Resource sharing between the Department of Child Safety, Youth and Women with the Non-Government SectorHello,

I provide you with another resource we would like to share. This word document contains some of the content from our inward facing training resource on the topic of understanding suicide – which forms part of our “working with young people” suite of learning assets. We are sharing this resource with the non-government sector via the various peak bodies.

I note that the content you receive will not be an exact duplication of the versions we provide to our internal staff, for several reasons. The aforementioned resource in their complete and original form contains licensed images, practice instructions, activities, etc., and are hosted on our online learning management system which is only accessible to our departmental staff. Additionally, in their original forms, the training materials are focused on practice and procedural guidelines for frontline staff, and are therefore not in all cases necessarily relevant to practitioners who do not operate within a statutory child protection context.

Consequently, we have extracted what we consider to be relevant content from some of our training modules for your consideration, with the intent that you individually determine the usefulness and relevance of the information provided in the context of meeting development needs of your respective cohorts of staff.

Additionally, we recognise that you have your own resources and training programs which may be entirely sufficient to your organisational needs in their own right. We have therefore elected to provide content from our area in the form of a word document - allowing easy access for review and implementation as you see fit.

We share this material in the spirit of collaboration and collegiality, but request that any content originating from this department is attributed back to the source, along with references to any third-party materials and articles.

Kind Regards,Istok StanojevicActing Manager - Organisational Capability Capability and Learning | People and Culture | Department of Child Safety, Youth and WomenPhone: 0417 746 479, Email: istok.stanojevic@csyq.qld.gov.au

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Content shared on 6 December 2020 Within the text of this document you will notice a number of section lines, this resource was an

eLearning module when viewed by our child safety staff, and we have maintained some of these section breaks for your ease of reading.

Please amend this content as required to meet the accessibility requirements of your audience (e.g., subtitles for videos, appropriate text to background colour contrast, etc.).

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Understanding SuicideTable of Contents

Course outline...................................................................................................................................... 5

Introduction.................................................................................................................................................. 5

Welcome.............................................................................................................................................. 5

Working with young people.................................................................................................................. 5

About this course.................................................................................................................................. 6

Learning outcomes............................................................................................................................... 6

Module 1: Understanding suicide and suicidal behaviour............................................................................7

Module Overview.................................................................................................................................. 7

How common is suicide in Australia?...................................................................................................7

The continuum of suicide prevention....................................................................................................8

Talking about suicide – language and stigma.......................................................................................9

Contrasting terminology........................................................................................................................ 9

Myth-busting – common misconceptions............................................................................................10

Non-suicidal Self Injury revisited.........................................................................................................10

Key messages about NSSI.................................................................................................................11

The Interpersonal Theory of Suicidal Behaviour (TSI)........................................................................11

Perceived Burdensomeness...............................................................................................................11

Ecological systems theory.................................................................................................................. 12

Ecological perspective of suicide........................................................................................................12

Acquired capability............................................................................................................................. 12

Key learnings from module 1..............................................................................................................13

Module 2: Working with populations at risk................................................................................................14

Module Overview................................................................................................................................ 14

General considerations....................................................................................................................... 14

WWYP: Development, attachment and trauma..................................................................................14

ACE studies and suicide.....................................................................................................................15

Occurrence of risk and protective factors...........................................................................................15

Communicating about risk factors and warning signs.........................................................................15

Warning signs – I.S. P.A.T.H. W.A.R.M.?...........................................................................................15

Warning signs in young people...........................................................................................................16

Situational precursors......................................................................................................................... 16

Risk among Aboriginal and Torres Strait Islander peoples.................................................................17

Fact sheets from conversations matter...............................................................................................17

Risk factors – rural and remote communities......................................................................................18

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Sexually and/or gender diverse individuals........................................................................................18

Gender and sexual diversity terminology............................................................................................18

Sex..................................................................................................................................................... 18

Gender............................................................................................................................................... 19

Sexual orientations............................................................................................................................. 20

Gender and/or sexual diversity and stigma........................................................................................21

Find out more about gender and sexually identity..............................................................................21

Key learnings from module 2..............................................................................................................22

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Course outlineThis course consists of the following four modules:

Module 1 – Understanding suicide and suicidal behaviour

Module 2 – Working with populations at risk

Module 3 – Crisis intervention with young people at risk

Module 4 – Self care

IntroductionWelcomeIn keeping with the spirit of Reconciliation, we acknowledge the Traditional owners of the lands upon which you are situated – and recognise that these have always been places of teaching and learning.

We pay respect to their Elders past, present and emerging – and acknowledge the importance of the role Aboriginal and Torres Strait Islander people continue to play within the community

This course was created by, and remains the property of, the Department of Child Safety, Youth and Women (DCSYW).

Working with young peopleThe training product you are currently accessing has been developed by the child safety training unit, in conjunction with leading industry partners including Encompass Family and community services as part of the working with young people suite of learning assets – a 3-stage blended learning pathway designed to assist statutory child protection workers in strengthening practice in meeting the challenges of supporting high risk young people.

Phase 1: Development, Attachment, and Trauma

This elearning course covers trauma informed practice, adolescent development, adverse childhood experiences, and ecological systems theories to provide a solid basis for the rest of the learning path.

Phase 2: Working with young people in statutory child protection: an introductory workshopThrough use of appreciative inquiry processes and a reflective approach, participants are supported in this face to face workshop to explore the fundamentals of “what do we know works” and “how to best work” with young people in the statutory child protection system.

Phase 3:

This phase of the learning path consists of a range of online and face to face training assets taking the fundamental concepts from phases 1 and 2 and providing a comprehensive practical and theoretical basis for advanced practice with high risk young people in statutory child protection.

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About this courseIn 2015, 3027 Australians died due to intentional self-harm; an increase of 14% over the last 10 years. Suicide is now the 13th leading cause of death in Australia.

Suicide was the leading cause of death of young people between 5 and 17 years of age, and the leading cause of death for Aboriginal and Torres Strait Islander persons between 15 and 34 years of age.

In 2015-2016, the standardised death rate for men was 19.3 deaths per 100000 people and 6.1 deaths per 100000 for women. That equates to a rate of deaths from intentional self-harm occurring among males three times more than that for females.

This course will help increase your understanding of suicide, and hopefully provide you with enhanced toolset for supporting young people at risk of death due to suicide.

Learning outcomesBy completing this module, you should:

1. Develop a basic understanding of the key components of the Interpersonal Theory of Suicide (ITS) and frameworks for suicide prevention through:

a. understanding primary, secondary, and tertiary suicide prevention and

b. identifying risk and protective factors, along with warning signs and situational precursors for various populations at risk of suicide and serious self-harm.

2. Learn to articulate ways you can contribute to the ongoing reduction of suicide risk through evidence-based practice strategies and effective engagement with young people in a culturally aware, person centred, and strengths-based way.

3. Deepen your understanding of applying structured professional judgement when assessing and responding to suicidal ideation and behaviours, in a crisis management context.

4. Attain a clearer sense of how to apply tools from the Strengthening Families Protecting Young People Framework for Practice for assessing and responding to suicide risk when working with young people, along with applying the Aim4© conceptual model to your interventions.

5. Learn to articulate and apply self-care strategies when working with suicide and vicarious trauma.

"We need to focus on asking people less of 'what's wrong with you?'

and more of 'what's happening for you and how can I unconditionally support you?’

After all, there's no magic pill for loneliness, social isolation, relationship breakdowns

and other personal crises."

