Circle of Support: Teens Helping Teens
	Introduction

When a trout rising to a fly gets hooked on a line and finds himself unable to swim about freely, he begins with a fight which results in struggles and splashes and sometimes an escape. Often, of course, the situation is too tough for him.

In the same way the human being struggles with his environment and with the hooks that catch him. Sometimes he masters his difficulties; sometimes they are too much for him. His struggles are all that the world sees and it naturally misunderstands them. It is hard for a free fish to understand what is happening to a hooked one.

Karl A. Menninger    

Intended Audience

This manual, one of two youth development components in the Circle of Support program, is designed to help high school students understand how to respond when a friend or classmate is depressed or suicidal. It brings new information about depression to high school youth, many of whom have little previous formal knowledge about the subject. In particular, it teaches students how to become more knowledgeable and effective bridges to appropriate school resources when a peer is in great need of help. The lessons in this manual are not intended for students who themselves are depressed or suicidal.

The enclosed lessons are to be used only by adults leaders who lead a pre-existing, high-quality peer helper program. By high-quality, we mean one that is in compliance with the National Peer Helpers Association Standards and Ethics for the Peer Professional and Peer Helper (Appendix F). We say this because, in introducing the sensitive topics of depression and suicide, we presuppose that the training will be done in a teenage group which has been together for some time, where a strong bond exists between participants, where the adults know the teens well, and where the teens already have had extensive training in basic communication and helping skills (e.g., question-asking, listening, and confidentiality). It is not intended to be used as a stand-alone training or with a group of students who have just come together.

The ideal training group includes high school students (ninth through twelfth or tenth through twelfth) who represent various student populations and groups. A heterogeneous group insures that the training information directly and indirectly reaches many different cliques on campus. These students can be part of an existing peer helping program or of a similar service project that has included systematic training in communication and helping skills. The training can take place during a peer helping class or study hall, after school, in the evening, or at some other mutually agreeable time. Because of the depth of the topics, larger time blocks (e.g., 90 minutes) are ideal for most of the sessions.

Content of This Manual

The lessons presented here cover information and skills that will help peer helpers:

• understand the seriousness of depression and the importance of seeking adult help.
• be able to identify the mixed types of behaviors that can signal depression.
• be able to identify warning signs of suicidal behavior.
• know how to respond if a friend is suicidal or seriously depressed.
• recognize the types of situations in which young people need to be referred for adult or professional help.
• be able to initiate and make an effective referral.
• identify and act upon the factors that lead to a sense of personal wellness and a positive school atmosphere.

To Learn More About Peer Helping

If you are interested in peer helping but do not have a program, we encourage you to read the material in Appendix D about peer programs and consider developing a full program before trying to use this manual. We strongly recommend that people starting programs take adult leadership training and develop their program in line with the National Peer Helpers Association Standards and Ethics for the Peer Professional and Peer Helper. For more information about training opportunities or the peer helping concept, contact Compass Institute (Appendix G) or the National Peer Helpers Association.

The Purpose of the Student Training

An informal, untrained peer helping network has long existed among teens. Students naturally share their concerns with each other during lunch, after school, and on the phone at night. What has changed in today's world is the seriousness of the problems discussed. If you were to ask a large group of students if they have had a friend who was suicidal, who was pregnant, who had been abused, who has a drug problem or who has an eating disorder, an overwhelming majority say "yes." But if you ask how many of these youth have sought adult help or advice for their friends, fewer than one in ten raise their hands. The result is that in crisis situations (i.e., those where a teenager's usual coping strategies are ineffective), many teens receive little or no professional help.

Since students already predominantly talk with their friends and classmates about these important issues, peer helping programs offer two different services: 1) They increase the students' skill in responding to and helping their friends; and 2) They train students to know when, how, and where to refer their classmates at a time of real crisis. One ninth grade counselor noted that the best thing about the school's peer program was the many timely referrals she received.

