Honoring Our Strengths Conference

June 25, 2014

Bill Mussell & Dr. Brenda Restoule

Native Mental Health Association of Canada

Define necessary skills and knowledge needed to provide culturally competent care in addressing trauma

To build knowledge on utilizing a trauma informed approach with a focus on cultural interventions for healing of intergenerational trauma

Culture refers to integrated patterns of human behavior that include the language, thoughts, communications, actions, customs, beliefs, values and institutions of racial, ethnic, religious or social groups.

Competence implies having the capacity to function effectively as an individual and an organization within the context of the cultural beliefs, behaviors and needs presented by consumers and their communities

Cultural competence is a set of congruent behaviors, attitudes, and policies that come together in a system agency or among professionals that enables effective work in cross-cultural settings

Adapted from Cross (1989)

Cultural competence is the integration and transformation of knowledge about individuals and groups of people into specific standards, policies, practices, and attitudes to increase the quality of services; thereby producing better outcomes Davis (1997)

Cultural competence requires cultural humility which is a commitment and active engagement in a lifelong process that individuals enter into on an ongoing basis with patients, communities, colleagues and with themselves that requires one to bring into check the power imbalances that exist in the dynamics of caregiver-client communication by using client-centered care

Cultural competence mandates that organizations, programs and individuals must have the ability to:1. Value diversity and similarities among all peoples;

2. Understand and effectively respond to cultural differences;

3. Engage in cultural self-assessment at the individual and organizational levels;

4. Make adaptations to the delivery of services and enabling supports;

5. Recognize and acknowledge cultural knowledge

Trauma: Any life event(s) that threatens a person’s physical or emotional/psychological health or safety

Traumatic events cause people to lose a sense of control, connection and meaning (Herman, 1997)

Complex Trauma: repetitive, prolonged and cumulative usually resulting from interpersonal betrayal

Intergenerational Trauma: A collective emotional or psychological injury over the lifespan and across generations. Often resulting from a history of genocide with the effects being mental, emotional, physical and spiritual

“Intergenerational or multi-generational trauma happens when the effects of trauma are not resolved in one generation. When trauma is ignored and there is no support for dealing with it, the trauma will be passed from one generation to the next. What we learn to see as “normal” when we are children, we pass on to our own children….The unhealthy ways of behaving that people use to protect themselves can be passed on to children, without them even knowing they are doing so. This is the legacy of physical and sexual abuse in residential schools.”

(Aboriginal Healing Foundation, 1999:A5)

Adrenaline is produced during a traumatic event to provide for

greater strength and endurance causing hyperarousal of the

nervous system

If the trauma is re-experienced repeatedly, the brain loses its

ability to regulate its own chemistry; flooding the brain with

adrenaline until temporarily depleted. The brain will compensate

by alternating patterns of over-stimulation and depletion

The body will enter a state of hyperarousal, anxiety and fear

causing the trauma victims to react to seemingly harmless

situations. If adrenaline is depleted the trauma victim may shut

down with no interest or energy to react or reach out

Neuroscience has found that individuals who experience chronic

and perpetuating stress develop a hypersensitivity to it and are

more likely to respond to it in maladaptive ways

Neurobiological and physiological changes:memory impairment that impacts on the ability to

process and integrate information (i.e., difficulty remembering aspects of the trauma, difficulty making decisions, poor concentration)

increased bodily response to fear triggers

Increased sensitivity to startle reflex

Sleep abnormalities

increased reactivity to both explicit and implicit trauma reminders

Hyper-vigilance

Increased autonomic reactions (i.e., shaky, sweaty, heart palpitations, trouble breathing)

Regardless of the source of the trauma, the experience has four common traits: it was unexpected;it was psychologically overwhelming;the person was unprepared or unable to cope

with it;there was nothing the person felt they could do

to prevent or mitigate it. It is thus, not the event per se that determines

whether an experience is traumatic, but the subjective experience of that person.

