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Listen; please: a teen Latina suicide prevention program

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Listen; please: a teen Latina suicide prevention program

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Content 1
LISTEN; PLEASE
A TEEN LATINA SUICIDE PREVENTION PROGRAM
Doctor of Social Work Capstone Project
Daniel E. Kennedy
University of Southern California
Suzanne Dworak-Peck School of Social Work
DSW Program
Loc Nguyen, PhD, MSW
May 2024
© 2024 Daniel E. Kennedy

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Table of Contents
Abstract 3
Acknowledgements 4
Positionality Statement 5
Problem of Practice and Literature Review 6
Conceptual Framework 12
Project Description 14
Methodology 18
Implementation Plan 23
Conclusion and Implications 29
References 33

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Abstract
Suicide is the second-highest cause of death in the United States for adolescents ages 10–19
(Ruch et al., 2019). The San Diego County (SDC), California teen Latina suicide rate increased
by 33% from 2019–2021, peaking at 7.37 per 100,000 in 2020 (San Diego County Medical
Examiner, 2024), more than double the 2020 national teen Latina rate of 3.33 per 100,000
(Centers for Disease Control and Prevention, n.d.-b). Listen; Please (LP) is a teen Latina suicide
prevention program developed to ensure the healthy development of all youth (Grand Challenges
for Social Work, 2019). It is innovative because it reaches the underserved Latino community in
SDC Hispanic churches, focusing on family dynamics and leveraging Hispanic collective culture
while reducing mental health stigma and social isolation—significant barriers to suicide
prevention (Keller et al., 2019). LP was developed with SDC stakeholders and will be scaled
throughout Southern California and the United States. LP employs films and discussion groups
to reduce suicide risk by improving family dynamics. A pilot program in two SDC Hispanic
churches with Latino parents (n = 48) and teens (n = 33) tested LP for effectiveness. Preprogram
and postprogram surveys measured change in parent–teen connectedness, mental health and
suicide conversations, and help-seeking behaviors. One-way analysis of variance tests were used
for data analysis. Preliminary outcomes suggested LP impacted teens positively because there
was a statistically significant increase in average connectedness, parent–teen conversations, and
help-seeking from the pretest to the posttest from 0.12 to 1.21, F(1,4) = 9.25, p < .05. There was
a non-statistically significant increase in the average connectedness, parent–teen conversations,
and help-seeking for parents from 1.90 to 2.11, F(1,10) = 0.08, p = .78. LP models the potential
of training parents and teens together rather than separately. Further studies should examine the
underlying mechanisms that promote help-seeking behaviors.

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Acknowledgements
Listen; Please (LP) is the manifest wholehearted response to my calling to alleviate
human suffering in the spirit of my North Star, Jesus Christ, the consummate social worker who
promoted grace, justice, and healing for all. My wife, Veronica, and daughters, Estela and
Daniella, are my core who inspired, influenced, and contributed to this capstone project. Daniel
and Isaiah, my grandsons born during the DSW program, are the joy that fuels my work. My
quasicounselor sister, Carmen, has been essential to my emotional fortitude. Dr. Francisco
Contreras invested generously in my postgrad education. Melissa Doiron-Min and Tracy Vega
have been outstanding research pod collaborators, motivators, true friends, and chosen sisters.
Peer-to-peer support and insight have been essential, and members of DSW Cohorts 15 and 17
have become family. My coworkers Mary Bernal, Ana Karehn Nieva, and Jocelyne Ventura
invested their time, talent, and artistry into this work. Emily and Sabrena were great editors.
Dr. Jennifer Lewis helped me see and set course for the destination. Professor Cassandra
Fatouros, Dr. Loc Nguyen, and Evita Limón Rocha, MD, helped me navigate the journey. Dr.
Nadia Islam and Dr. Eric Rice added wind to the sails. Lisa Klein and Professors Doug Blush,
Rafael Angulo, and Dr. Sara Schwartz taught me new skills critical to bringing this project into
harbor. Alissa Jones-Weisser, Kara Long, Bertha Loaiza, and Steve Bouchard sowed their lived
experiences into the LP films. Students from Highland Prince Academy, Teens 4 Teens Help
board members, and Jeff and Kathy Long fostered the project’s authenticity and relevance.
Pastors Waldo Garza and Ray Alonso and their congregations were fantastic prototyping and
program evaluation design partners. Support from the SDC Suicide Prevention Council and the
good people at the 988 Suicide and Crisis Lifeline enriched my work as well.
It really does take a village.

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Positionality Statement
Caring for Latina adolescents and their parents is a good fit for me for several reasons. I
am a dual-citizen Mexican American cisgender male Christian, fluent in English and Spanish,
and was raised by a White father and a Mexican mother. I experienced immigration stressors as
my mother and wife immigrated to the United States from Mexico. I reside in San Diego, have
worked in Mexico for 30 years, and have experienced White privilege because my last name and
physical features do not appear Latino. I bridge the age and sex differences with Latina teens by
showing nonjudgmental, unconditional, and positive regard and by focusing on cultural and
lived-experience commonalities. At age 11, my mother died, activating a decade of untreated
mental health challenges including depression, anxiety, suicidal thoughts, risky behaviors, and
self-harm. As a teen, I lived in Okinawa, Japan, and was bullied for being a foreigner. At 18, I
was told to move out, so I couch surfed for months until my grandparents took me in.
My master’s in counseling, development in the University of Southern California Doctor
of Social Work program, and years of counseling clients in a hospital and bereavement center
have prepared me for this work. As a bilingual, bicultural counselor who has experienced
adversity, self-harm, and suicidal thoughts, I empathize with Latina and Latino teens. As a parent
of two Latina daughters, both having dealt with mental health needs, I understand the challenges
parents of Latina teens encounter. As a former ordained pastor of a Hispanic church, I have
insights on how to work with Latino pastors and other gatekeepers. Being raised with a
conservative Christian doctrine and feeling rejected by people from White, Hispanic, and Asian
populations could present potential biases. If insensitive thoughts arise, I will center on my belief
in the worth and dignity of every person. This conviction galvanizes my commitment to
consistently providing high-quality equal treatment to all.

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Problem of Practice and Literature Review
Preventing teen suicide is a critical objective in the Grand Challenges for Social Work
(2019) to Ensure Healthy Development for All Youth because suicide is the second-leading cause
of death for youth aged 10–19 (Centers for Disease Control and Prevention [CDC], 2022), taking
one life every 3 hours and totaling 2,941 suicides per year in the United States (CDC, 2023a). A
literature review revealed an alarming upward trend in teen suicide and suicidality in the 21st
century with a 33% increase in teen suicide rates from 2001–2021 (CDC, 2023b). The annual
number of suicides increased for 10–14-year-old teens by 12.7% for girls and 7.1% for boys
from 2007–2016, and for 15–19-year-old teens by 7.9% for girls and 3.5% for boys (Zolot,
2019). California saw suicide rates decline in 2018 for the first time in 20 years for all age
groups except 10–18, which increased by 20% (California Department of Public Health, n.d.).
The urgency to prevent teen suicide and reduce suicidality has never been more apparent
than now because the COVID-19 global pandemic accelerated and exacerbated the two-decade
national upward trend of the youth mental health crisis (CDC, n.d.-b). Unfortunately, the
pandemic became an adolescent mental health petri dish studied closely by researchers
worldwide. Data collected from 2020–2022 revealed the pandemic intensified many risk factors
of suicide, including loneliness, social isolation, and suicidal behaviors (Thakur et al., 2023).
Emergency department (ED) visits in the United States for suicide attempts increased
50.6% for girls and 3.7% for boys aged 12–17 during the COVID-19 global pandemic (Yard et
al., 2021). In California, Latina teens have represented the highest percentage of ED visits for
self-harm (California Department of Public Health, n.d.). The female youth suicide and
suicidality upward trend has been especially disquieting. Suicides for women aged 15–24

