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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 TrainingTrainingCoping 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 … Why we need CAST …
.
Reconnecting Youth TM Inc. 3
Who is CAST for ?Who is CAST for ?Listen to the
stories of four typical CAST
students
.
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Meet a Typical CAST StudentMeet 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 freshmanVicki – 14 yr old freshman
.
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Meet Another Typical
Student
Meet Another Typical
StudentJim – 15 yr old sophomoreJim – 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
.
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Meet Another Typical
Student
Meet Another Typical
StudentAbdul – 17 yr old junior 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
.
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Finally, Meet . . . Finally, Meet . . .Clarissa – 16 yr old sophomoreClarissa – 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.
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The greater the number of factors evidenced, the higher the suicide risk
The greater the number of factors evidenced, the higher the suicide risk
Exposure to
Suicide
PositiveAttitudes/Beliefs
about Suicide Suicidal Ideation DirectSuicide
RiskFactors
Direct and Indirect Suicidal
Threats
Planning and Preparation
Prior Suicidal Attempts
CAST students may exhibit ...CAST students may exhibit ...
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Students may also exhibit ...Students may also exhibit ...
Family Distress
Depression
Anxiety
Anger/Aggression
RiskyBehaviors,Impulsivity
Violence,Victimization
SchoolProblems
Drug Involvement
Multiple Stressors
Hopelessness
RelatedSuicide
RiskFactorsMore
related risks increase suicide risk
Morerelated risks increase suicide risk
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SupportAvailability
Family Support
Satisfaction
ProtectiveFactors:
Personal and
SocialResources
Sense of
SupportPersonalControl
Problem-SolvingCoping
Self-Esteem
Assets counteract suicide risks
Assets counteract suicide risks
These students may lack
important assets . . .
These students may lack
important assets . . .
How do we find How do we find students students How do we find How do we find students students who need who need CAST ?CAST ?
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
Reconnecting Youth TM Inc.
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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 …
By screening, we can find students at risk for …
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CAST Meets Design Challenges
by:
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
CAST Program CAST Program FeaturesFeaturesDesign
challenges
Program structure
GoalsSkills training 12 sessionsLesson Structure
Content
Reconnecting Youth TM Inc.
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CAST Program StructureCAST 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
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CAST Content – 3 Goals designed to help at-risk youth to:
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
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CAST Content – 4 Major Skill
Areas
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!
An essential skill set to achieve the 3 CAST goals!
.
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Monitoring
Adult Motivation and Support
Peer Group Support
Access to Help
Assessment Feedback
Coaching / Skills Training
CAST Prevention Strategies
CAST Prevention Strategies
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CAST Content:12 SessionsCAST 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
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Cast Session Structure …Cast Session Structure …
Components Time
Constant Blend of Skills Training and Group Support
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
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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 FactorsSuicide Risk FactorsOO
UUTT
CC
OO
MM
EE
SS
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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 Emotional Distress Significant results for CAST [+CARE] youth relative to ‘usual care,’ treated controls :
OO
UUTT
CC
OO
MM
EE
SS
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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 InvolvementDrug InvolvementSignificant results for CAST [+CARE] youth relative to ‘usual care,’ treated controls:
OO
UUTT
CC
OO
MM
EE
SS
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24% in Personal Control (16% for controls)
24% in Problem-Solving Coping(4% for controls)
27% in Family Support (14% for controls)
Protective Factors 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:
OO
UUTT
CC
OO
MM
EE
SS
Monitoring
Adult Motivation and Support
Peer Group Support
Access to Help
Assessment Feedback
Coaching / Skills Training
CAST Process ModelCAST 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
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.
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Significant intervention effects included . . .
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
II
TT
WW
OO
RR
KK
SS
.
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Reasons to adopt CAST …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
II
TT
WW
OO
RR
KK
SS
.
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CAST Leaders are Key!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
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 Together we can make a difference!difference!
Who Benefits? Who Benefits?