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343Suicide and Life-Threatening Behavior 38(3) June 2008
2008 The American Association of Suicidology
The Zuni Life Skills Development Program:
A School/Community-Based Suicide
Prevention Intervention
Teresa D.LaFromboise,PhD,and Hayes A.Lewis,MEd
The Zuni Life Skills Development Program, an effective community-initiated
and high-school-based suicide prevention intervention, is featured. Development
and evaluation of this intervention are followed by note of the specific challenges
associated with stabilizing the program. A more tribally diverse, culturally-informed
model entitled the American Indian Life Skills Development Curriculum is then pre-
sented to illustrate a hybrid approach to the cultural tailoring of interventions.
This curriculum is broad enough to address concerns across diverse American
Indian tribal groups yet respectful of distinctive and heterogeneous cultural beliefs
and practices. Finally, we reflect upon issues in community-based research that
emerged during this collaboration.
Suicide and suicide-related behaviors are a lation until age 45, when the rate begins to
resemble that of the general U.S. populationmajor public health concern for American
Indian adolescents, yet their risk behavior (Goldsmith, Pellmar, Kleinman, & Bunney,
2002).pattern remains undefined. Suicide is the sec-
ond leading cause of death among American In studying adolescents from three
culturally distinct American Indian tribes,Indian adolescents and young adults in the
15- to 24-year-old age group and is the third Novins, Beals, Roberts, and Manson (1999)
noted that the correlates of suicidal ideationleading cause of death in the 10- to 14-year-
old age group (Centers for Disease Control, differed between tribes but were consistent
with the tribe’s social structure, individual2005). In addition, among American Indian
youth age 5 to 14 years, the rate of suicide is and gender expectations, support systems,
and conceptualization of death. These find-2.1 per 100,000 compared with .8 per
100,000 for U.S. youth in the same age ings underscore the need for caution when
generalizing across tribes about cultural in-group; the rate of suicide among American
Indian youth age 15 to 24 years is 37.4 per fluences on suicidal behavior. The variability
in rates and manifestation of symptoms may100,000 compared with 11.4 per 100,000 for
all U.S. youth in the same age group (Indian be a function of contagion within close-knit
and isolated communities rather than differ-Health Service, 2002). Suicidal behaviors
(i.e., suicidal ideation, suicide plans, and sui- ences in cultural mores or practices. Addi-
tional risk factors noted in the Novins et al.cide attempts) increase with age in this popu-
(1999) report, such as weak American Indian
identity and loss of cultural supports, have
Teresa D.LaFromboise is with Stanford not been found consistently in other related
University; and Hayes A.Lewis is with the Insti- research (LaFromboise, Medoff, Lee, &
tute of American Indian Arts. Harris, 2007). Recently, perceived discrimi-
Address correspondence to Teresa La- nation has joined the list of risk factors often
Fromboise, PhD, 485 Lasuen Mall, Stanford, Ca.
94305–3096; E-mail: lafrom@stanford.edu mentioned in other studies; such as negative
344 Zuni Life Skills Development Program
life events, depression, and substance use tion, most HUD homes were cheaply made
and thus required added resources to heat(Yoder, Whitbeck, Hoyt, & LaFromboise,
2006). and cool. Moreover, the jewelry market, a
major source of income for many families,In 1987 tribal and community leaders
and parents residing on the Zuni Indian res- bottomed out during that time period caus-
ing further economic hardship.ervation became increasingly alarmed over
the rising rates of youth and young adult sui- Suicide is an especially distressing phe-
nomenon for the Zuni because it is forbiddencide. Over a 7-year period from 1980 to
1987, 13 school-aged youth and young adults in their traditional culture. Zunis believe that
to take one’s own life will cause the soul tohad fatal suicidal behavior in Zuni, a pueblo
located in northwestern New Mexico about remain in a state of distress. The soul of the
deceased will wander and may cause harm to150 miles west of Albuquerque. The youth
were between the ages of 14 and 18 and in- family members and close associates. The de-
ceased person’s soul will not go to “Zunicluded 12 males and 1 female. It is uncertain
if all of the individuals knew each other, but Heaven” until the time that death would have
naturally occurred. The soul of the one whoit is certainly possible within this small ho-
mogeneous community. The tribe and local has died by suicide may not be called upon
to spiritually help the living during times ofeducators had great difficulty obtaining in-
formation on the actual circumstances of the sacrifice and religious participation. In addi-
tion, death by this means is a source ofsuicides from the Zuni service unit of the In-
dian Health Service (IHS), which made the stigma to the family (A. Seowtewa, personal
communication, March 19, 1987).incidents difficult to evaluate.
