Connected gatekeepers against suicide: exploring the relationship between teacher-student connectedness and confidence in suicide prevention and intervention

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Connected Gatekeepers Against Suicide: Exploring the Relationship Between Teacher-
Student Connectedness and Confidence in Suicide Prevention and Intervention
By
Sasha Reiisieh

Rossier School of Education
University of Southern California
A dissertation submitted to the faculty
in partial fulfillment of the requirements for the degree of
Doctor of Education

December 2022

© Copyright by Sasha Reiisieh 2022
All Rights Reserved

The Committee for Sasha Reiisieh certifies the approval of this Dissertation

Maryam Hafezi
Ruth Chung
Morgan Polikoff, Committee Chair

Rossier School of Education
University of Southern California
2022
iv
Abstract
Over the last 10 years, the United States has continued to see a startling increase in the number
of adolescent youths attempting suicide. With the signing of Assembly Bill 2246, California
began to require middle school and high school districts have not only a suicide prevention
policy, but trainings emphasizing assessment, safety planning, community referrals. With suicide
rates for teens being highest during the school year, school staff hold the unique responsibility to
promote a warm relationship that can ultimately increase healthy behaviors and reduce suicidal
thoughts and attempts. The “Connected Gatekeeper Framework” was designed to measure the
strength of a gatekeeper using both confidence in gatekeeper skills, as well as level of
connectedness to their students. Teachers from multiple districts across the southern Bay Area
were surveyed and found an average confidence level of 71%, with teachers who reported
feeling more connected to their students rating themselves more confident in their role as a
gatekeeper. Further evaluations among tenure, and awareness of suicide prevention policy found
significant differences in confidence ratings, creating implications for future training and
education.

v
Dedication
To my family and loved ones, thank you for supporting me on my educational journey since the
very beginning. From the highs and the lows, your love and dedication to my work has made
every step of the way worthwhile.

To all the great educators in my life who have inspired me along the way, I would not be where I
am today with your guidance, mentorship, and wisdom.

vi
Acknowledgments
I would like to acknowledge friends and acquaintances from the districts of Campbell
Union High School, Fremont Union High School, Mountain View-Los Altos Unified, and San
Jose Unified who helped promote participation from their colleagues in the study.
I am a licensed professional clinical counselor who has spent over 6 years providing
community and clinical based mental health care to children, teenagers, and their families. While
collaborating with school districts across Santa Clara County, I recognized a gap in mental health
awareness and knowledge that existed amongst teachers and other faculty. After connecting with
teachers and leaders across various districts, I set out to explore the impacts of the
student/teacher relationship on mental health.

vii
Table of Contents
Abstract ........................................................................................................................................... iv
Dedication ........................................................................................................................................ v
Acknowledgments .......................................................................................................................... vi
List of Tables .................................................................................................................................. ix
List of Figures ................................................................................................................................. xi
Chapter One: Overview of the Study .............................................................................................. 1
Background of the Problem ................................................................................................. 2
Statement of the Problem .................................................................................................... 2
Purpose of the Study ............................................................................................................ 3
Significance of the Study ..................................................................................................... 4
Limitations and Threats to Validity ..................................................................................... 4
Definition of Terms ............................................................................................................. 4
Organization of the Study .................................................................................................... 5
Chapter Two: Literature Review ..................................................................................................... 7
Prevalence ............................................................................................................................ 7
Risk Factors ....................................................................................................................... 13
Protective Factors .............................................................................................................. 20
Schools in Action .............................................................................................................. 27
Study Framework .............................................................................................................. 31
Chapter Three: Methodology ........................................................................................................ 41
Research Methods ............................................................................................................. 41
Sample and Population ...................................................................................................... 42
Instrumentation .................................................................................................................. 43
Data Collection .................................................................................................................. 48
viii
Data Analysis ..................................................................................................................... 48
Chapter Four: Results .................................................................................................................... 50
Participants ........................................................................................................................ 51
How Confident Are School Staff in Their Role as Gatekeepers Against Suicide? ........... 55
Does Feeling Connected to Students Increase Gatekeeper Confidence Against
Suicide? ............................................................................................................................. 57
Differences Between Gender, Staff Tenure, and Awareness of Policy ............................. 59
Summary of Results .......................................................................................................... 66
Chapter Five: Discussion ............................................................................................................... 68
Findings ............................................................................................................................. 69
Limitations ......................................................................................................................... 73
Implications for Practice .................................................................................................... 74
Future Research ................................................................................................................. 75
Conclusions ....................................................................................................................... 76
References ..................................................................................................................................... 78
Appendix A: Frameworks ............................................................................................................. 87
Appendix B: Surveys ..................................................................................................................... 90
Appendix C: Confidence and Connectedness Mean and Std. Deviation by Question .................. 94
Appendix D: Mean Confidence and Connectedness by Statement–Gender ................................. 96
Appendix E: Mean Confidence and Connectedness by Statement–Tenure .................................. 97
Appendix F: Mean Confidence and Connectedness by Statement–Policy Awareness ................. 99
Appendix G: Gender ANOVA .................................................................................................... 100
Appendix H: Tenure ANOVA ..................................................................................................... 102
Appendix I: Policy Awareness ANOVA ..................................................................................... 104

ix
List of Tables
Table 1: Cronbach’s Alpha Reliability Analysis of Social
Connectedness Questionnaire
47
Table 2: District Respondent Frequency 52
Table 3: Average Confidence and Connectedness Levels of
Gatekeepers
56
Table 4: Mean Levels of Confidence and Connectedness by Category 57
Table 5: Pearson Correlation Analysis of Total Connectedness and
Total Confidence
58
Table 6: Mean and Standard Deviation of Confidence and
Connectedness by Group
63
Table 7: Results of Total Confidence x Policy Awareness ANOVA 63
Table 8: Confidence Means of Measured Variables by Category 64
Table 9: Connectedness Means of Measured Variables by Category 65
Table A1: Definitions and Examples of the CIVIC Conceptual
Framework
89
Table C1: Mean and Standard Deviation of Confidence Scores by
Individual Statement
94
Table C2: Mean and Standard Deviation of Connectedness Scores by
Individual Statement
95
Table D1: Mean Confidence Scores of Individual Statements by Gender 96
Table D2: Mean Connectedness Scores of Individual Statements by
Gender
96
Table E1: Mean Confidence Scores of Individual Statements by Tenure 97
Table E2: Mean Connectedness Scores of Individual Statements by
Tenure
98
Table F1: Mean Confidence Scores of Individual Statements by Policy
Awareness
99
x
Table F2: Mean Connectedness Scores of Individual Statements by
Policy Awareness
99
Table G1: Between Group Significance Levels of Confidence and
Gender
100
Table G2: Between Group Significance Levels of Connectedness and
Gender
101
Table H1: Between Group Significance Levels of Confidence and
Tenure
102
Table H2: Between Group Significance Levels of Connectedness and
Tenure
103
Table I1: Between Group Significance Levels of Confidence and Policy
Awareness
104
Table I2: Between Group Significance Levels of Connectedness and
Policy Awareness
104

xi
List of Figures
Figure 1: Attempted Suicide During the Past Year by Gender 9
Figure 2: Female Suicide Deaths, by Method: United States, 1999 and 2014 10
Figure 3: Attempted Suicide During the Past Year by Race, United States, 2009–
2019
11
Figure 4: Attempted Suicide During the Past Year by Sexual Orientation, United
States, 2009–2019
12
Figure 5: Prevalence of Self-Mutilating Behavior and Suicide Attempts Among
Girls and Boys With ACES
17
Figure 6: Connected Gatekeeper Framework 40
Figure A1: Concentric Circles of the Social Ecology Continuum 87
Figure A2: UCARE Framework 88
Figure B1: Gatekeeper Self-Efficacy Scale 90
Figure B2: Social Connectedness Questionnaire 92

1

Chapter One: Overview of the Study
The American Academy of Pediatrics (AAP) first identified a startling increase in
hospital visits by youth ages 12–17 for suicidal ideation and suicide attempts (Lindsey et al.,
2019). Between the years of 2008–2015, the annual percentage of suicidal ideation and attempts
increased 176% for youth ages 12–14, and an increase of 103% for adolescent youth (ages 15–
17). Moreover, Lindsey et al., (2019) observed that both suicidal ideation and attempts were at
their highest during the months in which students were in school.
As a response to this crisis, the state of California established a national precedent with
the signing of Assembly Bill 2246 (AB-2246), the first ever bill that requires the adoption of
suicide prevention, intervention, and postvention plans by all local California school districts
with students in Grades 7–12. Within the context of the bill, educational agencies across the state
are mandated to develop their policies in collaboration with suicide prevention experts, mental
health professionals, and all involved stakeholders.
AB-2246 also establishes a requirement for California schools to provide staff trainings,
assessment and safety planning tools, data, and other resources that include how to identify
appropriate mental health services (both on campus and within the community), and when and
how to refer at-risk youth and their families to services. As stated in California’s model Youth
Suicide Prevention Policy, the possibility of suicide and suicidal ideation requires vigilant
attention from school staff. As a result, staff are ethically and legally responsible for providing
an appropriate and timely response in preventing suicidal ideation, attempts, and deaths, while
working to create a safe and nurturing campus that minimizes student suicidal ideation.
2

Background of the Problem
With the trajectory of the novel coronavirus pandemic in 2020, experts across the nation
have predicted a significant impact on the mental health of not just the general population, but
teenagers, in particular (Gavin et al., 2020; Golberstein et al., 2020; Imran et al., 2020; Lee,
2020). A review of a 2013 study of American youth who were directly impacted and quarantined
by the previous H1N1 and SARS viruses found evidence of posttraumatic stress disorder (PTSD)
in nearly 30% of their sample (Guessoum et al., 2020). PTSD, depression, and anxiety are just a
few of the potential negative outcomes on adolescent mental health during a pandemic (Creswell
et al., 2021; Golberstein et al., 2020; Guessoum et al., 2020; Imran et al., 2020). Over the course
of the pandemic, many school age children lost their abilities to engage in extracurricular
activities and saw fewer opportunities to engage with their peers and socialize with those they
felt close to (Guessoum et al., 2020; Lee, 2020). As a result, teens with mental health issues such
as anxiety, depression, and trauma may be more at risk of suicide than ever before.
Nevertheless, relational protective factors within the school environment can play a
significant role in reducing the risk of suicidal ideation and attempts, as positive relationships
with a teacher and a positive perception of belonging and connectedness were associated with
positive mental health and wellbeing (Aldridge & McChesney, 2018).
Statement of the Problem
As students return to on campus learning, California’s teachers and staff must be
prepared to face the potentially significant number of mental health challenges that are brought
in as a result of the impacts of the COVID-19 pandemic. The state has placed a high importance
on the prevention of teen suicide, but the new responsibilities placed on stakeholders may be
something that they are not prepared for. While there is limited data explaining the why behind
3

the increase in suicidal ideation and attempts in high school youth, it is important for all involved
stakeholders to increase their awareness, knowledge, and confidence to communicate with
students openly and compassionately about what is going on in their lives and normalizing their
conversations around mental health issues. There is a need for research based upon the
perceptions of school staff in their confidence to address youth suicide and developing a level of
connectedness to their students.
Purpose of the Study
The purpose of this correlational quantitative study is to examine the confidence levels of
California’s high school teachers and staff in their skills with both suicide prevention and
intervention both within and outside their classrooms. Furthermore, teachers can create and
develop a higher level of connectedness through positive and meaningful interactions with their
students. Given that suicide rates for teens are reported to be highest during the school year
(Lindsey et al., 2019), many school staff who often may be the first line of defense against teen
suicide hold the unique opportunity and responsibility to promote and create a protective and
warm relationship with their students, which ultimately can increase healthy behaviors and
reduce suicidal thoughts and attempts. The objective is to explore the relationship between how
connected staff feel to their students, and how confident they are in their ability to assess,
intervene with, and refer students who are at-risk of suicide.
Three research questions guided this study:
1. How confident are school staff in their role as gatekeepers against youth suicide?
2. Does feeling closer to students increase gatekeeper confidence to recognize and
address factors linked to youth suicide?
4

3. Is there a difference in confidence and connectedness levels based on gender, staff
tenure, and awareness of suicide prevention policy?
Significance of the Study
This study serves to highlight the crucial role of teachers and staff in recognizing and
responding to the various relational factors that are correlated with teen suicide prevention and
treatment. The possibility of suicide and suicidal ideation requires vigilant attention from school
staff. It is not only the ethical and legal responsibility of the adults to initiate these conversations,
but to also create a safe and nurturing environment that minimizes suicidal ideation in students.
The results of the study can assist California school districts in improving and/or adjusting
policy, staff training, and school/classroom activities to promote quality student/teacher
interactions and emphasize the importance of warm and protective relationships during the
school year to help mitigate the effects of depression, anxiety, and suicidal ideation.
Limitations and Threats to Validity
As much of the questions are direct and straight forward, there are possible threats to
validity in that respondents to the survey will inflate their responses to ensure that the results turn
out more positive and reflect a stronger teacher/student relationship. Lastly, the small sample
size of California teachers within their reported districts may impact the generalizability of the
results to all teachers across the state. Future surveys can attempt to reach out to teachers from
varying socioeconomic and diverse districts across California to provide their responses,
allowing the results to be more generalized for educators and staff within the state.
Definition of Terms
Gatekeeper refers to the individuals that are in contact with people at risk of suicide
(Takahashi et al., 2020). In the school setting, gatekeepers are identified as people who remain
5

aware, listen, support, and direct those in need towards the necessary resources (Breux et al.,
2017; Takahashi et al., 2020).
Suicide refers to both suicidal ideations, defined by thoughts of suicide and method of
suicide, and suicide attempt, defined by any attempts to try and kill oneself (Isohookana et al.,
2013).
Organization of the Study
This study is organized into five chapters. Chapter One introduces the problem, outlines
the purpose of the study and its importance in suicide prevention, and defines the research
problem that ultimately guided the study.
Chapter Two dives into a deep summary of the various risk and protective factors that
play into youth suicide and its prevention. The chapter also highlights studies current action steps
that are being taken by schools to train and educate their staff in the recognition, prevention, and
intervention of youth suicide.
Chapter Three presents the research methods employed within the quantitative study. The
chapter describes the research design, population and sampling, and instrumentation used during
the study. Furthermore, the procedures for data collection and analysis are also addressed in this
section, as well as issues of validity.
Upon the gathering of data, Chapter Four explores the findings that are provided by staff
who completed their provided surveys. Following an introduction to the participants, the chapter
explores themes from three main sections:
1. How confident are school staff in their role as gatekeepers against youth suicide?
2. Does feeling closer to students increase gatekeeper confidence to recognize and
address factors linked to youth suicide?
6

3. Are there differences in confidence and connectedness levels based on gender, staff
tenure, and awareness of suicide prevention policy?
Lastly, Chapter Five offers a discussion of the study that provides a summary of the
findings, implications for practice, and recommendations based on the results.

7

Chapter Two: Literature Review
With over 45,000 Americans dying by suicide each year (Center for Disease Control,
2019), suicide is a serious public health issue that is showing no signs of slowing down. As the
tenth leading cause of death among Americans of all ages, suicide is known to have lasting
emotional, physical, and economic effects on individuals, families, and their communities that
can translate into shock, anger, guilt, depression, and anxiety (Center for Disease Control, 2019;
Flores et al., 2020). As the battle to determine the most effective intervention and treatment to
this rapidly growing trend continues to rage for over a decade, the country’s adolescent youth
have faced their own challenges, which has seen a reported 67% increase in suicide rates
between 1999 and 2017 (Flores et al., 2020).
The United States has recognized this alarming trend and has named reducing youth
suicidal behavior a national priority for over a decade—yet rates have yet to show any intention
of declining. In the year 2017, youth suicide reached its highest point ever recorded, taking over
to become the second leading cause of death for individuals between the ages of 15 and 19, with
11.8 deaths per 100,000 persons (Center for Disease Control, 2020; Ivey-Stephenson et al.,
2020). As students return from a yearlong pandemic to on campus learning, it is essential for
schools to determine the readiness and knowledge of their staff to recognize and respond to the
various factors of teen suicide and their ability to act as a relational protective factor.
Prevalence
Today, suicidal thoughts and behaviors continue to widely present themselves amongst
America’s youth, with 18.8% of teenage youth having previously reported contemplating suicide
within the past year, and a startling 8.9% attempting one or more times (Center for Disease
Control, 2020; Ivey-Stephenson et al., 2020). Students that fall under the gender, race, and sexual
8

minority are more likely to face a combination of complex factors that, in turn, put them at
higher risk for depression and suicide (Aranmolate et al., 2017; Bauman et al., 2013; Ivey-
Stephenson et al., 2020).
Gender
For this population, the research has shown that females, in particular, continue to
struggle the most as they were more prone to internalizing their negative experiences in
comparison to their externalizing counterparts (Bauman et al., 2013; Center for Disease Control,
2020; Curtin & Heron, 2019; Ivey-Stephenson et al., 2020; Pisani et al., 2013). Results of the
2019 Youth Risk Behavior Study (as seen in Ivey-Stephenson et al., 2020) identified that over
the course of a year, nearly 24% of female high school students had serious contemplations about
taking their own life, with 20% having made a plan. As shown in Figure 1 (Ivey-Stephenson et
al., 2020), 11% of female students have attempted suicide, and over 3% being injured in their
attempt. Though females traditionally have higher rates of nonfatal suicidal behavior, data is now
showing an alarming trend in which females are now using more violent means to commit
suicide (i.e., gunshot, hanging; Curtin & Heron, 2019; Mirosi et al, 2017; Pisani et al., 2013). In
their systematic review of American teen suicides, Curtin et al. (2016) discovered in the year
2014, of all accounted female suicides, 31% of were attributable to firearms, 34% to poisoning,
26% to suffocation, and 9% to other. Their findings also indicated a near 200% increase in
suicides for youth between the ages of 10 and 14 (see Figure 2).
9

Figure 1 Attempted Suicide During the Past Year by Gender
Attempted Suicide During the Past Year by Gender

Note. From Ivey-Stephenson, A. Z., Demissie, Z., Crosby, A. E., Stone, D. M., Gaylor, E.,
Wilkins, N., Lowry, R., & Brown, M. (2020). Suicidal ideation and behaviors among high school
students-youth risk behavior survey, United States, 2019. Morbidity and Mortality Weekly
Report. Supplement, 69(1), 47–55. https://doi.org/10.15585/mmwr.su6901a6
10

Figure 2 Female Suicide Deaths by Method: United States, 1999 and 2014
Female Suicide Deaths by Method: United States, 1999 and 2014

Note. From Curtin, S. C., Warner, M., & Hedegaard, H. (2016). Increase in Suicide in the United
States, 1999–2014. NCHS Data Brief, 241, 1–8

Race/Ethnicity
Through the lens of race/ethnicity, 2019 also saw the continuation of a decade long trend
between White, Hispanic, and Black high school youth suicide rates (Curtin & Heron, 2019;
11

Ivey-Stephenson et al., 2020). As seen in Figure 3, results of the 2019 YRBS (as presented in
Ivey-Stephenson et al., 2020) demonstrated that roughly 20% of those who considered suicide
were White, yet only made up around 8% of those who followed through with their attempt.
Black youth represented nearly 17% of students with suicidal ideation, however, were
disproportionately represented, with 12% accounting for those who attempted suicide.

