1. Honoring Our Strengths Conference
June 25, 2014
Bill Mussell & Dr. Brenda Restoule
Native Mental Health Association of
Canada

2.  Define necessary skills and knowledge
needed to provide culturally competent care
in addressing trauma
 To build knowledge on utilizing a trauma
informed approach with a focus on cultural
interventions for healing of intergenerational
trauma

4.  Culture refers to integrated patterns of human
behavior that include the language, thoughts,
communications, actions, customs, beliefs, values
and institutions of racial, ethnic, religious or social
groups.
 Competence implies having the capacity to function
effectively as an individual and an organization within
the context of the cultural beliefs, behaviors and
needs presented by consumers and their
communities
 Cultural competence is a set of congruent behaviors,
attitudes, and policies that come together in a system
agency or among professionals that enables effective
work in cross-cultural settings
 Adapted from Cross (1989)

5.  Cultural competence is the integration and
transformation of knowledge about individuals
and groups of people into specific standards,
policies, practices, and attitudes to increase the
quality of services; thereby producing better
outcomes Davis (1997)
 Cultural competence requires cultural humility
which is a commitment and active engagement in
a lifelong process that individuals enter into on
an ongoing basis with patients, communities,
colleagues and with themselves that requires one
to bring into check the power imbalances that
exist in the dynamics of caregiver-client
communication by using client-centered care

6.  Cultural competence mandates that
organizations, programs and individuals must
have the ability to:
1. Value diversity and similarities among all peoples;
2. Understand and effectively respond to cultural
differences;
3. Engage in cultural self-assessment at the
individual and organizational levels;
4. Make adaptations to the delivery of services and
enabling supports;
5. Recognize and acknowledge cultural knowledge

8.  Trauma: Any life event(s) that threatens a
person’s physical or emotional/psychological
health or safety
 Traumatic events cause people to lose a sense of
control, connection and meaning (Herman, 1997)
 Complex Trauma: repetitive, prolonged and
cumulative usually resulting from interpersonal
betrayal
 Intergenerational Trauma: A collective emotional
or psychological injury over the lifespan and
across generations. Often resulting from a
history of genocide with the effects being mental,
emotional, physical and spiritual

9. “Intergenerational or multi-generational
trauma happens when the effects of trauma
are not resolved in one generation. When
trauma is ignored and there is no support for
dealing with it, the trauma will be passed
from one generation to the next. What we
learn to see as “normal” when we are
children, we pass on to our own
children….The unhealthy ways of behaving
that people use to protect themselves can be
passed on to children, without them even
knowing they are doing so. This is the legacy
of physical and sexual abuse in residential
schools.”
(Aboriginal Healing Foundation, 1999:A5)

10.  Adrenaline is produced during a traumatic event to provide for
greater strength and endurance causing hyperarousal of the
nervous system
 If the trauma is re-experienced repeatedly, the brain loses its
ability to regulate its own chemistry; flooding the brain with
adrenaline until temporarily depleted. The brain will compensate
by alternating patterns of over-stimulation and depletion
 The body will enter a state of hyperarousal, anxiety and fear
causing the trauma victims to react to seemingly harmless
situations. If adrenaline is depleted the trauma victim may shut
down with no interest or energy to react or reach out
 Neuroscience has found that individuals who experience chronic
and perpetuating stress develop a hypersensitivity to it and are
more likely to respond to it in maladaptive ways

11. Neurobiological and physiological changes:
memory impairment that impacts on the ability to
process and integrate information (i.e., difficulty
remembering aspects of the trauma, difficulty
making decisions, poor concentration)
increased bodily response to fear triggers
Increased sensitivity to startle reflex
Sleep abnormalities
increased reactivity to both explicit and implicit
trauma reminders
Hyper-vigilance
Increased autonomic reactions (i.e., shaky,
sweaty, heart palpitations, trouble breathing)

12.  Regardless of the source of the trauma, the
experience has four common traits:
it was unexpected;
it was psychologically overwhelming;
the person was unprepared or unable to cope
with it;
there was nothing the person felt they could do
to prevent or mitigate it.
It is thus, not the event per se that determines
whether an experience is traumatic, but the
subjective experience of that person.

