American Indian and Alaska Native young adults are strong and resilient. Interventions designed to improve their mental health and help-seeking skills are especially needed, particularly those that include culturally-relevant resources and relatable role models. The multi-media BRAVE intervention was designed for American Indian and Alaska Native teens and young adults to amplify and reinforce healthy social norms and cultural values, teach suicide warning signs, prepare youth to initiate difficult conversations with peers and trusted adults, encourage youth to access mental health resources (i.e. tribal clinics, chat lines), de-stigmatize mental health services, and connect youth to trusted adults.
The intervention can be flexibly delivered in three formats. It includes text messages, role model videos, a user’s guide, and small group activities. The lessons can be easily integrated into the flow of services provided by clinics, schools, treatment centers, and other community-based programs. BRAVE can be implemented by a variety of support staff and can be tailored to the needs and time constraints of any setting.
Age Group Designed For:
High School, Young Adults
LGBT Inclusive:
No
Trauma Informed:
Yes
Program Setting:
Flexible
Health Topics Covered:
Alcohol and Drug Prevention, Healthy Relationships, Mental Health, Other Healthy Life-Skills, Suicide Prevention, Violence or Bullying Prevention
Duration:
1 lesson at 30 minutes; 1 lesson at 45 minutes; or 7 lessons at 45 minutes apiece
No formal training is required to use the BRAVE User’s Guide. The BRAVE series was designed to be used in one of three ways:
Option 1: Self-Reflection Activity + Youth Sign-up to Receive the video series and Text Message Series (total activity time = 10-30 min)
Option 2: Facilitator shows the full-length video beginning to end, followed by a 35-minute individual activity and discussion (45 min)
Option 3: Facilitator shows one of the 7 episodes of the BRAVE video, followed by a 30-minute group activity (45 minutes, 7 lessons)
Ideas to Consider as you Plan Your Intervention
Consider offering food, raffle prizes, or other incentives to encourage participation
Send a letter home to parents ahead of time, letting them know about BRAVE and the topics it covers
Invite guest speakers to be a part of the conversation discussing domestic violence, substance misuse, social media, healthy relationships, native pride, and/or help seeking skills
Consider showing the video to a group of parents and young adults together to support parent-child conversations about help-seeking strategies
The BRAVE intervention was designed by the Northwest Portland Area Indian Health Board over five-years, using community based participatory research activities. The formative research process included three phases and more than 38 AI/AN teens and young adults, as well as content experts from across the U.S.
BRAVE builds on traditional teaching strategies and community values, and connects AI/AN teens and young adults to people, stories, resources, and teachings that demonstrate what it means to be strong and resilient.
Evaluation
The BRAVE intervention was designed and evaluated over five-years, through a series of community-based participatory research activities led by the Northwest Portland Area Indian Health Board. The formative research included three phases and more than 38 AI/AN young adults and content experts from across the United States. The efficacy phase involved 1,000 AI/AN teens and young adults nationwide.
The first phase of the study focused on better understanding alcohol misuse and the context of violence among Native males between the ages of 18-24 years. Our team interviewed 14 AI/AN men living in 13 states about their perceptions. Based on their insights, we designed a series of theoretically informed, culturally-relevant text messages (SMS). The messages were designed to shift alcohol outcome expectancies, provide normative feedback based on reported behavior, teach non-violent anger management skills, and promote healthy social norms (i.e., offering alternatives to alcohol use, setting and maintaining personal limits, respecting peer’s limits, etc.). In collaboration with Sky Bear Media, a Native-run film-making crew, we developed a complimentary role model video script to reinforce the skills described in the text messages.
During the second phase of the study, we pilot tested the text message intervention with 16 AI/AN young men with a history of alcohol use and violence, and with 8 topical experts in alcohol prevention, alcohol treatment, violence prevention, health communication, and adolescent health. The purpose of the pilot was to test the tone, content, and frequency of the planned text messages and video episodes (three staff read the role model script for the pilot test). Overall, participants thought the intervention was relatable and helpful, but gave helpful suggestions for improvement. A final round of edits were made to the text messages and video script. The resultant video shares the story of three relatable character-types (perpetrator, survivor, and bystander), including their personal histories with alcohol and violence, their relationships to one another, and a turning-point for behavior change.
To evaluate the impact of the program, the NPAIHB and mHealth Impact Lab partnered to carry out a year-long study that involved 1,000 AI/AN teens and young adults ages 15-24 nationwide. Participants were randomized to receive either 8 weeks of BRAVE text messages, designed to improve mental health, help-seeking skills, and promote cultural pride and resilience, or 8 weeks of STEM text messages, designed to elevate and re-affirm Native voices in science, technology, engineering, math, and medicine. Afterwards, the two groups switched, and participants received the other set of messages.
Participants reported improvements in mental health, reductions in alcohol & drug misuse, improvements in resilience and coping skills, and better self-esteem – even as it was delivered in the midst of the COVID pandemic.
Results indicate that behavioral interventions can be feasibly delivered via text message to AI/AN young adults and that including Native youth in the formative research is critical to designing a comprehensive, culturally-responsive intervention.
On behalf of the NPAIHB and our project partners, we hope that you enjoy implementing this program with your youth. If you have any questions about the intervention or would like additional health promotion resources, please feel free to contact us.
Acknowledgements
The intervention was designed, in part, with funding from SAMHSA (grants SM061780 and SM082106). The views, opinions and content of the campaign does not necessarily reflect the views, opinions, or policies of CMHS, SAMHSA, or HHS, and should not be construed as such.
We are grateful to the BRAVE study participants, the communities that support prevention and outreach, and the team at Sky Bear Media – for their commitment to wellness and building help-seeking skills in Native teens and young adults.
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