"Students will work in teams of 3 to 4 members and lead the discussion of the readings and additional materials about one of the racial/ethnic groups covered in the course or another topic approved by the instructor. This will involve presenting a summary of the readings about assessment and treatment issues for the selected group. Disparities in mental health services for the group should also be reviewed along with solutions for resolving them. If another topic is selected, the team will be responsible for summarizing the literature on the topic. Students are encouraged to create a PowerPoint presentation on their topic and provide handouts to the class." Class Syllabus from Dr. Vida Dyson

1. Native Americans & American Indians:
Considerations for Assessment & Treatment
Deep Battu| Miguel Gonzalez | Kulky Nakai| Jillian Richardson
1

2. COUNSELING
AMERICAN INDIANS
AND ALASKA NATIVES
(AI/AN)
Sue, D.W. & Sue, D. (2012). Counseling the
culturally diverse: theory and practice. (6th Ed).
New York: John Wiley & Sons.
2

3. Historical Considerations
 American Indians/Alaska
Natives (AI/AN) are
composed of 565 distinct tribes
 AI/AN population was 2.9 million in 2010
representing 0.9% of the total U.S. population
per the U.S. Census Bureau
 Of the 175 Native languages once spoken in
the U.S., only 20 are still passed on to younger
generations
3

4. Historical Considerations (cont’d)
 In 1887, the U.S. government determined
Indians were incapable of managing their own
land
 Land was placed into a trust with the
“promise” that the Indians would receive
income from the land
 Not until 1999 when a Federal Judge ruled
that the government had breached the
agreement
4

5. General Statistics

34% of AI/ANs live on reservations, where 57% reside in metropolitan
areas








Many return to reservations for work in casinos or for a nurturing
environment
FewerAI/ANsare high school graduates as compared to the general
population
The poverty rate amongAI/ANsis double that of the U.S. population
Mortality rate is over twice as high than that of the U.S. population
Injuries and violence account for 75% of all AI/AN deaths between
ages of 1 to 19
Depression and substance abuse is also disproportionately higher in
this population
Congress determined to have at least 25% of Indian blood to be
consideredAI/AN
Tribal leaders fought to develop their own criteria
5

6. Characteristics and Strengths

The tribe is a fundamental importance based on a
interdependent system

Family is more than parents, extended family is part of
the basic unit

Honor and respect are gained through sharing and
giving such as the accumulation of material goods

AI/ANswork hard to prevent discord and believe that
family and the tribe are more important than the
individual

Taught not to interfere with others and to observe
rather than react impulsively
6

7. Characteristics and Strengths (cont’d)
 AI/NAshow greater focus on the present than
on the future, therefore punctuality and
planning for the future may be unimportant
 Spirit, mind, and body are interconnected
where illness is believed to involve
disharmony with these elements
 Learning occurs from listening rather than
talking, hence direct eye contact with an elder
may be a sign of disrespect
7

8. Cultural Implications Based on Treatment

Assessment should include tribal relationships
and if any decision-making process would include
the tribe
 Of note, many who leave the reservation report losing
a sense of identity

Because parents are not only ones responsible for
raising the child, it is important to find what each
family member’s role may be to determine
appropriate interventions
 Goals of therapy or interventions may need input
from extended family or tribal leaders
8

9. Cultural Implications Based on Treatment (cont’d)

Due to emphasis on sharing, once enough money
is gathered, most AI/ANs stop working and spend
time focusing on ceremonial activities

Instead of going to work or school, AI/ANs may
prioritize helping family, thus may be seen as
unmotivated in school

Tasks are approached from a logical perspective
rather than based on timelines which can develop
a cultural conflict
9

10. Cultural Implications Based on Treatment (cont’d)
 Due to values on Spirituality,
treatment must
encompass all aspects of mind, body, and
spirit (i.e. sweat lodge, vision quests)
 Determine what types of nonverbal
communication are due to cultural values or
actual problems necessitating treatment
10

