The Medicine Wheel;The Medicine Wheel;Multi-Discipline Treatment Planning andMulti-Discipline Treatment Planning and

ReferralReferral

O i aa dawojiihiO i aa dawojiihiHada Hazi Dawo BizigoHada Hazi Dawo Bizigo

Addiction the Faster Easier Addiction the Faster Easier WayWayLong term pain/ Short term Long term pain/ Short term gaingain

SpeakersSpeakers• Michele Keim MS,CRC,CDPT, LMHCAMichele Keim MS,CRC,CDPT, LMHCA• Penny Wilson Pathway to Healing Penny Wilson Pathway to Healing

Advocate (DVSA)Advocate (DVSA)• Savenia Falquist Pathway to Healing Savenia Falquist Pathway to Healing

Community CoordinatorCommunity Coordinator

Terminology you may hear Terminology you may hear todaytoday• Traditionalist; people who live there lives in the old ways, Traditionalist; people who live there lives in the old ways,

following the natural laws to livefollowing the natural laws to live• Reservationist; people who live on the reservation but do Reservationist; people who live on the reservation but do

not follow or may not even know the tribal ways.not follow or may not even know the tribal ways.• Intermediates; these are people who either live on the Intermediates; these are people who either live on the

reservation or in Urban setting passing back and forth with reservation or in Urban setting passing back and forth with the traditionalist and living as close to the old ways as they the traditionalist and living as close to the old ways as they can.can.

• Modernist; these are people who live mainly in Urban Modernist; these are people who live mainly in Urban setting and have been almost completely assimilated into setting and have been almost completely assimilated into main stream living. main stream living.

• Hoop of life; is another way of talking about the Medicine Hoop of life; is another way of talking about the Medicine wheel. wheel.

Medicine Wheel from White Bison INC.Medicine Wheel from White Bison INC.

Tribal Medicine WheelsTribal Medicine Wheels

Medicine WheelMedicine Wheel• There are seven hoops to the Medicine Wheel.There are seven hoops to the Medicine Wheel.• First hoop; is the Great Mystery, (Spiritual/above)First hoop; is the Great Mystery, (Spiritual/above)• Second hoop; is the Earth, (Past/ Center, below, 7 Second hoop; is the Earth, (Past/ Center, below, 7

generation before)generation before)• Third hoop; family, (Future/7 generation to come)Third hoop; family, (Future/7 generation to come)• Fourth hoop; Social Society/Medicine Society Fourth hoop; Social Society/Medicine Society

(Duty) (Duty) • Fifth hoop; Community (Values)Fifth hoop; Community (Values)• Sixth hoop; the world we live in (Honor)Sixth hoop; the world we live in (Honor)• Seventh hoop; Is self (Integrity)Seventh hoop; Is self (Integrity)

Treatment Planning and Treatment Planning and ReferralsReferrals• In the Native world all things are connected In the Native world all things are connected

and for a person to find balance and be whole and for a person to find balance and be whole the hoop must be mended and connectedthe hoop must be mended and connected

• Each direction will need to be looked at and Each direction will need to be looked at and problems identified. This is not a new problems identified. This is not a new concept, it is done everyday in our work. concept, it is done everyday in our work. However, in the Native view it needs to be in However, in the Native view it needs to be in a circle not in a linear fashion. This creates a circle not in a linear fashion. This creates an easier understanding for Native clients.an easier understanding for Native clients.

Tradition Values (Tribal) compared toTradition Values (Tribal) compared toEuro-American Contemporary ValuesEuro-American Contemporary Values• Native American (Tribal) Euro-American Native American (Tribal) Euro-American

