Indigenous Evidence-Based Practice - One Sky Center

Indigenous Models of EvidenceBased Practice Oregons Tribal Best Practices Initiative 01/29/20 Indigenous Evidence-Based Practice 1 Presenters One Sky Center DHS/AMH

Douglas A Bigelow, PhD R. Dale Walker, MD, (Cherokee) Michelle J. Singer, BA (Navajo) Caroline M. Cruz, BS, CPS, CPM (Warm Springs) John Spence, MSW, PhD (Gros Ventre) Jason Yarmer, BS, CPS (Chippewa) The Nine Tribes of Oregon Burns Paiute Tribe Cow Creek Band Of Umpqua Indians Confederated Tribes Of Coos, Lower Umpqua & Siuslaw

Confederated Tribes Of Grand Ronde 01/29/20 Coquille Indian Tribe Klamath Tribes Confederated Tribes Of Siletz Confederated Tribes Of Warm Springs Confederated Tribes Of Umatilla Indigenous Evidence-Based Practice 2 The Scenario Mandate: Evidence-based Practices Problem: bad fit of EBP in Indian Country Response: Tribal Best Practices Initiative 1. Understand Culture-Based Practice 2. Design Tribal Best Practice Process

3. Implement TBP Initiative 01/29/20 Indigenous Evidence-Based Practice 4 Government Office of Money In God we trust, others please provide Evidence! 01/29/20 Indigenous Evidence-Based Practice 5

THE EVIDENCE-BASED PRACTICE MOVEMENT 01/29/20 Indigenous Evidence-Based Practice 6 The EBP Movement Matures What EBM is, and what it isnt (BMJ) Expertise plus research Multiple streams of evidence (COCE/SAMHSA) Experience + client factors + research Learning healthcare system (IOM) Continually increasing knowledge and skill

Best Practices = Science + Service+ Indigenous knowledge 01/29/20 Indigenous Evidence-Based Practice 15 Evaluability Program planning and evaluation (repertoire of techniques) Program theory and clarification Input-process-outcome The Logic Model 01/29/20

Indigenous Evidence-Based Practice 17 SERVICE TO SCIENCE: WHAT SERVICE KNOWS BEST 01/29/20 Indigenous Evidence-Based Practice 19 Service-Based Knowledge Addresses Critical Context Rural vs. urban setting Resources (electricity; water)

Physical condition of participants Spiritually- vs. materially-oriented participants Belief of participants Belief of personnel Context and culture 01/29/20 Indigenous Evidence-Based Practice 20 Service-Based Knowledge Addresses Crucial Behavioral Health Variables Choice Self-healing belief guided by expert healer Unique interpersonal relationships

Complex webs of inter-related and reciprocal factors 01/29/20 Indigenous Evidence-Based Practice 21 Service-Based Evidence: The Refinement Process Assembled experts Published research Practice experiences Debate quality and meaning of info Formal consensus process: conclusions 01/29/20 Indigenous Evidence-Based Practice

22 Service-Based Evidence: Dissemination Guidelines Standards Resource materials Strategic plans College curricula, courses, texts 01/29/20 Indigenous Evidence-Based Practice 23 CULTURE-BASED EVIDENCE 01/29/20

Indigenous Evidence-Based Practice 24 Why Understand Epistemology of Culture-Based Practices? Develop new CBP Validate proposed CBP Culturally appropriate tests of what works Cross-walk to EBP and PBP Disseminate and improve CBP Empower indigenous knowledge

01/29/20 Indigenous Evidence-Based Practice 25 Culture-Based Prevention & Treatment: Activities Experience, observation, listening, participating Traditions, ceremonies, daily observances Stories, songs, artwork Oral, modeling, practice, animation Language, worldview, teachings, experience 01/29/20 Indigenous Evidence-Based Practice

26 Culture-Based Health Practices: Materials Settings Dress; Regalia Symbols; Graphics; Pictures Sensory Substances Food Fun 01/29/20 Indigenous Evidence-Based Practice 27 Culture-Based Health Practices: Personnel

Enthusiasm, confidence Caring, compassion Vision, knowledge Charisma Credibility Community status Peer group status 01/29/20 Indigenous Evidence-Based Practice

28 Indigenous Health Practices: Immediate (Proximal) Outcomes Balance Connection family, culture, community, natural world, spiritual world Identity Meaning Power and hope

Self-esteem Community norms, adaptive capacity, sharing and support 01/29/20 Indigenous Evidence-Based Practice 29 Indigenous Health Practices: Distal Outcomes (NOMS)

Reduced morbidity; mortality Social participation Reduced ATOD Employment; education Well-functioning families Reduced criminality Mental health 01/29/20 Indigenous Evidence-Based Practice 30 THE OREGON TRIBAL BEST PRACTICES INITIATIVE 01/29/20

