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Screening for Mental Health Needs

Screening for Mental Health Needs. Hope M. Siler, MSW, LSW ASPEN Project Regional Director. www.wvaspen.com. OBJECTIVES. Participants will be introduced to SAMHSA’s “Preventing Suicide: A High School Toolkit” Participants will learn the significance of suicide as a public health concern

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Screening for Mental Health Needs

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  1. Screening for Mental Health Needs Hope M. Siler, MSW, LSW ASPEN Project Regional Director www.wvaspen.com

  2. OBJECTIVES • Participants will be introduced to SAMHSA’s “Preventing Suicide: A High School Toolkit” • Participants will learn the significance of suicide as a public health concern • Participants will learn to utilize tools for screening for mental health (PHQ-9, ASAP-20) www.wvaspen.com www.wvaspen.com

  3. Preventing Suicide:A Toolkit for High Schools This tool will help schools and communities: • Assess their ability to prevent suicide among students and respond to suicides that may occur • Understand strategies that can help students who are at risk for suicide • Understand how to respond to the suicide of a student or other member of the school community www.wvaspen.com www.wvaspen.com

  4. Preventing Suicide:A Toolkit for High Schools • Identify suicide prevention programs and activities that are effective for individual schools and respond to the needs and cultures of each school’s students • Integrate suicide prevention into activities that fulfill other aspects of the school’s mission, such as preventing the abuse of alcohol and other drugs. www.wvaspen.com www.wvaspen.com

  5. Why Suicide Prevention in Schools? Many high school students reported that they had seriously considered suicide in the past year CDC, 2010a www.wvaspen.com www.wvaspen.com

  6. Why Suicide Prevention in Schools? Suicide is the third leading cause of death among teenagers in the United States CDC, 2009 www.wvaspen.com www.wvaspen.com

  7. Why Suicide Prevention in Schools? One out of every 53 high school students (1.9 percent) reported having made a suicide attempt that was serious enough to be treated by a doctor or a nurse CDC, 2010a www.wvaspen.com www.wvaspen.com

  8. Why Suicide Prevention in Schools? • Maintaining a safe school environment is part of a school’s overall mission. • Many activities designed to prevent violence, bullying, and the abuse of alcohol and other drugs can also reduce suicide risk among students (Epstein & Spirito, 2009). • Programs that improve school climate and promote connectedness help reduce risk of suicide, violence, bullying, and substance abuse (Resnick et al., 1997; Blum, McNeely, & Rinehart, 2002). www.wvaspen.com www.wvaspen.com

  9. Why Suicide Prevention in Schools? • Maintaining a safe school environment is part of a school’s overall mission. • Efforts to promote safe schools and adult caring also help protect against suicidal ideation and suicide attempts among LGB youth (Eisenberg & Resnick, 2006). • Some activities designed to prevent suicide and promote student mental health can reinforce the benefits of other student wellness programs. www.wvaspen.com www.wvaspen.com

  10. Why Suicide Prevention in Schools? 1. Maintaining a safe school environment is part of a school’s overall mission. 2. Students’ mental health can affect their academic performance. • 1 out of 5 high school students receiving grades of mostly D’s and F’s attempted www.wvaspen.com www.wvaspen.com

  11. Why Suicide Prevention in Schools? 1. Maintaining a safe school environment is part of a school’s overall mission. 2. Students’ mental health can affect their academic performance. 3. A student suicide can significantly impact other students and the entire school community. • Knowing what to do following a suicide is critical to helping students cope with the loss and prevent additional tragedies that may occur. • Adolescents can be susceptible to suicide contagion www.wvaspen.com www.wvaspen.com

  12. Why Suicide Prevention in Schools? 1. Maintaining a safe school environment is part of a school’s overall mission. 2. Students’ mental health can affect their academic performance. 3. A student suicide can significantly impact other students and the entire school community. 4. Schools have been sued for negligence for the following reasons • Failure to notify parents if their child appears to be suicidal • Failure to get assistance for a student at risk of suicide • Failure to adequately supervise a student at risk www.wvaspen.com (Doan, Roggenbaum, & Lazear, 2003; Juhnke, Granello, & Granello, 2011; Lieberman, 2008–2009; Lieberman, Poland, & Cowan, 2006) www.wvaspen.com

