1. School Crisis: Ethical and Legal Issues for Best Practices
Dr. Scott Poland
Co-Director of the Suicide and Violence Prevention Office
Nova Southeastern University

2. NASP Principles for Professional Ethics: Revised 2010
Respect dignity and rights of all persons
Honesty and integrity in professional relationships
Responsibility to schools, families, community, the profession and society
Professional competence and responsibility

3. NASP Principles: Key Concepts
School psychologists consider children to be their primary responsibility and act as advocates for their welfare.
We also understand the public policy process to assist us in our efforts to advocate for children.
At the very least we do no harm.

4. Legal Cases Review
There are many legal cases that have implications for crisis intervention and school psychologists
School psychology literature about legal and ethical issues in school crisis is lacking
The following cases highlighted in a lessons learned format are all cases that I was personally involved in

5. Civil Lawsuits Against School Personnel: Common Questions
Did an injury occur?
Did the school owe a duty to the student?
Was there a breach of duty?
Is there a causal relationship between the injury and a breach of duty?

6. Choquette vs. Onstedt Schools
Elementary age students on school bus viewed a suicide victim
Parents were called immediately and a group activity provided next day for all bus riders (grades 1 to 6) by psychologist and counselor
One family did not want their 1st grade daughter to be told truth and later pulled her out of school and sued
The suit for 10$ million claimed she had PTSD as a result of intervention provided

7. Activity What do you think of the merits of the Choquette lawsuit?
How would you defend the school psychologist and counselor?
Was is it appropriate to conduct one intervention for bus riders grades 1 to 6?
Should parent permission have been obtained prior to the intervention for students?

8. Landmark Cases
Wyke v Polk County School Board in Florida 11th Federal Circuit Court found the district liable for not offering a suicide prevention program, providing inadequate supervision of a suicidal student and failing to notify parents when their child was suicidal

9. Landmark Cases
Szostek v Fowler and the Cypress-Fairbanks School District 189th District Court found the school had not negligently disciplined the student who died by suicide and were entitled to sovereign immunity. This case does highlight school discipline has been a common precipitating event for suicide.

10. Hope Witsell Tragedy
Middle school teen endured months of taunting after she sent a topless photo to a fellow student
The day before her suicide, she met with a social worker who had her sign a no suicide contract
No other school staff nor the parents were notified and parents found the contract after she hanged herself
Do you see a defense in the lawsuit and how do we prevent tragedies like this?

11. Parent Notification Issue: Suicidal Student
Maryland school psychologist believed a student to be suicidal and notified parents. Student was allowed to walk home per parent request. Student died by suicide that night and the parents filed a lawsuit against the school and the psychologist.

12. Parent Notification Case: White Pass, WA.
Sixteen year old male student
Referred to school counselor after he wrote a suicide note and gave it to a friend and there were rumors about a suicide pact
Student denied suicidal ideation or plans when interviewed by counselor
Please consider whether or not you would call parents after you review the following pieces of information that he shared with the counselor

13. Shared with Counselor New to school had been there 5 weeks
Sad as his best friend at new school who he was rumored to be in a pact with attempted suicide today
Under stress as facing felony charges
Gets along well with grandmother (who he now lives with) but not his mother as she hates him
His mother tried to kill herself last year
He reports his mother thinks he will probably kill himself
He reported he used to drink but has been sober for two weeks

14. U.S. Eastern District Court Lance v Lewisville ISD
9 year old boy M. hung himself in the school nurses bathroom in 2010
Special education student with Speech, Learning Disabilities and ADHD
In 2008 his parents referred him for psychological evaluation due to their concerns that he was suicidal
ARD in 2008 identified him with Emotionally Disturbed

15. The district does not have the psych evaluation that qualified M with ED
They have BASC raw data only that documents suicide/depression
He received special education counseling but there is no documentation that service provider ever talked with him about suicidal ideation
From the start of the school year and his death on 1/21/10 there were 30 behavioral incidents that resulted in him seeing the AP

16. The AP viewed each incident as conflict not bullying as that would have required the incidents to be written up and sent to the Superintendent
No evidence that the AP reviewed his IEP or his BIP
M saw the nurse on 16 occasions that year and on 7 of those occasions had physical injuries suffered at school
On 12/18/09 five students assaulted M in and he pulled a pocket knife from his pocket but did not open it
M was sent to the DAEP for 10 days and no MDR was held

17. His parents appealed the DAEP in writing first to the Principal and then to the Assistant Superintendent stating that he had been bullied
The appeals were denied
The DAEP was not notified that M was a special education student
M was suicidal at the DAEP and a high school counselor interviewed him and called his father but failed to fill out paperwork as per district protocol and did not notify his home elementary school of his suicidal ideation

