YOUTH SUICIDE PREVENTION SCHOOL-BASED GUIDE

1. YOUTH SUICIDE PREVENTIONSCHOOL-BASED GUIDE Guidance Counselor’s Meeting Student Support Services http://theguide.fmhi.usf.edu/

2. Overview • Identifies elements of a comprehensive, school based suicide prevention program • Examines scientific literature to determine elements that are the most effective. • Contains Checklists and Self Assessment • Guide for Administrators for program implementation • Reviewed by experts

3. Statistics • Suicide accounts for 13% of all adolescent deaths • Third overall cause of adolescent deaths • Increased in children from age 10-14 100% 1980-1996 • Estimated 3,500 adolescents attempt suicide daily

4. Statistics Continued • 35 die daily • More teenagers die from suicide then cancer, AIDS, birth defects, stroke, pneumonia, influenza, and chronic lung disease combined. • 1980-1985 rate for African American Youth increased 230% • 90% that die have mental health problem: depression, substance abuse

5. Reality of Suicide Unexpected death is always painful, but perhaps none more then self-destruction of a young person and a life, with all of its potential and promise, cut short by one desperate and too final act.

6. Why School Based Prevention • School can offer prevention, intervention and education. • In schools suicide issues may be evident more so then in other settings. • Issues may occur with the greatest frequency. • Schools offer a large exposure (teachers, counselors, peers) to youth.

7. Public Health Approach • Positive role schools can play. • Example of disease programs (inoculations, TB, Small Pox) • Up to date, accurate, research based information, guidelines and tools. • Reviews literature, evlauates and draws conclusions

8. Public Health Approach • Identifies the problem • Identifies risk factors • Indentifies causes of the problem • Develops interventions evaluated for effectiveness

9. OVERVIEW AREAS • Information Dissemination • School Climate • Risk Factors: Risk and Protective Factors, Early Warning Signs. • Risk Factors: How can a school Identify a Student At Risk for Suicide?

10. Overview Areas Continued • Administrative Issues • Suicide Prevention Guidelines • Intervention Strategies: Establishing a Community Response • Intervention Strategies: Crisis Intervention Teams

11. Overview Continued • Intervention Teams: Responding to Student Crisis • Preparing for and responding to death by suicide: Steps to Responding. • Preparing for and responding to death by suicide: Responding to and working with the media. • Family Partnerships • Culturally and linguistically Diverse Populations

12. Information Dissemination in the Schools • Suicide third leading cause of death in adolescents • School based programs have ideal exposure to large number of adolescents. • Should be facilitated by staff that are knowledgeable in the area. • Research suggest teachers may feel they are not prepared to assess or address suicide issues.

13. Information Dissemination in the Schools • Training faculty and staff essential in effective prevention programs. • Skills to develop knowledge, attitudes, and identification for appropriate referrals. • Essential to train administrators and parents for support of prevention efforts. • Brief two hour training is effective in increasing teacher’ awareness of adolescent suicide.

14. MYTHS Talking about suicide in the classroom will promote suicidal ideas and suicidal behavior.

15. MYTHS Parents are often aware of the child’s suicidal behavior.

16. MYTHS Most adolescents who attempt suicide fully intend to die.

17. MYTHS There is not a significant difference between male and female adolescents regarding suicidal behavior.

18. MYTHS The most common method for adolescent suicide ins drug overdose.

19. MYTHS Because female adolescents complete suicide at a lower rate than male adolescents, their attempts should not be taken seriously.

20. MYTH Suicide behavior is inherited.

21. MYTH Adolescent suicide occurs only among poor adolescents.

22. Myth The only one who can help a suicidal adolescent is a counselor or mental health professional.

23. SCHOOL CLIMATE • Connectedness • Participation • Academic Achievement • Safety • Training

24. SCHOOL CLIMATE • Discipline • Physical Environment • Security

25. Connectedness • Felt treated fairly, close to people at school, part of school. • Less likely to experience suicidal thoughts and emotional distress. • Less likely to drink alcohol, carry weapons, engage in delinquent behavior. • Foster afterschool activities, involvement in decision making and create small size learning groups.

26. Participation • Research: Students participate in decisions are healthier, more productive. • Assign students to meaningful school roles: monitor, classroom helpers, planning committees. • Example of Crime Stoppers. • Protective factor for “At Risk Students”

27. Academic Achievement • Set academic goals and supporting strategies. • Provide encouragement • May use media or other mechanism • Positive Behavioral Supports

28. SAFETY • Unsafe schools – Emotional and Physical Realms • Unsafe leads to poor academic performance and truancy. • Bullying • Relationship between bullying and emotional factors

29. SAFETY • Create ways for the student to feel comfortable to report potentially dangerous situation. • For example, list of adults they may contact if they feel unsafe or have knowledge of a potentially dangerous situation. • Ways for the staff to intervene in potentially dangerous situation. • For example, mental health, signs of distress in students, review of policies.

30. Training • Students should be taught skills training how to resolve conflict, problem solving, coping strategies (Life Skills). • Incorporate skills in existing classes i.e. health, drivers education, physical education. • Increasing social skills related to positive impact on cognitive development, academic achievement. • Curriculums need to be research based, active learning strategies, school wide and have adequate teaching resources.

