Upload
emil-davis
View
229
Download
0
Tags:
Embed Size (px)
Citation preview
PhD Dissertation Defense
Beverly Patchell, RN, MS, CNS
September 27, 2011
NEW MEXICO STATE UNIVERSITY SCHOOL OF NURSING
Dr. Mary HokeDr. Leslie Robbins
Dr. John LoweDr. Iris Mullins
Dr. Kathleen Chinn
DISSERTATION COMMITTEE
NATIVE AMERICAN INDIAN ADOLESCENTS:
RESPONSE TO A CULTURALLY TAILORED, SCHOOL-BASED
SUBSTANCE ABUSE INTERVENTION
SignificanceAims
MethodResults
Discussion Next Steps
OVERVIEW OF THE PRESENTATION
Substance abuse with Native American Indian tribes in the U.S.
• number one health concern for Native American Indians (NAI)
• Substance abuse among NAI adolescents
correlates with higher incidence of associated problems
(Substance Abuse Mental Health Services Administration, 2008)
BACKGROUND
• 2008 state statistics show the economic cost at $6 B/year
• personal cost is greater •85% of all homicides•80% of all prison incarcerations•65% of all child abuse cases•55% of all domestic assaults
• NAI are 9% of the general population, but >25% of the OK prison population.
(Oklahoma Department of Mental Health and Substance Abuse Services, 2008)
OKLAHOMA PROBLEM
• Beauvais et al. (2004) looked at patterns over the past 25 years and found substance abuse to be the primary contributor to health issues among NAI
• Clarke (2002) looked at the emotional issues related to the incidence of substance abuse
• SAHMSA and the Indian Health Service have written extensively about the health issues
LITERATURE REVIEW
• Prevention efforts have previously focused on protective factors such as parent-teen communication, decision-making skills, use of role models, and individual coping styles (Beebee et al., 2008; Chiong, Bry, & Johnson, 2009)
• Use of Native American Indian rituals and traditions has primarily been used in inpatient or residential treatment (Novins et al., 1996; Jacobs, 2002)
• The Cherokee Self-Reliance Theory and Model has demonstrated success based on a culturally tailored approach used with Cherokee adolescents (Lowe, 2006)
LITERATURE REVIEW
GAPS IN THE RESEARCH
• substance abuse treatment for NAI adolescents focuses on the inpatient and residential components of treatment
• education and early prevention focused on school-based education efforts, with poor to mixed results (Segal,
2003)
• there is a need for culturally adapted models and documentation of that adaptation (Domencech Rodriguiz, Baumann & Schwartz, 2011)
• Developed through research into Cherokee culturally-protective factors as described by Cherokee people (Lowe, 2002)
• Utilized theoretical concepts to determine if strengthening the cultural components of a substance abuse prevention model would influence decisions about substance use and abuse (Lowe, 2006)
CHEROKEE SELF-RELIANCE THEORY
CHEROKEE TALKING CIRCLE INTERVENTION
BEING RESPONSIBLE
• Substance Abuse Education • Recognition and Acknowledgement of Personal Substance Use Problems• Identification of High-Risk Situations• Relationship Building• Family Conflict Resolution• Social Support
BEING DISCIPLINED
• Self-Monitoring • Commitment Generation • Alternatives to Substance Use
BEING CONFIDENT
• Acceptance of Personal Strengths • Practicing Resistance/Refusal • Coping with Stress• Abstinence Violation Effect
• Based on the general world view of Native American Indian people
• The natural world is inherently circular and spiral, with ordered flow and movement
• Health requires order and ill health is a result of interrupted flow and dis-order
• Fibonacci sequence is recognized by Western science as the mathematical foundation of life and creation
CIRCULAR MODEL FOR CULTURAL TAILORING
• The tribes of the Great Plains Area encompasses many tribes and sweeps across the United States in the region between the Mississippi River and the western coastal states
• The tribes were historically rovers and hunters, nomadic and loosely organized
• Their prowess was in hunting, raiding, and war
POPULATION
Original Inhabitants of Oklahoma Land Area
1890’s Map of Oklahoma
Current Map of Oklahoma
ELDER’S TRANSFORM THE MODEL
BEING RESPONSIBLE• Substance Abuse Education• Recognition and Acknowledgement of Personal Substance Use Problem• Identification of High-Risk Situations• Relationship Building• Family Conflict Resolution• Social Support
BEING DISCIPLINED• Self-Monitoring • Commitment Generation • Alternatives to Substance Use
BEING CONFIDENT• Acceptance of Personal Strengths• Practicing Resistance/Refusal • Coping with Stress• Abstinence Violation Effect
(Adapted with permission from the Cherokee Talking Circle, Lowe, 2006)
NATIVE TALKING CIRCLE INTERVENTION
• adapt an existing culturally competent Cherokee theoretical model and school-based intervention targeting substance abuse prevention and intervention for use with Native American Indian adolescents in southwestern Oklahoma
• examine the impact of the adapted Native American Indian Self-Reliance Substance Abuse Intervention tool on cultural protective factors associated with substance abuse involvement by Native American Indian youth from Native American Indian Plains tribes.
