Transcript The Community Pulling Together A Tribal Community

The Community Pulling Together
A Tribal Community-University Partnership Project to
Reduce Substance Abuse and Promote Good Health in a
Reservation Tribal Community
Dennis M. Donovan, Robin LW. Sigo, Lisa R. Thomas,
C. Truth Griffeth, G. Alan Marlatt, Lisa Jackson
and the Suquamish Tribe
Objectives of Presentation
• Describe strategies for initiating, developing, and
sustaining research partnerships between Tribal
communities and university institutions
• Describe strategies for insuring Tribal oversight of
all research procedures in addition to conventional
university oversight
• Describe strategies for engaging the community
and keeping the community informed of and
involved in the research project
• Describe strategies for incorporating community
wisdom and expertise into research procedures and
the development of interventions
• Describe strategies for respectful dissemination of
project processes and findings
The Healing of the Canoe:
The Community Pulling Together
• Three-year planning and pilot project
• Funded by the National Center on Minority Health
and Health Disparities
• Collaborative project between the Suquamish Tribe
and the Alcohol and Drug Abuse Institute
• Based on community and Tribal traditions and
values
• Uses Community-Based Participatory Research
(CBPR) Methods
• Identify and reduce health disparities and promote
health and wellness
General Principles Guiding the
Tribal Community-University Partnership
• Principles of Community-Based
Participatory Research (CBPR)
• Tribal Participatory Research (TPR) Model
• Principles of Good Community-Campus
Partnerships
Principles of Community-Based
Participatory Research (CBPR)
•
Be conducted in full partnership with the target
community
•
Respond to issues of concern to the target community
•
Address needs of the community
•
Utilize and build on strengths and resources of the
target community
•
Employ interventions and assessment batteries that
are culturally appropriate and relevant
•
Is an iterative process
•
Generate data that not only inform science but also
provide the community with information that can
enhance the community’s ability to more successfully
reduce health disparities and promote health
Viswanathan, et al., 2004
Tribal Participatory Research (TPR) Model
•
•
Tribal oversight of the process and project
– Tribal Council resolutions and research code
– Community advisory council
– Ongoing communication with community
members
Use a cultural facilitator to act as an intermediary
between project staff and the oversight committee,
and to establish a culturally appropriate process for
meetings of community members and researchers
•
Training and employing community members as
project staff
•
Use culturally specific interventions and
assessments that incorporate traditional practices
and concepts
Fisher & Ball, 2002, 2003
Principles of Good Community-Campus
Partnerships
• Partners have agreed upon mission, values, goals,
and measurable outcomes for the partnership.
• The relationship between partners is characterized
by mutual trust, respect, genuineness, and
commitment.
• The partnership builds upon identified strengths
and assets, but also addresses areas that need
improvement.
• The partnership balances power among partners
and enables resources among partners to be
shared.
• There is clear, open and accessible communication
between partners, making it an ongoing priority to
listen to each need, develop a common language,
and validate/clarify the meaning of terms.
Community-Campus Partnerships for Health, 1998
Principles of Good Community-Campus
Partnerships
• Roles, norms, and processes for the partnership are
established with the input and agreement of all
partners.
• There is feedback to, among, and from all
stakeholders in the partnership, with the goal of
continuously improving the partnership and its
outcomes.
• Partners share the credit for the partnership's
accomplishments.
• Partnerships take time to develop and evolve over
time
Community-Campus Partnerships for Health, 1998
Recommendations on Methods/Principles
in Developing Research with AIAN
Communities
Before approaching AIAN communities
• Determine how the potential results of the study will
truly benefit AIAN communities.
• Learn and understand the beliefs, values, traditions,
and culture of the people to ensure that the
proposed study is compatible with that culture.
• Be aware of cultural norms regarding information
that is appropriate to share and that which is not
• Conceive the study as a partnership project
between AIAN communities and investigators.
• Participate in cultural sensitivity workshops or
training to refine intercultural communication skills
and foster respect for cultural diversity.
From Davis & Reid, 1999; Holkup, Tripp-Reimer, Salois, & Weinert, 2004
Recommendations on Methods/Principles
in Developing Research with AIAN
Communities
During negotiations with AIAN communities
• Involve members from AIAN communities in the
development and execution of research efforts.
• Respect different philosophies regarding time and
decision making. Many AIANs do not regard time as
a linear path of progress; some perceive it as a
temporal continuum composed of myth, memory,
and what non-Indians consider reality in which
events cyclically recur. Some cultures reach
decisions by consensus rather than majority.
From Davis & Reid, 1999; Holkup, Tripp-Reimer, Salois, & Weinert, 2004
Recommendations on Methods/Principles in
Developing Research with AIAN Communities
During and after research
• Include in Tribal Council resolution and memorandum of
understanding information regarding shared ownership of all
project materials and data
• Develop a formal process of review by Tribal Council/Advisory
Council for all presentations and publications
• Schedule feedback sessions with community members to
ensure correct collection and interpretation of data and
project evaluation; this is an iterative process.
• Invite AIAN professionals in the field of study or discipline to
participate in peer review.
• Establish with community representatives a value exchange
program for their investment of time, ideas, and knowledge
(eg, skills, employment, training, access to funding, and
mentoring).
From Davis & Reid, 1999; Holkup, Tripp-Reimer, Salois, & Weinert, 2004
How to Assure CBPR – A Combination of
Theory, Practice, and Common Sense
Laying the groundwork
• Be prepared for continued involvement and
potential delays given need to gain entry, trust, and
buy-in
• Be prepared to provide some training with research
institution-based offices regarding CBPR methods
• Be prepared to understand and navigate at least two
cultures, that of the research institution and that of
the community
Memorandum of understanding
• Codifying expectations
• Issues of tribal vs university procedures
How to Assure CBPR – A Combination of
Theory, Practice, and Common Sense
Issues around IRB
• When is research not research?
