PMHW Winter Faculty Highlight — Nancy Whitesell, PhD

Can you provide a brief summary of your current work and how it relates to Population Mental Health and Wellbeing? And can you tell us about the communities where you work?

My research is focused on improving health and developmental outcomes for children and adolescents in American Indian and Alaska Native (AIAN) communities.

With young children, this involves work through the Tribal Early Childhood Research Center (TRC; www.tribalearlychildhood.org), where I am Director of Research and Measurement. The TRC has been partnering with programs that serve young children and families in Tribal communities around the country since 2005 – Head Start, Home Visiting, and Child Care – to strengthen connections between programs and universities so that research-based innovations can be implemented by practitioners and practice-based questions can be answered by researchers. I am also leading the Multisite Implementation Evaluation of Tribal Home Visiting (MUSE), a study with 17 Tribal Maternal, Infant and Early Childhood Home Visiting (MIECHV) program partners from North Carolina to Alaska, working to understand how the home visiting is being implemented by AIAN communities. The early childhood interventions supported by this line of research support the healthy development of young children across multiple domains – social, emotional, language, physical, and cognitive.

With young adolescents, my work is focused within a longstanding partnership with one reservation community in South Dakota where I have been working for almost 20 years. Over the past 10 years, my team has developed Thiwáhe Gluwáš’akapi (sacred home in which family is made strong), an early substance use prevention program for youth that engages families and grounds a proven evidence-based approach in cultural values and practices. This work grew out of earlier research that identified disproportionate rates of early substance use in this community and elevated risks for developmental disruption associated with early use, and substance use remains a primary prevention focus. However, this work as also expanded to include a focus on mental health and the prevention of suicide risk as well as substance use. 

Another important aspect of my work is with the Native Children’s Research Exchange (NCRE; www.ncreconnect.org). NCRE is a national organization that I co-direct with Michelle Sarche. We founded NCRE in 2008 and host NCRE conferences that bring researchers working with children and families in AIAN and Native Hawaiian communities together to share our research and build collaborations. We also support the career development of Indigenous researchers through the NCRE Scholars Program (www.ncrescholars.org), supported by the National Institute on Drug Abuse to increase diversity among NIH principal investigators. To date, we have supported 23 graduate student, post-doc, and junior faculty Scholars building independent research careers focused on substance use research to improve outcomes for AIAN children and families. The community we work with in NCRE Scholars is emerging Indigenous researchers (AIAN and Native Hawaiian) – and they, in turn, work with Indigenous communities around the country. 

What are a few of the unique rewards and challenges that you have experienced in your work?

The rewards are many. My work teaches me something new every day. I have opportunities to work with people around the country who are committed to improving the lives of children and families and improving their communities. They are, as a group, inspiring, insightful, and tenacious. Because this work allows me to connect with people from a variety of different AIAN communities and cultures, I have opportunities to learn different perspectives on childhood and family.

I have also learned a great deal about how research has steamrolled through communities in the past, using blunt tools to gather information and draw conclusions rather than listening first to understand the best questions to ask and the best tools to use to gather valid information in order to accurately answer those questions. One challenge in my work is overcoming the distrust of research many people in AIAN communities understandably hold, a process I work at through building relationships and applying my research skills in ways that support both culturally and scientifically rigorous research.

What are the primary population mental health concerns in your communities and how are they working to improve those concerns?

This is a hard question to answer. First, I am hesitant to speak for the communities I work with, and, second, they are extremely diverse and primary needs vary greatly across communities. With the TRC, we work closely with numerous early childhood programs and connect with hundreds. There are more than 570 federally recognized tribes. Each one has a history and culture of its own, and each has a current cultural, social, and economic landscape that shapes primary mental health concerns. That said, I can tell you what the research documents (although we have spent too much time documenting problems and not enough focusing on solutions): There are mental health concerns that, statistically, tend to be more common in AIAN communities, and two that consistently bubble to the top are substance misuse and suicide. AIANs have some of the highest risk for both of these outcomes compared to other ethnic groups. These risks are often linked to common social determinants, such as trauma exposure (including historical trauma), discrimination, and economic stress.

How has COVID-19 impacted the communities that you work with?

Along with most communities of color, AIAN communities have been harder hit by COVID-19 than white communities. AIAN reservations have had some of the highest rates of COVID and some of the highest fatality rates in the country, and AIANs in urban settings have fared similarly. Crowded intergenerational housing common in many AIAN communities (both urban and reservation) is one factor that may elevate transmission risk, along with poor access to clean water in many remote communities. Aside from direct impacts of infections, we have seen the impact of COVID in AIAN communities with limited internet infrastructure and few tech resources in homes; remote school is extremely difficult in these contexts and children are at risk for falling behind during the pandemic. Another thing I have heard from partners around the country is that the losses in Tribal communities are extensive and felt deeply. I have one colleague who had lost 7 family members to COVID as of mid-December. In extended kinship networks of AIAN communities, these losses reverberate throughout the community. And in communities where elders are the last keepers of traditions and languages that were all but eliminated by federal policies designed to do just that, the loss of so many elders is devastating. Communities have been working hard on revitalization efforts, to save their languages, their stories, their ceremonies; the ravages of COVID are making the race to do so more urgent.

The PMHW program is working to connect students with faculty doing research in the field. Do you have (or anticipate having) opportunities for students to complete their practicum and/or capstone with you and your team?

Our in-person research activities in South Dakota are on hold for the time being due to the pandemic. We are hopeful that we may be able to begin implementation again in the fall of 2021, but that will depend on a COVID-19 vaccine being widely distributed to both families and children on the reservation by summer, as well as meeting several other milestones set by our Data and Safety Monitoring Board (e.g., tribal guidelines for safe in-person activities) so the timing remains tenuous.

Activities with the TRC and MUSE studies are ongoing, utilizing virtual data collection protocols, and their may be opportunities for student involvement in those efforts in the coming year.

Can you highlight a course that you teach and give us a brief summary?

I have been teaching two courses in the DrPH program for several years – the Advanced Seminar in Community and Behavioral Health, which I co-teach with Dr. Carol Kaufman, and Latent Variable Methods, an advanced statistics course. The Advanced Seminar is designed to give DrPH students in CBH an opportunity to dig into current issues in the field and push their own ideas forward at the cutting edge. Latent Variable Methods is designed to give these students tools to understand how to measure complex social and behavioral constructs and examine their relationships using statistical methods, using modeling techniques.