Implementation Factors Predicting Diffusion of a Peer-Led Suicide Prevention Program through Social Networks in Underserved Secondary Schools

Adolescence is a key suicide prevention window period and the developmental phase of many emerging problem behaviors. Nearly all widely used youth suicide prevention programs aim to increase identification and treatment of youth who are  suicidal or at high risk (e.g., depressed, substance abuse). The 2012 National Strategy for Suicide Prevention cites an urgent need for interventions that promote healthy populations to prevent emergence of suicidal behavior. Sources of Strength (LoMurray, 1995) is the first universal prevention program using adolescent peer leaders that enhances social-ecological factors associated with reducing suicidal behavior at a school population level (Wyman et al., 2010). We report initial findings from a large effectiveness trial (RO1MH091452) with 40 high schools from communities underserved by mental health services and over-representing populations at high risk (4 American Indian reservations); over 12,000 students enrolled for longitudinal assessments, including peer social networks. We summarize results testing implementation factors that predict diffusion of the intervention concepts through the activities of trained student peer leaders’, informed by diffusion of innovations (Rogers, 2003) and social network threshold models (Valente, 1995). In the 20 early implementing schools, 656 students (18-71 per school) received Peer Leader (PL) training and planned and executed activities to spread healthy coping practices, with adult mentoring.  Using a framework derived from the Stages of Implementation Completion (Saldana et al., 2011), we coded school reports of PL meeting dates and attendance as indices of school success in retaining and preparing PLs. Surveys with 5,700 students six months after PL activities began showed wide school-level variation in success of PLs in reaching their classmates with the prevention concepts including direct encouragement by a peer to adopt healthy coping practices. Multi-level models indicated that schools with a higher proportion of student population trained as PLs and greater retention of PLs had higher population exposure to Sources of Strength. Students in the population who were beyond two steps from a PL (friend of a friend of a PL)  had low exposure and few peer-related communications about healthy coping, congruent with diffusion of innovations theory. Final analyses will include results examining diffusion over two school years, success in reaching groups of students with barriers to health and competence, such as students with low school engagement, social isolaton and minority status in their communities.