Care, Assess, Respond, Empower: High School Suicide Prevention Program

Objective: The goals of Care, Assess, Respond, Empower (CARE) are threefold: to decrease suicidal behaviors, to decrease related risk factors, and to increase personal and social assets.

Description: CARE is a high school-based suicide prevention program targeting high-risk youth. CARE assesses the adolescent’s needs, provides immediate support, and then serves as the adolescent’s crucial communication bridge with school personnel and the parent or guardian of choice. The CARE program is typically delivered by school or advanced-practice nurses, counselors, psychologists, or social workers who have completed the CARE implementation training program and certification process. CARE includes a 2-hour, one-on-one computer-assisted suicide assessment interview followed by a 2-hour motivational counseling and social support intervention. The counseling session is designed to deliver empathy and support, provide a safe context for sharing personal information, and reinforce positive coping skills and help-seeking behaviors. CARE expedites access to help by connecting each high-risk youth to a school-based caseworker or a favorite teacher and establishing contact with a parent or guardian chosen by the youth. The program also includes a follow-up reassessment of broad suicide risk and protective factors and a booster motivational counseling session 9 weeks after the initial counseling session.

CARE was piloted and tested in participants 14 to 20 years old and has since been adapted for young adults (20 to 24 years old). Originally tested with diverse racial and ethnic groups, the program has also been specifically adapted for Native American and Hispanic students..


  • Suicide risk factors: Suicide risk factors decreased by at least 25% from baseline to 5- and 10-month follow-up assessments in more than 85% of the youth exposed to the CARE program.
  • Severity of depression symptoms: Severity of depression symptoms decreased by at least 25% in more than 65% of the CARE participants from baseline to 5- and 10-month follow-up assessments.
  • Drug involvement: Three measures of drug use frequency–alcohol, marijuana, and hard drug use frequency–decreased for CARE participants relative to a usual care control group of suicidal youth from baseline to 4-week follow-up. Significant rebound in alcohol use frequency occurred among the CARE participants and controls at the 10-week follow-up assessment. In contrast, reductions in marijuana use were sustained for CARE youth, and greater continued decreases in hard drug use occurred for CARE youth relative to usual care controls.

Population of Focus: American Indian or Alaska Native, Asian, Black or African American, Hispanic or Latino, Native Hawaiian or other Pacific Islander, White, Adolescents, Transition aged

Setting: Primary care facility, Reservation, School, Urban

Level of Intervention: Individual


Implementation: Reconnecting Youth Inc.
(425) 861-1177
Research: Beth McNamara, M.S.W.
(425) 861-1177