While research studies have investigated suicide prevention and intervention in secondary schools, there is very limited research that explores this support specifically at the elementary school level. This paper reviews the prevalence and associated risk factors of youth and adolescent suicide in the United States and best practices of school counselors providing suicide prevention and intervention in schools. The theory of adolescent suicide and social cognitive theory's self-efficacy will frame the discussion of the literature to provide a holistic picture of the elementary schools' needs of implementing suicide prevention and intervention. This research study is designed to fill a gap in the reviewed literature that shows the need for providing prevention and intervention in elementary school and the education that is currently being provided, as well as the level of self-efficacy among elementary school counselors providing suicide intervention to students at-risk. The following research questions guide the study:

1. What percentage of elementary education school counselors in the surveyed districts report having implemented suicide education as prevention in their elementary school with 4th and 5th graders, and what do these programs entail?
2. What are the perceptions of school counselors regarding the necessity of suicide education programs in elementary school?
3. What is the level of self-efficacy reported by school counselors regarding managing a crisis event of suicidality, such as a suicide attempt or student who died by suicide, as measured by the King Instrument?
4. To what extent are (a) years of experience in the field, (b) suicide education training in graduate school, (c) participation in professional development activities and/or in services, and (d) previous experience with a student expressing suicidal thoughts predictive of a counselor's self-efficacy for providing suicide education in the elementary school?

Responses from 98 elementary school counselors employed within three school districts in the mid-Atlantic region were surveyed to examine the current suicide prevention programs in place and explore counselor self-efficacy related to providing suicide intervention for at-risk students. The King Instrument (King, 1999) was adapted for elementary school counselors and used to answer the research questions. A total of 7 of participants reported providing suicide prevention to the upper elementary grades. A much larger number of this sample, 83 (84.7%), perceived that it is the role of the school counselor to identify students at risk of suicide. Participants reported high overall self-efficacy for providing suicide interventions. Only one variable, graduate school training (B=0.249, p<.01), was found to significantly predict self-efficacy. A review of the current study will discuss implications for school counselors and counselor educators, and provide suggestions for future research.