Suicide Intervention Training for K–12 Schools: A Quasi‐Experimental Study on ASIST

This quasi‐experimental study investigated differences between 104 school personnel who received a standardized suicide awareness and prevention training (i.e., Applied Suicide Intervention Skills Training) and 45 control group participants. Pre‐ and posttraining data included experimental and control group participants' (a) suicide intervention skills; (b) attitudes toward suicide; (c) knowledge of suicide; and (d) comfort, competence, and confidence in responding to individuals at risk of suicide. Results indicated a significant positive effect for training on all measures. Implications for training of school personnel and future research are discussed.     

Project HOPE: Implementing Sensory Experiences for Suicide Prevention in a Native American Community

Suicide remains a significant problem for Native American populations; however, culturally appropriate interventions are lacking (Suicide Prevention Resource Center, 2011 Suicide Prevention Resource Center . ( 2011 ). Suicide Among American Indians/Alaska Natives. Retrieved from http://www.sprc.org/library/ai.an.facts.pdf  [Google Scholar]). Occupational therapy practitioners can aid in suicide prevention and intervention (American Occupational Therapy Association, 2005). This study presents a culturally appropriate program and research project following a community-based participatory research design that explores the impact of a sensory curriculum for suicide prevention on Native American youth. The perceptions of the young peoples' sensory experiences are explored. Evidence from the study demonstrates the value of exploring the use of occupational therapy intervention in Native American communities to address significant health concerns.     

The Social Contextual Approach and Rural Adolescent Substance Use: Implications for Prevention in Rural Settings

Adolescents in rural areas use substances at rates comparable to urban adolescents; understanding causes of rural adolescent substance use is critical if prevention efforts are to succeed. The present review has three primary goals: (1) to define rural, (2) to evaluate the empirical evidence regarding correlates and causes of rural adolescent substance use from a social contextual framework (L. V. Scaramella, R. D. Conger, R. Spoth, & R. L. Simons, in press), and (3) to discuss the malleability of theoretically based risk or protective factors in rural settings. The review concludes with a discussion of the difficulties and challenges of implementing prevention programs in rural areas.     

Testing an App-Assisted Treatment for Suicide Prevention in a Randomized Controlled Trial: Effects on Suicide Risk and Depression

Suicide is a global public health problem and effective psychological interventions are needed. The objective of the present study was to evaluate the effect of an app-assisted suicide prevention treatment on suicide risk and depression. One hundred twenty-nine participants were randomized to treatment as usual (TAU), consisting of psychotherapy adhering to the framework of Collaborative Assessment and Management of Suicidality (CAMS), with (TAU + APP, N = 60) or without (TAU, N = 69) access to a mobile application (i.e., LifeApp’tite). Suicide risk and symptoms of depression were assessed pre- and posttherapy, and at 4-month follow-up. The TAU + APP group showed a smaller decrease on self-reported suicide risk at the end of treatment, corresponding to a medium between-group effect size (p = .008, d = 0.46). At the 4-month follow-up this was the case only at the trend level, where the effect size was also of a smaller magnitude (p = .057, d = 0.30). No differences between the treatment groups were observed on self-reported depressive symptoms, either immediately following treatment (p = .732, d = 0.05) or at follow-up (p = .467, d = 0.11). The unexpected negative effect concerning suicide risk points to crucial consideration of issues pertaining to timing, dosing, and content when adding new technology to existing treatments both in this and other populations.     

