Hi there, everybody. I'm Holly Echo-Hawk. I'm going to be the co-facilitator for today. Welcome to the monthly tour training session. If that's what you're looking for, you're in the right place. I don't know if we want to just wait a minute to see if more people join or if you want us to go ahead and move forward, Bobby. We can sure give it another couple, maybe half a minute, Holly. Sure, no problem. We're really happy that you all are joining us. And, you know, there's nothing, in my opinion, there's nothing more important than the TOR grantees and the work that you all are doing all across the country. It's incredibly important. And we're happy to, as part of the Opiate Response Network, we're happy to be here to support you and your work. And one of the ways that the Opiate Response Network helps is through these monthly training sessions. So today, we are very fortunate to have the second part of Mr. Al Falcon, who, if you all were with us last month, he did an overview and went through some of the cultural standards for health care professionals. And today, he's going to continue that, which I'm calling Part B on the Practical Application of Cultural Standards for Health Care Professionals. So if you all, when you join, could you do us and everyone a favor and put in the chat your name and your organization and your tribe? It would be great to say hello to everyone else that's on the call. So thanks for putting your information in the chat. And while you're doing that, let me also say that one of the things that the Opiate Response Network has developed for several years now is the development of a special Indigenous Communities Response Team. And Norm is on the call, so I'm going to hand it back over to Norm and let Norm talk about the Indigenous Community Response Team. Hey, thanks, Holly. So yeah, so as Holly said, ORN does have a tribal focus with Tribal Opiate Response Grant recipients. We do obviously respond to all requests from anyone. And if the tribe is not TOR funded, we would still respond to that request as well. Basically, what ORN has done was put together a specific team of technology transfer specialists who will respond to the tribal request and then work with a group of tribal consultants to provide you guys with the best, obviously, consultation or education consultation that we can provide you. And just like today with Al, if you were interested in more information about the work that he's presenting on today, you could submit a request to us and he could potentially be a consultant for you all in furthering that work. So I think that's... Is that the gist of it, Holly? Yeah, that's great. And it's super easy to make a request. And so I'm sure that at some point at the end of this presentation, there will be information about that. So let's go ahead and keep moving forward. And I'm not sure who is going to speak to the land acknowledgement. So I think that's Mr. Tudogs, I believe, is going to do the land acknowledgement for us. Oh, wonderful. No, it would be Norman or Holly, one of you two. Mr. Tudogs is going to do the cultural welcome. Yes. So Norman, do you want to go ahead and read the land acknowledgement? Yeah, absolutely. We acknowledge that the land that now makes up the United States of America was traditional home, hunting ground, trade exchange point and migration route for more than 574 American Indian and Alaska Native federally recognized tribes and many more tribal nations that are not federally recognized or no longer exist. We recognize the cruel legacy of slavery and colonialism in our nation and acknowledge the people whose labor has been exploited for generations to help establish the economy of the United States. We honor indigenous, enslaved and immigrant people's resilience, labor and stewardship of the land and commit to creating a future founded on respect, justice and inclusion for all people as we work to heal the deepest generational wounds. Norm. Yeah, sure. And then just some information about the grant here. Funding for this initiative was made possible in part by a grant from SAMHSA. The views expressed and written in conference materials or publications by the speaker or moderators do not necessarily reflect the official policies of the Department of Human Services, nor does mention of trade names, commercial practices, organizations apply endorsement by the U.S. government. And then ORN assists states, tribes, urban native organizations, cities and communities, as well as individuals by providing culturally responsive education and training to address and oversee or address the overdose crisis. We also help to enhance prevention, treatment and recovery, as well as harm reduction efforts and provide free training and consultation to help fill gaps as defined by the requester. And one of the things that I really appreciate about the Opioid Response Network, and I probably failed to mention that I'm also, I've been with the Opioid Response Network since its inception, and I'm the national co-director of the Indigenous Community Advisory Council for the ORN. And we helped develop these foundational premises for all the work that we do with tribal people and Alaska Native people and Native Hawaiian people, is the first fundamental principle is that we assume brilliance. Native people are brilliant, born brilliant, and we assume their native brilliance. And then there's three other principles, if you can just go ahead and put them up. We also believe that every Native community has tremendous strengths, tremendous expertise. They may just come to the ORN for a little assistance, a little boost in information, some more different resources, but we assume the strengths and expertise of communities. Obviously, we support sovereignty. And the last one is that we're here to help you all. So we follow your lead. What you need, we respond to that. So you're the boss. We're just your helpers. So the next slide. So the Indigenous Communities Response Team, each state and territory has a designated team led by a regional technology transfer specialist who is an expert in implementing evidence-based practices. ORN developed an Indigenous Communities Response Team to support requests from TOR grantees and other Native communities. And this will show you kind of the map of how the regions are divided within the United States and in the U.S. territories. So each color represents a different Tribal Opioid Response Territory that ORN responds to. And if you're in those territories, you will always probably be dealing with the same Tribal Opioid Response TTS. And here's just the website where you can visit the Opioid Response Network if you want more information about the work that we do or to submit a request. Again, like Holly said, it's super easy to submit a request. The Submit a Request button is always on the page on the website. And even if you're not sure you want to submit a request, but you just want more information about a potential project that you might do, I would suggest you submit the request anyway and then somebody will give you a call to talk about that a little bit more. And then we can go on. That's just some background about Norm and I are co-facilitating today. And we're really fortunate to have, and honored actually, to have Mr. Two Dogs with us today for the cultural opening. And, you know, we always want to start in a good way, so I will turn it over to Mr. Two Dogs. Good morning or good afternoon, depends on where you're at. So I'm going to pray my Lakota language. Can everybody hear me okay? Okay, thank you. Thank you very much. Thank you. Thank you, Mr. Two Dogs. Thank you so much for all those good words and prayers. So just to move forward, the objectives today is today you're going to hear some really, continue, if you weren't with us last month, this is continuation, the second part. And if you're just joining us today, you'll still receive the overview of the entire points that Mr. Falcon brought up last month. And it's basically a review of cultural health care standards. This session is going to talk more about the practical application of cultural standards, both from a behavioral health and health care lens. And we're going to have some open discussion, so there's going to be several opportunities to bring up challenges and suggestions, ideas you have about applying the cultural standards that Mr. Falcon is going to go over across the work that you do. So the next slide. Mr. Falcon, what a treat. And Mr. Falcon is the Director of Special Health Projects for the Native American Development Corporation. I know he's sitting in Billings, Montana. He's very highly trained, and you can see, well credentialed, and looking forward to hearing from him. So I'm going to turn it over to Mr. Falcon. Thank you. I'll say, everyone, I am Little Shell Chippewa Cree, as it says here. I identify mostly as Cree, as that was the language that my grandfather and grandmother spoke in the home. We, I was raised by my grandfather in a very traditional way, and he passed when I was a young man, but I continued our traditional practices in my life and learned what I can over the years from others, other family members, other tribal members, and so forth. So a lot of my thinking comes from a very traditional cultural place, although I am what is referred to as a third generation urban Native. That means that my family's been living off of a reservation for three