What do we mean by trauma-informed services and why is such an approach important?
- Resilience & Trauma Visit disclaimer page : The National Congress of American Indians Policy Research Center developed a resource that emphasized the growing recognition of trauma among American Indian/Alaskan Native (AI/AN) communities. For health and wellness efforts to have a meaningful impact in American Indian and Alaska Native (AI/AN) communities, they must explicitly emphasize resilience and seek to address trauma.
- Building a Trauma-Informed Tribal Nation Visit disclaimer page is a presentation developed by the National Institutes of Health. The theme of the presentation is Building a Trauma-Informed Nation: Moving the Conversation into Action.
- Engaging Native Families is a presentation delivered by the Paul Spicer Center for Applied Social Research at the University of Oklahoma through work with The American Indian and Alaska Native Head Start Research Center.
- The Idea Guides for Family Preservation were developed by the Administration for Native Americans in partnership with the Native Wellness Institute. The guides are intended to be an opportunity for trainers to implement as best fits the community and families with whom they are working.
- The Indian Country Child Trauma Center (ICCTC) Visit disclaimer page was established to develop trauma-related treatment protocols, outreach materials, and service delivery guidelines specifically designed for American Indian and Alaska Native (AI/AN) children and their families. The ICCTC is part of the National Child Traumatic Stress Network funded by the Substance Abuse Mental Health Services Administration (SAMHSA) under the National Child Traumatic Stress Initiative.
- Trauma Exposure in American Indian/Alaska Native Children Visit disclaimer page is a resource developed by the Indian Country Child Trauma Center.
- The Indian Health Service has available on its web site a presentation on Principles of Trauma-Informed Systems of Care Visit disclaimer page geared specifically for tribal communities.
- The Effects of Stress and Trauma on Mind, Body…Health Care is a presentation developed by the Indian Health Service addressing the consequences of stress and trauma specifically oriented to American Indian communities.
- ACF produced a webinar for Tribal TANF and Tribal TANF-Child Welfare Partnerships grantees titled Addressing Toxic Stress and Trauma in Native Communities: The Promise of Tribal Home Visiting Visit disclaimer page that presents an overview of toxic stress and how it affects AIAN child health, followed by an overview of the Tribal Maternal, Infant, and Early Childhood Home Visiting (MIECHV) program, and a presentation from a Tribal Home Visiting grantee that is actively working to address toxic stress in one tribal community.
My agency has decided it wants to be more trauma-informed. Where do I start?
Resources for AI/AN communities are organized around several issues. These include historical trauma, suicide prevention, and alcohol/drug issues.
Specific resources on historical trauma include:
- Historical Trauma & Microaggressions Visit disclaimer page through the ACEs Connection has a section entitled American Indian/Alaska Native (AIAN) - United States. There are numerous resources which can be used to address historical trauma.
- Historical Trauma among the Native American Population: What Service Providers Need to Know Visit disclaimer page is a resource from the National Resource Center for Tribes.
- An article entitled Native Families Impacted by Historical Trauma and the Role of the Child Welfare Worker Visit disclaimer page Visit disclaimer page is available from the National Native Children’s Trauma Center. The article begins on page 30 of the document.
Specific resources on suicide include:
- Historical Trauma and Suicide Visit disclaimer page is a presentation made available by the Indian Health Service.
- Suicide Prevention in Rural, Tribal Communities: The intersection of challenge and possibility Visit disclaimer page is a 2014 journal article that appeared in the Journal of Rural Mental Health and was produced by the National Native Children’s Trauma Center.
- Preventing and Responding to Suicide Clusters in American Indian and Alaska Native Communities Report Visit disclaimer page highlights the effects of suicide clusters on American Indian and Alaska Native communities. It discusses effective prevention strategies and explores resources communities can use to decrease the prevalence of suicide clusters.
We’ve begun working on these issues, but are trying to decide what to tackle next. How can I figure out next steps?
- The National Center for Parent, Family and Community Engagement has available a compendium of parenting interventions which includes resources helpful for engaging Native families.