(Western(Western• Cooperation………………….……………………………….CompetitionCooperation………………….……………………………….Competition• Group Emphasis……………………………………………..Individual EmphasisGroup Emphasis……………………………………………..Individual Emphasis• Modesty, Humility……………………………………………Self ImportanceModesty, Humility……………………………………………Self Importance• Individual Autonomy……………………………………….Interference/InvolvementIndividual Autonomy……………………………………….Interference/Involvement• Passivity/Calmness………………………………………….Activity/RestlessnessPassivity/Calmness………………………………………….Activity/Restlessness• Generosity………………………………………………………SavingGenerosity………………………………………………………Saving• Patience………………………………………………………….ImpatiencePatience………………………………………………………….Impatience• Non-materialism……………………………………………...MaterialismNon-materialism……………………………………………...Materialism• Work to meet needs…………………………………………Puritan Work EthicWork to meet needs…………………………………………Puritan Work Ethic• Time- always with us………………………………………..Time-Use every minuteTime- always with us………………………………………..Time-Use every minute• Orientation to Present……………………………………….Orientation to the Orientation to Present……………………………………….Orientation to the

FutureFuture• Pragmatic, Practical…………………………………………..TheoreticalPragmatic, Practical…………………………………………..Theoretical• Respect for Age…………………………………………………Respect for YouthRespect for Age…………………………………………………Respect for Youth• Right Brain Orientation……………………………………….Left Brain OrientationRight Brain Orientation……………………………………….Left Brain Orientation• Cooperation with Nature…………………………………….Control over NatureCooperation with Nature…………………………………….Control over Nature• Religion-Way of Life…………………………………………..Religion-Segment ofReligion-Way of Life…………………………………………..Religion-Segment of

Values Values continuedcontinued

• Personal Personal Caution…………………………………………………..Personal OpennessCaution…………………………………………………..Personal Openness• Listening/Observation Skills…………………………………Verbal SkillsListening/Observation Skills…………………………………Verbal Skills• Indirect Criticism………………………………………………..Direct CriticismIndirect Criticism………………………………………………..Direct Criticism• Extended Family…………………………………………………Nuclear FamilyExtended Family…………………………………………………Nuclear Family• Cultural Pluralist…………………………………………………AssimilationistCultural Pluralist…………………………………………………Assimilationist• No Eye-to-eye Contact………………………………………..Eye-to-eye Contact No Eye-to-eye Contact………………………………………..Eye-to-eye Contact ImportantImportant• Self-Exploratory Child Rearing…………………………….Strict DisciplineSelf-Exploratory Child Rearing…………………………….Strict Discipline• Restitution………………………………………………………..PunishmentRestitution………………………………………………………..Punishment• Character=Source of Status………………………………..Degree=Source of Character=Source of Status………………………………..Degree=Source of

StatusStatus• Bilingualism……………………………………………………….MonolingualismBilingualism……………………………………………………….Monolingualism• Illness=Imbalance's)………………………………Illness-Physical Illness=Imbalance's)………………………………Illness-Physical IssueIssue• Belief in the Unseen…………………………………………...Belief in the Seen/ Belief in the Unseen…………………………………………...Belief in the Seen/ ProvenProven• Respect for Tradition…………………………………………..Progress OrientedRespect for Tradition…………………………………………..Progress Oriented

• "This Conflict In Values Creates Stress, Anxiety And Frustration" "This Conflict In Values Creates Stress, Anxiety And Frustration"

““From Understanding Native American Culture Second Edition Copyright From Understanding Native American Culture Second Edition Copyright 2009 “ 2009 “

Don L. Coyhis Page 42Don L. Coyhis Page 42

Medicine wheel and ASAM Medicine wheel and ASAM • The Medicine Wheel is a way of viewing The Medicine Wheel is a way of viewing

ASAM from a holistic (circular) view as ASAM from a holistic (circular) view as apposed to a linear view. apposed to a linear view.

• Illness=Imbalance's)………Illness-Physical IssueIllness=Imbalance's)………Illness-Physical Issue• Dimensions 1 through 6 all fall Dimensions 1 through 6 all fall

somewhere in the Hoop of lifesomewhere in the Hoop of life• All Dimensions help to heal the All Dimensions help to heal the

people we are servingpeople we are serving

Needs ListNeeds List• Dimension I:Dimension I:• Pt. is in need of detoxification from Alcohol and Opiod Referred to LL Pt. is in need of detoxification from Alcohol and Opiod Referred to LL

