A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

The Dialogue

2022 | VOLUME 17 | ISSUE 4

Native American Disaster Behavioral Health
CONTENTS

3 In This Issue

5 Contributors

8 Technical Assistance Snapshot

9 Building Relations and Supporting Tribal Communities: New Mexico CCP’s Approach

13 Crisis Counselors on Navajo Nation Empower and Support Their Community Through 

Utah Strong Recovery Project

16 Building Indigenous Protective Factors for Disaster Preparedness: A Conversation 

With Seprieono Locario

19 Working With Tribal Communities Before, During, and After Disasters

25 Recent Technical Assistance Requests

The Dialogue is a quarterly technical assistance journal on disaster behavioral health which 

is produced by the Substance Abuse and Mental Health Services Administration (SAMHSA)

Disaster Technical Assistance Center (DTAC). Through the pages of The Dialogue, disaster 

behavioral health professionals share information and resources while examining the 

disaster behavioral health preparedness and response issues that are important to the field. 

The Dialogue also provides a comprehensive look at the disaster training and technical 

assistance services SAMHSA DTAC provides to prepare states, territories, tribes, and local 

entities so they can deliver an effective disaster behavioral health response. 

SAMHSA DTAC provides disaster technical assistance, training, consultation, resources, 

information exchange, and knowledge brokering to help disaster behavioral health 

professionals plan for and respond effectively to mental health and substance misuse needs 

following a disaster.

To learn more or receive The Dialogue, please call 1–800–308–3515, email dtac@samhsa.

hhs.gov, or visit the SAMHSA DTAC website at https://www.samhsa.gov/dtac.

The Dialogue is not responsible for the information provided by any web pages, materials, or organizations referenced in this publication. Although 

The Dialogue includes valuable articles and collections of information, SAMHSA does not necessarily endorse any specific products or services 

provided by public or private organizations unless expressly stated. In addition, SAMHSA does not necessarily endorse the views expressed by such 

sites or organizations, nor does SAMHSA warrant the validity of any information or its fitness for any particular purpose.
2022 | VOLUME 17 | ISSUE 4 | PAGE 3

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

In This Issue

In the 2020 Census, 9.7 million people, or 2.9 percent 

of the U.S. population, identified their race as American 

Indian or Alaska Native, alone or in combination with 

another race (Jones, Marks, Ramirez, & Rios-Vargas, 

2021). Today there are more than 800 Native American 

tribes in the United States (National Council of Urban 

Indian Health, 2018). Native Americans speak over 

160 languages, live in urban as well as rural areas and 

all U.S. states, and are part of tribes with their own 

distinctive cultures (Office of Minority Health, 2022; 

U.S. Census Bureau, 2011; U.S. Census Bureau, 2022). 

Along with being citizens of the United States and 

the states, counties, cities, and towns where they live, 

Native Americans also may be citizens of tribes, and 

most tribes today have their own governments with 

elected leaders (U.S. Department of the Interior, Indian 

Affairs, n.d.). Tribes are sovereign, meaning they have 

the right to govern themselves, as recognized in the U.S.

Constitution and treaties, Supreme Court decisions, 

and acts of Congress (National Congress of American 

Indians, n.d.). Tribes have a unique relationship to the 

U.S. government, sometimes referred to as a “nationto-nation relationship,” as sovereign nations within the 

United States.

In part due to the diversity of Native Americans in 

the United States, and in part due to the relationship 

between tribal governments and the U.S. government, 

disaster response in Indian Country is uniquely rich 

In 2020, 3.7 million people in the 

United States, or 1.1 percent of the population, identified themselves 

as American Indian/Alaska Native (AI/AN). People who identified 

themselves as AI/AN in combination with another race totaled 

9.7 million,

or 2.9 percent of the full U.S. 

population (Jones et al., 2021).

In 2020 Alaska’s population was nearly 

22 percent 

Alaska Native or American Indian, alone 

or in combination (Census Bureau, 2022).

and complex. As in all areas of 

disaster preparedness, response, 

and recovery, relationships among 

agencies and organizations that will 

work together in a disaster should be 

in place before a disaster so response 

and recovery proceed as smoothly as 

possible. 

In this edition of The Dialogue,

we bring stories from the field as 

well as tips on working with tribal 

communities after disasters. The 

first two articles describe Crisis 

Counseling Assistance and Training 

Programs—one in New Mexico 

and one in Utah—that relied on 

relationships and collaboration 

with tribal governments, leaders, 

and communities in supporting 
2022 | VOLUME 17 | ISSUE 4 | PAGE 4

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

disaster behavioral health during the COVID-19 

pandemic. A third article features insights from a 

leader with the Substance Abuse and Mental Health 

Services Administration (SAMHSA) Tribal Training and 

Technical Assistance Center about ways to foster mental 

health, freedom from substance use, and resilience in 

Indian Country. The final article offers tips from the 

SAMHSA Disaster Technical Assistance Center (DTAC) 

for working with tribal communities before, during, and 

after disasters. 

Have you been part of disaster planning and 

preparedness, response, and recovery work in Indian 

Country and/or with tribal communities? Other planners 

and responders can learn from your efforts. Please 

contact us to share your stories and lessons learned. 

CAPT Erik Hierholzer, B.S.N. Program Management 

Officer, Emergency Mental Health and Traumatic Stress 

Services Branch

erik.hierholzer@samhsa.hhs.gov

Nikki Bellamy, Ph.D. Public Health Advisor, 

Emergency Mental Health and Traumatic Stress 

Services Branch

nikki.bellamy@samhsa.hhs.gov

Shannon Loomis, M.A. Director, SAMHSA DTAC

dtac@samhsa.hhs.gov

READERS RESPOND

After the release of the edition of The Dialogue about people with access and functional needs in disasters (https://

www.samhsa.gov/sites/default/files/dtac-dialogue-vol-17-issue-1-2.pdf), the SAMHSA Disaster Technical Assistance 

Center received emails from readers with thoughts and insights related to the issue and its topic. We feature some 

highlights here.

“As a person with low vision 

since I was 17 . . . I have a unique 

perspective. I served in disaster 

response at my local congregation 

and was able to go to Houma, 

Louisiana, in September in response 

to a disaster there. Because of my 

own disabilities I tend to look for opportunities to serve 

the disabled. In our assessments and responses we try 

to ask if there’s any disability or disabled persons that 

we need to consider special needs for in the home, 

for example, those who are bedbound, those using 

wheelchairs, or those with low vision that may not be 

able to see hazards or risk. Including assessment factors 

for the disabled is very important in planning response 

kits . . . and more. 

This doesn’t just provide for the care of the needy and 

disabled, it also prevents the waste of materials such as 

tarps, nails, hammers, etc., that will not be beneficial in 

that home. We need to be wise stewards to be able to 

plan a response effective for the need.

Many blessings,

Karmen Payne, RN”

“In response to your newsletter The Dialogue request 

to share information on disaster readiness for people 

with access and functional needs I want to bring to 

your attention a recently developed ADA-compliant, 

multilingual video and infographic series to prepare 

families of children with disabilities and medical 

needs created by the Eastern Great Lakes Pediatric 

Disaster Consortium Region 5 for Kids: https://

emscimprovement.center/domains/preparedness/

asprcoe/eglpcdr/cyshcn/toolkit/beready.

Patricia Frost, RN, PHN, M.S., PNP”

■
2022 | VOLUME 17 | ISSUE 4 | PAGE 5

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Contributors

Deborah Altschul, Ph.D., is a 

psychologist and professor at 

the University of New Mexico’s 

Department of Psychiatry and 

Behavioral Science, the Vice 

Chair of Community Behavioral 

Health Research, and the CoDirector of the Division of Community Behavioral 

Health. Her work focuses on examining the connection 

between mental health and substance use disorderrelated disparities, cultural competency, consumer 

outcomes, and evidence-based practice. Altschul works 

closely with tribal communities and the State of New 

Mexico’s children and adult mental health and substance 

use authorities helping to develop a sustainable, 

culturally competent mental health and substance use 

disorder services infrastructure. Prior to working in 

New Mexico, Altschul worked at the University of 

Hawai’i Department of Psychology’s Mental Health 

Services Research, Evaluation, and Training Program 

where she led a project focusing on cultural adaptation 

of evidence-based practices. She also led the Consumer 

Assessment Team, involving individuals with serious 

mental illness in study design, data collection, analysis, 

interpretation, and report writing. Altschul completed 

a public policy postdoctoral fellowship with the 

University of Colorado Health Sciences Center and 

a National Institutes of Health-funded postdoctoral 

fellowship with the National Association of State Mental 

Health Program Directors aimed at improving racial 

and ethnic disparities in mental health services. She 

serves as the Evaluation Director for the New Mexico 

Behavioral Health Services Division’s (BHSD’s) 

E-COVID grant.