There was community speculation that At the time of this project, the epide-
miological reality of Zuni suicidal behaviorone of the possible reasons for this increase
in suicidal death was the fact that Zuni fami- was limited to a set of selected statistics from
1965–1988 which had been compiled by alies were becoming more fragmented. Family
and traditional support systems within the community member employed at the local
IHS hospital (Ghachu, 1989). Inferences oncommunity had weakened with an increase in
dispersed housing subdivisions. Traditional any earlier incidents of death by suicide had
to be made from this document. The list ofextended family dwellings had been virtually
replaced by single family dwellings. This risk factors associated with suicidal ideation
among Zuni adolescents during baseline as-broke up families and adversely affected the
value of the extended family as a social, emo- sessment for the current intervention re-
vealed the following: psychological symp-tional, cultural, and economic resource. As
the population expanded and extended family tomatology, past suicidal ideation, drug use,
depression, hopelessness, stress, limited so-units were separated, single-family Housing
and Urban Development (HUD) homes be- cial support, dislike for school, and weak in-
terpersonal communication (Howard-Pitney,came commonplace. The new housing pat-
terns also caused a cultural and spiritual LaFromboise, Basil, September, & Johnson,
1992).hardship because many families living in
Blackrock (a settlement three miles from What follows is an account of the de-
velopment and evaluation of the Zuni LifeZuni) began to find it more difficult to partic-
ipate in cultural activities. Absence from tra- Skills Development Program, a community-
initiated high school suicide prevention pro-ditional cultural activities weakened the
transference of cultural knowledge and be- gram designed to provide intervention strate-
gies consistent with cultural and communityliefs to younger family members. There was
a corresponding change in economic condi- values and strengths. We define the specific
challenges associated with institutionalizingtions in Zuni as well. Many families living in
HUD subdivisions had to make much higher this new and ultimately effective program,
which has been substantiated through adown payments to purchase homes. In addi-
LaFromboise and Lewis 345
quasi-experimental posttest evaluation study. Zuni IHS service unit to refine protocols for
appropriate response and support.Its derivative, the American Indian Life Skills
Development Curriculum, is presented as a The members of our team were first
hosted in the homes of Zuni communityculturally-informed model of suicide preven-
tion that is broad enough to capture concerns members in the spring of 1987. One member
was invited to spend the summer at Zuni torelevant across diverse tribal groups, yet re-
spectful of distinctive and heterogeneous learn about the community and to review ex-
isting school-based suicide prevention train-tribal beliefs and practices. Finally, we reflect
on critical issues in community-based re- ing programs. After a summer of fieldwork in
Zuni and 1 year of intervention developmentsearch that emerged in this collaboration.
