Am J Community Psychol (2011) 47:157169 DOI 10.

1007/s10464-010-9380-3

ORIGINAL PAPER

Behavioral Health Services Dont Work for Us: Cultural Incongruities in Human Service Systems for Alaska Native Communities
Lisa Wexler

Published online: 30 October 2010 Society for Community Research and Action 2010

Abstract Community psychology emphasizes the importance of context in the study of peoples lives, and culture inuences this in profound ways. To develop programs that effectively address diverse communities problems, it is essential to recognize how Euro-American human service systems are understood and responded to by the many different people being served by them. The article describes how some broadly dened social services conceptualized and implemented within a Euro-American frameworkare ill suited for the everyday realities of Alaska Native villages. The cultural discontinuities are illustrated through ethnographic vignettes. The article concludes with suggestions for developing more culturallyresponsive ways to conceive of and do programming for Alaska Native and possibly other Indigenous and minority communities. Keywords Health and social services Alaska native Indigenous Service delivery Culturally-specic Programs Cross-cultural Practice Introduction Although many researchers have documented the behavioral health1 disparities found in Indigenous populations, there has been less attention given to understanding the ways in which Euro-American service systems are situated to intervene in ways that do not make cultural sense. Community psychology provides an important perspective
L. Wexler (&) School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, MA, USA e-mail: lwexler@schoolph.umass.edu

to engage in this critical analysis with attention paid to the context of diversity and the diversity of context (ODonnell 2006; Trickett 1996), particularly as these affect community programming. The context in which everyday life occurs is profoundly shaped by the cultural meaning systems, patterns of behavior and interactional norms of a particular community. Instead of considering culture as an afterthought and creating programming that merely incorporates cultural symbols and traditional activities, community psychology offers a lens to understand the importance of culture as a context-shaping, meaninggenerating aspect of peoples lives. Continuing community psychologys tradition of challenging the decontextualized notions of traditional psychology (Nelson et al. 2007), the article focuses on the how service provision is itself a culturally-embedded process. Servicesconceptualized and implemented based on an Euro-American ontology and associated notions of relatedness, personal autonomy, and authoritycan be antithetical to indigenous ideas, values and practices. Community psychology has a role to play in understanding how this misalignment might contribute to the failure of many programs in minority communities (Weinstein 2006). In addition, the discipline, with its focus on context and collective, meaning-making structures, can offer alternative ways to conceptualize and collaboratively develop more culturally-responsive approaches to the provision of community services. This is particularly important for ethnic groups who suffer disproportionally from behavioral health issues.

Behavioral health refers to a category of health outcomes or wellbeing that is amenable to change through individual or collective behavior. Typically, behavioral health programs include mental health, substance abuse and prevention services.

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Alaska Native people have drastically higher rates of suicide, substance abuse, and unintentional injuries when compared to non-Native peoples in North America (e.g. Alaska Division of Public Health 2007; Castor et al. 2006; Wexler et al. 2008). There are many ways of understanding these health inequalities and their relation to historical and continuing aspects of colonization (e.g. Kral and Idlout 2009; Nebelkopf and Phillips 2004; Samson 2003; Wexler 2006a, b, 2009). The article borrows from these ideas and describes how community programming can be seen as inappropriate (at best) and a continuation of colonization (at worst) (Gone 2008). This is because many community programs are based on Euro-American conceptions and practices that are not meaningful for (or respectful of) indigenous communities because of the discordant cultural realities they reify and represent (Duran and Duran 1995; EchoHawk 1997). Ignoring the implications of this cultural misalignment has limited the usefulness of conventional psychological and social services for these communities (Gone 2003, 2004b, 2007), and is reected in the study populations assertions that typical behavioral health services do not work for them (Wexler 2005). This paper uses ethnographic data from a 2-year participatory study to underscore some of the cultural discontinuities in typical Euro-American approaches for an Inupiaq (Eskimo) population, and links them to the ineffectiveness of some community-based programs in a predominately Alaska Native region of rural Alaska. By articulating and emphasizing the culturally embedded structures of modern behavioral health programming, I hope to problematize aspects of this work that are largely taken for granted. For these purposes, the discussion presents a Euro-American versus Indigenous dichotomy that is necessarily overdrawn. Through this contrast, the article intends to provide clues for how to structure services and programs differently so that they are truly responsive to the cultural and social context of everyday community life in Northwest Alaska. This perspective has implications for the development of culturally-responsive health and social programs in other indigenous and minority communities. Although the importance of considering both the cultural meaning systems and the patterns of interaction within a community is not new to community psychology, the article provides an approach to critically investigating the effect of Euro-American culture on the formulation and provision of services at this intersection. In the papers conclusion, suggestions for developing more responsive ways to conceive of and do community programming in small, Alaska Native communities is offered as a point of discussion for this and possibly other non-Western communities. These kinds of critical and possibility-generating discussions are one way to widen community psychologys attentiveness to the implications of cultural understandings

and community practices. They can also provide perspectives from which to develop more culturally-responsive social and health programming.

