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S. HRG. 113–527 

PROTECTING OUR CHILDREN’S MENTAL HEALTH: 

PREVENTING AND ADDRESSING CHILDHOOD 

TRAUMA IN INDIAN COUNTRY 

HEARING 

BEFORE THE

COMMITTEE ON INDIAN AFFAIRS 

UNITED STATES SENATE 

ONE HUNDRED THIRTEENTH CONGRESS 

SECOND SESSION 

NOVEMBER 19, 2014 

Printed for the use of the Committee on Indian Affairs 

( 

(II) 

COMMITTEE ON INDIAN AFFAIRS 

JON TESTER, Montana, Chairman 

JOHN BARRASSO, Wyoming, Vice Chairman 

TIM JOHNSON, South Dakota 

MARIA CANTWELL, Washington 

TOM UDALL, New Mexico 

AL FRANKEN, Minnesota 

MARK BEGICH, Alaska 

BRIAN SCHATZ, Hawaii 

HEIDI HEITKAMP, North Dakota 

JOHN MCCAIN, Arizona 

LISA MURKOWSKI, Alaska 

JOHN HOEVEN, North Dakota 

MIKE CRAPO, Idaho 

DEB FISCHER, Nebraska 

MARY J. PAVEL, Majority Staff Director and Chief Counsel 

RHONDA HARJO, Minority Deputy Chief Counsel 

(III) 

C O N T E N T S 

Page 

Hearing held on November 19, 2014 ...................................................................... 1 

Statement of Senator Barrasso ............................................................................... 3 

Statement of Senator Begich .................................................................................. 4 

Statement of Senator Cantwell .............................................................................. 3 

Statement of Senator Franken ............................................................................... 7 

Statement of Senator Heitkamp ............................................................................. 7 

Statement of Senator Murkowski ........................................................................... 6 

Statement of Senator Tester ................................................................................... 1 

WITNESSES

Boerner, Verne ́, President/CEO, Alaska Native Health Board ............................ 28 

Prepared statement .......................................................................................... 30 

Enomoto, Kana, Principal Deputy Administrator, Substance Abuse and Mental Health Services Administration .................................................................... 19 

Prepared statement .......................................................................................... 20 

Listenbee Jr., Hon. Robert L., Administrator, Office of Juvenile Justice and 

Delinquency Prevention, U.S. Department of Justice ....................................... 8 

Prepared statement .......................................................................................... 10 

Roubideaux, Hon. Yvette, MD, MPH, Acting Director, Indian Health Service .. 14 

Prepared statement .......................................................................................... 15 

van den Pol, Rick, Ph.D., Director and Principal Investigator, Institute of 

Educational Research and Service, the University of Montana National 

Native Children’s Trauma Center ...................................................................... 25 

Prepared statement .......................................................................................... 27 

APPENDIX

Forquera, Ralph, Executive Director, Seattle Indian Health Board, prepared 

statement .............................................................................................................. 45 

Keita, Gwendolyn Puryear, Ph.D., Executive Director/Public Interest Directorate, American Psychological Association, prepared statement .................... 49 

Mathur, Rricha, Policy Research Associate/Program Manager, First Focus, 

prepared statement .............................................................................................. 46 

National Indian Child Welfare Association (NICWA), prepared statement ....... 50 

Response to written questions submitted to Verne ́ Boerner by: 

Hon. Mark Begich ............................................................................................. 62 

Hon. Jon Tester ................................................................................................ 60 

Response to written questions submitted by Hon. Jon Tester to Rick van 

den Pol .................................................................................................................. 58 

Written questions submitted to: 

Kana Enomoto .................................................................................................. 63 

Hon. Robert L. Listenbee, Jr. .......................................................................... 64 

Hon. Yvette Roubideaux .................................................................................. 65 

(1) 

PROTECTING OUR CHILDREN’S MENTAL 

HEALTH: PREVENTING AND ADDRESSING 

CHILDHOOD TRAUMA IN INDIAN COUNTRY 

WEDNESDAY, NOVEMBER 19, 2014 

U.S. SENATE, 

COMMITTEE ON INDIAN AFFAIRS, 

Washington, DC. 

The Committee met, pursuant to notice, at 2:30 p.m. in room 

628, Dirksen Senate Office Building, Hon. Jon Tester, 

Chairman of the Committee, presiding. 

OPENING STATEMENT OF HON. JON TESTER, 

U.S. SENATOR FROM MONTANA 

The CHAIRMAN. I will call this hearing of the Senate Indian Affairs Committee to order. 

This will be my last hearing as Chairman, hopefully for the short 

term, but the bottom line is I just want to thank the staffs of both 

the Majority and Minority for the work they have done. 

We would not get a lot done around here if it wasn’t for our 

staffs. I just want to say I appreciate their commitment to Indian 

Country. 

It has been great in my short tenure as Chairman of this Committee to be able to get around and see some of the challenges out 

there. As was pointed out to me when I was first elected to the 

United States Senate, the challenges in Indian Country are many. 

There are so many that it really does take a bipartisan effort to 

get those solved. 

I think this Committee has worked traditionally in a fairly good 

bipartisan way. We have some opportunities during this lame duck 

to get some stuff done for Indian Country and hopefully that will 

happen. Whether it is in the area of health, water, housing, police 

protection or whatever, these are very important issues. 

To get down to the business at hand, I have been able to spend 

some time in Indian Country speaking with tribal leaders, hearing 

from concerned tribal members, and visiting celebrations and ceremonies that keep Indian Country alive and vibrant. 

I must say I have enjoyed the time I spent in those communities. 

The diversity of Indian Country and the value that Indian Country 

places on its children to protect them and helping them to become 

future leaders for their people. 

2 

It is often said that children are our most precious resource. Nowhere is this more visible than in tribal communities I have visited. 

Yet, some disturbing realities persist. Studies show that Native 

children suffer from high rates of trauma, abuse and exposure to 

violence. They grow up in poverty at levels much higher than our 

non-Native counterparts. These children are exposed to a cycle of 

trauma that I think we need to address together to break. 

Earlier this week, the Department of Justice released a report 

entitled Ending Violence So Children Can Thrive, which outlined 

recommendations for addressing children exposed to violence. This 

report represents tireless research and work in the field of preventing childhood trauma and promoting resiliency in early childhood. 

Both are crucial to building strong communities. Both will be 

vital in the future of our Native children. It is precisely reports like 

this with recommendations from tribal people that we need to see. 

However, as we know all too well, it is more than words on paper 

that our children need. We need to turn these recommendations 

into actions, put safeguards in place for our most vulnerable community members. 

There are tremendous studies on brain research, some of which 

we will hear about today, that show us how a child’s brain development, social and emotional development are compromised when 

there are repeated and significant instances of fear, neglect and 

anxiety. 

A 2008 report by the Indian Country Child Trauma Center calculated that Native youth are two-and-a-half times more likely to 

experience trauma when compared to their non-Native peers. This 

is preventable. 

We have the power to ensure our children grow up in safe and 

supportive environments. We have the power to help support 

healthy and appropriate development and make it possible for our 

children to thrive. My hope is that is our focus today. 

We have heard what is wrong. Now we need to hear what we 

need to do to make it right, what we need to do to make it right 

by our children. That should be the most important question we 

ask and that is the question I know hard working folks in Indian 

Country are asking themselves every day. 

I look forward to this hearing from the Administration, education 

and tribal leaders who are here today about how issues of childhood trauma impact their respective agencies and communities and 

what we, as policymakers, can do better to help protect and promote resiliency among our Native children. 

As many of you have noticed, we originally scheduled two panels 

but we have one now because we have a vote a number of votes 

at 3 o’clock. We shortened the time frame to be able to give us a 

few more minutes for questions. 

With that, I would be remiss if I did not recognize the Vice 

Chairman, with whom it has been a pleasure to serve with over the 

past almost a year. With that, you can give your opening statement, Senator Barrasso. 

3 

STATEMENT OF HON. JOHN BARRASSO, 

U.S. SENATOR FROM WYOMING 

Senator BARRASSO. Thank you, Mr. Chairman. 

I just want to say how much I appreciate your leadership. You 

have been committed to Indian issues your entire career in the 

Senate, even more so as Chairman. The Montana tribes have benefitted greatly from your work. 

I want to thank you for your work and ask you all to join me 

in thanking the Chairman as this is his final hearing. 

I also want to tell you that I appreciate you holding this hearing. 

I agree with your very thoughtful comments. 

According to the Indian Health Service, childhood trauma is disproportionately experienced by Indian children. The reasons are 

multi-factorial, related to recurrent abuse, accompanied with high 

incidences of alcohol and drug abuse, suicide, violence and according to substance abuse and mental health services of the Administration, the death of family members can also be a significant cause 

of childhood trauma. 

These factors are particularly acute on the Wind River Reservation in Wyoming. The Indian Health Service has informed this 

Committee that the average age of death on the Wind River Reservation in Wyoming is 49 years of age. 

Alcohol-related injuries have been cited by the Indian Health 

Service as a significant contributing factor for the premature death 

rate. This is a sensitive matter and one that will require active 

participation from multiple disciplines and agencies to address. 

The Attorney General has established an advisory committee to 

his Task Force on American Indian and Alaska Native Children 

Exposed to Violence. The advisory committee was charged with examining this exposure to violence and providing recommendations 

on how to address the issue. 

Yesterday, the advisory committee issued its policy recommendations to the Department of Justice so I look forward to examining 

how those recommendations will address and prevent trauma to Indian children. 

I want to thank the witnesses and look forward to your testimony. 

Thank you, Mr. Chairman. 

The CHAIRMAN. Thank you, Senator Barrasso. 

Are there other opening statements? Senator Cantwell. 

STATEMENT OF HON. MARIA CANTWELL, 

U.S. SENATOR FROM WASHINGTON 

Senator CANTWELL. Thank you, Mr. Chairman. 

I too want to applaud your leadership. As Chairman of this Committee, you have certainly worked to improve economic opportunities, schools and obtain greater access to health care for tribal communities. 

We certainly will look forward to working with you in the new 

Congress in your capacity to continue to work on these issues. 

I certainly come to this hearing with still a heavy heart but am 

very thankful that you are having this hearing. As many know, 

Washington State suffered a devastating tragedy last month at the 

4 

Marysville Pilchuck High School that took the lives of five students, including the shooter. 

Three of those shooting victims were members of the Tulalip 

Tribe of Washington. Across Washington and across tribal communities, we continue to mourn this incredible tragedy. 

We will never know what exactly led to this senseless violence 

but it is a deadly and urgent reminder that we must do more to 

ensure the mental health system can help diagnose and treat 

young people when they need help. 

The Marysville shooting is tragic proof of an alarming statistic. 

According to the Department of Justice, assaults, homicide and suicide account for 75 percent of the deaths of American Indians and 

Alaska Natives between the age of 12 and 20. This is unacceptable. 

A robust mental health infrastructure is one key piece necessary 

to prevent these tragedies in the future. To that end, I would like 

to hear from the panelists how we can better integrate mental 

health and primary care services to make sure young people are 

not just turned away when they seek care. 

The State of Washington is revamping its Medicaid delivery system to merge behavioral health and primary health care services 

by 2020. I would like to know what the Indian Health Service is 

working on to also integrate those kinds of behavioral health and 

primary care. 

Unfortunately, data on the issues of psychiatric services available in Indian Country and data on the shortage are not widely 

available but a recent survey from Indian Health Services found 

there were only 950 psychiatric beds to serve all tribal communities 

across the United States of America. 

We have to do better, Mr. Chairman. Thank you so much for this 

important hearing. 

The CHAIRMAN. Are there other opening statements? Senator 

Begich? 

STATEMENT OF HON. MARK BEGICH, 

U.S. SENATOR FROM ALASKA 

Senator BEGICH. Mr. Chairman, I want to thank you for having 

this important hearing. 

To Verne ́, thank you for being here all the way from Alaska. We 

appreciate it. Hopefully we will hear some positive and encouraging 

testimony on what we can do better. 

Mr. Chairman, this is going to be my last meeting also in a different way. I just want to say thank you and also to Senator Akaka 

who was here originally when I came and Senator Cantwell who 

chaired this Committee. 

We did a lot of work on Alaska issues, the Nation’s First People 

issues and spent a lot of time in this Committee talking about the 

importance of a variety of issues that are important, not only to 

Alaska, but really across the country. It has been an honor to be 

here. 

As mentioned, the Attorney General’s Advisory Committee on 

American Indian and Alaska Native Children Exposed to Violence, 

that important report has now been released. It has incredible information for us, including the work by Val Davidson, Bethel and 

5 

many others who have spent the time to help us understand what 

more we can do. 

Mr. Chairman, I want to thank you for helping to move forward 

one piece of legislation, our Safe Families and Villages Act, something I worked on for the last six years. We were trying to get 

unanimous consent. I understand on the Democratic side there is 

not a problem but on the Republican side, there is. 

We have redrafted and hopefully the Republicans will look at 

this. We have streamlined it and hope to again hotline a different 

version tonight that streamlines it and resolves the concerns that 

the Republicans have on this issue. 

It is an important piece. When we passed VAWA, Alaska Native 

people were left out. All we want to do is fix it for Alaska Native 

people. That is all. 

Half the tribes of the Nation are from Alaska, not by population 

but by tribes. It just seems fair that we want to fix it for all first 

people of this country, not just the lower 48. 

Even though I would prefer a more robust Safe Families and Villages Act, we have streamlined it and cleaned it up to meet, I believe, the minority’s objections. Hopefully they will see it tonight 

and agree to hotline it as it is an important piece for Alaska. 

Let me also say, Mr. Chairman, the work that is still ahead of 

this Committee I will not be a part of obviously, but it is enormous. 

The first people of this country, from Alaska Natives to the first 

people of the lower 48 and Hawaiian Natives are important. Many 

times they are forgotten in the issues with which we deal with. 

Sometimes we pass great legislation and then forget there are 

also the first people who are touched by what we do. I would encourage this body as they move forward that not only is it important to discuss these issues here in this Committee, but as we talk 

on the floor of the Senate and other committees we sit on, that we 

discuss the importance of the first people of this country. 

Again, I am hopeful that the one remaining piece I think would 

create equity for Alaska Native people will hopefully be resolved tonight. We will see. 

I want to thank the Chairman and lastly, all the staff. The staff 

does incredible work for us. Sometimes we get to say all kinds of 

stuff in this forum but at the end of the day, it is the people who 

sit on the walls behind us that do an enormous amount of work 

and make sure the issues we care about are brought to the forefront and also help us make sure we get bipartisan support to get 

things done. 

Mr. Chairman, I want to thank you for the opportunity and past 

chairmen who have been here and given me the chance to talk 

about Alaska issues. 

Thank you. 

The CHAIRMAN. Senator Begich, I would just say you and I serve 

on a lot of the same committees in the United States Senate. I just 

want to thank you for all your work and dedication, especially to 

Indian Country. Bringing the Alaska perspective has been critically 

important as we look to serve all our Native American challenges. 

Are there other opening statements? Senator Murkowski. 

6 

STATEMENT OF HON. LISA MURKOWSKI, 

U.S. SENATOR FROM ALASKA 

Senator MURKOWSKI. Thank you, Mr. Chairman. 

I apologize that I was not able to hear not only the other statements from colleagues but particularly that of my colleague from 

Alaska. 

I want to take this opportunity to thank him for his leadership 

on these issues that we both agree are critically important to the 

Native people of our State and not just the Native people of our 

State because I think we recognize that our Alaska Native communities really represent what is the heart of Alaska. 

We see that come together at the annual convention and at the 

Alaska Federation of Natives. We see it when we are out in the villages, villages that I think face some of the most difficult living 

conditions anywhere in this country. 

When you look at the cost, when you think of the environment 

and the social factors that are against them, yet there is resilience, 

a strength and a beauty in these people that is to be celebrated. 

I appreciate the efforts that he has made on so many of these 

issues, working together and talking about the Safe Families and 

Villages Act, something that we have been working on for a period 

of years and our staffs have shared initiative on that. 

He mentioned that there has been resistance on the Republican 

side of the aisle. That is correct. There are those who have waited 

to hear the comments coming back from the Department of Justice 

on this. We are still waiting on that. It has made it complicated. 

I have committed to him, as I have committed to Alaskans, that 

one of the things we can do most certainly at this point in time is 

to repeal Section 910 of VAWA, absolutely Alaska-specific there, 

but I think an effort that goes a long way in ensuring that there 

is a level of equity for some of the most vulnerable. 

We will certainly work on that and I am happy to take a look 

at the streamlined version that he just mentioned. 

I also want to acknowledge the work of Senator Heitkamp. The 

hearing we are having today focusing on the mental health needs 

of our children within Indian Country, the leadership that has been 

demonstrated focusing on our Native children in the lower 48 as 

well as Alaska Natives, I think has stepped up the review to a 

point I have not seen in the 12 years I have been serving on this 

Committee. 

I think it is because of the doggedness of the Senator from North 

Dakota in focusing on this. I am pleased that we have been able 

to move forward the Children’s Commission. 

We see too clearly in the statistics the impact of child abuse, of 

neglect, of trauma and see that not only with the children but as 

these children grow to be contributing members of society, to become parents and knowing that trauma is not limited to that instance and how that ripples across our families and across our communities. 

We have some very, very troubling statistics in Alaska. Our Alaska Native Tribal Health Consortium Epidemiology Center has estimated that 75 percent of Alaska Native people have experienced 

adverse childhood experiences. 

7 

Senator Begich was with us in Fairbanks last year at the AFN 

convention when a group of young people from the village of 

Tanana took to the center stage of a convention of 4,000–5,000 people and basically said, we have had enough. We are tired of adults 

who are abusive, we are tired of the drinking, we are tired of the 

drugs, we are tired of adults who are not role models, and we are 

tired of the violence. 

When it takes our young people to shame the grownups into action, we darned well better be paying attention. I thank those who 

have joined us, those who have traveled far. Ms. Boerner, thank 

you. 

I also recognize we are going to have a whole series of votes. I 

don’t know how we are going to get through this critically important hearing and get all the information out on the table but I 

thank you for having it, Mr. Chairman. 

The CHAIRMAN. Thank you. 

Senator Heitkamp. 

STATEMENT OF HON. HEIDI HEITKAMP, 

U.S. SENATOR FROM NORTH DAKOTA 

Senator HEITKAMP. Very quickly, none of us can escape the statistics. They are out there every day. Now we have the most recent 

report but very few of us have lived those statistics. 

I have met people who have. The President has met people who 

have. People on this Committee have met the living and breathing 

examples of those statistics. 

If we, the powerful government of the United States, cannot protect the poorest, most disenfranchised and most vulnerable of all 

people, then we are not worthy of the seats we are sitting in. We 

are not worthy of where we are right now. 

This will be our unending commitment. I want to thank my good 

friend, Senator Murkowski from Alaska, for sharing this burden 

with me. I came here knowing this was going to be among my highest priorities because I have seen the faces of those statistics and 

they will haunt me. They haunt anyone who really opens their 

eyes. 

What you do is so important. I know the trauma you experience 

as first responders. I know that trauma because I have seen it. 

Thank you because you share that burden every day and you share 

the love for children. Hopefully you will share with us the solutions 

today. 

Thank you so much. 

The CHAIRMAN. Senator Franken. 

STATEMENT OF HON. AL FRANKEN, 

U.S. SENATOR FROM MINNESOTA 

Senator FRANKEN. I want to associate myself with all the statements I have heard so far and thank Senator Begich. 

I want to hear your testimony. I am sorry because of the votes, 

I would like to have this hearing again because I know we are not 

going to be able to do questions and answers. I will submit questions for the record but I want to get to your testimony. 

