Last week, we talked to Lee Yaiva (Hopi), CEO of Scottsdale Recovery Center, about barriers to recovery for Native Americans. In Part 2 of our interview, Lee offers unique insights into the solutions that support Native American sobriety and success.

Lee, you mentioned the importance of cultural competence for providers. What does that look like for a treatment center or detox clinic?

There needs to be a concerted effort to make sure people acquire knowledge and information. Make sure your team is equipped to have those conversations – don’t pull me in as a token Indian to do what you failed to do. Taking this on is a responsibility; you can’t just take on a Native patient because it’s better for your institution financially. You have to know what you’re doing and it requires a degree of insight about what’s appropriate.

For instance, one man came in with corn pollen to pray and staff took it from him as contraband, and they were going to flush it down the toilet. He told them, “That’s corn pollen, I pray with that.” They thought it was meth. So they called me and sent me a picture of it.

It’s the facility’s responsibility to learn that so they don’t put patients in the position of having to advocate for themselves. It can inhibit patients from seeking treatment, constantly having to justify themselves and explain.

What are some specific sobriety approaches that Native people are taking beyond twelve-step groups?

The recovery industry standard is that we execute best practices. In order for the provider to be reimbursed, treatment has to be recognized as a model. However, if Native people institute things innate to us, that may not be considered a best practice or recognized.

One thing I dealt with was sexual abuse. I thought I’d dealt with it but then it surfaced in recovery. One of the most heartbreaking things I dealt with in my career was sharing my story in a 16-bed, all male facility. And after I shared, I asked the men to raise their hands if it happened to them. All 16 men had their hands up. They were from all over the country.

What works is me saying, “I’ve been through this and I’m not going to be a victim but a victor.”

You’re not going to find that in a best practice. It has to be delivered with authenticity, with cultural responsibility, and true empowerment – not just cliched stuff like “Keep coming back, it works if you work it.”

It’s important to do something unique and innate to your community. Start being intentional with the need so everyone is welcome. You can inject something traditional like AA and use it as a platform but there are other pieces where you’ll be talking about things that are vastly different from the norm.

You can create something that’s your own. I am working with the Hopi substance abuse prevention center to create a Hopi curriculum that aligns with the seasonal calendar. 

So it’s about creating something unique to Native people? Is that the path to Native sobriety and recovery?

When I came into recovery, everything I learned was from non-Native people. I got trapped into the thinking, “This is not applicable. You don’t understand me.” But I prayed to Creator to send me guidance: “Whoever you send me, I’ll follow.”

This guy Jerry kept coming to me and talking about a group in the West Valley. At the time, I planned on going to Native American Connections but this guy kept coming and I thought, this must be who I should follow. So I went and it changed my life.

We can piggyback off whatever we want. But every Tribal community has lingo, jokes, language. Even dialect from one village to another can be different – so create something unique to you. Have a sense of Tribal identity and create a sense of trust and rapport.

One of the most empowering things we can do is self-advocate. If we individualize it to our community, how powerful would that be? Then you don’t have to go out because you’ve built it there. If you build it with pride and integrity, that’s something you’re not going to find anywhere else.

The answers are internal, trusted, and cultivated without reserve. It’s not being afraid about what we know about ourselves and being proud of it.

The Arizona fraud scandal with the fake sobriety houses is horrific. How can we stop something like that from happening again?

Nobody should be surprised that happened. Someone coming to an impoverished area with no resources who promises people houses and cars, saying, “All you have to do is come to Arizona to live in this mansion” – of course someone is going to come. It’s no different from what they did in the boarding school days. Promises of educational opportunities, coordination of care and housing served as enticement.

To mitigate risk in the future, it goes back to cultivating opportunities internally – because everything we don’t do or offer will be enticing to them. If you have housing, resources, and occupational opportunities on Tribal lands, people won’t be enticed.

In another 10-20 years, something like this could happen again unless we do things differently. When people are sick, they go elsewhere to find healing. Why can’t they get it here? Native people have a distinct innate foundation, in their practices, their land, their language. But when the healing isn’t available, we gravitate away from what’s innate and get into things that don’t apply to us.

People ask, “How do we create a treatment center?” Create the connection and they’ll never forget you or that experience. With SRC, they never come back because of a great AA program, they come back because of how we make them feel.

We have to start creating culturally appropriate care and create opportunities for people to become advocates. It’s everyone’s responsibility to do that. Until people create this, we will continue to empower and educate.

Thank you, Lee!

Addiction may be considered a disease today, but both the illness and the recovery are unique from other healthcare problems. Treatment can be hard to find, as well as expensive; 12-step programs like AA and NA may not work for everyone.

