…a spirit of suicide and alcohol and drug abuse seemed to walk freely among the members of a small Alaska river community. It had just claimed two more victims and was looking for more. Sheltered inside the community’s tribal hall, Elders, youth and parents huddled in a circle. Some in the circle hunched down, faces void of tears, tense bodies pressed against unyielding metal chairs. Others let tears quietly slide down their cheeks. The two recent deaths were newest heartaches in a long line of many.

The group knew too well the spirit’s easy reach into their community. They’ve carried many to the cemetery, dug many graves. They intimately knew how alcohol or drugs dull the pain, but deceitfully bring more tragedy and sorrow.

From time to time, outsiders have come to the village to help, but nothing they brought seemed to last. In spite of disappointments and heartbreak, the people gathered this day because they still believed things could change. This time the solutions and answers would come from their community, from themselves. (Alakanuk Community Planning Group et al., 2009, pg. 10).

Our goal with this paper is to describe the process undertaken in two communities in southwest Alaska that resulted in the creation of the Qungasvik, a “toolbox” for promoting youth sobriety and reasons for life in Yup’ik/Cup’ik communities (http://www.uaf.edu/canhr/projects/elluam/). Eliza Orr, our Yup’ik linguist and translator at the Center for Alaska Native Health Research (CANHR) suggested Qungasvik, or toolbox, as a name for the manual. Her father had carried a pouch, that he called his qungasvik. He filled his qungasvik with important hunting and survival tools, and always took it with him when out on the land. The communities agreed to name the intervention manual Qungasvik because it contains tools to help Yup’ik people find their own answers and approaches to problems threatening their communities and youth, including the problems of suicide and alcohol abuse.

This special issue shares the story of how two communities, along with researchers from CANHR, joined together to find ways to increase strengths and protections in young people, and to give them the tools they need to survive in today’s arctic. This paper will add another dimension to this story by describing the community based participatory research (CBPR) process supporting the development of the Qungasvik as a Yup’ik theory-driven intervention implementation process. The Qungasvik is not a how-to manual for fixing problems with youth in indigenous Footnote 1 communities. Stated differently, it is not a manual describing replicable components of an intervention. Instead, the Qungasvik describes a community-initiated and community-driven process. The process results in localized practices for intervention that are customized to each community setting, and ideally, “owned” by each community that implements them as locally created and designed elements of their own project.

The Qungasvik intervention is in many ways unique in this localized and culturally-grounded process approach. Its aim is to develop and deliver a cultural intervention in an indigenous community setting. The term cultural, and culturally-grounded, as used here should not be taken to mean rooted in a historically imagined or reimagined past. Rather, we refer to the ways that the research and the intervention were implemented by building up from local infrastructure, theories, and capacities. Similarly, we use the term cultural intervention to describe an extension of the notion of multi-level, culturally situated intervention (Schensul and Trickett 2009). In contrast to culturally situated intervention, in cultural intervention “culture” is a central focus of the intervention activities and the underlying theory guiding the intervention, which is itself indigenous to the culture.

The emphasis in the Qungasvik intervention is on how a community comes together and asks, ‘what can we do to deal with our problems?’ and ‘how can others (e.g., health professionals, outside researchers) inform and support our process and decision-making?’ The Qungasvik manual represents Yup’ik cultural process and practice as flexible, mutable, and syncretic, reflecting its aboriginal as well as post-colonial attributes (Fienup-Riordan 1991). Yet the Qungasvik should not be taken to represent simply a “best-of-both-worlds” approach. Rather the modules that engage youth and the community through intervention activities stand as outcomes from the collapsing of dualities in cultural discourses and knowledge in order to produce more integrated and continuous contemporary Yup’ik youth experience. This collapsing of dualities occurs in the process of cultural contact when there arises a shared recognition of ideas, concepts, and practices that, while they may appear to differ in expression, are based on similar underlying functions. So for example, the term “intervention” itself comes from a Western philosophical tradition; from the perspective of intervention science it refers to an act of interceding with the intent of causing or modifying the outcome. In this Western framework, the intervention typically focuses at the individual-level and intervention activities are often aimed at what is going on inside of the individual.Footnote 2 This way of conceiving intervention does not fit within an a Yup’ik framework that instead focuses on the individual as part of a collective and addresses what is going on around the individual. Further, intervention itself can be understood as a restoration of balance, or returning to similar structure as means to outcome, rather than as activity introducing new causal antecedents. This does not mean that intervention is not a useful concept and practice for Alaska Native people. However, the collapsing of dualities within the community of concern occurs when community members are in control of the process of identifying what is useful, and can define for them what constitutes the shared elements across culture and theory. Accordingly, this paper will provide a background on the implementation of the CBPR approach and the steps that were taken at the community-level to develop the intervention ‘modules’ or cultural-contextual activities.

