School Social Workers Knowledge of, and Responses to, Youth Suicidal Thoughts and Behaviors: Results of a National Survey

Background: Schools are a primary location for identification and intervention of suicidal thoughts and behaviors (STB). Prior research found that nearly 90% of school social workers (SSWs) work with suicidal youth, and yet only 57% report receiving graduate-level training. Although SSWs provide more crisis services than any other school personnel, there are almost no data on what SSWs know and how they respond to suicidal youth. The purpose of this study, therefore, was to document SSWs knowledge of risk factors, assessment, intervention and postvention of STB.

Methods: Letters were sent to the offices of 1400 active members of the School Social Work Association of America inviting them to complete a four-page survey using pen and paper, or online through Qualtrix. 302 SSWs completed the survey (201 paper, 101 online; 21% response rate). Respondents were 85% female, 74% white, reported an average age of 46 years (SD = 12) and 14.9 years of practice experience (SD = 10.3). Respondents worked at suburban (41.8%), urban (33%), and rural (23.5%) schools. Because SSWs can work in multiple schools and multiple levels, they were instructed to respond based on a single level of school. The distribution of school level was: elementary (34.4%), middle (29.8%), high (35.1%). Descriptive statistics were used to identify percentages of correct answers. Independent t-test was conducted to identify correlation between graduate-level training and SSWs’ responses.

Results: Nearly all (92%-99%) SSWs correctly identified the following risk factors for youth STB: history of suicide attempt, current psychopathology, interpersonal discord, and recent humiliation. Only 77% correctly identified presence of a gun in the home as a risk factor. A majority of SSWs incorrectly believed that antidepressants increased suicide risk (53%), that psychiatric hospitalization as an effective intervention (62%), and that suicide risk could be assessed by using the phrase “have you thought of hurting yourself?” (76%).  SSWs who endorsed graduate school training (50%) were significantly more likely to accurately recent humiliation (p=.046) and engaging in non-suicidal self-injury (p<.001) as risk factors for suicide. They were also significantly more likely to initiate contact with at-risk following a students’ suicide death (p<.001).

Implications:  SSWs’ knowledge of risk factors is high, particularly compared to studies of school psychologists (Debski, Spadafore, Jacob, Poole, & Hixson, 2007). Graduate school training provides a small but significant influence on SSWs knowledge of risk factors and best-practice responses. There is clear need for more education about the risks posed by guns, the lack of risk posed by antidepressants, and the most effective ways to assess for suicide risk. This study fills an important gap in the literature because it provides data on SSWs, and is the first national study of its kind. It highlights the need for SSWs to receive more advanced and targeted training on suicide assessment, intervention, and postvention.