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American Indian Life Skills Development/Zuni Life Skills Development

Suicide is the second leading cause of death among American Indians 15 to 24 years old, according to Centers for Disease Control and Prevention data. The estimated rate of completed suicides among American Indians in this age group is about three times higher than among comparably aged U.S. youth overall (37.4 vs. 11.4 per 100,000, respectively). American Indian Life Skills Development (the currently available version of the former Zuni Life Skills Development program) is a school-based suicide prevention curriculum designed to address this problem by reducing suicide risk and improving protective factors among American Indian adolescents 14 to 19 years old.

The curriculum includes anywhere from 28 to 56 lesson plans covering topics such as building self-esteem, identifying emotions and stress, increasing communication and problem-solving skills, recognizing and eliminating self-destructive behavior, learning about suicide, role-playing around suicide prevention, and setting personal and community goals. The curriculum typically is delivered over 30 weeks during the school year, with students participating in lessons 3 times per week. Lessons are interactive and incorporate situations and experiences relevant to American Indian adolescent life, such as dating, rejection, divorce, separation, unemployment, and problems with health and the law. Most of the lessons include brief, scripted scenarios that provide a chance for students to employ problem solving and apply the suicide-related knowledge they have learned.

Lessons are delivered by teachers working with community resource leaders and representatives of local social services agencies. This team-teaching approach ensures that the lessons have a high degree of cultural and linguistic relevance even if the teachers are not Native American or not of the same tribe as the students. For example, the community resource leaders can speak to students in their own language to explain important concepts and can relate curriculum materials and exercises to traditional and contemporary tribal activities, beliefs, and values. A school counselor (typically of the same tribe) serves as the on-site curriculum coordinator.

The Zuni Life Skills Development curriculum was developed with cultural components relevant to the people of the Zuni Pueblo in New Mexico and was tested and evaluated with that population. The Zuni curriculum served as the basis for the broader American Indian Life Skills Development curriculum that is now in use, which can be used with other American Indian populations when implemented with appropriate and culturally specific modifications.

Descriptive Information

Areas of Interest Mental health promotion
Outcomes Review Date: June 2007
1: Hopelessness
2: Suicide prevention skills
Outcome Categories Mental health
Suicide
Ages 13-17 (Adolescent)
Genders Male
Female
Races/Ethnicities American Indian or Alaska Native
Settings School
Other community settings
Geographic Locations Urban
Rural and/or frontier
Tribal
Implementation History The Zuni Life Skills Development curriculum was first implemented with high school students in the Zuni Pueblo, an American Indian reservation with about 9,000 tribal members located about 150 miles west of Albuquerque, New Mexico. The American Indian Life Skills Development curriculum, an adaptation of the Zuni version, has been implemented with a number of other tribes.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: No
Adaptations Adaptations of the curriculum have been developed for middle school students on a reservation in the Northern Plains area; for Sequoyah High School in Tahlequah, Oklahoma, a boarding school on the reservation of the Cherokee Nation that enrolls students from about 20 tribes across the country; and for young women of the Blackfeet tribe.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Universal

Quality of Research
Review Date: June 2007

Documents Reviewed

The documents below were reviewed for Quality of Research. The research point of contact can provide information regarding the studies reviewed and the availability of additional materials, including those from more recent studies that may have been conducted.

Study 1

LaFromboise, T., & Howard-Pitney, B. (1995). The Zuni Life Skills Development curriculum: Description and evaluation of a suicide prevention program. Journal of Counseling Psychology, 42(4), 479-486.

Supplementary Materials

Howard-Pitney, B., LaFromboise, T. D., Basil, M., September, B., & Johnson, M. (1992). Psychological and social indicators of suicide ideation and suicide attempts in Zuni adolescents. Journal of Consulting and Clinical Psychology, 60(3), 473-476.  Pub Med icon

LaFromboise, T. (2006). American Indian youth suicide prevention. Prevention Researcher, 13, 16-18.

