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Promoting Healing and Restoring Trust: Policy Recommendations for Improving Behavioral Health Care for American Indian/Alaska Native Adolescents

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American Journal of Community Psychology

Abstract

American Indian/Alaska Native youth represent the strength and continued survival of many Nations and Tribes. However, they currently experience numerous health disparities and challenges, including the highest rate of suicide among 15–24 year-olds in the United States. Our comprehensive review of the literature on the mental health of AI/AN youth highlighted seven focal causes of behavioral health disparities: (1) high levels of violence and trauma exposure and traumatic loss, (2) past and current oppression, racism, and discrimination, (3) underfunded systems of care, (4) disregard for effective indigenous practices in service provision, policy, and funding, (5) overreliance on evidence-based practices, (6) lack of cultural competence among systems of care and providers, and (7) barriers to care. Seven policy recommendations that recognize the importance of moving beyond exclusive reliance on western models of care and that seek to foster transformation of individuals, families, communities, behavioral health service systems of care, and social structures are presented, supported, and discussed.

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Notes

  1. There are some recent notable exceptions to the paucity of rigorous epidemiological research with Native American populations, including the American Indian Services Utilization and Psychiatric Epidemiology Risk and Protective Factors Project (see http://aianp.uchsc.edu/ncaianmhr/research/superpfp.htm).

  2. There are also critiques of the overemphasis on evidence-based practices more generally. Kemm raises issues regarding the expectation of randomized control trials (RCTs) to test public health interventions where the community rather than the individual is the unit of intervention (Kemm 2006). Another limitation of relying on RCTs is that the result is that most evidence comes from artificially controlled research, which does not address the realities of practice (Green 2006).

References

  • American Academy of Child and Adolescent Psychiatry, A. P. A. (2006). Joint Statement from the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association for the Senate Indian Affairs Committee Hearing on Teen Suicide Among American Indian Youth.

  • Anglin, T. M., Naylor, K. E., & Kaplan, D. W. (1996). Comprehensive school-based health care: high school students’ use of medical, mental health, and substance abuse services. Pediatrics, 97(3), 318–330.

    PubMed  Google Scholar 

  • Beals, J., Manson, S. M., Whitesell, N. R., Spicer, P., Novins, D. K., Mitchell, C. M., et al. (2005). Prevalence of DSM-IV disorders and attendant help-seeking in 2 American Indian reservation populations. Archives of General Psychiatry, 62, 99–108.

    Article  PubMed  Google Scholar 

  • Beals, J., Novins, D., Mitchell, C., Shore, J., & Manson, S. (2002). Comorbidity between alcohol abuse/dependence and psychiatric disorders: Prevalence, treatment implications, and new directions for research among American Indian populations. NIAAA Research Monograph Series, 37, 371–410.

    Google Scholar 

  • Beals, J., Piasecki, J., Nelson, S., Jones, M., Keane, E., Dauphinais, P., et al. (1997). Psychiatric disorder among American Indian adolescents: Prevalence in Northern Plains youth. Journal of the American Academy of Child & Adolescent Psychiatry, 36(9), 1252–1259.

    Article  Google Scholar 

  • Beauvais, F. (1992). Characteristics of Indian youth and drug use. American Indian and Alaska Native Mental Health Research, 5, 50–67.

    Google Scholar 

  • Beauvais, F. (1996). Trends in drug use among American Indian students and dropouts. American Journal of Public Health, 86, 1594–1599.

    Article  PubMed  Google Scholar 

  • Berry, J. W., & Worthington, E. L., Jr. (2001). Forgivingness, relationship quality, stress while imagining relationship events, and physical and mental health. Journal of Counseling Psychology, 48(4), 447–455.

    Article  Google Scholar 

  • Besaw, A., Kalt, J., Lee, A., Sethi, J., Wilson, J. B., & Zemler, M. (2004). The context and meaning of family strengthening in Indian America (the Annie E. Casey Foundation): The Harvard Project on American Indian Economic Development.

