Like all organizations, the Native Center for Behavioral Health (NCBH) had to rapidly rethink how to conduct its work in the wake of the COVID-19 pandemic. The center, housed at the University of Iowa College of Public Health, develops programs to support the behavioral health workforce in Native American and Alaska Native communities across the country.

The center’s projects include three technology transfer programs funded by the Substance Abuse and Mental Health Services Administration in the areas of addiction, mental health, and prevention, as well as tribal opioid response technical assistance, mental health technical assistance for K-12 schools, and a Tribal College and University Initiative. It also hosts a Leadership Academy for Native American and Alaska Native behavioral health professionals.

Because much of the center’s work typically involves travel along with face-to-face meetings and trainings, the pandemic quickly had an impact on programming. Events were postponed or adapted to a virtual format, but there was still the bigger question of how best to meet the needs of their constituents for the duration of the crisis.

“In the beginning of the COVID-19 pandemic, our team did not quite know how to support tribal and urban Indian providers in the most productive way, so we decided to ask our tribal colleagues what they needed through weekly listening sessions,” says Anne Helene Skinstad, director of the NCBH. Based on the topics suggested by participants, the center compiles resources and creates programs around the themes put forth as important and relevant for their work.

COVID and Trauma

Tribal communities have been hit hard by the pandemic. The incidence of COVID-19 cases among American Indians (AI) and Alaska Natives (AN) is 3.5 times that among white populations, according to an August 2020 report from the CDC.

Additionally, recent CDC studies have shown that “AI/AN are among the racial and ethnic minority groups at higher risk for severe COVID-19 outcomes. Persisting racial inequity and historical trauma have contributed to disparities in health and socioeconomic factors between AI/AN and white populations that have adversely affected tribal communities,” notes a CDC press release about the report.

This summer, the NCBH hosted a webinar series on trauma, including sessions on “Building Resilience in Our Patients, Communities, and Ourselves in a Time of COVID-19: Lessons for Behavioral Health Providers;” “Historical Trauma: Definition, Impact, and Hope for Healing;” and “Trauma, Adverse Childhood Experiences, and Their Impacts on the Health and Well-being of Native American & Alaska Native People.”

Another webinar series focused on “Native American Veterans: Healing the Returning Warrior,” ending with a presentation on Post-Traumatic-Stress Disorder (PTSD). The COVID-19 pandemic has activated PTSD issues in many Native community members, Skinstad says.

Compassion Fatigue

Another result of the pandemic is secondary trauma and compassion fatigue because COVID-19 has brought up historical and inter-generational trauma, both in patients and in providers.

“These past months have been exhausting for behavioral health providers and prevention and treatment providers,” Skinstad says. “In addition, in tribal and urban Indian communities, providers are not insulated from experiencing the loss of family members and friends, nor from getting ill themselves. Such challenges take a toll on people and often leads to exhaustion and compassion fatigue.”

The center offers numerous resources for understanding trauma, building resilience, and integrating Native American cultural practices and traditions into Western behavioral health methods. It also offers an annual Spirituality Round Table project to Native communities, in which this year’s panel discussed the ways in which Native culture is often misunderstood in Western mental health practice, which can lead to misdiagnosis.

“A team of six professionals and spiritual leaders/traditional healers have discussed how mental illness has been understood from a traditional Native perspective and compared it to the current Western way of understanding mental illness,” Skinstad says. “We have had a steady number of participants with major contributions to this very important discussion.”

The NCBH will continue to respond and adapt to the uncertain times, supporting behavioral health specialists so they can serve Native communities in a culturally appropriate manner.

Learn more about the center at www.public-health.uiowa.edu/ncbh/

This story originally appeared in the fall 2020 issue of InSight magazine.