- Head Start Trauma Smart Visit disclaimer page helps preschool children and the adults who care for them calmly navigate difficult life challenges by pairing practical tools in the classroom with coping strategies from the early childhood, health and mental health fields. Created by the Crittenton Children’s Center, the approach instructs caretakers to recognize and address mental health problems; actively includes parents in their child’s school experience; and improves the work environment for teachers and school personnel. Trauma Smart is a systemic practice model that addresses the aftermath of violence and trauma within the context of a natural environment – Head Start classrooms. The model provides children and adults with specific strategies and tools to develop self-care techniques and build personal and collective resilience. The model is currently provided in Head Start preschool programs in 26 counties in the Kansas City metro area and across Missouri, and includes around 3,200 children annually. It has also been implemented in the Menominee Nation Visit disclaimer page as part of their Safe Schools Project. Addressing both historic wounds and more recent suffering, members of the Wisconsin tribe are using this trauma-informed care model in its social and behavioral health services. This has dramatically changed life for its members. According to Ryan Coffey, an elementary school teacher and counselor, trauma informed care “doesn’t take a lot of planning. It doesn’t take extra time. It’s about getting to know your kids.”
My staff often burn out from dealing with clients’ trauma constantly. How can I support them?
- The Indian Health Service has developed a presentation on compassion fatigue specifically designed for the American Indian/Alaska Native audience. This presentation may be found at Trauma-Informed Care Practices and Strategies for Addressing Compassion Fatigue Visit disclaimer page .
What treatments for trauma have been adapted specifically for AI/AN communities and populations?
- The National Native Children’s Trauma Center has developed an article on Cultural Adaptations of Trauma Treatments in Indian Country Visit disclaimer page (the article appears on page 25 of the journal issue at the link). It is geared toward child welfare practice but is applicable to related fields as well. On page 30 of the same journal is an article entitled Native Families Impacted by Historical Trauma and the Role of the Child Welfare Worker Visit disclaimer page Visit disclaimer page .
- HHS’s Assistant Secretary for Planning and Evaluation published a document entitled Addressing Trauma in American Indian and Alaska Native Youth Visit disclaimer page that summarizes the research and practice literature and identifies programs and practices that specifically address various forms of trauma that have been adapted for AI/AN youth.
- The Indian Health Service has made available a slide presentation on addressing trauma in schools Visit disclaimer page .
- The National American Indian Alaska Native Addiction Technology Transfer Center has developed a resource on Recovery Schools: A Provider's Introduction to Recovery Programs in High Schools and Post-Secondary Schools (Conference Proceedings, June 2012) Visit disclaimer page .
- Project Venture Visit disclaimer page is an evidence-based practice in SAMHSA’s National Registry of Evidence Based Programs and Practices that is geared for tribal youth and young adults and focuses on a cluster of risk factors associated with trauma, substance use, and mental health. Project Venture developer McClelland Hall is working with SAMHSA’s National Network to Eliminate Disparities (NNED) in behavioral health. Multiple tribes have been trained and subsequently received funding from states through the state’s SAMHSA block grant to continue this work.
- The Indian Health Service promotes trauma-informed care for federal facilities, urban and tribal programs. The following projects provide examples of strategies and approaches which are fostering trauma-informed care in mental and behavioral health services. Several of these efforts are part of the agency’s Methamphetamine and Suicide Prevention Initiative Visit disclaimer page .
- Copper River Native Association – Methamphetamine and Suicide Prevention Initiative Project (Alaska Area): Innovative Cultural Practice Based Model: Resiliency Program. The Copper River Native Association utilizes an evidence-based, trauma-informed resiliency program for youth ages 8-24 years in the targeted communities. The program addresses historical/personal trauma issues that are known risk factors for suicide, methamphetamine and other substance misuse, and substance use disorders. This program builds upon participants strengths, provide skills training to overcome trauma responses, and involves families. A Project Coordinator is employed to coordinate the education, planning, development, training, and implementation of program activities. The project focuses on providing community education, training providers, fostering coalitions, and improving organizational practices.
- Indian Health Council, Inc. – Methamphetamine and Suicide Prevention Initiative Project (California Area): Evidence Based Practice Model: Cognitive Behavioral Therapy, Solution Focused Therapy and Psychodynamic Therapy. The Indian Health Council, Inc. (IHC) project utilizes trauma-informed treatment interventions that incorporate the following therapeutic approaches using a Family Systems Model: Cognitive Behavioral Therapy (CBT), Solutions Focused Therapy, and Psychodynamic Therapy in providing Behavioral Health services to patients with methamphetamine abuse and co-occurring disorders. The majority of clientele present with symptoms related to repeated traumatic experiences (complex trauma).
