Welcome to this webinar with Ms. Shelby Rowe on Suicide Prevention in Native Populations, a Cultural Introduction. This webinar is sponsored by the Suicide Prevention Resource Center in collaboration with the American Psychiatric Association. At the end of today's presentation, there will be a Q&A period where the audience may submit questions to the speaker. Before Ms. Rowe begins the presentation, there are just a few housekeeping items to go over. Please advance the slide. SPRC at the University of Oklahoma Health Science Center is supported by a grant from the Substance Abuse and Mental Health Services Administration, or SAMHSA. The views, opinions, and content expressed in this webinar do not necessarily reflect those of SAMHSA or DHHS. Next slide. There are no conflicts of interest to report for the webinar. Next slide. SPRC is the only federally funded resource center devoted to advancing implementation of the National Strategy for Suicide Prevention. Supported by SAMHSA, SPRC builds capacity and infrastructure for effective suicide prevention by working with state, tribal, health, and community systems, as well as professionals, partnerships, and other stakeholders. We would like to make you aware that the webinar is accredited and implemented by APA, which has designated the activity for one PRA category one credit. Instructions for claiming credit will be provided at the end of the webinar. Also please note that the handout for the webinar can be downloaded from your screen. If you're using the desktop version of GoToWebinar, the file is located in the handouts area of the attendee control panel. If you have joined from the instant viewer, instead you'll click the page symbol to display the handout icon. During the Q&A portion of the webinar, you can use the questions area of the control panel to ask questions by typing them into the display box on your screen. Now I'd like to introduce today's speaker. Shelby Rowe is the project director for the Suicide Prevention Resource Center. As a public health professional, crisis intervention expert, and suicide attempt survivor, Ms. Rowe has been a leader in the suicide prevention movement at the local, state, and national level since 2007. Ms. Rowe is a board member for RI International, and she currently serves on the American Indian and Alaska Native Task Force, and on the Care Transition Advisory Group for the National Action Alliance for Suicide Prevention. She also serves on the Clinical Advisory Board for the Crisis Text Line, and as co-chair of the Lived Experience Committee for the National Suicide Prevention Lifeline. She was named the 2016 Chickasaw Nation Dynamic Woman of the Year, and in 2019, she co-founded the Indigenous Peoples Committee for the American Association of Suicidology, and in 2020, she became a faculty member for the Zero Suicide Institute. Ms. Rowe, welcome, and thank you for joining us. Thank you, and thank you, everyone, for joining us today. Let's get started. This is our land acknowledgement for the Suicide Prevention Resource Center that was crafted by Dr. Dolores Bigfoot. We acknowledge that the land that now makes up the United States of America was the traditional home, hunting ground, trading exchange point, and migration route of more than 574 American Indian and Alaska Native federally recognized tribes, and many more tribal nations that are not federally recognized, and no longer exist. We recognize the cruel legacy of slavery and colonialism in our nation, and acknowledge the people whose labor was exploited for generations to help establish the economy of the United States. We honor Indigenous, enslaved, and immigrant peoples' resilience, labor, and stewardship of the land, and commit to creating a future founded on respect, justice, and inclusion for all people as we work to heal the deepest generational wounds. In today's presentation, we're going to go over some common terms and definitions. We'll go over a brief history of U.S. tribal relations, and talk about tips for working with individuals or members of federally recognized tribes in this country. So let's get started. One thing that I often hear are questions, so which term is the right term to use? Should I use American Indian, Native American, First Nations? It can be complicated, and I think the best answer would be, it depends. Different generations, different regions have preferred terms. So when possible and appropriate, especially in clinical settings, use the specific tribe, or when in doubt, just ask that individual. My preferred term is Native American. I know many individuals that their preferred term is American Indian, or First Nations, Indigenous. There are many terms, and the best way to pick the right one is just to ask whoever you're meeting with, speaking with, which term they prefer, and use that term. I also want to point out the definition of federally recognized tribes. I think oftentimes it gets confused, so I want to go over so that we know what we're talking about today. Federally recognized tribe is an American Indian or Alaska Native tribal entity that is recognized as having a government-to-government relationship with the United States, with the responsibilities, powers, limitations, and obligations attached to that designation, and is eligible for funding and services from the Bureau of Indian Affairs. The last part being relevant, of course, because I pulled this definition straight from the website for the Bureau of Indian Affairs. It goes on to say, furthermore, federally recognized tribes are recognized as possessing certain inherent rights of self-government, i.e., tribal sovereignty, and are entitled to receive certain federal benefits, services, and protections because of their special relationship with the United States. At present, there are 574 federally recognized American Indian and Alaska Native tribes and villages. Notice in this definition, there is nothing about race. Being a member of a federally recognized tribe is a political status, not a racial category. When we get into who is an American Indian and Alaska Native, tribal citizenship for every tribe, it varies. It's based on their unique treaty with the U.S. government because, again, it is more a political status than that lineage when we're looking at a member of a federally recognized tribe. As a member