Behavioral Therapy Teams for Obsessive-Compulsive Disorder: Lessons Learned From a Pilot Randomized Trial in a Community Mental Health Center

Community mental health centers (CMHCs) provide the majority of mental health services for low-income individuals in the United States. Exposure and response prevention (ERP), the psychotherapy of choice for obsessive-compulsive disorder (OCD), is rarely delivered in CMHCs. This study aimed to establish the acceptability and feasibility of testing a behavioral therapy team (BTT) intervention to deliver ERP in CMHCs. BTT consisted of individual information-gathering sessions followed by 12 weeks of group ERP and concurrent home-based coaching sessions. The sample consisted of 47 low-income individuals with OCD who were randomized to receive BTT or treatment as usual (TAU). Symptom severity and quality-of-life measures were assessed at pretreatment, posttreatment, and 3- and 6-month posttreatment. Feasibility of training CMHC staff was partially successful. CMHC therapists successfully completed rigorous training and delivered ERP with high fidelity. However, training paraprofessionals as ERP coaches was more challenging. ERP was feasible and acceptable to patients. BTT participants were more likely than TAU participants to attend their first therapy session and attended significantly more treatment sessions. A large between-group effect size was observed for reduction in OCD symptoms at posttreatment but differences were not maintained across 3- and 6-month follow-ups. For BTT participants, within-group effect sizes reflecting change from baseline to posttreatment were large. For TAU participants, depression scores did not change during the active treatment phase but gradually improved during follow-up. Results support feasibility and acceptability of ERP for this patient population. Findings also underscore the importance of implementation frameworks to help understand factors that impact training professionals.     

Implementing a Comprehensive Program for the Prevention of Conduct Problems in Rural Communities: The Fast Track Experience

Childhood conduct problems are predictive of a number of serious long-term difficulties (e.g., school failure, delinquent behavior, and mental health problems), making the design of effective prevention programs a priority. The Fast Track Program is a demonstration project currently underway in four demographically diverse areas of the United States, testing the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders. This paper describes some lessons learned about the implementation of this program in a rural area. Although there are many areas of commonality in terms of program needs, program design, and implementation issues in rural and urban sites, rural areas differ from urban areas along the dimensions of geographical dispersion and regionalism, and community stability and insularity. Rural programs must cover a broad geographical area and must be sensitive to the multiple, small and regional communities that constitute their service area. Small schools, homogeneous populations, traditional values, limited recreational, educational and mental health services, and politically conservative climates are all more likely to emerge as characteristics of rural rather than urban sites (Sherman, 1992). These characteristics may both pose particular challenges to the implementation of prevention programs in rural areas, as well as offer particular benefits. Three aspects of program implementation are described in detail: (a) community entry and program initiation in rural areas, (b) the adaptation of program components and service delivery to meet the needs of rural families and schools, and (c) issues in administrative organization of a broadly dispersed tricounty rural prevention program.     

Learning from Communities: Overcoming Difficulties in Dissemination of Prevention and Promotion Efforts

The model of prevention science advocated by the Institute of Medicine (P. J. Mrazek & R. J. Haggerty, 1994) has not lead to widespread adoption of prevention and promotion programs for four reasons. The model of dissemination of programs to communities fails to consider community and organizational capacity to implement programs, ignores the need for congruence in values between programs and host sites, displays a pro-innovation bias that undervalues indigenous practices, and assumes a simplistic model of how community organizations adopt innovations. To address these faults, researchers should locate, study, and help disseminate successful indigenous programs that fit community capacity and values. In addition, they should build on theoretical models of how locally developed programs work to make existing programs and polices more effective.     

An Intervention to Help Community-Based Organizations Implement an Evidence-Based HIV Prevention Intervention: The Mpowerment Project Technology Exchange System

Considerable resources have been spent developing and rigorously testing HIV prevention intervention models, but such models do not impact the AIDS pandemic unless they are implemented effectively by community-based organizations (CBOs) and health departments. The Mpowerment Project (MP) is being implemented by CBOs around the US. It is a multilevel, evidence-based HIV prevention program for young gay/bisexual men that targets individual, interpersonal, social, and structural issues by using empowerment and community mobilization methods. This paper discusses the development of an intervention to help CBOs implement the MP called the Mpowerment Project Technology Exchange System (MPTES); CBOs’ uptake, utilization and perceptions of the MPTES components; and issues that arose during technical assistance. The seven-component MPTES was provided to 49 CBOs implementing the MP that were followed longitudinally for up to two years. Except for the widely used program manual, other program materials were used early in implementing the MP and then their use declined. In contrast, once technical assistance was proactively provided, its usage remained constant over time, as did requests for technical assistance. CBOs expressed substantial positive feedback about the MPTES, but felt that it needs more focus on diversity issues, describing real world implementation approaches, and providing guidance on how to adapt the MP to diverse populations.     

