Promoting ethical research with American Indian and Alaska Native people living in urban areas.

Most health research with American Indian and Alaska Native (AI/AN) people has focused on tribal communities on reservation lands. Few studies have been conducted with AI/AN people living in urban settings despite their documented health disparities compared with other urban populations. There are unique considerations for working with this population. Engaging key stakeholders, including urban Indian health organization leaders, tribal leaders, research scientists and administrators, and policymakers, is critical to promoting ethical research and enhancing capacity of urban AI/AN communities. Recommendations for their involvement may facilitate an open dialogue and promote the development of implementation strategies. Future collaborations are also necessary for establishing research policies aimed at improving the health of the urban AI/AN population.

The Culture is Prevention Project: Adapting the Cultural Connectedness Scale for Multi-Tribal Communities.

The Culture is Prevention Project is a multi-phased communitybased participatory research project that was initiated by six urban American Indian and Alaska Native (AI/AN) health organizations in northern California. Issues driving the project were: i) concerns about the lack of culturally informed or Indigenous methods of evaluating the positive health outcomes of culture-based programs to improve mental health and well-being; and ii) providing an approach that demonstrates the relationship between AI/AN culture and health. Most federal and state funding sources require interventions and subsequent measures focused on risk, harm, disease, and illness reduction, rather than on strength, health, healing, and wellness improvement. This creates significant challenges for AI/AN communities to measure the true impact of local strength and resiliency-based wellness programs. This paper focuses on the methods and results from Phase 3 of the Culture is Prevention Project where we adapted the 29-item Cultual Connectedness Scale (CCS), developed in Canada, to be appropriate for California's multi-tribal communities. The resulting new Cultural Connectivity Scale - California (CCS-CA) was developed by urban AI/AN people for urban AI/AN people. The process, instrument, how to adapt for your community, and implications are reviewed.

Online role-play simulations with emotionally responsive avatars for the early detection of Native youth psychological distress, including depression and suicidal ideation.

Gatekeeper training is a widely used prevention method for training local community members to recognize the signs and symptoms of suicide and to support appropriate referrals for mental health. Training community "gatekeepers" is critical for increasing access to care for those youth who are in need, as youth often turn first to family and friends for help. This study examines the outcomes at pre-training, post-training, and 3-month follow-up for American Indian and Alaska Native (AI/AN) students, teachers, and faculty completing online role-play gatekeeper training simulations. The simulations use emotionally responsive avatars that have memory and personality, and respond like real students experiencing psychological distress in realistic situations. Data from 86 matched pairs showed significant increases in self-identified gatekeeper attitudes of preparedness, likelihood (behavioral intent) and self-efficacy to engage in helping behaviors (i.e., identifying those in psychological distress, talking to them, and supporting a referral for services) 3 months after training. This study provides promising evidence for use of online avatar-based training with AI/AN communities and has the potential to address many of the current challenges with gatekeeper training in Indian Country.

Indigenous youth-developed self-assessment: The Personal Balance Tool.

The Fresno American Indian Health Project (FAIHP) Youth Council developed and pilot tested a strength-based, holistic, and youth-friendly self-assessment tool grounded in the Medicine Wheel, a framework and theoretical orientation for teaching wellness in many tribal communities. This paper summarizes the development of the Youth Personal Balance Tool and the methods used for tool revisions through two separate pilot studies and ongoing process evaluations across 3 years. Using a community-based participatory evaluation model, FAIHP leveraged community resources to implement an annual youth Gathering of Native Americans to support youth in healing from historical and intergenerational trauma and restoring communities to balance by making them a part of the solution. This tool is one of many outcomes of their work. The Youth Council is offering the tool as a gift (in line with the cultural value of generosity) to other Indigenous communities that are searching for culturally competent self-assessment tools for youth. The authors believe this tool has the potential to progress the field in strength-based, holistic, youth-friendly assessment as a culturally competent method for Indigenous evaluation and research.

ADHD Symptoms in American Indian/Alaska Native Boys and Girls.

Despite the commonality of attention-deficit/hyperactivity disorder (ADHD), the diagnostic criteria are based largely on research with European American boys. Much less research is available regarding the prevalence of ADHD in other groups, specifically American Indian/Alaska Native (AI/AN) children. Moreover, research on sex differences in ADHD has typically not included AI/AN children. The current study examined parent- and teacher-reported ADHD symptoms in 72 AI children from one region in the Southern U.S., with a focus on sex differences. Data showed that AI children may have more pronounced sex differences in ADHD symptomology than is found in studies with primarily European American children. Implications, limitations, and future directions are discussed.

Event-related potential and behavioral measures of attention in 5-, 7-, and 9-year-olds.

In 2 experiments, the development of auditory selective attention in children was assessed. The participants, aged 5, 7, and 9 years, responded to target stimuli in the left ear for 1 series (ignoring the standard stimuli) and in the right ear for the other series. In Experiment 1, event-related potentials (ERPs) evoked by the auditory stimuli were recorded from frontal, central, and parietal sites. The 9-year-olds showed a greater processing negativity (Nd) to the attended channel compared with the 5-year-olds. Both 7- and 9-year-olds showed significantly larger amplitudes for the P3 component of ERPs in the attended vs. ignored condition. Behaviorally, the 5-year-olds made fewer hits and more false alarms than did older children, and the 9-year-olds made significantly more false alarms than did the 7-year-olds. The results of Experiment 2 showed that the detriment in the performance of the 9-year-olds was a result of task parameters. The inability of 5-year-olds to attend selectively appears to involve problems with the inhibition of the processing of irrelevant information and with selection of the correct response.

Rethinking the systems of care definition: an indigenous perspective.

This paper will describe systems of care as a cultural phenomenon by highlighting western versus indigenous models of thinking. Inherent within the system of care definition are biases and assumptions that result in a highly linear and culturally bound process for understanding a "reality" that is not necessarily shared by all. Overarching concerns include value-laden language, the development of the systems of care principles, and the conceptualization of the changing definitions over time. Within the definition of systems of care presented, there are biases and embedded assumptions that continue to cause disparities in health for culturally diverse communities. The paper will examine these cultural biases and assumptions and their link to access, availability, and acceptability of services.

Urban Indian voices: a community-based participatory research health and needs assessment.

This community-based participatory research (CBPR) project utilized a mixed-methods survey design to identify urban (Tulsa, OK) American Indian (AI) strengths and needs. Six hundred fifty AIs (550 adults and 100 youth) were surveyed regarding their attitudes and beliefs about their community. These results were used in conjunction with other community research efforts to inform program development, support proposals for external funding, and develop a comprehensive service system model to be implemented in the community.

Contrast sensitivity in children with and without attention deficit hyperactivity disorder symptoms.

Dopamine regulation may play a role in attention-deficit hyperactivity disorder (ADHD). Visual contrast sensitivity has been proposed as a measure of retinal dopamine that may predict frontal lobe dopamine levels. Individuals with disorders involving dopamine dysregulation (e.g., Parkinson's disease, Phenylketonuria) have shown poor contrast sensitivity. In this study, 110 6- to 13-year-old children with and without ADHD completed a task measuring visual contrast sensitivity. As predicted, contrast sensitivity was significantly worse in children with ADHD-Combined Type than controls. Contrast sensitivity was significantly correlated with inattention and hyperactivity. However, unlike many neuropsychological studies of ADHD, only hyperactivity accounted for unique variance.