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Advancing Health Equity for Native American Youth: Workshop Summary (2016)

Chapter: 3 Contributors to Resilience

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Suggested Citation:"3 Contributors to Resilience." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
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3

Contributors to Resilience

Native American psychologists have identified a Native American “resilience narrative” that emphasizes the ability to not only be effective, but to thrive despite adversity, said Teresa LaFromboise, professor in the Graduate School of Education at Stanford University, in her keynote speech at the workshop. For example, Emmy Werner (1992), in her longitudinal studies of Native Hawaiian children, was one of the first psychologists to identify people who were doing well despite growing up under harsh circumstances.

Such resilience is often attributed to protective factors that counteract stresses, providing a kind of scaffolding that helps individuals over the life course. Though initially seen as a trait inherent in individuals, resilience is actually more of a process, LaFromboise said (Masten, 2001). Seen in this light, every person has the potential to be resilient if the right mechanisms are in place and if interactions with the environment are supportive.

The medicine wheel, with its emphasis on body, mind, spirit, and context, makes the same point, LaFromboise observed. Thus, something as simple as the kitchen table can be a supportive context during a family dinner, as can stories meant to both entertain and instruct. A similar point was made by a Lakota elder, James Clairmont, quoted in Graham (2001):

The closest translation of “resilience” is a sacred word that means “resistance” . . . resisting bad thoughts, bad behaviors. We accept what life gives us, good and bad, as gifts from the Creator. We try to get through hard times, stressful times, with a good heart. The gift [of adversity] is the lesson we learn from overcoming it.

Suggested Citation:"3 Contributors to Resilience." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
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According to a social ecological model, risk and protective factors move through individual, interpersonal, community, and societal levels. For example, one of LaFromboise’s Ph.D. students has done a dissertation on community resilience among the Citizen Potawatomi in Oklahoma. This is “an area of exciting work,” LaFromboise said.

PROTECTIVE FACTORS IN NURTURING ENVIRONMENTS

Among the specific protective factors that can be identified as contributing to resilience are individual, family, community, peer, and school attributes. Among the attributes of individuals, social competence—the ability to draw out reactions in others—is a protective factor, according to research in suicide prevention. Aspects of social competence include flexibility—being able to adapt to a crisis and not being overwhelmed by it—empathy and caring for others, communication skills, and a sense of humor. As an example, Indian humor is “a wonderful coping mechanism,” said LaFromboise.

Autonomy is another individual attribute that can be protective. Autonomy, which includes self-awareness, resistance, and detachment, provides a sense of personal power and identity. For example, the ability to be detached gives children who are in troubled families a way to stay out of the fray. “They know how to still be a family member, engaged in what is going on, but stay away from trouble when it occurs,” she explained.

Cultural identity is a well-researched individual attribute that contributes to resilience, LaFromboise continued. According to research done with the Yup’ik people in Alaska, children who identify with a traditional way of life experience greater happiness, tend to be more spiritual, less frequently use drugs and alcohol, and have lower rates of suicide (Wolsko et al., 2007). The sense of belonging and commitment to a culture is “a very protective factor against many of the issues that children face,” LaFromboise said. Similarly, the level of engagement with traditional culture among the Pueblos, Apache, and Navajos has been correlated with lower death rates in New Mexico, and more traditional tribal groups tend to have lower death rates.

Another example of cultural continuity1 is the work with drum groups being done in Los Angeles by Daniel Dickerson at the University of California, Los Angeles, said LaFromboise (Dickerson et al., 2014). This provides an opportunity to get boys involved in cultural activities, whereas these activities usually involve more girls. The use of men as leaders and the provision of college credit for cultural activities are other ways to get boys

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1 Cultural continuity is defined as beliefs, practices, and traditions that are passed from generation to generation.

Suggested Citation:"3 Contributors to Resilience." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×

involved, she noted, adding that the objective is “to try to find creative ways to make [such activities] meaningful.”

Problem solving—the ability to plan and find solutions to life’s challenges—is another individual attribute that is protective. Problem solving involves resourcefulness, critical thinking, and what LaFromboise called “critical consciousness”—the ability to realize that another person is discriminating against an individual and the ability of that individual to act in his or her defense.

Family attributes are critical to resilience, yet more is known about individual and community factors than about family attributes. Families are protective of their own, LaFromboise said. They are not necessarily interested in being studied. Yet it is important to know more about supportive parenting, given its influence on resilience. Quality relationships and care, respect, and compassion are critically important. Children “come from the spirit world,” said LaFromboise, adding that “they are precious. They are spiritual.”

The care of a single adult—whether a parent, grandparent, guardian, or teacher—can help children overcome hardship. LaFromboise reminded the group that one-fourth of all Native children are being parented by grandparents. “That is wonderful, but it is also hard for the grandparents. Still, it says a lot about how important the sense of family is. . . . Also, grandparents are giving a lot of information about culture and values, [which] helps with the continuation of cultural beliefs,” she explained.

Peers are another major influence, especially with early adolescents. A sense of connectedness can overcome serious problems. For example, peer norms are a critical influence on substance abuse. “Knowing what peers are doing, rather than what they are rumored to be doing, can be effective in regulating one’s behavior,” she said. It also can be pivotal in suicide prevention. “Often children will talk to their friends,” LaFromboise observed. “They certainly won’t go to an IHS health clinic and reveal that they are suicidal or having suicidal ideation.”

