As evidenced in the literature, it is clear that Native American children experience more Adverse Childhood Experiences than other groups, including non-Hispanic whites [1]. Native American children are more than twice as likely to grow up in a household where one or both parents use drugs and/ or alcohol [1]. Additionally, NA children are more than three times as likely to have lived with a parent who has been incarcerated, and are seven times as likely to have been treated unfairly due to ethnicity [1]. As one of the most historically oppressed peoples in the United States, change is the only agent to ameliorate the social and health disparities experienced by the Native American community. Action must be taken to design and implement a trauma-informed and resilience-based community intervention for the Native American (NA) community. Specifically, the discussed intervention will target NA residents of Taos, New Mexico; furthermore, the intervention will target NA’s living in the Taos township rather than on tribal lands. The program’s intervention has three main components: (1) substance abuse education (2) community unification (3) health outreach. The intervention staff will work with Taos County public school faculty to provide training on NA knowledge and sensitivity, provide seminars for substance abuse awareness, and to continually act as confidants for school-age NA children. Additionally, the intervention will establish a community action council that will enable the NA community to have more power to achieve their desires. Finally, a mobile health outreach clinic will oversee treatment of NA’s to provide free primary and preventative healthcare services.
The proposed program will use trauma-informed care principles to most efficaciously deliver the intervention to the NA community. Specifically, the principles of peer support and self-help, cultural and historical issues, and trustworthiness and transparency will be utilized [2]. Peer support and mutual self-help allow a community’s members to reach out to each other and assisting organizations so that community members can be unified over past experiences [2]. A background in the historical and cultural issues affecting the NA population will allow the program to be sensitive to the NA community’s unique cultural attributes. The principle of trustworthiness and transparency will aim to inform community stakeholders of all objectives and goals for the community so that trust can be formed between the outside organization and the community.
The intervention aims to positively affect three levels of the Social Ecological Model: the individual, relationships, and community levels. At the individual level, the intervention proposed will benefit a person’s individual attributes by changing their attitudes and beliefs about substance use and ways of solving problems at home. Furthermore, individuals participating in the program will experience an increased level of perceived control in their lives stemming from the additional mechanisms provided through community unification. At the relationship level, the amelioration of substance abuse and social transience in the NA community will strengthen bonds among community members. Furthermore, the unification of community members through the establishment of a council will act as a protective measure against relationship adversities and peer pressure. At the community level, the establishment of a community council will provide both resilience and unification in the community, also having a downstream effect on other ecological levels.
Additionally, the proposed program and its intervention must be designed in the perspective of a public health framework for efficacy in resolving both social and health disparities in the NA community. A combination of trauma-informed legislation regarding the resolution of social disputes without law-enforcement intervention along with secondary prevention provided by the mobile outreach component of the intervention will protect and aid the NA community in Taos from the public health perspective. Involving a community stakeholder to resolve disputes creates a stable channel for the resolution of social adversities; the mobile health clinic will provide care to the NA community in the context of a public health framework by providing secondary intervention services such as screening of at risk groups and maternal health services. This combinations of actions would allow not only for a decrease in the incidence of incarceration, but a foundational step in restoring the social and physical health of the NA community.
The combination of all the program’s components, an approach rooted in trauma-informed care and public health, and the consideration of multiple ecological levels sets this intervention in an excellent position to positively affect the NA community in Taos, New Mexico, and ultimately remedy the disparities caused by the significant historical trauma in their past.
References
[1] Kenney, M. K., & Singh, G. K. (2016). Adverse Childhood Experiences among American Indian/Alaska Native Children: The 2011-2012 National Survey of Children's Health. Scientifica, 2016, 7424239.
[2] SAMHSA. (2014). SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach. Retrieved from https://store.samhsa.gov/system/files/sma14-4884.pdf
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