• • • • • • •

AGENDA

Challenges School psych role in SP Why the workshop Workshop description 3 schools Resources Questions

Challenges

• • •

Challenge: volatile mix of problems clouds the picture

Suicide is sometimes mixed in with behavioral crisis, mental health symptoms, non-suicidal self injury, family and social problems, substance abuse and police involvement, injuries and illnesses. 10% adolescents who die by suicide, treated in ED within 2 months prior to death, often not related to suicide. (Posner, 2011) Repeat visits – Attempts become more deadly over time • HINT: Use suicide discrete assessment tools (ex. Columbia Suicide Severity Rating Scale)

Challenge: Method / Intent

Type 1

“Attention Seeking,” “Gestures,” Low to No Risk

Type 2

“Can’t Prevent Someone Truly Intent” HINT: Don’t attempt to determine psychological intent from the method

Challenge: easy access

Youth Emergency Department Visits for Drug-Related Suicide Attempts

Alcohol

Most Likely to Involve Anti-Anxiety, Acetaminophen, and Antidepressant Drugs

Percentage of U.S. Emergency Department (ED) Visits for Drug-Related Suicide Attempts Among Youth Ages 12 to 17 Involving Selected Substances, 2008

(N=23,124 ED visits)

Anti-Anxiety Drugs Acetaminophen Products Antidepressants Ibuprofen Products Alcohol Illicit Drugs Antipsychotics Narcotic Painkillers Aspirin Products Stimulant Pharmaceuticals 14.9% 11.4% 8.8% 7.4% 5.1% 4.2% 1.5% 26.2% 25.4% 23.0% 0% 5% 10% 15% 20% 25% 30%

HINT: Assess, educate, problem–solve with families around access to means SOURCE: Adapted by CESAR from data from Substance Abuse and Mental Health Services Administration (SAMHSA), “Emergency Department Visits for Drug-Related Suicide Attempts by Adolescents: 2008,” The DAWN Report, May 13, 2010. Available online at www.oas.samhsa.gov/2k10/DAWN002/SuicideAttemptsYoungAdults.cfm.

Challenge: Getting relevant information for rapid assessment

• • • Story changes as the crisis abates Getting collateral information from family and care providers Getting at suicidal secrets requires skill • HINT: Establish rapport quickly. Use “Tell me more” conversational interview. “Tell me more” adapted from M. Underwood, Society for the Prevention of Teen Suicide

Challenge: “Hot Potato Effect”

• • • • Fewer than 20% of adolescent suicides receive any consistent treatment prior to their death

(Posner, 2011)

Mental Health Workforce has inconsistent training & skill specific to suicide care.

Many tools used to assess for risk have poor validity and reliability. Suicide is difficult to predict.

HINT: Do something helpful. Educate, Intervene, Problem-solve, Safety plan.

Challenge: Suicide Care in Psych Settings

• • • • • National MH Workforce Survey: October 2012 N=6,637 New York respondents 27.7% had one or more patient who ended their life while under care 45% Disagreed or didn’t know if they had the training they needed to help a suicidal patient 32.4% Disagreed or didn’t know if they had the supervisory support they needed to help

Role of the School Psychologist in School Based Suicide Prevention • Be knowledgeable about: – Risk factors & warning signs – Legal issues, best practices, EBP’s – The advantages of safety plans versus no-harm contracts – Crisis assessment & intervention – Issues related to suicide contagion & clusters (Berman, 2009)

Role of the School Psychologist in School Based Suicide Prevention • Be able to: – Formulate & conduct risk assessments – Differentiate between suicidal behavior & NSSI – Conduct crisis assessments and interventions – Involve parents/guardians of potentially suicidal youth in the intervention process – Safely reintegrate a student into the classroom following a suicide attempt – Effectively implement suicide postvention procedures (Berman, 2009)

Role of the School Psychologist in School Based Suicide Prevention – – – Integrate research evidence with clinical experience • Consider readiness, acceptability, cultural relevance Value experience and expertise of various school professionals • Share responsibility for identifying, planning, and delivering Use competencies in • Consultation • Team Process • • Problem-solving model Data-based decision making • Program evaluation (Kazak et al., 2010; Kratochwill & Steele Shernoff, 2004; NASP, 2010; Strein & Koehler, 2008)

Why the workshop?

• • • • • Raising skills & awareness (education & training) Building & supporting coalitions Youth Suicide Prevention Centers Zero Suicide Health and Behavioral Health Care Model SPCNY • • • • •

SCHOOLS

Unique governance Focus is education Local culture Titles vs. roles Lots of schools, all unique

• Engage school planning team in a process to: Review existing suicide prevention readiness • Receive evidence-based and best practice guidance • Develop comprehensive suicide prevention and response plan • Learn about resources to enhance safety and health of your school environment that are subsidized or available at low or no cost.

CSSS Workshop Model: Elements of Suicide Safety at School Policies & procedures are the foundational structure Parent & Community Engagement for support, referral and mutual aid Staff gatekeeper training, intervention skills Programming & education that supports protection and resiliency Crisis team has postvention training, resources, procedures Targeted intervention process for managing students with risk

Creating Suicide Safety in Schools:

Workshop Approach  Process vs. Product  Best practice and evidence-based practice  www.sprc.org/bpr & www.nrepp.samhsa.gov

 Contagion theory  Public health prevention models  Decrease risk Indicated  Increase protection Selected Universal

Creating Suicide Safety in Schools:

Workshop Components • • • • • • Suicide facts Scenarios Checklist Group work sessions Resource binder Planning worksheets



Sample Scenario:

Mr. Brown is in his second year of teaching English at your high school. He has become alarmed about a student, Jakob, who recently transferred into his third period class. Jakob has handed in a writing assignment in which he depicted morbid themes including suicide and the words, “what if hope hurts?” in one corner. Thinking back, Mr. Brown realizes that Jakob is often sullen, he doesn’t interact with any other students, and he often has his head down in class.  What would you like to see Mr. Brown do next?

 What might get in his way?

East Hampton High School

Long Island

East Hampton High School

Long Island ACTIONS TAKEN • • • • • • • • • NCSC School Climate Inventory School Climate Steering Committee Hired a bilingual, bicultural family liaison Rallied community support Ongoing meetings with local providers Intervention Protocols Lifelines Intervention Faculty Training Lifelines Postvention (upcoming)

Gowanda Central Schools

Western NY

Gowanda Central Schools

Western NY ACTIONS TAKEN • • • • • • Regional meeting on MH resources Intervention protocols & templates Lifelines Trilogy training Faculty protocol Faculty training (Making Ed. Partners) Sources of Strength

Salamanca City Schools Western New York

23

Salamanca City Schools Western New York

• • • • • • ACTIONS TAKEN Rallied community support Trained Crisis team Updated crisis plan ASIST Columbia SSRS Sources of Strength 24

Free Resources

• • • • • • Lifelines Trilogy of Trainings: Prevention, Intervention, Postvention SAMHSA Toolkit Faculty, staff & Parent education Online faculty training Classroom curriculum Resiliency based programming • • • • • • • Columbia SSRS training ASIST and SafeTALK training Postvention support and consultation Safety Planning Intervention training Safety planning App.

Means restriction brochure Sources of Strength

=Creating Suicide Safety in Schools Workshop =Workshop scheduled

Pat Breux [email protected]

PreventSuicideNY.org