A Native Path to Courage: Feasibility Study of a Culturally Adapted Emotional-Behavioral Prevention Program for American Indian Children
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 入组人数
- 28
- 试验地点
- 1
- 主要终点
- Post-Intervention Youth-reported Anxiety Disorder Symptoms From Pre- to Post-Intervention
研究概览
简要总结
American Indians (AI) are at greater risk for anxiety and depression early in life. This is concerning given the potential negative effects of these conditions across the lifespan (substance use, suicide). Available culturally adapted prevention and early interventions (PEIs) for anxiety and depression in AI youth are limited. Thus, there is a critical need for the development and evaluation of a culturally consonant, brief PEI for anxiety and depression in AI youth. The investigators' goal is to provide the community with a potentially successful PEI to mitigate AI youth's anxiety and depression that integrates culture and traditions for delivery in schools. The Specific Aims of the proposed research were to 1) culturally adapt a PEI program for AI youth living on a Northern Plains tribal reservation (chosen by the Cultural Advisory Board; CAB), 2) evaluate the feasibility and acceptability of the culturally-adapted program with AI youth living on the reservation, and 3) estimate effect size changes in anxiety and depressive symptoms of the culturally adapted program with the AI youth. The investigators built upon the investigators' strong community relationships and CBPR methods to achieve these aims. The investigators partnered with the CAB to culturally adapt the PEI program for AI youth in year 1 and 2 using a CBPR framework, including AI youth and parents. In year 2, the investigators trained an AI school counselor from the tribal community and a white school counselor from the two tribal serving schools on the reservation to implement the adapted PEI program. We pilot tested the 6-week program (one 20-30 minute session per week) with 28 AI 3rd-6th graders in two schools serving youth from the reservation in year 3. The investigators will partner with the tribal community to further refine and tailor the adapted PEI program using the results of this study. Moreover, further testing of the refined program's efficacy and sustainability will be conducted using a larger sample and randomized, two-group design.
详细描述
American Indians (AI) are at greater risk for anxiety and depression early in life. This is concerning given the potential negative effects of these conditions across the lifespan (substance use, suicide). Available culturally adapted prevention and early interventions (PEIs) for anxiety and depression in AI youth are limited. Thus, there is a critical need for the development and evaluation of a culturally appropriate, brief PEI for anxiety and depression in AI youth. These were the three main goals of this study: 1) Partner with a Northern Plains tribal community to culturally adapt the PEI program for AI youth living on the reservation. 2) evaluate whether they were able to successfully provide the program to AI youth in two tribal schools and whether youth would accept/enjoy the program, and 3) test whether there were changes in anxiety and depressive symptoms, as well as resilience, among the AI youth from pre- to post-intervention. The investigators partnered with the tribal community, including AI youth and parents, to culturally adapt the PEI program in years 1 and 2. In year 3, the investigators trained an AI school counselor from the tribal community and a white school counselor to provide the adapted PEI program in the two tribal-serving schools. Twenty-eight AI 3rd-6th graders (8-12 years-old) participated in the program. The investigators will continue to partner with the tribal community to further refine and tailor the culturally adapted program using the results from this study. Moreover, further testing of the refined program's efficacy and sustainability will be conducted using a larger sample and control group.
This study built upon a community-based participatory research partnership with a Northern Plains tribal community to culturally adapt a brief and evidence-based prevention and early intervention (PEI) program addressing anxiety and depression in American Indian (AI) 8-12-year-olds. The investigators evaluated how feasible it would be for AI providers from the tribal community to deliver the adapted intervention to AI youth attending two schools serving the tribe. The investigators also tested the hypotheses that AI youth will find the program acceptable and enjoyable, and it will reduce anxiety and depressive symptoms from pre- to post-intervention.
The investigators used an iterative adaptation process within a CBPR framework to culturally adapt the evidence-based PEI program. It involved collaborating with the Cultural Advisory Board (CAB) and conducting adult work groups and youth focus groups with keys community stakeholders, including AI youth and parents, to determine cultural adaptations and adapt the program. The investigators first collaborated with the CAB in reviewing prior literature on anxiety and depression, as well as the non-adapted PEI program. The CAB developed an initial conceptual model of what factors may cause or put AI youth at risk for anxiety and depression. In addition the model included what outcomes were expected from a prevention and early intervention program targeting these causal or risk factors. Next, they used AI cultural and tribal specific knowledge to modify the model integrate the understanding and meaning of anxiety and depression and behavioral determinants and outcomes from their tribal and cultural perspective. This involved adding, removing, or modifying/replacing certain parts of the initial model to better align with the tribe's worldview of mental health and healing. Moreover, the CAB identified cultural or tribal behavioral determinants (e.g., cultural identity) of anxiety and depression not described in the literature and add them to the model.
Next, the investigators recruited 20 community stakeholders (Elders, parents/legal guardians, and mental health specialists who serve the community) and 14 AI 8-12 year-olds to review the non-adapted intervention and suggest cultural adaptions and improvements to the content, strategies, and materials. Focus groups were audio recorded. Youth also completed a pre-adaptation usability survey (they reviewed only 3 of the 6 program modules) of the non-adapted PEI program that assessed acceptability, enjoyableness, and cultural appropriateness.
