New School-Based Initiative is Increasing Mental Health Care Access in Southeastern Ohio

Over the past 18 months, a new initiative in two Appalachian school districts – Jackson City Schools in Jackson County and Alexander Local Schools in Athens County – has been working to reduce the prevalence of mental health needs through prevention programs and to increase access to direct local mental health services.

It’s all possible through a partnership with Nationwide Children’s Hospital and the Cardinal Health Foundation.

“There's a growing understanding of the connection between health and education,” said Theresa Hatton, Care Connection Strategic Initiatives manager at Nationwide Children’s. “When most people think about education, they think about math, reading and science. However, we now know that setting a child up for success requires a focus on the ‘whole child.’"

The initiative seeks to serve students who are not receiving consistent medical care due to barriers like lack of transportation and lack of access to providers, and to support providers who are already engaged in the community. The program does this by: 

  • Increasing the capacity of primary care providers to provide both primary care and mental health care. This is accomplished through Project ECHO (Extension for Community Healthcare Outcomes), a virtual learning collaborative that helps train providers to diagnose and manage mental health needs.
  • Establishing relationships among between child psychiatry at Hopewell Health Centers and primary care providers in schools, supporting the providers’ learning and ability to conduct case-by-case consultation.
  • Developing integrated models of care between schools, school-based behavioral health clinicians and community-based primary care providers. Monthly meetings bring all parties to the table to enhance their effectiveness and coordination of care by communicating and working together.
  • Enhancing and expanding behavioral health prevention programs in school districts.

A key component of the initiative’s prevention programming is suicide prevention for middle- and high-school students. Suicide is the second-leading cause of death for youth ages 10 to 19 in the United States. In Ohio, it is the leading cause of death for children 10 to 14 years old.

Nationwide Children’s first began work in the area of youth suicide prevention in 2015 with the founding of the hospital’s Center for Suicide Prevention and Research (CSPR). The CSPR collaborates with schools by training them to implement the Signs of Suicide Prevention Program (SOS). This evidence-based program serves sixth- through twelfth-grade students and is the only universal school-based suicide prevention program with a documented 40% to 64% reduction in self-reported suicide attempts. 

Amberle Prater

“SOS is considered one of the gold-standard approaches to suicide prevention because it doesn’t just teach the students about the warning signs of suicide and how to respond, but it also teaches school staff, families and the community around the school how to respond to students in need.”

Amberle Prater, PhD, Clinical Lead Supervisor, Center for Suicide Prevention and Research

The program engages students through an initial two-day presentation, followed by a screening for potential risks of depression or suicide. The school staff is then trained to follow up on those screenings. 

“SOS is powerful because it gives schools the ability to connect with students that are otherwise not on their radar,” said Ms. Hatton.

School staff learns to identify suicide risk factors and warning signs and how to respond. All staff are invited to receive training, including drivers, librarians and cafeteria workers, as any individual working in a school could be a trusted adult for a student. School counselors and social workers are taught to effectively respond to suicide risk within the school, including conducting risk assessments when needed, making it possible for the program to become autonomous over time.

“Our goal is to support the school’s program by pulling in local agencies and clinics,” said Dr. Prater. “We want them to have the ownership and feel more confident in addressing challenges that may arise throughout the school year. We are always available for consultation but don't want to come in and take over. We are there to support while the program is established.” 

Over the 2020-2021 school year, SOS has demonstrated remarkable success. In Jackson City Schools, 60% of the staff had never received formal suicide prevention training and only 15% had any such training within the past year. After SOS training, 

  • 75% of staff felt confident that they could identify suicide warning signs in a student, an increase from 20% of staff feeling that way prior to training
  • 78% of staff felt comfortable approaching a student displaying warning signs and asking direct questions about suicide, an increase from 31% of staff feeling that way prior to training
  • 87% of staff felt comfortable having a conversation with a student they knew was thinking about suicide, an increase from 56% of staff feeling that way prior to training

The initial project will end after two years. Long-term, the initiative seeks to provide a framework that can be replicated in other school districts. 

“We're seeing ripple effects from this program having an effect on the entire community,” said Dr. Prater. “Through this work, you're changing the stigma around mental health and suicide risk. You’re changing the future of the whole community.”