Development of a Biomedical Program of Research in the Blackfeet Community: Challenges and Rewards

American Indian (AI) communities have high levels of stress and trauma and are disproportionately affected by numerous preventable diseases. Here, we describe an academic–community partnership based on a collaboration between Blackfeet Community College students and faculty in Psychology and Immunology at Montana State University (MSU). The collaboration, which has spanned over 5 years, was sparked by community interest in the relationship between stress and disease on the Blackfeet reservation. Specifically, community members wanted to understand how the experience of psychological stress and trauma may affect disease risk in their community and identify factors that promote resilience. In doing so, they hoped to identify pathways through which health could be improved for individual community members. Here, we discuss all stages of the collaborative process, including development of measures and methods and themes of research projects, challenges for community members and non‐indigenous collaborators, future directions for research, and the lessons learned. Finally, we note the ways in which this partnership and experience has advanced the science of community engagement in tribal communities, with the hope that our experiences will positively affect future collaborations between indigenous community members and non‐indigenous scientists.     

Beyond the Belmont Principles: A Community‐Based Approach to Developing an Indigenous Ethics Model and Curriculum for Training Health Researchers Working with American Indian and Alaska Native Communities

Individuals responsible for carrying out research within their diverse communities experience a critical need for research ethics training materials that align with community values. To improve the capacity to meet local human subject protections, we created the research Ethics Training for Health in Indigenous Communities (rETHICS), a training curriculum aligned within American Indian and Alaska Native (AI/AN) context, culture, and community‐level ethical values and principles. Beginning with the Belmont Report and the Common Rule that defines research with human subjects (46 CFR 45), the authors convened three different expert panels (N = 37) to identify Indigenous research values and principles common across tribal communities. The resulting culturally grounded curriculum was then tested with 48 AI/AN individuals, 39 who also had recorded debriefing interviews. Using a thematic analysis, we coded the qualitative feedback from the expert panel discussions and the participant debriefings to assess content validity. Participants identified five foundational constructs needed to ensure cultural‐grounding of the AI/AN‐specific research training curriculum. These included ensuring that the module was: (a) framed within an AI/AN historical context; (b) reflected Indigenous moral values; (c) specifically linked AI/AN cultural considerations to ethical procedures; (d) contributed to a growing Indigenous ethics; and (e) provided Indigenous‐based ethics tools for decision making. Using community‐based consultation and feedback from participants led to a culturally grounded training curriculum that teaches research ethical principles and procedures for conducting research with AI/ANs. The curriculum is available for free and the community‐based process used can be adapted for other cultural groups.     

A Balancing Act: Integrating Evidence‐Based Knowledge and Cultural Relevance in a Program of Prevention Parenting Research with Latino/a Immigrants

Family therapists have a unique opportunity to contribute toward the reduction of widespread mental health disparities impacting diverse populations by developing applied lines of research focused on cultural adaptation. For example, although evidence‐based prevention parent training (PT) interventions have been found to be efficacious with various Euro‐American populations, there is a pressing need to understand which specific components of PT interventions are perceived by ethnic minority parents as having the highest impact on their parenting practices. Equally important is to examine the perceived cultural relevance of adapted PT interventions. This qualitative investigation had the primary objective of comparing and contrasting the perceived relevance of two culturally adapted versions of the efficacious parenting intervention known as Parent Management Training, the Oregon Model (PMTO). According to feasibility indicators provided by 112 Latino/a immigrant parents, as well as findings from a qualitative thematic analysis, the core parenting components across both adapted interventions were identified by the majority of research participants as relevant to their parenting practices. Participants exposed to the culturally enhanced intervention, which included culture‐specific sessions, also reported high satisfaction with components exclusively focused on cultural issues that directly impact their parenting practices (e.g., immigration challenges, biculturalism). This investigation illustrates the relevant contributions that family therapy scholars can offer toward addressing mental health disparities, particularly as it refers to developing community‐based prevention interventions that achieve a balance between evidence‐based knowledge and cultural relevance.     

