1. Urban American Indian Elders Sharing Stories of Resilience
25th Annual Native Health Research Conference
June 2014
ABSTRACT
AMERICAN INDIAN STORIES OF RESILIENCE TO FOSTER WELLBEING. (K.M. Reinschmidt, A. Attakai; UA)
We documented American Indian (AI) stories of resilience and health with urban AI elders, using community-based participatory principles and qualitative methods. We also hosted community events and engaged AI community members to share stories of resilience and health. Thematic analysis showed that resilience strategies of AI elders and community members include utilizing individual responsibility rooted in community, family and cultural traditions. These protective factors can be operationalized to reduce health disparities. For this pilot, we will create digital stories and develop a 12 session program to promote resilient behaviors and strategies associated with wellbeing among Tucson’s AI community.

2. Documenting and Promoting Stories of Resilience Among Urban American Indians Elders
Pilot project funded by the Center for American Indian Resilience
National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number P20MD006872
Partnership between University of Arizona and Tucson Indian Center
PURPOSE
Document life narratives of urban American Indian (AI) elders at the Tucson Indian Center (TIC)
Focus on historical trauma and resilience from Elders’ perspectives.
Develop digital stories based on the narratives
Develop a resilience-based health promotion program/curriculum for youth at TIC consisting of 12 workshops notes

3. Team Members Agnes Attakai and Kerstin M. Reinschmidt (Co-PI)
Carmella Kahn-Thornbrugh (UA)
Shannon Whitewater (UA)
Tara Chico (UA)
Marlene Jose (TIC)
Phoebe Mills (TIC)
Nolando Neswood (elder)
Kathryn Foster (elder)
Nicolette Teufel-Shone (PI- CAIR)

4. CBPR Principles Tucson Indian Center-UA co-designed project
Research process with elders
Community Advisory Board
Co-designed project
UA had long relationship with TIC and it’s leadership wanted a project with elders
- After all they went through, why are Elders so happy when they are here? Let’s bottle it up and give it to the youth.
Or: CBPR principles: Initial consultation with Tucson Indian Center, developing their idea into a research proposal, obtained TIC and UA IRB approval, collaborating with TIC Staff, identified a designated TIC Project Liaison on CAIR CAB and developed a project CAB. Involvement of Elders to review the study materials, providing feedback concerning the research methodology, and providing feedback on questionnaire and curriculum developments.
Research process with elders
Research with elders as part of CBPR: modified interview questions and curriculum outline.
CAB
UA CAIR Pilot staff, TIC staff, urban AI elders (55+)
Monthly meetings at TIC (April-October 2013)
Trainings
2 CAB member were Human Subjects Protection approved
Two coding workshops with UA staff, 1 elder, and 1 TIC staff member
Topics covered during meetings include
Project updates
Demonstration of digital stories
Introduction/discussion on CBPR
Reciprocal relationship building
UA staff will assist CAB members
with projects (i.e. family history books)
Challenges
Low attendance
Re-conceptualized C
Need to re-conceptualize CAB

5. Goal
The purpose this qualitative pilot research project was to document and develop a youth health promotion curriculum on native elders’ stories of resilience.
Methods
Develop questionnaire based on literature
Test with elders and revise
Recruit 15 elder for interviews
Video tape, audio tape and transcribe
Code using NVIVO
Develop curriculum
Test, revise and finalize
Resilience: First is confronting the historical trauma. Second is understanding the trauma. Third is releasing the pain of historical trauma. Fourth is transcending the trauma.” (Brave Heart, M. Y. H., Chase, J., Elkins, J., & Altschul, D. B. 2011)
Research indicates that historical trauma becomes even more painful when it seems to be forgotten, trivialized, or denied: conspiracy of silence.”
Sharing stories is a traditional native practice that provides a vehicle for learning and healing.
Narratives grounded within a strengths-based perspective emphasize how family members are successful in overcoming difficulties and remaining strong in the face of traumatic circumstances or change.
Resilience: The concept of resilience in public health research includes individual internal characteristics and external support from family and community.
Cultural Resilience: For American Indians and other ethnic groups, the role of culture is a strength.
Culture: Shared rules, beliefs, attitudes and practices, which perceptions and shape our interpretation of life events.
Culture shapes our thought processes and understanding through distinctive linguistic interpretation (storytelling) , forged by experience (ceremonies/traditions) and environment (rural/urban, traditiona/contemporary), it facilitates our creation of a unique and comprehensive worldview. We have to make sense of and find meaning in our world.

