Respecting the Circle of Life Program

Yá’át’ééh! In today's episode, we are honored to host Barbara Harvey, a senior research program coordinator at the Johns Hopkins Center for Indigenous Health (JHCIH). Join us as we delve into the transformative Respecting the Circle of Life (RCL) program, exploring its goals, effectiveness, and impact on Navajo youth. 
Barbara shares insights into the major health challenges facing Navajo youth and the innovative approaches employed by JHCIH to address these issues. From discussing the cultural significance of RCL to outlining future endeavors of JHCIH, this conversation aims to shine a light on the remarkable work of the Respecting the Circle of Life program and inspire others to engage with their initiatives. Tune in to discover how honoring indigenous traditions can empower communities and foster holistic health and wellness.

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This podcast was sponsored by the Arizona Department of Health Services through federal funding from the Health Resources & Services Administration, with support from the Navajo Native American Research Centers for Health (NARCH) Partnership between Diné College and Northern Arizona University through federal funding from the National Institute of Health’s National Institute of General Medical Sciences, award number S06GM142121. The views expressed are the sole responsibility of the program staff and do not necessarily reflect the views of the Arizona Department of Health Services or the United States Government.

Transcript

Intro [00:00:05] Ya'at'eeh.. Welcome to the Maternal and Child Health podcast, where we discuss maternal and child health topics and provide strategies for improving the health of Navajo families.  Amá dóó áłchíní ats’íís baa áháyá baa yadelti. 

Yá'at'ééh, I am your host, Amber-Rose Begay.  ARW Hashk’ąąhadzohi nishli, Táchii’nii bashichiin and Tábąąhá dashichei and Naakai Dine’é dashinali. Nataani Nez denashaa. I'm originally from Shiprock, New Mexico, where I live and work at Diné College as a project coordinator of the Diné College Navajo Maternal and Child health projects. I'm a Navajo woman and mother of two. Thank you for joining us today to learn more about maternal and child health on the Navajo Nation. Today, I, along with my guest co-host DeeDee and our intern Ella, will be discussing the topic of sexual health. DeeDee, would you like to introduce yourself first?

DeeDee James [00:00:58] Yeah. Yá'at'ééh, Everyone, I am your co-host, DeeDee James. Tódich'ii'nii nishłį. Kiyaa'aa'nii éí bashichiin. Kinłich'iinii éí dashichei. Áadóó, Ta'neeszahnii éí dashinalí. Ákót'éego Diné asdzáán nishłį. Tsé'dijolidęę nashaa. Nidaa Kinłanídi kééhasht’į́. Hi again, everyone. I am DeeDee. I'm originally from Promise Rock, Arizona, which is a small area south of Monument Valley, Utah, but I currently live in Flagstaff, where I work at Northern Arizona University as a research coordinator of the Navajo Maternal and Child Health Project. Thank you for joining us today. Ella, would you like to introduce yourself? 

Ella Haas [00:01:36] Hi. My name is Ella Haas. I'm from Dallas, Texas, but I've been living in Flagstaff for a couple of years to attend Northern Arizona University. I'm finishing up my last semester and will be graduating with a Bachelor's of Science in Health Sciences, Public Health, and I'm excited for this opportunity to join the podcast and support native families in our audience. Thank you for listening and your support. 

Amber-Rose Begay [00:01:59] Thank you all. We would like to introduce our guest today, Barbara Harvey. Can you please introduce yourself for our audience? 

Barbara Harvey [00:02:07] Yeah. Hello, and Ahe'hee', thank you for inviting me here today. Tábaahí nishłį. Ma'ii Deeshgiizhnii bashichiin. Ta'neeszahnii dashicheii. Tótsohnii éí dashinalí. Barbara Harvey dashijiní.  Lukachukaidęę naashá. Dził Bi't'ódi kééhasht'į. I joined Johns Hopkins Center for Indigenous Health team in July of 2019. I'm currently a senior research program coordinator; I work primarily in behavioral health research, supporting initiatives focusing on American Indian youth, teen pregnancy prevention, and mother-daughter female pathways program. I aim to be a part of the solution in closing the health disparity gaps, specifically in our indigenous communities, and I enjoy establishing meaningful connections with the community. Enabling them to excel with the center Chinle-based behavioral health team. I feel very fortunate to be here, but also, more importantly, to be a part of our center family in Chinle, Arizona, and I will do my best to remain committed to making impactful contributions. Thank you. 

