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

Danielle Parker & Philmer Bluehouse

November 15, 2011

DEVELOPING COMMUNITY-BASED INTERVENTIONS FOR AMERICAN INDIAN MENTAL HEALTH

NNR-08-222

RESILIENCE, SURVIVAL, HISTORICAL TRAUMA & HEALING

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

2011 Navajo Nation Human Research Review Board Conference

1. 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

2. 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

BACKGROUND

SPECIFIC AIMS1. Conduct an in-depth study of the mental health needs,

current stressors, coping strategies, and strengths of 16 Navajo adolescents and their families.

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

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

4. 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 Philmer Bluehouse to complete curriculum

Curriculum approved by NNHRRB

Community Resources/ Protective Factors

Community Identified Problems/ Risk Factors

Program Logic ModelCo

ntex

t

Inputs Activities Short-term Outcomes

Long-term Outcomes

Y1’át’ééh

Ná1dléé[

Working to Restore

Balance & Harmony Model

Components of Program

Session Structure

Improved Social

Resources

Improved Cognitive Resources

Improved Emotional Resources

Decreased Mental Health

Problems

Community Outcomes/

Healing

Theories Guiding Logic Model

• Ecological

• Empowerment

• Resilience

• Cultural assets

• Holistic

• Grassroots approach

•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 Resources/Protective 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

Community Identified Problems/Risk Factors

• 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

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

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

I.

•Opening Prayer

II.

•Introduction/Review Objectives

III.

•Connection Activity

IV.

•Positive Wisdom

V.

•Healing Circle

VI.

•Group Reflection

VII.

•Closing Prayer

• Social support

• Caring relationships

• High expectations

• Meaningful participation

• Use of resources

• Family social dynamics

• Effective parenting practices

 

Short-term Outcomes: Improved Social Resources

• Connection to traditional culture (enculturation)

• Skills to cope with/reduce stress and trauma

• Problem-solving skills

• Conflict resolution skills

 

Short-term Outcomes: Improved Cognitive Resources

• Self-efficacy

• Cooperation & communication

• Empathy

• Future goals & aspirations

• Self-awareness

 

Short-term Outcomes: Improved Emotional Resources

• Depression symptoms

• PTSD symptoms

• Suicidality

• Substance use/abuse

 

Long-term Outcomes: Decreased Mental Health Problems

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

• 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

 

Implementation

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; jgoodkind@salud.unm.edu