Maryland Youth Risk Behavior Survey YRBS

1. Maryland Youth Risk Behavior Survey (YRBS) Brian J. Bartels, Specialist, School Psychology Maryland State Department of Education Student Services and Alternative Programs Branch

2. Outcomes: At the end of today’s presentation, participants will: Be aware of the Maryland YRBS Be knowledgeable about the incidence of youth suicide in Maryland Be familiar with basic components of the Maryland Youth Suicide Prevention School Program

3. Maryland YRBS - Summary A surveillance system developed by the CDC in 1990. Maryland is mandated to participate; first Maryland survey was implemented in 2005. Survey administered to high school students (gr. 9-12). Survey requires active parental consent. Increases awareness about high school students health and well-being.

4. Priority Youth Risk Behaviors Report covers seven areas of concern: Traffic Safety Personal Safety Tobacco Use Alcohol and Other Drug Use Suicide Diet, Nutrition, and Physical Activity Protective Factors

5. Defining Suicide Suicidal behavior includes: Suicidal ideation Attempts Completions

6. Incidence of Youth Suicide According to the U.S. Centers For Disease Control And Prevention (CDC), Suicide continues to be the third leading cause of death among youth in the United States and in Maryland.

7. Incidence of Youth Suicide Nationally, more children and adolescents die annually from suicide than from cancer, heart disease, AIDS, birth defects, and other medical conditions combined.

8. 2005 Maryland Youth Risk Behavior Survey Increasing percentage of Maryland high school students report: Experienced persistent sadness or hopelessness (29.7%) Seriously considered suicide (17.4%) They planned a suicide attempt (12.2%)

9. 2005 Maryland Youth Risk Behavior Survey Approximately 1 in 10 (9.3%) Maryland high school students attempted suicide in the previous 12 months. At this rate, Maryland students are comparable to high school students nationwide.

10. Incidence of Youth Suicide in Maryland During 2004, Maryland lost a total of 86 youth due to suicide.

11. Maryland Youth Suicide Deaths 2004, 2005 & 2006Source: Maryland Violent Death Reporting System (MVDRS)

12. Source: Maryland Violent Death Reporting System (MVDRS)

13. 2005 Maryland Youth Risk Behavior Survey Suicide attempts requiring medical treatment are infrequent for high school students in both the Maryland and the national YRBS samples (2.7 vs. 2.3 percent, respectively). There is no significant difference between genders or between grades in the incidence of suicide attempts that require medical attention.

14. Youth Suicide and Attempted Suicide (Ages 0 – 18) in Maryland, 2003-2005Source: Partnership for a Safer Maryland (May 2, 2006)

15. 2005 Maryland Youth Risk Behavior Survey Depression is the most common form of mental illness and is estimated to be involved in about two-thirds of all suicides.

16. 2005 Maryland Youth Risk Behavior Survey According to the YRBS, more than one-quarter of all Maryland high school students reported experiencing sustained periods of sadness or hopelessness over a 2-week period during the past 12 months (29.7 percent). This rate of incidence is comparable to the rate nationwide (28.5 percent).

17. 2005 Maryland Youth Risk Behavior Survey The survey reveals that female high school students are at a significantly greater risk of suicidal behavior than their male counterparts.

18. Youth Suicide Prevention School Program The Annotated Code of Maryland, Educational Article ?§ 7-503 establishes a statewide Youth Suicide Prevention School Program.

19. Youth Suicide Prevention School Program Prevention Intervention Postvention

20. Prevention Coordinated services and activities that help identify students who are “at-risk” for suicide

21. Prevention It is estimated that 4 of 5 suicide victims demonstrated identifiable warning signs before completing suicide. School personnel need to be knowledgeable about warning signs of youth suicide and potential triggers.

22. Warning Signs Current suicidal ideation, intent, and plan Verbal and written statements about suicide, death and dying Dramatic changes in behavior or personality Symptoms of depression Preoccupation with death and suicide themes Giving away prized possessions Increased use of alcohol or drugs Triggers Getting into trouble with authorities Death by suicide of a loved one or significant person Breakup with a boyfriend or girlfriend Academic crisis or school failure Death or loss of a loved one or significant person Bullying/victimization Youth Suicide

23. Prevention Maryland’s Voluntary State Curriculum (VSC) defines what students should know and be able to do at each grade level. The VSC content area of Health Education addresses Mental and Emotional Health (Standard 1.0).

24. Prevention Facts to Consider Most suicidal youth confide concerns more often to peers than adults. As few as 25% of peer confidants tell an adult about their troubled or suicidal peer. Reluctance to tell a helpful adult considered a risk factor. Contact with helpful adults may be considered a protective factor for a variety of troubled youth.

25. Intervention Those coordinated services and activities that are directed toward all students, but especially those students who are identified as “at-risk” for suicide, to interfere with the chain of events that may lead to suicide.

26. Intervention Suicide intervention guidelines for schools Detect warning signs of suicide. Identify suicidal student. Supervise the student. Remove access to methods. Inform appropriate staff member immediately. Notify the student’s parents. Assess and respond to student’s level of risk. Refer for community services & plan follow-up.

27. Intervention Many researchers contend that direct assessment of students is essential. Risk of suicidal behavior is a function of intent and lethality. Students with a high level of intent who use methods of high lethality (e.g., firearms) present the greatest risk.

28. Intervention Always contact the parent/guardian when a school personnel suspect student may be suicidal. “School counselors have a duty to use reasonable means to attempt to prevent a suicide when they are on notice of a child’s or adolescent’s suicidal intent.” (Eisel v. Board of Education 1997)

29. Postvention Postvention refers to the provision of systematic crisis intervention, support, and assistance for those affected by a completed suicide. Postvention provides appropriate emotional support and information to those affected by suicide. Postvention strategies are designed to minimize contagion.

30. Postvention Suicide postvention guidelines for schools Train the crisis team about youth suicide response. Disseminate accurate information to faculty, students, and parents. Report information to students in small groups (classrooms) and use uniform statements. Do not release information about a completed suicide in either a large assembly or over intercom systems. Provide counseling services for students. Provide counseling and/or discussion opportunities for the faculty.

31. References American Association of Suicidology (1999). Guidelines for School Based Suicide Prevention Programs (pp. 1 to 16). Maryland Youth Risk Behavior Survey (2005). Maryland State Department of Education. Baltimore, MD. http://www.marylandpublicschools.org/nr/rdonlyres/707b5fb5-9a0c-4a06-a741-92d16dc7b2e7/11688/2005yrbspowerpointpresentation.pdf Miller, D., & Lieberman, R. (2006). School Crisis Prevention and Intervention: Suicide . Presentation at Annual Conference of National Association of School Psychologists, New York City. Voluntary State Curriculum (2007). Maryland State Department of Education. Baltimore, MD. http://mdk12.org/instruction/curriculum/health/index.html

32. For More Information Brian Bartels, School Psychology Specialist, MSDE email bbartels@msde.state.md.us Richard Scott, Student Services Specialist, MSDE email rscott@msde.state.md.us

33. For Additional Information www.marylandpublicschools.org Or http://www.marylandpublicschools.org/MSDE/divisions/studentschoolsvcs/student_services_alt/suicide/