Lessons Learned from the National Arts and Youth Demonstration Project: Longitudinal Study of a Canadian After-School Program

We discuss some of the lessons the investigators learned during the development, implementation, and dissemination phases of the National Arts and Youth Demonstration Project (NAYDP). The lessons learned are relevant to various groups involved in large-scale, multi-site, community-based intervention studies: parents, youth, researchers, project staff, policy makers, and funders. Specific lessons learned include: (1) how to engage the community; (2) methodological lessons, including cross-site training and monitoring adherence to research protocol; (3) recruiting and sustaining involvement of parents and youth; (4) program development; and (5) dissemination strategies.     

Mobilizing Communities and Building Capacity for Youth Violence Prevention: The National Academic Centers of Excellence for Youth Violence Prevention

Violence, including its occurrence among youth, results in considerable physical, emotional, social, and economic consequences in the US. Youth violence prevention work at the Division of Violence Prevention (DVP) at the Centers for Disease Control and Prevention (CDC) emphasizes preventing youth violence-related behaviors, injuries, and deaths by collaborating with academic and community partners and stakeholders. In 2000 and 2005, DVP funded the National Academic Centers of Excellence (ACE) for Youth Violence Prevention. Most ACE Centers focus on building community capacity and competence so that evidence-based programs for youth violence prevention can be successfully implemented through effective and supportive research-community partnerships. This commentary provides historical information about the ACE Program, including the development, goals, accomplishments of the Centers, and the utilization of a community-based participatory research approach to prevent youth violence.     

Enculturation and Attitudes Toward Intimate Partner Violence and Gender Roles in an Asian Indian Population: Implications for Community-Based Prevention

This study examined the relationships among enculturation, attitudes supporting intimate partner violence (IPV-supporting attitudes), and gender role attitudes among one of the largest Asian Indian population groups in the US. Data were collected via computer-assisted telephone interviews with a random sample of Gujarati men and women aged 18–64 in Metropolitan Detroit. Using structural equation modeling, we modeled the effects of three components of enculturation (behavior, values, and community participation) on gender role attitudes and IPV-supporting attitudes among married respondents (N = 373). Analyses also accounted for the effects of respondent age, education, religious service attendance, perceived financial difficulty, and lengths of residence in the US. The second-order, overall construct of enculturation was the strongest predictor of IPV-supporting attitudes (standardized B = 0.61), but not gender role attitudes. Patriarchal gender role attitudes were positively associated with IPV-supporting attitudes (B = 0.49). In addition to the overall effect of the enculturation construct, two of the components of enculturation had specific effects. “Enculturation-values” had a specific positive indirect association with IPV-supporting attitudes, through its relationship with patriarchal gender role attitudes. However, “enculturation-community participation” was negatively associated with IPV-supporting attitudes, suggesting the importance of community-based prevention of IPV among this immigrant population group.     

Community Involvement in Adapting and Testing a Prevention Program for Preschoolers Living in Urban Communities: ParentCorps

We describe a university-community collaborative effort to tailor and deliver a prevention program for families of preschoolers living in low-income, urban communities. ParentCorps, which builds on efficacious interventions with parents and young children, aims to promote child social competence and prevent conduct problems by strengthening parenting skills, enhancing support for parents, and empowering parents to access resources in their communities. Active community engagement and collaboration were viewed as critical to the development of the program and its feasibility testing. We present an overview of community involvement in the development of ParentCorps and approaches taken to involve community members during a feasibility study. Areas of success and lessons learned are discussed.     

