Project Leader:  Dr. Janet Lindow | Southcentral Foundation

Abstract

Suicide, the leading cause of death in Montana American Indian (AI) youth between 10 and 18, is 8.9-fold higher than their US peers according to the latest report from WISQARS and the Montana Office of Public Instruction. Many interventions and prevention strategies have been tested; however, there is still no suicide prevention or mental health resiliency intervention definitively proven effective in any youth population. This proposal will develop the infrastructure to test a classroom-based, universal intervention, the Good Behavior Game (GBG), to increase mental health resiliency (the ability to navigate around or effectively through stress and crisis) in AI youth populations through improved social connectedness and behavioral skills. Research indicates that when delivered early in elementary school, large randomized, controlled trials of GBG have shown to significantly reduce early risk factors for later suicidality, such as aggressive/disruptive and asocial behaviors. Studies show It also significantly alters the life course of children by reducing suicidality in young adulthood, decreasing rates of criminal behavior and substance use/abuse, and lowering reported mental illnesses. Therefore, GBG represents a promising mental health resiliency and suicide intervention strategy, which, if effective, has the potential to benefit children over the course of their lifetime, and reduce other major public health problems plaguing AI populations.

We will employ a community-engagement based approach in Project Year 1 to grow the academic-AI community partnerships needed to perform a pilot trial testing the feasibility and acceptability of GBG in AI elementary school-age children. With guidance from the CTRP AI community liaisons, we will meet with Montanan Tribal school superintendents, elementary principals, community leaders, teachers, and community members to determine the interest in and feasibility of the proposed research, and develop a protocol and regulatory documents with feedback from all community and school stakeholders.

The international leader in GBG, Dr. Holly Wilcox, PhD, will provide expert direction, mentoring, and support to our efforts throughout the proposed project period. During the project development period, we will develop an application for a CTRP pilot award to fund a two-year (PY2-3) trial to test the feasibility and acceptability of the GBG in AI Tribal communities identified in PY1. In PY2, we will train teachers in GBG classroom management, and enroll AI first grade youth into a pilot feasibility study, which will continue through PY3. The primary objective will be to measure feasibility and acceptance of delivering the GBG in an uncontrolled design to approximately 176 students for two school years during PY2-3, to determine whether to expand to an RCT, adding additional AI and Alaska Native elementary schools in Montana and Alaska, respectively, or discontinue due to lack of significant findings. If pilot results prove promising, we will apply for an R01 to fund the expanded study for an additional five years.

This project is anticipated to impact children and teachers by enhancing the classroom environment, giving children the opportunity to learn with fewer disruptions, without bullying or other peer-related aggressive behavior, resulting in possible short-term behavioral improvement and life-long mental health resiliency, including a possible 50 percent reduction in suicidal ideation and attempts.