American Indian Youth: Who Southwestern Urban and Reservation Youth Turn to for Help with Mental Health or Addictions

We illustrate the addictions and mental health service use of American Indian adolescents. Interviews concerning mental health need and service configurations with 401 Southwestern American Indian (AI) youth used questions from the Diagnostic Interview Schedule (DIS) and the Service Assessment for Children and Adolescents (SACA). Seventy-nine percent had mental health or addiction problems, with half meeting criteria for at least one diagnosis. One in 4 youth met criteria for drug dependence'abuse or conduct disorder, 1 in 5 for depression, and 1 in 8 for alcohol dependence'abuse. Most youth were helped by a combination of providers. Youth meeting more diagnostic criteria were increasingly likely to use service configurations with adults, nonspecialist professionals, and specialists, respectively. Regardless of disorder, youth were least likely to use configurations with traditional healers or specialists and there was little difference in rates of use between the two. The lack of services from specialist providers was potentially offset by use of an extensive range of informal adults, nonspecialist professionals, and peers. Since informal helpers, peers, and nonspecialist providers, but not specialists, are providing the bulk of services they must be given support and skills so they can function effectively.     

Urban American Indian Youth Spirituality and Religion: A Latent Class Analysis

This article explores the interconnected spiritual, religious, and cultural worlds of the majority of American Indian (AI) youth who live in urban areas: their patterns of involvement in religion and Native spirituality and associated well‐being. Latent class analysis of data from 205 AI middle school students identified five distinctive classes using survey measures of religious affiliation, attendance at services, adherence to Christian and traditional spiritual beliefs, Native spirituality, and Native cultural practices. Two classes were Christian groups: one attending Christian churches and following Christian beliefs but uninvolved with Native beliefs, spirituality, or cultural practices; and a nominal Christian group affiliated with but not attending church and unattached to belief systems. Two groups followed Native beliefs and spiritual practices, one affiliated with the Native American Church and another unaffiliated with any church. The fifth, nonreligious group, had no religious affiliation, followed neither Christian nor traditional beliefs, and was uninvolved in Native spirituality and cultural practices. The two groups embracing AI spirituality reported better academic performance, more reservation contact, higher AI enculturation, and stronger bicultural orientations.     

Urban American Indian Community Perspectives on Resources and Challenges for Youth Suicide Prevention

American Indian (AI) youth have some of the highest rates of suicide of any group in the United States, and the majority of AI youth live in urban areas away from tribal communities. As such, understanding the resources available for suicide prevention among urban AI youth is critical, as is understanding the challenges involved in accessing such resources. Pre‐existing interview data from 15 self‐identified AI community members and staff from an Urban Indian Health Organization were examined to understand existing resources for urban AI youth suicide prevention, as well as related challenges. A thematic analysis was undertaken, resulting in three principal themes around suicide prevention: formal resources, informal resources, and community values and beliefs. Formal resources that meet the needs of AI youth were viewed as largely inaccessible or nonexistent, and youth were seen as more likely to seek help from informal sources. Community values of mutual support were thought to reinforce available informal supports. However, challenges arose in terms of the community's knowledge of and views on discussing suicide, as well as the perceived fit between community values and beliefs and formal prevention models.     

Promoting Healing and Restoring Trust: Policy Recommendations for Improving Behavioral Health Care for American Indian/Alaska Native Adolescents

American Indian/Alaska Native youth represent the strength and continued survival of many Nations and Tribes. However, they currently experience numerous health disparities and challenges, including the highest rate of suicide among 15–24 year-olds in the United States. Our comprehensive review of the literature on the mental health of AI/AN youth highlighted seven focal causes of behavioral health disparities: (1) high levels of violence and trauma exposure and traumatic loss, (2) past and current oppression, racism, and discrimination, (3) underfunded systems of care, (4) disregard for effective indigenous practices in service provision, policy, and funding, (5) overreliance on evidence-based practices, (6) lack of cultural competence among systems of care and providers, and (7) barriers to care. Seven policy recommendations that recognize the importance of moving beyond exclusive reliance on western models of care and that seek to foster transformation of individuals, families, communities, behavioral health service systems of care, and social structures are presented, supported, and discussed.     

