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.