Figure 3 Attempted Suicide During the Past Year by Race, United States, 2009–2019
Attempted Suicide During the Past Year by Race, United States, 2009–2019

Note. From Ivey-Stephenson, A. Z., Demissie, Z., Crosby, A. E., Stone, D. M., Gaylor, E.,
Wilkins, N., Lowry, R., & Brown, M. (2020). Suicidal ideation and behaviors among high school
students–youth risk behavior survey, United States, 2019. Morbidity and Mortality Weekly
Report. Supplement, 69(1), 47–55. https://doi.org/10.15585/mmwr.su6901a6
12

Sexual Orientation
Since the YRBS began collecting data on sexual orientation and gender identity, there
have been consistent and disproportionate disparities indicating lesbian, gay, bisexual,
transgender, and queer (LGBTQ) youth face greater health disparities than their cisgender
straight peers (Aranmolate et al., 2017). High school students who identified as lesbian, gay,
and bisexual were twice as likely as their straight peers to report feeling sad or hopeless—and
four times as likely to have attempted suicide. Demonstrated in Figure 4, results of the YRBS
indicate that nearly 23% of LGBTQ youth attempted suicide in the previous school year (Center
for Disease Control, 2020; Ivey-Stephenson et al., 2020).

Figure 4
Attempted Suicide During the Past Year by Sexual Orientation, United States, 2009–2019

Note. From Ivey-Stephenson, A. Z., Demissie, Z., Crosby, A. E., Stone, D. M., Gaylor, E.,
Wilkins, N., Lowry, R., & Brown, M. (2020). Suicidal ideation and behaviors among high school
students–youth risk behavior survey, United States, 2019. Morbidity and Mortality Weekly
Report. Supplement, 69(1), 47–55. https://doi.org/10.15585/mmwr.su6901a6
13

Risk Factors
Risk factors refer to personal or environmental characteristics that are associated with
suicide (Flores et al., 2020). Though there is no single, agreed-upon list of risk factors, there is
widespread understanding within scientific communities that various adverse life experiences,
mental health challenges, and environmental factors all deserve to be equally implicated as the
culprit (Miron et al., 2018; Padmanathan et al., 2020; Sheftall, 2018; Twenge et al., 2018). High
school students may often find themselves spending more time thinking about their identity, their
role in their community, and the future that awaits them outside the halls of their campus and
family home (Bauman et al., 2013). It can be a difficult transition for many students. They begin
to experience more opportunities for independence, with a wider range of activities to freely
engage in new and challenging activities. However, it is also during this time in which they begin
to feel the pressures of academic success, and the expectations from the world in which they will
one day step out to explore (Bauman et al., 2013; Twenge et al., 2018), and the rates of suicide
attempts increase dramatically (Curtin & Heron, 2019; Ivey-Stephenson et al., 2020; Miron et al.,
2019).
Mental Health Issues
Many factors can increase the risk for suicide or protect against it. For one, increases in
suicide rates appear to be accompanied by worsening mental health (Twenge et al., 2018;
Padmanathan et al., 2020). The presence of multiple behavioral health disorders (especially the
combination of mood and disruptive behavior problems or substance use) has been reported to
increase suicide risk.
Today, more young students are suffering from mental health issues, putting them at risk
for suicide and other potentially negative outcomes (Twenge et al., 2018). Problems with
14

emotional regulation, as well as a lack of having trusted adults in the home or community have
been linked to depressive and anxiety-related symptoms ultimately resulting in suicide attempts
(Pisani et al., 2013). Suicide attempts, self-harm and suicidal ideation in youth are predictive of
future suicide risk and other adverse psychopathological outcomes (Bauman et al., 2013; Flores
et al., 2020; Pisani et al., 2013). Depressive symptoms and suicide deaths among adolescents all
rose during the 2010s (Center for Disease Control, 2020; Curtin & Heron, 2019; Ivey-
Stephenson et al., 2020; Twenge et al., 2018).
Over the last 10 years, high school youth have seen an increase in reported suicidal
ideation, suicide planning, attempted suicides, and suicide-related injuries (Center for Disease
Control, 2020; Curtin & Heron, 2019; Ivey-Stephenson et al., 2020; Pisani et al., 2013). The vast
majority of students who are identified as high risk for suicide ideation and attempts often find
themselves more likely to engage in risky behaviors such as substance abuse and have a higher
likelihood to be experiencing physical and sexual violence involvement, high-risk sexual
behaviors, sleep deprivation, and poor academic performance (Bauman et al., 2013; Center for
Disease Control, 2020; Flores et al., 2020). Results of the 2019 National Youth Risk Behavior
Survey (Ivey-Stephenson et al., 2020) reveal that that little progress has been made in mental
health and suicide-related behaviors and experiences reported by students. Ivey-Stephenson et
al., (2020) report that more students, regardless of race/ethnicity, experienced persistent feelings
of sadness or hopelessness between 2009 and 2019. Additionally, more than one in three students
and nearly half of female students reported persistent feelings of sadness or hopelessness in
2019.
In a randomized trial, Pisani et al. (2013) surveyed 7,978 high school students regarding
problems with emotional regulation. Of 7,978 students, 683 (8.6%) reported that they had
15

attempted suicide in the past 12 months. Of those who attempted suicide, 341 (50%) reported
one attempt, 198 (29%) reported 2–3 attempts, and 55 (8%) reported 4–5 attempts, and 89 (13%)
reported 6 or more attempts. Through utilizing the Difficulties in Emotion Regulation Scale—a
reliable and valid self-report tool, it was found that lack of emotional clarity and limited access
to regulation strategies were found to be related to both depressive symptoms and suicide
attempts.
Adverse Life Experiences
Over the last 20 years, the medical world has started to gain a greater understanding on
the impact of adverse childhood experiences (ACEs) on both physical and mental health.
Adverse childhood experiences include, but are not limited to, physical/sexual/emotional abuse,
neglect, witnessing violence, substance abuse within the household, caregiver mental illness or
death, caregiver separation/divorce, caregiver incarceration, and more recently, poverty and
homelessness (Flores et al., 2020; Miron, et al., 2019; Pisani et al., 2013; Ports et al., 2017).
Constant exposure to these adverse experiences without a positive buffer, such as a nurturing
parent or caregiver, can lead to a toxic stress response in children. As a result, individuals can
begin to develop and experience health problems such as asthma, poor growth, and frequent
infections, as well as learning difficulties and behavioral issues. In the long term, exposure to
ACEs can also lead to serious health conditions like heart disease, stroke, and cancer later in life.
Recent evidence has discovered that individuals who have experienced adverse childhood
experiences (ACEs) are more likely to attempt suicide at some point in their lifetime (Flores et
al., 2020; Ports et al., 2017).
In 2012, Isohookana et al. interviewed 508 adolescent psychiatric inpatients aged 12–17
years who were frequently admitted between April 2001 and March 2006. As seen in Figure 5,
16

one major finding indicated that, of all ACEs investigated, sexual abuse was found to be the
highest risk factor for suicide attempts in girls, more than doubling the risks. Furthermore, boys
who were seeking treatment often came from divorced families and often suffered from parental
unemployment and parental death more often than their female counterparts. In turn, young girls
had more often been found to be involved in their parents’ psychiatric problems. Analyses of the
interviews introduced the concept that boys react psychically to external factors, such as the lack
of economic wellbeing, while girls react to the prevailing unfavorable atmosphere at home
(Isohookana et al., 2013).

17

Figure 5
Prevalence of Self-Mutilating Behavior and Suicide Attempts Among Girls and Boys With ACES

Note. From Isohookana, R., Riala, K., Hakko, H., & Räsänen, P. (2012). Adverse childhood
experiences and suicidal behavior of adolescent psychiatric inpatients. European Child &
Adolescent Psychiatry, 22(1), 13–22. https://doi.org/10.1007/s00787-012-0311-8
18

Environmental Factors
Another suspected reason for the increase in suicide amongst high school youth is the
rapidly growing popularity of social media and electronic communication, with some linking it
directly to increased feelings of loneliness and poor psychological wellbeing (Bauman et al.,
2013; Padmanathan et al., 2020; Twenge et al., 2018). The introduction of social media and new
avenues of electronic communication have also led to new forms of bullying, where high school
students’ experiences have been associated with suicidal behaviors (Bauman et al., 2013). As the
internet grows to become more ingrained within the daily facets of human life, it is also opening
the doors to toxic environments that promote cyberbullying, insecurity, emotional distress, and
ultimately, suicide (Bauman et al., 2013; Twenge et al., 2018).
Researchers at the University of Arizona (Bauman et al., 2013) explored the responses of
1491 high school students through their respective state’s Youth Risk Behavior Survey.
Analyzing all items related to depression, suicide, and bullying/electronic bullying, results
indicated that traditional bullying was a significant predictor of depression in females. When
accounting for depression, results also indicated that cyberbullying also played a direct role in
suicide attempts in males.
COVID-19 Pandemic
The impacts of the COVID-19 pandemic have introduced a new and unexpected factor
impacting the overall mental health and suicidal ideation of teenage youth. For this group, the
months of virtual learning, isolation from friends, and cancellation of social activities have
resulted in new or worsening mental health conditions (Canady, 2021; Lee, 2021). According to
a poll completed by a national sample of parents, 73% reported negative impacts on their teens’
ability to interact with their friends, with 46% noticing new or worsening mental health
19

challenges in their teen (Canady, 2021). Unfortunately, the recent pandemic has forced many
teens to be removed from their routine and normalized social, physical, and educational
interactions. Lockdowns, sudden deaths/hospitalizations, as well as social isolation have all been
identified as possible factors that result in higher reports of trauma, depression, and anxiety in
teenage youth (Creswell et al., 2021; Golberstein et al., 2020; Guessoum et al., 2020; Imran et
al., 2020).
With lockdowns, social distancing, deaths, and the loss of protective activities, the toll
that has been placed on the mental health of the world’s youth have been only exacerbated. As
found in studies completed by the Center for Disease Control, (2020) and YRBS (Ivey-
Stephenson et al., 2020), the prevalence of youth suicide is already on the rise with no signs of
slowing down. Students who already suffer from mental health issues or experience
environmental factors that impact their mental health are more likely to see an increase of
suicidal ideation during the school year (Isohookana et al., 2013; Ivey-Stephenson et al., 2020;
Lindsey et al., 2019). As doors to in-person learning begin to open for students to return, there is
a dire need for protective factors to be enhanced, and for the knowledge of teachers and staff to
be increased to recognize the ever-growing mental health challenges that could lead to suicide.
As reported by parents in the C.S. Mott Children’s Hospital National Poll on Children’s Health
(Canady, 2021), 36% of teenage girls saw an increase in anxiety/worrying, 31% saw an increase
in depression/sadness, and 24% reported negative changes in their sleeping patterns.
Though the longer-term outcomes specific to the COVID-19 pandemic remain unknown,
the impact on adolescent mental health can be guided by previous disasters such as Hurricane
Katrina in 2005, and the H1N1 influenza pandemic of 2009 (Guessoum et al., 2020; Rider et al.,
2021), which saw increased reports of anxiety, depression, and PTSD. While schools have taken
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many routes to address the issue, gatekeeper training has proven to offer the greatest short-term
and long-term results (Cooper et al., 2011; Katz et al., 2013; Yonemoto et al., 2019). Exploring
how prepared and confident teachers and staff are to play the role of a relational protective
factors with the students who need it the most is essential to help create a more welcoming and
warmer environment where teenage youth who are most at-risk can feel connected, supported,
and safe (Breux et al., 2017; Cavioni et al., 2020; Lindsey et al., 2019; Singer et al., 2019).
Protective Factors
There are several factors that exist within an individual and their life that protect them
from suicidal thoughts and behaviors. While the research regarding protective factors continues
to grow, it is important to identify and understand their impact on high school youth, as a key
component to effectively prevent teen suicide is to establish and enhance multiple protective
factors (Breux et al., 2017; King & Vidourek, 2012). A protective factor is defined as a
characteristic or attribute that reduces the likelihood of an individual attempting suicide (Breux
et al., 2017; King & Vidourek, 2012). Protective factors can be found in individual traits and
abilities, family dynamics, social environment, and positive relationships (Ahookhosh et al.,
2017; Allen et al., 2014; Johnson & Parsons, 2012; King & Vidourek, 2012; Pepler & Bierman,
2020; Pisani et al., 2013). It is recognized that the existence of these protective factors, even if
small in quantity, enhance resilience, and help develop a counterattack against the overwhelming
risk factors (Breux et al., 2017). Though increasing protective factors can serve to decrease the
risk of suicide, strengthening and increasing resiliency during the presence of stressful situations
is an ongoing process, that often requires a collaborative effort among all domains (Breux et al.,
2017; Johnson & Parsons, 2012; King & Vidourek, 2012).
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Individual Protective Factors
The continuum of protective factors starts at the individual level, encompassing a
person’s biology, psychology, and social history. Examples of protective factors on this level
may include an individual’s coping skills, daily activities, and academic resilience (King &
Vidourek, 2012; Pisani et al., 2013; Williams et al., 2017).
Emotional self-regulation refers to the ability to manage disruptive emotions and
impulses. Good emotional self-regulation includes, but is not limited to, an individual’s ability to
gain awareness, clarity, and acceptance of emotions of their emotions (Pisani et al., 2013). In
addition, a strong capacity for self-regulation includes one having effective strategies for
responding to their emotions and harnessing them towards trying to feel better (Pisani et al.,
2013). For many young teens, maladaptive tendencies regarding their emotional regulation
process have often been linked to suicidal risk factors, such as depression, anxiety, bipolar
disorder, drug/alcohol use and engaging in risky behaviors (King & Vidourek, 2012; Pisani et al.,
2013).
Individuals who demonstrate good self-regulation skills also demonstrate academic
resilience, which allows them to be academically successful despite any adverse life experiences
that they may have undergone in the past or are currently enduring (Pisani et al., 2013; Williams
et al., 2017). The high school years can introduce a multitude of academic stressors that may at
first be difficult for students to adjust to (Williams et al., 2017). As the transition from middle
school to high school introduces new challenges to young students, the ability to work through
and develop positive coping mechanisms to tackle the overwhelming academic experiences
becomes crucial in decreasing the risk of developing troubling mental health issues, such as
depression, anxiety, and suicidal ideation (King & Vidourek, 2012; Pisani et al., 2013).
22

