DOCUMENT: COMMOBIL.TXT This document has been submitted by: Scott McLean COMMUNITY MOBILIZATION ON THE WARM SPRINGS INDIAN RESERVATION by Scott McLean, M.A. ABSTRACT Community mobilization has been viewed as a useful and productive method to change perceptions and ultimately action. On a reservation distinctly tired of programs which have little perceptible affect on the community, members have readily expressed frustration at the lack of local control. Programs which work in one community may well fail in another. The lack of predictability creates the necessity for a re-examination of needs and methods to address those needs each time a new program comes to town. When the prescriptive program is over, the members cite another "tumbleweed" program without success. One way to counter this perception is to ask local community members what they perceive to be the risks, the needs, and constructive ways to address them. The combination of community member input and commitment with sufficient resources has enabled the Warm Springs Healthy Nations Group to form a mobilizing community. INTRODUCTION Community mobilization has been studied at length by social psychologists and prevention activists, and is now being explored by researchers within the social marketing realm. Its focus, to present a message which will affect a behavioral change in the individual, has contributions from many fields. Little research, however, has been conducted on the nature, scope, and role of communication in the overall process. The Robert Wood Johnson Foundation has funded a 6-year public health initiative, including 10 reservation-based and 5 urban groups, to reduce substance (use and) abuse among Native Americans. The needs assessment and implementation phases are to have a strong community mobilization component, focusing on the individual community's perceived needs and way to reduce substance use with local ownership. Social Psychologists have outlined stages of change, from precontemplation to action and maintenance (Prochaska and Di Clemente, 1982, 1992), but have not documented the communication process(es) to complete this task, particularly in an intercultural, intergenerational environment. The Warm Springs Indian Reservation has been an often- studied environment, with countless researchers and surveys. Subsequently, part of the orientation process for new employees is a glance at the "wall" of binder-bound reports of projects past, with commentary on how little was accomplished with any lasting results. Outsiders are circumspect, programs distrusted, and efforts to change met with resistance and suspicion. As a result, the project staff listened instead of planning, and a community ownership approach was found to mirror the positive aspects of community discourse and activity, in essence a good "fit." COMMUNITY MOBILIZATION Community mobilization is a planned effort to mobilize a community or groups within a community toward positive social change (May, Miller, and Wallerstein, 1993.) Social marketing, in contrast, is application of behavioral strategies, from a commercial marketing design, to market a "product" such as good health or adult literacy (Rogers, 1994). Social marketing incorporates marketing tools such as market segmentation, or creating categories of "consumers" according to a variable set such as "intravenous drug user" as opposed to "young professional with disposable income." This strategy has been studied in Latin America and Asia in terms of contraceptive use promotion, and more recently these techniques have spread to the United States (Rogers, 1994). Health Communication, a relatively recent discipline within the field of communication, is distinguished by an emphasis on education and collaboration among health professionals, combining the talents of health care providers, health educators, and community activists in an effort to educate and inform (Rogers, 1994). The distinction of community mobilization is the emphasis on the involvement and ownership of the process and outcome by the community members. While social marketers can measure change according to established practices, and health educators can measure health knowledge before and after a process, community mobilizers have the problem of measuring the level of community member involvement and commitment towards a common goal. "Comprehensive community-planned mobilization has become one of the most widely promoted prevention strategies for alcohol and other drug problems in the United States" (Dryfoos, 1993; Klitzner, 1993; May, Miller, and Wallerstein, 1993). Community leaders and target populations are engaged in planned collaborative efforts toward positive social change. These systematic efforts attempt to build community ownership of the issues and their impacts in order to mobilize community members toward the identification and addressing of barriers (Chavis, Resnick, Felix, & Kaye, 1993; Webb, Campbell, Schwartz, & Sechrist, 1966). Nation-wide campaigns against public