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YOUTH SUICIDE PREVENTION SCHOOL-BASED GUIDE. Guidance Counselor’s Meeting Student Support Services. http://theguide.fmhi.usf.edu/. Overview. Identifies elements of a comprehensive, school based suicide prevention program - PowerPoint PPT Presentation
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YOUTH SUICIDE PREVENTION
SCHOOL-BASED GUIDE
Guidance Counselor’s Meeting
Student Support Services
http://theguide.fmhi.usf.edu/
OverviewIdentifies elements of a comprehensive,
school based suicide prevention programExamines scientific literature to determine
elements that are the most effective.Contains Checklists and Self Assessment Guide for Administrators for program
implementationReviewed by experts
StatisticsSuicide accounts for 13% of all adolescent
deathsThird overall cause of adolescent deathsIncreased in children from age 10-14 100%
1980-1996Estimated 3,500 adolescents attempt
suicide daily
Statistics Continued35 die dailyMore teenagers die from suicide then
cancer, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined.
1980-1985 rate for African American Youth increased 230%
90% that die have mental health problem: depression, substance abuse
Reality of Suicide
Unexpected death is always painful, but perhaps none more then self-destruction of a young person and a life, with all of its potential and promise, cut short by one desperate and too final act.
Why School Based PreventionSchool can offer prevention, intervention
and education.
In schools suicide issues may be evident more so then in other settings.
Issues may occur with the greatest frequency.
Schools offer a large exposure (teachers, counselors, peers) to youth.
Public Health ApproachPositive role schools can play.
Example of disease programs (inoculations, TB, Small Pox)
Up to date, accurate, research based information, guidelines and tools.
Reviews literature, evlauates and draws conclusions
Public Health ApproachIdentifies the problemIdentifies risk factorsIndentifies causes of the problemDevelops interventions evaluated for
effectiveness
OVERVIEW AREASInformation DisseminationSchool ClimateRisk Factors: Risk and Protective Factors,
Early Warning Signs.Risk Factors: How can a school Identify a
Student At Risk for Suicide?
Overview Areas ContinuedAdministrative IssuesSuicide Prevention GuidelinesIntervention Strategies: Establishing a
Community ResponseIntervention Strategies: Crisis Intervention
Teams
Overview ContinuedIntervention Teams: Responding to Student
CrisisPreparing for and responding to death by
suicide: Steps to Responding.Preparing for and responding to death by
suicide: Responding to and working with the media.
Family PartnershipsCulturally and linguistically Diverse
Populations
Information Dissemination in the SchoolsSuicide third leading cause of death in
adolescentsSchool based programs have ideal
exposure to large number of adolescents.Should be facilitated by staff that are
knowledgeable in the area.Research suggest teachers may feel they
are not prepared to assess or address suicide issues.
Information Dissemination in the SchoolsTraining faculty and staff essential in
effective prevention programs.Skills to develop knowledge, attitudes, and
identification for appropriate referrals.Essential to train administrators and
parents for support of prevention efforts.Brief two hour training is effective in
increasing teacher’ awareness of adolescent suicide.
MYTHS
Talking about suicide in the classroom will promote suicidal ideas and suicidal behavior.
MYTHS
Parents are often aware of the child’s suicidal behavior.
MYTHS
Most adolescents who attempt suicide fully intend to die.
MYTHS
There is not a significant difference between male and female adolescents regarding suicidal behavior.
MYTHS
The most common method for adolescent suicide ins drug overdose.
MYTHS
Because female adolescents complete suicide at a lower rate than male adolescents, their attempts should not be taken seriously.
MYTH
Suicide behavior is inherited.
MYTH
Adolescent suicide occurs only among poor adolescents.
Myth
The only one who can help a suicidal adolescent is a counselor
or mental health professional.
SCHOOL CLIMATEConnectednessParticipationAcademic AchievementSafetyTraining
SCHOOL CLIMATEDisciplinePhysical EnvironmentSecurity
Connectedness
Felt treated fairly, close to people at school, part of school.
Less likely to experience suicidal thoughts and emotional distress.
Less likely to drink alcohol, carry weapons, engage in delinquent behavior.
Foster afterschool activities, involvement in decision making and create small size learning groups.
ParticipationResearch: Students participate in decisions
are healthier, more productive.Assign students to meaningful school roles:
monitor, classroom helpers, planning committees.
Example of Crime Stoppers.Protective factor for “At Risk Students”
Academic AchievementSet academic goals and supporting
strategies.
Provide encouragement
May use media or other mechanism
Positive Behavioral Supports
SAFETYUnsafe schools – Emotional and Physical
RealmsUnsafe leads to poor academic
performance and truancy.BullyingRelationship between bullying and
emotional factors
SAFETYCreate ways for the student to feel
comfortable to report potentially dangerous situation.
