Indian Country Health Challenges

Addressing Trauma and Mental Health Challenges in Indian Country


AUGUST 17, 2016

My name is Darren Cruzan and I am the Director for the Office of Justice Services at the Bureau of Indian Affairs in the Department of the Interior.  I am pleased to submit this statement for the Department on the topic of “Addressing Trauma and Mental Health Challenges in Indian Country.”

As a result of repudiated past federal policies intended to disrupt American Indian and Alaska Native (AI/AN) families, today many tribal citizens suffer from the effects of generational trauma.  Trauma may be from emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect, witnessing substance abuse or domestic violence in the home, or experiencing a parent’s divorce or incarceration. Symptoms can range from anxiety, impulsivity, to depression, and can manifest themselves as criminal behavior, poor school performance, chronic illness, and mental health issues. In November 2014, the Attorney General’s Taskforce on American Indian/Alaska Native Children Exposed to Violence documented a high rate of trauma in Indian Country and made policy recommendations to reduce it. 

As the Department responsible for providing law enforcement, child protection services and social workers, support for tribal courts, and education services, we know we are a key partner in addressing trauma in Indian Country. While we do not diagnose or treat individuals, we or tribes that administer our programs and services are the often the first responders to crisis in the home or at school and serve as a bridge for connecting families and individuals to the services they need. Officers, teachers, social worker and other professionals  also witness firsthand the lack of resources available to treat the underlying conditions responsible for many of the troubling statistics. We appreciate the Committee’s efforts to raise awareness of this important issue and the opportunity to provide testimony today.   

BIA Trauma Informed Care Training

Progress in addressing trauma in Indian Country cannot be made until more education on trauma and its effects occurs. To better equip our staff, earlier this year, the BIA provided training to all BIA regional social workers on trauma informed care.  This training was presented by subject matter experts from the National Institute of Health and Johns Hopkins University. The regional social workers received information on historical trauma and additional training opportunities regarding this issue.

In addition to this nationwide training, many of the regions are providing training directly to, or in partnership with, tribes in their service areas.  Some examples are:

  • Alaska Region - In partnership with the Southcentral Foundation Family Wellness Program, the Alaska Region provided trauma informed care training at the BIA Providers Conference this past year.  The presentation was attended by approximately 400 tribal representatives, including ICWA workers, tribal administrators and tribal council members.
  • Southern Plains Region – The Anadarko Agency, located in the Southern Plains Region, operates the Positive Indian Parenting Program, an effort to address the parenting challenges the Agency has identified in their clients. This program was developed by the Agency after years of seeing how historical trauma impacting parenting skills as a result of the parents’ experience during the boarding school era. These problems have been passed down generation to generation, and impacts many child protective services referrals the Agency receives. The Positive Indian Parenting Program instructor is certified through the Active Parenting Program and has attended and uses the curriculum from the National Indian Child Welfare Association’s (NICWA) Positive Indian Parenting training.  Through the combination of these parenting programs, the Agency has provided positive Indian parenting courses to Native parents.
  • Rocky Mountain Region - The Rocky Mountain Regional Office has forged a partnership with the Native Children's Trauma Center- University of Montana for the last five years to develop Trauma Informed Child Protection Services.  The Native Children’s Trauma Center has done training for social service staff and tribal court staff over that period, and has provided onsite technical assistance at case staffing and child protection meetings. The region provided several region-wide trainings, a webinar series and more recently in 2016, developed a two-week trauma informed training curriculum for Social Service staff.
  • Midwest Region - The BIA, Midwest Regional Office in partnership with the Native Wellness Institute (NWI) offered a series of trauma-informed training to the Tribes at the Midwest Region's 2016 Partners in Action Conference.  The NWI recognizes the great impacts of historical trauma on Native people, and its impact on current day trauma in our families and communities.  The NWI’s mission is to promote the well-being of individuals, families and communities; to create an awareness of where our negative behavior comes from and provide opportunities for community/family growth and healing.

Tiwahe Initiative

We are also empowering tribal communities to address trauma in their communities. As recommended by the Attorney General in 3.1 of its report, “Ending Violence so Children Can Thrive,” we created a new initiative to allow tribes to braid federal funds together to address the distinct needs of their communities. 

