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Intervention Summary

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CAST (Coping And Support Training)

CAST (Coping And Support Training) is a high school-based suicide prevention program targeting youth 14 to 19 years old. CAST delivers life-skills training and social support in a small-group format (6-8 students per group). The program consists of 12 55-minute group sessions administered over 6 weeks by trained 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.

Descriptive Information

Areas of Interest Mental health promotion
Substance abuse prevention
Outcomes Review Date: February 2007
1: Suicide risk factors
2: Severity of depression symptoms
3: Feelings of hopelessness
4: Anxiety
5: Anger
6: Drug involvement
7: Sense of personal control
8: Problem-solving/coping skills
Outcome Categories Alcohol
Drugs
Family/relationships
Mental health
Quality of life
Suicide
Violence
Ages 13-17 (Adolescent)
18-25 (Young adult)
Genders Male
Female
Races/Ethnicities American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
White
Settings School
Geographic Locations Urban
Suburban
Implementation History Since 1995, the intervention has reached more than 3,000 students in more than 60 middle schools and high schools in the United States and Canada.
NIH Funding/CER Studies Partially/fully funded by National Institutes of Health: Yes
Evaluated in comparative effectiveness research studies: Yes
Adaptations Originally piloted and tested in youth 14-19 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.
Adverse Effects No adverse effects, concerns, or unintended consequences were identified by the developer.
IOM Prevention Categories Selective
Indicated

Quality of Research
Review Date: February 2007

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 1

Eggert, L. L., Thompson, E. A., Randell, B. P., & Pike, K. C. (2002). Preliminary effects of brief school-based prevention approaches for reducing youth suicide: Risk behaviors, depression, and drug involvement. Journal of Child and Adolescent Psychiatric Nursing, 15(2), 48-64.  Pub Med icon

Randell, B. P., Eggert, L. L., & Pike, K. C. (2001). Immediate post intervention effects of two brief youth school-based prevention program. Suicide and Life-Threatening Behavior, 31(1), 41-61.

Thompson, E. A., Eggert, L. L., Randell, B. P., & Pike, K. C. (2001). Evaluation of indicated suicide risk prevention approaches for potential high school dropouts. American Journal of Public Health, 91(5), 742-752.  Pub Med icon

Supplementary Materials

Eggert, L. L. (1996). Psychosocial approaches in prevention science: Facing the challenge with high risk youth. Communicating Nursing Research, 29, 73-85.

Eggert, L. L. (2000). Science-based prevention approaches to promoting healthy adolescent behaviors. Communicating Nursing Research, 33, 1-13.

Eggert, L. L., Herting, J. R., & Thompson, E. A. (1996). The Drug Involvement Scale for Adolescents (DISA). Journal of Drug Education, 26(2), 101-130.  Pub Med icon

Herting, J. R., Eggert, L. L., & Thompson, E. A. (1996). A multidimensional model of adolescent drug involvement. Journal of Research on Adolescence, 6(3), 325-361.

Powell-Cope, G. M., & Eggert, L. L. (1994). Psychosocial risk and protective factors: Potential high school dropouts versus typical youth. In R.C. Morris (Ed.), Using what we know about at-risk youth: Lessons from the field (pp. 23-51). Lancaster, PA: Technomic Publishing.

Thompson, E. A., Mazza, J. J., Herting, J. R., Randell, B. P., & Eggert, L. L. (2005). The mediating roles of anxiety, depression, and hopelessness on adolescent suicidal behaviors. Suicide and Life-Threatening Behavior, 35(1), 14-34.  Pub Med icon

Thompson, E. A., Moody, K. A., & Eggert, L. L. (1994). Discriminating suicide ideation among high-risk youth. Journal of School Health, 64(9), 361-367.  Pub Med icon

Walsh, E., Randell, B. P., & Eggert, L. L. (1997). The Measure of Adolescent Potential for Suicide (MAPS): A tool for assessment and crisis intervention. Reaching Today's Youth, 2(1), 22-29.

