David Shern, Ph.D. Louis de la Parte Florida Mental ... - PsychSearch
David Shern, Ph.D. Louis de la Parte Florida Mental ... - PsychSearch
David Shern, Ph.D. Louis de la Parte Florida Mental ... - PsychSearch
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DEPARTMENT OF HEALTH & HUMAN SERVICES<br />
Substance Abuse and <strong>Mental</strong><br />
Health Services Administration<br />
Centerfor <strong>Mental</strong> Health Services<br />
Center for Substance Abuse<br />
Prevention<br />
Center for Substance Abuse<br />
Treatment<br />
Rockville MD 20857<br />
<strong>David</strong> <strong>Shern</strong>, <strong>Ph</strong>.D.<br />
<strong>Louis</strong> <strong>de</strong> <strong>la</strong> <strong>Parte</strong> <strong>Florida</strong> <strong>Mental</strong> Health Institute<br />
University ofSouth <strong>Florida</strong><br />
13301 Bruce B. Downs Boulevard<br />
Tampa, FL 336 12-3809<br />
Dear Dr. <strong>Shern</strong>,<br />
I have reviewed the report entitled, "<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project: Final Report,"<br />
submitted June 16, 2006. As part of this project, SAMHSA sought to gather information about<br />
several issues. Ofparticu<strong>la</strong>r interest was learning more about how parents respond to 1 requests<br />
to have their son or daughter screened for risk for suici<strong>de</strong> and 2 recommendations for further<br />
assessment or treatment that may result from the screening. The report does not accomplish<br />
either task.<br />
Because parents are and should remain the jltimate <strong>de</strong>cision makers regarding the health and<br />
well-being oftheir children, un<strong>de</strong>rstanding how parents respond to requests for participation in<br />
suici<strong>de</strong> prevention programs, and in particu<strong>la</strong>r how parents respond to receiving information that<br />
their son or daughter may be at risk for suici<strong>de</strong>, is crucial for engaging families. SAMHSA is not<br />
interested in simply finding ways to increase parental consent rates. Rather, SAMHSA is very<br />
interested in learning more about families’ concerns, hopes, worries, and reactions to schoolbased<br />
suici<strong>de</strong> prevention programs, and in learning more about how to actively and appropriately<br />
engage families in suici<strong>de</strong> prevention efforts.<br />
The five parent interview categories you established-parents who <strong>de</strong>clined participation,<br />
parents who agreed to participate, parents who did not return a consent form, parents who<br />
adhered to followup recommendations, and parents who did not follow up-seemed to hold<br />
promise for obtaining such information. However, your report does not systematically present<br />
the results ofthe parent interviews/focus groups, nor does it analyze the results across categories.<br />
Finally, no information is provi<strong>de</strong>d about the views ofparents who <strong>de</strong>clined to have their teens<br />
participate, <strong>de</strong>spite the importance that SAMHSA p<strong>la</strong>ces on un<strong>de</strong>rstanding these parents’<br />
concerns. Given the limited nature of the data collected, it is unclear how the data support the<br />
conclusion that "increasing participation rates is therefore a <strong>de</strong>sirable outcome."<br />
I also have several concerns regarding the materials <strong>de</strong>veloped through this project. SAMHSA’s<br />
un<strong>de</strong>rstanding was that these were to be educational materials <strong>de</strong>veloped based on feedback from<br />
families and teens. It is unclear how such feedback was incorporated into the <strong>de</strong>sign ofthe<br />
Office of the Administrator-Office of Applied Studies-Office of Communications-Office of Policy, P<strong>la</strong>nning and Budget-Office of Program Services
materials and whether these materials incorporated the recommendations articu<strong>la</strong>ted in the<br />
NIMI-l/CDC/SAMHSA-fun<strong>de</strong>d "Science ofPublic Messages for Suici<strong>de</strong> Prevention." See<br />
Suici<strong>de</strong> and Life Threatening Behavior. 2005 Apr; 3 52: 1 3445. Since these materials were not<br />
submitted to SAMHSA for review orclearance, you should not suggest or imply in any way that<br />
SAMLISA endorses or supports the content of the materials.<br />
Sincerely yours,<br />
1fr?/c<br />
f1/J.<br />
Richard McKeon, <strong>Ph</strong>.D.<br />
Special Advisor, Suici<strong>de</strong> Prevention<br />
Center for <strong>Mental</strong> Health Services
FLORIDA SUICIDE PREVENTION PILOT PROJECT<br />
June 22, 2004 through May 31, 2006<br />
Task 5<br />
Project Status Report<br />
Submitted May 16, 2006<br />
The Substance Abuse and <strong>Mental</strong> Health Services Administration SAMHSA was<br />
created in 1992 to improve prevention, treatment and rehabilitation services for<br />
individuals with health issues and substance disor<strong>de</strong>rs. Within SAMHSA, the Center for<br />
<strong>Mental</strong> Health Services CMI-IS provi<strong>de</strong>s national lea<strong>de</strong>rship and direction for policies,<br />
programs, and activities <strong>de</strong>signed to improve mental health prevention and treatment<br />
services. One of the most important areas for prevention efforts is the prevention of<br />
suici<strong>de</strong> across the life span. Suici<strong>de</strong> prevention efforts must be constructed differently for<br />
different at-risk popu<strong>la</strong>tions. For youth, school based suici<strong>de</strong> prevention is ofparticu<strong>la</strong>r<br />
importance. A promising approach to youth suici<strong>de</strong> prevention that has been i<strong>de</strong>ntified in<br />
the Report ofthe Surgeon General, the Institute of Medicine Report, Reducing Suici<strong>de</strong>: A<br />
National Imperative and in the Presi<strong>de</strong>nt’s New Freedom Commission Report is school<br />
based screening.<br />
There are several reasons that screening to <strong>de</strong>tect <strong>de</strong>pression, the risk of suici<strong>de</strong> and other<br />
mental disor<strong>de</strong>rs in youth is thought to be of importance. Suici<strong>de</strong> is the third leading cause<br />
of <strong>de</strong>ath among youth 10-24 years ofage. Almost as many adolescents and young adults<br />
die from suici<strong>de</strong> than from all natural causes combined. Studies of youth who have<br />
committed suici<strong>de</strong> called psychological autopsy studies have found that 90% had a<br />
diagnosable mental disor<strong>de</strong>r at the time of their <strong>de</strong>ath. According to the Youth Risk<br />
Behavior Survey 2001 8.8% of high school stu<strong>de</strong>nts self-report making a suici<strong>de</strong><br />
attempt, and 2.6% make an attempt serious enough to require medical attention. Yet while<br />
physical health screenings in schools are re<strong>la</strong>tively common, schools do not commonly<br />
screen for mental health problems. It is known that 7 million to 10 million teenagers suffer<br />
from a mental health condition. Additionally, 5-9% of all children suffer from a mental,<br />
behavioral, or emotional disor<strong>de</strong>r that substantially limits one or more major life activity<br />
including aca<strong>de</strong>mic performance and the ability to maintain interpersonal re<strong>la</strong>tionships. It
is estimated that only one-third of these teenagers have been i<strong>de</strong>ntified and are in<br />
treatment. It is also known that many mental health problems start in youth and worsen<br />
over time if not treated. It is hoped that by screening for these problems, particu<strong>la</strong>rly<br />
<strong>de</strong>pression, substance abuse, and suicidal i<strong>de</strong>ation or past suici<strong>de</strong> attempts, youth can be<br />
i<strong>de</strong>ntified early in the course of their illness and informed regarding their treatment<br />
alternatives. With successful treatment, <strong>de</strong>aths from suici<strong>de</strong> could be prevented, along<br />
with other untreated mental illness and re<strong>la</strong>ted issues such as substance abuse, violence,<br />
and school drop out.<br />
Structured suici<strong>de</strong> screening and systematic follow-up are important elements in any<br />
comprehensive suici<strong>de</strong>-prevention program. In or<strong>de</strong>r for screening to be effective,<br />
however, parents must allow their children to participate in the screening and follow-up<br />
with treatment recommendations for those teens who screen positive. While universal<br />
screening efforts i<strong>de</strong>ally inclu<strong>de</strong> all members of an i<strong>de</strong>ntified popu<strong>la</strong>tion, parental consent<br />
to school based screenings is often less than 50%. Simi<strong>la</strong>rly, parental follow-up after<br />
screening is often less than 50%. To the <strong>de</strong>gree to which these rates can be increased,<br />
screenings may become more effective in i<strong>de</strong>ntifying mental illnesses and preventing<br />
suici<strong>de</strong>. In this research project, we hoped to <strong>de</strong>velop methods that would increase<br />
screening consent while appropriately informing parents and teens of the issues that<br />
should be consi<strong>de</strong>red when consenting to participate. Such materials, if shown to be<br />
effective, would optimize the benefits of screening.<br />
This study consists of four phases with the first three using qualitative methods and the<br />
fourth a non-equivalent group comparison <strong>de</strong>sign. In the first phase, a meeting of school<br />
based mental health screening program representatives was hosted to i<strong>de</strong>ntify key issues<br />
in screening. The second phase utilized semi-structured interviews with parents and teens<br />
to i<strong>de</strong>ntify concerns that must be addressed in consent and follow-up materials as well as<br />
media that may be effective in communicating with parents and teens. In the third phase, a<br />
focus group was used to evaluate and improve draft communications materials e.g., teens<br />
respon<strong>de</strong>d to different sets ofposters. Currently in the fourth phase ofthe project, the
materials are being tested in several schools to <strong>de</strong>termine if differential consent rates are<br />
obtained with the new materials.<br />
sahPe I<br />
The project research team worked in tan<strong>de</strong>m with Roberts Communications facilitators<br />
and Columbia University participant i<strong>de</strong>ntification to host a TeenScreen Site<br />
Coordinators Meeting. We convened individuals who have implemented school based<br />
mental health screening programs across the United States i.e., three site coordinators or<br />
their representatives and a regional coordinator. These key informants participated in a<br />
full day, structured dialogue in which we i<strong>de</strong>ntified all of the key audiences that must be<br />
addressed in successfully implementing a screening and follow-up program, the concerns<br />
in reaching each audience, the issues that each may i<strong>de</strong>ntify in <strong>de</strong>ciding upon their<br />
participation and communication strategies to effectively address each audience. Based<br />
on observations and data from the facilitated dialogue, we <strong>de</strong>veloped a semi-structured<br />
interview protocol that was used with parents and teens at active screening sites. The<br />
dialogue was recor<strong>de</strong>d and findings co<strong>de</strong>d to <strong>de</strong>velop an initial framework for the<br />
<strong>de</strong>velopment of communications material and for the collection of data from parents and<br />
youth.<br />
sahPe II Task 2: TeenScreen and consent materials evaluation, Due Date August 31,<br />
2005<br />
Based upon the results from the structured dialogue, the research team <strong>de</strong>veloped a series<br />
of semi-structured interview protocols phase II materials that were used with parents and<br />
teens from three active screening sites to <strong>de</strong>termine how to most effectively address their<br />
concerns with regard to participation in screening and follow-up. Parents from five groups<br />
were interviewed. In each group, we inquired about the rationale for their <strong>de</strong>cision,<br />
information that would have been helpful in the <strong>de</strong>cision making process including<br />
evaluation ofthe communication approaches that were used in each site and how these<br />
might be improved. The five parent groups were:<br />
1. Parents who did not respond to the request for consent<br />
2. Parents who consented to have their teen participate
3. Parents who <strong>de</strong>clined to have their teens interviewed<br />
4. Parents who adhered to follow-up recommendations<br />
5. Parents who did not adhere to recommendations.<br />
Additionally the research team conducted interviews with teens about the same issues<br />
discussed with parents. Teens from two groups were interviewed.<br />
1. Stu<strong>de</strong>nts who screened positive but did not adhere to follow-up treatment<br />
recommendations<br />
2. Stu<strong>de</strong>nts who screened positive and did adhere to follow-up treatment<br />
recommendations.<br />
The research team members administered the interview protocol, conducting the<br />
interviews over the phone at a time that was convenient for the participants. The team<br />
audio taped the interviews and transcribed them for analysis.<br />
sahPe IIITask 3: Revise introductory TeenScreen and consent materials, Due Date<br />
October 31, 2005<br />
Based on information from the first two data collection activities, the research team<br />
worked with Roberts Communications to <strong>de</strong>velop communication materials. A<br />
TeenScreen brochure was <strong>de</strong>signed for parents and another for teens. A multi-set poster<br />
series for disp<strong>la</strong>y in schools was also produced with teens being the target audience. A<br />
stu<strong>de</strong>nt focus group was employed in testing the poster series. Roberts Communications<br />
conducted this activity with a group of ninth gra<strong>de</strong> stu<strong>de</strong>nts from a local school. In this<br />
second phase ofthe project, stu<strong>de</strong>nts were presented with draft communications materials<br />
i.e., two poster series and asked a series of open-en<strong>de</strong>d questions to assess the<br />
effectiveness ofthe material and suggest strategies that may be used to improve it. Based<br />
on the suggestions and concerns raised in the focus group, Roberts Communications ma<strong>de</strong><br />
appropriate modifications to the selected poster series.
