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Liljedahl SI, Hellner C, Pettersson A, Ghaderi A. School-based self-harm prevention programs: A systematic review with implications for international implementation. Scand J Psychol 2023; 64:825-837. [PMID: 37366058 DOI: 10.1111/sjop.12945] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 06/07/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023]
Abstract
Both self-harm and suicidal behaviors have been targeted through school-based prevention programs, many of which have been developed in the United States. The aims of this systematic review were to assess effects of school-based prevention programs on suicide and self-harm and to evaluate whether they are fit to the exporting culture. The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our inclusion criteria, structured according to population/problem, intervention, control/comparison, outome, were: children and youth up to 19 years of age, school-based programs at universal, selective or indicated levels compared with teaching as usual or with other programs, and outcomes of suicide or self-harm measured at least 10 weeks after intervention. Studies without a control group or using non-behavioral outcomes were excluded. A comprehensive and systematic literature search was conducted from the 1990s to March 2022. Risk for bias was assessed with checklists adapted from the Cochrane Risk of Bias (ROB) tool. A total of 1,801 abstracts were retrieved. Five studies fulfilled our inclusion criteria, but one had high risk for bias. Confidence in the evidence for effect was assessed with Grading of Recommendations Assessment, Development and Evaluation (GRADE). Studies included in this review were evaluated with respect to applicability in the context of international export. Only two school-based programs demonstrated efficacy in preventing suicidal behaviors. Although implementation of evidence-based interventions is a crucial next step, further replication with simultaneous attention to dissemination and implementation issues are called for. Funding and registration: conducted on assignment by the Swedish government. The protocol is available at the SBU website in Swedish.
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Affiliation(s)
- Sophie I Liljedahl
- Department of Psychiatry for Affective Disorders, National Specialized Medical Care Unit for Severe Self-Harm Behaviour, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Clara Hellner
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Agneta Pettersson
- Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden
| | - Ata Ghaderi
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Shilubane HN, Ruiter RAC, Khoza LB, van den Borne BHW. Perspective on the Prevention of Suicide among School Learners by School Management. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20105856. [PMID: 37239582 DOI: 10.3390/ijerph20105856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 04/17/2023] [Accepted: 05/08/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND Adolescents in South Africa have higher suicide rates than older people. A suicide or unexpected death of a fellow student can result in increased copycat behavior. Previous studies have placed emphasis on the significance of school involvement in the prevention of suicide. The study sought to explore the perspective on the prevention of suicide among school learners by school management. A qualitative phenomenological design was applied. The study used purposive sampling to select six high schools. In-depth interviews were conducted with six focus group discussions comprising fifty school management. A semi-structured interview guide guided the interviews. Data were analyzed using a general inductive approach. Findings revealed that school management should be supported through workshops to increase their skills in handling stressful situations at school. Support for learners through audio-visuals, professional counseling, and awareness campaigns also emerged. Parents-school partnership was said to be effective in preventing suicide among learners as both parties will be free to discuss the problems faced by the learner. In conclusion, empowering school management in the prevention of suicide is critical for Limpopo learners. Awareness campaigns conducted by suicide survivors where they can share their testimonies is necessary. School-based professional counseling services should be established to benefit all learners, particularly those experiencing financial challenges. Pamphlets in local languages should be developed for students to convey information about suicide.
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Affiliation(s)
- Hilda N Shilubane
- Department of Advanced Nursing Science, University of Venda, Private Bag X, Thohoyandou 0950, South Africa
| | - Robert A C Ruiter
- Department of Work and Social Psychology, Maastricht University, Minderbroedersberg 6, 6211 LK Maastricht, The Netherlands
| | - Lunic B Khoza
- Department of Health Studies, University of South Africa, Pretoria 0003, South Africa
| | - Bart H W van den Borne
- Department of Health Promotion, Maastricht University, Minderbroedersberg 6, 6211 LK Maastricht, The Netherlands
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Walsh EH, Herring MP, McMahon J. A Systematic Review of School-Based Suicide Prevention Interventions for Adolescents, and Intervention and Contextual Factors in Prevention. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:365-381. [PMID: 36301381 DOI: 10.1007/s11121-022-01449-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 11/26/2022]
Abstract
Suicide is the fourth leading cause of death among adolescents, globally. Though post-primary, school-based suicide prevention (PSSP) has the potential to be a key strategy for preventing adolescent suicidal thoughts and behaviours (STBs), there are persisting challenges to translating PSSP research to practice. Intervention and contextual factors relevant to PSSP are likely key to both PSSP effectiveness and implementation. As such, this systematic review aimed to summarise the effectiveness of PSSP for adolescent STBs and highlight important intervention and contextual factors with respect to PSSP. PsycINFO, Medline, Education Source, ERIC, Web of Science, and the Cochrane Central Register of Controlled Trials were searched to identify randomised and non-randomised studies evaluating the effectiveness of interventions located in post-primary, school-based settings targeting adolescent STBs. PSSP effectiveness and intervention and contextual factors were synthesised narratively. Twenty-eight studies were retained, containing nearly 47,000 participants. Twelve out of twenty-nine trials comparing intervention and independent control comparators reported statistically significant reductions in STBs postintervention, and 5/7 trials comparing preintervention and postintervention scores demonstrated significant reductions in STBs over time. Reporting and analysis of intervention and contextual factors were lacking across studies, but PSSP effectiveness and intervention acceptability varied across type of school. Although school personnel commonly delivered PSSP interventions, their input and perspectives on PSSP interventions were lacking. Notably, adolescents had little involvement in designing, inputting on, delivering and sharing their perspectives on PSSP interventions. Twenty out of twenty-eight studies were rated as moderate/high risk of bias, with non-randomised trials demonstrating greater risks of bias and trial effectiveness, in comparison to cluster randomised trials. Future research should prioritise complete reporting and analysis of intervention and contextual factors with respect to PSSP, involving key stakeholders (including adolescents and school personnel) in PSSP, and investigating key stakeholders' perspectives on PSSP. Given the inverse associations between both study quality and study design with PSSP effectiveness, particular consideration to study quality and design in PSSP research is needed. Future practice should consider PSSP interventions with universal components and PSSP which supports and involves key stakeholders in engaging with PSSP.