LaFromboise, T. D., & Howard-Pitney, B. (1994). The Zuni Life Skills Development curriculum: A collaborative approach to curriculum development. American Indian and Alaska Native Mental Health Research: The Journal of the National Center Monographs, 4, 98-121.

LaFromboise, T. D., & Howard-Pitney, B. (1995). Suicidal behavior in American Indian female adolescents. In S. Canetto & D. Lester (Eds.), Women and suicidal behavior (pp. 157-173). New York: Springer.

LaFromboise, T. D., & Lewis, H. A. (2008). The Zuni Life Skills Development program: A school/community-based suicide prevention intervention. Suicide and Life-Threatening Behavior, 38(3), 343-353.  Pub Med icon

LaFromboise, T. D., Medoff, L., Lee, C. C., & Harris, A. (2007). Psychosocial and cultural correlates of suicidal ideation among American Indian early adolescents on a Northern Plains reservation. Research in Human Development, 4(1-2), 119-143.

Outcomes

Outcome 1: Hopelessness
Description of Measures Feelings of hopelessness were measured with Beck's Hopelessness Scale, a 20-item, true-false inventory used to assess negative expectations about the future.
Key Findings Students receiving the Zuni Life Skills Development curriculum had less feelings of hopelessness compared with the no-intervention control group (p < .05).
Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 2.8 (0.0-4.0 scale)
Outcome 2: Suicide prevention skills
Description of Measures Sixty-two of the 128 Zuni students who participated in the formal evaluation study of the Zuni Life Skills Development curriculum were randomly selected for the role-play behavioral assessment; 28 of the 62 came from a matched-pair sample. In four 10-minute role-play scenarios, Zuni adolescents played "helpers" paired with one of two non-Zuni, American Indian university students assuming the role of the suicidal person. (The Zuni tradition prohibits Zuni students from acting out the role of a suicidal person.) After two practice role-play scenarios, another two role-plays, which included a mild suicide threat and a more serious/imminent suicide threat, were videotaped for later rating by judges and peers blind to the intervention and control conditions.

The videotaped suicide scenarios were rated independently by two American Indian graduate students trained as a team for 18 hours to apply the rating criteria uniformly, resulting in an interrater reliability of .85. Judges rated the suicide intervention and problem-solving skills displayed in the role-play scenarios across 10 criteria using a 6-point Likert scale that ranged from 1 (strongly disagree) to 6 (strongly agree). The same 10 criteria, with slight rewording, were used by peers who rated their classmates in the role-play scenarios.
Key Findings Students receiving the Zuni Life Skills Development curriculum demonstrated a higher level of suicide intervention skills compared with the no-intervention control group (p < .004). Students across both groups demonstrated greater problem-solving skills in the scenario with the mild suicide threat than in the scenario with the more serious suicide threat (p < .005).
Studies Measuring Outcome Study 1
Study Designs Quasi-experimental
Quality of Research Rating 2.3 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 13-17 (Adolescent) 65% Female
35% Male
100% American Indian or Alaska Native

Quality of Research Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the Quality of Research for an intervention's reported results using six criteria:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Hopelessness 4.0 4.0 2.0 2.0 1.8 3.0 2.8
2: Suicide prevention skills 2.5 1.5 2.0 2.0 3.0 3.0 2.3

Study Strengths

Beck's Hopelessness Scale is a clearly reliable, valid, and relevant scale. Participant attrition was addressed with appropriate analyses. The suicidal role-play scenario was a good method for dealing with some of the issues that this program aims to target. All suicidal scenarios were rated independently by two judges who were trained as a team for 18 hours to apply the rating criteria uniformly. The curriculum was tailored to the culture. Teachers and cultural resource persons were trained in the curriculum.

Study Weaknesses

The role-play scenarios pose some concerns related to reliability and validity. Other weaknesses of the study include a nonrandomized sample, a high attrition rate due to the need to match samples across groups, and a consequently small sample size that reduces power. Because both the intervention and control students were in the same school, contamination may have occurred. In addition, the fidelity of implementation may have been an issue with this curriculum.

