University of Washington

Here are the key items generated by participants focused on concerns, challenges, strengths, needs, suggestions and promising programs and practices. CONCERNS •Alarming health disparities for AIANs with regards to Maternal/Infant health as compared to other communities — e.g. 35% of moms who went through Medicaid program in Washington State had mental health issues. •Young people between the ages of 18-24 years old — difficult to reach, out of school, on the reservation, may be using drugs and alcohol, may be having children without appropriate care and services. •Traditional teaching was by watching and learning — we are losing that now. •Young mothers in urban areas getting involved with gangs. •Use of drugs and alcohol during and after pregnancy. •Expecting mothers using "legal drugs" such as prescription pain medications and methadone. •Young mothers in urban areas not having the community to "rally around" the child. •Grandparents raising grandchildren. •Domestic violence through birth control coercion — forcing women to use or discontinue use of birth control. Concerns regarding services •In the past aunties and grandmas were the teachers — we "lost" much of a couple of generations and lost that teaching/support practice. Going to an "expert" from outside the community may seem too foreign/uncomfortable. •Pregnancies in young mothers may be result of rape or coerced sexual encounters. •Prevention, intervention, treatment services not always culturally sensitive — a barrier for seeking treatment and care. •Mothers struggling with depression and other mental health issues. •May have experienced programs that don't follow through — barrier to seeking care again. •Mothers struggling with substance abuse. •Small communities where everyone knows everyone may be a barrier to accessing services. •Domestic violence and sexual assault — before pregnancy, during pregnancy and after birth of child. •Interruption in health mother/child attachment, in part as a result from mental health issues and substance abuse. •Babies being born addicted. •Abuse and neglect of babies and children. •Preventable infant/child deaths, including from SIDS. •Exposure to second hand smoke. •Young mothers not accessing services due to shame about using while pregnant, or who are in a domestic violence or other abusive situation, etc. •Not following through with referrals for needed services. •How to provide services to community members who are not members of the tribe? CHALLENGES •Hierarchy of needs — many families are struggling with providing food and shelter on a daily basis. •Programs like AA are difficult due to small community/ confidentiality. •Grandparents raising grandchildren. Difficult for them, parents are absent and/or using, often don't have legal guardianship. This is also a strength as grandparents can provide a more nurturing environment for the children. •Members leave the community for treatment — these are "unknown institutions." •Balancing traditional knowledge and norms with current guidelines, for example what is a healthy weight? In the past, being overweight may have been considered "healthy" but now is a risk factor for other health conditions. Challenges regarding services •Providers not culturally sensitive or trained for working with Native clients/patients. •Protecting and maintaining confidentiality is a challenge in small communities. •Many don't have resources to travel to and access services. •State programs that may have been supporting Maternal/ Infant health are being lost due to budget cuts. •Members may be apprehensive of seeking/receiving services as may be perceived as stigmatizing, e.g. having a social worker do home visits. •Some communities are very dispersed — difficult to access services even if they are aware of them. •If there are not evidence based programs for Maternal/Infant health in Indian communities, what are the impacts of using "promising programs" with regards to sustainability? Summary Report: April 4-5, 2012 7

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