For example, list of adults they may contact if they feel unsafe or have knowledge of a potentially dangerous situation.
Ways for the staff to intervene in potentially dangerous situation.
For example, mental health, signs of distress in students, review of policies.
TrainingStudents should be taught skills training
how to resolve conflict, problem solving, coping strategies (Life Skills).
Incorporate skills in existing classes i.e. health, drivers education, physical education.
Increasing social skills related to positive impact on cognitive development, academic achievement.
Curriculums need to be research based, active learning strategies, school wide and have adequate teaching resources.
DisciplineMethod to teach appropriate social
behaviors.Positive and proactiveFor example, positive behavioral supports.Example of Bullying Intervention, Problem
Solving Skills, Conflict Resolution, Appropriate Social Behaviors.
Avoid humiliating, harassing, scolding, nagging, physically aversive discipline, decreasing learning opportunities.
Physical EnvironmentResearch suggests students attitude about
the school may be related to the appearance of the school.
For example, flakey ceilings, graffiti tainted walls, scuffed up floors, dirty bathrooms, crumbling sidewalks, and leaky toilets:
May lead to “Why bother, no one cares” attitude.
Example, of Men’s Bathroom and breaking sink incident.
Negativism about the school may impact attitude towards teaching, learning, attendance and morale.
SecurityEnsure the school is free from weapons.Random search policyLinks to the community
resources/partnerships (Guam Police Department, Customs -random sweeps, Child Protective Services)
Utilize parent support
Security IssuesNumber and type of exitsLightingRooms and furnishings, Locker useParkingPositive posters: Behavioral ExpectationsPatterns of supervisionTraffic patternsIsolated areas
Security IssuesLocation and design of bathroomsGuardrailsHallwaysClosed campus
REGULAR SAFETY ASSESSMENTS
SAFE ENVIORNMENTStaff in-service trainingEstablished policies (bullying, random
searches)Opportunities to staff to share their concernEmphasize positive relationshipsSystem in place to refer students suspected
abuse and neglectTreat students with respect, support and
care.
SAFETY ENVIORMENTMonitor safetyConsistently enforce disciplinary,
harrassment, and civil rights policies.Inform students who they may contact if
there is a safety issue.Help students feel safe about approaching
and adult
Safety Learning EnvironmentAddress problem solving and social skillsEnsure high academic standardsDevelop links to the communities.Encourage and utilize parental involvement
Safety EnvironmentEducate students on tolerance,
harassment, bullying, and respecting others.
Ensure physical environmentPolicies and procedures on weapons and
safetyDevelop after school activitiesUse positive pro-social approach that de-
emphasizes punishment.
Risk and Protective Factors and Warning SignsSuicide is an extremely complex
phenomenaNine out ten adolescents show clues to
their attemptsNo tangible all encompassing method to
assess.Focus on risk factorsImpacting risk factors such as treating
depression or substance abuse, stressful life events may have positive effects.
RISK FACTORSPrevious suicide attempt or gestureFeelings of hopeless or isolationPsychopathology (depressive
disorders/mood disorders)Parental psychopathologySubstance abuse disorderFamily history of suicidal behaviorLife stressors: interpersonal losses,
relationship, social, work,Legal, disciplinary problemsAccess to firearms
RISK FACTORSPhysical AbuseSexual AbuseConduct disorders or disruptive behaviorsSexual orientation: homosexual, bisexual and
transgendered youth.Juvenile delinquencySchool or work problemsCongtigation or imitation (exposure to media
accounts or friends with suicidal behavior.Chronic physical illnessLiving alone or runawayAggressive-impulsive behaviors
PROTECTIVE FACTORSFamily cohesion (mutual involvement,
shared interests, emotional support)Good coping skillsAcademic achievementPerceived connectedness with schoolGood relationships with school or other
youthLack of means for suicidal behaviorHelp seeking behaviorImpulse control
PROTECTIVE FACTORSProblem solving/conflict resolution abilitiesSocial integration/opportunities to
participateSense of worth/confidenceStable environmentAccess to care for mental/physical
substance disordersResponsibilities for others/petsReligious activity (controversial topic
currently)
EARLY WARNING SIGNSWithdraw from friends of familyPreoccupation with deathMarked changes in personalityDifficulty concentratingDifficulties in school (decline in quality of
work)Frequent physical complaints often related
to emotions (stomach aches, headaches, fatigue
Persistent boredomLoss of interest in things one cares about
LATE WARNING SIGNSActually talking about a suicide or planExhibiting impulsivity: violent acts,
rebellious behavior, running away.Refusing help, feeling beyond help,Complaining “being a bad person”, rotten
inside.Making statements of hopelessness,
helplessness, worthlessness.
