Cultural Adaption of Behavioral Activation and Therapeutic Exposure for Grief Among American Indian People - Modified Project Summary/Abstract Section The aim of the Cultural Adaptation of Behavioral Activation and Therapeutic Exposure for Grief Among American Indian People project is to collaborate with the Montana Consortium for Urban Indian Health (MCUIH) to develop an intervention program that supports American Indian individuals struggling with grief. To accomplish this goal, I will 1) conduct focus groups (5 groups of 6 people) to gain feedback on the acceptability of the Behavioral Activation and Therapeutic Exposure for Grief (BATE-G) intervention and generate possible adaptations, 2) work with community partners to adapt the BATE-G intervention in light of the focus group findings, and 3) conduct a single-group feasibility trial of the culturally adapted BATE-G telehealth intervention and study components with adult American Indian and Alaksa Native (AI/AN; N = 20) who have experienced the loss of someone close to them. The feasibility test of this culturally adapted treatment for grief delivered through telemedicine technology by community-based paraprofessionals. This project will inform future PCT R01 projects that align with and fulfill the defined missions of NIMHD, specifically promoting research to understand and improve health outcomes and developing and testing interventions to reduce adverse health outcomes. Background: Approximately 6.6% (63,493) of Montana's population identifies as AI/AN.1 The state is home to 12 federally recognized tribes, most of whom reside on seven reservations. Approximately 30-40% of AI/AN people in Montana reside in urban areas, often relying on Urban Indian Organizations (UIOs) for their health services.1 There are five UIOs in Montana affiliated with the MCUIH, and I will work with these organizations to develop a culturally grounded grief intervention and carry out the proposed feasibility trial. AI/AN populations in the United States have the highest early death rates for young people compared to other populations.1-5 High mortality rates in AI/AN communities are attributed to chronic illness, accidental injuries, interpersonal violence/homicide, and suicide. 1,5 Experiencing the sudden or unexpected death of a loved one increases the risk of developing disabling grief-related Symptoms, which can lead to Prolonged Grief Disorder (PGD).6 PGD is characterized by impairing symptoms of depression and PTSD among surviving family and friends. Importantly, research on PGD in AI/AN communities is extremely limited, and no evidence-based treatments (EBTs) have been tested with this population. This is sadly unsurprising as AI/AN people are typically underrepresented in clinical trials and are underserved with regard to evidence-based behavioral health treatments.7, 8 The intervention selected for adaptation in this study, BATE-G, was developed and evaluated with Veterans and older adults.9-12 The BATE-G intervention is a personalized intervention, specifically tailored to an individual's values, which may be particularly useful for AI/AN populations.
