Suicide Prevention in School Settings: Sources of Strength and Creating Suicide Safety in Schools Evaluating the Impact of the CSSS Workshop on School Preparedness for Suicide Prevention Dana E. Boccio, Ph.D. Adelphi University Garden City, NY NYS Suicide Prevention Conference September 12-13, 2016 Albany, NY

Anticipated Direct and Indirect Effects Participation in CSSS workshop Changes in attitudes, knowledge, perceptions of administrative support, and feelings of empowerment Improvements in school suicide safety practices Pre-test Post-test 6-Month Follow-Up

Participant/School Demographics 93 participants (87 from New York, 6 from Arkansas); 86.5% Female, 13.5% Male; 64.4% School Counselors School Level % Elementary School 21.1 Middle School 16.7 High School 36.7 Multiple Levels 22.2 District Admin/Central Offices 2.2 Community 1.1 Community Type Urban 85.4 Suburban 3.4 Rural 7.9 Combination 3.3 Socioeconomic Status % Low 48.3 Medium 10.1 High 2.2 Mixed 39.3 School Affected by Suicide 25.3 Had Previous Training 63.3 # in Attendance 1 64.1 2 20.5 3 11.5 4 3.8

Impact on Attitudes Pre Post Item M (SD) df t p   Pre Post Item M (SD) df t p Youth suicide is a significant public health problem. 4.56 (0.71) 4.77 (0.59) 79 3.19 .002* Schools should play an important role in youth suicide prevention. 4.58 (0.75) 4.81 (0.55) 3.46 .001*   Pre Post Composite M (SD) df t p Attitudesa 9.13 (1.33) 9.58 (1.08) 79 4.11 .000* Items were rated on a 5-point scale (1 = Strongly Disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly Agree). *p < .05 aAttitude Composite – possible scores range from 2 to 10.

Impact on Knowledge Item M (SD) df t p Pre Post 3.52 (0.95)   Pre Post Item M (SD) df t p I have the knowledge I need to help a student at risk for suicide. 3.52 (0.95) 4.12 (0.58) 77 6.70 .000* I have the knowledge I need to respond after a suicide death or attempt affects my school. 3.30 (0.89) 3.94 (0.75) 5.49 I know of some specific evidence-based suicide prevention programs for schools. 2.93 (1.04) 4.17 (0.66) 76 9.37 I know how to judge school-based suicide prevention/intervention programs against best practice standards. 2.78 (0.88) 3. 82 (0.83) 9.42 I am familiar with some free or low-cost resources that could be used to enhance suicide safety at my school. 2.90 (1.10) 3.98 (0.73) 75 8.55   Pre Post Composite M (SD) df t p Knowledgea 15.30 (3.64) 20.01 (2.78) 70 10.98 .000* Items were rated on a 5-point scale (1 = Strongly Disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly Agree). *p < .05 aKnowledge Composite – possible scores range from 5 to 25.

Impact on Perceptions of Support   Pre Post Item M (SD) df t p My school has made suicide prevention a priority. 3.44 (1.00) 3.75 (0.88) 74 3.04 .003* My school values efforts at suicide prevention. 3.93 (0.79) 4.03 (0.76) 0.82 .418 I am part of a team that is working to improve suicide safety at my school. 3.83 (0.95) 4.01 (0.81) 72 1.99 .050* Our team has the support of our administration to work on improving suicide safety at our school. 3.99 (0.86) 4.08 (0.83) 73 1.56 .124 I have the support I need to help a student at risk for suicide. 3.79 (0.81) 4.01 (0.61) 2.97 .004* I have the support I need to respond after a suicide death or attempt affects my school. 3.64 (0.84) 3.94 (0.68) 75 3.49 .001*   Pre Post Composite M (SD) df t p Supporta 22.61 (3.93) 23.76 (3.65) 71 4.07 .000* Items were rated on a 5-point scale (1 = Strongly Disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly Agree). *p < .05 aSupport Composite – possible scores range from 6 to 30.

Impact of Feelings of Empowerment   Pre Post Item M (SD) df t p I feel empowered to work collaboratively with my colleagues on implementing our next steps for improving our school’s suicide safety. 3.90 (0.87) 4.20 (0.68) 74 3.45 .001* Items were rated on a 5-point scale (1 = Strongly Disagree, 2 = Disagree, 3 = Neutral, 4 = Agree, 5 = Strongly Agree). *p < .05

Participants’ Satisfaction Ratings of CSSS Workshop % (n) Item Strongly Disagree Disagree Neutral Agree Strongly Agree The content of this workshop was relevant to my job. 0.0 (0) 18.8 (15) 81. 3(65) I learned a lot from this workshop. 2.5 (2) 31.3 (25) 66.3 (53) I found this workshop useful. 32.5 (26) 67.5 (54) I would recommend this workshop to others. 68.8 (55) A follow-up consultation would help in furthering suicide prevention efforts in my school. 15.2 (12) 26.6 (21) 58.2 (46)

Practice/Procedures Currently in Place in Participants’ Schools % (n) Yes Some Aspects are in Place, but More is Needed   No Don’t Know Curricula or programs related to building resilience and protective factors (e.g., healthy problem-solving) in students 21.6 (16) 67.6 (50) 5.4 (4) A school-wide screening procedure to identify students at risk for suicidal behavior 13.5 (10) 39.2 (29) 41.9 (31) Training for teachers/staff in how to recognize suicidal warning signs and how to respond 19.2 (14) 49.3 (36) 24.7 (18) 6.8 (5) Training for students in how to recognize suicidal warning signs 9.5 (7) 40.5 (30) 8.1 (6) Clear referral procedures for school personnel (i.e., teachers and staff know how and to whom they should refer students) 45.9 (34) 33.8 (25) Clear risk assessment procedures 32.4 (24) 44.6 (33) A standard protocol or assessment instrument for assessing risk (e.g., semi-structured interview) 28.8 (21) 15.1 (11) Clear procedures for collaborative safety planning 31.1 (23) 50.0 (37) Clear procedures for parental notification and involvement 47.9 (35) 38.4 (28) 4.1 (3) Clear procedures for referring at-risk students and their families to community agencies/resources 41.7 (30) 40.3 (29) 6.9 (5) 11.1 (8) A collaborative relationship (involving adequate communication) with nearby hospitals/community agencies 12.2 (9) A clear plan for assisting students with re-entry into school after discharge from a hospital/inpatient setting 29.7 (22) 14.9 (11) A crisis plan for responding to suicide deaths and suicide attempts 28.4 (21) 47.3 (35) Procedures for coordinating school and community support services in the aftermath of a suicide or attempt 18.9 (14) 52.7 (39)

Summary of Results so far… Pre-test to post-test improvements in: Attitudes toward the importance of suicide prevention Knowledge of best practices and available resources Perceptions of school-based support to improve suicide safety Feelings of empowerment to move forward with suicide safety measures Attendees with and without prior training were similarly likely to benefit from workshop Individual and group attendance both resulted in benefits High satisfaction with workshop/attendees likely to recommend to others

Next Steps… 6-month follow-up assessment: Are schools enacting improvements to their suicide safety procedures subsequent to completion of the workshop? What barriers to implementation of suicide safety practices are being encountered?