Amber-Rose Begay [00:03:09] All right. Thank you, Barbara. So, we're going to start with our first question. What is respecting the Circle of Life program and what are the goals of the program?  

Barbara Harvey [00:03:19] Yeah. So respecting the circle of life with youth and parents is adapted kind of giving you the background from focus on youth with impact. It was a program originally developed in Baltimore to reduce the risk of HIV among urban African-American youth. With the Johns Hopkins Center for Indigenous Health, we worked with another native tribe in Arizona and its community members to adapt the program for use with native youth living in indigenous communities and to include a focus on unintended pregnancy in addition to STDs and HIV. Because many things, of course, we talk about these in everyday life, with our youth growing up to become young adults. Many things can lead to risk behaviors among youth, and it became clear from a lot of our team members talking with parents, youth and community leaders that the program would need to cover many topics. So topics including decision making, values, communication, and the knowledge about risky behaviors associated with HIV and other STDs, teen pregnancy, violence, and other alcohol and other drug use. So what the program does is it really heavily involves parents and guardians in their. For some people, they have other trusted adults. They're very important part of this effort. So this is why we provide those tools and materials to assist parents and trusted adults in talking with their youth around difficult topics such as abstinence, sex, condom use, pregnancy, HIV, and other STDs. So this program that Respecting the Circle of Life program gives plenty of information about teen pregnancy, HIV, and other STDs. Especially gives tips for having that good communication with their child or their youth, and information about especially, specifically using condoms and contraception.  The program goals that you mentioned. So the curriculum covers many topics, but the main ones that we talk about and cover, and it addresses the goals of the program are the reproductive system, pregnancy, and contraception. We talk about sexually transmitted infections and prevention. We talk about abstinence and condom use, problem-solving, and healthy decision-making skills. We also, more importantly, cover value clarifications. We talk about goal setting and, of course, focusing on youth really honing in and making them focus on their future. You know, what are the steps that I need to take after this program to remain a healthy decision-maker? And then after the program has been implemented in research, the program has shown that, yes, these goals we've put forth are showing in the results that we're getting. So it does improve reproductive health knowledge and attitudes. It increases condom use, self-efficacy. It improves knowledge of STI and pregnancy prevention methods. It increases intuition to abstain from sex and condom use initiation. It increases conversations with parents and family about reproductive health. So, really good stuff goes into this program. And then just touching a little bit more on some of the key features and innovations. So what's really nice and really special about the Respecting the Circle of Life program is that it's typically a camp model. A camp model, meaning that we have a summer camp where all youth come together and they work together. And why do we do that? It's because we like to teach in peer groups. We like to engage parents. We like to deliver the lessons by people who come from our communities. 

Amber-Rose Begay [00:07:13] You said that you had adapted it to make it culturally specific to Native American youth, but is it Navajo specific? 

