health and wellness

Reclaiming Indigenous Health in the US: Moving beyond the Social Determinants of Health

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The lack of literature on Indigenous conceptions of health and the social determinants of health (SDH) for US Indigenous communities limits available information for Indigenous nations as they set policy and allocate resources to improve the health of their citizens. In 2015, eight scholars from tribal communities and mainstream educational institutions convened to examine: the limitations of applying the World Health Organization’s (WHO) SDH framework in Indigenous communities; Indigenizing the WHO SDH framework; and Indigenous conceptions of a healthy community. Participants critiqued the assumptions within the WHO SDH framework that did not cohere with Indigenous knowledges and epistemologies and created a schematic for conceptualizing health and categorizing its determinants. As Indigenous nations pursue a policy role in health and seek to improve the health and wellness of their nations’ citizens, definitions of Indigenous health and well-being should be community-driven and Indigenous-nation based. Policies and practices for Indigenous nations and Indigenous communities should reflect and arise from sovereignty and a comprehensive understanding of the nations and communities’ conceptions of health and its determinants beyond the SDH.

Native Nations
Resource Type
Citation

Carroll,S.R.; Suina,M.; Jäger,M.B.; Black,J.; Cornell,S.; Gonzales,A.A.; Jorgensen,M.; Palmanteer-Holder,N.L.; DeLaRosa, J.S.; Teufel-Shone,N.I. Reclaiming Indigenous Health in the US: Moving beyond the Social Determinants of Health. Int. J. Environ. Res. Public Health 2022, 19, 7495. https:// doi.org/10.3390/ijerph19127495

Navigating the ARPA: A Series for Tribal Nations. Episode 5: Investing in Your Tribes' Behavioral Health

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From setting tribal priorities, to building infrastructure, to managing and sustaining projects, the American Rescue Plan Act (ARPA) presents an unprecedented opportunity for the 574 federally recognized tribal nations to use their rights of sovereignty and self-government to strengthen their communities. As the tribes take on the challenges presented by the Act, the Ash Center’s Harvard Project on American Indian Economic Development is hosting a series designed to assist tribes, to help tribes learn from each other and from a wide array of guest experts. During this session, the fifth in the series, following a round of discussion between the panelists a brief Q+A session will be held to maximize the opportunities for audience participation. This session, titled "Investing In Your Tribes’ Behavioral Health" will feature:

  • Stacy Bohlen (Sault Ste. Marie Tribe of Chippewa Indians), CEO, National Indian Health Board
  • Del Laverdure (Crow Nation), Attorney, Former Assistant Secretary of Indian Affairs, Department of Interior
  • Lynn Malerba (Mohegan Tribe), Lifetime Chief, Mohegan Tribe
  • Moderated by Karen Diver (Fond du Lac Band of Lake Superior Chippewa), HKS MPA 2003, Board of Governors, Honoring Nations, Harvard Project

Presentation slides:  Mental and Behavioral Health

Richard Peterson: Leading in the Traditional Way Alaska Tribal Government Symposium

Producer
Native Nations Institute
Year

President, Central Council of the Tlingit and Haida Indian Tribes of Alaska Richard (Chalyee Eesh) Peterson is Tlingit from Kaagwaantaan clan.  He gives his prespective on the ways tribal governement makes a presence in Alaska and the intergrating traditional knowledge and culture into tribal governance.

Native Nations
Resource Type
Topics
Citation

Native Nations Institute, "Richard Peterson Keynote Alaska Tribal Government Symposium," Alaska Tribal Government Symposium. Fairbanks, Alaska. November 16, 2016 

Governance and Wellness Roundtable - Alaska Tribal Government Symposium

Producer
Native Nations Institute
Year

This discussion at the Alaska Tribal Government Symposium emphasizes the connections between Indigenous self-government and wellness.  Western methodologies are eager to emphasize the gaps in wellness (social, economic, and medical and mental health outcomes) between natives and non-natives. These gaps have been a strong justification for the imposition of western health and wellness models on the delivery of services to Native populations. Yet a growing body of evidence suggest that shifting the responsibility for wellness to Native communities, foregrounding Indigenous ways of knowing and Native nation self-governance, gives rise to greater wellness than western approaches. Roundtable participants discuss their experience with these ideas from their own wide-ranging perspectives, and share indigenous measures of wellness.

