Name of Intervention/ Program
California Department of Public Health’s Office of Suicide Prevention Youth Co-Creation Campaign “Never a Bother”

Background and Situation Analysis
California is facing a critical challenge in youth mental health, underscored by troubling trends in suicide rates, self-harm, and psychological distress among young people. The COVID-19 pandemic has not only highlighted but also intensified this issue, revealing an urgent need for strategic interventions to support our most vulnerable youth. From 2018 to 2022, suicide emerged as the second leading cause of death among individuals aged 10-25 in California. Notably, there was a more than 20% increase in suicide rates among youths aged 10-18 from 2019 to 2020. These statistics are not just numbers; they reflect real struggles faced by young people and their families, signaling a need for comprehensive support and intervention. The underlying causes of this crisis are complex, involving a mix of heightened risk factors and diminished protective factors in the wake of the pandemic. Increases in emotional distress, trauma, and adverse childhood experiences have significantly contributed to this situation. Moreover, the challenge is exacerbated by a lack of easily accessible mental health resources, leaving many youths without the necessary support to overcome these obstacles. However, it’s important to remember that suicide prevention is possible. Tackling this issue head-on means being proactive in recognizing suicide warning signs, promoting resilience, and facilitating open discussions about mental health. Connecting young people to essential, life-saving resources is crucial, as is addressing the broader societal and systemic factors that contribute to increased suicide risk, including systemic racism and health inequities. Creating effective prevention campaigns requires authenticity and a focus on peer-to-peer communication strategies. Involving a diverse group of youth in the co-creation of these campaigns is vital to ensuring their relevance, resonance, and authenticity.

Priority Audiences(s)
Suicide poses a risk across all demographics, yet specific factors can amplify this risk among certain populations due to increased adversity, challenging social conditions, or reduced access to protective resources. In response, the Never a Bother campaign is strategically focused on reaching diverse and BIPOC youth groups. This includes African American/Black, Hispanic/Latinx, 2SLGBTQIA+, American Indian/Alaskan Native individuals, youths from rural areas, and those with experiences in the foster care or mental health systems, including those at the intersections of these identities. Insights gleaned from comprehensive listening sessions with young individuals statewide have revealed key psychographic characteristics. These youth are seeking affirmation that their feelings and experiences are both real and significant. They emphasize the importance of safety in accessing support networks and trust in the suicide prevention messages and resources provided. Furthermore, the value placed on peer-to-peer communication and support is profound, with many expressing a preference for turning to a friend during times of crisis. This highlights a clear preference for self-determination and personal agency in seeking help, steering away from a one-size-fits-all solution. They aspire to manage their mental health proactively, aiming for empowerment rather than feeling burdened by responsibility.

Behavioral Objectives
The campaign’s development and launch were rooted in a commitment to authentically embrace youth co-creation, The campaign’s website serves as the central tool to achieve the following objectives: Increase Access to Suicide Prevention Resources: Users will be able to identify and access comprehensive information on crisis lines, suicide prevention initiatives, and mental health supports within two clicks on the website, thereby increasing their awareness and use of these resources. Enhance Confidence in Recognizing Distress Signs: Through interactive content and real-life scenarios, users, especially youth, will improve their confidence in recognizing signs of distress in themselves or others, as measured by pre-and post-engagement surveys. Foster Proactive Support and Self-Advocacy Skills: Through the website’s resources, users will acquire practical knowledge and skills for proactive support and self-advocacy, increasing their likelihood of engaging in supportive behaviors or seeking help. Demystify the Help-Seeking Process: The website will reduce hesitancy in seeking help by providing users with a clear understanding of the process. It aims to increase the number of users who report feeling prepared and less anxious about reaching out for support.

Description of Strategy/Intervention
Overall, the implementation of the campaign strategy into the website focused on three interventions: validate the visitor’s feelings and struggles, provide them with resources and support, build trust in those resources, and share stories of youth who have been helped. While all three were lofty goals, the youth supported the strategy of combining validation, appeal, offering multiple pathways to help, building trust, and sharing stories, to create an environment where youth would feel comfortable to seek help and support. 

The implementation of the campaign strategy into the website demonstrates a comprehensive approach to addressing the mental health needs of young people and includes the following elements: Website Structure: Through collaborative brainstorming with the youth co-creators, it was agreed to present the website in “first and second” person to not only validate visitors but also to personalize their journey across various pages. Subheadings are crafted as direct questions that mirror the thoughts visitors might have, ensuring an immediate and profound connection with the content. For instance, a subheading like “I am having thoughts of suicide right now. What should I do?” instead of a more formal “Steps to take during suicidal ideation” breaks down barriers of formality, fostering a deeper connection with the youth and making the content feel more relatable and accessible. Access to Resources: ​ A primary objective of our campaign is to get resources to our audiences. Mirroring this priority, our website immediately presents the “Get Help Now” dropdown as the first feature encountered by young visitors. Clicking on this option grants them instant access to the two most recommended resources for this campaign. Feedback from our listening sessions revealed a prevailing mistrust among youth towards available resources. To address this skepticism and encourage engagement, we offer detailed insights into the benefits of these resources, elucidate the process of reaching out, and clarify the available times for contact. Our aim is to equip visitors with comprehensive information, empowering them to confidently initiate contact with a helpline via call or text message. Stories: Every page of the website included stories of youth sharing their own experiences, tailored to the content of that page. ​These stories validated the visitor’s distress, made them feel less alone, and built trust in the promoted resources. Success stories of youth positively impacting their friends and positive experiences of calling helplines were shared to address hesitancy and make visitors feel supported. ​

Evaluation Methods and Results
The evaluation of the campaign’s website in both the immediate or near future, as well as over the long term, focuses on assessing its effectiveness in meeting its outlined behavioral objectives. This evaluation will leverage qualitative and quantitative metrics to gauge the impact of the website’s structure, content, and accessibility on users’ awareness, confidence, skills, and behaviors regarding suicide prevention and mental health support. Short-term evaluation will measure initial user engagement metrics, such as the number of visitors, the average time spent on the site, and the click-through rates to the “Get Help Now” dropdown. User feedback, collected through short surveys or feedback forms on the website, will assess the clarity, relatability, and perceived usefulness of the content, including the real-life scenarios and stories shared. Pre- and post-engagement surveys will specifically target changes in users’ confidence in recognizing signs of distress and their understanding of the help-seeking process. Over the life of the campaign, the long-term and post-campaign evaluation will focus on sustained behavior changes among the website’s users. This will involve follow-up surveys to measure whether users have increased their engagement with suicide prevention resources, whether they have applied the knowledge and skills acquired from the website in real-life situations, and whether there has been a notable increase in proactive support and self-advocacy behaviors. Success stories and testimonials from users who have been positively impacted by the resources and interventions offered through the website will be collected and analyzed. Additionally, trends in the reduction of hesitancy towards seeking help, as reported by users over time, will serve as a critical indicator of the website’s long-term effectiveness. The combined insights from the immediate and long-term evaluations will not only highlight the strengths and areas for improvement of the website’s strategy and implementation but also guide ongoing optimizations to ensure the website remains a relevant and impactful resource for suicide prevention among youth.

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