Considering the importance of 'Communities of Practice' and Health Promotion Constructs for Upstream Suicide Prevention.

Background: Suicide is a serious and growing health inequity for Alaska Native (AN) youth (ages 15-24), who experience suicide rates significantly higher than the general U.S. youth population. In low-resourced, remote communities, building on the local and cultural resources found in remote AN communities to increase uptake of prevention behaviors like lethal means reduction, interpersonal support, and postvention can be more effective at preventing suicide than a risk-referral process. This study expands the variables we hypothesize as important for reducing suicide risk and supporting wellbeing. These variables are: 1) perceived suicide prevention self-efficacy, 2) perceived wellness self-efficacy, and 3) developing a 'community of practice' (CoP) for prevention/wellness work. Method: With a convenience sample (N = 398) of participants (ages 15+) in five remote Alaska Native communities, this study characterizes respondents' social roles: institutional role if they have a job that includes suicide prevention (e.g. teachers, community health workers) and community role if their primary role is based on family or community positioning (e.g. Elder, parent). The cross-sectional analysis then explores the relationship between respondents' wellness and prevention self-efficacy and CoP as predictors of their self-reported suicide prevention and wellness promotion behaviors: (1) working together with others (e.g. community initiatives), (2) offering interpersonal support to someone, (3) reducing access to lethal means, and (4) reducing suicide risk for others after a suicide death in the community. Results: Community and institutional roles are vital, and analyses detected distinct patterns linking our dependent variables to different preventative behaviors. Findings associated wellness self-efficacy and CoP (but not prevention self-efficacy) with 'working together' behaviors, wellness and prevention self-efficacy (but not CoP) with interpersonal supportive behaviors; both prevention self-efficacy and CoP with higher postvention behaviors. Only prevention self-efficacy was associated with lethal means reduction. Conclusions: The study widens the scope of suicide prevention. Promising approaches to suicide prevention in rural low-resourced communities include: (1) engaging people in community and institutional roles, (2) developing communities of practice for suicide prevention among different sectors of a community, and (3) broadening the scope of suicide prevention to include wellness promotion as well as suicide prevention.

Adapting PC CARES to Continue Suicide Prevention in Rural Alaska During the COVID-19 Pandemic: Narrative Overview of an In-Person Community-Based Suicide Prevention Program Moving Online.

This paper presents how a community mobilization program to prevent suicide was adapted to an online format to accommodate the impossibility of in-person delivery in Alaska Native communities during the COVID-19 pandemic. The intervention, Promoting Community Conversations About Research to End Suicide (PC CARES), was created collaboratively by researchers and Alaska Native communities with the goal of bringing community members together to create research-informed and community-led suicide prevention activities in their communities. To continue our work during the COVID-19 pandemic and restrictions, we adapted the PC CARES model to a synchronous remote delivery format. This shift included moving from predominantly Alaska Native participants to one of a mainly non-Native school staff audience. This required a pivot from Alaska Native self-determination toward cultural humility and community collaboration for school-based staff, with multilevel youth suicide prevention remaining the primary aim. This reorientation can offer important insight into how to build more responsive programs for those who are not from the communities they serve. Here, we provide a narrative overview of our collaborative adaptation process, illustrated by data collected during synchronous remote facilitation of the program, and reflect on how the shift in format and audience impacted program delivery and content. The adaptation process strove to maintain the core animating features of self-determination for Alaska Native communities and people as well as the translation of scientific knowledge to practice for greater impact.

Implementation beyond the clinic: Community-driven utilization of research evidence from PC CARES, a suicide prevention program.

While implementation and dissemination of research is a rapidly growing area, critical questions remain about how, why, and under what conditions everyday people integrate and utilize research evidence. This mixed-methods study investigates how participants of Promoting Community Conversations About Research to End Suicide (PC CARES) make sense of and use research evidence about suicide prevention in their own lives. PC CARES is a health intervention addressing the need for culturally responsive suicide prevention practices in rural Alaska through a series of community Learning Circles. We analyzed PC CARES transcripts and surveys for 376 participants aged 15+ across 10 Northwest Alaska Native villages. Quantitative analysis showed significant correlations between five utilization of research evidence (URE) factors and participants' intent to use research evidence from PC CARES Learning Circles. Key qualitative themes from Learning Circle transcripts expanded upon these URE constructs and included navigating discordant information, centering relationships, and Indigenous worldviews as key to interpreting research evidence. We integrate and organize our findings to inform two domains from the Consolidated Framework for Research Implementation: (1) intervention characteristics and (2) characteristics of individuals, with emphasis on findings most relevant for community settings where self-determined, evidence-informed action is especially important for addressing health inequities.

