BOX 11-2

A Program Adaptation for an American Indian Population

An American Indian tribe in the Southwest worked in collaboration with academic researchers to create the American Indian Life Skills (AILS) intervention for the purpose of reducing the factors associated with suicidal behavior (LaFromboise and Lewis, 2008). AILS was found to have a positive impact on American Indian high school students’ feelings of hopelessness, suicidal ideation, and ability to intervene in a peer suicidal crisis situation (LaFromboise and Howard-Pitney, 1993). When used as a comprehensive suicide prevention approach, the intervention demonstrated a substantial drop in suicidal gestures and attempts. Although suicide deaths neither declined significantly nor increased, the total number of self-destructive acts declined by 73 percent (May, Sena, et al., 2005).

Extensive input was solicited from members of the tribe initiating AILS in order to fit its cultural norms. Key aspects of giving instruction, problem solving, and helping others in that culture were examined. Focus groups members were selected by community leaders to give guidance on intervention content, implementation issues, and intervention refinement. It was believed that suicidal behavior could be attributed to direct modeling influences (e.g., peer or extended family member’s suicidal behavior) in conjunction with environmental influences (e.g., geographic isolation) and individual characteristics (e.g., hopelessness, drug use) that mediate decisions related to self-destructive behavior.

Life Skills Training was used throughout the intervention to complement traditional ways of shaping behavior. Each skill-building activity was selected from research supporting best practices for social emotional regulation and cognitive skills development, including methods of group cognitive and behavioral treatment.

Needed modifications were made to strategies identified. For example, in lessons on recognizing and overcoming depression, the Pleasant Events Schedule (Lewinsohn, Munoz, et al., 1986) was modified to reflect American Indian adolescent socialization in the reservation context, renamed “Depression Busters,” and used as the basis for both an intervention activity and a homework assignment. Items such as “talking on the telephone” or “playing a musical instrument” were retained, while new items, such as “doing heavy outdoor work (e.g., cutting or chopping wood, clearing land)” or “being at weddings and other ceremonies,” were added. In lessons addressing stress management, the eight ways of coping advanced by Folkman and Lazarus were shared in the focus groups to better determine cultural coping preferences and coping styles (Folkman, Lazarus, et al., 1986). The coping strategies most highly endorsed by participants in these groups were emphasized throughout the intervention. This “hybrid-like” approach (Castro, Barrera, and Martinez, 2004) encouraged the inclusion of traditional and contemporary tribal world views in the intervention without compromising its core psychological components.

After several formative evaluations with diverse tribal groups, AILS has been refined to address the needs of both traditional and pan-tribal adolescents (LaFromboise, 1995; LaFromboise, Coleman, and Hernandez, 1991). It has been

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