11. Challenges Based on History
 It is important to consider historical
sociopolitical relationships between
AI/ANsand the local, state, and federal
government
 Consideration with involving DCFS
 Suspicion is often seen towards majority
culture due to history of broken treaties and
governmental policies
11

12. Educational Challenges

AI/AN children display a decline in academic performance by
the 4th grade



Academic success is not perceived to be rewarding
Many have the perception of no need for “White man’s education”
Many AI/ANs drop out of high school

11% have Bachelor’s Degree as compared to 24% of U.S. population

Many AI/AN students feel “pushed out” of the school systems
and express mistrust for the teachers and White community

Recommended to have school system to bridge the gap
between NA and White cultures
12

13. Acculturation Challenges
 Many youth report feeling “torn” between
two cultures and fail to develop a positive selfidentity
 Bee-Gates et al. (1996) found that boys
frequently cited being an AI/AN as a problem,
while two-thirds of girls reported not wanting
to live due to self-identity stressors
13

14. Cultural Orientation Model
M.T. Garret and Pichette (2000)

Traditional: the individual may speak little English and
practice traditional customs

Marginal: individual may be bilingual but has lost touch with
their cultural heritage, yet is not fully accepted in mainstream
society

Bicultural: the individual is conversant with both sets of
values and can communicate in a variety of contexts

Assimilated: the individual embraces only mainstream
culture’s values, behaviors, and expectations

Pantraditional: the individual has been exposed to and
adopted mainstream values but is making a conscious effort
to return to the “old ways”
14

15. Cultural Model Implications

Assessment of the level of acculturation is recommended to
determine the selection of therapeutic interventions

Individuals with traditional orientations may be unfamiliar
with dominant culture expectations and may want to develop
skills to deal with mainstream society

Assimilated or marginal individuals may want to examine
possible value and self-identity conflicts

Acculturated AI/ANs have been found to have success in
treatment with CBT components, whereas traditional AI/ANs
are responsive to short-term focus, activity schedule, and
some forms of homework assignments
15

16. Alcohol and Substance Abuse

AI/ANs have the highest weekly consumption of alcohol
compared to any other ethnic group

It is common to begin drinking at an early age for AI/ANs

High use of alcohol and other drugs can be linked to cultural
value of sharing, giving and togetherness

Self-identity, cultural identity, social pressures can also be
linked to increase use of alcohol in this culture

Community-oriented programs that engage the entire
community rather than the individual and inclusion of tribal
leaders is a recommended intervention

Many tribes develop their own traditional substance abuse programs
16

17. Domestic Violence

Statistics rate AI/AN women to suffer 3.5 times
higher incidences of physical, sexual, and domestic
violence compared to the general population
 This may be a gross underestimation due to many women
not coming forth to report these incidences
Due to many women remaining silent, and continued
distrust for White-dominated agencies, fear of
familial alienation, many will continue to remain
silent
 When working with abused women, inclusion of
family, community, and tribal support is
recommended

17

18. Suicide

There is a high incidence of suicide among AI/ANs
 Thought to be result of alcohol abuse, poverty, boredom,
and family breakdown
Adolescence to adulthood is the time of greatest risk
for suicide among AI/ANs, especially males
 Recommended to include community and tribal
support for those living on reservations or with ties
to their tribes
 Many traditionally-based AI/AN individuals believe
mental illness is due to spiritual imbalance

18

19. IDENTIFYING EFFECTIVE MENTAL HEALTH
INTERVENTIONS FOR AMERICAN INDIANS
& ALASKA NATIVES
Gone, J. P. &Alcantara, C. (2007). Identifying
effective mental health interventions for American
Indians and Alaska Natives: A review of the
literature. Cultural Diversity and Ethnic Minority
Psychology, 13 (4), 356-363.
19

20. Purpose of Article
 Review of the literature pertaining to
Native American (NA) mental health
interventions that targeted the more
prevalent psychological disorders in the
community, within the EBP movement
20

