David Shern, Ph.D. Louis de la Parte Florida Mental ... - PsychSearch

DEPARTMENT OF HEALTH & HUMAN SERVICES
Substance Abuse and Mental
Health Services Administration
Centerfor Mental Health Services
Center for Substance Abuse
Prevention
Center for Substance Abuse
Treatment
Rockville MD 20857
David Shern, Ph.D.
Louis de la Parte Florida Mental Health Institute
University ofSouth Florida
13301 Bruce B. Downs Boulevard
Tampa, FL 336 12-3809
Dear Dr. Shern,
I have reviewed the report entitled, "Florida Suicide Prevention Pilot Project: Final Report,"
submitted June 16, 2006. As part of this project, SAMHSA sought to gather information about
several issues. Ofparticular interest was learning more about how parents respond to 1 requests
to have their son or daughter screened for risk for suicide and 2 recommendations for further
assessment or treatment that may result from the screening. The report does not accomplish
either task.
Because parents are and should remain the jltimate decision makers regarding the health and
well-being oftheir children, understanding how parents respond to requests for participation in
suicide prevention programs, and in particular how parents respond to receiving information that
their son or daughter may be at risk for suicide, is crucial for engaging families. SAMHSA is not
interested in simply finding ways to increase parental consent rates. Rather, SAMHSA is very
interested in learning more about families’ concerns, hopes, worries, and reactions to schoolbased
suicide prevention programs, and in learning more about how to actively and appropriately
engage families in suicide prevention efforts.
The five parent interview categories you established-parents who declined participation,
parents who agreed to participate, parents who did not return a consent form, parents who
adhered to followup recommendations, and parents who did not follow up-seemed to hold
promise for obtaining such information. However, your report does not systematically present
the results ofthe parent interviews/focus groups, nor does it analyze the results across categories.
Finally, no information is provided about the views ofparents who declined to have their teens
participate, despite the importance that SAMHSA places on understanding these parents’
concerns. Given the limited nature of the data collected, it is unclear how the data support the
conclusion that "increasing participation rates is therefore a desirable outcome."
I also have several concerns regarding the materials developed through this project. SAMHSA’s
understanding was that these were to be educational materials developed based on feedback from
families and teens. It is unclear how such feedback was incorporated into the design ofthe
Office of the Administrator-Office of Applied Studies-Office of Communications-Office of Policy, Planning and Budget-Office of Program Services

materials and whether these materials incorporated the recommendations articulated in the
NIMI-l/CDC/SAMHSA-funded "Science ofPublic Messages for Suicide Prevention." See
Suicide and Life Threatening Behavior. 2005 Apr; 3 52: 1 3445. Since these materials were not
submitted to SAMHSA for review orclearance, you should not suggest or imply in any way that
SAMLISA endorses or supports the content of the materials.
Sincerely yours,
1fr?/c
f1/J.
Richard McKeon, Ph.D.
Special Advisor, Suicide Prevention
Center for Mental Health Services

FLORIDA SUICIDE PREVENTION PILOT PROJECT
June 22, 2004 through May 31, 2006
Task 5
Project Status Report
Submitted May 16, 2006
The Substance Abuse and Mental Health Services Administration SAMHSA was
created in 1992 to improve prevention, treatment and rehabilitation services for
individuals with health issues and substance disorders. Within SAMHSA, the Center for
Mental Health Services CMI-IS provides national leadership and direction for policies,
programs, and activities designed to improve mental health prevention and treatment
services. One of the most important areas for prevention efforts is the prevention of
suicide across the life span. Suicide prevention efforts must be constructed differently for
different at-risk populations. For youth, school based suicide prevention is ofparticular
importance. A promising approach to youth suicide prevention that has been identified in
the Report ofthe Surgeon General, the Institute of Medicine Report, Reducing Suicide: A
National Imperative and in the President’s New Freedom Commission Report is school
based screening.
There are several reasons that screening to detect depression, the risk of suicide and other
mental disorders in youth is thought to be of importance. Suicide is the third leading cause
of death among youth 10-24 years ofage. Almost as many adolescents and young adults
die from suicide than from all natural causes combined. Studies of youth who have
committed suicide called psychological autopsy studies have found that 90% had a
diagnosable mental disorder at the time of their death. According to the Youth Risk
Behavior Survey 2001 8.8% of high school students self-report making a suicide
attempt, and 2.6% make an attempt serious enough to require medical attention. Yet while
physical health screenings in schools are relatively common, schools do not commonly
screen for mental health problems. It is known that 7 million to 10 million teenagers suffer
from a mental health condition. Additionally, 5-9% of all children suffer from a mental,
behavioral, or emotional disorder that substantially limits one or more major life activity
including academic performance and the ability to maintain interpersonal relationships. It

is estimated that only one-third of these teenagers have been identified and are in
treatment. It is also known that many mental health problems start in youth and worsen
over time if not treated. It is hoped that by screening for these problems, particularly
depression, substance abuse, and suicidal ideation or past suicide attempts, youth can be
identified early in the course of their illness and informed regarding their treatment
alternatives. With successful treatment, deaths from suicide could be prevented, along
with other untreated mental illness and related issues such as substance abuse, violence,
and school drop out.
Structured suicide screening and systematic follow-up are important elements in any
comprehensive suicide-prevention program. In order for screening to be effective,
however, parents must allow their children to participate in the screening and follow-up
with treatment recommendations for those teens who screen positive. While universal
screening efforts ideally include all members of an identified population, parental consent
to school based screenings is often less than 50%. Similarly, parental follow-up after
screening is often less than 50%. To the degree to which these rates can be increased,
screenings may become more effective in identifying mental illnesses and preventing
suicide. In this research project, we hoped to develop methods that would increase
screening consent while appropriately informing parents and teens of the issues that
should be considered when consenting to participate. Such materials, if shown to be
effective, would optimize the benefits of screening.
This study consists of four phases with the first three using qualitative methods and the
fourth a non-equivalent group comparison design. In the first phase, a meeting of school
based mental health screening program representatives was hosted to identify key issues
in screening. The second phase utilized semi-structured interviews with parents and teens
to identify concerns that must be addressed in consent and follow-up materials as well as
media that may be effective in communicating with parents and teens. In the third phase, a
focus group was used to evaluate and improve draft communications materials e.g., teens
responded to different sets ofposters. Currently in the fourth phase ofthe project, the

materials are being tested in several schools to determine if differential consent rates are
obtained with the new materials.
sahPe I
The project research team worked in tandem with Roberts Communications facilitators
and Columbia University participant identification to host a TeenScreen Site
Coordinators Meeting. We convened individuals who have implemented school based
mental health screening programs across the United States i.e., three site coordinators or
their representatives and a regional coordinator. These key informants participated in a
full day, structured dialogue in which we identified all of the key audiences that must be
addressed in successfully implementing a screening and follow-up program, the concerns
in reaching each audience, the issues that each may identify in deciding upon their
participation and communication strategies to effectively address each audience. Based
on observations and data from the facilitated dialogue, we developed a semi-structured
interview protocol that was used with parents and teens at active screening sites. The
dialogue was recorded and findings coded to develop an initial framework for the
development of communications material and for the collection of data from parents and
youth.
sahPe II Task 2: TeenScreen and consent materials evaluation, Due Date August 31,
2005
Based upon the results from the structured dialogue, the research team developed a series
of semi-structured interview protocols phase II materials that were used with parents and
teens from three active screening sites to determine how to most effectively address their
concerns with regard to participation in screening and follow-up. Parents from five groups
were interviewed. In each group, we inquired about the rationale for their decision,
information that would have been helpful in the decision making process including
evaluation ofthe communication approaches that were used in each site and how these
might be improved. The five parent groups were:
1. Parents who did not respond to the request for consent
2. Parents who consented to have their teen participate