In terms of education, schools can be sanctuaries for Native children, LaFromboise noted. For some youth, for example, school is the only place they can get a meal and feel safe. However, schools also can be sites of bullying, which can make a school a threatening place. Schools can help instill empathy in children, if time can be found for such preventative activities. Schools also can engage in a dialogue with students to help set policies and develop activities. Furthermore, schools can help transmit Native culture and languages, especially when culture and language are not being transmitted through communities and families. They can also showcase student talent and host cultural awareness events. As more Native teachers and administrators serve in schools, said LaFromboise, children will believe they are learning more and getting more opportunities.

Suggested Citation:"3 Contributors to Resilience." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×

Finally, communities have attributes that can build resilience. They are places that instill a basic sense of beliefs, values, and norms. They offer learning, social resources, recreational activities, economic resources, and many other opportunities. Communities can emphasize self-reliance and sovereignty. For example, they may invest the proceeds from economic activities into land rather than into individual per-capita payments, thereby fostering self-reliance and an emancipation spirit.

PROTECTIVE FACTORS AND SUICIDE

These protective factors can have an influence across the life span, with some more powerful in particular developmental phases. LaFromboise particularly called attention to parenting skills, which are often associated with first-time parents. But parenting requires support throughout the development of a child. For example, a parent liaison in schools can simultaneously understand what is going on in a school and be available to parents. Such individuals can check up on families on an annual basis and provide more extensive support or therapy if needed, including parenting skills training.

LaFromboise works in the area of suicide prevention, seeking to counter the substantially elevated rates of suicide among Native Americans. According to the Centers for Disease Control and Prevention, factors that contribute to higher rates of suicide among Native youth include

  • Behavioral health problems (e.g., anxiety, substance abuse, and depression)
  • Underuse of mental health services
  • High poverty
  • Poor educational outcomes
  • Substandard housing
  • Disease (e.g., diabetes; overweight and obesity)

To these, LaFromboise added factors such as acculturation stress, historical trauma, community violence, family disruption, and interpersonal problems.

In one study, depression and substance abuse—which LaFromboise called “the deadly duo”—predicted more than half of the variation in suicidal ideation, with smaller contributions from age, gender, and socioeconomic status. “The real heart of it is in the way that parents talk to their children and the kind of violence that they experience through bullying at school,” she said, adding that “that really makes the biggest difference in [suicide] prediction.”

Today, studies focused on risk factors are easier to have funded than

Suggested Citation:"3 Contributors to Resilience." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×

studies of enculturation,2 LaFromboise noted. But some of the new thinking among Native scholars is pointing to the importance of the latter. “Why is it that a woman at some point in time, at 35, decides that she is going to stop drinking with no treatment? Why is it that a community can totally turn it around if they choose to?” she asked. Enculturation is a critical link in such changes, said LaFromboise, and this link needs to be studied.

Interventions based on resilience factors, such as the development of better coping and problem-solving skills, can reduce the influence of some risk factors. For example, a community-driven suicide prevention program undertaken by invitation from the Pueblo of Zuni got good results in terms of reduced hopelessness, greater confidence, ability to manage anger, better peer suicide intervention skills, and better peer problem-solving skills (LaFromboise and Howard-Pitney, 1995). A similar comprehensive suicide prevention effort in the Southwest reduced suicide attempts from 40 in 1988 to 4 in 2002. An independent evaluation of a 30-session intervention in high schools found reduced hopelessness and suicidal risk and an increased sense of public collective esteem. “This is again a very exciting finding,” said LaFromboise.

Emphasizing the opportunities to make lives better rather than the challenges people face can inspire such programs, LaFromboise concluded. “People are much more excited about the theme of resilience than they are about trauma, hardship, and adversity.”

“People are much more excited about the theme of resilience than they are about trauma, hardship, and adversity.” —Teresa LaFromboise, Stanford University

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2 Enculturation is the process through which a person learns a traditional culture and assimilates its beliefs, values, and practices.

Suggested Citation:"3 Contributors to Resilience." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×

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Suggested Citation:"3 Contributors to Resilience." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×
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Suggested Citation:"3 Contributors to Resilience." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×
Page 16
Suggested Citation:"3 Contributors to Resilience." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×
Page 17
Suggested Citation:"3 Contributors to Resilience." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×
Page 18
Suggested Citation:"3 Contributors to Resilience." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×
Page 19
Suggested Citation:"3 Contributors to Resilience." National Academies of Sciences, Engineering, and Medicine. 2016. Advancing Health Equity for Native American Youth: Workshop Summary. Washington, DC: The National Academies Press. doi: 10.17226/21766.
×
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More than 2 million Americans below age 24 self-identify as being of American Indian or Alaska Native descent. Many of the serious behavioral, emotional, and physical health concerns facing young people today are especially prevalent with Native youth (e.g., depression, violence, and substance abuse). Adolescent Native Americans have death rates two to five times the rate of whites in the same age group because of higher levels of suicide and a variety of risky behaviors (e.g., drug and alcohol use, inconsistent school attendance). Violence, including intentional injuries, homicide, and suicide, accounts for three-quarters of deaths for Native American youth ages 12 to 20. Suicide is the second leading cause of death—and 2.5 times the national rate—for Native youth ages 15 to 24.

Arrayed against these health problems are vital cultural strengths on which Native Americans can draw. At a workshop held in 2012, by the National Academies of Sciences, Engineering, and Medicine, presenters described many of these strengths, including community traditions and beliefs, social support networks, close-knit families, and individual resilience. In May 2014, the Academies held a follow-up workshop titled Advancing Health Equity for Native American Youth. Participants discussed issues related to (1) the visibility of racial and ethnic disparities in health and health care as a national problem, (2) the development of programs and strategies by and for Native and Indigenous communities to reduce disparities and build resilience, and (3) the emergence of supporting Native expertise and leadership. This report summarizes the presentations and discussions from the workshop.

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