Understanding culturally honoring services with Native American survivors of violence

Culturally focused services among native communities

Multiple terms are used to describe a range of programming that integrates culture as a key feature in program or intervention development and service delivery. We use the term culturally focused because it includes general approaches to considering culture in service delivery, and describes both culturally adapted and culturally grounded programs (Gondolf and Williams 2001; Okamoto et al., 2014). Studies exploring culturally focused approaches usually describe discrete programmatic interventions that have either: (1) culturally adapted evidence-based practices (EBPs), or (2) developed interventions grounded in discrete cultural beliefs and practices. Cultural adaptation amends existing evidence-based interventions to incorporate features to make them more approachable or relevant for specific cultural groups (Okamoto et al., 2014). Culturally grounded interventions are developed starting with the norms, values, and worldviews of a specific culture (Okamoto et al., 2014).

Settler colonial policies targeted the disruption and erasure of Native cultural practices. These policies included forced displacement from traditional lands and those that sought to suppress Native language, sever family ties, and outlaw spiritual ceremonies (Echo-Hawk 2018). Boarding schools and other policies that sought to dispossess Native people of their family structures, lands, language, and cultural practices continue to impact the health and wellbeing of Native peoples (Evans-Campbell et al., 2012). This collective harm has been termed historical trauma, the “…cumulative emotional and psychological wounding across generations, including the lifespan, which emanates from massive group trauma” (Brave Heart et al., 2011). Research on culturally focused services has found improvements across a range of outcomes for Native study participants including reduced substance abuse, decreased symptoms of trauma, and increased positive coping skills (Gameon and Skewes 2020; Venner et al., 2016). Culturally focused interventions typically emphasize strengths and prioritize partnerships between researchers and communities to ensure alignment with the cultural context of specific tribes (Gameon and Skewes 2020; Walters et al., 2020). For example, Skewes et al. (2019, 2024) describe a multi-year partnership with a reservation-based tribal community to adapt a generalist substance use intervention to reflect cultural practices which included Native language lessons and other activities to foster cultural reconnection and pride. Other culturally focused interventions include reconnection to traditional land-based teaching; education on how clan structures can guide morals and behavior; and interventions that build intergenerational relationships between tribal role-models and youth (Walters et al., 2020).

Culturally focused approaches and IPV services

There are relatively few studies exploring the application of culturally focused approaches in IPV services for Native survivors. However, those that do exist provide helpful insights into the importance of investigating this issue further. Varcoe et al. (2017) examined the acceptability of a culturally adapted intervention, and the extent to which educators’ roles (nurses vs Elder or both) impacted participant engagement. They identified a need for greater education for facilitators on trauma-informed care and engaged nurses who had a greater understanding of Native women’s experiences. Holder (2025) interviewed Native violence advocates serving Native survivors of IPV to identify successful service strategies. They found that advocates working with Native survivors of violence utilized shared cultural experiences to connect with clients and combined Native cultural teachings with practices that were not explicitly Native to facilitate engagement and relationship building (Holder 2025). These studies provide insight into the important role practitioners play in providing culturally focused IPV services for Native communities. However, there remains limited research that explores practitioners’ perspectives on how they successfully implement these services and the challenges they may encounter in doing so.

Research team

The research team consists of the co-authors of this manuscript who were responsible for all data collection and analysis. The first author is a Latina woman who identifies as a non-tribally affiliated Indigenous person. She conducted most of the interviews and led analysis and authorship of this manuscript. The second author, a citizen of the Choctaw Nation of Oklahoma, was the principal investigator of the study. She conducted some interviews and subsequently supported analyses and community engagement. Analysis was shaped by the researchers’ training as social workers, giving them insight into service delivery and other direct practice aspects described by participants. For example, the second author has experience working as an advocate in IPV and sexual assault services. Their tribal and Indigenous identities shaped interpretations of data on cultural strengths as well as cultural disruption. Finally, the researchers’ identities as academic social work scholars explicitly shaped their understanding and framing of CHS. For example, their definition of CHS incorporates principles from social work such as Cultural Safety even though participants did not use that specific term when describing CHS. Thus, we use data to ground CHS as a framework rooted in participant descriptions and experiences while also situating it within relevant social work concepts.

