Cultural-Based Intervention for Psychological Trauma in Native American Caregivers

Overseen by Teresa Brockie, PhD

Age: 18+

Sex: Any

Travel: May Be Covered

Time Reimbursement: Varies

Trial Phase: Academic

Waitlist Available

Sponsor: Johns Hopkins University

No Placebo Group

Trial Summary

What is the purpose of this trial?

This trial tests a program called 'Wakȟáŋyeža' for Native American caregivers and their young children. It aims to reduce stress and trauma, improve parenting skills, and support children's development using culturally relevant methods. The program includes lessons on managing stress, better parenting, and promoting healthy child growth. The Wakȟáŋyeža program is an intergenerational intervention designed for Native American parents and children, incorporating unique cultural lesson-components to improve parent-child outcomes.

Do I have to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications.

What data supports the idea that Cultural-Based Intervention for Psychological Trauma in Native American Caregivers is an effective treatment?

The available research shows that Cultural-Based Intervention for Psychological Trauma in Native American Caregivers is effective because it focuses on healing through traditional knowledge and culturally based practices. One study highlights the importance of addressing historical trauma and current stressors like poverty and violence, suggesting that these interventions help build resilience and survival skills. Another study emphasizes the healing process through reclaiming indigenous heritage and spirituality, which helps neutralize the negative effects of colonization. These approaches are seen as beneficial in promoting mental health and well-being among Native American communities. ^{1 2 3 4 5}

What safety data exists for the Wakȟáŋyeža (Little Holy One) intervention?

The available research does not provide specific safety data for the Wakȟáŋyeža (Little Holy One) intervention. However, the intervention is being evaluated through a randomized controlled trial with an embedded single-case experimental design, as described in the protocol for the trial. Additionally, the intervention has been adapted for Native American Head Start teachers using a systematic process within a participatory framework, which included community input and iterative feedback. The safety and feasibility of this adapted intervention will be reported in a future publication. ^{1 5 6 7 8}

Is the treatment Wakȟáŋyeža (Little Holy One) a promising treatment for psychological trauma in Native American caregivers?

Yes, Wakȟáŋyeža (Little Holy One) is a promising treatment because it focuses on healing through cultural practices, addressing historical trauma, and strengthening community and family support, which are important for Native American caregivers dealing with psychological trauma. ^{1 2 5 9 10}

Research Team

Teresa Brockie, PhD

Principal Investigator

Johns Hopkins University

Eligibility Criteria

This trial is for Native American caregivers on a Northern Plains reservation with children aged 2-5. Participants must have experienced trauma or stress and be willing to join all study parts, including random assignment. Children should be members or descendants of the Fort Peck Tribes.

Inclusion Criteria

Child is an enrolled member of Fort Peck Tribes or the descent of an enrolled member

Parent or caregiver must be willing to participate in all aspects of the study including random assignment

The parent or caregiver has experienced a traumatic event during their childhood or in the past.

Exclusion Criteria

My parent or caregiver is younger than 18.

I cannot fully participate in the treatment plan.

Treatment Details

Interventions

• Wakȟáŋyeža (Little Holy One) (Behavioural Intervention)

Trial Overview The 'Wakȟáŋyeža (Little Holy One)' intervention includes active nutrition control, cultural components, adapted parenting lessons from Family Spirit, and CETA modules to reduce trauma symptoms in parents and improve child development outcomes.

Participant Groups

Group I: Little Holy One intervention Experimental Treatment 1 Intervention

The participants will receive 12 1-hour lessons on parenting, stress, and culture over a period of 16 weeks.

Group II: Nutrition control Active Control 1 Intervention

The active control condition will receive nutrition information, weekly food boxes and recipes based on seasonal foods, as well as a shopping list for making future meals.

Who Is Running the Clinical Trial?

Johns Hopkins University

Lead Sponsor

Trials

2,366

Recruited

15,160,000+

Theodore DeWeese

Johns Hopkins University

Chief Executive Officer since 2023

MD from an unspecified institution

Allen Kachalia

Johns Hopkins University

Chief Medical Officer since 2023

MD from an unspecified institution

National Institute of Mental Health (NIMH)

Collaborator

Trials

3,007

Recruited

2,852,000+

Dr. Joshua A. Gordon

National Institute of Mental Health (NIMH)

Chief Executive Officer since 2016

MD, PhD

Dr. Shelli Avenevoli

National Institute of Mental Health (NIMH)

Chief Medical Officer

PhD

Annie E. Casey Foundation

Collaborator

Trials

6

Recruited

1,600+

Findings from Research

A study involving 74 ethnographic interviews with 37 Diné youth, parents, and grandparents found that addressing historical trauma is crucial for understanding behavioral health inequities among Diné youth.

The research emphasizes the importance of current stressors like poverty and violence, and suggests that interventions should incorporate traditional knowledge and culturally based healing practices to promote resilience and social transformation.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"We're still in a struggle": Diné resilience, survival, historical trauma, and healing. Goodkind, JR., Hess, JM., Gorman, B., et al.[2021]

Interviews with 19 staff and clients at a Native American healing lodge revealed that addressing historical trauma involves recognizing and confessing pain, which is linked to adult dysfunction like substance abuse.

The healing process emphasizes the importance of reclaiming indigenous heritage and spirituality, suggesting that culturally sensitive approaches can effectively address the impacts of colonization and promote self-improvement.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A community-based treatment for Native American historical trauma: prospects for evidence-based practice. Gone, JP.[2009]

The article highlights the unique challenges of providing mental health services to isolated urban Native Americans living with HIV, who often face multiple trauma-related issues and have a deep distrust of traditional treatment methods.

