Dr. Joanne C. O’Connell

THE NATIVE AMERICAN Research and Training Center was established at Northern Arizona University in order to investigate barriers to service delivery for disabled Native Americans. The variables related to Native American traditional values, beliefs, and practices were identified as one source of influence effecting the successful delivery of educational and rehabilitation service to Native Americans. Therefore, a model for delivering services to the families of young, handicapped Native American children residing on rural reservations has been developed. The model components represent the strategies that have been used by the Institute for Human Development in serving these families, as well as an increased understanding of the cultural influences on service delivery to Native Americans.

The conceptual framework within which the model components are defined are in terms of the Family Systems Model, currently in the process of development at the Research and Training Center on Independent Living at the University of Kansas, Lawrence. A review of this model was provided by Turnbull, Brotherson, and Summers (1985). First, the Family Systems Model will be described, relying extensively on the Turnbull et al. (1985) review, and secondly, the implementation of such an approach with the White Mountain Apache communities will be presented as an example of the appropriateness of a family systems approach in rural, reservation communities.

The Family Systems Model consists of four subsystems and three perspectives of family dynamics. The four subsystems are identified as: (1) the spouse subsystem (husband and wife interactions); (2) the parental subsystem (parent-child interactions); (3) the sibling subsystem (child-child interactions); and (4) the extra-familial subsystem (nuclear family interactions with extended family and networks of social, community, and professional support) (Turnbull et. al., 1985). The existence of these subsystems will differ from family to family. For instance, the spousal subsystem may be less significant in a single parent family; in other families, the handicapped child may have no siblings.

Any educational intervention designed to target one of the subsystems will be effected by the other three. For instance, a single parent with a five-year-old handicapped child and a two-year-old busy toddler will have less time to devote to individual instruction for her handicapped child while caring for a young infant. However, it is the informal and formal support systems (the extra-familial subsystem) within reservation communities that may differ significantly for families residing on reservations than for families more integrated into the dominant society, and greatly influence the successful delivery of educational services to these families. The extrafamilial subsystem varies greatly in its breadth and in the quality of its contribution to family members. The informal support systems on many reservations are often quite strong, while the formal support systems (state agency offices and personnel) tend to be quite fragmented and difficult to access. On the White Mountain Apache Reservation the maternal grandmother is ever-present. To the contrary, state regional offices for agency caseworkers, etc., are rarely housed on the reservation, complicating an already existing problem of limited transportation for many Native American families. Modern mobile families however, often experience a loss of informal support networks, having moved away from their extended, familial support systems, and yet, are physically located in the heart of multiple agency offices and services.

According to Turnbull et al. (1985), family theorists have described family dynamics from three different perspectives: (1) structural approaches (Minuchin, 1974; Stanton, 1981); (2) functions assumed by families (Caplan, 1976); and (3) family life cycle (Carter & McGoldrick, 1980; Duvall, 1977, p. 117). The Native American early intervention family model to be presented here directly addresses elements of the family structure. As a brief overview, a definition of the family functions and family life cycle characteristics will be provided.

On the basis of a review of sociological literature and interview data, Turnbull et al. (1985) identified ten major family functions that consist of responsibilities related to meeting individual family member needs. Examples of family functions would be economic, physical needs, rest and recuperation, socialization, educational and guidance. The family life cycle perspective considers eight stages of family development and the influence of the developmental stage of the family on the family unit. The developmental stages in the family life cycle are: (1) unattached adult; (2) marriage; (3) birth of children; (4) children enter school; (5) children enter adolescence; (6) children launched into adulthood; (7) retirement and old age; and (8) death (p. 134).

While the family functions and family life cycle influence our ability to effectively deliver educational programs to families, the family structural perspective provides a viable framework from which to design more appropriate educational models for reservation Native American families.

The major components of family structure consist of: (1) variations in family membership and style; (2) variations in cultural style; (3) variations in ideological style; and (4) variations in relationship parameters (Turnbull et al., 1985, p. 118). In designing a model of early intervention services for the White Mountain Apache communities, the cultural characteristics of the Tribe were investigated and interviews with local tribal members helped identify those which appeared to have the most influence on service delivery programs. A definition of each of these components and how the proposed Native American model addresses concerns raised by the Family Systems Approach will be described.