health risks such as smoking have raised the level of awareness surrounding community mobilization. The first official government warning in 1964, from the Surgeon General's Report on Smoking, contributed to the mobilization of groups in our society towards a modification of their behaviors, ultimately resulting in decreases in both tobacco use and mortality rates (Surgeon General, 1989). As behavioral change occurred in more people, public policies discouraging smoking were enacted, further supporting this process (May, Miller, and Wallerstein, 1993). In 1979, the U.S. Surgeon General published HEALTHY PEOPLE: THE SURGEON GENERAL'S REPORT ON HEALTH PROMOTION AND DISEASE PREVENTION, which detailed planned interventions that proved to reduce cardiovascular risk factors (Farquhar et al., 1984; Shea and Basch, 1990), contributing to the overall understanding and potential application in the field. Creating links between community agencies, bringing people together to work toward common goals on the local level, has been the dominant method of alcohol and drug prevention through groups such as the Center for Substance Abuse Prevention, the Rockefeller Foundation, the Kauffman Foundation, the Kaiser Family Foundation, and the Robert Wood Johnson Foundation. (Davis, Lurgigio, & Rosenbaum, 1993; Hawkings, Catalano, & Associates, 1992; Rogers, 1994). While the process is based on sound theoretical principles of "increasing the community's protective bonds and institutional connections (May, Miller, and Wallerstein, 1993)," evaluation outcome results are problematic (Klitzner, 1993). Furthermore, there has been a distinct lack of communication of this dynamic process, reducing the capacity for others to replicate the model, particularly in reservation country. From an organizational communication perspective, community mobilization models often fall into two categories: top-down and community-driven (May, Miller, and Wallerstein, 1993). The top-down approach is typically expert-driven and is not sensitive to community needs. Strategic plans, while eloquent, often are designed apart from their target audience, with an emphasis on delivering services instead of involving local community members (May, Miller, and Wallerstein, 1993,) The community-driven approach requires local development, a committed interest in both the process and outcome, and motivational issues (Minkler, 1992; Rothman & Tropma, 1987). A key motivational element for this approach is "to encourage people to care enough to improve their life conditions by addressing their emotional concerns and to thereby engage in an ongoing interplay of self-interest and social concerns (May, Miller, and Wallerstein, 1993)." One model example of this interplay and social direction comes from the community education model of Brazilian educator Paulo Freire (Freire, 1970; Shor & Freire, 1987), detailed in figure 1. From this point, community-mobilization, with its social psychology basis, takes on distinct properties traditionally studied in the field of communication science. Freire details SPARKS and TRIGGERS, listening, dialogue, and action. This is a communication process, where "sender" and "receiver" are not clearly defined, but a model of a process can still be observed, and replicated. May, Miller, and Wallerstein, 1993, in MOTIVATION AND COMMUNITY PREVENTION OF SUBSTANCE ABUSE, outline the Freirian approach to community mobilization from a social psychology perspective. FIGURE 1 MOTIVATIONAL INTERVIEWING PREVENTION 1. EXPRESS EMPATHY LISTENING A. Acceptance facilitates 1. Gain Entry through invitation change from subgroups or through B. Skillful reflective being available and listening listening is fundamental C. Ambivalence is normal 2. Develop a Relationship/Rapport A. Listen for concerns 2. DEVELOP DISCREPANCY B. Dialogue A. Awareness of consequences C. Ask Questions is important D. Build Relationships B. A discrepancy between present behavior and DIALOGUE important goals will 3. Reflect on Community Status motivate change (Mirror Stage) C. The client should present A. Present accurate profile the arguments for change B. Utilize data about community problems 3. AVOID ARGUMENTATION - existing sources A. Arguments are counter- - invite surveys, productive prevalence and norms B. Defending breeds C. Meaningful discussion of defensiveness problems C. Resistance is a signal to D. Dispel myths change strategies E. Public health approach D. Labeling is unnecessary is useful 4. ROLL WITH RESISTANCE 4. Avoid Polarization A. Momentum can be used to A. Do not critique good advantage directly -- guide B. Perceptions can be B. Avoid reliance on easy/ shifted simple solutions C. New perspectives are C. Do not label invited but D. Depersonalize Issues D. The client is a valuable E. Facilitate issue- resource in finding oriented debate solutions to problems F. Do not over advocate for 5. SUPPORT SELF-EFFICACY 5. Maintain Ongoing Dialogue A. Belief in the possibility A. Be patient of change is an important