FLORIDA SUICIDE PREVENTION<br />
PILOT PROJECT<br />
FINAL REPORT<br />
Task 6<br />
June 22, 2004 through May 31, 2006<br />
Submitted June 16, 2006<br />
by<br />
<strong>David</strong> <strong>Shern</strong>, <strong>Ph</strong>.D, Principal Investigator<br />
Stephen Roggenbaum, MA, Co-Principal Investigator<br />
<strong>Louis</strong> <strong>de</strong> Ia <strong>Parte</strong> <strong>Florida</strong> <strong>Mental</strong> Health Institute<br />
University of South <strong>Florida</strong>
FLORIDA SUICIDE PREVENTION PILOT PROJECT<br />
June 22, 2004 through May 31, 2006<br />
Task 6<br />
Final Project Report<br />
The Substance Abuse and <strong>Mental</strong> Health Services Administration SAMHSA was<br />
created in 1992 to improve prevention, treatment and rehabilitation services for<br />
individuals with health issues and substance disor<strong>de</strong>rs. Within SAMHSA, the Center for<br />
<strong>Mental</strong> Health Services CMHS provi<strong>de</strong>s national lea<strong>de</strong>rship and direction for policies,<br />
programs, and activities <strong>de</strong>signed to improve mental health prevention and treatment<br />
services. One ofthe most important areas for prevention efforts is the prevention of<br />
suici<strong>de</strong> across the life span. SAMHSA has recently recognized the importance of suici<strong>de</strong><br />
prevention by adding it to their Matrix of Priorities. Suici<strong>de</strong> prevention is listed as the<br />
seventh Program/Issue see figure 1. Suici<strong>de</strong> prevention efforts must be constructed<br />
differently for different at-risk popu<strong>la</strong>tions. For youth, school based suici<strong>de</strong> prevention is<br />
ofparticu<strong>la</strong>r importance. School based screening is a promising approach to youth suici<strong>de</strong><br />
prevention that has been i<strong>de</strong>ntified in the Report ofthe Surgeon General, the Institute of<br />
Medicine Report, Reducing Suici<strong>de</strong>: A National Imperative and in the Presi<strong>de</strong>nt’s New<br />
Freedom Commission Report.<br />
There are several reasons that screening to <strong>de</strong>tect <strong>de</strong>pression, the risk of suici<strong>de</strong> and other<br />
mental disor<strong>de</strong>rs in youth is thought to be of importance. Suici<strong>de</strong> is the third leading cause<br />
of <strong>de</strong>ath among youth 10-24 years of age. Almost as many adolescents and young adults<br />
die from suici<strong>de</strong> than from all natural causes combined. Studies ofyouth who have<br />
committed suici<strong>de</strong> called psychological autopsy studies have found that 90% had a<br />
diagnosable mental disor<strong>de</strong>r at the time of their <strong>de</strong>ath Harris & Barraclough, 1997;<br />
Conwell el al., 1996. According to the Youth Risk Behavior Survey 2001 8.8% of high<br />
school stu<strong>de</strong>nts self-report making a suici<strong>de</strong> attempt, and 2.6% make an attempt serious<br />
enough to require medical attention. Yet while physical health screenings in schools are<br />
re<strong>la</strong>tively common, schools do not commonly screen for mental health problems. It is<br />
known that 7 million to 10 million teenagers suffer from a mental health condition.<br />
Additionally, 5-9% of all children suffer from a mental, behavioral, or emotional disor<strong>de</strong>r<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 1
Figure 1: SAMHSA Matrix of Priorities<br />
SAMHSA<br />
of<br />
Priorities<br />
that substantially limits one or more major life activity including aca<strong>de</strong>mic performance or<br />
the ability to maintain interpersonal re<strong>la</strong>tionships. It is estimated that only one-third of<br />
these teenagers are in treatment. Many mental health problems start in youth and worsen<br />
over time if not treated Kessler, Berglund, Demler, Jin, & Walters, 2005. By screening<br />
for these problems, particu<strong>la</strong>rly <strong>de</strong>pression, substance abuse, and suicidal i<strong>de</strong>ation or past<br />
suici<strong>de</strong> attempts, youth can be i<strong>de</strong>ntified early in the course oftheir illness and informed<br />
regarding their treatment alternatives. With successful treatment, <strong>de</strong>aths from suici<strong>de</strong> may<br />
be prevented, along with other re<strong>la</strong>ted problems such as substance abuse, violence, and<br />
school drop out.<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 2
Efforts to increase the <strong>de</strong>tection and treatment of <strong>de</strong>pression and other mental illnesses,<br />
such as structured suici<strong>de</strong> screening and systematic follow-up, are important elements in<br />
any comprehensive suici<strong>de</strong>-prevention program Public Health Services, 2001. In or<strong>de</strong>r<br />
for screening to be effective, however, parents must allow their children to participate in<br />
the screening and follow-up with additional assessment and, if nee<strong>de</strong>d, treatment<br />
recommendations for those teens who require care. Screening efforts are most effective<br />
when they inclu<strong>de</strong> all members of an i<strong>de</strong>ntified popu<strong>la</strong>tion. Parental consent to school<br />
based screenings, however, is often less than 50% thereby <strong>de</strong>creasing the overall impact of<br />
screening programs. Simi<strong>la</strong>rly, parental follow-up after screening is often less than 50%.<br />
To the <strong>de</strong>gree to which these rates can be increased, screenings may become more<br />
effective in i<strong>de</strong>ntifying mental illnesses and preventing suici<strong>de</strong>. In this research project,<br />
our goal was to <strong>de</strong>velop methods that would increase screening consent while providing<br />
parents and teens with the information that they i<strong>de</strong>ntify as important in reaching their<br />
<strong>de</strong>cision about screening participation. Such materials, if shown to be effective, would<br />
optimize the benefits ofscreening.<br />
This study consists of four phases with the first three using qualitative methods and the<br />
fourth a non-equivalent group comparison <strong>de</strong>sign. In the first phase, a meeting of school<br />
based mental health screening program representatives was hosted to i<strong>de</strong>ntify key issues<br />
in screening from multiple perspectives including schools, parents, teens and community<br />
resi<strong>de</strong>nts. The second phase utilized semi-structured interviews with parents and teens to<br />
i<strong>de</strong>ntify their concerns regarding consent and follow-up as well as media that may be -<br />
effective in communicating with them. In the third phase, a focus group was utilized to<br />
evaluate and improve draft communications materials e.g., teens respon<strong>de</strong>d to different<br />
sets of posters. In the fourth phase of the project we tested the materials in several<br />
schools to <strong>de</strong>termine if consent rates were increased with the use ofthe new materials.<br />
I - <strong>Ph</strong>ase<br />
Facilitated Dialogue with Site and RegionalCoordinators<br />
The project research team worked in tan<strong>de</strong>m with Roberts Communications facilitators<br />
and Columbia University participant i<strong>de</strong>ntification to host a TeenScreen Site<br />
Coordinators Meeting. We convened four individuals who have implemented school<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 3
ased mental health screening programs across the United States i.e., three site<br />
coordinators or their representatives and a regional coordinator. Three participants from<br />
the <strong>Louis</strong> <strong>de</strong> <strong>la</strong> <strong>Parte</strong> <strong>Florida</strong> <strong>Mental</strong> Health Institute FMHI participated in the meeting<br />
that was facilitated by two staff from Roberts Communications.<br />
These key informants participated in a full day, structured dialogue to i<strong>de</strong>ntify the key<br />
audiences that must be addressed in successfully implementing a screening and follow-up<br />
program, the concerns in reaching each audience, the issues that each may i<strong>de</strong>ntify in<br />
<strong>de</strong>ciding upon their participation in a screening and follow-up program and<br />
communication strategies to effectively address each audience. The dialogue was<br />
recor<strong>de</strong>d and findings co<strong>de</strong>d to <strong>de</strong>velop an initial framework for the communications<br />
material and for the semi-structured instrument to be used in collecting data from parents<br />
and youth in <strong>Ph</strong>ase II ofthe study. See Appendix A for TeenScreen Regional<br />
Coordinators Meeting report.<br />
H- Semi-Structured Interviews with Parents <strong>Ph</strong>ase andTeens<br />
Based upon the results from the structured dialogue, the research team <strong>de</strong>veloped a series<br />
of seven semi-structured interview protocols phase II materials that were used with<br />
parents and teens from three active screening sites to <strong>de</strong>termine how to most effectively<br />
address their concerns with regard to participation in screening and follow-up. Seven<br />
specific groups were i<strong>de</strong>ntified for inclusion in the data collection.<br />
1. Parents who returned the consent form and <strong>de</strong>clined to allow their teen the<br />
opportunity to participate in screening<br />
2. Parents who returned the consent form allowing their teen the opportunity to<br />
participate in screening<br />
3. Parents who did not return the consent form<br />
4. Parents whose teen screened positive on the screening and subsequent clinical<br />
interview and did not comply with the treatment recommendations<br />
5. Parents whose teen screened positive on the screening and subsequent clinical<br />
interview and did comply with treatment recommendations<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 4
Additionally the research team conducted interviews with teens about the same issues<br />
discussed with parents. See Appendix C for sample Stu<strong>de</strong>nt Interview Protocol. Teens<br />
from two groups were interviewed.<br />
6. Stu<strong>de</strong>nts who screened positive but did not adhere to follow-up assessment or<br />
treatment recommendations<br />
7. Stu<strong>de</strong>nts who screened positive and did adhere to follow-up assessment or<br />
treatment recommendations.<br />
Each category ofparents or stu<strong>de</strong>nts had an individualized interview protocol. Although<br />
many questions were used in all protocols, each contained questions uniquely appropriate<br />
for each group e.g., reasons for <strong>de</strong>clining to participate or agreeing to participate. See<br />
Appendix B for sample Parent Interview Protocol. Parents from five groups were<br />
