University of Washington

and expecting parents. The needs of a child change as they grow, and parents, families and communities need ongoing education and support as their children mature and become young adults. This includes traditional knowledge to be successful in Native communities and life, and academic knowledge, work skills and financial literacy to be successful in school and career. Culture remains key to successful navigation of each developmental stage. Communities also need to find ways to bring and welcome back their young members as they complete their education and/or enter the workforce, whether they become professionals (such as doctors, lawyers, etc.) or continue the practice of subsistence. Continuity of care across providers and integration of services are important. In addition, collaboration within and between tribal departments and Native organizations is critical, as is collaborating with non-Native agencies such as local schools, tribal colleges and universities. Attendees agreed that working together is a best practice and that a mechanism to continued collaboration is needed. An important theme that emerged was funding for, and access to, effective and culturally appropriate services. There is a great need for better access to care and more culturally appropriate services for most Natives in Washington State, including remote and isolated reservations, dispersed tribal communities, and Urban Indians. As some tribes and Native organizations grow and thrive, they are developing and implementing a variety of programs to serve their members. However, many communities and organizations are struggling with reduced budgets and resources and may not be able to provide all needed healthcare services. Many attendees described a hierarchy of needs whereby individuals and families are struggling to feed and house their children, and may not be able to tend to their emotional, physical, mental, spiritual, cultural and educational needs. One size does not fit all, and meeting families and communities "where they are" literally and figuratively is important. Access to effective and appropriate healthcare for descendants who are not, and maybe cannot be, enrolled is an emerging issue that needs to be addressed. There was some discussion about current "evidence-based practices" (EBPs) as many have not been shown to be effective for Native people and there is often apprehension and caution about using them. Again, many felt that integrating effective western approaches with traditional health practices would be most appropriate and effective. The context in which all of these discussions and issues emerged is culture, sovereignty and self-sufficiency. As one attendee stated, "that doesn't mean self-sufficiency just for the tribe itself, but it's self-sufficiency for every single tribal member." As the following sections indicate, there remain many concerns and challenges for Native people and communities with regards to health. At the same time, there is a strong sense of hope, determination and commitment, not just to the current generation of young Native people, but to future generations as well. Tribes and Urban Indian centers are in a unique position of power and culture to leverage resources, culture, Elders and sovereignty, and are working together to do so. Summary Report: April 4-5, 2012 3

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