8 

I just want to associate myself with the three Senators I just 

heard and especially thank Senator Begich for his service and his 

friendship. 

The CHAIRMAN. Thank you, Senator Franken and thank you all 

for your statements. 

I don’t know how this is going to work. We are going to listen 

to your opening statements and if we are pulled away, we may try 

to roll it for a while. Sometimes that works, sometimes it does not. 

We will see how it goes and see if we can get some Q and A in. 

Otherwise, the questions will be put forth in the record. The question will be in writing for you to answer at a later point in time 

and we will get them as part of the record. 

I want to welcome our panelists. First, we have Robert L. 

Listenbee Jr., Administrator, Office of Juvenile Justice and Delinquency Prevention, U.S. Department of Justice. I also want to welcome back a friend of the Committee, Dr. Yvette Roubideaux, Acting Director, Indian Health Service. 

We have Kana Enomoto, Principal Deputy Administrator, Substance Abuse and Mental Health Services Administration; Rick van 

den Pol, Director and Principal Investigator, Institute of Educational Research and Service, The University of Montana. This institute houses the National Native Children’s Trauma Center and 

I want to thank you for traveling a distance to be here, Rick. Finally, we welcome Ms. Verne ́ Boerner, President and CEO, Alaska 

Native Health Board in Anchorage, Alaska. Talking about a trip to 

come see us, thank you very much, Verne ́. 

I would remind the witnesses to try to keep your testimony to 

five minutes and know that your full written testimony will be a 

part of the record. 

We will start with you, Robert. 

STATEMENT OF HON. ROBERT L. LISTENBEE JR., 

ADMINISTRATOR, OFFICE OF JUVENILE JUSTICE AND 

DELINQUENCY PREVENTION, U.S. DEPARTMENT OF JUSTICE 

Mr. LISTENBEE. Thank you, Mr. Chairman. 

Chairman Tester, Vice Chairman Barrasso, and other distinguished members of the Committee, I want to thank you for the opportunity to discuss childhood trauma in Indian Country. 

The Department is committed to working with American Indian 

and Alaska Native communities and our partners to implement evidence-based approaches to preventing and addressing childhood 

trauma. 

As the Administrator of the Office of Juvenile Justice and Delinquency Prevention at the Department of Justice, Office of Justice 

Programs, I oversee programs that provide direct assistance and 

services to American Indian and Alaska Native youth. 

We work closely with tribal leaders, tribal elders and organizations to develop programs that take into account Native culture 

and practice. 

Prior to my appointment as the OJJDP Administrator, I served 

as a public defender and trial lawyer for nearly 30 years and dedicated myself to seeking justice for youth involved in the juvenile 

justice system. 

9 

I represented hundreds of children and learned that many of the 

youth entering the juvenile justice system were likely exposed to 

some form of violence as children. More than 60 percent of kids in 

America encounter some form of violence, crime or abuse ranging 

from brief encounters as witnesses to serious violent episodes as 

victims. 

As co-chair of the Attorney General’s Task Force on Children Exposed to Violence, in 2012, the task force issued a final report containing comprehensive policy recommendations aimed at reducing 

children’s exposure to violence and enhancing resiliency among affected children. 

One of the primary recommendations was the establishment of a 

separate task force to address the significant problem of children’s 

exposure to violence in American Indian and Alaska Native communities, recognizing the unique government-to-government relationship between the United States and tribes. 

The Attorney General’s Task Force on American Indian and 

Alaska Native Children Exposed to Violence, created in 2013, consisted of two components, the advisory committee and Federal 

working group. The department just received the recommendations 

from the advisory committee this week. 

The advisory committee, co-chaired by Senator Byron Dorgan 

and Ms. Joanne Shenandoah, held four hearings including one held 

in Anchorage, Alaska, and six listening sessions nationwide. 

They learned that American Indian and Alaska Native children 

experience various types of trauma at higher rates than other children, trauma that ranges from physical abuse as witnesses and victims to sex trafficking. 

Alaska Natives are disproportionately affected by violent crime 

and their children are therefore disproportionately exposed to that 

violence. This difference can be attributed to vast regional distances across the State, geographical isolation, extreme weather, 

exorbitant transportation costs and lack of economic opportunity 

and access to resources. 

Compounding these high rates of violence is historical trauma, a 

cumulative emotional and psychological wounding over the life 

span and across generations. 

The advisory committee discovered that some tribes and urban 

Indian organizations have found ways to incorporate tradition and 

develop resources to protect their children from harm and help 

them heal. The integration of traditional healing practices into 

mental health prevention and treatment for Native children is essential. 

In 2010, the Department of Justice launched its Coordinated 

Tribal Assistance Solicitation in direct response to tribes seeking a 

more streamlined, comprehensive grant process. CTAS gives tribes 

the flexibility needed to better address their criminal justice and 

public safety needs and funds initiatives such as the tribal youth 

programs. 

In fiscal year 2014, the department awarded CTAS grants to 169 

American Indian tribes, Alaska Native villages, tribal consortia 

and tribal designees. As part of the Attorney General’s Defending 

Childhood Initiative, OJJDP funded initiatives in the Rosebud 

Sioux Tribe in South Dakota and the Chippewa Cree Tribe at the 

10 

1OJJDP Children’s Exposure to Violence: A Comprehensive National Survey Bulletin, October 

2009. https://www.ncjrs.gov/pdffiles1/ojjdp/227744.pdf. 2Perry, S.W., American Indians and Crime (pdf, 56 pages), A BJS Statistical Profile 1992– 

2002, Washington, D.C. : U.S. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, December 2004, NCJ 203097. 3 In 2011, the Attorney General announced this Task Force as part of the Attorney General’s 

Defending Childhood Initiative, a project that addresses the epidemic levels of exposure to violence faced by our nation’s children. http://www.justice.gov/defendingchildhood/task-force-children-exposed-violence. 4Shortly after the release of the Task Force report, the Attorney general requested an Action 

Plan to implement the Task Force recommendations. The Action was developed and approved 

in 2013. The recommendations have been (and continue to be) acted upon by the Department 

and our federal partners. 5Listenbee, Robert L., Jr. et al., Report of the Attorney General’s National Task Force on Children Exposed to Violence, Washington D.C.: U.S. Department of Justice, Office of Juvenile Justice and Delinquency Prevention, December 2012. 

Rocky Boy Reservation in Montana. I describe these projects in my 

written testimony. 

OJJDP is also funding efforts to enhance the capacity of tribal 

healing to wellness courts to respond to alcohol-related issues of 

tribal youth. 

The National Institute of Justice in partnership with OJJDP and 

OJP’s Office of Victims of Crime is funding an effort to more effectively assess exposure to violence and victimization in American Indian and Alaska Native communities. 

Mr. Chairman, I appreciate the opportunity to appear before you 

today and I am prepared to respond to any questions you may 

have. 

[The prepared statement of Mr. Listenbee follows:] 

PREPARED STATEMENT OF HON. ROBERT L. LISTENBEE JR., ADMINISTRATOR, OFFICE

OF JUVENILE JUSTICE AND DELINQUENCY PREVENTION, U.S. DEPARTMENT OF JUSTICE

Introduction 

Chairman Tester, Ranking Member Barrasso and other distinguished members of 

the Committee, thank you for this opportunity to discuss childhood trauma in Indian Country. As Administrator of the Office of Juvenile Justice and Delinquency 

Prevention (OJJDP) at the Department of Justice’s Office of Justice Programs 

(OJP), I oversee programs that provide direct assistance and services to American 

Indian and Alaska Native youth. We work closely with tribal elders, tribal leaders 

and organizations to develop programs that take into account Native culture and 

practice. 

Prior to my appointment as the OJJDP Administrator, I served as a public defender and trial lawyer for nearly 30 years and dedicated myself to seeking justice 

for youth involved in the juvenile justice system. I represented hundreds of children 

and made an important but unsettling observation: many of the youth entering the 

juvenile justice system were likely exposed to some form of violence as children. 

While more than 60 percent of kids in America encounter some form of violence, 

crime, or abuse, ranging from brief encounters as witnesses to serious violent episodes as victims, 1 limited research and anecdotal evidence suggest rates of crime 

and violence, in some tribal areas are higher. 2

While serving as a Chief of the Juvenile Unit of the Defender Association of Philadelphia, I co-chaired the Attorney General’s Task Force on Children Exposed to Violence. 3 In 2012, the Task Force issued a final report containing comprehensive policy recommendations 4 aimed at reducing children’s exposure to violence and enhancing resiliency among affected children. 5 One of the primary recommendations 

was the establishment of a separate Task Force to address the significant problem 

of children’s exposure to violence in American Indian and Alaska Native communities in a way that recognizes the unique government-to-government relationship 

between the United States and tribes. 

11 

6Task Force on American Indian and Alaska Native Children Exposed to Violence website: 

http://www.justice.gov/defendingchildhood/task-force-american-indian-and-alaska-native-children-exposed-violence 7 It is noteworthy that while given their charge by the Attorney General, the Advisory Committee felt strongly that the problems facing children in American Indian and Alaska Native 

communities are so significant that only concerted action by the Executive branch agencies and 

Congress would begin to address them. Accordingly, they chose to address their recommendations to entities beyond the Department of Justice. 8 American Indian and Alaska Native Children Exposed to Violence Hearing Testimony: 

http://www.justice.gov/defendingchildhood/task-force-hearings 9Mato Standing High, Attorney General of the Rosebud Sioux Tribe, quoted in Report of the 

Attorney General’s National Task Force on Children Exposed to Violence, Dec. 12, 2012, http:// 

www.justice.gov/defendingchildhood/cev-rpt-full.pdf. Full quote: ‘‘For us in Rosebud, our reservation, the question is not who has been exposed to violence, it’s who hasn’t been exposed to 

violence.’’ 10Dolores Subia BigFoot et al., ‘‘Trauma Exposure in American Indian/Alaska Native Children,’’ Indian Country Child Trauma Center: 1–4 (2008), available at: http:// 

www.theannainstitute.org/American%20Indians%20and%20Alaska%20Natives/ 

Trauma%20Exposure%20in%20AIAN%20Children.pdf 11Deters, P. B., Novins, D. K., Fickenscher, A., & Beals, J. (2006). Trauma and posttraumatic 

stress disorder symptomatology: Patterns among AI/AN adolescents in substance abuse treatment. American Journal of Orthopsychiatry, 76(3), 335–345. 

Attorney General’s Task Force 

In 2013, the Attorney General created the Task Force on American Indian and 

Alaska Native Children Exposed to Violence. 6 The Task Force consisted of two components: 

• An Advisory Committee composed of non-federal subject matter experts who: (1) 

gathered information from public hearings, written testimony, site visits, listening sessions, and current research; and (2) used this information to draft a report to the Attorney General that includes recommendations to effectively address children’s exposure to violence in Indian Country. 7

• A Federal Working Group composed of federal officials from key agencies including the Departments of Justice, Interior, and Health and Human Services— 

who have experience with issues affecting American Indian and Alaska Native 

communities. This working group is in an ideal position to take steps to implement policy and programmatic changes for the benefit of American Indian and 

Alaska Native children exposed to violence. 

While the Department just received the recommendations from the Advisory Committee this week, OJJDP has long been committed to partnering with tribal governments to improve public safety in communities and to building a better future for 

all young people. 

The Advisory Committee, Co-Chaired by Senator Byron L. Dorgan and Ms. Joanne Shenandoah, held hearings in four locations (Bismarck, ND; Phoenix, AZ; Fort 

Lauderdale, FL; and Anchorage, AK) and six listening sessions nationwide which 

brought together national, regional, and local experts, solicited personal testimony, 

and provided a forum for discussion on the effects of exposure to violence and promising prevention and intervention strategies and programs. 8 During the hearings 

and listening sessions, the Advisory Committee learned that American Indian and 

Alaskan Native children experience various types of trauma at higher rates than 

other children—trauma that includes physical abuse (as witness and victims), sexual abuse, domestic violence, suicide, and victimization, and sex trafficking. 

The Advisory Committee heard that Alaska Natives are disproportionately affected by violent crime and Alaska Native children are, therefore, disproportionately 

exposed to that violence. This difference can be attributed to vast regional distances 

across the state, geographical isolation, extreme weather, exorbitant transportation 

cost, and lack of economic opportunity and access to resources. 

As one tribal leader told the Advisory Committee, ‘‘For us... the question is 

not who has been exposed to violence, it’s who hasn’t been exposed to violence.’’ 9

Violence, including assaults, homicide, and suicide, accounts for 75 percent of deaths 

of American Indian and Alaska Native youth ages 12 to 20. 10 These serious adversities often lead to chronic and severe trauma. A recent report noted that tribal children and youth experience posttraumatic stress disorder (PTSD) at a rate of 22 percent. 11

Compounding these high rates of violence in American Indian and Alaska Native 

communities is historical trauma: a cumulative emotional and psychological wounding over the life span and across generations. The Advisory Committee found that 

the degree of violence in American Indian and Alaska Native communities is directly related to historical trauma and the impact of policies and practices that have 

12 

12 ‘‘One of the main barriers both our youth and their families face are professionals who have 

the proper credentials required by the state but lack the cultural knowledge and ability or desire 

to even try to understand where our children and their families are coming from.’’ Darla Thiele, 

Director, Sunka Wakan Ah Ku Program Testimony before the Task Force on American Indian/ 

Alaska Native Children Exposed to Violence Hearing in Bismarck, ND, December 9, 2014 13Gone, J.P., & Alcantara, C., ‘‘Identifying Effective Mental Health Interventions for American Indians and Alaska Natives: A Review of the Literature,’’ Cultural Diversity and Ethnic 

minority Psychology, 13(4), (2007): 356–363. 14Grey, N., & Nye P. S., ‘‘American Indian and Alaska Native Substance Abuse: Co-Morbidity 

and Cultural Issues,’’ American Indian and Alaska Native Mental Health Research, 10(2), 

(2001): 67–82.; Rieckmann, T. R., Wadsworth, M. E., & Deyhle, D., ‘‘Cultural Identity, Explanatory Style, and Depression in Navajo Adolescents,’’ Cultural Diversity & Ethnic Minority Psychology, 10(4), (2004): 365–382.; Spicer, P., Novins, D. K., Mitchell, C. M., & Beals, J., ‘‘Aboriginal Social Organization, Contemporary Experience and American Indian Adolescent Alcohol 

Use,’’ Quarterly Journal of Studies on Alcohol, 64(4), (2003): 450–457.; Yoder, K. A., Whitbeck, 

L. B., Hoyt, D. R., & LaFromboise, T., ‘‘Suicide Ideation Among American Indian Youths,’’ Archives of Suicide Research, 10(2).(2006): 177–190. 15Walls, M. L., Johnson, K. D., Whitbeck, L. B., & Hoyt, D. R., ‘‘Mental Health and Substance 

Abuse Services Preferences Among American Indian People of the Northern Midwest,’’ Community Mental Health Journal, 42(6), (2006): 521–535. 

proved devastating to tribal communities. The testimony of the witnesses at the 

hearings underscored the fact that Native Americans share a history of displacement, forced assimilation, and cultural suppression, factors that may contribute to 

child maltreatment. 

Despite the epidemic levels of violence American Indian and Alaska Native children are exposed to, the Advisory Committee discovered that some tribes and urban 

Indian organizations have found ways to incorporate tradition and develop resources 

to protect their children from harm and help them heal. The Advisory Committee 

repeatedly heard testimony indicating that programs for tribal children and youth, 

including treatment and intervention programs, are most successful if they are 

based on tribal customs, language, and spiritual ceremonies that are deeply respectful of the traditional cultural values of the child, family and tribe. 12

The Advisory Committee heard that integration of traditional healing practices 

into mental health prevention and treatment for Native children and youth is essential. Many of those who testified recognized that, for American Indian and Alaska 

Native children and their families, emotional and psychological well-being cannot be 

separated from spiritual well-being. There is growing evidence that Native youth 

who are culturally and spiritually engaged are more resilient than their peers. 13

For example, research has revealed that over one third of Native adolescents and 

half of Native adults prefer to seek mental health services from a cultural or spiritual healer. 14 In other research, American Indian caregivers preferred cultural 

treatments for their children and found the traditionally based ceremonies more effective than standard or typical behavioral health treatment. 15

OJJDP-Funded Efforts 

In 2010, the Department of Justice launched its Coordinated Tribal Assistance Solicitation (CTAS) in direct response to tribes seeking a more streamlined, comprehensive grant process. CTAS gives tribes the flexibility needed to better address 

their criminal justice and public safety needs. 

In Fiscal Year 2014, the Department awarded CTAS grants to 169 American Indian tribes, Alaska Native villages, tribal consortia and tribal designees. The grants 

provide more than $87 million to enhance law enforcement practices and sustain 

crime prevention and intervention efforts in nine purpose areas including public 

safety and community policing; justice systems planning; alcohol and substance 

abuse; corrections and correctional alternatives; violence against women; juvenile 

justice; and tribal youth programs. 

As a part of the Attorney General’s Defending Childhood Initiative, OJJDP funded 

two initiatives that are tribally-directed and sensitive to tribal traditions and culture. The Rosebud Sioux Tribe in South Dakota delivers trauma-informed services, 

rooted in Lakota values that address educational, justice system, and health-care 

needs. The Chippewa Cree Tribe at the Rocky Boy reservation in Montana is involving elders and youth from throughout the community in the design of prevention 

and treatment programs that rely on traditional health and healing methods. These 

are promising approaches that take into account tribal customs aimed at enhancing 

resilience in affected children, and they represent some of the exciting work already 

being done to support children in tribal communities. Recently, leaders from both 

tribes participated in a three-day training on indigenous treatment for trauma offered by the National Native Child Trauma Center. 

13 

OJJDP is funding efforts to enhance the capacity of Tribal Healing to Wellness 

Courts to respond to alcohol-related issues of tribal youth who are younger than 21. 

A Tribal Healing to Wellness Court is not simply a tribal criminal or family court 

that orders individuals to treatment. Rather, it is an innovative and collaborative 

legal process that adapts the drug court concept and its key components to meet 

the need of referred youth in a manner that respects and includes tribal traditions. 

Under this initiative, participating courts are developing or enhancing policy, procedure, assessment tools, or service models that address underage drinking. A second 

component of the initiative will deliver training and technical assistance to the participating tribal courts. All programming is based on the 10 Key Components of an 

effective Tribal Healing to Wellness Courts, modeled after policies developed by the 

National Association of Drug Court Professionals. Current funding supports five 

tribes—Yurok Tribe (CA), Lac Du Flambeau Tribe of Lake Superior Chippewa Indians (WI), Southern Ute Indian Tribe (CO), White Earth Nation (MN), Winnebago 

Tribe of Nebraska (NE)—and a training and technical assistance provider. This program will be expanded in Fiscal Year 2015 to support additional tribes. 

Reaching children and families in tribal communities is a priority for the National 

Center for Missing & Exploited Children (NCMEC). NCMEC, which is funded by 

OJJDP, operates a national toll-free hotline and serves as a clearinghouse and resource center that collects and distributes data regarding missing and exploited children. NCMEC collaborates with tribal leaders and communities to address pressing 

issues such as multi-generational intra-familial sexual abuse, heavy substance 

abuse across generations, and the sexual exploitation of women and children. 

NCMEC is developing closer working relationships with tribal communities and organizations to help identify and provide resources and services to children and families living on tribal lands. In 2014, NCMEC added a Tribal Law Enforcement Liaison to its staff to help enhance collaboration with tribal law enforcement agencies; 

hosted a Tribal Cultural Awareness training for staff; and worked with tribal communities, schools and law enforcement to offer training. 

Efforts like these, as well as OJJDP funding that goes towards child advocacy centers, Internet Crimes Against Children (ICAC) task forces, and our youth tribal 

portfolio, are important ways OJJDP is working to prevent and address trauma in 

American Indian and Alaskan Native communities and tribes. 