Outcomes

Outcome 1: Suicide risk factors
Description of Measures Suicide risk factors were evaluated using 4 items from the High School Questionnaire: Profile of Experiences that measured favorable attitudes toward suicide, frequency of suicidal ideation, frequency of direct suicide threats, and number of suicide attempts in the past month.
Key Findings In a clinical randomized controlled trial (RCT) that compared CAST participants with usual care for youth also at suicide risk (a 30-minute one-on-one session with a school counselor or nurse), CAST participants showed significantly greater declines relative to usual care youth in two of the four suicide risk factors: declines in positive attitudes toward suicide and in suicidal ideation. The rates of decline in these suicidal behaviors were most pronounced in the first 4 weeks after baseline assessment (p < .05). A slight rebound occurred in positive attitude toward suicide at 10 weeks, but reductions were sustained at the 9-month follow-up (p < .05). For suicidal ideation, the initial declines were maintained throughout the 9 months of follow-up (p < .05).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.5 (0.0-4.0 scale)
Outcome 2: Severity of depression symptoms
Description of Measures Severity of depression symptoms was measured using a 6-item scale adapted from the Center for Epidemiologic Studies Depression Scale (CES-D). The items indexed depressed affect (e.g., feeling depressed, unable to shake off feeling "down" or "blue," feeling sad).
Key Findings In a clinical RCT, CAST youth had faster rates of decline in depressed affect compared with usual care youth (p < .05). Controlling for baseline depression, the severity of depression symptoms decreased significantly in the CAST youth relative to usual care youth (p < .008) at the 10-week follow-up, with an additional decrease at the 9-month follow-up after the baseline assessment (p < .002).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.5 (0.0-4.0 scale)
Outcome 3: Feelings of hopelessness
Description of Measures Feelings of hopelessness were evaluated separately because of their unique association with suicidal behaviors. This outcome was measured using 3 items from the High School Questionnaire: Profile of Experiences that assessed hopelessness about life versus satisfaction with life.
Key Findings In a clinical RCT, CAST participants, relative to usual care youth, experienced greater rates of decline in reported hopelessness from baseline to the 4- and 10-week assessments (p < .01) and from baseline to the 9-month follow-up (p < .05). Controlling for baseline levels, CAST participants had much lower reported feelings of hopelessness relative to those in usual care at 10 weeks immediately after the CAST intervention (p < .002); this difference was attributable to a steep rebound in hopelessness among the usual care group paired with continued declines for CAST participants. At the 9-month follow-up, the differences among the treatment and usual care groups remained significant (p < .05).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.4 (0.0-4.0 scale)
Outcome 4: Anxiety
Description of Measures Anxiety was evaluated using 4 items from the High School Questionnaire: Profile of Experiences. The items indexed physical, emotional, and cognitive signs of anxiety.
Key Findings In a clinical RCT, rates of decline in anxiety for youth in the CAST intervention were significantly greater than those for usual care youth (p < .001); however, these effects varied with gender. Female youth in CAST showed a steeper decline in anxiety (p < .001) from baseline through the 9-month follow-up assessment. Controlling for baseline levels, female CAST participants had greater anxiety decreases than female usual care youth at both the 10-week (p < .001) and 9-month follow-ups (p < .003). However, for males, CAST did not influence the rate of change in anxiety; the pattern was similar to that of usual care, and no significant differences were found between male CAST and usual care participants at 10 weeks or at 9 months after CAST completion. Males in both groups showed decreases by at least 20%. The CAST intervention effects on anxiety were mainly due to the responsiveness of females to the program.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.5 (0.0-4.0 scale)
Outcome 5: Anger
Description of Measures Anger control problems were evaluated using 4 items from the High School Questionnaire: Profile of Experiences: "tendencies to be easily angered and irritated," "feeling out of control when angry," "hitting something when upset or angry," and "getting into physical fights with someone."
Key Findings In a clinical RCT, rates of decline in anger for youth in the CAST intervention were significant relative to those in the usual care youth at the 10-week (p < .01) and 9-month (p < .01) follow-ups; these intervention effects were qualified by a differential gender-based responsiveness to CAST. Female CAST participants showed a faster decline in anger relative to usual care youth (p < .001), but after controlling for baseline levels, the difference between the groups was significant only through the 10-week follow-up (p < .006). Among males, both study groups--CAST and usual care--showed declines in anger at the 10-week follow-up (p < .001), with a nonsignificant rebound in the usual care group at the 9-month follow-up. No significant group differences were found in the male youth across any of the follow-up assessments (10 weeks or 9 months). Males showed improvements regardless of CAST or usual care group assignment, with declines in anger of at least 20% across all male participants. Among women, CAST was more effective in reducing anger control problems relative to usual care.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.5 (0.0-4.0 scale)
Outcome 6: Drug involvement
Description of Measures Drug involvement was measured using items from the High School Questionnaire: Profile of Experiences. The specific dimensions of drug involvement included frequency of use of 12 types of substances, drug use control problems, and adverse consequences of drug use. The analysis was a preliminary evaluation of the effects of CAST through the 10-week follow-up marking the completion of the CAST intervention.
Key Findings In a clinical RCT, both CAST participants and usual care youth reported decreases in (a) drug use frequency--including alcohol use (p < .05), marijuana use (p < .05), and "hard drug" use (p < .001)--(b) drug use control problems (p < .001), and (c) adverse consequences of drug use (p < .001) from baseline to the 4-week and 10-week follow-up assessments.