The Non-Indian Therapist Working with American Indian Clients

Abstract

The lack of success non-Indian therapists have had in working with American Indian clients has perpetuated a repetitive cycle of poor mental health services with this population. Although we cannot change the historic distrust that exists, we can begin to understand cultural differences and how they can impact treatment to obtain positive results. Acknowledgment of these differences can promote trust, a core ingredient that must be established between the client and therapist. This paper offers guidelines to assist the non-Indian therapist in working with the American Indian client.     

An Emergent Phenomenon of American Indian Postsecondary Transition and Retention

This study examined 21 American Indian students’ postsecondary transition and retention experiences through a phenomenological methodology. Postsecondary transition is the process of leaving home and adjusting to postsecondary education. Postsecondary retention is achieving success and remaining at a university for at least 6 months. Data sources included individual interviews, journal analysis, and document analysis. The 10 emergent themes described an interconnected phenomenon centered on institutional, social, and interpersonal dimensions.     

American Indian Acculturation: Tribal Lands to Predominately White Postsecondary Settings

Grounded theory provided a framework for examining 25 acculturating American Indian college students, 12 relatives of acculturating American Indians, and 7 postsecondary administrators. Acculturation was defined as the transformative process resulting from the integration of tribal culture and predominately White culture. Data sources included individual interviews, focus groups, and artifact analysis. The 16 emergent themes form an acculturation theory centered on a strength‐based acculturation process affecting American Indians’ transition to predominately White postsecondary settings.     

American Indian Historical Trauma: Community Perspectives from Two Great Plains Medicine Men

The field of community psychology has long been interested in the relations between how community problems are defined, what interventions are developed in response, and to what degree power is distributed as a result. Tensions around these issues have come to the fore in debates over the influence of historical trauma (HT) in American Indian (AI) communities. After interviewing the two most influential medicine men on a Great Plains reservation to investigate how these tensions were being resolved, we found that both respondents were engaging with their own unique elaboration of HT theory. The first, George, engaged in a therapeutic discourse that reconfigured HT as a recognizable but malleable term that could help to communicate his “spiritual perspective” on distress and the need for healing in the reservation community. The second, Henry, engaged in a nation-building discourse that shifted attention away from past colonial military violence toward ongoing systemic oppression and the need for sociostructural change. These two interviews located HT at the heart of important tensions between globalization and indigeneity while opening the door for constructive but critical reflection within AI communities, as well as dialogue with allied social scientists, to consider how emerging discourses surrounding behavioral health disparities might be helpful for promoting healing and/or sociostructural change.     

Families and Schools Together: an experimental analysis of a parent-mediated multi-family group program for American Indian children

The goals of this randomized intervention study were to: (a) increase academic performance among American Indian children ages 4-9 years and (b) reduce classroom problem behaviors. To achieve these goals, the multi-family group program called Families and Schools Together (FAST) was adapted with three American Indian Nations in Wisconsin. Over 3 years, seven multi-family group cycles of FAST were implemented, each lasting 8 weeks. In collaboration with the College of Menominee Nation, this parent intervention approach was adapted to express tribal values while maintaining its core components. Fifty pairs of universally recruited American Indian students at three schools who were assessed, matched on five variables, and then randomly assigned to either the FAST or non-FAST control condition. Pretest, posttest, and 9- to 12-month follow-up data were collected by American Indian staff and university students on multiple indicators of academic and behavioral performance. Of the 50 families that attended FAST meetings at least once, 40 graduated (80%) from the 7 FAST cycles. On the immediate posttest, statistically significant differences in improvement, favoring FAST participants were found on the Aggressive Behavior scale of the teacher-rated Child Behavior Checklist (CBCL) and on the parent-rated Withdrawn scale of the same instrument. On the 1-year follow-up assessment, parent CBCL ratings indicated that FAST students had maintained their less withdrawn status and teacher ratings on the Social Skills Rating Scale (SSRS) revealed that FAST participants had exhibited relatively greater improvement in their academic competence. Parent surveys of the graduated students generally showed satisfaction with the program. Implications of the present results and future research directions are discussed.     