B. Maintain rapport motivator C. Community is the solution B. The client is responsible D. Time frame is long for choosing and carrying E. Be a sounding board out personal change C. There is hope in the range ACTION of alternative approaches 6. Provide a Menu of Options available (Menu of Options) A. Provide information on prevention alternatives B. Prevention Specialists advise and consult on strategies/options Source: May, Miller, and Wallerstein (1993) The process from "express empathy," to "support self- effacy," and "listening" to "action," is a communication one. In order for one to listen and engage in dialogue, one must communicate and respond. "The sound one hand clapping," as a cultural description of a failure to communicate for lack of two willing participants is well known. Dialogue occurs over the phone, through letters, in coffeeshop conversation and in public broadcast. Defining specific actions in terms of motivation is less clear. Through example and detail, this essay retraces steps taken to achieve a mobilized community. The Freirian process serves as blueprint for community mobilization in Warm Springs. WARM SPRINGS The research on which this paper is based was conducted from 1994 to 1995 in the central community of Warm Springs on the Warm Springs Reservation in central Oregon. It was an outgrowth of a Robert Wood Johnson Foundation project. The first step in the process was to learn more about the community and reservation. The Confederated Tribes of Warm Springs Reservation was established by treaty in 1855 and is the home of three distinct tribes: the Warm Springs, the Wascoes, and the Northern Paiutes. The Warm Springs, speaking Sahaptin, and the Wascoes, speaking Wasco, are socially and culturally closely related. The Northern Paiutes were traditionally nomadic, and speak Paiute (Murdock, 1949). Warm Springs residents participate in a relatively stable economy featuring wood products from a tribal-owned and operated mill, cattle-raising, seasonal work such as fire- fighting, Federal government subsidies in the form of welfare and social security benefits, tourism and traditional art production, and tribal per-capita. The destination resort village Kah-Nee-Ta promises to provide additional revenue and further diversify the economy with a gambling casino, the first on the Reservation, in 1995. Lack of adequate housing and unemployment are serious problems. The Warm Springs Reservation encompasses 655,000 acres and a total Tribal enrollment of 3,525 (WS Vital Statistics, 1994), representing the Warm Springs (Simnasho District), Wasco (Agency District), and Northern Paiute (Seekseequa District) Tribes. Kaut (1957) and Basso (1970) note that kinship, by blood and by marriage, is one of the most powerful forces in the establishment and regulation of interpersonal relationships in Native communities. The focus of activity lies in the home, often intergenerational, in part due to the lack of housing. The next largest interacting group is that of "extended family," out to fourth and fifth generation cousins. Families within the Warm Springs, Wasco, and Northern Paiute Tribes form the interpersonal and political force within the governing body, a nine-member Tribal Council, representing the Simnasho, Agency, and Seekseequa Districts. Tribal members have inter-married for generations, but maintain independent groups. The Robert Wood Johnson Foundation joined in a partnership with the Confederated Tribes of the Warm Springs Reservation of Oregon to reduce substance use and abuse in December of 1993. The needs assessment phase, 18 months, included a behavioral risk factor survey, community meetings, focus groups, and interpersonal interviews. The conversations in this study were collected as the recorded focus groups of the needs assessment. The initial assessment of community organizing activity in general and substance use in particular revealed institutional programs, and little involvement, as the status quo. One initial informant, employed in education administration in May of 1994, indicated she was aware of three community health educators but had not seen them yet that school year. An employee at the public Tribal radio station indicated they had participated in a grant-funded public awareness campaign on alcohol, pregnancy, and the Fetal Alcohol Syndrome two years earlier, and the materials were stacked in a back closet. INTRODUCING THE HEALTHY NATIONS PROJECT TO WARM SPRINGS In 1988, rates of alcoholism among American Indian and Alaska native people were 433 percent high than rates among non-Indians, according to the Indian Health Services's 1993 TRENDS IN INDIAN HEALTH (ADVANCES, RWJF Newsletter, summer 1994). The Council on Alcohol and Drugs, the governing body of the project under the Tribal Council, indicated the first issues to be addressed by the coordinator were public awareness, knowledge and involvement in the project, and mobilizing the community members. The staff, consisting of a coordinator and assistant, attended