Preliminary effects of brief school-based prevention approaches for reducing youth suicide-risk behaviors, depression, and drug involvement

Journal of Child and Adolescent Psychiatric Nursing, Apr-Jun 2002 by Eggert, Leona L, Thompson, Elaine A, Randell, Brooke P, Pike, Kenneth C

Fidelity of intervention implementation. All study conditions were assessed for implementation fidelity throughout the study Also, across all conditions, immediate assistance was provided if risk of suicide was imminent. Initially, CAST group leaders received training, and a school-based pilot test of the intervention was conducted. Subsequently, process evaluation of CAST included videotaping all sessions to measure (a) exposure to program content, (b) the leaders' skills training competencies, and (c) skills acquired by the youth. To tap these aspects, group leaders coded their videotape after each session, using a standardized coding form. The principal investigator (PI) established interrater rehability by reviewing randomly selected videotapes. During CAST implementation, group leaders met weekly with the PI and/or CAST program coordinator for supervision, videotape reviews, and implementation fidelity assessments. Analyses of group leader and supervisor ratings revealed uniform implementation across leaders and cohorts. C-CARE interventions were pilot tested initially; then during this protocol delivery, assessment interviews were videotaped and reviewed weekly for implementation fidelity to the assessment/crisis intervention protocol. Interviewers and the C-CARE Program Coordinator independently rated randomly selected videotapes of the assessment component maintaining interrater reliability at 90% agreement.

"Usual care" control assessments also were pilot tested initially; standardized training was provided to the "usual care" interviewers, and assessments were videotaped. Once competency was established, reviews of randomly selected videotaped sessions were conducted by the program director to monitor and evaluate implementation fidelity. Interrater reliability was established using an independent psychologist's ratings.

Instruments

Study variables were measured with the High School Questionnaire: A Profile of Experiences (HSQ) (Eggert, Herting, & Thompson, 1995). Measurement was repeated four times at Time 1 (T^sub 1^), baseline/preintervention; Time 2 (T^sub 2^), 4 weeks from baseline and after the initial C-CARE and "usual-care" control interviews; Time 3 (T^sub 3^), 10 weeks from baseline, coinciding with CAST skills training completion; and Time 4 (T^sub 4^), at 9 months after baseline. Data for this study are from T^sub 1^, T^sub 2^ and T^sub 3^ only, as data collection for the final cohorts was still in process. T^sub 3^ measures serve as the immediate outcomes for CAST youth and follow-up boosters for C-CARE and Control youth.

The HSQ was used at all four time points to measure suicide-risk behaviors, related-risk, and protective factors. All measures were derived from standardized measures or constructed specifically for the Reconnecting Youth (RY) Prevention Research Program.

Over the past 15 years, traditional psychometric analyses and confirmatory factor analyses established reliability, construct, and predictive validity of all measures with multiple independent samples (Eggert & Herting, 1991, 1993; Eggert, Thompson, et al., 1995; Thompson et al., 1994, 2002). All items were measured using 7-point, Likert-type scales (ranging from 0 = never/not at all, to 6 = always/many times). The higher the score, the greater the level of the measured concept.