Good afternoon and welcome to this webinar with Dr. Dolores Bigfoot on Supporting Tribal Youth at Risk for Suicide, Honoring Children, Mending the Circle. This webinar is sponsored by the Suicide Prevention Resource Center in collaboration with 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 Dr. Bigfoot begins the presentation, there are just a few housekeeping items I'd like to go over. Next 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 product do not necessarily reflect those of SAMHSA or the Department of Health and Human Services. 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. Next slide. The webinar presents work conducted through the Indian Country Child Trauma Center, which was established to develop trauma-related treatment protocols, materials, and guidelines specifically designed for American Indian and Alaska Native children and their families. Dr. Bigfoot is the exclusive owner of copyright of the webinar content that was originally published under the IACCTC. We ask that you please do not distribute the webinar content without permission. Thank you. 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 1 credit. Instructions for claiming credit will be provided at the end of the webinar. Next slide. 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've joined from the instant viewer instead, you'll click the page symbol to display the handout icon. Next slide. 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, shown here. Next slide. Now, it's my pleasure to introduce today's speaker, Dr. Dolores, or D. 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 has led Project Making Medicine, a clinical training program on child maltreatment using culturally-based teachings. With the establishment of the Child Trauma Center in 2004, she was instrumental in cultural adaptations of four evidence-based child treatment protocols. Dr. Bigfoot was the director of the Suicide Prevention Resource Center at the University of Oklahoma from 2020 until 2022, and she currently serves as an SPRC Senior Advisor. Dr. Bigfoot, welcome, and thank you for joining us. Thank you. We always want to do a land acknowledgment, because a land acknowledgment is about not only our presence in terms of where we're individually located, but it's also an acknowledgment of that this should be a safe place, that this should be a protected space, that this should be an arena where we can have hard discussions and difficult discussions. I'd like to read the land acknowledgment. We acknowledge that the land that now makes up the United States of America was a traditional home, hunting ground, trade exchange point, and migration route for more than 574 American Indian and Alaska Native federally recognized tribes that exist today, and many more tribal nations that are not federally recognized or no longer in existence. We recognize the cruel legacy of slavery and colonization in our nation and acknowledge the people whose labors were exploited for generations to establish the economy of this 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. Thank you for allowing me to have this time with you. What I'm going to do is give you a little bit of background of myself, an overview, a brief overview since we only have 60 minutes to talk about treating childhood trauma within a cultural content, and then available for questions. What I'd like to say about my background is that I am an enrolled member of the Caddo Nation of Oklahoma, one of the 39 federally recognized tribes that exist within Oklahoma. Oklahoma is home to the 39 tribes, however, 37 of those tribes were removed into Oklahoma and Oklahoma is not their historical lands. I am a daughter, mother, grandmother, I'm an elder, I'm a storyteller, I'm a faith keeper. I also want to recognize that I was fortunate and for many of our tribal communities, we were raised in a community of not only one generation or two generations, but three and sometimes four generations within the home. I was fortunate to be raised in a home where my great-grandmother lived with us and helped me establish my own cultural, spiritual, and professional identity, and that it is through this grounding, including my professional identity, that I seek balance, so that balance is that mental wellness. And what we know is that when we have increased suicide protective factors, that we have individuals that feel like they're part of the community, and so it's these protective factors of a sense of identity, connectiveness, and belonging that were certainly part of my background, and so being in a culturally-based family with these several generations provided me with a sense of identity, connectiveness, and belonging. And it is through that sense of connectiveness, identity, and belonging that I also am privileged to be asked by the Northern Cheyenne Tribe of Montana, by the community members there, that I acknowledge them, and I've been fortunate to raise my children and have them have that sense of identity, too. They are enrolled members at Northern Cheyenne and have that same connectiveness, that same identity, and that same belonging, so by acknowledging them and acknowledging the fact that they know who they are as Cheyenne people, that's very critical. So as we think about Native children having that sense of belonging, having that sense of identity, having that sense of connectiveness is part of that inclusiveness of community, and even though my children are not necessarily in Montana, I'm in Oklahoma, and as adults they have chosen to remain in Oklahoma, they still have that connectedness to their home community, their tribal community. So as we think about treating childhood trauma, I'll be giving you an overview, and hopefully you have questions, and I'll