YOUTH SUICIDE PREVENTION

SCHOOL-BASED GUIDE

Guidance Counselor’s Meeting

Student Support Services

http://theguide.fmhi.usf.edu/

OverviewIdentifies elements of a comprehensive,

school based suicide prevention programExamines scientific literature to determine

elements that are the most effective.Contains Checklists and Self Assessment Guide for Administrators for program

implementationReviewed by experts

StatisticsSuicide accounts for 13% of all adolescent

deathsThird overall cause of adolescent deathsIncreased in children from age 10-14 100%

1980-1996Estimated 3,500 adolescents attempt

suicide daily

Statistics Continued35 die dailyMore teenagers die from suicide then

cancer, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined.

1980-1985 rate for African American Youth increased 230%

90% that die have mental health problem: depression, substance abuse

Reality of Suicide

Unexpected death is always painful, but perhaps none more then self-destruction of a young person and a life, with all of its potential and promise, cut short by one desperate and too final act.

Why School Based PreventionSchool can offer prevention, intervention

and education.

In schools suicide issues may be evident more so then in other settings.

Issues may occur with the greatest frequency.

Schools offer a large exposure (teachers, counselors, peers) to youth.

Public Health ApproachPositive role schools can play.

Example of disease programs (inoculations, TB, Small Pox)

Up to date, accurate, research based information, guidelines and tools.

Reviews literature, evlauates and draws conclusions

Public Health ApproachIdentifies the problemIdentifies risk factorsIndentifies causes of the problemDevelops interventions evaluated for

effectiveness

OVERVIEW AREASInformation DisseminationSchool ClimateRisk Factors: Risk and Protective Factors,

Early Warning Signs.Risk Factors: How can a school Identify a

Student At Risk for Suicide?

Overview Areas ContinuedAdministrative IssuesSuicide Prevention GuidelinesIntervention Strategies: Establishing a

Community ResponseIntervention Strategies: Crisis Intervention

Teams

Overview ContinuedIntervention Teams: Responding to Student

CrisisPreparing for and responding to death by

suicide: Steps to Responding.Preparing for and responding to death by

suicide: Responding to and working with the media.

Family PartnershipsCulturally and linguistically Diverse

Populations

Information Dissemination in the SchoolsSuicide third leading cause of death in

adolescentsSchool based programs have ideal

exposure to large number of adolescents.Should be facilitated by staff that are

knowledgeable in the area.Research suggest teachers may feel they

are not prepared to assess or address suicide issues.

Information Dissemination in the SchoolsTraining faculty and staff essential in

effective prevention programs.Skills to develop knowledge, attitudes, and

identification for appropriate referrals.Essential to train administrators and

parents for support of prevention efforts.Brief two hour training is effective in

increasing teacher’ awareness of adolescent suicide.

MYTHS

Talking about suicide in the classroom will promote suicidal ideas and suicidal behavior.

MYTHS

Parents are often aware of the child’s suicidal behavior.

MYTHS

Most adolescents who attempt suicide fully intend to die.

MYTHS

There is not a significant difference between male and female adolescents regarding suicidal behavior.

MYTHS

The most common method for adolescent suicide ins drug overdose.

MYTHS

Because female adolescents complete suicide at a lower rate than male adolescents, their attempts should not be taken seriously.

MYTH

Suicide behavior is inherited.

MYTH

Adolescent suicide occurs only among poor adolescents.

Myth

The only one who can help a suicidal adolescent is a counselor

or mental health professional.

SCHOOL CLIMATEConnectednessParticipationAcademic AchievementSafetyTraining

SCHOOL CLIMATEDisciplinePhysical EnvironmentSecurity

Connectedness

Felt treated fairly, close to people at school, part of school.

Less likely to experience suicidal thoughts and emotional distress.

Less likely to drink alcohol, carry weapons, engage in delinquent behavior.

Foster afterschool activities, involvement in decision making and create small size learning groups.

ParticipationResearch: Students participate in decisions

are healthier, more productive.Assign students to meaningful school roles:

monitor, classroom helpers, planning committees.

Example of Crime Stoppers.Protective factor for “At Risk Students”

Academic AchievementSet academic goals and supporting

strategies.

Provide encouragement

May use media or other mechanism

Positive Behavioral Supports

SAFETYUnsafe schools – Emotional and Physical

RealmsUnsafe leads to poor academic

performance and truancy.BullyingRelationship between bullying and

emotional factors

SAFETYCreate ways for the student to feel

comfortable to report potentially dangerous situation.

For example, list of adults they may contact if they feel unsafe or have knowledge of a potentially dangerous situation.

Ways for the staff to intervene in potentially dangerous situation.

For example, mental health, signs of distress in students, review of policies.

