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Journeys of the Circle

Journeys of the Circle. A Culturally Relevant Life Skills Intervention for Adolescent Indian Drinking. Research Society on Alcoholism Vancouver, B.C., June 28, 2004. A Collaborative Effort. University of Washington, Department of Psychology, Addictive Behaviors Research Center AND

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Journeys of the Circle

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  1. Journeys of the Circle A Culturally Relevant Life Skills Intervention for Adolescent Indian Drinking Research Society on AlcoholismVancouver, B.C., June 28, 2004

  2. A Collaborative Effort University of Washington, Department of Psychology, Addictive Behaviors Research Center AND The Seattle Indian Health Board

  3. PROJECT FUNDING • National Institute on Alcohol Abuse and Alcoholism (AA12321) • Robert Wood Johnson Foundation

  4. Seattle Indian Health Board (SIHB) • Seattle non-profit serving the Native Community for over 30 years • Offering a wide spectrum of health services for adults, youth, and children

  5. Executive Director Assistant Executive Director Operations Coordinator Community Services Manager Ralph Forquera, MPH Rebecca Gonzales Corpuz Crystal Tetrick, MPH Steve Gallion Seattle Indian Health Board Team

  6. Principal Investigator Co-Principal Investigators Project Post-Docs Research Coordinator Research Assistants G. Alan Marlatt, PhD Mary Larimer, PhD Patricia Mail, PhD, MPH Lillian Huang Cummins, PhD Heather Lonczak, EdD Jessica Cronce June La Marr Sandra Radin Karen Chan Kelly Burns University of WashingtonTeam

  7. UW and SIHB Partnership • In 1997, SIHB youth activities program staff approached members of the Addictive Behaviors Research Center (ABRC), University of Washington about the possibility of collaborating on a grant to develop a brief clinical intervention for adolescent clients of SIHB • The ABRC had several Native students enrolled in the Clinical Psychology program who were enthusiastic about the proposal

  8. Native American Youth • Alcohol use appears to begin at an earlier age among Native adolescents (Beauvais, 1992) • Perhaps as many as one-third of American Indian youth having consumed alcohol by age 11(May, 1986) • Over ½ report having been intoxicated at least once by age 15 (Beauvais, 1996)

  9. Culturally Specific Risk Factors • Ethnic Dislocation (May, 1982; Oetting, Beauvais &Velarde, 1982; Trimble Padilla, & Bell, 1987) • Acculturation Stress (LaFromboise, 1988) • Alienation from the Larger Culture (Moncher et al., 1990) • Unstructured time on reservations, during which drinking is also a response to boredom (Edwards & Edwards, 1988)

  10. Project Beginnings • Native youth were recruited for Focus Groups to provide input about the program • Community Elders were consulted • Meetings between UW and SIHB continued • Specific Aims developed

  11. Initial Project Challenges • Hiring appropriate intervention staff • Gaining community trust • Gathering community and youth input on assessments and intervention materials • Recruiting youth

  12. Project Development Canoe Journey, Life’s Journey

  13. The Canoe Journey • Pacific Northwest Coast people preferred water travel to any other means of transportationDrucker (1955) • Early explorers, missionaries and traders all commented on the Indian canoes, their size, utility, and manufacture(Gunther, 1972; Sproat, 1966) • Canoes were usually made from the straight-grained cedar trees (Drucker, 1955; Sproat, 1966

  14. The Canoe Journey • Canoe clubs were formed for interested adolescents and young adults, but designed to accommodate and include families and, eventually, the whole community

  15. Strengthen Native Identity Involve members of the community Canoe Clubs Canoe Families Powerful Primary Intervention All canoes are DRUG and ALCOHOL Free Reestablishing the Canoe Tradition

  16. Quinault Indian NationOcean Canoe Paddle

  17. Journeys of the Circle Addictive Behaviors Research Center Journeys of the Circle Seattle Indian Health Board Journeys of the Circle University of Washington Canoe Journey a metaphor for Life's Journey

