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~ Substance Abuse and Mental Health Services Administration 

~SAMHSA www.samhsa.gov • 1-877-SAMHSA-7 (1-877-726-4727) 

Substance Abuse and Mental Health 

Services Administration 

Contract No. HHSS280201300001C 

Tribal TTA Center 

Healing-informed Care Handout 

Submitted September 11, 2015 

Submitted to: 

Maureen Madison, Ph.D. 

Public Health Advisor 

Division of Prevention, Traumatic Stress, and 

Special Programs 

Center for Mental Health Services Administration

1 Choke Cherry Road, 6-1100 

Rockville, MD 20857 

Phone: 240-276-1772 

maureen.madison@samhsa.hhs.gov 

Jon Dunbar-Cooper, M.A., C.P.P. 

Public Health Analyst 

Division of Systems Development 

Center for Substance Abuse Prevention 

1 Choke Cherry Road, 4-1020 

Rockville, MD 20857 

Phone: 240-276-2573 

jon.dunbar@samhsa.hhs.gov 

Submitted by: 

Lori King 

Project Co-Director 

Tribal Tech, LLC 

218 North Lee Street, Suite 321 

Alexandria, VA 22314 

Phone: 906-440-279 

lking@tribaltechllc.com 

Gloria Guillory 

Project Co-Director 

Kauffman & Associates, Inc. 

South 165 Howard Street, Suite 200 

Spokane, WA 99201 

Phone: 509-747-4994 

gloria.guillory@kauffmaninc.com 
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Table of Contents 

Introduction....................................................................................... 3 

Healing-Informed Care and Trauma-Informed Approach................................. 3 

Worldview ......................................................................................... 4 

Ways of Knowing ................................................................................. 5 

Cultural Strategic Framework ................................................................. 6 

Indigenous Values................................................................................ 7 

Definition of Health Key Concepts............................................................ 8 

Indigenous Healing Practices .................................................................. 9 

Summary..........................................................................................11 

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Introduction 

The Tribal Training and Technical Assistance Center (the Center), funded by the Substance 

Abuse and Mental Health Services Administration (SAMHSA), provides training and technical 

assistance (TTA) on mental and substance use disorders, suicide prevention, and the promotion 

of mental health. 

Ultimately, our work in prevention is about healing—healing individuals and the communities 

they live in. Healing implies change but change can be difficult. Indigenous cultures have 

wisdom that has always provided guidance through difficult times. This wisdom calls us to 

focus on strengths, on what is working. SAMHSA recognizes this wisdom, guiding communities 

to base prevention on strengths-based practices that build protective factors and community 

collaborations. 

Healing-informed care is care based on Indigenous wisdom about wellness and what is 

necessary to heal. Culture has been shown to be a protective factor for AI/AN youth.1 Healinginformed care, derived from a rich understanding of Indigenous knowledge, is an extension of 

culture as a protective factor. It provides guidance to those who experience distress 

individually, in a family, or in a community. It provides a roadmap for maintaining or regaining 

health. 

The purpose of this handout is to define what Indigenous healing-informed care is, to 

demonstrate that healing-informed care is a trauma-informed approach,2 to explain the 

cultural foundations of healing-informed care and its relationship to the Cultural Strategic 

Framework. This will provide prevention workers and practitioners a deeper understanding of 

the cultural strengths that guide cultural resilience. By understanding how the Cultural Strategic 

Framework informs healing, prevention workers can formulate prevention and healing 

strategies that tap into the innate resilience of American Indian/Alaska Native (AI/AN) 

individuals and communities. 

