indigenous models of evidence-based practice
DESCRIPTION
Indigenous Models of Evidence-Based Practice. Oregon’s Tribal Best Practices Initiative. Presenters. One Sky Center. DHS/AMH. Caroline M. Cruz, BS, CPS, CPM (Warm Springs) John Spence, MSW, PhD (Gros Ventre) Jason Yarmer, BS, CPS (Chippewa). Douglas A Bigelow, PhD - PowerPoint PPT PresentationTRANSCRIPT
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Indigenous Models of Evidence-Based Practice
Oregon’s Tribal Best Practices Initiative
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Presenters
One Sky Center
• Douglas A Bigelow, PhD
• R. Dale Walker, MD, (Cherokee)
• Michelle J. Singer, BA (Navajo)
DHS/AMH• Caroline M. Cruz, BS, CPS, CPM
(Warm Springs)
• John Spence, MSW, PhD (Gros Ventre)
• Jason Yarmer, BS, CPS (Chippewa)
Indigenous Evidence-Based Practice 2
•Burns Paiute Tribe•Cow Creek Band Of Umpqua Indians•Confederated Tribes Of Coos, Lower•Umpqua & Siuslaw•Confederated Tribes Of Grand Ronde
•Coquille Indian Tribe•Klamath Tribes•Confederated Tribes Of Siletz•Confederated Tribes Of Warm Springs•Confederated Tribes Of Umatilla
The Nine Tribes of Oregon
04/21/23
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The Scenario
• Mandate: Evidence-based Practices
• Problem: bad fit of EBP in Indian Country
• Response: Tribal Best Practices Initiative1. Understand Culture-Based Practice2. Design Tribal Best Practice Process3. Implement TBP Initiative
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Government Office of Money
In God we trust,
…others please provide
Evidence!Indigenous Evidence-Based Practice 504/21/23
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THE EVIDENCE-BASED PRACTICE MOVEMENT
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The EBP Movement Matures• What EBM is, and what it isn’t (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
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Evaluability
• Program planning and evaluation– (repertoire of techniques)
• Program theory and clarification
• Input-process-outcome
• The Logic Model
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SERVICE TO SCIENCE: WHAT SERVICE KNOWS BEST
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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
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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
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Service-Based Evidence: The Refinement Process
• Assembled experts
• Published research
• Practice experiences
• Debate quality and meaning of info
• Formal consensus process: conclusions
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Service-Based Evidence: Dissemination
• Guidelines
• Standards
• Resource materials
• Strategic plans
• College curricula, courses, texts
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CULTURE-BASED EVIDENCE
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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
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Culture-Based Prevention & Treatment: Activities
• Experience, observation, listening, participating
• Traditions, ceremonies, daily observances
• Stories, songs, artwork
• Oral, modeling, practice, animation
• Language, worldview, teachings, experience
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Culture-Based Health Practices: Materials
• Settings
• Dress; Regalia
• Symbols; Graphics; Pictures
• Sensory Substances
• Food
• Fun
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Culture-Based Health Practices: Personnel
• Enthusiasm, confidence• Caring, compassion• Vision, knowledge• Charisma• Credibility• Community status• Peer group status
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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
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Indigenous Health Practices: Distal Outcomes (NOMS)
• Reduced morbidity; mortality• Social participation• Reduced ATOD• Employment; education• Well-functioning families• Reduced criminality• Mental health
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THE OREGON TRIBAL BEST PRACTICES INITIATIVE
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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
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Items Described for Tribal Best Practice
• Replications• Culture-based Evidence• Goals • Target population• Risk and protective
factors
• Tribal personnel• Activities• Materials• Optional Elements• Outcomes
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Evidence for Validity of TBPCriteria
• Longevity• Teachings (based on)• Values (based on; incorporated)• Principles (based on; incorporated)• Elder’s approval• Community feedback/evaluation/acceptance• Contribution to advancement of the people
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Tribal Best Practices Under Review
• Horse Program• Storytelling• Basketball Against Alcohol and Drugs (BAAD)• Elder-based Family Mediation• Cultural Sobriety Recognition Dinner• Powwow
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Horse ProgramCultural 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
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Horse ProgramCultural Evidence: Teachings
• Native Americans learned from animals; animal characters used as teaching tools
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Horse ProgramCultural Evidence: Values
• Respect • Patience • Personal responsibility • Generosity• Communication
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Horse ProgramCultural Evidence: Principles
• Mentoring • Relating with the natural world• Commitment to others• Leadership skills • Being compassionate• Calmness and self-control in presence of
greater power
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Horse ProgramCultural Evidence: Elders’ Approval
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Horse ProgramCultural Evidence: Community
feedback/acceptance
• Individual stories of youth and family• Tribes requesting program• Tribal satisfaction survey• Feedback from referring agent
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Horse ProgramReplications
• Equine assisted psychotherapy (www.eagla.org)
• Mustangs offering hope and renewal (www.charityblosson.org )
• Tribal horse programs in three other locations in OR.
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Horse ProgramGoals
• Criminal behaviors reduced• Mental health problems reduced• Suicide ideation and attempts reduced• School tenure and academic improvement
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Horse ProgramRisk 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
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Horse ProgramPersonnel
• Named, passionate program advocate, promoter, and implementer
• Named individuals trained and experienced with horses
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Horse ProgramKey Elements (Activities)
• Obtain tribal buy-in• Obtain referrals and subject’s buy-in• Incorporate into summer tribal camp• Teach horsemanship• Conduct ceremonies
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Horse Program Logic ModelMaterials
• Special horses • Water, feed, and grain• Corrals, tack, and equipment• Covered arena (preferred) • Round pen
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Horse Program Logic ModelOutcomes
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
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Horse Program Logic ModelOutcomes
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
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Vision
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Lessons Learned: Plan for Advancing Culture-Based Practices
Objective• Develop a logic model
• Understand evaluability
• Increasing commitment to evaluation
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 C-B and evaluable terms
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