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Comprehensive Suicide Prevention in Schools

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adam lesser

on 9 July 2014

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Transcript of Comprehensive Suicide Prevention in Schools

Shining the light on the issue
Comprehensive Suicide Prevention in Schools
What is the scope of the problem?

What can we do about it?

Adam Lesser, MSW
Deputy Director
Center for Suicide Risk Assessment
New York State Psychiatric Institute
Columbia University

The Scope of the Problem
Every 1 hours and 48 minutes, a person under age 25 dies by suicide in the United States.
Suicide is the 2nd leading cause of death in youth 10-24.
In 2010 suicide deaths of 10-14 year olds was the highest and more than 2X the average of the past 17 years.
Suicide death rate for boys is 4X that of girls
“What happened in our district could happen anywhere.”

“Every school in our district had a crisis plan if a staff member died of cancer or a student got in a car accident. But suicide . . . it wasn’t on my agenda,” said a superintendent. “We just did not think it was going to happen here. Unfortunately we learned the hard way. It was only after we had a [death in our school community by] suicide that we realized we needed to take a comprehensive approach to preventing a tragedy like this. And we realized we needed to involve everybody—the school staff, students, parents, and the community.”

—Superintendent in a New England School District
While everyone who cares for and about young people should be concerned with youth suicide, schools have special reasons for taking action to prevent these tragedies:
1. Maintaining a safe school environment is part of a school’s overall mission. There is an implicit contract that schools have with parents to protect the safety of their children while they are in the school’s care.

Programs that improve school climate and promote connectedness help reduce risk of suicide, violence, bullying, and substance abuse.
2. Depression and other mental health issues can interfere with the ability to learn and can affect academic performance.

Approximately 1 of 2 high school students receiving grades of mostly Ds and Fs felt sad or hopeless. But only 1 of 5 students receiving mostly grades of A felt sad or hopeless.

1 out of 5 high school students receiving grades of mostly Ds and Fs attempted suicide. Comparatively, 1 out of 25 who receive mostly A grades attempted suicide.
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 which may result in the relatively rare phenomenon of “suicide clusters”.
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 of suicide
Under the Family Educational Rights and Privacy Act (FERPA), parents are generally required to provide consent before school officials disclose personally identifiable information from students’ education records. There are exceptions to FERPA’s general consent rule, such as disclosures in connection with health or safety emergencies. This provision in FERPA permits school officials to disclose information on students, without consent, to appropriate parties if knowledge of the information is necessary to protect the health or safety of the student or other individuals. When a student is believed to be suicidal or has expressed suicidal thoughts, school officials may determine that an articulable and significant threat to the health or safety of the student exists and that such a disclosure to appropriate parties is warranted under this exception (Department of Education, 2010).
What about FERPA?

Join or build a local suicide prevention coalition that includes all groups and agencies interested in youth suicide prevention

Create close linkages with your system of care i.e. emergency responders, hospitals, and outpatient mental health care providers
What Can We Do In Our School?
Protocols for helping students at risk of suicide, including:
A protocol for helping students who may be at risk of suicide
A protocol for responding to students who attempt suicide at school
A protocol for students returning from treatment
Agreements with community providers to provide behavioral health services to students

Protocols for responding to sudden death, including:
Steps to take after the sudden death of a student or other member of the school community
Identify staff responsible for taking these steps
Agreements with community partners to help in the event of a sudden death
Develop Protocols
Education and training
Gatekeeper Training for All Staff:
Question Persuade and Refer (QPR) – www.qprinstitute.com
Signs of Suicide (SOS) - www.mentalhealthscreening.org
Making Educators Partners in youth Suicide Prevention – Society for the Prevention of Teen Suicide - free on-line training – http://Spts.pldm.com/
Parent education, including:
Information for parents about suicide and related behavioral health issues
Strategies to engage parents in suicide prevention programs
Develop Skills for Clinicians

