Teaching is ranked as one of the most stressful occupations in the U.S. with 46% of teachers reporting high daily stress during the school year. Teacher burnout, anxiety, depression, sleep disorders, poor performance and a high turnover rate have all been attributed to teacher stress and is estimated to cost more than $7 billion a year for our economically burdened US public education systems. Head Start is a national program designed to help break the cycle of poverty, providing preschool children of low-income families with a comprehensive program to meet their emotional, social, health, nutritional and psychological needs. It includes 34 American Indian and Alaska Native Head Start programs, which serve 44,000 children of American Indian heritage. Head Start teachers in remote Native American reservation settings are from the community, with more than twenty five percent reporting significant prior trauma exposure. With limited skills or support to cope with the stress of meeting the complex needs of the children and their families in this setting, the challenges for teachers can be immense. Reservation communities suffer more severe health disparities, often linked to the powerful effect of social determinants of health. Additionally, high rates of adverse childhood experiences (ACE), including discrimination, poverty and trauma are associated with violence, chronic disease, risk behavior and mental health outcomes. Head Start administration at Fort Peck reservation, Montana has requested that an intervention be implemented to help their teachers deal with stress and support them as they deal with children, and families struggling with poverty, severe health disparities, and mental health issues. The proposed mixed methods clinical trial research experience(CTRE) builds on the research infrastructure of ongoing NINR funded trial, Wa?Kan Ye? Zah (R01MH115840) which is a randomized controlled trial to test the effectiveness of the Wa?Kan Ye? Zah intervention with parent/child dyads enrolled in Tribal Head Start at Fort Peck. The proposed CTRE under the guidance of the applicants sponsors will focus on the Fort Peck teachers and use exploratory mixed methods to AIM 1: Explore Tribal Head Start teachers needs and expectations for a culturally appropriate intervention that promotes resilience, minimizes stress and strengthens capacity to implement Tribal Head Start program.
AIM 2 : Integrate findings from AIM 1 with Tribal Advisory Board and theater testing to co-design an adaption of the existing 4 cultural components of Wa'Kan Ye'Zah that is tailored to the needs of Tribal Head Start teachers.
AIM 3 : Examine feasibility and acceptability of prototype with sample of Tribal Head Start teachers . This study is consistent with NINR?s strategic goal of improving wellness by promoting health and preventing illness. Findings will provide the basis for future studies with the national Tribal workforce with the goal of improving the health and well-being of the entire community.

Public Health Relevance

Native American reservation communities suffer severe health disparities, high rates of adverse childhood experiences (ACE), including discrimination, poverty and trauma which are associated with violence, chronic disease, risk behavior and mental health outcomes. Head Start teachers that work on isolated Native American reservations with pre-school children are in need of culturally appropriate behavioral interventions to help support them to manage their stress and cope with the complex issues facing their students, families and communities. The purpose of this clinical trial research experience study is to adapt and test the feasibility and acceptability of the culturally appropriate behavioral intervention Wa?Kan ye zah as a model for reducing stress and promoting wellbeing in Tribal head start teachers.

National Institute of Health (NIH)
National Institute of Nursing Research (NINR)
Predoctoral Individual National Research Service Award (F31)
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National Institute of Nursing Research Initial Review Group (NRRC)
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Banks, David
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Johns Hopkins University
Schools of Nursing
United States
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