of that tribe, sometimes that is based on blood quantum limits. There are certain tribes that you must be able to document that you are at least one quarter of a direct lineage for that tribe. Others, it's established on descendants. For example, my tribe, I'm a citizen of the Chickasaw Nation. It is based on if you can show your descendancy from one of the original enrollees of the Dawes Act, then you are a member of the tribe. Tribes are different. Again, it's based on treaties. You can be of Native descent and not be a citizen of a tribal nation. The government, you can be a member, you can be descended from multiple tribes, but the government, again, because of political status, you can only be an enrolled citizen of one tribe. Individuals, like for me personally, I say I am a citizen of the Chickasaw Nation. I am descended from Cherokee ancestry because I am not a citizen of the Cherokee Nation. It gets complex. As you would imagine, with 574 nations plus many more, there are tribal community members that are not always tribal citizens. If you are not a tribal citizen, but you are married to a tribal citizen, your children are tribal citizens, you're often seen as a community member and are granted those social roles that fall with being a community member for that tribe, but not be a voting tribal citizen. Then we also have tribal citizens who, by their blood quantum, by whatever the requirement is of their tribe, they are a member of that tribe, but they do not affiliate with any tribal community, either an urban community or their tribe's headquarters, the location, a reservation-based community. They are a citizen, but not affiliated with their tribe. Again, being Native, we're talking about it's a cultural connection, a cultural affiliation, a political identity, or our race of the descendancy. It is complex, but I think it is navigable. Apologies if I say my mouse is giving me issues today, so I'm going to use my keyboard to progress. I want to talk about the history by showing you what I think is the most beautiful selfie in the world. You're probably looking at this and saying, Shelby, this is not a beautiful picture, which I concede. These women are wet, disheveled, and the background is a mess. This is my dear friend, Tracy, and her daughter, Elena. I think that this is the most beautiful selfie because I know who they are, and I know what they just came through. Tracy is a citizen of the Caddo Nation, and she is a culture keeper. She makes regalia, moccasins. She is one of the few people who knows the traditional way to make burial garments, things like that, wedding garments, birthing garments. Her daughter, Elena, is working on her PhD in linguistics and is working to revive the Caddo language because there are only a handful of traditional speakers left. This picture was taken at the Caddo Mounds State Park in Texas during culture days. Those two women had just walked out of this. The building on site at the state park in Texas was hit by a tornado. They were about three dozen culture keepers who were there for culture day, sharing their culture with park visitors and fellowshipping with one another. The building was hit by a tornado. Where the chair is in that picture on the left, Tracy and her daughter crawled out from underneath that wall. They also were holding onto the arm of a small boy, keeping him from being sucked away by the storm. Miraculously, of the three dozen people who were in the building, no one died. There were some critical injuries. Tracy herself suffered a closed head traumatic brain injury and has had significant things to overcome in her recovery. But they had just walked through this and they took a selfie because they were alive and they wanted to post it on social media so that people would know what they had walked through. We talk about trauma-informed mental health care, trauma-informed suicide prevention, but we can't have trauma-informed suicide prevention or mental health care without justice. And for the people indigenous to our continent, there has not been justice yet. A common saying, when my grandfather grew up and even when I was a child, was that the only good Indian was a dead Indian. Even Theodore Roosevelt had made this comment that I don't know so far as to think that the only good Indians are dead Indians, but I do believe nine out of every 10 are, and I shouldn't like to inquire too closely in the case of the 10th. For me growing up, when my mom and I would ask my grandfather, why would he never tell anyone that he was native? And he would say, well, because the only good Indian is a dead Indian. He would walk out of the room. The motto of the boarding school era, which I don't know if you've seen it, I strongly recommend Google the, there was a federal report that came out, volume one, of a look at the first report to document the boarding school era in the United States for federal boarding school policy. The motto of those schools was kill the Indian, save the man, to strip away all parts of culture and language and family, to fully assimilate tribal children into the westernized world. This is not just my opinion. Here's a statement from a bishop who ran one of the schools, we instill in them, the students, a pronounced distaste for the native life so that they will be humiliated when reminded of their origin. When they graduate from our institutions, the children have lost everything native except their blood. When we look at the history of those indigenous to this continent in the United States, they have faced every layer and level of genocide, from ecocide of the destruction of food sources, building of dams to keep the salmon from reaching communities in the Northwest, the buffalo slaughter, termination of treaty rights, of land rights, culture side in our boarding schools and separation from our homelands, from our families, from our communities, and then outright genocide. I did a quick Google search a few years ago looking for dates. I won't read all of these to you. I'm going to hit a few of them. The first one is the Declaration of Independence, and you might say, well, what does that have to do with native oppression? If you read in that document, it refers to individuals indigenous to this continent as merciless Indian savages. So that Declaration of Independence, you know, now that