Grantee Types: Garrett Lee Smith Tribal

The Chippewa Cree Tribe (CCT) Cultural Support Services (CCS) Youth Suicide Prevention Project (YSPP), hereafter referred to as YSPP, will employ evidence-based, culturally-appropriate, tribal youth suicide prevention and early intervention strategies that are grounded in public/private collaboration to reduce the incidence of suicide among at-risk, American Indian youth, ages 13-17, on Rocky Boys Indian Reservation, located in northern Montana.

This project is based on the premise that suicide and suicidal behavior are preventable. Inspired by the public health model that takes a proactive and holistic approach, this project will successfully reduce factors known to contribute to suicide by youth and strengthen factors known to help protect them against suicide. These approaches are intended to do more than help young people choose life. They will also help them choose to live their life well – full of hope in themselves, their culture, and their community.

The goal of this project is to reduce the incidence of suicide by creating a prevention-prepared community where Chippewa Cree Tribal members, families, schools, workplaces, and the community at large take action to prevent and reduce mental illness and substance abuse across the lifespan. YSPP measurable objectives include 1) implementation of American Indian Life Skills Development, an evidence-based practice that includes cultural education and activities, to at least 60 American Indian youth ages 13-17; 2) provision of at least 30 suicide education outreach sessions during established community events for the purpose of retaining and/or increasing participation in, and access to, treatment or prevention services to American Indian youth ages 13-17; and 2) enhancement of the CCT CSS Suicide Prevention Plan, as guided by the SAMHSA-endorsed To Live To See The Great Day That Dawns: Preventing Suicide by American Indian and Alaska Native Youth and Young Adults.

YSPP primary population of focus is youth ages 13-17, of whom approximately 98% are of American Indian descent, with 89% qualifying for free or reduced lunch, 58% of their families live below the poverty level (historical seasonal unemployment rates higher than 70%). A combined high school graduation rate is 58.8%, compared to a 94% graduation rate for the State of Montana. Risk factors (clinical characteristics) include history of alcohol and substance abuse, feelings of hopelessness, impulsive or aggressive tendencies, isolation, and loss (relational, social, work, or financial).

The Wiconi Ohitika Youth Suicide Prevention Project, serving youth on the Spirit Lake Nation, is a culturally enriched approach to youth suicide prevention, based on the culture, language, values and history of the Spirit Lake Dakota (Mni Wakan Oyate), promoting positive self-identity, increased self-esteem, and increased knowledge of the Dakota way of life. Its primary purpose is to provide suicide prevention education that will save lives and help survivors of suicide recover from tragic loss.

Wiconi Ohitika’s four goals, with objectives, are:

Goal 1: Increased awareness of suicide, its risk factors, protective factors and suicide prevention.

1. Increased awareness by community of suicide prevention and related activities
2. Reduced stigma regarding behavioral health issues

Goal 2. Increased identification of youth at risk, referral to appropriate resources, and follow-up.

1. 75 Professionals annually with increased capacity to identify youth and risk and refer to appropriate services
2. Organizations and professionals using the Crisis Response Plan, including its protocol, Referral Forms & Release of information

Goal 3. Increased youth, family, and community engagement.

1. 125 youth with increased skills (15 in Year 1, 40 in Year 2, and 60 in Year 3)
2. 600 Community members with increased sense of health and wellness
3. 200 community members with increased knowledge about the Dakota culture

Goal 4. Effective and efficient program implementation and sustainability.

1. Program managed effectively
2. Consultants in place and effectively supporting program development
3. Community Suicide Prevention coalition actively engaged in prevention activities
4. Maintenance of Spirit Lake Nation Suicide Prevention Plan
5. Participate in Youth Interagency Committee
6. Take a leadership role in state and regional coalitions
7. Dissemination of information guided by a Communication Plan
8. Determine community readiness and needs
9. Improve and update Surveillance plan
10. Data available in a timely fashion for program improvement

Activities designed to meet project objectives and goals are intended to address indicated, selective, and universal populations across different levels of the social ecology. The strategies were selected to meet the project’s goals and objectives: Awareness Activities-PSAs, videos, Sources of Strength; Community engagement–Suicide Prevention Coalition, Gatekeeper Training (QPR, ASIST), and Youth American Indian Life Skills, Sources of Strength, and Cultural Activities. Strategies were selected based on whether they were evidence based and culturally appropriate for American Indian youth, their families, and their community.