generations now, and with that I have a lot of natural assimilation and acculturation within myself, along with the forced assimilation and acculturation that's happened to our people over the years. And so what I've had the opportunity to do with my profession as both a licensed therapist and a licensed addiction counselor in the state of Montana is, I guess, in a sense, translate a lot of the Western study that I have in psychology and behavior, and translate that in ways in my own head that made sense to me from some of my traditional perspectives, and that's really helped me move that practice forward when helping individuals, especially Native individuals, in understanding the conditions that they struggle with, whether it be mental health conditions or substance use disorders, and then also the healing process that goes with that. So it's been very valuable to me in the way that I can translate some of Western society's teachings, if you will, the science behind addiction, the science behind mental health, and also recovery and healing, and make that, I guess, more culturally relevant for Natives that I've worked with over the years. And I will go out on a limb here and say that I've also had wonderful response from non-Natives as well with my approaches, because my approaches come from a Native place, a cultural place. They are very spiritual in foundation, and spirituality, especially for we as Native peoples, is not something you'd necessarily learn as much as it is a way of life and a way of being. So I teach people in many aspects of how to heal spiritually through my understanding. Next slide, please. So I work for Native American Development Corporation, and our mission is to serve as a hub for Native Americans, primarily in Yellowstone County in the Billings area. Although we have a lot of outreach, and I have worked closely with the different reservations, there are eight of them. In the state of Montana, there are actually 12 nations, but eight reservations. And of course, we have five urban Indian organizations, UIOs as well throughout the state. So I've worked very closely with them. And our mission at NADC is to provide access to success, whether it's business, somebody starting up their own business, Native American business, or within what we're talking about here today, within the health field as well. Next slide, please. This slide is just a little history of NADC. We started in 1996, and it really was about helping Native American businesses stand up and move forward and have some success with everything from technical assistance to securing loans and things like that. You can see in 2001, we became a CDFI, where we were actually able to help finance different Native American businesses and organizations. But I want to take you forward to 2011 is when we actually established ACES. ACES, American Indian Consulting Services, actually works with federal contracts. And those federal contracts are really important to us as well, since we have so much sovereignty throughout Indian country, and working with the federal government. But ACES is the organization within ourselves that I had worked closely with in developing these cultural standards of care that we'll go over today. And lastly, in 2018, we actually opened our UIO, our urban Indian organization that we call BUIC, Billings Urban Indian Health and Wellness Center. And when I was first hired at NADC, that's where I was hired as the behavioral health director. And then within a year, moved into a position as the center director itself, because we have a medical component with that clinic as well. So I oversaw the entire clinic for some time, and then slowly moved out of that position into the position I'm in now, which is the director of special health projects, where I have helped bring on and continue to bring on new lines of service within our clinic. So expanding the clinic services, and also expanding some of the services that Native American Development Corporation has as well. For instance, we have a toxicology and medical lab now that I started from the ground up, that is now up and running and on its own here in the Billings area. And as far as we know, I think it's the only Native American-owned lab, medical laboratory in the United States. There may be one other, but I'm not completely sure of that. So that's something that I helped bring up, and that's where the title comes in, special health projects, because it kind of gives me free reign to work in any aspect of behavioral and medical health and help us expand. Next slide, please. As we go through these cultural standards, this is a slide that I often talk about. As behavioral health professionals, I think we're all familiar with Maslow's hierarchy of needs. And if you haven't been made familiar with it, the picture next to Maslow's hierarchy is actually Blackstock's model, which is more in the realm of we as Native Americans and how we conduct ourselves in a traditional fashion. So Maslow's hierarchy of needs, there's some studies, some readings out there that talk about Maslow lived with the Blackfoot Nation of Alberta, Canada, for about a year, and he was influenced by his time with the people there and may have some influence on his hierarchy of needs. I think the only challenge to Maslow's hierarchy of needs when working with Native American populations is that it puts self-actualization at the top of this pyramid, which, by the way, Maslow did not create the pyramid. His model was more of a linear model, but later came the pyramid, and you can see how it's stacked. And in this model, it puts self-actualization as almost a goal to achieve, whereas if you look at Blackstock's model, you see self-actualization at the bottom of this is a tipi here, but the same type of model in the sense of a pyramid. And at the bottom of that is self-actualization. That's actually where you begin when you work with Native populations. And why that is, is because we as Native Americans are born into an identity, and self-actualization in a nutshell is about self-awareness, self-identity, and who you are as a human being. So that's what we try to aspire to is that self-actualization when we're helping our clients move through these stages of change or being. So in Blackstock's model, we look at self-actualization being the starting point, and this is what I've done throughout my entire career when working with individuals, but primarily Native individuals. And then we move into the second tier on Blackstock's model, which is the community actualization. We know that we as Native people are very communal, very social historically and currently. And so after we work with ourselves and who we are, and to put that in perspective is some of our belief systems are that we are born with gifts. We are born into this identity and we have gifts about us that we develop throughout our entire lives within our family units, within our community units. And when we get to community actualization is when we take these gifts and we begin to give back to our community and to our families. So it's all about the strength of the individual giving back to the community so that the community can prosper. And beyond that is what we get to cultural perpetuity, the top tier of that. And that's when we begin to take our teachings, our understandings, and who we are as human beings, and we begin to move that forward and teach the younger generation so that this continues as perpetual. So I just want to show you these two models as we move through these cultural standards, kind of keep these in the back of your mind. Next slide, please. And a third model, which I think works very well, and I've left this very plain, but it's the medicine wheel. And with the medicine wheel, we look at the human being, the little smiley face there at the center of the medicine wheel. So think of the medicine wheel, for those of you who are unfamiliar with it, as all of creation. Each one of these areas within the four areas within the medicine wheel reference something within creation, within the world. You can look at the self. You can look at emotionally, and physically, and mentally, and spiritually in each one of those, and so forth. And the colors themselves represent something. And each of these represents a different direction, east, south, west, and north. So I left it plain, because when you start working in Indian country, you'll find that different nations and different tribes may have different understandings for each direction, for each section. So I didn't want to put this in here in our Cree way, which is where I come from, and my understandings, but wanted to leave this kind of universal, just so that you see that the happy little face at the center of this is a human being at the center of all creation. And that is what we strive to be as human beings. And so when we're helping people within the behavioral health profession, we're trying to help them heal and find the center of the circle. So keep this model in mind. Not any one of these three models are completely right or completely wrong. They are just three different models to kind of reference when working with individuals and kind of help you to meet a person's needs as you continue to work with them. Next slide, please. The cultural standards, as I talked about last time, so I'm honored to come and speak to these again and kind of review them and go into a little more