we were a threat to the existence of the United States. The woman on the right is who I want to tell you about. This is one of my relatives. This is my ancestor. Her name is Mourning Tree Allen. Mourning Tree as in sad tree, and for a long time I didn't understand her name, but I kept asking people in my tribe, like, why would she name her child Sad Tree, Grieving Tree? And I had another Chickasaw relative explain to me what was happening at the time that Mourning Tree was born. Mourning Tree was born in 1833. As you'll see on our list on the side, Indian Territory was created by the Indian Removal Act. There was a law passed that all American Indians who were living east of the Mississippi would be forcibly removed from their land and moved to what is now Oklahoma. Our tribe, our removal began in 1837. Some of Mourning Tree's uncles were ambassadors for the tribe, and so they were very much involved with what was happening, and so her mother had knowledge of all of the details of that would be our forced removal. During this time, whenever our tribe would have ceremony and gatherings, our elders would go into the woods and they would hug the trees and cry and say goodbye to our ancestors. There are even tales of some rubbing their backs on the bark of the tree until it bled so that they could leave part of themselves in our homelands, which is now Mississippi, Alabama, Tennessee. And her name in Chickasaw is Iti Ishaya'a, which either means she who weeps for the tree or the tree who weeps for her. Mourning Tree was four or five years old when our forced removal began. She was an orphan at that time. Her brother asked for special permission from the Chickasaw government and U.S. government to stay in Mississippi under the guise of settling family affairs, but they were able to delay the removal for our family for 10 years, and I believe that was so Mourning Tree could grow up because being a five-year-old orphan during forced removal probably would have taken her life. She grew to be six foot tall, 300 pounds, which for my tribe is a very large woman. She was known as the boss. She was a traditional healer, midwife, and an entrepreneur. Her and her husband ran a trading post. So this picture was taken in the 1890s. You'll look during that time of pagan ceremonies banned. This banned all of our religious ceremonies, all of our traditional healing ceremonies, our dances and prayers. This picture shows who was impacted by that law. I think she looks more like Queen Victoria than a savage, but this is who was impacted by those laws. In 1902, they even went so far as to ban indigenous hairstyles. Men who had long hair or braids could be imprisoned or killed. This is some heavy material, and for me, one of my favorite coping skills to get through trauma is music, so we're going to add some music. You know I can be found, I sit in all alone, I don't be cruel to a heart that's true. In 1956, when Elvis was on the radio, the Indian Relocation Act was passed. What they were finding with the boarding school era is that individuals, despite their efforts to strip them of community ties, they were moving back home to their communities and rural areas. The goal was to move as many working age American Indian and Alaska Natives into urban areas. On that, in some ways, you could say that was a success because today up to 70% of tribal citizens live in urban areas, and 78% of us do not live on our tribal reservation lands. This also, because it occurred in 1956, this also created the time for, as they were moving all of our working age men and women into urban centers, they came together in the beginning of the Civil Rights Movement and formed the American Indian Movement. All right, I have one of my favorite people, this is my oldest son, to help us get through a really dark time. Hey baby, cause you're fine, and you're mine, and you look so divine, come and get your love, come and get your love. When I was a little girl, and showing my age, but I started kindergarten in 1977, and my grandmother, who's Chickasaw, and made sure that we were all enrolled, she told me when I started school, don't ever take your, don't take your Indian card with you, my CDIB card, and don't tell anyone you're Indian because if something happens to you, they will take you to the Indian hospital and you will die. I thought that this was a horrible way to scare a child. I now realize and learning about this that women and girls documented history of forced sterilization of native women and other women of color. It's believed that up to 25% of what was at the time full-blood native women of childbearing age were sterilized. This was ended in 1976. So within my lifetime and maybe within the lifetime of many of you. All right, the two people in my family that sing, I had to include them. ♪ For my heart must be true ♪ ♪ Nothing for me to do ♪ ♪ You are the one I want, you are the one I want ♪ ♪ Oh, oh, oh, oh, honey ♪ So in 1978, Greece was in the theaters and we finally have some good news on our tour. The American Indian Religious Freedoms Act was passed. This finally gave us freedom of religion in the United States. So our freedom of religion is as old as Star Wars and also the Indian Child Welfare Act was passed. This was intended to help undo some of the harm of the boarding school era and the era of the really any home was a better home for an American Indian or Alaskan Native child than in their tribal community. This gave tribes the ability to advocate and to help find homes within their tribal community when a child needed to be removed for their own safety. So this started to give us back the right to raise our own children. ♪ If you hold on for one more day ♪ ♪ If you hold on for one more day ♪ ♪ Things will go your way ♪ ♪ Hold on for one more day ♪ 1990, I graduated from high school, and more importantly, the Native American Graves and Repatriation Act was passed. Up until this time, and especially started at the turn of the century from the 1800s to 1900s, it was believed, like it's through scientific racism that American Indian cultures and peoples would be exterminated, would be eliminated. And so they were collecting objects. Sometimes this meant digging up graves and putting sacred objects on display. With this, museums, institutions, started the process of tribes were able to begin