Carmella Kahn-Thornbrugh, MPH Shannon Whitewater June 5, 2014

CAIR Team

Tucson Indian Center Vision Statement To have a prosperous, healthy, unified, and politically strong urban American Indian Community that promotes and preserves our culture

Background Role of American Indian (AI) elders Keepers and transmitters of knowledge (Wexler, 2011) Endured many adversities (Grandbois & Sanders, 2009) Life stories hold life lessons and foundational knowledge to better understand resilience Youth in today’s society Disconnect between elders and youth (Wexler, 2011) Urban AI youth face greater challenges connecting with elders (Stumblingbear-Riddle, 2012) Previous research acknowledges that ties to culture and other variables (i.e. social support) may be protective and lead to resilient outcomes for positive youth development ((LaFromboise et al., 2006; Wexler, 2011)

Protective intergenerational strategies Spirituality Tribal identity Elders Ceremonies and rituals Humor Oral tradition Family Support networks (HeavyRunner and Morris, 1997) What protective strategies can elders offer to enhance resiliency among urban American Indian youth?

Goal of the project Document life narratives and develop digital stories on resilience of urban American Indian (AI) elders that will be incorporated into 12 bi- monthly workshops for youth and family programs at the Tucson Indian Center (TIC), Tucson, Arizona

Methodology: ; 1)Develop a partnership between UA MEZCOPH and TIC 2)Form community advisory board (CAB): UA MEZCOPH and TIC staff members and urban AI elders 3)Conduct one focus group with 15 AI elders 2 hours – 13 females and 2 males – age 55+ Voice/audio recorded and transcribed Used to revise elder interview questions

1.What do you think of when you hear the words “historical trauma”? 2.How have your ancestors’ experiences with historical trauma or historical cultural shock impacted your community (or communities you have lived in)? 3.What are some examples of community resiliency that have helped your urban community face the challenges related to historical trauma or [term suggested by elder] ? 4.How important are spiritual resources in coping with life’s challenges?

Methodology continued: 4)Hold CAB member training in Human Subject Protection and qualitative data analysis 5) Conduct 13 elder interviews Video/audio recording Structured, open-ended questionnaire with 26 questions 2 sections: Historical Trauma – Resilience

Elder Interviews 11 females, 2 males; age hour duration; video/voice recorded UA staff edited stories 2 nd interview for digital story

Methodology continued: 6) Transcribed13 elder interviews 7)Combined consensus and thematic analysis Consensus approach to develop thematic codes (based on focus group) NVIVO coding Codes were shared with the team for curriculum design (CAB) Team consensus of final analysis and draft curriculum outline

Thematic Codes Used in NVIVO THEMESPATTERNS HISTORICAL TRAUMA Native ConceptsOppression, assimilation, fear Sense of Loss Boarding school, broken families, loss of language, loss of tradition, removal from family, removal from land, yearning Adversities Alcoholism/drugs, discrimination, generational gap, ill health, living conditions, loss of family members, lost voice, violence RESILIENCE Native ConceptsSurvival, life, get through hard times, bounce back, better myself Individual Know roots, participation, practicing spirituality, responsibility, strength, volunteerism Family Family members as role models, growing up, positive family relations, safe environment for kids, teaching kids Community Culture/traditions/language, economic development, TIC, other community resources, sharing stories, sovereignty, spirituality, traditional land use YouthActivities, education, get elders and youth together, know roots/know history HealthHealth now, health then, health of youth, strategies for health Strategies Non-Native Support and Connection Personal Story

Methodology continued: 8)Create digital stories based on themes/codes from elder interviews for the youth curriculum 9) Review digital stories with elders (future step) and CAB 10) Develop 12 bi-monthly workshops around the digital stories and the qualitative interview themes 11) Pilot test and evaluate workshops at TIC Target age: 8 th grade to 11 th grade

Qualitative Interview Process Build trust and comfort Address appearance concerns Refreshments and time for breaks Learning process Technical difficulties (camera, memory cards, lighting, microphones, minimize noise) Room issues

Digital stories for curriculum

Conclusion This pilot project offers an opportunity for AI elders, UA staff, and TIC staff to join together to explore the resilience of urban AI elders and to develop a culturally appropriate intervention to benefit youth and families through TIC programs.

Thank you Sponsor: National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number P20MD Tucson Indian Center: Jacob Bernal, Marlene Jose, Phoebe Mills- Cager, CAIR Community Advisory Board members. Contact Information: Carmella Kahn-Thornbrugh, Agnes Attakai, MPA, Co-PI, Kerstin M. Reinschmidt, PhD, MPH, Co-PI

References Gandbois, D. M., & Sanders, G. F. (2009). The resilience of Native American elders. Issues in Mental Health Nursing, 30, HeavyRunner, I., & Morris, J. S. (1997). Traditional Native culture and resilience. CAREI Research/Practice Newsletter, 5(1). LaFromboise, T. D., Hoyt, D. R., Oliver, L., & Whitbeck, L. B. (2006). Family, community, and school influences on resilience among American Indian adolescents in the upper midwest. Journal of Community Psychology, 34(2), Stumblingbear-Riddle, G., & Romans, J. S. C. (2012). Resilience among urban American Indian adolescents: Exploration into the role of culture, self-esteem, subjective well-being, and social support. American Indian and Alaska Mental Health Research, 19(2), Wexler, L. (2011). Intergenerational dialogue exchange and action: Introducing a community-based participatory approach to connect youth, adults and elders in an Alaskan Native community. International Journal of Qualitative Methods, 10(3),