The annual suicide death rate can be 18 times higher for American Indian/Alaska Native (AI/AN) youth ages 15-19 than for all American youth. The majority of AI/AN youth never receive behavioral health care, even when showing signs of anxiety, anger, depression, or other mental distress and when actively suicidal. In our study region, such services typically are utilized exclusively during crises, and only after peers and family members have depleted their social reserves, which include the informal social networks of family and friends upon which most rely in times of distress. Previous research indicates a need for culturally-responsive professional suicide prevention practice that builds on and extends community support, particularly in rural American Indian and Alaska Native (AI/AN) communities. Our tribal working group developed PC-CARES over the last three years. With this intervention, we aim to develop a public health system that decreases suicide risk and bolsters protective factors in tribal communities. PC-CARES will enhance collaborations among Native paraprofessional and non-Native professional mental health providers, reduce stigma for mental health help-seeking, and promote earlier interactions between providers and community members to better meet the needs of Native youth. Native village counselors and non-Native clinicians will be trained to facilitate the community outreach sessions that will bring together cultural/local knowledge and clinical expertise. This approach will promote knowledge exchange and relationship-building among providers and between them and community members. The relatively closed systems of participating AN villages, coupled with our 15+ years of research partnerships with the only tribal social and health care organization in the region, offer an unprecedented opportunity to document and track village-level patterns of help-seeking and caregiving for youth, and to describe how these support systems reflect and interact with formal health and mental health services. Instead of focusing on individual-level change, we propose an innovation to strengthen, expand, and track the systems of youth support at community and institutional levels, which will reduce youth suicidal behavior.
Aim 1 : Characterize the Institutional and Community Support Systems that can be Harnessed to Prevent Youth Suicide;Identify Changes that Occur after Implementation of PC-CARES.
Aim 2 : Test the Feasibility and Preliminary Outcomes of PC-CARES, an Intervention to Help Providers and Community Members Collaborate in Preventing Suicide in Native Youth. IMPACT: There is a significant gap between mental health services and family/peer support for Native youth at risk for suicide. PC-CARES will align these resources, galvanize supporters, and offer meaningful, community-based help. This approach can be used with other underserved, rural communities. With a suicide tracking system operational in the study region since 1990, we will be able to document our intervention's effect on referral behavior in this pilot study. We will document the impact of PC-CARES on suicidal behavior in the next stage of research.
The annual suicide death rate can be 18 times higher for American Indian/Alaska Native (AI/AN) youth ages 15-19 than for all American youth, and the majority of AI/AN youth never receive behavioral health care, even when showing clear signs of mental distress and when actively suicidal. Our tribal working group developed PC-CARES, a public health intervention that decreases suicide risk and bolsters protective factors in tribal communities, which will align Native and non-Native resources, galvanize supporters, and offer meaningful, community-based help. If successful, our pilot intervention will be used in a larger study of decreased suicidal behavior in Native youth and can be employed with other underserved, rural communities.
|Wexler, Lisa; McEachern, Diane; DiFulvio, Gloria et al. (2016) Creating a Community of Practice to Prevent Suicide Through Multiple Channels: Describing the Theoretical Foundations and Structured Learning of PC CARES. Int Q Community Health Educ 36:115-22|