Outcome
Type |
Measure |
Description |
Time frame |
Safety issue |
Primary |
Change in Post Traumatic Stress Symptoms |
Post traumatic stress symptoms will be measured using part 4 of the Harvard Trauma Questionnaire (HTQ). The scale ranges from 0 (Not at All) to 4 (Extremely). A higher score indicates a worse outcome. |
Baseline, Endline (8-12 weeks after baseline), Follow Up 1 (16 weeks after baseline), Follow Up 2 (20 weeks after baseline) Follow Up 3 (24 weeks after baseline) |
|
Secondary |
International Depression Symptom Scale (IDSS) |
The IDSS will be used to measure depression symptom severity. The scale ranges from 0-3. A higher score indicates a worse outcome. |
Baseline, Endline (8-12 weeks after baseline), Follow Up 1 (16 weeks after baseline), Follow Up 2 (20 weeks after baseline) Follow Up 3 (24 weeks after baseline) |
|
Secondary |
Anxiety |
Investigators will use the Hopkins Symptom Checklist for Anxiety to measure severity of anxiety symptoms. This scale will range from 1-4. A higher score indicates a worse outcome. |
Baseline, Endline (8-12 weeks after baseline), Follow Up 1 (16 weeks after baseline), Follow Up 2 (20 weeks after baseline) Follow Up 3 (24 weeks after baseline) |
|
Secondary |
Alcohol and Substance Use |
Investigators will use the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) to measure alcohol and substance use. This 15-item questionnaire screens for all levels of problems or risky substance use (alcohol, illegal drugs, and prescription drugs). A risk score is provided for each substance, and scores are grouped into low, moderate, or high risk, providing a comprehensive view of substance use. This scale ranges from 0-27+. A total score of 0-3 indicates low risk/no intervention. A total score of 4-26 indicates moderate risk/brief intervention. A total score of 27+ indicates high risk/more intensive treatment. |
Baseline, Endline (8-12 weeks after baseline), Follow Up 1 (16 weeks after baseline), Follow Up 2 (20 weeks after baseline) Follow Up 3 (24 weeks after baseline) |
|
Secondary |
Suicidal ideation |
We are using a 27-item version of The Suicide Ideation Questionnaire (SIQ) which has been previously adapted and tested in the local context. Each item is answered on a 7-point scale that assesses the frequency and severity of suicidal ideation in the past month, with scores from 0-162. Positive screens on the SIQ are defined as scoring at or above the suggested clinical cutoff of 37. The SIQ has previously been used with Native American groups, with a sensitivity and specificity of .80 and .86, and strong internal consistency for the total score (a = 0.96). As described above, the SIQ is administered during the initial follow-up visit as part of our current case management practice. The study team has devised a comprehensive safety protocol, approved by the JHU IRB and the WMAT Tribal Council and Health Board, to triage depending on risk. |
Baseline, Endline (8-12 weeks after baseline), Follow Up 1 (16 weeks after baseline), Follow Up 2 (20 weeks after baseline) Follow Up 3 (24 weeks after baseline) |
|
Secondary |
Hope |
Investigators will use the Trait Hope Scale to measure levels of hopefulness. This scale consists of 8 items and total scores range from 0-96. A higher score indicates a higher perceived level of hope (i.e. positive outcome). |
Baseline, Endline (8-12 weeks after baseline), Follow Up 1 (16 weeks after baseline), Follow Up 2 (20 weeks after baseline) Follow Up 3 (24 weeks after baseline) |
|
Secondary |
Communal Mastery |
Investigators will use a 10-item communal mastery questionnaire developed from two commonly employed measures of mastery and self-efficacy and adapted to add more collectivist statements for use specifically in Native American populations to measure self-efficacy and knowledge of communal resources. Scores will range from 0-40. A higher score indicates a more positive outcome. |
Baseline, Endline (8-12 weeks after baseline), Follow Up 1 (16 weeks after baseline), Follow Up 2 (20 weeks after baseline) Follow Up 3 (24 weeks after baseline) |
|
Secondary |
Historical Loss Scale |