We will begin with a description of the role of CBPR in the early stages of intervention development in the Yup’ik communities. This section focuses on the importance of community entry and intervention implementation to the overall CBPR project. We note the steps in entry and implementation critical for researchers working with indigenous peoples and communities, through a case study description of how these events unfolded in one of the intervention communities. The second part of the paper describes the module development process that resulted in the creation of the Qungasvik intervention manual. The third section presents case examples of three modules from the Qungasvik: Qasgiq (The Men’s House), Yup’ik Kinship Terms, and Surviving Your Feelings. These modules each represent the collaborative and syncretic process that the community co-researcher team took in deciding how to create protective experiences that: (1) create supportive community, (2) strengthen families, and (3) give individuals tools they can use to be healthy and strong. The modules in the Qungasvik are culturally-grounded in Yup’ik processes and practices but in addition, contain elements and underlying core principles that could be shared in a generalized way across other indigenous and non-indigenous social contexts. We conclude with a brief discussion illuminating the inherent tensions and negotiations involved in the development of interventions based on or arising from indigenous knowledge and cultural context.

Entry into a CBPR Intervention Development Process in Southwest Alaska

A distinguishing feature of the Qungasvik intervention is that it was community initiated, with researchers becoming involved by invitation of the community. This occurred at a point when leaders and other members of the community were ready to expand their efforts to address suicide and alcohol abuse through the addition of outside resources and support. The early history of the CBPR relationship-building process is described elsewhere in this volume (see Allen et al. 2014a). In this section, we provide a more detailed discussion of the specific researcher entry process in the villages seeking assistance with intervention development.

A distinguishing feature of the Qungasvik intervention was the degree to which it built on existing infrastructure, expertise, and programming from within the community in order to involve existing culturally meaningful settings and to create new ones, through a locally controlled process. This point is particularly important when considering prior research that shows the limitations of interventions with American Indian and Alaska Native populations that bring in new structures, settings, or resources, and then struggle to demonstrate effectiveness and more importantly, sustain the intervention over time (Waldram 2004; Wallerstein and Duran 2006). It underscores the importance, noted long ago by Sarason (1972), of the dilemmas in creating settings involving varied cultural groups. Sarason defined settings as ‘‘any instance in which two or more people come together in new relationships over a sustained period of time in order to achieve certain goals’’ (p. 1). In a contemporary Yup’ik setting, the individuals of varied cultural backgrounds involve not only the outside intervention researchers. Cultural divides of the type to which Sarason alludes, extend to a Yup’ik society in colonial and post-colonial social transition, which includes many Yup’ik monolingual Elders who grew up immersed in a nomadic, subsistence life, and often times monolingual English speaking Yup’ik youth, who spend much of their lives in Western schooling. Sarason’s work provided many examples of how the often-implicit assumptions of those joining together to create new programs or interventions affected the processes and outcomes. These assumptions were reflected in the contexts, or places in the community where intervention activities took place, the nature of those activities, and, importantly, in the power to shape or control the “what” and the “where” of the intervention.

Sarason attempted to understand why so many programs that rely on creating new settings failed, and why some partially succeeded during the 1960s and 1970s, when the federal government was stimulating significant social change through the creation of anti-poverty, literacy, and early childhood education programs. What he concluded was that it was extremely difficult to create and sustain new settings in the face of differing cultural assumptions, local histories, and resources among the varied groups coming together to effect change. The introduction of new settings in an established system, even if it is not an entirely functional system, does not often happen without conflict or tension.

Sarason’s emphasis on the importance of process and an appreciation of history when creating new settings underscores the importance of the Qungasvik intervention as a setting initiated by local concerns, and built on local traditions, understandings, and resources. Alaska Native communities, similar to other indigenous communities, have collectively experienced the legacy of colonial efforts to change them through schools and religious organizations (Wallerstein et al. 2008). Yup’ik Alaska Native people have retained their indigenous language despite the boarding school and other imposed assimilation experiences, demonstrating a profound capacity for resilience at both the individual and the community level. However, there have been few successful attempts to systematically build upon these local structures and resources contributing to resilience in order to create solutions for the health outcomes resulting from contemporary social determinants that include colonization and rapid, imposed social change.

The communities that invited the university research team to collaborate already had local infrastructure that provided actual and potential settings for intervention. These existing settings variously included such institutions as the traditional council (the local tribal government entity), village corporation (the local tribal shareholder owned entity), city council, local State of Alaska run school, Headstart program, regional health corporation (the tribally run regional health service organization offering universal, single payer health care) clinic, and local churches. All of these organizations were involved in local efforts to improve the health and well-being of the community and its youth. However, at the time of the start-up of the intervention, it was uncommon for members of these independent organizations to work together, or to even share space and resources to address similar goals. This fragmentation of agencies was itself a consequence of forced assimilation efforts over the years involving the imposition of outside institutions to assist with the governance of local economic, health, and social issues (Oswalt 2011). This social history is extremely important to understand and confront when attempting to address collective community issues like alcohol abuse and suicide disparities, which are perceived locally as direct outcomes of the fragmentation and disruption of indigenous structures and social systems (Fienup-Riordan 2000; Wexler 2009a, b). Out of these combined circumstances, it is therefore important to acknowledge that because of this history, attempts to ‘try something old,’ through the revitalization or re-engagement of traditional indigenous cultural practices may in fact constitute the creation of what will be perceived in the community, particularly among the younger generations, as the introduction of a new setting.