detail with a few of them. And the goal is to expand the practice of health care professionals by providing a better understanding of cross-cultural and cross-historical contexts that affect indigenous health care outcomes. Each one of these standards was designed so that when an individual, whether you're Native or non-Native, working with a Native American, a Native family, or a Native community, have a basic understanding of the things that we put together here, which will help you to sometimes interpret and understand behaviors and different things that you may see within an individual that may come from their culture completely. So the more that you understand about another person's culture, the stronger the rapport and relationship you can build with them, and the stronger the relationship is with any individual, that always leads to better outcomes and longer-term outcomes. Next slide, please. This slide is all of the standards that we had put together. Last time, for those of you who were here last time, I had spoke about we originally created 11 standards, cultural standards of care. We then rolled those into nine cultural standards of care. There are a couple of these that were actually placed into others. But what we have here and what we'll go through with the review are the standards as they were originally written by myself and my team. And keep in mind that within the health care profession and the medical profession across this country, there are standards of care for health care providers. Every clinic, every hospital, every practitioner, medical practitioner abides by these standards of care. We wanted to create something that was culturally relevant that people could adhere to and understand. And again, I'm going to use the term basic understanding because we're not talking about people being completely fluent in Native culture because that could take years, but at least have a basic understanding of how each of these standards works, what it means, how it may apply to your practice. So this is where as we go through each of these standards and we'll look at them three at a time here over the next few slides, if you have questions about any of them, please put that in the chat and we can stop the discussion or my presentation so we can address those questions. Because today's training is all about application of these. So for those of you who were here last time, this is your opportunity to ask more in-depth questions around any one of the standards. I will try to answer those as best I can, or if I can, and keep in mind as a consultant as well, if I don't have the answer or know the answer, I will look for the answer. Next slide, please. So again, this is a repeat of what you saw in that last slide. It's just the first three and the first standard, and these are in no particular order other than this is how I had developed them and brought them forward to the team. And then we defined them a little bit more throughout over time. So the first one is a basic understanding of historical trauma, intergenerational trauma, and how it's impacted native populations and individuals when working within Western systems of care. We're talking about mistrust, hostility, and avoidance. So a professional body, a person working in Indian country should hopefully have some trauma-informed training in their background and understand trauma and how trauma impacts individuals, how it impacts people, but what historical trauma is as well, where it impacts an entire group of people, and how generational trauma is a per individual taking that trauma that they've experienced and how it influences the next generation and so forth. So here we are generations beyond a lot of these different incidents that have happened to our people over time across this continent, and yet we still have generations still coming forth who are impacted by this trauma and how that works and what that means. And the mistrust and hostility and avoidance that we have in the parentheses really is when you start looking at trauma, these are some natural byproducts of trauma. Mistrust, for instance, when you are abused, say, by somebody that you know, that you trust, a caregiver, a parent, a guardian, whatever that might look like, when you can't trust the individual who as a child that you feel is there to protect you and raise you, who can you trust? So mistrust is a natural byproduct of things like trauma and hostility as well. Because we know that trauma itself and people's reactions, especially when trauma is triggered, become more hostile. So for providers, it's really important to understand that when you're working with a native individual and they seem standoffish, if they don't seem to engage, if they seem to, you know, these things very well may be a byproduct of that generational trauma. We can't say definitively that it is or it isn't, but if you're trauma-informed, you know that understanding human behavior is about assuming that everyone that you encounter, even coworkers, has some form of trauma in their background. And because of that, we try to interact with individuals from that place. So when working with Native Americans, it can be, and it's okay to move forward in that relationship, assuming that there's some trauma there, whether it's individual, because there most likely is, generational, because it definitely is there, and historical trauma and where these things come from. So it's gonna be very important for providers to understand that when working with Native populations. The second standard there is a basic understanding of life in urban areas and life on the reservations, you know, how discrimination, poverty, and limited healthcare access and different resources. So on the reservations, when you're working in Indian country, there are limited healthcare access. There, I think all of the reservations here in Montana now, they all have clinics, behavioral health, and medical clinics, but what they don't have is the ability to meet all medical or behavioral health needs. So there are still limitations, even on the reservations, whereas in the urban areas, there's more access, especially here in Billings. In Billings, we are a medical corridor. We have three hospitals here in Billings and multiple medical facilities, as well as our own urban Indian organization. So urban areas, there's more access to some of these things that are needed in the way of healthcare and behavioral health. But the limitation in the urban areas is access to cultural practices, cultural things. You know, we have powwows here in Billings and a lot of the urban areas will have powwows the college puts on. Both of the colleges here put on powwows throughout the year and try to do some cultural events, but you're not tied in directly to your community in a cultural way on a daily basis as you can be on the reservation. So there are limitations on both sides of that when it comes to life in both urban areas and on the reservations. And I think it goes without saying, but I will say it, and in the urban areas, native peoples are exposed to discrimination and racism on a regular basis, whereas on the reservations, you don't encounter that nearly as much because on the reservation, the population is primarily natives of that nation. So having a basic understanding that when you're working with natives, especially in urban areas, that they've had a lifetime of discrimination and racism that they've had to deal with, which also adds to the trauma that they've already experienced in their life because racism itself is what I refer to as a healthcare issue throughout this country because it creates what we call complex trauma. And it's an ongoing type of trauma because it can happen at any time and on any given day. The third slide on here, our third cultural standard on here is understanding how mental health disorders are perceived within Native American cultures. Traditional beliefs, for instance, we talk about the spirit realm and everything has a spirit to it. And this is where I've worked with Native Americans who have truly felt that the voices that they hear in their heads, the auditory and visual hallucinations that they experience are interactions with the spirit realm. So sometimes when you have a traditional thinking and traditional practicing individual, they may come from that place when they hear these voices. And I talked about this last time and I wanna just tell this story again. I was doing clinical supervision with an individual who works for a Department of Corrections facility and they had an individual came in, woman who came in, she was Cree as well. And she came in and she had auditory hallucination. Now, because she was with the DOC, the DOC, if you're familiar with how the Department of Corrections works, they wanted her on medications to limit psychotic features. And in the DOC, they can do that. In a regular community, if a person doesn't want to medicate, that is their choice. What we try to do as clinician is encourage them to try medications, to try to manage their mental health conditions and symptoms and that type of thing. But if a person doesn't wanna medicate, they don't have to. But in the DOC, this person was going to be placed on medications. But before we went there, I asked the person that I was supervising, tell me a little bit more about this. One, was this person suicidal? The answer was no. Was this person homicidal? The