Trauma-Informed Caring for Native American Patients and Communities Prioritizes Healing, Not Management

Abstract

Addressing intergenerational trauma remains a public health priority in Native American (NA) communities. Clinicians working with NA patients must express humility, understand local culture, collaborate, and develop an insider's perspective on NA past and present life in order to earn trust. This case considers an NA adolescent suffering from mental distress, possible substance use, and multiple traumas. The commentary argues that trauma-informed therapies are lacking in some current psychiatric and primary care practices in the Indian Health Service and that an interprofessional, trauma-informed approach that considers the interplay between relevant somatic and psychological factors can better motivate patient-centered care. Cultivating safe environments in which interventions are pursued within the patientclinician therapeutic alliance is key to generating optimal outcomes and healing among NA patients. CaseDr L is a new attending physician in an Indian Health Service (IHS) facility on the Colorado River Indian Reservation who has an interest in serving minoritized communities with few resources in the United States. Dr L is introduced to JM, a 16year-old who lives on the reservation. JM was brought to an emergency department (ED) last weekend after an apparent narcotic overdose and sees Dr L for follow-up. JM's blood pressure is slightly elevated at 145/90 mm Hg. Dr L asks about JM's family, with whom they interact only minimally.Substance abuse on the reservation has resulted in many adolescents' deaths in recent years. Dr L observes that JM has developed dysfunctional ways of coping with abundant stress, sources of which include having few resources and enduring grief over ancestral losses of land, status, and sense of a future. She also worries that JM might have tried to commit suicide last weekend and might try again.

Evolution of storytelling pedagogy in global health course at a U.S. Native American-Serving Nontribal Institution from Fall 2019 to Spring 2023

“…Stories were not used as fixed or measurable information but as interpretable frames of meaning-making for teaching-learning that occurred through narrative co-constructions. Studies show that this is particularly important in the context of a NASNTI where students' self-exploration and creating an engaging and exciting learning environment are deeply tied to their retention (54)(55)(56).…”