3. Parents who declined to have their teens interviewed
4. Parents who adhered to follow-up recommendations
5. Parents who did not adhere to recommendations.
Additionally the research team conducted interviews with teens about the same issues
discussed with parents. Teens from two groups were interviewed.
1. Students who screened positive but did not adhere to follow-up treatment
recommendations
2. Students who screened positive and did adhere to follow-up treatment
recommendations.
The research team members administered the interview protocol, conducting the
interviews over the phone at a time that was convenient for the participants. The team
audio taped the interviews and transcribed them for analysis.
sahPe IIITask 3: Revise introductory TeenScreen and consent materials, Due Date
October 31, 2005
Based on information from the first two data collection activities, the research team
worked with Roberts Communications to develop communication materials. A
TeenScreen brochure was designed for parents and another for teens. A multi-set poster
series for display in schools was also produced with teens being the target audience. A
student focus group was employed in testing the poster series. Roberts Communications
conducted this activity with a group of ninth grade students from a local school. In this
second phase ofthe project, students were presented with draft communications materials
i.e., two poster series and asked a series of open-ended questions to assess the
effectiveness ofthe material and suggest strategies that may be used to improve it. Based
on the suggestions and concerns raised in the focus group, Roberts Communications made
appropriate modifications to the selected poster series.

FLORIDA SUICIDE PREVENTION
PILOT PROJECT
FINAL REPORT
Task 6
June 22, 2004 through May 31, 2006
Submitted June 16, 2006
by
David Shern, Ph.D, Principal Investigator
Stephen Roggenbaum, MA, Co-Principal Investigator
Louis de Ia Parte Florida Mental Health Institute
University of South Florida

FLORIDA SUICIDE PREVENTION PILOT PROJECT
June 22, 2004 through May 31, 2006
Task 6
Final Project Report
The Substance Abuse and Mental Health Services Administration SAMHSA was
created in 1992 to improve prevention, treatment and rehabilitation services for
individuals with health issues and substance disorders. Within SAMHSA, the Center for
Mental Health Services CMHS provides national leadership and direction for policies,
programs, and activities designed to improve mental health prevention and treatment
services. One ofthe most important areas for prevention efforts is the prevention of
suicide across the life span. SAMHSA has recently recognized the importance of suicide
prevention by adding it to their Matrix of Priorities. Suicide prevention is listed as the
seventh Program/Issue see figure 1. Suicide prevention efforts must be constructed
differently for different at-risk populations. For youth, school based suicide prevention is
ofparticular importance. School based screening is a promising approach to youth suicide
prevention that has been identified in the Report ofthe Surgeon General, the Institute of
Medicine Report, Reducing Suicide: A National Imperative and in the President’s New
Freedom Commission Report.
There are several reasons that screening to detect depression, the risk of suicide and other
mental disorders in youth is thought to be of importance. Suicide is the third leading cause
of death among youth 10-24 years of age. Almost as many adolescents and young adults
die from suicide than from all natural causes combined. Studies ofyouth who have
committed suicide called psychological autopsy studies have found that 90% had a
diagnosable mental disorder at the time of their death Harris & Barraclough, 1997;
Conwell el al., 1996. According to the Youth Risk Behavior Survey 2001 8.8% of high
school students self-report making a suicide attempt, and 2.6% make an attempt serious
enough to require medical attention. Yet while physical health screenings in schools are
relatively common, schools do not commonly screen for mental health problems. It is
known that 7 million to 10 million teenagers suffer from a mental health condition.
Additionally, 5-9% of all children suffer from a mental, behavioral, or emotional disorder
Florida Suicide Prevention Pilot Project Final Report Page 1

Figure 1: SAMHSA Matrix of Priorities
SAMHSA
of
Priorities
that substantially limits one or more major life activity including academic performance or
the ability to maintain interpersonal relationships. It is estimated that only one-third of
these teenagers are in treatment. Many mental health problems start in youth and worsen
over time if not treated Kessler, Berglund, Demler, Jin, & Walters, 2005. By screening
for these problems, particularly depression, substance abuse, and suicidal ideation or past
suicide attempts, youth can be identified early in the course oftheir illness and informed
regarding their treatment alternatives. With successful treatment, deaths from suicide may
be prevented, along with other related problems such as substance abuse, violence, and
school drop out.
Florida Suicide Prevention Pilot Project Final Report Page 2

Efforts to increase the detection and treatment of depression and other mental illnesses,
such as structured suicide screening and systematic follow-up, are important elements in
any comprehensive suicide-prevention program Public Health Services, 2001. In order
for screening to be effective, however, parents must allow their children to participate in
the screening and follow-up with additional assessment and, if needed, treatment
recommendations for those teens who require care. Screening efforts are most effective
when they include all members of an identified population. Parental consent to school
based screenings, however, is often less than 50% thereby decreasing the overall impact of
screening programs. Similarly, parental follow-up after screening is often less than 50%.
To the degree to which these rates can be increased, screenings may become more
effective in identifying mental illnesses and preventing suicide. In this research project,
our goal was to develop methods that would increase screening consent while providing
parents and teens with the information that they identify as important in reaching their
decision about screening participation. Such materials, if shown to be effective, would
optimize the benefits ofscreening.
This study consists of four phases with the first three using qualitative methods and the
fourth a non-equivalent group comparison design. In the first phase, a meeting of school
based mental health screening program representatives was hosted to identify key issues
in screening from multiple perspectives including schools, parents, teens and community
residents. The second phase utilized semi-structured interviews with parents and teens to
identify their concerns regarding consent and follow-up as well as media that may be -
effective in communicating with them. In the third phase, a focus group was utilized to
evaluate and improve draft communications materials e.g., teens responded to different
sets of posters. In the fourth phase of the project we tested the materials in several
schools to determine if consent rates were increased with the use ofthe new materials.
I - Phase
Facilitated Dialogue with Site and RegionalCoordinators
The project research team worked in tandem with Roberts Communications facilitators
and Columbia University participant identification to host a TeenScreen Site
Coordinators Meeting. We convened four individuals who have implemented school
Florida Suicide Prevention Pilot Project Final Report Page 3

ased mental health screening programs across the United States i.e., three site
coordinators or their representatives and a regional coordinator. Three participants from
the Louis de la Parte Florida Mental Health Institute FMHI participated in the meeting
that was facilitated by two staff from Roberts Communications.
These key informants participated in a full day, structured dialogue to identify the key
audiences that must be addressed in successfully implementing a screening and follow-up
program, the concerns in reaching each audience, the issues that each may identify in
deciding upon their participation in a screening and follow-up program and
communication strategies to effectively address each audience. The dialogue was
recorded and findings coded to develop an initial framework for the communications
material and for the semi-structured instrument to be used in collecting data from parents
and youth in Phase II ofthe study. See Appendix A for TeenScreen Regional
Coordinators Meeting report.
H- Semi-Structured Interviews with Parents Phase andTeens
Based upon the results from the structured dialogue, the research team developed a series
of seven semi-structured interview protocols phase II materials that were used with
parents and teens from three active screening sites to determine how to most effectively
address their concerns with regard to participation in screening and follow-up. Seven
specific groups were identified for inclusion in the data collection.
1. Parents who returned the consent form and declined to allow their teen the
opportunity to participate in screening
2. Parents who returned the consent form allowing their teen the opportunity to
participate in screening
3. Parents who did not return the consent form
4. Parents whose teen screened positive on the screening and subsequent clinical
interview and did not comply with the treatment recommendations
5. Parents whose teen screened positive on the screening and subsequent clinical
interview and did comply with treatment recommendations
Florida Suicide Prevention Pilot Project Final Report Page 4

