Toolkit.Socialnetwork.Health - User contributions [en]

Ecological Validity

2024-07-30T21:07:58Z

Tmcgowan1: change formatting

=== Summary ===
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 ===

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.

=== Automatically generated stuff from ChatGPT to look over (Above) ===

'''''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

2024-07-30T19:11:26Z

Tmcgowan1: changing page

'''Upstream prevention is necessary'''.

Research has found that prevention is, in fact, the most effective way to prevent many mental health issues. []. 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.[] Preventive Interventions delivered in social systems are needed for broad impact.

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.

'''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.

Dig In: (Link these to the research page) We just need the title and then send them to the research)

'''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'''

<s>In modern contexts, preventative mental health care is rarely prioritized and extremely poorly resourced as a component of an integrated health care system in accordance with it's value to communities.[] '''(This is an opinion)'''</s>

<s>Many effective programs for children and adolescents prevent or reduce the severity of these mental, emotional, and behavioral problems, according to a recent National Academy of Sciences review. In addition to being a critical period for preventing disorders, childhood and early adolescence are important periods for preventing the onset of suicidal behaviors (Wyman 2014)</s>

Prioritizing Prevention

2024-07-30T18:50:43Z

Tmcgowan1: Working on structure

'''Upstream prevention is necessary'''.

Research has found that prevention is, in fact, the most effective way to prevent many mental health issues, including suicidal ideation, <s>in many circumstances</s>[]. Social Network Health approaches, which emphasize community relationships, are suited for prevention by design . In the absence of universal screeners or indicators available through diagnosis, broad based prevention can reach an entire community to reduce risk factors and increase protective factors.[] The side effects of focusing on prevention are, in sum, positive for community mental health. Preventive Interventions delivered in social systems are needed for broad impact.

Existing military suicide 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 theoretical framework to strengthen positive social bonds, and Building healthy norms that incentivize adaptive coping.This expanded focus on modifying “upstream” risk and protective processes—before the emergence of suicidal behavior—stands in contrast to current youth suicide prevention programming focused on identifying and treating individuals who are already suicidal or at high risk by training adult gatekeepers and screening. (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.

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. Strong bonds reduce vulnerability to depression, and postenlistment depression is a specific factor associated with suicide attempts among military personnel. Skills focused on growing and sustaining 4 core protective values: kinship (belonging and accountability), purpose (goals and motivating values), guidance (mentors and institutional resources), and balance (activities for well-being). Each class completed group exercises emphasizing cohesion, shared purpose, and the value of a healthy unit.

'''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). PBIS is a framework or approach that provides the means of selecting, organizing and implementing [evidence-practices] by giving equal attention to (a) clearly defined and meaningful student outcomes, (b) data-driven decision making and problem solving processes, and (c) systems that prepare and support implementers to use these practices with high fidelity and durability. (Sugai & Horner, 2010, p. 4).

Tier 1 systems, data, and practices support everyone across all settings. They establish the foundation for delivering regular, proactive support and preventing unwanted behaviors. Tier 1 emphasizes modeling, teaching, and acknowledging positive social, emotional, and behavioral (SEB) skills.

<nowiki>https://www.pbis.org/pbis/tier-1</nowiki>

Dig In: (Link these to the research page) We just need the title and then send them to the research)

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

In 38 US high schools, 10,291 students nominated close friends and trusted adults to construct social networks. Network interventions addressing these processes, such as maximizing youth-adult connections schoolwide and heightening influence of youth with healthy coping, could create more protective schools. Lower peer network integration and cohesion increased likelihood of SI and SA across individual and school-level models. Two factors increased SA: student isolation from adults and suicidal students' popularity and clustering.

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

To date, suicide prevention has focused primarily on individual-level psychiatric risk factors and on strategies to refer and treat high-risk youth. Yet researchers and policymakers recommend strengthening positive social bonds because social integration can reduce suicidal behavior in youth

To our knowledge, this is the first study of any adolescent health problem, including suicidal behavior, that integrates adult connections into friendship networks at a school population level.

Network interventions addressing these processes, such as maximizing youth–adult connections schoolwide and heightening influence of youth with healthy coping, could create more protective schools. The present study is the first empirical evidence linking more integrated youth–adult networks (i.e., students sharing trusted adults with friends) to lower Suicide Attempts.

'''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'''

Group training that builds cohesive, healthy military units is promising for upstream suicide prevention.

The Wingman-Connect program used group skill building for cohesion, shared purpose, and managing career and personal stressors. Wingman-Connect is the first universal prevention program to reduce suicidal ideation and depression symptoms in a general Air Force population. Group training that builds cohesive, healthy military units is promising for upstream suicide prevention.

Wingman-Connect is the first universal prevention program to reduce suicidal ideation and depression symptoms in a general Air Force population. Group training that builds cohesive, healthy military units is promising for upstream suicide prevention and may be essential for ecological validity.

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.

Strong bonds reduce vulnerability to depression, and postenlistment depression is a specific factor associated with suicide attempts among military personnel.

Skills focused on growing and sustaining 4 core protective values: kinship (belonging and accountability), purpose (goals and motivating values), guidance (mentors and institutional resources), and balance (activities for well-being). Each class completed group exercises emphasizing cohesion, shared purpose, and the value of a healthy unit.

Wingman-Connect participants gained on all class protective factors: cohesion, morale, bonds to classmates, and perceptions that members support healthy behaviors

Wingman-Connect increased positive career behaviors and reduced anxiety and anger. Social impairments were reduced among participants

The magnitude of effects at 1 month (ES, −0.23 to −0.24) was equivalent to those of state-of-the-art prevention programs targeting broad adolescent and young adult populations where the majority are not at high risk.61 The beneficial impact on reduced depression symptoms was maintained at 6 months, including lower likelihood of elevated depression (OR, 0.80) over the full study period.

