1. Weaving Holistic Care within Native American Communities

2. Oklahoma City Area Indian Health Service

3.  562 federally recognized Indian Tribes, bands, nations, pueblos, rancherias, communities and Native villages in the United States.  Oklahoma City Area is home to more than 39 Tribes and Tribal Organizations  Share some commonalities  But, basically each tribal Nation has unique characteristics EVEN within this local state A Few Cautions

5.  Sharing and generosity  Allegiance to family, community, and Tribe  Respect for elders  Non-Interference  Orientation to present time  Harmony with Nature  Respect for status of the Woman and the Child Child Common Values Among Natives

6.  A belief in an unseen power, or Creator or Creator  All things in the universe are related  Worship reinforces bonds between the individual, family, and community (our relatedness)  Spirituality is intimately connected to our health Common beliefs related to Spirituality

7.  Members of a particular cultural group are not alike. Although people may share a common language, they may have very different origins, culture beliefs, and practices  Acculturation is not always a linear process. Family members can be at different points in the cultural continuum at different points in their lives. Family values and practices may be more traditional with infants than with young adults  Some families incorporate both cultures into their lives, using both modern educational beliefs and traditional beliefs of services.  Trust and respect with providers are vitally important for families from all cultural groups. Trust and respect are earned over time Cultural beliefs and values

8.  Providers should be careful not to make assumptions about a family’s religious or spiritual practice  Providers need to acknowledge and support the spiritual or religious part of families’ lives  Family privacy around religious or spiritual practices must be honored Family Spirituality

9.  Confidentiality is particularly important for families who live in traditional cultural communities where providers can easily share personal information with other staff without permission Family privacy

10. Large families with many children are valued as wealth in many cultures. Large families with many children are valued as wealth in many cultures. Cultural traditions surrounding extended family continue even though family living conditions change. Cultural traditions surrounding extended family continue even though family living conditions change. It is important to ask the family who they would like to include. It is important to ask the family who they would like to include. Concepts of family

11.  The time taken for introductions and “small talk” shows respect. These are an essential part of establishing rapport and trust  Communication may be indirect  Families who speak limited or no English may hesitate to ask questions or admit they do not understand  It is disrespectful to ask questions, request information, or disagree, particularly with an authority figure  Honor, humility and privacy are important values in certain cultures Communication Styles

12.  Health or developmental problems may kept private and treated within the family. The family may be discouraged from seeking help outside their own culture  The medical system may be a second opinion or the last resort  Families may use traditional herbal remedies instead of, or in combination with, western medicine  Families want providers to respect their traditional healing methods  All families from different cultures do not use traditional healing practices  There may be “costs” to families when they seek out western medical interventions, like conflicts with family members or traditional healing methods Perceptions of illness and disability

13. Conflicting values Professional Systems Families from Different Cultures Facts rather than feelings/ personal relationships Building relationships with people not systems Impersonal Communications Sharing information through conversation not documents Formal appointments/Strict Timelines Schedules and appointment determined through family and cultural relationships Cost effective servicesFamily involvement in and support from the culture Speedy delivery of servicesTaking whatever time is needed to accomplish healing

15.  Accept: the family’s beliefs, values, and practices, even if you don’t agree;  Learn: about the culture of the community and the individual families you serve, and remember to ask questions rather than assume;  Explain: to families why you need information, why time and appointments are important, and how they willbenefit;  Respect: the family’s cultural ideas, beliefs, values, and practices,find culturally appropriate ways to show respect;  Train: educate to enhance understanding A.L.E.R.T.

16.  Tribes are governments that have authority with regard to their members  Tribes existed prior to the U.S.  Tribal Nations made treaties with colonial powers, states, and the U.S.  Nations within a nation Tribal Sovereignty

17.  Tribes are treated as governments by the federal government  Approval Protocols  Tribal “consultation”= means federal agency must meet with all federally recognized Tribal Nations Government-to-Government Relationship

18.   Serious behavioral health issues such as substance use disorders, mental health disorders, suicide, violence, and behavior-related chronic diseases have a profound impact on the health of American Indian/Alaska Native individuals, families, and communities. Through its programs, the IHS Division of Behavioral Health addresses these issues and follows the current Indian health care system focus on integrated behavioral health and primary care treatment that respects the balance, wellness, and resilience of AI/AN people IHS Division of Behavioral Health

