Dr. Tami DeCoteau, holds the sign-up sheet for a North Dakota trauma initiative, flanked by Dr. Zach Kaminsky, (left), Dr. Mary Cwik, (right) of the Center for American Indian Health, Johns Hopkins University, and Megan DesCamps, health policy advisor for U.S. Senator Heitkamp
There is often a distinct event that leaders in the trauma movement mention when asked about how it all got started in their community. Many times it is when one of the authors of the ACE Study, Drs. Vincent Felitti or Rob Anda, spoke to a group and elicited the personal “aha” moment that then led to taking collective action. The birthdate of the trauma-informed movement for the state of North Dakota is likely to be August 17 in Bismarck when U.S. Senator Heidi Heitkamp conducted a field hearing of the U.S. Senate Committee on Indian Affairs, and the Council on Native American Trauma-Informed Initiatives held a roundtable on trauma in Indian country.
The two events filled the United Tribes Technical College Gymnasium with a diverse crowd of tribal leaders, government officials, non-profit staff members, academics, healthcare professionals, and community leaders.
Heitkamp made it clear that she would lend her support to a statewide trauma initiative but that it must be homegrown and led locally. She said trauma is a community-based issue that requires education, involvement of diverse individuals including family members, and experts of all types, not limited to the fields of public health and medicine. She cited research showing multiple childhood traumas result in 20 years of lost life and asked, “In what world is this not a public health crisis?”
Heitkamp urged a heart-led movement that gets at the root causes of problems like addiction (not just the symptoms) and learns as it goes. She stayed throughout the day and long after the sessions to talk to constituents and others.
Dan Press, who leads the council, said the most significant outcome of the day’s forum was the enthusiastic and positive response to the invitation to attendees to join a statewide effort. Like Heitkamp, Press says universal approaches to reducing trauma are needed, but added, “Trauma is on steroids in Indian country.”
Dr. Tami DeCoteau, a Bismarck psychologist specializing in trauma-informed care who presented at both the hearing and the afternoon roundtable, was “heartened but not surprised” with the positive response to starting a statewide initiative. Volunteers who signed up were from around the state, and represented a variety of types of organizations and diverse sectors, including education, law enforcement, and healthcare.
The tradition of bipartisanship in the Indian Affairs Committee played out at hearing with the unexpected participation of U.S. Senator John Hoeven (R-ND), who also serves on the Senate committee. Hoeven asked the panelists to identify the most important strategy to address trauma. Panelists urged increasing resources for mental health services, training a skilled workforce, and investing in early childhood, including support for parents.
Heitkamp often mentions how she is informed by the experiences of members of her family who have worked professionally on some of these “symptoms,” e.g., domestic violence and addiction. She acknowledge the presence of her sister—Thomasine Heitkamp, a professor of social work and associate provost at the University of North Dakota—and spoke about her work on addiction and domestic violence. Another sister, Melanie Heitkamp, heads Youthworks of North Dakota, an organization that helps homeless and runaway youth.
A major controversy over the construction of the Dakota Access Pipeline near the Standing Rock Sioux reservation dominated the news (Bismarck Tribune carried a front page story on the event) and made its way into the hearing when tribal leaders were asked to make comments before the formal testimony. Standing Rock Sioux Tribal Chairman Dave Archambault and Cheyenne River Sioux Tribal Chairman Harold Frazier both spoke in opposition to the pipeline and connected the conflict to historical trauma and current trauma.
Lillian Sparks Robinson of the Administration for Children and Families, U.S. Department of Health and Human Services (HHS) and chair of the Intradepartmental Council on Native American Affairs, said the agency is developing an HHS-wide “comprehensive, integrated and trauma-informed” policy that will be completed before the end of the calendar year. The policy is being developed, she said, in cooperation with other federal agencies and with American Indian and Alaska Native partners. The Council (formerly called the Roundtable on Trauma-Informed Native American Communities) met with Sparks Robinson this spring to discuss the importance of moving ahead with the development of this policy, specifically requested by 12 U.S. Senators in a December 17, 2015 letter to HHS.
Dr. Zach Kaminsky, of Johns Hopkins University School of Medicine, opened the afternoon roundtable with a presentation on historical trauma, epigenetics (the interface between genes and the environment) and the implications for Native American communities. While more research is needed, he pointed to studies that show altered psychiatric outcomes in children of adults who have experienced disaster or trauma, citing historical trauma in Native American communities and holocaust survivors. Trauma-informed initiatives, he suggested, can help break the cycle of negative epigenetic changes.
Dr. Donald Warne, chair of Public Health, North Dakota State University, recommended the formation of an American Indian ACEs Center in North Dakota to address the effects of historical trauma and human suffering being experienced today. Warne described the need for data to document the impact of ACEs on health and pointed to a study conducted in the state of South Dakota that found high rates of ACEs, depression, alcohol misuse, and unmet health needs in pockets throughout the state, including counties where high numbers of American Indians reside. Findings from the study are reported in “Focus on South Dakota—A Picture of Health,” supported by the Helmsley Charitable Trust.
Myrna Warrington, a councilperson of the Menominee Indian Tribe of Wisconsin, described how the tribe, as part of the state’s Fostering Futures initiative, has achieved tangible results for children and families through early childhood programs and training in trauma of all workers on the reservation.
Anita Fineday, managing director of Casey Family Programs, described the foundation’s commitment to working with tribes and its goal to eliminate the need for foster care, noting how trauma and poverty are intertwined and how efforts are focused on finding solutions that break the cycle caused by poverty, neglect, substance abuse, and mental illness. Casey Family Programs provided support for the speakers to participate in the Roundtable.
On the same day of the Bismarck events, the New York Times carried the second article in a series of three articles about communities addressing trauma. The series points to a vital role for states to play in catalyzing communities to address childhood adversity. The trauma movement is gaining momentum around the country.