Children & Adolescents

Children & Adolescents

Mental Health/Crisis and Suicide

MENTAL HEALTHChildren & Adolescents

Children’s Mental Health

Mental health is an essential part of children’s overall health. This

has a complex interactive relationship with their physical

health and their ability to succeed in school, work, and society.

Physical and mental health affect how we think, feel and act on the

inside and outside.

(www.apa.org)

Children’s Mental Health

• An estimated 15 million of our nation’s young people can currently be diagnosed with a mental health disorder.

• Only about 7% of these youth who need services receive appropriate help.

www.cdc.gov

www.teensuicide.us

Factors Related to the Development of Childhood Disorders

• Temperament- Likely based on biogenetic factors that constitute a disposition that influences the child’s interaction with his/her world by affecting the nature and style of interacting with others.

• Identity- Internal mental construct that involves the child’s developing sense of self over time and situations.

• Gender- A component of identity, it often defines individuals and embodies specific behavior characteristics.

• Neuropsychological deficits- Deficits in cognitive functioning an involve the processes by which the child will process, organize, and recall information.

• Affect- The child’s repertoire of emotional responses both automatic and learned.

• Coping style- The child’s characteristic mode of adapting to internal and external stressors.

Factors Related to the Development of Childhood Disorders – Cont.

• Environmental stressors-This includes child’s family, school, religious training, and he stability of the systems.

• Motivation- Reflects the “why” of behavior.• Social facility- The child’s repertoire of social

interaction skills which will assist the child in relating to, and coping with others.

• Cognitive development-The child’s current cognitive level.

• Basic schemas- The rules the child uses to understand his/her world.

Children’s Mental HealthSymptoms of teen depression:

• Withdrawing from family and friends• Losing interest in social and extracurricular

activities• Displaying a lack of energy• Anxiety• Irritability• Anger• Significant weight changes• Sleep pattern changes• Indifference about the future• Guilty feelings• Decrease in self-esteem• Suicidal thoughts

www.cdc.gov www.teensuicide.us

Children’s Mental HealthTypes of teen depression:1. Major depression

Short duration but severe. 2. Dysthymia

Lasts longer and not as severe.

3. Adjustment disorder with depressed moodResults from a major life event.


PARENTS AND GUARDIANS


Parent/Legal Guardian• A “minor” is a person under 18 who has never

been married or declared an adult by a court. • Generally, minors do not have the legal capacity

to consent to medical treatment. • Texas law gives all parents the duty of providing

medical and dental care to their children which gives them the explicit right to consent to that treatment (including medical, dental, psychiatric, psychological and surgical treatment).

• As a general rule, if a minor requires treatment then a consent from a parent should be obtained.


Parent/Legal GuardianAuthorization agreement for

nonparent relative:• This is an agreement between the

parent of the child and the child’s grandparent, adult sibling, or aunt/uncle.

• Includes authorization of medical, dental, psychological, or surgical treatment; medical insurance, school enrollment, etc.


Parent/Legal GuardianThe authorization agreement must

contain:• Name and signature of the relative• Relationship of the relative to the child• Current address and phone of relative• Name and signature of the parent(s)• Current address and phone of parent(s)• A statement that the relative has been

given authorization to perform the function listed in the agreement voluntarily

• A statement of when the agreement expires

• Space for signatures and a notarywww.cdc.gov www.teensuicide.us

Parent/Legal GuardianEmergency circumstances:• Texas law does not require consent in

emergency circumstances where it is not possible to obtain consent from the parent or guardian.

• The statute states, “consent for emergency care for an individual is not required if…the individual is a minor who is suffering from what reasonably appears to be life-threatening injury or illness and whose parents or guarding, is not present.”


Parent/Legal GuardianThe appropriate staff should continue

efforts to notify a parent to secure consent for continuing treatment.

DCMHMR Procedure:• Clinicians should make every effort to

contact the parent/guardian prior to the risk of harm assessment.