    Google Scholar 

  • Buchwald, D., Beals, J., & Manson, S. M. (2000). Use of traditional health practices among Native Americans in a primary care setting. Medical Care, 38, 1191–1199.

    Article  PubMed  Google Scholar 

  • Committee on the Future of Rural Health Care. (2004). Quality through collaboration: The future of rural health care. Washington, DC: National Academy of Sciences.

    Google Scholar 

  • Cruz, C., & Spence, J. (2005). Oregon tribal evidence based and cultural best practices.

  • Deters, P. B., Novins, D. K., Fickenscher, A., & Beals, J. (2006). Trauma and posttraumatic stress disorder symptomatology: Patterns among american indian adolescents in substance abuse treatment. American Journal of Orthopsychiatry, 76(3), 335–345.

    Article  PubMed  Google Scholar 

  • Duran, E., & Duran, B. (1995). Native American postcolonial psychology. Albany, NY: State University of New York Press.

    Google Scholar 

  • Duran, B., Oetzel, J., Lucero, J., & Jiang, Y. (2005). Obstacles for rural American Indians seeking alcohol, drug, or mental health treatment. Journal of Consulting and Clinical Psychology, 73(5), 819–829.

    Article  PubMed  Google Scholar 

  • Durlak, J. A., & Wells, A. M. (1997). Primary prevention mental health programs: The future is exciting. American Journal of Community Psychology, 25(2), 233–243.

    Article  PubMed  Google Scholar 

  • Faimon, M. B. (2004). Ties that bind: Remembering, mourning, and healing historical trauma. American Indian Quarterly, 28(1 & 2), 238–251.

    Google Scholar 

  • Freedenthal, S., & Stiffman, A. R. (2007). ‘They might think i was crazy’: Young American Indians’ reasons for not seeking help when suicidal. Journal of Adolescent Research, 22(1), 58–77.

    Article  Google Scholar 

  • Garroutte, E. M., Goldberg, J., Beals, J., Herrell, R., Manson, S. M., & Team, T. A.-S. (2003). Spirituality and attempted suicide among American Indians. Social Science and Medicine, 56, 1571–1579.

    Article  PubMed  Google Scholar 

  • Gnanadesikan, M., Novins, D. K., & Beals, J. (2005). The relationship of gender and trauma characteristics to posttraumatic stress disorder in a community sample of traumatized Northern Plains American Indian adolescents and young adults. Journal of Clinical Psychiatry, 66(9), 1176–1183.

    Article  PubMed  Google Scholar 

  • Gone, J. P. (2004). Mental health services for Native Americans in the 21st Century United States. Professional Psychology: Research and Practice, 35(1), 10–18.

    Article  Google Scholar 

  • 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.

    Article  PubMed  Google Scholar 

  • Goodkind, J., Ross-Toledo, K., John, S., Hall, J. L., Ross, L., Freeland, L., et al. (2008). Project TRUST: Report and recommendations for enhancing the well-being of Native American youth, families, and communities. New Mexico: Department of Health, Office of School and Adolescent Health.

    Google Scholar 

  • Gray, N., & Nye, P. S. (2001). American Indian and Alaska Native substance abuse: Co-morbidity and cultural issues. American Indian and Alaska Native Mental Health Research, 10(2), 67–84.

    PubMed  Google Scholar 

  • Green, L. (2006). Public health asks of systems science: To advance our evidence-based practice, can you help us get more practice-based evidence? [Peer Reviewed]. American Journal of Public Health, 96(3), 406–409.

    Article  PubMed  Google Scholar 

  • Horn, S. D., & Gassaway, J. (2007). Practice-based evidence study design for comparative effectiveness research. Med Care, 45(10 Supl 2), S50–S57.

    Google Scholar 

  • Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. Washington, DC: National Academy Press.