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

The study’s findings validate the underlying network health model: stronger bonds within a more cohesive healthy class reduced suicidal ideation and depression symptoms

These findings suggest that Wingman-Connect classes became increasingly unified around healthy norms and encouraged classmates who were vulnerable to mental health or occupational problems at a key juncture of military training, in addition to meeting their needs for belonging

Instrumental mentoring can be a vehicle for evidence-based practice in a manner that allows for evaluations of independent and combined effects with other interventions. We propose that integration of SBM and school-wide supports systems can improve both programmes if stakeholder systematically ‘select, organize and implement’ instrumental programmes similar to the one described in this paper. For example, consider a middle school that has goals such as improving academic organization. The PBIS team could promote this goal at a primary prevention level (i.e. Tier 1) by setting school-wide expectations, encouraging universal classroom instruction and delivering rewards to students that maintain academic organization. A PBIS monitoring system could quickly identify at-risk students by measuring their response to the primary intervention. School support teams could then refer students not responding to the primary programme to an instrumental mentoring intervention, the mentoring programme being the Tier 2 or secondary intervention. By using volunteer mentors, school-based mental health teams could provide more Tier 2 intervention services to more students than they could using native school staff

<nowiki>https://www.researchgate.net/profile/Samuel-Mcquillin/publication/259176991_Innovation_in_school-based_mentoring_Matching_the_context_structure_and_goals_of_mentoring_with_evidence-based_practices/links/56bb5ede08ae0908186810d6/Innovation-in-school-based-mentoring-Matching-the-context-structure-and-goals-of-mentoring-with-evidence-based-practices.pdf</nowiki>

<s>Wingman-Connect addresses an urgent need for preventions that are effective in reducing suicide risk across broad populations – particularly where stigma and concerns about negative career impacts remain major barriers to disclosing suicidal thoughts/behaviors.</s>

<s>In modern contexts, preventative mental health care is rarely prioritized and extremely poorly resourced as a component of an integrated health care system in accordance with it's value to communities.[] '''(This is an opinion)'''</s>

<s>Many effective programs for children and adolescents prevent or reduce the severity of these mental, emotional, and behavioral problems, according to a recent National Academy of Sciences review. In addition to being a critical period for preventing disorders, childhood and early adolescence are important periods for preventing the onset of suicidal behaviors (Wyman 2014)</s>

Prioritizing Prevention

2024-07-30T18:29:58Z

Tmcgowan1: Changed summary at the top

Research has found that prevention is, in fact, the most effective way to prevent many mental health issues, including suicidal ideation, <s>in many circumstances</s>[]. Social Network Health approaches, which emphasize community relationships, are suited for prevention by design . In the absence of universal screeners or indicators available through diagnosis, broad based prevention can reach an entire community to reduce risk factors and increase protective factors.[] The side effects of focusing on prevention are, in sum, positive for community mental health.

<s>In modern contexts, preventative mental health care is rarely prioritized and extremely poorly resourced as a component of an integrated health care system in accordance with it's value to communities.[] '''(This is an opinion)'''</s>

NOTES:

'''Upstream prevention is necessary'''.

Existing military suicide intervention programming focuses on detecting and remediating risk after suicidal individuals are identified. Although undoubtedly saving lives, this approach is insufficient on its own.

Wingman-Connect addresses an urgent need for preventions that are effective in reducing suicide risk across broad populations – particularly where stigma and concerns about negative career impacts remain major barriers to disclosing suicidal thoughts/behaviors.

Wingman-Connect (Wyman et al., 2020 & 2022) uses a network health theoretical framework to strengthen two suicide-protective functions of social networks: 1) Strengthening positive social bonds, and 2) Building healthy norms that incentivize adaptive coping.

This expanded focus on modifying “upstream” risk and protective processes—before the emergence of suicidal behavior—stands in contrast to current youth suicide prevention programming focused on identifying and treating individuals who are already suicidal or at high risk by training adult gatekeepers and screening. (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.2 Many effective programs for children and adolescents prevent or reduce the severity of these mental, emotional, and behavioral problems, according to a recent National Academy of Sciences review.2 In addition to being a critical period for preventing disorders, childhood and early adolescence are important periods for preventing the onset of suicidal behaviors (Wyman 2014)

Interventions delivered in social systems are needed for broad impact Children develop through interactions within social systems (e.g., families, schools), and interventions in these systems can influence emotional and behavioral developmental processes of large youth populations essential to reduce suicide rates. (Wyamn 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 reduce adverse experiences such as bullying. (Wyman 2014)

''Wyman PA. Developmental approach to prevent adolescent suicides: research pathways to effective upstream preventive interventions. Am J Prev Med. 2014 Sep;47(3 Suppl 2):S251-6. doi: 10.1016/j.amepre.2014.05.039. PMID: 25145747; PMCID: PMC4143775.''

'''Treatment:'''

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

In 38 US high schools, 10,291 students nominated close friends and trusted adults to construct social networks. Network interventions addressing these processes, such as maximizing youth-adult connections schoolwide and heightening influence of youth with healthy coping, could create more protective schools. Lower peer network integration and cohesion increased likelihood of SI and SA across individual and school-level models. Two factors increased SA: student isolation from adults and suicidal students' popularity and clustering.

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

To date, suicide prevention has focused primarily on individual-level psychiatric risk factors and on strategies to refer and treat high-risk youth. Yet researchers and policymakers recommend strengthening positive social bonds because social integration can reduce suicidal behavior in youth

To our knowledge, this is the first study of any adolescent health problem, including suicidal behavior, that integrates adult connections into friendship networks at a school population level.

Network interventions addressing these processes, such as maximizing youth–adult connections schoolwide and heightening influence of youth with healthy coping, could create more protective schools. The present study is the first empirical evidence linking more integrated youth–adult networks (i.e., students sharing trusted adults with friends) to lower Suicide Attempts.