Following from what we learned about the social history and legacy of colonization, we identified several steps as critical to the CBPR entry process in a rural Alaska Native setting:

  1. 1.

    Understand our place in the social history of the community;

  2. 2.

    Work through the tribal council, Elders, and local leaders;

  3. 3.

    Recognize strengths and resources at the local level;

  4. 4.

    Identify settings in the community where research and intervention can potentially or already does take place;

  5. 5.

    Understand from the local, cultural perspective who represents the community and how decisions are made;

  6. 6.

    Develop a communication and collaboration plan that involves community members and the researchers in a process of information and knowledge sharing that is bi-directional, locally accessible, and indigenous rather than imposed to the greatest extent possible.

To illustrate these steps, we now describe the CBPR entry process that took place in one of the intervention communities, and the transition to module development in the intervention planning and feasibility stages of the project. It is important to note that there were important differences between the organizational structures and the resources of the grant funding across the intervention communities; however, though many of the details and events differed in important ways, the process was similar. As described in greater detail in Mohatt et al. (2014), some of these differences, such as the shorter time frame and lesser monetary resources of the grant mechanism funding for the project in the second community, provide part of the explanation for the observed differences in outcomes.

From Entry to Implementation in a CBPR Intervention Process

When Jerry Mohatt and his collaborators first went to Alakanuk, they did so at the invitation of the traditional council, and with the approval and support of the Yukon Kuskokwim Health Corporation (YKHC). The traditional council is the tribal government for the community. The YKHC is a 501(c)(3) nonprofit Alaska Native organization that provides health services as sole and single payer health provider for the region. Alakanuk is one of 58 communities in the Yukon Kuskokwim region that are each federally recognized tribes. Each of these 58 tribal governing councils, which are sovereign tribal entities, has authorized YKHC to act in its behalf in negotiating with the Indian Health Service to provide health care services under Title III of the Indian Self-Determination and Education Assistance Act of 1975. Additionally the YKHC, though the Human Studies Committee of its Board of Directors, provides health research oversight.

The initial community planning process involved explaining the role of research in the development and delivery of health interventions and concluded with a local Elder stating; “I know what this prevention is. It is what my parents gave me when I was growing up. They gave me yuuyaraq [the Yup’ik way of life], which is everything I needed to live a good life”. It is common among indigenous Elders to make statements such as these that seem to posit a utopian past and an expectation for a return to such an idyllic state through the return to traditional ways. But it is also common for indigenous Elders to allow and even to place upon listeners an expectation to make one’s own personal meaning from what is said. For Mohatt and his colleagues, this statement was a revelation that set the collaborative dynamic for the duration of the work. They took the Elder’s words as guidance to support what was already there in the community, utilizing their own knowledge and skills gained in the Western world system to strengthen and supplement local indigenous systems, that by their contemporary, post-colonial nature were necessarily syncretic and adaptable.

The research team quickly changed their focus from “how can we develop an intervention to reduce suicide and alcohol abuse among youth in the community?” to “how can research, intervention science, and social science support and enhance the healing resources already existing in the community?” This change in the research question reflected a very important shift from a researcher-driven and directed intervention development and implementation process, to a community-driven and researcher-supported process.

For the research team to take on such a critical role as part of the support system of a community, without slipping into a directive and prescriptive role, a governance structure to oversee the development and implementation of the CBPR process and intervention implementation was needed. Thus, choosing a community oversight and governance group to guide and direct the local intervention effort was the next step taken. The community had already established a joint resource group before the university became involved. This group was made up of representatives from the local organizations including the tribe, city, corporation, school, churches, Elders and natural helpers (youth). The joint resource group was given decision-making authority by the traditional council and was charged with addressing problems in the community related to the youth. Mohatt and his team were directed by the Tribal Administrator to work with the joint resource group to implement the CBPR intervention; together, this group decided to form a community planning group (CPG) specifically devoted to developing and directing the intervention.

The CPG was made up of individuals nominated by the joint resource group and included a core group of Elders, along with a group of community leaders, parents and youth that shifted in response to current needs of the intervention. The CPG and its subcommittees met 87 times during the course of the year and one half intervention planning, development, and implementation phase, often but not always with the local project staff and university-based research team. The CPG monitored progress towards intervention and research goals, made decisions regarding the use of funds and resources, and oversaw the cultural fidelity to a Yup’ik model of organizational process. Its role included assisting with the hiring selection and supervision of the two local project coordinators and the university-based project director.

One of the most important early decisions made by the community involved the decision about the focus of intervention and its orientation. The community engaged in a decision-making process, informed by a community-wide needs assessment conducted by the research team, and consultation input from numerous community members, and resolved to develop a strengths-focused intervention for youth between the ages of 12 and 18 years old and their parents, with the goal of decreasing two priority health concerns: alcohol abuse and suicide. As part of this decision-making process, Mohatt and his team presented findings from the People Awakening Project that described community, family, and individual level protective factors contributing to adult Alaska Native sobriety and well-being. A more detailed description of the development of the protective factors model can be found in Allen et al. (2014a) and an empirical test of this model is presented Allen et al. (2014b). The traditional council and the joint resource group decided to build their intervention around increasing exposure to these protective factors as they pertained to youth.

