JMIR Publications

ABSTRACT

Background:

Suicide is a leading cause of death for youth, and a prominent concern for school mental health providers. Indeed, schools play a key role in suicide prevention, including by participating in risk assessments for students expressing suicidal ideation. However, in the context of COVID-19, many schools now need to offer mental health services – including suicide risk assessment – via eHealth platforms. Post-pandemic, the use of eHealth risk assessments will support more accessible services for rural and remote youth. However, as the remote environment is a new context for many schools, guidance is needed on best practices for eHealth suicide risk assessment with youth.

Objective:

The purpose of this study was to conduct a rapid, systematic scoping review to explore promising practices for conducting school-based suicide risk assessment with youth via eHealth (i.e., information technologies that allow for remote communication).

Methods:

The search for this review included peer-reviewed articles published in English between 2000-2020, as well as grey literature. While we located no articles that specifically explored promising practices for school-based suicide risk assessment with youth via eHealth, we did locate 12 peer-reviewed articles and 23 grey literature documents that contained relevant information that addressed our broader study purpose, and thus these 35 sources were included in the review.

Results:

We identified five key recommendation themes for school-based suicide risk assessment with youth via eHealth in the 12 included peer-reviewed articles: 1) accessibility; 2) consent procedures; 3) session logistics; 4) safety planning; and 5) internet privacy. Specific recommendation themes from the 23 grey literature documents substantially overlapped with and enhanced three of the themes identified in the peer-reviewed literature (consent procedures, session logistics and safety planning). In addition, per findings from the grey literature, we expanded the “accessibility” theme to a broader theme of “youth engagement,” which includes information on accessibility, building rapport, establishing a therapeutic space and helping youth prepare for remote sessions. Finally, one new theme was identified in grey literature findings, specifically around school mental health professional boundaries. A second key difference between the grey and peer-reviewed literature was the former’s focus on issues of equity and access, and how technology can reinforce existing inequalities.

Conclusions:

For school mental health providers in need of guidance, we feel these six recommendation themes (i.e., youth engagement; school mental health professional boundaries; consent procedures; session logistics; safety planning; and internet privacy) represent the most current promising directions for school-based suicide risk assessment with youth via eHealth. However, suicide risk assessment with youth via eHealth in school settings represents a critical research gap. Based on the findings of our review, we provide specific recommendations for future research, including the need to focus on the needs of diverse youth.