19.   Positive mental and emotional health is crucial for the well-being of AI/AN individuals and their communities. The Indian Health Service work with AI/AN communities to provide clinical and preventive services that address the full range of mental health and social problems present in individuals to communities, including depression; suicide; traumatic life circumstances including child abuse, neglect and domestic violence; and co- occurring disorders including the interplay among physical disorders, addiction, and behavioral health. IHS Division of Behavioral Health

20.   ASAP nurtures excellence in holistic approaches that promote healthy lifestyles, families, and communities. Programs address alcohol and substance abuse by improving access to behavioral health services through tele-behavioral health efforts and providing a comprehensive array of preventative, educational and treatment services. Alcohol and Substance Abuse Prevention

21.   This initiative promotes the development of evidence-based and practice-based models that represent culturally appropriate prevention and treatment approaches to domestic and sexual violence from a community-driven context. The DVPI expands outreach and increases awareness by funding projects that provide victim advocacy, intervention, case coordination, policy development, community response teams, and community and school education programs. The funding may also be used for the purchase of forensic equipment, medical personnel training, and the coordination of sexual assault nurse examiner (SANE), sexual assault forensic examiner (SAFE), and sexual assault response team (SART) activities. Domestic Violence Prevention Initiative

22.  Cherokee Nation  Choctaw Nation of Oklahoma  Chickasaw Nation  Citizen Potawatomi Nation  Indian Health Care Resource Center Tulsa  Oklahoma City Indian Clinic Oklahoma City Area DVPI Projects

23.   Victims of violence and abuse require care from health professionals who are trained to treat trauma and provide medical forensic care for injuries sustained from sexual assault, intimate partner violence, child sexual abuse, elder abuse. Forensic healthcare providers are typically registered nurses, but also include advanced practice nurses, physicians, and physician assistants. They provide medical treatment and evaluation; have a specialized knowledge in injury identification; collect evidence; and offer testimony in a court of law to assist with prosecuting individuals who commit acts of abuse. Forensic Health Care

24.   The Methamphetamine and Suicide Prevention Initiative (MSPI) is a nationally-coordinated demonstration project, focusing on providing much-needed methamphetamine and suicide prevention and intervention resources for Indian Country. This initiative promotes the use and development of evidence-based and practice-based models that represent culturally- appropriate prevention and treatment approaches to methamphetamine abuse and suicide prevention from a community-driven context. Methamphetamine and Suicide Prevention Initiative

25.   Despite the strengths of American Indian and Alaska Native (AI/AN) families and communities, suicide remains a devastating and all too frequent event. Complex, interrelated factors contribute to an increased suicide risk among AI/AN people. Risk factors include mental health disorders, substance abuse, intergenerational trauma, and community- wide issues. Factors that protect AI/AN youth and young adults against suicidal behavior are a sense of belonging to one's culture, a strong tribal/spiritual bond, the opportunity to discuss problems with family or friends, feeling connected to family, and positive emotional health. Methamphetamine and Suicide Prevention Initiative

26.   The Methamphetamine and Suicide Prevention Initiative (MSPI) is a nationally-coordinated demonstration project, focusing on providing much-needed methamphetamine and suicide prevention and intervention resources for Indian Country. This initiative promotes the use and development of evidence-based and practice-based models that represent culturally- appropriate prevention and treatment approaches to methamphetamine abuse and suicide prevention from a community-driven context. Methamphetamine and Suicide Prevention Initiative

27.  Cherokee Nation  Chickasaw Nation  Choctaw Nation of Oklahoma  Citizen Potawatomi Nation  Eastern Shawnee Tribe of Oklahoma  Indian Health Care Resource Center of Tulsa  Iowa Tribe of Kansas and Nebraska  Kickapoo Tribe of Oklahoma  Kiowa Tribe of Oklahoma  Muscogee Creek Nation  Northeastern Tribal Health System  Oklahoma City Indian Clinic  Oklahoma City Area Office  Otoe-Missouria Tribe  Ponca Tribe of Oklahoma  Wyandotte Nation Oklahoma City Area MSPI Projects

28.  Policy  Assessment  Treatment  Healing OCA Project PATH

29.   Our mission is to provide, promote, and support the delivery of high quality, culturally competent tele-behavioral health services to American Indians/Alaska Natives when and where they are needed. Oklahoma City Area Tele-behavioral Health

30.  Primary Care  Women’s Health  Diabetes Wellness  Pediatrics Social Work/Behavioral Health Consultants

31. Yappalli

32. Questions?

33. Acknowledgements  Native American Parent Technical Assistance Center (NAPTAC)  Cultural Considerations in Community Based Research (NatAmCancer.org)

34. Thank you!