Project Stories The Strong People

Opioids Escalate Battle to Keep Native Children in Tribes

By Heena Srivastava

SEQUIM, Wash. – Indian child welfare caseworker Tanya Pankowski spends 30 minutes driving home along Washington’s Highway 101, crossing the Dungeness River and weaving through the mountains of Olympic National Park. Before she reaches her six dogs and cats and the stroganoff her husband often prepares for dinner, she tries to clear her mind of the work she left behind.

Pankowski’s days are unpredictable.

She scrambles to help working parents find money for childcare. She visits schools to make sure troubled children are behaving. She launches investigations for children who are reported to be hungry, abused or in homes with no heat. On her worst days, she’s forced to take them away.

The younger ones, she said, have trouble understanding why they have to go.

“Little children love their parents no matter what,” Pankowski said. “It’s really traumatic on the children. ‘No, you can’t see mom.’”

American Indian children are four times more likely to be placed in foster care than their white counterparts, according to the National Indian Child Welfare Association. Caseworkers such as Pankowski say the nation’s opioid epidemic has escalated the crisis.

Pankowski, who has spent 15 years working for the Jamestown S’Klallam tribe in northwest Washington, estimates that 95 percent of her child welfare cases are now opioid-related.

“It’s not too often that we have children come into the system because of physical abuse. It’s more because of neglect,” she said. “It’s a really long process for some parents to be able to get healthy. And so children stay in care longer than what we would like.”

In 2015, 41 in 100,000 American Indians in Washington died of drug overdoses, compared to a rate of 15 for whites, according to the Centers for Disease Control and Prevention. The epidemic has taken a toll on child welfare workers, parents and children.

Tribal leaders said they fear children removed from homes will be sent to nonnative communities, diminishing the tribal population. In 1978, Congress passed the Indian Child Welfare Act to ensure that displaced Native American children were placed within native communities. At the time, as many as 35 percent of all native children were being removed from their homes. The vast majority were placed outside of tribes.

The 41-year-old law is now being challenged in court by a Texas couple who successfully adopted a child with Cherokee and Navajo ties and are looking to adopt his sister. The adoption was contested by the Navajo Nation. In a widely watched lawsuit, Chad and Jennifer Brackeen, two other non-native couples and the states of Texas, Louisiana, and Indiana are challenging the constitutionality of the law.

In 2018, a federal judge in Texas backed the parents. This past August, a three-judge panel on the Fifth Circuit Court of Appeals overturned the ruling and granted a rehearing, which has not yet taken place.

In the state of Washington, officials are acting to ensure American Indian children stay in their communities.

Though caseloads are high, Pankowski said, only about 5 percent of Jamestown S’Klallam children are placed in foster care with non-native families. She said state Child Protective Services quickly determines whether a tribe should be notified about a displaced child.

“Is there any native ancestry?” Pankowski said. “Find out right away, so that process can start right away.”

Washington State’s Department of Children, Youth & Families also hosts case reviews every three months to make sure tribes are complying with the law.

“They pull up three cases to go over to see if everything was done properly, if there are any red flags or areas that need to be addressed,” said Michelle Claplanhoo, a caseworker with the Makah Tribe, 100 miles west of Jamestown S’Klallam. “If we are not getting reports or we are not getting what we need from the state, that is where we address it.”

Some tribal members have voluntarily placed their children outside the community.

Across the Puget Sound from Jamestown S’Klallam, Rita Boome-Revey has struggled for years to kick an addiction to opioids. She said her youngest daughter was placed with a non-native family. Though they stay connected through Facebook, Boome-Revey said they rarely see each other.

“It was one of the hardest things I did, but I did it so she could have a better life,” she said.

A member of the Upper Skagit tribe, Boome-Revey lives in an addiction recovery house in Swinomish nation. On a recent afternoon, she prepared to attend a funeral for her 41-year-old niece, who overdosed on opioids. She left behind three children.

Panskowski said she is all too familiar with the devastation. Day after day, she said she pushes aside her personal connections to local families to focus on the children.

“In tribal cultures,” she said, “our children are our future.”

Project Stories The Strong People

‘Coming Home to Themselves’: Native American Nations Turn to Tradition to Treat Addiction

By Mia Mamone, Jonah Dylan and Alena Prcela

June O’Brien isn’t too worried about ghosts. She said she believes that counselors working to treat drug and alcohol dependency at the Northwest Indian Treatment Center in western Washington see tribal ancestors standing behind patients.

That’s fine by her. The center sits on two and a half acres of ancestral land in rural Elma, Washington, where members of several Pacific Northwest tribes would once gather in the summer. Here, in this remote town of 3,000 about 40 miles east of the Pacific Ocean, spirituality is just as important as mainstream medicine.

Across the country, hard-hit indigenous communities are turning to tradition to battle the growing threat of substance abuse.

From Washington to Wisconsin and beyond, tribes are using cultural activities and nature-based medicines — some dating back thousands of years — to reach and treat members struggling with addiction.

Experts say many tribal members have traditionally distrusted Western medicine and that an integrated, holistic approach to drug treatment and recovery is crucial.

“Treatment of special populations has to reflect the identity of that population,” said O’Brien, the director of the treatment center run by the Squaxin Island Tribe, whose members for generations have lived along the seven southernmost inlets of Puget Sound. “We say that they are coming home to themselves.”

In Phoenix, the Patina Wellness Center has integrated talking circles and sweat lodges with more mainstream drug treatment The center is one of 18 sites run by the nonprofit Native American Connections.

“We believe that these traditional ways are what provide us with the guidance to understand our place in nature, in the family, to understand ourselves as individuals,” said cultural counselor Dwight Francisco. “Our goal is to reconnect them to those value systems that will help them to heal.”