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increased 87% from 2007–2020 (CDC, 2022). Although more male youth aged 12–26 die by
suicide, female youth in that age group make more attempts (Miranda-Mendizabal et al., 2019).
Impact on San Diego County Latina Adolescents
The increase in Latina teen suicide and suicidality is more pronounced in San Diego
County (SDC), California than nationally. In 2020, the SDC Latina teen suicide rate was 7.37 per
100,000, more than double the national suicide rate (3.35 per 100,000) for the same population in
the same year (see Appendix A, pg. 47). The SDC Latina teen suicide rate increased 49.8% from
2.95 per 100,000 in 2019 to 4.42 per 100,000 in 2021 (see Appendix A, pg. 47). The five tragic
SDC Latina teens suicides in 2020 were the tip of the iceberg (see Appendix B, pg. 48). Below
the suicide surface were 11,677 Latina teens who made a suicide plan, 7,285 who attempted
suicide, 2,580 who sustained an attempt-related injury that required medical care, and 31,771
who experienced persistent sadness or hopelessness (see Appendix B, pg. 48). Another
distressing trend in SDC emerged during the COVID-19 global pandemic. The gap between
Latina and Latino teen suicides closed dramatically during this time. The male-to-female teen
suicide rate in 2019 was 4:1 nationally (Miranda-Mendizabal et al., 2019), but the ratio in SDC
for Latino to Latina teen suicides was less than 2:1 in 2020 with seven males to five females
suicides (see Appendix A, pg. 47). The gap between SDC Latina and Latino teen suicide rates
decreased by 67.3% from 2019–2021 (see Appendix A, pg. 47).
The future of the United States depends on ensuring healthy development of all youths’
mental and behavioral health. However, it is challenging for Latina individuals because they
have one of the highest suicide risks among all races, with 8.2% of Latina teens attempting
suicide in 2017 (Gulbas et al., 2019). An issue holding the problem in place is Latino individuals
receive half the amount of mental health services and prescriptions as the non-Hispanic White

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population (Office of Minority Health, n.d.-b). Reduced use of services and medications may
partially explain why SDC Latina teens have the highest rate of persistent sadness or
hopelessness (46.8%) in the county and nation (County of San Diego Behavioral Health
Services, 2020). This high rate of persistent sadness is concerning because it is a common
symptom in all major depressive disorders, including major depressive disorder and persistent
depressive disorder (Chand & Arif, 2023).
Risk and Protective Factors
Adolescent suicide risk factors include depression, anger issues, suicidal thoughts, a
history of suicide attempts, alcohol and substance use, and physical and sexual abuse (King et
al., 2020). The use of social media correlates with depression and chronic depressive disorder
(Bozzola et al., 2022) and self-injury by teens who view self-harm behavior videos or receive
messages suggesting they should kill themselves (Lin et al., 2016). Cyberbullying is associated
with depression and an increased risk of suicide for Latinas (Lutrick et al., 2020). A previous
suicide attempt was associated with 40% of suicide deaths (Cavanagh et al., 2003). A data
analysis from the National Latino and Asian American Study found that 62% of Latino suicide
attempts occur for the first time before age 18 (Fortuna et al., 2007). The young age for Latino
suicide attempts may be due to cultural stressors, including discrimination, a lower sense of
belonging, and the struggle with ethnic identity (Fortuna et al., 2016). Other risk factors include
social isolation, familial structure, and family instability (Bilsen, 2018).
For the Latino population, family dynamics are powerful determinants. Suicidal ideation
is more prevalent in youth with negligent parents who do not make their children feel safe, do
not show affection, and assert control (Alvarez-Subiela et al., 2022). Parental conflict, sibling
disharmony, and low support create a perception of a hostile family environment, which is

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associated with elevated suicide risk (Mathew et al., 2021). The frequency of youths attempting
suicide, isolating socially, and feeling lonely is higher in Latino adolescents with parents who are
not close to their children, do not spend quality time together, and do not share interests (OrtizSánchez et al., 2023). Hostile families are an environment for adverse childhood experiences
(ACEs). Half of Latino youth aged 12–17 have suffered at least one ACE, and 10% of all youth
have suffered three or more ACEs (Meeker et al., 2021). Meeker et al. (2021) linked childhood
trauma and neglect to suicidality, self-harm behaviors, suicide attempts, and suicide. Therefore,
ACEs should be an essential part of any framework for assessing suicide risk. Teens in families
with a history of mental health issues also have a higher suicide risk (Barzilay et al., 2015).
Adolescent suicide protective factors include high self-esteem, solid academic
performance, engagement in school, adequate economic status, prosocial behavior, and social
support (Fonseca-Pedrero et al., 2022). Family relationships have the potential to be the most
potent protective factor, and parental caring and a sense of security in the family are associated
with lower suicide risk (Alvarez-Subiela et al., 2022). Restricting access to firearms has reduced
suicide rates by 30%–50% in other countries. This strategy must be considered in the United
States where half of all suicides use guns (Barber & Miller, 2014). Restricting access to firearms
will likely save some Latino teens’ lives because 29% of suicides from 2018–2022 included use
of a firearm (San Diego County Medical Examiner, 2024). Unfortunately, gun restrictions may
not protect Latina teens because they used means other than firearms in the same timeframe,
including 70% hanging, 20% jumping, and 10% drug overdose.
Stakeholders
Considering 30% of the 7.5 million girls attending high school in the United States
seriously considered suicide in 2023 (Gaylor et al., 2023), there are countless teen suicide

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stakeholders that operate at the macro, mezzo, and micro levels, which include affected families
and resource providers. The federal government and national nonprofit organizations make a
significant impact through education and federal funding. These stakeholders include the
Substance Abuse and Mental Health Services Administration (SAMHSA), the American
Foundation for Suicide Prevention, the National Alliance on Mental Health, the CDC, and the
National Institutes of Health. Agencies operating on a national level are data driven and charged
with lowering the economic and psychosocial burden of teen suicide.
At the mezzo level, the California Department of Education leads the statewide effort to
reduce teen suicide (O’Donnell, 2016). California’s commitment to teen suicide prevention is
formidable. Assembly Bill 2246 mandates Grades 7–12 teachers to be trained in suicide
awareness and prevention and address the needs of high-risk students. The state of California is
one of the most important funding sources for teen suicide prevention. On December 7, 2022,
Governor Gavin Newsom committed $480.6 million in grants to nonprofit and for-profit
organizations serving the mental health needs of youth under age 25 (Office of Governor Gavin
Newsom, 2022).
The micro level of SDC stakeholders includes Latina teens and their parents, San Diego
Behavioral Health Services, the SDC Suicide Prevention Council, schools, churches, counselors,
EDs, psychiatric hospitals, the SDC Crisis Hotline, and philanthropists. Three stakeholders have
great potential to prevent Latina teen suicides: schools, the SDC Suicide Prevention Council, and
Hispanic churches. Schools are the most influential stakeholders because they are well-funded,
have counselors, are mandated to train staff in suicide awareness and prevention, are required to
meet high-risk student needs, and are in regular contact with more than half of the Latina teen
population (National Center for Education Statistics, n.d.). Most schools provide training with

