A Suicide (Plus) Prevention Program Developers: Leona L. Eggert Liela J. Nicholas Funding: National Institutes of

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

2. Why we need CAST … • 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 2. Youth at risk for high-school dropout are at elevated risk for suicidal behaviors Reconnecting YouthTMInc.

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

4. Has had suicidal thoughts and a prior attempt Not much perceived support from peers Parental pressure to perform like high-achieving brother Skilled musician; many demands to practice Stressed by school—feeling hopeless Meet a Typical CAST Student Vicki– 14 yr old freshman Reconnecting YouthTMInc.

5. Jim – 15 yr old sophomore Maintaining a B average Out late at night; often gets to school late May lose credits due to frequent absences When confronted about behavior, acts angry andhopeless Partying, using drugs and/or alcohol daily Meet Another Typical Student Reconnecting YouthTMInc.

6. Abdul– 17 yr old junior Athletic, outgoing, social leader in school Befriends known drug/ alcohol users Says he is drug-free, not using now Wit, defiance causing conflicts with teachers, affecting grades and moods Evidences depression and anger Meet Another Typical Student Reconnecting YouthTMInc.

7. Workshard in classes, is a talented writer but failed math Spends a lot of time alone Interview revealed high levels of anxiety/ depression Teachers are concerned about withdrawal/ depression Has little tolerance for drug users Finally, Meet . . . Clarissa – 16 yr old sophomore Reconnecting YouthTMInc.

8. Risk and Protective Factors Addressed are… Direct SuicideRisk Factors Related SuicideRisk Factors ProtectiveFactors: Personal and Social Support Resources Reconnecting YouthTM Inc. 

9. CAST students may exhibit ... Suicidal Ideation Prior Suicidal Attempts Exposure to Suicide PositiveAttitudes/Beliefs about Suicide DirectSuicideRiskFactors Planning and Preparation Direct and Indirect SuicidalThreats The greater the number of factors evidenced, the higher the suicide risk Reconnecting YouthTMInc.

10. Students may also exhibit ... Anxiety Hopelessness Depression Anger/Aggression Family Distress Multiple Stressors Risky Behaviors, Impulsivity Violence, Victimization Drug Involvement School Problems RelatedSuicideRiskFactors Morerelated risks increase suicide risk Reconnecting YouthTMInc.

11. These students may lack important assets . . . Sense of Support PersonalControl ProtectiveFactors: Personal and SocialResources Self-Esteem SupportAvailability Problem-SolvingCoping Family SupportSatisfaction Assets counteract suicide risks Reconnecting YouthTMInc.

12. How do we find students who need CAST ? By screening for suicide-risk By selecting a known high-risk group – e.g. Depressed youthNative AmericansPotential DropoutsYouth in Transition Reconnecting YouthTM Inc. 

13. By screening, we can find students at risk for … • Potential high-school dropout, and • 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 graciouslyapproached and invited to participate! Reconnecting YouthTMInc.

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

15. CAST Program Features Design challenges Program structure Content GoalsSkills training 12 sessionsLesson Structure Reconnecting YouthTM Inc. 

16. CAST Program Structure  6-8 students per group Implemented in students’ school   Twelve 55-minute sessions over 6 weeks  Skills training in a supportive context (with content outlined next) Reconnecting YouthTMInc.

17. CAST Content – 3 Goalsdesigned to help at-risk youth to: 1. Decrease suicide-risk and emotional distress suicidal thoughts and behaviors; depression, hopelessness, anxiety, anger and aggression 2.Decrease drug involvementdrug use frequency, drug use control problems, and adverse drug use consequences 3. Decrease school problems, strainincrease grades and attendance, credits, and school bonding Reconnecting YouthTMInc.