answer was no. I said, tell me about the voices. Well, the voices themselves, and if you're familiar with people with auditory hallucination and psychosis, a lot of times those voices are very defaming. They're very detrimental to the individual because they can actually be putting them down. They're not good for their self-esteem and things like that. But in this particular case, the client reports that the voices were actually helpful. They were supportive. They almost were in many ways cheerleading and saying that, you know, she's gonna be okay. She can do this. She can get through this. And she truly believed that this was the voice of her ancestors or voices from the spirit realm encouraging her. So then I asked the question, are these voices disruptive to her programming? Do they get in the way of her treatment and her care? And the answer was no. So with all of this said, my recommendation was to go back to the team and let the team know that I think in this case, we can allow this individual to continue the way that they are because they did not want to medicate to see if they can engage through this cultural understanding and engage and continue to have success in their treatment. My supervisee did go back to the team, let them know that the conversation that we discussed and the team agreed that, okay, we can allow this for now. The other part of that was, you know, to continuously monitor to be sure that none of these things became detrimental to the individual's progress. So this individual was allowed to continue the way that they were and continue to have these auditory hallucinations and talk about them openly within the individual sessions. So I think it's important to also say here, you know, that was a very successful way of bringing culture into this person's treatment in a way that was not detrimental or disruptive. That's not always the case. Sometimes the case is that these are voices that may be detrimental, they may be disruptive. And so a person has to kind of apply, obviously through your clinical understanding, what the best need is for this individual. So again, encouraging a person to medicate these types of symptoms might be the best approach forward. So really assess that. I think the one thing we need to understand is whether an individual feels that this is coming from their culture, these are the voices of ancestors or some other spirit within the spirit realm, whether or not you yourself adhere to that belief system or practice in that way in your own life. You know, maybe you're non-native and this isn't something that is familiar to you. Just always understand this, when it comes to a person's delusion or hallucination, this is their reality and we have to help them with their reality. And so if this is their reality, this is part of their cultural practice, then we want to honor that and work with that as long as we're working towards healthy outcomes and healthy goals. I've also had other individuals and I'm currently working with one individual who also has voices from time to time. And she also believes that these voices are from her ancestors, but not her direct relatives in the way of blood relations, but ancestors in the way of medicine people from her tribe. So we're working with that. And right now they're not disruptive as well. So we will continue to move forward with her allowing these voices because she feels that she is honored by having her ancestors speak to her in this way. And once again, they're very positive and affirming in the way that they, with the message that they delivered to her. Next slide, please. These standards are basic understanding of the process of addiction and substance use amongst Native Americans and the impact it has on individuals, families, and communities. We know that substance use is a community and a family disease. It's not an individual's disease. And because of that, we have to take a look at how the substance use when we're working with an individual in treatment, how their substance use has impacted not only them, but everything around them. So if we go back to the model of the medicine wheel, what I've done with the medicine wheel is I developed a training around the four areas within the medicine wheel that relate to the four relationships. The four relationships are a teaching that within our culture of the relationships of all of creation, one of the areas is relationship with self. Another area is the relationship that we have with our inner circle, our friends and our family, those closest to us, those we are emotionally attached to. One of the third areas is relationship with our community. Going again, back to Blackstock's model and what I had talked about with community as we are a social people, we are communal people. So a relationship that we have with our communities. And then the fourth area within that medicine wheel would reference all of creation, everything else that doesn't fall into the first three relationships. And these are the relationships within a person's understanding and world. What happens within substance use is when a person starts using substances, they begin to compromise the value systems that they have within themselves. How I teach this to substance use clients is that we're all taught values within our own culture, within our own families, within our own societies. And one very common value that we're given as children is to never use drugs and alcohol. And somewhere along the line in the schooling, and I remember for myself, this was in sixth grade when we had health class and my good friend, Billy, we were both native and we remember saying to each other, we'll never use drugs and alcohol because that was the teaching of the health class was to not use them, how unhealthy they are and their path that can take you down. And we knew this firsthand because both of our families were steeped in alcoholism and even drug addiction. And we saw it firsthand what it could do to people. So we made a pact, never use drugs and alcohol. And that was sixth grade, that was 11 years old. Fast forward then about five years and each one of us starts drinking around age 15 or so, having our first drink, starting to party with friends, things like that. What we've done is we've compromised a value. We compromised a value that we had given to ourselves and in compromising that value, we begin to move ourselves out of the center of our circle because we start to disrupt that relationship we have with ourselves. Very harmless in the beginning, but it is truly a compromise of value. So that begins to impact us. As that substance use continues, maybe the drinking becomes heavier or more frequent. We see where it begins to impact our families. Maybe our guardians or our parents or our grandparents begin to worry about us because we're partying more and more. So it begins to impact that relationship as well. We move further away from the center of that circle. And at some point, it begins to disrupt the things and choices that we make. Maybe we become, maybe we start drinking and driving later in life or we start skipping school or we start maybe even worse yet, criminal activities. You can see where now it begins to impact our communities and how we were once engaged within our community. And now we're becoming, lack of a better term, antisocial in our behaviors. And it takes us away from all of creation in the sense that those things that keep us grounded and adhere to who we are as human beings, our cultural practices, our ceremonies, our ways of being. Maybe it's hunting and fishing. Maybe it's outdoors. Maybe it's just being close to nature and mother earth. And we start to drift further and further away from that as the substance use gets more and more of a hold on us. And you can see where it takes us away from our four relationships. And this all happens well before addiction. These things happen well before what we would call a diagnosable disorder. By the time we have the diagnosable disorder, we've probably moved well outside of, if not to this extreme edges of our circle all of creation and as the substance use disorder continues beyond that into the what we refer to as those stages of addiction early middle and late or chronic stages of addiction we are well outside the circle of creation at that point because the addiction has completely taken over and we know this from working with our clients because they become someone they're not someone they weren't born to be. I'll take it from here and I'll say that now we want to have that intervention the intervention for the individual is usually a legal intervention of some sort cps child protective services maybe it's a doc those types of things very few people truly are self-referred into treatment and because of that there's usually some form of intervention the intervention is the opportunity for the person to find their way back to the center of the circle and that is what we call recovery if they don't find that there's only one outcome for a person who continues in their substance use and that's death we know that substance use is a terminal disease so that is what will find them at the end of that journey the opportunity to return to the center of the circle is is helping this individual find those four relationships back in their life again how do they how do they heal those relationships as they move back to the center of the circle finding who