Everyone in Job Corps Plays a Role in Suicide Prevention ___________________________________________ ______ Richard Lieberman MA, NCSP Los Angeles County Suicide Prevention Network Loyola Marymount University 1

Webinar Overview  Core components of JC Suicide Prevention Program  Scope of the problem  National trends  Job Corps perspectives  Contemporary issues for schools and Centers 2

Webinar Overview  Protective factors  Risk factors & warning signs of youth suicide  Staff role in suicide prevention, intervention and postvention  Questions 3

Core Components of the Job Corps Suicide Prevention Program  PLANNING Expand crisis management team to address suicide prevention and response Establish center-wide policies & procedures for intervening with suicidal students Utilize SIR system for surveillance 4

Core Components of the Job Corps Suicide Prevention Program  TRAINING All staff will participate in suicide prevention training (SafetyNet) All students will participate in suicide awareness and prevention training (Wellness Education Curriculum) Contact federal/state/local resources for materials & brochures 5

Core Components of the Job Corps Suicide Prevention Program  ENVIRONMENTAL ACTIONS Ensure students have access to JC Health & Wellness mental health staff; community resources and national hotlines Remove access to means through security checks 6

Scope of the Problem: Suicide in US: 2011  NATIONAL TRENDS In 2011, 5104 youth aged (11.0) died by suicide in America Suicide is the second leading cause of death for Job Corps-aged youth Males are 4X more likely to die by suicide Females are 3X more likely to make an attempt 200 attempts for every completion The #1 environmental risk factor is the presence of a gun 7

Scope of the Problem: Suicide in the Job Corps  Suicide rates in Job Corps are generally well below the national average.  From PY , 14 deaths by suicide, 7 on center.  From PY , 91 percent of all suicide- related incidents occurred on center, with the dormitory being the most common location for occurrences. 8 Directive: Job Corps Information Notice No Promoting Student Safety through Suicide Awareness and Prevention Lenita Jacobs-Simmons, Acting National Director Job Corps

Scope of the Problem: Cultural Issues  White  American Indian/Alaskan Native  African American males  Asian/Pacific Islander  Hispanic 9

Scope of the Problem: Cultural Issues for Crisis Response  Identify cultural-related needs of community.  Obtain community resources to meet diverse needs.  Have materials translated into native languages.  Have translators available.  Know the traditions, rituals, and belief systems of your diverse population. 10

Scope of the problem: Youth Risk Behavior Surveillance Survey*  29.9% felt sad or hopeless  17.0% seriously considered suicide  13.6% made a suicide plan  8.0% made one or more attempts  2.7% actually got to medical help 11 *CDC, 2013

Contemporary Issues in Suicide Prevention and Intervention  Bullying and suicide  LGBTQ  Social Media  Non-Suicidal Self-injury (NSSI) 12

Contemporary Issues: Social Media  Utilize students as "cultural brokers" to help faculty and staff understand their use of social media.  Train students in gatekeeper role, and specifically identify what suicide risk looks like when communicated via social media.  Have staff work collaboratively with students to monitor social networks and provide safe messaging when important.  Encourage parents or guardians of minors to get involved in their child's social media. 13

Contemporary Issues: Social Media  Monitor for high-risk students.  Psycho-education: Make use of social media to post prevention messages, hotlines and community mental health resources.  Give students specific helpful language to include when making use of social media.  Work with YouTube and Facebook to take down messages, disturbing images or language.  Utilize the Facebook application for concerns or issues with content. 14

Signs of NSSI  Frequent or unexplained bruises, scars, cuts, or burns.  Consistent, inappropriate use of clothing designed to conceal wounds (often found on the arms, thighs, abdomen).  Secretive behaviors, spending unusual amounts of time in the student bathroom or isolated areas on campus.  General signs of depression, social-emotional isolation and disconnectedness. 15

Signs of NSSI  Substance abuse  Possession of sharp implements (razor blades, shards of glass, thumb tacks, clips)  Evidence of self-injury in work samples, journals, art projects  Risk taking behaviors such as gun play, sexual acting out, drinking & driving, choking game 16

Responding to students who self-injure Tips for Educators: DO  Connect with compassion, calm and caring.  Understand that this is his/her way of coping with pain.  Respond with a “respectful curiosity.”  Refer and offer to go with the student to your school counselor, psychologist, social worker or nurse.  Discover the student’s strengths.  Help to create circle of care at school. 17

18 Responding to Students who Self-Injure Tips for Educators: DON‘T  Discourage self-injury, threaten hospitalization, use punishment or negative consequences.  Act shocked, overreact, say or do anything to cause guilt or shame.  Never publicly humiliate the student or talk about their SI in front of class or peers.  Agree to hold SI behavior confidential.  Make deals in an effort to stop SI.  Make promises you can’t keep. 18

