A Systematic Review of School-Based Suicide Prevention Interventions for Adolescents, and Intervention and Contextual Factors in Prevention.

Suicide is the fourth leading cause of death among adolescents, globally. Though post-primary, school-based suicide prevention (PSSP) has the potential to be a key strategy for preventing adolescent suicidal thoughts and behaviours (STBs), there are persisting challenges to translating PSSP research to practice. Intervention and contextual factors relevant to PSSP are likely key to both PSSP effectiveness and implementation. As such, this systematic review aimed to summarise the effectiveness of PSSP for adolescent STBs and highlight important intervention and contextual factors with respect to PSSP. PsycINFO, Medline, Education Source, ERIC, Web of Science, and the Cochrane Central Register of Controlled Trials were searched to identify randomised and non-randomised studies evaluating the effectiveness of interventions located in post-primary, school-based settings targeting adolescent STBs. PSSP effectiveness and intervention and contextual factors were synthesised narratively. Twenty-eight studies were retained, containing nearly 47,000 participants. Twelve out of twenty-nine trials comparing intervention and independent control comparators reported statistically significant reductions in STBs postintervention, and 5/7 trials comparing preintervention and postintervention scores demonstrated significant reductions in STBs over time. Reporting and analysis of intervention and contextual factors were lacking across studies, but PSSP effectiveness and intervention acceptability varied across type of school. Although school personnel commonly delivered PSSP interventions, their input and perspectives on PSSP interventions were lacking. Notably, adolescents had little involvement in designing, inputting on, delivering and sharing their perspectives on PSSP interventions. Twenty out of twenty-eight studies were rated as moderate/high risk of bias, with non-randomised trials demonstrating greater risks of bias and trial effectiveness, in comparison to cluster randomised trials. Future research should prioritise complete reporting and analysis of intervention and contextual factors with respect to PSSP, involving key stakeholders (including adolescents and school personnel) in PSSP, and investigating key stakeholders' perspectives on PSSP. Given the inverse associations between both study quality and study design with PSSP effectiveness, particular consideration to study quality and design in PSSP research is needed. Future practice should consider PSSP interventions with universal components and PSSP which supports and involves key stakeholders in engaging with PSSP.

Preventing Teen Relationship Abuse and Sexual Assault through Bystander Training: Intervention Outcomes for School Personnel.

The purpose of the current study was to examine the impact of exposure to Bringing in the Bystander-High School Curriculum (BITB-HSC) on school personnel, which included a seven session classroom curriculum for ninth through twelfth graders (student curriculum), a bystander training workshop for school personnel (school personnel workshop), and reading materials (handout). We examined how exposure to these various BITB-HSC intervention components was associated with school personnel's knowledge and bystander efficacy, intentions, and barriers specific to student relationship abuse (RA) and sexual assault (SA). Participants were 488 school personnel from 12 high schools in upper New England who completed the 4-month follow-up survey that assessed for intervention exposure (284 participants completed both the baseline and follow-up survey). Whereas 53% of participants were exposed to no intervention components, the other half of the sample were exposed to a combination of intervention components. Higher baseline knowledge and reactive bystander intentions were associated with subsequent exposure to both the student curriculum and the handout, and fewer barriers to bystander action predicted exposure to the school personnel workshop. Exposure to the school personnel workshop, student curriculum, and handout was associated with subsequent greater knowledge, exposure to the student curriculum predicted reactive bystander intentions, and exposure to the handout predicted higher reactive bystander intentions and bystander efficacy. Findings suggest that despite challenges with engagement, exposure to the BITB-HSC components may be a useful tool in improving school personnel's responses to RA and SA among high school students.

Analysis of the effectiveness of training school personnel in the management of food allergy and anaphylaxis.

BACKGROUND: Food allergy is a very frequent and increasingly common disease in children and adolescents. It affects quality of life and can even be life-threatening. Given that 10-18% of allergic/anaphylactic food reactions take place in schools, it is essential to provide school personnel with training on the management of reactions. METHODS: The Allergy Unit of Hospital Universitario de Fuenlabrada, Spain, organized a conference entitled "Management of Food Allergy in Children and Adolescents in School Centers" during which teachers, cooks, cafeteria monitors, and summer-camp leaders underwent a training course. Attendees filled out a questionnaire with eight questions before and after the course to assess their self-efficacy in management of food allergy and anaphylaxis. The results were compared. RESULTS: A total of 191 people participated (51% dining-room monitors, 24% teachers, 13% cooks, and 12% other professions). The areas in which the attendees presented the lowest confidence before receiving the course were recognition of symptoms and treatment of the reactions/anaphylaxis. The mean score for each of the eight concepts evaluated improved after the training course. This improvement was significant in the management of anaphylaxis. CONCLUSIONS: Our study demonstrates the usefulness of a self-efficacy scale in school personnel as a tool to assess the ability to manage food allergy and anaphylaxis. It can help to identify problem areas in which more specific training programs can be implemented.

