Study Points

Providing Care to Alaska Natives

Course #77090 - $18 -

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  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.
  1. Between 1960 and 2000, the population of American Indians and Alaska Natives

    DEFINITIONS AND DEMOGRAPHICS

    The U.S. 2010 Census reported 5.2 million people identifying as American Indian or Alaska Native, a 39% population increase since 2000 [3]. An estimated 18% of Alaska's population is American Indian or Alaska Native [54]. Between 1960 and 2000, the population of American Indians and Alaska Natives increased by 250%, due partly to improved birth rates, more people identifying as Native American, and better data collection from the Census Bureau. Approximately 4% of the Native American population in the United States identifies as Alaska Native [1]. American Indians and Alaska Natives are considered to be the most impoverished ethnic group in the United States [1].

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  2. Which of the following statements regarding similarities between Alaska Natives and American Indians is FALSE?

    DEFINITIONS AND DEMOGRAPHICS

    Alaska Natives and American Indians share some similar experiences. For example, both Alaska Natives and American Indians are culturally diverse, consisting of different tribes with different languages and customs. Both American Indians and Alaska Natives were also, and to some extent continue to be, subsistence economies, an important part of Native American identity and culture. Alaska Natives and American Indians also both experienced population devastation due to diseases introduced by Europeans [1]. However, the relationship that Alaska Natives have had with the U.S. Government differs slightly from the experiences of American Indian tribes. This relationship will be discussed later in this course.

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  3. Which of the following Native Alaskan tribes is indigenous to southeast Alaska?

    HISTORY OF ALASKA AND ALASKA NATIVES

    Different Alaska Native cultures and tribes were found, and continue to be recognized, throughout the state of Alaska. According to the Alaska Federation of Natives, 11 distinct cultures can be described geographically: Eyak, Tlingit, Haida, and Tsimshian peoples in the southeast; the Inupiaq and St. Lawrence Island Yupik in the north and northwest; Yup'ik and Cup'ik Alaska Natives in southwest; the Athabascan peoples in Alaska's interior; and Alutiiq (Sugpiaq) and Unangax̂ peoples in south-central Alaska and the Aleutian Islands [54]. Today, the federal government recognizes 229 tribes in Alaska [6].

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  4. The Alaska Native Claims Settlement Act (ANCSA)

    ALASKA NATIVES AND THE U.S. GOVERNMENT

    The Alaska Native Claims Settlement Act (ANCSA) was passed by Congress in 1971 in order to begin the construction and development of the Trans-Alaska Pipeline System. In exchange for waving their claim to Native lands, Alaska Natives received $962 million and more than 44 million acres of land [1,5]. ANCSA had some positive effects for the Alaska Native population. For example, much of the land that had been allotted to them was inhabitable and rich in resources. Also, the settlement created 13 regional, 4 urban, and more than 200 village Native corporations, setting up regional and statewide structures that would give Alaska Natives political and economic power. However, in the early 1970s, the state legislature was reapportioned based on population; rural, mostly Native regions of the state lost a significant amount of power on the state level [5].

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  5. Under Title VIII of ANILCA, rural residents of Alaska have priority subsistence use of federal public lands.

    ALASKA NATIVES AND THE U.S. GOVERNMENT

    The Alaska National Interest Lands Conservation Act (ANILCA) of 1980 created the majority of the national parks in Alaska. ANILCA stipulates the designation of wilderness, subsistence management, transportation in and across parklands, use of cabins, mining, archaeologic sites, scientific research studies, and more [7]. Under Title VIII of ANILCA, rural residents of Alaska have priority subsistence use of federal public lands [8]. The federal management of subsistence harvests of fish and wildlife on federal land is unique to Alaska and does not exist elsewhere in the United States [9].

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  6. All of the following are examples of racism in Alaska today, EXCEPT:

    SOURCES OF DISCRIMINATION

    Racism in Alaska today can take many forms, from blatant hate crimes against Alaska Natives to a general failure to acknowledge or celebrate Alaska Native culture to systematic racism perpetuated by the state and federal government through biased policies and distribution of wealth [5]. While there is a lack of research about the relationship between experiencing racism and physical health problems of Native Americans, racism has been shown to linked to physical harm (e.g., hypertension, heart disease) among other racial/ethnic groups, such as African Americans and Latinos [15].

