Promoting Community Conversations About Research to End Native Youth Suicide in Rural Alaska

NCT03661255 | Active Not Recruiting

• 2 other identifiers: HUM001619691R01MH112458-01A1
• Study Type: interventional
• Target: 1,491
• Locations: 1 country
• Sites: 1

Brief Summary

This intervention study measures the outcomes of the PC CARES (Promoting Community Conversations about Research to End Suicide) project implemented in remote rural Alaskan villages. Researchers worked with local service providers and other partners to recruit facilitators who were trained to implement the 5-session PC CARES curriculum. The study will compare pre-post data from intervention participants to non-participants, and will analyze social networks related to suicide prevention behavior in each village.

Conditions

Suicide

Keywords

Suicide Prevention; Alaska Native; Community Intervention

Outcome Measures

Primary Outcomes (3)

• Change in Behaviors related to suicide prevention

  Behaviors (12 survey questions) related to suicide prevention will be measured at baseline, after each PC CARES session, and at follow up for participants (intervention group) and at baseline and followup only for non-participants (No intervention group).

  6 times over approximately 3 year period

• Change in Knowledge related to suicide prevention

  Knowledge (7 survey questions) related to suicide prevention will be measured at baseline, after each PC CARES session, and at follow up for participants (intervention group) and at baseline and followup only for non-participants (No intervention group).

  6 times over approximately 3 year period

• Change in Attitudes related to suicide prevention

  Attitudes (20 survey questions) related to suicide prevention will be measured at baseline, after each PC CARES session, and at follow up for participants (intervention group) and at baseline and followup only for non-participants (No intervention group).

  6 times over approximately 3 year period

Secondary Outcomes (3)

• Community level impact of PC CARES (type of interactions)

  Pre and post intervention (2 times over approximately 3 year period)

• Community level impact of PC CARES (number of interactions)

  Pre and post intervention (2 times over approximately 3 year period)

• Community level impact of PC CARES through social network analysis by describing changes in the supportive social networks of young people before and after the intervention.

  Pre and post intervention (2 times over approximately 3 year period)

Study Arms (2)

PC CARES Intervention

EXPERIMENTAL

Experimental: PC CARES Intervention Participants will attend 1-7 sessions of the PC CARES curriculum, either virtually or in-person. Investigators will collect data from this group at baseline, after each session they attend, and at follow-up.

Behavioral: PC CARES

No intervention

NO INTERVENTION

This group will not attend the PC CARES sessions. Investigators will collect data from this group at baseline and follow-up

Interventions

PC CARES BEHAVIORAL

PC CARES trains local residents to deliver the PC CARES curriculum in their own community. These facilitators will attend a 40 hour training, and then will deliver the 4 session PC CARES curriculum in their home village. To aid local facilitators, each session follows the same structure after a beginning ritual:(1) agreements/safe talk, (2)'small wins', (3)'what do we know?' (facilitator shares current research on suicide prevention or wellness) (4)'what do we think?' (participants have an opportunity to discuss their thoughts on the research presented), and (5)'what we want to do?' (participants identify what steps they can take in their village to make positive change).The content of learning circles (LCs) includes community-level conditions, evidence-based approaches, risk and protective factors that can prevent suicide and promote well-being.Each LC includes both primary and secondary prevention strategies.Teaching tools include charts, short films, and case studies.

PC CARES Intervention

Eligibility Criteria

• Age: 15 Years+
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• lives or works in village
• at least 15 years old

Sponsors & Collaborators

• University of Michigan: lead
• University of Nebraska Lincoln: collaborator
• Norton Sound Health Corporation: collaborator
• National Institute of Mental Health (NIMH): collaborator

Study Sites (1)

University of Michigan

Ann Arbor, Michigan, 48109, United States

Location

Related Publications (39)

• Wexler L, Trout L, Rataj S, Kirk T, Moto R, McEachern D. Promoting Community Conversations About Research to End Suicide: learning and behavioural outcomes of a training-of-trainers model to facilitate grassroots community health education to address Indigenous youth suicide prevention. Int J Circumpolar Health. 2017;76(1):1345277. doi: 10.1080/22423982.2017.1345277.