negotiating to bring these remains, bring these sacred objects back home. This was passed in 1990. We are still working on this. You know, a few years ago, some children who were buried at Carlisle Indian School in Pennsylvania were finally sent home to be with their relatives, and the tribe welcomed them back. Here in Oklahoma, we just recently in the past year, there were many objects that were collected from tribes in Oklahoma that were brought back. They were at the Smithsonian and they were returned to our state. They're now, some of them are on display, but they, and some have been returned for proper care, but they were welcomed with ceremony, with spiritual leaders from all the tribes from which they were removed, and they're on display at First Americans Museum in Oklahoma City. ♪ Is it you like the way you look at me, my true baby ♪ ♪ You should go and love yourself ♪ In 2016, Justin Bieber was on the radio Everywhere You Went, and there were some young people at the Standing Rock Reservation that they wanted to go protect their waterways. For many tribes, natural elements, things on this Earth are sacred, and they were going to protect the water, Mother's Milk from Mother's Earth from a pipeline that had been relocated from an urban area to right next to a major water source that also, its tributaries provide water for most Americans in the middle of the country. They not only inspired their community, they inspired individuals from all over the world, whereas the pipeline was built, and it has leaked, by the way, as they feared to pollute this waterway that is crucial to so many of us for drinking. So on that side, they were unable to stop that, but they were able to create unity and bring tribal nations together in a unified voice like never before. And they brought together political leaders, artists, entertainers, to create sort of a rebirth, a cultural renaissance from this era. Last song on our list, you may think, what could have possibly happened? After 2017. ♪ What a man gotta do, what a man gotta do ♪ ♪ Be totally locked up by you. ♪ Quick history lesson, if you remember the US Thanksgiving myth that we were all taught in kindergarten, the Mashpee Wampanoag is the tribe who greeted the Mayflower and took in the pilgrims, taught them how to farm, and kept them alive that first year. And the government is still attempting to terminate the rights to their land on Cape Cod. The tribe was able to appeal, and as of today, they still have their status and recognized, and they still have their land that's now shrunk down to just 312 acres. So you may think, what does this have to do with suicide prevention? You know, when we look at Dr. Thomas Joyner's interpersonal theory of suicidality, it teaches us that what causes that desire for suicide, you know, in cases of where the most high-risk suicide deaths, high-risk suicide attempts take place, is a sense of perceived burdensomeness, that my existence is a burden to my family and my community, and a thwarted belongingness, a feeling disconnected. And when we look at systemic issues in the United States, we look at just manifest destiny, that tribal citizens were taught from birth that our existence, our tribal identity, is a barrier to progress of the United States. So it's a perceived burdensomeness on a systemic level. And then the thwarted belongingness that comes from, you know, in my generation, most of the conversations I have with other tribal citizens my age is talking about our process of coming home. We were born to individuals who were raised in boarding schools, who had been taken away from their culture. And so we all have family stories of how do we reconnect? How do we find that belongingness? How do we re-indigenize? So of course, you know, these things play a role in our suicide risk. The not so surprising news, a policy of killing everything Indian, as was stated earlier, it actually does kill the man. And it is our men who are affected most, we see the suicide rates the highest. For our young men, starting at age 15, you'll notice in the blue bars, higher suicide rates than their white male counterparts. But something happens, and you'll notice at the 35 range, something happens. Our population, our suicide rates actually drop below that of our white peers. And this trend also happens with our females. So in this chart looking at, and this is a, I believe a five-year trend. I apologize for not having the dates on our charts, but this is from 2016 to 2020. And you'll notice the trend the same for our American Indian, Alaska Native males and females. The rates after about 30 start dropping down. There needs to be more research done. My hunch is that it is community connectedness and purpose that helps provide a powerful protective factor. And when we look across a lifespan, and we include all ethnicities, when we're looking at data, and when we take out Hispanic origin, we are erasing a significant chunk of American Indian, Alaska Native populations. Because many of our Southwestern tribes, that borderline between the US and Mexico was an arbitrary line and many identified. There are tribes, the Apache tribe has each year, they have ceremonies that take place in Mexico and ceremonies that take place in the United States because they existed in that space before that political barrier. And so when we're looking at data for American Indian, Alaska Native, it's crucial that we keep that, look at Hispanic and non-Hispanic. We look at all ethnic origins. So on this chart, I also kept all ethnic origins, the white counterparts. And you'll notice when we look across the lifespan, American Indian, Alaska Natives actually have a lower overall suicide rate. I think that's remarkable because we don't talk about that enough in suicide prevention. There are certain regions of the United States and maybe another point in discussion, we can talk about some of those other issues because there are segments that do have substantially higher. But when we look across the entire range, as a whole, American Indian, Alaska Natives, we actually have a lower suicide rate. So I wanna challenge you to question those stereotypes. When I was growing up, I grew up with the stereotype that all Indians were drunk. So we were all prone to be alcoholics, the drunk Indian stereotype. The Urban Indian Health Institute looked at data that was collected in all urban areas from 2009 to 2014. And what they found, and remember, 70% of all American Indian, Alaska Native individuals live in urban areas. Only 40% of those reported using alcohol in the past month, which was significantly lower. 