on campus, the team began interventionist
training for the pilot study. Initially, the
teachers selected to deliver the intervention
INITIATION INTO were resistant to becoming involved with the
THE COMMUNITY project. They were upset about an article that
appeared in a local newspaper (the Gallup In-
dependent) just days before the initial imple-When the first author was invited by
the second author, then superintendent of mentation of the curriculum in the field. This
article highlighted the irony of the tribethe Zuni Public School District, to help facil-
itate a community response to the latest sui- bringing in Stanford University researchers
to “save Zuni lives” during the winter Sha-cide crises among its adolescents, there al-
ready existed a Zuni-Stanford Committee to lako ceremonies and solstice fasting period
which, in fact, celebrates life. Despite nega-address areas of need on the Zuni reserva-
tion. This committee was initiated as a result tive reactions to this publicity within the
community, Zuni support was mobilized andof a formal agreement between Stanford
University, the Zuni Board of Education, and the teachers (all of whom were non-Indian)
were encouraged to continue. Two Zuni pro-the Zuni Tribal Council. It represented col-
laboration between an interdisciplinary fessionals, a cultural consultant and a mental
health technician, joined the interventiongroup of Stanford faculty and Zuni commu-
nity leaders for the purpose of sharing exper- team as cultural brokers between the stu-
dents’ school and home contexts.tise concerning pressing issues in Zuni re-
lated to communication, education, and Extensive input was solicited from
Zuni tribal members by members of the re-economic development. Once an institu-
tional review of our intervention project was search team in order to examine key aspects
of helping and problem solving in Zuni cul-conducted and approval granted by this com-
mittee, there began a 3-year process of con- ture and to establish community support for
a formative evaluation of the intervention.sulting with the Zuni community to develop
and evaluate a suicide prevention interven- Focus groups representing various house-
holds, medicine fraternities, or kiva societytion which would emphasize life skills devel-
opment and peer support. A life skills train- members were selected by the superinten-
dent and gave necessary guidance on imple-ing approach was selected because of its
preventive focus on offsetting the underlying mentation issues and further refinement of
the intervention. Their input led to a titlefactors of vulnerability that contribute to
high-risk behavior among adolescents. Help- change (from Zuni “suicide prevention” to
Zuni “life skills development”) and to a reor-ing youth build help-seeking behaviors and
teaching their peers to respond appropriately dering of the sequence of skills presented. In-
stead of directly addressing suicide preven-when they reach out became our focus. In
addition, our research team provided com- tion skills-training at the onset, the intervention
gradually phased in information about crisismunity and school gatekeeper training for
suicide prevention and collaborated with the intervention and suicide prevention after first
346 Zuni Life Skills Development Program
addressing skills-training in problem solving, youth appeared to confide in peers about
their concerns more often than they confidedovercoming depression, and stress and anger
management. in adults. It was believed that provision of
help by peers would be beneficial to both the
peer helpers and the students in need. Partic-Selecting a Skills-Training Approach
ipating in help-giving would be a way to en-
gage in pro-social behavior and support a val-A skills-training approach was selected
for use in this work because of its effective- ued community norm. Furthermore, increased
contact with caring adults while acquiring de-ness with American Indian adolescents in re-
ducing the risk factors of substance (Hawk- pression management techniques and stress
management, problem solving, crisis inter-ins, Cummins, & Marlatt, 2004) and tobacco
use (Schinke, Moncher, Holden, Botvin, & vention, and goal-setting skills would widen
their network of available helping resources.Orlandi, 1989). Skills-training has several
features that facilitate intervention with Youth skill-building programs have
been applied to diverse adolescent preventionAmerican Indian youth. In particular, it is a
flexible model with inherent potential to of- programs, especially in school-based settings.
