Culture Based Evaluation
NCN’s DOCUMENTION AND ASSESSMENT PRINCIPLES
- RELATIONSHIPS: We focus on operationalizing, documenting, and assessing interconnectedness and interactions; relationships between individuals as well as the interactions that occur between people and institutions (e.g. schools, law enforcement, social services, etc.).
- PARTICIPATION: Documenting, assessing and defining success is ultimately defined by all relevant stakeholders, especially by the individuals receiving services. We help build local capacity through local participation (e.g. local people are trained to assist in the design of the evaluation process and in the collection and analysis of the data).
- RESPECTFUL OF CEREMONY: We define ceremony as time honored practices whose purpose is to guide people back into balance. We acknowledge that asking questions influences the way in which people think and act. NCN therefore respects the ceremonial nature of healing events and attempts to minimize interference and maximize support for this process but strives to add to it.
- BALANCE: NCN uses a balanced-based approach when we view people, families and communities. We conceptualize behavior as being in a continuum; having both strengths and the resources to make change and heal themselves as well as responses that are counter to healthy development. Our instruments therefore capture what many may see as “pro-social” attitudes and behaviors and not just those that are destructive. The methods that we use to document and assess also reflect this balance. We use both qualitative and quantitative methods as well as non-traditional techniques such as video and audio-recording.
- HEALING-INFORMED: NCN believes that institutions are in place to heal people and communities, not merely to affect behavior change without purpose. Institutions have a curative function—to guide individuals that have become disconnected. Among other implications, this means that we collaborate and design documentation and assessment systems that are respectful of the organizations with which we work.
At the core of the LCC evaluation is a focus on relationships. For the purposes of evaluation, we divide relationships into three basic groupings; with the physical world, other people and with institutions.
One of the fundamental differences between indigenous culture and we might call modern “western” lifestyle is the attitude toward nature – earth, air, water and fire. Indigenous people see these elements as living entities, while in our modern world; they have been reduced to inanimate “objects”. Appreciating and valuing nature makes sense for people that sleep on the ground, rely on rain for their harvest or hunt for their dinner. Scientists name this understanding “animism”. Doing so makes it easy to dismiss this attitude toward the physical world as superstition. This is in spite of the fact that these same scientists tell us that all matter consists of the same atoms and molecules. The fundamental problem is that as human beings we naturally relate to other humans and easily accept that having life means being able to speak a formal language and move about on two legs. Our technology has separated us from the reality that we are still very much dependent on the physical world. Our attitude results in a complete devaluation of the physical forces that sustain our lives. Try holding your breath for three minutes to see what happens. How long do you suppose you would live without water or the sun’s heat?
We contend that this dismissal of our physical world leads to disconnection and disharmony. We literally are not aware of what sustains our lives or the simple fact that we have a life. It is easy to see how this ungrateful attitude is at the root of many of our depressed conditions. In LCC interventions, participants are encouraged to reconnect and we assess this process by asking about relevant behaviors. The evaluation of strategies, services and intervention therefore pays close attention to this aspect of relationships. Specific examples of the outcome domains that we measure are provided in the graphic below.
The importance of connections to other people in mental health is very self-evident and central the field of mental health. It requires little discussion. For example, “Transference”, “counter-transference” and the “therapeutic alliance” defined the focal point of Freud’s “talking cure. These terms all point to the importance of understanding behavior in terms of relationships. Today, mental health professionals look to a person’s past and current relationships to assess, diagnose and treat. In fact, most of our everyday conversation and activity revolves around relationships. In the LCC assessment, we simply add to this understanding by organizing relationships into three broad categories; relationships with ancestors, current and those yet to come. This perspective is consistent with several indigenous principles. First it is consistent with a cyclical view of life – the circle of life. While not immediately evident, current behavior is a manifestation of behaviors put into motion by our ancestors; how and where they lived. Malcolm Gladwell makes this point exceedingly clear in his discussion of the bloody feuds in Appalachia (See box). Secondly, Indigenous culture acknowledges the importance of ancestors the people that have made it possible for us to have life in the first place. Our ancestors have also struggled with existential life problems and pass down their wisdom to us. So the evaluation pays attention not only to those with whom we share life today, but also those that continue to influence us through past behavior.
The last category may take a little more thought and reflection to appreciate. This is especially true of us to toady that consume as many resources as possible, not accustomed to thinking about what we are leaving behind for those that follow us. However, just as we live out the traumas and accomplishments of our ancestors, our own children will do the same.
