Transcript Positive Behavioral Interventions and Supports

YOUTH SUICIDE
PREVENTION
SCHOOL-BASED GUIDE
http://theguide.fmhi.usf.edu/
Guidance Counselor’s Meeting
Student Support Services
Overview
 Identifies elements of a comprehensive, school based suicide
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prevention program
Examines scientific literature to determine elements that are
the most effective.
Contains Checklists and Self Assessment
Guide for Administrators for program implementation
Reviewed by experts
Statistics
 Suicide accounts for 13% of all adolescent deaths
 Third overall cause of adolescent deaths
 Increased in children from age 10-14 100% 1980-1996
 Estimated 3,500 adolescents attempt suicide daily
Statistics Continued
 35 die daily
 More teenagers die from suicide then cancer, AIDS, birth
defects, stroke, pneumonia, influenza, and chronic lung
disease combined.
 1980-1985 rate for African American Youth increased 230%
 90% that die have mental health problem: depression,
substance abuse
Reality of Suicide
Unexpected death is always painful, but
perhaps none more then self-destruction of
a young person and a life, with all of its
potential and promise, cut short by one
desperate and too final act.
Why School Based Prevention
 School can offer prevention, intervention and education.
 In schools suicide issues may be evident more so then in
other settings.
 Issues may occur with the greatest frequency.
 Schools offer a large exposure (teachers, counselors, peers)
to youth.
Public Health Approach
 Positive role schools can play.
 Example of disease programs (inoculations, TB, Small Pox)
 Up to date, accurate, research based information, guidelines
and tools.
 Reviews literature, evlauates and draws conclusions
Public Health Approach
 Identifies the problem
 Identifies risk factors
 Indentifies causes of the problem
 Develops interventions evaluated for effectiveness
OVERVIEW AREAS
 Information Dissemination
 School Climate
 Risk Factors: Risk and Protective Factors, Early Warning
Signs.
 Risk Factors: How can a school Identify a Student At Risk for
Suicide?
Overview Areas Continued
 Administrative Issues
 Suicide Prevention Guidelines
 Intervention Strategies: Establishing a Community Response
 Intervention Strategies: Crisis Intervention Teams
Overview Continued
 Intervention Teams: Responding to Student Crisis
 Preparing for and responding to death by suicide: Steps to
Responding.
 Preparing for and responding to death by suicide:
Responding to and working with the media.
 Family Partnerships
 Culturally and linguistically Diverse Populations
Information Dissemination in the
Schools
 Suicide third leading cause of death in adolescents
 School based programs have ideal exposure to large number
of adolescents.
 Should be facilitated by staff that are knowledgeable in the
area.
 Research suggest teachers may feel they are not prepared to
assess or address suicide issues.
Information Dissemination in the
Schools
 Training faculty and staff essential in effective prevention
programs.
 Skills to develop knowledge, attitudes, and identification for
appropriate referrals.
 Essential to train administrators and parents for support of
prevention efforts.
 Brief two hour training is effective in increasing teacher’
awareness of adolescent suicide.
MYTHS
Talking about suicide in the
classroom will promote suicidal
ideas and suicidal behavior.
MYTHS
Parents are often aware of the
child’s suicidal behavior.
MYTHS
Most adolescents who attempt
suicide fully intend to die.
MYTHS
There is not a significant
difference between male and
female adolescents regarding
suicidal behavior.
MYTHS
The most common method for
adolescent suicide ins drug
overdose.
MYTHS
Because female adolescents
complete suicide at a lower rate
than male adolescents, their
attempts should not be taken
seriously.
MYTH
Suicide behavior is inherited.
MYTH
Adolescent suicide occurs only
among poor adolescents.
Myth
The only one who can help a
suicidal adolescent is a counselor
or mental health professional.
SCHOOL CLIMATE
Connectedness
Participation
Academic Achievement
Safety
Training
SCHOOL CLIMATE
Discipline
Physical Environment
Security
Connectedness
 Felt treated fairly, close to people at school, part of school.