Neal Bowen, Ph.D., is a 

psychologist and the Director of 

the BHSD in the New Mexico 

Human Services Department, 

overseeing all adult mental 

health and substance use 

disorder services in the state. 

Prior to his appointment to this role by Governor 

Michelle Lujan Grisham, Bowen served as the Chief 

Mental Health Officer for Hidalgo Medical Services, a 

Federally Qualified Health Center located on the Mexico 

border in an underserved and economically challenged 

rural area. In 2011, Bowen was named the Behavioral 

Health Provider of the Year by the New Mexico Primary 

Care Association. Bowen became a psychologist later 

in life, after working to defend human rights in war 

zones, among other occupations. Witnessing a project 

in Sri Lanka created by a Dutch psychologist training 

village health workers to provide Mental Health First 

Aid inspired him to obtain training in psychology. After 

initial work in Milan, he obtained degrees, including a 

Ph.D. in counseling psychology, from the University 

of Texas at Austin. While there, he was awarded a 

fellowship for his work with refugees, culminating in the 

creation of The Sunrise Center, a mental health agency 

for refugees and asylum seekers. He joined the faculty 

of Central Washington University where he conducted 

research in multicultural competencies before moving 

to New Mexico. He serves as the Project Director of the 

BHSD E-COVID grant.

Raymond Daw, M.A., is a 

member of the Navajo Nation. 

He has spent his career focused 

on improving community 

quality of life by committing 

to effective substance use 

disorder treatment services for 
2022 | VOLUME 17 | ISSUE 4 | PAGE 6

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

American Indian and Alaska Native (AI/AN) people. 

Daw has been involved in substance use disorder 

treatment service delivery in Arizona, New Mexico, and 

Alaska. He has extensive knowledge and experience 

related to traditional healing and cultural practices, and 

translation of AI/AN values, beliefs, and history to better 

inform treatment services and research. Daw serves on 

numerous project boards and special expert workgroups 

and as a key stakeholder and cultural expert for AI/AN 

mental health and substance use disorder services. He 

co-manages the tribal media campaign for the BHSD 

E-COVID grant.

Courtney Freeman Fowler

is an experienced writer and 

provides support through the 

Substance Abuse and Mental 

Health Services Administration 

(SAMHSA) Tribal Training and 

Technical Assistance Center. 

She enjoys helping Native people share their stories 

of healing and cultural resiliency. She is a member of 

the Muscogee-Creek Nation as well as Cherokee on 

her mother’s side. In addition, Fowler has experience 

working in higher education, marketing, and information 

technology. She lives in Arlington, Virginia, with her 

husband, Mark, and they enjoy self-guided walking 

tours throughout the Washington, DC, area.

Seprieono Locario (Navajo/

Sicilian) was born and raised 

in San Francisco, California, 

and spent summers with his 

grandparents in Tohatchi, New 

Mexico, and throughout the 

Navajo Reservation. Locario 

earned his B.A. in public administration from San Diego 

State University and an M.A. in counseling psychology 

at the California School of Professional Psychology. 

Locario has dedicated 15 years of professional 

development to work with American Indian youth 

throughout the State of California, within multiple 

levels of incarceration, community mental health 

centers, higher education institutions, and reservation 

communities. In addition to providing direct clinical 

services, Locario has worked with various youth-serving 

agencies to bring about systemic change to improve 

the mental health and substance use disorder care for 

Native youth in California. Locario currently works 

as a Training and Technical Assistance Coordinator 

supporting the SAMHSA Tribal Training and Technical 

Assistance Center’s efforts across Indian Country.

Rebecca Minnick is a licensed 

clinical social worker. She is 

the Program Manager of the 

Utah Strong Recovery Crisis 

Counseling Project and works 

at the Huntsman Mental Health 

Institute. She received her 

undergraduate degree in sociology and her master’s 

degree in social work from the University of Utah 

and received the Pete Suazo Macro Practice Award. 

Minnick has over 30 years of community mental health 

experience working primarily with individuals with 

serious mental illness. She has a wealth of experience 

and knowledge, including her work at Valley Behavioral 

Health in which she was instrumental in developing 

the Jail Diversion Outreach Treatment Program and 

served as a liaison to the Utah State Hospital. She also 

has experience working with the U.S. Department 

of Veterans Affairs Assertive Community Treatment 

team and the Salt Lake Police Department. Minnick’s 

passions are advocacy and program development, and 

she has expertise in crisis management and trauma work. 

Minnick is the proud mother of three children. In her 

spare time, she enjoys spending time with her family, 

reading, hiking, and travel.
2022 | VOLUME 17 | ISSUE 4 | PAGE 7

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Stephine “Steph” Poston was 

born and raised on the Sandia 

Pueblo Indian Reservation. 

She worked for her tribe for 

11 years before launching 

Poston & Associates, a boutique 

full-service communications 

firm. She inspires clients to draw from core values, 

imagine what success looks like, and create strategic 

paths forward. She is committed to uplifting the Native 

American narrative through positive representation 

in the media. Poston’s expertise includes strategic 

facilitation, capacity building training, leadership 

development, strategic communication, and event 

planning. She has worked with numerous tribes and 

tribal entities in New Mexico and throughout Indian 

Country on public relations and marketing campaigns, 

sacred site protection, voter empowerment, water rights, 

tribal policy development, economic development, 

education, and health care, and she recently contributed 

to Indigenous Women Entrepreneurs of New Mexico: 

Surpassing Barriers and Stereotypes. She is a cofounder of Native Women Lead, encouraging Native 

women to become business owners. She co-manages the 

tribal media campaign for the BHSD E-COVID grant.

Are you looking for disaster behavioral health resources?

Check out the new and updated 

SAMHSA DTAC Disaster Behavioral Health Information Series (DBHIS) installments.

https://www.samhsa.gov/dtac/dbhis-collections
2022 | VOLUME 17 | ISSUE 4 | PAGE 8

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

TECHNICAL ASSISTANCE SNAPSHOT

Crisis Counseling Assistance and Training Program 

(CCP) Encounters With American Indian/Alaska 

Native (AI/AN) Participants by Year

AI/AN ENCOUNTERS

In 2013, the Sandy Recovery Improvement 

Act gave federally recognized AI/AN tribal 

governments the right to request a Presidential 

major disaster declaration independent of a state 

(Federal Emergency Management Agency, 2021). 

A Presidential major disaster declaration is required 

for a CCP, a supplemental grant program that helps 

states, territories, and federally recognized tribes 

address the challenging mental health and substance 

use-related effects of disasters. Since 2013, AI/AN 

tribes have begun implementing CCPs. Throughout 

the history of the CCP, state and territory programs 

have served AI/ANs, among others within the state 

or territory, typically by partnering with providers 

that serve tribal areas or reservations affected by a 

disaster and included in the disaster declaration.

CCPs collect anonymized data on their services. 

The graph shows some of this data—the number of 

individual/family encounters that included AI/AN 

participants. Prior to the COVID-19 pandemic, there 

were an average of 10 grants providing services a 

year, which contributed to lower frequency of reach 

to all populations, including AI/ANs. Starting in 

2020 with the pandemic, most states and territories 

began providing services, increasing the number of 

tribal members being reached. 

