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S h i e l d o f C a r e : P a r t i c i p a n t W o r k b o o k
™
NAME:
Shield of Care
“System Policy & Protocol” “Connectedness to Youth”“Communication Between Protectors”
SHIELD OF CARE: Participant Workbook
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™
System Policy and Protocol
Connectedness to Youth
Communication Between Protectors
PROT
ECTOR PROTECTOR
P R O T E C T O R
PROT
ECTO
R PROTECTOR
4 SHIELD OF CARE: Participant Workbook
IndexIntroductory Letter and Self Care Resources ...........................................5
Section I: Introduction to the Shield of Care ..............................................6
Section II: Overview ................................................................................. 7
Section III: Shield of Care Model
Overview ........................................................................................... 9
Part A: “Seeing” ................................................................................ 10
Part B: “Protecting” .......................................................................... 19
Part C: “Listening” ............................................................................ 21
Part D: “Assessing” ...........................................................................24
Part E: “Networking” ........................................................................ 27
Section IV: After a Suicide ......................................................................30
Youth Story Cards
Victoria ...........................................................................................32
Jake ................................................................................................34
Haley ...............................................................................................36
David ...............................................................................................38
Section V: Glossary ................................................................................40
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Self Care Guide
Thank you for joining us in this suicide prevention training. We hope this training will be a beneficial experience for you.
In this training, we will be learning about the prevalence of suicide in juvenile justice facilities, reflecting on our attitudes about suicide, and learning strategies for preventing suicide in our facility.
We know that suicide can be a difficult topic to think about and discuss. Learning or talking about suicide prevention can be especially difficult for those who have lost a loved one to suicide. For this reason, if the topic gets too personal or intense for you, feel free to quietly step out of the training and regroup. The trainers may also be able to assist you briefly during a break and talk with you about additional resources available.
If you would like additional one-on-one time to talk with someone about the thoughts/emotions you experienced during this training, you may contact any of the resources below. These resources in your community may also be used to find out more information about suicide prevention and/or as referral resources if someone you know is thinking of suicide.
National Suicide Prevention Resources:
• NationalSuicidePreventionLifeline:1-800-273-TALK (8255) • AmericanAssociationofSuicidology(AAS):http://www.suicidology.org • AmericanFoundationforSuicidePrevention(AFSP):http://www.afsp.org Note: If you’ve lost a loved one to suicide, AFSP and AAS have a list of survivor support groups listed by state. • NationalOrganizationforPeopleofColorAgainstSuicide(NOPCAS): http://www.nopcas.com • SuicidePreventionResourceCenter(SPRC):http://www.sprc.org Additional National Resources:
• PoisonControl:1-800-222-1212 • NationalCenteronInstitutionsandAlternatives:http://www.ncianet.org • GatekeeperSupportTools:http://www.gatekeeperaction.org
Local Suicide Prevention and Referral Resources: * ________________________________________________________ * ________________________________________________________ * ________________________________________________________ * Yoursupervisor _____________________________________________ * Anothertrustedco-worker ______________________________________
Ifyouareunabletocompletethistrainingduetoanintenseemotionalconcern,pleasecoordinatealternativetrainingoptionswithyoursupervisor.
6 SHIELD OF CARE: Participant Workbook
Section I: IntroductionIntroduction_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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Section ll: Overview
II
OverviewWhatisthepreventionpotentialofthisinformation?__________________________________________________________________________Howcanyoumaximizethepreventionpotentialofthisinformationgivenyourrole?__________________________________________________________________________
Whatisthepreventionpotentialofthisinformation?_____________________________________ _____________________________________Howcanyoumaximizethepreventionpotentialofthisinformationgivenyourrole?__________________________________________________________________________
Attention Deficit/Hyperactivity Disorder-isadevelopmentdisorder.“Symptomsincludedifficultystayingfocusedandpayingattention,difficultycontrollingbehavior,andhyperactivity(over-activity).”(NIMH)
Conduct Disorder –“isarepetitive,persistentpatterninchildrenoradolescentsofviolatingtherightsofothers,rules,orsocialnorms.”(SPRC)
Post Traumatic Stress Disorder–“Acommonanxietydisorderthatdevelopsafterexposuretoaterrifyingeventorordealinwhichgravephysicalharmoccurredorwasthreatened.“(WikEd)
Psychotic Disorder–“Amentaldisorderinwhichaperson’scontactwithrealityisimpaired.Duringapsychoticepisodeaperson’sthoughtpatternsareoftenconfusedanddisorganized.Theyfrequentlyexperiencesuchsignsandsymptomsasdelusions,hallucinationsandparanoia.”(Psychiatrynetworks.com).
(Source:SPRC/AFSPToolkitforSchools)
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Section ll: Overview
Whatisthepreventionpotentialofeachofthestatisticsonthisslide?
Statistic #1 _____________________________________________________________________________________________
Statistic #2 _____________________________________________________________________________________________
Statistic #3 _____________________________________________________________________________________________
Whatisthepreventionpotentialofthisinformation?__________________________________________________________________________Howcanyoumaximizethepreventionpotentialofthisinformationgivenyourrole?__________________________________________________________________________
Whatisthepreventionpotentialoftheinformationfromourownfacility?__________________________________________________________________________
Whatcanyoudoinyourroletomaximizethisinformation?__________________________________________________________________________
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Section lll: Shield of Care ModelPART A:SEEING
1. SEEING ATTITUDES
A. Activity:SuicideAttitudesSurvey Directions:Below,youwillseeseveralstatementsaboutsuicide.Afterreadingeachstatement,decidewhetheryou1)StronglyDisagree,2)Disagree,3)NeitherAgreeNorDisagree,4)Agree,or5)StronglyAgree.Therearenorightorwronganswers,onlywhatyouthinkorbelieve.Usetheanswergridprovidedtorecordyourresponses.
StronglyDisagree
Disagree NeitherAgreeNorDisagree
Agree StronglyAgree
1.Thereisn’tmuchIcandotostopayouthfromkillinghim/herself.
