The Concept of Best Practice CAAS -- UAA 2

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1 Establishing Best Practices for Traditional People Bernard Segal, Ph.D. Center for Alcohol and Addiction Studies Institute for Circumpolar Health Studies University of Alaska Anchorage CAAS -- UAA 1

2 The Concept of Best Practice CAAS -- UAA 2

3 The Concept of Best Practice The concept of "best practice" is linked to early efforts by the then Office for Substance Abuse Prevention (OSAP), part of the Substance Abuse Mental Health Service Administration (SAMHSA), to identify interventions that work best in the substance abuse prevention field. OSAP was seeking to target funding for prevention programs based on a body of research literature that documented the effectiveness of prevention strategies applicants were proposing to use to prevent substance abuse. The general purpose of CSAP's approach was to encourage practitioners in the substance abuse prevention field to institute prevention methodologies that reflected up-to-date information on the usefulness of these innovative prevention strategies for selected at-risk populations. CAAS -- UAA 3

4 Over time, however, the concept of best practice evolved to be restated as "science-based" (or evidence-based ) prevention and treatment approaches. Science-based prevention/treatment is perceived as a way of providing concrete evidence of what would work in prevention and treatment fields. The concept of a science-based approach has been adopted by the SAMHSA, the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) as a way of identifying what succeeds in the treatment of substance abuse and co-occurring disorders. CAAS -- UAA 4

5 The philosophy underlying the concept of a Best Practice (or Science-based ) treatment program is that a treatment program based on research insures that a program follows a proven model that results in measurable outcomes. Best practice has become the standard utilized by U.S. federal agencies to determine the efficacy of programs providing social, mental health and substance abuse services to the general population. This approach, however, does not accommodate the extremely diverse cultures among indigenous people. Thus, the application of a best practice procedure based on western standards may not represent a best practice when applied to indigenous people, whose traditions, values and physical environment are extremely different from most non-natives. In other words, one size does not fit all. CAAS -- UAA 5

6 Best Practices for Responding to the Needs of Indigenous People In the U.S., there are two ways to seek to establish best practices for indigenous people. The first represents an attempt to emulate documented practices chiefly established to provide services to non-indigenous people. In the U.S., this approach utilizes theories that have been developed for mainstream USA that are then applied to Native Americans. This approach follows the one size fits all approach. The problem with this approach is that most of the behavioral health research conducted in the United States is, often unwittingly, based on implicit assumptions about human behavior derived chiefly from the cultural and value systems espoused by the dominant culture, largely representative of European CAAS -- UAA 6

7 The second approach involves undertaking an understanding of the physical, sociocultural and economic factors involved in the life of indigenous people. This method involves the development of innovative theories and methodologies that represent the values of the people, which leads to novel practices that can result in establishing best practice procedures meaningful to the population to be served. This approach has been adopted in Alaska to pursue best practices for responding to the needs Alaska Native Elders. CAAS -- UAA 7

8 A recent study seeking to identify Best Practices for Alaska Natives concluded that no documented best practices were readily identifiable. Instead, key elements were recognized that need to be incorporated into treatment programs for Alaska Natives to begin a recovery journey. These elements, which can apply to other indigenous people, include: CAAS -- UAA 8

9 Native staff Traditional ceremonies Traditional arts and crafts Individual and group counseling utilizing traditional ways Family counseling Emphasis on Native values Case management Native foods Native advisory boards Subsistence activities Talking circle Life skills development Parenting education when children are in treatment Enhancement of selfesteem Involvement of Elders. CAAS -- UAA 9

10 Another important recommendation that emerged from the study was that Alaska Native communities, in order to overcome their adversities, had to begin to undertake their own "Healing Journeys." This journey involves recognizing the cause and nature of the problems in one s community, taking responsibility for or assuming ownership of the problems, and exerting selfdetermination to achieve individual and community healing. CAAS -- UAA 10

11 Defining Best Practice For Traditional People Best practice, as defined herein, represents the utilization of traditional customs and healing practices, coupled with western practices, as appropriate, to derive community-based solutions that are responsive to the needs of the people in the community. CAAS -- UAA 11

12 Translating Best Practice into Healing Practices It is important to begin to translate the best practices framework into a healing practice approach that more accurately responds to the needs of the people. The purpose of traditional customs and healing practices is to help people access their own answers and apply their strengths to restore a sense of self-worth and healthy relationships. The loss of cultural values has eroded the family structure and the practice of cultural traditions, and both losses have contributed to discourse in indigenous Communities. CAAS -- UAA 12

