Close
About
FAQ
Home
Collections
Login
USC Login
Register
0
Selected
Invert selection
Deselect all
Deselect all
Click here to refresh results
Click here to refresh results
USC
/
Digital Library
/
University of Southern California Dissertations and Theses
/
Principal implementation of Education Code 215: pupil and student suicide prevention policies in southern California public middle schools
(USC Thesis Other)
Principal implementation of Education Code 215: pupil and student suicide prevention policies in southern California public middle schools
PDF
Download
Share
Open document
Flip pages
Contact Us
Contact Us
Copy asset link
Request this asset
Transcript (if available)
Content
Running Head: PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 1
PRINCIPAL IMPLEMENTATION OF EDUCATION CODE 215:
PUPIL AND STUDENT SUICIDE PREVENTION POLICIES IN
SOUTHERN CALIFORNIA PUBLIC MIDDLE SCHOOLS
by
Benjamin R. Acker
A Dissertation Presented to the
FACULTY OF THE ROSSIER SCHOOL OF EDUCATION
UNIVERSITY OF SOUTHERN CALIFORNIA
In Partial Fulfillment of the
Requirements for the Degree
DOCTOR OF EDUCATION
May 2019
Copyright 2019 Benjamin R. Acker
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 2
Acknowledgements
I wish to extend my sincere gratitude to every member of the Trojan Family who
encouraged and empowered me throughout my years at the University of Southern California,
Rossier School of Education. First, I want to recognize my dissertation chair, Dr. Rudy
Castruita, who encouraged and supported me throughout this process. I also wish to express my
gratitude to my committee members, Dr. David Cash and Dr. Brent Forsee, who offered
guidance and counsel towards a successful dissertation. I am indebted to each of these
professionals for sharing their knowledge and mentorship.
I also want to thank my educational colleagues for providing me with encouragement,
support, and flexibility to pursue my dream of completing this dissertation.
A special thank you goes to Mrs. Mona Cravens, Director of Student Publications at the
University of Southern California, who more than 20 years ago encouraged a young Daily
Trojan writer and artist to complete his undergraduate studies, and believed in the possibility that
I would make a positive impact on the world. I am eternally grateful for your mentorship and
care.
Finally, I wish to acknowledge and thank my aunt, Mrs. Sandra Burch, an outstanding
veteran teacher, who patiently waited for me to see for myself that I was meant to be an educator,
and then helped me find my way to serving students and families for the past two decades.
Thank you for always believing in me.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 3
Dedication
First and foremost, I dedicate this work to my wife, Brandy, and to our three children,
Nathanael, Madolyn, and Maxwell. Each of you has demonstrated incredible love, patience,
selflessness, support, and understanding as I have taken this journey. This work is also dedicated
to my mom, my dad, and my five younger brothers, who have always believed in me, who reared
me with the tenet that there is nothing more important than family, and who instilled in me that
sacrifice is the language of love.
Finally, I dedicate this work to every person whose life was touched in some way by my
brother Matthew. Although his 22 years on this earth were tragically cut short by suicide,
Matthew’s legacy of courage and kindness endures in our shared stories, memories, laughs, tears,
and shared commitment to bring solace to those suffering in silence behind their smiles.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 4
Table of Contents
Abstract ..............................................................................................................................12
Chapter One: Overview of the Study .................................................................................13
Background of the Problem .........................................................................................15
Statement of the Problem .............................................................................................18
Purpose of the Study ....................................................................................................20
Research Questions ......................................................................................................20
Importance of the Study ...............................................................................................21
Limitations ...................................................................................................................21
Delimitations ................................................................................................................22
Definition of Terms......................................................................................................22
Organization of the Study ............................................................................................26
Chapter Two: Literature Review .......................................................................................28
Introduction ..................................................................................................................28
History of the Suicide Prevention Movement in the United States .......................28
National Youth Suicide Legislation Focusing on Education ................................32
Youth Suicide Prevention Legislation in California ..............................................34
Understanding Youth Suicide ......................................................................................36
Epidemiology ...............................................................................................................37
Age and Development......................................................................................38
Gender ..............................................................................................................39
Sexual Orientation ...........................................................................................40
Race and Ethnicity ...........................................................................................41
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 5
Suicide Risk and Protective Factors ......................................................................43
Individual Characteristics ................................................................................44
Prior Suicidal Behavior ..............................................................................44
Psychopathology ........................................................................................46
Family Characteristics .....................................................................................48
Family History of Suicide ..........................................................................48
Family Dynamics .......................................................................................49
Social-environmental Characteristics ..............................................................50
Location of Community .............................................................................50
Stress, Trauma, and Abuse.........................................................................51
Exposure to Suicide, Suicide Contagion ....................................................54
Access to Firearms and Other Means ........................................................55
Substance Abuse ........................................................................................57
Protective Factors.............................................................................................58
Middle School Suicide Prevention...............................................................................60
School-Based Prevention Strategies ......................................................................62
Universal Strategies .........................................................................................63
Selective Strategies ..........................................................................................65
Indicated Strategies ..........................................................................................68
Principal Leadership with Suicide Prevention Implementation ...................................70
Principal Applications of Bolman and Deal’s Four Frames ..................................72
The Structural Frame .......................................................................................72
The Human Resource Frame ...........................................................................72
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 6
The Political Frame ..........................................................................................73
The Symbolic Frame ........................................................................................73
Reframing Leadership in Support of Youth Suicide Prevention .....................73
Application of Four Frames Leadership Supporting Adolescent Suicide
Prevention ........................................................................................................74
Summary ......................................................................................................................76
Chapter Three: Methodology .............................................................................................78
Purpose of the Study ....................................................................................................78
Research Design.....................................................................................................79
Population and Sample ..........................................................................................79
Demographic Data .................................................................................................80
Procedures ..............................................................................................................80
Instrumentation ......................................................................................................82
Data Collection ......................................................................................................82
Data Analysis .........................................................................................................82
Ethical Considerations ...........................................................................................83
Summary ......................................................................................................................83
Chapter Four: Findings ......................................................................................................85
Results ..........................................................................................................................85
Purpose of the Study ....................................................................................................85
Demographic Data for Middle School Principal Participants......................................87
Years of Experience ...............................................................................................87
Age and Gender of Middle School Principals .......................................................88
Race/Ethnicity of Middle School Principals ..........................................................89
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 7
Professional Preparation ........................................................................................90
Distribution in Southern California .......................................................................90
Background and Analysis of Education Code 215 ................................................91
Legislative History ...........................................................................................92
Intent and Process ............................................................................................93
Strategy and Obstacles .....................................................................................95
Implementation and Evaluation .......................................................................96
Results for Research Question One ...........................................................................100
Research Findings Pertaining to Research Question One....................................100
Current knowledge of Education Code 215 ...................................................101
Prevalence of Youth Suicidality in Middle School ........................................103
Principal Knowledge Regarding Youth Suicidality .......................................106
Student Stressors ............................................................................................108
Impact of Social Media ..................................................................................110
Student Groups with Elevated Risk ...............................................................112
Mental Illness .................................................................................................117
Protective Factors...........................................................................................118
The Role of Principals in Youth Suicide Prevention Practices ......................120
Summary of Results for Research Question One ................................................123
Results for Research Question Two ...........................................................................124
Research Findings Pertaining to Research Question Two ...................................124
General Approach ..........................................................................................125
Appropriate Personnel ...................................................................................126
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 8
Crisis Response Teams ..................................................................................131
Professional Development .............................................................................134
Social-emotional Support Programs ..............................................................138
Summary of Results for Research Question Two ................................................144
Results for Research Question Three .........................................................................145
Research Findings Pertaining to Research Question Three .................................145
Compassionate Teachers ................................................................................146
Leveraging Compassion to Develop Confidence ..........................................151
The Changing Role of the Principal ...............................................................153
Summary of Results for Research Question Three ..............................................155
Results for Research Question Four ..........................................................................156
Research Findings Pertaining to Research Question Four ...................................156
Need for Ongoing Training ............................................................................157
Communication with Key Stakeholders ........................................................159
Students ....................................................................................................160
Parents ......................................................................................................163
Aligning Vision with Success ........................................................................166
Summary of Results for Research Question Four................................................169
Chapter Summary ......................................................................................................170
Chapter Five: Conclusions ...............................................................................................175
Purpose of the Study ..................................................................................................176
Research Questions ....................................................................................................176
Methodology ..............................................................................................................176
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 9
Results and Findings ..................................................................................................177
Research Question One ........................................................................................177
Research Question Two .......................................................................................179
Research Question Three .....................................................................................180
Research Question Four .......................................................................................181
Implications of the Study ...........................................................................................182
Recommendations for Future Research .....................................................................184
Conclusion .................................................................................................................185
References ........................................................................................................................187
Appendix A: Information Sheet for Research .................................................................225
Appendix B: Middle School Principal Survey.................................................................227
Appendix C: Interview Questions for Individuals Associated with the
Legislative Process.....................................................................................................235
Appendix D: Middle School Principal Interview Questions ..........................................236
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 10
List of Tables
Table 1: Years of experience in current position ...............................................................88
Table 2: Demographic data: Age and gender of participants ............................................89
Table 3: Demographic Data: Race/ethnicity ......................................................................90
Table 4: Distribution of participant middle school principals in
southern California ..............................................................................................91
Table 5: Education Code 215: Pupil suicide prevention policy .......................................101
Table 6: Local school district’s board policy about youth suicide
prevention ..........................................................................................................102
Table 7: Frequency of youth suicidality at participants’ middle
schools................................................................................................................104
Table 8: General knowledge about youth suicide ............................................................106
Table 9: Youth suicide warning signs ..............................................................................106
Table 10: Youth suicide risk factors ................................................................................107
Table 11: Youth groups with elevated risk of suicide ....................................................113
Table 12: Principal perceptions of policy application to high-risk
students ............................................................................................................114
Table 13: Youth suicide protective factors ......................................................................118
Table 14: Principal’s role in implementation of suicide prevention
practices ...........................................................................................................120
Table 15: Principal perceptions of current practice .........................................................126
Table 16: Staff involved in suicide prevention practices .................................................127
Table 17: Crisis team formed at middle school ...............................................................131
Table 18: Conducting a risk assessment .........................................................................132
Table 19: Appropriate intervention with a student demonstrating
suicidal behavior ..............................................................................................132
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 11
Table 20: Professional development received by middle school
principals .........................................................................................................134
Table 21: Suicide prevention training offered to school staff ..........................................136
Table 22: Principal perceptions of staff preparation ........................................................138
Table 23: Social emotional and prevention programs .....................................................139
Table 24: Teacher beliefs about youth suicide ................................................................146
Table 25: Caring adult staff members ..............................................................................149
Table 26: Teacher confidence to address youth suicide ..................................................151
Table 27: Principal perceptions of need for more staff training ......................................158
Table 28: Student awareness and knowledge to act.........................................................160
Table 29: Parent knowledge of suicide prevention practices ...........................................163
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 12
Abstract
The purpose of this study was to examine how suicide prevention practices mandated by
Education Code 215: Pupil and Student Suicide Prevention Policy are being implemented by
principals at public middle schools in southern California. The study also aimed to determine the
means by which principals are developing teacher leadership, efficacy, and motivation to
embrace suicide prevention initiatives, as well as the measures of accountability and evaluation
being utilized by middle school administrators to ascertain the effectiveness of current suicide
prevention practices. A mixed-methods study was conducted with 51 principals currently
serving at public middle schools in six southern California counties, who completed a survey
regarding practices, preparation, and knowledge of youth suicide. Ten middle school principals
and two individuals closely associated with the legislative development of EC 215 were
interviewed as well. The study’s findings highlighted the vital role of middle school principal
leadership with suicide prevention policies and practices, which includes both instructional
leadership and social-emotional support for students, staff, and community members. The study
revealed the prevalent and pervasive nature of myriad stressors that contribute to anxiety and
suicidal ideation among middle school adolescents. Findings indicated that effective suicide
prevention implementation is linked to addressing both the academic and social-emotional needs
of middle school students, establishing and maintaining open channels of communication with
multiple stakeholders, supporting various programs that sustain school connectedness for
students, and providing professional development and emotional encouragement for staff
charged with prevention, intervention, and postvention efforts.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 13
Chapter One: Overview of the Study
According to the California Department of Education (CDE), suicide consistently ranks
as the second or third leading cause of death among youth in California (Centers for Disease
Control and Prevention, CDC, 2019). In 2015, there were 506 confirmed deaths by suicide
among 10 to 24 year old individuals in the state (CDC, 2019). Almost 2,300 students in
California between the ages of 15 and 19 attempted suicide in 2014 (CDE, 2015). A staggering
3,575 hospitalizations occurred in 2014 for non-fatal self-inflicted injuries among individuals age
5 through 20 (Disdata.org., 2014). The most recent California Healthy Kids Survey (2015)
reported that 26% of 7th grade students, 32% of 9th graders, and 34% of 11th grade students
experience feelings of chronic sadness or hopelessness, and nearly one-fifth of high school
students stated they had seriously contemplated suicide in the previous 12 months. Despite
ongoing efforts to eliminate this clear danger to children and adolescents throughout California,
comprehensive solutions to diminish these somber statistics have evaded educators and
lawmakers for decades.
On September 26, 2016, California Governor Edmund Gerald Brown Jr. signed into law
AB 2246 (Assembly Bill No. 2246, 2016), establishing Education Code 215 (EC 215, California
Legislative Information, 2018), which required the governing board or body of a local
educational agency serving pupils in grades 7 through 12 to adopt a policy for suicide prevention
before the beginning of the 2017-2018 school year (Assembly Bill No. 2246, 2016). This
groundbreaking legislation distinguished California as the first state in the country to establish
such a law, creating policy not only for all secondary students in the state’s public schools, but
also specifically targeting high-risk groups, including students with disabilities, students with
mental illness, students bereaved by suicide, foster and homeless children, and lesbian, gay,
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 14
bisexual, transgender, or questioning youth (Assembly Bill No. 2246, 2016; Trevor Project,
2019).
In addition to the establishment of suicide prevention policies, EC 215 (California
Legislative Information, 2018) mandates public educational institutions to provide staff
development addressing youth suicide and prevention for middle and high school staff, direction
to teach coping skills and problem-solving strategies to students, improvement measures for
school connectedness and school climate, communication channels with parents and community
stakeholders, and a protocol for suicide prevention, intervention, and postvention (Assembly Bill
No. 2246, 2016).
In response to the state mandate, School Boards of Education throughout California
serving the targeted 7th through 12th grade secondary student populations ratified policies
addressing suicide prevention and related services within the required time frame established by
law. Many school districts utilized a sample board policy 5141.52 provided by the California
School Boards Association (CSBA, 2017). This policy aligned with existing policies for youth
services, bullying, positive school climate, staff development, and harassment (CSBA, 2017).
The language of EC 215 (California Legislative Information, 2018) stated, in part,
The policy shall be developed in consultation with school and community stakeholders,
school-employed mental health professionals, and suicide prevention experts and shall, at
a minimum, address procedures relating to suicide prevention, intervention, and
postvention.
As the instructional leaders of middle school sites, principals often fulfill such leadership
and implementation roles within their school communities. Although governing boards and
bodies of local educational agencies across California have met the initial adoption requirements
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 15
of EC 215 (California Legislative Information, 2018) set forth by the state, the implementation of
the policy at the middle school site level is not well documented in current research. This is
largely a function of the nascent status of EC 215, but also indicated by a lack of clear guidelines
provided within the language of the legislation for assessment of suicide prevention programs, or
a framework for the delivery of professional development to staff (Assembly Bill No. 2246,
2016). Furthermore, no additional funding is provided initially by the state to support the
mandate; instead, AB 2466 indicated that funding may be provided in the future should the
delivery of these initiatives represent a financial cost to districts and local educational agencies
(Assembly Bill No. 2246, 2016). These factors give this researcher the unique opportunity to
explore the processes and strategies middle school principals deploy to initiate and implement
suicide prevention programs at their school sites and within their districts which meet the
requirements of EC 215, and are designed to articulate from middle school through high school
(Assembly Bill No. 2246, 2016). From this perspective, a holistic understanding of (1) how EC
215 is being implemented at the middle school level; (2) how principals are empowering
students, staff, and other stakeholders to embrace these initiatives; and (3) the measures of
accountability and evaluation being utilized by administrators to assess the effectiveness of
suicide prevention programs is critical to supporting the safety, well-being, and success of all
students.
Background of the Problem
Effective middle school principals endeavor to be agents of change; to identify the core
competencies of stakeholders, develop a strong sense of purpose and organizational values, and
build a school culture that emphasizes maximizing student achievement (Clifton, 1999; Fowler,
2009; Fullan, 2014; Patterson, 2001; Riehl, 2000). Delivery of this ideology is not without its
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 16
challenges; effecting positive change within an organization can be impeded by myriad internal
and external forces (Fullan, 2012, Stecher & Kirby, 2004). Therefore, middle school leadership
for change must be accompanied by a collective purpose that represents the values,
understandings, and expectations of all stakeholders working collaboratively towards the
common goal of student success (Clifton, 1999; Fullan, 2014; Riehl, 2000). Fullan (2014)
asserted that individuals are motivated by (1) performing tasks that are intrinsically meaningful
to themselves, and (2) working with others to accomplish worthwhile goals never before
achieved. Thus, it is incumbent upon the middle school principal-leader to establish a shared set
of schoolwide beliefs, objectives, responsibilities, and practices that support student
achievement, and influence the dynamics of instruction and learning that transpire at the school
(Darling-Hammond, 2002; DuFour, DuFour, Eaker, & Many, 2006; Elmore, 2000; Fullan,
2012).
The primary measure of student achievement—and the nexus of many leadership-driven
efforts to improve student outcomes via curriculum and instruction—has historically been
academic performance (Fisher & Frey, 2005; Langer, 2001; Marzano; 2003). Recent federal and
state policies such as No Child Left Behind (NCLB, 2002) in 2001, California’s adoption of
Common Core State Standards (CCSS) in 2010, and Every Student Succeeds Act (ESSA, 2015)
galvanized a generation of principals and educators to prioritize academic achievement as the
foremost measure of student preparation. Consequently, principals have been compelled to
promote change within their schools largely focused upon academic quality and student
performance on annual high-stakes tests like the California Assessment of Student Performance
and Progress (CAASPP), reinforcing their roles as instructional leaders (Fullan, 2012; Kirst,
2013; NCLB, 2002).
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 17
The establishment of EC 215 (California Legislative Information, 2018), while born of
dire circumstances, serves to remind principals and educators that student success is not
grounded wholly in academic performance. EC 215 reflects a growing movement to provide
students with social and emotional learning (SEL) opportunities; fostering self-awareness,
managing emotions, social awareness, developing healthy relationships, and making responsible
and ethical decisions (DePaoli, Atwell, & Bridgeland, 2017). Research suggested that such an
approach can improve academic performance, while supporting the fundamental life skills
needed to be successful at school, work, home, and within the community (DePaoli et al., 2017).
Moreover, for those students enduring challenging life situations or suffering risk factors that
contribute to depression or suicidal ideation, it has the potential to save their lives.
Middle school leaders, in turn, must balance the duties of academic accountability and
evaluation with the cause of developing youth who will perform well as students, and grow to be
productive, contributing members of society (DePaoli et al., 2017). Accordingly, EC 215
(California Legislative Information, 2018) impels principals, “to use their power and influence,
their insight and compassion… to create the conditions for our basic human qualities of
generosity, contribution, community, and love to be evoked no matter what” (Wheatley, 2017).
AB 2246 (Assembly Bill No. 2246, 2016) identified that children and teens spend a
significant amount of time at school; consequently, teachers and staff who interact with them are
uniquely positioned to recognize warning signs of suicide and make appropriate referrals for
support. A variety of educational approaches to youth suicide prevention have been utilized in
secondary school settings for decades, but a common thread among them is the integral role of
teachers, and their ability to recognize risk factors and signs presented by students in crisis
(Johnson & Parsons, 2012; Kalafat, 2003; Nadeem et al., 2011). It is therefore crucial that
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 18
principals instill a sense of urgency and purpose among staff, and ensure teachers are provided
with the proper training to support students in need.
The troubling statistics surrounding youth suicide are indicative of serious social, public
health, and educational concerns. Historical state, national, and global data demonstrated that
while youth suicide numbers are relatively small compared to other age demographics, the death
of a child due to suicide poses severe adverse social emotional impacts on individuals, families,
communities, and schools. Annual medical expenses and work loss figures in the United States
indicated that suicide and self-inflicted harm represent an annual cost of $45 billion (CDC,
2014b). More disconcerting is the notion that the emotional and financial tolls reported likely do
not represent the full magnitude of this crisis; many suicides go unreported due to social stigma,
and countless thousands of at-risk youth neither seek nor receive the support and services they
require (CDC, 2014b; U. S. Department of Health and Human Services, 2012; World Health
Organization, 2018). Comprehensive initiatives to identify and treat students suffering from
depression or suicidal ideation, supported by multiple stakeholders across school communities,
warrant this issue to be addressed.
Statement of the Problem
Adolescent suicide is a pervasive and tragic event that not only endangers the lives of
children, but also devastates families, schools, and communities. Suicide rates in California are
below the national average, ranking 45th across all age groups (CDC, 2014a). However, with
4,214 suicide deaths in 2014, California ranks 1st in the United States (CDC, 2015b). Similarly,
suicide rates and deaths throughout California vary by county and geographic region (California
Department of Public Health, 2010). While the rate of suicide is highest in northern rural areas
of California, the largest number of suicides takes place in southern California urban areas with
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 19
markedly higher population density California Department of Public Health, 2010; Ramchand &
Becker, 2014). In Los Angeles county alone, there were 7,367 suicides reported during the 10
year period of 2004 through 2013, including 875 youth between the ages of 10 and 24
(California Department of Public Health, 2010). The policy implications of these statistics
strongly indicate that suicide prevention practices and resources are needed in every part of
California; indeed, balancing initiatives in rural areas where risk to individuals is statistically
higher, and in urban areas that account for the highest number of suicides, is crucial to save the
most lives (Ramchand & Becker, 2014). The evidence highlighted this study’s foundational
assertion that comprehensive and inclusive suicide prevention programs in southern California
middle schools must be implemented and fostered with fidelity by site principals and supported
collaboratively among multiple stakeholders, to save the lives of children in crisis.
With the recent inception of EC 215: Pupil Suicide Prevention Policies (California
Legislative Information, 2018) targeted towards 7th through 12th grade students in California
public schools, secondary principals are faced with the daunting but worthy task of leading the
implementation of suicide prevention programs at their schools. The problem is that it is
unknown what specific practices middle school principals will utilize to initiate and sustain
suicide prevention programs, how they will empower teachers and staff to embrace these
initiatives, and what accountability and evaluative measures will be espoused to assess and
improve. This problem is important to address because suicide is a leading cause of death
among youth in southern California. Additionally, AB 2246 cited a study by the Jason
Foundation, which concluded that teachers are the most likely person from which students would
seek help for a friend that was suicidal (Assembly Bill No. 2246, 2016). It is, therefore, crucial
that teachers have the knowledge, tools, and resources to respond and that principal leadership
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 20
facilitates, encourages, and empowers teachers to do so appropriately (Assembly Bill No. 2246,
2016).
Purpose of the Study
The purpose of this study was to determine how suicide prevention policies set forth by
EC 215 (California Legislative Information, 2018) are being implemented by principals at
middle schools in southern California, the means by which principals are developing teacher
leadership, efficacy, and motivation to embrace these initiatives, and the measures of
accountability and evaluation being utilized by middle school administrators to assess the
effectiveness of suicide prevention programs. The study utilized interviews with middle school
principals and other members of middle school communities, along with observations of
southern California middle schools to collect, categorize, and examine qualitative data and
ascertain the status of EC 215 implementation in these schools.
Research Questions
The following research questions guided this study:
1. How are middle school principals in southern California public schools leading the
implementation of EC 215: Pupil Suicide Prevention Policies?
2. What are the best practices and strategies being utilized in these middle schools to
support pupil suicide prevention, intervention, and postvention?
3. How are middle school principals leading faculty to change their perceptions and
attitudes that suicide prevention practices are a serious and worthy issue?
4. How do principals evaluate the progress and success of pupil suicide prevention
programs and practices?
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 21
Importance of the Study
Pursuant to the mandates of EC 215 (California Legislative Information, 2018), school
boards and governing bodies of local education areas ratified suicide prevention policies as
recently as the summer before the 2017-2018 academic year in California. This study examined
the practices and strategies of middle school principals to implement suicide prevention
programs during the inaugural year of EC 215, in the part of the state with the highest number of
deaths attributed to suicide (CDC, n.d.). The study contributes to the germinal knowledge
assessing the status of the policy implementation among the youngest targeted students in 7th
and 8th grades, with a focus on principal practices to train, encourage, and empower staff and
other stakeholders to work collaboratively towards positive student outcomes.
The study will assist secondary principals, district administration and executive
leadership, school boards of education, and the State Department of Education with foundational
knowledge of best practices for implementation and professional development, and what
protocols and practices elicit the most effective results at the middle school level.
The study will further aid various suicide support organizations (The Jason Foundation
The Trevor Project, American Foundation for Suicide Prevention) by providing a current context
for students, families, and friends of youth afflicted by risk factors, self-harm, or suicide to work
collegially with public middle school leadership and staff, utilizing the tools of EC 215
(California Legislative Information, 2018) mandated intervention, prevention, and postvention
programs for mutual support.
Limitations
Limitations of this study were:
1. The validity of data is subject to the researcher’s choice of instrumentation.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 22
2. The validity of data is subject to participants’ ability and willingness to provide truthful
and accurate responses, discrepancies in self-reporting, or the potential bias of the
researcher.
3. Data pertaining to suicide rates and numbers by county in California are largely
incomplete, as the majority of counties do not report data, instead citing a “low number
event.” Available data is generally two or three years old, due to the time required to
collect, compile, verify, and report (Ramchand & Becker, 2014).
Delimitations
The researcher recognizes the following delimitations:
1. Interviews were limited to 10 principals who have served in their current middle school
position for two or more years.
2. Data collection was limited to public urban and suburban middle schools located in the
southern California counties of Los Angeles, Orange, Riverside, San Bernardino, San
Diego, and Ventura that are in the process of implementing suicide prevention programs
pursuant to EC 215.
3. The nascence of EC 215 is universal to all secondary school settings and participants,
contributing to the generalizability of the study’s findings.
Definition of Terms
The following operational definitions are employed throughout this study:
Accountability: The justification of actions or decisions addressing the theory of action,
the technical specifications, the implementation, and the effect of a given policy
(Fuhrman, 2004); the “contractual” or obligatory relationships between a service provider
and a director (Stecher & Kirby, 2004). Hentschke and Wohlstetter (2004) described
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 23
accountability as the practice of holding educational systems responsible for the quality
of student knowledge, skills, and behaviors.
Capacity Building: Training and empowering groups and individuals to develop their
knowledge, skills, and abilities through ongoing teaching and learning (Elmore, 2000;
Hargreaves & Fullan, 2012).
Climate: The qualities and characteristics of school life, based on the patterns of students,
parents, and school personnel’s experiences that reflect the school community’s norms,
goals, values, interpersonal relationships, teaching and learning practices, and
organizational structures (National School Climate Council, 2007); these are subject to
the influence of school leadership (Heck, Larsen, & Marcoulides, 1990).
Culture: The guiding, shared beliefs, attitudes, stories, rituals, traditions, and values
evident among members of a school community (Deal & Peterson, 2009; Fullan, 2007;
Waters, Marzano, & McNulty, 2003). School culture fosters improvement, collaboration,
and learning among students and staff (Deal & Peterson, 2009).
Governing Board: A group of elected or appointed individuals tasked with the
management and oversight of a school district or local education agency.
Instructional Leader: An individual, such as a school principal, who is charged with
promoting student achievement through the practice of instructional leadership
(Bendikson, Robinson, & Hattie, 2012; Sergiovanni, 2009).
Instructional Leadership: Leadership theory emphasizing student achievement and
student outcomes through sound teaching practices, professional development, and the
development of school climate and culture conducive to student success (Bendikson et
al., 2012).
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 24
Intervention: With respect to youth suicide prevention practices, intervention involves
providing an individual enduring suicidal ideation with appropriate identification
measures, assessment, management, referral, support services, and monitoring to
preclude the individual from a suicide attempt (Drapeau & McIntosh, 2015; Heard
Alliance, 2017).
Local Education Agency: A board of education with administrative control and
management of the public schools within a city, school district, or county of a state.
Middle School: A school site serving grades 6th through 8th, or grades 7th through 8th
(Elmore, 2000).
Organizational Change: The process of changing the processes, procedures, strategies,
values, and culture of an organization occurring through internal and external means
(Bolman & Deal, 20a3; Kotter, 2012).
Postvention: With respect to youth suicide prevention practices, postvention involves
procedures aimed at identifying those affected by suicide to decrease negative reactions
and increase adaptive coping (Drapeau & McIntosh, 2015; Heard Alliance, 2017).
Prevention: With respect to youth suicide, prevention refers broadly to the practices and
policies to reduce the risk factors of suicide, develop systems of support for children and
adolescents suffering from depression, mental illness, or suicidal ideation and facilitate
training of individuals to identify and help those afflicted from these conditions (Drapeau
& McIntosh, 2015; Heard Alliance, 2017).
Principal: A school site administrator, leader, and manager who supervises instruction,
academics, personnel, community relations, finances, and other related functions (Fullan,
2014; Kafka, 2009).
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 25
Professional Development: Training provided to increase the knowledge, skills, and
capacity of teachers, administrators, and other stakeholders to provide for the continuous
improvement of instructional practice and student performance (Elmore, 2000; Guskey,
2000)
Re-entry Plan: With respect to youth suicide prevention, a re-entry plan is a protocol
through which school staff, families, and students collaborate after an incident of suicidal
ideation or attempt to reintroduce the student to school. Resources available to the
student and family, supervision of the student before, during, and after school, a safety
plan, and recommendations from health care practitioners and educational professionals
are discussed. (Drapeau & McIntosh, 2015; Heard Alliance, 2017)
Risk-factors: Research indicated that some groups are at higher risk for suicide than
others (California Healthy Kids Survey, 2015). Several factors contribute to an elevated
risk for some adolescents; research suggested that gender, ethnicity, identification as
lesbian, gay, bisexual, or transgender can be significant risk factors (Marshal et al.,
2013). Other risk factors include, but are not limited to: family history, past suicide
attempts, mental illness, substance abuse, significant adverse life events, poor
communication with parents, access to lethal means, exposure to the suicidal behavior of
others, and incarceration (CDC, 2015c; Child Trends Databank, 2015). The Jason
Foundation (2019) included in its literature several other elevated risk factors such as
perfectionist personalities, learning disabilities, low self-esteem, alcohol and drug abuse,
and victims of abuse, molestation, and neglect.
Self-harm: The act of intentionally harming one’s body, such as cutting or burning; while
suicidality is generally not the intention of self-harming behavior, such self-inflicted
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 26
injuries include the possibility of more serious or fatal consequences (Mayo Clinic,
2018a; Mental Health America, 2016).
Social Emotional Learning: The process of providing instruction to help students manage
emotions, establish positive goals, demonstrate empathy, develop and foster positive
relationships with others, and make positive decisions (DePaoli et al., 2017).
Suicidal ideation: According to the Mayo Clinic (2018b), suicidal ideation is “thinking
about, considering, or planning suicide.”
Suicide: The act of ending one’s life through self-inflicted means (Mayo Clinic, 2018b).
Trauma Informed School: Also referred to as trauma aware school, and trauma sensitive
school, a school that promotes an understanding of the effects of trauma on student
performance and outcomes. Trauma informed schools make positive connections among
students and adults; support the physical, emotional, social, and academic success of
students; supports the tenets of social emotional learning; and takes a collaborative,
teamwork-based approach to facilitate positive school connections for students (DePaoli
et al., 2017; Nealy-Oparah & Scruggs-Hussein, 2018; Trauma-Sensitive Schools, n.d.)
Organization of the Study
Chapter One includes the introduction of California AB 2246 (AB No. 2246, 2016) and
the resultant Education Code 215 (California Legislative Information, 2018), presents the
background of the problem, the statement of the problem, the purpose of the study, the questions
upon which this research study focused, a brief review of the limitations and delimitations, and
identifies key terms utilized in the course of the study. Chapter Two presents a review of the
literature relevant to middle school principal leadership, the implementation of suicide
prevention programs per the requirements of EC 215, professional development, and building the
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 27
capacity of stakeholders to improve student outcomes. The methodology utilized in this study,
the research questions, the study design, the sampling procedure, the rationale for performing a
qualitative study, the study’s participants, and the data collection and data analysis are presented
in Chapter Three. Chapter Four includes the results of the study. Chapter Five is a summary of
the findings, their implications for advising best practices for suicide prevention program
implementation collaboratively among middle school stakeholders, and recommendations for
future policy consideration and research.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 28
Chapter Two: Literature Review
Introduction
The literature review for this study begins with a brief history of suicide prevention in the
United States, highlighting the development of the field of suicidology, and the shifts in societal
perceptions of suicide from a mental health issue to a public health issue. The study sought to
examine the implementation of current law; this chapter focuses on national legislation
addressing the youth suicide epidemic, as well as a review of legislative efforts in the State of
California focusing on youth suicide prevention efforts. In an effort to better understand youth
suicide, an epidemiological review of the literature follows, including suicide risk and protective
factors, as well as research surrounding school-based universal, selective, and indicated suicide
prevention programs. The chapter concludes with a brief review of Bolman and Deal’s (2013)
four frames leadership model, which served as a conceptual framework for the current study.
Research related specifically to suicide prevention programs and measures at the middle school
level has been limited; consequently, this literature review aims to draw connections between
what is known about adolescent suicidality and prevention, and what might be derived to
facilitate the implementation of EC 215: Pupil Suicide Prevention Policies (California
Legislative Information, 2018) in California middle school settings.
History of the Suicide Prevention Movement in the United States
While the broad subject of suicide dates back thousands of years in various historical and
cultural contexts, the study of suicidology in the United States is generally considered to have
begun with the work of clinical psychologists Dr. Edwin S. Shneidman and Dr. Norman
Farberow in the early 1950s (Maris, Berman, & Silverman, 2000; Shneidman, 2004). After
discovering hundreds of suicide notes in the Los Angeles County morgue, their primary goal was
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 29
to help individuals suffering from suicidal ideation and behaviors, and obtain a better
understanding of suicidal behavior in adults (American Association of Suicidology, AAS, 2016;
U. S. Department of Health and Human Services, HHS, 2012).
The Los Angeles Suicide Prevention Center (LASPC) was established in Los Angeles,
California with funding from the U. S. Public Health Service by Dr. Edwin Shneidman,
Dr. Norman Farberow, and Dr. Robert Litman in 1958 (AAS, 2016; HHS, 2012; U. S.
Department of Health and Human Services. (2012). The center was the first of its kind in the
United States, dedicated to helping individuals and their loved ones dealing with suicide, and
building upon the limited clinical understanding of suicide (AAS, 2016). The LASPC
established the first suicide crisis phone line, and demand quickly outpaced the availability of the
founding doctors. Shneidman, Farberow, and Litman recruited and trained eight volunteers to
staff the crisis lines, and had them answer calls 24 hours a day (Spencer-Thomas & Jahn, 2012).
The LASPC gained international attention in 1962 when Litman led the investigation into the
untimely death of actress Marilyn Monroe, resulting in a marked increase in calls to the center
and highlighting the breadth of need for such prevention services (Spencer-Thomas & Jahn,
2012).
In 1966, the National Institute of Mental Health (NIMH) established the Center for
Studies of Suicide Prevention in Bethesda, MD (AAS, 2016; U. S. Department of Health and
Human Services, 2012). This resulted in suicide prevention centers, crisis hotlines, and
nonprofit prevention organizations, such as the American Association of Suicidology, being
established throughout the United States in the 1970s (AAS, 2016; U. S. Department of Health
and Human Services, 2012).
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 30
In 1983, the Centers for Disease Control and Prevention (CDC) released data to the
public indicating an increase in youth suicide rates (U. S. Department of Health and Human
Services, 2012). Six years later, the Secretary of the United States Department of Health and
Human Services published the Report of the Secretary’s Task Force on Youth Suicide
(Homeland Security Digital Library, 1989). The report raised awareness of the increasing rates
of youth suicide, and demonstrated that relatively few supports were in place to address this
epidemic. Consequently, the need for a national strategy to address youth suicide was identified
galvanizing ongoing efforts among public and private entities (U. S. Department of Health and
Human Services, 2012). This awareness culminated in a joint resolution from the 99th Congress,
creating “Youth Suicide Prevention Month” in June 1985 (President of the United States of
America, 1985). The Public Health Service Act (Mental Health Amendments, 1990) was
changed to fund efforts by the NIMH to address adolescent suicide and its prevention (Metha,
Weber, & Webb, 1998).
In 1999, Surgeon General David Satcher released a Call to Action to Prevent Suicide
(U. S. Department of Health and Human Services, 1999). This report identified myriad
strategies to support and develop suicide prevention efforts, including a framework of
“awareness, intervention, and methodology” (AIM). Although the report detailed 15 broad
recommendations, it is noteworthy for establishing suicide as a public health concern instead of
merely a mental health issue. Moreover, the report specifically identified youth as an important
population to target with suicide prevention strategies. In the same year, the National Hopeline
Network was established, creating the first nationwide suicide hotline, and laying the foundation
for more comprehensive suicide prevention phone services (Crosby, Cwik, & Riddle, 2015).
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 31
The groundswell of action and advocacy for youth suicide prevention in the 1980s and
1990s culminated in several reports of the early new millennium: the 2012 National Strategy for
Suicide Prevention (U. S. Department of Health and Human Services (HHS), 2012), the Institute
of Medicine’s Reducing Suicide: A National Imperative (2002), President Bush’s Achieving the
Promise: Transforming Mental Health Care in America (The President’s New Freedom, 2003;
see also Cooper, Clements, & Holt, 2011; Institute of Medicine, 2002; Joe & Bryant, 2007;
Stephan et al., 2007). Each of these reports, representing the collaboration of public and private
entities, government agencies, schools, and businesses served to not only add to the collective
knowledge of suicidology and prevention efforts, but also brought discussions and study of
suicide—a topic often considered taboo—into the national spotlight (King, 2006; U. S.
Department of Health and Human Services, 2012; Popenhagen & Qualley, 1998).
In 2012, the National Strategy for Suicide Prevention (NSSP), originally drafted 10 years
earlier, was revised by the National Action Alliance for Suicide Prevention, and U. S. Surgeon
General Regina Benjamin (U. S. Department of Health and Human Services, 2012). The 2012
U. S. Department of Health and Human Services identified four Strategic Directions for ongoing
suicide prevention initiatives: (1) empowering individuals, families, and communities to create
healthy, supporting environments; (2) developing clinical and community-based prevention
programs and services; (3) a comprehensive and multifaceted approach to treatment and ongoing
support services; and (4) develop methodologies to improve suicide-related research, data
collection, and evaluation. In each of these areas, schools are consistently identified as a critical
component of supporting suicide prevention initiatives. The important role of schools,
universities, and youth-service organizations was emphasized in Objective 5.2, which stated,
“Encourage community-based settings to implement effective programs and provide education
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 32
that promote wellness and prevent suicide and related behaviors” (U. S. Department of Health
and Human Services, 2012, p. 42). Notably, the U. S. Department of Health and Human
Services rebranded suicide as a general health issue, and not merely a mental health issue, calling
upon multiple stakeholders to engage in prevention practices and contribute to a better
understanding of suicide prevention (U. S. Department of Health and Human Services, 2012).
National Youth Suicide Legislation Focusing on Education
In 1997, the United States Senate passed Resolution 84 and the United States House of
Representatives passed Resolution 212 during the 105th Congress, declaring jointly that suicide
was a national problem, and preventing it was a national priority (King, 2006). Among the
recommendations in Reducing Suicide: A National Imperative (Institute of Medicine, 2002) was
a provision for federal funding through health and mental health-related agencies to support
suicide prevention programs. Building on the work of suicide prevention advocates in the public
and private sectors over the last few decades, state and federal governments have taken action to
support the development, funding, and mandates of youth suicide prevention programs (Institute
of Medicine, 2002; Knox, Conwell, & Caine, 2004; Reeves, Nickerson, & Brock, 2011).
Some of the first federal legislation passed in support of these efforts include the School
Safety Enhancement Act (1999), Goals 2000 Educate America Act (2000), and the School Anti-
Violence Empowerment Act (2000; Reeves et al., 2011). Each of these acts illustrated the need
for suicide prevention to be addressed in the school setting.
While the No Child Left Behind Act (2002) is most often cited as legislation designed to
promote the academic performance of students in the United States, the act also required schools
to use federal school safety funds to develop safety plans, school violence prevention strategies,
and a crisis management plan for responding to violent or traumatic incidents at schools (NCLB,
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 33
2002; Reeves et al., 2011). These requirements aligned with the youth suicide prevention
movement of the early 2000s and demonstrated the need for schools to attend to both academic
needs and health and safety needs of all students.
One of the most important federal legislative actions in support of youth suicide
prevention was the passage of the Garrett Lee Smith Memorial Act (GLSMA) in 2004 (Goldston
et al., 2010; U. S. Department of Health and Human Services, 2012). This law provided $80
million of direct federal funding in support of youth suicide prevention initiatives, including
screening, training programs, and a coordinated approach among community partners (Goldston
et al., 2010; HHS, 2012). The act additionally provided grants to states for youth suicide
prevention, with the stated intent of schools receiving and utilizing the funds for that purpose
(Joe & Bryant, 2007; Lieberman, Poland, & Cassel, 2008). Notably, while these funds were
designated to support suicide prevention efforts in schools, the act did not address specific
training of teachers and other staff, or assess their ability to deliver such programs.