LATE WARNING SIGNSVerbal hints: “I wont be a problem to you
much longer”“Nothing matters”, “It is no use”, “I won’t see
you again”.Becoming suddenly cheerful after a period
depression.(May mean student has made decision to
escape all problems by ending their life).Giving away favorite possessionsMaking last will or testamentSaying: “I am going to kill myself”, “I wish I
were dead”, I shouldn’t have been born”
How can school identify a student at risk for suicide?Suicide Awareness Curriculum
Gatekeeper training
Screening
CURRICULIUM Dose and length very important
Avoid: one shot sessions – may overwhelm students, reaction to stress, media dramatized
Long term programs – semester long
Incorporate into established classes: health, life skills problem solving skills, help seeking behaviors,
CURRICULIUMAvoid presentations by youth who may
have made previous attempts – may result in copy cat behavior.
Provide list of crisis intervention services
Have established policies and procedures on how to deal with suicidal adolescent
Introduce curriculum only after policy and protocol are established.
CURRICULIUMHave established community links that may
provide assistance.
Have trained staff available that know what to do with the suicidal adolescent.
GATEKEEPER TRAININGProvide staff with most current information
on adolescent suicide.
Have policies and procedures in place.
Establish community links (referrals): Mental Health, Police, EMS
Encourage staff to collaborate and cooperate.
GATE KEEPER TRAININGEducate staff regarding risk factors
Educate staff regarding warning signs
Educate staff on how to make referrals (who and when)
Provide regular (twice a year) brief trainings to all staff.
ScreeningMethod of Identifying at risk students: ASK
THE QUESTION
Effective and efficient in identifying students
Concerns: suicide behavior highly complex, need to assess at various frames of reference.
14 year old bipolar female example (CONFIDENTIAL)
SCREENING INSTRUMENTSThe Suicide Ideation Questionnaire
The Suicide Risk Screen
The Columbia Teen Screen
Signs of Suicide(SOS)
SCREENINGUse a questionnaire that is research
validated
Get parents consent first before proceeding
Have established referral system
Research suggests screening will NOT create suicidal ideations in adolescents who are not suicidal.
SCREENING
Staff made aware screening is not 100% in determining if a student will express suicide ideations.
Counselors aware of valid screening instruments.
Conduct repeated screening: once or twice a year.
ADMINISTRATIVE ISSUESImplementation
Developing Polices and Procedures:
Elements – issue is a priority, types of prevention efforts,Crisis management handbook, describe roles and responsibilities, how to respond to students,
Administrative IssuesDescribe criteria for assessing lethality of
student potentially At risk.
Describe how program will be evaluated.
Clear and detailed
School level and district level
Crisis Response TeamCrisis response plan
Roles and responsibilities
Team leader(s)
Supported by Adminstration
Evaluating ProgramsResearch based
Documentation and policy
Consultation
Evaluation component
Other indicators of risk factors (substance abuse, mental health
Program SupportAdministration
Teachers
Parents
Community partners
Duty, Responsibility, and LiabilityDuty of supervision by the school
Same level as parents at home
Failure to prevent due to lack of action = liability
Failure to notify parent = liability
Liability if violate a FERPA, HIPPA other Laws
Duty, Liability, ResponsblityPreventative measure to establish
programs
Keep accurate up to date records
Baker Act (72 hour hold)
Involuntary admissions Criteria: refused voluntary, likely to harm self if no admission, gravely disabled.
Suicide Prevention GuidelinesPolicy and ProceduresGatekeeper TrainingEducating Parents and community
membersStudent Curriculum Addressing SuicideTeaching Adaptive Skills to StudentsPeer Support GroupsScreening
Postvention Strategies (Strategies to responding to a Suicidal CrisisEstablished response teamCrisis Center and Hotlines:Reach important and underserved populationHelp those students that use themEndorsed by youth as more acceptable then
mental health centersCan serve as drop in center
Suicide Prevention GuidelinesSchool ClimatePolicy and ProceduresIn school response teamsParent involvementTraining: teachers, and staffCurriculum incorporated in existing classesProvide information re. coping skills,
problem solvingProvide screening program (research based
assessment)Counselors trained in best practices
SUICIDE PREVENTION GUIDELINESProvide Peer Assistance ProgramsProvide information re. community
resourcesEnsure school maintains positive climateInform parents of importance of restricting
weapons/violence.Ensure staff and personnel are supportive
and feel comfortable with prevention strategies.
INTERVENTION STRATEGIESCannot function without outside support
(community)
Positive community relationships enhance prevention
Provide information on services of community links.
