Wakȟáŋyeža (Little Holy One) - an intergenerational intervention for Native American parents and children: a protocol for a randomized controlled trial with embedded single-case experimental design 

Abstract

Background Trauma within Native American communities compromises parents’ parenting capacity; thus, increasing childrens’ risk for substance use and suicide over the lifespan. The objective of this manuscript is to describe the Wakȟáŋyeža (Little Holy One) intervention and evaluation protocol, that is designed to break cycles of intergenerational trauma, suicide, and substance use among Fort Peck Assiniboine and Sioux parents and their children. Methods A randomized controlled trial with an embedded single-case experimental design will be used to determine effectiveness of the modular prevention intervention on parent-child outcomes and the added impact of unique cultural lesson-components. Participants include 1) Fort Peck Assiniboine and Sioux parents who have had adverse childhood experiences, and 2) their children (3–5 years). Parent-child dyads are randomized (1:1) to Little Holy One or a control group that consists of 12 lessons taught by Indigenous community health workers. Lessons were developed from elements of 1) the Common Elements Treatment Approach and Family Spirit, both evidence-based interventions, and 2) newly created cultural (intervention) and nutrition (control group only) lessons. Primary outcomes are parent (primary caregiver) trauma symptoms and stress. Secondary outcomes include: Parent depression symptoms, parenting practices, parental control, family routines, substance use, historical loss, communal mastery, tribal identity, historical trauma. Child outcomes include, externalizing and internalizing behavior and school attendance. Primary analysis will follow an intent-to-treat approach, and secondary analysis will include examination of change trajectories to determine impact of cultural lessons and exploration of overall effect moderation by age and gender of child and type of caregiver (e.g., parent, grandparent). Discussion Many Native American parents have endured adverse childhood experiences and traumas that can negatively impact capacity for positive parenting. Study results will provide insights about the potential of a culturally-based intervention to reduce parental distress – an upstream approach to reducing risk for childrens’ later substance misuse and suicidality. Intervention design features, including use of community health workers, cultural grounding, and administration in Head Start settings lend potential for feasibility, acceptability, sustainability, and scalability. Trial registration ClinicalTrials.gov: NCT04201184. Registered 11 December 2019.

Redefining Child Protection

“…Strengths-based models focused on empowerment, home-visiting programs, and intergenerational interventions incorporating spirituality are promising models that have been explored among minoritized families. [44][45][46] With a restructuring of a notification system separate from child welfare services as described above, there is an opportunity to create and evaluate culturally appropriate models of enhanced support for families who may be facing significant challenges, including SUD that is separate from child welfare. Of course, if concerns of abuse or neglect arise at any point along this care continuum, a report to child welfare services would be mandated.…”

Perspectives of Child and Adolescent Psychiatrists on the Influence of School Connectedness on American Indian Youths

“…Caregiver connectedness relates to how youth perceive affection, genuine concern, and respect demonstrated by caregivers (Foster et al, 2017). Academic literature notes that positive relationships between a parent and child are a protective factor against substance abuse (Brockie et al, 2021), violence (Farrell et al, 2010), internalizing disorders (Day & Padilla-Walker, 2009), depression and anxiety (Eugene, 2021), suicidal ideation (Pharris et al, 1997), and suicide attempts (Borowsky et al, 2001;Brockie et al, 2021;Foster et al, 2017;Pharris et al, 1997). The CPs were asked: To what extent do parents or caregivers influence an adolescent's self-esteem?…”

Adaption of a culturally informed stress reduction intervention for Native American Head Start Teachers using ADAPT-ITT and CBPR methodologies

“…In Fort Peck, there is critical need for sustainable psychological and behavioral health support (23). However, provision of these services is hampered by the remote location of reservations, wait time of up to 3 months, lack of private or employment-based health insurance, reluctance to utilize existing health services due to structural and institutional racism (1,24), and the primary health care provider on reservations, the Indian Health Service, being chronically underfunded and understaffed, particularly in rural and remote settings (25).…”

“…3-5 years of age and attending tribal Head Start(23). The intervention is a strengths-based, 12-module curriculum focused on promoting family wellness across a holistic well-being (i.e., physical [behavioral], emotional, mental [cognitive], and spiritual) spectrum.…”