Individual and Community Resilience Factors Among Lesbian,Gay, Bisexual,Queer and Questioning Youth and Adults in Israel

Drawing on resilience theories, this study examined the individual and community factors of Israeli lesbians, gays, bisexuals, queers, and questioning (LGBQs) that contribute to positive mental health and the degree to which individual and community protective factors mitigate the adverse effect of risk factors for poor mental health. Differences in resilience factors between LGBQ youth and adults were explored. Data were collected on 890 LGBQ youth and adults. Findings emphasize the role of community‐level resilience factors in the lives of LGBQs, and that these support systems differ slightly between the two age groups. Among youth, family support was both a strong predictor for well‐being and a protective factor for mental distress. Although family support was found as a resilience factor among adults as well, other community‐level factors (friends’ support, LGBT connectedness and having steady partner) were found as protective factors for poorer mental health. These findings suggest for efforts on fostering familial support for LGBQ youth and a multi‐level system that offers support at the familial, peer, relationship and community levels for both LGBQ youth and adults.     

Psychological Trauma Among American Indian Families: A Two-Generation Study

The findings presented in this article come from a two-generation study exploring the psychological impact of trauma among American Indian/Alaskan Native (AI/AN) families and its perceived relationship to substance abuse across generations. Psychological traumas and stressors found to be pervasive across generations included physical and sexual abuse as well as persistent discrimination and racism, such as fear of having children removed from the home. A noteworthy finding was a decrease in reports of childhood traumas across the two generations within this sample. Implications and recommendations for clinicians and researchers working with AI populations are discussed in light of the findings.     

Relations Between Instructional Practices and On-Task Behavior in Classrooms Serving American Indian Students

Achievement disparities between American Indian students and non-American Indian peers are persistent and well documented. Student engagement is a promising target for intervention given its relation to academic achievement. This study investigated the relation between specific teacher practices (opportunities to respond [OTRs], praise, and reprimands) and classroom on-task behavior in an urban, public K–8 school that serves primarily American Indian students. OTRs and praise were positively associated with student on-task behavior, whereas reprimands were negatively associated with on-task behavior. Results from multilevel logistic regression indicated that OTRs significantly increased the likelihood that a classroom was highly on-task, whereas the reprimands significantly decreased the likelihood. Praise did not have a significant effect after controlling for the other variables in the model. Results are interpreted in a context of evidence-based instructional practices for increasing OTRs and praise, decreasing reprimands, and ultimately enhancing on-task behavior in an urban classrooms serving primarily American Indian youth.     

Sustaining and Expanding Systems of Care to Provide Mental Health Services for Children, Youth and Families Across America

The Substance Abuse and Mental Health Services Administration has been instrumental in supporting the development and implementation of systems of care to provide services to children and youth with serious mental health conditions and their families. Since 1993, 173 grants have been awarded to communities in all 50 states, Puerto Rico, Guam, the District of Columbia, and 21 American Indian/Alaska Native communities. The system of care principles of creating comprehensive, individualized services, family-driven and youth-guided care and cultural and linguistic competence, supported by a well-trained and competent workforce, have been successful in transforming the field of children's mental health and facilitating the integration of child-serving systems. This approach has achieved positive outcomes at the child and family, practice and system levels, and numerous articles have been published using data collected from system of care communities, demonstrating the effectiveness of this framework. This article will describe lessons learned from implementing the system of care approach, and will discuss the importance of expanding and sustaining systems of care across the country.     

Cross-Validation of the Behavioral and Emotional Rating Scale-2 Youth Version: An Exploration of Strength-Based Latent Traits

High-quality measurement is a necessary requirement to develop and evaluate the effectiveness of programs that use strength-based principles and strategies. Using independent cross-validation samples, we report two studies that explored the construct validity of the BERS-2 Youth Report, a popular measure designed to assess youth strengths, whose conceptual structure has not yet been examined. In Study 1, an exploratory factor analysis found a four-factor solution with conceptual support, which included both internal assets associated with (a) the management of emotions and positive social interaction skills and (b) engagement in the important social contexts of family and school. In Study 2, confirmatory factor analyses found reasonable model fit for the BERS-2 five-factor structure and superior model fit for the more parsimonious four-factor solution found in Study 1. In future studies, parallel reporting of the four-factor model may provide additional insight to the nature and structure of the BERS-2 Youth Version’s clinical validity and utility when compared with the five-factor model, thus potentially contributing to a broader objective to develop a better understanding of important strength-based latent traits.     