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  7. Which of the following statements regarding suicide in Alaska Native communities is TRUE?

    HEALTH AND MENTAL HEALTH

    American Indians and Alaska Natives have the highest rates of suicide of any racial or ethnic group in the United States, with suicide rates increasing since 2003. More than one-third of victims are between 10 and 24 years of age [19]. Based on data recorded between 1979 and 1984, Alaska Natives have a suicide rate twice that of the general population of the United States. Rates were found to be especially high for young, single Alaska Native men [21].

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  8. The Project Homeless Connect count found that Alaska Natives and American Indians made up what percentage of the homeless population in Alaska?

    HEALTH AND MENTAL HEALTH

    While American Indians and Alaska Natives make up only 1.3% of the U.S. population, 3.3% of people experiencing homelessness identify as Native American [27]. In the State of Alaska, 27 out of every 10,000 people in the general population are homeless [28]. In the Project Homeless Connect count, a yearly project that aims to count and survey homeless individuals, it was found that Alaska Natives and American Indians made up 54.6% of the homeless population in Alaska in 2013. In the city of Anchorage alone, Alaska Natives made up nearly 60% of the homeless population [29]. When surveyed, 34.3% of homeless individuals stated that the reason for homelessness was economic (e.g., loss of job). Unhoused individuals claimed that situational reasons (e.g., substance use disorders, mental health issues) were the reason for homelessness in 10% of the cases [29]. Past studies have found the same percentage of self-reported alcohol use disorder among Alaska Natives experiencing homelessness, although these self-reports are believed to be inaccurate and to underestimate the true prevalence [26].

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  9. What is the leading cause of death for Alaska Natives?

    HEALTH AND MENTAL HEALTH

    Cancer is the leading cause of death among Alaska Natives, with more than 50% of diagnosed cancers being breast, colorectal, lung, and prostate [14,24]. Lung cancer, colorectal cancer, cancer of the kidney, stomach cancer, and nasopharynx cancer are all more common in Alaska Natives than in the White population [24]. While cancer rates of Alaska Native women and White women were similar in the past, over the past 20 years cancer rates for Alaska Native women have increased, and today, their cancer rates are 20% higher than those of White women [24]. Some risk factors have been identified. An estimated 44.9% of Alaska Natives are current smokers—nearly twice the rate of White Alaskans. It has been found that approximately 90% of lung cancer cases in this population are related to smoking [24].

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  10. Which of the following statements regarding substance use disorders in the Alaska Native community is TRUE?

    HEALTH AND MENTAL HEALTH

    There is a misconception that genes that increase risk of substance misuse and related factors (e.g., tolerance, craving) are more common in American Indians and Alaska Natives than in White Americans—this is untrue [52]. Alcohol is the most misused substance among American Indians and Alaska Natives, as well as among the general population. Many American Indians and Alaska Natives do not drink at all, but binge drinking and alcohol use disorder occur among Native populations at relatively high rates [52]. In one study exploring the connection between alcohol use disorders and comorbid psychiatric disorders, Native men and women with alcohol use disorders and those who participated in binge drinking were more likely to suffer from another psychiatric disorder [1,49].

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  11. For Native Alaskan peoples, climate change will

    HEALTH AND MENTAL HEALTH

    The effects of climate change can and will increasingly be seen in the Alaska Native population, affecting both physical and mental health, as well as Native communities, homes, and the subsistence way of life [46,47]. Flooding and other natural disasters related to climate change will continue to lead to the displacement of people living in rural Alaska, many of whom are Alaska Natives. With climate change comes increased exposure to infectious disease due to rising temperatures and traditional ways of storing food. Water and food sources will also be more limited, and poor water quality is already a concern for rural Native communities. In addition, the cultural importance of the subsistence way of life will be endangered, as well as the relationship that Alaska Natives have historically had with their environment [46].

