Jessica Goodkind, Beverly Gorman, Laverne Storer, Julia Meredith Hess, Danielle Parker & Philmer Bluehouse November 15, 2011 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 ; 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 ; Years ) – 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

1.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.

 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 Model Context InputsActivities Short-term Outcomes Long-term Outcomes Y1’á t ’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

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 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

 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 Albuquerque, NM (505) ;