Youth-Nominated Support Team – Version II (YST-II)
*Note: The National Mentoring Resource Center makes these “Insights for Mentoring Practitioners” available for each program or practice reviewed by the National Mentoring Resource Center Research Board. Their purpose is to give mentoring professionals additional information and understanding that can help them apply reviews to their own programs. You can read the full review on the Crime Solutions website.
In considering the key takeaways from the research on this program that other mentoring programs can apply to their work, it’s useful to reflect on the features and practices that might have influenced its rating as “No effects” (that is, a program that, based on review of available evaluation research, does not show evidence of effectiveness for influencing juvenile justice or related outcomes).
One of the most ambitious trends in mentoring in recent years is the integration of mentoring with clinical supports for youth facing a variety of traumas and mental health needs. There is a fairly robust body of research on the value of close, supportive relationships⎯whether between patient and therapist or the patient and family and friends⎯in treating common mental health issues, such as depression or suicidal ideation (see the chapter on Youth with Mental Health Needs in the second edition of the Handbook of Youth Mentoring for a nice review of this research). So it seems logical to speculate that mentors, and the power of mentoring relationships, might be a good stand-alone or supplemental treatment for individuals with mental health needs.
There is also a growing interest in the idea of “networked” approaches to mentoring, in which a youth is paired with one or more mentors who work together, often in concert with other caring adults in the youth’s life, to create more of a “web” of support. This idea offers a promising strategy for harnessing the full range of caring and support available to a young person and, depending on the program model, this type of support can be focused on a particular need or circumstance (see also the chapter on Social Networks and Mentoring in the Handbook of Youth Mentoring for additional information on this theory).
One can see a real blend of these two ideas⎯mentoring as a clinical supplement and a networked approach⎯in the Youth-Nominated Support Team – Version II (YST-II) model. In this program, youth who have been hospitalized with suicidal thoughts or actions were asked to nominate a “team” of caring adults they already know to support their transition out of hospitalization. This is a particularly dangerous time for suicidal youth, as the risk of another attempt is markedly higher during this transition phase. The idea behind the YST-II program is that during this vulnerable period youth would be surrounded by multiple caring adults, ensuring that they would always have someone to turn to and many individuals checking in on the youth’s mood and progress. This team of adults was trained by a clinician to provide targeted support around suicide prevention and were individually tasked with having weekly contact with the youth.
The model makes a lot of sense on paper. Youth who are suicidal often follow through with an attempt based on three factors: perceptions of a lack of belonging, the sense that they are a burden to others, and having the means to actually commit suicide (e.g., acquiring a firearm or lethal drugs, being alone unsupervised for long periods of time, etc.). (See Why People Die By Suicide by Thomas Joiner for more details on this research.) It makes sense that having this team of highly trained, caring mentors, in addition to one’s family, would be a tremendous asset in each of those three areas. Mentors can help these youth feel loved and valued, help them feel positive about themselves and their future, and keep an eye on them to make sure that they stick to their treatment plans (especially medications) and have constant support. And that fact that these were adults the youth already knew meant that much of the potential awkwardness and trust-building of most program-arranged mentoring relationships could be bypassed in favor of deeper and more robust early support.
But in spite of the fact that YST-II seems like the type of support that would complement traditional treatment nicely, the research on the model to date shows no difference for participants compared to those who got treatment-as-usual once leaving the hospital. Not only did it not make a difference in the number of attempts, it also didn’t impact some common precursors of an attempt, such as depression, hopelessness, and everyday functionality. There was a slight decrease at 6 weeks post-treatment in suicidal ideation, but only for youth who had multiple previous attempts, and even then, the decrease did not hold up over time.
So why did this program with such a sound theory fail to produce measurable results? There are several possibilities:
- The mentoring provided through the program was not very long-lasting nor, it seems, robust. The intervention was designed to last only 12 weeks, the most critical time for these youth when leaving hospitalization. The average “team member” contacted these youth 9.51 times, with 7.62 being in-person. So youth did not consistently get the full volume of support the model intended. Particularly concerning, almost one-third of the 233 treatment youth did not have even two team members maintain contact over the entire 12 weeks. One wonders how a suicidal adolescent would feel knowing that their team members weren’t making as frequent contact as intended.
