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The Medicine Blanket Project

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The Medicine Blanket Project

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Content Running Head: THE MEDICINE BLANKET PROJECT !1
The Medicine Blanket Project
Joseph Pritchett II
Doctoral Capstone Project
Doctor of Social Work
Suzanne-Dworak School of Social Work
University of Southern California
May 2020
SOWK 724
Dr. Annalisa Enrile
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Executive Summary
The U.S. has seen an increase in mental illness and behavior disorders such as anxiety
and depression in recent years. Since 2012 the rate of depression among youth was at 5.9
percent, as of 2015 it has increased to 8.2 percent (MHA, 2015). According to the World Health
Organization (WHO) one in six children ages 10-19 years of age will be or have been diagnosed
with a form of mental health disorder (Project Atlas, 2018). As these statistics are alarming and
astonishing, something needs to be done. According Hawkins et al (2015), early intervention has
been the most effective way in dealing with childhood mental illness and behavioral disorders.
The Grand Challenge of Ensuring Healthy Development of All Youth: Unleashing the Power of
Prevention is an initiative that was developed by the American Academy of Social Work
(Hawkins, 2015). Their objective is to seek out innovative interventions that can lessen or
eradicate behavioral and mental health problems within the youth (Hawkins, 2015). As this is a
large-scale undertaking, the concentrations to work with smaller groups will be ideal. The
sample of the population that will be implementing the intervention will be the American Indian /
Alaskan Native (AI/AN).
Although the AI/AN, make up approximately 2% of the U.S. population they have the
highest rate of poverty, twice that of the U.S. population (26% vs 14%)
(www.apa.org;www.integration.samhsa.gov). The AI/ANs have a significantly higher rate of
suicides, depression, substance abuse and mental illness than any other ethnic group in the
United States (www.apa.org; Kopak, 2017). These disproportionate rates can be attributed to the
intergenerational trauma that has been inflicted among the native community (Kopak, 2017;
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Windholz, 2017). Examples of these such traumas are, the boarding school experience, the
removal of native lands and the relocation act of 1956 all of which have affected the economic,
physical and social lives of the AI/AN community (Bigfoot, 2010).
The population where the Medicine Blanket Project (MBP) will be employed will be the
Viejas Band of Kumeyaay Indians. Their reservation is in San Diego county in the city of
Alpine, 30 miles North of the Mexican border. They have a population of approximately 394
tribal members (Kumeyaay, 2010). They have a funded health facility governed by the Southern
Indian Health Council (SIHC) (About Us, 2019). The initial pilot program will use 10 families.
These 10 families will be provided with the counseling services and workshops, while they are
going through their pregnancy. The reason why this community of AI/AN are being selected has
to do with the high rate of serious mental illnesses within the community (www.chcf.org). The
California rate for AI/AN children with serious mental illness is 7.9%, this is the third highest in
behind Latino and African American children. As these children grow to adulthood statistics
show that they grow to the highest rate of mental illness with 7.0 % surpassing Latinos and
African Americans. Thus, the need for an intervention to address the children well-being is
needed in the AI/AN community and selecting California is only out of convenience to the
location of the researcher
The innovation that will be implemented is an early intervention that has a cultural
context for the American Indian /Alaska Native (AI/AN) population. The goal is to lessen or
prevent mental illness and behavior disorders within children. There have been studies
conducted on various tribes that have shown that a western mental health model alone does not
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work with the AI/AN population (www.psychriatic.org). This disparity can be attributed by
historical distrust of the non-American Indian/Alaskan Native population existing among many
tribes (eclkc.ohs.acf.hhs.gov; www.calmhsa.org). Individuals tend to have a negative opinion of
non-AI/AN health service providers and seek a traditional healing method
(eclkc.ohs.acf.hhs.gov; www.calmhsa.org). According to statistics, Indian Health Services fund
34 urban Indian health organizations, which operate at 421 sites located in cities throughout the
U.S. which offer mental health services along with drug and alcohol prevention centers.
Approximately 605,000 AI/AN are eligible to utilize these programs. However, only 1 in 5
reported having access to this care (www.calmhsa.org)
Research indicates that early intervention that supports families during the developmental
stages of a child’s life, have lasting effects on a multitude of populations (El-Sheikh, 2011). Not
will this intervention help mental illness, but it can also assist in lessening poverty in the AI/AN
population. The intervention will reintroduce a culture that has been lost on the reservations and
provide a new beginning for children. The intervention would break the cycle that is currently
on the reservation of poverty, depression and substance abuse.
The Medicine Blanket Project (MBP) is directed toward the parents of children that
reside on reservations. The families will be identified through Indian Health Service (IHS), as
the families are seeking prenatal care. This is a volunteer program, the families that adhere to the
program will be provided mental health service until the child reaches adolescents. As the
parents are going through the pregnancy, they will have monthly visits with a counselor. This
counselor will be trained in the relevant cultural context of healing ceremonies for tribe. The
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visits will be aligned with their regular doctor visits to eliminate or decrease the chances of
missing an appointment. The purposes of these counseling appointments are to establish and
develop a relationship between families the counselors. At the same time the family member
will receive counseling to address problems they may face (Bigfoot, 2010;
www.firstfivesandiego.net).
When the child is born, the parents continue monthly visits at their homes. This visit will
consist of a pediatric nurse and the counselor that the family has already been acquainted with
(www.firstfivesandiego.net). The familiarity that is established with the counselor will allow the
parents to ask intimate questions because of the relationship they have already established.
Research suggests that when a relationship has been established with a medical/mental health
provider there are better results in the healthcare provided and received (www.apa.org). The
final step in the intervention would be for the child to enter a head start program. The head start
programs were launched in 1965 to honor the rich cultural heritage of AI/AN children, families
and communities (www.eclkc.ohs.acf.hhs.gov). They are based on the needs of the
communities; the programs offer traditional language and cultural practices to provide high
quality services to young children and their families (www.eclkc.ohs.acf.hhs.gov).
The Medicine Blanket Project is an innovative intervention that has carefully considered
all relevant research in its creation. This specific topic is their area of expertise to have reached a
consensus on the best practices. The MBP would like to contribute to the advancement of the
mental health field with its intervention.
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Page Blank Intentionally
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Conceptual Framework
Grand Challenge of Social Work and the Wicked Problem
The U.S. has seen an increase in mental illness and behavior disorders such as anxiety
and depression in recent years. Since 2012 the rate of depression among youth was 5.9%, as of
2015 it has increased to 8.2 percent (Mental Illness, 2015). According to the National Alliance
of Mental Illness (NAMI), one out of five children ages 13 to 18 have or will develop some form
of serious mental illness. Of those, mood disorders,major depression, dysthymic disorder and
bipolar disorder, contribute to the third most common cause of hospitalization in adults (Mental
Illness, 2015). Half of all chronic mental illness begins by age fourteen and a third by age
twenty-four. Despite effective treatment, there are long delays, sometimes decades, between the
first appearance of symptoms and when individuals get help (Kessler, 2005). Studies suggest
that an interruption in a child’s development can contribute to a child developing mental illness
(Shapero, 2013). In areas where an intervention was implemented, a positive response was
found in children ages five to eighteen (Shapero, 2013; Campion, 2011). Nonetheless, it has
been shown that the family dynamic, in most cases, will have a greater effect on a child than
socioeconomic status, neighborhood and access to medical facilities (Parcel, 2012).
Shapero and Steinberg (2013), found a relationship between emotion and exposure to
household stress in childhood and adolescence. They found that there was a small relationship
between emotional reactivity and household stress however they did not account for a child’s
temperament and the ability they have to adapt. The original hypotheses of the research was
that children that were in lower socioeconomic households would develop emotional problems.
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The chaos and stressors within the household would exacerbate a child’s emotional reactivity,
thus leading to more problems. However, the temperament that the child had truly depicted the
emotional reactivity that they exhibit.
According to Carter, Andershed and Andershed (2014), associated the various
victimization with mental health within the adolescence population. They surveyed 2,500
Swedish youth adults between the age of 20-24, male and female. These individuals were
surveyed because they had experienced a form of victimized as an adolescent. The primary
forms of victimization that they found were physical abuse, sexual abuse, verbal abuse and
neglect. They also accounted for the perpetrator and the relationship to the victim. They found
that males were exposed to physical victimization more often than their female counterparts. As
for females, they found that they were often victims of sexual abuse which also led to co-
occurring behaviors. Although the research found that there was a correlation between
victimization and mental illness, there was a minority of test subjects that did not exhibit mental
illness who had experienced victimization. In the conclusion they found that when professionals
are evaluating people with mental illness they should assess any victimization in their past.
According to Campion, Bhui and Bhugra (2011) they believed that an early intervention
will have ramifications to the client’s symptoms. Their plan was to create an intervention that
included home visits and started when the child was born. The visit would assist with mental
and physical health, thus reducing conduct disorders, assisting with family relationships and
supporting parenting skills. There hope would be a reduction in antisocial behavior and crimes.
They wanted to enforce a preschool and early education program that would improve cognitive
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skills, school readiness and improved academic achievement. Ideally this would endorse a
resilient family structure. They suggested that the intervention should continue with youth and
teenagers. The program would enhance the curriculum that was taught in preschool and in early
education programs. The findings in this article suggested that the intervention would be capable
of working as long as the resources were available. The researchers illustrated that this would
need to be a cultural investment that would cross the government and non government agencies.
According Hawkins et al (2015), early intervention has been the most effective way in
dealing with childhood mental illness and behavioral disorders. The Grand Challenge of
Ensuring Healthy Development of All Youth: Unleashing the Power of Prevention is an initiative
that was developed by the American Academy of Social Work (Hawkins, 2015). Their objective
