Quality of Research
Review Date: September 2011
Documents Reviewed
The documents below were reviewed for Quality of Research. The research point of
contact can provide information regarding the studies reviewed and the availability
of additional materials, including those from more recent studies that may have been conducted.
Study 1Wyman, P. A., Brown, C. H., LoMurray, M., Schmeelk-Cone, K., Petrova, M., Yu, Q., et al. (2010). An outcome evaluation of the Sources of Strength suicide prevention program delivered by adolescent peer leaders in high schools. American Journal of Public Health, 100(9), 1653-1661. 
Supplementary Materials Gould, M. S., Velting, D., Kleinman, M., Lucas, C., Thomas, J. G., & Chung, M. (2004). Teenagers' attitudes about coping strategies and help-seeking behavior for suicidality. Journal of the American Academy of Child and Adolescent Psychiatry, 43(9), 1124-1133.
Schmeelk-Cone, K., Pisani, A. R., Petrova, M., & Wyman, P. A. (2012). Three scales assessing high school students' attitudes and perceived norms about seeking adult help for distress and suicide concerns. Suicide and Life-Threatening Behavior, 42(2), 157-172. (NOTE: At the time of the NREPP review, the manuscript of this article had been submitted for publication but not yet accepted.)
Outcomes
| Outcome 1: Attitudes about seeking adult help for distress |
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Description of Measures
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Attitudes about seeking adult help for distress were assessed with the Help-Seeking From Adults at School scale, a 4-item self-report measure. All scale items begin with the following stem: "If I was really upset and needed help…" Using a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree), students responded to the items, which assess intentions to seek help ("I would talk to a counselor or other adult at school"), expectations about receiving help ("I believe a counselor or other adult at school could help me"), and perceived support from their friends and family for seeking help ("My friends would want to me to talk to a counselor or other adult at school" and "My family would want me to talk to a counselor or other adult at school").
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Key Findings
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Participating schools were randomly assigned to the intervention condition or the wait-list control condition. Students designated as peer leaders in the intervention schools began training with Sources of Strength immediately, and those in the control schools began training 5 months later. Students (those who were designated as peer leaders and those who were not) completed the scale at baseline and at 4 months after baseline, before peer leaders in the control schools began training.
At 4 months after baseline, trained peer leaders were more likely than untrained peer leaders were to seek help from adults at school (p < .001). Also at 4 months after baseline, students in the intervention schools were more likely than students in the control schools were to seek help from adults at school (p = .04).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.1
(0.0-4.0 scale)
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| Outcome 2: Knowledge of adult help for suicidal youth |
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Description of Measures
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Knowledge of adult help for suicidal youth was assessed with the Adult Help for Suicidal Youth scale, a 3-item self-report measure. Using a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree), students responded to the following items: "I know adults who could help a friend thinking of suicide," "My school has people who can help students going through hard times," and "I can think of an adult who I trust enough to help a suicidal friend."
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Key Findings
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Participating schools were randomly assigned to the intervention condition or the wait-list control condition. Students designated as peer leaders in the intervention schools began training with Sources of Strength immediately, and those in the control schools began training 5 months later. Students (those who were designated as peer leaders and those who were not) completed the scale at baseline and at 4 months after baseline, before peer leaders in the control schools began training.
At 4 months after baseline, trained peer leaders were more likely than untrained peer leaders were to have knowledge of adult help for suicidal students (p < .001). Also at 4 months after baseline, students in the intervention schools were more likely than students in the control schools were to have knowledge of adult help for suicidal students (p = .034).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.1
(0.0-4.0 scale)
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| Outcome 3: Rejection of codes of silence |
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Description of Measures
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Rejection of codes of silence was assessed with the Reject Codes of Silence scale, a 6-item self-report measure designed to determine adolescents' attitudes toward overcoming secrecy barriers to engage adults about suicidal peers. Using a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree), students responded to each item (e.g., "I would tell an adult about a suicidal friend, even if that friend asked me to keep it secret").
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Key Findings
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Participating schools were randomly assigned to the intervention condition or the wait-list control condition. Students designated as peer leaders in the intervention schools began training with Sources of Strength immediately, and those in the control schools began training 5 months later. Students (those who were designated as peer leaders and those who were not) completed the scale at baseline and at 4 months after baseline, before peer leaders in the control schools began training.
At 4 months after baseline, trained peer leaders were more likely than untrained peer leaders were to reject codes of silence (p < .002). However, between students in the intervention and control schools, there was no significant difference in rejection of codes of silence.