Indigenous Evidence-Based Practice 31 Problem with the EBP Mandate Developer training & fidelity testing: alien Core components concept: not adaptable Exogenous programming: not credible Loss of the familiar and accepted Personnel, training, and testing capacity: non-extant Versus sovereignty and consultation 01/29/20 Indigenous Evidence-Based Practice 32 Items Described for Tribal Best Practice

Replications Culture-based Evidence Goals Target population Risk and protective factors 01/29/20

Tribal personnel Activities Materials Optional Elements Outcomes Indigenous Evidence-Based Practice 33 Evidence for Validity of TBP Criteria

Longevity Teachings (based on) Values (based on; incorporated) Principles (based on; incorporated) Elders approval Community feedback/evaluation/acceptance Contribution to advancement of the people 01/29/20 Indigenous Evidence-Based Practice 34 Tribal Best Practices Under Review

Horse Program Storytelling Basketball Against Alcohol and Drugs (BAAD) Elder-based Family Mediation Cultural Sobriety Recognition Dinner Powwow 01/29/20 Indigenous Evidence-Based Practice 35

Horse Program Cultural Evidence: Longevity of the Practice Role of horses stretches back several hundred years Tribal stories; old pictures of Native Americans and horses; use by plains Indians for hunting, transportation and warfare 01/29/20 Indigenous Evidence-Based Practice 36 Horse Program Cultural Evidence: Teachings Native Americans learned from animals; animal characters used as teaching tools

01/29/20 Indigenous Evidence-Based Practice 37 Horse Program Cultural Evidence: Values Respect Patience Personal responsibility Generosity Communication

01/29/20 Indigenous Evidence-Based Practice 38 Horse Program Cultural Evidence: Principles Mentoring Relating with the natural world Commitment to others

Leadership skills Being compassionate Calmness and self-control in presence of greater power 01/29/20 Indigenous Evidence-Based Practice 39 Horse Program Cultural Evidence: Elders Approval 01/29/20 Indigenous Evidence-Based Practice 40

Horse Program Cultural Evidence: Community feedback/acceptance Individual stories of youth and family Tribes requesting program Tribal satisfaction survey Feedback from referring agent 01/29/20 Indigenous Evidence-Based Practice 41

Horse Program Replications Equine assisted psychotherapy (www.eagla.org) Mustangs offering hope and renewal (www.charityblosson.org ) Tribal horse programs in three other locations in OR. 01/29/20 Indigenous Evidence-Based Practice 42 Horse Program Goals

Criminal behaviors reduced Mental health problems reduced Suicide ideation and attempts reduced School tenure and academic improvement 01/29/20 Indigenous Evidence-Based Practice 43 Horse Program Risk and Protective Factors

Drug free activity Involvement in cultural practice Bonding and positive relationships Re-uniting with family Learned patience, respect, personal responsibility Academic progress Recognition 01/29/20 Indigenous Evidence-Based Practice 44 Horse Program

Personnel Named, passionate program advocate, promoter, and implementer Named individuals trained and experienced with horses 01/29/20 Indigenous Evidence-Based Practice 45 Horse Program Key Elements (Activities)

Obtain tribal buy-in Obtain referrals and subjects buy-in Incorporate into summer tribal camp Teach horsemanship Conduct ceremonies 01/29/20 Indigenous Evidence-Based Practice 46 Horse Program Logic Model Materials

Special horses Water, feed, and grain Corrals, tack, and equipment Covered arena (preferred) Round pen 01/29/20 Indigenous Evidence-Based Practice 47 Horse Program Logic Model Outcomes Decrease/Increase(NOMS) Specific Indicator

Avoidable death/Longevity na Morbidity/health na Disability/ability Skill; leadership; responsibility; cooperation Suffering/well-being Feel good about self & life Isolation/connectedness

Involved in community; bonded to role models Substance abuse/non-harmful or no use Reduced use 01/29/20 Indigenous Evidence-Based Practice 48 Horse Program Logic Model Outcomes Decrease/Increase Specific Indicator

Unemployed/employed Prevocational skills; communication; work ethic; marketable skills Education failure/success Academic motivation Dysfunctional/healthy family Family re-unification; de-stressed family Delinquency/good behavior Not violating probation; better citizenship Homelessness/stability

na Bad/ Healthy attitude, beliefs, lifestyle Feels better; feels responsible; feels cooperative 01/29/20 Indigenous Evidence-Based Practice 49 Vision 01/29/20 Indigenous Evidence-Based Practice

50 Lessons Learned: Plan for Advancing Culture-Based Practices Objective Develop a logic model Understand evaluability Increasing commitment to evaluation 01/29/20 Action TPB form, suggestions, and instructions in logic model format

Goals, activities, and outcomes in measurable terms Participation of Tribes in conceptualizing TBP in both CB and evaluable terms Indigenous Evidence-Based Practice 51