The Urban American Indian Traditional Spirituality Program: Promoting Indigenous Spiritual Practices for Health Equity

Physical Pain Among Urban Native American Emerging Adults: Sociocultural Risk and Protective Factors

OBJECTIVE

American Indian/Alaska Native (AI/AN) people have high rates of physical pain. Pain is understudied in urban-dwelling, AI/AN emerging adults, a group with unique sociocultural risk and protective factors. We explore associations between socioeconomic disadvantage, additional sociocultural factors, and pain among urban AI/AN emerging adults.

METHODS

AI/AN participants aged 18-25 years ( N = 417) were recruited via social media. Regression models tested associations between socioeconomic disadvantage (income and ability to afford health care) and pain as well as additional sociocultural factors (discrimination, historical loss, cultural pride and belonging, visiting tribal lands) and pain. Multigroup regression models tested whether associations between sociocultural factors and pain differed between participants who were socioeconomically disadvantaged and those who were less disadvantaged.

RESULTS

In the full sample, lower income ( b = 1.00-1.48, p < .05), inability to afford health care ( b = 1.00, p = .011), discrimination ( b = 0.12, p = .001), and historical loss ( b = 0.24, p = .006) were positively associated with pain, whereas visiting tribal lands was negatively associated with pain ( b = -0.86 to -0.42, p < .05). In the multigroup model, visiting tribal lands 31+ days was negatively associated with pain only among the less socioeconomically disadvantaged group ( b = -1.48, p < .001).

CONCLUSIONS

Socioeconomic disadvantage may, in part, drive pain disparities among AI/AN emerging adults and act as a barrier to benefitting from visiting tribal lands. Results support a biopsychosocial approach to targeting pain in this population, including addressing socioeconomic challenges and developing culturally informed, strengths-based interventions.

From trauma to resilience: advancing cultural responsiveness and equity in the Muskowekwan First Nation's healing journey

Introduction

The Muskowekwan First Nation (MFN) in Saskatchewan, Canada, epitomizes the enduring strength and cultural preservation of the Saulteaux people. This community faces the lasting effects of colonial trauma, especially the violence, abuse, and adversity experienced by students at the Muskowequan Indian Residential School (MIRS). Decades of abuse by institutional leaders caused generational trauma, contributing to current mental health and well-being challenges. This study highlights the community's role in sharing experiences and shaping healing processes to develop the MFN Family Healing and Wellness Centre in response to urgent community concerns. It examines the integration of Justice, Diversity, Equity, and Inclusion (J-DEI) principles and cultural responsiveness in fostering community resilience and mental well-being.

Methods

Adopting a community-based participatory research framework, this study employs a mixed-methods approach, including community engagement sessions and surveys. Collaborating closely with the MFN leadership, it draws upon the specialized expertise of Author2 and Author1, leaders in Indigenous health and research. The research uses qualitative and quantitative data collection, emphasizing the importance of community input and leadership in shaping the research process and outcomes.

Results

Findings emphasize the community's commitment to spiritual and cultural practices as vital healing components. Amidst the heightened awareness of the lingering effects of the MIRS within the MFN community, these insights informed the development of the Centre, ensuring it incorporates the community's desires for culturally relevant healing practices. The grand opening of Phase I of the Centre in February 2023 emerged as a significant step forward, symbolizing a move towards holistic community health that honors resilience, holistic wellness, and cultural continuity.

Discussion

This case study contributes to the literature on integrated, culturally responsive healthcare models that address the needs of Indigenous peoples and communities. The study provides insights to guide the Centre's future programs and services, ensuring they are culturally tailored and responsive to the community's needs. By illustrating the potential for traditional wisdom and contemporary health practices to foster well-being, the case study advocates for holistic approaches to healing in Indigenous settings, offering a replicable framework for similar initiatives globally.

