Ethnocultural Aspects of Posttraumatic Stress Disorder

Trauma-informed care is a service provision model used across a range of practice settings. Drawing on an extensive body of research on trauma (broadly defined as experiences that produce enduring emotional pain and distress) and health outcomes, we have argued that the principles of trauma-informed care can be extended to social policy. Citing a variety of health-related policy examples, we have described how policy can better reflect 6 core principles of trauma-informed care: safety, trustworthiness and transparency, collaboration, empowerment, choice, and intersectionality. This framework conveys a politicized understanding of trauma, reflecting the reality that trauma and its effects are not equally distributed, and offers a pathway for public health professionals to disrupt trauma-driven health disparities through policy action.

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Trauma-Informed Social Policy: A Conceptual Framework for Policy Analysis and Advocacy.

(1996). Education for Extinction: American Indians and the Boarding School Experience, 1875–1928. History: Reviews of New Books: Vol. 24, No. 4, pp. 154-155.

Education for Extinction: American Indians and the Boarding School Experience, 1875–1928

Social and emotional wellbeing assessment instruments for use with Indigenous Australians: A critical review.

The effects of enculturation, self-esteem, subjective well-being, and social support on resilience among urban American Indian (AI) adolescents from a South Central region of the U.S. were explored. Of the 196 participants, 114 (58.2%) were female and 82 (41.8%) were male (ages 14-18 years). Thirty-three percent of the variance in resilience was accounted for by enculturation, self-esteem, and social support, while 34% of the variance in resilience was contributed by enculturation, subjective well-being, and social support. However, social support from friends remained the strongest predictor.

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Resilience among Urban American Indian Adolescents: Exploration into the Role of Culture, Self-Esteem, Subjective Well-Being, and Social Support.

Indigenous Peoples of the Americas have experienced devastating collective, intergenerational massive group trauma and compounding discrimination, racism, and oppression. There is increasing evidence of emotional responses to collective trauma and losses among Indigenous Peoples, which may help to inform ways of alleviating psychological suffering and unresolved grief. Tribal cultural and regional differences exist which may impact how the wounding across generations and within an individual's lifespan are experienced and addressed. This article will review the conceptual framework of historical trauma, current efforts to measure the impact of historical trauma upon emotional distress, and research as well as clinical innovations aimed at addressing historical trauma among American Indians/Alaska Natives and other Indigenous Peoples of the Americas. We will discuss assessment of historical trauma and implications for research and clinical as well as community interventions, and conclude with recommendations.

Historical Trauma Among Indigenous Peoples of the Americas: Concepts, Research, and Clinical Considerations

Although there is literature concentrating on cross-cultural approaches to academic and community partnerships with Native communities, few address the process and experiences of American Indian women leading federally funded and culturally grounded behavioral health intervention research in Native communities. This paper summarizes relevant literature on community-engaged research with Native communities, examines traditional roles and modern challenges for American Indian women, describes the culturally grounded collaborative process for the authors' behavioral health intervention development with Native communities, and considers emergent themes from our own research experiences navigating competing demands from mainstream and Native communities. It concludes with recommendations for supporting and enhancing resilience.

Women finding the way: American Indian women leading intervention research in Native communities.

American Indians face pervasive trauma exposure, collective histories of communal suffering, and elevated risk for depression and posttraumatic stress disorder. In addition to socioeconomic barriers, access to culturally responsive treatment is limited, which may compromise treatment engagement. The Iwankapiya study piloted the Historical Trauma and Unresolved Grief Intervention (HTUG), combined with Group Interpersonal Psychotherapy (IPT), to reduce symptoms of depression and related trauma and grief. The study hypothesized that HTUG + IPT would lead to greater group engagement and decreased depression and related symptoms compared with IPT-Only. American Indian adults (n = 52) were randomized into one of two 12-session interventions, HTUG + IPT or IPT-Only, at two tribal sites: one Northern Plains reservation (n = 26) and one Southwest urban clinic (n = 26). Standardized measures assessed depression, posttraumatic stress disorder, grief, trauma, and substance use. Data were collected at screening, baseline, end of intervention, and 8 weeks postintervention; depression and group engagement measures were also collected at Weeks 4 and 8 of the intervention. Depression scores significantly decreased for both treatments, but there were no significant differences in depression between the two groups: IPT-Only (30.2 ± 6.4 at baseline to 16.7 ± 12.1 at follow-up) and HTUG + IPT (30.2 ± 8.1 at baseline to 19.9 ± 8.8 at follow-up). However, HTUG + IPT participants demonstrated significantly greater group engagement. Postintervention, clinicians expressed preference for HTUG + IPT based upon qualitative observations of greater perceived gains among participants. Given the degree of trauma exposure in tribal communities, these findings in a relatively small sample suggest HTUG should be further examined in context of treatment engagement. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Josephine Chase

Papers

Historical Trauma Among Indigenous Peoples of the Americas: Concepts, Research, and Clinical Considerations

Women finding the way: American Indian women leading intervention research in Native communities.

Iwankapiya American Indian pilot clinical trial: Historical trauma and group interpersonal psychotherapy