Intergenerational. Agnes Attakai, MPA



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Agnes Attakai, MPA Director Health Disparities Outreach Prevention Education Mel and Enid Zuckerman College of Public Health CAIR-Community Education and Outreach Core AIHEC Behavioral Health Institute June 23, 2015 Intergenerational

Question that began our journey How do Native American elders continue to persevere each day and from what or where do they draw their determination to continue living? How can we share that with our native youth so they may become elders.

Definitions: Resilience Defined An ability to recover from or adjust easily to misfortune or change. (Merriam-Webster 2013) dynamic process that enables the individual to respond or adapt under adverse situations. (Stumblingbear-Riddle and Romans 2012, page 2) Resilience (term) is used in biological, physical and social sciences and in organizational theory and education. No precise theory or agreed upon definition of resilience. Resilience. Merriam-Webster Online Dictionary, accessed April 1, 2013. http://www.merriam-webster.com/dictionary/resilience This Emotional Life. PBS. Accessed April 1, 2013. http://www.pbs.org/thisemotionallife/topic/resilience/what-resilience

engineering business clinical psychology emergency preparedness

Resilience Research: Focusing on Individual vs Community Strengths Resilience research conceptualized as a process defined by access to and effective use of protective influences: includes individual internal characteristics, external support from family and community/culture. Cultural Resilience: building, maintaining, and nurturing those relationships that are a source of strength that helps people confront the challenges of life. Family support systems, caring communities, strong identities, spirtuality, cultural values, worldview, ceremonies, traditions Community identity versus individual identify: clans

Protective Factors in Resilience: Self, Family, Culture Storytelling =Intergenerational memories: The family holds values, customs, traditions and memories that guide a person s actions throughout their lives. Family/community transmit cultural identity to their children and future generations. Culture is a key factor in developing personal resilience. Culture links people to family, home, tradition, feeling part of something intergenerational, a community=a collective experience Family, mentors, kin network guide a person to develop selfesteem, self-reliance, confidence and efficacy by modeling cultural appropriate behaviors, storytelling and sharing ceremonies.

Scale asks children to answer 20 questions: Do you know where your grandparents grew up? Do you know where your mom and dad went to high school? Do you know where your parents met? Do you know an illness or something really terrible that happened in your family? The more children knew about their family s history (ups & downs) the more they were resilient: the stronger their sense of control over their lives, the higher their self-esteem and more successfully they believed their families functioned. Strong intergenerational self: they know they belong to something bigger than themselves = collective experience. Sense-making: the building of a narrative that explains what the group is about. Do You Know? Scale Bruce Feiler, The Stories That Bind Us. New York Times. Accessed March 17,2013. http://www.nytimes.com/2013/03/17/fashion/the-family-stories-that-bind-us-thislife.html?_r=1&

Narratives of Resilience Focus on the Transmission of Resilience along with the Transmission of Trauma: First is confronting the historical trauma. Second is understanding the trauma. Third is releasing the pain of historical trauma. Fourth is transcending the trauma. (Brave Heart, M. Y. H., Chase, J., Elkins, J., & Altschul, D. B. 2011) Sharing stories is a traditional native practice that provides a vehicle for learning and healing. Narratives grounded within a strengths-based perspective emphasize how family members are successful in overcoming difficulties and remaining strong in the face of traumatic circumstances or change. if you don t know your past, you don t know your future.

Resilience and American Indian adolescents: Measures variables of school success (LaFromboise et al.,2006 and Whitesell et al., 2009.) Positive relationship among enculturation and resilience in addition to familial, communal and school influences among reservation adolescents (LaFromboise et al.,2006 and 2010) Social Support, rather than enculturation, influences resilience in urban American Indian adolescents (Stiffman et al.2007 and Stumblingbear-Riddle and Romans) Results: A prominent sense of culture in family and community could serve as positive force for reservation-dwelling American Indians.

Resilience and Elders Wisdom of the Elders: Healing With The Heroes Journey Model. To recover the loss of cultural traditions and family structure across generations, Wisdom of the Elders, Inc. (WISDOM) has produced the Discovering Our Story Project, and is sharing videorecorded stories of resilient Native Americans. Resilience and Stereotyping: The Experience of Native American Elders Resilience must be studied and understood within the context of NA worldview Resilience is embedded in the culture. Native elders attain their strength and resilience from each other, families, relatives and communities. Resilience comes from a legacy of survival passed down by the ancient ones. Wisdom of the Elders. Transcending Historical Trauma. Accessed April 1, 2013 http://discoveringourstory.wisdomoftheelders.org/resources/transcending-historical-trauma Resilience and Stereotyping: The Experience of Native American Elders http://www.ndsu.edu/fileadmin/hde/research/nih-d.grandbois.pdf

Draft Resilience Story Model circular-spiral stories-the end of one story is the beginning of another. Karina Walters Individual Immediate/extended Family/clan Culture/ Community stressors Overcoming stressors Future generations- Lifecourse

Documenting and Promoting Resilience in Urban American Indians Co-PIs: Agnes Attakai and Kerstin M. Reinschmidt CAIR Research pilot using community based participatory principles to document stories of resilience among urban American Indian elders at the Tucson Indian Center. Defining resilience from the perspective of urban American Indian elders. Developing a resilience and youth curriculum based on the elder digital stories.

Background Pilot project funded by the Center for American Indian Resilience (CAIR) University of Arizona and Northern Arizona University National Institute On Minority Health And Health Disparities of the National Institutes of Health under Award Number P20MD006872 awarded to Northern Arizona University (NAU) Partnership between University of Arizona (UA) and Tucson Indian Center (TIC).