The Structure of Problem and Positive Behavior Among American Indian Adolescents: Gender and Community Differences

Using Problem-Behavior Theory as a framework, the latent structure of problem and positive behaviors was examined within a sample of 1,894 American Indian adolescents. Support was found for a two-factor second-order structure in which problem behaviors (antisocial behavior, alcohol use, drug use, and risky sexual behavior) and positive behaviors (school success, cultural activities, competencies, and community-mindedness) represented two relatively uncorrelated aspects of behavior. Hierarchical multiple regressions demonstrated that the positive behaviors construct contributed significant incremental construct validity in the statistical prediction of psychosocial outcomes, over and above the problem behaviors. In addition, the fit of the structure was examined across gender and the four participating communities. The importance of the inclusion of positive behaviors is discussed from the standpoint of both prevention/promotion activities and the communities' perceptions. Further recommendations are made for deeper understandings of community concerns and strengths in conducting preventive/promotive research efforts.     

The Relationship of Adverse Childhood Experiences to PTSD,Depression, Poly-Drug Use and Suicide Attempt in Reservation-Based Native American Adolescents and Young Adults

Adverse childhood experiences (ACEs) are associated with numerous risk behaviors and mental health outcomes among youth. This study examines the relationship between the number of types of exposures to ACEs and risk behaviors and mental health outcomes among reservation‐based Native Americans. In 2011, data were collected from Native American (N = 288; 15–24 years of age) tribal members from a remote plains reservation using an anonymous web‐based questionnaire. We analyzed the relationship between six ACEs, emotional, physical, and sexual abuse, physical and emotional neglect, witness to intimate partner violence, for those <18 years, and included historical loss associated symptoms, and perceived discrimination for those <19 years; and four risk behavior/mental health outcomes: post‐traumatic stress disorder (PTSD) symptoms, depression symptoms, poly‐drug use, and suicide attempt. Seventy‐eight percent of the sample reported at least one ACE and 40 % reported at least two. The cumulative impact of the ACEs were significant (p < .001) for the four outcomes with each additional ACE increasing the odds of suicide attempt (37 %), poly‐drug use (51 %), PTSD symptoms (55 %), and depression symptoms (57 %). To address these findings culturally appropriate childhood and adolescent interventions for reservation‐based populations must be developed, tested and evaluated longitudinally.     

Advancing Community-Based Research with Urban American Indian Populations: Multidisciplinary Perspectives

The US has witnessed significant growth among urban American Indian (AI) populations in recent decades, and concerns have been raised that these populations face equal or greater degrees of disadvantage than their reservation counterparts. Surprisingly little urban AI research or community work has been documented in the literature, and even less has been written about the influences of urban settings on community-based work with these populations. Given the deep commitments of community psychology to empowering disadvantaged groups and understanding the impact of contextual factors on the lives of individuals and groups, community psychologists are well suited to fill these gaps in the literature. Toward informing such efforts, this work offers multidisciplinary insights from distinct idiographic accounts of community-based behavioral health research with urban AI populations. Accounts are offered by three researchers and one urban AI community organization staff member, and particular attention is given to issues of community heterogeneity, geography, membership, and collaboration. Each first-person account provides “lessons learned” from the urban context in which the research occurred. Together, these accounts suggest several important areas of consideration in research with urban AIs, some of which also seem relevant to reservation-based work. Finally, the potential role of research as a tool of empowerment for urban AI populations is emphasized, suggesting future research attend to the intersections of identity, sense of community, and empowerment in urban AI populations.     

The Latent Structure of Substance Use Among American Indian Adolescents: An Example Using Categorical Variables

Researchers frequently have only categorical data to analyze and cannot, for theoretical or methodological reasons, assume that the observed variables are discrete representations of an underlying continuous variable. We present latent class analysis as an alternative method of measuring latent variables in these circumstances. Latent class analysis does not require the assumptions of factor analyses about the nature of manifest and latent variables, but does allow the use of more precise model selection than techniques such as cluster analysis. We modeled the lifetime substance use of American Indian youth. The latent class model of American Indian teenagers' substance use had four classes: Abstaining, Predominantly Alcohol, Predominantly Alcohol and Marijuana, and Plural Substance. We then demonstrated the usefulness of this latent variable by using it to differentiate levels of several variables in a manner consistent with Social Cognitive Theory.