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Behavioral Health Services for American Indians and Alaska Natives

Introduction

1. There are genetic factors unique to Native Americans that are associated with high rates of substance use.

A. True

B. False


2. Compared to White Americans, American Indians and Alaska Natives are less likely to:

A. Drink alcohol

B. Binge drink among those that consume alcohol

C. Have a higher rate of past-year alcohol use disorder

D. Abstain from alcohol and drugs


3. Research has found that Native Americans are more likely to have major depression than other Americans.

A. True

B. False


4. American Indians and Alaska Natives appear to be more likely than all other major racial and ethnic groups to seek substance abuse treatment services.

A. True

B. False


5. Most American Indians and Alaska Natives believe that _____ lies at the heart of substance use and mental disorders within their communities.

A. The misuse of native healing modalities

B. A genetic factor

C. Historical trauma, including the loss of culture

D. Living in isolation in a rural and remote area


6. Among many Native Americans, substance use is seen as:

A. A disease

B. A moral malady

C. A character flaw

D. An imbalance in the individual’s relationship with the world


7. All American Indian and Alaska Native clients recognize the importance of culture and perceive a need for traditional practices in their recovery.

A. True

B. False


8. American Indian and Alaska Native beliefs revolve around the value of connectedness and the importance of relationships, therefore, if providers do not build relationships or demonstrate interests in the community, the native community may be less accepting of the services offered.

A. True

B. False


9. To American Indians and Alaska Natives:

A. Providing direction on how something should be done is a customary practice.

B. Healing is intuitive; is interconnected with others; and comes from within, from ancestry, from stories, and from the environment.

C. Introducing the necessity of using evidence-based practices complements traditional healing practices and beliefs.

D. Providing direction on how something should be done, requiring the use of evidence-based practices, and allowing healing to come from within are all important.


Choosing a Path for Your Learning Journey

10. Which of the following shapes is the best image to organize the information that will be needed for working competently with American Indian and Alaska Native clients?

A. Triangle

B. Square

C. Circle

D. No shape should be used to organize information


11. American Indian and Alaska Native clients often do not care what a provider knows until they know that the provider cares.

A. True

B. False


Beginning in the East: The Direction of Cultural Knowledge

12. It was believed that American Indians could be more readily assimilated into mainstream culture if they were concentrated in one area; they could be “civilized,” and their native cultures would disappear.

A. True

B. False


13. The Alaska Native Allotment Act, passed in 1906, provided reservation land only for hospitals, schools, and:

A. Casinos

B. Religious worship

C. Sale of handmade items

D. Reindeer


14. The guiding philosophy of boarding schools was:

A. Kill the Indian, save the man.

B. Teach Christian values to the Native Indians.

C. Help the Native Indians carry on their traditions.

D. Learn from the Native Indians about how to survive off the land.


15. Historical trauma has been defined as:

A. Collective complex trauma inflicted on a group of people who share a specific group identify or affiliation.

B. The process through which past traumatic events affect one’s present-day functioning.

C. Cumulative emotional and psychological wounding across generations, including the lifespan, which emanates from massive group trauma.

D. Soul wounding that affected and continues to affect physical, social, cultural, and psychological health.


16. A stronger connection to traditional cultures may help reduce the effects of historical trauma on American Indians and Alaska Natives.

A. True

B. False


17. Which of the following is a common reason for why American Indian and Alaska Native clients experience grief?

A. Loss of their communities

B. Loss of freedom

C. Loss of land

D. Loss of their communities, loss of life, loss of freedom, loss of land, loss of self-determination, loss of traditional cultural and religious practices, loss of native languages, and the removal of children from their families


18. Which of the following factors mark historical trauma as different from other trauma?

A. It contributes to various mental and substance use disorders.

B. The distress resulting from the trauma is collective rather than individual.

C. There is an increased risk of experiencing other traumas.

D. Reactions include grief and other strong emotional / physical reactions.


19. Among American Indians and Alaska Natives, historical loss is associated with all of the following, except:

A. Malnutrition from not eating

B. Greater risk for substance abuse

C. Depressive symptoms

D. More feelings of anger


20. One important way historical trauma is transmitted across generations is through its effects on:

A. Education

B. Parenting

C. Language

D. Dietary habits


21. The most effective methods of treating the effects of historical trauma typically involve families and communities and supportive networks of people working to overcome similar problems or challenges.