they are and helping them them heal themselves the shame the guilt you know all the desperation and hopelessness that they have helping them to make amends to the family and the loved ones that they've hurt along the way and try to to heal those relationships try to give back to their communities in some way and begin to become what we say quote unquote a productive member of society and help them to re-engage in their ceremony and their and their culture in creation itself getting back into nature getting back into to all those things that that bring them back to the center of the circle so that's that model that basic understanding of of the substance use or addiction process and the recovery process as well through this Native American cultural perspective um al yes can I ask a question um yes you can actually answered it I think it's fascinating when you're talking about how values get compromised um and I was going to ask you to speak which you just did but I'm just making the point um how do you re-engage those values how do you how do you use values native values uh to help someone who's in the substance use world back on the the right path and I think you answered that by talking about helping them make amends uh more than just the conventional substance use treatment work but really helping them get back in their community can you say just a little bit more about that how yes values yeah absolutely and those values are actually in one of our other standards but you know so we'll skip that when we get to it but some of those values are those things that are traditionally taught to our children remember that our children historically and even today are raised within the family context it takes a village and traditionally that is the undertaking of an entire family unit in the raising of children you know aunties and uncles become surrogate mothers and fathers you know our families are that close and they are that entwined so these values that are taught are things like honesty you know humility and uh the different values love and all cultures want to teach these things to their children but in our native context they have so much value to them honesty for instance if somebody becomes dishonest within our communities they will forever be known as a dishonest person it's hard work to win back the trust of having compromised your honesty and we're not just talking about the words you use but the actions you take we're talking about integrity now so trying to help our clients to to re-establish honesty and integrity in their actions while trying to re-engage with their families you know things like humility and humility before all of creation and the creator himself you know those types of things and always having that that sense of self within the circle so helping people to heal and understand our cultural values and how they they can be brought back into their circle they can bring themselves back into the circle through those values but they have to begin practicing those things and we see this in in uh what i would call western models of treatment you know we help people 12 steps kind of follows this model in a sense as well so you can see within the 12 steps how those values and things are to help a person move back into healing relationships you know so so i think they're very strong models and those values are a huge part of re-establishing who we are as human beings and learning to love ourselves because we know that we are being honest and who we are so thank you for that question thank you uh the next one is basic understanding of how native american spirituality religion prayer and identity impact individuals seeking health services and healing and the role it plays what we're talking about here is that holistic approach and and i'm seeing so much more of this these days and an emphasis on the holistic approach you know even within our medical professions uh using people like uh our elders our culture keepers and our especially our spiritual healers um so actually having more of a hybrid approach to using uh traditional medicines along with western medicines and having medical providers who are more open to allowing that practice in while they are serving their patients so not necessarily the doctors doing this but allowing a co-doctoring happen with somebody who who is uh seen as a medicine or healer within their own communities so working together to heal a person not just physically that would be the medical doctor but spiritually and and culturally as well so it's having these basic understanding of how our spirituality is very important to us as human beings and our religion and our prayer and how that is a huge part of our healing and successful outcomes when dealing with behavioral health or even medical health so seeing seeing and hopefully seeing more in the future of how these holistic and integrated approaches to to healing are being practiced in in different areas of uh medical and behavioral health the next standard is understanding of how native american populations view and treat elders in the roles they play as healers culture keepers and council so this has to do a lot with protocols but when working with native uh individuals or native families understanding the the way that we view our elders is completely different than western culture views their elderly as well you know we hold our elders in such high regard because they are they are our culture keepers they're at the top of that that tp model if you will of cultural perpetuity this is where our wisdom comes from this is where our teachings come from and giving them that that level of respect that's very important for uh folks who don't understand that to have that basic knowledge because when you go into a family you need to honor you need to have respect for our elders and others within our communities to that regard or you may insult somebody insulting people especially if you're not from the area in indian country is a huge no-no because if you're a provider who insults somebody not only that individual but that individual's family that individual's community is going to know that you are somebody who insults and if you are known as somebody who insults these people are going to be less likely to come to you for services or come back to you for services and if that happens then we know that we're going to have negative outcomes whether it's behavioral or medical health we will have negative impact from that individual so having a basic understanding of of that how we treat our elders and and those um the knowledge that they keep and how it's held in such high regard is very important in indian country next slide please having a basic understanding of how matriarchal societies view women within their families this kind of goes back to what i was talking about with the elders as well but understanding our matriarchal values as native people you know the women in our society are at the center of our circle our family circles we have a matriarch or matriarchs within every family unit within within every community both historically and currently in some cases we have matriarchal families i myself have a matriarchal relationship with my wife and what these are is not that women rule in these types of societies but actually we share power we share balance there's balance there like there is within the natural world and these things have to be seen in such a way if you are a male medical provider for instance or even behavioral health provider for some nations and some of the the culture that's out there a woman may not be allowed to be alone or even seen especially in the medical field for women's issues and because of that that being compromised once again you have a situation where that individual may not come back to you for a follow-up session or for medical uh medical treatment which could lead to very negative outcomes for that individual so having an understanding of a matriarchal society the way that we view our women and hold them in very high regard um you know in the larger training that i do which is a four or five hour training going through all of these standards and native culture i talk in depth about what that really means but just having that understanding that as a matriarchal society typically you want to talk to and and be dealing with the matriarch within a family unit i said that i have a matriarchal relationship with my wife we will both go to something like a student a parent teacher conference and we have had teachers who will refer to me or talk to me as the man of the house and these are typically non-native teachers and i simply politely direct them towards speak to my wife you know i'm here in support we will have discussions my wife and i around any decisions being made but ultimately i will follow her lead because i honor her in that way and and give her that that level of uh support and also that level of uh authority if you will it's not really an authority but really you know kind of using western terms i guess she has the say within these final decisions even though we may have a discussion and there's a good reason for that we as men are are more pragmatic we're solution solution seekers and oftentimes we act out of wanting to solve something which may not be the best move forward because we want to do that immediately get things done where women are more practical and have more wisdom and will