Background
The Qungasvik (kung-az-vik) 'Toolbox' is a multilevel strength- based intervention developed by Yup'ik communities to reduce and prevent alcohol use disorder (AUD) and suicide in 12-18 year old Yup'ik Alaska Native youth. The intervention aims to increase strengths and protections against AUD and suicide by focusing on culturally meaningful 'reasons for sobriety' and 'reasons for life.' The intervention itself is based on a Yup'ik indigenous theory- driven implementation model. A manual of operations describes the community level cultural implementation process along with specific prevention activities along with specific prevention activities that the communities choose from and adapt to their local cultural context. The Qungasvik (Toolbox) prevention approach was developed in two remote Yup'ik communities in southwest Alaska. Through collaboration with university researchers the intervention has scaled-up to include an additional four communities as part of a prevention trial to assess the feasibility and efficacy of the approach using culturally and community tailored outcomes measures.
Methods
A distinguishing feature of the Qungasvik intervention is that it was community initiated, with researchers becoming involved by invitation of a community already engaged and mobilized to address the suicide and alcohol problems by leveraging local resources and supports. Following from what our team had learned about Yup'ik Alaska Native social history and the legacy of colonization, we identified several steps as critical to our community based participatory research (CBPR) approach that included our need to:
- Understand our place in the social history of the community
- Work through the Tribal council, Elders, and local leaders
- Recognize strengths and resources at the local level
- Identify settings in the community where research and intervention can potentially or already does take place
- Understand from the local, cultural perspective who represents the community and how decisions are made and
- Develop a communication and collaboration plan that involves community members and the researchers in a process of information and knowledge sharing that is bi-directional, locally accessible, and indigenous rather than imposed to the greatest extent possible.
Qasgiq (Communal House) Model
Translating Traditional Cultural Knowledge & Practices into Health Interventions
Traditional Qasgiq
In traditional Yup’ik culture the qasgiq (ph: kawz-gik), or “men’s house/communal place,” was a central structure in the community, connecting everyone together as one. It was a place for education, ceremony and healing. The Qasgiq Model builds on existing infrastructure, expertise, and programming from within the community in order to involve culturally meaningful settings and create new ones through a locally controlled process.
Yup’ik Indigenous Theory-Driven Intervention Implementation Model
Community comes together in the qasgiq: includes all key resources: elders, parents, youth, agency partners, tribal, city and corporation leaders and university researchers. Traditional Yup’ik values and practices are identified and key people chosen to lead the activities.
Youth between the ages of 12-18 years and their parents are involved in a set of culturally-based activities designed to increase reasons for life and to change young people’s attitudes and perspectives on alcohol. Youth, Elders and community members return to qasgiq to reflect on the activities and determine how the process is working.
A work group involves the community Elders, adult and youth who plan out the process for building strengths and protections for youth through engagement in the traditional Yup’ik activities. Youth, Elders and community members assess progress towards outcomes by tracking movement in a Yup’ik cycle of healing and development.
Outcomes are achieved through a successful community-driven process that moves youth and families towards greater interdependence.
Qasgiq Today
In contemporary Yup’ik culture the qasgiq serves as:
- A communal gathering place.
- An organizational structure for community leadership and decisionmaking.
- A setting for the delivery of community prevention services and activities.
- As a primary vehicle for conducting community-based participatory research (CBPR) locally.
People gather in the qasgiq to share knowledge and plan activities that build strength and protections in youth.
Cultural Prevention Activities Deliver Protective Experiences
RESULTS: Protective factors at the individual, family and community provide speci c, measurable prevention and health promotion program target variables. Prevention strategies include:
- Providing experiences that mitigate risk and contribute to resilience.
- Enhancing relational supports for youth in families; facilitating strategies to connect youth with cultural and social resources to solve problems, cope with stress and create a sense of purpose and belonging.
Ultimate outcome variables show protection from suicide and alcohol risk are part of a co- occurring process.
CONCLUSIONS: Development and evaluation of a cultural model of intervention involves:
- Identifying key processes and practices that represent dimensions of culture in a Yup'ik community context that contribute to personal and collective growth, protection and wellbeing
- Bridging historical cultural frames with contemporary contexts to create healthy relationships with the past for Indigenous youth in the Arctic.
- Adapting and developing measures to assess outcomes of a community-driven, culturally- grounded and indigenous theory-driven intervention.
ACKNOWLEDGMENTS: This work is supported by grants through the National Institutes of Health (NIAAAA R01AA11446, Dr. Gerald Mohatt, PI; NIAAAA R211AA016098, Dr. James Allen, PI; NIAAA R21AA01554, Dr. Gerald Mohatt, PI; NIMHD R24MD001626, Dr. Stacy Rasmus &Dr.JamesAllen,MultiplePIs;NIAAA R01AA023754,Dr.StacyRasmus &Dr.James Allen, Multiple PIs. Additional NIH grant support is provided by the Center for Alaska Native Health Research.
Project Collaborators:
Stacy Rasmus, Principal Investigator (UAF lead)
James Allen, Principal Investigator (University of Minnesota Medical School, Duluth)
Billy Charles, Co-Investigator
Cyndi Nation, Prevention Director
Jennifer Nu, Research Director and Technical Assistance Coordinator
Jorene Joe, Community Research and Evaluation Coordinator
Simeon John, Regional Prevention Coordinator
Dhara Shah, Graduate Research Assistant
Prior Research
Development of Research Informed Prevention for Youth based on Yup'ik Cultural Knowledge and Community Practices
People Awakening Project
(R01AA11446 NIAAA/NIMHD)
Cuqyun (Measurement)
(R21AA016098 NIAAA)
Ellangneq (Awareness)
(R24MD001626-1 NIMHD)
People Awakening Resilience Project
(R21AA015541 NIAAA)
Elluam Tungiinun (Towards Wellness)
(R24MD001626-4 NIMHD)
Qasgiq (Communal House)
(R24MD001626-8 NIMHD)
Qungasvik (Toolbox)
(R01AA023754 NIAAA/NIMH/NIGMS-IDeA)
Translating Intergenerational Strengths and Indigenous Knowledge into Practices to Prevent and Heal from Suicide and Substance Misuse
Key References
Ayunerak, P., Alstrom, D., Moses, C., Charlie, J., & Rasmus, S. M. (2014). Yup'ik Culture and Context in Southwest Alaska: Community Member Perspectives of Tradition, Social Change, and Prevention. American Journal of Community Psychology, 54(0), 91–99. http://doi.org/10.1007/s10464-014-9652-4
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