• After making reasonable attempts, the clinician should consult with triage to determine the next steps.

• If the parent/guardian is not able to be contacted, the clinician should contact CPS before a risk of harm assessment.


SUICIDE


Considerations When Working with Youth• Youth are the only demographic group that can

generally predict their environment for their foreseeable future.

• The majority of youth spend 12 years with a relatively stable peer group, representing up to 90% of their living years in some cases.

• This cocooning effect can magnify positive experiences and negative experiences alike; a special consideration when dealing with youth.

• Coupling physical reality with recent technical advances creates a vulnerability for suicide in youth.

(2012 Suicide Prevention and Postvention Toolkit for Texas Communities, p.68)

Definitions• Suicide

Death caused by self-directed injurious behavior with any intent to die as a result of the behavior. (cdc.gov)

• Suicide attemptA non-fatal, self-directed, potentially injurious behavior with any intent to die as a result of the behavior. A suicide attempt may or may not result in injury. (cdc.gov)

• Self-Injurious BehaviorSelf-injury, also called self-harm, is the act of deliberately harming your own body, such as cutting or burning yourself. It's typically not meant as a suicide attempt. Rather, self-injury is an unhealthy way to cope with emotional pain, intense anger and frustration. (mayo clinic.com)

Definitions• Suicidal ideation

Thinking about, considering, or planning for suicide. (cdc.gov)

• Passive Thoughts of DeathAlso known as morbid thoughts. For example, “I wish I was dead” or “It would be easier if I weren’t around”. Although these may be serious, and may develop into suicidal ideations, they are not considered suicidal ideations.

Suicide• In 2010, 267 children between the ages of

10-14 completed suicide. • In 2010, suicide was the third leading

cause of death for young people ages 15 to 24, after accidents and homicide. It was the second leading cause of death for this same age group in Texas. It results in approximately 4600 lives lost each year. Of every 100,000 young people in each age group, the following number died by suicide:– Children ages 5 to 14 - 0.7 per 100,000– Adolescents/Young Adults ages 15 to 24 -10.5

per 100,000www.cdc.gov www.teensuicide.us

Suicide• Risk of attempted (non-fatal) suicides

for youth are estimated to range between 100-200-1.

• The 2011 Youth Risk Behavior Survey found that 15.8% of U.S high school students had seriously considered attempting suicide in the previous year, 12.8% had made a suicide plan, and 8% reporting trying to take their own life.

• 157,000 youth between the ages of 10-24 received medical care for self-inflicted injuries at emergency rooms.


Suicide• Young people are much more likely to

use firearms, suffocation, and poisoning than other methods of suicide. – Firearms 45%– Suffocation 40%– Poisoning 8%

• Children 14 and under are more likely to use suffocation.

• 90% of young children who complete suicide have some type of mental health disorder. Also likely to be victims of sexual or physical abuse and engage in antisocial behavior.


Suicide• More than 30% of LGBT youth report at

least one suicide attempt within the last year.

• More than 50% of Transgender youth will have had at least one suicide attempt by their 20th birthday.

• Youth suicides out number youth homicides.


• Highest state averages for ages 15-24 are Alaska (46.0 per 100,000), Wyoming (31.9 per 100,000), and South Dakota 26.9 per 100,000). (2010, cdc.gov)

Suicide Deaths by Method and Age in Texas 2005-2010

(Rates per 100,000 – CDC WISQARS)

Ages Suicides by Firearm

Suicides by Poisoning

Suicides by Suffocation

Suicides by Falling

Suicides by Drowning

Suicides by Cutting/Piercing

All other means

5-14 years

34 0 80 0 0 0 0

15-24 years

1,122 139 819 47 11 18 43

Suicide Deaths in Texas2005-2010 Rates Per 100,000

(Crude Rates per 100,000 – CDC WISQARS)

5 to 14 15 to 240

2

4

6

8

10

12

200520062007200820092010

SuicideSuicide among pre-adolescents (9-14):• Pre-adolescents lack the abstract

thinking skills to allow them to understand the finality of death.