- Peter Shmigel (Lifeline CEO)

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Module 1: Understanding suicide and suicidal behaviour

“Understanding suicidal behaviours and thoughts requires us to reflect on

the society in which we live and to accept that suicide is everyone’s responsibility.

This means adopting a broad approach which takes into account social and

cultural as well as biological and medical factors, and acknowledging that individual

behaviours are determined in a complex interaction between the person, their mental

state, their support network, their culture and their society.”

- LIFE Framework

Module OverviewIn this section we will explore:

• contemporary suicide statistics

• terms and definitions

• language

• primary, secondary, and tertiary prevention

• myth-busting – common misconceptions

• non-suicidal self-injury (revisited)

• the interpersonal theory of suicide

How common is suicide in Australia?As outlined at the introduction of this course, suicide is now the 13th leading cause of death in Australia.

Suicidal Ideations Ideation is the formation of ideas or concepts. In this context, suicidal ideation is the formation of ideas or concepts relating to suicide, ranging from brief thoughts to persistent preoccupation and/or detailed plans for self-inflicted death.

Non-fatal suicidal behaviours Any non-habitual suicidal behaviour that does not have a fatal outcome can be referred to as a non-fatal suicidal behaviour. Basically, any behaviour that attempts to or actually causes harm to oneself, or that would have done so if not for the intervention of others.

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Fatal suicidal behaviour Fatal suicidal behaviour describes any behaviour that results self-inflicted death as a direct or indirect result of a deliberate positive (doing something) or negative (withholding or taking away something) act, which was intended to result in death.

Para-suicide The prefix “para-“ means “beside”, or “around”. In relation to suicide, the term para-suicide broadly refers to fatal and non-fatal suicidal behaviours.

Suicide Contagion Suicide contagion refers to the phenomena where a suicide or suicidal act within a school, community or geographic area increases the likelihood that others will attempt or die by suicide.

Sources:

Kolves K, De Leo D and AISRAP team (2013) Suicide and the Australian Man: Risk groups, risk factors and potentials for prevention.

Headspace (2015) Suicide contagion [Factsheet]. Retrieved from: https://www.headspace.org.au/assets/School-Support/Suicide-contagion-web.pdf

The continuum of suicide preventionCaldwell’s (2008) suicide continuum model looks at suicide intervention along the lines of public health models of intervention: primary, secondary, and tertiary. As a child safety officer, your practical efforts when working with young people at risk of suicide will entail a combination of secondary and tertiary efforts.

Primary Universal activities targeted at the whole population (aim to prevent suicide)

Activities that constitute primary intervention include any activities that:

enhance communication and support

reduce substance abuse

reduce exposure to violence

life skills enhancement to increase self-esteem and mastery

re-establish or strengthen cultural and community ties

Secondary Early intervention to prevent suicide related behaviour among at-risk populations

Secondary interventions are activities that:

• increase recognition of symptoms by the individual or others

• result in timely access to broad range of crisis services by

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strengthening community resources

• reduce stigma around suicide (increase help seeking)

• promote appropriate media handling of suicide

Tertiary Care and treatment where suicide related behaviours have already occurred

Activities that constitute tertiary intervention include any activities that promote assistance to return to a previous level of functioning by:

developing support groups

providing individual and family counselling

enhanced training of primary health care providers to monitor survivors

improving coordination between supports

Talking about suicide – language and stigmaValues and beliefs, intertwined with attitudes to shape the way we interact with our world. In part, the attitudes we take are in turn reflected in the language we use. In the context of suicide, we will contrast between appropriate and stigmatising terms of reference.

The Australian Psychological Society (APS) recommends that rather than using negative terms such as, ‘committed suicide’ or ‘failed attempt at suicide’ it is better to reconsider how we engage with people engaging in suicidal behaviour. Choosing more accurate and considerate terminology such as ‘died by suicide’, or ‘ended their life” creates a platform for engaging in meaningful conversations without stigmatising the deceased or the bereaved.

“Suicide is not a sin and is no longer a crime, so we should stop saying that people ‘commit’ suicide.

We now live in a time when we seek to understand people who experience suicidal ideation,

behaviours and attempts, and to treat them with compassion rather than condemn them.

Part of this is to use appropriate, non-stigmatising terminology when referring to suicide”

- Susan Beaton (MAPS) BeyondBlue Suicide Prevention Advisor

Contrasting terminologyThe Australian Psychological Society (APS) recommends that rather than using negative terms such as, ‘committed suicide’ or ‘failed attempt at suicide’ it is better to reconsider how we engage with people engaging in suicidal behaviour. Choosing more accurate and considerate terminology such as ‘died by suicide’, or ‘ended their life” creates a platform for engaging in meaningful conversations without stigmatising the deceased or the bereaved.

What are stigmatising ways to refer to suicide?

• Committed suicide

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• Successful suicide

• Completed suicide

• Failed attempt at suicide

• Unsuccessful suicide

What are some more appropriate ways to refer to suicide?

• Died by suicide

• Suicided

• Ended/took his/her life

• Non-fatal attempt at suicide

• Attempt to end his/her life

Myth-busting – common misconceptionsThere are many misconceptions about suicide, and with the gravity of the potential consequences of suicidal behaviours, it’s often easy for misconceptions to perpetuate.

Myth The truth as it pertains to each statement

Suicidality is a long-term risk

Heightened suicide risk is often short-term and situation specific.

 Suicide tends to happen suddenly and without warning

Suicide can occur spontaneously and without warning, but in many instances, indicators and signs are present – reinforcing how important it is to be vigilant.

Someone who is suicidal is unlikely to seek medical help

Most suicidal people visit a GP in the days, weeks or months before they attempt suicide.

Suicide is hereditary Family members may share risk factors due to shared environments, but likelihood of suicide is not inherited.

A suicidal person wants to die

Often, people who are suicidal will be ambivalent and go back and forth between wanting to live and die.

Attempting suicide is just a cry for help 

An attempt may be a cry for help (in which case it should not be ignored or downplayed), but it could also be a rehearsal.

Non-suicidal Self Injury revisitedHave you completed GRO O: Non-suicidal self-injury? 

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The learning objectives were that at the end of that course were:

• understand what defines non-suicidal self-injury (NSSI)

• understand the motivations behind NSSI

• be able to recognise the signs that someone may be engaging in NSSI

• be able to identify what cultural considerations need to be made when NSSI may be occurring

• understand how to communicate with a client about NSSI

• understand current best practices for working with NSSI

Key messages about NSSIThe five core messages from the non-suicidal self injury module were:

1. The most common reason why a person will self-injure is because they have difficulty regulating their emotions.

2. Abuse during childhood is a significant risk factor for someone self-injuring.3. People who self-injure are at a greater risk of dying by suicide than those who don’t.4. Many of those who self-injure do not think about suicide, as self-injury and suicide ideation have

different motivations.5. There are both psychological and physical signs that a person may be engaging in self-injury.

The Interpersonal Theory of Suicidal Behaviour (TSI)The interpersonal theory of suicidal behaviour (Joiner, 2005) describes the prerequisites for a suicide attempt as “Desire for suicide” and “Acquired Capability”

In other words, people die by suicide when they have the desire and capability to do so.

“Desire for suicide” comes about when two specific psychological states are present at the same time:

1. “perceived burdensomeness” 

2. “sense of low belonging”

“Acquired capability” is attained when individual develops the ability to disregard the innate survival instinct that all humans are born with.

