Suicidal Ideation and Behaviors

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Suicidal Ideation and Behaviors

• Excerpts adapted from Stephen E. Brock, Ph.D.,
  NCSP, LEP
• Shelley Hart
• California State University, Sacramento

Ridgway Presentation Spring
2007 John Lestino
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Suicide Risk Factors

• Psychopathology
• Associated with 90 of suicides
• Prior suicidal behavior the best predictor
• Substance abuse increases vulnerability and can
  also act as a trigger
• Familial
• History
• Stressor
• Functioning

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Suicide Risk Factors

• Biological
• Reduced serotongenic activity
• Situational
• 40 have identifiable precipitants
• A firearm in the home
• By themselves are insufficient
• Disciplinary crisis most common

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Suicide Warning Signs

• Suicide notes
• Direct indirect suicide threats
• Making final arrangements
• Giving away prized possessions
• Talking about death
• Reading, writing, and/or art about death
• Hopelessness or helplessness
• Social Withdrawal and isolation
• Lost involvement in interests activities
• Increased risk-taking
• Heavy use of alcohol or drugs

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Suicide Warning Signs

• Abrupt changes in appearance
• Sudden weight or appetite change
• Sudden changes in personality or attitude
• Inability to concentrate/think rationally
• Sudden unexpected happiness
• Sleeplessness or sleepiness
• Increased irritability or crying easily
• Low self esteem

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Suicide Warning Signs

• Dwindling academic performance
• Abrupt changes in attendance
• Failure to complete assignments
• Lack of interest and withdrawal
• Changed relationships
• Despairing attitude

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Predicting Suicidal Behavior (CPR)(Ramsay,
Tanney, Lang, Kinzel, 2004)

• Current plan (greater planning greater risk).
• How (method of attempt)?
• How soon (timing of attempt)?
• How prepared (access to means of attempt)?
• Pain (unbearable pain greater risk)
• How desperate to ease the pain?
• Person-at-risks perceptions are key
• Resources (more alone greater risk)
• Reasons for living/dying?
• Can be very idiosyncratic
• Person-at-risks perceptions are key

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Predicting Suicidal Behavior (CPR)(Ramsay,
Tanney, Lang, Kinzel, 2004)

• () Prior Suicidal Behavior?
• of self (40 times greater risk)
• of significant others
• () Mental Health Status?
• history mental illness (especially mood
  disorders)
• linkage to mental health care provider

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Suicide Intervention Risk Assessment Referral
Procedures

• 1. Conduct a Risk Assessment.
• 2. Consult with fellow school staff members
  regarding the Risk Assessment.
• 3. Consult with County Mental Health.

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Suicide Intervention Risk Assessment Referral
Procedures

• Use risk assessment information and consultation
  guidance to develop an action plan. Action plan
  options are as follows
• Extreme Risk
• If the student has the means of his or her
  threatened suicide at hand, and refuses to
  relinquish such then follow the Extreme Risk
  Procedures.
• B. Crisis Intervention Referral
• If the student's risk of harming him or herself
  is judged to be moderate to high then follow the
  Crisis Intervention Referral Procedures.
• C. Contracting
• If the student's risk of harming him or herself
  is judged to be low then follow the Contracting
  Procedures.

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Suicide Intervention Risk Assessment Referral
Procedures

• Extreme Risk
• Call the police.
• Calm the student by talking and reassuring until
  the police arrive.
• Continue to request that the student relinquish
  the means of the threatened suicide and try to
  prevent the student from harming him-or herself.
• Call the parents and inform them of the actions
  taken.

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Suicide Intervention Risk Assessment Referral
Procedures

• B. Crisis Intervention Referral
• Determine if the student's distress is the result
  of parent or caretaker abuse, neglect, or
  exploitation.
• Meet with the student's parents.
• Determine what to do if the parents are unable or
  unwilling to assist with the suicidal crisis.
• Make appropriate referrals.

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Suicide Intervention Risk Assessment Referral
Procedures

• C. Contracting
• Determine if the student's distress is the result
  of parent or caretaker abuse, neglect, or
  exploitation.
• Meet with the student's parents.
• Make appropriate referrals.
• Write a no-suicide contract.
• 5. Protect the privacy of the student and family.
  
• 6. Follow up with the hospital or clinic.

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Positive PsychologyWhere Existentialism meets
CBT

• Presented by
• Terry Molony, Ed.S.
• Cherry Hill Schools
• Philadelphia College of Osteopathic Medicine
• John C. Lestino, MA, LPC
• Edgewater Park Schools

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Attributional Styles

• Pessimists view
• Bad events
• Permanent
• Pervasive
• Internal
• Good events
• Temporary
• Specific
• External

• Optimists view
• Bad events
• Temporary
• Specific
• External
• Good events
• Permanent
• Pervasive
• Internal

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Components of Flow

• Task that we have a chance to complete
• Able to concentrate
• Task has clear goals
• Immediate feedback is provided
• Sense of control over actins
• Sense of self disappears
• Sense of duration of time is altered

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Functional Factors

• Behavior and Its Purposes

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Components of Functional Assessment

• Access to social attention
• Access to tangibles or preferred activities
• Escape, delay, reduction, or avoidance of tasks
• Internal stimulation (automatic reinforcement)

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Five Primary Components of a Functional
Assessment

• A clear description of the problem behavior.
• Identification of the events, times, and
  situations when behavior will and will not occur.
• Identification of the consequences that maintain
  problem behavior.
• Development of hypotheses that describe the
  behavior, the type of situation in which it
  occurs and the reinforcers maintaining it.
• The collection of direct observation data to
  support the hypotheses.

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Understanding social rules and what is expected
.How do people teach it?

• Social StoriesRule cards Feedback on
  performanceRole playsVideo instruction

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Social Stories

• Can be used with modifications such as pictures
  to assist with comprehension
• Developed by Carol Gray
• Can be used for multiple purposes
• multi-element tasks
• addressing fears
• addressing challenging behaviors

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What does not destroy memakes me stronger.

• Studies have shown that people who overcome
  difficult events often express positive
  psychological changes.
• The creation of meaning
• A cognitive theory is that the traumatic event
  provides new information about oneself or the
  world which is worked through until the schemas
  match reality.