Cultural Considerations in Service Provision Although there are many denitions of culture, in this article, it can be understood as the dynamic framework by which a society conducts and reproduces itself. More specically, culture helps to specify what behaviors are acceptable in any given society, when they are acceptable, and what is not acceptable. It also provides some guidance for dealing with the basic problems of life (Huff and Kline 1999, p. 7). It follows that a culturally-grounded understanding of the ways in which people handle and resolve health and social issues in specic communities can pave the way for formal services. Put differently, in order to effectively provide meaningful programming to a given community, it is important to consider the ways that that cultural group typically understands a health or social concern and to how these beliefs are translated into practices designed to address it (Berman 2006; Frankish et al. 1999; ODonnell 2006). In situations where the service systems are developed within a different cultural referent than that of recipients, an examination of the congruence between cultural structures should be done to discern the cultural t (Kagawa-Singer and Chung 1994). That is the ways these services make sense within the relationship structures, meanings and practices of the community being served. To date, behavioral health services have been largely ineffective in tribal communities (Calabrese 2008; Gone 2004a, b; Gone ntara 2007; Nebelkopf and Phillips 2004). This, in and Alca part, could be due to a general approach of service system, which reproduces, acknowledges and responds to a EuroAmerican worldview. In short, these services are generally not informed by non-Western wisdom, practices and preferences (Aisenberg 2008), and could be experienced as cultural proselytization (Gone 2008). The following section outlines some relevant Inupiat (Alaska Native) cultural formations and juxtaposes these with those found in the Euro-American service models that serve them. This discussion will be incomplete, focusing only on those areas of direct relevance to the paper (for a more detailed discussion, please see Burch 2006). This rendering is intended to provide the context needed to discuss some specic ways these cultural systems are misaligned. Inupiaq Society-Historic and Current In this brief overview, I will focus on power and leadership formations, ideas of autonomy and typical social and kinship networks of the Inupiaq in northwestern Alaska. These

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focal points are offered because they will lend perspective to the discussions of cultural misalignment that follow. Instead of living in sedentary villages with populations ranging from 90 to over 3,000 as they do today, the Inupiat traditionally lived in small, migratory groupings afliated by kinship. There were no formal governmental structures; instead, power and responsibility were allocated on the basis of a persons age, skills and knowledge, and family connections/resources (Burch 2000, 2005, 2006). Age absolute and relative (generation)conferred authority within family groups and across Inupiaq society. Generally speaking, this male dominated society gave older people greater authority than younger family and community members. Within this basic stratication, an umialik, a senior male regularly won the right to lead through their personal attributes of hunting, trading, human relation skills, energy and wisdom. These qualities were what gained them their following, and their following is what gained them their wealth (Chance 1990, p. 22). The family status of these individuals was reected and maintained by these attributes. Similarly, the dynamic hierarchies of Inupiaq society were reinforced through everyday interchanges, access to resources and performative achievements, not through formal roles. These leadership patterns are still viable in modern Inupiat villages (e.g. Bodenhorn 1988; Golovnev and Kan 1997). It is important to note that authority could also be allocated to someone else, an Ananiq, when necessary. It is unclear whether this authority was conferred by informal consensus or negotiation. However, an ananiqwith the blessing of the Umialikworked as a task group leader to complete a specic endeavor. This allocation of authority was short-livedonly used for doing a specic joband is believed to have been reective of that persons exceptional skills in a certain area and a particular community need (Burch 2006). As this leadership and governance style might indicate, there was a high level of autonomy afforded to Inupiat people. Ernest Burch (2006) described this as follows: To a degree scarcely fathomable in the contemporary United States, Inupiat were free to decide what they would do, how they would do it, and with whom they would do it. Of course, ones counterparts had equal freedom of choice, which meant that a person could deviate only so far from generally accepted norms of behavior without being made an outcast (p. 125). This kind of expansive individual autonomy constrained by social expectations has many contemporary manifestations.2
See Briggs (2001) for a description of Inuit autonomy which is similar to that of Inupiaq. Inupiaq autonomy differs greatly from the concept in European-American society.
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Cultural continuity is also clearly discernable through reciprocal sharing of resources and skills. Sharing within Inupiat families was and is standard practice and mutual aid between the families is (and was) common (Bodenhorn 2000). Family ties between people are strongest. Connections between family groups were established and maintained through trading and kinship ties (marriages) relationships. This continues today. The husband-wife relationship was not considered as strong as that between consanguinal kin. In traditional Inupiaq society, men and women did not spend a great deal of time in one anothers company (Burch 2006, p. 64). This continues in some forms today where men and women, who are not related, are not likely to spend time together in modern villages. Power and control were not held through formal governmental structures, instead social pressure was the primary means of creating order in Inupiaq society. Since all the men (harvesters) and women (processors of the harvest) possessed similar skills, Burch (2006) posits that everyone in Inupiaq society was qualied to make informal judgments about the quality of someone elses work and the skills. Critical appraisal of ones work was done by everyone in the settlement such that ones abilities were duly noted and remarked on by everyone (p. 73). This indirect form of social pressure was the primary means of fostering conformity within Inupiaq society, and holds sway today. Rapid social, political and economic changes occurred after 1816, when Otto Von Kotzebue crossed the Bering Straight from Russia to begin trading with the Inupiaq. By the mid-1800s, most Inupiat were involved with either seasonal wage employment or trading exchanges with the whaling industry (Bockstoce 1986; Senungetuk 1970). Churches and mandatory mission schools were established by the turn of the century, which forced Inupiat people to live in sedentary, village settings. This, in conjunction with rampant disease and famine, lead to devastating changes in the social structures and economic systems of the Inupiat3 (Chance 1990). In the 30-year period starting from the turn of the twentieth century, migratory patterns, access to food resources, social structures and the religion of the Inupiat was signicantly changed. Social problems of the sort that plague modern Inupiat communities were rst recorded at this time (Ducker 1996). This short outline of relevant Inupiaq social structures and abbreviated colonial history are intended to highlight a few areas in which Inupiaq structures of authority, roles and intergroup dynamics were constructed historically and continue (albeit in changed form) today. This overview
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See Wexler (2006a) for a description of how educational initiatives contributed to colonialism in the region.

