In the Spotlight

Culturally Appropriate Mental Health Care to Address American Indian/Alaska Native (AI/AN) Mental Health Disparities

posted Aug 3, 2018, 1:01 PM by daniel yoo   [ updated Aug 3, 2018, 4:28 PM ]

Posted by Sean A. Bear, BA, CADC, Co-Director, National American Indian and Alaska Native Addiction Technology Transfer Center, University of Iowa, and AI/AN Caucus Member 

Non-Hispanic American Indian and Native American (AI/AN) adults and children are at greater risk than all other racial groups of experiencing poor mental health outcomes and unmet medical and mental healthcare needs. For instance, suicide rates for AI/AN adults and youth are higher than the national average.

For native people, cultural differences play a crucial role in this gap as well as in the misdiagnosis. An accurate assessment is not possible without intimate knowledge of another culture; such knowledge cannot always be learned in the present educational systems, many of which do not share the same historical accounts or knowledge tribal systems have been teaching for thousands of years.

The Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) states that understanding a culture means comprehending and applying that culture’s beliefs, ceremonial rituals, and customs. With the Native American culture, this would not be possible without the actual time and tutelage of an American Indian or First Nations Healer and Spiritual Person, who would be most qualified to provide the appropriate expertise. In order for native-serving providers to meet the standards set forth in the DSM-5, they must learn from outside of the Western medical education system.

Few mental health diagnostic tools, assessments, or treatments have been studied in AI/AN communities. For instance, few mental health treatment models apply spiritual phenomena—such as spirits, ghosts, or healing—but this is an area common within Native American tribes.

Native Americans also experience historical trauma that produces negative impacts on mental health and wellbeing and that can be passed down through generations both socially and genetically. Native Americans can experience historical loss symptoms (e.g., depression, anxiety, substance use disorders) as a result of the cross-generational transmission of trauma from historical losses (e.g., loss of land and population). Historical trauma must be taken into account in mental health assessments of native clients and patients. When considering historical trauma, we should be reminded that the Native American Religious Freedom Act was passed only in 1978, meaning that native people in the United States have only legally been able to practice our ceremonial ways for the past 40 years.

Discrimination also contributes to poor mental health outcomes and persists among AI/AN communities. One example is what goes on in many community stores: Native people regularly experience looks of distrust and are followed from aisle to aisle. People from other cultures treat them with disgust and contempt. This is done not only by non-natives but also by those within the tribal community who have become assimilated to the Euro-American philosophy that blood quantum and being enrolled in a tribe is a traditional practice.

Looking at mental health disparities, we must remember to consider cultural differences between patients and providers, diagnostic tools, discrimination, and historical and continued trauma. Although some of these topics are not heard by many, they are important in the holistic care that is needed for tribal communities and members throughout the country. If we all seek true peace in and among all peoples, we must look into the possible future of mankind and the planet but also into the depths of ourselves, which is where our healing begins.

Webinar Recording: The Opioid Crisis and the Electronic Health Record

posted Aug 1, 2018, 11:46 AM by daniel yoo   [ updated Aug 2, 2018, 8:58 AM by Tech Support ]

The HIMSS Opioid Crisis and the Electronic Health Record webinar, sponsored by MEDITECH and recorded on June 28, explored the background and current state of the opioid crisis in the United States.

  • Dr. Upendra Thaker, MD, FIPP, Mount Nittany Medical Center (State College, PA) 
  • Janet Desroche, Associate Vice President, MEDITECH 
The webinar outlined the potential of the electronic health record (EHR) to provide tools that can reduce opioid-related harm and deaths as well as improve the quality of life for patients suffering from substance use disorder (SUD) in alignment with best practices and regulatory requirements. Dr. Thaker provided insights from the practicing physician perspective.

Learning objectives of this webinar: 
  • Understanding of the background that has led to the current opioid crisis in the United States 
  • Understanding of some of the key legislative activities associated with proposed solutions to the opioid crisis, with an emphasis on developments in EHR functionality 
  • Identification of the connection between accepted current best practices for opioid management and the increasing capabilities of EHRs to incorporate these best practices into prescriber workflows 
Access the recording here.

April 5 Webinar Recording and Post-webinar Graphic Report: AI/AN Webinar: Community-Based Participatory Research in Indian Country

posted Mar 28, 2018, 3:59 PM by Tech Support   [ updated Jun 26, 2018, 10:39 AM ]

This webinar focused on community-based participatory research (CBPR) principles to address health disparities among American Indian and Alaska Native communities. A brief overview of CBPR for health promising practices was provided, as were definitions and specific examples of practices associated with outcomes for improving health equity. The presenter discussed the development of CBPR partnerships and shared practices and tools, connecting them to research implementation.