Variations in family membership and style. Turnbull et al. (1985) describe the family membership and style characteristics as varying along many dimensions, i.e. the number of parents, nature of kinship relationships, and family size. In the White Mountain Apache community of White River, Arizona, it became clear from the published literature, and confirmed by the personal interviews that were conducted, that the maternal grandmother plays an integral role in the functioning of the family by her position in the family membership structure. The maternal grandmothers in the White Mountain Apache communities concern themselves in countless ways with the child’s development. They are constantly consulted by their daughters on problems of child rearing. Grandmother’s home is always open to the child. In fact, if for some reason the biological mother is unable to care for the child, it becomes the maternal grandmother’s responsibility to raise the child. Grandmothers function as teacher and instructor of the child. Paternal grandparents have less contact (Opler, 1965).

The continued strength of this relationship was confirmed by a review of the White River, Arizona, Head Start child enrollment, which indicated that 40% of the children enrolled in Head Start during the 1984-85 school year indicated the grandmother as the primary caretaker. Ignoring the importance of this kinship relationship between the grandmother and the daughters in this community could quite easily result in the failure of any early intervention program. Since the grandmothers represent an older, more traditional generation, it is even more likely that their values and beliefs about child-rearing may be different from those of the early intervention program. The special educators intervening with these families need to develop a strategy for including the grandmothers in the intervention program. In the model developed for the White Mountain Apache community, it was determined that the grandmothers would need to be included in the delivery of the educational plan.

Variations in cultural style. The family culture consists of many features, and are described by Turnbull et al. (1985) as including such elements as ethnic background, race, religious affiliation, socioeconomic status and location (urban/ rural/suburban). All of these substantially influence family reactions and coping. Because all of these features are dominating characteristics of Native American communities, they must be addressed through an appropriate intervention strategy. It is usually very difficult for agency service providers outside of the Native American communities to understand the full depth and breadth of influence the traditional culture has on educational services. In addition, the behaviors manifested by the family members we work with are often different from our expectations, and appear unexplainable.

In order to deal with the complexities of the cultural influence upon the successful delivery of early intervention services to reservation communities, indigenous, paraprofessional aides are employed. The Institute for Human Development on the Northern Arizona University campus has identified local community Native Americans to serve as paraprofessional educators in preschool handicapped classrooms on several reservations. Individuals selected for employment by the Institute understand how traditional values, beliefs and practices influence the caregiver’s willingness and ability to comply with the directions of the intervenor. For instance, a health provider may identify an epileptic infant in need of medication, and thus, tell the caregiver that the child must be taken to the Indian Health Service facility for an examination and prescription for medicine to control the seizures. In the meantime, grandmother is telling the young mother that the child’s "condition" is caused by viewing the blood of a dead animal during pregnancy. The young mother will experience conflict between the two sources of information she is receiving. Given the strong influence of the maternal grandmother, however, she may decide that there is really nothing that can be done and, therefore, fail to get her child the needed medication.

The local, indigenous paraprofessionals understand the traditional beliefs that are effecting the caregiver’s behavior. They are also able to determine whether or not the family is seeking help from a medicine man or healer and, hence, identify another very influential source of information. Most Native American parents are reluctant to share this type of information with an "outsider" or Anglo. These traditional beliefs need not be considered major barriers to service delivery. The first step in dealing with this information is in identifying it. The local, indigenous paraprofessionals are needed in order for this to be done appropriately.

Variations in ideological style. The family’s ideology pertains to their beliefs about what is important for individual members and the group (Turnbull et al, 1984, p. 120). These beliefs often constitute decision rules and guidelines for the family. Specific dimensions of ideological style include child-rearing beliefs, attitudes toward disability, and attitudes toward education. Early intervention to the Apache community is greatly influenced by the older, generational influence on child-rearing beliefs, the low formal educational level of the community as a whole, and the attitudes toward disability, which is reflected in the cultural value for conformity. That is, social conformity is a highly valued behavior for children. When there is a handicapped child in the family, he/she is often hidden or sent off the reservation for services because the family may become ostracized within the community for raising a child who doesn’t conform to the expected norms for that community.

The model addresses these concerns by designing a strong educational component. First, grandmothers and biological mothers are included in the educational process. In order to be more effective in changing attitudes and increasing the educational knowledge and understanding of child development and parenting practices, two strategies are employed: (1) "grandma" peer paraprofessionals are selected to work with the primary caregivers who are grandmothers; and (2) educational materials are developed for low-English-proficient adults. It is felt that in order for the paraprofessional to be effective with the older grandmother, that a peer should be identified who is viewed with respect within the community and who could be effectively trained as a peer educator, and in turn teach the grandmother. Secondly, since many of the caregivers are still bilingual and experience difficulty with the English language, the educational materials will need to be at a level of comprehension that can be understood by LEP (low English-proficient) adults, hence, increasing the overall effectiveness of the educational component.