Native Nations
Resource Type
Citation

Native Nations Institute. "Governance and Wellness Roundtable" Alaska Tribal Government Symposium. Fairbanks, Alaska. November 16, 2016. 

Transcript available upon request. Please email: nni@email.arizona.edu

Reimagining Indigenous Health: Moving Beyond the Social Determinants of Health

Year

Senior researcher Stephanie Carroll Rainie critiqued the application of social determinants of health models in Native communities and challenged readers to reconsider how they think about Indigenous health.

Resource Type
Citation

Rainie, Stephanie Carroll. Reimagining Indigenous Health: Moving Beyond the Social Determinants of Health. Poster Session: Research to Fuel our Futures. The NCAI Policy Research Center Tribal Leader/Scholar Forum. National Congress of American Indians Mid Year Conference. St. Paul, Minnesota. June 30, 2015. Poster.

 

Coeur d'Alene Tribal Wellness Center

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Created in 1998, the Wellness Center aims to promote healthy lifestyles by offering programs in fitness, aquatics, rehabilitation, childcare, and community health to 3,000 Indian and non-Indian clients. By employing the medicine wheel, or whole-life, approach to health and by focusing on preventative care, the Center complements the acute and chronic illness care provided by the Benewah Medical Center, which was created in 1990 through a joint venture between the Tribe and the City of Plummer, Idaho. Together with the Medical Center, the multi-purpose Wellness Center is the culmination of the Tribe’s goal to provide affordable health care services for all residents on the Reservation. Program participation is growing, tribal citizens are enthusiastic, and the Center is positively impacting members’ health–evidence that the Coeur d’Alene Tribe has successfully integrated primary health care, prevention, and wellness care.

Resource Type
Citation

"Coeur d’Alene Tribal Wellness Center". Honoring Nations: 2000 Honoree. The Harvard Project on American Indian Economic Development, John F. Kennedy School of Government, Harvard University. Cambridge, Massachusetts. 2001. Report.

Permissions

This Honoring Nations report is featured on the Indigenous Governance Database with the permission of the Harvard Project on American Indian Economic Development.

The Healing Lodge of the Seven Nations

Year

Owned by a consortium of seven tribes, the Healing Lodge is a treatment center that helps Native American youth and their families heal from the trauma of alcohol and drug abuse. With a focus on blending culture and spirituality with mental health/chemical dependency treatment, services include in-patient chemical dependency programs, mental health counseling, family counseling, a juvenile justice improvement project, recreation, education, and cultural activities. Since its creation in 1989, the Healing Lodge has served over 1,500 youth from more than 150 tribes, giving them fresh opportunities to better themselves and their communities.

Resource Type
Citation

"The Healing Lodge of the Seven Nations." Honoring Nations: 2002 Honoree. Harvard Project on American Indian Economic Development, John F. Kennedy School of Government, Harvard University. Cambridge, Massachusetts. 2003. Report. 

Permissions

This Honoring Nations report is featured on the Indigenous Governance Database with the permission of the Harvard Project on American Indian Economic Development.  

