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

与所有美国人相比，阿拉斯加农村原住民年轻人的失业率高出18倍 青年自杀(每10万人中有124人对6.9人)，青年自杀的健康差距继续困扰着农村土著居民 阿拉斯加的社区。目前的护理体系--侧重于心理健康--并不有效：79% 自杀死者和62%的未遂者没有得到精神卫生保健。易受伤害的年轻人更多 可能接触到医疗保健提供者、学校工作人员、公共安全工作者和其他 社区成员。此外，62%的人的朋友和家人事先注意到了风险的迹象 有自杀行为的记录。这些村民可以提供特定于文化的社会支持和安全措施 避免自杀危机，但他们没有接受过启动初级和二级预防的培训。目前，有三个 每四次，社区成员只有在此人有自杀的“迫在眉睫的危险”时才会动员起来。这 风险水平意味着脆弱的青少年被带到500英里外的密闭环境中进行评估 许多人将病房与“监狱”联系在一起。在经历了这段经历后，大多数年轻人回国后不太可能寻求 下次他们有自杀念头的时候，帮助他们。晚期干预切断了以文化、家庭和社区为基础的选择 关爱，这是年轻人和他们的家人喜欢的。开展促进健康、安全和健康的活动 支持在自杀危机之前，我们的部落工作组开发并试行了PC关怀：促进 关于结束自杀的研究的社区对话。这一前景看好且可行的教育 干预由当地的促进者领导，为村里的利益相关者提供了一系列学习圈，让他们学习什么 我们从预防研究中得知，并弄清楚如何将其应用于他们的工作、家庭和生活中。这个 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 当他们注意到脆弱的迹象时，他们社区中的其他人会采取支持性和安全行动。我们的 社区干预利用土著教育学和预防科学来增加村庄成员和 服务提供商找到“上游”、自主和响应文化的方式以减少 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 在个人和社区层面上的变化。目标1：跟踪PC关怀对参与者的影响 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： 通过跟踪旨在实现以下目标的互动的数量和类型，记录PC关怀对社区的影响 在参与的村庄预防青少年自杀和促进健康，并描述 干预前后青少年的支持性社会网络。影响：我们的可扩展模式 为资源不足的原住民社区提供将科学研究转化为文化的实用方法 相关努力减少自杀危险因素，增加安全、求助和支持，防止自杀。

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.