1. Region 11 K-12 Student Mental Health Initiative Suicide Prevention Ongoing Region 11 Training (SPORT) The California County Superintendents Educational Services Association’s Regional K-12 Student Mental Health Initiative is administered by the California Mental Health Services Authority (CalMHSA), an organization of county governments working to improve mental health outcomes for individuals, families and communities. Prevention and Early Intervention programs implemented by CalMHSA are funded through the voter-approved Mental Health Services Act (Prop 63). Prop 63 provides the funding and framework needed to expand mental health services to previously underserved populations and all of California's diverse communities.

2. Crisis Team Training Outline National trends & California perspectives Staff role in suicide prevention Risk factors & warning signs of youth suicide Intervening with suicidal students Assessing risk Notifying parents/guardians Collaborating with law enforcement/mental health agencies Safety planning Suicide postvention

3. After a Suicide: A Toolkit for Schools Preventing Suicide: A Toolkit for High Schools

4. US 38,364 all ages (12.0) 4867 youth aged 10-24 (10.5) – 2941 20-24 (12.5) – 1659 15-19 (7.8) – 267 10-14 (1.3) Youth Suicide in the US: 2010 CALIFORNIA 3,913 (10.5) #44 in US – Steady increase since 2005 457 15-24 (7.4) #45 in US – Steady increase since 2007 28 (10-14) – More than doubled since 2007 SUICIDE is the 3 rd leading cause of death for youth age 10-24; boys & girls; across all ethnicities

5. Youth Suicide: Just the Facts In recent years more young people have died from suicide than from cancer, heart disease, HIV/AIDS, congenital birth defects, and diabetes combined. For every young person who dies by suicide, between 100-200 attempt suicide. Males are four times as likely to die by suicide as females - although females attempt suicide three times as often as males. The #1 environmental risk factor for suicide is the presence of a gun. In the US & CALIFORNIA the gun was the method most often used among youth however in Los Angeles the method most often used by youth was strangulation.

6. Youth Suicide: Just the Issues  Bullying Handout: Bullying and Suicide  Cyber-bullying Lesbian, Gay, Bisexual, Transgender Questioning Handout: Suicidal Behavior among LGBT Youth Non-Suicidal Self-injury Handout: Cornell NSSI Fact Sheet Social Media

7. Youth Suicide: Just the Issues Bullying Handout: Bullying and Suicide Cyber-bullying  Lesbian, Gay, Bisexual, Transgender Questioning Handout: Suicidal Behavior among LGBT Youth Non-Suicidal Self-injury Handout: Cornell NSSI Fact Sheet Social Media

8. Youth Suicide: Just the Issues Bullying Handout: Bullying and Suicide Cyber-bullying Lesbian, Gay, Bisexual, Transgender Questioning Handout: Suicidal Behavior among LGBT Youth  Non-Suicidal Self-injury Handout: Cornell NSSI Fact Sheet  Social Media

9. High School Students who Display Suicidal Behaviors

10. Youth Risk Behavior Surveillance Survey – 27.6% felt sad or hopeless (28.5 US) – 14.3% seriously considered suicide (15.8 US) – 13.6% made a plan (12.8 US) – 10.8% made one or more attempts (7.8 US) – 4.1% actually got to medical help (2.4 US) Youth Suicide in Los Angeles: 2011

11. Cultural Considerations: YOUTH White Males22.6 Alaskan Native/American Indian21.0 Black Males8.7 Asian/Pacific Islander6.2 Latino*5.3 Suicide Rate= # of deaths/100,000

12. Cultural Considerations Identify cultural-related needs of community. Obtain community resources to meet diverse needs. Have materials translated into native languages Have translators available. Preventing Suicide Toolkit, Tool 1.H, pgs. 50- 51 Know the traditions, rituals, and belief systems of your diverse population.

