Manitoba start up webinar nov 2011

A connections model for public health

The National Peer Leadership Study

The Sources of Strength Model

Mark LoMurray

Sources of Strength Director

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2009 addition to the National

Best Practices Registry

Winner of the national 2005 Public Health Practice

Award from the American Public Health Association

(APHA) (Epidemiology Section)

PART III—SHIFTING NORMS

Network Positions

Central Members

Bridges

Group

Members

Isolate

3

Peripherals

Peer Networks in Communities

Peer Networks in Schools/Communities

With Suicidal Students

Youth who attempt suicide are harder to reach

• They are much less likely to have trusting relations with adults

• They have fewer friends

• Those friends they have are likely to feel positive towards suicide

6



And Peer Leaders



Peer Leaders

And Trusted Adults

Many areas

lacking

trusted

adults

Peer Leaders Expand

Trusted Adults Connections

Into Peer Groups that lack adult connections

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PEER INVOLVEMENT: WHY IT MAKES SENSE

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Rationale for peer involvement in suicide prevention

Research has shown peers are primary

influence on whether a teenager abuses alcohol/drugs

and uses SAFE SEX PRACTICES.

1.

BELIEFS ABOUT

WHAT HIS/HER FRIENDS

WOULD DO

(BRUCKNER, 2005)

PART II—PEER INVOLVEMENT

Benchmarks for Peer Prevention

• Provide Training

• Provide Supervision

• Clear and Focused Mission

• Involve Peers in Planning of delivering and tone

• Recognition/Honoring

• Health Messages

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Peer involvement

:

Cautionary points on

Grouping teens with antisocial norms may actually

REINFORCE those norms

IT’S IMPORTANT TO INVOLVE DIVERSE GROUPS OF

TEENS AND TO MONITOR THEM CLOSELY

TAKE

NOTE!


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Peer involvement

:

Cautionary points on

Youths can sometimes assume the role of a

JUNIOR COUNSELOR to their peers

THIS CAN BE HARMFUL TO BOTH PEER ADVISOR/LEADER AND THE YOUTH WHO MAY BE AT RISK FOR SELF-HARM

TAKE

NOTE!


Connections Model: Expands A Surveillance Model

Gatekeeper Training – Screening

Focus on Warning Signs

Identify and Refer

Mental Health Treatment

Sources of Strength

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5 CORE PRINCIPLES:

Bring together and train

both peer leaders and

caring adults. One

without the other lacks

prevention power


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5 CORE PRINCIPLES:

USE PEER LEADERS

TO BREAK DOWN

CODES OF SILENCE

AND INCREASE PEER

HELP SEEKING WITH

CARING ADULTS.


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5 CORE PRINCIPLES:

A CORE EMPHASIS ON

STRENGTHS THAT

GOES BEYOND A

SIMPLE FOCUS ON

SUICIDE RISK AND

WARNING SIGNS


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CORE PRINCIPLES:

MULTIPLE SOURCES

OF SUPPORT ARE

ENCOURAGED—

MOVING BEYOND A

SINGULAR FOCUS ON

MENTAL HEALTH

REFERRALS


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5 CORE PRINCIPLES:

HOPE, HELP AND

STRENGTH MESSAGES

ARE DEVELOPED WITH

LOCAL VOICES AND

FACES—SATURATING

LOCAL SCHOOLS

AND COMMUNITIES WITH

STORIES

OF RESILIENCY INSTEAD

OF TRAUMA


How does Sources of Strength differ from other peer programs?

1. Well researched – engaged in the nation’s largest randomized trial on impact of peer leaders on entire student populations.

2. Has focused and tested Hope, Help, Strength messaging strategies that are safe and effective.

3. Uses a wide diversity of peer leaders to spread into many cliques and groups.

4. Links closely with adult support – trusted adults

Help-Seeking Norms of Peer Leaders increased by training (p<.05) in Cobb County GA, North Dakota and NY

2.4

2.5

2.6

2.7

2.8

2.9

3

3.1

3.2

Control Schools Sources of Strength

Schools

Baseline

Post training

23

Mentors

Helpers -

Mediators

Sources of Strength

Sources of Strength Process

• Engage leaders/ administrators

• Review protocol

• Identify and train key adult advisors (4-6 hr)

• Train school or community staff (15 m – 1.5 hr)

• Recruit peer leaders

• Train peer leaders with adult advisors (3-4 hr)