DetoxDetox• Dimension II:Dimension II:• Medical Deferred at this timeMedical Deferred at this time• Dimension III:Dimension III:• Pt. reports un-dealt with child abuse and depression and loss of children Pt. reports un-dealt with child abuse and depression and loss of children

due to drug abuse. Referred to CTMH due to drug abuse. Referred to CTMH • Pt. reports not knowing about his tribe or Native culture. See open Pt. reports not knowing about his tribe or Native culture. See open

treatment plantreatment plan• Pt. has thinking errors that lead to self-defeating behaviors. Deferred to Pt. has thinking errors that lead to self-defeating behaviors. Deferred to

later datelater date• Dimension IV:Dimension IV:• Pt. reports several Treatments with no clean time or change. See Pt. reports several Treatments with no clean time or change. See

treatment plan.treatment plan.• Pt. reports not liking to go to community support groups. See open Pt. reports not liking to go to community support groups. See open

treatment plantreatment plan

Needs List continuedNeeds List continued• Dimension V:Dimension V:• Pt. lacks skills to combat relapse symptom and stop return to Pt. lacks skills to combat relapse symptom and stop return to

active addiction. See open treatment planactive addiction. See open treatment plan• Pt. lacks understanding how using friends helps contribute to Pt. lacks understanding how using friends helps contribute to

relapse process. Treatment plan to be addressed at later relapse process. Treatment plan to be addressed at later date.date.

• Pt. needs to develop a personal plan of action to help prevent Pt. needs to develop a personal plan of action to help prevent relapse. Treatment plan to be addressed at later date.relapse. Treatment plan to be addressed at later date.

• Dimension VI:Dimension VI:• Pt. needs to build strong health support system. Pt. needs to build strong health support system. • Pt will attend three different cultural events See open Pt will attend three different cultural events See open

treatment plan.treatment plan.• Pt. will explore community based support. See open Pt. will explore community based support. See open

treatment plantreatment plan

Lakota Medicine Wheel AND Lakota Medicine Wheel AND DIMENSIONSDIMENSIONS

• Dim. 1 Start in the Direction of the WestDim. 1 Start in the Direction of the West• Referral to medical or non-medical Detox.Referral to medical or non-medical Detox. In the traditional Native way, Detox is needed. The needs of the physical In the traditional Native way, Detox is needed. The needs of the physical

body must be addressed and detoxed, as well as the mental, emotional body must be addressed and detoxed, as well as the mental, emotional and spirit that have been poisoned. Remember everything is connected. and spirit that have been poisoned. Remember everything is connected. Mind, Emotion, body and Spirit need to be looked at. You may need to Mind, Emotion, body and Spirit need to be looked at. You may need to identify a Healer, Medicine person, or a Spiritual Ceremonial person to help identify a Healer, Medicine person, or a Spiritual Ceremonial person to help with detoxing. with detoxing.

((Always get a Release of information).Always get a Release of information). For the reservationist and the modernist, normal referrals to treatment For the reservationist and the modernist, normal referrals to treatment

modalities will suffice. With Intermediates either normal referral or the modalities will suffice. With Intermediates either normal referral or the traditionalist path is correct (It is better to follow the traditional path)traditionalist path is correct (It is better to follow the traditional path)

Note: Rarely will you see a traditionalist in your office. However due to economic need Note: Rarely will you see a traditionalist in your office. However due to economic need younger people raised traditionally may become clients. Living in the modern younger people raised traditionally may become clients. Living in the modern world does create a loss of identity and purpose for many of these young people. world does create a loss of identity and purpose for many of these young people. Confusion between traditional and modern value system creates stress. For theseConfusion between traditional and modern value system creates stress. For these young people homelessness and addiction become the norm. young people homelessness and addiction become the norm.

Lakota Medicine Wheel and Lakota Medicine Wheel and DimensionsDimensions

• Dim 2 Direction of the EastDim 2 Direction of the East• Many of the Natives that live in Urban Many of the Natives that live in Urban

settings live well below the poverty levels settings live well below the poverty levels and have not had needed medical exams.and have not had needed medical exams.

Referral to an I.H.S. (Indian Health Referral to an I.H.S. (Indian Health Services) may be needed. Health issues Services) may be needed. Health issues can be a reason for relapse, or failed can be a reason for relapse, or failed treatment due to self-medicating and treatment due to self-medicating and continued use. continued use.

