The origins of the curriculum lie in grief and resolve. Following devastating youth losses, a delegation of White Mountain Apache Tribal leaders met with the Johns Hopkins Center for Indigenous Health to expand their long-standing public health partnership into mental health. In 2001, exercising its political sovereignty, the Tribal Council passed a resolution establishing the Celebrating Life System, a tribally mandated suicide surveillance and case management system that has been linked to documented decreases in suicide deaths and attempts. Building on that foundation, an Elders’ Council formed and emphasized the importance of passing Apache language and traditions to youth as an upstream defense against suicide risk, which peaks between ages 15 and 24. The Elders chose to intervene earlier, at a developmental stage when children can comprehend and retain teachings about identity, belonging, and resilience. Since 2015 the curriculum has been delivered in reservation schools through monthly lessons that include Elders speaking Apache, sharing songs and stories, and assigning seasonal responsibilities for youth to practice with their families.

Scientifically, the study addresses a stubborn gap in prevention science. Culturally grounded interventions — those designed from the ground up with culture, values, and Indigenous worldviews at the forefront — are deeply valued by Native communities, yet they remain under-evaluated in the empirical literature. Standard Western frameworks assume a linear pipeline from intervention development to efficacy testing to scale-up, an approach rooted in Eurocentric knowledge construction that privileges cognition over lived experience, spirit, and relationality. The research team, led by Victoria M. O’Keefe of the Cherokee Nation and Seminole Nation, deliberately Indigenized this process, replacing the linear model with a relational, orbital, and iterative one. The goal was twofold: to identify the core components of the Elders’ Resilience Curriculum and the mechanisms through which it works, providing a theoretical basis for evaluation and future scaling, while safeguarding Apache teachings that have historically been shared orally and never disseminated outside the Tribe.

The study employed a non-parallel convergent mixed methods design embedded in Indigenous Community-Based Participatory Research. Rather than treating community members as subjects, the team worked with a Community Advisory Board of ten White Mountain Apache members who reviewed the design, interpreted results, and shaped dissemination. Language itself was decolonized: partners preferred the term “youth strength factors” over “protective factors against suicide,” reframing the work as strengths-based life promotion rather than deficit reduction. The research unfolded in deliberate steps, beginning with a consensus survey completed by faculty and staff involved in the program, who rated 31 potential core components and 13 potential youth outcomes for importance. A virtual consensus meeting then resolved ambiguities, ultimately confirming 28 core components rated very important or useful, spanning program activities, format and setting, curriculum delivery, organizational support, and Elder knowledge and training.

The qualitative phases brought the community’s voice to the center of the analysis. Focus group discussions with Elders and in-depth interviews with youth, caregivers, teachers, and Tribal leaders illuminated what makes the program meaningful. Participants described the intergenerational bonds forged when Elders enter classrooms, with one Tribal leader noting that Elders carry the wisdom to navigate life’s hardships and that connection between generations is “definitely needed.” Another leader described the ripple effect of a single lesson: a student goes home, shares an Elder’s words about respect with a parent, and plants seeds of dialogue that spread through the classroom, the school, the home, and the larger community. Elders spoke of pride in carrying forward the tools their own ancestors shared with them, now teaching children how to use those tools to weather storms and solve problems.

To identify the theoretical mediators — the youth strengths the curriculum is meant to build — the team used Nominal Group Technique, a participatory method in which participants independently generate, rank, and prioritize ideas. Community mental health specialists, youth ages 11 to 13, and youth ages 14 to 17 each produced ranked lists of what keeps young people strong and connected. The final consensus identified four paramount strength factors: connection to family, connection to religion and spirituality including prayer, connection to Elders through learning from and helping them, and connection to culture, encompassing cultural history, activities, and traditional foods. Notably, youth prioritized sleep and sports, factors not currently addressed in the curriculum — an input that points toward possible new lesson topics as Elders continue iterating the program. Community members framed expected outcomes as “positive changes,” spanning mental, emotional, spiritual, and social health, academic achievement, identity, belonging, Apache language, and cultural continuity.

The study’s most innovative methodological step came with pile sorts, in which Elders, youth, and community mental health specialists sorted notecards representing core program activities, youth strengths, and potential outcomes, mapping the relationships among them. Participants consistently described the elements as interconnected rather than sequential — a reciprocal, relational web rather than a causal chain. When the research team drafted a conventional linear theoretical model showing activities producing strengths that produce outcomes, Community Advisory Board members pushed back decisively. One member explained that everything moves back and forth constantly, a give and take rather than “this causes this causes that.” The model, they insisted, had to be circular.

