In an article being early released this week in Pediatrics, Katie Edwards, PhD, at University of Nebraska-Lincoln and colleagues at North Dakota State University describe the development and evaluation of a culturally attuned family-based program to prevent new adverse childhood experiences (ACEs) and new intimate partner violence (IPV) (10.1542/peds.2023-065412). Participants included children ages 10 to 14 years and their family caregivers living in a small city in South Dakota near several large, rural Indian Reservations. All families identified as having low income and/or being Indigenous. The Indigenous peoples included in this research are predominantly of the Lakota, also known as the Teton Sioux, one of three main tribes along with the Eastern Dakota and Western Dakota, of the Great Sioux Nation.
The research intervention is the “Tiwahe Wicagwicayapi” Program (TWP), which means “strengthening families” in the Lakota language. Each of the 7 (2.5-hour-long) TWP family education and intervention sessions is taught by Indigenous adults including Elders, and is named after a Lakota virtue (these include wisdom, respect, love, bravery, compassion, gentleness, patience). TWP was co-created using participatory methods and includes cultural practices such as storytelling, prayer, and talking circles. It was modelled on the Strengthening Families Program, an evidence-based program developed in 1982 originally aimed at discovering what skills parents need to prevent drug and alcohol use in their children.
The region of South Dakota for the intervention presents stark needs, and U.S. Census data for Oglala Lakota county, South Dakota, tell the story best:
- Among adults, 42.8% lack health care coverage.
- The employment rate is 34.1%.
- Among adults >25 years, 35.2% have a high school or equivalent degree.
- Among all residents, 55.8% live in poverty.
The study used a randomized controlled design with 66 families beginning the TWP immediately and 58 families wait-listed and given resources until they began the program. Fifty caregivers (75.8%) and 79 children (73.8%) attended at least one session. The authors compared rates of ACEs and IPV for the immediate (TWP) and wait-list (control) groups post-intervention and 6 months later, controlling for baseline scores. They also looked at rates of depression and other measures of mental health and social support.
The authors found that:
- The rate of new ACEs at 6 months was 36% lower in the TWP than control group.
- No significant change in new IPV between groups in the main analysis was noted, but
- Caregivers in the TWP versus control group reported decreased depression (p=0.04) and increased social support (p=0.01), and
- Children in the TWP group had less depression at 6 months than at baseline (p=0.01).
This fascinating study describes the first-ever evaluation of a culturally respectful intervention program designed to reduce ACEs among children who are Indigenous and low income. Join in celebrating every small gain made as the authors take us on a remarkable intervention journey.