Passing the Trash: Absence of State Laws Allows for Continued Sexual Abuse of K-12 Students by School Employees.

"Passing the trash," enabling teachers who sexually abuse students to pursue another job with no record of their sexual misconduct, is common practice for K-12 school district administrators who fear legal liability and tarnished reputations. The "Prohibition on Aiding and Abetting Sexual Abuse" provision in the United States Every Student Succeeds Act (ESSA) of 2015 aims to eliminate passing the trash. This study explores states' progress toward developing and implementing relevant law and policy to comply with the provision. Researchers collected data from representatives of state departments of education, asking whether representatives were aware of the provision and what progress their state had made toward complying with it. Overall, researchers found that just four states had fully complied; several others were in the process of creating relevant policy and legislation and a few began the process in response to researchers' queries. However, the overwhelming majority of states-39-had no plans to create relevant legislation or policy, either because they were unaware of the provision or because they believed, erroneously, that existing laws fulfilled the ESSA mandate. Passing the trash is clearly an unacceptable practice, yet research suggests it still occurs, and state-level laws and policies to prevent it are slow to emerge. The lack of knowledge or awareness exhibited by many state representatives suggests a need to educate policymakers and education leaders about what aiding and abetting sexual offenders consists of, what consequences it can have for vulnerable students, and what provisions states can enact to prohibit it.

Sexual Abuse and Exploitation of PreK-12 Students by School Personnel.

The abuse of students by PreK-12 school personnel continues to be a multifaceted issue that affects students, staff, parents, and communities at an alarming rate. This two-part special issue builds on the dated and limited literature in this topic area and includes qualitative and quantitative research on prevalence, victim and offender characteristics, barriers to prevention, and frameworks and standards for prevention. Together these articles highlight the need for systematic data collection, policy implementation, accountability, and training and awareness. The findings from these articles provide specific practices that schools can adopt and follow to prevent school employee sexual misconduct.

Exposing School Employee Sexual Abuse and Misconduct: Shedding Light on a Sensitive Issue.

While the media continue to report incidents of school employee sexual misconduct, few empirical studies focus on this issue. To address this gap in the literature, expand knowledge and awareness around the problem, and inform future research and programs, this research intends to document and analyze the characteristics of school employee sexual misconduct cases reported in the media. The authors conducted a landscape analysis of 361 published school employee sexual misconduct cases in the United States from 2014, documenting factors such as offender and victim characteristics, type of incident, technology use, location of offense, and resulting disciplinary actions by schools and law enforcement. These analyses showed that offenders were most often male and general education teachers, with approximately a quarter identified as athletic coaches. Offenders' average age was 36 years, while the average age of victims was 15. More than half of incidents took place at school or school-related events. Results also showed that school employee sexual misconduct incidents most often involved physical contact; however, technology (i.e., cell phones, computers, cameras/video recorders, and storage devices) played an important role in three out of four cases. Finally, analyses of the criminal and school-related consequences showed that over half of offenders were placed on administrative leave or resigned immediately following their arrest and almost all were convicted of their crimes. Additional findings concerning this topic are also reported in this article.

Prevention of preK-12 School Employee Sexual Misconduct and Abuse.

The abuse of preK-12 students by school personnel is a pervasive, understudied topic that has behavioral, psychological and monetary consequences for victims, their families, and their communities. This special issue is the second of a two-part series and focuses on studies of school employee sexual misconduct prevention training programs and prevention issues and frameworks. This compilation of articles presents evidence that effective training can lead to improved awareness and behavior changes, concerns about policy implementation that may contribute to continued prevalence, and presents strategies and guidelines for prevention. These articles provide considerations for prevention including training, loopholes, and frameworks.

A Standard of Care for the Prevention of Sexual Misconduct by School Employees.

This article describes the development of a standard of care for the prevention of adult to student sexual abuse in pre K-12 schools. Standard of care is not a phrase often used in educational practice, and yet, it is a legal concept that may be useful for school administrators. A sample of administrators, child sexual abuse specialists, and attorneys with experience in school employee sexual misconduct responded to 101 items that the literature indicates should be included in a standard of care. There was agreement on 94 of these items by sample participants. Categories of the standard of care were policies, hiring process, hiring screening, hiring interview, training, and reporting. Where there was disagreement by role of respondent, attorneys, child sexual abuse specialists, or both rated the item as more important for inclusion than did administrators.

