With a Spirit that Understands: Reflections on a Long-term Community Science Initiative to End Suicide in Alaska

Abstract

This retrospective analysis of a long-term community based participatory research (CBPR) process spans over two decades of work with Alaska Native communities. A call to action from Alaska Native leadership to create more effective strategies to prevent and treat youth suicide and alcohol misuse risk initiated a response from university researchers. This CBPR process transformed into a collaborative effort to Indigenously-drive and develop solutions through research. The People Awakening project started our team on this translational and transformational pathway through community intervention science in the Central Yup’ik region of Alaska. We examine more deeply the major episodes, and their successes and struggles in maintaining a long-term research relationship between university researchers and members of Yup’ik Alaska Native communities. We explore ways that our CBPR relationship has involved negotiation and engagement with power and praxis, to deepen and focus attention to knowledge systems and relational elements. This paper examines these deeper, transformative elements of our CBPR relationship that spans histories, cultures, and systems. Our discussion shares vignettes from academic and community perspectives to describe process in a unique collaboration, reaching to sometimes touch upon rare ground in emotions, tensions, and triumphs over the course of a dozen grants and twice as many years. We conclude by noting how there are points where, in a long-term CBPR relationship, transition out of emergence, into coalescing and transformation can occur.

We are made up of both body, spirit and our destiny, but our body is intelligent and has a spirit that understands. –Joe Eagle Elk, (Mohatt & Eagle Elk, 2000), p. 130)

This quote is drawn from an account of the life, training, and practice of Lakota traditional healer Joe Eagle Elk, as recorded and co-authored with the late Gerald (“Jerry”) V. Mohatt, a longtime student, colleague, and friend of Eagle Elk. The story of our long-term community science initiative in Alaska begins here, with this special relationship between two doctors of different trades and training. Brought up within dissimilar worlds, with bodies and destinies seemingly divergent in particularity and path, the two came together with a spirit to understand the power and mutuality of both their gifts. The collaboration fostered a connection that would transcend their lifetimes in a new research relationship and projects that followed.

Mohatt and Eagle Elk would form their bond while working in service to the Lakota people (Mohatt & Eagle Elk, 2000). Mohatt first came to the Rosebud Reservation as a Jesuit in the early 1960s, bringing a concern for social justice. The concern provided his calling to the community, and Mohatt would go on to develop educational and behavioral health programming for the Rosebud Sioux Tribe, notably becoming the founding president of Sinte Gleska Tribal College (now Sinte Gleska University (Mohatt, 1978). Throughout his time on the reservation, Mohatt also developed and maintained close, familial relationships with members of the Tribe. These relational experiences would deeply influence his research career. Resulting new understandings would shape an approach to science that would later influence a large-scale community effort directed to address suicide and alcohol misuse among Yup’ik Alaska Native youth through a focus on strengths and well-being (Allen, Mohatt, Beehler, & Rowe, 2014).

This paper provides a retrospective analysis of a long-term community-based participatory research (CBPR) partnership with rural and remote Yup’ik Alaska Native communities along the Bering Sea Coast (Table 1) spanning over two decades. We retrospectively map key relational pathways in the development of strengths-based, community-level and cultural strategies to reduce youth suicide and alcohol misuse (Allen et al., 2018). We systematically explore qualities of the relationship that have contributed to both success and struggle and examine steps and missteps in a CBPR effort in service to the Indigenous people and communities of Alaska.

Table 1.

People Awakening Translational Pathway

Project title	Funding Years	Funding Agency
People Awakening Project: Discovering Alaska Native Pathways to Sobriety	1998–2002	National Institutes of Alcohol Abuse and Alcoholism (NIAAA) R01AA11446–03
Cuqyun (Measurement)	2006–2007	National Institutes of Alcohol Abuse and Alcoholism (NIAAA) R21AA016098
Ellangneq (Awareness): CBPR Feasibility and Pilot Study	2005–2008	National Center for Minority Health and Health Disparities (NCMHD) R24MD001626–4
People Awakening Resilience Project	2005–2008	National Institutes of Alcohol Abuse and Alcoholism (NIAAA) R21AA015541
Elluam Tungiinun (Towards Wellness)	2008–2013	National Institute of Minority Health and Health Disparities (NIMHD) R24MD001626–4
Qungasvik Youth Sobriety Project	2011–2014	State of Alaska Designated Legislative Grant Program 12-CD-580
Qasgiq (Communal House): Dissemination Using Yup’ik Indigenous Implementation Strategies	2013–2016	National Institute of Minority Health and Health Disparities (NIMHD) R24MD001626–8
Qungasvik (Toolbox): Prevention of Alcohol/Suicide Risk in Alaska Native Youth	2015–2020	National Institutes of Alcohol Abuse and Alcoholism (NIAAA) R01AA023754
Emmonak Native Connections	2016–2021	Substance Abuse and Mental Health Services Administration (SAMHSA) SM063445
Toksook Bay Native Connections	2016–2021	Substance Abuse and Mental Health Services Administration (SAMHSA) SM063557
Scammon Bay Native Connections	2016–2021	Substance Abuse and Mental Health Services Administration (SAMHSA) SM063556

