Isaacson_542 Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 265 Native Elder and Youth Perspectives on Mental Well-Being, the Value of the Horse, and Navigating Two Worlds Mary J Isaacson, PhD, RN, CHPN 1 Rebecca C Bott-Knutson, PhD 2 Mary Beth Fishback 3 Angela Varnum 4 Shelly Brandenburger 5 1 Assistant Professor, College of Nursing, South Dakota State University, mary.isaacson@sdstate.edu 2 Van D. and Barbara B. Fishback Honors College Dean and Associate Professor, Department of Animal Science, South Dakota State University, rebecca.bott@sdstate.edu 3 Masters of Public Health Program Coordinator, South Dakota State University, mary.fishback@sdstate.edu 4 DVM Student, Colorado State University, agebhart@rams.colostate.edu 5 Associate Professor, Division of Health and Natural Science, Presentation College, shelly.brandenburger@presentation.edu Abstract Purpose: Native American youth experience significant challenges to mental well-being. As part of a larger study to evaluate hope and resilience in a Plains tribal population, the purpose of this study was to learn from Native American elders and youths what they feel is needed to for youth to grow up healthy on the reservation, and to identify connections between horse use and mental well-being. Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 266 Sample: Six Native American elders and eight Native American youths from the same Plains tribe. Method: The research team conducted Talking Circles with youths and elders. During the Talking Circles, participants identified community-specific questions for inclusion in a resilience measurement and provided personal stories regarding the relevance of the horse to well-being. Findings: Both groups felt cultural traditions and language, education, relationships, and interactions with horses have significant roles in enhancing identity development and resilience in youth. However, elders indicated that tribal youth seem to struggle in navigating two worlds. Elders expressed that for youth to be well, they need to return to traditional ways within the realms of culture, language, education, and relationships. On the other hand, the youths were more confident in their ability to navigate two worlds, and wished to seek opportunities to blend their traditional and contemporary lives. Conclusion: The challenges of navigating two worlds for Native Americans are experienced across generations. Both youths and elders said that resilient youth are able to successfully navigate these challenges when they: (a) know their indigenous identity, (b) participate in cultural activities, (c) have strong family ties, and (d) are able to learn in an environment where their culture is championed. We propose that future efforts must include community-based participatory methods in the development of interventions that include use of the horse to strengthen Native American youth resilience and foster health and well-being. Keywords: American Indian health, resilience, identity, mental well-being, horses Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 267 Native Elder and Youth Perspectives on Mental Well-Being, the Value of the Horse, and Navigating Two Worlds Historical trauma is the “cumulative and collective emotional and psychological injury both over the life span and across generations, resulting from a cataclysmic history of genocide” (Yellow Horse Brave Heart, 1999, p. 2). Historical trauma particularly affects Native American/American Indian (NA/AI) populations and through storytelling, the sharing of traditions, and collective memories of the population, traumatic experiences are passed from generation to generation (Sotero, 2006). The lasting effects of this intergenerational trauma among NA/AIs are linked to colonization practices, such as dissolution of traditional ceremonies, practices, and family structure, resulting in significant cultural losses. These losses have continued psychological ramifications across generations of NA/AIs (Garrett et al., 2013). For example, adults whose parents attended boarding school were shown to have higher rates of depression and suicide contemplation, being influenced by their parents' stress through disruptions in parenting behaviors as well as indirectly through disadvantages their parents suffered from being removed from their own families (Bombay, Matheson & Anisman, 2014). The negative psychological effects from historical trauma are especially persistent with NA/AI youth (Evans-Campbell, 2008; Whitbeck, Adams, Hoyt, & Chen, 2004). Not only do these youth live with historical trauma, but they may also experience original trauma through social inequality, poverty, and discrimination (Sotera, 2006). Sotera (2006) asserts that this exposure to historical and original trauma, also described as chronic trauma, can have serious negative effects on interpersonal relationships, development of life skills, and the ability to persevere in the face of challenges. NA/AI youth, ages 15-24, exhibit more than twice the rate of suicide as the national Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 268 average (Maza, 2015) and have a greater prevalence of depression, anxiety, post-traumatic stress disorder, and substance use disorders (Cunningham, O’Connor, & Asch, 2017). Moreover, youth represent the largest percentage of the NA/AI population (Garrett et al., 2013), thus there is an urgent need for culturally appropriate measurements to assess well-being and diverse interventions to improve the health of reservation communities (Gone & Trimble, 2012). Resilience Although NA/AIs experience significant mental health challenges, the persistent portrayal of Native health in a negative light can undervalue certain health strengths embedded in their cultures (Fast & Collin-Vezina, 2010). For indigenous communities, well-being is rooted in strengths such as balance, harmony, community connections, and spirituality (Rountree & Smith, 2016). All of these can lead to resilience, which is a new word for an old idea among Native elders. The concept of resilience is deeply ingrained in the history of NA/AI peoples; every indigenous language has a word that means resilience (HeavyRunner & Marshall, 2003). Resilience has been described as having internal strength and valor (Brokenleg, 2012). It can be also be defined as “the capacity to face challenges and to become somehow more capable despite adverse experiences” (LaFramboise, Hoyt, Oliver, & Whitbeck, 2006, p. 194). Resilience has also been described as a trait that can reduce the impact of negative stress in people's lives, moving people toward a more neutral (less negative) state (Van Dick, Ketturat, Hausser & Majzisch, 2017). Simultaneously, Van Dick and colleagues (2017) describe strong identity as something that moves people beyond neutral to a more positive state. Combined, resilience and identity development can have positive effects on health outcomes and both may be necessary in developing programming which aims to improve mental health of NA/AI youth and decrease rates of depression and suicide. Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 269 Identity Resilience is one of many factors influencing identity development in NA/AI youth. These factors differ between communities and are grounded in shared cultural traditions (Horse, 2005). Horse (2005) asserted that crucial to NA/AI identity development is the level of grounding in one’s culture. Garret et al. (2013) suggested that participation in ceremonies may create a sense of belonging and identity. Additionally, a child’s identity development is enhanced through learning his/her Native language, as language influences the way a child perceives his/her world and his/her connections within that world (Garrett et al., 2013). A particular challenge of identity development for Native youth is the concept referred to as ‘walking in two worlds.’ Lumbee tribal member Andrew Bentley (2015) describes this as trying to maintain one’s physical, mental, emotional, and spiritual well-being while maintaining a level of assimilation with the mainstream culture. Navigating in two worlds has been described as bicultural efficacy, the ability to navigate the world successfully in the mainstream culture while simultaneously maintaining one’s cultural identity (Okagaki, Helling & Bingham, 2009). For Native youth living in more remote reservation communities, exposure to ‘mainstream culture’ is less. Thus, when they leave the reservation and experience the dominant culture, a crisis of identity is likely (Houghton, 2014; Skousen, n.d.; Wong, 2017). This crisis of identity may be lessened in those whose ethnic identity is strong. For example, a study conducted with Mexican-American and NA youth concluded that “ethnic identity development may increase resilience to discrimination and prejudice which are often common and stressful for ethnic minority adolescents” (Romero, Edwards, Fryberg & Orduna, 2014, p. 1). Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 270 The Horse and Well-Being NA/AI youths’ development of ethnic identity is enhanced when they engage in traditional cultural practices. These cultural practices may also improve mental health, especially given the communal aspect of Native cultures (Smokowski, Evans, Cotter, & Webber, 2014). One such practice, deeply rooted in the NA/AI community highlighted in this study, is working with the horse. Because of the horse’s historical and present-day connections to many NA/AI peoples, it can enhance identity development and thus may have positive health outcomes for Native youth. Horses historically played a large role in family life, medicine, war, and survival for the Plains tribes during the eighteenth and nineteenth centuries (Horse Capture & Her Many Horses, 2006), and they continue to be used for recreation and work on reservations. Although there are no published quantitative studies of the horse’s effects on NA/AI youth wellness, case reports and descriptive studies among this population have documented positive results. For example, equine- assisted learning has been employed for substance misuse education and gang prevention in First Nations youth (Adams et al., 2015; Dell, 2011; Whitbeck, n.d.). Organized rides among Great Plains tribes also emphasize cultural values (Whitbeck, Walls, & Welch, 2012). The beneficial effects of horse-human interaction have been quantified in cultures other than NA/AI and can be experienced physically, emotionally, and socially (All, Loving, & Crane, 1999; Klontz, Bivens, Leinart, & Klontz, 2007; Pendry, Smith, & Roeter, 2014; Wilkie, Germain, & Theule, 2016), suggesting equine activities can positively influence mental health. Given the role of historical trauma in Native health outcomes, traditional cultural values combined with resilience and strong identity development may have potential positive effects on NA/AI youth well-being. The purpose of this two-part study was to learn from both Native elders Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 271 and youths what these groups feel is needed for youth to grow up healthy on the reservation, and to identify the connections between horse use and mental well-being. Methods Design This article reports the qualitative findings from a larger multi-method study conducted to evaluate the psychometric properties of the Herth Hope Index [HHI] (Phillips-Salimi, Haase, Kintner, Monahan, & Azzouz, 2007) and the Child and Youth Resilience Measure, Child Version [CYRM-28] (Liebenberg, Ungar, & Van de Vijver, 2012) in a Plains NA/AI adolescent population. Protocol for administration of the CYRM-28 recommends the inclusion of site-specific questions, generated from focus groups with community members (Resilience Research Centre, 2016). Following the advised protocol for the CYRM-28, the transdisciplinary research team invited NA/AI elders and adolescents to participate in two separate Talking Circles (i.e., focus groups). Talking Circles provide a culturally sensitive platform for NA/AIs to openly share their concerns regarding the topic area (Lowe & Wimbish-Cirilo, 2016). The transdisciplinary research team included three doctoral-prepared individuals: (a) registered nurse, (b) registered dietician, and (c) an equine scientist, along with two masters- prepared public health individuals: (d) physician’s assistant/mental health professional and (e) doctor of veterinary medicine student. Two of the team members have worked with this NA/AI population specific to the health of horses. Two other team members have experience with this population in the arena of childhood obesity and risk behaviors. One team member’s area of expertise is mental health. Two of the team members are skilled qualitative researchers and provided leadership and guidance throughout analysis of the narratives. Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 272 Participants and Setting In June, 2016, six Native elders and eight Native youths from the same tribe participated in separate Talking Circles. Following Krueger and Casey’s (2000) guidelines, the inclusion criteria for this study and the youth Talking Circle was: a group of eight NA/AI between the ages of 14- 18 years, tribal membership, and past/present experience with horses. Inclusion criteria for the elder Talking Circle was: a group of eight NA/AI elders, tribal membership, and past/present experience with horses. Elders were purposefully recruited through a researcher’s previously established affiliation with the director of the reservation’s Foster Grandparent program. Purposeful recruitment of youth occurred through two researchers’ contacts with members of the reservation’s horse community. Both groups identified site-specific questions for the CYRM-28 and explored Native adolescents’ relationships with horses. In addition, youth were to be between the ages of 13 to 18 years. Elder Talking Circle participants included two male and four female elders. Youth Talking Circle participants were between the ages of 13 to 17 years and included seven female participants and one male. The Talking Circles were held in a centrally-located college center on a reservation in the Northern Plains. This reservation is in a rural region as defined by the Economic Research Service (n.d.). Procedure and Data Collection After obtaining written elder and parent/guardian consent and youth assent, the Talking Circles began with introductions of the research team and the participants. Following introductions, the research team provided the participants with copies of the interview questions (Table 1), the HHI, and the CYRM-28. Each Talking Circle began with the first question noted in Table 1. Key comments from the participants and the site-specific questions were annotated on a white board, allowing everyone the opportunity to review in real time. Each Talking Circle Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 273 lasted approximately two hours and was digitally recorded. During the Talking Circles, each researcher kept separate notes, which were then combined after the discussions. The digital recordings were then transcribed verbatim by a qualified transcriptionist. One researcher listened to the recordings while reviewing the written transcriptions, correcting them as needed for accuracy. Table 1 Talking Circle Questions 1.) What is needed for youth to grow up well here? 2.) What does it mean to be healthy? 