Prevalence and Risk Factors of Internet Addiction Among Employed Adults in Japan.

BACKGROUND: The prevalence of Internet addiction (IA) among employed adults has not been reported using a large sample. To clarify the actual status of addictive Internet use among employed adults, this study aimed to evaluate the prevalence and the risk factors of IA and at-risk IA among employed adults in Japan. METHODS: This cross-sectional study surveyed all junior and senior high school personnel in Shimane Prefecture, a rural area in Japan. Eligible participants included 3,211 junior and senior high school personnel (1,259 men and 1,952 women). Participants completed a questionnaire on their activities and factors related to Internet use. RESULTS: The prevalence of IA and at-risk IA was 0.03% and 4.82%, respectively. Furthermore, game playing was shown to be the Internet activity most closely associated with at-risk IA. CONCLUSIONS: This study showed that around 5% of school personnel in a rural area in Japan are at risk for developing addiction to the Internet and that using the Internet for game playing is related to at-risk IA. Our results suggest that employed adults should be instructed to use the Internet properly.

Motivation and intention to integrate physical activity into daily school life: the JAM World Record event.

Research on the motivation of stakeholders to integrate physical activity into daily school life is limited. The purpose was to examine the motivation of stakeholders to participate in a world record physical activity event and whether motivation was associated with future intention to use activity breaks during the daily school life and future participation in a similar event. After the 2012 JAM (Just-a-Minute) World Record event, 686 adults (591 women; 76.1% participated for children <10 years) completed measures of motivational regulations and future intention to (a) use the activity breaks and (b) participate in the event. High intrinsic motivation and low extrinsic motivation and amotivation for participation in the next event were reported. Hierarchical regression analysis, controlling for age, gender, and occupation, showed that intrinsic forms of motivation positively predicted, whereas amotivation negatively predicted, future intention to participate in the event and use the activity breaks. Multivariate analyses of variance revealed that school-related participants were more intrinsically motivated and intended to use the activity breaks and repeat the event more than those who were not affiliated with a school. Nonschool participants reported higher extrinsic motivation and amotivation than school-related participants.

Associations between youth suicide rates and state school personnel suicide prevention training requirements.

Objective: As youth spend the majority of their time in school, school personnel suicide prevention training has gained support as an approach to mitigate rising youth suicide rates. This study examined associations between state school personnel suicide prevention training requirements (i.e., mandatory/non-mandatory and annual/not annual), year of legislation enactment (2013 or earlier/2014 or later), and changes in youth suicide rates by state from 2007-09 to 2016-18. Methods: School personnel suicide prevention training requirement data were collected through state-specific Department of Education websites while state-specific youth suicide rates were collected from the Center for Disease Control and Prevention's 2020 National Vital Statistics Report. Data were analyzed using a mixed effects linear regression model. Results: Training is mandated in 40/50 (80 %) states; 19/50 (38 %) require annual training. All states demonstrated increases in youth suicide rates from 2007-09 to 2016-18 (mean increase 3.9/100,000 [sd = 1.8]), but the change did not differ significantly by state requirements for mandatory (p = 0.44) or annual (p = 0.70) training, nor for year of enactment of legislation (p = 0.45). Conclusions: School personnel suicide prevention training requirements were not associated with changes in the youth suicide rate, though study results are limited in that data was not available on how successfully schools implemented the required trainings.

Support for Community School Personnel Working with Pediatric Cancer Patients: A Quality Improvement Initiative.

Improved therapies and increased survival rates are sending more pediatric cancer patients and survivors back to their classrooms; however, most community school personnel lack training or experience in working with these students. The aim of this quality improvement project was twofold: (a) to evaluate community school personnel's perceptions of their preparedness to work with patients and childhood cancer survivors who have reentered the classroom; and (b) to standardize school reentry supports to improve community school personnel preparedness. Twenty community school personnel, prekindergarten through 12-grade teachers, guidance counselors, and administrators, who had previously worked with a pediatric cancer patient were surveyed regarding their experiences with the patient's school reentry. Responses were coded and analyzed, and a thematic map was created. School personnel reported concerns related to student functioning, such as academic readiness, cognitive impacts of treatment, social-emotional adjustment, physical ability to participate in school, and medical fragility. They also reported concerns related to their own ability to accommodate the student's needs. These results were used to design educational guides for community personnel consisting of information and resources to support them in managing the unique academic, social-emotional, physical, and medical needs of pediatric cancer patients and survivors in the classroom.