'''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'''

Group training that builds cohesive, healthy military units is promising for upstream suicide prevention.

The Wingman-Connect program used group skill building for cohesion, shared purpose, and managing career and personal stressors. Wingman-Connect is the first universal prevention program to reduce suicidal ideation and depression symptoms in a general Air Force population. Group training that builds cohesive, healthy military units is promising for upstream suicide prevention.

Wingman-Connect is the first universal prevention program to reduce suicidal ideation and depression symptoms in a general Air Force population. Group training that builds cohesive, healthy military units is promising for upstream suicide prevention and may be essential for ecological validity.

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.

Strong bonds reduce vulnerability to depression, and postenlistment depression is a specific factor associated with suicide attempts among military personnel.

Skills focused on growing and sustaining 4 core protective values: kinship (belonging and accountability), purpose (goals and motivating values), guidance (mentors and institutional resources), and balance (activities for well-being). Each class completed group exercises emphasizing cohesion, shared purpose, and the value of a healthy unit.

Wingman-Connect participants gained on all class protective factors: cohesion, morale, bonds to classmates, and perceptions that members support healthy behaviors

Wingman-Connect increased positive career behaviors and reduced anxiety and anger. Social impairments were reduced among participants

The magnitude of effects at 1 month (ES, −0.23 to −0.24) was equivalent to those of state-of-the-art prevention programs targeting broad adolescent and young adult populations where the majority are not at high risk.61 The beneficial impact on reduced depression symptoms was maintained at 6 months, including lower likelihood of elevated depression (OR, 0.80) over the full study period.

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

The study’s findings validate the underlying network health model: stronger bonds within a more cohesive healthy class reduced suicidal ideation and depression symptoms

These findings suggest that Wingman-Connect classes became increasingly unified around healthy norms and encouraged classmates who were vulnerable to mental health or occupational problems at a key juncture of military training, in addition to meeting their needs for belonging

PBIS:

Tier 1 systems, data, and practices support everyone across all settings. They establish the foundation for delivering regular, proactive support and preventing unwanted behaviors. Tier 1 emphasizes modeling, teaching, and acknowledging positive social, emotional, and behavioral (SEB) skills.

<nowiki>https://www.pbis.org/pbis/tier-1</nowiki>

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). PBIS is a framework or approach that provides the means of selecting, organizing and implementing [evidence-practices] by giving equal attention to (a) clearly defined and meaningful student outcomes, (b) data-driven decision making and problem solving processes, and (c) systems that prepare and support implementers to use these practices with high fidelity and durability. (Sugai & Horner, 2010, p. 4).

Instrumental mentoring can be a vehicle for evidence-based practice in a manner that allows for evaluations of independent and combined effects with other interventions. We propose that integration of SBM and school-wide supports systems can improve both programmes if stakeholder systematically ‘select, organize and implement’ instrumental programmes similar to the one described in this paper. For example, consider a middle school that has goals such as improving academic organization. The PBIS team could promote this goal at a primary prevention level (i.e. Tier 1) by setting school-wide expectations, encouraging universal classroom instruction and delivering rewards to students that maintain academic organization. A PBIS monitoring system could quickly identify at-risk students by measuring their response to the primary intervention. School support teams could then refer students not responding to the primary programme to an instrumental mentoring intervention, the mentoring programme being the Tier 2 or secondary intervention. By using volunteer mentors, school-based mental health teams could provide more Tier 2 intervention services to more students than they could using native school staff

<nowiki>https://www.researchgate.net/profile/Samuel-Mcquillin/publication/259176991_Innovation_in_school-based_mentoring_Matching_the_context_structure_and_goals_of_mentoring_with_evidence-based_practices/links/56bb5ede08ae0908186810d6/Innovation-in-school-based-mentoring-Matching-the-context-structure-and-goals-of-mentoring-with-evidence-based-practices.pdf</nowiki>

Theory

2024-07-30T17:49:02Z

Tmcgowan1: Edit Theory main page

== Key Findings in Social Network Health ==
Social Network Health define implementation strategies we have studied through a meta analysis and direct practice. These 14 findings are critical to developing a [[SNH Maturity Model|mature approach]] to strengthening social networks in community. Among the key findings, we currently identify ten that necessitate specific actions to directly related to desired outcomes. The final four findings are direct community health measurements. The number of key findings we describe may change as further research and implementation reveal new insights over time.

=== Key Action Findings: (Beliefs/tenets) (HOW) ===

==== '''Prevention: ''' ====
Effective and efficient prevention builds individual and community protective factors and social norms. Network health approaches that address these processes, such as maximizing youth-adult connections school-wide, heightening influence of youth with coping, and creating protective schools.

Dive in: [[Prioritizing Prevention]]

==== '''Ecological Validity:''' ====
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.

Dive in: [[Ecological Validity]]

==== Evidence-Based Methodology: ====
Social Network Health approaches require an ongoing commitment to follow documented evidence of impact by studying research and implementation in the field of preventative mental health care.

Dive in: [[Evidence-Based Methodology]]
==== '''Consistency: ''' ====
Social Network Approaches require long-term commitment to intentional cultural integration, relationship and skill building, and re-evaluation and modification of programming over time. Mentors that regularly interact deeply with communities over time build consistent programming and genuinely change culture.

Dive in: [[Consistency]]

==== Discovery: ====
Discovery is the mechanism to explore personal strengths , how other’s strengths can be shared, and the community can borrow strength to affect change. When everyone’s competencies are recognized, the group is aware of it's collective strengths and the value of all members.