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provides the context necessary to understand the ways in which these cultural structures differ from some of those found in Euro-American behavioral health services. By this, I mean the programs and services commonly used to address mental health, substance abuse, injury prevention and health promotion in the study region. A brief discussion of the underlying cultural framework that structures Euro-American service systems will provide this referent. Cultural Underpinnings of Euro-American Service Systems Behavioral health services are conceptualized, organized and enacted in ways that are shaped by Euro-American values and perspectives. For instance, the reliance on rationality, realism, and objectivity in the framing of social and health issues is in itself a cultural phenomenon (Stein 1990). Currently within the American culture, a social process has occurred whereby a wide gamut of problems are redened and managed as more narrowly biomedical issues. As a result of this transmuting, matters rich in personal meaning and embedded in social signicance are denuded of their larger context. This medicalization of problems in the West is an example of the way groups dene problems and formulate their solutions in keeping with the cultural ethos, that is, with the distinguishing characteristics and shared assumptions that pervade a group and its constituent institutions (pp. 89). In this case, the decontextualized, scientic explanation of social and health problems as primarily biomedical disorders reects the Euro-American ethos that relies on binary conceptualizations (i.e. mindbody, addicted-recovering, disorder-health) and lionizes professional interventions over informal ones. It is important to interrogate the ways in which professional behavioral health practices and systems of intervention contain tacit cultural commitments. These understandings shape the ways in which mental health and associated services are conceived, rendered and evaluated. This is problematic when one considers the extent of diversity among cultural groups compared to the monolithic psychological regimes available to them in North America. As Calabrese (2008) notes, The societies of the world do not agree on fundamental issues of personhood, sexuality, health, consciousness alteration, religion, or childrearing. Instead, human societies have developed unique and heterogeneous ways of understanding and adapting to local

environments, maintaining relationships among consociates, and sustaining mental health. As such, a societys members are likely to respond more to therapeutic interventions that are appropriate to their unique histories of adaptation (pp. 336337). When this uniqueness is ignored in favor of seemingly culture-free professional practices that are embedded in a Euro-American, psychological framework, the result can be understood as a form of cultural prescription that harbors the ideological danger of an implicit Western cultural proselytization (Gone 2008). For instance, instead of employing the highly personal, attribute-driven social organization of the Inupiaq, EuroAmerican behavioral health services rely on prescriptive interactions based on assigned roles and formal education (i.e. client-provider). Specically, the bureaucratic model of identifying a problem and then paying someone (with specic credentials) to solve it through individual intervention comes from a Euro-American system of thought. This system privileges the Cartesian duality of mindbody and the Euro-American ideal of selfhood that emphasizes individuality (a specic conception of) autonomy and rationality (Kagawa-Singer and Chung 1994). This approach understands complex relationships as mechanistic models with inputs and outputs akin to capitalistic modes of productionand reconstitutes community and family members as social and health problems to be resolved through scientic programming and intervention (Bar-On 1999; Kleinman 1980). Thus, the Euro-American cultural framework creates systems of care that render complex social, political, economic and cultural phenomena into individual pathology devoid of context and in need of professional interventions (Airhihenbuwa 1995). This kind of programming also draws people into a system that shapes their interactions, motives and behaviors. Just as an ecological niche cannot be dened in and of itself but must instead be dened by its relation to other niches of the total system, so the position of the profession must be dened by its relation to other health workers in the system (Freidson 1970, p. 128). In this way, systems of care situate the actors in particular ways that can have deleterious consequences. For example, many such systems categorize some people as the helpers and others as in need of help. This hierarchy reects a colonial classication in which the designated helpers are usually those who have professional or vocational credentials and who can navigate Euro-American systems better than those who are deemed needy. These helping structures recongure power relations in the community because they reect hierarchies that do not conform to traditional ones (Sue and Zane 1987). For instance, a young Inupiaq man is more likely to have Euro-American credentials than an Elderly

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Inupiaq man, but the Inupiaq social hierarchy values the life experiences of Elders (age) over the youngsters education. Nevertheless, the young professional will, by virtue of this professional status, have authority over his Elder and be able to access resources (or not) based on this authority. By establishing and reinforcing social structures that contrast with local practices and traditional values, EuroAmerican programs can subordinate the ways of knowing and doing found in minority communities (Gone 2008; Lynn 2001; McCabe 2007). In this way, ignoring the cultural factors that shape professional interactions can create service systems that are, at best, contrived and ineffectual and, at the other extreme, imperialistic. Through ethnographic examples from 2-years of eldwork, I will illustrate how these kinds of cultural incongruities showed up for me as I traveled to and worked in several Inupiaq villages. The examples are intended to illustrate the ways in which (1) the EuroAmerican approach to health and social programming has become the dominant way many community members tackle village problems, despite the acknowledged cultural misalignment; (2) the limitations of professional helping roles in local communities; and (3) the tensions between village rhythms/responsibilities and scheduled activities and job-related duties. These examples support the contention that the structure of behavioral health programsbased mainly on Euro-American thinkingdo not work well in small Inupiat villages because of the different meaning systems, priorities and practices they respond to and represent.