Awareness of tobacco control policies and anti-tobacco attitudes and behaviors among school personnel.

INTRODUCTION: Adolescent smoking is a serious public health concern, and the role of personnel in reducing students'tobacco use has been proven. Anti-tobacco policies are strong factors for tobacco control but most are newly implemented in China. This study aimed to examine the awareness of anti-tobacco policies among school personnel in a southern city of China, and assess its influence on personnel's anti-tobacco attitudes and behaviors towards students. METHODS: An online cross-sectional study was conducted between September 2017 and January 2018 in schools of Shanghai, China. A total of 3194 subjects from 33 schools were selected by a two-stage stratified cluster randomized sampling design. Prevalence of anti-tobacco policy awareness is presented. Crude (ORs) and adjusted odds ratios (AORs) and their 95% confidence intervals (CIs) were estimated to assess the association between policy awareness and anti-tobacco attitudes or behaviors. RESULTS: In all, 22.4% of surveyed participants knew four or five polices presented in the survey and 13.0% of personnel knew none of these policies. Most of the participants fully support prohibiting indoor (94.6%) and outdoor (86.3%) smoking in public places, bans on tobacco advertising (90.9%), and printing warning pictures on cigarette boxes (89.5%). Less than half of the personnel had taken action to stop students from smoking (45.7%), encourage students to quit smoking (42.4%) or participated in relevant educational activities held by schools (37.4%) in the previous year. The school personnel's anti-tobacco attitudes (AOR=1.28; 95% CI: 1.21-1.36) and behaviors (AOR=1.10; 95% CI: 1.03-1.17) were strengthened with increasing level of policy awareness. CONCLUSIONS: The involvement of school personnel can be an important part of intervention to improve anti-tobacco campaigns on campus. The study calls for the implementation of projects or activities to improve anti-tobacco policy awareness in the school environment as part of school tobacco control strategy.

Effectively Supporting Youth with Chronic Illness in Schools: External Partnerships and Training Recommendations.

Across Western countries, approximately 15% to 20% of school-aged children and adolescents have a health-related disorder, with incidence rates of childhood chronic health conditions (CHCs) increasing. This contribution comprehensively reviews disease-level, school-level, and systems-level issues related to effectively supporting children with CHCs succeed from both psychosocial and educational perspectives. This article also delineates training needs as they pertain to graduate preparation and/or professional development to equip school personnel to appropriately address students' needs. The article concludes with recommendations for evidence-based prevention and intervention strategies and potential avenues for interdisciplinary collaboration and models of coordinated care for these medically compromised youth.

Development and Psychometrics of Instruments to Assess School Personnel's Bystander Action in Situations of Teen Relationship Abuse and Sexual Assault.

This article describes recently developed instruments that assess school personnel's bystander barriers and intentions in situations of teen relationship abuse, sexual assault, and sexual harassment, as well as perceptions of school readiness specific to relationship abuse, sexual assault, and sexual harassment prevention and response. Participants were 1,150 high school personnel from 25 schools in New Hampshire, Massachusetts, and Maine. Specific instruments focused on bystander intentions, bystander action, barriers to bystander action, and perceptions of school readiness. Participants were randomly divided into two groups for analysis-the exploratory sample (ES; n = 575) and the confirmatory sample (CS; n = 575). Overall, the measures demonstrated acceptable fit indices. Results suggested that most measures and subscales had adequate reliability, but a few subscales had less than ideal internal consistency, which can likely be attributed to the small number of items. More work is needed, but these measures act as a starting point by which the role of school personnel in prevention initiatives and bystander intervention can be evaluated.

The Mediating Effect of Parental Involvement on School Climate and Behavior Problems: School Personnel Perceptions.

As a reflection of the culture and norms of the school community, the school climate (SC) is a potential factor connected to students' major behavior problems (BP). Parental involvement (PI) is considered as an essential factor for SC, contributing to promote good students' educational results, as well as better social functioning. The present study aimed to analyze the mediating effect of PI on the relationship between SC and BP, taking into consideration the school personnel perceptions. A total of 329 school personnel (teachers versus no teachers) aged between 29 and 66 (M = 50.78, SD = 7.56), mainly female (79%), were integrated in the sample. Based on the perception of the school personnel, the results indicate moderate level of PI and SC, as well as the existence of different BP in the school context. The mediating effect of PI in the relationship between the SC and BP has been demonstrated. These results suggest that, if the SC and PI are improved, it could be an effective strategy to enhance the social functioning of students in the school context. This study thus contributes to a comprehensive empirical analysis of how PI can improve the relationship between the SC and the BP of Portuguese students.

