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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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
BACKGROUND Forward for the Navajo Nation

  • 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
SPECIFIC AIMS Forward for the Navajo Nation

  • 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
METHODS Forward for the Navajo Nation

  • 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 Forward for the Navajo Nation

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



Community Resources/Protective Factors Forward for the Navajo Nation

  • 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 Forward for the Navajo Nation

  • 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[: Forward for the Navajo NationWorking 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
Activities: Components of Program Forward for the Navajo Nation

  • 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 Forward for the Navajo Nation


    Short-term Outcomes: Forward for the Navajo NationImproved Social Resources

    • Social support

    • Caring relationships

    • High expectations

    • Meaningful participation

    • Use of resources

    • Family social dynamics

    • Effective parenting practices


    Short-term Outcomes: Forward for the Navajo NationImproved Cognitive Resources

    • Connection to traditional culture (enculturation)

    • Skills to cope with/reduce stress and trauma

    • Problem-solving skills

    • Conflict resolution skills


    Short-term Outcomes: Forward for the Navajo NationImproved Emotional Resources

    • Self-efficacy

    • Cooperation & communication

    • Empathy

    • Future goals & aspirations

    • Self-awareness


    Long-term Outcomes: Decreased Mental Health Problems Forward for the Navajo Nation

    • Depression symptoms

    • PTSD symptoms

    • Suicidality

    • Substance use/abuse


    Long term outcomes community outcomes healing
    Long-term Outcomes: Community Forward for the Navajo NationOutcomes/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 Forward for the Navajo Nation

    • 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
    Community advisory Council Forward for the Navajo Nation

    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
    NEXT STEPS Forward for the Navajo Nation

    • Continue analyzing quantitative and qualitative data

    • Complete program manual

    • Share manual on Navajo Nation through workshop/trainings

    • Address issues of engagement


    Contact information
    CONTACT INFORMATION Forward for the Navajo Nation

    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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