Importantly, the community leadership also decided to begin the intervention development with an emphasis on protective factors at the community and family level, rather than the individual level. This emphasis on addressing environmental indicators and external forces was consistent with a Yup’ik worldview that focuses more on understanding and addressing what is going on around the individual than addressing what is going on inside (Fienup-Riordan 1995; Rearden and Jacobsen 2009). It was stated in CPG meetings that to change what was going on with the youth in the community, first the community itself would have to change: Parents of youth and other adults in the community would have to strengthen themselves to be effective in helping their own children.

In what was a surprising decision to the university researchers, the CPG determined the intervention should include not only Yup’ik traditions and concepts, but also models from a Western psychological tradition brought by the outside researchers. Elders in particular pointed to the traditional importance of learning and acquiring knowledge from visitors. Great value had always been traditionally placed upon those who may come with knowledge or materials new to the region in that this knowledge might potentially provide useful or even life-saving contributions. The community chose an integrated and syncretic approach that would allow for multiple sources of expert knowledge in the development of the intervention without giving primacy to a single source or excluding potentially useful information. However, the overall aim was to have all information shared and the protective factors delivered by the intervention activities all within a Yup’ik setting.

The next step was to identify a series of Yup’ik settings promoting protective and prosocial activities within the community and culture, and to develop a process for ensuring the consistent delivery of protective factors within these settings. The CPG nominated a sub-committee that they named the “Work Group” (WG) to assist local staff in identifying the activities and settings that contribute to the development of healthy and strong young people, families, and communities. The WG was made up of three Elders, two local staff, two parents and two youth. The WG’s efforts were supported by the two local prevention staff who organized and recorded meetings and the university-based project director, who was a master’s level community psychology program graduate and licensed professional counselor, and traveled to the community two weeks a month through a two year period of intervention development and implementation.

Intervention Module Development at the Community, Family, and Individual Levels

The WG met weekly, or more often as needed, with the local project staff to plan the intervention activities or “modules.” University researchers introduced the term “module” as a way of identifying discrete activities undertaken as part of the intervention. The WG preferred the term “module” to “activity” because it conveyed a more formal sense of the process included in implementation of the intervention; activity seemed to them to not carry sufficient power and meaning. The resulting write-ups of modules included brief descriptions of the intervention setting for each, along with basic, adaptable process steps for delivering protective factors. This group also decided to develop community and family level modules first.

The first step in the development of a community-level intervention module involved the Elders identifying processes and practices from Yup’ik traditional values and teachings that build and create a sense of community, or as the Elders stated, a sense of “being of one mind.” All of the modules took local Yup’ik process and practice as their starting point. From this point onward, the WG, guided by the Elders, decided how to contextualize and adapt the Yup’ik process and practices to reflect contemporary concerns, context, and settings, and to include innovative and outside knowledge when necessary or desired. Not all traditional Yup’ik practices and processes are possible today, and the goal was not to go back to the way things were. Rather, contemporary Yup’ik traditions and practices were identified and built upon; these contemporary practices reflect the changed and changing social historical and cultural context. In this way, the intervention was designed not to be a temporarized set of activities from a period frozen in time, but to instead contemporize and situate an enduring cultural way of life for the present and future. The next section provides detailed case examples of how this occurred in the community development of three keystone modules at the community, family, and individual level.

Case Example of a Community Module: Qasgiq (Men’s House)

Module development typically began with a discussion to identify root causes of the issues underlying youth suicide and alcohol abuse that the intervention was seeking to address. These discussions centered on a local evaluation of how things have changed in the community and how these changes have impacted community-level process and outcomes for families and individuals. With respect to focal root causes at the community level, Elders in particular identified changes in how traditional community settings and practices that at one time brought the community together while they were growing up were no longer continuing today.

One practice Elders recalled that brought people together on regular basis was going to the qasgiq, the men’s house, that as the largest structure in a Yup’ik community would also serve as the communal sacred house and gathering place. The qasgiq was a place where all things were shared, including food, tools, and knowledge. One Elder remembered:

When I was little girl I used to hear stories about qasgiq. People used to go in qasgiq, everybody, and they used to show young teenagers how to live and what not to do. That’s the most important they used to do long ago. When a child is doing wrong and their mom and dad are ashamed of the child, they’d bring the little child or the teenager in there and let the Elders show him the right way how to live.

The qasgiq was a setting where young people not only were told about how to protect themselves and stay strong; here they were shown and given the tools they needed for yuuyaraq (to live a Yup’ik way of life). The qasgiq, aboriginally, served as the primary residence for Yup’ik men and boys, but women and girls had their place and role in the qasgiq. This role increased as the qasgiq became a more communally shared structure following missionary influences in the region, and in particular, the adoption of single-family residences.

A significant change from this community’s Elders’ experience growing-up has been the loss of the qasgiq as both a physical and an organizational structure in the community. Sacred activities that once took place in qasgiq now take place in secular spaces such as the tribal multipurpose complex, where other activities such as community meetings, bingo, and general social events occur. The qasgiq provided a local infrastructure for meeting and working together on things that would collectively benefit the people in the community. The Elders believed that when people stopped meeting and coming together in the qasgiq, things started to happen with the youth in the community that had not been happening before. Youth began acting in ways that would not have been allowed in the qasgiq. Their behaviors were going unseen and they were not held accountable because the adults were not meeting as regularly and interacting in public together.