Navajo Treatment Center for Children and Their Family

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Responding to high rates of child abuse and neglect, the Navajo Child Special Advocacy Project was launched in 1990 to provide Western and Navajo therapy to victims of sexual abuse between the ages of 3 and 17. With five offices on the Reservation, the project administers Navajo diagnosis, treatment, and traditional healing, as well as sand play, art therapy, and forensic interviews. Through an array of therapeutic approaches, the program has created a safe and nurturing environment that fosters emotional, mental, physical, and spiritual well-being of children and their families. Prior to the creation of the Navajo Child Special Advocacy Project, child victims of sexual abuse and their families lacked adequate support and help. Today, the program has accomplished the almost insurmountable task of coordinating the efforts of separate agencies by forming a core discipline group to address child sexual abuse. The results of this effort ensure that law enforcement, prosecution, child protective services, and advocates can work together for the benefit of the child.

Native Nations
Resource Type
Citation

"Navajo Treatment Center for Children and Their Family".Honoring Nations: 2000 Honoree. The Harvard Project on American Indian Economic Development, John F. Kennedy School of Government, Harvard University. Cambridge, Massachusetts. 2001. Report.

Permissions

This Honoring Nations report is featured on the Indigenous Governance Database with the permission of the Harvard Project on American Indian Economic Development. 

Honoring Nations: Jennifer Harris and Julia Davis-Wheeler: The Healing Lodge of the Seven Nations

Producer
Harvard Project on American Indian Economic Development
Year

Representatives Jennifer Harris and Julia Davis-Wheeler of the Healing Lodge of the Seven Nations youth treatment center discuss the Lodge's genesis and how it works to strengthen the families of the seven Native nations it serves.

Resource Type
Citation

Harris, Jennifer and Julia Davis-Wheeler. "The Healing Lodge of the Seven Nations." Honoring Nations symposium. Harvard Project on American Indian Economic Development, John F. Kennedy School of Government, Harvard University. Cambridge, Massachusetts. September 11, 2004. Presentation.

Amy Besaw Medford:

"Next up we have Jennifer Harris, who helped participate during the Family Strengthening Symposium. She's from the Healing Lodge of the Seven Nations and is a registered nurse.

Jennifer Harris:

"I'm so short. Good morning. As that wonderful introduction that Amy gave me, my name is Jennifer Harris. I'm a registered nurse at the Healing Lodge, which is located in Spokane, Washington. We are seven consortium tribes. We are not located on a reservation; we are located in the city limits of Spokane, but on federal property. I kind of broke my talk into two sections because I wanted to touch a little bit and explain about the Healing Lodge, but I also wanted to talk about the Strengthening American Indian Families [symposium] that some of us were here for a few years ago. So I'll start with the Healing Lodge, which is a 26-bed inpatient chemical dependency treatment facility. And I'm fortunate to have one of our past board presidents -- I don't want to pick on her -- Julia Davis, here in the audience. And the presentation before was so excellent. Julia was one of the founding members of the Healing Lodge. So maybe when I'm done, she might want to come up and say a few words about how many, many years ago these tribal leaders came together with this idea and have actually seen it through to a beautiful, working program. So maybe she would be gracious enough to do that for us later. At the Healing Lodge, we have our own school, which does have a Native American Studies program. We have cultural resource people who are there available to the children. I guess I should have said that it's inpatient treatment for 13 to 17 year olds. We will take a 12 year [old] or an 18 year old; 12 if it's a dire situation and 18 if they're still enrolled in school. Their days are planned from the moment they wake up [until] the time they go to bed with education and process groups and a medical staff. They have mental health counselors, recreation specialists, the medical department. We're just one small part of this wonderful program that tries to help these youth recover from substance abuse and give them skills to go back into their communities. And when I was here -- to kind of switch gears -- when I was here for the Strengthening Families Symposium, it was something that I heard over and over again and something that I hear when people ask me where I work is, 'How do you not despair? How do you go to work and hear these stories every day, see the tears in these young ladies' eyes and young men, and know that you're sending them back to these communities and again you're powerless?' You have them for such a short period of time, which is usually 60 to 90 days, and we try to help them heal, teach them skills and hope for the best when they go back to the communities. And at this symposium, the pieces of the puzzle just went together for me. When the Healing Lodge was given honors in 2002, I was not part -- I'm still not part of the administration -- but it was the administration that was involved in the nomination process. And we have the big plaque on the wall, but not all of us know how that came to be. And being here this weekend, like I said, really put these pieces together for me. And it's the youth programs, the family violence programs, the economic development that is helping these children that I see every day. What I do on the front lines is just a small, small piece and I see this economic development and these fabulous programs as what's going to break the cycle of poverty. It's no secret that the poverty leads to addiction, abuse, violence, crime and helping these children at this stage in their life to be sober and clean and healthy is one small piece, but it is the salmon hatcheries and the revitalization of culture that is going to stop the addiction before they ever get to me. You will put me out of a job and I will gladly go because that, like I said, my light bulb went on when I was involved in the breakout sessions and hearing the speakers, that the Honoring Nations programs are what is breaking the cycle of poverty, which is bringing the self-determination, the self-governance, the revitalization of culture and what is going to eventually bring the Native American people out of poverty, out of despair and break the cycle of addiction that I see every day and help these children hold their heads high, be proud of who they are and continue to be members of a society that has in the past not been honored. So if anybody would like to hear, the story is fascinating and the web site is www.healinglodge.org and it's a beautiful facility. We do have -- and Julia will touch on this most likely -- we are run by a board and to be on the board you have to be a tribal councilperson. So our leadership is all Native, which I know is important, that we're learning about today with the self-governance and sovereignty, and we focus on Native American hiring. It's very hard, I know some of you must know that finding qualified Native people who are willing to come and work in the programs is sometimes difficult but we try to make sure that our administrator, our treatment director, the people who are making the decisions, know the Native culture and are making those decisions coming from that place. So that's kind of a nutshell of the Healing Lodge and what I've learned today. And I just want to thank everyone for all of their awesome input and what they're doing in their communities. I think it's easy to lose track of why we get up and go to work every day and the things that we do and I know you see the faces of your own children, but I see the faces of the children that I work with and some of them come from the tribes that you're representing. And knowing that, I can see like the floodgates closing and it coming to a trickle and through the generations the healing and the addiction decreasing. That's really the most important thing that I learned from being here. So I'll turn it over to Julia."

Julia Davis-Wheeler:

