Health Care Issues
Evidence-Based Practices and Best Practices

More and more, funding is directed to “best practices”. Best practices are based on (1) research evidence proving that a practice “works”; (2) practitioners’ opinions about what works in practice; and (3) culture and local context which determines if and how a practice works here and now.

Combining these three very different ways of knowing—research; practice; and culture/context—to find best practices is challenging. Each has different approaches to “evidence” and to judging what is “proven.”

One Sky Center has (1) reviewed research to find practices proven to work in Indian Country; (2) reviewed practice descriptions to find those that look like they might work in Indian Country; (3) developed a framework for describing culture-based practices; and (4) held consensus conferences to combine science, practice, and culture-based knowledge.

In October of 2004, the One Sky Center, in collaboration with the Center for Substance Abuse Treatment (CSAT) in the Substance Abuse and Mental Health Services Administration (SAMHSA) and the National Diabetes Prevention Center in the Centers for Disease Control and Prevention (CDC), convened a resource panel of leading scientists, researchers, community leaders, and traditional healers to discuss the state of the literature in substance abuse prevention, substance abuse treatment, mental health treatment, and co-occurring disorders treatment. Please see below to view the monograph on Best Practices that was produced as a result of this workgroup.

In 2008 the One Sky Center developed a scientific framework on culture-based interventions (CBI) with the intent to translate CBI into the language and scientific framework used in evidence-based interventions (EBI) and to apply the existing scientific knowledge base on youth suicide, violence, and substance abuse to CBI. The goal is to facilitate communication with a scientifically oriented professional service and government community, particularly when preparing grant applications or seeking reimbursement. Please see the link on CBI below to view this paper.

The One Sky Center also works with the State of Oregon Department of Human Services Addictions & Mental Health Division and the nine tribes of Oregon regarding the implementation of an Oregon State law requiring evidence based programming in Oregon tribal communities. The One Sky Center serves as a resource to the Oregon Tribal Best Practices Tribal Stakeholder Committee. The State of Oregon is the first State to enact such a mandate and to combine research; practice; and culture-based knowledge. Please see below to view the Evidence-Based Programs Tribal Practice Approval Form that was developed in conjunction with this workgroup, as well as further information and background.

Best Practices
Best Practices in Behavioral Health Services for American Indians and Alaska Natives (pdf)

Recommendations for broadening the cultural base of the National Registry of Evidence-based Programs and Practices (NREPP) (Word)

Culture Based Interventions
Culture Based Interventions in the Native Aspirations Project (Word)

One Sky Center/State of Oregon Evidence Based Practice Efforts
The following pages describe Oregon’s approach to combining research, practice and culture knowledge in the search for best tribal practices.

Evidence-Based Programs Tribal Practice Approval Form (Word)

Evidence-Based Programs Tribal Practice Approval (short form only) (Word)

Tribal Practices The Good Ways of Providing Mental Health & Substance Abuse Prevention, Treatment & Rehabilitation Services (ppt)

Meeting the Evidence-Based Standard (ppt)

Following are examples of best practices that are based primarily on research or practice or culture. The following practices currently in American Indian/Alaska Native communities – on and off the reservation – have been judged effective in the prevention and treatment of substance abuse and mental health among Native people. Links are provided where available.

Research Based Practice

Project Venture – National Indian Youth Leadership Project

American Indian Life Skills

Canoe Journey

Equine Therapy

Practice Based Practice

Native HOPE (Helping Our People Endure)

Culture Based Practice

Gathering of Native Americans

Sweat Lodge

Talking Circle