  PMID: 28762305 BACKGROUND

• Wexler L, McEachern D, DiFulvio G, Smith C, Graham LF, Dombrowski K. Creating a Community of Practice to Prevent Suicide Through Multiple Channels: Describing the Theoretical Foundations and Structured Learning of PC CARES. Int Q Community Health Educ. 2016;36(2):115-22. doi: 10.1177/0272684X16630886. Epub 2016 Feb 15.

  PMID: 26880738 BACKGROUND

• Lee HW, Gauthier GR, Ivanich JD, Wexler L, Khan B, & Dombrowski K. A method for assessing the success and failure of community-level interventions in the presence of network diffusion, social reinforcement, and related social effects. ArXiv180108612 Phys. January 2018. http://arxiv.org/abs/1801.08612. Accessed February 8, 2018.

  BACKGROUND

• Palinkas LA, Holloway IW, Rice E, Brown CH, Valente TW, Chamberlain P. Influence network linkages across implementation strategy conditions in a randomized controlled trial of two strategies for scaling up evidence-based practices in public youth-serving systems. Implement Sci. 2013 Nov 14;8:133. doi: 10.1186/1748-5908-8-133.

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• Gest SD, Osgood DW, Feinberg ME, Bierman KL, Moody J. Strengthening prevention program theories and evaluations: contributions from social network analysis. Prev Sci. 2011 Dec;12(4):349-60. doi: 10.1007/s11121-011-0229-2.

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  BACKGROUND

• Rogers EM. Diffusion of Innovations. NY, NY Simon and Schuster, 2010.

  BACKGROUND

• Dombrowski K, Khan B, Moses J, Channell E, & Dombrowski N. Network sampling of social divisions in a rural Inuit community. Identities 21(2):134-151, 2014.

  BACKGROUND

• Wexler LM. Inupiat youth suicide and culture loss: Changing community conversations for prevention. Soc Sci Med. 2006 Dec;63(11):2938-48. doi: 10.1016/j.socscimed.2006.07.022. Epub 2006 Sep 6.

  PMID: 16952416 BACKGROUND

• Wexler L, Goodwin B. Youth and adult community member beliefs about Inupiat youth suicide and its prevention. Int J Circumpolar Health. 2006 Dec;65(5):448-58. doi: 10.3402/ijch.v65i5.18146.

  PMID: 17319089 BACKGROUND

• Hill R, Perkins R, Wexler L. An analysis of hospital visits during the 12 months preceding suicide death in Northern Alaska. Alaska Med. 2007 Jan-Mar;49(1):16-21.

  PMID: 17479732 BACKGROUND

• Wexler L, Hill R, Bertone-Johnson E, Fenaughty A. Correlates of Alaska Native fatal and nonfatal suicidal behaviors 1990-2001. Suicide Life Threat Behav. 2008 Jun;38(3):311-20. doi: 10.1521/suli.2008.38.3.311.

  PMID: 18611129 BACKGROUND

• Wexler L. Identifying colonial discourses in Inupiat young people's narratives as a way to understand the no future of Inupiat youth suicide. Am Indian Alsk Native Ment Health Res. 2009;16(1):1-24. doi: 10.5820/aian.1601.2009.1.

  PMID: 19340763 BACKGROUND

• Wexler L. Behavioral health services "Don't work for us": cultural incongruities in human service systems for Alaska Native communities. Am J Community Psychol. 2011 Mar;47(1-2):157-69. doi: 10.1007/s10464-010-9380-3.

  PMID: 21052820 BACKGROUND

• Ulturgasheva O, Wexler L, Kral M, Allen J, Mohatt GV, Nystad K; CIPA Team. Navigating International, Interdisciplinary, and Indigenous Collaborative Inquiry: Phase 1 in the Circumpolar Indigenous Pathways to Adulthood Project. J Community Engagem Scholarsh. 2011 Jun 19;4(1):50-59.

  PMID: 22866196 BACKGROUND

• Wexler L, Silveira ML, Bertone-Johnson E. Factors associated with Alaska Native fatal and nonfatal suicidal behaviors 2001-2009: trends and implications for prevention. Arch Suicide Res. 2012;16(4):273-86. doi: 10.1080/13811118.2013.722051.

