Abstract
BackgroundTrauma within Native American communities compromises parents’ parenting capacity; thus, increasing childrens’ risk for substance use and suicide over the lifespan. The objective of this manuscript is to describe the Wakȟáŋyeža (Little Holy One) intervention and evaluation protocol, that is designed to break cycles of intergenerational trauma, suicide, and substance use among Fort Peck Assiniboine and Sioux parents and their children.MethodsA randomized controlled trial with an embedded single-case experimental design will be used to determine effectiveness of the modular prevention intervention on parent-child outcomes and the added impact of unique cultural lesson-components. Participants include 1) Fort Peck Assiniboine and Sioux parents who have had adverse childhood experiences, and 2) their children (3–5 years). Parent-child dyads are randomized (1:1) to Little Holy One or a control group that consists of 12 lessons taught by Indigenous community health workers. Lessons were developed from elements of 1) the Common Elements Treatment Approach and Family Spirit, both evidence-based interventions, and 2) newly created cultural (intervention) and nutrition (control group only) lessons. Primary outcomes are parent (primary caregiver) trauma symptoms and stress. Secondary outcomes include: Parent depression symptoms, parenting practices, parental control, family routines, substance use, historical loss, communal mastery, tribal identity, historical trauma. Child outcomes include, externalizing and internalizing behavior and school attendance. Primary analysis will follow an intent-to-treat approach, and secondary analysis will include examination of change trajectories to determine impact of cultural lessons and exploration of overall effect moderation by age and gender of child and type of caregiver (e.g., parent, grandparent).DiscussionMany Native American parents have endured adverse childhood experiences and traumas that can negatively impact capacity for positive parenting. Study results will provide insights about the potential of a culturally-based intervention to reduce parental distress – an upstream approach to reducing risk for childrens’ later substance misuse and suicidality. Intervention design features, including use of community health workers, cultural grounding, and administration in Head Start settings lend potential for feasibility, acceptability, sustainability, and scalability.Trial registrationClinicalTrials.gov: NCT04201184. Registered 11 December 2019.
Highlights
There is strong evidence that negative parenting experiences in early childhood are associated with later adolescent and young adult substance use and suicide [1, 2]
The effectiveness of behavioral interventions often occur through multiple strategies, the strategies presented in the parent grant remain unchanged, we aim to explore the possible efficacy of the Little Holy One program on social networks as levers of change for conferring reduced risk of suicide and opioid use as the group-based nature of the intervention increase social interaction of parents, increases parenting support networks, and is founded in similar values of cultural strengths
This study was designed to address the high prevalence of childhood trauma and related substance use and suicide behavior in Fort Peck Assiniboine and Sioux youth, by intervening with parents during a critical development stage for their child
Summary
Background and rationale There is strong evidence that negative parenting experiences in early childhood are associated with later adolescent and young adult substance use and suicide [1, 2]. Parenting factors associated with childrens’ future substance use and suicide risk include parental stress, alcohol and drug use, parent-child attachment, multigenerational adversity, and poor monitoring [9, 10, 12,13,14]. ACEs in parents have been linked to high parenting stress, poor parent-child attachment, and harmful parenting practices such as corporal punishment during infancy [17,18,19,20] These trends in parents create a cycle of intergenerational ACEs, whereby children of parents who experience ACEs are at higher risk for ACEs themselves and grow up at risk for perpetuating negative parenting practices [2, 21]. Trauma within Native American communities compromises parents’ parenting capacity; increasing childrens’ risk for substance use and suicide over the lifespan. The objective of this manuscript is to describe the Wakȟáŋyeža (Little Holy One) intervention and evaluation protocol, that is designed to break cycles of intergenerational trauma, suicide, and substance use among Fort Peck Assiniboine and Sioux parents and their children
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