Experimental and pragmatic approaches to the incidence of adolescent suicide

Since the early 1960s, the incidence of adolescent suicide has been increasing at an alarming rate. In response, social science researchers working in both the experimental and pragmatic epistemological paradigms have been studying the processes involved in this phenomenon and developing suicide prevention and suicide response programs in schools. In this article we review general issues involved in the contrasting and, at times, conflicting approaches taken by experimental and pragmatic researchers to adolescent suicide. These issues are then illustrated in a case study in which experimental and pragmatic proponents worked together on an evaluation of a school-based suicide education program.     

近年来我国大学生自杀心理剖析

研究自杀大学生的心理变化过程,对预防大学生自杀具有积极的作用。对大学生自杀案例进行剖析的结果表明,大学生自杀行为“因穷至卑”和“因穷自杀”现象不明显;不同原因自杀的心理动机存在差异,并且主要集中在“情感挫折”、“学习就业压力”、“个人心理障碍”、“家庭原因”和“生理健康”5类。自杀大学生的心理状态随着自杀意念的发生发展呈现一定的规律性,他们在实施自杀的过程中都经历了复杂的心理过程。     

Principals' perceptions of benefits and barriers to school-based suicide prevention programs

Suicidal behavior among children and adolescents is a national problem and schools can be an effective context for suicide prevention and intervention efforts. School-wide screening programs are viewed as most effective from a public health standpoint, although they garner the least support from school administrators. The purpose of this article is to examine administrators' perceptions of three school-based suicide prevention models while also capturing opinions on barriers and benefits to implementation. Data were gathered through interviews with seven principals from one Midwestern state. Findings reveal agreement among principals that schools play a key role in suicide prevention, but they differ on which type of prevention approach is most appropriate. School principals believed the school-wide screening program included more barriers to implementation than either the in-service or the curriculum-based program, largely due to the likelihood of parental disapproval. Limitations of the study and implications for improving suicide prevention efforts are discussed.     

Countertransference Bias in Child Custody Evaluations Is Just a Horse of a Different Color: A Rejoinder to Martindale and Gould

ABSTRACT

The authors' reply to Martindale and Gould's critique of Pickar's article (2007a, this issue), “Countertransference Bias in the Child Custody Evaluator.” Martindale and Gould's objections to considering an evaluator's countertransference reactions as a potential source of bias are addressed by focusing on these four areas: (1) Whether it is useful to introduce the term “countertransference bias” to identify a potential source of distortion in custody evaluations; (2) How the empirical literature on countertransference in the context of psychotherapy might apply to the child custody evaluation process; (3) Clarification of areas of agreement and disagreement with Martindale and Gould, and (4) The importance of evaluator attempts at “debiasing.” We conclude that gaining awareness of countertransference reactions can only enhance the evaluator's ability to provide the most objective custody evaluation possible.     

Theory and method in treatment evaluation

We outline a conceptual model of evaluation research that has both guided and flowed from our research on the process and outcome of treatment for alcohol abuse and for depression. The conceptual model encompasses three basic processes: the process of treatment selection, the process of treatment, and the process underlying the onset and course of the disorder or problem being treated. A theory guiding a program evaluation can focus on one or more of these processes, and findings from evaluations can contribute to the development of better theories of these processes. We discuss how theories can guide both experimental and naturalistic evaluations, as well as aid in the estimation of treatment effects with either type of design. We then consider the role of theory and method in exploring patient-treatment matching. Finally, we discuss the implications of theory-guidance for the utility of evaluations—particularly the utility for evaluation researchers.     

Communication of results and utilization in participatory program evaluation

This paper explores the linkages between utilization and stakeholder participation in the evaluation process, specifically in the communication of results phase of evaluation. It is argued that key elements of a participatory evaluation process can be linked to meaningful and multiple forms of results utilization through cognitive and political uses of the evaluation process. Data from two small-scale participatory evaluations are used to support this argument.     

The results framework--an innovative tool for program planning and evaluation.

This article constitutes a case study of the development and implementation of the "results framework," an innovative planning and evaluation tool that is rapidly becoming a standard requirement for United States Agency for International Development (USAID) projects. The framework is used in a USAID-funded regional initiative for HIV/AIDS prevention in Central America. This new program evaluation and monitoring tool provides many advantages over traditional evaluation approaches that use outside consultants to provide midterm and end-of-project evaluations. The results-framework process, which spans the life of the project, provides an opportunity for program staff, donors, partners, and evaluators to work as a team to collect and use rich, longitudinal data for project planning, implementation, and evaluation purposes.     

