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Program Profile: Youth-Nominated Support Team-Version II (YST-II)

Evidence Rating: No Effects - One study No Effects - One study

Date: This profile was posted on January 15, 2015

Program Summary

Standard treatments for suicidal adolescents (ages 13-17) were supplemented with social support from caring adults. The goal was to reduce youths’ suicidal ideations, depression severity, and feelings of hopelessness and to improve their mood-related adaptive functioning. This program is rated No Effects. The program had no significant impact on participants’ suicidal ideation, depression, negative attitudes about the future, or parent-reported functional impairment.

This program’s rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Description

Program Goals/Target Population
The Youth-Nominated Support Team-Version II (YST-II) intervention was designed to supplement standard treatments for suicidal youths following psychiatric hospitalization by providing them with social support from caring adults. YST-II intervention services were provided to adults to facilitate their supportive role with adolescents. The intervention targeted adolescents, ages 13–17, who were psychiatrically hospitalized at a university- or private-hospital setting and had significant suicidal ideation or had made suicide attempt(s) within the past 4 weeks. The goal was to reduce youths’ suicidal ideations, depression severity, and feelings of hopelessness, and improve their mood-related adaptive functioning.

Program Activities
The period following psychiatric hospitalization is a time of high risk for suicidal incidents (Goldston et al. 1999). After being released from psychiatric hospitalization, suicidal adolescents were asked to nominate caring adults from their family, school, and neighborhood or other community settings, with whom they wanted to have regular supportive contact. YST-II intervention specialists facilitated the nomination process by developing a plan with the family for contacting the support persons and then inviting them to participate.

Adult support persons received psychoeducation and ongoing consultation from intervention specialists, and maintained regular contact with adolescents 3 months following their hospitalization. Intervention specialists conducted initial psychoeducation sessions with support persons. These were scheduled as individual sessions or group sessions in keeping with family preference and feasibility.

The average length of sessions was about 1 hour. Sessions involved discussions of information about 1) the adolescent’s psychiatric disorder(s) and psychosocial difficulties, 2) the adolescent’s treatment plan and rationale for recommended treatments, 3) risk factors for suicidal behavior and warning signs of possible imminent risk, 4) the availability of emergency services, and 5) strategies for communicating with adolescents. In addition, a collaborative plan for weekly telephone contact between the adult support person and the intervention specialist was developed.

Support persons were urged to have weekly contacts with the adolescents. During the contact with adolescents, adult support persons were encouraged to 1) talk with youths about their recent activities and support their involvement in healthy activities, 2) inquire about and listen to the adolescent’s concerns and engage in collaborative problem-solving, and 3) support treatment adherence and convey hopefulness about the possibility of positive change. The length of contacts was not prescribed, and flexibility was emphasized.

Program Theory
The intervention was guided by social-support and health-behavior models that posit that social relationships positively affect mental health through an improved sense of belonging and companionship (Heaney and Israel 2002). These models further hypothesize that social relationships may indirectly improve mental health through the facilitation of problem-solving and access to helpful information, which may lead to more effective coping and reduced exposure to stressors.

Key Personnel
Intervention specialists were mental health professionals (doctoral-level psychologists, masters-level social workers, and psychiatric nurses) who had a minimum of 3 years of professional experience with adolescents and families.

Additional Information
The YST-II intervention was an extension of an earlier version of the same intervention model, Youth-Nominated Support Team-Version I (YST-I; King et al. 2006). There were two major changes from YST-I to YST-II. The first change was the requirement in YST-II that only adults serve as support persons rather than offering adolescents the option of also nominating one peer support person, as was the case in YST-I. The second change was to use a 3-month rather than a 6-month period of intervention in YST-II.

Evaluation Outcomes

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Study 1
Suicidal Ideation
King and colleagues (2009) found there was no significant difference between treatment and control conditions in self-reported suicidal ideation at the 12-month follow-up.

Child’s Depression
There was no significant difference between treatment and control conditions in self-reported depression at the 12-month follow-up.

Negative Attitudes about the Future
There was no significant difference between treatment and control conditions in self-reported negative attitudes about the future at the 12-month follow-up. 

Child’s Functional Impairment
There was no significant difference between treatment and control conditions in parent-reported functional impairment of the youth at the 12-month follow-up.

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Evaluation Methodology

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Study 1
King and colleagues (2009) evaluated an intervention designed to supplement the routine treatment of suicidal youth following hospitalization. Those eligible for participation were adolescents, 13 to 17 years of age, with significant suicidal ideation or a suicide attempt within the past 4 weeks. All adolescents were psychiatrically hospitalized at either a university or a private hospital. A total of 448 suicidal adolescents were enrolled in the study. Using a computerized strategy to ensure balanced assignment at each site across gender, age, and history of multiple suicide attempts, 223 participants were randomly assigned to the treatment condition and 225 to the control condition. The treatment condition received the Youth-Nominated Support Team-Version II (YST-II) intervention and the control condition received treatment as usual. The average age of participants was 15.59 years and their racial/ethnic distribution was 84 percent white, 6 percent African American, 2 percent Hispanic, and 8 percent other. The sample was 71.2 percent female. There were no significant differences between groups in age, gender, racial/ethnic group, or parents’ education.