Tiwahe, which means family in Lakota, is an initiative designed to demonstrate the effectiveness of wraparound services in tribal communities. It looks at funding streams from social services, child welfare, employment and training, recidivism and/or tribal courts and asks tribes to develop a plan to combine these funding streams to improve outcomes. The goal is to reduce the rate AI/NA children enter foster care, increase family reunification rates, reduce recidivism rates, and build capacity within tribal courts. 

In FY 2016, six tribes are participating in the demonstration project.  These are: the Association of Village Council Presidents (AVCP); the Spirit Lake Tribe; Red Lake Band of Chippewa Indians; Ute Mountain Ute Tribe; Fort Belknap Indian Community; and the Pascua Yaqui Tribe.  In addition, all tribes received an across-the-board increase to their base funding, referred to as Tribal Priority Allocation, for Indian Child Welfare Act and Social Services.  We recently hired a National Tiwahe Coordinator who will start later this month to work with participating tribes.  

As we continue to build this program, our hope is to also improve how we collect data in partnership with tribes to fully understand how trauma and its effects impact Indian County. 
Current, relevant, and robust data is necessary to make informed policy decisions to craft effective trauma interventions.  

Suicide Prevention

There is no more important issue than addressing the high suicide rate in Indian Country, particularly among youth, which is often the result of an individual’s exposure to trauma. Indian Affairs is directly involved in youth suicide prevention through the BIE, which provides technical assistance and monitoring to ensure schools are compliant with intervention strategies and reporting protocols to further ensure student safety.  In addition, under the BIE reorganization the School Health Policy Advisor position was created.  This individual will support the BIE Associate Deputy Directors, staff in the Education Resource Centers and BIE schools with the development of additional mental health programs, initiatives and policies as well as suicide and substance abuse prevention. They will also coordinate with the BIA and support interagency work of the White House Council on Native American Affairs.

BIE’s partnering with other federal agencies, including the Departments of Health and Human Services (Substance Abuse and Mental Health Services Administration and the Indian Health Service (IHS)) and Education, has enabled BIE to address the unique needs of students within these schools in the areas of mental and substance use disorders, including suicide.

The BIE has developed a Suicide Prevention, Early Intervention and Postvention Policy to promote suicide prevention in BIE schools.  The policy mandates specific actions in all schools, dormitories and the two post-secondary institutions; and encourages tribally-operated schools to develop similar policies.  These actions create a safety net for students who are at risk of suicide and promotes proactive involvement of school personnel and communities in intervention, prevention and postvention activities.  

The BIA Office of Justice Services (OJS) partners with numerous health and social service programs to assist in educating and presenting at schools, seminars, workshops and community events to the youth and the community on suicide prevention.  OJS gathers statistical data and identifies youth suicide trends within Indian Country, and will look for ways to expand suicide prevention training with other stakeholders in the future.  

The BIA’s Law Enforcement and Tribal Services programs, along with the BIE, continually seek ways to collaborate and to support activities directed at suicide prevention and services coordination.  The BIE utilizes the Youth Risk Behavior Survey, Native American Student Information System (NASIS), local BIA Law Enforcement, and IHS data to develop interventions and track trends for program implementation and is committed to seeking out and enacting prevention strategies while ensuring a safe and secure environment for our students.

Additionally, BIE schools and dormitories use NASIS to track and identify specific behavior trends to develop interventions to address school specific behavior issues. Training is provided on site by the School Safety Specialist at a number of locations throughout the school year during staff training sessions and all residential staff are required to receive suicide prevention training.

It is important to note that Indian Country continues to suffer from a lack of comprehensive mental health treatment options. For example, OJS officers responding to a call for service involving a suicide threat are often left with no option but to arrest the individual. Without mental health facilities, jail is oftentimes the only place where the safety of the individual can be guaranteed.   


Indian Affairs has the advantage of working alongside tribes and understands firsthand the severity of the lack of resources in Indian Country and the impact it has on tribal communities. We look forward to our continued partnership with Tribal governments, on a government-to-government basis, and with our federal partners to continue to address trauma related issues. 

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