State legislation addressing teacher training in suicide prevention practices was first
passed in Tennessee in 2007. The Jason Flatt Act requires all teachers to complete two hours of
mandatory youth suicide prevention and awareness training annually as a condition of licensing
(American Foundation for Suicide Prevention, 2016; The Jason Flatt Act, 2019). At present, 19
states have signed the Jason Flatt Act into law; California was the third state to do so in 2008,
authorizing school districts that receive professional development block grant funds to offer (but
not mandate) two-hour suicide prevention trainings to teachers (The Jason Foundation, 2019;
The Jason Flatt Act, 2019). Data by the American Foundation of Suicide Prevention (2016)
reported that 17 states mandate teacher training, but not annually, and 14 states encourage
providing suicide prevention training for teachers and staff, but do not require it.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 34
The evolution of state and federal youth suicide prevention legislation in the United
States over the past two decades demonstrates an ever-increasing responsibility for school
district leadership and school site administrators to ensure that suicide prevention policies,
mental health supports, and counseling services are available to students, and that teachers and
staff are appropriately trained to address at-risk youth and students demonstrating warning signs
of suicidal ideation (U. S. Department of Health and Human Services, 2012; Whitney, Renner,
Pate, & Jacobs, 2011).
Youth Suicide Prevention Legislation in California
The United States Surgeon General’s description of suicide prevention as a serious public
health priority prompted each state to develop a public health approach to suicide prevention.
While California ranks among the lowest states in rates of suicide, California ranks first in the
number of suicide deaths in the United States (CDC, 2018). Since 2000, California legislators,
working in concert with public and private entities, have made several attempts to establish
statewide policy addressing the suicide epidemic in the state (Senate Bill 1356, 2006).
Assembly Bill 2877 (California Legislative Information, 2000) established the California
Suicide Prevention Act of 2000. Assembly Bill 2877 highlighted the particular danger of suicide
to adolescents, citing 1996 data of 207 youth suicide deaths in the state and estimating more than
20,000 youth suicide attempts annually. This legislation empowered the California Department
of Mental Health Services to establish and implement suicide prevention, education, and
gatekeeper training programs (California Legislative Information, 2000).
Several bills that followed were not successfully signed into law; however, they laid the
groundwork for later comprehensive suicide prevention policy. Among them were SB 405
(Senate Bill No. 405, 1999) which attempted to establish a California 24-hour suicide crisis
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 35
phone line network; SB 620 (Senate Bill No. 620, 2001) which outlined a more detailed
statewide suicide prevention policy; and, SB 1356 (Senate Bill 1356, 2006) which endeavored to
adopt a statewide strategic plan for suicide prevention. Governor Arnold Schwarzenegger, who
subsequently directed the California Department of Mental Health to administratively develop
the California Department of Mental Health (2008), vetoed senate Bill 1356. The plan
established a comprehensive and collaborative approach to suicide prevention, detailing
demographic data on suicide, targeted approaches, efforts to educate Californians about suicide,
and outlining recommended actions to improve the effectiveness and accountability of suicide
prevention initiatives (California Department of Mental Health, 2008). Moreover, the plan
underscored the importance that school staff has in detecting and addressing suicide among
youth (California Department of Mental Health, 2008, p. 36).
AB 2246 (Assembly Bill No. 2246, 2016) was signed into law on September 26, 2016 by
Governor Edmund Gerald Brown, Jr. The law established California Education Code 215: Pupil
Suicide Prevention Policies (California Legislative Information, 2018), requiring the governing
board or body of a local educational agency serving pupils in grades 7 to 12 to adopt a policy on
suicide prevention before the beginning of the 2017-2018 school year (Assembly Bill No. 2246,
2016). Specifically, the law required such prevention policies to address the needs of high-risk
groups, including students with disabilities; students with mental illness; students bereaved by
suicide; foster and homeless children; and lesbian, gay, bisexual, transgender, or questioning
youth (Assembly Bill No. 2246, 2016; Trevor Project, 2019).
Education Code 215 (California Legislative Information, 2018) further required training
to be provided to teachers of pupils in grades 7 through 12, addressing suicide awareness and
prevention; previously, such trainings were recommended, but not required by the state
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 36
(Assembly Bill No. 2246, 2016; Trevor Project, 2016). Whereas previous legislative efforts
alluded to the importance of schools and school staff in suicide prevention initiatives, EC 215
directly mandated governing boards and the school districts to oversee implementation of suicide
prevention programs with middle school and high school youth, as well as the teachers and staff
who serve them (Assembly Bill No. 2246, 2016; Trevor Project, 2019).
To facilitate this process, EC 215 (California Legislative Information, 2018) stated that
the California Department of Education (CDE) will develop and maintain a model policy as a
guide (Assembly Bill No. 2246, 2016; CDE, 2017b). In response, the CDE (2017b) provided the
Model Youth Suicide Prevention Policy on its website. The model policy serves as a template
for governing boards and local educational agencies to establish programs for prevention,
intervention, postvention, student and staff training, education, communication with
stakeholders, and crisis team action plans (CDE, 2017b).
Each of these sections of the model policy will be further examined within the context of
this literature review; moreover, effective principal implementation of AB 2246/EC 215
(Assembly Bill No. 2246, 2016; California Legislative Information, 2018) at the middle school
level requires a thorough understanding of how each contributes to a comprehensive suicide
prevention policy.
Understanding Youth Suicide
Suicide is generally defined as death resulting from self-inflicted injury with fatal intent
(Mayo Clinic, 2018b; Silverman, Berman, Sanddal, O’Carroll, & Joiner, 2007). However, the
term “suicidal behavior” represents a range of thoughts, behaviors, and actions associated with
the suicide potential of an individual, which include the following: (a) suicidal ideation (thinking
about, considering, or planning suicide); (b) suicidal intent (verbal and nonverbal communication
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 37
of a desire to die); (c) suicide attempt (self-injurious, non-fatal behavior); and (d) suicide (self-
injurious, fatal behavior) (CDE, 2017b; Mazza, 2006; Mazza & Reynolds, 2008; Miller &
Eckert, 2009; Silverman et al., 2007). As such, youth demonstrating suicidal behaviors exhibit a
variety of thoughts and actions along this continuum, which are neither mutually exclusive to
these steps, nor do they necessarily advance sequentially though them (Miller & Eckert, 2009).
Mazza and Reynolds (2008) suggested that although the frequency of behavior decreases along
this continuum, the level of lethality and probability of fatal results increases. Such findings
underscore the importance of early detection and comprehensive suicide prevention efforts
among middle school aged students.
Epidemiology
The Centers for Disease Control and Prevention biannually conduct the Youth Risk
Behavior Surveillance System (YRBSS), an instrument that monitors multiple types of health-
risk behaviors contributing to death and disability among middle and high school students in the
United States (CDC, 2015b). Survey data is reported nationally, by state, and in selected large
metropolitan areas (CDC, 2015b). According to data collected from California high school
students for the 2015 survey, 29.7% felt sad or hopeless, 17.9% seriously considered attempting
suicide, 15.2% made a suicide plan, 8.2% attempted suicide one or more times, and 1.9% made a
suicide attempt requiring medical attention from a doctor or nurse as a result of injury,
poisoning, or overdose (CDC, 2015b). Although middle school data is not available for
California, YRBSS data for Los Angeles, CA indicated that 22.8% of middle school students
seriously thought about killing themselves, 14.6% made a suicide plan, and 9.1% tried to kill
themselves (CDC, 2015b). While the statistics surrounding youth suicide in southern
California’s highly-populated counties are generally lower than in other rural parts of the state,
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 38
the number of students who ideate, attempt, and complete suicidal acts are highest in Los
Angeles County (CDC, n.d.).
A review of research literature addressing the epidemiological and etiological aspects of
suicide demonstrated how broadly the ominous subject affects individuals of all ages, lifestyles,
and demographics; nonetheless, a challenge of the current study is the comparatively low number
of research studies that address youth suicide among middle and high school aged youth targeted
by AB 2246 (Cash & Bridge, 2009; Daniel & Goldston, 2009; Joiner, 2007). Therefore, this
chapter endeavors to explore the various factors that are correlated with youth suicidal behavior,
acknowledging that most studies of suicide are not focused specifically on this age group.
Nonetheless, an effort to establish protocols to decrease the prevalence of youth suicide, to
identify risk factors and interventions, and to ascertain the effectiveness of prevention
implementation at the middle school level must consider such factors within the context of
suicide prevention policy directed at adolescents.
Age and development. Suicide is regularly the second or third leading cause of death
among youth ages 10 to 24 in California (CDC, 2019). The likelihood of suicide increases in
children as they age (Berman et al., 2006; Drapeau & McIntosh, 2015; Heron, 2015). During
adolescence, individuals undergo various physiological, social, emotional, and cognitive
transitions (Everall, Bostik, & Paulson, 2005). Developmentally, adolescents face issues of
identity, gender, sexuality, independence, and change; in some cases, such stressors create
feelings of hopelessness, solitude, and suicidal ideation (Everall et al., 2005; Maples, Packman,
Abney, Daugherty, Casey, & Pirtle, 2005). Research by Weller, Young, Rohrbaugh, and Weller
(2001) supported the notion that developmental immaturity increases feelings of hopelessness in
some teens. Middle school youth are particularly at risk for suicidal behavior, as children and
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 39
adolescents may have a more limited understanding of the lethality of suicidal acts, due to
cognitive immaturity and limited regulation of emotional activity (Pfeffer, 2001) as well as a
developmental tendency for impulsive behavior (Turecki, 2005).
Gender. Research supported that gender plays an important role in suicidal behavior
(CDC, 2015a; Drapeau & McIntosh, 2015; Gould, Greenberg, Velting, & Shaffer, 2003).
Berman et al. (2006) found that although females attempt suicide at rates two to three times the
rate of males, males commit suicide at a rate five times that of females. Drapeau and McIntosh
(2015) utilized 2014 WISQARS data to support the findings, reporting that males commit suicide
at a rate more than three times that of females, whereas females attempt suicide at three times the
rate of males. Among adolescents, such differences have been attributed to males using more
lethal means such as firearms than females in suicide attempts (Bridge et al., 2006; Gould,
Fisher, Parides, Flory, & Shaffer, 1996; Kung, Pearson, & Liu, 2003; Popenhagen & Qualley,
1998). A study by Callanan and Davis (2011) disaggregated data from 621 suicides by gender,
and found that females generally choose less lethal means to attempt suicide that were less likely
to disfigure the face or head, resulting in a lower suicide completion rate than males. Kung et al.
(2003) also found that males are more likely to use alcohol or drugs before a suicide attempt,
exacerbating the risk of completed suicide. Maris et al. (2000) found that males were more
likely than females to have significant suicide risk factors, and less likely to utilize protective
factors like seeking help or accessing support systems.
This researcher notes two areas of controversy in the literature regarding gender. First,
while marked differences exist between male and female suicidality, one gender is no more at
risk than the other; rather, males and females demonstrate various differences with respect to risk
factors. Second, traditional gender binary distinctions of male and female do not represent all
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 40
individuals; however, most suicide research relating to gender of the past 70 years does not
address non-binary gender individuals. Since 2001, relatively few research studies have
addressed suicidal behavior among transgender and gender-nonconforming adults (Clements-
Nolle, Marx, Guzman, & Katz, 2001; Clements-Nolle, Marx, Katz, 2006; Grant et al., 2011;
Maguen & Shipherd, 2010; Whittle, Turner, & Al-Alami et al., 2007; Whittle, Turner, & Rhodes,
2008; Xavier et al., 2005, 2007). Although none of these studies address youth under the age of
18, they collectively demonstrate much higher risk rates for suicidal behavior than individuals
who identify as either male or female (Haas, Rodgers, & Herman, 2014). While the next section
examines sexual orientation and identity, the literature groups transgender and non-binary
genders with LGBTQ youth.
Sexual orientation. Adolescents and youth who identify as gay, lesbian, bisexual,
transgender, or questioning (LGBTQ) are at an increased risk of suicidal behavior compared to
their heterosexual peers (Hong, Espelage, & Kral, 2011; Marshal et al., 2013; Mustanski & Liu,
2013; Russell & Joyner, 2001; Stone, Luo et al., 2014; Trevor Project, 2018). According to the
Centers for Disease Control and Prevention (2017), gay, lesbian, and bisexual youth are almost
five times as likely to attempt suicide as heterosexual youth. A national study of transgender
adults found that 40% reported attempting suicide, and 92% of these individuals made at least
one attempt before the age of 25 (James et al., 2016).
In 1998, a relatively early study of 7th through 12th grade students in Minnesota public
schools administered the Adolescent Health Survey to ascertain information about students’
behaviors, mental health, family, school, and sexual orientation (Remafedi et al., 1998).
Students were asked to complete a Likert scale rating the degree to which each was questioning
his or her own sexuality, ranging from completely sure to completely unsure. The study found
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 41
that students who self-identified as homosexual or bisexual were seven times more likely to
engage in suicidal thoughts or behavior, with 28.1% of homosexual and bisexual males and
20.5% of homosexual or bisexual females reporting suicide attempts. These figures were
markedly higher than the rates reported by heterosexual males and females in the study.
As with gender, research suggested that sexual orientation and identity is not the root
source of suicide risk; rather, various underlying factors and related stressors are more often
attributed to elevated risk of suicidal behavior (Mustanski & Liu, 2013; O’Donnell, Stueve,
Wardlaw, & O’Donnell, 2003; Russell, 2003; Silenzio et al., 2007, Trevor Project, 2018). Youth
identifying as LGBTQ are more likely to endure more frequent victimization, stress related to
gender nonconformity, stress associated with coming out, rejection from peers, bullying, societal
homophobia, and a lack of social support (O’Donnell et al., 2003; Russell, 2003; Trevor Project,
2018). Silenzio et al. (2007) posited that an unsupportive environment and lack of support
perceived by LGBTQ youth contributes profoundly to an elevated risk of suicidal behavior.
Hatzenbuehler, Birkett, Van Wagenen, and Meyer (2014) found that positive school climate and
social structures that are supportive of LGBTQ youth are an important protective factor to reduce
the risk of suicidal behavior. Positive support from parents (Mustanski & Liu, 2013) was also
determined to reduce the risk of suicide among LGBTQ youth. Such findings underscore the
importance of middle school principals to work with parents, staff, and other stakeholders to
ensure that school communities are safe and welcoming places for all students.
Race and ethnicity. Research indicated that racial and ethnic factors play a role in
suicidal behavior among adolescents (Crosby & Molock, 2006; Eaton et al., 2011). In the United
States, Native Americans, Alaskan natives, and Whites have the highest rates of suicide, but the
data is not conclusive as to which group is highest (American Association of Sociology, AAS,
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 42
2016; CDC, 2017; Curtin, Warner, & Hedegaard, 2016; Drapeau & McIntosh, 2015). These
discrepancies in the data are attributed to the multiyear delay in collecting comprehensive suicide
data, misclassification of race and ethnicity, and the assertion among researchers that cultural
and other factors result in suicide deaths being underreported for some ethnic groups (Curtin et
al., 2016; Jiang, Mitran, Miniño, & Ni, 2015). Data presented by the CDC (2014b) indicated
suicide rates for Native American and Alaska natives of 36.1%; Whites at 33.3%,
Hispanic/Latino at 12.8%, Asian/Pacific Islander at 12.4%, and African American at 11.8%. In
each of these ethnic groups, it is noteworthy that males committed suicide at more than three
times the rate of females (CDC, 2014b).
The suicide rate among African Americans, while lower than other groups, has increased
in recent years, especially among male youth (Crosby & Molock, 2006; Joe, Baser, Breeden,
Neighbors, & Jackson, 2006; Leong & Leach, 2007). Berman, Jobes, & Silverman (2006) found
that between 1960 and 2000, the suicide rate for African American males ages 15 to 19 increased
by 234%. Eaton et al. (2011) noted a marked increase in suicidal ideation and behavior among
Hispanic/Latino youth, particularly females, correlating to earlier research by Langhinrichsen-
Rohling, Friend, & Powell (2009) who found higher rates of mental illness among this ethnic
group.
As with other demographic indicators, disparities in suicide rates are not ascribed solely
to the ethnicity of the individual, and that cultural and economic differences among these groups
have a greater impact on suicidal behavior (Berman et al., 2006; Goldston et al., 2010; Leong &
Leach, 2007). For example, many Native Americans suffer from high rates of unemployment,
alcohol and substance abuse, access to firearms, difficult family relationships, depression, and
poor living conditions (Horwitz, 2014; Langhinrichsen-Rohling et al., 2009; Middlebrock,
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 43
LeMaster, Beals, Novins, & Manson, 2001). However, Berman et al. (2006) noted that suicide
rates vary widely among Native Americans by geographic location and tribe. Thus, for the
purposes of the present study, it is noted that suicide data disaggregated by race and ethnicity
bears a wide range of rates, risk factors, and protective factors. Such differences noted in the
literature may advise suicide prevention efforts among youth in the middle school setting, based
on the larger community in which the school operates.
Suicide Risk and Protective Factors
There is no single cause for suicide; rather, many different risk factors contribute to an
elevated risk of suicidal thoughts and behaviors among adolescents, as protective factors serve to
mitigate risk (American Foundation for Suicide Prevention, 2016; Bridge et al., 2006; Cash &
Bridge, 2009; Esposito-Smythers & Spirito, 2004; Evans, Hawton, & Rodham, 2004; Gould et
al., 2003; Institute of Medicine, 2002; Lieberman, Poland, & Kornfeld, 2014; Marshal et al.,
2013; U. S. Department of Health and Human Services, 2012; Stone & Crosby, 2014). The
aforementioned/ referenced literature revealed a comprehensive review of risk and protective
factors related to physical and mental health, family, environment, experiences, and social
structures. Often, risk and protective factors interact in complex ways and do not manifest the
same ways in different people.
An important distinction is to be made between risk factors and warning signs.
According to the American Psychiatric Association (2018), risk factors indicate that an
individual may be more likely to consider, attempt, or die by suicide (e.g. a family history of
suicide), whereas warning signs indicate an immediate risk of suicide (e.g. communicating a
desire to end one’s life). Van Orden, Witte, Selby, Bender, and Joiner (2008) suggested that risk
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 44
factors and warning signs often overlap, highlighting that risk factors represent a distal
relationship to suicidal behavior, whereas warning signs suggest a proximal relationship.
Many school-based suicide prevention programs aimed at adolescents require that staff
can recognize and respond appropriately to risk factors and warning signs (Lieberman et al.,
2008; Kalafat, 2003) As the current study sought to examine principal implementation of suicide
prevention practices among middle school aged youth, knowledge, understanding, and
application of risk and protective factors is of the utmost importance. While not exhaustive,
what follows in this chapter is an overview of select individual, family, and social-environmental
characteristics associated with an elevated risk of suicidal behavior among adolescents, and
related protective factors.
Individual characteristics. Prior suicidal behavior and psychopathology are well-
documented in the literature as chief risk factors for future suicidal ideation and attempt among
adolescents. Notably, many individuals who have survived acute or episodic past suicidal
behavior, as well as individuals with diagnoses of psychopathological disorders, lead functional
and productive lives. Nonetheless, research indicated that these risk factors demonstrate elevated
risk for future suicidal behaviors (Borowsky, Ireland, & Resnick, 2001; Bridge et al., 2006;
Joiner, 2007). The comorbidity and concurrence of multiple risk factors for many individuals
emphasizes the importance of training, vigilance, and action by those charged with
implementation of suicide prevention initiatives.
Prior suicidal behavior. Research indicated that history of one or more previous suicide
attempts is a strong predictor of additional suicidal behavior, with elevated risk within six
months of a prior suicide attempt (Borowsky et al., 2001; Bridge et al., 2006; Gould et al., 2003;
Joiner et al., 2007; Leong & Leach, 2007). Drapeau and McIntosh (2015) found an association
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 45
between the lethality of the previous suicide attempt method, and the likelihood of completing
suicide in the future. In particular, Bridge et al. (2006) determined that youth who attempt
suicide by hanging, firearms, or jumping are at extremely high risk for future suicide completion.
In somewhat ironic contrast to these findings, a study by Anestis (2016) utilized 2005-
2012 data from the National Violent Death Reporting System to examine suicide deaths
(n=71,775) by firearms and other means, to assess if a relationship existed between prior suicide
attempts and means affected to complete suicide. The study found that 12.1% of individuals
who completed suicide using firearms had reported a previous attempt, compared to 28.66% of
decedents who completed suicide by other means. The findings imply that individuals who
complete suicide by firearms die on their first attempt more often than other decedents, due in
part to the lethality of means. The study also alluded to the importance of means restriction as a
protective factor, which will be discussed later in the chapter.
Miranda, Ortin, Scott, and Shaffer (2014) sampled 506 high school aged adolescents to
complete the Columbia Suicide Screen and portions of the Diagnostic Interview Schedule for
Children to establish baseline data on the currency, frequency, seriousness, and duration of their
suicidal ideation. Their examination and follow up four to six years later revealed that
participants whose responses indicated they ideated suicide often, seriously, and for a long time
were associated with future suicide attempts. Such findings suggest the importance of
ascertaining youth suicidal ideation as a risk factor of future suicide attempts.
A 2003 study by Spirito, Valeri, Boergers, and Donaldson sampled 58 adolescents who
had attempted suicide to complete a baseline evaluation for risk factors and continued suicidal
ideation. Follow up at three months demonstrated that 45% of participants continued to ideate
suicide, and 12% reported a repeat attempt. The study also revealed that other risk factors, such
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 46
as familial stress and depression, contributed to repeated suicidal behavior. While these findings
highlight the complex nature of multiple risk factors, the study supported other research that
prior suicide attempts represent a significant risk factor for future suicide (Joiner, 2007; Miranda,
et al., 2008). This study by Spirito, Valeri, Boergers, and Donaldson (2003) is supported by
Leong & Leach’s (2007) and Miranda et al.’s (2008) findings that a suicide risk assessment must
inquire about previous suicide attempts, how recently the attempt occurred, the frequency of
previous attempts, and the ongoing accessibility of suicidal means.
Psychopathology. Numerous studies have shown the presence of mental and behavioral
disorders among youth who ideate, attempt, or complete suicide (Brent, Baugher, Bridge, Chen,
& Chiappetta, 1999; Bridge et al., 2006; Cavanaugh, Carson, Sharpe, & Lawrie, 2003; Groholt,
Ekeberg, & Haldorsen, 2006; Fleischmann, Bertolote, Belfer, & Beautrais, 2005; Nock et al.,
2013; Speaker & Peterson, 2000). Researchers conducting postmortem structured interviews
with family and friends of suicidal decedents revealed that approximately 90% of youth who die
by suicide were afflicted with at least one mental disorder (Brent et al., 1999; Fleischmann et al.,
2005; Gould et al., 2003). Miller and McConaughy (2005) stated that most youth who die by
suicide possess multiple comorbid psychiatric disorders or psychological issues.
Major depressive disorders are most commonly associated with psychopathological
suicide risk factors among adolescents (Apter & King, 2006; Fleischmann et al., 2005; Sanchez
& Lee, 2001). While the majority of clinically depressed youth are not suicidal, Speaker and
Peterson (2000) stated that half of teens ideating suicide also report feelings and symptoms of
depression.
Anxiety related disorders (e.g. panic disorder, post-traumatic stress disorder) and
substance-related disorders are also indicated in suicidal behavior (Brent et al., 1999; Gould et
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 47
al., 2003; Mazza & Reynolds, 2008; Nock et al., 2013; McManama O’Brien & Berzin, 2012).
The comorbidity of substance abuse with depressive and other disorders is highly associated with
adolescent suicidality and exacerbates the level of risk (McManama O’Brien & Berzin, 2012).
Bipolar disorder, characterized by shifts in mood between manic and depressive episodes,
has been associated with adolescent suicidal behavior. Hauser et al. (2013) conducted a review
of 14 studies addressing pediatric bipolar disorder and suicide risk. Their findings revealed that
57.4% of youth reported past suicidal ideation, 50.4% were presently ideating suicide, 21.3% had
attempted suicide in the past, and 25.5% had attempted suicide within the last year. At the time
of their study, Hauser et al. (2013) noted that only one of the 14 studies they reviewed addressed
suicide intervention among those afflicted with bipolar disorder.
Researchers for a connection to suicidal behaviors have also recently investigated
Attention Deficit-Hyperactivity Disorder (ADHD) and other disruptive behavior disorders. The
National Alliance on Mental Illness (2018) estimated 9% of children between the ages of 3 and
17 have ADHD. A meta-analysis of the literature by Mayes et al. (2015) found that 5.5% of
children with ADHD made at least one suicide attempt, and 15.8% of children with ADHD
ideated suicide. Diagnoses of comorbidity with other conditions (e.g. Oppositional Defiance
Disorder; ODD) increased suicide risk significantly (Mayes et al. 2015). The behaviors of
adolescents with ADHD, such as aggressiveness, lack of focus, and struggling to follow
directions often contributes to poor social relationships and low school performance (Carlson,
2006). These results, in turn, may increase stress, lower self-esteem, and increase the risk of
suicidal behavior in some youth.
Broadly, a diagnosis of mental illness in youth and adolescents is represented in the
literature as markedly increasing suicide risk. Research findings alluded to the importance of
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 48
careful monitoring of student behaviors by families and school personnel, and open
communication between them (Carlson, 2006; Mayes et al., 2015).
Family characteristics. In addition to the individual factors cited above, the literature
pointed at various family-related risk factors that contribute to adolescent suicidal behavior.
Parental psychiatric disorders, a family history of suicide, alcohol and substance abuse, conflict,
and difficulties with family life each contribute to the complex interactions of various suicide
risk factors for youth.
Family history of suicide. Adolescent suicide risk has been found to be higher for
individuals with a parental history of suicidal behaviors and psychiatric illness (Afifi et al., 2009;
Agerbo et al., 2002; Brent et al., 2002; Brent et al., 2015; Cheng et al., 2000; Lieb et al., 2005;
Nanayakkara et al., 2013; Powell et al., 2000; Qin, Mortensen, & Pedersen, 2009; Runeson &
Åsberg, 2003). Lieb et al. (2005) sampled 933 adolescents in a longitudinal study to determine
suicidal ideation and attempts of adolescents and their mothers, collecting baseline and four-year
follow up data. The results showed that compared to offspring of mothers without suicidality,
offspring of mothers reporting suicide attempts were nine times higher among both males and
females (Lieb et al., 2005).
While Lieb et al. (2005) did not conclude why the correlation exists, Mann et al. (2001)
suggested that suicidal behavior may be passed down genetically. One of the more common
neurobiological factors of suicide is abnormal functioning in the serotonergic system of the
prefrontal cortex, which has been associated with a variety of disorders like depression and
anxiety (Furczyk, Schutovöa, Michel, Thome, & Büttner, 2013). Some studies have determined
a genetic connection with such disorders that contribute to suicidality (Brent & Mann, 2005;
Mann et al., 2005; Roy & Janal, 2005). A family history of depression, bipolar disorder,
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 49
schizophrenia or other psychiatric illness may increase the likelihood that an individual will also
be so afflicted, thus increasing the risk for suicidal behavior (Turecki, 2005).
Family dynamics. In addition to a genetic link to suicidality, various social and
environmental aspects of family life may contribute to increased suicidal risk among youth.
Difficult relationships, poor family communication, parental psychiatric disorders, family
substance abuse, and stress in the household can also increase suicidality, particularly among
adolescents exposed to other risk factors (Afifi et al., 2009; Brent et al., 2015; Sourander et al.,
2006). Randell, Wang, Herting, and Eggert (2006) found that adolescents in homes with low
family trust, poor communication, or critical parents increased feelings of depression and
hopelessness. O’Donnell, O’Donnell, Wardlaw, and Stueve (2004) stated suicidal adolescents
tend to have negative and infrequent communication with parents.
Youth exposed to parental abuse are at increased risk of suicidal behavior (Afifi et al.,
2009; Brezo et al., 2008; Brock, Sandoval, & Hart, 2006; Fergusson, Boden, & Horwood, 2008;
Joiner, 2007; Lieberman et al., 2008). Brent et al. (2002) and Brodsky et al. (2008) noted that a
parent’s own experiences with abuse may manifest as mental illness, suicidal behavior, or
substance abuse that adversely affects their own children and increases suicide risk. Wagner,
Silverman, and Martin (2003) supported the notion that children and adolescents exposed to
parents with psychiatric disorders and suicidal behaviors may be at increased risk.
Family structure and relationships may also play a role in suicide risk among youth.
Bridge et al. (2006) and Gould et al. (2003) note that individuals who attempt or complete
suicide are more likely to have been reared by parents who were divorced or separated. Weller
et al. (2001) noted increased suicide risk among adolescents who experience regular conflict with
parents, domestic violence, and serious medical or mental illness in the family.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 50
Randell et al. (2006) sampled 1,083 low-performing students from 14 high schools to
assess how family risk and protective factors impacted their suicide risk. Results showed that
nearly half (47%) of the participants were at risk for suicide, with 131 at high risk. Higher levels
of suicide risk were associated with perceived parental conflict, unmet family goals, and family
depression, whereas perceived parental involvement, expression of affection, and family support
for school were found to be protective factors (Randell et al., 2006). For the purposes of the
present study, the findings demonstrated the significance of supportive interactions within the
family unit that are connected to student welfare. Moreover, meaningful connections between
school and families, particularly with students who may be at risk of suicidal behavior, can also
serve as a protective factor against suicide risk. Thus, effective implementation of school-based
adolescent suicide prevention should include elements that support the family and their role in
supporting the child at school.
Social-environmental characteristics. As mentioned in previous sections, multiple risk
factors and protective factors overlap in complex ways, perhaps differently for every adolescent.
The individual and family risk factors reviewed above do not occur in a vacuum; rather, these
risk factors interact within and are influenced by various social and environmental
characteristics.
Location of community. Research results are mixed on whether adolescents living in
urban or rural areas are at higher risk for suicide. O’Donnell et al. (2004) posited that suicide
rates tend to be higher in metropolitan inner-city areas, particularly economically disadvantaged
areas. Such areas, the researchers suggested, place youth at increased risk of experiencing
violence, substance abuse, having their needs unmet, or experiencing stress and mental health
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 51
issues (O’Donnell et al., 2004). Among 879 urban Black and Latino adolescents, 15% had
seriously considered suicide, 13% had made a suicide plan, and 11% had attempted suicide.
Armstrong and Manion (2006) offered contrasting findings from their study of suicidality
among 242 rural youth. The researchers found that geographic isolation in rural areas increased
risk factors for depression and suicide. Males, in particular, were found to have higher suicidal
ideation the farther their homes were from their school. This distance also affected students’
participation in extracurricular activities, which the researchers identified as a protective factor
against suicidal behavior.
A 2015 longitudinal study of adolescent suicide rates in rural and urban areas conducted
by Fontanella, Hiance-Steelesmith, Phillips, Bridge, Lester, Sweeney, and Campo examined
66,595 youth suicide deaths in the United States. The researchers found that rural suicide rates
were 19.93%, nearly double the 10.31% measure of urban suicide deaths. The study also found
that firearms deaths were 2.69 times higher in rural areas.
Data reported on the CDC (n.d.) website supports the notion that suicide rates in the state
are highest in the rural, northeastern counties; however, the number of deaths by suicide are
highest in more densely populated urban areas, particularly in the southern third of California.
Findings suggesting that urban youth may be at increased risk of substance abuse, violence, and
mental illness and that rural youth may struggle with isolation and social engagement, imply the
importance of considering how suicide prevention programs address the specific environmental
needs of students in different geographic areas.
Stress, trauma, and abuse. When coupled with the developmental and social difficulties
experienced during adolescence, stressful events can place youth at increased risk for suicidal
ideation and attempt (Mathew & Nanoo, 2013; Maples et al., 2005). Conflicts with friends, loss
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 52
of a romantic relationship, or the death of a loved one may cause an increase in adolescent
suicidal behavior (Ayyash-Abdo, 2002). Weller et al. (2001) asserted that feelings of
hopelessness and frustration are magnified in developing youth. Such feelings may lower self-
esteem and increase negativity.
Séguin, Renaud, Lesage, Robert, and Turecki (2011) conducted a retrospective study to
identify adversity and life events that lead to suicide. The researchers found that neglect and
sexual abuse were more predominant among adolescents who completed suicide than those in
the control group. Similar findings resulted from a 2017 longitudinal study of 220 adolescent
girls by Miller, Eisenlohr-Moul, Giletta, Hastings, Rudolph, Nock, and Prinstein. Participants
completed baseline and quarterly measures of suicidal ideation and behavior, depressive
symptoms, and stress. Miller et al. (2017) found that stress and depression are significant risk
factors among those with a history of sexual abuse, and that elevations in these risk factors
contributed to increased risk of suicidal ideation and behavior.
Brown, Holcombe, Bolen, and Thomson (2006) followed a cohort of children through
adolescence for 17 years, focusing on individuals who had experienced violence and neglect.
The researchers found that the stressors experienced by the participants rendered them three
times more likely to attempt suicide than those who had not experienced stress. Individuals who
had experienced sexual abuse were eight times more likely to exhibit suicidal behavior, and
found to be at greater risk for multiple suicide attempts (Brown et al., 2006). Hadland, Marshall,
Kerr, Qi, Montaner, and Wood (2012) studied a cohort of 495 street-recruited youth. While the
researchers conceded that snowball sampling was a significant limitation of the study, their
findings demonstrated a significant correlation between physical and sexual abuse, and suicide
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 53
attempts among the cohort. Forty-six of the participants reported a suicide attempt during the
study period, with 201 reporting physical abuse and 131 reporting sexual abuse.
Schmidt, Iachini, George, Koller, and Weist (2014) found social stressors such as
bullying, losing a loved one, or family problems contribute to suicidal behavior. Social isolation
and loneliness have been studies in youth suicide research. Perceptions of rejection and low peer
support contribute to suicide risk among adolescents (Ayyash-Abdo, 2002). Social relationships
in adolescence are an important part of development, and maintaining or losing connections with
same age peers can elicit anxiety or even become overwhelming (Bostik & Everall, 2007; Kidd
et al., 2006). Hall-Lande, Eisenberg, Christenson, and Neumark-Sztainer (2007) surveyed 4,746
middle and high school students regarding peer relationships, psychological health, school
connectedness and other factors. The researchers found that feelings of social isolation were
associated with increased risk for depression, lowered self-esteem, and suicide attempts (Hall-
Lande et al., 2007). Such studies underscore the importance of schools and families
collaborating to promote healthy peer relationships, connectedness, and involvement within the
school community.
As the number and frequency of adverse life experiences rises, the risk of youth suicidal
behavior also increases (King et al., 2001; Waldrop, Hanson, Resnick, & Kilpatrick, 2007).
Research findings support that stress, exposure to traumatic situations, and experiences of
physical or sexual abuse increase the risk of suicidality among adolescents. As with other risk
factors, comorbidity further increases the danger; thus, stress and trauma should be considered
among other risk factors in the development and delivery of adolescent suicide prevention
programs.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 54
Exposure to suicide, suicide contagion. One of the more common and enduring myths
surrounding youth suicide is the belief that asking an individual about suicide will prompt them
to become suicidal (Berman et al., 2006; Brock, 2002; Kalafat, 2003; Mazza & Reynolds, 2008;
Miller & Eckert, 2009). On the contrary, research has shown no empirical basis for this belief,
and that opportunities for youth to discuss suicide facilitate discussion of their feelings and
behaviors (Kalafat, 2003; Gould et al., 2005; Mazza & Reynolds, 2008; Miller & Eckert, 2009).
Miller (2013) posited that discussions with adolescents suspected of suicidal behavior are an
essential component of suicide risk assessment. In essence, speaking with an adolescent who is
not suicidal will not make him so; speaking with an adolescent who is already in a vulnerable
suicidal state may facilitate intervention.
Berman et al. (2006) stated dispelling the myth of suggested suicide is important for
school-based suicide prevention initiatives, which in some cases have been labeled as harmful
due to the belief that speaking with students about suicide will increase risk. Mathias et al.
(2012) found no relationship among adolescents receiving psychiatric treatment between
repeated conversations about suicidal ideation and any increase in self-reported ideation.
Seemingly paradoxical are research findings that demonstrate increased risk of suicidal
behavior among adolescents who are exposed to suicide. The term suicide contagion (Zenere,
2009) is used to describe this phenomenon. According to Haw, Hawton, Niedzwiedz, and Platt
(2013) and Zenere (2009), suicide contagion can spur the development of a suicide cluster; that
is, multiple suicidal behaviors occurring in an accelerated time frame and/or within a specific
geographic area. Mass clusters, historically associated with media coverage of suicide, occur
within a finite time frame; point clusters occur within a specific time frame and geographic
location (Haw et al., 2013). So-called “copycat suicides” are most commonly observed among
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 55
adolescents, with as many as 60% of all youth suicides being associated with suicide contagion
(Cox et al., 2012). Bearman and Moody (2004) found that adolescents with a friend who
attempted suicide were at increased risk of engaging in their own suicide attempt.
In 1989, the Centers for Disease Control and Prevention convened a national workshop to
address suicide contagion among adolescents and young adults, based in part on research
conducted by Phillips and Carstensen (1986) documenting an increase of suicide contagion
related to media coverage of suicide. Among the CDC (1994) recommendations were media
guidelines on how suicide should be reported in newspapers and on television, measures to avoid
glorifying suicidal individuals or means, avoiding excessive suicide reporting, and appropriate
common language.
The findings surrounding suicide contagion have profound implications for school-based
suicide prevention programs. Specifically, school staff must ensure that accurate, factual, and
appropriate information is shared with the school community regarding a student suicide death or
attempt without glamorizing it, and that all stakeholders remain vigilant to issues of suicide
contagion following a suicide (Brock et al., 2006).
Access to firearms and other means. Research supported that access to means of suicide
is an important risk factor to consider in suicide prevention efforts. Therefore, reducing or
eliminating such access is tantamount to lowering the risk of suicidal behavior to individuals in
crisis or who are exhibiting other risk factors (AAS, 2016; Barber & Miller, 2014; Brent, 1991;
Gould et al., 2003; Kposowa & McElvain, 2006). Barber and Miller (2014) stated that many
suicidal crises are short lived, and that individuals will generally utilize a suicide method that is
readily available to them. Thus, eliminating access to means can be an effective way to mitigate
the immediacy of a suicide attempt. Several studies interviewing individuals who attempted
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 56
suicide revealed that the time interval between deciding to commit suicide and making the
attempt was 10 minutes or less for 24% to 74% of participants (Barber & Miller, 2014;
Deisenhammer et al., 2009; Simon et al., 2001).
Access to weapons and other means of suicide is of particular concern for adolescents
experiencing suicidality. The American Association of Suicidology (2016), the American
Psychiatric Association (2018), and the Centers for Disease Control and Prevention (2018) all
recommend that parents and guardians carefully monitor children’s access to firearms, knives,
medications, and ropes. While eliminating access to such items does not remove suicide risk to
youth, it lowers the risk of adolescents attempting suicide impulsively, as the risk period for
suicide may be transient (APA, 2018; Gould et al., 2003).
Over the last three decades, studies have revealed that firearms account for the highest
number of suicide deaths among adolescents, ranging between 51% (American Journal of
Preventative Medicine, 2014) to 70% (American Association of Suicidology, 2011). Moreover,
AAS (2007) found that suicides from firearms are completed 78% to 90% of the time, making
firearms the most lethal means. An analysis of suicide data from all 50 states in the United
States by Spicer and Miller (2000) showed similar results, with firearms suicide lethality
between 85% and 90%. A 2007 study by Miller used survey-based measures of state household
firearm ownership in states with high gun ownership and states with low gun ownership,
controlling for poverty, unemployment, mental illness, drug and alcohol abuse, and other suicide
risk factors. Miller (2013) found that among 39 million people with household gun ownership of
47%, there were 9,749 firearms suicides between 2000 and 2002, whereas among 40 million
people with household gun ownership of 15%, there were 2,606 firearms suicides. Non-firearms
suicides were nearly the same between the two groups, with 5,060 and 5,446, respectively. Such
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 57
research findings demonstrate the importance of restricting youth access to guns, particularly
those with comorbid conditions or other risk factors.
Substance abuse. Adolescents demonstrating suicidal behaviors often have a history of
substance abuse, comorbid with psychiatric disorders, and other risk factors (American
Psychiatric Association, 2018; Ayyash-Abdo, 2002; Brent et al., 1999; Cavanaugh et al., 2003;
Gould et al., 2003; Nock et al., 2013; McManama O’Brien & Berzin, 2012). A 2002 study by
Ayyash-Abdo found 38% of adolescents who attempted suicide had consumed alcohol within six
hours prior to their attempt. Ayyash-Abdo (2002) found that suicidal adolescents were up to 50
times more likely to make an impulsive suicide attempt if they were under the influence of
alcohol or drugs; attributing these findings to impaired judgment, altered mood, reduced decision
making, and problem solving.
A more recent study by Liu, Case, and Spirito (2014) sampled 2,095 teens ages 12 to 17
who had potentially used injectable drugs and who reported comorbid feelings of depression.
The participants were interviewed about depression, substance use, suicidal ideation, and
behavior. Liu et al. (2014) found that 82% of participants reported suicidal ideation, 40% had
previously made a suicide plan, and 45% had made a suicide attempt. Sixty-two percent of teens
who affirmed they regularly injected drugs reported at least one suicide attempt. Liu et al.
(2014) concluded that while depression was a significant risk factor for suicide, participants who
also used injectable drugs were at greater risk.
The implications of these findings highlight the importance of immediate treatment for
youth with substance abuse issues. Moreover, school-based suicide prevention initiatives might
leverage existing anti-drug and alcohol education programs in the middle and high school health
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 58
curriculum. Family or school knowledge that an adolescent with other risk factors is using drugs
or alcohol should also trigger additional screening, risk assessment, and intervention.
Protective factors. The Centers for Disease Control and Prevention (2017) stated
whereas risk factors for suicide are comprised of individual, social, and societal factors that
increase an individual’s risk for suicidal behavior, protective factors serve to shield individuals
from suicidality. While risk factors are well-documented in the literature, protective factors have
not been studied as extensively (CDC, 2017). A growing body of research suggested that
protective factors are an effective buffer for suicidal risk factors, and that their study might
enrich suicide prevention practices and programs (Kleiman & Liu, 2014, Taliaferro &
Muehlenkamp, 2014, Walsh & Eggert, 2007).
