Limitations
We recognize some important limitations in our development and use of
the SDSPET. The inter-rater
reliability of the tool was determined from a small number of users on a
relatively modest number of total districts in a single state. Further
evaluation of the tool by more diverse users across a sample set with
broader geographic variability is needed. The current version of the
SDSPET has not been tested for content or criterion validity. After this
study was underway, a second edition of the MSDP was published and
contains some changes not reflected in the current version of the
SDSPET. Criteria weighting may also be considered in a future iteration
of SDSPET. Further analysis by experts in suicide, school district
policy, or contributors to the model policy itself would help determine
the validity of the tool. Factor analysis may also be beneficial in
identifying potentially interdependent criteria and result in the
simplification of the SDSPET.
Additionally, the SDSPET is only designed to assess
school-district-level policies, not school-level programs, pertaining to
suicide prevention. This is an important distinction both generally and
in our statewide analysis. Much of the evidence for suicide prevention
in schools focuses on specific interventions, including universal,
selected, and targeted programs.22 Further work will
be necessary to determine whether there is correlation between the
comprehensiveness of school-district-level suicide prevention policies
and both the adoption of evidence-based prevention programs and suicide
outcomes among adolescents.
Considering these limitations and the alarming trends in adolescent
suicide, we see the SDSPET being utilized by policymakers and
researchers alike once more rigorous validity and reliability testing is
complete. The tool may assist school district leadership in evaluating
and revising their policies to reflect best practices. Effective suicide
prevention requires an immense amount of coordination that involves
prevention and intervention strategies during all the years students are
in the education system.22 School districts are in a
unique position to coordinate suicide prevention efforts across schools.
This makes comprehensive and effective school district policies on
suicide vital to preventing suicide. Additionally, cultural
considerations play a vital role in suicide
prevention.10 The SDSPET does not provide rigid
guidelines that ignore these factors; instead, it provides a framework
for suicide prevention programs to be implemented in culturally
competent ways. Prevention question 5 (PR-5) discusses professional
trainings for staff regarding students at an elevated risk for suicide
and intervention questions 4-14 (I-4-14) discuss guidelines specifically
for at-risk youth. These cultural considerations, that may otherwise be
overlooked, are necessary for developing a comprehensive and effective
policy.
From a public health perspective, the quantitative nature of the SDSPET
allows for a nuanced analysis of an individual district’s policy and the
discovery of policy trends across different districts. One challenge in
studying school-based suicide prevention efforts at the school-level and
district-level is the heterogeneity of programs and organizations
involved; the SDSPET provides a uniform metric for assessing
district-level policy content addressing this complex issue. Further
work may help elucidate the potential relationship between
district-level policy content as assessed via the SDSPET with policy
implementation at the school-level, and outcomes of suicidal thoughts
and behaviors among school-aged adolescents.