1 2 3 4 5
2.Suicidalbehaviorsareirrational. 1 2 3 4 5
3.Youthinsecurefacilitieswhothreatenorattemptsuicideonlywantattention.
1 2 3 4 5
4.Suicideiswrong. 1 2 3 4 5
5.ImaychoosenottointervenewithasuicidalJJyouthsoIdonotbecomeliable.
1 2 3 4 5
6.IfayouthIworkwithinthefacilityconsidersorattemptssuicide,Ihavefailedathelpingthatyouth.
1 2 3 4 5
7.ThefacilityenvironmentincreasesJJyouth'sriskforsuicide.
1 2 3 4 5
8.SuicidepreventiontrainingcanhelpmesavelivesofJJyouth.
1 2 3 4 5
9.JJyouththinkaboutsuicidemoreoftenthannon-incarceratedyouth.
1 2 3 4 5
10.Youthinsecurefacilitieshavefewerreasonstolivethannon-offendingyouth.
1 2 3 4 5
11.Astaffpersonwhointerveneswhenayouthisconsideringsuicidebecomeslegallyresponsibleforthatyouth'slifeordeath.
1 2 3 4 5
12.IfeelcomfortablediscussingsuicideissueswithyouthinJJfacilities.
1 2 3 4 5
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Section lll: Shield of Care Model
III
PART A:SEEING
Once you’ve completed the survey, answer the following questions:
1. Doesattitude#1helporhinderacaregiver’sabilitytopreventsuicide? Why?/Whynot? _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________
2.Doesattitude#2helporhinderacaregiver’sabilitytopreventsuicide? Why?/Whynot? _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________
3.Doesattitude#3helporhinderacaregiver’sabilitytopreventsuicide? Why?/Whynot? _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________
4.Doesattitude#4helporhinderacaregiver’sabilitytopreventsuicide? Why?/Whynot? _________________________________________________________ _________________________________________________________ _________________________________________________________ _________________________________________________________
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Section lll: Shield of Care ModelPART A:SEEING
General Prevention Tips:
Develop
supportive
relationships
with youth
in general so
that it will
be easier
for them
to accept
your help
in a crisis
situation.
Help all
youth build
confidence
in their
ability to
solve smaller
problems. In
doing so, it
will be easier
for them to
solve larger
problems.
II. SEEING YOUTH
A. Thinking Patterns
1. Rigid thinking–Thisisanallornothingthinkingpattern.TypicallyifXdoesordoesn’thappen,IwilldoY.“Ifmydaddoesn’tcomeseemebymybirthday,I’mgivingup.”
2. Overgeneralizing–Takinganincident/experience/feeling,etc.andextendingittoanunreasonableconclusion.Forexample,afamilymembermayhavemissedavisitduetoanemergency,andyouheartheyouthsay,“See,shemissedthemeeting.Shedoesn’tgiveacrapandnooneelsedoeseither.”“Ican’tdothis.Ican’tdoanythingright.”“I’vebeeninthisstinkingplaceforyears,andnoonewillevertalktome.”
3. Catastrophizing–Takingsomethingandmakingitacatastrophe-“Ihavenothingtolookforwardto.Imightaswellbedead.”“Peopledon’tcareaboutanyoneexceptthemselves.”
4. Terminal statements–Anystatementthathintsofdeathorsuicide.“Imightaswelljustkillmyself,”“Ijustcan’ttakeitanymore.”
(Source:Maceetal.,2007)
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Section lll: Shield of Care Model
III
PART A:SEEING
III. SEEING RISK
Protectivefactorsarecharacteristicsthatmakeitlesslikelythatindividualswillconsider,attempt,ordiebysuicide.
Thesefactorsarelargelybiological,psychological,socialandenvironmental.
Biological:Intellectualability,personality/temperamentaltraits,andtoughness,Psychological:Resilience,motivation,humorandperceptionsofself;emotionalattributes-emotionalwell-being,lifesatisfaction,optimism,happiness,trust,optimism,hope;cognitive;spiritualattributes,andattributesofpost-traumaticgrowth.Social: Interpersonalskills,interpersonalrelationships,connectedness,andsocialsupportEnvironmental:Positivelifeeventsandsocioeconomicstatus.
(Bell,etal.,2005)
Formoreinformationonprotectivefactors,visit:http://www.giftfromwithin.org/html/promote.html
_________________________________________________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________
_________________________________________________________________________________________________________________________________________________________________________________________ _______________________________________________________________________________________________________________
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Section lll: Shield of Care ModelPART A:SEEING
A. HIGH RISK PERIODS OF CONFINEMENT
(Sources:Hayes,2009;Hayes,2007)
RoomConfinementDeathofAnotherYouthintheFacilityParentsThreatof/FailuretoVisitFailureintheProgramRidiculefromPeersSevereGuiltorShameaboutOffenseSexual/PhysicalAssault
Roomconfinementisasanctionthatcanhavedeadlyconsequencesandshouldbecloselyscrutinizedandutilizedjudiciously.
Infact,over 50% of all juvenile suicides occur while the youth is under room confinement status.
Thisisaverysignificantfinding.Placementofayouthonconfinementstatusmaytriggerself-injuriousbehavior.
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Section lll: Shield of Care
III
PART A:SEEING
B. SUICIDE WARNING SIGNS (Sources:SPRC;AFSP;Joiner,2005)
Warningsignsarethosesignsthatindicatethepossibilityofanimminentsuicidalcrisis.Thislistincludeswarningsignsmostcommonlycitedinawidebodyofresearch.Takeallsuicidalbehaviorseriously.
Ideation -Thoughtsofsuicide.Ideationcanbeexpressedthroughtalking,gesturing,writinganddrawing.
MayalsobeexhibitedthroughTerminal Statements-“Iwon’tbeaproblemforyoumuchlonger.”“IwishIweredead.”“I’mgoingtokillmyself.”“It’snouse.”
