Gerald V. Mohatt

Counseling Intervention and American Indian Tradition An Integrative Approach

The training of American Indian counseling and community psychologists should move away from conventional counseling tenets toward the use of culturally sensitive mental health approaches that maintain American Indian values. In this article, unique American Indian social and psychological perspectives concerning the process and theory of counseling are contrasted with the individualistic focus, style, and outcomes of therapy as practiced in America today. Empirical studies are reviewed concerning the role of social influences in the counseling process as perceived by American Indians and the types of problems Indians present in counseling. The under use of mental health services by American Indian is is associated with the tension surrounding power differentials in counseling relationships and perceived conflicting goals for acculturation between counselors and Indian clients. In addition, three types of psychological intervention-social learning, behavioral, and network -are reviewed and summarized for their contributions and implications for training counselors in effective mental health service delivery with American Indians.

Unheard Alaska: culturally anchored participatory action research on sobriety with Alaska Natives.

Alcohol research in Alaska Native communities has a contentious history. This project has attempted to address a critical need for research to guide alcohol abuse prevention and treatment with Alaska Natives using culturally anchored participatory action research. The process of grounding the research methodology in the culture and community is described, along with its contribution to community psychologys understanding of the importance of cultural factors. Tensions between indigenous values and ways of knowing, and Western research methodologies are delineated, along with how these tensions were resolved. Important issues that arose in doing culturally anchored participatory action research are described. These included the development of a community of inquiry, key methodological decisions, the empowerment of participants as coresearchers, and flexibility in research implementation.

The tools to understand: community as co-researcher on culture-specific protective factors for Alaska Natives.

SUMMARY A collaborative research process engaging Alaska Native communities in the study of protective factors in Alaska Native sobriety and the design of a preventative intervention using its findings is described. Study 1 was discovery oriented qualitative research whose objectives were identification of protective factors and development of a heuristic model. Study 2 involved quantitative survey methods to develop and test a measure of protective factors identified by the qualitative study. Empirical data from these studies is presented, and the role of Alaska Native co-researchers who did not possess specialist research training is described in the design and implementation of the study, interpretation of findings, and design of the intervention model and tools. Benefits that emerged from co-researcher involvement in this process, to the community and to the co-researchers themselves, are described.

Tied together like a woven hat: Protective pathways to Alaska native sobriety

BackgroundThe People Awakening Project (1RO1 AA 11446-03) had two purposes, completed in Phase I and Phase II of the project. The purpose of Phase I was to complete a qualitative study; the research objective was discovery oriented with the specific aim of identification of protective and recovery factors in Alaska Native sobriety. Results were used to develop a heuristic model of protective and recovery factors, and measures based on these factors. The research objective of Phase II was to pilot these measures and provide initial validity data.MethodsPhase I utilized a life history methodology. People Awakening interviewed a convenience sample of 101 Alaska Natives who had either recovered from alcoholism (n = 58) or never had a drinking problem (n = 43). This later group included both lifetime abstainers (LAs) and non-problem drinkers (NPs). Life histories were transcribed and analyzed using grounded theory and consensual data analytic procedures within a participatory action research framework. Analyses were utilized to generate heuristic models of protection and recovery from alcohol abuse among Alaska Natives.ResultsAnalyses generated a heuristic model of protective factors from alcohol abuse. The resulting multilevel and multi-factorial model describes interactive and reciprocal influences of (a) individual, family, and community characteristics; (b) trauma and the individual and contextual response to trauma, (c) experimental substance use and the persons social environment; and (d) reflective processes associated with a turning point, or a life decision regarding sobriety. The importance of cultural factors mediating all these protective processes is emphasized. For NPs, the resilience process drew from personal stores of self-confidence, self-efficacy, and self-mastery that derived from ability to successfully maneuver within stressful or potentially traumatizing environments. In contrast, for many LAs, efficacy was instead described in more socially embedded terms better understood as communal mastery. One style of mastery is more associated with individualistic orientations, the other with more collectivistic. Future research is needed regarding the generalizeability of this group difference.ConclusionsResults suggest that preventative interventions should focus on intervening simultaneously at the community, family, and individual levels to build resilience and protective factors at each level. Of particular importance is the building of reflexivity along with other cognitive processes that allow the individual to think through problems and to reach a life decision to not abuse alcohol.

