Jessica Goodkind, Beverly Gorman, Laverne Storer , Julia Meredith Hess,

1. Reflections from the Research Past to Define Research Forward for the Navajo Nation 2011 Navajo Nation Human Research Review Board Conference Developing Community-Based Interventions for American Indian Mental Health NNR-08-222 Resilience, survival, historical trauma & healing Jessica Goodkind, Beverly Gorman, Laverne Storer, Julia Meredith Hess, Danielle Parker & PhilmerBluehouse November 15, 2011

2. BACKGROUND • THRIVE: Adaptation of Cognitive Behavioral Intervention for Trauma in Schools (NNHRRB-05-164; Year 2005) • Decreased PTSD symptoms, anxiety symptoms, & negative coping strategies • Limitations with appropriateness and acceptability • Our Life Program: CBPR study to develop and implement community-based family program to promote well-being, heal trauma, and prevent future violence (NNHRRB-06-185; Years 2006-2008) • Increased self-esteem, quality of life, positive coping strategies, social support & identification/connection with Navajo culture (youth) • Increased positive parenting practices, self-confidence, social support, community involvement, and cultural knowledge (parents) • Limitations with completion rate, length of program, historical trauma component, integration of cultural teachings

3. SPECIFIC AIMS • Conduct an in-depth study of the mental health needs, current stressors, coping strategies, and strengths of 16 Navajo adolescents and their families. • Use a CBPR approach to adapt a community-based mental health services intervention model based on the results from Aim 1. • Conduct an investigation of the feasibility and acceptability of the revised community-based mental health intervention. • Conduct a waitlist control group study of the implementation and effectiveness of the community-based mental health intervention with 28 Navajo families.

4. METHODS • Conducted 78 interviews • Two interviews each with 14 youth, 17 parents/guardians, and 8 grandparents • Analyzed data, shared with community & Navajo Nation • University and community team developed logic model • Conducted four focus groups with youth, parents, and elders to refine model • Worked with PhilmerBluehouse to complete curriculum • Curriculum approved by NNHRRB

5. Program Logic Model Short-term Outcomes Long-term Outcomes Inputs Activities Community Resources/ Protective Factors Community Identified Problems/ Risk Factors Improved Social Resources Decreased Mental Health Problems Components of Program Y1’át’ééh Ná1dléé[ Working to Restore Balance & Harmony  Model Context Improved Cognitive Resources Community Outcomes/Healing Session Structure Improved Emotional Resources

6. Theories Guiding Logic Model • Ecological • Empowerment • Resilience • Cultural assets • Holistic • Grassroots approach

7. Community Resources/Protective Factors • Spiritual/religious beliefs & practices • K’e (Universal Relations) • Extended family network • Connection to land/physical environments • To’Hajiilee Community Action Team (TCAT) • To’Hajiilee Behavioral Health Services (TBHS) • To’Hajiilee Teen Center • To’Hajiilee Community School

8. Community Identified Problems/Risk Factors • Violence • Historical trauma • Current trauma • Substance abuse • Discrimination • Community conflict • Limited opportunity for positive youth development • Lack of understanding between elders, parents, and youth • Difficulties coping with stress, loss, grief, depression, suicidality, and substance abuse • Limited resources

9. Y1’át’ééh Ná1dléé[: Working to Restore Balance & Harmony • Multigenerational, family program • Integrates prevention, treatment & healing • Positive well-being achieved through making connections • Culturally-based approach • Prioritizes strengths • Wellness orientation • Provides group support, education, skill-building & community engagement

10. Activities: Components of Program • Psychoeducational group structure • Understanding and managing stress and trauma • Conflict resolution training • Anger management training • Self-efficacy and self-awareness promotion • Positive parenting skills • Diné teachings and practices • Motivational interviewing treatment engagement • Experiential activities • Community engagement/social action • Equine Therapeutic activities • Sports and crafts activities • Role playing

11. Activities: Structure of Each Session

12. Short-term Outcomes: Improved Social Resources • Social support • Caring relationships • High expectations • Meaningful participation • Use of resources • Family social dynamics • Effective parenting practices

13. Short-term Outcomes: Improved Cognitive Resources • Connection to traditional culture (enculturation) • Skills to cope with/reduce stress and trauma • Problem-solving skills • Conflict resolution skills

14. Short-term Outcomes: Improved Emotional Resources • Self-efficacy • Cooperation & communication • Empathy • Future goals & aspirations • Self-awareness

15. Long-term Outcomes: Decreased Mental Health Problems • Depression symptoms • PTSD symptoms • Suicidality • Substance use/abuse

16. Long-term Outcomes: Community Outcomes/Healing • Improved community relations/connections/networks • Decreased conflict and violence • Increased feelings of trust/safety • Increased recognition of community strengths, resilience • Increased individual, family, community connections/relations and cohesiveness • Interrupt cycles of violence/substance abuse • Increased individual, family, community well being

17. Implementation • Mixed-method waitlist control group design • Fall 2010/Spring 2011 • Four interviews with each participant • Group 1: pre, post, 3 and 6 month follow-ups • Group 2: pre1, pre2, post, and 3 month follow-up

18. Community advisory Council Our Connection to the Land • Community map project • Council identified individuals’ connectedness to land and historical narratives as important for well-being and healing • Council initiated this project to add to study • Have collected 40-50 place names and narratives • Interactive map will remain in the community for future use Formed in 2005 12 members Monthly meetings Provides guidance on all aspects of study

19. NEXT STEPS • Continue analyzing quantitative and qualitative data • Complete program manual • Share manual on Navajo Nation through workshop/trainings • Address issues of engagement

20. CONTACT INFORMATION University of New Mexico Prevention Research Center Division of Prevention & Population Sciences MSC 11 6145 Albuquerque, NM 87131 (505)272-4462; jgoodkind@salud.unm.edu