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D R . P A T R I C I A M A K O K I S

What’s New is Really Old: Trauma Informed Health Practices Through an Understanding of Historic Trauma. 1. D R . P A T R I C I A M A K O K I S S A D D L E L A K E C R E E N A T I O N U N I V E R S I T Y O F A L B E R T A A L B E R T A

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D R . P A T R I C I A M A K O K I S

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  1. What’s New isReallyOld: Trauma Informed Health Practices Through an Understanding of HistoricTrauma 1 DR. PATRICIA MAKOKIS SADDLELAKECREENATION UNIVERSITY OF ALBERTA ALBERTA DR.MARGOGREENWOOD ACADEMIC LEAD NATIONAL COLLABORATING CENTRE FOR ABORIGINAL HEALTH TRAUMA INFORMED CARE &PRACTICE

  2. Positioning Self inPresentation • 2 • Cree • Practiceceremony • PrivilegeIndigenous knowledge • Reside in community(Nation) • Married toEugene • Mother to Janice &James • Kokum toAtayoh • Servantleader • Work at the Universityof • Alberta TRAUMA INFORMED CARE &PRACTICE

  3. Dr. MargoGreenwood 3 • Indigenous scholar (Cree) • Academic Leader (NCCAH) • Focus on health and well-being of Indigenous children, families and communities • Vice-President of Aboriginal Health for the Northern Health Authority in BC • Professor – First Nations Studies and Education programs at UNBC TRAUMA INFORMED CARE &PRACTICE

  4. WebinarSession 4 • For staff who work front line with and for Indigenous Peoples (First Nations,Metis) • Assumptions: • Work in communityor • with staff incommunity • Community members who desire deeper understanding of historic trauma • Overview ofsession: • (broadperspective) • Strength amidst adversity(theme) • Colonialimpacts • Historic trauma (defining and rollout) • Community based impacts • Trauma informed health practice(old/new) TRAUMA INFORMED CARE &PRACTICE

  5. “Let us put our minds together asone.” • 5 • If we sat in a circle and put an object in the center of the circle and we all described what we saw, everyone would see different points of view fromeachother.Some wouldeven see opposites because they would be sitting on opposite sides of thecircle.In other words, you don’t have to see what Isee for you to beright. • In fact, everyone in the circle is right based on their own point ofview.If we are willing to listen to everyone’s pointofview, then we can get a more accurate description of the object in the center. This is one way to put ourmindstogether.Whenwe get the clarity from each other, we should give thanks andbe grateful to eachother. Irving Powless, Sr.Onondaga TRAUMA INFORMED CARE &PRACTICE

  6. Complex situation: Canadian Historyand IndigenousPeoples’ 6 RACISM INDOCTRINATION WHITEPRIVILEDGE INDIGENOUS KNOWLEDGEMISSING TRAUMA INFORMED CARE &PRACTICE

  7. Residential Schools &Inter-generational Trauma 7 INDOCTRINATION IDENTITY SAVAGENESS INFERIORITY WHAT WERE WE TAUGHTIN SCHOOL? INVISIBLENESS Ph.D “why didn’t I knowthis”? TAKE THE INDIAN OUT OF THEINDIAN TRAUMA INFORMED CARE &PRACTICE

  8. Understand HistoricTrauma • 8 • “The cumulative emotional and psychological wounding across generations, including the lifespan, which emanates from massive group trauma.” • Klinic, 2013, p. 44 citing Yellow Horse Brave Heart,2003 • Dr. Maria Yellow Horse BraveHeart TRAUMA INFORMED CARE &PRACTICE

  9. Canada’s Most Horrific SecretHistory 9 PHYSICALGENOCIDE •Masskilling •Targeted BIOLOGICALGENOCIDE •Destroy groups reproductivecapacity CULTURALGENOCIDE •Destruction of structures and practices (governance – familysystems) •Destroy political / socialinstitutions •Land isseized •Populations forciblytransferred •Movementrestricted •Languagesbanned •Spiritual leaderspersecuted •Spiritual practicesforbidden •Families disrupted to prevent transmission of cultural valuesand identity from generation togeneration TRAUMA INFORMED CARE &PRACTICE

  10. John A. MacDonald -1874 10 • Indian children should be taken away from their parents so as to eliminate their barbarian influence and expose the children to the benefits of civilization. The teacher has been sent out as an educational missionary to introduce cultural changes in Indian societies. • (Source: Makokis, 2000 citingPauls) • TRAUMA INFORMED CARE &PRACTICE