I.H.S. Clinics in local AreaI.H.S. Clinics in local Area• N.A.R.A Health Clinic Portland OR.N.A.R.A Health Clinic Portland OR.• Cowlitz Tribal Health Clinic Longview WA.Cowlitz Tribal Health Clinic Longview WA.• Chemawa Health Clinic Salem OR. (Dental Chemawa Health Clinic Salem OR. (Dental

Services also available)Services also available)• ““Always get a release”,Always get a release”, so you can so you can

communicate with health care providers for communicate with health care providers for continuing treatment planning and other continuing treatment planning and other future referrals. future referrals.

Note: If Native Americans have cultural values as in Dim 1 you may need to Note: If Native Americans have cultural values as in Dim 1 you may need to contact contact

Healer, Medicine person, or a Spiritual Healer or Ceremonial person to help.Healer, Medicine person, or a Spiritual Healer or Ceremonial person to help.

Lakota Medicine Wheel AND Lakota Medicine Wheel AND DIMENSIONSDIMENSIONS

• Dimension 3Dimension 3• This Dimension covers an area that can have a major This Dimension covers an area that can have a major

impact on a persons ability for long-term recovery. impact on a persons ability for long-term recovery. From abuse to mental health, these issues may need From abuse to mental health, these issues may need medication and medication management.medication and medication management.

• Many of theses problems are denied, minimized or Many of theses problems are denied, minimized or suppressed at time of assessment or admission. suppressed at time of assessment or admission. They will start to arise the longer the person is in They will start to arise the longer the person is in treatment. Educational didactics and process can treatment. Educational didactics and process can open many suppressed wounds.open many suppressed wounds.

• As in Dim. 2 Abuse and Mental health issues can be As in Dim. 2 Abuse and Mental health issues can be a reason for relapse, or failed treatment due to self-a reason for relapse, or failed treatment due to self-medicating and continued use.medicating and continued use.

Native Culture has some of the Native Culture has some of the highest rates per capita of any highest rates per capita of any other culture:other culture:• Domestic Violence Domestic Violence • Sexual AssaultSexual Assault• Child AbuseChild Abuse• SuicideSuicide• AddictionAddiction• Drop out rates from schoolDrop out rates from school• unemploymentunemployment

““WARNING”WARNING”• Know your limitations, never go out side your educational Know your limitations, never go out side your educational

and certified bias.and certified bias.

•Refer, Refer, Refer, Refer, Refer, Refer, Refer, Refer, Refer, ReferRefer, Refer

Abuse is a huge DIMENSIONS 3 Abuse is a huge DIMENSIONS 3 issue that needs on going care, issue that needs on going care, well past normal treatment well past normal treatment limits limits • Speakers: Penny Wilson Pathway to Speakers: Penny Wilson Pathway to

Healing Advocate (DVSA) and Healing Advocate (DVSA) and Savenia Falquist Pathway to Healing Savenia Falquist Pathway to Healing Community CoordinatorCommunity Coordinator

WarningWarning• Our purpose is to help people recover Our purpose is to help people recover

from a ‘Disease’ that destroys from a ‘Disease’ that destroys individuals, families, and communities.individuals, families, and communities.

•To do no harm ‘refer’To do no harm ‘refer’

Progress NoteProgress Note• 9/10/10 educational didactic was on 9/10/10 educational didactic was on

emotional management and how emotional management and how chemicals only provide short-term relief chemicals only provide short-term relief from feeling our feelings. Patient stated, from feeling our feelings. Patient stated, “I can’t recognize my feelings, I just “I can’t recognize my feelings, I just don’t feel. A) Open about not being able don’t feel. A) Open about not being able to feel, block emotions, honest about to feel, block emotions, honest about wanting to feel. P) Refer to Mental wanting to feel. P) Refer to Mental Health.Health.

DIMENSIONS 3 TREATMENT DIMENSIONS 3 TREATMENT PlanPlan• Young EagleYoung Eagle• Young Eagle reports, not being able to identify Young Eagle reports, not being able to identify

feelings.feelings.• Young Eagle stated, “I really don’t think I feel”.Young Eagle stated, “I really don’t think I feel”.• A) Young Eagle agrees to make an appt. with A) Young Eagle agrees to make an appt. with

Mental Health clinic for assessment and needs to Mental Health clinic for assessment and needs to be address. Report out come during next 1x1. be address. Report out come during next 1x1.