3.) What are challenges faced by youth? 4.) How is the horse important to your community? 5.) Describe the role of the horse in your life. Ethical Considerations The research team obtained approval from the University Institutional Review Board (IRB- 1508004-EXP) and the Tribal Research Review Board (102). All participants, including parents/guardians, were informed that their participation was voluntary and that they could withdraw from the Talking Circle at any time. To maintain confidentiality, participants are not named, but referred to as “youth” or “elder”. The participants provided general demographic information to the research team. After each Talking Circle concluded, each participant received a $25 gift card and shared a nutritious meal with the research team. All participant data was Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 274 maintained in a locked file, with narrative data stored and shared per a secure university-based online storage system. Data Analysis Using Braun and Clarke’s (2006) method of thematic analysis, each team member independently reviewed the transcripts by reading and rereading the narratives before their initial gathering to discuss the results. During the first meeting, members described their impressions of potential themes. Each team member then independently coded the narratives based on these initial themes. Later, the team met again and revisited the initial themes alongside each member’s coding. Secondary independent coding then ensued, with team members identifying key participant quotes. To solidify the emergent themes, each team member developed and shared a thematic map. Further discussion occurred, resulting in the selection of the overarching theme and supporting themes. Throughout the analysis, team members openly debated themes and discrepancies until reaching consensus. Rigor The research team addressed rigor, dependability, and trustworthiness by their willingness to share, discuss, refute, and revise their interpretations of the narrative data (Roberts, Priest, & Traynor, 2006). The details provided on the study’s design, process, participants, and setting allow the potential for transferability. Credibility of the study is noted, as the team diligently reviewed the youth and elder transcripts separately and as a whole, assessing for differences and commonalities (Thomas & Magilvy, 2011). Confirmability is present, as throughout the process the research team addressed individual preconceived notions and biases (Thomas & Magilvy, 2011). Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 275 Results The elder and youth narratives resonated with differing perspectives of navigating two worlds: the world of traditional Native values and modern white culture. Elders felt that this constant balancing act was the main cause of many destructive behaviors prevalent on the reservation. One elder portrayed the two-world phenomenon as a great chasm, where on one side he thought in his traditional ways and on the other, he was forced to think like a white man. The youths’ descriptions of the two worlds were less negative. They shared how they must be futuristic in their thinking and adapt to the white world, while maintaining connections to their cultural roots. They expressed confidence in who they were; however, they noted that many reservation youths lack this confidence and cope in negative ways. In order for adolescents to successfully navigate between these two worlds, it is essential for them to develop their identity, which became the over-arching theme. Impacting and shaping their identities are their cultural traditions and language, relationships, and education. Interwoven among all of these themes is the influence of the horse, whose historical and cultural significance is deeply embedded in this tribal community. Culture Elder and youth participant narratives underscored the importance of staying connected to language and cultural traditions. Yet the elders and youths described their language and cultural traditions in subtly different ways. The elders emphasized the need for language proficiency and asserted that youth should be able to speak the language. Youths said that while they wished to be fluent in the language, they had limited opportunities to attain fluency. In addition, the elders expressed an urgency about maintaining their cultural traditions, while the youths reported that they struggled to find ways to do so. Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 276 A Need to Speak the Language For this Native tribe, culture is intertwined with language and ceremonies, and is demonstrated in the continued use of the language and participation in these ceremonies. Each of the participating elders was a fluent speaker and expressed frustration with the lack of traditional speakers within the tribal government and educational systems. One elder shared his experience as a child learning to speak his native language and his concerns regarding the survival of the language in Native youth: When we grew up, we didn’t speak Wasicu [white man], we all spoke [our Native language], and it was common. When you are speaking [the Native language], you have the tendency to have a good memory…it’s inherent in your mind, you just pull it out. Today, one of the differences with our children is they go to school, and they have a hard time. They’re not dumb, they’re not naïve, but because of the historical grief and trauma caused by genocide, it’s painful to recall memory. This participant expressed great frustration with the loss of language. He earnestly pleaded that members of the Tribal Council should all speak the language. Furthermore, he added that knowing the language and the culture should be requirements for youth before they are given special honors: This is horrible, it’s bad, it’s ugly, it’s sad, it’s never going to go away unless leaders like the Tribal Council, they all start speaking [the Native language]. There’s other ways… have a pow-wow, have a princess contest. Before that little girl applies for princess she has to speak [the Native language] and know her culture. Before you are a leader you