CMSA Today - Issue 7, 2016 - 17

Holistic Health Return to Healing BY REBECCA PEREZ, BSN, RN, CCM not affect Native Americans until the arrival of the Europeans. So not only were they exposed to disease, war, and famine that resulted in diminished numbers, they were subjected to many forms of cultural destruction (Lucero, 2011). Mandated federal policies beginning with the Indian Removal Act of 1830 can be directly connected to this cultural destruction. For those that survived the federal mandates, their tribal communities were disconnected from their ancestral lands, their origin stories, medicine and overall way of life (Lucero, 2011). Fast-forward to the 20th and 21st centuries. Only 38 years ago, the federal government reversed the illegality of Native American cultural practices. The atrocities imposed on Native Americans in the 18th and 19th centuries resulted in trauma associated with these sociopolitical histories (Lucero, 2011). We are starting to see more research that demonstrates the need to be more inclusive of culture when working with Native Americans in healthcare. An American Indian/Native Alaskan scholar, Maria Yellow Horse Brave Heart, developed a paradigm after 20 years of research known as the Historical Trauma Theory (Lucero, 2011). The definition of Historical Trauma is the cumulative psychological wounding and trauma over a lifespan or across generations (Lucero, 2011). The trauma has resulted in Native Americans feeling a loss of self-determination, shame for cultural beliefs, and loss of community. Native Americans operate from a different worldview than non-Natives. The trauma experience of Native Americans has often resulted in poor physical and mental health, substance use, family dysfunction, crime, poverty, violence and spiritual imbalance (Nebelkpopf & Wright, 2011). "For Native Americans, balance means health. As part of our responsibility to practice care management with cultural competence, we must be open to acknowledging the Native American approach to healing." Enough research has occurred to demonstrate that a holistic approach of self-help, empowerment, and building a healthy community are the best strategies to return balance (Nebelkpopf & Wright, 2011). Spirituality plays a pivotal role in health for Native Americans. Interestingly, The Joint Commission has been requiring healthcare facilities that serve Native populations to conduct spiritual assessments. This requirement has been in place since 2011 and also includes behavioral health providers and those providing addiction services (Hodge & Lamb, 2010). "Indeed, although the dominant secular narrative often ignores spirituality, or even frames it as pathological, spirituality plays a central role in health and wellness for many Native Americans" (Hodge & Lamb, 2010). For Native Americans, balance means health. As part of our responsibility to practice care management with cultural competence, we must be open to acknowledging the Native American approach to healing, rather than forcing Western Medicine. There are several models that have been implemented with success demonstrated in literature; we will briefly look at three. The Indigenous Research Agenda developed by Linda Tuhiwai Smith demonstrates the environments indigenous people move through in order to achieve healing and wellness: Survival, Recovery, Development, and Self-determination, allowing for healing to become a way of life (Lucero, 2011). The Medicine Wheel is used to depict the areas of focus in Smith's model, and these are (Lucero, 2011): * Healing, which does not occur in a linear fashion; it happens at different times and different stages * Decolonization results in healing when psychological struggles are reduced with a feeling of empowerment and rejecting victimization * Mobilization results in healing when communities reconnect and collaborate * Transformation results in healing when an individual believes his or her needs are being met For Native Americans living in the urban areas of the San Francisco Bay Area, the Friendship house Association of American Indians has developed a Holistic System of Care (Nebelkpopf & Wright, 2011). This model also takes a whole-person approach and links treatment with prevention and recovery. The Holistic System of Care for Native Americans in an Urban Environment has developed specific interventions to reduce substance abuse among adult Native American men and women, the homeless, reduction in substance use in Native American adolescents, and is assisting in increased social connectedness of Native Americans with HIV/AIDS. The multiple approaches of the program have resulted in a 24 percent reduction of substance abuse after 30 days and an 11 percent increase in full-time employment. School enrollment also increased by 10 percent, and criminal Issue 7 * 2016 * DIGITAL CMSA TODAY 17

Table of Contents for the Digital Edition of CMSA Today - Issue 7, 2016

PRESIDENT’S LETTER
ASSOCIATION NEWS
CMSA CORPORATE PARTNERS
Are You Culturally Competent?
Return to Culture – Return to Healing
Appalachian Culture: A Guide for Case Managers
Professional Case Management’s Ethical Quartet for 2017: Part 1, Workplace Bullying and End of Life Care
Diversity of Role Reversal: When the Case Manager Becomes the Patient
INDEX OF ADVERTISERS
CMSA Today - Issue 7, 2016 - cover1
CMSA Today - Issue 7, 2016 - cover2
CMSA Today - Issue 7, 2016 - 3
CMSA Today - Issue 7, 2016 - 4
CMSA Today - Issue 7, 2016 - 5
CMSA Today - Issue 7, 2016 - PRESIDENT’S LETTER
CMSA Today - Issue 7, 2016 - 7
CMSA Today - Issue 7, 2016 - 8
CMSA Today - Issue 7, 2016 - 9
CMSA Today - Issue 7, 2016 - ASSOCIATION NEWS
CMSA Today - Issue 7, 2016 - 11
CMSA Today - Issue 7, 2016 - CMSA CORPORATE PARTNERS
CMSA Today - Issue 7, 2016 - 13
CMSA Today - Issue 7, 2016 - Are You Culturally Competent?
CMSA Today - Issue 7, 2016 - 15
CMSA Today - Issue 7, 2016 - Return to Culture – Return to Healing
CMSA Today - Issue 7, 2016 - 17
CMSA Today - Issue 7, 2016 - 18
CMSA Today - Issue 7, 2016 - 19
CMSA Today - Issue 7, 2016 - Appalachian Culture: A Guide for Case Managers
CMSA Today - Issue 7, 2016 - 21
CMSA Today - Issue 7, 2016 - 22
CMSA Today - Issue 7, 2016 - Professional Case Management’s Ethical Quartet for 2017: Part 1, Workplace Bullying and End of Life Care
CMSA Today - Issue 7, 2016 - 24
CMSA Today - Issue 7, 2016 - 25
CMSA Today - Issue 7, 2016 - 26
CMSA Today - Issue 7, 2016 - 27
CMSA Today - Issue 7, 2016 - Diversity of Role Reversal: When the Case Manager Becomes the Patient
CMSA Today - Issue 7, 2016 - 29
CMSA Today - Issue 7, 2016 - 30
CMSA Today - Issue 7, 2016 - 31
CMSA Today - Issue 7, 2016 - 32
CMSA Today - Issue 7, 2016 - 33
CMSA Today - Issue 7, 2016 - INDEX OF ADVERTISERS
CMSA Today - Issue 7, 2016 - cover3
CMSA Today - Issue 7, 2016 - cover4
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http://www.nxtbook.com/nxtbooks/naylor/CMSQ0111
http://www.nxtbook.com/nxtbooks/naylor/CMSQ1111
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