Violence and the Effects of Trauma on American Indian and Alaska Native Populations

"I Believed in Myself More Than Anything." Indigenous Intimate Partner Violence Advocates Promote Resiliency Among Clients

Indigenous intimate partner violence (IPV) advocates are essential for Indigenous women experiencing IPV who seek support amidst personal and historic trauma. IPV advocates work with and on behalf of clients to identify resources and promote resiliency. Indigenous advocates share their personal IPV experience. They provide individual ways they halted intergenerational trauma, moved toward becoming healthy, and made changes in their personal lives which affect services provided to their clients. This study fills a literature gap as it examines the intersection of Indigenous IPV advocates' personal journey of ending intergenerational trauma as a path to promoting resiliency among their clients.

"Why I Stayed in That Relationship": Barriers to Indigenous Women's Ability to Leave Violent Relationships

Indigenous women in the United States are among the most vulnerable to intimate partner violence (IPV), which has reached endemic levels. The purpose of this qualitative inquiry was to understand contextual factors and barriers to becoming liberated from violence. Reconstructive analysis of data from a critical ethnography with a sample of 231 women across two tribes who described IPV relationships identified the following themes: controlling relationships, losing sense of priorities, using children, socioeconomic stress, family pressures, and restricting relationships. Results revealed these tactics, which parallel those used in the patriarchal colonialism of historical oppression, impeded women's liberation from relationships.

"We've Already Endured the Trauma, Who is Going to Either End that Cycle or Continue to Feed It?": The Influence of Family and Legal Systems on Native American Women's Intimate Partner Violence Experiences

Native American (NA) women experience higher rates of intimate partner violence (IPV) compared to other U.S. racial/ethnic groups, yet previous research has not sufficiently examined the complex determinants shaping their IPV experiences. This research explores the interplay of family networks and legal systems influencing NA women's IPV experiences. Data were collected through in-depth individual and group interviews with 42 NA survivors and 41 health/social service providers from July 2016 to June 2017 in NA communities from three different U.S. regions. We used Grounded Theory to develop emergent themes from the data, focusing on system-level risk and protective factors of women's of IPV experiences. In terms of family systems, participants indicated that NA communities were comprised of highly influential and interwoven family systems, making them powerful sources of support for both survivors and their partners who use violence. Participants described how intergenerational violence exposures contributed to the normalization of violence. In terms of legal systems, participants described inconsistent consequences for abusers of NA women, insufficient protection from legal systems, and manipulation of jurisdictional complexities. Interactions between family and legal systems influenced decision-making and outcomes. Family and community-based approaches, and the incorporation of traditional language and cultures, are needed to promote healing. Our findings reflect the complex ways that family and legal systems shape NA women's IPV experiences. Results provide insight into how NA women interact with and navigate these systems when experiencing IPV and how these systems impact decision-making and the ability to be safe from IPV. Research is needed to advance understanding of the inter-relationships between intergenerational trauma, family systems, and legal systems on IPV survivors' mental health and wellness. To make meaningful change, further research examining IPV from an interdisciplinary perspective that explores the interplay of social determinants of health inequities is needed.

Community-based system dynamics modelling of stigmatized public health issues: Increasing diverse representation of individuals with personal experiences

Utility of community-based system dynamics (CBSD) models on stigmatized public health issues and health disparities depends upon how representative the model is to real-world experience within the community. "Personal experience" participants (PEP), especially from marginalized groups, are essential model contributors, but are often underrepresented in modeling groups due to multiple barriers. This study details a method to increase PEP representation for models on stigmatized issues. We use a case study from a CBSD project on health disparities within the association between alcohol misuse (AM) and intimate partner violence (IPV) for Northern Plains Indigenous women. Short group model building sessions were held at three community organizations providing relevant resources. Each model contributed unique system components, and there were few similarities between models. A consolidated model provided a rich picture of the complex system. Adding brief PEP-based group modeling sessions can enhance PEP representation in model development for stigmatized public health issues.

