Program Profile: Youth-Nominated Support Team-Version II (YST-II)

This program was designed to provide adult support to suicidal youth following psychiatric care. The program is rated Promising. Program participants showed statistically significant improvements on mortality, suicide and drug-related deaths, outpatient psychotherapy sessions, medication follow-up sessions, and outpatient drug or alcohol treatment but not on suicidal ideation, suicide, depression, negative attitudes about the future, functional impairment, or inpatient drug or alcohol treatment.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals/Target Population

The Youth-Nominated Support Team-Version II (YST-II) intervention was designed to supplement standard treatments for suicidal youths following psychiatric hospitalization by providing them with social support from caring adults. YST-II intervention services were provided to adults to facilitate their supportive role with adolescents. The intervention targeted adolescents, ages 13–17, who were psychiatrically hospitalized at a university- or private-hospital setting and had significant suicidal ideation or had made suicide attempt(s) within the past 4 weeks. The goal was to reduce youths’ suicidal ideations, depression severity, and feelings of hopelessness, and improve their mood-related adaptive functioning.

Program Activities

The period following psychiatric hospitalization is a time of high risk for suicidal incidents (Goldston et al. 1999). After being released from psychiatric hospitalization, suicidal adolescents were asked to nominate caring adults from their family, school, and neighborhood or other community settings, with whom they wanted to have regular supportive contact. YST-II intervention specialists facilitated the nomination process by developing a plan with the family for contacting the support persons and then inviting them to participate.

Adult support persons received psychoeducation and ongoing consultation from intervention specialists, and maintained regular contact with adolescents 3 months following their hospitalization. Intervention specialists conducted initial psychoeducation sessions with support persons. These were scheduled as individual sessions or group sessions in keeping with family preference and feasibility.

The average length of sessions was about 1 hour. Sessions involved discussions of information about 1) the adolescent’s psychiatric disorder(s) and psychosocial difficulties, 2) the adolescent’s treatment plan and rationale for recommended treatments, 3) risk factors for suicidal behavior and warning signs of possible imminent risk, 4) the availability of emergency services, and 5) strategies for communicating with adolescents. In addition, a collaborative plan for weekly telephone contact between the adult support person and the intervention specialist was developed.

Support persons were urged to have weekly contacts with the adolescents. During the contact with adolescents, adult support persons were encouraged to 1) talk with youths about their recent activities and support their involvement in healthy activities, 2) inquire about and listen to the adolescent’s concerns and engage in collaborative problem-solving, and 3) support treatment adherence and convey hopefulness about the possibility of positive change. The length of contacts was not prescribed, and flexibility was emphasized.

Program Theory

The intervention was guided by social-support and health-behavior models that posit that social relationships positively affect mental health through an improved sense of belonging and companionship (Heaney and Israel 2002). These models further hypothesize that social relationships may indirectly improve mental health through the facilitation of problem-solving and access to helpful information, which may lead to more effective coping and reduced exposure to stressors.

Key Personnel

Intervention specialists were mental health professionals (doctoral-level psychologists, masters-level social workers, and psychiatric nurses) who had a minimum of 3 years of professional experience with adolescents and families.

Additional Information

The YST-II intervention was an extension of an earlier version of the same intervention model, Youth-Nominated Support Team-Version I (YST-I; King et al. 2006). There were two major changes from YST-I to YST-II. The first change was the requirement in YST-II that only adults serve as support persons rather than offering adolescents the option of also nominating one peer support person, as was the case in YST-I. The second change was to use a 3-month rather than a 6-month period of intervention in YST-II.

Study 1

King and colleagues (2009) evaluated an intervention designed to supplement the routine treatment of suicidal youth following hospitalization. Those eligible for participation were adolescents, 13 to 17 years of age, with significant suicidal ideation or a suicide attempt within the past 4 weeks. All adolescents were psychiatrically hospitalized at either a university or a private hospital. A total of 448 suicidal adolescents were enrolled in the study. Using a computerized strategy to ensure balanced assignment at each site across gender, age, and history of multiple suicide attempts, 223 participants were randomly assigned to the treatment condition and 225 to the control condition. The treatment condition received the Youth-Nominated Support Team-Version II (YST-II) intervention and the control condition received treatment as usual. The average age of participants was 15.59 years and their racial/ethnic distribution was 84 percent white, 6 percent African American, 2 percent Hispanic, and 8 percent other. The sample was 71.2 percent female. There were no significant differences between groups in age, gender, racial/ethnic group, or parents’ education.

Baseline assessments occurred within 1 week of hospitalization. Follow-up assessments were conducted at approximately 6 weeks, 3 months, 6 months, and 12 months following the baseline assessment. The CrimeSolutions review of this study focused on the outcomes at the 12 month follow up. At the 12-month follow-up, 19.3 percent of participants who were assigned to the treatment condition and 21.8 percent of participants who were assigned to the control condition were not able to be assessed for various reasons.