2017–2021
2022 | VOLUME 17 | ISSUE 4 | PAGE 9

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Building Relations and Supporting Tribal 

Communities: New Mexico CCP’s Approach

By Deborah Altschul, Ph.D., Division of Community Behavioral Health, Department of Psychiatry and Behavioral 

Sciences, University of New Mexico Health Sciences Center; Stephine Poston, Poston & Associates; Raymond 

Daw, M.A., Consultant; Neal Bowen, Ph.D., Behavioral Health Services Division, State of New Mexico

Nearly 11 percent of people in 

New Mexico are Native American,

and during New Mexico’s Crisis 

Counseling Assistance and Training 

Program grant initiative, nearly 

one-third (31.3 percent) of calls 

received by the New Mexico 

Crisis Counseling Program (NM 

CCP) were from Native American 

individuals. These data points 

clearly indicate that the crisis 

hotline was accessible to tribal 

communities even in the most rural 

parts of the state. Early into the 

global COVID-19 pandemic, it was 

apparent Native Americans were 

experiencing severe impacts. Thus, 

it was critical to provide medical 

and other support services to the 

indigenous population of the state, 

which encompasses 23 federally 

recognized tribal nations (including 

part of the Navajo Nation, 19 

Pueblos, and 3 Apache Reservations) 

and a significant urban native 

population.

A Statewide Program With a 

Focus on Tribal Populations

NM CCP provided direct crisis 

counseling services statewide to 

individuals who tested positive 

for COVID-19; were awaiting test 

results; had family members who 

got sick with, or who died as a 

result of, COVID-19; and others at 

high risk of infection. New Mexico 

is geographically the fifth largest 

state in the nation, with tribes 

representing some of the most 

rural communities. To reach Native 

American and rural populations 

statewide, media campaigns were 

provided by three companies, 

with two specifically focused 

on conducting outreach to tribal 

communities throughout the state, 

and a third focused on statewide 

media across New Mexico. The 

three media companies worked in 

tandem to create marketing materials 

and ensure cultural relevance and 

reach. NM CCP also engaged in 

program marketing and public 

information activities to reach tribal 

communities statewide. 

New Mexico tribes, more than any 

other population in the state, have 

experienced tremendous impacts 

from the pandemic, with extremely 

high rates of positive cases and 

deaths due to COVID-19. This 

caused most tribes to shut down 

government services and close 

their borders to non-tribal people at 

various times during the pandemic 

to slow the spread of the virus and 

protect the people and culture. 

Significant time was spent at the 

beginning of the CCP initiative 

developing a solid strategic plan 

with strong, Native-appropriate 

outreach designs and relevant social 

media materials. This included 

the development of a project logo 

for utilization on materials such 

as backpacks, flyers, yard signs, 
2022 | VOLUME 17 | ISSUE 4 | PAGE 10

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

NM CCP signs help raise awareness of program services.

email blasts, and social media 

pages to promote CCP services 

and related information. Outreach 

materials focused on increasing 

public awareness of the importance 

and utility of the crisis counseling 

program; identification of symptoms 

suggesting the need for counseling; 

availability of the statewide 24/7 

crisis hotline; and the critical need 

for participation in testing, contact 

tracing, social distancing, masking, 

and vaccination for COVID-19.

Collaboration With Tribes To 

Reach Communities 

Much of the work with tribal 

communities was very “high touch” 

to ensure that communities and 

service providers saw the benefit 

of the CCP as a resource. Tribal 

outreach included contacting 

all tribal government officials, 

executive assistants, and health and 

wellness staff via phone and email 

and designing and distributing 

toolkits with introduction letters, 

yard signs, and one-pagers on the 

project with social media links. 

These tribal toolkits were distributed 

to all communities, and information 

was sent electronically to tribal 

educational, governmental, and 

health programs. Additionally, 

during the social media soft launch 

on Facebook and Instagram, 

communication with Native 

American social influencers began. 

Project posts were shared on hightraffic social media pages and 

accounts, such as those of the New 

Mexico Indian Affairs Department, 

Native Women Lead, and other 

Native American entities. 

Marketing, Media, and 

Educational Events

Marketing campaigns were 

diverse and far-reaching. Since 

October 2021, there have been 

five active CCP program-related 

billboards in New Mexico (three 

in the Albuquerque area, one in 

Crownpoint, and one on the Pueblo 

of San Felipe casino marquee on 

the I-25 corridor). Collaboration 

with Crownpoint Healthcare on the 

Navajo Nation resulted in a large 

educational billboard posted in the 

region with COVID-19 resources 

that reached approximately 28,000 

people. 

Other elements of marketing 

campaigns included flyers placed 

in convenience stores and transit 

centers, gas toppers at key gas 

stations, messages shared on 

casino marquees, radio and 

digital advertisements on social 

media, and yard signs put up and 

postcards distributed throughout 

tribal communities. In total, 82,475 

postcards, yard signs, door hangers, 

and Indian Health Service (IHS) 

pharmacy bags with COVID-19 

resources and information on 

the importance of vaccination 

were disseminated to Navajo 

communities and agencies in San 

Juan, McKinley, and Bernalillo 

Counties and throughout the 19 

Pueblos through venues including 

tribal checkpoints, heavily traveled 

roads in rural tribal communities, 

vaccine clinics, elder meal 

deliveries, faith-based organizations, 

tribal housing authorities, and food 
2022 | VOLUME 17 | ISSUE 4 | PAGE 11

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

distributions. Tribal leadership 

directed placement of yard signs and 

postcard dissemination throughout 

their communities, educating 

members on the importance of 

vaccination and the availability of 

CCP services. In collaboration with 

the state’s youth suicide prevention 

initiative, Honoring Native Life, 100 

door hangers with information about 

COVID-19 and related resources 

were disseminated in McKinley, 

San Juan, and Bernalillo Counties 

to Native families and social service 

agencies. Also, 1,500 backpacks 

with COVID-19-related information 

and supplies (e.g., hand sanitizer, 

masks) were disseminated to Native 

American homeless populations in 

Bernalillo, San Juan, and McKinley 

Counties.

The program also used social 

media and radio to reach Native 

Americans. Social media outreach 

efforts on Facebook, Instagram, 

and TikTok reached 84,128 

Native American people. On 

Facebook, social media outreach 

was conducted in part through the 

Navajo & Hopi Families COVID-19 

Relief group, which has 9,000 

members; the Farmington San Juan 

County NM: Community Group in 

Response to COVID-19 with over 

6,000 members; and the Diné Rights 

and Politics group with more than 

37,000 followers. Four TikTok ads 

were developed and disseminated 

(e.g., https://www.facebook.

com/nmcovid19supportservices/

videos/797872410826037).

Three radio spots were created, 

including spots in English, Spanish, 

and Diné (the Navajo language). 

Radio spots ran consistently on 

KTNN, which is operated by Native 

Broadcast Enterprise and is one of 

the most listened-to radio stations 

on the Navajo reservation, reaching 

the most rural parts of the Navajo 

Nation.

NM CCP distributed materials 

and participated in a range of 

educational events. These included 

monthly McKinley County Health 

Alliance COVID-19 response 

planning meetings with an average 

attendance of 18 agencies and health 

advocacy groups; New Mexico 

Native Prevention Collaborative 

meetings to enhance outreach, 

develop joint products, and stay 

connected to service providers; 

and two Indigenous Peoples’ Day 

events at the Indian Pueblo Cultural 

Center and Albuquerque Civic 

Plaza providing yard signs and 

postcards. The team collaborated 

with the Office of Navajo Nation 

President Jonathan Nez to provide 

public information about the 

COVID-19 CCP on radio to an 

audience that included San Juan and 

McKinley Counties and Facebook 

to a national audience. Also, the 

team disseminated information on 

COVID-19 resources to all three 

major Navajo IHS facilities in New 

Mexico and the Zuni IHS hospital.

Challenges and Lessons 

Learned

The program faced several 

challenges in reaching and serving 

tribal communities. First, rural 

and tribal communities in New 

Mexico were highly affected by 

COVID-19 and were difficult to 

reach due to a lack of infrastructure 

(e.g., lack of technology, limited 

bandwidth, lack of electricity, etc.). 