13. Intervening with Suicidal Students Guidelines for Crisis Teams and School Staff

14. Suicide Prevention: Staff Role Do not be afraid to talk to students about suicide Know the risk factors and warning signs of youth suicide Respond immediately: supervise student Have student escorted to crisis team Join the crisis team and provide valuable referral and background information HANDOUT: SUICIDE PREVENTION FOR STAFF TEACHERS_SPRC

15. Continuum of Self-Destructive Behavior Stressors: Chronic Mental Illness/Co-morbidity Warning signs ThoughtsBehaviors: Suicide attempts Self-injury Alcohol/substance abuse Stressors: Acute Precipitating Event

16. 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 High-risk group Preventing Suicide Toolkit, Tool 1.D, pgs. 33-36

17. Risk Factors of Youth Suicide SITUATIONAL CRISES (Precipitating Events) Loss (death, divorce, transience, romance, dignity) Victimization/exposure to violence School crisis (disciplinary, academic) Family crisis (abuse, domestic violence, running away, argument with parents) Suicide in community

18. Warning Signs of Youth Suicide Adolescents Suicide notes Threats Plan/method/access Depression (helplessness/hopelessness – Risk taking behaviors such as gun play, alcohol/substance abuse) Giving away prized possessions

19. Warning Signs of Youth Suicide Elementary Efforts to hurt self – Running into traffic – Jumping from heights – Scratching/cutting/marking the body Death & suicidal themes in writing/drawing Sudden changes in personality, friends, behaviors

20. Signs of Self-injury 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 HANDOUT: Cornell NSSI Fact Sheet

21. Signs of Self-injury 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, jumping from high places or running into traffic.

22. http://preventsuicide.lacoe.edu

23. Procedures SCHOOL SITE CRISIS TEAM Maintain Supervision throughout School Crisis Team Members: – Designated Reporter – Administrator – Support Personnel Assess risk and advise Collaborate with law enforcement and local mental health resources HANDOUT: INTERVENING WITH SUICIDAL STUDENTS SCHOOL MENTAL HEALTH_SPRC

24. Procedures SCHOOL SITE CRISIS TEAM Assessment of risk Duty to warn/notify parent/guardian Duty to refer Documentation Caveat – Collaboration is your liability insurance

25. Suicide Assessment Protective Factors Assess protective factors Internal Ability to cope with stress Religious beliefs Frustration tolerance External Positive therapeutic relationships Social supports School connectedness Responsibility to children or beloved pets HANDOUT: COLUMBIA SUICIDE SEVERITY RATING SCALE SAFE-T: SUICDE ASSESSMENT FIVE STEP EVALUATION AND TRIAGE

26. Brief Suicide Assessment Suicide inquiry – Ideation Frequency, intensity, duration (48 hrs; past month) – Plan Lethality, availability of means; preparatory acts – Behaviors Past attempts; rehearsals – Intent Explore ambivalence; reasons to die vs. reasons to live Ask parent: About evidence of thoughts, plans, previous behaviors, changes in mood/behaviors

27. Brief Suicide Assessment  Question: Have you ever thought about suicide (harming yourself)?  Question: Have you ever tried to kill (or hurt yourself) before?  Question: Do you have a plan to kill (harm) yourself today? LOW MODERATE HIGH HANDOUT: INTERVENING WITH SUICIDAL STUDENTS

28. SUICIDE INTERVENTION IN THE SCHOOLS: Intervention: LOW RISK Reassure and supervise student Notify parent Assist in connecting with school and community resources Suicide proof environments Mobilize a support system Safety planning Document all actions

29. SUICIDE INTERVENTION IN THE SCHOOLS: Intervention: MODERATE/HIGH RISK Supervise student at all times including trips to restrooms. Notify and release student ONLY to: – Parent/guardian who commits to seek an immediate mental health assessment – Law enforcement – Psychiatric mobile responder Document all actions.

30. SUICIDE INTERVENTION IN THE SCHOOLS: Intervention Notifying parents – Obtain relevant mental health history – Insurance information – History of traumatic losses; victimization; – Obtain signed release of information – Assess family support Utilize safety planning – Identify circle of care of adults – Promote help–seeking behaviors – Promote communication skill building – Grief resolution – Provide relevant hotlines/websites/resources HANDOUT: SAFETY PLANNING GUIDE

31. SUICIDE INTERVENTION IN THE SCHOOLS: Intervention Community resources – Emergency response teams – Collaborating with law enforcement – Culturally appropriate mental health agencies – Gay and Lesbian mental health agencies – Annually updated School district resources (Special Ed)

32. Re-entry Guidelines Have parent escort student back to school first morning following hospitalization 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. Provide interventions: – Modify academic programming as appropriate – Identify on-going counseling resources at school or in the community – Discover if student is on medications and monitor with parent consent. – Notify student’s teachers as appropriate