    Google Scholar 

  • Jones, M. C., Dauphinais, P., Sack, W. H., & Somervell, P. D. (1997). Trauma-related symptomatology among American Indian adolescents. Journal of Traumatic Stress, 10, 163–173.

    PubMed  Google Scholar 

  • Kaplan, D. W., Calonge, B. N., Guernsey, B. P., & Hanrahan, M. B. (1998). Managed care and school-based health centers. Use of health services. Archives of Pediatrics and Adolescent Medicine, 152(1), 25–33.

    PubMed  Google Scholar 

  • Kemm, J. (2006). The limitations of ‘evidence-based’ public health. Journal of Evaluation in Clinical Practice, 12(3), 319–324.

    Article  PubMed  Google Scholar 

  • Kilpatrick, D. G., Acierno, R., Saunders, B., Resnick, H. S., Best, C. L., & Schnurr, P. P. (2000). Risk factors for adolescent substance abuse and dependence: Data from a national sample. Journal of Consulting and Clinical Psychology, 68(1), 19–30.

    Article  PubMed  Google Scholar 

  • LaFromboise, T. D. (1988). American Indian mental health policy. American Psychologist, 43(5), 388–397.

    Article  PubMed  Google Scholar 

  • MacArthur Foundation Mental Health Policy Research Network. (2008). New Mexico behavioral health local collaboratives: Opportunities and impediments for Native Americans. Chicago, IL: The John D. and Catherine T. MacArthur Foundation.

    Google Scholar 

  • Maltby, J., Macaskill, A., & Day, L. (2001). Failure to forgive self and others: A replication and extension of the relationship between forgiveness, personality, social desirability and general health. Personality and Individual Differences, 30(5), 881–885.

    Article  Google Scholar 

  • Manson, S. M., & Altschul, D. B. (2004). Meeting the mental health needs of American Indians and Alaskan natives. National Association of State Mental Health Program Directors (NASMHPH) and National Technical Assistance Center of State Mental Health Planning (NTAC).

  • Marbella, A. M., Harris, M. C., Diehr, S., Ignace, G., & Ignace, G. (1998). Use of Native American healers among Native American patients in an urban Native American health center. Archives of Family Medicine, 7, 182–185.

    Article  PubMed  Google Scholar 

  • McCullough, M. E., Rachal, K. C., Sandage, S. J., Worthington, E. L., Jr., Brown, S. W., & Hight, T. L. (1998). Interpersonal forgiving in close relationships: II. Theoretical elaboration and measurement. Journal of Personality and Social Psychology, 75(6), 1586–1603.

    Article  PubMed  Google Scholar 

  • Miranda, J., Bernal, G., Lau, A., Kohn, L., Hwang, W., & LaFromboise, T. (2005). State of the science on psychosocial interventions for ethnic minorities. Annual Review of Clinical Psychology, 1, 113–142.

    Article  PubMed  Google Scholar 

  • National Institute of Mental Health. (1999). Bridging science and service. Bethesda, MD: National Institutes of Health.

    Google Scholar 

  • National Institute of Mental Health. (2000). Translating behavioral science into action: Report of the national advisory mental health council behavioral science workgroup. Bethesda, MD: National Institutes of Health.

    Google Scholar 

  • Novins, D. K., & Baron, A. E. (2004). American Indian substance use: The hazards for substance use initiation and progression for adolescents aged 14 to 20 years. Journal of the American Academy of Child & Adolescent Psychiatry, 43(3), 316–324.

    Google Scholar 

  • Novins, D. K., Fickenscher, A., & Manson, S. M. (2006). American Indian adolescents in substance abuse treatment: Diagnostic status. Journal of Substance Abuse Treatment, 30(4), 275–284.

    Google Scholar 

  • Pumariega, A. S. J., Rogers, K., & Rothe, E. (2005). Culturally competent systems of care for children’s mental health: Advances and challenges. Community Mental Health Journal, 41(5), 539–555.