• Peer leaders with adult support begin action steps and HOPE, HELP, STRENGTH MESSAGING (3-5 months)

Sources of Strength A Multi-year growth process

• Each year peer leaders and adult advisors come together for training (Year 1, Year 2, Year 3 curriculuum)

• Year 1 typically has PL’s engaged in 3-5 messaging activities – getting their feet wet

• Year 2 often adds more diversity for PL’s –begin to really get concepts and add creativity

• Year 3 – broad spread, partnering with many other student groups, become very creative at reaching groups, saturating school/comm

Administrative Support• Need approval for implementing the program

in school, community, church, or agency

• Commit staff time for adult advisors (4-6 hr training, plus about 15- 30 hrs over 3-5 months)

• Commit time, space, resources for peer leader training

• Commit time for ongoing peer leader meetings and activities – recognize peer contribution (from isn’t that nice, to this is a serious impacting program)

Community Buy-in

• Who can be key partners?

• Who will champion the Sources of Strength? program to others

• What agencies or groups have a track record of success?

• Who are the best people in our community with teens or young adults?

Adult Advisors

• Get the right adults – connected and caring

• Minimum of two – prefer 1-10 ratio

• Can be from a variety of roles

• Identify who will be the lead – communicate with the rest of the team

Peer Leaders

• Can come from existing efforts and programs

• Add diversity of peer leaders

• 1st year is usually teacher nominated

• 2nd year peer leaders begin recruiting others

• Who has influence in cliques and friendship groups

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Power in PREVENTION: Relational connectedness of

PEERS


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As part of Action Step 2 all students at Perry HS, NY are

naming their Trusted Adults and forming a growing circle

of trust

Peer Presentation Activities

• The Peer Leaders’ 5-8 min presentations

will focus on:

– Sharing stories of Hope, Help and Strength

– Don’t Keep it Secret if a friend is in crisis

– Help is Available – My trusted adults

– My Sources of Strength

Ongoing Support

1. Ongoing tele-conference support for AA’s and for teams.

2. Four webinars throughout school year for AA’s.

3. Step by Step Adult Advisor Guide – Resource page on www.sourcesofstrength.org

4. Site visits as needed.

5. Support and development of regional coordinators.

6. Develop regional trainers – 10 month process

http://www.sourcesofstrength.org/

Sustaining and Growing

• Funding and partnerships

• Get peer leaders in front of adult groups

• Teacher meetings, school boards, chambers of commerce, tribal councils

2.3

2.35

2.4

2.45

2.5

2.55

2.6

2.65

2.7

2.75

Mean

s C

orr

ecte

d f

or

Baseli

ne

Control Schools SoS Schools

Acceptability of Student Help Seeking from Adults:

Significantly Higher in High School Populations after Sources of

Strength Training (4-months of messaging)

2.475

2.735p-value 0.040

2.55

2.6

2.65

2.7

2.75

2.8

2.85

2.9

2.95

3

Mean

s C

orr

ecte

d f

or

Baseli

ne

Control Schools SoS Schools

Expectations that Adults at School Help Suicidal Youth:

Significantly Higher in High School Populations after Sources of

Strength Training (4-months of messaging)

p-value 0.034

2.705

2.991

Referred a Suicidal Peer to Adults: 2-fold increase by training (p<.05)

0

10

20

30

40

50

60

70

80

90

None 1 or more

times

Baseline

Time 2

0

10

20

30

40

50

60

70

80

90

None 1 or more

times

Baseline

Time 2

Control Schools Sources of Strength

Schools

Appraisals of Adult Help Availability for Suicidal Youth:

Largest Increase in Students with Suicide Ideation Histories

1.5

1.7

1.9

2.1

2.3

2.5

2.7

2.9

3.1

3.3

3.5

No ideation-SoS No ideation-Control Ideation-SoS Ideation-Control

Ad

ult

Help

Co

rrecte

d M

ean

s a

t T

2

No Suicide Ideation

SoS Schools No Suicide Ideation

Control Schools

Suicide Ideation

SoS Schools

Suicide Ideation

Control Schools

Expectations that Adults Help Suicidal Youth:

Largest Increase for Students in Population with Suicide Ideation Histories after Sources

of Strength Training

Four months after Sources of Strength training teens with suicide ideation histories were comparable to non-suicidal teens in

control schools

Health & Medicine

Manitoba start up webinar nov 2011