    Natural disasters and environmental changes caused by climate change can also be the cause of solastalgia, the distressing sense of loss that people experience as a result of unwanted environmental changes that occur close to one's home [47]. Climate change has also been linked to anxiety, depression, and post-traumatic stress disorder following extreme weather or natural disasters (e.g., erosion, fires, flooding, storms) [47]. Permafrost (defined as occurring when the ground remains frozen at 32 degrees or colder for at least two years) is found in 80% of the State of Alaska. With the thawing of permafrost in some areas, the landscape will ultimately change, possibly causing permanent damage to roadways or creating the need of some remote villages to relocate [47].

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  12. Which of the following is NOT a traditional Alaska Native healing method?

    HEALTH AND MENTAL HEALTH

    Alaska Native culture includes many natural healing methods dating back thousands of years. Although these practices became less common because of European settlers and missionary influence, they still exist today and they are gaining popularity. There is much diversity in the beliefs and practices of natural healing methods. However, traditional Alaska Native healing methods include, but are not limited to, therapeutic massage, prayer, cleansing by the burning of sage, drumming circles, traditional plant medicine, and talking circles [43].

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  13. It is normal for elderly Alaska Native peoples to separate and disengage from society at a certain age.

    BARRIERS TO OPTIMAL HEALTH AND CARE

    The perception of the elderly population can also differ in Alaska Native culture compared with White populations. For example, Alaska Native elders are never thought to reach an age when their opinions, stories, and experiences are unimportant. They continue to be a vital part of the Native community, passing culture to the younger generations. Therefore, when elder Alaska Natives have a medical condition that may require treatment or institutionalization outside of the community, it is to the detriment of the health of the elder and to the community as a whole [43]. While disengagement theory states that it is normal for elderly people to separate and disengage from society at a certain age, it is thought that in the case of Alaska Natives, it is a "forced disengagement" and not in line with Native customs and culture. In general, families and Tribes believe the best place for Native elders to be cared for is in a family home and that care should never be so restrictive as to limit elders from participating in community activities [43].

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  14. Because of permafrost, some villages in Alaska lack piped water and sewage, and outhouses and septic tanks do not function and are unusable.

    BARRIERS TO OPTIMAL HEALTH AND CARE

    In the State of Alaska, 6% of the population lives without basic plumbing, more than any other state. Because of permafrost, some villages lack piped water and sewage and outhouses and septic tanks do not function and, therefore, cannot be used. Looking for other ways to dispose human waste, sewage is often tracked around, disturbed by animals, spilled, spread by vehicles, or blown by the wind once dry. While this is a serious hazard to community health, another more serious problem for health is the lack of clean, running water [31].

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  15. The objectives of traditional mission schools in Alaska included all of the following, EXCEPT:

    BARRIERS TO OPTIMAL HEALTH AND CARE

    Like many Native Americans, Alaska Natives have a complicated history with the formal education system. In 1784, education was first imposed upon young Alaska Natives by Russian fur trader Grigory Shelikhov, and the curriculum included Christianity, Russian, and arithmetic. This first school was followed by mission schools, first operated by the Russian Orthodox Church and later by the American Protestant and Roman Catholic Churches, whose objectives were to Christianize Alaska Natives, to phase out Native traditions, and to teach students trades that would make them useful servants to the settlers. The last of the mission schools did not close until 1916 [51].

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  16. In Alaska, school materials, standardized tests, curriculum, and teaching styles usually take into consideration Native culture.

    BARRIERS TO OPTIMAL HEALTH AND CARE

    There are several barriers to education for Alaska Natives in the State of Alaska. First, many policies and programs around education are based on models used in the "lower 48" and do not translate well to the unique situation in Alaska, including geographically remote communities [48]. Also, there can be a lack of cultural understanding between students, parents, teachers, and school staff. This can also include difficulties in communication due to language differences [48,50]. School materials, standardized tests, curriculum, and teaching styles may also not take into consideration Native culture, and research has shown that Native Americans have different learning styles from non-Natives, making classroom learning more challenging [1,50]. Finally, systemic and community issues, such as poverty, alcohol use disorder, lack of educational role models, and lack of parental support, can present significant barriers to education [50]. Including Native culture and language in the classroom can help Alaska Native students be more successful and to continue education longer [50].