13.  Indigenous peoples’ experiences of contact
and cultural domination may reasonably be
viewed as a loss of predictability and control
and increases in vulnerability
 A report on mental health needs of 127
survivors of residential school found that
64.2% of these individuals met with criteria
for PTSD

14. Chronic and complex
grief
High rates of suicide
and homicide
High rates of violence
Accidental deaths
Lateral violence
incarceration
Poor health conditions
that impact on
functioning
Residential schools
Loss of language,
identity & culture
(through various acts of
assimilation)
High rates of family
violence
High rates of abuses,
particularly physical &
sexual abuse, especially
toward women &
children
Poor social conditions
(i.e., extreme poverty,
housing, water, sewage)
Culture of dependency

15.  Has led to family histories of ongoing trauma
and dependencies
 Created family histories of maladaptive
coping
 Led to loss of cultural understanding and
cultural behaviours to effectively deal with
trauma
 Neuroscience has found that individuals who
experience chronic and perpetuating stress
develop a hypersensitivity to it and are more
likely to respond to it in maladaptive ways

16.  The hypersensitivity to recognizing and
responding in maladaptive ways to stress are
transmitted to their children
 Individuals who suffer from historical trauma
often identify events or situations as stressful
or traumatic more frequently than those who
do not have historical trauma
 Historical trauma have co-occurring health
and social problems
 Individuals who suffer from historical trauma
often have more complex needs requiring
more long term and comprehensive care

17. “under the relentless influence of forced
assimilation, economic dependence and
isolation, Aboriginal cultures have undergone
a process of deculturation. Evidence for this
process of cultural degeneration is found in
such phenomena as alcoholism, substance
abuse, child neglect, suicide, family violence,
sexual abuse, vandalism and theft, all of
which are epidemic in many Aboriginal
communities. It is paramount to notice that
none of these indicators of cultural and
identity degeneration characterized pre-
colonized Aboriginal culture.” (RCAP - Peavey,
1993)

19.  Requires an understanding of trauma in all
aspects of service delivery
 Places the survivor’s safety, choice and control as
a priority
 Creates a treatment culture of nonviolence,
learning and collaboration
 Treatment requires building confidence and trust
to facilitate healing and recovery
 Facilitate engagement and meaningful
participation by consumers & families in planning
of services and programs
 Create collaborative relationships with other
systems from the social determinants of health

20. 1. Trauma awareness
2. Emphasis on safety and trustworthiness
3. Opportunity for choice, collaboration and
connection
4. Strengths-based and skill building
 Also common to the principles of cultural
competency

21.  Having a comprehension of cultural effects to
trauma
 Having a comprehension that cultural loss,
degeneration and culture stress are
significant forms of trauma
 Requires understanding cultural responses to
addressing trauma

23.  The World Health Organization defines traditional
medicine and healing as “the sum total of knowledge,
skills, and practices based on the theories, beliefs, and
experiences indigenous to different cultures, whether
explicable or not, used in the maintenance of health as
well as in the prevention, diagnosis, improvement of
treatment of physical and mental illness” (Martin Hill,
2003 p.3).
 Traditional healing has also been defined as “practices
designed to promote mental, physical, and spiritual
well-being that are based on beliefs which go back to
the time before the spread of western ‘scientific’ bio-
medicine” (Martin Hill, 2003 p.7).

24.  When Aboriginal people discuss the elements of traditional
healing, “they include a wide range of activities, from physical
cures using herbal medicines and other remedies, to the
promotion of psychological and spiritual well-being using
ceremony, counseling and the accumulated wisdom of elders”
(Martin Hill, 2003, p.7).
 On comparison with western medicine that typically has the
goal ‘to cure’, the goal of traditional medicine is ‘to improve
the quality of life with an emphasis on the healing journey’
(NAHO, 2002, p.9). As NAHO (2002) states, a basic principle
of the scientific method is “to separate parts from the whole
and to concentrate on the parts that need the most attention.
In the traditional model, the approach is to consider the
whole of the person’s being. Quality of life is the focus, with
an emphasis on achieving balance in all aspects” (lbid, p.9).

25. 1. Teaching cultural and community history
2. Teaching how historical trauma creates
risk for health, social and relationship
problems
3. Supporting opportunities for developing
self-awareness, self-worth and cultural
identity
4. Teaching life skills
5. Teaching strategies to cope with stress
and regulate emotions

26.  Cultural ceremonies
Sweats
Smudges
Use of medicines
Cedar baths
Soul retrieval
 Traditional teachings
Roles
medicines
 Traditional counselling
 Integrative or collaborative traditional &
western techniques

