El riesgo de crédito:

The following programs target youth who have been identified as being at high risk for suicide. They are designed to help the youth develop or strengthen positive social and coping skills (i.e., resilience) and reduce behaviors that place them at risk of suicide.

CARE (Care, Assess, Respond, Empower)** IOM classification: Selective, Indicated

Populations of focus:

• Male and female high-school students, ages 14 to 20, who are at high risk of suicide; and

• Male and female young adults, ages 20 to 24, who are at high risk of suicide and are being counseled in non-school settings, such as health care clinics.

Description: CARE (formerly called Counselors CARE [or C-CARE] and Measure of

Adolescent Potential for Suicide [or MAPS]) is a high school-based suicide prevention program targeting high-risk youth. CARE includes a 2-hour, individual computer-assisted suicide assessment interview. This interview is followed by a 2-hour motivational counseling and social support intervention. The counseling session is

a safe context for sharing personal information, and reinforce positive coping skills and help- seeking behaviors. CARE makes it easier for youth to obtain help by connecting each high- risk youth to a school-based caseworker or a favorite teacher and by establishing contact with a parent or guardian chosen by the youth. The program also includes a follow-up reassessment of broad suicide risk and protective factors and a booster motivational counseling session 9 weeks after the initial counseling session.

The goals of CARE are threefold: to decrease suicidal behaviors, to decrease related risk factors, and to increase personal and social assets. CARE assesses the adolescent’s needs, provides immediate support, and then serves as the adolescent’s crucial communication bridge with school personnel and the parent or guardian of choice. The CARE program typically is delivered by school or advanced-practice nurses, counselors, psychologists, or social workers who have completed the CARE implementation training program and certification process. Although CARE was originally developed to target high-risk youth in high

school — particularly those at risk of school dropout or substance abuse — its scope has been expanded to include young adults (ages 20–24) in settings outside of schools, such as in health care clinics.

Application to AI/AN communities: CARE was piloted and tested with participants ages 14 to 20 and has since been adapted for young adults (ages 20 to 24). Originally tested with diverse racial and ethnic groups, the program also has been adapted specifically for Native American and Hispanic students.

2009 Cost: Required online training in CARE implementation is being developed for interventionists, program coordinators, and administrators. Costs include (1) the training registration fee, (2) the purchase of a license for the use of the computer-assisted CARE

program; and, (3) follow-up training and certification process fees. Length of training may vary depending on the competency levels of participants and the time required for them to achieve and maintain a level of “distinguished” implementation performance.

Contacts:

Web site: http://www.reconnectingyouth.com For information about implementation or research studies:

Reconnecting Youth™ Inc. P.O. Box 20343

Seattle, WA 98102 Phone: 425–861–1177 Fax: 1–888–352–2819

CAST (Coping and Support Training)** IOM classification: Indicated

Population of focus: Male and female high school students, ages 14 to 19, who are at high risk of suicide.

Description: CAST is a high school-based suicide prevention program. CAST delivers life skills training and social support in a small- group format (6 to 8 students per group). The program consists of 12 55-minute group sessions administered over 6 weeks by trained, masters- level high school teachers, counselors, or nurses with considerable school-based experience. CAST serves as a follow-up program for youth who have been identified through screening as being at significant risk for suicide. In the original trials, identification of youth was done through a program known as CARE (Care, Assess, Respond, Empower), but other evidence- based suicide risk screening instruments can be used.

CAST’s skills training sessions target three overall goals: increased mood management (depression and anger), improved school

performance, and decreased drug involvement. Group sessions incorporate key concepts, objectives, and skills that inform a group- generated implementation plan for the CAST leader. Sessions focus on group support, goal setting and monitoring, self-esteem, decisionmaking skills, better management of anger and depression, “school smarts,” control of drug use with relapse prevention, and self- recognition of progress through the program. Each session helps youth apply newly acquired skills and increase support from family and other trusted adults. Detailed lesson plans specify the type of motivational preparation, teaching, skills practice, and coaching activities appropriate for at-risk youth. Every session ends with “Lifework” assignments that call for the youth to practice the session’s skills with a specific person in their school, home, or peer-group environment.

