Skip to main content

School Psychologists’ Experiences with and Training in Suicide Assessment: Challenges in a Rural State


Past research has shown that suicide rates for males and females are higher in rural than in urban areas. Because of the high incidence of suicide attempts and completion of youth in rural areas, it is critical that they receive mental health support within schools. Consequently, the current mixed-methods study surveyed school psychologists in Montana to obtain information about their involvement and training in suicide assessment and the related challenges they have encountered. Thirty-seven school psychologists participated in the study, with 47% serving schools in rural areas. Participants were recruited through the membership listserv of the Montana Association of School Psychologists (response rate of 27%) and through direct e-mail contact (response rate of 16%). Results indicated that only 17% of the participants take the lead in suicide risk assessments and 47% are involved in them less than five times a year, 93% of participants did not have a graduate class exclusively devoted to suicide assessment, and 58% received 10 or more hours of training in suicide assessment post-degree. Furthermore, qualitative thematic analyses, using NVivo software, yielded nine major categories of challenges in suicide assessment identified by school psychologists. Study limitations, future areas for research, and implications for school psychologists are also discussed.

This is a preview of subscription content, access via your institution.


  1. Allen, M., Jerome, A., White, A., Martson, S., Lamb, S., Pope, D., & Rawlins, C. (2002). The preparation of school psychologists for crisis intervention. Psychology in the Schools, 39, 427–439. doi:10.1002/pits.10044.

    Article  Google Scholar 

  2. American Foundation for Suicide Prevention (2015). Suicide: 2016 facts and figures. Retrieved from

  3. Braun, V., & Clarke, V. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101 Retrieved from .

    Article  Google Scholar 

  4. Center for Disease Control (2014). 10 leading causes of death by age group, United States- 2014. Retrieved from

  5. Center for Disease Control (2015). Suicide: facts at a glance 2015. Retrieved from

  6. Centers for Disease Control and Prevention. (2013). Web-based injury statistics query and reporting system (WISQARS) fatal injury reports, from

  7. Chandler, M. J., Lalonde, C. E., Sokol, B. W., Hallett, D., & Marcia, J. E. (2003). Personal persistence, identity development, and suicide: a study of native and non-native north American adolescents. Monographs of the Society for Research in Child Development, 68, i-138.

    Article  Google Scholar 

  8. Curtis, A. C., Waters, C. M., & Brindis, C. (2011). Rural adolescent health: the importance of prevention services in the rural community. The Journal of Rural Health, 27, 60–71. doi:10.1111/j.1748-0361.2010.00319.x.

    Article  PubMed  Google Scholar 

  9. Curtis, M. J., Castillo, J. M., & Gelley, C. (2012). School psychology 2010: demographics, employment, and the context for professional practices—part 1. Communiqué, 40, 28–30.

    Google Scholar 

  10. Debski, J., Spadafore, C. D., Jacob, S., Poole, D. A., & Hixson, M. D. (2007). Suicide intervention: training, roles, and knowledge of school psychologists. Psychology in the Schools, 44(2), 157–170. doi:10.1002/pits.20213.

    Article  Google Scholar 

  11. Doll, B., & Cummings, J. A. (2008). Transforming school mental health services. Thousand Oaks, CA: Corwin Press.

    Google Scholar 

  12. Fontanella, C. A., Hiance-Steelesmith, D. L., Phillips, G. S., Bridge, J. A., Lester, N., Sweeney, H. A., & Campo, J. V. (2015). Widening rural-urban disparities in youth suicides, United States, 1996-2010. Journal of the American Medical Association Pediatrics, 169, 466–473. doi:10.1001/jamapediatrics.2014.3561.

    PubMed  PubMed Central  Google Scholar 

  13. Goforth, A. N., Yosai, E. R., Brown, J. A., & Shindorf, Z. R. (2016). A multi-method inquiry of the practice and context of rural school psychology. Contemporary School Psychology, 1–13. doi:10.1007/s40688-016-0110-1.

  14. Hastings, S. L., & Cohn, T. J. (2013). Challenges and opportunities associated with rural mental health practice. Journal of Rural Mental Health, 37, 37–49. doi:10.1037/rmh0000002.

    Article  Google Scholar 

  15. Hatton, V., Heath, M. A., Gibb, G. S., Coyne, S., Hudnall, G., & Bledsoe, C. (2017). Secondary teachers’ perceptions of their role in suicide prevention and intervention. School Mental Health, 9, 97–116. doi:10.1007/s12310-015-9173-9.

    Article  Google Scholar 

  16. Heflinger, C. A., Wallston, K. A., Mukolo, A., & Brannan, A. M. (2014). Perceived stigma toward children with emotional and behavioral problems and their families: the attitudes about child mental health questionnaire (ACMHQ). Journal of Rural Mental Health, 38, 9–19. doi:10.1037/rmh0000010.

    Article  Google Scholar 

  17. Hirsch, J. K. (2006). A review of the literature on rural suicide. Crisis, 27(4), 189–199. doi:10.1027/0227-5910.27.4.189.

    Article  PubMed  Google Scholar 

  18. Jones, A. R., Cook, T. M., & Wang, J. (2011). Rural–urban differences in stigma against depression and agreement with health professionals about treatment. Journal of Affective Disorders, 134(1–3), 145–150. doi:10.1016/j.jad.2011.05.013.