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  17. Which of the following statements regarding the representation of American Indians and Alaska Natives in health research is FALSE?

    BARRIERS TO OPTIMAL HEALTH AND CARE

    Because American Indians and Alaska Natives make up a small percentage of the general population, they are often under-represented in medical or mental health research, and even when an attempt is made to include Native American subjects, inter-tribal diversity cannot be accurately reflected [1]. In 1993, legislation was passed in Congress to require more active recruitment of Native Americans in clinical trials. In the past, researchers have performed studies in Native communities without respect for or inclusion of the people themselves. These negative historical examples led to deeply seated fears and negative beliefs about research and have resulted in many Native people being unwilling to participate in research. Furthermore, some trials may involve invasive assessments or questioning contrary to cultural beliefs [44].

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  18. Most American Indians and Alaska Natives believe what factor lies at the heart of substance use and mental illness within their communities?

    BEST PRACTICES WHEN WORKING WITH ALASKA NATIVE CLIENTS

    With increased knowledge and improved awareness of the issues faced by Alaska Natives, clinicians should take steps to provide care that is culturally sensitive and appropriate. The Substance Abuse and Mental Health Services Administration emphasizes the following key points when providing care to American Indians and Alaska Natives [52]:

    • Importance of historical trauma. Providers should learn about, acknowledge, and address the effects of historical trauma when working with American Indian and Alaska Native clients. Most American Indians and Alaska Natives believe that historical trauma, including the loss of culture, lies at the heart of substance use and mental illness within their communities.

    • Acceptance of a holistic view of behavioral health. Among many American Indian and Alaska Native cultures, substance use and mental illness are not defined as diseases, diagnoses, or moral maladies, nor are they viewed as physical or character flaws. Instead, they are seen as symptoms of imbalance in the individual's relationship with the world. Thus, healing and treatment approaches must be inclusive of all aspects of life—spiritual, emotional, physical, social, behavioral, and cognitive.

    • Role of culture and cultural identity. Providers need to understand how clients perceive their own cultural identity and how they view the role of traditional practices in treatment. Not all American Indian and Alaska Native clients recognize the importance of culture or perceive a need for traditional practices in their recovery. Nonetheless, providers and administrators must be ready to address their clients' cultural identity and related needs. Helping clients maintain ties to their Native cultures can help prevent and treat substance use and mental disorders. Through reconnection to American Indian and Alaska Native communities and traditional healing practices, an individual may reclaim the strengths inherent in traditional teachings, practices, and beliefs and begin to walk in balance and harmony.

    • Recognition of sovereignty. Tribal governments are sovereign nations. Each nation adopts its own tribal codes and has a unique history with the U.S. federal government. Providers in Native and non-Native programs need to understand the role of tribal sovereignty and governance systems in treatment referrals, planning, cooperative agreements, and program development.

    • Significance of community. American Indian and Alaska Native clients and their communities must be given opportunities to offer input on the types of services they need and how they receive them. Such input helps match services to clients, increase community use of services, and use agency and tribal financial resources efficiently. Providers must involve them-selves in Native community events and encourage Native community involvement in treatment services.

    • Value of cultural awareness. If providers are aware of their own cultural backgrounds, they will be more likely to acknowledge and explore how culture affects their interactions, particularly their relationships with clients of all backgrounds. Without cultural awareness, providers may discount the influence of their own cultural contexts—including beliefs, values, and attitudes—on their initial and diagnostic impressions of clients and selection of healing interventions.

    • Commitment to culturally responsive services. Organizations have an obligation to deliver high-quality, culturally responsive care across the behavioral health service continuum at all levels—individual, programmatic, and organizational. Not all American Indian or Alaska Native clients identify or want to connect with their cultures, but culturally responsive services offer those who do a chance to explore the impact of culture, history (including historical trauma), acculturation, discrimination, and bias on their behavioral health.

    • Significance of the environment. An environment that reflects American Indian and Alaska Native culture is more engaging for, and shows respect to, clients who identify with this culture. Programs can create a more culturally responsive ethos through adapted business practices, such as using Native community vendors, hiring a workforce that reflects local diversity, and offering professional development activities (e.g., supervision, training) that highlight culturally specific American Indian and Alaska Native client and community needs.