Barbara Harvey [00:07:24] Yes it is. So, respecting the circle of life was culturally adapted. It just means that we've modified the evidence-based study from the previous native group that it was implemented with, and we took into consideration our target population. So, meaning like the Navajo language, the Navajo culture, the traditions, the teachings. So Johns Hopkins not only adapted it to our cultre, but the elements of the RCL program can be described as holisic, because at the very core of the curriculum that we teach the youth, it's really acknowledging the relationships and that interconnectedness of youth in relation to their peers, you know, their partner relationships, their parents, their support system, their community. Because as Navajo, we really you know, we live around the idea of family. So we try to incorporate a lot of those in any kind of relationship that the youth has. That means something and is important to them, is incorporated in this program. You know, how do you relate to these people that I just, you know, listen. There are fundamental skills in education that the youth gain when they participate in the Respecting the Circle of Life program. So, the recognized importance of relationships is evident, and it is implemented throughout the entire program. So, some of those examples of the curriculum being Navajo specific is, for example, we took lesson one, and we've incorporated the importance of our Navajo clans and our relationships. You know, what do these clans mean? How do you know what traits were given to you by your ancestors? What kind of relationships should you abstain from or, you know, take into consideration, especially in a relationship where you have a partner who is going to become a spouse later on? So we incorporated all of those Navajo teachings around that, the meaning of the Four Clans. We also talk about the family tree because in our culture, you know, a family tree is really built on the foundations of where we come from. And then in lesson three of the curriculum, we cover the youth's personal values. So we're really tying in in this session, their family, their that's their biggest support system. We also talk about how important their traditions are, whether they still practice the traditional ways or if i's, Native American church or if it's, you know, anointing into Christianity. We try to be considerate of these different cultures and teachings that they have, and we try to put that into the lessons that we have with them as examples. Maybe if we tell them, okay, so you practice your traditions a lot, like what are some examples? What ceremonies do you like to attend? Do you attend these ceremonies with your family? And these lead to really good conversations with the youth. All the the things that are important to us as Native Americans is incorporated in that specific lesson. And then, we move to lesson four, where we cover very briefly. We don't go into depth of the, coming of age ceremonies for both young men and, young women transitioning into adulthood if we don't go into details, because if we could sit down and talk about our Canada ceremony, it would probably take an entire day just to not only from the beginning to the end, but it would have a lot of details. What we try to do is give them the important parts of those, like the days what happens in each day, what's the reason behind relatives, you know, the community coming together for both the young woman and then for the young men? We talk about the culture. So the sweat, the sweat lodge ceremony and how that all of this is teaching them to become young adults and getting them ready for that adulthood. So when people come together, they're really giving and sharing their wisdom with them. So that's one of the the lessons. And then lesson nine, we try to build in a teen parent speaker from our community. So someone who has experience becoming a teen parent at a young age, but within their community, which is the same community that the youth come from, you know, how does that affect, did it affect them? It was it positive or negative? We're being real with them in these situations, because who better to hear from than someone who's actually experienced it, firsthand of becoming a teen parent. And then they, the youth will ask questions to these teen parent speakers. And then after each lesson we do review Navajo words. And those Navajo words are usually associated with what they learned that day. So like in lesson one, we talk about like, what is, like what the meaning behind it. And then they also learn that language. We talk about clans. So where do you come from? Even the number one, like some of these youth, are really excited to just learn those few words that we have in there. If it was up to us, this would probably be given a lot more Navajo words, or if we could incorporate it into speaking full Navajo. That would be an option that we would take advantage of. So those are just some examples. 

Amber-Rose Begay [00:12:33] Great. Thank you for that. I was wondering, as you were talking about the curriculum a little bit more. Do you go over any lessons around sexual identity? 

Barbara Harvey [00:12:44] Yes, we do actually. I'm glad you brought that up. In lesson five of our curriculum, we actually address the the topics around gender identity. But more importantly, it's like how a two spirited individual is inclusive in our native culture. Because when you talk about LGBTQ communities, there's that two spirited that's usually left out and only left and, talked about in native communities. You have the definitions of, you know what cisgender is, what, lesbian, gay. So we do we are very inclusive of them in that specific, topic or that specific area that we talk about, and then we give them the definitions behind those. Because when you talk to youth, not a lot of them are going to know the definition of cisgender. So we explained to them that cisgender is like for example, it's the anatomy that you were born with like a female or male at birth. That's what's given to you. Even those like details. But we also not only do we give them these definitions and we talk about that, but it's that self-awareness of them as a person. And then in our culture, you know, there is an important of two spirited individuals in they're held in high respect, high regards because they were one of the are some of the few that were here before men and female were actually even developed. And we talk about the separations of sexes. So we do incorporate gender identity into our curriculum. So it is there. It is present. 

Amber-Rose Begay [00:14:21] Awesome. Thank you for that. So my last question, for this round of questions, is where do you provide these services?  

Barbara Harvey [00:14:30] Yeah. So the unique thing about the Respecting the Circle of Life program is that it can be adapted to fit any needs of the youth in the settings of the community. So for Johns Hopkins Center for Indigenous Health, we incorporated Respecting the Circle of Life in White Mountain in a camp setting. So every day the youth would come to camp, they would spend, you know, anywhere from 5 to 8 hours there.  Half of the day learning the curriculum, the other half learning or doing sports or an activity that they choose. And then we would swap. So it could be services that we could provide are obviously the lessons. We also give them resources from the community because when we talk about indigenous indigenous communities, we're already limited on those resources. So like the services we provide, they include us going above and beyond to figure out, you know, where can someone go if they needed to get tested for an STD or STI? What programs do they have available for single moms or, even those who are? Possibly if it gets to that level of conversation, where could they go for domestic violence? So these are kinds of the kinds of services we provide the curriculum, but we also try to stay in contact with the youth, especially if they request it after the camp has concluded, in order for them to assure that they're getting the services that we recommended during the program and then after. So it could be like counseling. It could be like, where can you go to get condoms? So those are the kinds of services we provide for this specific program. And then the program itself. There's several there's several ways it could be implemented. It could be done in a camp. It could be done in schools, after schools. It could be done virtually. So that's the beauty of it, is that this this program, it really depends on those who implement it and feedback from the communities. It is easy to work with. It's feasible. It's very just friendly to anyone who wants to learn it but also teach it. So. 

