1. Gatekeeper Training A Community Approach to Youth Suicide Prevention Presented by Lucia R. Martin, M.Ed., NBCT Resource School Counselor Anne Arundel County Public Schools

2. History Annual county-developed gatekeeper training Trauma Response Teams Cluster suicides – Spring 2009 Garrett Lee Smith Youth Suicide Prevention Grant award – Levels 1 and 2 – Identification of QPR Gatekeeper Training – ASIST Formation of Youth Suicide Awareness Committee

3. Youth Suicide Awareness Committee QPR training Lifelines Youth Suicide Awareness Conference Trauma Response Process ID Card Lessons High School mini-grants

4. Gatekeeper training research results Increased knowledge Increased recognition of sources of stress Increased confidence and competence in helping someone in crisis Increased likelihood to intervene Increased likelihood to call a resource Satisfaction with the training For every 13 gatekeepers trained, there was one referral made Knowledge and skills are retained over time QPR Works!

5. Why QPR? Evidence-based, one of few allowed in the grant Cost, amount of time for training Accessible to a broad range of experience Online support/resources for trainers Several different formats available (for community, agencies, youth, educators)

6. QPR Training 60 Trainers trained November 2009 and September 2010 Parents trained at Parent Involvement Conference, YSA Awareness Conference All Student Services personnel trained Winter/Spring 2010 All coaches/assistants trained Fall/Spring 2010 - 11 All secondary schools trained SY 2010 – 2011 All elementary schools trained SY 2011 – 2012 Parents, community partners, faith-based community, etc. trained 2010 - 2012

7. QPR Ask A Question, Save A Life In School Settings

8. QPR Q uestion, P ersuade, R efer In School Settings

9. QPR QPR is not intended to be a form of counseling or treatment. QPR is intended to offer hope through positive action. In School

10. QPR Myths And Facts About Suicide MythSuicidal young people keep their plans to themselves. FactMost suicidal people communicate their intent sometime during the week preceding their attempt. Myth Those who talk about suicide don’t do it. FactPeople who talk about suicide may try, or even complete, an act of self-destruction. Myth Once a person decides to complete suicide, there is nothing anyone can do to stop them. Fact Suicide is the most preventable kind of death, and almost any positive action may save a life. How can I help? Ask the Question... In School

11. QPR Myths And Facts About Suicide MythIf a suicidal youth tells a friend, the friend will access help. FactMost young people do not tell an adult. In School Good Friends Don’t Keep Deadly Secrets!

12. QPR Suicide Clues And Warning Signs The more clues and signs observed, the greater the risk. Take all signs seriously. In School

13. QPR Strongest Predictors Verbal clues Indirect or “coded” clues Behavioral clues Situational clues Other youth-related clues In School

14. QPR Tips for Asking the Suicide Question If the young person is reluctant, be persistent Talk to the person alone in a private setting Allow the person to talk freely Give yourself plenty of time If in doubt, don’t wait, ask the question Have your resources handy: QPR Card, community resources phone numbers and know your school protocol for handling suicide risk Remember: How you ask the question is less important than that you ask it In School

15. Q QUESTION Direct Approach: “You know, when people are as upset as you seem to be, they sometimes wish they were dead. I’m wondering if you’re feeling that way, too?” “You look pretty miserable, I wonder if you’re thinking about suicide?” “Are you thinking about killing yourself?” NOTE: If you can not ask the question, find someone who can.

16. Q QUESTION HOW TO ASK THE SUICIDE QUESTION Less Direct Approach: “Have you been unhappy lately?” “Have you been very unhappy lately?” “Have you been so unhappy lately that you’ve been thinking about ending your life?” “Do you ever wish you could go to sleep and never wake up?”

17. WAYS NOT TO ASK THE QUESTION “You’re not thinking about suicide are you?” OR “You’re just kidding about killing yourself, right?” Asking in this way encourages a negative response from the young person you are talking with. It may also imply that you are frightened by the intensity of their feelings. Similarly, be aware of your own non-verbal clues.

18. P PERSUADE FOR QPR IN SCHOOL SETTINGS Listen to the problem and give them your full attention Remember, suicide is the solution to a perceived insoluble problem. Suicide is not the problem. Do not rush to judgment Offer hope in any form

19. P PERSUADE CONT. THEN ASK: “Will you go with me to talk with your school counselor, school psychologist, school social worker, school nurse?” “Would you like me to tell your school counselor school psychologist, school social worker, school nurse that you would like to talk to him or her?”

20. P PERSUADE CONT. “If you are unable or unwilling to talk to your counselor, school psychologist, school social worker, school nurse, I want you to know that I care enough about you that I will let them know.” NOTE: The school counselor, school psychologist, school social worker or school nurse and/or administrator must be informed if you believe you are seeing suicidal clues or warning signs from a student. *Here, we discuss our regulations, processes with school staff.

21. R REFER FOR QPR IN SCHOOL SETTINGS Suicidal young people often believe they cannot be helped, so you may have to do more. The best “referral” involves taking the person directly to see the school counselor, school psychologist, etc. The next best “referral” is when the student wants you to talk to the counselor first. (The young person should be monitored closely in the interim.) The third best option is to make sure the student is safe, is under observation by an adult, and then you tell the school counselor, school psychologist, etc. the warning signs you have observed.

22. NOTE: You are not being disloyal or violating a trust when you share of a young person’s suicidality with a school counselor or administrative staff. You are being disloyal if you do not!

23. REMEMBER Since almost all efforts to persuade a young person to live instead of attempt suicide will be met with agreement and relief, don’t hesitate to get involved.

24. Challenges Time for training: – Trainers in each secondary school (35) – Resource student services personnel – Support from executive staff Cost of booklets – Grant funds – Out of the Darkness Walk Communication

25. Youth Suicide Awareness Committee QPR training Lifelines Youth Suicide Awareness Conference Trauma Response Process ID Card Lessons High School mini-grants

26. Lifelines Evidence-based curriculum Reviewed by committee including community members, educators, students, parents 4 lessons, uses ASIST, but we are using QPR language Part of mandatory (graduation requirement) Health curriculum

27. Youth Suicide Awareness Committee QPR training Lifelines Youth Suicide Awareness Conference Trauma Response Process ID Card Lessons High School mini-grants

28. Conference held May 6, 2010 280 school system and community agency participants National presenters on cluster suicide Breakout sessions

29. Youth Suicide Awareness Committee QPR training Lifelines Youth Suicide Awareness Conference Trauma Response Process ID Card Lessons High School mini-grants

30. Trauma Response Process Each secondary school has a school-based Trauma Team made up of student services personnel assigned to the school. – Training provided to school-based personnel Feeder system teams made up of a school psych or sw, school counselor, ppw, and school nurse (personnel not assigned to that feeder) Elementary cluster teams with POC assigned by central office Trauma planners

31. Youth Suicide Awareness Committee QPR training Lifelines Youth Suicide Awareness Conference Trauma Response Process ID Card Lessons High School mini-grants

32. ID Cards State mandated for all secondary students Lessons developed by Central Office

33. Youth Suicide Awareness Committee QPR training Lifelines Youth Suicide Awareness Conference Trauma Response Process ID Card Lessons High School mini-grants

34. High School Mini-Grants Stemmed from STAR week $2000 per high school Must include QPR and Substance Abuse Must involve at least one community partner

35. Questions? Comments? Lucia Martin, M.Ed., NBCT Resource Counselor Anne Arundel County Public Schools