2 - (SYM 92) Cultural Adaptation of a Transdiagnostic Non-clinician Delivered Cbt-based Program for Use in Secondary Prevention Programs with U.S. Indigenous Communities

Indigenous communities in the U.S. experience disproportionate morbidity and mortality associated with mental and behavioral health problems. Access to culturally aligned services is limited due to chronic provider shortages, under-resourced infrastructure, and historical and contemporary experiences of discrimination and stigma. In response, the Johns Hopkins Center for Indigenous Health (JHCIH) partnered with the Common Elements Treatment Approach (CETA) team to adapt CETA for use in Indigenous communities. CETA is an evidence-based, modular, multi-problem intervention, and the adapted intervention is called Family Spirit Strengths (FSS).

The FSS adaptation process followed the Cultural Adaptation Framework (Fendt-Newlin, Jagannathan, & Webber, 2020) and was grounded in participatory processes led by a team of Indigenous and allied researchers (Marsiglia & Booth, 2015). Before adapting curriculum content, the JHCIH team met with home visitors to understand mental health challenges and ways of addressing these challenges. These early discussions shaped the selection of CETA and thoughts on incorporating Indigenous ways of healing. Based on these discussions, six of CETA’s eleven elements were selected for adaptation. These elements were presented to a national panel consisting of AI/AN experts in child development, home visiting, child welfare, and psychology. Adaptations were done through an iterative process that focused on maintaining fidelity to CETA while considering how shared Indigenous values and approaches to healing could be incorporated. The resulting draft elements were piloted and refined in partnership with two tribal communities. The final FSS intervention, consists of six elements and is conceptualized to prevent severe mental health and substance use morbidity through leveraging cognitive behavioral therapy skills and through an Indigenous knowledge-based approach, whereby the intervention will help increase participants’ awareness of connectedness and cultural efficacy. The FSS intervention is now being tested through a hybrid type-I implementation-effectiveness study.