Preventing Adolescent Suicide Mortality: Exploring Barriers and Facilitators of School Officials' Participation in Child Death Review Meetings

Project Summary
Suicide the second leading cause of death among adolescents ages 14-24; in 2022, approximately
18 adolescents died each day from suicide. Child death review (CDR) teams are one method used
across the US and internationally to dive deeply into the preceding circumstances of adolescent
death to form recommendations to prevent adolescent mortality. Adolescents spend a considerable
amount of time in schools, and school representatives can help a CDR team identify crucial proximal
and modifiable risk factors of adolescent suicide death. Shockingly, fewer than 3 in 10 CDR teams
have participation from school representatives, representing a major CDR implementation gap and
lack of actionable data for suicide prevention in the high-risk developmental period of adolescence.
The goal of this exploratory sequential mixed methods study is to explore barriers and facilitators to
school participation in CDR team meetings. The team’s location in Los Angeles County is a unique
strength because CDR methods were first developed in Los Angeles in 1978, and in 2000 Los
Angeles County began the only CDR devoted solely to adolescent suicide death. With substantial
connections to community partners to conduct this work, our team is uniquely equipped to complete
the proposed exploratory study, which (1) aligns with the developmental purposes of the R21
mechanism and (2) responds directly to the Notice of Special Interest in Mortality of Adolescents,
Young Adults, and Other NICHD Priority Populations in the United States (NOT-HD-23-001). We aim
to (1) explore facilitators and barriers to school representatives’ CDR participation for adolescent
suicide mortality; (2) explore school attorneys’ perspectives about school representatives’ CDR
participation for adolescent suicide mortality; and (3) describe school representatives’ experiences
with, concerns about, and recommendations for how to engage them in CDR team meetings. We will
conduct semi-structured interviews with (Aim 1) samples of school representatives (e.g., school
psychologists, social workers, counselors) and to explore emergent themes related to their concerns,
administrative processes, and decision-making about participating in a CDR team meeting. For Aim
2, we will interview school attorneys to explore how they advise schools about participating in CDRs,
probing about concerns of liability and confidentiality. We will use the interview data from Aims 1 and
2 to conduct a web-based survey (Aim 3) of school representative to describe leading barriers,
facilitators, and recommendations for CDR. School participation in CDR reviews is a major
undeveloped area of research for improving identification of mechanisms, correlates, and modifiable
risk factors of adolescent suicide mortality, and our team is well positioned to develop and test policy
and practice interventions to improve CDR participation based on the findings of this study.

Grant Number: 1R21HD115957-01
NIH Institute/Center: NIH
Principal Investigator: John Blosnich