Outside of the classroom, an adolescent’s individual involvement in interest-based clubs
and teams, religious and secular community organizations, and in their neighborhoods have also
shown to act as significant protective factors against suicide (Pepler & Bierman, 2020; Pisani et
al., 2013). With an increasing number of families seeing both parents working full-time hours,
teens are turning to outside programs to find adequate and structured supervision (Williams et
al., 2017). Involvement in these activities provides opportunities for struggling youth to enhance
their general mental and physical development (Veed et al., 2019; Williams et al., 2017), build
lasting and supportive relationships (Allen et al., 2014; Johnson & Parsons, 2012; King &
Vidourek, 2012), and improve upon their general educational experience (King & Vidourek,
2012; Williams et al., 2017). Surveying nearly 8000 students in New York and North Dakota,
Pisani et al. (2013) found that students who had relationships with trusted individuals in any
context outside of the classroom were 74% less likely to report a suicide attempt than students
who did not.
Family Protective Factors
Family cohesion has been noted to be a significant predictor of suicidal ideation
(Ahookhosh et al., 2017; King & Vidourek, 2012; Pisasni et al., 2013; Williams et al., 2017), and
adolescents who have attempted or completed suicide have often reported or been described as
having less meaningful and satisfying interactions with their identified caregivers (Ahookhosh et
al., 2017; Pisasni et al., 2013). For most adolescents, the teenage years often see a rise in conflict
between them and their caregivers, at times leading to less cohesion within the family dynamic
(Ahookhosh et al., 2017; Williams et al., 2017). Additionally, problems within the family, such
as those between caregivers, can undoubtedly have an impact on the development of their child’s
individual ability to manage their most overwhelming challenges (King & Vidourek, 2012;
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Pisasni et al., 2013). Other family experiences, such as the loss of a significant caregiver due to
divorce/death, parental mental health issues, and parental drug/alcohol use have all demonstrated
strong correlations to suicidal ideation in the teenage years and later (King & Vidourek, 2012).
Within many family dynamics, strong protective factors lessen the likelihood of their
youth engaging in any form of abuse or neglect towards themselves and/or others (Ahookhosh et
al., 2017; King & Vidourek, 2012; Pisasni et al., 2013). Protective factors within the family
include, but are not limited to, nurturing parenting skills, stable relationships, parental
employment, and adequate housing (King & Vidourek, 2012; Williams et al., 2017). Caregivers
themselves who demonstrate their own sense of resilience, have strong social connections, and
concrete support, and hold knowledge of child development are also known to establish a family
environment that enhances family strengths and promotes optimal child and youth development
(Pisani et al., 2013).
Social Environment Protective Factors
It is becoming more well known that an individual’s social and economic circumstances
directly affect their physical and mental health. Many common mental disorders, such as
depression and anxiety, are heavily associated with social inequalities, whereby the greater the
inequality the higher the risk (Allen et al., 2014; King & Vidourek, 2012). People are made
vulnerable to poor mental health via deep-rooted poverty, social inequality, and discrimination
(Allen et al., 2014; King & Vidourek, 2012). A student’s individual experiences within their
school environment and community are each noted to have a considerable impact on their mental
health (Breux et al., 2017; Franklin et al., 2012; Pisani et al., 2013)—for better or for worse.
Following a comprehensive review of the WHO Commission of Social Determinants of Health,
Marmot Review in England, WHO Review of Social Determinants of Health and the Health
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Divide, as well as pioneering WHO reports on mental health promotion and prevention of mental
health, Allen et al. (2014) found that poor environmental conditions such as overcrowding and
unhealthy living can add to stress leading to poor mental health outcomes.
Students generally perceive the school environment as a safe and stable area with
multiple support systems though many do not always find success when they turn to their school
for academic and/or emotional support or care (Allen et al., 2014; Bernstein‐Yamashiro &
Noam, 2013; Franklin et al., 2012; Johnson & Parsons, 2012). School environments that support
the adjustment of students, contribute to social skills, and equitably promote academic
achievement are poised to create a protective environment for their students who are
experiencing dire challenges with their mental health (Breux et al., 2017; King & Vidourek,
2012). Students who feel connected to and safe within their school corridors are more likely to
succeed academically (Franklin et al., 2012; King & Vidourek, 2012), and are more likely to
utilize its resources for support when in need (Breux et al., 2017; Johnson & Parsons, 2012;
Pisani et al., 2013). For many teenage students, they work through their daily activities in hopes
that others will consider them, be interested in them, be aware of their suffering, and hear their
cries of pain (Holliday & Vandermause, 2015; Pisani et al., 2013), while continuing to give them
the opportunity to grow and succeed. A positive school environment is the first step in ensuring
that they know that they are acknowledged, supported, and will be protected (Breux et al., 2017;
Pisani et al., 2013; Veed et al., 2019) regardless of their life circumstances.
Outside of the classroom, connections across multiple community settings are also
recognized to promote the development of protective factors, including better self-esteem and
lower depression (Allen et al., 2014; Franklin et al., 2012; King & Vidourek, 2012; Pisani et al.,
2013). Communities that encourage help-seeking, provide easy access to care, and also promote
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connectedness, all play a hand in developing a sense of belonging and hope in teens who
perhaps, need it the most (Breux et al., 2017; Pisani et al., 2013). Additionally, teens who
struggle with their mental health may find themselves interacting with medical providers within
their community, whose care, understanding, and support, can directly impact a youth’s future
behaviors. Unfortunately, reports indicate that providers often react to suicidal patients with
anger, frustration and are generally non empathetic, and the poor care that suicidal individuals
receive is linked to their providers' attitudes and lack of training related (Franklin et al., 2012;
Holliday & Vandermause, 2015).
Relational Protective Factors
Personal and peer relationships during the high school years can often have direct
influence on determining sense of social belonging and self-worth, and as a result can decrease
the risk of suicide (Allen et al., 2014; Bernstein‐Yamashiro & Noam, 2013; King & Vidourek,
2012; Pepler & Bierman, 2020). During this intricate period, these experiences with friends and
peers often pave the way to develop capacities for intimacy, empathy, and problem solving (King
& Vidourek, 2012; Pepler & Bierman, 2020; Veed et al., 2019). Engaging in strong relationships
with peers and teachers also creates new opportunities for young teenagers to learn how to
manage their emotions such as anger and jealousy, helping them to become able to resolve their
conflicts in positive ways (Bernstein‐Yamashiro & Noam, 2013; King & Vidourek, 2012; Pepler
& Bierman, 2020; Pisani et al., 2013).
For many teenage youths, one of the most important transitions that occurs during their
high school years is the rise in importance and influence of their friends and friend groups.
Friendships can play a key protective role in helping students cope with their personal struggles,
reduce stress, and provide a sense of belonging and purpose (Allen et al., 2014; King &
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Vidourek, 2012; Pepler & Bierman, 2020; Veed et al., 2019). In fact, teens who are often not
included in friendship groups may lack the developmental skills that become the foundation for
initiating and sustaining healthy romantic relationships and avoiding violence (King & Vidourek,
2012; Pepler & Bierman, 2020). Williams et al. (2013) identified that close friendships appear to
be much more important for teenage girls, and problems with these relationships have major
impacts on their mental health. Ultimately, teenage girls who are isolated from their peer groups
or whose social relationships are dissonant, are at greater risk for suicidal thoughts (Williams et
al., 2013; Pisani et al., 2013).
Adult relationships outside of the family, particularly school staff, also can play a
protective role against teen suicide (Allen et al., 2014; Bernstein‐Yamashiro & Noam, 2013;
King & Vidourek, 2012; Pisani et al., 2013; Veed et al., 2019). Though the parent-child
relationship may be the most important for youth, the influence of teachers only rises with the
increasing amounts of time spent in the classroom setting (Bernstein‐Yamashiro & Noam, 2013;
Miller-Lewis et al., 2014; Pisani et al., 2013). Strong levels of teacher caring demonstrated
through their daily interactions with students act as a protective factor against the initiation of
new suicidal thoughts and behaviors (Franklin et al., 2012; Johnson & Parsons, 2012; Pisani et
al., 2013). Emerging research is now recognizing the impact teacher-student relationships have
on motivation, learning, attitudes toward school, and general mental health (Bernstein‐
Yamashiro & Noam, 2013; Franklin et al., 2012; Miller-Lewis et al; Pisani et al., 2013).
Additionally, caring, and supportive student-teacher relationships are known to be associated
with increased classroom engagement, lower rates of retention, higher test scores, and serve an
important role in a student’s successful adaptation to their school environment (Bernstein‐
Yamashiro & Noam, 2013; Johnson & Parsons, 2012; Miller-Lewis et al; 2014).
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The student-teacher dynamic can be so impactful, that poorer relationships within this
dynamic are associated with greater mental health problems in a student’s life. Poor student-
teacher relationships, at any educational level, have often correlated with externalizing
behaviors, internalizing behaviors, and less than optimal prosocial skills (Franklin et al., 2012).
Unfortunately, the reciprocal transaction that exists between student and teacher can at times
form barriers to students who are struggling with their mental health, as their behaviors may lead
to student-teacher conflict or prevent them from engaging and connecting with their teachers
(Johnson & Parsons, 2012; Miller-Lewis et al; 2014).
Schools in Action
Promoting and enhancing the emotional regulation and communication skills is often at
the center of most suicide prevention models (Pisani et al., 2013). Though there are currently no
federal laws requiring American schools to address suicide prevention (Katz et al., 2013; Smith-
Millman & Flaspohler, 2019), it is highly recommended that schools take the necessary steps to
make resources available to their students that can ultimately help modulate their responses to
relational challenges, peer and family conflicts, and victimization to violence (Flores et al., 2020;
Pisani et al., 2013).
As of 2020, at least 27 states have mandated suicide prevention training for school
personnel; at least 15 states encourage training; and 12 states require school suicide prevention,
intervention and postvention policies or suicide prevention programming statewide (AFSP,
2020). For many schools across the nation, suicide prevention initiatives are hoping to become
deep rooted within the structures of academic and behavioral interventions (Breux & Boccio,
2019; Cooper et al., 2011; Schilling et al., 2016). Mirroring the country’s approach to public
health, schools receive interventions and training focused on three different levels: Universal,
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Selected, and Indicated (Breux et al., 2017; Cooper et al., 2011; Katz et al., 2013). Universal
strategies focus on promoting awareness and positive coping skills, and reducing hopelessness,
Selected strategies target at risk groups and work to train the gatekeepers to identify and refer
students who are at high risk of suicide, and Indicated strategies shifts its focus to improve
treatment to care for suicidal individuals (Breux et al., 2017). Nevertheless, due to the large
number of non-evidence based available programs, it has been difficult for policymakers and
districts to identify one program as the best (Substance Abuse and Mental Health Services
Administration, 2012; Smith-Millman & Flaspohler, 2019).
Prevention in the Classroom
Prevention programs are being implemented in various settings ranging from schools,
community centers, and within the healthcare system (Cooper et al., 2011) with a focus to
identify and reduce risk factors associated with suicide and provide support for those in need of
treatment (Substance Abuse and Mental Health Services Administration, 2012; Cooper et al.,
2011; Katz et al., 2013). The school setting, however, allows for unequaled access to most of the
nation’s youth, and acts as a prime location to provide multiple mental health prevention and
intervention services (Substance Abuse and Mental Health Services Administration, 2012;
Cooper et al., 2011). To combat youth suicide, most schools universally develop a
comprehensive plan that includes health promotion, prevention intervention, and postvention
(Cooper et al., 2011; Katz et al, 2011; Yonemoto et al., 2019). Cooper et al. (2011) describe
curriculum-based programs, screenings, gatekeeper training, and programs that enhance
protective factors as the best tools to reduce the overall prevalence of suicidal ideation, attempts,
and completions.

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The overall goal of suicide awareness programs in the classroom is to ensure students and
staff become familiar with the signs and symptoms of suicide not only in others, but within
themselves as well (Breuax & Boccio, 2019; Substance Abuse and Mental Health Services
Administration, 2012; Cooper et al., 2011; Schilling et al., 2016). It is common for learning
agencies to incorporate suicide education into their regular curriculum, however the literature
reports often mixed results (Cooper et al., 2011; Schilling et al., 2016). Curriculum-based
programs have developed significantly over the last 20 years and are currently being used with
promising results (Substance Abuse and Mental Health Services Administration, 2012; Katz et
al., 2013).
The most common and most successful universal program that promotes the
destigmatizing of suicide and mental health is Signs of Suicide (Cooper et al., 2011; Schilling et
al., 2016). With videos and guided classroom discussions, Signs of Suicide (SOS) emphasizes
the importance of students learning to acknowledge and take seriously the signs of suicide in
others and has demonstrated significant short-term and long-term effects in the number of self-
reported suicide attempts (Cooper et al., 2011; Schilling et al., 2016). Nevertheless, SOS fails to
have any significant impact on decreasing suicidal ideation or increasing help-seeking behaviors
(Cooper et al., 2011).
Screening
Screening is a process that involves looking for risk factors that are most prevalent with
suicide risk. The ultimate outcome of the utilization of screening tools is to identify at-risk
students who otherwise may go unnoticed and recommend the appropriate treatment. While
screening tools assess risk factors, there is a general awareness that false positives and false
negatives exist (Cooper et al., 2011; Katz et al., 2013), nevertheless, there is a lack of
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understanding on how to best treat individuals who are flagged during their screening process
(Breux & Boccio, 2019; Cooper et al., 2011). As identified by Katz et al. (2013), common
screening tools across the nation include the Suicidal Ideation Questionnaire (SIQ), Suicide Risk
Screen (SRS) and the Columbia Suicide Screen (CSS).
Nevertheless, several expert reviews have concluded that suicide screening remains an
imperfect science. Per the U.S. Preventive Task Force (2013), limited evidence suggests that
screening instruments may be able to identify individuals with an increased risk of suicide, and
that screening may be more effective when tied in with broader mental health screenings. Despite
the mixed findings on the effectiveness of screening, there is fairly widespread agreement that it
can be useful if conducted within a more comprehensive effort (Breux & Boccio, 2019; Katz et
al., 2013; O'Connor et al., 2013).
Gatekeeper Training
Gatekeeper training takes aim at those considered to be the classroom’s natural helpers,
hoping to give them the skills to recognize the symptoms and signs of suicide and intervene
(Cooper et al., 2011; Katz et al., 2013; Yonemoto et al., 2019). In the school setting, gatekeepers
include the teachers, counselors, and administrative staff who are in a position to observe and
intervene with at-risk youth (Substance Abuse and Mental Health Services Administration, 2012;
Yonemoto et al., 2019). There are several gatekeeper training programs available, such as
Question Persuade Refer (QPR), Living Works, and Suicide Options and Relief (SOAR).
Of the trainings, QPR has grown to become a universal program that has shown the most
promising short-term and long-term results (Cooper et al., 2011; Katz et al., 2013; Yonemoto et
al., 2019). QPR aims to increase suicide awareness amongst school personnel and enhance their
abilities to recognize the warning signs, learn to assess, and organize access to professional
31

services for intervention and treatment (Cooper et al., 2011; Katz et al., 2013; Yonemoto et al.,
2019). The use of QPR has shown positive effects on general knowledge, perceived
preparedness, and efficacy outcomes (Katz et al., 2013; Yonemoto et al., 2019), however has
demonstrated no positive effects on the behavioral outcomes of the gatekeeper (i.e., asking
students about suicide, referrals, enhanced student/teacher relationship; Cooper et al., 2011).
Skills Trainings
Schools often may turn to risk-reduction strategies designed to increase the prevalence of
protective factors for its students. Although not directly targeting suicide, these programs aim to
teach general life skills—such as adaptive coping, problem solving, and emotional regulation to
prevent the eventual development of suicidal behaviors (Cooper et al., 2011; Katz et al., 2013).
The most frequently utilized programs include Care, Assess, Respond, and Empower and
Coping and Support Training (Cooper et al., 2011; Substance Abuse and Mental Health Services
Administration, 2012; Katz et al., 2013). The Care, Assess, Respond, and Empower program is
designed to identify high-risk youth through a suicide-assessment interview and counseling, with
the goal being to decrease suicidal behaviors and related risk factors (Cooper et al., 2011).
Coping and Support Training also aims to increase life skills and enhance social support for
students using small groups, in hopes of improving overall mood management and school
performance. However, recent evaluations have found no significant effects of the programs on
the suicidal behavior outcomes (Cooper et al., 2011).
Study Framework
From the moment a child is born into this world, they are hardwired to feel safe and
secure (Cooper et al., 2011). This particular need to be in a secure relationship is built in, and
automatically begins to work nonstop diligently each day of its existence. Ultimately, the
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willingness for a trusting and caring adult to be there for the child can make all the difference.
Without this feeling of safety, young children may sense danger in love and belonging, struggle
to enhance their self-esteem, and limit their opportunities to grow and develop physically and
emotionally (Cavioni et al., 2020; Cooper et al., 2011; Payton et al., 2000).
Relationships and Mental Health in the Classroom
There is growing recognition showing that an individual's ability to understand, support,
and share the feelings of another can be one of the most rewarding gifts (Cooper et al., 2011).
For people of all ages, the willingness for someone to be with them makes the feelings less
overwhelming and helps establish a sense of confidence to seek out the support they need (Breux
et al., 2017; Cavioni et al., 2020; Cooper et al., 2011). As students are spending their days within
the walls of their classrooms, their experiences within that environment become central to
building the resilience necessary for suicide prevention (Breux et al., 2017; Cavioni et al., 2020).
In his book, Loneliness: The Experience of Emotional and Social Isolation, Weiss (1974)
established a multidimensional concept of loneliness, distributing loneliness into two categories:
social and emotional. For many individuals, social loneliness often came to light when
relationships that were considered socially integrative were found to be absent (Weiss, 1974).
This particular loneliness can lead to feelings of boredom, exclusion, and marginality (Wang et
al., 2018; Weiss, 1974) Emotional loneliness, however, can be traced back to the lack of intimate
relationships, where the absence of any form of close emotional attachment, can result of high
various levels of distress and anxiety (Cooper et al., 2011; Wang et al., 2018; Weiss, 1974).
For many young teens, having some form of social connectedness has been known to
reduce their risk of suicide by instead increasing their psychological wellbeing and exposing
them to more adaptive coping and help-seeking behaviors (Breux eta al., 2017; Cavioni et al.,
33

