Creating Suicide Safety in School

Creating Suicide Safety in SchoolAGENDA

• 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 Type 2“Attention Seeking,”

“Gestures,” Low to No Risk“Can’t Prevent Someone

Truly Intent”

HINT: Don’t attempt to determine psychological intent from the method

Youth Emergency Department Visits for Drug-Related Suicide Attempts Most Likely to Involve Anti-Anxiety, Acetaminophen, and Antidepressant Drugs

0% 5% 10% 15% 20% 25% 30%

Anti-Anxiety DrugsAcetaminophen Products

AntidepressantsIbuprofen Products

AlcoholIllicit Drugs

AntipsychoticsNarcotic Painkillers

Aspirin ProductsStimulant Pharmaceuticals

26.2%25.4%

23.0%14.9%

11.4%8.8%

7.4%5.1%

4.2%1.5%

LegendAlcohol

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.

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)

Challenge: easy access

HINT: Assess, educate, problem–solve with families around access to means

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

Workshop Goals: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

Staff gatekeeper training,

intervention skills

Crisis team has postvention training,

resources, procedures

Targeted intervention process for

managing students with risk

Programming & education that

supports protection and

resiliency

Parent & Community

Engagement for support, referral and mutual aid

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 Increase protection

Indicated

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 SchoolLong Island

East Hampton High SchoolLong 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 SchoolsWestern NY

Gowanda Central SchoolsWestern 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 SchoolsWestern New York

23

Salamanca City SchoolsWestern 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 Breuxpat.breux@omh.ny.govPreventSuicideNY.org