These programs have focused primarily onfer interventions that are culturally appro-
priate. Specific aspects of skills-training with the enhancement of competence in youth de-
velopment work (e.g., self-regulation), as wellAmerican Indian youth include the extensive
use of (a) small group work, which is compat- as the reduction of at-risk behaviors and the
prevention of mental health problems (Cata-ible with traditional and communal modes of
helping; (b) role modeling by adult guest lano, Berglund, Ryan, Lonczak, & Hawkins,
2002). Outcome data from these preventionspeakers on effective coping despite adver-
sity, which replicates knowledge transmission interventions have been promising, especially
when coupled with parent and family train-through apprenticeship opportunities with
designated family members—an essential ing and support (Weisz, Sandler, Durlak, &
Anton, 2005).source of childhood socialization in Zuni cul-
ture; and (c) community gatekeeping by School-based adolescent suicide pre-
vention is one area in which the skills-train-tribal members knowledgeable about the
tribal structure and worldviews (LaFrom- ing approach is insufficiently used. Increas-
ingly, school-based suicide prevention programsboise & Rowe, 1983). Skills-training lends it-
self to collaboration between community focus on early screening for suicidal risk, on
teaching information about suicide, on de-members and interventionists to determine
socially appropriate goals for the interven- tecting risk factors, on referring at-risk stu-
dents to mental health services, and on devel-tion, which could include the maintenance of
certain indigenous beliefs and skills as well as oping crisis intervention techniques. Few
explicitly strive to use skills enhancement tothe acquisition of new skills. This approach
allows the community to define the target modify suicide risk factors such as inadequate
problem solving or coping skills. The successproblems (e.g., substance use, violence) and
the types of behaviors deemed appropriate of the skills-training approach in ameliorat-
ing other adolescent risk behaviors suggestsfor each situation (e.g., refusal skills, coping
skills, anger management skills). It also facili- that it may be an effective approach for sui-
cide prevention with youth. This evidence oftates prevention efforts because it can be used
to develop skills and competencies prior to effectiveness coupled with the compatibility
of skills-training with Native American waysthe manifestation of behavioral problems or
deficiencies. of knowing made this approach appealing for
the universal intervention.The research team anticipated that a
universal intervention might raise the overall The Zuni Life Skills Development
Curriculum (ZLS; LaFromboise, 1991) wassupportiveness and responsiveness of the
school environment for at-risk youth. Zuni endorsed by the tribe to address essential risk
LaFromboise and Lewis 347
factors associated with adolescent suicide dents to remember that the life they were
given was the most important possession they(e.g., hopelessness, depression, anger). The
seven major units of the curriculum were as had. The beginning lessons focused on the
desire for community cohesion and knowl-follows: (1) build self-esteem; (2) identify
emotions and stress; (3) increase communica- edge of one’s family background. Core Zuni
values were underscored, such as resistancetion and problem-solving skills; (4) recognize
and eliminate self-destructive behavior; (5) and fortitude—qualities found necessary at
numerous times in their history, such as thelearn about current knowledge on the vari-
able rates of suicide across tribes, on risk fac- Pueblo Revolt of 1680 and subsequent
threats by outsiders over the years. Studentstors for American Indian adolescent suicidal
behavior, on the warning signs of suicide, and then began to review the ways in which other
tribal people had coped with stress, especiallyon facts and myths about suicide; (6) receive
suicide crisis intervention training; and (7) when struggling against the demeaning as-
pects of colonization. They also studied cul-engage in individual and collectivistic goal-
setting. Each lesson contained the standard ture-specific manifestations of psychological
symptoms associated with suicide from schol-skills-training techniques of providing infor-
mation about the helpful or harmful effects arly writings available at the time.
Each skill-building activity was se-of certain behaviors, modeling of target
skills, experiential activities and behavior re- lected by the first author from research sup-
porting best practices for social emotionalhearsal for skills acquisition, and feedback for
skill refinement. These four fundamental regulation and skills acquisition. The re-
search team made a thorough study of thecomponents tap a variety of different learn-
ing channels and actively engage students most efficacious components of group cogni-
tive and behavioral treatment strategies (seeearly in the training process.
review by Weisz et al., 2005). Once a treat-
ment procedure was identified, communityCultural Tailoring of the Intervention
input was sought concerning socially-valued
components of the procedure and necessaryA unique feature and strength of the
intervention was that it was specifically tai- modifications of the protocol. For example,
in the lessons on dealing with mild depres-lored to be compatible with Zuni cultural
teachings and world views, values, norms, sion, the Pleasant Events Schedule (Lewin-
sohn, Munoz, Youngren, & Ziess, 1986) wascommunication styles, and rewards and
forms of recognition. A key feature in the in- adapted for the adolescent developmental
level and for greater relevance to the reserva-tervention delivery process was team-teach-
ing: pairing a Zuni person with each non- tion context, and was used as a class activity
and homework assignment. Items such asZuni teacher to deliver the curriculum. Issues
of a highly personal nature brought up by “talking on the telephone” or “playing a mu-
sical instrument” were retained. However,students were often spoken in the Zuni lan-
guage to other students and the Zuni mem- new items were added: “doing heavy outdoor
work (cutting or chopping wood, clearingber of the team. It should be emphasized that
the deep structural aspects of Zuni culture land, etc.)” or “being at weddings and other
ceremonies.” In the lessons on stress man-were shared sparingly with the research team
during intervention development and only as agement, the eight coping categories ad-
vanced by Folkman and Lazarus were pre-they related to the goals of the intervention.