Walsh and Eggert (2007) sampled 730 urban at-risk high school students, and
administered the Measure of Adolescent Potential for Suicide (MAPS) instrument to assess the
relationship between risk factors, protective factors, and suicidal behavior. Protective factors
were separated into personal resources (e.g. self-esteem, personal control, problem solving) and
social resources (e.g. amount and availability of support from others). Participants were also
interviewed, screening for risk and protective factors, with half demonstrating some level of
suicidal risk. The study revealed that students with higher risk factors and lower protective
factors reported a history of suicidal ideation and attempts. Such students reported perceptions
of lower support from peers, parents, and their community. Notably, the study demonstrated
although all participants were determined to have other risk factors, those with greater protective
factors were at a reduced risk of suicide.
A study conducted in 2013 by Taliaferro and Muehlenkamp (2014) analyzed a
population-based sample of 70,022 students in grades 9 and 12 to determine risk and protective
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 59
factors among three emergent groups in the sample: no suicidality, suicidal ideation only, and
suicide attempt. Depressive symptoms and hopelessness were reported as significant risk factors
among those individuals exhibiting suicidal behavior. Parent connectedness and academic
achievement were shown to be important protective factors. Such findings in these studies hint
at the importance of not only facilitating protective personal and social protective factors among
at-risk youth, but also ensuring that school-based suicide prevention initiatives foster personal,
familial, and social development among adolescents.
As there are several risk factors associated with family dynamics and relationships, so too
are familial protective factors a critical component of reducing suicide risk among youth. A
perception of connection to family is associated with reduced suicide risk among adolescents
(Kaminski et al., 2010; Kleiman & Liu, 2013; O’Donnell et al., 2004). Children who live with
families that facilitate a sense of belongingness and positive interactions, along with social and
emotional support, have been shown to be less likely to make a suicide attempt when ideation
and other risk factors are present (Sharaf, Thompson, & Walsh, 2009). Religion and spirituality,
generally fostered by the family, has also been documented as a protective factor for youth
(Kleiman & Liu, 2014).
Protective factors should be considered an essential component of school-based suicide
prevention initiatives. Several protective factors documented in the literature aid adolescents in
dealing with stress, anxiety, feeling overwhelmed, and suicidality. Such protective factors may
foster resiliency and perseverance among youth, and balance the presence of suicide risk factors.
These notions point to the importance of identifying both risk factors and protective factors in a
youth risk assessment, particularly among school personnel charged with ensuring student safety.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 60
Middle School Suicide Prevention
In California, public middle schools are an ideal setting to address suicide prevention
with youth, a group for whom suicide is a leading cause of death. For the 2016-2017 school
year, there were 1,421,723 California public school students in grades 6 through 8, each required
to regularly attend school (CDE, 2017a). The school setting facilitates monitoring risk factors
and observing behaviors of these students that may suggest suicidal risk, and many middle
school staff include individuals with mental health training, such as school counselors and
psychologists (Kalafat, 2003; King, Price, Telljohann, & Wahl, 1999; Liebling-Boccio &
Jennings, 2012; Mazza & Reynolds, 2008). During the instructional day, a child may interact
with multiple teachers; each plays an integral role in identifying academic, social, or emotional
issues with which the student is dealing. While middle school administrators and staff are
primarily charged with the academic success of each student, they are also responsible to support
the well-being and mental health of students, including those demonstrating risk factors or
suicidal behaviors (Mazza & Reynolds, 2008). Efforts to educate students and staff about
suicide prevention, risk and protective factors, warning signs, screening students for suicidal
behaviors, intervening with a student in crisis, or providing mental health and re-entry support to
a student during postvention activities are the responsibility of school leadership and personnel
(Kalafat, 2003; Lieberman et al., 2014; Mazza & Reynolds, 2008).
“As children and teens spend a significant amount of their young lives at school, the
personnel who interact with them on a daily basis are in a prime position to recognize the
warning signs of suicide and make the appropriate referrals for help” (Assembly Bill No. 2246,
2016, Section 1(b)). This assertion was supported by Fisher (2006), who argued that school
administrators and teacher participation in suicide prevention—not simply more government
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 61
funding—is required to facilitate change in troubling youth suicide statistics. Fisher suggested
that students may not know the school nurse or social worker very well, but they often trust a
teacher with difficulties and problems, and approach that teacher first.
A number of literature reviews addressing suicide prevention have been conducted,
attempting to ascertain the types of suicide prevention programs implemented in school settings
and assessing their effectiveness. While most studies indicated that such programs appear to
improve knowledge regarding suicide among participants, some studies find little to no reduction
in suicidal behavior among adolescents (Cusimano & Sameem, 2011; Dumesnil & Verger, 2009;
Fountoulakis, Gonda, & Rihmer, 2011; Institute of Medicine, 2002; Gould et al., 2003; Robinson
et al., 2013; Stone & Crosby, 2014; Szumilas & Kutcher, 2011) while other researchers have
found some reduction in suicidal behavior and ideation (Aseltine, 2003; Aseltine & DeMartino,
2004; Aseltine, James, Schilling, & Glanovsky, 2007; Schilling, Lawless, Buchanan, & Aseltine,
Jr., 2014). Such research also suggested that comparisons among the studies are problematic due
to diverse methodologies and study objectives (Dumesnil & Verger, 2009). Despite the breadth
of multiple suicide prevention practices in educational settings, their implementation is
contingent upon school personnel and students recognizing and responding to suicidal behaviors
demonstrated among at-risk adolescents. As the current study seeks to identify the best practices
of prevention, intervention, and postvention; the perceptions and attitudes of suicide prevention
among school personnel; and the evaluation of program effectiveness, the remainder of this
section will briefly review the practices and strategies affected in school settings, as documented
in the literature.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 62
School-Based Prevention Strategies
School-based suicide prevention programs have historically fallen into three categories:
(1) universal strategies, (2) selective strategies, and (3) indicated strategies (Institute of
Medicine, 2002; Kalafat, 2003). Universal programs are aimed at addressing suicide awareness
and education among entire school populations, developing knowledge of what to say and do
with suicidal individuals, and increasing access to help and care. Selective programs target
subgroups demonstrating elevated risk factors for suicidal ideation and behavior, with the goal of
preventing suicidal ideation and behavior among specific populations; indicated programs are
directed at those adolescents with a high-risk of suicidality, or who have engaged in past suicidal
behavior, with the goal of reducing risk factors and increasing protective factors (Institute of
Medicine, 2002; Kalafat, 2003). Notably, the three categories of suicide programs focus
primarily on prevention, and to a lesser degree, intervention and postvention.
The implementation of each of these three types of suicide prevention programs requires
school staff to be trained and to respond appropriately, but principal leadership and other factors
play a role. Stein et al. (2010) conducted semi-structured telephone interviews with 42
principals, school psychologists, school counselors, and teachers from the Los Angeles Unified
School District, assessing the differences among schools with high implementation and low
implementation practices. The researchers determined that despite all schools in the study
receiving annual training, the high implementation schools had greater support from
administration, enjoyed greater access to school resources and materials, and followed clear
procedures for addressing students presenting as high risk. In contrast, the low implementation
schools relied on a few individuals to implement programs, and had lower administrative support
(Stein et al., 2010). Stein’s study supported the importance of site leadership, ensuring that all
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 63
staff receive training in suicide prevention practices, that resources are readily available, and that
regardless of the particular program being utilized, a culture of collaboration and support is
facilitated by the principal.
Disagreement exists in the literature with respect to the specific components of the three
prevention programs. Institute of Medicine (2002), for example, referred to screening and
gatekeeper trainings as a function of selective methodology, whereas Gould et al. (2003), and
Kalafat (2006) referred to school-wide screening and gatekeeper training as key components of a
universal approach. Such differences in the literature hint at researchers applying various
strategies to explore improvements for youth outcomes; moreover, they highlight the necessity
for school leaders to examine the specific and unique needs of their population to maximize
effectiveness of youth suicide prevention initiatives.
Universal strategies. Comprehensive suicide prevention programs that target the entire
school community are characterized by training for all teachers, parents, community members,
and students, and site administrators regarding suicide related procedures and policies (Kalafat,
2003). In the seminal text, Reducing Suicide: A National Imperative, Institute of Medicine
(2002) listed several advantages to school-based universal programs: (1) a high participation
rate, and thus, a higher number of adolescents who are exposed to the program, (2) the impact of
universal programs not only affect those who are currently at risk, but also those who experience
risk factors later, and (3) universal prevention programs target multiple outcomes; thus, risk
factors for suicide from various domains (e.g. personal, familial, social, and environmental) are
reduced.
Curriculum-based programs targeting an entire school’s student population are one of the
key elements of a universal suicide prevention strategy, generally delivered as a component of
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 64
health education (Miller, Eckert, & Mazza, 2009). The Signs of Suicide (SOS) program is one of
the most commonly used curriculum-based programs in high schools, aimed at raising awareness
of suicide and associated risk factors. Student participants receive instruction on suicide risk
factors and warning signs in themselves and among their peers using the Acknowledge-Care-Tell
(ACT) model (Aseltine et al., 2007). Research demonstrated different levels of effectiveness of
the SOS program; while some studies demonstrated improved student knowledge regarding
suicide risk factors (Aseltine et al., 2007; Schilling et al., 2014), other research has not shown
decreases in suicidal ideation or help-seeking behaviors among students (Aseltine & DeMartino,
2004; Cusimano & Sameem, 2011; Robinson et al., 2013).
Other curriculum-based programs include Surviving the Teens, which has been used
universally at the high school level to promote knowledge of risk and protective factors, drug and
alcohol use, school connectedness, and help-seeking behaviors (King, Strunk, & Sorter, 2011;
Strunk, Sorter, Ossege, & King, 2014), and the Good Behavior Game (Tingstrom, Sterling-
Turner, & Wilezynski, 2006) which is utilized with elementary school students to promote
positive social-emotional behaviors. Notably, none of the aforementioned curriculum-based
programs are targeted specifically at middle school aged youth; as such, middle school principals
tasked with implementation of EC 215 (California Legislative Information, 2018) must carefully
examine if a universal curricular approach is culturally appropriate for their population (Kral,
Idlout, Minore, Dyck, & Kirmayer, 2011). Daniel and Goldston (2009) suggested that student
participation in suicide prevention programs is a function of their developmental stage; thus, the
inclusion of developmentally appropriate supports embedded in universal curriculum-based
suicide prevention strategies must also reflect the well-being and mental health needs of middle
school students (Robinson et al., 2013).
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 65
Screening consists of brief surveys and questionnaires administered to an entire school
population, to determine if individuals are exhibiting risk factors or suicidal behavior (Kalafat,
2006). Screening relies on student self-reporting to identify students who may be at risk for
suicide; questions generally address risk factors such as depression, alcohol and substance use,
and suicidal behaviors (Gould et al., 2003; Kalafat, 2006). A variety of screening instruments
have been used for this purpose, including the Columbia Suicide Screen (CSS), the Risk of
Suicide Questionnaire (RSQ), the Suicidal Ideation Questionnaire JR (SIQ-JR), the Diagnostic
Predictive Scales (DPS), the Suicide Risk Screen (SRS), and the Suicide Probability Scales
(SPS) (Joe & Bryant, 2007; Peña & Caine, 2006). While each of these instruments have been
used effectively in school settings, one of the primary criticisms of universal screening is the
relatively high number of false positives; that is, students who report themselves at greater
suicide risk than they actually are (Gould et al., 2003; Hallfors et al., 2006; Kalafat, 2006).
Hallfors et al. (2006) suggested that many false positives increases suicide risk for students truly
in crisis, particularly when trained school personnel and resources are limited.
A 2009 study by Scott et al. sampled seven high schools to administer the Columbia
Suicide Screen (CSS). The researchers interviewed school staff to determine if they had
concerns about students’ emotional and mental health. The study found that 41% of students
who screened at risk for suicidal behavior were also identified by school staff; however, school
personnel identified a higher percentage of false positives (63.5%) compared to the CSS
(37.3%). Scott et al. (2009) stated these findings suggest screening instruments can be
beneficial, particularly when supported with other preventative measures and staff training.
Selective strategies. Suicide prevention strategies that target specific groups have been
utilized in school settings to identify youth with suicidal risk factors. Institute of Medicine
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 66
(2002) listed several components of selective prevention strategies: (1) screening to identify and
assess groups of at-risk students; (2) gatekeeper training supported by consultation and education
services; (3) skills training for staff and students; and (4) crisis team and referral services for at-
risk students. These components were used in a complementary manner, and are sometimes
implemented in conjunction with or as a follow-up to universal strategies (Aseltine et al., 2007;
Goldston et al., 2010). Based upon the tenet that adolescent suicidal risk is often episodic and
transient, repeated screening of students demonstrating risk factors is merited to identify and
intervene with students in crisis (Institute of Medicine, 2002).
Gatekeeper training is a key component of school-based suicide prevention strategies, as
it is designed to improve the knowledge of school personnel about risk factors and warning
signs, and facilitate their ability to identify students who may be at risk of suicidal crisis (Kalafat,
2003). Gatekeeper training is the most commonly implemented selective suicide prevention
strategy in schools, chiefly due to the relative ease of training school staff, as opposed to
delivering universal curriculum-based initiatives to all students (Goldston et al., 2010). Goldston
et al. (2010) and Institute of Medicine (2002) suggested the effectiveness of gatekeeper training
is augmented when coupled with screening to identify adolescents experiencing risk factors for
suicidality.
A variety of selective gatekeeper programs are documented in school-based suicide
prevention literature, including the Frameworks project (Baber & Bean, 2009), Suicide Options
Awareness and Relief (Project SOAR; King & Smith, 2000), Applied Suicide Intervention Skills
Training (ASIST; Lang, Ramsey, Tanney, & Kinzel, 2007), and Question-Persuade-Refer (QPR;
Quinnett, 2012), with the latter being the most commonly used in secondary school settings
(Cross et al., 2011). The QPR program includes four components to facilitate teachers and other
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 67
school staff to successfully work towards preventing adolescent suicide: (1) early recognition of
suicidal warning signs; (2) prompt intervention with a student exhibiting warning signs by asking
the student about suicidal behavior, persuading him to seek help, and referring the student to
support resources; (3) making a referral to a mental health professional immediately when
suicidal warning signs are observed, and (4) follow-up to verify the student contacted the
professional help and is receiving treatment (Quinnett, 2012). QPR training only takes one or
two hours to complete, supporting Goldston et al.’s (2010) assertion that selectively training staff
is easier than universally instructing all students (Quinnett (2012).
Three randomized studies conducted in school, clinical, and workplace settings examined
the impacts of the QPR training (Cross et al., 2011; Matthieu, Cross, Batres, Flora, & Knox,
2008; Wyman et al., 2008). Stratified samples of 340 public school teachers and parents and 602
counseling center staff participated in gatekeeper training using the QPR framework, with one
group receiving additional role-play experience in addition to the training protocol. The
researchers found that both training conditions resulted in improved knowledge and attitudes
about suicide intervention, with higher total gatekeeper scores than baseline immediately after
training, and at three month and one year follow up. In all studies, participants demonstrated a
decreased level of knowledge and attitude.
Keller et al. (2009), who stated QPR increases staff knowledge and self-efficacy in their
abilities to intervene with an adolescent showing warning signs or risk factors, further supported
these findings. Whitney et al. (2011) posited school principals perceive fewer barriers to
implementation for gatekeeper trainings and in-service, due to ease of implementation and lower
likelihood of parental disapproval. The implications for the current study suggest that school
principals must maintain regular and repeated trainings to ensure that staff knowledge and
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 68
attitudes remain high, thus providing students in crisis with the maximum level of support.
Furthermore, principals are well-advised to monitor not only teachers’ knowledge of adolescent
suicidality, but also their perceived self-efficacy to act when students present suicidality.
Indicated strategies. Indicated prevention programs target youth demonstrating high
risk of suicidality, including youth who have previously engaged in suicidal ideation, behavior,
or attempted suicide (Kalafat, 2003; Miller, Eckert, & Mazza, 2009; Mazza & Reynolds, 2008).
While indicated strategies present as interventions for students already in crisis, they also serve
as preventative measures, seeking to reduce the immediacy of suicidal crisis, and reducing the
risk for future suicidal behaviors (Kalafat, 2003; Mazza & Reynolds, 2008).
Institute of Medicine (2002) listed the components of indicated prevention programs to
include: (1) family support training; (2) skill-building support groups for high-risk individuals;
(3) case management; and (4) referrals for crisis intervention and treatment. At this level of
intervention, school psychologists, counselors, and other mental health professionals with
appropriate training are engaged in the implementation of indicated strategies, performing risk
assessments, directly intervening with adolescents engaged in suicidal behaviors, and addressing
postvention (Brock, 2002; Lieberman et al., 2008; Miller et al., 2009; Miller & McConaughy,
2005; Sandoval & Zadeh, 2008).
As with universal and selective strategies, indicated strategies are not well-documented in
the literature that specifically address middle school aged students; instead, studies generally
target high school aged youth. Institute of Medicine (2002) and Randell, Eggert, and Pike (2001)
identified the Counselors Care (C-CARE)/Coping and Support Training (CAST) program as the
most commonly used among high school students. The two-phase program begins with the C-
CARE protocol, including an individual assessment interview, counseling sessions, and
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 69
interventions that involve parents and designated school personnel. CAST supports the process
with multiple sessions of small-group skills training in self-esteem, academic performance,
substance abuse, setting goals, and personal control (Institute of Medicine, 2002; Thompson,
Eggert, Randell, & Pike, 2001).
Of the three prevention strategies, indicated programs are most closely aligned with
postvention, the process of supporting an adolescent after an attempted suicide, as well as the
survivors in a community following the death of an individual by suicide (Lieberman et al.,
2014). Abbott and Zakriski (2014) and Maples et al. (2005) found that survivors’ exposure to
attempted and completed suicide places them at an elevated risk of suicide. These recent
findings support earlier research by Gould et al. (2003) which suggest postvention must be
addressed appropriately within a school community following a suicide attempt or death, to
avoid negative impact on other students and members of the school community.
While research on postvention practices is limited in the literature, Lieberman et al.
(2014) offered postvention guidelines following an incidence of suicide attempt or death:
(1) emphasize the positive impact of the individual on the community and not the suicidal act
itself, (2) refrain from glorifying the suicide, and (3) limit the release of information regarding
the suicidal act in partnership with parents. Such actions may reduce the risk of suicide
contagion or clusters (Lake & Gould, 2014; Zenere, 2009).
Although indicated strategies affect the smallest number of students within a school
population, suicidal behaviors, attempts, or deaths have far-reaching consequences for the entire
school community. Therefore, principal implementation of indicated prevention, intervention,
and postvention strategies must carefully consider many factors, including allocating resources,
ensuring the availability of specialized staff trained to address students suffering with suicidal
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 70
crises, collaboration with families and community partners, and addressing the effects of
suicidality on survivors within the school community.
California Education Code 215 (California Legislative Information, 2018) mandates (1)
the development of procedures to address suicide prevention, intervention, and postvention for
all students as well as targeted, high-risk groups, (2) training for teachers of pupils in grades 7 to
12, inclusive, on suicide awareness and prevention, (3) training materials that include how to
identify appropriate mental health services, and (4) when and how to refer youth and their
families to services (Assembly Bill No. 2246, 2016; California Legislative Information, 2018).
Based upon the language of this law, requiring all members of a school community to receive
training, as well as targeted efforts aimed at specific, high-risk individuals, EC 215 highlights
that school leaders are faced with the task of synthesizing best practices from universal,
selective, and indicated suicide prevention initiatives, rather than reliance on a single model.
Moreover, one of the chief gaps in the literature with respect to school-based suicide
prevention programs is the lack of targeted initiatives for middle school students. While
programs designed for elementary and high school students are generally well-documented and
studied, programs specific to the needs of students in grades 6, 7, and 8 are few. Therefore, the
implementation of EC 215 (California Legislative Information, 2018) by middle school
principals must carefully consider the dynamic interaction of universal, selective, and indicated
prevention strategies, weighing the considerations of school culture, climate, and the myriad
needs of stakeholders within the school community.
Principal Leadership with Suicide Prevention Implementation
Despite the implementation of myriad research-based suicide intervention programs in
California public schools over the last three decades, suicide remains a leading cause of death
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 71
among youth from 10 to 24 years old (Gould et al., 2003; Miller et al., 2009; CDC, 2014a).
Research literature is limited with respect to principal implementation of suicide prevention
practices in the middle school setting; however, various roles associated with principal
leadership, such as providing professional development to staff, empowering and educating
stakeholders, and fostering leadership in teams and individuals are found within school-based
suicide prevention literature.
In reference to the role of principals to improve student achievement, McGowan and
Miller (2001) suggested that the implementation of legislation, financial expenditures supporting
educational initiatives, hiring qualified teachers, and conducting standardized assessments there
remain several flaws in the current model to affect positive change in schools. Rather than
employing past methodology to implement programs, principal leaders must be willing to take
risks, move people in new directions towards novel definitions and desired outcomes, build
relationships, partnerships and teams, and change existing culture to better serve students
(McGowan & Miller, 2001). Effective principal leaders must “cope with conflict, set direction,
align resources, and inspire stakeholders . . . to create long-term vision, define and clarify
problems and opportunities, create and commit to improvement strategies, and finally, take
action” (McGowan & Miller, 2001, p. 32).
Extrapolating this theory to principal implementation of suicide prevention programs in
middle schools, each of these functions are indicated within Bolman and Deal’s (2013) four
frames of leadership, which will be utilized in the current study as a leadership conceptual
framework.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 72
Principal Applications of Bolman and Deal ’s Four Frames
Bolman and Deal (2013) use the term frames to indicate a coherent set of ideas that allow
a leader to comprehend the complex ways organizations operate. The four frames designed by
Bolman and Deal are the Structural frame, the Human Resource frame, the Political Frame, and
the Symbolic Frame. Each of these areas offers an important but varied perspective of the
intricacies of an organization. The four frames model is appropriate for the middle school
setting, as principals must engage with the intricacies of students, systems, stakeholders, and
stories on a daily basis.
The structural frame. The Structural frame addresses leadership within an organization
with a reliance on clear goals, defined roles, and established communication channels (Bolman
& Deal, 2013). Leaders effectively utilizing the structural frame are viewed as analysts or social
architects; there is intentionality to leadership decisions based upon systems and implementation.
Leaders who do not possess strength in the structural frame are sometimes described as
disorganized and bureaucratic.
Considering the nascent status of AB 2246 Suicide Prevention Policy’s implementation
in California, middle school principals hoping to reframe their schools using the structural frame
must clarify their goals and carefully analyze the relationships among structure, strategy, and
environment. Success relies on the principal’s ability to design and implement procedures and
structures that fit the unique circumstances of the school with a focus on tasks and facts, not
emotions (Bolman & Deal, 2013).
The human resource frame. Bolman and Deal’s (2013) second leadership frame is the
Human Resource frame. Effective human resource leaders are viewed as facilitators, utilizing
emotional intelligence to motivate and empower others. They possess a clear understanding of
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 73
people’s strengths and weaknesses, placing value in building relationships and considering
feelings (Bolman & Deal, 2013). Perceived as servant-leaders by their constituents, human
resource leaders aim to empower and support individuals, recognizing the symbiotic relationship
between the organization and the people within it (Bolman & Deal, 2013).
The political frame. The third leadership frame offered by Bolman and Deal (2013), the
Political frame, demonstrates a principal-leader’s need to influence others, while remaining
responsive to their interests. Building key linkages to stakeholders, maintaining a constituency,
and unifying groups through negotiation and compromise define this leadership style. The
political frame depicts organizations as places of competition and sometimes conflict. As such,
effective political leaders clarify what they want, and appropriately persuade, negotiate, and
coerce if necessary (Bolman & Deal, 2013).
The symbolic frame. Bolman and Deal’s (2013) fourth frame is the Symbolic frame.
Symbolic leaders guide their organizations through both their actions and their words,
interpreting and reinterpreting experiences to imbue meaning and context to action. Relying on
stories, traditions, and purpose, the symbolic leader helps shape the culture of an organization
(Bolman & Deal, 2013). Effective symbolic leaders inspire and lead by example,
communicating a vision based on both the history of an organization and the organization’s
future goals.
Reframing leadership in support of youth suicide prevention. While principal-leaders
possess different strengths and styles, Bolman and Deal (2013) suggested effective leaders are
able to reframe their leadership; that is, address issues with a multi-framed approach, seeing the
same situation from different perspectives and making decisions that consider the diverse needs
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 74
of the organization, the stakeholders upon whom the organization relies, and those the
organization seeks to serve.
Bolman and Deal (2013) further stated that organizations are complex, surprising,
deceptive, and ambiguous; such terms may easily be ascribed to middle schools. The challenges
of ever-changing environments and people, the unpredictability of adolescence, inconsistent
communication among multiple stakeholders, and the occasional inability to identify problems,
needs, resources, and determinations of success illustrate some of the challenges faced by middle
school administrators (Bolman & Deal, 2013). Accordingly, middle school principals’
implementation of EC 215: Pupil Suicide Prevention Policies (California Legislative
Information, 2018) suggested a leadership approach that leverages the structural, human
resource, political, and symbolic frames; no single frame comprehensively encapsulates the
multiple perspectives required to implement and evaluate suicide prevention initiatives with
fidelity.
Application of Four Frames Leadership Supporting Adolescent Suicide Prevention
Joshi, Ojakian, Lenoir, Hartley, and Weitz (2015) posited school administrators serve a
key role in developing school crisis teams to help prevent youth suicide, and to deal with
students experiencing suicidal crisis. Crisis teams are generally comprised of administrators,
school counselors, psychologists, school nurses, and teachers (Adamson & Peacock, 2007;
Erbacher, Singer, & Poland, 2015; Nickerson & Zhe, 2004) as well as therapists, special
educators, information technology staff, and office staff (Joshi et al., 2015). Each of these
individuals serves a specific function as a member of the team, but work towards the common
goal of assisting students experiencing suicidality. Erbacher et al. (2015) stated the importance
of developing a team before a crisis occurs, and highlighted the value of selecting crisis team
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 75
members from school staff, as external team members impede communication, planning, and
availability. Joshi et al. (2015) stated administrative support is required for a successful crisis
team implementation. The development, training, resource allocation, and maintenance of such a
team suggest the need for a principal-leader to utilize a multi-framed approach.
A second area supporting school-based youth suicide prevention initiatives is the
emerging field of social emotional learning (SEL; DePaoli et al., 2017; Durlak et al., 2011).
Social-emotional learning helps students develop skills in problem solving, goal setting,
managing emotions, self-regulation, help seeking behaviors, positive relationships, and reducing
negative outcomes (DePaoli et al., 2017; Durlak et al., 2011; Moffitt et al., 2011). Dymnicki,
Sambolt, and Kidron (2013) identified that adolescents deal with significant social, emotional,
and mental barriers that impede their success in school and life; social emotional learning
addresses such barriers to learning and to health by supporting developmentally appropriate tasks
for youth (Durlak et al., 2011). At the middle school level, these include forming closer
relationships with peers of multiple genders, increasing independent completion of complex
academic tasks and content, managing transitions, and increased parental independence (Durlak
et al., 2011). Supporting students’ abilities to self regulate their actions and emotions draws
upon leadership skills from multiple frames (Bolman & Deal, 2013). With respect to the current
study, facilitating these abilities in adolescents serves the interests of reducing risk factors,
promoting protective factors, and supporting suicide prevention efforts in the middle school
setting.
A third application of Bolman and Deal’s (2013) four frames is represented in
administrative delivery of suicide prevention professional development, required by AB 2246
and EC 215 (Assembly Bill No. 2246, 2016; (California Legislative Information, 2018). Suicide
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 76
prevention training is most commonly delivered through professional development (Debski,
Spadafore, Jacob, Poole, & Hixson, 2007; Nickerson & Zhe, 2004; Suldo et al., 2010).
Successful implementation of middle school suicide prevention practices should consider teacher
knowledge and attitudes surrounding suicide prevention program delivery. Although AB 2246
mandated teacher training and involvement in prevention initiatives, research is limited regarding
teacher perceptions and attitudes about their ability to participate (Gould et al., 2003; Nadeem et
al., 2011; Rothi, Leavey, & Best, 2008; Wyman et al., 2008). Nadeem et al. (2011) interviewed
principals, teachers, and counselors to assess the role of teachers in suicide prevention efforts.
The study found that while teachers are willing to be involved in detection, prevention,
intervention, and training teachers reported they were more likely to refer a student in crisis to a
familiar staff member than to a more qualified member of the school’s crisis team. Graham,
Phelps, Maddison, and Fitzgerald (2011) found that while teachers are willing to support suicide
prevention in their schools, many do not perceive themselves to be prepared, and experience a
high level of frustration with their own feelings of inadequacy. Such findings imply the need for
principal-leaders to address professional development and teacher preparation from multiple
frames, addressing the structural and human resource aspects of professional development, as
well as the political and symbolic factors of teacher preparation and self-efficacy with respect to
suicide prevention.
Summary
Despite the complementary progression of suicidology and the legislative process in the
United States, comprehensive solutions for the epidemic of youth suicide have evaded
researchers for decades. Progress has been made in both arenas; state and federal legislation has
evolved from viewing suicide as a mental health issue to the acknowledgment of suicide as a
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 77
public health concern, requiring collaboration among clinicians, public and private entities, and
government. Furthermore, multiple studies have provided etiological and epidemiological data
identifying warning signs and risk factors for suicidal youth, as well as protective factors that
serve to buffer adolescents from suicidal behavior. Universal, selective, and indicated suicide
prevention approaches have shown mixed results in various school settings, although the
majority of the literature addresses such implementations at the high school level. With respect
to the inaugural year implementation of Assembly Bill 2246: Suicide Prevention Policies
(Assembly Bill No. 2246, 2016) in California public middle schools, the literature is very limited
regarding the steps and methods principals may use to implement such prevention programs.
Research suggested that principals must mitigate the middle school gap in the literature with
careful consideration of the unique needs of students and stakeholders at their schools,
extrapolating findings from studies with adults and older secondary youth, and enacting a
holistic, multiple-perspective approach to leadership (Cusimano & Sameem, 2011; Elmore,
2000; Maples et al., 2005).
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 78
Chapter Three: Methodology
This chapter includes an overview of the methodology for the research study. The
purpose of the study and the research design are described, and participant criteria and selection
are examined. The chapter further includes data collection and analyses, and details the research
instruments utilized.
Purpose of the Study
The study aimed to address the following research questions:
(1) How are middle school principals in southern California public schools leading the
implementation of EC 215: Pupil Suicide Prevention Policies?
(2) What are the best practices and strategies being utilized in these middle schools to
support pupil suicide prevention, intervention, and postvention?
(3) How are middle school principals leading faculty to change their perceptions and
attitudes that suicide prevention practices are a serious and worthy issue?
(4) How do principals evaluate the progress and success of pupil suicide prevention
programs and practices?
The purpose of this mixed-method study was to determine how middle school principals
within their school communities are implementing youth suicide prevention policies mandated
by Education Code 215 (California Legislative Information, 2018). Additionally, the study
sought to identify the leadership methods utilized by principals to empower teachers, students,
staff, parents, and other stakeholders to promote policies and initiatives that stand to reduce or
eliminate adolescent suicide risk. Finally, the study endeavored to identify the manner in which
principals hold members of the school community accountable for implementing suicide
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 79
prevention policies with fidelity, and to ascertain how principals evaluate the effectiveness of
programs at their schools supporting suicide prevention.
Research Design
This study utilized both interviews and a survey instrument to facilitate a mixed-methods
approach, collecting data from southern California public middle school principals employed in
their current positions for a minimum of two years. Quantitative data was collected via an
electronic survey e-mailed to principals, and qualitative data was obtained through semi-
structured interviews with principals.
Additionally, an interview was conducted with an individual closely connected to the
development, promotion, and ultimately, the passage of AB 2246 into law. This structured
interview utilized a different question protocol than semi-structured interviews conducted with
middle school principals, allowing the researcher to better understand the historical context and
policy development that contributed to AB 2246 (Assembly Bill No. 2246, 2016) and EC 215
(California Legislative Information, 2018) .
Population and Sample
The population for the current study consisted of southern California public middle
school principals. Utilization of the California Department of Education Public Schools and
Districts Data Files (CDE, 2018) website helped to identify the population: principals currently
serving at public middle schools in the southern California counties previously identified in this
study. As of June 2018, identification of 528 principals, alphabetized by last name with their
associated schools, school districts, and email addresses, and then numbered on an Excel
spreadsheet. Subsequently, the researcher utilized an online random sampling generator
(Research Randomizer, n.d.) to create a random set of 100 numbers, limited by the range of the
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 80
total population of southern California public middle school principals. The random numbers
generated were associated with the numeric identifiers of principals on the Excel spreadsheet,
and compiled to identify a random sample. This random sample (n=100) was utilized for the
quantitative components of the study, from which 51 completed surveys were returned to the
researcher by principals who met the criteria for inclusion.
Participants for the qualitative portion of the study were purposefully criterion and
convenience selected from among the qualifying respondents of the quantitative research
instrument; specifically, those selected were public middle school principals serving in their
assignment for a minimum of two years, who responded affirmatively to participation in a 45-
minute semi-structured interview to share their experiences addressing suicide prevention
practices at their middle schools, and whose middle schools are located in Los Angeles, Orange,
and Ventura counties.
Demographic Data
The survey protocol was utilized to collect self-reported demographic data on
participants, including age, gender, years of experience, race/ethnicity, highest level of
education, and location of the middle school at which the respondent serves as a principal.
Procedures
The researcher developed a survey consisting of questions designed to collect
demographic data on the participants, as well as Likert scale questions designed to ascertain
characteristics, attitudes, and behaviors of middle school principal-leaders with respect to the
status of suicide prevention programs at their schools. The researcher placed the survey online,
and distributed the survey instrument along with the Request to Participate letter by email to 100
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 81
randomly selected principals from among the population of all southern California public middle
school principals prior to August 2018.
Ten interviews were conducted with middle school principals who met the criteria for
participation in the current study, and responded affirmatively to a question on the quantitative
survey instrument indicating their willingness to participate in a one-on-one interview. All
participants were serving as a middle school principal at the time of their interview. The
researcher chose to conduct the interviews in the respective principals’ offices at their school
sites. Interviews were conducted utilizing a semi-structured interview protocol and script.
Interviews were conducted per each respondent’s schedule and availability, to facilitate their
participation, and to ensure each was able to designate 45 minutes of uninterrupted time to
participate. In order to record the most accurate data, the researcher requested permission to
audio record the interview and granted by each respondent to allow an audio recording of the
interview. During the interviews, the researcher also recorded handwritten notes. Subsequent to
each interview, the audio recordings were transcribed and the researcher synthesized the
handwritten notes into interview memos.
Additional qualitative data was gathered from two individuals closely associated with the
writing, promotion, and passage into law of AB 2246. The researcher made an appointment with
the individuals, and conducted two 45-minute interviews following a structured interview
protocol. As with the principal interviews, the researcher requested permission to audio record
the interview, which was granted; the researcher also recorded handwritten notes during the
interview. The audio recording was transcribed, and handwritten notes were collected.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 82
Instrumentation
The researcher, based upon similar questions in other recent survey instruments, created
the survey instrument utilized in this study: Middle School Principal Survey Pupil Suicide
Prevention. Such similarities contribute to the validity of the instrument to generate data
supporting the research questions for this study. Moreover, the researcher field tested the survey
with principals and assistant principals not included in the study to determine the time required
to complete the survey, and to ensure the instructions and completion of the survey were
straightforward for study participants. Based on field testing, and subsequent adjustments to the
survey instrument by the researcher, completion of the survey was estimated to take no longer
than 10 minutes.
Data Collection
The 100 middle school principals randomly selected from the California Department of
Education (2018) school database received an email containing the following:
1. The Request to Participate letter (see Appendix A)
2. Online link to the Middle School Principal Survey: Pupil Suicide Prevention
Data Analysis
The researcher utilizing the Statistical Package for the Social Sciences (SPSS) conducted
data analysis. Responses to the survey instrument were analyzed using descriptive statistics; that
is, frequencies, measures of central tendency, and measures of variability.
Analysis of qualitative data yielded through interviews applied Merriam and Tisdell’s
(2016) coding protocol, utilizing a constant comparative method. The data were reviewed for
concepts, ideas, and points that aligned with the research questions. These, in turn, generated a
structure to classify open codes into axial codes, demonstrating themes and relationships. The
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 83
researcher also drew upon youth suicide prevention literature to relate several a priori codes to
interview data (Merriam & Tisdell, 2016).
Ethical Considerations
The very nature of the current study, analyzing middle school principal involvement with
youth suicide prevention, lends itself to sacrosanct adherence of ethical research considerations.
The researcher acquired the consent of each participant in both the surveys and interviews. To
ensure the confidentiality of the processes, all audio recordings were transcribed using
pseudonyms and judiciously redacted of any identifying names; subsequently, the audio
recordings were destroyed. Moreover, the study was conducted in accordance with and under
the jurisdiction of the University of Southern California’s Institutional Review Board (IRB).
Finally, while every effort to be objective was made, the middle school principal-researcher,
currently implementing AB 2246 at his school, is astutely aware of the potential for bias in the
research findings.
Summary
This chapter outlined the procedures and methods used in the current study, including a
discussion of the quantitative and qualitative methodologies, the process by which participants
for the study were selected, the type of instruments employed to collect data, and the data
analyses conducted to ascertain the practices, strategies, and beliefs of southern California public
middle school principals implementing pupil suicide prevention policies, in accordance with EC
215 (California Legislative Information, 2018).
The purpose of this study was to determine how middle school principals at southern
California schools are implementing youth suicide prevention policies mandated by AB 2246
(Assembly Bill No. 2246, 2016). The researcher has endeavored to identify principal leadership
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 84
methods with stakeholders that promote policies, best practices, awareness, and efficacy to
support youth suicide prevention programs. Finally, the study sought to identify how principals
evaluate the effectiveness of suicide prevention initiatives in their middle school communities,
and the means by which they hold staff, students, and the community accountable in supporting
suicide prevention efforts.
In Chapter Four, a summary of findings will be presented with respect to the research
questions examined in this study, the data generated through the administration of survey and
interview instruments is analyzed, and the methodology applied is described and evaluated.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 85
Chapter Four: Findings
Results
While the growing congruence between the field of suicidology and the legislative
processes at state and national levels has been addressed in this study, the devastating effects of
youth suicide on individuals, families, schools, and communities continue without
comprehensive solutions. Suicide has persisted for decades as a leading cause of death for youth
between the ages of 10 and 24; in California alone, suicide attempts and hospitalizations among
this age group number in the thousands annually (Disdata.org., 2014; CDE, 2015; CDC, 2014a).
The ratification of Education Code 215 (California Legislative Information, 2018) in
2016 required the governing board or body of a local educational agency serving pupils in grades
7 through 12 to adopt policy for youth suicide prevention before the start of the 2017-2018
school year (Assembly Bill No. 2246, 2016). The law required school districts to create and
implement suicide prevention practices for secondary students with a focus on high-risk student
populations, and provide suicide prevention, intervention, and postvention training to staff
(Assembly Bill No. 2246, 2016; Trevor Project, 2019). Considering the nascent status of
Education Code 215 being implemented in California public schools, the researcher sought to
understand how middle school principals—those tasked with the initial implementation for the
target student demographics—are meeting the requirements of EC 215, developing programs,
supporting best practices, fostering the importance of this initiative with teachers, and evaluating
progress.
Purpose of the Study
Chapter Four includes an analysis of the data collected from this study, which endeavored
to explore how public middle school principals in southern California are addressing the
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 86
requirements of Education Code 215: Pupil Suicide Prevention Policies (California Legislative
Information, 2018). The study aimed to understand how middle school principal leadership
affects the implementation, best practices, stakeholder attitudes, and evaluation of youth suicide
prevention programs.
This research study was guided by the following research questions:
(1) How are middle school principals in southern California public schools leading the
implementation of EC 215: Pupil Suicide Prevention Policies?
(2) What are the best practices and strategies being utilized in these middle schools to
support pupil suicide prevention, intervention, and postvention?
(3) How are middle school principals leading faculty to change their perceptions and
attitudes that suicide prevention practices are a serious and worthy issue?
(4) How do principals evaluate the progress and success of pupil suicide prevention
programs and practices?
Quantitative data was gathered utilizing an online survey, distributed via email to 100
middle school principals who met selection criteria and who served in one of six southern
California counties; Los Angeles, Orange, San Diego, Riverside, San Bernardino, and Ventura.
The middle school principals were identified utilizing the California Department of Education
Public Schools and Districts Data Files (2018) website, and filtered to include principals at
currently-operating, non-charter, comprehensive public middle schools serving students in
grades six, seven, and eight. Fifty-one valid electronic surveys were completed, providing a
response rate of 51%. While zip codes were requested to validate participants serving in the
aforementioned southern California counties, no email addresses, participant names, schools, or
districts were collected to ensure confidentiality of the process. Qualitative data was collected
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 87
through interviews with 10 middle school principals. While 25 of the middle school principals
who completed the electronic survey indicated they were willing to participate in interviews, the
10 selected using purposeful criterion sampling were included to better understand principal
perceptions, strategies, and actions related to the research questions (Merriam & Tisdell, 2016).
To ensure the confidentiality of each participant throughout the research study, pseudonyms
were assigned to the 10 principals.
Additional qualitative data regarding the legislative history and policy development of
Education Code 215 (California Legislative Information, 2018), as well as its evolution from AB
2246 (Assembly Bill No. 2246, 2016), was obtained through interviews conducted with two
individuals involved in the legislative process. The researcher secured interviews with these
individuals by contacting their offices in Sacramento as well as their local field offices in
southern California. While these individuals were not averse to being personally identified, each
has been assigned a pseudonym to ensure confidentiality, as per the requirements of this research
study.