Behavioral health services in Urban American Indian Health Programs: Results from six site visits

This study explores behavioral health services for American Indians and Alaska Natives (AIANs) at six Urban Indian Health Programs (UIHPs). Interviews and focus groups with clinicians and staff inquired about behavioral health treatment available, service needs, client population, and financial and staffing challenges. Resulting site profiles were created based on focused coding and integrative memoing of site visit field notes and respondent transcripts. These six UIHPs evidenced diversity across multiple facets of service delivery even as they were united in their missions to provide accessible and effective behavioral health treatment to urban AIAN clients. Primary challenges to service provision included heterogenous client populations, low insurance coverage, limited provider knowledge, lack of resources, and incorporation of traditional healing. Collaborative research with UIHPs harbors the potential to recognize challenges, identify solutions, and share best practices across this crucial network of health care sites for improving urban AIAN well-being.

Traditional Ceremonial Practices as a Strategy to Reduce Problem Substance Use in American Indian Communities: A Systematic Review

Objective: This systematic review assessed the feasibility of American Indian traditional ceremonial practices (TCPs) to address problem substance use in both reservation and urban settings. Methods: Between September 24, 2021, and January 14, 2022, culturally specific review protocols were applied to articles retrieved from over 160 electronic databases-including PubMed, Global Health, Global Health Archive, CINAHL Complete, PsychInfo, Web of Science, Health and Wellness (Gale), Sage Online Journals, and ScienceDirect. Results: A total of 10 studies met the criteria for inclusion in the review. Studies were conducted with both urban (n = 7) and reservation (n = 3) American Indian and Alaska Native (AIAN) populations. The most common TCP activities reported were drumming (n = 9), sweat lodge (n = 7), and talking circles (n = 6). All 10 studies reported some type of quantitative data showing a reduction of substance use associated with TCP interventions or activities. Conclusions: The current status of the literature is emerging and does not allow for meta-analysis of existing studies. However, the existing literature does indicate promise for the use of TCPs to address problem substance use in AIAN communities in a way that is effective and also culturally congruent.

Adapting narrative exposure therapy with a tribal community: A community-based approach

OBJECTIVE

American Indian (AI) individuals are at increased risk for present-day trauma exposure and associated negative outcomes, as well as ongoing effects of intergenerational trauma exposure and adversity. However, few empirically supported treatments exist that are specifically tailored and/or tested with AI communities. This study describes the process of selecting, adapting, and implementing narrative exposure therapy (NET) with an AI community.

METHODS

A community and academic partnership was formed and worked together to make culturally mindful changes to NET to best fit the needs of the community. The partnership incorporated community leaders/Elders (n = 7), providers (n = 11), and participants seeking treatment (n = 50) to implement an iterative process of adapting and implementing the adapted form of NET.

RESULTS

Key adaptions included addressing historical and intergenerational trauma, greater protections for confidentiality in a small community, and incorporation of cultural customs and traditions. Overall, the adapted form of NET was favorably received by the participants, and the implementation appeared to be feasible, with improved retention over past trials of adapted trauma-focused treatments with this community and with highly positive satisfaction ratings and feedback.

CONCLUSIONS

NET was shown to be an appropriate approach for this AI community and should be considered as a treatment option for other AI communities. Future work should consider strategies outlined in this adaption as well as following a similar process for working with AI communities to implement culturally appropriate interventions for trauma-related symptoms.

Kongera Kwiyubaka (rebuilding ourselves again): Culturally responsive and contextually relevant collective healing in post-genocide Rwanda

Drawing on the local experiences, knowledge, and wisdom of Rwandan youth can make them agents of healing from the genocide against the Tutsi in ways that are culturally appropriate, relevant, and meaningful. This qualitative study aimed to develop an emerging framework for intervening with youth that is centered in the experiences and cultural context of the Rwandan youth post-genocide. Drawing on Grounded Action research of post-genocide community-led healing practices with a group of 23 high school students, results indicated that "psychological healing" in post-genocide Rwanda may require different approaches than the dominant Western healing models. For research participants, "healing" meant "kongera kwiyubaka" (building ourselves again after the genocide), requiring "kwigira" (self-reliance) and "gusasa inzobe" (openness to share what is in their hearts). This study recommends that scholars, policy makers, and funders reimagine existing models of healing in post-genocide Rwanda and support local initiatives drawing on wisdom from lived experiences.