13 Best or healing practices" for traditional people thus need to be derived from the traditional values, beliefs, and healing practices of their Tribes. Healing practices are then based on what has worked with traditional people over many generations. Embedded within the healing framework will be the historical traditions and practices that have been proven over time, and which can be applied to contemporary health and social problems. CAAS -- UAA 13

14 A Framework for Establishing Traditionally-based Healing Practices. What follows represents an example of an effort undertaken in Alaska to establish best practices for responding to the needs of Alaska Native youth in treatment for mental health and substance abuse. The concepts and procedures presented can serve as a model to develop best practice procedures for other Tribal groups. The following section begins with a review of cultural factors critical to the survival of Alaska Natives and their communities. The specific cultural ways presented are specific to the Yup ik and Chu pik people of Alaska. The cultural concepts described, as noted above, can be developed for different Tribal groups. CAAS -- UAA 14

15 Unique Cultural Elements Tribal Welfare Traditionally, the core of Native identity has been linked to the extent to which each individual is aligned with their tribal heritage. This principle is dramatically illustrated in the findings from a recent study that reported that Alaska Native Elders, despite the fact that they may be experiencing declines in their health, or are facing the problems associated with aging, expressed concern not for themselves, but for the welfare of the entire group that is, for the welfare of the community in which they live. CAAS -- UAA 15

16 Concern for Community Welfare An Alaska Native cultural framework represents a major difference between the world view of Alaska Natives and those reared in western traditions. Alaska Natives, across all the different tribal groups, have a tradition of living in an interdependent setting in which greater emphasis is placed on the community and family unity than on oneself as a member of the community. This difference is exemplified in the western emphasis on I and the traditional emphasis on we among Alaska Natives. Elders, within this cultural framework, have had a prescribed role of helping to maintain cultural integrity by being the knowledge bearers who pass on customs, values and traditions to younger tribal members. CAAS -- UAA 16

17 The Traditional of Value of Giving The Yup ik and Cup ik concept of Tagumjudargaq (generosity) represent the interdependency of tribal living. It is traditionally believed that being generous to others may bring further success to a hunter. A hunter s first catch is given to the elderly and other members of the community. The hunter is taught by parents and extended family to share his first catch with Elders and others. There is a traditional Yup'ik belief that says that when one does things for widows, orphans and Elders, their gratitude is so powerful that good things happen to you. CAAS -- UAA 17

18 Developing Best Practice in a Cultural Context it is essential, if Best Practice ways are to be developed for Alaska Natives, that one begin to understand how tribal groups continue to struggle to survive in their changing world. Part of this understanding involves an appreciation of their world view, derived from their cultural heritage, and how their belief systems guide their behavior. When working with Alaska Natives, for example, the task becomes one of understanding the nature of their cultural beliefs, and incorporating appropriate aspects of these beliefs into a treatment philosophy. Ernie Turner, an Athabascan Alaskan Indian, described some aspects of how a Native Spirit is kindled: CAAS -- UAA 18

19 Childhood experiences with my grandfather taught me a great deal about this wonderful world we live in. I cannot explain the emotions I experienced as I discovered some of the secrets of the earth and how terrified I would feel because of my own inadequacies in facing the power of those mysterious secrets. Grand-father said we come from "ngan" (ngan refers to earth, soil, ground, or mud in the Deg Hit'an language, the traditional language of the Inglik band of the Athabascan people), and grow like the "gidagadah" (root). The root is connected to the earth, which is our source of life. From the earth comes strength through the food we eat and from the thought generated into knowledge. He taught me that the Chief Spirit communicates with us through our connection with the earth. The thoughts we generate because of this connection is put into the mind before it is put into words. The words come from nothing into being and are a gift that is very sacred and must not be abused. He referred to this as "our way," or the "way of our people." CAAS -- UAA 19

20 The "way of the people" also involved a belief in the personal power of a "medicine man," and the techniques they used were simple, yet powerful. For the Natives, the medicine man, or Shaman for many, possessed the power of the mind and spirit in action. They knew a mind in harmony with the environment and the Creator was the nucleus of all life. These deeply rooted values are an essential part of existence, and if they are lost a person, in a Western term, faces "anomie." Substance abuse and anomie are related, and thus recovery and the regaining of a sense of self are intricately connected. It is possible to speculate that the loss of self-identity underlies the recent trend of Native American youth to find an identity through gang membership. Thus one identifies oneself by the name of the gang, which takes the place of not having a cultural identity. If a healing model is to be derived, the model not only has to be of value to the groups it serves, but the group also has to have an investment in it, and the treatment approach must reflect the group's cultural values. CAAS -- UAA 20