27.  Physical: relaxation, exercise, hunting or
being on the land, therapeutic dance,
healthy diet (including drinking water)
 Mental: teachings, identifying triggers and
symptoms, safety plans to reduce risk,
trauma narrative or map, visualization
 Emotional: anger management/release, art
therapy, strengthening support system,
personal affirmation, restoring pride in
self/identity/culture/history
 Spiritual: meditation, prayer, storytelling,
singing, drumming or dancing, involvement
in traditional activities (beading, carving),
hunting or spending time on the land

28. 1. Confront our trauma & embrace our history
 educate our people about our history & what
happened to us. Knowledge is power!
2. Understand the trauma
 educate about trauma response features & cultural
context to mourning & grief
3. Release the pain
4. Transcend the trauma
 heal & move beyond the trauma so that we no longer
define ourselves in terms of the trauma
*as presented by Dr. Maria Yellow Horse Brave Heart
(April 2005)

29.  Takini Network has conducted research on
their model that addresses trauma
testimony, trauma response issues and
moving beyond trauma
 All participants found intervention helped
them with grief resolution, feeling better
about themselves, experienced
improvements in their parenting and a
better understanding of why they felt so
bad & had so many health & social
problems

30. Attend to:
1. The mind by remembering, speaking & coming to
terms with the horrifying, overwhelming
experience(s) that led to trauma response
2. The body by learning to acknowledge and master
the physical stress response like anxiety &
sleeplessness
3. The emotions by re-establishing relationships and
secure social connections
4. The spirit by recognizing that the spiritual &
cultural have often been critical aspects of the
original wound or trauma for Aboriginal people

31. 1. The Journey Begins
 gathering of core group of people to address their own healing
needs
2.Gathering Momentum
 increase in healing activity with recognition of root causes of
addiction & abuse through community-wide awareness
workshops
3. Hitting the Wall
 building healing capacity by providing training & employment
with a focus on community development
4. From Healing to Transformation
 shifting from fixing the problem to transforming the system

32. Views Aboriginal peoples’ reaction to
Residential School as a Post-Traumatic
Stress Response to avoid terminology
of blame & weakness
Five (5) components to addressing PTSR
and health inequalities
1. Acknowledgement of socio-historical
context
2. Reframing of stress responses
3. Focus on holistic health & cultural renewal
4. Proven psycho-educational & therapeutic
approach
5. Communal and cultural model of grieving
and healing

33.  PTSR may arise from a multitude of individual &
community traumas, within and across
generations.
 Compound trauma referred to as historical trauma
or IT rooted in cultural loss
 Need to partner and share information about
social/historical impacts on the health of
indigenous people & conduct research across
similar populations. This will help identify
relationship between IT, health inequalities and
strategies to improve health within & across
indigenous peoples/communities.

34.  PTSR model reframes PTSD symptoms as human
responses to extreme circumstance seen as more
compassionate for individuals & communities who
have endured external trauma that is so profound
that it affects their ability to cope
 Need for a process to name historical & systemic
sources of personal & social ills that is a critical
political lens in developing a compassionate view
of current health inequalities. May assist in better
service delivery for Aboriginal people
 Rename, manage & transform historical stressors
& stress responses to health promoting behaviors
& positive health outcomes

35.  Need to promote holistic perspective of health that
is consistent with cultural concepts of Medicine
Wheel
 PTSR model includes life experiences and
environmental stressors as preconditions for health
& illness. Acknowledges historical stressors,
culture, Elders, traditional healing & community
processes
 Need to incorporate a lifespan approach to healing,
focus on capacity building & address all aspects of
the person’s response to stress.

36.  People do recover from post-traumatic
stress through effective psycho-
educational & therapeutic approaches.
 The Lakota First Nation has adapted
western based approaches that are
more suitable for Indigenous settings
& approaches to historical trauma.
They recommend 4 main components
to healing from intergenerational
trauma

37.  Therapeutic approaches to PTSD are
consistent with Indigenous values of
respect, care & collective models of
healing. They bring people together who
share a history of trauma to identify with
one another & further accept stress
responses and support a path to wellness
 Many Indigenous ceremonies that
promotes group healing and reduces
isolation; alleviates guilt, shame & anger;
and enhances feelings of self-worth

38. Healing, in Aboriginal terms, refers to
personal and societal recovery from the
lasting effects of oppression and systemic
racism experienced over generations.
Many Aboriginal people are suffering not
simply from specific diseases and social
problems, but also from a depression of
spirit resulting from more than 500 years
of damage to their cultures, languages,
identities and self-respect. The idea of
healing suggests that to reach ‘whole
health’, Aboriginal people must confront
the crippling injuries of the past
(RCAP, 1996:109).

40. MIIGWECH! THANK YOU