The California Rural Indian Health Board, Inc (CRIHB) is seeking funding under the SAMHSA Tribal Suicide Early Intervention and Prevention initiative to support the Healing Our Own People (HOOP) program, a population-based, comprehensive suicide intervention and prevention program that will include training for 225 health professionals and community support service providers and offer suicide prevention services to 1,500 American Indian/Alaska Native (AIAN) youth ages 10-24, in California over three years.In Year One, 385 youth will be served, in Year Two, 557, and in Year Three 558. The program will leverage an enhanced provider network of 20 California Tribal Health Programs (THPs) whose staff will be trained to use Applied Suicide Intervention Skills Training (ASIST) or Suicide Alertness for Everyone (safeTALK) to screen youth for suicide risk using the TeenScreen methodology, including the Pediatric Symptom Checklist (PSC-Y), Patient Health questionnaire Modified for Teens (PHQ-9), and (as appropriate) CRAFFT instruments as well as other risk-detection strategies. Once trained, providers will offer or refer youth to services at the participating 20 THPs where clients can choose from a menu of evidence-based, culturally-appropriate practices, including Gathering of Native American (GONA), Native H.O.P.E (Helping Our People Endure), and American Indian Life Skills Development. Each of the participating THP provider partners will receive a predetermined level of service vouchers powerfully leveraging CRIHBs SAMSHA-funded Access to Recovery (ATR) voucher management system (VMS), and programs supportive infrastructure. Vouchers will be issued based on assessments using the above mentioned best practice certified screening tools to determine the appropriate level of service: either clinical treatment or prevention. The HOOP program will employ a culturally sensitive and community-reflective social marketing campaign designed to increase awareness both of the suicide problem and of available program resources, including national and state hotlines and the Action Alliance. We also appreciate that it will be necessary to pen new pathways into the program for youth. Integration of AIAN ceremonies, values, and practices will be the key to program success, and will play a key role in training and successful implementation of intervention and prevention programming. Tribal communities will draw among community programs to partner in delivery of services to reflect tribal traditions and belief systems. The particular emphasis of HOOP will be the robust development of the multi-layered, culturally appropriate system to outreach and provide services to a maximum number of youth

Suicide is an on-going epidemic in the state of Alaska. Suicide rates among Alaskan Natives (AN) are higher than any other ethnicity in the state and unfortunately according to the YRBSS (2009), 13.9% among Alaska youth seriously considered attempting suicide (vs. the US average of 13.1%); 11.7% made a suicide plan (vs. 10.7%), while 8.5% attempted suicide (vs. 9.6%). Moreover, risk factors such as alcohol and substance abuse, child abuse, and assaults can lead to suicide ideation, attempts, and even death. These risk factors have been a deep concern among AN rural villages where isolation in hard-to-reach communities in the Alaskan frontier promotes these behaviors.

The best way to combat this epidemic is early intervention. The Bristol Bay Area Health Corporation Yuutpiciryarit (Our Way of Life) Peer Prevention Program (PPP) is a suicide prevention program targeting 400 youth ages 12-18 years old for over three years in 11 Tribal Alaskan Villages and its surrounding communities. PPP is based on the concept and social support elements of the Recovery Community Services Program (RCSP) framework, a proposed Evidenced-Based Practice. It is a holistic and community approach where peers can help other peers move along the continuum by offering hope, motivation and general social support through Alaskan Native traditional practices and activities. By this help, from one caring youth to help another – a way of life among Alaskan Natives – referrals for mental health services early on can help reduce suicide ideation, attempts, and death in the villages.

The Goal of PPP is to promote a healthy community utilizing Alaskan Native practices and Evidence Based practices aim to reduce the number of suicides and suicide attempts among Bristol Bay adolescents 12-18 years of age.

The Objectives: By providing early intervention in substance and alcohol abuse, the number of suicides and suicide attempts will be reduced among adolescents 12-18 years of age, and by providing early intervention in child abuse and child sexual assaults, the number of suicides and suicide attempts will be reduced among adolescents 12-18 years of age will hopefully increase awareness about suicide prevention and referrals among youth through Alaskan Native cultural practices.

Yuutpiciryarit (Our Way of Life) Peer Prevention Program is a culturally competent, sensitive, and caring youth program that believes if the program can save even one life, the program is a success.

Association of Village Council Presidents will develop and implement the Healthy Families Program, a community based suicide prevention program. The program will reach Alaska Native youth at risk for suicide or suicide attempts by creating a comprehensive culturally appropriate safety net in each of these communities. The first step is to form a strong, widely represented, well-informed and trained Suicide Prevention Coalition in each community. The Coalition will draft a Suicide Prevention Plan. The Plan will have two purposes: to give the community direction and to get everyone thinking about suicide prevention.  The Coalition will be the driving force behind incorporating cultural activities into the youth program; it is here that we will find adult volunteers to present traditional activities to youth such as building a qasiq, a fish camp, story circles, traditional crafts such as grass baskets and a mentoring program. The safety net will include the school as a strong and involved partner and implement the Zuni Life curriculum. A critical part of the safety net is to have a strong, vibrant, culturally-appropriate youth program; a place to implement cultural activities and traditional teachings, a place where the community can celebrate their young people. Sustainability is built into this program because a critical component to the program is recruiting, training and employing community volunteers. Strong partnerships with the schools are essential and part of this project. The project goal is the prevention of suicide in each community. The AVCP Healthy Families Program will serve the Alaska Native Villages of Alakanuk, Chevak, Hooper Bay and Scammon Bay. The villages are among the poorest in America, almost 100% Alaska Native and have the highest suicide rate in the country. 3,317 people will be served by this project.

