By John Seeley, PhD, Associate Dean for Research, College of Education, and Jonathan Rochelle, PhD, Research Associate, Suicide Prevention Lab, University of Oregon.
HEDCO Institute Blog 14- Sept 25, 2024
Suicide rates for youth and young adults (ages 10-24) increased 62% from 2007 through 2021, making suicide the second leading cause of death for youth aged 10-14 and the third for ages 15-24. As rates have increased over the past two decades, K-12 school systems have become an increasingly essential setting for providing comprehensive suicide prevention to youth. Schools are already serving as a leading mental health service provider for students and are the most frequent entry point into mental health services for youth. Additionally, schools implementing multi-tiered systems of support (MTSS) are equipped with key systems that can position staff with the resources to coordinate activities for suicide prevention, intervention, and postvention (i.e. responding after a suicide death has occurred) in a streamlined manner.
Despite schools being positioned as a crucial setting for youth suicide prevention, there remains confusion over what key prevention activities are effective and how these efforts should be organized. Due to this lack of clarity, this blog will review what exactly is meant by comprehensive suicide prevention along with detailing what key features are typically included in this type of approach.
What does school suicide prevention already look like?
To better understand the current recommendations regarding what activities schools can implement for suicide prevention best practice, the University of Oregon Suicide Prevention Lab(UOSPL) conducted a study in 2018 to determine what was already being done in Oregon schools for suicide prevention. Findings indicated that out of the 403 public schools surveyed, 71% had a documented protocol for identifying and referring students at-risk of suicide, while 58% had at least one evidence-based practice (EBP) for suicide prevention in place. Interestingly, the survey findings depicting the landscape of suicide prevention efforts in Oregon schools reflected the broader findings documented in the research literature, where student screening and staff training are the two must frequently studied practices.
A tiered approach for comprehensive school suicide prevention
To define a “comprehensive approach” to school suicide prevention, it’s helpful to view suicide prevention activities as an organized system instead of as distinct or separate activities operating in isolation. Comprehensive approaches to school-based suicide prevention and practice guides have been developed in the past several years, including the Suicide in Schools Model and the Jed Foundation’s (JED) Comprehensive Approach to Mental Health Promotion and Suicide Prevention for High Schools. Consistent with MTSS, these comprehensive approaches align with the public health prevention model of universal, selective, and indicated tiers.
Comprehensive approaches to school-based suicide prevention share many of the core features with MTSS, including the use of a continuum of EBPs; data-based decision making; implementation teams; professional development and technical assistance; early identification and screening; and engagement of students, families, and community members in culturally responsive programming.
For practitioners and educators interested in what EBPs are recommended for each tier, a systematic review by Singer and colleagues (2019) provides a framework that organizes the current EBPs for school suicide prevention by tier.
Core domains of suicide prevention activities
Operating within the system of comprehensive school suicide prevention are the programs, practices, trainings, and assessments available for school implementation. To help guide the selection of these activities, previous literature reviews have identified five key domains that serve as a foundation for organizing the selection and implementation process:
- Education or Awareness Programs – An upstream and universal approach used to familiarize students with the signs and symptoms of suicide in order to facilitate recognition in themselves or others. Example programs: Youth Aware of Mental health (YAM) and Signs of Suicide (SOS).
- Gatekeeper Training – One of the most widely disseminated types of suicide prevention programming in schools, these trainings are used to educate staff on how to detect the signs students at risk of suicide and then refer them to appropriate help. Example programs: Question, Persuade, Refer (QPR); Applied Suicide Intervention Skills Training (ASIST).
- Peer Leadership – A newer form of programming designed around selecting and training students to lead suicide prevention initiatives schoolwide. Example program: Sources of Strength
- Screening or Assessment – The three primary forms of screening and/or assessment currently being used are a) brief universal screening for risk, b) in-depth individual assessment, and c) crisis screening. Example screeners: Columbia-Suicide Severity Rating Scale (C-SSRS) and Ask Suicide-Screening Questions (ASQ).
Another key domain of a comprehensive approach is ensuring that student’s needs, perspectives, and input, are at the forefront school suicide prevention efforts. The promotion of school belonging is a key protective factor for students as discussed in a previous HEDCO blog post.
Additional resources:
- Substance Abuse and Mental Health Services Administration (SAMHSA) - Preventing Suicide: A Toolkit for High Schools
- American Academy of Pediatrics - Strategies for Community and School Settings for Youth Suicide Prevention
- American Foundation for Suicide Prevention – After a Suicide: A Toolkit for Schools
- Oregon Health Authority – Youth Suicide Prevention Programming Available at Low or No Cost
- American Foundation for Suicide Prevention - Model School Policy on Suicide Prevention
About the authors:
John R. Seeley, PhD, is an academic expert in emotional and behavioral disorders, school-based mental and behavioral health intervention, suicide prevention, and substance abuse prevention. John is especially interested in school-based screening, prevention, and treatment for internalizing and externalizing psychopathology. He serves as the principal investigator of a 4-year collaborative multisite study funded by the National Institute of Mental Health to evaluate adaptive treatment strategies for college students with moderate to severe suicidal ideation delivered through university counseling centers. Since 2016, John has served as an appointed member of the Oregon Alliance to Prevent Suicide and he directs the evaluation activities for the implementation of suicide prevention initiatives funded by the Oregon Health Authority and the Oregon Department of Education.
Jonathan Rochelle, PhD, is an expert in the field of mental health promotion and suicide prevention with a focus on school suicide prevention, intervention, and postvention. Jonathan utilizes a synthesis of several leading frameworks to inform his work with schools including research-practice partnerships (RPP), improvement science, implementation science, and quality improvement. Recently, he served as the principal investigator on a 3-year pilot project assessing the suicide prevention landscape in 10 high schools across Oregon State. Jonathan also works as a lead evaluator with the Oregon Alliance to Prevent Suicide where in addition to his support of school suicide prevention efforts, he oversees the regional networking of suicide prevention community coalitions and provides implementation and evaluation services for various suicide prevention evidence-based programs.