Preventing Suicide With A 'Contagion Of Strength'

For Whitney Bischoff, high school was tough. On the first day of her freshman year, a childhood friend committed suicide. Things weren't any better at home — her father died when she was 7 and her mom was an alcoholic with an abusive boyfriend.

She had a hard time making friends.

And when all the stress threatened to overwhelm her, she, too, considered suicide.

"I thought family was everything," Bischoff says. "I thought, if I didn't have family support – what am I going to do? Suicide seemed like the only way out."

As the thoughts persisted, Bischoff started going to group counseling sessions organized by her school in Rapid City, S.D.

But it didn't help. "I felt like it was always so depressing every time we talked," she says. "Having all that negative put to your face as a freshman – it was just a lot to take in."

But then something changed. Rapid City Central High started using a suicide-prevention program called Sources of Strength. The 15-year-old effort is now in more than 250 schools and community centers in 20 states. Researchers and advocates point to it as one of few prevention programs that has research behind it showing it can work.

Strength Is Contagious

I first learned about Sources of Strength last month, when four high schools in the Washington, D.C., suburbs started the program. I headed to Thomas S. Wootton High School — a top performing school in Rockville, Md., with enrollment of just over 2,000 — to see the initial student training.

It's a cold Friday morning in January. There are about 60 students sitting in folding chairs in the school's gymnasium. They're circled up, clustered around Dan Adams, a national trainer with the program. They're talking about the many stresses of high school.

"The stress of boundaries in dating," offers Shelby Ting, a sophomore. "Like what you're willing to do in your first relationship."

"I think we overlook the stress of being social," says Noah Braunstein, a senior. "Finding that group you fit in with is hard, and it's really taken me until senior year to find it."

Adams, in a black T-shirt and jeans, shifts the conversation to strengths: "What are the strengths in your life that help you deal with stress?" he asks.

Music. Friends. Family. Mac and cheese.

This emphasis on strengths is what Sources of Strength is all about: promoting positive behaviors in teens.

The curriculum is rooted in eight "strengths" – factors that research has shown are protective against suicide risk.

Adams walks the Wootton students through these eight strengths — family support, positive friends, spirituality, healthy activities, medical access, mentors, mental health and generosity.

For each category, students offer up examples from their own lives. "I know my really good friends don't put me under peer pressure," says a student. Another shares about how her church family really helped her get through her grandmother's passing.

"Not one of these pieces is enough to save someone from taking their own life," says Adams. "But a bunch of them – now that can make a real difference."

Jeff Brown, the acting principal of Wootton, is watching the training. He says that, like many schools, Wootton has faced issues with suicide. In 2014, the 154,000 student district lost five students to suicide.

And though national suicide rates have remained flat in recent years, it's still the third most common cause of death for 15- to 19-year-olds. And nationwide, 17 percent of American high school students said they had seriously considered suicide, according to the Centers for Disease Control and Prevention's 2013 Youth Risk Behavior Surveillance.

Teens are highly influenced by their peers – social development, peer acceptance and personal identity are all part of growing up. Researchers note that adolescents look to their peers to define acceptable ways to deal with problems.

"Kids learn from each other a great deal. So when peers are offering each other solutions, there is a greater chance kids are going to try them," says Dr. Jill Harkavy-Friedman, who leads research for the American Foundation of Suicide Prevention. She praised the Sources of Strength program for its methods, naming it as one of the few comprehensive suicide prevention programs that's based on research.

"We knew we had to have a peer component ... to bring teens into the mix," says Scott LoMurray, who runs the Sources of Strength program with his father. Mark LoMurray, Scott's father, developed the program in the late 1990s after working with law enforcement as a crisis-response expert. In a three year period, he attended 30 funerals of teenagers — a number of them due to suicide.

"We couldn't just train adults and expect that to be effective," Scott LoMurry says.

But the peer mentors didn't replace the role of adults. Instead, Sources of Strength uses adult advisers – teachers, parents and administrators – as resources for the peer-leaders.

Harkavy-Friedman says having this combination of peer-to-peer communication with adult backing makes the program stronger.

An Evidence-Based Approach

Over the next five months of school, Wooton High School's newly trained peer leaders will meet with their adult advisers and other students. They'll be talking about the power of positive support and sharing stories of how the eight pillars of strength play out in their own lives.

Administrators at the school are convinced Sources of Strength will have a strong impact on their school culture – and research tends to back that up.

"This is really the first peer-leader program that has shown impact on school-wide coping norms and influence on youth connectedness," says Peter Wyman, a psychiatry professor at the University of Rochester in New York.

Wyman has been studying suicide prevention for the last 12 years. He was one of the authors of a three-year study in the American Journal of Public Health that looked at the effectiveness of Sources of Strength.

The researchers looked at 18 schools in Georgia, New York and South Dakota and found big changes in health-seeking behavior. Students, the study found, started to think that adults in school could be helpful, and peer leaders successfully encouraged friends to seek help from adults. The biggest changes in behavior occurred among students who were, or had been, suicidal.

"Telling their own life stories, about overcoming adversity and people who helped – that seems to be a very potent tool for having an impact on diverse teens, including teens that may not be receptive to other kinds of information," Wyman says.

Schools are catching on — Sources of Strength is expanding programs in Palo Alto, Calif., Idaho and in a number of rural Alaskan villages north of Fairbanks. They're also starting new programs in several communities in Washington state, including one in the Tulalip tribal community.

But the price tag can be a deterrent: It costs close to $5,000 to bring the program to a new school. If a school chooses to spend $4,000 to certify a staff member as an official trainer, then it will cost a school about $500 each year to maintain it.

And despite the research — school counselors sometimes find it difficult to convince schools to make it a priority. Mary Hines-Bone, a prevention specialist for the Cobb County school district, near Atlanta, says it can be tough getting schools to implement it properly. The biggest obstacle in making the program successful: the time commitment.

"It's been a real challenge to get time during school days," says Hines-Bone. "And programs where students meet before and after school don't end up being as effective."

And so schools may turn to less costly and less time-consuming approaches, like suicide-prevention assemblies or presentations that discuss the warning signs and risks of suicide.

Some prevention experts warn that programs emphasizing risks might not work as well, and researchers say there is little evidence that such one-time lectures have any effect. And they say any sustained effort must include adults talking with kids: making students part of the the intervention and not the target of it.

"The biggest prevention piece that's out there is connection. When kids feel connected to somebody or their environment they're going to make fewer risky decisions, " says Tim McGowan, the school counselor who brought the Sources of Strength program to Rapid City Central High School.

After running the program there for seven years, he says he finally has a student body that has never experienced a fellow student who has died by suicide. He says he gets lots of calls asking for advice, asking how he turned his school around. His best advice: Listen to kids and trust them.

"Sometimes kids tell us things we don't want to hear," McGowan says. "But you have to be open to those – because if you're not open to those, then you lose that opportunity for growth."

Whitney Bischoff, now 21, says she's grateful for that openness. The program gave her a space to feel supported and the ability to recognize that, while her family support wasn't as strong, she had other strengths: her friends from theater, her spirituality and her school mentor — Mr. McGowan.

She says she's come a long way since freshman year. She's on track to graduate this spring from Black Hills State University in Spearfish, S.D., with a degree in Psychology.

"That program saved me," she says, "and it gave me the passion and the confidence to want to pass it on to others."