2020; Singer et al., 2019). Through proper training and support, teachers and staff have
demonstrated the capacity to significantly impact the school environment’s social norms and
attitudes towards seeking help for suicidal thoughts and related behaviors (Singer et al., 2019).
Creating Suicide Safety in Schools
Through the Creating Suicide Safety in Schools (CSSS) framework, the importance of
relational protective factors is highlighted, as families, school peers and staff, and community
members are each identified as meaningful tools to be utilized in the fight against suicide (Breux
et al., 2017). Breux et al. (2017) established their framework through the lens of the Concentric
Circles of the Social Ecology Continuum (see Appendix A; Figure A1) with the idea that no one
person can keep another safe from suicide, and it is the responsibility of a competent and caring
community to recognize their role and importance.
The CSSS framework is designed with a preventative mindset to implement interventions
at the individual, relational, and environmental level. Through the lens of risk/resiliency theory,
risk factors for suicide include, but are not limited to mental health disorders, alcohol and
substance abuse, impulsive or aggressive reactions to stress, chronic stress, feelings of
hopelessness and loss (Breux et al., 2017; Jenson & Fraser, 2015). The framework also
recognizes that all forms of abuse and assault (i.e. physical, sexual, emotional, neglect), lack of
mentors, loss of important relationships, rejection by peers, bullying, poor family dynamics,
having access to attempt suicide, low community cohesion, community trauma, poor community
resources, and social rejection (Breux et al., 2017; Jenson & Fraser, 2015; Layne et al., 2011;
Ports et al., 2014) as prominent risk factors of suicidal ideation and attempts.
The framework focuses on various categories that can ultimately contribute to a safer
school and community environment. Per the framework, basic training for all school staff and
34

faculty is encouraged, and should focus on the prevalence, risk/protective factors, warning signs,
and action steps (Breux et al., 2017). Breux et al. (2017) also place an emphasis on schools
developing programs that build the social emotional skills and resilience of students, with a focus
on reducing bullying and interpersonal violence, and establish a culture of respect and
acceptance to promote school connectedness.
The CSSS framework also establishes a need for a plan to help students who are at risk
for suicide. With the desire to create a collaborative community, Breux et al. (2017) recognize
the need to develop policies and procedures that standardize assessments, and utilizes
collaboration with administrators, parents, and community providers. However, the CSSS
framework lacks the emphasis on the importance of the relational factors that can be present and
developed within the classroom and school grounds.
UCARE Framework
Following decades of research and studies, early childhood researchers Layne et al.
(2011) developed a new framework designed to create a pathway towards healing. The Core
Curriculum on Childhood Trauma (CCCT) was designed to act as a foundational training tool
that would ultimately be used in conjunction with trauma-focused training. The primary aim of
the CCCT is to (a) enhance the empathic understanding of the nature of one’s traumatic
experiences and its after-effects; (b) facilitate the development of reasoning and judgment who
work with traumatized youth; (c) increase interest and readiness for trauma-informed practice;
(d) facilitate clear dialogue between different providers; and (e) encourage addressing each
particular case from multiple perspectives (Layne et al., 2011). To achieve these outcomes,
researchers further developed the understand, connect/communicate, accept, reduce risk, and
35

enhance coping (UCARE) framework, which focused on the overall intervention goal and
desired outcomes that would hope to be established (see Appendix A, Figure A2).
Under the UCARE framework, individuals are supported to understand the basic
connections between the traumatic experiences and current/past functioning (Layne et al., 2011).
With a growing understanding of the impact on adverse experiences with behavior and mental
health (Isohookana et al., 2013; Layne et al., 2011; Ports et al., 2017), the framework helps
establish the importance of creating a rich understanding of how these experiences impact not
just students, but individuals in general, and create a positive outlook on how to support and
manage those who are struggling the most. Helping find the strengths and support systems to
help overcome the challenges, rather than focusing on the behaviors themselves has often proven
to be effective in reducing repeated attempts (Katz et al., 2013; Layne et al., 2011; Payton et al.,
2000; Williams et al., 2017).
To connect and communicate is the next essential step in the framework, which was
designed to help the multiple providers and involved individuals to observe, assess, and
recognize how the specific child, family, individual, or system is seen and treated. The
framework places an emphasis on utilizing team meetings and general care coordination to
effectively communicate observations and screening results via cross system dialogues. Current
policies and practices often make it difficult for the many involved individuals to follow a
predictable, structured, and coherent process which the struggling individual can feel hopeful,
secure, and safe (Jenson & Fraser, 2015; Johnson & Parsons, 2012; Layne et al., 2011; O'Connor
et al., 2013; Schilling et al., 2016; Smith-Millman & Flaspohler, 2019).
Acceptance focuses on helping normalize the traumatic responses and help make sense of
behaviors that may be associated with trauma and stress triggers. Layne et al., 2011 place
36

emphasis on directing providers into looking at not what is wrong with people—but what has
happened to them. Acceptance of traumatic responses include understanding the cyclical nature
of traumatic responses, such as anniversaries, holidays, or sensory reminders (Ahookhosh et al.,
2017; Layne et al., 2011; Pisani et al., 2013; Ports et al., 2017), and having awareness of the
possible adverse reactions, both physically and emotionally, that may derive from them.
The next dynamic of the UCARE framework establishes the importance of reducing risk.
Anyone that is involved with traumatized youth are encouraged to identify and remove barriers
to positive change and reduce the factors associated with risk. Developing the skills to reduce
risk extend beyond the walls of the classroom (Breux et al., 2017; Cooper et al., 2011; Franklin
et al., 2012; Hare-Duke et al., 2019; Holliday & Vandermause, 2015). Multiple systems that are
involved in the lives of suicidal youth, such as school staff/leaders, police, paramedics, and even
child welfare, each have the pristine opportunity to enhance protection and reduce risk during
potentially traumatizing and emotionally overwhelming experiences. They also hold the power to
make the experience more traumatizing with their own reactions and responses (Holliday &
Vandermause, 2015).
Lastly, providers and involved parties are supported to enhance both regulatory and
reparatory capacities. The UCARE framework emphasizes strengthening existing resources to
develop protective and promotive factors that can ultimately create new opportunities and
contexts for learning strategies to better regulate and cope with triggers (Layne et al., 2011).
Helping integrate new learning in the core sense of self is vital in helping struggling youth with
moving forward in their recovery from the factors that impact their mental health and suicidal
ideation (Breux et al., 2019; King & Vidourek, 2012; Layne et al., 2011; Payton et al., 2000;
Pisani et al., 2013; Williams et al., 2017).
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CIVIC Conceptual Framework
The final framework that is used in the study is the CIVIC conceptual framework of
social connectedness. The CIVIC framework (see Appendix A, Table A1) was developed by
Hare-Duke and colleagues (Hare-Duke et al., 2019) following a systematic review that set out to
identify the measures of social connectedness among individuals with mental health issues. The
framework identifies five dimensions that each describe various experiences of social
connectedness: Closeness, Identity and common bond, Valued relationships, Involvement, and
Cared for and accepted.
Closeness refers to the degree of mutual dependence between two people, allowing an
individual to feel that there are people in their life they feel close to. By definition, someone who
reports high levels of closeness indicates that they have identified people they feel close to
within their environment and social groups. In their longitudinal study of 460 children, Miller-
Lewis et al. (2014) discovered that having a stable and high-quality student-teacher relationship
trajectory was positively associated with fewer mental health problems, conduct, hyperactivity,
and peer problems, as well as greater prosocial behavior.
Identity and common bond address the need to believe that one shares important
characteristics with other people, and that they are not alone in their life journey. Individuals
with a strong foundation of identity and common bond can often be found finding universality in
their experience and know that they are a representative of select groups. Pepler and Bierman
(2020) report that peer relations, particularly during the teenage years, play a strong role in
determining an individual’s sense of social belonging and self-worth. The rapid changes in
emotional development and increases in autonomy, all provide adolescent youth with prime
opportunities to develop or hinder their social-emotional capacity and sense of identity.
38

Valued relationships indicate the importance of one person valuing and/or positively
viewing the relationships in their life, allowing them to feel appreciative and glad to be a
member of the group/community. Adolescent youth may report feeling glad to be a member of
their respective groups and place a positive outlook on the relationships that play significant
roles in their lives. Research provided by Aranmolate et al. (2017) emphasizes the importance of
these relationships, especially for LGBTQ youth, where community support programs, policies,
resources, and the fostering of high-quality relationships with peers and adults would be required
to help decrease the risk of suicidal ideation and attempts.
Involvement refers to the perceived level of involvement in social engagement with
others, including group/social network involvement, as well as companionship. Individuals who
do not report a sense of involvement may indicate that they often feel left out of activities that
their peers and trusted adults may engage in. Involvement in activities and peer engagement, as
reported by Williams et al. (2017), has been found to help students develop a sense of resiliency
and connectedness. Students who are involved are also found to be more persistent in their work,
seek out resources from their community, and utilize mentors and trusted adults to provide
advice, support, and guidance towards emotional and physical success (Bernstein‐Yamashiro, B.,
& Noam, 2013; Cavioni et al, 2020; Cooper et al., 2011; Layne et al., 2011; Williams et al.,
2017).
Lastly, cared for and accepted addresses the feeling that one is cared for through social
acceptance and social support. General feelings of acceptance and feeling worthy of one’s place
in the world are a few examples of someone who reports feeling cared for and accepted by their
social circle. Due to the strong links between social connectedness and loneliness, establishing a
sense of social connectedness within the school environment can be utilized as a potential
39

treatment to loneliness and a possible target for interventions aiming to reduce suicide (Breux et
al., 2017; Cavioni et al., 2020; Hare-Duke et al., 2019; Singer et al., 2019).
Connected Gatekeeper Framework
The use of the frameworks offers an ability to measure how confident school staff are in
their ability to recognize and respond the various mental health challenges related to youth
suicide, and how connected they feel to their students. The study merges the two frameworks to
develop the Connected Gatekeeper Framework (see Figure 6) and develops questions for the
various involved gatekeepers that can determine their confidence (represented as strength) to
meet the essential emotional needs of their students who return to in-person learning.
Representing one side of the weights, the study measures school staff in their ability to
understand, cope, and positively respond to students who are presenting with indicators of
suicidal ideation or intent. Represented on the other end of the barbell, gatekeepers are measured
by their level of connectedness between them and their students and assessing their ability to act
as relational protective factors. As established in the bar itself, it is the acceptance of their
students that allows gatekeepers to evenly balance both sides and increase their strength as a
protective factor.
The framework is established from a lens of mental health and trauma-informed care,
which may be needed more than ever as students return from what many consider to be a
traumatic experience.

40

Figure 6 Connected Gatekeeper Framework
Connected Gatekeeper Framework

41

Chapter Three: Methodology
This chapter describes the methodology used to conduct this study. The first section
outlines the quantitative approach and describe the characteristics of the sample population
chosen for this. A description of the instruments and procedures used for data collection will
follow, concluding with an explanation of the data analysis.
Teachers have a large impact on student emotional well-being and play an important role as
relational protective factors (Johnson & Parsons, 2012; Miller-Lewis et al; 2014). Evaluating
their perceptions of self-efficacy and confidence levels are important for districts and schools to
use to help improve and monitor trainings and support. Furthermore, reducing loneliness in
students on campus has also been identified as a key protective factor against teen suicide (Hare-
Duke et al., 2019). The purpose of this study is to examine the following questions:
1. How confident are staff in their roles as gatekeepers against suicide?
2. Does feeling more connected increase confidence?
3. Are there differences in confidence and connectedness levels based on gender, tenure,
and policy knowledge?
Research Methods
The study understands and appreciates the importance of key actors as levers in the
implementation of their school’s suicide prevention and intervention policy (Lochmiller &
Lester, 2017). Ensuring that their voices are heard can help establish an equitable study that
explores whether policy is meeting the standards it was set out to do (Atkins & Duckworth,
2019). This study uses quantitative methods in the form of surveys provided to investigate how
confident teachers feel in their ability to meet the requirements of California’s suicide prevention
policy. Quantitative methods are the most appropriate approach because they enable us to
42

determine and measure the opinions, attitudes, and practices of a large population (Merriam &
Tisdell, 2016). Responses of provided surveys will provide insight into the thoughts,
perspectives, and levels of self-efficacy of the participants.
Sample and Population
Following the passing of AB-2246 in California, the governing board or body of a local
educational agency that served students in Grades 7 to 12 were to adopt a policy on pupil suicide
prevention that specifically addressed the needs of high-risk groups. Per the policy, all staff, at a
minimum, are to participate in training on the core components of suicide prevention
(identification, prevention, intervention, referral, and postvention) at the beginning of their
employment, and on an annual basis. Components of training include the identification of risk
factors, warning signs, and protective factors, how to talk and respond to students about thoughts
of suicide, and how to take the required next steps for referral to assessment and/or treatment.
Although training is mandated for many California teachers, researchers admit programs have
not adequately addressed teachers’ perceptions and confidence in their role in school-based
suicide prevention (Hatton et al., 2017).
Sampling
The study seeks to understand of the perceptions held by high school teachers about their
ability to identify, prevent, intervene, and refer suicidal youth for further support. The most
appropriate sampling method that is used during the study is purposive/purposeful sampling. To
gather the sample that is needed, the characteristics of the population that is of interest is
specified, and then individuals who meet the criteria are located (Johnson & Christensen, 2017).
Given the study focuses on the addressing of teen suicide (ages 14–17), the type of school (high
school) is an important criterion to consider. The group that is of most interest are Grades 9–12
43

staff within a local school district that have adopted and/or implemented a suicide prevention and
intervention policy. The staff includes all personnel that are on campus, including leadership
staff.
Participants
The participants in this study are school staff members that work in the various high
schools ranging across the Bay Area. To be included in the study, teachers must work in a school
that has in place an established suicide prevention policy, which was confirmed via information
provided through the district’s websites. Demographics of the staff (gender, ethnicity,
orientation, etc.) are not criterion for participation; however, they are measured for comparative
analysis. As this study aims to discover and report any gap between levels of confidence and
connectedness, results may not be easily generalized as they reflect the views of only a select
number of Bay Area districts. However, this opens the door for future studies to evaluate the
efficacy of a school or district’s suicide prevention and intervention trainings and policy.
Instrumentation
Ordinal surveys are the primary data collection tool to address the research question. The
goal of the study is to examine the level of confidence high school staff in their ability to act as
relational protective factors. Therefore, high school staff are given surveys to discover their
perception about their capacity to meet the requirements provided by the state of California, level
of connectedness to their students, as well general demographic questions to determine gender,
district, years tenured, and awareness of their school’s suicide prevention policy. Using a six-
point Likert scale (1 = very unconfident/strongly disagree to 6 = very confident/strongly agree),
the survey measures the level of confidence key actors have towards their capacity and support
regarding suicide prevention and intervention and level of connectedness. The quantified data
44

provided by participants will help answer the research questions and provide insight into specific
avenues of readiness and capacity.
Suicide Prevention Gatekeeper Self-Efficacy Scale
First established by in 2020, the Gatekeeper Self-Efficacy Scale (GKSES; see Appendix
B, Figure B1) is an easy to implement, highly reliable and valid form that can be useful to
evaluate the level of self-confidence an identified individual has in their gatekeeping skills
(Takahashi et al., 2020). A review of previous studies by a team of researchers identified the
appropriate and inappropriate attitudes of people supporting those at risk of suicide. Appropriate
attitudes include:
• calm response
• acceptance
• empathy and listening closely
• consultation with an open mind regarding suicide ideation/attempt
• statement and promise of support
• clear explanation and suggestions
• coping with various types of co-occurring mental upset and conflict
Inappropriate attitudes include:
• criticism
• rebuke
• indoctrinating
• uncertainty
• making unreasonable promises
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As a response, Takahashi et al. (2020) developed a nine-item questionnaire that addresses
one’s confidence levels when making contact with a suicidal person based on four framed
abilities and skills:
• attain basic knowledge about suicide
• assess suicide risk
• listen closely and counsel a suicidal person
• connect a suicidal person with social support services
Each question from the designed survey is correlated to the one of the four frames
identified and adjusted for teen/student suicide:
• attain basic knowledge about teen suicide
o Q1. I can understand the mental states of students who intend to die by
suicide.
o Q2. I know the appropriate attitudes when in contact with a suicidal student.
o Q6. I have basic knowledge about teen depression.
• assess teen suicide risk
o Q9. I can recognize the signs of suicide in a student.
o Q10. I can recognize the signs of depression in a student.
• listen closely and counsel a suicidal student
o Q3. I can listen closely to a suicidal student.
o Q4. I can calmly ask a student about their suicidal ideation and plan(s).
o Q8. I can cope calmly when talking to a student with suicidal ideation.
• connect a suicidal student with social support services
o Q5. I am familiar with resources that suicidal students can utilize.
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o Q7. I can connect a suicidal student with necessary resources.
The four framed abilities each are their own reflection of the selected UCARE conceptual
framework that emphasizes understand, connect/communicate, accept, reduce risk, and enhance
coping. For the purpose of this study, generalized vocabulary (i.e., person, place) is changed to
language that reflects the relationships that exist within the school setting (i.e., student,
classroom/campus). The GKSES is identified to be highly reliable (α = .95, item-total correlation
r = .81–.88) and shows evidence of validity through demonstrating a confirmed factor structure,
with all items having sufficient factor loadings from 0.77–0.87 (Takahashi et al., 2020).
Social Connectedness Questionnaire
To measure levels of social connectedness, I developed a series of 10 questions (see
Appendix B, Figure B2) that is derived through the section of the framework focused on
closeness. Ten total questions are formulated to reflect each component of connectedness—
closeness, identity/common bond, valued relationships, involvement, and cared for/accepted. For
this study, additional vocabulary was utilized to reflect the student/teacher relationship.
Items from the Social Connectedness Questionnaire (SCQ) are developed directly from
the study that measured various levels of closeness. As presented in Table 1, the SCQ
demonstrates a high level of internal consistency (α = .84). Each question is correlated to one of
the five identified dimensions of this psychological bond that teachers can feel within their
relationship with their students:
47

• closeness
o Q11. I feel close to the students that I teach.
o Q20. My students know they can depend on me.
• identity and common bond
o Q12. I feel similar to the students that I teach.
o Q17. I share common interests with my students.
• valued relationships
o Q13. I am glad to have the students that I teach in my classroom.
o Q16. I look forward to engaging with my students in class.
• involvement
o Q14. I join my students in school activities outside of class.
o Q18. I involve myself in our classroom activities
• cared for and accepted
o Q15. It is easy for me to accept my students for who they are.
o Q19. My students are aware that I care for them.

Table 1 Cronbach’s Alpha Reliability Analysis of Social Connectedness Questionnaire
Cronbach’s Alpha Reliability Analysis of Social Connectedness Questionnaire

Cronbach's alpha
(α)
Cronbach's alpha based on standardized items Total items
.845 .865 10
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Data Collection
Participants are provided a link to the survey via email to complete within their own time
schedule. Participants are recruited through direct contact with district leaders and teachers,
promotions via social media, school bulletin boards. To protect confidentiality, participants were
advised to complete the survey though a secure or trusted network. Each survey was expected to
take between 2–5 minutes to complete in one setting. The survey was live for a total of three
months for participants to provide their responses.
Data Analysis
Data analysis begins after the closing of the window provided to participants to complete
the survey. Mean levels of each item scale are calculated to determine the levels of confidence of
teachers in each ability and skill. Items on the GKSES are discussed and selected by expert
mental health professionals ensuring content validity (Takahashi et al., 2020).
Upon the gathering of data, average confidence levels are compared to determine general
differences amongst various levels of the survey and answer “How confident staff are in their
roles as gatekeepers against suicide?” Covariance levels between measures are identified to
determine the existence of any correlation—and explore “Does feeling more connected increase
confidence” in their ability to identify and support suicidal students. Finally, a comparison of
average confidence levels and social connectedness are made to participant gender, number of
years teaching, and awareness of school’s suicide policy through multiple ANOVA analyses,
determining if any significant differences exist within each group, and answer the question “Are
there differences in confidence and connectedness levels based on gender, tenure, and policy
knowledge?” Takahashi et.al (2020) identified a significant difference in confidence levels for
49

women who had experience working with suicidal individuals, offering a unique look into
possible gaps or similarities between teachers in California.

