AGENDA
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Challenges
School psych role in SP
Why the workshop
Workshop description
3 schools
Resources
Questions
Challenges
Challenge: volatile mix of problems
clouds the picture
• Suicide is sometimes mixed in with behavioral crisis,
mental health symptoms, non-suicidal self injury,
family and social problems, substance abuse and police
involvement, injuries and illnesses.
• 10% adolescents who die by suicide, treated in ED
within 2 months prior to death, often not related to
suicide. (Posner, 2011)
• Repeat visits – Attempts become more deadly over
time
• HINT: Use suicide discrete assessment tools (ex.
Columbia Suicide Severity Rating Scale)
Challenge: Method / Intent
Type 1
“Attention Seeking,”
“Gestures,” Low to No Risk
Type 2
“Can’t Prevent Someone
Truly Intent”
HINT: Don’t attempt to determine psychological intent
from the method
Challenge: easy access
Legend
Youth Emergency Department Visits for Drug-Related Suicide
Attempts
Alcohol
Most Likely to Involve Anti-Anxiety, Acetaminophen, and Antidepressant Drugs
Percentage of U.S. Emergency Department (ED) Visits for Drug-Related Suicide Attempts
Among Youth Ages 12 to 17 Involving Selected Substances, 2008
(N=23,124 ED visits)
Anti-Anxiety Drugs
26.2%
Acetaminophen Products
25.4%
Antidepressants
23.0%
14.9%
Ibuprofen Products
Alcohol
11.4%
Illicit Drugs
8.8%
Antipsychotics
Narcotic Painkillers
Aspirin Products
Stimulant Pharmaceuticals
0%
7.4%
5.1%
4.2%
1.5%
5% 10% 15% 20% 25% 30%
HINT: Assess, educate, problem–solve with families around
access to means
SOURCE: Adapted by CESAR from data from Substance Abuse and Mental Health Services Administration (SAMHSA), “Emergency Department Visits for
Drug-Related Suicide Attempts by Adolescents: 2008,” The DAWN Report, May 13, 2010. Available online at
www.oas.samhsa.gov/2k10/DAWN002/SuicideAttemptsYoungAdults.cfm.
Challenge: Getting relevant
information for rapid assessment
• Story changes as the crisis abates
• Getting collateral information from family and
care providers
• Getting at suicidal secrets requires skill
• HINT: Establish rapport quickly. Use “Tell me
more” conversational interview.
“Tell me more” adapted from M. Underwood, Society for the Prevention of Teen Suicide
Challenge: “Hot Potato Effect”
• Fewer than 20% of adolescent suicides receive
any consistent treatment prior to their death
(Posner, 2011)
• Mental Health Workforce has inconsistent
training & skill specific to suicide care.
• Many tools used to assess for risk have poor
validity and reliability.
• Suicide is difficult to predict.
HINT: Do something helpful. Educate, Intervene,
Problem-solve, Safety plan.
Challenge: Suicide Care in Psych
Settings
• National MH Workforce Survey: October 2012
• N=6,637 New York respondents
• 27.7% had one or more patient who ended
their life while under care
• 45% Disagreed or didn’t know if they had the
training they needed to help a suicidal patient
• 32.4% Disagreed or didn’t know if they had
the supervisory support they needed to help
Role of the School Psychologist in SchoolBased Suicide Prevention
• Be knowledgeable about:
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Risk factors & warning signs
Legal issues, best practices, EBP’s
The advantages of safety plans versus no-harm contracts
Crisis assessment & intervention
Issues related to suicide contagion & clusters
(Berman, 2009)
Role of the School Psychologist in SchoolBased Suicide Prevention
• Be able to:
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Formulate & conduct risk assessments
Differentiate between suicidal behavior & NSSI
Conduct crisis assessments and interventions
Involve parents/guardians of potentially suicidal youth in the
intervention process
– Safely reintegrate a student into the classroom following a suicide
attempt
– Effectively implement suicide postvention procedures
(Berman, 2009)
Role of the School Psychologist in SchoolBased Suicide Prevention
– Integrate research evidence with clinical experience
• Consider readiness, acceptability, cultural relevance
– Value experience and expertise of various school professionals
• Share responsibility for identifying, planning, and delivering
– Use competencies in
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Consultation
Team Process
Problem-solving model
Data-based decision making
Program evaluation
(Kazak et al., 2010; Kratochwill & Steele Shernoff, 2004;
NASP, 2010; Strein & Koehler, 2008)
Why the workshop?
