a suicide (plus) prevention program developers: leona l. eggert liela j. nicholas funding:

A Suicide (Plus)Prevention Program

Developers:Leona L. Eggert Liela J. Nicholas

Funding:National Institutes of HealthNational Institute of Nursing Research Reconnecting Youth TM Inc.

Coping And Support Coping And Support TrainingTraining

Reconnecting Youth TM Inc.2

2. Youth at risk for high-school dropout are at elevated risk for suicidal behaviors

1. Suicide is a 2nd or 3rd leading cause of death among youth 15-19 yrs. of age; in some states, youth suicide rates exceed homicide rates

3. At risk youth often experience other health risks, including depression, hopelessness, aggression and drug involvement

Why we need CAST …

.

Reconnecting Youth TM Inc. 3

Who is CAST for ?Listen to the

stories of four typical CAST

students

.


Meet a Typical CAST Student

Parental pressure to perform like

high-achieving brother

Skilled musician; many

demands to practice

Not much perceived

support from peers

Stressed by school—

feeling hopeless

Has had suicidal

thoughts and a prior

attempt

Vicki – 14 yr old freshman

.


Meet Another Typical StudentJim – 15 yr old sophomore

Out late at night; often

gets to school late

When confronted

about behavior, acts angry and

hopeless

May lose credits due to

frequent absences

Maintaining a B average

Partying, using drugs and/or

alcohol daily

.


Meet Another Typical

StudentAbdul – 17 yr old junior Athletic, outgoing,

social leader in school

Wit, defiance causing conflicts with teachers,

affecting grades and moods

Says he is drug-free,

not using now

Befriends known drug/ alcohol users

Evidences depression and

anger

.


Finally, Meet . . .Clarissa – 16 yr old sophomore

Teachers are concerned about

withdrawal/ depression

Spends a lot of time alone

Has little tolerance for drug users

Interview revealed high

levels of anxiety/ depression

Workshard in classes,

is a talented writer but failed math

Risk and Protective Risk and Protective FactorsFactorsAddressed Addressed are…are…Direct

SuicideRisk FactorsRelated SuicideRisk FactorsProtectiveFactors: Personal and Social Support Resources

Reconnecting Youth TM Inc.


The greater the number of factors evidenced, the higher the suicide risk

Exposure to

SuicidePositive

Attitudes/Beliefs about Suicide Suicidal Ideation Direct

SuicideRisk

Factors

Direct and Indirect Suicidal

Threats

Planning and Preparation

Prior Suicidal Attempts

CAST students may exhibit ...


Students may also exhibit ...

Family Distress

DepressionAnxiety

Anger/Aggression

RiskyBehaviors,Impulsivity

Violence,Victimization

SchoolProblems

Drug Involvement

Multiple Stressors

Hopelessness

RelatedSuicide

RiskFactorsMorerelated risks increase suicide risk


SupportAvailability

Family Support

Satisfaction

ProtectiveFactors:

Personal and

SocialResources

Sense of

SupportPersonalControl

Problem-SolvingCoping

Self-Esteem

Assets counteract suicide risks

These students may lack important assets . . .

How do we find How do we find students students who need who need CAST ?CAST ? By screening for suicide-risk

By selecting a known high-risk group – e.g.Depressed youth

Native AmericansPotential DropoutsYouth in Transition



1. Potential high-school dropout, and 2. Suicidal behaviors — i.e., those

endorsing Direct suicide risk behaviors —

thoughts, threats, plans or prior attempts

Related risk factors — depression, drug involvement

Students who ‘screen in’ should be graciously

approached and invited to participate!

By screening, we can find students at risk for …


CAST Meets Design Challenges

by: Addressing both ‘direct’ and ‘related’ suicide-risk factorsEnhancing protective factors

Being culturally and developmentallyappropriate for at-risk youthFacing the challenge of screening for level of suicide risk

CAST Program CAST Program FeaturesFeaturesDesign

challengesProgram structure

GoalsSkills training 12 sessionsLesson Structure

Content



CAST Program Structure

Skills training in a supportive context (with content outlined next)

6-8 students per group

Implemented in students’ school

Twelve 55-minute sessions over 6 weeks


CAST Content – 3 Goals designed to help at-risk youth to:

3. 3. Decrease school problems, strain increase grades and attendance, credits, and school bonding

1. 1. Decrease suicide-risk and emotional distress suicidal thoughts and behaviors; depression,

hopelessness, anxiety, anger and aggression 2.2. Decrease drug involvement drug use frequency, drug use control problems, and adverse drug use consequences


CAST Content – 4 Major Skill Areas1.Building Self-Esteem Learning to appreciate self and others 2.2. Decision Making

Choosing to make healthy decisions 3.3. Monitoring and Setting

Goals Deciding what we want & tracking progress

4.4. Personal Control Managing moods, drug use & school smarts

An essential skill set to achieve the 3 CAST goals!

.