Integrating art therapy and in-home therapy into mental health services can effectively support individuals who struggle to express their emotions verbally, thereby respecting their cultural context and addressing their specific mental health needs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Art therapy as emotional and spiritual medicine for Native Americans living with HIV/AIDS. Bien, MB.[2007]

Native American families possess strong resilience despite facing challenges like oppression and poverty, which can lead to mental health issues.

Cultural traditions that promote harmony can enhance mental health in Native American children and adolescents, highlighting the importance of culturally sensitive practices in healthcare.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Native American children and adolescents: cultural distinctiveness and mental health needs. Keltner, BR.[2019]

Native American and Alaska Native people face a higher incidence of traumatic events and are more susceptible to posttraumatic stress disorder, highlighting a significant public health concern.

Interviews with six Native healers revealed key themes related to trauma, emphasizing the importance of cultural competence in healthcare to better support Native trauma patients and improve their recovery outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"Our culture is medicine": perspectives of Native healers on posttrauma recovery among American Indian and Alaska Native patients. Bassett, D., Tsosie, U., Nannauck, S.[2022]

The Wakȟáŋyeža (Little Holy One) intervention is a culturally-based program aimed at reducing intergenerational trauma and improving parenting among Fort Peck Assiniboine and Sioux families, utilizing a randomized controlled trial design with 1:1 randomization of parent-child dyads.

The intervention focuses on addressing trauma symptoms and stress in parents, with secondary outcomes including improvements in parenting practices and child behavior, suggesting a potential upstream approach to reduce children's risk for substance use and suicide.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

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. Brockie, T., Haroz, EE., Nelson, KE., et al.[2022]

The Honoring Children, Mending the Circle (HC-MC) treatment is an adaptation of trauma-focused cognitive-behavioral therapy specifically designed for American Indian and Alaska Native populations, addressing their unique experiences with trauma.

HC-MC integrates traditional AI/AN teachings with cognitive-behavioral methods, providing a culturally relevant approach to therapy that aims to improve the mental health outcomes for these vulnerable communities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Honoring children, mending the circle: cultural adaptation of trauma-focused cognitive-behavioral therapy for American Indian and Alaska native children. BigFoot, DS., Schmidt, SR.[2022]

The Little Holy One intervention was successfully adapted for Head Start teachers on the Fort Peck Native American Reservation to address their high stress levels and support needs, using a participatory approach that involved community input from 27 teachers and parents.

This adaptation process, guided by the ADAPT-ITT methodology, emphasizes the importance of cultural relevance in mental health interventions, potentially improving psychological health outcomes for Native Americans who may not typically access traditional psychological services.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Pre-implementation Process of Adapting a Culturally Informed Stress Reduction Intervention for Native American Head Start Teachers. Wilson, DH., Nelson, KE., Gresh, A., et al.[2023]

The Iwankapiya study involved 52 American Indian adults and tested a combined intervention of Historical Trauma and Unresolved Grief Intervention (HTUG) with Group Interpersonal Psychotherapy (IPT) over 12 sessions, aiming to reduce depression and trauma symptoms.

While both treatment groups showed significant decreases in depression scores, HTUG + IPT led to greater group engagement, suggesting that this combined approach may enhance treatment participation, which is crucial for communities facing high levels of trauma.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Iwankapiya American Indian pilot clinical trial: Historical trauma and group interpersonal psychotherapy. Brave Heart, MYH., Chase, J., Myers, O., et al.[2022]

Indigenous adults in the USA face a high risk of mental health issues such as PTSD, depression, suicide, and substance use disorders, largely influenced by historical oppression and family problems.

Protective factors like family support and engagement in tribal cultural activities can help mitigate these risks, suggesting that holistic approaches are essential for effective mental health interventions in these communities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A Culturally Informed Systematic Review of Mental Health Disparities Among Adult Indigenous Men and Women of the USA: What is known? Ka'apu, K., Burnette, CE.[2020]

References

1. United States pubmed.ncbi.nlm.nih.gov

"We're still in a struggle": Diné resilience, survival, historical trauma, and healing. [2021]

2. United States pubmed.ncbi.nlm.nih.gov

A community-based treatment for Native American historical trauma: prospects for evidence-based practice. [2009]

3. United States pubmed.ncbi.nlm.nih.gov

Art therapy as emotional and spiritual medicine for Native Americans living with HIV/AIDS. [2007]

4. United States pubmed.ncbi.nlm.nih.gov

Native American children and adolescents: cultural distinctiveness and mental health needs. [2019]

5. United States pubmed.ncbi.nlm.nih.gov

"Our culture is medicine": perspectives of Native healers on posttrauma recovery among American Indian and Alaska Native patients. [2022]

6. England pubmed.ncbi.nlm.nih.gov

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. [2022]

7. United States pubmed.ncbi.nlm.nih.gov

Honoring children, mending the circle: cultural adaptation of trauma-focused cognitive-behavioral therapy for American Indian and Alaska native children. [2022]

8. Switzerland pubmed.ncbi.nlm.nih.gov

The Pre-implementation Process of Adapting a Culturally Informed Stress Reduction Intervention for Native American Head Start Teachers. [2023]

9. United States pubmed.ncbi.nlm.nih.gov

Iwankapiya American Indian pilot clinical trial: Historical trauma and group interpersonal psychotherapy. [2022]

10. England pubmed.ncbi.nlm.nih.gov

A Culturally Informed Systematic Review of Mental Health Disparities Among Adult Indigenous Men and Women of the USA: What is known? [2020]