"There are seven tribes that belong to the consortium and that is the Umatilla Tribe in Oregon, the Kalispel Tribe in Washington, the Colville Tribe in Washington, the Kootenai, Coeur d'Alene and Nez Pierce tribe in Idaho. That's seven tribes, right? Did I say them all? Spokane. And I see our Kootenai tribal chairman just walking in the door, Gary Aitken. He's on the board and all of the tribes passed a resolution after a working group got together in 1986 and they were all tribal leaders and they wanted to do something for the kids. And that's when the omnibus drug bill was going through Congress and the focus was treatment centers for youth and at that time, in the Portland area, we didn't have any youth treatment centers. And so Mel Tonasket, Bruce Wynn, Ernie Stensgar, myself, Amy -- your mother Amy -- a bunch of others of us got a working group together and this goes back to improving tribal government and what we can do for the youth. And so what we did was we formed a consortium of tribes and we invited any tribe that was interested to come in to work with us. And we especially wanted the bigger tribes, the Yakama, the Shoshone-Bannock, and of course the Colville. The Colville, which is one of the larger tribes in Washington, decided to come in with us, but the Yakama and the Shoshone-Bannocks, because they had their own treatment centers going, decided to not come in with us. So what we did is we formed a band, if you will, of tribal leaders to get this youth treatment center and to be designated as the residential youth treatment for the Portland area. Now I need to tell you that it was not easy. It was very hard because we had the competition of the coastal tribes, if you will. And no offense against any of the coastal tribes that may be here, but they have Seattle, Portland and that corridor where they wanted to have the youth treatment center over that way instead of inland. We wanted it east of the Cascade Mountains so we could serve all of those youth and so we did have a little bit of a tug of war there and we won them over and they decided to support us to go ahead and do this treatment center. I just needed to let you know that it was a lot of work; we had a lot of meetings, continuous meetings. We met with Indian Health Service and we were finally designated as the youth treatment center group. And then we had to go through that whole rigmarole of finding a building, finding a place, finding the land, getting appropriations. I can't tell you how many times we went back to Washington, D.C. to lobby and it was like a miracle from God that we got special appropriations back in 1989. Oh, we started this in 1986, in 1986 when we formed this tribal leaders working group to do this. We knew that we wanted to do it and it was in 1989, 1990 with the help of the Senate Committee on Indian Affairs, some of the staff people knew what we were doing [and they felt strongly] with it and so they helped us get special appropriations, which was...that's unheard of now. Anyway, we got the appropriations to build a building. And the reason I'm saying this is we are very proud of that building. It's a brand-new facility and after we got appropriated the money then we had to find the land because the omnibus drug bill said that you had to be near a hospital, you had to be near a metropolitan area, etcetera, etcetera, etcetera. We wanted to put it down in Pendleton, Oregon with the Umatilla Tribe and we were looking at buildings down there. We wanted to have it on a reservation and Indian Health Service kept telling us, 'No, you have to be near a metropolitan area.' And it was like we were hitting our heads up against a wall. We tried to have it in Coeur d'Alene. The State of Idaho does not have a good reimbursement rate for treatment beds, Medicare; it didn't work out there. We tried to do it in Washington. We were looking over on one of the reservations and there are no buildings. You all know that. There's nothing on the Indian reservations that could house a youth treatment center. So what we did was we said, 'Okay, we'll build one.' We knew we wanted to build one. So we went back, we talked to the Department of Health and Human Services and they agreed to purchase land for us. So we ended up buying four acres of land, six acres of land, within the city limits of Spokane. Now, I know a lot of our tribes in the Northwest cannot understand why we are off the reservation but we had to do that. So the residential treatment center is in Spokane, Washington, and if any of you go there I really want you to go out and look at the treatment center, it's beautiful. It's one of the best facilities in the west and it's brand new and it's out in some trees. We have a sweat lodge for the young men, we have a sweat lodge for the young women, we focus on culture, on helping those young people deal with the substance abuse and the alcohol abuse that they're going through. We have elders come in and meet with them and talk with them about, some of those kids have lost touch with their culture, they've lost touch with their spirituality. Some of them have, they're just like little babes. So we're really working with them to come back. But so that's how we ended up with the federal land, and I'm leaving a lot of other things out. We had to fight with the City of Spokane to even build that residential treatment center because the neighboring people around, they didn't want us there. They did not want us there. So we had to battle with the city, the counties, everybody, to even get that facility there. And so that's why it's so good to see that the Healing Lodge has been recognized for improving tribal governments because even though we couldn't actually do it hands-on ourselves, as tribal leaders what we could do is help all the young people that we could -- not just one tribe, but all of us tribes and help them so they don't have to go through what we see every day. And a lot of us are recovering people ourselves. I'm not ashamed to say I'm a recovering alcoholic; I've been sober now for geez, since 1988. No not '98, since 1980. So that's 20 some years. And I know Antone [Minthorn]is the chair of our Umatilla and I know he has a long time [in recovery] -- I hope you don't mind me saying that -- but there's many of us that really believe strongly in this, the Healing Lodge. And for any of you that do get a chance to come up that way, we have visitors that come from Canada. You know Charlene Belleau and Fred Johnson, those people that did the Alkali Lake video, they're interested in coming over to do some...they've gone from sobriety now to real inter-healing. They've gone from one step to another step and so we have a lot of visitors from Canada. They come and tour our facility. We've had visitors from Navajo; we've had visitors from Oklahoma, California. They all come to see our treatment center and it makes me feel really good. And I know that Gary is a member of the board and Gary, when you go back and talk to the other board members, tell them that we need to keep this going and keep it strong and invite everybody to come to the Healing Lodge and have a meeting or something there. So it was a lot of work, but it was worth it, and as Jennifer has talked about or touched on, working with those kids is an award that you're giving back as an adult to them so they don't have to go through hell, as it's said. So thank you."

