Suicide, the leading cause of death in Montana American Indian (AI) youth with ages 10-18, is 7.8-fold higher than their US peers. While many suicide interventions and prevention strategies have been tested, there is still no suicide prevention or mental health resiliency intervention definitively proven effective in any youth population. The GBG is a universal behavioral intervention, which has been successful in reducing suicidality, substance/alcohol use, criminal behaviors (incarcerations), and reported mental illnesses through young adulthood in multiple countries and cultures. However, the GBG has never been rigorously assessed in Native American communities or in children before they reach first grade. We therefore propose to perform a feasibility and acceptability study of an age- and culture-modified GBG in preschool AI children enrolled in Head Start on the Blackfeet Reservation in northwestern Montana. Co-primary outcomes will be feasibility and acceptability of the modified GBG program. An exploratory outcome will be changes in behaviors using a validated instrument (TOCA-R). Results will inform a larger, follow-up randomized controlled trial of the GBG in Native American schools. The GBG represents a promising mental health resiliency and suicide intervention strategy, which, if effective, has the potential to positively affect the life-course of AI youth.

Specific Aims

Aim 1. Modify the GBG to incorporate AI beliefs, values, and customs, and age-appropriate content.

  1. Review and discuss GBG materials and approaches with the CAB, coach, and Head Start faculty.
  2. Revise GBG materials and approaches based on recommendations of the community members participating in step a.
  3. Perform steps a) and b) iteratively until group agreement is achieved.
  4. Present a draft of the AI-GBG to the Blackfeet community for consideration in a town hall meeting.
  5. Incorporate revisions (step d) to form a final AI-GBG protocol, and submit amendment for IRB approval.

Aim 2. Conduct a pilot trial of the AI-GBG in preschool-age Blackfeet children to assess feasibility, acceptability, and short-term behavioral efficacy.

  1. Evaluate feasibility (co-primary outcome) of implementing the AI-GBG in Head Start by rates of teacher and youth enrollment, and completion of scheduled intervention sessions and assessments.
  2. Assess teacher adherence to the AI-GBG using fidelity measures.
  3. Ascertain acceptability (co-primary outcome) of the AI-GBG intervention through anonymous questionnaires administered to parents, teachers, and Head Start staff.
  4. Perform an exploratory evaluation of the efficacy of the AI-GBG on short-term behavioral outcomes (teacher evaluations of children’s aggressive, bullying, or disruptive behaviors using the validated Teacher Observation of Child Adaptation – Revised (TOCA-R) instrument’s “Authority Acceptance” subscale).

Aim 3. Explore novel models for sustainable delivery of the AI-GBG in AI schools.

  1. Discuss addition of teacher and coach GBG training as part of the Behavioral Health Aide Certificate program at Blackfeet Community College.
  2. Identify Tribal Extension faculty working in tribal communities who could perform GBG coaching functions as part of their regular work activities.

The successful completion of our three Aims will generate the critical feasibility and acceptability data and preliminary data on behavioral changes to inform a next-step, large-scale RCT to test short-term efficacy of the AI-GBG in AI youth. Additionally, the project contributes to the growing foundation for performing research in collaboration with the Blackfeet community. Lastly, and most importantly, if effective, the implementation of the GBG will promote the mental health of children in the Blackfeet and perhaps other tribal nations.


Janet Lindow janet.lindow@montana.edu