To address these root causes, the WG decided to centralize the qasgiq as a key community level intervention module. Once the setting was identified, the work of the WG shifted towards figuring out how to re-create this setting in a contemporary context to provide young people access to the protective potential afforded to the Elders in their youth through the traditional qasgiq settings.

Since there are no longer traditional qasgiq structures in the communities, the Elders felt it was important to re-create as closely as possible the inside of a traditional qasgiq. Traditional qasgiq structures were dug into the earth in the form of a circle, with driftwood used as supports for an above ground sod ceiling and walls. The qasgiq had a fire pit in the middle of the circle, with an opening in the ceiling directly above the fire pit for smoke and light.

As part of developing the qasgiq module, the Elders developed a process to guide the youth in setting up the traditional council building to resemble the inside of a qasgiq. The young people were directed to place their chairs in a circle with only one opening and to bring in wood to make a fire pit in the middle of the circle. Candles were placed in the middle of the wood, with foil attached to the ceiling to reflect the candlelight and create an appearance of the skylight, and the room would be dimmed to resemble a semi-underground structure.

Elders also determined a process for teaching the protective factors as part of the qasgiq module. They would not just ask youth to set the chairs in a circle and make a fire pit, but would share with them why these things were important. One Elder, for example, stated:

To me the qasgiq resembles the community and the fire in the middle with the big logs resemble the Elders, and little ones, the younger people. And the community needs everybody to work together to fix our issues and that is what it reminds me of.

The meaning of the circle and the fire in the center references safe places and a community that is interdependent and strong–able to care for its own.

The Qasgiq module would further involve an explanation of the role and purpose of the qasgiq in Yup’ik culture, and a demonstration of the sacredness of the space through a purification ritual to open each qasgiq meeting. As part of the WG process, the Elders remembered important rituals that took place in the qasgiq. There was a formal way to enter and leave the qasgiq, and the men were always purifying themselves by taking fire baths. The Elders decided to have a purification ritual be a part of the qasgiq module. Since it is not possible to re-create the fire bath experience as part of the qasgiq today, it was decided to have a respected Elder burn ayuk, or tundra tea, a type of tea leaf from the tundra, and have each individual purify themselves with the smoke of the leaves. The Elders in the WG stated that the meaning of the ritual purification helps people ellangneq, or become aware, and connects each person together to create a collective being-of-one-mind. In doing this, Elders created a sacred space for learning, differentiating the instruction in this Yup’ik setting from the instructional setting of Western schooling. This ritual opening provides one example of how the community worked to contemporize traditional Yup’ik teachings to connect youth, both boys and girls, to their culture.

The final step in the module development process involved the rehearsal of the activity by the WG members and Elder instructors who would take lead in delivering the protective factors. Figure 1 is the section from the Qungasvik describing the Qasgig module. For each module, the Qungasvik follows an identical organizational format, providing first a description of the goals, objectives, and intended learning and teaching activities. Next, the physical and organizational set up work required to implement the module is outlined. Finally, suggestions are provided regarding how to introduce the module to participants, key factors and events to reinforce during the module, and how to close the module. Each module also contains three information text boxes. One lists the protective factors to be delivered by the module. A second lists the Yup’ik associated cultural values as identified by Elders and other community members, underlying the activities of the module. Both are placed in each module to emphasize their discussion with youth as part of doing the activity, and in reflection after completing the activities. A third text box provides information on cultural-historical knowledge directly relevant to the module. In the Qasgiq module write-up, this includes a schematic drawing of a qasgiq with labels for its key architecture and artifacts, and a narrative description of the structure. Through this common organizational format, the Qungasvik presents for each module the protective factors involved, processes to be engaged in, and relationship of the Yup’ik tradition it teaches to contemporary issues facing youth. Since the time of its initial inception, the Qasgiq module has gone on to become a keystone module in the overall intervention model, providing not only a localized process that is a central feature of the intervention, but also an indigenous logic model for implementing the intervention that is specific and meaningful within Yup’ik culture and communities.

Fig. 1
figure 1

Description of Qasgiq–Men’s House module from Qungasvik

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Case Example of a Family Module: Yup’ik Kinship Terms

Another root cause affecting the well-being of Yup’ik youth related to changes within the traditional kinship structure in the community. Traditional Yup’ik naming practices are the basis for this kinship system (Fienup-Riordan 2001). These practices involve not only knowing whom you are related to, but also knowing your role and responsibilities to the people in your kinship network. These kinship roles and responsibilities were culturally prescribed, detailed, wide ranging, and adhered to in traditional culture. This kinship network, maintained through Yup’ik naming practices, was vital to survival as Elders were growing up and coming of age. One Elder stated:

If you absolutely have no food and it doesn’t have to be food, it could be something you really need but have no way of getting it, your relatives are the ones to go to. This is another reason to know who you are related to. Through kinship terms you will know who you can turn to in times of need. You learned to respect people by learning who they were, who you were related to.

