ABA and Cultural adaptation of Native Americans

American Indians and Alaska Natives (AI/ANs) are citizens of autonomous tribal lands and comprise 5.2million of the U.S. population (U.S. Department of Commerce, 2012) who have gone through genocide, involuntary assimilation, and replacement by colonizers. AI/Ans had to give their lands to the U.S. in exchange to U.S. promise to provide these tribes with decent health care, but till nowadays the promises have not been kept at full. (Greenfield et al, 2013).

            Mental health is one of several burning problems that should be solved in these regions, and cultural adaptations of evidence-based treatments (EBTs) is doing a lot in realizing this goal. Greenfield et al (2013) explains that cultural adaptation assumes “the systematic modification of an EBT or intervention protocol to consider language, culture, and context in such a way that it is compatible with the client’s cultural patterns, meanings, and values.”  They also add that cultural adaptations also presume changes in treatment processes such as additions or removals of treatment elements, changes in the amount of treatment, translation or use of local language and cultural dialects. Local researchers admit that “returning to indigenous ways of knowing and traditional healing practices may be an effective solution to mental health problems,” though they do not exclude other interventions in partnership with AI/AN which also may be very effective in healing  (Greenfield et al, 2013).  With that adaptation of EBTs should be regular, logical, very much careful, and concentrating only on the regions where the therapist will detect a real disparity between a certain EBT and an ethnocultural community.

           Native Americans is the population which combines numerous cultures, but there are some concepts which should certainly be mentioned in the adaptation of EBTs for native peoples.  These concepts comprise “collectivism or interdependence, respect for elders, importance of spirituality, and respect for nature.” There also exist a variety of examples in the level and types of adaptations concerning mental health problems. For example, Cultural Adaptations Suicide prevention. According to the 2009 statistics, an annual suicide attempt occurrence rate among young Apache was 17 times higher than the average. Yet, Apache surveillance statistics informs that only one-quarter of the young self- murders asked for psychological help, and only one-third of them came to the first session. So, an Emergency Department (ED)intervention has chosen  the White Mountain Apache (Apache) and Johns Hopkins Center for American Indian as the pace where these people were planned to get psychological rehabilitation because the practice in these facilities were known as evidence-based, short-term, delivering  best immediate coping skills post-attempt,  helping the youth who was seeking connections to available care in order not to stop the care (Greenfield et al., 2013). The treatment course also comprised a training workshop for ED providers, a videotape aimed at modifying families’ treatment expectations, and an on-call therapist. The community Advisory Board also adapted a new intervention, named New Hope, which concentrates on the problems connected with treatment initiation barriers and treatment adherence, reduces risk of suicide  and promotes safety, comprising emotion regulation, mental reformation, seeking social support, etc.

            Substance use disorder treatment is another example of Cultural Adaptation.  In 2007, the principal investigator initiated a meeting with one of the tribal committees to get an approval to perform an RCT (randomized controlled trial) of the two EBTs with the aim to compare their treatment with a usual one. The goal of this trial was to widen the EBTs practice by including its social forces such as discrimination and spirituality. The adaptation attempts in this case were concentrated on the assessment and clinical methods as well as the formation of vitally important specific skills, such as drug refusal. It was a pilot of 8 participants who finished the 16-week course of therapy and 4- and 8-month follow-ups and showed substantial advancements in percent days sober from alcohol and drugs.
Usually such trial has in mind mostly individuals, but for such special tribes as Native Americans who possess strong group identity, it was important to evaluate such a group quality as being particularly noticeable or important, and to assess for social factors such as discrimination, oppression, and poverty that may affect their “behavioral health.” Given the fact that most of the Native American population is poor, the trial included the parameters such as annual income, level of education, and employment status, as well as the absence of spirituality (after consulting tribal religious leaders and tribal council). Because the counselors are from this community, the EBTs will be evaluated positive when the grant funding will be needed again.

 References

Greenfield, B, Skewes, M.C, Dionne, R. Davis, B., Cwik, K, Venner, K, & Belcourt-Dittloff, A. 2013. Treatment for American Indians and Alaska Natives: Considering Cultural Adaptations.