21 Oscar Kawagley (1995), an Alaska Native, wrote, with respect to Yup ik culture, but applicable to others in Alaska and elsewhere: Western scientific technology has given much to make life easier and longer, but this has not always enhanced the quality of life. The high level of modern living enjoyed by a few is accompanied at the expense of many other people and of the Earth. We therefore must press for working within the natural laws and processes by which our ultimate relationship with the environment is governed. We can ill afford to continue to do otherwise. Paraphrasing Kawagley, it behooves us to utilize Native ways of knowing, beginning with a shift to a holistic word view to begin to seek solutions to the problems plaguing Alaska Natives. CAAS -- UAA 21

22 Traditional Ways Good health and healing means using traditional ways to recover from the effects of cultural oppression over generations. It is a process of developing the capacity of people and communities to overcome detrimental health, social and economic conditions and to regain patterns of living that sustain well being. Once this process occurs, people will be supported in their communities and regain their traditional roles and functions. Achieving "well-being" must go far beyond money and programbased solutions. Such "well-being" involves community and individual "empowerment the ability to take responsibility for one's behavior in order to control one's destiny and being part of the process that makes decisions affecting individual and community life, which represents empowerment. Empowerment begins by recognizing and gaining the strengths and resources necessary to take control to offset what is happening to individuals and communities. Empowerment takes commitment and requires assuming responsibility on a personal and community level. CAAS -- UAA 22

23 Recognizing and Using Traditional Ways* For generations, Alaska Natives practiced rich traditional ways. There are still many communities that continue to live in such traditional cultural ways. These cultural ways can be used in treatment programs that serve Alaska Native adolescents. When working with Alaska Native clients, respecting and understanding the cultural lifestyles will enhance the relationship the provider can have with clients. Traditionally, western practices have largely been used in treatment programs, which have not been helpful in addressing substance abuse problems among Native Americans. Integrating both ways can help to strengthen a program s ability to achieve greater results. The following are some traditional Yup'ik/Cup'ik ways that are promoted within the Yukon Kuskokwim region of Alaska. *I would like to acknowledge and express my appreciation to Louise Shavings, BSW, Kanaqlak (George P. Charles, Ph.D.,) and Edward and Esther Shavings for providing information about traditional ways and for helping to translate the terms used herein. CAAS -- UAA 23

24 Yuuryaraq/Cuuryaraq: The Way of the People Identifying Yup'ik/Cup'ik Values: Values are the ways and means considered to be important within a personal, cultural or communal framework. Qalamcik/Qanencit Passing down of stories orally. Yup ik and Cup ik people understand the importance of their ancestor s ways not only for preservation of the old ways, but to practice story telling as a means of showing discipline, respect, guidance and as an activity that brings people together to share in laughter and to bring a sense of belonging. Stories are actual personal experiences that have made an impact on the individual and are passed on to members of the community to share in terms of a lesson, a humorous story or something to be remembered about that certain individual; stories are a form of a cultural legacy. Translating this tradition into practice involves exposing clients to stories generally told by elders, or other story tellers, who can pass on traditional ways. Story telling is a discreet way of telling about life because values are embedded within each story. CAAS -- UAA 24

25 Takumcukluki/Naqlerdar-Compassion A Yup'ik/Cup ik term that literally means that one has compassion, understanding, tolerance, empathy and forgiveness with respect to others. In practice, takumcukluki means helping clients to understand that one does not exist by oneself, and that by showing compassion, empathy, understanding and forgiveness, one gains the ability to relate to others in a meaningful way. Takaqluki Takaqluki literally means having respect and honor for others. It is imperative to respect and honor our elders because they are the carriers of our ancestral ways and truths for life. Honoring and respecting elders means that the individual learns about his or her heritage and gains knowledge necessary to prepare for life. Learning about one s cultural heritage also prepares the individual to preserve and pass on cultural ways. Elders thus have to be an integral part of any treatment program that serves Alaska Natives. CAAS -- UAA 25

