Welcome to AzPA’s 2017 Annual Convention! Bridging the Gap: School and Clinical Psychologists Together Treating Child and Adolescent Suicidal Ideation and Self -Harm Paula J. McCall, PhD, NCSP AzPA 2017 Annual Convention | October 19th-21st, 2017 | Wild Horse Pass Hotel, Chandler, Arizona

Learning Objectives 1. Identify how the implementation of evidence-based interventions for suicidal ideation in children and adolescents differs over school and clinical environments. 2. Identify how the implementation of evidence-based interventions for non-suicidal self-injury in children and adolescents differs over school and clinical environments. 3. Identify 3 different functions and purposes of intervention and assessment related to suicidal ideation and non-suicidal self-injury in both the school and clinical environments. 4. Describe at least 3 methods of building collaboration between school and clinical psychological environments in relation to suicidal ideation and non-suicidal self-injury among children and adolescents.

Key Definitions Non-Suicidal Self-Injury: A coping strategy consisting of intentional bodily harm with intent of survival Suicidal Ideation: Active thoughts of intentional self-harm with the purpose of ending one’s life Both consist of spectrums of severity Both benefit from interagency collaboration

What Do Our Ethical Codes Say? American Psychological Association 3.09 Cooperation with Other Professionals  When indicated and professionally appropriate, psychologists cooperate with other professionals in order to serve their clients/patients effectively and appropriately. National Association of School Psychologists Principle III.3. Respecting Other Professionals To best meet the needs of children, school psychologists cooperate with other professionals in relationships based on mutual respect…If a child or other client is receiving similar services from another professional, school psychologists promote coordination of services. Principle IV.1. Promoting Healthy School, Family, and Community Environments School psychologists develop partnerships and networks with community service providers and agencies to provide seamless services to children and families.

Why Is Collaboration So Critical? Better decision making Increased quality of support Improved timelines of services Consistency and reinforcement of the message to the client

So Why Is Collaboration So Difficult? Personal variables between school and clinical psychologists Differences in conceptual overview Lack of understanding leads to lack of trust Lack of awareness of different roles and pressures in them Differences in perceived most important goals Personality clash Competition, sometimes fueled by others

Let’s Discuss the Differences Referral Initial response Communication with parents Caseload Barriers

Assessment of NSSI Duration and Methods Severity Function Clinical: Extensive background history School: Immediate, short-term access and risk Duration and Methods Clinical: Informs goals and treatment School: Informs communication with parents and school team, types of referrals needed Severity Clinical: Informs therapeutic approach School: Informs intervention Function

Assessment of Suicidal Ideation Clinical: Structured extensive interview School: Multiple sources of information, SRA process Severity, Frequency, & Intensity Clinical: To inform immediate response, individual determination School: To inform immediate response, team determination Availability and Intent Clinical: Direct impact on and access to parents; Informs therapeutic approach and goals School: Direct impact on and access to peers and school; Informs interventions Stressors and Supports

Interventions for NSSI School Monitoring across environments Daily check-ins Adult support School involvement Individual or small group support Coping skill development Clinical Self-monitoring Direct discussion of alternatives Treatment goals aligning with function Development of cognitive and emotional awareness, communication, and strategies Direct instruction of coping skills and reasons they are effective Reduction of NSSI Treatment of underlying problem

Interventions for Suicidal Ideation School Development and implementation of safety plan Building peer support and resiliency factors Frequent check-ins addressing emotions and cognitions Overview of interpretations using current situations Clinical Development and ongoing revision of safety plan Psychoeducation on depression, resiliency, etc. Identification of patterns of cognitions Direct guidance in coping strategies Safety and stabilization Treatment of depression or other underlying

Clarification about Special Education Team process outlined in federal law Duration of process intentional in order to avoid overidentification and inappropriate identification Not diagnostic, eligibility categories do not align with clinical conceptualization Clinical diagnosis does not directly transfer to sped eligibility Emphasis on adverse impact on educational performance Private providers can be a part of the team Lack of eligibility does not mean lack of support or intervention

The Full Picture of Collaboration School Crisis Response Impact on school and peers Use of school environment and team strategies Frequency Aspects of evidence-based approaches Clinical Long-Term Treatment Impact on parents and family Emphasis on individual cognitive and affective patterns and strategies Intensity Comprehensive evidence-based approaches

The Key Aspects of Effective Collaboration Directly address differences regarding perception, interpretation, beliefs, diagnosis, etc. with mutual respect Identify at the outset common goals regarding the client Maintain communication at all stages to facilitate awareness and consistency Recognize that each provider has unique skills and contributions to the situation Admit what we don’t know

So How Do We Accomplish This? Physical Steps Release of information Finding the right people Personal Steps Exploration of personal biases and reasons for them Recognition of possible misconceptions based on a few bad experiences Recognition of possibility of misunderstanding and lack of information Recognition of value of collaboration across environments

References Brent, D. A., Poling, K. D., & Goldstein, T. R. (2011). Treating depressed and suicidal adolescents A clinician’s guide. New York: Guilford Press. Herlihy, M. (2016). Conceptualising and facilitating success in interagency collaborations: Implications for practice from the literature. Journal of Psychologists and Counsellors in Schools, 26(1), 117-124. Langley, A. K., Nadeem, E., Kataoka, S. H., Stein, B. D., & Jaycox, L. H. (2010). Evidence-based mental health programs in schools: Barriers and facilitators of successful implementation. School Mental Health, 2, 105- 113. Miller, D. N., & Mazza, J. J. (2017). Evidence-based interventions for suicidal behavior in children and adolescents. In L. A. Theodore (Ed.), Handbook of evidence-based interventions for children and adolescents (55-66). New York: Springer. Walsh, B. W. (2012). Treating self-injury: A practical guide (2nd ed.). New York: Guilford Press.

Contact Information Paula J. McCall, PhD, NCSP Next Step Psychology, LLC Phoenix, AZ 480-577-5442 mccallpsych@gmail.com paulamccallphd.info