Student Nurse Screening, Brief Intervention and Referral to Treatment Training Program: Analysis 2016-2019.

BACKGROUND: Screening, brief intervention and referral to treatment (SBIRT) is an evidence-based set of skills and strategies used by health care providers. Data have suggested SBIRT should be used in detecting persons at risk for substance use and be included in every primary care encounter, as many needing substance abuse treatment do not receive it. METHODS: This descriptive study evaluated data for 361 undergraduate student nurses who participated in SBIRT training. Pretraining and 3-month posttraining surveys were used to evaluate changes in trainees' knowledge, attitudes, and skills toward people with substance use disorder. A satisfaction survey immediately after the training measured satisfaction with and usefulness of the training. RESULTS: Eighty-nine percent of students self-reported that the training increased their knowledge and skills related to screening and brief intervention. Ninety-three percent reported that they intended to use these skills in the future. Pre-post measures indicated statistically significant increases in knowledge, confidence, and perceived competence on all measures. CONCLUSIONS: Both formative and summative evaluation assisted in improving trainings each semester. These data confirm the need to integrate SBIRT content across the undergraduate nursing curriculum and include faculty and preceptors to improve rates of screening in clinical practice.

Community mobilization for rural suicide prevention: Process, learning and behavioral outcomes from Promoting Community Conversations About Research to End Suicide (PC CARES) in Northwest Alaska.

RATIONALE: This study evaluates the process and preliminary outcomes of Promoting Community Conversations About Research to End Suicide (PC CARES), an intervention that brings key stakeholders together so they can discuss suicide prevention research and find ways to put it into practice. Originally piloted in remote and rural Alaskan communities, the approach shows promise. METHOD: Using a multi-method design, the study describes a series of locally-facilitated "learning circles" over 15 months and their preliminary results. Sign-in sheets documented participation. Transcriptions of audio-recorded sessions captured facilitator fidelity, accuracy, and the dominant themes of community discussions. Linked participant surveys (n=83) compared attendees' perceived knowledge, skills, attitudes, and their 'community of practice' at baseline and follow-up. A cross-sectional design compared 112 participants' with 335 non-participants' scores on knowledge and prevention behaviors, and considered the social impact with social network analyses. RESULTS: Demonstrating feasibility in small rural communities, local PC CARES facilitators hosted 59 two to three hour learning circles with 535 participants (376 unique). Local facilitators achieved acceptable fidelity to the model (80%), and interpreted the research accurately 81% of the time. Discussions reflected participants' understanding of the research content and its use in their lives. Participants showed positive changes in perceived knowledge, skills, and attitudes and strengthened their 'community of practice' from baseline to follow-up. Social network analyses indicate PC CARES had social impact, sustaining and enhancing prevention activities of non-participants who were 'close to' participants. These close associates were more likely take preventive actions than other non-participants after the intervention. CONCLUSION: PC CARES offers a practical, scalable method for community-based translation of research evidence into selfdetermined, culturally-responsive suicide prevention practice.

College students' use of transportation networking companies: An opportunity to decrease substance-impaired driving.

Objective: To examine the use of transportation networking companies (TNCs) (eg, Uber) among substance-using students in rural and urban college settings. Participants: Students at two large state universities were randomly selected and screened for substance use. Participants reported use of TNCs generally and after substance use and whether TNC use was on or near campus or in other environments. Methods: Data were evaluated using chi-square test, t-tests, and Fisher's exact tests. Results: Most (85%) participants (n = 99, 61% response rate) had used a TNC. Among students who used TNCs on/near campus, 98% of rural students used them after substance use compared to 85% of urban students (p = .037). We did not detect differences in TNC use by gender or age. Conclusions: Results indicate that TNC use is common after college student substance use and may play a particularly important role in preventing impaired driving for rural campuses where existing transportation options are limited.

Promoting Community Conversations About Research to End Suicide: learning and behavioural outcomes of a training-of-trainers model to facilitate grassroots community health education to address Indigenous youth suicide prevention.