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evidence-based suicide prevention programs like the Signs of Suicide (SOS) program or Good
Behavior Game (GBG) program. The SDC Suicide Prevention Council is a nonprofit
organization with a stakeholder hub that coordinates the vision of zero suicides in the county
(Community Health Improvement Partners, n.d.).
Hispanic churches, comprised of families, pastors, and ministry leaders, are stakeholders
with great potential to prevent Latina suicides. Latino pastors influence church members
significantly and are highly committed to helping people (Lehmann et al., 2022). Working in
churches provides an opportunity to promote the suicide risk protective factor of healthy and
engaged parent–children relationships. Approximately 41% of youth attend church with their
parents, and about 66% of Latino churchgoers attend a church led by a Hispanic pastor or priest
(CDC, n.d.-a). Latino parents worry about their children’s mental health the same as other races
and ethnicities (Minkin & Menasce Horowitz, 2023). However, many Latino people do not have
sufficient access to mental health services (Office of Minority Health, n.d.-a), and a churchbased program could bridge this health gap.
Solution Landscape
Suicidality and suicide prevention are being addressed with many resources and
interventions, including crisis helplines, mental health smartphone apps, government agencies,
nonprofit organizations, schools, churches, teen mental health clubs, films, blogs, mental health
practitioners, medication, and advocates for lethal means access reduction (SAMHSA, 2022).
Only a few programs have published randomized clinical trials, including the GBG program
(Joslyn et al., 2019), SOS program (Aseltine et al., 2007), and Life is Precious (LIP) program
(Humensky et al., 2017).

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The GBG program teaches students how to manage negative emotions to produce healthy
attitudes and behaviors (Joslyn et al., 2019). Although not addressing suicide directly, GBG may
reduce suicide risks associated with negative emotions and behaviors. The SOS program has
shown a resulting suicide attempt reduction in high school and middle school students; it is a
good fit for Latina teens because 40% of study participants in Aseltine et al.’s (2007) study
identified as Hispanic. SOS is a psychoeducation program using PowerPoint presentations,
videos, and printed materials to teach youth to recognize signs of suicide, engage an at-risk
person, and connect that person to help (Volungis, 2020). LIP is an after-school communitybased program in New York for Latina youth aged 12–18 who experienced suicidal ideation or
suicide attempts (Humensky et al., 2017). LIP teaches communication skills to teens to improve
family relationships and provides academic support, creative expression resources, and wellness
education activities. A retrospective study found reduced suicidal ideation and depression and no
suicide attempts among participants (Humensky et al., 2017). Although SOS, GBG, and LIP
have shown effectiveness, they are provided to teens, but not parents. LP is innovative because it
is the only church-based program delivered to teens and their parents with the goal of improving
family dynamics to reduce suicidality and suicide.
Conceptual Framework
Suicide occurs in a constellation of risk factors, including ACEs, family and peer conflict,
social isolation, thwarted belongingness, depression, self-harm, suicidality of family and peers,
eating disorders, discrimination, and economic stress (Bachmann, 2018). Although the etiology
of suicide is not well-defined, Figure 1 is a theoretical framework developed through a deep and
broad literature review and ethnographic interviews with female adolescent survivors of suicide
attempts. This framework shows the most common risk factors Latina teems experience in an

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organized and logical progression toward suicide, including ACEs, persistent sadness,
depression, social isolation, deliberate self-harm (DSH), suicidal ideation, suicide planning,
suicide attempts, and suicide. Not all teens who attempt suicide experience all these risk factors,
but the framework shows a common progression.
Figure 1
Listen; Please San Diego County Latina Suicidality and Suicide Path Analysis
ACEs increase the likelihood of DSH, suicidal ideation, suicide planning, suicide
attempts, and suicide, and people who experience four or more ACEs are 9 times more likely to
report feeling suicidal (Bunting et al., 2023). About 50% of Latino adolescents have experienced
one or more ACEs (Claypool & Moore de Peralta, 2021). Persistent sadness and the inability to
regulate it increase suicidal ideation and suicide attempts (Kovacs & George, 2020). Latina teens
have the highest prevalence (46.8%) of persistent sadness or hopelessness nationwide (County of
San Diego Behavioral Health Services, 2020). Depression is the main predictor of suicide,
considering a study showing 66% of people who died by suicide had a depressive mood disorder
(Morales-Vives & Dueñas, 2018). High suicide risk is found in 50% of adolescents who
deliberately harm themselves, and 100% of people who attempt suicide have a history of DSH

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(Duarte et al., 2020). Latina individuals have a heightened risk for DSH (Croyle, 2007). Latina
adolescents report using DSH to control negative feelings, and when self-harm no longer
controls emotions, a sudden choice to attempt suicide often results (Gulbas et al., 2015). Social
isolation is associated with suicidal ideation and DSH, and youths who prefer solitude and isolate
socially have the highest suicide risk (Endo et al., 2017). A systematic literature review on the
link between social isolation and suicide not only confirmed social isolation is a risk factor, but
the authors also wrote social isolation is causal (Motillon-Toudic et al., 2022). This framework
helps determine intervention points and develop a logic model for the LP innovative solution.
Logic Model
The LP logic model (see Appendix C, pg. 49) outlines the inputs, activities, and outputs
to induce measurable outcomes, including improved parent–teen communication and
connectedness, increased parent–teen conversations about mental health and suicide prevention,
and greater use of mental health care services such as counseling and helplines. These outcomes
align with the LP theory of change (see Appendix D, pg. 50) that supports the idea that when
parents and teens participate in LP activities, parent–teen connectedness increases, the stigma of
mental health and suicide reduces, and parent–teen conversations about these topics become
normalized, facilitating an increase in help-seeking behavior. The logic model guided the
methodology in developing LP, and it evolved in the human-centered design process.
Project Description
LP is a suicide prevention and suicidality reduction program developed for Latina
adolescents and parents and implemented first in Hispanic churches in SDC. San Diego is the
southernmost county in the state of California. As of 2021, SDC had a population of 3.2 million
people, with 35% being Latino and 20.7% being under age 18 (U.S. Census Bureau, 2021). The

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Latino adolescent population aged 10–19 was 67,886 girls and 70,657 boys (Census Reporter,
n.d.). LP will integrate visual social work, faith and biblical principles, Latino collectivist and
familism culture, and church hospitality culture. The Real Comunidad and La Vid Church pastors
in the southern part of SDC granted access to the target population. The program will be
expanded first throughout SDC, working with the Hispanic Pastors Alliance and church
denominations representing upward of 349 Latino churches (SmartScrapers, 2023).
Rather than lectures, LP uses videos and images to teach concepts and model behaviors,
including how parents can speak to children about mental health and suicide and connect them to
help. LP shows teens how to manage strong emotions and seek help. After the videos,
beneficiaries will participate in guided roundtable discussions, a method Lewis-Kipkulei (2021)
found was well-received by 90% of their participants, with 70% indicating increased confidence
to make their voices heard after this type of learning activity.
Opportunity
LP is innovative because existing programs do not leverage family dynamics, faith, and
cultural aspects specific to Latino churchgoing families like LP will. The program specifications
that follow conform to the CDC’s suicide prevention best practices (Stone et al., 2017).
Target
LP was designed for the 18,000 Latina teens aged 15–19 and their parents in SDC who
attend a Hispanic church together. The 5-year goal will be to deliver LP to 2,700 Latina teens.
The program will be provided in English and Spanish to support the 72% of Latino individuals
who speak English proficiently and 70% who speak Spanish at home (Funk & Lopez, 2022).

