Wexler receives $700,000 NIH grant to study suicide prevention strategies among Alaska Native youth

December 15, 2014

The annual suicide death rate for American Indian/Alaska Native youth is as much as 18 times higher than the national average for all American youth. The majority of Native youth never receive behavioral health care, even when showing signs of anxiety, anger, depression, or other mental distress and when actively suicidal.

Now, through a $700,000 grant from the NIH’s National Institutes of Mental Health, researchers led by Associate Professor of Community Health Education Lisa Wexler of the University of Massachusetts Amherst School of Public Health and Health Sciences aim to develop a system of culturally-responsive public health intervention strategies that will reduce youth suicidal behavior and bolster protective factors in tribal communities.

Working with tribal partner the Maniilaq Association and the Northern Alaska Wellness Initiative (NAWI), a group of Alaska Native community members, behavioral health providers and academics dedicated to translating research to practice, Wexler will implement and evaluate a pilot-study intervention program titled Professional-Community Collaborations for At-risk youth Engagement and Support, or PC-CARES.

PC-CARES has been designed to enhance collaborations among Native paraprofessional and non-Native professional mental health providers, reduce stigma for mental health help-seeking, and promote earlier interactions between providers and community members to better meet the needs of Native youth.

“Our intervention will address the vulnerabilities of persons – and communities – before individuals become suicidal, and to account for patterns of help-seeking and extended support in tribal communities,” notes Wexler. “Instead of focusing on individual-level change, PC-CARES will strengthen, expand, and track the systems of youth support at community and institutional levels, which should offer many more ways to access support and reduce youth suicidal behavior. There is a significant gap between mental health services and family/peer support for Native youth who are at risk for suicide. PC-CARES will align these resources, galvanize supporters, and offer meaningful, community-based help.”

By using social network research methodologies, they will be able to identify community support systems with the most potential to influence and therefore prevent suicidal behavior. Native village counselors and non-Native clinicians will be trained to offer culturally-appropriate and clinically-sound suicide intervention and prevention strategies and to facilitate the community outreach sessions that will bring together cultural/local knowledge and clinical expertise. This approach will promote knowledge exchange and relationship-building among providers and between them and community members.

“PC-CARES creates a process where local people – service providers, parents and other community members -- can share stories and information so that people are reaching out to others more often in their everyday lives, noticing people that might be vulnerable, and figuring out ways to support them,” says Wexler.

The PC-CARES training uses adult learning theory and community development principles. Adds Wexler, “Instead of doing community education in a way that is didactic, where the person that's presenting tells the people how to do it, we're really trying to build those understandings from the ground up through community member stories. Really, it's less delivering the training than it is facilitating a conversation. The process starts with a short film featuring local community members sharing stories of resilience or care. Then, the facilitators – either the mental health clinician or the village-based counselor – will tell a story about providing care or reaching out to someone in ways that made a difference. People in attendance will then be invited to share their own stories and ideas. What’s more, they will find out about the mental health and wellness resources available to them and their loved ones. These sessions are intended to create spaces for lateral knowledge-sharing, but also to build trust between and among the service providers and community members.”

This educational approach is being augmented by intersecting and new wellness initiatives that offer informal support for recovery, re-entry into the community after incarceration or inpatient treatment, opportunities for youth leadership and mentoring and a re-working of the suicide service system.

The multilevel approach promises to make a big difference in the 12 small, remote Arctic communities served by the wellness programs, and Wexler and her colleagues will track the formal and informal support networks and service utilization before and 12 months after the program’s initiation. The study region also has had a suicide tracking system operational since 1990, which will provide Wexler an opportunity to fully document the intervention’s effect on suicidal behavior.

“This is an important step in our next stage of research,” says Wexler, “as this sort of program evaluation has been rarely done.”

Wexler concludes, “The thing that we're really trying to do with PC-CARES and the wellness initiatives in Northwest Alaska is to increase hope and possibility. Young people want the adults in their lives to spend more time just checking in with them, talking to them about what's going on in their lives and about their futures. The wellness initiatives strive to encourage these interactions, and provide spaces for community members to come together in productive ways, regularly. Those kinds of everyday things can make a really big difference for young people, their families and communities.”