At first glance having relationship with a social institution may seem as obscure of relating to the Earth, Water, Air or Fire. This may be in part due to the fact that in a similar fashion, we live embedded in culture. We literally do not see the forest for the trees. A little closer observation clearly reveals how the education and law enforcement systems play a vital role in how a person develops and lives. In their book Sociologists in Action, Korgen, White and White (2014) define social institutions as “patterns of behavior governed by rules that are maintained through repetition, tradition, and legal support. Members of every society create institutions to control human behavior and go about meeting their basic human needs” (italics added). The authors further identify the five major institutions as “the family, the economy, education, government, and religion”. Looking closely then, we can see that we do have a relationship with these deeply embedded patterns of behavior.
While there is endless debate as to the number and name of the many cultural institutions, we agree that the function of these institutions is to help us meet our basic human needs. However, we contend that institutions should have a curative function. We further divide cultural institutions into basic, those that help first develop behavior and secondary or those that help maintain that our ways of being. When basic institutions (Family, Religion and School) work well, the individual develops what we might call, a “pro-social” orientation. In such as condition, what we call secondary institutions are only minimally necessary.
When basic institutions do not adequately prepare, then secondary institutions become more pronounced. However, we maintain that that their ideal purpose is to help bring us back into balance. As the author John Bradshaw consistently noted, the term religion means to “re-bind” or “re-connect”. Its purpose is to remind us how to re-establish as sense of balance with the “sacred” or as many of the indigenous groups referred to as “that which sustains or supports our lives”. The family serves a source of security, but it is also a training ground for ways of relating to the people around us. This is the often forgotten basis of the “talking cure”. When this process does not work, government and law enforcement remind us that we have a responsibility to the people with whom we live. Culture, in other words should also provide a “cure” for disconnected and unbalanced relationships; la Cultura Cura.
The role of religion and spirituality in mental health is almost always controversial and problematic; so much so that most people avoid it. This may be in part due to the fact that much of mental health functioning comes from or through federal, state or local government organizations. And the prevailing norm in the United States is that religion be separate from government. In practical terms, this means that practitioners should be objective, not allowing their own religious or spiritual values interfere with their client’s beliefs. It is our position that this type of relationship is neither possible nor effective. While a discussion on religion, spirituality and mental health is well beyond the scope of this manual, it may be helpful to identify a few of our basic assumptions.
First, we should distinguish between religion and spirituality. Religion in our opinion refers to a specific denomination, which includes some form of religious scripture, doctrine about the ultimate source and meaning of life, as well as practices intended to connect one to that source. The purpose of the various denominations is to institutionalize and thereby preserve this knowledge so that it is accessible to others. We believe that spirituality to one’s personal experience relationship with what one believes to be the source and meaning of life. We believe this experience to be subjective, unique or “sacred”. We therefore agree that no one should be forcibly indoctrinated into a specific way of believing. Our intent is to help individuals develop their own healthy sense of “spirituality”.
Why is spirituality or a sense of connection to “the source of life?” We begin with the simple assumption that spirituality or a sense of relationship with “that which gives us life” is at the core of culture. In his book the Faith Instinct, Nicholas Wade (2009) professes that when anatomically modern humans left Arica some 75 to 100,000 years ago, they had already developed and took with them the beginnings of a “primordial religion” that facilitated communion with the world of the ancestors. Using modern imaging techniques, Jonathan Haidt (2001) asserts that our sense of “right and wrong” has a biological basis in our brain. He notes that years of conditioning has left us for a “need” for some kind of religion or spirituality. We contend that whether through evolution or conditioning, people need a connection with something beyond themselves, the “sacred”. This is essentially why we say “La Cultura Cura, culture heals”.
Outcome Domains and Measures
We have already discussed some of the outcome domains that we look for in our evaluation instruments and methods. For example, in assessing a person’s relationship to the physical world, we ask about their exercise and eating patterns. In terms of spirituality, we ask about prayer and meditation in their lives; about their service or volunteer work, etc. The graphic to the left provides some examples of questions that we ask with respect to family relationships. And the graph to the right lists examples of school-based questions.
The following section of this manual contains the forms and instruments that are used to collect the information necessary to conduct an evaluation of services, strategies and institutionalization. Each form is preceded by instructions for administration as well as rationale for the inclusion of variables.
NCN EVALUATION SERVICES
Ongoing technical assistance in design, creation and implementation of systems for documenting and assessing program effectiveness; including
- Development of logic models and evaluation plans that define culturally appropriate objectives, outcomes, indicators
- Development of culturally appropriate questionnaires and surveys
- Training on instrument administration
- Creation of database for inputting data
- Consultation on data analysis and writing reports