53% of non-Hispanic whites in urban areas reported using alcohol. So actually, American Indian, Alaska Natives, when looked at as a whole, have a much higher sobriety rate. A friend of mine who worked at a hospital and they did intake interviews. And their area had a pretty high Native American population in their community. And they had said, you know, when they thought of a Native American man, their first thought was homeless, suicidal, alcoholic. And that broke my heart. Because when I think about a Native American male, I think of John Harrington, the first tribal citizen to go up in space, who also happens to be a Chickasaw. I think of composer Jared Tate. I think of filmmaker Sterling Harjo, actor Wes Studi, entertainer Tabu from the Black Eyed Peas. I think of artist Stephen Paul Judd, who his art is scattered through this presentation. I think of my dad, standing here in his Chickasaw Warrior Society vest. And I think of my sons. Who do you think of when you think of a Native American male? I challenge you to question those stereotypes. I was at a conference once and someone said, the difference between a tragic tale, an inspiring story is how it's told. And I think when we're talking about mental health and suicide risk in tribal communities, it's time to tell a different story. Because in spite of over 500 years of systemic efforts to take away our land, our cultures, our traditions, our lives, we're still here. There are still 574 tribes that have political recognition from the federal government and many more that have state recognition. We are still here. And that is pretty remarkable. Our cultures are alive and continue to evolve and develop. My tribe, the Chickasaw Nation, we are not necessarily a powwow tribe, but we do stomp dance. And our women wear shakers. Our men carry hand drums. We dance around a fire. We go counterclockwise so that our hearts are always closest to the flame. Originally, our women's shakers were made from deer toes that their uncles and brothers and fathers would collect deer toes in their hunts. And when the young woman came of age, she wore these shakers. Once we realized, hey, we don't make a lot of money selling deers, we switched to tortoise shells that we filled with river rocks. And they made that noise and it connected us and reminded us of where we come from and our connection to other animals. After removal, tortoises became endangered. And in our commodity boxes, we were taken away and discouraged from using our traditional farming methods, farming, and we were given commodities. And in those commodities, there are little cans of condensed milk. And our women took those cans and they filled them with pebbles, still filled with river rocks, and they made much more durable shakers that are lighter weight. And I love that they come with instructions for future generations, because on the top of every can, it says shake well. We talk a lot of mental health about risk factors in tribal communities. So I wanna take a minute to talk about some of our strengths. One is the extended family and kinship ties. Because many of us and our parents and grandparents were removed and put in boarding schools, we created our own families, our extended family and kinship. I am part of a group in Oklahoma City called Matriarch. In this picture is one of my matriarch sisters and a few of our matriarch nieces. One in the background speaking, my sister Kendra is there getting a blessing from a younger child. We call each other sister, our children are each other's nieces and nephews, and we are there for each other like family to help celebrate good times and to help support during hard times. If that means showing up and helping a sister go to court because she's filing a protective order against an abusive boyfriend, or we're celebrating a national recognition. We have the ability to form that family, which is a cultural strength. We have the ability to walk in two worlds. We have the ability to walk in two worlds, which we can be in our tribal communities and then be in our mainstream society and go back and forth seamlessly. The retention and reclamation of our languages and cultural practices is a big. After that law was passed in 1978, the Religious Freedoms Act, for a lot of our tribes, unfortunately, lost some of that wisdom, but we are getting it back. Many tribes are investing a lot of resources into language revitalization programs and to cultural teaching lessons. And we're learning through research. Johns Hopkins has a beautiful report called Culture Forward to look at that shows where research, where engaging in these cultural practices is suicide prevention. It is good for us, it reduces risk factors, which shouldn't be a surprise because we know other things in mainstream Judeo-Christian society that having ties to church, having traditions, these are protective factors. And it's the same for our tribal citizens. Our culture is protection. And we often, given the chance, we can develop really strong tools that are good for everyone. I think often we look at tribal communities as a problem to fix instead of the answer to discover. Young people with the Fresno American Indian Health Project, they developed a self-assessment tool looking at what was out there. And they developed a tool that's strengths-based, holistic, youth-friendly. It was based on the medicine wheel. You'll notice the four main categories, generosity, sense of belonging, mastery of skills and gifts, and interdependence. These are all powerful protective factors for our mental health and to prevent suicide. Some of the questions from that survey that you'll notice that I think that this is a great self-assessment tool for any community, for any mental health professional to use, not just with tribal populations, these are good questions for everyone. Things like, I make an effort to learn something new every day. I'm not afraid to step up to be a leader, a role model or mentor in my community. I can usually control my reactions and emotions so that I don't do anything I will later