Additionally the research team conducted interviews with teens about the same issues
discussed with parents. See Appendix C for sample Student Interview Protocol. Teens
from two groups were interviewed.
6. Students who screened positive but did not adhere to follow-up assessment or
treatment recommendations
7. Students who screened positive and did adhere to follow-up assessment or
treatment recommendations.
Each category ofparents or students had an individualized interview protocol. Although
many questions were used in all protocols, each contained questions uniquely appropriate
for each group e.g., reasons for declining to participate or agreeing to participate. See
Appendix B for sample Parent Interview Protocol. Parents from five groups were
interviewed. In each group, we inquired about the rationale for their decision, information
that would have been helpful in the decision-making process including evaluation ofthe
communication approaches that were used in each site and how these might be improved.
All forms and interview protocols for parents and students were translated into Spanish
and a bilingual interviewer was hired to assist with the interviews. The research team
members administered the interview protocol, conducting the interviews over the phone at
a time that was convenient for the participants. The research team worked with a site
coordinator who preferred to have a local interviewer, whom she had identified, conduct
the local interviews in person. The research team audio taped the interviews and
transcribed them for analysis.
Three TeenScreen sites identified parents and students to be interviewed Las Vegas,
Nevada; Flagler County, Florida; and Jackson, Mississippi. The three site’s staff agreed to
participate although each site negotiated their assistance to be through slightly different
means. The Las Vegas site provided a list ofnames for the FMHI research team. The
FMHI research team contacted potential participants through a mailing, followed by
Florida Suicide Prevention Pilot Project Final Report Page 5

phone calls in which the researchers described the project, requested participation, and
scheduled and conducted the interview. Each initial mailing to potential interviewees
included an introductory letter, Informed Consents, and a list of the questions. The Flagler
site made initial contacts with potential interviewees to briefly describe the project and
request participation. The FMHI research team followed up with phone calls and again
described the project, requested participation, scheduled, and conducted the interviews.
The Jackson site identified a local school social worker that FMHI trained to conduct
interviews in the local community. Interviews were conducted between May and
December 2005.
The research team’s goal was to try to have five interviews from each site in each ofthe
seven interview categories see Table 1. Seven interview categories with five interviews
each would equal 35 interviews for each site for a total of 105 interviews.
Table 1: Interview Categories with Total Goal Number of Interviews by Site
Interview Categories
Las Vegas,
Nevada
Flagler County,
Florida
Jackson,
Mississippi
1. Parents who declined to have their
5 5 5
teens_participate.
2. Parents who consented to have their
5 5 5
teen_participate.
3. Parents who did not return the consent
5 5 5
form.
4. Parents who adhered to follow-up
5 5 5
recommendations.
5. Parents who did not adhere to followup_recommendations.
5 5 5
6. Students who screened positive but did 5 5 5
not adhere to follow-up assessment or
treatment_recommendations.
7. Students who screened positive and
5 5 5
did adhere to follow-up assessment or
treatment recommendations.
Total Goal Number of Interviews 35 35 35
The research team discovered that each site distributed TeenScreen materials differently
e.g., mailed to parents, handed out to students to take home, passed out in school and
Florida Suicide Prevention Pilot Project Final Report Page 6

-
mailed home and some ofthe sampling sub-groups could not be identified in specific
sites owing to their record keeping conventions. The lack ofpotential interviewees in all
seven categories impacted the total number of potential participants. Two sites with five
interview categories and one site with six interview categories created a revised potential
sampling frame with a potential for 80 interviews see Table 2.
Table 2: Interview Categories with Total Potential Number of Interviews by Site
Interview Categories
Las Vegas,
Nevada
Flagler County,
Florida
Jackson,
Mississippi
1. Parents who declined to have their
5 0 0
teens participate.
2. Parents who consented to have their
5 5 5
teen participate.
3. Parents who did not return the consent 0 0 0
form.
4. Parents who adhered to follow-up
5 5 5
recommendations.
5. Parents who did not adhere to followup
5 5 5
recommendations.
6. Students who screened positive but did
5 5 5
not adhere to follow-up assessment or
treatment recommendations.
7. Students who screened positive and did
adhere to follow-up assessment or
treatment recommendations.
5 5
5
Total Potential Number ofInterviews 30 25 25
Another factor that impacted the number of participants was the method of contacting
participants to be interviewed. When a local TeenScreen site representative made the
initial contact, as with two ofthe sites, the number of interviewees was higher than when
the research team made the first contact i.e., 18 and 12 compared to 7. In the third site,
despite repeated and extended attempts by the research team, the number ofparticipants
recruited was low i.e., seven.
A third potential influence on the number of participants was a hurricane that interrupted
contact with the Mississippi sites’ potential participants. The interviewer, who had been
identified by the local TeenScreen site coordinator and was herselfa local resident,
Florida Suicide Prevention Pilot Project Final Report Page 7

eported having great difficulty in continuing to attempt to reach potential interviewees.
Power was interrupted for several weeks in the area, displaced people relocated into the
area with family and friends, the influx of additional hurricane victims also increased the
number of students in the local schools, and residents seemed to be otherwise engaged.
Clearly, participating in a research project might not have been a priority at that time. The
numbers of completed interviews by site and by category are presented in Table 3.
Table 3: Interview Categories with Actual Number of Interviews by Site
Interview Categories
Las Vegas,
Nevada
Flagler County,
Florida
Jackson,
Mississippi
1. Parents who declined to have their
0 N/A N/A
teens_participate.
2. Parents who consented to have their
2 0 3
teen participate.
3. Parents who did not return the consent N/A N/A N/A
form.
4. Parents who adhered to follow-up
2 2 1
recommendations.
5. Parents who did not adhere to followup
2 6 5
recommendations.
6. Students who screened positive but did
1 4 0
not adhere to follow-up assessment or
treatment_recommendations.
7. Students who screened positive and did 0 6 3
adhere to follow-up assessment or
treatment recommendations.
Total Number of Interviews 7 18 12*
*Three interviews were not used in the analysis for proceaural reasons i.e., missed
deadline for analysis, missing research consent forms.
As is clear from Table 3, we failed to include parents who either did not respond to the
request to return the consent form or individuals who returned the form but declined to
participate. Missing these two perspectives substantially limits the range of response -
particularly for individuals who are a prime interest of the research.
Florida Suicide Prevention Pilot Project Final Report Page 8