Indigenous peoples’ experiences of contact and cultural domination may reasonably be viewed as a loss of predictability and control and increases in vulnerability

A report on mental health needs of 127 survivors of residential school found that 64.2% of these individuals met with criteria for PTSD

Chronic and complex grief

High rates of suicide and homicide

High rates of violence

Accidental deaths

Lateral violence

incarceration

Poor health conditions that impact on functioning

Residential schools

Loss of language, identity & culture (through various acts of assimilation)

High rates of family violence

High rates of abuses, particularly physical & sexual abuse, especially toward women & children

Poor social conditions (i.e., extreme poverty, housing, water, sewage)

Culture of dependency

Has led to family histories of ongoing trauma and dependencies

Created family histories of maladaptive coping

Led to loss of cultural understanding and cultural behaviours to effectively deal with trauma

Neuroscience has found that individuals who experience chronic and perpetuating stress develop a hypersensitivity to it and are more likely to respond to it in maladaptive ways

The hypersensitivity to recognizing and responding in maladaptive ways to stress are transmitted to their children

Individuals who suffer from historical trauma often identify events or situations as stressful or traumatic more frequently than those who do not have historical trauma

Historical trauma have co-occurring health and social problems

Individuals who suffer from historical trauma often have more complex needs requiring more long term and comprehensive care

“under the relentless influence of forced assimilation, economic dependence and isolation, Aboriginal cultures have undergone a process of deculturation. Evidence for this process of cultural degeneration is found in such phenomena as alcoholism, substance abuse, child neglect, suicide, family violence, sexual abuse, vandalism and theft, all of which are epidemic in many Aboriginal communities. It is paramount to notice that none of these indicators of cultural and identity degeneration characterized pre-colonized Aboriginal culture.” (RCAP - Peavey,

1993)

Requires an understanding of trauma in all aspects of service delivery

Places the survivor’s safety, choice and control as a priority

Creates a treatment culture of nonviolence, learning and collaboration

Treatment requires building confidence and trust to facilitate healing and recovery

Facilitate engagement and meaningful participation by consumers & families in planning of services and programs

Create collaborative relationships with other systems from the social determinants of health

1. Trauma awareness

2. Emphasis on safety and trustworthiness

3. Opportunity for choice, collaboration and connection

4. Strengths-based and skill building

Also common to the principles of cultural competency

Having a comprehension of cultural effects to trauma

Having a comprehension that cultural loss, degeneration and culture stress are significant forms of trauma

Requires understanding cultural responses to addressing trauma

The World Health Organization defines traditional medicine and healing as “the sum total of knowledge, skills, and practices based on the theories, beliefs, and experiences indigenous to different cultures, whether explicable or not, used in the maintenance of health as well as in the prevention, diagnosis, improvement of treatment of physical and mental illness” (Martin Hill, 2003 p.3).

Traditional healing has also been defined as “practices designed to promote mental, physical, and spiritual well-being that are based on beliefs which go back to the time before the spread of western ‘scientific’ bio-medicine” (Martin Hill, 2003 p.7).

When Aboriginal people discuss the elements of traditional

healing, “they include a wide range of activities, from physical

cures using herbal medicines and other remedies, to the

promotion of psychological and spiritual well-being using

ceremony, counseling and the accumulated wisdom of elders”

(Martin Hill, 2003, p.7).

On comparison with western medicine that typically has the

goal ‘to cure’, the goal of traditional medicine is ‘to improve

the quality of life with an emphasis on the healing journey’

(NAHO, 2002, p.9). As NAHO (2002) states, a basic principle

of the scientific method is “to separate parts from the whole

and to concentrate on the parts that need the most attention.

In the traditional model, the approach is to consider the

whole of the person’s being. Quality of life is the focus, with

an emphasis on achieving balance in all aspects” (lbid, p.9).

1. Teaching cultural and community history2. Teaching how historical trauma creates

risk for health, social and relationship problems

3. Supporting opportunities for developing self-awareness, self-worth and cultural identity

4. Teaching life skills5. Teaching strategies to cope with stress

and regulate emotions

Cultural ceremoniesSweatsSmudgesUse of medicinesCedar bathsSoul retrieval

Traditional teachingsRolesmedicines

Traditional counselling Integrative or collaborative traditional &

western techniques

Physical: relaxation, exercise, hunting or being on the land, therapeutic dance, healthy diet (including drinking water)

Mental: teachings, identifying triggers and symptoms, safety plans to reduce risk, trauma narrative or map, visualization

Emotional: anger management/release, art therapy, strengthening support system, personal affirmation, restoring pride in self/identity/culture/history

Spiritual: meditation, prayer, storytelling, singing, drumming or dancing, involvement in traditional activities (beading, carving), hunting or spending time on the land

1. Confront our trauma & embrace our history

educate our people about our history & what happened to us. Knowledge is power!

