Facilitators and Barriers to Implementing a Community Suicide Database and Prevention Program in Diverse Tribal Communities

Meredith Stifter (), Novalene Goklish, Charity Watchman, Kristin Mitchell, Jennifer Duncan, Michelle Miller, Mary HorseChief, Christopher G. Kemp, Mary Cwik and Emily E. Haroz
Additional contact information
Meredith Stifter: Johns Hopkins Center for Indigenous Health, 415 N. Washington St., Baltimore, MD 21231, USA
Novalene Goklish: Johns Hopkins Center for Indigenous Health, 415 N. Washington St., Baltimore, MD 21231, USA
Charity Watchman: Johns Hopkins Center for Indigenous Health, 415 N. Washington St., Baltimore, MD 21231, USA
Kristin Mitchell: Johns Hopkins Center for Indigenous Health, 415 N. Washington St., Baltimore, MD 21231, USA
Jennifer Duncan: San Carlos Apache Tribe, Life Is Precious, 203 Medicine Way Rd., Peridot, AZ 85542, USA
Michelle Miller: Hualapai Tribe, Behavioral Health, 488 Hualapai Way, Peach Springs, AZ 86434, USA
Mary HorseChief: Cherokee Nation, Tahlequah, OK 74464, USA
Christopher G. Kemp: Johns Hopkins Center for Indigenous Health, 415 N. Washington St., Baltimore, MD 21231, USA
Mary Cwik: Johns Hopkins Center for Indigenous Health, 415 N. Washington St., Baltimore, MD 21231, USA
Emily E. Haroz: Johns Hopkins Center for Indigenous Health, 415 N. Washington St., Baltimore, MD 21231, USA

IJERPH, 2024, vol. 21, issue 12, 1-12

Abstract: Suicide is the second leading cause of death for American Indian youth, far surpassing the rates of suicide experienced by other races. The White Mountain Apache Tribe has made significant impacts on suicide risk by implementing a robust suicide prevention program which includes a community-led database and case management follow-ups. Due to the success of the program in preventing suicides, the White Mountain Apache team has worked with other tribal communities to adapt the program. We wanted to understand the factors that are most important to implementing and sustaining this model and how these factors compare with existing implementation science frameworks. We employed an adapted nominal group technique to compile facilitators and barriers to implementation of the suicide prevention model across settings with five partner teams. Two researchers independently coded the resulting list of facilitators and barriers using the Consolidated Framework for Implementation Research (version 1.0) codebook. The final list of cross-site prioritized facilitators and barriers included 41 factors. Some factors did not match easily with the framework’s constructs. The White Mountain Apache suicide prevention team noted that seven of the top prioritized factors are considerations they most try to emphasize to new communities working in suicide prevention. The factors fall into two key themes: staffing and tribal engagement. This finding affirms their focus when they conduct suicide prevention trainings with new communities and provides an opportunity for more structure and in-depth training in those two areas. Several factors could not be easily coded to the framework, especially around the sociocultural characteristics of suicide prevention work in Native communities. This contributes to the larger discussion in implementation science concerning the ways in which Indigenous approaches to public health differ from Western models.

Keywords: American Indian; suicide prevention; implementation science; mental health; suicidal behaviors; native American (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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