Re-imagining mental health services for American Indian communities: Centering Indigenous perspectives

The Indigenous peoples of North America are heirs to the shattering legacy of European colonization. These brutal histories of land dispossession, military conquest, forced settlement, religious repression, and coercive assimilation have robbed American Indian communities of their economies, lifeways, and sources of meaning and significance in the world. The predictable consequence has been an epidemic of "mental health" problems such as demoralization, substance abuse, violence, and suicide within these communities. One apparent solution would seem to be the initiation or expansion of mental health services to better reach American Indian clients. And yet, conventional mental health services such as counseling and psychotherapy depend on assumptions and aspirations that may not fit well with American Indian cultural sensibilities. For example, counseling practices draw on the presumed value for clients of introspective and expressive "self talk," whereas Indigenous community norms may emphasize communicative caution outside of interactions with intimate kin, leading to marked reticence rather than candid disclosure. Moreover, given community sensitivities to salient histories of colonization, such differences have the potential to further alienate American Indian community members from the very services and providers designated to help them. In this article, I review a postcolonial predicament that bedevils American Indian community mental health services and trace a program of research that has sought to harness American Indian cultural and spiritual traditions for reimagining helping services in a manner that truly centers Indigenous perspectives.

Conceptualizing culture in (global) mental health: Lessons from an urban American Indian behavioral health clinic

The movement for global mental health (GMH) has brought perennial questions about human diversity in mental health to the fore through heightened debates over if and how established knowledge, institutions, and practices should be altered for ethical and effective interventions with diverse peoples around the world. Kirmayer and Pedersen (2014) encouraged dialogue between GMH scholars and communities considered for intervention to address differences and concerns about colonialism. American Indian mental health offers an instructive site for global mental health inquiry to understand frameworks that might facilitate this desired dialogue. Here, we draw from a clinical ethnography in urban American Indian behavioral health conducted between September 2014 and February 2015 to glean insights into a popular response to these differences: Incorporating Indigenous cultural forms into clinical practice. Our findings highlight a predicament this response presents to mental health professionals. They can either eschew their clinical training and its cultural assumptions to take up new lives enabling their representation of Indigenous cultural forms, or they can hold onto their professional training and modify what is clinically familiar to appear culturally different. Rather than a purposeful decision, in the clinic contextual factors-tacit assumptions, clinic structures, and popular culture concepts-powerfully shaped clinical practice and reconfigured Indigenous cultural forms to support familiar clinical processes (e.g., treatment-planning). Although potentially therapeutic, culturally repackaged mental health practices are not the therapeutic alternatives called for by many Indigenous communities, and when advertised as such, risk harmful appropriations and misleading reticent people into participating in culturally prescriptive interventions. Lessons for global mental health point away from incorporating Indigenous cultural forms into clinical practice, which is likely to result in cultural repackaging, toward ethnographically-informed dialogue of differences to inform models for medical and epistemic pluralism providing interested communities more culturally commensurate mental health services alongside well-supported Indigenous therapeutic alternatives.

An interview-based evaluation of an Indigenous traditional spirituality program at an urban American Indian health clinic

American Indians suffer from disproportionately high rates of mental health problems. Professional therapies may not meet the specific mental health needs of American Indians, owing to cultural mismatch and long histories of political disempowerment. Instead, Indigenous traditional spiritual practices are often promoted as alternative sources of health and help in these communities. In response to a community needs assessment, we developed a 12-week traditional spirituality curriculum in partnership with the urban American Indian health clinic in Detroit. Centered on the sweat lodge ceremony, the program was pilot tested with 10 community members. Semi-structured interviews were conducted with nine participants following the program. Based on our analyses, all participants endorsed responses within two overarching themes: impact on personal well-being, and suggestions for improvement reflecting their desire for an ongoing program. Participant responses about the program's impact comprised four themes: (1) improved psychological and spiritual well-being, (2) community benefit, (3) increase in cultural knowledge, and (4) a desire for further learning and sharing. Participant responses about their desire for an ongoing program also comprised four themes: (1) drop-in classes may be more practical as regular attendance was difficult for some, (2) future classes should include more areas of knowledge, (3) the program could be expanded to include more knowledge-holders and perspectives, and (4) the program should include a progression of classes to accommodate more diversity. Overall, participants reported benefit from participation in Indigenous spiritual practices; however, the program can be improved by further adapting the curriculum to the sometimes-challenging lives of its participants.