21. Method
 Comprehensive review of the literature using
four computerized bibliographic databases
encompassing English-language citations of
scholarly publications in the mental health
field
 PsycINFO, PubMed,
Social Work Abstracts, and the
Social Sciences Citation Index
 Proxy descriptors were used such as:
treatment, and prevention and intervention to
identify native-specific literature concerning
treatment outcomes
21

22. Method (cont’d)

13 additional descriptors of mental health problems were
used based upon epidemiological and anecdotal evidence
attesting to their prevalence in and relevance for NA
populations, including:

mental disorders, depression, anxiety, suicide, PTSD, emotional
trauma, child abuse, sexual abuse, attention deficit hyperactivity
disorder (ADHD), antisocial behavior, conduct disorder, juvenile
delinquency, and “postcolonial stress disorder”
Finally, “Native American”/“American Indian” and “Alaska
Native” were the terms selected to limit search results
 There were 312 searches that used this formula:
(Computerized Database [4] × Practice Descriptor [3] ×
Problem Descriptor [13] × Group identifier [2])

22

23. Results
3500 initial citations elicited 56 articles and chapters from Nativespecific mental health programs, interventions, and treatment
approaches
 This literature was nominally classified as follows:








(a) randomized or controlled outcome studies (n = 3)
(b) nonrandomized or uncontrolled outcome studies (n = 6)
(c) intervention descriptions (n = 14)
(d) summary intervention overviews (n = 2)
(e) clinical case studies (n = 7)
(f) intervention approaches (n = 24)
To summarize, the literature used the following descriptions:

prevention of maladaptive adolescent behaviors and suicide through the
cultivation of coping skills and prosocial competencies; treatment of
depression, trauma, and sexual abuse through both conventional and
innovative therapeutic methods; application of extended family therapy,
relaxation and assertiveness training, eye movement desensitization and
reprocessing therapy, and stimulus fading procedures in single clinical cases;
and implementation of innovative service delivery efforts within mental health
treatment systems and settings in NA communities
23

24. Results(cont’d)





9 outcome studies were used to identify EBP for mental health
problems
Very few articles and chapters were empirical reports so their value
for evidence based mental health treatments was limited
Of the 9 outcome studies classified above, 6 reported pre and post
intervention results for a treatment group with no untreated group
for comparison, thereby rendering valid inferences about the causal
relationship of intervention to outcome in these instances uncertain
Beyond these 6 articles, an additional outcome study reported the
efficacy of a pharmacotherapy (methylphenidate) rather than a
psychological intervention for comorbid ADHD and fetal alcohol
syndrome among four NA children
Finally, no literature was identified through these searches that
attempted an assessment of outcomes for NA traditional healing or
other culturally grounded ceremonies targeted at mental health
24

25. Results(cont’d)

Only 2 controlled outcome studieshad adequate
sample sizes and interpretable results:



Manson and Brenneman (1995)reported outcomes for an
intervention undertaken to prevent clinical depression
among olderAIsencountering health-related stressors in
the Pacific Northwest
LaFromboiseand Howard-Pitney (1995)reported outcomes
for an intervention undertaken to prevent suicide among
adolescentAIs through life skills training in a school-based
program in the American Southwest
These 2 studies attest that there is limited literature on
EBP and is it useful in looking at this population
25

26. Discussion






Should there be more culturally relevant or sensitive practices that we use
and identify and that could be more a more effective option for NA
clients?
The authors decided to present their findings in 2004 at the One Sky
Center, a federally funded national resource centerfor AI/AN substance
abuse and mental health services, in Oregon Health and Science University
Policymakers, practitioners, and mental health researchers all debated
and discussed the knowledge pertaining to EBP for NA populations
The consensus was that there should bean adaption of mental health and
substance abuse treatments in implementation withNA population
Some believed that EBP movement was just another way to exercise
control of mental health resources all levels and an example of arrogance
on behalf of European Americans
Others credited EBP with facilitating greater accountability for therapeutic
efficacy and having more protection for the Native people
26

27. Discussion (cont’d)



The authors recognized the importance of empirical literature pertaining to
intervention outcomes in the arena of NA mental health, but believe there is
enough reasons for reconsidering the call to EBP in NA mental health service
delivery
There are several limitations and contradictions that have yet to be resolved
within the EBP movement, especially as it prepares to assimilate mental
health service delivery within NA communities
One example is the limited external validity or generalizability of the
outcomes of RCTs relative to actual clinical practice.