    Article  PubMed  Google Scholar 

  19. Judd, F., Jackson, H., Komiti, A., Murray, G., Fraser, C., Grieve, A., & Gomez, R. (2006). Help-seeking by rural residents for mental health problems: The importance of agrarian values. Australian and New Zealand Journal of Psychiatry, 40(9), 769–776. doi:10.1111/j.1440-1614.2006.01882.x.

    Article  PubMed  Google Scholar 

  20. Kalafat, J. (2003). School approaches to youth suicide prevention. American Behavioral. Scientist, 46, 1211–1223.

    Google Scholar 

  21. Kann, L., McManus, T., Harris, W. A., Shanklin, S. L., Flint, K. H., Hawkins, J., Zaza, S. (2016). Youth risk behavior surveillance—United States, 2015. Retrieved from

  22. Liebling-Boccio, D. E., & Jennings, H. R. (2013). The current status of graduate training in suicide risk assessment. Psychology in the Schools, 50(1), 72–86. doi:10.1002/pits.21661.

    Article  Google Scholar 

  23. Miller, D. N., & DuPaul, G. J. (1996). School-based prevention of adolescent suicide: Issues, obstacles, and recommendations for practice. Journal of Emotional and Behavioral Disorders, 4, 221–230.

  24. Miller, D. N., Eckert, T. L., & Mazza, J. J. (2009). Suicide prevention programs in the schools: a review and public health perspective. School Psychology Review, 38, 167–188.

    Google Scholar 

  25. Morsette, A., van den Pol, R., Schuldberg, D., Swaney, G., & Stolle, D. (2012). Cognitive behavioral treatment for trauma symptoms in American Indian youth: preliminary findings and issues in evidence-based practice and reservation culture. Advances in School Mental Health Promotion, 5, 51–62. doi:10.1080/1754730X.2012.664865.

    Article  Google Scholar 

  26. National Association of School Psychologists (2010). Standards for graduate preparation of school psychologists. Retrieved from

  27. Nickerson, A. B., & Zhe, E. J. (2004). Crisis prevention and intervention: a survey of school psychologists. Psychology in the Schools, 41, 777–788. doi:10.1002/pits.20017.

    Article  Google Scholar 

  28. Office of Management and Budget, OMB (2015). Revised delineations of Metropolitan statistical Areas, Micropolitan statistical areas, and combined statistical areas, and guidance on uses of the delineations of these areas. OMB Bulletin No. 15–01. Retrieved from

  29. Ratcliffe, M., Burd, C., Holder, K., & Fields, A. (2016). Defining rural at the U.S. Census Bureau. Washington, DC: ACSGEO-1, U.S. Census Bureau Retrieved from

    Google Scholar 

  30. Saldana, J. (2013). The coding manual for qualitative researchers. Thousand Oaks, CA: Sage Publications Inc..

    Google Scholar 

  31. Searles, V. B., Valley, M. A., Hedegaard, H., & Betz, M. E. (2014). Suicides in urban and rural counties in the united states, 2006–2008. Crisis: The Journal of Crisis Intervention and Suicide Prevention, 35(1), 18–26. doi:10.1027/0227-5910/a000224.

    Article  Google Scholar 

  32. Singh, G. K., & Siahpush, M. (2002). Increasing rural–urban gradients in US suicide mortality, 1970–1997. American Journal of Public Health, 92(7), 1161–1167.

    Article  PubMed  PubMed Central  Google Scholar 

  33. U.S. Census Bureau. (2016). How the Census Bureau measures poverty, from

  34. U.S. Department of Health and Human Services. (2001). National strategy for suicide prevention: Goals and objectives for action. Rockville, MD: Author.

    Google Scholar 

  35. United States Department of Agriculture Economic Research Service. (2015). Rural poverty & well-being Retrieved October 21, 2015, from

  36. Wagenfeld, M. O. (2003). A snapshot of rural and frontier America. In B. H. Stamm (Ed.), Rural behavioral health care: an interdisciplinary guide (pp. 33–40). Washington, D.C: American Psychological Association.

    Chapter  Google Scholar 

  37. Yoder, K. A., Whitbeck, L. B., Hoyt, D. R., & LaFromboise, T. (2006). Suicidal ideation among American Indian youths. Archives of Suicide Research, 10, 177–190. doi:10.1080/13811110600558240.

    Article  PubMed  Google Scholar 

  38. Yoshikawa, H., Aber, J. L., & Beardslee, W. R. (2012). The effects of poverty on the mental, emotional, and behavioral health of children and youth: Implications for prevention. American Psychologist, 67, 272–284. doi:10.1037/a0028015.

    Article  PubMed  Google Scholar 

  39. Zaheer, J., Links, P. S., Law, S., Shera, W., Hodges, B., Tsang, A. K. T., et al. (2011). Developing a matrix model of rural suicide prevention. International Journal of Mental Health, 40, 28–49. doi:10.2753/IMH0020-7411400403.

    Article  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Jacqueline A. Brown.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Brown, J.A., Goforth, A.N. & Machek, G. School Psychologists’ Experiences with and Training in Suicide Assessment: Challenges in a Rural State. Contemp School Psychol 22, 195–206 (2018).

Download citation


  • Suicide assessment
  • Suicide training
  • Rural
  • Challenges
  • School psychologist