NIATx in New Places: Building Capacity for Effective School-Based Suicide Prevention

 By: Maureen Fitzgerald and Sarah McMinn

Sarah McMinn, LCSW, joined the Great Lakes MHTTC team in 2018 to lead the School-Based Mental Health Supplement. In her previous work as clinical program manager for a Colorado agency, Sarah had worked with homeless families and mental health clinicians. She had also helped launch a family and child clinical program at the agency’s early childhood education center. Sarah grew up in Madison, Wisconsin, and earned her undergraduate and graduate degrees at UW–Madison. The school-based mental health program manager position was an ideal match for Sarah's skills and background, with the bonus of being based at her alma mater. 

During the first year of the supplement, Sarah’s work focused on training and promoting school-based mental health across the Great Lakes region (HHS Region 5: IL, IN, MI, MN, OH, and WI) and launching the best practice modules developed by the MHTTC Network. In addition, Sarah organized a suicide prevention learning collaborative with suicide prevention expert Tandra Rutledge. 

“School-based mental health gained additional attention as a national issue in spring 2020 with the advent of COVID as school-based mental health providers struggled to meet their students’ needs,” comments Sarah. “We recognized that schools have a lot of resources and information on suicide prevention but lacked a concrete set of guidelines on how and where to start implementing those policies and procedures.”

The NIATx model offered a potential solution to meet this need. “We recognized that NIATx could provide a simple framework to help guide school districts that needed to update and implement their suicide prevention policies.”  

Identifying gaps

Sarah and Tandra, with assistance from NIATx coaches Scott Gatzke and Mat Roosa, developed an intensive learning collaborative that was structured around the NIATx Change Leader Academy (CLA). Schools and school districts applied to participate in the initial learning collaborative, and it was so successful that it has been repeated with a new cohort.

“To date, we have worked with 28 school districts across two cohorts embedding the NIATx CLA into intensive technical assistance efforts,” says Sarah.

Two NIATx tools that helped participating schools immediately were the walk-through and rapid-cycle PDSA testing.  

“For a lot of our schools, doing the walk-through as an eye-opener,” adds Sarah.

“The walk-through allowed schools to determine how new staff were introduced to, trained on, and kept updated on current suicide prevention policies and procedures at the school,” explains Sarah. “It allowed them to find the gaps in knowledge and training that needed to be addressed to have fully available and implemented suicide prevention strategies.

For example, one school did a walk-through as a new employee was called upon to help a student expressing suicidal ideation. The change team went through the process step-by-step to identify the resources a person would need and who they would need to contact to get the whole picture of what's required to appropriately respond to a student in crisis. The walk-through helped identify where additional training and directive was needed so that both current and new staff were better prepared.

The NIATx flowcharting tool helped another school’s change team identify the need to create a suicide crisis team. “They used flowcharting to determine what needs to happen from start to finish to create safety for the student, the provider, and the school," says Sarah. "This exercise also identified gaps in school staffing that community stakeholders could fill. As a result, they're now drafting a manual for prevention, intervention, and postvention."

NIATx: Easily adaptable to school settings

The school-based NIATx CLAs identified three areas where change teams can focus their efforts: 

• Increasing staff awareness of the district suicide prevention protocol 
• Increasing the use of a universal screener 
• Increasing number of staff trained in suicide prevention training (QPR, ACT, ASIST, etc.)

In addition, the CLAs have demonstrated how the NIATx approach can benefit school settings.

“Educators, student support staff, and school administrators are busy. They often have little time to commit to projects outside of immediate student needs and educational requirements. Furthermore, they often must weave through heavy bureaucracy to make significant changes. The NIATx process gives education teams the opportunity to identify a problem and try small, measurable changes quickly so they can support students efficiently. It also gives them data to show leaders that small changes building upon one another are necessary, important, and have the potential to create significant change.”

About the trainers

Sarah McMinn, LCSW is a program manager for the Great Lakes MHTTC in Madison, WI, part of a national network of SAMHSA technical assistance centers. She is responsible for coordinating training and TA to enhance the implementation of school-based mental health programming. Previously, Sarah was a therapist, clinical supervisor, and program manager working with homeless families and developing mental health services at an ECE and after-school program. She holds an MSW from UW-Madison.

Tandra M. Rutledge is a mental health and suicide prevention educator, advocate, and consultant. She is currently the Director of Healthcare Systems Initiatives for Project 2025, a national initiative of the American Foundation of Suicide Prevention to reduce the suicide rate by 20% by the year 2025. Tandra provides subject matter expertise on the Great  Lakes MHTTC school-based suicide prevention intensive technical assistance and has helped pilot the school-based NIATx Change Leader Academies.