    Article  PubMed  Google Scholar 

  • Regehr, C., & Gutheil, T. (2002). Apology, justice, and trauma recovery. Journal of the American Academy of Psychiatry and the Law, 30(3), 425–430.

    PubMed  Google Scholar 

  • Rieckmann, T. R., Wadsworth, M. E., & Deyhle, D. (2004). Cultural identity, explanatory style, and depression in navajo adolescents. Cultural Diversity & Ethnic Minority Psychology, 10(4), 365–382.

    Article  Google Scholar 

  • Smedly, B. D., Stith, A. Y., & Nelson, A. R. (2003). Unequal treatment: Confronting racial and ethnic disparities in health care. Washington, DC: The National Academies Press.

    Google Scholar 

  • Snipp, C. M. (2005). American Indian and Alaska Native children: Results from the 2000 Census. Washington, DC: Population Reference Bureau.

    Google Scholar 

  • Spicer, P., Novins, D. K., Mitchell, C. M., & Beals, J. (2003). Aboriginal social organization, contemporary experience and American Indian adolescent alcohol use. Quarterly Journal of Studies on Alcohol, 64(4), 450–457.

    Google Scholar 

  • The President’s New Freedom Commission on Mental Health. (2003). Achieving the promise: Transforming mental health care in America. Rockville, MD: Department of Health and Human Services. Final Report.

    Google Scholar 

  • Toussaint, L. L., Williams, D. R., Musick, M. A., & Everson, S. A. (2001). Forgiveness and health: Age differences in a U.S. probability sample. Journal of Adult Development, 8(4), 249–257.

    Article  Google Scholar 

  • Toussaint, L. L., Williams, D. R., Musick, M. A., & Everson-Rose, S. A. (2008a). The association of forgiveness and 12-month prevalence of major depressive episode: Gender differences in a probability sample of U.S. adults. Mental Health, Religion & Culture, 11(5), 485–500.

    Article  Google Scholar 

  • Toussaint, L. L., Williams, D. R., Musick, M. A., & Everson-Rose, S. A. (2008b). Why forgiveness may protect against depression: Hopelessness as an explanatory mechanism. Personality and Mental Health, 2(2), 89–103.

    Article  Google Scholar 

  • U.S. Commission on Civil Rights. (2003). A quiet crisis: Federal funding and unmet needs in indian country. Washington DC: U.S. Commission on Civil Rights.

    Google Scholar 

  • U.S. Public Health Service Office of the Surgeon General. (2001a). Mental health: A report of the surgeon general. Washington, DC: Government Printing Office.

    Google Scholar 

  • U.S. Public Health Service Office of the Surgeon General. (2001b). Mental health: Culture, race, and ethnicity: A supplement to mental health: A report of the surgeon general. Rockville, MD: Department of Health and Human Services.

    Google Scholar 

  • Walls, M. L., Johnson, K. D., Whitbeck, L. B., & Hoyt, D. R. (2006). Mental health and substance abuse services preferences among American Indian people of the Northern Midwest. Community Mental Health Journal, 42(6), 521–535.

    Article  PubMed  Google Scholar 

  • Whitbeck, L. B., Adams, G. W., Hoyt, D. R., & Chen, X. (2004a). Conceptualizing and measuring historical trauma among American Indian people. American Journal of Community Psychology, 33, 119–130.

    Article  PubMed  Google Scholar 

  • Whitbeck, L. B., Chen, X., Hoyt, D. R., & Adams, G. W. (2004b). Discrimination, historical loss and enculturation: Culturally specific risk and resiliency factors for alcohol abuse among American Indians. Journal of Studies on Alcohol, 65, 409–418.

    PubMed  Google Scholar 

  • Whitbeck, L. B., Hoyt, D., Johnson, K., & Chen, X. (2006). Mental disorders among parents/caretakers of American Indian early adolescents in the Northern Midwest. Social Psychiatry and Psychiatric Epidemiology, 41, 632–640.

