1. A Suicide (Plus) Prevention Program Developers: Leona L. Eggert Liela J. Nicholas Funding: National Institutes of Health National Institute of Nursing Research  Reconnecting Youth TM Inc. Coping And Support Training

2.  Reconnecting Youth TM Inc. 2 2. Youth at risk for high-school dropout are at elevated risk for suicidal behaviors 1.Suicide is a 2 nd or 3 rd 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 …

3. .  Reconnecting Youth TM Inc. 3 Who is CAST for ? Listen to the stories of four typical CAST students

4. .  Reconnecting Youth TM Inc. 4 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

5. .  Reconnecting Youth TM Inc. 5 Meet Another Typical Student Jim – 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

6. .  Reconnecting Youth TM Inc. 6 Meet Another Typical Student Abdul – 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

7. .  Reconnecting Youth TM Inc. 7 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 Works hard in classes, is a talented writer but failed math

8. Risk and Protective Factors Addressed are… Direct Suicide Risk Factors Related Suicide Risk Factors Protective Factors: Personal and Social Support Resources  Reconnecting Youth TM Inc.

9.  Reconnecting Youth TM Inc. 9 The greater the number of factors evidenced, the higher the suicide risk Exposure to Suicide Positive Attitudes/Beliefs about Suicide Suicidal Ideation Direct Suicide Risk Factors Direct and Indirect Suicidal Threats Planning and Preparation Prior Suicidal Attempts CAST students may exhibit...

10.  Reconnecting Youth TM Inc. 10 Students may also exhibit... Family Distress Depression Anxiety Anger/ Aggression Risky Behaviors, Impulsivity Violence, Victimization School Problems Drug Involvement Multiple Stressors Hopelessness Related Suicide Risk Factors More related risks increase suicide risk

11.  Reconnecting Youth TM Inc. 11 Support Availability Family Support Satisfaction Protective Factors: Personal and Social Resources Sense of Support Personal Control Problem- Solving Coping Self- Esteem Assets counteract suicide risks These students may lack important assets...

12. How do we find students who need CAST ? By screening for suicide-risk By selecting a known high- risk group – e.g. Depressed youth Native Americans Potential Dropouts Youth in Transition  Reconnecting Youth TM Inc.

13.  Reconnecting Youth TM Inc. 13 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 …

14.  Reconnecting Youth TM Inc. 14 CAST Meets Design Challenges by: Addressing both ‘direct’ and ‘related’ suicide-risk factors Enhancing protective factors Being culturally and developmentally appropriate for at-risk youth Facing the challenge of screening for level of suicide risk

15. CAST Program Features Design challenges Program structure Goals Skills training 12 sessions Lesson Structure Content  Reconnecting Youth TM Inc.

16.  Reconnecting Youth TM Inc. 16 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 

17.  Reconnecting Youth TM Inc. 17 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

18.  Reconnecting Youth TM Inc. 18 CAST Content – 4 Major Skill Areas 1.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!

19. .  Reconnecting Youth TM Inc. 19 Monitoring Adult Motivation and Support Peer Group Support Access to Help Assessment Feedback Coaching / Skills Training CAST Prevention Strategies

20.  Reconnecting Youth TM Inc. 20 CAST Content:12 Sessions 1.WELCOME and ORIENTATION 2.GROUP SUPPORT and SELF-ESTEEM 3.SETTING and MONITORING GOALS 4.BUILDING SELF-ESTEEM, BEATING THE BLUES 5.DECISION-MAKING – TAKING ‘STEPS’ 6.SCHOOL SMARTS 7.ANGER MANAGEMENT #1 8.ANGER MANAGEMENT #2 9.DRUG-USE CONTROL–MAKING HEALTHY DECISIONS 10.PREVENTING SLIPS and RELAPSES 11.RECOGNIZING PROGRESS and STAYING ON TRACK 12.CELEBRATING GRADUATION

21.  Reconnecting Youth TM Inc. 21 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 min Motivate / Today’s Big Ideas ~ 2 min Lifework (practice beyond group) ~ 5 min Practice (during group session) ~20 min 1 2 3 4 5 6

22. Does CAST Work? Experimental Results for Study Design CAST group (+ CARE one-to-one assessment & connections intervention), compared to Usual Care (the Beck interview & intervention) Suicide risk Emotional distress Drug involvement Protective factors  Reconnecting Youth TM Inc.

23.  Reconnecting Youth TM Inc. 23 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 Factors OUTCOMES

24.  Reconnecting Youth TM Inc. 24   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 : OUTCOMES

25.  Reconnecting Youth TM Inc. 25   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 Involvement Significant results for CAST [+CARE] youth relative to ‘usual care,’ treated controls: OUTCOMES

26.  Reconnecting Youth TM Inc. 26 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: OUTCOMES

27. Monitoring Adult Motivation and Support Peer Group Support Access to Help Assessment Feedback Coaching / Skills Training CAST Process Model Increased Personal Competencies and Increased Social Support Resources Implementing CAST as designed = positive outcomes! Prevention Mechanisms Mediators Outcomes Decreased Suicide Risk Behaviors Decreased Emotional Distress Decreased Drug Involvement  Reconnecting Youth TM Inc. 27

28. .  Reconnecting Youth TM Inc. 28 Significant intervention effects included... Declines in direct suicide risks suicidal attitudes, suicidal ideation Declines in related emotional distress depression, hopelessness, and for females, anxiety, anger control problems Declines in related drug involvement drug use control problems Increases in mediators / assets personal control, problem-solving coping ITWORKS

29. .  Reconnecting Youth TM Inc. 29 R easons 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 ITWORKS

30. .  Reconnecting Youth TM Inc. 30 CAST Leaders are Key! For their superior interpersonal skills with ‘at-risk’ youth W illing- C hosen - T rained- To be involved when invited In how to implement CAST 4 full days with follow-up support They need to be …

31. We all do when … We all do 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  Reconnecting Youth TM Inc. 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 difference! Who Benefits?