  13. How Schools Can Prevent Suicides • Protocols for helping students at risk of suicide www.wvaspen.com www.wvaspen.com

  14. How Schools Can Prevent Suicides • Protocols for helping students at risk of suicide • Protocols for responding to suicide death www.wvaspen.com www.wvaspen.com

  15. How Schools Can Prevent Suicides • Protocols for helping students at risk of suicide • Protocols for responding to suicide death • Staff education training www.wvaspen.com www.wvaspen.com

  16. How Schools Can Prevent Suicides • Protocols for helping students at risk of suicide • Protocols for responding to suicide death • Staff education training • Parent education www.wvaspen.com www.wvaspen.com

  17. How Schools Can Prevent Suicides • Protocols for helping students at risk of suicide • Protocols for responding to suicide death • Staff education training • Parent education • Student education www.wvaspen.com www.wvaspen.com

  18. How Schools Can Prevent Suicides • Protocols for helping students at risk of suicide • Protocols for responding to suicide death • Staff education training • Parent education • Student education • Screening www.wvaspen.com www.wvaspen.com

  19. Chapter 1GETTING STARTED The two essential components that every school should have in place are: • Protocols for helping students at possible risk of suicide (PREVENTION) • Protocols for responding to a suicide death (POSTVENTION) www.wvaspen.com www.wvaspen.com

  20. Chapter 1GETTING STARTED Step 1. Engage administrators, school boards, and other key players. • Explain why it is important to address suicide risk among students. • Highlight data and information specific to your district, State, or tribe. • Share your plans. www.wvaspen.com www.wvaspen.com

  21. SCHOOL STAFF RESPONSIBILITIES Superintendent *Curriculum director *Principal Assistant principal* Teachers *Technology staffHealth educator*Athletic staff *School nurse School health coordinator*school counselor Guidance counselor*School social worker Student assistance program staff*pupil services School psychologist*Special education staff Members of the Crisis Response *school resource officer School-based health centerand/ormental health center staff www.wvaspen.com www.wvaspen.com

  22. Chapter 1GETTING STARTED Step 2. Bring people together to start the planning process. • Engage school staff. • Engage community partners www.wvaspen.com www.wvaspen.com

  23. Chapter 1GETTING STARTED COMMUNITY PARTNERS Community Youth Center * Cultural Communities Leaders Mental health providers * Community mental health agencies Substance abuse counselors * Crisis center workers Healthcare providers * Community health department staff Hospital, ER staff * EMT’s * Fire & Rescue personnel First responders * Coroner Police * Clergy * County social services staff Child welfare providers * Juvenile justice professionals Media representatives * Immigrant & Refugee organization staff LGBT youth–serving program staff * YMCA * Boys & Girls Club www.wvaspen.com www.wvaspen.com

  24. Chapter 1GETTING STARTED Step 3. Provide key players with basic information about youth suicide and suicide prevention. www.wvaspen.com www.wvaspen.com

  25. RISK FACTORS • Behavioral Health Issues/Disorders • Personal Characteristics • Adverse/Stressful Life Circumstances • Risky Behaviors • Family Characteristics • Environmental Factors www.wvaspen.com www.wvaspen.com

  26. RISK FACTORS • Behavioral Health Issues/Disorders • Depressive disorders • Substance abuse or dependence • Conduct/disruptive behavior disorders • Other disorders (anxiety, personality, etc.) • Previous suicide attempts • Self-injury (without intent to die) • Genetic/biological vulnerability www.wvaspen.com www.wvaspen.com

  27. RISK FACTORS • Personal Characteristics • Hopelessness • Low self-esteem • Loneliness • Social alienation and isolation, lack of belonging • Low stress and frustration tolerance • Impulsivity • Risk-taking, recklessness • Poor problem-solving or coping skills • Perception of self as very underweight or very overweight • Capacity to self-injure • Perception of being a burden www.wvaspen.com www.wvaspen.com

  28. RISK FACTORS • Adverse/Stressful Life Circumstances • Interpersonal difficulties or losses • Disciplinary or legal problems • Bullying, either as victim or perpetrator • School problems • Physical, sexual, and/or psychological abuse • Chronic physical illness or disability • Exposure to suicide of peer www.wvaspen.com www.wvaspen.com