is to seek out innovative interventions that can lessen or eradicate behavioral and mental health
problems within the youth.
The wicked problem for this capstone proposal is the rising number of American Indian
children that have been and will be diagnosed with a mental illness. Statistics have revealed that
the AI/AN population has a significantly higher rate of suicide, depression, substance abuse and
mental illness than any other ethnic group in the United States (APA Fact Sheet, 2017;
eclkc.ohs.acf.hhs.gov). There has been studies conducted on various tribes that have shown that
a western mental health model does not work with the AI/AN population (Bigfoot, 2010; Drost,
2019; Marsh, 2018). As for an intervention that incorporates a traditional native aspect with
therapy, this could have lasting effects on the AI/AN populations. Not only does this
intervention affect mental health it can also contribute to a reduction in poverty within the AI/AN
Running Head: THE MEDICINE BLANKET PROJECT ! 10
population. The intervention would break the cycle that is currently felt on the reservation of
poverty, less education and substance abuse. This would create a population that is self-
sufficient in strengthening its identity as strong people.
Social Significance
The Medicine Blanket Project is an early intervention that will combine traditional native
healing with the western mental health model of therapy to the American Indian /Alaskan Native
(AI/AN) population. This intervention will be directed toward the parents. The intervention
will set counselors with the families prior to the child being born. During this time, parents will
learn child raising skills, along with addressing their own trauma that could affect raising the
child.
The goal for this early intervention is to lessen or prevent mental illness in the children
by breaking the cycle of intergenerational trauma. There have been studies conducted on
various tribes that have shown that a western mental health model alone does not work with the
AI/AN population (Fact sheet, 2017). As this information on the AI/AN communities, put the
AI/AN in a dangerous spiral where more people will continue to suffer from intergenerational
trauma. The significance of a culturally based intervention may become vital in this community.
As the native population looks for innovative ways to address these disparities, the tribes look for
concepts that they can utilize to heal their people. They look for cultural concepts that provide
identity, adaptability and perseverance. According to the American Psychiatric Association
there are a few protective factors that should be integrated when developing an intervention for
the American Indian. The following traits should be utilized: 1) A strong identification with
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culture and connection to the past, this is an individual's personal and family history which
determines their cultural structure. In their lifespan there culture may change as they are exposed
to multiple experiences. However, cultural identity in AI/AN people can be viewed as a
continuation that ranges between one who views himself or herself as “traditional” and practices
their culture daily. 2) Family, in the AI/AN community provides individuals the acceptance of
kinship ties, a shared sense of collective community, physical resources and indigenous
generational knowledge/wisdom. 3) Enduring spirit and Adaptability, is described when an
individual adapts during rough times in their life. 4) Traditional health practices (e.g.,
ceremonies), traditional spirituality and practices are integrated into the community's day to day
living. 5) Wisdom of elders, the experience that they have gained throughout their lifetime and
the historical knowledge is invaluable to the community and the decision making process.
These traits are necessary parts of any intervention, that will be introduced to AI/AN
populations. Not only does this intervention affect mental illness, it can also assist in lessening
poverty in the AI/AN population. Many issues on reservation are attributed to the
intergenerational trauma caused by the federal government such as the removal from lands,
boarding school experience and the relocation act (Bigfoot, 2010). The intervention will
reintroduce a culture that has been lost on the reservations and provide a new beginning for the
children. The intervention would break the negative cycle that is currently very rampant on the
reservation, these are problems of poverty, less education and substance abuse. This would
create a population that is self-sufficient in strengthening its identity as strong people.
Theory of Change and Logic Model
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This intervention is derived from evidence based research, which has shown that children
have a greater propensity of developing a mental illness or behavioral disorder when they
experience trauma during their developmental years (0-5 years of age) (Lieberman, 2011; El-
Sheikh, 2011, Khanan, 2016). The intervention is modeled after Albert Bandura’s social learning
theory, which entails developing behaviors from learning from other people (Mcleod, 2016).
The theory is separated into four distinct theories of Observational Learning, Classical
Conditioning, Operant Conditions and Mediating Process (Mcleod, 2016). The theories that will
be utilized in this intervention will be the observational learning and mediating process.
Observational learning aids individuals by developing new reactions by examining others
behavior (Mcleod, 2016). An example of this behavior is that of a child learning how to interact
with other people by watching their parents. The mediating process is a cognitive factor and is
used to determine if a new behavior is acquired. The four mediational processes are as follow:
attention, retention, reproduction and motivation. These processes are those that have been
proven to work and exhibit new behavior within children (Mcleod, 2016).
The innovative process of this intervention is the integration of western therapy and
traditional healing. In order to incorporate this process, the inclusion of culturally competent
counselors is a necessary attribute within the Medicine Blanket Project. Organizations such as
the Substance abuse and Mental Health Service Administration (SAMHSA), have begun looking
into ensuring that hospital administrators that cater to the AI/AN community are aware of the
needs in this community (Executive Summary SAMHSA, 2018). Thus, the importance of
having counselors attend training that discusses the tribal practices necessary for administering
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the intervention. The MBP will also be developing measurement tools that will identify the
frequency to which the family practices their tradition along with the exposure of trauma in their
lives. The use of this tool will help in determining to the extent to which the counselor will
need to develop a treatment plan. The workshops are going to be used to determine the number
of families that will be using the intervention. Ideally the immediate outcome is to build a
relationship between the family and the counselors. During the workshops the parents will also
be able to take part in traditional healing through breakout rooms. The intermediate outcome of
this tool is to show the importance of the two system integration and how it will affect the family.
The long term goal of the MBP is to become a vital part of the American Indian Culture which
lessens the amount of mental illness in the children. This can be found in Figure A.
Figure A: Logic Model
Inputs Activities Outputs Immediate
Outcomes
Intermediate
Outcomes
Long Term
outcome/
Overall Impact
Train
Counselors/
Create
workshops and
possible
certifications
Number of
availability
Counselors
increase
Counselors are
well versed on
American
Indian Culture
Relationships
are built
Intervention
becomes a vital
part of the
American Indian
Culture which
lessens the amount
of mental illness in
the Indian
communities Develop
Measurement
tools
Use Intake
survey and pre
– post surveys
Number of
families are
identified for
the program
MBP is aware
of what type of
trauma are
affecting the
parents
Parents
become aware
of suppressed
issue they may
have
Develop
workshops
New Families
attend the
workshops
Number of
parents are
using the tools
to become
successful in
the program
Relationship
between
counselors and
native healers
are built
Treatment
plans that
include
traditional
healing are
implemented
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Problem of Practice and Innovative Solutions
Mental Health Views in Society
Mental health is a topic that does not get the attention of most people until an incident
occurs (nasponline.org). Research suggests that often family members are aware of their child
exhibiting a mental illness prior to it exacerbating to violence. Villatoro, et al (2017), analyzed
how parents reacted to their child diagnosed with a mental illness. What they found was that
families would not recognize the symptoms of the mental illness only because the stigma may be
more than the family can handle. This would also cause the family to not seek out the proper
care needed for the family member diagnosed with an illness. According to Heary, Hennessy
Swords and Corrigan (2017), the norm among children and adolescents as it pertains to mental
illness is to discriminate toward those children exhibiting a mental illness. Research suggests
that because the children’s societal upbringing stems from adults’ supervision, they tend to model
those actions they have learned. Thus, when these children develop peer groups, they tend to
Introduce
program to
new parents
Integrate
intervention
with prenatal
care
Number of
Parent are
aware of
intervention
and learn how
they impact a
child’s success
Parents
acknowledge
their issues
Parents learn
new ways to
address issues
with their
household
Implement
Headstart to
reservations
Show the
benefit of
learning tools
for parents and
children
Number of
families are
shown the
benefits of
intervention
long range
Headstart is
used as a
teaching tool
rather than a
daycare
Children
become
nurtured
within school
system to stop
the pipeline of
dropouts
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exhibit the same behavioral or stereotypes toward mental health. When this occurs the person on
the receiving end of the stigma tends to show signs of exacerbated symptoms.
Researchers have based the hypothesis on the fact that socioeconomic status, access to
healthcare and ethnicity will contribute to a child’s mental health. However, according to
Lieberman, Chu, Van Horn and Harris (2011), the trauma that a child will suffer during their first
five years of life by parental figures will have an even greater role in that child developing a
mental illness. Researchers have found that children ages zero to five are disproportionately
vulnerable to traumatic events. These events could be falls or accidental injuries. However, if
they are exposed to trauma derived from domestic violence where their safety is always a
concern. They tend to have more psychological issues than those that are exposed to fewer
traumas. According to El-Sheikh and Erath, (2011) the family is one of the primary contexts to
the development of a child. When there are family conflicts, these tend to cause interruption in
which the child cannot process their emotions. At which point negative behavior and
psychological maladjustment are contributed. Although in this article the researcher did state
that a child can adapt to the family conflict consequently allowing the child to also develop
properly. They did stress that this will only occur if the child has a greater development of self.
In a study conducted by Khanan and Nghiem (2016), they tested the theory that the
effects of parental investment, parental stress and neighborhood characteristics would contribute
to the mental status of their children. They found that the parental income has a positive
cognitive outcome for children however the income did not have a significant effect on their
behavioral development. Another finding was that the parental physical and mental health,
Running Head: THE MEDICINE BLANKET PROJECT ! 16
parenting style and household characteristics (the presence of both parents) are important
determinants of the children’s non-cognitive and behavioral development. As behavior seems to
be an outcome derived from the family dynamic, the use of physical discipline by a parent was
also addressed.
