American Indian Life Skills Development: Implementation

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American Indian Life Skills Development
Implementation Evaluation Journey

• Teresa LaFromboise, Ph.D.
• Stanford University
• lafrom_at_stanford.edu
• 2007 IHS/SAMHSA National Behavioral Health
  Conference
• Albuquerque, New Mexico
• June 12,2007

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A Quick Tour . . . .

• What do we know so far about American Indian
  youth suicide risk?
• What is the American Indian Life Skills
  Development Curriculum?
• How effective is this curriculum?

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Stress and Suicidal Behavior from a Native
American Perspective
X
X
X
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Cumulative Stress

• Stressful life events
• Acculturation stress
• Perceived discrimination
• Environmental poverty
• Historical trauma
• Family stress
• Micro-aggressions

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American Indian Life SkillsSkill Focus

• Changing self talk
• Problem solving skills
• Communication skills
• Depression management
• Stress management
• Anger regulation
• Goal setting
• Suicide prevention skills

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American Indian Life SkillsIntervention Sections

• 1. Who am I? Building self-esteem. (7)
• 2. What am I feeling? Emotions and stress. (9)
• 3. How can I communicate with others and solve
  problems effectively? (5)
• 4. How can I recognize self-destructive behavior
  and find ways to eliminate it? (4)
• 5. Why do people attempt suicide? (4)
• 6. How can I help my friends who are thinking
  about suicide? (3)
• 7. How can I plan ahead for a great future? (8)

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Cultural Buffers

• Cultural identity
• Traditional spiritual involvement
• Participation in traditional activities
• Community mindedness
• Perceived community support

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Proximal Outcomes

• Personal control/self-regulation
• Cultural identity
• Community mindedness
• Perceived social/community support
• Coping skills
• Self-efficacy
• Social problem-solving orientation

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Distal Outcomes

• Negative Mental Health Indicators
• Depression
• Hopelessness
• Substance use
• Anger

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Ultimate Outcomes

• Reduction in suicidal ideation
• Reduction in suicidal behavior
• Reduction in suffering
• Increase in social competence
• Increase in life skills
• Increase in overall well-being

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How effective is the Zuni Life Skills
intervention?

• Psychological Variables
• Measure Intervention No-Intervention
  t p
• (n31)
  (n31)
  (one-tailed)
• ___________________________________
  _________________
• M SD M
  SD
• Hopelessness 3.5 2.6 4.6
  2.9 1.63 .05
• (range 0-20)
• Depression 3.3 0.9 3.4
  1.1 .30 ns
• (range 5-35)

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How effective is the Zuni Life Skills
intervention?

• Self-Efficacy Skills
• Measure Intervention No-Intervention
  t p
• (n31)
  (n31)
  (one-tailed)
• ___________________________________
  _________________
• M SD M
  SD
• Suicide Prevention 4.7 0.8 4.7
  1.2 0.02 ns
• Problem Solving --- --- ---
  --- --- ---
• Active Listening 4.6 0.9 4.5
  1.0 0.05 ns
• Anger Management 5.1 1.1 4.5 1.5
  1.92 .03
• Stress Management 4.5 0.9 4.5
  1.6 0.12 ns
• For all skills, Likert scale items ranged from
  1-6
• Problem solving was dropped from the posttest
  analysis because intervention and no-intervention
  groups were different at pretest on this variable

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How effective is the Zuni Life Skills
intervention?

• Measure Intervention
  No-Intervention Significant
• (n14)
  (n14) Effect
• ___________________________________
  _________________
• M SD M
  SD
• Suicide Intervention _________________________
  Main effect for
• Role-play 1 4.63 0.65 4.05
  0.84 group
• Role-play 2 4.71 0.84 3.66
  0.89
• Problem Solving ____________________________
  Main effect for
• Role-play 1 4.89 0.53 4.64
  0.66 role play
• Role-play 2 4.67 0.64 4.14
  0.70
• Significant at plt.01

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How effective is this intervention?
Outcomes of the Zuni Life Skills Curriculum
Evaluation

• Decreased hopelessness
• Increased confidence in ability to manage anger
• Increased peer suicide intervention skills

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Northern Plains Effectiveness Study of the
American Indian Life Skills Development
Curriculum

• Experimental Design
• Random assignment at the individual level
• 3 conditions intervention (AILSDC), comparative
  intervention (RY), and guidance as usual (wait
  list control)
• All conditions situated in learning period class
• Intervention conditions offered two days per week
  for 4 months
• Pretest, posttest, 10 month follow up survey
  conducted from February, 2006-March, 2007

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How effective is the American Indian Life Skills
Development intervention?