DeeDee James [00:16:43] Awesome. Thank you for that, Barbara. Very adaptable and, program that you guys have, but I know you mentioned like STIs and STD rates on Navajo. Is there any data for that? And also, the second question two-parter, what other major health problems do Navajo youth face? 

Barbara Harvey [00:17:05] Yeah, two really good questions. And I just want to address first the the question about the major health problems that Navajo youth face. So when I hear that question, it brings to mind so many think so many thoughts. So if you go into Google like anything, you'll see that Native Americans are more likely to have diabetes. We hear these conversations all the time. Cardiovascular disease, obesity, suffering from alcohol and drug, misuse or abuse. So you'll see all of that. There's it really comes down to that lack of knowledge behind all of this, how you know, to live a healthy lifestyle, how can we contribute to preventing these health problems? But in relation to the program, this is why we find it important to address health disparities, specifically around teen pregnancy, STD, and HIV prevention. So when you say health, health disparities or health problems with Navajo youth in relation to the program, we're looking at American Indian adolescents, the rates of them where we see, you know, there's four times the rate of sexually transmitted diseases compared to this specific ethnicity. And we always hear that, you know, AIDs is twice the proportion that compared to other national counterparts, 25% higher levels of teen birth. And we've shared these statistics in camp with the youth. They're given a youth workbook and it actually lays out like this. Many like native teens between the ages of like, for example, 10 to 14, experienced teen pregnancy at an early age, twice as high as, you know, the national average. So, we do share these statistics with them. And it's it's not it's not something that's not known now. But STDs are a problem here on the Navajo Nation with youth. So, by now, we've heard about STDs and sexually transmitted diseases problems in Arizona. And we've also heard the fact that STD rates have tripled in Arizona. And this is going off of the Navajo County. When you look at the community health improvement plans, or even just conversations that come up every day between people who work in, you know, the health field, you'll get these questions like, why do you think STD or STI is important to address? And these are the reasons why. So, after hitting a very low rate in 2015, we now see that there's a rise again in gonorrhea, chlamydia, and syphilis. All of those are on the rise since the 2000's. You know syphilis is the one that we're hearing more about today. So when we share these statistics with youth, it's a reality check, like a lot of the times, you'll hear them say like, wow, I didn't know that. Yes. It's here. It's known, it's known to people who work in the health field. But if you're an average everyday high school student going to school or going to college and focusing just on your education, there's a high chance that you won't know that it's there because we lack the knowledge or the ability to get that information out there, how can we do better? So this is why we share statistics with our youth throughout the entire program, especially around teen pregnancy, STD, HIV Aids, because it's, you know, what better way to give that message and deliver it to them than actually sharing numbers that are not coming from me or, you know, my coworkers or my colleagues. But it's really coming from places like the Center for Disease Control and Unplanned Pregnancy fact sheets from the Campaign to Prevent Teen and Unplanned Pregnancy. We shared STD fact sheets with them. All of this is really important information that you know it's important for them to know about. So that's when it when it comes to STD, we we try to look at it more for Navajo youth. And that's how we could relate it to specifically here on the Navajo Nation is really pushing that there is a rise that, you know, even with teen pregnancy, we see that there's a decline among other ethnicities like Hispanics or whites. There's a decline in native art, sorry, in teen pregnancy, but with Native American and Alaska Native communities, that seems that seems to not move. It's unchanged from when other ethnicities you see there's a drop. But for Native American communities and tribes, it's. Still the same. 

DeeDee James [00:21:44] Yeah. Thank you. Barbara. 