• Pre-adolescents are inherently impulsive and may lack the cognitive skills necessary to imagine a better future or realize the fleetingness of most of their troubles.

• Pre-adolescents lack the strategies older kids have to seek help or cope with problems.


Suicide

Suicide among pre-adolescents (9-14):

• Most pre-adolescent suicides involve hanging, with a minority involving firearms, asphyxiation and poison.

• Suicide risk is relatively high for pre-adolescent boys who suspect they might be gay.


SuicideGender differences in suicide among

young people:• Nearly five times as many males as

females ages 15 to 19 died by suicide.

• Just under six times as many males as females ages 20 to 24 died by suicide.

• Of the reported suicides the 10 to 24 age group, 81% of the deaths were males and 19% were females.

• Girls are more likely to report attempting suicide than boys.


Suicide

Cultural variations in suicide rates also exist.

• Native American/Alaskan Native youth have the highest rates of suicide-related fatalities.

• Hispanic youth were more likely to report attempting suicide than black and white, non-Hispanic peers in grades 9-12.


Suicide: Youth Warning Signs

• Disinterest in favorite extracurricular activities• Problems at work and losing interest in a job• Substance abuse• Behavioral problems/risk taking behaviors• Withdrawing from family and friends• Sleep changes• Changes in eating habits• Begins to neglect hygiene and personal

appearance• Emotional distress causing physical complaints• Hard time concentrating • Declining grades in school• Loss of interest in schoolwork• Bullying


Suicide: Youth Warning Signs – Cont.

• Verbal hints-”I won’t trouble you anymore”, “I want you to know something”

• Giving/throwing away belongings• Writes suicide note• Extreme mood swings• Unhealthy peer relationships (www.cdc.gov and www.teensuicide.us)

• Becoming suddenly cheerful after a period of depression-this may mean that the student has already made the decision to escape all problems by ending his/her life.

• Refusing help, feeling “beyond help”• Complaining of being a bad person or feeling

“rotten inside”.

Doan, J., Roggenbaum, S., & Lazear, K. (2003). Youth Suicide prevention school based guide – Issue Brief 3a: Risk Factors: Risk and Protective Factors, and Warning Signs. Tampa, FL: Department of Child and Family Studies, Division of State and Local Support Louis de la Parte Florida Mental Health Institute, University of South Florida. (FMHI Series Publication ( #218-3a,4, 6c)

http://www.cdc.gov/

Suicide: Youth Warning Signs – Cont.

• Making statements about hopelessness, helplessness, or worthlessness.

• Not tolerating praise or rewards• Actually talking about suicide or a plan • Exhibiting impulsivity such as violent

actions, rebellious behavior or running away.

• Using social media to convey messages

4 out of 5 teen suicide attempts have been preceded by clear warning signs.

Doan, J., Roggenbaum, S., & Lazear, K. (2003). Youth Suicide prevention school based guide – Issue Brief 3a: Risk Factors: Risk and Protective Factors, and Warning Signs. Tampa, FL: Department of Child and Family Studies,

Division of State and Local Support Louis de la Parte Florida Mental Health Institute, University of South Florida. (FMHI Series Publication ( #218-3a,4, 6c)

Acute Risk Factors For Suicide – Mnemonic from the AAS

I – Ideations of Suicide (Threats to hurt self, talking or writing about death)

S - Substance Use Increase

P - Purposeless (perception of no reason for living, no sense of purpose)

A – Anxiety (agitation, inability to sleep)

T – Trapped (feeling like there is no way out of situation)

H – Hopeless (no sense/perception the future will be better)

W - Withdrawn (from friends, family, work, and society in general)

A – Angry (uncontrollable rage/anger/revenge seeking)

R – Recklessness (engaging in risky behavior, activities, seemingly without thought)

M – Mood Swings (dramatic, unpredictable mood changes)