6. Elder Interviews 11 females, 2 males; age 55+
Structured, open-ended questionnaire with 25 questions
- 2 sections: Historical Trauma – Resilience
Questions
Explored the concepts of “historical trauma” and “resilience” from the Elders’ points of view
Solicited stories about their ancestors, their families and their own lives as related to these two concepts
- Sample Questions
- What do you think of when you hear the words historical trauma?
- How have your ancestors’ experiences with historical trauma or [term suggested by elder] impacted your community?
- 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]?
- What strategies did you use to get through hard times in your life?
- What are some strategies that can help Native urban youth in Tucson get through hard times?
11 females, 2 males; age 55+
1-3 hour duration; video/voice recorded
Stories edited
2nd interview to review digital story

7. Analysis Process Combined consensus and thematic analysis
Consensus approach to develop thematic codes
NVIVO coding
Coded texts shared with team for curriculum design
Complete analysis and interpretation
(CAB) Team consensus of final analysis
Combined consensus and thematic analysis
Consensus approach to develop thematic codes
Included one CAB member (Elder)
NVIVO coding
2 coders
Inter-rater reliability scores
Coders discussed and agreed
Coded shared with team for curriculum design
Complete analysis and interpretation
(CAB) Team consensus of final analysis (in process)  Will run analysis by Elders after March lunch meeting.

8. Thematic Codes Used in NVIVO
THEMES
PATTERNS
HISTORICAL TRAUMA
Native Concepts
Oppression, 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
Survival, 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
Youth
Activities, education, get elders and youth together, know roots/know history
Health
Health now, health then, health of youth, strategies for health
Strategies
Non-Native Support and Connection
Personal Story

9. Historical Trauma Events of the past led to
Loss of language, traditions and culture
Disruption of family life
Contemporary adversities as continuation past events
Alcoholism/drugs
Discrimination
Loss of family members
Generational gap
Untold stories
Strategies to overcome historical trauma
Building positive identities based on culture and tradition
Bringing the generations together
HISTORICAL TRAUMA
Native concepts: oppression, assimilation, fear
Events of the past
(1) led to loss of language, traditions and culture,
(2) disruption of family life (boarding school, removal from family, broken families)
Contemporary adversities seem to be a result/continuation of past events:
(1) alcoholism/drugs (most frequently mentioned adversity)
(2) discrimination (presented as a continuum from the past)
(3) loss of family members
(4) generational gap
(5) lost voice (not talking about historical trauma, untold stories)
To overcome historical trauma,
strategies mentioned included the building of a positive identity based on culture and tradition
and (mentioned by some) by bringing the generations together

10. Multiple, Interrelated Levels of Resilience
At the community level, sources of resilience are
Culture, language, traditions and sharing stories
Traditional land use
Tucson Indian Center and/or other community resources
The family plays important cultural roles by
Teaching the younger generation
Creating positive family relations
Providing family members as role models
The individual is a source of resilience as embedded in family, community and culture/traditions by
practicing spirituality
practicing responsibility
being strong
participating/volunteering
Native Concept: survival, life, getting through hard times, bouncing back, better myself
Resilience has multiple, interrelated layers: community, family and individual
At the community level, sources of resilience are
(1) culture, language and traditions,
(2) TIC (and other community resources),
(3) traditional land use, and
(4) sharing of stories; sovereignty and economic development were mentioned but not frequently
The family plays important cultural roles by
(1) teaching the younger generation,
(2) creating positive family relations (respect, gratitude),
(3) providing family members as role models (e.g. grandmothers knowledge/practices)
The individual is a source of resilience as embedded in family, community and culture/traditions by
(1) practicing spirituality,
(2) practicing responsibility,
(3) being strong, and
(4) participating/volunteering