50

Chapter Four: Results
The purpose of this study was to examine California’s high school teachers’ levels of
connectedness to their students and confidence levels in addressing the relational component of
teen suicide prevention both within and outside their classrooms. The study not only explored
levels of confidence, but also compared the difference in confidence and connectedness levels
between teacher gender, years teaching, and policy awareness, and explored the impact of
student-teacher connectedness on teachers’ confidence level to address issues related to teen
suicide. As mentioned in Chapter Two, gatekeeper training and programs that enhance protective
factors are some of the best tools to reduce the overall prevalence of suicidal ideation, attempts,
and completions (Breux et al., 2017; Cooper et al., 2011; Katz et al, 2011; Yonemoto et al.,
2019).
This chapter is dedicated to presenting the findings from the study on the levels of
confidence and connectedness of high school staff members from various districts across the
southern Bay Area of Northern California. Participants were provided a survey that asked them
to reflect and rank their levels of connectedness to their students, as well as their confidence
levels with their ability to attain basic knowledge about teen suicide, assess teen suicide risk,
listen closely and counsel a suicidal student, and connect a suicidal student with social support
services. The findings were developed from an analysis of the reported scores and provided a
richer picture to explore the relationship between confidence levels and connectedness.
The first part of the chapter introduces the background of the districts in which
participants came from. It is important to understand their socioeconomic, academic, and
demographic backgrounds as it may have a significant impact on their staff’s ability to have
access to quality to suicide prevention/intervention trainings and services, as well as their ability
51

to find common bonds and values amongst their identity with their students. In the following
sections of this chapter, findings from each research questions are presented by reflecting on the
analysis of the participants’ responses and exploring the various themes identified by those
scores. The findings show that teachers who report feeling more connected to their students also
present with more confidence in their ability to act as a gatekeeper against suicide. However, the
scores also address how there continues to be a need for training and support for high school
staff to increase their knowledge and understanding of teen mental health and suicide awareness.
The following themes emerged from the data: Gatekeepers (1) report more strengths in their
ability to accept, listen, and cope when a student needs support, (2) experience more challenges
with assessing for suicide risk and sharing common bonds with students, and (3) see a decrease
in their levels of confidence and connectedness the longer they are tenured.
Participants
The participants in this study included 140 high school teachers and administrators from
four Santa Clara County school districts serving communities across Campbell, Cupertino,
Mountain View, Los Altos, Los Gatos, San Jose, Santa Clara, Saratoga, and Sunnyvale (see
Table 2). Between the years of 2017–2019, Santa Clara Country reported a suicide completion
rate of 8.0 per 100,000 amongst its teenage youth (Centers for Disease Control and Prevention,
2020).
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Table 2 District Respondent Frequency
District Respondent Frequency
District
(N = 140)
n %
FUHSD 97 69.3
MVLA 15 10.7
CUHSD 16 11.4
SJU 12 8.6

Fremont Union High School District (FUHSD)
FUHSD is a public high school district with five schools serving 10,794 students
(EdData, 2021). Schools within the district include Cupertino High School, Fremont High
School, Homestead High School, Lynbrook High School, and Monta Vista High School. The
district is consistently recognized as one of the highest performing districts in the state—ranking
in the top 5% graduation rates, math proficiency, and reading proficiency (EdData, 2021), and
maintains a 24:1 student/teacher ratio. FUHSD records spending an average of roughly $24,000
per student and is also known to educate some of the most diverse group of students, with more
than 60 various languages being represented across its population (EdData, 2021).
The top three ethnicities represented within the district amongst both students and staff
include Asian (58% students/17% teachers), White (15% students/68% teachers), and
Hispanic/Latino (15% students/8% teachers; EdData, 2021). Over the last 5 years, FUHSD has
reported a staff consisting of roughly 60% women yet has consistently demonstrated a slightly
larger male presence amongst their students—with 52% of the population being male in the
2020–2021 school year (EdData, 2021). Per the district’s, website, FUHSD utilizes this diversity
53

to offer “many opportunities to emphasize the critical importance of inclusion and for our staff
and students to learn from the unique experiences of others”.
Mountain View-Los Altos Union High School District (MVLA)
MVLA is a public high school district comprised of two comprehensive high schools
(Mountain View High School, Los Altos High School), an alternative high school (Alta Vista
High School), an adult education center (MVLA Adults School), the Freestyle Academy for Arts
& Technology, and Middle College serving 4,394 students (EdData, 2021). MVLA is also
ranked as one of the top 5% of districts in California, with graduation rates and math proficiency
placing ranking in the top 30% across the state (EdData, 2021), and classrooms maintaining a
20:1 student/teacher ratio. MVLA records spending an average of roughly $22,000 per pupil
(EdData, 2021).
The top three ethnicities represented within the district amongst both students and staff
include White (38% students/65% teachers), Hispanic/Latino (26% students/11% teachers) and
Asian (15% students/17% teachers; (EdData, 2021). Over the last 5 years, MVLA has reported a
staff consisting of just over an average of 60% women but has reported a larger male presence
amongst their students, with 51% of the population identifying as male in the 2020–2021 school
year (EdData, 2021). Per the district’s website, MVLA, aims to recruit and retains excellent
teachers while fostering collegiality, respect, and cooperation among all students and staff.
Campbell Union High School District (CUHSD)
CUHSD is a public high school district operating through five main campuses serving
just over 8,000 students. Schools across the district include Branham High School, Del Mar High
School, Leigh High School, Prospect High School, and Westmont High School. With a
graduation rate of 91%, math and reading proficiency rates tanking in the top 50%, and a
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student/teacher ratio of 23:1 CUHSD is one of the top 20% of the schools in the state (EdData,
2021). CUHSD records spending an average of just over $18,000 per pupil (EdData, 2021).
The top three ethnicities represented within the district amongst both students and staff
include White (36% students/65% teachers), Hispanic/Latino (34% students/16% teachers), and
Asian (19% students/10% teachers; EdData, 2021). Over the last 5 years, CUHSD has reported a
staff consisting of an average of 60% women but has reported a larger male presence amongst
their students, with 51% of the population identifying as male in the 2020–2021 school year
(EdData, 2021). Per the district’s website, CUHSD’s mission is to make sure their schools are
places where their students “are safe, supported, and valued; develop knowledge, skills, and
confidence; and are engaged, challenged, and prepared”.
San Jose Unified School District (SJU)
SJU is a public K–12 urban school district serving over 30,000 students across 42
schools. The district is home to six high schools (Abraham Lincoln High, Gunderson High,
Leland High, Pioneer High, San Jose High, and Willow Glen High) serving roughly 9,000
students. High schools across the district record spending an average of roughly $16,000 per
pupil and have an average math proficiency of 38% and reading proficiency of 53%—just below
the statewide average (EdData, 2021). Nevertheless, the high schools maintain a high graduation
rate of 91% and a student/teacher ratio of 23:1 (EdData, 2021).
The top three ethnicities represented within the entirety of the district also comprises of
Hispanic/Latino (53% students/23% teachers), White (22% students/54% teachers), and Asian
(14% students/9% teachers; EdData, 2021). Over the last 5 years, SJU as has reported a staff
consisting of an average of 60% women but has reported a larger male presence amongst their
students, with 52% of the population identifying as male in the 2020–2021 school year (EdData,
55

2021). Per the district’s website, SJU’s mission is to prepare students to be “thinkers, leaders,
and creators of tomorrow with a unified community that elevates opportunities for all”.
How Confident Are School Staff in Their Role as Gatekeepers Against Suicide?
As shared in Chapter Two, AB-2246 establishes a requirement for California schools to
provide staff trainings, assessment and safety planning tools, data, and other resources that
include how to identify appropriate mental health services. Gatekeeper trainings are well
established within school districts and are known to enhance suicide awareness and enhance the
abilities of school personnel to recognize the warning signs, learn to assess, and organize access
to professional services for intervention and treatment (Cooper et al., 2011; Katz et al., 2013;
Yonemoto et al., 2019). However, as the gatekeepers become tasked with this new duty, there is
little to no follow-up exploring their confidence in their ability to carry out the task necessary to
prevent and/or intervene in the light of teen suicidal intention.
In the first half of the survey, participants of the study were asked to reflect on their skills
regarding their role as a gatekeeper against teen suicide and rate their confidence levels on a
scale of 0–6. Following a mean analysis of each individual survey response, participants reported
an average of confidence rating of 4.24 (see Table 3). Results demonstrated a clear variation of
strengths and weaknesses within the multiple confidence categories, where gatekeepers reported
feeling more confident in their knowledge of depression and listening skills, and less so with
their ability to truly understand how students are feeling/thinking when experiencing mental
states that could ultimately result in suicidal ideation.

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Table 3 Average Confidence and Connectedness Levels of Gatekeepers
Average Confidence and Connectedness Levels of Gatekeepers
Measure Total confidence score
(N = 140)
Total connectedness score
(N = 140)
m 4.24 4.79
SD 1.57 1.05
Range 6 6
# of items 10 10

Strengths and Weaknesses in Teacher Reports of Confidence
A deeper look into the results indicate a various range of scores within the multiple
components of gatekeeper confidence. A mean analysis of the reported scores reflects that the
participants felt most confident (4.54) in their ability to listen closely to and counsel a suicidal
student (see Appendix C, Table C1). This level of confidence was found to be true amongst each
measured variable (gender, tenure, and policy awareness). Of the 10 questions aimed at
measuring confidence levels, gatekeepers identified feeling most confident in their ability to
cope calmly (4.70) and listen closely (4.61) when engaging with a suicidal teen, and in their
basic knowledge about teen suicide (4.66; see Appendix C, Table C1).
The greatest struggle that was reported on average, teachers and staff felt the least
confident (3.99) in their ability to assess teen suicide risk (see Table 4). This low rating of
confidence with assessment for risk was found to be true amongst staff gender and awareness of
policy. Of the 10 questions aimed at measuring confidence levels, gatekeepers identified feeling
the least confident in their ability to engage in appropriate attitudes when in contact with a
suicidal student (3.76), understand the mental states of students who intend to die by suicide
(3.62), and recognize the signs of suicide in a student (3.65; see Appendix C, Table C1).
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Table 4 Mean Levels of Confidence and Connectedness by Category
Mean Levels of Confidence and Connectedness by Category
Categories m
Confidence

Attain basic knowledge about teen suicide 4.01
Assess teen suicide risk 3.99
Listen closely and counsel a suicidal student 4.54
Connect a suicidal student with social support services 4.37
Connectedness
Closeness 4.89
Identity/common bond 3.54
Valued relationships 5.36
Involvement 4.65
Cared for and accepted 5.37

Does Feeling Connected to Students Increase Gatekeeper Confidence Against Suicide?
Teens with mental health may be more at risk of suicide than ever before, however,
positive relationships with a teacher and a positive perception of belonging have been associated
with positive mental wellbeing—and can play a significant role in reducing the risk of suicidal
ideation and attempts (Aldridge & McChesney, 2018). For teens struggling with mental health
related challenges, having some form of social connectedness has been linked to a reduction in
suicide risk, and by increases psychological wellbeing by exposing them to more adaptive
behaviors that ultimately allow them to obtain the help that they need (Breux et al., 2017;
Cavioni et al., 2020; Singer et al., 2019). Through their attitudes and behaviors towards students
on campus, teachers and staff have already demonstrated the capacity to significantly impact the
school environment’s social norms and general attitudes towards seeking help for suicidal
ideation and other mental health challenges (Singer et al., 2019).
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Total scores of the 10 questions from both confidence and connectedness groups were
added and analyzed through a bivariate analysis to determine the level of correlation between
each of the groupings. Results found a significant correlation (r = .477, ρ = <.001) between total
connectedness and total confidence scores amongst teachers and staff (See Table 5).

Table 5 Pearson Correlation Analysis of Total Connectedness and Total Confidence
Pearson Correlation Analysis of Total Connectedness and Total Confidence
Combination r ρ
Total connection x total connectedness .477 <.001

Note. Correlation is significant at the 0.01 level (2-tailed), N = 140

59

Strengths and Weaknesses in Teacher Reports of Connectedness
Results of the surveys indicate a less varied range (SD = 1.05) of scores within the
multiple components of gatekeeper connectedness, with a total average score of 4.79 (see Table
4). A mean analysis of the reported scores reflects that the participants rated themselves highest
(5.37) in their ability to care for and accept their students (see Table 4). Of the 10 questions
aimed at measuring connectedness, gatekeepers identified feeling most in agreement with the
statements, “I look forward to engaging with my students in class” (5.49), “I am glad to have the
students I teach in my classroom” (5.48), and “It is easy for me to accept my students for who
they are” (5.44; see Appendix C, Table C2).
The greatest struggle that was reported on average, teachers and staff reported the most
disconnect (3.54) in their shared identity and common bond with their students (see Table 4). Of
the 10 questions aimed at measuring connectedness, gatekeepers identified feeling least in
agreement with the statements of “I feel similar to the students that I interact with on campus”
(3.01), and “I share common interests with my students” (4.07; see Appendix C, Table C2).
Differences Between Gender, Staff Tenure, and Awareness of Policy
As students begin their journey back to normal, it becomes essential for staff to develop a
more welcoming and warmer environment where teenage youth who are most at-risk can feel
connected, supported, and safe—however there are multiple factors that can impact the
preparedness and confidence of teachers and staff in their role (Breux et al., 2017; Cavioni et al.,
2020; Lindsey et al., 2019; Singer et al., 2019; Takahashi et al., 2020).
Three separate analyses of variance (ANOVA) were completed to examine the impact of
gender, number of years teaching, and awareness of suicide prevention policy on levels of
confidence and connectedness. Each ANOVA was conducted to determine not only if a
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significant difference existed between either the participant’s gender/tender/awareness and total
confidence and connectedness score, but also between each skill measured within the
questionnaire. Given Takahashi et.al (2020) finding a significant difference in confidence levels
for women, it was believed that staff who identify as female would have an overall higher score
in both confidence and connectedness. It was also assumed that staff who were tenured longer
would rank themselves more confident, yet less connected. Lastly, staff who were not aware of
their school’s policy intervention were also believed to report lower scores in their confidence
levels.
Gender
Findings indicate that total confidence and connectedness scores of female staff did not
significantly differ from their male counterparts. However, results of the scores shown in Table 6
reflected a higher average score for females in both total confidence (4.33) and connectedness
(4.86), while also scoring the highest average amongst each individual statement (see Appendix
D). As seen in Table 8, male teachers rated themselves highest (4.30) in their ability to listen
closely and counsel a suicidal student, and lowest (3.77) with their ability to assess for risk.
Female teachers also rated themselves as most confident (4.68) with their ability to listen closely
and counsel a suicidal student, and least confident (4.04) in their ability to attain basic
knowledge about teen suicide. Though total confidence scores saw no significant differences
across gender, a chi-square analysis found a significant difference between the variables of “I can
listen closely to a suicidal student” (ρ = .041), and “I can calmly ask a student about their
suicidal ideation” (ρ = .048; see Appendix G, Table G1).
In the category of connectedness, male teachers rated themselves highest (5.37) in their
valued relationships, and lowest (3.53) with their shared identity/common bonds with students
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(see Table 9). Female teachers also identically rated themselves as most confident (5.55) with
their valued relationships and least confident (4.04) in their shared identity/common bonds with
their students. Though total connectedness scores saw no significant differences across gender, a
chi-square analysis found a significant difference between the variables of “It is easy for me to
accept my students for who they are” (ρ = .015), “I involve myself in classroom activities (ρ
=.026), My students are aware that I care for them” (ρ = .011), and “My students know that they
can depend on me” (ρ =.004), with female staff scoring higher in each category (see Appendix G,
Table G2).
Tenure
Results of the surveys presented in indicate that total confidence and connectedness
scores did not significantly differ depending on the length of time they have been working as a
teacher, administrator, or staff member (see Appendix E). Interestingly, teachers who were
tenured between 6–10 years rated themselves highest in both categories of total confidence (4.4)
and connectedness (4.91; see Table 6). However, staff who have been tenured longer than 16
years ranked lowest in both average confidence (4.07) and connectedness (4.63). As seen in
Table 9, staff who have been working for longer than 16 years scored lowest in all connectedness
categories except “Valued Relationships”. Though total connectedness scores saw no significant
differences across tenure, a chi-square analysis found a significant difference between the
variables of “I feel similar to the students I interact with on campus” (ρ = 0.016), and “My
students know they can depend on me” (ρ = 0.027; see Appendix H, Table H2). No significant
difference was found amongst individual statements measuring confidence skills (see Appendix
H, Table H1).

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Policy Awareness
Awareness of one’s school/district policy on suicide prevention and intervention resulted
in having one of the most significant impacts on total confidence. With over 87% of respondents
reporting having knowledge of their school’s policy, average scores for those without awareness
was significantly different (ρ = 0.006; see Table 7). In the category of confidence, staff who were
aware of their policy rated themselves highest (4.57) in their ability to listen closely and counsel
a suicidal student, and lowest (4.13) with their ability to attain basic knowledge about suicide
(see Table 8). Table 8 also demonstrates that staff who reported not being aware of their
prevention policy also ranked themselves highest (4.37) in their ability to listen closely and
counsel a suicidal student, and lowest (2.92) with their ability to assess for suicide risk. A chi-
square analysis found a significant difference between the variables of “I know the appropriate
attitudes when in contact with a suicidal student” (ρ = .012), “I am familiar with resources that
suicidal students can utilize” (ρ = .012), “I have basic knowledge about teen depression” (ρ
= .002), “I can connect a suicidal student with necessary resources” (ρ = .004), “I can recognize
the signs of suicide in a student” (ρ = .001), and “I can recognize the signs of depression in a
student” (ρ = <0.001; see Appendix I, Table I1). Staff who held knowledge of their policy scored,
on average, higher in each individual statement (see Appendix F, Table F1).
In the category of connectedness, policy awareness, however, played no role in a
gatekeeper’s level of connectedness with their student. As presented in Table 9, “Valued
relationships” was rated highest for both teachers and staff with (5.49) and without (5.42)
knowledge of their suicide prevention plan/policy. Similarly, “Identity/common bond” with
students was also rated as the lowest for both staff with awareness (3.54) and without (3.59). No
63

significant difference was found amongst individual variables measuring connectedness (see
Appendix I, Table I2).

