Table 3 Barriers and facilitators in screening and prevention referral from the perspective of public health professionals

• Lack of knowledge about and depressive and suicidal symptoms

• Lack of experience with adolescents with depressive and suicidal symptoms

• Professionals find screening exciting (especially when they first start)

• Insufficient opportunities for inter-professional communication and consultation

• Management lacks insight in screening activities

• Lack of knowledge about the content of the preventive intervention

Professional capabilities

• Training in Dutch guidelines for suicide prevention

• Additional self-initiated training

• Several years of experience with screening for depressive and suicidal symptoms

• A supporting network to fall back on

• More extensive training about depressive and suicidal symptoms and personal interviews about these symptoms

• A proper introduction program (including job shadowing)

• Sufficient opportunities for inter-professional communication, intervision/supervision and consultation

• Improving professionals knowledge about the preventive intervention they refer to

• School staff is not informed

• Practicalities around screening are not arranged

• No permanent trainer at school for the preventive intervention

• Practicalities surrounding the preventive intervention are not arranged

• Insufficient awareness about the work of cooperating organizations

Organization and collaboration

• Practicalities around screening and the preventive intervention are arranged at school

• Schools and school personnel take screening seriously

• Schools support the preventive intervention and are committed to having as many adolescents with elevated depressive symptoms participate as possible

• Strong collaboration and joint approach between schools (including all school staff) and the public health organization

• Contact between trainer and adolescent prior to the start of the preventive intervention.

• Commencement of the preventive intervention soon after screening

• General awareness of the screening process among cooperating organizations

• Close ties between public healthcare and schools and cooperating organizations

• Stigmatizing thoughts of public health professionals

• Stigmatizing thoughts of school staff

• Negative beliefs (including stigma and taboo) of adolescents and parents:

 • Denying or downplaying screening results

 • Not recognizing symptoms

 • Not open for help

 • Not wanting a group and/or school intervention

Beliefs about depressive and suicidal symptoms and participation in preventive intervention

• Adolescents being open and willing to talk

• Parents taking the screening seriously

• Parents supporting participation in preventive intervention

• Motivational strategies of public health professionals:

 • Tailored approach during personal interviews

 • Being directive to ensure cooperation versus respect for autonomy of the adolescent

 • Linking elements of the intervention to symptoms of the adolescent

 • Explaining the added value of a group intervention

• More attention to mental health in general and specifically prior to screening (e.g. a mental health lesson for adolescents and parents)

• Raising awareness of the preventive intervention (e.g. in a mental health lesson or by referring to it in newsletters or school guides)