After a Suicide: A Toolkit for Schools Preventing Suicide: A Toolkit for High Schools SAMHSASPRC/AFSP 19

Suicide Intervention  No predictors of youth suicide so we must be vigilant even with low risk  Kids are not suicidal 24/7 and levels of risk can change within hours  Youth population is vulnerable to contagion  Try to create a circle of care between student, parent/guardian, center, community agencies  Collaborating with Center crisis teams 20

Staff Role in Suicide Prevention  Do not be afraid to talk to students about suicide or self injury  Know the risk factors & warning signs  Respond immediately, supervise the student  Have student escorted to mental health staff  Join the team in evaluating student 21

Suicide Prevention in the Schools Protective Factors  Strong individual coping and problem-solving skills  Strong sense of belonging and connection  Interpersonal competence/success  Family warmth, stability, support and acceptance  Positive connections at the Center  Spirituality & religious involvement  Access to mental health care & awareness of crisis hotline resources 22

Continuum of Self-destructive Behavior Behaviors: Suicide attempts Self-injury Alcohol/substance abuse Thoughts Stressors: Chronic Mental Illness/Co-morbidity Warning signs Stressors: Acute Precipitating Event 23

Risk Factors of Youth Suicide  Alcohol/substance abuse  Accessibility of means (i.e., guns, rope)  Internal vulnerabilities Psychiatric disorders  Depression  Conduct disorder Previous suicidal behavior History of loss/trauma/victimization  External vulnerabilities (family/community)  Hopelessness  Impulsivity  NSSI 24

Risk Factors of Youth Suicide  SITUATIONAL CRISES (Precipitating events) Loss (Death, divorce, transience, romance, dignity) Victimization/exposure to violence Center crisis (disciplinary, academic) Family crisis (abuse, domestic violence, running away, argument with parents) Suicide in community 25

Warning Signs of Youth Suicide Adolescents  Suicide notes/social media posts  Threats  Plan/method/access  Depression (helplessness/hopelessness) Risk-taking behaviors such as gun play, alcohol/substance abuse, choking game) 26

Warning Signs of Youth Suicide Continued  Giving away prized possessions  History of NSSI  Death & suicidal themes  Sudden changes in personality, friends, behaviors 27

Staff Role in Suicide Intervention Job Corps Protocols  Maintain supervision throughout  Collaborate with CMHC or Health & Wellness staff trained in suicide assessment  Contact Supervisor or HWC Person on Call (if after hours or on weekends) Know the Symptomatic Management Guideline for Non-Health Staff for Suicide Attempts/Threats Know your center’s SOP/COP for suicide risk assessment 28

Staff Role in Suicide Intervention Utilizing Safety Planning  Identify circle of care of adults at home and at Center  Promote help–seeking behaviors  Promote communication skill building  Grief resolution  Provide relevant hotlines/websites/resources 29 New App! MY3

Staff Role in Suicide Intervention Re-entry Suggestions  Have parent/guardian escort student back to Center first morning following hospitalization/MSWR and conduct re- entry meeting.  Collaborate with members of crisis team.  Obtain any records from hospital and have parent sign a release of information form, if minor.  Provide interventions: Modify academic programming as appropriate. Identify on-going counseling resources on center or in the community. Discover if student is on medications and monitor (with parent consent, if minor). Notify student’s teachers as appropriate. 30

Staff Role in Suicide Intervention Re-entry Guidelines  Monitor student to make certain no bullying takes place in the Center as many students may know the student was hospitalized and word spread through social networking.  Monitor social networking sites collaboratively with students with cooperation of the parent.  Identify circle of adults in the Center and at home  Check in frequently during the first week the student returns to the Center. 31

Staff Role in Suicide Intervention Local Resources  Emergency response teams  Collaborating with law enforcement  Culturally focused mental health agencies  Gay and lesbian mental health agencies  Annually update! 32

After a Suicide: A Toolkit for Schools Suicide Prevention Resource Center American Foundation for Suicide Prevention 33

Staff Role in Suicide Postvention Guidelines  Replacing rumors with facts and honoring the family's request for privacy  Encouraging the ventilation of feelings  Stressing the normality of grief and wide array of stress reactions children demonstrate  Discouraging attempts to romanticize the suicide  Identifying students at risk for an imitative response  Knowing how to make the appropriate referrals 34

35 Staff Role in Suicide Postvention: Talking to Students  Reach out and provide comfort care  Recognize basic needs and support problem solving  Validate feelings and thoughts  Provide honest and timely information  Connect student with systems of support  Provide education about stress responses  Reinforce strengths and positive coping strategies 35

36 RESOURCES National Lifeline TALK (8255) SPRC Trevor Project U-TREVOR