Abstract
BackgroundTechnology-enabled services (TESs), which integrate human service and digital components, are popular strategies to increase the reach and impact of mental health interventions, but large-scale implementation of TESs has lagged behind their potential.ObjectiveThis study applied a mixed qualitative and quantitative approach to gather input from multiple key user groups (students and educators) and to understand the factors that support successful implementation (implementation determinants) and implementation outcomes of a TES for universal screening, ongoing monitoring, and support for suicide risk management in the school setting.MethodsA total of 111 students in the 9th to 12th grade completed measures regarding implementation outcomes (acceptability, feasibility, and appropriateness) via an open-ended survey. A total of 9 school personnel (school-based mental health clinicians, nurses, and administrators) completed laboratory-based usability testing of a dashboard tracking the suicide risk of students, quantitative measures, and qualitative interviews to understand key implementation outcomes and determinants. School personnel were presented with a series of scenarios and common tasks focused on the basic features and functions of the dashboard. Directed content analysis based on the Consolidated Framework for Implementation Research was used to extract multilevel determinants (ie, the barriers or facilitators at the levels of the outer setting, inner setting, individuals, intervention, and implementation process) related to positive implementation outcomes of the TES.ResultsOverarching themes related to implementation determinants and outcomes suggest that both student and school personnel users view TESs for suicide prevention as moderately feasible and acceptable based on the Acceptability of Intervention Measure and Feasibility of Intervention Measure and as needing improvements in usability based on the System Usability Scale. Qualitative results suggest that students and school personnel view passive data collection based on social media data as a relative advantage to the current system; however, the findings indicate that the TES and the school setting need to address issues of privacy, integration into existing workflows and communication patterns, and options for individualization for student-centered care.ConclusionsInnovative suicide prevention strategies that rely on passive data collection in the school context are a promising and appealing idea. Usability testing identified key issues for revision to facilitate widespread implementation.
Highlights
BackgroundSuicide is the second leading cause of death for adolescents, and the rate of suicide in the United States has increased in recent years [1,2]
Innovative suicide prevention strategies that rely on passive data collection in the school context are a promising and appealing idea
Strategies to make suicide prevention efforts in high schools scalable, sustainable, and supportive may benefit from attention to how technology can facilitate and aid human efforts
Summary
BackgroundSuicide is the second leading cause of death for adolescents, and the rate of suicide in the United States has increased in recent years [1,2]. Data suggest that 17% of US high school students seriously consider suicide each year, and approximately 9% report a suicide attempt [3]. Despite this being a common health concern, our ability to predict suicide is poor [4]. Schools have the potential to play an essential role in supporting the identification and treatment of youth with mental health difficulties. School is the most common community setting where suicidal ideation is identified [10]; the majority of schools demonstrate poor adherence to gold standard practices related to the identification and treatment of youth at risk [11,12]. Technology-enabled services (TESs), which integrate human service and digital components, are popular strategies to increase the reach and impact of mental health interventions, but large-scale implementation of TESs has lagged behind their potential
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