should be a [Native language] speaker. Another participant shared these concerns. She recalled working with children as a foster grandparent and noticing their lack of engagement with the culture and the language: Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 277 …mostly I observed and watched the children, you know. They really fascinate me, and a lot of them do not care. They don’t care to learn the language, and I always ask them, But why? Youth Want to Speak the Language Dialogue with the youths identified a desire to learn the traditional language, but limited occasions to do so. Many of them attend the local parochial school, where the Native language is taught and opportunities to participate in the inipi (sweat) ceremony exist. One youth participant stated: …our [Native] language. We’re losing it, and we’re not really speaking it. I barely even know how to speak it…I guess we were supposed to be taught in school, but I guess some of us weren’t paying attention as much as we were supposed to be. It was [emphasized], but it wasn’t as much as what was needed. The youths also stated that knowing their traditional language was vital. If youth cannot speak the language, even in prayer, then they will lose the ability to communicate with the spirits. One youth explained this: The spirits, and without that, because they don’t understand English, and so like when we were taught, we were taught to pray in [our language], and so I’m sure all of us at least know some [traditional] prayers. Another youth said that the generalities of the language are taught at school but not sufficiently reinforced at home. This participant shared that there are no fluent speakers in her family: Outside of prayer, the most I’ve ever heard anyone, like anyone my age speak was an introduction…[for example, what’s your] name, where you were born, where you live, where you’re from, just things like that…It’s about that big (indicates by making a small space Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 278 between her thumb and index finger), and that’s about all I’ve ever heard someone my age say [in our language], and that’s taught so, I mean, we didn’t come in like that, come in to school knowing how to say that stuff. It was taught [at school, not at home]. The youths acknowledged the importance of their traditional language, especially to speak to the spirits, or to those who have passed on. This connection to the spirit world through the traditional language may be one way of reconnecting the youth with their cultural lifeways. A Need to Maintain the Cultural Traditions As a way of returning to their cultural traditions, honoring their ancestors, and providing a process for healing, one of the elder participant’s family members initiated an annual remembrance horseback ride in the 1980s, memorializing those lost in a historic tragedy. Pre-reservation, this NA/AI culture practiced seven sacred ceremonies. He indicated that in 1985 this had decreased to three. He recalled: The Sun Dance has always been popular, and they call it the sweat lodge, [the] Inipi, and the hunka. Those are the only three rituals [that were practiced], and they forgot about the grieving ceremony, the social give-away, the throwing of the ball…[does not name seventh]. Nobody knew the songs [that went with the ceremonies], nobody knew how the ritual went, how the procedures go, so in 1986 we started vision quest, [traditional] speakers, how do we bring that hunka, how do we bring…when you make a relative…so today, all the ceremonies are just being done any way. Another elder learned how to cook in the traditional way from her family, “I learned to make wasna.” Yet another recalled that her mother’s family was very traditional; they practiced the ceremonies. According to these elder participants, the rituals were taught from grandparents and Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 279 parents to the children. They express concern that this art has been lost or is being less vigilantly maintained. An elder also lamented the lack of understanding demonstrated by his tribe today with respect to the appropriate timing of the ceremonies. He expressed frustration that members of his tribe do not know the origins of the rituals and why they are practiced: We try to bring the tiospaye back. A lot of why our ceremonies that we’re practicing today, a lot of the rituals or even pow-wows, they don’t mean nothing because it’s not the tiospaye doing it. It’s just a bunch of people come together, and they put something on, it happens and goes. But when a tiospaye does it, it has meaning. Although there are concerns about the loss of understanding on the purpose of the rituals, the elders described their efforts to re-instill the importance of tiospaye and ceremonies into youths’ lives. One elder described how she works with new mothers: I talk to the new mothers about what I know about star knowledge and…who they are, you know…We started with the ceremonies…and so we became stronger spiritually as a family in our little expanding tiospaye. Adding to this, an elder related how important it was to listen to his grandparents tell stories at night. He described how the stories reverberated into his soul and became a part of him, “Listening to stories in the evening before bed, you go to sleep hearing them and when you wake up in the morning it feels like you can still hear them.” The Struggle to Maintain Cultural Traditions The youths seemed to recognize that in their minds they needed to look ahead and away from the reservation to be successful in today’s world. Yet, in their hearts, they felt the importance of knowing the language and the traditional ways. One youth’s family carries out many of the Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 280 traditions through continuation of the language and attending the Sun Dance. She expressed how much she enjoys going with her family to the Sun Dance: …being able to go out to the Sun Dance every year and sweat and, you know, it gives us something to look forward to. Like us guys, all our older relatives are dancers, so like when we get older we’re most likely going to be dancers too. I just think that traditional ways are a big key to staying positive on the reservation. She was concerned about her peers on the reservation who might not have the strong family connections to their traditional culture that she so freely experiences. She worries that this loss creates many of the issues present on the reservation: I think like someone without the culture would maybe feel a little like lost, because like we were disconnected to all the [traditional] way of life, you know, not so long ago. And then without it there they would feel lost. And I think that’s why like there’s a lot of bad things going on on the reservation now because they don’t know their traditions, and they don’t know how to pray in [traditional language]. This youth was adamant that knowing the traditions is essential. Another youth agreed, saying that going to “sweat” helps mentally. She voiced concern with the parochial school’s emphasis on church attendance and not on participation in sweats: At school, we go to church at least once a month, and sweat is offered. You don’t have to go, it’s offered - like every two months, so I think that’s a big inequality or something, but they focus on the like Christian views more than they do the [tribal] views…[mass is] required…Yep, and they don’t make such a big deal out of it [sweat]. It’s like you have to go to mass, you have [to] be there, you can’t chew gum. There’s so many rules, and like, ‘Oh, if you want to go to sweat, go ahead.’ Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 281 Both youths and elders expressed the value of knowing the language and participating in traditional practices. The elders emphasized the loss of the language and traditions because of forced assimilation practices. They expressed an urgent need to re-establish the tiospaye as a foundation, helping youth to reconnect with who they are. The youths said that learning the Native language and having the opportunity to participate in the traditional ceremonies were essential in shaping their identity. However, language acquisition as well as occasions to attend traditional ceremonies were limited. One youth willingly shared that her family has no fluent speakers; learning the language is only obtained through the school system. The remaining seven youths identified fluent speakers in the home, although none were fluent speakers themselves. For these youth, knowing their cultural traditions, including the language, are important for nurturing their physical and mental well-being and strengthening their resilience. Relationships Integral to Native cultures are family/kinship ties. These relationships, whether nuclear or extended, have over the centuries instilled the importance of cultural heritage, traditions, and language in youth. For the elder participants, family disruption occurred when they were forced to attend boarding schools, forever changing the traditional familial roles. Elders and Tiospaye Each elder introduced himself or herself based on his/her role within their family: grandma, grandpa, brother, sister, mother. This demonstrates that a significant component of the elders’ identity is their role within the family: Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 282 I’m a grandpa and a great-grandpa now. I’m just proud of my great-grandpa status. I’m only 65 years old, but I have to take on the role as an old elderly now in my tiospaye as I’m the eldest male… Elders learned about their culture and way of life through observing and modeling their own grandparents’ behaviors and stories. The close relationship between elders (as children) and their grandparents may have risen out of a need for connection to the traditional ways of life. Close relationships with grandparents could offer youth a way for seeking experience with, and understanding of, their roots and identity. One elder said: I grew up without parents, but my grandmother, my grandparents are always there. That’s how I learned [Native language], and I learned how to do mostly everything, what my grandma taught me…My other set on my mother’s side, they were the traditional, and they had ceremony and, you know, did all the traditional things. So I kind of grew up that way. The elders stressed the importance of family, indicating that they feel it has changed over time. Today’s elders were removed from their homes as children, disconnecting them from their parent and grandparent role models. This ultimately changed the way they interacted with their children and grandchildren. The elders expressed strong concern about the generational loss of culture and tradition, specifically regret for not having passed traditions to their children. They credit the destructive behaviors of their children to this failure, voicing a strong sense of responsibility for now passing knowledge onto their grandchildren: Eventually I began to understand that the switch in culture, the rules and stuff, that happens, and the men were lost. The women started doing the work that the men used to do, start working and earning money, and the men really had no place or anything, you know, that their old roles were gone…We were boarding school parents, we lost our parenting skills. Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 283 Additionally, the traditional tiospaye suffers in the government-designed reservation housing communities, where neighbors are often not members of the same extended family. The elders voiced concern about the youth not fully understanding or receiving the benefits of tiospaye. They feel family structure has deteriorated and created confusion among youth: We still all live together, and we encourage each other in our ways, and it is difficult for some of our young children that they live in the two worlds, and oftentimes they don’t know the world I knew growing up, and so it’s difficult for them to see and understand, so we’re working hard with them. I try to extend it to other children. Youth and Tiospaye Both elders and youths perceive trans-generational transfer of information as a way of learning. Youths articulated the importance of learning the traditions from their elders and expressed that in the future, they intend to disseminate the stories and traditions to their own children, “Like I said, it’s important to learn the stories they tell you…And maybe someday you’ll pass it along to your child.” Another youth shared, I think it’s really important to be connected to the family because my grandparents were raised like in the old ways, you know… keep to yourselves, worry about your family, things like that. But I think it should extend to like the community and things like that. While the youths understood the need to learn from family members, specifically their grandparents, they also voiced the importance of relying on outside support. They acknowledged that family may not always be available to learn from or family may not be a positive influence. In these circumstances, identifying someone or something else to connect with is a way for them to learn about themselves and their culture: Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 284 …sometimes your family is a bad place, and you find like someone to look up to outside your family, like it could be someone famous. It could be a storybook character. It could be anyone. It don’t necessarily have to be your family… but for some people that’s all they have. The youths said that an important part of growing up healthy and happy on the reservation includes having solid role models: people who are reliable, trustworthy, and whom they wish to emulate. The youths discussed the importance of being encouraged by others and how this encouragement helps them to overcome life’s challenges. They were unanimous in their responses regarding what they need to grow up well on the reservation, with the following comment capturing the group’s sentiments: I think probably like just a good support system like, you know, loved ones there for them and just good role models they can look up to…role models like, you know, maybe it’s an uncle or an older cousin, or maybe it’s like, you know, your teacher. The elders fear that the current reservation-based housing system is a detriment to the maintenance and thriving of the tiospaye. The youths are adapting the traditional concepts of tiospaye by building relationships and seeking support more inclusively. Both relationships and culture are key components of identity development and both groups expressed the value of having connections with others from their community. Although not explicitly stated by elders or youths, family relationships and the concept of tiospaye were implicated in the wellness of tribal youths. Relationships provide a connection within community as well as an avenue through which to develop identity, both are important concepts for supporting healthy perspectives and self-image. Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 285 Teaching and Learning The youth and elder participants portrayed formal education on the reservation and its association with boarding schools, abuse, and disruption of family and cultural ways differently. The elders emphasized the feeling of being torn by the educational system and they assumed that this is a painful division in the youth as well. One elder remembered: As I became more educated, though, I felt like I was missing something, and I remember being away to college in [another state], and I was coming home on a break. I came over that hill by [home] and I stopped, and for some reason I stopped and I just cried. I was so glad to be home, you know. Although elders were supportive of teaching and learning (several had teaching certifications and a wealth of formal and informal teaching experiences), most remained reserved toward public education. The elders shared stories of the physical and emotional pain experienced while attending boarding school. “Educators” delivered physical pain in the form of hitting, slapping with a ruler, and ear-pulling: We were in boarding school. I went to boarding school until high school, but they were so mean when I was there. They used to, if you were speaking your language, they would say, ‘Put out your hands,’ and then they would get a ruler and just really beat our hands. But I never cried. I could feel the tears coming, but I never cried. I was just - I just refused to give in. I’m still stubborn like that. While anger and pain were evident in some of the elders’ stories related to education, there remained an underlying agreement about the importance of education for youth. Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 286 We have to find a good leader to bring us all together and really work with the school systems and try to turn it around for our children, because they do need that education in order to survive in the future. Youths recognized a very similar feeling of being torn between a traditional life on the reservation and a new life provided by education elsewhere. Some recounted missing home while away at school in another state, but then looking forward to being back at school when returning home to the reservation during breaks. One individual, who during the school year lives and studies at an out-of-state high school, said, “We have our ties here. Twenty years down the road this will always be our home. This is where our ancestors were.” It seemed to be commonly accepted by these youths, however, that truly reaching out and striving for one’s fullest potential involved leaving the reservation: Yes, because it’s hard to believe, but there are a lot of people that think they have to stay here forever. Like they have to go to high school here, probably go to [the tribal college] and then work at IHS [Indian Health Services] or something like that. There are not a lot of people that think, ‘I can go to Harvard and Princeton and Penn State.’ Living far from the reservation for education was commonly recognized by the youth participants as very challenging, “I mean, to even go to high school off the rez, that takes like a lot because for some people the rez is all they’ve known, so it takes all they have to leave.” Although elders experienced historical abuses by the educational system against their collective cultural identity, both elders and youths spoke of the importance of receiving an education. Youths seemed to understand the gains inherent in attending school, even if it takes them away from the reservation and their cultural groundings. They sensed that the ability to navigate the educational system, like navigating a world apart from their own culture, would be a Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 287 source of well-being. The opportunity to receive a higher education brings both challenges and tools for youths to shape their identities. Horse Interwoven within the themes of culture, family, and education was the importance of the horse as teacher, friend, and cultural guide. These participants described how the horse traditionally impacted their ancestors’ way of life. Horse culture was extremely important to Plains Indians. The elders revealed the necessity to pass along culture, language, and tradition through their stories, and recognized the horse as a partner in teaching the youth important and basic values. Parallels existed between the perceptions of education and the perceptions of the horse by youths and elders. The elders emphasized the horse’s role as a teacher, not unlike the role that grandparents and community elders also have in educating children. One elder stated, “That horse will teach them, teach them to listen if they need to learn respect, self-esteem, and also self-control, you know. An animal teaches you a lot.” The horse’s physical and symbolic presence directs the youth back to traditional ways, which for many elders was the role that they felt education should play in youth’s lives. Besides living and interacting with the horse, learning the story of the horse may also help individuals to feel more connected with their cultures and glean strength. An elder shared: Because we have to also teach that the genocide committed against us, the same genocide story can be shared with the buffalo, with the bear, with the elk, with the deer, the genocide towards the horses. We share the same story. We are no different from the bear. We are no different from the grass. Elders saw the value of the horse as pointing youth back toward traditional ways, and even suggested a wider inclusion of the horse into the educational curriculum. Additionally, the horse Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 288 provides opportunities, such as on family rides and horseback events, to engage in the larger tiospaye, especially with the loss of the traditional family structure. While the youths did not voice distress over this loss, they did express deep appreciation for instances which bring extended family together, specifically via the horse. The youth participants tended to think of the horse, like education, as a means of looking forwards, not backwards. Just as multiple participants discussed being excited for opportunities to leave the reservation for education, several mentioned that the horse is important to them because they look forward to activities they can do on horseback to release stress. These activities include riding