Phase
III - Develop Introductory TeenScreen and ConsentMaterials
Data from the interviews were analyzed and general themes were identified. Interview
responses were grouped into the following categories:
o
o
o
Problems with current communications materials parental report
Suggestions to increase consent parental report
Suggestions to increase consent teen report regardless of whether or not they
participated in the screening
o
Factors that encouraged follow-up compliance teen report from those who
complied
o
o
o
Reasons for failure to follow-up parental report of noncompliant teens
Key supporting points teen report from those who participated in the screening
Key supporting points parental report of teens who participated in the
screening
Survey respondents often provided information in response to a specific question that
informed more than one content category. In these cases, the responses were tabulated in
each corresponding category e.g., If the question was "what did you like least about the
follow-up interview" and the respondent answered "time out of the school day but I really
liked the fact it was confidential," both answers were recorded in the appropriate
categories.
Individual responses were grouped by themes and tabulated. Each survey respondent was
counted only once per theme-response category e.g., if confidentiality‘was cited as a key
supporting point in more than one answer by the same respondent, it was only counted
once. If a respondent cited more than one item, however, each response was counted once
in the appropriate category e.g., if a respondent cited confidentiality and parental pressure
as factors encouraging follow-up, both responses were tabulated. See Appendix D for
tabulated results.
Several key concepts emerged from the completed interviews with parents and students
that guided the development of the communications material. Confidentiality was
Florida Suicide Prevention Pilot Project Final Report Page 9

mentioned repeatedly by both parents and students. Procedural information e.g..,
screening steps, what screening detects was also cited by respondents and addressed in
the material development. The material also underscored the frequency of mental health
problems among adolescents and the fact that they are common among youth from widely
varying backgrounds.
Based on information from the first two data collection activities i.e., Phase I and II, the
research team worked with Roberts Communications’ staff to develop communication
materials. A TeenScreen brochure was designed for parents and another for teens. A
multi-set poster series for display in schools was also produced with teens being the target
audience. A student focus group was employed in testing the poster series. Roberts
Communications conducted this activity with a group ofninth grade students from a local
school. In this phase of the project, students were presented with draft communications
materials i.e., two poster series and asked a series of open-ended questions to assess the
effectiveness ofthe material and suggest strategies that may be used to improve it. Based
on the suggestions and concerns raised in the focus group, Roberts Communications made
appropriate modifications to the selected poster series. The final media materials i.e.,
youth brochure, parent brochure, and poster set are submitted concurrently with this
report but under separate cover.
IV - Pilot revised TeenScreen and Consent Phase Materials in Active ScreeningSites
In this final phase of the project, the impact of the materials on consent rates was assessed
in three TeenScreen sites. The sites include: one school in Flagler, Florida; three schools
in Tulsa, Oklahoma; and three schools in Greene County, New York.
Two ofthe sites had conducted screenings prior to the screening in which the new
materials were tested. In one ofthese sites we were able to compare the screening results
using the new materials with the results obtained when their conventional materials were
used in an earlier screening. In the second site, we compared consent rates from three
health classes using new materials with the results obtained from the use of conventional
materials in three health classes that used the conventional materials. In the third site, the
Florida Suicide Prevention Pilot Project Final Report Page 10

new materials were used in conjunction with their inaugural screening efforts. Here, we
used the materials in three schools implementing screening and compared the consent
rates for these ‘experimental’ schools with those for the two schools using conventional
materials. We therefore have comparisons using the results of earlier screenings and of
screenings using the conventional material in different classrooms or schools.
In all sites the newly developed materials were distributed simultaneously to parents and
teens in addition to the materials that each site normally distributed. As is detailed below,
the posters generally were displayed in the schools to coincide with the distribution ofthe
other mental health screening materials.
The results ofthese field trials are displayed in Table 4. As can be seen from the table, the
schools in which we tested the communication materials substantially varied in their rates
ofparticipation in the screening. Response rates from students varied from 2.2% in
school A to 100% in school F. As might be expected, the procedures used in these widely
varying schools varied widely. In school A, for example, the requests were sent late in the
year and they competed with many other year end activities. In school F, guidance staff
called all of the parents who didn’t respond to the initial request to return the consent form
resulting in full parental participation.
Florida Suicide Prevention Pilot Project Final Report
Page Ii

.
Table 4: Results from Testing ofNewly Developed Communications Materials Compared
Conventional
Screeningand Consent Materials in Seven Schools.
to
Screening with New School School School School School School School
Communications Material A B C D E F G
Target grade level Spring 11 & 11 9 9 9 9 9
06
Consents and Brochures
distributed
Posters displayed
‘
12
Total
220 235 350 65 24 24 14 932
No
8 in
halls
10 in
halls
No
5 in
Class
Total Parents Responding 5 29 65 39 7 24 12 181
Percent Responding 2.2% 12.3% 18.6% 60.0% 29.2% 100% 85.7% 19. 4%
Parents giving consent 3 28 49 31 4 18 4 137
Parents denying consent 2 1 16 8 3 6 8 44
Percent Giving Consent 60.0% 96.6% 75.4% 79.5% 57.1% 75.0% 33.3% 75.7%
Comparison Data
Screening with
Conventional Material
comparison group
Target grade level
Comparison *Winter 05,
#Spring 06 or ASpring 06
Winter
same
school
9 &
10*
Winter
same
school
N/A D 3
health
classes
Local
school
H
5 in
Class
Local
school
I
5 in
Class
N/A
10* N/A 9# 9 9 N/A
Consents distributed 207 383 N/A 46 22 20 N/A 678
Parents Responding 47 82 37 8 7 181
Percent Responding 22.8% 21.4% 80.4% 36.4% 35% 26.7%
Parents giving consent 17 66 N/A 24 5 4 N/A 116
Parents denying consent 30 16 N/A 13 - 3 3 N/A 65
Percent Giving Consent 36.2% 80.5% 64.9% 62.5% 7.1% 64.1%
*Wjnter 05: Same school during previous quarter implementing screening.
#Spring 06: Remaining 3 health classes at School D.
Aspring 06: Two local schoOls also implementing TeenScreen for first time
Florida Suicide Prevention Pilot Project Final Report Page 12

Rates at which parents agreed to have their teens participate in screening also varied
considerably from a high 97% to a low of 33%. The pooled results across all schools are
displayed in the final column ofthe table. In total nearly 932 parents were approached
with the new communications material. Ofthe 932, 181 19.4% responded to the
request. Of the 181 responders, 137 75.7% agreed to have their teen participate in
screening. In the comparison conditions, 678 parents were approached with 181
providing some response 26.7%. Ofthe responders, 64.1% gave permission for their
teens to participate.
In terms ofthe overall response rates, parents who received the material responded to the
request for a consent decision at a significantly lower rate than individuals in the
comparison condition X2 = 11.9, p =.0005. Of the responders, however, parents were
significantly more likely to give consent for their teen to participate in the screening if
they received the new communications material X2 = 5.79, p .0 16. From these data,
therefore, we have an indication that the new communications material was significant in
improving consent of responders but, ironically, lowered the overall level of response.
Clearly, the results for School A are the most aberrant between trials with nearly no
parents responding to the consent request in the experimental trial as opposed to almost a
quarter in the comparison trial. If we eliminate School A’s data from the analyses, the
significance of the difference in response rate is eliminated X2 2.04, p = .15.
However, the significant difference between the experimental and comparison trials in
consent to participate also is eliminated X2 = 0.207, p .65.
The statistical analyses ofresponse and consent rates therefore are equivocal. Data from
an unusual school accounts both for the significant increase in consents and the significant
decrease in the response rate. Further testing in other sites will be required to determine if
the materials are effective in increasing consent rates.
In addition to the quantitative results, however, we had some anecdotal responses from the
schools regarding the impact and effectiveness of the materials.
Florida Suicide Prevention Pilot Project Final Report Page 13

