Tools for Life Interventions for Suicide Prevention in Alaska Native Youth

(BeWeL Trial)

Recruiting at 1 trial location

Overseen By Stacy Rasmus, PhD

Age: < 65

Sex: Any

Trial Phase: Academic

Sponsor: RAND

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: 5

Duration: 6 weeks

370 Participants Needed

Trial Summary

What is the purpose of this trial?

Two interventions will be delivered virtually to American Indian/Alaska Native youth who have been hospitalized with suicidal attempt, suicidal ideation, or associated risk behaviors, including alcohol-related injury.

Do I need to stop my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What data supports the effectiveness of the treatment Tools for Life Interventions for Suicide Prevention in Alaska Native Youth?

The Qungasvik (Tools for Life) intervention has shown effectiveness in enhancing protective factors against suicide and alcohol risk among young people in rural Alaska Native communities, suggesting its potential as a suicide prevention strategy. ^{1 2 3 4 5}

Is the Tools for Life intervention generally safe for humans?

The research does not provide specific safety data for the Tools for Life intervention, but it highlights the intervention's cultural adaptation and acceptability in Alaska Native communities, suggesting it is well-received and potentially safe for use in these settings. ^{1 2 3 6 7}

What makes the Tools for Life treatment unique for preventing suicide in Alaska Native youth?

The Tools for Life treatment is unique because it combines cultural strengths and community-based approaches to build resilience and protective factors in Alaska Native youth, rather than focusing solely on reducing risk factors. This strengths-based approach is tailored to the cultural context and needs of the community, making it distinct from more traditional methods. ^{6 7 8 9 10}

Eligibility Criteria

This trial is for Alaska Native youth aged 15-24 who have been hospitalized due to a suicide attempt, suicidal thoughts, or behaviors linked to alcohol use. Participants must self-identify as Alaska Native.

Inclusion Criteria

Self-identify as Alaska Native youth

I am between 14 and 24 years old.

Admitted to the hospital for suicide attempt, ideation, or associated risk behaviors including alcohol-related injury or acute intoxication

Timeline

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive either the Tools for Life or Tools for Life + MISN intervention virtually

6 weeks

2 visits (virtual)

Follow-up

Participants are monitored for safety and effectiveness after treatment with follow-up assessments at 3, 6, and 12 months

12 months

3 visits (virtual)

Treatment Details

Interventions

• Tools for Life
• Tools for Life +MISN
• Tools for Life + MISN

Trial Overview The study tests two virtual interventions: 'Tools for Life' and 'Tools for Life + MISN'. They aim to support American Indian/Alaska Native youth after hospitalization related to suicide or alcohol-related injury.

Participant Groups

Group I: Tools for Life Active Control 1 Intervention

All youth will receive the Tools for Life (Qungasvik) intervention. Tools for Life is an evidence-based, community-developed intervention focused on providing protective cultural experiences for Alaska Native youth to address suicide risk and alcohol use.

Group II: Tools for Life + Motivational Interviewing Social Network intervention (MISN) Active Control 1 Intervention

Half of the youth will will also receive MISN in addition to the Tools for Life intervention. MISN is an evidence-based treatment that augments motivational interviewing with personal social network composition and structure visualization as a means to cultivating healthy social networks and cultural worlds.

Who Is Running the Clinical Trial?

RAND

Lead Sponsor

Trials

145

Recruited

617,000+

Patient-Centered Outcomes Research Institute

Collaborator

Trials

592

Recruited

27,110,000+

Findings from Research

The Caring Contacts intervention, a suicide prevention program, showed high acceptability among American Indian/Alaska Native (AI/AN) communities, with 92% of participants reporting a positive experience during initial assessments.

Adaptations made during the study's Phase 1, such as broadening eligibility criteria and incorporating locally-informed methods of self-harm, significantly increased participant recruitment and allowed for a more comprehensive understanding of suicidal behaviors in these communities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"Keep up the messages, sometimes it was a lifesaver": Effects of cultural adaptation on a suicide prevention clinical trial in American Indian/Alaska Native communities. Bogic, M., Hebert, LE., Evanson, A., et al.[2023]

The PC CARES intervention trained 32 facilitators from 11 Northwest Alaska communities to implement culturally responsive suicide prevention strategies, demonstrating feasibility and community engagement.

Facilitators successfully hosted 54 learning circles with 309 community members, showing effective dissemination of research evidence and positive reflections on the program's impact in addressing youth suicide in rural Alaska Native communities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Promoting Community Conversations About Research to End Suicide: learning and behavioural outcomes of a training-of-trainers model to facilitate grassroots community health education to address Indigenous youth suicide prevention. Wexler, L., Trout, L., Rataj, S., et al.[2023]

The Qungasvik intervention effectively enhanced protective factors against suicide and alcohol misuse among 239 young people aged 12-18 in rural Alaska Native communities over a two-year period.

The intervention showed dose-dependent effects on ultimate protective factors, indicating its potential as a culturally relevant strategy for addressing urgent public health issues in these communities, although it did not demonstrate a direct impact on intermediate protective factors.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Culturally grounded strategies for suicide and alcohol risk prevention delivered by rural Alaska Native communities: A dynamic wait-listed design evaluation of the Qungasvik intervention. Allen, J., Charles, B., Fok, CCT., et al.[2023]

The study involves 304 American Indian youth aged 10-24 and aims to evaluate the effectiveness of two brief interventions, New Hope and Elders' Resilience, in reducing suicide ideation and promoting resilience, compared to a control group receiving Optimized Case Management.

