Crisis MANAGEMENT AND SUICIDE PREVENTION FOR CLINICIANS WORKING WITH EB/D STUDENTS

1. Crisis MANAGEMENT AND SUICIDE PREVENTION FOR CLINICIANS WORKING WITH EB/D STUDENTS (c) Dr. Sharron M. Singleton 2010

2. OBJECTIVES: • Identify the need for crisis management and suicide prevention services for public school systems • Provide a basic overview of crisis development and how it may manifest in the school setting • Provide basic attending and active listening skills that can be utilized in crisis management • Discuss suicide prevention and assessment strategies appropriate for public school use (c) Dr. Sharron M. Singleton 2010

3. THE SCHOOL AS A CONTEXT FOR CRISIS AND CRISIS management (c) Dr. Sharron M. Singleton 2010

4. THE BASICS ABOUT CRISIS and crisis development (c) Dr. Sharron M. Singleton 2010

5. Crisis refers to a sustained period of acute emotional upset arising from a person’s perception of events resulting in a temporary inability to cope by means of one’s usual problem solving devices (c) Dr. Sharron M. Singleton 2010

6. behaviors manifested by children in crisis • Academic problems • Altered states of consciousness • Anger/low frustration tolerance • Bully or bullied • Chemical and substance abuse • Criminal behavior • Delayed cognitive and affective development • Emotional lability/depression • External locus of control • History and threats of violence • Hypersensitivity • Impulsivity • Mental illness • Preoccupation with violent themes • Suicidal ideation (c) Dr. Sharron M. Singleton 2010

7. Impact on the learning environment • Creates: • Stress • Distractions • Hostile learning environment • Interferes with: • Ability to concentrate • Rhythm of teaching • Rhythm of learning

8. Common Properties • Precipitating event • Underlying factors or circumstances • Strong emotional reaction • Inability to cope • Defined by the person involved (c) Dr. Sharron M. Singleton 2010

9. Stages of Crisis Development Pre-crisis Post crisis Pre-crisis I Same Better Worse Pre-Crisis II Angle of resolution Angle of disorganization Active Crisis (c) Dr. Sharron M. Singleton 2010

10. The basics of CRISIS management/ INTERVENTION (c) Dr. Sharron M. Singleton 2010

11. Crisis Intervention/Management The immediate and timely intrusion into a person’s life at a time when the stress he or she is experiencing is too great to be handled and managed through the use of usual coping mechanisms (c) Dr. Sharron M. Singleton 2010

12. Purpose • Diffuse the emotional level of the child • Guide the child through resolving the problem (c) Dr. Sharron M. Singleton 2010

13. Crisis management… • Present oriented • Problem specific • Worker is a direct, active participant • Focus is on the return of the child to pre-crisis level of functioning (c) Dr. Sharron M. Singleton 2010

14. The a-b-c model (c) Dr. Sharron M. Singleton 2010

15. cquire rapport and information • Provide support • Build trust • Build a relationship • Collect information • Conduct Triage Assessment (c) Dr. Sharron M. Singleton 2010

16. Triage Assessment Model • Assumes that it is necessary to assess crisis in three domains: affective, cognitive, and behavioral • Assessment in the three domains helps to capture the complexity of the crisis and suggests how directive the intervention should be • Triage Assessment System for Students in Learning Environments (TASSLE) (c) Dr. Sharron M. Singleton 2010

17. Affective Domain Reactions • Anger/hostility • Anxiety/fear • Sadness/melancholy (c) Dr. Sharron M. Singleton 2010

18. Cognitive Domain Reactions • Perception of the event • Threat • Loss • Transgression (c) Dr. Sharron M. Singleton 2010

19. Behavioral Domain Reactions Immobility Avoidance Approach (c) Dr. Sharron M. Singleton 2010

20. oil down the emotions and problem or event • Make the time relationship connection • Identify the significance of the current appearance • Identify the precipitating event • Clarify the meaning of the event • Establish a working goal (c) Dr. Sharron M. Singleton 2010

21. oping skill development • Switch to a problem-solving focus • Utilize triage assessment score to guide work • Create options • Refer for service follow-up (c) Dr. Sharron M. Singleton 2010

22. Basic and Necessary Crisis management skills (c) Dr. Sharron M. Singleton 2010

23. Attending Skills • Eye contact • Posture • Physical distance • Facial expressions • Gestures • Setting • Position • Voice tone • Rate of speech • Movement • Level of energy (c) Dr. Sharron M. Singleton 2010

24. Active listening… (c) Dr. Sharron M. Singleton 2010

25. Emotion Labeling I hear sadness in your voice • Purpose is to establish trust & rapport and clarify the emotional status of the individual • Task is to respond to the emotions revealed, not the content (c) Dr. Sharron M. Singleton 2010

26. Paraphrasing So, what I hear you saying is that you are more ill than you first thought and that’s really scary… • Purpose is to clarify content, check perceptions, and provide feedback • Summarize in a concise form, the important content and emotions connected to the situation (c) Dr. Sharron M. Singleton 2010