This connection between peer helpers and adult resources is often not understood by educators who are only casually familiar with the peer helping concept. In this manual, the linkage is a cornerstone of the lessons. If successful, this program will make it more likely that students who most need adult help will receive it. Young people who develop serious concerns can be helped. Help should come as early as possible, and is most effective in a trusting atmosphere.

Besides the importance of referral skills, teens can be encouraged by these lessons to create an environment on their campuses where every student experiences a circle of support around him or her. This is an ongoing and substantial challenge. Many students experience strong neglect or rejection from their peers. Helen Keller wrote that the world is full of suffering, and of the overcoming of suffering. Research from the workplace to the Army to school campuses demonstrates that "the most potent buffer against stress may be membership in a stable, close-knit group or community" (Farmham, Alan, "Who Beats Stress Best--And How." Fortune Magazine, October 7, 1991, p. 72). Peer helpers are well situated and can be well trained to help address the ongoing need to create more humane, livable communities in our schools.

In summary, the purpose of these lessons is twofold:

1. Intervention: To help students strengthen and maintain their circles of support. The project is designed to teach students how to recognize the warning signs for depression and suicide, and to know when and how to respond.
2. Prevention: To widen the circle of support. The project is intended to contribute to creating a school atmosphere where students are less likely to consider suicide. The final lesson gives students an opportunity to make use of what they have learned about depression to strengthen their school. It offers a process, not a prescription, by which students can help build better campus environments.

Program Outcomes

Intended Outcomes for Peer Helpers

• To be more likely to refer friends for adult help when the need arises.
• To know when, where, and how to make a referral.
• To acquire an increased understanding of the seriousness of depression and an ability to identify the mixed types of behavior that can signal depression.
• To increase the ability to identify and respond to the possible warning signs of suicide.
• To develop an increased commitment to improving the quality of the circle of support within their school.
• To demonstrate increased personal development (e.g., sense of personal efficacy, locus of control, self-esteem, and social responsibility).

Intended Outcomes for the School

1. To increase the ability of students to assist adults with early intervention for those in critical situations and to encourage the establishment of norms to promote this behavior.
2. To increase a prosocial and supportive atmosphere among classes and students.
3. To decrease intergroup isolation and/or scapegoating.

Rationale

The quality of mercy is not strained, it droppeth as the gentle rain from heaven upon the place beneath. It is twice blessed. It blesses him that gives and him that takes.

William Shakespeare    

The Role of Youth as Contributors

Few people would argue with the need for an effective means to address the dual problems of youth depression and suicide. The disagreement occurs in the debate of how to address those concerns. Before any comprehensive program can be designed, one of the fundamental questions which must be answered is:

Should students be exclusively recipients of services (e.g., counseling, referrals) OR should students also be given a positive and appropriate role in helping solve these key issues?

Any youth program--in schools, scouting, 4-H, or church youth groups--could claim involvement in "youth development" work. In the current debate about effective program design, youth development advocates argue that this title most properly belongs to programs in which youth are given genuine responsibility and involvement. What does that mean? Rather than doing things to or for youth, the youth development model rests on youth making decisions, implementing projects, acting on the problem themselves. This practice is receiving widespread support and experimentation. In the areas of depression and suicide, however, youth are not the only resources needed. These issues rely on meaningful and professional adult involvement and intervention. But to neglect or bypass the role of youth is to overlook one of the best allies.

The Effectiveness and Limits of Peer Helping

Peer helping programs center on students helping other students, usually within a school setting (see Appendix D). The effectiveness of this model has been documented by Bonnie Benard (see Appendix E). Students have built-in advantages in helping their peers because:

1. Credibility: They come from the same social world and so may be accepted and believed more readily than adults.
2. Perceived Empathy: Teens often share similar feelings, reference points, and an understanding of events; they assume that peers are more empathetic.
3. Shared Knowledge: Teenagers share and know about the same environment. They can teach each other from within the same frame of reference.