Chronic Risk Factors Of Suicide for Youth

• Previous Suicide Attempts • Diagnosable Mental Illness • Previous Mental Health Hospitalizations • Chronic Isolation • Family History or exposure to suicide • Mental Health Issues • Childhood Abuse • Significant Medical Illness • Low Self-Esteem • Poor Coping Skills

(www.suicidology.org)

Chronic Risk Factors of Suicide for Youth

• Life Stressors/Losses/School and family problems/Living Alone

• Being Bullied• Sexual Orientation• Juvenile

Delinquency/Incarceration • Self-Injurious Behavior• Access to Firearms

Doan, J., Roggenbaum, S., & Lazear, K. (2003). Youth Suicide prevention school based guide – Issue Brief 3a: Risk Factors: Risk and Protective Factors, and Warning Signs. Tampa, FL: Department of Child and Family Studies, Division of State and Local Support Louis de la Parte Florida Mental Health Institute, University of South Florida. (FMHI Series Publication ( #218-3a,4, 6c)

Triggers for Suicide in Youth

• Being bullied• Break up with

girlfriend/boyfriend• Death of a parent• Divorce• Being ridiculed by peers/not

being accepted• A humiliating experience• Contagion

CASE STUDY – RATING HIGH, MODERATE OR LOW RISK


Issues of Suicide Cluster and Contagion in Youth

Suicide Contagion: A phenomenon whereby susceptible persons are influenced towards suicidal behavior through knowledge of another person’s suicidal acts. The CDC specifies that a contagion occurs when the death and/or attempts are connected by person, place, or time.

Suicide Cluster: The CDC specifies that a cluster has occurred when attempts and/or deaths occur at a higher number than would normally be expected for a specific population in a specific area.


• Youth are more vulnerable than adults because they may identify more readily with the behavior and qualities of their peers.

• Contagion is rare – only accounting for 1-5% of all suicide deaths annually. (After a Suicide Toolkit 2011: American Foundation for Suicide

Prevention and Suicide Prevention Resource Center: p.11, 35, 40-41, 43)

• Media coverage can contribute to contagion. Front page stories, simplistic explanations of suicide, graphic depictions and printing photos of the victim can be contributing factors.

(Suicide Prevention and Postvention Toolkit for Texas

Communities: p.71&78)


• Avoiding any sensationalizing, romanticizing or glorification of the suicide or the victim.

• Remember anniversary dates can also be a time of increased risk.

• Encourage students to get involved with living memorials which may help prevent other suicide deaths.

(Suicide Prevention and Postvention Toolkit for Texas Communities:

p.71&78)

Social Media and Suicide• A suicide death will be discussed using

this medium and there will often be a spontaneous memorial posted.

• Someone should monitor discussions on social media. Look for rumors, information on gatherings, derogatory messages and indications that a youth may need assistance. Language such as “I am going to join you soon,” “I can’t take life without you,” should be taken seriously and followed-up on.

(After a Suicide Toolkit 2011: American Foundation for Suicide Prevention and Suicide Prevention Resource Center: p.11, 35, 40-41, 43)

Social Media and Suicide• Be a part of the memorial by

posting positive and accurate help related information and hotline numbers.

• Find a student leader to help in these efforts and assure them that you are interested in supporting a healthy response to their peer’s death and not trying to thwart communication.

(After a Suicide Toolkit 2011: American Foundation for

Suicide Prevention and Suicide Prevention Resource Center: p.11, 35, 40-41, 43)

Social Media and Suicide• Facebook has specific policies concerning users

that have died. These are located at the Facebook Help Center: https://www.facebook.com/help/search?q=death+report

• Immediate family members can request removal of the site, the immediacy of social networking creates a critical time lag between the death and removal of the site, which can have serious consequences relating to contagion and cluster activity.

• It is critical that the deceased’s site be monitored until a final plan can be developed and executed on how to manage the Facebook page.