Research 

OJP’s National Institute of Justice (NIJ), in partnership with OJJDP and OJP’s 

Office for Victims of Crime (OVC), is funding a 30-month study intended to improve 

the health and well-being of youth in American Indian and Alaska Native communities who may have been exposed to violence and victimization. The study will develop and test a survey instrument and different administration modes that can effectively assess exposure to violence and victimization and determine the feasibility 

of using these procedures in tribal communities and settings. Although some research suggests higher rates of violence in tribal communities, there has never been 

a national study of tribal youth regarding their victimization experiences that provides reliable, valid estimates of the scope of the problem. As a result, the exact incidence, prevalence, and nature of victimization experienced by youth living in tribal 

communities requires more research. 

As part of the Attorney General’s Children Exposed to Violence Demonstration 

Program, NIJ has funded evaluations in two tribal communities (i.e., Chippewa 

Cree and Rosebud Sioux Tribes) that include a community survey addressing children’s exposure to violence as well as knowledge of and attitudes towards children’s 

exposure to violence and the prevalence of violence. Findings from these evaluations 

will highlight the models used by Tribal Nations to prevent, treat, and raise awareness about children’s exposure to violence, emphasizing the role of culture; discuss 

local challenges with implementing programs to address children’s exposure to violence; and provide recommendations for other communities looking to prevent, treat, 

and raise awareness about children’s exposure to violence. 

Responding to Victims 

OVC is engaged in several initiatives in Indian Country. OVC has responded to 

the challenge of helping service providers meet the needs of drug-endangered youth 

in American Indian and Alaska Native communities by producing a video series entitled, ‘‘A Circle of Healing for Native Children Endangered by Drugs.’’ This series 

not only explains the role that historical trauma has played in generating the complex traumatic stress experienced by these children, but it also highlights ongoing 

efforts to integrate cultural practices and traditional healing into therapeutic interventions for American Indian and Alaska Native families struggling with addiction 

and child maltreatment issues. OVC will debut the video at its upcoming Indian NaVerDate Mar 15 2010 12:47 Mar 03, 2015 Jkt 092529 PO 00000 Frm 00017 Fmt 6633 Sfmt 6621 S:\DOCS\92529.TXT JACK
14 

tions Conference in December and is confident that it will become an invaluable tool 

in helping child welfare and mental health professionals, among others, who are 

seeking information on innovative techniques to improve outcomes for drug-endangered children in American Indian and Alaska Native communities. 

OVC funds the Children’s Justice Act (CJA) Partnerships for Indian Communities 

Grant Program. OVC dedicated $8.1 million to support tribes in developing, establishing and operating programs to improve the investigation, prosecution and handling of child abuse cases, particularly cases of child sexual abuse, in a manner that 

limits additional trauma to child victims. The funding further supports the development and implementation of comprehensive programs for abused children, and procedures to address child abuse cases in tribal courts and child protection service systems. OVC is also working with the Flandreau Indian School, a Bureau of Indian 

Education boarding school in South Dakota, to provide specialized mental health 

services to students identified as victims. OVC is providing $1.5 million to support 

this demonstration project with the goal of establishing a culturally appropriate, 

trauma-informed system of care for students with long-term exposure to violence, 

trauma, and victimization. 

Closing Statement 

Mr. Chairman, OJJDP strives to strengthen the juvenile justice system’s efforts 

to protect public safety, hold offenders accountable and provide services that address 

the needs of youth and their families. We are committed to working with American 

Indian and Alaskan Native communities, and our partner agencies within the Department of Justice and throughout federal and state governments, to implement 

evidence-based approaches to preventing and addressing child trauma. I appreciate 

the opportunity to appear before you today, and I am prepared to respond to any 

questions you may have. 

The CHAIRMAN. Thank you very much, Mr. Listenbee 

Yvette Roubideaux. 

STATEMENT OF HON. YVETTE ROUBIDEAUX, MD, MPH, ACTING 

DIRECTOR, INDIAN HEALTH SERVICE 

Dr. ROUBIDEAUX. Thank you, Mr. Chairman, Vice Chairman 

Barrasso, and members of the Committee. 

I am Dr. Yvette Roubideaux, Acting Director of the Indian 

Health Service. I appreciate the opportunity to testify on preventing and addressing childhood trauma in Indian Country. 

Thank you so much for holding this hearing today on such a 

truly important topic. It is a serious problem with multiple reasons 

and causes as detailed in the testimony and has a profound impact 

on our communities. 

The problem of childhood trauma is multigenerational and a societal problem. It is sweeping in scope and will take a coordinated, 

comprehensive, multidimensional, public health response to change 

the course for our children and youth. 

I appreciate the opportunity discuss with the Committee what 

IHS is doing to address the many issues related to childhood trauma and be a part of the solution for these public health challenges. 

IHS is already and wants to continue to be a partner with other 

agencies, stakeholders and tribes in these efforts to find solutions. 

My testimony summarizes some of the major national programs 

and activities that IHS does for this issue as a part of our medical 

and public health response to childhood trauma. 

For the sake of time, I will just summarize by saying that the 

IHS’ policies, training, programs and partnerships promote a multifaceted range of activities for the identification, treatment and prevention of childhood trauma. 

15 

1 U.S. Department of Health & Human Services. Administration for Children and Families. 

(2012). Child Maltreatment 2012. Available at http://www.acf.hss.gov/programs/cb/ 

statslresearch/index.htm#can 

However, IHS cannot address these issues alone and it will take 

all of us to prevent and reduce childhood trauma. We welcome your 

partnership and assistance with this important issue. 

That concludes my remarks. Thank you. 

[The prepared statement of Dr. Roubideaux follows:] 

PREPARED STATEMENT OF HON. YVETTE ROUBIDEAUX, MD, MPH, ACTING DIRECTOR, 

INDIAN HEALTH SERVICE

Mr. Chairman and Members of the Committee: 

Good afternoon, I am Dr. Yvette Roubideaux, Acting Director of the Indian Health 

Service (IHS). Today, I appreciate the opportunity to testify on preventing and addressing childhood trauma in Indian Country. 

Background 

As you know, the IHS plays a unique role in the U.S. Department of Health and 

Human Services (HHS) to meet the federal trust responsibility to provide health 

care to American Indian and Alaska Native (AI/AN) people. The IHS provides comprehensive health service delivery to 2.1 million American Indians and Alaska Natives through a system of IHS, Tribal, and urban Indian operated facilities and programs based on treaties, judicial determinations, and Acts of Congress. The mission 

of the agency is to raise the physical, mental, social, and spiritual health of AI/AN 

people to the highest level, in partnership with the population we serve. The agency 

aims to assure that comprehensive, culturally acceptable personal and public health 

services are available and accessible to the service population. Our foundation is to 

promote healthy AI/AN people, communities, and cultures, and to honor the inherent sovereign rights of Tribes. 

Two major pieces of legislation are at the core of the Federal Government’s responsibility for meeting the health needs of American Indians and Alaska Natives: 

The Snyder Act of 1921, P.L. 67–85, and the Indian Health Care Improvement Act 

(IHCIA), P.L. 94–437, as amended. The Snyder Act authorized appropriations for 

‘‘the relief of distress and conservation of health’’ of American Indians and Alaska 

Natives. The IHCIA was enacted ‘‘to implement the federal responsibility for the 

care of the Indian people by improving the services and facilities of federal Indian 

health programs and encouraging maximum participation of Indians in such programs.’’ Like the Snyder Act, the IHCIA provides the authority for the provision of 

programs, services, functions and activities to address the health needs of American 

Indians and Alaska Natives. The IHCIA includes authorities for the recruitment 

and retention of health professionals serving Indian communities, health services for 

AI/AN people, and the construction, replacement, and repair of healthcare facilities, 

among other authorities. 

The IHS, in partnership with Tribes and urban Indian health programs, provides 

essential medical and mental health services in over 600 hospitals, clinics, and 

health stations. These services include medical and surgical inpatient care, emergency care, ambulatory care, mental health and substance abuse treatment and prevention, and medical support services such as laboratory, pharmacy, nutrition, diagnostic imaging, medical records, and physical therapy. Other services include public 

and community health programs such as diabetes; maternal and child health; communicable diseases such as influenza, HIV/AIDS, tuberculosis, and hepatitis; suicide 

prevention; substance abuse prevention; women’s and elders’ health; domestic violence prevention and treatment; and regional trauma/emergency medical delivery 

systems. The level of services provided in each community varies based on available 

resources. In addition, over half of the IHS budget is managed by Tribes under P.L. 

93–638, the Indian Self Determination and Educational Assistance Act, and many 

of the public, community and behavioral health programs are managed by Tribes 

even when the hospital or clinic is still under management by the IHS. 

Childhood Trauma in AI/AN Children 

According to the National Child Abuse and Neglect Data System, an estimated 

686,000 children were exposed to incidents of child abuse and neglect in 2012. These 

data translate to a rate of 9.2 occurrences of child abuse and neglect for every 1,000 

children per year. 1 While these data are not unique to AI/AN children, childhood 

16 

2 U.S. Department of Health & Human Services., (2014). Expenditures for Treatment of Mental Health Disorders among Children, Ages 5–17, 2009–2011: Estimates for U.S. Civilian Noninstitutionalized Population. Published by Agency for Healthcare Research and Quality. Available at: http://meps.ahrq.gov/mepsweb/datalfiles/publications/st440/stat440.shtml 

trauma is disproportionately experienced by AI/AN children. The reasons are multifactorial and related to the high incidence of alcohol and drug abuse, mental health 

disorders, suicide, violence, and behaviorally-related chronic diseases among AI/AN 

people. Recurrent physical, emotional, and sexual abuse, as well as emotional and 

physical neglect leads to childhood trauma impacting the mental health and 

wellbeing of children. Other contributing factors of childhood trauma include household members who may have a substance abuse disorder, chronic depression, or 

other mental health diagnoses, family members who may be incarcerated, experience suicidal ideation, domestic violence in the household, and parental loss. Each 

of these serious behavioral health related issues have a profound impact on childhood trauma, the health of individuals, family, and community wellbeing. 

Once again, another school shooting has shaken us to our core as one of the Nation’s most serious tragedies. The heartbreak facing the Marysville, Washington, 

community and Tulalip Tribe offers another opportunity for a collective effort to reduce the chances of similar future tragedies. There are no easy solutions and no single agency or single approach that will address the violence and many other problems impacting the mental health of our children and youth. The problem of childhood trauma is a multigenerational and societal problem. It is sweeping in scope 

and will take a coordinated, comprehensive, multi-dimensional public health response to change the course for our children and youth. Today, I appreciate the opportunity to discuss what the IHS is doing to address the many issues that relate 

to childhood trauma and to be part of the solution for these public health challenges. 

IHS is already, and wants to continue to be, a partner with other agencies, stakeholders and Tribes in these efforts to find solutions. 

IHS Medical and Public Health Response to Childhood Trauma 

The overall structure and types of services provided by IHS, Tribal and urban Indian health programs were described above. The funding IHS receives to provide 

primary care and behavioral health services is through the Hospitals and Health 

Clinics, Mental Health and Alcohol and Substance Abuse budgets, of which over 50 

percent of funds are transferred under P.L. 93–638 contracts or compacts to Tribal 

governments or Tribal organizations that design and manage the delivery of health 

programs in their communities. In addition, there are 34 urban Indian health programs serving approximately 600,000 AI/AN people, including children with varying 

levels of services. 

In Fiscal Year (FY) 2013, IHS per capita spending estimates were $47 per person for mental health services and $117 per person for alcohol and substance abuse 

services. The average public and private expenditure among school-age American 

children from 2009–2011 was $2,192 for mental health services. 2 While the IHS 

overall spending estimate on mental health services is not directly comparable for 

the amount spent per AI/AN child due to the nature of how services are accessed 

through our health system, it is a glimpse into the complexities faced by Tribes in 

providing comprehensive services for children and families. I would like to provide 

an overview of some of our major national programs and activities that are part of 

the IHS medical and public health response to childhood trauma. 

National Policy 

I spoke in my introduction about the dire statistics on child abuse and neglect and 

its huge impact on AI/AN children and youth. IHS works to positively influence the 

outcomes for children and youth who are victims of child maltreatment through development of policies, objectives, procedures, and responsibilities concerning the detection, management, prevention, and evaluation of child abuse and neglect. The 

IHS recently recognized the need for a more comprehensive, standalone policy, and 

the IHS is drafting a comprehensive national Child Maltreatment policy to ensure 

children who are abused or neglected receive comprehensive intervention and treatment services when they enter our health system, as well as outlines the health 

care responsibilities in providing a coordinated multidisciplinary response. This policy will help improve and enhance our overall response at IHS facilities. 

Training 

The IHS offers a comprehensive training program to meet the needs of our workforce as it relates to addressing childhood trauma. Specific for child abuse, IHS provides training related to the identification, collection, and preservation of medical 

forensic evidence obtained during the treatment of child sexual abuse. Monthly 

17 

webinars ensure the Indian health system receives the continuing education needed 

to maintain competencies in the treatment, prevention, and coordination of services 

for child maltreatment. For current and pressing behavioral health issues related 

to childhood trauma, the IHS provides virtual training seminars and consultation 

sessions on topics including child mental health, childhood trauma, suicide, historical trauma, Fetal Alcohol Spectrum Disorders, and school violence, among others. 

Youth Regional Treatment Centers 

To help youth battling substance abuse, IHS administers ten Youth Regional 

Treatment Centers (YRTCs) that provide inpatient treatment for substance abuse 

and co-occurring mental health disorders among AI/AN youth. The YRTCs provide 

a range of clinical services rooted in culturally relevant, holistic models of care including group, individual, and family psychotherapy, life skills development, medication management, aftercare relapse prevention, and post-treatment follow up services. YRTCs also provide education, culture-based prevention activities, and 

evidence- and practice-based models of treatment to assist youth overcome their 

challenges and become healthy, strong, and resilient community members. 

Recently, the Jack Brown Center, an IHS funded YRTC that is located in Tahlequah, Oklahoma, completed construction on a new facility that will increase Jack 

Brown’s capacity from 20 to 36 inpatient beds. Additionally, Congress authorized 

two YRTCs to be built in the IHS California Area. The Southern California facility 

is expected to open in FY 2015, and staffing costs were included in the FY 2015 

President’s Budget. The FY 2015 Budget also included construction costs for the 

Northern California YRTC. 

Community Health Representatives 

The IHS Community Health Representative, or CHR, program is communitybased program with a special focus on advocacy, health promotion, and disease prevention. In 2013, the CHR program partnered with Johns Hopkins University to implement Family Spirit, an evidence-based and culturally tailored in-home parent 

training and support program. Parents gain knowledge and skills to achieve optimum development for their preschool aged children across the domains of physical, 

cognitive, social-emotional, language learning, and self-help. The program is currently the largest, most rigorous, and only evidence-based home visiting program 

ever designed specifically for American Indian families. In 2013, IHS provided funding to further replicate the program in three American Indian communities. 

Methamphetamine and Suicide Prevention Initiative 

The IHS Methamphetamine and Suicide Prevention Initiative, or MSPI, is one of 

the most significant efforts at the core of the IHS’ response to methamphetamine 

abuse and suicide in AI/AN communities. The MSPI’s purpose is to promote the use 

and development of evidence-based and practice-based models that represent culturally-appropriate prevention and treatment approaches to methamphetamine 

abuse and suicide prevention from a community-driven context. Of the 130 IHS, 

Tribal, and urban Indian health projects supported across the country through the 

MSPI, over 80 percent of projects provide prevention and treatment services to 

youth. For example, one Tribal project increased access to services by funding school 

based mental health professionals at community schools. Youth now have immediate access to mental health providers in a familiar environment. These professionals are responsible for providing on-going mental health services to youth, as 

well as providing educational groups related to suicide, grief, and loss. School officials have witnessed the impact of the school-based health services and report youth 

are more likely to talk about suicide and reach out for help. 

Throughout the 5 years of the MSPI, projects have significantly raised awareness 

through diverse and innovative programming. From 2009–2013, the MSPI resulted 

in more than 7,500 individuals entering treatment for methamphetamine abuse, 

over 15,000 tele-health substance abuse and mental health encounters, over 10,000 

professionals and community members trained in suicide prevention and crisis response, and over 400,000 encounters with youth were provided as part of evidencebased and practice-based intervention and prevention services. 

Community Awareness 

To raise youth awareness on the issues of substance abuse and suicide, the IHS 

partnered with the Northwest Portland Area Indian Health Board to develop media 

campaigns. Using focus groups, youth developed the ‘‘I Strengthen My Nation’’ and 

‘‘Community is the Healer’’ media campaigns, which empower Native youth to resist 

drugs and alcohol, motivates parents to talk openly to their children about drug and 

alcohol use, and raises awareness about the issue of suicide. 

18 

Domestic Violence Prevention Initiative 

To prevent domestic and sexual violence, as well as family violence, the IHS administers the Domestic Violence Prevention Initiative, or DVPI. Through DVPI, 65 

IHS, Tribal, and urban Indian health projects provide outreach, victim advocacy, 

intervention, policy development, and community response teams. From 2010–2012, 

the DVPI resulted in over 28,000 direct service encounters including crisis intervention, victim advocacy, case management, and counseling services; over 36,000 referrals for domestic violence services, culturally-based services, and clinical behavioral 

health services; with 487 forensic evidence collection kits submitted to federal, state, 

and Tribal law enforcement. 

Drug and Alcohol Exposure during Pregnancy 

To identify women who are using alcohol and drugs during pregnancy, IHS 

healthcare facilities conduct screening during routine women’s health and prenatal 

encounters. In FY 2013, 65.7 percent of all AI/AN females ages 15 to 44 were 

screened for alcohol use. In one IHS service unit, approximately 54 percent of 

women tested positive for drug use while pregnant and 52 percent of the infants 

born tested positive for drugs. To combat this problem, IHS has drafted policies and 

coordinated efforts for a comprehensive and multidisciplinary response to provide 

services to mothers and families including prenatal services, treatment, and home 

visiting programs to promote healthy lifestyles. 

Fetal Alcohol Spectrum Disorder 

For the babies born with Fetal Alcohol Spectrum Disorders, or FASD, which is 

an umbrella term describing the range of effects that can occur in an individual 

whose mother drank alcohol during pregnancy, IHS administers the Fetal Alcohol 

and Drug Unit (Unit), located within the University of Washington’s Alcohol and 

Drug Abuse Institute. The Unit provides FASD information and strategies for prevention and intervention to AI/AN communities. Since 2012, over 300 high-risk, substance-abusing pregnant and parenting women and their families have received 

evaluation, diagnosis, and referral services through the Unit. Additionally, the Unit 

has provided training and technical assistance to over 4,400 healthcare providers 

and AI/AN community members on FASD prevention and intervention topics. 

IHS Partnerships 

The IHS has devoted considerable effort to develop and share effective programs 

throughout the Indian health system. Strategies to address public safety and justice 

issues that impact childhood trauma include collaborations and partnerships between IHS, Substance Abuse and Mental Health Services Administration, Department of Justice (DOJ), and Department of Interior (DOI) through three Memoranda 

of Understanding, established by the Tribal Law and Order Act, Indian Health Care 

Improvement Act, and Individuals with Disabilities Education Act. These interagency coordination efforts work to ensure Federal agencies are comprehensively addressing the serious problems that have a significant impact on childhood trauma, 

such as alcohol, substance abuse, mental illness. 