According to Lansford et al (2011), the researchers were under the impression that
physical discipline would have a direct relationship with the child’s externalized behavior. They
believed that if a child was disciplined by corporal punishment (spanking, slapping etc..), they
would show poor behavior in school. This correlation between the physical discipline and the
child’s behavior was a true statement. They found that the children that were physically
punished would exhibit behavior that was violent and abusive toward other people. When the
parents were redirected to using another form of discipline the child’s reckless behavior, such as
fighting or substance abuse, were also lessened. Consequently, with the intervention introduced
to the families they developed new skills that were not hostile to the child’s development.
A study conducted in the United Kingdom, by Gellantly, et al (2018), where either parent
had a mental illness, they found that those children were at risk to have poor mental, physical
and emotional health. These children would also experience lower socioeconomic status which
could contribute to a poor quality of life. The research also suggests that the children would also
lack the support needed to help with their parents. The study created an intervention where the
children and parents with a mental illness would be able to talk with counselors on different
ways to help each other. The intervention taught the children ways they could advocate for
themselves and the parents.
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In the article by Parcel, Campbell, and Zhong (2012), they analyzed the effect of what
family structure has on a child’s behavior. They did a comparison longitudinal study between the
United States (US) and Great Britain (GB). The research was done using a qualitative research
model, the population in the US for this research was 3,864 and the GB population was 1,430.
The surveys and interviews were conducted on children between the ages of 5 to 13 years old.
The mothers of the children provided the information and answers at various ages. However, for
13 years old children, they began to answer the questions themselves. The data collection in
both nations included questions such as behavioral problems, child characteristics, maternal
characteristics, paternal characteristics, family of origin, and work characteristics. In Britain,
they conducted the study by asking all citizens without any specific criteria. While in the US
they sampled those populations that are disadvantaged. In this research, the goal was to find out
if there was a difference in the child’s behavior in relation to the child’s environment. The
surveys that were used were the National longitudinal Survey of Youth for the US. In Britain
they used the National Child Development Study “British Child”. This article found that there
was a difference between countries that had a nationalized health system in place for children. In
the comparison, it was evident that those parents that were divorced or did not cohabitant with
each other resulted in children developing behavioral problems. The same research also suggests
that when the parents work more hours and are away from their children, the children tend to
develop more risky behavior which lead to more behavioral problems.
Introduction of an Early Intervention
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The distinguishing factor of this capstone project is to develop an early intervention that
can be used to assist the families of children with mental illness according to the World Health
Organization (WHO) when developing a interventions will be necessary to include the following
tenets created by the United Nations (UN) dealing with the rights of children:
! The importance of early detection and provision of evidence-based interventions
for mental and substance use disorders. WHO’s mental health Gap Action
Program (mhGAP) provides evidence-based guidelines for non-specialists to
enable them to better identify and support priority mental health conditions in
lower-resourced settings.
! Trans-diagnostic interventions – for example, those which target multiple mental
health problems.
! Delivery by supervised staff who are trained in managing adolescents’ specific
needs.
! Engaging and empowering caregivers, where appropriate, and exploring
adolescents’ preferences.
! Face-to-face and guided self-help methods, including electronic mental health
interventions. Due to stigma or the feasibility of accessing services, unguided
self-help may be suitable for adolescents.
! Psychotropic medication should be used with great caution and should only be
offered to adolescents with moderate-severe mental health conditions when
Running Head: THE MEDICINE BLANKET PROJECT ! 19
psychosocial interventions prove ineffective and when clinically indicated and
with informed consent. The treatments should be provided under the supervision
of a specialist and with close clinical monitoring for potential adverse effects
These tenets have been addressed within the following research that has been conducted
looking at mental illness. According to Hawkins et al (2015) the earlier the intervention the
more positive effect upon the subject.
Additional these articles dealing with early intervention by Greenwood et al (2016) and
Cooke, King and Greenwood (2016), the hypothesis were directed toward the stigma of mental
illness which would help promote better attitudes. They used story-based intervention that
examines the friendship between a young person with a mental illness and those without. In this
intervention they would discuss the importance of understanding how a person feels with a
mental illness. The outcome of this showed that this type of story-based scenario was highly
effective when it came to teaching students about mental illness. The children begin to show
more empathy toward those that experienced a mental disorder.
Currently there are no definitive cure for mental illness or behavioral disorders; however,
with interventions in place we can lessen its effect on the youth. Research has shown that the
family structures along with the community a child is raised in, will influence the development
of a child by Humphrey and Root (2017). Changing the culture in which the counseling
becomes an integral part of development is significant, according to Repetti, Sears, and Bai
(2015). As the evidence shows, an earlier intervention that is directed toward parents would
have a significantly better result to the development of children.
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According to Bigfoot and Schmidt (2010), who have worked on an intervention in the AI/
AN community, they found that when using western medicine along with traditional native
teaching the collaboration between the two decreased the effects of mental illness. As they
worked primarily with the youth, they developed tools that therapists would be able to use while
treating an AI/AN family. One tool that was created was an affiliation model. This model
outlines how much Native culture, practice, values and lifestyle the participant was utilizing.
This would help the therapist develop an appropriate treatment plan for the child. As this
intervention is primarily directed for the children, they do have portions of group therapy where
the family members are involved. As this intervention is directly available to help children using
traditional Native teachings, one intervention that is being used and is directed toward parents
and caregivers, this is the Positive Indian Parenting (PIP) program.
The National Indian Child Welfare Association (NICWA) (2018), developed a program
titled Positive Indian Parenting (PIP). The purpose of this program is to support parents in the
traditional ways of AI/AN child rearing. The NICWA suggested that the AI/AN families
neglected unique methods of child rearing that were normally passed down through generations.
The PIP tries to address the impact of the intergenerational trauma experienced in the AI/AN
communities. They created a curriculum to instill traditional family practices that have been lost
by generations earlier. The PIP curriculum has the following 8 modules that are taught to parents
or caregivers:
! Orientation/Traditional Parenting
! Lessons of the Storyteller
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! Lessons of the Cradleboard
! Harmony in Child Rearing
! Traditional Behavior Management
! Lessons of Mother Nature
! Praise in Traditional Parenting
! Choices in Parenting/Graduation
In each of these modules’ parents will be able to learn about a more cultural way to raise
a child. The use of this cultural intervention is ideal for this population; however, the program
does not have any formal evaluation. Currently the program does not have data to support any
claims that the program is successful. This is because they do not have a record of those tribes
and/or facilities that have implemented the program. As this program acknowledges the
importance of the family structure within the AI/AN communities, intervention like this will
need to be reinforced with improved documentation.
Effects of Indigenous Ways of Healing
Currently in Alberta Canada, there are novel ways to assist their indigenous people. In
the article by Drost (2019) the Alberta Health Service (AHS) and the native communities are
working on ways to integrate traditional ways of healing with the AHS medical /mental health
facilities. They are focusing on 5 protocols that they think are necessary for the problem of the
indigenous people. These 5 protocols are as follows: 1) enhancing cultural competency and
safety training among leadership and employees: 2) adhering to traditional and protocol; 3)
establishing meaningful partnerships; 4) strengthening organizational facets of program delivery:
Running Head: THE MEDICINE BLANKET PROJECT ! 22
and 5) need for additional financial, human and logistical resources. In conclusion of this article
they found that in order to improve the disproportional disadvantage that the Canadian
indigenous have experienced with the AHS, they will have to follow the protocol that they laid
out and begin partnerships with the community leadership and elders.
In the article The Sweat Lodge Ceremony: A Healing Intervention for Intergenerational
Trauma Substance Use, by Marsh (2018) they considered how the integration of a sweat lodge
and a sharing circle could be utilized to heal people. They worked with individuals that
experienced intergenerational trauma or substance abuse disorders who identified as indigenous.
The purpose of this research was to identify if both methods (sweat lodge and a sharing circle)
would help those participants in either reconnecting to their spiritual well-being or create a safe
place where they could work out their emotions. The research was conducted in Alberta,
Canada; they had 24 participants (12 men, 12 women). They recruited counselors that identified
as indigenous and were culturally aware of the traditional methods used in the area. The
program was a 13 weeklong intervention with sweat ceremonies on the 3
rd
, 9
th
and 12
th
week.
What they found was those participants that took part in the sweat lodge and the sharing circles
felt as though the traditional approach helped. They found an improvement in their spiritual,
emotional and physical well-being. Some of the participants discovered that they lost their
connection with the indigenous traditions by growing up away from the indigenous communities.
The participants also realized that using this intervention provided a re-connection. As all of the
participants had experiences with western mental health system, they found that incorporating
traditional healing improved their overall health.
Running Head: THE MEDICINE BLANKET PROJECT ! 23
Additionally, Garrett et al (2011) also did a study on the therapeutic properties that a
sweat lodge can have on people. The author studied the different aspects of a sweat lodge and its
benefits. The researcher wanted to learn if they introduced the traditional sweat lodge method
with counseling that would contribute to healing for the individual. The goal was to measure the
effectiveness of the sweat lodge with counseling. The results of the study were positive for all
individuals that participated in the study. They found that along with the mental and spiritual
effect, there was also physical detoxification that occurred. They found that when the sweat
metals were released within the body it also relieves stiffness. Their research suggests that the
combination of the two methods (sweat lodge and a sharing circle) were better for the clients
