Promoting Community Conversations about Research to end Native Youth Suicide in Rural Alaska

促进关于结束阿拉斯加农村土著青少年自杀研究的社区对话

• 批准号: 9901608
• 负责人: Lisa M. Wexler
• 金额: $ 68.19万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-06-19 至 2023-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9901608
• 关键词: Acute; Affect; Age; Air; Alaska; Alaska Native; American; Attitude; Behavior; Caring; Characteristics; Collaborations; Communities; Community Practice; Community Workers; Diffusion; Distress; Educational Intervention; Effectiveness; Elderly; Event; Family; Family member; Friends; Goals; Growth; Guns; Health; Health Educators; Health Knowledge, Attitudes, Practice; Health Personnel; Health Promotion; Healthcare; Home environment; Hospitals; Hour; Human Resources; Indigenous; Individual; Intervention; Interview; Jail; Knowledge; Learning; Measurement; Measures; Mental Health; Mentors; Methods; Modeling; Occupations; Outcome; Parents; Participant; Pattern; Personal Satisfaction; Persons; Pilot Projects; Plague; Positioning Attribute; Predictive Factor; Prevention; Prevention Research; Primary Prevention; Protocols documentation; Provider; Reporting; Research; Research Methodology; Resources; Risk; Risk Assessment; Risk Factors; Risk Reduction; Role; Rural; Safety; Schools; Science; Secondary Prevention; Series; Social Network; Social support; Stream; Suicide; Suicide prevention; Support System; Surveys; Testing; Time; Training; Translating; Variant; Work; Youth; age group; base; care systems; community based care; community based participatory research; community intervention; community organizations; dosage; experience; follow-up; grandparent; health disparity; help-seeking behavior; indigenous community; innovation; member; native youth; pedagogy; peer; post intervention; prevent; reducing suicide; rural Alaska; service providers; skills; social; suicidal; suicidal behavior; suicidal risk; suicide rate; teacher; working group

With rates up to 18 times higher for rural Alaska Native (AN) young people when compared to all American youth (124 vs 6.9 per 100,000), the health disparity of youth suicide continues to plague rural Indigenous communities in Alaska. The current system of care—with a focus on mental health—is not effective: 79% of suicide decedents and 62% of attempters received NO mental health care. Vulnerable AN youth are more likely to come into contact with healthcare providers, school personnel, public safety workers, and other community members. Additionally, friends and family members noticed signs of risk beforehand in 62% of all recorded suicidal behavior. These villagers can offer culturally-specific social support and safety measures to avert a suicide crisis, but they are not trained to initiate primary and secondary prevention. Currently, three times out of four, community members mobilize only when the person is in `imminent risk' of suicide. This level of risk means that vulnerable AN youth are taken 500 air miles away for assessment in a confined hospital room many associate with `jail'. After this experience, most AN youth return home less likely to seek help the next time they feel suicidal. Late intervention cuts off options for cultural, family and community-based care, which is preferred by AN youth and their families. To initiate activities to promote wellness, safety and support before a suicide crisis, our tribal working group developed and piloted PC CARES: Promoting Community Conversations About Research to End Suicide. This promising and feasible educational intervention is led by local facilitators, and offers village stakeholders a series of learning circles to study `what we know' from prevention research and figure out how they can apply it to their jobs, families, and lives. The goal of the intervention is to enhance knowledge, skills and attitudes among service providers, family members and tribal residents so that they promote wellbeing, recognize risk, support vulnerable youth, and work with others in their community to take supportive and safety actions when they notice signs of vulnerability. Our community intervention utilizes indigenous pedagogy and prevention science to increase village members' and service providers' capacity to find `up-stream', self-determined and culturally-responsive ways to reduce suicide risk. Using a community-based, participatory research (CBPR) approach, our specific aims track change on both individual and community levels. Aim 1: Track the effect of PC CARES on participants' knowledge, attitudes and behavior, and identify key factors influencing these outcomes over time. Aim 2: Document the community-level impact of PC CARES by tracking the number and type of interactions aimed at preventing youth suicide and promoting wellness in participating villages, and describe changes in the supportive social networks of young people before and after the intervention. IMPACT: Our scalable model offers under-resourced Native communities a practical method for translating scientific research into culturally relevant efforts to reduce suicide risk factors, and increase safety, help-seeking and support to prevent suicide.

与所有美国人相比，农村阿拉斯加原住民 (AN) 年轻人的发病率高出 18 倍 青年（每 100,000 人中有 124 人 vs 6.9 人），青年自杀的健康差距继续困扰着农村原住民 阿拉斯加的社区。当前关注心理健康的护理系统并不有效：79% 自杀死者和 62% 的自杀未遂者没有接受过心理保健。弱势 AN 青少年更多 可能会接触医疗保健提供者、学校人员、公共安全人员和其他人员 社区成员。此外，62% 的人的朋友和家人事先注意到了风险迹象 记录自杀行为。这些村民可以提供针对特定文化的社会支持和安全措施 避免自杀危机，但他们没有接受过进行一级和二级预防的培训。目前，三 四分之四的情况下，社区成员仅在该人处于“迫在眉睫的自杀风险”时才会动员起来。这 风险等级意味着脆弱的 AN 青少年被带到 500 英里外的密闭环境中进行评估 许多人将病房与“监狱”联系起来。经过这次经历后，大多数 AN 年轻人回家后不太可能寻求帮助 下次他们有自杀倾向时提供帮助。后期干预切断了基于文化、家庭和社区的选择 护理，这是 AN 青少年及其家人所偏爱的。发起活动以促进健康、安全和 为了在自杀危机发生前提供支持，我们的部落工作组开发并试点了 PC CARES：促进 关于终结自杀研究的社区对话。这种有前景、可行的教育 干预措施由当地协调员领导，并为村庄利益相关者提供一系列学习圈，以研究“什么” 我们从预防研究中了解并弄清楚他们如何将其应用到他们的工作、家庭和生活中。这 干预的目标是提高服务提供者、家庭成员的知识、技能和态度 和部落居民，以便他们促进福祉、认识风险、支持弱势青年并与 社区中的其他人在注意到脆弱迹象时采取支持和安全行动。我们的 社区干预利用本土教育学和预防科学来提高村庄成员和 服务提供商寻找“上游”、自主决定和文化响应方式来减少污染的能力 自杀风险。使用基于社区的参与性研究 (CBPR) 方法，我们的具体目标跟踪 个人和社区层面的变化。目标 1：追踪 PC CARES 对参与者的影响 知识、态度和行为，并确定随着时间的推移影响这些结果的关键因素。目标 2： 通过跟踪互动的数量和类型，记录 PC CARES 的社区层面影响 预防青少年自杀和促进参与村庄的健康，并描述农村地区的变化 干预前后年轻人的支持性社交网络。影响：我们的可扩展模型 为资源匮乏的原住民社区提供了将科学研究转化为文化的实用方法 采取相关措施减少自杀风险因素，并加强安全、寻求帮助和支持以预防自杀。