Skip to main content

Advertisement

SpringerLink
Log in

The Role of Youth Trainee–Trainer Alliance and Involvement in School-Based Prevention: A Moderated-Mediation Model of Student Gatekeeper Suicide Prevention Training

  • Original Article
  • Published:
Administration and Policy in Mental Health and Mental Health Services Research Aims and scope Submit manuscript

Abstract

This study examined the roles that youth involvement and youth trainee–trainer alliance play in school mental health prevention within the context of youth suicide gatekeeper training. Measures included youth involvement in programming, trainee–trainer alliance, and intentions to refer at-risk youth at pre- and post-training. A moderated-mediation design was used to examine associations among these factors. Results show alliance mediating pre- and post-training referral intentions, and involvement moderating the relationship between alliance and post-training intentions. On average, trainee intentions improved from pre- to post-training, but trainees reporting high alliance endorsed higher post-training referral intentions regardless of involvement level. Low alliance resulted in lower than average post-training referral intentions, even with active involvement in programming, and those with both low alliance and involvement showed the lowest post-training referral intentions. Given these findings, fostering the youth trainee–trainer relationship may be an avenue to optimize prevention program effectiveness.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  • Ajzen, I. (1985). From intentions to actions: A theory of planned behavior. In J. Kuhl & J. Beckman (Eds.), Action-control: From cognition to behavior (pp. 11–39). Heidelberg: Springer.

    Chapter  Google Scholar 

  • Ajzen, I. (2017). Constructing a Theory of Planned Behavior Questionnaire. Retrieved from: http://people.umass.edu/aizen/pdf/tpb.measurement.pdf.

  • Berkel, C., Mauricio, A. M., Schoenfelder, E., & Sandler, I. N. (2011). Putting the pieces together: An integrated model of program implementation. Prevention Science, 12, 23–33.

    Article  PubMed Central  Google Scholar 

  • Berry, K., Gregg, L., Lobban, F., & Barrowclough, C. (2016). Therapeutic alliance in psychological therapy for people with recent onset psychosis who use cannabis. Comprehensive Psychiatry, 67, 73–80.

    Article  Google Scholar 

  • Bickman, L., deAndrade, A. R. V., Athay, M. M., Chen, J. I., De Nadai, A. S., Jordan-Arthur, B. L., & Karver, M. S. (2012). The relationship between change in therapeutic alliance ratings and improvement in youth symptom severity: Whose ratings matter the most? Administration and Policy in Mental Health and Mental Health Services Research, 39, 78–89.

    Article  Google Scholar 

  • Bordin, E. S. (1979). The generalizability of the psychoanalytic concept of the working alliance. Psychotherapy: Theory, Research, and Practice, 16, 252–260.

    Article  Google Scholar 

  • Brown, C. H., Wyman, P. A., Brinales, J. A., & Gibbons, R. D. (2007). The role of randomized trial in testing interventions for the prevention of youth suicide. International Review of Psychiatry, 19, 617–631.

    Article  Google Scholar 

  • Brown, H. R., Totura, C. M. W., Labouliere, C. D., Gryglewicz, K., & Karver, M. S. (2018). Benchmarking the Question, Persuade, Refer program against established suicide prevention gatekeeper trainings. Suicide and Life-Threatening Behavior. https://doi.org/10.1111/sltb.12430.

    Article  PubMed  Google Scholar 

  • Bruffaerts, R., Demyttenaere, K., Hwang, I., Chiu, W. T., Sampson, N., Kessler, R. C., … Nock, M. K. (2011). Treatment of suicidal people around the world. British Journal of Psychiatry, 199, 64–70.

  • Castro-Blanco, D., Karver, M. S., & Chiechi, J. (2010). Conclusions: Looking ahead—Future directions in treatment engagement with high risk adolescents. In D. Castro-Blanco & M. S. Karver (Eds.), Elusive alliance: Treatment engagement strategies with high-risk adolescents. Washington, D.C.: American Psychological Association.

    Chapter  Google Scholar 

  • Centers for Disease Control and Prevention. (2016). Web-based Injury Statistics Query and Reporting System, Fatal Injury Data. Retrieved January 25, 2018 from https://www.cdc.gov/injury/wisqars/ fatal.html.

  • Cummings, C., Caporino, N., Settipani, C., Read, K., Compton, S., March, J., … Kendall, P. (2013). The therapeutic relationship in cognitive-behavioral therapy and pharmacotherapy for anxious youth. Journal of Consulting and Clinical Psychology, 81, 859–864.

  • Durlak, J. A., & DuPre, E. P. (2008). Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. American Journal of Community Psychology, 41, 327–350.

    Article  Google Scholar 

  • Fixsen, D. L., Naoom, S. F., Blase, K. A., & Friedman, R. M. (2005). Implementation research: Synthesis of the literature. Tampa: University of South Florida.

    Google Scholar 

  • Fluckiger, C., Del Re, A. C., Wampold, B. E., Symonds, D., & Horvath, A. O. (2012). How central is the alliance in psychotherapy? A multilevel longitudinal meta-analysis. Journal of Counseling Psychology, 59, 10–17.