The community’s answer to how to visualize that circularity came from Apache teachings themselves. A community mental health specialist and artist shared that he pictured the model as a cottonwood tree, a symbol whose specific teaching cannot be written or shared outside the Tribe. In his visualization, the core components form the roots, the youth strength factors form the trunk, and the positive changes form the branches and leaves. Other specialists added that trees hold knowledge and keep growing, and that new leaves replacing old each year mirror how youth learn, grow, and gain strength. Elders on the Elders’ Council affirmed the teaching, noting that the color yellow in the artist’s painting represents life in Apache tradition. A White Mountain Apache graphic designer then digitized the model, producing a theoretical framework grounded entirely in the community’s own Knowledge System — a living, growing structure rather than a static flowchart.

The implications extend well beyond one reservation. Other American Indian and Alaska Native communities have expressed interest in adapting the curriculum, and this research offers a pathway for scaling culturally grounded programs while respecting their origins: other communities can follow the same participatory process to integrate their own languages, knowledges, and practices rather than importing Apache content. The study also carries lessons for mainstream prevention science, challenging rigid fidelity requirements and suggesting that Indigenous interventions should remain dynamic, evolving documents shaped by community experts rather than academic ones. Limitations include COVID-19 pandemic delays that forced retrospective reporting and a purposive sample not designed for generalizable statistics. Yet the strengths are substantial: the research supported the re-implementation of the curriculum in fall 2023, empowered local interpretation at every stage, and culminated in community dissemination. Ultimately, the cottonwood tree model stands as both a scientific framework and a cultural statement — evidence that suicide prevention can be rooted in sovereignty, sustained by Elders, and measured in the flourishing of the next generation.

Subject of Research: Co-developing a theoretical model for the Elders' Resilience Curriculum, an Indigenous culturally grounded school-based suicide prevention intervention of the White Mountain Apache Tribe

Article Title: The Elders’ Resilience Curriculum: Co-developing a theoretical model of an Indigenous culturally grounded preventive intervention

Article References: O’Keefe, V. M., Goklish, N., Sinquah, F. L., Grubin, F., Haroz, E. E., Sierra, V., Cwik, M., Suttle, R., Cosen, E., Velasquez-Brawley, V., Garcia, M., Rock, H., Pablo, E., Cosen, R., Whitesell, N., Gallo, J. J., Keshen, R., & Barlow, A. (2026). The Elders’ Resilience Curriculum: Co-developing a theoretical model of an Indigenous culturally grounded preventive intervention. SSM – Mental Health, 10, Article 100701. https://doi.org/10.1016/j.ssmmh.2026.100701

Image Credits: AI Generated

DOI: 10.1016/j.ssmmh.2026.100701

Keywords: White Mountain Apache Tribe, Indigenous mental health, suicide prevention, Elders' Resilience Curriculum, culturally grounded intervention, Community-Based Participatory Research, Apache language, intergenerational connection, cultural continuity, prevention science, youth resilience, self-determination

The Grog survey app represents a pioneering blend of technology and public health, devised to address the pressing issue of alcohol misuse among Aboriginal and Torres Strait Islander populations. Alcohol consumption in these groups presents unique challenges due to historical, socio-economic, and cultural factors that have long influenced drinking behaviors and health outcomes. Researchers are now focused on harnessing modern technology to offer insightful and personalized feedback enhancing awareness and encouraging informed decision-making regarding alcohol use.

A mixed methods study protocol underlies the adaptation of this app, ensuring that the development process is not only evidence-based but also voices the concerns and experiences of the target demographics. Such an approach emphasizes an understanding of the cultural context surrounding alcohol consumption and the barriers faced by these communities in accessing traditional health resources. The adaptation process involves ongoing consultations with community stakeholders to tailor the app’s functionalities, ensuring relevance and acceptance.

The innovative features of the Grog survey app include self-reporting functions that allow users to track their alcohol intake and receive real-time feedback on their drinking patterns. The app is designed to be intuitive and engaging, providing a user-friendly interface that encourages consistent interaction. By integrating motivational messaging and culturally appropriate content, it seeks to empower users to make healthier choices regarding their alcohol consumption.