The Better Beginnings,Better Futures Project: Long‐term Parent,Family, and Community Outcomes of a Universal,Comprehensive, Community‐Based Prevention Approach for Primary School Children and their Families

Better Beginnings, Better Futures is a large‐scale, multi‐year, longitudinal research‐demonstration project designed to reduce children's problems, promote healthy child development, and enhance family and community environments in three economically disadvantaged communities in the province of Ontario, Canada. The initial intervention was implemented from 1993 to 1997 and focused on families with children from 4 to 8 years of age in their first 4 years of schooling (from Junior Kindergarten to Grade 2). This study examined the long‐term parent, family and community programme outcomes, 15 years after the start of the intervention, when the young people who had participated in the intervention as young children were 18 to 19 years of age. Comparison of intervention communities with matched non‐intervention communities showed a mix of outcomes. Although few significant differences between intervention and comparison communities were found with regard to parents' health and family outcomes, there was evidence that parents in the intervention communities were engaging in fewer risk behaviours, had lower levels of depression and had more community involvement than parents in the comparison communities. These results suggest that the intervention did have some positive long‐term effects on youths' parents and on their community environments. Results are discussed with respect to the importance of considering family and neighbourhood contexts in the development and evaluation of prevention programmes. Copyright © 2012 John Wiley & Sons, Ltd.     

Adapting School-Based Substance Use Prevention Curriculum Through Cultural Grounding: A Review and Exemplar of Adaptation Processes for Rural Schools

A central challenge facing twenty-first century community-based researchers and prevention scientists is curriculum adaptation processes. While early prevention efforts sought to develop effective programs, taking programs to scale implies that they will be adapted, especially as programs are implemented with populations other than those with whom they were developed or tested. The principle of cultural grounding, which argues that health message adaptation should be informed by knowledge of the target population and by cultural insiders, provides a theoretical rational for cultural regrounding and presents an illustrative case of methods used to reground the keepin’ it REAL substance use prevention curriculum for a rural adolescent population. We argue that adaptation processes like those presented should be incorporated into the design and dissemination of prevention interventions.     

A brief screening tool for suicidal symptoms in adolescents and young adults in general health settings: reliability and validity data from the Australian National General Practice Youth Suicide Prevention Project

Using data from a nationwide project on young people in Australia aimed at assessing suicidality in general health settings, we present a brief screening tool for suicidality (the depressive symptom index suicidality subscale). Two thousand eight hundred and fifty-one (15-24 year old) patients presenting to 247 Australian general practitioners between 1996 and 1998 were assessed. In addition to the suicide screen, patients completed the general health questionnaire-12 and the Center for Epidemiological Studies depression scale. Patients' chief complaints were taken from the summary sheets completed by their general practitioners. Using inter-item correlational and factor-analytic techniques, as well as a general approach to construct validity, we show that the measure has favorable reliability and validity characteristics. We also provide results on cut-points that may facilitate its use in clinical and research settings. Because the screen is brief, easy to use, reliable, and valid, we encourage its use to combat the vexing international health problem of suicide.     

“Let our Apache Heritage and Culture Live on Forever and Teach the Young Ones”: Development of The Elders’ Resilience Curriculum,an Upstream Suicide Prevention Approach for American Indian Youth

The White Mountain Apache Tribe have developed an innovative curriculum that connects youth through Elders to their heritage, traditions, and culture, which has been proven to be a protective factor for native Americans. The development process took 4½ years and included community stakeholder buy‐in, Elders’ Council group formation, extensive formative work to identify content, iterative feedback between curriculum writers and Elders, and Elder training prior to implementation. Members of the Elders’ Council have been visiting the local schools to teach youth about the Apache culture, language, and way of life since February 2014 reaching over 1000 youth. This approach demonstrates a promising upstream suicide prevention strategy. We discuss the process of development, implementation, and lessons learned, as this curriculum has potential for adaptation by other Indigenous communities.