Creating

Creating

Suicide Safety in School

Creating

Suicide Safety in School

AGENDA

Challenges

School psych role in SP

Why the workshop

Workshop description

3 schools

Resources

Questions

Challenges

Challenge: volatile mix of problems clouds the picture

Suicide is sometimes mixed in with behavioral crisis, mental health symptoms, non-suicidal self injury, family and social problems, substance abuse and police involvement, injuries and illnesses.

10% adolescents who die by suicide, treated in ED within 2 months prior to death, often not related to suicide.

(Posner, 2011

)

Repeat visits – Attempts become more deadly over time

HINT: Use suicide discrete assessment tools (ex. Columbia Suicide Severity Rating Scale)

Challenge: Method / Intent

“Attention Seeking,” “Gestures,” Low to No Risk

“Can’t Prevent Someone Truly Intent”

HINT: Don’t attempt to determine psychological intent from the method

Youth Emergency Department Visits for Drug-Related Suicide Attempts

Most Likely to Involve Anti-Anxiety, Acetaminophen, and Antidepressant Drugs

SOURCE: Adapted by CESAR from data from Substance Abuse and Mental Health Services Administration (SAMHSA), “Emergency Department Visits for Drug-Related Suicide Attempts by Adolescents: 2008,”

The DAWN Report

, May 13, 2010. Available online at www.oas.samhsa.gov/2k10/DAWN002/SuicideAttemptsYoungAdults.cfm.

Percentage of U.S. Emergency Department (ED) Visits for Drug-Related Suicide Attempts

Among Youth Ages 12 to 17 Involving Selected Substances, 2008

(N=23,124 ED visits)

Challenge: easy access

HINT: Assess, educate, problem–solve with families around access to means

Challenge: Getting relevant information for rapid assessment

Story changes as the crisis abatesGetting collateral information from family and care providersGetting at suicidal secrets requires skillHINT: Establish rapport quickly. Use “Tell me more” conversational interview.

“Tell me more” adapted from M. Underwood, Society for the Prevention of Teen Suicide

Challenge: “Hot Potato Effect”

Fewer than 20% of adolescent suicides receive any consistent treatment prior to their death

(Posner, 2011)

Mental Health Workforce has inconsistent training & skill specific to suicide care.

Many tools used to assess for risk have poor validity and reliability.

Suicide is difficult to predict.

HINT: Do something helpful. Educate, Intervene, Problem-solve, Safety plan.

Challenge: Suicide Care in Psych Settings

National MH Workforce Survey: October 2012

N=6,637 New York respondents

27.7% had one or more patient who ended their life while under care

45% Disagreed or didn’t know if they had the training they needed to help a suicidal patient

32.4% Disagreed or didn’t know if they had the supervisory support they needed to help

Role of the School Psychologist in School-Based Suicide Prevention

Be knowledgeable about:Risk factors & warning signsLegal issues, best practices, EBP’sThe advantages of safety plans versus no-harm contractsCrisis assessment & interventionIssues related to suicide contagion & clusters

(Berman, 2009)

Role of the School Psychologist in School-Based Suicide Prevention

Be able to:Formulate & conduct risk assessmentsDifferentiate between suicidal behavior & NSSIConduct crisis assessments and interventionsInvolve parents/guardians of potentially suicidal youth in the intervention processSafely reintegrate a student into the classroom following a suicide attemptEffectively implement suicide postvention procedures

(Berman, 2009)

Role of the School Psychologist in School-Based Suicide Prevention

Integrate research evidence with clinical experienceConsider readiness, acceptability, cultural relevanceValue experience and expertise of various school professionalsShare responsibility for identifying, planning, and deliveringUse competencies in ConsultationTeam ProcessProblem-solving modelData-based decision makingProgram evaluation

(Kazak et al., 2010; Kratochwill & Steele Shernoff, 2004; NASP, 2010; Strein & Koehler, 2008)

Why the workshop?

Raising skills & awareness (education & training)Building & supporting coalitionsYouth Suicide Prevention CentersZero Suicide Health and Behavioral Health Care ModelSPCNY

SCHOOLSUnique governanceFocus is educationLocal cultureTitles vs. rolesLots of schools, all unique

Workshop Goals:

Engage school planning team in a process to: Review existing suicide prevention readiness Receive evidence-based and best practice guidance Develop comprehensive suicide prevention and response plan Learn about resources to enhance safety and health of your school environment that are subsidized or available at low or no cost.

Parent Engagement & Community Support

Policies , Protocols & Procedures

CSSS Workshop Model:

Elements of Suicide Safety at School

Policies & procedures are the foundational structure

Staff gatekeeper training, intervention skills

Crisis team has

postvention

training, resources, procedures

Targeted intervention process for managing students with risk

Programming & education that supports protection and resiliency

Parent & Community Engagement for support, referral and mutual aid

Creating Suicide Safety in Schools: Workshop Approach

Process vs. Product Best practice and evidence-based practice www.sprc.org/bpr & www.nrepp.samhsa.gov Contagion theoryPublic health prevention modelsDecrease riskIncrease protection

Creating Suicide Safety in Schools: Workshop Components

Suicide facts

Scenarios

Checklist

Group work sessions

Resource binder

Planning worksheets

Sample Scenario:

Mr. Brown is in his second year of teaching English at your high school. He has become alarmed about a student, Jakob, who recently transferred into his third period class. Jakob has handed in a writing assignment in which he depicted morbid themes including suicide and the words, “what if hope hurts?” in one corner. Thinking back, Mr. Brown realizes that Jakob is often sullen, he doesn’t interact with any other students, and he often has his head down in class.

What would you like to see Mr. Brown do next?

What might get in his way?

East Hampton High SchoolLong Island

East Hampton High SchoolLong Island

ACTIONS TAKEN

NCSC School Climate Inventory

School Climate Steering Committee

Hired a bilingual, bicultural family liaison

Rallied community support

Ongoing meetings with local providers

Intervention Protocols

Lifelines Intervention

Faculty Training

Lifelines

Postvention

(upcoming)

Gowanda Central Schools

Western NY

Gowanda Central Schools

Western NY

ACTIONS TAKEN

Regional meeting on MH resources

Intervention protocols & templates

Lifelines Trilogy training

Faculty protocol

Faculty training (Making Ed. Partners)

Sources of Strength

Salamanca City SchoolsWestern New York

23

Salamanca City SchoolsWestern New York

ACTIONS TAKENRallied community support Trained Crisis teamUpdated crisis planASIST Columbia SSRS Sources of Strength

24

Free Resources

Lifelines Trilogy of Trainings: Prevention, Intervention, PostventionSAMHSA ToolkitFaculty, staff & Parent educationOnline faculty trainingClassroom curriculum Resiliency based programming

Columbia SSRS training

ASIST and

SafeTALK

training

Postvention

support and consultation

Safety Planning Intervention training

Safety planning App.

Means restriction brochure

Sources of Strength

=Creating Suicide Safety in Schools Workshop

=Workshop scheduled

Pat

Breux

pat.breux@omh.ny.govPreventSuicideNY.org