Indigenous Models of Evidence. Based Practice Oregon’s Tribal Best Practices Initiative 3/16/2018 Indigenous Evidence-Based Practice 1
Presenters One Sky Center DHS/AMH • • Douglas A Bigelow, Ph. D R. Dale Walker, MD, (Cherokee) Michelle J. Singer, BA (Navajo) • • Caroline M. Cruz, BS, CPM (Warm Springs) John Spence, MSW, Ph. D (Gros Ventre) Jason Yarmer, BS, CPS (Chippewa) The Nine Tribes of Oregon • Burns Paiute Tribe • Cow Creek Band Of Umpqua Indians • Confederated Tribes Of Coos, Lower • Umpqua & Siuslaw • Confederated Tribes Of Grand Ronde 3/16/2018 • Coquille Indian Tribe • Klamath Tribes • Confederated Tribes Of Siletz • Confederated Tribes Of Warm Springs • Confederated Tribes Of Umatilla Indigenous Evidence-Based Practice 2
The Scenario • Mandate: Evidence-based Practices • Problem: bad fit of EBP in Indian Country • Response: Tribal Best Practices Initiative 1. Understand Culture-Based Practice 2. Design Tribal Best Practice Process 3. Implement TBP Initiative 3/16/2018 Indigenous Evidence-Based Practice 4
Government Office of Money In God we trust, …others please provide Evidence! 3/16/2018 Indigenous Evidence-Based Practice 5
THE EVIDENCE-BASED PRACTICE MOVEMENT 3/16/2018 Indigenous Evidence-Based Practice 6
The EBP Movement Matures • What EBM is, and what it isn’t (BMJ) – Expertise plus research • Multiple streams of evidence (COCE/SAMHSA) – Experience + client factors + research • Learning healthcare system (IOM) – Continually increasing knowledge and skill • Best Practices = – Science + Service+ Indigenous knowledge 3/16/2018 Indigenous Evidence-Based Practice 15
Evaluability • Program planning and evaluation – (repertoire of techniques) • Program theory and clarification • Input-process-outcome • The Logic Model 3/16/2018 Indigenous Evidence-Based Practice 17
SERVICE TO SCIENCE: WHAT SERVICE KNOWS BEST 3/16/2018 Indigenous Evidence-Based Practice 19
Service-Based Knowledge Addresses Critical Context • Rural vs. urban setting • Resources (electricity; water) • • Physical condition of participants Spiritually- vs. materially-oriented participants Belief of personnel • Context and culture 3/16/2018 Indigenous Evidence-Based Practice 20
Service-Based Knowledge Addresses Crucial Behavioral Health Variables • Choice • Self-healing belief guided by expert healer • Unique interpersonal relationships • Complex webs of inter-related and reciprocal factors 3/16/2018 Indigenous Evidence-Based Practice 21
Service-Based Evidence: The Refinement Process • Assembled experts • Published research • Practice experiences • Debate quality and meaning of info • Formal consensus process: conclusions 3/16/2018 Indigenous Evidence-Based Practice 22
Service-Based Evidence: Dissemination • Guidelines • Standards • Resource materials • Strategic plans • College curricula, courses, texts 3/16/2018 Indigenous Evidence-Based Practice 23
CULTURE-BASED EVIDENCE 3/16/2018 Indigenous Evidence-Based Practice 24
Why Understand Epistemology of Culture-Based Practices? • • • Develop new CBP Validate proposed CBP Culturally appropriate tests of what works Cross-walk to EBP and PBP Disseminate and improve CBP Empower indigenous knowledge 3/16/2018 Indigenous Evidence-Based Practice 25
Culture-Based Prevention & Treatment: Activities • Experience, observation, listening, participating • Traditions, ceremonies, daily observances • Stories, songs, artwork • Oral, modeling, practice, animation • Language, worldview, teachings, experience 3/16/2018 Indigenous Evidence-Based Practice 26
Culture-Based Health Practices: Materials • Settings • Dress; Regalia • Symbols; Graphics; Pictures • Sensory Substances • Food • Fun 3/16/2018 Indigenous Evidence-Based Practice 27
Culture-Based Health Practices: Personnel • • Enthusiasm, confidence Caring, compassion Vision, knowledge Charisma Credibility Community status Peer group status 3/16/2018 Indigenous Evidence-Based Practice 28
Indigenous Health Practices: Immediate (Proximal) Outcomes • Balance • Connection – family, culture, community, natural world, spiritual world • • • Identity Meaning Power and hope Self-esteem Community norms, adaptive capacity, sharing and support 3/16/2018 Indigenous Evidence-Based Practice 29
Indigenous Health Practices: Distal Outcomes (NOMS) • • Reduced morbidity; mortality Social participation Reduced ATOD Employment; education Well-functioning families Reduced criminality Mental health 3/16/2018 Indigenous Evidence-Based Practice 30
THE OREGON TRIBAL BEST PRACTICES INITIATIVE 3/16/2018 Indigenous Evidence-Based Practice 31
Problem with the EBP Mandate • Developer training & fidelity testing: alien • “Core components” concept: not adaptable • Exogenous programming: not credible • Loss of the familiar and accepted • Personnel, training, and testing capacity: non-extant • Versus sovereignty and consultation 3/16/2018 Indigenous Evidence-Based Practice 32