    Google Scholar 

  • Whitbeck, L. B., Hoyt, D. R., McMorris, B. J., Chen, X., & Stubben, J. D. (2001). Perceived discrimination and early substance abuse among American Indian children. Journal of Health and Social Behavior, 42(4), 405–424.

    Article  PubMed  Google Scholar 

  • Whitbeck, L. B., McMorris, B. J., Hoty, D. R., Stubben, J. D., & LaFromboise, T. (2002). Perceived discrimination, traditional practices, and depressive symptoms among American Indians in the upper Midwest. Journal of Health and Social Behavior, 43, 400–418.

    Article  PubMed  Google Scholar 

  • White Bison. (2001). Developing culturally-based promising practices for Native American communities.

  • Witvliet, C. V., Ludwig, T. E., & Vander Laan, K. L. (2001). Granting forgiveness or harboring grudges: Implications for emotion, physiology, and health. Psychological Science, 12(2), 117–123.

    Article  Google Scholar 

  • Yoder, K. A., Whitbeck, L. B., Hoyt, D. R., & LaFromboise, T. (2006). Suicide ideation among American Indian youths. Archives of Suicide Research, 10(2), 177–190.

    Article  PubMed  Google Scholar 

  • Zimmerman, M. A., Ramirez, J., Washienko, K. M., Walter, B., Dyer, S., McCubbin, H. I., et al. (1998). Enculturation hypothesis: Exploring direct and protective effects among Native American youth resiliency in native American and immigrant families (pp. 199–220). Thousand Oaks, CA US: Sage Publications, Inc.

    Google Scholar 

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Acknowledgments

This research was supported by the New Mexico Department of Health Office of School and Adolescent Health. The authors wish to acknowledge the contributions of Lynn Abeita, Charvel Baldwin, Aaron Carr, Kris Carrillo, Georgina Castro, Gloria Collins, Yolanda Cordova, Krystal Curley, Josephine Dailey, Lorenzo Garcia, Myra Gould, Jana Gunnell, Erin O’Keefe, Ophelia Reeder, Jacob Salabiye, Howard Spiegelman, Emily Stafford, Chenoa Bah Stillwell-Jensen, Joseph Stone, and Casey Tom. We also wish to thank and express our gratitude to the traditional practitioners who guided our work: T.J. Anderson, Ray Daw, Lincoln Nez, and Aricke Willie, and the community members and service providers who participated in our study.

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Authors and Affiliations

  1. Department of Pediatrics, Division of Prevention and Population Sciences, University of New Mexico School of Medicine, MSC11 6145, Albuquerque, NM, 87131, USA

    Jessica R. Goodkind, Lance Freeland & Christopher Lee

  2. Coalition for Healthy & Resilient Youth, Gallup, NM, USA

    Kimberly Ross-Toledo

  3. Teen Life Center, Shiprock, NM, USA

    Susie John

  4. New Mexico Department of Health, Office of School & Adolescent Health, Gallup, NM, USA

    Janie Lee Hall

  5. New Mexico Department of Health, Office of Health Promotion/Community Health Improvement, Gallup, NM, USA

    Lucille Ross

  6. Department of Psychiatry, Center for Rural & Community Behavioral Health, University of New Mexico, Albuquerque, NM, USA

    Ernest Coletta & Charlene Poola

  7. New Mexico Department of Health, Office of School & Adolescent Health, Farmington, NM, USA

    Twila Becenti-Fundark

  8. New Mexico Health Advocacy Alliance and The Griffin Group, To’Hajiilee, NM, USA

    Regina Begay-Roanhorse

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  1. Jessica R. Goodkind
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Correspondence to Jessica R. Goodkind.

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Goodkind, J.R., Ross-Toledo, K., John, S. et al. Promoting Healing and Restoring Trust: Policy Recommendations for Improving Behavioral Health Care for American Indian/Alaska Native Adolescents. Am J Community Psychol 46, 386–394 (2010). https://doi.org/10.1007/s10464-010-9347-4

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