Native American (NA) studies focused on Adverse Childhood Events (ACEs) have found associations with alcohol, drug, and suicidal risk; and NA studies targeting alcohol and drug abuse and suicide have identified ACEs as risk factors. The goal of the Apache-JHU NARCH trauma research project is to: 1) better understand the types, meanings and impact of ACEs, and 2) how to effectively reduce the impact of these experiences in Apache adults with alcohol, drug and suicide risks. We will use a rigorous mixed-methods, community-based approach combining qualitative methods with a RCT to adapt and test a strength- and skills-based intervention, ?My Pathway to Healing.? My Pathway to Healing is based on a trauma-informed, common elements intervention that has a robust evidence-base internationally, and will be delivered using a task-shifting approach by culturally embedded Apache Community Mental Health Specialists (CMHS).
The specific aims are to: 1) to characterize the meaning and impact of ACES and identify key resilience factors for Apache adults ages 18-65 using Free Listing and In-Depth Interviews with N=30 key stakeholders. 2) To adapt a common elements intervention, My Pathway to Healing, based on Aim 1 findings and CAB input for piloting by Apache CMHS with N=10 Apaches ages 18-65 with recent suicide ideation and/or substance use. 3) To test the effectiveness of My Pathway to Healing using a wait-list controlled RCT with N=104 Apache adults ages 18-65 with recent suicide ideation and/or binge substance use. We hypothesize that participants will experience greater reductions in risk (trauma symptoms, depression) and increases in protective factors (hopefulness, communal mastery, functioning) related to substance use and suicidal behavior vs. controls at 6 months post-intervention. 4) To train and mentor 8 NA junior investigators in the trauma informed intervention, mixed methods research, data management, and ethical conduct of research. The Apache-JHU NARCH trauma research project builds on several successful rounds of NARCH funding, culminating in two Apache Co- Investigators completing their Master's degrees, enrolling in part-time doctoral programs in mental health, and being empowered to provide local clinical supervision for this study. This project will address critical next steps in trauma-informed care research by examining how ACEs and other trauma affect alcohol abuse, drug abuse, and suicidality?some of the largest health disparities for NAs. The use of a CMHS model will extend the reach, impact and scalability of culturally appropriate and evidence-based trauma-informed care for adults at risk of suicide in a community-based setting.
The Apache-JHU NARCH trauma study will conduct formative qualitative research in collaboration with a local Community Advisory Board to adapt and evaluate the impact of a strengths- and skills-based trauma intervention for adults with interrelated alcohol, drug, and suicidal risks in a RCT. The intervention will be delivered by culturally-embedded Apache Community Mental Health Specialists to extend the reach of effective programming and simultaneously build local capacity in trauma-informed intervention and research methods. This study will address critical public health needs, substance abuse and suicide, by reducing key risk factors related to Adverse Childhood Experiences and promoting important protective factors, including hopefulness and communal mastery, to promote long-term resilience.