We open with an examination of the literature from other long-term North American Indigenous CBPR projects. We are influenced by Guishard’s (2009) definition of participatory research through aspiration to construct inquiry that is democratic and transparent using collaboration based in equal partnerships. Through review of the literature, we attempt to place our own work within a broader context of community-engaged, Indigenous health disparities research. The surface, or more external aspects of engagement in a CBPR process of democratization of research includes considerations such as; attending to the location and physical dimensions of a space, modifying linguistic registers and communication styles, and adjusting attitudes (Burhansstipanov, Christopher, & Schumacher, 2005; Israel et al., 2010). All these aspects of engagement were important early on in our CBPR process. However, we seek here to examine ways our work has deepened over time beyond these more typically represented elements and forms. In key aspects, this aligns with a conceptual model of distinctions between surface structure and deep structure in CBPR (Okamoto, Kulis, Marsiglia, Steiker, & Dustman, 2014). As the work has matured, often following hardship and relational crises, its nature changed in structure and form. This occurred through events often not discussed in the published literature (Seifer & Sisco, 2006), but normal and expected through the course of close relationships sustained over time and distance: distance is used here in both a geographic and cultural sense. These deeper aspects of engagement extended beyond the traditional principles of ‘community engagement in a university science process;’ into some new category of inquiry that might instead be described as ‘university engagement in an Indigenous community science process.’ This transformation took place as university researchers and community partners together moved away from considerations of youth suicide, to examine the deeper, Indigenous systems and structures contributing to strengths, protection, and Alaska Native well-being.

To describe the journey, our discussion presents a series of experiential, process-focused vignettes that began with a prehistory (Sarason, 1988) on the Great Plains, pre-dating the Alaska research relationship. We focus our storytelling on key events in our relationships that propelled or stalled the work in its movement along a translational pathway, from discovery-based research, to intervention and an Indigenous implementation science. As part of a team dialogue, we interrogate the poetry of an Indigenous Yup’ik system continually unfolding, as it reconfigures in response to harsh perturbation introduced through opposing colonial systems. These colonial systems have included, at times, the researcher partners’ own scientific methods and epistemologies. Thus, the relational stories presented here reveal important and instigating interplay between frameworks and their accompanying psyches, as stories developing alongside the telling of the broader community narratives of strength and well-being. Through this interplay, progress towards creation of a shared, emancipatory ‘third space’ (Routledge, 1996) for new knowledge creation and common understanding unfolds.

Case examples are drawn across the lifespan of our research relationship with these Yup’ik communities. They include our experience in discovery research and its translation into CBPR intervention, and from intervention development to prevention trials, involving in some cases, a second implementation of the intervention with communities. Accompanying changes over the course of our relationship have led to a deepening of community direction, ownership, analyses, appraisals, and understandings. We conclude by suggesting points in a long-term CBPR relationship, where harmony can be achieved through the spirit of understanding, where meeting of disparate bodies and minds is not only possible, but necessary to the process of collective change and individual healing. In the understandings of a Yup’ik intervention science, outcomes at the individual level take place only after the community has come to ‘one mind,’ functioning in healthy and helpful ways together. The process of coming to ‘one mind’ is also at the heart of our examination of long-term CBPR and of science within this cultural context. Underlying this key principle is a theoretical orientation familiar within cultural psychology (Bruner, 1990) that we are all connected as human beings in one world, but often inhabit and understand our world in very different ways. Such difference can simultaneously inhibit our ability to understand, while at the same time creating opportunities for seeing the world in entirely new ways. At one point in our intervention work, one of us (S. John) cited a Yup’ik song written by his father, noting that through the youth and community-wide experiences that the intervention invokes, “we are opening a window to our ancestors.” Working and now writing with a spirit to understand, our collective aim is to similarly open a window to our forbearers and ourselves, to foster greater understanding of other worldviews, cultures, and lives. The effort has been revealing in the ways the relationships formed through the research have become relationships we will hold dear for life.

