Introduction

“If you have one hundred people who live together, and if each one cares for the rest, there is one mind.”

—Shining Arrow, Crow

The final chapter of this TIP provides you with organizational tools to help you, as administrators and program managers, address a number of the challenges mentioned in Part 2, Chapter 1. As you discover your unique pathways to designing and implementing programs and services specifically tailored to meet the behavioral health needs of American Indian and Alaska Native clients, this chapter offers you tools for:

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Developing a culturally competent and responsive workforce.

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Developing native evidence-based practices (EBPs).

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Integrating care, including traditional practices in behavioral health programs.

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Creating sustainability.

Some of these tools were originally developed for a specific American Indian or Alaska Native tribe or community, so in some circumstances, the material was revised to make it suitable for a pan-native population. Further adaptations may be required if your program is serving a specific tribe or community to make the material more culturally relevant. The tools presented in this chapter are either in the public domain, have been adapted from the original, or have been reprinted with permission from the author for use in your program.

Developing a Culturally Competent and Responsive Workforce

The first step in developing a culturally competent and responsive workforce in American Indian and Alaska Native communities is hiring and then orienting new staff to the community, culture, and traditions of the people they will be serving. The Indian Health Service (IHS) has produced a number of publications (available at www.ihs.gov/retention/retentionstrategies) that may be helpful to your program in recruiting and retaining staff. The New Hire Quick Reference Guide (IHS, 2015a) describes specific tasks for working with newly hired staff in your organization, including the community liaison (see “The Role of the Community Liaison”). The tasks are organized chronologically beginning prior to the employee's start date and continuing through the first 6 months.

THE ROLE OF THE COMMUNITY LIAISON

A key staff member involved in the orientation of new behavioral health employees is the community liaison. The community liaison keeps the lines of communication open between the local community and the Indian health facility or behavioral health program. A tribal leader, an accepted community member, an elder, or a supervisor at your program may act as the liaison. He or she takes on specific roles, such as:

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An ambassador who understands your program's mission and fosters goodwill and respect in the community, while also promoting the vision and values of the local tribe.

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A leader who maintains strong, collaborative relationships between your program and the local community and shares information about local events and community issues with your program, tribal entities, and community stakeholders.

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A guide who will introduce new staff to the community and expose staff to many aspects of the tribal culture, including ceremonial events, observances, and traditions.

Source: IHS, 2014.

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NEW HIRE QUICK REFERENCE GUIDE.

Adapted from material in the public domain.

Once your staff is in place, it is essential to provide culturally appropriate education opportunities for immersion into tribal culture, training, and culturally appropriate clinical supervision for all staff, but particularly for non-native providers. Two instruments, the Native American Cultural Assessment Survey and the Sample Pretest for Non-Native Counselors, provided below, are adapted from the Native American Curriculum for State Accredited, Non-Tribal Mental Health & Substance Abuse Programs in South Dakota offered by the National American Indian and Alaska Native Addiction Technology Transfer Center.

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A NOTE TO ADMINISTRATORS AND PROGRAM MANAGERS.

The Native American Cultural Assessment Survey is a useful tool to help you evaluate the cultural competence of your entire program, but it can also be used to give you a sense of how well your organization is doing in recruitment and hiring, providing culturally responsive training and supervision to your staff, and offering opportunities for staff immersion in the local tribal culture.

NATIVE AMERICAN CULTURAL ASSESSMENT SURVEY (CONTINUED) (PDF, 198K)

You can use the Sample Pretest for Non-Native Counselors to assess the knowledge of non-native providers before and after cultural competence training to evaluate how effective the training was in educating providers on key items of American Indian and Alaska Native culture.

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SAMPLE PRETEST FOR NON-NATIVE COUNSELORS.

American Indian and Alaska Native Workforce Development Resources

The following table highlights additional resources available to assist you in your efforts to develop a culturally competent and responsive workforce.