All involved acknowledged that it was impor- sented to community members and discussed
to better determine community preferencestant not to reveal tribal mores in spheres out-
side of the Zuni family, clan, and religious for each of the ways of coping (Folkman,
Lazarus, Dunkel-Schetter, DeLongis, &structures.
The curriculum began with an open- Gruen, 1986). The most highly ranked ways
of coping were featured in the lessons oning invocation from a Zuni leader, asking stu-
348 Zuni Life Skills Development Program
coping within the curriculum. Goal-setting, miliarity with community dynamics and fear
that the topic was a liability in local politicswhich is usually an individual endeavor, was
expanded to include both personal and com- among partner agencies were the chief rea-
sons for the end of the program (personalmunity goal-setting.
communication with J. West, November 20,
1994). Unfortunately, his views found accep-Stabilization of the Intervention
tance within the school site leadership,
among teachers, and with the school board.The ZLS was offered 3 days a week
in language arts classes during the first year It appears that the new leadership at
the administrative and board levels believedof the intervention, followed by booster ses-
sions on suicide prevention during the third that the Zuni-Stanford suicide prevention
goals were accomplished, since the numberyear. Using a multi-method evaluation ap-
proach including self-report, behavioral ob- of school-aged suicides had been drastically
reduced. The cumulative impact of changesservation, and peer rating, the intervention
was found to reduce suicidal thoughts and in district leadership and the sharp drop-off
in deaths by suicide resulted in a shift in pri-behaviors and feelings of hopelessness among
Zuni youth. It was also found to increase orities away from continuation of the suicide
prevention and intervention.problem-solving skills and suicide interven-
tion skills (LaFromboise & Howard-Pitney, In small, homogeneous tribal commu-
nities, many Native American service provid-1995).
Unfortunately, the ZLS was discon- ers and teachers believe that they know ev-
eryone else’s most private affairs. Whentinued 2 years following its promising evalua-
tion for several interrelated reasons. Suicide, blame for a suicide is assigned, particularly
when family dysfunction is assumed to be aas it occurs within the tribal community con-
text, has the potential to become not only major contributor, the process of intervening
with new systemic support systems from thecontroversial but adversarial at several levels.
Suicide prevention and intervention requires community and school becomes problematic
and controversial. A number of parents toldconstant vigilance and appropriate, timely ac-
tion. This takes energy, careful orientation, the second author that tribal and school-
based service providers were implying thattraining, community awareness, school and
community collaboration strategies, and the their inability to be “good parents” contrib-
uted to the suicide of their children. Feelingscreation of effective policies and protocols.
The second author, a Zuni tribal member, ex- of personal guilt and responsibility interfered
with their ability to effectively cope with theperienced first-hand initial resistance and
lack of support for the program by some IHS many complicated and emotion-laden issues.
This left many parents and relatives withpersonnel. Changes in the Zuni School Dis-
trict leadership occurred at the superinten- very few effective or appropriate ways to ex-
press their grief, frustrations, and fears.dent level the year following the final evalua-
tion. This involved reassignments of key
Zuni and other personnel who were familiar
with the school-community suicide issues. AMERICAN INDIAN LIFE SKILLS
DEVELOPMENT CURRICULUM
Key staff replacements were primarily non-
Indian personnel who had little familiarity or
knowledge of community priorities or dy- While the ZLS was struggling with
stabilization issues, the first author turned tonamics. The new superintendent was unwill-
ing to press for the necessary community ad- other American Indian school settings to re-
fine the intervention and address the prob-vocacy to insure long-term implementation
and institutionalization (personal communi- lems of youth from other tribal nations. Un-
derlying this work was the assumption thatcation with W. Eriacho, G. Keene, and M.