18. CAST Content – 4 Major Skill Areas • Building Self-Esteem • Learning to appreciate self and others • 2.DecisionMakingChoosing to make healthy decisions • 3.MonitoringandSettingGoalsDeciding what we want & tracking progress • 4. PersonalControlManaging moods, drug use & school smarts An essential skill set to achieve the 3 CAST goals! Reconnecting YouthTMInc.

19. AssessmentFeedback Adult Motivation and Support Peer Group Support Coaching / Skills Training CAST Prevention Strategies Access to Help Monitoring Reconnecting YouthTMInc.

20. CAST Content:12 Sessions • WELCOME and ORIENTATION • GROUP SUPPORT and SELF-ESTEEM • SETTING and MONITORING GOALS • BUILDING SELF-ESTEEM, BEATING THE BLUES • DECISION-MAKING – TAKING ‘STEPS’ • SCHOOL SMARTS • ANGER MANAGEMENT #1 • ANGER MANAGEMENT #2 • DRUG-USE CONTROL–MAKING HEALTHY DECISIONS • PREVENTING SLIPS and RELAPSES • RECOGNIZING PROGRESS and STAYING ON TRACK • CELEBRATING GRADUATION Reconnecting YouthTMInc.

21. Cast Session Structure … ComponentsTime Check In~10 min 1 Motivate / Today’s BigIdeas~ 2 min 2 3 4 Practice (during group session)~20 min Lifework (practice beyond group)~ 5 min 5 Sneak Peek – What’s Next?~ 5 min 6 Constant Blend of Skills Training and Group Support Learning Activities (learnskills)~15 min Reconnecting YouthTMInc.

22. Does CAST Work? Experimental Results for Suicide riskEmotional distress Drug involvement Protective factors Study DesignCAST group(+ CARE one-to-one assessment & connections intervention), compared toUsual Care (the Beck interview&intervention) Reconnecting YouthTM Inc. 

23. Suicide Risk Factors Significant results for CAST [+CARE] youth relative to ‘usual care,’ treated controls: O U T C O M E S 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) Reconnecting YouthTMInc.

24. Emotional Distress Significant results for CAST [+CARE] youth relative to ‘usual care,’ treated controls: O U T C O M E S 44% in Depression[24%for controls] 29% in Hopelessness[22% for controls] 34%(females), 27% (males)inAnxiety [13%(females), 21%(males)for controls] 24%(females),20%  (males) in Anger [12%(females), 20% (males)for controls] Reconnecting YouthTMInc.

25. Drug Involvement Significant results for CAST [+CARE] youth relative to ‘usual care,’ treated controls: O U T C O M E S 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) Reconnecting YouthTMInc.

26. 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: O U T C O M E S 24%in Personal Control(16% for controls) 24% in Problem-Solving Coping (4% for controls) 27% in Family Support (14%for controls) Reconnecting YouthTMInc.

27. CAST Process Model AssessmentFeedback Prevention Mechanisms Mediators Outcomes Access to Help Decreased Suicide Risk Behaviors IncreasedPersonalCompetenciesand Adult Motivation and Support Peer Group Support Decreased Emotional Distress Coaching / Skills Training IncreasedSocial SupportResources Decreased Drug Involvement Monitoring Implementing CAST as designed = positive outcomes! Reconnecting YouthTMInc. 27

28. Significant intervention effects included . . . I T W O R K S Declines in direct suicide riskssuicidal 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 / assetspersonal control, problem-solving coping Reconnecting YouthTMInc.

29. Reasons to adopt CAST … I T W O R K S CAST is evidence-based; the only small-group, skills-training, school-based programclassified as ‘Effective’ by SPRC, Suicide Prevention Resource Center 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 Reconnecting YouthTMInc.

30. Chosen - Willing - Trained - CAST Leaders are Key! They need to be … For their superior interpersonal skills with ‘at-risk’ youth To be involved when invited In how to implement CAST 4 full days with follow-up support Reconnecting YouthTMInc.

31. 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 Who Benefits? you and others reach out in your school communitiesto 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! Reconnecting YouthTM Inc. 