A. True

B. False


22. Talking individually with the client about their culture and its meaning to them is essential before making decisions about how to treat those clients.

A. True

B. False


23. Having Native American ancestry automatically qualifies a person as a member of a Native American nation or tribe.

A. True

B. False


24. American Indians in the Southwest may refer to their nation as:

A. A tribe

B. A pueblo

C. A band

D. The village to which they belong


25. Research suggests that native people who have self-governance are more economically prosperous and may have better behavioral health outcomes, such as a lower suicide rate.

A. True

B. False


26. All of the following are myths about American Indians and Alaska Natives, except:

A. The most successful substance abuse treatment programs have originated within native communities and use local models of recovery.

B. Most American Indians and Alaska Natives live on reservations.

C. All Alaska Natives are Eskimos.

D. Most profits from gaming give direct payments to tribal members.


27. American Indians and Alaska Natives are more likely to experience violent crime than are members of any other major racial or ethnic groups except for African Americans.

A. True

B. False


28. Native Americans commit the majority of domestic violence toward Native Americans.

A. True

B. False


29. American Indians and Alaska Natives are more likely than other racial or ethnic groups to have all of the following physical problems, except for:

A. Tuberculosis

B. Diabetes

C. Cardiovascular disease

D. Lung cancer


30. Seven of the 10 leading causes of death for Native Americans have a behavioral component and relate to all of the following, except:

A. Risky sexual behavior

B. Lack of exercise

C. Poor diet and nutrition

D. Tobacco or alcohol use


31. Native cultures are more community oriented than mainstream American culture and less concerned with the importance of individual efforts and privileges, and family is often defined as extending beyond the nuclear unit to include people who are not blood relations.

A. True

B. False


32. All of the following are basic spiritual principles shared by many American Indians and Alaska Natives, except for:

A. Living in harmony and balance with others and with the world

B. Believing that there is order to the universe

C. Accepting that health and illness are out of the hands of the individual

D. Feeling a connection with others and with all life


Moving to the South: The Direction of Cultural Awareness and Competence

33. What is the first step necessary in developing cultural awareness?

A. Gaining awareness of your own cultural values and the role they play in your life.

B. Becoming aware of cultural differences.

C. Developing an understanding of cultural dynamics, such as cultural barriers, prejudice, and racism.

D. Developing cultural awareness requires all three actions to occur simultaneously.


34. Awareness of cultural differences involves all of the following, except:

A. Observing your own reactions to American Indian and Alaska Native clients’ responses and presentation and taking time to look at how their cultural, linguistic, and historical experiences may differ from your own.

B. Not assuming that every individual from the same cultural group will respond the same way.

C. Giving personal advice so that the person receiving the advice feels more of a personal connection with the provider and doesn’t just feel like a number.

D. Being aware that culture plays a significant role while avoiding generalizations and allowing for individual differences.


35. Avoiding eye contact is an aspect of _____, because direct eye contact may be considered a challenge.

A. Modesty

B. Humility

C. Cooperation

D. Respect


36. American Indian and Alaska Native cultures perceive respect for tradition as more important than innovation and change.

A. True

B. False


37. Much of what typically occurs in treatment may be offensive or at least strange to an American Indian or Alaska Native client.

A. True

B. False


38. When determining their level of trust in you, Native clients are likely to place more importance on:

A. Who you are

B. What you have accomplished

C. Who you are and what you have accomplished are equally important

D. Trust is only given over an extended period of time, regardless of who you are or what you have accomplished


39. What is a way to develop relationships with American Indians and Alaska Natives who are not clients?

A. Working with traditional healthier or elders.

B. Identifying a community member who is willing to serve as a cultural consultant.

C. Working with traditional healthier or elders or identifying a community member who is willing to serve as a cultural consultant are both ways to develop relationships with American Indians and Alaska Natives who are not clients.