Application to AI/AN communities: Originally piloted and tested in youth ages 14 to 19 years old, the CAST program is currently being tested with middle school-aged youth. CAST has been evaluated with racially and ethnically diverse groups of high school youth at risk of dropping out of school. Although its use in Native communities is unknown, the program is an option for AI/AN communities.

2009 Cost: The CAST curriculum, which includes one copy of the CAST student notebook, CAST leader guide, and all related teaching aids, is $699 plus shipping and

handling. CAST Student Notebooks are $26.50 each plus shipping and handling, or $190.80 for a set of 8 Student Notebooks.

Registration for a 4-day training workshop for CAST leaders and coordinators is $16,000 for 14 to 16 participants. A 1-day training workshop for the administrators responsible for establishing the infrastructure to support implementation of the CAST program runs $400 per person. A 2-day advanced training for CAST coordinators costs $800 per person and is designed to follow

the prerequisite 4-day and 1-day trainings. The advanced training is intended for individuals responsible for the day-to-day support and supervision of staff to ensure program fidelity. Consult the Reconnecting Youth™ Inc. Web site for costs of curriculum materials and evaluation tools.

Free consultation is available from the developer by phone, and many materials and information are available at no cost from the program Web site.

Contacts:

For information about implementation and research studies:

Reconnecting Youth™ Inc. P.O. Box 20343

Seattle, WA 98102 Phone: 425–861–1177 Fax: 1–888–352–2819

Reconnecting Youth™ (RY)*

IOMclassification: Selective, Indicated

Population of focus: Male and female students, grades 9 through 12, who demonstrate suicide risk behaviors.

Description: RY is a school-based prevention program that targets high school students who show signs of poor school achievement, potential for school dropout, and other at-risk behaviors including suicide-risk behaviors. RY teaches skills to build resiliency with respect to risk factors and to moderate early signs of substance abuse, depression, and aggression. The program incorporates social support and life skills training. Classes include 10 to 12 students who meet daily, or on a block schedule, for an entire semester. The class is part of the high school curriculum, and students receive credit for participation. The class is led by a teacher who excels in working with high-risk youth and has completed RY training. The focus of the class is on skills training within

the context of adult and peer support. The RY class is delivered in five modules:

1. Getting started;

2. Self-esteem enhancement; 3. Decisionmaking;

4. Personal control; and

5. Interpersonal communication.

Forty-one class sessions and 23 booster/review sessions are included in the curriculum, leaving 16 class sessions for the social activities/school bonding components. The class involves:

• Small-group work and life skills training models to enhance personal and social protective factors of high-risk youth; • Social activities and school bonding for

establishing drug-free social activities and friendships, and healthy, pleasant activities for decreasing depression as well as for improving the teens’ relationship with school;

• School system crisis response plan that addresses schoolwide prevention and intervention approaches; and

• Parent involvement that includes active parental consent for student participation and at-home support of RY goals for their children.

Application to AI/AN communities: The program has been studied in six urban schools, but it has been put into place in a variety of schools in both urban and suburban settings and for diverse student populations. Although its use in Native communities is unknown, the program is an option for AI/AN communities.

2009 Cost: Costs vary depending on number of teachers trained, training-related costs (e.g., travel and substitute teacher payments), and materials. Cost estimates and a schedule of upcoming

trainings are provided on the RY Web site.

Contacts:

Web site: http://www.reconnectingyouth.com For RY™ Co. information, implementation consultation, or to schedule trainings: Reconnecting Youth™ Inc. P.O. Box 20343

Seattle, WA 98102 Phone: 425–861–1177 Fax: 1–888–352–2819