Hope to Heal Indian Country (H.H.I.C.)

Throughout Indian Country, the suicide epidemic among American Indian adolescents has been an ongoing battle.  Our elders are heartbroken, families are emotionally exhausted, adolescents are silent, and our communities continue suffering. Changes are needed in our communities and healing is the only answer.  Hope to Heal Indian Country will meet twice a month to provide prevention and direct services to American Indian adolescents that are in the 9th-12th grade.  The program will host group activities that will promote culture, traditions, education, and living a drug-free lifestyle.  Each group activity will focus on a negative social issue that is apart of our people’s struggle.  This program is designed as a community approach, elders will be actively involved, and we will support our tribal adolescents.  If scaled globally, our solution can positively change lives by implementing our interventions in other urban settings, as well as reservation and rural settings throughout Indian Country.   

Globally, American Indian adolescents have the highest suicide rates among other race for the last four decades.   American Indian adolescents have the highest rates of depression, marijuana use, meth use, and non-prescribed pills among other races.  Additionally, they have the high rate of high school dropout.  In 2019, the American High School Risk Survey reported that 42.5% of American Indians felt sad or hopeless for almost everyday for 2 weeks or more, 25.7% of American Indians seriously considered attempting suicide, 21.9% made a plan in how they would attempt suicide, and 17% attempted suicide.  In Oklahoma in 2019, American Indians adolescents had the highest rates of smoking cigarettes daily, reported that the largest number of alcoholic drink was 10 or more, ever used meth, and used steroids without a doctor’s prescription.   Within American Indian communities, everyone is affected by this tragedy. With the suicide epidemic among American Indian adolescents, there are many contributing factors, but the prominent problem is historical trauma.  Historical trauma has caused intergenerational cycles of trauma along with dysfunctional family dynamics, mental health symptoms, lack of effective communication, poor coping skills, and lack of strong support systems.  

The solution is culturally focused prevention and direct services that will help adolescents to begin building their self-esteem, become more self-aware, and learn healthy coping skills.  Each agenda will focus on a negative social issue among this population and help adolescents begin learning how to utilize their culture and traditions as a protective factor.  For an example, a beading class will be offered to the female participants, which will help them learn patience, control impulses, and balance their life.  For the young males, a sweat lodge class will be offered to teach them how to build a sweat lodge, purpose of the sweat lodge, and opportunities to heal throughout the process.  Throughout some other activities, adolescent will work together as teams and utilize IPADS to learn how to research current opportunities and future endeavors.  Additionally, technology will be utilized to have a few select guest speakers to attend virtually.  

In 2018, Oklahoma had 104,789 American Indians residing in Oklahoma City.  Hope to Heal Indian Country will be a Native-led program that will incorporate individuals from the community, along with respected elders.  It will be in the Oklahoma City area, which will also provide services to many American Indian adolescents that reside in the surrounding areas.  The program’s direct target population will be adolescents that identify as American Indian (9th-12 grade).  Even though this is the direct population, families will benefit.  The founder of this program currently works with this population, so she understands the needs and lack of resources.  The program will engage adolescents by providing a safe place, opportunity to meet new friends, and learn more about culture. This solution will meet their needs by teaching them how to effectively communicate, healthy coping skills, and ways to reach out for help if they ever struggle with depression.

Hope to Heal Indian Country utilizes traditional knowledge and technology to meet the social, environment, and economic goals of our community.  It's important to understand that the traditional knowledge and technology will teach American Indian adolescents how to effectively balance how to live in both worlds.  With the traditional knowledge, the program educates American Indian adolescents about culture and tradition, which are protective factors.  Protective factors help reduce social (i.e. substance abuse), environmental issues (i.e. dysfunctional families), which lead to economic issues in their future.  Throughout the program's activities, technology will be utilized to help engage their interest in education.  

