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Promoting Community Conversations about Research to end Native Youth Suicide in Rural Alaska - Firearm Mortality Supplement

Suicide rates in Alaska are almost double the national rate, and data show access to a firearm triples individual risk of death by suicide and 60% of suicide fatalities due to firearms. Restriction of lethal means for suicide is one of the most effective prevention strategies, yet, the field lacks consensus regarding the skills and knowledge that mental health providers require to facilitate firearms means restriction and deploying means restriction interventions across settings and situations remains a challenge, specifically in remote areas such as in many Alaskan communities. Guided by Social Cognitive Theory, the present study narrows research gaps by investigating the facilitative (e.g., practice skills, inter-professional relationships with first responders, community attitudes) and psychological factors (e.g., self-efficacy, outcome expectations) of effective firearm-related suicide risk assessment and intervention among mental health providers. We propose to explore community member and mental health provider perspectives to identify the knowledge and skills needed to effectively prepare mental health providers to work towards firearm lethal means reduction and firearm safety. The study aims to: 1) explore how community members and service providers discuss suicide, lethal means restrictions, and attitudes towards firearm-related suicide risk assessment and intervention in Alaskan Native (AN) communities; and, 2) identify the determinants of mental health providers’ assessment and intervention in reducing firearm-related suicide risk in Alaska. Aim 1 will involve content analysis of secondary qualitative interview (n=12) and community-based learning circle (n=54) data collected by the PI (Wexler) in a prior NIMH-funded study which examined the meanings assigned to suicide by medical and mental health workers, the health systems that shape practices of care, and the AN communities these systems serve. Aim 2 will involve conduct key-informant interviews with field supervisors (n~10) who oversee mental health providers in rural Alaska to investigate the facilitative and psychological factors that promote perceived effective assessment and intervention in firearm-related suicide encounters. Data will be analyzed inductively and iteratively using thematic analysis and the constant comparative approach to identify emergent themes with input from a Local Steering Committee in Alaska. Study findings will contribute to increased understandings of the identified key determinants that are required as a foundation for effective firearm-related suicide risk assessment and intervention; and thus, form the basis of future means-restriction training for mental health providers.

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