 Less likely to experience suicidal thoughts and emotional
distress.
 Less likely to drink alcohol, carry weapons, engage in
delinquent behavior.
 Foster afterschool activities, involvement in decision making
and create small size learning groups.
Participation
 Research: Students participate in decisions are healthier,
more productive.
 Assign students to meaningful school roles: monitor,
classroom helpers, planning committees.
 Example of Crime Stoppers.
 Protective factor for “At Risk Students”
Academic Achievement
 Set academic goals and supporting strategies.
 Provide encouragement
 May use media or other mechanism
 Positive Behavioral Supports
SAFETY
 Unsafe schools – Emotional and Physical Realms
 Unsafe leads to poor academic performance and truancy.
 Bullying
 Relationship between bullying and emotional factors
SAFETY
 Create ways for the student to feel comfortable to report
potentially dangerous situation.
 For example, list of adults they may contact if they feel unsafe
or have knowledge of a potentially dangerous situation.
 Ways for the staff to intervene in potentially dangerous
situation.
 For example, mental health, signs of distress in students,
review of policies.
Training
 Students should be taught skills training how to resolve
conflict, problem solving, coping strategies (Life Skills).
 Incorporate skills in existing classes i.e. health, drivers
education, physical education.
 Increasing social skills related to positive impact on cognitive
development, academic achievement.
 Curriculums need to be research based, active learning
strategies, school wide and have adequate teaching resources.
Discipline
 Method to teach appropriate social behaviors.
 Positive and proactive
 For example, positive behavioral supports.
 Example of Bullying Intervention, Problem Solving Skills,
Conflict Resolution, Appropriate Social Behaviors.
 Avoid humiliating, harassing, scolding, nagging, physically
aversive discipline, decreasing learning opportunities.
Physical Environment
 Research suggests students attitude about the school may be
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related to the appearance of the school.
For example, flakey ceilings, graffiti tainted walls, scuffed up
floors, dirty bathrooms, crumbling sidewalks, and leaky
toilets:
May lead to “Why bother, no one cares” attitude.
Example, of Men’s Bathroom and breaking sink incident.
Negativism about the school may impact attitude towards
teaching, learning, attendance and morale.
Security
 Ensure the school is free from weapons.
 Random search policy
 Links to the community resources/partnerships (Guam
Police Department, Customs -random sweeps, Child
Protective Services)
 Utilize parent support
Security Issues
 Number and type of exits
 Lighting
 Rooms and furnishings,
 Locker use
 Parking
 Positive posters: Behavioral Expectations
 Patterns of supervision
 Traffic patterns
 Isolated areas
Security Issues
 Location and design of bathrooms
 Guardrails
 Hallways
 Closed campus
 REGULAR SAFETY ASSESSMENTS
SAFE ENVIORNMENT
 Staff in-service training
 Established policies (bullying, random searches)
 Opportunities to staff to share their concern
 Emphasize positive relationships
 System in place to refer students suspected abuse and neglect
 Treat students with respect, support and care.
SAFETY ENVIORMENT
 Monitor safety
 Consistently enforce disciplinary, harrassment, and civil
rights policies.
 Inform students who they may contact if there is a safety
issue.
 Help students feel safe about approaching and adult
Safety Learning Environment
 Address problem solving and social skills
 Ensure high academic standards
 Develop links to the communities.
 Encourage and utilize parental involvement
Safety Environment
 Educate students on tolerance, harassment, bullying, and
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respecting others.
Ensure physical environment
Policies and procedures on weapons and safety
Develop after school activities
Use positive pro-social approach that de-emphasizes
punishment.
Risk and Protective Factors and
Warning Signs
 Suicide is an extremely complex phenomena
 Nine out ten adolescents show clues to their attempts
 No tangible all encompassing method to assess.
 Focus on risk factors
 Impacting risk factors such as treating depression or
substance abuse, stressful life events may have positive effects.
