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Healthy Nations Initiative

Friendship House Association of American Indians

About the Program

The Healthy Nations Circle of Strength Program is a multi-agency collaborative organization dedicated to promoting individual, family, and community healing and wellness. The program serves as a model of interagency collaboration by comprehensively addressing substance abuse issues in the Native American community while operating within a traditionally based Native framework (the Traditional Indian Medicine Model) of cooperative networking among various segments of the Native American community.

The Circle of Strength/Healthy Nations Traditional Indian Medicine Model consists of seven major program components: 1) COS Public Awareness Campaign, 2) COS Youth Prevention Program, 3) COS Aftercare Service Coordination, 4) COS Early Identification and Referral System, 5) COS Volunteer Corps, 6) COS Elders Advisory Council and 7) COS Project Caregivers Wellness Program. Each COS program component is deemed integral to the overall operation and maintenance of the project, with built-in mechanisms designed to promote community mobilization and agency capacity- building beyond the life of the program.

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Host Community/Organization

According to the 1990 Census figures, California has the second largest population of American Indians (242,000) of any state. The population is estimated to have increased approximately 20.3% statewide from the 1980 Census. Nationwide, American Indians are considered to be under-represented in the federal census by an estimated 5%. Some estimates of urban Indian undercounts are as high as 60% . A recent study of issues relating to the undercount of Bay Area Indians noted that Indian households were characterized by mobility between urban and rural/tribal areas, frequent moves within urban areas, fluidity in household composition, and non-standard housing.

California’s American Indian population is rapidly growing, widely dispersed, and highly mobile. American Indians frequently move from rural areas to the major urban areas and then back, and also relocate from other states. About 70% of American Indians are concentrated in the state’s major urban areas. Another consequence of this relocation, both within the nation and the state, is that the tribal composition of California’s American Indian population is quite varied. Urban Indian families tend to live dispersed among other groups, rather than clustered together in homogeneous neighborhoods. Unlike other populations that share a racial and ethnic heritage, and who often live in identified neighborhoods, California’s urban American Indian community is not located in any one part of a city. However, they are linked by a strong network of American Indian service organizations, providing medical and social services to both adults and children. For example, there are over 37,000 American Indians living within the Greater Bay Area.

Nationally, American Indians have one of the youngest populations comparatively. According to the 1980 census, 32% of the population was younger than 15 years and 5% was older than 65 years. In the 1990 Census, 22% of the population was younger than 18 years and 5% was older than 65 years. Accounting for the younger population characteristic of the Indian community may be the high Indian birth rate. The American Indian birth rate for 1982-84 of 28.8 per 1,000 was 86% higher than the U.S. All Races rate of 15.5 in 1983.

In general, the socioeconomic status of California Indians appears to be higher than that of Indians in the U.S. as a whole, but lower than that of the total population in California. Conditions in California are more favorable for Indians and for all races compared to the U.S. overall. Nevertheless, the social and economic profile of California Indians raises concerns about risk for alcohol and substance abuse associated with poverty and other demographic considerations. The 1980 Census indicates that American Indians differ substantially from U.S. residents overall. The Indian population is younger, with larger families that are more likely to be maintained by an adult female. The 1990 Census indicated that an average of 15% of Indian households are headed by a female. The estimates range from 10% to 20% in Marin and San Mateo counties, respectively.

Local studies have found that the San Francisco Bay Area American Indians are less likely to be educated and more likely to be unemployed. Median income is lower and Indian families have higher rates of poverty. A survey of Bay Area clinic users of the Native American Health Centers in San Francisco, Santa Clara, and Oakland showed that only 35% of the clinic population was employed full time. Over 45% were marginally employed or unemployed. In response to questions concerning sources of stress within the previous three months of survey, 72% included employment and 61% reported lack of money for necessities. Approximately 30% of the clinic users were on welfare. The high number of Indian families receiving state benefits is also indicative of the economic status of the community within this service area.

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Strategy 1: Public Awareness Campaign

The primary function of the public awareness campaign has been to impart the overall vision/mission of the Circle of Strength project to create a social movement promoting healing and wellness in the Native American community of the San Francisco Bay Area. The nature of the message has been designed and disseminated in a culturally sensitive approach, reflecting the multi-tribal make-up of the Native American community of the Bay Area. The Public Awareness Campaign component has been designed with four key questions in mind: whom the message is targeting, what the content of the message is, how the message is to be delivered, and where the message is to be delivered. The necessity of answering these questions was a prerequisite to formulating a comprehensive public awareness campaign focusing upon substance abuse issues in the Bay Area Native American community.