Community engagement is pivotal in this project. The involvement of local Aboriginal and Torres Strait Islander health services ensures that the app reflects the unique cultural nuances surrounding health and well-being in these communities. Through workshops, focus groups, and interviews, researchers gather qualifiable and quantifiable data, enhancing the app’s effectiveness. This collaborative spirit aims to cultivate a sense of ownership among users, fostering a supportive environment that encourages discourse on alcohol-related issues.

Moreover, the timing of this initiative is paramount. With rising concerns regarding alcohol consumption and its impact on health disparities, there is a pressing need for interventions that resonate with the specific socio-cultural realities of Aboriginal and Torres Strait Islander peoples. By leveraging technology, the Grog survey app aims to bridge gaps in current alcohol treatment frameworks, creating accessible pathways to support and resources.

The pilot testing of the app is anticipated to yield crucial insights, enabling researchers to evaluate its effectiveness in real-world settings. Early user feedback will provide valuable data, allowing researchers to refine the app further and adapt it to the evolving needs of the community. This iterative process is essential in ensuring that the app remains relevant in addressing the ongoing challenges surrounding alcohol use and abuse.

Beyond immediate health benefits, the Grog survey app embodies a long-term vision of sustainable change. By facilitating open dialogues about alcohol consumption and fostering healthier lifestyles, it contributes to a broader strategy of improving health outcomes and promoting well-being in Aboriginal and Torres Strait Islander communities. The goal is to instill a sense of agency among users, empowering them to take charge of their health narratives.

In the Australian context, addressing alcohol misuse and its associated health implications has been fraught with challenges, underscoring the necessity for tailored interventions. The Grog survey app stands out not only for its cultural sensitivity but also for its commitment to fostering collaborative efforts between researchers, health professionals, and community members. This collective engagement is pivotal for success and serves as a model for future health interventions targeting Indigenous populations.

The findings and outcomes of this study are expected to contribute significantly to the existing body of knowledge surrounding alcohol use and Indigenous health. It is anticipated that the lessons learned from the adaptation and implementation of the Grog survey app will inform similar initiatives both nationally and internationally. The exploration of technology-assisted health interventions can help redefine how public health approaches alcohol-related issues, particularly in culturally diverse populations.

Ultimately, the success of the Grog survey app may hinge on its ability to spark conversations around alcohol use and encourage proactive behaviors among users. By promoting awareness and facilitating access to health resources, the app seeks to dismantle barriers and stigmas associated with alcohol consumption in Aboriginal and Torres Strait Islander communities. The integration of empathy, technology, and community voice stands to empower individuals and effect change in health behaviors.

In summary, the adaptation of the Grog survey app symbolizes a significant step forward in addressing alcohol misuse through culturally appropriate and technological innovations. The commitment of the research team to inclusivity, community engagement, and evidence-based practices sets a precedent for future public health initiatives. This project not only represents hope for the immediate health issues at hand but also exemplifies the potential of technology in enhancing well-being among Indigenous populations.

As the world witnesses the evolving landscape of digital health applications, the lessons learned from the Grog survey app will likely reverberate throughout academic and healthcare communities. Continuous monitoring of its impact and effectiveness will provide valuable insights into the intersection of technology and public health, informing future endeavors aimed at promoting health equity among marginalized populations.

In conclusion, the Grog survey app offers a glimmer of hope in the ongoing fight against alcohol-related health issues within Aboriginal and Torres Strait Islander populations. By integrating community feedback, technological innovation, and an understanding of cultural contexts, it stands poised to make a significant impact in improving health outcomes and reshaping narratives surrounding alcohol consumption in these communities.

Subject of Research: Alcohol screening and feedback in Aboriginal and Torres Strait Islander health services.

Article Title: Adapting the Grog survey app for alcohol screening and feedback in Aboriginal and Torres Strait Islander health services: a mixed methods study protocol.

Article References:

Dzidowska, M., Conigrave, J.H., Wilson, S. et al. Adapting the Grog survey app for alcohol screening and feedback in aboriginal and Torres Strait Islander health services: a mixed methods study protocol.
Addict Sci Clin Pract 20, 70 (2025). https://doi.org/10.1186/s13722-025-00602-w

Image Credits: AI Generated

DOI: https://doi.org/10.1186/s13722-025-00602-w

Keywords: Alcohol, Aboriginal Health, Torres Strait Islander Health, Digital Health, Mixed Methods Research, Public Health Interventions.