RISK FACTORS
 Previous suicide attempt or gesture
 Feelings of hopeless or isolation
 Psychopathology (depressive disorders/mood disorders)
 Parental psychopathology
 Substance abuse disorder
 Family history of suicidal behavior
 Life stressors: interpersonal losses, relationship, social, work,
 Legal, disciplinary problems
 Access to firearms
RISK FACTORS
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Physical Abuse
Sexual Abuse
Conduct disorders or disruptive behaviors
Sexual orientation: homosexual, bisexual and transgendered
youth.
Juvenile delinquency
School or work problems
Congtigation or imitation (exposure to media accounts or friends
with suicidal behavior.
Chronic physical illness
Living alone or runaway
Aggressive-impulsive behaviors
PROTECTIVE FACTORS
 Family cohesion (mutual involvement, shared interests,
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emotional support)
Good coping skills
Academic achievement
Perceived connectedness with school
Good relationships with school or other youth
Lack of means for suicidal behavior
Help seeking behavior
Impulse control
PROTECTIVE FACTORS
 Problem solving/conflict resolution abilities
 Social integration/opportunities to participate
 Sense of worth/confidence
 Stable environment
 Access to care for mental/physical substance disorders
 Responsibilities for others/pets
 Religious activity (controversial topic currently)
EARLY WARNING SIGNS
 Withdraw from friends of family
 Preoccupation with death
 Marked changes in personality
 Difficulty concentrating
 Difficulties in school (decline in quality of work)
 Frequent physical complaints often related to emotions
(stomach aches, headaches, fatigue
 Persistent boredom
 Loss of interest in things one cares about
LATE WARNING SIGNS
 Actually talking about a suicide or plan
 Exhibiting impulsivity: violent acts, rebellious behavior,
running away.
 Refusing help, feeling beyond help,
 Complaining “being a bad person”, rotten inside.
 Making statements of hopelessness, helplessness,
worthlessness.
LATE WARNING SIGNS
 Verbal hints: “I wont be a problem to you much longer”
“Nothing matters”, “It is no use”, “I won’t see you again”.
 Becoming suddenly cheerful after a period depression.
(May mean student has made decision to escape all problems by
ending their life).
 Giving away favorite possessions
 Making last will or testament
 Saying: “I am going to kill myself ”, “I wish I were dead”, I
shouldn’t have been born”
How can school identify a student at
risk for suicide?
Suicide Awareness Curriculum
Gatekeeper training
Screening
CURRICULIUM
 Dose and length very important
 Avoid: one shot sessions – may overwhelm students,
reaction to stress, media dramatized
 Long term programs – semester long
 Incorporate into established classes: health, life skills
problem solving skills, help seeking behaviors,
CURRICULIUM
 Avoid presentations by youth who may have made previous
attempts – may result in copy cat behavior.
 Provide list of crisis intervention services
 Have established policies and procedures on how to deal with
suicidal adolescent
 Introduce curriculum only after policy and protocol are
established.
CURRICULIUM
 Have established community links that may provide
assistance.
 Have trained staff available that know what to do with the
suicidal adolescent.
GATEKEEPER TRAINING
 Provide staff with most current information on adolescent
suicide.
 Have policies and procedures in place.
 Establish community links (referrals): Mental Health, Police,
EMS
 Encourage staff to collaborate and cooperate.
GATE KEEPER TRAINING
 Educate staff regarding risk factors
 Educate staff regarding warning signs
 Educate staff on how to make referrals (who and when)
 Provide regular (twice a year) brief trainings to all staff.
Screening
 Method of Identifying at risk students: ASK THE QUESTION
 Effective and efficient in identifying students
 Concerns: suicide behavior highly complex, need to assess at
various frames of reference.
 14 year old bipolar female example (CONFIDENTIAL)
SCREENING INSTRUMENTS
 The Suicide Ideation Questionnaire
 The Suicide Risk Screen
 The Columbia Teen Screen
 Signs of Suicide(SOS)
SCREENING
 Use a questionnaire that is research validated
 Get parents consent first before proceeding
 Have established referral system
 Research suggests screening will NOT create suicidal
ideations in adolescents who are not suicidal.