Demographic Data for Middle School Principal Participants
Years of Experience
One of the selection criteria for participation in this research study was two years
minimum of current middle school experience. Of the 51 middle school principals who
responded to the survey, 100% of the participants met this criterion. The range of service in their
current position ranged from two years to 12 years, with a mean of 5.14 years. In addition to
being asked how many years they have served in their current middle school principal position,
respondents were asked how many years they have served as a principal in any capacity. The
data revealed that 39 (76.47%) of these principals are serving in their first principal job, while 12
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 88
(23.52%) of the current middle school principals served previously as a principal. Table 1
summarizes the years of experience reported by the survey participants in their current positions
as middle school principals.
Table 1
Years of Experience in Current Position
Middle School Principals
Years Frequency Percentage
2 4 7.8
3 12 23.5
4 8 15.7
5 11 21.6
6 3 5.9
7 4 7.8
8 2 3.9
9 4 7.8
10 1 2.0
11 1 2.0
12 1 2.0
Note: n = 51
Age and Gender of Middle School Principals
All of the middle school principals (n=51) who responded to the online survey reported
their age to fall between 30 and 70 years of age, with 34 of the 51 (66.7%) reporting their age
between 41 and 50. Thirty-two of the respondents indicated their gender as male (62.7%), and
19 reported their gender as female (37.3%). This survey data aligned with findings from the
National Center for Educational Statistics (Taie & Goldring, 2017), which reported the mean age
of middle school principals in the United States as 47 years of age. The study also reported that
nationally, 59.6% of public middle school principals are male, while 40.4% are female (Taie &
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 89
Goldring, 2017). Table 2 reflects the age and gender data reported by respondents to this
research study.
Table 2
Demographic Data: Age and Gender of Participants
Variable f Percentage
Age
0 to 30
31 to 40 5 9.8
41 to 50 34 66.7
51 to 60 11 21.6
61 to 70 1 2.0
70+
Gender
Male 32 62.7
Female 19 37.3
Note: n = 51
Race/Ethnicity of Middle School Principals
Table 3 displays the results of the 51 middle school principals’ race/ethnicity, as reported
on the electronic survey. Of the 51 respondents in this study, 60.8% are White, 27.5% are
Hispanic, 3.9% are African American, 3.9% are Asian/Pacific Islander, 2% are East Indian, and
2% reported two or more races. Research conducted by the National Center for Educational
Statistics (Taie & Goldring, 2017) found that across the United States, middle school principals
are predominately White (77.4%), followed by African American (11.5%), Hispanic (7.7%), and
all other groups (3.4%). While the majority of principals included in this research study are
White, it is noteworthy that the ratio of Hispanic principals is significantly larger than the
national statistics, while the ratio of African American principals is lower (Taie & Goldring,
2017).
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 90
Table 3
Demographic Data: Race/Ethnicity
Race/Ethnicity f Percentage
African American 2 3.9
Asian/Pacific Islander 2 3.9
East Indian 1 2.0
Hispanic 14 27.5
White 31 60.8
Two or more races 1 2.0
Note: n = 51
Professional Preparation
All of the middle school principal participants reported higher education degrees, with 31
(60.8%) holding Masters degrees, and 20 (39.2%) reporting Doctorate degrees. While the
number of principals with Masters degrees included in this study aligns closely with the national
figure of 65.2%, the number of principals with doctoral degrees nationally is reported at 8.9%
(Taie & Goldring, 2017). For the purposes of this research study, these data imply that the
sample (n=51) is more highly-educated than the national population.
Distribution in Southern California
To establish that participants were located in southern California, a question on the
survey asked for the zip code of the middle school at which the principal currently serves. All 51
of the respondents reported their current schools in one of six southern California counties.
Table 4 displays the distribution of the 51 middle school principals included in this study. To
ensure confidentiality of participants, the data are reported by county only; the individual zip
codes, cities, and schools are neither reported nor associated with the principal participants in
this research study. Notably, five of the six counties included in this study are the top five
counties by population in the State of California, with Ventura county being 13th by population
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 91
(United States Census Bureau, 2017). These six counties account for more than 56% of the
population of California (United States Census Bureau, 2017).
Table 4
Distribution of Participant Middle School Principals in Southern California
County f Percentage
Los Angeles 28 54. 9
Orange 12 23. 5
Riverside 2 3. 9
San Bernardino 1 2. 0
San Diego 7 13. 7
Ventura 1 2. 0
Note: n = 51
Background and Analysis of Education Code 215
As a means of gaining a more holistic understanding of Education Code 215: Pupil
Suicide Prevention Policy (California Legislative Information, 2018), the researcher conducted
interviews with two individuals closely associated with AB 2246 (Assembly Bill No. 2246,
2016), ratified into law in 2016. The first-hand knowledge shared of not only the content of the
law, but also the legislative history and intent, revealed a thematic foundation for this research
study. Moreover, the researcher was able to better ascertain how the legislative requirements of
EC 215 were interpreted and applied among the principal participants in the study. Within the
scope of conducting interviews, both of the individuals affirmed that they did not mind being
identified by name for the academic purposes of the current study. However, in the interest of
maintaining confidentiality of all participants, each has been assigned a pseudonym.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 92
Legislative history. The researcher conducted two telephone interviews, the first with
Assembly Member Opaleye and the second with Legislator Calico,
1
Ms. Calico stated that she had been involved with AB 2246 (Assembly Bill No. 2246,
2016) since it was first brought to the Assembly Member’s office in which she serves. When
asked to provide the background that prompted the Assembly Member to support AB 2246, Ms.
Calico stated,
It was brought to us as a proposal by the governmental relations staff at Equality
California. The proposal started from concern within that organization around high rates
of suicide, suicidal ideation, and suicide attempts among LGBTQ students. So that was
kind of the original impetus, but obviously the bill applies to all students. It’s one of the
reasons why you see specific subgroups of students mentioned, high risk groups.
Ms. Calico described the general process by which proposed laws are brought to the
Legislature, explaining that sometimes the members themselves generate ideas. At other times,
as was the case with AB 2246, recommendations for legislation are brought to the members by
outside groups. Ms. Calico described her office’s role in providing guidance and input on draft
legislation. In the case of AB 2246, Ms. Calico asked her chair, Assembly Member Opaleye, if
he was interested in being a supporter; he confirmed.
Assembly Member Opaleye described his background in working with students, prior to
pursuing a career in the political arena. When asked by the researcher what prompted him to
lend his support to AB 2246 (Assembly Bill No. 2246, 2016), Assembly Member Opaleye
shared openly, stating,
It’s personal and professional considerations. On the personal side, growing up, I saw
individuals, sadly, try to commit suicide and complete suicide. Professionally . . . , I saw
1
Further identification withheld for confidentiality purposes
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 93
these tragic events happen in my own schools or schools around me. And you know, as
an Assembly Member, when I got here, one of the things I wanted to do was to tackle this
topic, and I didn’t know how. I had to team with a variety of professionals to come up
with an approach we thought would work.
Both individuals alluded to the notion that AB 2246 (Assembly Bill No. 2246, 2016) was
not devised in isolation; rather, the bill, and Education Code 215 (California Legislative
Information, 2018) that resulted from it, was the product of multiple individuals and
organizations in the public and private sectors collaborating on a shared goal of saving children’s
lives.
Intent and process. The researcher asked Assembly Member Opaleye what makes
legislation like Education Code 215 (California Legislative Information, 2018) important. His
response was demonstrative of not only his commitment to students in California, but also of the
critical importance of ensuring that pupil suicide prevention policies are supported through sound
principal leadership. Assembly Member Opaleye commented further,
This is about human lives. There’s nothing more fundamental to our mission in the State
Assembly than to assist people. On the education front, our role is to help students and to
listen. Sometimes things go sideways in people’s lives and they take drastic measures.
We want to give them alternatives, but we don’t want to do it from the state level. We
want local school districts to develop their own policy set that best fits their students’
needs, best fits their culture. [EC 215] is to facilitate others to create policies and
practices that will help with prevention and postvention.
AB 2246 and the resultant Education Code 215 (California Legislative Information,
2018) are specifically targeted towards students from 7th through 12th grade (Assembly Bill No.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 94
2246, 2016). The researcher asked Assembly Member Opaleye why this age group was
specified for the legislation. He stated that various data prompted the developers of the bill to
focus on this age group; specifically, increased suicide risk among adolescents also identified
with relatively higher risk, including foster and homeless youth, students with disabilities,
students suffering from mental illness, and LGBTQ youth. Additionally, Assembly Member
Opaleye alluded to Bolman and Deal’s (2013) political frame, stating,
It was also on the qualitative side, if you will. There were also a variety of interest
groups supporting [AB 2246]. There were parents, there were school districts, quite
frankly, who have had tragedies like this happen at their schools; sometimes multiple
times, sometimes in clusters. So that’s how the strategy developed. It developed around
the stakeholders and their interests.
Legislator Calico supported the Assembly Member’s assertion that gaining the approval
of multiple stakeholders and developing a constituency of supporters was key to moving AB
2246 to become EC 215 (California Legislative Information, 2018). In her consultant function,
Ms. Calico described her role in facilitating analysis on different iterations of the bill as it moved
through committee and was scrutinized by various entities. She explained that providing this
analysis to the public and to members of the legislature is crucial for gaining feedback, refining
what is included on a piece of legislation, and ultimately, can have a major impact on how
members will vote on the bill. With respect to editing the bill as it was analyzed by the
Education Committee, she added,
We try to see if there are recommendations we can find from state and federal
government or state working groups or professional associations that have identified the
need for what is being proposed in the bill. Researching and including what other states
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 95
have done, and including information on what is in the current health curriculum
standards are important.
The data provided by these two individuals highlighted the importance of communicating
the purpose of AB 2246 in a coherent and specific manner. Moreover, the significance of
engaging in a transparent and collaborative process that encourages feedback and empowers
multiple stakeholders was integral to the process of AB 2246 being signed into law. The
researcher noted that principals would be well advised to include these tenets, then, in the
implementation of the law within their middle schools.
Strategy and obstacles. In response to the researcher’s question about why AB 2246
was not targeted to all students in California, Legislator Calico provided additional insight into
the political strategy employed to ensure that AB 2246 passed through various processes to
become law. Ms. Calico highlighted the sharp statistical increases in suicide among youth in
California, a point for which she stated, “It was hard for me to imagine any member having any
difficulty with the idea of K-12 schools adopting suicide prevention policies.” However
Ms. Calico shared that during the process, she and the Assembly Member had some funding
concerns about the viability of AB 2246,
My primary concern was fiscal. There are many good ideas that we get in our committee,
but there’s a limited amount of tax revenue that we have to support them. When the bill
came to [Education] Committee, we don’t have the authority or responsibility of looking
at the fiscal dimensions; that falls to the Appropriations Committee. Our Constitution
requires that when the state makes a new requirement on a local agency, including a
school district, that the local agency has the right to submit a claim to the Commission on
State Mandates for reimbursement.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 96
As a mitigating factor for this fiscal concern that was supported by other data, AB 2246
was targeted only towards secondary students in grades 7 through 12. Legislator Calico stated
that with, “lots and lots of small elementary districts in California,” expanding the legislation to
all students, “would have raised the cost dramatically, and may have killed [the bill].”
With respect to the obstacles to passing legislation like AB 2246, Assembly Member
Opaleye discussed previous attempts to pass legislation developing local school site protocols for
mental health referrals. He recounted,
That [bill] got all the way through the Legislature, and the Governor vetoed it. I feel like
it was a no-brainer, but the Governor didn’t like it because he said they could already do
it. I said yes, but they weren’t doing it. We are today acknowledging that schools in
general have a greater role in addressing student mental health, and that’s an umbrella,
under which falls suicide prevention.
Assembly Member Opaleye and Legislator Calico both accentuated the theme that
despite the work required to pass such a law as EC 215 (California Legislative Information,
2018), the more valuable work is in implementation for its intended benefactors. This statement
emphasizes the importance of the current study, examining how middle school principals are
working in their school communities to implement pupil suicide prevention policies, and change
the trajectory of youth suicide statistics.
Implementation and evaluation. With the passage of Education Code 215 in 2016
(California Legislative Information, 2018), and the majority of school districts in California
meeting the requirement of adopting pupil suicide prevention policy before the start of the 2017-
18 school year, Assembly Member Opaleye conceded that while most governing boards had
voted to approve policy for their respective school districts, there remain several challenges to
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 97
implementation at the school level. With experience as a veteran educator, Assembly Member
Opaleye recounted episodes with students experiencing mental challenges. He stated, “I would
just turn it over to . . . and there were no protocols. There were no site-level protocols.” He
underscored that schools must play a larger role in addressing student mental health needs, “And
with that comes the need for tools to at least land students at the appropriate resources.”
Assembly Member Opaleye said the Legislature should not place teachers in a position to treat or
diagnose mental illness, depression, or anxiety in students, but that having a greater
understanding of it at the local school and classroom level may contribute to improvements in
overall youth suicidality. He stated,
The most important part of this whole concept is school site protocols. Principals know
their schools, they know their culture better than I do. I shouldn’t tell a principal what his
protocol should be, but he needs to have a protocol, so there’s accountability built into
the system.
As a means of ensuring the implementation of EC 215 (California Legislative
Information, 2018), Assembly Member Opaleye stressed the importance of principals providing
teachers and school staff members with suicide prevention and intervention training. Moreover,
the Assembly Member encouraged principals to empower teachers, whom he perceived as caring
but undertrained, and leveraged their impact on students specific and directed practices. He
stated,
Teachers care about students so they care about a policy like this. What’s incumbent
upon principals and local school districts is that we need to make sure this is not just one
more thing. The training doesn’t have to take up multiple staff meetings. To me, it’s
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 98
kind of a simple approach of acknowledgement that we have a duty to engage in student
mental health issues, and then what is the protocol for doing so?
While the onus of implementation was clearly articulated through data collected during
interviews, the evaluation of the law was not clearly defined. Such discernment was not based
on a lack of knowledge or concern on the part of these two individuals associated with the
legislative process; rather, the researcher learned that evaluation—that is, determining whether or
not AB 2246/EC 215 (Assembly Bill No. 2246, 2016; California Legislative Information, 2018)
is being implemented and if it has had any measurable affect—is not a function that is within the
purview of Assembly Member Opaleye, his staff, or the Assembly Education Committee.
When asked about ongoing monitoring and evaluation of EC 215 (California Legislative
Information, 2018), Legislator Calico conceded to the researcher,
You’re getting at a weakness in our process. We work on many bills a year and then we
move on, essentially, to the new crop of bills. And so, while I would love to tell you that
I’m fully on top of the implementation and any issues, I really can’t say we are. We have
received a few calls—and this is just anecdotal—I can’t say if it’s representative at all of
the state, but a few calls from parents who are concerned that their district was slow in
implementing the bill, or had not implemented the bill. But I don’t know how seriously
to take that.
Assembly Member Opaleye stated that the California Department of Education was the
primary body responsible for evaluation of how EC 215 (California Legislative Information,
2018) is implemented in California schools. Assembly Member Opaleye added that his office
may play a role in oversight at some stage, but that the general approach with such legislation is
to give local districts some time to develop their policies and practices, and then evaluate them in
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 99
the future. Legislator Calico suggested that compliance reviews may only analyze a percentage
of schools annually; thus, she stated, “It can be a while—years—before anyone from the State
checks-up to make sure that the district has implemented the law.” Ms. Calico added that a
portion of those reviews are online reviews and not site reviews, further limiting the accurate
assessment and efficacy of implementation.
Assembly Member Opaleye alluded to the importance of the current study; further stating
to the researcher,
There are a lot of folks—yourself included—who are interested in this legislation, so I’m
quite confident there’s going to be some analysis outside of governmental entities that are
going to want to look at the ultimate impacts of this legislation.
Legislator Calico echoed Assembly Member Opaleye’s sentiments regarding the
importance of research such as the current study aimed at better understanding the process, the
implementation, and the evaluation of youth suicide prevention practices. When pressed about
how EC 215 (California Legislative Information, 2018) is being evaluated and who is doing so,
Ms. Calico stated,
Unless there is a public outcry that something is wrong, it’s not us. As to evaluation in
terms of, say, is there any measurable effect on suicide rates? I don’t know that anyone is
looking at that, which is really a shame. So please help us do that. We can do plenty of
legislating, but when it comes down to it, it’s people like you, people in the field, who
will answer that.
As previously stated in this study, the emerging implementation status of EC 215
(California Legislative Information, 2018), and the data provided through interviews with two
individuals associated with the legislative process for the law, evaluation of pupil suicide
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 100
prevention practices demonstrates a needed area of research. The collaborative efforts of public
and private entities, elected officials, and California citizens to develop a bill into law must
further manifest as sound practices in California’s schools, if any real change is to be affected for
students.
The next sections of Chapter Four will examine the findings of this study related to the
research questions. While such findings are rooted in the data collected from southern California
middle school principals utilizing a survey instrument and a semi-structured interview protocol,
the themes that emerged from conversations with California legislators established a foundation
for the current study. While the rates of suicide are highest in northern rural areas of California,
the largest number of suicides takes place in southern California urban areas with higher
population density (California Department of Public Health, 2010; Ramchand & Becker, 2014).
Los Angeles county reported the highest number of deaths by suicide, with 7,367 suicides
reported during the 10 year period from 2004 to 2013, including 875 youth between the ages of
10 and 24 (California Department of Public Health, 2010). Meaningful analysis of current
practices and evaluation at the school site level, particularly at middle schools in southern
California counties where youth suicide numbers are highest, are critical components of the
work required to reduce or eliminate suicide risk for California’s youth.
Results for Research Question One
Research Findings Pertaining to Research Question One
RQ1 asked: How are middle school principals in southern California public schools
leading the implementation of EC 215: Pupil Suicide Prevention Policies?
With an emphasis on principal leadership, the first research question focused on
gathering data regarding the impact and the perceived causes of youth suicidality by the
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 101
principal-leaders within these middle schools. Principals’ knowledge of Education Code 215
(California Legislative Information, 2018) and the various aspects of youth suicide in the context
of middle school communities influence how programs and practices are approached. The
researcher found middle school principals must possess, develop, and leverage such knowledge
to effectively lead their schools towards full implementation of suicide prevention policies and
programs in their schools.
Current knowledge of Education Code 215. Tables 5 and 6 depict the level of
principal knowledge about Education Code 215: Pupil Suicide Prevention Policy (California
Legislative Information, 2018), and their local school district’s board policy regarding youth
suicide prevention. Respondents were asked to assess their personal knowledge in this area on a
Likert scale, with the options to select Very Low, Low, Medium, High, or Very High.
Table 5
Education Code 215: Pupil Suicide Prevention Policy
Level of Principal Knowledge f Percentage
Very Low 2 3.9
Low 6 11.8
Medium 30 58.8
High 10 19.6
Very High 3 5.9
Note. n = 51
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 102
Table 6
Local School District’s Board Policy About Youth Suicide Prevention
Level of Principal Knowledge f Percentage
Very Low
Low 2 3.9
Medium 20 39.2
High 23 45.1
Very High 6 11.8
Note. n = 51
The researcher found that the survey results in these two focus areas display different
levels of knowledge among middle school principals. Level of knowledge related to Education
Code 215 (California Legislative Information, 2018) showed 58.8% of participants had a
Medium level of knowledge, with High representing the next highest response rate at 19.6%.
Notably, two principals reported Very Low knowledge of EC 215, and three represented their
knowledge as Very High. Knowledge of local school district board policies regarding youth
suicide prevention yielded 45.1% of respondents indicating High knowledge, followed by 39.2%
selecting Medium.
Interviews with middle school principals validated the survey responses, to the extent
they indicated generally High but varied knowledge levels about Education Code 215 (California
Legislative Information, 2018). Principals repeatedly stated that while they have not scrutinized
the law itself, they understand that it requires them to lead their schools in the implementation of
suicide prevention programs and practices to benefit their middle school students. Principal
Tiger stated,
We have good practice, but I haven’t focused on [EC 215] to be honest. I haven’t looked
at it. I don’t look at it like I have to do this or else we’re going to get hit. I think our
understanding is based on our practice. It is something we have to have in place because
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 103
it’s our responsibility to take care of these kids. We investigate and we flush out any
concern that’s brought to our attention.
Similarly, Principal Boccacio indicated that while the school district provided a memo on EC
215 (California Legislative Information, 2018), its contents were less about the education code,
and more about themes for suicide prevention week. A third principal, Dr. Vermillion stated,
I don’t know very much about this law because it really hasn’t pertained to my sweet
little Mayberry
2
school, although I realize there are kids who we’re unaware of, who
probably will benefit greatly. So apart from reading it, I don’t have many applications,
implementation, not a lot of hands-on experiences in the trenches with kids in great
distress.
The data imply that middle school principals’ perceived high levels of knowledge about
EC 215 (California Legislative Information, 2018) is grounded in their interpretations of its
contents, and the mandate that they must lead their stakeholders to implement programs that
support the mental health and social emotional well-being of students who attend their schools.
Prevalence of youth suicidality in middle school. Principal responses to both the
survey and interview prompts demonstrated that suicidal ideation and attempts are of paramount
concern. The researcher sought to validate the prevalence of suicidality among students in
southern California public middle schools through two survey questions regarding student
communication of suicidal ideation, and attempted or completed suicide. Table 7 indicates
middle school principals’ responses to these questions regarding the frequency of suicidality at
their school sites.
2
References town on Andy Griffith Show
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 104
Table 7
Frequency of Youth Suicidality at Participants’ Middle Schools
Variable f Percentage
While working in your current
position, has a student at your
school communicated suicidal
thoughts/ideation to any school
staff member?
Yes 51 100
No
While working in your current
position, has a student at your
school attempted suicide or
died by suicide?
Yes 27 52.9
No 24 47.1
Note. n = 51
This study’s survey data demonstrated that 100% of the participant principals had
students at their respective schools who communicated suicidal thoughts or ideation to school
staff, while more than half (52.9%) experienced a student who attempted or died by suicide.
These startling figures were supported universally by principals in the study, who shared
numerous stories of students in crisis. Asked about the impact at middle school, Principal
Aurora stated, “This year, we’ve assessed more kids in the first 11 weeks of school than we have,
combined, in the last two years; a huge spike in need, but also more assessments and kids being
hospitalized.” Principal Gopher stated, “Right now we’re actually just kind of under siege. We
have a cluster of seven [suicidal students] this week. The numbers are real.” A third participant,
Principal Tiger, recounted a recent incident with a student in crisis,
Our last close attempt was the parent brought the kid in just this week. We had a student
that in the morning was holding a knife to his own throat and so mom got the knife away
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 105
from him and got him in here. We got them some support. We don’t know how to heal
what’s going on at home, but mom brought him to school to get the help, because she
needed the help. And that weighs heavy on us, like what has life thrown at these kids?
In an interview with a fourth principal, Dr. Canary, the researcher asked the participant to
share more about the student indicated on the survey as having attempted suicide. Dr. Canary
stated,
I can think of lots of them [students], and I’m not sure exactly which one that I said yes to
right at that moment, but most recently we had a young lady who took a container full of
pills. But no one would describe her as at risk. She had no signs whatsoever that this
would be a possibility for her. And she told the therapist in the hospital that next time,
she would succeed. So it’s heightened alert.
Such statements confirm that southern California middle school principals recognize the
complex problem of youth suicide at their schools, and suggest their collective dire concern for
its enduring prevalence, particularly among middle school children. These stories shared by
principals from their daily practice allude to the profound impact youth suicide can have on not
only the principals themselves, but also on staff, other students, parents, and the school
community at large. The researcher found that the sheer number of students impacted by
suicidality, as reported by a sample of southern California middle school principals, imply the
vast scope of the problem statewide. Furthermore, the researcher found that these figures
highlight the importance for principal leaders statewide to develop, implement, monitor, and
evaluate the effectiveness of suicide prevention practices that are tailored to the individual
cultures and climates of the school communities they are charged to serve.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 106
Principal knowledge regarding youth suicidality. Tables 8, 9, and 10 demonstrate the
level of principal knowledge regarding youth suicide, youth suicide warning signs, and youth
suicide risk factors. Respondents were asked to assess their personal knowledge in these three
areas on a Likert scale, with the options to select Very Low, Low, Medium, High, or Very High.
Table 8
General Knowledge about Youth Suicide
Level of Principal Knowledge f Percentage
Very Low
Low 1 2
Medium 13 25.5
High 29 56.9
Very High 8 15.7
Note: n = 51
Table 9
Youth Suicide Warning Signs
Level of Principal Knowledge f Percentage
Very Low
Low
Medium 14 27.5
High 23 45.1
Very High 14 27.5
Note: n = 51
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 107
Table 10
Youth Suicide Risk Factors
Level of Principal Knowledge f Percentage
Very Low
Low
Medium 11 21.6
High 31 60.8
Very High 9 17.6
Note: n = 51
The results of the survey in these three areas demonstrated a range of self-reported
knowledge about youth suicide, warning signs, and risk factors among middle school principals.
More than half (56.9%) of the respondents reported High general knowledge of youth suicide,
while a quarter (25.5%) reported a Medium level of general knowledge. Similarly, a majority of
the respondents indicated a High level of knowledge regarding youth suicide warning signs
(45.1%) and youth suicide risk factors (60.8%), respectively. Notably, none of the respondents
indicated a Very Low level of knowledge in these three areas, and only one principal (2%)
selected a Low level of general knowledge regarding youth suicide. However, the relatively
smaller number of respondents assessing their knowledge of these three areas as Very High
implied that the majority of principals in this study acknowledge there is more for them to learn,
in the interest of more effectively developing and delivering comprehensive suicide prevention
programs within their school communities.
The generally high level of knowledge among principals represented by the survey data
was consistent with findings from interviews with principals. The researcher asked principals
why they believed students were experiencing suicidality at the middle school level. Principals
broadly attributed not only the existence of suicidality, but also a perceived increase among
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 108
middle school students, to risk factors contributing to stress and anxiety. Such findings from
interviews conducted in the scope of this study align with the literature for suicide risk.
Specifically, principal participants provided data connecting to the individual, family, and social-
environmental characteristics that contribute to suicidality, as well as to the protective factors
described in Chapter Two of this study, which increase the likelihood for students in crisis to
seek help, often from teachers and school staff.
Student stressors. Principals consistently stated that stress is perceived as a significant
factor of youth suicidality in middle schools. Summarizing the notion, Principal Vermilion
stated, “Middle school can be an incredibly nasty time for kids. Anecdotally, kids tend to kill
themselves when they feel there’s no hope.” While the causes of stress reported by principals
among middle school students were varied, they tended to fall into similar categories.
A central theme that emerged through interviews was the idea that middle school students
experience enormous pressure in middle school. Principals repeatedly highlighted the
importance of academic success, involvement in multiple activities, college and career goals, and
being connected to the school community. During the interview, Principal Starry stated, “Other
than it being a very high pressure society, school is also very high pressure. Students want to be
able to achieve, and many come from a culture where anything other than excellent performance
is frowned upon.” Principal Olive shared perceptions of the pressures students face in middle
school,
I believe—what I have heard from kids—is just work-life balance. They’re trying to
keep up with their grades, worried about high school and college. They’re trying to
balance extracurricular activities and social interactions with others. So they’re super
stressed-out by that.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 109
Principal Tiger referred to this middle school pressure as, “Fear of the unknown.”
Acknowledging the developmental changes experienced by students during their middle school
years, this principal suggested students are, “Getting so much information, they don’t know how
to navigate it and say, ‘it’ll be OK.’ They don’t have that bigger, broader perspective yet, their
brains can’t get quite there.” Assessing the pressures experienced by middle schoolers at the
school site, Principal Kelp stated that students seem to be on, “Emotional roller coasters that
they’re going through throughout the day.” Principal Quillback recalled a conversation during a
conference with a 6th grade student and her parents, in which a mother asked, “How is she going
to go to MIT if she doesn’t go to the super advanced math class?”
An additional source of stress faced by middle school students comes not from school,
but from aspects beyond the scope of the instructional day and the school community.
Difficulties at home, family issues, neglect, abuse, and past trauma impact student anxiety in
profound ways. One principal, Dr. Canary, who serves in a lower socio-economic area, shared
observations of middle school students’ stressors.
What we see here is a lot of the suicidal ideation comes up from ACEs—the adverse
childhood experiences that they’ve had. And as we look through the ACEs, we notice a
pattern that many of these students at this particular school are having some severe
trauma in their lives that’s really affecting them. As we start diving deeper, we suspect
there might be a history of sexual abuse, that there is alcoholism or drug use in the
family. Some of our students’ parents are suffering from incarceration. Students have
feelings of isolation and loneliness that come from the secrets that they’re holding, which
are truly intense. They need the opportunity to be able to connect with someone or feel
loved.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 110
During an interview, Principal Aurora also alluded to the influence of home life on
student well-being. This principal suggested that the economic downturn in the community has
contributed to student and family stress, a reduction in enrollment as people leave the city for
more affordable housing, more students attending on permits, and parents working extra jobs that
take away from time to help and supervise their children. Consequently, the participant reported
increased anxiety manifests in students during the school day.
The participants in this study were knowledgeable about the myriad pressures that middle
school students face, as well as the expectations that students place on themselves. Principals
were also cognizant that such high expectations were related to feelings of student stress and
anxiety, and that these feelings, in turn, may lead to suicidal risk for some students. For other
students, who are dealing with extraordinary life circumstances beyond their control, the adverse
effects on their emotional state can also contribute to anxiety and a feeling of hopelessness. The
practices that principals and their school communities are employing to mitigate these stressors
for students are explored in greater detail in the findings from Research Question 2.
Impact of social media. Exacerbating the pressure for high achievement in middle
school, findings of this study indicated social media plays a key role in feelings of stress and
anxiety among middle school students. Principals consistently stated that one of the major
factors contributing to student stress and anxiety is social media. Several principals suggested
that student use of social media is unavoidably linked to their interpersonal relationships,
bullying, peer pressure, social status, and reputation. Principal Vermilion shared an observation
that student feelings of hopelessness and anxiety, “Usually come from an onslaught of peer
bullying, kids being mean to each other, so this person feels defenseless and that there’s nothing
else they can do.” Principal Kelp stated that peer pressure is obvious, stating students are,
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 111
“Seeing things on social media, comparing themselves with others, comparing their lives with
others.”
Moreover, principals reported that an instructional focus on the use of technology both at
school and at home has increased access and connectivity for students. When asked to what
Dr. Aurora attributes a marked increase in stress, anxiety, and suicidal ideation for middle school
students, this principal stated,
Social media is a big component. The definition of what we encountered as kids—social
peer pressure—has drastically been redefined. Kids are being exposed to elements and
topics and things on a social level in middle school that we might have faced in high
school. So we’re seeing an increase in [suicidality] because of the exposure to that.
Principal Quillback also expressed his concern about student use of technology and social
media. This principal’s efforts to address student anxiety and stress acknowledge a schoolwide
focus on technology that has presented some adverse and unintended consequences for students.
Principal Quillback explained,
I see this issue of kids in crisis as it relates to technology, whether it’s like the impact of
social media or what it does to a child’s brain when they look at extreme pornography at
the age of 12, or addiction, and how many times a kid picks it up, or how many hours
they play Fortnite. So we need to be a part of the solution to things that go beyond
school. It is a huge blessing and it can be a total curse.
With a focus on how social media is used as a means of bullying, Principal Starry
highlighted the impulsivity of middle school students as a function of their brain development.
Principal Starry described student decision making as often being born of emotion rather than
reason. As such, Principal Starry explained that a great deal of work with students experiencing
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 112
the stress and anxiety of bullying and cyberbullying is showing students how to address such
situations in a positive way, rather than “going towards the negative.” Principal Starry stated,
Our students are used to displaying their lives on social media online. And what happens
is they’re always subject to scrutiny. A person with a device becomes very brave and
says things that might or might not be true; might or might not be kind. Some students
have a hard time dealing with this because they’re learning how to become independent,
and being in middle school, how to be able to cope.
Multiple research studies indicated the importance of social relationships to adolescents,
and that low peer support, rejection from peers, or losing connections with peers can lead to
feelings of overwhelming anxiety (Ayyash-Abdo, 2002; Bostik & Everall, 2007; Hall-Lande et
al., 2007; Kidd et al., 2006; Schmidt et al., 2014). The findings underscore the middle school
principal’s responsibility to carefully weigh the benefits and risks of technology use, to partner
with parents and students to set parameters for utilizing technology, and to collaborate with
district-level technology departments and educational services to establish monitoring and
support for students and their use of social media.
Student groups with elevated risk. Table 11 depicts the level of principal knowledge
regarding youth subgroups identified as having an elevated risk of suicidality. Education Code
215 (California Legislative Information, 2018) identifies these high-risk groups as students with
disabilities, students with mental illness, students bereaved by suicide, foster and homeless
children, and LGBTQ youth (Assembly Bill No. 2246, 2016; Trevor Project, 2019).
Respondents were asked to assess their personal knowledge in this area on a Likert scale, with
the options to select Very Low, Low, Medium, High, or Very High.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 113
Table 11
Youth Groups with Elevated Risk of Suicide
Level of Principal Knowledge f Percentage
Very Low
Low 7 13.7
Medium 17 33.3
High 20 39.2
Very High 7 13.7
Note: n = 51
Survey respondents reported 39.2% possessed High knowledge of these groups’ elevated
risk of suicide. A Medium level of knowledge was indicated by 33.3% of the respondents, while
the number of principals reporting Very High and Low were both 13.7%. As with other survey
questions regarding principal knowledge of youth suicide, these results demonstrate that middle
school principals largely connect the circumstances in students’ lives with an increased suicide
risk. However, principal knowledge in this specific area reported lower than general knowledge,
risk factors, and warning signs.
Table 12 depicts the level to which middle school principals agree the parents and
guardians of students at their schools are knowledgeable about the school’s suicide prevention
practices. Respondents were asked to rate their level of agreement with the statement on a Likert
scale, with the option to select Strongly Disagree, Disagree to Some Extent, Neither Disagree
nor Agree, Agree to Some Extent, or Strongly Agree.
The survey results demonstrated different levels of agreement from the middle school
principals. Among the principals, 45.1% Agree to Some Extent that high-risk student groups
needs are addressed in the school’s suicide prevention policy, while 39.2% of respondents
Strongly Agree with the statement. Combining the top two responses, the data imply that most
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 114
southern California middle school principals (84.3%) assert their suicide prevention practices
highlight these students.
Table 12
Principal Perceptions of Policy Application to High-Risk Students
Item Mean SD
Strongly
Disagree
a
Disagree
to Some
Extent
b
Neither
Disagree
nor
Agree
c
Agree
to
Some
Extent
d
Strongly
Agree
e
My school’s
suicide prevention
policy addresses
the needs of high-
risk groups,
including students
with disabilities,
students diagnosed
with mental illness,
students with
substance abuse
disorders, foster
youth, and LGBTQ
youth.
4.18 .92 9.8% 5.9% 45.1% 39.2%
Note. n = 51.
a
Strongly Disagree = 1 on a 5-point Likert scale
b
Disagree to Some Extent = 2 on a 5-point Likert scale
c
Neither Disagree nor Agree = 3 on a 5-point Likert scale
d
Agree to Some Extent = 4 on a 5-point Likert scale
e
Strongly Agree = 5 on a 5-point Likert scale
As previously stated, AB 2246 was originally proposed on behalf of LGBTQ youth, in
partnership with advocacy groups like the Trevor Project. While the final version of the law was
ratified to support all California students in grades 7 through 12, the legislation directs suicide
prevention policy development to address the needs of student groups considered to be at
elevated risk. The survey results highlight the need for ongoing professional development and
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 115
support of middle school site leaders to further refine programs and practices to benefit all
students.
Findings from interviews with principals demonstrated a range of knowledge on the topic
of high-risk student groups, aligning with the results of the survey. During interviews, the
researcher asked principals to describe their understanding of supporting students with a higher
risk of suicidality, including foster and homeless youth, students living in poverty, students with
disabilities, and LGBTQ youth. Notably, participants tended to focus their responses on LGBTQ
youth, with only a few principals addressing other groups included in the legislation. While
some principals could clearly articulate their school’s approach to supporting students considered
to be more at risk, others conceded that their current suicide prevention practices do not
specifically target these students. With respect to whether or not his middle school’s approach to
targeting high-risk students, Principal Gopher succinctly stated, “It’s pretty universal.” When
asked if middle school was directing supports for these populations, Principal Boccacio said,
No, not really. We did discuss some students who fall in those categories, but I don’t
think we’re at a place where we feel like we are specifically targeting them, with the
exception of making sure they have adult mentors and connections on campus.
Principal Starry spoke about several students who are homeless, and that the school has
been able to offer them counseling, support groups, and clothing donations, but that the most
important piece is to, “Not make them feel like they are singled-out.” Principal Starry also
described an approach to supporting students who have communicated that they are transgender,
but that as a school, they are still developing practices. Principal Starry stated,
In the locker rooms, for example, we had privacy changing areas built so students would
feel comfortable going in either locker room. This is a journey for us. We’re learning as
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 116
well, and we want to be able to support students with whatever they need. As long as
students know that you’re coming at it from a caring perspective, then they are more
likely to engage, and tell you what it is that they need or don’t need.
Like several other principals, Principal Kelp approached the topic with compassion, but
admitted that it is an area about which the participant would like to know more. When asked if
the school is supporting the needs of high-risk student groups, Principal Kelp stated,
I don’t think that’s something we have in place yet, but that we’re aware there’s a need
and so we’re trying to figure out ways to be sensitive, and to identify what those students’
needs are, then work as a staff to support them. The environment we’ve tried to create
here is that everyone is open to supporting each other and giving them an opportunity to
be who they are. And I’m hoping that would be a step towards allowing students to be
more welcoming and more inclusive to everybody.
Research showed that youth who identify as gay, lesbian, bisexual, transgender,
questioning, or gender non-conforming experience higher levels of stress and anxiety, and are at
an increased risk of suicidal behavior compared to their heterosexual peers (Hong et al., 2011;
Marshal et al., 2013; Mustanski & Liu, 2013; Russell & Joyner, 2001; Silenzio et al., 2007;
Stone, Luo et al., 2014; Trevor Project, 2018). King et al. (2001) and Waldrop et al. (2007)
broadly found that increased incidence and frequency of adverse life experiences, as may be
experienced by homeless and foster youth, students with disabilities, or other groups named in
EC 215 (California Legislative Information, 2018), increase the risk of youth suicidal behavior.
The results of the current study highlight that as compared with other areas of principal
knowledge surrounding adolescent suicidality, elevated risk groups are clearly a topic requiring
additional study, support, and training.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 117
Mental illness. Of the 10 principals interviewed in the course of this study, three (30%)
made passing references to mental illness when asked about their perceptions of increased
suicidality among their middle school students. With respect to suicidal ideation of students in
middle school, Principal Vermilion stated, “I also think that there’s mental illness involved
because it takes a huge leap to going from being unhappy with what somebody said to you, to
killing yourself.” Chapter Two of this study documents multiple studies that connect depressive
disorders, anxiety related disorders, and several other psychopathological afflictions with an
increased risk of suicide (Apter & King, 2006; Brent et al., 1999; Fleischmann et al., 2005;
Gould et al., 2003; Mazza & Reynolds, 2008; Nock et al., 2013; McManama O’Brien & Berzin,
2012).
The literature demonstrated a strong correlation between a diagnosis of mental illness in
youth and a marked increase in suicidal risk (Brent et al., 1999; Bridge et al., 2006; Nock et al.,
2013). While principals variably described their daily work supporting students in social-
emotional contexts, addressing student anxiety, family relationships, and environmental
stressors, it is noteworthy that the majority of middle school principals in this study did not
directly reference mental illness as a cause for concern related to youth suicide. Johnson and
Parsons (2012) highlighted the importance of school staff to receive targeted mental health
intervention training, as a means of supporting at-risk students with suicide prevention and
intervention. While the researcher did not specifically inquire as to the participants’ knowledge
about the implications of psychopathology as they relate to suicidal risk, these findings suggested
that principals may enhance their leadership and delivery of suicide prevention practices through
specific training on psychopathology, underscoring the epidemiological connection between
mental illness and youth suicidality.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 118
Protective factors. Table 13 depicts the level of principal knowledge regarding youth
suicide protective factors. The Centers for Disease Control and Prevention (2017) suggested that
protective factors serve to shield individuals from suicidality. Respondents were asked to assess
their personal knowledge in this area on a Likert scale, with the options to select Very Low, Low,
Medium, High, or Very High.
Table 13
Youth Suicide Protective Factors
Level of Principal Knowledge f Percentage
Very Low
Low 3 5.9
Medium 14 27.5
High 28 54.9
Very High 6 11.8
Note: n = 51
The survey results demonstrated the different levels of knowledge possessed by middle
school principals in the area of protective factors. More than half of the respondents (54.9%)
reported a High level of knowledge, followed by 27.5% of the principals who had a Medium
level of knowledge. Combining the High and the Very High responses yielded 66.7%, indicating
that the majority of principals are knowledgeable about protocols to support students who may
be suffering from suicidal ideation. As with other areas of general knowledge about youth
suicide, the results show there is a range among principals, and room for improvement to
maximize the efficacy of suicide prevention approaches.
The relatively higher levels of knowledge regarding protective factors for students in
crisis were consistent with themes that emerged from interviews with principals. The importance
of students having access to supports for their social-emotional health, as well as access to
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 119
support from others was discussed repeatedly by principals. Furthermore, several participants
shared their perceptions that recently higher numbers of students in crisis do not necessarily
represent an increase; rather, students feel more comfortable and empowered to seek help when
they are facing difficulties. In that sense, principals noted that the number of students
experiencing stress and anxiety may be on the rise due to various factors, but the number of
students seeking help is also increasing.
In response to why Principal Gopher believed there has been an uptick in the numbers of
students self-reporting, the participant described the leadership approach implemented at the
school site, stating,
It’s having broader conversations with the kids about their lives, and then kind of
building them up. We’ve opened up kids to come and talk to us. There’s more of that
going on, plus this generation is a little more sensitive I think. So they’re more willing to
come out and talk, where previous generations probably would not. There would be that
stigma of mental illness, but now I think we have accepted it a little more.
