== Precaution ==
This website is not to be considered medical advice under any circumstances.

If you, or anyone you know, are experiencing suicidal ideations, please visit the [https://www.iasp.info/suicidalthoughts/ International Association for Suicide Prevention]
== Introduction ==
This toolkit exists to make '''''freely available''''' and '''''accessible''''' the theory, practical implementation guidelines, and most prominent research in the field of [[Social Network Health]].

For anyone who wants to use a Social Network Health approach to improving the health of their community, this toolkit will provide the essential Theory, which should be understood first, and enough basic implementation guideline to provide the scope and precautionary information needed to evaluate training materials.

Use the major sections below to navigate, and please read through the context section if you are ever in doubt of the context of this toolkit. [https://groups.google.com/a/socialnetwork.health/g/discuss/ We are easy to reach.]

== Major Sections ==

{{Colored box|icon=Tiny_logo_x1.png|background-title-color=#36c|title=Sections|title-color=#fff|background-content-color=#eaf3ff|content=
'''''The Major Sections of this toolkit can be navigated via the hamburger menu: '''''

* [[Theory]] - The Key Findings in Social Network Health and their context.
* [[Practical Implementation]] - The fundamentals of practical implementation of a social network health approach.
* [[Research Library]] - Primary resources, seminal research, educational video explainers, and links to external resources.

}}
== Context ==

=== Project Status ===
The current status of this Toolkit is: '''Alpha'''

''That means we are testing this Toolkit and seeking peer review.''

What we have done to date:

* We have enumerated the key findings in theory, and added references and video support for each.
* We have enumerated the basic precautions and scope of practical implementation
* We have filmed and interviewed the most prominent research team in the field, and dozens of school administrators, teachers, counselors, students and education professionals. And we're just getting started. Less than 1% of that material has been added here to date - so we have a lot to do and a lot to learn and we'll be adding content regularly as time goes on.

==== History ====
This project was conceived in 2021 to document successful implementations in Social Network Health. [https://socialnetwork.health The Social Network Health project] has been filming teachers, students, administrators, counselors, researchers and others since early 2022 - that is ongoing as of this writing. In the process, we have collected research and observed common language, practices, and wisdom that is best compiled and presented in this living, mixed media format. We will be launching the first useful release of this site in 2024.

To learn more about the team, mission, and values of the Social Network Health Project, see [https://socialnetwork.health/about the about page on our main website.]

==== Non-commercial ====
Note that this is a charitable, non-commercial project - you can't buy anything here and we won't recommend anything for purchase, but we will profile materials and training professionals on our main site.

=== Active Research ===
The Network Health Approach describes tools and methods that are under active study, development, and use.

This means that this toolkit will be updated as new research dictates, and, most importantly the version history will reflect changes accurately.

To ensure that you have the latest information, you can check the most recent update date on any page in this wiki, view and read the full version history, see when it was last peer-reviewed, sign up for updates to this toolkit, join our discussion group, and apply to become an editor.

We will update this with new research as it develops. We have a research page where new contexts in which these tools can be used will be described as the tools are applied, researched, and tested within them.

=== Schools First ===
Throughout this toolkit, we will typically assume the context of a school. We are focused on helping there because the need for preventative solutions and research is strong. However, this approach has been proven effective in other contexts such as in the United States Air Force, Police departments, and other contexts you can learn more about on the research page.

Schools are a priority because of their vulnerable, high-potential populations, but also because they have become community hubs and therefore the second and third places in the terminology of Oldenburg. Their increasing importance in modern society as community infrastructure warrants our full attention. Schools can even pull family (the first place) into community by organizing family oriented activities and relationship building.

=== Universality of the Approach ===
We believe that a Social Network Health approach that is universally useful for all communities can be defined, but it will look nothing like the implementation of what is commonly known as a "program".

Programs are developed from approaches and ideally should dissolve into strong culture values and practices. Ecological validity is one finding of Social Network Health research that demands that a program is developed specifically and uniquely for a community - that’s what makes an approach so broadly applicable. This contention is supported by researched implementation across a breadth of communities. A network health approach to preventative care attempts to make individual and community protective factors and social norms a part of everyday culture. Network health approaches that address these processes and can only maintain their universality if they are co-implemented by the community they are developed in.

