Grantee Types: Garrett Lee Smith Tribal

KEYWAH II is an innovative program at the Pueblo of San Felipe aimed at expanding the efforts of the tribes prior Garrett Lee Smith Grant. The purpose of KEYWAH II is to develop and implement tribal youth suicide prevention and early intervention strategies, grounded in public/private collaboration including the schools, the Tribal Court, San Felipe Family Services, San Felipe Behavioral Health, the University of New Mexico, and other child and youth supporting organizations.

KEYWAH II will implement a continuum of evidence-based and best practices aimed at expanding capacity and creating a prevention-prepared community where youth, families, schools, and communities take action to prevent and reduce mental illness and substance abuse across the lifespan. The population of focus is American Indian (AI) male and female youth ages 10-24 years old at high-risk of suicide, with a priority population of youth who are members of military families, and those who are lesbian, gay, bisexual, or transgender (LGBT) residing at the Pueblo. Strategies include implementation of the PHQ9 as a universal screening; Mental Health First Aid and Natural Helpers for surveillance, early identification and referral; Project Venture as an outreach and engagement strategy; ALS and wraparound as interventions; and the further development of both local and statewide Suicide Prevention Coalitions.

Project goals and measureable objectives include:

(1) Increase the number of persons in youth-serving organizations trained to identify and refer youth at risk for suicide; (2) Increase the number of clinical service providers trained to assess, manage, and treat youth at risk for suicide; (3) Improve Interagency Collaboration; (4) Increase the outreach, identification of risk, referral and utilization of behavioral health care services; and (5) Develop a sustainability strategy to ensure continuation of the model after grant funding ends and promote tribal system-level change. 280 people will be served annually and 1420 people will be served throughout the lifetime of KEYWAH II.

Project HOPE, a community-based initiative will focus upon the prevention of suicides among the Omaha youth, focusing on a initial target of 200, 10-24 year olds. Suicide is a serious public health concern that results in approximately 4,400 lost lives each year as the second leading cause of death among American Indian adolescents and young adults. The project will utilize evidence-based models and curriculum in prevention and intervention strategies.

Suicide on the Omaha Reservation is a reality that was, not many years ago, rarely even talked about within the community. Ideology concerning suicide is difficult to target. Suicide attempts are often seen as severe bouts of depression or substance abuse related issues.? The current tribal system of care is overburdened and overwhelmed.? And an alarming number of youth are displaying disruptive behaviors and attitudes that are being left untreated.

The primary purpose of Project HOPE is to serve as a catalyst for preventing suicides among youth. This long-term initiative will be achieved by promoting foundational prevention efforts to prevent youth deaths due to suicide across the entire Four Hills of Life, reduce the after-effects associated with suicidal behaviors and traumatic impact of suicide on family and safe environment to enhance resiliency, resourcefulness, respect, and interconnectedness for individuals, families, and the community.

A comprehensive approach will be utilized as no single organization can successfully stop suicides. Partnerships will play key roles and prevention efforts will be carefully coordinated between local prevention programs, the two reservation schools, the Omaha Tribe of Nebraska and its entities within which include:? the Carl T. Curtis Health Education Center, Omaha Nation Law Enforcement, Omaha Tribal Court, and Omaha Nation Child Protective Services. Community-based prevention efforts will include community education and awareness trainings, forums, and cultural gatherings where suicide ideation criteria will be identified, brief interventions and clinical applications can be decided upon and planned, and public awareness strategies can be developed. Speakers and community trainers will be utilized to facilitate planning meetings and educate professionals, project partners, and community members on providing interventions. A media component will be used to carry out the message that Life is Sacred and displayed where the community can receive immediate and confidential assistance. The evidence-based Columbia University teen Screen will be utilized to screen, identify, and refer at-risk youth to appropriate providers. The American Indian Life Skills Development Curriculum (AILSDC), an evidence-based, skills-trainings approach, will be offered at both schools for youth in grades 9-12. And, an equine therapy program, EAGALA, which is dedicated to improving the mental health of individuals, families, and groups, will be offered.