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Affiliation(s)
- Eibhlin H Walsh
- School, Child & Youth (SCY) Mental Health and Wellbeing Research Lab, Department of Psychology, University of Limerick, Limerick, Ireland.
- National Institute of Studies in Education, University of Limerick, Limerick, Ireland.
- Health Research Institute, University of Limerick, Limerick, Ireland.
| | - Matthew P Herring
- Physical Activity for Health Cluster, Health Research Institute, University of Limerick, Limerick, Ireland
- Department of Physical Education and Sports Sciences, University of Limerick, Limerick, Ireland
| | - Jennifer McMahon
- School, Child & Youth (SCY) Mental Health and Wellbeing Research Lab, Department of Psychology, University of Limerick, Limerick, Ireland
- National Institute of Studies in Education, University of Limerick, Limerick, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
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Roslan AF, Pheh KS, Mahadevan R, Bujang SM, Subramaniam P, Yahya HF, Chan LF. Effectiveness of online advanced C.A.R.E suicide prevention gatekeeper training program among healthcare lecturers and workers in national university of Malaysia: A pilot study. Front Psychiatry 2023; 14:1009754. [PMID: 36741120 PMCID: PMC9892857 DOI: 10.3389/fpsyt.2023.1009754] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Accepted: 01/06/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Suicide is a major cause of death among adolescents and young adults, especially students. This is particularly true for healthcare students with a higher risk and more access to lethal means. Thus, it is vital for healthcare educators who have regular contact with these healthcare students to be trained as gatekeepers in preventing suicide. Evidence of the effectiveness of such gatekeeper training, mainly using an online module, is lacking predominantly in Malaysia. This study aims to investigate the effectiveness of an online gatekeeper suicide prevention training program that is conducted for healthcare lecturers. METHODS A single-arm interventional pre-and post-pilot study was conducted on a sample of healthcare lecturers and workers who are involved in supervising healthcare students. A purposive sampling technique was used to recruit 50 healthcare educators in Malaysia. The program was conducted by trained facilitators and 31 participants completed a locally validated self-rated questionnaire to measure their self-efficacy and declarative knowledge in preventing suicide; immediately before and after the intervention. RESULTS Significant improvement was seen in the overall outcome following the intervention, mostly in the self-efficacy domain. No significant improvement was seen in the domain of declarative knowledge possibly due to ceiling effects; an already high baseline knowledge about suicide among healthcare workers. This is an exception in a single item that assesses a common misperception in assessing suicide risk where significant improvement was seen following the program. CONCLUSION The online Advanced C.A.R.E. Suicide Prevention Gatekeeper Training Program is promising in the short-term overall improvement in suicide prevention, primarily in self-efficacy.
