Categories associated with best practice:
Determinants of Health: Personal health practices and coping skills, Social support networks, Healthy child development
Coping and Support Training (CAST) is a high school-based suicide prevention program that targets young people ages 14-18 in grades 9-12. It is intended to be used as a follow‐up intervention for youth identified as at‐risk for suicide by screening and assessment programs. CAST is a small group skills training intervention designed to enhance personal competencies and social support resources. The CAST program goals are to decrease: suicide risk and emotional distress, drug involvement, and school problems.
CAST involves twelve, 1-hour sessions incorporating skills training activities within the context of adult and peer support. CAST sessions are 55 minutes in length, fast-paced, interactive, and incorporate many different learning styles. Groups meet twice a week for six weeks on a rotating basis through the students’ school schedule. Close communication is maintained between the CAST Leader and the group members’ teachers in order for students not to fall behind in their classes and to encourage school staff to positively reinforce progress and growth in the CAST skills areas. CAST is delivered by trained, experienced, master’s-level high school teachers, counselors, or nurses.
CAST was evaluated in a randomized controlled trial along with C-CARE (Counselors Care, Assess, Respond, Empower), a selected program that identifies high-risk youth through an in-depth, computer-assisted suicide assessment interview and a subsequent motivational counseling intervention. Together with C-CARE, CAST was found to have a positive impact on attitudes toward suicide and in suicide ideation and in reducing depression and hopelessness.
Primary Source Document
EA Thompson, LL Eggert, BP Randell and KC Pike, Evaluation of Indicated Suicide Risk Prevention Approaches for Potential High School Dropouts American Journal of Public Health. 2001: 91(5); 742-752
Contact information of developer(s) and/or implementer(s)
The CAST program was based on a standardized protocol developed by L.L. Eggert, PhD, RN, FAAN and L.J. Nicholas, Med. CAST is owned and disseminated by: Reconnecting Youth™ Inc. P.O. Box 20343, Seattle, WA 98102 Phone: 425 / 861-1177 Fax: 888 / 3
|Intervention Goal / Objective||Level(s) Targeted||Equity Focus|
|Decrease drug involvement||People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.|
|Decrease school problems||People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.|
|Decrease suicide risk and emotional distress||People living in conditions of disadvantage are not explicitly stated to be a target population of the intervention.|
Health Issue(s) that is/are addressed by the Intervention
- Mental Health
- Prevent/reduce alcohol use/abuse
- Prevent/reduce illegal drug use/abuse
- Prevent suicide
Specific Activities of the Intervention
- Information sessions offered about a risk factor or condition
- Training offered to deliver the intervention
- Group process/program
Priority/Target Population for Intervention Delivery
- Youth (age 13-18 years)
- Secondary/Middle school
|Outcomes and Impact Chart|
|Level of Impact||Description of Outcome||Equity Focus|
|Individual Level||With respect to mean levels of hopelessness, controlling for baseline levels, follow-up tests found significant differences among group means at T3 and T4 F2, 456=7.62, P<.001; F2, 456=2.96, P<.05, respectively). For CAST vs usual care, hopelessness was significantly lower at T3 (P<.002) but not at T4.||Reported outcomes do not distinguish findings specific to people living in conditions of disadvantage.|
|Interpersonal Level||CAST, but not C-CARE, had significant influences on the rate of change in personal control (γ13=.242, P<.05; ?23= -.021, P<.05) and problem-solving coping (γ13=.349, P<.01; γ23=-.030, P<.05). Follow-up tests, controlling for baseline levels, detected significant differences in group means at T3 and T4 for problem-solving coping (F2,456=11.53, P<.001; F2,456=6.56, P<.002, respectively) and personal control (F2,456=5.62, P<.004; F2,456=4.94, P<.008, respectively). Youths participating in CAST, compared with those in C-CARE and usual care, showed significantly greater problem-solving coping immediately after the CAST intervention (T3) and at follow-up (T4) (both P<.001). CAST also was associated with significantly greater increases in personal control, relative to usual care participants, at T3 (P<.003) and at T4 (P<.006).||Reported outcomes do not distinguish findings specific to people living in conditions of disadvantage.|
|Individual Level||Intervention effects on rates of decline in anxiety for CAST (γ13=-.381, P<.001; γ23= .037, P<.001) and C-CARE (γ14=-.431, P< .001; γ24=.043,P<.001) and in anger for CAST (γ13=-.250, P<.01; γ23=.025, P<.01) and CCARE (γ14=-.253, P<.01; γ24=.024, P<.01) were significant.||Reported outcomes do not distinguish findings specific to people living in conditions of disadvantage.|
|Individual Level||Comparisons between the intervention groups, CAST and C-CARE, and usual care showed significantly lower levels of depression at T3 (P<.008 and P<.03, respectively) and T4 (P<.002 and P<.01, respectively). Compared with usual care, the growth curve analyses also showed significantly different rates of decline in hopelessness for both CAST (γ13=-.285, P<.01; γ23=.024, P<.05) and C-CARE (γ14=-.306, P<.01; γ24= .024, P<.05).|
|Individual Level||Compared with usual care, both CAST (γ13=-.292, P<.05; γ23=.030, P<.05) and C-CARE (γ14=-.223, P<.10; γ24=.020, P<.10) influenced the rate of change (β1) associated with favorable attitude toward suicide and suicidal ideation. Both interventions were associated with faster rates of decline compared with usual care, with comparable rates of decline for CAST and C-CARE.|
- Implemented once (could be a pilot) - The intervention has been implemented once and is theoretically replicable elsewhere.
Expertise Required for Implementation within the Context of the Intervention
- Requires specialized skills that are easily available within the context - The intervention requires the participation of personnel with advanced skills (e.g. medical doctors, epidemiologists, social workers) but that are easily available within the intervention context.
Are there supports available for implementation
Yes. Trainings for CAST Leaders, Coordinators and Administrators are offered on site, on demand, and in the Seattle area, as demand requires.
Are there resources and/or products associated with the interventions
Yes. Measures and methods for assessing processes and outcomes; curriculum and activities are detailed in a standardized implementation Leader Guide and Student Notebook. The CAST curriculum kit comes is a purpose designed box and contains: a 157 page CAST Leader Guide; a 102 page Student Notebook; 12 "What's Happening" Agenda posters for the 12 sessions; 67 posters - teaching aids; "Saying No" cards (for Session 8); "Special Instructions" for users.