Perceived BurdensomenessAccording to DeCataranzo (1995) Perceived burdensomeness is the term used to describe the degree to which someone has a perception that their own life itself is a burden on their family, friends, and the community.  A high degree of perceived burdensomeness correlates with suicidal ideation and is a “potentially fatal misperception“

 

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Researchers Lester and Gunn (2012) identified that when assessing “Perceived Burdensomeness”, the more strongly an individual reflects the following four feelings or perceptions, the higher their level of perceived burdensomeness.

1. Perceive themselves to be a burden on people who care for them or people they care about

2. Feeling like things would be better off if they were not around This can be evidenced by making comments such as “Everyone will be better off without me”

3. Feeling like an emotional or financial burden Believing they “make everyone around them miserable” or are a drain on family savings

4. Feeling like their death will bring about positive outcomes for those that they care about

Ecological systems theoryRemember GRO O: Working with Young People Development, Attachment, and Trauma?Ecological Systems Theory states human development is influenced by the different environmental systems that a person interacts with. Formulated by psychologist Urie Bronfenbrenner, this theory helps us understand the importance of always considering the development of young people from the context within which they exist.

This theory highlights the significance of belonging from a developmental and sociocultural perspective.

Ecological perspective of suicideWherever someone expresses that they feel disconnected from others, or are perceiving themselves as isolated from their group, or not fitting in, they are directly expression a sense of diminished connection.

Absence of a sense of connection is highly correlated with suicidal behaviour for many populations, including adolescents, and Aboriginal or Torres Strait Islander people(s).

Remember the five systems of ecological systems theory?

- Macrosystem- Mesosystem- Microsystem- Exosystem- Chronosystem

Acquired capabilityAcquired capability is the third prerequisite factor for suicide to occur. People develop this capability by overcoming the innate self-preservation instinct through repeatedly fighting against it.

Everyone has a built in mechanism that makes them automatically cling to life, and in order to consciously do something that endangers life, this tendency needs to be overcome.

Fighting against the self-preservation instinct is not about conscious choices but rather progressive exposure to painful stimuli, resulting in desensitisation.

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Acquired capability is gained over time through repeated exposure, and because of the nature of those experiences, it is about the development of tolerance for pain and fearlessness in the face of death.

Key learnings from module 1Let’s review the key learnings from this chapter. So far you have learned about:

• Statistics in relation to suicide in Australia

• Terms and definitions

o Suicidal Ideations

o Para-suicide

o Non-fatal suicidal behaviour

o Fatal suicidal behaviour

o Suicide Contagion

• Primary, Secondary, and Tertiary prevention

• Language guidelines, and stigma

• Myth-busting – common misconceptions

• Non-Suicidal Self Injury revisited

• The Interpersonal Theory of Suicide (ITS)

o Perceived Burdensomeness

o Low Belonging

o Acquired Capability

In the next section, we will be exploring working with populations at risk for suicide.

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Module 2: Working with populations at risk“Suicide was virtually unknown in traditional Aboriginal society. Even in postcolonial Australia, with its widespread dispossession and denial of basic human rights, it was very rare. While the validity of the

statistical data on which these assertions are based is questionable, it seems suicide rates among Aborigines and Torres Strait Islanders before 1960 were lower than in the general population. It is against this background that the apparent explosion in the incidence of suicide among the original Australians in

the later part of the 20th century has caused such concern and consternation"

- Professor Diego De LeoDirector, Australian Institute for Suicide Research and Prevention (AISRAP)

Module OverviewIn this section we will explore:

• links between Adverse Childhood Experiences (ACEs) and suicide

• risk and protective factors

• warning signs and how they differ from risk factors

• situational precursors for suicidal behaviour

• risk among some of the most at-risk populations in Australia including:

o Aboriginal and Torres Strait Islander peoples

o rural and remote communities

o LGBTIQ+ individuals

o culturally and linguistically diverse peoples

General considerationsAs covered in the previous chapter, the Interpersonal Theory of Suicide (ITS) provides a theoretical framework for the conditions that must be present for suicide to occur.

Over the next few slides we will explore some considerations in relation to risk and protective factors, as well as considerations that apply to specific populations.

As you work your way through this content, consider how these concepts interlink.

WWYP: Development, attachment and traumaRemember – the course you are currently doing is part of phase 3 of the working with young people learning pathway. The first phase of this pathway was the course GRO O: working with young people development, attachment, and trauma.

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As explained in that course, childhood experiences, both positive and negative, have a tremendous impact on likelihood of future violence victimisation and perpetration, and outcomes relating to lifelong health and opportunity. As such, early experiences are an important public health issue. Much of the foundational research in this area has been referred to as Adverse Childhood Experiences (ACEs).

ACE studies and suicideEarly adverse childhood experiences dramatically increase the risk of suicidal behaviours. Nearly two-thirds (64%) of suicide attempts among adults were attributable to ACEs and 80% of suicide attempts during young personhood/adolescence were attributed to ACEs.

An ACE score of 7 or more increased the risk of suicide attempts 51-fold among young people/adolescents and 30-fold among adults. Estimates of population attributable fractions for ACEs and suicide are “of an order of magnitude that is rarely observed in epidemiology and public health data.”

The strongest predictor of future suicide attempts in ACE research was emotional abuse.

Occurrence of risk and protective factorsRisk and protective factors are things which, when present or absent, either increase or decrease the risk or likelihood of something happening. These factors can occur at the individual or personal level, at the social level, or at the contextual level or the broader life environment.

Individual risk/protective factors

These include mental and physical health, self-esteem, and ability to deal with difficult circumstances, manage emotions, or cope with stress

Social risk/protective factors

These include relationships and involvement with others such as family, friends, workmates, the wider community and the person’s sense of belonging

Contextual risk/protective factors

These include the social, political, environmental, cultural and economic factors that contribute to available options and quality of life

Communicating about risk factors and warning signsConsider why it’s important to know the difference between a risk factor and a warning sign when communicating about suicide risk.

Talking about risk factors helps people understand what needs to change within an individual or a community to decrease suicide risk over time, while talking about warning signs helps people know what actions they can take right now to help someone at immediate risk for suicide.

Warning signs – I.S. P.A.T.H. W.A.R.M.?The American Association of Suicidology proposed a simple mnemonic for rapidly identifying warning signs: “IS PATH WARM“

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Please note that this makes for a basic checklist, but it’s not comprehensive. Warning signs are individualised factors.

I Ideation

S Substance abuse

P Purposeless

A Agitation

T Trapped

H Hopelessness

W Withdrawal

A Anger

R Restlessness

M Mood changes

Warning signs in young peopleShowing or expressing any of these signs is a serious warning sign of potential crisis – particularly when they are uncharacteristic of the person’s usual behavioural patterns. Wherever these are observed, an evaluation by a mental health professional is essential.

- Sudden and significant increase in the use of alcohol and/or drug use- Withdrawal from friends, family, and community- anxiety, agitation, trouble sleeping or sleeping excessively- Dramatic mood changes- Giving away prized possessions- Rage, uncontrolled anger, expressions of wanting or seeking revenge- Feelings of hopelessness- Expressions of having no reason for living or no sense of purpose in life- Reckless behaviour or more risky activities, seemingly without thinking- Feelings of being trapped - like there's no way out

Situational precursorsSituational precursors are like warning signs, but rather than being about individual behavioural changes, they are about situations that may have occurred which can result in an increased risk to the person experiencing them. In the presence of any situational precursors, along with pre-existing risk factors, you should increase your level of vigilance when monitoring for warning signs.

