Activity involvement among suicidal and nonsuicidal high-risk and typical adolescents.

The purpose of this study was to compare weekly activities among four groups of randomly selected high-risk and typical high school students: (1) potential dropouts at suicide risk, (2) typical youth at suicide risk, (3) potential dropouts not at suicide risk, and (4) typical youth not at suicide risk. Of the 1,286 participants, 39.4% of the high-risk and 30.1% of typical high school students screened in at suicide risk. Weekly activity comparisons across the four groups showed that suicide-risk adolescents, regardless of potential dropout status, engaged in more solitary activities on weekdays and weekends than did their nonsuicide risk peers. High-risk potential dropout youth engaged in less homework and more social activities during weekdays and weekends than did the typical high school students. These results provide important insight into the weekly activity involvement of at-risk youth while helping to gain a better understanding of suicide-risk adolescents. Implications of these findings are discussed for identifying youth at risk for suicidal behavior and for prevention programming.

Evaluation of indicated suicide risk prevention approaches for potential high school dropouts.

OBJECTIVES: This study evaluated the efficacy of 2 indicated preventive interventions, postintervention and at 9-month follow-up. METHODS: Drawn from a pool of potential high school dropouts, 460 youths were identified as being at risk for suicide and participated in 1 of 3 conditions randomly assigned by school: (1) Counselors CARE (C-CARE) (n = 150), a brief one-to-one assessment and crisis intervention; (2) Coping and Support Training (CAST) (n = 155), a small-group skills-building and social support intervention delivered with C-CARE; and (3) usual-care control (n = 155). Survey instruments were administered pre-intervention, following C-CARE (4 weeks), following CAST (10 weeks), and at a 9-month follow-up. RESULTS: Growth curve analyses showed significant rates of decline in attitude toward suicide and suicidal ideation associated with the experimental interventions. C-CARE and CAST, compared with usual care, also were effective in reducing depression and hopelessness. Among females, reductions in anxiety and anger were greater in response to the experimental programs. CAST was most effective in enhancing and sustaining personal control and problem-solving coping for males and females. CONCLUSIONS: School-based, indicated prevention approaches are feasible and effective for reducing suicidal behaviors and related emotional distress and for enhancing protective factors.

Immediate post intervention effects of two brief youth suicide prevention interventions.

This study evaluated the immediate postintervention effects of two brief suicide prevention protocols: a brief interview--Counselors CARE (C-CARE)--and C-CARE plus a 12-session Coping and Support Training (CAST) peer-group intervention. Subjects were students "at risk" of high school dropout and suicide potential in Grades 9-12 from seven high schools (N = 341). Students were assigned randomly to C-CARE plus CAST, C-CARE only, or "intervention as usual." The predicted patterns of change were assessed using trend analyses on data available from three repeated measures. C-CARE and CAST led to increases in personal control, problem-solving coping, and perceived family support. Both C-CARE plus CAST and C-CARE only led to decreases in depression, and to enhanced self-esteem and family goals met. All three groups showed equivalent decreases in suicide risk behaviors, anger control problems, and family distress.

Mediating effects of an indicated prevention program for reducing youth depression and suicide risk behaviors.

This study explored the intervention processes of an indicated prevention program for high-risk youth. It was hypothesized that intervention effects would be influenced by the direct and mediating effects of teacher social support on both peer group support and perceived personal control. In turn, personal control was hypothesized to mediate between teacher and peer group support, contributing to reductions in depression and suicide risk behaviors. The hypotheses were tested using a three-wave, longitudinal design incorporating data from preintervention, 5-month follow-up, and 10-month follow-up assessments of 106 high-risk youth divided into three comparison groups: two experimental, one control. For the two intervention groups, there were direct and/or indirect effects of teacher and peer group support on personal control, depression, and suicide risk behaviors. The general hypothesis that personal control mediates between support resources and reductions in depression and suicide risk behaviors received partial support across the study groups.

Using the suicide risk screen to identify suicidal adolescents among potential high school dropouts.

OBJECTIVE: To examine the validity of the Suicide Risk Screen (SRS) for identifying suicide-risk youths among potential high school dropouts. METHOD: Five hundred eighty-one potential dropouts, aged 14 to 20 years, participated in a 3-stage case identification protocol. A potential dropout pool was created in 7 schools; students, randomly selected, completed a questionnaire containing the SRS and participated in an assessment interview. Validity measures included Reynolds' Suicide Ideation Questionnaire (SIQ-JR) and 2 clinician rating scales, the Direct Suicide Risk (DSR) and Clinical Risk Assessment (CRA). RESULTS: Suicide-risk severity was significantly associated with categorization defined by the SRS criteria. SRS sensitivity ranged from 87% to 100%, specificity from 54% to 60%. Of 7 SRS elements, depression, suicidal ideation, and suicide threats predicted all validity measures. Suicide attempts predicted the DSR and CRA, but not Reynolds' SIQ-JR. Drug involvement, though relatively weaker, consistently predicted all validity measures. No additional psychosocial indicators improved the prediction of SIQ-JR or the DSR. Family support, likelihood of dropout, and risky behaviors, however, were additional predictors of the CRA ratings. CONCLUSIONS: The SRS is an effective and pragmatic method for identifying suicide-risk youths among potential dropouts in school settings.