The IHS is working with other federal officials from DOJ and DOI as part of the 

Defending Childhood Initiative as a member of the American Indian/Alaska Native 

Children Exposed to Violence Federal workgroup. This partnership seeks to take immediate steps to improve the Federal response to AI/AN children exposed to violence. The role of IHS in this group is to ensure services are comprehensive and 

coordinated so that every child has access to medical and counseling appointments 

in a timely manner and on a routine basis. 

The IHS partnership with the American Academy of Pediatrics’ Committee on Native American Child Health (CONACH) works to develop policies and programs to 

improve the health of AI/AN children. CONACH members are committed to increasing awareness of the major health problems facing Native American children and 

monitoring legislation affecting AI/AN child health. CONACH conducts pediatric 

consultation visits to IHS and Tribal healthcare facilities, makes recommendations 

to improve services, and works to strengthen ties with Tribes throughout the United 

States. 

Summary 

In summary, IHS policies, training, programs, and partnerships promote a multifaceted range of activities for identification, treatment and prevention of childhood 

trauma. However, IHS cannot address this issue alone, and it is imperative to continue to build a wide safety net of Federal, non-Federal and Tribal resources for AI/ 

AN children and families to help to further activities at the national, Tribal, state, 

and local levels. No one individual, community, or agency can do this alone. It will 

19 

take all of us to prevent and reduce childhood trauma and we welcome your partnership and assistance with this important issue. 

This concludes my remarks and I welcome any questions that you may have. 

Thank you. 

The CHAIRMAN. Thank you, Dr. Roubideaux. 

Kana. 

STATEMENT OF KANA ENOMOTO, PRINCIPAL DEPUTY 

ADMINISTRATOR, SUBSTANCE ABUSE AND MENTAL HEALTH 

SERVICES ADMINISTRATION 

Ms. ENOMOTO. Good afternoon, Chairman Tester, Vice Chairman 

Barrasso and members of the Committee. 

Thank you for inviting the Substance Abuse and Mental Health 

Services Administration to testify here today. I am pleased to be 

here with my colleagues from IHS, DOJ and from the field. 

I am particularly pleased to be here this morning, Senator 

Heitkamp, because I too heard from the faces of the statistics. 

SAMHSA’s Native Youth Conference was convened and we had a 

Federal listening panel. 

We heard loudly and clearly from Native youth from across the 

country that they want us to address childhood trauma. They want 

us to address the violence and the substance abuse in their communities and they want to be our partners in finding ways to heal and 

help their communities find a path to recovery, to hope and 

wellness, and doing that in a culturally, developmentally appropriate way. 

SAMHSA has many programs in its portfolio that address this 

issue. You also have that in my written testimony. I want to highlight for you one particular program; The Tribal Behavioral Health 

Grant Program. 

The President has requested for several years in a row funding 

to provide stable, predictable funding to all tribes to do substance 

abuse prevention, suicide prevention and mental health promotion 

in ways that fit their needs, that they can determine the best practices to use in that space. 

Just this last year, in FY14, Congress started us off with $5 million and we were able to give grants to 20 tribes with some of the 

highest rates of suicide. As you can imagine, that is not enough. 

We need to do more and look forward to doing more. We have 

invested for many years in the National Child Traumatic Stress 

Initiative which Dr. van den Pol will tell you more about. That is 

a space where we are also trying to promote effective clinical interventions for child trauma. We have funded the center at the University of Montana where we can bring together effective clinical 

interventions with cultural adaptations and traditional healing 

practices. 

We hope to do much more of that and partner with our colleagues across the Federal Government and Indian Country. 

We thank you very much for having this hearing. 

[The prepared statement of Ms. Enomoto follows:] 

20 

1Substance Abuse and Mental Health Services Administration. SAMHSA’s Concept of Trauma 

and Guidance for a Trauma-Informed Approach. HHS Publication No. (SMA) 14–4884. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014. 

PREPARED STATEMENT OF KANA ENOMOTO, PRINCIPAL DEPUTY ADMINISTRATOR, 

SUBSTANCE ABUSE AND MENTAL HEALTH SERVICES ADMINISTRATION

Chairman Tester, Ranking Member Barrasso, and members of the Senate Committee on Indian Affairs, thank you for inviting me to testify at this important hearing on protecting our children’s mental health. I am pleased to testify along with 

my colleagues from the Indian Health Service (IHS) and the Department of Justice, 

and inform the Committee of the Administration’s efforts to prevent and address 

childhood trauma in Indian Country. I am particularly pleased to be here today for 

several reasons. First, I began my career at the Substance Abuse and Mental 

Health Services Administration (SAMHSA) over fourteen years ago working on 

childhood trauma programs and have had the opportunity to see the agency’s programs evolve and expand over the years. In addition, just this past summer I accompanied Administrator Hyde to Indian Country where we visited tribes and Alaska 

Native villages in three of the states represented by members of this Committee. 

Shortly thereafter, SAMHSA established the agency’s Office of Tribal Affairs and 

Policy (OTAP), which serves as SAMHSA’s primary point of contact for tribal governments, tribal organizations, Federal departments and agencies’ tribal affairs efforts, and other governments and agencies on behavioral health issues facing American Indian and Alaska Native (AI/AN) populations in the United States. Finally, 

as I speak, SAMHSA is wrapping up its 2014 Native Youth Conference, which has 

focused on addressing behavioral health issues facing AI/AN youth. 

SAMHSA 

As you are aware, SAMHSA’s mission is to reduce the impact of substance abuse 

and mental illness on America’s communities. SAMHSA envisions a Nation that 

acts on the knowledge that: 

• Behavioral health is essential for health; 

• Prevention works; 

• Treatment is effective; and 

• People recover from mental and substance use disorders. 

In order to achieve this mission, SAMHSA has identified six Strategic Initiatives 

to focus the Agency’s work on improving lives and capitalizing on emerging opportunities. SAMHSA’s top Strategic Initiatives are: Prevention of Substance Abuse and 

Mental Illness; Health Care and Health Systems Integration; Trauma and Justice; 

Recovery Support; Health Information Technology; and Workforce Development. 

SAMHSA’s Trauma and Justice Strategic Initiative provides a comprehensive 

public health approach to addressing trauma and establishing a trauma-informed 

approach in health, behavioral health, human services, and related systems, with 

the intent to reduce both the observable and less visible harmful effects of trauma 

and violence on children and youth, adults, families, and communities. Recent activities of the strategic initiative include hosting a Tribal Juvenile Justice Policy 

Academy and releasing SAMHSA’s paper entitled ‘‘Concept of Trauma and Guidance 

for a Trauma-Informed Approach.’’ SAMHSA has participated in the Department of 

Justice’s Task Force on American Indian and Alaska Native Children Exposed to 

Violence and will work with our partners at the Office of Juvenile Justice and Delinquency Prevention to address the recommendations of the report. 

The Concept of Trauma and Guidance for a Trauma-Informed Approach publication was released in July of this year. SAMHSA intends this framework to be relevant to its Federal partners and their state, tribal and local system counterparts 

and applicable to practitioners, researchers, and trauma survivors, families and 

communities. The framework is anchored in SAMHSA’s concept of trauma which is 

that ‘‘individual trauma results from an event, series of events, or set of circumstances that is experienced by an individual as physically or emotionally harmful or life threatening and that has lasting adverse effects on the individual’s functioning, and mental, physical, social, emotional or spiritual well-being.’’ 1 The focus 

on experience highlights the fact that not every child will experience the same 

events as traumatic. While the immediate focus might be on a recent event, the individual’s reaction to that event may be affected by earlier experiences. As an example: A child bullied in school that comes for treatment or support may have experienced neglect or abuse at home, lived in multiple foster care settings, and witnessed 

the impact of community violence. That child may experience the bullying event 

21 

very differently from a child who has not been exposed to prior traumatic events 

or circumstances. 

Prevalence of Behavioral Health Conditions and Treatment 

According to SAMHSA’s 2012 National Survey on Drug Use and Health 

(NSDUH), the statistics related to behavioral health conditions among the AI/populations are very troubling. 

Mental Health 

• 5.2 percent of American Indian/Alaska Native youth had a major depressive episode (MDE) and 2.6 percent had an MDE with severe impairment. 

• NSDUH also found that in 2012, 11 percent of AI/AN youth had specialty mental health services during the past year with services provided in a range of settings from education and juvenile justice settings to general and specialty 

health settings. 

Substance Misuse and Abuse 

• The rate of substance dependence or abuse among people aged 12 and up was 

higher among the AI/AN population (21.8 percent) than among other groups. 

• AI/AN individuals have the highest rate of binge alcohol use (30.2 percent) compared with other groups. 

• American Indians and Alaska Natives are also more likely than other groups 

in the United States to die from drug-induced deaths, according to a 2013 Centers for Disease Control and Prevention (CDC) report on U.S. health disparities 

and inequities. 

Suicidal Thoughts, Attempts and Completions 

Based on data from SAMHSA and CDC, we also know that AI/AN youth are 

disproportionally impacted by suicide. 

• In 2011, American Indian and Alaska Native high school students reported 

rates of suicide attempts nearly twice that of the general population of U.S. 

high school students (14.7 percent vs. 7.8 percent). 

• In 2012, the suicide rate among American Indians and Alaska Natives ages 10 

to 24 years was 14.2 per 100,000, significantly higher than the suicide rate for 

people of the same age with the next highest rate (white 8.66) and almost three 

times the suicide rate for Asian/Pacific Islanders (5.51) and blacks (5.27). 

• In 2012, 5.9 percent of American Indians and Alaska Natives ages 18 and up 

had serious thoughts of suicide in the past year. This is higher than any other 

single racial or ethnic group. 

Trauma 

Based on SAMHSA’s definition of trauma, the agency is in the process of developing and implementing trauma measures for population surveillance, client level 

data, facilities surveys, and quality measures. 

Improving Practice 

SAMHSA, as the Federal agency that leads public health efforts to advance the 

behavioral health of the nation, has several roles. I just spoke about the ways in 

which SAMHSA provides leadership and voice and supports the behavioral health 

field with critical data from national surveys and surveillance. SAMHSA also has 

a vital role in collecting best practices and developing expertise around prevention 

and treatment for people with mental illness and substance use disorders. 

SAMHSA’s staff includes subject matter experts that provide technical assistance 

and training to individuals, organizations, states, tribes, and others every day. 

SAMHSA also supports a number of technical assistance and training centers that 

are focused on children’s mental health and addressing and preventing trauma. 

The SAMHSA Tribal Training and Technical Assistance (TTA) Center uses a culturally relevant, evidence-based, holistic approach to support Native communities in 

their self-determination efforts through infrastructure development and capacity 

building, as well as program planning and implementation. It provides training and 

technical assistance on mental and/or substance use disorders, suicide prevention, 

and mental health promotion. It also offers training and technical assistance, ranging from broad to focused and intense to federally recognized tribes, SAMHSA tribal 

grantees, and tribal organizations serving Indian Country. 

The National Center for Child Traumatic Stress (NCCTS) facilitates collaborative 

activity, oversees resource development, and coordinates national training and eduVerDate Mar 15 2010 12:47 Mar 03, 2015 Jkt 092529 PO 00000 Frm 00025 Fmt 6633 Sfmt 6621 S:\DOCS\92529.TXT JACK
22 

cation for the National Child Traumatic Stress Network. Housed jointly at the 

UCLA Neuropsychiatric Institute and the Duke University Medical Center, the 

NCCTS works to increase access to services and raise the standard of care for traumatized children and their families. 

The Suicide Prevention Resource Center (SPRC) also has a special focus on American Indians and Alaska Natives. SPRC provides technical assistance, training, and 

materials to increase the knowledge and expertise of suicide prevention practitioners and other professionals serving people at risk for suicide. 

SAMHSA has also published ‘‘To Live To See the Great Day That Dawns: Preventing Suicide by American Indian and Alaska Native Youth and Young Adults’’ 

which lays the groundwork for community-based suicide prevention and mental 

health promotion plans for American Indian and Alaska Native youth and young 

adults. 

Public Awareness and Support 

Creating public awareness of children’s mental health issues and targeting campaigns to prevent and address childhood trauma is a key role that SAMHSA plays 

in reducing the impact of mental illness and substance abuse in America’s communities. For example, in 2006 the SAMHSA-funded National Suicide Prevention Lifeline created a specific set of outreach materials for AI/AN teen suicide prevention 

public awareness campaign. The poster utilized in the campaign depicts an American Indian male who appears to have lost hope. But, the image emphasizes that 

there is help, and with help comes hope and urges those who are thinking about 

suicide to call the Lifeline. Posters to promote AI/AN use of the Lifeline are available for free from SAMHSA’s website and can be downloaded and printed or ordered 

from SAMHSA’s online store. SAMHSA encourages tribes and tribal organization to 

place the posters in a wide range of settings to ensure AI/AN individuals are aware 

of the Lifeline. 

As part of SAMHSA’s highly successful ‘‘Talk. They Hear You.’’ underage drinking 

prevention campaign, a promotion video was recently recorded with Rod Robinson, 

the former Director of SAMHSA’s Office of Indian Alcohol and Substance Abuse. In 

the video Mr. Robinson discusses materials developed to help prevent and reduce 

underage drinking in American Indian communities and he responds to questions 

such as why underage drinking is an important concern for American Indian populations. He also communicates ways in which the new ‘‘Talk. They Hear You.’’ materials will help parents and adult caregivers address underage drinking within tribal 

communities. The video is available on SAMHSA’s You Tube channel. 

Strategic Grant Making 

National Child Traumatic Stress Initiative 

Established in 2000, the purpose of the National Child Traumatic Stress Initiative 

(NCTSI) is to improve behavioral health treatment, services, and interventions for 

children and adolescents exposed to traumatic events. It has done so through the 

National Child Traumatic Stress Network (NCSTN), a national network of centers 

with expertise in child trauma. The goals of the NCTSN are to develop highly effective clinical and service interventions for child trauma, expand availability and accessibility of effective trauma-informed interventions, and promote better understanding of issues relevant to developing and providing effective interventions for 

children, adolescents, and families exposed to traumatic events. To date, the NCTSI 

has funded over 200 grants across the country. 

The National Native Children’s Trauma Center (NNCTC) at the University of 

Montana works in collaboration with IHS and other providers in tribal communities 

across the country to utilize evidence-based, culturally appropriate, trauma-informed interventions for AI/AN children, youth, and families who experience disproportionate violence, grief, and/or poverty; and childhood, historical, and/or 

intergenerational trauma. The NNCTC has delivered education and services in a 

broad range of locations and settings including the Fort Peck, Rocky Boy, Northern 

Cheyenne, Crow, Pine Ridge, White Earth, Leech Lake, Blackfeet and Flathead Reservations; Cracking Ice Lake, Pine Point, and Waubun, Minnesota; and Bethel, Anchorage, Emmonak, and Napis, Alaska just to name a few. NNCTC provides 

trainings and consultation in trauma-focused interventions such as Trauma-Focused 

Cognitive Behavioral Therapy; Attachment, Self-Regulation and Competency Clinical Services; Family Engagement through the Joining Process: Welcome, Honor, 

and Connect; trauma awareness, implications of the Adverse Childhood Experiences 

study; and the Students, Trauma, and Resiliency curriculum. The NNCTC has 

trained social workers, school counselors, nurses, and child protection workers. 

From April to June 2014, the NNCTC trained 1,180 individuals provided services 

at 46 sites and collaborated with 58 other organizations. 

23 

Other tribal focused grantees include the Native American Health Center (NAH) 

in Oakland, CA, which is using grant resources to further bridge the gap between 

western and AI/AN models of addressing trauma. 

In the past year, using evidence-based and trauma-focused interventions, NAH 

therapists have been working with three school age siblings who experienced multiple traumas, including the sudden death of their mother. NAH therapists integrated culturally adapted evidence-based trauma interventions developed and disseminated by the National Child Traumatic Stress Network, with traditional Native 

healing practices including participation in Cultural Ceremonies. For example, at 

the start of their treatment, one of the children was at risk for placement in a hospital or residential care setting, and the other two had significant behavior and emotional problems. At present all three are together in the care of their mother’s sister 

and nearing a successful end to their treatment. As a result of the multi-focused 

trauma treatment and the interventions of therapists, children and families are receiving effective and culturally sensitive healing services. 

Tribal Behavioral Health Grants 

For several years, the President’s Budget for SAMHSA had requested funding to 

address the high incidence of substance abuse and suicide in AI/AN youth and 

young adult populations. In Fiscal Year 2014, Congress appropriated for the first 

time $5 million to begin such a program, Tribal Behavioral Health (Native Connections). SAMHSA recently awarded 20 Tribal Behavioral Health grants of $200,000 

to tribes or tribal organizations with high rates of suicide to develop and implement 

a plan that addresses suicide and substance abuse (including alcohol) and is designed to promote mental health among tribal youth. Grantees such as the Selawik 

Village Council in Alaska, the Turtle Mountain Band of Chippewa Tribe in North 

Dakota, and the Pueblo of Nambe in New Mexico, indicated in their applications 

how they will incorporate evidence-based, culture-based, and practice-based strategies for tribal youth. Grantees are required to work across tribal suicide prevention, 

mental health, substance abuse prevention, and substance abuse treatment programs to build positive behavioral health among youth. Using real-time surveillance 

data of suicide deaths and attempts, grantees will create or enhance effective systems of follow up for those identified at risk of suicide and/or substance abuse or 

mental health issues that could lead to suicide. With a focus on tribal traditions, 

interagency collaboration, early identification, community healing, and preventing 

future deaths by suicide, grantees will connect appropriate cultural practices, intervention services, care, and information with families, friends, schools, educational 

institutions, correctional systems, substance abuse programs, mental health programs, foster care systems, and other support organizations for tribal youth. Attention to the families and friends of tribal community members who recently died by 

suicide is encouraged as well. In addition, technical assistance will be provided to 

grantees through SAMHSA’s Tribal Technical Assistance Center to support their 

ability to achieve their goals. 

GLS Youth Suicide Prevention 

The Garrett Lee Smith (GLS) Memorial Act authorizes SAMHSA to manage two 

significant youth suicide prevention programs and one resource center. The GLS 

State/Tribal Youth Suicide Prevention and Early Intervention grant program currently supports a total of 68 grantees which includes 29 tribes or tribal organizations in developing and implementing youth suicide prevention and early intervention strategies involving public-private collaborations among youth serving institutions. Recently announced tribal grantees include Native Americans for Community 

Action in Arizona, Confederated Salish and Kootenai Tribes in Montana, and the 

Yellowhawk Tribal Health Center in Oregon. The GLS Campus Suicide Prevention 

program currently provides funding to 82 institutions of higher education, inclusive 

of tribal colleges and universities. In a cross site evaluation of the GLS State/Tribal 

grant program, it was found that counties that had implemented grant supported 

youth suicide prevention activities had lower youth suicide rates than matched 

counties that had not implemented such activities in the year following those activities. 

Project LAUNCH (Linking Actions for Unmet Needs in Children’s Health) 

Project LAUNCH is a grant program that invests in ensuring healthy physical, 

social, emotional, cognitive, and behavioral development of young children. This investment forms the foundation for later success in school and life and serves to protect against negative outcomes such as school dropout, drug and alcohol abuse, delinquency, and other physical, social, and emotional problems. Project LAUNCH 

grantees implement, monitor, and evaluate evidence-based prevention and promotion practices in partnership with a wide variety of community organizations and 

24 

stakeholders. Project LAUNCH services are focused on five core strategies for promoting the social and emotional wellbeing of young children and their families: (1) 

increased developmental screening in a wide range of early childhood settings; (2) 

enhanced home visiting (with a focus on social/emotional wellbeing); (3) mental 

health consultation in early care and education settings; (4) integration of behavioral health into primary care; and (5) family strengthening/parent support. Each 

state/tribe and community’s Project LAUNCH Council on Young Child Wellness 

monitors infrastructure development, implementation of evidence-based practices, 

and sustainability of successful practices through policy, planning, data, and funding decisions that improve services and outcomes for young children and their families. 