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Affiliation(s)
- Amran Fadzrul Roslan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Kai Shuen Pheh
- Department of Psychology and Counselling, Faculty of Arts and Social Sciences, Tunku Abdul Rahman University, Kampar, Malaysia
| | - Raynuha Mahadevan
- Department of Psychiatry, Hospital Canselor Tuanku Muhriz, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Siti Mariam Bujang
- Department of Medical Education, Faculty of Medicine, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Ponnusamy Subramaniam
- Unit of Health Psychology, Faculty of Health Sciences, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Hanieza Fadzlina Yahya
- Department of Psychiatry, Hospital Canselor Tuanku Muhriz, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
| | - Lai Fong Chan
- Department of Psychiatry, Faculty of Medicine, National University of Malaysia (UKM), Kuala Lumpur, Malaysia
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Vargas B, Martínez P, Mac-Ginty S, Hoffmann T, Martínez V. Implementation strategies and outcomes of school-based programs for adolescent suicide prevention: A scoping review protocol. PLoS One 2023; 18:e0284431. [PMID: 37141337 PMCID: PMC10159337 DOI: 10.1371/journal.pone.0284431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 03/27/2023] [Indexed: 05/06/2023] Open
Abstract
OBJECTIVE This scoping review aims to identify and map the empirical literature on the implementation strategies and outcomes of school-based programs for adolescent suicide prevention (SBASP). INTRODUCTION School-based programs are preferred interventions for preventing suicide in adolescents, and their effectiveness has been well-systematized in several reviews. Implementation research is a growing field for prevention programs, making it possible to understand the nature of success or failure outcomes and maximize intervention benefits. However, there is a knowledge gap in the implementation research applied to adolescent suicide prevention in the educational context. We conduct a scoping review to provide the first overview of the scope of implementation research applied to adolescent suicide prevention programs in the school setting to know what implementation strategies and outcomes are reported by these programs and how they are evaluated. METHODS The proposed scoping review will be conducted following six stages, including the definition of objectives. Studies must be empirical and address implementation strategies or implementation outcomes of school-based programs for adolescent suicide prevention. Studies that focused exclusively on clinical efficacy or effectiveness evaluation will be excluded. A preliminary search of PubMed was conducted to refine the initial search strings, followed by a final search of several other electronic databases. Finally, a gray literature search will identify unpublished literature and reduce location bias. There will be no limits to a specific date. Two independent reviewers will screen, select, and extract the retrieved records. The results will be presented using tabular forms and a narrative summary with attention to the review objectives and research questions and their implications for research and practice of school-based programs for adolescent suicide prevention.
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Affiliation(s)
- Belén Vargas
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths Imhay, Santiago, Chile
- Doctoral Program in Psychotherapy, Faculty of Medicine and Faculty of Social Sciences, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Pablo Martínez
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths Imhay, Santiago, Chile
- Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, Québec, Canada
- Centre de Recherche Charles-Le Moyne, Québec, Canada
- Millennium Institute for Research in Depression and Personality MIDAP, Santiago, Chile
| | - Scarlett Mac-Ginty
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths Imhay, Santiago, Chile
- Faculty of Dentistry, Universidad de Chile, Santiago, Chile
- King's College London, Department of Health Service and Population Research, Institute of Psychiatry, Psychology & Neuroscience, London, United Kingdom
| | - Tamara Hoffmann
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths Imhay, Santiago, Chile
- Doctoral Program in Psychotherapy, Faculty of Medicine and Faculty of Social Sciences, Universidad de Chile and Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vania Martínez
- Millennium Nucleus to Improve the Mental Health of Adolescents and Youths Imhay, Santiago, Chile
- Millennium Institute for Research in Depression and Personality MIDAP, Santiago, Chile
- CEMERA, Faculty of Medicine, Universidad de Chile, Santiago, Chile
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Stickl Haugen J, Sutter CC, Tinstman Jones JL, Campbell LO. Teachers as Youth Suicide Prevention Gatekeepers: An Examination of Suicide Prevention Training and Exposure to Students at Risk of Suicide. CHILD & YOUTH CARE FORUM 2022; 52:583-601. [PMID: 35789706 PMCID: PMC9244378 DOI: 10.1007/s10566-022-09699-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2022] [Indexed: 11/30/2022]
Abstract
Background Teachers are important gatekeepers in suicide prevention for children and youth, yet little is known about factors that contribute to suicide prevention training effectiveness and the influence of student suicidality on teachers' role as gatekeepers. Objective This study examined teachers' attitudes and self-efficacy in suicide prevention including an examination of suicide prevention training and exposure to student suicidality. Researchers examined incremental prediction of the relationship between teachers' self-efficacy, outcome expectations, and outcome values following prevention training. Methods Participants included teachers in PreK-12th grade schools in the United States (N = 505). Researchers used non-parametric statistics to examine group level differences and a structural equation model (SEM) to test the proposed theoretical model. Results Teachers who experienced a student death by suicide reported significantly higher levels of gatekeeper reluctance than teachers who had not experienced a student death by suicide (p < 0.01). Similarly, teachers who encountered students with suicidal thoughts reported greater levels of gatekeeper reluctance (p < 0.01) and higher self-efficacy to engage in suicide prevention (p < 0.05) compared to teachers who had not had this exposure. Results of the SEM indicated an adequate goodness of fit and fit statistics [χ2 (87) = 194.420, p = 0.000; CFI = 0.95; RMSEA = 0.05]. The model remained in-tact when exposure to student suicide was added. Conclusions Findings support the importance of supporting teachers continued engagement in youth suicide prevention and prevention training that targets specific outcomes in teachers' attitudes and efficacy. Supplementary Information The online version contains supplementary material available at 10.1007/s10566-022-09699-5.