Reflecting on protective factors in place, with respect to six students who had been
referred or self-referred to the office for suicidal ideation in the current school year, Principal
Aurora stated,
I don’t like our numbers. Do I want to have six assessments in our community now? No.
At the same time, six kids got the help that they needed, they got hospitalized, they got
treatment, and they’re back in our environment. That’s a good thing.
Principal Boccacio described protective factors as being a primary focus for school
leaders. The principal explained, “When you advertise that culture of connection and kindness
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 120
are important to you as a school, it kind of keeps hitting home with kids, and circulates. And I
hope we see more of that.”
As middle school principals work towards implementation of Education Code 215
(California Legislative Information, 2018) at their sites, it is crucial for them to build upon
existing structures by which students experiencing stress, anxiety, depression, or other
difficulties in their lives can access help. Protective factors are a crucial element of a school-
based suicide prevention program. The researcher found that principals work to ensure that these
systems are in place, in order to facilitate support for students in need.
The role of principals in youth suicide prevention practices. Table 14 depicts the
level of principal knowledge regarding their role in the implementation of suicide prevention
practices at their respective middle schools. Respondents were asked to assess their personal
knowledge in this area on a Likert scale, with the options to select Very Low, Low, Medium,
High, or Very High.
Table 14
Principal’s Role in Implementation of Suicide Prevention Practices
Level of Principal Knowledge f Percentage
Very Low
Low 1 2
Medium 14 27.5
High 22 43.1
Very High 14 27.5
Note: n = 51
The survey results demonstrated the different levels of knowledge possessed by middle
school principals regarding their role in implementation. Twenty-two of the principal-
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 121
respondents (43.1%) reported a High level of knowledge, followed evenly by responses of
Medium and Very High, at 27.5% each. As in other areas of principal knowledge about youth
suicide, the data revealed there is a range among principals. Only one principal indicated a Low
level of knowledge, suggesting that while there may be differences in the descriptions of
different principal’s participation in the process, the majority have a relatively high
comprehension of their respective roles.
Data collected through interviews with principal participants were consistent with the
survey results. Moreover, the interview data clarified that while principals may understand their
leadership role implementing prevention protocols, their involvement in the delivery of suicide
intervention practices varied among participants.
Only two principals discussed how they are directly involved with suicide intervention
alongside staff members, including participation on crisis teams, contacting parents, and
conducting risk assessments. The other eight participants stated they were involved to varying
degrees, playing more of a supporting and advisory role. These principals reported that they rely
instead on counselors, psychologists, therapists, outside agencies, and other staff to work directly
with the students. Each principal was able to articulate his or her primary role, yet differences in
practice were noteworthy, considering the legal requirements of EC 215 (California Legislative
Information, 2018).
While it was evident during his interview that he cares deeply for the well-being of
students, Principal Canary was one principal who described indirect involvement with suicide
intervention at his school. Principal Canary stated,
I don’t sit in on the crisis and the threat assessments, I don’t do that. It’s not something
that is within what needs to happen because I have to be able to keep the ship moving
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 122
while they’re dealing with the crisis and situation. So I meet with [crisis response team
members] regularly and we go through, kid by kid, to figure out who needs what, and
what needs to happen, and how we can work through it.
Similarly, Principal Quillback expressed that suicide prevention is a concern as a
principal, and an area about which the participant has good knowledge. Still, Principal Quillback
stated, “Let me say clearly—I don’t feel as principal I’m leading the charge on suicide
prevention. I don’t deal directly with a lot of suicidal kids. Actually talking to the kid? That’s
not my role.” Principal Quillback instead referred to the responsibility as a principal to ensure
that school was safe and welcoming for all students, teachers, and members of the community.
The responsibility of intervening with students in crisis, Principal Quillback explained, generally
falls to the counselors, who receive the referrals from other staff. Principal Quillback conveyed,
“I might deal with the parents or be part of the intake when they come back,” but expressed a
reliance on the counselors, intervention and behavior specialists, and other support professionals
to directly address student needs.
When asked by the researcher about the role of principals in suicide prevention practices,
Principal Gopher conveyed the principal only deals directly with students in crisis when other
team members are occupied with students. As to the specifics of the role as principal, Principal
Gopher spoke broadly in terms of leadership. Principal Gopher stated,
We have to lead, and it starts with articulating the purpose of suicide prevention. It’s
having conversations with the leadership team and developing a plan. You have to have
the purpose and the plan; otherwise you’re just throwing another thing at teachers. For
example, I’m talking with our counselors, who are working on the plan to visit
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 123
classrooms; that they will implement with the students in small groups. And then using
data along the way to keep monitoring and adjusting.
One of the two principals who described direct involvement with suicide prevention and
intervention at a school site was Principal Tiger. This participant communicated that prior to the
principalship, Principal Tiger served as the school’s counselor. Principal Tiger described a level
of comfort working directly with students in crisis; likely the result of a background in
counseling. At the same time, Principal Tiger recognized the role of the principal in suicide
prevention is chiefly to facilitate the work of professional members on the crisis team. Principal
Tiger stated,
I’m not the expert in, in very many things, but I have to dabble in a lot, and then trust my
people to become the experts. I’m there to support, watch, help, and guide them, but let
them be there for the kids. As the school leader, you’re helping all these processes and
people move forward.
Summary of Results for Research Question One
As the survey data and interview data supported, middle school principal leadership plays
a critical role in the implementation of initiatives intended and designed to support the success
and well-being of students. While southern California principals may not have scrutinized
Education Code 215 (California Legislative Information, 2018) and related pupil suicide
prevention policies, they comprehend their leadership role to deliver on the promise of creating a
safe, welcoming, and healthy environment in which students can succeed. Moreover, the
knowledge that principals are able to acquire and apply in the area of suicide prevention
established the support systems and delivery mechanisms for schoolwide suicide prevention,
intervention, and postvention protocols.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 124
The epidemic of youth suicidality in southern California middle schools was poignantly
illustrated by the data that 100% of respondents (n=51) to the survey instrument reported
students have communicated suicidal ideation to staff members at their schools, and more than
half have endured students attempting or dying by suicide. These disturbing figures illustrate the
dire importance for principals to not only possess the requisite knowledge to recognize the
warning signs of students in crisis, but also the leadership to empower staff members with the
tools and the charge necessary to intervene in a meaningful manner.
The research from this study supports Bolman and Deal’s (2013) assertion that effective
principal-leaders leverage their knowledge, their individual talents and strengths, and their
different approaches tailored to the cultural uniqueness of their respective middle school
communities, to reframe their leadership. With a foundation in the knowledge required to
design, develop, and implement suicide prevention practices at their sites, the principals involved
in this study demonstrated the ability to approach the ongoing dilemma of adolescent suicidality
from different perspectives that are attuned to the diverse needs of stakeholders, and the
organization as a whole (Bolman & Deal, 2013).
Results for Research Question Two
Research Findings Pertaining to Research Question Two
RQ2 asked: What are the best practices and strategies being utilized in these middle
schools to support pupil suicide prevention, intervention, and postvention?
The data gathered for this area of the research was examined to ascertain how middle
school communities are addressing the epidemic of youth suicide in southern California public
schools. Programs and initiatives aimed at addressing student needs, and the procedures
employed by staff with respect to suicide prevention, intervention, and postvention are discussed.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 125
The data gathered through surveys and interviews with middle school principals revealed
distinct themes surrounding the practices, methods, and strategies schools require in order to
address growing concerns for student mental health and well-being. These themes include
appropriate personnel and staffing, professional development, and myriad social-emotional
support systems which foster student connectedness while leveraging school culture and climate.
Best practices are highlighted in the data by not only what principals and school communities are
providing to students, but also revealed by deficits in the programs and practices that are not
being offered. Such challenges—and how they contribute to principal evaluation of practices
and progress—are further examined in Research Question Four.
General approach. Table 15 depicts the level to which middle school principals agree
the suicide prevention practices at their respective schools delineate the appropriate protocols to
be followed by staff when they encounter a student experiencing suicidality. Respondents were
asked to rate their level of agreement with the statement on a Likert scale, with the option to
select Strongly Disagree, Disagree to Some Extent, Neither Disagree nor Agree, Agree to Some
Extent, or Strongly Agree.
The survey results demonstrated different levels of agreement from the middle school
principals. Among the principals, 64.7% Strongly Agree that their school has implemented
procedures with teachers to address a student at risk of suicide, while 31.4% of respondents
Agree to Some Extent with the statement. Two principals (3.9%) selected Disagree to Some
Extent. Combining the top two responses, the data implied that the vast majority of principals
(96.1%) represent that their schools have suicide prevention procedures in place, and that staff
members are identified as playing a key role in the process.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 126
Table 15
Principal Perceptions of Current Practice
Item Mean SD
Strongly
Disagree
a
Disagree
to Some
Extent
b
Neither
Disagree
nor
Agree
c
Agree
to
Some
Extent
d
Strongly
Agree
e
My school has
implemented
procedures
detailing the
appropriate steps
staff should take if
they encounter a
student
demonstrating
suicidal risk. 4.57 0.7 3.9% 31.4% 64.7%
Note: n = 51
a
Strongly Disagree = 1 on a 5-point Likert scale
b
Disagree to Some Extent = 2 on a 5-point Likert scale
c
Neither Disagree nor Agree = 3 on a 5-point Likert scale
d
Agree to Some Extent = 4 on a 5-point Likert scale
e
Strongly Agree = 5 on a 5-point Likert scale
This assertion represented by the survey responses was consistent with themes
demonstrated through interviews with principal participants. Each principal interviewed was
able to articulate their school’s general approach to suicide prevention, intervention, and
postvention in concert with teachers and other school staff. As suggested by Assembly Member
Opaleye, the design and delivery of these approaches vary as a function of school culture, school
climate, and the perceptions and experiences of the principals charged with leading the
implementation. Despite these differences among the school communities, the survey and
interview data revealed three themes shared among participants, integral to the implementation
of suicide prevention programs.
Appropriate personnel. During interviews with middle school principals, the
participants repeatedly indicated that having “the right people” plays an integral role in the
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 127
implementation of suicide prevention programs. Middle schools in southern California are
bolstering their ability to deliver suicide prevention to adolescents by not only leveraging
existing staff like counselors and psychologists, but by adding a more diverse group of
specialized professionals to support students suffering with suicidality.
Principals also described how their respective school districts have recently added new
positions to organize and facilitate the delivery of suicide prevention policy at secondary school
sites. Table 16 outlines the staff positions who serve important functions in suicide prevention
practices, and the frequency they were reported by principal participants during interviews at
southern California middle schools.
Table 16
Staff Involved in Suicide Prevention Practices
Worked
Position as Percentage
Counselor 10 100
Psychologist 8 80
Director of Student Wellness/Welfare 6 60
Marriage and Family Therapist 4 40
Transition Counselor 3 30
MFT Intern 3 30
School Resource Police Officer 3 30
Behavior Specialist 2 20
Social Worker 2 20
Social Work Intern 1 10
Yoga Instructor 1 10
Note: n = 10
At the district level, six principals described new director positions in the last two years
aimed at child welfare and student wellness. While each has ostensibly been added, in part, to
oversee the implementation of EC 215 (California Legislative Information, 2018) in accordance
with the law, the role of these directors in their respective school districts and their perceived
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 128
value to site principals differed among participants. Principal Canary, who serves a school
community located in a lower socio-economic area, stated,
We work with our Healthy Start or the Child Welfare and Attendance Officer to make
sure that students who are in MediCal can get counseling at school and those services are
provided at the school.
Principal Vermillion, who serves in a higher socio-economic middle school, reported the
school district’s Director of Child Welfare and Attendance has been invaluable to establishing
suicide prevention, intervention, and postvention protocols,
I have to give a nod to our director of programs at the district office who came to us from
LA Unified because he has realized that our little district, although well meaning, doesn’t
have processes and procedures in place. So he actually came to our school to work with
our safety team to create this plan, so that we are ready for any catastrophe that could
come down the line.
Other principals shared during interviews that while their respective school districts have
created director positions, opinions about the support from these individuals have been mixed.
Principal Gopher described how the district’s director created a committee of high school and
middle school students along with their parents to explore perceived needs for suicide
prevention, but according to Principal Gopher, “They haven’t really met a lot, and we haven’t
gotten a lot from them yet on that.” Principal Aurora vaguely explained that the district’s
Director of Wellness, “Kind of guides us in terms of implementation.”
Principal Quillback expressed outright frustration that the Director of Wellness in the
district, who has been two years on the job, seems more concerned with the district’s contractual
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 129
obligations with a private family service agency than supporting suicide prevention programs
and staff at the school site. Principal Quillback stated,
Our district has an interesting relationship with an agency that provides counseling and
support services. Our counselors reached out to another agency and asked, can you come
do training? So they set up this whole thing for all the counselors in the district, and then
the night before, we’re told we need to quash it. So I feel like my district is very cautious
about how we address things related to suicide.
At the site level, principals reiterated the importance of school counselors and
psychologists, acknowledging they have endured the most profound changes to their jobs as
adolescent suicide reporting has increased in recent years. Principal Gopher summarized
thoughts about suicide prevention practices, stating, “It really starts and ends with a good
counseling department.” Invariably, principals reported counselors are the individuals to whom
teachers, parents, and other staff refer students in crisis. Several principals also indicated that
more comprehensive implementation of suicide prevention, intervention, and postvention
practices in their middle schools has increased the work hours and expectations placed upon
counselors and psychologists. Principal Aurora described some of the novel work counselors at
school are providing as preventative measures:
We have three counselors now, and they run groups—lunch groups, peer groups, game
groups, anything that deals with connecting kids to the school and each other. They do
curriculum pieces where they visit each grade level and discuss things like coping with
anxiety and stress. Our counselors have a lot of discretion, but a lot of responsibility.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 130
Principal Starry expressed some frustration with staffing, recognizing that the suicide
prevention implementation and other programs at the school have suffered due to a lack of
appropriate staffing. Principal Starry stated,
Our support staff is not always here, because we share a psychologist and we have two
part-time counselors. We have everybody doing everything. We’re all trying to work
together to make sure these students are supported, and yet, run a school. And as long as
we’re doing everything else, and leading and focusing on instruction, and improving
student achievement, and all of that sort of stuff, it’s easy to not put time towards
something like prevention that is really important and necessary.
As a mitigating factor, several principals reported the addition of new staff to facilitate
suicide prevention efforts. Principal Canary stated the school site hosts licensed marriage and
family therapists, MFT interns, social workers, and social work interns, along with the existing
counselors. Principals Kelp, Olive, and Boccacio indicated that members of their local police
department serve on campus as school resource officers, providing various student disciplinary
and support services, including intervention for adolescents communicating suicidal ideation or
demonstrating warning signs. Principals Starry, Vermillion, and Olive described their transition
counselors as primarily helping students with coping and orientation between 5th and 6th grade
as well as articulating to high school; however, at all three schools, the transition counselors have
been called upon to assist with various adverse student mental health and social emotional
situations. Principal Quillback explained that an instructor was recently hired to teach yoga to
students once a week, to help them relax and center. Notably, while the participants in this study
articulated various individuals positively supporting suicide prevention efforts, there were many
differences in the composition of these middle school staffs.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 131
Crisis response teams. As a means of organizing the efforts of a variety of professionals
on different middle school campuses, several participants described the formation of crisis
response teams on their middle school campuses. The National Association of School
Psychologists (2017) stated that the crisis response team is responsible for developing and
implementing suicide risk assessments, and conducting suicide intervention, and postvention
practices. Table 17 shows the survey results of principals who were asked if their middle
schools had created a crisis team as a component of their suicide prevention practices.
Table 17
Crisis Team Formed at Middle School
Variable f Percentage
Yes 47 92.2
No 4 7.8
Note: n = 51
Survey respondents reported 92.2% of middle schools had created crisis teams.
Interviews with principals validated the survey data, as nine of the 10 principals reported the
existence of crisis response teams on their campuses. Principal Vermillion listed the members of
the middle school’s crisis response team as, “the psychologist, counselor, assistant principal, and
key teachers.” Principal Vermillion described their primary role is to use a risk assessment
protocol to determine the level of risk a student is exhibiting. Principal Canary described how
the crisis response team would act if a child were referred, stating,
Once the counselor secures the child in his office, we assemble a team that includes the
counselor, school psychologist, an administrator, and others to sit and talk through the
problem. They discuss the protocol. They want to hear the person actually say that they
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 132
are suicidal, and then they want to know if they have a plan, at that point in time. We
have to establish the level of risk, and take the next steps if needed.
Table 18 depicts the level of principal knowledge regarding conducting a risk assessment,
and Table 19 shows the level of principal knowledge about appropriate intervention with a
student demonstrating suicidal behavior. Respondents were asked to assess their personal
knowledge in this area on a Likert scale, with the options to select Very Low, Low, Medium,
High, or Very High.
Table 18
Conducting a Risk Assessment
Level of Principal Knowledge f Percentage
Very Low
Low 8 15.7
Medium 16 31.4
High 16 31.4
Very High 11 21.6
Note: n = 51
Table 19
Appropriate Intervention with a Student Demonstrating Suicidal Behavior
Level of Principal Knowledge f Percentage
Very Low
Low 2 3.9
Medium 14 27.5
High 23 45.1
Very High 12 23.5
Note: n = 51
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 133
The survey results illustrated the different levels of knowledge possessed by middle
school principals regarding risk assessments and appropriate interventions. With respect to risk
assessments, 31.4% reported a High level of knowledge, 31.4% reported a Medium level of
knowledge. Conspicuously, 15.7% of respondents indicated Low knowledge about conducting
risk assessments. Results for principal knowledge of appropriate intervention with a student
demonstrating suicidality trended higher, but also demonstrated a range of knowledge, with
45.1% reporting High knowledge, followed by 27.5% reporting Medium knowledge.
During interviews with the researcher, middle school principals repeated the need for
their crisis response teams to conduct risk assessments to get a clearer picture of a student’s
current emotional state. While participants described different processes, they generally outlined
a series of questions utilized by the crisis response team to determine a student’s level of risk.
The purpose of a risk assessment is to determine the most appropriate actions to ensure the
immediate and long-term safety of the student (National Association of School Psychologists,
2017).
Principals touched on such appropriate actions with respect to contacting a psychiatric
evaluation team (PET), reaching out to parents to encourage them to seek medical evaluation for
their child, or as part of postvention re-entry plans. However, none of the principals described
these as being discussed or designed by crisis response teams; instead, such intervention and
postvention practices were facilitated by counselors, assistant principals, or the principal-
participants themselves. The findings suggested that middle school principals require additional
training in the roles and responsibilities of crisis response teams, to maximize their effectiveness
and facilitate the best possible outcomes for students experiencing stress, anxiety, mental health
crises, or suicidality. Likewise, relatively greater number of survey respondents reporting Low
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 134
knowledge about risk assessments—a primary function of the crisis response team—further
illustrating the importance of developing this knowledge and application among middle school
principals.
Professional development. The language contained in EC 215 (California Legislative
Information, 2018) mandates that public educational institutions must provide staff development
for middle and high school staff that addresses youth suicide and prevention. Training is
required to include protocols instructing students with coping skills and problem-solving
strategies, facilitate school connectedness, improve school climate, develop communication
channels with parents, and create practices for suicide prevention, intervention, and postvention
(Assembly Bill No. 2246, 2016). Table 20 depicts the number of hours middle school principals
reported they have received addressing suicide prevention policy.
Table 20
Professional Development Received by Middle School Principals
Hours f Percentage
0 3 5.9
1 8 15.7
2 8 15.7
3 2 3.9
4 3 5.9
5 4 7.8
6 4 7.8
8 4 7.8
10 6 11.8
12 1 2
15 2 3.9
16 2 3.9
20 1 2
25 1 2
30 1 2
40 1 2
Note: n = 51
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 135
Of the 51 survey respondents, 94.1% indicated they have received some professional
development on suicide prevention practices; however, 70.5% reported having attended eight or
fewer hours of professional development on suicide prevention. Bimodal responses of 15.7% for
one hour of training, and 15.7% for two hours of training, summed with three respondents who
state they have received zero hours of training combine for 37.3% of respondents, more than four
times the 8% of principals reporting the top four training hours.
While the majority of middle school principals have received some professional
development in suicide prevention, they unanimously acknowledged that they would like more
training. Principal Boccacio described the principal training received as “Light,” explaining “We
received training on accessing the district mental health team and some protocols for evaluation.”
Lamenting minimal training before several challenges manifested at the middle school with
rising numbers of students reporting suicidality, Principal Aurora described the manner in which
staff received professional development, stating,
How it was presented to us was very superficial, very quick. This is what we have to do
and that’s it, along with my own research. I’m working with our other school sites to see
if there’s more we can do and provide. We need more. We’re assessing more and
getting more parent contact that they need help. Most of it is our own research, but is it
enough? No, we need more knowledge about it, more resources, more tools for
implementation. And the sustainability is a big thing, too, because we need to be able to
find money for it.
Principals universally supported the notion that training teachers and other staff is a
critical component of ensuring the best possible implementation of suicide prevention practices
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 136
at their middle schools. Table 21 shows the responses of principals asked if suicide prevention
training has been offered to members of their respective school staffs.
Table 21
Suicide Prevention Training Offered to School Staff
Variable f Percentage
Yes 42 82.4
No 9 17.6
Note: n = 51
Survey data demonstrated 82.4% of principal respondents have facilitated training for
their school staff. While interview data validated that most participants have provided their
teachers with foundational skills via professional development covering suicide prevention,
intervention, and postvention, they acknowledge staff require more specific training and support.
Several participants explained that their professional development is ongoing. Principal Kelp
described the training received alongside teachers, as well as plans for follow-up training for
staff,
We had the crisis team training that we all received; going through the documentation
and practices, role playing, going through different situations, how we would handle it.
We have identified a couple of staff members who will train our whole staff so they are
aware of what to look for and how to refer them for counseling, or bring them to the
office for support.
Similar to reflections on their own training, the researcher found that middle school
principals recognize some progress has been made, as principals have delivered or facilitated
presentations of professional development and suicide prevention training to teachers during
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 137
faculty meetings, in accordance with EC 215 (California Legislative Information, 2018) and
local board policies. Assessing how trainings have impacted teachers, Principal Vermillion
stated, “I think they’re going to reach out to the administration, the counselor, the psychologist.
Procedures are better now, but they’re just beginning to get better.”
Findings further suggested that principal perceptions of staff preparation bear
implications on how principals choose to lead teachers and support staff, and how to ascertain
when and if they are prepared to address a student in crisis. Table 22 depicts the level to which
middle school principals agree with statements about staff preparation. Respondents were asked
to rate their level of agreement with the statement on a Likert scale, with the option to select
Strongly Disagree, Disagree to Some Extent, Neither Disagree nor Agree, Agree to Some Extent,
or Strongly Agree.
The survey results in the two focus areas showed different levels of agreement among
middle school principals. Level of agreement related to school staff having received adequate
training with pupil suicide prevention practices showed 41.2% of respondents selected Agree to
Some Extent, with 25.5% selecting Strongly Agree. Level of agreement related to teacher
capability to recognize warning signs of suicide among students demonstrated 52.2% of
respondents selected Agree to Some Extent, with 23.5% selecting Strongly Agree. Given the
emergent status of EC 215 (California Legislative Information, 2018), the survey results
suggested that principals largely believe staff members possess at least a requisite level of
training to address youth suicidality; however, the responses demonstrating less than strong
agreement imply principals perceive the need for staff to receive additional professional
development.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 138
Table 22
Principal Perceptions of Staff Preparation
Item Mean SD
Strongly
Disagree
a
Disagree
to Some
Extent
b
Neither
Disagree
nor
Agree
c
Agree
to
Some
Extent
d
Strongly
Agree
e
The staff of our
school have received
adequate training
regarding pupil
suicide prevention
practices.
3.73 1.08 2% 15.7% 15.7% 41.2% 25.5%
Teachers at my
school are capable
of recognizing the
warning signs of
suicide among
students.
3.90 .88 9.8% 13.7% 52.9% 23.5%
Note: n = 51
a
Strongly Disagree = 1 on a 5-point Likert scale
b
Disagree to Some Extent = 2 on a 5-point Likert scale
c
Neither Disagree nor Agree = 3 on a 5-point Likert scale
d
Agree to Some Extent = 4 on a 5-point Likert scale
e
Strongly Agree = 5 on a 5-point Likert scale
Social-emotional support programs. As the foundation of suicide prevention practices,
southern California middle school principals facilitate delivery of a variety of social emotional
programs within school communities. Such programs mentioned by participants in the study
broadly fall under the umbrella of social emotional learning, which is the process of providing
instruction to help students manage their emotions, establish positive goals, demonstrate
empathy, develop and foster positive relationships with others, and make measured decisions
towards beneficial outcomes (DePaoli et al., 2017). Principals reported myriad student clubs,
activities, peer groups, academic and emotional support systems, and designated school facilities
that work in concert to assuage student stress, support social emotional health, and connect
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 139
students to their school and to one another. Table 23 outlines the various types of social
emotional and prevention programs described by principals of southern California middle
schools.
Table 23
Social Emotional and Prevention Programs
Type of Program Worked as Percentage
Restorative Practices 6 60
Where Everybody Belongs 5 50
Wellness Center 5 50
PBIS 4 40
Peer Tutoring 4 40
Group Counseling 4 40
Mindfulness Training 4 40
Student-Created Clubs 4 40
AVID 4 40
Student Assemblies 3 30
Group Counseling 3 30
GSA/LGBTQ Student Groups 3 30
Gender-Specific Student Groups 3 30
Lunch Groups 2 20
Growth Mindset Intervention 2 20
Leader in Me 2 20
Parent Education Programs 2 20
Outdoor Science School 2 20
On-Site Therapy 2 20
Yoga 1 10
Note: n = 10
Notably, many of these collective efforts serve largely as a function of universal
prevention; that is, practices and policies directed towards all students to reduce the risk factors
of suicide, and systems of support for children and adolescents suffering from depression, mental
illness, sadness, anxiety, or suicidal ideation (Drapeau & McIntosh, 2015; Heard Alliance, 2017).
In response to EC 215 (California Legislative Information, 2018) requiring suicide prevention
among middle school youth, long-standing programs on middle school campuses like Positive
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 140
Behavior Interventions and Supports (PBIS) and Leader in Me (Covey, 2018) have been retooled
and repurposed. Additionally, while several of these programs, such as AVID and peer tutoring,
were originally conceived as academic support initiatives, middle school principals continually
expressed not only the connection between academics and emotional well-being, but also that
aspects of these programs—like organizational skills and goal-setting—contribute directly to the
social emotional learning of middle school students.
For example, Principal Kelp explained that the school’s AVID students, “Are visiting and
reaching out to the elementary schools with social activities like movie nights after school, to
help them feel connected to the school before they even get here.” Principal Vermillion credited
Outdoor Science School with opportunities for “Kids learning independence, but also
collaborating to solve real-world problems.” And Principals Tiger and Aurora described student-
conceived clubs dedicated to LGBTQ concerns that took on new significance in light of EC
215’s (California Legislative Information, 2018) mandate to support specific student populations
determined to be at higher risk of suicidality.
Six participants indicated the use of Restorative Practices as an important element of their
suicide prevention approach. Restorative Practices is, in part, a social science process that
examines how to build social capital through participatory learning and decision-making which
have shown to reduce violence and bullying, improve behavior, and restore relationships
(Wachtel, 2013). Principal Starry summarized the school’s general prevention practice as a
system that, “Empowers students first, and then teachers can lead them towards a direction of
social emotional health.” Principal Starry described the use of Restorative Practices as the
means by which staff are working to build the social emotional capacity of students, stating,
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 141
Students lives are completely stressful, with all the demands on their time. [Restorative
Practices] allow the school to be a place where students are the leaders, the teachers, the
facilitators, and we just give them the environment that they need to develop in a calm,
quiet way, so they can reach their full potential.
Principal Canary detailed the middle school’s use of Restorative Practices as part of an
approach to social emotional supports. Principal Canary stated the staff has been trained to work
with students on, “Nonviolent communication strategies, community building circles, and
problem-solving circles,” all components of Restorative Practices. Principal Canary stated that
these methods are used in every classroom with all students to build community and connections,
while students at an elevated level of risk may participate in more intensive problem solving and
coping skill circles.
Principal Olive expressed amazement at how community circles in classrooms—a
component of Restorative Practices—have allowed teachers to check on the emotional status and
preparation of their students. Principal Olive stated that several teachers “circle-up” each day,
creating circles without laptops or note papers; just knees, ears, and hearts. Principal Olive
stated,
In a circle, kids tend to open up and you can find out things about them without realizing
it, like stand up and move if you ate a healthy breakfast this morning; then, you see all the
ones sitting down who didn’t eat breakfast. So there are lots of ways this has made kids
feel more part of the community. The approach has really made this a happier, gentle,
more inclusive place.
Principal Vermillion described the school’s initial use of Restorative Practices as a means
of alternative discipline, but staff realized the impact the program had on student social
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 142
emotional well-being, interactions, and connections to their school community. Principal
Vermillion offered that the program has changed the culture of the school, stating,
Restorative Practices is a program which looks to restore rather than to punish, and that
means that when a kid does something wrong, rather than excluding him from the class,
we really get to the root of what happened and how that student can restore the situation.
Whether it’s an apology to the person that he offended, the teacher, or it’s some other
way that he can be reconnected. Now, we have found students will get together on their
own to work out their problems.
Another program cited by middle school principals as having a clear impact on the social
emotional well-being of students is Where Everyone Belongs (WEB). The program is a middle
school orientation and transition program that trains and empowers 8th grade student leaders to
welcome new students, making them feel comfortable and connected throughout their middle
school years (The Boomerang Project, n.d.). Principal Tiger indicated that WEB has made a
huge difference for students, who learn not only to support one another in times of stress and
anxiety, but also gives students permission to seek help from peers, who in turn, refer their peers
to adult resources. Principal Vermillion suggested the school’s WEB program “Is a huge
component of making kids feel accepted and comfortable.” Principal Canary described the
impact WEB has had on middle school students, stating,
Not only have we seen great strides among our incoming students healing, being
accepted, and acclimating to the school, but we’re also seeing huge leadership
opportunities and growth with our students. Some of the students you’d never really
expect to take these leadership strides suddenly completely turn around and live up to the
expectations of their peer mentors.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 143
Half of the interview participants reported the development of wellness centers on their
middle school campuses; specially designed and designated places at school where students can
retreat for a short break, to refresh and regroup, to participate in positive activities, or to connect
with an adult who can lend a listening ear or offer support. Principal Quillback expressed the
middle school has only offered a wellness center for three weeks, but administration has already
received positive feedback from students,
Our counselors have taken a classroom and they’re there every day at lunch. On two of
the days, there are different programs, like ‘Keep Calm and Craft On’ which helps kids
deal with stress by crafting. Another one is a general stress management group. It’s just
drop in, like how can we help you? Every day at lunch, now, the kids know they can go
to this spot.
Principal Boccacio described the school’s wellness center as, “A place to fill other
people’s cups back up.” A refurnished classroom on campus was stocked with board games,
puzzles, art supplies, and other activities for students to use during lunch, giving students an
alternative to the lunch tables, athletic fields, and other traditional places on campus.
Principal Tiger remarked that the middle school’s wellness center, dubbed the Teen Zone,
is a safe place to be after school to hang out. Describing what makes their wellness center a
popular choice for students, Principal Tiger stated,
We’ve got some different foosball tables, a basketball hoop-shoot thing, it’s a lounge set
up. So there are some couches, some tables where they can just be. We have phone
chargers and music speakers for them. An X-Box. I staff it with MFT interns, and the
whole purpose is just to go and be. And be nice to each other. It has been full and the
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 144
kids are coming in. I opened the room next to it as a create-space, so we’re trying to have
outlets for them to do different things when life gets too stressful.
In the area of providing social-emotional support programs to facilitate student well-
being and connectedness to the school community, the findings indicated that the blend of
programs and supports serving each school community are as unique as the principals
themselves. The researcher found that principals extend the influence of such programs by
connecting their purpose to the individual culture and climate of the school, while addressing the
ongoing social emotional needs of students. While some participants shared common
terminology and programs that exist on several middle school campuses, there is currently no
unified approach demonstrated by the data. What is cohesive among participants, however, is a
shared commitment to maximizing these programs, and the stakeholders charged with their
delivery, as key components of the instructional program.
Summary of Results for Research Question Two
The survey and interview data demonstrated southern California middle schools utilize
various people, programs, and practices to deliver on the promise of supporting pupil suicide
prevention policies. The themes of appropriate staffing, professional development, and social
emotional programs that facilitate school connectedness were common among survey responses
and interviews. Middle school principals articulated the need for school personnel who are as
skilled as they are compassionate. Furthermore, these individuals, whether serving at the school
site or at the district level, require the proper training and tools to address youth suicidality and
related adolescent concerns like stress, anxiety, adversity, peer dynamics, and social emotional
development.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 145
In the relatively short amount of time that has transpired between the inception of EC 215
(California Legislative Information, 2018) and the present implementation of suicide prevention
practices, there is a clear indication that middle school principals are taking the approach of
modifying existing school-based programs which address student leadership, character
education, and goal-setting, while augmenting offerings to students with novel concepts or
experimental supports. The impetus for such approaches, however varied, is a drive shared by
all participants in this study; namely, providing a comprehensive methodology to tackle student
social emotional health, multiple opportunities for students to invest in their own success, and
leveraging sustainable, beneficial programs for middle school youth. The next research question
presents findings of how middle school principals are working to change faculty perceptions that
suicide prevention practices are an issue worthy of their attention.
Results for Research Question Three
Research Findings Pertaining to Research Question Three
RQ3 asked: How are middle school principals leading faculty to change their perceptions
and attitudes that suicide prevention practices are a serious and worthy issue?
Both AB 2246 (Assembly Bill No. 2246, 2016 and Fisher (2006) support the tenet that
teachers are the most likely members of a school community to be approached by a student in
crisis, or a student concerned about the well-being of a friend. However, the traditional role of
teachers has been instructional pedagogy; addressing student mental health, stress, anxiety, and
social-emotional health is relatively new ground.
As such, Research Question Three examines the critical importance of teachers and their
invaluable role in school communities to address youth suicide prevention practices. In the
context of supporting the social-emotional needs of students, the changing roles of teachers and
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 146
the principal leader are further examined in this section. Research Question Three addresses the
notion that principals must ensure teachers and staff have not only the tools and training to know
what to do with students experiencing suicidal crisis, but also the willingness and confidence to
act. The ongoing support required for the well-being of staff, and the self-reflection required by
principals on the changing nature of middle school leadership are discussed.
Compassionate teachers. Table 24 depicts the level to which middle school principals
agree the teachers at their schools believe youth suicide is an important issue. Respondents were
asked to rate their level of agreement with the statement on a Likert scale, with the option to
select Strongly Disagree, Disagree to Some Extent, Neither Disagree nor Agree, Agree to Some
Extent, or Strongly Agree.
Table 24
Teacher Beliefs about Youth Suicide
Item Mean SD
Strongly
Disagree
a
Disagree
to Some
Extent
b
Neither
Disagree
nor
Agree
c
Agree
to
Some
Extent
d
Strongly
Agree
e
Teachers at my
school believe
that youth
suicide is an
important issue. 4.49 .64 7.8% 35.3% 56.9%
Note. n = 51.
a
Strongly Disagree = 1 on a 5-point Likert scale
b
Disagree to Some Extent = 2 on a 5-point Likert scale
c
Neither Disagree nor Agree = 3 on a 5-point Likert scale
d
Agree to Some Extent = 4 on a 5-point Likert scale
e
Strongly Agree = 5 on a 5-point Likert scale
The survey results in this focus area demonstrated a strong assertion among middle
school principals that teachers believe suicide is an important issue. Responses to this survey
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 147
question indicated that 56.9% of principals Strongly Agree, followed by 35.3% who Agree to
Some Extent. Compared to other questions utilized by the researcher in the survey instrument,
this focus yielded one of the highest mean scores at 4.49.
Themes revealed through interviews with middle school principals were consistent with
the survey results. Principals recurrently expressed that teachers at their schools recognize the
apparent increases to student stress, anxiety, worry, and pressure that adversely impact outcomes
in academics, interpersonal relationships, and emotional health. Perhaps more importantly,
teachers feel strong compassion and empathy for their students, and want them to be successful
in all their endeavors. Principal Starry described how teachers perceive their role working with
classroom communities containing more students at risk of suicidality,
Teachers have been very much onboard with this, because they care very much for their
students and want to make sure they’re getting the help they need. And so they take it as
their role to be someone who students can turn to, and as an extension of that, they turn to
me to be able to help out with families and the students.
Principal Olive shared that middle school teachers take more of a universal approach to
building rapport and positive relationships with students. This principal expressed that it is more
about creating safe and welcoming classroom communities than it is about suicide prevention
practices. Yet, the approach has helped to identify students in selected and indicated ways,
resulting in referrals and treatment for students in need. Principal Tiger reported having ongoing
conversations with teachers about their role as the “eyes and ears” of middle school suicide
prevention. Principal Tiger described teachers as the “front line” stating,
[Teachers] know the kids way better than I do, so they’re the ones that are bringing issues
to our attention a lot of the time, and that’s how I know they are involved in it, that they
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 148
care for this and they try to keep their fingers on the pulse of their students. There’s a
concern. They want to make sure the kids are taken care of because they have good
student-to-staff connections.
Several principals mentioned the shift in mindset among teachers from instructional
pedagogy to the social emotional learning and mental health of students. Such an adjustment,
suggested middle school principals, requires middle school teachers to augment their academic
approach to include topics such as mindfulness, balance, self-confidence, and goal-setting.
Principal Vermillion described a continuing process at the school by which teachers are not
simply focusing on academics, but enhancing them with social emotional learning. Principal
Vermillion stated,
I believe it is important to have a culture of connections. Teachers need to remember it’s
not the subject they teach, it’s the students they teach. And without the social emotional
connection to students, not only will they not be effective as an academic instructor, but
they won’t make those connections to make learning meaningful for students. The kids
are going on field trips and theme days and getting to step outside the classroom, which
connects them to the school, their colleagues, and their teachers.
Principal Canary went a step further, outlining an instructional culture at school that
places the emotional health of students above academics. This principal shared,
[Teachers] try to connect with students, and try to be the person that makes them feel
better connected to school, so it’s part of our culture. It’s part of who we are as
educators, and it’s part of why our test scores aren’t as good as other schools. We spend
a lot of time nurturing the whole child and making sure they have the ability to keep
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 149
going and move forward. While we expect all students to perform well academically, we
also see it as a responsibility that we’re supposed to take care of them.
Table 25 depicts the level to which middle school principals agree students at their
schools know at least one caring adult staff member to whom they can go if they need help for
themselves or for another student. Respondents were asked to rate their level of agreement with
the statement on a Likert scale, with the option to select Strongly Disagree, Disagree to Some
Extent, Neither Disagree nor Agree, Agree to Some Extent, or Strongly Agree.
Table 25
Caring Adult Staff Members
Item Mean SD
Strongly
Disagree
a
Disagree
to Some
Extent
b
Neither
Disagree
nor
Agree
c
Agree
to
Some
Extent
d
Strongly
Agree
e
Students at our
school know at
least one caring
adult staff
member to whom
they can go if
they need help
for themselves or
another student.
4.33 .65 2% 3.9% 52.9% 41.2%
Note: n = 51
a
Strongly Disagree = 1 on a 5-point Likert scale
b
Disagree to Some Extent = 2 on a 5-point Likert scale
c
Neither Disagree nor Agree = 3 on a 5-point Likert scale
d
Agree to Some Extent = 4 on a 5-point Likert scale
e
Strongly Agree = 5 on a 5-point Likert scale
Similar to teacher beliefs about the importance of youth suicide prevention practices,
survey results in this focus area show middle school principals represent that students possess a
higher level of comfort approaching staff members in times of crisis. Responses to this survey
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 150
question indicated that 52.9% of principals Agree to Some Extent, followed by 41.2% who
Strongly Agree with the statement.
During interviews, participants expressed their hopes that every child on campus would
feel safe and comfortable enough to approach any staff member if he or she needed help. While
this was represented as more of a collective goal among principals than an assessment of current
practice, several principals shared that deliberate efforts to increase the accessibility of adult
resources on middle school campuses have led to increased connections with students. This, in
turn, has increased the number of students who are receiving indicated supports and treatment.
Principal Starry described how teachers and other staff encouraging students to speak up about
their emotional afflictions has identified more students in need,
What’s happening is that students are able to be very honest about their feelings. And
when they do that, teachers are more aware, other students are more aware, and we have
had many more reports of students feeling depressed or suicidal.
Principal Olive has also seen the benefits of teachers increasing their availability for
students, empowering them to bring concerns to the teachers at her middle school. Principal
Olive stated, “Our teachers are very good about opening themselves up to the class and letting
kids know they are there for them. And students are pretty receptive to that and take advantage
of speaking to teachers.”
During interviews, middle school principals affirmed what Assembly Member Opaleye
proffered to the researcher: teachers care about their kids, so they care about legislation like
EC 215 (California Legislative Information, 2018). Accordingly, principals communicated that
they clearly understand their obligation to ensure the teachers who work with middle school
students on a daily basis are consistently demonstrating the appropriate blend of empathy and
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 151
vigilance. As Principal Boccacio summarized, “Having the right people on the bus makes a huge
difference for kids.”
Leveraging compassion to develop confidence. Despite the universal assertion that
most teachers believe in the importance of implementing strategies and practices to address
youth suicide at southern California middle schools, teachers may struggle with the confidence to
believe they are capable of providing the right forms of help for students in crisis. Table 26
depicts the level to which middle school principals agree the teachers at their schools are
confident in their own abilities to intervene with a student manifesting suicidality. Respondents
were asked to rate their level of agreement with the statement on a Likert scale, with the option
to select Strongly Disagree, Disagree to Some Extent, Neither Disagree nor Agree, Agree to
Some Extent, or Strongly Agree.