Project LAUNCH has funded a total of 10 Tribal grantees. The Red Cliff Band 

of Lake Superior Chippewa completed a Project LAUNCH grant and tribal members 

have noted that the grant continues to serve as one of the powerful transformative 

mechanisms for the Red Cliff community. For example, during the grant period one 

leader noted that ‘‘I think the most important thing that LAUNCH is helping us 

do is looking at the difficult things the families have to juggle, making us take a 

step back and take a look from the family’s point of view. And say, ‘Okay, if I was 

in that position, what would I need to help me?’ or better yet, asking the family, 

‘What do you need for help?’’’ 

Children’s Mental Health Initiative (CMHI) 

The CMHI supports the development of comprehensive, community-based systems 

of care for children and youth with serious emotional disorders (SED) and their families. A system of care (SOC) is a strategic approach to the delivery of services and 

supports that incorporate family-driven, youth-guided, strength-based, and culturally and linguistically competent care in order to meet the physical, intellectual, 

emotional, cultural, and social needs of children and youth. These guiding principles 

also call for a broad array of effective services, individualized care, and coordination 

across child and youth-serving systems (e.g. juvenile justice, child welfare, education, primary care, and substance abuse) and have become standards for care 

throughout much of the nation. Recently announced CMHI grantees include Rocky 

Boy Health Board in Montana, the Santee Sioux Nation in North Dakota, and 

Lummi Nation in Washington. 

National program evaluation data reported annually to Congress indicates that 

CMHI systems of care are successful, resulting in many favorable outcomes for children, youth, and their families, including: 

• Sustained mental health disorder improvements for participating children and; 

• Improvements in school attendance and achievement; 

• Reductions in suicide-related behaviors; 

• Decreases in the use of inpatient care and reduced costs due to fewer days in 

residential settings; and 

• Significant reductions in contacts with law enforcement. 

Circles of Care Grant Program 

The Circles of Care program is the longest running SAMHSA grant program specifically designed for AI/AN communities. The program began in 1998 as a result 

of discussion and consultation with tribes and American Indian behavioral health 

professionals. To date, SAMHSA has awarded a total of $49 million in Circles of 

Care grants to 49 AI/AN communities. These communities have mobilized to develop 

the tools and resources necessary to build their own culturally competent systems 

of care model for children’s mental health. Thus, many Circles of Care grantees go 

on to receive larger CMHI grants 

In FY14, SAMHSA funded 11 tribes and tribal organization as part of a new cohort of Circles of Care grantees. Among the grantees include the Osage Tribe of Indians in Oklahoma, the Makah Tribe in Washington, and the Red Cliff Band of 

Lake Superior Chippewa in Wisconsin. 

Conclusion 

Thank you again for this opportunity to discuss children’s mental health as it relates to preventing and addressing childhood trauma in Indian Country. I hope you 

can see that this issue is a major priority for SAMHSA and recent activities such 

as the establishment of our OTAP, release of the trauma concept paper, and hosting 

this week’s Native Youth Conference underscore our dedication. I would now be 

pleased to answer any questions that you may have. 

The CHAIRMAN. Kana, thank you for your testimony. 

25 

Rick? 

STATEMENT OF RICK VAN DEN POL, PH.D., DIRECTOR AND 

PRINCIPAL INVESTIGATOR, INSTITUTE OF EDUCATIONAL 

RESEARCH AND SERVICE, THE UNIVERSITY OF MONTANA 

NATIONAL NATIVE CHILDREN’S TRAUMA CENTER 

Dr. VAN DEN POL. Thank you for the invitation. 

My name is Rick van den Pol. I serve as Principal Investigator 

at the National Native Children’s Trauma Center at the University 

of Montana. 

I have been a professor at the University of Montana tenured in 

psychology and education for 33 years. I have worked with children 

who have trauma for 33 years but only about half the time did I 

know what trauma was. 

Only about half the time was I able to provide trauma-informed, 

effective services. This is a very young field and the science is very 

young. I cannot give you an authentic perspective or an authentic 

Native perspective on childhood trauma but as principal investigator, I can share with you some findings from our work in the National Native Children’s Trauma Center. 

In my written testimony, I have five exhibits. The first is a chapter written for pediatricians about the impact of trauma on the developing child and the developing brain. A very important component of that message is missing from the national dialogue about 

ACE’s, Adverse Childhood Experiences. 

The missing component is the treatability of childhood trauma. 

We absolutely want to invest in long term prevention. I am reminded of a statement sometimes attributed to Chief Joseph that 

we need to consider the impacts of our actions on the next seven 

generations. But, the present Congress needs to have some solutions it can implement more quickly than that. 

The second exhibit is a handout from the National Child Traumatic Stress Network, the network created by the National Child 

Traumatic Stress Initiative of SAMHSA. 

The handout speaks to the treatability of trauma, the newness 

of the science and the importance of training clinicians who are 

currently practicing on an in-service basis and new clinicians as 

they come through our graduate and medical schools. 

The third finding I share with you is research performed by Dr. 

Mary Kaas and colleagues, not associated with our center. They believe that the prevalence of childhood trauma in Indian Country is 

probably about twice as bad as the statistic you cited, Mr. Chairman. 

According to them, using the ACE 4 point scale, about five times 

as many individuals in their sample of Native Americans tested at 

4 ACE points. In the original fluidity sample published by the Centers for Disease Control, it was 20 percent of that rate and there 

were also symptoms of trauma present. 

The fourth exhibit I offered is work done by one of my colleagues, 

Dr. Aaron Morsette, who was then a graduate student working at 

our center. Aaron tested a trauma treatment in three different reservation schools in the northern plains and found very positive results. 

26 

Native students, who qualified, who presented with trauma, on 

average, two-thirds showed significant reductions after ten hours of 

participation with a group of peers and more than half showed 

measurable reductions in symptoms of depression. 

Dr. Morsette, as we all were, has been puzzled by the prevalence 

of trauma in Indian people. His dissertation, yet unpublished but 

cited and discoverable on the Internet, examined the etiology of 

trauma in one reservation school population, using a very creative 

but valid statistic. 

Dr. Morsette was able to identify that it was grief and loss that 

appeared to contribute more powerfully mathematically to trauma 

symptoms than violence exposure. This is quite revolutionary as we 

always screen for violence exposure but screening for traumatic 

grief is not part of our standard practice yet. 

I asked Dr. Morsette, at his dissertation defense, why he did that 

and he said, it just didn’t ring true for me and it didn’t seem to 

be true for my friends and our people, so I had to put some science 

to it. 

I would share three recommendations, not the official position of 

the University of Montana but my own on what we can do immediately. 

Immediately, we need to make sure that we continue to train 

doctoral level MDs and PhDs, clinicians and researchers who are 

themselves Native. We cannot achieve our goals of self determination if in the next generation, it is non-Natives trying to lead the 

discussion about policy, research and practice. 

Second, the National Child and Traumatic Stress Initiative supports 80 funded centers with a budget of about $50 million. With 

a budget of about $75 million, that number could increase to about 

120. That network has been extraordinarily effective across the Nation and extraordinarily effective in addressing the needs of Native 

children with trauma. 

Finally, I would like to endorse the comment of Director 

Enomoto. 

Thank you for allowing us to infuse traditional cultural healing 

with evidence-based scientific approaches to trauma treatment. I 

think that is why we have been able to demonstrate the results 

that we have. 

I actually never thought I would sit in a setting such as this and 

hear a Federal official say that was not only permissible but encouraged. We really have come a long way. 

Thank you. 

[The prepared statement of Dr. van den Pol follows:] 

27 

PREPARED STATEMENT OF RICK VAN DEN POL, PH.D., DIRECTOR AND PRINCIPAL

INVESTIGATOR, INSTITUTE OF EDUCATIONAL RESEARCH AND SERVICE, THE

UNIVERSITY OF MONTANA NATIONAL NATIVE CHILDREN’S TRAUMA CENTER


1119a1.eps
28 

*The exhibits referred to have been retained in the Committee files. 

The CHAIRMAN. Thank you, Rick. 

Verne ́. 

STATEMENT OF VERNE BOERNER, PRESIDENT/CEO, ALASKA 

NATIVE HEALTH BOARD 

Ms. BOERNER. Chairman Tester, Vice Chairman Barrasso, and 

members of the Committee, my name is Verne ́ Boerner. I am the 

President and CEO of the Alaska Native Health Board. 

I submit this statement for the record. I would also like to note 

that ANHB’s testimony is supported by the National Indian Health 

Board. 

Thank you for inviting me to provide input on protecting our 

children. We all share in this awesome obligation. No group this 

size is more vulnerable, more dependent, or whose experiences will 

determine the health and prosperity of our people. 

I sit here before you with two asks that go toward breaking the 

cycle of violence and abuse. Repeal Section 910 of the Violence 

Against Women Act. We will be watching for the Safe Families and 

Villages Act and how that progresses as well. 


1119a2.eps
29 

The second ask is to increase the Indian Health Service behavioral health funds in a non-grant and non-competitive manner and 

confer other Federal resources such as the Prevention and Health 

Fund to the IHS. 

I am extremely appreciative of my co-panelists who have painted 

a picture and have defined so well the impacts of childhood trauma. I offer to you a face to go with those numbers. 

I was sexually abused from the time I was nine years old until 

14. I lived in fear and silence those years. When the man who 

abused me told me that my sister, who turned nine years old, was 

ready, I went to the police. 

During those years, our family experienced other abuses as well. 

The aftermath was also quite devastating. I have to lift my mother 

up for her strength and support during that time. However, my sister went through this during her formative years. She later became 

an alcoholic. She too got involved with abusive men and turned 

away from the good man in her life. 

She died three days before her 29th birthday, not from overdose 

or poisoning but because she was trying to quit. 

A most painful fact is that my story is not unique. It is far too 

common. In Alaska, over 50 percent of Alaska Native women report 

having experienced some form of abuse. It is from these experiences and the women and children in our communities that I express my gratitude to my Senators, Lisa Murkowski and Mark 

Begich, for your work and efforts to repeal Section 910 of the Violence Against Women Act. Thank you. 

Addressing violence against women is a key component of breaking the cycle and preventing the associated childhood trauma. 

Regarding my second ask, the U.S. Government engages with 

tribes on a government-to-government basis seeking input on the 

Indian Health Service budget formulation process. Tribes in Alaska 

and nationally have consistently identified behavioral health as a 

key funding priority. 

The increase should not come at the expense of other IHS services and programs. Its system is already stressed and plagued by 

chronic under funding. I do understand the fiscal constraints that 

we face as a Nation, but the cost of not breaking the cycle of violence and abuse is higher still. 

Furthermore, tribes have proven to be a good investment and 

have demonstrated innovation and capacity in designing and/or 

participating in effective projects. I would like to highlight the efforts of two of ANHB’s members. 

The Alaska Native Tribal Health Consortium has long engaged 

in scientifically rigorous, culturally informed or modified approaches, one of which is the Alaska Native Adverse Childhood Experiences Study. 

This study is contributing to the general body of knowledge regarding the unique conditions and impacts that adverse childhood 

experiences have in the varied settings throughout our State. 

The second is, the Southcentral Foundation has created the Family Wellness Warriors Initiative. There are many things I can say 

about this program and its integration with others, but due to the 

lack of time, I will focus on one special aspect. 

30 

It incorporates the men. It seeks to celebrate their traditional 

role as protectors and engages them as heroes and champions. 

These are just two of the many approaches out there. They are 

doing meaningful work. Please support the efforts and allocate 

more resources so that together we can eliminate two of the most 

infrequent levels of childhood trauma. 

Thank you. 

[The prepared statement of Ms. Boerner follows:] 

PREPARED STATEMENT OF VERNE ́ BOERNER, PRESIDENT/CEO, ALASKA NATIVE

HEALTH BOARD

Chairman Tester, Vice Chairman Barrasso and Members of the Committee: 

Thank you for the opportunity to provide input for this hearing addressing one 

of our greatest charges, our children. My name is Verne ́ Boerner. I am the President 

and CEO of the Alaska Native Health Board (ANHB) and a member of the Indian 

Health Service Budget Formulation Workgroup. Established in 1968, ANHB serves 

as Alaska’s statewide voice on Alaska Native health issues. Our 26 member organizations deliver health care programs and services to over 143,000 Alaska Native and 

American Indian people residing in the state of Alaska. ANHB’s mission is to promote the spiritual, physical, mental, social, and cultural wellbeing and pride of Alaska Native people. 

By way of introduction, my appreciation for your having this hearing is personal 

as I was sexually abused from the time I was 9 years old until I was 14. I lived 

in silence and fear for all that time until right before I went to the police. What 

prompted me to go to the police was when my sister turned 9 years old the abuser 

told me she was ‘‘ready.’’ 

In addition, my mother and older brother were victims of domestic violence, we 

spent nights at women’s shelters, and my younger sister started to experience the 

abuse I had and aftermath of the full breakdown of the family unit. She later became an alcoholic and involved in abusive relationships. She passed away three 

days before her 29th birthday from ‘‘complications due to chronic ethanolism.’’ Her 

death was categorized as ‘‘Natural.’’ I know it is a technical term, but there is nothing natural about that. 

Requests. With regard to preventing and addressing childhood trauma in Indian 

Country, ANHB has two asks: 

1. Repeal Section 910 (the Alaska exception) of the Violence Against Women Act 

(VAWA), and 

2. Increase Indian Health Service behavioral health program funds in a nongrant and non-competitive manner and provide other federal sources such as 

the Prevention and Public Health Fund. 

As of the time of this writing, we did not have a copy of the recommendations 

of November 18 to the Attorney General regarding trauma among Native children, 

but we look forward to reviewing the report and making further comments. 

Repeal of Section 910 of the Violence Against Women Act 

We support repeal of the ‘‘Alaska exception’’ to the Violence Against Women Act. 

While we recognize the unique situation in Alaska, it is clear that the current system is failing our women and families. The Tribal governments in Alaska are not 

able to carry out local, culturally relevant solutions to effectively address the lack 

of law enforcement and prosecution in villages that allows perpetrators to slip 

through the cracks. The law enforcement and judicial systems created and administered by Indian tribes or tribal organizations within Alaska will be more responsive 

to the need for greater local control and accountability in the administration of justice than centralized State of Alaska systems. (Kastelic, 2014) 

We specifically extend our appreciation to Senator Murkowski and Senator Begich 

for their support and efforts to repeal the Alaska exception of the Violence Against 

Women Act. Thank you also, Senator Murkowski, for your emphasis on finding increased resources for courts in Alaska to deal with what would be expanded VAWA 

authority. 

Alaska Native women face domestic and sexual violence in the home at disproportionate rates and in many cases this violence is witnessed and/or experienced by 

children in the home, as was the case in my family. And sadly, I personally witnessed the long-term effects of trauma with my sister. According to the National Indian Child Welfare Association, Alaska Native children made up 17.3 percent of 

31 

Alaska’s child population, yet they represented 50.1 percent of the substantiated reports of maltreatment. (Kastelic, 2014). No matter the challenges, we must endeavor 

to develop the jurisdictional framework in Alaska to enable tribal communities to 

protect our families. 

Addressing violence against women is a key component of breaking the cycle and 

preventing the associated childhood trauma. 

Increase Funding for Behavioral Health 

Indian Health Service 

The IHS Budget Formulation Process is a government-to-government consultation 

process and is reflective of the tribes’ own determined priorities. Behavioral health 

and Alcohol and Substance Abuse Programs have consistently been identified as priorities. Funding to these IHS programs, granted in a non-competitive and non-grant 

manner, offers the greatest flexibilities to tribes to exercise self-determination, and 

has a track record of success. ANHB urges Congress to enact the Budget Formulation Workgroup’s recommendation that Mental Health funding be increased by 

$51.5 million above the President’s FY 2015 request for a total of $134 million. 

Tribes think holistically and they have specified that a continuum of care for both 

prevention and treatment through integrated behavioral health programs is needed. 

Congress agreed, codifying it in the Indian Health Care Improvement Act (IHCIA). 

Unfortunately to date, the new authorities in the IHCIA have not had the appropriations needed to implement the provisions. 

While we can point to the IHS budget increasing in recent years, those increases 

are in particular areas—most welcome, to be sure—but the area of behavioral 

health has not seen program increases. 

Prevention and Public Health Fund 

It was encouraging when the Administration proposed as part of the FY 2012 budget to allocate $50 million of the Affordable Care Act (ACA) Prevention and Public Health Fund (PPH) for coordinated tribal services to prevent substance abuse 

and suicide. The Administration proposed to administer the program through 

SAMHSA, with funding being provided to each applicant tribe and additional funding based on population and need. While the PPH funding does not need to be appropriated ($17.7 billion over ten years, some of which has been rescinded) because 

it is mandatory funding. Congress must allocate from the Fund on an annual basis, 

and unfortunately did not allocate the funds for tribes as requested by the Administration. 

We find that funding provided directly to tribal organizations works better than 

having it filter through the state or another organization and allows us to better 

design services, including the inclusion of culturally appropriate services. We ask 

Congress to allocate $50 million of the PPH Fund to the Indian Health Service for 

behavioral health services and that it be on a recurring basis. 

Alaska Approaches 

Tribal programs in Alaska have taken a variety of approaches toward preventing 

and addressing childhood trauma. These approaches are innovative, scientifically 

rigorous, and are community and culturally based. The following are just a few of 

the activities that Alaska tribes have implemented. 

Alaska Native Tribal Health Consortium 

The Alaska Native Tribal Health Consortium’s vision is that Alaska Native people 

are the healthiest in the world. To achieve this vision, Alaska Native people need 

healthy families and healthy communities. Domestic violence and sexual violence 

(DV/SV) can profoundly wound individuals, families and whole communities. It is 

common to hear that DV/SV disproportionately affects Alaska Native people. By ensuring we have reliable data and by monitoring changes over time, we can better 

understand which programs and interventions are most successful. The ANTHC Adverse Childhood Experiences Study adds to the growing literature and general understanding of the problem. Every child, teen, pregnant woman, adult, and Elder 

is precious and deserves to live a life without violence. Having communities without 

DV and SV would contribute to making the vision of Alaska Native people as the 

healthiest people in the world a reality. (Alaska Native Tribal Health Consortium, 

2013) 

Yukon Kuskokwim Health Corporation 

Yukon Kuskokwim Health Corporation’s (YKHC) incorporated trauma-informed 

services by implementing the Adverse Childhood Experiences (ACEs) questionnaire, 

including translating the questionnaire into Yupik. YKHC’s staff is comprised of all 

Native Alaskans who have personal experience with trauma. The questionnaire has 

32 

been given to each of their clients entering the Crisis Respite Center, and has also 

been administered to the general population at several Family Wellness/Suicide Prevention gatherings in the YKHC area of Alaska. The biggest reaction from YKHC’s 

clients has been, ‘‘I’ve never told anyone this before.’’ Many are relieved that someone is asking them about trauma and is willing to help. YKHC found that the most 

valuable use of the ACEs Survey was to open a conversation with the client and 

begin to work through their residual responses to trauma. (Bryan) 

Tanana Chiefs Conference 

Tanana Chiefs Conference (TCC) also uses a Trauma-informed Services approach, 

which begins when a new client is screened into the various programs TCC offers. 