Preliminary hypotheses suggest that New Hope will significantly reduce suicide ideation, while Elders' Resilience will enhance resilience, with the combination of both interventions expected to yield the greatest improvements, highlighting the importance of culturally relevant approaches in mental health care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Employing a sequential multiple assignment randomized trial (SMART) to evaluate the impact of brief risk and protective factor prevention interventions for American Indian Youth Suicide. O'Keefe, VM., Haroz, EE., Goklish, N., et al.[2022]

American Indian and Alaska Native (AI/AN) veterans are at a significantly higher risk for suicidal ideation compared to non-Hispanic White veterans, highlighting a critical public health issue that lacks targeted intervention.

Current suicide prevention programs for veterans do not specifically address the needs of AI/AN veterans, and while culturally specific programs exist, they are not widely disseminated or tailored for veterans, indicating a need for a new model that integrates best practices with tribal cultural approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A scoping review of veteran suicide prevention programs in Native American communities and in the general population. Mohatt, NV., Begay, RL., Goss, CW., et al.[2022]

The study analyzed statewide school survey data to understand suicide attempts among American Indian/Alaska Native (AI/AN) youth compared to non-AI/AN youth, revealing that AI/AN youth require a higher level of risk before attempting suicide.

Protective factors, such as support systems, were found to effectively reduce the impact of risk factors on suicide attempts, especially for those AI/AN youth who were at higher risk.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The power of protection: a population-based comparison of Native and non-Native youth suicide attempters. Mackin, J., Perkins, T., Furrer, C.[2022]

The National Institute of Mental Health has funded three regional Collaborative Hubs focused on suicide prevention research and policy development specifically for American Indian and Alaska Native (AIAN) communities, addressing the alarming rates of youth suicide in these populations.

These Hubs utilize innovative, community-driven research methods and comprehensive ecological approaches to develop effective suicide prevention strategies, which can also be applied to other marginalized communities globally.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

New Collaborative Research on Suicide Prevention, Practice, and Policy With American Indian and Alaska Native Communities Holds Promise for All Peoples. Barlow, A., Haroz, EE., O'Keefe, VM., et al.[2023]

The Qungasvik intervention, a culturally grounded program for Yup'ik youth, significantly improved 'Reasons for Life' protective factors against suicide risk, demonstrating its effectiveness in promoting mental health among Alaska Native youth.

While the high-intensity intervention showed positive effects on suicide prevention, it did not significantly impact reflective processes regarding alcohol use, indicating that different aspects of health may require tailored approaches.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Multi-Level Cultural Intervention for the Prevention of Suicide and Alcohol Use Risk with Alaska Native Youth: a Nonrandomized Comparison of Treatment Intensity. Allen, J., Rasmus, SM., Fok, CCT., et al.[2022]

Community members in Northwest Alaska believe that a community-based approach, focusing on increased communication and connection to culture, is essential for preventing youth suicide, as identified through a survey of 382 respondents.

There is a significant difference in perspectives between adults and youth regarding the causes of suicide; adults see boredom as a key factor, while youth attribute it to stress, highlighting the need for aligned prevention strategies that address both viewpoints.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Youth and adult community member beliefs about Inupiat youth suicide and its prevention. Wexler, L., Goodwin, B.[2022]

The Reasons for Life (RFL) scale, developed to measure protective factors against suicide, was tested on 302 rural Alaska Native Yup'ik youth and showed strong psychometric properties, indicating it is a reliable tool for assessing culturally based protective factors.

The RFL scale identified three distinct factors contributing to resilience, suggesting that culturally grounded approaches to suicide prevention can effectively promote protective factors rather than just focusing on risk reduction.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Strengths-Based Assessment for Suicide Prevention: Reasons for Life as a Protective Factor From Yup'ik Alaska Native Youth Suicide. Allen, J., Rasmus, SM., Fok, CCT., et al.[2022]

References

1. England pubmed.ncbi.nlm.nih.gov

"Keep up the messages, sometimes it was a lifesaver": Effects of cultural adaptation on a suicide prevention clinical trial in American Indian/Alaska Native communities. [2023]

2. United States pubmed.ncbi.nlm.nih.gov

Promoting Community Conversations About Research to End Suicide: learning and behavioural outcomes of a training-of-trainers model to facilitate grassroots community health education to address Indigenous youth suicide prevention. [2023]

3. England pubmed.ncbi.nlm.nih.gov

Culturally grounded strategies for suicide and alcohol risk prevention delivered by rural Alaska Native communities: A dynamic wait-listed design evaluation of the Qungasvik intervention. [2023]

4. England pubmed.ncbi.nlm.nih.gov

Employing a sequential multiple assignment randomized trial (SMART) to evaluate the impact of brief risk and protective factor prevention interventions for American Indian Youth Suicide. [2022]

5. United States pubmed.ncbi.nlm.nih.gov

A scoping review of veteran suicide prevention programs in Native American communities and in the general population. [2022]

6. United States pubmed.ncbi.nlm.nih.gov

The power of protection: a population-based comparison of Native and non-Native youth suicide attempters. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

New Collaborative Research on Suicide Prevention, Practice, and Policy With American Indian and Alaska Native Communities Holds Promise for All Peoples. [2023]

8. United States pubmed.ncbi.nlm.nih.gov

Multi-Level Cultural Intervention for the Prevention of Suicide and Alcohol Use Risk with Alaska Native Youth: a Nonrandomized Comparison of Treatment Intensity. [2022]

9. United States pubmed.ncbi.nlm.nih.gov

Youth and adult community member beliefs about Inupiat youth suicide and its prevention. [2022]

10. United States pubmed.ncbi.nlm.nih.gov

Strengths-Based Assessment for Suicide Prevention: Reasons for Life as a Protective Factor From Yup'ik Alaska Native Youth Suicide. [2022]