Most village communities in Alaska are still kinship-based communities, but relatively recent changes including the movement of families and individuals into new permanent settlements based around schools have disrupted elements of the kinship system and naming practices. Today, Yup’ik children are given an English name and a Yup’ik name at birth. Yup’ik naming is a careful, family-driven effort to recognize and develop inherent strengths in the child. Children named after a deceased grandparent, a great-grandparent, an uncle, or an aunt, inherit not only this name, but also their spirit, their gifts and talents, and their place in the family. It is still common to hear Elders address toddlers and younger children by saying “hello auntie” or “how is my apa (grandpa) today?” as an acknowledgement of their multiple roles in the extended family environment. Thus, Yup’ik names are ancestral names that connect the child within the family by passing down not just the name of the ancestor but also roles and responsibilities that the person they are named for carried.

Today, though young people are still given Yup’ik names, they are less often told in sufficient detail about who they are named after or how their names reflect these deeper kinship roles and traditions in Yup’ik society. Some people have thus forgotten or have not learned their role and responsibilities as part of the extended family. Because rural Alaska Native communities are essentially made up of a relatively small number of extended families, a healthy community requires the strengthening of families. The WG thus identified disruptions in the kinship system as a weakness in the extended family structure that contributed to youth problem behavior. The WG developed a module to address these disruptions.

As part of developing the Yup’ik Kinship Terms family-level module, the Elders and WG members first identified processes for parents and young people to learn about the meaning and function of Yup’ik kinship terms and naming practices. They identified relevant protective factors related to increased sense of kinship, such as respect for others and family role models. They identified processes and activities for a module intended to deliver these protective factors by reconnecting youth with their kinship history.

For example, as part of this module Elders would guide families through the process of knowing one’s Yup’ik name, and the roles and responsibilities that came with carrying the name. Sometimes a parent may not know the person that their own child was Yup’ik-named after, but an Elder or another family member would know, and this activity provided a setting for bringing together resource people to help make these connections. After everyone learned or was reminded of their Yup’ik name and was aware of the meaning for their naming, they would be provided instruction on Yup’ik kinship terms and their meaning. With the help of Elders, each family group would construct a genogram together, going back as far as they could, and then assign kinship terms to the family members in the genogram. Parents and youth would be asked to identify people in the family based on their strengths and resources. This was seen as a way of delivering protective factors by identifying the resource people and role models in each family. The Yup’ik Kinship Terms module was designed as a culturally grounded set of activities to connect young people and parents together within a wider and more densely interconnected network where everyone has a vital role.

Case Example of an Individual Module: Surviving Your Feelings

While many modules focused on strengthening community process and family environment, others were developed to strengthen individuals and their internal process.

Here, discussion of root causes for suicide and alcohol abuse focused on changes in the experiences and feelings that young people have today versus when the Elders were growing-up. Dealing with strong feelings has long been of central concern for Yup’ik and other Inuit (Oswalt 2011; Briggs 1970). It was important historically, to develop social as well as internal psychological protections against what were communally considered socially dangerous emotions, such as anger, grief and lonesomeness—feelings that could lead an individual to cause harm (Briggs 1970). For Yup’ik individuals aboriginally, there were socially prescribed ways for dealing with strong feelings, and as a part of these ways, these types of emotional experiences were collectively shared, providing a means for the group to assist the young person in regulating the experience of strong emotion. Elders in the WG talked about how “calm” and “quiet” their youth experience was compared to what they observe the young people experience in their village today. The Elders also noted that young people today see and experience things that they reported they did not or rarely experienced in their own youth, such as drinking parents, domestic violence, and sexual abuse. In addition, youth today grow up surrounded by a large peer cohort, with a lot more time for engaging in peer-focused activities than in their Elders’ youth. In contrast, Elders recalled while growing up going to camp with only their families for months at a time as common practice. In contrast, young people growing up in the village today go out to camp for a few days at time, if at all. Elders grew up helping their families get food, chop wood, feed sled dogs; they had important responsibilities for a myriad of tasks crucial to the welfare of their family. In general, the Elders noted that when they were young, they had much less time to spend with friends in activities outside of the household. Finally, the Elders also noted young people today experience states of mind unknown to the Elders in their youth, such as boredom, and experience feelings of peer-related anger and jealousy, with far less access to communal knowledge in how to deal with the intensity of these feelings, and fewer communally facilitated outlets for expressing them and redirecting their energies.

The intensity of young people’s feelings were both identified by the WG as related to the many community and family changes over time, including the disconnection of youth from family and cultural knowledge, and as one of the root causes for youth problem behavior. The Elders and WG identified it as particularly important in understanding youth suicide. An Elder member stated:

People want to commit suicide when they don’t deal with or talk about their feelings. Someone might be sad and soon starting thinking about committing suicide, and then if there is no help he will commit suicide. We may get hurt in many ways or hurt by losing our friends, mother, parents, brother and sisters, or somebody hurt us directly or indirectly. Sometimes we hurt other people by our mouth; by talking. And when that person finds out you’re talking about him that feeling intensifies. When you don’t talk about your feelings it intensifies and leads to suicide.