Outreach was especially difficult 

to tribal communities, as many 

communities were closed to limit 

infection entering the community. 

Also, provider engagement in public 

information dissemination sessions 

was difficult due to the elevated 

infections, provider shortages, 

remote work, and numerous crises. 

In addition, most people served 

by crisis counselors had limited 

internet access; thus, encounters 

typically occurred via the telephone 

instead of via video chat or video 

meeting (as originally planned). 

Stigma surrounding asking for crisis 

counseling assistance was initially 

evident, especially in rural and tribal 

New Mexico’s program uses social media to reach 

Native populations.
2022 | VOLUME 17 | ISSUE 4 | PAGE 12

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

communities. Crisis counselors 

worked to establish rapport and build 

trust in communities, and this work 

resulted in high rates of engagement. 

The state as a whole was hard 

hit by COVID-19, and 32 of the 

33 counties were already health 

professional shortage areas prior to 

the pandemic; therefore, there was 

less than adequate access to health, 

mental health, and substance use 

disorder treatment. Despite these 

challenges, contact was established 

and resources disseminated to all 

tribal communities over the life of 

the initiative.

The state learned several lessons 

through its work to engage and 

support tribal communities during 

the pandemic. First, states 

should consider engaging with 

individuals with strong histories 

of meaningfully working with 

tribal communities. NM CCP 

worked with two marketing 

companies with expertise and 

established connections with tribal 

communities in New Mexico. 

Poston & Associates (P&A) is a 

Native American-owned small 

business headquartered in the Pueblo 

of Sandia that offers full-service 

communications and marketing 

with specialized expertise in 

communication services for the 

pueblos of New Mexico. Raymond 

Daw, M.A., LLC, has a master’s 

in counseling and is a member 

of the Navajo Nation who has 

extensive experience developing 

and leading comprehensive mental 

health and substance use disorder 

treatment programs in Native 

American communities, particularly 

on the Navajo Nation and in the 

surrounding communities. P&A and 

Daw’s role in leading the outreach to 

tribal communities across the state 

was invaluable.

Second, states and counties should 

work collaboratively with tribal 

community representatives and 

tribal leadership to ensure CCP 

programming that is culturally 

relevant and accessible. Prior to 

the awarding of the CCP grant, 

the marketing companies and the 

state Behavioral Health Services 

Division partnered to develop 

social marketing strategies related 

to COVID-19, in collaboration with 

local tribal communities and tribal 

leaders. This partnership as well as the 

prior work of the marketing companies 

across tribal communities statewide 

laid the groundwork for subsequent 

outreach through NM CCP. 

Finally, the importance of 

addressing basic needs must be 

considered when initiating crisis 

counseling programs in underresourced areas. NM CCP identified 

access to basic needs such as clothing, 

hygiene items, food, and financial 

assistance as top priorities for 

individuals engaged with the 

program. ■

“American Indians and Alaska Natives 

(AI/ANs) experienced some of the highest 

rates of COVID-19 disease and death in 

the United States . . . . The disproportionate 

impact of COVID-19 in AI/AN communities 

is a result of historically rooted systems of 

colonization, oppression, and marginalization. 

. . . Despite these challenges, the COVID-19 

vaccination efforts in many AI/AN 

communities have been 

major successes; 

AI/ANs have the highest 

COVID-19 vaccination 

rate of any racial or ethnic 

group in the country” 

(Haroz et al., 2022).
2022 | VOLUME 17 | ISSUE 4 | PAGE 13

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Crisis Counselors on Navajo Nation Empower 

and Support Their Community Through Utah 

Strong Recovery Project

By Rebecca Minnick, LCSW, Utah Strong Recovery Crisis Counseling Project; with contributions from Calandra 

Hollie, M.P.H.; Jerilyn Price, M.S.W.; Susie Martin, M.S.W.; Autumn Secody, M.S.W.; Deborah Woody, ACMHC; 

and Rick Hendy, LCSW

Utah health officials announced 

the first case of COVID-19 in the 

state on March 6, 2020, and Utah 

Governor Gary R. Herbert issued 

an executive order declaring a state 

of emergency in response to the 

evolving outbreak of COVID-19. 

Over the following weeks as case 

counts and deaths started to climb, 

the Utah Division of Substance 

Abuse and Mental Health applied 

for an Immediate Services Program 

(ISP) grant to start the Utah Strong 

Recovery Project. Utah Strong 

would provide crisis counseling 

for individuals, families, first 

responders, and businesses across 

the state experiencing the impacts of 

COVID-19. As we planned for this 

grant and further grant extensions it 

became apparent we needed crisis 

counselors in as many communities 

across the state as possible. 

COVID-19 affected everyone, 

unlike other disasters which tend 

to have a more centralized area 

of impact. Utah, like so much of 

the country, has a mix of urban 

and rural communities, each with 

different needs, and the Utah Strong 

Recovery Project needed to be able 

to adapt to meet all these unique 

needs. To address this issue, four 

teams were developed, one of which 

worked with those on the Navajo 

Nation, as well as disproportionately 

affected minority populations, rural 

communities, and any hot spots that 

developed outside the geographic 

regions not served by the other 

teams. The community that was 

hit the hardest in Utah was those 

living on the Navajo Nation. By the 

time Utah applied for the ISP, the 

Navajo Nation had the third highest 

per capita rate of COVID-19 in the 

country, after New Jersey and New 

York.

A group photo for a nomination for community heroes. Staff from left to right: Calandra Hollie, Deborah Woody, Susie Martin, Autumn Secody, Jerilyn Price, 

Rick Hendy.
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Utah built on existing relationships 

with the Utah Navajo Health 

System (UNHS) in Montezuma 

Creek to build a team of five parttime crisis counselors who lived 

and worked on the Navajo Nation. 

It was critical the team already 

have existing rapport within their 

community and be recognized as 

part of the community. The Utah 

Strong Recovery Project started June 

15, 2020, and ended on December 

27, 2021. During this time period, 

the team based out of the Nation 

was able to meet with 2,921 

individuals for counseling sessions 

and interacted with another 1,272 

individuals briefly while offering 

support, education, or resources. 

Utah Strong made or answered over 

1,800 phone calls, sent 626 emails, 

made 217 networking contacts, and 

distributed almost 6,000 flyers with 

information about coping skills. 

However, it’s not the numbers that 

tell the story but the stories behind 

the numbers that show the success of 

this partnership.

The Navajo Nation in Utah has a 

very limited infrastructure. Many 

of the individuals and families 

served live in isolated areas or small 

communities with no running water, 

electricity, or phone service and are 

only accessible by dirt roads. Often 

crisis counselors would drive hours 

on these undeveloped dirt roads to 

meet with one or two individuals to 

deliver care packages, food supplies, 

firewood, personal protective 

equipment, and cleaning supplies. 

During much of the grant the Navajo 

Nation was on lockdown to try and 

slow the spread of the virus, and 

only essential workers were allowed 

in the community. Utah Strong staff 

were considered essential workers, 

as the program had hired individuals 

who already had positions with 

the UNHS and, embedded in their 

own communities, they had the 

clearance and connections to do 

the much-needed outreach. Having 

Navajo-speaking counselors was 

very beneficial in helping the 

Navajo elders understand how 

COVID was spread. Many elders 

were very puzzled on how the virus 

spread and thought it was spread 

only through touching objects and 

not necessarily from the air we 

breathed in close quarters. The Utah 

Strong team was able to access the 

help of a traditional medicine man, 

Ernest Harry Begay, who is very 

knowledgeable in herbal remedies 

that helped relieve symptoms of 

COVID. Mr. Begay brought back 

some old practices of how their 

ancestors used herbs to smudge and 

cleanse their bodies, which was also 

appreciated by many families. Many 

of these teachings and practices 

would have died with the elders who 

succumbed to COVID had he not 

been able to share them with some 

of the younger generation during 

this time. Mr. Begay as part of his 

work with the team provided sage 

to the team to deliver as part of 

their care packages and would take 

referrals for the Utah Strong team to 

individuals and families who could 

benefit from his offers of prayers and 

hope on their behalf. Furthermore, 

these staff maintained the critical 

relationships and trust of their 

fellow community members during 

tumultuous and scary times. 