actually think things through my wife has kept me out of more trouble than i can count let me just say that okay so understanding that matriarchal society and how that works is very important uh understanding of the extended family structure and hierarchy of native families i talked about this earlier but this has to do with that communal practice you know we call it extended families if we want but we we have these families that are very closely tied my cousins even second cousins lack of better terms there these are all brothers and sisters to me they're like siblings we are that close as a native family and because of that that needs to be understood when working with a native family if i if i have a cousin which i had just recently uh pass away i've lost a sibling and that's very important to me in a lot of western society if you look at things and within companies like bereavement in most western uh communities and western companies if you have a a family member pass and they're a cousin you're not going to get bereavement for that in most situations and in most companies but in indian country we look at well beyond just that when my cousin recently passed that was the loss of a brother is what just recently happened to me so it's very important to understand the closeness and structure within native families having a basic understanding of sharing and prosperity for all is the next standard this has to do with our communal traditional communal living uh as a social people prosperity for one is prosperity for for all so when one person struggles an entire community struggles so we try to hold each other up we try to lift each other up we try to be there for each other this is very important to understand especially in behavioral health because when we see this in behavioral health from a western lens oftentimes we may call this codependency and that's something we really have to watch in indian country because and i've had examples of this uh not too long ago one of the recovery courts that i work on did not allow an individual native individual to bring his brother into the home why because his brother was also a felon and he was not doing well in his recovery he had frequent relapses things like that so not a very healthy individual we know that that puts an individual at risk who's in recovery we know that but in the cultural sense by telling him he couldn't have his brother live with him because his brother was homeless what he simply did was went underground with it what that means is he allowed his brother to live with him and didn't tell anyone until he had gotten caught now we have a whole new issue to deal with because now we have somebody who is non-compliant uh with their programming and with what they've been told by the courts and now we have to deal with that issue as well whereas if we approach this from a cultural standpoint we have to find a way a compromise if you will or a middle ground to how do we help him help his brother without compromising his own recovery and his own programming through the recovery court that would be a cultural approach to this situation and i was not asked to consult on this individual's situation until he was already his brother was already caught at his place at that point i did have the discussion around how do we work with this and and we came up with a few different plans to do this because once again you're going to see this with what we call again codependency but when we have family members who are homeless when you live couch surf with your family in indian country you are not homeless within that cultural context from a western perspective a person who couch surfs is homeless so you can see the conflict that happens there within the two cultural understandings so working with that that understanding and that prosperity for all that we will take care of one another we will try to hold each other and lift each other up even when it means putting ourselves at risk so that that's really important to understand when working with native populations rather than push against it no you can't do that let's work with that and see how can we make this work so that we can keep this individual engaged in the healing path that they're on our next one is a next slide please sorry the next one is understanding native american values and how respect so we talked about this early respect discipline compassion trust honesty and there's so many more uh we had actually with this uh reached out to a couple of the different tribes here in montana and asked the elders within the tribes to give us a list of some of those values from their own traditional teachings and these are the things that they came up with and they were pretty much universal across the board and that's why i often say that you know these sound these things sound familiar to anyone in just about any culture but how we approach them within our native upbringing is really important to understand because respect we give respect a lot of the clients we work with especially those who come from the streets if you will and and gangs and things like that oftentimes they'll tell you i don't give respect unless i get respect but within our native culture we are taught to respect in our native culture we are taught that all life is sacred and therefore we respect all life so we are taught to give that respect in return we often get that respect and i try to teach clients all the time that giving respect doesn't mean that you have to be walked over sometimes you give that respect because it's the right thing to do and a person can be disrespectful back to you well at that point then walk away from that relationship or that situation you don't have to stay engaged with a disrespectful person if it doesn't work for you but giving the respect is what the teaching is and always having that respect for all things and all people the next one is understanding of the importance that the land mother earth holds for indigenous peoples you know the spiritual we we kind of talked about that at the beginning when we talked about honoring the land you know we do not look at our mother the earth as property as something that we own it's something that we live on our ancestors walked these lands i'm from montana i live in billings i'm a little bit south about 200 miles south of where i grew up but for me i'll never leave montana i did for a while in the military but i can never leave here because this is where my ancestors were and it's very important to me to be a part of that to be a part of where they once walked so we honor the land in that regard i'm in billings montana this is referred to as crow country and i honor the place that i live uh in that way and and uh in that i'll i'll say it this way when i pray in our cree way and in in ending a prayer in cree we say hi hi which means thank you uh in the crow the absolute away they say aho so in my way of honoring here when i do a cree prayer when i say a cree prayer i will say aho in honor of crow country and and the ancestors who walked this area so that's just one example of of how we we view our mother the earth and the land that we we walk on we are stewards of the land and if you're familiar with the term seven generations you understand what that means what i do to the land today will have impact for the next seven generations so if i take care of the land it will continue to be taken care of for my children my grandchildren and great-grandchildren and so forth so it's very important to us to understand because most reservations not all but most reservations have been dwindled down over time but they still are mostly on traditional lands of the people who live there so the land the reservation land is very important to the individuals who live there in this ancestral way next slide please so i went through those rather quickly and gave some examples it looks like we're doing pretty well for time are there questions about any of those if you can remember them because i went through them quickly but any questions or examples that you may have around some of that those different standards for your own practice for your own knowledge we'll wait a second to see if anyone in the audience has a question or a comment and then if not i have a question but i'm going to wait to see what the audience says yeah and feel free to come off mute and just ask your question Hello, this is Stacy Hilde. I have a question. So I've had kind of a new perspective when we are talking about the cultural family connection. We have recently opened a tribal healing center here in the St. Croix tribal community. And there have been several instances where family members might be attending treatment at the same time. And in Western society, that would be an absolute hard line, no. Can you describe how that might benefit our Native people? Well, in small communities, I think it's probably one of the best ways to explain it. Because we're talking about conflicts of interest, for one. And we do know that if somebody is in treatment with another family member, there can be barriers to disclosure. Somebody not wanting to talk about certain things within those settings, for fear of a family member will hear this and they didn't want them to hear this. And that would go into the shame and guilt complexes as well. But in small communities, everybody knows everybody. In Indian country, I'm going to go so far as to say