    Article  Google Scholar 

  • Fredricks, J. A., Bohnert, A. M., & Burdette, K. (2014). Moving beyond attendance: Lessons learned from assessing engagement in afterschool contexts. New Directions for Student Leadership, 144, 45–58.

    Google Scholar 

  • Garvey, C., Julion, W., Fogg, L., Kratovil, A., & Gross, D. (2006). Measuring participation in a prevention trial with parents of young children. Research in Nursing & Health, 29, 212–222.

    Article  Google Scholar 

  • Hagger, M. S., Chan, D. K., Protogerou, C., & Chatzisarantis, N. L. (2016). Using meta-analytic path analysis to test theoretical predictions in health behavior: An illustration based on meta-analyses of the theory of planned behavior. Preventive Medicine, 89, 154–161.

    Article  Google Scholar 

  • Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York: Guilford Press.

    Google Scholar 

  • Hayes, A. F. (2018). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach (2nd edn.). New York: Guilford Press.

    Google Scholar 

  • Hogue, A., Dauber, S., Stambaugh, L. F., Cecero, J. J., & Liddle, H. A. (2006). Early therapeutic alliance and treatment outcome in individual and family therapy for adolescent behavior problems. Journal of Consulting and Clinical Psychology, 74, 121–129.

    Article  PubMed Central  Google Scholar 

  • Horvath, A. O., Re, D., Flückiger, A. C., C., & Symonds, D. (2011). Alliance in individual psychotherapy. Psychotherapy, 48, 9–16.

    Article  Google Scholar 

  • Johansson, P., & Høglend, P. (2007). Identifying mechanisms of change in psychotherapy: Mediators of treatment outcomes. Clinical Psychology & Psychotherapy, 14, 1–9.

    Article  Google Scholar 

  • Kalafat, J., & Elias, M. (1994). An evaluation of a school-based suicide awareness intervention. Suicide and Life-Threatening Behavior, 24, 224–233.

    CAS  PubMed  Google Scholar 

  • Karver, M., Shirk, S., Handelsman, J., Fields, S., Crisp, H., Gudmundsen, G., & McMakin, D. (2008). Relationship processes in youth psychotherapy: Measuring alliance, alliance-building behaviors, and client involvement. Journal of Emotional & Behavioral Disorders, 16, 15–28.

    Article  Google Scholar 

  • Karver, M. S., De Nadai, A. S., Monahan, M., & Shirk, S. R. (2018). Meta-analysis of the prospective relation between alliance and outcome in child and adolescent psychotherapy. Psychotherapy, 55, 341–355.

    Article  Google Scholar 

  • Kim, H. Y., & Cappella, E. (2016). Mapping the social world of classrooms: A multi-level, multi-reporter approach to social processes and behavioral engagement. American Journal of Community Psychology, 57, 20–35.

    Article  Google Scholar 

  • Labouliere, C., Reyes, J. P., Shirk, S., & Karver, M. (2017). Therapeutic alliance with depressed adolescents: Predictor or outcome? Disentangling temporal confounds to understand early improvement. Journal of Clinical Child & Adolescent Psychology, 46, 600–610.

    Article  Google Scholar 

  • Labouliere, C., Tarquini, S., Totura, C., Kutash, K., & Karver, M. (2015). How much is learned by students participating in suicide prevention gatekeeper training? Crisis, 36, 274–280.

    Article  PubMed Central  Google Scholar 

  • Low, S., Van Ryzin, M. J., Brown, E. C., Smith, B. H., & Haggerty, K. P. (2014). Engagement matters: lessons from assessing classroom implementation of steps to respect: A bullying prevention program over a one-year period. Prevention Science, 15, 165–176.

    Article  Google Scholar 

  • McCormick, M. P., O’Connor, E. E., Cappella, E., & McClowry, S. G. (2013). Teacher–child relationships and academic achievement: A multilevel propensity score model approach. Journal of School Psychology, 51, 611–624.

    Article  Google Scholar 

  • McLeod, B. D., Islam, N. Y., Chiu, A., Smith, W., Chu, M. M., B. C., & Wood, J. J. (2014). The relationship between alliance and client involvement in CBT for child anxiety disorders. Journal of Clinical Child & Adolescent Psychology, 43, 735–741.

    Article  Google Scholar 

  • Michie, S., van Stralen, M., & West, R. (2011). The behavior change wheel: A new method for characterizing and designing behavior change interventions. Implementation Science, 6, 1–11.

    Article  Google Scholar 

  • Murphy, R., & Hutton, P. (2018). Practitioner review: Therapist variability, patient-reported therapeutic alliance, and clinical outcomes in adolescents undergoing mental health treatment—a systematic review and meta-analysis. The Journal of Child Psychology and Psychiatry, 59(1), 5–19.

    Article  Google Scholar 

  • Nix, R. L., Bierman, K. L., McMahon, R. J., & The Conduct Problems Prevention Research Group (2009). How attendance and quality of participation affect treatment response to parent management training. Journal of Consulting and Clinical Psychology, 77, 429–438.