community gatherings, spiritual services, departmental meetings, and family gatherings and listened. Staff then compiled notes from each interaction in a central data base and filed originals. Local lines of communication include the bi-monthly tribal newspaper SPILYAY TYMOO, the public tribal radio station, KWSO 91.9FM, public-access television channels (new to the reservation in 1994) via cable, local print productions TOMAHAWK II, WARM SPRINGS ELEMENTARY SCHOOL NEWSLETTER, HEALTHY NATIONS NEWSLETTER, FLYERS AND BROCHURES, and by word of mouth, which is everywhere in our small town. Through this process of coming to understand community dialogue, it became clear through repeated interpersonal reports from numerous individuals/departments in and outside of the tribal structure, that surveys and traditional research methods were over utilized. In addition, the credibility issue of surveys, their results, and community ownership of programs were directly in question (Warm Springs Satisfaction Surveys, 6/93, 6/94). Quintin Kingfisher, of the Northern Cheyenne tribe in eastern Montana, and LaDonna Fowler of the Flathead reservation in western Montana, spoke at the Montana Supported Employment Conference held September 10, 1993 in Missoula on the issue of credibility in Native American communities. Jerry Dwyer, who is of Osage descent, also contributed to the process. Their observations and commentary were included in an article published in THE RURAL EXCHANGE, Fall 1993 issue, a rural health publication produced by the University of Montana: "There are so many needs that tribes set their priorities, and if you have no credibility, your program won't be a priority," Kingfisher said. "If you have a good reputation, you have to hold onto it. People talk to people. They talk to their families. If one person walks out, many will - and they won't come back. Maybe after you're around a couple of years and we get to know you, something will happen," said Dwyer. In an attempt to identify a method with credibility and effectiveness, a good "fit," the Warm Springs Healthy Nations staff conducted a literature review and found the Freirian approach to community mobilization had been shown effective in native populations, through the use of communication channels in three stages, without formal techniques. A Freirian approach involves three overlapping stages that are not linear but that continue to cycle indefinitely: listening, dialogue, and action (Freire, 1970: Shor & Freire, 1987 cited by May, Miller, & Wallerstein, 1993) A community-driven Freirian model that elicits generative themes can be compared with the stages-of-change readiness model (Prochaska and Di Clemente, 1982, 1992). Prochaska and Di Clemente detail precontemplation, contemplation, preparation, action, and maintenance as the five distinct phases of change. This model (page five) of listening and engaging in dialogue at community events and familiar locations follows a similar course, and has shown the ability to prepare the Warm Springs Community for mobilization. The Freirian process, with overlapping stages, compliments the Warm Springs Community in numerous ways. Time is regarded differently as has been noted in many cultures, where a 3:00 meeting is really starts around 3:30. This observation in not universal in Warm Springs, however, and the social rank of the individuals participating as well as the presence of outsiders, relation to the day of the week, time of the month, relation to local holidays, and funerals all affect the importance of time. Each person takes his or her time within the culture of Warm Springs, with elders tending to take more time while the youth take less. One example of this distinction occurred during recorded focus groups. Elders would take much longer pauses between turns speaking, almost never overlapping each other, and never interrupting a mid-turn pause. Elders would sometimes say "Eee," meaning yes and indicating they are listening, but even that feedback was extremely rare. In sharp contrast, middle-aged and younger members tended to have much shorter pauses between turns speaking, competing for the conversation floor. Among the 15-17 year old participants, this was particularly apparent. Overlapping stages of listening, dialogue, and action allow for the differences in time, across age groups. In order to reach the groups within the group of Warm Springs, an individualized approach was necessary: "Most researchers focus their thinking on, say, the interpersonal level and differentiate it from adjacent level such as that of the individual actor or the social network. Others, working perhaps at the level of the local community, are aware of alternative possibilities - the nation, or the family or local institutions within the community. But community-level researchers are as a rule unlikely to bear in mind the interpersonal processes, or vice versa." (Berger and Chaffee, 1987). The individual is central to community-wide social action (Hewes and