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| == Summary: ==
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| 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]
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| 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.
| | == Key Findings in Social Network Health == |
| | These 14 findings are critical to developing a mature approach to strengthening social networks in a community. Among the key findings, we currently identify ten that require implementation action and 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. |
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| 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.
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| 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.
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| 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.
| | {{Colored box|icon=Tiny_logo_x1.png|background-title-color=#36c|title=Key Action Findings|title-color=#fff|background-content-color=#eaf3ff|content= |
| | === Key Action Findings: === |
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| 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.
| | ==== '''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. |
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| 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.
| | Dive in: [[Prioritizing Prevention]] |
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| == 14 Points == | | ==== '''Ecological Validity:''' ==== |
| '''The Networks of Support Approach''' | | 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. |
| '''Essential factors for effective prevention programming'''
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| '''Evidence'''
| | Dive in: [[Ecological Validity]] |
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| == '''1 - Why Prevention?: ''' == | | ==== Evidence-Based Methodology: ==== |
| '''Effectiveness Trial of Wingman-Connect Implemented Across Career Phases'''
| | 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. |
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| Submitted to the National Institute of Mental Health, PAR21-130, 10/13/2022
| | 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. |
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| ???? Possibilities: Some data but no paper, yet - quote not publicly accessible:
| | Dive in: [[Consistency]] |
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| <nowiki>https://classic.clinicaltrials.gov/ct2/show/NCT05967364</nowiki>
| | ==== 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. |
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| <nowiki>https://ctv.veeva.com/study/career-enhancement-training-study-delivered-across-career-phases</nowiki>
| | Dive in: [[Discovery]] |
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| '''Upstream prevention is necessary'''. | | ==== '''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. |
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| Existing military suicide intervention programming focuses on detecting and remediating risk after suicidal individuals are identified.<sup> </sup> Although undoubtedly saving lives, this approach is insufficient on its own.
| | Dive in: [[Whole Community]] |
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| 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.
| | ==== Peer Influence: ==== |
| | Peer influenced or peer-peer activities promote relationships between peers and engage people in their existing communities, leveraging existing relationships and common interests, while enhancing their knowledge of one another and their potential within their community. |
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| 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.
| | Dive in: [[Peer-influenced|Peer Influence]] |
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| 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)
| | ==== '''Mentoring: ''' ==== |
| | Mentoring is a practice and a skill set that supports others through listening, sharing and connecting. |
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| 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)
| | Dive in: [[Mentoring]] |
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| 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)
| | ==== Active/Experiential 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. |
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| 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)
| | Dive in: [[Active Learning]] |
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| ''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.'' | | 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. |
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| '''Treatment:'''
| | ==== 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. |
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| '''Peer-adult network structure and suicide attempts in 38 high schools: implications for network-informed suicide prevention (10,291 students) '''
| | Dive in: [[Deep conversations|Deep Conversations]] |
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| 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.
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| '''Journal of Child Psychology and Psychiatry *: * (2019), Peter A. Wyman, Trevor A. Pickering, Anthony R. Pisani, et al.'''
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| 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
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| 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.
| | {{Colored box|icon=Tiny_logo_x1.png|background-title-color=#36c|title=Key Outcome Findings|title-color=#fff|background-content-color=#eaf3ff|content= |
| | === Key Outcome Findings: === |
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| 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.
| | ==== '''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. |
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| '''Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training. A Cluster Randomized Clinical Trial'''
| | Dive in: [[Group cohesion|Group Cohesion]] |
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| '''JAMA Open Network, October, 2020''' | | ==== '''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. |
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| Group training that builds cohesive, healthy military units is promising for upstream suicide prevention.
| | Dive in: [[Connection to Guidance]] |
| | ==== '''Belonging:''' ==== |
| | A sense of Belonging is the feeling of being accepted, valued, and connected within a community or group. |
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| 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.
| | Dive in: [[Belonging]] |
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| 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.
| | ==== '''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. |
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| 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.
| | Dive in: [[Help-Seeking Behaviors|Help Seeking]] |
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| Strong bonds reduce vulnerability to depression, and postenlistment depression is a specific factor associated with suicide attempts among military personnel.
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| 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.
| | == Commentary on Key Findings: == |
| | To summarize the key findings in brief: |
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| Wingman-Connect participants gained on all class protective factors: cohesion, morale, bonds to classmates, and perceptions that members support healthy behaviors
| | Preventative care is one category within a holistic integrated system of care. Simplistically and fundamentally, it is critically important to address both Preventative and Emergency care within an integrated system. 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. Instead, building protective factors across a community, which results in a widespread sense of belonging, appears to be extremely effective in reducing risk factors. |
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| Wingman-Connect increased positive career behaviors and reduced anxiety and anger. Social impairments were reduced among participants
| | 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 a healthy culture needs to be intentionally approached by developing ecologically valid skills and practices that are unique to each community. Research has shown that the time spent building healthy connections and protective factors tends to provide a reduction in suicide ideation, social pruning, documented disciplinary incidents, and health and wellbeing of the entire community. |
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| 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.