be happy to answer those questions as we go along. Project Making Medicine is a training program that allowed us to train clinicians in the treatment of child maltreatment as well as other things, and then with the Indian Country Child Trauma Center, which is the center that houses Project Making Medicine, we have been able to make cultural adaptations. There are four that are more prominent, and we call it the Honoring Children Series, and we have culturally enhanced evidence-based treatment. The one that I'm going to talk about today is Honoring Children Running the Circle, which is a cultural enhancement of trauma-focused cognitive behavioral therapy. We have also culturally enhanced parent-child interaction therapy, and we title that Honoring Children Making Relatives. The third one of this particular series is Treatment of Problematic Sexual Behavior, and we titled it Honoring Children in Respectful Ways. Just a brief bit of information. We have a toolkit for tribal communities on problematic sexual behavior on the national website of the National Center for the Sexual Behavior Review. So what I'm going to talk about primarily today is trauma-focused cognitive behavioral therapy and the cultural enhancement of that particular model. As we considered how to culturally enhance evidence-based models, what we wanted to do was look at the core principles that drove these models. And so we wanted to have evidence-based models that were driven by theory that were compatible or something that complemented or something that was familiar as we looked at American Indian, Alaska Native worldviews or understandings about the world. We wanted evidence-based models that were compatible and had the least bias in terms of assumptions around how these models could be implemented. So what we did is make comparable concepts. So for example, as we looked at a cognitive behavioral approach, one of the aspects of that is affect. And so we can look at expressions of feelings can be recognized by certain ceremonies that tribal communities have, and one such ceremony is well-established in certain tribal communities is wiping of the tears. Another concept is child-centered attentiveness, and that can be recognized by the concept of children being the center of the circle in our cultural teachings and our cultural ways in our beliefs about children. We also wanted to identify cultural practices that were therapeutic. There are many things that we saw as therapeutic, and what we wanted to do is to bring those particular practices that could replace or be used in collaboration with evidence-based practice. So for example, we know that in evidence-based practice, relaxation is very a principle, and along with relaxation is that sense of grounding, that sense of mindfulness. So as we looked at culturally-based practice, smudging is very therapeutic. It can be grounding. It can be relaxation. It can be an understanding of, you know, involving all the senses. So identifying cultural-based practices that were therapeutic was the important part. The other aspect of this is that we really wanted to maintain fidelity. We wanted to maintain fidelity to the evidence-based structure and implementation for effectiveness because we didn't want to do something that would shift what would be an effective outcome. We have a lot of our tribal communities have been experimented on, or a lot of things have been implemented that did not show or did not have evidence that was helpful, and we certainly wanted to make sure that the model that we were implementing had fidelity and that we could maintain that fidelity. It's really important that we involve families, and especially with all the models that we used that were evidence-based, family involvement was critical, so that was another aspect. So determining what level of cultural integration was desired by a particular family was important. And then in terms of supporting therapists, what we wanted to do is have them work with cultural teachers, cultural liaison, cultural experts to better understand the customs, traditions, stories, and symbols relevant to those particular Indigenous communities that they were working with or within their geographic area because there may be more than one or two. So as we looked at the evidence-based models and what theories drove those models, we're going to take trauma-focused cognitive behavioral therapy as an example, and then we wanted to look at what were the Indigenous knowledge, what was the practices that were there that would be compatible with those models or the theories that drove the evidence-based practice. With trauma-focused cognitive behavioral therapy, the models that drive it are cognitive behavioral principles, attachment theory, humanistic theory, developmental theory, neurobiology, and empowerment. So as we think about those and we consider our Indigenous knowledge, well, thinking has always been a part of our Indigenous world anyway, so that's not a new concept. And the way we know that is because we were observers. We thought about things. We were observers of the universe, of stars, of water, of land, of trees. I mean, this is how we ended up, you know, having lodges built or creating, you know, methods to deal with different kinds of problems. And also, as we think about behavioral principles, early on, you know, generations, hundreds of generations ago, the thing that our tribal communities were doing were using birds of prey to capture, you know, rodents and other kinds of things for food. So they shaped the behavior of birds of prey, they shaped the behavior of dogs, and they shaped the behavior of horses. We know this by, you know, the history that's been presented. In fact, there's still Indigenous people around