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Setting
LP will be provided in Hispanic churches in SDC. Churches are an ideal setting because
more people with mental disorders seek help from clergy than psychiatrists (Wang et al., 2003),
and Latino church leaders help and influence their parishioners significantly (Lehmann et al.,
2022). Approximately 41% of youth attend church with their parents, and 66% of Latino
churchgoers attend a church led by a Hispanic pastor or priest (CDC, n.d.-a). Because parents
and children are together at church, there is excellent opportunity to promote the suicide risk
protective factor of healthy and engaged parent–child relationships (De Luca et al., 2020). Latino
individuals trust Hispanic churches and consider them a haven where U.S. Latino culture is
celebrated free from discrimination and immigration anxiety (Parra-Cardona et al., 2021). Latino
churchgoers share life experiences and connect culturally, engendering belongingness and a safe
environment for positive change.
Theory of Change
Although the etiology of teen suicide has not been defined beyond risk factors (Cha et al.,
2018), it has been well-documented that stigma and social isolation are the most common
contributors to suicidal ideation and are significant barriers to help-seeking behavior (Keller et
al., 2019). The social roots theory of suicide postulates suicide rates correlate with the strength of
social relationships (Mueller et al., 2021). If teens do not feel highly connected to and supported
by their parents, they may isolate themselves in silence for fear of rejection or judgment if
perceived as having a mental illness. The resulting feeling of loneliness or lack of belonging due
to perceived rejection and isolation increases the risk of suicide (Calati et al., 2019).
LP addresses stigma and social isolation and affects change by providing interventions to
improve parent–teen communication, relationships, and connectedness; normalize parent–teen

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conversations; and teach help-seeking behaviors (see Appendix D, pg. 50). The program is
family focused because parents’ mental health influences their teens’ mental health, and
connectedness is a protective factor (De Luca et al., 2020) that lowers depressive symptoms
(Raymond‐Flesch et al., 2021). The program aligns with best practices outlined in the CDC’s
“Preventing Suicide: A Technical Package of Policy, Programs, and Practices” by making
suicide prevention care easily accessible to Latino individuals, creating a protective environment,
promoting connectedness, and teaching coping and problem-solving skills (Stone et al., 2017).
Prototypes
LP prototypes include five digital assets comprised of two documentary films, one
narrative short, a TikTok series (see Appendix E, pg. 51), and a conversation starter card (see
Appendix F, pg. 52) with prompts to facilitate roundtable discussions designed to increase helpseeking behavior and normalize conversations about mental health and suicide prevention. The
prototypes are culturally inclusive for the SDC Latino population with all materials featuring
both English and Spanish.
Grand Challenge for Social Work: Ensure Healthy Development for All Youth
The overarching goals of the grand challenge to Ensure Healthy Development for All
Youth (Grand Challenges for Social Work, 2019) includes (a) reducing behavioral health
problems in young people by 20% and (b) reducing disparities in behavioral health problems by
20%. LP will contribute to these goals by improving Latina adolescent mental health through
strengthening parent–teen communication, connectedness, parental support, and family cohesion
and function, all of which are factors that reduce depressive symptoms in Latina youth
(Raymond-Flesch et al., 2021). LP will lower disparities in mental health care access for Latina
teens by providing suicide prevention training in Hispanic churches and introducing the

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participants to a licensed clinical social worker (LCSW) or licensed marriage and family
therapist (LMFT), and other mental health resources.
Likelihood of Success
LP is likely to succeed if the theory of change fits the target group. The protective
environment of Hispanic churches is culturally inclusive and promotes family and social
connections (Derose & Rodriguez, 2020). Inviting beneficiaries, users, and other key
stakeholders to participate on the design team will bring the wisdom of lived experience and
expertise while diminishing pushback during implementation. Using best practices and evidencebased interventions will also increase the probability of success. LP will be successful if Latino
families served are trained in suicide prevention, engage in conversations about mental health
and suicide prevention, and reach out to counselors or helplines when teens or parents need
mental health support. Presurveys and postsurveys will be given on the day of the workshop and
at 30 days, 90 days, and 6 months to measure parent–teen connectedness, mental health and
suicide prevention conversations, and help-seeking behavior (see Appendix F, pg. 52).
Methodology
LP was developed from Summer 2021 through Spring 2024, employing a humancentered design thinking process guided by design justice principles asking four simple
questions: What is? What if? What wows? and What works? (Liedtka et al., 2019). The what is
step was taken to identify existing problems and existing solutions. A literature review was
conducted using PubMed, the University of Southern California Library article finder, Google
Scholar, government websites, and government database portals using search keywords such as
suicide, suicidality, suicide prevention, Latina adolescents, Latino families, incidence,
prevalence, mental health, risk factors, protective factors, Hispanic and Latino culture, faith-

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based programs, church, stigma, and awareness. The searches generated a bountiful selection of
peer-reviewed quantitative, qualitative, and experimental studies. Government databases and
websites were located, including the CDC’s (n.d.-b) WISQARS data visualization, the San Diego
Medical Examiner’s data portal, and SAMHSA’s database for evidence-based programs. Google
Scholar also identified relevant YouTube videos, teen TEDx Talks on mental health, television
programs, documentaries, and films. The literature review identified SOS, GBG, and LIP as
benchmark solutions and discovered the gap in solutions focused on family dynamics, delivered
in churches, and tailored culturally for the Latino population.
Human-Centered Design
To understand the problem further, a human-centered approach was also employed to
learn directly from people experiencing teen suicidality or suicide and people who are trying to
help. Ethnographic interviews were conducted with students at SDC high schools, several teen
survivors of suicide attempts, and parent survivors of suicide loss. A stakeholder focus group
was conducted with the SDC Suicide Prevention Council to gain insight from representatives of
nonprofit organizations with lived experience. There were 14 Latino pastors, four counselors, 50
Latino parents, and 40 teens who were surveyed. Interviews were conducted with suicide
prevention researchers at the University of Southern California, Harvard, Stanford, and Berkley,
along with suicide prevention program directors, including 988, SOS, Teens4TeensHelp,
Survivors of Suicide Loss San Diego, and Coronado Safe Harbor. A matrix was used to
categorize gathered information into problem data, existing solutions, theories of cause and
change, and insights from people with lived experiences.

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Design Justice Principles
Design justice principles were employed, centering on Latino teen, parent, and pastor
voices and expertise for collaborative development. These principles ensured the LP program
would empower the community with new knowledge and skills to promote healing and close the
mental health care gap. To empathize and understand the intersectionality of this wicked
problem, interviews with teen suicide attempt survivors were essential to define their journey. A
teen Latina suicidality journey map was developed based on interviews with seven adolescent
suicide attempt survivors. The journey map (see Appendix L, pg. 58) focused primarily on the
life of Alissa, a Latina teen who experienced being given up for adoption as a toddler, being
raped by a neighbor’s teen son, three suicide attempts, and multiple hospitalizations. Alissa
signed a grant release and waiver, agreeing to share her name. She spoke candidly and in detail
about her experiences. Her testimony was the basis of the documentary heal the disconnect, one
of four films featured in LP.
The teen suicide and suicidality problem was defined by synthesizing the literature’s data
with emergent themes from the ethnographic interviews, focus groups, and surveys. The main
themes were consistent with the outcomes in peer-reviewed studies, except for clergy attitudes
about suicide and mental health care. Although it was expected most people would believe
suicide is a sin, few pastors interviewed held that view. Another unexpected outcome was the
clergy interviewed believed most people could benefit from mental health care and would be
interested in having suicide prevention training done at their churches (see Appendix G, pg. 53).
Design Criteria and Ideation
The second design thinking step is to ask what if to ideate, experiment, and refine the LP
design criteria (see Appendix M, pg. 59) to ensure prototypes would be culturally inclusive, fit

