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Abstract: 

In the western North Carolina region of rural Appalachia, the 12-month prevalence rate of suicide attempts among adolescents is much higher than the national average. Despite this major public health problem, there is a dearth of sufficient and standardized protocols, especially within the school context, to serve adolescents who are experiencing significant mood disorders and the common correlate of suicidal ideation. The Prevention of Escalating Adolescent Crisis Events (PEACE) protocol was developed as a comprehensive risk assessment and intervention plan for student-expressed threats of suicidal or homicidal ideation and was designed to be implemented by a school-based mental health clinician in collaboration with other school personnel. Over the course of the 2012–2013 academic year in a school in rural Appalachia, the PEACE protocol was used in 33 separate crisis events (n = 20), with zero completed suicides. This paper discusses the clinical implications, importance, and specifics of using the PEACE protocol.

Keywords: Rural schools, adolescent depression, suicide, school mental health services, Assessment, Support and Counseling (ASC) Center, Prevention of Escalating Adolescent Crisis Events (PEACE) protocol

Affiliations:  1: Appalachian State University; 2: Appalachian State University; 3: Ohio University; 4: Ashe County High School Assessment, Support and Counseling Center; 5: Appalachian State University.