Supporting Evidence-based Interventions with American Indian Alaska Native Populations

Guided by Mission

We have worked with the Northwest Portland Area Indian Health Board (NPAIHB) for almost five years. Their work and our mission fully align to build equity, connection, and advocacy for the people, organizations, and communities we serve. Our work supports the development of evidence-based interventions for American Indian and Alaska Native teens and young adults.


What

BRAVE is a multi-media intervention designed for American Indian and Alaska Native teens and young adults to amplify and reinforce healthy social norms and cultural values, teach suicide warning signs, prepare youth to initiate difficult conversations with peers and trusted adults, encourage youth to access mental health resources (i.e., tribal clinics, chat lines), de-stigmatize mental health services, and connect youth to trusted adults.


We love this intervention because it can be flexibly delivered in three formats . BRAVE includes text messages, role-model videos, a user’s guide, and small group activities.


The BRAVE curriculum authors include Stephanie Craig Rushing, PhD, MPH, David Stephens, RN, Colbie Caughlan, MPH, Allyson Kelley, DrPH, MPH, Dyani Bingham, MPH, Bethany Fatupaito, MPH, Amanda Gaston, MAT, Thomas Ghost Dog, Paige Smith, CADC1, CPS, Danica Love Brown, PhD, MSW, Celena McCray, MPH, Michelle Singer, BS, and Roger Peterson, BS.


How

NPAIHB received funding from the TAM Program during the BRAVE study efficacy phase led by one of my favorite colleagues, Dr. Stephanie Craig Rushing. Over two years, NPAIHB collected data and disseminated the BRAVE intervention to tribal health educators and teachers.


Macrina Singleton at AKA led the design and formatting of the BRAVE manual , Bethany Fatupaito led the curriculum development, and Dyani Bingham provided cultural reviews and resources.


An exciting part of this work is that BRAVE is now posted with the Title IV-E Prevention Services Clearinghouse for the world to see and know.


Overview of the BRAVE Program with the Methods and Findings

A major part of what we do is disseminate evaluation and research findings. We realized that having a curriculum is an excellent place to start, but a curriculum like BRAVE needs to reach the intended audience. NPAIHB asked us to develop a Dissemination Guide for BRAVE (see download below).


This guide outlines the source of messaging, the audience, the message, and dissemination channels. A task list serves as a model for dissemination methods, frequency, and audience--this can be used for any mHealth intervention or health education strategy with various populations.

BRAVE Dissemination Guide
.pdf
Download PDF • 658KB

BRAVE Users Guide
.pdf
Download PDF • 582KB


AKA also worked with NPAIHB to publish several papers about BRAVE:

Craig Rushing, S., Kelley, A., Bull, S., Stephens, D., Wrobel, J., Silvasstar, J., Peterson, R ., Begay, C., Ghost Dog, T., McCray, C., Love Brown, D., Thomas, M., Caughlan, C., Singer, M., Smith, P., & Sumbundu, K. (2021). Efficacy of an mHealth Intervention (BRAVE) to Promote Mental Wellness for American Indian and Alaska Native Teenagers and Young Adults: Randomized Controlled Trial. JMIR Mental Health, 8(9), e26158.


Wrobel, J., Silvasstar, J., Peterson, R., Sumbundu, K., Kelley, A., Stephens, D., Craig Rushing, S., & Bull, S. (2022). Text Messaging Intervention for Mental Wellness in American Indian and Alaska Native Teens and Young Adults (BRAVE Study): Analysis of User Engagement Patterns. JMIR Formative Research, 6(2), e32138.


Craig Rushing, S., Kelley, A., Stephens, D., Singer, M., Caughlan, C., Fatupaito, B.... & McCray, C. (2021). The BRAVE Study: Formative Research to Design a Multimedia Intervention for American Indian and Alaska Native Young Adults. American Indian and Alaska Native Mental Health Research (Online), 28(1), 71-102.



Stephens, D., Peterson, R., Singer, M., Johnson, J., Rushing, S. C., & Kelley, A. (2020). Recruiting and Engaging American Indian and Alaska Native Teens and Young Adults in a SMS Help-Seeking Intervention: Lessons Learned from the BRAVE Study. International Journal of Environmental Research and Public Health, 17(24), 9437.


Looking back on the last several years, what I love the most about our partnership with NPAIHB is the possibilities of evidence-based interventions with American Indian and Alaska Native youth. We learned more about the process of developing evidence-based interventions, core components of dissemination strategies, and how to share what works and what does not. This has been huge.


Why

Most evidence-based interventions are created with the US general population in mind. These interventions fail to address the historical, cultural, and community factors that make-up American Indian and Alaska Native communities. Evidence-based interventions like BRAVE may be more effective than interventions designed for the general population because they are culturally centered, values-driven, and context-specific.


With everything going on in our world and our work, why not be BRAVE. Check out the curriculum, think about the mission, and consider expanding partnerships and dissemination strategies for maximum impact.

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