Planalp, 1987), getting to know and reaching the individual community members must be preceded by invitation: "From the beginning of a community-driven model, motivation of the community comes either through a) an INVITATION to prevention professionals to work within a community, or b) through a widespread listening and dialogue process in synergy with community members and leaders, who must ultimately direct the community mobilization." (May, Miller, & Wallerstein, 1993) Understanding the overall distrust of professionals, the project staff attempt to position themselves as community members while acknowledging inherent limitations. In Warm Springs, the main efforts in this area were the hiring a well-known local mother of six, who was related to many in the community, emphasis placed on the coordinator's roots and hometown, Omak, Washington, on the western edge of the Colville Reservation, and their repeated attendance at community functions. The assistant reinforced local input by her presence. Informal inquiries about this new program were fielded informally, as well as by phone, which "rang off the hook" after she joined the project. The second aspect of this listening approach to community involvement reinforced perceived similar values, likes and dislikes, particularly in the area of "country living," care and handling of livestock, and agricultural interests. Credibility was gained as the member of the outgroup (Gudykundst, 1985) was seen to have similar traits to members of the in-group, slowly reinforcing that ingroup members were not "communicating with a stranger (Gudykundst and Kim, 1984)." Finally, public attendance of community events and displays of interest and inquiry in terms of what community members perceived as local issues of substance abuse reinforced the importance of local leaders and customs. The invitation from community leaders and elders to participate in community events has been central to acceptance and involvement at Warm Springs. The RWJF Project was invited and approved by Tribal Council, the coordinator was invited by the Council on Alcohol and Drugs. On a more personal level, the coordinator and administrative assistant have been invited to community functions, ceremonies, meetings, and family functions. They are actively included in the process of community, at an average rate of 15 functions per month in 1994 and 1995. Through this active, interpersonal approach (listening), the staff participate in the widespread dialogue process with community leaders. "A starting motivational catalyst in community prevention is often the SPARK TOPIC" (May, Miller, & Wallerstein, 1993). A good spark topic has an appeal to emotion, has a broad base of impact and subsequent concern, and results in motivating individual/group consensus about issues, planning, and action. Warm Springs is a young community. It is also one affected strongly by substance use and abuse. Accidental death and suicide among Warm Springs youth remains several times the national average; and the average mortality rate in 1992 was age 44, well below the national average (Warm Springs Vital Statistics, IHS (1992), affecting almost everyone in Warm Springs. These topics serve as a natural spark topic to generate dialogue. Donohew, Palmgreen, and Lorch (1994) indicate the need for sensation in health communication campaigns. In community mobilization, the spark or trigger also recognizes this need, with an emphasis on the positive and perceived ability to change one's environment, rather than a self-defeating or fearful tone which creates a "community feeling of powerlessness over a problem" (May, Miller, & Wallerstein, 1993). The Warm Springs Healthy Nations project systematically utilizes five primary communication channels, resulting in a significant increase in community member awareness of the project, and subsequent involvement. MOTIVATIONAL INTERPERSONAL INTERVIEWS Motivational interviewing is based on five core principles: (a) expressing empathy, (b) developing discrepancy, (c) avoiding argumentation, (d) rolling with resistance, and (e) supporting self-efficacy (Miller & Rollnick, 1991, pp. 55-63). Through the five primary channels, the staff implemented the Freierian approach in 1994 and 1995. For example, the Project monthly newsletter introduces a topic (substance abuse/children), is sent out to the community, and ellicts a response. This response is self-selected, comes in the form of letters, telephone calls, and/or dialogue in small group/interpersonal settings (office, front of post office, Sunday services), and is recorded. The role established in this model for the community activist is that of facilitator and gate-keeper, bringing together people, gathering specific information on past and present perceptions of the issues, and creating momentum through listening and dialogue. The Warm Springs Healthy Nations staff member, usually the staff member from the community, listens with empathy. She then points out the subtly of discrepancies. for