Safety Plan Writing - Barbara Stanley and Gregory K. Brown
Lifelines Intervention: Helping Students at Risk for Suicide
Collaborative Approach to Managing Suicide (CAMS) - David Jobes
Counseling on Access to Lethal Means (CALM) http://training.sprc.org/

Sources of Strength – www.sourcesofstrength.org
Programming for school climate change to promote help seeking behaviors, connectedness and a welcoming and tolerant environment
Well researched – engaged in the nation’s largest randomized trial on impact of peer leaders on entire student populations.
Has focused and tested Hope, Help, Strength messaging strategies that are safe and effective.
Uses a wide diversity of peer leaders to spread into many cliques and groups.
Links closely with adult support – trusted adults
How does Sources of Strength differ from other peer programs?
Core Messaging Goals for School
in Sources of Strength
These are our ‘Sources of Strength’ that help in staying strong, making good decisions, handling tough emotions
The more ‘Sources of Strength’ you have, the better you can get through tough times
Surround someone in crisis with multiple Sources of Strength
There are ‘Trusted Adults’ available who can help – these are my trusted adults
In the case of suicidal thoughts, don’t keep it a secret
Help-Seeking Norms of Peer Leaders increased by training (p<.05) in Cobb County GA, North Dakota and NY
Middle School - Swainsboro, GA
Student Health Survey Before and After Implementing QPR and Sources of Strength
Sources of Strength Process
Engage leaders/ administrators
Review protocol
Identify and train key adult advisors (4-6 hr)
Train school or community staff (15 m – 1.5 hr)
Recruit peer leaders
Train peer leaders with adult advisors (3-4 hr)
Peer leaders with adult support begin action steps and HOPE, HELP, STRENGTH MESSAGING (3-5 months)

Thank You!

2011-2012 Student Health Survey
High School
2011 CDC Youth Risk Behavior Survey
High School
39% have used alcohol at least once in the past month
20% have been bullied on school property at least once in the past year
16% have been electronically bullied
6% skipped at least one day of school in the past month because they felt unsafe
At-risk youth
Coping and Support Training (CAST) www.reconnectingyouth.com
School-wide screening
Columbia Suicide Severity Rating Scale (C-SSRS) - free on-line or DVD training
Programming for students
Ideation: 60%
Attempt: 30%
Within any typical classroom it is likely that three students (one boy and two girls) have attempted suicide in the past year
Shaffer, 2005
CDC YRBSS 2011, Gould et al., 1998, Grunbaum et al., 2004
Ideation: 16%
With a plan: 13%
Attempt: 8%
Attempt requiring
medical attention: 2.4%

Ideation (Lifetime): 50%
Ideation (Past Year): 10%
Attempt: 1.5%
The 2008-2009 School Crime Supplement (National Center for Education Statistics and Bureau of Justice Statistics) indicates that, nationwide, 28% of students in grades 6–12 experienced bullying
Bully victims are 2-9x more likely to consider suicide (Yale University)
160,000 kids stay home from school every day because of fear of bullying (ABC news)
Bullying & Suicide
Safe Schools Initiative Final Report, U.S. DOE, 2002
78% of attackers exhibited a history of suicide attempts or suicidal thoughts at some point prior to their attack
27% reported suicide as a motive in their attack
2/3 of attackers had not received any formal mental health evaluation
School Shootings and Suicide
Only 9% of teachers feel confident they can identify a student at-risk of suicide (King, 1999)

Would identification be a burden on teachers?
Teachers are already approached: In one study, 25% report being approached by an at-risk child (Leane, 1998)
Teachers respond to suicide prevention programs in a “positive and welcoming manner” (CDC 1992)
Teachers & Suicide Identification
A word about screening: High Schools screening programs associated with 2X detection of at-risk individuals (Scott, et al., 2004)
Preventing Suicide: A Toolkit for High Schools, SAMHSA, 2012
Full transcript