Crisis counselor helping to vaccinate goats during outreach.
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The Utah Strong team on the Navajo

Nation included Calandra Hollie, 

M.P.H., Jerilyn Price, M.S.W., Susie 

Martin, M.S.W., Autumn Secody,

M.S.W., and Deborah Woody, 

ACMHC, and their work literally 

saved lives. The UNHS has very 

limited resources and did not have 

staff to take care packages

to families who often lived great 

distances from the UNHS clinic. 

With the support of Utah Strong 

we were able to assemble and have 

our crisis counselors reach out and 

deliver care packages, which 

provided individuals and families 

throughout the Nation with needed 

supplies after someone tested 

positive for COVID-19. On one 

such delivery they were showing a 

COVID-19-positive patient how to 

use the pulse oximeter found in the 

care package. While doing so they 

realized her oxygen saturation, 

which needed to be above 90 

percent, was in the low 80s. This 

same staff member was able to use 

her Utah Strong cell phone and 

provide the GPS coordinates to 

emergency medical personnel, who 

were able to get the patient to the 

hospital. This person and others 

might have died without support 

from this Utah Strong team, as they 

often did not have access to phone 

service.

Utah Strong staff on the Nation

were able to help identify adult

family members through tribal

records to take custody of minor

children who lost their parents to

COVID-19. Next, the staff went

further in their advocacy and 

helped families navigate the court 

system to make formal custody 

arrangements. Because of this, in an 

already difficult time, children were 

able to stay with family members. 

Whenever Utah Strong would do 

outreach, they would ask families 

what they could do to assist them in 

getting their needs met. One elderly 

woman asked if they could stay and 

help her vaccinate her herd of goats, 

which they happily did. Several of 

the staff on the Nation commented 

that despite growing up and living 

on the Nation, it was through their 

work with Utah Strong that they 

were really able to get to know 

their neighbors and community in a 

way that might not have otherwise 

occurred. The actions of Utah Strong 

helped a community grow closer 

and stronger together. We learned 

that it doesn’t always take an army 

to conquer challenges. Utah Strong 

demonstrated that being able to 

work together and offer information, 

care, and support is the best way to 

manage such difficult and tenuous 

times.

Utah Strong would not have had the 

success we achieved without the 

vision and wisdom of Robert H.

Snarr, M.P.A., LCMHC. Robert 

worked for the Utah Division of 

Substance Abuse and Mental Health.

After the Columbine shooting, 

Robert had the foresight to create 

Utah Responds. As part of this 

program he trained a cadre of over 

500 crisis counselors across the 

State of Utah who could be activated 

to respond to a crisis or disaster, 

large or small. He was passionate 

about preparing Utah for a mass 

casualty event. The relationships and 

networking he did for Utah 

Responds laid the foundation for 

Utah Strong to connect with the 

Navajo Nation team early in the 

pandemic. This combined team 

effort saved lives, and Robert’s 

dedication to crisis counseling 

contributed to that. Robert H. Snarr 

was involved in training and 

administrative work to support

Utah Strong right up to the time of

his death from cancer on May 27,

2021. ■

CCP staff stock up on care packages for second wave of pandemic, delivering to Monument Valley.
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Building Indigenous Protective Factors for 

Disaster Preparedness: A Conversation With 

Seprieono Locario

By Courtney Freeman Fowler, Muscogee-Creek and Cherokee, SAMHSA Tribal Training and Technical 

Assistance Center; Seprieono Locario, M.A. (Navajo/Sicilian), SAMHSA Tribal Training and Technical 

Assistance Center

In late March of 2020, the 

devastating effects and widespread 

toll of the opioid epidemic continued 

to be felt across Indian Country, 

with opioid overdose taking more 

lives among Native Americans 

than the full U.S. population 

(Centers for Disease Control and 

Prevention [CDC], 2021a). Then 

the COVID-19 pandemic arrived. 

Once again, Native Americans were 

disproportionately affected—to date, 

non-Hispanic American Indians 

or Alaska Natives have been more 

than three times as likely to be 

hospitalized for COVID-19, and 2.7 

times likelier to lose their lives to the 

illness, than non-Hispanic Whites 

(CDC, 2021b). But the opioid crisis 

did not fade away when COVID-19 

arrived. They are now intertwined, 

continuing to deepen the cycle 

of depression, isolation, poverty, 

healthcare deprivation, substance 

misuse, and suicide across Indian 

Country.

Against this backdrop, Seprieono 

Locario works to bolster tribal 

communities’ disaster preparedness, 

response, prevention, and recovery 

efforts. He believes that the most 

effective strategies are also the 

simplest—as he says, “I was 

always taught that some of the best 

things you can do in community 

prevention are free.” Mr. Locario’s 

understanding of indigenous cultural 

customs aids his approach and is 

vital to helping tribal communities 

tap into cultural strengths when 

natural disasters or mental health 

or substance use-related challenges 

arise. He hopes sharing these 

strategies will prove helpful to 

others working in the disaster 

behavioral health field.

A proud member of the Navajo 

Nation with Sicilian roots, Mr. 

Locario grew up visiting and 

living on the Navajo reservation 

each summer. Today, as a Tribal 

Action Plan and Wellness 

Coordinator working with 

indigenous communities as part of 

the Substance Abuse and Mental 

Health Services Administration 

(SAMHSA) Tribal Training and 

Technical Assistance (TTA) Center, 

Mr. Locario stresses simple ways 

to engage with and among tribal 

nations and their communities. 

Through his training and technical 

assistance work, he understands 

the importance of exchanging 

simple native greetings and holding 

culturally appropriate discussions 

focused on resiliency and 

community protective factors, which 
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is critical in finding communitybased solutions. The most effective 

strategies are woven together with 

traditional knowledge, integrate 

cultural best practices, and share 

lessons learned from westernized 

approaches.

Diversity and Building 

Relationships for Disaster 

Preparedness in Tribal 

Communities

The diversity of tribal nations and 

communities across the United 

States is often overlooked or 

misunderstood by the federal and 

state organizations designated to 

support them. Depending on the 

state, this insight is critical for 

emergency response management 

and non-tribal disaster behavioral 

health professionals who want 

to build relationships with tribal 

nations and their communities. 

Across the United States, 

tribal diversity encompasses 

geographical locations, cultural 

and socioeconomic differences, 

or whether each tribal nation 

holds state, federal, or non-federal 

recognition. Each diversity factor 

matters to each tribal nation.

Within this diversity lie varying 

challenges. Systemic problems 

such as substance misuse, suicide, 

depression, poverty, and hunger 

have been ongoing for many 

years. New challenges such as the 

COVID-19 pandemic have revealed 

severe disparities that deeply hurt 

many tribal nations. It is important 

to recognize these challenges have 

all affected tribal nations as harshly 

as forest fires, flooding, and other 

natural disasters, but they do not 

receive the same level of media 

attention and response. Native 

communities have long struggled on 

their own to address these difficult 

challenges. Developing effective 

disaster response and recovery 

efforts offers important opportunities 

to address these challenges. 

Mr. Locario notes, “Some of the 

best things we can do when working 

with and supporting tribes who 

are navigating crisis situations is 

understanding that cultural lens as 

well as the best practices of crisis 

management. As we jump into 

Indian Country, sometimes it’s best 

if we jump ears first.” This key 

insight may help governments and 

organizations build relationships 

with tribal nations before disasters 

occur, and it may enhance the 

effectiveness of disaster response 

and the outcome of recovery efforts.

Mr. Locario has long contemplated 

a collective tribal response to crisis 

management. He is concerned 

that siloed efforts are ineffective, 

but he is energized by collective 

efforts across tribes to address an 

array of systemic challenges. In 

contemplating a unifying response 

to a crisis, Mr. Locario poses 

these questions: “Where do we 

start to unify all of the things we 

do really well?” and “What are 

Indian Country’s best practices for 

addressing prevention in our own 

tribal nations?”