Table 6 Mean and Standard Deviation of Confidence and Connectedness by Group
Mean and Standard Deviation of Confidence and Connectedness by Group
Variables Confidence Connectedness
n % m SD m SD
Gender

Female 89 63.6 4.33 1.44 4.86 1.02
Male 51 36.4 4.08 1.39 4.65 1.07
Tenure

<1 year 2 1.4 4.1 0.28 4.85 1.06
1 to 5 years 34 24.3 4.35 1.4 4.83 1.01
6 to 10 years 29 20.7 4.4 1.4 4.91 0.99
11 to 15 years 30 21.4 4.22 1.37 4.85 0.98
16+ years 45 32.1 4.07 1.5 4.63 1.12
Policy awareness

Yes 122 87.1 4.34 1.39 4.78 1.04
No 18 12.9 3.57 1.49 4.79 1.09

Table 7 Results of Total Confidence x Policy Awareness ANOVA
Results of Total Confidence x Policy Awareness ANOVA
Total confidence score t df α (two-sided p)
Equal variances assumed 2.802 138 .006

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Table 8 Confidence Means of Measured Variables by Category
Confidence Means of Measured Variables by Category
Confidence
Category
Attain basic
knowledge
about teen
suicide
Assess
teen
suicide
risk
Listen
closely and
counsel a
suicidal
student
Connect a
suicidal
student with
social
support
services
n % m m m m
Gender

Female 89 63.6 4.04 4.12 4.68 4.43
Male 51 36.4 3.95 3.77 4.3 4..27
Tenure

<1 year 2 1.4 4.0 3.5 5.0 3.5
1 to 5 years 34 24.3 4.22 3.98 4.78 4.28
6 to 10 years 29 20.7 4.03 4.23 4.71 4.64

11 to 15 years 30 21.4 4.06 3.97 4.53 4.27
16+ years 45 32.1 3.81 3.88 4.24 4.38
Policy awareness
Yes 122 87.1 4.13 4.14 4.57 4.5
No 18 12.9 3.24 2.92 4.37 3.5

65

Table 9 Connectedness Means of Measured Variables by Category
Connectedness Means of Measured Variables by Category
Connectedness
category
Closeness Identity/common
bond
Valued
relationships
Involvement Cared
for and
accepted
n % m m m m m
Gender
Female 89 63.6 4.99 3.55 5.55 4.73 5.5
Male 51 36.4 4.71 3.53 5.37 4.5 5.14
Tenure
<1 year 2 1.4 5 4 5.5 4.25 5.5
1 to 5 years 34 24.3 4.86 3.86 5.37 4.62 5.47
6 to 10 years 29 20.7 5.18 3.52 5.45 4.81 5.59

11 to 15
years
30 21.4 4.9 3.55 5.55 4.92 5.32
16+ years 45 32.1 4.73 3.29 5.55 4.4 5.18
Policy
awareness

Yes 122 87.1 4.9 3.54 5.49 4.63 5.37
No 18 12.9 4.86 3.59 5.42 4.75 5.36

66

Summary of Results
At the center of most classroom suicide prevention models often lies the promotion and
the enhancement of emotional regulation and communication skills (Pisani et al., 2013) and
students who feel connected and safe within their school corridors are more likely to succeed
with the development of those skills (Franklin et al., 2012; King & Vidourek, 2012), and are
more likely to utilize its resources for support when in need (Breux et al., 2017; Johnson &
Parsons, 2012; Pisani et al., 2013). To act as a safeguard when those protective factors are not
enough, gatekeeper trainings were developed to heighten the capacity of school personnel to
recognize the signs of suicide, assess students for ideation, and refer correctly for intervention.
Nevertheless, results indicate that teachers and staff lack confidence with their knowledge
in assessment for depression and suicidal ideation and continue to struggle to understand the
various factors that influence the mental states of their students. While staff generally feel
confident in their ability to act as gatekeepers against suicide, confidence seems to decline
following 10 years of employment—which may be attributed to generational and culture gaps, as
well as constant changes to the understanding of teen mental health. Staff who were informed
and aware of the procedures and policies of their district regarding teen suicide prevention and
intervention were also found to be significantly more confident in the role, as well.
To heighten their impact on teen metal health and wellbeing, teachers and staff can create
and develop a higher level of connectedness through positive and meaningful interactions with
students on campus (Aldridge & McChesney, 2018; Breux et al., 2017; Pisani et al., 2013).
Despite challenges with finding shared identities and common bonds with their students, it was
found that teachers generally feel connected with their students regardless of their gender, tenure,
or awareness of their district or school’s suicide prevention policy. Moreover, it was
67

demonstrated that teachers who feel more connected to their students reported feeling more
confident in their overall role as a gatekeeper against suicide. Like confidence levels, it became
evident that staff who were tenured longer than 10 years also scored lower in total
connectedness—and most significantly, with their shared identity and common bond. This too,
may be attributed to cultural and generational gaps that continues to grow with each wave of new
students.

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Chapter Five: Discussion
California’s teachers and staff have already begun preparing themselves for the
significant number of mental health challenges that will potentially be brought forth because of
the impacts of the COVID-19 pandemic. Already, California has placed a high importance on
teen mental health and the prevention of suicide—and these added stressors placed on
gatekeepers could be an overwhelming experience. The purpose of this study was to examine the
level of connectedness staff demonstrated with the students on their campus, while exploring
their confidence levels in their role as gatekeepers against suicide. Given that suicide rates for
teens are reported to be highest during the school year (Lindsey et al., 2019), the objective was to
explore the relationship between how connected staff feel to their students, and how confident
they are in their ability to assess, intervene with, and refer students who are at-risk of suicide.
The study intended to address three research questions:
1. How confident are school staff in their role as gatekeepers against youth suicide?
2. Does feeling closer to students increase gatekeeper confidence to recognize and
address factors linked to youth suicide?
3. Is there a difference in confidence and connectedness levels amongst gender, staff
tenure, and awareness of suicide prevention policy?
To explore these questions, 140 teachers and staff from four high school districts across
the cities of Campbell, Cupertino, Mountain View, Los Altos, Los Gatos, San Jose, Santa Clara,
Saratoga, and Sunnyvale answered a twenty-question digital survey measuring their self-efficacy
in their role as gatekeepers as well as their levels of social connectedness between their students.
Additionally, respondents answered questions about their current school district, years
tenured, gender, and awareness of their school or district’s suicide prevention/intervention
69

policy. The average means were calculated and compared for significance and general themes
across responses were identified.
Findings
The response to the question “How confident are teachers and staff in their role as
gatekeepers against youth suicide?” participants reported an average of confidence rating of 4.24
and demonstrated the greatest strengths in their accepting, listening, and coping skills put into
use when a student needs emotional support. To combat youth suicide, schools across the nation
have developed comprehensive plans that includes health promotion, prevention intervention,
and postvention (Cooper et al., 2011; Katz et al, 2011; Yonemoto et al., 2019).
Gatekeeper trainings are designed ultimately to enhance the abilities of school personnel
to recognize the signs of suicide, assess students for ideation, and refer correctly for intervention.
While it is a task that is heavily emphasized in trainings, there is seldom a focus on the mental
state of the gatekeepers themselves during the process. However, results of reported confidence
levels demonstrate participants identified more strengths in their own ability to accept, listen, and
cope when a student needs support. High school staff demonstrated a higher capacity with their
executive functioning skills—allowing them to be present, actively listen, and follow the
necessary tasks required to keep their students safe and protected. Surprisingly, though
participants reported confidence in these skills, they presented with more doubts in their ability
to have the right attitudes when interacting during these situations.
The disconnect that was also presented within the confidence results seemed to
demonstrate that despite the high ability for teachers and staff to actively support suicidal
students who are coming to them for support, they continue to face challenges with their
knowledge of assessment skills and teen mental health. Respondents found themselves feeling
70

less confident in their ability to truly understand the mental states of the students and recognize
the signs of a teen who is possibly depressed, traumatized, or anxious. Evidently, it creates a
contrast with the presented claims that that gatekeeper trainings enhance skills to identify the
signs of teen mental health challenges and assess for suicidal ideation.
In search for the answer to “Does feeling closer to students increase gatekeeper
confidence to recognize and address factors linked to youth suicide?” results from the surveys
indicated a significant correlation between their total confidence and total connectedness scores.
Teachers have a large impact on student emotional well-being and can play a significant role in
reducing the risk of suicidal ideation and attempts, as positive relationships with and acceptance
of their students were associated with positive mental health and wellbeing. (Aldridge &
McChesney, 2018; Johnson & Parsons, 2012; Miller-Lewis et al; 2014). General feelings of
acceptance within the school environment can be applied as a potential treatment to loneliness
and a possible target for interventions aiming to reduce suicide (Breux et al., 2017; Cavioni et al.,
2020; Hare-Duke et al., 2019; Singer et al., 2019).
The impact of the student-teacher relationship can be so large, that poor student-teacher
relationships, at any age, have often correlated with externalizing and internalizing behaviors,
and less than optimal prosocial skills (Franklin et al., 2012). Strong levels of positive and quality
interactions with students have demonstrated their ability to act as a protective factor against the
initiation of new suicidal thoughts and behaviors (Franklin et al., 2012; Johnson & Parsons,
2012; Pisani et al., 2013). Given this, teachers and staff hold the unique responsibility to promote
and create a protective and warm relationship with their students, leading to the increase of
heathy behaviors and a possible reduction in suicidal thoughts and attempts. Still, the shared
interaction that exists between students and staff can at times continue to create challenges, as
71

both the behaviors of the student or the staff member may lead to relational conflict and/or
prevent the student or staff from engaging and connecting with one another (Johnson & Parsons,
2012; Miller-Lewis et al; 2014).
Per the results, teacher and staff presented with high ratings of connectedness amongst
their students. Staff reported feeling close to their students, involving themselves in their
activities both inside and outside of the classroom, being able to accept their students for who
they are, and value the relationships that they hold with them. There seemed to be a consensus
amongst the participants that the relationship they held with their students was important in
value, and their acceptance of them was just as much a priority. Nevertheless, the greatest
discrepancy found in the level of connectedness between teachers and students was their shared
identity and common bond. However, given that 32% of the participants reported being tenured
for more than 16 years, it almost comes as no surprise given the existence of multiple generation
gaps that possibly exist between most of the respondents and their students. With the rapid
changes in teens’ emotional development, increases in their autonomy, and often, the cultural
shifts that come with each generation, the challenges that teachers and staff hold with identifying
shared experiences and characteristics may be understood.
Quality peer relationships during adolescence can often have direct influence on a teen’s
sense of self-worth, and as a result can decrease the risk of suicide (Allen et al., 2014; Bernstein‐
Yamashiro & Noam, 2013; King & Vidourek, 2012; Pepler & Bierman, 2020). Identity and
common bond address the need to believe that one shares important characteristics with others,
and that they are not alone (Hare-Duke et al., 2019), and for many young teens, having some
form of universality in their life experience has been known to reduce their risk of suicide (Breux
et al., 2017; Cavioni et al., 2020; Singer et al., 2019). Though teachers present with limitations in
72

their own ability to find these shared identities with their students, it is possible that students
within the four districts surveyed can find these common bonds and experiences via multiple
groups and organizations on campus that are targeted towards their culture, gender/sexuality, and
general interests.
While exploring the question “Is there a difference in confidence and connectedness
levels amongst gender, staff tenure, and awareness of suicide prevention policy?” Results
provided by participants reflected those of Takahashi et.al (2020), finding on average, female
teachers generally felt more confident in their role as gatekeeper against suicide and presented
with stronger ratings in their ability to listen and ask questions to counsel a suicidal student.
However, despite the higher scores in these executive skills, male staff found themselves feeling
more confident in holding the space and presenting with the right attitude when interacting with
a student in need. Additionally, despite female staff on average scoring higher with their shared
identity and common bond, male staff reported feeling more like their students.
Staff who have been tenured longer presented on average a decrease in both confidence
in their skills and connectedness to their students. Results indicate that staff tenured longer than
10 years start to face the heaviest impact on both their gatekeeper skills and connectedness.
However, a strength that longer tenured staff held over their newer counterparts included holding
more knowledge and awareness of the resources that were readily available for students in need
of mental health support services. Staff tenured between 6 and 10 years found themselves feeling
most confident and most connected to their students, however presented with less confidence in
their ability to attain knowledge and assess for suicide and scored second lowest in shared
identities and common bonds. Results demonstrated it was the newer teachers, those who have
73

been teacher for 5 years or less, that shared the most common bonds with their students, and felt
the most confident in their ability to assess for risk and listen closely to a suicidal student.
Awareness of policy, which resulted in having the most significant impact on gatekeeper
confidence, demonstrated the importance of ensuring teacher and staff stay aware and up to date
regarding the steps and actions required to keep students at risk of suicide safe and protected.
Lack of policy awareness directly impacted both staff’s confidence in their ability to not only
understand and gain knowledge about mental health and their ability to assess for risk of suicide
with students they interact with. Knowing this information can play a significant role in teacher
education and trainings for upcoming years, allowing staff to always stay informed.
What was established through mean analysis was that the levels of confidence and
connectedness of gatekeepers ultimately decreased the longer they were tenured, though not
significantly. Again, one must take into consideration the ever-changing world of mental health,
as well as the culture that teachers and staff find themselves immersed in, and how that impacts
their ability to assess for suicide risk and find common identities with their students.
Furthermore, staff that were not aware of their prevention policy found themselves significantly
at a disadvantage with their confidence and ability to identify and intervene when faced with a
teen struggling with mental health challenges.
Limitations
They study has certain limitations. Foremost among these limitations, is the small
geographically limited sample that was represented. All respondents were from cities in Santa
Clara County and that is not equally representative of the socioeconomic diversity that exists
within the state of California and across the nation. The county is recognized for its high
economic and academic achievement with an emphasis on social justice and wellbeing. Most
74

participants came from FUHSD, heavily impacting the generalizability of the results across the
districts.
Additionally, participants were derived from schools where the top three ethnicities of the
students were identical to the top three ethnicities of its teachers, thus impacting the total
connectedness score. Another limitation includes the content of the questionnaire, which may
also have increased the chances of participants presenting with a desirability bias, ranking
themselves higher to avoid a lower score.
Implications for Practice
The purpose of this study was ultimately to assist California school districts in improving
and/or adjusting policy, staff training, and school/classroom activities to promote quality
student/teacher interactions and help mitigate the effects of depression, anxiety, and suicidal
ideation during the school year. The findings of this study have provided valuable information in
how to support the development of these elements and increase both the level of connectedness
between students and staff, as well as the confidence teachers and staff have in their role as
gatekeepers against suicide.
To increase confidence, results indicate that teachers and staff continue to need support in
the areas of assessment and their general understanding and knowledge of teenage mental health.
While staff feel confident in being actively playing the role of a gatekeeper when in time of
crisis, they face doubts about how to recognize the signs prior to the crisis occurring. Schools
and districts can utilize this information to develop or provide trainings that emphasize skills
related to identifying and assessing for signs and symptoms of depression, anxiety, trauma, and
suicidal ideation, as well as current trends about teen mental health. These trainings can be
75

provided on a more frequent and on-going basis that can help mitigate the decrease in confidence
that is seen take place over time.
Lastly, teachers and staff share feeling connected to their students, but face the most
challenges with their shared identify and common bonds. While it may not be necessary for
students to find their sense of universality through their teachers, staff, and leaders, it invites the
possibility of welcoming this group of adults to find creative and safe ways to share their
interests, talents, and experiences with their students, while continuing to embrace, accept, and
delight in their unique and changing identities.
Future Research
Continued research around teen mental health and suicide prevention within the
classroom is essential to remain ahead of the curve that represents the yearly increase in teen
suicide rates. The present study found that teachers and staff continue to lack the confidence in
their ability to develop the skills necessary to assess for suicidal ideation and struggle in their
capacity to understand the factors related to mental states of teens who intent to die by suicide.
With gatekeeper trainings designed to reinforce the capability of school personnel to identify the
signs of suicide, assess students for ideation, and refer correctly for intervention, future research
can better explore the relationship between confidence levels of type of training received.
Additionally, using a larger sample with districts from varying socioeconomic settings
and a different majority representation of ethnic backgrounds may also provide a richer
understanding in the levels of confidence and connectedness California teachers and staff hold.
The gender sample in this study also found its own limitations in that the participants reported
identifying as male and female, with teachers identifying with the LGBTQ+ community not
76

being represented. Future studies can explore levels of confidence and connectedness with
teachers of varying gender identity and sexuality.
To further explore the teacher-student relationship’s impact on teen mental health, a
follow up study exploring the level of connectedness between students and teachers from the
perspective of the student may also provide insight into the effectiveness of the school and
teacher’s attempts to enhance the relationship.
Conclusions
Over the last 10 years, the United States has continued to see a startling increase in the
number of adolescent youths attempting suicide. To tackle this national crisis, the state of
California signed into law AB-2246, the first bill of its kind that required the adoption of suicide
prevention, intervention, and postvention plans by districts serving middle school and high
school students. The bill further established a requirement for California schools to provide their
teachers and staff with gatekeeper trainings and continuing education focused on assessment,
safety planning, and referral to resources both on campus and within the community.
The purpose of this study was to examine not only the confidence levels of California’s
high school teachers and staff in their role as gatekeepers against suicide, but also how connected
they feel to the students on their campus. Suicide rates for teens are reported to be highest during
the school year, and many school staff and teachers can create and develop a higher level of
connectedness through positive and meaningful interactions with their students. The objective
was to explore the relationship between how connected staff feel to their students, and how
confident they are in their ability to assess, intervene with, and refer students who are at-risk of
suicide. The correlational quantitative study utilized a twenty-question survey sent to high school
teachers across four school districts across Santa Clara County. Average scores were compared,
77

contrasted, and analyzed for significant differences across gender, tenure, and awareness of their
school’s suicide prevention policy.
Results found that teachers and staff felt most confident in their basic knowledge about
suicide and their ability to cope with their own feelings and listen when a suicidal student is in
need. However, their lack of confidence was found in their skills in suicide assessment and
knowledge of teen mental health. Staff that were not aware of their suicide prevention policy
found themselves significantly at a disadvantage with their confidence as gatekeepers against
suicide. There was also found to be a significant correlation between the confidence and
connectedness levels of teachers and staff. Those who reported feeling more connected to their
students were more likely to rate themselves higher in confidence in their gatekeeper skills.
However, despite teachers and staff reporting a high level of connectedness with their students,
they also experienced more challenges with sharing common bonds and identities with them, and
over time, most saw that level of connectedness and confidence decrease.
As students continue to find their way back to normal, California’s teachers and staff find
themselves facing the mental health challenges that are brought in because of the COVID-19
pandemic. This study served to highlight the crucial role of these gatekeepers in recognizing and
responding to the various factors that are correlated with teen suicide prevention and treatment. It
is hopeful that the results of the study can assist California school districts in their ongoing
efforts to improve and adjust staff trainings and school culture to promote positive individual
mental health factors and quality relationships during the school year to help mitigate the effects
of depression, anxiety, and suicide.