  PMID: 23137218 BACKGROUND

• Wexler L, Gubrium A, Griffin M, DiFulvio G. Promoting positive youth development and highlighting reasons for living in Northwest Alaska through digital storytelling. Health Promot Pract. 2013 Jul;14(4):617-23. doi: 10.1177/1524839912462390. Epub 2012 Oct 24.

  PMID: 23099660 BACKGROUND

• Wexler L, Jernigan K, Mazzotti J, Baldwin E, Griffin M, Joule L, Garoutte J Jr; CIPA Team. Lived challenges and getting through them: Alaska Native youth narratives as a way to understand resilience. Health Promot Pract. 2014 Jan;15(1):10-7. doi: 10.1177/1524839913475801. Epub 2013 Feb 21.

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• Wexler L. Looking across three generations of Alaska Natives to explore how culture fosters indigenous resilience. Transcult Psychiatry. 2014 Feb;51(1):73-92. doi: 10.1177/1363461513497417. Epub 2013 Sep 6.

  PMID: 24014514 BACKGROUND

• Wexler L, Joule L, Garoutte J, Mazziotti J, Hopper K. "Being responsible, respectful, trying to keep the tradition alive:" cultural resilience and growing up in an Alaska Native community. Transcult Psychiatry. 2014 Oct;51(5):693-712. doi: 10.1177/1363461513495085. Epub 2013 Sep 6.

  PMID: 24014513 BACKGROUND

• Allen J, Hopper K, Wexler L, Kral M, Rasmus S, Nystad K. Mapping resilience pathways of Indigenous youth in five circumpolar communities. Transcult Psychiatry. 2014 Oct;51(5):601-31. doi: 10.1177/1363461513497232. Epub 2013 Aug 21.

  PMID: 23965730 BACKGROUND

• Ulturgasheva O, Rasmus S, Wexler L, Nystad K, Kral M. Arctic indigenous youth resilience and vulnerability: comparative analysis of adolescent experiences across five circumpolar communities. Transcult Psychiatry. 2014 Oct;51(5):735-56. doi: 10.1177/1363461514547120.

  PMID: 25217145 BACKGROUND

• Wexler L, Chandler M, Gone JP, Cwik M, Kirmayer LJ, LaFromboise T, Brockie T, O'Keefe V, Walkup J, Allen J. Advancing suicide prevention research with rural American Indian and Alaska Native populations. Am J Public Health. 2015 May;105(5):891-9. doi: 10.2105/AJPH.2014.302517. Epub 2015 Mar 19.

  PMID: 25790403 BACKGROUND

• Silveira ML, Wexler L, Chamberlain J, Money K, Spencer RM, Reich NG, Bertone-Johnson ER. Seasonality of suicide behavior in Northwest Alaska: 1990-2009. Public Health. 2016 Aug;137:35-43. doi: 10.1016/j.puhe.2016.02.010. Epub 2016 Mar 24.

  PMID: 27021788 BACKGROUND

• Curran T, Wexler L. School-Based Positive Youth Development: A Systematic Review of the Literature. J Sch Health. 2017 Jan;87(1):71-80. doi: 10.1111/josh.12467.

  PMID: 27917486 BACKGROUND

• Hagan K, Hill R, & Wexler L. The prevention of suicide within the Health Care setting and in Alaska. Primary Care:Indian Health Service, 32(7):198-201, 2007.

  BACKGROUND

• Wexler L, & Graves K. The importance of culturally-responsive training for building a behavioral health workforce in Alaska Native villages: A case study from Northwest Alaska. Special SAMHSA issue of the Journal of Rural Mental Health 32(3): 22-33, 2008.

  BACKGROUND

• Wexler L. The importance of identity, culture and history in the study of indigenous youth wellness. The Journal of the History of Childhood and Youth 2(2):267-278, 2009.

  BACKGROUND

• Wexler L. Intergenerational exchange as data collection: introducing a community-based participatory approach to connect youth, adults and elders in a tribal community. International Journal of Qualitative Methods 10(3): 248-264, 2011.

  BACKGROUND

• Wexler LM, Gone JP. Culturally responsive suicide prevention in indigenous communities: unexamined assumptions and new possibilities. Am J Public Health. 2012 May;102(5):800-6. doi: 10.2105/AJPH.2011.300432. Epub 2012 Mar 15.