TrainingStudents should be taught skills training

how to resolve conflict, problem solving, coping strategies (Life Skills).

Incorporate skills in existing classes i.e. health, drivers education, physical education.

Increasing social skills related to positive impact on cognitive development, academic achievement.

Curriculums need to be research based, active learning strategies, school wide and have adequate teaching resources.

DisciplineMethod to teach appropriate social

behaviors.Positive and proactiveFor example, positive behavioral supports.Example of Bullying Intervention, Problem

Solving Skills, Conflict Resolution, Appropriate Social Behaviors.

Avoid humiliating, harassing, scolding, nagging, physically aversive discipline, decreasing learning opportunities.

Physical EnvironmentResearch suggests students attitude about

the school may be related to the appearance of the school.

For example, flakey ceilings, graffiti tainted walls, scuffed up floors, dirty bathrooms, crumbling sidewalks, and leaky toilets:

May lead to “Why bother, no one cares” attitude.

Example, of Men’s Bathroom and breaking sink incident.

Negativism about the school may impact attitude towards teaching, learning, attendance and morale.

SecurityEnsure the school is free from weapons.Random search policyLinks to the community

resources/partnerships (Guam Police Department, Customs -random sweeps, Child Protective Services)

Utilize parent support

Security IssuesNumber and type of exitsLightingRooms and furnishings, Locker useParkingPositive posters: Behavioral ExpectationsPatterns of supervisionTraffic patternsIsolated areas

Security IssuesLocation and design of bathroomsGuardrailsHallwaysClosed campus

REGULAR SAFETY ASSESSMENTS

SAFE ENVIORNMENTStaff in-service trainingEstablished policies (bullying, random

searches)Opportunities to staff to share their concernEmphasize positive relationshipsSystem in place to refer students suspected

abuse and neglectTreat students with respect, support and

care.

SAFETY ENVIORMENTMonitor safetyConsistently enforce disciplinary,

harrassment, and civil rights policies.Inform students who they may contact if

there is a safety issue.Help students feel safe about approaching

and adult

Safety Learning EnvironmentAddress problem solving and social skillsEnsure high academic standardsDevelop links to the communities.Encourage and utilize parental involvement

Safety EnvironmentEducate students on tolerance,

harassment, bullying, and respecting others.

Ensure physical environmentPolicies and procedures on weapons and

safetyDevelop after school activitiesUse positive pro-social approach that de-

emphasizes punishment.

Risk and Protective Factors and Warning SignsSuicide is an extremely complex

phenomenaNine out ten adolescents show clues to

their attemptsNo tangible all encompassing method to

assess.Focus on risk factorsImpacting risk factors such as treating

depression or substance abuse, stressful life events may have positive effects.

RISK FACTORSPrevious suicide attempt or gestureFeelings of hopeless or isolationPsychopathology (depressive

disorders/mood disorders)Parental psychopathologySubstance abuse disorderFamily history of suicidal behaviorLife stressors: interpersonal losses,

relationship, social, work,Legal, disciplinary problemsAccess to firearms

RISK FACTORSPhysical AbuseSexual AbuseConduct disorders or disruptive behaviorsSexual orientation: homosexual, bisexual and

transgendered youth.Juvenile delinquencySchool or work problemsCongtigation or imitation (exposure to media

accounts or friends with suicidal behavior.Chronic physical illnessLiving alone or runawayAggressive-impulsive behaviors

PROTECTIVE FACTORSFamily cohesion (mutual involvement,

shared interests, emotional support)Good coping skillsAcademic achievementPerceived connectedness with schoolGood relationships with school or other

youthLack of means for suicidal behaviorHelp seeking behaviorImpulse control

PROTECTIVE FACTORSProblem solving/conflict resolution abilitiesSocial integration/opportunities to

participateSense of worth/confidenceStable environmentAccess to care for mental/physical

substance disordersResponsibilities for others/petsReligious activity (controversial topic

currently)

EARLY WARNING SIGNSWithdraw from friends of familyPreoccupation with deathMarked changes in personalityDifficulty concentratingDifficulties in school (decline in quality of

work)Frequent physical complaints often related

to emotions (stomach aches, headaches, fatigue

Persistent boredomLoss of interest in things one cares about

LATE WARNING SIGNSActually talking about a suicide or planExhibiting impulsivity: violent acts,

rebellious behavior, running away.Refusing help, feeling beyond help,Complaining “being a bad person”, rotten

inside.Making statements of hopelessness,

helplessness, worthlessness.