21
the target population, preserve the dignity and value of participants, be innovative, and align with
the objectives based on the theory of change and best practices. A community participatory
collaboration included pastors, parents, and teens in the prototyping process, which led to
discovering what wows and what works. Participant feedback resulted in the production of two
films in Spanish with English subtitles to fit the local Latino culture better. What wows were the
group conversations where parents and teens became profoundly engaged and desired to spend
much more time in the activity. A decision was made to focus on what works in the group
discussion by increasing the activity time from 20 minutes to 40 minutes and reduce the number
of talking prompts significantly. The first iteration included eight cards with five prompts. These
40 prompts were distilled to the five critical prompts that fit on one conversation starter card.
Market Analysis
The economic burden of suicides and suicide attempts in the United States is nearly $70
billion in medical costs and lost productivity (CDC, 2022). SAMHSA (2023b) allocated $244
million in 2024 to improve youth mental health and prevent suicide. California (2023) will fund
$16.3 million in 2024 for grants to organizations working to prevent teen suicide. Suicide
prevention programs are funded through federal and state grants, donations, and license fees.
Countless organizations and programs are dedicated to suicide prevention. However, LP
is unique and innovative because it is the only one developed with and for Latino families in a
Hispanic church setting focused on improving family dynamics. LP is eligible for federal
funding for faith-based organizations (SAMHSA, 2023a) and state grants on GrantWatch (n.d.).
Measuring Social Change and Impact
In line with the LP theory of change, the program will be successful if it increases
parent–teen connectedness, mental health and suicide conversations, and help-seeking behaviors.

22
A pilot program was conducted in two SDC Hispanic churches. To measure LP’s social change
and impact, the following specific, measurable, attainable, realistic, and timely (SMART)
objectives were used for evaluation:
• Connectedness: Using a Likert scale of agreement (0 = not connected to 5 = perfectly
connected), parent–teen connectedness will increase by 10% from baseline Likert
scores 30 days after the program, 20% at 60 days, and 30% at 90 days.
• Mental health conversations: Measured by a frequency question (0–5 times per
month), parents will increase conversations about mental health with their teens from
baseline by 10% at 30 days after the program, 20% at 60 days, and 30% at 90 days.
• Suicide prevention conversations: Measured by a frequency question (0–5 times per
month), parents will increase suicide prevention conversations with their teens from
baseline by 10% at 30 days after the program, 20% at 60 days, and 30% at 90 days.
• Help-seeking: Using a likelihood question (0 = no to 5 = absolutely will), the number
of parents connecting their teens to 988, the SDC helpline, or a counselor will
increase from baseline by 10% at 30 days after the program, 20% at 60 days, and 30%
at 90 days.
Participants
The pilot program was conducted in two SDC Hispanic churches. The pilot included
Latino parents (n = 48) and teens (n = 33).
Measures
Preprogram and postprogram surveys were used to measure any change in parent–teen
connectedness, parent–teen conversations about mental health and suicide, and the likelihood of
seeking help from a counselor. Parents’ likelihood to seek help from a pastor was also measured.

23
The first survey was administered on the day of the LP pilot before the workshop, and the
postsurvey was done 30 days after the program. A one-way analysis of variance (ANOVA) was
used to analyze the parent survey data and again in a separate analysis of the teen survey data.
Results
Though the parents’ presurvey and postsurvey showed positive change, the impact of LP
on parent outcomes was not statistically significant (see Appendix I, pg. 55). However, the
ANOVA analysis for the teens’ presurvey and postsurvey impact of LP on teen-reported
outcomes was statistically significant (see Appendix K, pg. 57). The 10% increase at 30 days
was met for almost every SMART objective. For parents, connectedness to their teen increased
by 26.6%, mental health conversations increased by 15.6%, suicide conversations increased by
49.5%, taking their teen to a counselor decreased by 94.8%, the likelihood of seeking help from a
counselor increased by 13.7%, and the likelihood of seeking help from a pastor increased by
4.9% (see Appendix H, pg. 54). For teens, connectedness to their parents decreased by 13.2%,
mental health conversations increased by 14%, suicide conversations increased by 84.8%, and
the likelihood of seeking help from a counselor increased by 83.4% (see Appendix J, pg. 56).
There was a significant need for LP because only 4.2% of parents and 6.1% of
adolescents had any suicide prevention training before LP (see Appendices H and J, pgs. 54 &
56). The probability that LP will be accepted by many churches in SDC is high because 85.7% of
pastors surveyed believed mental health care could benefit most people, and 84.6% believed
their members were interested in the topic of suicide (see Appendix G, pg. 53).
Implementation Plan
LP will be implemented in SDC Hispanic churches before scaling throughout California
and the United States. This implementation plan includes strategies for micro, mezzo, and macro

24
marketing efforts to introduce and expand the LP program across various regions and
demographics effectively.
Micro Marketing Strategy: SDC Hispanic Churches
The 10-year goal outlined in the logic model (see Appendix C, pg. 49) is to hold
workshops in 114 churches representing 33% of the 349 SDC Hispanic churches (SmartScrapers,
2023), reaching 5,700 Latina teens, 5,700 Latino teens, and 11,400 parents for a total of 22,800
participants. Although LP was developed for Latina teens, the pilot program included adolescent
Latino teens, and the workshop was equally effective with boys and girls. The marketing strategy
consists of referrals and networking. Pastors who hosted the LP program previously will be
asked to provide testimonials and referrals to pastors in their circles of influence. In addition to
referrals, LP will collaborate with the SDC Hispanic Pastors’ Alliance to leverage its network of
24 SDC pastors and facilitate introductions to interested churches. LP will also partner with the
SDC Suicide Prevention Council to raise awareness about LP and seek referrals from
participating mental health practitioners and organizations. This strategy involves essential SDC
suicide prevention stakeholders including Latino families; pastors; school counselors; and mental
health practitioners, clinics, and nonprofit organizations.
Mezzo and Macro Strategies
To scale the LP program beyond SDC, a communication strategy will use tailored
outreach materials highlighting the benefits of LP for congregations and communities. These
materials will be distributed through email. Other marketing efforts will include calls and
networking with church denomination leaders and the American Association of Christian
Counselors at conferences.

25
Another strategy to scale LP is to modify the program materials to resonate with the
cultural values and preferences of the Black, White, Asian, Native American, Native Hawaiian,
and Pacific Islander populations by collaborating with community leaders and cultural experts to
ensure the program’s relevance and effectiveness in different ethnic groups. The next step in this
strategy is to develop targeted marketing campaigns to promote the LP program among churches
serving diverse ethnicities and cultures.
Exploration, Preparation, Implementation, and Sustainment Framework
The exploration, preparation, implementation, and sustainment framework (see Appendix
N, pg. 60) has been used in LP’s development exploration and preparation phases, and will be
employed for implementation regionally and nationally. Sustainment will be through funding and
evaluation. During the implementation phase, outer context stakeholders including suicide
prevention organizations and SDC pastors will be engaged, as well as inner context stakeholders
including an LCSW or LMFT who will serve at each workshop, Latino families who participate,
and pastors who are gatekeepers of local churches. Several barriers related to internal cultural
and religious norms were identified along with external factors that affect Hispanic churches.
Facilitators can help overcome the barriers for successful implementation of the LP program.
Barriers
Pastors may resist approving the implementation of LP because of Latino cultural norms.
Mental health stigma is higher in Latino communities in the United States than in other
populations (DuPont-Reyes et al., 2020). Stigma against people experiencing suicidal ideation is
also higher in the Latino population, especially foreign-born older Latino adults (Brewer et al.,
2022). Staffing can also be an issue. If LP film content brings up strong emotions in a person,
churches may not have mental health professionals capable of supporting teens or parents with

