Implementing School Nursing Strategies to Reduce LGBTQ+ Adolescent Suicide

Reducing youth suicide in the U.S. is a national public health priority. A supportive and safe school environment is pivotal to preventing youth suicide, and schools are now widely accepted as part of the de facto mental healthcare infrastructure for adolescents.

Lesbian, gay, bisexual, transgender and questioning (LGBTQ) youth are at elevated risk for suicide. Safer school environments decrease this risk. The school nurse is well positioned to implement evidence-based (EB) strategies to enhance school environments and improve the mental health of all students, particularly members of this vulnerable population. These strategies include the creation of “safe spaces,” adoption of harassment and bullying prohibitions, improved access to community health and mental health providers experienced in working with youth and LGBTQ people, school staff development, and incorporation of LGBTQ-specific information into health education curricula.

These strategies promote positive mental health outcomes for LGBTQ youth, and their cisgender, heterosexual peers as well. This five year study, funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development grant number R01HD083399, will evaluate our intervention model called “RLAS” (Implementing School Nursing Strategies to Reduce LGBTQ Adolescent Suicide). It builds on the Exploration, Preparation, Implementation, and Sustainment conceptual framework and the Dynamic Adaptation Process (DAP), a structured methodology for implementing the EB strategies. The DAP accounts for the multi-level context of school settings, facilitates appropriate expertise and feedback to make them “implementation ready,” and provides for targeted training of school nurses.

Per the DAP, the nurses or other school professionals will convene and lead Implementation Resource Teams (IRTs) consisting of counselors, social workers, health educators, and youth. With the guidance of coaches, the IRTs will engage in an iterative process of assessment and planning to build school capacity and implement the EB strategies.

To evaluate this model, we combine qualitative methods with population-based surveys and pursue three major goals. First, we will utilize the DAP to enable specially-trained IRTs to implement and sustain EB strategies to address the needs of LGBTQ high school students. Second, we will conduct a cluster randomized controlled trial (RCT) to assess whether sexual minority students and their peers in RLAS schools report reductions in suicidality, depression, substance use, and bullying, and increased safety compared to those in usual care schools. Third, we will examine the individual, school, and community factors influencing both implementation and outcomes.

The RLAS keeps with national priorities to improve school-based services for pediatric populations and LGBTQ youth mental health, and represents a novel contribution to implementation science.

Additional Investigators

• Sonnie Davies, M.P.H.
• Shannon Fluder, M.A.
• Lara Gunderson, Ph.D.
• Janie Lee Hall, R.N.
• Patricia Hokanson, M.P.H.
• Alena Kuhlemeier, Ph.D.
• Daniel Gene Shattuck, Ph.D.