I selected the pilot stage of development.  With Hope to Heal Indian Country, the program will be piloted in the Oklahoma City area, which has a large number of American Indian people.  With this program, our goal is to test a minimum of 10 adolescents and the program's effectiveness will be evaluated by the PHQ-9 (an evidence-based depression screener) and a self-developed questionnaire.  The overall goal of the program to eliminate the suicide epidemic among American Indian adolescents.  With the program short and long term goals are to decrease symptoms of depression among this target population, build self confidence, decrease usage of substance abuse, increase effective communication among families, decrease suicidal thoughts, and decrease suicide attempts/occurrences in our community. 

Hope to Heal Indian Country is innovative, because it is a community approach with elders actively involved and community members will be hands on working with adolescents and families.   By utilizing this type of approach, the program will help American Indian adolescents identify and share their feelings while building their self-esteem and providing hope for their future.  This program could be catalytic and it could provide a good foundation for other communities in the urban, rural, and reservation settings.  

With the technology utilized in the program, it is existing technology that our adolescents have a limited access.  In many of our American Indian homes, adolescents do not have access to internet, computers, or other technology devices.  By familiarizing them on how to utilize the IPAD, researching topics, and how to connect with others virtually, it is a huge success.  Through Covid-19, many of our adolescents had to lease technology from their local schools and hotspots.  With the leased technology, they struggled with submitting assignments and didn't have support in their home due to their caregivers having limited knowledge.  

https://www.sdnewswatch.org/st...

I provided an article about how the pandemic brings new challenges to education system on Native American reservations in South Dakota.  Even though my program is located in Oklahoma City, many of the students that I serve will be in similar living environments, poverty issues, and some may attend a local boarding school.  

The technology will not introduce any risks, because community members will be monitoring all activities that the group are conducting.  

Hope to Heal Indian Country's identified activities will contribute to successfully meeting the outcomes of the program.  For example, by providing group activities the program will contribute to attaining long-term outcomes of decreasing participants’ symptoms of depression by 35%, participant’s suicidal attempts by 35%, and as result, 85% of participants will not take their own lives.  Additionally, 60% of participants will have learned a minimum of 3 healthy coping skills that they can utilize to decrease their symptoms of anxiety, depression, and stress; 40% of participants will be able to effectively communicate with an identified safe person and be able to identify their thoughts, feelings, and converse about their reactions to situations; and 40% of participants will choose to live a drug and alcohol-free lifestyle.  

With Change Theory, Hope to Heal Indian Country identified the most common negative social norms among this population, which interventions will help individuals to change negative behaviors, and transformed these behaviors into healthy, positive coping skills. By changing the social norms, the overall goal would be that participants would begin healing from trauma by identifying how they feel, communicating to others how they feel, and heal by processing situations that occurred in the past.  Resulting implications would be participants begin breaking intergenerational cycles of trauma, which cause many common social issues to decrease and eventually transform to a healthier way of life.   The program is designed to provide prevention, direct services, and support. Providing support to adolescents, the program will help build their self-esteem and teach them how to utilize “their voice.”  By obtaining these characteristics and skills, participants will begin seeing their value.  When seeing their value, they will have more “hope” about their future endeavors.   

At this current time, my solution has not piloted.  After this innovation begins, our goal is to serve 25 adolescents in the next year and 75 in five years.  

For the next year, Hope to Heal Indian Country:

• 70% of participants and their families will be educated about symptoms of depression
• 60% of Participants will be drug and alcohol free
• Participants’ symptoms of depression decrease by a minimum of 35%
• Participants’ suicidal attempts will decrease by a minimum of 35%
•  85% of participants will not take their own life
• 60 % of participants self-report to feel more culturally grounded
• 60% of participants self-report to feel more comfortable communicating with their caregivers about problems

For the next 5 years, Hope to Heal Indian Country will:

• Be implemented in 4 urban settings, 4 reservation settings, and 2 rural settings
• 75% of participants and their families will be more educated on symptoms of depressions and signs of suicide ideation 
• Decrease symptoms of depression by a minimum of 40%
• Decrease suicidal attempts by a minimum of 45%
• 90% of participants will not take their own life
• 70% of participants self-report to feel more culturally grounded
• 65% of participants self-report to feel more comfortable communicating with their caregivers about problems

With the planned activities, our program will be able to obtain these outcomes. Each activity is specifically designed to provide awareness, educate, and transform unhealthy coping skills to healthy coping skills. 