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Affiliation(s)
- Jaimie Stickl Haugen
- Present Address: School of Education, College of William & Mary, Williamsburg, VA USA
- School of Education, Counselor Education, St. Bonaventure University, St. Bonaventure, NY USA
| | | | | | - Laurie O. Campbell
- College of Community Innovation and Education, University of Central Florida, Orlando, FL USA
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Bowman S, McKinstry C, Howie L, Hepworth G, McGorry P. Perceptions of rural high school teachers - on the frontline of youth suicide. Aust J Rural Health 2022; 30:608-618. [PMID: 35767662 DOI: 10.1111/ajr.12894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 01/28/2022] [Accepted: 05/26/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the perceptions and beliefs of rural high school teachers about student suicide completion in their school and their perceived self-efficacy in identification of suicidality in students (suicidal ideation, plans and behaviours). DESIGN A cross-sectional survey methodology. SETTING Gippsland and the Loddon Mallee regions of Victoria, Australia. PARTICIPANTS Rural high school teachers. OUTCOME MEASURE A survey that aimed to obtain participants' perceptions and self-reports about students who had died by suicide in their school within the last 5 years, their perceived self-efficacy in identifying suicidal students and barriers to helping students at risk. RESULTS Two hundred and seventy-seven rural high school teachers participated and 86% reported that a student from their school had died by suicide within the last 5 years. Sixty-five per cent believed that more than one student had died by suicide and 70% perceived they were currently aware of students experiencing suicidality in their class. Receiving professional development about suicide and obtaining help from mental health clinicians predicted perceived self-efficacy in identification of suicidality in students. Participants perceived the barriers to help students at risk included insufficient numbers of school-based mental health professionals and community mental health services. CONCLUSIONS Many rural high school teachers perceive they are at the front line of the youth suicide crisis due to unmet service need in youth mental ill health. Increased access to effective services immediately after teachers become aware of suicidality may assist in reducing youth suicide in rural areas.
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Affiliation(s)
- Siann Bowman
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Vic., Australia
| | - Carol McKinstry
- La Trobe Rural Health School, La Trobe University, Bendigo, Vic., Australia
| | - Linsey Howie
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Vic., Australia
| | - Graham Hepworth
- Statistical Consulting Centre, The University of Melbourne, Melbourne, Vic., Australia
| | - Patrick McGorry
- Orygen, Centre for Youth Mental Health, University of Melbourne, Melbourne, Vic., Australia
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Patterson PR, Walther CAP, Elkins SR. Associations Among Teacher Identification of Symptomology in the Classroom and Children’s Post-traumatic Stress Disorder Symptomology: Potential Influences of Caregiver History of Childhood Maltreatment. CHILD & YOUTH CARE FORUM 2022. [DOI: 10.1007/s10566-021-09662-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Alonzo D, Popescu M, Zubaroglu-Ioannides P. Training non-mental health professionals to assess and manage suicide risk: Community level intervention for suicide prevention in Guatemala. Int J Soc Psychiatry 2021; 67:705-712. [PMID: 33148098 DOI: 10.1177/0020764020970237] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Domestic violence, childhood physical and sexual abuse, and gang violence are prevalent and growing problems for Guatemalan youth, particularly in low socioeconomic (SES) areas. Resources in the community for psychosocial support are greatly lacking. Schools often serve as the main source of support for these highly vulnerable adolescents. Yet, many teachers lack the training to manage the psychological distress of their at-risk students and to properly engage, assess, and manage the psychological needs of their students. We developed a brief risk assessment and management training for teachers to address this gap. AIMS We present the acceptability and preliminary effectiveness of the training at increasing teacher's knowledge and understanding of how to engage and work with their at-risk students around their thoughts and feelings of suicide. METHOD Twenty-two teachers from a school in a low SES community in Guatemala participated in the training program. Mixed methods were used to explore effectiveness, acceptability, and satisfaction with the training. Primary outcomes assessed were changes in self-reported knowledge and understanding of engaging and working with students at risk of suicide. RESULTS Participants reported increased knowledge and understanding of all training targets (p < .05). Acceptability was high as no participants dropped out and all participants rated the training as useful for their professional development, meeting their expectations, and as highly satisfying. CONCLUSION Brief, focused training on suicidality can be effective and is acceptable to lay professionals. Further examination of the effectiveness of the training in a larger sample is required to assess the long-term impact of the training and its transportability to other communities.
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Affiliation(s)
- Dana Alonzo
- Graduate School of Social Service, Fordham University, West Harrison, NY, USA
| | - Marciana Popescu
- Graduate School of Social Service, Fordham University, West Harrison, NY, USA
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Goodwin J, Behan L, O'Brien N. Teachers' views and experiences of student mental health and well-being programmes: A systematic review. J Child Adolesc Ment Health 2021; 33:55-74. [PMID: 37539544 DOI: 10.2989/17280583.2023.2229876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Background: In schools, teachers are often tasked with implementing mental health and well-being programmes. However, little is known about teachers' views on and experiences with implementing these programmes.Aim: The aim of this systematic review was to explore teachers' views and experiences of mental health and well-being intervention programmes developed to promote and protect student mental health.Methods: A systematic review of the empirical literature was conducted using the following databases: Academic Search Complete, APA PsycArticles, APA PsycInfo, British Education Index, Education Full Text (H.W. Wilson), ERIC, Social Sciences Full Text (H.W. Wilson), and SocINDEX with Full Text.Findings: Seven papers met the inclusion criteria. Teachers reported several challenges to the successful implementation of mental health and well-being programmes, including a lack of time allotted in the curriculum, insufficient training, and inadequate interagency support. There was evidence of conflicting opinions regarding the role of teachers in supporting students.Conclusion: It is recommended that mental health and well-being are viewed as central to schools' ethos and that teachers are adequately prepared to implement programmes.
