Promising - One study
Date: This profile was posted on May 22, 2012
A school-based, culturally sensitive, suicide-prevention program for American Indian adolescents, also known as Zuni Life Skills Development. This program is rated Promising. Intervention students demonstrated a significantly higher level of suicide intervention skills. The intervention group showed significantly fewer feelings of hopelessness, however, there were no significant differences on measures of suicide probability and depression.
Program Goals/Target Population
The American Indian Life Skills Development curriculum, also known as the Zuni Life Skills Development curriculum, is a school-based, culturally sensitive, suicide-prevention program for American Indian adolescents. Tailored to American Indian norms and values, the curriculum was designed to reduce behavioral and cognitive factors associated with suicidal thinking and behavior.
Among American Indians/Alaska Natives ages 15 to 34, suicide is the second-leading cause of death (CDC 2009). Around 1987, the Zuni Pueblo reservation of approximately 9,000 tribal members in New Mexico became concerned with the sudden rise in the number of youth and young adult suicides. It was thought that the increase may be associated with the fact that Zuni youths were losing touch with their traditions, as families and communities became more fragmented. For Zuni, suicide is an especially distressing incident because it is forbidden in their traditional culture (LaFromboise and Howard–Pitney 1995). Zuni leaders initiated the development of a suicide prevention program for students in high school (9th and 11th grades) with the goal of reducing the risk factors related with suicidal behavior.
The life skills curriculum draws heavily from social cognitive theory (Bandura 1986). From this theoretical perspective, suicidal behavior is attributed to direct learning or modeling influences (such as peer suicidal behavior) in conjunction with environmental influences and individual characteristics that mediate decisions related to suicidal behavior. Life skills training should lessen the impact of these influences by developing social cognitive skills of youth (LaFromboise and Howard–Pitney 1995).
The American Indian Life Skills Development curriculum can be delivered three times a week for 30 weeks, during the school year or as an afterschool program. The curriculum is structured around seven major units: 1) building self-esteem, 2) identifying emotions and stress, 3) increasing communication and problem-solving skills, 4) recognizing and eliminating self-destructive behavior such as pessimistic thoughts or anger reactivity, 5) receiving suicide information, 6) receiving suicide intervention training, and 7) setting personal and community goals. The curriculum also incorporates three domains of well-being indicators that are specific to tribal groups: helping one another, group belonging, and spiritual beliefs systems and practices.
Each lesson in the curriculum contains standard skills training techniques for providing information about the helpful or harmful effects of certain behaviors, modeling of target skills, experimental activities, behavior rehearsal for skill acquisition, and feedback for skills refinement. These components rely on a variety of different learning techniques and actively engage students early in the training process. The sessions follow the social learning skills training format and provide material relevant to students in general as well as to students who are most at risk for suicide.
The curriculum is unique because it was specifically adapted to be compatible with Zuni norms, values, beliefs, and attitudes; sense of self, space, and time; communication style; and rewards and forms of recognition.
LaFromboise and Howard–Pitney (1995) found mixed results regarding the effectiveness of the American Indian Life Skills Development curriculum. Participating in the program led to significant improvements on one of the psychological variables. The intervention group showed significantly fewer feelings of hopelessness than the no-intervention group. However, there were no significant differences between the groups on measures of suicide probability and depression. In addition, students’ self-efficacy ratings for skills covered in the curriculum showed no significant intervention effect.
Of the sample of 62 students, the behavioral observations of 28 students from the matched pair sample were analyzed (14 from the intervention and 14 from the no-intervention group). A significant main effect was found for the intervention group for both skills measures. Intervention students demonstrated a significantly higher level of suicide intervention skills than the no-intervention group. Intervention students also demonstrated significantly higher levels of problem-solving skills but only in the more mild suicide scenario, and not in the more serious suicide scenario.
There were no significant intervention effects on peer perceptions of classmates’ suicide intervention and problem-solving skills.
The program evaluation of the American Indian Life Skills Development curriculum by LaFromboise and Howard–Pitney (1995) included a nonrandom, quasi-experimental research design with two conditions: an intervention and a no-intervention condition. A multimethod approach was used to assess the effectiveness of the curriculum. It included a pretest and posttest self-report survey of risk factors associated with suicide, behavioral observations of suicide intervention skills targeted in the curriculum judged by two American Indian graduate students, and peer ratings of classmates’ skills and abilities relevant to suicide intervention. Freshman students in high school enrolled in a required language arts class were eligible for the study, and juniors were included to increase the sample size. Sophomores were expressly excluded because of their participation in a program pilot test the previous year.