Cultural Protection from Polysubstance Use Among Native American Adolescents and Young Adults

Reservation-based Native American youth are at disproportionate risk for high-risk substance use. The culture-as-treatment hypothesis suggests aspects of tribal culture can support prevention and healing in this context; however, the protective role of communal mastery and tribal identity have yet to be fully explored. The objectives of this study were to investigate (1) the relationship between cultural factors and high-risk substance use, which includes polysubstance use, early initiation of alcohol and illicit drugs, and binge drinking, and (2) substance use frequency and prevalence of various substances via cross-sectional design. Multiple logistic regression modeling was used to analyze data from 288 tribal members (15–24 years of age) residing on/near the Fort Peck Reservation in the Northern Plains. When controlling for childhood trauma and school attendance, having at least a high school education (OR = 0.434, p = 0.028), increased communal mastery (OR = 0.931, p = 0.007), and higher levels of tribal identity (OR = 0.579, p = 0.009) were significantly associated with lower odds of polysubstance use. Overall prevalence of polysubstance use was 50%, and binge drinking had the highest single substance prevalence (66%). Prevalence of early initiation of substances (≤ 14 years) was inhalants (70%), alcohol (61%), marijuana (74%), methamphetamine (23%), and prescription drug misuse (23%). Hydrocodone, an opioid, was the most frequently misused prescription drug. Findings indicate programs focused on promoting education engagement, communal mastery, and tribal identity may mitigate substance use for Native American adolescents living in high-risk, reservation-based settings.

"I Went into This as One Person, and Then Came Out a Totally Different Person": Native LGBTQ2S+ Young Adults' Conceptions of Trauma

Intersecting sources of stigma influence harmful mental health outcomes for lesbian, gay, bisexual, transgender, queer, and Two-Spirit (LGBTQ2S+) young adults (YA) of color as they must manage multiple oppressions. Experiencing both mental health challenges and victimization, LGBTQ2S+ YA of color struggle with distinctive psychological traumas. There is a critical need to determine how certain groups of LGBTQ2S+ YA of color's marginalized social statuses shape trauma understandings. Native LGBTQ2S+ people in general endure diverse forms of oppression and trauma, such as histories of colonialism, contemporary racism, sexism, homophobia, and classism. Understanding the subjective interpretations of violence and trauma among Native LGBTQ2S+ YA is needed to best meet their mental health needs. Through in-depth interviews with 13 Native LGBTQ2S+ YA between 18 and 24 years old, this study delineates processes of how an underrepresented, underserved group of rurally embedded YA conceptualize violent and traumatic life experiences within the context of their mental health. First, participants described their traumatic experiences as shaping persistent harmful mental health outcomes throughout their lives. Second, YA conceptualized trauma as pivotal moments that were profound and influential in their significance as a turning point in their lives. Finally, YA underscored multiple traumas as cumulative and complex in how they interacted to create distinctively harmful mental health challenges. Expansive conceptualizations of trauma can better inform understandings of trauma etiology and promote inclusive health services.

Intimate Partner and Sexual Violence, Reproductive Coercion, and Reproductive Health Among American Indian and Alaska Native Women: A Narrative Interview Study

Background: The disproportionately high prevalence of poor reproductive and sexual health outcomes among American Indian and Alaska Native (AI/AN) women is related to histories of colonization, oppression, and structural racism. Intimate partner violence (IPV) and sexual violence (SV) contribute to these health outcomes. Materials and Methods: Narrative interviews were conducted with AI/AN women from four tribal reservation communities. Interviews explored connections among sexual and reproductive health, IPV, SV, reproductive coercion (RC), and pregnancy experiences as well as women's experiences of healing and recovery. Results: Among the 56 women interviewed (aged 17-55 years, 77% were aged 40 years and younger), all described multiple exposures to violence and highlighted lack of disclosure related to sexuality, childhood abuse, SV, and historical trauma. Access to confidential reproductive health services and contraceptive education was limited. Almost half (45%) reported experiencing RC in their lifetime. Use of substances occurred in both the context of SV and for surviving after exposure to violence. Women underscored the extent to which IPV, SV, and RC are embedded in histories of colonization, racism, and ongoing oppression. Interventions that incorporate AI/AN traditions, access to culturally responsive reproductive health and advocacy services, organizations, and services that have AI/AN personnel supporting survivors, public discussion about racism, abuse, sexuality, and more accountable community responses to violence (including law enforcement) are promising pathways to healing and recovery. Conclusions: Findings may advance understanding of AI/AN women's reproductive health in the context of historical trauma and oppression. Intervention strategies that enhance resiliency of AI/AN women may promote reproductive health.