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Affiliation(s)
- John Goodwin
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Ireland
| | - Laura Behan
- Health Information and Quality Authority, Ireland
| | - Niamh O'Brien
- Department of Education, South East Technological University, Ireland
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Bohnenkamp JH, Schaeffer CM, Siegal R, Beason T, Smith-Millman M, Hoover S. Impact of a School-Based, Multi-Tiered Emotional and Behavioral Health Crisis Intervention on School Safety and Discipline. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2021; 22:492-503. [PMID: 33453044 DOI: 10.1007/s11121-020-01195-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2020] [Indexed: 12/01/2022]
Abstract
Schools across the United States are struggling with how to formulate comprehensive and effective programs to address the mental health needs of students and to promote school safety. This study, funded as part of the National Institute of Justice Comprehensive School Safety Initiative, employed a randomized controlled study design to evaluate the impact of a multi-component package of crisis prevention and response interventions on school safety and discipline outcomes, including suspensions, office discipline referrals, bullying reports, juvenile justice referrals, threat assessments, and follow-up procedures. Forty schools participated, all in a culturally diverse Mid-Atlantic, US school system spanning urban, suburban, and rural areas. The Emotional and Behavioral Health-Crisis Response and Prevention (EBH-CRP) intervention is a comprehensive training, organizational, and support protocol for school and community stakeholders aimed at increasing competence in preventing and responding to student EBH crises using multiple evidence-informed strategies that address emotional and behavioral health concerns across the continuum of supports. Results indicate that the EBH-CRP intervention had a significant positive effect on suspensions, office discipline referrals, and juvenile justice referrals for secondary schools. In addition, the intervention had positive effects on the number of bullying reports overall, with a particularly strong impact on primary schools. The intervention also had positive effects in maintaining more use of threat assessment and follow-up procedures. Although the intervention had a significant positive effect on secondary school-level suspensions, there was no impact on racial/ethnic disproportionality rates for this outcome. Implications for school safety prevention are discussed.
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Affiliation(s)
- Jill H Bohnenkamp
- National Center for School Mental Health, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Office 422, 737 West Lombard Street, Baltimore, MD, 21230, USA.
| | - Cindy M Schaeffer
- National Center for School Mental Health, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Office 422, 737 West Lombard Street, Baltimore, MD, 21230, USA
| | - Rachel Siegal
- National Center for School Mental Health, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Office 422, 737 West Lombard Street, Baltimore, MD, 21230, USA
| | - Tiffany Beason
- National Center for School Mental Health, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Office 422, 737 West Lombard Street, Baltimore, MD, 21230, USA
| | - Mills Smith-Millman
- National Center for School Mental Health, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Office 422, 737 West Lombard Street, Baltimore, MD, 21230, USA
| | - Sharon Hoover
- National Center for School Mental Health, Division of Child and Adolescent Psychiatry, University of Maryland School of Medicine, Office 422, 737 West Lombard Street, Baltimore, MD, 21230, USA
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Fortune S, Sharma V, Bowden L, Hobbs L, Marshall D, Mitchell C, Clarke A, Robinson J, Shave R, Macleod E, Witt KG, Hawton K, Jordan V, Hetrick SE. Prevention of self-harm and suicide in young people up to the age of 25 in education settings. Hippokratia 2021. [DOI: 10.1002/14651858.cd013844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Sarah Fortune
- Department of Social and Community Health, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Vartika Sharma
- Department of Psychological Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
- Children and Young People Satellite, Cochrane Common Mental Disorders; The University of Auckland; Auckland New Zealand
| | - Linda Bowden
- Department of Psychological Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Linda Hobbs
- Department of Psychological Medicine; Dunedin School of Medicine, University of Otago; Dunedin New Zealand
| | - David Marshall
- Centre for Reviews and Dissemination; University of York; York UK
- Cochrane Common Mental Disorders Group, Centre for Reviews and Dissemination; University of York; York UK
| | - Claire Mitchell
- Department of Psychological Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | | | - Jo Robinson
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Roger Shave
- Clinical Advisory Services Aotearoa; Christchurch New Zealand
| | - Emily Macleod
- Research School of Psychology, ANU College of Health and Medicine; The Australian National University; Canberra Australia
| | - Katrina G Witt
- Orygen; Parkville, Melbourne Australia
- Centre for Youth Mental Health; The University of Melbourne; Melbourne Australia
| | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry; University of Oxford; Oxford UK
| | - Vanessa Jordan
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
| | - Sarah E Hetrick
- Department of Psychological Medicine, Faculty of Medical and Health Sciences; The University of Auckland; Auckland New Zealand
- Children and Young People Satellite, Cochrane Common Mental Disorders; The University of Auckland; Auckland New Zealand
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Taking Youth Suicide Prevention to the Schools: Pilot Evaluation of School-Based Clinician Outcomes and Perspectives of a Multi-Modal Program Including Post-Training Online Consultations for Management of Ongoing Suicide Risk. PSYCHIATRY INTERNATIONAL 2020. [DOI: 10.3390/psychiatryint1010002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