(A Suicide Prevention and Postvention Toolkit for Texas Communities, 2012, p.180-181)

https://www.facebook.com/help/search?q=death+report

https://www.facebook.com/help/search?q=death+report

Social Media and Suicide• Immediate family should notify

Facebook of the death. This is done by providing information through an online form located at the Facebook Help Center:

https://www.facebook.com/help/contact/?id=305593649477238

• A moderator should be identified for the person’s online accounts (usually parents or friend of the deceased).

• Provide information to explain how social networking sites can impact further suicidal ideations.

(A Suicide Prevention and Postvention Toolkit for Texas Communities, 2012, p.180-181)

https://www.facebook.com/help/contact/?id=305593649477238

Suicide Prevention• Parents and teachers can foster early

coping skills.• Raise awareness to de-glamorize

television and film on suicide. • 2:37 (2006) A drama telling the tale of

six high school students whose lives are interwoven with situations they face. The story takes place during a normal school day. At 2:37 pm a tragedy will occur, affecting the lives of a group of students and their teachers.


Suicide Prevention

• Arm youth with accurate information on warning signs, risk factors, how to intervene and link to assistance.

• Encourage participation in a gatekeeper training such as ASIST, QPR, ASK, or another evidence based program to develop skills.

Protective Factors

• Family connectedness and school connectedness

• Reduced access to firearms

• Safe schools• Academic achievement• Self-esteem

(American Association of Suicidology – www.suicidology.org

http://www.suicidology.org/

Protective Factors Cont.• Positive relationships with other school youth• Lack of access to any means • Help-seeking behavior • Impulse control • Problem solving/conflict resolution abilities• Stable environment• Access to care for mental/physical and Substance Use

Disorders• Responsibilities for others/pets• Spiritual connectedness/Religion

Remember that anything a youth indicates as a reason for living can be a protective factor!

Doan, J., Roggenbaum, S., & Lazear, K. (2003). Youth Suicide prevention school based guide – Issue Brief 3a: Risk Factors: Risk and Protective Factors, and Warning Signs. Tampa, FL: Department of Child and Family Studies, Division of State and Local

Support Louis de la Parte Florida Mental Health Institute, University of South Florida. (FMHI Series Publication ( #218-3a,4, 6c)

BULLYINGChildren & Adolescents

Bullying

• According to Merriam Webster :VERB1: To treat abusively2: To affect by means of force or

coercionInvolves an imbalance of power,

intentions to cause harm and repetition of incidents. See HB

1942 definition.

Types of Bullying - Physical• Physical bullying involves real

bodily contact between a bully and his or her victim, for the purpose of intimidation or control.

• Biting, Kicking, punching, wrestling, scratching, slapping, poking and choking may be involved

• May involve destroying personal property

• Sometimes called “hazing”

Types of Bullying - Social

• Verbal – name calling, making “fun”

• Rumors/gossip• Exclusion – keeping people

“out” on purpose• Manipulation/intimidation –

frightening someone to get what you want.

Types of Bullying: Cyberbullying

• Using interactive technologies to bully.• Text messages, e-mail or instant messages to

spread gossip or to threaten others• Stealing passwords and posting things the

person did not really say or locking them out of their own technology

• Posting on “bashing sites”• Sending people viruses, etc.• Posting videos or sound bites on sites like you-

tube with titles that embarrass others• Harassing on gaming sites or social networking

sites

Bullying StatisticsAccording to the 2011 CDC Youth Risk Behavior Surveillance (YRBS) in Texas:• 16.5% of High School Students reported being

bullied on school property in the last 12 months.• 7.1% did not go to school because they felt

unsafe at school or on their way to or from school on at least 1 day in the last month.

• Current research indicates that cyberbulling victims are 1.9 times more likely and cyberbullying offenders were 1.5 times more likely to have attempted suicide than those who were nor cyberbulling victims or offenders.