Resolving conflicting demands on evaluation: A test demonstration of videotex for farmers

Evaluating an innovation for federal, state, and local policymakers and program managers alike entails conflicting demands on the evaluation study. Policymakers at federal, state, and local levels are best assisted by impact evaluations, whereas state and local program managers are best assisted by process evaluations. In-house evaluators often have an advantage in conducting process evaluations; external evaluators generally have an advantage in conducting impact evaluations. A cost-effective approach may be to combine in-house process evaluation and external impact evaluation. This dual approach was found to reduce conflicting demands on the evaluation of an experimental videotex system for agricultural producers.     

Book Review

The prevalence of suicide suggests social workers will encounter clients at risk for suicide, but research shows social workers receive little to no training on suicide and suicide prevention and feel unprepared to work effectively with clients at risk. Baseline results from a randomized intervention study of the Question, Persuade, and Refer suicide prevention gatekeeper training with 73 advanced master’s of social work student interns show suicide knowledge was average, attitudes about suicide prevention were generally neutral, and use of suicide prevention practice skills was low. These results indicate an opportunity for enhancing student outcomes through training and inform social work education regarding necessary preparation for student interns and new graduates to identify and respond effectively to client suicide risk.     

Non-formal educator use of evaluation results

Increasing demands for accountability in educational programming have resulted in increasing calls for program evaluation in educational organizations. Many organizations include conducting program evaluations as part of the job responsibilities of program staff. Cooperative Extension is a complex organization offering non-formal educational programs through land grant universities. Many Extension services require non-formal educational program evaluations be conducted by field-based Extension educators. Evaluation research has focused primarily on the efforts of professional, external evaluators. The work of program staff with many responsibilities including program evaluation has received little attention. This study examined how field based Extension educators (i.e. program staff) in four Extension services use the results of evaluations of programs that they have conducted themselves. Four types of evaluation use are measured and explored; instrumental use, conceptual use, persuasive use and process use.Results indicate that there are few programmatic changes as a result of evaluation findings among the non-formal educators surveyed in this study. Extension educators tend to use evaluation results to persuade others about the value of their programs and learn from the evaluation process. Evaluation use is driven by accountability measures with very little program improvement use as measured in this study.Practical implications include delineating accountability and program improvement tasks within complex organizations in order to align evaluation efforts and to improve the results of both. There is some evidence that evaluation capacity building efforts may be increasing instrumental use by educators evaluating their own programs.     

No One Theory of Suicide: The Experience of a Cancer Patient Who Killed Himself

More than a million people worldwide die by suicide annually, and more than 30,000 of them in the United States. Cancer patients are two to four times more likely to die by suicide than the general population. The purpose of this article is to use the results of a phenomenological psychological autopsy to (1) illustrate the interplay of the interpersonal and intrapersonal circumstances of one colon cancer patient’s struggle and ultimate suicide, and (2) demonstrate that health and mental health practitioners need to use more than one theory of suicide to inform their assessment of risk. The findings present a telling picture of the struggles of the decedent, and the authors recommend how the results inform health and mental health practitioners’ practice, policy, and research related to suicide prevention.     

Evaluating theory-based evaluation: information, norms, and adherence

Programmatic social interventions attempt to produce appropriate social-norm-guided behavior in an open environment. A marriage of applicable psychological theory, appropriate program evaluation theory, and outcome of evaluations of specific social interventions assures the acquisition of cumulative theory and the production of successful social interventions - the marriage permits us to advance knowledge by making use of both success and failures. We briefly review well-established principles within the field of program evaluation, well-established processes involved in changing social norms and social-norm adherence, the outcome of several program evaluations focusing on smoking prevention, pro-environmental behavior, and rape prevention and, using the principle of learning from our failures, examine why these programs often do not perform as expected. Finally, we discuss the promise of learning from our collective experiences to develop a cumulative science of program evaluation and to improve the performance of extant and future interventions.     

Development Guidelines from a Study of Suicide Prevention Mobile Applications (Apps)

Every day, Americans are inundated with advertisements and appeals to purchase the latest mobile technology in the form of smart phones, tablets, and their accompanying applications (apps). Human service organizations (HSOs) across the United States have begun to recognize that apps can provide a valuable resource for individuals and communities by addressing social issues. Additionally, forward-thinking HSOs are aware that apps are a fresh and important way of reaching a rapidly changing, tech-savvy population. But just like the marketplace at large yields a variety of apps that range from useful and engaging to poorly contrived and ineffective, HSOs' foray into app development has achieved mixed results. This report analyzes existing mobile applications available for one specific field of HSO service delivery—suicide prevention—in order to describe what is currently available and to generate beginning guidelines for the development, implementation, and evaluation of new suicide prevention apps for underserved populations. Twenty-seven apps were analyzed and recommendations for HSOs and future research are presented.     

