The White Mountain Apache Tribe, in partnership with John Hopkins, plans to amplify its existing youth suicide prevention program with the current grant. The proposed initiative, titled "Empowering our Spirits," will deploy a three-tiered prevention strategy (universal, selective, indicated) including three culturally-adapted evidence-based interventions that build on unique tribally mandated suicide surveillance system. Primary intervention targets will include: community-wide education to promote protective factors and reduce risks; early identification and triage of high-risk youth; and intensive prevention intervention with youth who attempt suicide and their families.
Tier 1 Universal objectives are to promote broad community advocacy and education to increase understanding that suicide is preventable and reinforce protective factors that are core to the Apache belief system. Specific strategies will include engagement of tribal leadership in mandating prevention activities; community workshop series to build prevention skills among parents and youth caretakers; and mass media campaigns.
Tier 2 Selected intervention objectives are to increase early identification and continuity of care for youth. Strategies will include: tribally mandated inter-agency collaboration to coordinate care for high-risk youth; ASIST training for community gatekeepers; resilience promotion activities led by elders and community role models for high-risk youth; school-based life skills promotion for middle school youth utilizing the American Indian Life Skills Development Curriculum; and targeted workshops for relevant care providers about early identification and provider stress management.
Tier 3 Indicated intervention objectives are to prevent suicide and promote linkages to care, safety planning, problem-solving and coping among youth who attempt suicide and their families. Strategies will include implementation and evaluation of two-evidence based interventions for youth who attempt suicide and their families. These include the Specialized Emergency Department Intervention and American Indian Life Skills Development Curriculum adapted for use by the Apaches during current grant period.
Infrastructure: The proposed efforts will be strengthened by three levels of community support: 1) a team of Apache Natural Helpers trained by Johns Hopkins mental health experts and employed by the project to carry out all activities; 2) an inter agency "Health and Safety Coalition;" and 3) an Elders' Advisory Council. Numbers to be Served: Tier 1 universal activities will expose 85% of the entire community (~13,000 of 15,500). Tier 2 will reach 150 community "caretakers" through ASIST trainings; 320 middle school youth; 50 providers through technical training workshops; and 300 high risk youth served though Elder-youth activities. Tier 3 strategies will serve 75 youth who attempt suicide and their families. Continued implementation of the tribally mandated suicide surveillance system will ensure ~90% of youth reported for attempts or ideation will receive follow-up from Natural Helpers to assess imminent suicide severity and refer to treatment.