(Hinduja S, et.al, Bullying, Cyberbullying and Suicide)

Bullying Statistics• According to Yorber and Kern in 2003,

only 30% of students who had witnessed or been the target of bullying said teachers intervened “often” or “always” – contrasted with up to 85% of teachers who described themselves as doing so.

• The prevalence of bullying was higher among females (21.2%) than males (18.7%). (CDC.gov)

Consequences of Bullying• Grades drop• Missed School• Physical Problems• Youth who are bullied have higher rates

of suicide, depression, post-traumatic stress disorder, and substance abuse

• Boys who are identified as bullies in middle school are 4 times as likely than those who do not to have a criminal conviction before the age of 24!

(stopbullyingnow.gov)

Common Characteristics of a Bully• Impulsive and dominant• Easily frustrated• Lacks empathy• Views violence in a positive way• May have difficulty following

rules• May have issues at home• It is a myth that bullies have low

self esteem or are loners! They may bewell connected socially & have social power!

(stopbullying.gov)

The Truth Is…

Those who bully others do not need to be stronger or bigger

than those they bully. The power imbalance can come from a number of sources—

popularity, strength, cognitive ability—and children who bully

may have more than one of these characteristics. (stopbullying.gov)

Warning Signs – Bullying Others• Get into physical or verbal fights

• Have friends who bully others • Are increasingly aggressive • Get sent to the principal’s office or to detention

frequently • Have unexplained extra money or new

belongings • Blame others for their problems • Don’t accept responsibility for their actions • Are competitive and worry about their

reputation or popularity (stopbullying.gov)

Warning Signs – Being Bullied

• Unexplainable injuries • Lost or destroyed clothing, books, electronics, or

jewelry • Frequent headaches or stomach aches, feeling sick or

faking illness • Changes in eating habits, like suddenly skipping

meals or binge eating. Kids may come home from school hungry because they did not eat lunch.

• Difficulty sleeping or frequent nightmares • Declining grades, loss of interest in schoolwork, or

not wanting to go to school • Sudden loss of friends or avoidance of social

situations • Feelings of helplessness or decreased self esteem • Self-destructive behaviors such as running away from

home, harming themselves, or talking about suicide (stopbullying.gov)

Why Do People Bully?• Because they see others doing it.• Because it's what you do if you want to hang out

with the right crowd. • Because it makes people feel stronger, smarter,

or better than the person they are bullying. • Because it's one of the best ways to keep from

being bullied.• The bully may have been bullied themselves.• There are issues in the home environment.

(stopbullyingnow.gov)

What Can A Youth Do?• Encourage a student to stay in a large group and

not to walk alone.• Take a different route to class than the bully when

at school.• Tell an adult they trust. This is not tattling!• Encourage the child to look at the bully and tell

him or her to stop in a calm, clear voice. They can also try to laugh it off. This works best if joking is easy for them. It could catch the kid bullying off guard.

• If speaking up seems too hard or not safe, walk away and stay away. Find an adult to stop the bullying on the spot.

• Call a Crisis line.• Talk to a counselor.

(stopbullying.gov)

What Should They NOT Do…

•Blame themselves.

•React or fight back…it is not safe!

What Can Children Do For Each Other?

• Respect each other!• Swarm!!!• If they feel safe, stand up to

the bully• Tell an adult they trust to help• Make a pledge to not bully

others or be OK with others being bullied

What Can Parents Do?• Not accept that bullying is a "rite of passage” or a

“learning experience”.• Do not encourage the child to ignore the behavior or

blame the child for being bullied.• Have an open dialogue with children regarding

bullying and know the warning signs.• Be aware of HB 1942 and school policies.• Monitor use of social networking sites.• Keep in communication with educators.• Obtain help for their child.• Do not encourage fighting back.• Resist the urge to call other parents directly as this

could make things worse. Let the school mediate.

(stopbullying.gov)

What Any Adult Can Do…• Intervene immediately. It is ok to get

another adult to help. • Separate the kids involved. • Make sure everyone is safe. • Meet any immediate medical or mental

health needs. • Stay calm. Reassure the kids involved,

including bystanders. • Model respectful behavior when you

intervene.(Stopbullying.gov)

What We Should Expect Educators to Do..