26 Eniluki/Niijurniq (Listening) Eniluki literally means listening to them. It is considered to be an important self-disciplinary tool for all age levels. To attain active listening skills means that the individual will follow alerkuutet (ways of doing) and inerquutet (ways of discipline), which teaches about safety to self and to the community. By listening one also learns piciryariit, their way of doing things. By respectful listening to the elders, one learns kincigyaraq, the way of finding meaning. As applied to treatment, staff members should encourage listening skills to help clients hear the message not just the words. When one has learned to listen, they will be able have a balanced and harmonious life. CAAS -- UAA 26

27 Alerkuutet This refers to teachings about how one must conduct oneself for the sustenance of the community. In other words -- I will obey my parents and elders within the village so that nothing bad will come upon me, my family or the community. Alerkuutet have been set in place for thousands of years and have contributed to harmonious living because they have been respected and followed. It also means things that should be done. Alerkuutet, as practiced in a treatment setting, means that when someone acts in a way that breaks harmony, or unbalances the environment, the individual whose behavior is disruptive, has to be addressed to recognize that their behavior brings disharmony to the community, as well as themselves. Correcting the unacceptable behavior will bring harmony back to themselves and to the community. CAAS -- UAA 27

28 Inerkuutet Inerkuutet are ways of discipline that teach how one s behavior or attitudes may not be conducive to the health of self or the community. Inerkuutet, if necessary, are conducted by an elder who is best suited to reach such individuals and to discipline them. Inerkuutet essentially means what not to do. Traditionally, this is the way elders approached people whose behavior needed to be corrected. The person is usually invited by the elder to undertake an activity, such as hunting or sewing, with no one else around who will embarrass the individual being inerkuuk-ed. The unacceptable behavior or attitude is confronted through a story that reflects the individual s misbehavior or bad attitude, with the intent that the story's moral will be internalized and recognized as personal and that the person will begin to correct the behavior or attitude. In some cases, if the individual continues to ignore these inerkutit, a community approach may be the last resort. Providers, when engaged in a disciplinary role, need to be respectful and gentle to reach the individual to help him/her correct their disruptive behaviors. When the client is misbehaving, such behavior first needs to be addressed immediately, but in private and in accordance with Inerkuutit. If this private way is unsuccessful, then it has to be addressed within the community, such as holding a community (or group) meeting. The program is a community, and an individual is part of the community. Emphasis is thus on we, not I. CAAS -- UAA 28

29 Uciqciluni Uciqciluni means humility. It teaches to better understand oneself, others and Creator, but especially others. One does not exist for him/herself. One never considers oneself to be above or over another individual; we are all created equal, except that our elders and teachers of life are especially respected. In the past, the community, in order to teach humility to one who did not practice it, conducted a public ceremony in which everyone participated in humiliating the individual who needed to be corrected. This was the only time in which the community engaged in public humiliation, but even here the ceremony was done humorously. The community effort to discipline through humiliation very often led to humility and brought the individual back to the community. The belief is that no one can survive on their own, but togetherness keeps individuals and traditions alive. In practice, uciqciluni is a means of self discipline to help learn about existing amongst others in a community. CAAS -- UAA 29

30 Qastuluni In the face of adversity, such as a life threatening storm, qastuluni, or courage, means that one shows courage in leading others to safety. Courage, in a treatment context, involves helping clients to take responsibility for their behavior and to become leaders in their treatment community. Usvitulirq (Wisdom) The elders wisdom must be respected, which provides understanding about our existence and those of our forebears. Providers can show wisdom by respecting the clients and teaching them to understand the difference between healthy and unhealthy ways of life. CAAS -- UAA 30

31 Taringtuluani (Understanding) Tarngtuluani means one who has the ability understand or to gain knowledge, such as elders. Elders use such knowledge to pass on the traditions of their people. Applying tarngtuluani in treatment means helping the youth to learn and gain knowledge to bring harmony and balance to their lives. CAAS -- UAA 31

32 Ukvig Trust and Honesty In communal living, trust and honesty are necessary for the survival and existence of our people. Honesty and trust are inherent values in Yup'ik/Cup'ik cultures. Within the treatment community, providers who establish trust and show honesty will have more success in interactions with clients. Aruqe/Illagurlugi: Sharing Sharing is an interaction, traditionally shown through hunting and food gathering. Sharing promotes community cohesiveness and sustains the community. One must not be selfish, otherwise the communal lifeline may be broken. It is necessary to share so that the Ellum Yua (Creator) will see this beautiful act and will provide the necessities in life -- food, water and a safe environment. Providers who promote sharing in the program will help clients grow as individuals and as members of the treatment community. CAAS -- UAA 32

