Presenters
- Denise Middlebrook, PhD, Training and Technical Assistance Director, Reno, NV
- Brenda Freeman, PhD, Professor, Educational Psychology & Counseling, Reno, NV
- Tonya Lewis, MSW, I.H.S. Behavioral Health Integrated Care T.A. Director, Reno, NV
Summary
The psychological footprint of historical trauma, a term associated with colonization, the forced removal of American Indian/Alaska Native (AN/AI) peoples from tribal lands, and the boarding school era, is a legacy of health and mental health challenges, substance abuse, high unemployment, low per capita income, reduced educational access, and low graduation and high mortality rates. Yet within many of the tribal cultures and histories, great strength, spirituality, and unique perspectives on physical and emotional healing can be found. Working inside AIAN cultural paradigms is central to improving the quality of services and creating an environment where AIAN patients can heal and flourish. For AIAN patients the inclusion of AIAN culture in integrated care can be a powerful strength-based healing agent. This presentation uses qualitative data to explain the application of culture and culture-based programs in integrated care. The rationale for the study was the paucity of published research and evaluation on culture and AIAN integrated care. The findings to be presented were gathered across three years of integrated care implementation in six AIAN clinics/communities. The communities included rural, reservation, and urban tribal clinics in the western and mid-western United States. The design of the study used a content analysis approach. Data were compiled from a standard template completed every quarter for the three years by project leads and included organizational self-assessments pertaining to strengths, weaknesses, opportunities, threats, culture, achievement, fidelity, and outcome evaluation. The content analysis utilized an applied thematic analysis approach using NVivo. The analysis resulted in four themes addressing the research question: What are the perceptions of AIAN integrated care teams on inclusion of AIAN culture in integrated care? The themes will be presented within the context of understanding the impact of history, culture, and social determinants of health in AIAN communities.
Objectives
- To understand how AIAN integrated care teams understood the overlap between Native culture and integrated care.
- To identify five or more ways social determinants of health impact the delivery of integrated care in AIAN settings.
- To discuss the relationship between cultural competence and integrated care in AIAN communities.
