School Nurse Screening Intervention for Suicide Risk in Two Rural K-12 Public School Districts: A Pilot Study

Suicide is one of the leading causes of death in school-aged children and adolescents with notable increases in youth suicide risk among those residing in rural communities. The situation is especially dire in North Carolina (NC), where the rate of suicide among 10- to 17-year-olds is the highest seen in two decades. Given that students spend a significant portion of their day in school, school-based suicide prevention programs offer an effective approach to connect students to mental health services. In most NC public schools, school counselors have the primary role of screening students for suicide risk. However, students often present first to the school nurse with psychosomatic complaints, making school nurses well-positioned to also identify at-risk students and connect them to mental health services. Yet, our research indicates that the majority of school nurses do not have a role in suicide risk screening. Instead, we found that most refer to another in-school clinician to complete screening, delaying the prompt identification of risk level and postponing any necessary immediate actions to ensure safety. Our objective is to test the effectiveness of a school nurse suicide risk screening intervention in two NC rural school districts and devise a model for use in other school districts across the state. To accomplish this objective, we will use a mixed methods design using a Community-Based Participatory Research approach targeting two specific aims. AIM #1 is to establish the feasibility and acceptability of a school nurse screening intervention for youth suicide risk. AIM #2 involves steps to determine the fidelity in carrying out the intervention and to identify the prevalence of screening outcomes. This outcome data, along with data generated from focus groups with school nurses and school counselors, will be used to determine the effectiveness of the intervention.

We expect the intervention will result in an increase in student screening and referrals to mental health services, and greater collaboration between school nurses and school counselors. We also anticipate the implementation of a screening intervention will capture outcome data to illuminate the added value of training school nurses to identify at-risk students. Our sample will include 50 school nurses and 40 school counselors employed in either Nash or Craven County Public School Districts. The proposed study will provide outcome data specific to school nurses and how they might contribute to the early identification and treatment of youth in crisis. If successful, this study will offer a model for other NC school districts to expand efforts to mitigate suicide rates within our state by strengthening the school nurses’ capacity to be integral members of the mental health team in schools and expanding the pool of trained professionals who can screen and identify at-risk students.