Honoring Nations: Tina Scott and Nan Smith: Mississippi Band of Choctaw Family Violence and Victim's Services

Producer
Harvard Project on American Indian Economic Development
Year

Program representatives Tina Scott and Nan Smith provide an overview of Mississippi Choctaw's Family Violence & Victim's Services program and discuss how its integrated approach has improved the quality and effectiveness of the services it provides to Choctaw citizens.

Resource Type
Citation

Scott, Tina and Nan Smith. "Mississippi Band of Choctaw Family Violence and Victim's Services." Honoring Nations symposium. Harvard Project on American Indian Economic Development, John F. Kennedy School of Government, Harvard University. Cambridge, Massachusetts. September 11, 2004. Presentation.

Tina Scott:

"Good morning. I'd like to introduce Nan Smith. She is my director for the family and community services on the Choctaw reservation in Mississippi."

Nan Smith:

"Good morning. We just kind of want to give you a short description, a quick description, of how the program came into being. The Department of Family and Community Services was created in 1999 when the chief and tribal council passed a resolution to create a department that would encompass all the family programs. And I call it 'all the problem programs on the reservation.' And we did something very unique when that happened. Behavioral Health, which is funded by Indian Health Services and is physically located at the Choctaw Health Center, was carved out organizationally and put under the department because we were having problems with Behavioral Health and Social Services communicating, and we still seem to have that problem a few years later. But that was, I think, really forward-thinking on the council's part that that was a good idea. It has helped. Our planning has greatly improved and then the more funding we got for family violence, we decided that in order to have their own identity, we found a building to put them in and pulled them out of the Social Services building. So that was real, I think, forward-thinking on our part in terms of it needed its own identity, it did not need to be part of Social Services although they serve the same families, but it was for different reasons.

And as those of you who are aware of when we got the award, we had an attorney that was the program director serving the program and now Tina came over from the health center and has assumed that responsibility. And so what we're doing in order to continue providing legal representation is Tina's going to serve as a lay advocate plus we are using some of our funds to contract out that service, but I'm going to let her talk more about that. But that in a way is very promising to us, because there were concerns when we were being reviewed for Honoring Nations that since we have an attorney, she's specialized, how's the program going to continue when Paula leaves? We have a solution and are also bringing a different perspective than what we had in terms of we were heavy on the legal side, now we're moving further into the case management side where we're able to...and so Tina was hired as a program director, not as an attorney. And so I really look forward to seeing a lot of improvement in the case-management perspective of that program. But I'll let her tell you more."

Tina Scott:

"Well, this is a wonderful program and we're so honored to be here. Amy [Besaw Medford] emailed me this huge paper maybe a month ago. I was like, 'Amy, what do you want me to do with this paper?' But anyway, let me tell you a little bit about the Family Violence and Victim Services on the reservation. It's sort of a...we like to think of as it a one-stop shop for victims and their families. It's confidential for one thing, it's comprehensive, and we feel that it's convenient for victims to come by and their families to come by. A lot of times, on any given day, at any given moment, you can have a man or a woman or a grandmother, an extended family member, aunt or uncle, come in with children and they may be in charge of those children for the weekend, for the week a month, they may not know and they have all these questions and we're able, we're so fortunate we're able to provide the answers for them. And if we can't, we have a legal defense, legal services department on the reservation that's able to take over for problems that we cannot solve, but a lot of times they come to us with questions and we're able to help them.