Peers have both built-in advantages and built-in limits as helpers. Peer helping, like any program, is effective only when it is well organized and aware of boundaries. The subjects of depression and suicide are far more serious than welcoming a new student or volunteering as a tutor. Realistically, how can students play a legitimate and helpful role in this difficult area?

Students already play a daily role, at least informally, in the lives of all of their classmates. Students who are depressed or suicidal often are socially marginalized, neglected, avoided, or given (sometimes poorly directed) attempts to help. Without systematic training and information, students may attempt to carry the burden of a friend threatening suicide, rather than having the attitude and skills necessary to make a referral.

The real question is not whether students will be involved. This will happen with or without adults' blessings. It is whether they will have the appropriate training and knowledge to respond when one of their friends or classmates reaches a critical juncture.

By training peer helpers in the areas of depression and suicide, the following effects can be achieved:

Breaking the Code of Silence. Among teenagers, there is a natural code of silence. Students are likely to be much more aware of what is happening to their peers than are parents, school officials, and other adults. In a midwestern state several years ago, secondary students were asked, If you had a drug problem, how many of you would seek an adult for help? Only 4 percent said they would. One of the ongoing problems of helping youth in crisis is developing effective means of early identification of those who need help. Experience has shown that peer helpers can learn the importance and limits of confidentiality, and can become an important source for early identification.

Stimulating Appropriate Helping. Because of the code of silence, it is common that students receive no help or receive well-intentioned but largely ineffective intervention by their friends. In a well-established peer helping program, students act as partners with others, including adults in the school, to connect young people in trouble with those who can best help. For this to happen, students must be well-trained in when, how, and why a person may need adult help.

Organizational Issues

Include Appropriate School Personnel

Because one of the main goals of this program is to increase the number of students who act as a bridge between peers and adults, it is recommended that the school psychologist, social worker, and/or counselor--whoever would appropriately handle students on campus who are depressed or suicidal--attend this portion of the student training. If his or her expertise would be useful during the three sessions, we recommend that he or she get to know the group at an earlier time in an informal meeting. If peer helpers can form a positive personal relationship with the appropriate school guidance staff, they will be much more likely to refer friends for help within the school. This is critical. Teens are reluctant to involve adults in serious peer issues. If they seek out anyone, it typically will be an adult they already know and trust.

Include Students from a Variety of Cliques

There are many potential benefits of having peer helper training groups reflect the heterogeneity of your school. It is a perfect place for students to break down barriers and form new alliances that can alter the school atmosphere. A common, meaningful task offers a structure and comfortable environment in which to meet others. Although certain peer projects may require special selection criteria, most would benefit from such a mix. In this project, it is important that the peer helpers reach people within every campus group.

Be Sensitive to the Needs of the Peer Helpers During the Training

Although these lessons are designed to train peer helpers about how to identify and refer friends who need adult help, it is quite possible that some peer helpers may be dealing with depression or some other crisis in their own lives. It is imperative that adult leaders debrief each training session completely, and, when necessary, follow up by talking with students outside of the group and/or referring them to the proper person within your school. Be especially sensitive to monitoring student reactions to the videotape. This training is not intended as an intervention tool, but some students, especially after viewing the video, may identify themselves as being depressed.

Importance of Follow-Up on the Lessons

While the first three lessons deal with the issues of depression and suicide, the fourth lesson focuses on personal and school wellness. How can peer helpers improve their school atmosphere? When students are given information and training, they need a chance to use their new knowledge and skills in genuine and important ways. You and your students need to ask how you can positively respond to the concerns raised in the lessons.

The most obvious response is an increased likelihood that peer helpers will appropriately refer classmates or themselves for help. However, the students also may want to create one or several new projects to extend or improve the circle of support within their school. The options are almost limitless, involving new students, foreign students, cliques on campus, teacher-student relationships, etc. Lesson 4 can be a springboard to a long-term effort to improve the school atmosphere for all students.

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