Abstract. An 18-year longitudinal case study of the suicide rates of students attending a large, urban, multicultural school district between 1989 and 2006 is described. The high rate of suicide (5.5 per 100,000 students ages 5-19) in the district during the period 1980-1988 led to the development and implementation of a district-wide Youth Suicide Prevention and Intervention Program. The program is based on a three-tier suicide prevention model incorporating universal, selected, and indicated prevention/intervention strategies. Suicide and suicide attempt data were collected from crisis hotline reports. Since implementation of the program, a significant decrease in the suicide rate (1.4 per 100,000) was observed from 1989 to 2006. There also was a steady decline in the suicide attempt rate during this same period. This study is among the first to provide longitudinal evidence that youth suicidal behavior can be reduced potentially through school-based suicide prevention programs.
Youth suicidal behavior, particularly its most extreme forms (i.e., suicide attempts; suicide), is a continuing national problem (Miller & Eckert, 2009). The issue of youth suicidal behavior is a critical one for our nation's schools and has led to increased calls for school-based suicide prevention (e.g., Kalafat, 2003; Lazarus & Kalafat, 2001; Mazza, 1997; Mazza & Reynolds, 2008; Miller & DuPaul, 1996) and intervention (e.g., Lieberman & Davis, 2002; Lieberman, Poland, & Cassel, 2008; Sandoval & Zadeh, 2008) efforts. In response to the growing need for suicide prevention programs in the schools, the Miami-Dade County Public Schools in Miami, Florida, developed a comprehensive, multitier suicide prevention and intervention program after 18 students took their own lives in 1988. In this case study, the components of the program and its effect on youth suicide and suicide attempts over an 18-year span are described. This study is significant for being among the first to demonstrate the potential utility of comprehensive school-based prevention programs for reducing youth suicidal behavior over sustained periods.
Although other studies examining the effectiveness of school-based suicide prevention programs have been evaluated, to date these have largely focused on measuring changes in students' knowledge and attitudes regarding suicide rather than suicidal behavior (Berman, Jobes, & Silverman, 2006). In contrast, Zenere and Lazarus (1997) conducted a study in which they examined program effects on various aspects of suicidal behavior, including suicidal ideation, suicide attempts, and suicide. Further, this suicide prevention program deviated significantly from others reported in the professional literature, in that a district-wide program was developed, implemented, and evaluated over a 5-year period. Although no significant reductions were observed in suicidal ideation, both the number of student suicide attempts and suicides decreased substantially following program implementation. This case study provided one of the first clear documentations that school-based suicide prevention programs can potentially reduce suicidal behavior, including its most severe forms (i.e., suicide and suicide attempts). The study was also notable for being the only 1 among 13 school-based suicide prevention programs to be classified as exhibiting promising evidence for educational/clinical significance (Miller, Eckert, & Mazza, 2009) according to the Task Force on Evidence-Based Interventions in School Psychology Procedural and Coding Manual (Kratochwill & Stoiber, 2002). The present study was designed as a longitudinal extension of this earlier work.
Miami-Dade County Public Schools is the nation's fourth largest school district, serving over 350,000 students in 392 school sites. The district provides educational services to a multilingual and culturally diverse student community. …