TCC’s approach empowers clients as they are given choices as to how long, and 

what kind of therapy they will accept, and what issues to address. TCC offers early 

intervention and prevention therapies as well as longer styles of therapy. This approach builds on each client’s individual strengths and cultural ties, which are seen 

as major components to the program. The therapist and clients work together as 

equals in developing a treatment plan; if it is determined that one is needed. The 

goal is to increase the client’s skills to allow them to manage their symptoms and 

reactions on their own.’’ (Bryan) 

Southcentral Foundation 

For more than 15 years, Alaska Native people have been leading the charge to 

end domestic violence, child abuse and child neglect in Alaska through Southcentral 

Foundation’s (SCF) Family Wellness Warriors Initiative (FWWI). SCF’s strategies 

are based on Alaska Native cultural strengths and bringing back traditional values 

that are protective of family wellness. FWWI helps build the capacity of individuals, 

families and communities to reverse the trends of domestic violence and child maltreatment. Over a period of many years, we have been successful in providing the 

education, tools and skills needed to bring awareness to the issues; creating safe environments for sharing and healing; and initiating changes in attitudes, behaviors, 

and beliefs. 

The work of ending domestic violence, child abuse and child neglect is too important to keep it within the bounds of a few programs or services. For broader impact, 

FWWI is also built into the structure and design of SCF’s Nuka System of Care. 

Every year, new improvements are made to the way that trauma and abuse are assessed and responded to throughout the health care system. (Southcentral Foundation, 2014) 

In closing, Alaska Native Health Board thanks you for your attention to child 

trauma issues. We believe that repealing Section 910 of the Violence Against 

Women Act and increased resources for tribal behavioral health services will substantially help break the cycle of childhood trauma in tribal communities. 

*** 

Works Cited 

Alaska Native Tribal Health Consortium. (2013, March). Retrieved November 16, 

2014, from ANTHC Today: http://www.anthctoday.org/epicenter/publications/ 

alaskanativefamilies/dvsaBulletinl2ndledlfinal.pdf 

Bryan, M. (n.d.). ATTC Network. Retrieved November 16, 2014, from http:// 

www.attcnetwork.org/find/news/attcnews/epubs/addmsg/documents/TraumalPartl3%20May%2031.pdf 

Kastelic, S. (2014). Deputy Director, National Indian Child Welfare Association. 

Portland: National Indian Child Welfare Association. 

Southcentral Foundation. (2014, January). Southcentral Foundation. Retrieved 

November 16, 2014, from Southcentral Foundation: https:// 

www.southcentralfoundation.com/newsletter/2014JanFebANN.pdf 

The CHAIRMAN. Thank you all for your testimony. It is very much 

appreciated. 

We will do five minute rounds. I will start with you, Mr. 

Listenbee. 

Communities often seek to integrate traditional healing practice 

into programs aimed at addressing trauma. Can you tell me what 

obstacles exist to allow for traditional healing programs to happen? 

Mr. LISTENBEE. Senator, we know from the report submitted by 

the advisory committee yesterday that incorporating traditional 

33 

healing programs into current practices and therapeutic practices 

is really important. 

We know that one-third of children who have been given an opportunity to use traditional healing methods or traditional cultural 

healing, persons have chosen that over other approaches. We know 

that half of the adults have chosen those approaches over other approaches as well. 

We think it is very important. We encourage it and we have tried 

to implement that in the various programs that we have developed 

throughout the Department of Justice. 

The CHAIRMAN. You don’t see any roadblocks though? 

Mr. LISTENBEE. Senator, as we know from the report that was 

submitted yesterday, there are a number of problems and issues involved with developing new approaches and incorporating traditional approaches into current practices. 

We know these are things that have to be carefully considered 

and reviewed. As we go forward in terms of implementing the recommendations of the report, we expect that we will be working 

closely with experts in the field to help develop more effective approaches. 

The CHAIRMAN. I would just say that if there are roadblocks, we 

need to find out how we can resolve those roadblocks because I 

think this could add to the effectiveness of any sort of programs out 

there. 

Dr. van den Pol, I have a question for you. 

Your testimony mentions that new research suggests that trauma may be tied more to loss and bereavement than to violence. 

Can you tell me what that means for Indian Country? 

Dr. VAN DEN POL. Mr. Chairman, my impression is subjective 

and has not been subjected to any kind of systematic study but in 

my conversations with many Native colleagues, there is a vast disparity in the number of deaths of loved ones they have experienced 

as opposed to my non-Native colleagues. 

This is something that comes up as a surprising matter 

anecdotally and I don’t know of anyone who has looked at it in a 

systematic fashion. When Dr. Morsette was working with clients in 

his trauma treatment regimen, he did not ask them, what is wrong 

with you. He asked them, what happened to you? 

What they talked about was having their grandma die from cancer or losing a sibling to an accident. It seems that qualitative research is very suggestive about child traumatic grief, particularly 

for Native youth. 

The CHAIRMAN. I am going to turn the Chair over to Senator 

Cantwell. 

Senator CANTWELL. [Presiding] Thank you. 

Senator Murkowski? 

Senator MURKOWSKI. Thank you, Madam Chair. 

I will be brief. Hopefully the rest of my colleagues can move forward. 

I want to thank all of you, particularly Verne ́, for your testimony. 

It was truly spoken from the heart. 

Know that I am committed. We are going to get this Section 910 

repealed, get that done and over with. 

34 

I also want to acknowledge Valerie Davidson in the room who 

has been on the Task Force on American Indians and Alaska Native Children Exposed to Violence. I really appreciate your work on 

that, Val. Thank you for that. 

There has been a lot of discussion about the funding and how do 

we make this available through grants. You have mentioned nongrant, IHS funds. This is going to be a query to you, Administrator 

Listenbee. 

When we talk about grants, we appreciate the variability of that 

funding. The fact of the matter is that not only do our tribal justice 

programs have to be adequately funded but they need to occur on 

an annual basis. You need to be able to rely on them. 

Right now, our tribes in Alaska do not receive Department of Interior law enforcement nor tribal court funds. I am working on 

that. I am on the Interior Appropriations Committee. I think we 

are going to be in a position to perhaps advance that. 

I am wondering whether the Department of Justice would be 

willing to put forward a formula-funded structure for tribal justice 

programs? We have to be able to have the resources to provide for 

this level of safety and security. 

Can you at least tell us that you are going to look at it? We have 

to make some headway on this. 

Mr. LISTENBEE. Senator, what we know is that we agree with the 

advisory committee that the current method for providing funding 

for unique financial and criminal justice issues in Alaska does not 

really address the concerns. We recognized this issue some time 

ago because the tribes brought it to our attention. 

At the Justice Department, we developed the Coordinated Tribal 

Assistance Solicitation Process in 2010 and we have been using 

that since then. This process allows the Department to streamline 

the application process and to more effectively address specific concerns raised by the tribes. 

It also gives American Indian and Alaska Native communities 

the opportunity to focus their concerns on their most important 

criminal justice and public safety issues and then to develop innovative programs and evidence-based practices to address them. 

Along with that, Senator, since fiscal year 2011, the President’s 

Office of Justice Programs Submission of Budget has indicated and 

requested a 7 percent setaside that would be used for this particular purpose. 

We are hoping that 7 percent setaside will be coming forth sometime in the not too distant future. 

Senator MURKOWSKI. I would really encourage that. Quite honestly, folks don’t want to hear that we are engaged in more process. 

They want to know that we have resources on the ground. They 

know that tribal courts are funded in the lower 48; they know that 

they are not funded in Alaska. That doesn’t make sense to them; 

it doesn’t make sense to me. 

We are going to be working on this. We would like the Department of Justice to be working with us. 

Very quickly, Dr. Roubideaux, we have had this conversation before about our village-built clinic program and the fact that these 

clinics do not have the funding. They simply do not have the funding and yet when we want to make sure that we have behavioral 

35 

health aides, when we want to make sure that we have our community health aides who can be that resource for those who have 

been violated, for those who do need that help, we don’t have these 

systems in place. 

I was just in a conversation yesterday where once again, we are 

concerned that we are not getting any support from the Administration on ensuring that our village health clinics are adequately 

funded. 

We have to have these instruments in place. We have to have the 

protective side through the ability to enforce some level of justice, 

but we also have to have the health side. You have got to help us 

with these village-built clinics. You have got to help us. Yes? 

Dr. ROUBIDEAUX. Well, yes, we do want to help. That is why we 

have been working—— 

Senator MURKOWSKI. But we have not seen that through the 

budgets put forth by this Administration. We have seen zero help 

there. We need you to help us. I am going to be very direct with 

that because we are going to demand that you help us. 

We have been very polite and we have waited a long time. In the 

meantime, we are losing what we have built. 

Dr. ROUBIDEAUX. I have heard loud and clear from the tribes. It 

is a very important issue for Alaska and I would like to work with 

you on that. 

Senator MURKOWSKI. It is very important. Thank you. 

Senator CANTWELL. Senator Heitkamp. 

Senator HEITKAMP. I have just a couple quick comments. Thank 

you all for your work in this very important area and thank you 

for your personal testimony. It is so important that we tell the stories and the truth about what really is going on. 

I have a question. None of you mentioned as a potential solution 

better screening of children when they enter the education system. 

I am wondering if anyone wants to comment on whether that is a 

strategy we are pursuing anywhere and if we have better diagnosis 

which gives us a better opportunity for early intervention and better treatment options and outcomes? 

Ms. BOERNER. Yes, I do know that the Tanana Chiefs Conference 

in Alaska has implemented such a program. I can ask them to provide more information. I will definitely make sure we get that to 

you. I do know they are looking at early intervention and early 

screening starting with the school age kids. 

Yes, there are programs out there. I will get more information 

for you. 

Ms. ENOMOTO. We are also working on developing clinical measures as well as epidemiological measures to measure trauma in primary care settings and other settings where we have children and 

adults, as well as in our surveillance instruments looking at measuring trauma nationwide as it relates to mental health and substance abuse. 

Senator HEITKAMP. One of the kind of pushes for this Committee 

hearing came out of some work that I was doing in North Dakota 

with a woman there who is dealing with treatment of historic trauma. 

Great results are being experienced. When we deal with it on the 

front end, we know we have a higher graduation rate, more secure 

36 

communities, more secure kids and so this is something we can’t 

let another generation go and say, we know you feel our pain, we 

just want you to do something about it. 

This idea that we are working on it in the face of these statistics 

is not an adequate response. I think you all know that. 

I will close with that. 

Senator CANTWELL. Thank you, Senator Heitkamp. 

Thank you for your leadership. You have been quite vocal on the 

importance of this to Indian Country health overall. We appreciate 

it. 

I would like to go back to you Mr. Listenbee, about the CTAS 

grants, the coordinated tribal assistance solicitation the Department of Justice does. 

I was quoting your statistics about 75 percent of deaths of American Indian and Alaska Native youth from the ages of 12–20, that 

about 75 percent of that is related to assaults, homicide or suicide. 

The coordinated tribal assistance solicitation I am assuming are 

trying to tackle or get at that issue. 

I know in the case of the Tulalips, they had one last year for over $1 million. I am asking about the metrics that the department uses 

to measure the results of those grants. What are the kinds of activities they are undertaking to try to lower that statistic of 75 percent? 

Mr. LISTENBEE. Senator, first of all, that statistic is actually supported and comes from research done by Dolores Subia Bigfoot, a 

member of the advisory committee, based upon studies that she 

performed. It is a very solid fact. 

In terms of what the department is doing, through the CTAS 

programs, we have a wide range of efforts that are available to address this specific issue. Tribes are permitted, in the various purpose areas, to follow through and address this particular issue. 

One of the specific things we are doing through the Office of Juvenile Justice and Delinquency Prevention is tribal healing and 

wellness courts. We introduced that in fiscal year 2014. There are 

five courts that have been selected. 

Our purpose is to use traditional approaches and culturally specific approaches combined with basic tenets of drug courts to help 

children who have been exposed to alcohol abuse. We are hoping 

that will be helpful. It goes up to age 21. 

Senator CANTWELL. What are some of the measurements you are 

using on those grants? How are you coming back and saying, here 

is the amount of money we have spent and how are we being successful with this? What measurements are you using? 

Mr. LISTENBEE. Throughout the Department of Justice and Office 

of Justice Programs, we have some very standard metrics that we 

use to measure the effectiveness of all of our grants. We are applying the same metrics to the specific tribal grants we have also. 

Senator CANTWELL. If you don’t have those today, could you get 

them to me or if you have some idea about what they are, either 

way? 

Mr. LISTENBEE. We are willing to provide that information to 

you. 

Senator CANTWELL. Okay, but those are being measured you are 

saying? 

37 

Mr. LISTENBEE. Yes. 

Senator CANTWELL. Have you come up with anything you would 

like to change based on those metrics? 

Mr. LISTENBEE. At this point in time, Senator, I will have to get 

back to you on that. I don’t have any metrics information with me 

that would allow me to provide you with specific information about 

that. 

Senator CANTWELL. Okay. 

Dr. Roubideaux, I wanted to ask you about better coordination 

between mental health and other tribal services. In my State, we 

are embarking on trying to integrate both behavioral health and 

primary care services for the Medicaid population. 

What is happening in Indian Country to try to integrate those 

same services? 

Dr. ROUBIDEAUX. I am glad to hear that because we are very 

committed to integrating behavioral health into primary care. We 

have our Improving Patient Care Program which is our patient 

centered medical home initiative now in 172 sites. 

Next month, their training session is going to be on integration 

of behavioral health into primary care, making sure that we can do 

that so that we can identify and treat these conditions earlier. 

Senator CANTWELL. What do you think that means? What types 

of services? I have been impressed as I have traveled around various Indian Country health care facilities. For example, in Anchorage, the facility there is almost like the community hub. Everybody 

hangs out there. That is a very positive environment where you can 

see issues of concern or frustration on the behavioral side may be 

brought up right in the environment. 

I have been to other places where the health care delivery system is at one end of the community and maybe not even that frequently used unless someone absolutely needs it. 

How are we getting to integration of behavioral health? 

Dr. ROUBIDEAUX. With our Improving Patient Care Program, it 

helps coordinate the team of providers rather than having mental 

health over here, primary care there, dental here and pharmacy 

there. The whole team of providers is working together to help 

have a better coordinated response to helping identify, diagnose 

and treat the patients. 

It is something that we see as helping. Patients are telling us 

that they are more satisfied and that it creates a more welcoming 

environment as you described. I think we share the same vision of 

that is where we want our system to go. 

Through the training we are providing, the structure, through 

the accreditation process for patient center medical homes, we are 

really hoping that will help us move towards that goal. 

Senator CANTWELL. What about programs specifically on the reservations? What ideas do you have, any of the panelists, for creating better awareness on tribal reservations and an entry point 

for discussion, even if it is just education and training for tribal 

leaders or tribal elders or ways to identify problems? 

Dr. ROUBIDEAUX. For the Indian Health Service, we do a lot of 

training in partnership with tribes on mental health, alcohol and 

substance abuse, child maltreatment and all those issues. They 

give us opportunities to share best practices. 

38 

In a number of our programs, we have a lot of evidence-based 

and practice-based programs that can be replicated in other areas. 

That includes not only doing the clinical component of it, but also 

incorporating tradition and culture because we really think that is 

the way we are going to be able to address these problems more 

effectively. 

We have been using more webinars, tele-behavioral health and 

more training to try to make sure that we are not just training our 

staff, but community members, tribal leaders and youth. We are 

working with the schools as well. 

Senator CANTWELL. These statistics are so shocking. As my colleague from Alaska said, she has been to places and I have certainly been to places where the youth have expressed their own 

frustrations. 

My question is, what can we do to better orient these programs 

to somebody really being on site or integration, in this case, with 

the school systems so that these kinds of concerns, anxieties or 

pressure points by students from the behavioral health side can be 

more directly answered immediately, brought to the surface, developed or even things their friends and classmates can say, these are 

some of the things that are going on here, this is what needs to 

be dealt with. 

I see you nodding, Dr. van den Pol. Do you have something to 

add to that? 

Dr. VAN DEN POL. I am not sure that I do. I was agreeing enthusiastically with your remarks. 

I think there is huge potential in schools to address trauma. One 

of the early studies of trauma treatment was after Hurricane 

Katrina, we were invited to Jefferson Parish to work in the school 

there. 

One of our counterparts who developed the Cognitive Behavioral 

Intervention for Trauma in Schools, Dr. Lisa Jaycox with the 

RAND Corporation, evaluated a group of students who had been 

through Katrina and were sent to a clinic for mental health treatment and students who were seen in school who received the same 

treatment. 

I believe the students in the school were three to four times more 

likely to engage with the treatment program than students going 

to the clinic. 

We know where the kids are and we can get them there. Sometimes we need consent for certain kinds of treatments but I think 

in terms of looking for efficient and effective return on investments, 

one setting where we are going to find kids who have trauma is 

in schools. 

Senator CANTWELL. Thank you. 

Ms. Boerner, did you want to add something to that? 

Ms. BOERNER. I do. Within the Indian Health Care Improvement 

Act there are unfunded authorities that have been passed, one of 

which creates a continuum of care within behavioral health issues. 

One of the recommendations that came from Alaska tribes was 

to embark on training and education programs to encourage more 

tribal members to enter the field. That is something where perhaps 

existing practitioners may be able to develop a program where they 

are more present and more a part. 

39 

Hopefully we reduce some of the stigmatization that exists out 

there so there can be more open, less taboo discussions, perhaps 

creating that interest within our youth to enter the field. 

Senator CANTWELL. I am sorry, I had to confer with my colleagues. The Chairman might be returning. 

You are saying you think there are certain subjects that right 

now there is a problem because people don’t want them more openly discussed and we should be discussing them more openly? 

Ms. BOERNER. I believe that we might be able to pique the interest of our youth if we are more present out there with these programs and create more of a mentorship, an involvement. 

I think there is a lot of stigmatization and a lot of fear around 

mental health and behavioral health issues that is a barrier. It is 

not something I think many of our youth are even considering as 

a possible future. 

I think if you get more of the practitioners out there and involved 

in a sort of mentoring program, thinking of the long term effects 

of having more practitioners and the seventh generation concept. 

What we do today has those lasting impacts. Today, if our action 

is if we need something in the immediate, that is something that 

perhaps we can do, create a greater visibility of how beneficial this 

field can be to our people, then perhaps we will get those kids involved. 

Then down the line our grandchildren’s grandchildren will be 

more involved and a part of the conceptualization and creation of 

those programs. 

Senator CANTWELL. Not to put you on the spot about it, but how 

do you think that is best achieved? How do you think 

destigmatizing behavioral health could be accomplished? 

Ms. BOERNER. One reason why I am open about my own personal 

experiences is because it is something that is filled with taboo and 

the discussions are not necessarily happening. I am in a place personally where I feel I can be open and I can share those things. 

I have certain protective factors I think that allow me to do that 

and I certainly understand others do not have that but having and 

opening that conversation starts to release a lot. Once people start 

opening up and some of what I have read from the Yukon 

Kuskokwim when they have implemented the ACE study, some of 

the members said, I have never shown that before. It is sort of like 

an ‘‘aha’’ moment. 

I think having them out there, having them visible just creates 

a natural situation where the conversations are happening. Once 

that happens, it starts breaking down those barriers and builds the 

understanding. 

Senator CANTWELL. Thank you for sharing that and for what you 

are trying to do to break down the barriers. 

Ms. Enomoto, did you have a comment? 

Ms. ENOMOTO. At SAMHSA, since the time of Columbine and the 

unfortunate events there, SAMHSA has had a long track record of 

partnering with the Department of Education and the Department 

of Justice in addressing school violence and working to promote 

mental health in schools and prevent violence in schools. 

Under the President’s Now Is the Time Initiative, we have started to take that to scale where we want to launch a nationwide efVerDate Mar 15 2010 12:47 Mar 03, 2015 Jkt 092529 PO 00000 Frm 00043 Fmt 6633 Sfmt 6601 S:\DOCS\92529.TXT JACK
40 

fort to integrate schools, communities and behavioral health to 

really promote both mental health literacy, violence prevention and 

create positive school climates in every school in America. 