In regard to whom the message is targeting, it is not enough to simply state the Native American community of the greater San Francisco Bay Area. In developing the strategic plan for the project's public awareness campaign, it was necessary to ascertain who and what this community actually is, including: geographic distribution, where population concentrations are located, and various tribal representations, types of service organizations that tie the community together. A broad profile of educational levels, income distribution, and a history of the local Indian community are crucial. In analyzing the demographic profiles of the population distribution of Native Americans in the Bay Area (and in respect to the seven counties this project intends to serve), it is evident there are no concise parameters which define the urban American Indian community in terms of geographic concentration or specific tribal identification, as would be the case for reservation based populations. Since the Bay Area American Indian community is unevenly distributed throughout the seven counties that constitute the greater Bay Area, most of the project's community activities have revolved around existing service agencies concentrated in and around Oakland and San Francisco.

The message is promoting a social and cultural movement for the healing and wellness of the Native American community in the Bay Area. These core messages represent the fundamental program philosophy and approach in addressing substance abuse issues in the urban American Indian community. These messages have been systematically integrated into our Public Awareness Campaign, and into all of our program components and activities. The overall goal of the Public Awareness Campaign was to increase public consciousness regarding existing ATOD problems in the Native American community and to offer concrete, feasible solutions through other program components such as the COS Youth Prevention Program, COS Treatment/Aftercare Service Coordination, the COS Community Volunteer Corps and the COS Elders Advisory Council.

Public Service Announcements: The Center for American Indian Research and Education produced a 14-minute video for the public awareness campaign. Local Indian leaders were filmed and the background took place at the AICRC sponsored Indian Education Conference in Sacramento. Many meetings and focus groups were held to capture the message to be used in the video. The film was distributed to Indian agencies, local agencies and community members. It is anticipated that sections of the film may be used for PSAs.

COS Newsletter: Another aspect of the public awareness campaign was to inform the community of the Healthy Nations Program. Identification of the appropriate message targeting adults for the public awareness campaign was accomplished through meetings of the Public Awareness Committee of the Circle of Strength program. Statements made by community members at the visioning meetings were used to formulate the ideas that went into the set of newsletter articles and brochures distributed to the community. Three newsletters were utilized, the Native American Health Center's newsletter that reaches over 100 employees and their families, the youth Empowerment Program's newsletter that targets American Indian youth and the United Indians Nation's newsletter, Yacha is a quarterly publication that has a mailing list of over 2,000 families in the Oakland/San Francisco Bay Area.

Journal and Newspaper Articles: In the spring 1994 issue of Yacha, the front-page article was called "Healthy Nations Project Begins" and it contained two articles on tobacco abuse and an invitation to the community meeting on substance abuse. The summer 1994 issue of Yacha reported the results of the Visioning Meeting and again emphasized the critical importance of community-focused solutions.

Dissemination of Information at Indian Gatherings: The Circle of Strength piloted the public awareness campaign by developing a Program Brochure that states the Healthy Nations vision, the history of substance abuse problems and what can be done to heal the wounds resulting from substance abuse in the Indian community. Six hundred brochures were printed and distributed throughout the seven counties, at American Indian agency offices, pow-wows, and at community events. Another 500 programs with a detailed description of the Circle of Strength vision, goals and objectives were disseminated at the San Francisco State University pow-wow.

Teen Outreach / YEP Drama Group: For the messages relating specifically to youth, the Circle of Strength staff worked with the Youth Empowerment Program under the Native American Health Center. The Native American Youth Needs Assessment was accomplished by two methods: 1) meetings with Circle of Strength staff and service providers to youth to identify the issues youth face and 2) focus groups and discussions with youth involved with the Youth Empowerment Program (YEP) and the American Indian Child Resource Center.

Community Wide Campaign: The United Indian Nations coordinated community-wide functions to build community strengths and enhance pro-social activities. This included over 20 community-based organizations to serve as forums for American Indian community members to voice their challenges, issues and concerns about living in the San Francisco/Oakland urban environment. Four community-visioning meetings were held over the life of the project with the themes of “Confronting Substance Abuse”, “Empowering the Family”, “Our Vision for Education” and “Promoting Healthy Communities”. Community councils, including the health council, were formed as a result of these meetings to ensure an ongoing mechanism to address the substance abuse problems in the Indian community.

The COS Public Awareness Campaign continues to strengthen bonds with Native and non-Native individuals in the greater Bay Area, and is still creating a positive vision among the Native American community.

