University of Washington

" Maternal Infant Health We're talking about programs. There are no programs. We're talking about state dollars. There are no state dollars. We really need to be concentrating on helping the families make their strategic plan on how they're going to care for themselves." SUMMARY An important aspect of American Indian/Alaska Native (AIAN) communities is the value placed on families. A number of concerns were expressed about the current state of families and maternal infant health in Native communities. Among the concerns expressed by participants were (1) a lack of knowledge and education about healthy pregnancies, families and ways of living and wellbeing; (2) the effect of alcohol, illicit drugs and prescription drug abuse on pregnancies (e.g., fetal alcohol and drug effects) and on families; (3) domestic violence during and after pregnancy; (4) coercive birth control; (5) difficulties reaching youth and young adults who are at increased risk for substance use and substance-related negative consequences; (6) services that are not culturally sensitive; (7) issues regarding accessing services; and (8) families unable to feed and clothe themselves and their children, let alone provide a healthy environment. Despite these concerns, a number of community-level strengths were identified. These included (1) a strong commitment to future generations and to healthy families; (2) workplaces that are supportive of pregnancies and breast feeding; (3) an increased focus on the use of traditional herbs, medicines and ways of being healthy; (4) an increased involvement of youth who are "taking charge" in communities and who value healthy lifestyles; and (5) culture and traditional teachings with regards to health. Participants identified a number of needs that, if successfully addressed, they feel would improve maternal infant health and family life. These include educational and programmatic services. Participants emphasized the importance of expanding the educational process to include individuals, providers (e.g., medical, mental health, substance abuse prevention and treatment, and social service), families and communities to improve communication about risk and protective factors, and so that everyone understands what is needed for healthy children and families. With respect to programs, having more specialists with child and adolescent treatment expertise, including child and adolescent 6 psychologists and psychiatrists, would also be important. Mental health and substance abuse services should include continuing support and care in the communities. Similarly, there should be continuity of care from prenatal delivery to postnatal care which could be delivered by family practice rather than specialty providers. Further, there should be increased coordination across all programs dealing with child, maternal and family health to assure continuity of care. A number of challenges were identified that may represent barriers to implementing some of the programmatic and policy changes suggested by participants. Small tribal communities may make maintaining confidentiality difficult. The perceived lack of confidentiality, as well as apprehension about possible stigmatization, may reduce the likelihood of community members seeking/receiving services or attending 12-step self-help meetings such as Alcoholics Anonymous. While participants noted the need for more professionals and services, concerns were expressed about providers not being culturally sensitive or trained for working with Native clients/ patients. Similarly, in the absence of Native-specific programs in tribal communities, members often need to leave the community for treatment, going to "unknown institutions." This may both reduce treatment-seeking, and make continuity of care more difficult. Many of the suggestions for improved services involve state programs that may have been supporting maternal infant health. The reality is that many such programs are being lost due to budget cuts. Given this, participants noted that communities need to be concentrating on helping families make their strategic plan on how they are going to care for themselves. Suggestions included bringing in aunties, uncles and grandparents as teachers and support; educating the entire community about healthy families; and coordinating services between departments and between tribes, Urban Indian centers and other agencies. Finally, we include a list of formal and informal promising practices for Maternal/Infant health. Washington Tribes & Recognized American Indian Organizations (RAIOs) Health Priorities Summit

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