than using therapy alone.
The same research also found that the use of the sweat lodge was a benefit to both Native
and non-native people can be used to revitalize their clients. However, they suggest that
counselors should not conduct the sweat lodge unless they have the proper training and
procedures in conducting such a ceremony. They also found that there were non-native sweat
lodges around the community that were using the lodges as an endurance test which was not the
primary objective of the sweat lodge. Nonetheless, the sweat lodge did serve the purpose of
creating a spiritual experience for those individuals that had gone through different traumas in
life.
Traditional native healing takes many different forms, much as the tribes that practice
them. Each ceremony has a purpose depending on the different tribes. An example of this is a
smudging ceremony; this ceremony is used to release negative energy within a person or place.
Running Head: THE MEDICINE BLANKET PROJECT ! 24
Sweet grass or sage is burnt, the smoke produced is waved with an eagle feather around a person
or place. At the same time a healer or medicine man would chant a prayer to release the negative
energy. According to Mullin, Lee, Hertwig, and Silverthorn (2001), this ceremony was used in
an Ontario, Canada hospice. The doctors and the nursing staff observed this ceremony and they
equated it to those ceremonies conducted in the Judeo-Christian faiths. Today, the same hospice
practices the philosophy of a patient-centered model of care. Patient-centered model of care, is
focused on palliating patients’ pain and other symptoms, attending to their and their family’s
emotional and spiritual needs while incorporating the patient’s traditional beliefs (uptodate.com).
Hospice staff in charge of individuals requesting such treatment noticed that these patients are
more at ease and comfortable with this type of treatment. A patient, who normally takes pain
medication to sleep stopped using the medication. This method of treatment inspired staff of the
same facility to research more about holistic practices. This ceremony helped the patient’s pain
management which resulted in the betterment of well-being for the patient.
Stakeholders Perspectives
The primary stakeholders for this intervention are the parents of the children. As parents
want to provide the best possible life for their child, they would want to ensure that they are
positive role models (Shapero, 2011; Bigfoot, 2010; Drost, 2019; Marsh, 2018). They would
want to ensure that their heritage would continue, and the tribe would be represented in a
positive light (Bigfoot, 2010; Drost, 2019; Marsh, 2018). Therefore, the elders in the
communities would begin to teach traditional ways to the youth to ensure that the traditions
would not be lost.
Running Head: THE MEDICINE BLANKET PROJECT ! 25
Tribal and Federal governments are stakeholders that would like to see an improvement
in the mental health of the AI/AN community. As the poorer tribes seek out grants to pay for
mental health facilities, the federal government may not be inclined to provide the funds
necessary to create an intervention that can provide the right amount of help required.
Therefore, it is necessary to create an evidence-based intervention that can provide the answers
that would be requested when soliciting a grant from the federal government. Other stakeholders
would be the Indian Health Services (IHS), local businesses that primarily work with tribes.
Nike has also been known to work with tribes. They have developed the N7 fund which
provides grants to organizations that better the American Indian community. They do this by
working with the community by creating American Indian inspired shoes and clothes.
(www.psychiatric.org; Bigfoot, 2010; Drost, 2019; Marsh, 2018; N7 Fund, 2019). If they were
to partner with the intervention, they may be able to request more funds for areas that provide
fewer services.
Project Structure, Methodology, and Action Components
Phases/Major steps of intervention
The phases of the MBP will begin with identifying those counselors that have developed
the cultural competency necessary to assist American Indian parents to develop the skills to
utilize both the Western Therapy Model along with the Kumeyaay native way of healing. These
counselors will be a licensed clinician. It is vital that they are licensed to show the clients the
competency level of the counselors. Once the counselors have been identified they will conduct
workshops for those families that volunteered to participate. They will also be assigned families
Running Head: THE MEDICINE BLANKET PROJECT ! 26
to start counseling sessions to support those parents that show signs of mental illness or
behavioral disorders. This will be done within the first month leading into the initial workshop.
These counseling sessions will be linked to the expectant mother’s prenatal visit. In the
nine-month period the mother and father will take surveys. The initial survey will be given
during the intake process. The questions identify the amount of trauma the parents may have
experienced and their view on child rearing. The next survey will be given at the four-month
mark asking similar questions. At this point there will be an introduction of the Parental Stress
Index (PSI) survey. This survey will evaluate the parent’s level of stress when it comes to
raising a child. The last survey will be given a month after the baby is born. This survey will be
asking about the whole experience till this point.
The workshops are two-day events where the parents are introduced to the traditional
native healing. They are taught how to use the traditional healing in conjunction with the therapy
sessions. There will be breakout groups that will go over ceremonies such as sweat lodges and
smudging in smaller groups. These ceremonies may vary depending on which tribe the MBP is
working with however, for the Kumeyaay the use of the sweat lodge and smudging will be used.
The last procedure will be to increase the counseling sessions that observe the baby and
parent’s interaction. Once again, the sessions will be linked to the baby’s well visit. This is to
only ensure that the session will continue once the baby is born. This will continue for the next
three months at which point the intervention will continue a need’s basis only. However, when
the child has their medical appointment the family will check in with the counselor to maintain
and reinforce what was taught to the parents. The final phase of the intervention is when the
Running Head: THE MEDICINE BLANKET PROJECT ! 27
child enters the head start program. At this point of the child’s life we can verify that the
intervention is working by reviewing the IHS records for the children that took part in the
intervention.
The units of service will be conducted by the pre and post surveys done in a nine-month
period by the family. The importance of this will show how the family is improving on the skill
needed to address issues within their life. As they are learning to cope with a new addition, they
will be able to learn healing techniques that can alleviate added trauma to a newborn baby. The
observation of the interaction is necessary to show that the parents are learning new skills that
can counteract those behaviors that have been passed down by generations.
Prototype
The Medicine Blanket Project’s prototype is the workshop manual that will be used for
all of the workshops in the program. The manual outlines what is needed for each part of the
workshop. An example is the checklist that describes the type of facility that is needed for the
duration of the workshops along with what goes into the conference rooms. The manual is
accompanied by a series slide decks that illustrate what will be taught during each part of the
workshop. The manual is a step by step process to ensure that all of the instructors can relay the
same message regardless of who is teaching.
The first section of the manual is the introduction. This is where the overview of the two
is explained along with the introduction of all the counselors and Native healers. During this
time the facilitators will explain the definition of intergenerational trauma and the effects it has
on people (Bigfoot, 2010; Shapero, 2011). The facilitator will explain what the Medicine
Running Head: THE MEDICINE BLANKET PROJECT ! 28
Blanket Project is and why it was created. This will open up how the collaboration of traditional
practice and therapy will be implemented (Bigfoot, 2010).
The facilitator put everyone into two groups. The first group will go through what will
take place during a smudging ceremony (Drost, 2019). The explanation will be given by the
native healer with the counselor accompanying them (Drost, 2019). The second group will
participate in a sharing circle addressing the types of trauma they may have experienced in their
life. In this group there will be a counselor in attendance to help those people that may be
triggered by something that is brought up in the sharing circle. Once the two activities are
completed they will attend a debrief. Here the facilitator will ask questions about the emotions
that were felt during the smudging ceremony and the sharing circle. Once all conversations are
completed the facilitator will dismiss everyone for the day.
Day two starts with a check in and question period with the facilitators. Once the
questions and check in is concluded the overview of the day will begin. There will be two
presentations with slide decks addressing “How Trauma Affects Parenting” and “How are My
Parenting Skills?” (Lieberman, 2011; El-Sheikh, 2011, Khanan, 2016). Both of these
presentations will be directed by a facilitator asking questions to the audience about various
scenarios. The purpose of these two presentations is to begin a discussion about parenting skills
that shape a child (Lieberman, 2011; El-Sheikh, 2011, Khanan, 2016). The next activity that is
scheduled in the manual is a mock sweat lodge (Marsh, 2018; Garrett, 2011).
The Native Healers and counselors will all take part in the activity. The healers will
explain all parts of the ceremony and what occurs during the different intervals (Marsh, 2018;
Running Head: THE MEDICINE BLANKET PROJECT ! 29
Garrett, 2011). The counselors will be in attendance to address anyone that has a phobia for
small spaces. This evolution will take approximately two hours. Once the mock sweat lodge
ceremony is completed the facilitator will ask if there are any questions. At which point the
group will provide suggestions of how the workshop could go better or what could be added.
Then the facilitator will dismiss the workshop. The Medicine Blanket Project Workshop
Manual can be seen in appendix F.
Analysis of Implementation
The Medicine Blanket Project is an intervention that will be implemented to the
Kumeyaay band of Indians in San Diego. This tribe and those in the surrounding area have
casinos which provide the membership the option of residing off the reservation. Thus, creating
a smaller pool of participants that utilize the Indian Health Services. Those that reside off the
reservation may use other health insurance companies that will not allow the MBP to utilize
those patient’s information. In order to alleviate a small pool of participants the recruiting will
expand to other tribes in California that are not Kumeyaay. This will change the type of
traditional healing that is taught however, with the use of the local tribal healer the incorporation
will be seamless.
An obstacle that may be present will be informed consent and confidentiality. The AI/AN
population has had a history of distrust and mistreatment from medical facilities (Bigfoot, 2010).
Gaining the trust and acknowledging that there were problems before, and they will not take
place within the intervention will take some time. However, with culturally competent
counselors available the population may learn to trust the organization (SAMHSA, 2018). Allow
Running Head: THE MEDICINE BLANKET PROJECT ! 30
the MBP to perform the needed procedure without issue. As the intervention starts to move
forward, this ethical aspect will be taken seriously and at no point will the population have more
distrust toward an organization that is aiding.
The intervention is a learning theory model, the outcomes will be measured using a pre
and post survey (Mcleod, 2016). The surveys will measure the amount of trauma they have been
exposed to. It will also indicate their current mental state ie. if they are showing symptoms of
depression or anxiety. As the parents go through the intervention, they will be asked to
