SAMHSA-Funded Projects Highlight
American Indians & Alaska Natives
By Melissa Capers
Four SAMHSA grantees published articles about their programs in
the January-March 2003 issue of the Journal of Psychoactive
Drugs, a publication of Haight-Ashbury Free Clinics, Inc.,
San Francisco, CA. The issue focuses on efforts in American Indian
and Alaska Native communities to address health disparities and
provide culturally competent substance abuse and mental health treatment
through the integration of traditional, indigenous practices, and
Western treatment techniques.
Family and Child Guidance Clinic, Native American Health Center,
Founded in 1972, the Native American Health Center provides a variety
of medical and social services to urban communities of American
Indians and Alaska Natives in the San Francisco Bay Area. This locale
has one of the highest concentrations of American Indians living
in urban areas of the United States. Outpatient mental health and
substance abuse treatment is provided through the Family and Child
Guidance Clinic (FCGC).
In "A Holistic System of Care for Native Americans in an Urban
Environment," Ethan Nebelkopf, Ph.D., and Janet King describe
the strategic planning process used to develop appropriate services
to meet critical community needs. In 1998, a 3-year planning grant
from SAMHSA's Circle of Care Initiative supported the FCGC in developing
a Circle of Care-a local system of care rooted in cultural values
within the community. Through interviews with diverse community
stakeholders, the FCGC identified key issues and resources in the
community of more than 80,000 individuals representing more than
100 different tribes. They created a holistic, solutions-focused
model that develops bridges between traditional spirituality and
values and community systems of care.
Beginning in a central circle representing the Creator, an illustration
of the FCGC Circle-of-Care model represents morbidities such as
substance abuse, hunger, domestic violence, and mental illness as
imbalances within the quadrants of spirit, body, feelings, and thought.
These quadrants of human experience are coordinated to the four
traditional elements of creation-fire, earth, water, and air-and
to community systems of care, including the criminal justice system;
the housing, managed health care, welfare, and mental health systems;
and schools. The model focuses on solutions, and highlights both
Native "exemplary practices" (e.g., the talking circle)
and Western ones (e.g., case management).
In another article, "The Women's Circle Comes Full Circle,"
Karen Saylors, Ph.D., describes the history and impact of the Women's
Circle project of the FCGC. Initiated in 1996, the Women's Circle
focuses on HIV prevention for American Indian and Alaska Native
women. In 1999, SAMHSA supported expansion of substance abuse treatment
services and the provision of mental health services within the
Women's Circle, where culturally based interventions are combined
with Western psychotherapeutic and medical services.
Ninety-five different tribal affiliations are represented among
Women's Circle clients, and individual clients vary in their desire
to engage in traditional practices. In response to this individual
and cultural diversity, clinical assessment at the Women's Circle
includes a spiritual/cultural domain, which is used in the development
of an individual treatment plan. The treatment plan may include
sage, cedar, or sweet grass smudges, along with singing, drumming,
sweat lodge ceremonies, talking circles, and other cultural healing
Dr. Saylors emphasizes that, ". the way cultural interventions
often occur is on the individual level, with counselors assessing
a client's desire or readiness to work with traditional ways."
Providing individualized, culturally based treatment appears quite
effective: Rates of substance abuse among clients decreased sharply
after treatment at the Women's Circle.
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Dine' Center for Substance Abuse Treatment, Navajo Nation
In October 1993, the Navajo Nation founded the Dine' Center for
Substance Abuse Treatment as one of six Rural, Remote, and Culturally
Distinct Populations projects funded by SAMHSA. The traditional
healing practices used by the Dine' Center in alcohol and substance
abuse treatment included sweat lodge ceremonies. In 1994, these
ceremonies were made available to inmates in the Navajo Nation's
Window Rock Jail. There, 190 men participated in a 3-year study
(from 1996 to 1999) of the effect of these ceremonies in jail-based
substance abuse treatment. Weekly alcohol education classes were
paired with weekly group psychotherapeutic sessions conducted within
the context of a sweat lodge ceremony.
"The way cultural interventions often occur is on the individual level, with counselors assessing a client's desire or readiness to work with traditional ways."
The results of this study are reported in "Sweat Lodge Ceremonies
for Jail-Based Treatment," by J. Phillip Gossage, Ph.D., Louie
Barton, Lenny Foster, Larry Estsitty, Clayton Lone Tree, Carol Leonard,
M.P.H., and Philip A. May, Ph.D. The small sample size and data
collection challenges faced by investigators limit the conclusions
that can be drawn from this study. However, the data show a decrease
in the average number of drinks participants consumed at drinking
sessions (from a mean of 6.7 to a mean of 5.3) and improvement in
participants' world view, suggesting that further efforts and study
on the provision of culturally based treatment for American Indians
within the criminal justice system are necessary and appropriate.
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Village Sobriety Project, Hooper Bay and Scammon Bay, Alaska
The Village Sobriety Project, funded by a 3-year SAMHSA grant (from
1999 to 2002), preserves and honors traditional practices by weaving
them into mental health and substance abuse treatment. In "Incorporating
Yup'ik and Cup'ik Eskimo Traditions Into Behavioral Health Treatment,"
Phoebe A. Mills, M.S.W., reports on efforts in the Yukon-Kuskokwim
Delta of southwest Alaska to preserve culture and enhance outcomes,
as well as to ensure access to services through developing Medicaid-reimbursable
treatment plans that incorporate traditional and Western healing
Before the project, the authors say, treatment services for this
population "were approached solely from the Western framework,
operating with such tools as the DSM-IV, cognitive therapy, rational-emotive
therapy, play therapy, and art therapy. One premise behind the incorporation
of traditional modalities into behavioral health treatment is that
if Western modalities can utilize play and art in therapy, then
traditional cultural activities can be considered just as valid
in formal treatments."
Some of the traditional cultural practices incorporated into treatment
included hunting, chopping wood, taking tundra walks, and gathering
edible and medicinal plants. Through making clear correlations between
traditional activities and Medicaid service components, and meeting
certain requirements regarding staff qualifications and documentation
of treatment, program staff were able to develop a service model
that is not only culturally competent, but also financially sustainable
and accessible to clients.
In Mental Health: Culture, Race, and Ethnicity (1999),
the U.S. Surgeon General reported that culture plays a role in the
effectiveness of mental health treatments, and that racial and ethnic
minorities are less likely than the general population to receive
quality services. The efforts highlighted in the Journal of
Psychoactive Drugs (Jan-Mar 2003) suggest that both of these
concerns might be addressed through culturally competent mental
health and substance abuse services blending traditional Native
and contemporary Western practices.
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