Research Process The article uses data generated by a community-based research project aimed at describing the meanings and practices surrounding youth suicide in a rural region of Alaska. The data collection and analysis reported here took place between 1999 and 2004. As part of this larger study, I worked with my Inupiaq colleague, Brenda Goodwin,4 and with a large number of local volunteersthe Regional Suicide Prevention Taskforceto design and carry out research we deemed relevant to understanding youth suicide in the region (Wexler 2005). The taskforce held quarterly meetings from March 2001 to October 2002 with some thirty members (not all the same) attending each session. Data collection for the larger project included quantitative analysis of suicide reports in the region, interviews, eld notes, surveys, community meetings, and focus groups and is reported elsewhere (Wexler 2006a, b, 2009; Wexler and Goodwin 2006; Wexler et al. 2008; Hill et al. 2007). In addition, the project resulted in other kinds of initiatives focused on community wellness (20022004), youth wellness (20032005) and empowerment through the use of digital storytelling (2006-present). This article reports mainly on the eld notes about service provision taken as I worked on my dissertation and was employed as the Suicide Prevention Coordinator for a tribal non-prot organization in a region in Alaska (19992002). These notes are used to illustrate the main points of the paper and are not intended to provide a thorough account of service provision in the region. All procedures were reviewed and approved by the University of Minnesota Institutional Review Board, where the author received her doctoral degree. Consistent with ethnographic methods (Stewart 1998; Thomas 1993), I wrote eld notes throughout the two and a half year project whenever I heard, thought or talked about something related to suicide, mental health and the health service system. My daily documentation records the ways that services and programs were talked about, enacted and received. I self-consciously wrote about White people and how professionals (myself included) viewed Inupiat others and how (I felt) we were received and conceived by them. I tried to keep track of my responses to experiences so that I had an on-going barometer of my feelings and the context within which they where generated. Along with these general notes, my writing documented the ways that suicide and substance abuse were talked about and responded to in everyday life. At the end of the 2 year project, these notes lled two journals, equaling 400 handwritten pages of documentation. Many times, writing gave me space to log my thinking and reminders to draw from when I told these stories to
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Method Setting The rural arctic region reported on here encompasses approximately 50,000 square miles and includes approximately a dozen small Inupiat villages. The population of the region is less than 8,000, and is mostly Inupiat (90%) (United States Census Bureau 2005). These villages are not connected by roads, but family ties are extensive throughout the region. The collaborating Native nonprot service organization is the regions largest employer with over ve hundred employees in the health and social service professions. Each village in the region employs several local residents (e.g. village counselors, Indian child welfare workers, family service workers) to provide behavioral health services to their communities. These positions are typically supervised by non-Native professionals residing in the largest village, which is accessible only by airplane throughout the year.

Brenda Goodwin consented to being identied.

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others. I used these to reect on my experiences and to elicit responses from my colleagues (both professional colleagues and Inupiat taskforce members). They served as my dialogic partners and cultural translators because they were willing to struggle with their paradox of familiarity. The paradox of familiarity refers to participants over-familiarity with their own cultural practices, which makes them unable to articulate or identify internal patterns. Many times, these discussions would spark new thoughts and more writing. In an on-going manner, I sought insight from local people. I asked them what they thought of various theories and how they interpreted some of the stories I collected. They helped me apply reality checks to my critical reection. The process also offered my colleagues ample opportunities to inuence the direction of my analyses. The assertions in this paper have been reconceptualized and presented in the context of service provision here. Although I did not receive on-going guidance in writing this, the article in draft form has been reviewed by an advisory committee of the collaborating, Native non-prot organization and approved for publication by its board. This arrangement involves sharing information and discussing conclusions, and is expected as a vital exchange in doing research in the region. This process is consistent with doing tribal, participatory research advocated for in community psychology (Fisher and Ball 2003).

Results: Cultural Misalignments of Euro-American Programming for Alaska Native Communities The idea of programming as a solution to community problems is alluring since it structures peoples good intentions and produces a tangible result, i.e. funding to perform a needed service. In this way, programs provide an easy solution. Calling for and developing EuroAmerican-style programs to address peoples explicit needs is acknowledged as an ineffective strategyprograms dont work for usbut it is all that many community members feel able to do given the constraints of village life. More specically, village members often say that they do not intervene in others business because they do not want to offend, intrude or cause conict. Avoidance of conict is itself locally articulated as a cultural value. So, although every village member knows every other and many are related somehow, there are social boundaries that allow people to affect only those who are the closest to them. Even in intimate relationships, it is likely that respect for ones personal autonomy and privacy will keep people from explicitly interfering in anothers affairs.5
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Instead of intervening openly, Inupiat people tend to offer support in ways that do not draw attention to the helping nature of the exchange (Hippler 1970). Throughout the 2-year data collection period, I noticed this indirect and subtle support. For instance, if a child often comes to ones house hungry, s/he will be fed without question. It is unlikely that anyone will explicitly talk about this kindness, or inquire to nd out why the child is consistently underfed at home. If someone was sad or depressed, for another example, invitations would be offered to travel, special jokes would be told to highlight a happy memory, or friends would come by for a visitnot because a problem has been identied as such but because being there for each other in ways that highlight personal connection is important. This responsiveness in relation to others is not intended to affect a particular behavioral outcome; it is done to show connectionafnity and relatednessand care. This might be considered a culturally consonant way for a sociocentric society to reassure a person that they do, in fact, still belong. In other situations, particularly related to village members who are isolated or surrounded by people with similar difculties (such as alcohol abuse), neighbors call for and develop programs. This is how they can garner resources for their community, and other avenues for intervention are unclear. However, the social norms, relational expectations and behavioral patterns of small Alaska Native villages, do not always lend themselves to these kinds of EuroAmerican programming regimes. These approaches rarely work to affect the targeted, positive change as the forthcoming examples illustrate. One reason for this is that many programs respond to and create lines of authority that do not conform to those found in Inupiaq villages. This shift from traditional to imposed social patterns can be counterproductive. Indeed, the idea of Euro-American programs, with their sometimes inappropriate social responsibilities, can render the indirect processes of social control and support found in Inupiaq society less visible. Secondly, many social and health programs depend on the creation of formal professional roles to establish new kinds of interaction, but these have limited value in the context of village communities where relationships have depth, history and well-established patterns. Lastly, Euro-American programming regimes structure time and activities in ways that do not make sense given the family responsibilities and community rhythms of Alaska Native villages. These discontinuities will be illustrated with examples and discussions in the next three sections. The Idea of Programs Can Obscure What Community Members Know During the project, a near fatal tragedy occurred that provides a clear example of the way that Euro-American