  29. RISK FACTORS • Risky Behaviors • Alcohol or drug use • Delinquency • Aggressive/violent behavior • Risky sexual behavior www.wvaspen.com www.wvaspen.com

  30. RISK FACTORS • Family Characteristics • Family history of suicide or suicidal behavior • Parental mental health problems • Parental divorce • Death of parent or other relative • Problems in parent-child relationship www.wvaspen.com www.wvaspen.com

  31. RISK FACTORS • Environmental Factors • Negative social and emotional environment • Lack of acceptance of differences • Expression and acts of hostility • Lack of respect for the cultures of all students • Limitations in school physical environment • Weapons on campus • Poorly lit areas conducive to bullying and violence • Limited access to mental health care • Access to lethal means, particularly at home • Exposure to other suicides, leading to suicide contagion • Exposure to stigma and discrimination www.wvaspen.com www.wvaspen.com

  32. PROTECTIVE FACTORS • Individual Characteristics and Behaviors • Family and Other Social Support • School • Mental Health and Healthcare Providers and Caregivers • Access to Means www.wvaspen.com www.wvaspen.com

  33. WALL OF RESISTANCE www.wvaspen.com There is HOPE. Ask for HELP. Choose LIFE. Suicide Prevention Lifeline 1-800-273-TALK (8255)

  34. WARNING SIGNS“IS PATH WARM” • I…ideation • S…substance abuse • P…purposelessness • A…anxiety • T…trapped • H…hopelessness • W…withdrawal • A…anger • R…recklessness • M…mood changes (sudden, positive or negative) www.wvaspen.com www.wvaspen.com

  35. Suicide Crisis Episode Years Days Hours Days Years Risk Imminent Crisis Peaks www.wvaspen.com There is HOPE. Ask for HELP. Choose LIFE. Suicide Prevention Lifeline 1-800-273-TALK (8255) Crisis Begins Risk Level Crisis Diminishes Hazard Encountered Stable Stable Plus or minus three weeks

  36. The Many Paths to Suicide Cause of Death Fundamental Risk Acute Risk Poison Biological www.wvaspen.com There is HOPE. Ask for HELP. Choose LIFE. Suicide Prevention Lifeline 1-800-273-TALK (8255) Firearm Increased hopelessness serious contemplation Personal/Psychological WALL OF RESISTANCE Hanging Jumping Environmental Autocide

  37. Stopping the chain reaction anywhere = PREVENTION www.wvaspen.com

  38. NATIONAL DATAAges 13-19 • 2009, 1,852 young people died by suicide • Suicide is the 3rd leading cause of death • For every completed suicide death, there is 100-200 attempts (1 every 60 seconds) • For every suicide death, there is at least 6 survivors left behind www.wvaspen.com www.wvaspen.com

  39. NATIONAL DATAYRBS Report • 1/53 high school students reported having made a suicide attempt that was serious enough to be treated by a doctor or nurse • 1/16 high school students reported having attempted suicide at lease once. • 1/9 had made a plan about how to attempt suicide • 1/7 reported having seriously considered attempting suicide during the preceding 12 months www.wvaspen.com www.wvaspen.com

  40. There is HOPE. Ask for HELP. Choose LIFE. West Virginia Data15-24 Years 2000-2009 www.wvaspen.com Suicide Prevention Lifeline 1-800-273-TALK (8255)

