From (Harvard Kennedy School Project on Indigenous Governance and Development)

The Yukon Kuskokwim Health Corporation established the Calricaraq program as its behavioral health prevention service in 2011. Calricaraq is a Yup’ik word that conveys the idea of living a balanced life through adherence to a set of ancestral principles. The program’s foundational idea is that traditional knowledge can guide individuals and communities as they deal with trauma and seek healing. The Calricaraq Elder’s Council, consisting of more than 40 elders from throughout the delta region, provides leadership and advice on the program’s activities. Service provision begins when a tribe’s leaders formally invite behavioral health prevention staff to visit a village and share Calricaraq. Staff members work with village elders and other community leaders to facilitate awareness of ancestral knowledge. This outreach prepares the ground for the flagship Calricaraq activity, a three-day community gathering that follows a set format. The first day explores the concept of historical trauma, the second day is devoted to discussing hurtful behavior and abuse, and the third day offers Yup’ik teachings about the path to wellness and healthy living. Individuals with a “heavy heart” or a “heavy mind” are encouraged to speak openly about their suffering and accept that others are present to give unconditional love and support. In accordance with Yup’ik teachings, individuals are reminded that every person has a contribution to make to the community at each stage of his or her life. In the words of one staff member, “Calricaraq assures Alaska Natives that their value is in who they are, not what they have.” In addition to three-day gatherings, the Calricaraq program offers a range of community services on an as-needed basis. These include tribal council orientations, talking circles, skillbuilding workshops, healing ceremonies, school presentations, and crisis intervention. The program also offers “train the trainers” workshops that teach community members to facilitate Calricaraq within their own villages. Working with the Elders’ Council, behavioral health prevention employees have developed two curriculum manuals to guide community activities. Community members use these tools to lead talking circles and workshops with their elders and to adapt Calricaraq activities for use in local schools, churches, health clinics, and tribal child welfare and justice programs. 

Calricaraq has dramatically changed the Yukon Kuskokwim Health Corporation’s approach to behavioral health. Although western-based providers and treatments are still available, the Calricaraq program has become the health organization’s most requested intervention service. In the Calricaraq program’s first four years, staff members were invited to over 30 communities, and they hosted 10-15 community gatherings annually. Because of the high demand for services, the department has grown rapidly, from three to fifteen fulltime staff members. Three communities have requested their own village-based Calricaraq provider. Most important, Calricaraq teachings have helped numerous individuals and communities turn their lives around by finding balance and wellbeing in Yup’ik teachings. As one program participant put it, Calricaraq helped him live “the good ways our elders taught us, living life to the fullest. Beginning with me first. Working on myself first. Healing myself from the past.” A PHILOSOPHY FOR HEALING 

Through its Calricaraq program, the Yukon Kuskokwim Health Corporation has taken a stand on the importance of incorporating ancient knowledge in medical care for Alaska Natives. Yet because it is a holistic reintroduction of the Yup’ik philosophy of life, it is difficult to assess the impact of the Calricaraq program in the narrow, evidence-based terms of Western medicine. Even so, during its short existence, the program appears to have achieved significantly better outcomes than other piecemeal medical interventions. One program staff member notes, “We have seen people stop drinking, substance abusing, and abusing others almost instantly after gatherings. Some take more time to internalize what they learn, but many participants equate Calricaraq to a life changing experience because it changes the way people see their world.” The teachings reconnect participants to their Native identity in order to counter the harms caused by the imposition of non-Yup’ik worldviews. Calricaraq aims to address the unhealthy behavior passed on through the generations by treating its underlying causes, including the loss of Yup’ik culture, language, identity, spirituality, parenting skills, autonomy, and self-control. Through the stories that are shared in gatherings, talking circles, and workshops, individuals learn where they came from, who they are, and the values that will guide them to a long and healthy life. Another reason Calricaraq has a powerful effect on behavior is because it is community-driven.

The Yukon Kuskokwin Health Corporation provides programming only if a tribe makes a formal request and is actively engaged in the process. Each village adapts Calricaraq to its own traditions, and its elders serve as facilitators and teachers. In the words of a program staff member, “The Calricaraq program teaches our people that their elders are their experts, and these elders and other knowledgeable tribal leaders have the solutions to their tribe’s issues, all within their community.” In all of its activities, Calricaraq respects tribal sovereignty while building community capacity and confidence to address pressing social problems with local resources and local knowledge. Guidance comes from the ancient wisdom transmitted by village elders, so tribes control their own healing rather than depending on federal or state programs. In three villages, this focus also is reflected in innovative staffing arrangements, in which tribes supervise community-based Calricaraq providers, but the Yukon Kuskokwim Health Corporation pays their salaries. 

Finally, Calricaraq is distinctive because it addresses mental and behavioral issues by involving the entire village. Rather than treating an individual’s symptoms one-on-one, in isolation with a provider, Calricaraq ensures that healing takes place in a group. A visiting medical professional has little knowledge of the relationships in the community, and writing a prescription does little to restore balance. The Calricaraq program reestablishes the leadership role of elders, families, and the community in supporting individuals as they go through challenging times. In the village of Alakanuk, for example, several troubled teens were acting out and destroying property. A Calricaraq talking circle brought them together with their parents, police, elders, and community leaders. As a result, rather than being sent away for treatment, the youth were more deeply integrated into tribal life and ceased their harmful behavior. Calricaraq continuously emphasizes the message that each tribal citizen has a specific and valuable contribution to make to the community. This encourages individuals to take care of themselves so they can live in harmony with others. Participants are becoming better sons, daughters, fathers, mothers – and better tribal citizens. 

The Calricaraq program of the Yukon Kuskokwim Health Corporation is restoring the health of individuals and communities through traditional teachings. By reinforcing culturally appropriate ways of being, Calricaraq successfully provides preventative care where non-Indigenous approaches have failed. The journey to overcome generations of historical trauma is challenging and long, but the revival of traditional lifeways in the Yukon Kuskokwim delta region brings new optimism.  Find out more by contacting YKHC.