Native Americans who want to get sober typically walk an even tougher road. They face the challenges of any addict, while also confronting greater barriers to treatment access and the lack of culturally appropriate care. Which can lead to destructive patterns, given that:

• Native Americans have the highest rates of alcohol, marijuana, cocaine, and hallucinogen use disorders and the second highest methamphetamine abuse rates.
• One study found Native youth living on or near reservations had significantly higher rates of alcohol and marijuana use compared to other teenagers; 56% of Native eighth graders reported using compared to 16% of other eighth grade students.
• Between 70% and 95% of all Native people incarcerated were arrested for alcohol-related crimes. That sounds like a high number, right? But consider how many suburban and city residents can evade jail if they choose treatment after getting into legal trouble. That’s rarely a feasible option for Native people who live far from treatment centers, which routes them straight to court.
• In fact, only 12% of Native adults receive the treatment they need at facilities – and the providers there may ignore or disrespect their cultural needs. 

There are several dynamics here that aren’t easily solved. The long history of violation from the medical community has fostered understandable distrust on Indigenous lands. Native American public health services also receive significantly lower funding compared to other services; per capita, Indian Health Service funding is less than half of Veterans Health Administration and less than a third for Medicare. The result: provider shortages and only 52% of the space needed for patient populations.

Exploitation is still thriving in some corners, as in the current Arizona scandal involving fake “sober living homes” that defrauded Medicaid and Native patients. These places took the Native patients’ names, birthdates, and social security and ACHCSSS numbers, then kicked hundreds of patients out onto the street while bribing others into staying with drugs and alcohol. Many patients were left homeless; some overdosed; one woman discovered her cousin had been cremated and buried in a resting place for unclaimed remains. In the meantime, the fraudsters billed Medicaid for therapy services that were never provided, defrauding the state of hundreds of millions of dollars.

In search of modern Indigenous recovery

Most recovery experts agree that Native American patients require both evidence-based clinical practices and culturally-based holistic care. The practices and structures can differ quite a bit, though.

Some tribes hold powwows to celebrate sobriety. Wellbriety is an Indigenous-led program that seeks to align mind, body, and soul. Typical meetings begin with prayer and smudging, involve teachings from elders, and then offer group discussions much like you’d find at a traditional AA meeting. The Red Road is a sacred Native path where people in recovery can build resilience through cultural traditions, share stories of trauma, and support each other’s sobriety. 

Interview with Lee Yaiva (Hopi)

Lee Yaiva is Chief Executive Officer of Scottsdale Recovery Center, a highly-praised treatment center that offers detox, inpatient, residential, and outpatient services. We talked to him about challenges and options for Native Americans who want to get sober.

Lee, thank you for speaking with us. Can you share some common challenges for Native patients who want to get sober?

Geography is one. Access to treatment can be limited, depending on your location.

Another one is cultural competence. People reach out to me about programs and say, “I’m looking at this program but I’m not sure what they’re about and if I can trust them.” I encourage them to ask questions to get a sense of comfort and confidence. Those places will say “Oh, yes, we serve Native Americans all the time” but how do they do that? People should ask, “How are you accommodating my cultural and spiritual beliefs?” And if you hear a pause or uncertainty, that’s not where you want to go.

At Scottsdale Recovery Center, I ask, “What spiritual practices can I accommodate for you? Do you need corn pollen, sweet grass?” They may be coming from across the country but I’ll be able to design something that’s innate to them but also individualized.  I’ll meet with them and talk to them to eliminate that barrier immediately. I become a mediator between their intervention and their cultural practice.

We encourage people to ask questions because if the other person can’t answer those questions, they’re deficient. There’s nothing wrong with that. But it may tell you it’s not the appropriate environment for you to be in.

At Tribal Health, we hear about Native patients trying to get sober in treatment facilities where their cultural needs are ignored and the staff make no attempt to understand where they’re coming from.

I want to touch on cultural responsibility. Because of cultural responsibilities back home, Native people may not want to leave for treatment because, who’s going to attend to the sheep or take care of the fields? They might say, “I want to come to treatment but I can only stay for 30 days because I have to go back and harvest the corn” or other practices at different times of the year.

I understand 100% what that cultural responsibility is. Trying to manage both that and treatment is difficult.

So what I do is, when they go home, I keep engaging until they can come back. Or if they can’t, I establish collaborative efforts with existing structures on Tribal lands. But they may not have the resources, the technology, or the critical expertise to pick up where we left off – so that can be challenging.

That cultural responsibility is difficult to put aside. You’re taught from a young age that you have to come home for this, you have to come home for that. When you disregard that, it’s like you’re disregarding your cultural identity for something non-Native.

That makes a lot of sense.

There’s also a warrior mentality: you’re supposed to be stoic, you don’t express emotion. Men may be taught that if someone disrespects you, you don’t talk about it – you fight over it. You exude your dominance in a way that ensures it doesn’t happen again. Being self-destructive is celebrated and doing good is made fun of. It’s important to have the integrity and confidence to walk away from negative interaction. So we’re learning that serves us better as people.

And sometimes I meet people who believe they can pray the trauma away or can do this ceremony. But while those things are significant, those people still need clinical intervention. And sometimes people do that, still combat their issues, and wonder why it’s not working.

It needs to merge both: therapeutic intervention such as EMDR or trauma-informed care and ceremony.

Next week, Lee talks to us about creating recovery programs that build on Indigenous community and culture.

