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American Indian Perspectives on Evidence-Based Practice Implementation: Results from a Statewide Tribal Mental Health Gathering

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Abstract

Implementation of Evidence-Based Practices (EBP) within American Indian and Alaskan Natives communities is currently an area of debate and contention. There is considerable concern about expanding EBP policy mandates to AI/AN communities as these mandates, either through funding restrictions or other de facto policies, recall past histories of clinical colonization and exploitation by the state and federal government. As a response, work is being done to evaluate indigenous programs and examine strategies for culturally-sensitive implementation. While the literature reflects the perspectives of AI/AN populations on EBP generally, no one has yet reported the perspectives of AI/AN communities on how to feasibly achieve widespread EBP implementation. We report the findings of a statewide Tribal Gathering focused on behavioral health interventions for youth. The Gathering participants included AI/AN individuals as well as staff working with AI/AN populations in tribal communities. Participants identified strengths and weaknesses of the five legislatively fundable programs for youth delinquency in Washington State and discussed strategies likely to be effective in promoting increased uptake within tribes. Analysis of these discussions resulted in many useful insights in program-specific and community-driven strategies for implementation. In addition, two major themes emerged regarding widespread uptake: the importance of a multi-phase engagement strategy and adopting a consortium/learning community model for implementation. The findings from this Gathering offer important lessons that can inform current work regarding strategies to achieve a balance of program fidelity and cultural-alignment. Attending to engagement practices at the governance, community and individual level are likely to be key components of tribal-focused implementation. Further, efforts to embed implementation within a consortium or learning community hold considerable promise as a strategy for sustainability.

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Acknowledgments

We would like to thank The Washington State Partnership Council for Juvenile Justice for funding the Tribal Gathering referenced in this paper and for all of the participants at this Gathering. We would also like to thank Monica Reeves for her partnership in planning the Gathering, Asia Bishop for her administrative assistance and to the two anonymous reviewers for their helpful suggestions

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Authors and Affiliations

  1. Division of Public Behavioral Health & Justice Policy, University of Washington School of Medicine, 2815 Eastlake Ave Ste 200, Seattle, WA, 98102, USA

    Sarah Cusworth Walker

  2. Native American Law Center, University of Washington School of Law, Seattle, WA, USA

    Ron Whitener

  3. University of Washington School of Medicine, Seattle, WA, USA

    Eric W. Trupin

  4. University of Washington School of Law, Seattle, WA, USA

    Natalie Migliarini

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  1. Sarah Cusworth Walker
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Correspondence to Sarah Cusworth Walker.

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Walker, S.C., Whitener, R., Trupin, E.W. et al. American Indian Perspectives on Evidence-Based Practice Implementation: Results from a Statewide Tribal Mental Health Gathering. Adm Policy Ment Health 42, 29–39 (2015). https://doi.org/10.1007/s10488-013-0530-4

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