Development of Relationship in CBPR with Indigenous Communities

There is a growing focus in the literature on the utility and benefits of community engagement in health disparities research, particularly with minority and underserved populations, and especially with groups experiencing historical marginalization and systematic oppression (Holkup, Tripp-Reimer, Salois, & Weinert, 2004). The majority of the CBPR literature examines its theory, practice, and underlying principles (Wallerstein, Duran, Oetzel, & Minkler, 2017). Most attention is placed first on establishment of effective and trusting relationships between community member partners and research partners. Then, as a second step, the literature examines maintenance of community-academic relationships, usually over the course of a research study, typically lasting the length of a grant cycle. Depending on the grant mechanism, this is can be as brief as three to five years. Very rarely are the mechanisms of “CBPR gone wrong” examined, or are strategies described for righting relationships between differently positioned groups once these relationships have become “muddled” (Mayan & Daum, 2015, pg. 69). An undercurrent in the literature also seems to suggest tensions and conflicts may resolve or lessen over time, and this is often presented as an ideal outcome of CBPR put to best practice, without accompanying evidence. In contrast, in our own case history of a long-term CBPR partnership, tensions and conflicts may instead ebb and flow in certain areas over time. While flowing, opportunities emerge for the partnerships to change, grow and possibly move in new directions or achieve greater depth in their exploration of issues.

It is important to also note long before the term “CBPR” gained popularity, researchers were utilizing its core principles of trust, respect, and equanimity in community psychology and other disciplines (Bennett et al., 1966; Trickett & Espino, 2004). The CBPR perspective is particularly well aligned with community psychology through its aim to stimulate generation of emancipatory understanding regarding current, oppressive circumstances and solutions to them, potentially based in universal understandings across knowledge systems. The longer the CBPR relationship, the more opportunities exist for examination and translation between knowledge systems, with greater potential for broader social action and greater impact of co-produced research findings across contexts, cultures, and disciplinary fields.

Additionally, in CBPR, the community level is an analytical starting point and ultimate focus, even when primary concern is related to individual behavior, as is the case in our work on youth suicide and problem drinking. This orientation is in accord with broader frameworks of community psychology (Trickett, 2009) and cultural psychology (Bruner, 1990; MacDonald, Ford, Willox, & Ross, 2013). An orientation to cultural factors and their influence on behavior and outcomes is also a key theoretical underpinning within many Indigenous cultural systems, allowing CBPR to “indigenize” more readily within these systems (Rasmus, 2014).

Long-term Collaborations within Indigenous Communities

This paper focuses on one example of an ongoing CBPR initiative in Alaska, People Awakening (Mohatt, et al., 2004), that has involved a large team of Alaska Native community members, leaders, and expert stakeholders working alongside university researchers to end youth suicide and reduce alcohol misuse through an Indigenously-developed intervention that builds protective factors, reasons for life and sobriety with wellbeing as an ultimate outcome (Rasmus, Charles, & Mohatt, 2014; Rasmus, Trickett, Charles, John, & Allen, 2019). Before exploring this relationship, it is crucial to acknowledge other selected long-term collaborations taking place within Indigenous communities in North America that have guided our work. Similar to our efforts, these develop and implement interventions to reduce health inequities, while holding community and stakeholder knowledge and involvement as central to the research process.

Several examples of long term CBPR are currently taking place within rural and reservation-based Indigenous communities. Collectively these teams are engaging in transformative efforts to culturally-adapt or develop new interventions to address tribal health priorities; similar to our own work, many of these efforts focus on reducing disparities in youth suicide and substance misuse. In the southwest United States, a three decade long collaboration of the White Mountain Apache with researchers from Johns Hopkins University has produced a nationally recognized tribal suicide surveillance system (Ballard et al., 2014; Cwik et al., 2014; Mullany et al., 2009) and development of culturally-grounded projects and interventions at multiple ecological levels driven by the community to effectively prevent suicide (Cwik et al., 2016) and address a broad range of additional health related issues, including reproductive health (Tingey et al., 2017) and alcohol misuse (Tingey et al., 2016).

Another long-term collaboration bringing together researchers with tribes in Minnesota and First Nations in Canada has culminated in development of an adapted preventive intervention to reduce substance misuse among Anishinaabe youth. The intervention is currently in a fourth phase of adaptation and testing (Ivanich, Mousseau, Walls, Whitbeck, & Whitesell, 2018). This work is important in demonstrating the ways that Indigenous interventions are influenced and change over time, through deepening understanding among the researchers of culturally specific risk and resilience factors (Walls, Whitbeck, & Armenta, 2016).

