American Indian and Alaska Native (AI/AN) youth face disproportionate challenges related to mental health, substance use, and intergenerational trauma. These challenges are compounded by historical and colonial oppression, systemic inequities, and cultural disconnection. In response, researchers and clinicians have developed culturally adapted family therapy models that integrate traditional AI/AN values with evidence-based practices. This article examines three such interventions: the Thiwáhe Gluwáš’akapi Program, the Our Life intervention, and Honoring Children, Mending the Circle (HC-MC).
- Thiwáhe Gluwáš’akapi Program: Strengthening Families Through Cultural Integration
The Thiwáhe Gluwáš’akapi Program, meaning “sacred home in which family is made strong,” is a culturally adapted version of the Strengthening Families Program for Parents and Youth 10–14. Developed for a Northern Plains reservation community, this program embeds cultural kinship teachings and aligns content with local traditions. Using a community-based participatory research approach, the program addresses early substance use prevention among AI youth.
Pre- and post-intervention assessments revealed significant improvements in parental communication about substance use, youth resistance skills, stress management, family cohesion, and overall well-being. Adults reported enhancements in parenting behaviors and family dynamics. These findings suggest that culturally grounded adaptations of evidence-based programs can effectively address substance use risks among AI families by reinforcing modifiable protective factors.
Reference: Asdigian NL, Tuitt N, Mousseau AC, Ivanich JD, Schultz K, Keane EM, Zacher T, Skinner L, Richards FRW, Bear Robe L, Whitesell NR. Grounding evidence-based prevention within cultural context: promising effects of substance use prevention adapted for American Indian families. Subst Use Misuse. 2023;58(8):1004-1013. doi: 10.1080/10826084.2023.2201847. Epub 2023 Apr 26. PMID: 37125477; PMCID: PMC10259753.
- Our Life Intervention: Healing Historical Trauma Through Family Engagement
The Our Life intervention is a six-month, community-based program developed through a partnership between university researchers and AI tribal members. It aims to promote mental health among AI youth and their families by addressing root causes of violence, trauma, and substance abuse. The intervention comprises four components: recognizing and healing historical trauma, reconnecting to traditional culture, parenting and social skill-building, and strengthening family relationships through equine-assisted activities.
Feasibility and acceptability studies indicated that while engagement and retention posed challenges, participating youth experienced significant increases in cultural identity, self-esteem, positive coping strategies, quality of life, and social adjustment. Qualitative data supported these findings, highlighting the importance of cultural reconnection and family involvement in therapeutic processes.
Reference: Goodkind J, LaNoue M, Lee C, Freeland L, Freund R. Feasibility, Acceptability, and Initial Findings from a Community-Based Cultural Mental Health Intervention for American Indian Youth and Their Families. J Community Psychol. 2012 May 1;40(4):381-405. doi: 10.1002/jcop.20517. PMID: 25414529; PMCID: PMC4235231.
- Honoring Children, Mending the Circle: Adapting Trauma-Focused Cognitive Behavioral Therapy
Honoring Children, Mending the Circle (HC-MC) is an adaptation of trauma-focused cognitive behavioral therapy (TF-CBT) tailored for AI/AN children. Developed by the Indian Country Child Trauma Center, HC-MC integrates AI/AN traditional teachings with cognitive-behavioral methods to address the unique cultural and spiritual needs of AI/AN youth who have experienced trauma.
The HC-MC model guides the therapeutic process by incorporating traditional AI/AN beliefs and practices, such as storytelling, rituals, and the use of cultural symbols, into the standard TF-CBT framework. This integration aims to enhance engagement and effectiveness by aligning therapy with the cultural values and worldviews of AI/AN communities. While empirical evaluations are ongoing, preliminary case illustrations demonstrate the model’s potential in promoting healing among AI/AN children.
Reference: BigFoot DS, Schmidt SR. Honoring children, mending the circle: cultural adaptation of trauma-focused cognitive-behavioral therapy for American Indian and Alaska native children. J Clin Psychol. 2010 Aug;66(8):847-56. doi: 10.1002/jclp.20707. PMID: 20549679.
Conclusion
Culturally adapted family therapies for AI/AN youth demonstrate the importance of integrating traditional values and practices into evidence-based interventions. Programs like the Thiwáhe Gluwáš’akapi Program, Our Life intervention, and HC-MC highlight the effectiveness of culturally grounded approaches in addressing mental health and substance use challenges within AI/AN communities. These models underscore the necessity for healthcare providers and therapists to engage with AI/AN cultural frameworks, ensuring that interventions are respectful, relevant, and responsive to the unique needs of AI/AN youth and their families.
AUTHOR:
Shawn Singh Sidhu, MD, DFAPA, DFAACAP
Co-Medical Director, Vista Hill Foundation
Vista Hill Native American SmartCare Program