RCTsare seen as artificial and not realistic
The authors proposed that the demonstration of positive therapeutic
outcomes for an intervention through RCTs is the first phase in identifying
EBP; a second crucial empirical endeavor is the establishment of parameters
regarding the range of conditions and contexts in which the established
causal relationship between intervention and outcome remains intact.
Lastly, both efficacy and effectiveness studies depend on the reliable and
valid assessment of psychological attributes and outcomes, an endeavor only
infrequently investigated among NA respondents
27

28. Discussion (cont’d)





Another critique looks at how the mental health EBP movement
asserts that the designation of the RCT as the gold standard for the
evaluation of pharmacological interventions in medicine cannot be
meaningfully extended to the evaluation of psychotherapeutic
interventions in the mental health professions
Finally, critics argue that mental health professionals should pursue
EBP by prescribing empirically supported therapeutic relationships
(ESTRs) instead of specific clinical techniques, and place emphasis on
healing relationships
The culture of the mental health clinic is not the culture of the
reservation community
In many Native communities, the contemporary status of AI “mental
health” remains significantly caught up in history, culture, identity,
and (especially) spirituality, all within the devastating context of
European American colonialism
Return to sacred tradition and practice from which a renewed sense
of purpose, source of coherence, and semblance of continuity might
be fashioned
28

29. Discussion (cont’d)
The role of EBP seems to have little relevance in the NA community
 New roles which advocate more for community psychology might
be more appropriate
 There could be more traditional clinical services and community
mental health approaches and service delivery
 Looking at reaching larger numbers of people through brief
consultations and crisis intervention; instead of the clinician's office,
the location of intervention is practice in the community; instead of
assuming an intrapsychic cause of disorder, the etiological factors of
interest are the environmental causes of maladaptation; instead of
rehabilitative services or “treatments,” the type of service delivery
is often preventative in nature; instead of professional control of
mental health services, the locus of decision making is shared
responsibility between professionals and community members; and
so on

29

30. Conclusion
• The NA population may need a different type
of service that no one has yet thought of
• More empirical research needs to be done on
the population
30

31. HONORING THEIR WAY:
COUNSELING AMERICAN
INDIAN WOMEN
Rayle, D. A., Chee, C., & Sand, J. K. (2006).
Honoring their way: Counseling American
Indian women. Journal of Multicultural
Counseling and Development, 34(2), 66-79.
31

32. American Indian (AI) Women
Throughout U.S. history, multiple assaults of
racism, sexism, and sociopolitical and economic
disadvantages compound the discrimination and
injustices against AI women
 Contributes to higher levels of poverty, school
drop outs, unemployment, substance abuse,
alcohol-related mortality, domestic violence,
suicide, gang-related violence, poor physical
health, and other mental health problems (e.g.,
depression and feelings of hopelessness)

32

33. AI Stigma
 Historical incidents of the past may have
negatively affected AI’s view of their cultural
values that differ from those of mainstream
America (i.e., cultural dissonance)
 Led to have considerable distrust of European
American counselors
 AI’s do not feel liberated or free enough to
seek help
 Indian Health Service (IHS) serves over 500K
33

34. Experience of AI Women Today
Crucial to consider in counseling:
History and values of females in the U.S. (especially
women of color who face forms of racism, sexism,
inequality, and stereotyping)
 Experiences with the acculturation process (often
varies in identity development and level of
acceptance of and commitment to tribal values,
beliefs, and practices)
 Gender-neutral behaviors, or psychologically
androgynous, is viewed as a strength

34

35. Core AI Values













Harmony
Unity
Noninterference
Respect for elders and all others
Sharing
Being
Cooperation
Collectivism
Reservation life
Matriarchal systems
Present-time living and orientation
Traditional spiritual beliefs and healing methods
Harmony with nature, oppression, and racism
35