Outcome measures included the youth’s self-reported suicidal ideation, depression, and negative attitudes about the future. Parents completed a self-report measure to assess their child’s functional impairment. Linear mixed-methods models were used to examine the effect of the intervention on each outcome and accounted for nesting of the intervention effects within the four follow-up time periods (6 weeks, 3 months, 6 months, and 12 months). Analyses controlled for baseline scores on each outcome measure, as well as for both the youth’s self-reported depression and the severity score on a self-report screening measure for adolescent substance abuse, at baseline.

Study 2

King and colleagues (2019) conducted a post-hoc secondary analysis of data from Study 1 (King et al. 2009) using National Death Index (NDI) mortality data. This follow-up study was based on the same sample as the 2009 study and used NDI data obtained from January 1, 2002, to December 1, 2016 (the mean length of the NDI follow-up period was between 11.2 to 14.1 years). Research staff, who were blind to participants’ intervention status in Study 1, matched participants’ data to NDI records using Centers for Disease Control and Prevention guidelines.

Outcome measures included total recorded deaths in the NDI, deaths by suicide or drug overdose, and deaths by suicide alone. Additional outcome measures, which were related to the use of mental health services during the 12 months following initial psychiatric hospitalization, were assessed by parent report. These measures included number of outpatient psychotherapy sessions, number of medication follow-up sessions, participation in outpatient alcohol or drug treatment, and participation in inpatient alcohol or drug treatment. Adult encouragement of youth treatment engagement and adherence was a component of the intervention.

Differences in mortality were evaluated by comparing the Kaplan-Meier survival curves for the two groups, using the Cox proportional hazards regression model to estimate the hazard ratio (HR) and compare the mortality rates between the control and treatment conditions. Group differences in the mean number of outpatient psychotherapy and medication follow-up sessions were assessed through independent-sample t tests on log-transformed data. Group differences in participation in alcohol or drug treatment (inpatient or outpatient) were assessed with chi-square tests of independence. No subgroup analysis was conducted.

The Youth-Nominated Support Team-Version II (YST-II) intervention manual provided explicit guidelines for psychoeducation sessions and telephone check-ins with nominated adult support persons. Intervention specialists completed 12 hours of YST-specific training and successfully completed a certification exam that assessed knowledge of YST-II components and intervention competencies. Weekly individual supervision was provided to intervention specialists with quarterly, cross-site group supervision/booster meetings. To assess intervention fidelity, all intervention sessions with support persons were audiotaped, and intervention specialists completed intervention checklists following each psychoeducation session (King et al. 2009).

Re-Review and New Rating
In 2014, the Youth-Nominated Support Team–Version II (YST–II) intervention received a final program rating of No Effects based on a review of the study by King and colleagues (2009). In 2020, CrimeSolutions conducted a re-review of a new study by King and colleagues (2019), using the updated CrimeSolutions Program Scoring Instrument. The re-review resulted in a new overall program rating of Promising. Promising programs have some evidence to indicate they achieved their intended outcomes.

Subgroup Analysis
In addition to the overall effect of the intervention on the evaluation outcomes, King and colleagues (2009) analyzed the effect of the intervention across gender, site location, and lifetime multiple-suicide-attempt status subgroups. Subgroup analyses did not yield statistically significant differences in program effects on any of the outcome variables at the 12-month follow-up.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

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Mentoring for Youth Development

This practice provides youth with a positive and consistent adult or older youth relationship to promote healthy youth development and social functioning and to reduce risk factors. The practice is rated Effective in reducing delinquency and improving educational outcomes; Promising in improving psychological outcomes and cognitive functioning; and No Effects in reducing substance use.

Evidence Ratings for Outcomes

	Crime & Delinquency - Multiple crime/offense types
	Education - Multiple education outcomes
	Mental Health & Behavioral Health - Psychological functioning
	Mental Health & Behavioral Health - Cognitive functioning
	Mental Health & Behavioral Health - Social functioning
	Drugs & Substance Abuse - Multiple substances

Youth-Initiated Mentoring for Youth Development

Youth-initiated mentoring involves a hybrid approach in which youths are empowered to identify, develop, and strengthen natural mentoring relationships from their existing social networks, rather than being assigned a new mentor through a more formal mentoring relationship. The practice is rated Promising for improving psychological, health, school/academic, and social outcomes, and rated No Effects for cognitive functioning outcomes.

Evidence Ratings for Outcomes

	Mental Health & Behavioral Health - Psychological functioning
	Education - Multiple education outcomes
	Mental Health & Behavioral Health - Social functioning
	Mental Health & Behavioral Health - Cognitive functioning

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?