the world that are still using birds of prey. How did they do that? Based on behavioral principles. So thinking, feeling, doing. And I talked earlier about feeling in terms of affect and the wiping of the tears, which is one ceremony among many. Then if we look at attachment theory, we have always had relational and circle theory as part of our ways of relating to one another. Extended family, how camps are set up, all of those things were based on who was attached to who. And also naming ceremonies was also another aspect of that relational aspect and circle theory. Humanistic, recognizing that we're all related. Not only are we related in terms of human beings, but we're related in terms of how do we engage with, you know, animals, how do we engage with the earth, plants, water, fire, the sun. And so the understanding that there are many different kinds of relationships and that we're all part of this existence. And so the humanistic aspects of evaluating things that we're part of. Developmental, as I said earlier, naming, different names came about throughout a person's lifespan because of different stages of development. And those stages of development is very much based on the medicine wheel. And I apologize, I just now realized the medicine wheel is not capitalized and it really should be because it is a teaching. Just like we would recognize the Bible, we would capitalize the Bible, we would also capitalize the medicine wheel because it's a teaching that has been with us for thousands of generations. It's about developmental, it's about relational aspects of life, it's about existence in this environment. So it has many different components in terms of the teachings of the medicine wheel. And neurobiology, we've always had an understanding of mind, body, heart, spirit connection, that it's not another, it's not a new concept. For example, we always think the earth was round, that's the concept we've had for, you know, ever since the concept of the medicine wheel probably. And Scott Momaday has talked about racial memories, that we handed down our memories from one generation to the other, and that as individuals we can experience what our ancestors have experienced. And that's why we have the seven generations because each generation can anticipate what the next generation is going to experience. And then empowerment, it's about decision-making, about non-interfering, being able to allow people to make their own decisions. It's about non-judgmental, allowing people to make decisions and having that equity, having that voice, having that empowerment of decision-making. As we looked at the Indigenous knowledge, we saw that it was very compatible with the theories that drive evidence-based practice, especially trauma-focused cognitive behavior therapy. And as we look at TF-CBT, we see the components of TF-CBT, psychoeducational and parenting skills, relaxation, affect modulation, cognitive coping, trauma narrative, cognitive processing, in vivo desensitization, unjoined parent-child syndrome, it should be syndrome, it should be sessions, enhance future safety and development. Apologize for that. So here is the working model for honoring children and men in the circle. If you're familiar with trauma-focused cognitive behavioral therapy, you know that there are the components and that the cognitive triangle with thinking, feeling, or cognitive behavioral affect as part of each one of those points in terms of the triangle. And so what we did was to expand, again, relying on circle theory, expand this to a circle, include the mental or the cognitive, emotional in terms of affect, and physical in terms of behavioral. And the reason why we use the terms physical, mental, and emotional, that's terms or terminology that's more common within our tribal communities. And so the concept remains the same. It's just another version of using the same concept with a different word. And then this working model is there in terms of the circle. And it also includes the spiritual and the relational. So I think in the TFCBT, having conjoint family, have parent-child session, that relational is implied. But with this particular model, what we want to do is to make certain that as people view this model, that they recognize that the relational aspect, the family aspect, the caregivers, all the things that are important to them, whether it's the location, the land, the things that are taught to them, the teachings, that all of those relational aspects are very much part of this model. And then the spiritual part is not separate from, but it overlays all of this. And we didn't want it to not stand out, so this is why we put it in the circle. But it really is overlaying all aspects. So as we work within the model of honoring children and in the circle, what we want to do is make certain that we're addressing each one of these aspects within the content of the TFCBT component. So how we're doing that is looking at this indigenous pathway. And as we train clinicians and we work with them, part of the implementation is that we train clinicians in the model, and then we provide weekly phone consultation with them as they implement the model in their respective communities. So what we want to do is to help them look at how this model can be rolled out. And so identifying indigenous practices that are healing. So what are different aspects of ceremony? And ceremony can be very, very, very large, or it can be very small. It can be the simple act of offering water to someone. And we have an amazing example where this one clinician that was being trained in the model, and we talked about water and the offering of water and how important that is. So this particular clinician got a bottle of water, and every time anyone