Webinar Recording_Apr5.18_AIAN Behavioral Health Webinar Series_ Community-Based Participatory Research in Indian Country.mp4

In this post-webinar graphic report, we share information about participants' satisfaction with the webinar and its delivery, their ability to apply the webinar’s information to their work, and how they plan to use the information.

To view/download the webinar presentation slides (PDF format) meeting materials, please click on the links below.

Recording Now Available: AI/AN Behavioral Health Webinar: Tackling the Opioid Epidemic in the Chickasaw Nation

posted Jan 31, 2018, 3:43 PM by Tech Support   [ updated Apr 6, 2018, 10:32 AM ]

This webinar highlighted Define Your Direction, a comprehensive prescription opioid abuse prevention movement created by the Chickasaw Nation using Substance Abuse and Mental Health Services Administration (SAMHSA) and Southern Plains Tribal Health Board funding.
Define Your Direction utilizes multiple strategies aimed at increasing awareness, reducing access to drugs and alcohol, and preventing overdose deaths. Focus was on the movement’s various components, challenges experienced during its development and implementation phases, and successes.

MP4 Recording

Webinar Recording_Jan25.18_AIAN Behavioral Health Webinar Series_ Tackling the Opioid Epidemic in the Chickasaw Nation.mp4

ASTHO Webinar: Integrating Health Equity into Funding Opportunity Announcements

posted Jan 24, 2018, 7:19 AM by Tech Support   [ updated Jan 24, 2018, 7:20 AM ]

Date: Tuesday, February 20 
Time: 2 p.m.–3 p.m. EST 

The Association of State and Territorial Health Officials (ASTHO), with support from the HHS Office of Minority Health, will host a webinar for public health professionals involved in programming to advance health equity or in the grant-making process based on its guide for integrating health equity language into funding announcements. 

Objectives for this webinar are to: 
  • Describe federal leadership on state/regional health equity initiatives; 
  • Provide specific examples of how a state health agency has incorporated health equity language into its funding announcements; and 
  • Describe the new tool for health equity developed by ASTHO and the HHS Office of Minority Health. 
For more information and to register:

Wednesday 1/17: Webinar on SAMHSA Grants to Expand Treatment Capacity in Adult Drug and Tribal Healing to Wellness Courts

posted Jan 12, 2018, 12:09 PM by Tech Support   [ updated Jan 12, 2018, 12:11 PM ]

The National Association of Drug Court Professionals (NADCP) and the Substance Abuse and Mental Health Services Administration(SAMHSA) will co-present a free, pre-application webinar to provide more information on and answer questions related to fiscal year 2018 Grants to Expand Substance Abuse Treatment Capacity in Adult Treatment Drug Courts and Adult Tribal Healing to Wellness Courts.

The webinar will take place Wednesday, January 17, 1:30-3:30 pm EST.

The purpose of this program is to expand* substance use disorder (SUD) treatment services in existing adult drug treatment courts and adult tribal healing to wellness courts that use the treatment drug court model in order to provide SUD treatment (including recovery support services, screening, assessment, case management and program coordination) to defendants/offenders.

*Note: These grants apply only to treatment capacity expansion, not enhancement, and include increased funding for recovery housing and medication-assisted treatment (MAT).

Participants must call the number below and log in to the link provided to join the webinar. The dial-in number allows participants to hear the conversation; the web link allows participants to view the PowerPoint.

Dial-in number: 1-877-918-3036
Passcode: 9559891
Web link:
WebEx Required Download: To use WebEx for your operator-assisted conferences, presenters and participants alike must have the WebEx Event Manager installed prior to joining. To download the Event Manager, see the instructions on the WebEx Downloads page.

UIHI/TONL stock photo project tells authentic stories of Native American life

posted Jan 11, 2018, 12:48 PM by Tech Support   [ updated Jan 11, 2018, 12:48 PM ]

On December 26, the Urban Indian Health Institute (UIHI) and TONL debuted “We Exist,” a modern and authentic selection of stock imagery featuring American Indian and Alaska Native (AI/AN) peoples. According UIHI Director Abigail Echo-Hawk, "The need for images accurately representing AI/AN people had been apparent to the UIHI for some time, which is why they partnered with TONL—a stock photography business that is focused on making accessible culturally diverse photos that depict the true narrative of diverse communities. This collaboration was envisioned as a way show the beauty, strength, and diversity of AI/AN peoples, while simultaneously addressing the lack of accurate representation of them in stock images.”