36. Counseling Needs of AI Women
Historical Effects:
 18th-19th Century: Battle of Wounded Knee
and the Indian Removal/Trail of Tears where AI
women were beaten, raped, and killed
because they were considered “savages”
 20th Century: AI women were forced to leave
their families and attend nonreservation
boarding schools that influenced their
worldviews, experiences, and trust levels
(especially with the government)
36

37. Counseling Needs of AI Women (cont’d)
Cultural Values:
 Political, social, and cultural histories, in addition
to personal, gender, familial, and cultural values
and beliefs
 A sense of connection to the land is primary in
the psychological makeup of all AI women, as this
is intertwined with AI’s religion, values, culture,
and complete life experience
 5 Levels of acculturation: 1) traditional, 2)
marginal, 3) bicultural, 4) assimilated, and 5)
pantraditional
37

38. Counseling Needs of AI Women (cont’d)
Physical and Mental Health:
 Health irregularities did not exist prior to colonization
 Most vital mental and physical health concerns are the
effects from alcoholism and substance abuse
 Higher alcoholism rates than any other women of color
in U.S. society
 Increased emotional and psychological disturbance,
such as depression, which affects 79% of AI women
who use IHS mental health services (IHS, 2000)
 Suicide rates are four times greater than all other U.S.
women
38

39. Counseling Needs of AI Women (cont’d)
Traditional Responsibilities and Education:
 27% of AI households are headed by women,
which requires women to stay at home
 1% of AI women have obtained higher education
and formal training, but often experience barriers
that interfere with or hinder their success in
professional careers (also consider gender
variations in educational attainment)
 Consider an intentional decision for traditional AI
women to refuse leaving their reservations and
families, losing their cultural heritage, and
trusting others from outside reservation life
39

40. Considerations for Counseling
AI Women (cont’d)
Acculturation and Identities:
 Openly address acculturation and life experiences as a
woman, as an indigenous AI person, and as an AI
woman
 Encourage the beginning process of therapy using selfdisclosure and initiating conversation about the scope
of counseling and how the process is likely to unfold
 Inquire about comfort level in bridging both cultural
experiences of traditional healing (i.e., songs, herbs,
sand paintings) and nontraditional approaches to
healing
 Encourage her to visit the reservation to reinforce her
identity and mainstream connections with extended
family in order to navigate both worlds
40

41. Considerations for Counseling
AI Women (cont’d)
Tribal and Clan Membership and Values:
 Inquire about her tribal affiliation, clan
membership, and values
 Common AI values:
 Humility
 Cooperation over competition
 Silence over words
 Respect for elders (only speak when asked)
 Preference for matriarchal society
41

42. Considerations for Counseling
AI Women (cont’d)
Culturally Specific Counseling Approaches:
 Definition of “sick” is being unbalanced or losing
the path of beauty
 Religion = Medicine
 Honor values by redefining or rediscovering
harmony and balance to build loyalty, respect, and
trust in therapeutic relationship
 Interact and consult with elders in the community,
and be aware of urban community resources
 Empower her regarding abilities and selfconfidence
42

43. Counselor Cultural Awareness & Techniques:
Build credibility with AI women by having the
knowledge and awareness of AI culture
 Weave Western counseling techniques with elements
of AI culture, beliefs, and philosophy
 Traditional AI learning processes emphasize a narrative
approach (i.e., legends, stories, metaphors) to create
symbolic meanings and share tribal histories to convey
complex concepts
 Humor brings people together and reaffirms bonds of
kinship, therefore laughter relieves stress and creates
an atmosphere of sharing and connectedness (often
used to deal with painful and oppressive experiences)

43

44. Counseling Implications

Acquire basic knowledge of AI women’s historical
and current challenges (etic) and their cultural
values and individual personal beliefs (emic), in
order to understand worldviews and to integrate
culturally appropriate counseling interventions