School-based youth-specific suicide prevention and early intervention initiatives are presently underdeveloped. The current study conducted a pilot evaluation of a multi-modal suicide prevention training program for school-based social workers, ‘Management of Youth Suicidality Training for Schools’ (MYSTS). The program comprised a two-day workshop and six fortnightly post-workshop webinar online consultations. Participants were 36 social workers (years’ experience M = 11.23, SD = 8.29) employed by the Department of Education in Tasmania, Australia. Outcomes were self-rated confidence, competence, and knowledge of self-harm in young people, and attitudes toward suicide prevention and suicide-related behaviors. Exploratory quantitative results indicated significant improvements with large effect sizes for participants’ self-reported competence (d = 1.33), and confidence (d = 1.29) to identify and respond therapeutically to youth suicidality following the workshop. Confidence remained significantly higher than baseline following the online consultations (d = 0.90). Qualitative analysis of online supervision consultations indicated key themes of accessibility, communication and information sharing, and clinical management. Participants endorsed the MYSTS package as well-presented, with relevant topics, and effective learning activities. This study highlights the need for continued supervisory or implementation support to practitioners following suicide prevention training initiatives and suggests web-based teleconference technology as a feasible strategy for this. Further evaluation of the MYSTS package, including a suitable comparison or control condition, is indicated.
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Mbwayo AW, Mathai M, Khasakhala LI, Kuria MW, Vander Stoep A. MENTAL HEALTH IN KENYAN SCHOOLS: TEACHERS' PERSPECTIVES. GLOBAL SOCIAL WELFARE : RESEARCH, POLICY & PRACTICE 2020; 7:155-163. [PMID: 32864296 PMCID: PMC7449150 DOI: 10.1007/s40609-019-00153-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION This qualitative study, conducted in public primary and secondary schools, sought teachers' perceptions of mental health concerns that are relevant in school settings. Based on the phenomenological theory, the study aimed to understand the teachers experiences of mental health problems in the schools and how they handled them. METHOD The schools sampled represented rural, suburban and urban sections of Kiambu County in Kenya. Data were collected through Focus Group Discussions (FGDs). The researcher made summary notes from both audio taped interviews and notes made by the research assistants and summarized the major themes. RESULTS Teachers reported that they were aware that students suffered from mental health problems. They recognized learning difficulties, externalizing problems, internalizing problems, bizarre behavior, and problem substance use among students. Teachers reported that lack of skills and time were challenges in dealing with student mental health problems. CONCLUSION Teachers perceive presence of mental health problems among the students. There is need for in- service training for identification and referral and that school psychologists be employed to deal with student mental health problems.
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Affiliation(s)
- Anne Wanjiru Mbwayo
- Department of Psychiatry, College of Health Sciences, University of Nairobi; PO Box 19676 - 00202, Nairobi
| | - Muthoni Mathai
- Department of Psychiatry, College of Health Sciences, University of Nairobi; PO Box 19676 - 00202, Nairobi
| | - L I Khasakhala
- Department of Psychiatry, College of Health Sciences, University of Nairobi; PO Box 19676 - 00202, Nairobi
| | - Mary Wangari Kuria
- Department of Psychiatry, College of Health Sciences, University of Nairobi; PO Box 19676 - 00202, Nairobi
| | - Ann Vander Stoep
- Child Health Institute, University of Washington, P.O. Box 354920, Seattle, Washington USA 98195
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Kuiper N, Goldston D, Godoy Garraza L, Walrath C, Gould M, McKeon R. Examining the Unanticipated Adverse Consequences of Youth Suicide Prevention Strategies: A Literature Review with Recommendations for Prevention Programs. Suicide Life Threat Behav 2019; 49:952-965. [PMID: 29999179 DOI: 10.1111/sltb.12492] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 04/16/2018] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Youth suicide is a public health problem in the United States. Suicide prevention programs have been shown to be beneficial; however, knowledge of unanticipated adverse consequences of programs is limited. The objective of this review is to present what is known about these consequences so informed decisions and appropriate planning can be made prior to implementation of suicide prevention interventions. METHOD A narrative but systematic review was conducted assessing what is known about adverse consequences utilizing a comprehensive keyword search of EBSCO and PubMed databases. Study populations beyond youth were included. RESULTS Unanticipated adverse consequences of suicide prevention interventions were included in 22 publications. Consequences occur at three levels: at the level of the youth, those who identify or intervene with at-risk youth, and at the system level. While rare, unanticipated adverse consequences include an increase in maladaptive coping and a decrease in help-seeking among program targets, overburden or increased suicide ideation among program implementers, and inadequate systemic preparedness. CONCLUSIONS Overall, the benefits of youth suicide prevention outweigh the unanticipated adverse consequences. Nevertheless, these results may be utilized for informed decision-making regarding suicide prevention programming, and to ensure appropriate infrastructure is in place prior to prevention efforts.