Anecdotal reaction about the new materials was mixed. At one site, the posters reportedly
prompted several class discussions. Additionally, a school representative reported "there
is quite a bit of talk among the kids about the posters. They seem to be getting attention
and causing kids to think about these issues, if nothing else. One kid actually stole 2 of the
posters and took them home." However, several students at least in this school requested
that the posters be taken down because the students felt the posters were depressing or not
true. One principal refused to hang one of the posters due to the caption [i.e., Voted most
likely to succeed He killed himself instead]. At another site, some of the teachers from
one school thought the posters were "too much in your face" about the issue ofsuicide.
No reactions to the posters from the remaining three schools at these two sites were
shared.
Suicide often referred to as the silent epidemic, is a sensitive topic and not often
discussed. The posters are a reminder that a variety of individuals might be at risk for
mental illness and suicide, even successful students. Anecdotal reactions may reflect the
false belief that discussing suicide increases the risk ofsuicidal behavior. Leenaars &
Wenckstern, 1999. Perhaps providing additional information on suicide and prevention to
school staff would be a helpful supplement to these materials.
Teachers and site representatives, however, reported a favorable reaction to the teen and
parent brochures. Individuals made positive comments ‘about the brochure’s appearance
e.g., nice, colorful and language e.g., easy to read, informative. No site liaisons
reported negative reactions to the brochures other than the challenge of ensuring students
take materials home and give them to parents.
Finally, one site’s liaison offered a comment about the impact and effectiveness of the
materials. "The return rates are low even where they are usually highest, so I don’t think it
has to do with the brochures or posters."
Florida Suicide Prevention Pilot Project Final Report . Page 14

Conclusions
Adolescent suicide is a major public health problem in the United States. School based
suicide prevention programs hold promise for reducing the rate of suicide in adolescents.
Screening with validated instruments and follow-up of teens that screen positive could
enhance school based suicide prevention programs. Similarly, effective treatment of
mental illnesses in teens would have wide ranging effects in improving school
performance and other functional outcomes in teens.
Parental participation is a critical element in successful suicide prevention and screening
programs. Increasing participation rates is therefore a desirable outcome. In this study,
we used a systematic series of techniques to develop educational materials that we hoped
would both better inform parents regarding the screening decision and increase rates of
participation and follow-up. The results of our initial evaluation are equivocal since
analyses of the full data set indicated that parental consent significantly increased after
exposure to the materials while the overall participation rate decreased significantly.
Eliminating one school, whose data seemed particularly aberrant, resulted in eliminating
all significant effects. Anecdotal reaction to the posters have been mixed and suggest that
other educational materials should be distributed with the .posters.
Reactions to the
brochures were universally positive. We therefore recommend that the materials be
further tested in settings where multiple schools will implement screening simultaneously
or in which prior screening consent rates may be used for comparison.
Florida Suicide Prevention Pilot Project Final Report Page 15

References
Conwell Y, Duberstein, P.R., Cox, C., Herrmann, J.H., Forbes, N.T., & Caine, E.D,
1996. Relationships of age and axis I diagnoses in victims of completed suicide:
A psychological autopsy study. American Journal ofPsychiatry, 1538, 1001-
1008.
Harris, E.C., & Barraclough, B. 1997. Suicide as an outcome for mental disorders: A
meta-analysis. British Journal ofPsychiatry, 170, 205-228.
Kessler, R.C., Berglund, P., Demler, 0., Jin, R., & Walters, E.E. 2005. Lifetime
Prevalence and Age-of-Onset Distributions ofDSM-IV Disorders in the National
Comorbidity Survey Replication. Archives of General Psychiatry, 626, 593-602.
Leenaars, A., & Wenckstern, S. 1999. Suicide prevention in schools: The art, the issues,
and the pitfalls. Crisis, 203, 132-142.
PHS Public Health Services 2001. National Strategyfor suicide prevention: Goals and
objectivesfor action. U.S. Department of Health and Human Services, Rockville,
MD.
U.S. Department of Health and Human Services. Mental Health: A Report ofthe
Surgeon General. Rockville, MD: U.S. Department of Health and Human
Services, Substance Abuse and Mental Health Services Administration, Center for
Mental Health Services, National Institutes ofHealth, National Institute ofMental
Health, 1999.
New Freedom Commission on Mental health, Achieving the Promise: Transforming
Mental health Care in America. Final Report. DHHS Pub. No. SMA-03-3832.
Rockville, MD: 2003.
Grunbaum, J. A., Kann, L., Kinchen, S. A., Williams, B., Ross, J. G., Lowry, R., & Kolbe,
L. 2002. Youth risk behavior surveillance: United States, 2001. Atlanta, GA:
U.S. Dept. of Health and Human Services, Centers for Disease Control and
Prevention CDC, Epidemiology Program Office
Goldsmith, S. K., Pelimar, T. C., Kleinman, A. M., & Bunney, W. E. eds. Reducing
suicide: A national imperative. Washington, DC: Institute of Medicine of the
National Academies, the National Academies Press
Florida Suicide Prevention Pilot Project Final Report Page 16

APPENDIX A
TeenScreen Regional Coordinators Meeting
Report
Florida Suicide Prevention Pilot Project Final Report Page 17

University of South Florida
Louis de la Parte Florida Mental Health Institute
TeenScreen Regional Coordinators Meeting
January 20, 2005
ROBERTS
COMMUNICATIONS
Florida Suicide Prevention Pilot Project Final Report Page 18

TeenScreen Regional Coordinator Meeting
Best Practices Research and Communications Tool Kit Development
Goal
The goal ofthis regional coordinator meeting is to design a communications tool kit that
effectively presents information on teen mental health screening in order to increase
accessible, informed consent procedures.
Objective
To obtain valuable input from TeenScreen coordinators who are on the "front line" of
program implementation through the sharing of best practices.
Overview
Roberts Communications and Marketing, Inc. facilitated this meeting. The meeting included a
brief overview of the project and work completed to date. Roberts Communications led
TeenScreen coordinator participants through a discussion to identify target audiences and the
most effective communications tools. The meeting concluded with a brainstorming session
on messages and methods to increase informed consent and maximize participation rates.
Agenda
I. Welcome/background
II. Introductions
III. Review of project and work completed to date
IV. Guided discussion
* audience identification and characterization
* message and methods identification
* most effective communications tools
V. Wrap up
VI. Conclusion/overview next steps
Format
The format of the meeting was guided discussion. Roberts Communications used a
PowerPoint presentation to move through the agenda and action items.
Florida Suicide Prevention Pilot Project Final Report . Page 19

Content
The content of the meeting included:
Audience identification and characterization
* The audiences important to the organization must be identified. More importantly,
the characteristics must be carefully defined for each group. It may be determined
that while the community is an important public, there are significant subsets of
interests that should be addressed.
Messages and Methods Identification
* Guided discussion on what are the key messages that need to be communicated to
increase informed consent and participation rates. Identify methods of
communication that work most effectively to reach the target audiences.
Effective Communications Tools
* Guided discussion to identify the most effective implementation strategies, effective
communications tools and additional tools needed to enhance implementation at
sites.
Florida Suicide Prevention Pilot Project Final Report Page 20