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.1
(0.0-4.0 scale)
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| Outcome 4: Referrals for distressed peers |
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Description of Measures
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Referrals for distressed peers were assessed with the Referred Distressed Peers to Adults scale, a 2-item self-report measure. Using a 4-point frequency scale (never, 1–2, 3–5, 6 or more times), students designated as peer leaders responded to each item: "I told a friend who was considering suicide to get help from an adult" and "I told a friend to get help because of emotional or behavior problems."
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Key Findings
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Participating schools were randomly assigned to the intervention condition or the wait-list control condition. Students designated as peer leaders in the intervention schools began training with Sources of Strength immediately, and those in the control schools began training 5 months later. Students who were designated as peer leaders completed the scale at baseline and at 4 months after baseline, before peer leaders in the control schools began training.
At 4 months after baseline, trained peer leaders were more likely than untrained peer leaders were to refer distressed peers to adults at school (p = .03).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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3.0
(0.0-4.0 scale)
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| Outcome 5: Maladaptive coping attitudes |
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Description of Measures
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Maladaptive coping attitudes were assessed with the Maladaptive Coping scale, a 4-item self-report measure. Using a 4-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree), students designated as peer leaders responded to each item (e.g., "Suicide is a possible solution to problems").
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Key Findings
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Participating schools were randomly assigned to the intervention condition or the wait-list control condition. Students designated as peer leaders in the intervention schools began training with Sources of Strength immediately, and those in the control schools began training 5 months later. Students designated as peer leaders completed the scale at baseline and at 4 months after baseline, before peer leaders in the control schools began training.
At 4 months after baseline, trained peer leaders had a greater decrease in maladaptive coping attitudes compared with untrained peer leaders (p < .01).
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Studies Measuring Outcome
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Study 1
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Study Designs
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Experimental
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Quality of Research Rating
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2.8
(0.0-4.0 scale)
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Study Populations
The following populations were identified in the studies reviewed for Quality of
Research.
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Study
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Age
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Gender
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Race/Ethnicity
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Study 1
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13-17 (Adolescent)
18-25 (Young adult)
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54% Female
46% Male
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82.6% White
11.8% Hispanic or Latino
5.6% Black or African American
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Quality of Research Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the Quality of Research for an intervention's
reported results using six criteria:
For more information about these criteria and the meaning of the ratings, see Quality of Research.
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Outcome
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Reliability
of Measures
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Validity
of Measures
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Fidelity
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Missing
Data/Attrition
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Confounding
Variables
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Data
Analysis
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Overall
Rating
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1: Attitudes about seeking adult help for distress
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2.8
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3.5
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2.5
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3.0
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3.5
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3.5
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3.1
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2: Knowledge of adult help for suicidal youth
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2.8
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3.5
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2.5
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3.0
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3.5
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3.5
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3.1
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3: Rejection of codes of silence
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2.8
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3.5
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2.5
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3.0
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3.5
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3.5
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3.1
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4: Referrals for distressed peers
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2.5
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3.0
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2.5
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3.0
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3.5
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3.5
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3.0
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5: Maladaptive coping attitudes
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2.0
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2.5
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2.5
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3.0
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3.5
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3.5
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2.8
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Study Strengths The study article presents factor analytic findings that bolster reliability and validity for some outcome measures. The psychometric scales developed for the study have reasonable reliability. All scales have acceptable content validity, as established by the program developer and/or expert panel reviews. Intervention fidelity checks were conducted. The study randomized schools and used a control condition, which helped control for confounding variables. Statistical power was thoroughly addressed and appeared to be adequate. Data were collected across many sites in a number of geographical regions. Data analysis was sophisticated and appropriate.
Study Weaknesses The psychometric properties of some outcome measures are not well documented. Although fidelity checks were conducted, documentation of intervention fidelity was inadequate. Inability to match the study participants from baseline to the postbaseline assessment was a limitation because it precluded a clear assessment of change over the course of the study.
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Readiness for Dissemination
Review Date: September 2011
Materials Reviewed
The materials below were reviewed for Readiness for Dissemination. The implementation
point of contact can provide information regarding implementation of the intervention
and the availability of additional, updated, or new materials.
