The Sources of Strength Australia Project: a trial investigating the effect of the Sources of Strength program on help-seeking for suicidality in adolescents.

The universal Sources of Strength peer leadership program (https://sourcesofstrength.org/) takes a social connectedness approach to improving help-seeking for suicide and general psychological distress. The program will be run in ACT and NSW high schools. The Sources of Strength program will consist of four phases in the first year of implementation. The first phase will be school and community preparation and will involve a 1-hour presentation to all school staff, and the nomination and training (4-6 hours) of 2-3 staff members per school to act as adult advisors. The initial one-hour recruitment presentation will be delivered by webinar by the United States Sources of Strength Team (Scott LoMurray), facilitated by the research teams at the Australian National University and the Black Dog Institute. The webinar will be presented to the staff members that are nominated to attend from each school. Following school consent to participate in the trial, a one-hour presentation will be delivered to school staff by the trial managers located at the Australian National University and Black Dog Institute. The role of adult advisors will be to support and guide the peer leaders to conduct safe suicide prevention messaging. The adult advisor training will be carried out during one 4-6 hour session. This will be led by the research teams at the Australian National University and the Black Dog Institute. The training is based on a training manual that has been developed by the US Sources of Strength Team. The mode of administration of the training sessions will be group sessions with a researcher. The first phase, school preparation and training of adult advisors, will take place over several months in early 2016. The second phase of the program will be the nomination and training of peer leaders. Schools will be invited to nominate 2-10% (max 50 students) of their students as peer leaders, selecting key opinion leaders in diverse groups. The peer leaders will be nominated by school staff (e.g., executive staff, year co-ordinators, classroom teachers), as identified ‘peer leaders’ of the student body. The focus of peer leader training (4 hours) will be on interactive learning about the 8 protective sources of strength, skills for increasing these resources for themselves and others in times of need, and engaging trusted adults to help distressed and suicidal peers. The term ‘strength’ in this program primarily refers to resilience and coping strategies that may be drawn upon during difficult periods of life. The training and program will focus on positivity, influence and leadership, rather than purely on suicide prevention. The peer-leader training will be conducted by nominated adult advisors and the research teams at the Australian National University and the Black Dog Institute. It will be group information sessions, focusing on teaching skills about asking for help and coping strategies, which they can then pass on to their peer groups. The mode of peer leader training will be one single 4 hour group session. The second phase, nomination and training of peer leaders, is hoped to be completed over two months in early 2016. If enough schools are not recruited into the trial at this time, the training will take place again over two months in the second half of 2016. The third phase of the intervention will be whole-school messaging, which will entail activities to increase connectedness and will be undertaken over a 3-month period. In the first year, the messaging will involve (i) engaging trusted adults by contacting them and acknowledging them as such, (ii) encouraging friends to identify their trusted adults and sharing these on a wall of trust, (iii) undertaking pre-rehearsed classroom presentations to spread the sources of strength message by modelling how they have overcome adversity using positive coping and how they would engage a trusted adult for support for a suicidal friend, and (iv) wider school "Hope, Help, and Strength" messaging using posters, public service announcements, videos and messages posted on social media sites (creating their own materials or using those available on the Sources of Strength Facebook page) to further disseminate the messages of the Sources of Strength program. Messaging will be empowering and strength-based, avoiding trauma, shock or negative messaging, which could instill hopelessness. Peer leaders will meet fortnightly with the adult advisors to plan and approve messaging activities. The third phase, whole-school messaging, will take place over 3 months in each high school allocated to the intervention condition. The fourth phase will be an honouring celebration to recognise the peer leaders for their roles and accomplishments. Peer leaders will provide brief suicide prevention training to parents by sharing what they have learnt. This final phase, of recognising the peer leaders for their roles and accomplishments, and peer leaders providing brief suicide prevention training to parents by sharing what they have learnt, will take place over one session per school at the conclusion of the intervention period. In the second year (2017), the program will be continued with the addition of new adult advisors and peer leaders, and a repeat of the whole-school messaging. The reach and sophistication of messaging is expected to increase in the second year, as peer leaders become more comfortable and confident in their role. The questionnaires that will be delivered at post-intervention will include questions relating to adherence to the intervention for students in the intervention schools, and some questions specific to peer leaders regarding their involvement in the program. Teachers in intervention schools will also be delivered a brief questionnaire regarding the level of intervention exposure and reach that they have witnessed, to monitor school’s adherence to the intervention program. Additionally, researchers will attend sporadic peer-leader meetings at schools, to monitor the conduct of the intervention.