Monitoring

Adult Motivation and Support

Peer Group Support

Access to Help

Assessment Feedback

Coaching / Skills Training

CAST Prevention Strategies


CAST Content:12 Sessions1. WELCOME and ORIENTATION2. GROUP SUPPORT and SELF-ESTEEM 3. SETTING and MONITORING GOALS4. BUILDING SELF-ESTEEM, BEATING THE BLUES5. DECISION-MAKING – TAKING ‘STEPS’6. SCHOOL SMARTS 7. ANGER MANAGEMENT #18. ANGER MANAGEMENT #29. DRUG-USE CONTROL–MAKING HEALTHY

DECISIONS10.PREVENTING SLIPS and RELAPSES11.RECOGNIZING PROGRESS and STAYING ON

TRACK12.CELEBRATING GRADUATION


Cast Session Structure … Components

Time

Constant Blend of Skills Training and Group Support

Learning Activities (learn skills) ~15 min

Sneak Peek – What’s Next? ~ 5 min

Check In ~10 minMotivate / Today’s Big Ideas ~ 2 min

Lifework (practice beyond group) ~ 5 min

Practice (during group session) ~20 min

1

2

3

4

5

6

Does CAST Work? Does CAST Work? Experimental Results for

Study DesignCAST group (+ CARE one-to-one assessment & connections intervention), compared toUsual Care (the Beck interview & intervention)

Suicide riskEmotional distress Drug involvement Protective factors



Significant results for CAST [+CARE] youth relative to ‘usual care,’ treated controls:

65% in Global Suicide Risk Behaviors (56% for controls)

64% in Positive Attitudes toward suicide (56% for controls)

58% in Suicidal Ideation (42% for controls)

63% in Suicidal Threats (44% for controls)

68% in Suicide Attempts (43% for controls)

Suicide Risk FactorsOO

UUTTCCOOMMEESS


44% in Depression [24% for controls]

29% in Hopelessness [22% for controls]

34% (females), 27% (males) in Anxiety[13% (females), 21% (males) for controls ]

24% (females), 20% (males) in Anger[12% (females), 20% (males) for controls]

Emotional Distress Significant results for CAST [+CARE] youth relative to ‘usual care,’ treated controls :

OOUUTTCCOOMMEESS


16% in Alcohol Use (3% for controls)

7% in Marijuana Use (10% for controls)

62% in Hard Drug Use (27% for controls)

33% in Drug Control Problems (2% for controls)35% in Adverse Drug Use Consequences

(24% for controls)

Drug InvolvementSignificant results for CAST [+CARE] youth relative to ‘usual care,’ treated controls:

OOUUTTCCOOMMEESS


24% in Personal Control (16% for controls)

24% in Problem-Solving Coping(4% for controls)

27% in Family Support (14% for controls)

Protective Factors Significant results for CAST [+CARE] youth relative to ‘usual care’ controls:Significant results for CAST [+CARE] youth relative to ‘usual care,’ treated controls:

OOUUTTCCOOMMEESS

Monitoring

Adult Motivation and Support

Peer Group Support

Access to Help

Assessment Feedback

Coaching / Skills Training

CAST Process Model

IncreasedPersonal

Competenciesand

IncreasedSocial Support

Resources

Implementing CAST as designed = positive outcomes!

Prevention Mechanisms Mediators Outcomes Decreased

Suicide Risk Behaviors

DecreasedEmotional

Distress

DecreasedDrug

Involvement


.


Significant intervention effects included . . .

Declines in direct suicide risks suicidal attitudes, suicidal ideation

Declines in related emotional distressdepression, hopelessness, and for females,anxiety, anger control problems

Declines in related drug involvementdrug use control problems

Increases in mediators / assetspersonal control, problem-solving coping

IITT

WWOORRKKSS

.


Reasons to adopt CAST …

Research showed that suicide-risk screening was feasible and CAST was effective for reducing suicide risk among adolescents—one of the Surgeon General’s goals

Other studies suggest CAST works with middle-school youth transitioning to high-school, and as a general risk-reduction, asset-building intervention for teens

CAST is evidence-based; the only small-group, skills-training, school-based program classified as ‘Effective’ by SPRC, Suicide Prevention Resource Center

IITT

WWOORRKKSS

.


CAST Leaders are Key!

For their superior interpersonal skills with ‘at-risk’ youth

Willing-

Chosen -

Trained -

To be involved when invited

In how to implement CAST4 full days with follow-up support

They need to They need to be …be …

We all do We all do when …when …high-risk youth have less emotional distress, more coping skills and social support—to offset stressful life events that lead to depression and suicide risk


you and others reach out in your school communities to identify and engage youth in CAST

you can expect positive outcomes with your students IF you deliver CAST as it is designed

Together we can make a Together we can make a difference!difference!

Who Benefits?

a suicide (plus) prevention program developers: leona l. eggert liela j. nicholas funding:

Documents

cast reconnecting youth

cast content

cast goals

suiciderisk screening

cast works

cast research

typical cast studentvicki

elevated risk