27. Reflecting Things will never be the same? • Purpose is to clarify and obtain information when the person is only giving vague clues • Repeat, word-for-word, what the person just said, with a questioning inflection in your voice (c) Dr. Sharron M. Singleton 2010

28. Open-ended Questions What will never be the same? • Purpose is to collect information while reducing the feeling of being interrogated • Begin all questions with what, when who, where, or how; never why (c) Dr. Sharron M. Singleton 2010

29. Consensual Validation It’s okay to feel frightened. • Purpose is to build trust and rapport and validate the person’s right to have emotions • Task is to focus on feelings without justifying negative behavior (c) Dr. Sharron M. Singleton 2010

30. Effective Pause • Purpose is to provide time for thinking and to set limits • Task is to remain silent for an effective period of time (c) Dr. Sharron M. Singleton 2010

31. Minimum Encouragers So, I said to her, I said, you don’t really love me; … • Purpose is to encourage the person to continue talking without interrupting them • Task is to let them know you are listening Umm… (c) Dr. Sharron M. Singleton 2010

32. I Message I feel very uncomfortable when you talk this way because I know you really do want things to be better. • Purpose is to redirect an unproductive interaction • Task is to set limits in a non-threatening manner (c) Dr. Sharron M. Singleton 2010

33. SUICIDE among children and adolescents • Adolescent suicide is generally unexpected • Among 10 – 24 year olds • Homicide is the 2nd leading cause of death • Suicide is the 3rd leading cause of death • The survivors are left with guilt, anger, and a sense of unfinished business with the deceased (c) Dr. Sharron M. Singleton 2010

34. Suicide A situation in which an individual engages in behaviors for the intended purpose of ending his or her life (c) Dr. S. M. Singleton, 2010

35. Types of Suicide • Intentional suicide • Chronic suicide • Neglect suicide • Sub-intentional suicide • Accidental suicide • Victim precipitated homicide (c) Dr. S. M. Singleton, 2010

36. Why Children Commit Suicide • Feelings of hopelessness and helplessness • Magical thinking • Psychache • Certain situations • Sudden loss • Lack of social supports • Sudden changes in life patterns • Chronic physical or mental illness • Unfulfilled expectations (self/others) • Unexpressed anger (c) Dr. S. M. Singleton, 2010

37. Characteristics of Suicidal Intent • Direct expression of deep feelings of hopelessness and helplessness • Provision of clues • Indirect verbal clues are expressions that contain hints about suicidal plans • Behavioral clues are hints that we get through discussions of recent behavior • Situational clues are clues inherent in the person’s situation that they reveal in discussion. • Syndromatic clues are a constellation of psychological factors that, in combination may indicate a risk for suicide. (c) Dr. S. M. Singleton, 2010

38. Suicide Intervention Procedure (c) Dr. S. M. Singleton, 2010

39. Strategies and suggestions • Trust your suspicions that the young person may be self destructive • Tell the child that you are worried about him/her; then listen with a nonjudgmental and supportive attitude • Ask direct questions • Don’t act shocked or debate whether suicide is right or wrong • Don’t promise to keep the intentions a secret • Don’t’ leave the child alone if you think the suicide is immediate • Don’t be embarrassed or reticent about getting help • Ensure that the child is safe and that the appropriate adults responsible for the child are notified • Assure the child that something is being done and that their feelings are not being discounted • Assume an active and authoritarian role as needed to protect the child at risk • Actively acknowledge the reality of suicide as a choice but do not “normalize” suicide as a good choice (c) Dr. S. M. Singleton, 2010

40. RESOURCES • Allen, M., Burk, K., Bryan, E., Carter, D., Orsi, R., & Durkan, L. (2002). School counselors’ preparation for and participation in crisis intervention. Professional School Counseling, 6(2), 96-102. • Bridge, S., Hanssens, L., & Santhanam, R. (2007). Dealing with suicidal thoughts in schools: Information and education directed at secondary schools. Australasian Psychiatry, 15(supplement), s58-s62. • Brock, S. E., Sandoval, J., & Lewis, S. (2001). Preparing for crises in the schools: A manual for building school crisis response teams. New York: John Whiley & Sons. • Couvillon, M., Peterson, R. L., Ryan, J. B., Scheuermann, B., & Stegall, J. (2010). Teaching Exceptional Children, 42(5), 6-17 • Klicker, R. L. (2000). A student dies, a school mourns: Dealing with death and loss in the school community. Philadelphia: Accelerated Development. • Suicide assessment and treatment. • Knox, K. S. & Roberts, A. R. (2005). Crisis intervention and crisis team models in schools. Social Work, 27(2), 93-100. • Sandoval, J. (Ed.). (2002). Handbook of crisis counseling, intervention, and prevention in the schools. Mahwah, NJ: Lawrence Erlbaum. (c) Dr. Sharron M. Singleton 2010