Engaging Urban American Indian Community Members to Culturally Adapt and Implement, Parenting in 2 Worlds, a

Prevention Curriculum

15th Annual Summer Institute

ASU Center for Applied Behavioral Health Policy

July 15, 2014

Funding provided by the National Institute on Minority Health and Health Disparities (NIMHD)/NIH, (award P20MD002316 & R01MD006110), and the Arizona Governor’s Office

for Children, Youth and Families Parents Commission

Patricia Hibbeler, M.A., Salish/Kootenai

Wendy Wolfersteig, Ph.D.

Nicholet Deschine, M.S.W., Lakota/Diné

Presentation Overview

• Learning Objectives

• UAIPP phases

• UAIPP goals

• What did we do to engage community

members

• Cultural adaptation process

• RCT implementation

• Moving forward

Learning Objectives

1. Understand how Community-based

Participatory Research (CBPR) led to a

culturally adapted curriculum and program

implementation of a prevention curriculum for

urban American Indian families.

2. Discuss lessons learned in engaging the

community through CBPR.

3. Experience a culturally adapted activity from

Parenting in 2 Worlds.

Project Partners

Partnering for 10 years

Phoenix Indian Center

&

ASU – Southwest Interdisciplinary

Research Center

Urban American Indian Parenting Project Phases

UICAZ Needs

Assessment

Community involvement

Data collection

Coalition goals

Program evaluation

Families Preparing a New Generation,

universal

Community involvement

Data collection

Cultural Adaptation

Community involvement

Pilot curriculum, 1st adaptation

Data collection

Parenting in 2 Worlds, final adaptation

Randomized Control Trial

Community involvement

Data collection

P2W & HF2W

Moving Forward

RCT data analysis

Effectiveness trial

UICAZ Needs Assessment

UICAZ Needs

Assessment

Community involvement

Data collection

Coalition goals

Program evaluation

Families Preparing a New Generation,

universal

Community involvement

Data collection

Cultural Adaptation

Community involvement

Pilot curriculum, 1st adaptation

Data collection

Parenting in 2 Worlds, final adaptation

Randomized Control Trial

Community involvement

Data collection

P2W & HF2W

Moving Forward

RCT data analysis

Effectiveness trial

UICAZ Needs Assessment Findings

Problem addressed by community members

Coalition planning

Decisions are data driven

Needs assessment process

Three urban areas in Arizona

American Indian Community Involvement

UIC

AZ

Nee

ds

Ass

essm

ent

American Indian Community Involvement

UICAZ used SPF/SIG Process

UIC

AZ

Nee

ds

Ass

essm

ent

UICAZ Parent Project Goals

Increase communication and

prevention skills between parents

and their children

Increase community capacity,

attachment and norms

UIC

AZ

Nee

ds

Ass

essm

ent

Pro

gra

m E

val

uat

ion

Phoenix Indian Center Program Evaluation

UICAZ Needs

Assessment

Community involvement

Data collection

Coalition goals

Program evaluation

Families Preparing a New Generation,

universal

Community involvement

Data collection

Cultural Adaptation

Community involvement

Pilot curriculum, 1st adaptation

Data collection

Parenting in 2 Worlds, final adaptation

Randomized Control Trial

Community involvement

Data collection

P2W & HF2W

Moving Forward

RCT data analysis

Effectiveness trial

Pro

gra

m E

val

uat

ion

Universal parenting intervention

Implement and Evaluate

Pro

gra

m E

val

uat

ion

Partnership between the Indian Centers in three urban areas in Arizona

Community co-facilitators and observers

External program evaluation, training, & technical assistance provided by ASU SIRC

AI Community Involvement & Data Collection

Research Project Goals

Develop a culturally adapted parenting intervention for urban American Indian parents, to help them prevent

their children from engaging in substance use and risky

sexual behavior

Conduct a RCT to determine the feasibility, efficacy, and

effect size of the intervention

Cu

ltu

ral

Ad

apta

tio

n

RC

T

NIMHD Research Funding

Community-based Participatory Research

“CBPR in health is a collaborative approach to

research that equitably involves all partners in the

research process and recognizes the unique

strengths that each brings. CBPR begins with a

research topic of importance to the community

and has the aim of combining knowledge with

action and achieving social change to improve

health outcomes and eliminate health

disparities.” - W.K. Kellogg Foundation

What did we do to engage community members?