Healing-Informed Care and Trauma-Informed 

Approach 

Indigenous healing-informed care is consistent and has a lot in common with the SAMHSA 

trauma-informed approach. The trauma-informed approach has six key principles: (1) safety; 

1 R. Sanchez-Way, S. Johnson. (December 2000). Cultural Practices in American Indian Prevention Programs. 

Juvenile Justice, 7(2). Retrieved from https://www.ncjrs.gov/html/ojjdp/jjnl_2000_12/cult.html 2 SAMHSA Trauma-Informed Approach and Trauma-Specific Interventions. Retrieved from 

http://www.samhsa.gov/nctic/trauma-interventions 

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(2) trustworthiness and transparency; (3) peer support; (4) collaboration and mutuality; (5) 

empowerment, voice, and choice; and (6) cultural, historical, and gender Issues. 

The trauma-informed approach can be seen as a “how to” that is in alignment with 

healing-informed care. Providing and supporting physical and emotional safety is a way to 

demonstrate respect and caring. Being trustworthy and transparent promotes cooperation and 

group harmony. Offering peer support reinforces relationships that are essential in healing and 

community building. Collaboration and mutuality are hallmarks of respect. Empowerment, 

voice, and choice mirror the values of autonomy and respect. Respecting cultural, historical, 

and gender issues is essential to healing. As the Cultural Strategic Framework states, healing 

begins with acknowledging the role of historical trauma.3 Gender is an essential aspect of every 

individual that, if not respected, would inhibit healing. Healing also cannot be expected to 

happen if an individual’s or a community’s culture is not respected. 

Worldview 

Our worldview helps us make critical decisions, which shape our future. It helps us cope with 

complexity and change; it can provide a roadmap for wellness. Scholars suggest that worldview 

constitutes our psychological orientation in life and can determine how we think, behave, make 

decisions, and define events. 4 As indigenous peoples, we have ancient, culture-specific 

philosophies and practices, called ways of knowing, that continue to provide us with guidance 

in everyday life. Ways of knowing have also been defined as “information that people in a 

community, based on experience and adaptation, have developed over time, and continue to 

develop. This knowledge is used to sustain the community and its culture.”5 This guidance can 

be especially important in the healing process, as all wellness exists within the framework of 

our worldview and our ways of knowing help us define health. 

Indigenous peoples perceive life as a gift from the Creator. They understand that they have a 

responsibility to nurture and care for that gift at a personal and collective level. A good life, or 

good health, is perceived to be a "balance of spiritual, mental, emotional, and physical 

elements.” 6 This worldview is often characterized graphically. Although these representations 

vary from tribe to tribe, the medicine wheel is one representation of the Indigenous worldview, 

showing the balance of spiritual, mental, emotional, and physical human experiences, as 

exemplified in Figure 1. 

3 PrettyPaint, I. (2008). Miracle survivors: A grounded theory on educational persistence for tribal college students. 

Minneapolis, MN: University of Minnesota. 

4 English, R. (1984). The challenge for mental health: Minorities and their worldviews. Austin: The University of Texas at Austin. 

5 Barnhardt, Kawagley, Indigenous Knowledge Systems and Alaska Native Ways of Knowing 6 Poonwassie, A., & Charter, A. (2001). An Aboriginal Worldview of Helping: Empowering Approaches. Journal of 

Counseling, 35(1), 63–73. 

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North 

West East 

South 

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Figure 1. American Indian Worldview Represented by the Medicine Wheel 

Ways of Knowing 

Ways of knowing have been defined as “information that people in a community, based on 

experience and adaptation, have developed over time, and continue to develop. This 

knowledge is used to sustain the community and its culture.”7 In other words, ways of knowing 

are what has made it possible for Indigenous peoples to survive. 

Characteristics of Indigenous ways of knowing that are important in healing are: 

• Holistic – Interconnectedness underlies all of human experience. 

• Balance – Because of the interdependencies of all life, achieving and maintaining 

balance is important both to the individual and the larger group. 

• Moral Code – The physical and metaphysical worlds are linked to a moral code. 

• Respect – Respect of all living things and each other is essential for balance.