INTERVENTION STRATEGIESCrisis Intervention and Response Teams
Coordinate district wide
Based on resources
Training and regular team meetings
Mobilization and screening
INTERVENTION STRATEGIESTEAM SUPPORTAdministration acknowledgment Method of notificationTraining of staff to make referrals to the
Crisis TeamTraining in identification of students and
risk factors
INTERVENTION STRATEGIES RESPONDING TO STUDENT CRISISPlanning how to respondStudent behaviorEstablished intervention proceduresClear written plan of action
WHAT TO DOAlways ensure a student’s safety: Plan,
means and method
Asking directly “Have you thought about a way to hurt yourself”
Remain with the student
Send for help : Crisis Team
WHAT TO DO CONTINUEDListen: Acknowledge feelings and problems in the
students own terms.
Allow the student to express feelings – open communication, permission to express.
WHAT TO DO CONTINUEDBe Direct
Remain Calm
Be Empathetic
Be honest
Always take the student seriously
WHAT TO DO CONTINUEDKnow your limits – if in immediate danger
escort student to appropriate referral (nurses office, counseling area, principal).
Make sure the student knows what is going on at each stage of the intervention.
Eg. Escort to the team, Events and responses that will happen.
A chaotic and confusing situation requires clear communication
WHAT TO DOINFORM PARENTSCommunity Agencies/Resources
Risk Factors
Safety of student
What has happened and reason for response
Restricting access to lethal means: ensure monitoring
WHAT NOT TO DODon’t be judgmentalDon’t preach to the studentNever leave the student alone or send the
student awayDon’t under react or minimizeIf threatening suicide and does have a
weapon, never try to physically take the weapon away from the student.
(Avoid endangering your life, life of the student or lives of others in the school).
WHAT NOT TO DODon’t ever dare the student to attempt
suicide.
Don’t debate with the student about whether suicide is right or wrong.
Don’t promise secrecy or confidentiality
Don’t panic
RESPONDING TO VARIOUS LEVELS OF RISK
LEVEL 1 – Low or moderate risk
LEVEL 2 – Severe Risk
LEVEL 3 – Extreme Risk
LEVEL 1 – LOW or MODERATE RISK
Staff member observes warning signs student may be at risk
Student may have verbalized suicidal thoughts, does not have a plan, does not have access to potentially lethal weapon.
ACTION: Notify team, meet with student, and assess.
Monitor periodically (once a week)
LEVEL 2 – SEVERE RISKStudent overtly voiced the intent to engage
in suicidal act.Gone beyond mere thoughts has thoughts
of action and plan.Has a plan – but does not have means to
carry out plan.
ACTION: Notify team, administrator, supervision of student, contact parents, restriction of means, referral to appropriate resource, follow up on referral, monitor progress.
LEVEL 3 EXTREME RISKStudent has voiced the intent to engage in a suicidal
act.Student has access to lethal means needed to carry
out this act.Student may have access to lethal means on person.
ACTION: Notify team, mobilize community resources (GPD, EMS, DMHSA, notify parents, follow crisis intervention procedures. Follow up on referral
ENSURE SAFETY – DO NOT INCREASE LEVEL OF POTENTIAL HARM
PREPARING AND WORKING WITH THE MEDIARefer all contacts to the Administrator –
subsequently to the Superintendent or designee.
Generally (if designee): communicate dangers of imitation behaviors and how inappropriate reporting may contribute to more suicidal behavior.
Acknowledge: struggles and positive aspects (may provide sense of balance)
PREPARING AND WORKING WITH THE MEDIA: WHAT NOT TO DO-Do not present as tool for accomplishing
certain ends.
Avoid focusing on only the positive (provide balanced picture).
Avoid using language that may contribute to more suicides:
Headlines, connotations of sinful behavior, contrasting suicide deaths with non fatal attempts do not utilize terms such as:
Successful, unsuccessful, or failed
Family PartnershipsPresent information at appropriate forumsDistribute written informationInvolve the mediaSchedule parent workshopsReach out to faith-based communitiesContact advocacy groupsFrequent teacher parent contactInform parents of students participation in
prevention events’Expand concept of volunteerism
Culturally and Linguistically Diverse PopulationsHigher rates in some groups (African
American increased 230% in 1980 to 1995.
1979-1992 – American Indian Youth – accounted for 64% of all suicides of Native Americans. 1.5 times higher then general population.
Asian Pacific Islanders – Highest rate for females in the country. Fastest growing ethnic group
Culturally and Linguistically Diverse PopulationsGirls age 5 -12. 30% Asian females
reported depressive symptoms. Youth Risk Behavior Survey – Half of youth had previous contact with
mental healthCulture impact on views of mental illness,
accessing servicesRole of school climate and ethnicity (FSM
example)Role of victimization and bullyingRefugee status and potential risksHarassing behaviors
COMPREHENSIVE PLANAccounts for cultural and linguistic
differences
Utilizes appropriate translators and culture liaisons
Follows up with evaluation of effectiveness
Incorporates best practices and research