Glossary

Adverse Childhood Experiences (ACEs) ²⁹: ACEs refer to specific negative events in childhood that research has shown affect development and continue to influence health into adulthood. Examples include experiencing physical or emotional abuse, growing up in a household where there was substance abuse or mental illness, and experiencing emotional or physical neglect.
Alaska Native Corporations (ANCs): Alaska Native Corporations are any regional, village, urban, or group corporations organized under the laws of the State of Alaska in accordance with the Alaska Native Claims Settlement Act, as amended (43 U.S.C 1601, et seq.).
Consultations: Consultation is a legal obligation based on the government-to-government relationship between tribes and the U.S. federal government, requiring federal and state governments to consult with tribes about any policy having an impact on them.
Cultural Resilience ³⁰: Cultural resilience is related to resilience (the combination of the personal attributes and external factors allowing a person to endure, adapt to, and recover from stress or adversity). Factors might include an individual’s thoughts, social networks, and available resources. Cultural resilience expands the concept of resilience to include the importance of cultural factors in an individual and community’s ability to endure, adapt to, and recover from adversity. Examples of factors that contribute to tribal cultural resilience include spirituality, a focus on family unity, and traditions.
Dear Tribal Leader Letters: The Dear Tribal Leader Letter is a way of notifying tribes of a Critical Event that may affect a specific tribe. The letter serves as an official notification of the need for consultation with the affected tribe or tribes, but is not the consultation itself.
Federal Recognition: Federal recognition means that the United States government via the Bureau of Indian Affairs recognizes a government-to-government relationship with the tribes, making them eligible to receive services and funding.
Government-to-Government Relationship: A government-to-government relationship recognizes that tribal governments, as sovereign nations with the right of self-governance, are administratively equivalent to the U.S. federal government. In practice, all policy decisions affecting a tribe must be negotiated and coordinated with a tribal government by the federal government through formal processes, like consultations.
Federally Qualified Health Center: A federally-funded community-based health care provider that offers clinical services in underserved areas.; A government-to-government relationship recognizes that tribal governments, as sovereign nations with the right of self-governance, are administratively equivalent to the U.S. federal government. In practice, all policy decisions affecting a tribe must be negotiated and coordinated with a tribal government by the federal government through formal processes, like consultations.
Historical Trauma ³¹: Historical trauma refers to a complex and collective trauma experienced over time and across generations by a group of people who share an identity, affiliation, or circumstance. It is a theory used across multiple disciplines to explain how a large-scale, historical traumatic event, such as war or mass displacement, continues to have powerful negative health effects on the children and grandchildren of those who experienced the trauma.
Indian Health Service (IHS): Indian Health Service (IHS) is a federal agency within the Department of Health and Human Services that is responsible for upholding the U.S. government’s trust responsibility to provide health care to American Indians and Alaska Natives. IHS operates clinics and other facilities to provide direct patient care, advocates for the health of AI/ANs within the federal government, and provides funding to tribal health services managed by tribes, including Urban Indian Health Programs.
Indian Self-Determination and Education Assistance Act of 1975: The Indian Self-Determination and Education Assistance Act (ISDEAA) are legal reforms from 1975 that created a system of contracts and compacts allowing tribes to exercise their right to administer programs and services—and control the associated funds—previously under federal control.
Protective Factors: Protective factors are assests, resources, or conditions associated with resilience that make it less likely for individuals to experience negative outcomes when exposed to risk or trauma. Protective factors for some native communities include family cohesiveness, a focus on spirituality, and a connection with elders.
Non-Federal Recognition: Non-federal recognition means that tribes have no government-to-government relationship with the federal government. Without federal recognition, tribes miss out on certain protections, are not afforded the right to self-government, and are ineligible for services and programs outlined in the trust responsibility. Federal recognition is independent of state recognition. A non-federally recognized tribe can be recognized by a state government.

Historically, federal recognition has been conferred upon tribes through treaties, federal court decisions, and other actions by the federal government. ³² However, in 1978 the federal acknowledgment process was created to allow tribes to petition for recognition. Despite this process being created, few tribes have been able to meet the seven criteria, which can be incredibly time consuming and costly to reach. ³³
Northwest Region: In this toolkit, the northwest region is defined as Alaska, Idaho, Oregon, and Washington.
Self-Determination: Self-determination is the right of a group of people to choose their own form of government. Within the context of tribal nations, self-determination historically has referred to the rights defined by the Indian Self-Determination and Education Assistance Act of 1975. These include the rights of federally recognized tribes to contract for the administration of programs, activities, and services previously controlled by the federal government, such as health care and housing services. Today, the discussion of self-determination continues to evolve and expand to include the rights of all tribes to control their own data and resources. For tribal communities, self-determination expands far beyond the administration of services. It is a “reclaiming [of] their unique cultural knowledge systems for the health of future generations.” ⁴⁸
Social-Ecological Model: Theoretical models that visually represent how an individual’s health is influenced by larger social systems and environments. For example, the CDC uses a four level model that looks at how individuals are influenced by their own history and biology, their personal relationships and peers, their community, and broad societal factors, such as the economy, laws, educational systems etc.
Sovereign Immunity: Sovereign immunity protects federally-recognized tribes, state governments, the federal government, and, to an extent, employees of all three entities from lawsuits ³⁴. One of the primary purposes of tribal sovereign immunity is to protect tribal property and self-governance. ³⁵ Only tribes and Congress have the ability to waive or limit tribal sovereign immunity.
Sovereignty: Sovereignty is the right of a governing body, in this case Indian nations, to autonomously govern; protect; and enhance the health, safety, and welfare of its citizens within its jurisdiction.
State Recognition ³⁶: State recognition means that a state government, usually through legislative action, has formally recognized a tribe. It is a powerful tool that can help facilitate state and tribal collaboration by creating a formalized relationship and processes. State recognition guarantees no funding from the state or the federal government and is unrelated to a tribe’s federal recognition status. There are currently 16 states that recognize Indian tribes.
Trauma-Informed Approaches: Trauma-informed approach is an organizational level strategy focusing on creating a sense of safety by considering individuals’ personal and community history. It includes educating staff on the trauma, integrating this knowledge in to the organization’s policies and culture, and actively seeking to avoid re-traumatizing clients, staff, and others.
Tribal Health Services: Tribal Health Services are any health care programs managed by tribes with funding from IHS.
Tribal Health Organizations (THOs): Tribal Health Organizations (THOs) manage health care facilities throughout Alaska. THOs provide medical services, but also provide health and wellness programs, sanitation services, and environmental health programs.
Trust Responsibility: Federal trust responsibility is the legal obligation of the U.S. government to protect tribal self-governance, treaty rights, lands, assets, and resources, as well as to provide the certain mandated services, such as health care.
Urban Indian Health Programs: Urban Indian Health Programs provide outpatient services for AI/AN people living in urban areas. These programs are operated by nonprofit organizations receiving funding from Indian Health Service, along with funding from other sources such as Medicaid and Medicare reimbursements, private insurance reimbursements, and private foundations.