8 

Healing has been defined as “transition toward meaning, wholeness, connectedness, and 

balance.9 

7 Barnhardt, R., & Kawagley, A.O. (April, 29, 2005). Indigenous Knowledge Systems and Alaska Native Ways of 

Knowing. Anthropology and Education Quarterly, 36(1), 8–23 8 ibid, p. 16 

9 Katz, O. & St. Denis, V. Teacher as healer. Journal of Indigenous Studies 2 (2): 24-36, 1991 

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Cultural Strategic Framework 

The Cultural Strategic Framework provides the foundation for Indigenous healing approaches 

for mental health issues, substance use, and suicide prevention in Indian Country. Using the 

framework to align approaches with the Indigenous worldview will contribute to effectiveness 

of prevention activities. 

The Center’s healing-informed care approach is built upon the cultural strategic framework of: 

• Vision – Behavioral health and wellness for tribal communities begins with 

acknowledging the effects of historical trauma, honoring cultural values, and developing 

of a vision of success. 

• Circles of Relationships – The quality and authenticity of relationships provides the 

critical pathway for this work to be effective and sustainable. These circles of 

relationships must emerge from the community and be based on the successful 

integration of memberships and responsibilities. 

• Sense of Hope – Tribal communities believe spirituality is at the core of their survival. 

A sense of hope includes interconnectedness (circles of relationships), sacredness of 

inner spirit (cultural resilience), balance (awareness), and responsibility to be lifelong 

learners (growth).

10 

Picture 1. Two Native boys in traditional dress 

10 PrettyPaint, I. (2009). Miracle survivors: A grounded theory on educational persistence for tribal college 

students. Minneapolis, MN: University of Minnesota. 

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Indigenous Values 

For prevention activities to work within a community, they need to fit the community values.11 

Understanding the values that AI/AN cultures are based in helps complete the picture of 

indigenous healing. A good reference for understanding Indigenous values is SAMHSA’s Culture 

Card, A Guide to Build Cultural Awareness.12 Research has identified 10 American Indian 

cultural values.

13 These values are similar, but not identical, to Alaska Native values identified 

by the Alaska Native Knowledge Network.14 To compare and contrast, Table 1 shows how 

American Indian and Alaska Native cultural values align. 

Table 1. American Indian and Alaska Native Cultural Values Alignment 

American Indian Cultural Values Alaska Native Cultural Values 

Spirituality Pray for guidance 

Child-rearing and connectedness with 

extended family 

See connections—all things are related 

Respect of age, wisdom, tradition Honor your elders 

Respect for nature (There is no comparable value stated, but, 

as referenced above, this value is implicit 

in the AN worldview) 

Generosity and sharing Share what you have and take care of 

others 

Cooperation and group harmony Live carefully—what you do will came back 

to you 

Know who you are—you are a reflection 

on your family 

Autonomy and respect for others Show respect to others 

11 National Institute of Arthritis and Musculoskeletal and Skin Diseases, Taking Action: Health Promotion and 

Outreach with American Indians and Alaska Natives Literature Review, September 1, 2006, retrieved from 

12 SAMHSA, Culture Card: A Guide to Build Cultural Awareness, retrieved from 

http://www.niams.nih.gov/About_Us/Mission_and_Purpose/Community_Outreach/Multicultural_Outreach/AIAN 

_WG/NIH_AIAN_Lit_Rev.asphttp://store.samhsa.gov/shin/content//SMA08-4354/SMA08-4354.pdf 13 PrettyPaint, I., (2009). Miracle survivors: A grounded theory on educational persistence for tribal college 

students. Minneapolis, MN: University of Minnesota 

14 Retrieved August 20, 2015, from the Alaska Native Heritage Center at http://www.alaskanative.net/en/mainnav/about-us/anhc-mission-new/. 

7 
Composure and patience Accept what life brings and have patience 

Relativity of time (Not applicable) 

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Definition of Health Key Concepts 

The Indigenous worldview, ways of knowing, values, and cultural theoretical framework inform 

our concepts of health and wellness. From these foundational elements, the following basic 

principles of health and wellness for indigenous peoples are derived.15 

• Balance – Illness is seen as being out of balance; some part of the whole is not in 

balance with the rest of the whole. To heal, all four aspects of an individual should be 

considered and should be in balance—mental, emotional, spiritual, and physical. 