interviewed. In each group, we inquired about the rationale for their <strong>de</strong>cision, information<br />
that would have been helpful in the <strong>de</strong>cision-making process including evaluation ofthe<br />
communication approaches that were used in each site and how these might be improved.<br />
All forms and interview protocols for parents and stu<strong>de</strong>nts were trans<strong>la</strong>ted into Spanish<br />
and a bilingual interviewer was hired to assist with the interviews. The research team<br />
members administered the interview protocol, conducting the interviews over the phone at<br />
a time that was convenient for the participants. The research team worked with a site<br />
coordinator who preferred to have a local interviewer, whom she had i<strong>de</strong>ntified, conduct<br />
the local interviews in person. The research team audio taped the interviews and<br />
transcribed them for analysis.<br />
Three TeenScreen sites i<strong>de</strong>ntified parents and stu<strong>de</strong>nts to be interviewed Las Vegas,<br />
Nevada; F<strong>la</strong>gler County, <strong>Florida</strong>; and Jackson, Mississippi. The three site’s staff agreed to<br />
participate although each site negotiated their assistance to be through slightly different<br />
means. The Las Vegas site provi<strong>de</strong>d a list ofnames for the FMHI research team. The<br />
FMHI research team contacted potential participants through a mailing, followed by<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 5
phone calls in which the researchers <strong>de</strong>scribed the project, requested participation, and<br />
scheduled and conducted the interview. Each initial mailing to potential interviewees<br />
inclu<strong>de</strong>d an introductory letter, Informed Consents, and a list of the questions. The F<strong>la</strong>gler<br />
site ma<strong>de</strong> initial contacts with potential interviewees to briefly <strong>de</strong>scribe the project and<br />
request participation. The FMHI research team followed up with phone calls and again<br />
<strong>de</strong>scribed the project, requested participation, scheduled, and conducted the interviews.<br />
The Jackson site i<strong>de</strong>ntified a local school social worker that FMHI trained to conduct<br />
interviews in the local community. Interviews were conducted between May and<br />
December 2005.<br />
The research team’s goal was to try to have five interviews from each site in each ofthe<br />
seven interview categories see Table 1. Seven interview categories with five interviews<br />
each would equal 35 interviews for each site for a total of 105 interviews.<br />
Table 1: Interview Categories with Total Goal Number of Interviews by Site<br />
Interview Categories<br />
Las Vegas,<br />
Nevada<br />
F<strong>la</strong>gler County,<br />
<strong>Florida</strong><br />
Jackson,<br />
Mississippi<br />
1. Parents who <strong>de</strong>clined to have their<br />
5 5 5<br />
teens_participate.<br />
2. Parents who consented to have their<br />
5 5 5<br />
teen_participate.<br />
3. Parents who did not return the consent<br />
5 5 5<br />
form.<br />
4. Parents who adhered to follow-up<br />
5 5 5<br />
recommendations.<br />
5. Parents who did not adhere to followup_recommendations.<br />
5 5 5<br />
6. Stu<strong>de</strong>nts who screened positive but did 5 5 5<br />
not adhere to follow-up assessment or<br />
treatment_recommendations.<br />
7. Stu<strong>de</strong>nts who screened positive and<br />
5 5 5<br />
did adhere to follow-up assessment or<br />
treatment recommendations.<br />
Total Goal Number of Interviews 35 35 35<br />
The research team discovered that each site distributed TeenScreen materials differently<br />
e.g., mailed to parents, han<strong>de</strong>d out to stu<strong>de</strong>nts to take home, passed out in school and<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 6
-<br />
mailed home and some ofthe sampling sub-groups could not be i<strong>de</strong>ntified in specific<br />
sites owing to their record keeping conventions. The <strong>la</strong>ck ofpotential interviewees in all<br />
seven categories impacted the total number of potential participants. Two sites with five<br />
interview categories and one site with six interview categories created a revised potential<br />
sampling frame with a potential for 80 interviews see Table 2.<br />
Table 2: Interview Categories with Total Potential Number of Interviews by Site<br />
Interview Categories<br />
Las Vegas,<br />
Nevada<br />
F<strong>la</strong>gler County,<br />
<strong>Florida</strong><br />
Jackson,<br />
Mississippi<br />
1. Parents who <strong>de</strong>clined to have their<br />
5 0 0<br />
teens participate.<br />
2. Parents who consented to have their<br />
5 5 5<br />
teen participate.<br />
3. Parents who did not return the consent 0 0 0<br />
form.<br />
4. Parents who adhered to follow-up<br />
5 5 5<br />
recommendations.<br />
5. Parents who did not adhere to followup<br />
5 5 5<br />
recommendations.<br />
6. Stu<strong>de</strong>nts who screened positive but did<br />
5 5 5<br />
not adhere to follow-up assessment or<br />
treatment recommendations.<br />
7. Stu<strong>de</strong>nts who screened positive and did<br />
adhere to follow-up assessment or<br />
treatment recommendations.<br />
5 5<br />
5<br />
Total Potential Number ofInterviews 30 25 25<br />
Another factor that impacted the number of participants was the method of contacting<br />
participants to be interviewed. When a local TeenScreen site representative ma<strong>de</strong> the<br />
initial contact, as with two ofthe sites, the number of interviewees was higher than when<br />
the research team ma<strong>de</strong> the first contact i.e., 18 and 12 compared to 7. In the third site,<br />
<strong>de</strong>spite repeated and exten<strong>de</strong>d attempts by the research team, the number ofparticipants<br />
recruited was low i.e., seven.<br />
A third potential influence on the number of participants was a hurricane that interrupted<br />
contact with the Mississippi sites’ potential participants. The interviewer, who had been<br />
i<strong>de</strong>ntified by the local TeenScreen site coordinator and was herselfa local resi<strong>de</strong>nt,<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 7
eported having great difficulty in continuing to attempt to reach potential interviewees.<br />
Power was interrupted for several weeks in the area, disp<strong>la</strong>ced people relocated into the<br />
area with family and friends, the influx of additional hurricane victims also increased the<br />
number of stu<strong>de</strong>nts in the local schools, and resi<strong>de</strong>nts seemed to be otherwise engaged.<br />
Clearly, participating in a research project might not have been a priority at that time. The<br />
numbers of completed interviews by site and by category are presented in Table 3.<br />
Table 3: Interview Categories with Actual Number of Interviews by Site<br />
Interview Categories<br />
Las Vegas,<br />
Nevada<br />
F<strong>la</strong>gler County,<br />
<strong>Florida</strong><br />
Jackson,<br />
Mississippi<br />
1. Parents who <strong>de</strong>clined to have their<br />
0 N/A N/A<br />
teens_participate.<br />
2. Parents who consented to have their<br />
2 0 3<br />
teen participate.<br />
3. Parents who did not return the consent N/A N/A N/A<br />
form.<br />
4. Parents who adhered to follow-up<br />
2 2 1<br />
recommendations.<br />
5. Parents who did not adhere to followup<br />
2 6 5<br />
recommendations.<br />
6. Stu<strong>de</strong>nts who screened positive but did<br />
1 4 0<br />
not adhere to follow-up assessment or<br />
treatment_recommendations.<br />
7. Stu<strong>de</strong>nts who screened positive and did 0 6 3<br />
adhere to follow-up assessment or<br />
treatment recommendations.<br />
Total Number of Interviews 7 18 12*<br />
*Three interviews were not used in the analysis for proceaural reasons i.e., missed<br />
<strong>de</strong>adline for analysis, missing research consent forms.<br />
As is clear from Table 3, we failed to inclu<strong>de</strong> parents who either did not respond to the<br />
request to return the consent form or individuals who returned the form but <strong>de</strong>clined to<br />
participate. Missing these two perspectives substantially limits the range of response -<br />
particu<strong>la</strong>rly for individuals who are a prime interest of the research.<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 8
<strong>Ph</strong>ase<br />
III - Develop Introductory TeenScreen and ConsentMaterials<br />
Data from the interviews were analyzed and general themes were i<strong>de</strong>ntified. Interview<br />
responses were grouped into the following categories:<br />
o<br />
o<br />
o<br />
Problems with current communications materials parental report<br />
Suggestions to increase consent parental report<br />
Suggestions to increase consent teen report regardless of whether or not they<br />
participated in the screening<br />
o<br />
Factors that encouraged follow-up compliance teen report from those who<br />
complied<br />
o<br />
o<br />
o<br />
Reasons for failure to follow-up parental report of noncompliant teens<br />
Key supporting points teen report from those who participated in the screening<br />
Key supporting points parental report of teens who participated in the<br />
screening<br />
Survey respon<strong>de</strong>nts often provi<strong>de</strong>d information in response to a specific question that<br />
informed more than one content category. In these cases, the responses were tabu<strong>la</strong>ted in<br />
each corresponding category e.g., If the question was "what did you like least about the<br />
follow-up interview" and the respon<strong>de</strong>nt answered "time out of the school day but I really<br />
liked the fact it was confi<strong>de</strong>ntial," both answers were recor<strong>de</strong>d in the appropriate<br />
categories.<br />
Individual responses were grouped by themes and tabu<strong>la</strong>ted. Each survey respon<strong>de</strong>nt was<br />
counted only once per theme-response category e.g., if confi<strong>de</strong>ntiality‘was cited as a key<br />
supporting point in more than one answer by the same respon<strong>de</strong>nt, it was only counted<br />
once. If a respon<strong>de</strong>nt cited more than one item, however, each response was counted once<br />
in the appropriate category e.g., if a respon<strong>de</strong>nt cited confi<strong>de</strong>ntiality and parental pressure<br />
as factors encouraging follow-up, both responses were tabu<strong>la</strong>ted. See Appendix D for<br />
tabu<strong>la</strong>ted results.<br />
Several key concepts emerged from the completed interviews with parents and stu<strong>de</strong>nts<br />
that gui<strong>de</strong>d the <strong>de</strong>velopment of the communications material. Confi<strong>de</strong>ntiality was<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 9