    • Respect for many paths. There is no one right way. Providing direction on how something should be done is not a comfortable or customary practice for American Indians and Alaska Natives. For them, healing is often intuitive; it is interconnected with others and comes from within, from ancestry, from stories, and from the environment. There are many paths to healing.

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  19. Which of the following statements regarding cultural identity and the role of traditional practices in the treatment of Alaska Native clients is TRUE?

    BEST PRACTICES WHEN WORKING WITH ALASKA NATIVE CLIENTS

    With increased knowledge and improved awareness of the issues faced by Alaska Natives, clinicians should take steps to provide care that is culturally sensitive and appropriate. The Substance Abuse and Mental Health Services Administration emphasizes the following key points when providing care to American Indians and Alaska Natives [52]:

    • Importance of historical trauma. Providers should learn about, acknowledge, and address the effects of historical trauma when working with American Indian and Alaska Native clients. Most American Indians and Alaska Natives believe that historical trauma, including the loss of culture, lies at the heart of substance use and mental illness within their communities.

    • Acceptance of a holistic view of behavioral health. Among many American Indian and Alaska Native cultures, substance use and mental illness are not defined as diseases, diagnoses, or moral maladies, nor are they viewed as physical or character flaws. Instead, they are seen as symptoms of imbalance in the individual's relationship with the world. Thus, healing and treatment approaches must be inclusive of all aspects of life—spiritual, emotional, physical, social, behavioral, and cognitive.

    • Role of culture and cultural identity. Providers need to understand how clients perceive their own cultural identity and how they view the role of traditional practices in treatment. Not all American Indian and Alaska Native clients recognize the importance of culture or perceive a need for traditional practices in their recovery. Nonetheless, providers and administrators must be ready to address their clients' cultural identity and related needs. Helping clients maintain ties to their Native cultures can help prevent and treat substance use and mental disorders. Through reconnection to American Indian and Alaska Native communities and traditional healing practices, an individual may reclaim the strengths inherent in traditional teachings, practices, and beliefs and begin to walk in balance and harmony.

    • Recognition of sovereignty. Tribal governments are sovereign nations. Each nation adopts its own tribal codes and has a unique history with the U.S. federal government. Providers in Native and non-Native programs need to understand the role of tribal sovereignty and governance systems in treatment referrals, planning, cooperative agreements, and program development.

    • Significance of community. American Indian and Alaska Native clients and their communities must be given opportunities to offer input on the types of services they need and how they receive them. Such input helps match services to clients, increase community use of services, and use agency and tribal financial resources efficiently. Providers must involve them-selves in Native community events and encourage Native community involvement in treatment services.

    • Value of cultural awareness. If providers are aware of their own cultural backgrounds, they will be more likely to acknowledge and explore how culture affects their interactions, particularly their relationships with clients of all backgrounds. Without cultural awareness, providers may discount the influence of their own cultural contexts—including beliefs, values, and attitudes—on their initial and diagnostic impressions of clients and selection of healing interventions.

    • Commitment to culturally responsive services. Organizations have an obligation to deliver high-quality, culturally responsive care across the behavioral health service continuum at all levels—individual, programmatic, and organizational. Not all American Indian or Alaska Native clients identify or want to connect with their cultures, but culturally responsive services offer those who do a chance to explore the impact of culture, history (including historical trauma), acculturation, discrimination, and bias on their behavioral health.

    • Significance of the environment. An environment that reflects American Indian and Alaska Native culture is more engaging for, and shows respect to, clients who identify with this culture. Programs can create a more culturally responsive ethos through adapted business practices, such as using Native community vendors, hiring a workforce that reflects local diversity, and offering professional development activities (e.g., supervision, training) that highlight culturally specific American Indian and Alaska Native client and community needs.

    • Respect for many paths. There is no one right way. Providing direction on how something should be done is not a comfortable or customary practice for American Indians and Alaska Natives. For them, healing is often intuitive; it is interconnected with others and comes from within, from ancestry, from stories, and from the environment. There are many paths to healing.