There were 128 students measured at pretest. Sixty-nine students were assigned to the intervention condition, and 59 students were assigned to the no-intervention condition. The sample was 64 percent female and 36 percent male. Ages ranged from 14 to 19, with an average age of 15.9. A pretest indicated that 81 percent of the sample was in the moderate to severe range on the Suicide Probability Scale. Forty percent of students reported that a relative or friend had committed suicide, while 18 percent reported having personally attempted suicide. However, there were significant baseline differences between the intervention and no-intervention control groups. The no-intervention control group was significantly less suicidal and hopeless than the intervention group. Therefore, students from the two conditions were matched on two clinically important measures that differed (suicide probability and hopelessness). For each intervention participant, a matched comparison participant was selected whose scores fell in the same cell of the matrix. Using this procedure, there were 31 pairs of students matched. This reduced the sample size, but there were no significant differences between the intervention and no-intervention groups.
Posttest measures were taken 8 months after the pretest. The self-report survey was made up of a set of suicide vulnerability, hopelessness, depression, and self-efficacy scales, including suicide prevention skills, active listening, problem solving, anger management, and stress management. The reliability for anger management and stress management was considered unacceptably low, so these variables were excluded from further analysis. Problem solving was also dropped at posttest analysis because the two groups differed significantly at pretest on this variable. The graduate students rated the suicide intervention and problem-solving skills of the sample using 10 six-point Likert scale items ranging from 1 (strong disagree) to 6 (strongly agree). Peer ratings used the same 10 items that were slightly reworded for use in the peer assessment.
The differences between the matched groups on posttest scores were examined using one-tailed t–tests.
There is no cost information available for this program.
The American Indian Life Skills Development Curriculum is available for purchase through the University of Wisconsin Press Web site: http://uwpress.wisc.edu/books/0129.htm. The book costs approximately $30.
Information about implementation of the curriculum on the Zuni Pueblo reservation is also available in several published studies (LaFromboise and Howard–Pitney 1995; LaFromboise 2006; LaFromboise and Lewis 2008). As the curriculum was developed, extensive community input was solicited to examine key aspects of helping and problem solving in Zuni culture and to establish community support for implementation of the curriculum.
Evidence-Base (Studies Reviewed)
These sources were used in the development of the program profile:Study 1LaFromboise, Teresa D., and Beth Howard–Pitney. 1995. “The Zuni Life Skills Development Curriculum: Description and Evaluation of a Suicide Prevention Program.” Journal of Consulting Psychology 42(4):479–86.
These sources were used in the development of the program profile:Bandura, Albert. 1986. Social Foundations of Thought and Action: A Social Cognitive Theory. Englewood Cliffs, N.J.: Prentice–Hall.Bee–Gates, Donna, Beth Howard-Pitney, Teresa LaFromboise, and Wayne Rowe. 1996. “Help-Seeking Behavior of Native American Indian High School Students.” Professional Psychology: Research and Practice 27(5):495–99.CDC (Centers for Disease Control and Prevention). 2009. “Suicide.” Facts at a Glance. CDC, National Center for Injury Prevention and Control. http://www.cdc.gov/ViolencePrevention/pdf/Suicide-DataSheet-a.pdfHoward–Pitney, Beth, Teresa D. LaFromboise, Mike Basil, Benedette September, and Mike Johnson. 1992. “Psychological and Social Indicators of Suicide Ideation and Suicide Attempts in Zuni Adolescents.” Journal of Consulting and Clinical Psychology 60(3):473–76.LaFromboise, Teresa D. 2006. “American Indian Youth Suicide Prevention.” The Prevention Researcher 13(3):16–18.LaFromboise, Teresa D., and Hayes A. Lewis. 2008. “The Zuni Life Skills Development Program: A School-/Community-Based Suicide Prevention Intervention.” Suicide and Life-Threatening Behavior 38(3):343–53.May, Philip A., Patricia Serna, Lance Hurt, and Lemyra M. DeBruyn. 2005. “Outcome Evaluation of a Public Health Approach to Suicide Prevention in an American Indian Tribal Nation.” American Journal of Public Health 95(7):1238–44.Metha, Arlene, and L. Dean Webb. 1996. “Suicide Among American Indian Youth: The Role of the Schools in Prevention.” Journal of American Indian Education 36(1):1–8.Middlebrook, Denise L., Pamela L. LeMaster, Janette Beals, Douglas K. Novins, and Spero M. Manson. 2001. “Suicide Prevention in American Indian and Alaska Native Communities: A Critical Review of Programs.” Suicide and Life-Threatening Behavior 31(Supplement):132–49.Yoder, Kevin A., Les B. Whitbeck, Dan R. Hoyt, and Teresa LaFromboise. 2006. “Suicidal Ideation Among American Indian Youths.” Archives of Suicide Research 10:177–90.