Psychological‐Mindedness and American Indian Historical Trauma: Interviews with Service Providers from a Great Plains Reservation

The concept of historical trauma (HT) was developed to explain clinical distress among descendants of Jewish Holocaust survivors and has since been ascribed new meanings to account for suffering in diverse contexts. In American Indian (AI) communities, the concept of AI HT has been tailored and promoted as an expanded notion of trauma that combines psychological injury with historical oppression to causally connect experiences with Euro‐American colonization to contemporary behavioral health disparities. However, rather than clinical formulations emphasizing psychological injury, a focused content analysis of interviews with 23 AI health and human service providers (SPs) on a Great Plains reservation demonstrated strong preferences for socio‐cultural accounts of oppression. Reflective of a local worldview associated with minimal psychological‐mindedness, this study illustrates how cultural assumptions embedded within health discourses like HT can conflict with diverse cultural forms and promote “psychologized” perspectives on suffering that may limit attention to social, economic, and political determinants of health.     

Making the Invisible Visible: Identifying and Articulating Culture in Practice‐Based Evidence

This study describes a conceptual tool, labeled the “culture cube,” developed to identify and articulate the cultural underpinnings of prevention and early intervention projects in five priority populations (i.e., African American, Asian Pacific Islander, Latino, Native American, and Lesbian, Gay, Bisexual, Transgender, Queer, and Questioning), participating in the California Reducing Disparities Project Phase 2 (CRDP Phase 2). The culture cube was developed for evaluation of these practice‐based evidence services (PBEs) for three purposes: (a) to focus attention on revealing and articulating more fully the operative worldview and culturally grounded frameworks underlying PBEs, explicitly identifying the links between cultural beliefs and values, community needs, and intervention design; (b) to guide the methods used to assess and evaluate PBEs so that the outcome indicators and process measures are conceptually consistent, community defined, and culturally centered; and (c) to invite communities to use their own indigenous epistemological frameworks to establish credible evidence. After reviewing the literature in this area and describing the theoretical framework for the culture cube, we describe its development, application, and the response to its use in the initial stages of the California Reducing Disparities Project‐Phase 2.     

Waimānalo Pono Research Hui: A Community–Academic Partnership to Promote Native Hawaiian Wellness through Culturally Grounded and Community‐Driven Research and Programming

Although Hawai‘i is often portrayed as an idyllic paradise and is recognized as one of the healthiest States in the United States, pervasive health disparities exist among Native Hawaiians. Similar to other indigenous populations across the globe, these disparities are linked to unjust social and economic policies rooted in colonization and historical trauma. Western‐centric efforts to address these disparities have yielded limited results. Consequently, indigenous frameworks to decolonize western‐centric research processes have emerged. The Waimānalo Pono Research Hui is an example of a community–academic partnership that uses indigenous methodologies and principles of community‐based participatory research as the foundation to engage Native Hawaiian community members in research. Monthly gatherings are held where community members and academic researchers share a meal and discuss community priorities with the goal of shaping research and programming that are rooted in Native Hawaiian values. A mission for the group has been created as well as protocols for community engagement to ensure all projects that work with the Waimānalo Pono Research Hui are ethically sound and grounded in the community's preferences, cultural knowledge, and lived experiences. Our community members continually report that the Waimānalo Pono Research Hui has positively transformed their perception of and willingness to engage in research. Similarly, university students and academic researchers express how much their knowledge about working with communities has grown and inspired them. Creating spaces for communities and researchers to build authentic relationships and engage in ongoing conversations can promote culturally grounded and community‐driven research and programming.     

The Implementation of Mindfulness‐Based,Trauma‐Informed Parent Education in an Underserved Latino Community: The Emergence of a Community Workforce

In this practice‐oriented program review, a mindfulness‐based, trauma‐informed parent intervention, called Safe, Secure and Loved? (SSL), designed to strengthen nurturing parenting and children's resilience, was implemented in an underserved Latino community. Across 5 years, a volunteer community workforce of promotoras transformed an academic–community research partnership into a community‐led program partnership and established sustainable agency parent education programming. To better understand this transformation, we used a modified implementation science (IS) framework to structure interviews from members of the academic–community research partnership. Findings suggest that the commitment and cultural expertise of the volunteer community workforce acted as the major leadership drivers to create the community‐led program partnership. Employing mindfulness‐based, trauma‐informed parent education designed to promote nurturing parenting and children's resilience may be an effective training model to engage and mobilize a volunteer community workforce from an underserved community.     