    Click to Review
  20. Programs can create a more culturally responsive ethos through adapted business practices, such as

    BEST PRACTICES WHEN WORKING WITH ALASKA NATIVE CLIENTS

    With increased knowledge and improved awareness of the issues faced by Alaska Natives, clinicians should take steps to provide care that is culturally sensitive and appropriate. The Substance Abuse and Mental Health Services Administration emphasizes the following key points when providing care to American Indians and Alaska Natives [52]:

    • Importance of historical trauma. Providers should learn about, acknowledge, and address the effects of historical trauma when working with American Indian and Alaska Native clients. Most American Indians and Alaska Natives believe that historical trauma, including the loss of culture, lies at the heart of substance use and mental illness within their communities.

    • Acceptance of a holistic view of behavioral health. Among many American Indian and Alaska Native cultures, substance use and mental illness are not defined as diseases, diagnoses, or moral maladies, nor are they viewed as physical or character flaws. Instead, they are seen as symptoms of imbalance in the individual's relationship with the world. Thus, healing and treatment approaches must be inclusive of all aspects of life—spiritual, emotional, physical, social, behavioral, and cognitive.

    • Role of culture and cultural identity. Providers need to understand how clients perceive their own cultural identity and how they view the role of traditional practices in treatment. Not all American Indian and Alaska Native clients recognize the importance of culture or perceive a need for traditional practices in their recovery. Nonetheless, providers and administrators must be ready to address their clients' cultural identity and related needs. Helping clients maintain ties to their Native cultures can help prevent and treat substance use and mental disorders. Through reconnection to American Indian and Alaska Native communities and traditional healing practices, an individual may reclaim the strengths inherent in traditional teachings, practices, and beliefs and begin to walk in balance and harmony.

    • Recognition of sovereignty. Tribal governments are sovereign nations. Each nation adopts its own tribal codes and has a unique history with the U.S. federal government. Providers in Native and non-Native programs need to understand the role of tribal sovereignty and governance systems in treatment referrals, planning, cooperative agreements, and program development.

    • Significance of community. American Indian and Alaska Native clients and their communities must be given opportunities to offer input on the types of services they need and how they receive them. Such input helps match services to clients, increase community use of services, and use agency and tribal financial resources efficiently. Providers must involve them-selves in Native community events and encourage Native community involvement in treatment services.

    • Value of cultural awareness. If providers are aware of their own cultural backgrounds, they will be more likely to acknowledge and explore how culture affects their interactions, particularly their relationships with clients of all backgrounds. Without cultural awareness, providers may discount the influence of their own cultural contexts—including beliefs, values, and attitudes—on their initial and diagnostic impressions of clients and selection of healing interventions.

    • Commitment to culturally responsive services. Organizations have an obligation to deliver high-quality, culturally responsive care across the behavioral health service continuum at all levels—individual, programmatic, and organizational. Not all American Indian or Alaska Native clients identify or want to connect with their cultures, but culturally responsive services offer those who do a chance to explore the impact of culture, history (including historical trauma), acculturation, discrimination, and bias on their behavioral health.

    • Significance of the environment. An environment that reflects American Indian and Alaska Native culture is more engaging for, and shows respect to, clients who identify with this culture. Programs can create a more culturally responsive ethos through adapted business practices, such as using Native community vendors, hiring a workforce that reflects local diversity, and offering professional development activities (e.g., supervision, training) that highlight culturally specific American Indian and Alaska Native client and community needs.

    • Respect for many paths. There is no one right way. Providing direction on how something should be done is not a comfortable or customary practice for American Indians and Alaska Natives. For them, healing is often intuitive; it is interconnected with others and comes from within, from ancestry, from stories, and from the environment. There are many paths to healing.

    Click to Review

  • Back to Course Home
  • Participation Instructions
    • Review the course material online or in print.
    • Complete the course evaluation.
    • Review your Transcript to view and print your Certificate of Completion. Your date of completion will be the date (Pacific Time) the course was electronically submitted for credit, with no exceptions. Partial credit is not available.