In many instances whole households and family members have shared traumatic experience either directly or indirectly. In order to address the family system, the IHC utilizes a Family Systems Model framework for treatment in a community where collective health of a family has greater value over the needs of the individual. As a result of historical trauma and health disparity, the IHC clientele have developed an adaptive mistrust of government, corporate, and agency models of health. Therefore, many clients will not identify and disclose recent or childhood experiences of trauma until trust with the provider has been established.
Utilizing a trauma-informed treatment approach allows the provider to work at the pace of the patient in developing the safety, respect, and connection needed to begin the healing process. Integrating therapeutic methods has proven successful with the communities the IHC serves as it incorporates the present (CBT), the future (Solutions Focused), and the past (Psychodynamic) in decreasing symptoms. IHC providers understand the importance of past, present, and future when working with clients from multi-generational homes where the effects of trauma and/or re-traumatization may be passed from one generation to the next. The project goal is to reduce methamphetamine use in American Indian communities by expanding prevention and behavioral health care, including treatment and aftercare services.
- Ramah Navajo School Board Inc. – Domestic Violence Prevention Initiative Project (Albuquerque Area): Practice Based Model: Risking Connection. The Ramah Navajo School Board, Inc. project utilizes evidence based models to expand and improve existing domestic violence program. The Sidran Institute’s Risking Connection Online trauma-specific intervention trainings are used to train staff and community about trauma-informed care. The Mental Health First Aid model is utilized to educate the community about mental health and its effects on domestic violence. The Duluth Model Intervention Curriculum of Coordinated Community Response is used to create and improve their Domestic Task Force. The project goal is to provide evidence-based training on domestic violence to key personnel in order to eliminate domestic violence within the community.
- Chickasaw Nation Department of Family Services – Tribal Community Program (Oklahoma Area): Evidence Based Practice Model: The Sanctuary Model. The Chickasaw Nation Department of Family Services is dedicated to promoting the Chickasaw Nation Mission statement, “to enhance the quality of life for all Chickasaw People.” Recognizing that trauma can affect treatment and recovery outcomes, the Department of Family Services is engaged in adoption of the Sanctuary Model in efforts to promote a trauma-informed culture. The Sanctuary Model is a blueprint for clinical and organizational change which, at its core, promotes safety and recovery from adversity through the active creation of a trauma-informed community. A recognition that trauma is pervasive in the experience of human beings forms the basis for the Sanctuary Model's focus not only on the people who seek treatment, but equally on the people and systems who provide that treatment.
- Choctaw Behavioral Health – Tribal Community Program (Nashville Area): Evidence Based Treatment and Protocols: Trauma Focused Cognitive Behavioral Therapy and Eye Movement Desensitization and Reprocessing. The Choctaw Behavioral Health provides resources for emotional, mental, behavioral and addictions services to the Choctaw community. The primary goal of the program is to support the enhancement of life for those suffering from mental health and substance use disorders, in turn creating healthier Choctaw communities. The program provides trauma-informed care services including Mindfulness, Trauma Focused Cognitive Behavioral Therapy, and Eye Movement Desensitization and Reprocessing Therapy. All services are provided in a culturally oriented model to engage with the community to work in full collaboration with other human service programs both on and off the reservation for the benefit of patients and community.
- American Indian Health and Family Services, Inc. – Methamphetamine and Suicide Prevention Initiative Project (Urban Area): Practice Based Model: Gather of Native Americans (GONA). The American Indian Health and Family Services, Inc. utilizes the GONA curriculum to provide culturally specific preventive interventions for addressing substance misuse in Native American communities. Community healing from historical and cultural trauma is a central theme of the GONA approach. This includes an understanding and healing of self, family, and community.
The curriculum focuses not only on alcohol and other drug misuse, but the many underlying issues that may lead to individuals, families, and communities becoming at risk for addictions and self-destructive behaviors. The curriculum recognizes the importance Native American values, traditions, and spirituality play in healing from the effects of historical trauma and substance misuse.
