Principles for Participatory Research with American Indian and Alaska Native Communities: Lessons from the Circles of Care Initiative

Full text

Principles for Participatory Research with
American Indian and Alaska Native Communities:
Lessons from the Circles of Care Initiative
Douglas K. Novins, Brenda Freeman, Pamela Jumper Thurman, Ethleen Iron Cloud-Two
Dogs, James Allen, Pamela L. LeMaster, & Pamela B. Deters
Poster Presented at the 2006 Conference Indigenous Suicide Prevention Research and Programs
in Canada and the United States: Setting a Collaborative Agenda, Albuquerque, New Mexico,
February 7-9, 2006. Sponsored by the National Institutes of Health, the Substance Abuse and
Mental Health Services Administration, the Indian Health Service, Health Canada, and the
Canadian Institutes of Health Research.
INTRODUCTION
 Many authors have emphasized the importance of guiding principles for participatory
research projects (e.g., Freeman, Iron Cloud-Two Dogs, Novins, & LeMaster, 2004; Israel et
al., 2003; Jumper Thurman, Allen, & Deters, 2004; Minkler & Wallerstein, 2003).
 While these principles vary from author to author, a clear statement of principles and
ongoing efforts and assessments of adherence to them is viewed as critical to the ultimate
success of such work. (Freeman et al., 2004; Israel et al., 2003; Thurman et al., 2004;
Minkler & Wallerstein, 2003).
 Here we review the principles we identified during our work with nine diverse American
Indian and Alaska Native (AI/AN) communities as part of the Circles of Care initiative
(Freeman et al., 2004; Thurman et al., 2004) and compare these principles to those developed
Israel et al. (2003) for community-based participatory research projects more broadly.
METHOD
The Circles of Care Initiative:
 Funded by the Center for Mental Health Services (CMHS), the Circles of Care initiative
provides funding to plan, design, and assess the feasibility of implementing a culturally
appropriate mental health service model for AI/AN children with serious emotional
disturbances and their families.
 The first cycle of Circles of Care grantees were funded from 1998-2001:
o Cheyenne River Sioux Tribe, Eagle Butte, South Dakota;
o Choctaw Nation of Oklahoma, Talihina, Oklahoma;
o Fairbanks Native Association, Fairbanks, Alaska;
o Feather River Tribal Health, Oroville, California;
o First Nations Community HealthSource, Albuquerque, New Mexico;

Novins et al., 2006
2
o In-Care Network, Billings, Montana;
o Inter-Tribal Council of Michigan, Sault Ste. Marie, Michigan;
o Oglala Lakota Tribe, Porcupine, South Dakota; and the
o Urban Indian Health Board/Native American Health Center, Oakland, California.
 Two other cycles of grantees have subsequently participated in the initiative (seven grantees
funded from 2001-2004 and seven from 2005-2008.
Development of Principles for Strategic Planning, Evaluation, and Research:
 After the conclusion of their planning work, the first cycle grantees produced a series of ten
academic papers, two of which (Freeman et al., 2004; Thurman et al., 2004) included a
description of the principles underlying their participatory planning and evaluation efforts.
 As noted by the authors of these papers, “A set of basic strategic planning beliefs evolved
naturally over the course of the Circles of Care initiative. These were not explicitly stated to
the grantees, but over the course of the evaluation technical assistance workshops and site
visits, the following strategic planning/evaluation principles became evident (Freeman et al.,
2004, p. 23).”
o In this poster, we compare the twelve principles described in these papers to those
developed by Israel et al. (2003) in their description of the principles underlying
community-based participatory research.
RESULTS
 The principles identified through the Circles of Care initiative were largely consistent with
those described by Israel et al. (2003). See Table 1.
 In general, the principles identified through the Circles of Care process addressed provided
more specific details regarding participatory work in AI/AN communities. For example,
while Israel et al. (2003) address the importance of utilizing community strengths and
resources, the principles emerging from Circles of Care provided greater specifics in this
regard, including the following:
o that specific issues should be considered in the participatory process, such as
recognizing potential tensions emerging from diversity in traditions, culture, and
rural-urban-reservation factors;
o that AI/AN values, such as the establishment of trust, flexibility, reciprocity,
suspending judgment, inclusion, and bravery should be used to define the
participatory process; and
o that the spirituality is likely to play a particularly important role in this process in
AI/AN communities.

Novins et al., 2006
3
Table 1. Guiding Principles Based Upon the Circles of Care Initiative (Freeman et al., 2004; Thurman et al., 2004) and
Those Described by Israel et al. (2003)
PRINCIPLES FROM THE CIRCLES OF
CARE INITIATIVE
CORRESPONDING PRINCIPLES
FROM ISRAEL ET AL. (2003) OVERARCHING PRINCIPLE

