Program Goals/Target Population
The Sources of Strength program is a universal, school-based program that is designed to change the norms and behaviors surrounding suicide within a school community and increase social support and connectedness among students, including suicidal students. Sources of Strength aims to build socioecological-protective influences across the entire student population, to reduce the likelihood that vulnerable high school students will become suicidal. The program focuses on changing the norms and behaviors of students through youth opinion leaders. Youth opinion leaders are trained by certified trainers and supported (by adult advisors) in preparing and conducting suicide prevention-messaging activities. The activities are designed to change unhealthy norms around help seeking and trust towards adults, encouraging students to connect suicidal friends with a trusted adult (thereby reducing implicit acceptability of suicide in response to distress and increasing the acceptability of seeking help); improve communication between students and adults; and promote the use interpersonal and formal coping resources.
Program Components
The Sources of Strength program is implemented in three phases: 1) school and community preparation, 2) peer-leader training, and 3) school-wide messaging. In the school and community preparation phase, each school uses a standardized procedure to nominate 5 percent to 10 percent of students as peer leaders, selecting key opinion leaders in diverse groups, including at-risk adolescents. In addition, each school selects multiple staff or community members to serve as adult advisors who will guide the peer leaders in safe suicide prevention messaging. Adult advisors receive 4 to 6 hours of training in the peer-leader curriculum and evaluation. School staff members may also receive a 1-hour orientation to the intervention, covering components of a suicide-prevention gatekeeper training and specific school protocol, which identifies and refers youths who exhibit suicidal ideation or concerning behavior.
In the peer-leader training phase, peer leaders and adult advisors receive 4 to 5 hours of interactive training that follows 15 modules. The modules focus on eight protective ‘‘sources of strength’’ (family support, positive friends, mentors, healthy activities, generosity, spirituality, medical access, and mental health access), and on the skills for increasing those resources for themselves and other students. Another focus of the training is on engaging “trusted adults” to help distressed and suicidal peers.
During the school-wide messaging phase, adult advisors support peer leaders in developing and implementing specific messaging steps. Adult advisors and peer leaders meet roughly every other week for 30 to 60 minutes to work on messaging strategies. During these meetings, adult advisors also help peer leaders practice applying and sharing the eight strengths in their own lives and their world. Peer leaders use multiple messaging activities (PSAs, presentations, videos, text messages, etc.) to encourage other students to develop and use their own sources of strength, including identifying and reaching out to trusted adults when they or their peers are in distress. Peer leaders engage in 12 to15 hours of these prevention activities throughout the school year.
Key Personnel
School personnel play a significant role in the intervention. All staff members are asked to nominate peer leaders and also receive a 1-hour orientation to the intervention. Two to fifteen staff members (depending on the size of the team and interest of staff) are also selected and trained to serve as adult advisors to peer leaders, helping them develop and implement the school-wide messaging activities. These adult advisors are viewed as critical in the process of engaging and sustaining peer-leader involvement and should possess a corresponding set of skills. These skills include empathy, the ability to provide strength-focused feedback to peer leaders, group-facilitation skills, and the ability to model coping and sources of strength. Training is provided by certified Sources of Strength trainers.
Program Theory
The program is based on social-connectedness models of health and suicide prevention (CDC 2009) with a broader social-ecological framework (Bronfenbrenner 1979) that emphasizes the interplay among personal attributes, social contexts, and environmental conditions in influencing individual behavior. The implementation model draws on diffusion of innovations theory and research (Rogers 2003) showing the importance of trusted others in adopting new norms and practices. For adolescents, schools serve as appropriate program settings for suicide prevention programs, based on the expectation that they provide a cost-effective and significant peer social context and availability of supportive adults. Further, the intervention’s goals of increasing positive connections to adults and peers, increasing expectations of peer support for seeking help from trusted adults, and promoting use of positive coping behaviors are rooted in well-established ties between suicidal behaviors and social ties and norms (Insel and Gould 2008; Joe et al. 2007).