HavingaSuicide Plan
Actively Seeking Access to Suicide Means
Unbearable PainoftenasaResultofaLoss/Crisis-deathofalovedone,divorce,break-up,peerrejectionorthelossofanythingthatisofgreatvaluetotheteenespeciallyinconjunctionwithdepression
Perceived Lack of Resources–InternalandExternal Perceived Expendability–Beliefthatnoonewouldmisstheteen,theteen’sexistencedoesn’tmatter,orthatpeoplewouldbebetteroffwithouthim/her
Increased/PersistentorMore Pronounced Signs of Depression(especiallyanger,sadnesstomisery,withdrawal/isolation,lackofinterestinusualactivities)
Making final arrangements,sayinggoodbyeasifs/hewon’tseesomeoneelseagain
Giving Away Possessions Refusinghelp,feeling“beyond help” Becomingsuddenly cheerful afteraperiodofdepression–thismaymeanthat
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Section lll: Shield of Care ModelPART A:SEEING
theteenhasalreadymadethedecisiontoescapeallproblemsbyendinghis/herownlife Feelingsofhopelessnessorpurposelessness
Bullyingand/orharassmentand/orextremeembarrassment/humiliation
C. SUICIDE RISK FACTORS(Source:SPRC)
Riskfactorsarethosesignsthatpredisposesomeonetosuicide.Thefollowinglistincludesthoseriskfactorsmostcommonlycitedinresearch.
Biopsychosocial Risk Factors•Mentaldisorders,particularlymooddisorders,schizophrenia,anxietydisorders andcertainpersonalitydisorders• Alcoholandothersubstanceusedisorders• Hopelessness• Impulsiveand/oraggressivetendencies• Historyoftraumaorabuse• Somemajorphysicalillnesses• Previoussuicideattempt• Familyhistoryofsuicide• Environmentalriskfactors• Joborfinancialloss• Relationalorsocialloss• Easyaccesstolethalmeans• Localclustersofsuicidethathaveacontagiousinfluence
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Section lll: Shield of Care
III
PART A:SEEING
Is it Depression?
Likely if…the
changes persist
for longer than
two weeks; the
signs continue
to worsen;
attempts to
relieve the
symptoms are
unsuccessful;
and/or the
symptoms
interfere with
everyday
activities.
Sociocultural Risk Factors;• Lackofsocialsupportandsenseofisolation• Stigmaassociatedwithhelp-seekingbehavior• Barrierstoaccessinghealthcare,especiallymentalhealthandsubstance abusetreatment• Certainculturalandreligiousbeliefs(forinstance,thebeliefthatsuicideis anobleresolutionofapersonaldilemma)• Exposureto,includingthroughthemedia,andinfluenceofotherswho havediedbysuicide• Problemswiththelaw/involvementwiththejuvenilejusticesystem
Althoughthemajorityofpeoplewhohavedepressiondonotdiebysuicide,severedepressiondoessignificantlyincreasetheriskofsuicide.
D. SIGNS OF DEPRESSION
(Sources:DMVIV;NationalAssociationofSchoolPsychologists)
Behavioral Changes
• Depressed,angryorirritablemoodmostoftheday,nearlyeveryday• Diminishedinterestorpleasureinall,oralmostall,activities• Diminishedabilitytoconcentrate;orindecisiveness• Changeinschoolperformance(globaldropingrades)• Changeinattitudeaboutschool• Substanceabuse• Constantfeelingsofworthlessnessorexcessiveorinappropriateguilt• Problemsinrelationships• Recurrentthoughtsofdeath(notjustfearofdying),recurrentsuicidalideation, asuicideattemptoraspecificplanforcommittingsuicide• Refusaltoattendorparticipateinschool• Outburstsofshouting,complaining,unexplainedirritability,orcrying
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Section lll: Shield of CarePART A:SEEING
• Withdrawal,socialisolation,andpoorcommunication• Extremesensitivitytorejectionorfailure• Unusualtempertantrums,defiance,oroppositionalbehavior• Chronicboredomorapathy
Physical Symptoms• Significantweightlossorgainordecrease/increaseinappetite• Difficultysleepingorexcessivesleeping• Agitated-alwaysmoving• Psychomotorretardation• Mopingaroundnearlyeveryday• Vaguephysicalcomplaints;constantfatigueorlackofenergy
E. Challenging behavior
Depressedorsuicidalyouthmaychallengeyouwiththeirbehaviorparticularlyifangerisapredominantsignofdepression.Rememberthatthisbehaviormaybedrivenbyanillnessratherthanthedesiretomakeyourlifedifficultortochallengeyourauthority. F. Activity: Video Viewing Tasks
Please note any of the following:
1.Signsofdepression: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________2.Riskfactorsofsuicide: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
3.Warningsignsofsuicide: ___________________________________________________________ ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
G. Activity: Youth Story Cards–Refertothe“Seeing”QuestionsontheYouthStoryCardintheAppendixforthisExercise.
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Section lll: Shield of Care
III
PART B:PROTECTING
“PROTECTING”
I INTERVENTIONS
A. Responding to a Suicide Attempt
Roomconfinementisasanctionthatcanhavedeadlyconsequencesandshouldbecloselyscrutinizedandutilizedjudiciously.Infact,over50%ofalljuvenilesuicidesoccurwhiletheyouthisunderroomconfinementstatus.Thisisaverysignificantfinding.Placementofayouthonconfinementstatusmaytriggerself-injuriousbehavior.
NotesOnOurFacility’sObservationLevels:________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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Section lll: Shield of Care Model
PART B:PROTECTING
B. Activity: YouthStoryCards–Refertothe“Protecting”QuestionsontheYouthStoryCardintheAppendixforthisExercise.
C. Activity: PolicyReview
Pleasetakeoutyourcopyofthepoliciesandproceduresandstayinyourgroupstodiscussthefollowingexerciseandquestions:
Inwhatwaysarethesepolicieshelpfultoyouasacaregiverwhenthinkingaboutprotectingayouthatriskforsuicide?
Inwhatwaysisyourrolelimitedbypolicyinregardtoprotectingyouthatriskforsuicide?