would come into her session, especially with TFCBT being rolled out with her, she would offer them a bottle of water, just a small bottle of water. And she said she noticed that an elder was watching her as she would be in that front part, in the front office, and bringing a bottle of water to anyone who was going to have a session with her. And she said some time later, this elder had made an appointment with her, came to her and told her how important water was within that particular tribal community, and how important it was to see her offer this small ceremonial gesture of water, this gift of water, and was able to share with her stories about water. So as we think about what ceremony is, ceremony is about healing. And we don't expect our therapists to do traditional ceremonies. However, we expect them to have ceremony built into their session, such as offering water or greeting a person in a certain way, that this is a protocol for greeting people, and working with them individually, if necessary, to help bring that comfort level. We want to incorporate Indigenous ways of explaining the world. And one of these are the tribal creation stories. All tribes have creation stories. Sometimes they have more than one. And so how do we incorporate these creation stories into their delivery? And drop on those as we think about resiliency, as we think about cognitive coping, or it could be even relaxation stories. Identification of Indigenous ways to explain how things happen. So we have a lot of how, why, when stories. How the raven ended up with black feathers. A lot of times when we do psycho-ed, what we want to do is explain why things happen. And so these stories can set the stage for explaining how things happen. And also, identification of Indigenous ways to explain when things don't go well. And we have a lot of trickster stories, so like Thomas, Spider, Coyote, that share when individuals or when a trickster makes poor decisions, why there are certain kinds of consequences. And then the real critical one, as we think about why people, or why individuals, why families come for trauma-focused cognitive behavioral therapy is because of history of trauma or traumas that are impacting their lives. So Indigenous ways of moving from one status to another, and that this transition that they're going through from something like or diagnosis of post-traumatic stress disorder to a post-healing pathway, this post-growth, this ability to move beyond the trauma, to recognize that there's a lot of different kinds of things that happen to people. And how do you go beyond that? So this transition period, there's all different kinds of transition recognition within our tribal communities. So as we share this information with the clinicians that we work with and the communities that they work with, we do talk about Indigenous ways of knowing and that there's Indigenous ways of knowing that we can actually utilize. But there's also things in terms of that great mystery out there that we can't explain. And that within this model that we're using, that we have culturally enhanced, that there is this spiritual element. And we may not always have an understanding of that great mystery, that spiritual element. But we do know that we can work within Indigenous ways. And so those Indigenous ways are useful in defining what might be concepts that we take for granted in a more dominant profession or the dominant culture. So for example, we think about defining child well-being. And I was fortunate that I was in Alaska some years back. And one of the understandings was, oh, I'm sorry. One of the questions was, how do you define child well-being? How do you define Alaska Native child well-being? And I am not from Alaska. I don't think that I have that competency to define for the Alaskan people how they would define well-being. So I asked them. And so we had a conversation. And they said they would define Alaska Native child well-being as dry salmon. And typically, we hear about safety. We hear about having the balance in one's life. We hear about making sure kids get educated, making sure that they're well-fed, making sure that they're any number of things that we would look at in terms of just well-being. But for the Alaskan Native people in this particular area, it was about salmon. And they said that if individuals could gather together during the summer for fish camp, then they would have this opportunity that the eels that have befallen them during that year, they could sort out. They could work through. They could have conversations. They could reconciliate. They could sing together, pray together, laugh together, work together, and figure out how to make things better, that there's time for storytelling, time for work, time for play, time for sharing the things that have occurred to them, and make plans for the next year. And there's this whole process of being together that allowed for the healing of so much. And that at the end of this fish camp, if somebody looked at their harvest, that they could say, me and my family are good for another season. We have come to a point of well-being here together. And so as we think about the cultural understandings that community brings, the cultural understandings that families bring, that it is really around what they know and how they define things. So being able to recognize this opportunity to not think things in a more linear fashion, but think things in terms of the circle and the wealth of knowledge that our tribal communities bring. I'm giving you a very brief overview of the information that we share in our training. We have a training manual. We have handouts. We present the information with the components of TF-CBT, psychoeducation, parenting, relaxation, affect