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| 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 | |
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| The study’s findings validate the underlying network health model: stronger bonds within a more cohesive healthy class reduced suicidal ideation and depression symptoms
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| 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
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| == '''2 - Why Ecological Validity?:''' ==
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| '''Effectiveness Trial of Wingman-Connect Implemented Across Career Phases'''
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| Submitted to the National Institute of Mental Health, PAR21-130, 10/13/2022
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| Group training that builds cohesive, healthy military units is promising for upstream suicide prevention and may be essential for ecological validity
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| '''Data-informed implementation preparation.'''
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| A “voltage drop” and poor sustainment are common as interventions transition from controlled efficacy trials to regular use.
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| Conversely, scaled out interventions are more impactful with careful preparation using implementation science frameworks.
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| “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.”
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| 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.’
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| ''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.''
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| 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
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| 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).
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| ''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.''
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| == '''3 - Why Evidence-based Methodology?:''' ==
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| '''Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training. A Cluster Randomized Clinical Trial'''
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| '''JAMA Open Network, October, 2020'''
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| '''Research Outcomes – Evidence Based Key Findings include:'''
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| * Increased class cohesion, morale, positive bonds, and acceptability of help seeking
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| * Reduction in suicide risks scores, depression, and reactivity to anger
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| * Nearly 50% reduction in occupational impairment (corrective training, negative counseling)
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| '''Measurable Impact on both Protective Factors and Risk Factors'''
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| 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.
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| Social Science & Medicine Social Science & Medicine 296 (2022) 114737
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| '''Wingman-Connect Program increases social integration for Air Force personnel at elevated suicide risk: Social network analysis of a cluster RCT'''
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| 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.
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| Evidence based practice is defined as a deliberate and conscientious approach to problems olving within clinical practice. An evidence-based approach embodies the best evidence from well designed studies while taking into consideration patient values, preferences, and a clinician’s expertise in making decisions regarding patient’s care (Melnyk and Fineout-Overholt, 2019).
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| Melnyk et al. (2012) describes evidence based practice (EBP) as a clinical decision-making tool that improves clinical outcomes. EBP has a proven track record of improving quality of care and patient outcomes (McGinty and Anderson, 2008). Evidence-based practice as a problem-solving approach fits with Institute of Medicine (IOM) recommendations that all health professionals translate the research into practice (Institute of Medicine, 2003).
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| It is also important for faculty to incorporate quality improvement and evidence-based practice in the facilitation, evaluation, and redesign of curriculum. Knowledge gained from quality improvement initiatives and evidence-based assessments of teaching allow for informed decisions that are based on quantitative and qualitative data thus providing a better assessment of teaching effectiveness and will serve as a consistent guide for improvement and a measure of teaching success.
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| McNeill, C., George, N., Stephens, U., & Walker, T. (2024). Teaching Evidence-Based Practice to MSN, DNP and PhD students: Lessons Learned. ''ABNFF Journal'', ''1''(1), 53–60.
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| '''This is where the book ends maturity model, pre and post should go.'''
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| == '''4 - Why Consistency?: ''' ==
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| '''Effectiveness Trial of Wingman-Connect Implemented Across Career Phases'''
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| Submitted to the National Institute of Mental Health, PAR21-130, 10/13/2022
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| '''Data-informed implementation preparation.'''
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| A “voltage drop” and poor sustainment are common as interventions transition from controlled efficacy trials to regular use.
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| Conversely, scaled out interventions are more impactful with careful preparation using implementation science frameworks.
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| '''Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training. A Cluster Randomized Clinical Trial'''
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| '''JAMA Open Network, October, 2020'''
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| Wingman-Connect’s group training design ecologically-valid and appealing for participants. '''Wingman-Connect development benefited from strong organizational collaboration, resulting in an ecologically valid program.'''
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| == '''5 - Why Discovery?: ''' ==
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| 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.
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| Dr. Peter Wyman’s interview 2022
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| == '''6 - Why Whole Community?: ''' ==
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| Everyone is invited and contributes to the overall health of the social network.
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| Social Science & Medicine Social Science & Medicine 296 (2022) 114737
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| '''Wingman-Connect Program increases social integration for Air Force personnel at elevated suicide risk: Social network analysis of a cluster RCT'''
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| Findings support a growing case for the unique contribution of group-level interventions to improve social health of broader populations.
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| 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.
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| 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.