The WG identified this practice of not talking about certain topics and keeping things inside as having unintentional consequences today because of the new things that young people were experiencing and feeling. It was not just suicide-related talk that was taboo in a traditional Yup’ik context; this was part of a broader cultural norm to avoid talk about angry, hurtful, or unwanted things. Particular to the Elders experience of growing up, there were things that were not discussed openly due to cultural norms and practices related to the power of words and speech (Hensel 1996). This does not mean that feelings were not expressed at acceptable times and in acceptable places. In fact, it was common practice to talk to dogs, other animals, rocks, logs or anything in the natural environment as a way of releasing negative, and potentially harmful thoughts and feelings held within an individual (Rearden and Jacobsen 2009).

This cultural norm of avoiding public sharing of certain topics helped to keep the peace within families and communities and is a common way, both within and outside of Alaska, of maintaining social order in small, kinship-based communities (Briggs 1998; Hensel 1996). However, for members of the WG it was also seen as further contributing to young people keeping intense feelings to themselves that were sometimes overpowering. One Elder summed it up this way: “When we were growing up we had to learn how to survive our hunger and the weather; today these young people have to learn how to survive their feelings”.

To respond to this contemporary issue on the level of the individual, the WG developed a module they called Surviving Your Feelings. The goal of the module was to create a setting in the community where young people and adults could openly express their feelings and talk about issues that are not normally discussed, like suicide. The WG members identified steps in the process that included setting up a safe place for sharing; in this case a qasgiq-style meeting would be directed at elicitation and group processing of individual feelings and experiences. A community member would lead the meeting and role model protective self-expression through storytelling of a personal experience that tested their own capacity to survive, that was personally difficult, but at the same time, in surviving it, was transformational. Elders would attend the meeting in a supportive and protective capacity to witness the discussion, to role model caring and concern along with emotional regulation, and to learn about what the young people and parents are going through today in order to provide follow-up advice, support, and guidance, as this activity could potentially bring out unresolved grief and trauma.

A desired outcome of the activity was to have individuals “take out” of themselves certain strong or disturbing feelings and thoughts. In a tradition Yup’ik understanding, once such feelings are “taken out,” they are manageable within a shared, collective context, as they can then be extinguished, or cast out of the collective consciousness by the group. This activity allows talking about bad feelings and hurtful experiences normally “taken out” of everyday interaction, allowing these intense emotions to be expressed safely with others and to become part of a collective, controlled, managed, and manageable process. Prayer, purification, and ritual are mechanisms through which collective consciousness is achieved in the group assembled, and activated in this context. To appreciate the power of this group setting, it is also important for the reader to recognize how all the community participants have known each other from an early age, grown up together, often have kinship relations, and essentially, have all been members of a relatively small group of people who have know each other all their lives, within an isolated, remote community.

The individual-level modules were perhaps the modules most informed by Western psychological theory, but it would be inaccurate to understand them through elements of cognitive-behavioral therapeutic practices. While the Surviving Your Feelings module was at various points supported by some of its basic techniques, it was not developed from its theoretical knowledge base regarding theory of change or its understanding of emotional problems. Instead, it was the community that identified strong feelings and difficulties in coping with these strong feelings, in a deeply culturally patterned way, as a “root cause” of substance abuse and especially, of suicide among youth in the community. The researchers on the team with backgrounds in psychology were able to draw from their own knowledge and training regarding the role of emotions and the function of emotional management to validate and strengthen the indigenous theories regarding emotional regulation from a Yup’ik cultural perspective. However, the activities that were developed came out of this Yup’ik understanding, and came from the local process of intervention development.

As one example of how this played out, a closing ritual was created for the Surviving Your Feelings module to re-focus the activity back away from individual self-expression (typically a desired outcome in Western clinical psychology traditions), and to instead reconnect youth to protective group processes and an understanding of emotional regulation from a perspective more aligned with that of collectivism (a contrasting desired outcome from a Yup’ik healing tradition), This closing ritual involved all participants forming a circle, and engaging in an activity involving the passing of a ball of string from one person across the circle to the next, as part of a question and answer game. At the end of this therapeutic game, everyone in the qasgiq circle is holding the string and tangibly seeing their interconnections with everyone else in the circle, in a real way.

Similarly, the activity itself was led by a community member, and not by a mental health professional. The approach was patterned around traditional practices for sharing problems and resolving feelings, and consciously eschewed a professional services model. Though the professional counselor and other licensed psychologist professional staff were present, they joined with the community as witness, not as facilitators. Instead, a community member was facilitator. Finally, the activity itself was multi-level. It involved education about the psychology of emotion for youth, but at the same time, also often provided an experience of healing for many of the adult participants. In several cases, this extended, to the activity leader who gave testimonial, typically regarding trauma mastered from their own life. For many of the adult participants, the module provided a strong element of community building and of role formation through reinforcement of their caregiver role, responsible for a community of youth. In its blurring of boundaries between prevention and treatment, and in its many ties to cultural modes of healing and emotional regulation, the Surviving Your Feelings module transcended the Western psychotherapeutic approach from which it borrowed discrete elements.

