Enhanced Screening and Follow-up during School-based Suicide Prevention Programming

Body of Abstract: Research

Aims: Suicide, an increasing public health concern in the United States, is the second leading cause of death among youth. Schools, via school mental health services and prevention efforts, have become an essential component of the system of care for children and adolescents. However, to date there is no consensus regarding best practices in school-based universal suicide risk screening. Though early identification of youth at risk for suicide in schools may be an important upstream approach to preventing suicide, there is some concern that schools may initiate screening programs without full consideration of how best to manage and support those students identified as at risk. The Center for Suicide Prevention and Research (CSPR) at Nationwide Children’s Hospital delivers evidence-based suicide prevention programming in schools, in conjunction with a universal suicide risk screening process using the Brief Screen for Adolescent Depression (BSAD). The CSPR has utilized a continuous quality improvement approach to improve implementation and program success over time. Key components of this programming include school-hospital-community partnerships, an implementation framework, a sustainability focus, and facilitation with fidelity and flexibility. The goals of this presentation are twofold: 1) To describe the iterative approach to develop and improve a school-based universal screening process for depression and suicide risk by enhancing program reach, adoption, effectiveness, stakeholder engagement, early identification of suicide risk, and staff confidence and competence; and 2) to describe suicide risk screening outcomes from 9 years of CSPR implementation, from academic years 2015-2016 to 2023-2024.

Methods: We will use descriptive statistics to characterize overall program reach and screening outcomes. Chi-square tests will be used to examine whether screening outcomes differ by school characteristics. We will also incorporate survey responses from school administrators on their perceptions of the effectiveness of the triage training, screener, and student response cards, as well as whether the programming helped schools identify students in need and whether the programming overwhelmed the response team due to a large number of students requiring follow up.

Results: Over the first 9 years of program implementation, the CSPR team reached 84,913 students in 276 schools. Overall, 14,243 students screened positive for depression/suicide and 16,388 requested to speak with a trusted adult. Regarding follow-up, response teams conducted 22,743 triage assessments to discern whether formal risk assessment was indicated leading to 2,688 suicide risk assessments. This enhanced identification and follow-up process led to 4,526 outpatient referrals, and 425 crisis referrals. Over time, there was a significant increase in the percent of students who screened positive on the BSAD with increases in suicide specific indicators. Additional outcomes describing school characteristics and screening implementation training outcomes will be reviewed.

Conclusions: This presentation describes a large-scale implementation project of a universal suicide risk screening program in schools. Based on the numbers of schools participating and the increase in schools over time, this implementation project demonstrates that schools can adopt and sustain universal suicide risk screening practices. We will also share lessons learned, such as providing advanced training across a number of staff implementation roles and developing a clear post-screening algorithm, to help other organizations avoid pitfalls we encountered and ultimately improve future mental health outcomes for youth.

Learning Objectives:

• Describe the iterative approach the CSPR has used in implementing school-based suicide prevention initiatives.
• Identify strategies and lessons learned by CSPR that may be applicable to your work in the field of suicide prevention.
• Describe how universal suicide risk screening outcomes have changed over time and vary by school characteristics.