Multiple Stakeholder Perspectives on School-Based Responses to Student Suicide Risk in a Diverse Public School District
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ORIGINAL PAPER
Multiple Stakeholder Perspectives on School‑Based Responses to Student Suicide Risk in a Diverse Public School District Tamar Kodish1 · Joanna J. Kim2 · Kenny Le1 · Stephanie H. Yu1 · Laurel Bear3,4 · Anna S. Lau1
© Springer Science+Business Media, LLC, part of Springer Nature 2019
Abstract Schools across the US have implemented suicide prevention procedures to detect risk among students and facilitate linkage to mental health services. Yet, many students at risk for suicide do not access mental health treatment, and significant racial/ ethnic disparities in service utilization persist. Quality improvement of suicide prevention procedures is needed to enhance care for suicidal youth. The present study examined perspectives of multiple stakeholders involved in school-based suicide prevention procedures through a qualitative design, in order to generate a set of quality improvement targets. Participants included school staff, students assessed for suicide risk at school, and their caregivers. Results indicated points of commonality and divergence across stakeholder groups. Students and parents described feelings of exclusion from decision-making processes, perceptions of rigid and disciplinary assessment procedures, traumatic experiences with crisis intervention, and practical barriers and facilitators to follow-up services. Staff perspectives highlighted positive regard for standardized protocols, efforts to reduce negative student experiences with assessment procedures, prioritization of student safety, and potential practical and attitudinal barriers and facilitators to follow-up care. Given these findings, a set of quality improvement targets is proposed and discussed, with a focus on family-centered interventions to promote engagement. Keywords Suicide · Prevention · Assessment · Schools · Disparities · Quality improvement · Mental health services
Introduction Suicide is the second leading cause of death among US youth (Centers for Disease Control and Prevention [CDC], 2015), carrying enormous consequences for families and communities (Cash & Bridge, 2009; Nock et al., 2013). Youth with suicidal ideation at age 15 are almost 12 times more likely to attempt suicide by age 30, and are at elevated risk for negative life outcomes, including poverty and mental illness (Reinherz et al., 2006). Rates of hospitalization due to youth suicide and self-injury have increased by 151% from 2006 to 2011 (Torio et al., 2015). Yet, the majority of youth * Tamar Kodish [email protected] 1
Department of Psychology, University of California, Los Angeles, USA
2
Reach Institute, Arizona State University, Tempe, AZ, USA
3
Alhambra Unified School District, Alhambra, CA, USA
4
Los Angeles County Department of Mental Health, Los Angeles, CA, USA
with suicidal ideation and behavior do not receive mental health services (Husky et al., 2012; Pirkis et al., 2003; Wu et al., 2010). Even in the context of reduced access barriers in school-based suicide prevention efforts, at-risk students are more likely
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