D. The only way to develop a relationship with those who are not clients is by word of mouth through current clients.


40. Both research and clinical experience suggest that American Indian and Alaska Native clients respond poorly to providers who:

A. Share their own experiences.

B. Use stories.

C. Give examples of how behavioral changes have helped in their own lives.

D. Try to instruct them on how to behave.


Continuing West: Cultural Perspective on Behavioral Health

41. Native people may see labeling an illness as a naming ceremony that increases its power and discussing a prognosis or consequence of a behavior or illness as a prediction or prophecy, believing that thought and language have the power to shape reality and the future.

A. True

B. False


42. Which physical condition may be viewed by Native peoples as a process or sign that the person’s spirit has already crossed over into the next world?

A. Epilepsy

B. Dementia

C. Psychosis

D. Stroke


43. When framing inquiries on the use of traditional healers, it is probably better to use the term:

A. Medicine men / women

B. Services

C. Practices

D. Help-seeking


44. When are healers expected to be authentic?

A. When an official body has sanctioned that traditional healer.

B. Only practitioners who openly claim to represent native traditions.

C. Those healers that are accepted by their tribes’ elders and community leaders.

D. Providers who have become enthralled with the native culture and incorporate their interpretation of a traditional healing practice with clients.


45. Traditional healing practices separate mental disorders from physical and spiritual ones.

A. True

B. False


46. Native Americans now experience the highest meth usage rates of any ethnic group in the United States.

A. True

B. False


47. The primary substance of abuse for American Indians and Alaska Natives is:

A. Methamphetamine

B. Marijuana

C. Prescription opioids

D. Alcohol


48. Today, all of the following are the most significant mental health concerns among American Indians and Alaska Natives, except:

A. Traumatic stress

B. Attention deficit hyperactivity disorder

C. Bipolar disorders

D. Depression


Arriving in the North: The Direction of Culturally Specific and Responsive Skills and Practices

49. The most important thing that a provider can do is:

A. Listen

B. Give advice

C. Help finish the client’s sentences if they are silent for a period of time

D. Hold eye contact


50. Calling an American Indian or Alaska Native “a person with an alcohol use disorder” rather than “a person in recovery” will likely improve the client’s reaction and possibly the prognosis.

A. True

B. False


51. All of the following pertain to humor used by most American Indians and Alaska Natives, except for:

A. Humor can help address a specific problematic behavior without showing disrespect to an individual or family.

B. Humor may significantly help the client to be more resilient.

C. Humor is only a defense to distract from underlying issues.

D. Humor can promote healing.


52. Native communities believe that cultural knowledge and practice are the pathway to prevention and healing.

A. True

B. False


53. All of the following are questions to help assess cultural identity, except for:

A. How do you self-identify?

B. Who is in your family?

C. How do you practice your spirituality?

D. What do you do when you participate in ceremonies?


54. American Indian and Alaska Native clients generally respond well to all of the following treatment modalities, except:

A. Individual-based

B. Group-based

C. Community-based

D. Advice-based


55. Which of the following is the greater risk factor for relapse of substance use or a reoccurrence of psychological symptoms among American Indians and Alaska Natives compared to all other ethnic or racial groups?

A. The perceived and real probability of encountering social conflict or social pressure.

B. The lack of an adequate social support system.

C. Not being part of a mutual-help group.

D. Not involving a traditional healer in the treatment program.


Introduction

56. The _____ is said to be fifty percent of the healing and balance.

A. Use of sacred items

B. Spirit name

C. Ceremony process

D. Traditional healing method


Vignette 1 - Establishing Relationships, Acknowledging the Past, and Choosing Treatment

57. Beyond specific techniques, one of the most important provider characteristics is:

A. Genuineness

B. Active listening

C. Self-disclosure

D. Asking open-ended questions


58. Many American Indian and Alaska Native clients see _____ as a primary characteristic in selecting providers.

A. Empathy

B. Native heritage

C. Authenticity

D. Listening skills


59. A core counseling skill is choosing questions that are mostly open-ended, or questions that require more than a one-word or one-phrase response.

