Cultural Guideposts of Health: A crisis response evaluation framework for California's diverse Indigenous communities

American Indian and Alaska Native communities are disproportionately impacted by the crises of overdose death, self-harm, and other traumas, which lead to inequities in health outcomes. Despite these inequities, American Indian and Alaska Native people have rich and varied traditional practices rooted in resiliency that promote health but have often been overlooked, excluded, or dismissed entirely in Western medicine.

This paper describes Cultural Guideposts of Health, a crisis response evaluation framework for California's diverse American Indian and Alaska Native communities. In an adaptation of Yamane and Helm's 2022 Culture-as-Health paradigm, a Guiding Coalition of Traditional Healers and Knowledge Keepers convened, both in person and online, and collaborated with a team of academic researchers and cultural advisors to develop the Cultural Guideposts of Health Framework. The Guiding Coalition included cultural leaders, youth, individuals with lived experience, health care providers, and community members throughout the state and engaged in an iterative process of Indigenous Conversation to develop a culturally adaptive and responsive crisis response model for use across diverse Tribal and urban American Indian and Alaska Native communities.

Discussion topics included Indigenous definitions of health, healing, and wellness and culture as health within domains of Indigenous Spirituality, Indigenous Cultural Practices, Indigenous World View, and Place-Based Sacred sites.

The final product was a toolkit which includes a framework for evaluating crisis response and other evidence-based interventions that is adaptable across geography, organizational structures, service delivery models, and distinct Tribal contexts. Future directions include pilot testing and exploration of the framework's utility as an evaluation tool.