Enhancing outcomes in an indicated drug prevention program for high-risk youth.

This study examined the net effects of refining a high school-based indicated drug prevention program. The Personal Growth Class (PGC), tailored to meet the needs of high-risk youth, was designed to increase control of drug use, school performance, and emotional well-being. The program integrates social support and life-skills training. Process evaluation revealed the need for program enhancements to address underestimated levels of depression, anger, and suicidal behaviors prevalent among high-risk youth and to ensure that core content was being emphasized consistently. Youth participating in Late cohorts received the refined PGC with enhanced skills training. Study participants (N = 280) were youth, primarily ages fifteen to-seventeen, at high-risk for school failure or dropout. Indicators of emotional well-being (e.g., depression, stress, anger, self-esteem, personal control), drug involvement, and school performance were compared for Late versus Early cohorts. Regression analyses revealed the Late versus Early cohorts showed significantly greater decreases in hard drug use, depression, perceived stress, and anger, and greater increases in self-esteem. The results support arguments that effective indicated prevention programs should target specific high-risk youth employing strategies to counteract the multifaceted risk factors they experience and enhance needed protective factors.

The Drug Involvement Scale for Adolescents (DISA).

This article specifically addressed the need for a multidimensional approach to measuring adolescents' drug involvement. The Drug Involvement Scale for Adolescents (DISA) was theoretically specified and its measurement properties were tested using Confirmatory Factor Analyses and traditional procedures with 705 high-risk and typical high school students. Five first-order dimensions, Drug Access, Alcohol Use, Other Drug Use, Drug Use Control Problems and Adverse Drug Use Consequences, and a hierarchical model of Drug Involvement demonstrated a good fit between model and data. Further, the DISA demonstrated good internal consistency (alpha = .91); correlated as expected with known correlates of adolescent drug use; discriminated drug involvement between high-risk and typical high school students; and predicted later drug involvement and known drug-related consequences among adolescents. The results suggest the DISA should be useful for capturing a multidimensional view of adolescent drug involvement in both etiologic and prevention studies. A major advantage of the DISA is its brevity: twenty-two indicators constructed from twenty-nine items.

Reducing suicide potential among high-risk youth: tests of a school-based prevention program.

This study tested the efficacy of a school-based prevention program for reducing suicide potential among high-risk youth. A sample of 105 youth at suicide risk participated in a three-group, repeated-measures, intervention study. Participants in (1) an assessment plus 1-semester experimental program, (2) an assessment plus 2-semester experimental program, and (3) an assessment-only group were compared, using data from preintervention, 5-month, and 10-month follow-up assessments. All groups showed decreased suicide risk behaviors, depression, hopelessness, stress, and anger; all groups also reported increased self-esteem and network social support. Increased personal control was observed only in the experimental groups, and not in the assessment-only control group. The potential efficacy of the experimental school-based prevention program was demonstrated. The necessary and sufficient strategies for suicide prevention, however, need further study as the assessment-only group, who received limited prevention elements, showed improvements similar to those of the experimental groups.

Discriminating suicide ideation among high-risk youth.

This study examined the hypothesis that among one group of high-risk youth--potential high school dropouts--key psychosocial factors would distinguish adolescents endorsing high suicide ideation from those who do not. Survey data compared high-risk youth with high suicide ideation (n = 43) with randomly selected samples of high-risk (n = 43) and "typical" youth (n = 42) without high suicide ideation. Repeat sampling of comparison groups verified results. Compared to high-risk and typical youth without suicide ideation, high-risk youth with high suicide ideation reported more psychosocial distress, problems with drug involvement, and disrupted family relations. They also described more unmet school goals and perceived a greater likelihood of dropping out of school. Discriminant analysis revealed that depression and low self-esteem were most effective in distinguishing between high-risk youth with and without high suicide ideation; family strain, anger, stress, and drug involvement also were differentiating factors. Implications for school-based screening and prevention programs are discussed within the context of the findings.

Psychosocial assessment for treatment planning and evaluation.

1. Use of standardized measures to document a client's psychosocial status and circumstances yields readily interpretable data. These data can provide a basis for treatment selection and make possible reliable documentation of change. 2. Identification of the best measure(s) for a particular purpose requires consideration of the reason for the assessment, intended use of the data, characteristics of instruments, capabilities of respondents, and available resources. 3. Increased use of measures can advance efforts to obtain rigorous and comparative data in psychosocial nursing research and practice. Such information advances science, develops clinical acumen, and documents the results of interventions.

