Transcript journeys of the circle - University of Washington

Journeys of the
Circle
A Culturally Relevant
Life Skills
Intervention for
Adolescent Indian
Drinking
Research Society on Alcoholism
Vancouver, B.C., June 28, 2004
A Collaborative Effort
University of Washington,
Department of Psychology,
Addictive Behaviors Research Center
AND
The Seattle Indian Health Board
PROJECT FUNDING
 National
Institute on Alcohol
Abuse and Alcoholism (AA12321)
 Robert Wood Johnson Foundation
Seattle Indian Health Board
(SIHB)
Seattle non-profit serving the Native
Community for over 30 years
 Offering a wide spectrum of health
services for adults, youth, and
children
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Seattle Indian Health Board
Team
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Executive Director
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Assistant Executive
Director
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Operations
Coordinator
Community Services
Manager
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Ralph Forquera,
MPH
Rebecca Gonzales
Corpuz
Crystal Tetrick,
MPH
Steve Gallion
University of Washington
Team
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Principal Investigator
Co-Principal
Investigators
Project Post-Docs
Research Coordinator
Research Assistants
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G. Alan Marlatt, PhD
Mary Larimer, PhD
Patricia Mail, PhD, MPH
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Lillian Huang Cummins, PhD
Heather Lonczak, EdD
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Jessica Cronce
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June La Marr
Sandra Radin
Karen Chan
Kelly Burns
UW and SIHB Partnership
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In 1997, SIHB youth activities program
staff approached members of the
Addictive Behaviors Research Center
(ABRC), University of Washington about
the possibility of collaborating on a grant
to develop a brief clinical intervention for
adolescent clients of SIHB
The ABRC had several Native students
enrolled in the Clinical Psychology program
who were enthusiastic about the proposal
Native American Youth
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Alcohol use appears to begin at an earlier
age among Native adolescents (Beauvais, 1992)
Perhaps as many as one-third of American
Indian youth having consumed alcohol by
age 11(May, 1986)
Over ½ report having been intoxicated at
least once by age 15 (Beauvais, 1996)
Culturally Specific Risk Factors
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Ethnic Dislocation
(May, 1982; Oetting, Beauvais &Velarde,
1982; Trimble Padilla, & Bell, 1987)
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Acculturation Stress (LaFromboise, 1988)
Alienation from the Larger Culture
(Moncher et al., 1990)
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Unstructured time on reservations,
during which drinking is also a
response to boredom (Edwards & Edwards, 1988)
Project Beginnings
Native youth were recruited for
Focus Groups to provide input about
the program
 Community Elders were consulted
 Meetings between UW and SIHB
continued
 Specific Aims developed
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Initial Project Challenges
Hiring appropriate intervention
staff
 Gaining community trust
 Gathering community and youth
input on assessments and
intervention materials
 Recruiting youth
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Project Development
Canoe Journey,
Life’s Journey
The Canoe Journey
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Pacific Northwest Coast people preferred
water travel to any other means of
transportation
Drucker (1955)
Early explorers, missionaries and traders
all commented on the Indian canoes, their
size, utility, and manufacture (Gunther, 1972; Sproat,
1966)
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Canoes were usually made from the
straight-grained cedar trees (Drucker, 1955; Sproat,
1966
The Canoe Journey
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Canoe clubs were formed for
interested adolescents and young
adults, but designed to
accommodate and include families
and, eventually, the whole
community
Reestablishing the Canoe
Tradition
Strengthen
Native Identity
 Involve members
of the
community
 Canoe Clubs
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Canoe Families
 Powerful Primary
Intervention
 All canoes are
DRUG and
ALCOHOL Free
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Quinault Indian Nation
Ocean Canoe Paddle
Canoe Journey, Life’s Journey
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Development of Culturally Relevant Life
Skills Manual
Canoe Journey as a metaphor for life’s
journey
Use of other traditionally Native symbols,
particularly the Medicine Wheel