Situational precursors are also known as triggers.

Losses and other events (whether they are anticipated or have actually occurred) - can lead to feelings of shame, humiliation, or despair, and contribute to an overall circumstance that may serve as triggering events for suicidal behaviour. A previous episode of suicidal behaviour can also be considered a situational precursor.

Examples of other triggering events include

• unanticipated ‘failures’ in emotionally invested domains

• failing to get an expected outcome in application for an important job…

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• loss 

• death of close friends or family, exposure to suicidal behaviour among others or in the media, relationship breakdowns…

• bullying

• trouble with authorities

• child protection matters, police interactions, school suspensions…

• emergent health problems that increase the likelihood of perceived burdensomeness

This is especially true for youth already vulnerable because of low self-esteem or a mental disorder, such as depression.

Risk among Aboriginal and Torres Strait Islander peoplesSuicide has only been prevalent in Indigenous cultures in Australia since the 1960s and the research indicates that this relates to the general disenfranchisement and marginalisation of Aboriginal and Torres Strait Islander people. Additionally, alcohol and substance abuse, under-utilisation of health services, as well as disadvantages in social and health conditions contribute to this tragic statistic.

In Australia, suicide rates among Aboriginal and Torres Strait Islander peoples are the highest of any Australian population.

Aboriginal and Torres Strait islander males have higher rates of suicide while females engage more in non-fatal suicidal behaviour.

Aboriginal and Torres Strait Islander males aged 25-34 years have the highest rates of suicide.

In Queensland, suicide among Aboriginal and Torres Strait Islander males is 2.3 more common than among non-indigenous males.

Hanging is the most common suicide method among Aboriginal and Torres Strait Islander males in Australia.

Statistically, Aboriginal and Torres Strait Islander males also have a significantly elevated risk of suicide contagion.

Fact sheets from conversations matterThe following fact sheets have been developed by Conversations Matter for professionals working with Aboriginal communities.

The content is focused on the NSW context, but is still applicable to help support conversations if you are:

• worried that someone is thinking about suicide

• unsure how to have a conversation with someone after a suicide, or

• how to talk about suicide prevention in your community

Fact sheet: Yarning about suicide prevention in our community - http://www.conversationsmatter.com.au/LiteratureRetrieve.aspx?ID=163899

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Fact sheet: Yarning if someone is thinking about suicide - http://www.conversationsmatter.com.au/LiteratureRetrieve.aspx?ID=163897

Fact sheet: Yarning after a suicide - http://www.conversationsmatter.com.au/LiteratureRetrieve.aspx?ID=163898

Risk factors – rural and remote communitiesSuicide rates are higher in rural and remote areas of Australia than in metropolitan areas, and this is especially so amongst males.

Vulnerable groups in the rural and remote areas include farmers, Aboriginal and Torres Strait Islander Peoples, and migrants.

Identified suicidal risk factors specific to people residing in rural and remote include:

climatic variability

political issues related to the farming industry

economic fluctuations

impacts of in the mining industry (fly-in-fly out work, danger, etc)

Sexually and/or gender diverse individualsMany suicidal behaviours among sexually and/or gender diverse people occur while the individual is still coming to terms with their sexuality and/or gender identity, and often occur prior to having disclosed their identity to others.

The underlying factors and circumstances that contribute to mental health concerns, and risk factors for suicidal behaviours vary for each person.

The psychosocial stressors that many sexually and/or gender diverse people may face are not due to their identity as a gay or transgendered person for example but are more likely to arise from discrimination and social, cultural, or legal barriers and stigmatisation surrounding their sexuality and gender.

Gender and sexual diversity terminologyLanguage and terminology in relation to gender and sexual diversity can be confusing. Broadly, the concepts are split between conceptions of sex, gender, and sexual orientation.

Please note: the content here is by no means intended to be an exhaustive list, but rather a brief primer of some common terminology.

SexSex is a complex concept consisting of anatomical, chromosomal, and hormonal characteristics.

Sex is classified as either male or female at birth based on a person's external anatomical features.

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However, sex is not always straight forward as some people may be born with an intersex variation.

Also, anatomical and hormonal characteristics can change over a lifespan.

Intersex is an umbrella term that refers to individuals who have anatomical, chromosomal and hormonal characteristics that differ from medical and conventional understandings of the binary definitions of male and female bodies.

Intersex people may be "neither wholly female nor wholly male; a combination of female and male; or neither female nor male.“

Intersex people may identify as either men, women or non-binary.

GenderGender refers to socially constructed hierarchical categories that are assigned to people on the basis of their apparent sex at birth

While other genders are recognised in some cultures, in western society, people are generally expected to conform to one of two gender roles matching their apparent sex; for example, male = man/masculine and female = woman/feminine.

Gender norms define expectations of dress, actions and behaviours, and the appropriate roles and positions of privilege people have in society. Failing to adhere to the norms associated with one's gender can result in ridicule, intimidation and even violence

Many people do not fit into these narrowly defined and rigid gender norms. Some women may feel masculine, some men may feel more feminine and some people may not feel either, or may reject gender altogether. 

 

Below are the relevant definitions:

Gender identity refers to an inner sense of oneself as man, woman, masculine, feminine, neither, both, or moving around freely between or outside of the constraints of binary conceptions of gender.

Gender binary means the distinct and separate categorisation of gender into distinct and opposite constructs of male and female based on biological sex. The social embedding of this categorisation is also known as binarism or genderismCisgender means “having a gender identity that corresponds to the gender identity one was assigned at birth”. It is the literal opposite of transgender.

You may be surprised to learn that the term originates from the Latin prefix cis - , meaning "on this side of".

The Latin prefix trans - means "across from" or "on the other side of". In the context of modern usage, if we take gender to refer to the gender that was assigned at birth…

Cisgender means “On this side of the gender you were assigned at birth” whereas transgender means “On the other side of the gender you were assigned at birth”

Gender questioning is not necessarily an identity but is a term used in some contexts to refer to a person who is unsure which gender, if any, they identify with.

Sistergirl/BrotherboySistergirl and Brotherboy are terms used for transgender people within some Aboriginal or Torres Strait Islander communities. Sistergirls and Brotherboys have distinct cultural identities and roles.

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Sistergirls are Indigenous women who were classified male at birth but live their lives as women, including taking on traditional cultural female practices.

Brotherboys are Indigenous transgender people, whose bodies were considered female at birth but "choose to live their lives as male, regardless of which stage/path medically they choose."

Transgender, trans-, and gender diverse are umbrella terms to refer to people whose assigned sex at birth does not match their internal gender identity, regardless of their gender falling within gender binary definitions or not. Transgender/trans or gender diverse people may identify as non-binary which means they may:

• not identify exclusively as either gender

• identify as both genders

• identify as neither gender

• move around freely in between binary gender categories or

• reject the idea of gender altogether

Transgender, trans, or gender diverse individuals have the same range of sexual orientations as the rest of the population. Transgender/trans or gender diverse people's sexuality is referenced in terms of their gender identity, rather than their sex. For example, a woman may identify as lesbian whether she was assigned female at birth or male.

Transgender/trans or gender diverse people may also use a variety of different pronouns including he, she, they, ze, hir, etc. Using the incorrect pronouns to refer to or describe trans people is disrespectful and can be harmful.

Sexual orientationsSexual orientation is distinct and different from gender identity. In part, it’s about who someone is attracted to romantically, emotionally, and sexually.

