Methods: The Iowa Strengthening Families Program for Parents and Youth 10-14 (SFP 10-14) was adapted through an iterative process with community advisors and program developers, creating the Thiwáhe Gluwáš’akapi (TG; “Strengthening Families”) program. Cultural kinship teachings were incorporated, reinforcing messages about family connections, roles, and responsibilities. Using MOST, three additional adaptations were explored: (1) tribal language for kinship terms; (2) Facebook groups to reinforce program messages, and (3) removing substance use session.
The TG program was implemented with 20 groups of families (N=141 families, 220 adults, 193 youth) in 12 rural communities around a Northern Plains reservation, from September 2015 to December 2017. Intervention groups were randomly assigned to MOST conditions. Up to 2 adults and 2 youth per family were surveyed: Baseline (1-2 weeks prior to program), post-program (1-2 weeks after program), and follow-up (6 months after program).
Results: Baseline surveys were completed by 197 adults and 170 youths. The majority of adults (73%) were female and ages ranged from 19-78 (M=40.3, sd=10.8). Fifty percent were mothers of participating youth; 17% fathers; and 12% grandmothers. Among youth, 47% were female; average age was 11.6 (sd=1.3); and grade level ranged from 4-9. Most youth (84%) reported getting As or Bs in school; 84% were participating with their primary female caretaker and 39% with their primary male caretaker. Data collection will be complete in January 2018, and outcome analyses will be presented.
Conclusions: This study leveraged prevention science and cultural traditions to develop an early substance use prevention program for AI youth and families, helping to fill a significant gap in resources for addressing developmental risk in this population. Utilization of the MOST design enabled a strategic approach to evaluating program components and refining the intervention for future implementation, but not without costs. Challenges with the MOST design in a complex, community-based intervention will be discussed, including maintaining fidelity with multiple versions of the program implemented concurrently.