Corrigendum: School Refusal or Truancy? A Qualitative Study of Misconceptions Among School Personnel About Absenteeism of Children From Immigrant Families.

[This corrects the article DOI: 10.3389/fpsyt.2020.00202.].

School Refusal or Truancy? A Qualitative Study of Misconceptions Among School Personnel About Absenteeism of Children From Immigrant Families

Background: School refusal is a form of school attendance problem (SAP) distinct from truancy, school withdrawal, and school exclusion; it requires specific mental health care. Schools' identification and referral to care of school refusers depends on school personnel's interpretation of the reasons for absences. Because cultural factors can induce misunderstanding of the young people's behavior and of their parents' attitudes toward school attendance, school personnel can have difficulty understanding these reasons for children with transcultural backgrounds (migrants or children of migrants). The aim of this study was to explore the experiences and opinions of school personnel, mainly teachers, related to school refusal among these students. Methods: Grounded theory methodology was used to conduct 52 qualitative interviews of school personnel in two regions of France. Their daily practices with students presenting with school refusal were addressed in general (i.e., in response to absence of all youth) and in transcultural contexts (i.e., absence of migrant children or children of migrants). This study analyzed the interviews of the 30 participants who reported working with students from transcultural backgrounds. Results: Many school personnel reported experiencing difficulties, ambivalence, and destabilizing feelings in situations involving immigrant families whose school culture differed from their own. Talking about culture appeared to be taboo for most participants. These situations challenged the participants' usual strategies and forced them to devise new ones to deal with these young people and their families. Although some personnel were at risk of developing exclusionary attitudes, others dealt with school refusal with both commitment and creativity. Conclusion: The tensions experienced by these participants reveal contradictions between the French universalist ideology and the reality of daily life in schools becoming increasingly multicultural. School personnel's attitudes toward children with transcultural backgrounds presenting with school refusal can affect children's access to care and shape social inequalities. Further research should develop, implement, and assess interventions including transcultural training of school personnel, improved use of interpreters at school for migrant families, and the addition of a transcultural dimension to SAP assessment scales, especially for school refusal.

Conventional Cigarette and E-Cigarette Smoking among School Personnel in Shanghai, China: Prevalence and Determinants.

Smoking cigarettes and e-cigarettes is widely popular among Chinese students. Considering that school personnel are considered role models in the student community, we investigated the prevalence and determinants of such behavior among high school personnel in China so as to provide references for future related intervention measures. We used a stratified cluster sampling design on a total number of 3311 school employees recruited from 33 representative schools. Complex sampling analysis and logistic regressions were used for univariate and multivariate analyses. Among 3194 participants that met the study criteria, 7.4% were cigarette users, and 3.6% e-cigarette consumers. For conventional cigarette smokers, certain characteristics, such as being older and male, attaining less education, and having been exposed to secondhand smoke, were associated with heavier smoking. Nevertheless, e-cigarette users were predominantly male and of younger age. Those who understood the hazards of conventional cigarette smoking had less inclination to smoke but were at a higher risk of e-cigarette use. Our analysis suggests that it is necessary to target different populations for monitoring and controlling conventional cigarette smoking and e-cigarette use respectively among school personnel. In addition, China is in need of more relevant and strict anti-smoking regulations.

School Personnel's Bystander Action in Situations of Teen Relationship Abuse and Sexual Assault: Prevalence and Correlates.

BACKGROUND: Relationship abuse (RA) and sexual assault (SA) are major problems among high school students, and school personnel are an important part of preventing RA and SA among youth. Therefore, we examined the rates and correlates of bystander intentions among school personnel in situations of RA and SA. METHODS: School personnel (N = 1150) from 25 high schools in New England completed surveys that assessed their RA and SA knowledge, perceptions of school climate specific to RA and SA, and RA and SA bystander efficacy and bystander intentions. RESULTS: Across each type of bystander behavior measured, the vast majority of school personnel reported intentions to intervene. In the multilevel regression analyses, both proactive and reactive bystander intentions were related to higher levels of RA and SA bystander efficacy and perceptions of a more positive school climate and lower levels of RA and SA barriers to intervene. CONCLUSIONS: These data support the utility of school-based interventions that seek to improve school climate and teach school personnel skills that enhance bystander efficacy and reduce bystander barriers in student situations of RA and SA. Although they would need to be evaluated, such interventions could promote positive bystander action among school personnel and untimely contribute to reductions in RA and SA among high school youth.