Dive in: [[Discovery]]

==== '''Whole Community''': ====
A Social Network Health approach is when everyone in the community is invited to contribute to the overall health of the social network. Involving as much of the community as possible contributes to efficiency (using the community instead of outsiders), co-creation (ecological validity), and discovery of strengths.

Dive in: [[Whole Community]]

==== Peer Influence: ====

Peer influenced or peer-peer activities promote relationships between peers, engages people in their existing communities, leveraging existing relationships and common interests, while enhancing their knowledge of one another and their potential within their community.

Dive in: [[Peer-influenced|Peer Influence]]

Notes:

We might want to change this to: [[Social Leverage]]

"leveraging social influences to prevent emerging risk"

The argument against social leverage is that it doesn't itself communicate that relationships between peers are the practical core of the idea, here.

==== '''Mentoring: ''' ====
Mentoring is a practice and a skill set that supports others through listening, sharing and connecting.

Dive in: [[Mentoring]]
==== Active Learning: ====
High-energy activities maintain interest, motivation, and create shared positive emotional experiences to create norms and provide incentive to acquire adaptive coping skills through experience. Space is created to practice skills that grow healthy bonds and draw upon resources in the community.

Dive in: [[Active Learning]]

Notes: We are preferring Active Learning to experiential learning because it's a more modern and recognizable term and it is more common to find the term in supporting evidence.

==== Personally Meaningful Sharing: ====
Participants are invited to share personally relevant goals, values, and experiences. Using meaningful sharing draws upon real life strengths and conversations as a way to teach, discover, and understand one another.

Dive in: [[Deep conversations|Deep Conversations]]

=== Key Outcome Findings: ===

==== '''Group Cohesion:''' ====
Group Cohesion is an outcome resulting from feeling connected to others. An environment where youth-adult networks share in experiential learning maximizes protective bonds.

Dive in: [[Group cohesion|Group Cohesion]]

==== '''Connection to Guidance:''' ====
Connection to guidance is the protective factor that encourages the identification of trusted adults who can be used as a resource, free of judgment, during times of relational disconnection or crisis.

Dive in: [[Connection to Guidance]]
==== '''Belonging:''' ====
A sense of Belonging is the feeling of being accepted, valued, and connected within a community or group.

Dive in: [[Belonging]]

==== '''Help Seeking:''' ====
Help seeking behaviors are actions taken by individuals to seek assistance or resources to address potential or existing mental health concerns before they become more severe.

Dive in: [[Help-Seeking Behaviors|Help Seeking]]

== Commentary on Key Findings: ==
Preventative care is one category within a holistic integrated system of mental health continuum. Simplistically and fundamentally, it is critically important to address both Preventative and Emergency care within an integrated system. A key result from meta analysis, is many social factors increase the risk of developing a mental health condition. However, focusing on reactive treatment of those factors is not the most efficient way to reduce the onset of mental health conditions. [citation required]. Instead, building protective factors across a community, which results in a widespread sense of belonging, appears to be extremely effective in reducing risk factors.

The makeup of a healthy school environment is unique to every school. A healthy school environment cannot be duplicated by simply following a written manual or video series and/or taking a one-time training. Building culture needs to be intentional by developing ecologically valid skills and practices that are unique to each community. Research has shown that the time spent building healthy connections has an impact on the reduction in suicide idealization, social pruning and documented disciplinary incidents. A Social Network Health Approach to preventative mental health care, draws on published research from the University of Rochester Center for the Study and Prevention of Suicide and from the implementations by preventative mental health care professionals in close cooperation with them.

<s>Individuals who feel a sense of belonging in their community can acquire skills in the naturally occurring environment they are in.</s>

<s>by an increase in attendance and performance, and by an emotionally recharged community that spends the bulk of their time working preventatively, instead of performing interventions after disruptive and damaging incidents.</s>

<s>To make that happen in a community (a school environment, for example), the school community must develop group cohesion. Cohesion is created from strong, healthy connections between student peers and between students and trusted adult guides throughout the community.</s>

<s>To engage with one another optimally, a community must discover the strengths of individuals and groups. Discovery must be practiced and developed as a skill. Active learning and heavily [[peer-influenced]] activities and initiatives have been show to be effective as part of a methodology to kick-start discovery and ultimately lead to deep conversations, which are the most powerful method of learning and bonding in social networks.</s>

<s>When a whole school community is cohesive, and has strong, healthy connections throughout, it’s members become more activated, more engaged, and more energized. </s>

<s> These skills and practices become cultural norms that are developed across years of consistency of practice.</s>

<s>Defining the Social Network Health Approach within an integrated system of care:</s>

Mentoring

2024-07-28T23:26:45Z

Tmcgowan1: added to definition of mentroing

=== Summary ===
Training youth as mentors allows them to lead and guide each other. In school contexts, the selection of mentors has been studied extensively and is an important part of the process of building a community of both activated adults and activated peers. This not only builds leadership and other skills for peer mentors, but it expands the number of community members who are involved in developing the program and building stronger relationships throughout the community. Many more positive interactions (both shallow and deep shares) can be had within the community, between those with more shared experience, at far lower resource expenditure, if more peers are involved in the process of growing the program and establishing healthy cultural norms.

For the purpose of this model we will focus on two types of mentoring:‘

'''Developmental'''-Relationship, dyadic, social, emotional, cognitive development.

'''Instrumental''': Skill acquisition, goal setting, curriculum based

=== Notes and References ===

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

Airmen learn skills to grow and sustain protective factors essential to job success, mental health and reduced suicide risk (Kinship, Purpose, Guidance, Balance). 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 (Four Cores):

* Group cohesion and belonging (Kinship)
* Informal and formal support and help-seeking (Guidance)

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

Specific modules and activities build healthy relationships and accountability (Kinship) informal and formal help-seeking (Guidance).

