Circle of Support

The CIRCLE OF SUPPORT is a community-wide prevention and intervention program addressing adolescent depression and self-destructive behavior. The goals are:

Six manuals, three videos and a slide set are the educational tools which provide current research information, activities for learning, case studies to stimulate discussion, agendas to guide teaching, and written materials for handouts.

There is something for every audience: school teachers, administrators, counselors and psychologists; parents and interested community adults; friends and peers; peer helpers and teen teachers; mental health professionals and community caregivers working with teens and their families. Working together, these people form the circle of support needed to sustain vulnerable young people through troubled times.

Circle of Support is centered in the school, but it relies on the wider community for its success. It is based on a community mental health model that includes both prevention and intervention strategies. Its six component manuals offer opportunities for a variety of community agencies and educational programs to participate.

	Building a Circle of Support: A Model for Intervention and Prevention of Adolescent Mental Health Problems lays out the philosophy and describes steps to implement a mental health promotion program. Contents are intended for school administrators, counselors, a mental health center directors, and other health care professionals interested in establishing a community-based program with an active school component.
	Adults Who Care: Education for Parents and School Staff contains agendas, activities, and handouts for two 90-minute educational programs to help parents and school staff recognize and understand adolescent depression. The "Puzzle Pieces" and "Faces of Depression" videos are used with these training sessions.
	Tackling Tough Stuff: Adolescent Skills to Understand Depression is intended for general use with young people 12 to 18 years old. The seven topics are adaptable for classroom, small group or retreat settings. The experiential activities promote recognition and understanding of depression. Skill-building activities focus on coping, communication, and solving problems.
	Reaching In/Reaching Out: Topics for Counseling Support Groups contains activities, topics, and ideas to help therapeutic groups address issues of loss, conflict, and depression. It is designed for use by counselors or other trained professionals experienced in leading small groups of adolescents involve din therapy and building support.
	Teens Helping Teen: Peer Helper Training on Depression and Suicide Attempts contains educational materials to instruct peer helpers at the junior and senior high school levels on the topics of depression and suicide. The manual assumes a peer helper program is already in place.
	Teen Teachers: Cross-Age Education to Building Friendship Skills gives directions to engage high school students in the delivery of cross-age teaching to upper elementary school students on the topics of being a friend and building a circle of support.

UNIVERSITY OF MINNESOTA

Division of Child and
Adolescent Psychiatry
Department of Psychiatry
Medical School

Circle of Support is a comprehensive program developed by psychiatrists, psychologists, and educators at the University of Minnesota. The aim of this program is to address depression and self-destructive behavior in adolescents. A feature unique to this program is that it has evolved from more than five years of research during which over 15,000 students were surveyed. The intervention and prevention programs, then, are based on solid research findings and information presented by the students themselves. The human element of anguish and desperation common to suicidally depressed teenagers impacted and guided us the most in the development of these programs.

A number of issues were consistently observed. First, at any time, between 6 and 8 percent of all the high school students surveyed indicated that they were severely depressed. They exhibited many of the behaviors commonly associated with the clinical disorder called depression. The depression not only was characterized by sadness, remorse, hopelessness and nihilism, but it also was associated with anger, irritability, and hostility. At times, the depressed individuals looked intermittently sad and downcast, and at other times, irritable, angry and delinquent. A combination of factors including the inner anguish, irritability, delinquent acts and impulsivity appears to be the forerunner of self-destructive and risk taking behaviors. Drug taking and alcohol abuse were commonly reported at times of heightened irritability, anger, and depression. The breakdown of critical social support systems and the absence of significant adults (teachers, parents, coaches) who could guide and buttress the adolescent through stressful and challenging circumstances are strongly associated with suicide attempts. The lessons that we have learned from our studies indicate that there are adolescents who are at particular risk and who experience both inner pain and outer impulsive and aggressive behaviors. Those two behavioral components, along with a breakdown of the social matrix, appear to be the strongest contributors to our understanding of why some adolescents end their lives through suicide.

This program represents an opportunity to establish a permanent social support matrix that will be incorporated in all of our junior and senior high schools. This program is based within our school system and predicated on a strong collaborative effort with parents and community personnel. There are specific programs for teachers, school personnel, parents, students, youth at risk and other students in a supportive, helping role. These six programs, 1) Building A Circle of Support: A Model for the Intervention and Prevention of Adolescent Mental Health Problems; 2) Adults Who Care: Education for Parents and School Staff; 3) Tackling Tough Stuff. Adolescent Skills to Understand Depression; 4) Reaching In/Reaching Out: Topics for Counseling Support Groups; 5) Teens Helping Teens: Peer Helper Training on Depression and Suicide Attempts; 6) Teen Teachers: Cross-Age Education to Build Friendship Skills; provide opportunity for all within our adolescent community to acquire the knowledge, sensitivity and skills to intervene in a timely and constructive manner.

Teens Helping Teens: Peer Helper Training on Depression and Suicide Attempts is a program that contains educational materials to instruct peer helpers at the junior and senior high school levels on the topics of depression and risk-taking. This manual assumes a peer helper program is already in place.

In reading this material and learning from it, you will gain some skills necessary to stop the progression of depression and intervene before a suicide occurs. We have learned that when some young people become depressed, because of their feelings of inner pain and despair, they do not care about family, community, and school rules. They frequently turn to alcohol and drugs to self-medicate themselves out of their inner pain. The young person who shows these behaviors is most at risk for self-destructive behavior. The recognition of these individuals and their linkage to a new and perhaps more therapeutic social network can protect them through this difficult period.

The goal of this program is for everyone involved to understand and recognize depression in our youth. An equally important goal is to organize a support network and safety net that will provide the remedial environment in which the youngsters can regain their emotional well-being. The recognition of depression and its appropriate management is our goal.

"I shall never learn what "caused" my depression, as no one will ever learn about their own. To be able to do so will likely forever prove to be an impossibility, so complex are the intermingled factors of abnormal chemistry, behavior and genetics. Plainly, multiple components are involved -- perhaps three or four, most probably more, in fathomless permutations. That is why the greatest fallacy about suicide lies in the belief that there is a single immediate answer -- or perhaps combined answers -- as to why. the deed was done."
"Darkness Visible" by William Styron (1990) Random House: New York, pp. 38-39.

Barry D. Garfinkel, M.D., F.R.C.P. (C)
Director of the Division of Child and
Adolescent Psychiatry