regulation, cognitive coping. So we present those concepts and then have different cultural activities or different cultural presentations that we bring in. And so one of the cultural activities that we have is a native healing worksheet. So this is a worksheet. We have a couple of examples of this. And we have the clinicians in training work on a healing practice that they're familiar with within their tribal communities that they are working with. So for example, singing a goodbye song after a family member passes away. And I think the thing that we can recognize is that, like I said earlier, a lot of things are therapeutic and it doesn't necessarily have to occur within the setting of the therapeutic session within a clinic with just a therapist and the child that recognize that there are a lot of things that are therapeutic that communities can engage in and have been able to engage in. And so this is just one example as we think about a ceremony that has occurred. So singing of a song after a family member has passed away. And so there's the activity. The purpose is to help family members say goodbye to the deceased family member and to recognize a family member's spirit is on a new journey. The other part of this is that sometimes after this goodbye song, maybe the individual that the particular culture may have beliefs and practices around the person's name, how soon the burial, the type of service, the sharing of gifts with others. I mean, so there might be other kinds of things that are surrounding this. But as we look at one aspect of it, it may be this particular opportunity to recognize what an individual may encounter and how we can use it therapeutically. So the singing of the goodbye song, giving permission for the journey that the spirit has started going forward into this next phase of recognizing that this is in process. And also very critical is the knowledge that this is a transition period for everyone, that it's not only a transition period for the person that has died, but it's a transition period for all the relatives, all the friends. The individual is important in different ways. So how do we manage this transition period? Giving permission to mourn. So this is a lot around the goodbye songs are around mourning and recognizing that loss. When you have all these different individuals that are part of this event, then it provides that supportive structure for mourning that it's not only permission to, but it's also who is around that people can turn to and who can they lean on. And a lot of times, individuals may come up and stand with someone, recognizing that they can be supportive. And then in terms of the song itself, it can serve as a reminder for that particular loved one or that particular family member, or maybe serve as a reminder for prior losses that have occurred. And so, excuse me, that the song, we don't want it to be a trigger, but we want it to be a gentle reminder in some way. So how do we help bring these kinds of helpful cognitive coping mechanisms into place? And so what we have are this healing practice worksheet and the clinician identifies something that might be an activity, might be an object, that could be, an object could be like a drum, an item could be like clothing. So it could be anything and what would be the purpose and what would be the meaningfulness. And then from there, they go into which practice component would this activity address. And for this particular one, it could be relaxation because of the song. It could be the cognitive coping because of the reassurance. It could be also just the cognitive processing, just being in that supportive structure. So the healing practice worksheet is really helpful because a lot of times clinicians say, well, yeah, this is what a lot of family members practice. So for example, a giveaway or a giveaway ceremony or a, you know, some other kind of gathering. And so they're able to incorporate that into what would be therapeutic. And this is just a little example. We have the trauma narrative. And at the beginning of each component, we actually have stories that introduce the components. And so we want to build in the storytelling throughout the whole protocol of TFCPT. And so we talk about creation stories, say that they're a history and tradition of the tribes. They tell how the world began and in what manner. They explain how the world, people, animals, and plants are related. So you can see that there's a lot to these stories. Through creation stories, people can understand the natural order of life and in what direction they came and in what direction they're going in terms of their cultural teachings, their cultural way of being. They give reasons for the overall scheme of things. And the reason why creation stories are important, and we want to reinforce that, is to understand the creation of things because it provides a framework in which wise decisions can be made. So that was the purpose of creation stories, is to, you know, what is the framework and what are the foundational points and what are the values that come out of that and how to make good decisions or how to make important decisions. And so what we talk about is that storytelling was a form of transmittal, communicating, teaching, being able to help people sort out, help people think, help, I'm saying people, but we're working with children, so help them to better understand the impact other things have on them as well as their own behaviors. So it's how things were and how things happened and recognizing that there's winter stories and summer stories, stories for the day that the rains fell or the snow fell or the wind blew, stories for early morning, stories for night. And so there's a lot of different kinds of stories