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Historical Trauma and Unresolved Grief: Implications for Clinical Research and Practice with American Indians and Alaska Natives
Maria Yellow Horse Brave Heart, Ph.D.
American Indians and Alaska Natives are disproportionately burdened with mental health disparities and severely underrepresented in mental health services research. Engagement and retention of this population in therapy has been difficult due to mistrust of government sponsored treatment, lack of cultural sensitivity of providers, challenges in establishing a therapeutic alliance, and lack of empirically supported treatments (EST) with Native communities. This lecture covers the development of the Historical Trauma and Unresolved Grief Intervention (HTUG), a Tribal Best Practice and its utilization in clinical intervention research. HTUG frames current depression, complicated or prolonged grief, and trauma responses within a collective multigenerational context aimed at reducing stigma and fostering increased utilization of traditional tribal cultural protective coping and self-soothing strategies.
Current National Institute of Mental Health-funded research is underway at two tribal sites: one Northern Plains reservation community and one Southwest urban community outpatient behavioral health settings. This pilot clinical trial includes random assignment to two treatment conditions at each site: one group receives HTUG combined with IPT and the other group receives IPT only. Preliminary data reveals that: a) the mean depression scores and PTSD symptoms are elevated and b) clinical providers perceived the group participants developing bonding and sharing with other participants, perceived the HTUG/IPT group as helpful, the group intervention model, and the predominant interpersonal issue related to depression is primarily grief, followed by role transition, often related to death or relationship loss. The most recent available data at the time of the lecture will be reported.
There are significant challenges to successful implementation of a clinical study in tribal communities, including socioeconomic barriers such as transportation problems related to distances, difficult roads, unreliable vehicles, spotty cell phone coverage which makes follow up contact difficult at times, child care, and ongoing trauma in the community; all of these factors interfere with attendance at group session. Clinicians are often overloaded and behavioral health facilities have inadequate resources. Tribal providers are not immune from high rates of trauma exposure and socioeconomic challenges as well. Despite these challenges, the group participants appear highly motivated, engaged, and receptive to group treatment. Clinicians who have been able to sustain engagement in the training, ongoing supervision in the HTUG/IPT and IPT models perceive the group treatment as effective and observe engagement of the participants, although we do not yet have results on outcome measures, as the groups are still ongoing.
Faculty: Maria Yellow Horse Brave Heart, Ph.D.,(Hunkpapa/Oglala Lakota) is Associate Professor of Psychiatry/Director of Native American and Disparities Research at the University of New Mexico (UNM) Department of Psychiatry and Behavioral Sciences, Division of Community Behavioral Health. Previously, Dr. Brave Heart was Associate Professor at Columbia University School of Social Work and clinical intervention research team member at the Hispanic Treatment Program, New York State Psychiatric Institute/Columbia University College of Physicians and Surgeons. Throughout her academic career, Dr. Brave Heart has been Associate Professor at the University of Denver Graduate School of Social Work and founding President/Director of the Takini Network/Institute, based in Rapid City, South Dakota, a Native collective devoted to community healing from intergenerational massive group trauma.
Currently, Dr. Brave Heart is Principal Investigator for a National Institute of Mental Health-funded R34 pilot study Iwankapiya-Healing: Historical Trauma Practice and Group IPT for American Indians. The goal of Iwankapiya is to examine the effectiveness of the HTUG intervention combined with group Interpersonal Psychotherapy (IPT) for American Indian adults with depression and related disorders, at two outpatient behavioral health clinics: one in a Southwest urban area and one Northern Plains reservation site. Dr. Brave Heart is also Principal Investigator of the New Song Mountain Tribal Preventive and Early Mental Health Intervention Project focusing on Southwestern reservation youth, funded by the National Institute for Minority Health and Health Disparities, part of the UNM Center for the Advancement of Research, Engagement, and Science on Health Disparities. Dr. Brave Heart is Chair of the Special Interest Group on Intergenerational Trauma and Resilience for the International Society for Traumatic Stress Studies. She is also a Senior Fellow at the NIMHD-funded New Mexico Center for the Advancement of Research, Engagement, and Science on Health Disparities and Senior Fellow for the Robert Wood Johnson Foundation Center for Health Policy at UNM.
Dr. Brave Heart received a Bachelor of Science in Psychology, Magna Cum Laude, from Tufts University, a Master of Science from Columbia University School of Social Work in 1976, and a Ph.D. in Clinical Social Work from Smith College in 1995. In 1992, she founded the Takini Network and developed theHistorical Trauma and Unresolved Grief Intervention(HTUG), recognized as an exemplary model, in a special minority initiative, by the Center for Mental Health Services in 2001. In 2009, HTUG was selected as a Tribal Best Practice by the First Nations Behavioral Health Association, the Pacific Substance Abuse and Mental Health Collaborating Council, and the Substance Abuse and Mental Health Services Administration (SAMHSA). Dr. Brave Heart also incorporated the HTUG components in reservation parenting interventions and developed the international Models for Healing Indigenous Survivors of Historical Trauma: A Multicultural Dialogue among Allies Conference from 2001-2004, supported by SAMHSA.
The Enduring Paradox of Immigrants and Access to Health Care
Margarita Alegría, Ph.D.