Approach AI females as individuals first

Evaluate personal ideas, beliefs, and traditions
regarding her role as a woman in her respective
tribe, family, society, and workplace, as well as
the influences of AI women’s multiple identities
44

45. Acculturation Assessment






Personal and tribal definitions of traditional and
nontraditional activities, beliefs, and values
Beliefs regarding family roles and religion
Level of traditionalism, acculturation, or assimilation
Reactions to and experiences with mainstream society
Preferences for daily language use, meals, clothing, and
music and reading selections
Overall cultural identity (e.g., race/ethnicity, gender,
religious/spiritual, etc.)
Bidirectional Assessment: Building Rapport with AI Clients
Counselors encouraged to self-disclose about themselves
45

46. Communication Styles with AI Women
Both nonverbal body language (e.g., eye contact, body
space preference, body posture) and verbal language
clarifies AI individual’s worldview and level of
acculturation or assimilation
 More traditional AI women may use less direct eye
contact or may display contact at short glances as a
way to maintain privacy in order to show respect for
counselors
 Counselors should allow for silence and allow AI
women to tell their life stories in their time frame
(especially if struggling from depression and loneliness)

 Silence helps build trust and rapport, and also allows for
peaceful, culturally appropriate, and non-rushed
counseling sessions
46

47. Holistic, Wellness-Based Approach
 Strengths-based
 Mirrors cultural values of balance and
harmony
 Assess childhood and family structures and
systems
 Involve families and/or a Shaman (tribal
medicine person/healer) may help AI women
feel honored in the healing environment
47

48. Strengths-Based Encouragers
Use open-ended, non-intrusive questions about:
 Where they are from
 Their strengths
 Their areas of wellness
 Their family and tribal systems
 Their cultural and gender identities
 Their personal and ethnic beliefs and values
 Their spiritual beliefs
 Their experiences with power and oppression
 Their lives on and of reservation land
 Their experiences as AI women living in the U.S.
 Their counseling needs
48

49. Holistic, Wellness-Based Approach (con’t)
Respect from the counselor allows access to
information about:
 Ceremonies and spiritual beliefs to include in therapy
 Extended family or elders to be involved in the healing
process
 Their histories and presenting issues
 Their previous attempts at resolving dilemmas
 The ways in which they define their identities
 Their roles as individuals, immediate and extended
family members, and as members of their tribe/clan
49

50. Therapy Goals
 Reestablish harmony between physical,
emotional, and spiritual selves
 Honor traditions, families, tribes, values and
beliefs, histories, needs for harmony and
balance, and their roles as women and AIs
 Aim for holistic, intentional wellness-based
collaboration, awareness, understanding, and
education
50

51. Words of Wisdom








Remain aware of cultural and political events that affect AI women’s
identities and worldviews
Be cautious when prescribing your own internalized gender constructs and
stereotypes that might be influenced by history and media
Physical and mental health may reflect longstanding traditions of mindbody dualism in Western health care (Miresco & Kirmayer, 2006)
Physical or mental illnesses effectively treated by traditional Shaman or
“medicine men” or “spiritual healers” may have somaticized forms of
relational and interpersonal distress
Counselors can use cultural awareness as a means to empower their
clients
Acknowledge feelings, perceptions, and interpretations of AI woman’s
experiences in an urban setting that might be molded by her expectations
before arriving to counseling
AI individuals strongly discourage boasting about themselves and is
considered disrespectful to make oneself look better at the expense of
others
Do not elicit or use forms of humor that are painful or oppressive in
nature with AI clients
51

52. BEST PRACTICES
IN COUNSELING
NATIVE AMERICANS
Thomason, T. (2011). Best practices in counseling Native
Americans. Journal of Indigenous Research, 1(1), Art. 3
52

53. Survey Study
Pilot-test on Counseling NAs using a group of
AI/NA/ANpsychologists and counselors
 Most members of the listserv of the Society of
Indian Psychologists or were experts who have
extensive experience
 Internet administration
 30-questions (both closed and open)
 1-hour completion time
 Offered financial stipend to compensate