The four themes of the curriculum reflect the four levels of life’s teachings. They are: (1) Belonging: a time when infants and children learn who they are, where they belong, and a sense of protection; (2) Mastery: a time when adolescents and young adults learn to understand their gifts, their vision, where they come from, and how to master their talents; (3) Interdependence: a time for adulthood, responsibility to others and an understanding of interconnectedness with all things; and (4) Generosity: a time when, as elders, families and communities can give back through sharing of wisdom, teachings, culture, rituals, stories, and song. By following the life’s stages of personal development, the GONA curriculum provides a structure for Native American communities to begin to address what it means to heal from the effects of historical trauma and alcohol and other drug misuse in communities, and how to develop community response plans and strategies.
Additional or specialized resources
- Established in 1974 through the Native American Programs Act (NAPA), the Administration for Native Americans (ANA) serves all Native Americans, including federally recognized tribes, American Indian and Alaska Native organizations, Native Hawaiian organizations and Native populations throughout the Pacific Basin (including American Samoa, Guam, and the Commonwealth of the Northern Mariana Islands). ANA promotes self-sufficiency for Native Americans. ANA has developed a wide variety of resources to inform and connect with applicants, grantees and the public. The resource library includes guides, videos, fact sheets, reports, and webinars produced by ANA and its Technical Assistance Providers, partners, and grantees.
- SAMHSA Visit disclaimer page provides training and technical assistance to tribes, such as help with prevention program planning and Tribal Action Plan development.
- Understanding Urban Indians' Interactions with ACF Programs and Services, 2011-2014 The purpose of this project is to implement an exploratory research study to better understand the challenges and context for family self-sufficiency of low-income Alaska Natives and American Indians living in urban areas and their interactions with services and programs offered by ACF.
- Webinar on Trauma-Informed Teen Pregnancy Prevention for Tribal Youth Visit disclaimer page has a key outcome of recognizing how trauma (including from teen dating violence) presents itself in Tribal communities.
- A Summary of Research and Publications on Early Childhood for American Indian and Alaska Native Children, is a resource about culturally appropriate curricula and practices, language acquisition, teacher training, parent involvement, assessment tools and practices, health and physical well-being, and mental health.
- The Facts on Violence Against American Indian/Alaskan Native Women Visit disclaimer page from Futures without Violence, provides information and resources for American Indian women living on Indian reservations who experience unique challenges that intensify the epidemic of violence against them.
- Positive Indian Parenting at the South Puget Intertribal Planning Agency: Located in western Washington state, the South Puget Intertribal Planning Agency Visit disclaimer page (SPIPA) is a consortium that includes five tribes: the Chehalis, Nisqually, Shoalwater Bay, Skokomish, and Squaxin Island. SPIPA provides direct services, planning, and technical assistance to each tribe and to eligible Native Americans residing within the SPIPA service area. SPIPA is a recipient of an ACF Tribal Home Visiting grant, through which it created the Healthy Families Project. The goal of SPIPA’s Healthy Families Project, which uses the Parents as Teachers Visit disclaimer page (PAT) home visiting model, is to improve the health and wellbeing of Native American families and children through the development and provision of a comprehensive, culturally appropriate home visitation service delivery program that will increase levels of child and family development and increase the use of traditional Native American parenting skills. To meet these goals, SPIPA supplemented its PAT model with the Positive Indian Parenting Visit disclaimer page (PIP) curriculum. Created by the National Indian Child Welfare Association Visit disclaimer page , Positive Indian Parenting (PIP) draws on historic Native child-rearing practices related to storytelling, cradleboards, harmony, lessons of nature, behavior management, and the use of praise. It also addresses the historic impact of boarding schools, intergenerational trauma and grief, and forced assimilation on parenting. PIP is strengths based, conveying a message that AIAN ancestors’ wisdom is a birthright for Native parents (National Center for Parent, Family, and Community Engagement, 2015). SPIPA’s intent in implementing PAT and PIP as part of the Healthy Families Project is that Native American parents who learn and consistently implement traditional Native American parenting skills will gain access to the rich resources and cultural support within the tribal community, by engaging a traditional Native American model of child and family development. As part of its grant, SPIPA is evaluating whether parents who participate in the Healthy Families Project show increases in the use of traditional AIAN parenting practices after successful participation in the program.
- SAMHSA has developed a resource Visit disclaimer page on what providers of disaster services should know about historical trauma as they respond to disasters in Indian Country.