The entire “We Exist” collection is available for purchase at

Register for AI/AN Behavioral Health Webinar: Tackling the Opioid Epidemic in the Chickasaw Nation

posted Dec 7, 2017, 11:53 AM by Tech Support   [ updated Dec 7, 2017, 11:54 AM ]

This one-hour webinar will take place on Thursday, January 25 at 3:00 p.m. EST and will feature Define Your Direction, a comprehensive prescription opioid abuse prevention movement created by the Chickasaw Nation. Learn about the movement’s various components, challenges experienced during its development and implementation phases, and successes.

Learn more and register:

Recording Now Available For the Project Venture – Positive Youth Development for American Indian and Alaska Native (AI/AN) Youth Webinar

posted Sep 25, 2017, 1:40 PM by Tech Support   [ updated Sep 25, 2017, 1:41 PM ]

Watch the latest AI/AN NPA Caucus webinar about Project Venture, an evidence-based intervention, combines traditional native wisdom with positive youth development, social emotional learning, outdoor adventure, and service learning to create a unique approach that has been successful for more than 25 years. The webinar highlights the project’s core elements and guiding principles of this unique, internationally recognized native youth program and assist participants with exploring their readiness to implement it.

View it here:

AI/AN Caucus Member Dr. Joe Coulter explains the crisis of unintended deaths and injuries in Indian Country

posted Jun 8, 2017, 6:45 AM by Tech Support   [ updated Jun 8, 2017, 6:46 AM ]

An Unintended Legacy: Unintentional Injuries are a Leading Cause of Death for American Indian and Alaska Native Populations
By Joe D. Coulter, Ph. D.


It is no secret that American Indian and Alaska Native (AI/AN) populations face unique challenges. Whether it be the extreme remoteness of some tribal lands, the lack of available resources, environmental concerns, or access to adequate healthcare, gaining health equity for AI/AN populations might seem insurmountable. However, given the right amount of focus, resources and involvement from the community, even the most pressing barriers and obstacles to care facing AI/ANs can be addressed – leading to greater health of Native populations.

Among the myriad of challenges faced by American Indians and Alaska Natives, unintentional injuries remains one of the leading causes of death. There are a number of factors that may explain why unintended injuries continue to be a leading cause of death, but the bigger question and the greater challenge is how to reduce unintended deaths and injuries among AI/ANs.

Unintentional Death and Injuries Among the AI/AN Population

For American Indians and Alaska Natives, death and injury rates are staggering compared to those for the non-AI/AN population. For example, while eight percent of the general population will die before they reach 45 years of age, for AI/ANs, that number increases to 25% (one out of four). The sad but true fact is that a quarter of the Native population won’t see their 45th birthday not because of medical, chronic or genetic issues but rather avoidable and preventable unintentional injuries that lead to death. When the data are broken down by age, this is a common trend regardless of which age group is being examined.

Why Unintentional Injuries are So Dangerous

Support for many of the social determinants of health that contribute to a Native person’s overall well-being are lacking for this population. Many factors – such as socioeconomic status, geographic location, access to health care and health services, transportation, nutrition, and lack of physical activity contribute to the problem.

Most Indian tribal lands are located in remote, isolated areas. According to the National Highway Traffic Safety Administration, deaths from car accidents are greater in rural than urban areas. Among AI/AN 19 years old and younger, motor vehicle crashes are the leading cause of unintentional injury-related death, followed by drowning and poisoning.

Being rural alone does not lead to the unintentional death rate crisis that AI/AN people currently face, but it does contribute to another key factor, which is environment. Many tribes and Indian tribal lands are located in areas where the environment can be seen as perilous. Similarly, access to health services is extremely limited in these areas meaning that Native individuals need to travel great distances to receive their medical care. Conversely, medical professionals need to travel great distances to reach those who call for help. Additionally, lack of healthy and/or nutritional options and lack of transportation other than people’s own vehicles exacerbate both the causes of unintentional injuries and death.

What can be Done?

While the statistics paint a bleak picture, there is hope. Although the data on unintentional injury leading to death rates for American Indian and Alaska Natives are striking, they actually show a slight improvement – indicating both the scope of the problem and the fact that small changes, such as education and intervention, can lead to significant improvements. As attention to this issue increases, more solutions can be developed and implemented. By starting with culturally competent, socially acceptable approaches and focusing on each of the aforementioned social determinants, progress can – and will – be made to alleviate the extremely high rates of unintentional injuries and deaths among our Native populations.


Dr. Joe Coulter is Professor Emeritus, College of Public Health, Carver College of Medicine, The University of Iowa, a member of the National Partnership for Action’s (NPA) AI/AN Caucus and an enrolled member of the Potawatomi Tribe.

Author’s note: all statistics come from the HIS report, "Trends in Indian Health: 2014" unless otherwise noted. For more information, the full report can be found here.

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