An ongoing effort in Hawai’i with rural, Native Hawaiian communities seeks to identify risk, resilience, and cultural protective factors from substance use disorders among youth (Okamoto, Helm, Kulis, Delp, & Dinson, 2012) and develop and test a culturally-grounded curriculum to prevent drug use and measures of its impacts (Helm & Okamoto, 2013; Okamoto, Helm, et al., 2014; Okamoto, Kulis, Helm, Lauricella, & Valdez, 2016). The translational trajectory of this research team in many ways mirrors the People Awakening pathway in starting with exploratory studies to identity key risk and protective factors for drug use among youth and paying particular attention to factors specific to a Native Hawaiian cultural and community context. Next, the team translated these culture-specific protective factors into an intervention model, developed measures to assess outcomes, piloted the culturally-developed curriculum for feasibility, and is currently conducting prevention trials. The publications describe elements of their collaborations with community partners and stakeholders in Hawaii, including the critical role community members played in shaping the cultural curriculum, adapting measures, and delivering and disseminating the intervention (Helm & Okamoto, 2013).

Finally, Kahnawake, a north-eastern Kanien’kehá:ka (Mohawk) community in Canada has collaborated with a research team on the Kahnawake Schools Diabetes Prevention Project (KDSPP), a long-term health promotion CBPR project that dates back to 1987. In addition to producing notable outcomes (Paradis et al., 2005), the group has explored numerous issues in the CBPR relational partnership. These explorations have produced process descriptions of the community governance of the research project and development of a culturally directed code of ethics to guide the project (Cargo et al., 2003; Macaulay et al., 1998), a frank consideration of whether the democratic ideal of CBPR can ever be truly achieved in current Indigenous-academic partnerships (Cargo et al., 2008), insightful observations on the influence and role of social context upon interventions (Cargo, Salsberg, Delormier, Desrosiers, & Macaulay, 2006), and efforts to describe and understand the role of community empowerment and additional factors in intervention effectiveness (Lévesque, Guilbault, Delormier, & Potvin, 2005; Macaulay et al., 2006). Most relevant, the group has carefully and extensively described the developmental progression of their 30-year research relationship through the lens of a social movement framework (Tremblay, Martin, Macaulay, & Pluye, 2017). They define four distinct stages–emergence, coalescence, momentum, and maintenance / integration (Tremblay, Martin, McComber, McGregor, & Macaulay, 2018). Their work has been influential in our own thinking.

The Evolution of Relationship with Community Engagement

While it is abundantly clear all these groups have worked effectively together for decades, it is equally clear that current intervention science reporting standards leave out much of the story, which remains unheard (Ryerson Espino & Trickett, 2008; Trickett, Trimble, & Allen, 2014). Little is relayed through the scientific literature by way of description of the evolutionary steps of relationship with communities, and relationship’s impact on the science and its understanding. Nor are there many clues as to the inevitable tensions and their resolutions as they come into play in these relationships over time, particularly as projects and grants go through their up and down cycles of funding, activity, and interest over the long haul.

While there is discussion in the literature reviewed here of important elements in CBPR and its developmental process in mobilizing communities, there has been significantly less examination of ways that the core academic-community relationships with Indigenous communities have been managed, maintained, and changed over the long-term, or in turn, how relational change impacts the research and intervention outcomes. Further, existing efforts exploring relationships have largely explored social action as outcomes (Tremblay et al., 2018). While this is an important and central goal of CBPR, it leaves out other critical dimensions important in the current cultural surround of research in contemporary Indigenous settings, including prominently, transformation of knowledge to include Indigenous knowledge systems, as well as how they potentially reflect concurrent transformations of power relations in science.

In response, this paper seeks to fill an important gap in the literature by systematically examining key aspects of our own long-term CBPR relationship. We have published other facets of our research to date, considering design, outcomes, methods, and process (Allen & Mohatt, 2014; Rasmus, 2014; Rasmus et al., 2014). This paper will examine relational perspectives to extend existing developmental theory on CBPR in Indigenous settings (Tremblay et al., 2017; Tremblay et al., 2018) by describing three sequences in relational development (a) emergence, (b) coalescence, and (c) transformation (Table 2). We have chosen vocabulary carefully in use of the term sequence. Progression of our relationship does not neatly fit definitions of a true stage theory, in which each successive stage builds upon and is dependent upon development in previous stages. Instead, rather than a linear progression to more advanced, qualitatively distinct stages in various areas of the work, relationship has passed over coalescence and immediately entered transformative realms, without resolution of a previous stage conflict. In other areas, for example, relationships during application of complex quantitative methods for analysis of outcomes, may remain ‘stuck’ in coalescence while other areas progress more rapidly. At times, relationships exhibited features of more than one sequence, with bidirectional movement across different sectors of work or community.