=== Historical Context ===
The history of preventative mental health care is beyond the scope of this wiki, but it is worth arguing that the characteristics of Social Network Health approaches differ from how mental health has been approached in modern societies most of the world over for the last 100 years, but they are not that different from what existed and still does exist in most cultures in the more distant past. The fact that research has taken humanity full circle to rediscovered excellence is notable and in some cases relevant. Some discussion of this is relevant to understanding practical implementation roadblocks, so this history is expanded on in the [[Practical Implementation|implementation]] page.

=== Medical Model v. Strengths model ===
We are attempting to outline Social Network Health in the context of what we call a "strengths model". The "medical model" of care requires identification of a weakness to begin recommending treatment. In mental health care, some issues have no strong correlates that can be identified as weaknesses early on. Interestingly, there are correlates that can be identified as risk factors in communities that are much stronger indicators of future risk, and more readily identifiable, than individual risk factors.[citation needed] In some cases, strengths-based models that seek to identify strengths of individuals and communities have been shown to be more effective in reducing risk factors than a weakness-based medical model. Treating a community preventatively withy a strengths based-model can also be done without isolating individuals as weak links, separating them from connections. Instead, a strengths based preventative care program identifies strengths and integrates individuals into broader communities.

Ecological Validity

2024-08-07T11:36:27Z

Richbodo: split up the notes and refs

=== Summary ===
[[File:Ecological Validity.mp4|thumb|Dr Peter Wyman, in interview with Tim McGowan, describes the key finding that Ecological Validity is critical to preventative mental health care interventions.]]
Approaches that are designed and built by and with the community (authenticity, organic, grassroots, culturally relevant) have higher transfers of beliefs and skills to daily life. A "program" that is transferred from one environment to another is not a valid Social Network Health approach, and is unlikely to address the cultural norms of the new environment.

=== Notes and References ===

==== Automatically generated stuff from ChatGPT to look over ====
In the context of preventative mental health care, "ecological validity" refers to the extent to which the findings and interventions of mental health research or practices are applicable or relevant to real-world settings. This concept emphasizes the importance of ensuring that research studies, assessment tools, and interventions are reflective of the conditions, challenges, and dynamics that individuals encounter in their everyday lives. Ecological validity is crucial for the effective translation of theoretical knowledge and clinical insights into practical strategies that can be implemented in various environments, such as schools, workplaces, communities, and healthcare settings.

For preventative mental health care, ecological validity ensures that:

# Assessment Tools are relevant and applicable to the diverse situations and contexts in which individuals might experience mental health challenges. This means that tools should accurately reflect the range of symptoms and behaviors as they occur in natural settings, outside of the controlled conditions of a clinical or research environment.
# Interventions are designed to be feasible and effective in the real world. For example, an intervention that promotes mental well-being through regular physical activity should consider factors like access to safe outdoor spaces, availability of time, and cultural attitudes towards exercise.
# Research Findings can be generalized or applied to the target population in their everyday environments. Studies that have high ecological validity provide more useful and actionable insights for public health policies, school-based programs, workplace wellness initiatives, and community mental health services.
# Cultural and Contextual Relevance is maintained, acknowledging that the effectiveness of preventative strategies may vary based on cultural norms, societal structures, and environmental factors. Interventions with high ecological validity respect and incorporate these differences to ensure relevance and effectiveness across diverse populations.

Improving the ecological validity of preventative mental health care initiatives involves ongoing collaboration between researchers, practitioners, community members, and policy-makers. It also requires a commitment to participatory research methods, where interventions are co-developed with those who are meant to benefit from them, and continuous evaluation and adaptation based on real-world feedback and outcomes. By prioritizing ecological validity, preventative mental health care can offer more meaningful, accessible, and sustainable support to individuals and communities.

==== Important References ====
'''''Data-informed implementation preparation.'''''

''Holleman GA, Hooge ITC, Kemner C, Hessels RS. The 'Real-World Approach' and Its Problems: A Critique of the Term Ecological Validity. Front Psychol. 2020 Apr 30;11:721. doi: 10.3389/fpsyg.2020.00721. PMID: 32425850; PMCID: PMC7204431.''

''The main intention for cultural adaptation frameworks (EVM) is to increase the cultural acceptability and effectiveness of the psychological treatment. This is accomplished by making changes that align with the culture of the beneficiary population, while maintaining the components of the evidence-based research that supports the treatment''

''The EVM was selected because it is based on the view that individuals must be understood within their cultural, social, and political environment. The EVM framework serves to ‘culturally center’ an intervention through eight dimensions that must be incorporated for an intervention to have ecological validity and be embedded within the cultural context (Bernal, 2003). These dimensions include language, persons, metaphors, content, concepts, goals, methods, and context (Table 1 in online Supplementary material).''