regret. These are all great questions to have the young people we are working with in treatment to go through this self-assessment tool. Some tips, I want to go over some basic tips. And again, this is not all-inclusive. These are just a few things to help start that conversation. Keeping it focused on our clients in a mental health setting, asking those open-ended questions. The, can you tell me more about that? Or when I heard you say this, what did you mean by that? This can really help because research has shown that even though most American Indian, Alaska Natives speak English, we can use English in a different way. And sometimes the meaning can be misinterpreted or overlooked, which can be harmful in a therapeutic relationship. Because one of the side effects of not being allowed to express emotions and not being allowed to express emotions in boarding school situations, in those boarding schools that were really run like military boot camps, any expression of emotions was harshly punished. And so learning to not express emotion was a survival skill. And so even though now like expressing emotions is something that we as general society perceive as something that we should do, in many tribal communities, we still believe that we can't, that sharing emotions is not safe. And so we'll say things like, I felt some kind of way when that happened. Or, you know, when they said that, it made me feel some kind of way. Ask what that means. That can mean a multitude of things. But ask, say, hey, when you said that, can you tell me more, what kind of way? Or one example that was given in a painful story was saying things, you know, minimizing and saying, well, he was bothering me. There was a young girl who lived in Alaska and she had reached out for help, called a local hotline and had been telling them, she made a few calls saying, at home, I'm really upset, I don't know what to do, I don't, there doesn't seem to be a way out. And there was an uncle in the household that she said was bothering her. And the main true hotline, they didn't really grasp the meaning. She somehow got the number for one that was operated by tribal citizens in her area, and they instantly picked up that she was trying to tell them that she was being molested by this uncle. So when they say things of asking those questions, what do you mean by that? Tell me more about that to welcome and encourage that sharing of emotions so that we can help learn, help heal and learn how to communicate in those ways. Again, body language can have different meanings. Not making eye contact can be a sign of respect. It does not mean that they are avoiding, oftentimes, young native boys, even girls are seen as being disrespectful or trying to be sneaky for not making eye contact, where culturally, they feel that they are, it was a sign of respect of keeping your head bowed and not making eye contact when someone older is speaking to you. So checking the meaning, because they could be in their mind being very respectful, but sometimes that behavior is seen, as trying to not connect, where really they're trying to be respectful. And that stoic, flat affect, again, this can be not trying to express emotions. So creating safe spaces in your homes and in therapeutic situations and communities to help that it is okay to express emotions, be it joy, fear, anger, pain, that it is safe to express those emotions. And suicide prevention, I hear often from practitioners as well, you know, we have a tribe in our area, and we can't do suicide prevention because they won't say the word suicide. And I would say that that's not a problem because they do say the words healing and grief and recovery, community strengthening, family mending. So we can talk about healing after a suicide loss, and we can talk about preventing the death of a community member without using the word suicide. There are tribes that there is no word. There are tribes, and there are tribes and their belief that when we name something, when we use that word, that we are inviting that, that all words have power and that you are inviting that to come into your community. For some that we don't say, there are tribes that we don't mention the names of those who die by, you know, die a traumatic death or die by suicide because we want, we don't want their spirit to feel that they need to stay with us. We want their spirit to go on and be with the ancestors. So a lot of traditional, what we see in mainstream society of grieving or practice, you know, community grieving practices after a death by suicide can actually be culturally and spiritually harmful for a tribal citizen who feels that by using that person's name, that we are bringing their spirit back and we're not letting them rest. For my tribe, we do have a word for suicide. It is elebi. Follow the lead of your community and reflect their language for effective communication. We would do this if we visited any other nation around the world, we would want to know what their cultural norms are so we could follow them. I was talking with someone yesterday who works with tribal communities and we talked about, you know, every community they go into, they essentially create for themselves a dossier. They create a profile, they go online and they look and they read about the tribe. Where are they located? Where were they originally from? Where, you know, what kind of industry do they have? How many citizens do they have? Learning about that country so they can go interact with them. We do this, you know, imagine if you were going to Europe, you would want to know what country you were visiting. If you are going into a tribal community in your state, you are going onto lands that, you know, a federally recognized tribal land, learn about their cultural norms and reflect that in your communication. Assessing, there are surveys and things that talk about, you know, tribal acculturation. Sometimes even just filling out one of those acculturation surveys can trigger a trauma response. Many of us, I know for me personally and our family, there is shame that we don't know a lot of those traditions, but they were taken from us. So grieving that, so just taking those surveys causes grief and psychological discomfort. Instead, it can be more helpful to actually tell you more about that person. Not do they know the history