Background: The Southwest Hub consists of a collaborative network of Indigenous and allied tribal leaders, investigators, and providers across several U.S. states to advance suicide prevention programs and strategies in their communities. The overall aim of the Hub is to develop effective and scalable interventions for preventing suicide and promoting resilience in suicidal youth ages 10-24. With one tribe, we are studying two brief interventions designed to be delivered by community mental health specialists, New Hope and Elders’ Resilience. As part of the clinical trial, the delivery of the two interventions are evaluated for fidelity to inform our understanding of their implementation in this and other Native communities.
Methods: The Hub study utilizes a factorial design to evaluate the impact of the two interventions alone or in combination for Apache youth ages 10-24 years old who have had a recent suicide attempt, ideation, or binge substance use + ideation. Participants are assessed repeatedly through six months on the primary outcomes of suicide ideation and resilience and a set of secondary outcomes. Each intervention visit with community mental health specialists is audio recorded, and a minimum of 20% of the sample of New Hope and Elders visits respectively is being reviewed for quality by researchers using a standardized checklist that covers lesson delivery and interaction with the participant. The Elders Resilience evaluations provide insights into teaching aspects of Apache language and culture, and thus, lessons were reviewed by an Apache Elder.
Results: We present the fidelity results from the quality assurance evaluations of New Hope and Elders Resilience lessons, including duration of visits, scores for the individual checklist components corresponding to the intervention content, themes from reviewer comments in those areas, and other circumstances, trends, and participant-case manager relationship variables. The audio recordings are selected to represent a variety of timepoints and interventionists across the study and any trends in these domains will also be presented.
Conclusions: Findings have potential to inform the evidence base for brief community-based, culturally proficient interventions delivered by community mental health specialists to maximize impact and resource efficiency, particularly needed to promote health equity in Indigenous populations and other low resource settings.