UICAZ Needs

Assessment

Community involvement

Data collection

Coalition goals

Program evaluation

Families Preparing a New Generation,

universal

Community involvement

Data collection

Cultural Adaptation

Community involvement

Pilot curriculum, 1st adaptation

Data collection

Parenting in 2 Worlds, final adaptation

Randomized Control Trial

Community involvement

Data collection

P2W & HF2W

Moving Forward

RCT data analysis

Effectiveness trial

Culturally Relevant Curriculum

Culturally Adapt

Families Preparing a New Generation

for urban American Indian parents =

Cu

ltu

ral A

dap

tati

on

Cu

ltu

ral A

dap

tati

on

AI Community Involvement

Pilot implementation

•Community facilitators & co-facilitators

•Community observers

Sources for cultural adaptation

Cu

ltu

ral A

dap

tati

on

Cultural Adaptation Source Data

95 Parent Participants provided Pre-/Post-surveys &

feedback at each workshop

26 Parent Participants in 3 focus groups

13 Community Observers at each workshop

12 Workshop Facilitators & Observers, 1 focus group

12 Key Informants from the AI community

P2W Cultural Adaptation

Addressing “deep structure”

Locating and building on urban Indian culture

“What makes cultural adaptation

successful is the translation of not just

language but also core principles and

treatment concepts so that they

become meaningful to the culturally

targeted group while still maintaining

fidelity.”

Big Foot & Schmidt (2010).

Cu

ltu

ral A

dap

tati

on

Deep Structure Adaptations

Starting point emphasis on

traditional culture as a strength

Holistic-circular learning:

Whole-to-part-to-whole versus linear

Storytelling

Change terminology to reflect AI

worldview on parenting: “guiding” versus

“disciplining,” “managing”, setting boundaries”

(Re-)creating parenting communities, network

support

Cu

ltu

ral A

dap

tati

on

Parenting in 2 Worlds Video

Partnered with White Springs Creative, LLC to

incorporate modern-day storytelling via videos

Cu

ltu

ral A

dap

tati

on

What did we do to engage community members?

UICAZ Needs

Assessment

Community involvement

Data collection

Coalition goals

Program evaluation

Families Preparing a New Generation,

universal

Community involvement

Data collection

Cultural Adaptation

Community involvement

Pilot curriculum, 1st adaptation

Data collection

Parenting in 2 Worlds, final adaptation

Randomized Control Trial

Community involvement

Data collection

P2W & HF2W

Moving Forward

RCT data analysis

Effectiveness trial

AI Community Involvement

Community Recruiters

•$10 payment per eligible person

Community Facilitators

•Parenting in 2 Worlds, intervention

curriculum

•Healthy Families in 2 Worlds, control

curriculum

•$10 payment per hour, up to 3 hours per

week

Ran

do

miz

ed C

on

tro

l T

rial

PIC CEO

PIC Project Manager

PIC Project Specialist

Community Recruiters

Community Facilitators

PIC Project Specialist

Community Recruiters

Community Facilitators

PIC Project Specialist

Community Recruiters

Community Facilitators

SIRC Research PI & Evaluation PI

SIRC Project Manager

Managing Community Workers R

and

om

ized

Co

ntr

ol

Tri

al

P2W Activity: Identifying Family Traditions, Norms & Values

Ran

do

miz

ed C

on

tro

l T

rial

TRADITIONS are knowledge, beliefs, and customs

that are passed from one generation to another

often by word of mouth or by example.

NORMS are what we do, and what is accepted as

“normal” in the society in which we live.

VALUES are principles or ideals that are important to

each of us.

P2W Activity: Identifying Family Traditions, Norms & Values

Ran

do

miz

ed C

on

tro

l T

rial

TRADITIONS are knowledge, beliefs, and customs

that are passed from one generation to another

often by word of mouth or by example.

NORMS are what we do, and what is accepted as

“normal” in the society in which we live.

VALUES are principles or ideals that are important to

each of us.

P2W Activity: Identifying Family Traditions, Norms & Values

Ran

do

miz

ed C

on

tro

l T

rial

TRADITIONS are knowledge, beliefs, and customs

that are passed from one generation to another

often by word of mouth or by example.

NORMS are what we do, and what is accepted as

“normal” in the society in which we live.

VALUES are principles or ideals that are important to

each of us.

P2W Activity: Identifying Family Traditions, Norms & Values

Ran

do

miz

ed C

on

tro

l T

rial

TRADITIONS are knowledge, beliefs, and customs

that are passed from one generation to another

often by word of mouth or by example.

