Culturally Adapting Caring Contacts for Suicide Prevention in Four Alaska Native and American Indian Communities.

AIM: Despite substantial tribal, state, and federal effort, American Indian and Alaska Native (AI/AN) suicide rates have changed little in the last 30 years, prompting attention to new and innovative approaches to this persistent health disparity. Suicide prevention interventions with demonstrated success in other populations may be useful in AI/AN communities. Caring Contacts is a suicide prevention intervention that has been adapted and shown to reduce suicide ideation, attempts, and deaths in other populations. CONCLUSION: Overall, AI/AN study participants in four diverse AI/AN communities endorsed the use of Caring Contacts for suicide prevention in their communities. Intervention adaptations for use in these communities centered primarily on message frequency and timing as well as expanding access to Caring Contacts. The results of this study may be applicable to other populations that experience suicide-related health disparities. METHODS: We used a community-based participatory research approach to gather qualitative data from community members, healthcare providers, and leaders in four AI/AN communities. These data were analyzed thematically and used to adapt Caring Contacts for use in a subsequent clinical trial with AI/AN people at high risk for suicide. RESULTS: A total of 189 community members and other health system stakeholders in four tribal communities participated in focus groups and interviews. Caring Contacts was perceived in all communities to be acceptable. Feedback for intervention adaptations focused on the themes of trial eligibility criteria; instruments; message frequency, timing, and content; and cultural considerations.

A Culturally-Grounded Biopsychosocial Assessment Utilizing Indigenous Ways of Knowing with the Cowichan Tribes.

Extant research foregrounds the need for culturally responsive, evidence-based mental health practices when working with Indigenous communities. This study presents an Indigenous biopsychosocial assessment designed by members of the Cowichan Tribes to evaluate the social, developmental, and mental health histories of Cowichan youth. The assessment takes the form of an in-depth narrative interview whose parameters were developed through a culturally grounded, community-based process. This process supported a focus on relationality, interdependence, and intergenerational transmission of knowledge during the interview. Five participants aged 12-18 years completed interviews, which yielded sufficient data to enable completion of both Indigenous and standard biopsychosocial assessments.

Insights from Cowichan: A Hybrid Approach to Understanding Suicide in One First Nations' Collective.

Explanations for suicide are theorized primarily in terms of the individual, seldom considering the interdependent orientation of Indigenous communities. Drawing on the interpersonal theory of suicide and settler colonial theory, this study addresses Indigenous suicide on two levels: the individual and the collective. Twenty-one interviews were conducted with members of the Cowichan Tribes to understand reasons for suicide in one community. Qualitative analysis identified explanatory constructs proposed by the interpersonal theory as well as negative conditions stemming from colonialism, as proposed by settler colonial theory. These results argue that Indigenous suicidal behavior is best understood from an interdependent standpoint.