LATE WARNING SIGNSVerbal hints: “I wont be a problem to you

much longer”“Nothing matters”, “It is no use”, “I won’t see

you again”.Becoming suddenly cheerful after a period

depression.(May mean student has made decision to

escape all problems by ending their life).Giving away favorite possessionsMaking last will or testamentSaying: “I am going to kill myself”, “I wish I

were dead”, I shouldn’t have been born”

How can school identify a student at risk for suicide?Suicide Awareness Curriculum

Gatekeeper training

Screening

CURRICULIUM Dose and length very important

Avoid: one shot sessions – may overwhelm students, reaction to stress, media dramatized

Long term programs – semester long

Incorporate into established classes: health, life skills problem solving skills, help seeking behaviors,

CURRICULIUMAvoid presentations by youth who may

have made previous attempts – may result in copy cat behavior.

Provide list of crisis intervention services

Have established policies and procedures on how to deal with suicidal adolescent

Introduce curriculum only after policy and protocol are established.

CURRICULIUMHave established community links that may

provide assistance.

Have trained staff available that know what to do with the suicidal adolescent.

GATEKEEPER TRAININGProvide staff with most current information

on adolescent suicide.

Have policies and procedures in place.

Establish community links (referrals): Mental Health, Police, EMS

Encourage staff to collaborate and cooperate.

GATE KEEPER TRAININGEducate staff regarding risk factors

Educate staff regarding warning signs

Educate staff on how to make referrals (who and when)

Provide regular (twice a year) brief trainings to all staff.

ScreeningMethod of Identifying at risk students: ASK

THE QUESTION

Effective and efficient in identifying students

Concerns: suicide behavior highly complex, need to assess at various frames of reference.

14 year old bipolar female example (CONFIDENTIAL)

SCREENING INSTRUMENTSThe Suicide Ideation Questionnaire

The Suicide Risk Screen

The Columbia Teen Screen

Signs of Suicide(SOS)

SCREENINGUse a questionnaire that is research

validated

Get parents consent first before proceeding

Have established referral system

Research suggests screening will NOT create suicidal ideations in adolescents who are not suicidal.

SCREENING

Staff made aware screening is not 100% in determining if a student will express suicide ideations.

Counselors aware of valid screening instruments.

Conduct repeated screening: once or twice a year.

ADMINISTRATIVE ISSUESImplementation

Developing Polices and Procedures:

Elements – issue is a priority, types of prevention efforts,Crisis management handbook, describe roles and responsibilities, how to respond to students,

Administrative IssuesDescribe criteria for assessing lethality of

student potentially At risk.

Describe how program will be evaluated.

Clear and detailed

School level and district level

Crisis Response TeamCrisis response plan

Roles and responsibilities

Team leader(s)

Supported by Adminstration

Evaluating ProgramsResearch based

Documentation and policy

Consultation

Evaluation component

Other indicators of risk factors (substance abuse, mental health

Program SupportAdministration

Teachers

Parents

Community partners

Duty, Responsibility, and LiabilityDuty of supervision by the school

Same level as parents at home

Failure to prevent due to lack of action = liability

Failure to notify parent = liability

Liability if violate a FERPA, HIPPA other Laws

Duty, Liability, ResponsblityPreventative measure to establish

programs

Keep accurate up to date records

Baker Act (72 hour hold)

Involuntary admissions Criteria: refused voluntary, likely to harm self if no admission, gravely disabled.

Suicide Prevention GuidelinesPolicy and ProceduresGatekeeper TrainingEducating Parents and community

membersStudent Curriculum Addressing SuicideTeaching Adaptive Skills to StudentsPeer Support GroupsScreening

Postvention Strategies (Strategies to responding to a Suicidal CrisisEstablished response teamCrisis Center and Hotlines:Reach important and underserved populationHelp those students that use themEndorsed by youth as more acceptable then

mental health centersCan serve as drop in center

Suicide Prevention GuidelinesSchool ClimatePolicy and ProceduresIn school response teamsParent involvementTraining: teachers, and staffCurriculum incorporated in existing classesProvide information re. coping skills,

problem solvingProvide screening program (research based

assessment)Counselors trained in best practices

SUICIDE PREVENTION GUIDELINESProvide Peer Assistance ProgramsProvide information re. community

resourcesEnsure school maintains positive climateInform parents of importance of restricting

weapons/violence.Ensure staff and personnel are supportive

and feel comfortable with prevention strategies.

INTERVENTION STRATEGIESCannot function without outside support

(community)

Positive community relationships enhance prevention

Provide information on services of community links.