mentioned repeatedly by both parents and stu<strong>de</strong>nts. Procedural information e.g..,<br />
screening steps, what screening <strong>de</strong>tects was also cited by respon<strong>de</strong>nts and addressed in<br />
the material <strong>de</strong>velopment. The material also un<strong>de</strong>rscored the frequency of mental health<br />
problems among adolescents and the fact that they are common among youth from wi<strong>de</strong>ly<br />
varying backgrounds.<br />
Based on information from the first two data collection activities i.e., <strong>Ph</strong>ase I and II, the<br />
research team worked with Roberts Communications’ staff to <strong>de</strong>velop communication<br />
materials. A TeenScreen brochure was <strong>de</strong>signed for parents and another for teens. A<br />
multi-set poster series for disp<strong>la</strong>y in schools was also produced with teens being the target<br />
audience. A stu<strong>de</strong>nt focus group was employed in testing the poster series. Roberts<br />
Communications conducted this activity with a group ofninth gra<strong>de</strong> stu<strong>de</strong>nts from a local<br />
school. In this phase of the project, stu<strong>de</strong>nts were presented with draft communications<br />
materials i.e., two poster series and asked a series of open-en<strong>de</strong>d questions to assess the<br />
effectiveness ofthe material and suggest strategies that may be used to improve it. Based<br />
on the suggestions and concerns raised in the focus group, Roberts Communications ma<strong>de</strong><br />
appropriate modifications to the selected poster series. The final media materials i.e.,<br />
youth brochure, parent brochure, and poster set are submitted concurrently with this<br />
report but un<strong>de</strong>r separate cover.<br />
IV - Pilot revised TeenScreen and Consent <strong>Ph</strong>ase Materials in Active ScreeningSites<br />
In this final phase of the project, the impact of the materials on consent rates was assessed<br />
in three TeenScreen sites. The sites inclu<strong>de</strong>: one school in F<strong>la</strong>gler, <strong>Florida</strong>; three schools<br />
in Tulsa, Ok<strong>la</strong>homa; and three schools in Greene County, New York.<br />
Two ofthe sites had conducted screenings prior to the screening in which the new<br />
materials were tested. In one ofthese sites we were able to compare the screening results<br />
using the new materials with the results obtained when their conventional materials were<br />
used in an earlier screening. In the second site, we compared consent rates from three<br />
health c<strong>la</strong>sses using new materials with the results obtained from the use of conventional<br />
materials in three health c<strong>la</strong>sses that used the conventional materials. In the third site, the<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 10
new materials were used in conjunction with their inaugural screening efforts. Here, we<br />
used the materials in three schools implementing screening and compared the consent<br />
rates for these ‘experimental’ schools with those for the two schools using conventional<br />
materials. We therefore have comparisons using the results of earlier screenings and of<br />
screenings using the conventional material in different c<strong>la</strong>ssrooms or schools.<br />
In all sites the newly <strong>de</strong>veloped materials were distributed simultaneously to parents and<br />
teens in addition to the materials that each site normally distributed. As is <strong>de</strong>tailed below,<br />
the posters generally were disp<strong>la</strong>yed in the schools to coinci<strong>de</strong> with the distribution ofthe<br />
other mental health screening materials.<br />
The results ofthese field trials are disp<strong>la</strong>yed in Table 4. As can be seen from the table, the<br />
schools in which we tested the communication materials substantially varied in their rates<br />
ofparticipation in the screening. Response rates from stu<strong>de</strong>nts varied from 2.2% in<br />
school A to 100% in school F. As might be expected, the procedures used in these wi<strong>de</strong>ly<br />
varying schools varied wi<strong>de</strong>ly. In school A, for example, the requests were sent <strong>la</strong>te in the<br />
year and they competed with many other year end activities. In school F, guidance staff<br />
called all of the parents who didn’t respond to the initial request to return the consent form<br />
resulting in full parental participation.<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report<br />
Page Ii
.<br />
Table 4: Results from Testing ofNewly Developed Communications Materials Compared<br />
Conventional<br />
Screeningand Consent Materials in Seven Schools.<br />
to<br />
Screening with New School School School School School School School<br />
Communications Material A B C D E F G<br />
Target gra<strong>de</strong> level Spring 11 & 11 9 9 9 9 9<br />
06<br />
Consents and Brochures<br />
distributed<br />
Posters disp<strong>la</strong>yed<br />
‘<br />
12<br />
Total<br />
220 235 350 65 24 24 14 932<br />
No<br />
8 in<br />
halls<br />
10 in<br />
halls<br />
No<br />
5 in<br />
C<strong>la</strong>ss<br />
Total Parents Responding 5 29 65 39 7 24 12 181<br />
Percent Responding 2.2% 12.3% 18.6% 60.0% 29.2% 100% 85.7% 19. 4%<br />
Parents giving consent 3 28 49 31 4 18 4 137<br />
Parents <strong>de</strong>nying consent 2 1 16 8 3 6 8 44<br />
Percent Giving Consent 60.0% 96.6% 75.4% 79.5% 57.1% 75.0% 33.3% 75.7%<br />
Comparison Data<br />
Screening with<br />
Conventional Material<br />
comparison group<br />
Target gra<strong>de</strong> level<br />
Comparison *Winter 05,<br />
#Spring 06 or ASpring 06<br />
Winter<br />
same<br />
school<br />
9 &<br />
10*<br />
Winter<br />
same<br />
school<br />
N/A D 3<br />
health<br />
c<strong>la</strong>sses<br />
Local<br />
school<br />
H<br />
5 in<br />
C<strong>la</strong>ss<br />
Local<br />
school<br />
I<br />
5 in<br />
C<strong>la</strong>ss<br />
N/A<br />
10* N/A 9# 9 9 N/A<br />
Consents distributed 207 383 N/A 46 22 20 N/A 678<br />
Parents Responding 47 82 37 8 7 181<br />
Percent Responding 22.8% 21.4% 80.4% 36.4% 35% 26.7%<br />
Parents giving consent 17 66 N/A 24 5 4 N/A 116<br />
Parents <strong>de</strong>nying consent 30 16 N/A 13 - 3 3 N/A 65<br />
Percent Giving Consent 36.2% 80.5% 64.9% 62.5% 7.1% 64.1%<br />
*Wjnter 05: Same school during previous quarter implementing screening.<br />
#Spring 06: Remaining 3 health c<strong>la</strong>sses at School D.<br />
Aspring 06: Two local schoOls also implementing TeenScreen for first time<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 12
Rates at which parents agreed to have their teens participate in screening also varied<br />
consi<strong>de</strong>rably from a high 97% to a low of 33%. The pooled results across all schools are<br />
disp<strong>la</strong>yed in the final column ofthe table. In total nearly 932 parents were approached<br />
with the new communications material. Ofthe 932, 181 19.4% respon<strong>de</strong>d to the<br />
request. Of the 181 respon<strong>de</strong>rs, 137 75.7% agreed to have their teen participate in<br />
screening. In the comparison conditions, 678 parents were approached with 181<br />
providing some response 26.7%. Ofthe respon<strong>de</strong>rs, 64.1% gave permission for their<br />
teens to participate.<br />
In terms ofthe overall response rates, parents who received the material respon<strong>de</strong>d to the<br />
request for a consent <strong>de</strong>cision at a significantly lower rate than individuals in the<br />
comparison condition X2 = 11.9, p =.0005. Of the respon<strong>de</strong>rs, however, parents were<br />
significantly more likely to give consent for their teen to participate in the screening if<br />
they received the new communications material X2 = 5.79, p .0 16. From these data,<br />
therefore, we have an indication that the new communications material was significant in<br />
improving consent of respon<strong>de</strong>rs but, ironically, lowered the overall level of response.<br />
Clearly, the results for School A are the most aberrant between trials with nearly no<br />
parents responding to the consent request in the experimental trial as opposed to almost a<br />
quarter in the comparison trial. If we eliminate School A’s data from the analyses, the<br />
significance of the difference in response rate is eliminated X2 2.04, p = .15.<br />
However, the significant difference between the experimental and comparison trials in<br />
consent to participate also is eliminated X2 = 0.207, p .65.<br />
The statistical analyses ofresponse and consent rates therefore are equivocal. Data from<br />
an unusual school accounts both for the significant increase in consents and the significant<br />
<strong>de</strong>crease in the response rate. Further testing in other sites will be required to <strong>de</strong>termine if<br />
the materials are effective in increasing consent rates.<br />
In addition to the quantitative results, however, we had some anecdotal responses from the<br />
schools regarding the impact and effectiveness of the materials.<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 13
Anecdotal reaction about the new materials was mixed. At one site, the posters reportedly<br />
prompted several c<strong>la</strong>ss discussions. Additionally, a school representative reported "there<br />
is quite a bit of talk among the kids about the posters. They seem to be getting attention<br />
and causing kids to think about these issues, if nothing else. One kid actually stole 2 of the<br />
posters and took them home." However, several stu<strong>de</strong>nts at least in this school requested<br />
that the posters be taken down because the stu<strong>de</strong>nts felt the posters were <strong>de</strong>pressing or not<br />
true. One principal refused to hang one of the posters due to the caption [i.e., Voted most<br />
likely to succeed He killed himself instead]. At another site, some of the teachers from<br />
one school thought the posters were "too much in your face" about the issue ofsuici<strong>de</strong>.<br />
No reactions to the posters from the remaining three schools at these two sites were<br />
shared.<br />
Suici<strong>de</strong> often referred to as the silent epi<strong>de</strong>mic, is a sensitive topic and not often<br />
discussed. The posters are a remin<strong>de</strong>r that a variety of individuals might be at risk for<br />
mental illness and suici<strong>de</strong>, even successful stu<strong>de</strong>nts. Anecdotal reactions may reflect the<br />
false belief that discussing suici<strong>de</strong> increases the risk ofsuicidal behavior. Leenaars &<br />
Wenckstern, 1999. Perhaps providing additional information on suici<strong>de</strong> and prevention to<br />
school staff would be a helpful supplement to these materials.<br />