  41. Suicide: A PREVENTABLE DEATH IN OUR STATE West Virginia Suicides by county Ages 15-24 2000-2009 Rate per 100,000 Population Hancock 4 (12.26) Brooke 4 (12.56) Ohio WV Average Rate 13.2/100,000 320 Deaths by Suicide 7 (10.81)) Marshall 12 (29.79) Morgan Monongalia Wetzel 3 (15.30) www.wvaspen.com There is HOPE. Ask for HELP. Choose LIFE. Suicide Prevention Lifeline 1-800-273-TALK (8255) 10 (3.97) 3 (18.15) Tyler Marion Preston Berkeley 5 (46.92) 11 (12.38) 6 (16.39) 11 (9.89) Pleasants Mineral Jefferson 0 (0.00) Harrison Taylor Hampshire Dodd- 13 (15.36) 7 (20.00)) 6 (9.75) ridge 5 (26.13) 2 (7.78) Wood Ritchie 1 (9.88) 10 (9.68) Grant 4 (34.13)) Barbour Tucker 1 (13.19) 2 (16.07) Hardy 4 (19.02) Wirt Lewis 3 (20.28) 1 (13.66) Gilmer Cal- 2 (10.22) houn 2 (12.97) Upshur Randolph Jackson 2 (22.25) 4 (10.52) 3 (8.30) Mason 3 (9.01) 3 (10.07) Roane Braxton Pendleton 1 (5.34) 2 (11.34) 0 (0.00) 18.15 – 46.92 Putnam Webster 10 (16.14) Clay Cabell 3 (26.51) 4 (30.34) 12.26 – 16.39 18 (10.32) Kanawha Nicholas Pocahontas 47 (20.96)) Lincoln 5 (15.89) 2 (20.60) 10.07 – 11.34 Wayne 4 (14.53) 5 (9.63) Boone Fayette 2 (6.79) 0.00 – 9.89 Greenbrier 16 (27.19) Logan 8 (20.23)) 9 (20.92) Raleigh Mingo 10 (10.55) Wyoming Summers Monroe 3 (8.81) 1 (3.47) 2 (13.69) 0 (0.00) Mercer McDowell 12 (160.5) 2 (6.68)

  42. Chapter 1 GETTING STARTED Step 4: Develop your overall strategy. • Assess your current policies, programs and school culture www.wvaspen.com www.wvaspen.com

  43. No one is safe from the risk of suicide – wealth, education, intact family, or popularity cannot protect us from this risk www.wvaspen.com www.wvaspen.com

  44. Chapter 2PROTOCOLS FOR HELPING STUDENTS AT RISK FOR SUICIDE WHY IS IT IMPORTANT TO BE PREPARED TO HELP STUDENTS AT RISK OF SUICIDE? www.wvaspen.com www.wvaspen.com

  45. Chapter 2PROTOCOLS FOR HELPING STUDENTS AT RISK FOR SUICIDE Why is it important to be prepared…? • Maintain a safe and secure school environment • Promote the behavioral health of students, which enhances their academic performance • Avoid liability related to suicides or suicide attempts by students www.wvaspen.com www.wvaspen.com

  46. Chapter 2PROTOCOLS FOR HELPING STUDENTS AT RISK FOR SUICIDE • Suicide risk resources • Self-injury and suicide risk information • Guidelines for notifying parents • Parent contact acknowledgement form • Guidelines for student referrals • Student suicide risk documentation form • Protocol for responding to a student suicide attempt • Guidelines for facilitating a student’s return to school www.wvaspen.com www.wvaspen.com

  47. Chapter 3AFTER A SUICIDE • Immediate response protocol • Sample script for office staff • Sources of postvention consultation • Guidelines for working with the family • Guidelines for notifying staff • Sample announcements • Sample letter to families • Talking points for students and staff after a suicide • Guidelines for Memorialization • Guidelines for working with the media • Long-term response protocol • Guidelines for anniversaries of a death www.wvaspen.com www.wvaspen.com

  48. Chapter 3AFTER A SUCIDE • Key Terms: • Survivor: a person who has experienced the suicide of a family member, friend, or colleague • Attempt survivor: a person who attempts suicide but does not die • Postvention: refers to programs and interventions for survivors following a death by suicide • Suicide contagion: is “a process by which the suicide or suicidal behavior of one or more persons influences others to commit or attempt suicide” (Davidson and Gould, 1989) www.wvaspen.com www.wvaspen.com

  49. Chapter 4STAFF EDUCATION & TRAINING • All staff should be… • Aware of risk of suicide • Aware that the school is taking steps to reduce suicide risks • Trained to recognize the warning signs • Able to take action if they become aware of a student who displays suicide warning signs www.wvaspen.com www.wvaspen.com

  50. Chapter 4STAFF EDUCATION & TRAINING • NREPP (National Registry for Evidenced-Based Prevention Practices) Gatekeeper Trainings: • Lifelines • BPR (Best Practice Registry) Gatekeeper Trainings: • QPR (Question, Persuade, Refer) • More Thank Sad • safeTALK • ASIST www.wvaspen.com www.wvaspen.com

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