STUDY AIMS
• Following implementation of the adapted NativeAmerican Self-Reliance Intervention:
• there will be a significant increase in self-reliance (α ≤ .05) • there will be a significant decrease in reported substance
abuse (α ≤ .05)
• there will be significant decrease in perceived stress (α ≤ .05)
• Design: Pre-test/post-test quantitative study
RESEARCH HYPOTHESES/DESIGN
• Institutional Review Boards at New Mexico State University and the University of Oklahoma.
• Support letter from the Comanche Nation
• Certificate of Confidentiality from the National Institute on Drug Abuse.
• Permission of superintendents and principal's of the high schools.
• Parental permission and student assent
HUMAN SUBJECTS PROTECTION
Convenience sample obtained using two rural high schools in SW Oklahoma with high populations of Plains tribal adolescents; i.e., Comanche, Kiowa, Apache, Wichita, Lenape, Caddo
Sample size • N = 44• Power
Inclusion Criteria:• Self-identified member of one of the Plains tribes of SW
Oklahoma.• Attending one of the designated schools, in grades 9-12.• Between the ages of 16-19• Referred by a counselor due to being at risk for substance use or
abuse
SAMPLE
• Demographic Questionnaire • Adapted Cherokee Self-Reliance
Questionnaire• Global Appraisal of Individual Needs-
Quick (GAIN-Q)• Written Stories of Stress using the
Linguistic Inquiry Word Count (LIWC)
INSTRUMENTS
• 3 GROUPS• 8.5 WEEKS• 10 HOURS OF INSTRUCTION• GROUP RULES• ADAPTED TOPIC CONTENT
NATIVE TALKING CIRCLE INTERVENTION
Obtained informed consent/assent
Pre-intervention data collection• occurred at first session
• Demographic questionnaire• Native Self-Reliance• GAIN-Q• Written Stories of Stress
Post-intervention data collection• demographic questionnaire was omitted
DATA COLLECTION
• Descriptive statistics
• Paired t-test
• Cronbach alpha
• SPSS
• LIWC
DATA ANALYSIS
Age• 16 = 26 (59)• 17 = 12 (27)• 18 = 6 (14)Gender• M= 20 (45)• F=24 (55)Grade• 10th = 30 (68)• 11th = 9 (20)• 12th = 5 (11) Tribe• Comanche = 32 (73)• Kiowa = 8 (18)• Apache = 4 (9)
Living Situation• Parent(s) = 40 (91) • Extended = 23 (52)Siblings• Yes = 42 (95) • No =2 (5)Drug Use• Alcohol = 11 (25)• Marijuana = 4 (9)• None = 29 (66) Team/School Activities• Yes = 28 (64)• No = 16 (36)
Participant Demographics
• Pre-test baseline mean of 86.23 (SD=23.40) increased to a post-intervention mean of 92.20 (SD=18.46), SE = .369, medium effect size
• Supporting the hypothesis that self-reliance would increase post-intervention
NATIVE SELF-RELIANCE QUESTIONNAIRE
Baseline Post Intervention
Paired Differences
Indices
M SD M SD M SD t df p value
General Life Problems (N=41)
9.536 7.504 7.415 5.723 2.122 5.887 2.308 40 .013
Internal Behaviors(N=44)
3.636 4.098 2.023 2.937 1.614 3.452 3.101 43 .002
External Behaviors Internal Behaviors(N=42)
4.357 4.477 3.310 3.453 1.048 4.884 1.390 41 .086
Substance Problems Internal Behaviors(N=34)
2.265 4.266 1.265 2.968 1.000 3.162 1.844 33 .037
GAIN-Q Indices at Baseline, Post-Intervention and Paired T-Test Results
Baseline Post Intervention
Paired Differences
Dimensions of Words
M SD M SD M SD t df p
Positive Emotion
4.431 2.653 3.600 2.075 .8311 2.955 2.308 25 .082
Negative Emotion
5.120 1.929 6.037 2.430 -.9165 3.319 3.101 25 .086
Social
9.411 3.329 10.860 4.024 -1.448 4.505 1.390 25 .057
LIWC WORD USE RESULTS AT BASELINE, POST-INTERVENTION, AND PAIRED T-TEST
(N=26)
• Groups were facilitated by a Native American Indian woman with extensive adolescent group experience
• The intervention was flexible enough to allow the participants to express themselves in multiple ways
• Convenience sample• Self-identified tribal members• Self-reporting of substance use could
be biased
STRENGTHS AND LIMITATIONS
This study:• addresses a significant problem for
Native American Indian adolescents and the specific tailoring of a successful intervention to meet the needs of the participants
• demonstrates the effectiveness of specific tailoring using traditional and contemporary life experiences
• provides a template/model for use in future studies
DISCUSSION
• Native Talking Circle Intervention requires replication of the study with larger sample sizes and longitudinal studies to address long term effectiveness
• Validation of the effectiveness of the CMCT as a timely cultural tailoring model across subsets of Indigenous cultural groups
RECOMMENDATIONS FOR FURTHER RESEARCH
QUESTIONS?
Thank You
Wado!
TO THE AUDIENCE