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Section lll: Shield of Care Model
III
PART C:LISTENING
“LISTENING”
A. Reflection
B. Activity:Listening–IndividualWork
Directions:Paraphrasethefollowingstatement.Avoidpitfalls!
“Nooneunderstands.Noonewilleverunderstand.”
Paraphrasehere _____________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________
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Section lll: Shield of Care ModelPART C:LISTENING
C. Activity: Listening–PairWork
Objective:Thepersonintheroleoflistenerwillpracticelisteningskillsinthecontextofthespeaker’saggravationdrivingexperience.
Directions:Thelistenerwillpracticeparaphrasingthespeaker’sexperienceascloselyaspossiblewhileresistingthetemptationofofferingasolution,sharingasimilarexperienceorcriticizingtheotherdriver.
1.Individually–Thinkofsomethinganotherdriverdidthatreallymadeyoumad. Writeithere _______________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________
2.Begintheexercisewiththestatementbelow.
Open with “You look really [upset].”
3.Allowyourpartnertodiscusstheexperience
4.Practiceusingthefollowing:
“So you’re saying…” “What I hear you saying is …Mirror the statement – Near word for word restatement.
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Section lll: Shield of Care Model
III
PART C:LISTENING
5.Onceyou’vereflectedtheexperience,followitupwith.“I’msorrythathappenedtoyou.”
Wait for trainer to debrief
D. Activity: Youth Story Cards–Refertothe“Listening”QuestionsontheYouthStoryCardintheAppendixforthisExercise.
E. Activity: Policy Review
Pleasetakeoutyourcopyofthepoliciesandproceduresandstayinyourgroupstodiscussthefollowingexerciseandquestions:
Inwhatwaysarethesepolicieshelpfultoyouasacaregiverwhenthinkingaboutlisteningtoayouthatriskforsuicide?
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Section lll: Shield of Care ModelPART D: ASSESSING
“ASSESSING”
A. Asking about suicide
1.Whataresomewaystoaskdirectlyaboutsuicide?________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
B. Listening and Asking
Example of using listening skills and asking the question:S = Staff, Y = youth
S-Iseethatyou’rereallyangry.What’sgoingon?Y – Mymomdidn’tshowupagain.S–You’resayingthatyourmomdidn’tshowupagain.Icanunderstandwhy _ youwouldbeangryaboutthat.Y – Shedoesn’tcare.Noonedoes.Iwon’tbeaproblemforhermuchlonger.
Basedontheaboveexample,answerthefollowingquestions:
1.Whatmightleadyoutothinkthatsuicideisanissue? ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________
2.Woulditbetoosoontoaskaboutsuicide? ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________
3.Howwouldyoudoit? ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________
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Section lll: Shield of Care Model
III
PART D: ASSESSING
C. Activity: Video Viewing Tasks
Directions: Inyourgroups,decidewhowillbefocusingonseeing,whowillbefocusingonprotecting,whowillbefocusingonlisteningandwhowillbefocusingonassessing.Oncetheserolesareassigned,takenotesinyourassignedsectionbelow: “Seeing” Tricia1.Noteanysignsofdepression,riskfactors/warningsignsforsuicideorhighriskperiodsofconfinementhere. ________________________________________________________ ________________________________________________________ ________________________________________________________
“Protecting”Tricia2.Noteanyprotectingactionshere. ________________________________________________________ ________________________________________________________ ________________________________________________________
“Listening”toTricia3.NoteexamplesofhowDarlenelistenedhere ________________________________________________________ ________________________________________________________ ________________________________________________________
“Assessing” Tricia4.HowdidDarlenedetermineTriciawassuicidal? ________________________________________________________
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Section lll: Shield of Care ModelPART D: ASSESSING
5.Ifyourememberthequestion,pleasenoteithere. ________________________________________________________
When the video is over, wait for instructions from your trainer.
Discuss the following questions.
1.WhatpromptedDarlenetobegintalkingwithTricia? ________________________________________________________
2.HowdidDarlene“protect”Tricia’semotionalsafety? ________________________________________________________ ________________________________________________________
3.HowdidDarlenephysicallyprotectTricia? ________________________________________________________ ________________________________________________________ ________________________________________________________
4.WhatspecificwarningsigndirectlyaskingandledtoDarleneaskingdirectlyaboutsuicide? ________________________________________________________
D. Activity: Youth Story Cards –Refertothe“Assessing”QuestionsontheYouthStoryCardintheAppendixforthisExercise.
E. Activity: Policy Review
Please take out your copy of the policies and procedures and stay in your groups to discuss the following questions:
Whatdoesthepolicysayaboutassessingayouthatriskforsuicide?
Inwhatwaysarethesepolicieshelpfultoyouasacaregiverwhenthinkingaboutassessingayouthyouperceivetobeatriskforsuicide?
Inwhatwaysisyourrolelimitedbypolicyinregardtoassessingayouthyouperceivetobeatriskforsuicide?
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Section lll: Shield of Care Model
III
PART E: NETWORKING
“NETWORKING”
A. Activity: Video Viewing Tasks
1.HowdoesthestaffworktogethertohelpEddie’s? ________________________________________________________ ________________________________________________________
2.AtwhatpointdidSaldoesstandbackandletNickcontinue? ________________________________________________________ ________________________________________________________
3.HowdoesNickhelpprotectEddies’emotionalsafety? ________________________________________________________ ________________________________________________________ 4.HowdoesNickmakethereferraleasierforthementalhealthstaff? ________________________________________________________ ________________________________________________________
B. Activity: Youth Story Cards –Refertothe“Networking”QuestionsontheYouthStoryCardintheAppendixforthisExercise.
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Section lll: Shield of Care ModelPART E: NETWORKING
C. Activity: S-PLAN Review
FactsUsepromptsbelowtolistfivethingsyoueitherlearnedorreviewedinthistrainingthatcouldhelpyousavealife.Beasspecificaspossible.Anexampleisprovidedbelowtohelpyougetstarted.
Example:
AnimportantFACTaboutsuicideis:SuicideistheTHIRDleadingcauseofdeathamongyouthages10-24.
