Postvention in Schools An Overview for School Leaders Suicide is a difficult topic Most of us have been touched professionally andor personally by suicide Important to support one another as we approach this topic todayand in days following ID: 739682
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Slide1
Suicide Prevention, Intervention & Postvention in Schools
An Overview for School LeadersSlide2
Suicide is a difficult topic…
Most of us have been touched,
professionally and/or personally, by suicide
Important to support one another as we approach this topic today….and in days following
No scheduled breaks, come and go as is right for you
If you would like to talk to someone, we are available to help.Slide3
Context for the presentationThis presentation targets the School Mental Health Leadership Team
It is designed to:
Build common understanding about suicide amongst school mental health leaders
Highlight helpful prevention, intervention and
postvention
strategies
Provide recommendation actions for consideration at the school levelSlide4
Session Outline
Brief Overview of Suicide in Children and Youth
Suicide Prevention, Intervention &
Postvention
Strategies
Issues for School Leaders
Recommended Actions for the MH Leadership Team
Roles and Protocols (
mh
leadership team, school administration, critical incident response team)
Strategies (early identification and treatment of mental health problems, youth engagement, community culture building)
Capacity-Building (information dissemination, gatekeeper training)Slide5
Child and youth suicide
Brief OverviewSlide6
Suicidal behaviour
Non-Suicidal Self-Injury
a
deliberate attempt to cause injury to one’s body without the conscious intent to die
Suicidal Ideation
Suicidal
thoughts
that
include
both
contemplating death by suicide
and
planning actions
that could
result in death
Suicide Attempt
self-harming
behaviour
that includes an intention to die
Death by Suicide
self-harming
behaviour
that
results in deathSlide7
Facts and Figures
2
nd
leading cause of death after accidents, accounting for
17.3- 20.4%
of adolescent mortality
(but important to put this in context, death is relatively uncommon in this age group)
1.4% of all suicides
occur in children under
14 years of
age
Death by suicide is more prevalent in males than females aged 15-19
Recent Canadian epidemiological study shows overall stable rates of suicide over the past 30 years, but trends are changing: decreasing rates for males and increasing rates for females
(Skinner &
McFaull, 2012)Slide8
The complexity of Risk
Protective FactorsSlide9
Vulnerabilities - self
Mental illness
(e.g., mood, anxiety, conduct disorders)
Past suicidal behavior
Substance
use
Unstable mood, high impulsivity
Rigid thinking or coping
patterns
Poor physical health / chronic illness
NOTE: These risk factors are correlational and not causal; typically it is a compounding of risk factors that is associated with suicidal behavior.Slide10
Vulnerabilities - home
Family history of suicides / attempts
Parental mental illness
Alcohol / substance
abuse in the home
History of violence and/or abuse
Divorce
,
separation
,
other losses, death
Tension and aggression between parents
Parental
lack of time; rejection; neglect
NOTE: These risk factors are correlational and not causal; typically it is a compounding of risk factors that is associated with suicidal behavior.Slide11
Vulnerabilities – school/community
Learning problems
D
isengagement
from
school
Lack of connectedness
Marginalization
Discontinuity in identity
(cultural, language, gender, sexual)
Some communities are at heightened vulnerability (e.g., aboriginal, LGBTQ, homeless)
Negative social relationships, including bullyingSlide12
Pre-existing vulnerability
Increases
risk for bullying
Victimization
New or Exacerbated:
Anxiety
Depressed mood
Diminished self-worth
Feelings of
entrapment
Loneliness
Withdrawal
Sleep/eating problems
Hopelessness
Which are risk factors for:
Suicidal ideation
Suicide attempt
Death by suicide
Adapted Lenny Berman 2010 Bullying and Suicide 8doc.webinar American Association of
Suicidology
Bullying and SuicideSlide13
Triggers
Break
up with boy/girl friend
Conflicts
and increased arguments with parents and/or siblings
Loss
of close friend
School
related difficulties-conflicts with teachers, classmates
Difficulties
with the law
C
hange
