The document describes the Sources of Strength peer leadership model for suicide prevention. It discusses how the model trains peer leaders and caring adults to shift social norms to reduce suicide risk. The 5 core principles are: 1) bringing together peer leaders and caring adults, 2) using peer leaders to break down codes of silence, 3) emphasizing strengths beyond risk/warnings, 4) encouraging multiple support sources beyond referrals, and 5) developing local hope/help messages. Research shows the model increases help-seeking norms, adult support expectations, and peer referrals to adults for suicidal peers.

1. A connections model for public health
The National Peer Leadership Study
The Sources of Strength Model
Mark LoMurray
Sources of Strength Director

2. SOURCES OF STRENGTH: Shifting Teen Social Norms to Counter Risk for PART III—SHIFTING NORMS
Suicide
2009 addition to the National
Best Practices Registry
Winner of the national 2005 Public Health Practice
Award from the American Public Health Association
(APHA)
(Epidemiology Section)

3. Network Positions
Peripherals
Bridges
Group
Members
Central Members
Isolate
3

4. Peer Networks in Communities

5. Peer Networks in Schools/Communities
With Suicidal Students

6. Youth who attempt suicide are harder
to reach
• They are much less likely to have trusting
relations with adults
• They have fewer friends
• Those friends they have are likely to feel
positive towards suicide
6

7. Peer Networks in Schools/Communities
With Suicidal Students
And Peer Leaders

8. Many areas
lacking
trusted
adults
Peer Networks in Schools/Communities
With Suicidal Students
Peer Leaders
And Trusted Adults

9. Peer Leaders Expand
Trusted Adults Connections
Into Peer Groups that lack adult connections

10. SOURCES OF STRENGTH: Shifting Teen Social Norms to Counter Risk for
Suicide
WHY IT MAKES SENSE
PEER INVOLVEMENT:

11. SOURCES OF STRENGTH: Shifting Teen Social Norms to Counter Risk for PART II—PEER INVOLVEMENT
Rationale for peer involvement in suicide prevention
Research has shown peers are primary
1. influence on whether a teenager abuses alcohol/drugs
and uses SAFE SEX PRACTICES.
Suicide
BELIEFS ABOUT
WHAT HIS/HER FRIENDS
WOULD DO
(BRUCKNER, 2005)

12. Benchmarks for Peer Prevention
• Provide Training
• Provide Supervision
• Clear and Focused Mission
• Involve Peers in Planning of delivering and
tone
• Recognition/Honoring
• Health Messages

13. SOURCES OF STRENGTH: Shifting Teen Social Norms to Counter Risk for PART II—PEER INVOLVEMENT
Cautionary points on
Peer involvement
:
Suicide
Grouping teens with antisocial norms may actually
REINFORCE those norms
TAKE
NOTE!
IT’S IMPORTANT TO INVOLVE DIVERSE GROUPS OF
TEENS
AND TO MONITOR THEM CLOSELY

14. SOURCES OF STRENGTH: Shifting Teen Social Norms to Counter Risk for PART II—PEER INVOLVEMENT
Cautionary points on
Peer involvement
:
Suicide
Youths can sometimes assume the role of a
JUNIOR COUNSELOR to their peers
TAKE
NOTE!
THIS CAN BE HARMFUL TO BOTH PEER ADVISOR/LEADER
AND THE YOUTH WHO MAY BE AT RISK FOR SELF-HARM

15. Connections Model: Expands A
Surveillance Model
Gatekeeper Training – Screening
Focus on Warning Signs
Identify and Refer
Mental Health
Treatment

16. Sources of Strength

17. SOURCES OF STRENGTH: Shifting Teen Social Norms to Counter Risk for PART III—SHIFTING NORMS
5 CORE PRINCIPLES:
Suicide
Bring together and train
both peer leaders and
caring adults. One
without the other lacks
prevention power

18. SOURCES OF STRENGTH: Shifting Teen Social Norms to Counter Risk for PART III—SHIFTING NORMS
5 CORE PRINCIPLES:
Suicide
USE PEER LEADERS
TO BREAK DOWN
CODES OF SILENCE
AND INCREASE PEER
HELP SEEKING WITH
CARING ADULTS.

19. SOURCES OF STRENGTH: Shifting Teen Social Norms to Counter Risk for PART III—SHIFTING NORMS
5 CORE PRINCIPLES:
Suicide
A CORE EMPHASIS ON
STRENGTHS THAT
GOES BEYOND A
SIMPLE FOCUS ON
SUICIDE RISK AND
WARNING SIGNS

20. SOURCES OF STRENGTH: Shifting Teen Social Norms to Counter Risk for PART III—SHIFTING NORMS
CORE PRINCIPLES:
Suicide
MULTIPLE SOURCES
OF SUPPORT ARE
ENCOURAGED—
MOVING BEYOND A
SINGULAR FOCUS ON
MENTAL HEALTH
REFERRALS

21. SOURCES OF STRENGTH: Shifting Teen Social Norms to Counter Risk for PART III—SHIFTING NORMS
5 CORE PRINCIPLES:
Suicide
HOPE, HELP AND
STRENGTH MESSAGES
ARE DEVELOPED WITH
LOCAL VOICES AND
FACES—SATURATING
LOCAL SCHOOLS
AND COMMUNITIES WITH
STORIES
OF RESILIENCY INSTEAD
OF TRAUMA