Ella Haas [00:21:47] I know you touched on this a little bit when you were talking about the program, but what is the importance of having the program involve not only young native girls, but also their caregivers? 

Barbara Harvey [00:21:57] Yeah. Another another good question. These all great questions. So with the program, it's important to include not only the young lady or the young man in the program but, as I've mentioned, relationships. So, for the program, we like to teach in what we call peer groups, with the idea being that those peers are important to the teens in their everyday lives, like they live off of what their friends tell them or share with them social media. Those peer groups that they're in the sessions with, like their classmates, their friends, their teammates, they're the ones who help influence decisions. So think about it this way if we can change the attitudes and the knowledge of an entire peer group, then hopefully that will have more impact rather than changing the attitudes and knowledge with just one youth. If we do one youth at a time, we're going to need all the time in the world to make sure and ensure that those changes are happening. But if we do them in peer groups, you're talking to like 12 to 15 youth at one time, and it goes even after. Not only that, are you hitting a larger amount of people, but you're also ensuring that these conversations carry on after camp, whether it comes up in a in a casual way or it was it was I was I meant to ask this kind of question or remember what we learned in camp. So that's why peer groups are important also to the youth. And then we like to engage parents or trusted adults. And I just wanted to define a trusted adult is someone who or anyone whom the youth felt comfortable talking about sexual reproductive health with. And it could be like an auntie or a grandparent, an older cousin, an older sibling. So this just that's who a trusted adult is. And it reflects the multigenerational household common in these communities, native communities, but also the importance of family with regard to adolescent decision-making. So when that parent and that trusted adult are involved in the youth with the program, there's a chance that that communication will happen more openly, more freely, and more honestly with their youth, especially around topics that are not easy to talk about. So, like sex, relationships, the prevention of pregnancy, HIV, STD. They are the ones that can also help promote their teens' overall health and reduce their chances of making risky decisions. So, therefore, we try to incorporate the parents by having a parent-youth session with them after the youth has gone through all of their sessions. 

Amber-Rose Begay [00:24:45] Thank you, Barbara. Next question. And so I did a little work with the Respecting the Circle of Life program back when I was an undergrad student. And so I found that I had a little bit of pushback from community members when I was trying to recruit for the program. So I just wanted to know if you have faced any barriers as part of the work with this program. And how did you overcome these? 

Barbara Harvey [00:25:14] Yeah, I think with, with any with any program, there's always going to be barriers. We know that once a program has been, you know, incorporated into the community, we are always going to hear, well, no change has really come from this, or I'm not going to allow you to talk to my youth about sex because then they're going to become sexually active. There's a lot of, of course, thoughts around that, but I think it's really just how you communicate with the parent and just being upfront with them about everything that they're going to talk about in the program. So when I how I overcame that barrier of, you know, parents or trusted adults being hesitant to have their youth join the program or be a part of the program is really just telling them, you know, let's let's be real. Let's be honest. You know, we're living in a time where things are not the same as 20 years ago, 30 years ago. Yes, these conversations would have been more of like taboo. We're not supposed to talk about that. If you talk about it, you're going to make it happen. But now we're looking at times of, you know, I and I like to use statistics again like syphilis is on the rise or teen pregnancy is happening more often than we'd like. Then there's that little bit of, okay, I'm listening, and I can see it with the parent or the trusted adult. Okay. I'm listening. Keep going. And it's really just telling that the program is not intended to make their youth become sexually active. It's actually the intention of it is we really stress abstinence. So, not having sex until you're ready or not having sex until after marriage. We really tell the parents and the trusted adults that we we emphasize this. That's the first and foremost thing that's important. Reality happens. So and I tell the parent or trusted adult this, that reality happens. Our kids are going, our youth are going to grow up. They are going to become sexually active. And this process, we're at least trying to delay that process, you know, then become sexually active until a later age. So that's the kind of the thing that we get with people who have that pushback. They're hesitant because as soon as I say we're going to learn about sex, they're like, no. And it's just re-explaining to them that we're not going to talk about how it happens or what takes place. What we're talking about is how sex is actually related to, you know, teen pregnancy, STD, and HIV. So we can educate them about what sex is. There's a better chance that we can prevent it. So it really comes down to just talking to the individual about these and why it's important, and just really selling it. On how, you know, we're living in a different time and age. If they don't hear from us in a program that they're going to get it from social media, they're going to get it from movies, they're going to get it from, you know, older kids who might have the wrong information. So it comes down to you being able to communicate and just be upfront with that person and say, like, this is why we choose to do it. It's not to make your teen become sexually active. So we haven't, I've haven't personally experienced any pushback with schools specifically because they're, they're all for sexual, reproductive health education. I've heard nothing but comments like, I wish we had this when we were in school. And a lot of parents actually do say that. I wish I was taught this at a younger age, especially when the program ended. Wow, I didn't know you were going to learn this much information. This is a lot and we do stress to them. Yes, you're going to be uncomfortable during this program, but that's all a part of the process. It's  you becoming a parent who's able to, you know, use those tools that we give you to let your daughter or your son grow up with making healthier decisions. 