33 Piciryaarit (Traditions) Piciryaarit literally means their ways of doing things. It involves the transmission of cultural ways to future generations. Knowing about, practicing and passing on traditions, through stories, dancing, singing and rituals enables a culture to survive. CAAS -- UAA 33

34 Yuuyaraq/Cuuyaraq (The Way of the Human Being or the Way of Living) As with all other Alaska Natives, Yup'iks and Cup'iks believed that everything, animate and inanimate, had a Yua/Cua (or spirit). Ellum Yua (Creator) breathed spiritual life into the universe. Because all animate and inanimate things have spirits, there are rituals in place that respect even the animals existence. For example, when a hunter catches a seal, he offers the dead animal water, and slits the throat so that the spirit of the seal would be released back into the universe and be able to present itself to another hunter in the future. By respecting the seal s spirit, the life cycle is continued for the hunter, animal and community. Human beings also have spirits. It is important to present oneself with humility and respect towards others, which maintains spiritual connectedness and peace. One must be careful not to offend one s spirit because turmoil may come to the individual or community and could have detrimental effects for self or others. CAAS -- UAA 34

35 Spirituality is knowing about who one is in both the traditional or western sense. What is important is the recognition that if Alaska Natives do not have a sense of spiritual connectedness, they may practice unhealthy lifestyles. CAAS -- UAA 35

36 Interrelating Traditional Ways with Western Treatment Approaches Cultural activities can be used as part of the therapeutic process in treatment programs. Historically, the Yup'ik/Cup'ik people practiced many traditional activities that promoted positive methods to address problems that an individual might experience in daily life. Due to the rapid acculturation and assimilation of the Yup'ik/Cup'ik population, many youths and others -- suffer from loss of identity and self-esteem, which contributes to their drug/alcohol use. The emphasis on findings one's bearings or balance through traditional cultural activities is believed to be critical to developing self-esteem and a sense of purpose to replace feelings of hopelessness and loss. Although treatment programs for Yup'ik/Cup'ik clients include western treatment methods, western approaches can incorporate traditional practices that have been a successful part of Yup'ik/Cup'ik people's way of life for centuries. These traditional activities can be used in treatment planning, in counseling sessions and for billing purposes. Use of traditional activities is a way of returning to successful traditional healing practices as well as a way of validating Yup'ik/Cup'ik culture and history and passing on of traditional ways. CAAS -- UAA 36

37 An integrated approach incorporates traditional treatment modalities into western treatment protocols.* For the most part, they can be related to western substance abuse methods. The traditional Yup'ik/Cup'ik treatment strategies follow. Pissuryaq (Hunting) Provides for the strengthening of families and interpersonal relationships, communication skills development, skill building, relapse prevention, selfesteem development, grief therapy -- privacy allows for processing grief and an opportunity for trust building during early stages of treatment. Western Component - Outpatient, Continuing Care (Aftercare) Aqevyigsuq/At'sasuq (Berry Picking) Provides for social interaction, strengthening of the family unit, interpersonal relationship development, informal/ motivational counseling, social/recreational therapy, stress reduction, enhances feelings of self worth by assisting in provision of food, and skill building. Western Component -- Outpatient, Continuing Care (Aftercare) *These ways were developed by Joan Hamilton under the Rural Remote and Culturally Distinct Demonstration Project in Bethel, Alaska. CAAS -- UAA 37

38 Neqsuq-Kuvyiiluuni (Fishing) Provides for skill building, relapse prevention, stress reduction, recreational therapy, "time out", interpersonal relationship development, feelings of self-worth, by assisting with provision of food, and the building of trust between client and counselor during early stages of treatment process.* Western Component -- Outpatient, Continuing Care (Aftercare) Kaluukaq (To hold a feast or conduct a ceremony) Activity provides for community bonding, social/recreational therapy, crisis intervention and helps dealing with grief and loss. Western Component -- Outpatient, Continuing Care (Aftercare), Outreach Cuilqerluni (Tundra Walk) A directed or a self-imposed walk into the tundra. Time spent to relieve stress or become "centered" and time spent for reflection. A scheduled walk can be done alone or with a counselor. The walk is a way of demonstrating to a person that he/she is capable of gaining control of him/herself. A tundra walk with a counselor, Elder, or another person can be time for improvement of interpersonal communication, enhancement of individual growth, bonding and education. A tundra walk is a good way to build trust between counselor and client in beginning stages of treatment. It can also be utilized for relapse prevention. Western Component -- Outpatient, Continuing Care (Aftercare) CAAS -- UAA 38