Growing up in the San Francisco 

area, Mr. Locario was able to 

experience an inter-tribal community 

response to the substance misuse 

challenges faced by indigenous 

“The American Indian and Alaska Native people have long 

experienced lower health status when compared with other 

Americans. Lower life expectancy and the disproportionate disease burden 

exist perhaps because of inadequate education, disproportionate poverty, 

discrimination in the delivery of health services, and cultural differences. 

These are broad quality of life issues rooted in economic adversity 

and poor social conditions” (Indian Health Service, 2019).
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people, and that integrated recovery 

response model now serves as his 

vision of best practices in both 

community prevention and recovery. 

The Friendship House of American 

Indians is an 80-bed residential 

treatment center where indigenous 

people participate in finding their 

balance. “I witnessed this integrated 

community support model. I had the 

opportunity to experience cultural 

healers from other tribal nations, 

who provided teachings and lessons 

from their tribal customs. Learning 

the Lakota way, such as the sweat 

lodge, which is not my tribal 

practice, but I was able to participate 

in—that inter-tribal lens to recovery 

is huge.”

How Can We Help Our 

Relatives on the Front Lines?

As the full U.S. population grows 

more aware through social media 

and greater visibility of difficult 

challenges affecting native 

communities, it will be important 

for tribal nations and professionals 

who work to support them to learn 

effective ways to respond and align 

resources and energy where they 

can have the greatest impact. Mr. 

Locario has given much thought to 

the best ways to offer effective and 

supportive responses to crises.

“I check my own readiness. I try to 

raise awareness. Everyone wants to 

be on the front lines, but we can’t 

all be on the front lines. I think of 

Standing Rock. Our relatives went 

there to protect their water and their 

livelihood. I know my limitations, 

but that doesn’t mean I can’t attend 

events locally in my community 

and think about where and how I 

spend my dollars and discern how 

I can direct my money in a more 

environmentally conscious way. We 

can all be in tune to ways to assist 

and help.”

The Tribal TTA Center is just one of 

many SAMHSA programs offering 

information, training, and technical 

assistance to improve the quality and 

delivery of mental and substance use 

disorder prevention and treatment 

services across the nation.

The Work Ahead for Tribal 

Nations—Getting to the Core 

of Who We Are

Mr. Locario shares his appreciation 

for tribal nations who take every 

opportunity to incorporate their 

indigenous cultural symbols, 

language, and knowledge to 

represent their native land. It helps 

build indigenous pride in the people. 

“If . . . I see a tribal reservation or 

community that has lit a ceremonial 

fire to raise awareness about 

suicide or substance misuse, with 

traditional firekeepers tending the 

fire, it touches me deeper—from an 

indigenous perspective. I’m pushing 

for us to create symbols that mean 

something to us in Indian Country.”

Mr. Locario believes native 

communities face an increasing 

need for healing and learning from 

our resiliency. He is working to 

focus on best practices through 

an inter-tribal lens and hopes that 

aligning tribal nations’ resiliency and 

current cultural resources will help 

create effective prevention, crisis 

management, and healing strategies 

that work for their tribal citizens. 

“When we experience indigenous 

knowledge, it goes right to the DNA 

of who we are as indigenous people, 

and we start to see, reflect, and begin 

our healing paths. I really believe in 

recovery and best practices; we need 

to deploy those techniques to have 

an impact on our people in the core 

of who we are.” ■

“I’m pushing for us to 

create symbols that 

mean something to us 

in Indian Country.”

—Seprieono Locario

As of 2020, the 10 U.S. states 

with the largest American Indian 

and Alaska Native populations 

were 

Alaska, 

Arizona, 

California, 

New Mexico, 

New York, 

North Carolina, 

Oklahoma, 

South Dakota, 

Texas, 

and Washington

(Office of Minority Health, 2022).
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Working With Tribal Communities Before, 

During, and After Disasters

By the SAMHSA Disaster Technical Assistance Center

Native Americans have been in 

North America for at least 15,000 

years, and possibly much longer 

(Smithsonian National Museum 

of the American Indian, n.d.; 

Pauls, 2019). Since their arrival, 

Native American communities 

have developed governments, 

irrigation and agricultural systems, 

tools and technologies, religions, 

and distinctive forms of art 

and architecture (Pauls, 2019). 

They have experienced forced 

displacement and various forms 

of oppression and violence by 

European settlers and settlers’ 

descendants, and they have fought 

for and partnered in development 

of laws and policies supporting 

tribal sovereignty and a nation-tonation relationship with the Federal 

Government (see sidebar). As noted 

in the introduction to this edition of 

The Dialogue, today there are more 

than 800 Native American tribes 

in the United States—including 

574 federally recognized tribes 

and over 240 state or non-federally 

recognized tribes—who speak over 

160 languages, live in urban as well 

as rural areas and all U.S. states, 

and have their own cultures and 

governments (U.S. Department of 

the Interior (DOI), Indian Affairs, 

n.d.; Office of Minority Health, 

2022; U.S. Census Bureau, 2011; 

National Council of Urban Indian 

Health, 2018; U.S. Census Bureau, 

2022).

Language & Key Concepts

In this article, we respectfully use 

the term Native Americans to 

describe the hundreds of tribes, 

reservations, pueblos, villages, 

rancherias, nations, bands, and 

communities throughout the United 

States. We also use the words 

tribe and tribal often in reference 

to Native American communities for 

brevity and simplicity, even though 

Native American communities may 

go by many names other than tribe. 

As noted in the introduction, tribes 

are sovereign, which means they 

have the right to govern themselves 

(National Congress of American 

Indians, n.d.). As such, tribes have 

a nation-to-nation relationship

with the U.S. government, and 

the U.S. government has a trust 

responsibility to act morally and 

ethically toward Native Americans 

and take steps in support of health 

and wellness in tribal communities 

(DOI, Indian Affairs, n.d.).
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Given this rich history and 

diversity, it is important to take 

steps to understand the specific 

Native American community 

you are working with in disaster 

preparedness, response, and 

recovery. Also key is understanding 

shared history and circumstance 

today, as well as taking a traumainformed approach to help in 

addressing challenges tribal 

communities may be facing. In 

the following sections, we offer 

some information and tips for 

collaborating with and supporting 

tribal communities through all 

phases of disaster. 

Tribal Government

Tribes are sovereign nations 

(National Congress of American 

Indians, n.d.). Many tribes have 

their own constitutions, and most 

have a tribal council, village council, 

or tribal business committee that 

serves as a legislative body (DOI, 

Indian Affairs, n.d.). Tribes often 

have governments organized with 

legislative, executive, and judicial 

branches, like the U.S. government, 

though this can vary (DOI, Indian 

Affairs, n.d.). 

Tribes and Culture

While every tribal community is 

unique, some general cultural values 

are shared by many Native American 

communities and may be helpful 

to understand in collaborating and 

offering support:

• Harmony with the environment is 

seen as important (Willmon-Haque 

& BigFoot, 2008).

• For some Native Americans, tribal 

land is important because it is 

closely tied to identity (Beasley, 

Jones-Locklear, & Jacobs, 2021).

• Many communities see each 

person as part of a larger system 

(Willmon-Haque & BigFoot, 

2008; Haroz et al., 2022).

• Community members respect 

elders and other leaders in the 

community for their knowledge 

and wisdom (Willmon-Haque & 

BigFoot, 2008). 

• Children are the future and are to 

be protected and supported.

• Value is placed on connections to 

relatives, community, and place 

(Beasley, Jones-Locklear, & 

Jacobs, 2021).

 574

There are 574 federally recognized 

tribes in the United States (U.S. 

Department of the Interior, Indian 

Affairs, n.d.-b).

240

“There are more than 570 federally 

recognized Tribes in the U.S., and 

more than 240 state or non-federally 

recognized Tribes, many of whom 

are petitioning for federal recognition. 

There are similar attributes from 

Tribe to Tribe, but just as many 

differences in Tribal languages, 

cultures, organizational structures, 

etc.” (National Council of Urban Indian 

Health, 2018).
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• Helping others is more important 

than helping yourself. A 

community approach to healing is 

often emphasized.