'''An Outcome Evaluation of Suicide Prevention Program Delivered by Adolescent Peer Leaders in High Schools ''' Am J Public Health. 2010 September; 100(9): 1653–1661

The norms most strongly enhanced through the intervention were students' perceptions that adults in their school can provide help to suicidal students and the acceptability of seeking help from adults.

Belonging

2024-07-28T23:05:40Z

Tmcgowan1: Added to summary

=== Summary ===
A sense of Belonging is the feeling of being accepted, valued, and connected within a community or group. The importance of social connectedness and sense of belonging is supported by the findings on numerous health risks of the experience of social isolation and loneliness. Research supports the notion that the phenomenon of belonging and connectedness is universal and appears to be a basic human need in the context of well-being and participation, regardless of the type of community one belongs to.

Belonging is an outcome of environment building and participation in healthy group activities. When everyone in a group is invited to participate in an activity, and they then experience the positive and appropriate engagement of others, this encourages positive social bonds that augment the protective effects of inclusion and support, and build trust.

=== Notes and References ===
'''JAMA Open Network, October, 2020'''

Group training that builds cohesive, healthy military units is promising for upstream suicide prevention.

The study’s findings validate the underlying network health model: stronger bonds within a more cohesive healthy class reduced suicidal ideation and depression symptoms. These findings suggest that Wingman-Connect classes became increasingly unified around healthy norms and encouraged classmates who were vulnerable to mental health or occupational problems at a key juncture of military training, in addition to meeting their needs for belonging.

We cannot separate the importance of a sense of belonging from our physical and mental health. The social ties that accompany a sense of belonging are a protective factor helping manage stress and other behavioral issues. When we feel we have support and are not alone, we are more resilient, often coping more effectively with difficult times in our lives. Coping well with hardships decreases the physical and mental effects of these situations.

<nowiki>https://www.mayoclinichealthsystem.org/hometown-health/speaking-of-health/is-having-a-sense-of-belonging-important</nowiki>

Social connectedness and sense of belonging—the feelings of being a part of a larger group of individuals—are thought to be basic human needs [24,25]. The experience of a significant bond with a physical, relational, symbolic, or even imagined collectives is crucial for the survival of the individual, as well as for the continuity and prosperity of the community

The prevalent theoretical framework for a sense of community addresses four core elements [6]. ‘Membership’ (1) addresses feelings of belonging, emotional security, and identification. ‘Influence’ (2) refers to the ability of members make an impact on a community, and vice versa. ‘Integration and fulfillment of needs’ (3) implies that the community is capable of satisfying the physical and psychological needs of its members, which will reinforce members’ commitment to it. ‘Shared emotional connection’ (4) stems from identifying with a shared history of the community through personal investment and interaction with other members of the community

Indeed, there was a wide range of reported communities to belong to in this study, e.g., family, work, leisure groups, etc. Each type of community had its specific characteristics, suggesting different social roles, patterns of relationship, and communications, and providing different pathways and possibilities for connectedness and belonging [64,65].

This result is of importance in light of the strong association between the extent of the sense of connectedness and belonging and the level of well-being [23,25,30], suggesting that once the person established connectedness and belonging to any community, this provides a beneficial effect on well-being.

<nowiki>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10002207/</nowiki>

=== ChatGPT generated stuff for inspiration ===
[[File:Belonging generated image.webp|alt=placeholder image - picture of people standing in a circle|thumb|placeholder image - picture of people standing in a circle]]

Belonging in the context of preventative mental health care refers to the feeling of being accepted, valued, and connected within a community or group. This sense of belonging is crucial for mental well-being and can play a significant role in preventing mental health issues. Here are several ways belonging contributes to preventative mental health care:

# '''Social Support''': Feeling a sense of belonging provides individuals with a network of support, which can be crucial in times of stress or crisis. Supportive relationships can help buffer the effects of stress and reduce the risk of mental health problems such as anxiety and depression (National University).
# '''Self-Esteem and Identity''': Belonging contributes to a positive self-concept and identity. When individuals feel accepted and valued by their community, it enhances their self-esteem and overall sense of worth, which are protective factors against mental health issues (National University) (Center for Teaching & Learning).
# '''Resilience''': A strong sense of belonging can foster resilience, helping individuals cope more effectively with life's challenges and setbacks. Knowing that one has a supportive community can encourage adaptive coping strategies and reduce feelings of isolation and hopelessness (Vanderbilt University) (Center for Teaching & Learning).
# '''Positive Behavioral Health''': Communities that promote belonging often engage in collective activities that encourage healthy behaviors and provide opportunities for social engagement, physical activity, and purposeful involvement, all of which contribute to better mental health outcomes (National University) (Center for Teaching & Learning).
# '''Early Detection and Intervention''': In communities where belonging is fostered, members are more likely to notice when someone is struggling and offer help or encourage them to seek professional support. This can lead to earlier detection and intervention for mental health issues, preventing them from becoming more severe (Center for Teaching & Learning) (Wikipedia).

Promoting a sense of belonging can be achieved through various strategies, such as creating inclusive environments, encouraging social connections, and fostering a culture of acceptance and support within communities and organizations. This holistic approach is essential in developing effective preventative mental health care systems.

Deep conversations

2024-07-28T22:57:51Z

Tmcgowan1: Added summary

'''Summary'''

An individual’s sense of social connectedness and belonging is based on the perception of how she/he relates to others or a community, with an emphasis on the relationship’s quality and the nature of mutual trust and reciprocity; these over and above practical and technical aspects of social support. ‘Shared emotional connection’ stems from identifying with a shared history of the community through personal investment, conversation, and interaction with other members of the community. Used in this way, deep conversations and belonging reflect a subjective evaluation of the extent to which one has meaningful, close, and constructive relationships with others (i.e., individuals, groups, and society) and it may be easily understood as an experience that leads to deeper connection.