everybody knows everybody. I meet people all the time and I may not know them directly, but I know of their families or we know of other people within families. So you're going to get this regardless when you're working with Natives. If you have a complete Native group, they may not know each other, but they know somebody who knows somebody. And because of that, you know, so what really needs to happen there is adherence to disclosure and confidentiality, talking to the individuals in individual sessions to see if there's issues there with them being near a relative, you know, in a group setting. Because if they have issues there and they have reservations there about disclosing and feel it would be some kind of hindrance, then we need to take steps to separate them. I think a common practice would be, and it's almost a policy within our ethics anyways, is to not put them together in a group. But sometimes you have no choice. So I think those steps need to be taken to be sure that both people feel safe within that environment to walk their own journey. If they feel that they can't, then we have to take steps to protect them. But I will say this, when you start getting deeper into recovery, and by that I mean further along and people are making strides and changing, you know, and becoming healthier, usually what you end up seeing with a person who's in recovery, especially over time, is that they begin to look at the things they used to do in a way that is positive. Not that the things they did were positive, but what they've learned from that is positive. So you hear things like, you know, if it weren't for the things I've done, I wouldn't be the person I am today. And that honesty, as they say within the program of AA and NA, honesty in all of our affairs, the more that that person can become honest with themselves and with others, the more healing happens and the more integrity and trust and those types of things that are rebuilt. But early recovery when a person's in treatment is hard for them to grasp those concepts early on. So again, it comes back around to really having that discussion with the individuals to be sure that it's not going to be some kind of compromise for their treatment. I hope that that's helpful. I see that Claudia had a question too. And what is that question? Hello. Yeah, it's actually Lisa. I'm sorry. I'm under my boss's name, but I just want to say thank you to you, Al. You really hit on some good points. And I just wanted to say in our language, we say Eeya'ahun, which is Kumeyaay. And then I also work for Apollo tribe and they say Eechom. But also I just wanted to share with you, because we're California natives, we always get recognized as out-of-state natives and we are a little bit different. We do bird singing and we bird with the gourds and dance as well. And we have gatherings. And then a lot of our therapy is like playing traditional games as well. But we are in the works of building a wellness center. So we will offer all culture aspects, which is the sweat lodge. Even though it's not California based, we do want to honor those that come down. And some people still believe that you get purified through certain ways. And yeah, so that's part of our therapy. Like I said, we play traditional Indian games and we really just try to work on self-identity. And I think, Al, you pointed out all of that. And I just really want to say thank you. And that's all I have. Thank you. Thank you so much for that. I appreciate that. And you bring up a very good point because most of the cultural teachings around the standards that I do come from the Plains tribes and the Plains understanding. We as Cree, I'm Plains Cree. We have different factions of Cree. We have Plains Cree, Woodland Cree, Eastern Cree, Swampy Cree. And because of that, each of these teachings would be just a little bit different within these nations as well. So a lot of the things that I talk about, like the sweat lodge, for instance, and the sweat lodge is about purification. And I think that goes back to the discussion in the standard around matriarchal societies. Women are naturally purified every month through their moon time. And so because of that, they have more spiritual power than we do as men. We men are purified at birth when we are born, but then have to seek the sauna or the sweat in order to pure ourselves before ceremony or before these different things. So honoring that for those who practice in that way, I think is very important. And the games themselves, you know, people steeping themselves or jumping into their culture, even when they weren't raised that way, can be very healing. Because when we are Native people, whether we are traditional or non-traditional, and it is a spectrum. You know, there are no Natives who are fully traditional anymore. You know, I challenge you to find a Native who doesn't get their groceries at a grocery store or drive a vehicle, you know, to get from point A to point B. So we are all acculturated and assimilated in some way. And then we also have those who are very non-traditional who were maybe removed generations ago through things like 1935, the Indian Removal Act, when their families were taken off to reservations and placed into the inner cities. And some of them have lived there for years. Some have moved back to the reservations, but some have still lived there and they aren't as connected to their traditional cultural practices and ceremonies and those types of things. But yet they still know that they are Native and engaging in some Native cultural practices, whether they're their own or they're introduced to them, you know, which is a part of natural assimilation and acculturation anyways. It can be a positive thing, you know, if it's not forced. And that can be very healing for people and help them to engage in whatever that is, whether it's medical, behavioral health and those types of things. So thank you for that. Thank you. And can you drop your email in the chat as well? Yes, we can do it. Can somebody do that for me? Well, I guess I could do it. No, they can do it. It's on the screen. We want to keep your focus on your great expertise. So I have a general question. Let me just see if anyone else has a comment or a question before. Anyone else? Norm, do you see anyone else that has a comment or question? Yeah, not seeing anyone. I think you're safe. Okay. Well, I'm just thinking about, you know, there are so many TOR grantees all across the country, right, all across Indian country, urban, rural, reservation. And the reason that they pursued a TOR tribal opiate response grant is because they're concerned something's going on in their community and they're concerned. And I was thinking about what you were talking about, again, back to values. That all Native people were raised with very clear values, almost always, and something happens in the course of their lifetime and they start moving away from that, but they don't forget their values. They still remember them. I'm just thinking in a lot of the communities that I've visited, and even in my own community, there's always at least one person, sometimes more than one, who have, living in the addiction world, they've made a lot of mistakes and they get somewhat ostracized in the community. And they're kind of pushed away. They're still living in the community, but they're pushed away. They're deep into addiction. And I'm just wondering, in that case for the TOR grantees, if there are people like that in your community, what steps would you suggest that they take to try to bring them back? I think that, one, I think it starts with the community. Again, it takes a village. And I think it takes a village to help people heal. You know, we have to have that compassion. And that's one of our traditional values is to have compassion. You know, one of the things I was raised with was compassion. And that's why I can work with somebody with any disorder. And I do mean any. I've worked with sexual offenders and things like that, because I don't look at what the individual has done, but who the individual is. And work with that individual to help them find who they are and bring them back to the center of the circle, so help them to heal. And I think that's what we need to do as communities, is to not ostracize these people, but understand that through historical trauma, historical trauma and trauma itself, and all the disparities that come from trauma, things like community, things like poverty. There are a lot of other factors in that, but things like poverty and lack of access to opportunities, but individual things like low self-esteem and low self-confidence. You know, when you look at historical trauma and how the roles of men and women were taken from them over time and left them with not knowing who they are. How we have the boarding schools, which took children out of their teaching because we are taught from birth until adulthood to nurture and strengthen our gifts to give back to our communities. We are taught to nurture, men are taught to nurture by the women in their community, their aunties and their mothers, because we as men need to learn that. It doesn't come naturally to us, and we're taken out of that and placed in a boarding school and we never get that. How do we become a loving father when we were never loved ourselves in that way? And mothers being raised by their aunties and how to raise their children