Summary
Executive
This focus group included seven participants representing TeenScreen site coordinators,
Columbia TeenScreen regional coordinator and FMHI staff. These are the major findings:
The participants were very involved in the discussion and provided very detailed insight to
the program and successful implementation. The participants provided an excellent road
map for the development of an effective communications tool kit.
* Several key audiences were identified. This represents the variability across sites on
what audiences are important for successful implementation. It also represents the
complexity and levels of authorization in place at most sites to implement the
program. The most critical audiences discussed and outlined during the meeting were
students, parents, health care community, school boards, school administration and
staff.
* All other audiences identified are still important in the implementation of the
program. We recommend that a communications checklist be created that identifies
these audiences and recommends which communications tools would be most
beneficial to use to reach them.
* Detailed information was outlined that characterized each of the key audiences.
There were a few umbrella messages that were important to each of these audiences:
o Free, voluntary and confidential
o Extensive research behind program, science-based
o No association with pharmaceutical companies
o Mental health check-up just as important as regular health check-up
o Committed to providing resources and follow through
* Participants discussed many effective ways to deliver the important messages about
the TeenScreen Program. They expressed the importance of partnerships that
increase credibility in the community. The participants also identified that small
group presentations were much more effective than large group presentations.
Personal communication is paramount when delivering the TeenScreen message.
* Branding the program with consistent images to show that TeenScreen is for all
genders and ethnicities. The participants felt that it was important to show visually
that feelings matter and the confidentiality ofthe process.
* Many communications tools were recommended as important in the successful
implementation of the program. The participants voiced that technology is key here.
They recommended several communications tools that were Web-based, including
CDs, DVDs, enhanced Web sites, delivering messages and resources through Web
sites.
Florida Suicide Prevention Pilot Project Final Report Page 21

* The participants also expressed the need for resources for parents.
Recommendations to reach this critical audience included an information package
that includes a brochure, fact sheet, frequently asked questions and resource cards.
* Our next step is to conduct interviews of parents and students at local TeenScreen
sites. This will be critical to ensure that the most effective comrtiunications tools are
developed.
Florida Suicide Prevention Pilot Project Final Report Page 22

Target Audience Identification and Characterization
Participants were asked to identify all target audiences for TeenScreen. The participants
brainstormed the target audiences which are categorized below.
Target AudiencesIdentified
School
* School boards
* Students
* School health programs
* School administration
* Superintendent
* Discipline chiefs
* School district lawyer
* Existing school-based programs
* After-school programs
* School faculty and support staff
* Non-teaching professionals
* Resource officers
* Existing suicide prevention programs
Government
* State agencies
* State government officials
* Local universities
* Local government officials
Business
* Businesses
* Chambers of commerce
Community
* Local funding agencies
* Local non-profits
* Faith-based organizations
* Suicide survivor groups/affinity groups
* Parents
Health
* Community mental health institutions
* Public health community
* Clinicians
Florida Suicide Prevention Pilot Project Final Report Page 23

* Clinics
* Hospitals
Target AudiencesCharacterized
The participants were then asked to identify the characteristics of each audience. Including
descriptions of: age, background experiences, desired depth of the topic, education,
ethnicity, familiarity with topic, gender, profession, religious affiliation and any other
significant description they found important. The participants also described the most
effective communications tactics for these audiences.
School Administration! Faculty/Staff
* Educated group
* Need education on teen suicide and prevention programs
* Need to clearly explain process
* Complement existing programs
* One-on-one communication
o Principal
o Info on program and time frame
* Buy-in at all levels teachers, counselors, aids, etc.
* Focus on student achievement personal and academic
* Staff orientation video
* Notification to staff from principal communication is more effective from this source
* Newsletter communication
* Focus on confidentiality
o Cite the law
o Limits of the law
* Report successes
* Risk averse
* Resources critical
* Health information
* Not gateway to special education
Students
* Engage student leaders
* Emotional and behavioral health screen check-up
* Present TeenScreen in "non-scary" terms
* Presentation prior to screening
* Links to curriculum
* Age: 6th -
12th 9th grade is ideal
* Explanation ofprocess
o Video
Florida Suicide Prevention Pilot Project Final Report Page 24

* Branding program
o Signage/posters
o Shirts
* Keep casual, fun
* Information for students that don’t participate
o Provide them with community resources
* Leave-behind with resources
* Assets to succeed
* Let them know they are not being singled out
* Confidential
* Web communication important
Parents
* Birth, foster, and legal guardians legal authorization
* Greater good
* Opportunity for feedback
* Free
* Voluntary
* Variety of demographics
* Multi-lingual
*
6th grade reading level
* Information on confidentiality
* Interest varies by parent
* Culturally influenced
* There is a stigma to overcome
* Affordability
* Independent from pharmaceutical companies
* Not research project
* School support
* PTA buy-in
* Provide Who/what/how - next steps
* Research-based
* Provide detailed health information - how they can get resources
* Multiple communications options mail and sent home with students
* Partnership - nothing is done without their input and consent
* Students not penalized for non-participation
* Level and extent of follow up to parent
School Boards Trustees
* Generally elected officials sometimes appointed
* State school boards and local school boards
* Elected have greater prestige
* Leaders in community
Florida Suicide Prevention Pilot Project Final Report Page 25

* Some have education background - educated group of people
* Familiarity with topic varies
* Control and access to schools
* Big decision makers, they set policy
* Everything goes some votes through school board
* Press packet - high level info needed
* Information needs to provide them with education on the issue
* Confidentiality and implementation details JeenScreen is not used for research
* Simple, straightforward verbal presentation
* Liability
* Cost
* Research behind program evidence-based, confidential, volunteer
* Time from staff
Clinicians / Existing programs I Clinics / Hospitals
* Clinicians
o Volunteers must have Bachelors degree
* College students
* Screeners
* Clinical interviews
o Need overview of program
o Students often receive services at school
* Opportunities for involvement
o Different from site to site
* Clear definition of protocol and procedures
* Not gateway to special education services
* High level of mental health knowledge
* Qualification standards
Florida Suicide Prevention Pilot Project Final Report Page 26

Messages and Methods
Participants were asked to identify key messages that need to be communicated to increase
informed consent and participation rates. Participants also identified methods of
communication that work most effectively to reach each target audience.
Messages
* Science-based
* Improve academic achievement
* Importance of healthy workforce
* Improve family life and relationships
* Not pharmaceutical company related
* Screening process
* Mental health and health check-up
* Not used for research
* Community-based, highlight partnerships
* Informing parents
* Providing parents information, resources, and support
* Tools and support for parents
* Positive testimonials
* Success stories
* Positive introduction to mental health
* "Your feelings matter"
* Saving lives
* Cost-effective
* Screening, not treatment
* Easy to get, easy to use
* Free, voluntary and confidential
* Parent resource
* Provides innovative resources to parents and students
* Committed to provide resources and follow through
* Message about statistics to illustrate that it is a public health issue only for some
audiences
* Message on confidentiality and how information is handled
* If you aren’t going to do it yourself do it for someone else
* "Our vision is clear" visual - a fuzzy background picture
* Teen Screen - "because your feelings matter"
Methods to Deliver Messages
* Outline and adhere to strict set of protocols
* Credibility through support partnerships
* Deliver messages through school communications
Florida Suicide Prevention Pilot Project Final Report Page 27

* Public relations campaign
* Paid media to general public
* Multicultural team and approach
* Multigenerational
* Incentives
* Small groups of students
* Close proximity to students, provide personal communication
* Single point of contact
o Point of entry or exit
* Confidentiality is paramount
* Two distribution points of information:
o Education about program and issue
o Consent
* Community meeting
* Student leadership involvement
* Presentations in classes, no larger
o Small groups much more successful
Florida Suicide Prevention Pilot Project Final Report Page 28