YST-II is based on an earlier version that was a 6-month intervention that produced slightly more encouraging results. Ultimately, the authors of the published article wonder themselves if “the intervention was too ‘lightweight’ in its intensity to overcome or divert the developmental trajectories of these adolescents.” Perhaps a model that provided longer term relationships with more diligent follow-through by the “team” would have produced better results.
- It’s also unclear just how much “mentoring” was happening in these relationships. Other than tracking their contacts with the youth, the researchers didn’t attempt to assess the quality or closeness of these relationships. In theory, since these were all caring adults that the youth already had a relationship with, one can see how they might assume that these relationships were already close. But there was no data in this study of the youth’s perceptions of support or whether they found these relationships helpful.
Perhaps these adults had difficulty transitioning into the role required here? The program did provide training on the youth’s psychiatric disorders and treatment plan, as well as suicide warning signs and strategies for communicating with adolescents. And the support team members were encouraged to do things like help the youth problem-solve and convey hopefulness and caring during their check-ins. But providing this kind of support was likely a challenge to some of the participants and it’s unclear as to how much the program prepared them for this shift in the nature of their relationships with the child. Being someone’s baseball coach or neighbor or teacher is very different than talking directly with them about suicide and depression. One might wonder if perhaps more training is needed to prepare support team members (or youth themselves) for the change that this model will make to their pre-existing relationships.
- One also wonders about the composition of these support teams. In YST-II, parents had final say about who would serve on the support team. Indeed, it would be difficult to imagine an intervention involving minors where parents would not be granted this type of role. One wonders, though, how this played out in this particular intervention. In some instances, parents could have wound up impacting the make-up of these teams in ways that made them less appealing or helpful to the youth. Perhaps, for example, some parents exerted some control over who participated by disagreeing with the youth about their nominations. It’s worth noting that YST-II removed the option (included in YST-I) for a same-age peer to be part of the team. One wonders if perhaps being confronted with a team of parent-approved adult supporters, and no peers, might have played a role in how enthusiastic youth were about the program or how valuable they found the support. It’s entirely possible that a model like this could wind up intensifying a youth’s contact with an already-dysfunctional support system.
- A final possibility behind the “no effects” results is something that the authors of the study note themselves: That this approach actually intensifies the feelings of being a burden for these youth. The authors speculate that “it’s possible that an increase in burdensomeness occurred among some YST-II participants,” although they point out that they have no data confirming this. For a youth who already feels low coming out of a suicidal episode, one can easily see how having this team of adults have to check in on you and devote all this time to your well-being could easily be interpreted as being even more of a “burden” on loved ones. So programs that want to employ mentors in these types of mental health circumstances are well-advised to be aware of the subtle negative messages that can unintentionally be sent by providing the very caring and intensive help these youth need.
The bottom line is that suicide prevention is exceedingly difficult. The study authors note that “multiple evidence-based interventions⎯in combination or in sequence⎯will likely be needed” to turn around this dire circumstance for youth. But we should applaud the researchers behind YST-II for their valuable contributions to our understanding of the intersection between mentoring and mental health services. This program did no harm and there are some hints that it could have a positive impact with more robust design and implementation. Other programs, ideally in collaboration with researchers to ensure rigorous evaluation, should pick up where this idea left off and see what features, such as deeper training or more intensive staff support, can make a difference. But this program also shows that mentoring programs wishing to serve youth with mental health needs must be designed extremely carefully and strive for full fidelity to the model being recommended. In these situations, it really is a matter of life or death.
For more information on research-informed program practices and tools for implementation, be sure to consult the Elements of Effective Practice for Mentoring™ and the "Resources" section of the National Mentoring Resource Center site.