DeeDee James [00:29:24] Awesome. I love how you're breaking that barrier or that cycle of, like, the parent being uncomfortable, but like, this helps. Then like, the children and them have that comfortable conversation around an uncomfortable conversation, which is like the goal. And I also feel like, like you said, being patient with the parents or, you know, the trusted adults when talking about sex and stuff is just like long time ago. You know, they didn't have these kinds of STI increases that STIs or unwanted or like teen pregnancy and things. So I can definitely understand why they may be hesitant at first. But on to our next question. How can we determine that this program is effective? 

Barbara Harvey [00:30:08] Yeah. So I, I could say, and I'm going to say, that the program is effective because we had a high overall retention rate through 12 months. When you think about research, 12 months is a long time. And for this program to have that high overall retention rate goes to show that we did something right in that process and through data collection. So we do data collection in three different phases. First, one is at baseline. And then, we did two additional time point post interventions, meaning that after the ninth lesson is completed, both the youth and the parent or trusted adult are able to we're able to produce those findings based on those assessments. So, just to give you a really quick, you know, research rundown of the assessments and the timelines. So, the youth who enroll in the program will do what we call a baseline assessment. And these are questions that, you know, there could be like 200 questions based off of their education, their social life, their family life. All of those are in that baseline. It's done before we implement the program. And then aftrwards, when they've completed all of the sessions or the required lessons, they do a program feedback form. And then, they also do a three-month and a nine-month assessment. So the similar thing for the parent. So they go through those 12 months of the program, the assessments, and also the program. And we found that, like I'm going to use as an example some of the findings that we got from a second randomized control trial of the RCL program, we receive findings that we had, you know, where we had over a thousand youth and parents enrolled in the study and the results from the nine-month and 12-month that the youth received reported that they had better scores in their sexual and reproductive health knowledge. They had greater condom usage and contraceptive use self-efficacy, so their belief in their confidence in their skills to use condoms and contraception was pretty high. And the RCL program spent a lot of time around building condoms and contraceptive use. And it's it's super fun. It's interactive. It's very engaging. We also saw that from these findings, there were lower intentions among youth who received RCL to have sex within the next year. And if they did, they did have that higher intention to use condoms. We saw that like for example, there was an improved partner negotiation skill around condom and contraceptive use. Again, there's a lot of work, there's a lot of content skills training around communication and not just with the parent, but also with their, you know, their partners or romantic partners. And then finally, we also found that the program reported a greater ability for communication with the parent, the youth, and the parent about sexual and reproductive health actually increased too. So, from the pre- and the post and the assessment with that data that's collected, it goes to show that, yes, this program is effective. And we wouldn't continue to really, I guess, sell the program to other outside organizations if we didn't think it was effective. But because we believe that this is a really huge program and anybody can benefit from it and it's easily adapted. We really try to, you know, stress to schools, choose RCL, respecting the circle of life because it's a program that has a significant long-term impact on several long-term domains, and that we know they're essential to those domains. We know they're essential to behavioral change when it comes to having a pregnancy when you want to have a pregnancy, and then, of course, being able to have to prevent STIs. So that's kind of just my, my take on, you know, why RCL is important and effective. It's based off those assessments. And these assessments are done in self-report. So, the youth and the parent are given the assessment. And then, if they need help, of course, we're there just to clarify anything not to give them answers. What happens is a lot of it's self-report. So the self-reporting part is giving them, you know, time on their own to complete it, but also letting them know that any answers that they share is not going to be shared with anyone outside the program or the evaluation work part of part of it. And then also really stressing to them that this is anonymous. Like this program is anything you share with us will not come back to you specifically as a youth. 