    Article  PubMed Central  Google Scholar 

  • Prochaska, J. O., DiClemente, C. C., & Norcross, J. C. (1992). In search of how people change: Applications to the addictive behaviors. American Psychologist, 47, 1102–1114.

    Article  CAS  Google Scholar 

  • Sandler, I., Wolchik, S. A., Cruden, G., Mahrer, N. E., Ahn, S., Brincks, A., & Brown, C. H. (2014). Overview of meta-analyses of the prevention of mental health, substance use, and conduct problems. Annual Review of Clinical Psychology, 10, 243–273.

    Article  PubMed Central  Google Scholar 

  • Shirk, S. R., Karver, M. S., & Brown, R. (2011). Alliance in child and adolescent psychotherapy. Psychotherapy, 48, 17–24.

    Article  Google Scholar 

  • Thompson, S. J., Bender, K., Lantry, J., & Flynn, P. M. (2007). Treatment engagement: Building therapeutic alliance in home-based treatment with adolescents and their families. Contemporary Family Therapy, 29(1–2), 39–55.

    Article  PubMed Central  Google Scholar 

  • Totura, C. M. W., Figueroa, L., Wharton, H., C., & Marsiglia, F. F. (2015). Assessing implementation of evidence-based childhood obesity prevention strategies in schools. Preventive Medicine Reports, 2, 347–354.

    Article  PubMed Central  Google Scholar 

  • Totura, C. M. W., Kutash, K., Labouliere, C. D., & Karver, M. (2017). Evaluating active parental consent procedures for school programming: Addressing the sensitive topic of suicide prevention. Journal of School Health, 87, 114–120.

    Article  Google Scholar 

  • Totura, C. M. W., Tarquini, S., Naoom, S., Karver, M. S., & Kutash, K. (2008). Planned Behavior & Implementation Questionnaire. Unpublished. Tampa: University of South Florida.

    Google Scholar 

  • Wandersman, A., Duffy, J., Flaspohler, P., Noonan, R., Lubell, K., Stillman, L., … Saul, J. (2008). Bridging the gap between prevention research and practice: The interactive systems framework for dissemination and implementation. American Journal of Community Psychology, 41(3–4), 171–181.

  • Weisz, J. R., Doss, A. J., & Hawley, K. M. (2005). Youth psychotherapy outcome research: A review and critique of the evidence base. Annual Review of Psychology, 56, 337–363.

    Article  Google Scholar 

  • Whittaker, K. A., & Cowley, S. (2012). An effective programme is not enough: A review of factors associated with poor attendance and engagement with parenting support programmes. Children & Society, 26, 138–149.

    Article  Google Scholar 

  • Xia, Y., Taylor, S., & de Guzman, M. R. T. (2017). Evaluation of the Health Rocks! Program: The association of youth engagement with program outcomes. Journal of Youth Development, 11, 95–104.

    Article  Google Scholar 

  • Zhao, X., Lynch, J. G., & Chen, Q. (2010). Reconsidering Baron and Kenny: Myths and truths about mediation analysis. Journal of Consumer Research, 37, 197–206.

    Article  Google Scholar 

Download references

Acknowledgements

Special thanks to Sarah Gunderson, Renee Brown Hangartner, Jason I. Chen, Sarah J. Tarquini, and Krista Kutash for their invaluable assistance.

Funding

This research was supported by Substance Abuse and Mental Health Administration Grants (#SM57442-01, 02–3) to Drs. Karver, Kutash, and Totura. Dr. Labouliere was supported as a post-doctoral fellow by Award #2T32 MH16434-34 from the National Institute of Mental Health (NIMH) at the National Institutes of Health (NIH). The contents of the manuscript are solely the responsibility of the authors and do not necessarily represent the official views of NIMH or SAMHSA.

Author information

Authors and Affiliations

  1. Department of Psychology, Auburn University, 226 Thach Hall, Auburn, AL, 36849, USA

    Christine M. Wienke Totura

  2. Division of Behavioral Health Services and Policy Research, New York State Psychiatric Institute, Columbia University, 1051 Riverside Drive, New York, NY, 10032, USA

    Christa D. Labouliere

  3. School of Social Work, University of Central Florida, 12805 Pegasus Drive, Orlando, FL, 32816, USA

    Kim Gryglewicz

  4. Department of Psychology, University of South Florida, 4202 East Fowler Avenue, Tampa, FL, 33620, USA

    Marc S. Karver

Authors
  1. Christine M. Wienke Totura
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Christa D. Labouliere
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kim Gryglewicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marc S. Karver
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christine M. Wienke Totura.

Ethics declarations

Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical Approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all participants included in the study via university Institutional Review Board approved waiver of parental signed informed consent.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Totura, C.M.W., Labouliere, C.D., Gryglewicz, K. et al. The Role of Youth Trainee–Trainer Alliance and Involvement in School-Based Prevention: A Moderated-Mediation Model of Student Gatekeeper Suicide Prevention Training. Adm Policy Ment Health 46, 209–219 (2019). https://doi.org/10.1007/s10488-018-0907-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10488-018-0907-5

Keywords

Search

Navigation