Published August 24, 2026

Anne Helene Skinstad, emerita clinical professor of community and behavioral health in the University of Iowa College of Public Health, has dedicated her career to helping people with substance use and mental health disorders.

A trained clinical psychologist, Skinstad is a national expert on behavioral health in Tribal communities, where drug overdose and suicide rates are among the highest in the nation. Her work has reached more than 300 of the 570-plus federally recognized American Indian and Alaska Native (AIAN) Tribes across the United States, helping communities identify and implement solutions that work for them.

“In my department, community-based participatory programming is something we do and research. It’s the gold standard of community work,” she said. “In the Native community, it’s the only way to do it. We often refer to it as tribally driven, community-based participatory programs.”

Early in her career, Skinstad opened Norway’s first inpatient treatment center for women with co-occurring substance use and mental health disorders and their children. After moving to the United States, she worked in addiction treatment and recovery programs in Iowa, joined the University of Iowa faculty, and developed a successful master’s program to train therapists.

Turning to Tribal health and safety

In 1998, Skinstad’s work took a new direction. A federal grant officer encouraged her to expand her efforts through the Substance Abuse and Mental Health Services Administration’s Addiction Technology Transfer Center network.

“I asked them, ‘What should we do here?’” Skinstad recalled of a discussion with her advisory council. “They said, ‘South and North Dakota have some of the most poverty-stricken Native communities in the country. We want you to focus on workforce development in Native communities.’ So from 1998 until today, this has been my major focus.”

For 14 years, Skinstad has directed the Native Center for Behavioral Health at the College of Public Health. Before the center was established, she worked with Tribal communities all over the upper Midwest.  The training and research center develops programs that support the behavioral health workforce in Tribal communities nationwide.

During the COVID-19 pandemic, she organized online listening sessions with Tribal members and leaders, reaching more than 11,000 Indigenous people. Participants identified challenges and community-driven approaches to address health concerns and maintain access to mental health services.

More recently, Skinstad has focused on adverse childhood experiences and trauma among Native children and families. Her team is collecting data to better understand the experiences of American Indian children living on reservations, in urban Indian communities, and elsewhere.

“We have worked on some horrific suicide epidemics in Tribal communities, and these situations rarely make the news,” she said. “These communities share generational trauma.”

Cultural adaptations of Motivational Interviewing training

Skinstad has worked with the state of Oregon to provide Motivational Interviewing (MI) training for Native providers and communities. Through a Native lead trainer, the program has been adapted to reflect Indigenous teaching methods and cultural perspectives.

MI uses open-ended questions to help people strengthen their motivation and commitment to change rather than using persuasion or confrontation.

“We asked, ‘How do we train in a way that includes Indigenous pedagogical methods?’” she said.

Skinstad recommends the following practices when working with Tribal communities:

• Design training materials that reflect Native cultures.
• Help participants connect concepts to their own Tribal communities.
• Allow additional time for discussion.
• Consider the unique culture and traditions of each Tribe.
• Adapt terminology when appropriate. For example, use “talking circles” instead of “group therapy.”
• Invite an Elder to open meetings with a blessing or words of wisdom.
• Learn about a Tribe’s history, current priorities, and culture before working in the community.
• Build relationships and wait for an invitation to engage, recognizing that trust takes time.

Behavioral health workforce development in Tribal communities

Early in her workforce development efforts, Skinstad noticed that Native professionals often struggled to pass certification exams required for substance use counseling. She said the process did not adequately reflect the cultural values, experiences, and traditions of Native communities.

To address this barrier, Skinstad and her team developed a support program that helped participants achieve an 88% pass rate on certification exams.

“In South Dakota, we discovered that 45% of Native people with substance use disorders were being treated in nontribal programs by providers who had little understanding of Native culture,” she said.

Skinstad and her colleagues also created training for non-Native providers working on Tribal lands using approaches compatible with Native cultures.

Although many of her research and training grants end in 2026, Skinstad hopes to continue working with the UI Injury Prevention Research Center and support colleagues interested in implementing programs in Tribal communities.

“A lot of Tribal and urban Indian communities do not want somebody to come in and do their evaluation for them,” she said.

The key, Skinstad added, is empowering communities to adapt programs and training to their own cultures and priorities.

Some resources

Addressing violence and injury prevention in Indian Country (UI IPRC blog post)