According to Planned Parenthood (2017), sexual orientations is about WHO you are attracted to…Gender identity is about who you ARE.

Relevant definitions below:

Lesbian is a label used to describe an individual who identifies as a woman and is sexually and/or romantically attracted to other people who also identify as women.

Gay is a label used to refer to an individual who identifies as a man and is sexually and/or romantically attracted to other people who identify as men. The term gay can also be used in relation to women who are sexually and romantically attracted to other women.

The term bisexual describes an individual who is sexually and/or romantically attracted to both men and women.

Heterosexual - The prefix Hetero- comes from the Greek word héteros, meaning "other" or "another", which when used in a medico-scientific context science as a prefix meaning "different” The antonym to hetero- is homo- which is derived from the Greek word homos meaning “same”. Heterosexual therefore refers to individuals who within a binary gender context are sexually and/or romantically attracted to people with the “other” gender to their own. Homosexual refers to individuals within a binary gender context who are sexually and/or romantically attracted to people with the “same” gender as their own

The term asexual describes a sexual orientation that reflects little to no sexual attraction, either within or outside relationships. People who identify as asexual can still experience romantic attraction across the sexuality continuum.

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Pansexuality (sometimes known as omnisexuality) is derived from the Greek prefix “pan-”, meaning "all." As such, pansexual individuals may be attracted to those of all biological sexes or gender identities — including men, women, those who don't identify with a specific sex or gender or those who are transsexual or transgender.

The term “queer” describes a range of sexual orientations and gender identities. Although it has in the past, and can in some contexts still be considered a derogatory term, “Queer” encapsulates political ideas of resistance to heteronormativity and homonormativity and is often used as an umbrella term to describe the full range of LGBTIQ+ identifiers.

Gender and/or sexual diversity and stigmaSome people may experience homophobia, bullying or non-acceptance by family and peers – and this stigmatisation creates a heightened sense of thwarted belonging and perceived burdensomeness.

 There are limited sources of reliable suicide statistics for gender and/or sexually diverse people; many instances of suicidal behaviour occur amongst sexually and/or gender diverse people before they have fully come to grips with their identity. It is likely that this population may be significantly under-represented in suicide death statistics.

 Australian data indicates:

Compared to heterosexual males, bisexual and homosexual males are:

o at the highest risk of suicidal behaviours

o have higher levels of suicide ideation and suicide attempts

Sexually and/or gender diverse individuals are:

o up to three times more likely to experience depression and anxiety than the broader community

o up to twice as likely to experience higher levels of psychological distress

What do you think happens to the overall risk level for an individual who has a high ACE score, is a gay male, living in a rural or remote community, and is of Aboriginal and/or Torres Strait Islander heritage?

Find out more about gender and sexually identityBe on the lookout for the GRO-O working with young people training on sexual and gender identity!

 

LGBTIQ+The Queensland public sector is committed to supporting all employees and creating an inclusive and diverse workforce that better reflects the community we serve.

Up to 11% of the population identify as LGBTIQ+ (lesbian, gay, bisexual, transgender, intersex and queer). This roughly equates to 23,000 Queensland public sector employees.

Research shows that in Australian workplaces:

approximately 45% of LGBTIQ+ employees hide their sexual orientation, gender identity or intersex status at work

one-third of those expend significant energy hiding their identity

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one in two LGBTIQ+ employees have witnessed homophobia (jokes, harassment or discrimination) at work

one in six have personally experienced homophobia at work

LGBTIQ+ employees need to feel safe, valued and supported to bring their whole selves to work.

LGBTIQ+ inclusionThe Queensland public sector LGBTIQ+ inclusion strategy   provides a framework for strengthening LGBTIQ+ inclusion across the public sector. It builds on the Queensland public sector inclusion and diversity strategy 2015–2020.

Key learnings from module 2Let’s review the key learnings from this chapter. So far you have learned about:

• links between Adverse Childhood Experiences (ACEs) and suicide

• risk and protective factors

• warning signs and how they differ from risk factors

• situational precursors for suicidal behaviour

• risk among some of the most at-risk populations in Australia including:

o Aboriginal and Torres Strait Islander peoples

o rural and remote communities

o LGBTIQ+ individuals

o culturally and linguistically diverse peoples

In the next section, we will be exploring crisis intervention with populations at risk for suicide.

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Module 3: Crisis intervention with young people at risk

- “You have to be the pushy friend, and when...- If you can see that someone's struggling, I think…you gotta remember that it's not about keeping

them happy, it's about helping them.- Don't underestimate how important supporting someone that needs help is.

- It's really important. And if you're the person that needs help, don't underestimate how willing people will be to help you.”

- Transcript of short video from Beyond Blue

Module OverviewIn the context of suicide and young people, working effectively requires bringing all of the values, principles, knowledge, and core skills/processes of our framework for practice, to our application of relationships, purposeful planning, and teamwork, in the domains (or contexts) of family/kin, peers/school, the care environment, and the care system to meet each of the core needs of belonging, identity, healing and security.

In this section, we will unpack the above elements, and contextualise them to supporting young people at critical risk.

Responding to suicide risk behaviourThe child safety practice manual outlines 3 key steps promoting the safety and well-being of children through implementing responsive suicide risk management practices:

1. Identify that a child is at risk of suicide

2. Respond to the child with a suicide risk alert

3. Review the suicide risk management plan

Excerpts from the manual are incorporated into the next section, but for a detailed breakdown of the policy and procedure in relation to responding to suicide risk behaviours, consult the practice manual “10.9 - responding to suicide risk behaviour”.

1. Identify that a child is at risk of suicideCriteriaA child will be identified at risk of suicide one or more of the following criteria are met:

the child displays or discloses a history of suicide attempt/s

the child expresses suicidal ideation and/or it is assessed that the child has suicidal ideation

it is assessed that the child’s self-harming behaviour (actual or threatened/expressed) places him/her at risk of suicide

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it is assessed that the child’s involvement in risky or dangerous behaviour is linked to suicidal ideation

the child is diagnosed with depression or exhibits behaviour or symptoms that may be associated with depression and it is assessed that either:

the child presents as suicidal

the child’s actual or threatened self-harming behaviour places him/her at risk of suicide.

Note: where the child has been diagnosed with depression, the name of the diagnosing doctor and the date of the diagnosis must be included in the suicide risk alert (SR1) form.

2. Respond to the child with a suicide risk alertDevelop a medium to long-term suicide risk management planMedium to long-term suicide risk management plans are only developed for young people who are subject to an ongoing intervention case. The medium to long-term suicide risk management plan is to be developed in ICMS within two weeks of recording the suicide risk alert and developing the immediate suicide risk management plan.

The maximum lifespan of a medium to long-term suicide risk management plan is three months.

Medium to long-term suicide risk management plansMedium to long-term suicide risk management plans include the following:

details of interventions that have occurred since recording the suicide risk alert, including outcomes of the interventions already undertaken as part of the immediate suicide risk management plan

strategies for how and when the medium to long-term suicide risk management plan will be monitored and reviewed, including persons responsible

any further follow-up to be undertaken, including persons responsible

an assessment about the current level of risk (high, medium, low)

3. Review the suicide risk management planReviewing an immediate Suicide risk planImmediate suicide risk management plans bust be reviewed within two weeks of creating the suicide risk alert and immediate suicide risk plan.

A suicide risk alert and the immediate suicide risk management plan created during intake or during an investigation and assessment can only be closed after the following criteria are met:

1. Agreement has been reached by the relevant parties to undertake the actions documented in the immediate suicide risk management plan.