The history of domestic violence in Choctaw country, in Mississippi, goes as this: it was merely a family problem that should be left out of the court system. And so with that in your mind -- and you have all these against you coming -- it was really hard for people to set up this program in a way, and it's still a lot of taboo in certain cultures. Around 1998-99, as she mentioned, she was hired and then they hired an attorney to lay the groundwork for this program that was really needed on the reservation and they were able to do that. What they found out was they had a fragmented, the tribe already had money coming in, but they had this fragmented approach. They had money here, they had money there and they had personnel there. So they decided with tribal council approval to combine all the services for family violence under one roof and tribal council gave them the building and approval and they were able to move everybody into one building to give us this Family Violence and Victim Services program.

After this reorganization, they decided they needed some goals and one of the main important goals was to provide legal representation at no cost to the victim, and we're still doing that today and we're glad to be doing that. A domestic violence criminal code was established to mandate arrests for domestic violence-related crimes on the reservation. And another thing they looked at was the reporting. They wanted the police to start reporting, and we work really well with the police department on the tribe right now. They send us reports, we can pick it up or they could bring it over, but it could be daily, it could be weekly. We pretty much pick it up on a Monday from the weekend. So we're working really well with the law enforcement agency on the reservation and the schools. That's another thing. The schools have really helped us. They do their part in reporting any abuse. And another thing was increasing community awareness and we're still working on this. It's a lot of work when you're trying to get the community to buy into this, but I'll take a quote from Amy's report and it says, 'Children do not do well unless families do well and families do not do well unless communities do well.' And we've got this huge poster on our wall in the office and it says, 'When a mother cries, the children cry.' So that really gets to my heart because I have children.

So we've been, I think, fortunate and successful. We've received a lot of response to the program because we've been able to have support, tribal council support. And it's really important that when you're working on these social problems that you tell your leaders what is wrong or what you see and I'm sure that they see it too and they're probably being pulled in a lot of different directions. So it's important that you get their support when you're trying to establish these programs. And initially the tribal revenue funding was not there, but recently we have tribal revenue funding. So we're very fortunate that the tribe has recognized this need and has given us money. Besides federal or state funding, we have tribal funding. So that's really good to have that support from all the levels, different levels.

With the Harvard Project award we plan to have a website, we feel we should share this with other communities, probably in December of 2005, maybe January, if we encounter any difficulties; refusetoabuse.org is what we plan to use. And it's going to list everything from the initial start of this program up to present for those people who are interested in starting a program such as this in their communities. But that is another thing I wanted to mention was the paper touched a lot on self-determination. And I grew up on the reservation, I am Choctaw, I am a tribal member, I speak the Choctaw language, and I did not hear the term 'self-determination' until I was probably 16. I was competing in this pageant and that was one of the requirements was knowing what self-determination was. So you mentioned that a lot in the paper and now we like to know of it as 'Choctaw Self-Determination.' We've taken ownership of that term. It's not just self-determination, but Choctaw Self-Determination. And so I know about it and a lot of people know about it, we have it on our letterhead, on our envelopes, it's everywhere and it's important that you get people that are non-Indian working in your communities to buy into this concept. And we have a very dedicated staff of family violence and victim services who actually believe in this self-determination to strengthen families. But I wanted to thank you."

Nan Smith:

"Just to follow up on Tina's comment about self-determination, I'm real proud to say that out of the seven divisions I have within my department, which includes Social Services, Food Distribution, -- which is your basic commodities program -- the Elderly Activities center -- which we're real proud the tribe invested over $2 million to build a facility for us -- then we've got Family Violence, we've got Behavioral Health, Boys and Girls Club. And out of all seven, I have five division directors who are tribal members and I'm really thrilled with that. Like I said, with Tina coming over from the health center, her background is in public health administration, she's not an attorney, but there's no reason why she can't function as a lay advocate. She speaks the language, she's female, and most of our clients are Choctaw females, and so she's bringing a totally different flavor and we're real pleased to have her. And she hasn't been there very long and look at how much she knows about it already. So we're really pleased to have her and we're pleased to have been invited. Thank you."