THRIVE is a community-based participatory research project that seeks to promote the mental health and well-being of American Indian youth by addressing violence exposure and historical and chronic trauma. This project is based within our school-based health centers, which were founded in 1983 to increase the accessibility of medical services, mental health services, and prevention services to students in three American Indian communities in New Mexico. THRIVE has two main components: 1) adaptation, implementation, and evaluation of Cognitive Behavioral Intervention for Trauma in Schools (CBITS), an evidenced-based group intervention designed to be implemented in school settings; and 2) development, implementation, and evaluation of a community-based intervention for Native youth and their parents/guardians to address chronic and historical trauma through a combination of traditional healing modalities, psychoeducational groups, equine-assisted therapy, and reconnection of youth to traditional culture and language.

Component 1: THRIVE (Teen Health Resiliency Intervention for Violence Exposure)
The first component of THRIVE has involved the adaptation, implementation, and evaluation of an evidence-based intervention (Cognitive Behavioral Intervention for Trauma in Schools; CBITS) for American Indian youth who have been exposed to trauma. CBITS is a group intervention that includes education about trauma to de-stigmatize symptoms, relaxation training to combat anxiety, cognitive therapy to address negative beliefs about self and world, real life and imagined exposure to feared situations to reduce anxiety, and social problem-solving to address anger and impulsivity. This intervention demonstrated promising results in a randomized experiment with urban youth in Los Angeles (Stein et al., 2003). However, its effectiveness and cultural appropriateness had not been evaluated for rural Native youth. Through this study, we screened 231 students in three American Indian communities and 34 students participated in the group intervention. Preliminary results suggest that participants in the intervention experienced significant decreases in PTSD (post-traumatic stress disorder) symptoms and general anxiety symptoms. Adaptations to the intervention have been documented.

Expanding the Definition of Trauma
For years the focus of trauma therapy has been on acute traumas and on individual treatments. However, there are many other types of traumas and treatment approaches. In recent years researchers have focused on how to address different types of trauma, such as chronic trauma, or repeated exposure to stressful or threatening life events. Living in a violent neighborhood is considered chronic trauma because it is something that you fear almost every day. Researchers have also begun studying historical trauma, which involves the effects of historically traumatic events on groups of people that have been oppressed or traumatized. Research has shown that people can be affected by a trauma from the past that they did not experience firsthand, but re-lived through stories from family members. This phenomenon is called intergenerational transmission of trauma.

Historical Trauma and American Indians
For American Indians, historical trauma originates from 500 years of genocide (wars and disease), oppression (taking of land and property, discrimination), cultural destruction (outlawing of traditional practices and languages), forced removal of children to boarding schools, and relocation of families to urban areas from reservations. Given these realities, it is not surprising that American Indians have significantly higher rates of trauma exposure than the overall U.S. population (Manson et al., 2005). A great deal of the research on historical trauma for American Indians was done by Dr. Maria Yellow Horse Brave Heart (Brave Heart, 1998; Brave Heart, 1999a; Brave Heart, 1999b; Brave Heart & DeBruyn, 1998;).

Addressing Historical Trauma
From this research, treatment approaches have been adapted from the individual focus to a community focus on healing. Although different groups chose to tailor their community healing interventions depending on their cultural beliefs/traditions and their specific needs for healing, treatments for historical traumas often include the following core elements:

The goals of the research project are to promote individual and community mental health and well-being and to reduce trauma and violence exposure through the development, implementation, and evaluation of a community intervention. We also hope that through this process, we begin to build an evidence base for mental health interventions developed by American Indian communities and their partners. We intend to develop a model and process that can be shared with other American Indian communities that are facing similar issues of historical trauma, violence, and challenges for youth and parents. The intervention was piloted first in June – December 2006. A second pilot implementation will begin in June 2007.

For more information about the THRIVE Project, please contact at 505-272-4462, Principal Investigator: Jessica Goodkind, Ph.D., jgoodkind@salud.unm.edu .
Co-Investigators: Lance Freeland, BS, Richard Hough, PhD.

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