Eriacho, November 13, 2005). His lack of fa- many tribes, especially more traditional ones,
LaFromboise and Lewis 349
would be reluctant to share valued deep- tective factors specific to American Indian
youth to inform the development of preven-structure cultural information. However, it
was believed by the first author and sup- tion strategies in their review of suicide pre-
vention programs in American Indian/Alaskaported by the diverse tribal community con-
sultants who worked on the project that Native communities. Greenberg, Domitrov-
ich, and Bumbarger (2001) also deemed it amany of the cultural nuances in the Zuni pro-
gram could be adapted to create intervention promising program in their review of preven-
tion interventions for mental disorders inprograms for other tribes. The more tribally
heterogeneous version for this process was school-aged children.
Clearly, further effectiveness studies ofpublished as the American Indian Life Skills
Development Curriculum (AILS; LaFrom- the AILS for suicide prevention are needed
in order to meet current standards of evi-boise, 1995). This curriculum encourages in-
terventionists to incorporate traditional and dence against which preventive interventions
are evaluated. If more evaluations of thecontemporary worldviews of their tribes and
communities into the cultural content of the AILS support continuation of this interven-
tion, applications in urban settings must becurriculum without altering the skills-train-
ing form of program delivery or compromis- studied. Then this intervention could be used
in tandem with evidence-based substanceing the core psychological components of the
intervention. Castro, Barrera, and Martinez abuse programs already implemented with
American Indian adolescents (Moran & Rea-(2004) have labeled the heuristic for this type
of cultural tailoring a “hybrid-like frame- man, 2002).
work.”
With the AILS we also attempted to
address the needs of both traditional and CONTROVERSY OVER
CULTURAL SENSITIVITY
pan-tribal adolescents. The AILS contains
certain universal Native American values and
behaviors such as respect, kindness, and gen- Within the community of American
Indian mental health scholars there is in-erosity, but also allows for the local tailoring
of intervention content and training pro- creasing advocacy for an emic (within the
culture or “insider”) approach in which inter-cesses. Since its inception in 1995 it has been
used by representatives of traditional healing ventions are highly specific to the traditional
wisdom and healing practices of a particularsocieties with youth on reservations as well as
by teachers in after-school programs, and tribe (Gone, 2004). The ZLS is an example
of such an approach. This work not only in-with American Indian students in both public
and tribal schools. volved ongoing collaboration between the re-
search team and the Zuni-Stanford Commit-The AILS has been featured as an ef-
fective suicide prevention program for rural tee, it required ongoing reports about the
intervention, its related evaluation activities,American Indian communities in the Insti-
tute of Medicine of the National Academies’ and its results to the tribal council and to the
school board. There were also formativereport, Reducing Suicide: A National Imperative
(Goldsmith et al., 2002). Its inclusion in this evaluations of the ZLS conducted by tribal
educators and students (LaFromboise &report was based on a program evaluation at
the Cherokee Nation in Tahlequah, Okla- Howard-Pitney, 1994).
However, the field of prevention is di-homa, where there was a reversal of the Se-
quoyah High School’s 20-year suicide rate, vided about whether culturally-adapted in-
terventions are more effective than genericwith zero deaths by suicide recorded since the
AILS was implemented in the late 1980s. interventions when applied to ethnic minor-
ity populations. A number of researchersMiddlebrook, LeMaster, Beals, Novins, and
Manson (2001) noted that the AILS was have noted relatively limited success when
trying to involve ethnic minorities in generic,unique as a program that used risk and pro-
350 Zuni Life Skills Development Program
but evidence-based, prevention programs These authors have subsequently advocated
for phased intervention procedures that allow(Bernal & Scharron-Del-Rio, 2001; Dent,
Sussman, Ellickson, Brown, & Richardson, for post-intervention modifications of ge-
neric programs. They suggest that further1996; Turner, 2000). They suggest that ge-
neric interventions appear irrelevant or inac- evaluation of the generic intervention for
cultural appropriateness should be conductedcessible to individuals from communities that
strongly identify with their cultural heritage. by expert members of the target cultural
group (Kumpfer, Alvarado, Smith, & Bel-The movement to put generic, tested inter-
ventions into practice, including a mandate lamy, 2002).
