Wa'Kan Ye'Zah: Enhancing caregivers' and children's well-being through an evidence-based and culturally informed prevention intervention

本研究的总体目标是制定、调整和评估代际预防干预措施， 名为“Wa' Kan ye' zah（小圣人）”，与佩克堡阿西尼博因和苏族照顾者和他们的3至5- 岁的孩子。干预旨在：1）减少历史创伤和日常压力的症状 在父母/照顾者中，2）改善养育，3）改善儿童的情绪和行为 发展成果，以减少未来自杀和物质使用的风险。科学的前提是 这项工作植根于理解土著社区历史和当前创伤的高发生率 损害照顾者的心理健康和养育，这反过来又影响幼儿行为问题 以及增加青少年和年轻人自杀和使用药物风险的不良事件 成年如果不进行干预，这种代际循环可能会重演。Wa' Kan ye' zah将联合收割机 要素：1）创伤集中的认知行为疗法，一个基于证据的干预证明 有效减轻压力，抑郁和创伤相关症状，2）家庭精神，一个以证据为基础的 父母培训计划，以促进积极的早期儿童发展，在美洲土著社区，和3） 文化因素考虑到部落特有的自杀和药物滥用风险和保护因素 在导致这一建议的社区研究中确定的。干预措施将包括每周12次 在白杨和狼点学前教育机构为家长和儿童（3至5岁）提供个别课程 由土著社区卫生工作者提供，为加强参与者的参与而选定的交付战略， 当地的可接受性和可持续性。干预时机集中在一个关键的发展阶段， 主要的依恋仍然是父母，但当孩子们过渡到更大的自我调节， 与老师和同龄人在“先声夺人”课堂上合作。本研究将采用随机对照试验 (RCT)采用嵌入式单例实验设计（SCED）确定 在N=120对亲子对中进行心理健康和行为结果的干预， 探索特定文化成分对父母/照顾者结果的额外好处。心理健康 在N=120个亲子配对中，研究了文化的额外好处， 父母的成果。该研究计划位于一个良好的信任关系， 部落社区，创新的形成性研究，导致这一建议，和一个经验丰富，多- 由土著PI领导的纪律严明的研究团队。

The overall goal of this study is to develop, adapt and evaluate an intergenerational prevention intervention, named “Wa’ Kan ye’ zah (Little Holy One),” with Fort Peck Assiniboine and Sioux caregivers and their 3-to-5- year-old children. The intervention aims to: 1) reduce symptoms of historical trauma and everyday stress among parents/caregivers, 2) improve parenting, and 3) improve children’s emotional and behavioral developmental outcomes to reduce future risk for suicide and substance use. The scientific premise of this work is rooted in understanding that high rates of historical and current trauma in Native communities compromise caregivers’ mental health and parenting, which in turn affect early childhood behavior problems and adverse events that increase children’s risk for suicide and substance use in adolescent and young adulthood. Without intervention, this intergenerational cycle may repeat. Wa’ Kan ye’ zah will combine adapted elements of: 1) Trauma-Focused Cognitive Behavioral Therapy, an evidence-based intervention proven effective to reduce stress, depression and trauma-related symptoms, 2) Family Spirit, an evidence-based parent training program to promote positive early child development in Native American communities, and 3) cultural components informed by tribal-specific risk and protective factors for suicide and substance abuse identified in community-based studies that led to this proposal. The intervention will consist of 12 weekly individual lessons taught to parents and children (ages 3 to 5) at the Poplar and Wolf Point Head Start facilities by indigenous community health workers, a delivery strategy selected to enhance participant engagement, local acceptability and sustainability. Intervention timing is focused at a critical developmental phase—when primary attachment is still to parents, but while children are transitioning to greater self-regulation and cooperation with teachers and peers in Head Start classrooms. This study will use a randomized control trial (RCT) with an embedded single-case experimental design (SCED) to determine the effectiveness of the intervention on mental health and behavioral outcomes among N=120 parent-child dyads, while empirically exploring the added benefit of specific cultural components on parent/caregiver outcomes. on mental health and behavioral outcomes among N=120 parent-child dyads, while exploring the added benefit of cultural components on parent outcomes. The study plan is situated within a well-established trust relationship with tribal communities, innovative formative research that led to this proposal, and an experienced, multi- disciplined study team led by an indigenous PI.