Table 2.

Relational Sequence Framework in People Awakening

Sequence	Definition	Praxis	Example
Sequence 1: Emergence	Beginning of the relationship in response to a community health or social priority	Early stage negotiations	Personal awakenings, seeking understanding Bonds form through shared negative reactions Navigating funding loss
Sequence 2: Coalescence	Development of a relational identity as a team undergoing active negotiation in efforts towards understanding	Navigations through western and Indigenous knowledge systems	Tragedy and Leadership Transition R(e)discovery of Qasgiq Academic relocation “The researchers became more Yup’ik”
Sequence 3: Transformation	Development of new shared understandings and more co-equal power structures as part of life long relationships extending beyond the project and the research	Creation of a third space defined by the spirit of the intervention / research: Connecting partners through Indigenous kinship structures	Passing of Elders The process becomes more sacred Sustaining the spirit

We begin with stories from our early, emergent CBPR relational work on the People Awakening Project (Allen, et al., 2014). Next, we weave in stories from our coalescing phase, focusing on ways our team strategies and even its composition has gone through crises and adjustments reflected and resolved through shared understandings of our roles. For example, from a researcher perspective on the team, what is needed to continue the CBPR work in a rural Alaska Native community context is not always supported, or is even at times perceived as at odds with what is needed to continue the work as an academic in a department community. Finally, we will touch on a few key stories that are representative of movement into a transformative set of relations for creating deeper levels of understanding across the partnership. Our goal is to share experiences at each sequence in relational development that our team of community and academic partners found led to change in managing our complex and multifaceted relationships over the long term.

Alaska Awakening: Relationship Emergence in CBPR (1996–2007)

No, Jerry, it’s not a new life. It’s my life as it is meant to be lived. –People Awakening participant (2002).

Jerry Mohatt came to Alaska with a spirit to understand. He was open to hearing the words and experiences of Alaska Native people as they lived, and at times struggled to live through their worlds, histories, and present systems. Mohatt was also open to being changed through his relationships with the Indigenous peoples of the north. Mohatt was a different kind of “doctor” who valued above all the relationships forged with the communities he would come to know and love, and who would come to know and respect him. His relationship with his mentor, Joe Eagle Elk, provided a framework for this values orientation evident from the beginning of his work with Alaska Native communities. Eagle Elk instructed Mohatt to focus on the “gifts” all people share and hold within. He also entreated him to trust his own gifts and his training as a community psychologist, educator, and healer.

The Western doctors are just like Indian doctors. They are doctors because they have a gift. They cannot do their work without the help of the people. The patients have to think real deeply about the doctors and think real deeply about the medicine and talk to the medicine so it will be filled with its power to do the work that it can do. They need to put all of their thoughts into this doctor so he can become strong. The physician or medicine man has the same responsibility to think deeply about his medicine and about the patient and to use his gift fully. But today it looks to me like the reason a lot of physicians are having a hard time and are troubled is because the relationships between them and the patients are not good (Mohatt & Eagle Elk, 2000, p. 131).

CBPR begins with individuals willing to understand each other. CBPR is above all about relationships formed and reformed, begun and sometimes are ended, that shape not only the form of the work that will take place, but the function of the union that guides the labor. Mohatt listened, heard, and acted upon people’s concerns; together a program of research developed promoting Alaska Native strengths and resilience (Mohatt et al., 2004) that would come to be known as People Awakening (Allen et al., 2014). Mohatt carried with him both a spirit to understand as well as belief in the value of the gifts or the strengths all people possess, that also exists in families, communities, and the spiritual worlds creating the capacities of a collective people. He and the university research team were similarly affected, at a NIH conference focused on problems and pathology, by the negative reaction it engendered in the Alaska Native audience (Mohatt et al., 2004). Contributing to People Awakening was in contrast, growing personal awakening to an assets-based and resilience-focused research framework that would define the collaboration.

Personal Awakenings

All the co-authors of this paper came to the CBPR team through their own personal awakenings. The personal awakening part of the CBPR process while rarely examined is what brings us all to the proverbial table. One of the co-authors (Rasmus), attended a presentation in spring of 1999 that Mohatt gave at Northwest Indian College. She was currently working with the Lummi Nation and had plans to attend a PhD program closer to home; this talk changed her life and career trajectory. Having seen many researchers come and go, and focus on problems in American Indian and Alaska Native communities, Mohatt’s presentation was a startling change to hear. He described a study that would examine stories of strength and resilience in Alaska Native communities, with aims to promote a narrative of success in recovery and protection from alcohol misuse. On the encouragement of Elders attending this talk, she would approach Mohatt, apply to the University of Alaska Fairbanks (UAF), and become a graduate research assistant on People Awakening, a path that would lead to her current role in leadership of the projects that would follow.