that are available. And also, you know, stories that can be created because they are in a transition period, and transition periods always allow for stories to be started. So creation stories were retold and retold many times in the growing years. So we really want to build in as much storytelling into this as possible because this is the method that they're going to be conveying. And we want the story to be their story, that the experience or the experiences, the trauma that occurred to them, that they can rewrite the story to help manage and master that reminders, memories, triggers, and they will know that they're reminders, they will know that they're triggers, and they don't have to become so devastated they can't function anymore. And what we see with storytelling is that there's, even with very short stories, there's reassessing and decision making, there's an understanding of consequences and the multiple kinds of outcomes that occur, and with the cognitive processing, especially outcomes are an important part of that component in TF-CPT. Explanations about behavior or behaviors, and, you know, we get a lot of kids that say, why did they do that? Why did they do that? Why did this happen? And so storytelling is a great way of explaining about different kinds of behaviors, character and attributes, you know, recognizing poor choices and people's willingness to, you know, harm others or the strengths that individuals have, the resiliency. So, you know, building all of this into these stories, and again, the stories don't have to be very long. They can be very short. Values and beliefs, especially the suffering and sorrow, you know, that, you know, kids want to know who else has experienced this, and there's a lot of shame around, you know, when they think that it's their fault. So understanding how these situations come to be and who has responsibility. So maintaining the self-sufficiency, so we want to build that resiliency in terms of grounding and growing from that, so that post-traumatic growth and how individuals can benefit from understanding their place in the world and understanding how they can ground themselves, understanding even with reshaping their own identity and helping with that sense of belonging and connectedness. So do we have any questions? I just want to say that this is a picture of Northern Cheyenne and in Montana, and we had traditional healing camps, and I don't know if this is a particular picture of that, but we certainly had camps that look like this. Any questions or comments? Thank you for that presentation. So I just wanted to remind the audience as we move into the Q&A portion of the webinar, you can use the questions area of your control panel to type in a question. Dr. Bigfoot, one question we got says that, I work at the Jed Foundation directly with colleges and universities on things like equitable implementation of mental health services. Out of all the fantastic information you provided, are there major things you would highlight for college counselors and staff that we work with as they support their tribal students? Let's go back to the beginning where we have the land acknowledgment. I think the first thing is... Let's just go back to that real fast. I think just initially, any location needs to be aware of who existed there prior and, you know, who are the indigenous people that are there currently, and so every organization, whether it's a university or a business or a, you know, government, should readily embrace this practice of land acknowledgment. And I think, you know, And I think with students, and especially students coming from family situations where they may have very strong support for education or may not have, you know, strong support for education, they're coming into a new environment, and this is another transition. So how do they transition into this new environment? What might be support services for this transition? How do we have that sense of belonging, connectiveness, and identity? And so this land acknowledgment is that first step in acknowledgment, a sense of belonging, recognizing that there were others there, and then how do new visitors, even if they are indigenous, how do they fit in to this community that probably has a harsh beginning? And I think being able to start with the land acknowledgment, because that allows for students to recognize that there are others that were there, how do you build that sense of identity? Again, you know, with the indigenous nations, who can invite people in? And so when we have land acknowledgment, it's about protection, it's about safety, it's about invitation, it's about not creating harm, it's about welcome. Initially, many, many, many tribes, when a visitor came, they were sung in, and songs were very much a part of visiting, and then when they left, they were sung out. So if you think about it, we do that quite naturally with infants. We sing them to sleep, we sing them awake, we have this sing-song voice that we, I certainly do, maybe not everybody, but it's a common thing, I think, for many people, to have this different kind of way of interacting with infants. It's the same kind of, not necessarily tone of voice, but it's the same kind of heartfelt desire to have this welcome, to have this sense of protectiveness, this sense of embracing. And so being able to sing in students, because some of them really have had a hard time, and it doesn't necessarily mean just song, but how do we have that sense of belonging and welcome to enforce that connectedness, to enforce that identity? So I think starting out with land acknowledgement is a critical first step, and then there's a lot more information on websites about land acknowledgement, and what does it mean to belong in a