Youth Suicide Prevention in Rural America National Webinar: SPRC and STIPDA Sources of Strength Mark LoMurray Director 7

1. Youth Suicide Prevention in Rural America National Webinar: SPRC and STIPDA Sources of Strength Mark LoMurray Director 701-471-7186 marklomurray@gmail.com

2. Network Positions Peripherals Bridges Group Members Central Members Isolate 2

3. Sources of Strength Description A program that trains both adult advisors and diverse peer leaders – with five follow-up action steps that take peer leaders/adult advisor teams three to four months to complete Usually school-based, but faith, community, cultural is used. The purpose is to reduce codes of silence and promote help seeking by teens to caring adults in their local school and community. Started in ND in 1998, used extensively in a statewide campaign from 2000-2004. In 2005 the project received the national APHA Public Health Practice Award – epidemiology section Rigorous randomized research is underway in 18 schools in GA, upstate NY, and ND through the University of Rochester, NY and University of South Florida.

4. A Connections Model is Different than The Surveillance Model

5. A Singular Focus on Mental Health Referrals Leaves rural and tribal communities feeling disempowered Rural communities are often mental health shortage regions A one way model that requests referrals to medical and mental health services, but generally does not refer back to village-based supports and strengths.

6. A Connections Model Sources of Strength A focus on developing multiple sources of support A strength-focused approach Bring peers and adults together for prevention power Use peer connections to change peer social norms about adult help seeking, strengths Spread Hope, Help, Strength messages, not stories of trauma – local faces and voices

7. Basic Process Awareness Phase -Engage leaders/ administrators Review protocol Identify and train key adult advisors (2-6 hr) Train school or community staff (20 m – 1.5 hr) Recruit peer leaders Train peer leaders with adult advisors (3-4 hr) Peer leaders with adult support begin 5 action steps (3-4 months)

8. Sources of Strength Access to Mental Health Family Support Positive Friends Access to Medical Spirituality Caring Adults Positive Activities Generosity/Leadership

9. Prevention Power in Rural Connections

10. Early ResultsImpact of training on 176 Teen Peer Leaders in 6 Schools (GA) • 6 high schools in Cobb County that already received staff gatekeeper training • Randomized design – to immediate training or wait-list • More than 50% of peer leaders aware of suicidal peers • Positive training effect (at school-level (4 d.f.) on: • Help-seeking Norms p< 0.05 • Coping Using Sources of Strength p< 0.05 • Knowledge of helping Suicidal Peers p< 0.01 • Referral of Suicidal Peers to Adults p< 0.05

11. Knowledge of Helping Suicidal Peers increased by training (p<.01)

12. Help-Seeking Norms increased by training (p<.05)

13. Referred a Suicidal Peer to Adults: 2-fold increase by training (p<.05) Control Schools Sources of Strength Schools

14. Initial Conclusions for Peer Leader Training (Sources of Strength) In high schools with adult staff training (QPR), peer leaders can be trained and implement ‘peer to peer’ messaging Training increases Peer Leaders’ positive help-seeking attitudes, reduces ‘codes of silence’ Trained Peer Leaders refer more suicidal peers to adults for help (self-reported), unlike adult training which did not increase referral behaviors in high schools

15. Promoting Help-seeking Behaviors A model that values village-based supports as highly as institutional services. Intentional and strategic about using peer and rural connections to change social norms Localize – create names, faces, of local supports on a small town, village, housing project level. Move from just help seeking around suicide to include strength building behaviors, early emotional distress = caring conversations

16. Using Data to Focus Resources

17. Data and Surveillance • North Dakota experience of needing to look at a fuller picture • raw numbers of suicide fatalities • rates of suicide fatalities – gender, age, ethnicity • Breakdown into state regions and counties • Use ten year averages – recent and long-term trends • Compare to national rates and to surrounding states • Use YRBS, lack of injury data – ambulance trips • Surveillance system needed – contagion response

18. Clinical Care – one example • Mental Health – Faith-based Partnerships • Many pastors and spiritual leaders provide a bulk of rural counseling • Many lack training • Almost all lack support and consultation services • Be intentional about bringing ministerial- spiritual leaders in regular meetings with mental health providers. • Encourage cross system referrals

19. Screening and Identification • First do no harm • Make sure adequate resources are in place to handle youth identified • Universal school-based screening – 20% identification of students is not uncommon • Tiered system • Hospital, outpatient, small support groups, mentors

20. Supporting Attempters Oniyape – home tracker model Maniilaq Association, Alaska – letter writing Hotlines – phone follow-up support Sponsors – Mentors to provide ongoing support