In response to a severe national and local problem with adolescent suicidality, the Albuquerque Public Schools (APS) have developed a Multiple Component Suicide Prevention Program (MCSPP) in their high schools that includes gatekeeper training for school personnel, parents, and students and a multi-stage suicide risk screening process. APS has also formed strong partnerships with community mental health agencies to ensure that at risk youths are assessed and referred for treatment immediately upon being identified.
This research will allow us to evaluate what will be one of the most impressive multiple component suicide prevention programs in the country. Through this research, we hope to show that gatekeeper training procedures increase knowledge and peer identification abilities of students. We also hope to show that the various gatekeeper, screening, and referral procedures result in improved functioning, decreased symptoms, and decreased suicidality of at risk youths. In addition, there is very little research that has been done that tracks successful school referral for mental health and nothing is known about the processes (relationships between youths and referring professional, acceptability of referral to parents, etc.) involved in a successful referral. This study will give us the opportunity to study the referral process and the outcomes of referral.
In the end, this program should provide us with information to improve family involvement in school suicide prevention efforts, to increase success of referrals of high risk youths, and to decrease suicidality of adolescents attending APS schools.
The prevention program and the research occur within three phases. These phases are (Phase 1) training of students, staff and parents, Phase 2 for youth at risk of suicide, screening/assessment/referral, and (Phase 3) Service Utilization.
Phase one consists of suicide recognition and referral training(gatekeeper training) for all of those who come in contact with youths. This training is essential because most people do not know how to recognize the signs of potential suicide in youths. The training will be delivered through the use of the following prevention programs: Question, Persuade, Refer (QPR), and the Jason Foundation — A Promise for Tomorrow Curriculum (JFC). The goal of QPR is to offer awareness, dispel myths, give facts, and teach school staff and community professionals the warning signs and strategies to intervene and refer at risk youths. The JFC program is for additional gatekeepers such as students and parents (it can also be used for staff training); it teaches about the magnitude of the problem, and presents tools and resources to help in referral of identified at risk youths. Staff, students, and parents will complete surveys before and after training to ensure information was obtained by each group. Site coordinators will coordinate/oversee all aspects of getting consents, delivery of the trainings, and conducting of the research on site. Details are provided later in this document.
As a result of phase one, some students will be referred to school counselors and thus enter phase two. Once referred, the students’ parents will be notified. With parental consent and student assent, students will complete the Columbia Health Screen. For all positively screened students, a parent will be asked to come in and meet with the school counselor. These students will be referred to a community mental health professional for a same day emergency suicide risk assessment. Those who do not screen positively can also be referred for services at counselor discretion. Also at this time, school counselors will be asked to also get parental consent and student assent for participation in the evaluation of the prevention program. Site coordinators will oversee counselors’ consistent following of the counselor manual detailing steps for delivering the prevention program and getting consent for the research (Details on monitoring are covered in the Steps section of this manual). Two B: Once the student and family makes contact with a community professional, the community professional will conduct an in-depth evaluation to determine suicidal risk (Southwest Family Institute has agreed to work with APS but families can choose their own provider). Those determined to be at risk by the community professional will be referred to a mental health treatment agency without being put on a waiting list (five agencies are also working with the school system but families can choose their own provider). The USF research team will conduct phone interviews after the assessment in order to collect data on symptoms and functioning, and on student and parent level of engagement with the mental health professional that conducted their assessment and referred them for treatment. This part is for informational purposes only; site coordinators will have no additional responsibilities for Phase Two B.
Measuring the effectiveness of services During the last phase, mental health services will be provided to referred youths who follow through on referrals. A six-month follow-up will be conducted by the USF research team through a phone interview with the youth and family members. They will be asked about service utilization and long-term outcomes. Site coordinators will have no additional responsibilities for Phase Three.
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