Investigators will use a 14-item version of the Historical Loss Scale, a self-report measure assessing the frequency with which Indigenous individuals think about loss of land, peoples, culture, ways of life as a result of colonization (i.e., historical trauma) to measure types of historical discrimination and trauma. Responses are scored on a 6-point Likert-type scale from never (1) to several times a day (6); scores are recoded so that higher scores indicate higher frequency of thinking about historical trauma. Just items 1-13 are used in scoring as item 14 is an open ended question. |
Baseline, Endline (8-12 weeks after baseline), Follow Up 1 (16 weeks after baseline), Follow Up 2 (20 weeks after baseline) Follow Up 3 (24 weeks after baseline) |
|
Secondary |
Adverse Childhood Experience (ACE) Scale |
Investigators will use an adapted version of the Behavioral Risk Factor Surveillance System (BRFSS) ACEs module in combination with questions about ACEs identified in formative qualitative work for this project. The ACEs scale ranges from 0-31. A higher score indicates more adverse childhood experiences. |
Baseline |
|
Secondary |
Self-Esteem |
Investigators will use the Rosenberg Self-Esteem Scale to measure level of self-esteem. The 10-item scale ranges from 0-30. A higher score indicates a higher level of self-esteem (i.e., positive outcome). |
Baseline, Endline (8-12 weeks after baseline), Follow Up 1 (16 weeks after baseline), Follow Up 2 (20 weeks after baseline) Follow Up 3 (24 weeks after baseline) |
|
Secondary |
Coping |
Investigators will use an adapted version of the Brief Cope Measure to assess a participant's ability to cope with stress in their life. The measure includes 28 items and response options range from 1-4. A higher overall score indicates a better outcome. |
Baseline, Endline (8-12 weeks after baseline), Follow Up 1 (16 weeks after baseline), Follow Up 2 (20 weeks after baseline) Follow Up 3 (24 weeks after baseline) |
|
Secondary |
Functioning |
Investigators developed a locally relevant functioning scale from primary outcome data, in which participants were asked about tasks and activities that are important for people to do for themselves, their families and the community. The most frequently mentioned responses are combined to create the 9-item scale. The scale ranges from 0-4. A higher score indicates a worse outcome. This approach has been used widely in culturally diverse contexts internationally. We also include the 12 items from the World Health Organization's Disability Assessment Schedule (WHODAS) 2.0 which assess activities of daily living combined with two items from formative work. Each item of the WHODAS 2.0 is scored on 0 to 4 scale, with total possible scores ranging from 0-56 and higher meaning more difficulty in functioning. |
Baseline, Endline (8-12 weeks after baseline), Follow Up 1 (16 weeks after baseline), Follow Up 2 (20 weeks after baseline) Follow Up 3 (24 weeks after baseline) |
|
Secondary |
Mental Health and Wellbeing |
The Client Monitoring Form will be used to track the mental health and well-being of intervention participants on a regular basis. There are 17-questions that measure recent substance use, anxiety and depression symptoms, and PTSD symptoms. Questions are asked on a scale of 0 (never) to 4 (Daily or almost daily). A higher score indicates a worse outcome. Additionally, clients are screened for suicidal ideation. |
Regularly from baseline to 8-12 weeks post baseline (during intervention sessions) |
|
Secondary |
Grief |
The brief grief questionnaire will be used to assess symptoms of grief. This 5-item scaled has been adapted for this study to ask about deaths of loved ones, instead of the death of a single index loved one. Each question is scored from 1-3, with a total sum calculated and higher scores indicating a greater burden of grief. |
Baseline, Endline (8-12 weeks after baseline), Follow Up 1 (16 weeks after baseline), Follow Up 2 (20 weeks after baseline) Follow Up 3 (24 weeks after baseline) |
|
Secondary |
Identity |
A modified version of the Leach identification scale adapted for the local context is used to assess tribal identity and how much an individual identifies with and feels connected to their community. Response options range from 0-3 on this 7-item scale. |
Baseline, Endline (8-12 weeks after baseline), Follow Up 1 (16 weeks after baseline), Follow Up 2 (20 weeks after baseline) Follow Up 3 (24 weeks after baseline) |
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