# Southwest Hub for American Indian Youth Suicide Prevention Research

> **NIH NIH U19** · JOHNS HOPKINS UNIVERSITY · 2021 · $540,293

## Abstract

PROJECT ABSTRACT
The research component of the Southwest Hub will identify effective, feasible and sustainable
interventions to prevent suicide and promote resilience among American Indian (AI) youth building on
20+ years of partnership between the Johns Hopkins Center for American Indian Health (CAIH), the
White Mountain Apache Tribe (WMAT) and Navajo Nation (NN). The foundation of these partnerships is
tribally-mandated surveillance for early identification, and follow-up and case management to connect
at-risk youth to treatment after a recent suicide attempt, ideation or binge substance use episode. In
addition, we have been designing and piloting brief interventions informed by local tribal data. Two such
interventions were selected to be evaluated in sequence by our Suicide Prevention Study. Both employ
Native paraprofessionals as a means of task-shifting much-needed psychoeducation and promoting
continuity of care in under-resourced communities. The first intervention, New Hope (NH), is an
evidence-based first-stage strategy delivered by paraprofessional community mental health workers
(CMHWs) focused on reducing immediate suicide risk through safety planning, emotion regulation skills,
and facilitated care connections. The second, the Elder’s Resilience (ER) intervention, is a longer-term
strategy delivered by Elders with support from CMHWs to promote resilience by increasing youth’s
connectedness, self-esteem and cultural identity and values. Our Primary Aim is: to use a Sequential
Multiple Assignment Randomized Trial (SMART) design to evaluate which of four sequences of New
Hope (NH), Elders Resilience (ER) and Case Management (CM) has the greater effect on immediate and
longer-term suicidal ideation (primary outcome) and resilience (secondary outcome) among AI
adolescents ages 10-24 identified at risk for suicide. We hypothesize that: a) New Hope vs. Case
Management alone will significantly reduce participant suicidal ideation; b) Elders Resilience vs. Case
Management alone will significantly improve participant resilience; c) New Hope followed by Elders
Resilience will have the strongest effects on suicidal ideation and resilience; and d) Case Management
alone will have the weakest effects of all combinations. Our Secondary Aims are: 1) to examine
mediators and moderators of treatment effectiveness and sequencing in order to determine which
types and sequence of interventions is best suited for which youth; and 2) to assess the acceptability,
feasibility and capacity for sustainability of the Hub’s key intervention components with core and
satellite partners, the Navajo, San Carlos Apache, Hualapai, and Cherokee nations. Due to
heterogeneity of suicide risk factors generally and among AIAN youth, not all youth require the same
type of interventions. Generating evidence for what works, when it works and for whom is even more
paramount to AI suicide prevention efforts, where rates are currently high and resources are limited.

## Key facts

- **NIH application ID:** 10166935
- **Project number:** 5U19MH113136-05
- **Recipient organization:** JOHNS HOPKINS UNIVERSITY
- **Principal Investigator:** Mary Cwik
- **Activity code:** U19 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $540,293
- **Award type:** 5
- **Project period:** 2017-06-20 → 2024-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10166935

## Citation

> US National Institutes of Health, RePORTER application 10166935, Southwest Hub for American Indian Youth Suicide Prevention Research (5U19MH113136-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10166935. Licensed CC0.

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