• Prayer, traditions, and spirituality 

are important facets of life 

(Beasley, Jones-Locklear, & 

Jacobs, 2021).

Historical Trauma and 

Resilience

Historical trauma is the cumulative, 

multigenerational, collective 

experience of emotional and 

psychological injury in communities 

and in descendants (Brave Heart 

et al., 2012; Brave Heart, 2003). 

Historical trauma is common across 

Native American communities 

due to events after the arrival of 

European settlers, who expanded 

the United States in part through 

relocating, renaming, combining, 

dispersing, and sometimes 

destroying Native American 

communities (Library of Congress, 

n.d.). Traumatic events, such as 

forced relocation and assimilation, 

massacres, and abduction, abuse, 

and even death of children and 

adolescents in government-funded 

boarding schools, have caused 

lasting impacts on Native American 

communities (Manson et al., 2021; 

National Native American Boarding 

School Healing Coalition, n.d.). 

Responses to historical trauma may 

include low self-esteem, depression, 

substance misuse, and increased risk 

of suicide (Skewes et al., 2020).

Many Native American communities 

have developed resilience based in 

strong family, social, and religious 

and spiritual ties; long histories of 

coping with challenges; recognition 

and appreciation of culture and 

history; and participation in 

traditions (Beasley, Jones-Locklear, 

& Jacobs, 2021). These strengths 

can be valuable elements of disaster 

response and recovery plans.

Tips for Working With Tribes: 

Disaster Planning and 

Preparedness

As with other communities, it 

is important to start building 

relationships with Native 

Find Out More

Some of the information and 

tips in this article come from 

the SAMHSA DTAC tip sheets 

Understanding Historical Trauma 

When Responding to an Event 

in Indian Country (https://

store.samhsa.gov/product/

Understanding-HistoricalTrauma-When-Respondingto-an-Event-in-Indian-Country/

SMA14-4866) and Cultural 

Awareness When Working in 

Indian Country Post Disaster 

(https://store.samhsa.gov/

product/Cultural-AwarenessWhen-Working-in-IndianCountry-Post-Disaster/sma14-

4867). These tip sheets are 

being updated. Stay tuned for 

an announcement when the 

new versions are posted to the 

SAMHSA Store website!
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American communities before a 

disaster occurs, as part of overall 

preparedness. It is also crucial to 

show respect for the community, 

its government, and its culture and 

beliefs. 

• Build relationships with tribal 

communities near you or within 

your state well in advance of a 

disaster (ASPR, 2020). Regular 

meetings may be helpful. So may 

formal agreements for mutual aid 

and support to make it easier to 

collaborate in a disaster (Federal 

Emergency Management Agency 

Center for Domestic Preparedness, 

n.d.).

• Before a disaster, get to know 

trusted tribal liaisons, such as tribal 

emergency managers or spiritual 

leaders. By showing respect and 

working with a tribal liaison, you 

will increase your professional 

credibility.

overcome past trauma and 

adversity (Strickland, Walsh, & 

Cooper, 2006)? 

• How are children in the 

community taught coping and 

problem-solving skills?

• Learn who the traditional and 

elected tribal leaders are and how 

to appropriately request to speak 

with them.

• Emphasize traditional values, 

beliefs, and expressions of culture 

(especially related to health and 

illness, emotional well-being, and 

resilience) for the tribe during all 

phases of emergency management.

During and After a Disaster

• Always check in with the tribal 

community and leaders to see 

if they agree with the response 

before moving forward.

• Identify and collaborate with tribal 

liaisons to ensure program efforts 

More than three-quarters, or 78 

percent, of Native Americans 

live in places other than 

reservations (Office of Minority 

Health, 2022).

• Before an event occurs, you may 

consider seeking the wisdom of 

community leaders. The words 

and phrases used to describe 

mental and emotional health 

differ in tribal communities. It is 

important to know how your local 

community refers to these concepts 

before you meet with the leaders. 

Keeping in mind that every tribe 

is different and knowing your 

community’s disaster risks, you 

may choose to ask leaders some of 

these questions to help you build a 

relationship and connection:

• What is the leaders’ sense of 

their community’s physical and 

emotional well-being (Novins, 

King, & Stone, 2004)? 

• What strengths do community 

members have that can help 

them cope with and overcome 

their problems?

• How have leaders helped 

community members 
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demonstrate an understanding of 

the unique needs of the community 

and are focused on strength and 

resilience. 

• Just after an event occurs, you may 

wish to ask community leaders if 

they can talk to residents about 

the event in a way that shows how 

it relates to their tribe’s creation 

stories or other traditional teaching 

stories. This technique can be 

used as a way to explain why 

things happen and emphasize the 

community’s ability to respond 

and recover. It is important to have 

a respected leader support the 

community through this process 

and encourage collective wellbeing.

• Some tribes do not have a word 

for “disaster” and refer to disasters 

differently than non-Native cultures 

do. Some may feel that saying the 

word “disaster” may bring harm to 

their community. It is important to 

pay attention to how members of 

the local tribal community refer 

to disasters and other traumatic 

events and use the same words and 

phrases they use.

• Hire people from the tribal 

community to provide disaster 

behavioral health services to 

people in the tribal community. 

Members of all communities 

often feel more willing to talk 

with people who were part 

of their community prior to a 

disaster about how the disaster 

has affected them and the 

community. If establishing a 

crisis counseling program with 

provider organizations, select 

organizations that are from the 

tribal communities they will be 

serving.

• Make an effort to help reestablish 

traditional responses and 

protective factors that were in 

place prior to the disaster. It 

is important to build trusting 

relationships and recognize the 

many strengths of the community 

while responding to a disaster.

• Community-based healing 

programs that emphasize cultural 

values and unity can provide 

participants with feelings of 

belonging and interdependence. 

If the tribal community engages 

in an activity, event, or practice 

that is familiar and engaging 

to their members, request that 

a disaster behavioral health 

responder be allowed to participate 

or be present. The local leader 

and disaster behavioral health 

responder can discuss the issues 

to bring to the group and how 

these will be presented to meet 

community needs and build 

resilience. ■

A majority of American Indians 

and Alaska Natives—71 

percent—live in urban areas 

(Maudrie et al., 2021). 
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A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

RECOMMENDED RESOURCES

TIP 61: Behavioral Health Services for American 

Indians and Alaska Natives

This Treatment Improvement Protocol (TIP) manual 

from SAMHSA provides mental health and substance 

use disorder treatment professionals with guidance for 

working with American Indians and Alaska Natives. It 

can help professionals improve cultural competence and 

provide culturally appropriate services while learning 

about the importance of historical trauma and the 

significance of community.

This resource is available through the SAMHSA Store at 

https://bit.ly/3ofnAdY. 

Tribal Affairs

This page from Federal Emergency Management 

Agency (FEMA) provides a link to the FEMA Tribal 

Policy, notes the nation-to-nation relationship of FEMA 

and tribal governments, and discusses the disaster 

declaration process for federally recognized Indian 

tribal governments. Also provided are links to tools 

and resources for disaster preparedness, response, and 

recovery in Indian Country.

Find the page at https://www.fema.gov/about/

organization/tribes. 

Tips for Disaster Responders: Cultural Awareness 

When Working in Indian Country Post Disaster

This tip sheet highlights the importance of cultural 

awareness when responding to a disaster in Indian 

Country. It notes the uniqueness of individual tribal 

cultures and communities, highlights some elements 

of culture that are common across many tribal 

communities, and offers tips for incorporating the tribe’s 

beliefs and practices into disaster response.

Find the SAMHSA resource at https://store.samhsa.gov/

product/Cultural-Awareness-When-Working-in-IndianCountry-Post-Disaster/sma14-4867. 

FEMA Tribal Curriculum

FEMA offers a curriculum composed of several courses 

that aim to increase the resilience of tribal nations 

and communities. Informed by consultation with 

representatives of tribal governments, the courses range 

from 4 hours to 4 days and teach the knowledge and 

skills needed to prepare communities for an emergency, 

ways to reduce potential losses, and more.

Find all of the courses at https://training.fema.gov/tribal. 

