Committee room—after many times being there—“for the first time with a feeling of hope.” The day before she participated in an Indian Affairs Committee oversight hearing on childhood trauma in Indian country that addressed multiple facets of trauma in Native American communities, including some of the issues raised in the report released November 18 of the Advisory Committee of the Attorney General’s Task Force on American Indian and Alaska Native Children Exposed to Violence.
The day following the hearing a group of about 25 representatives from Indian organizations, Senate staff, federal agencies as well as clinicians and researchers participated in the “Roundtable on Traumatic Stress in Native American Communities,” addressing the role of trauma in the high rates of suicide, alcoholism and other addiction, school dropouts and justice system involvement.
The roundtable discussions focused on how these problems can be addressed and featured initiatives and policies that have improved outcomes, hence the feeling of hope as expressed by Sen. Heitkamp. The forum included short presentations on historical trauma, the ACE Study, the Johns Hopkins suicide study, the Menominee Trauma Prevention program, and the National Congress of American Indians (NCAI) Resilience program.
In addition to Senator Heitkamp, the chairman of the Indian Affairs Committee, John Tester (D-MT), attended the roundtable and reflected on the difficult problems, especially for children, in Indian country and the need to find solutions.
Daniel S. Press, a partner with the Washington, DC, law firm Van Ness Feldman and an adjunct professor at Columbia University, and Tami DeCoteau, a psychologist from Bismarck, ND, worked closely with Sen. Heitkamp in organizing the roundtable and are taking the lead on creating an initiative that will continue the work of the roundtable.
DeCoteau said that historical trauma occurs when a culture is destroyed, creating psychological wounds across generations. She said the symptoms of depression, substance abuse and unresolved grief create a vicious cycle that perpetuates the pattern across generations and the field of epigenetics is revealing how gene expression is altered in response to trauma.
During the presentation on the ACE Study, Sen. Heitkamp asked whether the ACE Study findings are being taught in medical school or included in physician training. While the group was unaware of specific requirements being in place now, it was noted that at least one state legislature debated this approach. A weakened version of a bill passed in Vermont required a state review to address whether, how, and at what expense ACE-informed medical practice should be integrated into the health plans offered to the majority of the state’s residents. It was also reported that the American Academy of Pediatrics is planning to establish a center or institute to explore what science is discovering about the impact of toxic stress on health and how practice should reflect that new knowledge.
Dr. Zachary Kaminsky of Johns Hopkins University addressed how the field of epigenetics is shedding light on how genes and the environment interrelate; he said that you can think of genes having “dimmer switches” that can be changed by the environment. He reported on a specific study of the biological links to later life outcomes such as suicide and PTSD. The discovery of a chemical alteration in a single gene linked to stress reaction may lead to a blood test for suicide risk as reported in an article by Kaminsky and others in The American Journal of Psychiatry.
The success of the Menominee Trauma Prevention Program was described by Stephanie Autumn of the American Institutes for Research, an organization that is providing technical assistance to the program through the Substance Abuse and Mental Health Services Administration (SAMHSA). Through the program, a paradigm shift occurred as the community came to understand that the “dropout crisis” was, in fact, a public health crisis that required schools and other sectors in the community to work together toward solutions.
The Menominee Indian School District system engaged the community on public health issues such as teen pregnancy and poverty that impact student learning. Autumn highlighted these numbers as evidence that progress is being made: The dropout rate in the district decreased to 1.19% (lower than the state rate of 1.60%) in 2009-10 from 6.96% in 2005-06. Part of the solution was training the agency and school staff on ACEs and trauma-informed care. Training will be expanded to families through a Safe Schools Health Students Grant.
Plans are now underway for the group to form committees to address issues related to preventing trauma, mitigating the impact of trauma, and building resilience in Native American communities. Committees will examine what action is needed by Congress, federal agencies, state legislatures, and tribes. According to Press, the roundtable participants will form a team to work collaboratively on a multi-pronged initiative to implement trauma-informed and trauma-sensitive programs to prevent suffering in future generations. One committee will design pilot programs that would “test different approaches for creating a comprehensive trauma-informed community” across health, education, social services, judicial, law enforcement and other systems, according to Press.
A Native Americans group on ACEs Connection has been formed to facilitate the sharing of information and the development of new resources. The participants plan to convene again in the spring. In the meantime, Press and the other members of the team will examine comprehensive programs that have been developed both in Indian country and cities and towns to address trauma and build resiliency. “There is no need to reinvent the wheel,” says Press.