Iwankapiya-Healing: Historical Trauma Practice and Group IPT for American Indians

In this pilot study (R34), we will explore the feasibility, acceptance and sustainability of
a treatment engagement and retention strategy that combines the Historical Trauma and
Unresolved Grief Tribal Best Practice (HTUG) and Group Interpersonal Psychotherapy (IPT).
HTUG is designed to engage and retain American Indian (AI) adults in treatment by focusing
on grief resolution related to AI collective massive group trauma across generations. The
model has potential for engaging AIs in empirically supported or evidence based treatments
(EBTs) through the acknowledgment of the negative effects of colonialism on well-being and
reducing the stigma of mental health problems. This study will test HTUG's potential to
engage AIs in IPT, an EBT that may be particularly well suited for treating depression and
related mental disorders in this population. IPT has demonstrated efficacy for treatment of
depression and grief in diverse populations, and promising results to date with PTSD;
however, to our knowledge, IPT has not been studied with AIs.

The specific aims for this proposal are:

1. Manualize, field test, and refine a combined group HTUG/IPT intervention model and
related clinician training and research protocols. Under Aim 1, we will: a) develop
HTUG/IPT model and initial manual, b) refine IPT for use with AIs, c) solicit AI
Advisory Panel (AP) member and clinician review of models, d) prepare pilot measures,
e) prepare HTUG/IPT training materials, and f) recruit and train providers.

2. Conduct a pilot randomized trial of HTUG/IPT compared to IPT Only at two sites
(Albuquerque, New Mexico and Pine Ridge Indian Reservation, South Dakota) to further
refine the manual and protocols, and assess the feasibility and acceptability of our
procedures for conducting a subsequent large-scale clinical trial. Under Aim 2, we will
conduct the randomized trial in two waves; we will: a) recruit participants, b)
implement interventions and collect data, c) analyze data, and d) develop "products" -
the finalized HTUG/IPT manual, an R01 proposal, conference presentations and
manuscripts, and the final manual and data report to the two clinics.

Upon completion of these aims, we will have piloted methods and established the feasibility
and acceptance of the HTUG/IPT intervention model, which will provide foundational data for
an R01 to test strategies for improving engagement and retention of AIs in EBTs. What is
learned in the proposed program of research could have significant promise for reducing
disparities in mental health treatment and disease burden across AI populations and in
culturally unique, disadvantaged and poorly served populations in general. Improving
engagement and retention in culturally relevant EBTs among AIs is of great practical
importance given the rates of lifetime prevalence of mental health disorders (ranging from
35% to 54%), the fact that mental health care for AIs is severely underfunded, and the
reality that treatment research with AIs is sorely lacking.

Two sites are participating in this project in two different Indian Health Service (IHS)
Areas: Southwest urban and Northern Plains reservation outpatient behavioral health clinics.
These include First Nations Community HealthSource in the Albuquerque Area in New Mexico and
Oglala Lakota College/Kyle Health Center on the Pine Ridge Reservation in the Aberdeen Area
in South Dakota. Participants will be randomly assigned to either the IPT Only treatment or
the combined HTUG/IPT group; both will be 12 two hour sessions of group intervention. We
anticipate that the HTUG/IPT group will show increased positive response to the intervention
as measured on a number of scales for depression, grief, and interpersonal functioning as
well as satisfaction with the model. We will use the results to design a more in-depth
randomized clinical trial (R01) at additional tribal sites.

Inclusion Criteria

- American Indian adults

- Depression

- Co-occurring unresolved, prolonged or complicated grief included

- Co-occurring PTSD or other trauma response included

- Score of 16 on Hamilton Depression Scale and clinician assessment

- DSM 5 Substance Use Disorder Mild for alcohol or cannabis only or remission

Exclusion Criteria:

- Psychosis

- Personality disorder

- Bipolar disorder

- Severe vegetative depressive symptoms such as psychomotor retardation

- Acutely suicidal or homicidal individuals

- Mild, moderate or severe substance abuse disorder for amphetamines, methamphetamines,
opioids, hallucinogens or inhalants.