July 2014-April 2017. “Developing Effective Proximal Care to Prevent Rural Alaska Native Youth Suicide”
Kirk Dombrowski and Lisa Wexler, Principal Investigators (in collaboration with the University of Massachusetts, $706,603).

The rate of suicide for rural, American Indian/Alaska Native (AI/AN) youth represents a significant health disparity. AI/AN suicide is even more pronounced in young people: elevated youth suicide rates are found across tribal communities. Making matters worse, the majority of AI/AN youth never receive behavioral health care even when showing signs of anxiety, anger, depression, or other mental distress, or when actively suicidal. Like other tribal areas, analyses from the study region reveal an astounding under-utilization of services despite access to services and no cost barriers to care. The annual suicide death rate in the study area was 18 times higher for Alaska Native youth ages 15-19 than for all American young people (124 versus 6.9 per 100,000). Most of these AI/AN suicidal youth never receive mental health services.

The soaring rates of American Indian/Alaska Native youth suicide underscore a need for community-based, culturally-responsive care. Yet available acute services offer the opposite, often being individually-focused and clinic-based. This approach to care is particularly onerous in rural areas and in crisis situations where inpatient facilities are often times far away. In the study region, if a clinician determines that a youth is in imminent risk for suicide, s/he is typically taken (by airplane) from their home village to a hospital in the regional hub community for individual psychological assessment in a hospital setting. If determined to be in ‘imminent risk,’ s/he is sent to Anchorage (500+ miles away) or to the contiguous states, far from local support networks that can potentially serve as important resources in behavior change. Further, in removing young people from their communities, treatment raises memories of the US government forcibly separating families, which endured into the latter half of the twentieth century in Northwest Alaska and has been associated with historical trauma and on-going youth health issues.

Aside from the potential to be distressing, this typical practice returns young people back to their villages with less inclination to seek formal services when they feel hopeless, anxious, out-of-control or depressed. Forced removal from one’s home also represents a missed opportunity to build on the protective factors of tribal villages, reach out to community supports and to align mental health services with the locally meaningful cultural practices, a protective factor for Native youth suicide.

Although previous studies have underscored this need, none have documented the patterns of relationships among and between formal and informal care givers and worked with tribal partners to develop a practical and transportable educational intervention. Our intervention—Professional-Community Collaborations for At-Risk (youth) Engagement and Support (P-C CARES)—aims to fortify the safety net of at-risk Native youth at a non-crisis stage of suicide risk. With our community partners, we aim to strengthen collaborative relationships to provide more comprehensive, community-based support to distressed, Native youth. This project will test and evaluate the PC-Cares model in several Alaska villages and evaluate the results using cutting edge social network techniques. The three year collaboration will team community groups in Alaska, public health researchers from the University of Massachusetts, and social network analysts from the University of Nebraska-Lincoln.

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