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| == '''7 - Why Peer Influence?: ''' ==
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| 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’.
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| '''Effectiveness Trial of Wingman-Connect Implemented Across Career Phases'''
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| Submitted to the National Institute of Mental Health, PAR21-130, 10/13/2022
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| '''WINGMAN-CONNECT PROGRAM MODEL AND DEVELOPMENT'''
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| Wingman-Connect is an adaptation of a network-informed intervention. Since
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| 2010, PI Wyman has led research (NIH, CDC funded) testing that program, which disseminates skills for social health through youth peer networks.<sup> </sup> The high-energy, interactive training improves student connectedness and coping norms, and protective effects spread school-wide including adult help for suicidal youth.<sup> </sup> A study aggregating three RCTs (N=78 schools; 39,900 students) showed fewer suicide deaths in schools implementing this approach. <sup> </sup>
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| Wingman-Connect Program structure and key elements together strengthen relationship networks, cohesion, adaptive coping and group norms.
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| '''Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training. A Cluster Randomized Clinical Trial'''
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| '''JAMA Open Network, October, 2020'''
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| 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):
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| Social Science & Medicine Social Science & Medicine 296 (2022) 114737
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| '''Wingman-Connect Program increases social integration for Air Force personnel at elevated suicide risk: Social network analysis of a cluster RCT'''
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| 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.
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| 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.
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| This study extends knowledge of the social and relationship impact of the Wingman-Connect Program as it decreased suicide risk.
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| 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.
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| == '''8 - Why Mentoring?: ''' ==
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| '''Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training. A Cluster Randomized Clinical Trial'''
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| '''JAMA Open Network, October, 2020'''
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| 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):
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| * Group cohesion and belonging (Kinship)
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| * Informal and formal support and help-seeking (Guidance)
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| Social Science & Medicine Social Science & Medicine 296 (2022) 114737
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| '''Wingman-Connect Program increases social integration for Air Force personnel at elevated suicide risk: Social network analysis of a cluster RCT'''
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| Specific modules and activities build healthy relationships and accountability (Kinship) informal and formal help-seeking (Guidance).
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| An outcome evaluation of the Sources of Strength suicide prevention program delivered by adolescent peer leaders in high schools
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| Am J Public Health. 2010 September; 100(9): 1653–1661
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| 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.
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| == '''9 - Why Active Learning? :''' ==
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| 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.
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| '''Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training. A Cluster Randomized Clinical Trial'''
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| '''JAMA Open Network, October, 2020'''
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| '''Active Learning and Transfer of Training to Life'''
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| * Drawing out ‘real-world’ strengths from participants as a primary method to teach Kinship, Purpose, Guidance, & Balance.
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| * High energy activities maintain interest, motivation, and a shared positive emotion.
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| * ‘Real-world’ exercises inside and outside of training reinforce the application of skills in groups and in individual activities of daily life.
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| == '''10 - Why Deep Conversations?:''' ==
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| Personally meaningful - participants are invited to share personally relevant goals and values referenced throughout. Drawing upon ‘real life’ strengths and conversations as the primary way to teach. Provides space for culturally relevant customs, celebrations, and traditions.
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| '''Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training. A Cluster Randomized Clinical Trial'''
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| '''JAMA Open Network, October, 2020'''
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| 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.'''
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| == '''11 - Why Group Cohesion?:''' ==
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| Social Science & Medicine Social Science & Medicine 296 (2022) 114737
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| '''Wingman-Connect Program increases social integration for Air Force personnel at elevated suicide risk: Social network analysis of a cluster RCT'''
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| In more connected, healthier units, vulnerable members can borrow strength from adaptive members. Stronger units also promote job fitness, as shown by W-CP’s impact reducing occupational problems, an effect that may reduce future problems that precipitate new instances of suicidal thoughts and behaviors. In that sense, W-CP may specifically assist vulnerable Airmen in overcoming barriers to forming meaningful social connections.
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| Wingman-Connect Program’s interactive training created more dynamic relationship networks. Airmen in W-CP groups made more changes in who they named as valued connections, even as the overall average number of valued connections increased. The largest dynamic changes were for Airmen with elevated suicide risk in W-CP groups, who made on average three times more new valued connection nominations.
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| '''Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training. A Cluster Randomized Clinical Trial'''
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| '''JAMA Open Network, October, 2020'''
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| '''Research Outcomes – Evidence Based Key Findings include:'''
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| * Increased class cohesion, morale, positive bonds, and acceptability of help seeking
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| Wingman Connect strengthens skills to grow and sustain healthy social bonds. Natural organization (tech school classes) units train together to incorporate skills into culture, build cohesion and shared purpose. '''The objective is preventing occupational and behavioral health problems.'''