Working With Indigenous/Native American Patients

This page from the American Psychiatric Association 

offers an overview of the history of the indigenous 

population and best practices for working with Native 

American patients. Things to keep in mind include 

avoiding stereotypes and translating forms to the 

language of the people in the area. The page also 

includes a video and downloadable guide.

Find the page at https://bit.ly/3ucbRkn.
2022 | VOLUME 17 | ISSUE 4 | PAGE 25

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

Recent Technical Assistance Requests

In this section, read about responses SAMHSA DTAC staff have provided to recent technical assistance (TA) requests. 

Send your questions and comments to dtac@samhsa.hhs.gov.

Request: A representative from the Intertribal 

Agriculture Council serving Nebraska, South Dakota, 

and North Dakota requested mental health resources for 

agriculture producers facing drought and other disasters. 

Response: SAMHSA DTAC provided a list of statespecific services and resources for tribal communities. 

The resources below are a sample of those sent. For 

additional information, please contact SAMHSA DTAC 

at 1–800–308–3515.

 Have You Experienced a Disaster?—This SAMHSA 

poster describes the effects disasters of all types may 

have lists common reactions to disasters, and identifies 

sources of support. https://store.samhsa.gov/product/

have-you-experienced-disaster-poster-pertaining-adultreactions/PEP19-01-01-003

 SAMHSA Tribal Training and Technical Assistance 

(TTA) Center—The SAMHSA Tribal TTA Center 

offers training and TA on mental health problems 

and substance use disorders, suicide prevention, and

mental health promotion for tribal communities and 

programs. https://www.samhsa.gov/tribal-ttac

 SAMHSA Mental Health Technology Transfer 

Center (MHTTC) Network—These collaborative 

networks support resource development and 

dissemination, training, and TA to cover the full 

continuum of mental health care, including mental 

illness prevention, treatment, and recovery support. 

https://mhttcnetwork.org

 Mountain Plains MHTTC https://mhttcnetwork.

org/centers/mountain-plains-mhttc/home

 Rural Mental Health & Farm Stress https://

mhttcnetwork.org/centers/mountain-plains-mhttc/

rural-mental-health-farm-stress

 Mid-America MHTTC https://mhttcnetwork.org/

centers/mid-america-mhttc/home

 National American Indian & Alaska Native 

MHTTC https://mhttcnetwork.org/centers/

national-american-indian-and-alaska-native-mhttc/

home

Request: SAMHSA requested resource letters in 

response to tornadoes that occurred in Arkansas, Illinois, 

and Kentucky. 

Response: The resources below are a sample of those 

sent. For the complete resource list, please contact 

SAMHSA DTAC at 1–800–308–3515.

 Disaster-specific Resources: Tornadoes—This 

part of the SAMHSA Disaster Behavioral Health 

Information Series resource collection features 

materials about coping after a tornado. Resources 

focus on staying safe during cleanup after a tornado, 

Help Improve SAMHSA’s Disaster 

Services and Products

As a subscriber to this 

newsletter, you are 

invited to participate in a 

short, web-based survey 

to provide the SAMHSA 

Disaster Technical 

Assistance Center (DTAC) with feedback about 

your experiences with our products and services. 

The survey should take no more than 15 minutes. 

Complete the survey by clicking on this link, 

or copy and paste the URL https://iqsolutions.

qualtrics.com/jfe/form/SV_bjYCSJDUQAGi1h3

into your web browser.
2022 | VOLUME 17 | ISSUE 4 | PAGE 26

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

supporting children in coping, and managing stress 

during deployment as part of response after a 

tornado. https://www.samhsa.gov/resource-search/

dbhis?rc%5B0%5D=type_of_disaster%3A20553 

 A Guide to Managing Stress in Crisis Response 

Professions—This SAMHSA guide is designed for 

first responders, public health workers, construction 

workers, transportation workers, utility workers, 

and volunteers who respond to disasters and other 

crises. The guide provides information on signs 

and symptoms of stress and offers simple, practical 

techniques for lowering stress before, during, and after 

disaster response. https://store.samhsa.gov/product/

guide-managing-stress-crisis-response-professions-2/

sma05-4113

 Tornadoes and Severe Storms—At this web page, 

the SAMHSA Disaster Distress Helpline describes 

tornadoes and the effects they can have, lists 

populations at heightened risk of post-tornado distress, 

and provides links to related resources. https://www.

samhsa.gov/find-help/disaster-distress-helpline/

disaster-types/tornadoes 

 Natural Disasters, Severe Weather, and 

COVID-19—At this web page, the Centers for 

Disease Control and Prevention provides information 

and links to resources about staying safe after natural 

disasters during the COVID-19 pandemic. Information 

is provided about hurricanes and COVID-19, safety 

in public disaster shelters during the pandemic, and 

wildfires and COVID-19. https://www.cdc.gov/

disasters/covid-19/disasters_severe_weather_and_

covid-19.html

Request: A Community Emergency Response Team 

in Massachusetts requested resources to include in their 

leadership training. The requestor noted the leadership 

team is composed of volunteers interested in materials 

dedicated to emergency response and de-escalation 

techniques.

Response: SAMHSA DTAC provided a list of 

trainings and publications dedicated to disaster response 

and first responders. The trainings below are a sample 

of those sent. For additional information, please contact 

SAMHSA DTAC at 1–800–308–3515.

 Creating Safe Scenes Training Course—This 

training course was originally designed for uniformed 

first responders but would still be helpful for other 

responders. https://www.samhsa.gov/dtac/creatingsafe-scenes-training-course

 Psychological First Aid (PFA)—Offered by the 

National Child Traumatic Stress Network, PFA is a 

free online course that includes a 6-hour interactive 

training that puts the participant in the role of a 

provider in a post-disaster scene. https://learn.nctsn.

org/enrol/index.php?id=596

SAMHSA DTAC also included some publications and 

tip sheets for first responders, their supervisors, and 

others who work with first responders. A sample of these 

resources is included below:

 Helping Staff Manage Stress When Returning to Work: 

Tips for Supervisors of Disaster Responders

 Tips for Disaster Responders: Preventing and 

Managing Stress

 Tips for Disaster Responders: Returning to Work
2022 | VOLUME 17 | ISSUE 4 | PAGE 27

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

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Carron, R. (2020, June). Health 

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Nurturing innovation at the roots: The 
2022 | VOLUME 17 | ISSUE 4 | PAGE 28

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

success of COVID-19 vaccination 

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nsduh-detailed-tables
2022 | VOLUME 17 | ISSUE 4 | PAGE 29

A Quarterly Technical Assistance Journal on Disaster Behavioral Health 

Produced by the SAMHSA Disaster Technical Assistance Center

SAMHSA. (2021). Table 5.5B – 

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characteristics, percentages, 2019 

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The Dialogue is not responsible for the 

information provided by any web pages, 

materials, or organizations referenced 

in this publication. Although The 

Dialogue includes valuable articles and 

collections of information, SAMHSA 

does not necessarily endorse any 

specific products or services provided 

by public or private organizations 

unless expressly stated. In addition, 

SAMHSA does not necessarily endorse 

the views expressed by such sites or 

organizations, nor does SAMHSA 

warrant the validity of any information 

or its fitness for any particular purpose.

The views, opinions, and content 

expressed in this publication do not 

necessarily reflect the views, opinions, 

or policies of the Center for Mental 

Health Services (CMHS), the Substance 

Abuse and Mental Health Services 

Administration (SAMHSA), or the U.S. 

Department of Health and Human 

Services (HHS).
Prepare • Respond • Recover

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The SAMHSA Disaster Behavioral Health Information Series contains resource collections 

and toolkits pertinent to disaster behavioral health. Installments focus on specific populations, 

specific types of disasters, and other topics related to all-hazards disaster behavioral health 

preparedness and response. Visit the SAMHSA DTAC website at 

https://www.samhsa.gov/dtac/dbhis-collections to access these materials.

CONTACT US

SAMHSA Disaster Technical 

Assistance Center

Toll-free: 1–800–308–3515 

dtac@samhsa.hhs.gov 

https://www.samhsa.gov/dtac