  18. Canoe Journey, Life’s Journey • Development of Culturally Relevant Life Skills Manual • Canoe Journey as a metaphor for life’s journey • Use of other traditionally Native symbols, particularly the Medicine Wheel • Medicine Wheel generally understood to have similar meaning across tribal boundaries

  19. Canoe Journey, Life’s Journey • The Wheel is often used to represent the four directions: North, South, East, West • Four Seasons: Summer, Fall, Winter, Spring • Four parts of self: Physical, Mental, Emotional, Spiritual

  20. 1. The Medicine Wheel/Canoe Journey as a metaphor for Health 2. Who Am I? Beginning at the Center 3. Community Help and Support: Help on the Journey 4. The Quest: Goal Setting 5. Overcoming Obstacles: Solving Problems 6. Effective Communications: Listening to Others & Expressing Self 7. Moods and Coping with Negative Emotions 8. Strengthening our Body and Spirit Canoe Journey, Life’s JourneyThe Manual Sessions

  21. Canoe Journey, Life’s JourneyThe Manual Sessions • The manual sessions are taught by a lead facilitator, and a co-facilitator • The facilitators involve participants through role-plays, practice of skills, and reflective journal writing • The courses can be taught individually or in a group setting • The courses can be taught in one hour blocks or divided into two 3-4 hour sessions

  22. Sample Population • Participants, age 13-19, were initially recruited from Seattle Public Schools and eventually through Outpatient Services at the Seattle Indian Health Board

  23. Geographic Region n=88 Urban n (%) Suburban Rural Education Status n=93 In School Graduated High School Not Attending or Dropped Out 61 (65.6) 25 (26.9) 2 (2.2) 82 (88.2) 5 (5.4) 6 (6.5) Sample PopulationDemographics

  24. Tobacco n (%) Alcohol Cannabis Cocaine Amphetamines Barbiturate/Sedatives Inhalants Hallucinogens Opiates 50 (53.8) 55 (59.1) 49 (52.7) 10 (10.8) 7 (7.5) 1 (1.1) 5 (5.4) 9 (9.7) 5 (5.4) Sample PopulationAlcohol and Drug UseEver Used n=92

  25. Tobacco n=34 Alcohol n=13 Cannabis n=29 12.62 (SD=2.42) 13.08 (SD=1.61) 13.07 (SD=1.81) Sample PopulationAlcohol and Drug UseAge of First Regular Use

  26. Used while in a dangerous situation n=93; n (%) Had accidents or was injured n=93 Had repeated legal problems n=92 Consistently used instead of going to school n=92 4 Includes non-users, coded as zero 13 (14) 7 (7.5) 4 (4.3) 12 (12.9) Sample PopulationAlcohol and Drug UseProblems Associated with Use4

  27. Blacked out due to alcohol n=92 Experienced withdrawal symptoms n=92 Perceives him/herself as maybe or definitely having a substance use problem n=92 4 Includes non-users, coded as zero 14 (15.1) 10 (10.8) 12 (12.9) Sample PopulationAlcohol and Drug UseProblems Associated with Use4

  28. Participants: Demographics (N = 50)

  29. Assessment Measures • Comprehensive Adolescent Severity Index (CASI) • Past month substance use: tobacco, alcohol, marijuana, any drugs excluding tobacco • Rutgers Alcohol Problem Index (RAPI) • Alcohol-related consequences • Situational Confidence Questionnaire (SCQ) • Confidence to resist the urge to drink heavily

  30. Past Month Substance Use

  31. Alcohol-Related Consequences p < .05

  32. Confidence to Resist Urge to Drink

  33. Summary of Results • Trends towards reduced alcohol, marijuana, and other drug use and increased confidence to resist the urge to drink in multiple contexts • increased tobacco use? • Participants reported a significant decrease in alcohol-related consequences at follow-up

  34. Implications/Issues • Environment: Urban versus Reservation • After School Intervention v. Camp setting • Transportation and Food • Can there be one program that works successfully across different Native communities?

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