Variations in relationship parameters. Relationship parameters have to do with both familial and extra-familial characteristics, such as power and hierarchy, role assignments, boundary definitions, and communication style (Turnbull et al., 1985, p. 122). For purposes of the model described here, the relationship of the family to the extra-familial support system will be the focus. The community members within the small, reservation communities exert a strong influence over the behavior, attitude and acceptance of individual members, as well as families.

Evidence of a clan system is still quite strong. The clan is considered unilateral kinship, composed of people who consider themselves related through the maternal line and descendants of those ancestors who founded the clan’s first farming site (Basso, 1976). Intermarriage within the clan is prohibited. Many barriers exist between families within the small, reservation communities because of grievances incurred by a member of one clan from another clansman which resulted in long-standing family disagreement. Families with clanship barriers do not generally accept or respect one another and interactions between them will be strained. This would have an impact on selecting local paraprofessionals as the intervenors, in which care is taken to insure the general acceptance of these individuals within the community. Organizing community-wide parent groups provides another example of clanship influence, the result of which could be low participation rates and passive non-compliance during large group meetings.

The Apache model incorporates strategies for community input and education. The model itself was developed by extensive interviews with individuals from many facets of the community, i.e. professionals in education, health, and social services, and "key informants" who could articulate elements of the culture and community that could facilitate and hinder the delivery of early intervention services. Any early intervention program in rural, reservation communities should establish on-going advisement mechanisms with individuals who need to be kept informed of the intervention activities, can advocate within the community for the existence of such a program, and can provide feedback regarding its effectiveness from the community’s perspective. It is also critical to identify the structure of the Tribal Government and determine how to best interact with its members and meet the requirements of the Tribe for delivering educational services.

Summary. Native Americans represent the most economically disadvantaged and underserved groups in America. They have the lowest average income, lowest educational level and lowest standard of living (Levitan & Johnston, 1975). Appropriate, effective service delivery to handicapped Native Americans is sorely lacking. The layers of bureaucracy that exist between tribal, state, and federal governments contribute to the barriers that exist in serving this population. The traditional cultural values, beliefs, and practices contribute to the misunderstandings in how to effectively service Native Americans.

The Apache model described here attempts to address some of the major problems and concerns for educators trying to deliver early intervention to rural, reservation Native American families. The Family Systems Approach provides a conceptual framework from which the Native American families can be viewed within their unique community milieu. What may have originally been considered "cultural barriers" can now be viewed as "cultural differences", and intervenors can be sensitive to the needs of families with young, handicapped children to function effectively within their Native American cultural communities, while presenting them with information and alternatives to child-rearing practices in order to facilitate the development of their handicapped child. The Native American cultural values and beliefs can then be viewed as essential to delivering early intervention services.

Basso, H.K. (1969). Western Apache witchcraft. Anthropological papers of the University of Arizona, #15. Tucson: University of Arizona Press.

Caplan, G. (1976). The family as a support system. In G. Caplan & M. Killilia (Eds.), Support systems and mutual help: Multidisciplinary explorations. New York: Grune & Stratton.

Carter, E., & McGoldrick, M. (1980). The family life cycle and family therapy: An overview. In E. Carter & M. McGoldrick (Eds.), The family life cycle: A framework for family therapy. New York: Gardner Press.

Duvall, E. (1977). Marriage and family development (5th ed.). Philadelphia: J. B. Lippincott.

Levitan, S., & Johnston, W. (1975). Indian giving federal programs for Native Americans. Baltimore: Johns Hopkins University Press. Minuchin, S. (1974). Families and family therapy. Cambridge, MA: Harvard University Press.

Opler, E.M. (1965). Apache life way. New York: Copper Square Publishing.

Stanton, M. (1981). An integrated structural/strategic approach to family therapy. Journal of Marital and Family Therapy, (74), 427-440.

Turnbull, A.P., Brotherson, M.J., & Summers, J.A. (1985). The impact of deinstitutionalization of families. In R. Bruininks & K. Lakin (Eds.) Living and learning in the least restrictive environment. Baltimore: Paul H. Brookes.