• Who is a subject?
• Informing/educating IRBs
Dual Review
• Cultural Cooperative review and approval / University
IRB review and approval of all forms, questionnaires, and
procedures
Ethical Issues
• How do you define and insure confidentiality in small,
relatively closed communities?
• How do you define data, and who owns the data? (e.g.
narratives)
• How to manage findings that may cast the community in
a negative light?
How to Assure CBPR – A Combination of
Theory, Practice, and Common Sense
Cross-training
• Something to learn, something to give
• University staff trained in Tribe’s culture, traditions,
and values
• Tribal staff and members trained in research
methods and CBPR
• Developed a list of articles, books, movies, and
other materials
Tribal involvement - what goes around comes around
• Community meetings
• Cultural Coop
• Tribal Council
How to Assure CBPR – A Combination of
Theory, Practice, and Common Sense
Project staffing
• Hire from within the community
• Be sensitive to the multiple roles that communitybased project staff maintain
Key Informant interviews – Who and What
• Who is a key informant and how many do you need?
• What – Tri-Ethnic Center Community Readiness
Community Readiness
Assesses community’s
– Awareness of issues, resources and
potential solutions
– Readiness to engage in change
– Uses key informants in the community
– Questions are adapted to fit the particular
issue(s)
Oetting, E.R., Jumper-Thurman, et al., 2001
Community Readiness
Six domains
– Existing efforts
– Community knowledge of efforts
– Leadership
– Community climate
– Community knowledge of the problem(s)
– Resources available
Oetting, E.R., Jumper-Thurman, et al., 2001
How to Assure CBPR – A Combination of
Theory, Practice, and Common Sense
Focus Groups
Focus group methodologies provide a mechanism
for:
• Exploration of topics of interest
• Clarification of priorities
• Understanding historical and current context
• Development of questionnaires and instruments
while grounding them in the norms, values, and
experiences of the target population or
community
How to Assure CBPR – A Combination of
Theory, Practice, and Common Sense
Conventional focus group methodologies will
be adapted to be culturally appropriate and
respectful, including:
• The structuring of the seating (circle);
• Inclusion of food and "give aways";
• Increasing the length from 1-2 hour to 2-4 to
allow time for prayers, rituals, meals, and
personal narratives; and
• Respecting the sometimes slower,
purposeful tempo of Native interactions.
Strickland, 1999a, 1999b
How to Assure CBPR – A Combination of
Theory, Practice, and Common Sense
How are we doing? The Importance of Feedback
• Be open to input and evaluation
• Be flexible
• Be able to develop commitment, perseverance,
and some ability to tolerate discouragement
• Be willing to adapt as needed
• Formal assessment process
• Assessment instruments for quality of
collaborative relationships and meeting
effectiveness
Using Community-Based Participatory
Methods to Develop / Adapt
a Culturally Sensitive Substance Abuse
Prevention Intervention for Tribal Youth
Manyhands by Roy Henry Vickers
"I'm an alcoholic in recovery. I went to a
medicine man to learn our ancient ways
of sobriety, which connected me to the
old ways of being spiritual, and that led
me to the canoe which is a sacred part of
who we are."
Native artist Roy Henry Vickers, WaveLength Magazine, February - March 2003
Tuesday, July 29, 2003
A Journey toward Healing, by Canoe
Tribes gather after traditional canoe trip for
ceremonies,
circles to promote clean living
By LEWIS KAMB
SEATTLE POST-INTELLIGENCER REPORTER
Through last night and all of this week, the canoe journey's
celebration continues under a theme of
"Healing Through Unity"
during a series of ceremonies and counseling
"circles" that bring tribal elders, parents and
youths together seeking to heal common
ailments of drug and alcohol abuse.
"The 'journey' is an opportunity to teach prevention
through our culture," explained Herman Williams Jr., tribal
council chairman of the hosting Tulalip Tribes. "It brings
self-esteem and reminds us all where we come from."
Seattle Post-Intelligencer, Tuesday, July 29, 2003
A journey toward healing, by canoe
CANOE JOURNEY / LIFE’S JOURNEY
• An 8-session life skills curriculum based on the
Canoe Journey
• Developed for an urban AIAN population
• To prevent the initiation of substance use and
promote abstinence
• To reduce the risk of harm and the potential for
developing an addiction
• To help Native youth identify and utilize healthy and
appropriate social skills and lifestyle choices
LaMarr & Marlatt, 2002; Marlatt et al., 2003
CANOE JOURNEY / LIFE’S JOURNEY
• Addresses interpersonal and
intrapersonal life skills
• Culturally grounded
• Uses of culturally appropriate
metaphor
• Adaptable to other communities
• Incorporates feedback from focus
groups
LaMarr & Marlatt, 2002; Marlatt et al., 2003
CANOE JOURNEY / LIFE’S JOURNEY
Cultural Grounding
•
•
•
•
•
•
•
•
•
Appropriate, meaningful, relevant, and respectful
Utilizes CBPR
Utilizes community experts
Incorporates community values and context
Community Advisory Council
Key informants, community stakeholders
Focus groups
Cultural auditing
Collaboration
CANOE JOURNEY / LIFE’S JOURNEY
Adaptation of the Intervention
• Adaptation and/or development of culturallygrounded best practices with extensive and
consistent community input
• CBPR methods
– Cultural grounding
– Community experts
– Community Advisory Council
– Key Informants and Stakeholders
– Focus Groups