in a traditional way or taking output in boarding schools and then placed back in those situations. So the historical trauma has had so much impact, and we know about the disparities like mental health, substance use, domestic violence, sexual violence, violence itself, that come from people who have traumas. And these things are within our communities. And because of the acculturation and the assimilation that Western thinking that so many of our people have, because again, we sit on the spectrum, it's easy for us to point fingers and to judge without compassion. So we need to bring compassion back to our communities in a traditional way. And I think the community needs to be taught that so that the community doesn't ostracize folks, but actually embraces them in the healing process. That's great. Thank you. Thank you, Al. I remember once I was in a community and it was a meeting like some kind of the people who program people were all meeting and outside of the meeting room, there was a native man that was very, you know, pretty scruffy, I guess. And, you know, really was one of these kind of ostracized people. But the programs people, people walked in and kind of walked past him. And then in the beginning of the meeting, they had food, some snacks and stuff in there. Somebody went outside and got him and brought him in and he ate and he drank coffee. And then during the course of the meeting, they gave him a marker and a whiteboard and he became a note taker and drawing as part of the meeting. And it was just a really wonderful visual of bringing in someone who is ostracized, like a tour grant program people in a sense brought in someone who had been somewhat ostracized. And instead of being afraid of that person, they brought him in and then his natural talent came out. And so thank you for sharing that, Al, your perspective. Thank you. I love that story. That's wonderful. And I see Scott put in the chat, really interesting comment. We need to never forget the medical field and providers that have prescribed this medical management that we lost a lot of people through addiction, through opiates. Bringing about change must include the truth as well as change towards our healthy ways. Thank you, Scott. And Al, you also did it. I just love what you said about and your support of. I mean, you're Native centric, of course, you know, everything you're your perspective is Native centric, but you're also not kicking to the curb. Western medicine or Western, some Western approaches that might work for Native people. So you absolutely Scott's comment there about. Yeah, yeah, absolutely. I mean, from that I was I was taught about psychology and behavior through Western schools, Western understanding, cognitive behavior. I mean, everything from analytical all the way to, you know, gestalt. I consider myself an existentialist very much when you start to identify things through psychology and behavior. So I'm able to identify and understand that. I wouldn't go so far as to say fluently because I'm always learning, but very astute in the approaches that I have. And again, it goes back to my traditional upbringing of trying to make sense of some of this stuff from this Native kid who didn't quite understand these concepts. And then as I learned these concepts and had better understanding of translating them into in my own head into what made more sense to me. And I found that that what I was doing was taking Western concepts and translating them into a cultural understanding and that worked both directions. And that's where I started to use some of these different approaches to working with individuals across the board, non-Native as well, because it helped them even to understand. We as Native people, and I know for myself, I speak a lot in metaphor and use a lot of analogies, you know, metaphor from the natural world and things like that. But people responded to that, whether they were Native or non-Native, you know, people who are hesitant to act, to take action in their recovery. And I would oftentimes give them the analogy of the lead cow within a herd of elk. And that, you know, that when they move from one migration route to from winter to summer and summer to winter, they'll mill around and they don't really act. And it seems as though they're kind of stuck and stagnant in this place. I said, that's where you are, but you have to be like that lead cow because one day she'll just up and go and the herd will follow. You know, and so using analogies like that to help motivate them to make a decision and move forward in your recovery or move forward in whatever it is you're trying to do. So translating things like that from understanding from Western behaviors and approaches and into something that is more grounded in my understanding. I hope that makes sense. That makes total sense as a Montana Native to use an elk example. Perfect. Visualize it. That's awesome, Al. Thank you. Any other questions or comments from anyone? Anyone from the OTAP office or Norm have any comments or questions or accolade? I guess I would just ask one question, Al, is, you know, obviously a lot of non-tribally focused centers for recovery and are not Native focused, right? So they're more urban areas, if you will. What do you think are the most common misconceptions about cultural standards, you know, that can lead to misunderstandings about how these non-Native focused treatment facilities are treating Native Americans, right? Because I think that they sometimes it feels like they don't really believe that there's a difference in the way that they should be treating this individual. Yeah, that is a great question. It's a very complex question, but I think it comes down to a couple of basic things. And one comes back to compassion. And I think you find that compassion within people who understand trauma and historical trauma. So if you can understand trauma and how you can interact and develop a relationship and a rapport with an individual through that understanding, you're going to, compassion is going to come along. And I think it's that that will help a person to then meet the person where they are instead of where they think they should be. And the other part of that is the spectrum that I talk about. You know, not all Natives were born with traditional values and traditional ways and understand that. But yet we have a misconception. This is where the stereotypes come in because a person is Native, and especially in states like Montana, where we have a heavy Native population, you know, eight reservations, plus all the other nations that come from outside the state and reside here as well. So there's a lot of stereotypes that people just assume that if you're Native American, you sit at one end of the spectrum because you're Native. Or if you come from the reservation, that you sit at one end of the spectrum. And it's not the case. You know, we are individuals as well, and we have generations of acculturation and assimilation, both forced and natural. And because of that, you have to meet people where they are. And I think that's the biggest thing, message I would take forward to any organization is to understand trauma and historical trauma and find that compassion. And also understand that you have to meet individuals where they are regardless. Just like I had said with the mental health piece, you know, we from a Western perspective and Western psychology may understand psychosis from that perspective. But because this person doesn't understand that and comes from a cultural perspective and believe that it's coming from somewhere else, that's their reality. We have to meet them at their reality. If we bring them into our reality and try to meet them there, then it'll never be successful. And I think the same thing goes with the cultural piece. Well, that was terrific, Al, to hear the 11 principles, and thank you again so much. That was just really very thought-provoking, I think, for people, and you can see a lot of thank-yous coming up in the chat as people are having to leave. Yes, thank you, it was an honor, so I appreciate it, thank you. Yeah, and I'm not sure if there is one more slide for a survey. So, as we kind of end this discussion, if you all would be so kind as to fill out the survey, you can just scan the QR code, or there's a link there, to just do a brief survey, just helps us understand kind of a little bit more about how you feel about the work that we're doing here, and how we can better serve you with these types of presentations in the future. And I am going to defer to Bobbi for the date of the next presentation, I just, I can't recall it. Sorry, Norman, you put me on the spot, and I don't have my calendar up, but it is the second, it's the second Wednesday of the month at 2 p.m. Eastern Time, so looking at my calendar here really quickly, that will be February 12th. Well, I think with that, is there another slide, or is this the last slide? Yeah, I think this is it, this, just the survey, I think that that does it for us. Again, thanks everyone for joining us here, and we will see you next month. Good to see everybody, thanks for joining. Bye y'all.

Tribal Opioid Response

cultural standards

Native American communities

Holly Echo-Hawk

Opiate Response Network

Al Falcon

historical trauma

Native spirituality

elders and matriarchal roles

holistic healthcare

community compassion

culturally responsive practices