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Suicide remains the third leading cause of death among youth and represents one of the most persistent health disparities affecting American Indian and Alaska Native (AIAN) communities. Strategies that promote everyday, community-led suicide prevention practices within AIAN contexts have shown promising evidence. However, little is known about how to identify and address the contextual complications that arise for implementation of approaches that depart from top-down, expert driven activities (e.g., risk detection, clinical treatment), to community-driven activities (e.g., talking safely about suicide, building social connection, and safe firearm storage). To support transformative change in practice and policy, further insights are needed into the local conditions that shape the success of dissemination and implementation strategies in AIAN community settings.
Methods
This study draws on focus groups and ethnographic field observations to examine the contextual determinants of implementing suicide prevention programs in two distinct AIAN communities. At one site, on a Northern Plains reservation, we examined the implementation determinants for using social network data from the Tribal Reservation Adolescent Connections Study (TRACS). In the second site, in rural Alaska, we examined a novel approach of partnering with a higher education program to implement an evidence-based program, Promoting Community Conversations About Research to End Suicide (PC CARES), in Alaska Native communities.
Design of focus groups and field observations was grounded in participatory approaches. For example: collaboration with community leaders on recruitment of participants, and local steering committee oversight for measurement design and interpretation of results. Focus group guide and qualitative analyses were informed by the Consolidated Framework for Implementation Research (CFIR), an evidence-based implementation determinants framework.
Results
We report barriers and facilitators to implementing community-based suicide prevention programs, including common and distinctive contextual determinants across these two AIAN communities. Our findings highlight AIAN community features for each of the CFIR domains, (Inner Setting, Outer Setting, Intervention Characteristics, Implementation Process, Individuals Involved), centering perspectives of local service providers, who are often tasked with implementing community-based programs. We reflect on these findings in light of sociocultural considerations and the differing stages of intervention development occurring in each community.
Conclusion and Implications
This study elevates AIAN community voices and works towards strategies that bridge social work prevention research and practice. Results highlight the importance of structural supports for community implementation, including resources and training to facilitate collaborative relationships that connect stakeholders across multiple community sectors. In alignment with the 2026 SSWR conference theme, this work demonstrates how research approaches that blend evidence-based practice and local knowledge can catalyze real-world changes in local practice, moving beyond evidence creation to transformative community impact.