Baseline assessments occurred within 1 week of hospitalization.  Follow-up assessments were conducted at approximately 6 weeks, 3 months, 6 months, and 12 months following the baseline assessment. At the 12-month follow-up, 19.3 percent of participants who were assigned to the treatment condition and 21.8 percent of participants who were assigned to the control condition were not able to be assessed for various reasons.

Outcome measures included the youth’s self-reported suicidal ideation, depression, and negative attitudes about the future. Parents completed a self-report measure to assess their child’s functional impairment. Linear mixed-methods models were used to examine the effect of the intervention on each outcome and accounted for nesting of the intervention effects within the four follow-up time periods (6 weeks, 3 months, 6 months, and 12 months). Analyses controlled for baseline scores on each outcome measure, as well as for both the youth’s self-reported depression and the severity score on a self-report screening measure for adolescent substance abuse, at baseline.

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There is no cost information available for this program.
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Implementation Information

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The Youth-Nominated Support Team-Version II (YST-II) intervention manual provided explicit guidelines for psychoeducation sessions and telephone check-ins with nominated adult support persons. Intervention specialists completed 12 hours of YST-specific training and successfully completed a certification exam that assessed knowledge of YST-II components and intervention competencies. Weekly individual supervision was provided to intervention specialists with quarterly, cross-site group supervision/booster meetings. To assess intervention fidelity, all intervention sessions with support persons were audiotaped, and intervention specialists completed intervention checklists following each psychoeducation session.

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Other Information (Including Subgroup Findings)

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In addition to the overall effect of the intervention on the evaluation outcomes, King and colleagues (2009) analyzed the effect of the intervention across gender, site location, and lifetime multiple-suicide-attempt status subgroups. Subgroup analyses did not yield significant differences in program effects on any of the outcome variables at the 12-month follow-up.
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Evidence-Base (Studies Reviewed)

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These sources were used in the development of the program profile:

Study 1

King, Cheryl A., Nicole Klaus, Anne Kramer, Sanjeev Venkataraman, Paul Quinlan, and Brenda Gillespie. 2009. "The Youth-Nominated Support Team–Version II for Suicidal Adolescents: A Randomized Controlled Intervention Trial." Journal of Consulting and Clinical Psychology 77(5):880–93.

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Additional References

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These sources were used in the development of the program profile:

Goldston, David B., Stephanie Sergent Daniel, David M. Reboussin, Beth A. Reboussin, Patricia H. Frazier, and Arthur E. Kelley. 1999. "Suicide Attempts Among Formerly Hospitalized Adolescents: A Prospective Naturalistic Study of Risk During the First 5 Years After Discharge." Journal of the American Academy of Child & Adolescent Psychiatry 38(6):660–71.

Heaney, Catherine, and Barbara Israel. 2002. “Social Networks and Social Support.” In Glanz, Karen, Barbara K. Rimer, and Francis Lewis (eds.). Health Behavior and Health Education: Theory, Research, and Practice. 3rd ed. San Francisco, Calif.:  John Wiley & Sons.

King, Cheryl A., Anne Kramer, Lesli Preuss, David C.R. Kerr, Lois Weisse, and Sanjeev Venkataraman. 2006. "Youth-Nominated Support Team for Suicidal Adolescents (Version 1): A Randomized Controlled Trial." Journal of Consulting and Clinical Psychology 74(1):199–206.
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Related Practices

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Following are practices that are related to this program:

This practice provides at-risk youth with positive and consistent adult or older peer contact to promote healthy development and functioning by reducing risk factors. The practice is rated Effective in reducing delinquency outcomes; and Promising in reducing the use of alcohol and drugs; improving school attendance, grades, academic achievement test scores, social skills and peer relationships.

Evidence Ratings for Outcomes:
Effective - One Meta-Analysis Crime & Delinquency - Multiple crime/offense types
Promising - More than one Meta-Analysis Drugs & Substance Abuse - Multiple substances
Promising - One Meta-Analysis Education - Multiple education outcomes
Promising - One Meta-Analysis Mental Health & Behavioral Health - Psychological functioning
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Program Snapshot

Age: 13 - 17

Gender: Both

Race/Ethnicity: Black, Hispanic, White, Other

Geography: Urban

Setting (Delivery): Inpatient/Outpatient, Other Community Setting

Program Type: Mentoring

Current Program Status: Not Active

Listed by Other Directories: Model Programs Guide