Research Project

CDC, Centers for Disease Control: 2002-2005

• Dr. Brooke P. Randell (PI)
• Dr. Jerald R. Herting
• Dr. Leona L. Eggert
• Dr. Elaine A. Thompson

Cast-Plus: A Commmunity Suicide Prevention Partnership is a multi-site effectiveness trial of Cast-Plus. CAST-Plus is an indicated prevention program for suicide-vulnerable youth. The intervention addresses one of society's most disturbing trends: the co-occurrence of suicide-risk behaviors, anger/aggression, and depression among youth. CAST-Plus responds to recent calls from CDC for tests of efficacious school-based efforts to curb violent behaviors and intentional injuries (PA-02003).

CAST-Plus extends and augments the efficacious school-based Competence & Support Training (CAST) program for potential high school dropouts who are at risk for suicide with an innovative parent component. Parents CARE (P-CARE) is a promising program currently being tested through funding from NINR and CDC. P-CARE includes home visits where parents learn to talk with tenns about suicide and help teens practice mood management and healthy decision-making. Both components are delivered during a school, providing a "dose" of social network support and life skills training that has proven effective in reducing suicide-risk behaviors in this population. This approach is designed to reduce known risk factors and enhance protective, mediating factors within individual, family, school and peer contexts.

The proposed study is a randomized trial; a 2-group factorial design with 4 repeated measures over 9 months. It is hypothesized that the CAST-Plus program will be significantly more effective than "usual care" in reducing high-risk youths' suicide-risk behaviors as well as the co-occurring problem behaviors of school dropout and aggression/depression. Moreover the study examines the critical features that account for adoption and implementation across sites when communities select best practices and attempt to institutionalize these efforts on behalf of youth in their communities. The sample will consist of 1152 suicide vulnerable, high-risk youth in grades 9-12. Individual students' antecedent, mediating and outcome dimensions are measured; process measures will assess the implementation of the parent and school programs including measures of exposure, participation, receptivity and implementation fidelity. Latent growth models will be used to examine variance/covariance structures and changes in outcomes and to test the hypothesized mediating intervention effects.

The proposed study is both innovative and significant. It has implications for both theory-testing and prevention science implications. There are currently no other known indicated programs for suicide vulnerable that have been tested for efficacy. This research should markedly increase our understanding of how efficacious programs are taken to scale and if under these conditions the efficacious outcomes observed under strict research conditions can be maintained.