Communications Tools & Strategies
Participants identified the most effective implementation strategies and the most effective
communications tools for each target audience. Participants also identified what tools they
thought would work most effectively at their site. One of the biggest messages about
communication: Access is key.
Web
* Web site
o Informational purposes
* Web-based suicide hotline
* Use technology to deliver the message video on Web
Print
* Information package
o Background
o Process
* Parent brochure with letter and consent form
* Posters
o TeenScreen brand
* Resource card
o Resources
o Development assets
* Fact sheet
* Press kit and ethics of reporting on this issue
* Frequently asked questions
* Brochures that include testimonials over 90% of parents say they would know
o Kids and parents
* Information packet - specific to audience
* Information packet speaking to fundraising indirectly, but powerful
* Information brochures on different issues -
o To help with follow up
o Follow up with brochure
o Mental Health Association gives free brochure
Video
* CD of information
* DVD/VHS video on TeenScreen for community and students for development purpose
as well
* 3-tiered CD - Different levels of info that builds upon the other
o Make sure audience specific
o Show kids on computer, show questions asked, program history
Advertisement
* Movie theater advertisements
Florida Suicide Prevention Pilot Project Final Report Page 29

Other
* Establish a TeenScreen office
o Have students be able to contact staff through Web
* Media training
* Be sure that images capture TeenScreen participants of all genders, race, ethnicity, etc.
* Images need to show feelings
* Teacher incentives
o video, announce name, CEU
* Build TeenScreen into curriculum
Florida Suicide Prevention Pilot Project Final Report Page 30

APPENDIX B
Interview Protocol for
Parents who consented
to allow their teen to participate
Florida Suicide Prevention Pilot Project Final Report Page 31

________________________________________
Questionnaire For Mental HealthScreening
1. Which of the following age groups are you in?
o 18-29
U 30-49
o 50-65
o 66 & older
2. What is the highest level of education you have reached so far?
o
o
o
o
Less than high school
High school graduate
Some college
College graduate
3. What is your present employment status?
o
o
o
o
o
Employed full-time
Employed part-time
Voluntarily not in the work force in school; raising family, etc.
Unemployed but not retired
Retired
4. What type of media sources do you feel is the most trustworthy select one?
o
o
o
o
o
o
TV
Newspaper
Internet
Magazine
Radio
Other:
5. Please identify the annual income category your household falls into?
o Less than $20,000
o $20,000-$29,999
U $30,000-$49,999
o $50,000-$74,999
U $75,000+
Florida Suicide Prevention Pilot Project Final Report Page 32

.
I would now like to ask you a few questions about mental health in teens. For each of the
questions I would like you to tell me if you strongly agree with the statement, agree,
agree slightly, are undecided about it, slightly disagree, disagree or strongly disagree.
Question
6. Mental illness is a
serious problem in
teens?
7. Treatments for mental
illness_are_effective?
8. Treatments for mental
illnesses are
dangerous?
9. I would trust a
psychologist?
10. I am confident that I
could recognize a
mental health problem
with my child?
11. Ifeel pretty
knowledgeable about
mental illness
12. I think mental illness
affects_a_lot_of teens?
Strongly
Agree
Agree
Slightly
Agree
Undecided
Slightly
Disagree
Disagree
Strongly
Disagree
The next few questions relate to the most effectiveways to communicate with you.
13. What would be the best way to inform you about a school-based health screening?
What would be the second best way?
ci By phone
ci Through the mail
ci School meeting
ci Materials sent home from school with your child
ci Via email
o Personal visit to the home -
Florida Suicide Prevention Pilot Project Final Report Page 33

I’m now going to list several ways in which you could be reminded about the program and
the need to return your child’s consent form. Considering all of the information that you
receive each day, how helpful would each of the following contact methods be in
informing you about the program or reminding you to return the consent form for your
child?
Question
How helpful would it be:
14. To send you a follow-up
card in the mail
reminding you about the
screening and the need
to return the consent
form?
15. To send home a
reminder with your child
about the screening and
the_consent_form?
16. To send you an email
reminding you about the
screening_and_consent?
17. To call you over the
phone reminding you
about_the_screening?
Very
Helpful
Helpful
Slightly
Helpful
Not
Sure
Slightly
Unhelpful
Unhelpful
Very
Unhelpful
18. What kind of media would you find most useful in learning about the program?
ci
ci
ci
ci
ci
ci
Informational brochure
Video/DVD
Radio advertisement
Television advertisement
Newspaper advertisement
Web site
19. Considering the seven types of information listed below in reaching your decision
about participating in a screening program, which would be the most important? What
would be the second most important?
ci
a
ci
ci
ci
a
a
What the program tests for
Whether the program has been tested elsewhere
How effective the screening instrument is at detecting the illness
How effective treatments are for treating the illness
Description of who will be doing the screening
The time it will take to take the screening
What will happen if you screen positive
Florida Suicide Prevention Pilot Project Final Report Page 34

_______________________________
I believe you returned your consent form the TeenScreen program attempts to make sure
every parent receives whose son or daughter has the opportunity to participate.
20. Overall, what was your reaction to the materials?
21. Was the program clearly presented; for example could you understand what the
program was about and what Would happen if you agreed to let your child participate?
0 Yes NoD
a
What made the information Unclear?
o Language El
a Description of the program o
o Description of the process and what will happen 0
Other:
22. Looking at the materials, what do you like the most about materials?
23. What do you like the least about the materials?
24. Should there be anything else included in the consent form that you don’t see state
examples like the number of kids who suffer from mental illness in the US, the
effectiveness of treatments for these suffering teens, etc?
25. Should anything in the materials be excluded?
26. Was there anything in the materials that directly led to your decision to let your teen
participate? If so then what?
Florida Suicide Prevention Pilot Project Final Report Page 35

27. On a scale from one to five 1 being not concerned at all and 5 being very concerned
how concerned were you that your teen would be found to be in need of services?
28. You eventually did provide consent for your teen to be screened. What do you think
were two or three of the most important factors that led you to your decision to provide
consent I thought we should leave this as an open-ended question and use these factors
below as interviewer prompts but I was not sure?
Suggested Prompts:
Because / trusted the program
My teen convinced me to let him/her participate in the program
/ trusted the people who were conducting the screening
I knew that my teen could benefit from taking the screening
29. Even though you did agree to let your child participate what worries or concerns did
you have about your decision?
30. Do you have any other suggestions about how we can increase the likelihood that
parents will return the consent form and allow their teen the opportunity to participate?
If you have any questions please feel free to call Steve Roggenbaum at 813-974-6149.
Florida Suicide Prevention Pilot Project Final Report Page 36

APPENDIX C
Interview Protocol for
Students who screened positive and
did adhere to follow-up treatment
recommendations
Florida Suicide Prevention Pilot Project Final Report Page 37

