Identifying Effective Mental Health Interventions for American Indians and Alaska Natives: A Review of the Literature

Department of Psychology, University of Michigan, Ann Arbor, MI 48109-1043, USA.
Cultural Diversity and Ethnic Minority Psychology (Impact Factor: 1.36). 11/2007; 13(4):356-63. DOI: 10.1037/1099-9809.13.4.356
Source: PubMed


The pursuit of evidence-based practice (EBP) within the mental health professions has contributed to efficacious clinical intervention for individuals struggling with mental health problems. Within the context of the EBP movement, this article reviews the treatment outcome literature for mental health interventions directed specifically toward American Indians and Alaska Natives experiencing psychological distress. Fifty-six articles and chapters pertaining to the treatment of Native Americans with mental health problems were identified, though the vast majority of these did not systematically assess outcomes of specified treatments for Native American clients under scientifically controlled conditions. Of just nine studies assessing intervention outcomes, only two were controlled studies with adequate sample sizes and interpretable results relative to the identification of EBP among American Indians and Alaska Natives. The advantages and limitations of EBP for treatment of Native American mental health problems are discussed.

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Available from: Joseph P Gone
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    • "A few reviews have focused on interventions to treat Indigenous people, but these cited interventions are not holistically or culturally-based [27,28]. One literature review considered evidence-based practice in Native American mental health service delivery, but deliberately excluded treatments that targeted substance use [29]. "
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    ABSTRACT: Background Cultural interventions offer the hope and promise of healing from addictions for Indigenous people.a However, there are few published studies specifically examining the type and impact of these interventions. Positioned within the Honouring Our Strengths: Culture as Intervention project, a scoping study was conducted to describe what is known about the characteristics of culture-based programs and to examine the outcomes collected and effects of these interventions on wellness. Methods This review followed established methods for scoping studies, including a final stage of consultation with stakeholders. The data search and extraction were also guided by the “PICO” (Patient/population, Intervention, Comparison, and Outcome) method, for which we defined each element, but did not require direct comparisons between treatment and control groups. Twelve databases from the scientific literature and 13 databases from the grey literature were searched up to October 26, 2012. Results The search strategy yielded 4,518 articles. Nineteen studies were included from the United States (58%) and Canada (42%), that involved residential programs (58%), and all (100%) integrated Western and culture-based treatment services. Seventeen types of cultural interventions were found, with sweat lodge ceremonies the most commonly (68%) enacted. Study samples ranged from 11 to 2,685 clients. Just over half of studies involved quasi-experimental designs (53%). Most articles (90%) measured physical wellness, with fewer (37%) examining spiritual health. Results show benefits in all areas of wellness, particularly by reducing or eliminating substance use problems in 74% of studies. Conclusions Evidence from this scoping study suggests that the culture-based interventions used in addictions treatment for Indigenous people are beneficial to help improve client functioning in all areas of wellness. There is a need for well-designed studies to address the question of best relational or contextual fit of cultural practices given a particular place, time, and population group. Addiction researchers and treatment providers are encouraged to work together to make further inroads into expanding the study of culture-based interventions from multiple perspectives and locations.
    Full-text · Article · Sep 2014 · Substance Abuse Treatment Prevention and Policy
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    • "EMDR is used with treatment of unresolved traumas, whether a small embarrassment or major life trauma. AIs have experienced many traumas throughout history (boarding schools experiences, loss of culture, loss of language, genocide (Gone, 2007); and, in their lives today, from extreme poverty to the many deaths of young people from suicide, homicide, and traumatic deaths from accidents, fires, drowning, and weather (Alcántara & Gone, 2007; Centers for Disease Control and Prevention, 2007). EMDR is usually conducted with a visual object such as a hand, light, or pen for the client to follow with their eyes. "
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    ABSTRACT: Because of the paucity of research on evidence-based treatments with American Indian/Alaska Native (AI/AN) clients, this article addresses barriers to that research and how to adapt treatment to make it more culturally appropriate and acceptable to AI/AN clients so they might benefit from and remain in treatment. Debido a la escasez de investigación sobre tratamientos basados en la evidencia con clientes Indoamericanos/Nativos de Alaska (AI/AN, por sus siglas en inglés), este artículo trata las barreras para ese tipo de investigación y cómo adaptar el tratamiento para hacerlo más apropiado culturalmente y aceptable para los clientes AI/AN, para que puedan beneficiarse del mismo y permanecer en tratamiento.
    Full-text · Article · Apr 2012 · Journal of multicultural counseling and development
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    • "Nevertheless, many substance abuse programs serving AI/AN communities continue to draw upon 12-step approaches that were originally introduced when funds for such programs were first made available in the United States in the 1960s and 1970s [27-30]. While there have been some highly successful efforts to meld the traditions of AI/AN tribes with that of 12-step approaches [31,32], some AI/ANs remain profoundly uncomfortable with the dominance of this Euro-American approach to substance abuse services in their communities [27,33]. This long-standing tension has now been compounded by the emergence of a number of evidence-based treatments (EBTs; described further below) [34] that, while holding substantial promise for improving services for AI/ANs with substance use problems (as they do for non-AI/ANs), may conflict with both AI/AN and 12-step healing traditions and may be seen as yet another imposition of alien approaches in AI/AN programs. "
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    ABSTRACT: A variety of forces are now shaping a passionate debate regarding the optimal approaches to improving the quality of substance abuse services for American Indian and Alaska Native communities. While there have been some highly successful efforts to meld the traditions of American Indian and Alaska Native tribes with that of 12-step approaches, some American Indian and Alaska Natives remain profoundly uncomfortable with the dominance of this Euro-American approach to substance abuse treatment in their communities. This longstanding tension has now been complicated by the emergence of a number of evidence-based treatments that, while holding promise for improving treatment for American Indian and Alaska Natives with substance use problems, may conflict with both American Indian and Alaska Native and 12-step healing traditions. We convened a panel of experts from American Indian and Alaska Native communities, substance abuse treatment programs serving these communities, and researchers to discuss and analyze these controversies in preparation for a national study of American Indian and Alaska Native substance abuse services. While the panel identified programs that are using evidence-based treatments, members still voiced concerns about the cultural appropriateness of many evidence-based treatments as well as the lack of guidance on how to adapt them for use with American Indians and Alaska Natives. The panel concluded that the efforts of federal and state policymakers to promote the use of evidence-based treatments are further complicating an already-contentious debate within American Indian and Alaska Native communities on how to provide effective substance abuse services. This external pressure to utilize evidence-based treatments is particularly problematic given American Indian and Alaska Native communities' concerns about protecting their sovereign status. Broadening this conversation beyond its primary focus on the use of evidence-based treatments to other salient issues such as building the necessary research evidence (including incorporating American Indian and Alaska Native cultural values into clinical practice) and developing the human and infrastructural resources to support the use of this evidence may be far more effective for advancing efforts to improve substance abuse services for American Indian and Alaska Native communities.
    Full-text · Article · Jun 2011 · Implementation Science
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