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Affiliation(s)
| | - David Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, NC, USA
| | | | | | - Madelyn Gould
- Department of Epidemiology and Psychiatry, Columbia University Medical Center, New York, NY, USA
| | - Richard McKeon
- Mental Health Services, Substance Abuse and Mental Health Services Administration, Rockville, MD, USA
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Sylvara AL, Mandracchia JT. An Investigation of Gatekeeper Training and Self-Efficacy for Suicide Intervention Among College/University Faculty. CRISIS 2019; 40:383-389. [PMID: 30888226 DOI: 10.1027/0227-5910/a000577] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Suicide is a major global issue; US college students may be at greater risk and faculty may play a crucial role in prevention. Aims: The primary purpose of the present study was to examine: the level of confidence of college/university faculty in identifying at-risk students, to what extent they believed that their actions might reduce suicide, and their knowledge and experiences of their school's policies regarding intervention with at-risk students. Method: Data from 507 higher education faculty across the US were obtained via an online survey tool. Participants consisted mostly of professors and all had completed some level of graduate school. Results: Most participants reported believing it is the college/university faculty's role to identify students at risk for suicide; however, many reported that their institution did not provide gatekeeper training. Participants who had received gatekeeper training were more confident in identifying and assisting at-risk students. Limitations: The study did not determine participants' actual policy knowledge or the various types and lengths of training received. Conclusion: More widespread gatekeeper training for college/university faculty may provide benefits to faculty's confidence and could promote increased assistance for at-risk students.
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Affiliation(s)
- Ashley L Sylvara
- Department of Psychology, Missouri Western State University, Saint Joseph, MO, USA
| | - Jon T Mandracchia
- Department of Psychology, Missouri Western State University, Saint Joseph, MO, USA
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Green JG, Keenan JK, Guzmán J, Vinnes S, Holt M, Comer JS. Teacher perspectives on indicators of adolescent social and emotional problems. ACTA ACUST UNITED AC 2017; 2:96-110. [PMID: 30775446 DOI: 10.1080/23794925.2017.1313099] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Teachers are a primary source of referral to mental health services for children and adolescents. However, studies find that students identified by teachers differ from those identified by standardized screening scales. This suggests possible discrepancies in conceptualizations of student emotional and behavioral challenges. The current article describes results of a study that explores how teachers conceptualize the emotional and behavioral challenges of adolescents. Middle and high school teachers across the U.S. were identified using a stratified random sampling process and recruited for participation. Twenty-nine teachers (26% of those recruited) were interviewed and asked to describe markers that indicated to them that a student was experiencing emotional and behavioral challenges. Themes in teacher responses were identified and coded. Teachers identified multiple, diverse markers that they perceived were indicators of emotional and behavioral challenges among their students. Markers described by teachers were compared to those typically measured by standardized screening scales. Discrepancies between markers identified by teachers and screening scales are highlighted as potential areas for professional development and enhanced school-based intervention efforts. These findings underscore the importance of integrating teacher perspectives in understanding the referral process for students.
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McConnellogue S, Storey L. System constraints on efficacious teacher behaviours in school-based suicide prevention initiatives; a qualitative study of teacher views and experiences. EMOTIONAL AND BEHAVIOURAL DIFFICULTIES 2017. [DOI: 10.1080/13632752.2017.1288848] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Sheila McConnellogue
- School Social Sciences, Education and Social Work, Queen’s University, Belfast, Northern Ireland
- University Road, Belfast, Northern Ireland
| | - Lesley Storey
- University Road, Belfast, Northern Ireland
- School of Behavioural Sciences, Queen’s University, Belfast, Northern Ireland
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Lamis DA, Underwood M, D'Amore N. Outcomes of a Suicide Prevention Gatekeeper Training Program Among School Personnel. CRISIS 2016; 38:89-99. [PMID: 27561223 DOI: 10.1027/0227-5910/a000414] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Gatekeeper suicide prevention programs train staff to increase the identification and referral of suicidal individuals to the appropriate resources. AIMS We evaluated Act on FACTS: Making Educators Partners in Youth Suicide Prevention (MEP), which is an online training program designed to enhance the knowledge of suicide risk factors and warning signs as well as improve participants' attitudes and self-efficacy/confidence. METHOD School personnel (N = 700) completed a survey administered before and immediately after the training to assess gains in training outcomes and to evaluate participants' satisfaction with the training. RESULTS Results indicated that MEP participants demonstrated significant increases in suicide knowledge, attitudes, and self-efficacy. Moreover, exploratory analyses revealed moderating effects of professional role on pre-/posttest changes in self-efficacy, but not suicide knowledge or attitudes. Specifically, guidance counselors demonstrated significantly smaller increases in self-efficacy/confidence compared with teachers and classroom aids, whereas teachers demonstrated significantly larger increases in self-efficacy/confidence compared with administrators. The majority of school personnel who completed the MEP program were satisfied with the training content and experience. CONCLUSION Although the current findings are promising, more rigorous evaluations employing randomized controlled research designs are warranted to adequately determine the effectiveness of the MEP program.