22. How does Sources of Strength
differ from other peer programs?
1. Well researched – engaged in the nation’s
largest randomized trial on impact of peer
leaders on entire student populations.
2. Has focused and tested Hope, Help, Strength
messaging strategies that are safe and
effective.
3. Uses a wide diversity of peer leaders to
spread into many cliques and groups.
4. Links closely with adult support – trusted
adults

23. Help-Seeking Norms of Peer Leaders increased by training
(p<.05) in Cobb County GA, North Dakota and NY
3.2
3.1
3
2.9
2.8
Baseline
2.7 Post training
2.6
2.5
2.4
Control Schools Sources of Strength
Schools
23

24. Mentors
Helpers -
Mediators
Sources of
Strength

26. Sources of Strength Process
• Engage leaders/ administrators
• Review protocol
• Identify and train key adult advisors (4-6 hr)
• Train school or community staff (15 m – 1.5
hr)
• Recruit peer leaders
• Train peer leaders with adult advisors (3-4 hr)
• Peer leaders with adult support begin action
steps and HOPE, HELP, STRENGTH MESSAGING
(3-5 months)

27. Sources of Strength
A Multi-year growth process
• Each year peer leaders and adult advisors
come together for training (Year 1, Year 2, Year
3 curriculuum)
• Year 1 typically has PL’s engaged in 3-5
messaging activities – getting their feet wet
• Year 2 often adds more diversity for PL’s –
begin to really get concepts and add creativity
• Year 3 – broad spread, partnering with many
other student groups, become very creative at
reaching groups, saturating school/comm

28. Administrative Support
• Need approval for implementing the program
in school, community, church, or agency
• Commit staff time for adult advisors (4-6 hr
training, plus about 15- 30 hrs over 3-5
months)
• Commit time, space, resources for peer leader
training
• Commit time for ongoing peer leader
meetings and activities – recognize peer
contribution (from isn’t that nice, to this is a
serious impacting program)

29. Community Buy-in
• Who can be key partners?
• Who will champion the Sources of Strength?
program to others
• What agencies or groups have a track record
of success?
• Who are the best people in our community
with teens or young adults?

30. Adult Advisors
• Get the right adults – connected and caring
• Minimum of two – prefer 1-10 ratio
• Can be from a variety of roles
• Identify who will be the lead – communicate
with the rest of the team

31. Peer Leaders
• Can come from existing efforts and programs
• Add diversity of peer leaders
• 1st year is usually teacher nominated
• 2nd year peer leaders begin recruiting others
• Who has influence in cliques and friendship
groups

32. SOURCES OF STRENGTH: Shifting Teen Social Norms to Counter Risk for
Suicide
PART III—SHIFTING NORMS

33. SOURCES OF STRENGTH: Shifting Teen Social Norms to Counter Risk for PART III—SHIFTING NORMS
Power in PREVENTION: Relational connectedness of
PEERS
Suicide

34. As part of Action Step 2 all students at Perry HS, NY are
naming their Trusted Adults and forming a growing circle
of trust 34

35. Peer Presentation Activities
• The Peer Leaders’ 5-8 min presentations
will focus on:
– Sharing stories of Hope, Help and Strength
– Don’t Keep it Secret if a friend is in crisis
– Help is Available – My trusted adults
– My Sources of Strength

36. Ongoing Support
1. Ongoing tele-conference support for AA’s and
for teams.
2. Four webinars throughout school year for AA’s.
3. Step by Step Adult Advisor Guide – Resource
page on www.sourcesofstrength.org
4. Site visits as needed.
5. Support and development of regional
coordinators.
6. Develop regional trainers – 10 month process

37. Sustaining and Growing
• Funding and partnerships
• Get peer leaders in front of adult groups
• Teacher meetings, school boards, chambers of
commerce, tribal councils

38. Acceptability of Student Help Seeking from Adults:
Significantly Higher in High School Populations after Sources of
Strength Training (4-months of messaging)
p-value 0.040
2.735
2.75
2.7
Means Corrected for
2.65
2.6
Baseline
2.55
2.5
2.475
2.45
2.4
2.35
2.3
Control Schools SoS Schools

39. Expectations that Adults at School Help Suicidal Youth:
Significantly Higher in High School Populations after Sources of
Strength Training (4-months of messaging)
p-value 0.034
2.991
3
Means Corrected for Baseline
2.95
2.9
2.85
2.8
2.705
2.75
2.7
2.65
2.6
2.55
Control Schools SoS Schools

40. Referred a Suicidal Peer to Adults: 2-fold
increase by training (p<.05)
90 Baseline 90
Baseline
80 Time 2 80
Time 2
70 70
60 60
50 50
40 40
30 30
20 20
10 10
0 0
None 1 or more None 1 or more
times times
Control Schools Sources of Strength
Schools

41. Expectations that Adults Help Suicidal Youth:
Largest Increase for Students in Population with Suicide Ideation Histories after Sources
of Strength Training
Four months after Sources of StrengthAdult Helpteens with suicide ideation histories were comparable to non-suicidal teens in
Appraisals of training Availability for Suicidal Youth:
Largest Increase in Students w ith Suicide Ideation Histories
control schools
3.5
3.3
3.1
Adult Help Corrected Means at T2
2.9
No Suicide Ideation
2.7
SoS Schools No Suicide Ideation
2.5
Control Schools
2.3
2.1 Suicide Ideation
1.9 SoS Schools
1.7
1.5 Suicide Ideation
No ideation-SoS No ideation-Control Ideation-SoS Ideation-Control
Control Schools