2. All relevant information including the rationale for the decision has been documented.

3. A decision has been made that no further departmental intervention is required.

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If the child is subject to ongoing intervention OR a subsequent investigation and assessment has resulted in ongoing intervention, reviewing the risk management plan will result in either:

1. Keep the suicide risk alert open and develop a medium to long-term suicide risk management plan

OR

2. close the suicide risk alert

Closing the suicide risk alertTo close a suicide risk alert, you must complete an incident closure form in the suicide risk event in ICMS.

The incident close form must include:

1. The relevant person’s agreement to undertake actions outlined in the suicide risk management plan.

2. The rationale for closure

3. Team leader’s verbal approval for the decision in the ‘reason for closure’ field.

Note:The date of the decision to close the suicide risk alert is recorded as the ‘end date’ in the incident closure form.

Reviewing a medium to long-term suicide risk management planReviewing a medium to long-term suicide risk management plan results in one of two decisions:

Keep the alert open and review/update the medium to long-term suicide risk management plan

OR

Close the suicide risk alert.

Until it is closed, the medium to long-term suicide risk management plan must be reviewed within at least every three months.The suicide risk alert cannot be closed if it is assessed that the medium to long-term suicide risk management plan actions have not sufficiently resolved the risk of suicide the criteria for a suicide risk alert are still present.

GRO-O working with young people – a retrospectiveRemember – this course is part of a suite of training under the working with young people project.

This program includes a range of courses –both face to face and e-learning – which collectively outline a comprehensive approach to working with young people who exhibit high-risk behaviours, including guidelines around effective high intensity responses. To get the most out of this learning opportunity - talk to your team leader, or contact your local training officer to make sure you have access to all the content, particularly:

GRO O: Working with young people development, attachment, and trauma onlineGRO-O Working with young people in statutory young person protection: an introductory workshop

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GRO-O Working with young people in statutory young person protection: managing the challenges

Practice wisdom – advice distilled from practiceWorking with high-risk young people is an extremely complex area of practice, and while it takes a lot of creativity to be able to be effective in this space, there’s no need to ‘reinvent the wheel’. These practice papers below (click to download copies) contain a rich body of practice wisdom to assist you in your work and are highly recommended additions to your collection of reference material.

The practice papers also include advice in relation to high intensity responses when working with Aboriginal and Torres Strait Islander young people. Some of the key pieces of wisdom include advice relating to developing trust and harm minimisation.

Action Description Resource

Read The importance of developing trustThe following is an excerpt from the practice paper working with young people and young people in out-of-home care.

This paper highlights the importance of developing trust and rapport with a young person.

Remember, trust comes from being consistent and not just saying the ‘right thing’ but also doing the right thing - consistently.

Additional guidelines for developing trust include

following through never making promises that you cannot keep being clear about boundaries where trust

cannot be maintained.

The last point is significant– it’s crucial that young people are informed that you are unable to keep information that they provide to you secret in some circumstances such as instances when the young person discloses harm, abuse or neglect that has occurred to them or others, including suicidal ideation, or information pertaining to a criminal offence.

Ref required

The importance of harm minimisationThe practice paper, a framework for practice with ‘high-risk’ young people (12-17 years) highlights the critical importance of harm minimisation when working with young people who engage in high-risk behaviours. work proactively to minimise harm until they can be helped to make changes.

The following considerations are particularly pertinent when implementing a high intensity response with a young person at risk of death by suicide.

• Keep open and timely lines of communication with all concerned.

Ref required

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• Discuss your concerns with the young person, their family and other helping professionals.

• Put in place a mechanism for quick communication which keeps everyone with a ‘need to know’

• Negotiate plans for timely responses by members of the network that comprises the high intensity response

• Make contingency plans for possible scenarios

The practice paper also highlights the importance of never leaving the young person uninformed about the plans that have been developed to manage their high-risk behaviours, unless it has assessed as unsafe to tell them.

High intensity responses when working with Aboriginal and Torres Strait Islander young peopleIn addition to the considerations outlined in the discussion around minimising harm, when working with Aboriginal and Torres Strait Islander young people, ensure that you consult with the recognised entity or appropriate community member who is part of the care team. This is important for many reasons ranging from legislative to practical, but fundamentally, remain mindful that there may be current cultural or community impacts on the young person that you need to be aware of.

Ref required

Download

Practice paper: Working with young people and young people in out of home care

https://www.communities.qld.gov.au/resources/childsafety/practice-manual/prac-paper-workinouthomecare.pdf

Practice paper: A framework for practice with ‘high-risk’ young people (12-17 years)

https://www.communities.qld.gov.au/resources/childsafety/practice-manual/prac-paper-framework-high-risk-young-people.pdf

Applying elements of our practice framework The development of our current framework for practice was a major milestone in the reform of the child and family support system in Queensland in the wake of the Carmody Enquiry. The Strengthening Families Protecting Children Framework for Practice is a transparent strengths-based, safety-oriented approach to work undertaken by Child Safety through all phases of the child protection process.

In the next section, we will explore some conceptual applications of elements of the framework to enhance your work with young people and families in the context of working with young people at risk of suicide.

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Solution-focused inquirySolution-focused inquiry, an integral part of our framework for practice, is an approach to questioning or interviewing practice based on the concept that the areas people focus on are the areas that grow or develop.

Solution focused inquiry provides strategies for workers to efficiently and effectively facilitate a change process by using questions to draw the attention of the young person to those aspects of their life that reduce their sense of perceived burdensomeness and low belonging.

Read the table below to find out more about some of the questions of solution focused inquiry in the context of working with young people at risk of suicide.

Miracle questions

Miracle questions are used to help people create goals and envision what they will be doing differently in their desired future.

Let us imagine it is six months in the future from now and all the problems that you are experiencing now are totally resolved… What would it look like?Consider this question from the perspective of a young person who is struggling to consider a life in six months from now.

By focussing the conversation on a future time, where the current crisis is resolved, you are reinforcing the message that the present is not permanent. And by assisting the young person to self-identify the issues they are facing, you can begin a process of developing a collaborative plan that is driven by the young person’s views and wishes.

Scaling questions

When a young person is struggling to conceptualise the future, because their problems currently seem so insurmountable, reflecting on instances when the problem could have occurred but did not, can provide them with evidence to support the argument that there can and will be a future where the problems they are experiencing now won’t be as pressing, or that they have already demonstrated that they have the capability to overcome their current obstacles

Tell me about a time when the problems you’ve mentioned were not happening for you, or were less intense? When was that? How did you make that happen?

Exception questions

Scaling questions provide rich opportunities for discussion and understanding of danger and safety, and also for opportunities to build hope. The number isn’t what’s important – it’s the opportunity for conversation that follows the scaling process that is where the power lies. Scaling questions can help elicit ‘next steps’ to change.

In the context of suicide, try to focus on protective factors at the individual or personal, social, and contextual levels (as described in chapter 2 of this training).

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Using E.A.R.S.U.P. to combine solution focused questionsThe E.A.R.S.U.P. model, adapted from motivational interviewing provides a useful flow for the process of solution focused inquiry with a young person at risk of suicide. Remember, the interpersonal theory of suicide, and in particular the aspects of perceived burdensomeness and low belonging. Use solution focused inquiry to build the young person’s perception of belonging, and to reduce perceived burdensomeness.

