The Pre-implementation Process of Adapting a Culturally Informed Stress Reduction Intervention for Native American Head Start Teachers

Head Start is a federally funded program for children (3–5 years) from low-income families. In the Fort Peck Native American Reservation, tribal Head Start teachers have reported high stress in supporting children experiencing adverse childhood experiences. Thus, we adapted the Little Holy One intervention (ClinicalTrials.gov: NCT04201184) for the teachers’ context and culture to enhance psychological health and well-being. Within a participatory framework, the eight-step ADAPT-ITT methodology was used to guide the adaptation process: assessment; decision; adaptation; production; topical experts; integration; training; and testing. For Step 1, we purposive sampled 27 teachers, ancillary staff, and parents to understand teachers’ stress, support mechanisms, and interest in an intervention via focus groups ( n = 9) and individual interviews ( n = 18). Qualitative data underscored teachers’ experiences of stress, depression, and need for support (Step 1). Iterative feedback from a tribal advisory board and Little Holy One designers rendered selection of five lessons (Step 2, 5), which were adapted for the teachers via theater testing (Step 3, 4). Community capacity assessment revealed their ability to implement the intervention (Step 6). Testing of this adapted intervention in a feasibility trial (steps 7, 8) will be reported in a future publication. A rigorous systematic process within a participatory framework allowed intervention adaption based on community input. Leveraging “culture as treatment” may be useful for enhancing psychological health outcomes for Native Americans who historically underutilize existing psychological services.