At SAMHSA, we would look forward to partnering with BIE, 

with tribes and their tribal schools to expand models such as Safe 

Schools, Healthy Students and mental health first aid for youth in 

Indian Country. 

Senator CANTWELL. What do you think the next step is? Is it an 

actual agreement with BIE? We clearly see from the statistics we 

have a great need. We may be seeing there are some cultural 

issues or something that may be blocking us. 

Obviously moving to more outreach efforts directly in the community, you can see they are desperately needed. 

Ms. ENOMOTO. Right. We have begun conversations with BIA. 

We would welcome more opportunities to partner with them on 

that. 

Senator CANTWELL. Okay. 

Dr. Roubideaux, I would like to ask you about the bed shortage 

issue. Obviously, we cannot simply board people at the county jail. 

Our State is moving towards trying to deal with this. How do we 

deal with the shortage of psychiatric beds in Indian Country? 

Dr. ROUBIDEAUX. It is a significant problem you have raised. It 

is something we definitely need to work more on. It is an issue, for 

example, with youth we have our youth regional treatment centers 

in 12 areas but they have a certain number of beds. 

In terms of how we pay for those, we have our Purchase and Referred Care Program where we pay for the services. As the funding 

has been increased over the past few years, thank you for your advocacy on that, we are able to pay for more referrals and that 

would help us pay for more of those services if beds are available. 

Bed availability is a huge issue. 

Senator CANTWELL. Do you have an estimate of what it would actually take to service Indian Country? Do you have a number of 

how many psychiatric beds you actually think we need and what 

the distribution looks like? 

Dr. ROUBIDEAUX. I would be happy to talk with my staff and get 

back to you with an estimate. 

Senator CANTWELL. Thank you. 

Let me see if I had any other questions for anyone else on the 

panel. 

Mr. Listenbee, the advisory committee created by Attorney General Holder released a report pertaining to criminal jurisdiction 

over non-tribal individuals. Obviously, we deal with the Violence 

Against Women Act. 

What else do we need to do to make sure we are getting justice 

for crimes committed against children? Do we need to do more to 

reform the system? 

Mr. LISTENBEE. As regards to jurisdictional issues, those are certainly very important issues. Having just received the report on 

November 18th, we are reviewing those recommendations and trying to make some decisions about how best to address that particular issue going forward. 

Earlier, you asked about suicide prevention. I want to bring to 

your attention that we have tribal youth programs that have been 

41 

around since 2010. At that time we were funded at a level of $25 

million a year to focus on developing youth leadership. We have 

been doing that since then. Funding has gone down to the $5 million level but we nevertheless bring young people together, we talk to them about leadership 

roles, we have regional leadership groups and national leadership 

groups. 

At those meetings, we do training on suicide prevention for all 

the youth who are involved. This seems to have had a positive effect on youth as they have indicated to us. We think this is one of 

the important ways we can address this issue. 

You asked earlier about activities on actual reservations. We 

support mentoring programs on reservations. We think these are 

also very helpful. We have Boys and Girls Clubs on some of the 

reservations. 

I would also like to bring to your attention that the Office of Vio- lence Against Women has more than $30 million in programs in 

Alaska. Many of them are in the rural communities and villages. 

They are focusing on developing shelters for women in those areas. 

Those are some of the only shelters available for women to address 

those specific issues. 

Senator CANTWELL. Thank you. 

I have to go vote. I will look forward to following up with you 

on the details of those resources. I will turn it over to Senator 

Franken. 

Senator FRANKEN. [Presiding] Thank you. I guess I am the chairman. I recognize Senator Franken. 

Thank you, Senator Franken. 

[Laughter]. 

Senator FRANKEN. I am sorry I couldn’t be here, I had to vote, 

obviously but I thank you for your testimony. 

I have a question that is open to anyone. I would think Dr. van 

den Pol and Mr. Listenbee may have something to say about this. 

This is about the cultural or historic circled trauma as a concept. 

What is the history of that in terms of when was that identified 

or named or understood to be part of what children or anyone in 

Indian Country faces? 

I understand it is now included in the list of traumas in this and 

this is mainly about childhood trauma but when was that named? 

What is the history of that? 

Mr. LISTENBEE. On that matter, I would have to defer to Ms. 

Enomoto or to Dr. van den Pol. 

Dr. VAN DEN POL. Senator Franken, I can’t tell you the first published study that discussed historical trauma. I can attempt to conceptualize historical trauma with a broader understanding of trauma. 

For example, part of the definition clinically is that trauma is a 

personal sense of being overwhelmed by a horrific circumstance. 

Two individuals experiencing the same automobile accident with 

the same injuries, one may be traumatized and the other may not. 

You have to ask and that is one of the things that makes early 

assessment and early screening difficult if a young child doesn’t 

have the verbal skills to answer questions about intrusive thoughts 

or insomnia, for example, whereas an adult might. 

42 

With historical trauma, when we talk to Native people, many of 

them express trauma symptoms regarding loss of land, loss of ancestors, broken treaties, lies that were told and that distress isn’t 

slight, it is considerable. It is clinically significant. 

While academics currently debate the putative validity of the 

concept of historical trauma, Native people experience it and as a 

consequence, I am convinced it is real. I don’t think the first publications using that term were more than 20 or 25 years ago. Conversation about trauma began in Vietnam but trauma in children 

began really at the end of the 1990s. 

Senator FRANKEN. Ms. Enomoto, did you want to speak? Anyone 

can speak to this. I am the chairman. Oh, you are the chairman. 

I yield myself infinite amount of time. 

Ms. ENOMOTO. Administrator Listenbee noted that SAMHSA has 

recently issued a concept of trauma and guidelines for trauma in 

practice. In that, we outline three Es for trauma: how to define the 

individual experience of trauma. First, there is an event or a series 

of events which a person perceives as potentially life threatening 

or which result in physical or emotional harm. 

There is the experience of that event. As Dr. van den Pol noted, 

it could be how the individual perceives or lives through that event 

and then the long term adverse effects of that event. 

For two children who are bullied at school, you might imagine 

that one child who is raised in a nurturing home with safe and stable relationships might have more resilience and coping skills in 

order to address that bullying whereas another child who has been 

physically or sexually abused, who has witnessed domestic violence 

or who has been bounced around from multiple foster homes might 

not be able to deal with that bullying in the same way. 

As the science tells us, our bodies are biologically primed to react 

to the world as a more dangerous and threatening place if we have 

experienced multiple adverse events and we have been stimulated 

in that fight or flight mode over time. 

You can imagine that historical trauma, while there are these 

broad political, social, cultural, legal wrongs that have occurred, 

also translate into very concrete actions. The first reports on the 

boarding schools, for example, from the 1960s outlined terrible 

crimes against young children and families. 

In my recent visit to Fort Belknap, I heard a very sad story 

about someone’s grandmother who was sent away to boarding 

school at a very young age. But the gentleman I was talking with 

said, but she couldn’t read. I said, ‘‘she went to boarding school, oh, 

they didn’t learn anything there’’. They were subjected to forced 

labor, to significant abuse, to the degradation of their culture and 

their language. 

When these young children are removed from their homes for 

three, four, five or ten years and then return home, how can they 

reintegrate into their families? How can they become parents when 

their experience of childhood and their upbringing was by strangers, by abusive adults, by people who were supposed to be trusted 

who actually violated that trust? 

Those experiences, while historical, play out in families, in 

homes, in communities. Whether it is the historical trauma of the 

Holocaust, the historical trauma of slavery or the historical trauma 

43 

of the Indian boarding schools, you can see where those things can 

play out in the homes of families with the next generation who 

grow up to witness people who have difficulties with attachment, 

substances, mental illness and so on. 

Senator FRANKEN. Mr. Chairman, may I have a little bit more 

time. 

The CHAIRMAN. [Presiding.] Yes. 

Senator FRANKEN. I have no doubt that historical trauma is a big 

piece of this. The way you define it was how your actions affects 

seven generations down. There is historical trauma in a lot of different senses. One is what a parent does can traumatize. 

I noticed in your attachments that the definition of trauma is 

normal reaction to an abnormal event. These are adverse childhood 

experiences we are talking about. 

What I wanted to get to is that if the idea of, the history of cultural trauma, historical trauma is new, I would like to say that I 

also think about the absence of cultural identity, the absence of a 

language, and the absence of a cultural identity. 

I am Jewish. I am not a terribly devout Jew but I know I am 

Jewish and it is very much a part of my identity. I probably went 

into comedy in no small part because I am Jewish. It means a lot 

to me and who I am. 

What I have heard from you and read from you, Mr. Listenbee, 

is about culturally sensitive treatments. What I want to know is 

how old that is, what is the history of that and how do we measure, 

how do we begin to measure the effects of that, define it and define 

how we use that because I think that is terribly important. 

Mr. LISTENBEE. I am not an expert on this issue so I will make 

one brief comment about it. 

The science of adolescent development has grown tremendously 

in the last two decades. Neurosciences have grown. Our ability to 

actually watch the brain as it responds to different types of stimuli, 

using a variety of new tools that have come on line in the last two 

decades. 

That science has become powerful enough so that the United 

States Supreme Court in several major decisions has relied upon 

the science of adolescent development and the neurosciences that 

accompany it. 

I can tell you that these are new sciences for us. We are trying 

and tasked by the various experts with which we deal to do as 

much research as we can to better understand how adolescent development is derailed by trauma. We know that it is but we don’t 

know always how to get children back on task. 

We know that trauma informed care helps but it is still a new 

field. We do know we are heading in the right direction. We know 

that trauma for American Indian and Alaska Native children derails their normal development. We know a lot of the things science 

is telling us can help us get back on line. 

That is enough to be dangerous, but it is what I know and what 

I have learned from really great experts when I worked with the 

Attorney General’s National Task Force on Children Exposed to Violence. 

I would add one other thing. Those experts told us this. They 

said that all American children should be assessed to determine 

44 

whether they have experienced trauma at every important juncture, when they go to school, when they go to see their pediatricians, and if they have experienced trauma and it has derailed 

their normal development, what we need to do is get them trauma 

informed care. 

That is what I know. I know that from the experts but if you 

take me farther than that, Senator, I would have to turn to my esteemed colleagues on the panel to explain the mechanics of it. 

The CHAIRMAN. We would love to have you do that except the 

next vote has been called, so I think we have to wrap this up. I 

know I look like I run the 100 in less than 10 seconds but I don’t. 

I just want to thank the panel members for being here. Those of 

you who have traveled long distances, a special thank you. The 

hearing record will remain open for two weeks. There will be some 

written questions. You have been a great wealth of information, all 

of you. I just want to thank you all for being here today. 

With that, the hearing is adjourned. 

[Whereupon, at 3:53 p.m., the Committee was adjourned.] 

(45) 

A P P E N D I X 

PREPARED STATEMENT OF RALPH FORQUERA, EXECUTIVE DIRECTOR, SEATTLE INDIAN

HEALTH BOARD

Chairman Tester and members of the Senate Committee on Indian Affairs, my 

name is Ralph Forquera. I am the Executive Director for the Seattle Indian Health 

Board in Seattle Washington. The Health Board is an urban Indian health organization partially funded by the Indian Health Service. We provide direct and enabling 

health services for urban American Indians and Alaska Natives in Western Washington. 

One of the services offered here at the Health Board is mental health counseling. 

In the last year, with expansion of the Medicaid program under the Affordable Care 

Act, the Health Board has likewise expanded its mental health services to better 

serve Indian youth. Over the years, we have been acutely aware of mental health 

problems among our urban Indian youth. Many face enormous social challenges 

being an Indian living in a city. This often shows up at school where we continue 

to see a high drop out rate among Indian youth and declining academic performance 

starting at the middle school. We are also aware that some Indian youth turn to 

gangs as a way of finding protection from bullying, and as a source of identity. For 

Indian girls, this can often result in sexual abuse or in some instances, coercion into 

prostitution and drugs. 

As noted during a recent visit by Chairman Tester to our agency, urban Indians 

continue to be a mostly invisible population. Local resources including law enforcement and the public schools are ill prepared to address the social and cultural challenges that Indian youth face. The Health Board itself has limited resources to 

reach Indian youth. The fact that they are geographically dispersed throughout the 

metropolitan area means that finding Indian youth and offering emotional support 

is difficult. For the few that we work with, we know that there are many that remain without the proper attention needed. 

Urban Indians are often overlooked when legislation regarding Indians is considered. For example, urban Indians are not included in the Violence Against Women 

Act directives for Indian Country. Funding through the Indian Health Service is 

limited to the single line item in the annual budget, so funds allocated for specific 

Indian health needs, like mental health, may not be available for urban Indians. 

We do receive a small grant for mental health generally from the Indian Health 

Service, but the resource is limited. With more than 7 out of 10 Indians now living 

in cities, according to the 2010 United States Census, a large number of Indian 

youth are living in cities without adequate social, cultural, or clinical support. 

Cities provide unique mental health challenges for Indian youth. In most cases, 

the small number of Indians in any given region of a major city makes their presence almost invisible. In schools. there are seldom more than a feNA students and 

often, they come from different tribes with different cultural roots. Because some 

come from families where educational success was not likewise achieved, nearly a 

quarter of the Indians in the Seattle School District are enrolled in special education. While well meaning to get extra help for an Indian student, by placing an 

Indian youth in special education, the child may find this label added to other labels 

that may negatively reflect on their self-image. These unintended consequences of 

educational strategies are only appreciated by the Indian community. Without guidance from the community to recognize these cultural differences, a school district 

may not think to consider these matters when addressing the educational needs of 

native students. 

While a growing percentage of native youth live in loving homes with supportive 

families, others are not so fortunate. In cities like Seattle, the cost of living is quite 

high and the educational demands for reasonable employment are extensive. In this 

vane, we often find Indian children without proper parental supervision or living in 

conditions that are not conducive to sound mental and emotional health. Drugs, alcohol, violence, and the insecurity that comes from poverty afflict a significant numVerDate Mar 15 2010 12:47 Mar 03, 2015 Jkt 092529 PO 00000 Frm 00049 Fmt 6601 Sfmt 6621 S:\DOCS\92529.TXT JACK
46 

ber of Indian youth. The ability to concentrate in school may be compromised by 

hunger or the emotional scars of an unsafe life. 

Statistics are scarce regarding urban Indians. As a mostly invisible population, 

statistics related to Indians in cities is often lumped in the ‘‘other’’ category denying 

local leaders of important information to help plan and advocate for assistance. The 

small number of Indian youth in any single school district makes educational assistance difficult. Funding for Indian education, like other safety net services has declined over the last few decades while need has grown. Until and unless groups like 

the Senate Committee on Indian Affairs demand that local municipalities and other 

government institutions collect and analyze data on urban Indians and provide adequate support, the population will remain invisible and help will never reach those 

most in need. 

Mental health is a serious health epidemic among Indian people both on and off 

reservation. The effects of untreated mental health problems is witnessed in incarceration, domestic and sexual violence, drug abuse and alcoholism, suicide, poor 

school performance, high—school drop out rates starting in middle school, and the 

many manifestations that accompany mental and emotional disharmony. We share 

the concerns of the members of the Senate Committee on Indian Affairs that there 

is a grave need to expand mental health services for Indian youth. Please remember 

as you deliberate that many of these youth live in American cities. Addressing youth 

mental health must reach beyond the reservation boundaries to American cities if 

the crisis in mental health among Indian youth is to be effectively addressed. 

Thank you. 

PREPARED STATEMENT OF RRICHA MATHUR, POLICY RESEARCH ASSOCIATE/PROGRAM

MANAGER, FIRST FOCUS

Chairman Tester and Vice Chairman Barrasso, we thank you for the opportunity 

to submit this statement for the record in response to the recent Committee hearing 

on ‘‘Preventing and Addressing Childhood Trauma in Indian Country.’’ 

The First Focus Campaign for Children is a bipartisan advocacy organization 

dedicated to making children and families a priority in federal policy and budget 

decisions. Our organization is committed to promoting policies that serve the best 

interest and safety of children in the child welfare system. As you know, child abuse 

and neglect often contribute to long-lasting trauma in children and can impede child 

wellbeing and healthy development. We are concerned, as you are, by data and reports pointing to disproportionality in incidence of child abuse and neglect on Indian 

reservations and hope we can identify and promote effective and appropriate programs and services to address maltreatment for this vulnerable population. 

A number of societal factors contribute to child abuse and neglect on Indian reservations. In 2009, 32.4 percent of American Indian children under the age of 18 

lived in poverty. Unemployment rates for AI/AN adults are 14.6 percent—almost 

double that of White unemployment rates nationally.1, 2 2 Financial instability can 

often strain families and reduce a parent’s ability to manage stress and respond appropriately to a child. It can often mean that a parent feels unable to meet the 

needs of his or her child(ren). There is also a high propensity for sexual violence, 

substance abuse and trafficking on tribal lands due in part to a historic lack of law 

enforcement on Indian reservations.3 AI/AN women are 2.5 times more likely to experience sexually violent crimes that other women.4 These factors and others place 

AI/AN children at an increased risk for abuse and neglect and must be addressed. 

A recent Department of Justice report, Ending Violence so Children can Thrive, 

authored by the Attorney General’s Advisory Committee on American Indian/Alaska 

Native Children Exposed to Violence, underscores the urgent need for additional resources and supports for this population of children. The Committee found that AI/ 

AN children experience violence at higher rates than any other race in the United 

States and face significant issues due to trauma resulting from exposure to violence. 

’’The immediate and long term effects of this exposure to violence includes increased rates of altered neurological development, poor physical and mental health, 

poor school performance, substance abuse, and overrepresentation in the juvenile justice system. This chronic exposure to violence often leads to toxic stress reactions and 

severe trauma; which is compounded by historical trauma.’’ 5

We fully support the Committee’s efforts and would like to highlight several key 

recommendations included in its report: 

1.3 Congress should restore the inherent authority of American Indian 

and Alaska Native (AI/AN) tribes to assert full criminal jurisdiction over all 

persons who commit crimes against AI/AN children in Indian country. 

47 

Comment: Tribes must be given the authority to adjudicate crimes in their territories to deter violence from occurring and to impose penalties on those who commit 

crimes against children. The lack of enforcement by federal authorities to prosecute 

criminals in these areas and the powerlessness of the tribal courts to hold perpetrators responsible has historically attracted criminals to Indian country. Much of the 

trauma experienced by AI/AN children is the result of violence and empowering 

tribes to carry out justice on their lands will help reduce the incidence of violence, 

and therefore trauma and services needed. 

1.4 Congress and the executive branch shall direct sufficient funds to AI/ 

AN tribes to bring funding for tribal criminal and civil justice systems and 

tribal child protection systems into parity with the rest of the United 

States and shall remove the barriers that currently impede the ability of 

AI/AN Nations to effectively address violence in their communities. 

Comment: Tribal programs are underfunded and many problems with the judicial 

and child protection programs cannot be solved until more money is invested in 

these programs. The United States, as a trustee of tribal lands and resources, has 

an obligation to ensure the wellbeing of AI/AN tribes. Specifically, increases in funding should be made for the Department of Interior: Welfare Assistance and Indian 

Child Welfare Act On-Reservation Programs and the Department of Health and 

Human Service’s Promoting Safe and Stable Families and Child and Child Welfare 

Services programs. 

2.1 The legislative and executive branches of the federal government 

should ensure Indian Child Welfare Act (ICWA) compliance and encourage 

tribal-state ICWA collaborations. 