For two of the co-authors (Charles and John), their awakening to research came through their own Yup’ik process of coming to awareness of the world and their role within it that is embodied in the term ellangneq (eshl-law-nek; to awaken; literally, to wake up). For Charles, his ellangneq to research was tied to his ancestral knowledge and experiences being out on the land, fishing, hunting, and gathering. He reflects,

They had it down to a science, the Elders, our ancestors. They knew how to survive. They knew the biology, the environment, the navigation systems, the weather. They had so much knowledge that they knew everything about the people. They were child psychologists and philosophers. They had a system and they understood how every person had a place in the system. They were strong, stronger than us maybe. We need to be that strong again (Charles, 2018, personal communication).

Charles would first meet Mohatt and another co-author (Allen) in his community when they traveled to propose a new prevention research project. Charles’ community was struggling with the rise of suicide and alcohol-related traumas impacting young people most heavily. He attended the presentation by the researchers because of his concerns regarding the strengths and vulnerabilities of this upcoming generation.

“It wasn’t something new they were trying to bring out here. No, they didn’t promise us they would fix the problems for us. They were different. They talked about a model that was based on our protective factors, those qanruyutet. They described a process that had taken place in our neighboring community, and I recognized that process as qasgiq (men’s house/communal structure). That process was brought back and utilized to deal with the negative influences and the spirit of suicide in the community. I got it then; our ancestors had already done the research for us, they knew what was needed to make us strong in our minds and resilient. We just needed to bring that spirit of strength back in to our communities. These new doctors, the PhD-types, can work with us to demonstrate the Yup’ik science today. It’s not a time for trying new things, it’s time to try something old, that’s proven” (Charles, 2018, personal communication).

A year following this presentation in 2008, Charles assumed a leadership role in the intervention research that would follow from People Awakening (Rasmus, Charles & Mohatt, 2014).

For John, this process of awakening to research began early and was heavily influenced by the teachings of his father, the late Dr. Paul John (John & Fienup-Riordan, 2003). John also had an early meeting with Mohatt that was formative to his early engagements in CBPR.

I first saw him in 2000 when he introduced himself and his project to the people. He was very likeable and open and didn’t impose anything on us but just got us talking about our culture and way of life. It wasn’t until later on that he talked about the work he was doing in looking at our Native strengths. I remember at the time thinking that this was the first time I encountered somebody, especially from a university, who wanted to look at our strengths instead of what was wrong with us. He gave a good impression that we are resilient people and our resiliency is our culture. It gave us hope, and personally, it gave me more confidence about the rich culture that we have. We can do it. This is how our people have stood and withstood through the generations. Through research, we would gain more strength and competency in our culture (John, 2018, personal communication).

In 2002, John would join as a member of the External Advisory Committee for the Center for Alaska Native Health Research (CANHR), of which Mohatt was founding director. He also became involved in the early intervention development phase of the research that was taking place in his home community, and after a lapse in the relationship would assume a leadership role in a later prevention trial phase of the work.

The last co-author (Allen) trained in clinical psychology with interest in rural community psychology. Allen first met Mohatt in 1990, when he came to the University of Alaska Fairbanks’ community psychology program. Then, at University of South Dakota, he learned more about the work Mohatt had previously done through five years of collaborations on the Rosebud Reservation, returning to UAF in 1996. Originally motivated through social justice concerns, he came to deeper appreciation of Indigenous cultures, finding in it a life’s work. With no specialty background in alcohol, suicide, measurement, qualitative analysis, or analysis of complex intervention, he undertook training in response to community need, served as co-investigator on People Awakening. He has continuously served in a leadership role on the projects to follow People Awakening, finding the relational element in research with Indigenous communities the most fulfilling part of a professional career that grew to deep personal commitment.

Through People Awakening and projects to follow, the strengths and resilience Alaska Native peoples moved from being “unheard” by forging pathways of understanding (Mohatt et al., 2004). This movement would not come without challenges. Following People Awakening, the project would struggle to gain funding for its next phases, with accompanying community disappointment in grant rejection. Some community partners chose to remove themselves from the relationship during these down cycles, or during times of stress and uncertainty that the relationship would continue beyond and outside of the grant funding. Defining and continuing a relationship outside of a funded CBPR process has been one of the greatest sources of hardship and challenge that our team has faced. This funding struggle would repeat itself on multiple occasions, during which time the CBPR team would disperse and take on new roles and projects. However, the team would coalesce around critical events such as a Yup’ik community experiencing a suicide cluster among youth, and then reform when funding was again secured. The coalescing phase of the research would bring new challenges, unexpected crises, and opportunity for growth, change, and eventual transformation.

