Indigenous populations in the U.S. and Pacific Islands are underrepresented in mental health and substance abuse research, are underserved, and have limited access to mainstream providers. Often, they receive care that is low quality and culturally inappropriate, resulting in compromised service outcomes. The First Nations Behavioral Health Association (U.S.) and the Pacific Substance Abuse and Mental Health Collaborating Council (Pacific Jurisdictions), have developed a Compendium of Best Practices for American Indian/Alaska Native and Pacific Island Populations. The private and public sector's increasing reliance on evidence-based practices (EBP) leaves many Indigenous communities at a disadvantage. For example, funding sources may require the use of EBP without awareness of its cultural usefulness to the local Indigenous population. Indigenous communities are then faced with having to select an EBP that is rooted in non-native social and cultural contexts with no known effectiveness in an Indigenous community. The field of cultural competence has tried to influence mainstream research, and the escalating requirement of EBP use. These efforts have given rise to the practice-based evidence (PBE) and the community-defined evidence (CDE) fields. All of these efforts, ranging from evidence-based practice to community-defined evidence, have a shared goal: practice improvement.
This theoretical paper introduces the concept of the "negotiated space", a model developed by Linda Tuhiwai Smith, Maui Hudson and colleagues describing the interface between different worldviews and knowledge systems. This is primarily a conceptual space of intersection in-between different ways of knowing and meaning making, such as, the i Pacific indigenous reference and the dominant Western mental health paradigm of the bio-psycho-social. When developing Pacific models of care, the "negotiated space" provides room to explore the relationship between different (and often conflicting) cultural understandings of mental health and illness. The "negotiated space" is a place ofp urposive re-encounter reconstructing and re-balancing of ideas and values in complementary realignments that have resonance for Pacific peoples living in Western oriented societies. This requires making explicit the competing epistemologies of the Pacific indigenous worldviews and references alongside the bio-psycho-social and identifying the assumptions implicit in the operating logic ofe ach. This is a precursor to being empowered to negotiate, resolve and better comprehend the cultural conflict between the different understandings. This article theorises multiple patterns of possibility of resolutions and relationships within the negotiated space relevant to research, evaluation, model, service development and quality assurance within Pacific mental health.
In the period 1971-1981, 1,835 cases of leprosy were reported in the United States; only 10% of these cases were indigenous. Since 1977, the number of new cases reported each year has risen because of an increase in imported cases of disease, a situation reflecting the increased number of refugees and immigrants who have entered the United States from areas endemic for leprosy. Forty-five of the 50 states reported cases. In only 25% of the imported cases were the patients known to have had leprosy at the time of immigration; the remaining 75% were diagnosed in this country. The highest rate of disease onset for this latter group occurred within 12 months after entry into the United States, but cases continued to be reported 10 years after entry. Active refugee resettlement programs have widely distributed persons with leprosy, contacts of diseased persons, and persons from endemic areas throughout the 50 states, a situation necessitating the development of expertise by medical professionals and public health officials in the diagnosis, treatment, and long-term follow-up of patients with leprosy.
Developing cultural competence is a key requirement for social workers in the multicultural environment of the 21st century. However, the development of social work interventions that are syntonic with specific cultural groups is a great challenge. Interventions that are based on the traditional healing practices of a particular culture ensure cultural relevance and consistency with its values and worldview. This article discusses the importance of culturally based interventions within a cultural competence framework and offers examples of such interventions used with Native Hawaiians. Two interventions are discussed, targeted to the micro (direct practice) level and macro (community practice) level of practice. Culturally based social work interventions may be most appropriate for client systems within a particular culture; however, some methods, such as ho'oponopono, have been successfully used with clients from other cultures as well.
Research is deficient regarding the strengths of Pacific Island parents of children who are medically fragile. The purpose of this qualitative ethnographic study was to explore the strengths of Pacific Island parents of these children. Audiotaped interviews were analyzed using Text Smart and peer review. The core theme reflecting strength was positive energy. Participants believed that parents needed to have the ability to handle emotional feelings, solve problems, connect with their spirituality, find meaning, take care of themselves, use family support, use community support, use a positive attitude, be resourceful, meet a challenge, interact with nature, and focus on the present. Themes were affirmed by the literature with the exception of interacting with nature, which may be indigenous to the population's cultural orientation.