alone, riding with family, and participating in rodeos. A simple trail ride offers an opportunity to engage extended families in a common purpose. One youth said: Yeah, my uncle does quite a few trail rides, and it just like feels good to see everyone come and, you know, all my nieces and nephews or even like, you know, friends and family just happy, getting their horse, getting ready. It just brings joy to my heart to see that. While these youth participants identified a strong connection to the horse, they indicated that not all reservation adolescents feel similarly. One participant stated that many of her classmates felt that riding a horse provided a less “cool” alternative to unhealthy habits such as drugs and parties. This participant thought that many youths would perhaps change their views if they had the chance to develop and nurture relationships with horses: …it’s kind of like it’s not cool, or, do you know what I mean? Like they’d rather be out drugging and partying and stuff like that…and horses are for hicks and country people. It’s things like that. If they could ride a horse, they would change, I think. Horses are credited by youths as having healthy, healing powers. Interactions between these adolescents and horses provides a therapeutic release that may or may not be accessible through Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 289 family relationships. As one youth shared, “The horse, it like, it helps you like, if you’re feeling bad you go ride, and it’ll like help you. He has that power to do that, you know, [know] how you’re feeling.” For the youths, the horse was touted as a companion they could look forward to spending time with and a way to take care of themselves. Youth seek affirmation and solace from family and friends. When those venues are not available to them, they combat isolation by seeking role models and companionship in other aspects of their lives. Therefore, the horse is considered a friend and a helper by them. One youth described, “Just like a human friend would, they help you get things.” The horse also transcends friendship and becomes family in the eyes of these youths. Perhaps this is a modern anthropomorphic construct of youth living partially in white culture; although, it certainly could be viewed as an example of youth leaning quite literally on their native concept of Mitakuye Oyasin. One youth described the role of the horse in her life today, “My friend, brother. Horses are pretty important in my life.” The youths’ ability to demonstrate resilience by looking ahead and gaining new strengths from the world around them was reflected in their visions of the horse, representative of their ability to navigate in two worlds. The elders’ perceptions of the horse were largely situated around helping youth to choose to walk in the traditional world of their tribe. Both elders and youths recognized the value of staying connected to their culture through language, traditions, ceremonies, and even the horse. However, for the youths it seemed that in their hearts they knew traditional ways were important, but that in their heads they knew they also needed to look ahead for success in the world. Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 290 Discussion These candid narratives shared by Native elders and youths provide a view into the landscape of challenges experienced by NA/AIs in contemporary society. On the surface, there appeared to be a disconnect in opinion between the youths and the elders regarding the need to learn to navigate in two worlds. However, a deeper exploration of the narratives revealed only subtle differences in how to reintroduce and reinforce the traditional way of thinking into youth’s lives. Both the youths and the elders agree that each area is essential for improving mental well-being for Native children today. Because the power of the horse was a recurring theme throughout the focus groups, we discuss potential ways this animal can assist NA/AI youths in navigating two worlds. Our participants stressed the importance of knowing and participating in traditional cultural activities, including language proficiency, as ways of decreasing adolescent risk behaviors. Pu and colleagues’ (2013) study of NA/AI adolescents and violence concluded that adolescent interest in tribal lifeways was positively associated with decreased tendencies toward violence. A review of the literature (Henson, Sabo, Trujillo, & Teufel-Shone, 2017) regarding protective factors and NA/AI adolescent health, characterized connection to traditional culture as a multi-level protective factor. This cultural connectedness included language acquisition and participation in cultural activities. Further, six studies found that adolescents who were more engaged with their culture had greater resilience, improved school success, and fewer behavioral delinquencies (Henson et al., 2017). NA/AI youth participation in cultural activities has also demonstrated enhanced ethnic identity when compared to those not participating in these activities (Schweigman, Soto, Wright, & Unger, 2011). Brown, Dickerson, and D’Amico’s (2016) study with urban NA/AI adults and adolescents found that youth feel disconnected from their cultures and have limited opportunities to discover their cultural roots. Adults in that study also expressed concerns for the youth related Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 291 to this disconnect and felt that if youth could rediscover their cultural identities there would be fewer delinquent behaviors (Brown et al., 2016). Participants in this study characterized family relationships as an important aspect of living and thriving. For elders, the concept of tiospaye came to life as they learned about culture and the world from their own grandparents, and, in turn, sought to pass on their knowledge to their grandchildren. Youth participants in the present study echoed the importance of tiospaye and suggested that they too, would one day pass along important information to their grandchildren. It is common practice in this community for grandparents to raise their grandchildren, or community grandchildren, in order to mitigate risks or negative circumstances, despite having little financial means to do so (Dennis & Brewer, 2016). In some cases, elders become the preservers and teachers of culture, traditions, and societal roles, guiding grandchildren and expanding upon school curriculum (Kincheloe & Bull, 1982). Henson and colleagues (2017) also identified the importance of family connectedness as a protective factor for NA/AI youth well-being. The role of elders as conveyors of cultural information demonstrates the importance of teaching and learning to NA/AI cultures. However, some youths felt torn between a life on the reservation, surrounded by their families and traditional culture, and pursuing their educational dreams. The educational system often does not support NA/AI values such as being part of a clan, generosity, and collaboration (Deyhle & Swisher, 1997; López, Schram & Vasquez, 2013). Thus, NA/AI students may feel pressured to sacrifice traditional values while attending high school or striving for a higher