Sample

This qualitative study used a purposive sampling strategy. Researchers sought to recruit two to three individuals working with advocacy programs from each of the 12 federally recognized tribes in the state of Michigan. The final study sample included 19 individuals working in 10 tribes. In three of those tribes, we were able to recruit only one participant and for another tribe we interviewed five participants. Twelve participants were Native and nine of them worked for their own tribe.

The term advocate typically refers specifically to tribal victims’ advocates, but the term was also used by staff with different job titles and roles. Therefore, anyone working directly with victims in tribal victim advocacy programs were eligible to participate. UTFAV provided contact information for potential participants and the researchers reached out with information on the study. The researchers also worked with UTFAV to identify individuals working with tribal advocacy programs who had a particularly high level of insight into the research questions. These individuals received targeted outreach emails. In some instances, program staff suggested additional contacts or forwarded recruitment materials to colleagues.

Study participants served in a variety of roles including as social workers, case managers, cultural specialists, and advocates. Most participants reported primarily serving survivors of IPV or sexual violence and related crimes (e.g., human trafficking and stalking), with some describing their service population more broadly (e.g., ‘victims of crime’). Thus, most provided services tied directly to interpersonal violence including safety planning, crisis intervention, and personal advocacy and support, as well as financial assistance and emergency shelter placement. All programs served Native and non-Native survivors through victim services and other capacities (e.g., cultural education for a non-Native IPV survivor parenting Native children). Study participants reported a range of years serving their organizations, from one to more than 20 years. Given the small, regionally focused sample and to maintain confidentiality, details on individual participants are not provided.

Data collection

Interviews were conducted over Zoom, a video conferencing platform, to accommodate flexibility in scheduling across the state. Verbal informed consent was documented, and participants were offered a $45 gift card for completing the interview and a short survey. The survey asked about practice experience and services their programs provided. Interview questions asked about job roles and responsibilities, how CHS was integrated into that work, and perceived barriers and facilitators to that integration. Interviews lasted between 20 minutes and 1 hour.

Analysis

Interviews were transcribed, cleaned, and de-identified before coding. Coding included deductive codes based on study questions and the interview guide and inductive codes developed from the data. The researchers reviewed and coded transcripts independently, making memos of interpretations, questions, or notable patterns that could warrant additional codes or other revisions to the codebook. They met regularly to discuss analytic decision making several times, and the development of the codebook was an iterative process. Coding was completed using Dedoose, an application for qualitative analysis. A reflexive thematic analysis approach (Braun and Clarke 2021) was used to develop themes. This approach emphasizes the researchers’ engagement with the situated and subjective nature of qualitative data analysis (Braun and Clarke 2021). The researchers discussed data interpretations with UTFAV leadership and tribal advocates, including several study participants, for feedback on the definition of CHS and thematic findings. UTFAV leadership, advocates, and other program staff affirmed interpretations with no revisions.

Following the client’s lead: Openness, flexibility, and respect

Study participants approached services with a sensitivity to clients’ diverse familiarity and comfort with cultural practices and knowledge. In some cases, this included lack of knowledge or cultural disconnection. Study participants were sensitive to varied relationships clients had related to cultural knowledge and did not assume that engagement with cultural practices would always be assumed in their interactions with clients:

… a lot of our clients, even though they're from the community, they're not much into the culture, but yet they want to be. They just don't know how to get started. So we try to work with them at whatever level they're at, bring in whatever services and whatever programs that they would like to see that would be healing to them. – Barbara, Native Staff Member ⁴

Study participants practiced with the knowledge that Native people are not monolithic and may have varying preferences for cultural practices throughout this process. They took an open-minded approach and prioritized clients’ preferences:

…there are young people that are starting to do cultural practices that were lost for many years. And then you have folks that still have ties to the church, and so you have to be respectful of what their belief system is, just like anywhere. And that's how they guide us. – Trixie, Non-Native Advocate

In addition to being responsive to personal experiences and preferences, this approach also affirmed clients’ agency. Some study participants saw similarities between the denial of control often present in violent relationships and denial of clients’ choices about cultural engagement:

… part of that victimization process is feeling like you have a lack of control over what you're doing. You can't do or say the things that you really want to do. And I think just allowing people the space to make the choice. What does my own meaningful engagement of the culture look like…what do I want it to look like? – Sheila, Native Advocate

This reflection offers insight into the trauma-informed facet of CHS. Practitioners are aware they are often working with survivors coming from situations of extreme control. As a result, participants we spoke with emphasized a commitment to a service framework where survivors had opportunities to assert their autonomy in all facets of care, including cultural engagement.

