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

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
Develop a campaign that is informed by and co-created with diverse California youth to, in the longer term, reduce rates of suicide, suicide attempts, and suicidal ideation among the priority populations disproportionately impacted. Achieving this involves a three-pronged approach towards behavior change, building on three foundational principles: co-creation with youth, a safe and effective messaging framework from the Suicide Prevention Action Alliance, and suicide prevention and intervention best practices. Our behavior change framework and objectives for the campaign are to: Increase awareness of the warning signs of suicide, crisis lines, and other suicide prevention and mental health resources and supports. Enhance self-efficacy and beliefs among youth that they deserve support, encouraging trust in their instincts regarding a peer’s well-being, and equipping them with the skills and knowledge to support themselves and a friend. Promote help-seeking behavior by providing information about what happens when young people reach out for help and demystifying the help-seeking process. These objectives, and our framework, are further informed by Social Norms theory (Perkins and Berkowitz,1986) in promoting awareness and help-seeking behavior through positive stories of our priority audiences (BIPOC and 2SLGBTQIA+ youth) effectively obtaining support through our campaign and resources, which in turn, helps decrease stigma, mistrust, and apprehension in seeking support before, during, and after a crisis.

Description of Strategy/Intervention
The campaign’s development and launch were rooted in a commitment to authentically embrace youth co-creation, transcending mere lip service to make it a fundamental and innovative aspect of its implementation. Aware of the limitations of a one-size-fits-all strategy for a diverse audience, the team emphasized the inclusion of varied voices and insights, achieved through initial listening sessions and face-to-face meetings. A significant part of the co-creation effort was the engagement of native Spanish speakers, ensuring thoughtful transcreation of Spanish-language materials. This approach sought to capture the essence of cultural nuances rather than simply converting text from English, ensuring materials resonated authentically with the intended audience. To tackle the challenge of engaging multiple hard-to-reach groups and fostering an environment conducive to open dialogue, the campaign strategically utilized a network of subject matter experts and community-based organizations. Central to this approach was the formation of a Youth Advisory Board, which brought together a diverse group of paid youth consultants from across California. Meeting monthly, the board was instrumental in shaping the campaign, providing valuable insights, feedback, and ongoing updates on its development. This guaranteed that the voices of the priority audiences were not just heard, but were actively guiding the campaign’s trajectory at every step. The campaign’s foundational research and development phase was marked by an extensive engagement process, reaching nearly 400 young individuals through a series of listening group meetings and insight sessions. This wide-reaching collaboration was instrumental in capturing a diverse array of perspectives from our target audience. The insights gathered from these interactions laid the groundwork for a multi-faceted strategy designed to resonate with the audience across five key dimensions: Validate: Recognizing the impact of a young person’s mental health, the strategy emphasizes validating their distress within the context of their families and communities. By openly acknowledging their struggles are real and affirming the importance of getting help, the campaign aims to dismantle the stigma surrounding mental health issues. Appeal: Central to the campaign is the empowerment of youth, providing them with practical “how-tos” for self-support and aiding friends. This empowerment is about equipping young people with the knowledge and tools they need to navigate their mental health proactively. Offer: Understanding that crises can manifest in various forms and intensities, the campaign offers multiple avenues for seeking and receiving help. This includes warm and crisis lines, chat and text options, and other resources available before, during, and after a crisis, ensuring accessibility and options that cater to different preferences and needs. Build Trust: Trust is fundamental in encouraging young people to seek help. The campaign provided honest information about the help-seeking process, what to expect when they reach out for help, and reasons to believe things will get better. This transparency is aimed at building trust and reassuring young people that their courage to seek help will be met with supportive and effective care. Share positive and genuine stories: Lastly, the strategy includes sharing uplifting and authentic stories from diverse young individuals supported by crisis and other resources. These narratives serve as powerful testimonials to the effectiveness of seeking help and the positive impact it can have, inspiring hope and encouraging others to reach out. The co-creation process led to the Never a Bother message, addressing the barriers and key insights that youth conveyed feelings “like a burden” or “bother” when expressing feelings of crisis or when seeking help. The campaign’s creative direction features bright, illustrated graphics and vibrant visuals, making the sensitive subject matter feel approachable and personal, to help destigmatize mental health discussions. Consistent with the co-creation model, youth not only inform the campaign, but are actively engaged in co-creating video content for mediums such as the website, socials (e.g., TikTok and Instagram), and printed materials for use in their community.

