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ATTC Messenger November 2014: Native American Heritage Month

November 2014

National American Indian Heritage Month: Acknowledging the Importance of Cultural Coniserations in Technology Transfer

Anne Helene Skinstad, PhD
Project Director

Sean A. Bear, 1st, BA, CADC
Senior Behavioral Health and Training Coordinator

National American Indian & Alaska Native ATTC

The initial observance of American Indian Day took place in 1914. The concept of an American Indian Heritage month was started a century ago, but it was not until 1990 that President George H.W. Bush designated November as Native American Heritage Month to celebrate the diversity of American Indian and Alaska Native cultures across the country.

Why is it important for us to observe American Indian Heritage Month as behavioral health professionals? First and foremost, the American Indian and Alaska Native communities have for many years been invisible to the dominant culture. Their cultures were considered “savage,” resulting in our total lack of understanding of their very lengthy cultural heritage, ceremonies, and medical practices. Generational knowledge is technology – it is not primitive, and it is not folklore (Robyn, 2002) as it is so often portrayed in the literature. Furthermore, we have wholly inadequate knowledge about how American Indian/Alaska Native cultures and practices have influenced our own. Examples relevant for behavioral health include the vast indigenous knowledge developed over many centuries, such as the use of herbs for medicinal purposes that the pharmaceutical companies have used (but rarely acknowledge) to develop many current medicines.

wheelCulturally informed technology transfer principles. When you live in an agricultural state like Iowa, you cannot avoid listening to farmers and learning about their practices. Iowa farmers translated the American Indian way of growing corn and beans into the current way of growing corn and soybeans: alternate years in the same field to preserve the soil. American Indian attitudes towards Mother Earth are that we only borrow the land; it is not our property, and we are to preserve the land for future generations. This example illustrates the importance of considering and understanding the American Indian and Alaska Native attitudes about the land before we start planning a technology transfer project.

Respect for the people who care for plants and the land is as important as respect for people who care for tribal members with behavioral health problems. Accordingly, preparing people to care for our tribal members is just as important as selecting the right people to care for plants and gardens and to cook and to serve our meals. Agriculturally and medicinally, everything is connected spiritually to all things as we live, work, and utilize them in everyday life. “Nature can live without man, even thrive, yet man cannot live without nature.”(S. Bear, personal communication, October 29, 2014. See also: See Planting season—old style. The Why? Files The Science Behind the News.

One important way we can celebrate American Indian Heritage Month is to acknowledge the wealth of indigenous knowledge the American Indian and Alaska Native communities offer before we initiate our workforce development initiatives. The ATTC Network Technology Transfer Model can be a very helpful tool in this process when culturally adapted (Addiction Technology Transfer Center Network Technology Transfer Workgroup, 2011). The ATTC model is based on extensive literature reviews from many different fields of implementation science. In addition, to be successful in working with the American Indian and Alaska Native communities, we need to use community based participatory research and programming (CBPRP) methods. Representatives from the American Indian and Alaska Native behavioral health workforce need to be involved in the technology transfer initiatives from the beginning to make the efforts successful.

ATTC Network Model of Technology Transfer in the Innovation Process

The tradition of giving in American Indian communities should be an integrated part of how we approach these communities. We have many times been met with suspicion when we offer “to help them” improve their behavioral health practices. In doing so we assume they agree with us that they need assistance. The first question raised would be “What is there in it for us?” In such a situation, we would have overlooked the fact that American Indian communities are sovereign nations that want to set their own agendas. Translated into public health practice, community based participatory research programming, and technology transfer principles, we need to meet the American Indian communities “where they are,” not where we think they should be.

Often times when we implement a workforce development program, we base our initiatives on a deficit evaluation, meaning we have completed a needs assessment of the behavioral health workforce and found a need for support and assistance. The American Indian and Alaska Native communities have many challenging and perplexing public health issues to deal with, and health disparity is obvious when travelling in Indian Country. We cannot overlook the health disparity issues, but our initiatives need to be focused on the community’s strengths and include all the indigenous knowledge that is available to support efforts, but is often overlooked.

We need to do our homework before we offer suggestions for improvement. Sometimes that means immersing ourselves in the community before we undertake to initiate a new program. Spiritual leaders and medicine men in American Indian and Alaska Native communities are leaders who would be called “opinion leaders” in Western society. Anyone coming into the community to make changes would be wise to connect with the wise Elders and spiritual leaders before making suggestions.

Engaging community members and behavioral health specialists in any initiative is crucial for success. Our Center engages community members frequently, and tries to include as many tribal partners as possible in our projects. Cultural adaptation is facilitated through consensus building panels of providers, where the translation is focused on understanding the essence of an intervention, and then finding how the essence of the intervention can be translated into American Indian and Alaska Native behavioral health practice.

Training events should be offered in culturally informed and respectful ways, which our Center has translated into starting and ending a training day and a training event “in a good way,” that often includes music and blessings of the day. In developing an educational program, we consider the importance of allotting time for processing and discussing the material presented. This serves a dual purpose: 1) it enhances learning and understanding, and 2) it provides an opportunity to find a way to put the knowledge into a cultural perspective. Often times we hear the reference to circular thinking, rather than linear thinking, which is the most common way of processing new information in Western culture.

Indigenous healing practices: Use of herbs and traditional healing methods has a long tradition in Native communities. Many community members will consult their spiritual leaders and medicine men and women before they consult Western medical professionals. When a community or a person is in crisis, there are ways of offering a ceremony for healing and acknowledging the pain. Forgiveness ceremonies are also a good way to start the process of recovery from an illness.

Spirituality is important within the recovery movement, and many native tribal members have made this part of the recovery movement into their own culturally adapted ways. Spirituality is also an integral part of the practices of tribal communities across the country, and our tribal colleagues have asked that our Center acknowledge the importance of spirituality in treatment and early intervention of behavioral health disorders. In response, we will conduct a round table discussion on the topic on November 13, 2014, at the Shakopee Nation’s Mystic Lake Casino, in Prior Lake, Minnesota. Respecting the Native communities’ oral tradition, we will develop a white paper from the round table discussion, with plans to publish it in Spring 2015 after review by the participating spiritual leaders. Part of spirituality is the belief that people, plants, stones, animals, trees, and all things have a spirit, and that all are connected. With plants, when picking herbs, these plants are spoken to and asked to help the people; it is important to respect all of Creation. With this event we are trying to acknowledge the importance of spirituality in behavioral health and respect the fact that American Indian communities’ religious freedom was granted them in 1978, through the American Indian Freedom of Religion Act.

We are very excited about this signal event and welcome behavioral health professionals who want to participate to contact us. We will also continue to acknowledge the importance of supporting our Native children, teens and young adults in recovery, through a special issue of our The National American Indian & Alaska Native ATTC Newsletter dedicated to adolescents and young adults in treatment. Our digital storytelling project will continue on a monthly basis featuring an adolescent in recovery each month.