Featured Resources: Native American History and Cultures, Integrated Health, and Effective Clinical Practices
4-5 Minute Read
Author: Judy Bolstad-Hanrahan, JD, MA
Native American and indigenous individuals experience disproportionately poor healthcare access and health outcomes when compared to other Americans,(1) so for Native American Heritage Month,(2) we are spotlighting resources in the areas of Native American history and culture, integrated health, and effective clinical practices.
First, the November 16, 2023 webinar Honoring Native American Cultures in Integrated Health promises to be a “conversation with health equity experts and Native scholars and clinicians to find solutions for providing culturally responsive integrated care that contributes positively to health outcomes of Native American and Indigenous communities.”(3) The webinar is offered by the National Council for Mental Wellbeing, a membership organization of over 3,300 mental health and substance use treatment organizations across the United States.
The concept of integrated health, which the webinar focuses on, generally refers to the integration of behavioral health into medical care, but it can also refer to integrating culturally relevant health beliefs and practices for Native American populations.(4) Integrated Care with Indigenous Populations: A Systematic Review of the Literature found “that targeted integrated care for Indigenous patients resulted in positive health and systems outcomes in the reviewed articles.” (4 p100) A previous edition of Preceptor, Code Talkers, Boarding Schools, & Approaches to Healthcare for Native American Patients, discussed the imporance of, and provided resources for, incorporating cultural humility, a strengths-based care approach, and native health and healing practices in medical practice.(5)
“Native patients report comfort working with non-Natives when they have a contextual understanding of their history and experience in this society.”(6 citing 7)
Towards better understanding of Native American and indigenous peoples’ rich history and cultural practice around health and illness, we encourage you to explore Native Voice: Native Peoples’ Concepts of Health and Illness maintained by the National Library of Medicine where one may learn about the Medicine Wheel and the Four Directions depicted above, healing plants, and the intersections of traditional and western healing.(8) Find out which Native American and Indigenous communities were the first peoples where you live and work using the Native Land Digital resource map. Small acts such as incorporating local healing plants in the planter boxes outside of your medical practice or incorporating representations of the medicine wheel in your waiting room can signal to Native American and Indigenous patients your commitment to integrated medical practice.
Finally, Visioning an Effective Health Encounter: Indigenous Healthcare Experiences and Recommendations for Health Professionals,(10) which we encourage you to read in its entirety, includes a checklist for effective health encounters that we have adapted below (you can also click here to download a .pdf of the adapted checklist):
Recommendations for Achieving Effective Health Encounters with Indigenous Patients
Clinical Care Delivery
Be informed on indigeneity: knowledgeable of Indigenous history, Indigenous people in the region, and basic cultural beliefs and practices.
Acknowledge settler-colonial trauma and its effect on the health and well-being of Indigenous patients, and acknowledge healthcare settings as sources of trauma due to discrimination and build relationships accordingly.
Provide bias and stigma-free, (e.g., race, disability, mental health, substance abuse, cardiometabolic syndromes), quality, and culturally humble care.
Assess and treat modern-day and historical trauma.
Assess Indigenous linguistic and cultural health needs and beliefs and incorporate them into a treatment plans.
Support Indigenous beliefs and lifeways in the hospital and clinic.
Consider the whole patient system in a treatment plan and include family (patient-defined) needs, community needs, tribal needs.
Consider Indigenous beliefs and resources in a treatment plan. For example, be familiar with community resources for Indigenous people (e.g., social activities, ceremonies, traditional medicine people for referral).
Provide a thorough explanation of diagnosis and treatment and ensure that the patient understands the diagnosis and treatment plan, including information about medications.
Provide opportunities for patient feedback, and actively check on patient satisfaction. Did the patient receive what they came to the clinic for? Do they believe you listened to and understood their concerns?
Follow up with patients in a timely manner after the appointment.
Patient Provider Relationship
Build a real relationship with your patient. Positive provider attributes include: respect, kindness, care, and understanding.
Allow and use appropriate humor.
Reduce patient–provider hierarchy by using cultural humility techniques (e.g., What are my own cultural identities and how do they shape my experience? What assumptions and biases am I bringing to this interaction? What do I need to know about this patient’s culture and beliefs to provide appropriate care?)
Acknowledge and validate the expertise of Indigenous patients over their bodies and life experiences. Engage in shared decision making (e.g., co-create treatment plans).
Notice and praise patients for work towards and success around positive health behaviors.
Administrative Practices and Policies
Provide timely services (e.g., appointments, medication).
Provide care first, bill later.
Provide expanded, Indigenous-centered, integrated care (including medical, dental, behavioral health, substance abuse treatment, social needs, family needs, community needs, and cultural needs).
Provide traditional Indigenous medicine.
Ensure continuity of care by providing an environment that will reduce provider turnover and burnout.(10)■
References
(1) Indian Health Service. Disparities. 2023.
(2) National Museum of the American Indian. Native American Heritage Month. 2023.
(3) National Council for Mental Wellbeing. Equity in Action: Honoring Native American Cultures in Integrated Health. 2023.
(4) Lewis ME, Myhra LL. Integrated Care with Indigenous Populations: A Systematic Review of the Literature. Am Indian Alsk Native Ment Health Res. 2017;24(3):88-110. doi:10.5820/aian.2403.2017.88
(5) Bolstad-Hanrahan J. Code Talkers, Boarding Schools, & Approaches to Healthcare for Native American Patients. Precept: Ideas and Inspir for Clin Educ. Jun 16, 2023.
(6) Waltman JA. Working with Native American Patients and Clients- The 3 C’s. Minn Psychol Assn. Sept 30, 2023.
(7) Trimble JE. The virtues of cultural resonance, competence, and relational collaboration with Native American Indian communities: A synthesis of the counseling and psychotherapy literature. Couns Psychol. 2010;38(2):243-256.
(8) National Library of Medicine. Native Voice: Native Peoples’ Concepts of Health and Illness. 2023.
(9) Native Land Digital. Native-land.ca. 2023.
(10) Lewis ME, Wildcat S, Anderson A. Visioning an Effective Health Encounter: Indigenous Healthcare Experiences and Recommendations for Health Professionals. Int J Environ Res Public Health. 2023;20(20):6917. Published 2023 Oct 13. doi:10.3390/ijerph20206917