demonstrate the tools they have learned. Then an observation will be conducted with the
children to measure their cognitive ability and if they are any mental illness or behavioral
disorders present. As with most interventions that are addressing behavior, they will take some
time in order to get the outcome, especially the effects of positive parenting. Ideally the
intervention would take 5 years; approximately when the child starts attending kindergarten.
However, there can be short term outcomes attached to the counseling sessions, the learning
seminars/classes that will be introduced to the parents within the intervention. These short-term
outcomes will be able to measure if the intervention is working correctly by the results of the
parents during the surveys and observations.
In order to address the issue of mental illness and behavioral disorders the proper
evaluation system will be needed (www.tribaljustice.org). In examining other interventions that
have attempted to address the American Indian population the evaluation procedure was never
put into place (www.eclkc.ohs.acf.hhs.gov). Thus, there is not much data on the effectiveness of
Running Head: THE MEDICINE BLANKET PROJECT ! 31
mental health intervention in Indian country. Especially those interventions that are directed
toward the parents of AI/AN children.
Stakeholders
The Medicine Blanket Project will consist of a board of directors, a Chief Executive
Officer (CEO), Chief Financial Officer (CFO) and a Human Resource Director (HRD). The
board will have representation from the tribal government, donors, members of the mental health
community and IHS. The board member’s purpose will be to generate secure forms of funding
both at the state and federal level. The CEO and CFO will work together to maintain that the
approved budget is managed correctly. Although both officers will have detailed job description
that they will fulfill, they will also be well versed on the details of the intervention. These two
officers will be the face of the organization so their leadership qualities will have to exemplify
this. They will have to be maestros in their given field but will have to be capable in explaining
ideas to the masses. The HRD will provide the hiring of the competent counselors and admin
support. They will also ensure that the proper training is being upheld so that the counselors are
knowledgeable in all areas of the intervention.
Tribal and Federal governments would like to see an improvement in the mental health of
the AI/AN community. As the poverty-stricken tribes pursue grants to pay for mental health
facilities, the federal government may not be inclined to provide the funds necessary to create an
intervention that can provide the right amount of help required. Therefore, it is essential to
create an evidence-based intervention that can deliver the remedies that would be requested
when soliciting a grant from the federal government.
Running Head: THE MEDICINE BLANKET PROJECT ! 32
The Indian Health Services (IHS) is an essential organization that provides the majority
of health care to the tribes. The research suggests that there is a lack of mental health utilization
among tribal members (www.psychriatric.org). Therefore, it would be an ideal situation if the
MBP were to partner with the IHS, to provide the intervention to areas that they do not reach.
The IHS and federal government will have a greater influence on how the funding will be
utilized. As with most grants they have stipulations that must be met in order to maintain the
grant funding. It will be necessary to keep a good relationship with these external stakeholders.
Revenue Strategy and the Main Types and Source(s) of Revenue
The Medicine Blanket Project will be a nonprofit entity. The purpose for filing as a
nonprofit entity, has to do with the abundance of revenue sources that will be used to maintain
the service needed in the AI/AN community. The qualifications for the certain grants that the
MBP will be applying for, require certain affiliation to a tribal organization (www.mdedge.com).
Thus, partnering with a tribal government and working with the Indian Health Services (IHS)
will prove to be beneficial while applying for financing. The MBP has already began the process
to file as a 501© (3) organization. Upon approval from the state of California and the Internal
Revenue Service (IRS), the MBP will begin coordination with financial supporters. An
Additional form of revenue that the MBP will take part in will be fundraising events. They will
take part in local tribal events such as the Sycuan Annual Pow Wow and the Barona Annual Pow
Wow. These events are held in September and promotes American Indian unity with dancing
ceremonies and various competitions. Each year they have a theme that promotes the uplifting
Running Head: THE MEDICINE BLANKET PROJECT ! 33
spirit of the native community. At these types of events the MBP will be conducting
advertisements for the intervention and providing pertinent information about the organization.
Staffing Cost and Spending plans
The Medicine Blanket Project will be recruiting four licensed counselors that are
culturally competent with American Indian culture. The expedient salaries for the counselors
will be $200K a year, this is to maintain a cohesive group of counselors that will stay with the
organization. There will be negotiation with the Southern Indian Health Council to provide
medical and dental benefits for the counselors, staff and their families. There will be a full-time
office manager that will work 30 hours a week with a salary of $21,600 a year. The CFO and a
CEO that will receive $100K a year. There will be coordination with the local universities
(SDSU, UCSD, USD and Pt Loma Nazarene) for a non paying internship that will provide office
workers the needed hours for their academic programs.
There will be a request for office space on tribal trust land as to maintain a
presence with the clients. The cost should be minimal or even free, this will make available
money to purchase office supplies such as computers, internet, printers, cell phones plans,
insurance, two vehicle, travel cost, advertisements and the supply to maintain a monthly
workshop. The expectant total of these supplies will be approximately $70, 000.
As the proposed budget for the Medicine Blanket Project seem acquire most of the
revenue from government grants, the MBP does not plan on relying on government funding.
Those types of organizations that strictly relied on government funding tend to collapse when
they move into a macro stage (Donnelly, 2014). Thus, becoming an organization that is well
Running Head: THE MEDICINE BLANKET PROJECT ! 34
rounded with various sources of revenue tends to maintain their existence within the social
service field.
Conclusion, Actions, & Implications
The objective of the Medicine Blanket Project is to have less children exhibit mental
illness within the AI/AN communities. The intervention is directed toward the parents instead of
the children. This has to do with the reinforcement aspect of the intervention. Once the
intervention has completed its first cycle, an observation will be conducted while the children are
in the headstart program. At this point observations of the cognitive theories that have been
taught to the parents have been shown to improve the child’s overview. Ideally a successful
program will have parents that can nurture their child using the tools that have been taught to
them within the workshops and the counseling session.
The intervention will use a series of surveys to identify how the parents feel about being a
parent. The Medicine Blanket Project will be using the Parental Stress Index questionnaire. The
component of the questionnaire measure two things:
! Measures the levels of stress experienced by parents.
! Takes into account positive and negative aspect of parenting.
This will be used during the workshops the three times that a survey will be administered.
When the intervention is in final stages and the child is going to the doctor’s office regularly the
IHS will use the battery of questions that are used to examine mental health.
Running Head: THE MEDICINE BLANKET PROJECT ! 35
The intervention will also have an observation tool in which the counselor will be able to
observe the interaction of the families. This will be used as a measurement tool to address if the
parents are truthfully using what they have learned in the workshops and in the counseling
sessions. As with all outcomes there are levels of false answers that can misrepresent the results
and skew the success of the intervention. In this case adjustment will be made to the
intervention to ensure a more positive outcome.
As the intervention is disseminated to the tribal members, the cultural context of the
traditional native healing will be kept in a dignified manner. As stated previously when most
tribes use mental health facilities their views of mental health are overlooked.
Once this intervention has completed the initial pilot program the MBP will disseminate
the finding in a scholarly paper that lays out the evaluation cycle, measurements used and the
overall outcomes of the initial trial group. This will show that as most people can use the
western model of therapy, the American Indian community will need a different form of therapy
to assist the whole community.
Although there is no definitive cure for mental illness or behavioral disorders, with the
Medicine Blanket Project in place we can lessen its effect it has on the youth. Interventions that
concentrate on the family dynamic alone tend to portray the parents as the villain (Lieberman
2011; Lansford, 2011; Goldstein, 2018). This could at times cause the families to shy away from
programs where they are being questioned on their competency. The reason behind this is
because most parents believe that they are doing the best thing for their child (www.ted.com;
Landford, 2011). Particularly when it comes to how they are disciplining their children. Most if
Running Head: THE MEDICINE BLANKET PROJECT ! 36
not all parents/caregivers believe that they are correct when it comes to the subject of parenting
(Lansford, 2011). So, changing the behavior in which counseling and traditional native child
healing becomes an integral part of development is significant (Repetti, 2015; Bigfoot, 2010;
www.tribaljustice.org). As the evidence illustrates, an earlier intervention that is directed toward
parents would have a significantly greater outcome to the development of children. Changing
the view of the social worker or counselor may be a difficult task in the beginning however, with
the explanation that the counselors are there to assist the families, the behavior may change.
Running Head: THE MEDICINE BLANKET PROJECT ! 37
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Appendix A
Parental Stress Scale
The following statements describe feelings and perceptions about the experience of
being a parent. Think of each of the items in terms of how your relationship with your
child or children typically is. Please indicate the degree to which you agree or disagree
with the following items by placing the appropriate number in the space provided.
1 = Strongly disagree 2 = Disagree 3 = Undecided 4 = Agree 5 = Strongly agree
1 I am happy in my role as a parent
2 There is little or nothing I wouldn't do for my child(ren) if it was
necessary.
3 Caring for my child(ren) sometimes takes more time and energy than
I have to give.
4 I sometimes worry whether I am doing enough for my child(ren).
5 I feel close to my child(ren).
6 I enjoy spending time with my child(ren).
7 My child(ren) is an important source of affection for me.
8 . Having child(ren) gives me a more certain and optimistic view for
the future.
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9 The major source of stress in my life is my child(ren).
10 Having child(ren) leaves little time and flexibility in my life.
11 Having child(ren) has been a financial burden.
12 . It is difficult to balance different responsibilities because of my
child(ren).
13 The behaviour of my child(ren) is often embarrassing or stressful to
me.
14 . If I had it to do over again, I might decide not to have child(ren).
15 I feel overwhelmed by the responsibility of being a parent.
16 Having child(ren) has meant having too few choices and too little
control over my life.
17 I am satisfied as a parent
18 I find my child(ren) enjoyable
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Scoring
To compute the parental stress score, items 1, 2, 5, 6, 7, 8, 17, and 18 should be
reverse scored as follows: (1=5) (2=4) (3=3) (4=2) (5=1). The item scores are then
summed.

