Lessons from the Field: Implementation of a Culturally-Adapted Early Substance Use Prevention Program with American Indian Youth and Families on a Northern Plains Reservation

Introduction: Early initiation of substance use among American Indian (AI) youth is associated with poor outcomes both in adolescence and adulthood, and early prevention efforts are imperative. Efforts to delay use and thus reduce risk, however, have met with limited success. Recent efforts to translate evidence-based programs for AI communities hold promise for leveraging both culture and prevention science for effective intervention, but must consider the need for adaptations both program content (the mechanisms of change addressed) and program context (the social validity of the program within the local context). This paper will describe the implementation of a carefully adapted evidence-based program (the Iowa Strengthening Families Program for Parents and Youth 10-14; SFP 10-14) and the challenges to implementation that suggest further attention to social and cultural validity of the context of implementation is warranted.

Methods: Twenty intervention groups (5 cohorts) and 2 pilot groups (1 cohort), each consisting of 4-10 families (middle school youth and their parents and other caretakers) living in 12 communities on a Northern Plains reservation, have received the adapted SFP 10-14 program, Thiwáhe Gluwáš’akapi. The intervention is led by field staff embedded within the community, most of them tribal members. Process data on recruitment and retention for the first five cohorts (including the pilot) are presented here (the final cohort will receive the intervention in the fall of 2017).

Results: Several challenges to participant engagement were encountered. These included logistical problems in identifying appropriate venues and times for recruitment, interruptions in program delivery due to school events and significant incidents in the community that impacted families, and inconsistent program attendance due to lack of transportation or child care and difficulties arranging to provide either as a part of the research study. We will discuss a variety of strategies implemented to address these challenges, both those that met with some success and those that proved unfruitful. Field staff perspectives on the social and cultural validity of approaches to recruitment, retention, and engagement will be discussed.

Conclusions: This study used process data from an evaluation of an adapted evidence-based family program to highlight the need to consider not just the fit of the program per se but also the feasibility of implementation within the complex cultures and contexts in which it will be implemented. Lessons learned here can inform both the adaptation of interventions in other contexts and the creation of implementation strategies within AI communities.