The Pascua Yaqui Tribe’s Centered Spirit Crisis Program: A Program Evaluation

Abstract

Background: The Pascua Yaqui Tribe experiences disproportionately high mental health crisis rates, including for Post-Traumatic Stress Disorder PTSD, substance use disorders, and suicide attempts. External Emergency Mobile Pediatric and Adolescent Crisis Team (EMPACT) services caused two-hour delays, culturally insensitive care, and eroded trust.Purpose: This Doctor of Nursing Practice (DNP) project program evaluation assessed the Centered Spirit Crisis Pilot Program's community-led model, using trained Pascua Yaqui Fire Department Emergency Medical Technicians (EMTs), and examined its effectiveness in preventing crisis escalation, improving mental health outcomes, and fostering community trust through culturally sensitive interventions. Methods: A program evaluation was completed using CDC's Framework, which collected data from clients (N=11, 55% response rate) and stakeholders, including EMTs, clinicians, and staff (N=13, 100% response rate). Data utilized included safety, respect, cultural competence, collaboration, confidence, and trust using 5-point Likert scales and open-ended questions. Results: Client satisfaction was exceptional: 100% felt safe/supported and treated respectfully; 73% felt their cultural values were respected; 91% would recommend services. Stakeholders reported high confidence (69%) but significant collaboration challenges (31% agreed collaboration was effective) and uncertainty about community-level outcomes (69% neutral on trust). EMTs identified jurisdictional confusion outside reservation boundaries and requested clear protocols to prevent care delays. Conclusions: Results of this program evaluation support the conclusion that the Centered Spirit Crisis Pilot Program successfully delivers culturally grounded crisis intervention with exceptional client satisfaction. However, collaboration deficits, jurisdictional gaps, and the absence of outcome tracking require immediate attention. Recommendations include developing eligibility protocols, strengthening interprofessional collaboration, enhancing cultural training, implementing outcome monitoring, and expanding community engagement to ensure sustainability and serve as a model for tribally driven crisis intervention.