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Strategy 2: Community-Wide Prevention

The Circle of Strength Youth Prevention Program is a multi-faceted, culturally based coordinated system of service delivery of various prevention modalities, activities and approaches toward reducing substance abuse prevalence among Native American youth of the San Francisco Bay Area. The overall strategy of the COS Youth Prevention Program is designed to reduce existing high-risk factors in the community that directly contribute to ATOD use by instilling various culturally-focused resiliency factors to be incorporated into the everyday lifestyle of American Indian youth.

The target populations of this project are high-risk Native American youth between the ages of 10-22, residing in the seven county service areas. The urban American Indian youth face many difficult problems struggling to survive in a psychosocial environment that is not fully supportive of their basic cultural, emotional and spiritual needs. High-risk factors related to substance abuse include poverty, dysfunctional family orientations, social and cultural alienation, urban violence, gang related activities, negative peer influences, and an absence of meaningful family/tribal activities. The COS Youth Prevention Program has clearly made a sufficient effort to ensure that our youth have healthy alternatives, positive role models, mentors, community involvement, self-identity, an understanding of cultural heritage, clean and sober recreation activities, educational information, a sense of belonging and an extended family.

Research in the ATOD prevention field among Native American children and adolescents has raised a number of significant issues regarding cultural competency, settings and methodologies employed. Over the years, the formulation of effective strategies and the development of theoretical frameworks for community-based models have been designed for replication in other communities. The direction among community based health promotion programs is oriented towards increasing program ownership by community organizations and grassroots leaders, visioning community health in addition to the health needs of individuals. ATOD prevention education modalities will integrate positive cultural norms while negating opportunities for initial early ATOD experimentation. Among the American Indian population, the earlier the age group is exposed to prevention education, the more effective such programs are in developing long term, internalized cultural resiliency factors.

COS Prevention Committee: The COS Prevention Coordinator is responsible for establishing the Prevention Committee consisting of all participating agencies. The Prevention Committee met on a quarterly basis in order to plan and implement prevention goals and objectives.

Outreach Services: COS worked with Intertribal Friendship House Youth Center, identifying various schools, community centers, and cultural events to conduct Outreach Presentations to recruit youth to participate in the IFH Youth Center's program activities.

Youth Leadership Program: COS Youth Prevention Program, in conjunction with Intertribal Friendship House Youth Center, developed and implemented a total of 48 Youth Leadership Meetings throughout the project life. Community leaders addressed issues such as leadership, community problems, substance abuse, and traditional Native values.

Talking Circle Support Groups: COS conducted weekly Talking Circle Support Groups at Intertribal Friendship House and Youth Empowerment Program, as well as for Native American youth (12-15 year olds) at the American Indian Public Charter School. The United Indian Nations provided a facilitator to conduct Support Groups for young adults in recovery.

Youth Sports and Recreation Program: COS worked with Intertribal Friendship House, AICRC, Youth Empowerment Program and YMCA to conduct a weekly sports and recreation program as well as developed a weekly physical fitness program. The weekly sports and recreation program for 3-4 year olds was such a success that a Tribal Athletic league was formed under the guidance of the Native American Health Center.

School-Based Prevention Workshops: With assistance from Title V and the Indian Education Program, COS identified significant American Indian student populations and provided 24 culturally relevant prevention education workshops on such topics as ATOD and mental health issues to various elementary and high schools in the seven county service area.

School-Based Talking Circles: CAIRE provided the initial development of Talking Circle curricula utilizing storytelling and traditional values as a means of early avoidance of ATOD. These weekly Talking Circles were conducted in conjunction with Hintil Kuu Ca.

Parenting Education Classes: COS coordinated and developed classes in collaboration with AICRC, CAIRE, Hintil Kuu Ca, Title V Programs and the Sacred Circle of Birth of the Native American Health Center. Six ATOD classes were provided per year to parents, targeting prenatal women.

Parenting Conferences: The Sacred Circle of Birth conducted annual 1-2 day long conferences for prenatal and postpartum women and traditional American Indian parenting values, incorporating ATOD education and prevention information materials. These collaborations were sponsored in collaboration with other agencies such as CAIRE and Native American Health Center Sacred Circle of Birth.

Social Service Providers Training: COS conducted a total of 4 workshops per year for case managers and social service providers on ATOD specific issues affecting Indian families, 2 training workshops at the American Indian Public Charter School in Oakland (60 est.), California and 2 workshops in the Martinez School District Contra Costa County (12 est.) per workshop.