example, the difference between the goal (keeping your child in school, for example) and reality (your child has not attended school for some time), and helps the participants focus on a solution (say a peer mentor, or a tribal member resource person in the school system who is available much like a counselor). The staff member is careful to avoid argumentation and supports the concept that the person can positively change his or her environment. In addition, the participant is clearly told each time that his or her thoughts and ideas will not be represented, anonymously or otherwise, without their consent. The staff member records the interview in terms of written notes, as a tape recorder was found to compromise the discussion. It is curious to note that out of 76 interpersonal interviews recorded across 14 months, 35 were from the coordinator, the outgroup member. It is possible that the status of the coordinator as an outsider also meant that the participants were taken at face value. It may have been easier to relate perceived risks and solutions to the outsider than to family or friends who may respond unfavorably or judgementally. At any rate, the combination of staff has proven successful. This record of an interpersonal interview is then published, with permission, in the next edition of the newspaper and/or newsletter without the individual's name, and then returned to the community to again illicit a response. This Freirian process is used across four channels currently, and the project is currently exploring production for the public-access television channel. The level of involvement required to track and continue this process is high. To date, the quality and level of response has also been high. In order to talk and listen with others, the staff attends almost every community event. Annual events, Sunday services at each long house and regular, weekly attendance of the Senior's luncheon at the Senior's Center. Physical presence and listening leads to invitation which leads to dialogue which in turn, occasions an new spark topic and increases the level of message output. For example, a respected community leader requested the coordinator attend a public school meeting with the principal concerning the gang-related activity of his daughter. The Coordinator was asked to act as an observer, but the level of intimacy this invitation implies is paramount. It reveals a level of trust in an outsider. It also increase credibility of the program, its goals, and ultimately, community member ownership in this community- driven process. The Warm Springs Healthy Nations staff has steadily increased their level of involvement, and observed a corresponding increase in the quantity of interpersonal interviews, each averaging approximately one half hour. FOCUS GROUPS/RADIO PROGRAMS Radio programs featuring local individuals have been a highly successful way to create dialogue among community members. Community adults and youth, many recovering abusers, addressed three questions in seven focus groups in 1994 and 1995. 1) WHAT CAN OUR COMMUNITY DO TO REDUCE ALCOHOL AND DRUG USE AND ABUSE? 2) WHAT CAN INDIVIDUAL COMMUNITY MEMBERS DO TO REDUCE ALCOHOL AND DRUG USE AND ABUSE? and 3) WHAT DO YOU SEE IN OUR COMMUNITY TODAY? Their response, publicly broadcast, resulted in a significant increase in the level of community feedback to project staff. Community members would quote the speaker, indicating he or she has a good idea. One participant expressed this eloquently in a radio program, where she said on tape she felt much better, hopeful for the future, after listening to the others. Positive, constructive ideas were passed around and the programs generated dialogue. In rural areas, radio reaches out across the miles, bringing the community together in ways print cannot. The first program featured three well-known and widely regarded female elders. They came together in one location, a well-lit place where native language classes are often held. The first speaker, and elder in the Warm Springs Tribe, addressed issues of substance use among the youth. She took as long as she wanted to speak and no one interrupted. The second speaker, her sister, spoke of the difference between today's youth and substance use, and long ago. At age 94, she recounted a time when the reservation seemed more remote, and alcohol harder to come by. The third speaker, an elder of the Northern Paiute Tribe, spoke of modern day instances with children and grand children. When the programs were broadcast, many community members had heard of their production, and listened with anticipation. Requests for copies were numerous, over 120 sixty minutes tapes used in the first week. By request, the programs were rebroadcast three more times throughout 1994. The programs focused on the elders' messages with very little editing. There words, in the way of Warm Springs, were received with much more enthusiasm than if an outsider had said the same words, or delivered the same message