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CFR

training
by

adam lesser

on 10 October 2012

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Transcript of CFR

Conclusion Thank you for your attention! Athens/Clarke County
Banks County
Effingham County
Emanuel County
Habersham County
Jasper County
Rabun County
Georgia Cyber Academy
Atlanta Public Schools And one more thing... Organize your prevention approach CDC UNIFORM DEFINITIONS
Self-Directed Violence Using uniform definitions for suicidal behavior
Collecting needed information for case review
Identifying detailed suicidal behavior in case review - Psychological Autopsy
Preventing further deaths by suicide PSYCHOLOGICAL AUTOPSY Skills for Identification,
Case Review and Prevention
For Child Fatality Review Teams YOUTH SUICIDE: Behavior that is self-directed
and deliberately results in
injury or the potential of injury
to oneself Suicidal self-directed violence Behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. There is evidence, whether implicit or explicit, of suicidal intent. Undetermined self-directed violence Behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. Suicidal intent is unclear basd on the available evidence. Non-suicidal self-directed violence Behavior that is self-directed and deliberately results in injury or the potential for injury to oneself. There is no evidence, whether implicit or explicit, of suicidal intent. Suicide Death caused by self-directed injurious behavior with any intent to die as a result of the behavior. Suicide attempt A non-fatal self-directed potentially injurious behavior with any intent to die as a result of the behavior. A suicide attempt may or may not result in injury. Interrupted self-directed violence - by self or others By other - A person takes steps to injure self but is stopped by another person prior to fatal injury. The interruption can occur at any point during the actsuch as after the initial thought or after onset of the behavior.
By self - A person takes steps to injure self but stops self prior to fatal injury Other suicidal behavior including prepatory acts Acts or preparation towards making a suicide attempt, but before potential harm has begun. This can include anything beyond a verbalization or thought, such as assembling a method (e.g. buying a gun, collecting pills) or preparing for one's death by suicide (e.g. writing a suicide note or will, giving things away) Source: Posner K, Oquendo MA, Could M, Stanley B, Davies M. Columbia Classification Algorithm of Suicide Assessment (C-CASA): Classification of Suicidal Events in the FDA’s Pediatric Suicidal Risk Analysis of Antidepressants. Am J Psychiatry. 2007; 164: 1035-1043. http//cssrs.columbia.edu/ Completed suicide Implies achieving a desirable outcome. Use "suicide" or "died by suicide". Non-fatal suicide A contradiction. Use "suicide attempt". Parasuicide Formerly used to refer to a person's self-directed violence whether or not the person had an intent to die. The World Health Organization is now favoring the term "suicide attempt" Unacceptable Terms Failed attempt Negative impression of a person's action. Similar to "unsuccessful attempt". Use "suicide attempt" Suicidality Often used to refer simultaneously to suicidal thoughts and suicidal behavior. These are two separate phenomena and should be identified separately. Use "suicidal thoughts" and "suicidal behavior". Suicide gesture, Manipulative act, Suicide threat Each gives a value judgement with a pejorative or negative impression of the persons intent. A more objective description of the event is preferable such as "non-suicidal self-directed violence" or "suicidal self-directed violence". Unacceptable Terms COLLECTING INFO Assure that the CDC recommended data elements (pages 27-28) are completed in the case record before CFR case review Identifying Information
Individual Sociodemographics
Socioeconomic Status
Event Information
Individual and Family History
Medical History and Associated Factors Use a certified professional to develop a psychological autopsy to complement other components of the investigation To increase the validity of the mode of death determination
To determine proximate causation
To better understand pathways to suicide
To discern prevention possibilities
To address questions: Why?, Why now?, Why in this way? PREVENTION Up to 15% of the youth population in the school where a suicide or other traumatic death has occurred (such as a traffic fatality) are at risk of a suicide attempt in the aftermath of the death.

An important prevention effort for CFR teams is to work to prevent suicide attempts and deaths in the aftermath of a suicide or other traumatic death in the community and to record those prevention effortsand outcomes in the death review. POSTVENTION IS PREVENTION Join the DBHDD Suicide Prevention Program's Youth Suicide Prevention Postvention Initiative as a CFR Team by contacting us.
Take the online survey (TBA) to indicate where your CFR Committee stands in organizing your prevention efforts
Follow the 7 steps in preparing your community for traumatic loss
Report your progress at each CFR meeting and to DBHDD
Record your prevention efforts in your case reviews Thanks to our first members of the initiative These school systems have joined the Youth Suicide Prevention Postvention Initiative in 2012 Each of these school systems has at least one LIFELINES trained person ready to support all schools in their system in how to respond as a caring community after suicide or other traumatic death. PSYCHOLOGICAL AUTOPSY Objectives: A "psychological biography" PSYCHOLOGICAL AUTOPSY Objectives: Last days and hours
State of mind
Intentionality PSYCHOLOGICAL AUTOPSY The Procedure Structured interviews
Death scene evidence
Physical autopsy and lab reports
Archival documents
Medical records
Mental health records
School records
Juvenile justice records Discussion
The Suicide Prevention Program trained 20 individuals from Georgia in July to become certified professionals in psychological autopsies.

Contact DBHDD, CFR or GBI to access this service for your team. CFR Report Sections A, D-G and I28-29 CFR Report Section I28-29 Family History and Associated Features
(In narrative, if possible, give more detail) Prior threats and attempts
How many?
How recent?
Family History of Suicide
Who?
Acute crisis
How recent? Preventing Suicide Deaths
After a Youth Death in the Community:
A Role for Child Fatality Review in Prevention 1. Prepare the community to recognize the signs and symptoms of someone at risk for suicide and screen for elevated risk. (Gatekeeper training such as QPR)

2. Encourage the school system to adopt and practice a best practice response to suicide or other traumatic death. (LIFELINES)

3. Support the use of the Columbia Suicide Severity Rating Scale (C-SSRS) community wide to screen for risk of attempt. (www.cssrs.columbia.edu) and use individualized Suicide Prevention Safety Plans by certified professionals 4. Identify and prepare "trusted adults" to be available to youths throughout the community

5. Prepare community protocol for referral for assessment and treatment of youth identified as at risk and distribute it widely. Community members, especially parents, should know where to get help

6. Prepare local behavioral health and substance abuse providers to use best practice screening, assessment and treatment methods such as safety pland ans cognitive-behavioral therapy

7. Prepare media to use safe messaging and best practice reporting (http://reportingonsuicide.org) Department of Behavioral Health and Developmental Disabilities
Suicide Prevention Program Adam M. Lesser, LCSW
amlesser@dbhdd.ga.gov

Sally vander Straeten, ACSW
savanderstraeten@dbhdd.ga.gov A Timeline Model for Preventing Suicide Deaths
After a Youth Death in the Community Develop a safety net of awareness & services for youth affected by a death Practice skills and response to youth death Prepare media for safe response to youth death BEFORE Immediate response using LIFELINES in caring school community FROM DEATH TO FUNERAL Activate safety net of awareness & services for youth affected by a death AFTER Safe Messaging in Media Begin to identify youth at risk of suicide attempt in next year using C-SSRS Media gives hope, help and strength messages Continue to identify youth at risk of suicide attempt in next year using C-SSRS Character and Personality
Developmental History
Psychiatric History
Emotional life and Coping Style Pike County
Upson County
Jackson County
Gwinnett County
Fulton County
Lamar County
Floyd County
Cobb County
Rockdale County
Full transcript