Based on research conducted during the past five years, this presentation discusses some of the main reasons why immigrants do not appear to access care for their mental health problems. We discuss some of the challenges that contribute to disparities in behavioral health treatment services for immigrants. Focusing on immigrants allows us to consider the rapidly changing context of today increasingly connected world of migration and the complex challenges it poses for culturally appropriate mental health and substance abuse services. Furthermore, the focus on immigrants calls attention to the role of acculturation in behavioral health disorders, the logistics of continuity of care across borders, and the challenges of language and of intergenerational conflict. The presentation integrates examples of our work on psychiatric epidemiology, health services research, intervention research, and community partnered research to illustrate how research findings can offer guidance when taking steps to eliminate behavioral health disparities and the negative consequences of these disparities in immigrant populations.
Faculty: Margarita Alegría is the director of the Center for Multicultural Mental Health Research (CMMHR) at Cambridge Health Alliance and Harvard Medical School, and a professor of psychology in the Department of Psychiatry at Harvard Medical School. Dr. Alegría is currently the PI of three National Institutes of Health (NIH)-funded research studies: International Latino Research Partnership; Effects of Social Context, Culture and Minority Status on Depression and Anxiety; and Building Community Capacity for Disability Prevention for Minority Elders. She is also a PI of a Patient-Centered Outcomes Research Institute (PCORI) project: Effectiveness of DECIDE in Patient-Provider Communication, Therapeutic Alliance & Care Continuation. Dr. Alegría has published over 200 papers, editorials, intervention training manuals, and several book chapters, on topics such as improvement of health care services delivery for diverse racial and ethnic populations, conceptual and methodological issues with multicultural populations, and ways to bring the community's perspective into the design and implementation of health services.
As an acknowledgement of her contributions to her field, Dr. Alegría has been widely recognized and cited. Among the many awards: the Mental Health Section Award of American Public Health Association, 2003; the Health Disparities Innovation Award from the National Institute of Minority Health and Health Disparities, 2008; and the Award of Excellence from the National Hispanic Science Network on Drug Abuse in 2011. In October 2011, she was elected as a member of the Institute of Medicine. Dr. Alegría was selected as El Planeta's (Massachusetts's largest circulating Spanish-language newspaper) 2013s Powermeter 100 most influential people for the Hispanic community in Massachusetts.
Treating Trauma with Plain Old Therapy
Jon G. Allen, Ph.D.
In a field dominated academically by a multitude of specialized, evidence-based treatments, we need a solid scientific foundation to guide what many of us generalists actually provide: plain old ("talk") therapy. Attachment theory, now enriched by research on mentalizing, provides that foundation. This presentation highlights trauma in attachment relationships, which substantially undermines the development of mentalizing and compromises individuals' capacity to make optimal use of psychotherapy. The sheer complexity of developmental psychopathology associated with such trauma calls for a flexible, generalist approach to psychotherapy, with a focus on mentalizing in attachment relationships as its organizing principle.
Faculty: Jon G. Allen is Senior Staff Psychologist and holds the Helen Palley Chair in Mental Health Research at The Menninger Clinic; he is also Professor of Psychiatry in the Menninger Department of Psychiatry and Behavioral Sciences at the Baylor College of Medicine. He is an adjunct faculty member of the Center for Psychoanalytic Studies in Houston and of the Institute for Spirituality in the Texas Medical Center. He teaches and supervises fellows and residents, and he conducts psychotherapy, diagnostic consultations, psychoeducational programs, and research on clinical outcomes.
Allen is on the editorial boards of the Bulletin of the Menninger Clinic, Journal of Trauma and Dissociation, Psychiatry, and Psychological Trauma. His books include Coping with Trauma: From Self-Understanding to Hope, Coping with Depression: From Catch-22 to Hope, Mentalizing in Clinical Practice,Restoring Mentalizing in Attachment Relationships: Treating Trauma with Plain Old Therapy, and Mentalizing in the Development and Treatment of Attachment Trauma.
Women of Color in Academia: Challenging the Presumption of Incompetence
Carmen G. Gonzalez, J.D.
Presumed Incompetent: The Intersections of Race and Class for Women in Academia, by Carmen G. Gonzalez, sparked a long overdue conversation about the climate that female faculty of color encounter in the nation's colleges and universities. How can academic institutions make sure that female faculty of color not only survive but also thrive in the academic workplace? This program is designed to promote reflection among faculty and academic leaders about the barriers to professional success and about the concrete measures that can be adopted to foster an equitable and inclusive campus climate.
Faculty: Carmen G. Gonzalez is a Professor of Law at Seattle University School of Law, who has published widely in the areas of international environmental law, environmental justice, and environmental human rights. She is the co-editor of the critically acclaimed book, Presumed Incompetent: The Intersections of Race and Class for Women in Academia. Through personal narratives and qualitative empirical studies, Presumed Incompetent examines the persistence of race, gender, class and other forms of bias in academia, and the strategies that can be adopted to create a more welcoming and inclusive campus climate.
Professor Gonzalez holds a B.A. from Yale University and a J.D. from Harvard Law School. She was a Fellow at the U.S. Supreme Court, a Fulbright Scholar in Argentina, and a visiting scholar at Cambridge University in the United Kingdom. She practiced law in the private sector and in government before becoming a law professor. In addition to her teaching and scholarship, Professor Gonzalez served as an advisor to the U.S. Environmental Protection Agency on environmental justice matters, and has represented non-governmental organizations in multilateral environmental treaty negotiations. She has also taught and/or worked on environmental law projects in China, Ukraine, Moldova, Chile, Argentina, Brazil, Guatemala, Colombia, and Mexico. Her latest book, International Environmental Law and the Global South, will be published by Cambridge University Press in 2015.