'''This is a placeholder page for testing purposes generated automatically - don't use it for anything important - if you are an editor, please correct it!'''

In the context of preventative mental health care, "deep conversations" refer to meaningful, in-depth discussions that go beyond superficial topics, allowing individuals to explore and express their thoughts, feelings, beliefs, experiences, and concerns. These conversations can play a significant role in emotional well-being by providing an opportunity for emotional release, fostering a sense of connection and understanding, and facilitating self-discovery and reflection. Engaging in deep conversations can help individuals process emotions, gain new perspectives, and develop coping strategies, all of which are crucial for mental health prevention and resilience.

Deep conversations in preventative mental health care have several key characteristics and benefits:

# Emotional Support and Validation: Deep conversations provide a platform for emotional support, where individuals can feel heard, understood, and validated. This can reduce feelings of isolation and loneliness, which are risk factors for mental health issues.
# Stress and Anxiety Reduction: By discussing worries, fears, and stressors in a supportive environment, individuals can experience relief from emotional burden. Sharing problems can lead to a decreased sense of overwhelm and may help in identifying solutions or coping mechanisms.
# Increased Self-awareness: Engaging in introspective discussions encourages individuals to reflect on their own mental health, behaviors, and emotional responses. This increased self-awareness is fundamental in recognizing early signs of mental distress and seeking timely help.
# Development of Coping Strategies: Conversations that explore how individuals deal with challenges and adversity can lead to the discovery of new coping strategies and resilience-building techniques.
# Strengthening Relationships: Deep conversations can strengthen bonds between individuals, creating stronger support networks. Supportive relationships are a key protective factor against mental health problems.
# Facilitating Behavioral Change: Discussing topics related to health behaviors, lifestyle choices, and their impact on mental well-being can motivate individuals to engage in healthier habits.
# Encouraging Help-seeking Behavior: Open discussions about mental health challenges and the importance of seeking help can reduce stigma and encourage individuals to access professional support when needed.

For deep conversations to be effective in preventative mental health care, they should occur in an environment of trust and respect, where participants feel safe to share openly without fear of judgment. These conversations can be facilitated by mental health professionals, but they can also occur naturally within supportive relationships with friends, family members, mentors, or peers. Encouraging deep conversations is an essential component of creating a culture that supports mental health awareness, early intervention, and the overall well-being of the community.

Whole Community

2024-07-28T22:45:22Z

Tmcgowan1: Chance summary

=== Summary: ===

Children develop through interactions within social systems (e.g., families, schools), and interventions in these systems can influence emotional and behavioral developmental. ''Normative'' social systems—such as public schools, community youth organizations—are settings for universal interventions and serve the broadest populations. Interventions delivered universally have the greatest theoretic potential to affect change at a preventive level, if such interventions can address needs and priorities to make them attractive to social systems. System-level interventions modify social ecologic contexts, which have risk-protective effects above and beyond individual factors.

Whole community addresses:

(1) Childhood programs strengthen a broad set of self-regulation processes (i.e., behavioral and emotional self-control) through family and school-based modalities

(2) Adolescent programs that leverage system-level influences (e.g., peer norms) to prevent emerging risk behaviors (e.g., substance abuse) and strengthen relationships and skills that are protective (e.g., coping).

=== Notes and references: ===

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

Findings support a growing case for the unique contribution of group-level interventions to improve social health of broader populations. The Wingman-Connect Program trains all members of natural organizational units together to strengthen group bonds and the diffusion of suicide-protective norms and practices. Skill-building activities focus on relationships and practices supportive of mental health.

Group skill-building activities identify strengths of all group members, and members learn how a strong network supports all members’ health and fitness. W-CP uses high energy activities and peer-to-peer teaching; exercises inside and outside of training promote adoption of skills into unit culture.

'''NIMH'''

Program structure and key elements together strengthen relationship networks, cohesion, adaptive coping and group norms using group-based, interactive training based on research-informed strategies.

==== '''''Discovery:''''' ====
''Discovery of personal strengths and how those strengths impact our social network, and the discovery of other’s strengths and how those strengths impact us and the social network. Everyone’s competencies are recognized.''

Dr. Peter Wyman’s interview 2022

==== '''''Peer Influence:''''' ====
''Social networks provide the mechanisms for the diffusion of norms and practices and the context for peer group monitoring and support.''' ''' Positive social bonds augment the protective factors while learning and modeling skills for growing relationships and developing connections to each other. These connections reduce ‘Pruning’. ''

'''NIMH'''

'''WINGMAN-CONNECT PROGRAM MODEL AND DEVELOPMENT'''

Wingman-Connect is an adaptation of a network-informed intervention. Since 2010, PI 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. 

Wingman-Connect Program structure and key elements together strengthen relationship networks, cohesion, adaptive coping and group norms.

Program’s novel group intervention strengthens ''social bonds'' as well as ''peer network norms'' that incentivize healthy coping. This interactive training progresses from individual engagement (e.g., each participant shares career goals and values) to building group level skills and norms (e.g., mapping group strengths).

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

Airmen learn skills to grow and sustain protective factors essential to job success, mental health and reduced suicide risk (Kinship, Purpose, Guidance, Balance). 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 (Four Cores):

The study’s findings validate the underlying network health model: stronger bonds within a more cohesive healthy class reduced suicidal ideation and depression symptoms. These findings suggest that training classes became increasingly unified around healthy norms and encouraged classmates who were vulnerable to mental health or occupational problems at a key juncture of military training, in addition to meeting their needs for belonging. Work with recent social network modeling show that cohesive groups serve a protective regulatory function through norms and pressures to conform.

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

Wingman-Connect counteracted the typical '''drift''' towards disconnection for Airmen at elevated suicide risk. Six-month findings again showed that W-CP offset the typical trajectory of decreasing connections for Airmen at elevated suicide risk.