In effective strategic planning the unique
characteristics and needs of different
tribal entities are recognized, including
recognizing tensions among traditions,
culture, and rural-urban-reservation
factors.
 The process of engagement for the
evaluation is defined by a common set
of AI/AN values that include the
establishment of trust, flexibility,
reciprocity, suspending judgment,
inclusion, and bravery.
 As in other aspects of AI/AN life,
spiritual values become an important
part of the evaluation process and how
the evaluation is conducted.
Recognizes community as a unit of
identity
Builds on strengths and resources within
the community
Involves a long-term commitment by all
partners.
PROCESS (1). Projects should be
community-based, build upon the strengths
of all research partners, and recognize the
diversity of viewpoints and traditions within
the community.
 Effective strategic planning requires the
direct participation of key stakeholders.
 Successful strategic planning
necessitates establishing staff credibility.
 In effective strategic planning
processes, evaluation and project
development are integrative, though
each has a distinct set of
responsibilities.
Promotes a co-learning and empowering
process…
Facilitates collaborative, equitable
involvement of all partners in all phases
of the research.
Involves a cyclical and iterative process.
PROCESS (2). Projects should rely on the
development of a collaborative, inclusive
investigative approach in which all
participants share their skills, learn from
each other, and appreciate the
contributions of all team members.
 Effective strategic planning includes a
central belief in change and change
processes.
 Evaluation occurs within a wider socio-
political context in AI/AN communities.
Addresses health from both positive and
ecological perspectives.
…attends to social inequalities.
Integrates knowledge and intervention for
mutual benefit of all partners
BELIEF IN CHANGE. Projects should be
based on the belief that change is possible
– for individuals and families as well as
communities – and that research can be a
positive agent in the change process.
 Strategic planning processes need to be
documented through process
evaluation.
 In the reporting of evaluation results,
consensus or recognition of differences
may be valued more than compromise
in many AI/AN communities.
Disseminates findings and knowledge
gained to all partners.
DISSEMINATION. Projects should
disseminate study results to all key
stakeholders.
 Effective strategic planning
encompasses an outcome-oriented
approach, with outcomes determined by
participatory action research methods.
OUTCOMES. Projects should delineate
and achieve specific outcomes as
developed through an inclusive and
culturally-appropriate research process.
 Interestingly, the principles emerging from the Circles of Care initiative emphasize the
importance of an outcomes-oriented approach, which is not mentioned by Israel et al. (2003).
 This focus on outcomes may represent the impact of the nature of the focus of the Circles of
Care initiative, which provided a specific goal for the grantees to achieve.
 However, it is more likely that this represents the value these AI/AN communities placed on
positive outcomes, which they felt would be best achieved through a participatory process.
 We found that the principle of consensus/recognition of differencesin reporting evaluation
results was particularly important in the Circles of Care evaluation. In many of the

Novins et al., 2006
4
participating communities, a consensus on the strategic plan emerged as one of the key
outcomes to which the evaluation process contributed.
 The relationships of the four overarching principles for participatory evaluation, planning,
and research in AI/AN communities is displayed in Figure 1. As emphasized by both Bess,
Allen, and Deters (2004) regarding the Circles of Care initiative, and Israel et al. (2003)
regarding participatory processes more general, these processes should be cyclical and
iterative, building with each passing cycle.
 Similarly, the participatory principles that emerged from the Circles of Care initiative are
interdependent upon one another, and build upon one another in an cyclical manner.
Circle
of
Care
Overarching
Principles
Belief in
Change
Outcomes
Process
Dissemination
Figure 1. The Relationships of the Four Overarching
Principles for Participatory Research in the
Circles of Care Initiative
CONCLUSIONS
 While Circles of Care was originally designed with only the broadest of participatory
processes in mind, a series of principles emerged that were highly consistent with those
describedfor community-based participatory research, enriched by the unique local contexts
of evaluation and strategic planning with AI/AN communities.

Novins et al., 2006
5
 Although Circles of Care focused on strategic planning that was supported by an extensive
evaluation effort, we believe that the principles are likely to be applicable to those projects
with a more explicit research focus
REFERENCES
 Bess, G., Allen, J., Deters, P.B. (2004) The evaluation lifecycle: A retrospective assessment
of stages and phases of the Circles of Care initiative. American Indian and Alaska Native
Mental Health Research, 11(2), 30-41.
 Freeman, B., Iron Cloud-Two Dogs, E., Novins, D. K., & LeMaster, P. L. (2004). Contextual
issues for strategic planning and evaluation of systems of care for American Indian and
Alaska Native communities: An introduction to Circles of Care.American Indian and Alaska
Native Mental Health Research, 11(2), 1-29.
 Israel, B. A., Schulz, A. J., Parker, E. A., Becker, A. B., Allen III, A. J., & Guzman, R.
(2003). Critical issues in developing and following Community Based Participatory Research
principles. In M. Minkler & N. Wallerstein (Eds.), Community Based Participatory Research
for Health (pp. 53-76). San Francisco: Jossey-Bass.
 Jumper Thurman, P., Allen, J., & Deters, P. B. (2004). The Circles of Care evaluation: doing
participatory evaluation with American Indian and Alaska Native communities. American
Indian and Alaska Native Mental Health Research, 11(2), 139-154.
 Minkler, M., & Wallerstein, N. (2003). Community-Based Participatory Research for
Health. San Francisco: Jossey-Bass.
SUPPORT: Federal Center for Mental Health Services, Substance Abuse and Mental Health
Services Administration; Indian Health Service; Department of Justice; and the National Institute
of Mental Health.
ACKNOWLEDGEMENTS: The authors gratefully acknowledge the assistance of Linda Son-
Stone Barbara Plested, Teisha Simmons, and DeWayne Tahein for the conceptualizations
presented in the papers on which this poster is based.