Teachers and site representatives, however, reported a favorable reaction to the teen and<br />
parent brochures. Individuals ma<strong>de</strong> positive comments ‘about the brochure’s appearance<br />
e.g., nice, colorful and <strong>la</strong>nguage e.g., easy to read, informative. No site liaisons<br />
reported negative reactions to the brochures other than the challenge of ensuring stu<strong>de</strong>nts<br />
take materials home and give them to parents.<br />
Finally, one site’s liaison offered a comment about the impact and effectiveness of the<br />
materials. "The return rates are low even where they are usually highest, so I don’t think it<br />
has to do with the brochures or posters."<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report . Page 14
Conclusions<br />
Adolescent suici<strong>de</strong> is a major public health problem in the United States. School based<br />
suici<strong>de</strong> prevention programs hold promise for reducing the rate of suici<strong>de</strong> in adolescents.<br />
Screening with validated instruments and follow-up of teens that screen positive could<br />
enhance school based suici<strong>de</strong> prevention programs. Simi<strong>la</strong>rly, effective treatment of<br />
mental illnesses in teens would have wi<strong>de</strong> ranging effects in improving school<br />
performance and other functional outcomes in teens.<br />
Parental participation is a critical element in successful suici<strong>de</strong> prevention and screening<br />
programs. Increasing participation rates is therefore a <strong>de</strong>sirable outcome. In this study,<br />
we used a systematic series of techniques to <strong>de</strong>velop educational materials that we hoped<br />
would both better inform parents regarding the screening <strong>de</strong>cision and increase rates of<br />
participation and follow-up. The results of our initial evaluation are equivocal since<br />
analyses of the full data set indicated that parental consent significantly increased after<br />
exposure to the materials while the overall participation rate <strong>de</strong>creased significantly.<br />
Eliminating one school, whose data seemed particu<strong>la</strong>rly aberrant, resulted in eliminating<br />
all significant effects. Anecdotal reaction to the posters have been mixed and suggest that<br />
other educational materials should be distributed with the .posters.<br />
Reactions to the<br />
brochures were universally positive. We therefore recommend that the materials be<br />
further tested in settings where multiple schools will implement screening simultaneously<br />
or in which prior screening consent rates may be used for comparison.<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 15
References<br />
Conwell Y, Duberstein, P.R., Cox, C., Herrmann, J.H., Forbes, N.T., & Caine, E.D,<br />
1996. Re<strong>la</strong>tionships of age and axis I diagnoses in victims of completed suici<strong>de</strong>:<br />
A psychological autopsy study. American Journal ofPsychiatry, 1538, 1001-<br />
1008.<br />
Harris, E.C., & Barraclough, B. 1997. Suici<strong>de</strong> as an outcome for mental disor<strong>de</strong>rs: A<br />
meta-analysis. British Journal ofPsychiatry, 170, 205-228.<br />
Kessler, R.C., Berglund, P., Demler, 0., Jin, R., & Walters, E.E. 2005. Lifetime<br />
Prevalence and Age-of-Onset Distributions ofDSM-IV Disor<strong>de</strong>rs in the National<br />
Comorbidity Survey Replication. Archives of General Psychiatry, 626, 593-602.<br />
Leenaars, A., & Wenckstern, S. 1999. Suici<strong>de</strong> prevention in schools: The art, the issues,<br />
and the pitfalls. Crisis, 203, 132-142.<br />
PHS Public Health Services 2001. National Strategyfor suici<strong>de</strong> prevention: Goals and<br />
objectivesfor action. U.S. Department of Health and Human Services, Rockville,<br />
MD.<br />
U.S. Department of Health and Human Services. <strong>Mental</strong> Health: A Report ofthe<br />
Surgeon General. Rockville, MD: U.S. Department of Health and Human<br />
Services, Substance Abuse and <strong>Mental</strong> Health Services Administration, Center for<br />
<strong>Mental</strong> Health Services, National Institutes ofHealth, National Institute of<strong>Mental</strong><br />
Health, 1999.<br />
New Freedom Commission on <strong>Mental</strong> health, Achieving the Promise: Transforming<br />
<strong>Mental</strong> health Care in America. Final Report. DHHS Pub. No. SMA-03-3832.<br />
Rockville, MD: 2003.<br />
Grunbaum, J. A., Kann, L., Kinchen, S. A., Williams, B., Ross, J. G., Lowry, R., & Kolbe,<br />
L. 2002. Youth risk behavior surveil<strong>la</strong>nce: United States, 2001. At<strong>la</strong>nta, GA:<br />
U.S. Dept. of Health and Human Services, Centers for Disease Control and<br />
Prevention CDC, Epi<strong>de</strong>miology Program Office<br />
Goldsmith, S. K., Pelimar, T. C., Kleinman, A. M., & Bunney, W. E. eds. Reducing<br />
suici<strong>de</strong>: A national imperative. Washington, DC: Institute of Medicine of the<br />
National Aca<strong>de</strong>mies, the National Aca<strong>de</strong>mies Press<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 16
APPENDIX A<br />
TeenScreen Regional Coordinators Meeting<br />
Report<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 17
University of South <strong>Florida</strong><br />
<strong>Louis</strong> <strong>de</strong> <strong>la</strong> <strong>Parte</strong> <strong>Florida</strong> <strong>Mental</strong> Health Institute<br />
TeenScreen Regional Coordinators Meeting<br />
January 20, 2005<br />
ROBERTS<br />
COMMUNICATIONS<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 18
TeenScreen Regional Coordinator Meeting<br />
Best Practices Research and Communications Tool Kit Development<br />
Goal<br />
The goal ofthis regional coordinator meeting is to <strong>de</strong>sign a communications tool kit that<br />
effectively presents information on teen mental health screening in or<strong>de</strong>r to increase<br />
accessible, informed consent procedures.<br />
Objective<br />
To obtain valuable input from TeenScreen coordinators who are on the "front line" of<br />
program implementation through the sharing of best practices.<br />
Overview<br />
Roberts Communications and Marketing, Inc. facilitated this meeting. The meeting inclu<strong>de</strong>d a<br />
brief overview of the project and work completed to date. Roberts Communications led<br />
TeenScreen coordinator participants through a discussion to i<strong>de</strong>ntify target audiences and the<br />
most effective communications tools. The meeting conclu<strong>de</strong>d with a brainstorming session<br />
on messages and methods to increase informed consent and maximize participation rates.<br />
Agenda<br />
I. Welcome/background<br />
II. Introductions<br />
III. Review of project and work completed to date<br />
IV. Gui<strong>de</strong>d discussion<br />
* audience i<strong>de</strong>ntification and characterization<br />
* message and methods i<strong>de</strong>ntification<br />
* most effective communications tools<br />
V. Wrap up<br />
VI. Conclusion/overview next steps<br />
Format<br />
The format of the meeting was gui<strong>de</strong>d discussion. Roberts Communications used a<br />
PowerPoint presentation to move through the agenda and action items.<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report . Page 19
Content<br />
The content of the meeting inclu<strong>de</strong>d:<br />
Audience i<strong>de</strong>ntification and characterization<br />
* The audiences important to the organization must be i<strong>de</strong>ntified. More importantly,<br />
the characteristics must be carefully <strong>de</strong>fined for each group. It may be <strong>de</strong>termined<br />
that while the community is an important public, there are significant subsets of<br />
interests that should be addressed.<br />
Messages and Methods I<strong>de</strong>ntification<br />
* Gui<strong>de</strong>d discussion on what are the key messages that need to be communicated to<br />
increase informed consent and participation rates. I<strong>de</strong>ntify methods of<br />
communication that work most effectively to reach the target audiences.<br />
Effective Communications Tools<br />
* Gui<strong>de</strong>d discussion to i<strong>de</strong>ntify the most effective implementation strategies, effective<br />
communications tools and additional tools nee<strong>de</strong>d to enhance implementation at<br />
sites.<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 20
Summary<br />
Executive<br />
This focus group inclu<strong>de</strong>d seven participants representing TeenScreen site coordinators,<br />
Columbia TeenScreen regional coordinator and FMHI staff. These are the major findings:<br />
The participants were very involved in the discussion and provi<strong>de</strong>d very <strong>de</strong>tailed insight to<br />
the program and successful implementation. The participants provi<strong>de</strong>d an excellent road<br />
map for the <strong>de</strong>velopment of an effective communications tool kit.<br />
* Several key audiences were i<strong>de</strong>ntified. This represents the variability across sites on<br />
what audiences are important for successful implementation. It also represents the<br />
complexity and levels of authorization in p<strong>la</strong>ce at most sites to implement the<br />
program. The most critical audiences discussed and outlined during the meeting were<br />
stu<strong>de</strong>nts, parents, health care community, school boards, school administration and<br />
staff.<br />
* All other audiences i<strong>de</strong>ntified are still important in the implementation of the<br />
program. We recommend that a communications checklist be created that i<strong>de</strong>ntifies<br />
these audiences and recommends which communications tools would be most<br />
beneficial to use to reach them.<br />
* Detailed information was outlined that characterized each of the key audiences.<br />
There were a few umbrel<strong>la</strong> messages that were important to each of these audiences:<br />
o Free, voluntary and confi<strong>de</strong>ntial<br />
o Extensive research behind program, science-based<br />
o No association with pharmaceutical companies<br />
o <strong>Mental</strong> health check-up just as important as regu<strong>la</strong>r health check-up<br />
o Committed to providing resources and follow through<br />
* Participants discussed many effective ways to <strong>de</strong>liver the important messages about<br />
the TeenScreen Program. They expressed the importance of partnerships that<br />
increase credibility in the community. The participants also i<strong>de</strong>ntified that small<br />
group presentations were much more effective than <strong>la</strong>rge group presentations.<br />
Personal communication is paramount when <strong>de</strong>livering the TeenScreen message.<br />
* Branding the program with consistent images to show that TeenScreen is for all<br />