A dose-response decrease was seen in both drug use control problems and adverse consequences of drug use for participants in the CAST and usual care conditions. The steepest and most rapid declines occurred among CAST youth relative to the usual care youth (p < .001), although the usual care group showed a gradual linear decrease in both measures through the 4-week and 10-week follow-up assessments.
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.6 (0.0-4.0 scale)
Outcome 7: Sense of personal control
Description of Measures Sense of personal control was evaluated using 5 items from the High School Questionnaire: Profile of Experiences: "confidence in handling problems," "ability to make good things happen for self," "ability to learn to adjust/cope with problems," "confident about feeling better eventually," and "feeling capable and in control."
Key Findings In a clinical RCT, CAST participants reported more rapid increases in their perceived sense of personal control through 9 months of follow-up compared with youth receiving usual care (p < .05). After controlling for baseline levels, CAST youth reported comparatively greater personal control at both the 10-week (p < .003) and 9-month follow-ups (p < .006).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.6 (0.0-4.0 scale)
Outcome 8: Problem-solving/coping skills
Description of Measures Problem-solving/coping skills were evaluated using items from the High School Questionnaire: Profile of Experiences. Items included "face problems head on until settled," "imagine myself solving the problem, then handling it for real," and "think about options, choose the best, and take action."
Key Findings In a clinical RCT, CAST participants reported more rapid gains in their problem-solving/coping skills at intervention exit (p < .01) through 9 months of follow-up compared with youth receiving usual care (p < .05). Follow-up tests detected significant differences in group means between CAST and usual care youth, after controlling for baseline levels. CAST youth reported comparatively higher levels in their problem-solving/coping skills immediately after the CAST program completion at 10-weeks (p < .001) and at the 9-month follow-up (p < .001).
Studies Measuring Outcome Study 1
Study Designs Experimental
Quality of Research Rating 3.7 (0.0-4.0 scale)

Study Populations

The following populations were identified in the studies reviewed for Quality of Research.

Study Age Gender Race/Ethnicity
Study 1 13-17 (Adolescent)
18-25 (Young adult)
52% Male
48% Female
49% White
19% Black or African American
18% Asian
10% Hispanic or Latino
4% American Indian or Alaska Native

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:

  1. Reliability of measures
  2. Validity of measures
  3. Intervention fidelity
  4. Missing data and attrition
  5. Potential confounding variables
  6. Appropriateness of analysis

For more information about these criteria and the meaning of the ratings, see Quality of Research.

Outcome Reliability
of Measures
Validity
of Measures
Fidelity Missing
Data/Attrition
Confounding
Variables
Data
Analysis
Overall
Rating
1: Suicide risk factors 3.5 3.5 3.8 3.0 3.5 3.9 3.5
2: Severity of depression symptoms 3.5 3.5 3.8 3.0 3.5 3.9 3.5
3: Feelings of hopelessness 3.3 3.3 3.7 3.0 3.5 3.8 3.4
4: Anxiety 3.5 3.5 4.0 3.0 3.5 3.5 3.5
5: Anger 3.5 3.5 4.0 3.0 3.5 3.5 3.5
6: Drug involvement 3.5 3.5 4.0 3.0 3.5 4.0 3.6
7: Sense of personal control 3.5 3.5 3.9 3.2 3.5 3.9 3.6
8: Problem-solving/coping skills 3.5 3.5 4.0 3.4 3.8 4.0 3.7

Study Strengths

The study used an excellent randomized research design with a good intervention fidelity protocol and an appropriate analytic strategy. The inclusion of intent-to-treat youth and use of multiple imputation procedures with the NORM program constitute a more conservative, state-of-the-art approach to missing data. The study also demonstrated good intervention fidelity and used good instrumentation and data analysis.

