Family Wellness Warriors Initiative
- Need: Decrease rates of domestic violence, child sexual abuse, and child neglect for Alaska Native people in remote villages.
- Intervention: An evidence-based model inclusive of traditional culture trains local communities on methods of prevention and treatment for domestic and interpersonal violence.
- Results: Self-sustaining local system with improved family and spiritual well-being and decreased healthcare access needs.
Established in 1982 under the Cook Inlet Region, Inc. tribal authority, Southcentral Foundation (SCF) is an Alaska Native health care organization established to improve the health and social conditions of Alaska Native people. Specifically, the Foundation provides healthcare for 55 rural villages (nearly 13,000 residents) in the Anchorage Service Unit located, all within an area of 107,000 square miles in Southcentral Alaska. Employing the Nuka System of Care, healthcare delivery is family-centered and based on relationships built with customer-owners — the phrase used instead of patients and clients. Care is also focused on "outcome not income, service not practice."
American Indian and Alaska Native people show 4 in 5 women and 4 in 5 men will experience violence in their lifetime, according to 2010 findings from the National Intimate Partner and Sexual Violence Survey results. With a goal of ending domestic violence, child abuse and neglect in this generation, SCF has established the Family Wellness Warriors Initiative (FWWI).
The program first started in 1999 and is a 3-year program using evidence-based engagement methods and a trauma-informed care approach. It also builds on the strengths of Alaska Native traditional values: respect and honor for elders (Cup'ik); sharing and welcoming everyone (Alutiiq); love for children and honor for family (Athabascan); respect for others (Inupiaq); respect for self (Tlingit); and listening with your heart and mind (Yup'ik). All Alaska Native tribes have a story-sharing tradition that allows participants to identify and address the root cause of behaviors and motivations around violence, but to allow healing from violence at the individual, family, and community level.
Key to the program's success is its formal implementation steps. FWWI understands the most effective way of working with Native communities is to gain the trust and commitment of the tribal and community leadership. After an initial program of awareness occurs for village community members and leaders, a systematic method of relationship building follows. With these relationships in place, tribal leaders must then extend a formal invitation to SCF's leadership inviting FWWI to come to their community. This formality is part of proven evidence-based systematic methods of engaging communities. Also key to the program is using previously trained regional tribal leaders to train new leaders. This allows a "see one, share one, do one" model that also contributes to continued relationship building.
Funding for the Initiative in its early years included support from the Robert Wood Johnson Foundation.
Several specific training sessions provide education and information around the impact of trauma, abuse, and neglect: Beauty for Ashes, Arrigah House, and Advanced Leadership Education and Training. These programs build skills for effective management of the many challenges surrounding domestic violence. Training also results in a personal growth experience that translates into healthier relationships at home and work, in addition to community.
The program involves a 3-year framework, but that time frame is flexible and can be modified. Four implementation steps are involved:
Phase 1: Engaging Community
- Formal invitation
- Local Steering Committee formation
- Phase 2: Community Development
- Advanced leadership education and training
Phase 2: Community Development Plan continues
- Strategic planning
Phase 3: Implementation
- FWWI-led Arrigah House training
- Small group work continues
Phase 4: Transition and Sustain
- Continued strategic planning
- Community readiness workshops/Capacity building
- Region-led Arrigah House training sessions
As of 2018, nearly 3,500 customer-owners have participated in FWWI.
FWWI has been implemented across Alaska:
- Kodiak (all surrounding villages)
- Tanana (interior Alaska) this included the village of Minto
- Bristol Bay – all surrounding villages with specific focus on Togiak and Ekwok
- South East Alaska (the Alaska "panhandle") – focus area Ketchikan
- Cook Inlet
- Copper River
- Yukon Kuskokwim – focus area Bethel, but most surrounding villages included
Current implementation activity is in the Kotzebue area and all surrounding villages. The Aleutian Pribilof Islands have approved requests.
Internal results have shown improvement in family and spiritual well-being. Unpublished results have shown the program decreases unhealthy substance use and decreases in acute healthcare resource utilization (emergency room and acute hospitalization). Additional results have been formally submitted for publication.
For more on this program:
Ray, L., Outten, B., & Gottlieb, K. (2020). Health care utilisation changes among Alaska Native adults after participation in an indigenous community programme to address adverse life experiences: a propensity score-matched analysis. International journal of circumpolar health, 79(1).
Gottlieb, K., Outten, B. Family Wellness Warriors. (2011). Family and Community Health. 34(3), 235-41. Abstract
This Family Wellness Warriors Initiative video introduces the goal of ending abuse in this generation:
Contact InformationBobbi Dyan Outten, MA, LPC, Director of Family Wellness Warriors Initiative
Abuse and violence
American Indian or Alaska Native
Culture and cultural competency
Integrated service delivery
Service delivery models
October 11, 2018
Date updated or reviewed
November 18, 2020
Suggested citation: Rural Health Information Hub, 2020. Family Wellness Warriors Initiative [online]. Rural Health Information Hub. Available at: https://www.ruralhealthinfo.org/project-examples/1035 [Accessed 2 December 2020]
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