My Pathway to Healing (MP2H): a pilot randomized implementation trial to promote healing from the impacts of adverse childhood experiences, trauma, and suicide risk among Native American adults—trial rationale and protocol

Abstract Background Adverse childhood experiences (ACEs) are common in many communities. In Native American communities, ACEs are also related to historical trauma. ACEs are correlated with a variety of health problems, among them substance abuse and suicidal behaviors. Despite historical and contemporary efforts to assimilate and eradicate American Indian communities and cultures, these communities are resilient and continue to benefit from unique cultural strengths and values surrounding health today. The White Mountain Apache Tribe (WMAT) leverages tribal sovereignty to implement programs and policies to address health inequities in their community. The Johns Hopkins Center for Indigenous Health supported work toward health equity in the community through developing the My Pathway to Healing intervention aimed at supporting adults struggling with substance abuse and/or suicidal behaviors by addressing trauma, including historical trauma and ACEs. Methods This pilot randomized trial will assess the feasibility and preliminary impacts of the My Pathway to Healing intervention with a two-armed randomized wait-list controlled trial. We will use stratified randomization and 1:1 allocation to assign participants to receive either the intervention or the current standard of care (those randomized to receive standard of care will be offered the intervention upon completion of the study). We aim to enroll N = 30 adults from the WMAT community who are between ages 18 and 65, have engaged in recent (i.e., past 90 days) suicidal, self-harm, or binge substance use behavior, who have experienced at least two ACEs, and who are currently experiencing elevated symptoms of posttraumatic stress. Participants will be recruited through the local community-based suicide surveillance system by community mental health specialists. Analysis will be conducted to assess feasibility of implementing a larger trial in the future and whether the intervention decreases symptoms of posttraumatic stress and increases hopefulness and communal mastery. Discussion The My Pathway to Healing intervention leverages WMA cultural strengths and fills an important gap in programming available to older adults in the WMAT community. This trial will yield results on the utility of a multi-problem approach to addressing similar issues stemming from historical and contemporary trauma. Trial registration ClinicalTrials.gov Identifier: NCT04585906. Registered 14 October 2020, https://classic.clinicaltrials.gov/ct2/show/NCT04585906 .