Successful Approaches to Native Children’s Care
To understand the widespread health issues affecting Native children, it is essential to understand their historical context. “We’re increasingly coming to recognize that the problems in indigenous communities, including the issues that are most vexing in child health, have as their basis historical and ongoing trauma,” says Dr. Jarvis.
Dr. Jarvis cites the Adverse Childhood Experiences (ACEs) study, which was first conducted in 1995 by Kaiser Permanente in Southern California. The study concludes that ACEs have been linked to risky health behaviors, chronic health conditions, low life potential, and early death.3 Prior to the ACEs study, medical professionals did not necessarily see the link between childhood trauma and an issue like obesity. As Dr. Jarvis tells it, Dr. Vince Fellini, one of the study’s major researchers, asked a patient when she had started gaining weight. She responded that her weight gain started when she was eleven years old.
“It turns out that when she was eleven, she was sexually abused by two of her uncles,” Dr. Jarvis explains. “So this patient’s response was to start eating, and she noticed that when she gained weight and became obese, her uncles left her alone.” The ACEs study found that many adult health outcomes correlate highly with childhood traumas, “including things you think couldn’t possibly be linked,” says Dr. Jarvis, “Like developing lupus, or developing rheumatoid arthritis, or having a child with developmental disabilities.”
“Tribal elders have been saying this for a long time,” Dr. Jarvis continues. Years ago, Dr. Jarvis traveled to the Cheyenne Reservation to study the high prevalence of rheumatic diseases there, and a Cheyenne elder told him, “If you want to know why we’re having such high rates of disease, look at our history.” In this case, history refers to the individual and the collective—a collective that has experienced centuries of pain.
In the treatment of Native American children, honoring both childhood and historical trauma is essential to providing quality healthcare. “We can take a trauma-informed approach to dealing with a whole community,” Dr. Jarvis explains. He offers the story of the Menominee Nation in Wisconsin: tribal elders, health care professionals, and community leaders have shifted to asking “What happened to you?” rather than, “‘What’s wrong with you?’ This approach has been implemented across the Menominee health system, in their schools, and even in their court systems. “You assume you are dealing with a traumatized population, and all of your interactions reflect that,” says Dr. Jarvis. “Dealing with the trauma as it exists, instead of pretending it’s only in the past, has been shown to be incredibly successful.” The Menominee Nation considers trauma dating back to the 1860s, when American Indian children were forcibly sent to boarding schools to be “Westernized,” in their present-day approach to healing.4
In partnership with tribal leadership, Dr. Jarvis says that medical professionals “are beginning to develop strategies for trying to prevent adverse childhood experiences.” In many communities, the prevention model begins with the development of sex education programs for young people. Programs such as Family Spirit, run out of the Johns Hopkins Center for Native American Health, focus on maternal health and intergenerational behavioral health problems as a means to improve outcomes for children. Essential to Family Spirit’s program is its honoring of an indigenous understanding of health; culture and community are integrated to support young parents as they navigate pregnancy and early childcare. “More and more, tribal nations are trying to take control of their health systems, taking them out of the hands of the federal government,” says Dr. Jarvis. “And if this means we are empowering indigenous people to improve their health through indigenous practices, then this is wholly a good thing.”