SCHOOLS
• Raising skills & awareness
(education & training)
• Building & supporting
coalitions
• Youth Suicide Prevention
Centers
• Zero Suicide Health and
Behavioral Health Care
Model
• SPCNY
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Unique governance
Focus is education
Local culture
Titles vs. roles
Lots of schools, all
unique
Engage school planning team in a process to:
• Review existing suicide prevention readiness
• Receive evidence-based and best practice guidance
• Develop comprehensive suicide prevention and response plan
• Learn about resources to enhance safety and health of your
school environment that are subsidized or available at low or
no cost.
CSSS Workshop Model:
Elements of Suicide Safety at School
Policies &
procedures are the
foundational
structure
Parent &
Community
Engagement for
support, referral
and mutual aid
Staff gatekeeper
training,
intervention skills
Programming &
education that
supports
protection and
resiliency
Crisis team has
postvention training,
resources,
procedures
Targeted
intervention
process for
managing students
with risk
Creating Suicide Safety in Schools:
Workshop Approach
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Process vs. Product
Best practice and evidence-based practice
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www.sprc.org/bpr & www.nrepp.samhsa.gov
Contagion theory
Public health prevention models
 Decrease risk
Indicated
 Increase protection
Selected
Universal
Creating Suicide Safety in Schools:
Workshop Components
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Suicide facts
Scenarios
Checklist
Group work sessions
Resource binder
Planning worksheets
Sample Scenario:
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Mr. Brown is in his second year of teaching English at your high school. He
has become alarmed about a student, Jakob, who recently transferred into
his third period class. Jakob has handed in a writing assignment in which he
depicted morbid themes including suicide and the words, “what if hope
hurts?” in one corner. Thinking back, Mr. Brown realizes that Jakob is often
sullen, he doesn’t interact with any other students, and he often has his
head down in class.
What would you like to see Mr. Brown do next?
 What might get in his way?
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East Hampton High School
Long Island
East Hampton High School
Long Island
ACTIONS TAKEN
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NCSC School Climate Inventory
School Climate Steering Committee
Hired a bilingual, bicultural family liaison
Rallied community support
Ongoing meetings with local providers
Intervention Protocols
Lifelines Intervention
Faculty Training
Lifelines Postvention (upcoming)
Gowanda Central Schools
Western NY
Gowanda Central Schools
Western NY
ACTIONS TAKEN
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Regional meeting on MH resources
Intervention protocols & templates
Lifelines Trilogy training
Faculty protocol
Faculty training (Making Ed. Partners)
Sources of Strength
Salamanca City Schools
Western New York
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Salamanca City Schools
Western New York
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ACTIONS TAKEN
Rallied community
support
Trained Crisis team
Updated crisis plan
ASIST
Columbia SSRS
Sources of
Strength
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Free Resources
• Lifelines Trilogy of
Trainings: Prevention,
Intervention, Postvention
• SAMHSA Toolkit
• Faculty, staff & Parent
education
• Online faculty training
• Classroom curriculum
• Resiliency based
programming
• Columbia SSRS training
• ASIST and SafeTALK
training
• Postvention support and
consultation
• Safety Planning
Intervention training
• Safety planning App.
• Means restriction
brochure
• Sources of Strength
=Creating Suicide Safety in Schools Workshop
=Workshop scheduled
Pat Breux
pat.breux@omh.ny.gov
PreventSuicideNY.org