Medicine Wheel generally understood to
have similar meaning across tribal
boundaries
Canoe Journey, Life’s Journey
The Wheel is often used to represent
the four directions: North, South,
East, West
 Four Seasons: Summer, Fall, Winter,
Spring
 Four parts of self: Physical, Mental,
Emotional, Spiritual
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Canoe Journey, Life’s Journey
The Manual Sessions
1. The Medicine
Wheel/Canoe Journey
as a metaphor for
Health
2. Who Am I? Beginning
at the Center
3. Community Help and
Support: Help on the
Journey
4. The Quest: Goal
Setting
5. Overcoming Obstacles:
Solving Problems
6. Effective
Communications:
Listening to Others
& Expressing Self
7. Moods and Coping
with Negative
Emotions
8. Strengthening our
Body and Spirit
Canoe Journey, Life’s Journey
The Manual Sessions
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The manual sessions are taught by a lead
facilitator, and a co-facilitator
The facilitators involve participants
through role-plays, practice of skills, and
reflective journal writing
The courses can be taught individually or in
a group setting
The courses can be taught in one hour
blocks or divided into two 3-4 hour
sessions
Sample Population
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Participants, age 13-19, were
initially recruited from Seattle
Public Schools and eventually
through Outpatient Services at the
Seattle Indian Health Board
Sample Population
Demographics
Geographic Region n=88
 Urban n (%)
 Suburban
 Rural
Education Status n=93
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In School
Graduated High School
Not Attending or Dropped
Out
61 (65.6)
25 (26.9)
2 (2.2)
82 (88.2)
5 (5.4)
6 (6.5)
Sample Population
Alcohol and Drug Use
Ever Used n=92
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Tobacco n (%)
Alcohol
Cannabis
Cocaine
Amphetamines
Barbiturate/Sedatives
Inhalants
Hallucinogens
Opiates
50 (53.8)
55 (59.1)
49 (52.7)
10 (10.8)
7 (7.5)
1 (1.1)
5 (5.4)
9 (9.7)
5 (5.4)
Sample Population
Alcohol and Drug Use
Age of First Regular Use
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Tobacco n=34
Alcohol n=13
Cannabis n=29
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12.62 (SD=2.42)
13.08 (SD=1.61)
13.07 (SD=1.81)
Sample Population
Alcohol and Drug Use
Problems Associated with Use4
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4
Used while in a
dangerous situation
n=93; n (%)
Had accidents or was
injured n=93
Had repeated legal
problems n=92
Consistently used
instead of going to
school n=92
Includes non-users, coded as zero
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13 (14)
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7 (7.5)
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4 (4.3)
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12 (12.9)
Sample Population
Alcohol and Drug Use
Problems Associated with Use4
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4
Blacked out due to alcohol
n=92
Experienced withdrawal
symptoms n=92
Perceives him/herself as
maybe or definitely having
a substance use problem
n=92
Includes non-users, coded as zero
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14 (15.1)
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10 (10.8)
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12 (12.9)
Participants: Demographics
(N = 50)
Age
Female
Native American
Native and Other
Identifies with a
tribe
Recruited from
SIHB
15.24 years (SD =
1.61)
27 (54%)
32 (64%)
16 (32%)
40 (80%)
28 (56%)
Assessment Measures
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Comprehensive Adolescent Severity Index
(CASI)
 Past month substance use: tobacco,
alcohol, marijuana, any drugs excluding
tobacco
Rutgers Alcohol Problem Index (RAPI)
 Alcohol-related consequences
Situational Confidence Questionnaire (SCQ)
 Confidence to resist the urge to drink
heavily
Past Month Substance Use
16
14
Baseline
12
Follow-up
10
8
6
4
2
0
Tobacco
Alcohol
Marijuana
All But Tobacco
Alcohol-Related Consequences
20
18
16
Baseline
14
Follow-up
12
10
8
6
4
2
0
Alcohol-Related Consequences
p < .05
Confidence to Resist
Urge to Drink
160
140
120
Baseline
100
Follow-up
80
60
40
20
0
Intrapersonal
Determinants
Interpersonal
Conflict
Positive
Emotional
States
Interpersonal
Determinants
Summary of Results
Trends towards reduced alcohol,
marijuana, and other drug use and
increased confidence to resist the
urge to drink in multiple contexts
 increased tobacco use?
 Participants reported a significant
decrease in alcohol-related
consequences at follow-up
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Implications/Issues
Environment: Urban versus
Reservation
 After School Intervention v. Camp
setting
 Transportation and Food
 Can there be one program that works
successfully across different Native
communities?
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