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

这项研究的总体目标是开发、调整和评估代际预防干预措施， 名为“Wa‘Kan ye’zah(小圣者)”，由Peck Assiniboine堡和苏族照顾者以及他们的3-5-5人组成- 一岁大的孩子。干预的目的是：1)减少历史创伤和日常压力的症状 在父母/照顾者中，2)改善父母教育，3)改善孩子的情绪和行为 发展成果，以减少未来自杀和药物使用的风险。这其中的科学前提是 工作植根于理解土著社区历史和当前的高伤害率 损害照顾者的心理健康和养育方式，这反过来又会影响幼儿的行为问题 和不良事件，增加青少年儿童自杀和使用药物的风险 成人期。如果不进行干预，这种代际循环可能会重演。Wa‘Kan Ye’zah将结合改编 要素：1)以创伤为重点的认知行为治疗，一种循证干预被证明 有效减轻压力、抑郁和创伤相关症状，2)家庭精神，循证 父母培训计划，以促进美洲原住民社区儿童的积极早期发展，以及3) 由部落特有的自杀和药物滥用风险和保护因素提供信息的文化因素 在导致这一提议的基于社区的研究中确定了。干预将包括每周12次 在杨树角和沃尔夫角启动点设施为家长和孩子(3至5岁)开设的个人课程 土著社区卫生工作者选择的提供战略，以加强参与者的参与度， 地方可接受性和可持续性。干预时机集中在关键的发展阶段-当 主要的依恋仍然是对父母的依恋，但当孩子们过渡到更多的自我调节和 在Head Start课堂上与老师和同龄人合作。这项研究将使用随机对照试验 (RCT)，采用嵌入式单病例试验设计(SCED)，以确定 对N=120名亲子二人组的心理健康和行为结果的干预 探索特定文化因素对父母/照顾者结果的额外好处。论心理健康 和N=120个亲子二人的行为结果，同时探索文化的附加好处 父级结果的组成部分。该学习计划建立在与 部落社区，导致这一提议的创新形成性研究，以及经验丰富的多方面的 由土著少年派领导的纪律严明的研究小组。

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.