The H.H.I.C. program will utilize three instruments that will be able to measure the long-term outcomes and program effectiveness. These three instruments are PHQ-9 screeners (depression screener) and self-developed pre and posttests. The PHQ-9 will measure quantitative data and this tool will be administered monthly to each participant in the program.  Therapist will compare each number monthly to see if depression symptoms have increased, stayed the same, or decreased.  This information is important, because it will determine if the identified interventions utilized are effective or not effective.  The pre and posttest questionnaire will measure qualitative data, which will ask questions pertaining to alcohol/drug use, culturally grounding, and effective communication.  Additionally, questions pertaining to knowledge about symptoms of depression will be inquired.  The pre and posttest will be administered once every 6 months.  These measures will determine if H.H.I.C. is effective in decreasing participant’s symptoms of depression, attempts of suicides, and suicide occurring among this community.  

With Hope to Heal Indian Country, potential barriers have been identified for the next year, which are marketing concerns.  The marketing concerns could be advertisement of the program.  With potential barriers for the next five years are future funding opportunities.  With federal funding, this can be a potential barrier, because we are still unsure what funding opportunities will be available.  

In the next year, marketing is a possible barrier.  With this barrier, the founder plans to begin networking with the local Native American Student Services, local American Indian churches in the community, as well as advertise in the tribal newspapers.  With the five year potential barriers, the founder plans to begin fundraising efforts and will eliminate the program relying on federal funds.  

There will be one full-time staff, founder, Dr. Crystal "Nikki" Factor.  With guest speakers and cultural preservation staff, they will be contracted.  

Dr. Crystal "Nikki" Factor has a bachelor’s degree in education through Haskell Indian Nations University, a master’s degree in Social Work from the University of Oklahoma, and doctorate degree in Social Work from the University of Southern California.  She is a Licensed Clinical Social Worker. She is first-generation Native college student, former foster parent, and an adoptive mother.  Throughout her career, she has worked closely with tribal adolescents and their families in urban, rural, and reservation settings.  She has worked in many fields, which include social services, domestic violence, Indian Child Welfare, and counseling through a variety of Tribes and non-profit Indian facilities.    She has experience administering tribal programs through federal, state, and private funders.  With each contractor apart of the team, they have experience working with American Indian adolescents and the importance of incorporating culture and traditions in some aspect of their work.  With each team member, they have first-hand experienced the intergenerational cycle of trauma, so they fully understand the importance of breaking negative cycles. With the designed agendas of our program, our topics will focus on balancing both worlds, healthy coping skills, self-awareness, education, living a sober lifestyle, and honoring our ancestors. 

My approach to building a diverse, equitable, and inclusive leadership team is having individuals on the team with these types of characteristics:

• Nonjudgmental
• Empathetic
• Open to learn and grow
• Respectful to everyone on the team
• Supportive of one another

By having a diverse, equitable, and inclusive leadership, the team will be able to work together in eliminating the suicide epidemic among American Indian adolescents.   

I am applying to Solve, because I believe that this innovation is beneficial for not only my community, but many communities in Indian Country.  I want to eliminate the suicide epidemic that has haunted Indian communities for over four decades.  With the identified barriers, I believe Solve can help resolve these barriers and help establish a strong, resilient program that can help many individuals, families, Tribes, and communities through the United States and Canada.  

With Hope to Heal Indian Country, I believe our program would benefit with assistance establishing a solid board.  I believe our program has individuals in mind, but outside feedback and recommendation would be very beneficial.  

With Hope to Heal Indian Country, potential partners would be successful organizations that are somewhat similar even if they serve a different population and MIT faculty would be beneficial.  I currently have some professors at the University of Southern California that would be supportive and provide some feedback, recommendation, and feedback.  I believe that any type of innovative professionals would benefit our program.  

If granted with the Robert Wood Johnson Foundation Prize, these monies would advance my solution by allowing our program to expand services and provide participants will a small incentive to participates.  

If granted this ASA prize for Equitable Education, our program can pivot to a different setting, but also continue expanding services.