The Parenting in 2 Worlds (P2W) intervention was developed to create and test the efficacy of a culturally grounded parenting program specifically tailored to the social and cultural worlds of urban American Indian (AI) families. The intervention was produced through a partnership between the Urban Indian Coalition of Arizonathe Phoenix Indian Center, and the Southwest Interdisciplinary Research Center at Arizona State University (SIRC).  It is designed to address the disproportional health disparities associated with substance abuse and risky sexual behavior that are experienced by AI families living in urban areas, and the lack of evidence-based prevention approaches to prevent, reduce and eliminate health disparities among this rapidly growing population.  Family disruption, stresses related to poverty and rural-to-urban migration, and loss of cultural and social connections frequently operate as pathways to adverse health outcomes among urban AI families. The Parenting in 2 Worlds study has two main aims:  1) to develop, test and implement a culturally grounded parent education curriculum for parents of American Indian youth 10-17 years old who live in urban areas in Arizona; and 2) to build the capacity of parents, the community, and partnered agencies to prevent youth substance use and risky sexual behaviors.

The parenting intervention, Parenting in 2 Worlds (P2W), aims to strengthen family functioning and communication to help parents strengthen culturally relevant parenting skills, promote their children's health and well-being, and reduce their children’s risk of substance use and risky sexual behavior.  P2W is an adaptation of an existing parenting intervention incorporating American Indian cultural values, communication styles and customs related to parenting unique to American Indian families living an urban experience. P2W is designed to be a 10-workshop curriculum, each workshop approximately two hours in length, administered over 10 weeks (one workshop per week) and facilitated by trained community members who represent the urban American Indian community where the curriculum is being implemented.

An initial version of the curriculum, P2W-pilot, was tested in Spring 2012 in three urban areas throughout Arizona. The P2W-pilot was administered over five weeks (two workshops per week) to 95 parent participants of American Indian youth 10-17 years old. In addition to the pilot curriculum being facilitated by trained urban American Indian community members, each workshop was observed by trained urban American Indian community members.

Community-based participatory research was used to guide the cultural adaptation process of the P2W-pilot curriculum. Quantitative and qualitative data was gathered during the pilot implementation from participants, facilitators, workshop observers and key informants from fields of curriculum construction and design and the American Indian community. Multiple focus groups were held with pilot participants, facilitators and observers, and key informants. Additional data collection tools included: workshop reflection forms completed by participants; workshop evaluation forms completed by the facilitators; workshop observations completed by observers; and pre-/post-surveys completed by participants.

The adaptation resulted in P2W being culturally grounded incorporating American Indian cultural values, an American Indian worldview on parenting, and reflective of customs specific to American Indians living an urban experience. The ten workshops are titled:

Workshop 1 – “Introduction to Parenting in 2 Worlds
Workshop 2 – “Building Parenting Communities”
Workshop 3 – “Identifying Family Traditions, Norms & Values”
Workshop 4 – “Knowing Your Child’s World”
Workshop 5 – “Communicating with Your Child”
Workshop 6 – “Receiving and Giving Support”
Workshop 7 – “Guiding Your Child’s Behavior Effectively, part 1”
Workshop 8 – “Guiding Your Child’s Behavior Effectively, part 2”
Workshop 9 – “Talking to Teens about Risky Behaviors”
Workshop 10 – “Putting It All Together”

Each workshop is designed to be two hours in length and includes the following elements: Welcome and making connections review (review of prior workshop); agenda and objectives; topics and activities related to parenting practices; making connections; and a wrap-up. Various facilitation strategies are used throughout the P2W curriculum: informational discussions; individual and small group activities; videos; role-plays; games; scenarios; group presentations; activity sheets; and home projects and activities. Additionally, a series of short video clips of American Indian parents and grandparents sharing their experiences of raising children and grandchildren was specifically produced for each workshop with the intent that participants watch, listen to the stories shared and reflect on their own parenting experiences.

The final P2W curriculum is being implemented in a randomized-control trial in three urban areas of Arizona: Phoenix, Tucson and Flagstaff. The curriculum is facilitated by trained urban American Indian community members, and trained observers from the urban American Indian community collect observations from: Workshop 3 “Identifying Family Traditions, Norms & Values” and Workshop 8 “Guiding Your Child’s Behavior Effectively, Part 2”.

The second goal of the UAIP Project is to build community capacity not only by raising substance abuse and risky behaviors awareness and prevention skills of parents who participate in the parenting curriculum but also by increasing the prevention skills of mentoring facilitators from the American Indian population.  The efforts build the capacity of all project participants and workers, as well as partnered agencies involved in community-based participatory research.