E Elicit Use miracle questions

A Amplify Use exception questions

R Reinforce Nonverbally – show that you are attentive, verbally – paraphrase and clarify and ask depth questions

S Seek detail Try to unpack as much detail as you can about the positives

U Use compliments Be sincere in acknowledging their strengths and resourcefulness

P Project exceptions Scale protective factors, and explore what’s needed to increase their rating

Circles of safety and supportStrengths-based, safety-oriented practice is built on development or strengthening of safety and support networks - people who will support the development and maintenance of a safety plan for the young person.

The circles of safety and support tool was designed to help family members identify people for the family’s safety and support network. In the context with risk of suicide, circles of safety and support can be an exceptionally useful tool in building a person’s sense of belonging – either by helping the young person see that they do have a broader network than they believed, or alternatively, by assisting you to collaborate with the young person in forming a network of belonging.

Applying AIM4© to crisis and ongoing interventionsThink back to the GRO-O face to face workshop “working with young people in statutory child protection: an introductory workshop”, which formed phase 2 of the working with young people project.

You learned about the Aim4 concept map, developed by Encompass family and communities. Take a moment to reflect on what you remember about this concept map and look at how the elements of the map interact with each other.

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AIM4© revisitedThe AIM4© concept map provides a way to conceptualise the:

• core needs for young people in the statutory child protection system

• domains for intervention to meet these needs

• vehicles for delivery of intervention

As outlined in our framework for practice and legislation, our core focus is always on the safety, wellbeing, and best interest of the child. To apply AIM© concepts, consider how you can address the four core areas of need for young people in statutory child protection: belonging, identity, healing and security. We do this by implementing interventions in the domains by using the vehicles. For young people in care, physical, emotional and cultural safety remains a foundational need, underpinning each of core areas.

The AIM4© domains and vehiclesThe four domains for intervention to address needs identified by AIM4© are:

1. family/kin

2. peers/school

3. the care environment (the young person’s placement)

4. the care system

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AIM4© proposes 3 key vehicles for delivery of intervention and response to need within these domains.

1. relationship

2. purposeful planning

3. teamwork

AIM4© when working with risk of suicideAIM4© provides a frame of reference that enables you to consider how holistically you are addressing your work.

In the context of suicide and young people, working effectively requires bringing all of the values, principles, knowledge, and core skills of our framework for practice, to our application of relationships, purposeful planning, and teamwork, in the domains (or contexts) of family/kin, peers/school, the care environment, and the care system to meet each of the core needs of belonging, identity, healing and security.

To refresh your memory about the core needs, read about each need below:

Belonging The importance of belonging has been established as a core principle of the working with young people project, and bringing together what we know about ecological systems, attachment, and the interpersonal theory of suicide provides us with an effective platform for addressing this area of need in crisis and ongoing work with young people. Attachment theory establishes a sense of belonging as a fundamental need for safety and survival, and the interpersonal theory of suicide highlights how thwarted belonging is one of the criteria that, when present, makes suicide a real and present possibility.

Your imperative when applying this need within the context of the AIM4© concept map is therefore to consider how you can use relationships, purposeful planning, and teamwork as vehicles to implement strategies in the domains of family/kin, peers/school, the care environment, and the care system.

Identity Identity is a central focus for adolescence. Trauma in childhood can lead to issues with fragile and unstable identity later in life, and a sense of identity integrates with the potential to form connections and belonging.

Look for future training in relation to life story work with young people, for more information about how you can help how adolescents can be supported to must integrate what has happened to them into their life story.

Security Brent Richardson (2001) explained that simply put, “young people need a secure base and a sense of belonging.”

If a young person feels secure within themselves and in their world they are not preoccupied with survival or unmet needs, and they begin to feel a sense of

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reliability and certainty in their care context.

Emotional, practical and material support enables young people to explore the world and a retreat when needed.

Healing Healing requires workers to be attuned to the impacts of trauma, loss and attachment issues for all young people in the child protection system. For Aboriginal and Torres Strait Islander young people these issues are compounded by inter-generational cultural trauma and loss.

The suicide call-back serviceThe suicide call-back service is a 24-hour, nationwide service that provides telephone and online counselling to people 15 years and over who fit one of the following categories:

* people who are suicidal

* people caring for someone who is suicidal

* people bereaved by suicide

* health professionals supporting people affected by suicide

This service is especially suited to people who are geographically or emotionally isolated.

How it works…The suicide call-back service provides immediate telephone counselling and support in a crisis.

Additionally, they can provide up to six further telephone counselling sessions with the same counsellor scheduled at times best suited to your needs.

Professional counsellors with specialist skills in working with suicide-related issues will assist you in working through difficult emotions. The counsellor will help you with goal planning, ensuring your own safety, and help to link you to other services in the community.

For more information call the 1300 659 467, or go to https://www.suicidecallbackservice.org.au/

The service is available 24 hours a day, seven days a week anywhere in Australia.

Suicide call back service – safety plansIf you, or anyone you know is experiencing suicidal thoughts, or is otherwise at risk, an option you may wish to consider is contacting the suicide call back service to make a safety plan.

More information on how to do this, and what it entails is available here:

https://www.suicidecallbackservice.org.au/im-feeling-suicidal/making-a-safety-plan/

Note: this is not an alternative to the Departmental processes and plans, but rather an additional resource. Consult with your team leader about whether or not these options are viable or in keeping with the individual context of the young person you are working with.

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Conversations matter – talking about suicideConversations Matter is a practical online resource to support safe and effective community discussions about suicide.

It is a new suite of online resources developed to support community discussion about suicide.

The resources provide practical information for communities and professionals to guide conversations about suicide.

To find out more, go to: http://www.conversationsmatter.com.au

Key learnings from Module 3Let’s review the key learnings from this chapter. So far you have learned about:

• Responding to suicide risk behaviour

• GRO-O working with young people - a retrospective

• Practice wisdom – advice distilled from practice

• Applying elements of our practice framework

• Applying Aim4© to crisis and ongoing intervention

• Aim4© when working with risk of suicide

• The suicide call back service

• How the suicide call-back service works

• Suicide call back service - safety plans

• Conversations matter – talking about suicide

In the next chapter we will learn about self-care and mitigating vicarious trauma.

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Module 4: Self care- “Work with suicidal patients is considered the most stressful of all clinical endeavours.”

- Bruce Bongar

Module OverviewWorking with suicide is a complex practice and can bring with it a significant risk of vicarious trauma. In this section, we will explore the concept of vicarious trauma and discuss self-care.

Vicarious traumaVicarious trauma can be thought of as the cost and impact that comes about as a result of caring for and caring about others.

It is an accumulation of your inner experience that comes about as a result of empathic engagement with other people’s trauma.

Empathy is a powerful asset when working to help others in settings such as child protection, but it also presents a vulnerability for you as the practitioner. The more empathetic you are, the more you are potentially vulnerable to the impacts of vicarious trauma and the related constructs of burnout, compassion fatigue, and countertransference.

BurnoutThe term “burnout” was coined in the 1974 by the American psychologist Herbert Freudenberger. He used it to describe the consequences of high levels of stress and idealism in helping professions (such as doctors, nurses, and social workers). Working in this context comes with a risk of leaving practitioners exhausted, listless, and unable to cope. 

Note: Depersonalisation in this context is an overall feeling of disengagement or detachment from the world around you.

Compassion fatigueCompassion fatigue is also sometimes called secondary traumatic stress. It is the negative impact that people who work in helping professions can experience from prolonged efforts in trying to support trauma survivors, or working in environments where they are exposed to the trauma of other people. The term is often used interchangeably with vicarious trauma, although vicarious trauma implies more of a permanent stress response.

