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.     

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.     

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.     

Promoting Healing and Restoring Trust: Policy Recommendations for Improving Behavioral Health Care for American Indian/Alaska Native Adolescents

American Indian/Alaska Native youth represent the strength and continued survival of many Nations and Tribes. However, they currently experience numerous health disparities and challenges, including the highest rate of suicide among 15–24 year-olds in the United States. Our comprehensive review of the literature on the mental health of AI/AN youth highlighted seven focal causes of behavioral health disparities: (1) high levels of violence and trauma exposure and traumatic loss, (2) past and current oppression, racism, and discrimination, (3) underfunded systems of care, (4) disregard for effective indigenous practices in service provision, policy, and funding, (5) overreliance on evidence-based practices, (6) lack of cultural competence among systems of care and providers, and (7) barriers to care. Seven policy recommendations that recognize the importance of moving beyond exclusive reliance on western models of care and that seek to foster transformation of individuals, families, communities, behavioral health service systems of care, and social structures are presented, supported, and discussed.     

American Indian Researcher Perspectives on Qualitative Inquiry About and Within American Indian Communities

It is presumed that Indigenous researchers are optimally positioned to conduct research about or within their own or other Indigenous communities. However, these researchers may still experience challenges, barriers, and distressing events that are important to identify. Qualitative inquiry may be a particularly vulnerable context for Indigenous researchers given the nature of data collection methods and an emphasis on researcher–participant relationships. This paper details the personal reflections of two American Indian (AI) researchers who carried out qualitative research focused on AI issues and/or communities. The first project examined undergraduate students’ opinions of the use of AI imagery in the form of a race‐based university mascot. The second was a study of the mental health needs of AI youth and families in an urban community. Several themes characterized both of their experiences and might be generalizable to others working in these contexts: (a) coping with racism and microaggressions; (b) the role and impact of identity politics; (c) community insider/outsider tension; and (d) managing personal distress associated with the research topics and process. These themes are discussed to illuminate ways that Indigenous researchers, engaged in research on Indigenous topics and/or with Indigenous communities, are challenged and affected by their work.     

Suicide Ideation among Adolescent American Indians: An Application of General Strain Theory

The objective of this study is to compare suicidal thoughts among American Indian/Alaskan Natives (AI/AN) to a series of non-AI/AN comparison groups, using data from the National Longitudinal Study of Adolescent to Adult Health. This study uses general strain theory as the guiding framework for understanding differences between racial groups in their suicidal ideation. A statistically significant difference is present between AI/AN and comparisons in suicidal ideation. The factors that may explain these differences addressed in this study include: alcohol abuse, exposure to suicidal behavior of friends and family, depression, and gun access. Implications for prevention and treatment are discussed.     

Demographic,Clinical, and Service Utilization Factors Associated with Suicide‐Related Visits among Alaska Native and American Indian Adults

Alaska Native and American Indian people (AN/AIs) are disproportionately affected by suicide. Within a large AN/AI health service organization, demographic, clinical, and service utilization factors were compared between those with a suicide‐related health visit and those without. Cases had higher odds of a behavioral health diagnosis, treatment for an injury, behavioral health specialty care visits, and opioid medication dispensation in the year prior to a suicide‐related visit compared to gender‐, age‐, and residence‐ (urban versus rural) matched controls. Odds of a suicide‐related visit were lower among those with private insurance and those with non‐primary care ambulatory clinic visits.     

Cultural Missteps and Ethical Considerations with Indigenous Populations: Preliminary Reflections from Northeastern Ontario,Canada

Within this submission the authors share their experiences as a blended research team with Aboriginal community and mainstream academic researchers. The team has collaborated since 2004 on several externally funded research projects. Initially, the team engaged in research through mainstream methodologies. In the process, the community co-researchers and participants were silenced through mainstream cultural practices that were unfamiliar and meaningless in Wikwemikong culture. More recently, the team has employed a community conceived de-colonizing methodology, developed from within Wikwemikong Unceded Indian Reserve. Within this submission, the authors will highlight their initial cultural missteps, followed by more recently utilized culturally relevant approaches. It is proposed that what might be ethically sound research with mainstream participants and among mainstream researchers can silence and subvert practices among those from marginalized groups/cultures. Provisional suggestions are offered for researchers interested in co-researching in Aboriginal communities.     

Psychological Trauma Among American Indian Families: A Two-Generation Study

The findings presented in this article come from a two-generation study exploring the psychological impact of trauma among American Indian/Alaskan Native (AI/AN) families and its perceived relationship to substance abuse across generations. Psychological traumas and stressors found to be pervasive across generations included physical and sexual abuse as well as persistent discrimination and racism, such as fear of having children removed from the home. A noteworthy finding was a decrease in reports of childhood traumas across the two generations within this sample. Implications and recommendations for clinicians and researchers working with AI populations are discussed in light of the findings.     

Changing the Academic Integrity Climate on Campus Using a Technology-Based Intervention

This article focuses on the use of a technology-based intervention to change academic integrity (AI) knowledge and attitudes. Using a sample of more than 5,000 freshman students drawn from two major midwestern universities in the United States over a 3-year period, an online intervention was used to determine whether AI knowledge and attitudes could be changed. Based the results of this study, AI knowledge and attitudes can be improved using an online intervention. These results contribute to a better understanding of the AI climate on campus and suggest that technology-based interventions can be used to enhance knowledge and change attitudes toward AI on campus.     