These findings are, to our knowledge, the first to show that a suicide prevention program for small personnel units improved significantly the group relationship network and socially integrated members over time. This study extends knowledge of the social and relationship impact of the Wingman-Connect Program as it decreased suicide risk.

Wingman-Connect Program counteracted the expected drift towards disconnection for Airmen at elevated suicide risk by targeting the unit’s relationship network itself. These groups built enhanced suicide protection into their relationship networks, with the most consistent benefits for Airmen at elevated risk of suicide and for those starting with fewest connections.

Program built enhanced suicide protection into unit relationship networks and counteracted standard drift towards disconnection for at-risk Airmen, despite no explicit content targeting connections specifically to at-risk Airmen. Findings support a growing case for the unique contribution of group-level interventions to improve social health of broader populations.

Theory

2024-07-28T22:40:35Z

Tmcgowan1: fixed typos

== Key Findings in Social Network Health ==
We will outline the key findings in Social Network Health that define the implementations we have studied. The findings are critical to developing a [[SNH Maturity Model|mature approach]] to health in a community using Social Network Health.

Among the key findings, we currently identify ten that necessitate specific actions to achieve the outcomes of four key findings by which community health can be measured. The number of key findings we describe may change as further research and implementation reveal new insights over time.

In general, we know that in practice, in school contexts, all 14 of these findings are heavily relied upon, but in some other contexts, some of these findings are not ecologically valid, and not used.

=== Key Action Findings: ===

==== '''Prevention: ''' ====
Effective and efficient Prevention builds individual and community protective factors and social norms. Network health approaches that address these processes, such as maximizing youth-adult connections school-wide, heightening influence of youth with coping, and creating protective schools.

Dive in: [[Prioritizing Prevention]]

==== '''Ecological Validity:''' ====
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.

Dive in: [[Ecological Validity]]

==== Evidence-Based Methodology: ====
Social Network Health approaches require an ongoing commitment to follow documented evidence of impact by studying research and implementation in the field of preventative mental health care.

Dive in: [[Evidence-Based Methodology]]
==== '''Consistency: ''' ====
Social Network Approaches require long-term commitment to intentional cultural integration, relationship and skill building, and re-evaluation and modification of programming over time. It is, unfortunately, rare to find training and mentors that regularly interact deeply with communities over years to build a consistent program and genuinely change culture.

Dive in: [[Consistency]]

==== Discovery: ====
Discovering how ones personal strengths are viewed by the group, and the discovery of other’s strengths and how those strengths impact oneself and the social network is a powerful experience. When everyone’s competencies are recognized, the group is aware of it's collective strengths and the value of all members.

Dive in: [[Discovery]]

==== '''Whole Community''': ====
We maximize the impact of a Social Network Health approach when everyone in the community is invited and contributes to the overall health of the social network. Involving as much of the community as possible contributes to efficiency (using the community instead of outsiders), co-creation (ecological validity), discovery of strengths, and many other endemic principles and practices of Social Network Health.

Dive in: [[Whole Community]]

==== Peer Influence: ====

Peer influenced or peer-peer activities promote relationships between peers, and engage people in their existing communities, leveraging their existing relationships and common interests, while enhancing their knowledge of one another and their potential within their community.

Dive in: [[Peer-influenced|Peer Influence]]

Notes:

We might want to change this to: [[Social Leverage]]

"leveraging social influences to prevent emerging risk"

The argument against social leverage is that it doesn't itself communicate that relationships between peers are the practical core of the idea, here.

==== '''Mentoring: ''' ====
Mentoring is a practice and a skillset that supports others through listening, sharing and connecting. In a school context, mentors are selected by staff and maintain a pseudo-counselor relationship between peers. This is a feature of social network health approaches in schools, but not always in other contexts.

Dive in: [[Mentoring]]
==== Active Learning: ====
High-energy activities maintain interest, motivation, and create shared positive emotional experiences and create norms that incentivize adaptive coping skills. Space is created to practice skills that grow healthy bonds and draw upon resources in social environments to meet goals, manage career and personal challenges, and prevent behavioral health problems.

Dive in: [[Active Learning]]

Notes: We are preferring Active Learning to experiential learning because it's a more modern and recognizable term and it is more common to find the term in supporting evidence.

==== Personally Meaningful Sharing: ====
Participants are invited to share personally relevant goals, values, and experiences as a Social Network Health approach evolves, drawing upon real life strengths and conversations as a way to teach, discover, understand one another.

Dive in: [[Deep conversations|Deep Conversations]]

=== Key Outcome Findings: ===

==== '''Group Cohesion:''' ====
Group Cohesion is an outcome that results in kinship between peers. An environment in which integrated youth-adult networks share in experiential learning and maximize protective bonds can ultimately result in strong group cohesion as measured by personal sharing and peers naming each other as trusted friends.

Dive in: [[Group cohesion|Group Cohesion]]

==== '''Connection to Guidance:''' ====
Connection to Guidance is the connection with a mentor, a trusted adult or person of guidance provides a protective bond that encourages help-seeking behaviors.

Dive in: [[Connection to Guidance]]
==== '''Belonging:''' ====
A sense of Belonging is the feeling of being accepted, valued, and connected within a community or group.

Dive in: [[Belonging]]

==== '''Help Seeking:''' ====
Help seeking behaviors are actions taken by individuals to seek assistance or resources to address potential or existing mental health concerns before they become more severe.

Dive in: [[Help-Seeking Behaviors|Help Seeking]]

== Commentary on Key Findings: ==
A key result from meta analysis is that although many factors are believed to increase the risk of developing a mental health condition, but focusing on treatment those factors is not the most efficient way to reduce the prevalence of mental health conditions. [citation required]

Instead, building protective factors across a community, resulting in a widespread sense of belonging seems to be extremely effective in reducing the risk of mental health conditions.

