Data-informed, community-driven interventions

Indigenous communities in the United States experience elevated risk for suicide for a number of reasons, including unredressed historical and cultural trauma. The presumed scientific rigor provided by randomized controlled designs has been described as culturally unacceptable and perhaps unethical in some tribal contexts. Community desire to address emerging health issues often takes precedence over the methodological demands of formal evaluation procedures. We describe two examples of suicide prevention efforts in indigenous communities.

Many communities have responded to the need for suicide prevention — particularly among young people —  with:

• cultural adaptations of suicide prevention interventions developed in other communities; and

• locally-developed interventions that center culture as preventative.

Spotlight

Cultural Adaptation for Rural Native Hawaiian Communities

The Connect Suicide Prevention Program developed by National Alliance on Mental Illness - New Hampshire (NAMI-NH) is recognized as a National Best Practice Program. Using a combination of PowerPoint slides, interactive exercises, and case scenarios, the Connect Suicide Prevention Program uses a public health model to enhance participants’ abilities to recognize warning signs of suicide risk, increase their comfort level in connecting with youth who may be at risk, promote knowledge of risk and protective factors, and reduce stigma around mental health issues.  Through Hawaii’s Caring Communities Initiative, the program was adapted to be more culturally appropriate for Native Hawaiian and Pacific Islander communities.  For example, local experts identified the importance of time to build trust and connections between trainers and participants through extended introductions and time to “talk story.” Quick introductions that did not include all participants were not culturally acceptable. The program was also adapted to include more local images and examples, and to include more hands-on learning activities.

Spotlight

Locally-Developed Intervention for Alaskan Native Youth

The Village Wellness Team Program is a locally-developed, strength-based initiative of rural Athabascan Alaska Native villages to promote community resilience and wellness as a community-level universal suicide prevention effort. Central to the program is a local Village Wellness Team in each participating community, which is an independently functioning team of local volunteers who meet together to discuss village health issues and to plan activities to promote wellness in ways that respond to the unique needs of their particular village. The program model addresses community-determined suicide risk factors including language loss and loss of traditional cultural activities by sponsoring community wide events that preserve and teach traditional cultural practices.

Reflection Questions

• What existing suicide prevention strategies in your community could be culturally adapted to support marginalized communities? 

• What locally-developed suicide prevention strategies support groups with marginalized identities in your community?  How can these locally-developed strategies inform your community’s overall strategy?

LGBTQ+ youth are at elevated risk for suicide because of their marginalized identity.  There is evidence that discrimination, harassment, and violence that targets LGBTQ+ youth because of their identity is particularly harmful, and is associated with higher risk for suicidal ideation and attempts for this group of young people. There are no suicide-prevention interventions developed specifically for LGBTQ+ youth that meet the “best available research evidence” criteria from the CDC’s technical package.  There is strong evidence in the research literature for the importance of the “creating protective environments” strategy for LGBTQ+ young people, because of the role of violence and victimization based on gender expression or sexual orientation in increased suicide risk.

Spotlight

The Trevor Project

At the national level, the Trevor Project operates the only 24-7 suicide prevention hotline specifically for LGBTQ+ youth.  The Trevor Project’s crisis intervention services include a traditional hotline and crisis services by online chat and text.  The Trevor Project’s resources and trainings include two best practices:  

• LGBTQ on Campus is a 30-minute online, interactive training simulation that assists institutions of higher education in creating a safe and supportive campus community by 1) increasing awareness and empathy for the challenges faced by LGBTQ students, and 2) building the skills of students to connect and communicate with respect. 

• Step in, Speak Up! is a 30-minute online, interactive training simulation that helps adults understand the challenges that LGBTQ students in grades 6-12 face, and gives them the opportunity to practice techniques for creating a supportive environment by engaging in a series of virtual role-play scenarios with virtual students.

Spotlight

The Affirmative Research Collaborative (ARC) engages in innovative research and provides training and consultation aimed at improving the mental health and wellbeing of LGBTQ+ (lesbian, gay, bisexual, trans*, queer, etc.) youth and young adults. They have developed evidence informed interventions that address suicide risk and protective factors including:

• Youth Affirm: a brief cognitive behavioral affirmative intervention for LGBTQ+ youth that seeks to integrate identity affirmation with cognitive-behavioral interventions that are already known to work.

• ASSET: Affirmative Supportive Safe and Empowering Talk (ASSET) is an eight-week school-based group counseling intervention created specifically to promote the resilience of sexual and gender minority youth.

Despite the growing suicide risk experienced by Black and Latino young men, as well as Latina girls, the research literature has yet to identify promising suicide prevention strategies tailored to these populations. There is clearly a need for innovation to more effectively address suicide risk in these marginalized communities.

Spotlight

The National Compadres Network is a national voice for racial equity and healing that emphasizes culturally-based indigenous practices of Chicano, Latino, Indigenous, Native, Raza, and other communities of color. The organization bases its efforts on the philosophy of La Cultura Cura, or Transformational Healing, to process intergenerational trauma and build on what is healthy within individuals, families, communities and culture. By acknowledging indigenous teachings and building the capacity of communities across the nation to address generational pain and racial inequity and lift up cultural strengths, the network helps support healthy development, prevent violence, and address risk factors of suicide like trauma and substance misuse in youth, families, and communities of color.  

Photo credit: National Compadres Network