31. Discipline • Method to teach appropriate social behaviors. • Positive and proactive • For example, positive behavioral supports. • Example of Bullying Intervention, Problem Solving Skills, Conflict Resolution, Appropriate Social Behaviors. • Avoid humiliating, harassing, scolding, nagging, physically aversive discipline, decreasing learning opportunities.

32. Physical Environment • Research suggests students attitude about the school may be related to the appearance of the school. • For example, flakey ceilings, graffiti tainted walls, scuffed up floors, dirty bathrooms, crumbling sidewalks, and leaky toilets: • May lead to “Why bother, no one cares” attitude. • Example, of Men’s Bathroom and breaking sink incident. • Negativism about the school may impact attitude towards teaching, learning, attendance and morale.

33. Security • Ensure the school is free from weapons. • Random search policy • Links to the community resources/partnerships (Guam Police Department, Customs -random sweeps, Child Protective Services) • Utilize parent support

34. Security Issues • Number and type of exits • Lighting • Rooms and furnishings, • Locker use • Parking • Positive posters: Behavioral Expectations • Patterns of supervision • Traffic patterns • Isolated areas

35. Security Issues • Location and design of bathrooms • Guardrails • Hallways • Closed campus • REGULAR SAFETY ASSESSMENTS

36. SAFE ENVIORNMENT • Staff in-service training • Established policies (bullying, random searches) • Opportunities to staff to share their concern • Emphasize positive relationships • System in place to refer students suspected abuse and neglect • Treat students with respect, support and care.

37. SAFETY ENVIORMENT • Monitor safety • Consistently enforce disciplinary, harrassment, and civil rights policies. • Inform students who they may contact if there is a safety issue. • Help students feel safe about approaching and adult

38. Safety Learning Environment • Address problem solving and social skills • Ensure high academic standards • Develop links to the communities. • Encourage and utilize parental involvement

39. Safety Environment • Educate students on tolerance, harassment, bullying, and respecting others. • Ensure physical environment • Policies and procedures on weapons and safety • Develop after school activities • Use positive pro-social approach that de-emphasizes punishment.

40. Risk and Protective Factors and Warning Signs • Suicide is an extremely complex phenomena • Nine out ten adolescents show clues to their attempts • No tangible all encompassing method to assess. • Focus on risk factors • Impacting risk factors such as treating depression or substance abuse, stressful life events may have positive effects.

41. RISK FACTORS • Previous suicide attempt or gesture • Feelings of hopeless or isolation • Psychopathology (depressive disorders/mood disorders) • Parental psychopathology • Substance abuse disorder • Family history of suicidal behavior • Life stressors: interpersonal losses, relationship, social, work, • Legal, disciplinary problems • Access to firearms

42. RISK FACTORS • Physical Abuse • Sexual Abuse • Conduct disorders or disruptive behaviors • Sexual orientation: homosexual, bisexual and transgendered youth. • Juvenile delinquency • School or work problems • Congtigation or imitation (exposure to media accounts or friends with suicidal behavior. • Chronic physical illness • Living alone or runaway • Aggressive-impulsive behaviors

43. PROTECTIVE FACTORS • Family cohesion (mutual involvement, shared interests, emotional support) • Good coping skills • Academic achievement • Perceived connectedness with school • Good relationships with school or other youth • Lack of means for suicidal behavior • Help seeking behavior • Impulse control

44. PROTECTIVE FACTORS • Problem solving/conflict resolution abilities • Social integration/opportunities to participate • Sense of worth/confidence • Stable environment • Access to care for mental/physical substance disorders • Responsibilities for others/pets • Religious activity (controversial topic currently)

45. EARLY WARNING SIGNS • Withdraw from friends of family • Preoccupation with death • Marked changes in personality • Difficulty concentrating • Difficulties in school (decline in quality of work) • Frequent physical complaints often related to emotions (stomach aches, headaches, fatigue • Persistent boredom • Loss of interest in things one cares about

46. LATE WARNING SIGNS • Actually talking about a suicide or plan • Exhibiting impulsivity: violent acts, rebellious behavior, running away. • Refusing help, feeling beyond help, • Complaining “being a bad person”, rotten inside. • Making statements of hopelessness, helplessness, worthlessness.

47. LATE WARNING SIGNS • Verbal hints: “I wont be a problem to you much longer” “Nothing matters”, “It is no use”, “I won’t see you again”. • Becoming suddenly cheerful after a period depression. (May mean student has made decision to escape all problems by ending their life). • Giving away favorite possessions • Making last will or testament • Saying: “I am going to kill myself”, “I wish I were dead”, I shouldn’t have been born”

48. How can school identify a student at risk for suicide? • Suicide Awareness Curriculum • Gatekeeper training • Screening

49. CURRICULIUM • Dose and length very important • Avoid: one shot sessions – may overwhelm students, reaction to stress, media dramatized • Long term programs – semester long • Incorporate into established classes: health, life skills problem solving skills, help seeking behaviors,

50. CURRICULIUM • Avoid presentations by youth who may have made previous attempts – may result in copy cat behavior. • Provide list of crisis intervention services • Have established policies and procedures on how to deal with suicidal adolescent • Introduce curriculum only after policy and protocol are established.