Extending a Theory of Change: Qualitative Research of a Novel Approach to Suicide Prevention

• In Event: Past and Future of School-Based Youth Suicide Prevention: Overview and Exemplar from the Field

Abstract

Paper 3 will present findings from a pilot qualitative study conducted as preliminary research for a mixed-method 40-school randomized waitlist-control study of the Directing Change school-based program (currently underway). In Directing Change, students create brief films in mental health/suicide prevention and disseminate them to the school community. The hands-on process of filmmaking is designed to facilitate learning of prevention actions, and program features encourage students to infuse messages with youth-oriented, identity- and culturally-specific perspectives. As students discuss and disseminate films in schools, Directing Change is expected to reduce stigma and change norms, connecting youth to trusted adults more quickly than they would otherwise. A 2016 matched-comparison study demonstrated evidence of impacts on student knowledge, behaviors, and norms (Ghirardelli et al., 2016).

We conducted one hour one-on-one interviews with ~20 advisors and student participants, to understand their experiences with the program and the program’s theory of change. Advisors represented differing roles in schools (teacher, counselor, principal) and had implemented Directing Change in a variety of class settings (i.e., film, video production, freshman seminar, English) with a range of students (i.e., all freshman as a required class, an advanced film class for seniors, elective open to all grades). We transcribed and coded the interviews using a directed approach, using our preliminary theory of change as an initial guidepost.

Our thematic review identified the following mechanisms of change: a) greater knowledge: about the signs of suicidal thinking and self-efficacy to intervene on behalf of a friend; b) shifting norms and opening up conversations: among teammates as they worked on films together, between advisors and students in the class, between students more broadly, and, sometimes, between students and families; c) students becoming leaders (“reluctant leaders”) in ways they hadn’t expected and students (and advisors) finding themselves “known” as sources of information and support to other students after films were disseminated; and d) sense of connectedness and belonging: by making films and watching films, students reported seeing that peers were struggling with similar challenges as they were, making them feel less alone. See Table 1 for exemplar student quotes from these qualitative surveys. As a result of our qualitative interviews, we refined our theory of change for how Directing Change is thought to impact focal students (in Directing Change classrooms) and other students in those same schools (see Figure).

These analyses extend our understanding of this innovative program and demonstrate the value of embedding qualitative surveys at the outset of program evaluation efforts as a means to guide study design efforts. This work provided preliminary guidance to a William T. Grant-funded cluster (school) randomized study of the Directing Change program that launched in summer 2022 of 40 largely Latinx high schools across California. Findings will be presented in the context of that ongoing work, including responses of an embedded Youth Advisory Board. We will close with a discussion of implications for school-based suicide prevention and promising levers of change.

Authors

• Rachel M Abenavoli, New York University
  Presenting Author

• Pamela Morris-Perez, New York University