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

300 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial tests new methods to support Alaska Native youth hospitalized for suicide-related issues, such as suicide attempts or thoughts, and behaviors linked to alcohol use. The trial focuses on two treatments: "Tools for Life," which uses cultural experiences to reduce suicide risk, and "Tools for Life + MISN," which incorporates motivational interviewing to foster healthier social networks. This trial suits Alaska Native youth aged 14 to 24 who have faced these challenges. As an unphased trial, it provides a unique opportunity to explore innovative treatments tailored to cultural needs.

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.

Is there any evidence suggesting that this trial's treatments are likely to be safe?

Research shows that the "Tools for Life" program helps young people in rural Alaska reduce risks related to suicide and alcohol. It uses cultural activities to encourage Alaska Native youth to stay sober and avoid harmful behaviors. Studies have not reported any major safety issues with this program.

The "Tools for Life + MISN" program adds motivational interviewing and social network visualization to the cultural approach. This helps young people understand their social connections and build healthier relationships. Research with similar groups has not shown any significant negative effects, indicating this combined approach is also safe.

Both programs aim to provide positive experiences without adding risks, according to the available data. Those considering joining a trial with these programs will find a focus on enhancing safety and support through cultural and social connections. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about these interventions because they offer a culturally tailored approach to suicide prevention for Alaska Native youth, which is not a focus of most current treatments. The "Tools for Life" intervention is unique in that it provides protective cultural experiences, helping youth connect with their heritage as a way to address suicide risk and alcohol use. Additionally, when combined with the Motivational Interviewing Social Network (MISN), it goes a step further by visualizing social networks to cultivate healthier relationships and cultural worlds. This dual focus on cultural engagement and social network enhancement sets these interventions apart from more conventional methods.

What evidence suggests that this trial's interventions could be effective for suicide prevention in Alaska Native youth?

Research has shown that the Tools for Life program, provided to participants in this trial, effectively helps Alaska Native youth reduce risks related to suicide and alcohol. This program uses cultural activities to mitigate these risks. Studies have found that young people in rural areas who participated in Tools for Life developed stronger motivations to stay sober and value life, which are crucial for preventing suicide and alcohol problems.

In this trial, some participants will also receive the Motivational Interviewing Social Network (MISN) intervention alongside Tools for Life. MISN aids youth by teaching them how to build healthy social connections. It complements Tools for Life by helping young people recognize and enhance their personal relationships and cultural ties. Both programs are designed to address the specific cultural needs of Alaska Native youth facing these challenges. ^{1 2 5 6 7}

Are You a Good Fit for This Trial?

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

I am between 14 and 24 years old.

Self-identify as Alaska Native youth

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

Timeline for a Trial Participant

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)

What Are the Treatments Tested in This Trial?

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.

How Is the Trial Designed?

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+

Published Research Related to This Trial

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 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]

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 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 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]

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]

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 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]

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 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]

Citations

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hdpulse.nimhd.nih.gov

hdpulse.nimhd.nih.gov/tools/interventions-portal/detail/IP-074/

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Qungasvik (Tools for life) is an indigenous intervention that focuses on enhancing protective factors for suicide and alcohol risk among adolescents/young ...

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pmc.ncbi.nlm.nih.gov

pmc.ncbi.nlm.nih.gov/articles/PMC5803385/

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Suicide and alcohol use disorders are primary determinants of health disparity among Alaska Native people in contrast to the U.S. general population.

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uaf.edu

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bmcpublichealth.biomedcentral.com

bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-025-24710-z

BMC Public Health - BioMed Central

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formative.jmir.org

formative.jmir.org/2025/1/e67885

Using the Healthy Native Youth Implementation Toolbox to ...

This study examines user reach and engagement from 2022 to 2024 of web-based decision support (the Healthy Native Youth [HNY] website and the embedded HNY ...