Evaluating and Sustaining Sources of Strength
Program Web site, http://www.sourcesofstrength.org
Sources of Strength Adult Advisor Step-by-Step Guide
Sources of Strength Implementation Manual
Sources of Strength Peer Leaders Spreading Hope, Help, and Strength
Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)
External reviewers independently evaluate the intervention's Readiness for Dissemination
using three criteria:
- Availability of implementation materials
- Availability of training and support resources
- Availability of quality assurance procedures
For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.
Implementation
Materials
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Training and Support
Resources
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Quality Assurance
Procedures
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Overall
Rating
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4.0
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4.0
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4.0
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4.0
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Dissemination Strengths Comprehensive materials that address program design and implementation are available electronically and in print. Materials are visually appealing and written in clear, audience-appropriate language. A start-up questionnaire is included on the program Web site to help potential implementers assess their readiness for program implementation. The program Web site provides easily navigated hyperlinks to program materials, and descriptive content is readily accessible. The program uses social media (e.g., Facebook, YouTube, Twitter) to enhance the potential resonance of the program with the target population. The developer also provides a grant writing packet, which contains information to enhance implementation and sustainability opportunities for implementers. The training for adult advisors and peer leaders follows a well-developed curriculum and is conducted by a certified trainer. Trainings include didactic instruction and experiential exercises. Implementers participate in monthly technical assistance support calls with Sources of Strength trainers, which provide opportunities for peer-to-peer sharing. The Web-based technical support system and toolkit facilitate the monitoring of progress and include opportunities for ongoing developer feedback. The fidelity guidelines are specific to each step in the implementation process and include benchmarks that should be achieved by implementers. When implementers fall below benchmarks, program facilitators are alerted and provided with possible reasons as well as guidance and support. The online data entry system that tracks program fidelity and assists in evaluating program impact also provides reports that the implementer can use to compare the local program data with national norms. Outcomes are further measured by the systematic use of several pre- and postprogram implementation surveys.
Dissemination Weaknesses No weaknesses were identified by reviewers.
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Costs
The cost information below was provided by the developer. Although this cost information
may have been updated by the developer since the time of review, it may not reflect
the current costs or availability of items (including newly developed or discontinued
items). The implementation point of contact can provide current information and
discuss implementation requirements.
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Item Description
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Cost
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Required by Developer
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Program I Model Package (includes implementation manuals; organizational support; protocol review; four annual Webinars, plus teleconference support; adult advisor and peer leader training materials; Web, audio, and video resources; and Facebook and texting resources and templates)
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- $4,000 per school or community team per year (for years 1 and 2 of implementation), plus travel expenses
- $2,500 per school or community team for year 3 of implementation, plus travel expenses
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Yes (one program model package is required)
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Program II Model Package (includes all items in the Program I Model Package, as well as community and schoolwide presentations; additional creative support in developing local posters and videos; evaluation tools, analysis, and summary reports; and trainer Webinars)
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- $10,000 per school or community team per year (for years 1 and 2 of implementation), plus travel expenses
- $5,000 per school or community team for year 3 of implementation, plus travel expenses
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Yes (one program model package is required)
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Sources of Strength annual affiliation fee (includes updated handouts, manuals, access to monthly teleconference support, Web-based trainings, and updated messaging templates)
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$500 per year
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Yes, starting with year 3 of implementation
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Provisional trainer certification
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- $4,000 per trainer for first year
- $1,000 for recertification training every 2 years
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No
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On-site Regional Certified Trainer Training
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$500-$1,200 per team, plus travel expenses
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Yes
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Basic evaluation toolkit
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Included in the cost of the Program I Model Package
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Yes
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Multilevel program evaluation (includes online pre- and posttest survey systems for advisors and peer leaders, as well as evaluations for large student bodies)
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$500-$4,000 per team, depending on the needs of the implementer
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No
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Additional Sources of Strength items (e.g., T-shirts, wristbands, mugs, sweatshirts, blankets, magnets, posters)
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$8-$10
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No
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Additional Information Before implementation begins, the developer provides the site with a memorandum of agreement that clarifies yearly costs, deliverables, expectations of local schools and community partners, the estimated number of advisors and peer leaders needed per team, and information on Sources of Strength staff travel. Peer leader resources, which include food and drinks during training, recognition events, printing, and materials used during messaging campaigns, are estimated to cost between $300 and $1,000 per team. For large school districts, regions, tribes, and States that want to develop multiple peer leader teams, a regional multiteam model package is available. The package includes all features of the Program I Model Package, with costs ranging from $25,000 to $75,000 per year (for years 1 and 2 of implementation), depending on the needs of the implementer.
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Replications
No replications were identified by the developer.
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