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Bedard-Gilligan M, Kaysen D, Cordero RM, Huh D, Walker D, Kaiser-Schauer E, Robjant K, Saluskin K, Pearson C. Adapting narrative exposure therapy with a tribal community: A community-based approach. J Clin Psychol 2022; 78:2087-2108. [PMID: 35621371 PMCID: PMC9811656 DOI: 10.1002/jclp.23395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 02/05/2022] [Accepted: 05/07/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVE American Indian (AI) individuals are at increased risk for present-day trauma exposure and associated negative outcomes, as well as ongoing effects of intergenerational trauma exposure and adversity. However, few empirically supported treatments exist that are specifically tailored and/or tested with AI communities. This study describes the process of selecting, adapting, and implementing narrative exposure therapy (NET) with an AI community. METHODS A community and academic partnership was formed and worked together to make culturally mindful changes to NET to best fit the needs of the community. The partnership incorporated community leaders/Elders (n = 7), providers (n = 11), and participants seeking treatment (n = 50) to implement an iterative process of adapting and implementing the adapted form of NET. RESULTS Key adaptions included addressing historical and intergenerational trauma, greater protections for confidentiality in a small community, and incorporation of cultural customs and traditions. Overall, the adapted form of NET was favorably received by the participants, and the implementation appeared to be feasible, with improved retention over past trials of adapted trauma-focused treatments with this community and with highly positive satisfaction ratings and feedback. CONCLUSIONS NET was shown to be an appropriate approach for this AI community and should be considered as a treatment option for other AI communities. Future work should consider strategies outlined in this adaption as well as following a similar process for working with AI communities to implement culturally appropriate interventions for trauma-related symptoms.
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Affiliation(s)
- Michele Bedard-Gilligan
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Debra Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, California, USA
| | - Rebeca Marin Cordero
- Indigineous Wellness Research Institute, School of Social Work, University of Washington, Seattle, Washington, USA
| | - David Huh
- Indigineous Wellness Research Institute, School of Social Work, University of Washington, Seattle, Washington, USA
| | - Denise Walker
- Indigineous Wellness Research Institute, School of Social Work, University of Washington, Seattle, Washington, USA
| | - Elisabeth Kaiser-Schauer
- Vivo International, Konstanz, Germany
- Center of Excellence for Psychotraumatology, University of Konstanz, Konstanz, USA
| | | | - Kathy Saluskin
- Yakama Nation Behavioral Health, Toppenish, Washington, USA
| | - Cynthia Pearson
- Indigineous Wellness Research Institute, School of Social Work, University of Washington, Seattle, Washington, USA
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LoSavio ST, Holder N, Wells SY, Resick PA. Clinician Concerns About Cognitive Processing Therapy: A Review of the Evidence. COGNITIVE AND BEHAVIORAL PRACTICE 2022. [DOI: 10.1016/j.cbpra.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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3
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DePrince AP. Translating Scientific Knowledge About Trauma into Action. J Trauma Dissociation 2022; 23:205-211. [PMID: 35446242 DOI: 10.1080/15299732.2022.2041225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Anne P DePrince
- Center for Institutional Courage, University of Denver, Denver, Colorado, USA
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Cox GR, FireMoon P, Anastario MP, Ricker A, Thunder REG, Baldwin JA, Rink E. Indigenous standpoint theory as a theoretical framework for decolonizing social science health research with American Indian communities. ALTERNATIVE (AUCKLAND, N.Z. : 2005) 2021; 17:460-468. [PMID: 38680293 PMCID: PMC11046738 DOI: 10.1177/11771801211042019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Theoretical frameworks rooted in Western knowledge claims utilized for public health research in the social sciences are not inclusive of American Indian communities. Developed by Indigenous researchers, Indigenous standpoint theory builds from and moves beyond Western theoretical frameworks. We argue that using Indigenous standpoint theory in partnership with American Indian communities works to decolonize research related to American Indian health in the social sciences and combats the effects of colonization in three ways. First, Indigenous standpoint theory aids in interpreting how the intersections unique to American Indians including the effects of colonization, tribal and other identities, and cultural context are linked to structural inequalities for American Indian communities. Second, Indigenous standpoint theory integrates Indigenous ways of knowing with Western research orientations and methodologies in a collaborative process that works to decolonize social science research for American Indians. Third, Indigenous standpoint theory promotes direct application of research benefits to American Indian communities.