• Participants
• 122 6th, 7th, and 8th grade students in a
  reservation middle school
• 47 males, 53 females 11-15 year age range
• 8.1 at the critical level on Suicidal Ideation
  Questionnaire-JR at pretest
• 19.6 reported having attempted suicide

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How effective is the American Indian Life Skills
intervention?

• Pretest survey findings
• Of those who had attempted suicide
• 10.8 had attempted once
• 5.9 had attempted twice
• 2.9 had attempted 3 or more times
• 6.9 had attempted with the last month
• 2.9 had attempted within the last 6 months
• 96.1 did not go to the reservation clinic,
  hospital, or see a doctor

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How effective is the American Indian Life Skills
intervention?

• Pretest survey findings
• Of those who had attempted suicide
• 21.5 of those who attempted were girls
• 17.5 of those who attempted were boys
• Girls had higher levels of depression than boys
• Girls had higher levels of suicidal ideation than
  boys

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How effective was the American Indian Life Skills
intervention?

• Measure Pretest
  Posttest Follow up
  (n36)
  (n24) (n32)
  
  __________________________________________________
  __
• M SD M SD
  M SD
• Hopelessness 4.17 3.4
  4.7 3.5 3.3 3.1
• (range 0-17)
• Suicidal Ideation 17.2 23.5 9.6
  16.7 12.0 14.9
• (range 0-90)

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How effective was the Reconnecting Youth
intervention?

• Measure Pretest
  Posttest Follow up
  (n37)
  (n28)
  (n32)
• ________________________________________
  ____________
• M SD M SD
  M SD
• Hopelessness 4.78 4.3
  3.5 2.9 2.4 2.5
• (range 0-17)
• Suicidal Ideation 14.0 23.8
  6.8 9.5 3.7 4.8
• (range 0-90)

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How effective was the learning period class
(guidance as usual)?

• Measure Pretest
  Posttest Follow up
  (n37)
  (n33) (n33)
  
• ________________________________________
  ____________
• M SD M SD
  M SD
• Hopelessness 4.0 3.6
  3.5 2.9 3.9 4.1
• (range 0-17)
• Suicidal Ideation 6.8 14.5
  5.5 12.7 7.6 15.1 .
• (range 0-90)

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Major Outcomes of the American Indian Life Skills
Development Curriculum Effectiveness Study

• 10-month follow up survey findings
• Reconnecting Youth decreased hopelessness
  (Kazdin, Rodgas, Colbus, 1986)
• Reconnecting Youth decreased suicidal ideation
  (Reynolds, 1988)
• Leona Eggert Liela Nicholas (2004).
  Reconnecting Youth A Peer Group Approach to
  Building Life Skills. Bloomington, IN National
  Educational Service..

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Student Report on Outcome Survey American
Indian Life Skills Development Curriculum
Effectiveness Study

• Why and how did you try to kill yourself the last
  time?
• Family members both as precipitators deterrents
  of the attempt
• High levels of major life events and more
  frequent events
• Anger expression

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• Psychosocial and Cultural Correlates of Suicidal
  Ideation Among American Indian Early Adolescents
  on a Northern Plains Reservation
• LaFromboise, Medoff, Lee, Harris (2007).
  Research in Human Development, 4 (12), 119-143.

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Suicidal Ideation and Significant Univariate
Correlates

• Correlation is significant at the 0.05 level
  (2-tailed)
• Correlation is significant at the 0.01 level
  (2-tailed)

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Conditionally Independent Predictors of Suicidal
Ideation
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Where do we go from there?

• Modified AILSDC curriculum for middle school
  application this spring (with fiscal support from
  the Indian Country Child Trauma Center/SAMHSA)
• Currently conducting a formative evaluation of
  the AILSDC middle school version with youth in
  summer programs and Boys and Girls Clubs on
  reservations

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Common Practice Elements of EBTs

• Assertiveness Training
• Parent-monitoring
• Modeling
• Ignoring or DRO
• Parent Praise
• Problem Solving
• Parent coping
• Psycho education-Parents
• Relaxation
• Tangible Rewards
• Self-monitoring
• Cognitive/Coping
• Psychoeducation-Child
• Exposure

• Directed Play
• Limit Setting
• Time Out
• Cost Response
• Educational Support
• Activity Scheduling
• Maintenance
• Skill Building (anger, stress)
• Social Skills Training
• Therapist Praise/Rewards
• Natural and Logical Consequences
• Communication Skills
• Chopita et al. (2005)

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Practice Element Profile for the AILSDC Middle
School Version
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Where will we go from here?

• Conduct a effectiveness study (randomized,
  treatment vs. control group design) of the
  AILSDC middle school version during AY 2007-2008
• Evaluate infusion of AILSDC high school version
  into existing curricula

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• Thank you!