Contextualising and evaluating the preliminary effectiveness, feasibility, and acceptability of a Suicide Prevention Program for Secondary School Students in Nepal

SafeTALK is a community-wide awareness program about suicide, its core concepts are Safety and Connectedness (Turley, 2018). To implement the SafeTALK program in Nepal two training programs will need to be completed. The first program is the LivingWorks Applied Suicide Intervention Skills Training (ASIST) - two days (15 Hours) of in-person training. After completing ASIST, a two-day in-person workshop in the Suicide alertness SafeTALK Training for Trainers (T4T) course should also be completed. For this study, the candidate and supervisors will participate in two days of ASIST training (15 hours) in a group of 15 participants, and the PhD candidate will complete the 2 days T4T workshop before implementation of the program. Both ASIST and T4T trainings will be provided by registered trainers of LivingWorks Australia. ASIST means applied suicide intervention skills training, which is two days' workshop containing recognising suicide invitaions, suicide risk assessment assessment and connecting to appropriate service and care to keep the person safe. It is pre-requisite for SafeTALK training for trainers T4T. Training for trainers' is a workshop, which enables the trainer to deliver the SafeTALK. Phase I Focus groups will be conducted to contextualise the SafeTALK program in Nepalese context. (qualitative study). Students studying in grade nine and/or ten in Sunsari districts, parents, teachers, school nurses, mental health professionals, and representative health policymakers will be eligible to participate. The sample size will be 5 to 8 adolescents, 1 to 2 parents, 1 to 2 teachers, 1 school nurse, 1 psychiatric nurse, and 1 policymaker from the epidemiology and disease control division. They will be interviewed in two focus groups (one adolescent group and one stakeholder group). Each focus group will take 1-2 hours depending on the robustness of discussion. A package will be developed outlining the main elements of the existing program (SafeTALK) to facilitate the focus group discussion. This package will be sent to the participants as pre-reading and preparation (two weeks in advance). A guide for the topics to be discussed in the focus group discussion will be provided to participants. Phase II (Intervention/exposure phase) The contextualised SafeTALK program will be delivered by a LivingWorks (Australia) trained researcher (the Ph.D. candidate) who will implement the program across the classroom after having informed consent. The class will be divided into small class sizes (maximum of 30 in each group), up to four groups to deliver the program. One group will receive the intervention one time for approximately 3 hours SafeTALK training; the standard training designed by LivingWorks. containing classroom activities, short videos and discussion. While delivering the program to one group, other students who are not receiving the program at that moment, will be engaged by schoolteachers in other rooms. Maximum of two groups will be trained in one day, training will be completed in 2-3 days. Two support persons will be in the room throughout the intervention to provide mental health support to the participants if required. Session attendance will be marked by roll number of the students. Phase III (qualitative study) Feasibility and acceptability will be assessed by interview method using pre-developed interview schedule. The interviews will be taken by PhD candidate and audio recordings will be obtained with prior consent. Each interview will be conducted for 15-20 minutes. The sample size will be 5 adolescents,3 parents, 3 teachers, 3 nurses, and 3 policymakers from the epidemiology and disease control division (total 15-17). The study population will be selected purposively.