• Relational – This concept emphasizes the interconnectedness of all things. Health is 

holistic, but also communal. If an individual is unwell, the family, community, and 

future generations are affected. By the same token, the effects of a healthy person will 

also ripple through the community. 

• Strengths-based – The indigenous worldview assumes that all individuals have innate 

strengths they bring when facing adversity. Healing-informed care recognizes this belief 

and helps individuals and communities express these strengths. 

15 Barnhardt, R., & Kawagley, A.O. (April, 29, 2005). Indigenous Knowledge Systems and Alaska Native Ways of 

Knowing. Anthropology and Education Quarterly, 36(1), 8–23 

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Picture 2. Native fathers drumming, holding children 

Indigenous Healing Practices 

Cultural healing practices vary from tribe to tribe and village to village. They are based on the 

place, as well as the people; however, there are commonalities among the practices. 

Indigenous healing practices include practices for purification, renewal, and transformation. 

These Indigenous practices help in promoting healing and nourishing resilience. Table 2 shows 

examples of cultural practices and potential benefits that can be derived from these practices. 

Table 2. Cultural Healing Practices and Benefits 

Cultural Practices Benefits 

Language classes • Informs the cultural worldview, ways of knowing, 

knowledge systems, values, and practices 

• Connects us to each other and our culture 

• The key that unlocks the worldview, values, and 

teachings 

Smudging (purification) • Helps provide a feeling of the sacred and safety, which 

are important in healing trauma 

• Helps focus attention and intention 

• Helps turn thinking from negative to positive 

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Cultural Practices Benefits 

Ceremonies and ritual • Gets people in touch with a sense of spiritual 

connection 

• Focuses the mind, heart, and body on healing 

• Communicates a message of personal responsibility, 

“You have to do something, too” 

• Reminds us that healing is relational and takes place in 

the context of one’s community 

Stories and artwork • Illustrates and clarifies values 

• Connects us to each other and to a place 

• Conveys culturally specific values, including high 

expectations, caring, support, and opportunities for 

participation 

Talking circles • Promotes belonging 

• Provides a safe and healthy way to resolve conflict 

• Encourages community 

Gift giving (generosity) • Demonstrates and solidifies connectedness 

• Shows respect for the giver and recipient 

Visiting • Encourages people to tell their stories and to connect 

with each other 

• Helps release internalized pain 

• May help show the connection between thought and 

feeling 

• Helps people get in touch with their purpose 

Subsistence/culture camps • Teaches Indigenous values 

• Contributes to belonging and a sense of self worth 

Respect of elders • Teaches Indigenous values 

• Contributes to belonging and a sense of self worth 

• Provides support 

Fun walks/runs • Addresses the physical component of wellness 

• Brings the community together 

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Cultural Practices Benefits 

Powwows • Connects us to each other and our culture 

• Conveys cultural values, including high expectations, 

caring, support, and opportunities for participation 

Regalia, arts and craft • Connects us to each other and our culture 

making • Provides opportunities for hands-on learners to 

connect to their culture 

Summary 

Healing-informed care principles are strengths-based and specific to each culture and 

community. However, the common ground that underlies these principles is found in the 

indigenous worldview, ways of knowing, and cultural practices. To understand the foundation 

of healing-informed principles is to more fully recognize the rich cultural knowledge that 

informs cultural practices. These are summarized in the Cultural Strategic Framework. When 

grounded in the Cultural Strategic Framework, healing practices stay true to the precepts of 

Indigenous healing, that is, vision, circles of relationship, and a sense of hope. This grounding 

can help the AI/AN tribes and villages served by the Tribal TTA Center as they plan and 

implement activities to address mental and substance use disorders, suicide prevention, and 

the promotion of mental health. 

11