NORMS are what we do, and what is accepted as

“normal” in the society in which we live.

VALUES are principles or ideals that are important to

each of us.

Lessons Learned

Retaining community

members

Identifying community

members

Modifying trainings

Retaining Community Members

High turn over

Over 2 years, conducted 24 trainings

with 74 community members

Training # of Trainings

Offered # of Participants

P2W Facilitator 8 28

HF2W Facilitator 6 14

Recruiter 10 32

Identifying Community Members

Gate-keepers

Self-motivated

Independent

workers

Time to commit

Modifying Trainings

Facilitator and recruiter trainings

•Add additional P2W training day

•Add additional training on program

evaluation and administrative forms

•Revise recruiter training

•Incorporate time to complete the Human

Subjects Protections training (IRB required)

Coordinator Trainings

•Focus on team management

P2W Activity: Identifying Family Traditions, Norms & Values

Ran

do

miz

ed C

on

tro

l T

rial

TRADITIONS are knowledge, beliefs, and customs

that are passed from one generation to another

often by word of mouth or by example.

NORMS are what we do, and what is accepted as

“normal” in the society in which we live.

VALUES are principles or ideals that are important to

each of us.

Moving Forward

UICAZ Needs

Assessment

Community involvement

Data collection

Coalition goals

Program evaluation

Families Preparing a New Generation,

universal

Community involvement

Data collection

Cultural Adaptation

Community involvement

Pilot curriculum, 1st adaptation

Data collection

Parenting in 2 Worlds, final adaptation

Randomized Control Trial

Community involvement

Data collection

P2W & HF2W

Moving Forward

RCT data analysis

Effectiveness trial

Thank You

More information:

http://sirc.asu.edu

Patti Hibbeler

pattih@phxindcenter.org

Wendy Wolfersteig

wendy.wolfersteig@asu.edu

References BigFoot, D.S., & Schmidt, S.R. (2010). Honoring children, mending the circle: Cultural adaptation of trauma focused cognitive-behavioral therapy for American Indian and Alaska Native children. Journal of Clinical Psychology, 66, 847–856.

Jumper-Reeves, L., Dustman, P.A., Harthun, M.L., Kulis, S., & Brown, E. (2013). American Indian Cultures: How CBPR

Illuminated Intertribal Cultural Elements Fundamental to an Adaptation Effort. Society for Prevention Research,

W.K. Kellogg Foundation Community Health Scholars. (2007). Kellogg Health Scholars Program Overview, Community Track. Retrieved from: http://www.kellogghealthscholars.org/about/community.cfm

Kulis, S., & Brown, E. (2011). Preferred drug resistance strategies of urban American Indian youth of the Southwest. Journal of Drug Education, 41, 203-235.

Kulis, S., Napoli, M., & Marsiglia, F.F. (2002). Ethnic pride, biculturalism, and the drug use norms of urban American Indian adolescents. Social Work Research, 26, 101-112.

Kulis, S., Okamoto, S.KI., Rayle, A.D., & Sen, S. (2006). Social contexts of drug offers among American Indian Youth and their relationship to substance use: An exploratory study. Journal of Cultural Diversity and Ethnic Minority Psychology, 12, 30-44.

Kulis, S., Reeves, L.J., Dustman, P.A., & O’Neill, M. (2011). Strategies to resist drug offers among urban American Indian youth of the Southwest: An enumeration, classification, and analysis by substance and offeror. Substance Use & Misuse, 46, 1395-1409.

Okamoto, S.K., Hurdle, D.E., & Marsiglia, F.F. (2001) Exploring culturally-based drug resistance strategies used by American Indian adolescents of the Southwest. The Journal of Alcohol and Drug Education, 47, 45-59.

Okamoto, S.K., LeCroy, C.W., Dustman, P.A., Hohmann-Marriott, B., & Kulis, S. (2004). An ecological assessment of drug related problem situations for American Indian adolescents of the Southwest. Journal of Social Work Practice in the Addictions, 4, 47-63.

Resnicow, K., Soler, R., Braithwaite, R., Ahluwalia, J., & Butler, J. (2000). Cultural sensitivity in substance use prevention. Journal of Community Psychology. 28(3), 271–290.

Wallerstein, N.B., & Duran, B. (2006). Using community-based participatory research to address health disparities. Health Promotion Practice, 7(3), 312–323.