39 Makiiraq (Gathering edible and medicinal plants) This activity represents a way of bonding with elders or counselors, and helps educate youth about cultural traditions and ways of life. It can be used as social/recreational therapy, informal motivational counseling, relapse prevention and family unit counseling. Western Component -- Outpatient, Continuing Care (Aftercare) Maqiq (Steam bath) The Maqiq was traditionally a men's social group activity, but Women are currently utilizing this activity. It can be used as a social/recreational activity and for relapse prevention. It also provides physical relaxation, which promotes mental health, provides social interaction for the socially isolated individual and serves as an avenue for informal motivational counseling. Western Component -- Outpatient, Continuing Care (Aftercare), Outreach. CAAS -- UAA 39

40 Caliinguaq (Traditional arts and crafts) Traditional arts and crafts activities were typically done in groups, which provides a social/recreational experience, as well as helping in relapse prevention. Involvements in arts and crafts validates culture, builds self-esteem and promotes social interaction, bonding and informal counseling. Arts and crafts can also be used with support groups. Western Component -- Outpatient, Continuing Care (Aftercare) CAAS -- UAA 40

41 Qulirat (The telling of legendary stories handed down for entertainment. Usually includes a model for behavior or has a moral to the story) and Qanenciq (The retelling of real life events, i.e. history of people) Story telling is an important way of helping people to learn about traditional ways to deal with life events such as grief. Story telling fosters community bonding and as a way of learning about culture, which helps to build self-esteem Western Component Group counseling CAAS -- UAA 41

42 Tegganeq Cinirluku (Time spent with Elders) Elders can help individuals who experience distress overcome their difficulties and help them regain positive thinking and begin to re-appreciate life. Western Component Individual counseling Yuraq (Yup'ik/Cup'ik dance) Dancing is a traditional activity that is an intrinsic part of ceremonies. It helps one to connect with their culture and to build self-esteem. Dancing can be utilized for social/recreational therapy, community bonding, life-skills development and provides for mental/ physical exercises. Dancing is also a way of telling stories. Western Component Recreational therapy, group therapy Neqlivik (Summer fish camp) This represents time for families and community to work together during the summer. Fathers or older male relatives fish with sons while the mothers or female relatives teach young girls how to cut and prepare fish. This experience contributes to family bonding and to communication skill building. It also helps in developing life skills and promotes positive self-esteem and respect for life. Western Component Outpatient counseling, occupational/recreational therapy and aftercare activities CAAS -- UAA 42

43 Mingqiiyaraq (Sewing) Sewing is a group activity for women that provides for support group activities, skill building, community bonding, interpersonal relationship building, communication skill building and a safe opportunity for expressing oneself in a group. Western Component Group counseling, Continuing Care (Aftercare), occupational/recreational therapy and relapse prevention Ikayurcitalria (To help; to bless; those in the community who help others) This activity provides an opportunity to assist others in the community who may need help. It fosters Interpersonal relationship development and community bonding, Western Component Outpatient counseling, Continuing Care (Aftercare), relapse prevention Yuuyaraq/Cuuyaraq (Native Way) This is a way of validating one's cultural heritage, building self-esteem, and turning to traditional ways of healing. It can be used with individuals, families and community groups. Western Component Individual and group counseling CAAS -- UAA 43

44 In summary, these healing activities can be incorporated into a program s current functions. For example, traditional group counseling could be transformed, when practical, into an activity-related format, using a traditional endeavor. Individual counseling, in the western traditional sense of one-to-one counseling in a closed room, can shift to talking about issues in traditional way, such as a tundra walk. This approach should provide more counseling time, but the counselors will have to feel comfortable working in this manner, and understand that is an effective way of helping clients. Further, a traditional western-based program could be oriented to form a holistic Alaska Native approach to healing that leads clients to gain or regain a sense of personal empowerment, help clients achieve a positive sense of self and achieve an awareness of cultural traditions. This restoration should not only support sobriety, but will also establish personal values that will discourage substance use while helping one to maintain a sense of cultural pride and practice Yup ik/cup ik ways. CAAS -- UAA 44

45 Thank you for listening! CAAS -- UAA 45

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