Coalescing (2008–2016)

Four episodes briefly described from our coalescing sequence lay out some of its major contours. One event was tragic loss; Mohatt, who had been struggling for years with a chronic illness, passed away abruptly in 2010, due to complications of Non-Hodgkin Lymphoma. The unexpected loss was felt tremendously by the team and the communities; John’s community closed all businesses the day of his passing in remembrance. A process of mourning brought community members and academic researchers together in grief in a moving, co-created memorial ceremony. This great loss required each person in leadership, from among earlier career university researchers to community leaders, to engage in some deep reflection about stepping up to lead in Mohatt’s place. This led to a very honest, at times painful, and deeper level of shared dialog on a commitment to carry out the work, in part in testament and respect for our lost colleague. Ultimately, two of the co-authors, Rasmus and Allen, would come to share in the university portion of the leadership of People Awakening. The projects that followed would reflect their commitment to team science (Tebes, 2018), CBPR, and to Alaska Native people and communities.

Around this time, it also became clear the project team was in need of strong Yup’ik leadership and Charles, who had assumed a project leadership role alongside Rasmus was increasingly taking on intellectual and theoretical work in the research. Charles was carefully observing the process of the intervention work, and increasingly noted how naturally the process came to resemble qasgiq (kawz-gick). This Yup’ik word has dual meaning. Qasgiq as a noun describes the traditional Yup’ik men’s communal house. But it also functions as a verb, describing a cultural protocol and method of social organization for action with Yup’ik communities, in response to crisis or an important need requiring community decision and response (Ayunerak, et al., 2014; Rasmus et al., 2014). Through Charles’ encouragement, the project began to describe the Qasgiq Model as a framework for community intervention (Rasmus, Trickett, Charles, John & Allen, 2019), and then explicitly to practice it. This framework guided implementation of the Qungasvik (koo-ngaz-vick; Tools for Life; literally, tool holder) intervention, and the scientific work to understand the intervention (People Awakening Team, 2009). This development proved pivotal in opening our work further to the Indigenous knowledge systems and practices guiding the Qasgiq Model, and increasingly guided the intervention research into transformative terrain.

A third event involved loss in a different way; Allen was recruited to a new university in 2012. It was striking how, when Allen first told Charles about his upcoming plans to move, he spontaneously responded by repeating word for word the statement an Elder had made to Mohatt when he announced to her he was leaving Rosebud for Alaska years earlier: “I was just getting to know you” (Allen, Mohatt, Markstrom, Novins, & Byers, 2011). Would this repeat previous research relationships of betrayal of trust, where researchers leave to never return? Many community partners had legitimate doubts, but out of their strength and shared commitment, and perhaps Mohatt’s role modeling and loss experience, communities gave Allen a chance. Much of long-term CBPR involves continuing to show up to be there, along with continued learning in how the spirit of relationship extends beyond office and career.

Finally, an observation by an Elder, reported in greater detail elsewhere (Rasmus, 2014), occurred as part of a qualitative evaluation of the CBPR process for intervention development and feasibility testing. This Yup’ik Elder, who had guided much of the work, succinctly observed in few words one of its outcomes. Her observation caused the team to reflect deeply; through the process of the research, she concluded “the researchers became more Yup’ik.” As part of our reflection, we now understand, and did not understand at the time, that she was focusing her observation not only on the researchers’ way of thinking, but more importantly, on their relational way of being. What was remarkable was how the researcher stance with community, and their role within community had changed. In important and culturally patterned ways, their understanding of their role and their behavior had become more Yup’ik: relational, sacred, and enduring, in ways that expanded beyond the boundaries of a western, scientific, professional relationship. With this reflexive event and new understandings on the part of the university researchers, our effort coalesced further, and began to shift in transformative ways.

Transformational Shifts in CBPR: Navigating Indigenous and Western Knowledge Systems in Prevention of Youth Suicide and Alcohol Risk (2016-present)

Suicide had stalked a Yup’ik community in southwest Alaska. The People Awakening team received outreach and invitation to be part of a community-driven solution to develop a suicide and alcohol misuse intervention in two Yup’ik communities (Rasmus, Charles & Mohatt, 2014). We focus here on aspects of transformation in our CBPR process around (a) tragedy and leadership transitions, (b) opportunities and expansion of relationship, and (c) sustainability of the spirit of the intervention and relational research process.

