{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T01:08:51Z","timestamp":1787620131275,"version":"build-2736575974"},"reference-count":27,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T00:00:00Z","timestamp":1736985600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Public Health"],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Indigenous connectedness is an impetus for health, well-being, self-confidence, cultural preservation, and communal thriving. When this connectedness is disrupted, the beliefs, values, and ways of life that weave Indigenous communities together is threatened. In the Spring of 2020, the COVID-19 virus crept into Tribal Nations across the United States and exacerbated significant health-related and educational inequities. The first case of COVID-19, or <jats:italic>Dikos Ntsaa\u00edg\u00ed\u00ed-19<\/jats:italic> in the <jats:italic>Din\u00e9<\/jats:italic> (Navajo) language, arrived in the Southwest in March 2020. The virus quickly spread amongst Din\u00e9 communities and contributed to immediate school closures. These closures created significant disruption to connectedness on the Navajo Nation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>As part of the Community Based Participatory Research process, our team worked with a Community Advisory Board (CAB) to facilitate a longitudinal cohort study titled \u201cProject SafeSchools\u201d and, most critically, to culturally adapt mental health interventions to be implemented as a part of this study. This paper describes the process our team used to select, adapt, and test Safety Planning and Caring Contacts interventions to reduce elevated rates of depression, anxiety, and suicidal ideation amongst Din\u00e9 adolescents and adults. CBPR was the primary approach used to engage with Navajo Nation communities and the adaptation process was guided by a scoping study of frameworks for adapting public health evidence-based interventions (EBI) and was guided by the cultural adaptation process. Our team met virtually several times in 2021 and 2022 as the parent launched and as the pilot randomized clinical trial called \u201c+Connection is Medicine\u201d started. When Safety Planning and Caring Contacts messaging was selected, the study team, which consisted primarily of Navajo research personnel led by a Navajo community-based principal investigator (PI) and allied PIs with extensive experience in implementation science, infectious disease prevention, and CBPR, were adapted and presented to CAB members. This CAB also included a youth advisory council who participated in the field testing and further adaptation process.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The use of the CAB allowed for a collaborative workgroup effort to examine the feasibility and acceptability of using safety planning to help reduce suicide risk factors with Navajo adolescents and adults. Most importantly, this CAB collaborative with researchers to further tailor safety plan intervention materials to align with Navajo values related to connectedness to relatives, community, mental health resources, and the land. In addition, the caring contacts messaging was aligned with safety plans to provide culturally sensitive messages that would be shared with randomized participants.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Mental health stigma is highly common in reservation-based communities. In Indigenous communities, mental illness has association with not living well or not living culturally aligned further complicates the likelihood of at-risk community members contacting resources available in their communities. By using an Indigenous approach that restores connectedness, and reminds participants of their belonging, +CiM researchers were able to develop enhanced versions of safety plans to use in their pilot randomized controlled trial.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fpubh.2024.1376686","type":"journal-article","created":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T16:02:51Z","timestamp":1737043371000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["The adaptation process of a safety planning intervention to promote connectedness and reduce distress in Din\u00e9 adolescents and adults during the COVID-19 pandemic"],"prefix":"10.3389","volume":"12","author":[{"given":"Joshuaa Dominic","family":"Allison-Burbank","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Begaye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kyann","family":"Dedman-Cisco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lisa","family":"Jim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shannon","family":"Archuleta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renae","family":"Begay","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lacey","family":"Howe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily E.","family":"Haroz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,16]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"121","DOI":"10.1177\/1177180119828114","article-title":"For the love of our children: an indigenous connectedness framework","volume":"15","author":"Ullrich","year":"2019","journal-title":"AlterNative"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"e045893","DOI":"10.1136\/bmjopen-2020-045893","article-title":"Indigenous perspectives on concepts and determinants of flourishing in a health and well-being context: a scoping review protocol","volume":"11","author":"Nelson","year":"2021","journal-title":"BMJ Open"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/978-3-030-15367-0_4","article-title":"Wellbeing as positive outcome of a social connectedness pathway to resilience: an indigenous psychology perspective","volume-title":"Handbook of quality of life in African societies","author":"de Gouveia","year":"2019"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"5395","DOI":"10.3390\/ijerph20075395","article-title":"From deficit to strength-based aboriginal health research\u2014moving toward flourishing","volume":"20","author":"Bullen","year":"2023","journal-title":"Int J Environ Res Public Health"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1853","DOI":"10.15585\/mmwr.mm6949a3","article-title":"COVID-19 mortality among American Indian and Alaska native persons \u2014 14 states, January\u2013June 2020","volume":"69","author":"Arrazola","year":"2021","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref6","volume-title":"The response of rural districts to the Covid-19 pandemic","author":"Nicola","year":"2020"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1177\/8756870520982294","article-title":"Challenges for rural native American students with