space that may have had a history of hostility, and how do we bring in that equity, inclusion, justice, diversity, because many universities are desirous for that. So that first thing is that land acknowledgement. I hope this makes sense. Let me know if that doesn't clarify things for you. Sure. I think that comment, Dr. Bigfoot, touches on this issue of recognizing that tribes are not all one in the same. They share some common histories, but they're also unique in different ways, and so this land acknowledgement kind of touches on that point of recognizing that tribes have different lands, and I was wondering if you could talk also about how you would customize an honoring the children intervention for different tribes. I understand it was developed as a general framework, but how might you think about adapting the intervention for a tribe that might be new or unfamiliar to a person learning about the intervention? Well, I think it's probably easier than what you think because the way that we consider this is that these are concepts that can be adapted or I shouldn't say adapted, can be recognized in all of our cultural teachings. So there's something about the physical. There's something about the emotional. There's something about the mental, relational, and spiritual. So basically all tribes have some spiritual understandings, and so I myself probably would not, as a Caddo in landlocked Oklahoma, would not necessarily see salmon as a means of child well-being. So looking at Alaska, what would be those creation stories about the things that are around them that would be meaningful to them? What are their stories? What are their concepts about mental well-being or mental balance? How do they describe emotional or affect? So it really is looking locally, and the thing that comes... There are certain things that are common, or I shouldn't say consistent. I shouldn't say common. Certain things that are consistent. So most tribes have creation stories, and those creation stories are varied in different ways. So clinicians can pull on those creation stories, and for the most part, all tribes have one or more creation stories on their website, so it's not hard to find how they came to be, what their belief systems are. So a lot of times, the local tribes will have that information readily available on websites or at community colleges or something that's locally grown, and pulling from their creation stories or their history allows you to customize whatever it might be. So for example, some tribes use tobacco as an offering, whereas other tribes might use some other kind of plant, and so you're not looking to say that everybody uses tobacco, but you would say what kind of offerings might be made, and maybe it's some kind of cactus or some kind of willow or some kind of berry. And so being able to recognize the concepts and not necessarily where the actual practice may vary. So that's why we have this in a circle. All tribes have something that are common in terms of circles. All tribes have something similar in terms of creation stories. All tribes have something in terms of ceremony and what they see as healing. So what we try to do is make it so that clinicians can... I probably wouldn't know anything about the majority of the 574 tribes that are available. I know some about the tribes that are within the central states, Oklahoma up to North Dakota and into Canada. So the local cultural teachers can be drawn upon. Or even the family. And maybe the family might say, well, we're pipe carriers, and so utilizing that concept. Or maybe they might say we're Native American church or we use some dancing. So the families can also help identify what might be reassuring to them. Oops, I'm over time. Sorry. No, we're still okay on time. We can end at 4.05 Eastern. I just wanted to ask one final question. For anyone looking for additional resources on the medicine wheel or on how to get training in particular for the interventions that you've overviewed, where can they go for that? Well, the medicine wheel is not what we have, even though we have a circle. We have many in the circle. So the medicine wheel, there's a lot of information out there on the Internet about the medicine wheel, and there's actually an actual medicine wheel that is physically in Wyoming, and there's information out there. But each tribe has things sometimes on their website about the medicine wheel as per their teachings. And our honoring children and men in the circle, we have several publications. I think we have some references that people can draw from. Let me see if I can shift this. I have to get to the references. I'm going as fast as I want to go. I can't make it move. That's okay. The audience can see the handout with the list of references. Okay. I just wanted to mention, too, that before we conclude today's session, please take a moment to review the information in the handout about claiming credit for your participation. If you do have any questions about claiming credit, you can e-mail LearningCenter at psych.org, and they'll get back to you. Dr. Bigfoot, thank you so much for your time. We also appreciate all the participants who attended today, and I wanted to also let everyone know that we have another upcoming webinar that will focus on cognitive behavioral therapy for suicide prevention. That webinar will be presented by Dr. Donna Sudack on July 19th at 3 p.m. Eastern. Thanks so much. ♪♪♪

Supporting Tribal Youth at Risk for Suicide

Honoring Children, Mending the Circle

Dr. Dolores Bigfoot

Suicide Prevention Resource Center

American Psychiatric Association

Indian Country Child Trauma Center

Trauma-focused Cognitive Behavioral Therapy (TF-CBT)

Cultural adaptation

Indigenous knowledge

Land acknowledgement