Universal Suicide Prevention for Air Force Trainees: Retention As an Indicator of Progress in Program Adaptation

Military populations are underserved in access to many prevention strategies. For example, military suicides are higher than their counterparts in the U.S. population, yet military suicide prevention focuses on a narrow range of selective and indicated strategies (e.g., treatment for high risk groups). Universal prevention approaches are needed that proactively strengthen skills and relationships; relationship disruptions are major precipitants for military suicides (DoD, 2012). This study reports results from a phase of adapting a universal suicide prevention program (Sources of Strength; Wyman et al., 2010) for Air Force personnel in training. Enrollment and retention were examined along with longitudinal assessments of proximal factors targeted by the training.

Method

In partnership with a large Air Force training school we adapted the content and implementation of Sources of Strength over 16 months with 9 cohorts using an iterative process: training in adapted modules, evaluation, and revision. Each squadron allocated time for 3-5 training classes per cohort (25-30 airman) to attend enrollment sessions and 8 hrs. training over 4-6 weeks (if enrolled). Classes were invited as a unit because Sources of Strength uses an active learning model within which natural social groups build connectedness. Airman completed measures of engagement, retention of concepts, and cohesion.

Results

Nine cohorts comprised of 25 classes (n=281) were invited. Enrollment was consistently high (95% overall), whereas retention varied by cohort (66% - 100%). Retention increased following a modification mid-way through the adaptation process: addition of a module to increase class interaction (pre-activity retention: 77.86%; post-activity: 95.24%). Increased retention corresponded with increased class cohesion (p < 0.05) and perceived preparation to apply training skills outside the training environment (64% to 88%). Completed analyses for the final paper will use multi-level modeling (airman nested in class) to evaluate class cohesion and retention over tie.

 Discussion

With Air Force partners we used an iterative process to adapt a universal suicide prevention program. Increases in subject retention was a key indicator of progress in successful adaptation of the program. Validity of using retention as a criterion was supported by associations between retention and increased class cohesion, which is a key proximal goal of the intervention. Data showing high rates of retention contributed to enthusiasm of AF leaders in the project and approval to transition to an RCT phase to test the adapted program. Our findings point to the value of engaging military partners in planning adaptation process and incorporating retention rates to evaluate adaptation progress.