In this training, I learned (or reviewed) that: . . .
1.AnimportantFACTaboutsuicideis: ________________________________________________________ ________________________________________________________2.MyOPINIONaboutsuicideincludestheattitude/beliefthat: ________________________________________________________ ________________________________________________________
3. YouthmaydemonstrateRISKFACTORS/WARNINGSIGNSofsuicide.Oneis: ________________________________________________________ ________________________________________________________
4.YouthmaydemonstratePROTECTIVEFACTORSagainstsuicide.Oneis: ________________________________________________________ ________________________________________________________
5.TheMOSTIMPORTANTthing(s)Ilearnedintrainingthatwillhelpmesavealifeis: ____________________________________________________ ________________________________________________________
Responding to Risk
Usethequestionsbelowtothinkaboutwaysyoucanapplywhatyoulearnedintrainingtorespondtoyouthatriskforsuicide.
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Section lll: Shield of Care Model
III
PART E: NETWORKING
1. HowissuicideriskmostlikelytobedisplayedintheJuvenileJustice populationatyourfacility?
a)Ayouthmightsaysomethinglike ____________________________
b)Ayouthmightdosomethinglike ____________________________ 2.Thinkaboutyourroleinyourparticularjuvenilejusticefacility(e.g.,“Security Officer;”CorrectionsTeacher).WhatpartsoftheShieldofCaremodelare youmostequipped/abletoperforminyourworkrole?Whatdoyourpolicies andproceduressayabouthelpingsuicidalyouth?
Shield of Care Action Plan
Anyoftheyouthwithwhomyouworkcouldbeatriskofsuicide.FillintheblankswithspecificinformationrelatedtotheS-PLANtodemonstratehowYOUwillhelpayouthatrisk.
1.S – ____________________________________________________
2.P – ____________________________________________________
3.L – ____________________________________________________
4.A – ____________________________________________________
5.N – ____________________________________________________
D. Activity: Busting Barriers
When I, (Your Name Here)
, encounter potential barriers to suicide prevention at
(Your Name Facility) , I will use these Barrier Busting Techniques to help save a life.
Potential Barrier to Helping Someone At Risk of Suicide:
1. ____________________________________________________________
2. ____________________________________________________________
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Section IV - After a Suicide
3. ____________________________________________________________
Barrier Busting Technique:
1. ____________________________________________________________
2. ____________________________________________________________
3. ____________________________________________________________
AFTER A SUICIDE
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
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Section IV - After a Suicide
IV
AFTER ASUICIDEA. Self Care - Watch for Signs of Stress
Tension: Physicalandemotionaltension,beingexcessivelyhyper,unabletorelaxorsitstillforverylong,muscletremorsortwitches.
Nausea: Especiallyduringorimmediatelyaftertheincident.
Body temperature regulation:Profusesweatingorchillsatunusualtimes.
Sleep disturbances:Eithertheinabilitytofallasleep,disruptivedreamsornightmaresorwakingupearlierthanusual.
Fatigue: Alwaystired.Nopeporenergy.Intrusive thoughts or memories: Thinkingabouttheincidentorsomerecurringmemoryobsessivethoughtsaboutwhenyoudon’twantto.
Negative feelings/Crying:Unpleasantfeelingsthatmaycomewithoutwarning,suchasprofoundsadness,helplessness,fear,anxiety,anger,rage,discouragement,frustrationordepression.
A feeling of vulnerability or lack of control:Feelingexposedtothreats,notincontrolofone’slife,experiencingparanoia.
Interpersonal problems:increasedirritability,insensitivity,blamingothers,distancingfromothers.
Substance Abuse:“Self-medication”canbeasymptomofstress.
Compulsive behavior:Increasedproblemssuchascompulsiveeatingorotheruncontrolled,repetitivebehaviors.
Self Blame:Usuallythisfixesonsomeparticularaspectoftheincident.Asenseofhavinglostself-valueordiminishedself-esteem.“Icouldhavedonethisorshouldhavedonethat.”
(UsedwithpermissionfromtheCaliforniaDepartmentofCorrectionsandRehabilitation)
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STORY
Victoria picked up her tray in the cafeteria line and looked for a place
to sit in the dining room. She saw a seat at a table near Jennifer,
Latisha and Monica, who always seemed to be having fun, but it
seemed like they suddenly stopped talking and looked down at their
trays as she approached, so she walked past and sat at the very next
table.
She couldn’t tell what they were whispering about, but they stopped
again when she got up to get more water. She was drinking a lot of
water the last day or so because her anti-depressant was making her
mouth so dry. She hasn’t had much appetite, and you’ve noticed that
she hasn’t been her chipper self recently or been interacting with staff
and other youth.
Victoria was just thinking of turning her tray in and heading back to her quarters when an officer walked up and
announced, “Come on, Vicky. The health clinic can take care of your request for a pregnancy test now.” Victoria could
hear the girls snickering as she stood up and looked at the officer, hissing “Thanks, bitch,” through clenched teeth. “Oh
yes you will get some ISO time for that mouth, Miss Taylor,” the officer replied. As they marched out of the cafeteria, she
could hear Monica’s distinctive voice: “You in trouble now, tricky Vicky. That rabbit done died!”
SEEINGIn groups: Identifysignsofdepression,riskfactorsorwarningsignsofsuicide,highriskperiodsofconfinementorotherworrisomebehavior.
Preparetoshareanoverviewofthiscase,discusswhichelementsofS-PLANareapriority,andanswerthefollowingquestion:
WhatdoyouseethatmaypossiblyputVictoriaatriskforsuicide?Discussanyworrisomebehavior.Whyisitworrisome?Whatcouldbedoneaboutit,ifanything?_____________________________________________________________________________
PROTECTINGHowwillyouprotectVictoria?_____________________________________________________________________________ _____________________________________________________________________________
LISTENINGInpairs,practiceyourlisteningskillsandavoidthecommonpitfalls.OnepersonwilltaketheroleofcaregiverandtheothertheroleofVictoria.Remembertomakeeyecontactandmaintainanopenbodyposture.