Table 26
Teacher Confidence to Address Youth Suicide
Item Mean SD
Strongly
Disagree
a
Disagree
to Some
Extent
b
Neither
Disagree
nor
Agree
c
Agree
to
Some
Extent
d
Strongly
Agree
e
Teachers at my
school are
confident in their
abilities to
intervene with a
student whose
behavior suggests
the possibility of
suicide.
3.49 .97 19.6% 25.5% 41.2% 13.7%
Note: n = 51
a
Strongly Disagree = 1 on a 5-point Likert scale
b
Disagree to Some Extent = 2 on a 5-point Likert scale
c
Neither Disagree nor Agree = 3 on a 5-point Likert scale
d
Agree to Some Extent = 4 on a 5-point Likert scale
e
Strongly Agree = 5 on a 5-point Likert scale
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 152
The survey results in this focus area indicated a range of agreement levels among middle
school principals, with respect to teacher confidence in their own intervention abilities.
Responses to this survey question showed 41.2% of principals Agree to Some Extent, followed
by 25.5% who Neither Disagree nor Agree with the statement. Notably, 19.6%, or nearly one
out of every five respondents Disagree to Some Extent with the statement, with the lowest
response of 13.7% reporting they Strongly Agree.
The range of responses regarding teacher confidence to intervene with a student
experiencing suicidality corresponded to themes revealed during interviews with middle school
principals. Recurrently, participants stated that the level at which teachers believe suicide
prevention is valuable and worthy does not necessarily match their perceived abilities to deliver
on such an implementation. Principal Kelp shared observations of middle school teachers,
stating,
I think it’s hard for teachers. We have teachers who are part of the crisis team, and we’re
in the process of including them in a lot of the risk assessments now, but I think it is
emotionally very draining for them, especially while they’re constantly teaching. But
they also see the students hurting, so we can see that it is really hard on their emotions.
Principal Vermillion expressed some concern for a few members of his middle school
staff, particularly a few veteran teachers who are more reticent and resistant to change. Such
concerns were somewhat alleviated by the confidence that these individuals would quickly refer
students in crisis to the office. Acknowledging that teachers might struggle, Principal Vermillion
explained,
As long as the teacher connects with somebody. I’m thinking about our most traditional
teachers, and I’m thinking they are very fragile human beings who would completely
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 153
empathize with that student, and also be terrified of handling this alone, and go running
very quickly to the counselor. And then boom, you’re locked in with your processes.
Principal Tiger captured the essence of the participants’ assertions about the dynamics of
teacher readiness and teacher confidence sharing,
They never think they’re prepared enough, but it goes with the trade. They’re solid in
what they’re doing here. There’s that thirst to become better. They are prepared to
handle these situations, but they can always use more support, and they want more.
They’d never feel we’re 100% ready for this, but when the time comes, teachers help
kids. It’s what they do.
Despite professional development, conversations with individual teachers and with
groups during faculty meetings, and the implementation of various social emotional programs on
middle school campuses, principals represented that many teachers experience anxiety and fear
at the prospect of interacting with suicidal adolescents. The researcher found that principal
leadership requires consistent monitoring and care for the emotional well-being of students, as
well as the teachers tasked with educating and nurturing them. The findings also highlighted the
importance for principals to regularly check-in with teachers to hear their concerns, assuage their
apprehensions, and reinforce their genuine care for children with similarly heartfelt approbations.
The changing role of the principal. During interviews, the researcher asked middle
school principals how they perceive their job has changed during their tenure. The responses
from participants aligned with Research Question Three’s examination of changing teacher
attitudes about suicide prevention practices, and in a larger sense, the overall goals of teaching
adolescents. Furthermore, principals provided insights and reflection supporting the premise of
transformational leadership (Bass & Riggio, 2006; Northouse, 2018). Principals shared several
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 154
characteristics they leverage as leaders that enable them to inspire stakeholders, to gain the trust
and respect from faculty and staff, and empower them to work diligently towards the
implementation of suicide prevention practices. Principal Tiger offered a principal needs
“Patience, forgiveness, and you’ve got to be fun.” Principal Vermillion’s first rule of
administration is, “Visibility; being present for teachers and students.” Principal Quillback
shared,
It’s appreciating people and being relational. I use the word love when I talk to my
people all the time. I mean, I tell them I love them. We’re family and we’re not going to
just say it to say it. We love each other. We rally around each other, and support one
another.
As with teachers, study participants reiterated the shifting focus of the principalship from
a historical role of instructional leader, to an enhanced role that includes the social emotional
well-being of adolescent students as well as adult educators. Principal Gopher shared reflections
on how the current middle school principal job bears different demands than previous
administrative positions held,
I’m 10 years into it now, and when I came in, social-emotional just wasn’t talked about.
But now, it’s kind of the cornerstone of what we do. If you look at Maslow’s Hierarchy
of Needs, if you don’t have those basics of safety and food, someone that loves you,
you’re not going to care about what a verb is or an adjective or some math formula. That
goes for kids and adults at this school.
Utilizing personal conversations with teachers, formal department meetings, leadership
team meetings, and working with department chairs directly, Principal Aurora explained how the
transition from a high school assistant principal to a middle school principal brought with it the
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 155
beliefs that the administrator needed to focus on instructional leadership and being a practitioner
of pedagogy. Aurora continued, “And it’s completely not that. It’s about the safety of kids and
adults. Everything has been transformed and flipped to really focusing our energy on social
emotional.”
Summary of Results for Research Question Three
As evidenced by the findings from survey and interview data, and supported by the
literature, teachers play an integral role supporting adolescent suicide prevention (Fisher, 2006;
Graham et al., 2011; Kalafat, 2003). Teachers in southern California middle schools draw upon
their genuine care for their students to provide support for students in crisis. The development of
positive rapport between teachers and students provides middle school youth with caring adults
who, in turn, provide a range of services from a simple listening ear to counseling referrals to
life-saving psychiatric evaluation and treatment.
While teachers generally embrace this responsibility to care for their students, the somber
topic can create apprehension and anxiety among teachers charged with serving as the front lines
of middle school suicide prevention practices. Consequently, principals—who have traditionally
served primarily as instructional leaders—must expand their repertoire of skills to include social
emotional support for not only students, but also the adult teachers and staff who empathize with
their students’ afflictions. As EC 215 (California Legislative Information, 2018) identified
teachers as the most likely individuals to whom students will report with mental health concerns,
the results of the current study suggest principals are an important source of support,
encouragement, and validation for teachers serving their students and school communities. The
final research question presents findings related to how principals are evaluating the progress and
results of pupil suicide prevention programs on their middle school campuses.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 156
Results for Research Question Four
Research Findings Pertaining to Research Question Four
RQ4 asked: How do principals evaluate the progress and success of pupil suicide
prevention programs and practices?
In October 2018, The Trevor Project, an advocacy organization for LGBTQ youth that
supported Assembly Bill 2246: Youth Suicide Prevention Policies (Assembly Bill No. 2246,
2016), released a report regarding the California Department of Education schools’ compliance
with the new law. They found that 86% of the 478 school districts and local educational
agencies serving grades 7 through 12 in California had adopted a suicide prevention policy
(Trevor Project, 2018).
While the Trevor Project (2018) report demonstrated the existence of such policies in
school districts, the study did not indicate how the policy was being implemented in districts and
schools. This highlights the importance of Research Question Four’s central goal of evaluating
progress in the context of individual middle school communities, as well as any measures of
success, where the lower range of the targeted 7th through 12th grade population attends school
daily.
A principal’s ability to locally assess the current implementation of suicide prevention
practices at middle school is tantamount to ensuring the safety, success, and well-being of
students. Moreover, considering the nascent status of EC 215 (California Legislative
Information, 2018) , and the assertion by associates of the California State Assembly who stated
to the researcher that it may take years for the California Department of Education to conduct
formal evaluation of the law’s implementation and effectiveness, Research Question Four
examines the early returns of feedback from a sample of middle school principals working
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 157
directly with students and stakeholders. This section examines the reported need for ongoing
training with suicide prevention initiatives in middle school communities, the manner in which
principals utilize communication with students and parents to evaluate the reach of prevention
programs, and how principals align their leadership vision with success.
Need for ongoing training. Despite the best efforts of middle school principals, there
are invariably challenges to leading successful implementations. As discussed in Research
Question Three, supporting teachers’ readiness and willingness to employ systems of support for
students in crisis is of the utmost importance to the implementation of suicide prevention
practices. Consequently, the evaluation of middle school suicide prevention initiatives is directly
connected to the staff preparation and willingness to act on behalf of students in crisis.
Table 27 depicts the level to which middle school principals agree the school’s faculty
and staff need more youth suicide training. Respondents were asked to rate their level of
agreement with the statement on a Likert scale, with the option to select Strongly Disagree,
Disagree to Some Extent, Neither Disagree nor Agree, Agree to Some Extent, or Strongly Agree.
Results of the survey data collected in this focus area showed 41.2% of respondents
Agree to Some Extent with the notion that faculty and staff of their schools need more youth
suicide training, while 39.2% Strongly Agree with the assertion.
The relatively high level of agreement paralleled themes that emerged during interviews
with middle school principals. The majority of participants affirmed their beliefs that teachers,
counselors, office staff, and even custodians and lunch proctors would benefit in both practical
application and confidence by receiving additional training in youth suicide prevention. While
Research Question Two addressed that most participants have ensured teachers and other staff
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 158
had received some level of professional development, principals repeated that suicide prevention
training for staff had begun, but not ended.
Table 27
Principal Perceptions of Need for More Staff Training
Item Mean SD
Strongly
Disagree
a
Disagree
to Some
Extent
b
Neither
Disagree
nor
Agree
c
Agree
to Some
Extent
d
Strongly
Agree
e
Our school’s
faculty and staff
need more
training
regarding youth
suicide.
4.09 . 98 11.8% 7.8% 41.2% 39.2%
Note: n = 5.
a
Strongly Disagree = 1 on a 5-point Likert scale
b
Disagree to Some Extent = 2 on a 5-point Likert scale
c
Neither Disagree nor Agree = 3 on a 5-point Likert scale
d
Agree to Some Extent = 4 on a 5-point Likert scale
e
Strongly Agree = 5 on a 5-point Likert scale
Principal Starry succinctly stated, “Our greatest challenge is that we’re still in the process
of training everybody.” Principal Aurora, who serves in a district that has established an
exclusive partnership with a family service agency, shared the details of this challenge to get
additional training on the middle school campus, stating,
We need to find the right people who can teach us, and what to look for from a
professional perspective. Who are the experts? Right now, we’re in a really tough spot
politically. We are not allowed to go and seek out other professionals, without stepping
on political toes. We’re not a resource, we don’t know enough about what to look for,
the kinds of questions to ask, and then conduct assessments. I need to make sure my
adults are taken care of–—then progress towards improvements for students.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 159
Principals repeatedly attributed this need to a lack of time, working to ensure teacher
buy-in, and the opportunity cost to other school and district initiatives of importance to
stakeholders. Principal Olive summarized this ongoing debate with teachers, exclaiming, “I tell
them suicide prevention is not one more thing on your plate; it is the plate!”
Principal Canary, whose school community has encountered several suicidal ideations
and attempts in the current school year, stated the biggest challenge has been twofold:
Number one, the unpredictability of timing for these situations is never ideal. Friday at
3:00 p. m. sort of thing. I’ve had situations where I had to stay until nine or 10 o’clock at
night waiting for a PET team. And the second problem we have is that these situations
seem to come in waves; whether it’s the time of the year, holidays, copycats, whatever it
may be, so that makes it really difficult to manage as many as we have going on at once.
Principal Tiger shared Principal Canary’s concern about clusters of suicidality, and the
demands that multiple students needing help at the same time places on a relatively small
number of middle school staff qualified to intervene.
These findings underscore the importance of maintaining ongoing training for faculty and
staff that is relevant to their daily practice. These findings suggest that professional development
provides teachers with not only the most current practices and information, but also serves to
bolster their confidence to engage students in crisis. Moreover, additional trained staff can
provide much needed relief to overtaxed crisis response teams, counselors, and administrators.
Communication with key stakeholders. Bolman and Deal’s (2013) Structural frame
describes leadership within an organization with a reliance on clearly defined goals, structures,
and communication with stakeholders. As EC 215 (California Legislative Information, 2018) is
in its early years of implementation, middle school principals are prudent to maintain open
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 160
channels of communication with students and parents, as a means of measuring progress and
evaluating the reach of suicide prevention practices.
Students. Table 28 depicts the level to which middle school principals agree the students
at their schools have been trained on appropriate actions if one of their friends is manifesting
suicidality. Respondents were asked to rate their level of agreement with the statement on a
Likert scale, with the option to select Strongly Disagree, Disagree to Some Extent, Neither
Disagree nor Agree, Agree to Some Extent, or Strongly Agree.
Table 28
Student Awareness and Knowledge to Act
Item Mean SD
Strongly
Disagree
a
Disagree
to Some
Extent
b
Neither
Disagree
nor
Agree
c
Agree
to
Some
Extent
d
Strongly
Agree
e
Students at my
school have
received
instruction
regarding youth
suicide, and
know what to do
if one of their
friends is at risk
of suicide.
3.45 1.06 5.9% 13.7% 21.6% 47.1% 11.8%
Note: n = 51
a
Strongly Disagree = 1 on a 5-point Likert scale
b
Disagree to Some Extent = 2 on a 5-point Likert scale
c
Neither Disagree nor Agree = 3 on a 5-point Likert scale
d
Agree to Some Extent = 4 on a 5-point Likert scale
e
Strongly Agree = 5 on a 5-point Likert scale
The survey results in the area of student preparation and knowledge regarding youth
suicide show a range of agreement levels among middle school principals. Responses to this
item demonstrate 47.1% of principals Agree to Some Extent, followed by 21.6% who Neither
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 161
Disagree nor Agree with the statement. This area is one of the few survey items upon which
respondents selected Strongly Disagree, at a rate of 5.9%.
The relatively wider range of responses on this survey item was validated in themes
developed through interviews. Principals shared several stories of students whose actions
potentially saved the lives of their classmates. Anecdotally, participants chiefly evaluate the
effectiveness of their suicide prevention programs through the actions of students, who either
self-refer for help, or report another student who is depressed, anxious, or potentially suicidal.
Such evaluations are reliant on the premise that middle school students need to be taught the
importance and value of reporting to an adult when they witness a student in crisis, when they
read social media postings that suggest suicidal ideation, or just experience concerns about a
friend. During interviews, principals shared their school’s progress with students expressed both
successes and areas for growth at their respective middle schools.
Principal Canary, who intervened with a classmate battling through thoughts of suicide
and violence against a family member, illustrated the story of a student taking appropriate action
to help a friend,
We had a young lady who is a cutter, and had been cutting herself with a razor blade.
She said she was going to kill herself, but first she was going to kill her dad. And one of
her friends was very upset about it. The friend is new to our school, but she was
volunteering in a teacher’s classroom on an early release Friday, and told the teacher
about her friend, but not before she had taken the razor blade away from her friend. So
our students are that well-trained, that not only do they know what to do, but they also
intervene to try to help.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 162
Principal Tiger described a different situation in which a student was keeping a journal
using a Google Doc he had shared with a few of his friends. The student had written, “I want to
die,” and his friends brought it to the attention of the counselor. The student, who Principal
Tiger described as an advanced student, had been wrestling with gender identity issues. In the
journal, the student had written a date he planned to kill himself, which was the following day.
Principal Tiger described the interaction with the student reporters stating,
After addressing the student who was in trouble and getting him support, we had to
check-in with his friend group, and we come to find out some of them were struggling
now, like, how do I help my friend? And they were like, don’t die. I don’t want you to
die. The students were feeling heavy, but they reported it. And once we got to them, and
they were sharing more, we are able to help relieve some of the anxiety about their friend
wanting to potentially end his life. The indicator of success is that friends are taking care
of each other.
Principal Quillback’s middle school spends the month of October with the theme, “Speak
Up,” aimed at working with kids on anxiety and stress issues, and empowering them to reach out
if they need help for themselves or for another student. The initiative is aimed at encouraging
students to tell an adult if they or a friend are being bullied, being abused, or thinking of hurting
themselves. The resounding message among staff and students with this initiative is, “That’s
what good friends do. They speak up for others and for themselves.”
During interviews, several principals reflected that every student who reported a worry or
concern about a friend may have helped avert another student’s death. These stories shared by
middle school principals underscore the critical importance of training, reinforcing, and
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 163
maintaining open communication with students, who often bear the burden of their friends’ pain
before they decide whether or not to report it.
Parents. Table 29 depicts the level to which middle school principals agree the parents
and guardians of students at their schools are knowledgeable about the school’s suicide
prevention practices. Respondents were asked to rate their level of agreement with the statement
on a Likert scale, with the option to select Strongly Disagree, Disagree to Some Extent, Neither
Disagree nor Agree, Agree to Some Extent, or Strongly Agree.
Table 29
Parent Knowledge of Suicide Prevention Practices
Item Mean SD
Strongly
Disagree
a
Disagree
to Some
Extent
b
Neither
Disagree
nor
Agree
c
Agree
to
Some
Extent
d
Strongly
Agree
e
Parents/Guardians
of students at my
school are
knowledgeable
about our school’s
suicide prevention
policy and
practices.
3.18 1.00 7.8% 17.6% 29.4% 43.1% 2%
Note. n = 51.
a
Strongly Disagree = 1 on a 5-point Likert scale
b
Disagree to Some Extent = 2 on a 5-point Likert scale
c
Neither Disagree nor Agree = 3 on a 5-point Likert scale
d
Agree to Some Extent = 4 on a 5-point Likert scale
e
Strongly Agree = 5 on a 5-point Likert scale
Similar to their perceptions of student knowledge, respondents reported a range of
agreement, with 43.1% of principals stating they Agree to Some Extent, followed by 29.4% of
principals who Neither Disagree nor Agree. Noticeably, this focus area on parents represents the
lowest level of agreement in the study, with a combined 25.4% or principals who Disagree to
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 164
Some Extent and Strongly Disagree that parents are knowledgeable about the middle school’s
suicide prevention policy and practices.
The survey data exhibiting a range of agreement levels among principals were evident in
the results gathered through interviews with middle school principals. Parent perceptions,
participation, and feedback with middle school suicide prevention initiatives varied among
principals in this study. Study participants alluded to the view that the level of parent
involvement and knowledge regarding youth suicide prevention practices are tied to other
demographic indicators and family dynamics. While some principals described highly engaged
parents who were supportive of the school’s efforts, others portrayed interactions that were
disconnected, apathetic, and contentious.
Principal Starry, who serves a high-performing and affluent school community, shared
supportive interactions with parents of suicidal children, stating, “This is always a difficult thing
for families, but the last few have thanked us for bringing them into the picture and helping their
kids.” Principal Starry further described leveraging a positive relationship with the school’s
parent teacher association (PTA) to provide seminars on youth suicide prevention and adolescent
brain development for parents. Principal Starry also described that PTA meetings present the
opportunities for “hallway conversations” with influential, well-connected members of her
parent community, who share targeted information with other parents.
Principal Gopher also shared the PTA is deeply concerned about student stress, anxiety,
depression, and suicidality. Gopher shared, “I had a PTA coffee a few weeks ago, and half of the
conversations were about suicide. That’s all they talk about, so there’s serious concern with
parents.” Principal Gopher described how counselors provide parent nights, assemblies, and a
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 165
regular newsletter featuring information on school-based social emotional programs, in an effort
to maintain a dialogue with parents.
In contrast, Principal Olive illustrated a recent suicide intervention and resultant parent
interaction that was troubling. Olive recounted how a 7th grade female student, who had missed
most of her 6th grade year due to long-term care for an eating disorder, self-referred to the office
and shared that she tried to kill herself the night before by taking pills. An assessment was
conducted, the student was determined to be high-risk, and the school resource officer and a PET
team were called. Principal Olive described the subsequent interaction with the parent:
I called her mom, and her mom was like, :I’m busy. I’m at work. Is this serious? She’s
looking for attention and being dramatic.” Once I convinced mom to come to the school,
the PET team decided to take her on a 5150 hold. Mom then freaked out again because
of insurance. I learned later that the hospital contacted DCFS because of things the
student shared. They did a home visit, and I got a lot of follow up from the social
worker. Ultimately, the mom wanted to help her daughter, but it was a difficult process.
Participants shared that despite their efforts to communicate their vision of supporting
students’ social emotional needs through positive programs and prevention initiatives, the
response from parents is not always ideal. Principal Canary shared, “My parent community is
relatively absent, so for many of them, they’re not really part of the discussion.” Principal
Canary described the PTA president as “very new,” and despite Principal Canary’s efforts to
promote social emotional learning concepts for parents, the PTA’s primary focus was on creating
a school garden. Principal Kelp explained that parents contacted about their children
demonstrating elevated risk for suicide or self-harm have resulted in a variety of reactions.
Principal Kelp shared that while some parents have been cooperative and grateful, “It’s not easy
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 166
news to hear about your child. And a few feel we’re going overboard, overreacting. They tell us
their child is fine and they’ll handle it.”
Principal Aurora connected the evaluation of suicide prevention practices directly to
parents, but illustrated the challenges of a parent stakeholder group that is dealing with its own
adversity. Aurora stated,
We need more support from our parents and more support for our parents. It’s a huge
piece of our formal prevention. But every family, every parent has a story. We go to the
CUM files and ok, we have a custodial agreement here. Dad’s not in the picture there.
There’s no adult figure for this kid. Between seven [a. m.] and three [p. m.], we have the
ability to really try to control, contain, and intervene. But what happens at home now is a
big, glaring issue.
The range of experiences principals reported in dealing with parents on the issue of youth
suicide underscores the importance of communication and partnership with families to facilitate
student wellness. The literature documented an adolescent’s positive connection to family
reduces suicide risk (Kaminski et al., 2010; Kleiman & Liu, 2013; O’Donnell et al., 2004). The
results of the current study indicated that consistent, clear messaging, utilizing school-based
parent groups and influential individuals whenever possible, cannot only support middle school
principal evaluation of their developing suicide prevention initiatives, but also extend supports
for students into their homes and lives beyond the instructional day.
Aligning vision with success. As a closing question during interviews, the researcher
asked middle school principals, “What is your vision for success, and how will you know you’ve
made it?” Responses from participants were as diverse as the principals themselves, but aligned
in distinct themes. Principals repeatedly described personal leadership visions for the school,
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 167
tied to the success, health, and wellness of students, staff, and other stakeholders. Principals also
described their “next steps,” with the implementation of suicide prevention practices. Each
principal described their efforts to lead the implementation with fidelity; yet, they demonstrated
their understanding that there is more to learn, more to do, and more to accomplish in order to
resolve this ongoing threat to the safety and success of southern California middle school
students.
Participants shared a common message of what success looks like at their respective
middle schools, founded in a culture of learning, caring, and connectedness. Principal
Vermillion stated, “We encourage positive relationships, engaged learning, and responsible
citizenship. That covers everything; show up, be nice, do your work.” Principal Tiger stated a
desire for students to like school. “If they want to be in school, that’s a win,” Principal Tiger
said. With respect to a leadership vision of success, Principal Boccacio expressed,
When I have the school environment where I know every kid is connected and every
adult is focused on building kids up and being there to support them, and everybody realizes the
importance and value of those connections, then I’ll consider it success. But I don’t think I can
ever just say, “It’s perfect, we’re good.” It’s always going to be evolving.
Connecting these shared visions of success to the implementation of EC 215: Pupil
Suicide Prevention Policy (California Legislative Information, 2018), participants acknowledged
both the difficulty and the importance of this work for student outcomes. Asked about
evaluating the success of the school’s suicide prevention program, Principal Canary stated
directly,
No more dead kids. I mean, honestly, the kids are going to have the problems, and it’s
our job to help them work through it. I just don’t want anyone else to die. The truth of
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 168
the matter is that at this particular school, the students who have suicidal ideations and
attempts are almost always students with adverse childhood experiences, and we don’t
have any way to change that. We’re always going to be chasing what happened in their
past, so our success is making sure they graduate from high school, give them
opportunities for college and careers they deserve, and that they come out being
productive members of society.
Principal Starry, whose vision of success demands the best possible supports of staff and
school environment to facilitate the best possible opportunities for students, described middle
school suicide prevention practices,
like the earthquake emergency bin; you keep it stocked and ready to go, and you hope
you never have to open it. We’re keeping everyone up to code in terms of training, and
discussions, and improvements to our practices, and I hope we never have to use them.
Before EC 215 (California Legislative Information, 2018) was ratified, Principal Olive
had evaluated the middle school’s suicide prevention program, “by the number of kids who
actually reach out. It’s effective if you know they’re actually going to the counselor or reaching
out to a teacher, asking for advice, and getting help.”
The findings in this focus area accentuated the value of principals coherently sharing
their leadership vision, and aligning it with efforts to fully implement youth suicide prevention
measures at their middle schools. Bolman and Deal (2013) described effective symbolic leaders
as those who inspire and lead by example, and who communicate a vision based on both the
history of an organization and its goals for the future. As a measure of evaluating the progress of
suicide prevention programs and practices, the researcher found that southern California middle
school principals repeatedly demonstrate the significance of rooting EC 215 (California
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 169
Legislative Information, 2018) in a strong foundation of school culture, common purpose, and
above all else, the welfare of middle school students.
Summary of Results for Research Question Four
As suggested by Assembly Member Opaleye and Legislator Calico at the beginning of
Chapter Four, evaluating the emergent implementation of EC 215 (California Legislative
Information, 2018) in southern California middle schools is an ongoing process that is only in the
early stages of development. While the Trevor Project (2018) study determined adoption of
policies and procedures has been achieved in the majority of school districts throughout
California, the efficacy of current practices may take years to be measured.
As with other academic, behavioral, and developmental implementations at their sites,
middle school principals report ongoing evaluation of suicide prevention practices. Principals
facilitate this work through collaborative processes involving professional development and
encouragement of front-line staff, and communication with key stakeholders such as teachers,
parents, and students. The implementation of EC 215 (California Legislative Information, 2018)
in southern California middle schools relies on consistent reflection, monitoring of programs,
people, perceptions, and the principals themselves. Principals have begun to refine and assess
prevention, intervention and postvention processes, mitigating challenges with incomplete staff
trainings, and staff buy-in with visionary, transformational leadership practices. Through survey
data and interviews, it is clear that principals must maintain a consistent commitment to cohesive
and coherent communication of their vision; a dedicated effort to promoting positive school
culture and climate; and a well-defined, comprehensive approach to student well-being.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 170
Chapter Summary
Chapter Four presented the results of data gathered through surveys and interviews with
southern California middle school principals, as well as two individuals closely associated with
the legislative process that ultimately led to the ratification of Education Code 215: Pupil and
Student Suicide Prevention Policy (California Legislative Information, 2018). The survey
instrument yielded demographic data describing the study sample, as well as quantitative data
assessing principal perceptions regarding the various aspects of adolescent suicide prevention,
intervention, and postvention. Chapter Four contained a section reporting findings from
interviews with an Assembly Member and a legislative staff member who supported EC 215
from its inception as AB 2246 (Assembly Bill No. 2246, 2016). The data collected from these
individuals provided legislative history, analysis, and context for the current study. These
interviews with legislators detailed the collaborative efforts of public and private entities to move
suicide prevention from a beneficent concept to state law; furthermore, interview data revealed
that evaluation of EC 215 is a weakness in the legislative model, highlighting a foundational
premise for the current study.
This chapter also included information gathered from interviews with 10 southern
California middle school principals. The themes revealed through study findings emphasized the
leadership strategies of principals, current best practices and strategies being employed in
southern California public middle schools to facilitate suicide prevention, the importance of
preparing and supporting middle school teachers, and early efforts to evaluate the effectiveness
of the current implementation of EC 215 (California Legislative Information, 2018). The
quantitative and qualitative data related to the four research questions denoted the following
findings.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 171
Research Question One asked, How are middle school principals in southern California
public schools leading the implementation of EC 215: Pupil and Student Suicide Prevention
Policies? The data collected through surveys and interviews underscored the critical role
principal leadership plays in adolescent suicide prevention efforts. Despite findings that
principals have not thoroughly inspected the text of EC 215 (California Legislative Information,
2018), they are committed to providing relevant, effective supports for middle school students
experiencing stress, anxiety, depression, or suicidality. Alarming findings revealed by survey
and interview data showed that 100% of study participants reported students communicated
suicidal ideation at their middle schools, and more than half reported students who attempted or
died by suicide. As a result, principals demonstrated generally high levels of knowledge
regarding youth suicidality, a heavy focus on the adverse impacts of stress, peer pressure, and
social media. Middle school principals presented an understanding of EC 215’s emphasis on
students considered to be vulnerable to an elevated risk of suicide, but focused these efforts on
LGBTQ youth more than other identified groups such as foster youth, homeless students, or
students with diagnoses of mental illness. Survey and interview data showed middle school
principals have an awareness of protective factors, particularly supportive trained adults and
social emotional support systems. A final common theme explored the varying roles of
principals as they pertain to involvement in suicide intervention, finding that while some
principals interact directly with students in crisis, others rely on school counselors,
psychologists, and other trained professionals.
Research Question Two asked, What are the best practices and strategies being utilized in
these middle schools to support pupil suicide prevention, intervention, and postvention? Survey
data and interviews revealed themes pertaining to the approach principals and their middle
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 172
school communities are taking to address students suffering with emotional distress and suicidal
crisis. The study illustrated the high degree to which principals represent that their schools have
implemented youth suicide prevention practices. Survey data and interviews detailed common
themes pertaining to the components of suicide prevention program delivery.
Principals highlighted the integral role of appropriately trained staff, including existing
positions such as counselors and psychologists, as well as novel personnel like licensed marriage
and family therapists. Results from principals were mixed regarding the effectiveness of new
district-level positions, such as directors of student wellness and welfare, who function
differently in various southern California school districts. Collaborative efforts of trained
personnel, such as those organized in the formation of crisis response teams, serve a vital role
performing suicide risk assessments, and providing intervention services to students in crisis;
however, principals did not connect postvention methodology, such as creating reentry plans for
students, to the work of crisis response teams, as was suggested by the literature (Adamson &
Peacock, 2007; Brock, 2002; Nickerson & Zhe, 2004). Survey and interview data demonstrated
the importance of professional development for teachers, staff, and the principals themselves.
Study participants validated the premise that professional development has increased the
capability of school staff to recognize the warning signs of suicide among students, but the
consensus is that all staff would benefit from additional, targeted training. Finally, to support
suicide prevention efforts within middle school communities a variety of programs focused on
student connectedness, character education, peer mentoring, conflict resolution, and student
leadership were leveraged and synergized. Categorized under the theme of social emotional
learning, the data demonstrated principals facilitate different combinations of student-centered
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 173
programs to help students manage their emotions, set positive goals, foster meaningful
interpersonal relationships, and make good decisions.
Research Question Three asked, How are middle school principals leading faculty to
change their perceptions and attitudes that suicide prevention practices are a serious and worthy
issue? The findings from survey data and interviews aligned with the assertion in both AB 2246
and the literature, that teachers are the most likely individuals at school to whom students will go
with concerns about suicidality (Fisher, 2006; Graham et al., 2011; Kalafat, 2003). Principals
universally indicated that teachers understand the dire importance of suicide prevention practices
at the middle school level; moreover, teachers draw upon their compassion for youth to embrace
their role, shifting from a traditional definition of instructional delivery to a contemporary role
that includes attending to the emotional well-being of students. Concomitantly, data from
surveys and interviews showed that teachers may not possess the confidence in their current
abilities to effectively intervene with a student in crisis. The dichotomy between teacher
commitment and teacher confidence emphasized the final theme revealed by the data; the role of
middle school principals, like that of teachers, has also shifted from the conventional role of
instructional leader, to a more progressive function that includes support, encouragement, and
validation of teachers fostering social emotional supports for students.
Research Question Four asked, How do principals evaluate the progress and success of
pupil suicide prevention programs and practices? Survey and interview data identified three
main themes: the need for ongoing training, communication with students and parents, and
aligning the principal’s leadership vision for success with the relatively nascent implementation
of EC 215 (California Legislative Information, 2018). Principal responses highlighted the
perceived need for ongoing training for middle school faculty and staff. Considering that
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 174
professional development was reported as a component of best practices of the current
implementation, the data showed that principals identify continued, targeted professional
development for all school employees as an evaluative measure of program success.
Survey and interview data highlighted the critical importance for principals to maintain
open channels of communication with students and parents as a key component of evaluating the
effectiveness and acceptance of suicide prevention practices. Principals shared poignant stories
of students in crisis, illustrating the direct link between students being cognizant of the
importance to report a classmate suffering with suicidal ideation to an adult. Principal
reflections that each such action potentially saved a student’s life present a valuable measure of
evaluation. Communications and interactions with parents varied among principals, but study
participants expressed their commitment to partnerships with parents despite numerous
challenges. As a final theme, principals supported the premise that their leadership visions—
grounded in the unique culture and climate of their respective school communities—must be
linked to their commitment of delivering a comprehensive suicide prevention policy to the entire
school community. As a measure of evaluation, principals highlighted the subsequent steps each
plans to take towards sustaining and improving middle school suicide prevention programs,
demonstrating their perceived obligation and steadfast resolve to ensure students receive the best
possible supports to survive and succeed.
Chapter Five includes further analysis of data and summarizes the research study.
Implications for practice, limitations of the study, and conclusions are contained therein.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 175
Chapter Five: Conclusions
The epidemic of youth suicide in California has persisted for decades, consistently
ranking as the second or third leading cause of death among individuals 10 to 24 years of age
(CDC, 2014a, 2019). Despite the ongoing complementary efforts of health professionals,
legislators, and educators to eliminate this threat to California’s youth, thousands of adolescents
attempt suicide or die by suicide each year across the state (Disdata.org., 2014; CDE, 2015;
CDC, 2014a). The profound impact of youth suicidality upon individuals, families, schools, and
communities cannot be overstated; nonetheless, comprehensive solutions to address this
enduring public health crisis have yet to be established.
In response, AB 2246 (Assembly Bill No. 2246, 2016)was signed into law in 2016,
requiring the governing board or body of a local educational agency serving pupils in grades 7
through 12 to adopt policies for suicide prevention, before the beginning of the 2017-18 school
year (Assembly Bill No. 2246, 2016; Trevor Project, 2018). The law, established as Education
Code 215: Pupil and Youth Suicide Prevention Policy (California Legislative Information,
2018), targeted all secondary students in California, with a distinct focus on high-risk student
groups, including students with disabilities, students with mental illness, students bereaved by
suicide, foster and homeless children, and LGBTQ youth (Assembly Bill No. 2246, 2016; Trevor
Project, 2019). Considering the nascent status of EC 215, the significance of the current study
was to explore the early applications and learnings surrounding the implementation of youth
suicide prevention practices among the youngest members of the population targeted by the
legislation, and further contribute to the body of research designated to eradicate the threat of
suicide to adolescents in California.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 176
Purpose of the Study
The purpose of this study was to examine how pupil suicide prevention policies and
practices mandated by EC 215 (California Legislative Information, 2018) are being implemented
in southern California middle schools. The study sought to determine the manner by which
principals are leading their school communities to support the cause of youth suicide prevention,
as well as the strategies being utilized to foster effective prevention, intervention, and
postvention methods. The study investigated how principals empower and support teachers—
identified in the literature as the group to whom students will most likely report in times of
crisis—and finally, how middle school principals assess the effectiveness and progress of their
suicide prevention programs.
Research Questions
This research study was guided by the following research questions:
(1) How are middle school principals in southern California public schools leading the
implementation of EC 215: Pupil Suicide Prevention Policies?
(2) What are the best practices and strategies being utilized in these middle schools to
support pupil suicide prevention, intervention, and postvention?
(3) How are middle school principals leading faculty to change their perceptions and
attitudes that suicide prevention practices are a serious and worthy issue?
(4) How do principals evaluate the progress and success of pupil suicide prevention
programs and practices?
Methodology
The study employed a mixed-methods approach. Quantitative data was collected from an
electronic survey, completed by 51 principals currently serving at public middle schools in six
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 177
southern California counties. The survey instrument, consisting of selected open-ended prompts
and Likert-scale responses, was guided by the four research questions, a review of the current
literature, and the components of Education Code 215: Pupil Suicide Prevention Policy
(California Legislative Information, 2018).
Qualitative data was obtained through interviews with 10 middle school principals,
selected for participation based on criteria of length of employment in their current position, a
principalship at a public middle school serving grades six, seven, and eight, and schools located
in southern California. A semi-structured approach was utilized during interviews consisting of
14 questions on the interview protocol, guided by the research questions. Responses to the
survey instrument were analyzed using descriptive statistics. Analysis of qualitative data
gathered during interviews applied Merriam and Tisdell’s (2016) coding protocol, utilizing a
constant comparative method. The process of coding the quantitative and qualitative data
revealed common themes amidst the data. Multiple data points from surveys and interviews
were evaluated utilizing the process of triangulation to support the study’s findings.
Results and Findings
The current study’s findings are founded in the data that was gathered and analyzed. The
quantitative and qualitative data indicated the following findings with respect to the four research
questions.
Research Question One
How are middle school principals in southern California public schools leading the
implementation of EC 215: Pupil Suicide Prevention Policies?
Both the survey data and interview responses demonstrated the vital role of middle
school principal leadership in the implementation of policies intended to prevent, intervene, and
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 178
follow incidents of youth suicidality. While findings revealed that middle school principals are
not currently well-versed with the actual language of Education Code 215 (California Legislative
Information, 2018), their collective dedication to providing school communities that are safe,
welcoming, and responsive to the social emotional needs of students was evident in their actions
and practices.
The prevalence of suicidal ideation and suicide attempts among middle school-aged
youth is an ominous fact about which middle school principals are anxiously aware. Principals
leverage a strong foundation of knowledge regarding suicide warning signs, risk factors, the
focused needs of students at elevated risk, and the palliative impact of protective factors to
contend with the pervasive threat of suicide for adolescents.
A dominant theme that emerged from the study included various stressors middle school
students face, often contributing to feelings of anxiety and depression, and which may lead to an
increased risk of suicidality. Stress is exacerbated by the pervasive nature of social media in the
lives of middle school students; a key focus area for principals, who recognize the impact of
increased utilization of technology in middle schools—and the resultant, albeit, unintended
increase in access to social media—as a contributing factor to anxiety, bullying, and suicidal
ideation.
Concurrently, the study findings suggested the emergent implementation of suicide
prevention practices, mandated by EC 215 (California Legislative Information, 2018) and led by
principals in southern California middle schools, stand to improve over time through consistent,
targeted development of comprehensive supports for students, stakeholders, and the principals
themselves.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 179
Research Question Two
What are the best practices and strategies being utilized in these middle schools to
support pupil suicide prevention, intervention, and postvention?
Survey data and interview responses demonstrated that southern California middle school
principals design and facilitate adolescent suicide prevention practices by strategically utilizing
appropriate staffing, professional development, and various programs that foster social emotional
learning opportunities for students. Findings show that middle school suicide prevention efforts
have benefitted from not only the addition of new district-level director positions dedicated to
student wellness and welfare, but also through novel, innovative approaches and applications of
traditional site-level support staff like counselors and psychologists. This study highlighted how
middle school principals rely on these individuals and their specialized skillsets to support the
implementation of suicide prevention, intervention, and postvention methods. Moreover, the
coordinated efforts of these individuals serving together on crisis response teams to conduct risk
assessments and affecting designated referrals for potentially suicidal youth enhances the breadth
and scope of suicide prevention efforts in middle schools.
Study findings support the integral role of professional development for principals,
teachers, and school staff to increase awareness, refine prevention and intervention skills, and to
develop protocols to address the needs of students in crisis.
All schools included in the study utilized a variety of programs designed to support
academic preparation, student discipline, goal-setting, character education, peer mentoring,
school connectedness, and student leadership. As a means of fostering youth suicide prevention
practices, principals and middle school staff have modified several existing programs such as
restorative practices, peer mentorship programs, and youth leadership programs to address social
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 180
emotional and mental health needs of students, while adding new initiatives such as campus
wellness centers to augment beneficial student support systems. Principal efforts to combine the
best people, practices, and programs promote the intended outcomes of reducing student stress,
anxiety, depression, and feelings of hopelessness in an effort to lessen or eliminate the number of
students experiencing suicidality.
Research Question Three
How are middle school principals leading faculty to change their perceptions and
attitudes that suicide prevention practices are a serious and worthy issue?
Survey and interview data aligned with the literature, supporting the tenet that teachers
are the most likely individuals to whom students will go in times of crisis (Fisher, 2006). The
findings indicated that principals represent middle school teachers understand the critical
importance of suicide prevention with adolescent students. Teachers leverage compassion,
rapport, and positive interactions with students to augment their instructional practice, including
social emotional learning as a key component of pedagogy.
Despite their commitment to the well-being of their students, findings indicated that
teachers struggle with the self-confidence to provide effective intervention with students
demonstrating suicidality. Survey and interview data revealed that principals, who have
traditionally served as instructional leaders at their middle schools, have found the need to
extend social emotional supports not only to students, but also to the teachers and staff to whom
students turn with their own stress and anxiety. The researcher found that principals are an
invaluable source of encouragement, reinforcement, and assistance for teachers, who themselves
play an integral role in youth suicide prevention.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 181
Research Question Four
How do principals evaluate the progress and success of pupil suicide prevention
programs and practices?
The current study, which examined the developing implementation of Education Code
215 (California Legislative Information, 2018) in southern California middle schools, found that
principal implementation and evaluation is an ongoing process in the early stages of assessment.
Survey and interview data revealed that while principals have initialized programs and practices
aimed at tempering the scourge of youth suicidality, measuring the effectiveness of such efforts
may span years.
The researcher found that principals evaluate middle school suicide prevention programs
through both professional development and encouragement for teachers, counselors, and other
key staff. Consistent communication with stakeholders provides principals with feedback from
teachers, parents, and students about the efficacy of suicide prevention, intervention, and
postvention methods. Findings also demonstrated that principals reflect on the programs to
which students avail themselves as preventative, social emotional supports, as well as the
intervention processes accessed by students in crisis that lead to appropriate care. Principal
reflection contributes to improved practices, collaborative approaches to work through and
beyond implementation challenges.