In essence, the iterative process of in-that programs funded by the Substance
Abuse and Mental Health Services Adminis- tervention modification with both generic
and culturally-tailored interventions alreadytration (SAMHSA) select interventions from
lists of evidence-based practices in its registry occurs in the field. Once an evidence-based
intervention is adopted by a school or com-of effective programs, is seen by many Amer-
ican Indians as yet another stringent imposi- munity, it is often modified to respond to
pressing issues and preferred modes of inter-tion placed on them by the federal govern-
ment. acting within the local context. The extent
of local cultural tailoring depends upon theBotvin and his colleagues attempted to
address this issue in their studies of the effec- interest, energy, and degree of traditional
involvement of members of the field curricu-tiveness of both culturally-focused and ge-
neric skills-training approaches to alcohol lum team. Adaptations range from surface
level modifications to versions based on care-and drug abuse prevention among ethnic mi-
nority adolescents. They compared the two ful analysis of the deeper structural cultural
tenets underlying each phase of the interven-prevention approaches and found that both
programs influenced mediating variables as- tion. Unfortunately, these locally modified
forms of intervention are rarely subjected tosociated with non-drug use more than the
information-only control group (Botvin, the rigor of the evaluation standards on
which the empirically validated version wasSchinke, Epstein, & Diaz, 1994). In a 2-year
follow-up study, they found that adolescents endorsed.
in both a culturally-focused and a generic in-
tervention approach had less current alcohol
use and lower intentions to engage in future FURTHER CONSIDERATIONS
alcohol use relative to adolescents in the con-
trol group. Adapting the program for a specific The opportunity for the authors to re-
flect on this community-initiated suicide pre-ethnic group led to lower levels of risk-taking
among students in the culturally-focused in- vention effort has been helpful in several im-
portant ways. The emotional distance createdtervention group compared to students in the
generic skills intervention group (Botvin, by time and space allowed us to think
through some of our original assumptions re-Schinke, Epstein, Diaz, & Botvin, 1995).
This finding points to the potential effective- garding the long-term implementation of the
ZLS. We learned that tribal and commu-ness of tailoring interventions to specific
populations. nity leaders assumed that prevention strate-
gies and intervention activities would con-Kumpfer and her colleagues posited
that culturally-adapted prevention programs tinue to be effective without monitoring sup-
port, after apparent successes, but programswould substantially improve engagement and
acceptance, leading to better involvement of were adversely affected by changes in leader-
ship. We discovered that advocacy for pro-ethnic communities in the intervention.
However, participants in culturally-adapted gram development, application, and institu-
tionalization should not depend upon a fewprograms only slightly improved on out-
comes (Aktan, Kumpfer, & Turner, 1996). individuals or agencies, especially when the
LaFromboise and Lewis 351
prevention of suicide is a vital concern the intervention unless parents were mem-
bers of the school board, school staff, or thethroughout the tribal community. We as-
sumed that the tribal community and school tribal council. Parental involvement was also
necessary to ensure cultural compatibilityleadership would initiate appropriate public
policy and procedures to continuously moni- and longevity of the prevention effort given
the importance of the family in Zuni culture.tor, support, and enhance the program as
well as strengthen the community’s capacity Perhaps if more Zuni parents had had the
opportunity to discuss positive parentingto address suicide needs and concerns. How-
ever, given the widely-held misperception by practices and become familiar with the con-
tent of the ZLS, they would have felt lesstribal/community and school leadership that
the suicide problem had been solved, neces- threatened by the insinuations that students’
family situations were to blame for their be-sary policy recommendations for commu-
nity-wide coordination and resource sharing havior. The research team should have re-
ported the evaluation findings to parentdid not occur. In addition, the tribal council
and community leadership did little to create groups who were not able to attend Zuni
School Board meetings. We can only specu-systemic approaches to maintain vigilance or
create second-level strategies to address the late about what might have happened if par-
ents had advocated for the continuation ofrelated causes of family and community vio-