• Assess the climate at school.• Take reports of bullying seriously and

investigate.• Monitor “hot spots” within the school.• Create an environment of mutual

respect in school and at school supported activities.

• Assure ALL school staff have training on what bullying is and is not.

• Praise positive behavior.(stopbullying.gov)

Common Mistakes• Don’t ignore it. Don’t think kids can work

it out without adult help. • Don’t immediately try to sort out the

facts. • Don’t force other kids to say publicly

what they saw. • Don’t question the children involved in

front of other kids. • Don’t talk to the kids involved together,

only separately. • Don’t make the kids involved apologize or

patch up relations on the spot .(Stopbullying.gov)

Get Emergency Attention When…

• A weapon is involved. • There are threats of serious physical

injury. • There are threats of hate-motivated

violence, such as racism or homophobia. • There is serious bodily harm. • There is sexual abuse. • Anyone is accused of an illegal act, such

as robbery or extortion—using force to get money, property, or services

(Stopbullying.gov)

What Should Happen Next?

• Get the facts.• Determine if it is bullying.• Support the child that is being

bullied.• Addressing bullying behavior

appropriately.

(stopbullying.gov)

Bullying and Suicide• Both victims and perpetrators of bullying are at

higher risk for suicide than their peers. Children who are both victims and perpetrators of bullying are at highest risk

(Kim &Leventhal,2008; Hay & Meldrum, 2010; Kaminski & Fang, 2009).

• All three groups (victims, perpetrators and perpetrator/victims) are more likely to be depressed than children who are not involved in bullying (Wang, Nansel et. al., in press). Depression is a major risk for suicide.

• Bullying is associated with increases in suicide risk in young people who are victims of bullying as well as increases in depression and other problems associated with suicide (Gini & Pozzoli, 2009; Fekkes,

Pipers & Verloove-Vanhorcik, 2004).

Bullying and Suicide • There is a difference between causation

and correlation.• Most research demonstrates that

bullying is a risk factor for many outcomes, but it is not the only “cause”.

• Not all who experience or engage in bullying will have this outcome.

• Not everyone who had this outcome was bullied.

(samhsa.gov)

SCHOOLSChildren &Adolescents

HB 1386

• House Bill 1386 passed in the 82nd Legislative Session 2011. It was effective September 1, 2011.

• “An act relating to the public health threat presented by youth suicide and the qualification of certain persons serving as marriage and family therapists in school districts.”

HB 1386• Each school district shall have a district

improvement plan that is developed, evaluated, and revised annually, in accordance with district policy, by the superintendent with the assistance of the district-level committee (Section 11.251 Texas Education Code)

• The district improvement plan must include strategies for improvement of student performance that include methods for addressing the needs of students for special programs, including suicide prevention programs (Texas Education Code 11.252 (a)(3)(b))

Best PracticeHB 1386 states that DSHS will coordinate with TEA to provide and annually update a list of recommended early mental health

intervention and suicide prevention programs for implementation in public

elementary, junior high, middle, and high schools within the general education

setting. These programs are to be based upon best practices. Each school district

may select from the list of program or programs appropriate for implementation in the district. The list can be found at:

http://www.sprc.org/bpr.

Best Practice RegistryThe BPR is organized into three sections,

each with different types of best practices. In essence, the BPR is three registries in one. The three sections do not represent levels, but rather they include different

types of programs and practices reviewed according to specific criteria for that

section.Section I: Evidence-Based Programs: Lists interventions that have undergone

evaluation and demonstrated positive outcomes.

http://www.sprc.org/bpr/section-i-evidence-based-programs

http://www.sprc.org/bpr/section-i-evidence-based-programs

Best Practice RegistrySection II: Expert and Consensus Statements

Lists statements that

summarize the current knowledge in the suicide

prevention field and provide best practice recommendations

to guide program and policy development.