  PMID: 22420786 BACKGROUND

• Wexler L, Eglinton K, & Gubrium A. Using digital stories to understand the lives of Alaska Native young people. Youth & Society 46(4): 478-504, 2014.

  BACKGROUND

• Wexler L, White J, Trainor B. Why an alternative to suicide prevention gatekeeper training is needed for rural Indigenous communities: presenting an empowering community storytelling approach. Crit Public Health. 2015;25(2):205-217. doi: 10.1080/09581596.2014.904039. Epub 2014 Apr 7.

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• Wexler L & Gone JP. Exploring alternatives for Indigenous suicide prevention: Responding to cultural understandings and practices. In Jennifer White, Ian Marsh, Michael Kral & Jonathan Morris (Eds), [Suicide and] Suicide Prevention: Critical Perspectives, Cambridge University Press, 2015.

  BACKGROUND

• Wexler L, Dam HT, Silvius K, Mazziotti J, &Bamikole I. Protective factors of Native youth: findings from a self-report survey in rural Alaska. Journal of Youth Studies 19(3): 358-373, 2016.

  BACKGROUND

• Wexler L, Poudel-Tandukar K, Rataj S, Trout L, Poudel KC, Woods M, Chachamovich E. Preliminary Evaluation of a School-Based Youth Leadership and Prevention Program in Rural Alaska Native Communities. School Ment Health. 2017 Jun;9(2):172-183. doi: 10.1007/s12310-016-9203-2. Epub 2016 Nov 19.

  PMID: 35572790 BACKGROUND

• White LA, Wexler L, Weaver A, Moto R, Kirk T, Rataj S, Trout L, McEachern D. Implementation beyond the clinic: Community-driven utilization of research evidence from PC CARES, a suicide prevention program. Am J Community Psychol. 2022 Dec;70(3-4):365-378. doi: 10.1002/ajcp.12609. Epub 2022 Jun 28.

  PMID: 35762450 BACKGROUND

• Wells CC, White L, Schmidt T, Rataj S, McEachern D, Wisnieski D, Garnie J, Kirk T, Moto R, Wexler L. Adapting PC CARES to Continue Suicide Prevention in Rural Alaska During the COVID-19 Pandemic: Narrative Overview of an In-Person Community-Based Suicide Prevention Program Moving Online. Am Indian Alsk Native Ment Health Res. 2022;29(2):126-154. doi: 10.5820/aian.2902.2022.126.

  PMID: 35881985 BACKGROUND

• Markowski KL, White L, Harcey SR, Schmidt T, McEachern D, Habecker P, Wexler L. What Kinds of Support are Alaska Native Youth and Young Adults Reporting? An Examination of Types, Quantities, Sources, and Frequencies of Support. Health Promot Pract. 2023 Sep;24(5):863-872. doi: 10.1177/15248399221115065. Epub 2022 Sep 1.

  PMID: 36047453 BACKGROUND

• Wexler L, Schmidt T, White L, Wells CC, Rataj S, Moto R, Kirk T, McEachern D. Collaboratively adapting culturally-respectful, locally-relevant suicide prevention for newly participating Alaska Native communities. Journal for Social Action in Counseling and Psychology. 2022; 14(1): 124-151. https://doi.org/10.33043/JSACP.14.1.124-151

  BACKGROUND

Related Links

• Site describing the PC CARES philosophy, curriculum, team, and how people can get involved

MeSH Terms

Conditions

Suicide; Suicide Prevention

Condition Hierarchy (Ancestors)

Self-Injurious Behavior; Behavioral Symptoms; Behavior

Study Officials

• Lisa Wexler, PhD

  University of Michigan

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: NON RANDOMIZED
• Masking: NONE
• Purpose: PREVENTION
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor of Social Work

Model Details: The study will have a stepped wedge design with 3 cohorts (in successive years) of 3 villages each. In each village, we will collect baseline data and follow-up data on knowledge, attitudes, and behavior related to suicide prevention from participants and non-participants. Participants will also provide data on these topics after each learning circle they attend. Intervention participants will be self-selecting.

Study Record Dates

• First Submitted: July 12, 2018
• First Posted: September 7, 2018
• Study Start: September 12, 2019
• Primary Completion: February 18, 2025
• Study Completion: December 15, 2025
• Last Updated: February 19, 2025

Record last verified: 2025-02

Locations

US (1)