The study’s findings demonstrated the importance for principals to align a coherent and
cohesive leadership vision to the implementation of suicide prevention practices in their school
communities. Themes revealed in this study demonstrate that the long-term success of youth
suicide prevention practices at middle schools is inevitably linked to the steadfast resolve of
principals to lead school communities towards improved outcomes for students.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 182
Implications of the Study
The results and findings of this study highlight the significance of principals in the
interpretation, design, implementation, and evaluation of youth suicide prevention programs.
Principal leadership that inspires and empowers stakeholders to affect systemic change across
school communities serves to promote positive school culture, improved school climate, and
fosters a comprehensive approach to improving student well-being. The ability of principals to
reframe their leadership is critical to the ongoing success of a comprehensive approach to youth
suicide prevention (Bolman & Deal, 2013). In order to navigate the dynamic and interrelated
components of legislative policy, the social emotional needs of students, staff, and families, the
resources required to support programs and professional development, and the vision to build a
legacy of compassion and connectedness, middle school principals must examine the pervasive
threat of adolescent suicide from multiple perspectives. Principals must remain poised to make
leadership decisions that maximize opportunities and strengths, mitigate weaknesses and threats,
and properly align all available resources to turn the tide of youth suicidality in southern
California middle schools.
This study adds to the current body of literature for secondary school leaders, district
administration and executive leadership, school boards of education, and the California
Department of Education by identifying the current status of EC 215’s (California Legislative
Information, 2018) implementation; the strategies being used at the middle school level to
combat student stress, anxiety, depression, and suicidality; and the needs of school-based
stakeholders who have been tasked with combating the devastation of youth suicide.
Concurrently, the study provides a context for the current status of suicide prevention in southern
California public middle schools, such that suicide prevention organizations, along with the
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 183
youth and families they serve, might better understand the approach being taken, thus revealing
future opportunities for collaboration and cooperation.
Principals who participated in this study overwhelmingly reported elevated incidence of
stress, anxiety, depression, and suicidal ideation and attempt among middle school students in six
southern California counties. Notably, while the rates of suicide are significantly higher in
northern California counties, the numbers of suicides in southern California are far greater, due
to higher population density (California Department of Public Health, 2010; Ramchand &
Becker, 2014). Regardless, the study highlighted principals’ somber intimations that the death of
even a single student has devastating consequences for every member of a school community;
thus, every effort must be made to prevent suicide among adolescents.
Moreover, AB 2246 was signed into law fewer than three years before the current study
was conducted, and governing boards were required to sign local policy mandating suicide
prevention in school districts at the beginning of the 2017-18 school year. Considering the
nascent status of EC 215 (California Legislative Information, 2018), and the assertion by the
legislators who supported AB 2246 that the measurable results of the current law may take years
to manifest, the current study highlighted how principals must draw upon effective leadership
practices and a schoolwide foundation of student success to move suicide prevention practices
forward with fidelity and efficacy.
In a broader sense, this study was conducted not as a summative assessment of youth
suicide prevention practices, but rather as benchmark of current practices aimed at overcoming
the devastation of youth suicide. While the findings demonstrated a multitude of approaches
being taken by middle school communities, the results of the study highlight the critical
importance of providing ongoing training for staff, empowering them with social emotional
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 184
supports, and maintaining programs designed to engage and connect students to school and to
one another. Principals must continue to take such a holistic approach to youth suicide,
reflecting upon their practice through the lenses of empathy, efficiency and efficacy, and
collaborating with multiple stakeholders to regularly reassess the reach, impact, and critical
importance of suicide prevention measures.
Recommendations for Future Research
The current study reported on findings from surveys completed by 51 middle school
principals and interviews conducted with 10 middle school principals in southern California.
Based upon the results of this study, the researcher recommends the following areas be
considered for additional research and exploration:
Expand the current study to include the practices, strategies, and methods being utilized
to support EC 215 implementation in northern California middle schools, particularly
those in counties where suicide rates are significantly higher than in southern California.
Strengthen the research focus on proactive prevention methodology, as opposed to
reactive intervention and postvention practices.
Expand the current study to include best practices being utilized in California charter
middle schools and private middle schools, in which resources, personnel, and program
composition may be different than in comprehensive public middle schools.
Further explore the growing field of web-based screening programs, variably designed
for universal, selective, and indicated applications to identify youth with elevated risk of
suicidality.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 185
Explore the implications of supplementary professional development for staff, including
trauma-informed practices, behavior supports, and non-academic interventions for
students.
A study of the intersection between campus safety and youth suicide prevention
practices, focused on student voice, empowerment, mentoring, and leadership.
Expand the synergistic collaboration of local and state government entities, private youth
advocacy groups, and public secondary schools to establish signature practices and
model policies based on real-time data.
Conclusion
Southern California middle school principals are solemnly cognizant of the
extraordinarily detrimental impact of youth suicidality. Middle school students are subjected to
ever-increasing amounts of stress and anxiety, which extrapolates to California leading the
United States in youth suicide rates (CDC, 2015c). This study has demonstrated that it is
incumbent upon principals, as leaders of their school communities, to examine the policies and
methods being implemented to combat the public health crisis of youth suicide.
Throughout the study, principals’ perceptions and knowledge of youth suicide, risk
factors, prevention, intervention, and postvention were explored. Despite the limited passage of
time between the ratification of EC 215 (California Legislative Information, 2018) and the
current study, the researcher sought to explore the best practices and strategies being utilized by
principals and stakeholders within school communities, and illustrate the manner in which
principal-leaders are measuring the efficacy of their collective efforts.
The study highlights the augmented leadership role of the principal, whose traditional
function as an instructional leader has taken on greater significance. As the needs of schools and
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 186
students change, the principal’s multifaceted role has also shifted to address students’ social
emotional learning needs, maintain open channels of communication with multiple stakeholders,
ensure the maintenance and accessibility of myriad programs and resources that sustain a
comprehensive approach to youth suicide prevention, and foster continuous support for front-line
staff through both professional development and emotional encouragement.
As educators and leaders, middle school principals have dedicated themselves to the
success and well-being of adolescents, during a time in students’ lives defined by change. The
implementation and ongoing evaluation of Education Code 215 (California Legislative
Information, 2018) requires that principals and middle schools must also transform and evolve,
continually assessing and refining practices to better the lives of the students they endeavor to
serve.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 187
References
Abbott, C. H., & Zakriski, A. L. (2014). Grief and attitudes toward suicide in peers affected by a
cluster of suicides as adolescents. Suicide and Life ‐Threatening Behavior, 44(6), 668-
681. doi:10.1111/sltb.12100
Adamson, A. D., & Peacock, G. G. (2007). Crisis response in the public schools: A survey of
school psychologists’ experiences and perceptions. Psychology in the Schools, 44, 749-
764. doi:10.1002/pits.20263
Afifi, T. O., Boman, J., Fleisher, W., & Sareen, J. (2009). The relationship between child abuse,
parental divorce, and lifetime mental disorders and suicidality in a nationally
representative adult sample. Child Abuse and Neglect, 33(3), 139-147. doi:10.1016/j.
chiabu.2008.12.009
Agerbo, E. E., Nordentoft, M., & Mortensen, P. B. (2002). Familial, psychiatric, and
socioeconomic risk factors for suicide in young people: Nested case-control study. BMJ,
325, 74. doi:http://dx.doi.org/10.1136/bmj.325.7355.74
American Association of Suicidology. (2011). Know the warning signs of suicide. Washington,
DC: Author.
American Association of Suicidology. (2016). Surviving after suicide fact sheet. Retrieved from
http://www.suicidology.org/Portals/14/docs/Resources/FactSheets/SurvivingAfterSuicide
.pdf
American Foundation for Suicide Prevention. (n.d.). Facts and figures. Retrieved on December
1, 2008 from www.afsp.org
American Foundation for Suicide Prevention. (2016). State laws on suicide prevention training
for school personnel. Washington, DC: Author.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 188
American Psychiatric Association. (2018). Suicide prevention. Retrieved from
https://www.psychiatry.org/patients-families/suicide-prevention
Anestis, M. D. (2016). Prior suicide attempts are less common in suicide decedents who died by
firearms relative to those who died by other means. Journal of Affective Disorders, 189,
106-109. doi:10.1016/j.jad.2015.09.007
Apter, A., & King, R. A. (2006). Management of the depressed, suicidal child or
adolescent. Child and Adolescent Psychiatric Clinics, 15(4), 999-1013.
Armstrong, L. L., & Manion, I. G. (2006). Suicidal ideation in young males living in rural
communities: Distance from school as a risk factor, youth engagement as a protective
factor. Vulnerable Children & Youth Studies, I, 102-113. doi:10.1080/17450120600
659010
Aseltine, R. H., & DeMartino, R. (2004). An outcome evaluation of the SOS suicide prevention
program. American Journal of Public Health, 94, 446-451. doi:10.2105/AJPH.94.3.446
Aseltine Jr, R. H. (2003). An evaluation of a school based suicide prevention program.
Adolescent and Family Health, 3(2), 81-88.
Aseltine Jr, R. H., James, A., Schilling, E. A., & Glanovsky, J. (2007). Evaluating the SOS
suicide prevention program: A replication and extension. BMC Public Health, 7(1), 1.
doi:10.1186/1471-2458-7-161
Assembly Bill No. 2246. (2016). Pupil suicide prevention plicites. Retrieved from
https://leginfo.legislature.ca.gov/faces/billNavClient.xhtml?bill_id=201520160AB2246
Ayyash-Abdo, H. (2002). Adolescent suicide: An ecological approach. Psychology in the
Schools, 39, 459-474.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 189
Baber, K., & Bean, G. (2009). Frameworks: A community-based approach to preventing youth
suicide. Journal of Community Psychology, 37, 684-696. doi:10.1002/jcop.20324
Barber, C. W., & Miller, M. J. (2014). Reducing a suicidal person’s access to lethal means of
suicide: A research agenda. American Journal of Preventive Medicine, 47(3), S264-S272.
doi:10.1016/j.amepre.2014.05.028
Bass, B. M., & Riggio, R. E. (2006). Transformational leadership. Psychology Press.
Bearman, P. S., & Moody, J. (2004). Suicide and friendships among American adolescents.
American Journal of Public Health, 94, 89-95. doi:10.2105?AJPH.94.1.894
Bendikson, L., Robinson, V., & Hattie, J. (2012). Principal instructional leadership and
secondary school performance. Set: Research Information for Teachers, (1), 2-8.
Berman, A. L., Jobes, D. A., & Silverman, M. M. (2006). Adolescent suicide: Assessment and
intervention (2nd ed.). Washington, DC: American Psychological Association.
Bolman, L. G., & Deal, T. E. (2013). Reframing organizations: Artistry, choice and leadership
(5th ed.). San Francisco, CA: Jossey-Bass.
Borowsky, I. W., Ireland, M., & Resnick, M. D. (2001). Adolescent suicide attempts: Risks and
protectors. Pediatrics, 107(3), 485-493.
Bostik, K. E., & Everall, R. D. (2007). Healing from suicide: Adolescent perceptions of
attachment relationships. British Journal of Guidance & Counselling, 35, 79-96.
doi:10.1080/0306988061106815
Brent, D. A., & Mann, J. J. (2005). Family genetic studies, suicide, and suicidal behavior.
American Journal of Medical Genetics, 133C, 13-24. doi:10.1002/ajmg.c.30042
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 190
Brent, D. A., Baugher, M., Bridge, J., Chen, T., & Chiappetta, L. (1999). Age- and sex-related
risk factors for adolescent suicide. Journal of the American Academy of Child &
Adolescent Psychiatry, 38, 1497-1505. doi:10.1097/00004583-199912000-00010
Brent, D. A., Melhem, N. M., Oquendo, M., Burke, A., Birmaher, B., Stanley, B . . . Mann, J.
(2015). Familial pathways to early-onset suicide attempt: A 5.6-year prospective study.
JAMA Psychiatry, 72(2), 160-168. doi:10.1001/jamapsychiatry.2014.2141
Brent, D. A., Oquendo, M., Birmaher, B., Greenhill, L., Kolko, D., Stanley, B., . . . Mann, J. J.
(2002). Familial pathways to early-onset suicide attempt: Risk for suicidal behavior in
offspring of mood-disordered suicide attempters. Archives of General Psychiatry, 59(9),
801-807. doi:10.1001/archpsyc.59.9.801
Brent, D. A., Perper, J. A., Allman, C. J., Moritz, G. M., Wartella, M. E., & Zelenak, J. P.
(1991). The presence and accessibility of firearms in the homes of adolescent suicides: A
case-control study. JAMA, 266(21), 2989-2995. doi:10.1001/jama.1991.03470210057032
Brezo, J., Paris, J., Vitaro, F., Hébert, M., Tremblay, R. E., & Turecki, G. (2008). Predicting
suicide attempts in young adults with histories of childhood abuse. The British Journal of
Psychiatry, 193(2), 134-139. doi:10.1192/bjp.bp.107.037994
Bridge, J. A., Goldstein, T. R., & Brent, D. A. (2006). Adolescent suicide and suicidal behavior.
Journal of Child Psychology and Psychiatry, 47, 372-394. doi:10.1111/j.1469-7610.20
06.01615.x
Brock, S. E. (2002). School suicide postvention. In S. Brock, P. Lazarus, & S. Jimerson (Eds.),
Best practices in school crisis prevention and intervention (pp. 553-576). Bethesda, MD:
National Association of School Psychologists.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 191
Brock, S. E., Sandoval, J., & Hart, S. (2006). Suicidal ideation and behaviors. In G. Bear &
K. Minke (Eds.), Children’s needs III: Development, prevention, and intervention
(pp. 225-238). Bethesda, MD: National Association of School Psychologists.
Brodsky, B. S., Mann, J. J., Stanley, B., Tin, A., Oquendo, M., Birmaher, B., . . . Brent, D.
(2008). Familial transmission of suicidal behavior: Factors mediating the relationship
between childhood abuse and offspring suicide attempts. Journal of Clinical Psychiatry,
69(4), 584-596.
Brown, M. B., Holcombe, D. C., Bolen, L. M., & Thomson, W. S. (2006). Role function and job
satisfaction of school psychologists practicing in an expanded role model. Psychological
Reports, 98, 486-496. doi:10.2466/PRO.98.2.486-496
California Department of Education. (2015). News Release. State Superintendent of Public
Instruction Tom Torlakson thanks governor for signing student suicide prevention bill.
Retrieved from https://www.cde.ca.gov/nr/ne/yr16/yr16rel67.asp
California Department of Education. (2017a). Enrollment/number of schools by grade span &
type - CalEdFacts. (2017). Retrieved from https://www.cde.ca.gov/ds/sd/cb/cefenroll
gradetype.asp
California Department of Education. (2017b). Model Youth Suicide Prevention Policy. Retrieved
from https://www.cde.ca.gov/nr/el/le/yr17ltr0510.asp
California Department of Education. (2018). Public Schools and Districts Data Files. Retrieved
from https://www.cde.ca.gov/ds/si/ds/pubschls.asp
California Department of Mental Health. (2008). California strategic plan on suicide prevention:
Every Californian is part of the solution. Retrieved from https://www.sprc.org/sites/
default/files/California_CalSPSP_V92008.pdf
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 192
California Department of Public Health. (2010). CalEVDRS—California electronic violent death
reporting system. Retrieved from http://epicenter.cdph.ca.gov/ReportMenus
/ViolentDeathTable.aspx
California Legislative Information. (2018). Article 2.5. Pupil and Student Suicide Prevention
Policies [215 - 216] (Heading of Article 2.5 amended by Stats. 2018, Ch. 460, Sec. 1).
Retrieved from https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?
lawCode=EDC&division=1.&title=1.&part=1.&chapter=2.&article=2.5.
California Legislative Information. (2000). Chapter 6: Suicide Prevention programs. [4098 -
4098.5] (Chapter 6 added by Stats. 2000, Ch. 93, Sec. 44.5). Retrieved from
https://leginfo.legislature.ca.gov/faces/codes_displayText.xhtml?lawCode=WIC&divisio
n=4.&title=&part=1.&chapter=6.&article=
California School Boards Association (CSBA). (2017). CSBA sample: Board policy. Students:
Suicide Prevention. BP 5141.52(a). Retrieved from https://www.csba.org/Governance
AndPolicyResources/DistrictPolicyServices/~/media/CSBA/Files/GovernanceResources/
PolicyNews_Briefs/StudentHealth/201410BP-AR5141-52-SuicidePrevention.ashx
Callanan, V. J., & Davis, M. S. (2011). Gender and suicide method: Do women avoid facial
disfiguration? Sex Roles, 65, 867-879. doi:10.1007/s11199-011-0043-0
CalSCHLS. (2015). Query CalSCHLS. Retrieved from
http://chks.wested.org/indicators/155/seriously-considered-attempting-suicide-in-the-
past-months-by-level-of-connectedness-to-school/
Carlson, K. T. (2006). Mood variability in adolescent suicide: importance in domains of self-
schemas in adolescent suicide. Child & Youth Care Forum, 35, 79-99. doi:10.1007/s
10566-005-9004-5
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 193
Cash, S. J., & Bridge, J. A. (2009). Epidemiology of youth suicide and suicidal behavior.
Current Opinion in Pediatrics, 21, 613-619. doi:10.1097/MOP.0b013e32833063e1
Cavanaugh, J. T. O., Carson, A. J., Sharpe, M., & Lawrie, S. M. (2003). Psychological autopsy
studies of suicide: A systematic review. Psychological Medicine, 33, 395-405. doi:10.10
17/S0033291702006943
Centers for Disease Control and Prevention (CDC). (n.d.). About multiple cause of death, 1999-
2017. Retrieved from https://wonder.cdc.gov/mcd-icd10.html
Centers for Disease Control and Prevention. (1994). Suicide contagion and the reporting of
suicide: Recommendations from a national workshop. Morbidity and Mortality Weekly
Report. 43(RR-6), 9-18. Retrieved from http://www.cdc.gov/mmwr/preview/
mmwrhtml/000 31539.htm
Centers for Disease Control and Prevention. (2014a). Data & Statistics (WISQARRS
TM
): Cost of
injury reports. Retrieved from http://wisqars.cdc.gov:8080/costT/
Centers for Disease Control and Prevention. (2014b). National suicide statistics at a glance:
Suicide rates among persons 10 years and older by race/ethnicity in the United States,
2005-2009. Retrieved from http://www.cdc.gov/violenceprevention/suicide/statistics/
rates01.html
Centers for Disease Control and Prevention (CDC). (2015a). Suicide prevention: Youth suicide.
Retrieved from http://www.cdc.gov/violenceprevention/pub/youth_suicide.html
Centers for Disease Control and Prevention (CDC). (2015b). 1991-2017 High school youth risk
behavior survey data. Retrieved from https://nccd.cdc.gov/youthonline/App/Default.aspx
Centers for Disease Control and Prevention. (2015c). Suicide: Facts at a glance fact sheet.
Retrieved from http://www.cdc.gov/violenceprevention/pdf/suicide-datasheet-a.pdf
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 194
Centers for Disease and Control and Prevention. (2017). LGBT youth. Retrieved from
https://www.cdc.gov/lgbthealth/youth.htm
Centers for Disease Control and Prevention. (2018). Suicide mortality by state. Retrieved from
https://www.cdc.gov/nchs/pressroom/sosmap/suicide-mortality/suicide.htm
Centers for Disease Control and Prevention. (2019). WISQARS fatal Injury data visualization.
Retrieved from https://wisqars-viz.cdc.gov:8006/
Cheng, A. T., Chen, T. H. H., Chen, C. C., & Jenkins, R. (2000). Psychosocial and psychiatric
risk factors for suicide: Case-control psychological autopsy study. The British Journal of
Psychiatry, 177(4), 360-365. doi:10.1192/bjp.177.4.360
Child Trends Databank. (2015). Teach suicide: Key facts about teen suicide. Retrieved from
https://www.childtrends.org/?indicators=suicidal-teens
Clements-Nolle, K., Marx, R., & Katz, M. (2006) Attempted suicide among trans-gender
persons: The influence of gender-based discrimination and victimization. Journal of
Homosexuality, 51(3), 53-69. https://doi.org/10.1300/J082v51n03_04
Clements-Nolle, K., Marx, R., Guzman, R., & Katz, M. (2001). HIV prevalence, risk behaviors,
health care use, and mental health status of transgender persons: Implications for public
health intervention. American Journal of Public Health, 91(6), 915-921.
Clifton, D. (1999). Who needs a constituency? LEADING EDGE, (4)
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, 696-
702. doi:10.3109/01612840.2011.597911
Covey, F. (2018). The leader in me. Retrieved from
https://www.franklincovey.com/Solutions/education/TLIM.html
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 195
Cox, G. R., Robinson, J., Williamson, M., Lockley, A., Cheung, Y. D., & Pirkis, J. (2012).
Suicide clusters in young people: Evidence for the effectiveness of postvention strategies.
Crisis, 33, 208-214. doi:10.1027/0227-5910/a000144
Crosby, A. E., & Molock, S. D. (2006). Introduction: Suicidal behaviors in the African American
community. Journal of Black Psychology, 32(3), 253-261. doi:10.1177/0095798406290
552
Crosby, B. M., Cwik, M. F., & Riddle, M. A. (2015). Awareness, attitudes, and use of crisis
hotlines among youth at ‐risk for suicide. Suicide and Life-Threatening Behavior, 45(2),
192-198. doi: 10.1111/sltb.12112
Cross, W. F., Seaburn, D., Gibbs, D., Schmeelk-Cone, K., White, A. M., & Caine, E. D. (2011).
Does practice make perfect? A randomized control trial of behavioral rehearsal on suicide
prevention gatekeeper skills. The Journal of Primary Prevention, 32(3-4), 195-211.
doi:10.1007/s10935-011-0250-z
Curtin, S. C., Warner, M., & Hedegaard, H. (2016). Suicide rates for females and males by race
and ethnicity: United States, 1999 and 2014. Retrieved from https://www.researchgate.
net/publication/301688054_Suicide_Rates_for_Females_and_Males_by_Race_and_Ethni
city_United_States_1999_and_2014
Cusimano, M. D., & Sameem, M. (2011). The effectiveness of middle and high school-based
suicide prevention programmes for adolescents: A systematic review. Injury Prevention,
17(1), 43-49. doi:10.1136/ip.2009.025502
Daniel, S. S., & Goldston, D. B. (2009). Interventions for suicidal youth: A review of the
literature and developmental considerations. Suicide and Life-Threatening Behavior, 39,
252-268. doi:10.1521/suli.2009.39.3.252
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 196
Deal, T. E., & Peterson, K. D. (2009). Shaping school culture: Pitfalls, paradoxes, and promises
(2nd ed.). San Francisco, CA: Jossey-Bass.
Debski, J., Spadafore, C. D., Jacob, S., Poole, D. A., & Hixson, M. D. (2007). Suicide
intervention: Training, roles, and knowledge of school psychologists. Psychology in the
Schools, 44, 157-170. doi:10.1002/pits.20213
Deisenhammer, E. A., Ing, C. M., Strauss, R., Kemmler, G., Hinterhuber, H., & Weiss, E. M.
(2009). The duration of the suicidal process: how much time is left for intervention
between consideration and accomplishment of a suicide attempt? Journal of Clinical
Psychiatry, 70(1), 19-24.
DePaoli, J. L., Atwell, M. N., & Bridgeland, J. (2017). Ready to lead: A national principal
survey on how social and emotional learning can prepare children and transform schools.
Washington, DC: Civic Enterprises and Hart Research Associates for CASEL. Retrieved
from http:// www.casel.org/wp-content/uploads/2017/11/ReadyToLead _FINAL.pdf
Disdata.org. (2014). Suicidal Ideation (Student Reported), by Gender and Grade Level. Retrieved
from http://www.kidsdata.org/topic/1826/suicidal-ideation-gender/table#fmt=229
5&loc=2&tf=81&ch=78,77,305,306,431,1142,1177,1176&sortColumnId=0&sortType=
asc
Drapeau, C. W., & McIntosh, J. L., (2015). U.S.A. suicide 2014: Official final data. Washington,
DC: American Association of Suicidology. Retrieved from http://www.suicidology.org
DuFour, R., DuFour R., Eaker, R., & Many, T. (2006). Learning by doing: A handbook for
professional learning communities at work
TM
. Bloomington IN: Solution Tree.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 197
Dumesnil, E., & Verger, P. (2009). Public awareness campaigns about depression and suicide: A
review. Psychiatric Services, 60(9), 1203-1213. http://dx.doi.org/10.1176/ps.2009.60.9.
1203
Durlak, J. A., Weissberg, R. P., Dymnicki, A. B., Taylor, R. D., & Schellinger, K. B. (2011). The
impact of enhancing students’ social and emotional learning: A meta ‐analysis of school ‐
based universal interventions. Child Development, 82(1), 405-432.
Dymnicki, A., Sambolt, M., & Kidron, Y. (2013). Improving college and career readiness by
incorporating social and emotional learning. College & Career Readiness & Success
Center. Washington, DC: American Institutes for Research.
Eaton, D. K., Foti, K., Brener, N. D., Crosby, A. E., Flores, G., & Kann, L. (2011). Associations
between risk behaviors and suicidal ideations and suicide attempts: Do racial/ethnic
variations in associations account for increased risk of suicidal behaviors among
Hispanic/Latina 9th-to-12th-grade female students? Archives of Suicide Research, 15(2),
113-126. doi:10.1080/13811118.2011.565268
Elmore, R. (2000). Leadership for effective middle school practice: Conclusion. Phi Delta
Kappan, 82(4), 291-292. doi:10.1177/003172170008200410
Erbacher, T. A., Singer, J. B., & Poland, S. (2015). Suicide in the schools: A practitioner’s guide
to multi-level prevention, assessment, intervention, and postvention. New York, NY:
Routledge.
Esposito ‐Smythers, C., & Spirito, A. (2004). Adolescent substance use and suicidal behavior: a
review with implications for treatment research. Alcoholism: Clinical and Experimental
Research, 28(s1), 77S-88S. doi:10.1097/01.ALC.0000127417.99752.87
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 198
Evans, E., Hawton, K., & Rodham, K. (2004). Factors associated with suicidal phenomena in
adolescents: A systematic review of population-based studies. Clinical Psychology
Review, 24, 957-979. doi:10.1016/j.cpr.2004.04.005
Everall, R. D., Bostik, K. E., & Paulson, B. L. (2005). I’m sick of being me: Developmental
themes in suicidal adolescent. Adolescence, 40(160), 693-708.
Every Student Succeeds Act of 2015. (2015). Every Student Succeeds Act of 2015, Public
Law No. 114-95 § 114 Stat. 1177. Retrieved from https://www.congress.gov/114/
plaws/publ95/PLAW-114publ95.pdf
Fergusson, D. M., Boden, J. M., & Horwood, L. J. (2008). Exposure to childhood sexual and
physical abuse and adjustment in early adulthood. Child Abuse and Neglect, 32(6), 607-
619. doi:10.1016/j.chiabu.2006.12.018
Fisher, D. (2006). Keeping adolescents ‘Alive and Kickin’ It’: Addressing suicide in the schools.
Phi Delta Kappan, 87, 784-786.
Fisher, D., & Frey, N. (2005). Better learning through structured teaching: A framework for the
gradual release of responsibility. Association for Supervision and Curriculum
Development. Alexandria, VA.
Fleischmann, A., Bertolote, J. M., Belfer, M., & Beautrais, A. (2005). Completed suicide and
psychiatric diagnoses in young people: a critical examination of the evidence. American
Journal of Orthopsychiatry, 75(4), 676-683.
Fontanella, C. A., Hiance-Steelesmith, D. L., Phillips, G. S., Bridge, J. A., Lester, N., Sweeney,
H. A., & Campo, J. V. (2015). Widening rural-urban disparities in youth suicides, United
States, 1996-2010. JAMA Pediatrics, 169(5), 466-473. doi:10.1001/jamapediatrics.2014
.3561
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 199
Fountoulakis, K. N., Gonda, X., & Rihmer, Z. (2011). Suicide prevention programs through
community intervention. Journal of Affective Disorders, 130, 10-16. doi:10.1016/j.jad.20
10.06.009
Fowler, F. C. (2009). Policy strategies for educational leaders. Boston, MA: Pearson Education.
Fuhrman, S. H. (2004). Introduction. In Fuhrman, S. H. & Elmore, R. F. (Eds.). Redesigning
accountability systems for education (pp. 3-14). New York, NY: Teachers College Press.
Fullan, M. (2007). The new meaning of educational change (4th ed.). New York, NY: Teachers
College Press.
Fullan, M. (2012). Leading in a culture of change. San Francisco, CA: Jossey-Bass.
Fullan, M. (2014). The principal: Three keys to maximizing impact. San Francisco, CA: Jossey-
Bass.
Furczyk, K., Schutová, B., Michel, T. M., Thome, J., & Büttner, A. (2013). The neurobiology of
suicide: A review of post-mortem studies. Journal of Molecular Psychiatry, 1, 1-22.
doi:10.1186/2049-9256-1-2
Garrett Lee Smith Memorial Act, 42 U. S. C. § 2634. (2004). Public Law 108-355. Retrieved
from https://www.congress.gov/108/plaws/publ355/PLAW-108publ355.pdf
Goldston, D. B., Walrath, C. M., McKeon, R., Puddy, R. W., Lubell, K. M., Potter, L. B., &
Rodi, M. S. (2010). The Garrett Lee Smith Memorial suicide prevention program. Suicide
and Life-Threatening Behavior, 40(3), 245-256. doi:10.1521/suli.2010.40.3.245
Gould, M. S., Fisher, P., Parides, M., Flory, M., Shaffer, D. (1996). Psychosocial risk factors of
child and adolescent completed suicide. Archives of General Psychiatry, 53(12), 1155-
1162. doi:10.1001/archpsyc.1996.01830120095016
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 200
Gould, M. S., Greenberg, T., Velting, D. M., & Shaffer, D. (2003). Youth suicide risk and
preventative interventions: A review of the past 10 years. Journal of the American
Academy of Child & Adolescent Psychiatry, 42(4), 386-405. doi:10.1097/01.CHI.00000
46821.95464.CF
Gould, M. S., Kleinman, M. H., Lake, A. M., Forman, J., & Midle, J. B. (2014). Newspaper
coverage of suicide and initiation of suicide clusters in teenagers in the USA, 1988-96: A
retrospective, population-based, case-control study. The Lancet Psychiatry, 1(1), 34-43.
Gould, M. S., Marrocco, F. A., Kleinman, M., Thomas, J. G., Mostkoff, K., Cote, J., & Davies,
M. (2005). Evaluating liatrogenic risk of youth suicide screening programs: A
randomized controlled trial. Journal of the American Medical Association, 293(13),
1635-1643. doi:10.1001/jama.293.13.1635
Govtrack. (1990). Mental Health Amendments of 1990. Public Law No.101-639 § 104, Stat.
4600. Retrieved from https://www.govtrack.us/congress/bills/101/s2628
Graham, A., Phelps, R., Maddison, C., & Fitzgerald, R. (2011). Supporting children’s mental
health in schools: Teacher views. Teachers and Teaching: Theory and Practice, 17(4),
479-496. doi:10.1080/13540602.2011.580525
Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice
at every turn: A report of the national transgender discrimination survey. Bethesda, MD:
National Center for Transgender Equality and National Gay and Lesbian Task.
Groholt, B., Ekeberg, O., & Haldorsen, T. (2006). Adolescent suicide attempters: What predicts
future suicidal acts? Suicide and Life-Threatening Behavior, 36(6), 638-650.
doi:10.1521/suli.2006.36.6.638
Guskey, T. R. (2000). Evaluating professional development. Thousand Oaks, CA: Corwin Press.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 201
Haas, A. P., Rodgers, P. L., & Herman, J. (2014). Suicide attempts among transgender and
gender non-conforming adults: Findings of the national transgender discrimination
survey. Retrieved from https://williamsinstitute.law.ucla.edu/wp-content/uploads/AFSP-
Williams-Suicide-Report-Final.pdf
Hadland, S. E., Marshall, B. D., Kerr, T., Qi, J., Montaner, J. S., & Wood, E. (2012). Suicide and
history of childhood trauma among street youth. Journal of Affective Disorders, 136(3),
377-380. doi:10.1016/j.jad.2011.11.019
Hallfors, D., Brodish, P. H., Khatapoush, S., Sanchez, V., Cho, H., & Steckler, A. (2006).
Feasibility of screening adolescents for suicide risk in “real-world” high school settings.
American Journal of Public Health, 96, 282-287. doi:10.2105/AJPH.2004.057281
Hall-Lande, J., Eisenberg, M. E., Christenson, S. L., & Neumark-Sztainer, D. (2007). Social
isolation, psychological health, and protective factors in adolescence. Adolescence,
42(166), 265-286.
Hargreaves, A., & Fullan, M. (2012). Professional capital: Transforming teaching in every
school. New York, NY: Teachers College Press.
Hatzenbuehler, M. L., Birkett, M., Van Wagenen, A., & Meyer, I. H. (2014). Protective school
climates and reduced risk for suicide ideation in sexual minority youths. American
Journal of Public Health, 104(2), 279-286. doi:10.2105/AJPH.2013.301508
Hauser, M., Galling, B., & Correll, C. U. (2013). Suicidal ideation and suicide attempts in
children and adolescents with bipolar disorder: A systematic review of prevalence and
incident rates, correlates, and targeted interventions. Bipolar Disorders, 15(5), 507-523.
doi:10.1111/bdi.12094
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 202
Haw, C., Hawton, K., Niedzwiedz, C., & Platt, S. (2013). Suicide clusters: A review of risk
factors and mechanisms. Suicide and Life-Threatening Behavior, 43(1), 97-108.
doi:10.1111/j.1943-278X.2012.00130.x
Heard Alliance. (2017). Tools for intervention. Retrieved from http://www.heardalliance.org/tool
kit-intervention-attachments/
Heck, R. H., Larsen, T. J., & Marcoulides, G. A. (1990, May). Instructional leadership and
school achievement validation of a causal model. Educational Administration Quarterly,
26(2), 94-125. https://doi.org/10.1177/0013161X90026002002
Hentschke, G. C., & Wohlstetter, P. (2004). Cracking the code of accountability. (USCUrban ed:
The magazine of the USC Rossier School of Education, Spring/Summer, 17-19.
Heron, M. (2015). Deaths: Leading causes for 2011. National Vital Statistics Reports, 64(7), 1-
96. Hyattsville, MD: National Center for Health Statistics.
Homeland Security Digital Library. (1989). Report of the Secretary's Task Force on Youth
Suicide: Volume 1: Overview and Recommendations. Retrieved from
https://www.hsdl.org/?abstract&did=743317
Hong, J. S., Espelage, D. L., & Kral, M. J. (2011). Understanding suicide among sexual minority
youth in America: An ecological systems analysis. Journal of Adolescence, 34(5), 885-
894. https://doi.org/10.1016/j.adolescence.2011.01.002
Horwitz, S. (2014, Mar 9). The hard lives – and high suicide rate – of Native American children
on reservations. The Washington Post. Retrieved from https://www.washingtonpost.com/
world/national-security/the-hard-lives--and-high-suicide-rate--of-native-american-
children/2014/03/09/6e0ad9b2-9f03-11e3-b8d8-94577ff66b28_story.html?utm_
term=.f11dbddbb134
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 203
Institute of Medicine. (2002). Reducing suicide: A national imperative. Washington, DC: The
National Academies Press. https://doi.org/10.17226/10398
James, S. E., Herman, J. L., Rankin, S., Keisling, M., Mottet, L., & Anafi, M. (2016). The report
of the 2015 U.S. transgender survey. Washington, DC: National Center for Transgender
Equality.
Jiang, C., Mitran, A., Miniño, A., & Ni, H. (2015). Racial and gender disparities in suicide
among young adults aged 18-24: United States, 2009-2013. National Center for Health
Statistics, Center for Disease Control and Prevention. Retrieved
https://www.cdc.gov/nchs/data/hestat/suicide/racial_and_gender_2009_2013.pdf
Joe, S., & Bryant, H. (2007). Evidence-Based suicide prevention screening in schools. Children
& Schools, 29(4), 219-227. https://doi:10.1093/cs/29.4.219
Joe, S., Baser, R. E., Breeden, G., Neighbors, H. W., & Jackson, J. S. (2006). Prevalence of and
risk factors for lifetime suicide attempts among blacks in the United States. JAMA,
296(17), 2112-2123. doi:10.1001/jama.296.17.2112
Johnson, L. A., & Parsons, M. E. (2012). Adolescent suicide prevention in a school setting.
NASN School Nurse, 27(6), 312-317. https://doi.org/10.1177/1942602X12454459
Joiner, T. (2007). Why people die by suicide. Cambridge, MA: Harvard University Press.
Joiner, T., Kalafat, J., Draper, J., Stokes, H., Knudson, M., Berman, A. L., & McKeon, R.
(2007). Establishing standards for the assessment of suicide risk among callers to the
National Suicide Prevention Lifeline. Suicide and Life-Threatening Behavior, 37(3), 353-
365.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 204
Joshi, S. V., Ojakian, M., Lenoir, L., Hartley, S., & Weitz, E. (2015). Comprehensive suicide
prevention toolkit for schools. Retrieved from http://www.heardalliance.org/wp-
content/uploads/2016/03/ComprehensiveSuicidePreventionToolkitforSchools.pdf
Kalafat, J. (2003). School approaches to youth suicide prevention. American Behavioral
Scientist, 46, 1211- 1223. doi:10.1177/0002764202250665
Kalafat, J. (2006). Youth suicide prevention programs. The Prevention Researcher, 13(3), 12-15.
Kaminski, J. W., Puddy, R. W., Hall, D. M., Cashman, S. Y., Crosby, A. E., & Ortega, L. A. G.
(2010). The relative influence of different domains of social connectedness on self
directed violence in adolescence. Journal of Youth and Adolescence, 39(5), 460-473.
doi:10.1007/s10964-009-9472-2
Keller, D. P., Schut, L. J., Puddy, R. W., Williams, L., Stephens, R. L., McKeon, R., & Lubell,
K. (2009). Tennessee lives count: Statewide gatekeeper training for youth suicide
prevention. Professional Psychology: Research and Practice, 40(2), 126-133.
doi:10.1037/a0014889
Kidd, S., Henrich, C. C, Brookmeyer, K. A., Davidson, L., King, R. A., & Shahar, G. (2006).
The social context of adolescent suicide attempts: Interactive effects of parent, peer, and
school social relations. Suicide and Life Threatening Behavior, 36(4), 386-395.
doi:10.1521/suli.2006.36.4.386
King, K. A. (2006). Practical strategies for preventing adolescent suicide. The Prevention
Researcher, 13, 8-11.
King, K. A., & Smith, J. (2000). Project SOAR: A training program to increase school
counselors’ knowledge and confidence regarding suicide prevention and intervention.
Journal of School Health, 70(10), 402-407. doi:10.1111/j.1746- 1561.2000.tb07227.x
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 205
King, K. A., Price, J. H., Telljohann, S. K., & Wahl, J. (1999). High school health teachers'
perceived self-efficacy in identifying students at risk for suicide. Journal of School
Health, 69(5), 202-207.
King, K. A., Strunk, C. M., & Sorter, M. T. (2011). Preliminary effectiveness of surviving the
teens(®) suicide prevention and depression awareness program on adolescents’
suicidality and self-efficacy in performing help-seeking behaviors. Journal of School
Health, 81(9), 581-590. doi:10.1111/j.1746-1561.2011.00630.x
King, R. A., Schwab-Stone, M., Flisher, A. J., Greenwald, S., Kramer, R. A., Goodman, S. H.,
Gould, M. S. (2001). Psychosocial and risk behavior correlates of youth suicide attempts
and suicide ideation. Journal of the American Academy of Child & Adolescent
Psychiatry, 40(7), 837-846. doi:10.1097/00004583-200107000-00019
Kirst, M. W. (2013). The common core meets state policy: This changes almost everything.
Stanford, CA: Policy Analysis for California Education. Retrieved from
https://www.edpolicyinca.org/publications/common-core-meets-state-policy-changes-
almost-everything
Kleiman, E. M., & Liu, R. T. (2013). Social support as a protective factor in suicide: Findings
from two nationally representative samples. Journal of Affective Disorders, 150(2), 540-
545. doi:10.1016/j.jad.2013.01.033
Kleiman, E. M., & Liu, R. T. (2014). Prospective prediction of suicide in a nationally
representative sample: Religious service attendance as a protective factor. The British
Journal of Psychiatry, 204(4), 262-266. doi:10.1192/bjp.bp.113.128900
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 206
Knox, K. L., Conwell, Y., & Caine, E. D. (2004). If suicide is a public health problem, what are
we doing to prevent it? American Journal of Public Health, 94(1), 37-45. doi:10.2105/AJ
PH.94.1.37
Kotter, J. P. (2012). Leading change. Boston, MA: Harvard Business Review Press.
Kposowa, A. J., & McElvain, J. P. (2006). Gender, place, and method of suicide. Social
Psychiatry and Psychiatric Epidemiology, 41(6), 435-443. doi:10.1007/s00127-006-
0054-2
Kral, M. J., Idlout, L., Minore, J. B., Dyck, R. J., & Kirmayer, L. J. (2011). Unikkaartuit:
Meanings of well-being, unhappiness, health, and community change among Inuit in
Nunavut, Canada. American Journal of Community Psychology, 48(3-4), 426-438.
doi:10.1007/s10464-011-9431-4
Kung, H. C, Pearson, J. L., & Liu, X. (2003). Risk factors for male and female decedents ages
15-64 in the United States. Social Psychiatry, 38, 419-426.
Lake, A. M., & Gould, M. S. (2014). Suicide clusters and suicide contagion. In S. Koslow,
P. Ruiz, & C. Nemeroff (Eds.) A concise guide to understanding suicide: epidemiology,
pathophysiology and prevention (pp. 52-61). Cambridge University Press, Cambridge.