Scoring the tool :
We want a low score to signify a low level of stress, and a high score to signify a
high level of stress
! Overall possible scores on the scale range from 18 – 90.
! The higher the score , the higher the measured level of Parental stress
Use a simple table to show the before and after results to evidence whether an
intervention has had a positive effect.
! Comparison of individuals before / after or longitudinal overall Parental
Stress Scale scores.
! The comparison of before and after mean average scores for groups
(parents/carers accessing the particular intervention/group sessions,
service or provision)
References:
Berry, JD, & Jones, W,H, (1995) The Parental Stress Scale : initial psychometric
evidence. Journal of Social and Personal Relationships, 12, 463 – 472.
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Appendix B
Medicine Blanket Project Intake Form
1. Where were you raised (Reservation, Colony, Village)? __________________________
2. Who raised you?__________________________________________________________
3. Have you or anyone in your family attended a boarding school or any American Indian
educational institutions? Yes No
a. If yes which ones___________________________________________________
4. Have you or anyone in your family served in the military? Yes No
5. Have you ever been exposed to substance abuse? Yes No
6. Have you or anyone in your family been incarcerated? Yes No
a. If yes when and for what? ____________________________________________
7. What are your views on mental health facilities?
_________________________________
8. Have you or anyone in your family been to a therapist? Yes No
a. If yes when and how long ago. ________________________________________
9. What is your relationship status? _____________________________________________
10. Have you or anyone in your family been in a abusive relationship? Yes No
a. If yes who _________________________________________________________
b. What was the outcome? ______________________________________________
11. Have you attended a sweat lodge ceremony? Yes No
12. Have you ever experienced any type of American Indian ceremony? Yes No
a. If yes what type ____________________________________________________
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13. What type of trauma have you experienced in your lifetime? _______________________
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Appendix B
Medicine Blanket Project
PHQ-9 Patient Questionnaire
Patient Name: _______________________________________ Date: ________
Dear Patient,
In an effort to provide the highest standard of care and meet the requirements of your insurance company, we ask
that you fill out the form below. This form is used as both a screening tool and a diagnostic tool for depression.
Your provider will discuss the form with you during your visit. Thank you for your cooperation and the opportunity
to care for you.
1. Over the last 2 weeks, how often have you been bothered by any of the following problems?
Not Several More than Nearly
at all days half the every
days day
0 1 2 3
a. Little interest or pleasure in doing things
b. Feeling down, depressed, or hopeless.
c. Trouble falling/staying asleep, sleeping too much.
d. Feeling tired or having little energy.
e. Poor appetite or overeating.
f. Feeling bad about yourself – or that you are
a failure or have let yourself or your family
down.
g. Trouble concentrating on things, such as
reading the newspaper or watching television.
h. Moving or speaking so slowly that other people
could have noticed. Or the opposite – being so
fidgety or restless that you have been moving
around a lot more than usual.
i. Thoughts that you would be better off dead or of
hurting yourself in some way.
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2. If you checked off any problem on this questionnaire so far, how difficult have these problems made it for you to
do your work, take care of things at home, or get along with other people?
Not difficult at all Somewhat difficult Very difficult Extremely difficult

