In rural and frontier Alaska, the root network of our entire health services system is a collective of local paraprofessionals. In fact, relatively few Alaska Natives have credentialed or degree-level positions. Yet a new entry-level career ladder program aims to attract and prepare residents for the behavioral healthcare workforce. Thanks to a grant from the Jobs to Careers initiative, our project allows frontline workers to enter the educational pathway while living and working in their home communities. Jobs to Careers is an initiative of the Robert Wood Johnson Foundation in collaboration with the Hitachi Foundation and the U.S. Department of Labor, and our partners in the project include the Norton Sound Health Corporation, Annapolis Coalition on the Behavioral Health Workforce, and Western Interstate Commission for Higher Education.
Providing behavioral healthcare services in Alaska's rural and frontier communities involves unique challenges. Small community size and insufficient resources limit the availability of even the most basic mental healthcare services for many residents. Although 60% of Alaska's 680,000 citizens live in or near the three largely urban boroughs that encompass Anchorage, Fairbanks, and Juneau, the remaining 40% (272,000) live throughout rural, frontier, or “bush” Alaska in a region nearly 2-1/2 times the size of Texas. Alaska's rural regions primarily are organized as city communities and villages, with populations ranging from 50 to 13,500 with an average of 1,600.
Access to behavioral healthcare services in Alaska is not measured in terms of how many miles someone has to drive to get help. Rather, for the majority of rural residents it is measured by how long a client or provider must fly to receive or administer services. It may be inconvenient driving 30, 50, or even 100 miles in rural America to access services, but remember that in frontier Alaska there are no roads!
In addition, much too frequently behavioral healthcare services to rural and frontier Alaskans are discontinuous due to the professional workforce's high turnover. In many regions professional providers cycle through positions every one to two years.
In response to the unique challenges of providing behavioral healthcare services in rural and frontier Alaska, the University of Alaska Fairbanks (UAF) has developed an educational pathway to “grow our own” culturally attuned workforce. Although we continue to design and provide education and training for new and emerging professionals throughout our state, one of our highest priorities is to empower local residents, particularly Alaska Natives, to be the foundation of a culturally attuned and grounded professional behavioral healthcare workforce.
While Alaskans have access to traditional education routes, many potential frontline behavioral healthcare workers find formal education unattainable. Some of the obstacles include the cost, need to work and provide for self and family, disruption of the basic and honored family unit when someone leaves, ill-preparedness for academic work (including limited success with public education), culture shock of moving from village life to urban areas, and perceived relevancy and practical application of the academic curriculum at home.
UAF's new work-based learning program fills a void in our educational pathway to building a sustainable behavioral healthcare workforce. It is much more than an on-the-job training experience. Consistent with the best practices of adult learning theory, community service learning, and experiential education, it establishes a competency-based educational model within the context of the regular workday. Work-based “learners,” as they are called, can earn college credit, earn a certificate in human services, transfer into a related degree program such as social work or psychology, demonstrate industry-recognized competency standards, and provide immediate services for their employing agencies while under the instruction and mentorship of faculty, clinical supervisors, and Alaska Native elders who, together with the other learners, form the instructional team for this learning community or cohort model.
Unique to this work-based program is the role of Alaska Native elders, who have had undeniable value in UAF's similar behavioral healthcare workforce programs. Writing about the elders' roles and influences in formal learning contexts merits a whole paper in itself, but for the purpose of this article their role can be considered as “keepers” of their culture. Elders model and assist learners from all backgrounds in the ways of their people and culture. They provide the critical eye and standards for “cultural attunement,” a term that has evolved to represent something more active or sensitive than “cultural competency.”
Cultural attunement represents the dynamic nature of understanding diversity and cultures. Whereas cultural competence historically is recognized as a set of “competencies,” it often is examined at one point in time and for specific cultural settings or applications. Cultural attunement involves ongoing and active “tuning in.” It comes from a position of “cultural humility,” but it represents active attention and ongoing mindfulness. Cultural at-tunement is the active and vigilant practice of maintaining cultural humility.