One Sky Center R. Dale Walker, MD, Director Michelle Singer, Communications Coordinator, ICMI Project Director Doug Bigelow, PhD, Deputy Director

 Evidence-Based vs Culture-Based Dilemma  What is “Evidence”?  Multiple Streams of Evidence  The Learning Healthcare System  Description: A Scientific Framework  Some Culture-Based Interventions

 Epistemological gulf  Western  Traditional AI/AN  Epistemological debate  Validity of traditional world view  Freedom to live by a traditional world view  Practical debate  Controlling by purse strings

 Bridging  Evidence is?  Status of evidence for EBI  How to meet reasonable standards of evidence  Practice Improvement  Multiple Streams of Evidence  Learning Healthcare System

1. Intervention/program research  Randomized Controlled Trials (RCT)  Nonrandomized, uncontrolled  Evaluation  Adaptation of Proven Intervention  Like a Proven Intervention  Basis in Proven Theory, Principles, Facts

 Criteria:  Fidelity  Internal Validity (vs confounding variables)  External validity  Reliability—repeatability.  Process:  Scientific experts  Independent judging and rating  Compilation and Summary

 Therapeutic power of Choice  Self-healing guided by expert healers  Uniqueness of interpersonal relationships  Complexity of factors

1. Individual studies 2. Reviewed collections 3. Lists of model, best, promising, alternative 4. Survivors of meta-analyses

 “Best Practices” = highest scientific standards  Balance point  Reasonable standards are:  Repeatability  Achievable within resources and constraints  Allow conclusions without intolerable doubt  Low risk of harm, if conclusions are wrong

Adoption requires buy-in  Acceptance  Implementation

Adaptation to unique local culture and context  Players  Rules, expectations, traditions  Resources/collaborations  Opportunity to contribute to strategic plan

 MI, CBT, SFP, Project Venture, Canoe Journey implementations  are unique in every setting  Every replication is an Adaptation

 The EBI idea is changing  SAMHSA: “multiple streams of evidence”  IOM: “Learning Healthcare System”

 Intervention/program RTC; Evaluation 1. Adaptation of Proven Intervention 2. Analogous to a Proven Intervention 3. Basis in Proven Theory, Principles, Facts

 “Operationalization” a way of knowing/believing  From black box to detail  Consistency with body of knowledge  Who, what, when, where, how, decisions  Repeatability

 Social ecology (influences)  Prevention  Universal/ selected/ indicated  Risk and Resilience  Readiness to Change  Risk taking/seeking  Stress vulnerability  Modeling (observational learning)  Instrumental learning  Group dynamics  Conformity, altruism  Listening and support  Catharsis  Psychopharmacology

Screening Gatekeeping Diagnosis Treatment Traditional healing Traditional ritual/ceremony Postvention Parent/family training Group work School/institution-based Education/skills Experiential Socialization/acculturation Public Health (risk/resilience) Services develop/coord L E/justice/corrections Community competency Community change Culture

 Story telling  Talking circles  Sweat Lodge  Ceremonies and Ritual  Purification  Passages  Naming  Grieving  Drumming, singing, dancing Vision Quest Flute playing/ meditation Reconciliation Mentoring Service learning GONA

 Cultural Enhancement Through Story Telling (Tohono O’odham Res)  AI Strengthening Families Program (U UT )  Across Ages (Mentoring) (Temple U)  Creating Lasting Family Connections  Dare to Be You (Ute Res)  With Eagles Wings (N. Arapaho Nat)  Families That Care—Guiding Good Choices

 Families and Schools Together (Rural Wisconsin Res)  Parenting Wisely  Preparing for Drug Free Years  Project Alert  Project Venture (NIYLP)  Promoting Alternative Thinking Strategies  Zuni Life Skills (Zuni Pueblo)

 Deal with Epistemological Gulf  Know limitations of Evidence in EBI  Agree upon “Practice Improvement” Goal  Make credibility gains with “Scientific Framework” for Description  Use existing practices and knowledge as evidence for similar CBI

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