1
VICTORIA
SHIELD OF CARE: Participant Workbook 33
NOTES: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
DecideonanegativeemotionthatwouldlikelybedemonstratedbyVictoriaandareasoncontainedinthestoryforthatemotion.
Thepersonintheroleofcaregiverwillsimplyreflectthatemotion,thereasonandacknowledgethefeeling.
Use the following example dialogue. Change the details to relate to your story. S = Staff, Y=Youth
S – Iseethatyou’rereallyangry.What’sgoingon? Y – Mymomdidn’tshowupagain. S – You’resayingthatyourmomdidn’tshowupagain.Icanunderstandwhyyou wouldbeangryaboutthat.
ASSESSING
UsingthesamenegativeemotionandreasonforthatemotionwithinVictoria’sstory,you’regoingtoaddawarningsignforsuicideandaskdirectlyaboutsuicide.
Inpairs,practiceyourassessingskillswithonepersonactingintheroleofcaregiverandtheotherintheroleofVictoria.
Use the following example dialogue. Change the details to relate to your story, and ask about suicide. S = Staff, Y=Youth.
S–Iseethatyou’rereallyangry.What’sgoingon? Y – Mymomdidn’tshowupagain. S – You’resayingthatyourmomdidn’tshowupagain.Icanunderstandwhyyou wouldbeangryaboutthat. Y– Shedoesn’tcare.Noonedoes.“Iwon’tbeaproblemforhermuchlonger.” S – Sometimeswhenpeoplesaythat,theyarethinkingaboutsuicide.Areyou thinkingaboutsuicide?
NETWORKING
UsingtheReferralResponseGuideforyourfacility,determinethepersonwithwhomyouwillnetworkandhowtocontactthisperson.
Who: ____________________________________________________________________________________________________________
How to contact: ___________________________________________________________________________________________________________________________________________________________
JAKESTORY
You hear Jake and Matt talking about Jake’s upcoming transfer to
another facility and “CTB” catches your attention. You begin listening
closely now and hear Matt asking Jake whether he “has a ticket.”
You’re listening closely because you recognize these terms from a
suicide prevention training. During the training, you learned that
people will sometimes use the phrase “catch the bus” to mean suicide,
and that “having a ticket” means that a person has the means and a
plan to complete suicide.
You don’t want to let them know you’re listening, but you move
closer because you want to hear what Jake says in response to Matt’s
question.
You can’t hear what Jake said in reply to Matt’s question, but Matt
moves away, leaving Jake sitting at a table with his head down. Jake approached you last week and told you that his
father had died. He also said that he has a hard time talking to anyone about it.
SEEINGIn groups: Identifysignsofdepression,riskfactorsorwarningsignsofsuicide,highriskperiodsofconfinementorotherworrisomebehavior.
Preparetoshareanoverviewofthiscase,andanswerthefollowingquestion:
WhatdoyouseethatmayindicateJakeisthinkingaboutsuicide?Discussanyworrisomebehavior.Whyisitworrisome?Whatcouldbedoneaboutit,ifanything?__________________________________________________________________________________________________________________________________________________________
PROTECTINGHowwillyouprotectJake?_____________________________________________________________________________ _____________________________________________________________________________
LISTENINGInpairs,practiceyourlisteningskillsandavoidthecommonpitfalls.OnepersonwilltaketheroleofcaregiverandtheothertheroleofJake.Remembertomakeeyecontactandmaintainanopenbodyposture.
DecideonanegativeemotionthatwouldlikelybedemonstratedbyJakeandareasoncontainedinthestoryforthatemotion.
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34 SHIELD OF CARE: Participant Workbook SHIELD OF CARE: Participant Workbook
Thepersonintheroleofcaregiverwillsimplyreflectthatemotion,thereasonandacknowledgethefeeling.
Use the following example dialogue. Change the details to relate to your story. S = Staff, Y=Youth.
S – Iseethatyou’rereallyangry.What’sgoingon? Y – Mymomdidn’tshowupagain. S – You’resayingthatyourmomdidn’tshowupagain.Icanunderstandwhyyou wouldbeangryaboutthat.
ASSESSING
UsingthesamenegativeemotionandreasonforthatemotionwithinJake’sstory,you’regoingtoaddawarningsignforsuicideandaskdirectlyaboutsuicide.
Inpairs,practiceyourassessingskillswithonepersonactingintheroleofcaregiverandtheotherintheroleofJake.
Use the following example dialogue. Change the details to relate to your story, and ask about suicide. S = Staff, Y=Youth.
S–Iseethatyou’rereallyangry.What’sgoingon? Y – Mymomdidn’tshowupagain. S – You’resayingthatyourmomdidn’tshowupagain.Icanunderstandwhyyou wouldbeangryaboutthat. Y– Shedoesn’tcare.Noonedoes.“Iwon’tbeaproblemforhermuchlonger.” S – Sometimeswhenpeoplesaythat,theyarethinkingaboutsuicide.Areyou thinkingaboutsuicide?
NETWORKING
UsingtheReferralResponseGuideforyourfacility,determinethepersonwithwhomyouwillnetworkandhowtocontactthisperson.
Who: ____________________________________________________________________________________________________________
How to contact: ___________________________________________________________________________________________________________________________________________________________
SHIELD OF CARE: Participant Workbook 35
NOTES: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
™
HALEYSTORYAt 17, Haley was raised in a family with money.
After an abusive event on vacation with her father 6 months prior to entering the facility, Haley had attempted to kill herself by jumping in front of a car on a busy highway near her home. Although she had several broken bones, she lived through the attempt. She was recently arrested outside a pawn shop after stealing jewelry from a high end store. She told the arresting officer that she needed the money to buy a gun because she “was just done with her miserable existence.”
Once she entered your facility, other youth avoided her. She spoke and acted very differently than others. The remark about getting a gun to kill herself was not conveyed by the arresting officer, and she denied any suicidal thoughts or behaviors on intake, so she was not placed on suicide watch.