Substance Use Research with Indigenous Communities: Exploring and Extending Foundational Principles of Community Psychology

Many Indigenous communities are concerned with substance use (SU) problems and eager to advance effective solutions for their prevention and treatment. Yet these communities also are concerned about the perpetuation of colonizing, disorder‐focused, stigmatizing approaches to mental health, and social narratives related to SU problems. Foundational principles of community psychology—ecological perspectives, empowerment, sociocultural competence, community inclusion and partnership, and reflective practice—provide useful frameworks for informing ethical community‐based research pertaining to SU problems conducted with and by Indigenous communities. These principles are explored and extended for Indigenous community contexts through themes generated from seven collaborative studies focused on understanding, preventing, and treating SU problems. These studies are generated from research teams working with Indigenous communities across the United States and Canada—inclusive of urban, rural, and reservation/reserve populations as well as adult and youth participants. Shared themes indicate that Indigenous SU research reflects community psychology principles, as an outgrowth of research agendas and processes that are increasingly guided by Indigenous communities. At the same time, this research challenges these principles in important ways pertaining to Indigenous–settler relations and Indigenous‐specific considerations. We discuss these challenges and recommend greater synergy between community psychology and Indigenous research.     

Indigenizing CBPR: Evaluation of a Community-Based and Participatory Research Process Implementation of the Elluam Tungiinun (Towards Wellness) Program in Alaska

The process that community based participatory research (CBPR) implementation takes in indigenous community contexts has serious implications for health intervention outcomes and sustainability. An evaluation of the Elluam Tungiinun (Towards Wellness) Project aimed to explore the experience of a Yup'ik Alaska Native community engaged within a CBPR process and describe the effects of CBPR process implementation from an indigenous community member perspective. CBPR is acknowledged as an effective strategy for engaging American Indian and Alaska Native communities in research process, but we still know very little about the experience from a local, community member perspective. What are the perceived outcomes of participation in CBPR from a local, community member perspective? Qualitative methods were used to elicit community member perspectives of participation in a CBPR process engaged with one Yup'ik community in southwest Alaska. Results focus on community member perceptions of CBPR implementation, involvement in the process and partnership, ownership of the project with outcomes observed and perceived at the community, family and individual levels, and challenges. A discussion of findings demonstrates how ownership of the intervention arose from a translational and indigenizing process initiated by the community that was supported and enhanced through the implementation of CBPR. Community member perspectives of their participation in the research reveal important process points that stand to contribute meaningfully to implementation science for interventions developed by and for indigenous and other minority and culturally diverse peoples.     

Risk and Protective Processes Predicting Rural African American Young Men's Substance Abuse

Informed by a life course perspective, this study tested a cascade model linking harsh, unresponsive parenting during childhood to young African American men's substance abuse via precocious transitions, economic instability, and future orientation. The moderating influence of community disadvantage and romantic partner support on the hypothesized pathways was also examined. At the baseline, the sample included 505 African American men between ages 19 and 22 years from high‐poverty rural communities. Follow‐up data were collected 18 months after baseline. Using structural equation modeling, we identified harsh, unresponsive parenting influenced precocious transitions in adolescence, which in turn increased economic instability during young adulthood. Economic instability was associated with a reduction in future orientation, a proximal influence on increases in substance abuse. Also, residence in a disadvantaged community amplified the influence of precocious transitions on economic instability and the influence of economic instability on future orientation. Involvement with supportive romantic partnership evinced a protective effect, attenuating the influence of precocious transitions on economic instability and the influence of economic instability on a future orientation. This study expands understanding of young adults’ substance abuse by demonstrating the risk and protective processes linking substance abuse to developmental factors across childhood, adolescence, and young adulthood.     

