Preliminary outcomes show the PC CARES model feasibility and social impact

The process and preliminary outcomes of the PC CARES intervention are explained and the results are presented in this study. Linked participant surveys (n=83) compared attendees’ perceived knowledge, skills, attitudes, and “community of practice” at baseline and follow-up. A cross-sectional design compared 112 participants’ with 335 non-participants’ scores on knowledge and prevention behaviors, and considered the social impact with social network analyses. Learning Circle transcripts were scored for accuracy and fidelity to the curriculum, and participants’ discussions were analyzed for understanding of the research content and application in everyday life. Social network analyses indicate PC CARES had social impact, sustaining and enhancing prevention activities of non-participants who were in close relationships with participants. These close associates were more likely take preventive actions than other non-participants after the intervention. This article concludes that PC CARES offers a practical, scalable method for community-based translation of research evidence into self-determined, culturally-responsive suicide prevention practice.

Wexler, L., Rataj, S., Ivanich, J., Plavin, J., Mullany, A., Moto, R., Kirk, T., Goldwater, E., Johnson, R., Dombroski, K. (2019). Community mobilization for rural suicide prevention: Process, learning and behavioral outcomes from Promoting Community Conversations About Research to End Suicide (PC CARES) in Northwest Alaska. Social Science & Medicine, 232, 398-407.

Linking decolonization and suicide prevention efforts

Colonialism and historical trauma have been linked to disproportionately high rates of suicide in Indigenous communities, yet traditionally suicide prevention rely on clinical, Western-style approaches that can further alienate or traumatize rural Alaskans.

PC CARES is part of an innovation in prevention practice emphasize local control through processes that utilize research evidence, but privilege self‐ determined action based on local and personal contexts, meanings, and frameworks for action. The first of nine PC CARES learning circles focuses on narratives of local people who link the contemporary youth suicide epidemic to 20th century American colonialism, and situates prevention within this context. This article describes the theoretical framework and feasibility and acceptability outcomes for this learning circle, and explains how the educational model engages community members in decolonial approaches to suicide prevention education and practice, serving as a bridge between Western and Indigenous traditions to generate collective knowledge and catalyze community healing.

Trout, L., McEachern, D., Mullany, A., White, L., & Wexler, L. (2018). Decoloniality as a framework for Indigenous youth suicide prevention pedagogy: Promoting Community Conversations About Research to End Suicide. American Journal of Community Psychology, 62, 3-4.

New method for acquiring and interpreting social network data

The method proposed in this paper, called “perceptual tomography” involves the collection of multiple reports on randomly chosen pairs of individuals, and statistical means for aggregating these reports into data of conventional sociometric form. Perceptual tomography aggregates multiple 3rd-party data on the perceived presence or absence of individual properties and pairwise relationships.

Key features of the method include its low respondent burden, flexible interpretation, as well as its ability to find “robust intransitive” ties in the form of perceived non-edges. This latter feature allows for the application of conventional balance clustering routines to perceptual tomography data. The article describes both the method and an example of the implementation of the method from the PC CARES study. Interview data from 170 community residents is used to ascribe 4446 perceived relationships (2146 perceived edges, 2300 perceived non-edges) among 393 community members, and to assert the perceived presence (or absence) of 16 community-oriented helping behaviors to each individual in the community. Using balance theory-based partitioning of the perceptual network, the researchers show that people in the community perceive distinct helping roles as structural associations among community members. The fact that role classes can be detected in network renderings of “tomographic” perceptual information lends support to the suggestion that this method is capable of producing meaningful new kinds of data about perceptual networks.

Lee, H.-W., Melson, M., Ivanich, J., Habecker, P., Gauthier, G. R., Wexler, L., Khan, B., ... Bianconi, G. (November 12, 2018). Mapping the structure of perceptions in helping networks of Alaska Natives. Plos One, 13, 11.

Success of the PC CARES training-of-trainers model detailed in International Journal of Circumpolar Health

How do the developers of PC CARES train the local leaders to deliver to the program? What skills and knowledge do facilitators gain during the 40-hour training of facilitators? How feasible is the Training of Facilitators (ToF) as a replicable program component and how can it be improved? These questions are explored in the International Journal of Circumpolar Health.

During the ToF, 32 people from 11 northwest arctic village communities prepared to implement the intervention in their home communities. Facilitators completed pre-post surveys that focused on readiness to facilitate. A group quiz assess participants’ understanding of relevant research evidence, and practice exercises demonstrated facilitator competency. To see whether facilitators were delivering the curriculum as designed, fidelity and accuracy scores were calculated using audio recordings of the learning circles by two independent raters.

Wexler, L., Trout, L., Rataj, S., Kirk, T., Moto, R., & McEachern, D. (2017). Promoting Community Conversations About Research to End Suicide: learning and behavioural outcomes of a training-of-trainers model to facilitate grassroots community health education to address Indigenous youth suicide prevention. International Journal of Circumpolar Health, 76, 1.

Explaining the theories that built PC CARES from an idea to a program that impacts lives

Combining health education and community mobilization, PC CARES is built on a transactional-ecological framework that emphasizes community and cultural protective factors in Alaska Native communities, and the multiple, interacting conditions of suicide. PC CARES extends typical suicide prevention initiatives beyond the traditional gatekeeper model and the bounds of formal clinical encounter to empower individuals, families, and communities to drive change at the local level.

Wexler, L., McEachern, D., DiFulvio, G., Smith, C., Graham, L. F., & Dombrowski, K. (2016). Creating a Community of Practice to Prevent Suicide Through Multiple Channels: Describing the Theoretical Foundations and Structured Learning of PC CARES. International Quarterly of Community Health Education, 36, 2, 115-22.