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

34. SUICIDE INTERVENTION IN THE SCHOOLS: Documentation Establish Documentation procedures Document all actions of crisis team response NO Immediate Timelines! (fill out later!) Keep in a confidential file (not Cumulative Folder) Documentation never leaves district Coordination when student transfers or graduates to other schools within district

35. After a Suicide: A Toolkit for Schools SUICIDE PREVENTION RESOURCE CENTER AMERICAN FOUNDATION FOR SUICIDE PREVENTION

36. Practical Suggestions Intervene only when indicated Do not inform staff or students by intercom Triage staff and make appropriate notification in person (not by memo or email) Have substitutes to relieve staff during the day Facilitate social support systems for HS/Secondary students

37. Suicide Postvention Checklist 1.Verify that a death has occurred and confirm cause 2.Mobilize the Crisis Response Team 3.Assess the suicide’s impact on the school and estimate the level of postvention response 4.Notify other involved school personnel 5.Contact the family of the suicide victim 6.Determine what information to share about the death 7.Determine how to share information about the death

38. 38 8.Identify students significantly affected by the suicide and initiate a referral mechanism 9.Conduct a faculty planning session 10.Initiate crisis intervention services 11.Conduct daily planning sessions 12.Memorials 13.Social Media Suicide Postvention Checklist

39. Number 5: Contact the Family of the Suicide Victim Contact should be made in person within 24 hours of the death. Purposes include: Express sympathy Offer support Identify the victim’s friends who may need assistance Discuss the school’s postvention response Identify details about the death that could be shared with outsiders Discuss funeral arrangements and whether the family wants school personnel and/or students to attend.

40. 40 Number 8: Identify those Significantly Affected by the Suicide & Initiate Referral Procedures Risk Factors for Imitative Behavior Facilitated the suicide Failed to recognize the suicidal intent Believe they may have caused the suicide Had a relationship with the suicide victim Identify with the suicide victim Have a history of prior suicidal behavior Have a history of psychopathology Show symptoms of helplessness and/or hopelessness Have suffered significant life stressors or losses Lack internal and external resources

41. Number 9: Conduct a Staff Planning Session Guidelines for staff include: 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

42. Number 9: Conduct a Staff Planning Session Address staff reactions. Staff need to know HOW they respond in the eyes of the children is very important and have a great impact on elementary- aged students. Staff may need to be provided a common fact sheet to be read in classes determined by the crisis team. Staff could be provided... – Current information regarding the death – Information about suicide contagion – Suicide risk factors – Plans for the provision of crisis intervention services – Specific activities/responsibilities

43. Number 12: Memorials Strive to treat all student deaths the same way Encourage and allow students, with parental permission, to attend the funeral Reach out to the family of the victim Contribute to a suicide prevention effort in the community Develop living memorials, such as student assistance programs, that address risk factors in local youth Address spontaneous memorials on school grounds

44. Number 13: Social Media Often outside of school’s literal control Can still be utilized as part of school’s response Partnership with key students Identify and monitor relevant social networking sites Share prevention-oriented safe messaging Offer support to students who may be struggling to cope Identify students who could be at risk

45. Prevention Messaging for Administrators While suicide is widely known as preventable, sadly, some suicides cannot be prevented. The goal now is to reach out to everyone in the school community who might be in need of support and to identify those in need of referrals and local mental health resources. We want our students to know that under no circumstances is suicide an option. Help is available. If they are concerned about a friend they should never hold such information confidential and they should tell a trusted adult. Suicide and the grief that follows a death by suicide are very complex and no one person, no one thing is ever to blame.

46. The legacy of survivors includes many questions that cannot be answered but a key to healing for many has been to become an advocate for suicide prevention efforts in the community they live in. There are very clear risk factors for suicide and they include a history of depression, alcohol and substance abuse, and recent losses. Often a precipitating event will ignite the fuel of depression and result in suicidal thoughts and actions: Events such as a loss of romance, dignity, or death by suicide; an economic, health, academic or disciplinary crisis; an argument with parents, peers. 46 Prevention Messaging for Administrators

47. YOUTH SUICIDE: RESOURCES Suicide Prevention Resource Center http://sprc.org American Association of Suicidology http://suicidology.org American Foundation for Suicide Prevention http://afsp.org National Association of School Psychologists http://nasponline.org Centers for Disease Control http://www.cdc.gov/ViolencePrevention/suicide /

48. QUESTIONS??? Contact us: SMHI@lacoe.edu