SCREENING
 Staff made aware screening is not 100% in determining if a
student will express suicide ideations.
 Counselors aware of valid screening instruments.
 Conduct repeated screening: once or twice a year.
ADMINISTRATIVE ISSUES
 Implementation
 Developing Polices and Procedures:
 Elements – issue is a priority,
types of prevention efforts,
Crisis management handbook,
describe roles and responsibilities,
how to respond to students,
Administrative Issues
 Describe criteria for assessing lethality of student potentially
At risk.
 Describe how program will be evaluated.
 Clear and detailed
 School level and district level
Crisis Response Team
 Crisis response plan
 Roles and responsibilities
 Team leader(s)
 Supported by Adminstration
Evaluating Programs
 Research based
 Documentation and policy
 Consultation
 Evaluation component
 Other indicators of risk factors (substance abuse, mental
health
Program Support
 Administration
 Teachers
 Parents
 Community partners
Duty, Responsibility, and Liability
 Duty of supervision by the school
 Same level as parents at home
 Failure to prevent due to lack of action = liability
 Failure to notify parent = liability
 Liability if violate a FERPA, HIPPA other Laws
Duty, Liability, Responsblity
 Preventative measure to establish programs
 Keep accurate up to date records
 Baker Act (72 hour hold)
 Involuntary admissions Criteria: refused voluntary, likely to
harm self if no admission, gravely disabled.
Suicide Prevention Guidelines
 Policy and Procedures
 Gatekeeper Training
 Educating Parents and community members
 Student Curriculum Addressing Suicide
 Teaching Adaptive Skills to Students
 Peer Support Groups
 Screening
Postvention Strategies (Strategies to
responding to a Suicidal Crisis
 Established response team
 Crisis Center and Hotlines:
Reach important and underserved population
Help those students that use them
Endorsed by youth as more acceptable then mental health
centers
Can serve as drop in center
Suicide Prevention Guidelines
 School Climate
 Policy and Procedures
 In school response teams
 Parent involvement
 Training: teachers, and staff
 Curriculum incorporated in existing classes
 Provide information re. coping skills, problem solving
 Provide screening program (research based assessment)
 Counselors trained in best practices
SUICIDE PREVENTION GUIDELINES
 Provide Peer Assistance Programs
 Provide information re. community resources
 Ensure school maintains positive climate
 Inform parents of importance of restricting
weapons/violence.
 Ensure staff and personnel are supportive and feel
comfortable with prevention strategies.
INTERVENTION STRATEGIES
 Cannot function without outside support (community)
 Positive community relationships enhance prevention
 Provide information on services of community links.
INTERVENTION STRATEGIES
 Crisis Intervention and Response Teams
 Coordinate district wide
 Based on resources
 Training and regular team meetings
 Mobilization and screening
INTERVENTION STRATEGIES
 TEAM SUPPORT
 Administration acknowledgment
 Method of notification
 Training of staff to make referrals to the Crisis Team
 Training in identification of students and risk factors
INTERVENTION STRATEGIES
RESPONDING TO STUDENT CRISIS
 Planning how to respond
 Student behavior
 Established intervention procedures
 Clear written plan of action
WHAT TO DO
 Always ensure a student’s safety: Plan, means and method
 Asking directly “Have you thought about a way to hurt
yourself ”
 Remain with the student
 Send for help : Crisis Team
WHAT TO DO CONTINUED
 Listen:
Acknowledge feelings and problems in the students own terms.
Allow the student to express feelings – open communication,
permission to express.
WHAT TO DO CONTINUED
 Be Direct
 Remain Calm
 Be Empathetic
 Be honest
 Always take the student seriously
WHAT TO DO CONTINUED
 Know your limits – if in immediate danger escort student to
appropriate referral (nurses office, counseling area,
principal).
 Make sure the student knows what is going on at each stage
of the intervention.
Eg. Escort to the team, Events and responses that will happen.