in parents’ financial status
Serious
illness or injury in family member
Real
or perceived loss of status Slide14
ContagionOccurs when suicidal behavior influences an increase in the suicidal behavior of others
Multiple suicidal behaviors/suicide deaths that occur within a geographical area or fall within an accelerated time frame may represent a potential cluster
Although clusters are rare, they are most common amongst adolescentsSlide15
Circles of vulnerability
Population at Risk
Lahad
& Cohen, 2006Slide16
The role of cyber/social media
Increasingly there are sites, chat rooms and blogs that promote suicidal ideation
Methods of suicide are discussed on-line and some researchers have suggested that increases in particular methods in recent years may be related to this dialogue
The rapid spread of rumours and details of deaths by suicide is difficult to manage
Paradoxically, social media may hold potential benefits for suicide prevention
(Skinner &
McFaull
, 2012)Slide17
The role of media Media can be helpful or harmful – it is never benign and they cannot view themselves as impartial observers
Contagion (mimicking of suicidal behavior) is a real phenomenon and youth are particularly vulnerable
Media needs to be held accountable for adhering to safe reporting guidelines following a death by suicide
Media can be helpful in bringing awareness to issues of child and youth mental health more broadlySlide18
Responding to mass media / social media coverage
Recent weeks have brought us…
A very tragic example of the complexity of suicidal behavior
An illustration of the influence and dangers of social media
Irresponsible media coverage and oversimplification of the issues in much public discourse
Well-intentioned, but potentially harmful, actions
Contagion
A magnification of the need for district and school leadership to ensure student safetySlide19
Protective factors
Problem solving, life & communication skills
Sociability
Resilient Personality
A sense of belonging (school, community)
Secure attachment to positive parent/family
Access to other caring & supportive adults
Pro-social peers
Appropriate discipline, limit setting & structure
Opportunities to develop self-esteem
Good Mental HealthSlide20
Youth suicide is complex and is often the result of many converging factors.
The explanations and the solutions are equally complex. Slide21
What can we do?Reduce vulnerabilities - at school
Ensure school is safe and accepting, especially for vulnerable students (enhance sense of belonging, increase connectedness and engagement, show respect for differences
)
Build on protective factors
Provide skill-building, opportunities to build esteem, etc.
Look out for triggers
Identify students at risk, listen
Minimize the risk for contagion
Have a plan for helpSlide22
Suicide prevention, intervention, & postvention
Strategies for Slide23
First, do no harm
In considering various prevention, intervention, and
postvention
strategies, the Mental Health Leadership Team needs to understand that this area of work is not benign
Some actions are more effective than others, some are risky, and many have not been evaluated rigorously
This may mean taking a fresh look at existing practices to ensure alignment with the evidence base in this area
Close communication with your senior administration team will be important if practice changes are requiredSlide24
Through this section, Consider…What is your school doing consistently across the system in suicide prevention, intervention and
postvention
?
Are these initiatives aligned with the evidence-base?Slide25
SCHOOL RESPONSE TO SUICIDEFour components: Administrative Foundation, Prevention, Intervention &
Postvention
Slide26
What is Administrative foundation?The administrative foundation is the support and commitment of the school board, as articulated through the principal, to policies and procedures that address the range of needs presented by students who might be at risk for suicide.Slide27
What is Suicide Prevention
?
Efforts to reduce the risk of suicidal thoughts and behavior amongst students in a systematic way Slide28
What is intervention?
Practices involved in recognizing and responding to students with suicidal ideation or behavior
Practices involved in supporting vulnerable students transitioning to and from mental health careSlide29
What is postvention?