78

References
Ahookhosh, P., Bahmani, B., Asgari, A., & Moghaddam, H. H. (2017). Family relationships and
suicide ideation: The mediating roles of anxiety, hopelessness, and depression in
adolescents. International Journal of High-Risk Behaviors & Addiction, 6(1).
https://doi.org/10.5812/ijhrba.31573
Aldridge, J. M., & McChesney, K. (2018). The relationships between school climate and
adolescent mental health and wellbeing: A systematic literature review. International
Journal of Educational Research, 88, 121–145. https://doi.org/10.1016/j.ijer.2018.01.012
Allen, J., Balfour, R., Bell, R., & Marmot, M. (2014). Social determinants of mental health.
International Review of Psychiatry, (Abingdon, England), 26(4), 392–407.
https://doi.org/10.3109/09540261.2014.928270
Aranmolate, R., Bogan, D. R., Hoard, T., & Mawson, A. R. (2017). Suicide risk factors among
LGBTQ youth. JSM Schizophrenia, 2(2), 1011.
Bauman, S., Toomey, R. B., & Walker, J. L. (2013). Associations among bullying,
cyberbullying, and suicide in high school students. Journal of Adolescence (London,
England.), 36(2), 341–350. https://doi.org/10.1016/j.adolescence.2012.12.001
Bernstein-Yamashiro, B., & Noam, G. G. (2013). Teacher-student relationships: A growing field
of study. New Directions for Youth Development, 2013(137), 15–26.
https://doi.org/10.1002/yd.20045
Breux, P., & Boccio, D. E. (2019). Improving schools’ readiness for involvement in suicide
prevention: An evaluation of the creating suicide safety in schools (CSSS)
workshop. International Journal of Environmental Research and Public Health, 16(12),
2165-. https://doi.org/10.3390/ijerph16122165
79

Breux, P., Boccio, D. E., & Brodsky, B. S. (2017). Creating Suicide Safety in Schools: A public
health suicide prevention. Suicidologi, 22(2). https://doi.org/10.5617/suicidologi.5438
Canady, V.A. (2021). Poll: Parents reporting teens’ MH worsening during pandemic. In Mental
Health Weekly (Vol. 31, Issue 12, pp. 6–6). Wiley Periodicals, Inc.
https://doi.org/10.1002/mhw.32731
Cavioni, V., Grazzani, I., & Ornaghi, V. (2020). Mental health promotion in schools: A
comprehensive theoretical framework. The International Journal of Emotional
Education, 12(1), 65–82.
Centers for Disease Control and Prevention (2020). Fatal injury reports, national, regional, and
state, 1981–2018. U.S. Department of Health and Human Services,
https://webappa.cdc.gov/sasweb/ncipc/mortrate.html.
Cooper, G.D., Clements, P. T., & Holt, K. (2011). A Review and Application of Suicide
Prevention Programs in High School Settings. Issues in Mental Health Nursing, 32(11),
696–702. https://doi.org/10.3109/01612840.2011.597911
Cooper, G.D., Hoffman, K., Powell, B., & Marvin, R. (2011). The circle of security intervention.
Disorganized attachment and caregiving, 318–343. Guilford Press
Creswell C., Shum, A., Pearcey, S., Skripkauskaite, S., Patalay, P., & Waite, P. (2021). Young
people’s mental health during the COVID-19 pandemic. The Lancet Child & Adolescent
Health, 5(8), 535–537. https://doi.org/10.1016/S2352-4642(21)00177-2
Curtin, S. C., & Heron, M. (2019). Death Rates Due to Suicide and Homicide Among Persons
Aged 10–24: United States, 2000–2017. NCHS Data Brief, 352, 1–8.
Curtin, S. C., Warner, M., & Hedegaard, H. (2016). Increase in Suicide in the United States,
1999–2014. NCHS Data Brief, 241, 1–8
80

EdData (2021). District profile: Campbell union high. http://www.ed-data.org/district/Santa-
Clara/Campbell-Union-High.
EdData (2021). District profile: Fremont union high. http://www.ed-data.org/district/Santa-
Clara/Fremont-Union-High.
EdData (2021). District profile: Mountain view los altos union high. http://www.ed-
data.org/district/Santa-Clara/Mountain-View-Los-Altos-Union-High.
EdData (2021). District profile: San jose unified. http://www.ed-data.org/district/Santa-
Clara/San-Jose-Unifed.
Substance Abuse and Mental Health Services Administration (2012). Preventing suicide: A
toolkit for high schools. U.S. Department of Health and Human Services.
https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/sma12-4669.pdf
Flores, J.P., Swartz, K. L., Stuart, E. A., & Wilcox, H. C. (2020). Co-occurring risk factors
among U.S. high school students at risk for suicidal thoughts and behaviors. Journal of
Affective Disorders, 266, 743–752. https://doi.org/10.1016/j.jad.2020.01.177
Franklin, C. G., Kim, J. S., Beretvas, T. S., Zhang, A., Guz, S., Park, S., Montgomery, K.,
Chung, S., & Maynard, B. R. (2017). the effectiveness of psychosocial interventions
delivered by teachers in schools: A systematic review and meta-analysis. Clinical Child
and Family Psychology Review, 20(3), 333–350. https://doi.org/10.1007/s10567-017-
0235-4
Gavin, B., Lyne, J., & McNicholas, F. (2020). Mental health and the COVID-19 pandemic. Irish
Journal of Psychological Medicine, 37(3), 156–158. https://doi.org/10.1017/ipm.2020.72
81

Golberstein, E., Wen, H., & Miller, B. F. (2020). Coronavirus disease 2019 (COVID-19) and
mental health for children and adolescents. Archives of Pediatrics & Adolescent
Medicine, 174(9), 819–820. https://doi.org/10.1001/jamapediatrics.2020.1456
Guessoum, S. B., Lachal, J., Radjack, R., Carretier, E., Minassian, S., Benoit, L., & Moro, M. R.
(2020). Adolescent psychiatric disorders during the COVID-19 pandemic and
lockdown. Psychiatry Research, 291, 113264-113264.
https://doi.org/10.1016/j.psychres.2020.113264
Hare-Duke, L., Dening, T., de Oliveira, D., Milner, K., & Slade, M. (2019). Conceptual
framework for social connectedness in mental disorders: Systematic review and narrative
synthesis. Journal of Affective Disorders, 245, 188–199.
https://doi.org/10.1016/j.jad.2018.10.359
Holliday, C., & Vandermause, R. (2015). Teen experiences following a suicide attempt. Archives
of Psychiatric Nursing, 29(3), 168–173. https://doi.org/10.1016/j.apnu.2015.02.001
Imran, N., Zeshan, M., & Pervaiz, Z. (2020). Mental health considerations for children
& adolescents in COVID-19 pandemic: Mental health considerations for children in
COVID-19 pandemic. Pakistan Journal of Medical Sciences, 36(COVID19-S4).
https://doi.org/10.12669/pjms.36.COVID19-S4.2759
Ivey-Stephenson, A. Z., Ivey-Stephenson, Demissie, Z., Crosby, A. E., Stone, D. M., Gaylor, E.,
Wilkins, N., Lowry, R., & Brown, M. (2020). Suicidal ideation and behaviors among
high school students-youth risk behavior survey, United States, 2019. Morbidity and
Mortality Weekly Report. Supplement, 69(1), 47–55.
https://doi.org/10.15585/mmwr.su6901a6
82

Isohookana, R., Riala, K., Hakko, H., & Räsänen, P. (2012). Adverse childhood experiences and
suicidal behavior of adolescent psychiatric inpatients. European Child & Adolescent
Psychiatry, 22(1), 13–22. https://doi.org/10.1007/s00787-012-0311-8
Jenson, J. M., & Fraser, M. W. (2015). Social policy for children and families: A risk and
resilience perspective. Sage Publications.
Johnson, R.B. & Christensen, L. B. (2017). Educational research: quantitative, qualitative, and
mixed approaches (Sixth edition.). Sage Publications.
Johnson, L. A., & Parsons, M. E. (2012). Adolescent suicide prevention in a school setting: Use
of a gatekeeper program. NASN School Nurse, 27(6), 312–317.
https://doi.org/10.1177/1942602X12454459
Katz, C., Bolton, S.L., Katz, L. Y., Isaak, C., Tilston-Jones, T., & Sareen, J. (2013). A systematic
review of school-based suicide prevention programs. Depression and Anxiety, 30(10),
1030–1045. https://doi.org/10.1002/da.22114
King, K. A., & Vidourek, R. A. (2012). Teen depression and suicide: effective prevention and
intervention strategies. The Prevention Researcher, 19(4), 15–17.
Layne, C. M., Ippen, C. G., Strand, V., Stuber, M., Abramovitz, R., Reyes, G., Amaya Jackson,
L., Ross, L., Curtis, A., Lipscomb, L., & Pynoos, R. (2011). The core curriculum on
childhood trauma: A tool for training a trauma-informed workforce. Psychological
Trauma, 3(3), 243–252. https://doi.org/10.1037/a0025039
Lee, J. (2020). Mental health effects of school closures during COVID-19. The Lancet Child &
Adolescent Health, 4(6), 421–421. https://doi.org/10.1016/S2352-4642(20)30109-7
83

Lindsey, M. A., Sheftall, A. H., Xiao, Y., & Joe, S. (2019). Trends of suicidal behaviors among
high school students in the United States: 1991–2017. Pediatrics (Evanston), 144(5).
https://doi.org/10.1542/peds.2019-1187
Lochmiller, C. R., & & Lester, J. N. (2017). An introduction to educational research: connecting
methods to practice. SAGE.
Miller-Lewis, L. R., Sawyer, A. C., Searle, A. K., Mittinty, M. N., Sawyer, M. G., & Lynch, J.
W. (2014). Student-teacher relationship trajectories and mental health problems in young
children. BMC Psychology, 2(1), 27–27. https://doi.org/10.1186/s40359-014-0027-2
Merriam, S. B., & Tisdell, E. J. (2016). Qualitative research: a guide to design and
implementation (Fourth edition.). Jossey-Bass.
Miron, O., Yu, K.- H., Wilf-Miron, R., & Kohane, I. S. (2019). Suicide rates among adolescents
and young adults in the United States, 2000–2017. JAMA: the Journal of the American
Medical Association, 321(23), 2362–2364. https://doi.org/10.1001/jama.2019.5054
O'Connor, E., Gaynes, B. N., Burda, B. U., Soh, C., & Whitlock, E. P. (2013). Screening for and
treatment of suicide risk relevant to primary care: A systematic review for the U.S.
Preventive services task force. Annals of Internal Medicine, 158(10), 741–754.
https://doi.org/10.7326/0003-4819-158-10-201305210-00642
Payton, J. W., Wardlaw, D. M., Graczyk, P. A., Bloodworth, M. R., Tompsett, C. J., &
Weissberg, R. P. (2000). Social and emotional learning: A framework for promoting
mental health and reducing risk behavior in children and youth. The Journal of School
Health, 70(5), 179–185. https://doi.org/10.1111/j.1746-1561.2000.tb06468.x
Pepler, D. J., & Bierman, K. L. (2020). With a little help from my friends: The importance of
peer relationships for social-emotional development, Edna Bennett Pierce Prevention
84

Research Center, Pennsylvania State University.
https://www.rwjf.org/content/dam/farm/reports/issue_briefs/2018/rwjf450248
Pisani, A. R., Wyman, P. A., Petrova, M., Schmeelk-Cone, K., Goldston, D. B., Xia, Y., &
Gould, M. S. (2012). Emotion regulation difficulties, youth-adult relationships, and
suicide attempts among high school students in underserved communities. Journal of
Youth and Adolescence, 42(6), 807–820. https://doi.org/10.1007/s10964-012-9884-2
Ports, K. A., Merrick, M. T., Stone, D. M., Wilkins, N. J., Reed, J., Ebin, J., & Ford, D. C.
(2017). Adverse childhood experiences and suicide risk: Toward comprehensive
prevention. American Journal of Preventive Medicine, 53(3), 400–403.
https://doi.org/10.1016/j.amepre.2017.03.015
Rider, E. A., Ansari, E., Varrin, P. H., & Sparrow, J. (2021). Mental health and wellbeing of
children and adolescents during the covid-19 pandemic. BMJ (Online), 374, n1730-
n1730. https://doi.org/10.1136/bmj.n1730
Schilling, E. A., Aseltine, R. H., & James, A. (2015). The SOS suicide prevention program:
further evidence of efficacy and effectiveness. Prevention Science, 17(2), 157–166.
https://doi.org/10.1007/s11121-015-0594-3
Sheftall, A. H., Asti, L., Horowitz, L. M., Felts, A., Fontanella, C. A., Campo, J. V., & Bridge, J.
A. (2016). Suicide in elementary school-aged children and early adolescents. Pediatrics
(Evanston), 138(4). https://doi.org/10.1542/peds.2016–0436
Singer, J. B., Erbacher, T. A., & Rosen, P. (2018). School-based suicide prevention: A
framework for evidence-based practice. School Mental Health, 11(1), 54–71.
https://doi.org/10.1007/s12310-018-9245-8
85

Smith-Millman, M. K & Flaspohler, P. D. (2018). School-based suicide prevention laws in
action: A nationwide investigation of principals’ knowledge of and adherence to state
school-based suicide prevention laws. School Mental Health, 11(2), 321–334.
https://doi.org/10.1007/s12310-018-9287-y
Takahashi, A., Tachikawa, H., Morita, N., Aiba, M., Shiratori, Y., Nemoto, K., & Arai, T.
(2021). Suicide prevention gatekeeper self-efficacy scale (GKSES). Crisis: The Journal
of Crisis Intervention and Suicide Prevention, 42(2), 128–135.
https://doi.org/10.1027/0227-5910/a000698
Twenge, J. M., Joiner, T. E., Rogers, M. L., & Martin, G. N. (2018). Increases in depressive
symptoms, suicide-related outcomes, and suicide rates among U.S. adolescents after 2010
and links to increased new media screen time. Clinical Psychological Science, 6(1), 3–17.
https://doi.org/10.1177/2167702617723376
Veed, G. J., McGinley, M., & Crockett, L. J. (2019). Friendship network influence on the
development of internalizing symptoms during adolescence. Journal of Applied
Developmental Psychology, 60, 157–165. https://doi.org/10.1016/j.appdev.2018.09.002
Wang, J., Mann, F., Lloyd-Evans, B., Ma, R., & Johnson, S. (2018). Associations between
loneliness and perceived social support and outcomes of mental health problems: A
systematic review. BMC Psychiatry, 18(1), 156–156. https://doi.org/10.1186/s12888-018-
1736-5
Weiss, R. S. (1974). Loneliness: The experience of emotional and social isolation. MIT Press.
Williams, J. M., Bryan, J., Morrison, S., & Scott, T. R. (2017). Protective factors and processes
contributing to the academic success of students living in poverty: Implications for
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counselors. Journal Of Multicultural Counseling and Development, 45(3), 183–200.
https://doi.org/10.1002/jmcd.12073
Yonemoto, N Kawashima, Y., Endo, K., & Yamada, M. (2019). Gatekeeper training for suicidal
behaviors: A systematic review. Journal of Affective Disorders, 246, 506–514.
https://doi.org/10.1016/j.jad.2018.12.052

87

Appendix A: Frameworks
Figure A1 Concentric Circles of the Social Ecology Continuum
Concentric Circles of the Social Ecology Continuum

Note. Concentric Circles of the Social Ecology Continuum. Recreated from “Creating Suicide
Safety in Schools: A Public Health Suicide Prevention” by P. Breux, D.E. Boccio, & B.S.
Brodsky, 2017.Suicidologi, 22(2). Copyright 2017 National Center for Suicide Research and
Prevention.
88

Figure A2 UCARE Framework
UCARE Framework

Note. U.C.A.R.E. framework. Adapted from “The Core Curriculum on Childhood Trauma: A
Tool for Training a Trauma-informed Workforce,” by C. M. Layne, C. G. Ippen, V. Strand, M.
Stuber, R. Abramovitz, G. Reyes, L. Amaya Jackson, L. Ross, A. Curtis, L. Lipscomb, & R.
Pynoos, 2007. Psychological Trauma, 3(3), 243–252. Copyright 2011 by the American
Psychological Association.
Table A1 Definitions and Examples of the CIVIC Conceptual Framework
Definitions and Examples of the CIVIC Conceptual Framework

Dimensions Definition Example Items
Closeness Degree of mutual dependence between two people “There are people that I feel close to in this
social group”
Identity and common
bond
Believing that one shares important characteristics with
other people
“I feel similar to the average person with
depression”
Valued relationships Valuing and/or positively appraising relationship “I am happy that I am a member of the group
I belong to”
Involvement Perceived level of involvement in social engagement with
others.
Group/network involvement: Feeling engaged with
on-going group activities
Companionship: Perceived availability of social
contacts for engaging in shared activities.
“I am involved in the activities of lots of
different groups”
Cared for and
accepted
Feeling that one is cared for
Social acceptance: Perception of being an
accepted member of a particular community
and that one’s contributions towards social
activities are seen as valuable
Social Support: That others care for one’s
wellbeing and would be willing to provide
support if necessary
“I generally feel that people accept me”

Note. CIVIC conceptual framework. Adapted from “Conceptual Framework for Social Connectedness in Mental Disorders:
Systematic Review and Narrative Synthesis,” by L. Hare-Duke, T. Dening, D. de Oliveira, K. Milner, & M. Slade, 2019. Journal of
Affective Disorders, 245, 188–199. Copyright 2019 by the International Society for Affective Disorders
89
90

Appendix B: Surveys
Figure B1 Gatekeeper Self-Efficacy Scale
Gatekeeper Self-Efficacy Scale
We are asking about your level of confidence in addressing suicidal students. Confidence levels
are presented on a sliding scale from 0 (not at all) to 6 (extremely): How do you feel now? Please
drag and select the percentage.