Lang, W. A., Ramsay, R. F., Tanney, B. L., & Kinzel, T. (2007). ASIST Trainer Manual.
Calgary, AB: LivingWorks Education.
Langer, J. (2001). Beating the odds: Teaching middle and high school students to read and write
well. Retrieved from https://journals.sagepub.com/doi/10.3102/00028312038004837
https://doi.org/10.3102/00028312038004837
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 207
Langhinrichsen-Rohling, J., Friend, J., & Powell, A. (2009). Adolescent suicide, gender, and
culture: A rate and risk factor analysis. Aggression and Violent Behavior, 14(5), 402-414.
doi:10.1016/j.avb.2009.06.010
Leong, F. T. L., & M. M. Leach. (2007). Ethnicity and suicide in the United States: Guest
editors' introduction. In F. T. L. Leon & M. M. Leach, Ethnicity and suicide in the United
States, Death Studies, 31(5), 393-398. https://doi.org/10.1080/07481180701244520
Lieb, R., Bronisch, T., Höfler, M., Schreier, A., & Wittchen, H. U. (2005). Maternal suicidality
and risk of suicidality in offspring: Findings from a community study. The American
Journal of Psychiatry, 162(9), 1665-1671.
Lieberman, R., Poland, S., & Cassel, R. (2008). Best practices in suicide intervention. In
A. Thomas & J. Grimes (Eds.), Best practices in school psychology V (pp. 1457-1472).
Bethesda, MD: National Association of School Psychologists.
Lieberman, R., Poland, S., & Kornfeld, C. (2014). Best practices in suicide prevention and
intervention. In P. Harrison & A. Thomas (Eds.), Best practices in school psychology:
Systems-level services (pp. 273-288). Bethesda, MD: The National Association of School
Psychologists.
Liebling-Boccio, D., & Jennings, H. R. (2012). The current status of graduate training in suicide
risk assessment. Psychology in the Schools, 50(1), 72-86. https://doi.org/10.1002/pits.
21661 ?
Liu, R. T., Case, B. G., & Spirito, A. (2014, Sept.). Injection drug use is associated with suicide
attempts but not ideation or plans in a sample of adolescents with depressive
symptoms. Journal of Psychiatric Research, 56, 65-71. doi: 10.1016/j.jpsychires.2014.
05.001
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 208
Maguen, S., & Shipherd, J. C. (2010). Suicide risk among transgender individuals, Psychology &
Sexuality, 1(1), 34-43. doi:10.1080/19419891003634430
Mann, J. J., Apter, A., Bertolote, J., Beautrais, A., Currier, D., Haas, A., . . . Hendin, H. (2005).
Suicide prevention strategies: A systematic review. JAMA, 294(16), 2064-2074.
doi:10.1001/jama.294.16.2064
Mann, J. J., Brent, D. A., & Arango, V. (2001). The neurobiology and genetics of suicide and
attempted suicide: A focus on the serotonergic system. Neuropsychopharmacology,
24(5), 467-477. doi:10.1016/S0893-133X(00)00228-1
Maples, M. F., Packman, J., Abney, P., Daugherty, R. F., Casey, J. A., & Pirtle, L. (2005).
Suicide by teenagers in middle school: A postvention team approach. Journal of
Counseling & Development, 83, 397-405.
Maris, R. W., Berman, A. L., & Silverman, M. M. (2000). Comprehensive textbook of
suicidology. New York, NY: Guilford Press.
Marshal, M. P., Dermody, S. S., Shultz, M. L., Sucato, G. S., Stepp, S. D., Chung, T., Burton, C.
M., Markovic, N., & Hipwell, A. E. (2013). Mental health and substance use disparities
among urban adolescent lesbian and bisexual girls. Journal of the American Psychiatric
Nurses Association, 19(5), 271-9. doi:10.1177/1078390313503552
Marzano, R. J. (2003). What works in schools: Translating research into action. Alexandria,
VA: ASCD.
Mathew, A., & Nanoo, S. (2013). Psychosocial stressors and patterns of coping in adolescent
suicide attempters. Indian Journal of Psychological Medicine, 35(1), 39-46.
doi:10.4103/0253-7176.112200
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 209
Mathias, C. W., Furr, M., Sheftall, A. H., Hill-Kapturczak, N., Crum, P., & Dougherty, D. M.
(2012). What’s the harm in asking about suicidal ideation?. Suicide and Life-Threatening
Behavior, 42(3), 341-351. doi:10.1111/j.1943-278X.2012.00095.x
Matthieu, M. M., Cross, W., Batres, A. R., Flora, C. M., & Knox, K. L. (2008). Evaluation of
gatekeeper training for suicide prevention in veterans. Archives of Suicide
Research, 12(2), 148-154.
Mayes, S. D., Calhoun, S. L., Baweja, R., Feldman, L., Syed, E., Gorman, G. A.,…Siddigui, F.
(2015). Suicide ideation and attempts are associated with cooccurring oppositional
defiant disorder and sadness in children and adolescents with ADHD. Journal of
Psychopathology and Behavioral Assessment, 37(2), 274-282.
http://dx.doi.org/10.1007/s10862-014-9451-0
Mayo Clinic. (2018a). Self-injury/cutting. Retrieved from https://www.mayoclinic.org/diseases-
conditions/self-injury/symptoms-causes/syc-20350950
Mayo Clinic. (2018b). Suicide and suicidal thoughts. Retrieved from https://www.mayoclinic
.org/diseases-conditions/suicide/symptoms-causes/syc-20378048
Mazza, J. J. (2006). Youth suicidal behavior: A crisis in need of attention. In F. A. Villarruel &
T. Luster (Eds.), Child psychology and mental health. The crisis in youth mental health:
Critical issues and effective programs, (Vol. 2). Disorders in adolescence (pp. 155-177).
Westport, CT: Praeger Publishers/Greenwood Publishing Group.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 210
Mazza, J. J., & Reynolds, W. M. (2008). School-wide approaches to prevention of and
intervention for depression and suicidal behaviors. In B. Doll & J. Cummings (Eds.),
Transforming school mental health services: Population-based approaches to promoting
the competency and wellness of children (pp. 213-241). Thousand Oaks, CA: Corwin
Press and the National Association of School Psychologists.
McGowan, P., & Miller, J. (2001). Management vs. leadership. School Administrator, 58(10),
32-34.
McManama O’Brien, K. M., & Berzin, S. C. (2012). Examining the impact of psychiatric
diagnosis and comorbidity on the medical lethality of adolescent suicide attempts. Suicide
and Life-Threatening Behavior, 42, 437-444. doi:10.1111/j.1943-278X.2012.00102.x
Mental Health America. (2016, August 17). Self-injury (Cutting, Self-Harm or Self-Mutilation).
Retrieved from http://www.mentalhealthamerica.net/self-injury
Merriam, S. B., & Tisdell, E. J. (2016). Qualitative research: A guide to design and
implementation (4th ed.). San Francisco, CA: Jossey-Bass.
Metha, A., Weber, B., & Webb, L. D. (1998). Youth suicide prevention: A survey and analysis
of policies and efforts in the 50 states. Suicide & Life-Threatening Behavior, 28(2), 150-
164.
Middlebrook, D. L., LeMaster, P. L., Beals, J., Novins, D. K., & Manson, S. M. (2001). Suicide
prevention in American Indian and Alaska Native communities: A critical review of
programs. Suicide and Life-Threatening Behavior, Spring 31(Supplement to Issue 1),
132-149.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 211
Miller, A. B., Eisenlohr-Moul, T., Giletta, M., Hastings, P. D., Rudolph, K. D., Nock, M. K., &
Prinstein, M. J. (2017). A within-person approach to risk for suicidal ideation and
suicidal behavior: Examining the roles of depression, stress, and abuse exposure. Journal
of Consulting and Clinical Psychology, 85(7), 712-722. doi: 10.1037/ccp0000210
Miller, D. N. (2013). Assessing risk for suicide. In S. H. McConaughy (Ed.). Clinical interviews
for children and adolescents: Assessment to intervention (2nd ed.) (pp. 208-227). New
York, NY: Guilford Press.
Miller, D. N., & Eckert, T. L. (2009). Youth suicidal behavior: An introduction and overview.
School Psychology Review, 38(2), 153-167.
Miller, D. N., & McConaughy, S. H. (2005). Assessing risk for suicide. In S. H. McConaughy
(Ed.), Clinical interviews for children and adolescents: Assessment to intervention (2nd
ed.) (pp. 184-199). New York, NY: Guilford Press.
Miller, D. N., Eckert, T. L., & Mazza, J. J. (2009). Suicide prevention programs in the schools: A
review and public health perspective. School Psychology Review, 38(2), 168-188.
Miller, M., Lippmann, S. J., Azrael, D., & Hemenway, D. (2007). Household firearm ownership
and rates of suicide across the 50 United States. Journal of Trauma and Acute Care
Surgery, 62(4), 1029-1035.
Miranda, R., Ortin, A., Scott, M., & Shaffer, D. (2014). Characteristics of suicidal ideation that
predict the transition to future suicide attempts in adolescents. Journal of Child
Psychology and Psychiatry, 55(11), 1288-1296. doi:10.1111/jcpp.12245
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 212
Miranda, R., Scott, M., Hicks, R., Wilcox, H. C., Munfakh, J., & Shaffer, D. (2008). Suicide
attempt characteristics, diagnoses, and future attempts: Comparing multiple attempters to
single attempters and ideators. Journal of the American Academy of Child & Adolescent
Psychiatry, 47(1), 32-40. doi:10.1097/chi.0b013e31815a56cb
Moffitt, T. E., Arseneault, L., Belsky, D., Dickson, N., Hancox, R. J., Harrington, H., ... & Caspi,
A. (2011). A gradient of childhood self-control predicts health, wealth, and public
safety. Proceedings of the National Academy of Sciences, 108(7), 2693-2698.
doi:10.1073/pnas.1010076108
Mustanski, B., & Liu, R. T. (2013). A longitudinal study of predictors of suicide attempts among
lesbian, gay, bisexual, and transgender youth. Archives of Sexual Behavior, 42(3), 437-
438. doi:10.1007/s10508-012-0013-9
Nadeem, E., Kataoka, S. H., Chang, V. Y., Vona, P., Wong, M., & Stein, B. D. (2011). The role
of teachers in school-based suicide prevention: A qualitative study of school staff
perspectives. School Mental Health, 3(4), 209-221. doi:10.1007/s12310-011-9056-7
Nanayakkara, S., Misch, D., Chang, L., & Henry, D. (2013). Depression and exposure to suicide
predict suicide attempt. Depression and Anxiety, 30(10), 991-996. doi:10.1002/da.22143
National Alliance on Mental Illness. (2018). ADHD. Retrieved from https://www.nami.org/
Learn-More/Mental-Health-Conditions/ADHD
National Association of School Psychologists. (2017). School Safety & Crisis. Retrieved from
https://www.nasponline.org/resources-and-publications/resources/school-safety-and-
crisis
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 213
National School Climate Council. (2007). National school climate standards: Benchmarks to
promote effective teaching, learning and comprehensive school improvement. New York,
NY: Author. Retrieved from https://www.schoolclimate.org/themes/schoolclimate/
assets/pdf/policy/school-climate-standards.pdf
Nealy-Oparah, S., & Scruggs-Hussein, T. (2018). Trauma-informed leadership in schools: From
the inside-out. Leadership. Jan/Feb 2018 47(3). 12-16. Retrieved from
http://ticiess.com/wp-content/uploads/2018/12/ARTICLE-TI-Schools-by-SNO-TCS-Jan-
2018.pdf
Nickerson, A. B., & Zhe, E. J. (2004). Crisis prevention and intervention: A survey of school
psychologists. Psychology in the Schools, 41(7), 777-788. doi:10.1002/pits.20017
No Child Left Behind Act of 2001 (NCLB). (2002). Public Law 107-110, § 115, Stat. 1425.
Retrieved from http://www2.ed.gov/policy/elsec/leg/esea02/107-110.pdf
Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., &
Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior
among adolescents. JAMA Psychiatry, 70(3), 300-310. doi:10.1001/2013.jamapsy
chiatry.55
Northouse, P. G. (2018). Leadership: Theory and practice. Sage Publications.
O'Donnell, L., O'Donnell, C, Wardlaw, D. M., & Stueve, A. (2004). Risk and resiliency factors
influencing suicidality among urban African American and Latino youth. American
Journal of Community Psychology, 33(1-2), 31-41. doi:10.1023/B:AJCP.0000014317.
20704.0b
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 214
O'Donnell, L., Stueve, A., Wardlow, D., & O'Donnell, C. (2003). Adolescent suicidality and
adult support: The reach for health study of urban youth. American Journal of Health
Behavior, 27(6), 633-644. doi:https://doi.org/10.5993/AJHB.27.6.6
Patterson, J. (2001). Resilience in the face of adversity. School Administrator, 58(6), 18-21.
Peña, J. B., & Caine, E. D. (2006). Screening as an approach for adolescent suicide prevention.
Suicide and Life-Threatening Behavior, 36(6), 614-637. doi:10.1521/suli.2006.36.6.614
Pfeffer, C. R. (2001). Diagnosis of childhood and adolescent suicidal behavior: Unmet needs for
suicide prevention. Biological Psychiatry, 49(12), 1055-1061. http://dx.doi.org/10.1016/S
0006-3223(01)01141-6
Phillips, D. P., & Carstensen, L. L. (1986). Clustering of teenage suicides after television news
stories about suicide. The New England Journal of Medicine, 315, 685-698. doi:10.1056/
NEJM198609113151106
Popenhagen, M. P., & Qualley, R.M. (1998). Adolescent suicide: Detection, intervention, and
prevention. Professional School Counseling, 1(4), 30-35.
Powell, J., Geddes, J., Hawton, K., Deeks, J., & Goldacre, M. (2000). Suicide in psychiatric
hospital in-patients. The British Journal of Psychiatry, 176(3), 266-272.
doi:10.1192/bjp.176.3.266
President of the United States of America. (1985, May 29). Proclamation 5348 of May 29, 1985.
Very Special Arts U.S.A. Mont, 1985; and Proclamation 5349 (1985, June 4) Youth
Suicide Prevention Month, 99 Stat. 2060. Retrieved from https://www.govinfo.gov/con
tent/pkg/STATUTE-99/pdf/STATUTE-99-Pg2060.pdf
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 215
Qin, P., Mortensen, P. B., & Pedersen, C. B. (2009). Frequent change of residence and risk of
attempted and completed suicide among children and adolescents. Archives of General
Psychiatry, 66(6), 628-632. doi:10.1001/archgenpsychiatry.2009.20
Quinnett, P. (2012). QPR gatekeeper training for suicide prevention: The model, theory and
research. QPR Institute. Retrieved from http://www.qprinstitute.com/uploads/QPR%20
Theory%20Paper.pdf
Ramchand, R., & Becker, A. (2014, July 14). PDFSuicide Rates in California: Trends and
implications for prevention and early intervention programs. Retrieved from
https://www.rand.org/pubs/research_briefs/RB9737.html
Randell, B. P., Eggert, L. L., & Pike, K. C. (2001). Immediate post intervention effects of two
brief youth suicide prevention interventions. Suicide and Life-Threatening Behavior,
31(1), 41-61. doi:10.1521/suli.31.1.41.21308
Randell, B. P., Wang, W.-L., Herting, J. R., & Eggert, L. L. (2006). Family factors predicting
categories of suicide risk. Journal of Child and Family Studies, 15(3), 255-270.
doi:10.1007/s10826-006-9020-6
Research Randomizer. (n.d.). Generate numbers. Retrieved from https://www.randomizer.org/
Reeves, M. A., Nickerson, A. B., & Brock, S. E. (2011). Preventing and intervening in crisis
situations. In T. M. Lionetti, E. P. Snyder, & R. W. Christner (Eds.), A practical guide to
building professional competencies in school psychology (pp. 193-207). New York, NY:
Springer.
Remafedi, G., French, S., Story, M., Resnick, M., & Blum, R. (1998). The relationship between
suicide risk and sexual orientation: Results of a population-based study. American
Journal of Public Health, 88(1), 57-60. doi:10.2105/AJPH.88.1.57
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 216
Riehl, C. J. (2000). The principal’s role in creating inclusive schools for diverse students: A
review of normative, empirical, and critical literature on the practice of educational
administration. Review of Educational Research, 70(1), 55-81. https://doi.org/10.3102/
00346543070001055
Robinson, J., Cox, G., Malone, A., Williamson, M., Baldwin, G., Fletcher, K., & O’Brien, M.
(2013). A systematic review of school-based interventions aimed at preventing, treating,
and responding to suicide-related behavior in young people. Crisis, 34(3), 164-182.
doi:10.1027/0227-5910/a000168
Rothi, D. M., Leavey, G., & Best, R. (2008). On the front-line: Teachers as active observers of
pupils’ mental health. Teaching and Teacher Education, 24(5), 1217-1231.
Roy, A., & Janal, M. (2005). Family history of suicide, female sex, and childhood trauma:
separate or interacting risk factors for attempts at suicide? https://doi.org/10.1111/j. 1600-
0447.2005.00647.x
Runeson, B., & Åsberg, M. (2003). Family history of suicide among suicide victims. American
Journal of Psychiatry, 160(8), 1525-1526. http://dx.doi.org/10.1176/appi.ajp.160.8.1525
Russell, S. T. (2003). Sexual minority youth and suicide risk. American Behavioral Scientist,
46(9), 1241-1257. doi:10.1177/0002764202250667
Russell, S. T., & Joyner, K. (2001). Adolescent sexual orientation and suicide risk: evidence
from a national study. American Journal of Public Health, 91(8), 1276-1281. Retrieved
from https://www.ncbi.nlm.nih.gov/pubmed/11499118
Sanchez, L. E., & Le, L. T. (2001). Suicide in mood disorders. Depression and Anxiety, 14(3),
177-182. doi:10.1002/da.1063
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 217
Sandoval, J., & Zadeh, S. (2008). Principles for intervening with suicide. School Psychology
Forum: Research in Practice, 2(2), 49-66.
Schilling, E. A., Lawless, M., Buchanan, L., & Aseltine Jr., R. H. (2014). “Signs of Suicide”
shows promise as a middle school suicide prevention program. Suicide and Life-
Threatening Behavior, 44(6), 653-667. doi:10.1111/sltb.12097
Schmidt, R. C., Iachini, A. L., George, M., Koller, J., & Weist, M. (2014). Integrating a suicide
prevention program into a school mental health system: A case example from a rural
school district. Children & Schools, 37(1), 18-26. doi:10.1093/cs/cdu026
Scott, M. A., Wilcox, H. C., Schonfeld, I. S., Davies, M., Hicks, R. C., Turner, J. B., & Shaffer,
D. (2009). School-based screening to identify at-risk students not already known to
school professionals: The Columbia suicide screen. American Journal of Public Health,
99(2), 334-339. doi:10.2105/AJPH.2007.127928
Séguin, M., Renaud, J., Lesage, A., Robert, M., & Turecki, G. (2011). Youth and young adult
suicide: A study of life trajectory. Journal of Psychiatric Research, 45(7), 863-870.
doi:10.1016/j.jpsychires.2011.05.005
Senate Bill No. 405. (1999). An Act to add and repeal Division 109 (commencing with Section
1302000) of the Health and Safety Code, relating to mental health, and making an
appropriation therefor. Retrieved from http://www.leginfo.ca.gov/pub/99-
00/bill/sen/sb_0401-0450/sb_405_bill_19990407_amended_sen.html
Senate Bill No. 620. (2001). An act to add Sections 4028 and 4029 to the Welfare and
Institutions Code, relating to mental health, and making an appropriation therefore.
Retrieved from http://www.leginfo.ca.gov/pub/01-02/bill/sen/sb_0601-0650/sb_620_bill
_20010222_introduced.pdf
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 218
Senate Bill No. 1356. (2006). An act to amend Section 4098 of, and to add Section 1098.6 to,
the Welfare and Institutions Code, relating to suicide prevention. Retrieved from
http://www.leginfo.ca.gov/pub/05-06/bill/sen/sb_1351-1400/sb_1356_bill_20060
627_amended_asm.pdf
Sergiovanni, T. J. (2009). The principalship: A reflective practice perspective (6th ed.). Boston,
MA: Pearson Education.
Sharaf, A., Thompson, E. A., & Walsh, E. (2009, August). Protective effects of self-esteem and
family support on suicide risk behaviors among at-risk adolescents. Journal of Child and
Adolescent Psychiatric Nursing, 22(3), 160-168. doi:10.1111/j.1744-6171.2009.00194.x
Shneidman, E. S. (2004). Autopsy of a suicidal mind. New York, NY: Oxford University Press.
Silenzio, V. M. B., Pena, J. B., Duberstein, P. R., Cerel, J. & Knox, K. L. (2007). Sexual
orientation and risk factors for suicidal ideation and suicide attempts among adolescents
and young adults. American Journal of Public Health, 97(11), 2017-2019.
Silverman, M. M., Berman, A. L., Sanddal, N. D., O’Carroll, P. W., & Joiner, T. E. (2007).
Rebuilding the tower of babel: A revised nomenclature for the study of suicide and
suicidal behaviors part 1: Background, rationale, and methodology. Suicide and Life
Threatening Behavior, 37(3), 248-263. doi:10.1521/suli.2007.37.3.248
Simon, T. R., Swann, A. C., Powell, K. E., Potter, L. B., Kresnow, M. J., & O'Carroll, P. W.
(2001). Characteristics of impulsive suicide attempts and attempters. Suicide and Life-
Threatening Behavior, 32(1 Syppl), 49-59.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 219
Sourander, A., Aromaa, M., Pihlakoski, L., Haavisto, A., Rautava, P., Helenius, H. & Sillanpää,
M. (2006). Early predictors of deliberate self-harm among adolescents: A prospective
follow-up study from age 3 to age 15. Journal of Affective Disorders, 93, 87-96.
doi:10.1016/j.jad.2006.02.015
Speaker, K. M., & Petersen, G. J. (2000). School violence and adolescent suicide: Strategies for
effective intervention. Educational Review, 52(1), 65-73. doi:10.1080/00131910097423
Spencer-Thomas, S. & Jahn, D. R. (2012). Tracking a movement: US milestones in suicide
prevention. Suicide and Life-Threatening Behavior. 42(1), 78-85. 10.1111/j.1943-
278X.2011.00072.x
Spicer, R. S., & Miller, T. R. (2000). Suicide acts in 8 states: incidence and case fatality rates by
demographics and method. American Journal of Public Health, 90(12), 1885-1891.
Spirito, A., Valeri, S., Boergers, J., & Donaldson, D. (2003). Predictors of continued suicidal
behavior in adolescents following a suicide attempt. Journal of Clinical Child and
Adolescent Psychology, 32(2), 283-289. doi:10.1207/S15374424JCCP3202_14
Stecher, B., & Kirby, S. N. (2004). Chapter One: Introduction. In B. Stecher & S. N. Kirby
(Eds.), Organizational improvement and accountability: Lessons for education from
other sectors (pp. 1-7). Santa Monica, CA: Rand Corporation. Retrieved from
https://www.rand.org/pubs/monographs/MG136.html
Stein, B. D., Kataoka, S. H., Hamilton, A. B., Schultz, D., Ryan, G., Vona, P., & Wong, M.
(2010). School personnel perspectives on their school’s implementation of a school-based
suicide prevention program. The Journal of Behavioral Health Services & Research,
37(3), 338-349. http://dx.doi.org/10.1007/s11414-009-9174-2
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 220
Stephan, S. H., Weist, M., Kataoka, S., Adelsheim, S., & Mills, C. (2007). Transformation of
children’s mental health services: The role of school mental health. Psychiatric Services,
58(10), 1330-1338. http://dx.doi.org/10.1176/appi.ps.58.10.1330
Stone, D. M., & Crosby, A. E. (2014). Suicide prevention. American Journal of Lifestyle
Medicine, 8(8), 404-420. doi:10.1177/1559827614551130
Stone, D. M., Luo, F., Ouyang, L., Lippy, C., Hertz, M. F., & Crosby, A. E. (2014). Sexual
orientation and suicide ideation, plans, attempts, and medically serious attempts:
Evidence from local Youth Risk Behavior Surveys, 2001-2009. American Journal of
Public Health, 104(2), 262-271. doi:10.2105/AJPH.2013
Strunk, C. M., Sorter, M. T., Ossege, J., & King, K. A. (2014). Emotionally troubled teens’ help-
seeking behaviors: An evaluation of Surviving the Teens® suicide prevention and
depression awareness program. The Journal of School Nursing, 30(5), 366-375.
doi:10.1177/1059840513511494
Suldo, S., Loker, T., Friedrich, A., Sundman, A., Cunningham, J., & Saari, B. (2010). Improving
school psychologists’ knowledge and confidence pertinent to suicide prevention through
professional development. Journal of Applied School Psychology, 26(3), 177-197.
doi:10.1080/15377903.2010.495919
Szumilas, M., & Kutcher, S. (2011). Post-suicide intervention programs: A systematic review.
Canadian Journal of Public Health / Revue Canadienne De Sante'e Publique, 102(1), 18-
29.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 221
Taie, S., & Goldring, R. (2017). Characteristics of public elementary and secondary school
principals in the United States: Results from the 2015-16 national teacher and principal
survey: first look (NCES 2017-070). Washington, DC: U.S. Department of Education.
National Center for Education Statistics. Retrieved from https://nces.ed.gov/pubs2017/
2017070.pdf
Taliaferro, L. A., & Muehlenkamp, J. J. (2014). Risk and protective factors that distinguish
adolescents who attempt suicide from those who only consider suicide in the past
year. Suicide and Life ‐Threatening Behavior, 44(1), 6-22. doi:10.1111/sltb.12046
The Boomerang Project. (n.d.) What is WEB? Retrieved from http://www.boomerang
project.com/web/what-web
The Jason Flatt Act. (2019). The Jason Flatt Act started s an idea that was presented by ayoung
legislator in New Jersey in 2001. Retrieved from http://jasonfoundation.com/about-
us/jason-flatt-act/
The Jason Foundation. (2019). Risk factors. Retrieved from http://jasonfoundation.com/youth-
suicide/risk-factors/
The President’s New Freedom. (2003). Achieving the Promise: Transforming mental health car
in America. Final Report. Washington, DC: President's New Freedom Commission on
Mental Health.
Thompson, E. A., Eggert, L. L., Randell, B. P., & Pike, K. C. (2001). Evaluation of indicated
suicide risk prevention approaches for potential high school dropouts. American Journal
of Public Health, 91(5), 742.
Tingstrom, D. H., Sterling-Turner, H. E., & Wilczynski, S. M. (2006). The good behavior game:
1969-2002. Behavior Modification, 30(2), 225-253.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 222
Trauma-Sensitive Schools. (n.d.). Four Perspectives. Retrieved from https://traumasensitive
schools.org/
Trevor Project. (2018). Report on student suicide prevention policies in California. Retrieved
from https://www.thetrevorproject.org/wp-content/uploads/2018/10/California-Student-
Suicide-Prevention-Policy-Report.pdf
Trevor Project. (2019). Preventing Suicide: Facts about suicide. Retrieved from
https://www.thetrevorproject.org/resources/preventing-suicide/facts-about-
suicide/#sm.000003myrh3eczf1p10ey6zblg63m
Turecki, G. (2005). Dissecting the suicide phenotype: The role of impulsive-aggressive
behaviours. Journal of Psychiatry & Neuroscience, 30(6), 398-408.
U. S. Department of Health and Human Services. (1999). The surgeon general’s call to action to
prevent suicide. Retrieved from http://www.sprc.org/sites/sprc.org/files/library/
surgeoncall.pdf
U. S. Department of Health and Human Services. (2012). National strategy for suicide
prevention: Goals and objectives for action. Washington, DC: HHS, Office of the
Surgeon General, and National Action Alliance for Suicide Prevention.
United States Census Bureau. (2017). Quick facts California. Retrieved from
https://www.census.gov/quickfacts/ca
Van Orden, K. A., Witte, T. K., Gordon, K. H., Bender, T. W., & Joiner, T. E. (2008). Suicidal
desire and the capability for suicide: Tests of the interpersonal psychological theory of
suicidal behavior among adults. Journal of Consulting and Clinical Psychology, 76(1),
72-83.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 223
Wachtel, T. (2013). Defining restorative. Retrieved from https://www.iirp.edu/pdf/Defining-
Restorative.pdf
Wagner, M. M., Silverman, M. A. C., & Martin, C. E. (2003). Family factors in youth suicidal
behaviors. American Behavioral Scientist, 46(9), 1171-1191. doi:10.1177/000276420
2250661
Waldrop, A. E., Hanson, R. F., Resnick, H. S., & Kilpatrick, D. G. (2007). Risk factors for
suicidal behavior among a national sample of adolescents: Implications for prevention.
Journal of Traumatic Stress, 20(5), 869-879.
Walsh, E., & Eggert, L. L. (2007). Suicide risk and protective factors among youth experiencing
school difficulties. International Journal of Mental Health Nursing, 16(5), 349-359.
Waters, T., Marzano, R. J., & McNulty, B. (2003). Balanced Leadership: What 30 Years of
Research Tells Us about the Effect of Leadership on Student Achievement. A Working
Paper. Retrieved from http://www.peecworks.org/peec/peec_research/I01795EFA.
0/Marzano
Weller, E. B., Young, K. B., Rohrbaugh, A. H., & Weller, R. A. (2001). Overview and
assessment of the suicidal child. Depression and Anxiety, 14(3), 157 -163.
doi:10.1002/da.l061
Wheatley, M. J. (2017). Who do we choose to be?: Facing reality claiming leadership restoring
sanity. Oakland, CA: Berrett-Koehler Publishers.
Whitney, S. D., Renner, L. M., Pate, C. M., & Jacobs, K. A. (2011). Principals’ perceptions of
benefits and barriers to school-based suicide prevention programs. Children and Youth
Services Review, 33(6), 869-877. doi:10.1016/j.childyouth.2010.12.015
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 224
Whittle, S., Turner, L., & Al-Alami, M. (2007). The Equalities Review. Engendered penalties:
Transgender and transsexual people’s experiences of inequality and discrimination.
Retrieved from https://www.ilga-europe.org/sites/default/ files/trans_country_report_-
_engenderedpenalties.pdf
Whittle, S., Turner, L., & & Rhodes, S. (2008). Transgender EuroStudy: Legal Survey and
Focus on the Transgender Experience of Health Care. Brussels: ILGA Europe.
World Health Organization. (2018). Suicide: Key facts. Retrieved from http://www.who.int/
mediacentre/factsheets/fs398/en/
Wyman, P. A., Brown, C. H., Inman, J., Cross, W., Schmeelk-Cone, K., Guo, J, & Pena, J.
(2008). Randomized trial of a gatekeeper program for suicide prevention: 1- year impact
on secondary school staff. Journal of Consulting and Clinical Psychology, 76(1), 104-
115. doi:10.1037/0022-006X76.1.104
Xavier, J. M., Bobbin, M., Singer, B., & Budd, E. (2005). A needs assessment of transgendered
people of color living in Washington, DC. International Journal of Transgenderism, 8(2-
3), 31-47.
Xavier, J., Honnold, J. A., & Bradford, J. B. (2007). The health, health-related needs and life
course experiences of transgender virginians. Virginia Department of Health. Retrieved
from http://www.vdh.virginia.gov/content/uploads/sites/10/2016/01/THISFINAL
REPORT Vol 1.pdf
Zenere, F. J. (2009). Suicide clusters and contagion. Principal Leadership, 10(2), 12-16.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 225
Appendix A: Information Sheet for Research
University of Southern California
Rossier School of Education
Waite Phillips Hall
3470 Trousdale Parkway
Los Angeles, CA 90089
A mixed-methods study of middle school principal implementation of California Education
Code 215: Pupil Suicide Prevention Policies in Southern California public schools.
You are invited to participate in a research study conducted by Benjamin Acker at the University
of Southern California. Please read through this form and ask any questions you might have
before deciding whether or not you want to participate.
PURPOSE OF THE STUDY
This research study aims to understand the means by which middle school principals are leading
the implementation of pupil suicide prevention policy, how they develop teacher leadership,
efficacy, and motivation to embrace youth suicide prevention initiatives, and the measures of
accountability and evaluation being utilized to assess the effectiveness of suicide prevention
programs.
PARTICIPANT INVOLVEMENT
You have been selected at random from the California Department of Education Public Schools
and Districts Data Files. If you agree to take part in this study, you will be asked to complete an
anonymous online survey that should take no longer than 10 minutes to complete. At the end of
the survey, there is a question to indicate if you are willing to participate in a 30 minute
interview. You are not required to answer any questions you do not wish to answer.
CONFIDENTIALITY
There will be no individually identifiable information obtained in connection with this
study. Your name, address, school, district, or other identifiable information will not be
collected. Survey responses and any written or audio recordings of interviews will be destroyed
at the conclusion of the research project. When the results of the research are published or
discussed in conferences, no identifiable information will be used.
RISK/BENEFITS
You have the right to be informed of all potential risks associated with your participation in this
research. The questions in this research pose minimal risk or harm to you as a participant.
Benefits of participation in the research include contributing to the progress of youth suicide
prevention research.
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 226
INVESTIGATOR CONTACT INFORMATION
If you have any questions or concerns about the research, please contact Benjamin Acker at
benjamra@usc.edu.
IRB CONTACT INFORMATION
If you have questions, concerns, or complaints about your rights as a research participant or the
research in general and are unable to contact the researcher, or if you want to speak with
someone independent of the research team, please contact the University Park Institutional
Review Board (UPIRB), 3720 South Flower Street #301, Los Angeles, CA 90089-0702, (213)
821-5272 or upirb@usc.edu.
If you have read and understand the research study procedure described above and you agree to
participate in the study, please click the link in the email included with this Information Sheet for
Research. You may also access the online survey at this link:
https://goo.gl/forms/NSsu0elOFOXo203F2
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 227
Appendix B: Middle School Principal Survey
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 228
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 229
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 230
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 231
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 232
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 233
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 234
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 235
Appendix C: Interview Questions for Individuals
Associated with the Legislative Process
1. Would you begin by describing your role in the legislative history of Assembly Bill 2246
which became Education Code 215?
2. What prompted you to lend your support to AB 2246?
3. Can you describe any of the significant legislative history pieces that contributed to AB
2246 ultimately becoming law?
4. Can you speak to the strategy of the bill being targeted towards secondary students?
5. Why does the bill’s language specifically target high-risk groups, such as foster students,
homeless students, and students who identify as LGBTQ?
6. What do you believe makes a piece of legislation like this important?
7. How do you see the roles of schools changing with respect to the balance between
academics and the social-emotional needs of children in California?
8. Through communication with constituents and your own knowledge, what have you
learned is contributing to student anxiety, stress, or suicidal ideation?
9. What process is used to evaluate the implementation of EC 215?
10. What next steps do you suggest for middle school leadership and school communities
with respect to the implementation of suicide prevention policies?
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 236
Appendix D: Middle School Principal Interview Questions
1. How would you describe your school’s approach to youth suicide prevention?
(Subject to follow-up, clarification of terms)
2. What is your current understanding of what is required by AB2246/EC 215?
3. What benefits have you noted from the school’s implementation of AB 2246?
4. What challenges have you faced as a school community this year during implementation?
5. As principal, what have been the key components to supporting teachers in the process of
implementing suicide prevention policies?
6. Suppose a student in crisis approached one of your teachers a few years ago before AB
2246/EC 215 was initiated, and then suppose that child in crisis walked into that teacher’s
classroom today. What changes or differences might we notice that would best
demonstrate the shifts brought by AB 2246?
7. In the survey, you responded YES to one or both questions regarding students
who have experienced suicidal ideation and suicide attempt. If you’re
comfortable doing so, can you share what happened? How did your staff
respond?
8. How have you been able to determine that teachers believe suicide prevention is a serious
and worthy issue at your middle school?
9. As principal, what is your school’s vision for success?
a. (Possible follow-up) How does your vision for education align with your school’s
current implementation of AB 2246?
b. (Follow-up) What steps have you taken to ensure alignment between the
school’s vision, the district vision, and AB 2246?
PRINCIPAL IMPLEMENTATION OF SUICIDE PREVENTION 237
10. How has your role as principal changed during your school’s implementation of suicide
prevention practices?
11. What feedback have you received from students regarding the implementation of suicide
prevention practices?
12. What feedback have you received from parents about the school’s work implementing
suicide prevention practices?
13. How are you assessing the effectiveness of suicide prevention practices?
a. (Follow-up) What signs will you look for to determine success?
14. What are the next steps for your school with suicide prevention practices?
15. What qualities or characteristics does a principal need to successfully lead a school
community through this process of implementing suicide prevention practices?
Abstract (if available)
Abstract
The purpose of this study was to examine how suicide prevention practices mandated by Education Code 215: Pupil and Student Suicide Prevention Policy are being implemented by principals at public middle schools in southern California. The study also aimed to determine the means by which principals are developing teacher leadership, efficacy, and motivation to embrace suicide prevention initiatives, as well as the measures of accountability and evaluation being utilized by middle school administrators to ascertain the effectiveness of current suicide prevention practices. A mixed-methods study was conducted with 51 principals currently serving at public middle schools in six southern California counties, who completed a survey regarding practices, preparation, and knowledge of youth suicide. Ten middle school principals and two individuals closely associated with the legislative development of EC 215 were interviewed as well. The study’s findings highlighted the vital role of middle school principal leadership with suicide prevention policies and practices, which includes both instructional leadership and social-emotional support for students, staff, and community members. The study revealed the prevalent and pervasive nature of myriad stressors that contribute to anxiety and suicidal ideation among middle school adolescents. Findings indicated that effective suicide prevention implementation is linked to addressing both the academic and social-emotional needs of middle school students, establishing and maintaining open channels of communication with multiple stakeholders, supporting various programs that sustain school connectedness for students, and providing professional development and emotional encouragement for staff charged with prevention, intervention, and postvention efforts.
Linked assets
University of Southern California Dissertations and Theses
Conceptually similar
PDF
Student mental health and wellness in K-12 high-performing school districts in Northern California: best practices for educational leaders
PDF
Student mental health and wellness in K-12 high performing school districts in Southern California: best practices for educational leaders
PDF
Effective leadership practices used by middle school principals in the implementation of instructional change
PDF
Middle school principals’ impact on effective professional learning communities in public schools in California
PDF
How urban high school principals implement social and emotional learning (SEL)
PDF
Future ready schools: how middle and high school principals support personalized and digital learning for teachers and students at a mid-sized urban middle/high school
PDF
Uncovered leaders in hidden schools: effective leadership practices in California Model Continuation High School principals
PDF
Elementary principals attitudes, perceptions, and their ability to support students with autism and emotional behavioral disturbances in inclusive settings
PDF
Mitigating the risk of veteran suicide: an evaluation study of suicide prevention resiliency implementation
PDF
Analyzing middle school teachers’ implementation and sustainability of professional development regarding non-exclusionary discipline practices
PDF
The impact of the COVID-19 pandemic on K–12 public school districts in southern California: responses of superintendents, assistant superintendents, and principals
PDF
The impact of the COVID-19 pandemic on K–12 public school districts in southern California: responses of superintendents, assistant superintendents, and principals
PDF
The impact of the COVID-19 pandemic on K–12 public school districts in southern California: responses of superintendents, assistant superintendents, and principals
PDF
Elementary principal leadership and learning outcomes for low socioeconomic status Hispanic English learners
PDF
The characteristics of high schools that have successfully implemented Positive Behavioral Interventions and Supports
PDF
Use of Kotter’s change model by elementary school principals in the successful implementation of inclusive education programs for students with disabilities in K-6 elementary schools in Southern ...
PDF
A study of the leadership strategies of urban elementary school principals with effective inclusion programs for autistic students in the general education setting for a majority of the school day
PDF
Best practices to improve mathematics achievement of middle school Latina/o students
PDF
An examination on educational management and the fostering of leadership sustainability in Hawaiian Catholic K-12 schools
PDF
The impact of the COVID-19 pandemic on K–12 public school districts in southern California: responses of superintendents, assistant superintendents, and principals
Asset Metadata
Creator
Acker, Benjamin Russell
(author)
Core Title
Principal implementation of Education Code 215: pupil and student suicide prevention policies in southern California public middle schools
School
Rossier School of Education
Degree
Doctor of Education
Degree Program
Education (Leadership)
Publication Date
04/25/2019
Defense Date
03/21/2019
Publisher
University of Southern California
(original),
University of Southern California. Libraries
(digital)
Tag
anxiety,crisis team,Ed Code 215,Education Code 215,ideation,indicated strategies,intervention,leadership,middle school,OAI-PMH Harvest,postvention,Prevention,Principal,risk assessment,risk factors,selective strategies,self harm,social emotional,Stress,suicidality,Suicide,suicide contagion,suicide legislation,suicide risk,suicidology,threat assessment,universal strategies,warning signs,youth suicide
Format
application/pdf
(imt)
Language
English
Contributor
Electronically uploaded by the author
(provenance)
Advisor
Castruita, Rudy (
committee chair
), Cash, David (
committee member
), Forsee, Brent (
committee member
)
Creator Email
backer@ausd.net,benacker11@gmail.com
Permanent Link (DOI)
https://doi.org/10.25549/usctheses-c89-146848
Unique identifier
UC11660006
Identifier
etd-AckerBenja-7268.pdf (filename),usctheses-c89-146848 (legacy record id)
Legacy Identifier
etd-AckerBenja-7268.pdf
Dmrecord
146848
Document Type
Dissertation
Format
application/pdf (imt)
Rights
Acker, Benjamin Russell
Type
texts
Source
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 a...
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
Tags
anxiety
crisis team
Ed Code 215
Education Code 215
ideation
indicated strategies
intervention
postvention
risk assessment
risk factors
selective strategies
self harm
social emotional
suicidality
suicide contagion
suicide legislation
suicide risk
suicidology
threat assessment
universal strategies
warning signs
youth suicide