For generations, American Indians weren't consulted about how to solve their psychosocial problems, from high rates of suicide to substance abuse. Instead, psychologists moved in with Western interventions, often ignoring input from the communities they sought to help.
"None of the Indians' suggestions were taken seriously," says Joseph Trimble, PhD, psychology professor at Western Washington University and president of APA's Div. 45 (Society for the Psychological Study of Ethnic Minority Issues).
But today psychologists recognize that successful prevention and intervention is possible only when the community has a strong voice in developing prevention efforts. Using community-based, multigenerational approaches, psychologists in a range of programs are finding success in helping American Indians address their communities' greatest psychosocial problems.
"We need to prepare psychologists to think about how to intervene, yet be respectful to American Indians' self-determination," says Stanford University psychologist Teresa D. LaFromboise, PhD.
In American Indian culture, people tend to live in close-knit communities, and the psychosocial problems they face are multigenerational, often stemming from American Indians being pushed to assimilate into Western culture. Many psychologists say this repression of culture has resulted in long-term trauma, which some call "post-colonial stress disorder."
"The term recognizes that the trauma they face is not a discrete event, but a long-term kind of trauma that happens every day and is not going away," says Beth Todd-Bazemore, PhD, associate professor of clinical psychology at the University of South Dakota. "It's the affect of being raised by parents and grandparents who experienced this trauma."
Suicide is one problem that has multigenerational roots and has become one of the greatest tragedies among American Indians: The rate of suicide among American Indians age 10 to 14 is about four times higher than the rate for adolescents from other ethnic groups.
Several psychologist-designed programs are encouraging community members to take active roles in designing suicide prevention programs. One is in the Zuni Pueblo community in New Mexico, which invited LaFromboise of Stanford to help them design a curriculum that would reduce suicidal thinking and behaviors in teen-agers.
Working together, they developed a 43-session program that high school teachers use to coach students on such life skills as problem-solving, depression and stress management, anger regulation and goal-setting. The curriculum was initially tested on students at the Zuni Public High School and the Sequoyah High School in the Cherokee Nation of Oklahoma.
Outcomes studies of the program have shown that students exposed to this curriculum have a reduced risk of suicidal behavior and showed a higher level of problem-solving skills. The curriculum is now used by several American Indian communities, LaFromboise says.
Similarly, numerous tribes are working with the Healthy Nations Initiative, funded by the Robert Wood Johnson Foundation, to reduce substance abuse in their communities. American Indians die of alcoholism-related conditions at a rate that's six times higher than for other Americans. In addition, drug and alcohol use among American Indian teens is 10 percent to 15 percent higher than among European-American peers.
Healthy Nations aims to give tribes financial and administrative support to develop their own solutions to the problem. Northwest New Mexico Fighting Back, Inc., for example, received support from Healthy Nations to work with the Navajo, Zuni and Laguna Pueblo communities.
In this intervention, members of a small Navajo community suggested working with liquor stores to reduce the availability of alcohol, says Ray Daw, executive director of Fighting Back. They taught the establishments to pay closer attention to the age and intoxication level of its patrons, he says, and one business voluntarily closed its doors because the community and liquor store owners felt it had too many liquor stores.
"The solutions aren't in the universities and the think tanks," says Timothy Noe, deputy director of the Healthy Nations Initiative. "They're in the local community."
'A good way of life'
Another intervention encourages multigenerational involvement in a child's life as a way to help children learn Indian values. The Three Villages Project, funded by the National Institute on Drug Abuse in the upper Midwest, brings together children, parents and grandparents to learn about the dangers of substance abuse through a 10-week prevention program.
As part of that program, fam ilies play a board game, The Minobimaadiziwin Game, that incorporates traditional spiritual images and native language to help families communicate with each other and to help parents instill American Indian values in their children. Minobimaadiziwin is the Indian word for "a good way of life."
Game participants travel through seven stages of life, from birth to tribe elder. Participants each take a turn rolling one dice and traveling around the game board. If a player lands on a tomahawk symbol, he picks from a pile of cards that represents negative behaviors, reads the card aloud and takes a penalty. For instance, one card states, "I have to repeat these words to myself 10 times, 'I will not give in to peer pressure.'"
When a player lands on the medicine-wheel symbol, she picks from a pile of cards that represent values. For example, one card states, "I get three free spaces for having the strength to say 'no.'"
In addition to the board game, counselors discuss the role of family and community with participants and teach anger-management skills, problem-solving skills and ways to ask for help. Participants also role-play refusing drugs and alcohol.
The program is being tested on more than 300 fifth- to eighth-grade students and their families. While there are no data yet to prove its effectiveness, researchers expect the preliminary results to be encouraging when they're released this summer.
"We're probably not going to get everyone in the family where there's a chronic alcohol problem to stop drinking," says Les Whitbeck, PhD, project director and professor of sociology at the Institute of Behavioral and Social Research at Iowa State University. "But if we can reach one family member, we can create a support system for that kid."
Psychologists are also developing programs to train mental health providers to collaborate with community members. One program, Project Making Medicine, teaches mental health providers to work more closely with tribal leaders and be more sensitive to the community's tribal and spiritual beliefs.
The program, at the Center on Child Abuse and Neglect, encourages providers to use many traditional native teachings including the use of symbols and language from tribal creation stories when they work with children and their families.
While each tribe's creation story is different, the story typically includes teachings on how the tribe came to be, how animals and plants are part of creation, the principles that native people can live by and how they bring balance into their lives, says Dolores Subia BigFoot, PhD, director of Project Making Medicine, which is part of the Native American Programs for the Center on Child Abuse and Neglect.
Prevention programs that empower American Indians to solve the psychosocial challenges in their communities hold the most promise, says LaFromboise. "This could be the century of recovery for American Indians."
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LaFromboise, T.D. (1996). American Indian Life Skills Development Curriculum. Madison: University of Wisconsin Press.