Study Weaknesses

The study used only selected items from well-established instruments and only a few items for each measure. The attrition rate was 7% for the CAST condition and 10% for the usual care condition.

Readiness for Dissemination
Review Date: February 2007

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.

CAST: Coping And Support Training curriculum. (2007). Redmond WA: Reconnecting Youth Publications, a division of RY, Inc.

CAST Program Web site, http://www.reconnectingyouth.com/cast

Eggert, L. (2007). CAST and CARE: Quality assurance procedures and measures for process evaluation and outcome evaluation.

Eggert, L. (2007). CAST supporting documentation for rating category: Readiness for Dissemination.

Purchasing CAST: The costs and materials. Retrieved December 2007 from the CAST Web site ("Getting Started" section), http://www.reconnectingyouth.com/cast/start_main.html

Reconnecting Youth, Inc. (2006). CAST T4T Guide: Training for CAST trainers (with accompanying CAST T4T PowerPoint slides on CD-ROM). Redmond, WA: Reconnecting Youth Publications, a division of RY, Inc.

Reconnecting Youth, Inc. (2006). CAST Trainer Guide: Coping And Support Training for CAST leaders (with accompanying CAST Trainer's PowerPoint slides on CD-ROM). Redmond, WA: Reconnecting Youth Publications, a division of RY, Inc.

Readiness for Dissemination Ratings by Criteria (0.0-4.0 scale)

External reviewers independently evaluate the intervention's Readiness for Dissemination using three criteria:

  1. Availability of implementation materials
  2. Availability of training and support resources
  3. Availability of quality assurance procedures

For more information about these criteria and the meaning of the ratings, see Readiness for Dissemination.

Implementation
Materials
Training and Support
Resources
Quality Assurance
Procedures
Overall
Rating
3.9 3.5 3.1 3.5

Dissemination Strengths

The program curriculum is well represented in a leader guide and student notebook organized around 12 high-quality sessions. The CAST Web site provides detailed information on staff roles, responsibilities, and qualifications and organization-level implementation. Training is available to prepare leaders, coordinators, and administrators to carry out the program. Measures and methods for assessing processes and outcomes are described to support quality assurance.

Dissemination Weaknesses

The materials are voluminous enough that it may be difficult for an implementer to develop a coherent, overall picture of program implementation. The T4T trainer guide is difficult to follow. Further information is needed on how to interpret the data collected with the quality assurance measures.

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.

Item Description Cost Required by Developer
CAST curriculum $425 each Yes
Student notebooks $16 each or $115.20 for eight Yes
4-day, on- or off-site training workshop for CAST leaders and coordinators
  • $8,800 per group of five to eight participants, or
  • $9,900 per group of nine participants, or
  • $1,100 per participant to attend an open training
Yes
Self-paced online CAST tutorial for administrators $49 per person for unlimited access No
2-day, on- or off-site advanced training for CAST coordinators $800 per person No
Unlimited phone consultation Free No
1-day, on-site follow-up consultation Varies depending on site needs and location No
Evaluation materials and services Varies depending on site needs No
Replications

Selected citations are presented below. An asterisk indicates that the document was reviewed for Quality of Research.

McCauley, E., Pelton, J., Vander Stoep, A., & Thompson, K. (2007, June). Who benefits? Analyses of a school based prevention program to reduce risk for depression during the transition to high school. Paper presented at the meeting of the International Society for Research in Child and Adolescent Psychopathology, London.

Contact Information

To learn more about implementation, contact:
Reconnecting Youth Inc.
(425) 861-1177
info@reconnectingyouth.com

To learn more about research, contact:
Beth McNamara, M.S.W.
(425) 861-1177
beth@reconnectingyouth.com

Consider these Questions to Ask (PDF, 54KB) as you explore the possible use of this intervention.

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