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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
Wendy Wolfersteig
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.