Readiness for Dissemination
Review Date: June 2007

Materials Reviewed

The materials below were reviewed for Readiness for Dissemination. The implementation point of contact can provide information regarding implementation of the intervention and the availability of additional, updated, or new materials.

American Indian Life Skills Curriculum: Lesson Observation Guide

American Indian Life Skills Development Curriculum: Teacher/Community Resource Feedback

American Indian Life Skills Outcome Survey

American Indian Life Skills Training Evaluation

Example Memorandum of Understanding

Handouts:

  • AILSDC Training Objectives [PowerPoint handout]
  • American Indian Life Skills: Confidentiality Issues & Ethics [PowerPoint handout]
  • American Indian Life Skills Training: Fidelity Issues in Cultural Tailoring [PowerPoint handout]
  • American Indian Life Skills Training: Why Use the Skills Training Model? [PowerPoint handout]
  • Native Aspirations: American Indian Life Skills: Circle of Opportunities
  • Native Aspirations: American Indian Life Skills Training, Wolf Point, Montana, May 24, 2007 [PowerPoint handout]
  • Native Aspirations: Community Readiness Stages
  • Piloting American Indian Life Skills: 12 Essential Lessons! [PowerPoint handout]
  • Skill Building Pattern for Lessons
  • Stress and Suicidal Behavior From a Native American Perspective
  • Suggested Outcome Measures for American Indian Life Skills Development Curriculum

LaFromboise, T. (1996). American Indian Life Skills Development curriculum. Madison: University of Wisconsin Press.

LaFromboise, T., & School of Education, Stanford University. (2007). American Indian Life Skills Development curriculum: Draft middle school version. Madison, WI: Board of Trustees, Leland Stanford Junior University.

LaFromboise, T., & School of Education, Stanford University. (2007). American Indian Life Skills Development student workbook: Middle school version. Madison, WI: Board of Trustees, Leland Stanford Junior University.

May, P. A., Serna, P., Hurt, L., & DeBruyn, L. M. (2005). Outcome evaluation of a public health approach to suicide prevention in an American Indian tribal nation. American Journal of Public Health, 95(7), 1238-1244.  Pub Med icon

Native Aspirations: American Indian Life Skills Training, Wolf Point, Montana, May 24, 2007 [training manual]

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.9 4.0 2.8 3.6

Dissemination Strengths

Program materials are developmentally appropriate, culturally sensitive, and engaging for an adolescent audience. A variety of training resources are available to ensure effective program implementation. Tools for assessing program outcomes, training effectiveness, and intervention fidelity are provided to support quality assurance.

Dissemination Weaknesses

No materials are offered to help engage or inform parents. Fidelity to the intervention is assessed using an observational measure, but no information is available about how reliability is ensured. No information is provided on how quality assurance materials might be used to improve program implementation.

Costs

The cost information below was provided by the developer. Although this cost information may have been updated by the developer since the time of review, it may not reflect the current costs or availability of items (including newly developed or discontinued items). The implementation point of contact can provide current information and discuss implementation requirements.

Item Description Cost Required by Developer
American Indian Life Skills Development Manual $30 each Yes
3-day, on-site Key Leader training (includes 6 hours of phone consultation) $9,000 per site plus travel expenses No
Additional consultation Varies depending on site needs No
AILS Observation Guide Free No
Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

LaFromboise, T. (2006). American Indian youth suicide prevention. Prevention Researcher, 13, 16-18.

LaFromboise, T. D., & Howard-Pitney, B. (1994). The Zuni Life Skills Development curriculum: A collaborative approach to curriculum development. American Indian and Alaska Native Mental Health Research: The Journal of the National Center Monographs, 4, 98-121.

LaFromboise, T. D., Medoff, L., Lee, C. C., & Harris, A. (2007). Psychosocial and cultural correlates of suicidal ideation among American Indian early adolescents on a Northern Plains reservation. Research in Human Development, 4(1-2), 119-143.

Contact Information

To learn more about implementation or research, contact:
Teresa D. LaFromboise, Ph.D.
(650) 723-1202
lafrom@stanford.edu

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.