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| 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. Work with recent social network modeling show that cohesive groups serve a protective regulatory function through norms and pressures to conform.
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| '''Effectiveness Trial of Wingman-Connect Implemented Across Career Phases'''
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| Submitted to the National Institute of Mental Health, PAR21-130, 10/13/2022
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| '''Novel Intervention Targeting Peer Social Networks of Military Members'''
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| The Wingman-Connect 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).
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| == '''12 - Why Connection to Guidance?:''' ==
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| Informal and formal help-seeking. Cohesive youth–adult networks may promote more help-seeking for students and for their friends with whom they share a common bond to a supportive adult.
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| [https://pubmed.ncbi.nlm.nih.gov/31392720/#:~:text=Results%3A%20Lower%20peer%20network%20integration%20and%20cohesion%20increased%20likelihood%20of%20SI%20and%20SA%20across%20individual%20and%20school%2Dlevel%20models.%20Two%20factors%20increased%20SA%3A%20student%20isolation%20from%20adults%20and%20suicidal%20students%27%20popularity%20and%20clustering. Evidence of help-seeking behavior has been developed.]
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| '''Peer-adult network structure and suicide attempts in 38 high schools: implications for network-informed suicide prevention (10,291 students) '''
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| '''Journal of Child Psychology and Psychiatry *: * (2019), Peter A. Wyman, Trevor A. Pickering, Anthony R. Pisani, et al.'''
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| Social networks provide the mechanisms for the diffusion of norms and practices and the context for peer group monitoring and support. Network characteristics influence the spread of many health behaviors. By focusing on patterns of relationships, network methods can clarify the contexts in which relationships form and exert influence on others.
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| Cohesive youth–adult networks may promote more help-seeking for students and for their friends with whom they share a common bond to a supportive adult.
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| Maximizing protective bonds across school populations, increasing opportunities for group cohesion including integrated youth– adult networks, and promoting influence of youth with healthy coping. Our findings suggest effective interventions will involve youth and adults.
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| == '''13 - Why Belonging?:''' ==
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| '''Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training. A Cluster Randomized Clinical Trial'''
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| '''JAMA Open Network, October, 2020'''
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| Group training that builds cohesive, healthy military units is promising for upstream suicide prevention.
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| The study’s findings validate the underlying network health model: stronger bonds within a more cohesive healthy class reduced suicidal ideation and depression symptoms.<sup> </sup> 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.
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| == '''14 - Why Help Seeking?:''' ==
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| '''Effect of the Wingman-Connect Upstream Suicide Prevention Program for Air Force Personnel in Training. A Cluster Randomized Clinical Trial'''
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| '''JAMA Open Network, October, 2020'''
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| '''Research Outcomes – Evidence Based Key Findings include:'''
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| * Increased class cohesion, morale, positive bonds, and acceptability of help seeking
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| == Context of this project: ==
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| Defining the Social Network Health Approach within an integrated system of care:
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| 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.
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| 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.
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| === Active Research ===
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| The Network Health Approach describes tools and methods that are under active study, development, and use.
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| This means that this toolkit will be updated as new research dictates, and, most importantly the version history will reflect changes accurately.
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| 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.
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| 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.
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| === Schools First ===
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| Throughout this toolkit, we will 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.
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| === Universality of the Approach ===
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| Programs are developed from approaches. Ecological validity is one part of the Network Health Approach that demands that a program is developed specifically and uniquely for a community - that’s what makes this approach so broadly applicable. This contention is supported by researched implementation across a breadth of communities.
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| Difference from previous approaches
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| A network health approach to preventative care builds individual and community protective factors and social norms. Network health approaches that address these processes, such as maximizing youth-adult connections schoolwide and heightening influence of youth with coping, create more protective schools.
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| === Historical Context ===
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| The history of preventative mental health care is beyond the scope of this wiki, but it is worth arguing that the characteristics of this approach are different than what has been created in the societies of most of the world over 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. Not an immediate focus, but the fact that research has taken humanity full circle to rediscovered excellence is notable and in some cases relevant.
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| === Medical Model v. Strengths model ===
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| 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. 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.
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| In the parlance of Social Emotional Learning in US schools there Tiers - Tier 1 (prevention-based) comes before Tier 3 (isolation-based) because it is, colloquially, terrible to have to isolate people - generally, Tier 1 is the success case and Tier 3 is the last line of defense for individuals who need it. This is appropriate prioritization from the perspective of a social network health approach. In practical implementation, however, far fewer communities put as many resources into effective Tier 1 programming as Tier 3.
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| TBD - We could make a matrix of all the characteristics of programs out there and see where this approach fits - that might be overkill to start with, but it would be useful to those who are trying to find the right approach in a sea of approaches.
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