NYAPRS Note: We’ve highlighted several articles in the past year about Alaskan healthcare, specifically around suicide prevention, isolation, unemployment, and cultural competence in early intervention strategies. Many of us may wonder what Alaskan healthcare has to teach us. The study highlighted below will likely show that there is much that can be learned in approaches that work for Alaskan youth, particularly around culturally sensitive engagement strategies, cooperative learning between professionals and paraprofessionals, and models that deescalate the stress and stigmatization of mental healthcare.
Suicide Prevention Strategies Among Alaska Native Youth
Native American Times; UMASS Amherst School of Public Health, 12/17/2014
The annual suicide death rate for American Indian/Alaska Native youth is as much as 18 times higher than the national average for all American youth, and most native youth never receive behavioral health care, even when they show clear signs of distress such as depression, or when they are actively suicidal.
Now, with a two-year, $700,000 grant from the National Institute of Mental Health, researchers led by Lisa Wexler of the University of Massachusetts Amherst School of Public Health and Health Sciences plan to develop culturally-responsive public health intervention strategies they hope will reduce youth suicidal behavior and bolster protective factors in 12 remote Arctic tribal communities in northwest Alaska.
Wexler, an associate professor of community health education, is working with tribal partner the Maniilaq Association of Kotzebue, the Northern Alaska Wellness Initiative led by Wexler at UMass Amherst and representing more than 26 tribes in two Arctic regions, plus behavioral health providers and academics dedicated to translating research to practice. They will implement and evaluate a pilot study intervention they call Professional-Community Collaborations for At-risk youth Engagement and Support, or PC-CARES.
Wexler says, “The thing that we’re really trying to do with PC-CARES and the wellness initiatives in northwest Alaska is to increase hope and possibility. Young people want the adults in their lives to spend more time just checking in with them, talking to them about what’s going on in their lives and about their futures. The wellness initiatives strive to encourage these interactions, and provide spaces for community members to come together in productive ways, regularly. Those kinds of everyday things can make a really big difference for young people, their families and communities.”
PC-CARES is designed to enhance collaborations among native paraprofessional and non-native professional mental health providers, reduce the stigma of seeking mental health services and promote earlier interactions between providers and the community to better meet the needs of native youth.
The approach is based in adult learning theory and community development principles, Wexler explains. Instead of a presenter telling people how to do things, “we’re really trying to build those understandings from the ground up through community member stories,” she notes. “Really, it’s less delivering the training than it is facilitating a conversation.”
Instead of focusing on individual-level change, PC-CARES will strengthen, expand and track the systems of youth support at community and institutional levels, which should offer many more ways to access support and reduce youth suicidal behavior, she says. “There is a significant gap between mental health services and family/peer support for native youth who are at risk for suicide. PC-CARES will align these resources, galvanize supporters and offer meaningful, community-based help.”
Native village counselors and non-native clinicians will be trained to offer culturally appropriate and clinically sound suicide intervention and prevention strategies and to facilitate the community outreach sessions that combine cultural/local knowledge and clinical expertise.
Wexler says, “PC-CARES creates a process where local people, service providers, parents and other community members can share stories and information so that people are reaching out to others more often in their everyday lives, noticing people that might be vulnerable and figuring out ways to support them.”
Participants begin by watching a short film featuring local community members sharing stories of resilience or care. Then either the mental health clinician or the village-based counselor tells a story about reaching out to someone in ways that made a difference. Participants will be invited to share their own stories and ideas. They’ll learn about available mental health and wellness resources.
An important component of the research is evaluation, which is rarely done, Wexler points out. She and her colleagues will track the formal and informal support networks and service use before and 12 months after PC-CARES is introduced. The study region also has had a suicide-tracking system since 1990, which provides the opportunity to fully document the PC-CARES program’s effect on suicidal behavior.