However, she became extremely upset whenever staff discussed either her upcoming visit with her mom and younger brother or her court date. As the family visit approached, Haley began to refuse meals. When asked about it, she said that she wanted to see her family, but that she was extremely embarrassed to be there, and that she felt torn between seeing them and being seen in “juvenile jail.” A few days prior to the visit, she would nod off in the day room and had to be reminded that sleeping was not allowed. The third time she put her head down and slept, staff placed her on room confinement for the rest of the day.
Despite the fact that Haley wasn’t on suicide watch, you get a strong feeling that you should probably check on her. When you do, you discover that she had obtained a radio cord, had wrapped it around her neck, and is barely responsive.
SEEINGIn groups: Identifysignsofdepression,riskfactorsorwarningsignsofsuicide,highriskperiodsofconfinementorotherworrisomebehavior.
Preparetoshareanoverviewofthiscase,andanswerthefollowingquestion:
WhatdoyouseethatmayindicateHaleyisthinkingaboutsuicide?Discussanyworrisomebehavior.Whyisitworrisome?Whatcouldbedoneaboutit,ifanything?__________________________________________________________________________________________________________________________________________________________
PROTECTINGUsingtheSuicideInterventionandPrecautionGuide,howwillyouprotect her?_____________________________________________________________________________ __________________________________________________________________________________________________________________________________________________________
3
36 SHIELD OF CARE: Participant Workbook SHIELD OF CARE: Participant Workbook
LISTENINGInsteadofconfininghertoherroom,youtooksometimetolistentoHaley.
Inpairs,practiceyourlisteningskillsandavoidthecommonpitfalls.OnepersonwilltaketheroleofcaregiverandtheothertheroleofHaley.Remembertomakeeyecontactandmaintainanopenbodyposture.
DecideonanegativeemotionthatwouldlikelybedemonstratedbyHaleyandareasoncontainedinthestoryforthatemotion.
Thepersonintheroleofcaregiverwillsimplyreflectthatemotion,thereasonandacknowledgethefeeling.
Use the following example dialogue. Change the details to relate to your story. S = Staff, Y=Youth.
S – Iseethatyou’rereallyangry.What’sgoingon? Y – Mymomdidn’tshowupagain. S – You’resayingthatyourmomdidn’tshowupagain.Icanunderstandwhyyou wouldbeangryaboutthat.
ASSESSING
ImaginethatyouhadtheopportunitytoassessHaleypriortoherattempt.UsingthesamenegativeemotionandreasonforthatemotionwithinHaley’sstory,you’regoingtoaddawarningsignforsuicideandaskdirectlyaboutsuicide.
Inpairs,practiceyourassessingskillswithonepersonactingintheroleofcaregiverandtheotherintheroleofHaley.
Use the following example dialogue. Change the details to relate to your story, and ask about suicide. S = Staff, Y=Youth.
S–Iseethatyou’rereallyangry.What’sgoingon? Y – Mymomdidn’tshowupagain. S – You’resayingthatyourmomdidn’tshowupagain.Icanunderstandwhyyou wouldbeangryaboutthat. Y– Shedoesn’tcare.Noonedoes.“Iwon’tbeaproblemforhermuchlonger.” S – Sometimeswhenpeoplesaythat,theyarethinkingaboutsuicide.Areyou thinkingaboutsuicide?
NETWORKING
UsingtheReferralResponseGuideforyourfacility,determinethepersonwithwhomyouwillnetworkandhowtocontactthisperson.
Who: ____________________________________________________
How to contact: ____________________________________________________________________________________________________
SHIELD OF CARE: Participant Workbook 37
NOTES: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
™
DAVIDSTORY
David, 15, did not have a history of conflict with other youth at the
facility, but lately, he has been spending quite a bit of time in room
confinement for physical and verbal conflicts with youth and staff.
After he was discharged from room confinement for yelling at staff
again earlier this week, David became particularly upset after a
phone call from his father canceling his visit for the second time that
month.
David had been outspoken prior to the call, but hasn’t said much
since. Once an active participant in class he has started to do the bare
minimum. A teacher saw him drawing a noose in the margins of his
notepaper today and alerts you immediately. While you are waiting
for mental health staff, you talk with him and discover that although
his girlfriend broke up with him, he seems disturbingly cheerful.
SEEINGIn groups: Identifysignsofdepression,riskfactorsorwarningsignsofsuicide,highriskperiodsofconfinementorotherworrisomebehavior.
Preparetoshareanoverviewofthiscaseandanswerthefollowingquestion:
WhatdoyouseethatmayindicateDavidisthinkingaboutsuicide?Discussanyworrisomebehavior.Whyisitworrisome?Whatcouldbedoneaboutit,ifanything?__________________________________________________________________________________________________________________________________________________________
PROTECTINGIsDavid’sphysicaloremotionalsafetyapriority?UsingtheSuicideInterventionandPrecautionGuide,howwillyouprotecthim?_____________________________________________________________________________ _____________________________________________________________________________
LISTENINGInpairs,practiceyourlisteningskillsandavoidthecommonpitfalls.OnepersonwilltaketheroleofcaregiverandtheothertheroleofDavid.Remembertomakeeyecontactandmaintainanopenbodyposture.
DecideonanegativeemotionthatwouldlikelybedemonstratedbyDavidandareasoncontainedinthestoryforthatemotion.
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38 SHIELD OF CARE: Participant Workbook SHIELD OF CARE: Participant Workbook
Thepersonintheroleofcaregiverwillsimplyreflectthatemotion,thereasonandacknowledgethefeeling.
Use the following example dialogue. Change the details to relate to your story. S = Staff, Y=Youth.
S – Iseethatyou’rereallyangry.What’sgoingon? Y – Mymomdidn’tshowupagain. S – You’resayingthatyourmomdidn’tshowupagain.Icanunderstandwhyyou wouldbeangryaboutthat.
ASSESSING
UsingthesamenegativeemotionandreasonforthatemotionwithinDavid’sstory,you’regoingtoaddawarningsignforsuicideandaskdirectlyaboutsuicide.