Omaha Nation Community Response Team, a 501©(3) nonprofit corporation, which was established in 2004 to address substance abuse issues among the youth of the Omaha Nation, has also developed and successfully implemented “Project HOPE.”  Project HOPE was developed to serve as a catalyst for preventing suicide among the youth.  Project HOPE has delivered seamless suicide prevention efforts for youth ages 10-24, young adults, and community members among the Omaha Tribe of Nebraska. Project HOPE incorporates prevention, early intervention, outreach services and a media campaign to focus and reduce the existing suicide ideology in the communities in which it serves.  Project HOPE has one specific goal and four objectives in which we have continued to successfully implement and accomplished. Our goal and objectives include:

Project Goal: To provide effective and comprehensive suicide prevention and early intervention strategies for youth ages 10-24 on the Omaha Reservation in Northeast Nebraska. 

Objective 1: To implement a culturally relevant, evidence-based approach, the American Indian Life Skills Development Curriculum (AILSDC), for youth in grades 6 -12 in both K-12 schools on the Omaha Reservation;
Objective 2: To create effective community partnerships in order to integrate new and existing youth suicide prevention and early intervention strategies to provide a comprehensive approach to suicide prevention;
Objective 3: To initiate a series of community forums and trainings in coordination with a community media campaign to promote the Omaha Nation Youth Suicide Prevention Initiative; and
Objective 4: To implement emergency response services to promote healing for affected families and the community when a suicide is completed.
 
In addition to our goal and objectives, Project HOPE also strives to strengthen and enhance the tribal system of care by incorporating Omaha culture and knowledge to also reduce the risk of suicide behaviors.  Thus far, Project HOPE has positively impacted many lives among the Omaha people and continues to provide community-based prevention and early intervention activities for those we serve.

The Sweet Grass Suicide Prevention Project on the Oglala Lakota Nation includes Culture, Collaboration, and Coaching.  (Wahokunkiya) Is a Lakota cultural value, which includes teaching, similar to providing presentations (QPR, Yellow Ribbon, Lakota Mental Health) to young people, providing them with tools and instruction on what to do when a friend or relative is experiencing suicidal ideation.

The Lakota Culture is very important in Suicide prevention in order to be effective; one primary aspect is (Wowaunsila) having compassion for the people.  The other is (Wokigna) is comforting people when they are experiencing the psychic pain that prompts them to commit suicide.  (Wazila) is a Lakota cultural way of using Sweet Grass or Sage to purify an area before one offers a (Wochekiya) which is an appeal to the creator and the spirits for assistance during a difficult time. 

The Pine Ridge Reservation is a very isolated place, it takes over and hour for emergency personnel to reach an often-unspecified location.  Coaching people not to panic when they are in a suicidal situation is important, because they need to stay with the individual until help arrives.  This is where the cultural value (Woohitika) bravery, finding the courage within oneself to stay calm during this critical time.  Most people on the Pine Ridge Reservation who express ideation are under the influence of alcohol or drugs.  Which creates additional stress, therefore it is important to get others involved in the situation.

This is where collaboration is important, (Tiwahe) Nuclear family, (Tiospaye) Extended family, (Ospaye) Community members, (Chanksa yuha) Law enforcement, and Tribal Programs need to be mobilized and prepared for suicidal situations.  The Sweet Grass Suicide Prevention Project is working to develop these collaborations in two of the nine districts on the Pine Ridge Indian Reservation.  The purpose is to work with partner agencies to establish a system for tracking all ideations, attempts and completions.  The final goal is to establish a Referral Committee made up of past and present volunteers to create a referral and follow up plan for people who have attempted suicide.  So they don’t fall through the cracks in the different Tribal, State and Federal systems. 

