Multiple Stakeholder Perspectives on School-Based Responses to Student Suicide Risk in a Diverse Public School District

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.