• B) Young Eagle agrees to follow Mental Health B) Young Eagle agrees to follow Mental Health referrals, report problem to CDP.referrals, report problem to CDP.

Dimension 3 Issues that can Dimension 3 Issues that can effect Dimension 4 Progress effect Dimension 4 Progress • Trust issues towards; authority, non-natives, Trust issues towards; authority, non-natives,

government/ the view of government includes government/ the view of government includes police, DSHS, CPS.police, DSHS, CPS.

• Many of the Reservationist and Modernist will Many of the Reservationist and Modernist will have feelings of not belonging or fitting in have feelings of not belonging or fitting in anywhere. With Modernist raised in an urban anywhere. With Modernist raised in an urban setting associating with the Mexican or Black setting associating with the Mexican or Black population there is a loss of culture, language, population there is a loss of culture, language, and tradition family connectionsand tradition family connections

• Note: This is not new in our profession: we have been dealing with family Note: This is not new in our profession: we have been dealing with family dysfunction for years (socialization). However with Native people this go dysfunction for years (socialization). However with Native people this go far past just family dysfunction to “Generational Trauma”far past just family dysfunction to “Generational Trauma”

NoteNote• Treatment planning should follow Treatment planning should follow

assessment to treatment plan to assessment to treatment plan to progress note. Or progress note to progress note. Or progress note to treatment plan to assessment.treatment plan to assessment.

• Always update assessment with new Always update assessment with new information to make sure of the information to make sure of the continued flow of the chart.continued flow of the chart.

For all New Treatment PlansFor all New Treatment Plans• Assessment to Treatment Plan to Assessment to Treatment Plan to

NotesNotes

Then back to Then back to assessmentassessment and update and update

The Medicine Wheel and The Medicine Wheel and Dimension 4Dimension 4

• Dimension 4 west, east, and southDimension 4 west, east, and south• Always use the clients strengths when writing your treatment plan.Always use the clients strengths when writing your treatment plan.

• Right Brain Orientation………………………………Left brain Orientation aesthetics Right Brain Orientation………………………………Left brain Orientation aesthetics linear linear

• In a traditional view everything has a power.In a traditional view everything has a power.• Identify what the substance did for them in the beginning an then how it turned against Identify what the substance did for them in the beginning an then how it turned against

them. By doing so you start gaining information for Dim 3, 5, and 6 treatment planning.them. By doing so you start gaining information for Dim 3, 5, and 6 treatment planning.

• Another treatment plan objective is to identify family and community norms, giving you a Another treatment plan objective is to identify family and community norms, giving you a view of their socialization and personal norms and values.view of their socialization and personal norms and values.

• Another treatment plan objective is have them do a value exercise. Another treatment plan objective is have them do a value exercise.

The Medicine Wheel and The Medicine Wheel and Dimension 5Dimension 5

• Dimension 5 east, south and westDimension 5 east, south and west• Many of the objectives should revolve Many of the objectives should revolve

around feelings management, around feelings management, negative thinking errors, and negative thinking errors, and behaviors that lead back to active behaviors that lead back to active addictionaddiction

• Once again use the clients strengths; Once again use the clients strengths; art, music, dance, or story telling.art, music, dance, or story telling.

Dimension 5 issuesDimension 5 issues• As in Dim. 3 these un-dealt with issues become stuck As in Dim. 3 these un-dealt with issues become stuck

points in a persons recovery.points in a persons recovery.

• Domestic Violence Domestic Violence • Sexual AssaultSexual Assault• Child AbuseChild Abuse• SuicideSuicide• AddictionAddiction• Drop out rates from schoolDrop out rates from school• UnemploymentUnemployment• Un-dealt with these issues may set clients up for a return to Un-dealt with these issues may set clients up for a return to

active addiction.active addiction.

