1. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Suicide Assessment and Treatment for Children and Adolescents

2. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Introduction Charles Pemberton –Ed.D. in Educational Counseling –16 years in Counseling and Mental Health –Presented in England, South Africa, Central America, and US. –Adjunct Professor – Graduate University of Louisville Undergraduate – IvyTech and KCTCS –Private Practice – 80% children and families ADHD Depression Aggression Anxiety

3. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Today’s Schedule Current Statistics Treatment and Assessment Methods Legal Concerns Questions

4. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Quick Quiz There is a correlation between winter holidays and suicide rates – T/F Men attempt suicide more often than women – T/F Suicide rates are higher in the western states than in the eastern states – T/F American Indian males have the highest suicide rate – T/F

5. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Quick Quiz There is a correlation between holidays and suicide rates – F –Rates in the US are lowest in winter/highest in spring Men attempt suicide more often than women – F –Women report attempting 3x that of men Suicide rates are higher in the western states than in the eastern states – T –Higher than national average/lower in eastern and midwestern American Indian males have the highest suicide rate – F –Caucasians have highest/American Indians are 2nd

6. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Current Statistics

7. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Current Statistics

8. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Current Statistics

9. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Adolescent Suicide Suicidal Ideation –thinking about suicide common among adolescents

10. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Adolescent Suicide, cont. Five reasons for erroneous belief that suicide is common in adolescent –rate is triple the rate of 40 years ago –adolescents lumped together with young adults as one statistical category -adolescent suicide is shocking and grabs attention -social prejudice considers teenagers as problems -suicide attempts are more common in adolescence

11. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Parasuicide—deliberate act of self- destruction that does not end in death Parasuicide and suicide depend on five factors –availability of lethal means, especially guns –lack of parental supervision –alcohol and other drugs –gender –cultural attitudes Parasuicide

12. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Worldwide, parasuicide is higher for females; completed suicide is higher for males –except in China, where females complete suicide more than males Cluster suicides occur when several suicides are committed within the same group in a short time Gender, Ethnic and National Differences in Suicide

13. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Assessment First, remember to do three things: 1) consult - this allows for another opinion, better care, and protects you 2) document, document, document! Everything you do, everyone you talk to, every question you ask the client should be documented 3) evaluate the client's risk

14. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Risk Factors mental diagnosis, especially depression and substance abuse, or Borderline Personality Disorder which increase risk over 45 years old are higher risk sex (men try more lethal means, women try more often)

15. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Risk Factors cont’ marital status (unmarried are lowest risk, never married, divorced, widowed, recently separated are highest risk) recent job loss increases risk chronic illness is higher risk

16. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Risk Factors cont’ recent loss of loved one increases risk, as does the anniversary of the loss and fantasies of reuniting with the deceased hospitalized and discharged with improvement; this may seem counterintuitive, but many suicidal people feel better once they have made the decision to kill themselves, and have the energy to wrap up loose ends, see others and say goodbye...

17. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Risk Factors cont’ Caucasian - ethnic minorities have a lower suicide risk previous attempts - this is one of the best predictors gay/lesbian youth - may be at 3 to 5 times the risk for suicide as heterosexual Caucasian youth

18. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Risk Factors extensive and detailed plans, or plans using a highly lethal means history of suicide in their family history of impulsive or reckless behavior

19. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Questions to ask Do you have thoughts of suicide? Are they related to current stressors going on in your life, or have you had such thoughts before? Do you have a plan? Tell me. Ask if they have access to the components of their plan, like a gun, pills, etc...

20. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Signs of Depression sleep, energy, weight, or appetite changes decreased interest in sex and other pleasurable activities feelings of helplessness and hopelessness social isolation and withdrawal from others

21. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Other thoughts Empathize with the client They are experiencing crises and stress, hopelessness, and helplessness. Offer that there is a part of them that wants to live, since they were cooperative with you. Offer too that services and referrals, as well as social support could be helpful to use now too. Make a No-Suicide Contract This is best when the client has support, is low risk, and can give clear reasons why they would not kill themselves; the client agrees they won't hurt themselves, and if they feel they can't stop themselves, they will call 911, an ER, a crises line, a therapist, or another designated special person, and will return for help on next appointment. Make the patient sign it and get a witness. Family Intervention This is best is there is high support and low impulsiveness in the client. The clients agree with you to contact their family. They stay with the family member until the suicidal thoughts have been addressed in treatment, and the family is briefed on who to contact for help in an emergency. The family also takes an active role to remove drugs, guns, or other means of suicide from the home, and promises 24 hour supervision. Hospitalization This is best if there is little family support, or mental illness, substance use or impulsiveness. Try voluntary admission, but use involuntary if needed.

22. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Inventories Beck CDI Hamilton

23. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Medical vs. Collaborative Depression Lack of sleep Poor appetite Anhedonia Suicidality??? Suicidality Pain Stress Agitation Hopelessness Self-hate Reasons for living vs. reasons for dying

24. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Treatment Options-standard Individual Psychopharmacological Group/Family EMDR ECT CDI Hamilton

25. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Treatment Options-CBT Journaling Interactive journaling/email Bibliotherapy Physical activity Self-soothing

26. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Stages of Treatment Stage 1 – Acute Stage 2 – Short Term CBT and Stabilization Stage 3 – Longer Term Psychodynamic/Interpersonal Treatment

27. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Three Pillars of Liability Forseeability Treatment Planning Follow-up/Follow-through

28. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Legal Concerns Screen all clients for suicidal risks during initial assessment and remain alert to issue throughout Arrange an environment that will not offer easy access to instruments Create actively supportive environment

29. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Legal Concerns Make every effort to communicate and justify realistic hope Consider use of contracts Explore client’s fantasies Be clear and communicate impact to interventions Conform to State Laws

30. 1700 UPS Dr. Suite 107 Louisville, KY 40223 Phone: 502-327-8045 Fax: 502-327-7272 Email: email@pembertoncounseling.com www.pembertoncounseling. com PEMBERTON COUNSELING SERVICES, PSC Web links http://www.psychpage.com/learning/library/counseling/suicid e.htmlhttp://www.psychpage.com/learning/library/counseling/suicid e.html http://aacap.org/page.ww?name=Teen+Suicide&section=Fac ts+for+Familieshttp://aacap.org/page.ww?name=Teen+Suicide&section=Fac ts+for+Families http://www.athealth.com/practitioner/Newsletter/FPN_7_3.ht mlhttp://www.athealth.com/practitioner/Newsletter/FPN_7_3.ht ml http://archfami.ama-assn.org/cgi/content/full/9/10/1119 http://www.cdc.gov/nchs/fastats/suicide.htm http://suicideandmentalhealthassociationinternational.org/int ervadol.htmlhttp://suicideandmentalhealthassociationinternational.org/int ervadol.html http://www.save.org/cdcstat1.html http://www.suicidepreventtriangle.org/Suichap6.htm http://www1.endingsuicide.com/PageReq?id=3048:7576 http://www.cdc.gov/ncipc/dvp/suianno.htm http://www.nimh.nih.gov/suicideprevention/suifact.cfm http://www.aafp.org/afp/20020501/tips/15.html http://www.who.int/mental_health/prevention/suicide/suicidep revent/en/http://www.who.int/mental_health/prevention/suicide/suicidep revent/en/