Running Head: THE MEDICINE BLANKET PROJECT ! 53
Appendix D
Medicine Blanket Project Workshop Agenda
! !
Running Head: THE MEDICINE BLANKET PROJECT ! 54
Appendix E
Workshop Manual
The Medicine
Blanket Project
Workshop Manual
Running Head: THE MEDICINE BLANKET PROJECT ! 55
Material for Workshop
Conference hall or Room
Microphone
Approved Lunch providers
Continental Breakfast
Coffee/Juice/Water
Plate/Napkins/Forks/Spoons/Cups
Chairs/Tables
Computer with WIFI access
Projector or TV streaming
Slide Deck with MBP material
MBP Notebooks
Pens
Flyers with MBP material
 
Running Head: THE MEDICINE BLANKET PROJECT ! 56

PURPOSE OF THE MANUAL
To assist in the facilitation of the Medicine Blanket Project.
Day 1
1. Introduction
Speakers: Joseph Pritchett II
Counselors
Native Healers
2. Directions
All speaker with come to the front of the room line up and introduce themselves
The following information will be requested:
! Name
! Technical Background
! Years of Service
! Why they are working in this capacity
3. Overview of Workshop
Director will provide the following speech:
The next two days you are here to learn new ways to address various types of
traumas that you may have encountered that can carry on to your children. We
are not here to chastise you or tell you that you had crappy childhood and you will
treat your kids wrong, NO! We are here to assist in the positivity that you have in
raising your child. We would like you to think about the information that you will
be receiving and incorporate it into our life. Over the next two days you will go
through some thing that may trigger an emotion. We are okay with that but we
are here to help you through it. So, don’t be scared about this program LEAN into
to and enjoy the these couple of days.
Presentation 1: History of Intergenerational Trauma
4. Introduction
Explain what historical intergenerational Trauma is:
Historical trauma is intergenerational trauma experienced by a specific cultural
group that has a history of being systematically oppressed. ... Historical trauma can
Running Head: THE MEDICINE BLANKET PROJECT ! 57
have an impact on psychological and physical health. Historical trauma is
cumulative and reverberates across generations.
Give example of the historical trauma in the native communities: Relocation Act
of 1956, Boarding School Experience, Removal from Native Lands and so on.