Support for school communities in responding to suspected, attempted, or death by suicideSlide30
Helpful Prevention strategies
Safe and accepting school
culture
Social emotional learning (coping skills, conflict resolution)
Early identification and treatment of mental health problems
Gatekeeper training
Information dissemination (staff, parents, students)Slide31
Prevention Strategies to avoid
There are risks inherent in the following strategies:
Suicide awareness curriculum with students, particularly if done in a single or stand alone lesson(s)
(curriculum is best delivered in the context of instruction related to mental health more generally, over a period of several lessons, with a focus on protective factors…after adults have received gatekeeper training)
Assigning suicide as a central or sole focus of study
Large assemblies with guest speakers who talk about suicide
Events that have the potential to glorify/glamorize suicide
Peer counseling related to suicideSlide32
Prevention Strategy
Evidence
Early identification and treatment of mental health problems
Solid
School/community culture building
Solid
Adaptive
coping skill development
Solid
I
nformation dissemination / gatekeeper training
Promising
Screening and referral
Mixed
Youth engagement / peer helper programs
Mixed
Suicide awareness curricula for students
Mixed
Means restriction
Mixed
Crisis hotlines
Mixed
Media education programs
Insufficient Evidence
Effective
postvention
Insufficient
EvidenceSlide33
Information Dissemination and Gatekeeper training
Different audiences have different knowledge needs
AWARENESS - Classroom teachers can benefit from as little as a 2-hour session that provides information about risk factors, warning signs, and what to do if one of their students appears to be at risk for suicide
LITERACY - More in-depth gatekeeper training can be offered for select individuals in a school who are in a position that makes is more likely that students will approach them for help (e.g., admin team, guidance, student success), and who are willing to provide consultation and support when crises occur
EXPERTISE - School mental health professionals should maintain strong knowledge and skills with respect to suicide assessment and supportSlide34
Needed Knowledge
For intervention to be successful, basic knowledge about warning signals can be shared with those in a position to notice changes in behavior amongst youth
School staff, parents, students, youth-involved community members
Can be shared in a variety of ways (brochures, workshops, fact sheets, trusted websites, media)
Key warning signals are described here as a handy reference
Note that 100% accurate prediction of suicide is impossible. We can only do our best.Slide35
WARNING SIGNALS:
Behavioural
Loss of interest in former activities
Withdrawal from social contact
D
ifficulty concentrating, problems with judgment and memory
D
ramatic shift in quality of academic performance
F
eelings of sadness, emptiness and hopelessness, often expressed in written assignments
S
leep disturbances
These signals also relate to problems in mental health more generallySlide36
Strong and overt expressions of anger and rage
E
xcessive use of drugs and/or alcohol
P
romiscuous
behaviour
U
ncharacteristic delinquent, thrill-seeking
behaviour
S
elf-mutilation
O
ccurrence of previous suicidal gestures or attempts
P
lanning for death; making final arrangements; giving away
favourite
possessions
WARNING SIGNALS: BEHAVIOURALSlide37
WARNING SIGNALS: Communication
Statements revealing a desire to die, or a preoccupation with death
N
ihilistic comments: life is meaningless, filled with misery, what’s the use of it all?
V
erbal or written threats
S
udden cheerfulness after prolonged depression may be relief because decision has been takenSlide38
Helpful intervention strategies
Identification and Referral
Ensure staff aware of warning signals
Ensure clear protocol at school level
Provide immediate and calm support
to the student
Ensure
safety and supervision
Facilitate assessment
and care
Contact parent/guardian
Document actionsSlide39
Helpful intervention strategies
Supporting Vulnerable Students
Ensure staff understand role and limits of competence
Support staff with caring adult role
Identify vulnerable students
Work with clinical staff, when involved
Create a school safety plan for each student, as needed
Implement and monitor plans, as neededSlide40
Intervention strategies to avoidPeer intervention models with inadequate adult supervision and monitoring
Recruitment of gatekeepers who are uncomfortable / unready for the role
Counseling of high risk students by unqualified professionalsSlide41
Helpful postvention strategies
Understand the phases of
postvention
H
ave
a plan for who does what at each phase of
postvention
First 24 hours
Next 48-72 hours
During the first month
Planning for the future
Practice deliberate self- and team-careSlide42
Working through phasesThe accompanying presentation for the School Mental Health Team articulates considerations for the
postvention
period, through these phases
This difficult work is usually led by the school admin team, with support from the Superintendent, Crisis Response Team, MH leadership team, and corporate communications, as needed
Main message – have a plan for who does what at each phase of
postventionSlide43
First 24 hours
Verify the death, confirm the facts, talk with the student’s family personally (usually the principal, with support from the Board Team)
Mobilize the critical incident response team