26
trauma-informed care. It can also be challenging to refer participants because access to mental
health services is limited due to the Latino population having more uninsured people than all
other populations in the United States (Office of Minority Health, n.d.-a). Another barrier to a
suicide prevention program like LP is many people in Hispanic churches still consider suicide to
be self-murder and a sin against God (Cusack, 2018).
Facilitators
The aforementioned barriers and resistance can be offset by several facilitators, including
the social connection and support that happens in churches due to their culture of hospitality and
helping. Although stigma against mental health issues exists, a church’s hospitality offers a sense
of belonging. The hospitality culture may be why people needing mental health support turn to
pastors and priests more often than they go to psychiatrists (Lehmann et al., 2022). Church
attendance is associated with lower suicide attempts, even though it does not reduce suicidal
ideation (Lawrence et al., 2016). Although the erroneous religious belief that suicide is a sin
could be a barrier, it could also serve as a facilitator motivating church leaders to work to prevent
suicide. Finally, to overcome the barrier of limited access to mental health practitioners at
churches and in the community, LP workshops will have a licensed clinical social worker
(LCSW) or licensed marriage and family therapies (LMFT) ready to support participants during
the event and offer appointments to those seeking help.
Line-Item Budget
Appendices O and P (see pgs. 61 & 62) display the line-item budgets for the startup year
and the 1st full year of operation. Sources of revenue include federal and state grants, film
grants, donations, and program fees totaling $138,100 in the startup year (see Appendix O, pg.
61) and $129,200 in the 1st full year of operation (see Appendix P, pg. 62). Expenses include

27
per-workshop honorariums for the program director, manager, and LCSW or LMFT; program
materials; transportation; mobile phones; computers; accounting services; web and social media
services; and equipment. Expenses total $127,470 in the startup year, leaving a surplus of
$10,630, and 1st operational year expenses totaling $89,720, generating a surplus of $39,480.
The surplus is less in the startup year because LP will require two laptop computers, a highresolution projector, and a sound system for its workshops, and the one-time cost of this
equipment is $21,000. A financial highlight is LP is structured to allocate a $1,000 facility use
fee payable to the church where the workshop will be held. These funds will allow the church to
pay LP a $350 event fee and keep $650 to help the church’s general budget.
Fund Development Plan
LP engaged the grant writing and consulting services of a seasoned grant writer and
program developer, who is working closely with LP to fund most of its budget through federal
and state grants dedicated to faith-based programs. LP will also apply for grants at FilmDaily
(n.d.) to produce more films to enrich its program. Additional funding will be obtained through
supporters, friends, family donations, and a program fee for each workshop.
Evaluation Plan
LP will be monitored closely for program fidelity to ensure participants receive the
designed experience and benefits in every workshop. LP will also be evaluated for effectiveness
in creating social change and participant satisfaction. Preparticipation and postparticipation
surveys will be used for monitoring and evaluating with a commitment to continuous
improvement. One of LP’s goals is to be evaluated for efficacy in several randomized clinical
trials and publish its results in peer-reviewed academic journals.

28
The implementation plan for the LP program outlines a comprehensive approach to
introducing, expanding, and scaling the program across micro, mezzo, and macro regions. By
leveraging referrals, networking, targeted outreach, and cultural adaptation strategies, the LP
program aims to help Latino and other populations prevent teen suicide while fostering
collaboration with key stakeholders for sustainable growth and measuring social impact.
Challenges
LP is provided to parents and teens together, which presents challenges such as
generational differences in perception and opinion, language preference, and resistance to
speaking openly in front of each other. To mitigate these challenges, LP includes a mix of film
styles that can appeal to a range of ages, all materials are provided in English and Spanish, and
family members are assigned to separate discussion groups. A limitation is the ability to follow
up with postsurveys over 6 months because people move, change churches, or lose interest in the
program. To overcome this limitation, LP must assign the follow-up responsibility to a person
who will check in with participants periodically and update any changes in contact information.
Participants may engage in follow-up surveys if LP provides incentives like access to additional
films for people who complete surveys. Finally, the primary obstacle is resistance for pastors to
host LP or for church members to participate due to mental health and suicide stigma. Meetings
with pastors to show the need and benefits of LP will be the primary means to overcome the
stigma obstacle. Leadership qualities and techniques such as relationship building, persuasive
and charismatic communication, and community engagement will help navigate the challenges,
limitations, and obstacles.

29
Ethical Considerations
LP has been designed to affirm the value and dignity of every stakeholder and
participant. An awareness that LP may activate strong emotions that could increase the risk of
suicidality has inspired the inclusion of a trauma-informed LSCW or LMFT at workshops and
the provision of a resource guide so all participants will have contact information for the
counselor, LP program administrator, and local helplines and mental health crises treatment
centers. Suicide can be impulsive and difficult to predict (Abdullah et al., 2023), so the support
of counselors during workshops and a follow-up call will reduce the risk of a negative outcome.
Conclusion and Implications
Prevention is the best option for all intractable social challenges except suicide, where
prevention is the only option. LP was designed with Latino community stakeholders in response
to the 33% increase in teen suicide rates of all races and ethnicities in the 21st century and, more
specifically, the 51% increase in Latina adolescent suicide rates in that period (CDC, n.d.-a). LP
is innovative because it is the only culturally inclusive program for Latino parents and teens in
Hispanic churches focused on improving parent–teen connectedness, communication, and access
to mental health care resources. LP’s family focus contrasts with most school-based programs
because in schools, students are trained, but parents are not included. If parents do receive
training in schools, it is often gatekeeper education. Such trainings increase suicide literacy, but
no meaningful change in suicidality in teens has resulted (Torok et al., 2019).
LP focuses on the importance of parent–teen relationships. The stronger the relationship
between adolescents and their parents, the better teens regulate emotions. (Branje & Morris,
2021). Family functioning is especially a significant determinant of suicidality in Latina
adolescents (Gulbas et al., 2019).

30
Lessons Learned
The LP pilot program resulted in several lessons learned: (a) people want to talk about
suicide; (b) teens speak without inhibition when they feel safe from judgment, minimizing, and
rejection from parents; (c) therapy is necessary for teens with high suicide risk; (d) parents are
essential to getting teens to help; and (e) pastors’ and church members’ attitudes and beliefs
about mental health care and suicide have evolved in positive ways. One more lesson was
learned. The pilot program included and surveyed Latino boys, and the results showed that LP’s
acceptability and feasibility is the same for Latino boys as it is with girls. A One ANOVA
indicated that the change in average parent-teen connectedness and parent-teen suicide
prevention conversations differed between Latina teens and Latino teens, but the difference
between girls and boys was not statistically significant as indicated by p = .70 (see Appendix Q,
pg. 63).
LP breaks stigma-driven silence by normalizing conversations about mental health and
suicide and inviting families to talk about them openly. Through the design process, several
anecdotes were collected. Two teens said the LP workshops were the first time they felt safe to
talk about their feelings and thoughts of suicide. Ten parents shared how hopeful they felt after
discussion groups. Several teen suicide attempt survivors stated therapy was critical help that
improved their mental health and gave them necessary coping skills to manage emotions and
reduce suicidality. The teens also stated they would not have sought help without the insistence
and aid of their parents. Finally, despite the historic conservative religious beliefs that demons
induce mental health issues and suicide is an unforgivable sin, this perspective has evolved
because most pastors and church members in SDC Hispanic churches believe suicide is a mental
health issue and most people can benefit from mental health care (see Appendix G, pg. 53).