The purpose of the Oglala Sioux Tribe Tribal Youth Suicide Prevention Program is to develop and implement a comprehensive and sustainable program to prevent suicide among Tribal youth, ages 15-24. The approach has been designed to increase community awareness and support, strengthen capacity and resources for early identification of at-risk youth, and develop comprehensive and sustainable systems to prevent youth suicide. It builds on the current 2008 Tribal Youth Suicide Program grant to the OST and proposes two evidence-based programs American Indian Life Skills Development and Sign of Suicide to be implemented in middle and high schools on the Reservation.

The suicide rate for South Dakota young people, ages 15 to 24, is double the average rate in the nation and young American Indian males in South Dakota die from suicide at a rate that is four to five times the national rate. The OST Tribal Work Group on Youth Suicide Prevention has identified several specific areas of need that, together, offer promise for developing a sustainable program for Tribal youth suicide prevention. These include:

1. Need for greater community awareness, support, coordination, and resources for youth suicide prevention;
2. Need to develop and establish linkages between Tribal and Indian Health Service to coordinate and support referral, and follow-up of at-risk youth; and
3. Need to provide young people with the understanding and skills to cope with depression and problems

The OST Program has four primary goals:

Goal 1: Increase community awareness, support, coordination, and resources for Tribal Youth Suicide Prevention;

Goal 2:Strengthen capacity and resources for referral, and follow-up of at-risk youth;

Goal 3: Extend American Indian Life Skills Development Curriculum and SOS Signs of Suicide Program to six middle/high schools; and

Goal 4: Contribute to local, regional, and national knowledge and effective strategies for Tribal Youth Suicide Prevention.

The approach is community-based, incorporates culture and traditions of the Tribe and local communities within the Reservation, emphasizes coordination among existing organizations that serve youth and families, builds capacity for sustaining the program through training and resource development, and strengthens linkages between Tribal, State, and local resources for youth suicide prevention. Involvement of Oglala Lakota College, with established campuses in several areas of the Reservation, offers the opportunity to expand training and skills on youth suicide prevention to social work and other students who are likely to seek jobs on the Reservation. The approach also includes a well-designed local evaluation, to monitor the effectiveness of services and to advance knowledge of youth suicide prevention.

Housed at the Northwest Portland Area Indian Health Board, the THRIVE project (Tribal Health: Reaching out InVolves Everyone) has worked with the NW tribes to prevent suicide since 2009. The NPAIHB is a tribal non-profit organization that represents 43 Federally-recognized American Indian tribes in Washington, Oregon, and Idaho. In collaboration with the NW Tribes, tribal clinics, and regional partners, THRIVE will build regional suicide prevention capacity and prevent suicide among American Indian and Alaska Native youth 10-24 years old. Our approach builds upon a strong tribal network and acquired expertise in culturally-relevant intervention strategies and expands the most effective activities carried out by THRIVE during our prior GLS grant (cohort 9). Our goals are to:

Goal 1.      Improve protective mental health knowledge, attitudes, coping skills, and help-seeking behaviors among AI/AN youth (10-24 years old) nationwide, by delivering evidence-based suicide prevention interventions.

Goal 2.      Promote mental health and the social acceptability of mental health services for AI/AN youth and their families.

Goal 3.      Enhance organizational practices in NW tribal clinics, tribal health departments, and tribal colleges to improve suicide prevention, screening, referral, treatment, and post-suicide services for AI/AN youth (10-24 years old) and their families.

Goal 4.      Improve and expand the delivery of suicide prevention and early intervention strategies in tribal settings, including: tribal clinics, tribal and public schools, tribal colleges, juvenile justice systems, substance use programs, health departments, foster care systems, and other community settings by focusing on youth and returning veterans.

