Suicide Prevention

1
Suicide Prevention

• John Brinkman
• Jennifer Croyle
• Donna McInturff
• Georgia Association of School Psychologists Fall
  Conference

2
What We Know

• Most Adolescents who are contemplating suicide
  tell a friend prior to the attempt
• Friends usually do not give good advice
• Adults are usually the last people an adolescent
  will tell about their plan
• Most teens report that when they do talk to an
  adult, they find it helpful

3
National Strategy for Suicide Prevention

• By 2005 Increase the proportion of school
  districts with evidence-based programs designed
  to address serious childhood and adolescent
  distress and prevent suicide
• This objective suggests schools should screen for
  youth at-risk for suicide
• School staff needs to be trained and aware of the
  warning signs for suicidal youth and have a plan
  of action for helping those at-risk

4
International Suicide Prevention Strategies

• First national suicide prevention strategy was
  initiated in Finland in 1986
• Norway, Sweden, New Zealand, Australia, Estonia,
  and France all have national suicide prevention
  strategies
• All of these countries share a number of common
  elements in their suicide prevention programs.
  One common element is that they all have suicide
  prevention programs in their schools.

5
Suicide Prevention in the SchoolsCases and
Implications

• A lack of state mandates for suicide prevention
  programs and staff trainings does not necessarily
  justify a school districts failure to implement
  such a program. In the future it is likely that
  court cases involving school districts
  negligence in providing prevention programs will
  be upheld since many other school districts have
  suicide prevention programs in place.

6
Suicide Prevention in SchoolsCases and
Implications

• Wyke vs. Polk County School Board (1997) This
  case emphasizes the importance of training
  educators to recognize the signs of suicide.
• 13-year old male student attempted suicide twice
  at school before hanging himself at home. Two
  administrators were aware of the incidents, spoke
  with the child, yet failed to notify the parents.
• This school district was held negligent.

7
Suicide Prevention in SchoolsCases and
Implications

• Brooks v. Logan (1995) Addresses teacher
  negligence and the issue of school district
  negligence in the absence of a district wide
  suicide prevention program
• Male high school student committed suicide in his
  home
• Teacher read class journal after suicide

8
Signs of Suicide (S.O.S.)- Video

• Video includes series of vignettes of teens
  contemplating suicides
• Includes interviews with
• Real teens who attempted suicide
• The sister of a teen who completed suicide
• A high school counselor who explains what she
  would do if assessing a student contemplating
  suicide

9
S.O.S. Implementation

• Day 1
• Presentation of Depression Screening
• Safe Schools Clinician maintains the base
• Individual Interviews
• Day 2
• -Continuation of presentations and interviews

10
S.O.S. Implementation

• Day 3
• -Completion of Interviews
• -Safe School Clinician completes the screening
  by tallying up data and recording it
• Follow-up
• -Comply with recommendations from the screening
• -Follow-up completed within 30 days

11
Things to Remember

• Be Prepared!!
• Keep Good Records
• Anticipate the Aftermath
• Be sure program is supervised by school
  psychologist or mental health professional
• Know your schools regulations and guidelines
  (confidentiality, parental consent, etc.)
• A lack of state mandates for suicide prevention
  programs does not justify a districts decision
  to fail to implement such a program

12
Things to Remember

• You CANNOT require a student to complete the form
  or sign his/her name without parental
  authorization. The students must be made aware of
  their choice
• Once you have information that suggests a student
  is at-risk, you are ethically obligated to take
  action

13
Individual Screening Assessment

• Completed by counselor conducting individual
  interview
• List concerns, recommendations, need for referral
  to other resources (in-home, outpatient) and if
  there is a need for follow-up

14
Suicide Depression and Suicide Prevention Master
Checklist

• Planning
• Classroom Presentations
• Post-Screening Interviews
• Follow-up

15
Planning

• A sufficient number of professionals have been
  recruited to assist with classroom presentations
  and post-screening interviews.
• All classroom presenters have been given adequate
  training for their role, and are familiar with
  the topics of depression and suicide in youth.
• All post-screening interviewers have been given
  adequate training for their role, and are
  qualified to provide crisis intervention
  services.
• Screening checklists and all other relevant
  resources are available and ready for use.
• All relevant community agencies and other
  referral options have been identified.
• All classroom presentations have been scheduled
  and cleared with classroom teachers
• Appropriate arrangements have been made for
  videos, guest speakers, or other classroom
  presentation aids.