31
Implications for Practice and Future Use
LP creates the opportunity to impact the teen suicide prevention ecosystem positively by
bridging the mental health care gap Latinos experience in several innovative ways. LP
overcomes the language barrier by providing print materials in Spanish and English and films
with subtitles in both languages. Workshops are provided in churches, a setting where Latinos
feel safe from discrimination and privacy issues associated with health care institutions. The
benefits of mental health care are modeled, and help-seeking is normalized. Finally, LP makes
mental health care accessible by having a Spanish-speaking LCSW or LMFT present at
workshops and available for scheduled appointments, with fees charged on a sliding scale. LP
may change the future of teen suicide prevention by changing the focus of programs from
teaching suicide sign recognition to teens and parents separately to programs that gather teens
and parents together to improve connectedness, communication, and help-seeking behaviors.
Action Plan
LP will be implemented in SDC Hispanic churches beginning in Spring 2024. The
following activities will help ensure successful implementation. First, a new a 501c3 called
“MindRev” will be incorporated in California to manage the LP program. MindRev’s
organizational structure, roles, and responsibilities will be defined during the incorporation
process, and necessary legal approvals and registrations for nonprofit status will be obtained by
the author, who will be the organization’s first executive director. A comprehensive grantwriting strategy to secure funding for LP will be developed. Grant opportunities from
government agencies, foundations, film grant programs, and philanthropists will be identified,
and applications will be submitted. Fundraising campaigns soliciting donations from corporate

32
sponsors and community members will be organized and implemented in addition to grant
writing.
LP will partner with mental health organizations to recruit licensed counselors to
participate in its workshops and provide after-care support. Meetings with pastors and church
leaders will be held to promote and schedule LP workshops. An online presence will be
generated with a MindRev website and social media accounts. The website will be the hub for LP
information, resources, registration, and private donations. MindRev social media accounts on
Facebook, Instagram, TikTok, and X will promote LP and engage with the community with
mental health and suicide prevention educational content.
MindRev’s executive director and project manager will organize and provide LP
workshops in six SDC Hispanic churches by the end of 2024. The project manager will
coordinate logistics, including venue setup, audiovisual equipment, and materials distribution.
MindRev’s project manager will collect feedback from participants, mental health professionals,
and community partners to identify strengths and areas for improvement. LP will be refined
continuously based on evaluation findings and stakeholder input to enhance program outcomes.
LP’s pilot study results cannot be generalized because participants were predominantly of
Mexican origin, and the Latino population is diverse, with roots in 33 nations, each with unique
cultures and languages other than Spanish. Therefore, community members will be consulted to
adapt LP for optimal cultural fit when scaling. Although pilot study results affirmed LP’s
potential to prevent suicide and reduce suicidality in SDC adolescent Latina girls and boys,
further research is needed to explore underlying mechanisms and optimize the program’s
effectiveness for both parents and teens. Strengthening parental engagement and tailoring
interventions to meet diverse family needs may enhance program outcomes.

33
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47
Appendix A
San Diego County and United States Latino Teen Suicide Rates Per 100,000
Data and sources:
The San Diego County Latino female adolescent population is an estimated 67,886 (Census
Reporter, n.d.).
The San Diego County Latino male adolescent population is an estimated 70,657 (Census
Reporter, n.d.).
The San Diego County suicide data source is the San Diego County Medical Examiner (2024).
The national suicide data source is the WISQARS fatal and nonfatal injury reports (CDC, 2022).
Year #F SDC
Suicides
F SDC
Suicide
Rate/
100K
#M SDC
Suicides
M SDC
Suicide
Rate/
100K
Difference
F:M SDC
F National
Suicide
Rates
M
National
Suicide
Rates
2017 0 0.00 3 4.25 4.25 2.88 7.37
2018 0 0.00 6 8.49 8.49 2.66 7.19
2019 2 2.95 5 7.08 4.13 2.52 6.72
2020 5 7.37 7 9.91 2.54 3.35 7.17
2021 3 4.42 4 5.66 1.24 3.11 6.80
0 0
2.95
7.37
4.42
4.25
8.49
7.08
9.91
5.66
2.88 2.66 2.52
3.35 3.11
7.37 7.19 6.72 7.17 6.8
-2
0
2
4
6
8
10
12
2017 2018 2019 2020 2021
Latino Suicide Rates Per 100,000 San Diego County Vs. USA
Female SDC Male SDC Female USA
Male USA Linear (Female SDC)

48
Appendix B
San Diego County 2020 Suicide and Suicidality
1. https://censusreporter.org/profiles/05000US06073-san-diego-county-ca/
2. CDC. (2023). YRBSS Data Summary & Trends. Centers for Disease Control & Prevention.
3. SDCME. (2022). San Diego Medical Examiner, cases by manner of Death (annual comparison): Open Data Portal.
Latina Teen Suicides, San Diego County, 2020 Population: 67,886
© Daniel E. Kennedy 2024
5
11,676
2,580
7,285
31,771
Died by suicide.
Developed a suicide plan.
Experienced persistent feelings
of sadness or hopelessness.
Required medical care following
suicide attempt.
Attempted Suicide.
Below the Surface
1
2,3
3
2,3
2,3
2,3

49
Appendix C
Listen; Please Logic Model

50
Appendix D
Listen; Please Theory of Change Model
© Daniel E. Kennedy 2024
Listen; Please Theory of Change Model
Output
Production
Impact
IMPROVE NORMALIZE CONNECT
• Parent-teen communication
• Parent-teen relationship and
connectedness
• Parent-teen conversations
about mental health
• Parent-teen conversations
about suicidality and
suicide prevention
• Mental health practitioners
• Crises helplines
• School counselors
• Pastors or youth leaders
• Youth mental health
organizations and clubs
Stigma-driven silence on mental health topics, including suicide, is a powerful social norm holding suicide in
place. The fear of social rejection or becoming a burden to others compels silence and social isolation.
Social roots theory of suicide underpins the Listen; Please theory of change:
The suicide rate correlates with the strength of social relationships.
Mueller, A. S., Abrutyn, S., Pescosolido, B., & Diefendorf, S. (2021). The social roots of suicide: Theorizing how the external social world matters to suicide and
suicide prevention. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.621569

51
Appendix E
Listen; Please Films
Listen; Please Films
Title Style Password QR Code
Living Through It Documentary Short LPCapstone
heal the disconnect Documentary Short LPCapstone
Wake Up Mijita! Narrative Short LPCapstone
Listen; Please TikTok TikTok/Reel LPCapstone
Click on title or scan QR code to watch films.