Items Described for Tribal Best Practice • • • Replications Culture-based Evidence Goals Target population Risk and protective factors 3/16/2018 • • • Tribal personnel Activities Materials Optional Elements Outcomes Indigenous Evidence-Based Practice 33
Evidence for Validity of TBP Criteria • • Longevity Teachings (based on) Values (based on; incorporated) Principles (based on; incorporated) Elder’s approval Community feedback/evaluation/acceptance Contribution to advancement of the people 3/16/2018 Indigenous Evidence-Based Practice 34
Tribal Best Practices Under Review • • • Horse Program Storytelling Basketball Against Alcohol and Drugs (BAAD) Elder-based Family Mediation Cultural Sobriety Recognition Dinner Powwow 3/16/2018 Indigenous Evidence-Based Practice 35
Horse Program Cultural Evidence: Longevity of the Practice • Role of horses stretches back several hundred years • Tribal stories; old pictures of Native Americans and horses; use by plains Indians for hunting, transportation and warfare 3/16/2018 Indigenous Evidence-Based Practice 36
Horse Program Cultural Evidence: Teachings • Native Americans learned from animals; animal characters used as teaching tools 3/16/2018 Indigenous Evidence-Based Practice 37
Horse Program Cultural Evidence: Values • • • Respect Patience Personal responsibility Generosity Communication 3/16/2018 Indigenous Evidence-Based Practice 38
Horse Program Cultural Evidence: Principles • • • Mentoring Relating with the natural world Commitment to others Leadership skills Being compassionate Calmness and self-control in presence of greater power 3/16/2018 Indigenous Evidence-Based Practice 39
Horse Program Cultural Evidence: Elders’ Approval 3/16/2018 Indigenous Evidence-Based Practice 40
Horse Program Cultural Evidence: Community feedback/acceptance • • Individual stories of youth and family Tribes requesting program Tribal satisfaction survey Feedback from referring agent 3/16/2018 Indigenous Evidence-Based Practice 41
Horse Program Replications • Equine assisted psychotherapy (www. eagla. org) • Mustangs offering hope and renewal (www. charityblosson. org ) • Tribal horse programs in three other locations in OR. 3/16/2018 Indigenous Evidence-Based Practice 42
Horse Program Goals • • Criminal behaviors reduced Mental health problems reduced Suicide ideation and attempts reduced School tenure and academic improvement 3/16/2018 Indigenous Evidence-Based Practice 43
Horse Program Risk and Protective Factors Drug free activity Involvement in cultural practice Bonding and positive relationships Re-uniting with family Learned patience, respect, personal responsibility • Academic progress • Recognition • • • 3/16/2018 Indigenous Evidence-Based Practice 44
Horse Program Personnel • Named, passionate program advocate, promoter, and implementer • Named individuals trained and experienced with horses 3/16/2018 Indigenous Evidence-Based Practice 45
Horse Program Key Elements (Activities) • • • Obtain tribal buy-in Obtain referrals and subject’s buy-in Incorporate into summer tribal camp Teach horsemanship Conduct ceremonies 3/16/2018 Indigenous Evidence-Based Practice 46
Horse Program Logic Model Materials • • • Special horses Water, feed, and grain Corrals, tack, and equipment Covered arena (preferred) Round pen 3/16/2018 Indigenous Evidence-Based Practice 47
Horse Program Logic Model Outcomes Decrease/Increase(NOMS) Specific Indicator Avoidable death/Longevity na Morbidity/health na Disability/ability Skill; leadership; responsibility; cooperation Suffering/well-being Feel good about self & life Isolation/connectedness Involved in community; bonded to role models Substance abuse/non-harmful or no use Reduced use 3/16/2018 Indigenous Evidence-Based Practice 48
Horse Program Logic Model Outcomes Decrease/Increase Specific Indicator Unemployed/employed Prevocational skills; communication; work ethic; marketable skills Education failure/success Academic motivation Dysfunctional/healthy family Family re-unification; de-stressed family Delinquency/good behavior Not violating probation; better citizenship Homelessness/stability na Bad/ Healthy attitude, beliefs, lifestyle Feels better; feels responsible; feels cooperative 3/16/2018 Indigenous Evidence-Based Practice 49
Vision Practice Best Practice Science 3/16/2018 Culture Indigenous Evidence-Based Practice 50
Lessons Learned: Plan for Advancing Culture-Based Practices Objective Action • Develop a logic model • TPB form, suggestions, and instructions in logic model format • Understand evaluability • Increasing commitment to evaluation 3/16/2018 • Goals, activities, and outcomes in measurable terms • Participation of Tribes in conceptualizing TBP in both CB and evaluable terms Indigenous Evidence-Based Practice 51
Скачать презентацию Indigenous Models of Evidence Based Practice Oregon s Tribal
0f0b0cd60eee68aa4fa82e4633a8a52d.ppt