A chaotic and confusing situation requires clear communication
WHAT TO DO
 INFORM PARENTS
Community Agencies/Resources
Risk Factors
Safety of student
What has happened and reason for response
Restricting access to lethal means: ensure monitoring
WHAT NOT TO DO
 Don’t be judgmental
 Don’t preach to the student
 Never leave the student alone or send the student away
 Don’t under react or minimize
 If threatening suicide and does have a weapon, never try to
physically take the weapon away from the student.
(Avoid endangering your life, life of the student or lives of
others in the school).
WHAT NOT TO DO
 Don’t ever dare the student to attempt suicide.
 Don’t debate with the student about whether suicide is right
or wrong.
 Don’t promise secrecy or confidentiality
 Don’t panic
RESPONDING TO VARIOUS LEVELS OF
RISK
 LEVEL 1 – Low or moderate risk
 LEVEL 2 – Severe Risk
 LEVEL 3 – Extreme Risk
LEVEL 1 – LOW or MODERATE RISK
 Staff member observes warning signs student may be at risk
 Student may have verbalized suicidal thoughts, does not have
a plan, does not have access to potentially lethal weapon.
ACTION: Notify team, meet with student, and assess.
Monitor periodically (once a week)
LEVEL 2 – SEVERE RISK
 Student overtly voiced the intent to engage in suicidal act.
 Gone beyond mere thoughts has thoughts of action and plan.
 Has a plan – but does not have means to carry out plan.
ACTION: Notify team, administrator, supervision of student,
contact parents, restriction of means, referral to appropriate
resource, follow up on referral, monitor progress.
LEVEL 3 EXTREME RISK
 Student has voiced the intent to engage in a suicidal act.
 Student has access to lethal means needed to carry out this
act.
 Student may have access to lethal means on person.
ACTION: Notify team, mobilize community resources (GPD,
EMS, DMHSA, notify parents, follow crisis intervention
procedures. Follow up on referral
ENSURE SAFETY – DO NOT INCREASE LEVEL OF
POTENTIAL HARM
PREPARING AND WORKING WITH THE
MEDIA
 Refer all contacts to the Administrator – subsequently to the
Superintendent or designee.
 Generally (if designee): communicate dangers of imitation
behaviors and how inappropriate reporting may contribute to
more suicidal behavior.
 Acknowledge: struggles and positive aspects (may provide
sense of balance)
PREPARING AND WORKING WITH THE
MEDIA: WHAT NOT TO DO Do not present as tool for accomplishing certain ends.
 Avoid focusing on only the positive (provide balanced
picture).
 Avoid using language that may contribute to more suicides:
Headlines, connotations of sinful behavior, contrasting suicide
deaths with non fatal attempts do not utilize terms such as:
Successful, unsuccessful, or failed
Family Partnerships
 Present information at appropriate forums
 Distribute written information
 Involve the media
 Schedule parent workshops
 Reach out to faith-based communities
 Contact advocacy groups
 Frequent teacher parent contact
 Inform parents of students participation in prevention events’
 Expand concept of volunteerism
Culturally and Linguistically Diverse
Populations
 Higher rates in some groups (African American increased
230% in 1980 to 1995.
 1979-1992 – American Indian Youth – accounted for 64% of
all suicides of Native Americans. 1.5 times higher then
general population.
 Asian Pacific Islanders – Highest rate for females in the
country. Fastest growing ethnic group
Culturally and Linguistically Diverse
Populations
 Girls age 5 -12. 30% Asian females reported depressive
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symptoms.
Youth Risk Behavior Survey –
Half of youth had previous contact with mental health
Culture impact on views of mental illness, accessing services
Role of school climate and ethnicity (FSM example)
Role of victimization and bullying
Refugee status and potential risks
Harassing behaviors
COMPREHENSIVE PLAN
 Accounts for cultural and linguistic differences
 Utilizes appropriate translators and culture liaisons
 Follows up with evaluation of effectiveness
 Incorporates best practices and research