The Elders' Resilience Curriculum: Toward Building Empirical Evidence for a Culturally Grounded American Indian Youth Suicide Prevention Intervention

项目摘要 自杀不成比例地影响美国印第安人/阿拉斯加原住民（AI/AN）社区， AI/AN儿童和青少年经历的负担。AI/AN中精神卫生保健资源匮乏 环境指出，迫切需要在传统精神卫生之外提供自杀预防干预措施 临床环境。过去的研究表明，文化保护因素的方法将比风险更有效- 重点干预措施，以减少AI/AN青年自杀。基于文化的预防 干预措施-将当地文化和价值观置于干预措施设计、实施和 评估-持有强烈的承诺，以防止AI/AN青年自杀。然而，我们对核心知之甚少 组成部分，机制和结构，通过文化接地干预可以防止自杀。 长者韧性课程（ERC）是一个以学校为基础，以文化为基础， 目前由白色山地阿帕奇部落长老通过每月课程提供干预 关于部落文化价值观，信仰，生活方式和阿帕奇语言的青少年年龄9-14，一个新生阶段 在这个社区自杀的最高风险期（15-24岁）之前。拟议的研究建立 基于约翰霍普金斯美国印第安人健康中心和WMAT 35年以上的研究和公共卫生 * 通过基于社区的活动，继续创新和扩大预防干预措施的伙伴关系 参与式研究。候选人将与部落-大学合作伙伴进行探索 序贯混合方法研究，以确定关键的自杀保护因素和ERC核心组成部分， 针对这些因素，完善一个理论模型，说明因果机制和结果，开发一个 文化适应评估电池，并试行严格的评估，以测试理论模型， 文化适应措施，为更大规模的R 01有效性研究做准备。如果成功，新的理解 ERC运作以防止AI/AN青少年自杀的机制和结构将支持 将这种干预复制并扩展到其他遭受青年自杀差异的AI/AN社区。的 拟议的K 01将为来自切罗基/塞米诺尔族的候选人提供以下方面的关键培训： 定性和混合方法研究，基于文化的干预设计和评估，以及 儿童/青少年发展，因为它涉及到弹性，文化认同和自杀预防。候选 将接受来自最前沿的国家专家指导小组的指导和有针对性的培训， 土著心理健康预防科学。这个K 01奖将支持她成为土著NIMH 独立调查员专注于文化知情，基于优势的心理健康促进研究。 拟议的研究和候选人的职业目标与NIMH战略目标4一致，即“加强 NIMH支持的研究的公共卫生影响”和“识别，验证和扩大创新计划 目前正在使用的改善服务不足人群的精神卫生服务”（4.1）。

PROJECT SUMMARY 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).