Implementing signs of suicide program and Columbia-Suicide Severity Rating Scale in a school-based setting: a quality improvement project

Abstract

In Montana, the youth suicide rate is more than double the national rate. Signs of Suicide (SOS) is one prevention program that is utilized within the school-based setting to educate middle and high school students. In a rural Montana school, the Brief Screen for Adolescent Depression (BSAD) is administered in conjunction with the SOS program to screen for depression; however, no focused suicide risk screening protocol exists. A Plan, Do, Study, Act cycle was implemented throughout 6 weeks to screen middle and high school students for depression, introduce subsequent suicide risk screening, and refer to mental health professionals as indicated. The school counselor (SC) performed SOS/BSAD, then subsequently collected Columbia-Suicide Severity Rating Scale (C-SSRS) scores, made referrals, and followed up as necessary. All data were de-identified and entered into an excel document before analysis and dissemination by the DNP-S. One hundred percent of high school and middle school students (n=144) participated in the SOS program and completed a BSAD. Of 20 identified as high-risk for depression, 11 completed the C-SSRS. Of those 11, three were identified as at-risk for suicide. All three students had completed referrals with a mental health professional. Follow-up C-SSRS indicated an ultimate reduction in suicide risk. The project effectively identified students at risk for depression and subsequently evaluated suicide risk and closely tracked completed referrals. Future research should evaluate long-term changes in C-SSRS scores over time post follow-up with mental health professionals.