in a slick "Hollywood" style. The importance of this program became self-evident. It established a baseline of credibility and local support. By speaking out on the topic of substance use, the elders, in many cases actual CUTLAHS (grandmothers) to many community members, has indicated this topic was worthy of discussion. The issues then became agenda items for the elders' sons and daughters, peers and friends. Many had been involved in this area, but the message from their grandmothers was that substance use in Warm Springs is important now. Three other programs featuring male elders, adults and young adults were produced and well received. The second round of focus groups produced as radio shows featured three male elders, two groups of 4th and 5th graders, one group of adults, and students in the Warm Springs Alternative Education program continued to give community members a voice from different perspectives. Adults stated the youth need to quit substance use. The youth stated there is nothing to do and noted "do as I say, not as I do" adult role models. This strength of dialogue directly translates into credibility, which enhances community involvement and ownership. Individual community members carry authority that outsiders cannot. These programs provide a forum for this dialogue. The last program in this round featuring the AE youth took considerable effort. At first, students were excited they would produce and direct their own show, with only the topic limiting their creativity. In addition, they would receive high school credit for their effort. Upon return Monday morning, many voiced a reluctance to participate. Others refused outright. Later it was learned that after spending time with friends and family over the weekend, each had come to the conclusion that to speak out on substance use was to speak out against the actions of those close to them. Three months later, the idea was again approached, this time with the students in near complete control. The idea worked, and the program addressed the issues in ways adults couldn't, reaching other teens in the community. Speaking out in public is not a general tendency in Warm Springs. Basso (1970) and Braithwaite (1981) note the importance of silence in Native American conversations. This general tendency towards silence and reluctance to public exposure was observed at first among Warm Springs Tribal members. One way this was addressed was through consistency. The Warm Springs elders have a luncheon at the Senior Center every Tuesday and Thursday. The staff attended one day a week for three months before they were asked to announce who they were and what they hoped to accomplish. Patience is an important part of community mobilization in Warm Springs. After some time, the two elder sisters and their peer agreed to speak out, and with their action, encouraged others. LONGHOUSE MEETINGS, PUBLIC DISCOURSE Meetings held at each Tribal Longhouse brought community members together around the central topic. Radio programs properly timed served to publicize the meetings, and attendance was high. Public service announcements on the radio and announcements in the paper and at meetings contributed to the publicity. The Longhouse is a structure in each Tribal district where members gather to discuss community issues and hold spiritual services. After dinner, individuals rose to speak out on what they perceived as the risks of substance use and ways to reduce it. Individuals spoke one at a time, not interrupting the speaker. One Tribal member rose and spoke of how little she knew of her own culture and how difficult it was to pass her heritage on to her children. She spoke of a sincere desire to learn and pass on the traditional value system. This disclosure than lead to elders discussing ways to bring people together of all ages to learn, in formats such as culture camps where participants learn to make drums, for example, while listening to the old stories. General themes from each district were similar, and members of each district were curious of discussions at the other Longhouses. Records were kept and served to generate further discussions. PRINT PRODUCTIONS One example of community mobilization involves the Warm Springs Healthy Nations art and writing contest. Student were asked to portray their idea of what is "healthy" through pictures, words, or both. Students entered their submissions and awards were made publicly. Local elders were then asked to write "healthy phrases" in their native languages (Sahaptin, Wasco, and Paiute). This joint effort combined to make beautiful poster featuring local youths' creative talents, traditional native language and cultural references, and was well accepted by the community. The posters were quickly gone, as supply was clearly exceeded by demand. What it represented was local ownership of an action, a public statement of the importance of reducing substance use in Warm Springs. Another example is the monthly Healthy Nations newsletter. An initial survey