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

NCT03661255 | Completed Results

• 2 other identifiers: HUM001619691R01MH112458-01A1
• Study Type: interventional
• Target: 1,427
• 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 (6)

• Wellness Self-Efficacy

  The Wellness Self-Efficacy scale includes two items: 1. I know how I can make positive changes for school wellness 2. There are things I can do to promote wellness here Items were measured on a 7-point Likert scale with response options ranging from Strongly Disagree (1) to Strongly Agree (7) with a neutral midpoint. Responses to the two items are averaged to calculate a composite Wellness Self-Efficacy score ranging from 1 to 7. The reported outcome measure is the mean (standard deviation) of the composite score. Higher scores indicate greater self-efficacy for promoting school wellness.

  At follow up, an average of 7 months

• Community of Practice

  The Community of Practice scale includes three items: 1. Many people in this community work together for suicide prevention/wellness. 2. I have regular opportunities to work with others to increase wellness. 3. I have many people to work with in my community to prevent suicide. Items were measured on a 7-point Likert scale with response options ranging from Strongly Disagree (1) to Strongly Agree (7) with a neutral midpoint. Responses to the three items are averaged to calculate a composite Community of Practice score ranging from 1 to 7. The reported outcome measure is the mean (standard deviation) of the composite score. Higher scores indicate a stronger community of practice for suicide prevention and wellness.

  At follow up, an average of 7 months

• Suicide Prevention Self-Efficacy

  The Suicide Prevention Self-Efficacy scale includes three items: 1. I know how to talk safely about suicide, in ways that help with prevention 2. I know how to decrease suicide risk for others by the way I talk about suicide 3. I feel confident that I can do things to prevent suicide Items were measured on a 7-point Likert scale with response options ranging from Strongly Disagree (1) to Strongly Agree (7) with a neutral midpoint. Responses to the three items are averaged to calculate a composite Suicide Prevention Self-Efficacy score ranging from 1 to 7. The reported outcome measure is the mean (standard deviation) of the composite score. Higher scores indicate greater self-efficacy for engaging in suicide prevention.

  At follow up, an average of 7 months

• Working Together

  The Working Together scale includes six items: 1. I asked someone for help doing prevention/wellness work when I needed it 2. I spoke up about what the school can do to reduce the risk of youth suicide 3. I talked with others about wellness 4. I worked with others to increase wellness in the school community 5. I worked with others to prevent suicide 6. I let others know what resources are available for prevention. Participants were asked if they had completed the action in the past few months (Y/N), resulting in a count of the types of actions taken.

  At follow up, an average of 7 months

• Interpersonal Support

  The Interpersonal Support measure included 7 items: 1. I spent time listening to a teen or child who just wanted to talk about their experience 2. I trusted others in the school community to hear what I have to say 3. I reached out to a child who was hurting (alone, sad, angry) 4. I helped a youth (child/teen) who was feeling down get help (Behavioral Health Services, Alaska Careline, etc.) 5. I reminded someone that just listening to someone can be more supportive than giving advice 6. I quietly listened to a youth (child or teen) who had a problem, reflecting back to them what I heard 7. I encouraged others to offer small acts of kindness when someone was having a hard time. Participants were asked if they had completed the action in the past few months (Y/N), resulting in a count of the types of actions taken.

  At follow up, an average of 7 months

• Postvention

  The Postvention Behavior measure includes five items: 1. I shared only the basic facts of a suicide (avoiding details) 2. I spoke to someone about how to talk safely after a suicide 3. I talked about how suicide is no one's fault 4. I shared that it can be harmful to honor someone who died by suicided more than is done for other deaths 5. I talked about how we can help prevent further harm after a suicide happens Participants were asked if they had completed the action in the past few months (Y/N), resulting in a count of the types of actions taken.

  At follow up, an average of 7 months

Study Arms (2)

PC CARES Intervention

EXPERIMENTAL

Experimental: PC CARES Intervention Participants will attend 1-7 sessions of the PC CARES curriculum. 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 Nebraska Lincoln: collaborator
• Norton Sound Health Corporation: collaborator
• University of Michigan: lead
• 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.

  PMID: 24229373 BACKGROUND

• 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.

  PMID: 21728069 BACKGROUND

• Tseng V. The uses of research in policy and practice. Sharing Child and Youth Development Knowledge 26(2):1-16, 2012.

  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.

  PMID: 23431127 BACKGROUND

• 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.

  PMID: 36779086 BACKGROUND

• 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

Results Point of Contact

• Title: Dr. Lisa Wexler
• Organization: University of Michigan

lwexler@umich.edu

(413) 824-1190

Study Officials

• Lisa Wexler, PhD

  University of Michigan

  PRINCIPAL INVESTIGATOR

Publication Agreements

• PI is Sponsor Employee: Yes
• Restrictive Agreement: No

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: This intervention study will measure the outcomes of the PC CARES (Promoting Community Conversations about Research to End Suicide) curriculum implemented remotely during COVID pandemic years (2020-2022). It will compare pre-post data from intervention participants to non-participants, and will analyze social networks related to suicide prevention behavior in each village. Researchers worked with local service providers and other partners to recruit participants who have access to the internet for virtual sessions. 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 12, 2025
• Last Updated: August 19, 2026
• Results First Posted: August 19, 2026

Record last verified: 2026-05

Locations

US (1)