American Indian and Alaska Native young adults are strong and resilient. Interventions designed to improve their mental health and help-seeking skills are especially needed, particularly those that include culturally-relevant resources and relatable role models. The multi-media BRAVE intervention was designed for American Indian and Alaska Native teens and young adults to amplify and reinforce healthy social norms and cultural values, teach suicide warning signs, prepare youth to initiate difficult conversations with peers and trusted adults, encourage youth to access mental health resources (i.e. tribal clinics, chat lines), de-stigmatize mental health services, and connect youth to trusted adults.
The intervention can be flexibly delivered in three formats. It includes text messages, role model videos, a user’s guide, and small group activities. The lessons can be easily integrated into the flow of services provided by clinics, schools, treatment centers, and other community-based programs. BRAVE can be implemented by a variety of support staff and can be tailored to the needs and time constraints of any setting.
No formal training is required to use the BRAVE User’s Guide. The BRAVE series was designed to be used in one of three ways:
Ideas to Consider as you Plan Your Intervention
The BRAVE intervention was designed by the Northwest Portland Area Indian Health Board over five-years, using community based participatory research activities. The formative research process included three phases and more than 38 AI/AN teens and young adults, as well as content experts from across the U.S.
BRAVE builds on traditional teaching strategies and community values, and connects AI/AN teens and young adults to people, stories, resources, and teachings that demonstrate what it means to be strong and resilient.
In 2016, the Northwest Portland Area Indian Health Board’s (NPAIHB) We R Native project conducted a national Youth Health Tech survey. After surveying 675 AI/AN teens and young adults, results showed 88% had regular access to a smartphone and over 62% reported getting health information from the internet or social networking sites on a weekly or monthly basis.
Knowing this, the team developed a theoretically informed text message campaign, and worked with a film crew to create a complimentary role model video to reinforce the skills described in the text messages. The video shares the story of three relatable character-types (perpetrator, survivor, and bystander), including their personal histories with alcohol and violence, their relationships to one another, and a turning-point for behavior change.
To evaluate the program, the NPAIHB conducted a year-long study that involved 1,000 AI/AN teens and young adults ages 15-24 nationwide. Participants were randomized to receive either 8 weeks of BRAVE text messages, designed to improve mental health, help-seeking skills, and promote cultural pride and resilience, or 8 weeks of STEM text messages, designed to elevate and re-affirm Native voices in science, technology, engineering, math, and medicine. Afterwards, the two groups switched, and participants received the other set of messages.
On behalf of the NPAIHB and our project partners, we hope that you enjoy implementing this program with your youth. If you have any questions about the intervention or would like additional health promotion resources, please feel free to contact us.
The intervention was designed, in part, with funding from SAMHSA (grants SM061780 and SM082106). The views, opinions and content of the campaign does not necessarily reflect the views, opinions, or policies of CMHS, SAMHSA, or HHS, and should not be construed as such.
The efficacy study was supported by the Technology & Adolescent Mental Wellness (TAM) program, run by the Social Media and Adolescent Health Research Team, housed within the Department of Pediatrics at the University of Wisconsin-Madison.
We are grateful to the BRAVE study participants, the communities that support prevention and outreach, and the team at Sky Bear Media – for their commitment to wellness and building help-seeking skills in Native teens and young adults.