The focus on tradition and culture is so integral in Arizona that the state’s Inter Tribal Council, which represents 21 tribes, has urged state officials to use Medicaid funding to reimburse hospitals and clinics that employee traditional healers as regular workers or consultants.

“I’ve seen firsthand how traditional healing alleviates the stress of the situation,” said Alida Montiel, health and human services director of the Inter Tribal Council of Arizona. “Hopefully, it helps you find out the root of the illness, helps you with the next step.”

At addiction-focused ceremonies in South Dakota, Native American Church members gather from dusk to dawn to call on spirit helpers and to commune with peyote, a small cactus with psychoactive properties used by tribal members for thousands of years. Peyote, which grows in southern Texas and northern Mexico, can minimize withdrawal symptoms, tribal members say.

Though peyote is classified as a Schedule 1 drug, the American Indian Religious Freedom Act Amendments of 1994 allows Native Americans to use the cactus for religious purposes.

“The peyote way of life is a healing way of life,” said Sandor Iron Rope, an Oglala Sioux Lakota from the Pine Ridge Reservation and the president of the Native American Church of South Dakota.

A poster highlights traditional foods and medicines at the Didgwalic Wellness Center, an opioid treatment center in Anacortes, Wash., run by the Swinomish Nation. Counselors say Native American culture and tradition are essential to the healing process for patients recovering from addiction. (Syd Stone/MEDILL)

Peyote is more commonly used to treat alcohol addiction and other ailments. In Michigan, Native Americans are fighting the opioid epidemic with other natural medicine.

Fawn YoungBear-Tibbetts, a White Earth Ojibwe traditional practitioner, uses sage to help ease the symptoms of opioid withdrawal, including nausea.

In western Washington, the Squaxin Island Tribe, known as “The People of the Water,” used federal money to open its widely touted, 28-bed treatment center in 1994.

The tribe has long combined mainstream medicine with cedar-weaving, drumming and beading. Residents have access to an on-site sweat lodge for purification ceremonies and a healing garden with traditional medicine and food, such as nettles, violets and dandelion leaves.

O’Brien, the director of the center, said the oppression shouldered by generations of Indian people created cycles of poverty, trauma and substance abuse. Traditional healing, she said, is an integral part of the recovery process.

“Everything here is cultural,” she said.

Dying Alone Project Stories

In nation’s hard-hit nursing homes, COVID-19 tests are in short supply

By Dan Rosenzweig-Ziff and Alexa Mikhail

In early April, as the coronavirus spread among America’s nursing homes, Cissy Sanders received the phone call she had been dreading.

Riverside Nursing and Rehabilitation Center in Austin, Texas, where her 70-year-old mother lived, was reporting three positive cases among residents, she recalled. The 51-year-old event planner sprang into action.

She called the nursing home. She called the state’s long-term care ombudsman and the Texas nursing home hotline. She called her city council representative, then her state representative, then the Austin Public Health Department.

During each call, Sanders said she pleaded for covid-19 testing, arguing it was the only way to prevent the continued spread of a virus that was devastating nursing homes in the U.S., killing thousands of elderly residents. Time and again, she said she was turned away.

“Sorry, you don’t get the luxury of throwing up your hands,” she recalled saying at the time. “The only way you’re going to win is if you test, test, test.”

Months into the coronavirus pandemic, nursing home leaders say testing supplies and support are still in short supply, undermining facilities across the country as they struggle to contain the virus.

In a letter to Congress in late May, LeadingAge, which represents more than 6,000 long term care providers, called for funding for test kits, as well as additional personnel to administer the tests. Both staff members and residents need repeated testing rather than single tests that provide a “snapshot in time,” the organization wrote.

“Federal leadership and funding are especially needed to cover baseline and weekly testing of all residents and staff in nursing homes,” Katie Smith Sloan, LeadingAge’s president, said in the letter. “It is irresponsible of federal leaders to tell nursing home providers to ‘talk to your governor’ to supply and pay for testing.”

Testing nearly 3 million nursing home residents and staff would cost $439 million, according to the American Health Care Association and National Center for Assisted Living, which represents more than 14,000 long-term care facilities. The group has pressed the federal government for $10 billion in emergency relief for more testing and staffing help.

“Without testing, it is virtually impossible for us to know who in our facility, whether they are residents or staff, are COVID-positive,” Mark Parkinson, president of the group, said in late April.

Early on during the pandemic, some nursing homes reached out to local hospitals and to state health departments for tests. Providers also turned to private labs.

Randy Bury, chief executive officer of the South Dakota-based nonprofit Evangelical Lutheran Good Samaritan Society, said he discovered the tests cost as much as $80 each. The nonprofit, which operates 269 long-term care facilities in 24 states, has been able to prioritize testing for facilities that have had difficulty securing testing kits from states, he said.

“There’s many people including the elderly, that are asymptomatic, and you’re not going to know unless you test,” Bury said.

In New Mexico and West Virginia, the governors provided tests for all nursing home residents and staff. Other states, including Colorado and Massachusetts, have enlisted the National Guard. New Jersey partnered with local universities to test nursing home residents; Maryland bought 500,000 tests from South Korea.

But too many nursing homes, Parkinson said, have been largely left to fend for themselves. Recent reports show the nationwide death toll in nursing homes has surpassed 30,000.

An official at Riverside, where Sanders’ mother has lived for four years, said testing was completed in April. The tests were provided by Austin health authorities and by a private provider.

Sanders said her mother tested negative on April 21. Sanders said she now wants to focus on homes in the rest of the country. She has applied to become a member of a newly formed national nursing home advisory board, where she would help set covid-19 policies.

“I want the public to know that the nation is failing our nursing home residents,” Sanders said.  “Who are the test kits being saved for if the most high-risk nursing home population can’t get them?”