November 14, 2017
A research team led by Associate Professor of Community Health Education Lisa Wexler collaborated on a recently published feasibility study of a community-based intervention aimed at preventing youth suicide among Indigenous Alaskans. In addition to lead author Wexler, contributors included SPHHS research fellow Lucas Trout (now at Maniilaq Association) and evaluation manager Suzanne Rataj, along with Tanya Kirk and Roberta Moto from the Maniilaq Association, and Diane McEachern of the University of Alaska Fairbanks. Their findings appear in the International Journal of Circumpolar Health.
Wexler partnered with mental health practitioners and rural Alaska Native community members to develop a community-based intervention called Promoting Community Conversations About Research to End Suicide (PC CARES) that used a grassroots approach to develop multilevel and community-based methods to prevent suicide. Their work was informed by evidence that shows the current professional mental health practices are inefficient at providing effective and culturally-competent suicide prevention services in rural and remote Alaska.
Facilitators were local Indigenous leaders and service providers. Thirty-four people representing eleven villages attended a 40-hour training prior to implementing PC CARES in their community. These facilitators offered 54 PC CARES learning circles in ten villages over the course of a year. Community members, family members, village-based paraprofessionals, and regional health workers participated in these three-hour long learning circles.
The structure of each learning circle followed a distinct pattern. Facilitators shared with participants the practical research evidence related to suicide prevention. Then, participants discussed how the research applies to their lives and how they, as family members, professionals and/or as a community, want to use that information to prevent suicide. The self-determined approach to suicide prevention enables these front-line persons to translate research into sensible actions that reduce risk factors and increase safety and support.
In their article, the researchers examined “…the theoretical and practical considerations of the approach, and [assessed] the feasibility and preliminary learning and importantly the behavioral outcomes of the training-of-trainers model.” Their results were based on several measures: pre-post assessments of facilitators’ readiness and satisfaction with the approach, facilitator demonstrations and group quiz to evaluate knowledge. Real-time recordings of village learning circles allowed researchers to assess the implementation of the program, and facilitators’ fidelity to the curriculum. Lastly, facilitator reflections on their experiences were overwhelmingly positive and still offered PC CARES developers ideas for improvement. The researchers found an increase in facilitators’ readiness to facilitate, acceptable fidelity to the curriculum, and positive feedback from facilitators’ reflections, leading them to conclude that PC CARES “…offers rural and remote Indigenous communities a practical and scalable method for translating research evidence into community-driven, culturally responsive suicide prevention practice.”