Reflections from the Research Past to Define Research Forward for the Navajo Nation
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Reflections from the Research Past to Define Research Forward for the Navajo Nation 2011 Navajo Nation Human Research Review Board Conference. Developing Community-Based Interventions for American Indian Mental Health NNR-08-222 Resilience, survival, historical trauma & healing.

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Jessica Goodkind, Beverly Gorman, Laverne Storer , Julia Meredith Hess,

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Reflections from the Research Past to Define Research Forward for the Navajo Nation

2011 Navajo Nation Human Research Review Board Conference

Developing Community-Based Interventions for American Indian Mental Health

NNR-08-222

Resilience, survival, historical trauma & healing

Jessica Goodkind, Beverly Gorman,

Laverne Storer, Julia Meredith Hess,

Danielle Parker & PhilmerBluehouse

November 15, 2011


BACKGROUND

  • 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

  • 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


SPECIFIC AIMS

  • Conduct an in-depth study of the mental health needs, current stressors, coping strategies, and strengths of 16 Navajo adolescents and their families.

  • Use a CBPR approach to adapt a community-based mental health services intervention model based on the results from Aim 1.

  • Conduct an investigation of the feasibility and acceptability of the revised community-based mental health intervention.

  • 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 PhilmerBluehouse to complete curriculum

  • Curriculum approved by NNHRRB


Program Logic Model

Short-term Outcomes

Long-term Outcomes

Inputs

Activities

Community Resources/ Protective Factors

Community Identified Problems/ Risk Factors

Improved Social Resources

Decreased Mental Health Problems

Components of Program

Y1’át’ééh Ná1dléé[

Working to Restore Balance & Harmony

 Model

Context

Improved Cognitive Resources

Community Outcomes/Healing

Session Structure

Improved Emotional Resources


  • Theories Guiding Logic Model

  • Ecological

  • Empowerment

  • Resilience

  • Cultural assets

  • Holistic

  • Grassroots approach


Community Resources/Protective Factors

  • 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 Identified Problems/Risk 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


Y1’át’ééh Ná1dléé[: Working to Restore Balance & Harmony

  • 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


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


    Short-term Outcomes: Improved Social Resources

    • Social support

    • Caring relationships

    • High expectations

    • Meaningful participation

    • Use of resources

    • Family social dynamics

    • Effective parenting practices


    Short-term Outcomes: Improved Cognitive Resources

    • Connection to traditional culture (enculturation)

    • Skills to cope with/reduce stress and trauma

    • Problem-solving skills

    • Conflict resolution skills


    Short-term Outcomes: Improved Emotional Resources

    • Self-efficacy

    • Cooperation & communication

    • Empathy

    • Future goals & aspirations

    • Self-awareness


    Long-term Outcomes: Decreased Mental Health Problems

    • Depression symptoms

    • PTSD symptoms

    • Suicidality

    • Substance use/abuse


    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


    Implementation

    • 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


    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 INFORMATION

    University of New Mexico

    Prevention Research Center

    Division of Prevention & Population Sciences

    MSC 11 6145

    Albuquerque, NM 87131

    (505)272-4462; [email protected]


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