''Sangraula M, Kohrt BA, Ghimire R, Shrestha P, Luitel NP, Van't Hof E, Dawson K, Jordans MJD. Development of the mental health cultural adaptation and contextualization for implementation (mhCACI) procedure: a systematic framework to prepare evidence-based psychological interventions for scaling. Glob Ment Health (Camb). 2021 Feb 19;8:e6. doi: 10.1017/gmh.2021.5. PMID: 33996110; PMCID: PMC8082944.''

'''''NIMH'''''

'''''Data-informed implementation preparation.'''''

''A “voltage drop” and poor sustainment are common as interventions transition from controlled efficacy trials to regular use. Conversely, scaled out interventions are more impactful with careful preparation using implementation science frameworks.''

'''''JAMA Open Network, October, 2020'''''

''group training design ecologically valid and appealing for participants. Wingman-Connect development benefited from strong organizational collaboration, resulting in an ecologically valid program.''

'''''Evidence-based Methodology:''''' ''A commitment to follow the evidence of impact. Networks of Support’s structure and key elements strengthen relationship networks, cohesion, adaptive coping, and group norms. Group-based, interactive training uses research-informed strategies.''

'''''JAMA Open Network, October, 2020'''''

'''''Research Outcomes – Evidence Based Key Findings include:'''''

* ''Increased class cohesion, morale, positive bonds, and acceptability of help seeking''
* ''Reduction in suicide risks scores, depression, and reactivity to anger''
* ''Nearly 50% reduction in occupational impairment (corrective training, negative counseling)''

'''''Measurable Impact on both Protective Factors and Risk Factors'''''

''Wingman-Connect was tested using the '''gold-standard research design with Airmen in Training''' from 2017-2019 (randomized controlled trial). Training showed statistically significant increases in group and individual level protective factors, as well as reductions in negative outcomes including and depression and suicide risk. ''

''Class exercises create more cohesive units with skills extended into group culture.''' ''' Wingman Connect training is delivered to organizational units using interactive exercises to build key group and individual protective factors.''

''Wingman-Connect impact promoting more cohesive, healthy training classes was a mechanism that reduced risk for suicidal thoughts and behaviors. More cohesive, healthy classes ‘lifted up’ individuals who were vulnerable to fitness and mental health problems. Study findings suggest that group training for organizational units may be critical for ‘transfer’ of training concepts and skills into the organization’s culture.''

'''''Social Science & Medicine''' Social Science & Medicine 296 (2022) 114737''

''The current attention on the detection and treatment of suicidal military members is necessary, but ultimately insufficient to meet the needs of many suicidal service members. Results from our study suggest that the status quo progression for many service members at elevated suicide risk is one of worsening disconnection, evidenced by the trajectory of declining valued connections found in the active control condition.''

''Program achieved the objective of strengthening the network structure of unit relationships over time, including socially integrating those currently at elevated risk for suicide. This is an especially important hypothesis since W-CP training has no content encouraging Airmen to form connections with at-risk peers.''

'''''NIMH'''''

''Effective upstream suicide prevention programs that can be implemented in real-world settings are urgently needed to address the significant and growing problem of suicides.''

''No RCT-validated universal programs shown to reduce vulnerability to suicide are in wide use. To fill this gap, we developed the Wingman-Connect Program–group-based prevention approach that strengthens protective relationship networks and skills for managing challenge. This strategy of reducing suicide risk could be highly impactful as a complement to the predominant approach of trying to mitigate risk only after suicidal individuals are identified.''

''Wyman has led research (NIH, CDC funded) testing that program, which disseminates skills for social health through youth peer networks. The high-energy, interactive training improves student connectedness and coping norms, and protective effects spread school-wide including adult help for suicidal youth. A study aggregating three RCTs (N=78 schools; 39,900 students) showed fewer suicide deaths in schools implementing this approach.'' 

'''''Effectiveness Trial of Wingman-Connect Implemented Across Career Phases'''''

''Submitted to the National Institute of Mental Health, PAR21-130, 10/13/2022''

''Group training that builds cohesive, healthy military units is promising for upstream suicide prevention and may be essential for ecological validity''

''A “voltage drop” and poor sustainment are common as interventions transition from controlled efficacy trials to regular use.''

''Conversely, scaled out interventions are more impactful with careful preparation using implementation science frameworks.''