of their people and know historic traditions, but are they affiliated? Do they have an identity with their tribe or with a tribal community? You'll notice on the scale, sometimes there may be someone, again, that is a tribal citizen, but has little or no tribal affiliation, but they have a very strong identity tied to a different part of themselves, either being Black American, being Hispanic, being Italian. Some have little or no tribal affiliation, but have that strong cultural identity. Maybe they don't really identify when you meet them as being, you know, a citizen of the Chickasaw Nation, for example, like myself, but they may say, you know what, I am Episcopalian through and through, or, you know, identifying with other things. And others may be a tribal citizen, but they have little or no tribal affiliation, but they have that deep yearning to come home. One of my friends who worked for a tribal behavioral health program had said oftentimes when they were doing intake assessments, the person would say, I really want traditional healing to be part of my treatment. And they would say, great. How can we help facilitate that? What does that mean for you? And oftentimes the clients would cry and say, I don't know, but I know that I want it. So helping people find that affiliation, helping people come home is good for their mental health. In closing, I'm gonna talk about, you know, appreciating the diversity among the cultures. There are, in the picture on the side, this is our traditional village at the Chickasaw Cultural Center. You will notice there are no teepees. Not all tribal citizens lived in teepees. We had our main, you know, our community building. And there, it looks kind of like a pyramid. And each family had two houses. You had a winter house and a summer house. The winter house was very well insulated. The summer house, not so much, because it was hot in Mississippi and Alabama. But knowing the different traditions in the imagery, there's so much diversity. And again, any one of us, just as none of us could, you know, be a good representative for our city, for our state, for the United States, there's no one size fit all. And each individual, no matter what their tribal affiliation is, has their own individual experience. And we need to respect and honor that, because there's no monolithic. There is no way to become culturally competent in all tribal nations, but we can all be culturally respectful and have that cultural humility and come ready to learn. Again, back to my friend Tracy and Elena, when we're looking at, when a tribal citizen comes into your facility for mental health care, before we pass judgment on the list of risk factors, I just ask that you take a moment and respect the storm that they had walked through to get there, to get to your office seeking help. We are extraordinary survivors. With that, I'm gonna invite our moderator, Ben, and Dr. Bigfoot to come and join me for Q&A. Yeah, thanks Shelby. A lot of powerful information and tips for working with communities and tribal members. As we move into the Q&A portion, I'd just like to remind participants that they can use the questions area of the control panel to type in a question. And for the Q&A, as Ms. Rowe mentioned, we're joined by Dr. Dee Bigfoot, who is the Director of the Suicide Prevention Resource Center. She and Ms. Rowe work together on all aspects of SPRC. Dr. Bigfoot is a Child Psychologist and Presidential Professor at the University of Oklahoma. She directs the Indian Country Child Trauma Center at the university. And since 1993, she's led Project Making Medicine, which is a clinical training program on child maltreatment that uses culturally based teachings. She's also been instrumental in the cultural adaptations of different child treatment protocols. And as I mentioned, is directing SPRC and has been doing so since 2020. So Dr. Bigfoot, thank you for joining us. While audience questions roll in, I wonder if I might kick off the Q&A just by stepping back to the part of the presentation about cultural strengths. Ms. Rowe, you had mentioned the ability to walk in two worlds as a strength. So could you and Dr. Bigfoot say a bit more about that? Sure, I'm gonna let Dr. Bigfoot go first. We can't hear you, if you could unmute. I think I'm unmuted now. Okay, great. Thank you. I just wanna say thank you, Shelby, for laying a wonderful foundation of knowledge and understanding and perspective about what so many families go through to get to this point. And I think that as we think about the understanding of the different pathways, the walking in two worlds, and I think you saw it demonstrated well here, the ties to cultural identity, the ties to cultural teachings, the ties to native ways, and then being able to demonstrate and to explain how the impact of the atrocities and the policies have really impacted our tribal communities. So I think just the understanding of how do we present information in a way that is receivable without triggering a lot of reminders, but also recognizing the strengths that are there. So when we think about walking in two worlds or more than even that, I think when we think about walking in, when the interchange amongst cultures, whether it is the culture of education, the cultural of health, the culture of native connections, that being able to navigate the norms, navigate the understandings, navigate the language, and continue to draw from the strength of what is those foundational anchors that allow an individual to know and feel and the willingness to be part of different societies, different communities. And just when we think about what it means to be in a safe space or in a community, how do we allow and recognize that space is safe? And how do we support individuals who have had these histories and is challenged by things that are triggering or things that have such heart-wrenching histories? So I think it was well-demonstrated today. Shelby? Yes, and I appreciate, Dr. Bigfoot and I had a good conversation about this before, and she had brought up, we were going over the slides, and I had the walking in two worlds, and so there's multiple worlds. And I was like, oh, you're right. Even within different tribal communities, like here in Oklahoma, I was invited to a dinner with the Pawnee Nation. And I went, in my tribe, we are