Feasibility of a Culturally Adapted Emotional-Behavioral Prevention Program for American Indian Children

NCT ID: NCT05371665

Last Updated: 2025-09-04

Basic Information

• Recruitment Status: COMPLETED
• Clinical Phase: NA
• Total Enrollment: 28 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2022-03-28
• Study Completion Date: 2024-05-14

Brief Summary

American Indians (AI) are at greater risk for anxiety and depression early in life. This is concerning given the potential negative effects of these conditions across the lifespan (substance use, suicide). Available culturally adapted prevention and early interventions (PEIs) for anxiety and depression in AI youth are limited. Thus, there is a critical need for the development and evaluation of a culturally consonant, brief PEI for anxiety and depression in AI youth. The investigators' goal is to provide the community with a potentially successful PEI to mitigate AI youth's anxiety and depression that integrates culture and traditions for delivery in schools. The Specific Aims of the proposed research were to 1) culturally adapt a PEI program for AI youth living on a Northern Plains tribal reservation (chosen by the Cultural Advisory Board; CAB), 2) evaluate the feasibility and acceptability of the culturally-adapted program with AI youth living on the reservation, and 3) estimate effect size changes in anxiety and depressive symptoms of the culturally adapted program with the AI youth. The investigators built upon the investigators' strong community relationships and CBPR methods to achieve these aims. The investigators partnered with the CAB to culturally adapt the PEI program for AI youth in year 1 and 2 using a CBPR framework, including AI youth and parents. In year 2, the investigators trained an AI school counselor from the tribal community and a white school counselor from the two tribal serving schools on the reservation to implement the adapted PEI program. We pilot tested the 6-week program (one 20-30 minute session per week) with 28 AI 3rd-6th graders in two schools serving youth from the reservation in year 3. The investigators will partner with the tribal community to further refine and tailor the adapted PEI program using the results of this study. Moreover, further testing of the refined program's efficacy and sustainability will be conducted using a larger sample and randomized, two-group design.

Detailed Description

American Indians (AI) are at greater risk for anxiety and depression early in life. This is concerning given the potential negative effects of these conditions across the lifespan (substance use, suicide). Available culturally adapted prevention and early interventions (PEIs) for anxiety and depression in AI youth are limited. Thus, there is a critical need for the development and evaluation of a culturally appropriate, brief PEI for anxiety and depression in AI youth. These were the three main goals of this study: 1) Partner with a Northern Plains tribal community to culturally adapt the PEI program for AI youth living on the reservation. 2) evaluate whether they were able to successfully provide the program to AI youth in two tribal schools and whether youth would accept/enjoy the program, and 3) test whether there were changes in anxiety and depressive symptoms, as well as resilience, among the AI youth from pre- to post-intervention. The investigators partnered with the tribal community, including AI youth and parents, to culturally adapt the PEI program in years 1 and 2. In year 3, the investigators trained an AI school counselor from the tribal community and a white school counselor to provide the adapted PEI program in the two tribal-serving schools. Twenty-eight AI 3rd-6th graders (8-12 years-old) participated in the program. The investigators will continue to partner with the tribal community to further refine and tailor the culturally adapted program using the results from this study. Moreover, further testing of the refined program's efficacy and sustainability will be conducted using a larger sample and control group.

This study built upon a community-based participatory research partnership with a Northern Plains tribal community to culturally adapt a brief and evidence-based prevention and early intervention (PEI) program addressing anxiety and depression in American Indian (AI) 8-12-year-olds. The investigators evaluated how feasible it would be for AI providers from the tribal community to deliver the adapted intervention to AI youth attending two schools serving the tribe. The investigators also tested the hypotheses that AI youth will find the program acceptable and enjoyable, and it will reduce anxiety and depressive symptoms from pre- to post-intervention.

The investigators used an iterative adaptation process within a CBPR framework to culturally adapt the evidence-based PEI program. It involved collaborating with the Cultural Advisory Board (CAB) and conducting adult work groups and youth focus groups with keys community stakeholders, including AI youth and parents, to determine cultural adaptations and adapt the program. The investigators first collaborated with the CAB in reviewing prior literature on anxiety and depression, as well as the non-adapted PEI program. The CAB developed an initial conceptual model of what factors may cause or put AI youth at risk for anxiety and depression. In addition the model included what outcomes were expected from a prevention and early intervention program targeting these causal or risk factors. Next, they used AI cultural and tribal specific knowledge to modify the model integrate the understanding and meaning of anxiety and depression and behavioral determinants and outcomes from their tribal and cultural perspective. This involved adding, removing, or modifying/replacing certain parts of the initial model to better align with the tribe's worldview of mental health and healing. Moreover, the CAB identified cultural or tribal behavioral determinants (e.g., cultural identity) of anxiety and depression not described in the literature and add them to the model.