An Exploratory Evaluation of the Family Meal Intervention for Adolescent Anorexia Nervosa

Although weight restoration is a crucial factor in the recovery of anorexia nervosa (AN), there is scarce evidence regarding which components of treatment promote it. In this paper, the author reports on an effort to utilize research methods in her own practice, with the goal of evaluating if the family meal intervention (FMI) had a positive effect on increasing weight gain or on improving other general outcome measures. Twenty‐three AN adolescents aged 12–20 years were randomly assigned to two forms of outpatient family therapy (with [FTFM] and without [FT]) using the FMI, and treated for a 6‐month duration. Their outcome was compared at the end of treatment (EOT) and at a 6‐month posttreatment follow‐up (FU). The main outcome measure was weight recovery; secondary outcome measures were the Morgan Russell Global Assessment Schedule (MRHAS), amenorrhea, general psychological symptoms, and eating disorder symptoms. The majority of the patients in both groups improved significantly at EOT, and these changes were sustained through FU. Given its primarily clinical nature, findings of this investigation project preclude any conclusion. Although the FMI did not appear to convey specific benefits in causing weight gain, clinical observation suggests the value of a flexible stance in implementation of the FMI for the severely undernourished patient with greater psychopathology.     

Rose L. Clark: award for distinguished early career contributions to psychology in the public interest

Presents a citation for Rose L. Clark, who received the Award for Distinguished Early Career Contributions to Psychology in the Public Interest "for her leadership and contributions to the field of psychology in the awareness and advancement of research, practice, and policy on behalf of American Indian/Alaska Native (AI/AN) children, families, and communities." A brief profile and a selected bibliography accompany the citation. ((c) 2006 APA, all rights reserved).     

Cultural models of education in American Indian,Asian American and European American contexts

Three studies examined models of education among American Indian (AI), Asian American (AA), and European American (EA) students. Cultural models of education are patterns of ideas and practices relevant to schools, teachers, and self that mediate and regulate behavior in the academic domain. In study 1, mainstream university students (N = 148) and AI University students (N = 187) viewed education as a tool for success. AI, however, generated more mentions of education as a tool for community success and more negative associations to education. Study 2 (N = 166) showed that AI, in contrast to EA and AA, placed family and community concerns ahead of academic concerns. In Study 3 (N = 118), AI and AA endorsed independent and interdependent representations of self, while EA endorsed only independent representations. For AI and AA, but not for EA, interdependent representations were positively related to trust for teacher.     

Population-Wide Parenting Intervention Training: Initial Feasibility

A population-level approach to deliver parenting and family support is a necessary but neglected approach needed to reduce the high prevalence of emotional/behavioral problems in children, decrease inadequate and potentially abusive parenting practices, and to provide improved parenting support to all parents within a specified population. We examined the initial feasibility of a large-scale professional training regimen to prepare existing service providers to implement an evidence-based preventive intervention in the realm of parenting and family support. Data from the U.S. Triple P System Population Trial are used to illustrate how a parenting and family support intervention can be successfully disseminated to a large, multidisciplinary workforce. We discuss lessons learned from this dissemination effort as well as implications for population-based approaches to child and family well-being.     

Interpersonal Psychotherapy—Adolescent Skills Training With Youth From Asian American and Immigrant Families: Cultural Considerations and Intervention Process

Although research has identified effective evidence-based depression prevention interventions for diverse youth, little is known about how the intervention process unfolds with immigrant family youth. This study utilized a qualitative approach to explore cultural and clinical differences in the implementation of Interpersonal Psychotherapy–Adolescent Skills Training (IPT-AST) in two schools, one serving youth from primarily immigrant, Asian American families and the second, youth from mostly nonimmigrant, non-Hispanic White families. A total of 131 IPT–AST sessions were audio recorded, transcribed, and coded for presence and patterns of cultural and clinical constructs. Results revealed that sessions with immigrant family youth were more likely to contain discussions of interpersonal problems characterized by estrangement, goals of spending time together with important others, mentions of emotion suppression and academic achievement expectations, conversations about acculturation, differences in value orientation, and discomfort with implementing new intervention skills. Dialogue from interventionist and youth exchanges is presented to illustrate how these themes emerged and were addressed by interventionists in a culturally responsive manner. The study highlights how IPT–AST with immigrant family and Asian American youth may unfold differently compared to youth from nonimmigrant families. Implications of findings for providers are discussed.     

Fidelity Assessment to Improve Teacher Instruction and School Decision Making

Teachers must provide high-quality instruction based on evidence-based practices to provide students meaningful opportunities to learn and to improve school outcomes. Although teachers have access to a variety of resources on evidence-based practices, poor implementation may limit the effectiveness of teacher practices, as indicated by low levels of student achievement and flat rates of progress. However, inadequate student response to instruction or intervention may also be due to a mismatch between teacher practices and student needs such as when students require more intensive support. As a result, school teams must determine the degree to which teachers provide instruction and intervention as intended (i.e., fidelity of implementation) to determine if an inadequate student response is due to poor implementation of practices that match student needs or due to a need for more intensive support. The authors report the necessity of including contingencies for measuring fidelity within school-wide assessment practices. Methods for assessing fidelity that can be used by school administrators, school psychologists, and teachers are discussed. Examples of recommended methods are provided for both academic and behavioral practices.