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.
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.
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.
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.
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.