The Power of Protection: American Indian/Alaska Native Youth Resilience

Transcription

1 The Power of Protection: American Indian/Alaska Native Youth Resilience IOM Roundtable: Promotion of Health Equity & Elimination of Health Disparities Albuquerque, NM May 6, 2014 Teresa LaFromboise, PhD

2 Presentation Journey Review experiences working with individual, family and community protective factors in Native American communities Describe Native American concepts in tandem with western concepts of psychological resilience Share information about evidence-based interventions to support: individual, family, community resilience.

3 Mainstream Perspectives on Resilience Personal bootstrapping Recovery from trauma Sustained competence under stress Invulnerability despite risk Interaction between protective & risk factors

4 Lakota Resilience The closest translation of resilience is a sacred word that means resistance resisting bad thoughts, bad behaviors. We accept what life gives us, good and bad, as gifts from the Creator. We try to get through hard times, stressful times, with a good heart. The gift [of adversity] is the lesson we learn from overcoming it. James Clairmount, Lakota elder, quoted in B. Graham, 2001

5 Social Ecology Model Risk and protective factors move through layers of ecological systems

6 Protective Factors in Nurturing Environments Individual Attributes Family Attributes Community Attributes Peer Attributes School Attributes

7 Flexibility Individual Attributes: Social Competence (ability to draw out positive reactions from others) Sense of Humor Empathy and caring for others Communication Skills

8 Individual Attributes: Autonomy (sense of personal power and identity)

9 Individual Attributes: Cultural Identity (sense of belonging in an ethnic/cultural group)

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11 Family Attributes: Supportive Parenting (Care, Respect, and Compassion)

12 Family Attributes: Supportive Parenting (Cont.)

13 Peer Norms Pivotal person in suicide prevention

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16 Language Retention Showcase student talent Host Cultural Awareness Events

17 Community Attributes: Cultural Values (convey the norms, beliefs and values of its members)

18 Community Attributes: Connectedness Communities provide settings for: 1. Learning 2. Social and recreational activities 3. Resources

19 Individual Family Peer School Community flexibility sense of humor empathy communication autonomy self-awareness resistance detachment cultural identity problem solving: -resourcefulness -critical thinking -critical consciousness supportive parenting quality relationships healthy interdependence cultural continuity settings for positive involvement contexts to support identity development social support peer norms pivotal resource in suicide prevention belongingness learning safety authentic caring mentors hope language retention opportunities for prevention contexts to support identity development host cultural awareness events transmission of beliefs, norms and values places of learning traditional activities social activities recreational activities resources cultural continuity contexts to support identity development

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21 Why are concerned? Suicide is 2 nd leading cause of death behind unintentional injuries for AI/ANs ages 10 to 34 Death by suicide is 72% more common among AI/ANs than the general population Estimated rate of death by suicide among AI/AN youth is 17 times higher than the national average AI/AN males aged have highest rate

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23 Suicide Attempts Among Youths as a Function of Gender and Ethnicity One-year rates of Youth Risk Behavior Surveillance self-reported suicide attempts African American AI/AN AA/PI Latino White Males Goldston et al., 2008 Females

24 Centers for Disease Control : Reasons for AI/AN Suicide Behavioral health problems (e.g., anxiety, substance abuse, & depression Underutilization of mental health services High poverty Poor educational outcomes Substandard housing Disease

25 Community-Driven Suicide Prevention Invitation from the Pueblo of Zuni

26 Zuni/American Indian Life Skills Intervention 1. Who am I? Building self-esteem. (7) 2. What am I feeling? Emotions and stress. (9) 3. How can I communicate with others and solve problems effectively? (5) 4. How can I recognize self-destructive behavior and find ways to eliminate it? (4) 5. Why do people attempt suicide? (4) 6. How can I help my friends who are thinking about suicide? (3) 7. How can I plan ahead for a great future? (8)

27 Zuni Life Skills Intervention Target Skills Positive thinking / Problem solving Open communication Handling depression Stress management Anger regulation Suicide prevention Individual/community goal setting

28 Risk Factors Intervention Mediating Factors Outcome Variables Acculturation Stress Historical Trauma Pervasive Poverty Avoidant Coping Ineffective Problem Solving Suicide Community Violence Negative Thinking Family Disruption Interpersonal Problems Depression Substance Abuse Psychological Disorder Stress AILS Intervention Approach Coping Effective Problem Solving Positive Thinking Resilient Adaptation Age/Gender LaFromboise & Fatima, 2011

29 Effectiveness of Zuni Life Skills Participants 101 freshman and 27 junior students in language arts classes in Zuni Public High School 65% girls, 35% boys year age range 81% were in the moderate to severe range on suicidal ideation at pretest 40% had a relative or friend who had died by suicide 18% reported having attempted suicide

30 Effectiveness of Zuni Life Skills Treatment vs. Control Group at Posttest Survey Less hopelessness * More confidence in ability to manage anger * Behavioral Role Play Study Better peer suicide intervention skills ** Better peer problem solving skills 1 1 p<.07, *p<.05, **p<.01 -LaFromboise & Howard-Pitney, 1995

31 SW Tribal Nation Comprehensive Suicide Prevention Project

32 Independent Evaluation of AILS: Southwestern Nation Examining the Effect of Time on Outcomes at Post-Test Controlling for Pretest Score Hopelessness* Suicide Risk * Public Collective Esteem* (What participants believe others think about their race/ethnicity) Self-Efficacy** Self-Awareness*** *p<.05, **p<.01. ***p<.001

33 American Indian Life Skills AILS is a high and middle school based life skills and suicide prevention curriculum 30, 40-minute sessions given over a semester covering anger, depression, anxiety, and suicidal thoughts & behaviors Engages community members and peer helpers in youth suicide prevention Uses real life situations to increase youth help seeking from caring adults Teaches coping strategies to overcome stressful life events

34 Coping and Support Training CAST is a high school-based suicide prevention program Delivers life-skills training and social support in small group format (6-8 students) 12, 55-minute sessions given over 6 weeks Trained by HS teachers, counselors, or nurses with considerable school-based experience Goals: increase mood management, improve school performance, & decrease drug involvement.»

35 Sources of Strength Brings together and trains both peer leaders & caring adults Uses peer leaders to break down the code of silence & increase peer help seeking from caring adults Uses a core emphasis on strengths that goes beyond a simple focus on suicide prevention and warning signs Encourages multiple sources of support Hope, health & strength messages are developed with local voices & faces saturating local schools and communities with stories of resiliency instead of trauma» Wyman et al., 2010