Suicide disproportionately affects American Indian/Alaska Native (AI/AN) communities, with the greatest burden experienced by AI/AN children and adolescents. A paucity of mental health care resources in AI/AN settings points to a critical need to deliver suicide prevention interventions outside conventional mental health clinical settings. Past research has shown cultural protective factor approaches will be more effective than risk- focused interventions to reduce AI/AN youth suicide. Culturally grounded (or ?ground up?) prevention interventions?which place local culture and values at the forefront of intervention design, implementation, and evaluation?hold strong promise to prevent AI/AN youth suicide. However, we know little about core components, mechanisms, and constructs through which culturally grounded interventions can prevent suicide. The Elders? Resilience Curriculum (ERC) is a school-based, culturally grounded, suicide prevention intervention currently delivered by White Mountain Apache Tribe (WMAT) Elders through monthly lessons about tribal cultural values, beliefs, ways of life, and Apache language to youth ages 9-14, a nascent stage prior to the highest risk period for suicide (15-24 years old) in this community. The proposed research builds upon the Johns Hopkins Center for American Indian Health and WMAT?s 35+ year research and public health partnership that continues to innovate and scale prevention interventions through community-based participatory research. The candidate will engage with the tribal-university partners to conduct an Exploratory Sequential Mixed Methods study to identify key suicide protective factors and ERC core components that target these factors, refine a theoretical model specifying causal mechanisms and outcomes, develop a culturally adapted assessment battery, and pilot a rigorous evaluation to test the theoretical model and culturally adapted measures to prepare for a larger R01 effectiveness study. If successful, new understanding of the mechanisms and constructs through which ERC operates to prevent AI/AN youth suicide will support replication and scaling of this intervention to other AI/AN communities suffering youth suicide disparities. The proposed K01 will provide the candidate, who is from the Cherokee/Seminole Nations, with critical training in qualitative and mixed methods research, culturally grounded intervention design and evaluation, and child/adolescent development as it relates to resiliency, cultural identity, and suicide prevention. The candidate will receive guidance and targeted training from a mentorship team of national experts at the forefront of Indigenous mental health prevention science. This K01 award will support her to become an Indigenous NIMH independent investigator focused on culturally-informed, strengths-based mental health promotion research. The proposed research and candidate?s career goals align with NIMH Strategic Objective 4 to ?strengthen the public health impact of NIMH-supported research? and ?identify, validate, and scale-up innovative programs currently in use that improve mental health services for underserved populations? (4.1).
Culturally grounded mental health prevention interventions hold significant promise to reduce suicide among American Indian/Alaska Native (AI/AN) youth, a group at highest risk in the nation. However, there is little research to understand how core components included in these interventions impact mental health outcomes and promote resiliency against suicide. The proposed study with White Mountain Apache Tribe research partners will focus on an innovative, culturally grounded AI youth suicide prevention intervention, ?The Elders? Resilience Curriculum,? to: a) identify core components that impact protective factors against suicide; b) develop a youth resilience theoretical model; c) culturally adapt measures to assess outcomes; and d) pilot a culturally acceptable and rigorous evaluation to inform future research and scaling of this intervention to other AI/AN communities.