SUICIDE PREVENTION AS A COMMUNITY DEVELOPMENT PROCESS: UNDERSTANDING CIRCUMPOLAR YOUTH SUICIDE PREVENTION THROUGH COMMUNITY LEVEL OUTCOMES

Abstract Objectives. Community-based models have become increasingly prominent in prevention, and have special relevance for suicide prevention in circumpolar Indigenous communities. It follows that outcomes from circumpolar suicide prevention programs might be more completely understood at the community level. We present here a methodology for analysis at this level. This paper seeks to understand a cultural prevention program for rural Yup’ik youth in Alaska targeting suicide and co-occurring alcohol abuse as a community development process through changes at the community level. Study Design. Quasi-experimental design with assessment at pre-and post-intervention or at 4 time points. The community development process for this project began in October 2004. The first program baseline assessment began in November 2006, prior to prevention activities with youth and parents, and the post-intervention assessment concluded in March 2008. Methods. Five key informants pre-and post-intervention completed a community readiness assessment, which is a structured procedure assessing a community’s awareness of suicide as an issue and its organizational readiness for prevention programming. Forty-three adult caregivers or sponsors of youth in the prevention program completed an assessment of behaviours that contributed to community protective factors from youth suicide and alcohol abuse at 4 time points before, during and after the intervention. The 54 youth who participated in the prevention program completed an assessment of community protective factors, also at 4 time points before, during and after the intervention. The community protective factors from suicide that were assessed included safety, enforcement of alcohol prohibitions, role models, support and opportunities for youth. Results. Community readiness for the prevention efforts increased to new developmental stages of readiness post-intervention, and a trend in the data suggested community protective factors increased in the amount of protective behaviours performed by adults (slope estimate=0.0162, 95% CI-0.0028–0.0351, d=.55) and in the perceptions of youth (slope estimate=0.0148, 95% CI-0.0004–0.0291, d=.45), in a dose response relationship to the number of prevention program sessions attended by adults and youth. Conclusions. Using data from a feasibility study, this paper demonstrates the feasibility and potential utility of methodological approaches that use community-level variables beyond individual level outcomes in circumpolar suicide prevention research.

Stress, coping, and well-being among the Yup`ik of the Yukon-Kuskokwim Delta: the role of enculturation and acculturation

Objectives. To report on the relationships between cultural identity and stress, coping, and psychological well-being in Yup`ik communities. Study Design. A quantitative self-administered questionnaire. Methods. A health and wellness survey was completed by a total of 488 Yup`ik participants (284 women and 204 men) from 6 rural villages in the Yukon-Kuskokwim Delta region. Respondents were fairly equally distributed across an age range of 14 to 94 (mean +/- SD = 38.50 +/- 17.18). Results. Participants who reported living more of a Kass`aq way of life (greater acculturation) reported experiencing greater psychosocial stress, less happiness, and greater use of drugs and alcohol to cope with stress. Participants who reported identifying more with a traditional Yup`ik way of life reported greater happiness, more frequent use of religion and spirituality to cope with stress, and less frequent use of drugs and alcohol to cope with stress. Conclusions. In conjunction with previous research, the data strongly indicates that in general, Yup`ik people in the Y-K Delta tend to associate stress and negative health outcomes with the process of acculturation, and health and healing with the process of enculturation. Research that focuses on documenting the intrinsic strengths of indigenous worldviews may contribute to positive transformations in community health.