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Affiliation(s)
- Genevieve R Cox
- Department of Health & Human Development, Montana State University, USA
| | | | - Michael P Anastario
- Department of Health Promotion and Disease Prevention, Florida International University, USA
| | | | | | - Julie A Baldwin
- Center for Health Equity Research, Northern Arizona University, USA
| | - Elizabeth Rink
- Department of Health & Human Development, Montana State University, USA
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Armenta RF, Kellogg D, Montoya JL, Romero R, Armao S, Calac D, Gaines TL. "There Is a Lot of Practice in Not Thinking about That": Structural, Interpersonal, and Individual-Level Barriers to HIV/STI Prevention among Reservation Based American Indians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3566. [PMID: 33808175 PMCID: PMC8037532 DOI: 10.3390/ijerph18073566] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/22/2021] [Accepted: 03/22/2021] [Indexed: 11/17/2022]
Abstract
American Indians (AI) face significant disparities in HIV/STI morbidity and mortality, and historical, structural, interpersonal, and individual level barriers stymie prevention efforts. The objective of this paper is to examine barriers to HIV/STI prevention among reservation-based AI. We conducted face-to-face qualitative interviews with 17 reservation-based AI community leaders and community members in Southern California on HIV/STI knowledge and attitudes and barriers to prevention. The disruption of traditional coping mechanisms and healing processes were compromised by historical trauma, and this allowed stigmas to exist where they did not exist before. This impacted access to healthcare services and trust in medicine, and is linked to individuals adopting negative coping behaviors that confer risk for HIV/STI transmission (e.g., substance use and sexual behaviors). Most of the participants reported that HIV/STIs were not discussed in their reservation-based communities, and many participants had a misperception of transmission risk. Stigma was also linked to a lack of knowledge and awareness of HIV/STI's. Limited available services, remoteness of communities, perceived lack of privacy, and low cultural competency among providers further hindered the access and use of HIV/STI prevention services. These findings highlight the need to address the historical, structural, and interpersonal factors impacting individual-level behaviors that can increase HIV/STI transmission among reservation-based AIs. Prevention work should build on community strengths to increase HIV/STI knowledge, reduce stigma, and increase access to preventative care while using culturally grounded methodologies.
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Affiliation(s)
- Richard F Armenta
- Department of Kinesiology, California State University, San Marcos, CA 92078, USA
| | - Daniel Kellogg
- School of Public Health, San Diego State University, San Diego, CA 92182, USA;
| | - Jessica L Montoya
- Department of Psychiatry, University of California, La Jolla, San Diego, CA 92093, USA;
| | - Rick Romero
- Southern California Tribal Health Center, San Diego, CA 92539, USA; (R.R.); (S.A.); (D.C.)
| | - Shandiin Armao
- Southern California Tribal Health Center, San Diego, CA 92539, USA; (R.R.); (S.A.); (D.C.)
| | - Daniel Calac
- Southern California Tribal Health Center, San Diego, CA 92539, USA; (R.R.); (S.A.); (D.C.)
| | - Tommi L Gaines
- Division of Infectious Diseases and Global Public Health, Department of Medicine, School of Medicine, University of California, La Jolla, CA 92093, USA;
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Hirchak KA, Hernandez-Vallant A, Herron J, Cloud V, Tonigan JS, McCrady B, Venner K. Aligning three substance use disorder interventions among a tribe in the Southwest United States: Pilot feasibility for cultural re-centering, dissemination, and implementation. J Ethn Subst Abuse 2020; 21:1-17. [PMID: 33135985 PMCID: PMC8095342 DOI: 10.1080/15332640.2020.1836701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
In this article we describe cultural re-centering, dissemination, and implementation activities in partnership between an American Indian reservation community and a university in the Southwest United States. We offer examples of cultural adaptation and implementation of evidence-based treatments (e.g., Motivational Interviewing, Community Reinforcement Approach and the Community Reinforcement and Family Training) using the Interactive Systems Framework. Facilitators and barriers are described within each study including recruitment strategies, training, and sustainability of counselors in the community. Through this Tribal-university partnership, we offer insight on the cultural adaptation and implementation process that will be translatable and clinically meaningful to other rural and reservation communities.