of supervisors and employees within the Tribal structure indicated many departments had tried to produce newsletters, but the quickly grew cumbersome as more and more members wanted their articles published. To address this need, the HN newsletter was designed as a two-side, single page production, much like early "penny papers." The first editions introduced issues and staff, with black and white pictures of the local Council on Alcohol and Drug members. This profile of local leader was well received. One person was shown holding open one of her handmade quilts. Recognition and respect contributed to the notoriety. Soon community individuals were contributing articles and poems. To meet the response and maintain the production format, more than one issue was put produced each month. The time invested in recognition of local leaders facilitated the acceptance of the medium and message. This newsletter, with incorporation of positive local coverage and anonymous interpersonal reports as spark topics, is a practical example of the mirror stage in the Freirian approach. SUMMARY Gathering the information gained through listening, dialogue and action, clear community goals came into focus. These goals were announced across the established communication channels along with an indication of possible funding, and community groups, already in dialogue, formed to address these needs. Volunteer parents groups formed to address what could be done after school for the youth. A community member presented the idea of a community garden to be raised in the center campus of Warm Springs to illustrate the growth in the community. Local youth proposed weekend and evening activities involving sports at little cost, including midnight basketball and family nights on weekends. Elders proposed programs to reintroduce community members, particularly youth, to cultural and traditional practices, their meaning and importance, and assist in teaching the native languages by holding a culture day camp and periodic workshops throughout the year. Thirty-three groups, representing over 110 people, presented ideas on how to reduce substance use, with only four requesting staffing dollars. The outcome of this two year process has been community leaders, parents, and individuals taking ownership of the issue. At the outset of this process, programs were more institutional than community-based. After almost two years, groups of community members who found they had similar concerns and interest are starting the process of mobilizing the community. Two people and an idea became over a hundred with a mission. Out of a total population of 3,252, the percentage of those involved belies the significance. The Warm Springs Healthy Nations staff learned the importance of local peer leaders from different age groups, the importance of consistency, the same general theme carried across multiple channels, and the importance of patience and timing. In order to reach members of a group, one must learn and show respect and recognition for customs and traditions. Only then can members recognize similarities in common concerns and goals, and begin to form lasting partnerships, one by one, for the future. According to Annie Lea Shuster, Robert Wood Johnson Foundation senior program officer, "The idea behind Healthy Nations is to build a value system and a positive self-image that doesn't support a life of substance abuse. The goal is for recipients to garner community-wide support in confronting the issues and healing the wounds (Advances, RWJF Newsletter, summer 1994)." Each of the fifteen communities was given the instruction to set their own goals and decide how best the job could be done. In Warm Springs, the value system and positive self-images are in place and only need to be publicly reaffirmed. Thirty-three groups may appear to be a small group after two years, but their impact through involvement will impact relatives and friends across the Reservation. Listening to each other, discussing the issues and planning for the future, and owning local actions to reduce substance use has been a positive way for Warm Springs to achieve community goals. ACKNOWLEDGEMENTS This article was a direct outgrowth of the Robert Wood Johnson Foundation's HEALTHY NATIONS program, directed by faculty at the University of Colorado Health Sciences Center. Warm Springs Healthy Nations is in its second year of the nationwide project, which concludes in December 1999. This community process was aided by the research of Dr. Philip May, Director of the Center on Alcoholism, Substance Abuse, and Addictions (CASAA) at the University of New Mexico. WORKS CITED Berger, C.R., and Chaffee, S. H. (1987). HANDBOOK OF COMMUNICATION SCIENCE. Sage Publications: Newbury Park Basso, K. A. (1970). To Give up on Words: Silence in Western Apache Culture, In (1990) D. Carbaugh (Ed). CULTURAL COMMUNICATION AND INTERCULTURAL CONTACT. Hillsdale, NJ: Laurence Erlbaum Braithwaite, C. 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