Transformations in Relationship

By the end of the first prevention trial the team had moved from considering not only how family and community-level factors contribute to risk and protection from suicide and alcohol misuse at an individual level for youth, but how spiritual factors are an important force in local understandings of the intervention. Yup’ik Elders instructed us to understand the spirit of all things, even suicide. This spiritual element extended to understandings of a sacred nature to relationship. Relations formed among the university-community research and intervention team, and with communities, involved shared efforts in the often difficult task of confronting suicide on behalf of their youth. These spiritual elements came into the intervention science when the CBPR process itself became sacred. The sacred element has now carried the team through hardships and crises that would unfold naturally in the course of the work as it grew and propelled the researchers and the research to change and adapt alongside the communities.

Through this time spent working together, our CBPR process has become ever more deeply embedded in a Yup’ik relational methodology, while at the same time maintaining Western science methodologies and communication between each approach to understanding. This synergizing across knowledge systems has created our shared ‘third space,’ increasingly directed by Indigenous understandings and social organizational processes. In it, the human relationships transcend the research, becoming part of something larger. With spiritual complexity in the intervention and the CBPR process came spiritual crises, perhaps no more poignantly expressed than through the loss of a generation of key influential Elders who were deeply involved with the creation of Qungasvik in one intervention development community.

Transformational CBPR and the Spirit of the Intervention and the Science

Yup’ik Elders are the living repositories of Indigenous cultural knowledge. Elders provide a cultural and intellectual foundation to understanding for this work. Sadly, a majority of the Elders who designed and built this foundation over fifteen years ago have now passed. We have entered with communities into a phase where we collectively struggle with questions: How to replace what is in the end irreplaceable? A key transformational shift in CBPR relationships has involved loss and transition of Elders as a sacred relational task in which our project is still currently engaged. The importance of this to a long-term research project may be a distinctive element to Indigenous work. As one way to help overcome this crisis and challenge, we continue to share knowledge from these Elders with new generations of youth. Transformational CBPR attends to the spirit of the intervention science. By creating a sacred space for the confluence of Indigenous and Western systems; Indigenous leadership, local control, and capacity building can take place, grow, and transition. Long-term CBPR constitutes a process in which relationships can transcend time and distance, and become something both more personal and more permanent.

Conclusion

We conclude by noting how there are points in a long-term CBPR relationship where transition can occur from its emergence, into coalescing and transformation. Appreciation of these dynamic points of movement expands our conceptions of CBPR in Indigenous settings. Movement occurs as part of an experiential relational process. Through this process, research can progress to university engagement in an Indigenous community science that uses Indigenous social organizational process to tap Indigenous systems of knowledge alongside Western science. Our own story is about a poetry of systems in relationship. Accompanying the story are shifts in understanding and in researcher-community power relations, facilitated through the dialectic of Indigenous and Western knowledge systems and ways of knowing. Along the CBPR pathway came accompanying changes in leadership structures and praxis, or processes and structures of the research. Our story is also of growth that parallels a broader contemporary movement to greater self-determination undertaken by Alaska Native people.

We list below, in sequential terms, summary points and questions that remain, as part of our long-term CBPR journey:

• We endeavor to understand and awaken to ourselves and to others while developing relationship in CBPR.

• Not all CBPR relationships go well all the time, nor are even meant to go the distance. Relationships can and do break-up. They can sometimes then re-form anew. These cycles are a natural part of a relational process that can have significant impact on the research.

• We prepare ourselves for crises and suffer through loss of key partners and loved ones. Through the time together, our team has experienced loss of family members, Elders, and academic partners central to our lives and our research process. In navigating these cycles of life and death, through the CBPR relationship, we have become part of an Indigenous system, witnessing rebirth and renewal of our own roles and the roles of others, in a process of welcoming the next generations of youth, Elders, and mentors.

• We manage our emotions and emotional distance in a coalescing relationship. As relationships deepen, joys as well as sorrows intensify. Emotions can run strong, and deep relationships form. Disagreements and conflicts can take on more personal meaning, and geographic and cultural distance complicates it all. It is through this deepening that trust is built.

• The process of becoming ‘of one mind’ is at the heart of long-term CBPR within this Yup’ik Indigenous cultural context.

• We allow the spirit to come into the science. This transforms personal relationships, and the relationship of Western to Indigenous knowledge systems. This allows our research process and practice to become “more Yup’ik.”

• Finally, we continue to wonder and to struggle: how do we fund and sustain a sacred science in an intersectional world?