441 The pervasiveness in general of American Indian suicide suggests a social

441 the pervasiveness in general of american indian

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from the Garrett Lee Smith Memorial Act. 441 The pervasiveness, in general, of American Indian suicide suggests a social-cultural basis. Sup- porting this assertion is work of LaFromboise and her colleagues, which concludes that the suicide decisions related to American Indian youth may be attributed to direct learning and modeling in- fluences such as influence of family members’ suicide behaviors. 442-444 This social-cultural theory has led to the need to treat suicide in this population as a chronic illness that begins in childhood and develops over years, first as vulnerability, later as ability, and finally a determination. 445 Anti- suicide interventions within this theoretical framework have to address risk and protective factors on an individual, family and community basis, resulting in them being culturally adapted. 438 Cultural adaptation is motivated, in part, by the Celebrating Life Study’s integrated three-tiered approach to suicide prevention. 438, 441 Tier One focuses on community education and awareness regarding suicide behavior and on promoting community-wide protective factors that can broadly reduce youth suicide risk. For this tier, community education occurs in community meetings, schools, churches, and various tribal gatherings. Tier Two involves highly targeted prevention out- reach for youth with suicide risk factors but without a suicide-attempt history. “Caretakers” such as school counselors, physicians, and religious leaders are identified as contact persons for youth. Strategies include life-skills workshops for youths and parents. Tier Three targets youth that have made a suicide attempt. Specialized emergency department and psychiatric post-hospital crisis intervention followed by six months of family-based aftercare uses life-skills training that have proved effective among tribes. These interventions are based on the randomized controlled sui- cide prevention trials led by Rotheram-Borus and Spirito. 230, 236, 238, 377 The emergency department family intervention strategy successfully used in a clinical trial led by Asarnow has been adapted to the circumstances of the White Mountain Apache Tribe. 181 A related component is family educa- tion during in-home visits. The Celebrating Life Study also builds suicide-prevention infrastructure. The existing tribal suicide registry and suicide behavior surveillance procedures will be enhanced. This study compo- nent is called “Tribally Mandated Surveillance.” Researchers will interview youth that have made a recent attempt to better understand key determinants of suicide. Follow-up studies will be done with youth that have made a recent suicide attempt. The lessons learned from the study will be
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Continuity of Care for Suicide Prevention and Research 110 used to engage community opinion leaders with an aim to implement and test additional suicide- prevention strategies and improve the existing ones. A foundation will be laid for future evaluation research. Appropriately, these last study components are called “Empowering Our Spirits.” Section Commentary:
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