Sharing results from complex disease genetics studies: a community based participatory research approach

Objectives. Dissemination of research results to communities builds capacity of the community to understand and utilize the results. The objective of this manuscript was to propose a culturally appropriate approach to disseminate complex disease genetics research findings in small Alaska Native communities. Study Design. The Center for Alaska Native Health Research is a community-based participatory research project (CBPR) directed at understanding the interactions between genetic, nutritional and psychosocial risk factors for obesity, diabetes, and cardiovascular disease in Yup`ik Eskimos. Methods. We have consulted with regional healthcare providers, tribal leaders, and university-, local-, and national-institutional review boards to identify potential mechanisms for sharing population-based genetics research results or progress. Results. We propose a six step CBPR-approach to conducting genetics research in isolated identifiable communities. This CPBR-approach includes generating a common research question, determining community interest, recruitment, capacity building, sharing power and control, avoiding group harm, and development of culturally appropriate dissemination procedures. Conclusions. Research scientists and community members should both benefit from population-based genetics research. Although we are just beginning our discussions with regard to sharing genetics research progress and findings, we believe that it is essential move forward as co-researchers in the CBPR enterprise.

Suicide and alcohol-related disorders in the U.S. Arctic: boosting research to address a primary determinant of health disparities

Objectives. To review the existing epidemiological literature on suicide and alcohol-related disorders and their social determinants in the U.S. Arctic, as it relates to U.S. government research and evaluation efforts, and to offer recommendations to boost research capacity in the U.S. Arctic and collaborations across the circumpolar Arctic as part of global health initiatives. Study design. Synthetic literature review. Methods. Published literature; federal and state reports on suicide and alcohol-related disorders; and federal databases on research and program evaluation in the U.S Arctic were reviewed, with a focus on epidemiological trends over the past 50 years. Results. Suicide and alcohol-related disorders play a significant role in health disparities in the U.S. Arctic, with evidence of a disturbing prevalence trend over the past 50 years. Important variations exist in suicide rates across different regions of Alaska with different majority populations of Alaska Native cultural groups — and, in selected key instances, within these regions — with immense implications for guiding effective prevention efforts. Consequences of alcohol abuse are severe and particularly significant in their impact upon Alaska Native people. Health-related conditions associated with alcohol abuse are among the leading causes of mortality. Conclusions. Recommendations to boost research capacity in behavioural health in the U.S. Arctic are offered, specifically on strategies and methods of inquiry and analysis; distinctions between populations and communities in rural circumpolar contexts; and future epidemiological and implementation research.

People Awakening: Collaborative Research to Develop Cultural Strategies for Prevention in Community Intervention

The consequences of alcohol use disorder (AUD) and suicide create immense health disparities among Alaska Native people. The People Awakening project is a long-term collaboration between Alaska Native (AN) communities and university researchers seeking to foster health equity through development of positive solutions to these disparities. These efforts initiated a research relationship that identified individual, family, and community protective factors from AUD and suicide. AN co-researchers next expressed interest in translating these findings into intervention. This led to development of a strengths-based community intervention that is the focus of the special issue. The intervention builds these protective factors to prevent AUD and suicide risk within AN youth, and their families and communities. This review provides a critical examination of existing literature and a brief history of work leading to the intervention research. These work efforts portray a shared commitment of university researchers and community members to function as co-researchers, and to conduct research in accord with local Yup’ik cultural values. This imperative allowed the team to navigate several tensions we locate in a convergence of historical and contemporary ecological contextual factors inherent in AN tribal communities with countervailing constraints imposed by Western science.

A Protective Factors Model for Alcohol Abuse and Suicide Prevention Among Alaska Native Youth

AbstractThis study provides an empirical test of a culturally grounded theoretical model for prevention of alcohol abuse and suicide risk with Alaska Native youth, using a promising set of culturally appropriate measures for the study of the process of change and outcome. This model is derived from qualitative work that generated an heuristic model of protective factors from alcohol (Allen et al. in J Prev Interv Commun 32:41–59, 2006; Mohatt et al. in Am J Commun Psychol 33:263–273, 2004a; Harm Reduct 1, 2004b). Participants included 413 rural Alaska Native youth ages 12–18 who assisted in testing a predictive model of Reasons for Life and Reflective Processes about alcohol abuse consequences as co-occurring outcomes. Specific individual, family, peer, and community level protective factor variables predicted these outcomes. Results suggest prominent roles for these predictor variables as intermediate prevention strategy target variables in a theoretical model for a multilevel intervention. The model guides understanding of underlying change processes in an intervention to increase the ultimate outcome variables of Reasons for Life and Reflective Processes regarding the consequences of alcohol abuse.