Comment: A recent policy brief authored by the National Indian Child Welfare Association identifies ICWA’s key requirements as: 

1) Encouraging more intensive examination of the efforts to prevent removals 

of AI/AN children and rehabilitate their parents, 

2) Improving the identification of tribal and relative families who can serve as 

placement resources for AI/AN children, 

3) Increasing access to culturally appropriate services, 

4) Clarifying roles between states and tribes in child welfare matters, 

5) Increasing sharing of funding and other resources between states and tribes, 

and 

6) Stimulating the development of state policy to improve the effectiveness of 

services and supports for AI/AN children and families. 

Unfortunately, implementation of these requirements has been varied and the 

purpose of these provisions is not being met. Lack of oversight by federal authorities 

as well as limited resources appropriated have made it difficult for ICWA to reach 

its potential.6

2.6 The Secretary of Health and Human Services (HHS) should increase 

and support access to culturally appropriate behavioral health and substance abuse prevention and treatment services in all AI/AN communities, 

especially the use of traditional healers and helpers identified by tribal 

communities. 

Comment: Adults with substance abuse and behavioral health issues can endanger the lives of surrounding children in their communities as well as those in their 

care. Investments must be made in preventative services to strengthen families so 

that children are not exposed to violence, abuse, and neglect in the first place and 

to empower members of tribes through resources and culturally appropriate 

trainings so they can provide services to their peers. In addition, funding and access 

to mental health services by AI/AN children is essential. Investments should continue to be made in the Children’s Mental Health Initiative system of care grants 

and the Children and Family Programs circle of care grants. 

Moving forward, we believe the swift and effective implementation of all of the 

Committee’s recommendations is vital to improving the lives of AI/AN children. 

An all too common response to the violence and trauma AI/AN children experience 

is to place them in the foster care system. Yet there are practice concerns that need 

to be addressed. AI/AN children are three times more likely to be reported to child 

protective services and twice as likely to remain in foster care for more than two 

years than their non-AI/AN peers. For example, in North Dakota, AI/AN make up 

9 percent of the population, but 30 percent of the state’s child abuse victims.7 This 

overrepresentation of AI/AN children in foster care can be, in part, attributed to a 

bias in the system, leading child protective services to view certain cultural practices as child neglect or abuse, or view AI/AN families as less likely to benefit from 

48 

family preservation or alternate response, services and supports that would keep 

them out of the foster care system, or even perhaps, that these families are inherently more likely to be abusive and criminal and removal of a child is almost always 

the right choice. 

ICWA addresses some of these concerns by recognizing the important role of 

tribes in removal and placement decisions and by providing protections to keep AI/ 

AN families safely together and children connected to their communities and cultures. However, widespread non-compliance with ICWA and a lack of adequate services and supports for American Indian families continues to place high numbers of 

American Indian children at risk of removal and entry into the foster care system. 

We are encouraged by Attorney General Holder’s December 3rd announcement 

that the Department of Justice is launching a new initiative to promote compliance 

with ICWA. States are also working to implement pieces of ICWA into their state 

codes by incorporating new AI/AN specific definitions, ensuring notification to AI/ 

AN parents and tribes of custody proceedings, and increasing collaborations between 

states and tribes. States are also issuing guidance to providers and relevant agencies to encourage compliance with ICWA.8 We hope that Congress will do its part 

as well and make the necessary resources available to aid the Administration in this 

important effort.9

We thank you again for the opportunity to submit this statement for the record 

and look forward to working with you to ensure that the recommendations put forth 

by the Attorney General’s Advisory Committee are fully implemented. 

llllllllllllll 

1 Aspen Institute, Fast Facts on Native American Youth and Indian Country 

(Sept. 2013), Available at http://www.aspeninstitute.org/sites/default/files/content/images/Fast%20Facts.pdf. 2 Simmons, David, Improving the Well-Being of American Indian and Alaska Native Children and Families through State-Level Efforts to Improve Indian Child Welfare Act Compliance (Sept. 2014). Available at: http://www.nicwa.org/government/ 

documents/Improving%20the%20Well-being%20of%20American%20Indian 

%20and%20Alaska%20Native%20Children%20and%20Familiesl2014.pdf 3 Substance Abuse among American Indian or Alaska Native Adults, June 24, 

2010. Available at http://www.samhsa.gov/data/2k10/182/AmericanIndian.htm 4 Patricia T jaden and Nancy Thoennes, Full Report of the Prevalence, Incidence, 

and Consequences of Violence Against Women, pg. 23. Available at https:// 

www.ncjrs.gov/pdffiles1/nij/183781.pdf. 5 U.S. Department of Ending Violence So Children Can Thrive, Attorney General’s 

Advisory Committee on American Indian and Alaska Native Children Exposed to Violence (Nov. 2014), Available at http://www.justice.gov/sites/default/files/ 

defendingchildhood/pages/attachments/2014/11/18/finalaianreport.pdf 6 Simmons, David, Improving the Well-Being of American Indian and Alaska Native Children and Families through State-Level Efforts to Improve Indian Child Welfare Act Compliance, pg. 4 (Sept. 2014). Available at: http://www.nicwa.org/government/documents/Improving%20the%20Wellbeing%20of%20American%20 

Indian%20and%20Alaska%.20Native%20Children%20and%20Familiesl2014.pdf 7 Tomothy Williams, Officials See Child Welfare Dangers on a North Dakota Indian Reservation (July 7, 2014), Available at http://www.nytimes.com/2012/07/ 

08/us/child-welfare-dangers-seen-onspiritlakereservation.html?pagewanted=all&lr=0 8 Simmons, David, Improving the Well-Being of American Indian and Alaska Native Children and Families through State-Level Efforts to Improve Indian Child Welfare Act Compliance, pg. 9 and 10 (Sept. 2014). Available at: http://www.nicwa.org/ 

government/documents/Improving%20the%20Wellbeing%20of%20American 

%20Indian%20and%20Alaska%20Native%20Children%20and%20Familiesl2014.pdf 9 Attorney General Eric Holder Delivers Remarks During the White House Tribal 

Nations Conference, Dec. 3 2014. Available at: http://www.justice.gov/opa/speech/ 

attorney-general-eric-holder-delivers-remarks-during-white-house-tribal-nations 

49 

PREPARED STATEMENT OF GWENDOLYN PURYEAR KEITA, PH.D., EXECUTIVE

DIRECTOR/PUBLIC INTEREST DIRECTORATE, AMERICAN PSYCHOLOGICAL ASSOCIATION


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PREPARED STATEMENT OF THE NATIONAL INDIAN CHILD WELFARE ASSOCIATION

(NICWA) 


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RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. JON TESTER TO

RICK VAN DEN POL

Question. One of the stated goals of the National Native Children’s Trauma Center is to significantly increase the cultural relevancy of the interventions it disseminates across Indian Country. In its trainings and consultations, how exactly does 

the Center work to ensure that cultural practices are incorporated into treatment 

for behavioral health? 

Answer. In the thirteen years that we have been treating youth with trauma in 

Indian Country, we have seen a positive shift in the willingness of federal agencies 

to allow Native cultural practices to be included in evidence-based trauma treatment. 


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In about 2003, the 40-year old field of Implementation Science was not well understood. Implementation Science is concerned with ‘‘high fidelity’’ implementation 

of treatment protocols. Procedural deviations were considered methodological and 

clinical flaws. However, during the past five years Implementation Science has expanded to include ‘‘treatment optimality,’’ and the inclusion of cultural practices has 

proven an excellent fit within a framework of treatment optimality research. 

In fact, when we first began including Elders and Healers in school-based trauma 

treatment we expected criticism from the field and from our sponsors for failing to 

have a high fidelity trauma treatment protocol. But currently when we speak of 

treatment optimality, we find strong support among our peers, editors and grant officials. At the November 2014 SCIA Oversight Hearing, it was truly dramatic to 

hear officials from SAMHSA and OJJDP explain that they uniformly support treatment innovations that include cultural practices. 

‘‘While not conducive to short-term change, we have developed three developmental approaches that seem to support long term relationships with Tribes and 

tribal members. First, we only work in communities where we have been invited. 

Second, we consider that all data resulting from tribal partnerships are the property 

of the Tribe; the Tribe may or may not give us permission to disseminate those data. 

Third, in addition to protecting individual identity, we do not disclose the identity 

of a Tribe unless the Tribe asks us to do so.’’ 

‘‘We also have found it valuable to engage local community members in 

participatory dialog regarding their perceptions of the value of treating childhood 

trauma, what the outcomes of successful trauma treatment should look like, and 

whether there already are traditional support strategies that could be blended with 

the evidence-based trauma treatment. While some local adaptations have been procedural (e.g., inviting students to draw a picture to supplement their oral trauma 

narrative), we also have invited local cultural experts to contribute traditional language and traditional healing strategies during group trauma treatment.’’ 

‘‘In some communities, our early efforts to include traditional Native language 

and culture stimulated apprehensions among our tribal partners. One set of concerns involved the proprietary nature of Native language and culture. Closely linked 

were perceptions that researchers might exploit or otherwise profit from information 

shared by healers and Elders. (And because we do this work as part of our university employment, we cannot completely nullify this perception.)’’ 

‘‘To date, no Tribe has refused our request to share results of trauma treatment. 

However, the extent to which we discuss traditional language and culture follows 

one of three protocols. Which protocol is followed is determined by Tribal Council 

decision with recommendations from Elders. In the first case, traditional language 

and healing ceremonies are made available to children and youth who choose them, 

but whether and how that occurs is not disclosed in our dissemination. In the second case, we report that a community volunteer with expertise in language and culture participated in the trauma treatment program, but the intervention(s) he or 

she used are not recorded, named or described. In the third case, the traditional 

ceremony may be named and may be described. In every case, we inform the Tribal 

Council of our findings before disseminating elsewhere.’’ 

(Reprinted from Whitegoat, W. and van den Pol, R. 2014. Cultural adaptations 

of trauma treatments in Indian Country, CW 360 Trauma Informed Child Welfare Practice, Winter 2013, 25, 38.) 

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RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. JON TESTER TO

VERNE ́ BOERNER


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RESPONSE TO WRITTEN QUESTIONS SUBMITTED BY HON. MARK BEGICH TO

VERNE ́ BOERNER


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*Response to the following questions was not available at the time this hearing 

went to print* 

WRITTEN QUESTIONS SUBMITTED BY HON. JON TESTER TO

KANA ENOMOTO

Question 1. In your testimony you mention your agency recently awarded 20 Tribal Behavioral Health grants to tribes to develop and implement plans that address 

suicide and substance abuse. Do you have any idea how many tribes currently have 

a youth suicide prevention plan? 

Question 2. You’ve been working on trauma with SAMHSA for over a decade now. 

What have been some of the biggest steps forward in the Agency’s efforts to address 

trauma? In your opinion, what still needs to be done within the Agency? 

Question 3. Could you briefly discuss how SAMHSA has made sure that its programs for Native communities are culturally informed? 

WRITTEN QUESTIONS SUBMITTED BY HON. TOM UDALL TO

KANA ENOMOTO

Question 1. I see value in the Tribal Behavioral Health grant program, where 

each tribe can develop and implement behavioral health interventions best suited 

for their own members. However, with 566 federally recognized tribes, 20 grants do 

not go a long way. How can SAMHSA reach more tribes with this program? 

Question 2. As research is revealing more effective tools and strategies for screening and identifying those who have experienced historical trauma, what is the capacity of the screeners to know how to respond and refer? 

Question 3. Are there sufficient places for treatment that these children and their 

family members (if appropriate) can/will be referred to? 

Question 4. What can be done to address the need for effective treatment as effective screening will increase the demand for such services? 

Question 5. The services, programs and funding of IHS, SAMHSA and DoJ are 

all vital to help prevent, identify, refer and treat Native Americans and Alaska Natives for mental health and childhood trauma issues. How are these (and any other 

federal agencies) working together to coordinate efforts so that tribes benefit from 

synergy of these efforts, and that federal definitions, screening tools, practice guidelines, funding streams and other aspects of these activities are coordinated, streamlined, flexible and consistent federally? 

Question 6. Given the extent of the problem and the actual appropriations currently available, what proportional increase would be required to address closer to 

90 percent of the need? 

Question 7. While biomarker and interview screening can help identify people at 

risk for behavioral health problems based on historical trauma, children re-experience the trauma of feeling worthless when we send them to schools that are crumbling and unsafe, and health clinics and hospitals that are dilapidated and out of 

date. 

Question 8. What are you doing to end this form of trauma by creating environments that reflect the worth and value of Indian children through every encounter 

with your services? 

WRITTEN QUESTIONS SUBMITTED BY HON. MARK BEGICH TO

KANA ENOMOTO

Question 1. It has been noted by HHS’s Health Resources and Service Administration that there are apx 4,000 mental health shortage areas across the country, many 

of which are in Native communities. 

Question 2. Can you talk a bit about how technology is being incorporated to close 

these gaps? 

Question 3. How effective has tele-health been in closing these national gaps? 

64 

WRITTEN QUESTIONS SUBMITTED BY HON. JON TESTER TO

HON. ROBERT L. LISTENBEE, JR. 

Question 1. Childhood trauma is an issue that many departments are attempting 

to address. How have agencies and departments ensured adequate coordination between initiatives? 

Question 2. DOJ, SAMHSA, and IHS mentioned using videos, hotlines, and outreach publicity campaigns to address trauma prevention and treatment. How are we 

measuring ‘‘success’’ and effectiveness in these programs and campaigns? 

Question 3. How does the shortage of Native mental health care providers impact 

the delivery of trauma treatment services? 

Question 4. Communities often seek to integrate traditional healing practices into 

programs aimed at addressing trauma. What obstacles exist that limit or prevent 

the inclusion of such practices? 

Question 5. You’re funding evaluations in two tribal communities, including one 

in my home state of Montana with on the Rocky Boy’s Reservation. Many of our 

tribal communities in Montana have been hit hard by the sudden deaths of young 

people—through accidents, through substance use, through suicide, and through violence. While I applaud the effort to build the body of research, how do we ensure 

that we’re actually making a difference in tribal communities? How are we measuring success in the face of such extreme and immediate need? 

Question 6. How is your office making sure that tribes have the technical resources to compete for grants—particularly for smaller tribes? 

Question 7. How are the DOJ and OJJDP’s Native trauma efforts reaching Native 

kids who live off reservation in urban communities? What resources are available 

for that population? 

Question 8. Unfortunately, the DOJ works with many Native kids who are both 

victims and victimizers. What is the DOJ doing to make sure that Native children 

held in federal prisons and institutions are receiving treatment for previously experienced trauma? 

Question 9. In August of this year, I held a listening session on Human Trafficking in Indian Country at the Fort Peck Reservation in Montana. Although there 

have been Indian communities struggling against these heinous crimes for years, in 

my State of Montana, the uptick in the trafficking industry is has been truly disturbing. The historical trauma you mention in your testimony makes our Native 

communities even more vulnerable to trafficking. As your office funds the National 

Center for Missing & Exploited Children, I’m wondering if you can provide us some 

more information on how it is increasing coordination with tribes to provide them 

tools to combat against traffickers. 

Question 10. Much of the prosecution of trafficking crimes is under the jurisdiction of States. What type of outreach to State attorneys general and prosecutors are 

being undertaken by the Department to combat trafficking in Indian Country? 

WRITTEN QUESTIONS SUBMITTED BY HON. TOM UDALL TO

HON. ROBERT L. LISTENBEE, JR. 

Question 1. The services, programs and funding of IHS, SAMHSA and DoJ are 

all vital to help prevent, identify, refer and treat Native Americans and Alaska Natives for mental health and childhood trauma issues. How are these (and any other 

federal agencies) working together to coordinate efforts so that tribes benefit from 

synergy of these efforts, and that federal definitions, screening tools, practice guidelines, funding streams and other aspects of these activities are coordinated, streamlined, flexible and consistent federally? 

Question 2. Given the extent of the problem and the actual appropriations currently available, what proportional increase would be required to address closer to 

90 percent of the need? 

Question 3. While biomarker and interview screening can help identify people at 

risk for behavioral health problems based on historical trauma, children re-experience the trauma of feeling worthless when we send them to schools that are crumbling and unsafe, and health clinics and hospitals that are dilapidated and out of 

date. 

Question 3a. What are you doing to end this form of trauma by creating environments that reflect the worth and value of Indian children through every encounter 

with your services? 

65 

WRITTEN QUESTIONS SUBMITTED BY HON. MARK BEGICH TO

HON. ROBERT L. LISTENBEE, JR. 

Question. Mr. Listenbee, I very much appreciate your background on the various 

DOJ programs. I see there are a handful of pilot or demonstration projects currently 

in place that sound fantastic, but that are only set up in 2 or 3 tribal communities. 

How does the DOJ envision expanding these demo projects over the next 3–5 years, 

once there is evidence-based data showing their effectiveness? 

WRITTEN QUESTIONS SUBMITTED BY HON. JON TESTER TO

HON. YVETTE ROUBIDEAUX

Question 1. What does the IHS do to recruit and retain mental health providers 

that specialize in children’s mental health? 

Question 2. What is the current vacancy rate for mental health providers at the 

IHS? Please provide a detailed breakdown of the vacancies by region and position. 

Question 3. Is the current funding for children’s mental health treatment and 

youth suicide prevention sufficient? 

Question 4. You mentioned the importance of ensuring that efforts to address 

trauma in Indian Country are coordinated across agencies. How does IHS coordinate 

with other agencies, NGOs, etc., to ensure the biggest impact is made? 

Question 5. Your testimony mentioned a new comprehensive national Child Maltreatment policy for IHS. When can we expect to see this new policy rolled out? 

What initiatives and changes will such a policy include? 

Question 6. How does the IHS attempt to integrate traditional healing practices 

into its mental health and trauma treatment plans? 

WRITTEN QUESTIONS SUBMITTED BY HON. TOM UDALL TO

HON. YVETTE ROUBIDEAUX

Question 1. It has been noted by HHS’s Health Resources and Service Administration that there are approximately 4,000 mental health shortage areas across the 

country, many of which are in Native communities. Can you talk a bit about how 

technology is being incorporated to close these gaps? 

Question 1a. How effective has tele-health been in closing these national gaps? 

Question 2. Dr. Roubideaux, in your testimony you note that IHS has had over 

15,000 tele-health substance abuse and mental health encounters in the last 5 

years. How does IHS measure the success rate of these encounters? 

Question 3. Dr. Roubideaux, you note several times in your testimony that over 

50 percent of Mental Health, Alcohol and Substance Abuse funds are transferred 

under 638 contracts to tribes/tribal organizations that run their own programs. Does 

IHS have a system in place to evaluate the success/outcomes of tribally managed 

programs? 

Question 3a. Is there a system in place that allows IHS to incorporate and design 

federally managed programs, based on tribal models that are proven to be effective? 

WRITTEN QUESTIONS SUBMITTED BY HON. MARK BEGICH TO

HON. YVETTE ROUBIDEAUX

Question 1. The services, programs and funding of IHS, SAMHSA and DoJ are 

all vital to help prevent, identify, refer and treat Native Americans and Alaska Natives for mental health and childhood trauma issues. How are these (and any other 

federal agencies) working together to coordinate efforts so that tribes benefit from 

synergy of these efforts, and that federal definitions, screening tools, practice guidelines, funding streams and other aspects of these activities are coordinated, streamlined, flexible and consistent federally? 

Question 2. Given the extent of the problem and the actual appropriations currently available, what proportional increase would be required to address closer to 

90 percent of the need? 

Question 3. While biomarker and interview screening can help identify people at 

risk for behavioral health problems based on historical trauma, children re-experience the trauma of feeling worthless when we send them to schools that are crumbling and unsafe, and health clinics and hospitals that are dilapidated and out of 

date. What are you doing to end this form of trauma by creating environments that 

66 

reflect the worth and value of Indian children through every encounter with your 

services? 

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