gen<strong>de</strong>rs and ethnicities. The participants felt that it was important to show visually<br />
that feelings matter and the confi<strong>de</strong>ntiality ofthe process.<br />
* Many communications tools were recommen<strong>de</strong>d as important in the successful<br />
implementation of the program. The participants voiced that technology is key here.<br />
They recommen<strong>de</strong>d several communications tools that were Web-based, including<br />
CDs, DVDs, enhanced Web sites, <strong>de</strong>livering messages and resources through Web<br />
sites.<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 21
* The participants also expressed the need for resources for parents.<br />
Recommendations to reach this critical audience inclu<strong>de</strong>d an information package<br />
that inclu<strong>de</strong>s a brochure, fact sheet, frequently asked questions and resource cards.<br />
* Our next step is to conduct interviews of parents and stu<strong>de</strong>nts at local TeenScreen<br />
sites. This will be critical to ensure that the most effective comrtiunications tools are<br />
<strong>de</strong>veloped.<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 22
Target Audience I<strong>de</strong>ntification and Characterization<br />
Participants were asked to i<strong>de</strong>ntify all target audiences for TeenScreen. The participants<br />
brainstormed the target audiences which are categorized below.<br />
Target AudiencesI<strong>de</strong>ntified<br />
School<br />
* School boards<br />
* Stu<strong>de</strong>nts<br />
* School health programs<br />
* School administration<br />
* Superinten<strong>de</strong>nt<br />
* Discipline chiefs<br />
* School district <strong>la</strong>wyer<br />
* Existing school-based programs<br />
* After-school programs<br />
* School faculty and support staff<br />
* Non-teaching professionals<br />
* Resource officers<br />
* Existing suici<strong>de</strong> prevention programs<br />
Government<br />
* State agencies<br />
* State government officials<br />
* Local universities<br />
* Local government officials<br />
Business<br />
* Businesses<br />
* Chambers of commerce<br />
Community<br />
* Local funding agencies<br />
* Local non-profits<br />
* Faith-based organizations<br />
* Suici<strong>de</strong> survivor groups/affinity groups<br />
* Parents<br />
Health<br />
* Community mental health institutions<br />
* Public health community<br />
* Clinicians<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 23
* Clinics<br />
* Hospitals<br />
Target AudiencesCharacterized<br />
The participants were then asked to i<strong>de</strong>ntify the characteristics of each audience. Including<br />
<strong>de</strong>scriptions of: age, background experiences, <strong>de</strong>sired <strong>de</strong>pth of the topic, education,<br />
ethnicity, familiarity with topic, gen<strong>de</strong>r, profession, religious affiliation and any other<br />
significant <strong>de</strong>scription they found important. The participants also <strong>de</strong>scribed the most<br />
effective communications tactics for these audiences.<br />
School Administration! Faculty/Staff<br />
* Educated group<br />
* Need education on teen suici<strong>de</strong> and prevention programs<br />
* Need to clearly exp<strong>la</strong>in process<br />
* Complement existing programs<br />
* One-on-one communication<br />
o Principal<br />
o Info on program and time frame<br />
* Buy-in at all levels teachers, counselors, aids, etc.<br />
* Focus on stu<strong>de</strong>nt achievement personal and aca<strong>de</strong>mic<br />
* Staff orientation vi<strong>de</strong>o<br />
* Notification to staff from principal communication is more effective from this source<br />
* Newsletter communication<br />
* Focus on confi<strong>de</strong>ntiality<br />
o Cite the <strong>la</strong>w<br />
o Limits of the <strong>la</strong>w<br />
* Report successes<br />
* Risk averse<br />
* Resources critical<br />
* Health information<br />
* Not gateway to special education<br />
Stu<strong>de</strong>nts<br />
* Engage stu<strong>de</strong>nt lea<strong>de</strong>rs<br />
* Emotional and behavioral health screen check-up<br />
* Present TeenScreen in "non-scary" terms<br />
* Presentation prior to screening<br />
* Links to curriculum<br />
* Age: 6th -<br />
12th 9th gra<strong>de</strong> is i<strong>de</strong>al<br />
* Exp<strong>la</strong>nation ofprocess<br />
o Vi<strong>de</strong>o<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 24
* Branding program<br />
o Signage/posters<br />
o Shirts<br />
* Keep casual, fun<br />
* Information for stu<strong>de</strong>nts that don’t participate<br />
o Provi<strong>de</strong> them with community resources<br />
* Leave-behind with resources<br />
* Assets to succeed<br />
* Let them know they are not being singled out<br />
* Confi<strong>de</strong>ntial<br />
* Web communication important<br />
Parents<br />
* Birth, foster, and legal guardians legal authorization<br />
* Greater good<br />
* Opportunity for feedback<br />
* Free<br />
* Voluntary<br />
* Variety of <strong>de</strong>mographics<br />
* Multi-lingual<br />
*<br />
6th gra<strong>de</strong> reading level<br />
* Information on confi<strong>de</strong>ntiality<br />
* Interest varies by parent<br />
* Culturally influenced<br />
* There is a stigma to overcome<br />
* Affordability<br />
* In<strong>de</strong>pen<strong>de</strong>nt from pharmaceutical companies<br />
* Not research project<br />
* School support<br />
* PTA buy-in<br />
* Provi<strong>de</strong> Who/what/how - next steps<br />
* Research-based<br />
* Provi<strong>de</strong> <strong>de</strong>tailed health information - how they can get resources<br />
* Multiple communications options mail and sent home with stu<strong>de</strong>nts<br />
* Partnership - nothing is done without their input and consent<br />
* Stu<strong>de</strong>nts not penalized for non-participation<br />
* Level and extent of follow up to parent<br />
School Boards Trustees<br />
* Generally elected officials sometimes appointed<br />
* State school boards and local school boards<br />
* Elected have greater prestige<br />
* Lea<strong>de</strong>rs in community<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 25
* Some have education background - educated group of people<br />
* Familiarity with topic varies<br />
* Control and access to schools<br />
* Big <strong>de</strong>cision makers, they set policy<br />
* Everything goes some votes through school board<br />
* Press packet - high level info nee<strong>de</strong>d<br />
* Information needs to provi<strong>de</strong> them with education on the issue<br />
* Confi<strong>de</strong>ntiality and implementation <strong>de</strong>tails JeenScreen is not used for research<br />
* Simple, straightforward verbal presentation<br />
* Liability<br />
* Cost<br />
* Research behind program evi<strong>de</strong>nce-based, confi<strong>de</strong>ntial, volunteer<br />
* Time from staff<br />
Clinicians / Existing programs I Clinics / Hospitals<br />
* Clinicians<br />
o Volunteers must have Bachelors <strong>de</strong>gree<br />
* College stu<strong>de</strong>nts<br />
* Screeners<br />
* Clinical interviews<br />
o Need overview of program<br />
o Stu<strong>de</strong>nts often receive services at school<br />
* Opportunities for involvement<br />
o Different from site to site<br />
* Clear <strong>de</strong>finition of protocol and procedures<br />
* Not gateway to special education services<br />
* High level of mental health knowledge<br />
* Qualification standards<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 26
Messages and Methods<br />
Participants were asked to i<strong>de</strong>ntify key messages that need to be communicated to increase<br />
informed consent and participation rates. Participants also i<strong>de</strong>ntified methods of<br />
communication that work most effectively to reach each target audience.<br />
Messages<br />
* Science-based<br />
* Improve aca<strong>de</strong>mic achievement<br />
* Importance of healthy workforce<br />
* Improve family life and re<strong>la</strong>tionships<br />
* Not pharmaceutical company re<strong>la</strong>ted<br />
* Screening process<br />
* <strong>Mental</strong> health and health check-up<br />
* Not used for research<br />
* Community-based, highlight partnerships<br />
* Informing parents<br />
* Providing parents information, resources, and support<br />
* Tools and support for parents<br />
* Positive testimonials<br />
* Success stories<br />
* Positive introduction to mental health<br />
* "Your feelings matter"<br />
* Saving lives<br />
* Cost-effective<br />
* Screening, not treatment<br />
* Easy to get, easy to use<br />
* Free, voluntary and confi<strong>de</strong>ntial<br />
* Parent resource<br />
* Provi<strong>de</strong>s innovative resources to parents and stu<strong>de</strong>nts<br />
* Committed to provi<strong>de</strong> resources and follow through<br />
* Message about statistics to illustrate that it is a public health issue only for some<br />
audiences<br />
* Message on confi<strong>de</strong>ntiality and how information is handled<br />
* If you aren’t going to do it yourself do it for someone else<br />
* "Our vision is clear" visual - a fuzzy background picture<br />
* Teen Screen - "because your feelings matter"<br />
Methods to Deliver Messages<br />
* Outline and adhere to strict set of protocols<br />
* Credibility through support partnerships<br />
* Deliver messages through school communications<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 27
* Public re<strong>la</strong>tions campaign<br />
* Paid media to general public<br />
* Multicultural team and approach<br />
* Multigenerational<br />
* Incentives<br />
* Small groups of stu<strong>de</strong>nts<br />
* Close proximity to stu<strong>de</strong>nts, provi<strong>de</strong> personal communication<br />
* Single point of contact<br />
o Point of entry or exit<br />
* Confi<strong>de</strong>ntiality is paramount<br />
* Two distribution points of information:<br />
o Education about program and issue<br />
o Consent<br />
* Community meeting<br />
* Stu<strong>de</strong>nt lea<strong>de</strong>rship involvement<br />
* Presentations in c<strong>la</strong>sses, no <strong>la</strong>rger<br />
o Small groups much more successful<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 28
Communications Tools & Strategies<br />
Participants i<strong>de</strong>ntified the most effective implementation strategies and the most effective<br />
communications tools for each target audience. Participants also i<strong>de</strong>ntified what tools they<br />
thought would work most effectively at their site. One of the biggest messages about<br />
communication: Access is key.<br />
Web<br />
* Web site<br />
o Informational purposes<br />
* Web-based suici<strong>de</strong> hotline<br />
* Use technology to <strong>de</strong>liver the message vi<strong>de</strong>o on Web<br />
Print<br />
* Information package<br />
o Background<br />
