jessica goodkind, beverly gorman, laverne storer , julia meredith hess,
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Jessica Goodkind, Beverly Gorman,Laverne Storer, Julia Meredith Hess,
Danielle Parker & Philmer Bluehouse
November 15, 2011
DEVELOPING COMMUNITY-BASED INTERVENTIONS FOR AMERICAN INDIAN MENTAL HEALTH
NNR-08-222
RESILIENCE, SURVIVAL, HISTORICAL TRAUMA & HEALING
Reflections from the Research Past to Define Research Forward for the Navajo Nation
2011 Navajo Nation Human Research Review Board Conference
1. THRIVE: Adaptation of Cognitive Behavioral Intervention for Trauma in Schools (NNHRRB-05-164; Year 2005)– Decreased PTSD symptoms, anxiety symptoms, & negative coping
strategies– Limitations with appropriateness and acceptability
2. Our Life Program: CBPR study to develop and implement community-based family program to promote well-being, heal trauma, and prevent future violence (NNHRRB-06-185; Years 2006-2008)– Increased self-esteem, quality of life, positive coping strategies,
social support & identification/connection with Navajo culture (youth)
– Increased positive parenting practices, self-confidence, social support, community involvement, and cultural knowledge (parents)
– Limitations with completion rate, length of program, historical trauma component, integration of cultural teachings
BACKGROUND
SPECIFIC AIMS1. Conduct an in-depth study of the mental health needs,
current stressors, coping strategies, and strengths of 16 Navajo adolescents and their families.
2. Use a CBPR approach to adapt a community-based mental health services intervention model based on the results from Aim 1.
3. Conduct an investigation of the feasibility and acceptability of the revised community-based mental health intervention.
4. Conduct a waitlist control group study of the implementation and effectiveness of the community-based mental health intervention with 28 Navajo families.
METHODS Conducted 78 interviews
Two interviews each with 14 youth, 17 parents/guardians, and 8 grandparents
Analyzed data, shared with community & Navajo Nation University and community team developed logic model Conducted four focus groups with youth, parents, and
elders to refine model Worked with Philmer Bluehouse to complete curriculum Curriculum approved by NNHRRB
Community Resources/ Protective Factors
Community Identified Problems/ Risk Factors
Program Logic ModelCo
ntex
t
Inputs Activities Short-term Outcomes
Long-term Outcomes
Y1’át’ééh
Ná1dléé[
Working to Restore
Balance & Harmony Model
Components of Program
Session Structure
Improved Social
Resources
Improved Cognitive Resources
Improved Emotional Resources
Decreased Mental Health
Problems
Community Outcomes/
Healing
Theories Guiding Logic Model
• Ecological • Empowerment• Resilience• Cultural assets• Holistic • Grassroots approach
•Spiritual/religious beliefs & practices•K’e (Universal Relations)•Extended family network•Connection to land/physical
environments•To’Hajiilee Community Action
Team (TCAT)•To’Hajiilee Behavioral Health
Services (TBHS)•To’Hajiilee Teen Center•To’Hajiilee Community School
Community Resources/Protective Factors
• Violence • Historical trauma• Current trauma• Substance abuse• Discrimination• Community conflict • Limited opportunity for positive youth development• Lack of understanding between elders, parents, and youth• Difficulties coping with stress, loss, grief, depression,
suicidality, and substance abuse• Limited resources
Community Identified Problems/Risk Factors
• Multigenerational, family program• Integrates prevention, treatment & healing• Positive well-being achieved through making connections• Culturally-based approach• Prioritizes strengths• Wellness orientation• Provides group support, education, skill-building &
community engagement
Y1’át’ééh Ná1dléé[: Working to Restore Balance & Harmony
Activities: Components of Program
• Psychoeducational group structure Understanding and managing
stress and trauma Conflict resolution training Anger management training Self-efficacy and self-awareness
promotion Positive parenting skills
Diné teachings and practices• Motivational interviewing treatment
engagement• Experiential activities• Community engagement/social action• Equine Therapeutic activities• Sports and crafts activities• Role playing
Activities: Structure of Each Session
I. •Opening Prayer
II. •Introduction/Review Objectives
III. •Connection Activity
IV. •Positive Wisdom
V. •Healing Circle
VI. •Group Reflection
VII. •Closing Prayer
• Social support• Caring relationships• High expectations• Meaningful
participation• Use of resources• Family social
dynamics• Effective parenting
practices
Short-term Outcomes: Improved Social Resources
• Connection to traditional culture (enculturation)• Skills to cope with/reduce stress and trauma• Problem-solving skills• Conflict resolution skills
Short-term Outcomes: Improved Cognitive Resources
• Self-efficacy• Cooperation & communication• Empathy• Future goals & aspirations• Self-awareness
Short-term Outcomes: Improved Emotional Resources
• Depression symptoms• PTSD symptoms• Suicidality• Substance use/abuse
Long-term Outcomes: Decreased Mental Health Problems
Long-term Outcomes: Community Outcomes/Healing
• Improved community relations/connections/networks
• Decreased conflict and violence
• Increased feelings of trust/safety
• Increased recognition of community strengths, resilience
• Increased individual, family, community connections/relations and cohesiveness
• Interrupt cycles of violence/substance abuse
• Increased individual, family, community well being
• Mixed-method waitlist control group design• Fall 2010/Spring 2011• Four interviews with each participant • Group 1: pre, post, 3 and 6 month follow-ups • Group 2: pre1, pre2, post, and 3 month follow-
up
Implementation
COMMUNITY ADVISORY COUNCIL Our Connection to the Land
• Community map project• Council identified individuals’
connectedness to land and historical narratives as important for well-being and healing
• Council initiated this project to add to study
• Have collected 40-50 place names and narratives
• Interactive map will remain in the community for future use
Formed in 2005 12 members Monthly meetings Provides guidance on all
aspects of study
NEXT STEPS Continue analyzing quantitative and qualitative data Complete program manual Share manual on Navajo Nation through
workshop/trainings Address issues of engagement
CONTACT INFORMATIONUniversity of New Mexico
Prevention Research CenterDivision of Prevention & Population Sciences
MSC 11 6145Albuquerque, NM 87131
(505)272-4462; jgoodkind@salud.unm.edu
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