education. Perceived discrimination against one’s traditions can significantly impact resilience in a negative way (LaFramboise et al., 2006). Conversely, engagement with one’s culture can promote resilience for indigenous individuals (LaFramboise et al., 2006) and cultivating an ethnic identity can shape minority individuals’ optimism, self-esteem, and mental Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 292 health (Smokowski et al., 2014). Thus, educational institutions must not only accept, but cultivate, cultural knowledge and viewpoints, or risk performing a grave disservice to their students. There is also compelling evidence for the role the horse plays in helping to live well and to shape identity. Horses can help youths become comfortable and confident within themselves. This is accomplished through an activity that means something to them—an activity which can help them to forge their identity and relationships. Perhaps out of necessity, due to the loss of traditional structure, or perhaps as a normal path in adolescent development, youth seek relationships and affirmation outside of the family structure. The horse offers such relationship and affirmation. Communication with the horse is predicated upon a common unspoken language (Brandt, 2004). They rely on sensing and intuiting; or as one youth in the present study stated, “horses can sense the way you feel.” Participants shared that horses served at times as opportunities to connect with families, and at others, they served as an opportunity to retreat with a sensing partner. Horses have been implicated in cultural healing through the connection of Native people to their roots in “indigenous wellness paradigms” (White Plume, 2016, para.3). Youths provided evidence of the horse providing retreat, strength, and healing within their lives. Limitations There are limitations to this study. The purposeful recruitment of the participants through previous contacts resulted in some having a familial relationship, i.e., two elders were married and some of the youths were cousins. These familial ties could have resulted in “like” thinking; however, the youths were quick to respectfully disagree with one another and offer their own opinion versus agreeing with the group. In addition, the purpose of the Talking Circles was to form context specific questions to include with the CYRM-28. Thus, the team did not conduct additional youth or elder Talking Circles in order to achieve theoretical saturation (Krueger & Casey, 2000). Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 293 A final limitation is that the elder participants offered opinions regarding the importance of the horse to youth well-being; youths were specifically asked about their relationships with horses and were recruited from horse related contacts. Implications for Future Work Our study and recent literature demonstrate the value for NA/AI youth of knowing and participating in cultural activities. However, for tribal youth, these opportunities may be limited due to a lack of cultural engagement within their family. Both youth and elder participants highlighted transgenerational relationships as crucial to the survival of a generation as well as a culture. Youths, however, expressed a need to expand their community of support, even including those outside the traditional tiospaye, in order to live well. Traditional NA/AI education views learning as integrated across all activities, not as a compartmentalized part of a child’s life (López et al., 2013). Incorporating elders and community activities into a child’s learning has been shown to improve learning outcomes for NA/AI students when done with culturally congruent instruction (Aronson & Laughter, 2016; Oakes & Maday, 2009). Educational and cultural experiences, both within and outside of the classroom, should serve to guide NA/AI youth who navigate two worlds, not increase the width of the chasm between the two. Finally, we recommend the horse as a potential catalyst to reaffirm important relationships and the tiospaye, while reconnecting youth with their cultures, and ultimately elevating wellness in NA/AI youths. The affinity of our youth participants for horses may be an intuitive attempt to preserve Native identities while navigating present-day mainstream white culture. Additionally, the horse can be an aid in the educational process. Within the classroom, the horse offers a unique opportunity to integrate teachings of culture, relationships, and science, technology, engineering, and math fields. At home, the horse may create transgenerational bonds and connections. In Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 294 partnership with the horse, NA/AI youth can build upon the foundations of relationship, education, and culture needed to live well while navigating two worlds. Further work is necessary to identify ways to incorporate the horse as a partner in the creation of guided, family-centric cultural activities, where families which are uncomfortable about and unfamiliar with cultural traditions feel welcome to attend and reengage. Conclusion The current study was developed as a holistic, multifaceted approach to understanding what it takes for NA/AI adolescents to be well. Our transdisciplinary approach acknowledges that wellness is complex. The participants in our study revealed meaningful connections among culture, families and tiospaye, and teaching and learning in strengthening their identity. Interwoven throughout these themes, is the value of the horse, which has the potential to impact the youth’s ability to successfully navigate two worlds. The challenges of navigating two worlds for NA/AIs are experienced across generations. In our study, both youths and elders said that resilient youth are able to successfully navigate these challenges when they: (a) know their indigenous identity, (b) participate in cultural activities, (c) have strong family ties, and (d) are able to learn in an environment where their culture is championed (Dennis & Brewer, 2016; Henson et al., 2017; Lundberg, 2014; Schweigman et al., 2011). Absent in the literature is the value of the horse toward promoting the aforementioned themes. To address this gap and bridge the two worlds, we propose that future efforts must include community-based participatory methods in the development of interventions that include use of the horse to strengthen NA/AI youth resilience and foster health and well-being. Acknowledgements Online Journal of Rural Nursing and Health Care, 18(2) http://dx.doi.org/10.14574/ojrnhc.v18i2.542 295 The authors wish to thank our participants for their candor and willingness to share their personal thoughts. We are also grateful for the guidance of the Tribal Research Review Board. Special thanks to Dr. Charles Woodard for critical review of the manuscript. Funding This work was supported by the South Dakota State University Scholarly Excellence Fund and the Rocky Mountain Public Health Training Center Public Health Student Stipend. References Adams, C., Arratoon, C., Boucher, J., Cartier, G., Chalmers, D., Dell, C. A., . . . Wuttunee, M. (2015). 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