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Affiliation(s)
- Katherine A. Hirchak
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
- Revitalzing Indigenous Values in Empirical Research (RIVER) Lab, Albuquerque, NM, USA
| | - Alexandra Hernandez-Vallant
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
- Revitalzing Indigenous Values in Empirical Research (RIVER) Lab, Albuquerque, NM, USA
| | - Jalene Herron
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
- Revitalzing Indigenous Values in Empirical Research (RIVER) Lab, Albuquerque, NM, USA
| | - Violette Cloud
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
- Revitalzing Indigenous Values in Empirical Research (RIVER) Lab, Albuquerque, NM, USA
| | - J. Scott Tonigan
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Barbara McCrady
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Kamilla Venner
- Center on Alcoholism, Substance Abuse and Addictions, University of New Mexico, Albuquerque, New Mexico, USA
- Department of Psychology, University of New Mexico, Albuquerque, NM, USA
- Revitalzing Indigenous Values in Empirical Research (RIVER) Lab, Albuquerque, NM, USA
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Pearson CR, Kaysen D, Huh D, Bedard-Gillgan M, Walker D, Marin R, Saluskin K. A randomized comparison trial of culturally adapted HIV prevention approaches for Native Americans reducing trauma symptoms versus substance misuse: The Healing Seasons protocol. Contemp Clin Trials 2020; 95:106070. [PMID: 32561467 DOI: 10.1016/j.cct.2020.106070] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 05/27/2020] [Accepted: 06/12/2020] [Indexed: 11/28/2022]
Abstract
Native Americans (NA) experience interrelated risks of trauma exposure, substance use, and HIV risk behaviors that put them at increased risk for HIV infection. Despite these known risk factors, there are very few published randomized trials testing interventions to reduce trauma-related symptoms and substance misuse among NA. METHODS The Healing Seasons study is a randomized comparsion trial of two counseling strategies, Narrative Exposure Therapy (NET) addressing PTSD or Motivational interviewing with cognitive behavioral therapy skills training (MIST) addressing substance misuse as a means to prevent HIV among NA. Using a community-based participatory research approach, we adapted both evidence-based interventions to be specific to the risk contexts and realities of NA and to include psychoeducational and skill-building components that include cultural-specific stories, virtues, and traditional treatment strategies. Participants, 16 years and older, were recruited from a Pacific Northwest tribal community, screened over the phone, enrolled in person, and randomized in equal numbers to NET or MIST. We stratified by age (16-29 years and 30 or older) and gender (male or female identified) to ensure balance between treatment arms. The primary outcomes were number of sex partners and frequency of sexual acts (with and without condoms), sex under the influence of substances, frequency of substance use, and PTSD severity. DISCUSSION Behavioral interventions for NA are needed to prevent HIV risk behaviors when faced with trauma symptoms and substance misuse. This study will provide evidence to determine feasibility and efficacy of addressing related risk factors as part of counseling-based HIV prevention intervention to reduce sexual risk among this population. TRIAL REGISTRATION ClinicalTrials.gov number, NCT03112369, registered April 12, 2017.
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Affiliation(s)
- C R Pearson
- Indigenous Wellness Research Institute, School of Social Work, University of Washington, Seattle, WA, USA.
| | - D Kaysen
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - D Huh
- Indigenous Wellness Research Institute, School of Social Work, University of Washington, Seattle, WA, USA
| | - M Bedard-Gillgan
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - D Walker
- Innovative Programs Research Group, School of Social Work, University of Washington, Seattle, WA, USA
| | - R Marin
- Indigenous Wellness Research Institute, School of Social Work, University of Washington, Seattle, WA, USA
| | - K Saluskin
- Yakama Nation Behavioral Health Services, Toppenish, WA, USA
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Pearson CR, Kaysen D, Huh D, Bedard-Gilligan M. Randomized Control Trial of Culturally Adapted Cognitive Processing Therapy for PTSD Substance Misuse and HIV Sexual Risk Behavior for Native American Women. AIDS Behav 2019; 23:695-706. [PMID: 30607757 PMCID: PMC6407746 DOI: 10.1007/s10461-018-02382-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
An overlooked sequela of HIV risk is trauma exposure, yet few HIV interventions address trauma exposure, mental health, and substance misuse. In a two-arm randomized controlled trial 73 Native American women were randomized to a culturally-adapted Cognitive Processing Therapy (CPT) or 6-weeks waitlist. Outcomes assessed: PTSD symptom severity, alcohol use frequency, substance abuse or dependence diagnosis, and high-risk sexual behavior defined as vaginal/anal intercourse (a) under the influence of alcohol and/or illicit substances, (b) with a partner who was concurrently sexually active with someone else, and/or (c) with more than one partner in the past 6 weeks. Among immediate intervention participants, compared to waitlist participants, there were large reductions in PTSD symptom severity, high-risk sexual behavior, and a medium-to-large reduction in the frequency of alcohol use. CPT appears to improve mental health and risk behaviors, suggesting that addressing PTSD may be one way of improving HIV-risk related outcomes.
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