  11. Dr. Duncan CampbellScott • 11 • “Our objective is to continue untilthere is not a single Indian in Canada that has not been absorbed into the body politic, and therein no Indian question.” • Source: Makokis, 2000, p.18 (citing York, 1990, p.23) TRAUMA INFORMED CARE &PRACTICE

  12. Dr. Peter Bryce (Medical Officer –1904) 12 • Inspected residentialschools 1537 children (25%dead) • 1 school (69%dead) • Overcrowdness, inadequate heat, ventilation, poornutrition His report was metwith hostility bygovernment http://ottawacitizen.com/news/local-news/beechwood-ceremony-to-honour-medical-officers-tenacity TRAUMA INFORMED CARE &PRACTICE

  13. Learninghistory: ColonizedClassrooms • 13 • Colonization isviolent, • on-going andtraumatic • ….violence continues to shape current practices, behaviours and responses. (p.18) • How important is it for ALL of us tounderstand trauma informed care andpractice? TRAUMA INFORMED CARE &PRACTICE

  14. Trauma Informed Care &Practice 14 Why? What? • “People who have experienced trauma are at risk of beingre- traumatized in every social service and health caresetting.” • (Klinic Community Health Care Centre, 2013, p.6) • “….regardless oftheir primary mission – to deliver primary care, mental health, addiction services, housing, etc. – their commitment is to provide services in a manner that is welcoming and appropriate to the special needs of those affected bytrauma.” • (KlinicCommunity Health Centre,2013, p. 15) • Ie: ACEstudy • MainstreamAmerica • Poor healthoutcomes • TRCpresentation • 60-70 – maybe 10hands • up TRAUMA INFORMED CARE &PRACTICE

  15. A trauma informed service provider, system and organization: (idealworld) • 15 • Realizes the widespread impact of traumaand • understands potential paths forhealing • Recognizes the signs and symptoms of trauma in staff, clients, patients, residents and others involved in the system • Responds by fully integrating knowledge abouttrauma • into policies, procedures, practices andsettings Source: Klinic Community Health Centre, 2013, p.16 TRAUMA INFORMED CARE &PRACTICE

  16. Core Trauma InformedPrinciples 16 • Acknowledgment (traumapervasive) • Safety • Trust • Choice andcontrol • Compassion • Collaboration • Strengthbased • Challenges: • Internal readiness (community capacity, leadership practices, staff professional development) • Externalprofessional • Development • /readiness TRAUMA INFORMED CARE &PRACTICE

  17. Challenges 17 Externalchallenges Internalchallenges Share power, willingness to finda way, challenge statusquo Internalized oppression, marginalization, lateralviolence TRAUMA INFORMED CARE &PRACTICE

  18. 18 TRAUMA INFORMED CARE &PRACTICE

  19. Source of IndigenousLaws • 19 • Songs • Ceremonies • SacredBundles • SacredSites • Mountains andother Land/ Watersites • Medicines (tobaccoetc.) TRAUMA INFORMED CARE &PRACTICE

  20. Teachings embedded on theland • 20 • Land is ourbook • Teachings carved into the landscape (petro glyphs) • IF the land isour book, how do we learntogether? TRAUMA INFORMED CARE &PRACTICE

  21. Colonization Impacts: Dr. PapaarangiReid: • U of Auckland (Dec/ 08) Vancouver Diabetesconference • 21 • We need to know the powerof • colonization • Our realities become“myths” • Dominators stories become the “reality” • Colonization transformsNations • Become “insiders andoutsiders” • Results in resentment,frustration, anger • Social, political, economic resource depletion (including land / policy alienation) • Social breakdown (unequal / inferior citizenship) • Barrier to ourdevelopment • Leads to high crime, high riskbehavior TRAUMA INFORMED CARE &PRACTICE

  22. CognitiveImperialism 22 “When Indigenous knowledge is omitted or ignored in the schools, and a Eurocentric foundation is advanced to the exclusion of other knowledge's and languages, these are conditions that define an experience of cognitive imperialism.” (Battiste, 2013, p.26) TRAUMA INFORMED CARE &PRACTICE

  23. Adverse Childhood Experiences:ACE (R. Anda, V. Felitti, J.Bremner, J. Walker, C. Whitfield, B. Perry, S. Dube, W. Giles, 2006) • 23 • The ACEStudy(San The study makes adirect • Diego,CA.) • 17,337 adultpatients • Assessed 10 adverse childhood experiences (ACEs) includingabuse, witnessing domestic violence, and serious householddysfunction. connection between a person’s ACE score and later life chronic health conditions such as diabetes, heart disease, mental illness, andmore TRAUMA INFORMED CARE &PRACTICE