lence. the program after the disruption in school
leadership.Interventions within tribal communi-
ties must include important protocols associ- The intervention was found to have a
positive impact on hopelessness (as measuredated with cultural resources, indigenous val-
ues, and healing practices. The reliance on by the Beck Hopelessness Scale; Beck, Weiss-
man, Lester, & Trexler, 1974), suicidal ide-evidence-based practices to address tribal
youth suicide needs may narrow family and ation (as measured by the Suicide Probability
Scale; Cull & Gill, 1988), and students’ abil-community options and neglect valuable cul-
tural resources found within tribal communi- ity to intervene in a peer suicidal crisis situa-
tion (as determined by the behavioral studyties, particularly in those that still maintain a
strong cultural and traditional base. The reported in LaFromboise & Howard-Pitney,
1995). These results only partially confirmedidentification and inclusion of traditional
healers has often been marginalized among the original cultural hypothesis: that Zuni
youth were engaged in fatal suicidal behaviorresearchers and interventionists who come to
tribal communities to work on issues of sui- due to rising levels of hopelessness and de-
creased involvement in cultural traditions,cide. The absence of this important cultural
resource sends mixed messages to commu- which in turn was associated with increased
family fragmentation and economic hardship.nity members who depend on traditional
healers for ongoing healing services, and di- This cultural hypothesis was tested in an
analysis of risk factors for suicidal ideationminishes the value of such a critical resource.
Although tribal cultural resources were an in- using data collected during the baseline as-
sessment. Traditionality (as defined by thetegral aspect of the ZLS, traditional heal-
ers should have been asked to participate fur- Zuni tribal council on a 10-item scale avail-
able from the first author) was not found tother, to support the appropriate community
infrastructure, and to help develop the capac- be a risk factor for suicidal ideation (Howard-
Pitney et al., 1992). More intensive efforts atity of the community for responsibility and
self-reliance in suicide prevention. improving this measure for the final evalua-
tion should have occurred, given the salienceAlthough the parents of Zuni High
School students were updated about the pro- of traditionality in Zuni culture. The con-
structs of enculturation and family cohesiongram on a regular basis and were invited to
celebrate their child’s completion of the pro- were not assessed in this evaluation. How-
ever, measures of enculturation have beengram, family members were not included in
352 Zuni Life Skills Development Program
subsequently developed for studies with and advocacy for capacity development.
While there is a strong sense of urgency toother tribes (Whitbeck, McMorris, Hoyt,
Stubben, & LaFromboise; 2002), and could address the critical needs and issues of suicide
within the American Indian community con-serve as a useful model in this regard. The
measurement of family cohesion, deemed too text, there are many community and tribal
relationships and protocols that must be con-personal for inclusion within this study, may
have further informed the cultural hypothesis sidered in any mobilization effort to address
suicide. Often it takes quite a bit of time totesting. Thus the process of confirming, dis-
confirming, and reconfirming cultural hypoth- bring people, agencies, and resources to-
gether, which may leave researchers with theeses was limited in this research and may
have left important community stakeholders impression that there is little active concern
on the part of tribal leaders and communitywanting more.
members. In terms of tribal capacity for de-
velopment and effective intervention, tribal
leadership must take the initiative and re-
CONCLUSION sponsibility for promoting public policy that
will enhance community-wide responsibility
for the elimination of suicide within Ameri-One of the tenets in community-based
research is to intervene, yet to wait for can Indian communities. In terms of inter-
vention development and outcome researchchange in order not to interfere. This sug-
gests that the researcher must seek guidance to support intervention effectiveness and va-
lidity, researchers must intervene in the mostfor the development and application of inter-
ventions from tribal/community leaders and professional and culturally competent man-
ner possible. To do less on either part is aother resource people. Local people are often
best positioned to know the community dy- serious disservice to tribes and to the field of
mental health.namics and needs, and can provide leadership
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