Integrating Native American Indigenous Healing Practices in the

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					 Integrating Native American
Indigenous Healing Practices
in the Eurocentric Behavioral
  Health Care System of New
           Mexico

   Loren Sekayumptewa
   Na‘nizhoozhi Center, Inc.
   www.wellbriety-nci.org
            Objectives
• Know the components of traditional
  (indigenous) healing knowledge and
  practice.
• Introduce techniques for integrating
  indigenous and eurocentric
  approaches.
• Understand the practical task of
  identifying best practices
Can Eurocentric evidence-based
practices and indigenous healing
practices be used together?


•Why?
•Can they?
                Why?
• Eurocentric research continually
  validates that culturally appropriate
  interventions result in poor outcomes.
• New Mexico’s indigenous population is
  significant.
• Research emphasizes cultural
  competency and appropriateness.
• Behavioral health problems are not
  being significantly impacted by
  Eurocentric practices.
  Can integration happen?
• Yes.
• Understanding the strengths of two
  worldviews.
• Indigenous interventions are based on
  historical and empirical knowledge for
  specific populations.
• Some Eurocentric interventions are
  similar to indigenous worlviews.
                    Native American
                         Barriers
Colonization
and forced
migration of
tribes

Internment of
tribes after
conquest

Repression of
indigenous
practices,      Paternalism          by      governmental
beliefs,        institutions,religious organizations, and
language,
                reorganization of established governance.
and identity
Deconstructing Colonization


  “Tradition is
    Enemy of
    Progress”
Substance abuse or
   misuse is not
condoned within the
 indigenous value
      system.

     The norm is for
 respect yourself by
not using substances
      that are not
     indigenous or
  acceptable to the
 tribe (Doo dilzin da:
abuse of the natural
         world).
        Euro-centric Treatment
•   Disease Model-based
•   AA Philosophy driven
•   12 Step design
•   Confrontational styles
•   Morals driven
•   Individual focused
•   Recovery oriented
•   Relapses considered bad
•   Indigenous approaches never
    considered valid.
 Dissimilar Helping Paradigms
• Eurocentric Paradigms (boxing)
  –   Treatment
  –   Chronic condition
  –   Individual orientation
  –   Physical symptoms
• Indigenous Paradigms (circular)
  –   Healing
  –   Non-chronic condition
  –   Social orientation
  –   Behavioral problems
  Motivational Interviewing = Native
          American Model
• Historical trauma
• Dependency
• Violent behavior
  – Domestic violence     -Homicide
• High mortality rates
• High rates of substance abuse
  – Alcohol           -Drugs
  – Tobacco           -Food
 Prochaska’s Stages of Change

• Prayer and blessings motivate.
• Spiritual practices focus upon the
  development of resilient persons,
  particularly in environments of poverty.
• Healing, not treatment, is the primary
  aim of indigenous interventions.
• Stages of Change Model has
  application
Indigenous Healing Models
Stages of Change

 • Non-verbal        Recurrence

   and verbal
   cues

                                    Contemplation
                                 •The client acknowledges
                                 concerns and is considering
                                 the possibility of change
                                 but is ambivalent and
                                 uncertain.




                   Preparation
           K’e’
Each individual
  has a
  relationship with
another
person,
place,
the
world
Kinship


Many tribes,
particularly in
the southwest,
have strong
 clan or family
systems that
enhance
community
resiliency and
personal worth.
Stages of Change

 • Listening        Recurrence




                          Preparation
                   •The client is committed to and
                   planning to make a change in
                   the near future but is still
                   considering what to do.
  Listening

Listen, before
  talking.
Think, before,
  talking.
Reverence
Responsibility is
each person’s to
respect and in
honor of self and
relationships.
   Belonging
Premise: all persons
  belong and have
  purpose.

Cognitive-
 behavioral
 therapies provide
 good framework
 for motivated
 clients.
Medicine
 Wheel
Stages of Change

 • ACTION                    Recurrence




             Action
            •The client is actively
            taking steps to change
            but has not yet reached
            a stable state.



                                      Preparation
Talking Circle
     Natoh
Contemplation
 creates
 motivation for
 action and
 change.

Indigenous use of
  herbal smoking
  promotes this.
Sweat Lodge



  Sacred
 Mountains
Stages of Change
                                           Recurrence
 • Being
   resilient        Maintenance
               The client has achieved initial
               goals such as abstinence and
               is now working to maintain
               gains.




                                           Preparation
Asking




 Sacred
Practices
 spirituality
Indigenous
  Understanding
  of Balance
• ach'ąh sodizin:
  protective
  blessing
• Hozho ji:
  celebratory
  blessing
           Service Definitions
• Based on context of treatment.
  –   Group
  –   Individual
  –   Family
  –   Residential
• Based on activities
  – Case management
  – Medication management
  – evaluation
       Indigenous Services
• Sweatlodge       Smudging
  – Group              -individual
  – Individual
  – family             -group
• Talking Circle       -family
  – Group
  – family         Herbal medicine
• Tobacco              -individual
  – Individual
  – Family             -group
  – group
                       -family
            Credentialing
• Dine’ Medicineman Association; is the
  formal indigenous practitioner organization
  that is accepted by Navajo government
  and incorporated within the Eurocentric
  incorporation system.

• Apache; are there formal indigenous
  practitioner organizations?

• Pueblos; are there Pueblo-specific formal
  indigenous practitioner organizations?
 What Matters
                                                        Talking Circle




• Increasing American
  Indian identity

• Decreasing structural
  poverty


Doing so will decrease
 the probability of
 alcohol symptoms and
 drug use.
  AMERICAN INDIAN SERVICES UTILIZATION, PSYCHIATRIC EPIDEMIOLOGY, RISK AND PROTECTIVE FACTORS PROJECT (AI-
  SUPERPFP) , University of Colorado at Denver and Health Services Center
   Eurocentric Best Practices
         Stages of change
  Cognitive behavioral therapy
     Motivational interviewing
Motivational enhancement therapy
   Contingency management
    Community reinforcement
Indigenous Best Practices
       Sweatlodge
      Talking Circles
   Tobacco ceremony
     Herbal medicine
        Smudging
         Blessings
                  Similarities
• Indigenous teachings emphasize;
  –   alertness
  –   listening
  –   Attending
  –   Responsible behavior
  –   Relationships


• Cognitive-behavioral approaches are similar
       Recommendations
• Include indigenous healers.
• Integrate indigenous healers.
• Trust indigenous healer competency.
• Understand the levels of competency
  within the healing community.
• Rely on indigenous healer leadership.
• Let go of bias and prejudices
• Be culturally competent