matriarchal. And our elders, if we're having a meal, our elders go first, and then our men go last after our women and children. But in the Pawnee tradition, their men go first. They're patriarchal in theirs. And so of respecting those differences and knowing when you come into a new culture to take time and learn those norms. Like many of us have gone, even we look on the level of going to a fancy restaurant for the first time, and you watch others to see which fork to use and using that, and knowing when we go into communities. Oftentimes, whenever we're part of a dominant community, it feels uncomfortable being in another space, but go in as a learner, as a compassionate, friendly learner, and that will go a long way in building that rapport with that individual, with that family, with that community, because we are all Americans, and just embrace the beauty of the difference in those cultures. But yes, that's a tribal strength. There are many other communities that also have that strength, but I think it's something that we overlook. I think so much was put on, well, this person was, you know, sort of like resi, and they don't know how to act in the city. I tell you, there's people in the city that do not know how to act in rural America either, you know, that it's not a tribal thing. And so a lot of times those stereotypes and those harmful negative stereotypes, if we just step back and look, that all of us get shy, awkward, uncomfortable going into new spaces, and I think that tribal populations, for centuries before Europeans ever touched this continent, were good at walking in multiple worlds and had trade routes that went from Nova Scotia down to Argentina. So that is a strength, and I think that we should celebrate that more. Yeah, thank you. Related to these ideas of safe spaces and approaching tribal communities and individuals with openness, there was a question from the audience asking about some actions that we can all take to better be allies to Native communities. So you've mentioned a few things, but could you expand on those? Sure. So one thing I think that often, you know, and as someone who in the past, you know, was a State Director of Suicide Prevention for a few states, oftentimes it's, you know, very good intentions of going, oh my goodness, I've noticed, you know, there's a suicide death or there seems to be a suicide contagion in this tribal community. And what is culturally appropriate for us at the state level, like, oh, let me, let me be a part of this, let me be a part of this, but at the state level, like, oh, let me, let me come in with all my resources. In that tribal community, I think best to approach it as a neighbor and just say, hey, I'm so sorry for your loss. Do you need anything? What can I do to help support healing in your community? And give them the opportunity to ask for what they want before we rush in with that toolbox of everything that you need. Wait and let them ask because they may have a lot of good options and give them a chance so that you can help support their strategy instead of us with our well intentions rolling in with our own strategy that can really feel impersonal and dismissive. And think about that in your own home. We all have friends or relatives that are a little overbearing that roll in and wanna take over our life situation. And giving that example to be like, we've all experienced this, just knowing that on that tribal level, that coming in, that being, coming in as a guest in their space, just first come in as a friend, come in as a neighbor, and that will go a long way in being allies. But yes, any of us, if someone came in and said, hey, I noticed you've got this issue. Like for me personally, I'm trying to exercise more. My oldest son is a vegetarian, a yoga instructor and a fitness guru. And he knows not to roll in and tell mom how I need to be eating, what I need to be doing. But he'll answer my questions. And I think that of being respectful and not always rolling in, because again, for our tribal communities, they are doing something right that suicide rates drop and continue to drop once they're in their 30s. Maybe roll in and go, hey, what is working for you? How can I learn from you? So as allies, always thinking they have answers for us to discover, and then rolling in and asking what they would like help with, instead of rolling in with all the answers. Sometimes our good intentions really get in our own way. So that would be one thing I'd recommend. I see more enthusiastic allies that kind of come across off-putting than people who don't care. So you probably care, just come in and ask, check and see if they're okay first and then we can start offering them all of our tools. And Dr. Bigfoot, do you have anything to add on that? I just want to go back to what, how this webinar was started and how we try to start all of our introductions with the land acknowledgement. And if you're wanting to be that ally, think about that land acknowledgement, think about what it means to be in that particular space with the community and what their connections to that space is, and that there's that history there. And are you willing to look at that land acknowledgement and understand the privileged space that you might come from and how that might skew what you see as helpful or not so helpful interactions with the community? Great, well, thank you both for joining. We are a little bit past the hour. So I think we'll wrap up the Q&A here. If you could advance the slides, I wanted to give the audience a second to review how to claim credit for today's webinar. So there are some instructions there for you to follow. If you have any questions, please email learningcenteratpsych.org. APA staff will be able to answer any questions you might have. And again, I'd just like to thank you, Ms. Rowe and Dr. Bigfoot for your time. We also appreciate all of the participants who attended today. Please also consider joining us for SPRC's next webinar, which is on supporting tribal youth at risk for suicide. That'll be led by Dr. Bigfoot on June 14th at 3 p.m. Eastern. So this concludes today's webinar session. Thanks again. ♪♪

webinar

suicide prevention

Native populations

cultural introduction

tribal communities

safe spaces

open-ended questions

cultural practices

cultural humility

diversity among tribes