o Process<br />
* Parent brochure with letter and consent form<br />
* Posters<br />
o TeenScreen brand<br />
* Resource card<br />
o Resources<br />
o Development assets<br />
* Fact sheet<br />
* Press kit and ethics of reporting on this issue<br />
* Frequently asked questions<br />
* Brochures that inclu<strong>de</strong> testimonials over 90% of parents say they would know<br />
o Kids and parents<br />
* Information packet - specific to audience<br />
* Information packet speaking to fundraising indirectly, but powerful<br />
* Information brochures on different issues -<br />
o To help with follow up<br />
o Follow up with brochure<br />
o <strong>Mental</strong> Health Association gives free brochure<br />
Vi<strong>de</strong>o<br />
* CD of information<br />
* DVD/VHS vi<strong>de</strong>o on TeenScreen for community and stu<strong>de</strong>nts for <strong>de</strong>velopment purpose<br />
as well<br />
* 3-tiered CD - Different levels of info that builds upon the other<br />
o Make sure audience specific<br />
o Show kids on computer, show questions asked, program history<br />
Advertisement<br />
* Movie theater advertisements<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 29
Other<br />
* Establish a TeenScreen office<br />
o Have stu<strong>de</strong>nts be able to contact staff through Web<br />
* Media training<br />
* Be sure that images capture TeenScreen participants of all gen<strong>de</strong>rs, race, ethnicity, etc.<br />
* Images need to show feelings<br />
* Teacher incentives<br />
o vi<strong>de</strong>o, announce name, CEU<br />
* Build TeenScreen into curriculum<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 30
APPENDIX B<br />
Interview Protocol for<br />
Parents who consented<br />
to allow their teen to participate<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 31
________________________________________<br />
Questionnaire For <strong>Mental</strong> HealthScreening<br />
1. Which of the following age groups are you in?<br />
o 18-29<br />
U 30-49<br />
o 50-65<br />
o 66 & ol<strong>de</strong>r<br />
2. What is the highest level of education you have reached so far?<br />
o<br />
o<br />
o<br />
o<br />
Less than high school<br />
High school graduate<br />
Some college<br />
College graduate<br />
3. What is your present employment status?<br />
o<br />
o<br />
o<br />
o<br />
o<br />
Employed full-time<br />
Employed part-time<br />
Voluntarily not in the work force in school; raising family, etc.<br />
Unemployed but not retired<br />
Retired<br />
4. What type of media sources do you feel is the most trustworthy select one?<br />
o<br />
o<br />
o<br />
o<br />
o<br />
o<br />
TV<br />
Newspaper<br />
Internet<br />
Magazine<br />
Radio<br />
Other:<br />
5. Please i<strong>de</strong>ntify the annual income category your household falls into?<br />
o Less than $20,000<br />
o $20,000-$29,999<br />
U $30,000-$49,999<br />
o $50,000-$74,999<br />
U $75,000+<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 32
.<br />
I would now like to ask you a few questions about mental health in teens. For each of the<br />
questions I would like you to tell me if you strongly agree with the statement, agree,<br />
agree slightly, are un<strong>de</strong>ci<strong>de</strong>d about it, slightly disagree, disagree or strongly disagree.<br />
Question<br />
6. <strong>Mental</strong> illness is a<br />
serious problem in<br />
teens?<br />
7. Treatments for mental<br />
illness_are_effective?<br />
8. Treatments for mental<br />
illnesses are<br />
dangerous?<br />
9. I would trust a<br />
psychologist?<br />
10. I am confi<strong>de</strong>nt that I<br />
could recognize a<br />
mental health problem<br />
with my child?<br />
11. Ifeel pretty<br />
knowledgeable about<br />
mental illness<br />
12. I think mental illness<br />
affects_a_lot_of teens?<br />
Strongly<br />
Agree<br />
Agree<br />
Slightly<br />
Agree<br />
Un<strong>de</strong>ci<strong>de</strong>d<br />
Slightly<br />
Disagree<br />
Disagree<br />
Strongly<br />
Disagree<br />
The next few questions re<strong>la</strong>te to the most effectiveways to communicate with you.<br />
13. What would be the best way to inform you about a school-based health screening?<br />
What would be the second best way?<br />
ci By phone<br />
ci Through the mail<br />
ci School meeting<br />
ci Materials sent home from school with your child<br />
ci Via email<br />
o Personal visit to the home -<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 33
I’m now going to list several ways in which you could be remin<strong>de</strong>d about the program and<br />
the need to return your child’s consent form. Consi<strong>de</strong>ring all of the information that you<br />
receive each day, how helpful would each of the following contact methods be in<br />
informing you about the program or reminding you to return the consent form for your<br />
child?<br />
Question<br />
How helpful would it be:<br />
14. To send you a follow-up<br />
card in the mail<br />
reminding you about the<br />
screening and the need<br />
to return the consent<br />
form?<br />
15. To send home a<br />
remin<strong>de</strong>r with your child<br />
about the screening and<br />
the_consent_form?<br />
16. To send you an email<br />
reminding you about the<br />
screening_and_consent?<br />
17. To call you over the<br />
phone reminding you<br />
about_the_screening?<br />
Very<br />
Helpful<br />
Helpful<br />
Slightly<br />
Helpful<br />
Not<br />
Sure<br />
Slightly<br />
Unhelpful<br />
Unhelpful<br />
Very<br />
Unhelpful<br />
18. What kind of media would you find most useful in learning about the program?<br />
ci<br />
ci<br />
ci<br />
ci<br />
ci<br />
ci<br />
Informational brochure<br />
Vi<strong>de</strong>o/DVD<br />
Radio advertisement<br />
Television advertisement<br />
Newspaper advertisement<br />
Web site<br />
19. Consi<strong>de</strong>ring the seven types of information listed below in reaching your <strong>de</strong>cision<br />
about participating in a screening program, which would be the most important? What<br />
would be the second most important?<br />
ci<br />
a<br />
ci<br />
ci<br />
ci<br />
a<br />
a<br />
What the program tests for<br />
Whether the program has been tested elsewhere<br />
How effective the screening instrument is at <strong>de</strong>tecting the illness<br />
How effective treatments are for treating the illness<br />
Description of who will be doing the screening<br />
The time it will take to take the screening<br />
What will happen if you screen positive<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 34
_______________________________<br />
I believe you returned your consent form the TeenScreen program attempts to make sure<br />
every parent receives whose son or daughter has the opportunity to participate.<br />
20. Overall, what was your reaction to the materials?<br />
21. Was the program clearly presented; for example could you un<strong>de</strong>rstand what the<br />
program was about and what Would happen if you agreed to let your child participate?<br />
0 Yes NoD<br />
a<br />
What ma<strong>de</strong> the information Unclear?<br />
o Language El<br />
a Description of the program o<br />
o Description of the process and what will happen 0<br />
Other:<br />
22. Looking at the materials, what do you like the most about materials?<br />
23. What do you like the least about the materials?<br />
24. Should there be anything else inclu<strong>de</strong>d in the consent form that you don’t see state<br />
examples like the number of kids who suffer from mental illness in the US, the<br />
effectiveness of treatments for these suffering teens, etc?<br />
25. Should anything in the materials be exclu<strong>de</strong>d?<br />
26. Was there anything in the materials that directly led to your <strong>de</strong>cision to let your teen<br />
participate? If so then what?<br />
<strong>Florida</strong> Suici<strong>de</strong> 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<br />
how concerned were you that your teen would be found to be in need of services?<br />
28. You eventually did provi<strong>de</strong> consent for your teen to be screened. What do you think<br />
were two or three of the most important factors that led you to your <strong>de</strong>cision to provi<strong>de</strong><br />
consent I thought we should leave this as an open-en<strong>de</strong>d question and use these factors<br />
below as interviewer prompts but I was not sure?<br />
Suggested Prompts:<br />
Because / trusted the program<br />
My teen convinced me to let him/her participate in the program<br />
/ trusted the people who were conducting the screening<br />
I knew that my teen could benefit from taking the screening<br />
29. Even though you did agree to let your child participate what worries or concerns did<br />
you have about your <strong>de</strong>cision?<br />
30. Do you have any other suggestions about how we can increase the likelihood that<br />
parents will return the consent form and allow their teen the opportunity to participate?<br />
If you have any questions please feel free to call Steve Roggenbaum at 813-974-6149.<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 36
APPENDIX C<br />
Interview Protocol for<br />
Stu<strong>de</strong>nts who screened positive and<br />
did adhere to follow-up treatment<br />
recommendations<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 37
For <strong>Mental</strong><br />
HealthScreening<br />
Questionnaire<br />
I am going like to ask you a few questions about mental health in teens. For each of the<br />
questions I would like you to tell me if you strongly agree with the statement, agree,<br />
agree slightly, are un<strong>de</strong>ci<strong>de</strong>d about it, slightly disagree, disagree or strongly disagree<br />
Question<br />
1. <strong>Mental</strong> illness is a<br />
serious problem in<br />
teens?<br />
2. Treatments for<br />
mental illness are<br />
effective?<br />
3. Treatments for<br />
mental illnesses are<br />
dangerous?<br />
4. I would trust a<br />
psychologist?<br />
5. Iwouldbe<br />
embarrassed if my<br />
friends found out that<br />
I screened positive<br />
on_the_screening?<br />
6. I feel pretty<br />
knowledgeable about<br />
mental illness<br />
7. I think mental illness<br />
affects a lot of teens?<br />
Strongly<br />
Agree<br />
Agree<br />
Slightly<br />
Agree<br />
Un<strong>de</strong>ci<strong>de</strong>d<br />
Slightly<br />
Disagree<br />
Disagree<br />
Strongly<br />
Disagree<br />
The next couple of questions have to do with the most effective ways that we could<br />
communicate with you.<br />
8. What would be the best way to inform you about a school-based health screening?<br />
What would be the second best way?<br />
ci<br />
ci<br />
a<br />
a<br />
u<br />
ci<br />
By phone<br />
Through the mail<br />
In your homeroom c<strong>la</strong>ssroom<br />
At a school assembly<br />
Via email<br />
Personal visit to your home<br />
9. What type of media sources do you feel is the most trustworthy select one?<br />