5. Directions
Using the slide deck go to slide
1) Definition of Intergenerational Trauma
a. Give the definition of the term explaining
2) Slide shows pictures of the example of trauma to the Indian communities
a. Give the acts of trauma in order of the pictures
3) Slide will give example of how these traumas effect the community
a. explain how parents/family members may have been affected
4) Show the Logo for the Medicine Blanket Project
a. Explain what we do for the community
b. Explain the Western Therapy Model
c. Explain what we are going to do with the traditional healing
5) Slide with enter into what the MBP intend to do for them
6) Slide Ends.
6. Break
Release the group for a 15 min break
7. Overview of Medicine Blanket Project
At this time, instructors will be introduced the Medicine Blanket Project : Explain
the purpose of the intervention and why it was created for the AI/AN community.
Presentation 2: Collaboration of Traditional and
Therapy
8. Introduction
In this presentation the instructor will address the importance of the combination
of traditional healing and therapy. The instructor will go though the research that
Running Head: THE MEDICINE BLANKET PROJECT ! 58
has been conducted showing how most western therapy models alone do not work
with the AI/AN population.
9. Directions
Using the slide deck
1) Show slide that has quotes from researcher explaining why therapy doesn’t
work by itself
a. Ask question: How many here have used mental health facilities?
How many people felt that it worked?
2) Show slide explaining the benefits of traditional healing
a. Ask question: How many have used traditional healing?
What was the outcome? Or How many felt it worked?
3) Show slide showing the various healing procedures
a. Give a brief explanation of the healing procedure and the benefits
4) Summarize MBP
5) Slide showing what will happen after lunch
a. release for lunch 1 hour
Breakout Groups: Tribal Group / Therapy Group
10. Introduction
At this time the course participants will be divided into two groups that will go
into a various room to take part into the group therapy session and the traditional
healing procedure. Each group will be in the breakout room for an hour, then they
will switch. The instructor will be the person moving from room to room not the
participants.
11. Tribal Group
The native healer will perform a smudging ceremony.
1. Gather everyone in a circle
2. Explain to group that there will be smoke in the area if there are people
that allergic please let us know.
3. Explain the procedure of the ceremony
a. Purpose of the shell
Running Head: THE MEDICINE BLANKET PROJECT ! 59
b. Purpose of the sage or sweat grass
c. Purpose of the smoke
d. Purpose of the feather
4. Start the ceremony
5. As the ceremony is being conducted the healer will go through the what is
happening
6. Conclusion
a. The groups will switch rooms
At the conclusion of this exercise, instructors will be asked the participate
to write in their notebooks the emotions they have experience.
12. Therapy Group
This group will get into a circle and address the following questions:
1. Does the trauma that I have seen in my life affect me?
2. Are there things in my life that currently that my effect my child rearing?
3. Conclusion
a. The groups will switch rooms
At the conclusion of this exercise, instructors will be asked the
participate to write in their notebooks the emotions they have
experience
Combine Groups: Debrief
13. Directions
The instructors bring everyone back into the main hall. The following questions
will be asked:
1. What emotions were felt while doing the smudging ceremony?
2. What emotion were felt while in the therapy session?
3. Which one group had an easier time addressing their emotions.
The instructors will ask for volunteers that would like to talk about their
experience with the with the different groups. The instructor needs to make sure
that one person does not monopolize that conversation.
Running Head: THE MEDICINE BLANKET PROJECT ! 60
14. Adjourn for the Day
Day 2
o 2.1 Check in and Questions
Instructor will ask the returning participant how they are doing today? They will
also as if there are any questions
o 2.2 Overview of the day
Instructor will address what the plan of the day is. The instructor will tell them
what is coming up according to the agenda.
Presentation 1: How Trauma Effect Parenting
o 2.3 Introduction
Explain how trauma can affect a parent’s skill
1. Modeling
2. Learned actions
The slide deck will have these two slides. During each slide the instructor will
provide examples of how these actions can affect the way a new parent will raise
a child. This presentation will use more conversation than slide deck. The
instructor will need to be well versed in the effects of trauma.
Presentation 2: How are My Parenting Skills?
o 2.4 Introduction
The instructor will use a slide deck for this area
o 2.5 Direction
Show slides:
1. Slide will display the title
a. Explain why this question is important? This question reveals the type of
parenting skills you have and are they passed down through generations
2. Slide shows the tribal way of explaining how things are explained
a. death – use the story of Wolf and Coyote to explain death
3 Slide shows explains how storytelling provides morals and norms in culture.
4. Slide show explains how stories are passed down through generations.
Running Head: THE MEDICINE BLANKET PROJECT ! 61
5. Conclusion – go into a break
Survey Parental Stress Index
o 2.6 Introduction
Explain the purpose of this survey and how the answers are scored.
1. Take the test
2. Answer questions
Break for lunch for an hour
Traditional Healing in Groups
o 2.7 Introduction
The instructor will explain how a sweat lodge ceremony is conducted and the
benefits of them.
o 2.8 Direction
Split the group in to two groups and go into a mock sweat lodge.
1. In this training atmosphere will go over the procedure
2. Symbolization of the lodge
3. The four direction
4. The purpose of the heated rocks and steam
5. The purpose of the songs sung
6. Explain common myths and skewed views.
Conclude the training and put the group on a break
Workshop Review
o 2.9 Question from the group
Instructor will ask if there are any question that the participant have?
o 2.10 How did we do any suggestions
Instructor will write down any suggestion they participants have for the next
workshop
o 2.11 Adjourn

Abstract (if available)

Abstract The wicked problem for this capstone proposal is the rising number of American Indian children that have been and will be diagnosed with a mental illness. Statistics have revealed that the AI/AN population has a significantly higher rate of suicide, depression, substance abuse and mental illness than any other ethnic group in the United States (APA Fact Sheet, 2017

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Asset Metadata

Creator Pritchett, Joseph Stanley, II (author)

Core Title The Medicine Blanket Project

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Publication Date 07/29/2020

Defense Date 04/17/2020

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Alaskan Natives,American Indians,behavioral disorder,family dynamic,family structure,historical trauma,Indian Country,mental illness,Native Americans,OAI-PMH Harvest

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Enrile, Annalisa (committee chair), Blonshine, Rebekah (committee member), James, Jane (committee member)

Creator Email joseph_pritchett2@yahoo.com,jpritche@alumni.usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c89-349897

Unique identifier UC11664033

Identifier etd-PritchettJ-8824.pdf (filename),usctheses-c89-349897 (legacy record id)

Legacy Identifier etd-PritchettJ-8824.pdf

Dmrecord 349897

Document Type Capstone project

Rights Pritchett, Joseph Stanley, II

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the a...

Repository Name University of Southern California Digital Library

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