disabilities during COVID-19","volume":"40","author":"Running Bear","year":"2021","journal-title":"Rural Special Educ Quart"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"1481","DOI":"10.1186\/s12889-022-13208-7","article-title":"Measuring the effects of the COVID-19 pandemic on Din\u00e9 and White Mountain apache school personnel, families, and students: protocol for a prospective longitudinal cohort study","volume":"22","author":"Allison-Burbank","year":"2022","journal-title":"BMC Public Health"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"S350","DOI":"10.2105\/AJPH.2024.307576","article-title":"Indigenous community-based participatory research approach and safe return to in-person learning for Din\u00e9 youth and families","volume":"114","author":"Begay","year":"2024","journal-title":"Am J Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"246","DOI":"10.1097\/FCH.0b013e318219606f","article-title":"Applying indigenous community-based participatory research principles to partnership development in health disparities research","volume":"34","author":"Christopher","year":"2011","journal-title":"Fam Community Health"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/tbm\/ibx067","article-title":"A scoping study of frameworks for adapting public health evidence-based interventions","volume":"9","author":"Escoffery","year":"2019","journal-title":"Transl Behav Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"807432","DOI":"10.3389\/fpsyt.2022.807432","article-title":"Cultural adaptation of the mothers and babies intervention for use in tribal communities","volume":"13","author":"Ward","year":"2022","journal-title":"Front Psych"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"2183","DOI":"10.2105\/AJPH.2016.303453","article-title":"Decreases in suicide deaths and attempts linked to the White Mountain apache suicide surveillance and prevention system, 2001\u20132012","volume":"106","author":"Cwik","year":"2016","journal-title":"Am J Public Health"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"256","DOI":"10.1016\/j.cbpra.2011.01.001","article-title":"Safety planning intervention: a brief intervention to mitigate suicide risk","volume":"19","author":"Stanley","year":"2012","journal-title":"Cogn Behav Pract"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"74","DOI":"10.1037\/ser0000645","article-title":"Caring contacts for suicide prevention: a systematic review and meta-analysis","volume":"20","author":"Skopp","year":"2023","journal-title":"Psychol Serv"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"e18","DOI":"10.2105\/AJPH.2014.301872","article-title":"Community-based surveillance and case management for suicide prevention: an American Indian tribally initiated system","volume":"104","author":"Cwik","year":"2014","journal-title":"Am J Public Health"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"106291","DOI":"10.1016\/j.cct.2021.106291","article-title":"(2021) a randomized, controlled trial of the safety planning intervention: research design and methods","volume":"103","author":"Boudreaux","year":"2021","journal-title":"Contemp Clin Trials"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"5","DOI":"10.1027\/0227-5910\/a000093","article-title":"Caring letters project: a military suicide-prevention pilot program","volume":"33","author":"Luxton","year":"2012","journal-title":"Crisis"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1037\/pro0000134","article-title":"Implementation methods for the caring contacts suicide prevention intervention","volume":"48","author":"Reger","year":"2017","journal-title":"Prof Psychol Res Pract"},{"key":"ref20","first-page":"168","article-title":"From myPlan to ourCircle: adapting a web-based safety planning intervention for native American women exposed to intimate partner violence","volume-title":"Indigenous health equity and wellness","author":"Bagwell-Gray","year":"2022"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s43058-022-00376-1","article-title":"Planning for implementation and sustainability of a community-based suicide surveillance system in a native American community","volume":"4","author":"Brockie","year":"2023","journal-title":"Implement Sci Commun"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1037\/ser0000358","article-title":"Increasing culturally responsive care and mental health equity with indigenous community mental health workers","volume":"18","author":"O'Keefe","year":"2021","journal-title":"Psychol Serv"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"61","DOI":"10.1089\/heq.2017.0001","article-title":"Use of community health workers and patient navigators to improve Cancer outcomes among patients served by federally qualified health centers: a systematic literature review","volume":"1","author":"Roland","year":"2017","journal-title":"Health Equity"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"2253","DOI":"10.2105\/AJPH.2010.300106","article-title":"Effectiveness of a community health worker intervention among African American and Latino adults with type 2 diabetes: a randomized controlled trial","volume":"101","author":"Spencer","year":"2011","journal-title":"Am J Public Health"},{"key":"ref25","volume-title":"Navajo Families without Internet Struggle to Home School during COVID-19 Pandemic","author":"Groetzinger","year":"2020"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1022","DOI":"10.1080\/13811118.2021.1915217","article-title":"The Effectiveness of the Safety Planning Intervention for Adults Experiencing Suicide-Related Distress: A Systematic Review","volume":"26","author":"Ferguson","year":"2022","journal-title":"Archives of suicide research: official journal of the International Academy for Suicide Research"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"894","DOI":"10.1001\/jamapsychiatry.2018.1776","article-title":"Comparison of the Safety Planning Intervention With Follow-up vs Usual Care of Suicidal Patients Treated in the Emergency Department","volume":"75","author":"Stanley","year":"2018","journal-title":"JAMA psychiatry"}],"container-title":["Frontiers in Public Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1376686\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,16]],"date-time":"2025-01-16T16:02:55Z","timestamp":1737043375000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpubh.2024.1376686\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,16]]},"references-count":27,"alternative-id":["10.3389\/fpubh.2024.1376686"],"URL":"https:\/\/doi.org\/10.3389\/fpubh.2024.1376686","relation":{},"ISSN":["2296-2565"],"issn-type":[{"value":"2296-2565","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,16]]},"article-number":"1376686"}}