Honoring children, mending the circle: cultural adaptation of trauma‐focused cognitive‐behavioral therapy for American Indian and Alaska Native children

Abstract

American Indians and Alaska Natives are vulnerable populations with significant levels of trauma exposure. The Indian Country Child Trauma Center developed an American Indian and Alaska Native (AI/AN) adaptation of the evidence-based child trauma treatment, trauma-focused cognitive-behavioral therapy. Honoring Children, Mending the Circle (HC-MC) guides the therapeutic process through a blending of AI/AN traditional teachings with cognitive-behavioral methods. The authors introduced the HC-MC treatment and illustrated its therapeutic tools by way of a case illustration.

Counselor and Client Perspectives of Trauma-Focused Cognitive Behavioral Therapy for Children in Zambia: A Qualitative Study

“…TF-CBT (Cohen, Mannarino & Deblinger, 2006; www.musc.edu/tfcbt) has several randomized controlled trials supporting its efficacy in treating many outcomes, including child behavior problems, safety skills, social competence, depression, PTSD, traumatic grief, child shame, and parental reactions to child trauma (Cohen & Mannarino, 2004; Cohen, Berliner & Mannarino, 2010; Cohen, Deblinger, Mannarino & Steer, 2004; Cohen et al, 2006; King et al, 2000). Studies have also shown that TF-CBT is adaptable across different cultures (BigFoot & Schmidt, 2010; Huey & Polo, 2008). The literature on cross-cultural adaptation of TF-CBT (e.g., BigFoot & Schmidt, 2010), as well as the wider literature on EBT (Patel et al, 2011; Verdeli et al, 2003; Verdeli et al, 2008) suggest that modifications are primarily on methods of implementation (rather than core concepts), simplifying text, and reducing jargon.…”

“…Studies have also shown that TF-CBT is adaptable across different cultures (BigFoot & Schmidt, 2010; Huey & Polo, 2008). The literature on cross-cultural adaptation of TF-CBT (e.g., BigFoot & Schmidt, 2010), as well as the wider literature on EBT (Patel et al, 2011; Verdeli et al, 2003; Verdeli et al, 2008) suggest that modifications are primarily on methods of implementation (rather than core concepts), simplifying text, and reducing jargon. One component of TF-CBT that was hypothesized to require some adaptations in LMIC is parenting skills.…”

“…In their review of the use of EBTs with survivors of child abuse and neglect, Chaffin and Friedrich (2004) argue that some EBTs may be inflexible and restrictive of therapist creativity. Research has also suggested that EBTs developed in high-income countries (HIC) are often developed for the general population and then applied to specific cultures without consideration of differences in culture and worldview (Bigfoot & Schmidt, 2010; Gone, 2009). There is general agreement that collaboration between community members and researchers is essential for EBTs to be culturally appropriate while maintaining the core components of the treatment (Bernal & Rodriguez, 2009; Bos, Schaalma, & Pryor, 2008; Gone, 2009; Pearson & Jordan, 2010; Wessells, 2009).…”

Clinical Considerations Related to the Behavioral Manifestations of Child Maltreatment

“…For example, Bigfoot and Schmidt report the integration of trauma-focused care with traditional American Indian practices. 80 …”

Funding Cultural Adaptations to Promote Effective and Efficient Mental Health Service Provision

“…However, small sample sizes of racial and ethnic populations in randomized, controlled trials research prevent strong and clear conclusions about the effectiveness, generalizability, and appropriateness of EBPs delivered to racial and ethnic minority communities. Prior research indicates the importance of addressing culture in mental health services and treatment, as culturally adapted treatments are more likely to yield positive results (BigFoot & Schmidt, 2010;Harris & Franklin, 2003;Muñoz & Mendelson, 2005;Sue, 2003).…”