''“The concept of ecological validity has become familiar to psychologists. It reminds them that the artificial situation created for an experiment may differ from the everyday world in crucial ways. When this is so, the results may be irrelevant to the phenomena that one would really like to explain.”''

''To bridge the gap between lab and life, many researchers have called for experiments with more ‘ecological validity’ to ensure that experiments more closely resemble and generalize to the ‘real-world.’''

Prioritizing Prevention

2024-08-07T11:32:59Z

Richbodo: divide refs off

=== '''Upstream prevention is necessary'''. ===
[[File:Universal Prevention.mp4|thumb|Dr Peter Wyman describes the import of prioritizing universal approaches to prevention for community mental health.]]Research has found that prevention is, in fact, the most effective way to prevent many mental health issues. [citation needed]. Social Network Health approaches, which emphasize community relationships, are suited for prevention by design. Network health interventions target natural organizational groups to strengthen bonds, cohesion, and adaptive coping norms, all of which are logical targets for upstream suicide prevention. The side effects of focusing on prevention are, in sum, positive for community mental health. In the absence of the administration of universal screeners, or risk indicators available through diagnosis, broad based prevention can reach an entire community to reduce risk factors and increase protective factors.[citation needed] Preventive Interventions delivered in social systems are needed for broad impact.
[[File:Prevention or Intervention.mp4|thumb|Dr Peter Wyman explains that a "preventatative intervention" that engages a community as a whole and creates natural networks through shared experience can build protective factors into the community.]]
Existing intervention programming focuses on detecting and remediating risk after suicidal individuals are identified. Although undoubtedly saving lives, this approach is insufficient on its own. According to Wyman (2020), using a network health framework, that strengthens positive social bonds and building healthy norms that incentivize adaptive coping, is a prevention model that has shows promising benefits. Expanding the focus on modifying “upstream” risk and protective processes—before the emergence of suicidal behavior—stands in contrast to current prevention programming focused on adult gatekeepers and screening after risks are identified. (Wyman 2014)

Upstream interventions, delivered through social systems in childhood and early adolescence, have the potential for reducing population-level suicide rates. By decreasing the number of adolescents with mental emotional and behavioral problems, as well as creating social environments that expose adolescents to positive coping norms, increase youth-adult connections, and reducing the impact adverse experiences. (Wyman 2014) Childhood and adolescence are key suicide “prevention window” periods. Approximately one half of emotional and behavioral disorders that are well-defined risk factors for suicide have onset of symptoms by age 14 years.

=== Research References to integrate: ===
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578767/#:~:text=That%20diverse%20personnel%20benefited%20from%20the%20program%20illustrates%20a%20strength%20of%20a%20universal%20prevention%20strategy%20for%20military%20populations%20with%20members%20at%20low%20risk%20and%20others%20at%20higher%20risk%20who%20may%20not%20seek%20mental%20health%20services. 1] - That diverse personnel benefited from the program illustrates a strength of a universal prevention strategy for military populations with members at low risk and others at higher risk who may not seek mental health services.

[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7578767/#:~:text=The%20dual%20benefits,to%20be%20sustained. 2] - The dual benefits for occupational functioning and mental health underline a strength of upstream prevention implemented before the detection of serious suicidal behavior: skills that strengthened the trainee’s capability to meet job-related challenges also reduced depression and suicidal ideation. Universal prevention programs that support operational and suicide prevention objectives are more likely to be sustained.

'''Prevention in schools:'''

Modern conceptions of mental health have transitioned from a predominantly problem reduction focus to a wellness promotion focus (Suldo & Shaffer, 2008). Thus, rather than exclusively targeting symptom reduction in individuals with mental illness, mental health services have gravitated towards prevention services that promote general wellness of the population (Prinz & Sanders, 2007). To attend to these issues, school-wide interventions based on the public health prevention model emerged in schools, most notably in the form of positive behavior interventions and support (PBIS; Smith, Molina, Massetti, Waschbush, & Pelham, 2007). Tier 1 systems, data, and practices support everyone across all settings. They establish the foundation for delivering regular, proactive support and preventing unwanted behaviors.

'''Peer-adult network structure and suicide attempts in 38 high schools: implications for network-informed suicide prevention (10,291 students) '''

'''Journal of Child Psychology and Psychiatry *: * (2019), Peter A. Wyman, Trevor A. Pickering, Anthony R. Pisani, et al.'''

'''Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training. A Cluster Randomized Clinical Trial'''

'''JAMA Open Network, October, 2020'''