Inpairs,practiceyourassessingskillswithonepersonactingintheroleofcaregiverandtheotherintheroleofDavid.
Usethefollowingexampledialogue.Changethedetailstorelatetoyourstory,andaskaboutsuicide.
Use the following example dialogue. Change the details to relate to your story, and ask about suicide. S = Staff, Y=Youth.
S–Iseethatyou’rereallyangry.What’sgoingon? Y – Mymomdidn’tshowupagain. S – You’resayingthatyourmomdidn’tshowupagain.Icanunderstandwhyyou wouldbeangryaboutthat. Y– Shedoesn’tcare.Noonedoes.“Iwon’tbeaproblemforhermuchlonger.” S – Sometimeswhenpeoplesaythat,theyarethinkingaboutsuicide.Areyou thinkingaboutsuicide?
NETWORKING
UsingtheReferralResponseGuideforyourfacility,determinethepersonwithwhomyouwillnetworkandhowtocontactthisperson.
Who: ____________________________________________________________________________________________________________
How to contact: ___________________________________________________________________________________________________________________________________________________________
SHIELD OF CARE: Participant Workbook 39
NOTES: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
™
Section V - Glossary
40 SHIELD OF CARE: Participant Workbook SHIELD OF CARE: Participant Workbook
Anchor–Afixedobject,suchasawindowframeorcamerahousing,fromwhichtohangoneself.
Causal factor-Afactorlinkedtothecausationofadiseaseorhealthproblem.
Contagion -Aprocessbywhichexposuretothesuicideorsuicidalbehaviorofoneormorepersonsinfluencesotherstocommitorattemptsuicide.
HIPAA–Enactedin1996,HIPAAortheHealthInsurancePortabilityandAccountabilityActhelpsworkersretainhealthinsurancewhentheychangeorlosetheirjobsandprotectstheprivacyofpersonallyidentifiablehealthinformation.
Ligature –Anythingthatcanbeusedtohangoneself.Thismaybearag,plasticbag,shoelaceoranyothermaterialthatcanbeusedaroundtheneckandthatcanwithstandtheweightofabody.
Mortality review –Aninvestigationfollowingasuicidewherebythedetailsprecipitatingasuicidearedocumentedanddiscussedwiththeintentofpreventingadditionalsuicides.
Postvention -TheAmericanAssociationofSuicidePreventiondefinessuicidepostventionasthe“provisionofcrisisintervention,supportandassistanceforthoseaffectedbyacompletedsuicide.”
Precipitating factor-Thecatalystforanillness,symptom,orepisode.Thismaynotbetheunderlyingcauseofanillness,ratheritiswhatleadsuptoit.
Protective factor-Protectivefactorsareskills,strengths,orresourcesthathelppeopledealmoreeffectivelywithstressfulevents.Protectivefactorsmaybepersonal,external,orenvironmental.
Room confinement –Definedasabehavioralsanctionimposedonyouththatrestrictsmovementforvaryingamountsoftime.Itincludes,butisnotlimitedto,isolation,segregation,time-out,oraquietroom[Hayes,2009].
Risk factor–Anindividual’scharacteristics,circumstances,historyandexperiencesthatincreasethestatisticalriskforsuicide.
Suicide-Deathcausedbyself-directedinjuriousbehaviorwithanyintenttodieasaresultofthebehavior.(Source:CDC)
Section V - Glossary
V
SHIELD OF CARE: Participant Workbook 41
Suicide attempt-Anonfatalself-directedpotentiallyinjuriousbehaviorwithanyintenttodieasaresultofthebehavior.Asuicideattemptmayormaynotresultininjury.
Suicidal ideation –Thoughtsofharmingorkillingoneself.Ideationcanbeexpressedthroughtalking,gesturing,writingordrawing.MayalsobeexhibitedthroughTerminalStatements-“Iwon’tbeaproblemforyoumuchlonger.”“Nothingmatters.”“IwishIweredead.”“I’mgoingtokillmyself.”“It’snouse.”
Suicide precaution-Anobservationalstatusplaceonsuicidalyouthrequiringincreasedstaffsurveillanceandmanagement.(Hayes,2005)
Warning signs -Variablesthatsignalthepossiblepresenceofsuicidalthinking
42 SHIELD OF CARE: Participant Workbook
TheTennesseeDepartmentofMentalHealth(TDMH)istheauthor/ownerofthismaterialdevelopedaspartoftheTennesseeLivesCountJuvenileJusticeproject fundedviaagrant(#2U79SM057400-04)fromtheSubstanceAbuseandMentalHealthServicesAdministration(SAMHSA),U.S.DepartmentofHealthandHumanServices(HHS).Theviews,policies,andopinionsexpressedarethoseof theauthorsanddonotnecessarilyreflectthoseofSAMHSAorHHS.TheTennesseeDepartmentofMentalHealth(TDMH)istherecipientofthisgrantmadepossiblethroughtheGarrettLeeSmithMemorialActof2004.TheTLC/JJprojectiscollaborativelyimplementedwithMentalHealthAmericaofMiddleTennessee,theCenterstoneResearchInstitute,andtheTennesseeSuicidePreventionNetwork.
ShieldofCare™CopyrightStatementAllmaterials,trainermanuals,workbooks,logoandvideopresentationsoftheShieldofCare™arethesolepropertyoftheTennesseeDepartmentofMentalHealthTDMH,StateofTennessee,andshallnotbereproducedorpresentedinpartorinwholewithoutexpresswrittenpermissionofTDMH.ContacttheDivisionofMentalHealthServicesat(615)253-5078orwriteto:LygiaWilliams,Project
Director,10thFloor,AndrewJohnsonTower,710JamesRobertsonParkway,Nashville,Tennessee27243.©2012,FirstEdition
PublicationAuthorization339523;50copies@$4.48ea.March,2012,TennesseeDepartmentofMentalHealth
For more information visit:
www.tn.gov/mental (click on suicide prevention)
www.tspn.org/shield-of-care