Historical loss and contemporary disconnection

In some cases, historical loss influenced how study participants and their clients related to cultural knowledge and practices. When asked about barriers to integrating CHS, many participants reflected on a lack of knowledge and familiarity with cultural practices among clients. As one described, “…people who have a lot of historical trauma or are coming back to the community for the first time and they’re thirsty for that cultural knowledge, but they don’t necessarily know how to access it” (Sheila, Native Advocate).

Study participants also described disconnection due to boarding schools or other historical trauma, “…because of historical trauma, not all of us fit the proper mold. Not all of us have all of our cultural teachings. Not all of us know our family or know our history” (Sheila, Native Advocate). This lack of knowledge could lead to uncertainty or discomfort among survivors:

I think at first, it’s a little bit scary. Like, “Oh, my God. I don’t know anything about that. I don’t want to sound stupid.” I had this one lady [say], “I don’t know if I should do that. I don’t know anything about my own culture.” … we’re very understanding of the fact that not everybody has grown up in a cultural way, and maybe you choose not to. That’s totally fine.” – Barbara, Native Staff Member

Several Native staff members who were raised with their traditional teachings recognized that not all Native people have access to those experiences. One Native advocate shared, “I’m very blessed and fortunate that I do know… I do have a very strong sense of who I am and who I come from and what my teachings are. But I know that not everybody has that” (Sheila, Native Advocate). In cases like these, staff were able to draw upon their personal experience to provide support and education (e.g., teaching clients about medicines or how to smudge). In other instances, staff less familiar with cultural practices relied upon colleagues, learning as they went. As this advocate, who was in the process of learning more about their culture shared:

…I definitely lean on my coworkers who are more traditional and know more about the language or like I mentioned before, the survivor kits [that include traditional plant medicines]. I had a client ask me, “What are all of these medicines and stuff for?” And I told her, “Honestly, I'm not sure. I don't know.” – Linda, Native Advocate

This participant later shared, “My coworker made those little signs for me [referencing explanatory notes] so that I could help the clients understand better, and so that I could learn too.” This reflection demonstrates uncertainty about cultural knowledge, but also how these services could prompt cultural education and reconnection for both advocate and client. Both Native and non-Native individuals working in these programs expressed a high level of investment in learning about and providing CHS to survivors.

Grants facilitate and constrain culturally honoring services

Funding for CHS was a complex issue. Grants were credited for allowing programs to integrate cultural practices in a variety of ways, including culturally focused programs and staff positions. For example, some tribes were able to hire cultural specialists who provided educational support for survivors of violence, staff and the surrounding community. These positions were especially important in developing individualized approaches to cultural connection for survivors, “...bringing on the cultural specialists, we were able to do programs that were just geared towards clients. So we’ve done shawl making. We’ve done beadwork. We’ve done a lot of medicine walks… have them access resources safely” (Sheila, Native Advocate).

Granting terms also presented challenges, which often precluded culturally normative practices such as gifting:

…when we approach somebody and ask them to do a cultural teaching. We like to offer them tobacco, and then when they come do it for us we like to give them a gift thanking them for their time. And it's kind of hard because money is what grants will let you gift as a stipend, but money isn't what an Elder wants when you go to give them something.

– Christina, Native Advocate

Using grant funding to pay for food was another commonly cited challenge, “I know in a couple of grants we tried to put food, and that’s like a big no-no in any [funder] grant…but food also in our culture is so important. Feasting is so important” (Layla, Native Advocate). There is generally a misalignment between funding requirements and cultural practices, “Grant funders do not understand the notion of gifting and its importance within our communities… And tribal people like to get gifts. I mean, we’ll try to gift something to the feds, “Oh, I can’t accept that.” Do you know how insulting that is to a Native American person?” (Katrina, Native Advocate).