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Affiliation(s)
- Dorian A Lamis
- 1 Department of Psychiatry and Behavioral Sciences, Emory School of Medicine, Atlanta, GA, USA
| | | | - Nicole D'Amore
- 2 Society for the Prevention of Teen Suicide, Freehold, NJ, USA
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21
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Ten Recommendations for Effective School-Based, Adolescent, Suicide Prevention Programs. SCHOOL MENTAL HEALTH 2016. [DOI: 10.1007/s12310-016-9189-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Secondary Teachers’ Perceptions of their Role in Suicide Prevention and Intervention. SCHOOL MENTAL HEALTH 2016. [DOI: 10.1007/s12310-015-9173-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nadeem E, Santiago CD, Kataoka SH, Chang VY, Stein BD. School Personnel Experiences in Notifying Parents About Their Child's Risk for Suicide: Lessons Learned. THE JOURNAL OF SCHOOL HEALTH 2016; 86:3-10. [PMID: 26645415 PMCID: PMC4747656 DOI: 10.1111/josh.12346] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 03/05/2015] [Accepted: 05/04/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Schools across the nation are increasingly implementing suicide prevention programs that involve training school staff and connecting students and their families to appropriate services. However, little is known about how parents are engaged in such efforts. METHODS This qualitative study examined school staff perspectives on parent involvement in the implementation of a district-wide suicide prevention program by analyzing focus group and interview data gathered on the program implementation processes. Participants included middle school teachers, administrators, and other school personnel. RESULTS Study results revealed that in the immediate wake of a crisis or concern about suicide, school staff routinely contacted parents. However, substantial barriers prevent some students from receiving needed follow-up care (eg, lack of consistent follow-up, financial strain, parental stress, availability of appropriate services). Despite these challenges, school staff identified strategies that could better support parents before, during, and after the crisis. In particular, school-based services increased the success of mental health referrals. CONCLUSIONS Our study suggests that systematic postcrisis follow-up procedures are needed to improve the likelihood that students and families receive ongoing support. In particular, school-based services and home visits, training and outreach for parents, and formal training for school mental health staff on parent engagement may be beneficial in this context.
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Affiliation(s)
- Erum Nadeem
- Ferkauf Graduate School of Psychology, Yeshiva University, 1165 Morris Park Ave, Bronx, NY 10461.
- Department of Child & Adolescent Psychiatry, New York University School of Medicine, One Park Ave, 7th Floor, NYU Child Study Center, New York, NY 10016.
| | | | - Sheryl H Kataoka
- Center for Health Services and Society, Semel Institute for Neuroscience and Human Behavior, University of California, 10920 Wilshire Boulevard, Los Angeles, CA 90024.
| | | | - Bradley D Stein
- RAND Corporation, Adjunct Associate Professor of Psychiatry, University of Pittsburgh School of Medicine, 4570 Fifth Ave., Pittsburgh, PA 15213.
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Joshi SV, Hartley SN, Kessler M, Barstead M. School-based suicide prevention: content, process, and the role of trusted adults and peers. Child Adolesc Psychiatr Clin N Am 2015; 24:353-70. [PMID: 25773329 DOI: 10.1016/j.chc.2014.12.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Suicide is a leading cause of preventable death in youth, and numerous curricula and other prevention and intervention programs have been developed in the last 15 years. Comprehensive suicide prevention planning should include the 4 components of health promotion, prevention/education, intervention, and postvention. School-based suicide prevention and mental health education programs have become more common as an efficient and cost-effective way to reach youth. Process considerations that are based on the principles of therapeutic engagement with patients and families can provide mental health professionals with strategies that can assist education professionals, students, and the larger school community simultaneously.
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Affiliation(s)
- Shashank V Joshi
- Lucile Packard Children's Hospital at Stanford University, Palo Alto, CA, USA.
| | - Samantha N Hartley
- School Mental Health Team, Lucile Packard Children's Hospital at Stanford University, 401 Quarry Road, Stanford, CA 94305, USA
| | - Moira Kessler
- Lucile Packard Children's Hospital at Stanford University, Palo Alto, CA, USA
| | - Maura Barstead
- Lucile Packard Children's Hospital at Stanford University, Palo Alto, CA, USA
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Ekornes S. Teacher Perspectives on Their Role and the Challenges of Inter-professional Collaboration in Mental Health Promotion. SCHOOL MENTAL HEALTH 2015. [DOI: 10.1007/s12310-015-9147-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ekornes S, Hauge TE, Lund I. Teachers as mental health promoters: a study of teachers' understanding of the concept of mental health. INTERNATIONAL JOURNAL OF MENTAL HEALTH PROMOTION 2012. [DOI: 10.1080/14623730.2013.798534] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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