http://www.sprc.org/bpr/section-ii-expertconsensus-statements

http://www.sprc.org/bpr/section-ii-expertconsensus-statements

Best Practice RegistrySection III: Adherence to Standards Lists suicide prevention programs and

practices whose content has been reviewed for accuracy, likelihood of

meeting objectives, and adherence to program design standards. Inclusion in

this section means only that the program content meets the stated criteria. It does

not mean that the practice has undergone evaluation and demonstrated positive

outcomes. (Such programs are listed in Section I.)

http://www.sprc.org/bpr/section-iii-adherence-standards

RISK OF HARM ASSESSMENT REVIEW AND OTHER DOCUMENTATION

Children and Adolescents

For C&A Staff – NEO Review

• Definition of crisis• Crisis –vs- Emergency• Steps of the crisis model, goal of

intervention and ways to achieve goal of intervention

• Factors that influence how a crisis is handled

• Communication Review – GENE and beyond

• Review decision tree

Documentation

• Review Emergency Screening Form (Pink Sheet), Crisis Plan/Safety Plan and Assure Safety Form.

• Emergency Screenings are coded 3300, Follow-ups are 3301 if SP0, 5 or regular services. Code will be 206 if SP9. If between the ages of 10-24 and don’t have Medicaid the Code will be 275.

• CANS will need to be completed. Suicide Risk, Self Mutilation, Other Self Harm, Dangerous to Others, Fire Setting, and Psychosis are the dimensions that will need to be completed for SP0.

Documentation• NTSH will do voluntary

admissions for C&A.• Emergency Screenings must

accompany a child to North Texas State Hospital.

• Must complete a Continuity of Care Tracking System Form (CCTS) when going to NTSH. See example.

Safety Planning• Barbra Stanley Safety Plan

– Completed when the clients symptoms have increased and an Emergency Screening is not appropriate.

– Clinician will go over the following:• Warning signs that a crisis may be developing• Internal coping strategies• People and social settings that provide a distraction• Individuals they can contact and ask for help• Professionals or agencies they can contact in a crisis• How they can make the environment safe• Protective factors

– Frequent phone and/or face to face follow ups will be needed until their symptoms have decreased to a level where the client is no longer a risk of harm.

• Review handout of positive coping skills appropriate for children and adolescents.

Child and Adolescent Crisis Services (SP0) Totals

Dec. 2007

-Nov. 2008

Dec. 2008

-Nov. 2009

Dec. 2009

-Nov. 2010

Dec. 2010

-Nov. 2011

Dec. 2011

-Nov. 2012

40 107 138 146 128

WRAP UPChildren & Adolescents

With C & A in Crisis….• Try to instill hope and help decrease the pain

they are in.• Capitalize on protective factors• Know there will be ambivalence and normalize

this.• Understand that this population can be more

impulsive and take precautions to keep them safe.

• Seek out other sources of information (parents/law enforcement/counselors/teachers) if you feel the individual is not giving all the information or is not being truthful.

RESOURCESChildren & Adolescents

Resources American Association of Suicideology –

www.suicideology.org American Foundation for Suicide Prevention –

www.afsp.org Centers for Disease Control – www.cdc.gov Grant Halliburton Foundation –

www.granthalliburton.org Mental Health America of Texas – www.mhatexas.org National Institute for Mental Health –

www.nimh.nih.gov Substance Abuse and Mental Health Services

Administration – www.samhsa.gov Suicide Prevention Resource Center – www.sprc.org Texas Department of State Health Services –

www.dshs.state.tx.us The Trevor Project – www.thetrevorproject.org The Jed Foundation – www.jedfoundation.org

http://www.suicideology.org/

http://www.afsp.org/

http://www.cdc.gov/

http://www.mhatexas.org/

http://www.sprc.org/

http://www.dshs.state.tx.us/

http://www.thetrevorproject.org/

Documents

Children & Adolescents