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FIRST NATIONS BEHAVIORAL HEALTH ASSOCIATION (FNBHA) LISTING OF NATIVE WORKFORCE DEVELOPMENT PROGRAMS.

ADDITIONAL TRAINING AND WORKFORCE DEVELOPMENT RESOURCES

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Information on the effectiveness of the Native American Curriculum for State Accredited, Non-Tribal Mental Health & Substance Abuse Programs in South Dakota training for non-native providers is available in the form of a conference poster (Mackey, Zavadil, Skinstad, Peters, & Summers, 2008) and can be downloaded online (www​.888betsoff.com/links​/08_presentations/handouts/1B.pdf).

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Through the Diamond Threshold: Promoting Cultural Competency in Understanding American Indian Substance Misuse (Robbins, Asetoyer, Nelson, Stilen, & Tall Bear, 2011) includes a number of exercises that can be used with non-native providers and other staff members to better understand issues related to American Indian and Alaska Native behavioral health issues and services. Twelve training activities are included, along with training agendas for using the activities in a half-day, whole-day, or 2-day training.

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The Substance Abuse and Mental Health Services Administration's (SAMHSA's) Tribal Training and Technical Assistance (TTA) Center supports native community self-determination through infrastructure development, capacity building, and program planning and implementation. The TTA website offers a series of training webinars on a variety of behavioral health topics (https://www​.samhsa.gov​/tribal-ttac/webinars).

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The Alaska Commission for Behavioral Health Certification (ACBHC) has established a process to nominate a traditional provider who offers services in your behavioral health program for lifetime certification. The ACBHC defines a traditional provider as an individual who is either an Alaska Native or who has been raised with traditional values, provided voluntary services, and been a positive force in reducing substance abuse in the community. This certificate is a way to acknowledge and validate the knowledge and wisdom of traditional healers. You can download the application form online (www​.akcertification.org​/wp-content/uploads​/sites/13/2018/08/Traditional-Counselor-Recognition.pdf).

Developing Native EBPs

As you consider developing and implementing EBPs in your behavioral health service program, a good first step is to review current practices and programs that are specifically designed for American Indians and Alaska Natives. The table below presents summaries of these evidence- and practice-based programs and interventions that you might want to consider. It is based on criteria developed by an expert panel at a meeting sponsored by FNBHA in 2008 at Portland State University in Portland, OR.

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FNBHA CATALOG OF EFFECTIVE BEHAVIORAL HEALTH PRACTICES FOR TRIBAL COMMUNITIES.

Integrating Care: Traditional Practices in Behavioral Health Programs

As mentioned previously, the American Indian and Alaska Native perspective on healing is holistic. In addition to integrating primary health care and other social services into your program, it is critically important to integrate traditional healing practices and healers into your behavioral health services for American Indian and Alaska Native clients. Likewise, you need to determine what tribal practices to include in American Indian and Alaska Native clients' treatment and recovery plans and evaluate what benefit might be expected from them. This section contains an administrative tool, a Tribal Practice Approval Form, which can help you with this task.

The Oregon Addictions & Mental Health Division (n.d.) has created a process for approving evidence-based tribal practices. The application form and instructions can help you identify, evaluate, and monitor American Indian and Alaska Native cultural and healing practices unique to your tribal community that you might want to include in your behavioral health service program.

Creating Sustainability

Sustaining programs and systems of behavioral health care is an especially important issue in many American Indian and Alaska Native communities, where time-limited funding may be available to initiate a new service but not to support long-range services. The self-assessment tool that follows, developed by SAMHSA's Center for Mental Health Services (CMHS) and the Child, Adolescent and Family Branch (2003), is intended to help communities and systems of care (SOCs) plan for sustaining their behavioral health initiatives. The self-assessment tool developed for American Indian and Alaska Native communities and SOCs should be used prior to developing a sustainability plan.

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AMERICAN INDIAN/ALASKA NATIVE SUSTAINABILITY SELF-ASSESSMENT TOOL.