American Indian (AI) youth (aged 15-24 years) have the highest rate of suicide in the United States and they are twice as likely as non-Hispanic whites to have witnessed abuse or violence. The subsequent psychological distress is associated with heart disease (the leading cause of death among AI adults) and suicide. Helping these youths deal with psychological distress may help reduce long-term complications.
Project collaborators pilot-tested an adapted version of Cognitive Behavioral Intervention for Trauma in Schools (CBITS) as a school-based intervention for identifying and reducing psychological distress among American Indian (AI) youth who witness or experience violence (e.g., child abuse, domestic violence). Researchers also pilot-tested Our Life, a 6-month program they designed with an AI community, to help AI adolescents cope with the effects of chronic violence exposure.
Project collaborators adapted CBITS for AI adolescents by incorporating cultural examples, beliefs, and practices. Researchers used a mental health screening questionnaire to survey 6th to 12th grade AI students in 3 communities (names are confidential) in New Mexico about violence-related trauma and enrolled 24 students who met CBITS criteria. Several exclusion criteria were applied, such as physiologic distress due to grief rather than violence exposure and trauma from sexual abuse only. Pairs of mental health providers and school or tribal counselors went through facilitator training to implement the adapted version of CBITS. Sessions were held weekly for 10 weeks with groups of 5–10 participants. Facilitators led discussions about students’ experiences of violence and trauma and the emotional and social stress created by these experiences. During these sessions, the group practiced strategies, such as creating safety plans in case of future violent incidents, relaxation techniques, and ways to deal with negative responses to stress and anxiety. Facilitators also met individually with each student one to three times to address specific needs and held separate group meetings with parents and teachers to provide information about violence exposure, common reactions among exposed youth, and how parents and teachers could help.
More than 71% of the participants attended 8 or more sessions over 10 weeks and nearly all participants (23) were included in data analysis. Participants completed surveys at baseline, the end of the program, and 3 and 6 months after the program. The surveys measured participants’ levels of post-traumatic stress disorder (PTSD), depression and anxiety symptoms, use of coping strategies, and recent exposure to violence. This pilot test did not include a control or comparison group. In focus groups after the program, students reported that they benefited from the sessions and would participate in a similar group in the future. Survey analyses showed that participants reported fewer symptoms of post-traumatic stress disorder, depression, and anxiety as well as less avoidance of their problems. Decreases in students’ anxiety and depression symptoms persisted 6 months after the end of the intervention, but students’ PTSD symptoms returned to initial levels 6 months after they completed the program. Researchers propose that reductions in PTSD symptoms were not sustained because CBITs was designed to focus on acute events and that a program lasting longer than 10 weeks might help AI adolescents address complex, chronic violence.
In Our Life, researchers conducted a pilot test in an AI community to determine how well the program addressed the negative effects of violence and related trauma on the parent-child relationship. Our Life consisted of 3 or 4 evening and 1 Saturday session per month for 6 months (27 sessions). At the sessions, youth and parents worked together and separately to improve family relationships, promote positive parenting skills, strengthen self-esteem, and reconnect with their traditional culture. Our Life activities included role-playing on how to ask friends and family members for help, participating in activities for exploring emotional triggers and responses, and being involved in physical exercises that build trust. All Saturday sessions incorporated working with horses to build cultural connectedness and confidence.
Eighteen youth and 10 of their mothers participated in at least 9 sessions and were included in the data analysis. Researchers surveyed participants 5 times over an 18-month period before participation, 3 months into the program, at program end, and at 6 and 12 months after the program. Researchers measured each participant’s recent exposure to violence as well as self-esteem, willingness to face feelings, quality of life, and connection to AI culture. Each of the five surveys incorporated open-end questions, asked by a trained interviewer, about what the participants wanted to learn and accomplish and what they liked and disliked about the program, what they learned, and any changes they thought could be attributed to participating in the program.
Researchers are analyzing data from participants and plan to disseminate the results. The PRC has received funds from the National Institute of Mental Health to improve and test the effectiveness of the Our Life intervention.
Goodkind JR, Lanoue MD, Milford J. Adaptation and implementation of cognitive behavioral intervention for trauma in schools with American Indian youth. Journal of Clinical Child and Adolescent Psychology 2010;39(6):858-72.