SOS Signs of Suicide® Program (OJJDP Model Program Guide)

Office of Justice Programs, Innovation - Partnerships – Safer Neighborhoods

Office of Juvenile Justice and Delinquency Prevention (OJJDP) Serving Children, Families and Communities

PREVENTION

IMMEDIATE SANCTIONS

INTERMEDIATE SANCTIONS

RESIDENTIAL

REENTRY

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SOS Signs of Suicide® Program

Intervention:

The SOS Signs of Suicide® Program (SOS) is a school-based suicide prevention that serves secondary school students ages 13 to 18. The program teaches students that suicide is directly related to mental illness—typically depression—and that it is not a normal reaction to stress or emotional upset. This approach stands in direct contrast to other programs that seek to destigmatize suicide by separating it from mental illness. SOS concentrates on teaching youths to recognize the signs of suicide and depression in themselves and others and the specific actions needed to respond to those signs. SOS is also currently being used in other nonschool settings that serve youth.

The main teaching materials are a video and a discussion guide. The video includes dramatizations depicting the right and wrong ways to treat someone who is depressed and suicidal. It features interviews with people whose lives have been touched by suicide as well as interviews with school-based professionals and experts in the child psychiatry and child suicide prevention fields. After watching the video, students are asked to complete the Brief Screen for Adolescent Depression (BSAD)—a seven-question screening instrument for depression, suicidality, and its related risk factors. The students themselves score the screening form. A score of 4+ on the BSAD is considered a strong indicator of depressive disorder, and students who score so high are encouraged to seek help immediately. Students answering affirmatively to questions about suicidal thoughts or attempts are strongly recommended to see a mental health professional regardless of their total score. Schools participating in the program receive a kit of materials containing the video, a discussion guide, screening forms for students (in English and Spanish), a training video for staff, and other educational and promotional items. They also receive a procedure manual that describes best practices for implementing the program and addressing some of the issues involved (e.g., parental notification, referrals, anonymous versus identified screening, staff training, ensuring follow-up with at-risk youth). Templates for sample materials are provided, including a parent letter, a student-tracking form, information for school staff, and consent forms. There are also educational flyers, posters, and an additional parent screening form (in English and Spanish) that is sent home to help parents determine whether their child is exhibiting symptoms of depression and suicidal ideation.

Evaluation Methodology:

There have been two published studies evaluating the SOS program. The first presented process and outcome data from an evaluation of the safety, efficacy, and feasibility of implementing the SOS prevention program using data collected from 92 schools during the 2000–2001 school year. A large majority of the participating schools were public (86 percent), containing an average of 900 students. Most of the students were white (76 percent); there was a slight overrepresentation of white students in the sample (76 percent in the sample versus 64 percent nationally), while Hispanics were underrepresented (5 percent in the sample versus 14 percent nationally). Roughly similar proportions of students resided in urban, suburban, and rural areas. About 25 percent of the students in participating schools qualified for free or reduced school lunches. The data for the evaluation was collected in three separate, structured questionnaires completed by the site coordinators (typically the school psychologist, a school counselor, or a nurse) immediately after implementation, 30 days after implementation, and 3 months following implementation.

The second published study examined the effectiveness of the SOS program in reducing suicidal behavior. The experimental design consisted of randomized treatment and control groups and posttest-only data collection, using 2,100 high school students from two schools in Columbus, Ga. (n=665), and three schools in Hartford Conn. (n=1,435). The student populations of the two schools in Columbus were mostly white and living in working- or middle-class families. Conversely, most of the students from the three Hartford schools were economically disadvantaged youths from diverse racial and ethnic backgrounds (63 percent Latino; 21 percent African-American). Twenty percent of the Hartford students had been placed in a remedial English or bilingual program during high school.

Students in both the treatment (n=1,027) and control groups (n=1,073) were asked to complete a short questionnaire in a group setting during class time, roughly 3 months following the implementation of the program. The questionnaire included items relevant to three specific outcomes: 1) suicidal ideation and suicide attempts, 2) knowledge and attitudes about depression and suicide, and 3) help-seeking behavior.