Next, the investigators recruited 20 community stakeholders (Elders, parents/legal guardians, and mental health specialists who serve the community) and 14 AI 8-12 year-olds to review the non-adapted intervention and suggest cultural adaptions and improvements to the content, strategies, and materials. Focus groups were audio recorded. Youth also completed a pre-adaptation usability survey (they reviewed only 3 of the 6 program modules) of the non-adapted PEI program that assessed acceptability, enjoyableness, and cultural appropriateness.

The investigators analyzed focus and work group discussions to identify common themes and group suggestions together. The CAB used this information and integrate with their own suggestions to: 1) modify a conceptual framework of anxiety and depression prevention and early intervention in AI youth, and 2) determine the cultural adaptations that are most warranted given possible logistical barriers (e.g., time/funding). Identified themes were reviewed and validated with the CAB and Project Manager. The CAB worked with the research team to culturally adapt the intervention and identified two school counselors (i.e., an American Indian tribal member and a white non-tribal member) to provide it in the schools.

The two school counselors provided the program to 28 AI youth in the 3rd to 6th grade (8-12 years-old) in the two schools that serve the tribal community. The adapted intervention was delivered once a week for six weeks and each session lasted 20-30 minutes. Youth completed a post-adaption usability survey at the end of each session to assess acceptability and likeability of the adapted program. The investigators also collected survey data on the primary and secondary measures 1 week before the intervention (pre) and 1 week following the intervention (post). Survey data was collected electronically using a tablet or computer and included: youth demographics, the primary outcomes of youth anxiety and depressive symptoms (from youth and teachers), and secondary outcomes that include youth resilience, youth's beliefs whether they can control their anxiety symptoms, and youth's use of rumination when sad. The CAB worked with the research team using the conceptual model in the adaptation process to decide on the addition, removal, or further revision of the assessments. The youth who completed the intervention and were present for session 6 participated in a post-intervention focus (3-4 youth per group) to further discuss their experiences with adapted intervention and suggest improvements. The focus groups were audio recorded. The two intervention providers also recorded youth attendance and provided additional information about following the program guidelines and steps as trained, what material was covered or not covered, and their judgements on implementing the program.

Conditions

Anxiety Disorder; Depressive Disorder

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: PREVENTION
• Blinding Strategy: NONE

Study Groups

Culturally Adapted Cognitive-Behavioral Prevention and Early Intervention (PEI) Program

All youth received the culturally adapted prevention and early intervention program from trained providers in the school setting.

Group Type: EXPERIMENTAL

Culturally Adapted Cognitive-Behavioral Prevention and Early Intervention (PEI) Program

Intervention Type: BEHAVIORAL

The prevention and early intervention is originally an indicated cognitive-behavioral program for 8-13-year-old youth with higher anxiety. Our CAB adapted it as a universal prevention and early intervention for all American Indian youth in the tribal community. It was delivered across six weeks with 20-30 min weekly sessions. Youth engaged in games and role-play reducing anxiety and stress in mildly challenging situations to provide in-vivo exposure. Session 1 involved introductions, relaxation training, and discussing emotions. Session 2 taught youth about worries and how to handle them. Session 3 focused on having conversations with others. Session 4 taught youth how to be assertive (CAB identified this as an area of adaption in initial meetings). Session 5 taught youth how to face their fears. Session 6 was a review session. Parents and teachers were sent notes of what youth learned in each session and asked to encourage youth to practice their learned skills.

Interventions

Culturally Adapted Cognitive-Behavioral Prevention and Early Intervention (PEI) Program

The prevention and early intervention is originally an indicated cognitive-behavioral program for 8-13-year-old youth with higher anxiety. Our CAB adapted it as a universal prevention and early intervention for all American Indian youth in the tribal community. It was delivered across six weeks with 20-30 min weekly sessions. Youth engaged in games and role-play reducing anxiety and stress in mildly challenging situations to provide in-vivo exposure. Session 1 involved introductions, relaxation training, and discussing emotions. Session 2 taught youth about worries and how to handle them. Session 3 focused on having conversations with others. Session 4 taught youth how to be assertive (CAB identified this as an area of adaption in initial meetings). Session 5 taught youth how to face their fears. Session 6 was a review session. Parents and teachers were sent notes of what youth learned in each session and asked to encourage youth to practice their learned skills.

Intervention Type: BEHAVIORAL

Eligibility Criteria

Inclusion Criteria

• 8-12 year-old youth who attends either tribe-serving school and resides on the reservation with their parent/legal guardian.

• Minimum Eligible Age: 8 Years
• Maximum Eligible Age: 12 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: Yes

Sponsors

National Institute of General Medical Sciences (NIGMS)

NIH

Sponsor Role: collaborator

Montana State University

OTHER

Sponsor Role: lead

Responsible Party

Brandon Scott

Associate Professor

Responsibility Role: PRINCIPAL_INVESTIGATOR

Locations

Montana State University

Bozeman, Montana, United States

Countries

United States

Provided Documents

Document Type: Study Protocol and Statistical Analysis Plan

View Document

Other Identifiers

5P20GM104417

Identifier Type: NIH

Identifier Source: secondary_id

View Link

bscott

Identifier Type: -

Identifier Source: org_study_id