11. Resilience Strategies for Youth
Education
Activities
Getting elders and youth together
Knowing roots/history
Sources of resilience for youth focused on
(1) education and
(2) activities (traditional or other) and also mentioned
(3) getting elders and youth together and
(4) knowing roots/history
 - I'll have to look more closely into health codes again, but here's what I remember: in general, earlier generations were healthier than current ones; to regain health, youth needs responsibility, activities and spirituality

12. Resilience curriculum
4 modules with elder stories to promote resilient behaviors and strategies among American Indian youth
Public health interventions should adopt strength-based approaches with youth and families to break away from challenges.
Curriculum Development
Completed
Developed curriculum outline
Focus group with 20 Elders to review outline
In process
Developing curriculum, including thematic digital stories
Conduct 6 focus groups with elders to review the digital stories

13. Draft Curriculum
Goal 1: Build connections between elders and youth by enhancing the knowledge of the role of elders in American Indian communities
Goal 2: Enhance youth identity through storytelling
Goal 3: Increase knowledge among youth about American Indian resilience
Goal 1: Build connections between elders and youth by enhancing the knowledge of the role of elders in American Indian communities
Volunteerism
Role Model
Culture, Tradition, Language and Spirituality
Growing Up/History
Health
Goal 2: Enhance youth identity through storytelling
What is storytelling?
Telling your personal story
How to share stories
Goal 3: Increase knowledge among youth about American Indian resilience
History of American Indian Resilience
Personal stories of resilience
Native traditional values and teachings
Personal visions

14. culture, tradition, language growing up/history role models
Goal 1: Build connections between elders and youth by enhancing the knowledge of the role of elders in American Indian communities
Codes
health
generation gap
spirituality
values
culture, tradition, language
growing up/history
role models
volunteerism
Lesson Plans
Voice of Elders
Volunteerism
Role Models
Culture, Tradition, Language and Spirituality
Growing-up/History
Health

15. Goal 2: Enhance youth identity through storytelling
Codes
generation gap
Culture, language, tradition
Lesson Plans
Storytelling
What is storytelling?
Telling your personal story
How to share stories

16. Goal 3: Increase knowledge among youth about American Indian resilience
Lessons Plans
Resilience
History of American Indian Resilience
Personal stories of resilience
Native Traditional values and teachings
Personal visions
Historical Trauma
Specific topics: TBD
Adversity: discrimination,
Codes
Resilience
Individual resilience
Family resilience
Role models
Positive family relations
Community resilience
Traditions
Economic development
Sovereignty
Spirituality
Historical Trauma
Adversity: alcoholism, discrimination, generational gap, ill health, living conditions, loss of family members, lost voice, violence.
sense of loss: boarding school, broken families, language, traditions, removal.
Native Concepts
Health then and now

17. Sample Lesson: Adversity
Facing Adversity
To have participants learn about prejudice, discrimination and how American Indians have faced adversity.
Show video: Historical Trauma: Discrimination (2:03)
Reflect: After viewing video, ask the students what they saw.
Activity: Characteristics and Skills
Discuss: definitions of prejudice, discrimination and stereotypes.
Action: Write in journal how they will use their new knowledge.

18. NEXT STEPS Completing Project Pilot, evaluate and revise curriculum
Present final curriculum and digital stories to Tucson Indian Center

19. Acknowledgements
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:
Agnes Attakai, MPA, Co-PI,
Kerstin M. Reinschmidt, PhD, MPH, Co-PI

20. Thank you 