Intervention Research in a Yup’ik Setting: Creating the Qungasvik (Toolbox)

Over the course of 18-months and 87 meetings, the WG developed the modules that were eventually included in the Qungasvik. These modules were combined with those developed in the second intervention community, and the resulting Qungasvik includes a total of 36 modules. In addition to the Qasgiq module, other community-level modules included Preparing for the Journey—an activity that contributes to community mobilization, Lap Ball—a traditional Yup’ik game that is somewhat like cricket, Storytelling—an activity that revives the oral tradition, and Prayer Walk—an activity that addresses the spirit and spiritual wellness of the community.

Along with the Yup’ik Kinship Terms module, other family-level modules included Traditional Yup’ik Parenting in the Twenty-First Century—an activity with a curriculum developed by a Yup’ik team of Elders and cultural experts that teaches parents how to use Yup’ik disciplinary techniques and socialization practices today, Arenqiirturyaraq (Protectively Caring for Our Youth)—an activity that reinforces strengths-based parenting practices, and Staying on Task—an activity that engages parents and youth together in a traditionally important activity like sewing skins of animals to make mittens, boots or parkas, making spears or spear throwers or other tools to live.

In addition to the Surviving Your Feelings module, other individual level activities included Murilkelluku Cikuq (Watch the Ice)—an activity that involves ice safety instruction and the construction by each youth of an ayaruq, a tool symbolizing protection, with a probe on one end designed to test river ice stability and navigate overflows, and a grappling hook on the other to allow a person to survive breaking through the ice by allowing a means to pull oneself out of the water, Awareness of Alcohol Effects—a syncretic activity that combines local experiences and knowledge of alcohol and its adverse effects with Western biomedical knowledge on the effects of alcohol on the body and the brain, Seal Hunting—and activity that engages male youth in a traditional rite of passage to becoming a young man; Unataryaraq (Berry Picking)—an activity that engages youth on the tundra in an activity traditionally associated with a rite of passage for girls; and Rumors and Gossip—an activity directly addressing the adverse effects of talking about others in harmful and hurtful ways.

The process of creating the modules that make up the Qungasvik was community-driven, but not without its tensions and challenges. One example of a tension concerned consensus building around what constitutes a protective experience for young people and what constitutes Yup’ik cultural practices that should be used to create them. Not all of the CPG and WG members agreed all of the time about which Yup’ik settings and practices should be part of the intervention. In one of the communities, a minority contingent in the community was against the use of purification rituals as part of creating an intervention setting. This group felt that the practice was not a traditional Yup’ik one and went against their current beliefs, some of which were rooted in their fundamentalist church membership. The Elder leadership decided to retain the ritual purification practice but made clear that participation in the smudging ritual with ayuk was optional for those participating in the activity.

Consensus building is particularly critical in CBPR intervention research. As is the case in many health disparities settings, for a variety of complex reasons, interventions undertaken in an indigenous community context ideally require significant buy-in from the members of the community. Interventions that are developed within the cultural and community context, and created by community members themselves are more likely to achieve this buy-in. It is nearly impossible, though, to involve and represent an entire community in this type of process, and invariably someone or something gets left out or rendered incompletely.

This critical negotiation is at the center of tensions experienced in trying to develop and implement interventions that utilize “culture” as a primary mechanism for prevention. Indigenous culture and cultures are constantly changing and adapting to contemporary conditions, and historical memory tends to shift with the changing circumstances. There is tendency among indigenous groups, as well as their non-Indigenous allies in the work, to romanticize the pre-colonial, aboriginal experience, and to present indigenous culture uncritically as a conduit in the production of healthy, happy youth and communities. Increasing, indigenous researchers are questioning the utility of such non-reflexive “culture is prevention” approaches by identifying aspects of indigenous culture history and ways of living that were not always protective and nurturing, and in some instances that even contributed to personal and collective trauma (Gone 2013). In many ways, the intervention described in this article represents a development in this type of reflexive examination and syncretic expression of an indigenous cultural tradition.

The community negotiated this complex process by first identifying those aspects of Yup’ik yuuyaraq (ways of life) that were protective and strengthening, and then devising ways to promote and more consistently reproduce these functional aspects in a contemporary Yup’ik context. Elder leadership was essential in identifying protective factors in contemporary Yup’ik contexts and, indeed, one overall consequence of the module development was an unanticipated ripple effect separate from the aims of the project; the re-emergence of Elders as sources of authority and protection. As one adult member of the community observed, “the project took the Elders off the shelf, and made them useful again.”

Conclusion

This paper represents an effort to fill in another of the many pieces of the complex, culturally grounded intervention described in this special issue. The intent has been to provide a more in-depth narrative about how theory became practice than is often available in the literature. The intervention development process described and its accompanying creation of the Qungasvik provide examples of how culture can combine with CBPR to create a locally valid and meaningful program of intervention activities. More broadly, the Qungasvik manual represents the results of a CBPR intervention development process grounded in culture and local process. It is further representative of a syncretic and reflexive blending of Indigenous and Western theories and practices, with important implications for cultural approaches to treatment and prevention in indigenous and non-indigenous communities.