53

54. Participants
 N=68
 Demographics:
 57% Native American and 43% non-Native
 68% Female and 32% Male
 42% Psychologists,
27% Counselors, 16% Teachers,
16% Researchers, 10% Social Workers, 25% More
than one profession
 73% worked in counseling center or mental health
clinic working with Native American clients
54

55. Building Rapport in the
st
1
Session
Warm welcome
 Refreshments (water, coffee, tea)
 Minimize intake paperwork
 Story telling from client’s point of view
 Self-disclosure of counselor
 Address role of culture in client’s life
 Discuss confidentiality and expectations for
counseling
 Collaborate with client about the content of and
goals for counseling sessions

55

56. Significant Barriers to Help-Seeking
 Stigma, mistrust, or fear of being judged
 Lack of money
 Shortage of providers
 Long wait lists
 Dysfunctional systems of care
 Racial discrimination
56

57. Increase Comfort in Help-Seeking
 Counselors are encouraged to build
relationships with the local Native
communities and speak with tribal elders
 Ask what counselors should know or how they
can help
 Display Native art on the walls or with
books/magazines
 Offer refreshments
57

58. Results
60% do not agree with using Native health practices such as
talking circles, purification ceremonies, etc., as this may be
seen as patronizing and may be harmful (unless
professionally trained and competent)
 50% of Native American counselors are more effective with
Native American clients than non-Native counselors (20%
said no difference, 18% depends on cultural competence of
counselor)
 55% feel that spirituality is important to incorporate in the
counseling process (41% said depends on the client)
 73% approve of psychological testing, but are cautious of
potential bias and lack of adequate norms due to
consideration of how the client’s culture affects the test
results

58

59. AI/NA/AN:
SPECIFIC CONCERNS
59

60. Alcohol Consumption
(Henry, et al., 2011)
Alcohol use is considered a problem within the
population, even in urban areas
 Early onset alcohol use (prior to 14) is strongly
correlated with alcohol problems throughout life

 Heavy use during adolescents, specifically between the
ages of 16-18
 Experienced more alcohol related problems between the
ages of 16-18
 Higher rate of alcohol related diagnoses by the age of 18
 Three times the risk for life long alcohol related issues
60

61. Alcohol Consumption (cont’d)
(Henry, et al., 2011)
 Factors that contribute to early alcohol
consumption:
 Delinquency
 Family history of alcohol abuse or dependence
 Poverty
 Broken family structure
 Limited family cohesiveness
 Family conflict
61

62. Reproductive Health Needs
(Ravello, Tulloch, & Taylor, 2012)
 STD rates among AI/AN youth (15-24 years of
age) are the second highest in the U.S.
 4.5 times more likely to be diagnosed with chlamydia
 3 times more likely to be diagnosed with gonorrhea
 2 times more likely to be diagnosed with syphilis
 HIV rates are difficult to assess due to limited
testing
 Account for 20% of new cases in the U.S.
62

63. Reproductive Health Needs (cont’d)
(Ravello, Tulloch, & Taylor, 2012)
Teen birth rates have increased 12% over two years
 1 in 5 AI/AN girls will give birth before 20th birthday
 30% had parental care later in pregnancy or no
prenatal care (U.S. population 16%)
 AI/AN mothers experience higher rates of:

 Low birth weight
 Preterm birth
 Post neonatal mortality
 Infant mortality (SIDS)
63

64. Reproductive Health Needs (cont’d)
(Ravello, Tulloch, & Taylor, 2012)

AI/AN gay, lesbian, bisexual, transgender, and questioning
youth experience more physical and sexual abuse
 Gay and bisexual youth:
 17.8% reported sexual abuse
 26.7% reported physical abuse
 23.3% reported running away
 Lesbian and bisexual youth:
 42.4% reported sexual abuse
 51.5% reported physical abuse
 32% reported running away

Alarming rate of sexual and physical abuse for AI/AN girls
 31.1% reported sexual abuse
 33.6% reported physical abuse

AI/AN girls are believed to make up a large percentage of
human trafficking and sexual exploitation
64