16
Classroom Presentations

• All presentations have been carried out
  successfully!!!
• All completed screening checklists have been
  returned to mental health coordinator.

17
Post-screening Interviews

• All screening checklists have been tallied
• A master post-screening list has been created, to
  include name of interviewed student, name of
  interviewer, outcome of interview, outcome at
  follow-up.
• All identifiable students with a significant
  score on the screening checklist have been
  assigned to a post-screening interviewer.
• All post-screening interviews have been
  conducted, with a summary form completed for each
  interviewed student.
• All students with an identified need for services
  have been referred to an appropriate resource or
  agency.

18
Follow-up

• All students referred for additional assistance
  have been checked on after an appropriate length
  of time to determine whether services are being
  received.
• All records have been properly stored!

19
Suggestions for Classroom Presentations

• Provide case examples that the students can
  relate to
• If possible, provide local youth suicide
  statistics to help students understand that the
  problem is close to home
• Emphasize the fact that school age peers often
  simply dont know what to say to someone who is
  suicidal, which is why it is so important to let
  an adult professional know

20
Suggestions for Classroom Presentations

• Encourage students to be honest and open when
  completing the screening checklists. While you
  cannot require them to put their names on the
  checklists, feel free to suggest it.
• Remind students that school professionals are
  always available to talk to, even if some
  students choose not to sign their name or
  complete the screening.

21
Q.P.R.

• Question, Persuade, Refer

22
Why School Personnel Need Training

• 1999 survey of school counselors in the U.S.
  found that only 38 believed that they could
  identify a student at-risk for suicide.
• Similar survey of 228 health teachers showed that
  only 9 felt that they could identify a student
  at-risk for suicide.

23
Q.P.R.

• Q.P.R. is NOT intended to be a form of counseling
  or treatment!!
• Q.P.R. IS intended to offer hope through positive
  action

24
Q.P.R.

• Ask a Question, Save a Life

25
Q.P.R.Question

• Direct Verbal Cues
• Ive decided to kill myself
• I wish I were dead
• Im going to end it all
• If (such and such) doesnt happen, Ill kill
  myself

26
Q.P.R.Question

• Behavioral Cues
• Any previous suicide attempts
• Acquiring a gun or stockpiling pills
• Co-occurring depression, moodiness, hopelessness
• Putting personal affairs in order
• Giving away any prized possessions

27
Q.P.R.Question

• Sudden interest or disinterest in religion
• Drug or alcohol abuse, or relapse after a period
  of recovery
• Unexplained anger, aggression, and irritability

28
Q.P.R.Question

• Indirect or Coded Verbal Cues
• Im tired of my life. I just cant go on.
• My family would be better off without me.
• Who cares if Im dead anyway.
• I just want out.
• I wont be around much longer.

29
Q.P.R.Question

• Situational Cues
• Recently being expelled from school
• Recent or upcoming unwanted move
• Loss of any major relationship
• Death of a close friend or relative-especially if
  by suicide
• Diagnosis of serious or terminal illness

30
Q.P.R.-Tips for Asking the Suicide Question

• If in doubt, dont wait, ask the question
• Be persistent
• Talk to the child in a private setting
• Allow the child to talk freely
• Give yourself plenty of time
• Have resources handy
• REMBMER How you ask the question is less
  important than that you ask it

31
Q.P.R.-Asking the Suicide Question

• Less Direct Approach
• Have you been feeling unhappy lately?
• Do you ever wish you could go to sleep and never
  wake up?

32
Q.P.R.-Asking the Suicide Question

• Direct Approach
• Are you thinking about harming/hurting
  yourself?
• You look pretty upset. Im wondering if youre
  thinking about suicide?
• NOTE If you cant ask the question, find someone
  who can!!

33
Q.P.R.-Persuade

• How to Persuade Someone to Stay Alive
• Listen to the problem and give them your full
  attention
• Do not rush to judgment
• Offer hope in any form
• Suicide is not the problem-just the solution to a
  perceived insolvable problem

34
Q.P.R.-Persuade

• Persuade, Then Ask
• Will you go with me to get help?
• Will you let me help you get help?
• Will you promise me not to kill yourself until
  weve found some help?
• YOUR WILLINGNESS TO LISTEN AND TO HELP CAN
  REKINDLE HOPE AND MAKE ALL THE DIFFERENCE!!!

