Duties When an Anonymous Student Health Survey Finds a Hot Spot of Suicidality

Abstract

Public health agencies regularly survey randomly selected anonymous students to track drug use, sexual activities, and other risk behaviors. Students are unidentifiable, but a recent project that included school-level analysis discovered a school with alarmingly prevalent student suicidality. Given confidentiality protocols typical of surveillance, the surveyors were uncertain whether and how to intervene. We searched literature for duties to warn at-risk groups discovered during public health surveillance, but we found no directly applicable guidance or cases. Reasoning by analogy, we conclude that surveyors should contact the school’s leaders to call attention to its outlier status, but public warning is unwarranted. However, such an ad hoc decision to issue a warning, even if only to school leaders, raises significant practical, legal and ethical issues. National public health and education associations should produce guidance that clarifies ethical and legal duties owed to schools and students involved in population health-risk surveillance.     

Identification of Nearly Fatal Suicide Attempts: Self-Inflicted Injury Severity Form

The Self-inflicted Injury Severity Form (SIISF) was developed as an epidemiological research tool for identifying individuals in hospital emergency departments who have life-threatening self-inflicted injuries. Data were collected from 715 patients with self-inflicted injuries in two large hospitals. In 295 of these cases, a second set of data was independently collected for assessment of interrater reliability. Validity was assessed by comparing the SIISF results with simultaneously collected Risk—Rescue Ratings. Assessment of interrater reliability found that only 2.4% of physicians disagreed on the suicide method used. The kappa statistic for method used was .94, indicating excellent agreement. The SIISF was found to distinguish between severe and less severe injuries. Thus, it appears to provide a simple method to distinguish patients who have life-threatening self-inflicted injuries.     

Auditory and visual word-stem completion: Separating data-driven and conceptually driven processes

Two experiments investigated the contributions of data-driven and conceptually driven processing on an implicit word-stem completion task. In Experiment 1, individual words were studied either visually or auditorily and were tested using either visual or auditory word-stems. Keeping modality the same from study to test led to more priming than did changing modality, but there was reliable cross-modal priming. In Experiment 2, subjects read sentences like The boat travelled underwater and inferred the subject noun (i.e. “submarine”) or sentences like The submarine travelled underwater and categorized the subject noun (i.e. “boat”). At test, there was reliable priming for both actually read nouns and inferred nouns. In addition, a modality effect was evident for the actually read nouns but not for the inferred nouns. Taken together, these results imply that there is a basic conceptually driven contribution to priming plus an additional contribution of data-driven processing when surface form is the same at study and test.     

Facilitators and barriers to the implementation of motivational interviewing for bullying perpetration in school settings

Bullying is a perplexing and persistent problem with negative consequences for all involved. Schools are assigned considerable responsibility for the management of bullying because of its prevalence amongst youth. Despite considerable efforts over decades to curtail bullying through the use of anti-bullying policies and other school-based interventions, the rates of young people who frequently bully has not decreased significantly. Motivational Interviewing (MI) is a relational and affirming conversational method that strengthens an individual's motivation and commitment to change, overcoming ambivalence toward the problem. The aim of the current study was to provide preliminary insight into the feasibility of incorporating MI into student service repertoires for addressing bullying. Ten staff participants from six secondary schools, who had roles in bullying intervention within their respective schools, were offered training in MI and invited to use and monitor this method in their practice as an intervention for students who perpetrate bullying. Results indicated a number factors which influenced the uptake of MI in schools. Facilitators enabling the use of MI included practitioner's professional background, administrative support, training and implementation of MI. Barriers to the use of MI included time pressure and administrative expectations, school roles and system limitations, and preconceptions and the stigma of bullying.