Helping students at risk for suicide

Suicide is a public health and school safety concern for schools. “Schools are not responsible for meeting every need of their students. But when the need directly effects learning, school must meet the challenge.” (Carnegie Task Force on Education) “And to meet the challenge schools and communities must work together.” (Public Health Reports, v.120, 2006) Creating suicide safety in your school is a process, not just about getting the right product or training. It’s about integrating suicide prevention competencies into a school’s way of doing business. There has been an explosion of programs and offerings on the subject of suicide prevention, this workshop draws from what is current best practice. There also needs to be an awareness of contagion theory. The idea that if one child dies or is engaging in suicidal behavior, it makes it more likely that others will. Suicide can be said to be socially contagious. A public health approach looks at universal, selective and indicated strategies and actions. And also we think about the ecological model which says that if someone is at risk they have risk and protective factors along this continuum. The work of suicide prevention is decreasing risk and increasing protective factors at all these different levels. An individual risk factor might be that they have depression. An individual protective factor might be that they like to talk about their problems and get support. If their friends are engaged in drug abuse or drinking- Peer risk factor Family supportive of getting care – Family protective factor A school/community level risk factor might be lack of local MH services A school/community level protective factor might be effective bully prevention programming On the society/culture level – depictions of suicide in the media, glorification of suicide/other and self/directed violence – risk factor

PH rather than MH is the focus Not medical/mental health care model Public health School Safety Mandate is broader and includes primary prevention Requires collaboration with MH providers and shared responsibility

Public Health Prevention Risk Resiliency Theory Social Ecological Model Creating suicide safety in your school is a process, not just about getting the right product or training. It’s about integrating suicide prevention competencies into a school’s way of doing business. There has been an explosion of programs and offerings on the subject of suicide prevention, this workshop draws from what is current best practice. There also needs to be an awareness of contagion theory. The idea that if one child dies or is engaging in suicidal behavior, it makes it more likely that others will. Suicide can be said to be socially contagious. A public health approach looks at universal, selective and indicated strategies and actions. And also we think about the ecological model which says that if someone is at risk they have risk and protective factors along this continuum. The work of suicide prevention is decreasing risk and increasing protective factors at all these different levels. An individual risk factor might be that they have depression. An individual protective factor might be that they like to talk about their problems and get support. If their friends are engaged in drug abuse or drinking- Peer risk factor Family supportive of getting care – Family protective factor A school/community level risk factor might be lack of local MH services A school/community level protective factor might be effective bully prevention programming On the society/culture level – depictions of suicide in the media, glorification of suicide/other and self/directed violence – risk factor Risk factors Protective factors Environment Relationship Individual

Suicide safety happens in the context of a competent and caring school community If you are going to take on suicide safety in a comprehensive way and integrate it into your school culture, it is helpful to have an overarching value associated with it. This model is adapted from Maureen Underwood at the Society for the Prevention of Teen Suicide. Suicide safety happens in the context of a competent and caring school community. What that means is…… Adapted from Caring and Competent Communities for Suicide Prevention, M. Underwood, SPTS

In a caring community: We are all connected We care about each other’s wellbeing and safety. In a caring community: We are all connected We care about each other’s wellbeing and safety. Adapted from Caring and Competent Communities for Suicide Prevention, M. Underwood, SPTS

In a competent community: Everyone has a role to play: Faculty, staff. administrators, students, parents, board and community care providers. Everyone knows how, when and where to get help and is consistently inclined to do so. In a competent community: Everyone has a role to play: Faculty, staff. administrators, students, parents, board and community care providers. Everyone knows how, when and where to get help and is consistently inclined to do so. Adapted from Caring and Competent Communities for Suicide Prevention, M. Underwood, SPTS

Framework for Creating Suicide Safety at School Parent Engagement & Community Support So as we begin to work on plans and actions to develop a suicide safer school environment throughout the course of the rest of today, we will use these six elements as our framework. Protocols & Procedures Trained faculty & staff Resilient students Plan to help a student at risk Plan for suicide deaths

Plan for helping a student at risk for suicide Plan to help a student at risk Supported by procedures to: intervene collaborate safety plan notify parents document manage return to school This component of a suicide safety addresses the tools and Resources to: identify students at risk for suicide assess the level of risk create a plan for safety refer to appropriate care provide follow up care when a student returns to school   Staff designated to manage students with suicidal thoughts or behaviors should be supported by policies and procedures that standardize: Assessment and intervention Collaboration Communication w/administrators Safety planning Parent notification Documentation of risk Follow up

Developmental considerations CONCERN TIP Young children have a different understanding of permanence and universality of death. May not know what suicide is. Use developmentally appropriate language to describe the feelings of wanting to be dead.

Developmental considerations CONCERN TIP Young children change the story depending on the reaction of the adults interviewing them. Gatekeepers should recognize and refer. Avoid repeat interviews. Keep a conversational tone. Interview parents and other adults who interact with student. Share documentation. Quote the child.

Developmental considerations CONCERN TIP More immediate sense of time. Crisis resolves quicker. Don’t tolerate strong feelings as long. Don’t be fooled. Provide brief interventions near the time of crisis. Try to identify triggers.

Developmental considerations CONCERN TIP Intent of self-destructive behavior is often mixed. More prone to social and emotional contagion. Interview for nuances of intention: What was the behavior communicating to who? Ask about exposure to death and suicide.

Developmental considerations CONCERN TIP Suicide attempts are often more impulsive. Suicidal behavior gets more deadly over time. More attempts to deaths than adults. Don’t know what it takes. Don’t confuse the lethality of the attempt or plan with the desire/intent to die. Two very different things with kids.

Plan for helping a student at risk for suicide Plan to help a student at risk With skills and tools to: Understand & Intervene (ASIST) Assess/Assign Risk (CSSRS) Plan for safety (SPI) Engage challenging students and parents (Lifelines) With support from: Community care providers Additionally, these staff members may want specialized training in community and school-based risk assessment, intervention skills and safety planning. While staff members have likely had training in suicide risk assessment, there is great variability in professional preparation. Staff members whose job it is to respond to suicidal risk may find it helpful to have training in assessment tools that were designed for schools and developmentally appropriate for intervention with children and adolescents, as well as tools and assessment models that are designed for community intervention as opposed to clinical management of a person at risk for suicide. Applied Suicide Intervention Skills Training (ASIST)- a two day, intensive practice oriented suicide first aid training designed for use by community first responders and those who may interact with someone at risk of engaging in suicidal behavior.   Columbia Suicide Severity Rating Scale- a tool that provides a few simple questions to help a caregiver hone in on important interview questions for assessing risk. It provides common definitions for suicidal ideation and suicidal behavior. It is broadly used by many OMH licensed programs across New York State. Safety Planning Intervention - an individualized list of coping strategies and sources of support for persons to use to cope with a suicidal crisis. Lifelines: Helping Students at Risk for Suicide - one day training is designed for school pupil personnel staff. School personnel who attend the training will learn: Essential components for a developmentally appropriate suicide risk assessment. Techniques for engaging resistant students and/or parents in the assessment/referral process The “Tell Me More” assessment technique Essential Knowledge about Suicide Prevention - created by the New York Psychological Association, this recorded webinar provides an overview of basic tools and skills for suicide risk assessment and management Developing relationships and memoranda of understanding between schools and their community mental health providers for the purposes of providing continuity of care is a considerable asset. Schools cannot manage suicide risk in a vacuum and need the support of a caring and competent community to provide assistance to students.

Thank you! Pat Breux, BSN pat.Breux@omh.ny.gov