Briggs (2001) description of personal autonomy in Canadian Inuit communities can be aptly applied to this context.

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program planning offers community members an explicit solution, but one that sometimes ignores the social understandings and norms that structure village life. A vibrant 10-years-old boy, Donny,6 almost drowned in a small village while I was there. The village has several areas where the currents are dangerous. These can be seen from a main thoroughfare of the community. After hearing several stories about the incident, I understood that one of the boys friends had gotten caught in the swift current while they were swimming. Donny jumped into the river to save her. He was dragged into the churning water, and after a vigorous struggle, was seen face down by a group of his friends. He had to be taken from the village in an emergency, medical helicopter. In talking to John, the administrator for the Native Village, I learned the village lost a kid there last year because the current is swift and unpredictable. John said that the tribal government had written a grant to take care of the problem. They received the funding some time ago and are now able to hire a lifeguard. The tribal government would pay someone to be in their boat and buy their gas if they would watch for children swimming. He thought one of the villages men would want that job, but no one applied. John said, What a shame no one applied. If we had had a lifeguard, this wouldnt have happenedWe [the tribal government] had money to pay a lifeguard for the kids. We announced it on the CB (citizen band radio) lots of timesno one was interested. There are life vests available for all the kids in the village too. John kept repeating, Such a shame, we had the money sitting right here. I could not help but wonder about how this seemingly rational program failed. I also thought that since the lifeguard position was vacant, all the village adults could decide not to allow any children to swim in that spot on the river. I posed this option to John and he said, In the village, people get really touchy about people saying things to their children. You really couldnt do that. You could only tell your own kids what to do. When I asked other community members, they reiterated this sentiment, yet despite this general opinion, tribal leaders overlooked this accepted village norm when conceptualizing their grant application for hiring a life guard. Their structured intervention assumed that the title and role of lifeguard would allow any person who got the job to control all village children on the river regardless of their family and relationships. This perspective assumes that a job title can confer legitimate authority to an individual, and that this professional role would carry enough clout to overshadow the social constraints of the village
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social organization. No one applied to be a lifeguard although the qualications were minimal and the pay was goodperhaps because the role was in direct opposition to established community practices. It is striking that John, a tribal leader, did not identify or acknowledge this cultural discontinuity7 when conceptualizing the program, but was quick to point out the incongruity when speaking about informal village agreements. Somehow, the tribal grant writers adopted a foreign paradigm that shifts responsibility for safety from the children themselves (autonomy) and their families, and places it squarely onto the shoulders of an individual who is paid to enact an assigned (and inappropriate) role. This approach is untenable in Inupiat communities. Individuals, once they reach a level of maturity (often pre-puberty), are (and were) expected to make their own decisions about a myriad of things, including safety (Bodenhorn 1997). Only when an individuals behavior was inappropriate and unaffected by subtle gestures or hints, are explicit instructions or orders issued from someone, usually within the family, who held a position of authority (Burch 2006). Another form of social control can be issued by illugiik (dual), joking cousin relationships. In this role, one could publically comment about the negative aspects of someones behavior to evoke laughter from the audience and elicit change in the behavior of another (Heinrich 1955 reported in Burch 2006). These kinds of special relationships are still very much part of the social fabric of modern village life. The job of lifeguard runs counter to these ideas of personal autonomy, earned authority within families and the role of personal relationship (joking cousins) to bring about a change in someones behavior. The duties and responsibilities of the lifeguard assume that authority over all village children can be conferred through ones employment. However, if the assigned role does not follow established social patterns and is not aligned with that persons role in community and family life, it is unlikely that s/he will be able to do the job. In this way, creating a new job or funding a village program is unlikely to achieve its purpose if it does not t the social systems and cultural practices of a community. Unfortunately, this failure is attributed to a lacking within the community (i.e. no one applied to be life guard) rather than the inability of the program to offer a meaningful path forward. Village members, like John, feel regret and shame that his people would let such a tragedy occur instead of questioning the cultural validity of the program itself.

All names are pseudonyms, and other details have been changed to protect condentiality.

While this article was under review, tribal members commented on this peculiar blind spot, and in so doing veried this interpretation.