Understanding the prevalent eating disorders in the pediatric population necessitates an exploration of risk factors and cultural influences. The Latino community, characterized by its rich traditions and specific societal pressures, presents a unique case study for researchers delving into this pressing health issue. The multitude of factors—from familial expectations to societal standards of beauty—plays a significant role in shaping the experiences of young Latino individuals struggling with their body image. This intervention aims to bridge the gap between existing healthcare practices and the lived realities of these children and their families.

The foundation of this innovative research emanated from focus group discussions, which served as an essential mechanism for gathering insights directly from the community. These groups comprised children, parents, and healthcare providers who provided a comprehensive view of the existing barriers in accessing effective care. The qualitative data derived from these discussions was invaluable, revealing the cultural stigmas surrounding mental health and body image that often impede individuals from seeking help.

Participants highlighted a profound disconnect between conventional healthcare approaches and their specific emotional and cultural needs. Many emphasized that across various settings, there is a significant lack of cultural competence among healthcare providers, resulting in feelings of alienation for Latino families. This feedback is crucial, indicating that to foster a healthier environment for those grappling with eating disorders, interventions must be contextualized within the cultural frameworks of the individuals involved.

In addition to providing culturally sensitive educational resources, the proposed intervention will train healthcare providers on effective communication and culturally competent care practices. This dual approach will enhance the overall quality of care for Latino children experiencing eating disorders. The findings of the study highlight the importance of integrating cultural context into healthcare initiatives to develop more effective treatment strategies tailored to specific populations.

Moreover, researchers found that family dynamics play a pivotal role in shaping attitudes towards eating and body image among Latino youth. It became clear that parents often possess their own unresolved issues regarding body image, which they may inadvertently project onto their children. Understanding and addressing these familial dynamics will be paramount in facilitating healthier conversations about body image and diet among Latino families.

The researchers also noted the influence of media portrayals of body image and beauty standards, which heavily impact young Latino individuals. The saturation of idealized body images in popular culture can contribute to the development of disordered eating behaviors among susceptible youth. This insight reinforces the necessity for community-wide discussions about media literacy and self-acceptance as tools for combating these pervasive issues.

With the advent of this culturally informed intervention, the researchers aim to set a new precedent for pediatric care that respects and incorporates the values and experiences of Latino families. Feedback loops established through focus groups will continue to inform the development and implementation of the program, ensuring it remains relevant and impactful. By prioritizing the voices of those directly affected, the intervention seeks to create a sustainable model of care that can be adapted by other communities facing similar challenges.

Additionally, it is critical to evaluate the long-term impacts of these interventions on the health outcomes of Latino youth. The study’s researchers advocate for ongoing assessments to measure changes in eating behavior, body image perception, and overall mental health. By systematically documenting these changes, healthcare providers can refine their approaches to better serve not only Latino families but also other diverse groups facing comparable challenges.

In conclusion, the insights generated from this study represent a beacon of hope for addressing the complexities of eating disorders within the Latino community. As the healthcare field moves towards more inclusive practices, the lessons learned here may pave the way for broader applications in pediatric care across diverse cultures. The potential to influence policy, funding, and educational initiatives stems from this research and speaks to the critical nature of culturally sensitive healthcare practices.

The journey towards effective, equitable healthcare for all requires a commitment to understanding and integrating the diverse backgrounds and experiences of patients. With further research, tailored interventions can be developed, ensuring that no child is left behind in the pursuit of health and wellness. As we gather more stories from the community and refine our approach, there exists a hopeful frontier where healthcare can be a unifying thread, rather than a divisive barrier, in the lives of children battling eating disorders.

Subject of Research: Culturally sensitive intervention for eating disorders in the Latino community.

Article Title: Laying the groundwork for a culturally sensitive pediatric primary care eating disorders intervention for the Latino community: insights from focus groups.

Article References:
Rodriguez, I., Valdez-Aguilar, M., Reyes-Rodríguez, M.L. et al. Laying the groundwork for a culturally sensitive pediatric primary care eating disorders intervention for the Latino community: insights from focus groups. J Eat Disord 13, 274 (2025). https://doi.org/10.1186/s40337-025-01451-3

Image Credits: AI Generated

DOI: https://doi.org/10.1186/s40337-025-01451-3

Keywords: eating disorders, Latino community, pediatric healthcare, cultural sensitivity, primary care intervention.