The investigators analyzed focus and work group discussions to identify common themes and group suggestions together. The CAB used this information and integrate with their own suggestions to: 1) modify a conceptual framework of anxiety and depression prevention and early intervention in AI youth, and 2) determine the cultural adaptations that are most warranted given possible logistical barriers (e.g., time/funding). Identified themes were reviewed and validated with the CAB and Project Manager. The CAB worked with the research team to culturally adapt the intervention and identified two school counselors (i.e., an American Indian tribal member and a white non-tribal member) to provide it in the schools.
研究设计
- 研究类型
- Interventional
- 分配方式
- Na
- 干预模型
- Single Group
- 主要目的
- Prevention
- 盲法
- None
入排标准
- 年龄范围
- 8 Years 至 12 Years（Child）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •8-12 year-old youth who attends either tribe-serving school and resides on the reservation with their parent/legal guardian.
排除标准
- •Does not meet inclusion criteria.
研究组 & 干预措施
Culturally Adapted Cognitive-Behavioral Prevention and Early Intervention (PEI) Program
All youth received the culturally adapted prevention and early intervention program from trained providers in the school setting.
干预措施: Culturally Adapted Cognitive-Behavioral Prevention and Early Intervention (PEI) Program (Behavioral)
结局指标
主要结局
Post-Intervention Youth-reported Anxiety Disorder Symptoms From Pre- to Post-Intervention
时间窗: Post-Intervention
The Revised Child Anxiety and Depression Scale - Short Version Child Report (RCADS-25-S) is a 25-item instrument used to assess DSM-IV anxiety disorders symptoms (15 items) and depressive disorder symptoms (10 items). Youth rated how often each anxiety and depressive disorder symptom is true of them on a rating scale consisting of: 0 (Never), 1 (Sometimes), 2 (Often), and 3 (Always). Mean scores range from 0 to 3 with higher mean scores indicating greater frequency of youths' anxiety disorder symptoms at post-intervention, 8 weeks post-baseline.
Post-Intervention Youth-reported Depressive Disorder Symptoms
时间窗: Post-Intervention
The Revised Child Anxiety and Depression Scale - Short Version Child Report (RCADS-25-S) is a 25-item instrument used to assess DSM-IV anxiety disorders symptoms (15 items) and depressive disorder symptoms (10 items). Youth rated how often each anxiety and depressive disorder symptom is true of them on a rating scale consisting of: 0 (Never), 1 (Sometimes), 2 (Often), and 3 (Always). Mean scores range from 0 to 3 with higher mean scores indicating greater frequency of youths' depressive disorder symptoms at post-intervention, 8 weeks post-baseline.
Post-Intervention Teacher-reported Anxiety Disorder Symptoms
时间窗: Post-Intervention
The Revised Child Anxiety and Depression Scale - Short Version Teacher Report is a 25-item instrument used to assess DSM-IV anxiety disorders symptoms (15 items) and depressive disorder symptoms (10 items). Teachers rated how often each anxiety and depressive disorder symptom is true of each youth on a rating scale consisting of: 0 (Never), 1 (Sometimes), 2 (Often), and 3 (Always). Mean scores range from 0 to 3 with higher mean scores indicating greater frequency of youths' anxiety disorder symptoms at post-intervention, 8 weeks post-baseline.
Post-Intervention Teacher-reported Depressive Disorder Symptoms
时间窗: Post-Intervention
The Revised Child Anxiety and Depression Scale - Short Version Teacher Report is a 25-item instrument used to assess DSM-IV anxiety disorders symptoms (15 items) and depressive disorder symptoms (10 items). Teachers rated how often each anxiety and depressive disorder symptom is true of each youth on a rating scale consisting of: 0 (Never), 1 (Sometimes), 2 (Often), and 3 (Always). Mean scores range from 0 to 3 with higher mean scores indicating greater frequency of youths' depressive disorder symptoms at post-intervention, 8 weeks post-baseline.
次要结局
- Post-Intervention Youth-reported Anxiety Control Beliefs(Post-Intervention)
- Post-Intervention Youth-reported Rumination(Post-Intervention)
- Post-Intervention Youth-reported Personal Skills Resilience(Post-Intervention)
- Post-Intervention Youth-reported Peer Support Resilience(Post-Intervention)
- Post-Intervention Youth-reported Psychological Caregiving Resilience(Post-Intervention)
- Post-Intervention Youth-reported Social Skills Resilience(Post-Intervention)
- Post-Intervention Youth-reported Physical Caregiving Resilience(Post-Intervention)
- Post-Intervention Youth-reported Spiritual Resilience(Post-Intervention)
- Post-Intervention Youth-reported Educational Resilience(Post-Intervention)
- Post-Intervention Youth-reported Cultural Resilience(Post-Intervention)
- Post-Intervention Youth-reported Tribal Specific Resilience(Post-Intervention)
研究者
Brandon Scott
Associate Professor
Montana State University