Suicide prevention on college campuses: What works and what are the existing gaps? A systematic review and meta-analysis

Abstract

Objective: To examine the effects of universal and targeted suicide prevention programs on relevant outcomes in college campuses. Methods: College suicide prevention programs published from 2009 to 2018 were assessed on outcomes including knowledge, skills, self-efficacy, suicidal ideation, and suicidal behaviors. Effects of the interventions on outcome variables with sufficient studies to warrant meta-analysis (ie, knowledge, skills, and self-efficacy) were meta-analyzed. Studies reporting on the remaining outcomes (ie, suicidal ideation and behaviors) were systematically reviewed. Results: Significant increases in suicide prevention knowledge, skills, and self-efficacy were observed in universal prevention interventions that typically employed gatekeeper prevention strategies. Evidence of reductions in suicidal ideation and behaviors was observed across targeted suicide prevention programs for at-risk students. Conclusion: Prevention programs are beneficial for training those likely to come in contact with people endorsing suicidality, but further research is needed to show that suicide interventions can consistently have significant effects on suicidal students as well.     

Evaluation considerations for community-based gender-informed health interventions

Evaluations of gender-based interventions have been consistently criticized for their lack of methodological rigor. This is largely due to the complex design of many of the interventions, coupled with difficulties in measuring the outcome and impact of these interventions. This article proposes a number of ways to improve these evaluations both at the community and individual level. We recommend use of organizational theory and narrative inquiry methods, such as the appreciative inquiry technique, to examine how communities design gender-based interventions. In addition, we suggest a variety of methods to measure the effects of these interventions on gender norms in the community for example, policy analysis, multilevel modeling, and social conversations. With respect to measuring outcomes at the individual level, we argue for more rigorous evaluation designs in order to improve internal and external validity claims. Additionally, we suggest that evaluations should incorporate different methodologies, for example autobiographical narratives, which allows one to give saliency to the subjective voices of participants. Finally, we emphasize that evaluation designs need to document the long term effects of intervention programs and define the expected outcomes with greater specificity.     

Young people's explanations for youth suicide in New Zealand: a thematic analysis

New Zealand has one of the highest youth suicide rates in the developed world and dominant approaches to prevention do not always take into account the views of young people. The purpose of this research was to update our understanding of young people's explanations of suicide in order to inform suicide prevention efforts. Focus groups were conducted with 38 young people, including 30 young women and 8 young men aged 15–22. The data was analysed thematically to identify the range of explanations young people ascribe to youth suicide. Five themes were identified by the analysis including that suicide could be explained by inescapable difficulties, constant pressure, emotional distress and could also be seen as a cry for help. In contrast to these normalised experiences, participants also expressed the view that mental illness might also account for suicide. The findings suggest that young people recognise suicide as a complex problem with multiple causes. While they recognised mental health problems as contributing, youth suicide was primarily understood by young people as a normal response to emotional distress and pressure. Prevention programmes should address the full range of explanations that young people give for suicide in order to promote their engagement in prevention programmes.     

Issues in the Evaluation of an Online Prevention Exercise

ABSTRACT

The rapid growth of computer and Internet technologies and their acceptance as a viable medium for human services delivery has opened up new possibilities for providing effective prevention programming. This article reviews some of the major online prevention websites and evaluations of their effectiveness. In addition, it reports the struggle to evaluate an interactive multimedia anger management exercise that is part of a teen substance abuse prevention website. The evaluation provided some support that a 30-minute exposure to a web-guided prevention exercise could increase teens' prevention knowledge and that completing the online exercise as supplemental homework reinforces the classroom experience. However, positive changes in other measures of behavior change were not supported. The study pointed to many issues that occur when developing and evaluating online interventions in real-world environments.

This background section presents the advantages of online prevention, a brief overview of prevention research and its advantages, and an overview of prevention websites and their evaluation.     

Explaining variation in the effects of welfare-to-work programs

Evaluations of government-funded training programs often combine results from similar operations in multiple sites. Findings inevitably vary. It is common to relate site-to-site variations in outcomes to variations in program design, participant characteristics, and the local environment. Frequently, such connections are constructed in a narrative synthesis of multisite results. This article uses findings from the evaluations of California's Greater Avenues for Independence (GAIN) program and the National Evaluation of Welfare-to-Work Strategies (NEWWS) to illustrate why it is important to question the legitimacy of such syntheses. The discussion is carried out using a simple multilevel evaluation model that incorporates models of both individual outcomes within sites and variation in program effects across sites. The results indicate that tempting generalizations about GAIN and NEWWS effects are statistically unjustified but that significant progress might be made in identifying the determinants of program effects in future demonstrations with some changes in evaluation strategy.