of healing into their work. First, the TIP explores the basic elements of American Indian and Alaska Native cultures. Second, it emphasizes the importance of becoming aware of and identifying cultural differences between providers and clients. Third, it highlights native cultural beliefs about illness, help seeking, and health. Fourth, it offers culturally adapted, practice-based approaches and activities informed by science and the restorative power of native traditions, healers, and recovery groups.
Part 1: Practical Guide to the Provision of Behavioral Health Services for American Indians and Alaska Natives
Part 1 is for behavioral health service providers who work with American Indian and Alaska Native clients and communities to support their mental health and drug and alcohol recovery.
Part 1 consists of two chapters. Part 1, Chapter 1, explains the background and context for Chapter 2, so it is strongly recommended that readers examine it frst. Part 1, Chapter 1, includes:
• A summary of American Indian and Alaska
Native history, historical trauma, and critical cultural perspectives on such key topics as health beliefs and help-seeking behaviors.
• An overview of American Indian and Alaska
Native demographics, social challenges, and behavioral health issues.
• Strategies to expand providers’ cultural
awareness/competence and culture-specifc knowledge.
• Specifc treatment interventions, including
traditional American Indian and Alaska Native interventions and cultural adaptations of standard treatment/prevention strategies.
Part 1, Chapter 2, content provides:
• Several case histories in the form of story-based
vignettes that demonstrate specifc knowledge and clinical skills necessary for providing effective counseling to American Indians and Alaska Natives across behavioral health settings.
viii
• For each vignette, an outline of the client’s
presenting concerns and treatment needs, provider–client dialog, and master provider notes.
• Practical suggestions and guidance for key
stages in the provider–client relationship.
In Part 1, readers will learn that:
• Not all native cultures are the same. Similarities
across native nations exist, but not all American Indian and Alaska Native people have the same beliefs or traditions.
• The use of diagnostic terminology in clinical
work with American Indian and Alaska Native clients can be problematic, because the process of “naming” can have signifcant spiritual meaning and may infuence individual and community beliefs about outcome.
• For hundreds of years and into the present,
American Indians and Alaska Natives have endured traumatic events resulting from colonization. They and their communities continue to experience repercussions (i.e., historical trauma) from these events.
• American Indian and Alaska Native clients
experience grief for unique reasons, such as loss of their communities, freedom, land, life, self-determination, traditional cultural and religious practices, and native languages, as well as the removal of American Indian and Alaska Native children from their families.
• Among American Indians and Alaska Natives,
historical loss is associated with greater risk for substance abuse and depressive symptoms.
• Genes that increase risk of substance misuse
and related factors (e.g., tolerance, craving) are no more common in American Indians and Alaska Natives than in White Americans.
• Alcohol is the most misused substance among
American Indians and Alaska Natives, as well as among the general population. Many American Indians and Alaska Natives do not drink at all, but binge drinking and alcohol use disorder occur among native populations at relatively high rates.
• American Indians and Alaska Natives start
drinking and using other substances at a younger age than do members of other major racial or ethnic groups. Early use of substances has been linked with greater risk for developing substance use disorders.