Ella Haas [00:34:52] Okay. And then our last question is what kind of training do facilitators of the program undergo? 

Barbara Harvey [00:34:59] So training can be done in two different ways. So the first one and a lot of this adapting came from COVID. So the first one is an in-person training. And it could take an entire week for the facilitators to be able to go in there. Of course, they get the introduction of the Respecting the Circle of Life program, the background, the history. They look at recruitment and enrollment. The study flow is really where we try to, you know, ingrain it into their their minds and their brains because it talks about the study overview. We talk about what kind of design we're going to use. We talk about the roles of everyone involved. You know what is an independent evaluator? What is a participant, what is a parent or to. So all of this, it's literally starting from the ground up. It's a very intense training. But we also practice, a lot of the recruitment and consenting because like I just mentioned, when you're talking to parents about this, you have to be able to really sell the program to them and show them that, yes, this can make a difference with your youth if you would give it a chance. So that's what we try to do. We talk about, we walk through like for example, how to do the baseline assessment. We practice it. Everything we do, we talk about but we practice it. And then we also put them into role playing. We all know that if you put like for example, me, before coming into this program, if you were to put me into a role play position like ten years ago, I would have been super shy. I would not have wanted to do it. I would have been like, no call on someone else. But what this program has really done is it's opened up my ability to not only speak to people, but also participate and be like my natural acting. It just comes out it it makes me comfortable because a lot of the role playing you have to do for the youth in order for to take them out of their comfort zone and put them into non-real life characters, and that just allows them to be free and act upon those characters. So that's what that the kind of training that we usually do with the facilitators, they really just know how have to know their audience. We know what kind of people are coming into the room, what kind of youth are coming into the room, how can you read a room? So everything like that from like being able to talk for an hour and a half straight all the way to, you know, transitioning from an activity to back to a lecture or, you know, doing a voting or poll. So multiple things, they have to know how to multitask. They have to know how to engage the youth in these sessions and have good conversations with them. They have to know how to probe, ask questions, get the youth talking and those brain juices flowing. Interact with them. They have to know how to make it fun. So a lot of it is for people who are very they're extroverts. They don't don't get me wrong, we have people who are introverts that do the program really well, but we know that you have to be outgoing. You have to know how to do role play. You have to learn about the study design, whether it's a randomized controlled trial or, you know, whatever other type of research they choose to that specific program, how to do the enrollment, how do you do the consenting, how to do recruitment, how to do the deliver the program, and then how do we do follow up post assessments? All of that has to be incorporated in the training. And it's a very long training. It can be offered both in person and online. In-person is recommended because there's no better way to interact with a lot of the people than in person. A lot of the, you know, relationship building happen in person. So we do also data management training and then just kind of like, you know, what's going to happen during camp? There's a there's a lot more that goes into like the training for the facilitators. But majority of that is just knowing your audience and learning how to interact with them and being comfortable, just being comfortable in that space in that time, being able to address a lot of the questions that come up. And if you don't know any of the questions, how do you say, like, okay, we'll come back and revisit this at a later time. So how can you address those? How can you read the room to know that a youth needs help when you're talking about topics that are really sensitive, like sexual assault, harassment, rape, and those do come up in the in the camp. How can you read that a youth is uncomfortable in a how do you know that youth needs help. So really, just like you know that psychology part of a person will really come out. So. That's the kind of training that we also do, but it's also stuff that we probably can't teach that a person has to develop on their own. 

Amber-Rose Begay [00:39:53] Awesome. Thank you Barbara. It sounds like the Respecting the Circle of Life program has been very successful over the years, and I remember just thinking back to when I interned, I was I think I was able to recruit like 2 or 3 people, 2 or 3 students, and I think only one showed up, actually showed up. So it's really great. I think it's great that they have you on board because it seems like you're very, I guess, the extrovert. You can talk about these topics because not everybody can. But I feel like in our role, especially just as public health, health workers, you know, we do have to be open to talking about difficult topics and guiding our people, their families to to talk about them as well. So thank you. That was really great. 

DeeDee James [00:40:40] Yes. I just wanted to ask a follow up question that also if you already mentioned it or what, but what are like the future plans for the program? Are you guys actively recruiting and how can participants contact them, contact you guys if if they're interested in being a part of the program? 