The American Indian Health and Family Services of Southeast Michigan’s Manidookewigashkibjigan Sacred Bundle: R.E.S.P.E.C.T. Project, a State/Tribal Youth Suicide Prevention Cooperative Agreement, serves primarily American Indian/Alaska Native (AI/AN) youth and young adults ages 10-24 in Detroit and Southeastern Michigan, with a goal to partner with tribal communities throughout the state. In collaboration with State and County Suicide Prevention authorities and crisis centers, the R.E.S.P.E.C.T. project has utilized evidence-based practice (EBP) interventions and treatment strategies as well as culturally-infused Practice-Based Evidence to expand the safety net of suicide prevention and intervention for urban AI/ANs, who are at higher risk of suicide attempts and deaths than other racial/ethnic groups in the United States. The goals of the R.E.S.P.E.C.T. (Respecting, Engaging, Supporting, Protecting, Empowering, Connecting and Teaching) Project are to:

• Increase the number of persons in schools, foster care systems, juvenile justice programs, and tribal sites trained to identify and appropriately refer youth at risk for suicide.
• Increase the number of clinical service providers trained to assess, manage, and treat youth at risk for suicide.
• Improve continuity of care and follow-up of youth identified at risk for suicide who are discharged from emergency departments and inpatient psychiatric units.
• Increase identification of risk, referral to and utilization of behavioral health care services.
• Increase the promotion and utilization of the National Suicide Prevention Lifeline.
• Comprehensively implement applicable sections of the 2012 National Strategy for Suicide Prevention to reduce rates of suicide ideation, attempts, and deaths in our communities.

Four measurable outcomes include: 1) Increased Outreach for suicide awareness (1400 annually, 7000 total), 2) Expanded Training and technical assistance to improve ability of local and tribal community members and professionals to identify, manage and treat youth at risk (100 annually, 500 total); 3) Continued Screening to increase identification of at-risk youth (100 annually, 500 total), and 4) Improved and expanded Treatment measured by an increase of at-risk youth receiving culturally appropriate behavioral health care (50 annually, 250 over 5 years).

To successfully meet these goals and outcomes we plan to: 1) Expand training of mental health professionals, gatekeepers, and community members, 2) Extend Outreach to develop collaborative relationships with community members (urban and tribal), educational institutions, and youth serving organizations and 3) Create a sustainability plan for the AIHFS and tribal communities to ensure the ongoing mental health and well-being of our youth.

The mission of American Indian Health and Family Services of SE Michigan (AIHFS) is to enhance the physical, spiritual, emotional and mental well being of Native American families and other underserved populations in Southeastern Michigan. We serve the American Indian and Alaskan Native (AI/AN) urban population that resulted largely from the relocation policies of the federal government in the 1950s, policies designed to remove Native Americans from the reservation and relocate them in the major U.S. urban areas. The result was that about 65% of American Indians became dislocated; families were broken up. Communities destroyed. Consequently, today many are unemployed, living in poverty and at significant health risk with abnormally high incidences of heart disease, diabetes, depression, alcohol and drug addiction, and suicide.

Suicide is a major public health problem for American Indians in the United States (Olson & Wehab, 2006; La Fromboise, 2006; Goodkind, LaNoue & Milford, 2010). The rate of suicide for AI/AN is 70% higher than for that of the general population and youth between age 10 and 24 are the most at risk (Dorgan, 2010). While data are sparse for urban American Indian suicides, and suicide attempts, in particular, the risk factors associated with these outcomes would predict high incidence. We believe we are well situated to implement the goals of the Garrett Lee Smith State/Tribal Youth Suicide Prevention grant to:

• Increase the number of persons in youth serving organization such as schools, foster care systems, juvenile justice programs, trained to identify and refer youth at risk for suicide
• Increase the number of health, mental health, and substance abuse providers trained to assess, manage and treat youth at risk for suicide
• Increase the number of youth identified as at risk for suicide
• Increase the number of youth at risk for suicide referred for behavioral health care services
• Increase the number of youth at risk for suicide who receive behavioral health care services
• Increase the promotion of the National Suicide Prevention Lifeline

Our SAMHSA Circles of Care (COC) grant has allowed us to develop the infrastructure to assess and build community readiness for creation of an integrative model with youth, adults, elders, educators and providers in urban Southeast Michigan. The infrastructure grants support an array of strategies and activities that have advanced our base for delivering and sustaining effective mental health services, in an integrated, culturally competent and comfortable setting.