A Community‐Responsive Adaptation to Reach and Engage Latino Families Affected by Maternal Depression

As family researchers and practitioners seek to improve the quality and accessibility of mental health services for immigrant families, they have turned to culturally adapted interventions. Although many advancements have been made in adapting interventions for such families, we have yet to understand how the adaptation can ensure that the intervention is reaching families identified to be in greatest need within a local system of care and community. We argue that reaching, engaging, and understanding the needs of families entails a collaborative approach with multiple community partners to ensure that adaptations to intervention content and delivery are responsive to the sociocultural trajectory of families within a community. We describe a cultural adaptation framework that is responsive to the unique opportunities and challenges of identifying and recruiting vulnerable families through community partnerships, and of addressing the needs of families by incorporating multiple community perspectives. Specifically, we apply these principles to the cultural adaptation of an intervention originally developed for low‐income African American and White families facing maternal depression. The new intervention, Fortalezas Familiares (Family Strengths), was targeted to Latino immigrant families whose mothers were in treatment for depression in mental health and primary care clinics. We conclude with key recommendations and directions for how family researchers and practitioners can design the cultural adaptation of interventions to be responsive to the practices, preferences, and needs of underserved communities, including families and service providers.     

People Awakening: Collaborative Research to Develop Cultural Strategies for Prevention in Community Intervention

The consequences of alcohol use disorder (AUD) and suicide create immense health disparities among Alaska Native people. The People Awakening project is a long-term collaboration between Alaska Native (AN) communities and university researchers seeking to foster health equity through development of positive solutions to these disparities. These efforts initiated a research relationship that identified individual, family, and community protective factors from AUD and suicide. AN co-researchers next expressed interest in translating these findings into intervention. This led to development of a strengths-based community intervention that is the focus of the special issue. The intervention builds these protective factors to prevent AUD and suicide risk within AN youth, and their families and communities. This review provides a critical examination of existing literature and a brief history of work leading to the intervention research. These work efforts portray a shared commitment of university researchers and community members to function as co-researchers, and to conduct research in accord with local Yup’ik cultural values. This imperative allowed the team to navigate several tensions we locate in a convergence of historical and contemporary ecological contextual factors inherent in AN tribal communities with countervailing constraints imposed by Western science.     

Utilizing Community Partnerships to Devise a Framework for Cultural Adaptations to Evidence-Based Mental Health Practice in Diverse Communities

Mental health disparities for diverse communities (particularly immigrants and people of color) in terms of access to evidence-based treatments, lack of education/awareness about mental health symptoms and treatment options, and lack of culturally responsive treatments have been frequently documented. Hence, diversity considerations in the diagnosis, assessment, and treatment of psychological disorders remain vital and imperative in clinical practice. There is also substantial work indicating that cultural values likely play an essential role in shaping how individuals conceptualize and experience mental or emotional health. Therefore, the present study was developed for community-engaged clinicians and researchers to outline the process by which to create a culturally responsive, evidence-based treatment framework for community mental health interventions in close partnership with communities of color. This study was conceptualized and designed collaboratively with community leaders across five different communities of color: African American/Black, Latino/a, Native American, Pacific Islander, and African immigrant communities in a major U.S. city. This paper describes the mixed methods for such a community-engaged collaboration, highlighting critical elements for ongoing culturally engaged clinical work/research, and providing recommendations for culturally adapted interventions for mental health based on specific process observations made in the current example.     

Insiders and outsiders: Levels of collaboration in research partnerships across resource divides

With increasing recognition of the health and psychosocial challenges in developing countries, more research in these countries is essential. Research collaborations between wealthier and less wealthy countries are, however, complex. A partnership model has been proposed which emphasizes the importance of mutually respectful and beneficial relationships in international research. Using an example of a mother‐infant intervention project in South Africa we describe the elements of an equitable partnership model of research. An issue which has been overlooked, however, is the reality of power differentials within the poorer countries themselves. We show that there are many intersecting levels of relationships within intercountry research, and suggest that power dynamics within countries deserves equal attention as international issues. Based on our experiences, we present some tentative guidelines for international research which builds long‐term capacity and recognizes the importance of multiple levels of analysis and interaction.     