Over 353,000 AI/ANs reside in Idaho, Oregon, and Washington, representing 6.8% of the nation’s AI/AN population. Over five years, our project activities will reach: 325 AI/AN youth during THRIVE’s youth conferences; 1,000 AI/AN young adults with mental health skill-building tools delivered via text message and social media; 300 AI/AN youth with caring messages; 120 AI/AN veterans with caring messages; 800,000 viewers with suicide prevention social marketing campaigns (#WeNeedYouHere); 200 AI/AN youth (10-24) with other culturally-appropriate EBIs; 5,000 AI/AN youth (10-24) with screening, assessment, treatment, and case management; and 3,500 youth-serving adults with gatekeeper training. Additionally, our monthly eNewsletters will be sent to 2,000+ contacts throughout the U.S, and our suicide prevention social media messages (delivered via We R Native) will reach 31,000 AI/AN viewers per week across the U.S. Our tribes, clinics, and partners are deeply committed to completing this scope of work, fulfilling elements of the Tribal Behavioral Health Agenda using socio-cultural-ecological approaches to improve adolescent mental health in the Pacific Northwest.

For every Youth a Witness~Tribal Suicide Prevention Vision Statement Coast Salish traditional beliefs, the role of witnesses is an essential part of collective, community process and healing. The Witnessing Our Future (WOF) Project will utilize this indigenous concept in a culturally-adapted implementation of the Model Adolescent Suicide Prevention Program (MASPP) with the Northwest Indian College (NWIC) and the Lummi Nation. This program will:

1. Conduct a community-based, family-driven and youth-guided adaptation of the MASPP to fit within a Coast Salish cultural context;
2. Utilize a promising practice in suicide prevention from Alaska to engage the community in an indigenous-theory driven intervention implementation process;
3. Establish a suicide surveillance system with screening and referral services for youth at risk at the NWIC;
4. Implement a community-wide, culturally-based preventive intervention for tribal youth;
5. Evaluate outcomes of the services and prevention.

The WOF Project will utilize the infrastructure developed as part of the SAMHSA Lummi System of Care Initiative to accelerate and enhance suicide surveillance, prevention and clinical services goals. Preventive Surveillance – The NWIC Center for Health and the Lummi Nation, will establish a suicide surveillance system to assess the problem among the highest risk youth: the 207 tribal college students ages 18-24 attending any of the seven NWIC campuses, with the goal of increasing referrals for youth identified at risk, and also among those youth 18-24 residing on the Lummi reservation but not attending NWIC. Preventive Services – A community-based and culturally-informed adaptation of the MASPP will combine universal, selected and targeted strategies, in alignment with the National Strategy for Suicide Prevention to service the 721 Lummi enrolled youth between the ages of 10 and 24 years old. Our community prevention implementation strategies will model a promising practice from Alaska that has demonstrated positive outcomes for Yupik Alaska Native youth in the villages, by increasing reasons for life and protective resources. The WOF Project will implement screening and referral services for youth with highest suicide risk and other co-occurring mental health and substance abuse disorders and provide trainings and community awareness events for those in the NWIC and Lummi Nation communities. Training and awareness events will create a community-wide mobilization toward identification of those at risk and referral to appropriate behavioral and cultural health resources. Local evaluation efforts will assess the effects of the intervention on key outcomes goals and provide information vital to other tribal youth-serving agencies as to what individual, family and community-level factors best associate with achieving our tribal suicide prevention vision to have each youth connected to their culture, community and future.

The Northern Cheyenne Board of Health (NCBH) is a tribal health serving organization, overseeing all behavioral health programs and services on the reservation. The mission of the NCBH is to provide complete care to the community with a culturally coordinated approach. The Honor Your Life (HYL) project proposal is the result of multiple tribal programs and community members identifying the desperate need for increased services and training in suicide prevention. HYL will serve the Northern Cheyenne population, focusing on youth ages 10-24, veterans, military families, and lesbian bay bisexual and transgender youth (LGBT). HYL will utilize multiple evidence based strategies and interventions, including: American Indian Life Skills, Lifelines, QPR, ASIST, Trauma-focused Cognitive Behavioral Therapy, cultural-community consultations, and early intervention skill building (Native HOPE, Good Road of Life).