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Limitations of Professional Roles Even in cases where there is a capable village member willing to take on a difcult (incongruous) role in the community, interpersonal community norms continue to structure the kinds of interactions that occur among people. The next excerpt was generated in the context of a substance abuse counseling session that I was allowed to observe. Sue, a middle-aged village counselor, and Richard, an older, recovering community member were enacting the prescribed relationship of counselor and client. However, their cultural expectations and familiarity make this formal interaction clumsy and forced, mostly helpful in meeting the concrete requirements of his probation and her job. Richard had been ordered to seek help for his alcoholism by the court. He completed his residential, substance abuse treatment program and wasaccording to a treatment plan generated by non-Native professionals expected to go to weekly counseling sessions with Sue as part of his aftercare. He had been complying with this plan for several months and was expected to nish his aftercare soon. This is how the counseling session went: Sue: Richard: Hows Marge [Richards mother] and them [his family]? Good, we just got caribou, Ellens [Richards sister and Sues friend] been over [helping process the meat] Yea. You got to take care of your mother

Sue: Richard: Sue: Richard:

We got some clams out by the [family name] place, right where that sandbar comes out Oh, yea? I will bring you some I sure like them

Pause in conversation Sue: Well, say hi to your mom and them for me, OK?

Sue:

Sue closes the door for privacy Sue: Did you bring your homework?

Richard pulls a folded bunch of papers from his pocket and unfolded his homework Sue: Good

Sue pulls out a bulging folder with a client number typed at the top and places his homework papers into it. She closes the le and puts it back into her desk drawer Richard: Sue: Richard: [I saw] caribou up river toward the [place name] The caribou are really fat this year. Nice and fat! That [place name] up there is a good spot

Pause in conversation Sue: You been going to AA [Alcoholics Anonymous] meetings?

Richard nods Sue: Good

Pause in conversation

Richard nods, stands up and leaves with a quick wave Sues counseling role makes it her responsibility to ask about compliance issues, namely his counseling homework and self-help meeting attendance. For Richards part, he is expected to demonstrate that he is meeting his aftercare requirements on a weekly basis. These performative tasks are concrete, and as such, provide clear guidelines for their formal interaction. Other counseling techniques are not as easy to adopt because they require different social expectations and subtle shifts in authority. As an Inupiaq woman, Sue will not try to talk to Richard about personal things; men and women generally do not interact in this way. Sues title of counselor does not change her sense of decorum nor does it affect her deference for Richard, which is evidenced by her questions after the health of Richards mother. Likewise, Richards court-ordered vulnerability does not affect his status as a man, a provider in the village, and a patriarch in his family. Their relationship is not signicantly changed by the fact that Sue is paid to be the counselor and Richard is serving out his time. The roles of counselor and client offer each their own reward, but their value is limited to the larger systems these roles intersect with: Sues paycheck and Richards release from probation. The substantive aspects of a counseling relationship are more difcult to manufacture. The right to question, listen and tell personal stories or lend support does not come from formal roles in small, Inupiat communities. Rather, these practices conform to the social patterns of the village (e.g. women talk to women, men talk to men, and both speak mostly to those in their generation) and require relationships developed in the context of everyday life. If the counselor and client have a conictual relationship (or family history) or if the social roles are too incongruities (e.g. young woman counselor and an Elder man client), the conditions of probation are not likely to be met. Most relationships in the villages are shaped by a persons age, sex and personal attributes, and are formulated within ones family and network of relations. This reects a situation in which social arrangements, including power and leadership, are not now nor historically established through formal roles. Instead, ones social standing is (and traditionally was) determined in an on-going manner through everyday interchanges and performative

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achievements and within the context of gender, age and family status (Burch 2006). It follows that village members follow their own sense of etiquette and appraise each others abilities and wisdom by what they know of their past and present, not by their current employment. No matter how able a village counselor is, their ability to provide meaningful counseling to everyone in the village is doubtful given the importance of personal relationship, family histories and ones particular social role. Schedules, Personal Autonomy and Village Rhythms Euro-American behavioral health programs are by design prescriptive, orchestrating a particular behavioral outcome that is intended to produce social and personal changes. The underlying philosophy of such an approach reects a Western ethos about time, personhood and autonomy. These kinds of programs require a schedule of events or services, done within a specied timeline and affecting particular individual responses. The rationality that supports these kinds of interventions conceptualizes human behavior as (1) individually experienced and expressed, (2) decipherable in mechanized ways, and (3) able to be manipulated through evidence-based practice, no matter the context. These Euro-American assumptions reect a philosophic tradition that differs greatly from that found in many non-Western societies. This discontinuity is important because it affects the ways in which these services are actualized (or not) in the everyday happenings of villages. During my 2 years of data collection, more than forty community activities that had been planned (for weeks, sometimes months, in advance) were cancelled or postponed due to some unforeseen occurrence. Many of these planned events had been specically requested by community members, but something elseimportant or more interestinghad come up. Although this happened to all kinds of service providers (Inupiaq and non-Native), only the non-natives seemed upset about it. This underscores the different kinds of expectations related to personal conduct and responsibility. Briggs (2001) description of personal autonomy is a useful construct here. She talks about the distaste many Inuit have for the imposition of everyday rules from Euro-American society, such as: come to work everyday, and on time, and dont leave until the clock says you may; put away your tools at the end of the day; let your supervisor know if you are sick, and explain why you need a day off; schedule your summer holidayyou only get 2 weeksand so on (p. 230). This rule of the clock contrasts greatly with the everyday freedoms in Inuit (and Inupiaq) society. Perhaps that is why no matter what the planned-for event is, if something else happens that is more relevanta beautiful day for berry picking, a tragedy, caribou crossing

at an accessible spot of the riverthe scheduled activity is abandoned for the more pressing and/or relevant activity. When a search party is needed because someone did not return from a trip, people ock from all neighboring villages to help not only search, but also cook and take care of those who do. This can go on for weeks and months. Other times, people clear their schedules in order to help with a harvest and therefore be entitled to shares of meat (Bodenhorn 2000). Non-native professionals complained bitterly about the frequency of these changes whereas, my Alaska Native colleagues always received the news graciously, nodding with empathy when hearing that something of immediate import or interest took precedence over our scheduled activity. To do otherwise reects a EuroAmerican orientation that constrains personal freedoms in ways that seem onerous to many Inupiaq.