The Chinese Life-Steps Program: A Cultural Adaptation of a Cognitive-Behavioral Intervention to Enhance HIV Medication Adherence

China is considered to be the new frontier of the global AIDS pandemic. Although effective treatment for HIV is becoming widely available in China, adherence to treatment remains a challenge. This study aimed to adapt an intervention promoting HIV-medication adherence—favorably evaluated in the West—for Chinese HIV-positive patients. The adaptation process was theory-driven and covered several key issues of cultural adaptation. We considered the importance of interpersonal relationships and family in China and cultural notions of health. Using an evidence-based treatment protocol originally designed for Western HIV-positive patients, we developed an 11-step Chinese Life-Steps program with an additional culture-specific intervention option. We describe in detail how the cultural elements were incorporated into the intervention and put into practice at each stage. Clinical considerations are also outlined and followed by two case examples that are provided to illustrate our application of the intervention. Finally, we discuss practical and research issues and limitations emerging from our field experiments in a HIV clinic in Beijing. The intervention was tailored to address both universal and culturally specific barriers to adherence and is readily applicable to generalized clinical settings. This evidence-based intervention provides a case example of the process of adapting behavioral interventions to culturally diverse communities with limited resources.     

Stress-coping-support in rural communities: A model for primary prevention

Conclusion Because of the relatively small and homogeneous population in rural communities, community-wide prevention efforts are often more manageable than in urban areas. Community needs and resources can be identified more easily, and the feasibility of different interventions can be assessed more readily.To guide the rural prevention agent in developing community programs, the stress-coping-support framework has been proposed here. The value of this model is that it delineates the aspects of community life that must be assessed, and it outlines several different intervention goals. The model in its most general form proposes that prevention activities should reduce stress, increase coping, and build support. While this model can be applied to any community or target group, the framework has been elaborated here to address the unique physical, occupational, and societal characteristics of rural communities.Although some of the issues in applying this model to rural, as opposed to urban, areas have been pointed out here, the variation among rural communities has not been addressed fully. The different types of rural communities, e.g., the mining town, the isolated farmlands, the Indian reservation, have unique characteristics which may determine whether a proposed prevention program is needed, feasible, and effective.It is hoped that rural practitioners, long sensitive to the need for prevention, will use this model to devise additional prevention directions and to generate useful and culturally syntonic programs for their communities.     

Chicago Urban Resiliency Building (CURB): An Internet-Based Depression-Prevention Intervention for Urban African-American and Latino Adolescents

Early preventive interventions for depressive disorders in racial/ethnic minorities may help to reduce lifetime depression outcome disparities by improving developmental trajectories and social outcomes. We describe the development process, intervention and evaluation plan for a culturally adapted, low-cost, primary care/Internet-based depression-prevention intervention (CURB, Chicago Urban Resiliency Building). CURB is culturally adapted for socio-economically disadvantaged African-American and Latino adolescents according to the PEN-3 model of health promotion programs (Airhihenbuwa in Health and culture: beyond the Western paradigm, Sage Publishers, Thousand Oaks, 1995). Based on the idea that health behavior is rooted in culture, the PEN-3 model contains three interdependent dimensions that influence health beliefs and behaviors. Within each dimension are factors (using the acronym PEN) that must be considered about the target culture. Application of the PEN-3 model occurred in 3 phases. In each phase, a dimension of the model was explored and subsequent changes were made to the intervention so as to be more culturally suitable. In the CURB clinical trial, adolescents ages 13–17 will be recruited from wait-lists for mental health services at community health care provider organizations and screened for risk of future depressive disorder in the primary care sites. Adolescents screening positive for persistent depressed mood will be randomly assigned to either the CURB intervention group or the wait-list control group. The study aims are to determine if participants in the CURB intervention group will have lower levels of depressive symptoms and/or a lower cumulative incidence of depressive episodes.