For Mental
HealthScreening
Questionnaire
I am going like to ask you a few questions about mental health in teens. For each of the
questions I would like you to tell me if you strongly agree with the statement, agree,
agree slightly, are undecided about it, slightly disagree, disagree or strongly disagree
Question
1. Mental illness is a
serious problem in
teens?
2. Treatments for
mental illness are
effective?
3. Treatments for
mental illnesses are
dangerous?
4. I would trust a
psychologist?
5. Iwouldbe
embarrassed if my
friends found out that
I screened positive
on_the_screening?
6. I feel pretty
knowledgeable about
mental illness
7. I think mental illness
affects a lot of teens?
Strongly
Agree
Agree
Slightly
Agree
Undecided
Slightly
Disagree
Disagree
Strongly
Disagree
The next couple of questions have to do with the most effective ways that we could
communicate with you.
8. What would be the best way to inform you about a school-based health screening?
What would be the second best way?
ci
ci
a
a
u
ci
By phone
Through the mail
In your homeroom classroom
At a school assembly
Via email
Personal visit to your home
9. What type of media sources do you feel is the most trustworthy select one?
ci
ci
ci
TV
Newspaper
Internet
Florida Suicide Prevention Pilot Project Final Report Page 38

ci
ci
o
Magazine
Radio
Other:
The next few questions deal with how we could remind you about a screening taking
place in your school. Before we screen we send out a form describing the program and
asking for your parents’ permission. We understand that these forms are easily forgotten
so we are just wondering about how best to remind you about the screening. For each of
these methods just tell me how helpful each would be in reminding you about the chance
to take the screening.
.
Question
How helpful would it be to:
Very
Helpful
Helpful Slightly
Helpful
10. Send you a follow-up
card in the mail
reminding you about the
screening?
11. To remind you about the
screening in your
homeroom?
12. To send you an email
reminding you about the
screening?
13. To call you over the
phone reminding you
about the screening?
Not
Sure
Slightly
Unhelpful
Unhelpful
Very
Unhelpful
14. What kind of media would you find most effective in learning about the program?
What would be the second most effective?
ci
ci
ci
ci
ci
ci
ci
Informational brochure sent in the mail
Video/DVD
Radio spot
Television advertisement
Newspaper advertisement
Web site
Informational poster or flyer put up around school
15. Considering the seven types of information listed below, which would be the most
important in reaching your decision about participating in a screening program? Which
would be the second most important?
ci
ci
ci
ci
ci
ci
ci
What the program tests for
Whether the program has been tested elsewhere
How effective the screening instrument is at detecting the illness
How effective treatments are for treating the illness
Description of who will be doing the screening
The time it will take to take the screening
What will happen if you screen positive
Florida Suicide Prevention Pilot Project Final Report Page 39

_________________________________
16. How were you told about the program?
17. Overall, what was your reaction when you first heard about the program?
18. Was the program clearly presented; for example could you understand the goal of the
program and what would happen if you agreed to participate?
El Yes NoEl
a
What made the information Unclear?
o Language El
a Description of the program El
a Description of the process and what will happen El
Other:
19. What did you like most about the way the program was presented?
20. What do you like the least about the way the program was presented?
21. When you were told about the program did you have any questions? If so, what were
they?
22. When you were told about the program was there anything that you felt should have
not been discussed?
Florida Suicide Prevention Pilot Project Final Report Page 40

23. Was there anything in particular that really made you decide that this was something
that you wanted to do? If so, what was it?
24. What was your initial reaction when you heard that you were going to meet with a
counselor soon after the screening?
25. When you met with the counselor what did you like the most about the interview?
26. When you met with the counselor what did you like least about the interview?
27. What did you want the counselor to say to your parents when he/she called home to
inform them of your screening results?
28. What factors led you to want to follow-up with the recommendations made by the
counselor I knew I needed to get help, my parents made me go, I trusted the people who
suggested I get help?
29. What worries did you have about following-up other kids finding out, embarrassed,
money, my parents would be upset, inconvenience?
30. How worried were you about other teens finding out that you screened positive and
would be referred to follow-up services?
Florida Suicide Prevention Pilot Project Final Report Page 41

31. My parents were important in getting me to follow up?
ci
ci
ci
ci
ci
ci
ci
Strongly Agree
Agree
Slightly Agree
Undecided
Slightly Disagree
Disagree
Strongly Disagree
32. What do you think that we could say to teens who need follow-up to increase the
chances that they actually would follow-up?
33. What was the hardest part for you in following up?
34. Do you have any other suggestions about how we can talk to teens to get them to get
to follow-up?
35. Lastly, what grade are you in
interviewee’s name
ci
ci
ci
ci
ci
ci
7th
8th
gth
10th
11th
12th
Ifyou have any questions, pleasefee/free to call Steve Roggenbaum at 813-974-6149.
Florida Suicide Prevention Pilot Project Final Report Page 42

APPENDIX D
Qualitative Research Methodology
for Parent and Student Interviews with
Tabulated Results
Florida Suicide Prevention Pilot Project Final Report Page 43

Qualitative Research Methodology for Parent and Student Interviews with Results
General themes were identified and subsequently qualitative interview responses were
grouped into the following categories:
o Problems with current communications materials as reported by parents
o Suggestions to increase consent as reported by parents
o Suggestions to increase consent as reported by teens regardless of whether or
not they participated in the screening
o Factors that encouraged follow-up compliance as reported by teens who
complied
o Reasons for failure to follow-up as reported by parents of teens who did not
comply
o Key supporting points as reported by teens who participated in the screening
o Key supporting points as reported by parents of teens who participated in the
screening
Often, survey respondents provided information in response to a single question that could
be included in more than one category. In these cases, the responses were tabulated in
each corresponding category e.g., if the question was "what did you like least about the
follow-up interview" and the respondent answered "time out ofthe school day but I really
liked the fact it was confidential," both answers were recorded in the appropriate
category.
Individual responses were grouped together by themes and tabulated. Each survey
respondent was counted only once per theme-response category e.g., if confidentiality
was cited as a key supporting point in more than one answer by the same respondent, it
was only counted once. If a respondent cited more than one item, however, each response
was counted once in the appropriate category e.g., if a respondent cited confidentiality
and parental pressure as factors encouraging follow-up, both responses were tabulated.
The tabulated interview results are as follows:
Problems with current communications materials as reported by parents
o Too wordy or technical - should be easy for common person to read and
understand 5
o Passive consent - don’t like it 3
a Information is too vague/parent did not get a good idea about what the
problem was 3
a Seems to treat everyone the same 1
Suggestions to increase consent as reported by parents
a Parents want to see results ofthe screen - tell them upfront what they will
see5
a What disorders will the screening detect? 4
a Provide information about program/treatment costs 4
Florida Suicide Prevention Pilot Project Final Report Page 44

Resources that are available/how resources will be provided ifthe child
screens positive 4
o Explanation ofthe steps of the screening process 4
o Increase personal communications upfront phone call or letter with
information 3
o Information about why their child or every child should participate 2
Factors encouraging follow-up compliance as reported by students who complied
o Confidentially 5
o Teen wanted to talk to someone - already seeking help/wanting
answers/need to discuss issues with someone confidentially 3
o Parental pressure 1
Reasons for failure to follow-up as reported by parents whose teens did not
comply
o Worried about stigma of child being treated in school/worried about child
being embarrassed or harassed by peers 5
o Worried about cost/inability to pay for treatment 4
o Did not want child to loose time from school day for treatment 3
o Transportation issues made follow-up impossible 3
o Feel that child did not need help/would outgrow problems in time 2
Key supporting points as reported by students who participated in screening
o Confidential 6
o Wanted to talk 2
o Would get answers about themselves2
a Curiosity1
Key supporting points as reported by parents whose teens participated
a Would get answers about their child 2
o Teen wanted to talk to a counselor and/or wanted to participate 2
o Want their teen to get help 1
Suggestions to encourage follow-up and/or consent as reported by all groups
o Explain confidentiality guidelines 4
o Make the process fun and/or interesting - not boring 2
a
Assure students that this is common and does not mean that they are
"weird" 2
o Assure children that they do not need to commit up front - they can try it
and stop ifthey choose.
Florida Suicide Prevention Pilot Project Final Report Page 45