The Never a Bother campaign’s strategic communications plan was crafted with a focus on fostering genuine social engagement. By aligning with micro-influencers and spotlighting youth-generated content and stories, the campaign forges an authentic connection with its audience. This approach encapsulates three distinct content categories designed for both organic social and paid media platforms: Always On Messaging: This foundational layer of communication ensures a constant presence of supportive and engaging content, reinforcing the campaign’s core messages and values across all seasons. Tentpole Content: Aligned with significant moments and transitions in a young person’s life, such as back-to-school periods and graduations, this content category is strategically released to resonate with the audience during times of heightened emotion and change. Topical Content: Agile and responsive, this content type addresses current events and trending topics, ensuring the campaign remains relevant and engaged with the evolving interests and concerns of its audience. Beyond social media, the campaign’s reach extends through a diverse media mix, incorporating digital, radio, television, out-of-home, and print platforms. A dedicated campaign website offers resources, compelling shared stories from young people, and videos collectively aimed to build trust and rapport. To amplify its statewide presence, the campaign partners with a network of 34 youth-serving community organizations and Tribal partners. These collaborations enable local adaptation of campaign materials, fostering additional co-creation with the youths these organizations serve. This strategic partnership underscores the campaign’s commitment to authenticity, ensuring that its messages and materials are unique to the audiences and resonant with each community’s specific needs and cultures. Through these multifaceted strategies, Never a Bother speaks directly to the hearts of young people, empowering them to voice their struggles and seek help, reassured that they are never a bother.

Evaluation Methods and Results
The campaign launched in spring 2024 and will be evaluated through a robust framework inclusive of: Overall campaign outcome measures (e.g. reductions in rates of emergency department visits for suicide attempts and self-harm), Knowledge measures (e.g., increases in youth awareness of suicide crisis lines, suicide warning signs, and awareness of the campaign and website), Belief measures (e.g., increased willingness to engage in peer-to-peer conversations on suicide prevention, and increased self-reported comfort in utilizing crisis lines), Behavior measures (e.g. increased self-reported use of campaign resources, increased conversations about suicide prevention), and Co-creation measures (e.g., number of youth co-created campaign assets, number of listening sessions held with youth across the state among campaign partners), and Overall campaign engagement measures (e.g., traditional website, social media, digital media, and earned media engagement with the campaign). To effectively measure the impact and reach of the Never a Bother campaign, a comprehensive evaluation strategy is underway. This includes a robust statewide reach and recall survey scheduled for 2025, which will complement a set of pre- and post- campaign surveys administered by UCLA. These surveys measure youth and young adults’ awareness and engagement through the 34 community-based organizations and Tribal partners to gauge shifts in baseline knowledge, attitudes, and behavioral intentions related to mental health and suicide prevention. Initial findings from the 2023 survey conducted by UCLA revealed that 28% of youth and young adults would hesitate to seek help if experiencing suicidal thoughts. This insight underscores a critical area the campaign addresses: enhancing awareness and trust in available support services, such as the 988 hotline and Teenline. These platforms represent vital resources for those in crisis, and improving trust and familiarity among the target audience is paramount to use. By analyzing ongoing changes in these baseline measures, the campaign can identify the most effective strategies and areas for further development. The ultimate goal is to significantly reduce the stigma around seeking help for mental health issues and encourage more young people to reach out when they need support. Through targeted outreach, engaging content, and strategic partnerships, Never a Bother aims to create a culture where help-seeking is normalized and readily embraced, ensuring that every individual knows they’re not alone, never a bother, and that seeking help is not just necessary; it’s a path toward recovery.

Entry Letter: YY

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