Recommendations for Optimizing xaʔtus (First Face) for Mental Health Training: Insights from Key Informants.

Native adolescents experiencing mental health challenges, including substance misuse, often prefer to seek support from their peers and other informal sources, which may be due to lack of access to, and cultural fit with, professional behavioral health services. xaʔtus (First Face) for Mental Health is a Tribal community-based intervention designed to strengthen networks of informal mental health support and open pathways to more formal support. We sought insights from key informants to optimize the planning, promotion, and delivery of First Face trainings to seven Tribal communities in the Northwest United States. We conducted three focus groups with (1) teens completing a residential chemical dependency program at the Healing Lodge of the Seven Nations (n = 10), (2) clinical staff representing the Healing Lodge's Behavioral Health Department (n = 9), and (3) community members representing educators and social service professionals at five of the Tribal nations that support the Healing Lodge (n = 6). Discussion generated planning, promotion, and training recommendations. Planning recommendations focused on showing respect for trainees' time by holding the training during convenient times and factoring in trainees' commitments to work and family, integrating the training into high school science or health education classes, and taking steps to protect trainees' physical safety in the age of COVID while avoiding "Zoom fatigue." Promotion recommendations highlighted community members' possible reluctance to become a First Face due to fear about the responsibilities associated with taking on this role and the need to emphasize the personal relevance of First Face training. In terms of training delivery, participants emphasized the importance of including engaging, interactive activities; instructing future First Faces in self-care; and acknowledging the impact of traumatic contemporary experiences on mental health, while at the same time preventing heated and distressing political debates. We describe our response to participants' recommendations and the rationale for those responses.

Recommendations for improving adolescent addiction recovery support in six northwest tribal communities.

American Indian and Alaska Native (AI/AN) communities offer tangible and intangible resources, including centuries of indigenous wisdom and resiliency, to support their young people in recovery from substance use disorders. At the same time, tribal youth returning home from residential or inpatient treatment are vulnerable to relapse, especially if they encounter the same environmental triggers in which their substance misuse developed. This study endeavored to learn about community stakeholder perceptions of existing strengths and needs for supporting recovering adolescents among six tribal communities of the Inland Northwest. Using a Tribal Participatory Research approach, we conducted Group Level Assessments with key stakeholders representing educators/coaches, medical and behavioral health providers, social service providers, cultural leaders/elders, and legal professionals among each participating tribe (N = 166). We used content analysis to identify emergent themes among participants' recommendations for improving recovery support. The five emergent themes were (1) Communication, Collaboration, and Accountability among Tribal Departments and Agencies; (2) Community-wide Education; (3) The Importance of Providing Wraparound/Supportive Services; (4) Youth-focused Education, Services, and Events; and (5) Recovery Coaching Model. AI/AN culture was infused within nearly all recommendations for improving recovery support that composed these themes. We discuss specific ways to implement these recommendations, including the forthcoming development of a culturally-grounded community-wide mental health training program developed specifically for, and with, these tribes.