Team Members Agnes Attakai and Kerstin M. Reinschmidt (Co-PIs UA CAIR) Carmella Kahn-Thornbrugh (UA CAIR) Shannon Whitewater (UA CAIR) Tara Chico (UA CAIR) Marlene Jose (TIC) Phoebe Mills (TIC) Nolando Neswood (Elder) Kathryn Foster (Elder) Nicolette Teufel-Shone (PI CAIR)

Activities Develop questionnaire based on literature Test with elders and revise Recruit 15 elder for interviews Video tape, audio tape and transcribe Code using NVIVO Develop curriculum Test, revise and finalize

Elder Interviews 11 females, 2 males; age 55+ 1-3 hour duration; video/voice-recorded Stories edited 2 nd interview to review digital story

Analysis Process Combined consensus and thematic analysis Consensus approach to develop thematic codes NVIVO coding Coded texts shared with team for curriculum design Complete analysis and interpretation (CAB) Team consensus of final analysis

Multiple, Interrelated Levels of Resilience At the community level, sources of resilience are Culture, language, traditions and sharing stories Traditional land use Tucson Indian Center and/or other community resources The family plays important cultural roles by Teaching the younger generation Creating positive family relations Providing family members as role models The individual is a source of resilience as embedded in family, community and culture/traditions by practicing spirituality practicing responsibility being strong participating/volunteering

Resilience Curriculum 12 stories from elder to promote resilient behaviors and strategies among American Indian youth 12-18. Goal 1: Build connections between elders and youth by enhancing the knowledge of the role of elders in American Indian communities Goal 2: Enhance youth identity through storytelling Goal 3: Increase knowledge among youth about American Indian resilience

Sample Lesson: Generational Gap Generational Gap (45 minutes) Show video: Generational Gap (2:00) Reflect: After viewing video ask the students what they saw Activity: Then and Now: student is paired with and elder to interview them about class, food, chores, traditions, fashion, etc. Discuss: Students report out on their elder interviews Act: Thank their elders and commit to volunteering with elders.

Strategies for Youth Continued benefit of strength-based curriculum Encourage learning of traditional and Western knowledge Provide opportunities for involvement in extracurricular/traditional activities Provide opportunities for intergenerational gatherings among native elders and youth Instill the love of knowing your personal family and tribal history

Acknowledgements Tucson Indian Center: Jacob Bernal, Marlene Jose, Phoebe Mills- Cager, CAIR Community Advisory Board members. Contact Information: Agnes Attakai, MPA, Co-PI Kerstin M. Reinschmidt, PhD, MPH, Co-PI kerstin@email.arizona.edu agnesa@email.arizona.edu

Citations Berry, J. W., Kim, U., Minde, T., & Mok, D. (1987). Comparative studies of acculturative stress. International Migration Review, 21(3), 491-511. doi:10.2307/2546607 Brave Heart, M. Y. H. (1999). Oyate Ptayela: Rebuilding the Lakota nation through addressing historical trauma and loss among Lakota parents. Journal of Human Behavior & Social Environment, 2(1/2), 109-126. doi:10.1300/j137v02n01_08 Brave Heart, M. Y. H. (2003). The historical trauma response among Natives and its relationship to substance abuse: A Lakota illustration. Journal of Psychoactive Drugs, 35, 7-13. doi: 10.1080/02791072.2003.10399988 Brave Heart, M. Y. H., Chase, J., Elkins, J., & Altschul, D. B. (2011). Historical trauma among Indigenous peoples of the Americas: Concepts, research, and clinical considerations. Journal of Psychoactive Drugs, 43(4), 282-290. doi:10.1080/02791072.2011.628913 Duran, E. (2006). Healing the soul wound: Counseling with American Indians and other Native peoples. New York, NY: Teachers College Press. Duran, E., & Duran, B. (1995). Native American postcolonial psychology. Albany, NY: State University of New York Press. Gone, J. P. (2007). We never was happy living like a Whiteman : Mental health disparities and the postcolonial predicament in American Indian communities. American Journal of Community Psychology, 40(3-4), 290-300. doi: 10: 1007/s10464-007-9136-x Grandbois D. M. and Sanders G.F. (2012) Resilience and Stereotyping: the Experience of Native American Elders. J Transcult Nurs. Oct; 23(4); 389-96 LaFromboise, T. D., Hoyt, D. R., Oliver, L., & Whitbeck, L. B. (2006). Family, community, and school influences on resilience among American Indian adolescents in the upper Midwest. Journal of Community Psychology, 34(2), 193-209. doi:10.1002/ jcop.20090 LaFromboise, T. D., Albright, K., & Harris, A. (2010). Patterns of hopelessness among American ndian adolescents: Relationships by levels of acculturation and residence. Cultural Diversity & Ethnic Minority Psychology, 16(1), 68-76. doi: 10.1037/a0016181 Stumblingbear-Riddle, G. and Romans, JSC. (2012)Resilience Among Urban American Indian Adolescents: Exploration Into the Role of Culture, Self-esteem, Subjective Well-being, and Social Support. American Indian Alaska Native Mental Health Research, 19(2). doi: 10.5820/aian.1902.2012.1 Whitbeck, L. B., Walls, M. L., Johnson, K. D., Morrisseau, A. D., & McDougall, C. M. (2009). Depressed affect and historical loss among North American indigenous adolescents. American Indian and Alaska Native Mental Health Research, 16(3), 16-41. doi: 10.5820/aian.1603.2009.16 Whitesell, N. R., Mitchell, C. M., Spicer, P., & The Voices of Indian Teen Project Team. (2009). A longitudinal study of self-esteem, cultural identity, and academic success among American Indian adolescents. Cultural Diversity and Ethnic Minority Psychology, 15(1), 38-50. doi:10.1037/a0013456