52
Appendix F
LP Conversation Starter Card
listen; please conversation starters
indRev
• What are some ways we can support each other without judgment when it comes to mental health
struggles and suicide prevention in our family or community?
• Discussing suicide won't plant the idea in someone's mind. It can save lives and provide a sense of
relief from pain or hurt. How can we encourage these conversations without fear?
• What can we do to create a safe space for our family members to express how they feel and provide
the support for them to get help from a counselor?
• A strong family connection helps protect against teen suicide. How can you strengthen your family
bonds and communication to better support one another during challenging times?
• Belonging, safety, and dignity are crucial for resilience. How can you foster these qualities within your
family and community?
• How will you ensure that mental health and suicide prevention conversations continue beyond this
roundtable and become an ongoing part of your family member's lives?
• How can we support each other in seeking help and breaking our culture's stigma around mental
health?
Positive Statement: Our families are our strength. When we communicate openly and support each
other, we protect each other from rejection, sadness, and suicidal thoughts.
© Daniel E. Kennedy 2024
listen; please iniciadores de conversación
indRev
• ¿Cuáles son algunas formas en que podemos apoyarnos unos a otros sin juzgarnos cuando se trata de
problemas de salud mental y prevención del suicidio en nuestra familia o comunidad?
• Hablar del suicidio no plantará la idea en la mente de nadie. Puede salvar vidas y brindar una
sensación de alivio del dolor o las heridas. ¿Cómo podemos fomentar estas conversaciones sin
miedo?
• ¿Cómo podemos crear un espacio seguro dentro nuestras familias para expresar las emociones y
buscar la ayuda de un consejero cuando sea necesario?
• Una conexión familiar fuerte es un factor protector vital contra el suicidio adolescente. ¿Cómo pueden
fortalecer sus vínculos familiares para apoyarse mejor unos a otros durante tiempos difíciles?
• La pertenencia, la seguridad y la dignidad son cruciales para la resiliencia. ¿Cómo puedes fomentar
estas cualidades dentro de tu familia y comunidad?
• ¿Cómo se aseguraría usted que las conversaciones sobre salud mental y prevención del suicidio se
extiendan más allá de esta mesa redonda y se conviertan en una parte constante de la vida de sus
familiares?
• ¿Cómo podemos apoyarnos unos a otros para buscar ayuda y romper el estigma de nuestra cultura en
torno a la salud mental?
Positive Statement: Nuestras familias son nuestra fuerza. Cuando nos comunicamos abiertamente y nos
apoyamos mutuamente, nos protegemos unos a otros del rechazo, la tristeza y los pensamientos
suicidas.
© Daniel E. Kennedy 2024

53
Appendix G
Listen; Please Pastor Survey Results

54
Appendix H
Listen; Please Parent Survey Results

55
Appendix I
Parent Survey Data Analysis
Although the postsurvey average for parents of 12.7 (SD = 1.4) was higher than the
presurvey average for parents of 11.4 (SD = 1.2), there was a non-statistically significant
increase in the average connectedness, parent–teen conversations, and help-seeking for parents
from 1.90 to 2.11, F(1,10) = 0.08, p = .78.

56
Appendix J
Listen; Please Youth Survey Results

57
Appendix K
Youth Survey Data Analysis
Outcomes suggest that LP positively impacted teens in which there was a statistically
significant increase in average connectedness, parent–teen conversations, and help-seeking from
the pretest to the posttest from 0.12 to 1.21, F(1,4) = 9.25, p < .05.

58
Appendix L
Listen; Please Journey Map
Latina Teen Suicidality Journey Map: Alissa
Birth family was conflictive. First
memory of social worker visit: Age 2.
Separated from birth family and
adopted at age 3.
Started therapy at age 3. Started cutting at age 11 after
observing peer’s self-harm behavior.
Social Roots Theory Interpersonal Theory Protective Factor
1 2 3
Sexually Assaulted at age 15.
Social Learning Theory
ACES: Sexual Abuse
Became depressed and socially
isolated, and continued self-harm.
Depression • Social Isolation • Self-harm
First suicide attempt at age 15,
followed by two more over 2 years.
Hospitalized at UCLA
neuropsychiatric hospital.
Learned coping skills from therapist. Observed other teens with similar
problems getting better.
Started mental health club with
others at high school.
Continues DBT with psychotherapist
and is university psycho major.
Protective Factor Social Learning Theory Protective Factor: Social Connection/Belonging Protective Factor
Hopelessness led to Self-Injurious Behaviors Protective Factor
5 6 7 8
9 10 11 12
Self-injurious Behavior
Causation Theory
Risk Factor
Protective Factor

59
Appendix M
Listen; Please Design Criteria
© Daniel E. Kennedy 2024

60
Appendix N
Listen; Please EPIS Framework
© Daniel E. Kennedy 2024
Listen; Please EPIS Framework
Output Outcomes
Production
Impact Year 1
• 12 Seminars
• 1,000 participants
Year 5
• 48 seminars
• 4,000 participants
10 Year Cumulative Goal
• Seminars in 300
churches
• 34,000 participants
• Reduced stigma of
mental health and
suicide conversations
and help-seeking
behaviors
• Increase awareness of
suicide prevention
• Fewer teens socially
isolated
• Decrease of suicide
attempts and suicides
• Equitable access to
mental health care
EXPLORATION PREPARATION IMPLEMENTATION SUSTAINMENT
OUTER CONTEXT
• Government agencies
• Non-profit organizations
• Researchers
• Mental health practitioners
OUTER CONTEXT
• Suicide prevention program
leaders
• People with lived experience
OUTER CONTEXT
• Suicide prevention
stakeholders
• San Diego County Hispanic
pastors’ alliance
OUTER CONTEXT
• Faith community
• Philanthropic organizations
• Federal and state funding
• Donor base
• County of San Diego
Behavioral Health and
Human Services
INNER CONTEXT
• Monitoring for quality and
fidelity
• Promotion and recruiting
• Adaptation for other
populations and settings
INNER CONTEXT
• Program leaders
• Partner churches and
gatekeepers
• Counselor
INNER CONTEXT
• Target population design
partners
• Expert design partners
INNER CONTEXT
• Pastors
• Church youth leaders
• Parents
• Teens
BRIDGING FACTORS San Diego County Suicide Prevention Council • Faith-based counselors
INNOVATION FACTORS Church setting • Cultural fit • Parents & teens participate together • Film & participatory conversations

61
Appendix O
Listen; Please Fiscal Year 2024 Start-Up Budget

62
Appendix P
Listen; Please Fiscal Year 2025 Budget

63
Appendix Q
Listen; Please Impact on Teen Latina Girls vs. Teen Latino Boys
The change in average parent-teen connectedness, and parent-teen suicide prevention
conversations differed between Latina teens and Latino teens, but the difference between girls
and boys was not statistically significant as indicated by p = .70.

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Asset Metadata

Creator Kennedy, Daniel E. (author)

Core Title Listen; please: a teen Latina suicide prevention program

School Suzanne Dworak-Peck School of Social Work

Degree Doctor of Social Work

Degree Program Social Work

Degree Conferral Date 2024-05

Publication Date 05/03/2024

Defense Date 03/22/2024

Publisher Los Angeles, California (original), University of Southern California (original), University of Southern California. Libraries (digital)

Tag Adolescent,Anxiety,Daniel E. Kennedy,depression,family dynamics,film therapy,Hispanic,Latina,Latino,neurocinematics,OAI-PMH Harvest,self-harm,suicidality,Suicide,suicide prevention,teen suicide prevention,youth mental health crisis

Format theses (aat)

Language English

Contributor Electronically uploaded by the author (provenance)

Advisor Nguyen, Loc (committee chair), Fatouros, Cassandra (committee member), Limon-Rocha, Evita (committee member)

Creator Email dekenned@usc.edu,eaglesflightstudio@gmail.com

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC113920139

Unique identifier UC113920139

Identifier etd-KennedyDan-12891.pdf (filename)

Legacy Identifier etd-KennedyDan-12891

Document Type Capstone project

Format theses (aat)

Rights Kennedy, Daniel E.

Internet Media Type application/pdf

Type texts

Source 20240507-usctheses-batch-1148 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

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Repository Name University of Southern California Digital Library

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