Addressing Teen Suicide Through Evidence-Based Interventions
Suicide has been a grave concern to the White Mountain Apache Tribe. During 2001 and 2006, the average suicide rate for the whole tribe was nearly four times the national suicide rate. The suicide rate for individuals aged 15 to 24 was over 7 times the national American Indian or Alaska Native rate for the same age group, and over 13 times the suicide rate for individuals aged 15 to 24 nationally.i To address this issue, tribal leadership, in collaboration with the Johns Hopkins Center for American Indian Health (CAIH), developed the Empowering Our Spirits initiative to prevent suicide. This community-wide effort was developed by a coalition comprised of representatives from different tribal agencies including mental health, foster care, schools, justice system/tribal police force, and community leaders and organizations, such as traditional healers and churches, in collaboration with CAIH. The initiative was implemented in 2006.
Empowering Our Spirits is a multipronged initiative consisting of interventions that target both the entire tribal community as well as activities specific to youth within the tribe. Educational activities, such as media campaigns using the local radio and newspaper, and workshops are designed to raise awareness about suicide throughout the reservation. Empowering Our Spirits also delivers programs to help youth—the population at highest risk for suicide—through gatekeeper training and activities with the elders. Finally, Empowering Our Spirits adapts evidence-based interventions to reach youth who have attempted suicide in an effort to prevent future attempts. The coalition and CAIH staff use suicide and self-injury data collected in the tribally mandated registry to refine these programs continually.
Two of the most successful interventions of the Empowering Our Spirits initiative have been A New Hope and the Re-Embracing Life projects, both of which are home-based interventions that focus on youth aged 10 to 19 who have made a suicide attempt. Both programs use bilingual Apache community mental health workers trained by CAIH staff to help youth and their families. The community mental health workers act as case managers, patient advocates, and family educators for the youth and their families, as well as assist with the logistical components of seeking care, such as providing transportation to appointments and helping youth with their outpatient care plan.
A New Hope is a brief, 2- to 4-hour intervention that was culturally adapted from an Emergency Room Intervention for Adolescent Females, an evidence-based program included in SAMHSA’s National Registry of Evidence-based Programs and Practices. It consists of a 20-minute video and a short workbook that youth work through with their families. The video, which was filmed in the community with Native American actors, demonstrates the serious impact of a suicide attempt on individuals, families, and the community, and features elders—using the Apache language—who emphasize that life is sacred and youth must get help. Community mental health workers watch the video with the youth and their families, then discuss the film, develop a safety plan, and use problem-solving and motivational techniques to reinforce positive aspects of treatment.
Re-Embracing Life is an adaptation of the American Indian Life Skills Development Curriculum, another evidence-based program.ii In this project, community mental health workers deliver nine educational sessions on coping, problem-solving skills, conflict management, and communication skills to youth and their families.
The recent evaluation of New Hope conducted in a pilot, open trial from 2009–2010 demonstrated statistically significant decreases in negative thinking and depressive symptoms among at-risk youths aged 10 to 19 years. Youths showed a 28 percent reduction on their scores for the Children’s Negative Cognitive Error Questionnaire and a 37 percent reduction on their scores for the Center for Epidemiologic Studies Depression Scale following their participation in the program. In summary, the Empowering Our Spirits program demonstrates the White Mountain Apache Tribe’s commitment to using data to drive public health decision making and to address youth suicide through blending evidence-based prevention strategies with traditional expertise.
i Mullany, B., Barlow, A., et al. (2009). “Toward Understanding Suicide Among Youths: Results From the White Mountain Apache Tribally Mandated Suicide Surveillance System, 2001–2006.” American Journal of Public Health, 99(10): 1840–1848.
The Office of Disease Prevention and Health Promotion (ODPHP) challenged America’s health organizations to come up with new and innovative projects that could tackle some of today’s most pressing public health issues.
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