Where Are School Social Workers? Understanding Barriers and Facilitators to Participation In Child Suicide Death Reviews

Background: In 2024, suicide was the second leading cause of death among adolescents ages 10-24 in the United States. Nationwide, child death reviews (CDRs) are used as tools for suicide prevention by bringing together a multidisciplinary team for a systems-level review. CDR teams conduct in-depth reviews of the circumstances leading up to a child’s death and develop recommendations to improve prevention efforts.

School representative participation in CDR meetings is paramount to gathering a better understanding of the young person’s life. Adolescents spend a considerable amount of time in school, for this reason, school representatives often have information that may not be documented in medical examiner, law enforcement, or child and family services reports (i.e., bullying, relationship changes, sexual orientation).

School social workers (SSWs) are one group of school professionals who are invited to CDR meetings. SSWs are in a unique position where they engage with students as mental health clinicians, work within the school system, and engage with families–making them a valuable source of information for CDR meetings. However, a 2023 study by the National Center for Fatality Review and Prevention found that school representatives participated in only 28% of suicide CDR meetings.

Our goal was to explore barriers and facilitators to SSW participation in suicide CDR meetings in order to guide practice and inform policy interventions encouraging participation in CDR meetings.

Methods: Semi-structured interviews were conducted with district and school-based social workers employed in California (n=15). Participants were recruited through purposive and snowball sampling. 92% of participants identified as women, 26.7% identified as White, Non-Hispanic, and 46.6% identified as Hispanic. Analysis was conducted using the Rapid Identification of Themes from Audio Recordings (RITA) method.

Results: Of the 15 SSWs, 47% had at least one suicide occur in their school district. 93% of participants believed CDRs served an important function, but only 47% were aware of these meetings.

Common themes included concerns over litigation or liability and concerns over confidentiality. One participant stated, “I think in school settings there’s a lot of concern around liability of things and potential litigation... so I think sometimes that makes people feel like ‘I shouldn’t provide information, or I shouldn't be part of something if it could end up coming back and being a problem.’”

Participants also discussed potential facilitating measures such as developing detailed guidelines for SSWs. They recommended including the purpose of meetings, samples of questions asked during the review meeting, and guidelines on what information they would be able to share.

Conclusions and Implications: SSWs are a valuable source of information for CDR meetings and increasing their participation can enrich the data gathered during reviews and better inform recommendations that lead to more effective suicide prevention. While SSWs face barriers that are specific to their role, results from these interviews can be used to inform CDR teams on how to increase school participation by addressing barriers and implementing reasonable facilitating measures.