Alaska Native (AN) youth suicide remains a substantial and recalcitrant health disparity, especially in rural/remote communities. Promoting Community Conversations About Research to End Suicide (PC CARES) is a community health intervention that responds to the need for culturally responsive and evidence-supported prevention practice, using a grassroots approach to spark multilevel and community-based efforts for suicide prevention. This paper describes theoretical and practical considerations of the approach, and assesses the feasibility and preliminary learning and behavioural outcomes of the training-of-trainers model. It details the training of a first cohort of intervention facilitators in Northwest Alaska (NWA). Thirty-two people from 11 NWA village communities completed the PC CARES facilitator training, preparing them to implement the intervention in their home communities. Facilitator pre-post surveys focused on readiness to facilitate, a group quiz assessed participants' understanding of relevant research evidence, and practice facilitation exercises demonstrated competency. Curriculum fidelity and accuracy scores were calculated using audio recordings from learning circles conducted by facilitators in their home communities. Facilitator reflections describe the successes of the model and identify several areas for improvement. As of March 2017, 20 of the 32 trained facilitators in 10 of the 11 participating villages have hosted 54 LCs, with a total of 309 unique community members. Coding of these LCs by 2 independent raters indicate acceptable levels of fidelity and accurate dissemination of research evidence by facilitators. Facilitator reflections were positive overall, suggesting PC CARES is feasible, acceptable and potentially impactful as a way to translate research to practice in under-resourced, rural AN communities. PC CARES represents a practical community education and mobilisation approach to Indigenous youth suicide prevention that displays preliminary success in learning and behavioural outcomes of local facilitators.

Preliminary Evaluation of a School-Based Youth Leadership and Prevention Program in Rural Alaska Native Communities.

Youth Leaders Program (YLP) is a health intervention implemented in a rural Alaskan school district, which utilizes natural helpers and peer leaders to increase protective factors such as school engagement and personal/cultural identities, and to reduce risks associated with drug/alcohol abuse, violence, and bullying. Through these means, the program aims to ultimately decrease the disproportionately high rates of indigenous youth suicide in the region. This paper describes process and outcome evaluation findings from the program during the 2013-2014 school year. Data collected include a survey for program participants done at the beginning and end of the study year (n = 61, complete pairs); pre- and post-intervention school data (attendance, GPA, and disciplinary actions) (n = 86); an all-school survey asking students at the participating schools about their experience with YLP and participating youth (n = 764); interviews with program advisors (n = 11) and school principals (n = 2); and focus groups with participating students at all eleven participating schools at the end of the year. Outcomes included increased school attendance (mean attendance increased from 146 to 155 days) and improved academic performance (mean GPA of 8th, 9th, and 10th graders increased from 3.01 to 3.14) of program participants; positive peer reviews of participating student interventions in cases of bullying, depression, and suicidality; and a reported increase in the sense of agency, responsibility, and confidence among participating youth. The YLP appears to improve school climate and increase school and other protective factors for participating students. Recommendations for program implementation in the future and implications for school health will be discussed.

Gaps Between Self-Rated Job Importance and Abilities for Community Health Workers in Massachusetts.

Introduction Community health workers (CHWs) serve increasingly active roles in clinical care and population health. To identify priorities for training programs, we developed a training needs assessment (TNA) tool by integrating and distilling core competencies previously identified by various national and state agencies. Methods CHWs were asked to self-rate, using a 4-point scale, the importance to their work and their ability to perform 49 competencies categorized under 10 domains. A difference score-Ability minus Importance-was calculated to determine relative Need. Results The 96 CHWs who completed the TNA were mostly female (80%) and Latino (40%). While CHWs indicated training was needed for all competencies, the scores ranged from -0.04 to -0.45, on a scale running from 0 to -3, where larger negative numbers indicate higher need. In general, there was a high level of congruence between individual competencies with high Need and domains with Need, with few outliers. Competencies with high Need scores related to culture, case assessment and coordination, and behavior change. CHWs rated client-based competencies higher than population health competencies in Ability scores (3.43 vs. 3.05, respectively) and Importance scores (3.70 vs. 3.35, respectively). However, overall Need scores showed no difference between client-based and public health-based competencies. Conclusion CHWs can successfully rate the importance of core competencies to their work and rank their ability to perform these competencies. Training needs generally favored clinical individual client-focused skills over prevention and public health competencies. Using scales that incorporate self-rated measures of core competency ability and importance can inform priorities for CHW training programs and contribute to successful curriculum development.