1. Beverly Patchell, RN, MS, PMH-BC New Mexico State University School of Nursing PhD Program

2. Committee Members Mary Hoke, PhD. MSN, RN-BC, PHCNS-BC Public/Community Health Nursing Clinical Specialist Professor, School of Nursing, New Mexico State University Leslie Robbins, PhD, RN, PMH NP-BC, PMH CNS-BC Associate Professor, New Mexico State University School of Nursing Kathleen Chinn, Ed.D. Professor, New Mexico State University School of Speech and Language John Lowe, RN, PhD, FAAN Associate Professor, Florida Atlantic University Christine E. Lynn College of Nursing

3. Introduction and Background BSN and MS/CNS from the University of Oklahoma Clinical Nurse Specialist, Psych/Mental Health – 1988 AANC Certified since 1991 in PMH care of Children and Adolescents Enrolled member of the Cherokee Nation of Oklahoma/Muscogee (Creek) Nation Became a MFP Fellow in 2007-08 Experience in private, public, and tribal substance and psychiatric/mental health settings.

4. Description of the Problem Native American Indian elders refer to alcohol as something that “takes the true spirit of a person and replaces it with a false spirit” (K. Coosewoon (Comanche/Kiowa) 2002-2006 SAMHSA survey results report that of adolescents age 12-20, 27.2% of Oklahoma American Indians in this age range report alcohol use. A 2001 report indicated that use of alcohol across Native American Indian groups varied with location and some areas had as much as 73% of adolescents using alcohol, 42.4% using illicit drugs, and 37.7% reporting marijuana use during the year prior to the survey (U.S. Department of Health and Human Services, 2007). In 2008, the Oklahoma Department of Mental Health and Substance Abuse Services (DMHSAS) reported the cost for substance abuse as nearly $6 billion.

6. Assumptions Drug and alcohol abuse in AI adolescents of the selected tribes of southwestern OK stems from a lack of self-reliance, which leads to a combination of factors, including developmental processes, environmental influences, and stress associated with negotiating traditional and contemporary cultures.

7. Hypotheses There will be a significant decrease in reported substance use/abuse following implementation of a school-based culturally appropriate intervention for southwestern Oklahoma Native American Indian adolescents. There will be a significant increase in Native American Indian self-reliance following implementation of the adapted Self-Reliance substance abuse intervention. There will be significant reductions in perceived stress among Native American Indian students following completion of the adapted Native Self-Reliance Substance Abuse Intervention school-based tool.

8. Cherokee Self-Reliance Theoretical Framework for Substance Abuse Prevention and Treatment Caring for Others » respecting others - being dependable - being accountable » respecting the Creator - using resources provided by the Creator - honoring the Creator BEING RESPONSIBLE Caring for Self » earning an income » getting assistance when needed BEING CONFIDENT Having a Sense of Identity » being proud of heritage » accepting beliefs and values Having a Sense of Self Worth » accepting personal attributes » contibuting to the group BEING DISCIPLINED Setting Goals » making decisions » taking risks Pursuing Goals » creating a plan » getting assistance » redirecting one’s efforts

9. BEING RESPONSIBLE Caring for Self » earning an income » getting assistance when needed » respecting others - being dependable - being accountable » respecting the Creator - using resources provided by the Creator - honoring the Creator BEING DISCIPLINED Setting Goals » making decisions » taking risks » creating a plan » getting assistance » redirecting one’s efforts Pursuing Goals Caring for Others BEING CONFIDENT Having a Sense of Identity » being proud of heritage » accepting beliefs and values = Cherokee Self- Reliance Theoretical Framework

10. Cultural Tailoring It is a truism of health education that programs and interventions will be more effective when they are culturally appropriate for the populations they serve. The various approaches to health education have generally been described in the literature as personalized, targeted and tailored.

11. Personalized approaches are usually generic without customization to the individual. These have also been called standard, generic, or general approaches. Targeted approaches are designed for a specific population (or subgroup of a population); are often based on demographic characteristics and are delivered to all members of a group having similar characteristics. Tailored approaches are more refined and complex and customized to an individual's situation and needs

12. Standard Treatment

13. Example of Cultural Tailoring

14. Measures Adapted Cherokee Self-Reliance Measure - 24 item questionnaire administered during the sessions. Cronbach’s alpha coefficient of.84. Global Appraisal of Individual Needs-Quick Currently being used by 9 AI adolescent and adult substance abuse treatment projects. Alpha’s for adolescents are SA problem -.88; mental distress -.95. Stories of Stress/Linguistic Inquiry and Word Count – software program that translates words into numeric values for quantitative analysis. Stories will specifically be about stress leading to substance use.

15. Population Comanche, Kiowa, Apache, and/or Caddo. By referral from school counselors. Power analysis of 0.8 requires 36 participants. 10 week intervention process in three schools.

16. Thank you and Questions?