  24. Categories of adverse childhood events(middle classAmerica) 24 Abuse (bycategory)(%) Psychological (byparents) Physical (by parents) Sexual(anyone) Neglect (bycategory) Emotional Physical Prevalence11% 28% 22% 15% 10% Household Dysfunction (bycategory) (Source: ACE ppt, Edmonton,2009) TRAUMA INFORMED CARE &PRACTICE

  25. 25 TRAUMA INFORMED CARE &PRACTICE

  26. Losses (unresolved / perpetualgrief) • 26 • Shame • Internalizedpain • Loss ofself • Loss ofworth • Loss of personalidentity • Loss of parentingskills • In-fighting (gossip,hatred, • familyfeuds) • Self harm (suiciderisk) • Groupoppression • (Oppressed – oppressothers) TRAUMA INFORMED CARE &PRACTICE

  27. …..More about lateral violence (communitycontext) 27 • shaming -humiliating • damaging -belittling • sometimes violent behavior directed toward a member of a group by other members of the same group (gossip, putdowns, competition, family feuds, religious wars, gang wars, turf protection, lack of cooperation, bullying, more…..) TRAUMA INFORMED CARE &PRACTICE

  28. Disruptedattachments: individually,families,community/cultureDisruptedattachments: individually,families,community/culture Individual: Isolation / alienation Shame Anger toward school / parents Self-hatred Internalized racism Fear of authority Lowself-esteem Self-destructive behaviors (substance abuse,gambling, alcohol) Actingaggressively Family:Unresolved grief Difficultyparenting Family violence Loss ofstories Loss oftraditions Loss ofidentity Community /culture: (losses) -connectedness with languages, traditions and culturalhistory -togetherness /collective support support fromElders -lack of control over land/resources Increased suiciderate Lack of communal raising of children Lack of initiative Dependency onothers Communalviolence (Source: Trauma Informed Toolkit, p. 46-47)

  29. Walking the path together:in respectful relationships 29 • Integrativeapproaches • Indigenousand • non-Indigenousallies • Multiplestrategies - • individual, • family, • community • address relational stressors withinand amonggroups TRAUMA INFORMED CARE &PRACTICE

  30. Elder Teachings: We are allrelated! 30 A COLLECTIVE LEARNING JOURNEY: Removing the shackles thatbind TRAUMA INFORMED CARE &PRACTICE

  31. Strength of IndigenousKnowledge 31 WOMEN’SPIPE TEACHINGS SHARE KNOWLEDGE SYSTEMS HUMANKIND WILLBENEFIT TRAUMA INFORMED CARE &PRACTICE

  32. Privileging IndigenousKnowledge Indigenous scholars and Elders(team teaching) Landbased Indigenous knowledge core with western knowledge 32 TRAUMA INFORMED CARE &PRACTICE

  33. Dr. Regan: Relationships arekey! 33 All people (Indigenous and Non-Indigenous Canadians) need to take that “genuine leap of imagination” to guideour steps today and into the future In reality, institutionsdo not lead socialchange. The peopledo. And so it is up tous. TRAUMA INFORMED CARE &PRACTICE

  34. Were inthistogether: Ourcollective responsibility! 34 Remove fear, worktogether! Window of opportunity and we must take it. Window: TRC, Calls to Action. Thankyou! Dr. PatriciaMakokis Dr. MargoGreenwood TRAUMA INFORMED CARE &PRACTICE

  35. Sources • 35 • ACE study.http://www.theannainstitute.org/ACE%20Study/ACE-PUB.pdf • Battiste, M. (2013) . Decolonizing Education: Nourishing the LearningSpirit. • Purich , Saskatoon,Sk. • Cote-Meek,S.(2014). Colonized Classrooms, Racism, Traumaand Resistance in Post-Secondary Education. Fernwood Publishing, Halifax &Winnipeg. • Slide 8, Dr. Marie: Klinic, 2013, p. 44 citing Yellow Horse Brave Heart,2003 • Makokis, P. (2000). An Insider’s Perspective: The Dropout Challenge for Canada’s First Nations. Unpublished doctoral dissertation, University of San Diego, San Diego,CA. • Reid, P. (2008) Personal notes taken at Vancouver Diabetesconference • Regan, P. “A Transformative Framework for Decolonizing Canada: A Non- Indigenous Approach” (paper presented at IGOV Doctoral Student Symposium, University of Victoria, 20 January 2005), available online; and Regan, Unsettling the Settler Within: Indian Residential Schools, Truth Telling, and Reconciliation in Canada (Vancouver: University of British Columbia Press, 2010). • Trauma Informed Toolkit,2nded. 2013 • University of Alberta (2016). Aboriginal Community Industry Relations brochure TRAUMA INFORMED CARE &PRACTICE

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