1. CDSMP in Tribal Communities: Recipes for Success Shelly Zylstra Northwest Regional Council zylstra@dshs.wa.gov

2. Overview Why in Indian Country? What is different? Classes may be a little different! Good things will happen!

3. A Disparate Culture Indian lands were exchanged for treaty promises, most of which have not been upheld – Food, medical care, education were primary and common to most treaties – Commodity foods, IHS on the non-entitlement budget, and Indian Boarding Schools were what the tribes received Years of poverty, poor medical care and loss have left tribes in a vulnerable position

4. Disparities Infant mortality +33% Accidental death +38% Diabetes death +54% Cirrhosis death +126% Alcohol death +178% CVD unheard of 40 years ago! Diabetes unheard of in 1900!

5. Socioeconomic Characteristics

6. Chronic Disease Rates

7. Health in Indian Country Great emphasis on all aspects of person— emotional, spiritual, physical, and community “Tolerated Illness”— based in importance of community; acceptance Traditional practices Require connectedness between healer and self Self-care is viewed as a complement to the care of family members – “I cannot care for them unless I care for myself.”

8. CDSMP Dissonance Is a self-efficacy model The answer is inside yourself and you hold the power to overcome and manage your symptoms How to encourage self- efficacy in a community where it is considered rude to think of yourself first? How to promote self- reliance and empowerment in a culture where family and community are more important than self?

9. Cultural Differences American Mainstream Family includes biological parents and kids with roles defined by their relationships and position. Autonomy and self- reliance are valued – “Self-made Man” – Bootstraps American Indian Family includes extended family and the community. The elder, family, and community determine family member responsibilities. Decisions and direction are made collaboratively with emphasis on what is better for the community as a whole.

10. Cultural Differences American Mainstream Education is highly respected and counts for a great deal. Time is short! Seize the moment! American Indian Education is important but experience and age can mean more than education. Take your time to listen, think, and make a decision. Right now is more important than tomorrow.

11. Cultural Differences American Mainstream Health = Body parts “Going in Circles” is a waste of time. Healers are made through education American Indian Health = Body, Mind, Spirit which cannot be separated. Circles are important and represent unity of the person, environment, and spiritual things. Healing is a gift from an ancestor or relative

12. Some Things to Remember Don’t start with business Know how to say the name of the tribe Never interrupt an elder Begin and end with prayer Have some food but don’t eat before all of the elders are served

13. More Things to Remember Outcomes which are not important to the community are not important Much of what happens is built on relationships Personal space and eye contact may be different Take your cues from the elders

14. The Classes Tribal people get their information from a number of sources— usually word of mouth – Doctors – Social Service Directors – Health Clinic Staff – Elders’ Program Coordinators – Tribal Breakfasts or Newspapers Connect your class with another event—a congregate meal or another well-attended activity NOTHING beats a personal invitation!

15. CDSMP Classes Almost all parts of the class were identical to the mainstream classes with some exceptions – The “partner” activities were done as two groups – Defer to older partner – Reporting out was problematic with partners Emphasized the total number of years in each group to demonstrate the “age” of wisdom represented Some attended with low literacy so did not heavily emphasize the book – Showed the pictures

16. CDSMP Classes Provided more support than other classes – Pencils, paper, other resources – Considered rude to not share what I obviously had! Many began the class as “Lookie Lou’s” – Janitor listened while he washed the floor While questions were posed during class, they were not answered due to “time” – Took notes on training which was necessary to get folks the information they needed Action Plans started slow but grew

17. Lessons Learned Don’t plan to stick to timelines exactly – If an elder is speaking, you don’t interrupt Food and Prayer – You don’t gather tribal members without providing it—we tied ours to meal sites. – Health is sacred—begin and end each session with a blessing Bring pencils and paper Get ready for stories and prepare to laugh Emphasize age and wisdom – Ask for the participation of the elders and start with them during brainstorms and problem-solving Emphasize self-efficacy for the benefit of the community and NOT for the individual