Eleven-year-old Sean has recently been placed by county child protective services in foster care under the care of his grandmother in a large metropolitan area. His parents and brother were recently killed in a car accident and now Sean’s only living relative is his grandmother. Sean needed to move away from his home where he was born and raised on an Ojibwe reservation in northern Minnesota to live with his grandmother in the city.

Sean is energetic and outgoing and has made friends quickly in his new school that provides an alternative to public school education for children who would benefit from additional educational support services. Sean is obese and has been recently diagnosed with hypertension and type 2 diabetes. In this new school there are only a few Native American peers for Sean and no cultural support partners or programs for Native American students. Sean doesn’t currently have an adult male role model in his life. However, he remembers his father well, who was the lead singer for a powwow drum group for his home reservation.

Sean is very proud of his dad and wants to learn to sing and to drum like him. Sean also wants to be a football player.

You are the public health nurse who visits the school weekly to provide health screening services and noticed Sean brings snacks to school that include soft drinks, potato chips, and candy. You are participating in his parent/guardian: teacher conference next week and would like to talk with Sean’s grandmother about how to support Sean to best live with his diagnosis and promote his optimal health at school.

To prepare for his parent/guardian: teacher conference next week, you are reviewing the following questions:

1. Is type 2 diabetes in Native American children common in the United States? Share what you know about the disease and its evolution to younger age groups in this country and globally.
2. Discuss what you have learned about poverty and its possible influence on Native American children like Sean.
   • Too Many Children Continue to Live in Poverty in Minnesota (PDF)
   • One-third of Native American and African American children are (still) in poverty
3. Before meeting with Sean’s grandmother, you want to learn more about the role of the Native American elder and grandmother in the family and how to best communicate respectfully with her to discuss Sean’s health and nutrition. Where would you go to learn more on these topics?
   (Byers, 2010: https://www.researchgate.net/publication/233123902_Native
   _American_Grandmothers_Cultural_Tradition_and_Contemporary
   _Necessity)
4. What is the meaning and purpose of the Native American drum? How are traditional drums made?  Recent research has shown the sound of the drum can positively impact health – research and discuss your findings on this statement.
   http://www.oneskycenter.org/wp-content/uploads/2014/03/D.Dickerson-UtilizationofDrummingforAmericanIndians
   andAlaskaNativeswithSubstanceAbuseDisorde.pdf
5. You would like to highlight and support Sean’s strengths towards his future health and well-being. What strengths would you like to discuss with Sean and his grandmother? Give specific examples on the words/phrases you would use and what questions you would ask in this conversation.
6. Name two culture-based referrals or resources for Sean you would like to suggest for his grandmother at the parent/guardian: teacher conference. Describe how you see these referrals providing added support for Sean and for his grandmother?

Root cause of health inequity

Centuries of US federal policy that has threatened natural Native American kinship and family structure and forced assimilation of Native Americans into the White culture. Also, “…health outcomes for Native Americans are adversely impacted by wholly inadequate access to comprehensive health services” (Smith, 2022).

Policy Considerations

1. Seek reimbursement for culturally adapted services and kinship navigator programs
   • Effective January 2021, the US Children’s Bureau provided new guidance on allowable flexibilities related to cultural adaptations of evidence-based prevention programs and services in Title IV-E prevention services for tribal communities. Prevention services include mental health services, parent training, and substance abuse prevention and treatment. Tribes agree and may seek reimbursement for culturally adapted services.
2. Continue collecting data on all the Indian Child Welfare Act (ICWA) data elements
   • The Biden-Harris Administration is looking to hear from tribes on their position regarding restoration of 2016 data elements on Native American and LGBTQ+ child welfare that were removed by the prior Trump Administration from the adoption and foster care analysis reporting system (AFCARS). As the Federal lawsuit is pending, tribes are urged to consult with their state child welfare agency on how they will collect data on all the Indian Child Welfare Act (ICWA) data elements to assure representation in data for tribal communities.   
3. Growth of ICWA On-Reservation and Off-Reservation programs
   • The Biden-Harris Administration budget request has proposed several increases to child welfare programs that tribes will administer. The request will include items for the ICWA On-Reservation and Off-Reservation programs. The National Indian Child Welfare Association (NICWA) is following specific requests for these funds for the future of each program.

Calls to Action

• Gain understanding of intergenerational trauma.
• Provide resources to families and health professionals on how to provide cultural based support to Native youth as a protective factor

References

Byers, L. (2010). Native American grandmothers: Cultural tradition and contemporary necessity. Journal of Ethnic & Cultural Diversity in Social Work, 19(4), p. 305-316

National Indian Child Welfare Association. (2021). Child and family policy update: November 2021. http://www.nicwa.org/policy-update/