Coordination of Tobacco Cessation: Worked with existing tobacco cessation and education programs in the Native American community. This on-going objective was implemented through the Tobacco Cessation Project at United Indian Nations, Inc. COS co-sponsored and facilitated tobacco education workshops for Native American youth (100 est.) at the youth Gathering, 8/98.

Talking Circle Tobacco Lessons: Development and implementation of tobacco specific curriculum for Talking Circle prevention activities. Solicited materials from local and national programs for curriculum development and implemented activities at the traditional youth gathering and the American Indian Public Charter School in Oakland California.

Traditional Youth Gathering: Conducted the annual Traditional Youth Gathering that drew families and youth from seven counties in the Bay Area. Financial assistance was received from the American Indian Health Center of Santa Oara Valley with donations received from various San Francisco Bay area businesses.

Based on the findings and the existing following of volunteers and community supporters, the COS project is and continues to be an overwhelming success.

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Strategy 3: Early Identification, Intervention and Referral

The goal of the Circle of Strength Treatment/Aftercare Services Program is to implement and design a comprehensive treatment and aftercare system of service delivery for the San Francisco Bay Area American Indian community .The necessity for multi-agency collaboration of service coordination is critical to address the under-met needs and existing gaps and barriers relative to treatment and aftercare services for community members seeking treatment and transitioning out of primary residential care facilities. The COS Traditional Indian Medicine Model in addressing treatment and aftercare service offers a continuum of care approach, ranging from outreach, prevention activities, early ATOD identification referrals, and the aftercare component which develops support groups, employment training and other transitional needs. Creating social networks assist clients in meeting both short term and long-range goals for the recovery process. The COS program assisted in agency networking and maintaining a referral system within the American Indian agencies in the Bay Area.

New Years Wellness Celebration Pow-Wow: Annual New Years Eve Wellness Celebration Powwow for the purpose of outreaching the greater Indian community and publicizing the project's goals and objectives. This event draws several hundred participants and is an excellent source for COS to promote the project and celebrate a healthy lifestyle of sobriety.

Aftercare Re-entry Program: Conducted activities with the four existing treatment centers, provided Aftercare Re-entry Program service coordination for 20 clients per year. On-going activities referrals were made on a regular basis by all COS and FHAAI staff. The Friendship House is still providing aftercare services at this date utilizing the recruited volunteers, "Native Wellness Helpers."

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Strategy 4: Substance Abuse Treatment and Relapse Prevention

The Treatment/Aftercare component of implementing a service delivery system is still in existence. Those individuals are a clean and sober group that have been given the responsibility of being a part a critical decision making team in the Native American community .The true answer is the community. The COS project will move on and continue to provide the best services possible, regardless of funding or lack thereof. We are part a community of over 50,000 in seven (7) counties depending on the COS project Recovery and wellness will not end with time lines or lack of funding. We have gone too far to stop now.

COS Treatment/Aftercare Committee: This committee was created for the purpose of planning and coordinating the goals and objectives of the COS Treatment/Aftercare Services component of the project This objective has been implemented and is coordinated by COS traditional counselor and aftercare committee. This committee is comprised of Friendship House aftercare clients and alumni.

Talking Circle Support Groups: Established 2 on-going Talking Circle Support Groups during each project year, for a total of 6 for the three-year project life. The COS traditional counselor facilitated Talking Circle meetings at the Friendship House Association of American Indians Inc., of San Francisco, and at the American Indian Family Healing Center in Oakland.

Native Wellness Helpers Program: Recruitment and training of 3 community volunteers per year to be designated as "Native Wellness Helpers" and to support in the coordination of project activities. This is an on-going activity but problematic due to the transient population of residents at Friendship House Primary Residential Treatment Facility. Residents are there for a minimum of 90 days at a time with constant change taking place. Volunteers have been trained to help facilitate some of the project's needs.

Young Adults Employment Training Program: Provided weekly ATOD education/support classes where recovering American Indian young adults would receive employment/education training. This is an ongoing weekly activity at United Indian Nations, Inc. in Oakland.

Family Addiction Awareness Conference: Conducted annual Family Addiction Awareness Conference focusing on families in recovery. The focus of this objective is Families in Recovery.

Native American 12-Step Groups: Conducted weekly culturally specific 12-Step meetings throughout the Bay Area Indian community. This on-going objective took place weekly at United Indian Nations, Inc. and the Intertribal Friendship House in Oakland.

Aftercare Family Support Groups: Coordination of weekly Aftercare family support groups at the American Indian Family Healing Center for individuals and their families who are going through recovery.

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Friendship House Association of Native Americans

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