INTERVENTION STRATEGIESCrisis Intervention and Response Teams

Coordinate district wide

Based on resources

Training and regular team meetings

Mobilization and screening

INTERVENTION STRATEGIESTEAM SUPPORTAdministration acknowledgment Method of notificationTraining of staff to make referrals to the

Crisis TeamTraining in identification of students and

risk factors

INTERVENTION STRATEGIES RESPONDING TO STUDENT CRISISPlanning how to respondStudent behaviorEstablished intervention proceduresClear written plan of action

WHAT TO DOAlways ensure a student’s safety: Plan,

means and method

Asking directly “Have you thought about a way to hurt yourself”

Remain with the student

Send for help : Crisis Team

WHAT TO DO CONTINUEDListen: Acknowledge feelings and problems in the

students own terms.

Allow the student to express feelings – open communication, permission to express.

WHAT TO DO CONTINUEDBe Direct

Remain Calm

Be Empathetic

Be honest

Always take the student seriously

WHAT TO DO CONTINUEDKnow your limits – if in immediate danger

escort student to appropriate referral (nurses office, counseling area, principal).

Make sure the student knows what is going on at each stage of the intervention.

Eg. Escort to the team, Events and responses that will happen.

A chaotic and confusing situation requires clear communication

WHAT TO DOINFORM PARENTSCommunity Agencies/Resources

Risk Factors

Safety of student

What has happened and reason for response

Restricting access to lethal means: ensure monitoring

WHAT NOT TO DODon’t be judgmentalDon’t preach to the studentNever leave the student alone or send the

student awayDon’t under react or minimizeIf threatening suicide and does have a

weapon, never try to physically take the weapon away from the student.

(Avoid endangering your life, life of the student or lives of others in the school).

WHAT NOT TO DODon’t ever dare the student to attempt

suicide.

Don’t debate with the student about whether suicide is right or wrong.

Don’t promise secrecy or confidentiality

Don’t panic

RESPONDING TO VARIOUS LEVELS OF RISK

LEVEL 1 – Low or moderate risk

LEVEL 2 – Severe Risk

LEVEL 3 – Extreme Risk

LEVEL 1 – LOW or MODERATE RISK

Staff member observes warning signs student may be at risk

Student may have verbalized suicidal thoughts, does not have a plan, does not have access to potentially lethal weapon.

ACTION: Notify team, meet with student, and assess.

Monitor periodically (once a week)

LEVEL 2 – SEVERE RISKStudent overtly voiced the intent to engage

in suicidal act.Gone beyond mere thoughts has thoughts

of action and plan.Has a plan – but does not have means to

carry out plan.

ACTION: Notify team, administrator, supervision of student, contact parents, restriction of means, referral to appropriate resource, follow up on referral, monitor progress.

LEVEL 3 EXTREME RISKStudent has voiced the intent to engage in a suicidal

act.Student has access to lethal means needed to carry

out this act.Student may have access to lethal means on person.

ACTION: Notify team, mobilize community resources (GPD, EMS, DMHSA, notify parents, follow crisis intervention procedures. Follow up on referral

ENSURE SAFETY – DO NOT INCREASE LEVEL OF POTENTIAL HARM

PREPARING AND WORKING WITH THE MEDIARefer all contacts to the Administrator –

subsequently to the Superintendent or designee.

Generally (if designee): communicate dangers of imitation behaviors and how inappropriate reporting may contribute to more suicidal behavior.

Acknowledge: struggles and positive aspects (may provide sense of balance)

PREPARING AND WORKING WITH THE MEDIA: WHAT NOT TO DO-Do not present as tool for accomplishing

certain ends.

Avoid focusing on only the positive (provide balanced picture).

Avoid using language that may contribute to more suicides:

Headlines, connotations of sinful behavior, contrasting suicide deaths with non fatal attempts do not utilize terms such as:

Successful, unsuccessful, or failed

Family PartnershipsPresent information at appropriate forumsDistribute written informationInvolve the mediaSchedule parent workshopsReach out to faith-based communitiesContact advocacy groupsFrequent teacher parent contactInform parents of students participation in

prevention events’Expand concept of volunteerism

Culturally and Linguistically Diverse PopulationsHigher rates in some groups (African

American increased 230% in 1980 to 1995.

1979-1992 – American Indian Youth – accounted for 64% of all suicides of Native Americans. 1.5 times higher then general population.

Asian Pacific Islanders – Highest rate for females in the country. Fastest growing ethnic group

Culturally and Linguistically Diverse PopulationsGirls age 5 -12. 30% Asian females

reported depressive symptoms. Youth Risk Behavior Survey – Half of youth had previous contact with

mental healthCulture impact on views of mental illness,

accessing servicesRole of school climate and ethnicity (FSM

example)Role of victimization and bullyingRefugee status and potential risksHarassing behaviors

COMPREHENSIVE PLANAccounts for cultural and linguistic

differences

Utilizes appropriate translators and culture liaisons

Follows up with evaluation of effectiveness

Incorporates best practices and research