HYL has three outcome goals, which support the strategic suicide prevention goals of the state of Montana and the Northern Cheyenne Tribe:

1. We will increase early screening 10% among youth ages 10-24 who are at risk for suicide on the Northern Cheyenne Reservation during the three-year project period;
2. Youth, LGBT youth, military families and veterans on the Northern Cheyenne Reservation will accept services provided through this project 50% of the time (including referrals, training, culturally-based contact and follow-up recommendations); and
3. Substance abuse by at-risk youth will decrease 10% during the three-year project period on the Northern Cheyenne Reservation.

Individuals reached through this project include clinicians, youth-serving organizations, schools, courts, tribal programs, college students, military families, youth, and LGBT. HYL has developed three strategic goals to achieve maximum project results:
Strategic Goal 1: Increase the understanding of suicide prevention.
Strategic Goal 2: Help those in need through targeted interventions and culturally based coordination
Strategic Goal 3: Coordinate multi-level agency partnerships for maximum involvement

The intended outcomes of the HYL project are: community members will have access to local training and resources they need to identify at-risk individuals; providers will be trained to recognize at-risk behaviors; those in need will benefit from culturally-based targeted interventions; and multiple agencies and programs will work together to provide continued services and interventions for future generations.

On behalf of the Navajo Nation, The Navajo Department of Behavioral Health (NNDBH), along with the National Indian Youth Leadership Project (NIYLP) and the Edventures Group on the Navajo Nation, seek to implement Project Ke. Project Ke is based on a three-tiered approach modeled after the Institute of Medicine (IOM) continuum which begins with the promotion of mental and behavioral health and wellness for universal populations, and continues through a full range of evidence-based suicide prevention and early intervention services for selective and indicated populations of youth and their families in our designated communities. Over the three-year course of the project, approximately 1650 from the Universal population will participate in small group public awareness activities/forums (tens of thousands more from the multi-media awareness campaign), 750 selective population members will participate in the TANAY schools-based project component and 165 members of the indicated population will receive at least one component of the Edventures program. All components are based on positive youth development approaches to wellness and are influenced by Native elders which stands in contrast to mainstream prevention approaches (Project Ke will focus on strengths rather than deficits).The overarching goal of our proposed Project Ke is to create prevention prepared communities in which to implement our tribal youth suicide prevention and early intervention strategies grounded in public/private collaboration (e.g. schools, educational institutions, juvenile justice, foster care systems, substance abuse and mental health programs, and other child and youth supporting organizations). Ke is a Navajo word for relations/relationships and it conceptually defines the Navajo individual place in the world, community, family, and with self. Project Ke was developed after extensive community planning in response to 54 suicide attempts and deaths among individuals aged 13-45 between January 2010 and October 2010 (most of them occurred in our 60-square mile target geographic area of Thoreau New Mexico and its surround rural communities). The deaths of so many young people at their own hand reveals that the increasing threat of drugs and crime is leading many youth American Indians to feel they have limited prospects in society. American Indian youth in NM had the highest suicide rate of all racial and ethnic groups, with 43.6 suicides per 100,000 population in 2006 (most recent data). The Navajo Nation has declared a medical emergency in the Eastern Navajo Agency and provides a strong rationale for selecting youth aged 11-18 residing in Thoreau and the surrounding communities, including survivors of suicide attempts and of suicide loss, as our population of focus.Our project will coordinate additional streams of prevention funding/programs (such as substance abuse prevention, violence prevention, etc.) in our target communities. We will also leverage the funding and counseling resources that were brought to bear following the declaration of medical emergency in our area. Additionally, the Ohrstrom Family Foundation and other project partners have committed $116,200 in funding and in-kind contributions.