Assess the impact of the death and level of response required
If parents do not wish the suicide to be disclosed, and students are unlikely to find out the cause of death, large scale suicide
postvention
is not indicated
In contrast,
high impact events that will involve
media would call for support from the board response team and enacting of
postvention
protocols
Identify vulnerable students and provide support
Determine what information to share, with whom, how
Inform Superintendent, notify school staff, inform students simultaneously in their classrooms (not through announcements or a large assembly) using prepared scripts
Manage the media, using one designated liaison person with media training (may be a member of the board team)Slide44
Next 48-72 hours
Restore school to regular routines
Liaise with bereaved/affected family
Consider involvement with funeral/memorials
Avoid on-campus memorials that could glorify suicide
Monitor staff well-being
Keep school community informed
Involve community partners in
postvention
support
Document actionsSlide45
During The first month
Monitor all staff and student well-being
Plan for school events of relevance (year book, award nights, graduation)
Conduct a critical incident review
Consider offering information sessions for parent community with mental health agency
Continue documentation of actions
Response Team DebriefingSlide46
Planning for the future
Continue support and monitoring of students and staff
Plan for anniversaries, birthdays and significant events
Implement recommendations from the critical incident review, in consultation with SO and MH Leadership Team
Assess current suicide prevention strategies and enhance as needed
Share
the
postvention
plan with new staff
members
Continue to work with community to refine response for futureSlide47
Media
Social MediaSlide48
Take care of each otherDeath by suicide is a special kind of school crisis that impacts us in significant ways, professionally and personally
The School Team needs to work together, to debrief often, and to reach out when members are struggling
Members need to practice self-care deliberately
The Board Team can provide support in this regard – the School Team is not aloneSlide49
Documentation of Ontario community mobilization response following a suicide clusterSlide50
A Comprehensive suicide prevention strategy includes:
Proactive, universal strategies that promote a sense of belonging at school (reaching out to vulnerable students)
Wide-spread instruction in adaptive coping skills, like problem solving and conflict resolution
Knowledge and skills for early identification of mental health problems (with clear connections to service)
Gatekeeper training, with protocols for students at risk
Effective
postvention
, with protocols
Other strategies? Evaluate!!Slide51
Issues for school leaders
Child and Youth SuicideSlide52
It takes a village…Many players needed, to assume different roles
Suicide Strategy Planning and Communication
E.g., Board Mental Health Leadership Team, Senior Administration Team, Corporate Communications / Public Relations, Community Partners
Suicide Prevention and Intervention
E.g., Board Mental Health Leadership Team, School Mental Health Professionals, School Administration, School Staff, Community Partners
Postvention
E.g., Initial team may include: Principal/Vice-Principal(s),
Critical Incident
Response
Team, Superintendent, Board Mental Health Leadership Team,
Corporate Communications, Community PartnersSlide53
Pertinent issues for school leaders
Determining a coordinated school-wide approach
Establishing systematic and proactive suicide
prevention
initiatives within the context of wider mental health promotion and prevention efforts
Ensuring clear protocols and roles for
intervention
with students exhibiting suicidal behavior
Developing or updating
postvention
protocols in light of new realities (consistent with established board protocols)
Communicating the suicide strategy and related supports and expectations with staffSlide54
Suicidal behavior is a reality in your schools
Be proactive,
Be PreparedSlide55
Components of an effective Suicide strategy
Protocols for students at risk
Protocols following a death by suicide
Broad focus on mental health promotion, skill-building and caring school cultures
Staff
education and
training
Media
education
Parent
education
An effective strategy builds common understanding across the board & community, and signals a systematic, proactive approachSlide56
Recommended actionsSchool LeadersSlide57
Consider….Roles and
Existing/Needed Protocols
Existing/Needed Strategies (e.g., early
identification and treatment of mental health problems, youth engagement, community culture building
)
Existing/Needed Capacity-Building (e.g., information
dissemination, gatekeeper
training)Slide58
Getting organized
Identify Existing/Needed Teams
(Board, School, Critical Incident Response)
Clarify Roles, as needed
Develop/update protocols for intervention &
postvention
Develop/update tools/templates for intervention &
postvention
Select and implement prevention
strategies
Stage capacity-building efforts
Communicate the suicide strategy to staff
Monitor, evaluate and refine the strategy
Many
school have teams and tools in place. For these
schools,
it is a matter of confirming that these resources are aligned with the wider board strategy, ensure capacity, and meet your needs within the current context.Slide59
Identify Teams*
Board
Suicide Strategy Team – protocol development, strategy selection, etc.