Our latest nurse spotlight shines on Shaneyl Rowe, a Rosebud nurse who is surrounded by nurses at work and at home!

How did you get into nursing, Shaneyl?

I’ve always wanted to help people. Caregiving is in my nature. I’m the oldest of six girls. Making a difference in people’s lives was something I’ve always wanted to do – and I‘ve known that for a long time.

I’ve been a nurse for eight years, coming up on nine.

How did you come to Tribal Health?

I was working in the Rosebud facility when Tribal Health earned the contract. It was a much smaller company then.  I got connected with John and Morgan and decided to come on board with them. I have never left Tribal Health since! 

Have you always worked in the emergency department?

No, I haven’t. Before I worked in ED, I worked in Winner, which has an emergency room, Labor and Delivery, Medsurg, swing bed patients, and one ICU bed.

What drew you to serving on Tribal lands?

I’ve lived in South Dakota all my life. I knew there were limited resources available on Tribal land. I thought this was a good way to serve my rural community.

What’s your favorite part of the job?

Being able to see my patients feel better through the treatments that my coworkers and I provide.  

What advice do you have for other nurses?

To remember that we often see people on their worst day. Being kind is the easiest way to improve patient outcomes and overall patient experience.

What would surprise people about you if they knew?

My husband, sister, sister-in-laws, and mother-in-law all work in the nursing field for the local community.  I also have many other relatives that work in the nursing field all around the state. 

Do you talk shop when you’re off the clock?

We do try not to talk about work outside of business hours.  We enjoy getting together frequently as a family for many different activities. 

Thank you, Shaneyl!

Brandy Pinkerton, RN, is a travel nurse and owner of Travel Nurse 101. She’s been a nurse for more than 18 years, with experience spanning neonatal and pediatric ICU, critical care float pool, flight nursing, and travel nursing. On her site Travel Nurse 101, she also helps nurses successfully navigate the travel nursing landscape.

We talked to her about common nursing struggles – from managing money to pandemic stressors to avoiding burnout. Here’s what she had to say.

Brandy, what issues do you see in the nursing industry? 

The dynamics of nursing have changed. It used to just be nursing. Now we are nurse, social worker, housekeeper, secretary, dietary – all of the things basically. The demands are higher and the patients are sicker and we aren’t being paid anymore to wear all of those hats.

Here’s my perspective as a nurse pre, during, and post pandemic: nurses lost credibility during the pandemic and it wasn’t even our fault. We were being told so many controversial things with a lack of evidence-based practices like we are used to doing. It was almost like trial and error but with people’s lives at stake. We had no clear guidance or resources from our government leaders or from hospital admin down to the doctors.

I know we were truly navigating an unknown and something that we’ve never experienced. I think I can speak for many when I say that as healthcare providers, we felt very unsupported and our health and well-being was pushed to the back burner.

Do you have any tips for nurses who want to protect their mental health in difficult healthcare environments? Some of the places our nurses work may lack resources; many of the patients deal with historical trauma.

When you work in an emotionally and mentally challenging healthcare environment, you have to prioritize your mental health. Here are my tips.                                    

One is to practice self-awareness and acceptance. Acknowledge your feelings without judgment. It’s normal to feel stressed or overwhelmed in such an environment, and that doesn’t make you weak. Practicing mindfulness and meditation is something that can help you stay present, manage stress, and cultivate resilience. So can taking small breaks to recharge.

Seeking support is also important. Remember, protecting your mental health is crucial for providing good patient care. Try connecting with colleagues who understand your challenges and be candid with them about your experiences and feelings. But also be aware of signs of burnout, such as exhaustion, cynicism, and reduced effectiveness. And don’t be afraid to reach out to counselors who can help with coping strategies.

Boundaries are another big one. Avoid taking work-related stress home with you – and make sure you keep up with your favorite hobbies and creative outlets outside of work. Exercise offers amazing benefits for managing stress so try to develop even a simple exercise routine – and stick to it. You might also consider limiting your exposure to traumatic content and media.  

Finally, remember to practice gratitude and focus on the positive impact you make in patients’ lives.

What’s the best way for a nurse to deal with compassion fatigue/burnout? We hear about nurses quitting the profession entirely, but is there another option beyond leaving the nursing field?

I truly believe that you have to put yourself and prioritize your wellbeing first. You cannot pour from an empty cup. You have to take time to escape and recharge on your days off.

Plan rest days, fun events, and vacations so you have something to look forward to. Learn to say NO – it’s ok to say NO to working extra shifts and picking up extra shifts if it is affecting your mental health. Keep your WHY close at heart at all times!

The biggest help for me has been getting into travel nursing. It allows a lot of flexibility in your schedule, you can take more time off, and you get to explore with a purpose. You constantly have something new and exciting to look forward to and that momentum keeps you going. You don’t have to get involved in any staff politics or drama. You are just there to help them for 13 weeks and then move on to the next place.

Travel nursing changed my outlook on nursing and quite honestly saved my career and even my life.

Thank you! Next week, we’ll share Brandy’s advice on how nurses and other healthcare professionals can better manage their money.