Barbara Harvey [00:40:57] Yeah. So respecting that circle of life, this is actually a really good question. I had a conversation with my colleague just this morning about, we need to see what organizations in our community are currently implementing respecting the circle of life, because it doesn't just sit with Johns Hopkins. We're actually letting outside organizations like schools or health care institutes to let them know that it is available on ETR. It's a it's a website. You can go there and you can purchase. Respecting the circle of life. And what we do is we just provide the training for those individuals. I think it's being incorporated, implemented. Sorry, in, Brock Point School right now, as well as in the pinion area. And then with our health promotions in Chinle. So it was it was really it's a program that we sold and we'd we told about these outside organizations and they actually were able to say like, yes, this is actually a really good idea and really good, you know, so they're moving forward with it with specifically with the Johns Hopkins, because we we did the program during Covid. We offered it in a virtual setting from 2020 to 2022. We did a two year program where everything was virtual. It was delivered in a zoom online platform, and it was broken down into 12 sessions instead of nine. So when we did that with this program, that there's a whole lot more that goes into it. But we we closed out that program with 200 youth, so we were able to bring 200 youth to sit with me online for 12 sessions at 45 minutes a session. And we were successful in meeting our enrollment numbers. We enrolled 200, and we've completed about 85% of those in lessons before the program stopped. So we offered it as a service. And then now what we're doing is we're working with another teen pregnancy prevention program. We're currently in the process of figuring out the name for the program, what kind of evidence based program we're going to select, but it is a teen pregnancy prevention program. We're also looking at the logo. So we're pretty much starting from the beginning. And RCL, respecting the circle of life is actually going to be one of the programs that we use on the side of whatever, beside whatever EBP we choose. So we're going to use respecting the circle of life because we love it. We just I want I cannot stress enough, we love that program. We find it effective. So the 10 to the 13 year olds are going to receive the respecting the circle of life, and then the 14 to 19 year olds, there's another EBP that we're still trying to, get approved. So I won't mention it now, but you'll hear about it very soon. It's for 14 to 19 year olds, and we're going to see if we can get that to go kind of coincide with the respecting the circle of life. That program, we're going to run it in a one week camp this coming summer. So from June 17th through the 21st of this year, we're going to we're going to have that camp in Chinle, Arizona. And anybody who lives within that 50 mile range is eligible to come. Of course, we don't push anybody away who's like from Red Mesa or T snow sports. It just they just have to know that the commute is going to be pretty long. It is going to be from about 8:00 in the morning to probably about 8:00 at night. So there'll be more information, more fliers coming out for that specific, camp this summer. So it is still around. It's still happening, but this camp that we're going to be doing the summer. It is a teen pregnancy prevention just like how RCL was, but it's going to have a different name and a different logo. 

DeeDee James [00:44:51] Awesome. Thank you for that. Yeah. I know, Amber-Rose mentioned that it really does sound like a successful program for sure, and that you guys are able to, like, implemented in other places and also use it as to create, like other programs too. So that's really awesome to hear. You know, especially in the public health, specifically maternal child health. I think it's really important to include all the family members, and I feel like that's what you guys are doing. So kudos to you, everybody at Johns Hopkins and in this program. And also just, you know, thank you, Barbara, for coming on today, taking the time. I know you're very busy today too. You know, share this information with our audience, and hopefully that they're going to be able to contact you guys and want to know more information about this program. So I just want to say Ahe'hee', you know, thank you for being here today. 

Barbara Harvey [00:45:44] Thank you for inviting me here today to speak on behalf of our Teen Pregnancy Prevention, Respecting the Circle of Life program. And we look forward to, you know, being contacted by anyone who's interested in learning more about or several of the programs we actually offer with Johns Hopkins Center for Indigenous Health. You can find us on our website. Just type in Johns Hopkins Center for Indigenous Health, and there we are. You can contact our Chinle office for programs specific to that area. And I want to thank the team here today for, you know, giving me the time to share a little bit about why programs are very unique and specific to our Navajo communities, and we will continue to advocate and promote health among native youth. Thank you so much. 

Outro [00:46:30] Ahe’hee. Thanks for listening to the MCH podcast. For more information about the Navajo MCH Project, please visit us on Facebook at the Navajo Maternal and Child Health Project at Diné College.