Culturally Responsive Behavioral Health Services

Oct 29, 2024

Behavioral Health Services for American Indians and Alaskan Natives

Overview

  • Presentation based on SAMHSA TIP 61.
    • TIP: Treatment Improvement Protocol, available for free download.
    • Focus on counseling practice more than historical context.

Key Objectives

  • Improve understanding of American Indian and Alaskan Native behavioral health.
  • Emphasize the importance of cultural awareness, identity, and culture-specific knowledge.
  • Explore native culture's role in health beliefs, health-seeking behavior, and healing practices.
  • Discuss prevention and treatment interventions from culturally adapted, evidence-based practices.
  • Methods for achieving cultural responsiveness at the program level.

Demographics and Cultural Insights

  • 22% of American Indians and Alaskan Natives live on reservations; 60% live in urban areas.
  • 200+ tribes in Alaska; significant cultural differences exist among tribes.
  • Eskimo considered derogatory; language awareness is crucial.
  • Health solutions often come from within the community.

Social and Economic Context

  • 25% live in poverty (compared to 13% of the general population).
  • Education is protective but less accessible; importance of oral tradition and auditory learning.
  • Family structures often include extended and non-biological members.

Behavioral Health Issues

  • Lower rates of drinking but higher binge drinking and alcohol use disorder rates.
  • Higher rates of anxiety disorders and youth suicide.
  • Exposure to poverty, unemployment, trauma, and loss of cultural traditions as factors.

Historical Trauma

  • Historical trauma impacts communities and individuals.
    • Collective trauma from oppression, loss of traditions, and cultural practices.
  • Trauma impacts future generations through parenting and exposure to adverse events.

Counseling Approaches

  • Initial Meeting:
    • Establish rapport; promote prevention activities.
    • Respect cultural norms (handshakes, eye contact, confidentiality).
  • Assessment:
    • Explore cultural identity, causes of problems, potential healing.
    • Tailor treatment goals, incorporate cultural activities if desired.

Cultural Responsiveness

  • Engage community leaders, avoid paternalism.
  • Build relationships through community involvement (festivals, events).
  • Healing approaches should include spiritual, emotional, physical, social, behavioral, and cognitive aspects.

Traditional Healing Practices

  • Include community in healing efforts; involve native healers when appropriate.
  • Utilize traditional practices like sweat lodges, chanting, and smudging.
  • Recognize and respect the balance between individual and community health.

Interventions

  • Adapt Motivational Interviewing and trauma-informed approaches.
  • Acceptance and Commitment Therapy aligns well due to its emphasis on values and mindfulness.
  • Use stories and traditional wisdom in Cognitive Behavioral Therapy.

Final Thoughts

  • Understand tribal sovereignty and engage with communities in service provision.
  • Create environments reflecting American Indian and Alaskan Native cultures for respect and engagement.
  • Use mnemonic RESPECT for culturally responsive interactions.

Additional Resources

  • SAMHSA provides further guidance and materials on culturally responsive services.

This comprehensive outline should help in understanding and working effectively with American Indian and Alaskan Native populations in behavioral health services.