Efficacy of an mHealth Intervention (BRAVE) to Promote Mental Wellness for American Indian and Alaska Native Teenagers and Young Adults: Randomized Controlled Trial.

BACKGROUND: Culturally relevant interventions are needed to help American Indian and Alaska Native (AI/AN) teenagers and young adults navigate common risky situations involving family and friends, including drug and alcohol misuse, dating violence, and suicidality. Leveraging We R Native, a multimedia health resource for Native teenagers and young adults, staff of the Northwest Portland Area Indian Health Board designed the BRAVE intervention for Native youth. The program is delivered via SMS text messaging and includes role model videos, mental wellness strategies, links to culturally relevant resources, and social support from family and friends. OBJECTIVE: We aim to conduct a randomized controlled trial of the BRAVE intervention among AI/AN teenagers and young adults (aged 15-24 years) to assess its impact on their physical, mental, and spiritual health; their resilience and self-esteem; and their coping and help-seeking skills. METHODS: From October to December 2019, we recruited 2334 AI/AN teenagers and young adults nationwide via social media channels and SMS text messages and enrolled 1044 participants. AI/AN teenagers and young adults enrolled in the study received either BRAVE SMS text messages, designed to improve mental health, help-seeking skills, and cultural resilience, or 8 weeks of science, technology, engineering, and math (STEM) SMS text messages, designed to elevate and reaffirm Native voices in STEM and medicine and then received the BRAVE SMS text messages. The impacts of the BRAVE intervention were tested using linear mixed-effect models and linear regressions. RESULTS: A total of 833 AI/AN teenagers and young adults were included in the analysis. Individuals in the BRAVE and STEM arms showed significant positive trends over the course of the study for all outcomes, except cultural identity and help-seeking behavior. Mean scores were significantly different for health (P<.001), resilience (P<.001), negative coping (P=.03), positive coping (P<.001), self-efficacy (P=.02), and self-esteem (P<.001). Changes in help-seeking self-efficacy were significant in those exhibiting risky behaviors at baseline to exit (P=.01). Those who reported positive coping scores at baseline also reported better health on average; however, no difference was found in risky drug and alcohol use (P<.001). The number of participants who used SMS text messages to help themselves increased from 69.1% (427/618) at 3 months to 76% (381/501; P<.001) at 8 months. Similarly, the number of participants who used SMS text messages to help friends or family members increased from 22.4% (138/616) at 3 months to 54.6% (272/498) at 8 months. CONCLUSIONS: This is the first national randomized controlled trial of a mobile health intervention among AI/AN teenagers and young adults to test the efficacy of a mental wellness intervention in relation to STEM career messages. This study provides new insights for supporting the next generation of AI/AN changemakers. TRIAL REGISTRATION: ClinicalTrials.gov NCT04979481; https://clinicaltrials.gov/ct2/show/NCT04979481.

The BRAVE Study: Formative Research to Design a Multimedia Intervention for American Indian and Alaska Native Young Adults.

American Indian and Alaska Native (AI/AN) young adults are strong and resilient. Interventions designed to improve their mental health and help-seeking skills are especially needed, particularly those that include culturally relevant resources and relatable role models. This paper presents formative research from the BRAVE study, a five-year community based participatory research project led by the Northwest Portland Area Indian Health Board. Formative research included three phases and more than 38 AI/AN young adults and content experts from across the United States. Results indicate that behavioral interventions can be feasibly delivered via text message to AI/AN young adults and that including Native youth in the formative research is critical to designing a comprehensive, culturally-responsive intervention. Lessons learned from this five-year process may help other youth-serving organizations, prevention programs, policymakers, researchers, and educators as they support the next generation of AI/AN leaders.

Indigenous Perspectives for Strengthening Social Responses to Global Environmental Changes: A Response to the Social Work Grand Challenge on Environmental Change.

The "Grand Challenges for Social Work," is a call to action for innovative responses to society's most pressing social problems. In this article, we respond to the "Grand Challenge" of Creating Social Responses to a Changing Environment from our perspective as Indigenous scholars. Over the last several decades, diminishing natural resources, pollution, over-consumption, and the exploitation of the natural environment have led to climate change events that disproportionately affect Indigenous peoples. We present how environmental changes impact Indigenous peoples and suggest culturally relevant responses for working with Indigenous communities. We propose a decolonizing cyclical, iterative process grounded in Indigenous Ways of Knowing.

Boys do(n't) cry: Addressing the unmet mental health needs of African American boys.

If African American boys are contemplating taking their lives at early ages, the hope for future generations is challenging at best. What is going on in African American communities that there is a lack of safe spaces for boys to express their emotions and to share their travails with supportive networks in lieu of ending their lives? The situation of African American boys (ages 5-11) committing suicide at higher levels-more than any other group-and the recent studies regarding the rising rates of suicide among African American adolescent boys (12 and older) call for greater reflection and more discourse around the mental health challenges faced by this group. We must identify the emotional and psychological reasons that underlie suicidal behaviors for African American boys and work to provide immediate intervention. Families, educators, and community workers play key roles in identifying signs of mental health challenges such as depression and connecting African American boys to mental health care services. In this article, the authors discuss specific ways to better support boys who exhibit early signs of depression and suicidal behavior. Topics discussed include (1) untreated depression among African American youth; (2) looking deeper at the reasons for untreated depression; (3) misunderstanding and denial of mental health challenges; (4) risk factors in schools; (5) harsh discipline practices; (6) low teacher expectations; and (7) disconnection from adults. (PsycINFO Database Record