Individuals who feel a sense of belonging in their community have the sklls and environment they need to become more involved and to actively seek the help they need.

To make that happen in a community (a school environment, for example), the school community must develop group cohesion. Group cohesion is created from strong, healthy connections between student peers and between students and trusted adult guides throughout the community.

To engage with one another optimally, a community must discover the strengths of individuals and groups. Discovery must be practiced and developed as a skill. Active learning and heavily [[peer-influenced]] activities and initiatives have been show to be effective as part of a methodology to kick-start discovery and ultimately lead to deep conversations, which are the most powerful method of learning and bonding in social networks.

When a whole school community is cohesive, and has strong, healthy connections throughout, it’s members become more activated, more engaged, and more energized. The time spent building healthy connections is repaid manyfold by a reduction in suicide, pruning and disciplinary incidents, by an increase in attendance and performance, and by an emotionally recharged community that spends the bulk of their time working preventatively, instead of performing interventions after disruptive and damaging incidents.

The makeup of a healthy school environment is unique to every school. A healthy school environment cannot be duplicated by simply following a written manual or video series and/or taking a one-time training - rather, such an environment is built by developing ecologically valid skills and practices that are unique to each community. These skills and practices become cultural norms that are developed across years of consistency of practice.

Defining the Social Network Health Approach within an integrated system of care:

This toolkit describes the Social Network Health Approach to preventative mental health care, drawing on published research from the University of Rochester Center for the Study and Prevention of Suicide and from the implementations by preventative mental health care professionals in close cooperation with them.

Preventative care is only one category of care within a holistic integrated system of mental health care. Simplistically and fundamentally, it is critically important to address both Preventative and Emergency care within an integrated system. Preventative care is clearly preferable, when effective, to emergency care when the risk of suicide is in play.

Whole Community

2024-07-28T22:40:13Z

Tmcgowan1: added summary

=== Summary: ===

Children develop through interactions within social systems (e.g., families, schools), and interventions in these systems can influence emotional and behavioral developmental. ''Normative'' social systems—such as public schools, community youth organizations—are settings for universal interventions and serve the broadest populations. Interventions delivered universally have the greatest theoretic potential to affect change at a preventive level, if such interventions can address needs and priorities to make them attractive to social systems. System-level interventions modify social ecologic contexts, which have risk-protective effects above and beyond individual factors.
=== Notes and references: ===

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

Findings support a growing case for the unique contribution of group-level interventions to improve social health of broader populations. The Wingman-Connect Program trains all members of natural organizational units together to strengthen group bonds and the diffusion of suicide-protective norms and practices. Skill-building activities focus on relationships and practices supportive of mental health.

Group skill-building activities identify strengths of all group members, and members learn how a strong network supports all members’ health and fitness. W-CP uses high energy activities and peer-to-peer teaching; exercises inside and outside of training promote adoption of skills into unit culture.

'''NIMH'''

Program structure and key elements together strengthen relationship networks, cohesion, adaptive coping and group norms using group-based, interactive training based on research-informed strategies.

==== '''''Discovery:''''' ====
''Discovery of personal strengths and how those strengths impact our social network, and the discovery of other’s strengths and how those strengths impact us and the social network. Everyone’s competencies are recognized.''

Dr. Peter Wyman’s interview 2022

==== '''''Peer Influence:''''' ====
''Social networks provide the mechanisms for the diffusion of norms and practices and the context for peer group monitoring and support.''' ''' Positive social bonds augment the protective factors while learning and modeling skills for growing relationships and developing connections to each other. These connections reduce ‘Pruning’. ''

'''NIMH'''

'''WINGMAN-CONNECT PROGRAM MODEL AND DEVELOPMENT'''

Wingman-Connect is an adaptation of a network-informed intervention. Since 2010, PI 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. 

Wingman-Connect Program structure and key elements together strengthen relationship networks, cohesion, adaptive coping and group norms.

Program’s novel group intervention strengthens ''social bonds'' as well as ''peer network norms'' that incentivize healthy coping. This interactive training progresses from individual engagement (e.g., each participant shares career goals and values) to building group level skills and norms (e.g., mapping group strengths).

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

Airmen learn skills to grow and sustain protective factors essential to job success, mental health and reduced suicide risk (Kinship, Purpose, Guidance, Balance). 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 (Four Cores):

The study’s findings validate the underlying network health model: stronger bonds within a more cohesive healthy class reduced suicidal ideation and depression symptoms. These findings suggest that training classes became increasingly unified around healthy norms and encouraged classmates who were vulnerable to mental health or occupational problems at a key juncture of military training, in addition to meeting their needs for belonging. Work with recent social network modeling show that cohesive groups serve a protective regulatory function through norms and pressures to conform.

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

Wingman-Connect counteracted the typical '''drift''' towards disconnection for Airmen at elevated suicide risk. Six-month findings again showed that W-CP offset the typical trajectory of decreasing connections for Airmen at elevated suicide risk.

These findings are, to our knowledge, the first to show that a suicide prevention program for small personnel units improved significantly the group relationship network and socially integrated members over time. This study extends knowledge of the social and relationship impact of the Wingman-Connect Program as it decreased suicide risk.

Wingman-Connect Program counteracted the expected drift towards disconnection for Airmen at elevated suicide risk by targeting the unit’s relationship network itself. These groups built enhanced suicide protection into their relationship networks, with the most consistent benefits for Airmen at elevated risk of suicide and for those starting with fewest connections.

Program built enhanced suicide protection into unit relationship networks and counteracted standard drift towards disconnection for at-risk Airmen, despite no explicit content targeting connections specifically to at-risk Airmen. Findings support a growing case for the unique contribution of group-level interventions to improve social health of broader populations.