65. Suicidality
(Dorgan, 2010)
 AI/AN population’s suicide rate is 70% higher
than the US general population
 AI/AN individuals between the ages of 10-24
have the highest suicide rate of any racial group
 Suicide is the second leading cause of death for
AI/AN between that ages of 10-34
 AI/AN suicide rates are highest between the ages
of 15-19
 AI/AN males are 5 times more likely to take their own
lives than AI/AN females
65

66. Suicidality (cont’d)
(Range, et al., 1999; US Commission on Civil Rights, 2003; Gone, 2004)
Risk factors:
 High rates of poverty
 Limited and/or poor education
 Substandard housing
 High rates of disease
 Weakening parental influence
 Dislocation from native lands
 Weakening tribal unity
 Limited and/or no access to mental health professionals
 Underutilization of mental health services and
discontinuation of services during treatment
66

67. Prevention

Focus on psychoeducation





Target reservations and tribes
Raise awareness of the long term effects of alcohol use and the
trajectory individuals are likely to take with early consumption
Discuss the importance of reproductive health needs
Discuss resources available for suicidal individuals
Explain steps to reduce factors that contribute to alcohol use,
reproductive issues, suicidality
Make resources available to the community without
pushing medical model of assessment and treatment
 Work within the goals or “dreams” of the population

Alcohol can be included in natural healing and can help
spirituality/faith
 Cultural considerations of reproductive health and
contraception

67

68. EXAMPLES OF NATURAL HEALING
http://www.youtube.com/watch?v=xlnJTbDuQ9Y&feature=related
http://www.youtube.com/watch?v=MaxoEQKLwMI&feature=relmfu
68

69. Video Discussion

What are your personal beliefs of the concept of
“Natural Healing”?

How would you discuss ancestral situations with your
clients?

How can we encourage and facilitate treatment with
clients who opposed modern medicine?

What do you think of Gayokla’s explanation and
treatment of mental illness?

What challenges have you faced in working with this
population?

What are your concerns in working with this population?
69

70. References
Gone, J. P. (2004). Mental health services for Native Americans in the 21st century United States. Professional
Psychology: Research and Practice, 35, 10-18.
Gone, J. P. & Alcantara, C. (2007). Identifying effective mental health interventions for American Indians and Alaska
Natives: A review of the literature.Cultural Diversity and Ethnic Minority Psychology, 13 (4), 356-363.
Henry, K. L., McDonald, J. N., Oetting, E. R., Walker, P. S., Walker, R. D., &Beausvais. F. (2011). Age of Onset of First
Alcohol Intoxication and Subsequent Alcohol Use Among Urban American Indian Adolescents. Psychology of
Addictive Behaviors, 25(1), 48-56. doi:10.1037/a0021710.
Range, L. M., Leach, M. M., McIntyre, D., Posey-Deters, P. B., Marion, M. S., Kovac, S. H., et al. (1999). Multicultural
perspectives on suicide. Aggression and Violent Behavior, 4(4), 413-30.
Ravello, L., Tulloch, S., & Taylor, M. (2012). We will be known forever by the tracks we leave: Rising up to meet the
reproductive health needs of American Indian/Alaska Native Youth. American Indian and Alaska Native Mental
Health Research, 19(1), i-x. doi: 10.5820/aian.1901.2012.i.
Rayle, D. A., Chee, C., & Sand, J. K. (2006). Honoring their way: Counseling American Indian women. Journal of
Multicultural Counseling and Development, 34(2), 66-79.
Sue, D.W. & Sue, D. (2012). Counseling the culturally diverse: theory and practice. (6th Ed). New York: John Wiley &
Sons.
Thomason, T. (2011). Best practices in counseling Native Americans. Journal of Indigenous Research, 1(1), Art. 3
U.S. Commission on Civil Rights. (2003). A quiet crisis: Federal funding and unmet needs in Indian Country. Washington
D.C.: Manuel Alba and MireilleZieseniss, http://www.usccr.gov/pubs/na0703/na0731.pdf
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