Skip Navigation

Strengthen the Evidence for Maternal and Child Health Programs

New: MCHbest strategies database for sample ESMs

Evidence Tools
MCHbest. NPM 7: Injury Hospitilization

MCH Best Logo mother and young girl in pajamas holding hands

Strategy. Implementation of Established, Evidence-based or Informed Suicide Prevention Programs

Approach. Apply implementation science and quality improvement for testing, adapting, sustainably implementing, and widely spreading established suicide prevention programs.

Return to main MCH Best page >>

Overview. Specific suicide and self-harm prevention programming in school-based settings has been identified as moderately preventative. For example, programs such as Signs of Suicide; Question, Persuade and Refer; Sources of Strength, and The Good Behavior Game can be implemented at the school-level.1

Evidence. Moderate Evidence. This strategy has been tested more than once and results trend positive overall. See references below for peer-reviewed sources to support this strategy. It should be noted that the approach to use specific evidence-based/informed programs that have been shown to be effective can be used across child safety topics.2

Target Audience. School-Based/Student

Outcome. School-based interventions: A systematic review found evidence that school-based interventions "can be effective in improving a number of health outcomes. Four studies specifically reviewed school-based suicide prevention programs. One review of 16 programs identified two programs, Signs of Suicide and The Good Behavior Game, reduced suicide attempts, while other programs reduced suicide ideation and improvement in general life skills. [[citation]]

Examples from the Field. Access descriptions of ESMs dealing with suicide and self-harm prevention. Access descriptions of all current ESMs that generally use implementation science and quality improvement fto advance programs across child safety topics. You can use these ESMs to see how other Title V agencies are addressing the NPM.

The Tennessee Department of Health (TN-DOH) formed a state team of partners to reduce suicide and self harm among 10 - 19 year olds through sustainable implementation and spread of the gatekeeper program Question, Persuade and Refer (QPR). Conducting weekly survelliance, the TN-DOH monitored suicide-related behaviors and provided this information to the Tennessee Suicide Prevention Network. This partnership contributed to 111 QPR trainings to more than 3,700 adolescents in one year.

The Role of Title V. Title V agencies can use implementation science and quality improvement metods to identify pilot sites, support funding, train, and provide technical assistance (TA) for sustainable implementation and spread of evidence-based/informed strategies and programs.

For additional suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies.

Sample ESMs. Using the approach “Apply implementation science and quality improvement for testing, adapting, sustainably implementing, and widely spreading established suicide prevention programs,” here are sample ESMs you can use as a model for your own measures using the Results-Based Accountability framework:

Quadrant 1:
Measuring Quantity of Effort
("What/how much did we do?").

  • Number of schools offering evidence-based/informed suicide or self harm reduction programs to high school students.
  • Number of schools offering evidence-based/informed suicide or self harm reduction programs to middle school students.

Quadrant 2:
Measuring Quality of Effort
("How well did we do it?")

  • Percent of schools offering evidence-based/informed suicide or self harm reduction programs to high school students
  • Percent of schools offering evidence-based/informed suicide or self harm reduction programs to middle school students.

Quadrant 3:
Measuring Quantity of Effect
("Is anyone better off?")

  • Rate of hospitlization among adolescents, aged 11 - 19 from a suicide or self harm attempt.

Quadrant 4:
Measuring Quality of Effect
("How are they better off?")

  • Percent of adolescents, aged 11 - 19, who report a decrease in suicide or self harm ideation after participating in an evidence-based/informed suicide or self harm prevention program.

Note. ESMs become stronger as they move from measuring quantity to measuring quality (moving from Quadrants 1 and 3, respectively, to Quadrants 2 and 4) and from measuring effort to measuring effect (moving from Quadrants 1 and 2, respectively, to Quadrants 3 and 4).

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.


References:

1 Langley et al. (2009). The Improvement Guide (2nd ed.). Jossey-Bass: San Francisco, CA.

2 Abbott & Elliott, 2017; Burrus et al., 2012; Filene, Kaminski, Valle, & Cachat, 2013; Langford et al., 2014; MacArthur et al., 2018.

 

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.