WALKING IN BEAUTY ON THE RED ROAD A HOLISTIC CULTURAL TREATMENT MODEL FOR AMERICAN INDIAN & ALASKA NATIVE ADOLESCENTS AND FAMILIES PROGRAM DESCRIPTION AND CLINICAL MANUAL Prepared by Candice Sabin, Ph.D. Hoskie Benally, B.S. Susan K. Bennett, LMSW Eleanor Jones, M.A. This manual was prepared under funding provided by grant no. KD1 TI11888 from the Center for Substance Abuse Treatment (CSAT), Substance Abuse and Mental Health Services Administration (SAMHSA). The model and approaches described in this document are those of the authors and do not necessarily reflect views or policies of CSAT or SAMHSA. TABLE OF CONTENTS PREFACE ................................................................................................................... 6 ACKNOWLEDGMENTS. ......................................................................................................... 7 INTRODUCTION ................................................................................................................... 8 I. ORGANIZATION HISTORY AND PROGRAM EVOLUTION ............................................ 9 II. OVERVIEW OF AOD AND BEHAVIORAL HEALTH STATUS OF AI/AN ADOLESCENTS ................................................................................................................. 11 A. Prevalence Of Alcohol And Other Drug Abuse (AOD) ................................................ 11 B. Juvenile Justice System Involvement............................................................................ 12 C. Mental Health Status .................................................................................................... 12 D. Abuse, Trauma And Victimization ............................................................................... 12 E. Prevalence Of Suicide .................................................................................................. 13 F. Academic Status........................................................................................................... 14 G. Impact Of Historical Issues .......................................................................................... 14 H. Treatment And Outcome Studies.................................................................................. 15 III. GENERAL THEORETICAL ASSUMPTIONS.................................................................. 17 A. Language Of Spiritual Dialogue................................................................................... 17 B. Alternation Theory And Ethnic Socialization ............................................................... 19 1. Alternation Theory ........................................................................................... 19 2. Ethnic Socialization.......................................................................................... 20 C. Theory Of Wellness And Unwellness........................................................................... 21 D. Theory Of Cultural Treatment...................................................................................... 26 1. Process Of Change ........................................................................................... 26 2. Integration Of Healing Practices....................................................................... 27 3. Creating A Place Of Safety............................................................................... 28 4. Cultural Evaluation And Diagnosis................................................................... 28 5. Treatment Implementation................................................................................ 29 E. Integration Of Cultural And Western Treatment ........................................................... 30 1. Pathway To Adolescent Aod ............................................................................ 30 2. Stages Of Change............................................................................................. 31 3. Motivation Enhancement Therapy And Techniques.......................................... 32 4. Cognitive Behavior Therapy, Imagery, Relaxation And Prayer......................... 32 5. Crisis Stress Debriefing Process ....................................................................... 33 6. Theory Of Emotional Intelligence..................................................................... 34 7. Theory Of Family Systems............................................................................... 35 8. Clanship System............................................................................................... 37 9. Navajo Philosophy, Values And Teachings ...................................................... 37 10. Teaching Family Boundaries .......................................................................... 39 2 IV. DESCRIPTION OF TREATMENT DESIGN AND DELIVERY OF WBRR MODEL ...... 41 A. Treatment Design......................................................................................................... 41 1. Program Scope ................................................................................................. 41 2. Program Goals.................................................................................................. 41 3. Program Services.............................................................................................. 42 4. Client Expectations and Grievance Process....................................................... 43 B. Delivery of WBRR Model............................................................................................ 43 1. Identification Stage .......................................................................................... 43 a. Triage ................................................................................................... 43 b. Suicidal/Homicidal Ideation and/or Plan ............................................... 45 c. Evaluation and Admission Team........................................................... 45 d. Waiting List.......................................................................................... 45 2. Engagement and Initiation Stage ...................................................................... 46 a. Admission Process................................................................................ 50 b. Orientation............................................................................................ 50 c. Three Levels of Care............................................................................. 53 d. Level System ........................................................................................ 56 3. Retention Stage ................................................................................................ 57 4. Maintenance and Discharge Stage .................................................................... 57 a. Maintenance Stage................................................................................ 57 b. Discharge Stage.................................................................................... 58 5. Follow-up Stage ............................................................................................... 58 C. Program Orientation, Training, Development, Responsibilities & Supervision ............. 59 1. Orientation of Personnel................................................................................... 59 2. Personnel Training, Development, Responsibilities & Supervision................... 59 3. Qualifications................................................................................................... 60 4. Program Environment ...................................................................................... 60 D. Client Profile................................................................................................................ 61 1. Demographics .................................................................................................. 61 2. Alcohol and Other Drug Profile........................................................................ 62 3. Bio-Psycho-Social-Cultural Status.................................................................... 62 E. Client Profile ................................................................................................................ 63 1. Profile of Referral Sources ............................................................................... 63 2. Program Participation of Referral Sources........................................................ 63 V. CULTURALLY APPROPRIATE COMMUNICATION AND INTERACTION. ................ 64 VI. CULTURAL-TRADITIONAL PROGRAM....................................................................... 66 A. Spiritual Grounding: Four Sacred Herbs....................................................................... 66 1. Smudging......................................................................................................... 66 2. Cultural Teaching: Gift of Resilience From the Holy Ones ............................... 67 B. Sweat Lodge-Inipi Stone People Lodge Ceremony ....................................................... 68 C. The Smoking Ceremony............................................................................................... 69 D. The Protection Way Ceremony..................................................................................... 70 E. Drumming and Singing................................................................................................. 70 3 VII. ALCOHOL AND OTHER DRUG PROGRAM ...............................................................