Discussion: Developing Culturally-Responsive Programs The ndings have so far outlined broad ways in which the idea, enactment and structure of Euro-American behavioral health programs do not t the socio-cultural patterns of Alaska Native villages. Instead of importing intervention ideas or manufacturing programs that are embedded in and built upon Euro-American constructs, culturally-responsive programming should be based on the sensibilities, social organization and current channels of inuence in the participating communities. In this section, three innovations for service provision will be suggested for Inupiat communities. These are based on traditional and on-going social patterns, interpersonal relations, and understandings found in the Alaska Native villages that participated in this study. They are intended to provide examples of how social and health services could be structured in culturally-congruent ways. Building on Existing Social Structures One way to do this is to work with community members to recruit an inuential man and womanknown for their interpersonal skills and highfrom each family group in order to tackle a community concern. Once identied, key leaders can be asked for guidance in recruiting natural helpers (similar to ananiqs) from their social circle to affect a particular village problem. This is vitally important since each village member is uniquely positionedwithin a matrix of social roles and personal historiesto help some people and not others. If a whole community is to be offered a service, it is important to have several people in the helper role so that they can work with those whom they are most suited to help. This not only strengthens the

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existing safety nets of village communities, but by employing men and women, young and old, it increases the likelihood that community members will be able to seek help from an appropriate person. In this way, distributing job duties across genders, generations and families of an Alaska Native village makes cultural sense. It increases the likelihood that most people will nd an appropriate provider, and will make the position more culturally consonant and appealing. Instead of being expected to serve (i.e. have close personal relationships with) everyone in the community, this strategy allows workers to utilize their connections and build upon and expand their established relationships. Thus, it invites people to enact the role of friend, Elder, joking cousin, or task leader based on who they are in their everyday life. By building on their own social position within their community, providers are more able to work in accordance with their appropriate role (i.e. women supporting women, men engaging with men, old guiding young, etc.) and to utilize what they know in service of others. In the study region, there are two village counselors (out of 12) who mainly work within their social circles and in accordance with their role expectations because of their active clientele. These counselors have remained in their positions for many (10?) years which is signicantly longer than most (average less than 2 years). This indicates a level of satisfaction that can be (at least partially) attributable to social role consonance. In addition, employing several people to take on similar responsibilities could also allow workers to respond to other opportunities or family needs without leaving their post vacant. Together, these conditions promote culturallysalient village practices that augment existing social structures and invite people to draw on their local, relational and cultural knowledge as service providers. Community psychologists can use their knowledge of community and cultural context and mental health to identify key community members to recruit into these kinds of positions. They can also further these efforts by utilizing their listening and facilitation skills to support culturally-responsive programs. Lastly, they can begin to translate the viability of culturally-responsive programming structures to funding agencies. Not Dictating the Form of Services, Just the Purpose Just as the role of helper should follow social formations in the community, the content of behavioral health programs can be made similarly culturally congruent by allowing each person to do their work in a way that makes sense to them. Instead of dening the job duties of a position, people can be employed to work toward a collective aim without specifying how this should be done. This approach

emphasizes the kind of personal autonomy Inupiat people regularly employ. Enlisting support for addressing a community issue (without dictating its form) could invite relationship-specic action within the contexts of peoples everyday lives. This is done regularly in the study area when recruiting adults and elders to participate in the local and regional culture camps for youth. Men with hunting expertise, elders who are known for their storytelling or particularly skillful basket makers are invited to the camp because of their acknowledged knowledge and skills. These people understand that they are expected to come and contribute, not by following a specied curriculum according to a schedule of events, but by doing and sharing what they do best. Without explicit job duties or timeslots in the campers day, these individuals seek out and create opportunities for young people to learn from them on their own terms. In this way, not prescribing how to address a problem (e.g. position duties, and scheduled activities with prescribed goals) allows community members to consider how they might work within their context and realm of inuence to address it. This kind of approach can be supported by on-going reection and dialogue between community members who are working within their personal realms of inuence to affect change. Community psychologists and other professionals can provide this unique, reective opportunity while tracking the outcomes of the shared effort. By creating space for people to discuss their activities and to get support, community psychologists can use their training to ask helpful questions related to context, relations, mental health and peoples lives. These conversations can facilitate new thoughts and directions, and can galvanize efforts aimed at achieving a shared community goal. Using Social and Personal Orientations of the Community to Support Efforts Lastly, given the importance of social acceptability in Inupiaq society, this could be used to buttress community members efforts to address village problems. Community psychologists or other professionals could offer participating households or individuals a marker of some sort to highlight, in a public way, the villages growing commitment to solving an identied problem. Public recognition can foster enthusiasm for the collective effort (Sprott 1997) and can provide indirect encouragement for those who are not yet involved. In the study area, this was just done successfully in a grassroots, suicide prevention initiative. In a region with only 8,000 people, local organizations from each village hosted a Walk for Life in May 2009. This walk invited community members to come out and March in support of