Prevention research program: reconnecting at-risk youth.

This research program focuses on some of society's most profound problems: adolescent drug involvement, school failure, and suicide behaviors. The program goals address several interdisciplinary research challenges: (a) testing theory-driven preventive interventions focusing on the multifaceted etiology of adolescent drug involvement and suicide potential; (b) targeting potential school dropouts from a distinctly underserved high-risk population; and (c) integrating preventive interventions into school-based programs that utilize a multidisciplinary team of clinicians and researchers. Three sets of studies are described; they illustrate how ethnographic, experimental, and causal modeling designs and methods were intricately woven in successive theory construction and testing steps. Ethnographic and etiologic studies revealed a profile of vulnerabilities in personal, peer, family, and school contexts. Instrumentation studies led to reliable and valid process and outcome measures of key constructs. Tests of the preventive intervention demonstrated its efficacy for decreasing school deviance, drug involvement, and suicide potential among high-risk youth.

A measure of adolescent potential for suicide (MAPS): development and preliminary findings.

This paper describes an instrument designed to assess the suicide potential of youth 14-18 years of age who are at risk for suicidal behaviors. A comprehensive measurement theory provides the basis for three central constructs in the Measure of Adolescent Potential for Suicide (MAPS): direct suicide risk factors, related risk factors, and protective factors. The MAPS entails an introductory questionnaire followed by a computer-assisted, structured interview. Two samples were used to examine psychometric properties of the MAPS (n = 43; n = 123). Results revealed generally strong validity (content, criterion, construct) and reliability (internal consistency) for the MAPS. Further verification studies with large and diverse samples are warranted.

Preventing adolescent drug abuse and high school dropout through an intensive school-based social network development program.

Purpose. The hypothesis tested was that experimental subjects, relative to controls, would demonstrate significant increases in school performance and decreases in drug involvement at program exit (5 months) and at follow-up (10 months). Design. A two-group, repeated-measures, intervention trial was the design used. Setting. The study involved four urban Northwest high schools. Subjects. Participants included 259 youth at high risk of potential school dropout, 101 in the experimental group and 158 in the control group. Intervention. The Personal Growth Class experimental condition was a one-semester, five-month elective course taken as one of five or six regular classes. It had a 1:12 teacher-student ratio, and integrated group support and life-skills training interventions. The control condition included a regular school schedule. Measures. School performance measures (semester GPA, class absences) came from school records. Drug use progression, drug control, and adverse consequences were measured by the Drug Involvement Scale for Adolescents. Self-esteem, school bonding, and deviant peer bonding were measured using the High School Questionnaire: Inventory of Experiences. All multi-item scales had acceptable reliability and validity. Results. As predicted, trend analyses revealed significantly different patterns of change over time between groups in drug control problems and consequences; in GPA (but not attendance); and in self-esteem, deviant peer bonding, and school bonding. The program appeared to stem the progression of drug use, but group differences only approached significance. Conclusion. Program efficacy was demonstrated particularly for decreasing drug control problems and consequences; increasing GPA and school bonding; and desired changes in self-esteem and deviant peer bonding. Program effects on progression of drug use were less definitive.

Drug involvement among potential dropouts and "typical" youth.

Drug involvement, conceptualized as drug use frequency, drug access, drug use control, and adverse use consequences, is described and compared among two randomly selected groups of students aged fourteen to nineteen years: 203 low-risk typical high-school students and 160 youths at high-risk of school problems and dropout. High-risk youth, compared to low-risk youth and national statistics, endorsed a much greater breadth and depth of drug use, greater access to drugs, less drug use control, and greater adverse consequences due to use. A secondary analysis showed low-risk users (experimenters) were similar to high-risk youth in their access to drugs and eroding drug use control, but showed low frequencies of drug use and negligible adverse use consequences. Measuring and exploring these four facets of drug involvement provided a robust picture of the adolescents' drug milieu and revealed differences in patterns of drug involvement that would not have been evident by looking purely at drug use frequency. Implications for prevention programming are suggested.

Effects of a school-based prevention program for potential high school dropouts and drug abusers.

This study tested the effects of a prevention program based on an integrated social support and psychoeducational model. A semester-long Interpersonal Relations (IPR) class was predicted to deter school drop-out problems and drug abuse among adolescents. Quasi-experimental designs were used to field test the IPR program with 264 high-risk students in one of two conditions: (1) pretest, treatment, and posttest; (2) pretest and posttest. All hypotheses were supported. Significantly more potential dropouts were retained in the treated (74%) versus the comparison group (61%); differences in daily attendance (F = 12.88) and GPA, school achievement (F = 16.89), were significantly better in the treatment group (p less than .0001); drug involvement declined significantly from pre- to posttreatment for IPR program participants (t = 4.61, p less than .0001). Implications for treatment and recommendations for future research are discussed.