Evaluation Outcome:

The first study found that, in general, the program and its materials were well received. The vast majority of site coordinators reported that the program was effective in increasing help-seeking; in improving communication among students, parents, and teachers; and in bringing students in need of help to the school’s attention. A particularly compelling finding was the nearly 60 percent increase in help-seeking among students who participated in the program: site coordinators reported that the number of students seeking counseling for depression or suicidal ideation increased from an average of 6.79 per month over the past year to 10.63 in the 30 days following the program’s implementation. Contrary to the belief that some suicide intervention programs may actually increase the risk of suicide among adolescents, no high schools reported any adverse reactions among students exposed to the SOS program.

In the second study, significantly lower rates of suicide attempts and greater knowledge and more adaptive attitudes about depression and suicide were observed among students in the intervention group. The modest changes in knowledge and attitudes partially explained the beneficial effects of the program on suicide attempts. The research found that SOS was the first school-based suicide prevention program to demonstrate significant reductions in self-reported suicide attempts in a study using a randomized experimental design.

Other Information:

References:

Aseltine, Robert H. Forthcoming. “An Evaluation of a School-Based Suicide Prevention Program.” Adolescent and Family Health.

Aseltine, Robert H., and Robert DeMartino. 2004. “Outcome Evaluation of the SOS Suicide Prevention Program.” American Journal of Public Health 94(3):446–51.

Program Specification:

Current Rating:

Promising

Expected Date of Re-Review:

Summer 2013

Program Type:

Classroom Curricula

Ethnicity:

Asian

African American

Hispanic or Latino (of any race)

White

Gender:

Both

Age:

14 - 18

Target Settings:

Rural

Suburban

Urban

Problem Behaviors:

Trauma Exposure

Risk & Protective Factors:

Risk

Community

Low community attachment

Family

Family management problems / Poor parental supervision and/or monitoring

Poor family attachment / Bonding

Individual

Antisocial behavior and alienation / Delinquent beliefs / General delinquency involvement / Drug dealing

Cognitive and neurological deficits/Low intelligence quotient/Hyperactivity

Life stressors

Mental disorder / Mental health problem / Conduct disorder

Peer

Peer rejection

School

Low academic achievement

Negative attitude toward school / Low bonding / Low school attachment / Commitment to school

Protective

Community

Presence and involvement of caring, supportive adults in the community

Prosocial opportunities for participation / Availability of neighborhood resources

Family

Good relationship with parents / Bonding or attachment to family

Having a stable family

High family expectations

Opportunities for prosocial family involvement

Individual

Healthy / Conventional beliefs and clear standards

High individual expectations

Perception of social support from adults and peers

Positive / Resilient temperament

Positive expectations / Optimism for the future

Self-efficacy

Social competencies and problem solving skills

Peer

Good relationships with peers

School

High expectations of students

Presence and involvement of caring, supportive adults in school

Additional Information:

Status:

Program is in operation at this time.

Performance Measures:

Suggested OJJDP Performance Measures for the Program Types(s):

Delinquency Prevention
Classroom Curricula
Logic Model: PDF
Performance Matrix:PDF
School Programs
Classroom Curricula
Logic Model: PDF
Performance Matrix:PDF

Contact Information:

Program Developer:
Sharon Pigeon, MSW, LICSW
Screening for Mental Health, Inc.
One Washington Street, Suite 304
Wellesley Hills, MA 02481
Phone: 7812390071
Fax: 7814317447
Email: Click Here
Website: Click Here

Training & TA Provider:
Sharon Pigeon, MSW, LICSW
Screening for Mental Health, Inc.
One Washington Street, Suite 304
Wellesley Hills, MA 02481
Phone: 7812390071
Fax: 7814317447
Email: Click Here
Website: Click Here