Implementing trauma informed suicide prevention care in schools: Responding to acute suicide risk

Suicide is the second leading cause of death of school-aged youth, and youth with histories of trauma are at increased risk of suicidal thoughts and actions. Given the impact of trauma on youth development, there has been an increased emphasis on trauma-informed practices in schools. However, while school-based providers encounter, assess, and intervene with youth at risk of suicide, the extent to which trauma-informed practices are incorporated in these procedures is unclear. Available evidence suggests that schools are sometimes over-reliant on emergency services rather than collaborating with students and families in a trauma-informed manner to develop plans for stabilization and linkage to care that are alternatives to referral to higher levels of care. This paper outlines key considerations for school-based suicide risk assessment and crisis intervention, including safety planning, and offers recommendations for improving intervention procedures in school settings that are trauma-informed and support care linkage. An enhanced school-based risk assessment and intervention care process model is offered with special considerations for collaborating with families, developing safe alternatives to emergency service referral (as appropriate), and connecting students to appropriate care proportionate to identified risk. SAFETY-A, an intervention model intended to complement school-based risk assessment procedures, is described to demonstrate a trauma-informed approach in working with students and families at-risk of suicide or self-harm following the enhanced care process model.