Dimension 6 encompasses all Dimension 6 encompasses all directions directions

• We all know support is needed but We all know support is needed but we can combine Native ways with we can combine Native ways with Urban supportUrban support

• Ceremonies for HealingCeremonies for HealingSun DanceSun DanceGhost Dance Ghost Dance Mtn. DanceMtn. DanceNaming Ceremonies Naming Ceremonies Pipe CeremoniesPipe CeremoniesWater CeremoniesWater CeremoniesWeddingWeddingCrossing/Passing Crossing/Passing Sweat LodgeSweat LodgeWelcoming Welcoming BlanketBlanket

Employment is a means to Employment is a means to support a clients growth, support a clients growth, family, and healthy life style family, and healthy life style (recovery)(recovery)Speaker: Michele Keim MS,CRC,CDPT, Speaker: Michele Keim MS,CRC,CDPT,

LMHCA LMHCA

Hanandziihi godiyaa yee Hanandziihi godiyaa yee nahonlkidnahonlkid

(Your healing starts by your (Your healing starts by your asking)asking)

The Medicine WheelThe Medicine Wheel• The Medicine Wheel allows us to see The Medicine Wheel allows us to see

that all things, Individual, family, that all things, Individual, family, community, and earth are connected.community, and earth are connected.

• Thought, Emotion, Physical, and Thought, Emotion, Physical, and Spiritual wellness are connected.Spiritual wellness are connected.

• We can no longer work on just We can no longer work on just symptoms. We have to take a holistic symptoms. We have to take a holistic approach to healing.approach to healing.

Canoe Journeys and Races: Canoe Journeys and Races: Events like these are helping the healing for Events like these are helping the healing for the Individual, family, community, and earth.the Individual, family, community, and earth.

Cultural Camps• Bring Elders, Young, and families back together• Teaching the old stories, songs, and building unity in

the Communities and families

Drum CirclesDrum Circles

Ceremonies to heal the past Ceremonies to heal the past between different culturesbetween different cultures

Veterans Healing Ceremonies Veterans Healing Ceremonies and Pipe Ceremoniesand Pipe Ceremonies

Alcohol and Drug free events Alcohol and Drug free events Providing a safe healing place Providing a safe healing place

Successes is Possible

Change is Possible

When you leave here think about what you can do to adapt your

programs to help the Hole.

May You Walk in Beauty the Rest of Your Days

ReferencesReferences• Post-Colonial Psychology E. & B. DuranPost-Colonial Psychology E. & B. Duran• Healing the Soul Wound DuranHealing the Soul Wound Duran• Cowlitz Tribal Sexual Assault and Domestic Violence Cowlitz Tribal Sexual Assault and Domestic Violence

ProgramProgram• Center for Disease ControlCenter for Disease Control• Red Road to Wellbrity Red Road to Wellbrity • Understanding Native American Culture Don L. CoyhisUnderstanding Native American Culture Don L. Coyhis• ASAM Criteria (American Society of Addiction Medicine)ASAM Criteria (American Society of Addiction Medicine)• Rethinking Columbus Bigelow and PetersonRethinking Columbus Bigelow and Peterson• Alcohol Problems in Native America D. Coyhis and W. Alcohol Problems in Native America D. Coyhis and W.

WhiteWhite• Personal Works JD AmburnPersonal Works JD Amburn

The Lakota Way By Joseph M Marshall IIIThe Lakota Way By Joseph M Marshall IIIThe Sixth Grandfather By Raymond J The Sixth Grandfather By Raymond J DemallieDemallieThe Sacred PipeThe Sacred PipeThe Seven Sacred Ceremonies The Seven Sacred Ceremonies Black Elk Speaks By Joseph Epes BrownBlack Elk Speaks By Joseph Epes BrownTunkashila By Gerald Hausman Tunkashila By Gerald Hausman Myths and Tales of the Jicarilla Apache Myths and Tales of the Jicarilla Apache Indians By Edward Morris OplerIndians By Edward Morris OplerWhite Eagle Medicine Wheel By Wa-Na-White Eagle Medicine Wheel By Wa-Na-Nee-CheNee-CheNight Flying Woman By Ignatia BrokerNight Flying Woman By Ignatia BrokerKill the Indian Save the Man By Ward Kill the Indian Save the Man By Ward ChurchillChurchill