Suicide Response Team – support school team, work with media, etc.
School
Suicide Strategy Team – protocol development, strategy selection
Suicide Response Team – support students, staff, community, etc.
Crisis Response Team
Support staff and students in need of immediate support individually or in small groups
* These may be existing leadership teams at the board and school level, or subgroups within theseSlide60
Clarify rolesLeadership and Planning Teams
Who will be involved in confirming our school protocols for intervention and
postvention
?
Who will be involved in selecting prevention approaches?
Response Teams
Who will support the school and the school team during the crisis? Following the crisis? Who does what? For example,
Who will contact the family, communicate with staff, students, etc.
Who will support the school response team?
Who will work with media?
Who will work with community?
Who will link with mental health partners? Slide61
Develop/update protocols
Obtain information about any board-wide protocols for intervention and
postvention
Consult with colleagues in developing/updating protocols for your school, particularly those who have worked through
postvention
Where appropriate to do so at the school level, work with local agencies to plan for community mobilization during
postvention
(note that this may be worked out at a system level)
Develop/update your Intervention Protocol (clearly state what to watch for, what to do, who in involve, where to document)
Develop/update your
Postvention
Pr
otocolSlide62
Access tools
Access
pertinent tools and
templates available at the board level and ensure the School Mental Health Team knows how to access these in the event of a suicidal crisis
Intervention
Fact sheets / warning signals
At a glance protocol or flowchart
More detailed protocol with rationale
Postvention
Letters for school community
Scripts for students
Key messages for media
Support documents for staff
Documentation outline
Critical incident review formSlide63
Select and implement prevention strategies
If you have a mental health strategy that includes universal promotion and skill-building, you are already doing some of this work
Work with caring and accepting schools professionals to enhance sense of belonging in schools
Prepare information for dissemination with key groups
Work towards mobilization of communitySlide64
Capacity - buildingWhen possible, sequence capacity-building:
School Leaders
School Staff
Gatekeeper Training
Parents
Students
Different audiences will have different knowledge needsSlide65
Communicate with staffCommunicate the protocol and related tools and templates
Board MH Team School Leaders
School Leaders School Staff
Some messages may need to go directly from the Board MH Team to all Staff and to mediaSlide66
Monitor, evaluate, refineDocumentation and debriefing of actions and enablers/challenges is important; for prevention, intervention, and especially
postvention
Postvention
is emotionally-charged, and the more that our actions can be routinized the better
While every situation is unique, each offers learning opportunities that can be used in future Slide67
Sources, with ThanksMH Leader Suicide Subgroup
Ian
Manion
,
Ontario Centre of Excellence for Child and Youth Mental Health
Ian Brown,
School Mental Health ASSIST
Stephan
Roggenbaum
& Katherine
Lazear
,
University of South Florida
Key Resources:
SAMHSA Toolkit, Suicide Postvention Guidelines South Australia, Principal Leadership 2009, NASP Postvention Strategies for School Personnel, Kutcher 2008Slide68
Contact
School Mental Health ASSIST
Kathy Short, Ph.D.,
C.Psych
.
Director, School Mental Health ASSIST
Kathy.Short@hwdsb.on.ca
905-527-5092, x2634
School Mental Health
ASSIST
Équipe d’appui en santé mentale pour les écoles