ci<br />
ci<br />
ci<br />
TV<br />
Newspaper<br />
Internet<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 38
ci<br />
ci<br />
o<br />
Magazine<br />
Radio<br />
Other:<br />
The next few questions <strong>de</strong>al with how we could remind you about a screening taking<br />
p<strong>la</strong>ce in your school. Before we screen we send out a form <strong>de</strong>scribing the program and<br />
asking for your parents’ permission. We un<strong>de</strong>rstand that these forms are easily forgotten<br />
so we are just won<strong>de</strong>ring about how best to remind you about the screening. For each of<br />
these methods just tell me how helpful each would be in reminding you about the chance<br />
to take the screening.<br />
.<br />
Question<br />
How helpful would it be to:<br />
Very<br />
Helpful<br />
Helpful Slightly<br />
Helpful<br />
10. Send you a follow-up<br />
card in the mail<br />
reminding you about the<br />
screening?<br />
11. To remind you about the<br />
screening in your<br />
homeroom?<br />
12. To send you an email<br />
reminding you about the<br />
screening?<br />
13. To call you over the<br />
phone reminding you<br />
about the screening?<br />
Not<br />
Sure<br />
Slightly<br />
Unhelpful<br />
Unhelpful<br />
Very<br />
Unhelpful<br />
14. What kind of media would you find most effective in learning about the program?<br />
What would be the second most effective?<br />
ci<br />
ci<br />
ci<br />
ci<br />
ci<br />
ci<br />
ci<br />
Informational brochure sent in the mail<br />
Vi<strong>de</strong>o/DVD<br />
Radio spot<br />
Television advertisement<br />
Newspaper advertisement<br />
Web site<br />
Informational poster or flyer put up around school<br />
15. Consi<strong>de</strong>ring the seven types of information listed below, which would be the most<br />
important in reaching your <strong>de</strong>cision about participating in a screening program? Which<br />
would be the second most important?<br />
ci<br />
ci<br />
ci<br />
ci<br />
ci<br />
ci<br />
ci<br />
What the program tests for<br />
Whether the program has been tested elsewhere<br />
How effective the screening instrument is at <strong>de</strong>tecting the illness<br />
How effective treatments are for treating the illness<br />
Description of who will be doing the screening<br />
The time it will take to take the screening<br />
What will happen if you screen positive<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 39
_________________________________<br />
16. How were you told about the program?<br />
17. Overall, what was your reaction when you first heard about the program?<br />
18. Was the program clearly presented; for example could you un<strong>de</strong>rstand the goal of the<br />
program and what would happen if you agreed to participate?<br />
El Yes NoEl<br />
a<br />
What ma<strong>de</strong> the information Unclear?<br />
o Language El<br />
a Description of the program El<br />
a Description of the process and what will happen El<br />
Other:<br />
19. What did you like most about the way the program was presented?<br />
20. What do you like the least about the way the program was presented?<br />
21. When you were told about the program did you have any questions? If so, what were<br />
they?<br />
22. When you were told about the program was there anything that you felt should have<br />
not been discussed?<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 40
23. Was there anything in particu<strong>la</strong>r that really ma<strong>de</strong> you <strong>de</strong>ci<strong>de</strong> that this was something<br />
that you wanted to do? If so, what was it?<br />
24. What was your initial reaction when you heard that you were going to meet with a<br />
counselor soon after the screening?<br />
25. When you met with the counselor what did you like the most about the interview?<br />
26. When you met with the counselor what did you like least about the interview?<br />
27. What did you want the counselor to say to your parents when he/she called home to<br />
inform them of your screening results?<br />
28. What factors led you to want to follow-up with the recommendations ma<strong>de</strong> by the<br />
counselor I knew I nee<strong>de</strong>d to get help, my parents ma<strong>de</strong> me go, I trusted the people who<br />
suggested I get help?<br />
29. What worries did you have about following-up other kids finding out, embarrassed,<br />
money, my parents would be upset, inconvenience?<br />
30. How worried were you about other teens finding out that you screened positive and<br />
would be referred to follow-up services?<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 41
31. My parents were important in getting me to follow up?<br />
ci<br />
ci<br />
ci<br />
ci<br />
ci<br />
ci<br />
ci<br />
Strongly Agree<br />
Agree<br />
Slightly Agree<br />
Un<strong>de</strong>ci<strong>de</strong>d<br />
Slightly Disagree<br />
Disagree<br />
Strongly Disagree<br />
32. What do you think that we could say to teens who need follow-up to increase the<br />
chances that they actually would follow-up?<br />
33. What was the har<strong>de</strong>st part for you in following up?<br />
34. Do you have any other suggestions about how we can talk to teens to get them to get<br />
to follow-up?<br />
35. Lastly, what gra<strong>de</strong> are you in<br />
interviewee’s name<br />
ci<br />
ci<br />
ci<br />
ci<br />
ci<br />
ci<br />
7th<br />
8th<br />
gth<br />
10th<br />
11th<br />
12th<br />
Ifyou have any questions, pleasefee/free to call Steve Roggenbaum at 813-974-6149.<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 42
APPENDIX D<br />
Qualitative Research Methodology<br />
for Parent and Stu<strong>de</strong>nt Interviews with<br />
Tabu<strong>la</strong>ted Results<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 43
Qualitative Research Methodology for Parent and Stu<strong>de</strong>nt Interviews with Results<br />
General themes were i<strong>de</strong>ntified and subsequently qualitative interview responses were<br />
grouped into the following categories:<br />
o Problems with current communications materials as reported by parents<br />
o Suggestions to increase consent as reported by parents<br />
o Suggestions to increase consent as reported by teens regardless of whether or<br />
not they participated in the screening<br />
o Factors that encouraged follow-up compliance as reported by teens who<br />
complied<br />
o Reasons for failure to follow-up as reported by parents of teens who did not<br />
comply<br />
o Key supporting points as reported by teens who participated in the screening<br />
o Key supporting points as reported by parents of teens who participated in the<br />
screening<br />
Often, survey respon<strong>de</strong>nts provi<strong>de</strong>d information in response to a single question that could<br />
be inclu<strong>de</strong>d in more than one category. In these cases, the responses were tabu<strong>la</strong>ted in<br />
each corresponding category e.g., if the question was "what did you like least about the<br />
follow-up interview" and the respon<strong>de</strong>nt answered "time out ofthe school day but I really<br />
liked the fact it was confi<strong>de</strong>ntial," both answers were recor<strong>de</strong>d in the appropriate<br />
category.<br />
Individual responses were grouped together by themes and tabu<strong>la</strong>ted. Each survey<br />
respon<strong>de</strong>nt was counted only once per theme-response category e.g., if confi<strong>de</strong>ntiality<br />
was cited as a key supporting point in more than one answer by the same respon<strong>de</strong>nt, it<br />
was only counted once. If a respon<strong>de</strong>nt cited more than one item, however, each response<br />
was counted once in the appropriate category e.g., if a respon<strong>de</strong>nt cited confi<strong>de</strong>ntiality<br />
and parental pressure as factors encouraging follow-up, both responses were tabu<strong>la</strong>ted.<br />
The tabu<strong>la</strong>ted interview results are as follows:<br />
Problems with current communications materials as reported by parents<br />
o Too wordy or technical - should be easy for common person to read and<br />
un<strong>de</strong>rstand 5<br />
o Passive consent - don’t like it 3<br />
a Information is too vague/parent did not get a good i<strong>de</strong>a about what the<br />
problem was 3<br />
a Seems to treat everyone the same 1<br />
Suggestions to increase consent as reported by parents<br />
a Parents want to see results ofthe screen - tell them upfront what they will<br />
see5<br />
a What disor<strong>de</strong>rs will the screening <strong>de</strong>tect? 4<br />
a Provi<strong>de</strong> information about program/treatment costs 4<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 44
Resources that are avai<strong>la</strong>ble/how resources will be provi<strong>de</strong>d ifthe child<br />
screens positive 4<br />
o Exp<strong>la</strong>nation ofthe steps of the screening process 4<br />
o Increase personal communications upfront phone call or letter with<br />
information 3<br />
o Information about why their child or every child should participate 2<br />
Factors encouraging follow-up compliance as reported by stu<strong>de</strong>nts who complied<br />
o Confi<strong>de</strong>ntially 5<br />
o Teen wanted to talk to someone - already seeking help/wanting<br />
answers/need to discuss issues with someone confi<strong>de</strong>ntially 3<br />
o Parental pressure 1<br />
Reasons for failure to follow-up as reported by parents whose teens did not<br />
comply<br />
o Worried about stigma of child being treated in school/worried about child<br />
being embarrassed or harassed by peers 5<br />
o Worried about cost/inability to pay for treatment 4<br />
o Did not want child to loose time from school day for treatment 3<br />
o Transportation issues ma<strong>de</strong> follow-up impossible 3<br />
o Feel that child did not need help/would outgrow problems in time 2<br />
Key supporting points as reported by stu<strong>de</strong>nts who participated in screening<br />
o Confi<strong>de</strong>ntial 6<br />
o Wanted to talk 2<br />
o Would get answers about themselves2<br />
a Curiosity1<br />
Key supporting points as reported by parents whose teens participated<br />
a Would get answers about their child 2<br />
o Teen wanted to talk to a counselor and/or wanted to participate 2<br />
o Want their teen to get help 1<br />
Suggestions to encourage follow-up and/or consent as reported by all groups<br />
o Exp<strong>la</strong>in confi<strong>de</strong>ntiality gui<strong>de</strong>lines 4<br />
o Make the process fun and/or interesting - not boring 2<br />
a<br />
Assure stu<strong>de</strong>nts that this is common and does not mean that they are<br />
"weird" 2<br />
o Assure children that they do not need to commit up front - they can try it<br />
and stop ifthey choose.<br />
<strong>Florida</strong> Suici<strong>de</strong> Prevention Pilot Project Final Report Page 45