2. Understand the trauma

educate about trauma response features & cultural context to mourning & grief

3. Release the pain

4. Transcend the trauma

heal & move beyond the trauma so that we no longer define ourselves in terms of the trauma

*as presented by Dr. Maria Yellow Horse Brave Heart (April 2005)

Takini Network has conducted research on their model that addresses trauma testimony, trauma response issues and moving beyond trauma

All participants found intervention helped them with grief resolution, feeling better about themselves, experienced improvements in their parenting and a better understanding of why they felt so bad & had so many health & social problems

Attend to:

1. The mind by remembering, speaking & coming to terms with the horrifying, overwhelming experience(s) that led to trauma response

2. The body by learning to acknowledge and master the physical stress response like anxiety & sleeplessness

3. The emotions by re-establishing relationships and secure social connections

4. The spirit by recognizing that the spiritual & cultural have often been critical aspects of the original wound or trauma for Aboriginal people

1. The Journey Begins

gathering of core group of people to address their own healing needs

2.Gathering Momentum

increase in healing activity with recognition of root causes of addiction & abuse through community-wide awareness workshops

3. Hitting the Wall

building healing capacity by providing training & employment with a focus on community development

4. From Healing to Transformation

shifting from fixing the problem to transforming the system

Views Aboriginal peoples’ reaction to Residential School as a Post-Traumatic Stress Response to avoid terminology of blame & weakness

Five (5) components to addressing PTSR and health inequalities

1. Acknowledgement of socio-historical context

2. Reframing of stress responses3. Focus on holistic health & cultural renewal4. Proven psycho-educational & therapeutic

approach5. Communal and cultural model of grieving

and healing

PTSR may arise from a multitude of individual & community traumas, within and across generations.

Compound trauma referred to as historical trauma or IT rooted in cultural loss

Need to partner and share information about social/historical impacts on the health of indigenous people & conduct research across similar populations. This will help identify relationship between IT, health inequalities and strategies to improve health within & across indigenous peoples/communities.

PTSR model reframes PTSD symptoms as human responses to extreme circumstance seen as more compassionate for individuals & communities who have endured external trauma that is so profound that it affects their ability to cope

Need for a process to name historical & systemic sources of personal & social ills that is a critical political lens in developing a compassionate view of current health inequalities. May assist in better service delivery for Aboriginal people

Rename, manage & transform historical stressors & stress responses to health promoting behaviors & positive health outcomes

Need to promote holistic perspective of health that is consistent with cultural concepts of Medicine Wheel

PTSR model includes life experiences and environmental stressors as preconditions for health & illness. Acknowledges historical stressors, culture, Elders, traditional healing & community processes

Need to incorporate a lifespan approach to healing, focus on capacity building & address all aspects of the person’s response to stress.

People do recover from post-traumatic stress through effective psycho-educational & therapeutic approaches.

The Lakota First Nation has adapted western based approaches that are more suitable for Indigenous settings & approaches to historical trauma. They recommend 4 main components to healing from intergenerational trauma

Therapeutic approaches to PTSD are consistent with Indigenous values of respect, care & collective models of healing. They bring people together who share a history of trauma to identify with one another & further accept stress responses and support a path to wellness

Many Indigenous ceremonies that promotes group healing and reduces isolation; alleviates guilt, shame & anger; and enhances feelings of self-worth

Healing, in Aboriginal terms, refers to personal and societal recovery from the lasting effects of oppression and systemic racism experienced over generations. Many Aboriginal people are suffering not simply from specific diseases and social problems, but also from a depression of spirit resulting from more than 500 years of damage to their cultures, languages, identities and self-respect. The idea of healing suggests that to reach ‘whole health’, Aboriginal people must confront the crippling injuries of the past

(RCAP, 1996:109).

MIIGWECH! THANK YOU