May 27, 1999
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A Healing Spirit Is Transmitted To The Maine Woods

Video hookups help to train health professionals

By Alvin Powell
Contributing Writer

"Kmihqitahasultipon" is the Passamaquoddy word for "we remember."

Despite centuries of war and disease that have reduced their numbers to just 3,500, the Maine-based Passamaquoddy remember their tribal language and traditions better than most New England tribes.

But they have not been untouched by the ills that affect Native Americans across the country.

As the Passamaquoddy work to re-establish certain traditions and encourage healthy lifestyles, they must also search for ways to combat high rates of unemployment, alcoholism, and substance abuse, as well as their effects on children of the tribe.

For the Passamaquoddy at Maine's Indian Township reservation, the battle is made more difficult by the fact that surrounding Washington County is one of the 10 poorest counties in the country.

Lending a hand is the Harvard Telepsychiatry Project, an innovative initiative of Harvard Medical School's Department of Psychiatry.

Working with counselors at the Indian Township Tribal Health Center, Harvard University psychologists provide weekly consultations via a long-distance videophone hookup.

The weekly sessions, which typically include two Harvard psychologists and five or six counselors at Indian Township, give the Passamaquoddy counselors a chance to get expert advice from people at the cutting edge of the mental health field.

"When I saw the health center and the dedicated staff, I fell in love with the place," said Dennis Norman, an associate professor of psychology in Harvard Medical School's Psychiatry Department, chief of psychology at Massachusetts General Hospital, and one of the two counselors who regularly consult with the Passamaquoddy. "The ability to work with a staff that is up to its eyeballs in very tough cases is very rewarding. Working with people who take the very littlest thing you say so to heart is very rewarding."

The Telepsychiatry Project's collaboration with the tribe is part of a mental health initiative called Kmihqitahasultipon, which aims to address problems on the reservation through a combination of cutting-edge mental health techniques and a reliance on Passamaquoddy cultural traditions and practices.

"We're getting the experience of one of the best universities in the world," said Marjorie Withers, clinical coordinator at the Indian Township Tribal Health Center. "We're used to getting the dregs. This is no dreg."

Addressing Centuries of Ills

Social work and psychiatry at Indian Township present an enormous challenge to mental health professionals.

Unemployment in the area around the reservation is approximately 50 percent. Rates of substance abuse, alcoholism, and violent crime on the reservation are high, leading to a life- expectancy of just 46 years, Withers said.

Complicating things are the centuries of discrimination that the Passamaquoddy have experienced. Many of the parents of today's schoolchildren had negative experiences in school, including instances of overt, hostile racism. Though they believe in education, parents find it hard to advocate for their children's needs in schools where they were once victims.

Growing up in that kind of environment can result in a variety of problems for children, ranging from hopelessness and educational problems to substance abuse, post-traumatic stress disorder, and fetal alcohol syndrome.

"The mental health needs are similar to many groups who have a long history of being on the outside," said Carol Taylor, clinical instructor in psychology in the Department of Psychiatry, who, along with Norman, provides much of the consulting to the Passamaquoddy. "That reality makes our being invited 'inside' the tribal community to offer clinical help and support even more of an honor."

The remote location makes treating these problems doubly difficult.

Sandwiched between the ocean and the Canadian border, Indian Township is a six-hour drive from Boston and, until recently, 90 miles from the nearest child psychiatrist.

"What we have is a lot of land, moose, bear, and not a lot of psychiatric services," Withers said.

Over the centuries, the Passamaquoddy have retained important parts of their tribal culture, including their language. Ceremonial rituals, such as drumming and participating in a "sweat," have also been preserved. And the high value traditionally placed on children is finding a new expression in Kmihqitahasultipon.

A group of counselors from the Tribal Health Center are using Kmihqitahasultipon to help revive tribal traditions and skills, and to promote what is right about tribal life even as they try to heal what is wrong.

"A major piece of the program is to help the community remember a healthier time," Withers said.

Though several of the counselors are fluent in Passamaquoddy, only three of the nine counselors in Kmihqitahasultipon have college degrees, creating a real need for the kind of expertise that exists at Harvard.

"We have access to the best minds in the world with respect to child behavior," said Liz Martin, director of the Tribal Health Center and a member of the tribe. "It's been very valuable. It helps develop treatment plans that can be implemented on the reservation."

Reaching Isolated Populations

Serving just these kinds of isolated populations is the reason the Telepsychiatry Project was founded in 1993 by Lee Baer, associate professor of psychology in Harvard Medical School's Department of Psychiatry and director of the Telepsychiatry Project.

The Project's goal was to experiment with communications technology to provide mental health services to underserved communities.

The Project has experimented with a variety of technologies to provide a variety of mental health services to different audiences. It has pioneered, for example, the use of a recorded, anonymous telephone service to screen callers for clinical depression. The telephone system, in which the caller uses the telephone keypad to answer recorded questions, is in use across the country today.

The consultations with the Passamaquoddy are conducted with a videophone hookup over a regular telephone line. Though there are some limitations to the technology - such as a slow, jerky picture - participants on both sides of the conversation say being able to see the other person adds a dimension of trust important in discussing sensitive and confidential mental health cases.

Both Norman and Taylor say they've been impressed with the dedication and wisdom of the mental health staff at Indian Township.

The actual sessions are conducted from the Boxford home of Taylor and Norman, who are married.

The Passamaquoddy counselors fax materials about cases they want to discuss ahead of time, so Taylor and Norman can review them before the session.

Taylor and Norman do not actually counsel Passamaquoddy youth because of unresolved legal questions raised by the technology, such as which state the counselors should be licensed in, Maine or Massachusetts. In addition to providing advice on individual cases, the consultations are also intended to foster clinical expertise among tribal counselors.

The counselors at Indian Township are able to see Taylor and Norman on a television-size screen, but Norman and Taylor are limited to a 6-inch-by-6-inch screen on their unit.

Both sides agree that the video hookup works because they also meet face to face every three months, either on the reservation or at a site somewhere between Indian Township and Boston.

"Once you've established a relationship, it's a very powerful tool," Norman said. "We can see when you talk to someone about cases, you get a visceral reaction by seeing their expression, which is important feedback in consultation."

A Rejected Grant and Free Service

The relationship with the Passamaquoddy was established three years ago. Baer initially applied for a federal grant to set up a high- quality videoconferencing hookup to work with children from the Passamaquoddy and Penobscot tribes in eastern Maine.

That grant was rejected but Baer agreed to work with the Passamaquoddy for free via a lower-quality videoconferencing setup. After a year, the videoconferencing was funded as part of a grant the tribe received for the Kmihqitahasultipon project, which includes a wide range of diagnostic, outpatient, and home-based services to Passamaquoddy youth.

"[Baer] came up with a team of people. It was one of those things as close to love at first sight as it can get," Withers said.


Copyright 1999 President and Fellows of Harvard College