American Indian Behavioral Health Treatment Preferences as Perceived by Urban Indian Health Program Providers

Behavioral health services specifically targeted for ethnoracial clients are typically tailored to the specific needs and preferences of these populations; however, little research has been done with American Indian clients specifically. To better understand how clinicians handle provision of treatment to this population, we interviewed 28 behavioral health staff at six Urban Indian Health Programs in the United States and conducted focus groups with 23 staff at five such programs. Thematic analysis of transcripts from these interviews and focus groups suggests that these staff attempt to blend and tailor empirically supported treatments with American Indian cultural values and practices where possible. Simultaneously, staff try to honor the client's specific preferences and needs and to encourage clients to seek cultural practices and connection outside of the therapy room. In so doing staff members were acutely aware of the limitations of the evidence base and the lack of research with American Indian clients.

Four Principles for Cultivating Alternate Cultural Paradigms in Psychology: Summary Reflections on Innovative Contributions

The contributors to this special issue have demonstrated the potency and promise of cultivating Alternate Cultural Paradigms (ACPs) in psychology that reflect and express the lived realities of non-White communities in America. Based on my past research engagement with several distinct American Indian and First Nations communities, I offer for consideration four principles for psychologists who seek to further cultivate ACPs: (a) attend independently to culture and power, (b) anchor conceptual abstractions in empirical examples, (c) complicate stock oppositions and essentialisms, and (d) integrate emancipation with application. Adoption of these four principles should assist with the development of robust ACPs that accurately reflect the lived experiences of non-White communities. The promotion of these in psychology represents the exciting possibility for a more just and equitable future in which the injuries of White racism are remedied and all Americans are granted equal opportunities to live and thrive in self-determined fashion.

Reassessing the Mental Health Treatment Gap: What Happens if We Include the Impact of Traditional Healing on Mental Illness?

In this Fresh Focus, we reassess what the mental health treatment gap may mean if we consider the role of traditional healing. Based on systematic reviews, patients can use traditional healers and qualitatively report improvement from general psychological distress and symptom reduction for common mental disorders. Given these clinical implications, some high-income countries have scaled up research into traditional healing practices, while at the same time in low-and middle-income countries, where the use of traditional healers is nearly ubiquitous, considerably less research funding has studied or capitalized on this phenomena. The World Health Organization 2003-2020 Mental Health Action Plan called for government health programs to include traditional and faith healers as treatment resources to combat the low- and middle-income country treatment gap. Reflection on the work which emerged during the course of this Mental Health Action Plan revealed areas for improvement. As we embark on the next Mental Health Action Plan, we offer lessons-learned for exploring potential relationships and collaborations between traditional healing and biomedicine.

A process of healing for the Labrador Innu: Improving health and wellbeing in the context of historical and contemporary colonialism

In light of the negative effects of historical and contemporary colonialism on the Labrador Innu, healing initiatives grounded in self-determination, renewal of cultural practices, and non-reliance on Western bio-medicine, are known, taught and widely practiced among the Innu. The value of Indigenous healing practices in the treatment of Indigenous people is well-recognized in Indigenous wellness literature, yet non-Indigenous health practitioners know little about healing processes. Moreover, to our knowledge, no studies have examined any contemporary Labrador Innu healing process. The main aim of this paper is to describe the process of healing among the Innu. Although there may be multiple processes of healing, we shed light on a major process that emerged from interviews and focus groups with 39 participants. Five stages of healing were described: being "under the blanket"; finding spiritual strength; extending hands out; finding strength and power; and helping others. Findings highlighted enablement of healing through spiritualities, support from Elders, return to culture, and resistance to negative stereotypes. We provide health professionals with valuable information for considering Innu healing as a model that expands their views for the benefit of Innu seeking mental health services. Implications for non-Innu health and social service providers are about broadening their understanding of the significant role of self-determination among Innu, learning Innu ways-of-knowing and being, recognizing one's own biases, and acknowledging the power imbalances between themselves and Innu people.