Project Summary/ Abstract Candidate: The overall goal of this K01 career development proposal is to provide me with the training experience needed to become a leader in health equity research with American Indian/ Alaska Native (AI/AN) populations. My preliminary Community Based Participator Research (CBPR) work with AI/AN communities showed that grief symptoms negatively impact health and wellness. As my research progressed, it became clear that culturally grounded mental health services were needed for people struggling with losing a loved one. These findings helped shape the direction for this K01 proposal, which aims to culturally adapt and pilot test the feasibility of Behavioral Activation and Therapeutic Exposure for Grief (BATE-G) with AI/AN participants. To accomplish research and training goals for this K01 project, I will work closely with community partners and academic mentors. The training plan is structured to support training in: 1) designing randomized control trials for behavioral health interventions, 2) developing advanced quantitative analysis skills, 3) developing and leading CBPR projects, and 4) developing skills in implementation science. The mentorship team will also provide guidance throughout the proposed research project. Research: AI/AN populations in the United States have the highest early death rates for young people compared to White, Black, and Hispanic populations.1-4 High mortality rates in AI/AN communities are attributed to chronic illness, accidental injuries, interpersonal violence/homicide, and suicide.1, 5 Experiencing the sudden or unexpected death of a loved one increases the risk of developing disabling grief-related symptoms, which can lead to Persistent Complex Bereavement Disorder (PCBD).6 PCBD is characterized impairing PCBD with and evidence-based by symptoms of depression and PTSD among surviving family and friends. Importantly, research on in AI/AN communities is extremely limited, and no evidence-based treatments (EBTs) have been tested this population. This is sadly unsurprising as AI/AN people are typically underrepresented in clinical trials are underserved with regard to evidence-based behavioral health treatments. 7, To address the need for treatments for grief in AI/AN populations, will 8 I 1) conduct focus groups (4 groups of 6 people) to gain feedback on the acceptability of the BATE-G intervention and generate possible adaptations, 2) work with community partners to adapt the BATE-G intervention in light of the focus group findings, and 3) conduct a single group feasibility trial of the culturally adapted BATE-G telehealth intervention and study components with adult AI/AN (N = 20) who have experienced the loss of someone close to them due to accidental death. The feasibility community-based plan test of this culturally adapted treatment for PCBD delivered through telemedicine technology by paraprofessionals will inform future RCT R01 grant projects. The K01 research and training fulfills the defined missions of NIMHD related topromoting research to understand and improve the health of racial/ethnic minority populations and developing and testing interventions to reduce health disparities.

Project Narrative This research project builds on our current community partner relationships and uses a Community-Based Participatory Research (CBPR) framework to culturally adapt and test the feasibility of a Behavioral Activation and Therapeutic Exposure for Grief (BATE-G) intervention among American Indian and Alaska Native (AI/AN) people who are experiencing impairing grief-related symptoms diagnosed as Persistent Complex Bereavement Disorder (PCBD). BATE-G employs trained AI/AN community paraprofessionals to deliver intervention content via telehealth, increasing access to culturally responsive evidence-based treatments for this often-underserved population. This project will also contribute to the research and training development of an early career investigator whose career goals center around understanding and addressing health inequalities in underserved communities with a focus on trauma and grief.