A. True

B. False


60. It is important to track the metaphors the client introduces in discussions, as it is far more powerful to use the language and images of the client than to create ones that may not match their experiences.

A. True

B. False


61. Summaries of what the client has said serves which purpose?

A. They are a good barometer for an accurate understanding between the client and the provider.

B. They allow for the important elements of the client’s problem to come together for the client to hear.

C. They help the client clarify their experience by allowing them to hear their own thoughts and experiences from someone else.

D. Summaries are a good barometer for an accurate understanding between the client and the provider, allow for the important elements of the client’s problem to come together for the client to hear, and help the client clarify their experience by allowing them to hear their own thoughts and experiences from someone else.


Vignette 2 - Addressing Methamphetamine Dependence, Reconnecting With Family, and Recovering on the Reservation

62. As with any client, native or non-native, using more formal introductions before determining a preference shows respect.

A. True

B. False


63. What is the universal belief about dreams across American Indian and Alaska Native cultures?

A. It is the time when the spirit travels.

B. They are considered visions.

C. They are powerful spiritual messages.

D. There is no universal belief about dreams across the American Indian and Alaska Native cultures.


64. Boasting sessions are typically very helpful when working with those in American Indian and Alaska Native cultures and promotes a broad perspective of strengths-based practice.

A. True

B. False


65. Talk about consequences or the potential effects of drugs and alcohol can be perceived by some American Indian and Alaska Native clients as:

A. Disrespectful

B. An omen

C. Therapeutic

D. Helpful in resisting the urge to use


66. Which stage would a client be in, under the Stages of Change Model, if they are aware that their behavior is problematic, but they feel stuck, ambivalent, or overwhelmed with the idea of doing something about it?

A. Action

B. Preparation

C. Contemplation

D. Precontemplation


67. Within the Stages of Change Model, individuals who have sustained change for _____ months are considered to be in maintenance.

A. 3

B. 6

C. 9

D. 12


68. Living native traditions is much more inclusive and grounding than a treatment plan targeting a specific problem, such as substance abuse or a mental health issue.

A. True

B. False


69. The consensus panel suggests that a provider should treat their American Indian and Alaska Native clients like relatives.

A. True

B. False


Vignette 3 - Facilitating Support, Creating Family Connections, Honoring Traditional Ways, and Recovering Remote Alaska Villages

70. Traumatic stress cannot be displayed through depressive symptoms alone.

A. True

B. False


71. The initial family session should be used for all of the following, except:

A. Rid oneself of a secret or a surprise

B. Build connections

C. Increase awareness of the effects of substance use or psychological problems on the family

D. Bridge any gap of support


72. Noninterference among American Indian and Alaska Native cultures is all of the following, except:

A. It allows things to happen the way they are meant to be.

B. It helps maintain peace or decreases conflict within the family and community.

C. It is synonymous with unwillingness to act.

D. It shows respect.


73. For many American Indian and Alaska Native cultures, saying ____ is seen as disrespectful.

A. No

B. Goodbye

C. A diagnosis

D. Indian


Vignette 4 - Making Connections Between Losses and Alcohol Use, Using One-Stop Outreach and Case Management Services for Homelessness and Treatment Service Needs, and Building Relationships Using Traditional Practices in Recovery

74. In counseling strategies that focus on building relationships, it is good practice to ask permission when introducing a set of questions or before providing suggestions.

A. True

B. False


75. When providing direction to clients on how to consult elders in treatment and in the community, the clients should approach the elders seeking:

A. Advice

B. Guidance

C. An opinion

D. Traditional rules


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