Multi-tiered Youth Suicide Prevention Program

Mental Health Promotion, Suicide Prevention, Youth Development

The Johns Hopkins Center for American Indian Health launched a three-tiered suicide prevention intervention in 2006 across the White Mountain Apache Tribe under a program called Empowering Our Spirits. These tiers include: a universal tier targeting the general community in an effort to raise education and awareness on the problem of suicide; a selective tier targeting youth specifically at risk for suicide through gatekeeper training and increased screening programs; and an indicated tier, the local adaptation of evidence-based interventions for youth who have already attempted suicide.

Multi-Disciplinary Media Campaign (Universal Tier)

In an effort to educate the community as a whole, the Apache Suicide Prevention Team is working with local media outlets to get out information about youth suicide and also where to turn to get help. Media campaigns include the use of the tribal radio station for weekly programming and public service announcements; the tribal newspaper offering advertising space and periodic articles; brochures placed in clinics and community centers; print media (billboards and ads) placed in high-traffic areas of the community including the grocery store, gas stations and bar, and tables at health fairs offering handouts and displaying print messages. Messages promote protective factors, education about mental illness; and traditional pathways for promoting mental health. They also provide information about mental health and illness and existing treatment services. 

Gatekeeper/Caretaker Trainings (Selective Tier)

The Apache Suicide Prevention Team holds two-day caretaker trainings for groups of 30 community members several times a year. The ASIST (Applied Suicide Intervention Skills Training) gatekeeper training is a nationally recognized program designed to train individuals who have high contact with at-risk youth to be able to recognize early signs of suicidal behavior in order to get youth needed assistance. Several Apache Suicide Prevention Team members completed the train-the-trainers training in order to become on-site leaders of these trainings. Over the years, continued trainings aim to reach all adult community members who have high-contact with youth including key personnel from hospitals, schools, police, community centers, churches, tribal service agencies, as well as youth and parent groups.

A New Hope (Indicated Tier)

A New Hope is a brief 2 hour intervention designed to serve youth aged 10 to 19 who have made a suicide attempt and their family members. Natural Helpers meet with youth and family members soon after discharge from the ED or hospital from a suicide attempt. This meeting may take place in the family’s home, in the Apache Suicide Prevention Team office, or in a private room of the hospital. They first watch a video (filmed in the community with Native American actors) which demonstrates the serious impact of an attempt on individuals, families and the community, as well as elders emphasizing in the Apache language that life is sacred and youth must get help. Natural Helpers discuss the video with youth and a family member, develop a safety plan, use problem-solving and motivational techniques to reinforce positive aspects of treatment, and screen youth for suicide severity. 

All team members are tribal members from the community they serve. CAIH professionals in Baltimore work on the adaptation of all materials with the input of the Apache Suicide Prevention Team and other tribal members. They also provide members of the Apache Suicide Prevention Team with extensive training offering the needed knowledge and skills to become mental health paraprofessionals. This work has been supported by SAMHSA Garrett Lee Smith funding. 

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