Care packages to promote universal suicide prevention for remote Alaska Native communities: What worked?

Promoting Community Conversations About Research to End Suicide (PC CARES) is a community health program that trains local facilitators to share research-based insights to spark multi-sector and multi-level collective action for Alaska Native youth wellness. During the COVID-19 pandemic, the PC CARES research team had to pivot away from in-person gatherings. Guided by expert feedback from a Local Steering Committee (LSC), the team implemented a distance-delivered approach that included:

1) Virtual PC CARES Learning Circles and

2) PC CARES at Home Care Packages.

This paper explores the development and acceptability of PC CARES at Home, which equipped community members with care packages containing health-promoting education (e.g., CDC recommendations for well-being), activities (e.g., conversation cards), and resources (e.g., snacks and stickers) adapted from the PC CARES curriculum.

The PC CARES LSC guided the creation of the care packages, ensuring they were culturally responsive and aligned with regional priorities. Originally, packages were shipped to PC CARES facilitators, who had been trained pre-pandemic, for them to distribute around their communities. Later, recipients also included virtual PC CARES participants, LSC members, and community members nominated by existing recipients. Overall, 1527 care packages covering 10 different themes were sent to 492 recipients across 34 communities in Alaska from June 2020 to July 2022.

To evaluate how acceptable and useful these care packages were, both participant surveys and phone interviews were conducted. Paper surveys (N=208) were included in the care packages and assessed participant experiences through satisfaction ratings and open-ended questions. Actions and activities participants could take after receiving the care packages, like joining the PC CARES Facebook group, were also accounted for in the survey. Participant phone numbers were randomly contacted for 15-20 minute user experience phone interviews (N=24), which followed a semi-structured interview guide evaluating satisfaction and takeaways from the care packages.

A vast majority of survey respondents and interviewees expressed satisfaction with the care packages, underscoring the importance of centering community voices and local priorities in developing acceptable and feasible culturally responsive interventions. In addition, the care packages built on the PC CARES Learning Circles that had already occurred in communities by reinforcing wellness self-efficacy and tangibly reducing barriers to health promotion action (e.g., one care package included a lockable medication pouch to safely store lethal means). Overall, PC CARES at Home was a novel upstream suicide prevention intervention that effectively equipped trusted adults in remote communities with culturally appropriate tools to take action for the youth in their lives.

Download the full article here.

Kennedy, J., Wexler, L., Schmidt, T., Rataj, S., Garnie, J., Moto, R., Tao, Z., White, L., & McEachern, D. (2025). Care packages to promote universal suicide prevention for remote Alaska Native communities: What worked?. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association, 41(2), e70032. https://doi.org/10.1111/jrh.70032

Want to learn more?

Get a glimpse into our report back to communities on lessons learned from PC CARES at Home.

Check out how we adapted PC CARES Learning Circles virtually during the pandemic.

Considering the importance of 'Communities of Practice' and Health Promotion Constructs for Upstream Suicide Prevention

Taking a public health approach to suicide prevention is vital to addressing the systemic factors that contribute to the high rates of suicide among AIAN youth. This requires mobilizing resources and strategies across the spectrum of prevention. In this paper, we highlight how developing collaborative relationships for suicide prevention (Communities of Practice, or ‘CoP’) and self-efficacy for wellness promotion and suicide prevention can advance multi-sector community actions for upstream prevention. 

Linking Communities of Practice and Self-Efficacy to Suicide Prevention

We examine and describe the connections between community members’ perceived self-efficacy, community of practice, and actions taken for prevention, considering the different roles different people play in their communities. This involved analyzing survey data from 398 participants over the age of 15 from five remote AN communities, collected through our community-based participatory study on PC CARES (Promoting Community Conversations About Research to End Suicide). 

We looked at how participants’ self-perceptions about their ability to promote wellness (wellness self-efficacy) and prevent suicide (prevention self-effiacy) affect their actions taken for wellness and prevention. We also examined how having a community of practice influences the types of promotion and prevention actions taken. Here are some findings in this article:

Collaborative Capacity Drives “Working Together” Behaviors

Participants who felt more well-equipped to support wellness (wellness self-efficacy) and who had others in the community they could work with for wellness and prevention (CoP) reported taking more collaborative actions to prevent suicide and promote health (“working together” behaviors). 

Confidence Sparks Supportive Actions

Participants with higher wellness self-efficacy and prevention self-efficacy took actions to offer support to someone going through a hard time (“interpersonal support” behaviors). 

Strength in Community for Postvention

Having prevention self-efficacy and a community of practice were linked to more actions taken to create healthy community spaces to grieve and process after a suicide death (“postvention” behaviors). 

Prevention Self-Efficacy and Lethal Means Reduction

Among participants with high prevention self-efficacy, more actions related to restricting access to lethal means, like medications and firearms, were reported (“lethal means” behaviors). 

Building on Strengths for Upstream Impact

These results expand the field of suicide prevention in key ways, underscoring the importance of leveraging family, community, and cultural strengths in preventing suicide before a crisis. 

Download the full article here. 

Wexler, L., White, L., Ginn, J., Schmidt, T., Rataj, S., Wells, C. C., Schultz, K., Kapoulea, E. A., McEachern, D., Habecker, P., & Laws, H. (2025). Developing self-efficacy and 'communities of practice' between community and institutional partners to prevent suicide and increase mental health in under-resourced communities: expanding the research constructs for upstream prevention. BMC public health, 25(1), 1323. https://doi.org/10.1186/s12889-025-22465-1

Final Report on PC CARES for Northwest Alaska

Executive Summary

Developed in partnership with Maniilaq Wellness Program, Kawerak Wellness, and members of Northwest Alaska and Bering Strait communities, Promoting Community Conversations About Research to End Suicide (PC CARES) offers a clear way to address youth suicide in self-determined ways. This approach shares helpful information, but does not tell participants how they should use it. Instead, PC CARES assumes that each participant can best determine how to put the new prevention information to use.

In the first ever roll out of PC CARES in Maniilaq’s service area from 2015-2017, it shows great success! Facilitated by 23 community volunteers, PC CARES brought together 495 local people and service providers in 10 villages to participate in 64 PC CARES learning circles. Each of the 8 learning circles highlights a different piece of research aimed at sharing ‘what we know’ about suicide prevention and wellness. Participants, then, discuss how the research applies to their unique lives and communities. Importantly, the last part of each learning circle is spent considering ‘what they want to do’ for prevention and wellness within their villages and families.

Hosted by local facilitators, PC CARES learning circles were popular and worthwhile. Ten out of 11 villages implemented PC CARES, and half completed the 8-session, ~24 hour curriculum. Participants in these learning circles talked about how much they liked the model. Pre-post surveys show that PC CARES participants increased their knowledge, skills, and prevention activities after attending the learning circles. Our social network surveys, which was done with PC CARES participants and others, showed that people who are ‘close to’ PC CARES participants also learned something about prevention. These ‘close others’ did more prevention activities when compared to other community members. This finding suggests that PC CARES participants talked about what they were learning with close friends and family members, who then did more for prevention.  

With strong evidence showing significant benefits of the intervention, PC CARES is a promising and practical way to translate scientific research into community-driven, culturally responsive and suicide prevention practice that could reduce suicide risk in rural Alaska Native communities.

Download full report here.