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suicide prevention. Two-thousand people (25% of the population) participated, carrying signs supporting their suicide prevention ideas and marching in the village streets. A service provider held a sign that said, Prevent suicide! A mother, whose son died by suicide, waved a poster that read: Your life is not yours to take, and a teenagers sign proclaimed, No more suicides! Creating collective space for individual action invites people to contribute in a way they nd to be appropriate and meaningful while gaining broader support for a shared effort. Participants reported feeling incredibly inspired by the collective initiative, having gained a new sense of shared momentum and community purpose. In addition, many who did not participate felt more inclined to get involved in the effort the next time. As the example illustrates, this kind of effort acknowledges a shared problem and asks people to contributein a personal yet public wayto the solution. This individual and collective approach seems more aligned with the socio-centric orientation of Inupiaq and other indigenous people. These suggestions are by no means the only or best options; but they offer an important innovation in the conceptualization of health and social service programming: they are built on the social organization and values of the society being served. Instead of ascribing roles and prescribing action to address a community issue, the ideas presented build on the interpersonal networks, social norms and understandings that structure Inupiaq village life. These suggested approaches also work within the social roles (gender, age, family), values (respect for personal autonomy) and forms of social control (indirect social pressure) found in the community. Instead of forcing a foreign paradigm on Inupiat communities, these ideas invite people to do somethingboth collectively and on their own termsto affect a shared problem in a culturally congruent way.

Conclusion Community psychology has long emphasized the importance of context to understand the diverse forces that inuence peoples mental health. These include the social and cultural understandings and practices that shape peoples lives (Nelson et al. 2007; ODonnell 2006). The discipline has used this perspective to question the status quo, and expand the lens of psychology to include an ecological orientation that critically examines the cultural t between services and the people who utilize them. Clearly, social and health service systems are likely to be more effective when they are built upon the basic social organization and values of a cultural group. Weinstein (2006) states that in order to do this in service of the social

good, community psychology must draw from a strong research base, a deep knowledge of social setting and respect for local conditions and local people, a trusting community partnership, and a commitment to both envisioning and enabling (p. 18). Attending to these criteria through a long-term relationship with the participating community, I offer ethnographic examples to describe how Euro-American approaches to service provision (and the assumptions upon which they are built) can be misaligned with local understandings and practices in Northwest Alaska. The examples are specic, but have larger relevance to other indigenous and non-Western minority groups. As illustrated above, many human and social services are built on a system of beliefs that reect an EuroAmerican ethos. Joseph Gone (2004a), a community psychologist, has identied the ways in which modern psychotherapies are themselves cultural artifacts (i.e. cultural creations or products situated within a unique time and place) whose mechanisms and meanings emerge from and depend upon the cultural intelligibility of their operations to both therapist and client (p. 15). This standpoint acknowledges that culture not only exists in the realm of the other, minority group, but also in the human service regimes intended for them (Weinstein 2006). It is therefore important to examine the ways programs and service models themselves are culturally-situated and to assess the t between this and the culture of the service recipients (Bar-On 1999; Brislin and Yoshida 1994; Lynn 2001; McCabe 2007). The article broadens this angle of inquiry to include not just the clinical encounter between psychotherapists and indigenous clients (and all that this symbolizes), but also investigates the cultural alignment of basic program conceptualizations that structure modern service provision. To do this, I highlight the ways that Euro-American culture inuences how social problems are dened and addressed within an indigenous community, despite their misalignment with the local practices and social roles. Specically, the medical model privileges Euro-American constructs and mechanized solutions over organic, spiritual or personal approaches. This can have the unintended consequence of subjugating Indigenous knowledge (Airhihenbuwa 1995, Bar-On 1999; Gone 2004a, b, 2008). The examples serve to highlight some subtle ways in which this works to suppress local understandings. Instead of building on village beliefs and practices to combat health or social issues, Alaska Native community members (and their professional colleagues) will overlook what they know in favor of ideas and strategies from the dominant society that are concretized through specic notions of what constitutes legitimate programming. These kinds of programs often require scheduling, goal setting, and role responsibilities that, by

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their design, are based on Euro-American assumptions about personhood, relatedness and social organization. These cultural discontinuities can undermine the project and stymie the accomplishment of program goals. More specically, in the study region, there is a disjuncture between the ascribed authority gained through formal roles and that gained by personal relationships and achievements. This limits the effectiveness of these positions. There also tends to be a discrepancy between program schedules and everyday village realities which contributes to the lack of success of many culturally-incongruent programs. Describing the ways these cultural discontinuities play out in Alaska Native communities can offer perspectives from which to develop culturally appropriate service strategies. In the examples offered, I tried to show how cultural patterns shape the ways service regimes are conceived, rendered and received in small Alaska Native communities. This has resonance for other Indigenous and minority communities that suffer from health disparities and who have been ill served by Euro-American approaches to services (Duran 2006). Instead of continuing these kinds of culturally-incongruent strategies, community psychology can strive to understand the social and cultural patterns of the people being served. The culturally congruent program options offered in the article are presented to illustrate how service strategies can recognize informal networks as legitimate recipients of resources and support, and be built upon indigenous understanding and social practices. This perspective offers a place to begin discussions about how community psychology can expand its line of inquiry at the intersection of culture and community-based programming.
Acknowledgments This work was supported by funding through the Youth Violence Prevention Cooperative AgreementYouth Suicide Prevention. Center for Substance Abuse Prevention; Substance Abuse and Mental Health Services Administration, Department of Health and Human Services. Thank you to the anonymous reviewers whose thoughtful comments improved the manuscript greatly, and my appreciation goes out to the collaborating tribal non-prot for their guidance and support throughout the study period and beyond.

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