Effectiveness Trial of Youth Suicide Prevention Delivered by Teen Peer Leaders
Condition: Suicide Prevention
MeSH terms: Suicide; Suicide Prevention
Study type: Interventional

Summary: 
      The purpose of this study is to evaluate the impact of the school-based Sources of Strength
      program in reducing suicidal behaviors in the population of high school students and
      determine how the program works (mechanisms of change). Sources of Strength trains diverse
      high school students as Peer Leaders, who conduct school-wide prevention messaging activities
      with ongoing adult mentoring designed to increase positive coping norms and practices,
      help-seeking and increase youth-adult connections. Sources of Strength is expected to enhance
      school coping practices, increase help-seeking among distressed and suicidal youth, and
      reduce the number of students in the population who attempt suicide. A total of 40 high
      schools in primarily rural and micropolitan regions of New York State and North Dakota will
      participate in this study that uses a randomized wait-listed design.
    

Detailed description: 
      Investigators will enroll and conduct this trial with 3-4 separate cohorts of high schools
      over five years, allowing the logistical load to be evenly distributed throughout the study
      (total 40 schools). Randomization will occur at the school level since Sources of Strength is
      a school-wide intervention. In each cohort, schools will be enrolled as pairs from the same
      regions in New York State or North Dakota, for a total of six pairs per cohort. One school
      from each pair will be randomly assigned to begin training within a few months (Immediate
      Intervention) or to a wait-list to receiving training approximately 2 years later (Wait
      List). By pairing schools from the same region and state, before they are randomly assigned
      to one of the two study conditions, the design reduces the potential for external events
      (e.g., suicide of a local celebrity) biasing students' behaviors or self-reports within one
      of the conditions, which could affect investigators' ability to evaluate intervention impact.

      The active intervention period in each cohort will span approximately 16 months to test the
      impact on the school population of Sources of Strength training and messaging steps over two
      school years, which is the optimal time-period for this intervention. Schools assigned to the
      Wait List Condition will receive training and begin program implementation in the fall of the
      third school year, and investigators will provide those schools with training and technical
      assistance to complete the intervention over 16 months, fully comparable to the early
      intervention schools.

      To assess outcomes of suicide attempts, hypothesized mechanisms of intervention impact
      (coping norms and practices, connections with adults and peers), and mental health and
      behavioral risk factors, investigators will conduct a baseline and 3 repeated surveys of the
      student population in each school using surveys. The investigators have successfully employed
      this strategy previously to test Sources of Strength in 12 high schools in New York and North
      Dakota and attained high rates of participation, commensurate to or higher than other studies
      evaluating screening or other community suicide prevention strategies. Baseline surveys (B)
      will be administered to all students in schools in both conditions before the intervention
      begins in any school. The next survey administrations will occur at the end of the first
      school year (6 months, T1), the beginning of the next school year (12 months, T2), and end of
      the second school year (18 months, T3). Investigators will provide full training and support
      for those cohort 3 control schools to complete their intervention. In addition, social
      network data (close friend nominations, trusted adults named) will be collected across all
      schools to determine network mediators of intervention effects.
    

Intervention name(s): Sources of Strength
Intervention type(s): Behavioral
Intervention description(s): Sources of Strength (http://www.sourcesofstrength.com/) has three phases:
Introduction to school and community partners. Staff advisors for the program are identified and trained.
A standard process is used for nominating student peer leaders, who are trained through a 4-hour interactive workshop. A major focus is on increasing knowledge of 'sources of strength' and skills for increasing use of those resources for themselves and other students.
Peer Leaders plan and conduct messaging with Adult Advisor mentoring. A school-wide messaging phase involves presentations; media campaigns through posters, public service announcements, videos.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Prevention
Keywords: Adolescent suicide prevention; Peer Leader prevention model; Universal school-based prevention