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Countertransference“Countertransference” refers to a situation in which a person working to help other people is influenced by their own unresolved issues (e.g., lingering impact of their own trauma history). This may lead to avoidance and over-identification with the client.

It can result in workers taking on an overly protective role for their client, becoming a “rescuer”.

Common signs of vicarious traumaWhen monitoring for signs of vicarious trauma, reflect three domains: feelings, cognitions, and behaviours.

Simply put – what you feel, what you think, and how you are behaving.

In your own reflections, and in the eyes of those close to you, as well as in conversation with your supervisor, be vigilant for some of the warning signs.

FeelingsIf you find yourself more often than usual feeling any of the following, and these feelings linger…

If so, your feelings indicate that you may be at risk.

Sad for your clients Guilt Apathetic Overwhelmed Angry Despairing Without pleasure Alienated Detached Rejected by peers

Ashamed Depressed Self-bout Burnt out Drained Overly involved emotionally Distant Overloaded Isolated Emotionally exhausted

Cognitions Are you finding yourself preoccupied unduly with thoughts of clients outside of your work? Has your team leader, or any of your peers indicated that they feel you might be “over-identifying”

with your clients? Has anyone in your social circle noticed a change in you? A loss of hope? Increasing pessimism,

cynicism, or nihilism? Do you find yourself questioning your own competence and self-worth? Has your job satisfaction

diminished? Are your basic beliefs around safety, trust, esteem, intimacy and control changing? Do you feel a heightened sense of vulnerability and personal threats?

The more of these to which you answer yes, the more your cognitions are indicating you may be at risk.

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Behaviour Have you found yourself distancing yourself form the clients you work with, or from your

supports? Are you becoming detached? Avoiding listening to stories of traumatic experiences? Have you found it more difficult to maintain professional boundaries?

If your behaviour has changed in the ways described, you may be at risk.

Supervision and supportSome questions that you could consider adding into your regular supervision include:

How have I changed since I began this work? Both positively and negatively What would I like to change? What am I going to do to take care of myself? What gives me a sense of personal accomplishment in my work? What work barriers get in the way of my having more satisfaction and how can these barriers be

addressed? What do I need? What changes, if any, do I see in myself that I do not like? As I think of my work with my clients, what are my specific goals? How successful am I in

achieving these goals? How am I doing? What is hardest about this work? What worries me most about my work?

Coping with vicarious traumaMeichenbaum (2007) identified three levels at which support can be implemented to mitigate the risk of vicarious trauma – individual, peer, and organisational.

Read below to find out more about coping with vicarious trauma at each of these levels.

Individual There are four main strategies you can adopt, to increase your own self-care:

Increase your self-observations • Recognize and chart signs of stress - maintain self-

awareness.

• Conduct self-analysis.

Engage in emotional self-care behaviours • Engage in relaxing and self-soothing activities, and practice

mindfulness.

• Ensure physical and mental well-being.

• Have outside outlets.

• Express feelings through writing or art.

Use your cognitive abilities

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• Recognize you are not alone.

• Set realistic expectations to enhance feelings of accomplishment.

• Avoid wishful thinking. Adopt as philosophical and accepting a stance as you can.

• Do not take on responsibility to “heal” your clients.

• Challenge negativity: Don’t play the blame game! Search for meaning and hope.

Engage in behavioural activities • Try to maintain balance in the composition of case-loads

(avoid taking on the role of “specialist” in one particular type of case).

• Monitor work balance and work/life balance.

• Share reactions with clients: Nurture therapeutic alliance and monitor and impose personal limits.

• When necessary, take time off. Take a break (daily, weekly, and monthly).

Peer Peer level supports are strategies that people can adopt to support each other in reducing the risk of vicarious trauma:

• Seek social support from supervisor, colleagues, and family members.

• Provide support: Don’t overdo it!

• Use buddy system, especially for novices.

• Obtain peer supervision.

• Engage in debriefing. Develop informal opportunities to connect.

• Participate in training opportunities.

• Participate in agency building or community building activities.

Organisational From the perspective of a supervisor, the following guidelines will enhance your ability to support your staff:

• Be proactive in promoting awareness of and reducing vicarious trauma.

• Schedule team meetings and incorporate “emotional check-ups”.

• Try to balance the case-loads of staff.

• Provide ongoing supervision, especially for novice helpers.

• Promote education and training.

• Encourage staff to take care of themselves in terms of nutrition, exercise, sleep and that they take frequent breaks.

• Be consistent in monitoring staff and help them maintain an awareness of boundaries.

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• Support “altruistic” activities – charitable activities, fundraising, etc.

Seeking assistance – other resourcesBelow, you’ll find some useful resources you can access online – consider adding these to your bookmarks.

(Once a link is open in your web browser, just hit CTRL+D to quickly favourite it).

These resources are not by any means an exhaustive list, but nonetheless contain useful and easily accessible resources material.

Talk – 1800 650 890 Web: http://headspace.org.au/

Chat: https://www.eheadspace.org.au/

Talk to someone in person: http://headspace.org.au/headspace-centres/

Talk – 1300 22 4636 Web: http://www.youthbeyondblue.com/understand-what's-going-on/suicide-prevention-knowing-the-signs

Chat: http://www.beyondblue.org.au/get-support/get-immediate-support

Email: https://online.beyondblue.org.au/WebModules/Email/InitialInformation.aspx

Kids Helpline

Talk – 1800 55 1800 Web: http://www.kidshelp.com.au/teens/get-info/hot-topics/lets-talk-about-suicide.php

Chat: https://kidshelpline.com.au/teens/get-help/webchat-counselling/

Email: http://www.kidshelp.com.au/teens/get-help/email-counselling/index.php

Talk – 13 11 14 Web: https://www.lifeline.org.au/

Chat:https://www.lifeline.org.au/Get-Help/Online-Services/crisis-chat

Talk - 13 11 14 Web: http://au.reachout.com/

Chat:https://www.lifeline.org.au/Get-Help/Online-Services/crisis-chat

Key learnings from Module 4Let’s review the key learnings from this chapter

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So far you have learned about:

Vicarious trauma

Common signs of vicarious trauma

Coping with vicarious trauma

Seeking assistance – other resources

Key learnings from the courseCongratulations! You have completed this course.

By completing this course you have:

1. Developed a basic understanding of the key components of the Interpersonal Theory of Suicide (ITS) and frameworks for suicide prevention through:

a. understanding primary, secondary, and tertiary suicide prevention and

b. identifying risk and protective factors, along with warning signs and situational precursors for various populations at risk of suicide and serious self-harm

2. Learned to articulate ways you can contribute to the ongoing reduction of suicide risk through evidence-based practice strategies and effective engagement with young people in a culturally aware, person centred, and strengths-based way.

3. Deepened your understanding of applying structured professional judgement when assessing and responding to suicidal ideation and behaviours, in a crisis management context.

4. Attained a clearer sense of how to apply tools from the Strengthening Families Protecting Young People Framework for Practice for assessing and responding to suicide risk when working with young people, along with applying the Aim4© conceptual model to your interventions.

5. Learned to articulate and apply self-care strategies when working with suicide and vicarious trauma.

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Hunter institute for mental health (2017b) Fact Sheet: The LIFE Framework (overview). Retrieved from https://www.lifeinmindaustralia.com.au/docs/LIFE-fact-sheet-1.pdf

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