1. 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

2. 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.

3. 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

4. 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.

5. 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

6. 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

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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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), 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, 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.

17. Contact Information Paula J. McCall, PhD, NCSP Next Step Psychology, LLC Phoenix, AZ paulamccallphd.info