1. I can understand the mental states of students who intend to die by suicide.

0 6

2. I know the appropriate attitudes when in contact with a suicidal student.

0 6

3. I can listen closely to a suicidal student.

0 6

4. I can calmly ask a student about their suicidal ideation (“wanting to die”)
and plan(s).

0 6

5. I am familiar with resources that suicidal students can utilize.

0 6

6. I have basic knowledge about teen depression.

0 6

91

7. I can connect a suicidal student with necessary resources.

0 6

8. I can cope calmly when talking to a student with suicidal intention.

0 6

9. I can recognize the signs of suicide in a student.

0 6

10. I can recognize the signs of depression in a student.

0 6

92

Figure B2 Social Connectedness Questionnaire
Social Connectedness Questionnaire
Next, we are asking about your level of agreement in the following statements regarding social
connectedness. Agreement levels are presented on a scale from 0 (extremely disagree) to 6
(extremely agree): How do you feel now? Please slide the scale and mark the score.

11. I feel close to the students that I interact with on campus.

0 6

12. I feel similar to the students that I interact with on campus.

0 6

13. I am glad to have the students I teach in my classroom.

0 6

14. I am involved with activities on campus outside of my classroom.

0 6

15. It is easy for me to accept my students for who they are.

0 6

16. I look forward to engaging with my students in class.

0 6

17. I share common interests with my students.

0 6

93

18. I involve myself in classroom activities.

0 6

19. My students are aware I care for them.

0 6

20. My students are aware they can depend on me.

0 6

94

Appendix C: Confidence and Connectedness Mean and Std. Deviation by Question
Table C1 Mean and Standard Deviation of Confidence Scores by Individual Statement
Mean and Standard Deviation of Confidence Scores by Individual Statement
Confidence statement

m SD
I can understand the mental states of students who
intend to die by suicide.
3.62 1.457
I know the appropriate attitudes when in contact
with a suicidal student.
3.76 1.483
I can listen closely to a suicidal student. 4.61 1.323
I can calmly ask a student about their suicidal
ideation (“wanting to die”) and plan(s).
4.31 1.518
I am familiar with resources that suicidal students
can utilize.
4.14 1.482
I have basic knowledge about teen depression. 4.66 1.398
I can connect a suicidal student with necessary
resources.
4.60 1.468
I can cope calmly when talking to a student with
suicidal intention.
4.70 1.273
I can recognize the signs of suicide in a student. 3.65 1.483
I can recognize the signs of depression in a
student.
4.32 1.390

95

Table C2 Mean and Standard Deviation of Connectedness Scores by Individual Statement
Mean and Standard Deviation of Connectedness Scores by Individual Statement
Connectedness statement

m SD
I feel close to the students that I interact with on
campus.
4.51 1.226
I feel similar to the students that I interact with on
campus.
3.01 1.311
I am glad to have the students I teach in my
classroom.
5.48 .835
I am involved with activities on campus outside of
my classroom.
4.06 1.622
It is easy for me to accept my students for who they
are.
5.44 .771
I look forward to engaging with my students in
class.
5.49 .734
I share common interests with my students. 4.07 1.355
I involve myself in our classroom activities. 5.24 .870
My students are aware that I care for them. 5.29 .894
My students know they can depend on me. 5.27 .855

96

Appendix D: Mean Confidence and Connectedness by Statement–Gender
Table D1 Mean Confidence Scores of Individual Statements by Gender
Mean Confidence Scores of Individual Statements by Gender
Confidence statement Male Female
m m
I can understand the mental states of students who intend to die by
suicide.
3.53 3.67
I know the appropriate attitudes when in contact with a suicidal
Student.
3.82 3.72
I can listen closely to a suicidal student. 4.31 4.79
I can calmly ask a student about their suicidal ideation
(“wanting to die”) and plan(s).
3.98 4.51
I am familiar with resources that suicidal students can utilize. 4.04 4.20
I have basic knowledge about teen depression. 4.51 4.74
I can connect a suicidal student with necessary resources. 4.49 4.66
I can cope calmly when talking to a student with suicidal intention. 4.61 4.75
I can recognize the signs of suicide in a student. 3.39 3.80
I can recognize the signs of depression in a student. 4.14 4.43

Table D2 Mean Connectedness Scores of Individual Statements by Gender
Mean Connectedness Scores of Individual Statements by Gender
Connectedness statement
Male Female

m m
I feel close to the students that I interact with on campus. 4.41 4.56
I feel similar to the students that I interact with on campus. 3.06 2.98
I am glad to have the students that I teach in my classroom. 5.37 5.54
I am involved with activities on campus outside of my classroom. 3.98 4.10
It is easy for me to accept my students for who they are. 5.24 5.56
I look forward to engaging with my students. 5.37 5.55
I share common interests with my students. 4.00 4.11
I involve myself in our classroom activities. 5.02 5.36
My students are aware that I care for them. 5.04 5.44
My students know they can depend on me. 5.00 5.43

97

Appendix E: Mean Confidence and Connectedness by Statement–Tenure
Table E1 Mean Confidence Scores of Individual Statements by Tenure
Mean Confidence Scores of Individual Statements by Tenure
Confidence statement <1 year 1 to 5
years
6 to 10
years
11 to 15
years
16+
years
m m m m m
I can understand the mental states of
students who intend to die by suicide.
3.50 3.79 3.86 3.50 3.42
I know the appropriate attitudes when in
contact with a suicidal student.
4.00 4.12 3.69 4.00 3.36
I can listen closely to a suicidal student. 5.50 4.91 4.93 4.57 4.18
I can calmly ask a student about their
suicidal ideation (“wanting to die”) and
plan(s).
4.50 4.68 4.34 4.30 4.02
I am familiar with resources that suicidal
students can utilize.
2.50 4.00 4.45 4.10 4.16
I have basic knowledge about teen
depression.
4.50 4.76 4.55 4.67 4.64
I can connect a suicidal student with
necessary resources.
4.50 4.56 4.83 4.43 4.60
I can cope calmly when talking to a student
with suicidal intention.
5.00 4.76 4.86 4.73 4.51
I can recognize the signs of suicide in a
student.
3.00 3.71 3.90 3.63 3.49
I can recognize the signs of depression in a
student.
4.00 4.24 4.55 4.30 4.27

98

Table E2 Mean Connectedness Scores of Individual Statements by Tenure
Mean Connectedness Scores of Individual Statements by Tenure
Connectedness statement <1 year 1 to 5
years
6 to 10
years
11 to 15
years
16+
years
m m m m m
I feel close to the students that I interact
with on campus.
4.50 4.62 4.69 4.40 4.38
I feel similar to the students that I interact
with on campus.
3.00 3.62 3.03 2.90 2.60
I am glad to have the students that I teach in
my classroom.
5.50 5.44 5.38 5.50 5.56
I am involved with activities on campus
outside of my classroom.
4.00 4.09 4.21 4.37 3.73
It is easy for me to accept my students for
who they are.
5.50 5.50 5.69 5.27 5.36
I look forward to engaging with my
students.
5.50 5.29 5.52 5.60 5.53
I share common interests with my students. 5.00 4.09 4.00 4.20 3.98
I involve myself in our classroom activities. 4.50 5.15 5.41 5.47 5.07
My students are aware that I care for them. 5.50 5.44 5.48 5.37 5.00
My students know they can depend on me. 5.50 5.09 5.66 5.40 5.07

99

Appendix F: Mean Confidence and Connectedness by Statement–Policy Awareness
Table F1 Mean Confidence Scores of Individual Statements by Policy Awareness
Mean Confidence Scores of Individual Statements by Policy Awareness
Confidence statement
Yes No
m m
I can understand the mental states of students who intend to die
by suicide.
3.70 3.06
I know the appropriate attitudes when in contact with a suicidal
student.
3.88 2.94
I can listen closely to a suicidal student. 4.66 4.33
I can calmly ask a student about their suicidal ideation (“wanting
to die”) and plan(s).
4.34 4.11
I am familiar with resources that suicidal students can utilize. 4.26 3.33
I have basic knowledge about teen depression. 4.80 3.72
I can connect a suicidal student with necessary resources. 4.74 3.67
I can cope calmly when talking to a student with suicidal
intention.
4.70 4.67
I can recognize the signs of suicide in a student. 3.80 2.61
I can recognize the signs of depression in a student. 4.48 3.22

Table F2 Mean Connectedness Scores of Individual Statements by Policy Awareness
Mean Connectedness Scores of Individual Statements by Policy Awareness
Connectedness statement
Yes No

m m
I feel close to the students that I interact with on campus. 4.49 4.61
I feel similar to the students that I interact with on campus. 2.97 3.28
I am glad to have the students that I teach in my classroom. 5.48 5.44
I am involved with activities on campus outside of my classroom. 4.02 4.28
It is easy for me to accept my students for who they ar.e 5.45 5.39
I look forward to engaging with my students. 5.50 5.39
I share common interests with my students. 4.10 3.89
I involve myself in our classroom activities. 5.24 5.22
My students are aware that I care for them. 5.29 5.33
My students know they can depend on me. 5.30 5.11

100

Appendix G: Gender ANOVA
Table G1 Between Group Significance Levels of Confidence and Gender
Between Group Significance Levels of Confidence and Gender
Confidence statement Between group
x
2
f ρ
I can understand the mental states of students who
intend to die by suicide.
.679 .319 .573
I know the appropriate attitudes when in contact with a
suicidal student.
.354 .160 .690
I can listen closely to a suicidal student. 7.247 4.239 .041*
I can calmly ask a student about their suicidal ideation
(“wanting to die”) and plan(s).
8.944 3.966 .048*
I am familiar with resources that suicidal students can
utilize.
.862 .391 .533
I have basic knowledge about teen depression. 1.742 .891 .347
I can connect a suicidal student with necessary
resources.
.967 .447 .505
I can cope calmly when talking to a student with suicidal
intention.
.681 .418 .519
I can recognize the signs of suicide in a student. 5.334 2.449 .120
I can recognize the signs of depression in a student. 2.721 1.413 .237

Note. *Indicates significant difference
101

Table G2 Between Group Significance Levels of Connectedness and Gender
Between Group Significance Levels of Connectedness and Gender
Connectedness statement Between group
x
2
f ρ
I feel close to the students that I interact with on
campus.
.730 .484 .488
I feel similar to the students that I interact with on
campus.
.214 .124 .725
I am glad to have the students that I teach in my
classroom.
.902 1.296 .257
I am involved with activities on campus outside of my
classroom.
.473 .179 .673
It is easy for me to accept my students for who they are. 3.456 6.031 .015*
I look forward to engaging with my students. 1.027 1.917 .168
I share common interests with my students. .409 .222 .639
I involve myself in our classroom activities. 3.747 5.095 .026*
My students are aware that I care for them. 5.161 6.730 .011*
My students know they can depend on me. 5.910 8.516 .004*

Note. *Indicates significant difference
102

Appendix H: Tenure ANOVA
Table H1 Between Group Significance Levels of Confidence and Tenure
Between Group Significance Levels of Confidence and Tenure
Confidence statement Between group
X
2
F ρ
I can understand the mental states of students who
intend to die by suicide.
1.238 .576 .680
I know the appropriate attitudes when in contact with a
suicidal student.
3.424 1.583 .182
I can listen closely to a suicidal student. 4.032 2.398 .053
I can calmly ask a student about their suicidal ideation
(“wanting to die”) and plan(s).
2.100 .909 .460
I am familiar with resources that suicidal students can
utilize.
2.215 1.009 .405
I have basic knowledge about teen depression. .194 .097 .983
I can connect a suicidal student with necessary
resources.
.603 .274 .894
I can cope calmly when talking to a student with suicidal
intention.
.681 .413 .799
I can recognize the signs of suicide in a student. .973 .435 .783
I can recognize the signs of depression in a student. .536 .272 .896

103

Table H2 Between Group Significance Levels of Connectedness and Tenure
Between Group Significance Levels of Connectedness and Tenure
Connectedness statement Between group
X
2
F ρ
I feel close to the students that I interact with on campus. .620 .405 .805
I feel similar to the students that I interact with on
campus.
5.124 3.166 .016*
I am glad to have the students that I teach in my
classroom.
.154 .215 .930
I am involved with activities on campus outside of my
classroom.
2.071 .782 .538
It is easy for me to accept my students for who they are. .790 1.343 .257
I look forward to engaging with my students. .443 .817 .517
I share common interests with my students. .693 .371 .829
I involve myself in our classroom activities. 1.289 1.739 .145
My students are aware that I care for them. 1.476 1.896 .115
My students know they can depend on me. 1.975 2.842 .027*

Note. *Indicates significant difference

104

Appendix I: Policy Awareness ANOVA
Table I1 Between Group Significance Levels of Confidence and Policy Awareness
Between Group Significance Levels of Confidence and Policy Awareness
Confidence statement Between group
X
2
F ρ
I can understand the mental states of students who intend
to die by suicide.
6.614 3.166 .077
I know the appropriate attitudes when in contact with a
suicidal student.
13.643 6.445 .012*
I can listen closely to a suicidal student. 1.630 .932 .336
I can calmly ask a student about their suicidal ideation
(“wanting to die”) and plan(s).
.853 .368 .545
I am familiar with resources that suicidal students can
utilize.
13.536 6.406 .012*
I have basic knowledge about teen depression. 18.055 9.829 .002*
I can connect a suicidal student with necessary
resources.
17.993 8.818 .004*
I can cope calmly when talking to a student with suicidal
intention.
.023 .014 .906
I can recognize the signs of suicide in a student. 22.294 10.85 .001*
I can recognize the signs of depression in a student. 24.957 14.14 <.001*

Note. *Indicates significant difference
105

Table I2 Between Group Significance Levels of Connectedness and Policy Awareness
Between Group Significance Levels of Connectedness and Policy Awareness
Connectedness statement Between group
X
2
F ρ
I feel close to the students that I interact with on campus. .223 .148 .701
I feel similar to the students that I interact with on
campus.
1.513 .879 .350
I am glad to have the students that I teach in my
classroom.
.024 .034 .853
I am involved with activities on campus outside of my
classroom.
1.006 .381 .538
It is easy for me to accept my students for who they are. .060 .101 .752
I look forward to engaging with my students. .194 .357 .551
I share common interests with my students. .688 .373 .542
I involve myself in our classroom activities. .004 .005 .944
My students are aware that I care for them. .034 .042 .838
My students know they can depend on me. .531 .724 .396

Asset Metadata

Creator Reiisieh, Sasha (author)

Core Title Connected gatekeepers against suicide: exploring the relationship between teacher-student connectedness and confidence in suicide prevention and intervention

Contributor Electronically uploaded by the author (provenance)

School Rossier School of Education

Degree Doctor of Education

Degree Program Educational Leadership (On Line)

Degree Conferral Date 2022-12

Publication Date 11/02/2022

Defense Date 10/30/2022

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag classroom intervention,confidence,connectedness,gatekeeper,OAI-PMH Harvest,protective factors,Relationship,Suicide,suicide prevention,teen suicide

Format theses (aat)

Language English

Advisor Polikoff, Morgan (committee chair), Chung, Ruth (committee member), Hafezi, Maryam (committee member)

Creator Email reiisi_sasha@yahoo.com,reiisieh@usc.edu

Permanent Link (DOI) https://doi.org/10.25549/usctheses-oUC112212386

Unique identifier UC112212386

Identifier etd-ReiisiehSa-11295.pdf (filename)

Legacy Identifier etd-ReiisiehSa-11295

Document Type Dissertation

Format theses (aat)

Rights Reiisieh, Sasha

Internet Media Type application/pdf

Type texts

Source 20221103-usctheses-batch-989 (batch), University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the author, as the original true and official version of the work, but does not grant the reader permission to use the work if the desired use is covered by copyright. It is the author, as rights holder, who must provide use permission if such use is covered by copyright. The original signature page accompanying the original submission of the work to the USC Libraries is retained by the USC Libraries and a copy of it may be obtained by authorized requesters contacting the repository e-mail address given.

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus MC 2810, 3434 South Grand Avenue, 2nd Floor, Los Angeles, California 90089-2810, USA

Repository Email uscdl@usc.edu

Abstract (if available)

Abstract Over the last 10 years, the United States has continued to see a startling increase in the number of adolescent youths attempting suicide. With the signing of Assembly Bill 2246, California began to require middle school and high school districts have not only a suicide prevention policy, but trainings emphasizing assessment, safety planning, community referrals. With suicide rates for teens being highest during the school year, school staff hold the unique responsibility to promote a warm relationship that can ultimately increase healthy behaviors and reduce suicidal thoughts and attempts. The “Connected Gatekeeper Framework” was designed to measure the strength of a gatekeeper using both confidence in gatekeeper skills, as well as level of connectedness to their students. Teachers from multiple districts across the southern Bay Area were surveyed and found an average confidence level of 71%, with teachers who reported feeling more connected to their students rating themselves more confident in their role as a gatekeeper. Further evaluations among tenure, and awareness of suicide prevention policy found significant differences in confidence ratings, creating implications for future training and education.