The importance of support networks

Working within a tribal context offered opportunities for practitioners working with Native survivors of violence to connect with multiple departmental and community resources, and vital peer networks. For example, some cultural centers or language departments supplement victims’ services education efforts, “We can reach out to our history and culture departments and plug into whatever existing events they have going on because not everybody has the same set of skills and the same set of teachings and knowledge” (Sheila, Native Advocate). Study participants also relied upon other resources in the community, including tribal elders:

...my approach is not being afraid to reach out to our elders or our boarding school survivors who have gone through so much, that have all this knowledge that has been locked away... [before] I would just only look for the information in text. I now reach out to my community... – Tanya, Native Cultural Educator

Supportive peer networks of advocates within tribes and across the state were frequently described. Intertribal networks, some facilitated by UTFAV, supported relationship building with other tribes and provided capacity building support for securing grants:

...[UTFAV] has the advocate meetings...so being able to ask those questions of other advocates like, “Hey, how have you done this in the past?” Or, “I'm kind of stuck on this issue. How have you all done this?” Or, “Do you have any input or advice?” Having that sense of, again, community and knowing that we're not alone in doing this work. There's other tribal programs out there that I'm sure are experiencing some challenges and barriers, and we can all learn from each other. – Layla, Native Advocate

This quote exemplifies reflections we heard across interviews that having a centralized resource that programs could go to with questions about grant requirements, funding challenges, or general support was incredibly helpful to their success in practicing CHS. While participants in our sample were located across the state, often in rural areas, they communicated utilizing resources internal to their tribal communities, as well as robust peer-networks. These elements supported their ability to integrate CHS and respond to funding limitations.

Defining culturally honoring services

We began interviews without a set definition of CHS and developed one based on how participants conceptualized and used cultural teachings and practices in service settings. Staff sometimes noted using EBPs adapted or grounded in Native culture as part of how they were integrating CHS. More often they described CHS as an overarching approach in their work. Integrating CHS included incorporating cultural practices into services for survivors (e.g., sweat lodges or medicine kits), but also included a broad, flexible approach that included prioritizing client preferences for service engagement and education related to cultural practices. We did not identify significant differences in language or framing around CHS between Native and non-Native practitioners. A concise definition of CHS is that it is service delivery that recognizes and accounts for historical and contemporary trauma by: (1) integrating cultural practices that survivors find supportive and grounding, (2) promoting respect for clients’ cultural practices and how they choose to integrate them into healing, and (3) taking a flexible and relational approach to collaborating with survivors.

Implications for practice

Implications for research

Strengths and limitations

Scholars have long called for researchers to meaningfully collaborate with Native communities in researching issues pertinent to those communities (Walters et al., 2020). This study’s findings were strengthened by our engagement with community collaborators throughout the design, implementation, analysis and dissemination phases. Our purposive sampling approach prioritized the engagement of participants with rich insights into research questions. Individuals worked across a range of tribes and programs that operate in urban and rural areas and with varying levels of resources for this type of work. We were also able to speak with both Native and non-Native participants with a range of life experiences and practice approaches.

Qualitative methodologies utilize sampling logics distinct from quantitative approaches that rely on generalizability and replicability (Small 2009; Staller 2021). The purpose of this study was not to produce findings that were representative of any population, but instead to identify findings that could be transferable across practice contexts as is appropriate in qualitative research. This research does not seek to represent or speak for the experiences of all tribal advocates working with survivors of violence. However, it does contribute to empirical knowledge of how culturally focused programming functions in the contexts presented and provides insights that can be used to inform practice with potential transferability to other tribal communities with similar contexts.

Given the nature of our sampling strategy, we cannot say how findings might apply to organizations that are not functioning within a tribal system, or who do not serve significant numbers of Native clients. Lastly, our study participants in general were generally aware of the impacts of historical trauma on Native communities, were generally supportive of the integration of CHS, and many prioritized educating themselves on cultural practices (if they were not already well-versed) including most of our non-Native participants. We cannot know how our findings might apply in organizations where staff do not similarly prioritize cultural knowledge and education.