Risk and Resilience Factors in Urban American Indian and Alaska Native Youth during the Coronavirus Pandemic

American Indians and Alaska Natives suffer disproportionately from poverty and other inequities and are vulnerable to adverse health and socioeconomic effects of COVID-19. Using surveys and interviews (May - July 2020), we examined urban American Indian/Alaska Native adolescents' (N=50) health and behaviors, family dynamics, community cohesion, and traditional practice participation during COVID-19. About 20% of teens reported clinically significant anxiety and depression, 25% reported food insecurity, and 40% reported poor sleep. Teens also reported high family and community cohesion, and many engaged in traditional practices during this time. Although many teens reported problems, they also emphasized resilience strategies.

Identifying as American Indian/Alaska Native in Urban Areas: Implications for Adolescent Behavioral Health and Well-Being

American Indian and Alaska Native (AI/AN) youth exhibit multiple health disparities, including high rates of alcohol and other drug (AOD) use, violence and delinquency, and mental health problems. Approximately 70% of AI/AN youth reside in urban areas, where negative outcomes on behavioral health and well-being are often high. Identity development may be particularly complex in urban settings, where youth may face more fragmented and lower density AI/AN communities, as well as mixed racial-ethnic ancestry and decreased familiarity with AI/AN lifeways. This study examines racial-ethnic and cultural identity among AI/AN adolescents and associations with behavioral health and well-being by analyzing quantitative data collected from a baseline assessment of 185 AI/AN urban adolescents from California who were part of a substance use intervention study. Adolescents who identified as AI/AN on their survey reported better mental health, less alcohol and marijuana use, lower rates of delinquency, and increased happiness and spiritual health.

Why social justice matters: a context for suicide prevention efforts

Suicide is among the 10 leading causes of death in the US and has the potential to suddenly change many lives. It often occurs when people are disproportionately affected by societal conditions, including inequities, discrimination, oppression, and historical trauma. We posit that a social justice framework can improve suicide prevention efforts when incorporated into existing strategies because it mandates that inequities be addressed. It does so through education, engagement, advocacy, and action, and can be especially effective in states and nations with high suicide rates and entrenched societal inequities.

Community mobilization for rural suicide prevention: Process, learning and behavioral outcomes from Promoting Community Conversations About Research to End Suicide (PC CARES) in Northwest Alaska

RATIONALE

This study evaluates the process and preliminary outcomes of Promoting Community Conversations About Research to End Suicide (PC CARES), an intervention that brings key stakeholders together so they can discuss suicide prevention research and find ways to put it into practice. Originally piloted in remote and rural Alaskan communities, the approach shows promise.

METHOD

Using a multi-method design, the study describes a series of locally-facilitated "learning circles" over 15 months and their preliminary results. Sign-in sheets documented participation. Transcriptions of audio-recorded sessions captured facilitator fidelity, accuracy, and the dominant themes of community discussions. Linked participant surveys (n=83) compared attendees' perceived knowledge, skills, attitudes, and their 'community of practice' at baseline and follow-up. A cross-sectional design compared 112 participants' with 335 non-participants' scores on knowledge and prevention behaviors, and considered the social impact with social network analyses.

RESULTS

Demonstrating feasibility in small rural communities, local PC CARES facilitators hosted 59 two to three hour learning circles with 535 participants (376 unique). Local facilitators achieved acceptable fidelity to the model (80%), and interpreted the research accurately 81% of the time. Discussions reflected participants' understanding of the research content and its use in their lives. Participants showed positive changes in perceived knowledge, skills, and attitudes and strengthened their 'community of practice' from baseline to follow-up. Social network analyses indicate PC CARES had social impact, sustaining and enhancing prevention activities of non-participants who were 'close to' participants. These close associates were more likely take preventive actions than other non-participants after the intervention.

CONCLUSION

PC CARES offers a practical, scalable method for community-based translation of research evidence into selfdetermined, culturally-responsive suicide prevention practice.