35
Q.P.R.-Refer

• Best referral involves taking the child directly
  to someone who can help
• Second best referral is to get a commitment from
  them to accept help and then make the
  arrangements to get that help
• Third best referral is to give referral
  information and get a commitment that the
  individual will not attempt suicide

36
For Effective Q.P.R.

• Say, I want you to live or Im on your
  sidewell get through this.
• Get others involved-family, friends, siblings,
  pastors, physicians
• Join a team (school wide crisis team district
  wide crisis team, etc.)
• Follow-up with a visit or phone call, whatever
  feels comfortable to you, to let them know you
  care about what happens to them

37
A Final Thought.

• When you apply Q.P.R. you plant the seeds of
  HOPE. Hope helps prevent suicide.

38
Critical Incident Stress Management (C.I.S.M.)

• Reduce the risk of acute and intense
  psychological crises or trauma
• Stabilize and reduce the immediate severity or a
  crisis or traumatic event
• Facilitate recovery and restoration from a crisis
  or traumatic episode

39
C.I.S.M.

• Crisis Management Briefing
• -45-75 Minutes
• -Designed for large groups (up to 300)
• Defusing
• -Shortened version of debriefing
• -20-45 Minutes
• -Small groups
• -3 Stages
• Debriefing
• -Small groups
• -1 ½ -3 hours
• 7 Stages

40
C.I.S.M. with Children

• Children Below Age 6
• Structured process is limited
• Children should be brought together in their
  natural groups so a familiar person such as their
  teacher can provide them with general
  information, reassurance, guidance, and emotional
  support
• Use age-appropriate language
• Keep session brief
• Other options drawings, dolls, or one-on-one
  support from trusted adults

41
C.I.S.M. with Children

• Children Ages 6-10
• Can use process but needs to be modified
• Dont force children to speak
• Be interactive with children
• Some young children will move towards group
  leaders because they are frightened and need hugs
  and reassurance. Provide appropriate support
• Efforts should be made to bring a quiet child
  into the discussion
• Use a more active role in exploring emotions
• Encourage outside contacts and supports (Parents)
• Children who are withdrawn or show significant
  distress should be seen immediately

42
C.I.S.M. with Children

• Children 13 and Older
• Use C.I.S.M. process to identify those young
  people most likely to need additional help
• Emphasize information
• Guidance
• Practical strategies

43
C.I.S.M.Crisis Management Briefing

• An intervention technique designed for use with
  large groups
• 45-75 Minutes in length
• Goals
• Provide Information
• Rumor Control
• Reduce sense of chaos
• Provide coping resources
• Facilitate follow-up
• Assess further needs of group

44
C.I.S.M.Crisis Management Briefing

• Process
• Assemble participants
• Provide facts regarding crisis
• Discuss and normalize common behavioral/
  psychological reactions
• Discuss personal and community stress management
• Direct towards further resources

45
C.I.S.M.Defusing

• Small group crisis intervention
• 20-45 minutes in length
• Within 1-8 hours of event
• 3 Stages
• Introduction- Introduce intervention team
  members, explain process, set expectations
• Exploration- Discuss traumatic experience via
  participants disclosure of facts, cognition, and
  emotional reactions. Discuss symptoms of distress
  related to the traumatic event
• Information- Cognitively normalize and educate
  with regard to stress, stress management, and
  trauma

46
C.I.S.M.Debriefing

• Small group crisis intervention
• 1-1 1/2 hours in length
• 1 days after event
• 7 Sages Introduction, Fact, Thought, Reaction,
  Symptom, Teaching, Re-entry

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C.I.S.M.Debriefing-Stages

• Introduction Introduce intervention team
  members, explain process, expectations
• Fact Describe traumatic event from each persons
  perspective on a cognitive level
• Thought Allow participants to describe cognitive
  reactions and to transition to emotional
  reactions
• Reaction Identify the most traumatic aspect of
  the event for the participants and identify
  emotional reactions
• Symptom Identify personal symptoms of distress
  and transition back to cognitive level
• Teaching Educate regarding normal reactions and
  adaptive coping mechanisms for stress management
• Re-entry Clarify ambiguities, facilitate
  psychological closure

48
Suicide Prevention

• Isnt it time you started a suicide prevention
  program at your school?

49
Resources

• Signs of Suicide Program (S.O.S.)
• www.mentalhealthscreening.org
• Question, Persuade, Refer (Q.P.R.)
• www.qprinstitute.com
• Critical Incident Stress Management (C.I.S.M.)
• www.icisf.org