1. Impact of Suicide on Youth and Families The Ones We Miss

2. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. 2

3. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Video 3

4. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. What do we know? Wisconsin – 5 th highest in nation 10-14 year olds Second leading cause of death – 15-24 yr. olds National Rate = 8.76 Wisconsin Rate = 10.78 People who die in Wisconsin due to suicide are younger… 4

5. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. What else do we know? Inpatient hospitalization for youth (15-24) is more than double than the nation. E.R. visits are slightly lower than national rates What would this mean to you? 5

6. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Why are YOU here today? 6

7. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Learning Objectives 1.Gain understanding of the phenomenology of suicide and its impact on children and adolescents. 2.Understand the warning signs, risk factors, and protective factors of suicide when assessing children and families. 3.Gain understanding of the scope of the problem facing Wisconsin, and thus Child Welfare and Juvenile Justice Professionals. 7

8. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Learning Objectives Cont… 4.Develop an awareness and understanding of who are the “Ones We Miss”, including children in out-of-home care and youth who are bullied. 5.Have an opportunity to discuss several strategies currently utilized in Wisconsin to address the problem of child/adolescent suicide to use in case planning. 6. Develop a system of care and crisis plan for a child in the child/adolescent in the system to use in case planning 8

9. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. The Burden of Suicide in Wisconsin “Suicide affects an entire community and, because it is a complex issue, it will take a community to work on it.” Pat Derer, President, HOPES (Helping Others Prevent and Educate about Suicide) Rates remain constant (2000 to 2006) Greatest number – ages 35-54 Greatest ER/hosp. – ages 15-24 Native American have highest rate 9

10. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. The Burden of Suicide in Wisconsin Firearms most frequently used method 1 of 4 have history of previous attempts Over 33% had alcohol present in their system Mental health – especially depression 4:1 male to female suicide deaths Cost – years lost to society (20,000 years/year) 10

11. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Method Location Circumstances Interpersonal circumstances Life Stressor Circumstances 11

12. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Interesting Data on WI US rate declined 24% during 1995-2005 Wisconsin only 8% decline Firearms = 60% of completed youth suicides But….88% hospitalizations for O.D. & cutting So….most lethal methods = no hospitalization Rates of attempts, mortality, and self-reported risk among youth is unacceptably high 12

13. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Who are we missing? Male deaths outnumber female deaths – use more lethal methods – are not hospitalized What else do we know about male adolescents? More to come… 13

14. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Risk Factors and Warning Signs 14

15. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Suicidal Behaviors 1.Suicide 2.Suicide Attempt 3.Suicide Ideation 4.Suicide Plans 15

16. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Ones we miss….. 55% talked about suicide within a month of their suicide 45% did not 73% who died DID NOT mention intent or ideation during last contact w/ a professional Those who did: 60% - spouses 50% relatives 18% caregivers 16

17. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Specific Risk for Males Relationships Access and ability to use lethal means Murder – Suicide Socially isolated Family history Mental illness or substance abuse Divorce Homosexuality 17

18. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Self-Injurious Behavior (SIB) Severe Stereotype Socially Acceptable/ Emblematic Superficial/Moderate 18

19. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Children Attempt suicide much younger than previously thought Hanging is the most common method Don’t express suicidal intent or signs of depression Have conflicts with parents 19

20. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Children Warning signs: – Past attempts/threats – Past violent aggressive behavior – Cognitive immaturity/impulsivity – Little to no supervision – Bringing weapons to school – Recent experience of humiliation/shame – Bullying – Victim of abuse/neglect – Witnessing violence in the home – Themes of death/preoccupation with violence – Poor peer relationships – Vandalism, cruelty to animals, fire setting 20

21. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Adolescents What separates those who attempt from those that think about it? – Substance abuse (12.8 times) – Enduring hopelessness – Isolation – Reluctance to discuss suicidal thoughts – Psychopathology 21

22. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. General Risk Factors for Adolescents 1.Previous suicide attempt 2.Mental Illness 3.Imitation 4.Family history of suicide 5.Sexual orientation 6.Sexual abuse 7.Other stressors 8.Incarceration 22

23. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Protective Factors 1.Friends - most important protective factor 2.Supportive parent 3.School relationships 23

24. Boys LGBTQ African American Bullies Bullied Native American The System Are these… “Ones We Miss”? Boys 24

25. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Girls Ratio of attempts to completions: 4,000:1 Suicide attempt is NOT a statistical risk factor Depressive episode IS a risk factor Do not always have a precipitating event May attempt while recovering from depression Panic attacks ARE a risk factor 25

26. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Boys Ratio of attempts to completions: 500:1 Attempts ARE statistical risk factor Often kill themselves within a few hours of a precipitating event: – Anxiety – Legal problems, relationships, humiliating experience, etc. Aggressiveness IS a risk factor 26

27. Boys LGBTQ African American Bullies Bullied Native American The System Are these some of the “Ones We Miss”? Native American 27

28. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Richard Cardinal 28

29. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Possible Reasons for Increase Stigma around mental health Non-native workers Removed from “community” Historical oppression Intergenerational trauma 29

30. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Protective Factors Culture Tradition Community Family 30

31. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Richard Cardinal Risk Factors? Protective Factors? Commonalities to youth in the system today? 31

32. Boys LGBTQ African American Bullies Bullied Native American The System Are these some of the “Ones We Miss”? African American 32

33. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. African American Youth Historically lower rates than whites This is changing – 10-14 year olds greatest increase Why? – Better knowledge, attention, reporting – Same as white counterparts – Structural barriers to health care – Attitudinal barriers – Economics/employment 33

34. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. African American Youth Access to firearms Isolation from social institutions Protective factors: family, church, school, community 34

35. Boys LGBTQ African American Bullies Bullied Native American The System Are these some of the “Ones We Miss”? LGBTQ 35

36. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. LGBTQ Youth Extremely high rate of depression, suicidal thoughts, and suicide attempts 30% of all adolescent suicides Primary cause (reported by LGBT teens) is negative family interactions “One’s We Miss”……………. 36

37. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. 37

38. Boys LGBTQ African American Bullies Bullied Native American The System Are these some of the “Ones We Miss”? Bullies Bullied 38

39. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. The Bullied and the Bullies Definition of Bullying: Unwanted aggressive behavior that is intentional and that involves an imbalance of power or strength. Typically repeated over time. Physical: hitting, tripping, breaking possessions Verbal: name calling, threatening, taunting Social/Relational: shunning, gossip/rumors, cyber bullying 39

40. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Profile of a Bullied Child/Adolescent Two main groups: The Passive Victim The Provocative Victim LGBTQ Youth: Teens bullied 26 times/day 31% threatened or injured last year Impairs their education 2-4 times as likely to attempt suicide 28% drop out of school 4 of 5 say they don’t know ONE supportive person at school 40

41. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Myths 1.Bullies are usually “loners” 2.They have low self-esteem 3.Bullying is the same as conflict 4.Most bullying is physical 5.It isn’t serious 6.Most likely to happen in urban school 7.Most likely to happen on the bus 8.Most kids who are bullied tell an adult. 9.Bullied kids learn to deal with it on their own. 41

42. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Small Group Discussion On your current caseload…  Which youth are “at risk”?  Identify specific risk factors  Identify protective factors 42

43. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Familial Pathways to Early-Onset Suicidal Behavior 43 Parent’s suicide attempt Parent’s mood disorder Child’s mood disorder Suboptimal family environment Abuse and neglect of child Child’s suicide attemptLife stressors Child’s impulsive aggression or neurocognitive deficits Parent’s impulsive aggression or neurocognitive deficits Brent, D.A., and Mann, J.J. (2006). Familial pathways to suicidal behavior – Understanding and preventing suicide amount adolescents. Perspective. Retrieved from http://www.nejm.org.

44. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. The Question Model 1.Ask the question(s) 2.Listen and respond 3.Act or refer 44

45. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Let’s Practice! 1.Dyads 2.Each person has a brief scenario 3.You will have 5 minutes to interview and practice asking the difficult questions 4.Feedback 45

46. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Now, what do you do with what you know? 46

47. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Additional Approaches Department of Education  Health Classes  SOS (Signs of Suicide)  ACT (Acknowledge, Care and Tell)  Teen Screen  Addressing Bullying 47

48. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. What about YOU? 12 areas of impact for the Social Worker Denial and Disbelief Grief and Loss Anger Self-Blame and Guilt Professional Failure and Incompetence Responsibility 48

49. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. What about YOU? Isolation Avoidant Behaviors Intrusion Changes in Professional Behavior Justification Acceptance 49

50. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Small Group Discussion 1.Discuss your reaction to these themes. 2.Talk about your experience with a completed or attempted suicide client situation. What was helpful? What was not helpful? Be ready to share what was helpful/not helpful with larger group. 50

51. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Whew! That is a lot of information! Suicide in WI Risk factors Warning signs Protective factors The “ones we miss” Special risks for children and youth in care How to ask the questions 51

52. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. System of Care Application Use Jared case scenarios Choose JJ or CPS perspective Read the scenario Develop a System of Care Document on System of Care handout 52

53. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Support Plan (Crisis Plan) Application Use same CPS or JJ perspective - read corresponding handout Create a Crisis Plan for when Jared returns to home (JJ) or foster home (CPS) Discuss: How would you know if Jared is in crisis? What strategies would you implement? Use Support Plan handout-Question 6 for documentation 53

54. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. For the Bullied and Beautiful 54

55. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. Resources www.afsp.orgwww.afsp.org (American Foundation for Suicide Prev.) www.sprc.orgwww.sprc.org (Suicide Prev. Resource Center) www.mhawisconsin.orgwww.mhawisconsin.org (Mental Health of WI) www.hopes-wi.orgwww.hopes-wi.org (Helping Others Prev. & Educate) www.suicidology.org www.suicidepreventionlifeline.org www.spanusa.orgwww.spanusa.org (Suicide Prev. ActionNetwork USA) www.nimh.nih.gov 55

56. NEW Partnership for Children and Families University of Wisconsin - Green Bay Impact of Suicide on Youth and Families: The Ones We Miss Revised: May 2013 May be reproduced with permission from original source for training purposes. The One Thing 56