Native American adolescents help shape “Safe Passage” project

CAIH research team.jpeg

The team behind the Alliance’s “Safe Passage for Native American Adolescent Girls” Impact Grant recently returned from two site visits to help establish the new project.

Allison Barlow, director of the Johns Hopkins Center for American Indian Health, and her team, which includes Teresa Brockie from the School of Nursing and Takera Igusa from the Whiting School of Engineering, have been working since September to develop Safe Passage, an app that aims to promote healthy relationships and reproductive health among Native American adolescent girls, while providing support to prevent suicide and substance use.

During the visits, the team met with members from the Fort Peck Indian Reservation in Montana and the White Mountain Apache tribe in Arizona. They reviewed the purpose and progress of Safe Passage with community advisory boards, conducted round tables to address the needs of adolescent girls, and selected members for youth-led design teams who will work to create graphics and content for the app.

“We’re in a formative development stage to design the app with the communities,” Barlow said. “Specifically, we’re working with the youth on the design process. We’re hiring youth who will form design teams in both communities to help design the content and graphics for the app.”

Planning the app

Planning the app

Safe Passage will provide girls ages 13 to 17 with information on four key areas: relationships; reproductive health; suicide; and substance use. In addition, the roundtables revealed that the girls want the app to have content to help them plan for the future—including school and career planning. The girls also endorsed inclusion of an emergency call button that will alert their immediate safety net—family or friends who they choose—if they are in harm’s way. Core to the work is incorporating cultural values and positive tribal knowledge and identity into the app design.

“Underlying our work is the goal to promote strong womanhood, strong girlhood, and traditional knowledge that supports positive cultural identity—factors that our previous research shows help buffer adolescent girls from potential traumas,” Barlow said.

The idea for Safe Passage evolved out of work of the Center for American Indian Health, along with Brockie’s research on risk and protective factors for trauma among Native American adolescents. In addition, another of Barlow’s colleagues, Emily Haroz, had previously worked with Igusa, from the School of Engineering, who is designing the software for the app with two of his PhD students.

For Barlow, the interdisciplinary aspect of the Alliance grant has been incredibly beneficial.

“All of us are spending more time on this than afforded by the grant, because we’re deeply invested in the work,” Barlow said. “We would never have had the opportunity to work with Tak otherwise, and I think it’s also really solidifying our Center’s work with the School of Nursing, and we love it.”

The collaboration with the Native American communities originated from previous relationships the team has had with the two tribes. The Center has been working with the White Mountain Apache since the 1980s, and Brockie has previously worked with the Fort Peck community.

“I’ve been working with them since 2011. I initially did an adolescent-suicide study with them, and we’re getting ready to implement an intergenerational trauma intervention,” Brockie said. “When this announcement came up, we thought it was a good idea to collaborate together to work on these projects.”

Barlow explained that originally her team had planned to take two already-existing apps—MyPlan, developed by faculty at the Johns Hopkins School of Nursing, and Crush, designed primarily for African American and Latinx communities—and adapt them for Native American girls. However, once the team began to work with the tribes they realized they would need to start from scratch in order to make the app as culturally relevant as possible.

Participants of adolescent health program in Whiteriver, AZ/Fort Apache. Photo credit: Ed Cunicelli

Participants of adolescent health program in Whiteriver, AZ/Fort Apache. Photo credit: Ed Cunicelli

Barlow hopes to complete the design phase by December, and then spend the subsequent pilot period learning which aspects of Safe Passage are the most popular—via chatbots, surveys, and back-end data analysis. Eventually, the team plans to measure the app’s impact on its four key focus areas, as well as its effects on users’ cultural identity, knowledge, autonomy, and planning for the future.

“The design of the app itself will allow us to get constant input and reflection from those who are using it,” Barlow said. “In both communities we have a system for continually reporting progress to the tribal leadership, including community advisory and health boards, and Tribal Councils.”

In the future, the team hopes to expand Safe Passage to other tribal communities and demographics.

“If we’re building an app for adolescent girls, why not also build an app for adolescent boys?” Brockie said. “I think that will be a next step.”

Barlow and Brockie agree that the best part of the project is working with adolescents, who are all excited about helping develop Safe Passage.

“It’s been inspiring and incredibly moving at times,” Barlow said. “The girls we’ve spoken to are so strong. They have shared a lot about the challenges they face. There’s a huge need for the app and the resources they seek.”

Article by AHW Global Health Scholar Alyssa Wooden. Alyssa is majoring in Public Health Studies and minoring in Environmental Studies. Since 2017 she has served as the editor for the Johns Hopkins News-Letter and has worked with a local organization to prepare policy briefs for environmental impacts on child health.