A History of Childhood Maltreatment and Intimate Partner Violence Victimization Among Native American Adults

This study examined the association between childhood maltreatment and intimate partner violence (IPV) victimization among Native American adults. Based on Riggs's theoretical model of the long-term effects of childhood abuse, we also examined the mediating roles of insecure attachment patterns and depressive symptoms. The current study was a secondary data analysis using the 2013 General Well-Being Among Native Americans dataset ( N = 479). Structural equation modeling was used to examine the hypothesized relationships among key constructs. Consistent with existing literature of revictimization, our findings showed that the experience of childhood maltreatment was positively associated with IPV victimization. Mediation analyses indicated that depression was a significant mediator in the association between childhood maltreatment and IPV victimization. In addition, all the paths linking childhood maltreatment, fearful attachment, depressive symptoms, and IPV victimization were statistically significant, although the overall mediation effect was not significant. The results of this study suggest that Riggs's model can serve as a useful theoretical framework for understanding the long-term effects of childhood maltreatment among Native American adults. Practitioners in the area of IPV should include maltreatment history and current attachment patterns in client assessments, which could help address conflict and violence within intimate relationships.

The Importance of Culture in Addressing Domestic Violence for First Nation's Women

Indigenous women in Canada face a range of health and social issues including domestic violence. Indigenous women (First Nations, Inuit and Métis) are six times more likely to be killed than non-Aboriginal women (Homicide in Canada, 2014; Miladinovic and Mulligan, 2015). Aboriginal women are 2.5 times more likely to be victims of violence than non-Aboriginal women (Robertson, 2010). These and other statistics highlight a significant difference in the level of violence experienced by Indigenous women to that experienced by women in the mainstream population in Canada. The historical impacts of colonization and forced assimilation are viewed as the main social determinant of health for aboriginal people in Canada, as they led to intergenerational trauma, with communities struggling today against discrimination, stigma, poverty and social exclusion. Most disturbing and damaging are the outcomes of domestic violence, mental health and addiction issues (Prussing, 2014). First Nation's women who want to leave a violent situation have limited access to helping services, as most are located in large cities and towns, far from remote reserves where many of the women live. Services were originally designed by and for the mainstream population. First Nation's women who manage to access these programs often find staff with limited cultural competence and program supports that have little cultural safety or relevance for them. Indigenous culture is defined in various levels of legislation as having a set of specific rights based on their historical ties to a particular region, with cultural or historical distinctiveness from the mainstream and other populations (Indigenous Peoples at the UN, 2014). In Canada, indigenous cultural beliefs are closely tied to belief in a creator, ancestors and the natural world, influencing their spirituality and their political perspectives (Waldram et al., 2006). Cultural safety, a concept that emerged in the 1980's in New Zealand, is viewed as an environment that is spiritually, socially, emotionally and physically safe for people; where cultural identity is recognized and valued through shared respect, meaning, knowledge and the experience of learning together. This paper will explore current evidence-based literature to determine if there is empirical evidence to support program policies and practices that reflect culturally safe, competent and relevant domestic violence services to address the cultural needs of Indigenous women in Canada.

Couples Counseling for Aboriginal Clients Following Intimate Partner Violence: Service Providers' Perceptions of Risk

Interventions for family violence in Aboriginal communities should take a culture-based approach and focus on healing for the whole family. The purpose of this research was to identify risk issues from the perspective of service providers for couples counseling with Aboriginal clients following intimate partner violence. A total of 25 service providers participated in over the phone interviews concerning risk with Aboriginal men in couple counseling. Five concepts emerged including (a) collaterals, (b) commitment to change, (c) violence, (d) mind-set, and (e) mental health. It was concluded that culturally competent interventions should involve the entire community and have a restorative approach. The concepts were compared and contrasted with the available literature.

Treating ethnic minority adults with anxiety disorders: current status and future recommendations

The past three decades have witnessed an increase in the number of empirical investigations examining the phenomenology of anxiety and related conditions. There has also been an increase in efforts to understand differences that may exist between ethnic groups in the expression of the anxiety disorders. In addition, there is now substantial evidence that a variety of treatment approaches (most notably behavioral and cognitive behavioral) are efficacious in remediating anxiety. However, there continues to be comparatively few treatment outcome studies investigating the efficacy of anxiety treatments among minority populations. In this paper, we review the extant treatment outcome research for African American, Hispanic/Latino[a] American, Asian American, and Native Americans suffering with one of the anxiety disorders. We discuss some of the specific problems with the research in this area, and then provide specific recommendations for conducting treatment outcome research with minority populations in the future.