18. M was in trouble on his second day back at his home campus and he hung himself in the nurse clinic bathroom
The nurse had known for two years that she did not have a key to unlock the bathroom door and M and other students had been known to lock themselves in the bathroom and she had to call custodian for help
No one ever told the nurse that M was known to be suicidal
The day after he died a new lock was installed and the nurse was provided a key to the bathroom

19. Legal Term: Special Relationship
“In loco parentis doctrine” raises the question of whether a special relationship exists between school officials and students as students are released by parents for control and supervision by school officials
Critical issues are the age and existence of disabilities for a student and whether or not the district placed the student in harms way

20. Lance Case: Outcome
Court dismissed the case and placed emphasis on the 2012 Doe v Covington case decided by the Fifth Circuit Court
No Special Relationship existed as he was not incarcerated, involuntarily committed, nor in foster care
He was not discriminated against as the AP failed to implement the bullying prevention policy for all students

21. Bullying and Suicide
Children who have been bullied have reported a variety of behavioral, emotional and social problems.
Suicide is the third largest cause of mortality in children and adolescents.
Studies reported positive associations between all bullying types and suicidal risks.
Children who have been bullied have reported a variety of behavioral, emotional and social problems, including: bed wetting, sleep difficulties, anxiety, depression, school phobia, feelings of insecurity, and unhappiness at school; they may also have low self-esteem, loneliness, isolation, and somatic complaints.
Suicide is third leading cause of mortality in children and adolescent in the United States of America and around the world.
According to a review of 37 studies completed by Kim & Leventhal (2008), most of the studies reported positive associations between all bullying types and suicidal risks. 21

22. What does the research say?
Kaminsky (2009) victimization by peers is associated with greater reporting of suicidal ideation and behavior.
Klomek, Sourander & Gould (2010) found that bullies also have been reported to have an increased prevalence of suicidal ideation and suicide attempts.
Kim & Leventhal (2008) discussed that any participation in bullying increases the risk of suicidal ideation and behaviors, with the strongest risk for suicide was in Victim-Perpetrators.
Kaminsky (2009) victimization by peers is associated with greater reporting of suicidal ideation and behavior. The study controlled for differences in age, sex, race/ethnicity or depressive symptoms.
Klomek, Sourander & Gould (2010) found that bullies also have been reported to have an increased prevalence of suicidal ideation and suicide attempts than those not involved in bullying behaviors.
Kim & Leventhal (2008) discussed that any participation in bullying increases the risk of suicidal ideation and behaviors, with the strongest risk for suicide was in Victim-Perpetrators, both in the general population of children and adolescents and in the population with special needs (behavioral problems or LGB sexual orientation). Victim-perpetrators (also known as aggressive victims) experience more psychopathology, as well as problematic family and academic functioning compared to other victims. 22

23. Klomek, Sourander & Gould (2010) reported that the associations between bullying behaviors and suicidality have been found in children of all ages.
D’Augelli and colleagues (2005) found that increased sexual orientation-based verbal victimization, as well as psychological abuse from parents predicted suicide attempts described as ‘‘gay related.’’
Traditional bullying and cyberbullying have been found to be related to suicidal ideation in similar ways (Klomek et al., 2008; Hinduja & Patchin, 2010).
Klomek, Sourander & Gould (2010) reported that the associations between bullying behaviors (whether victim or bully) and suicidality have been found in children in elementary, middle and high school.
D’Augelli and colleagues (2005) found that increased sexual orientation-based verbal victimization, as well as psychological abuse from parents predicted suicide attempts described as ‘‘gay related.’’
Traditional bullying and cyberbullying have been found to be related to suicidal ideation in similar ways (Klomek et al., 2008; Hinduja & Patchin, 2010) 23

24. SPRC Brief: Suicide and Bullying
Both victims and perpetrators are at higher risk than peers
Personal characteristics such as internalizing problems; low self-esteem; and low assertiveness increase the risk of being bullied and these factors are also associated with risk for suicide
Children most at risk for suicide are also at risk for being bullied and it is difficult to control all the risk factors to determine if being bullied was a proximal cause to a youth suicide

25. SPRC Continued
Personal risk factors alone do not cause a child to be suicidal as other key components are family, mistreatment, domestic violence, parental depression and a school environment that lacks adequate support and supervision along with inconsistent discipline
Relationship between bullying and suicide is the strongest for LGBTQ youth
Promotion of social support, mental health services and connectedness at school is recommended

26. Bullying and Suicide Prevention: Common Strategies
Promote a positive school environment
Educate parents about warning signs and increase their involvement
Key is to build relationships with all students
Identify students and families in need of services and obtain services for them

27. Suicide Postvention
Mares v Shawnee Mission Schools Kansas the school system settled out of court after being sued following the suicides of two brothers. The district failed to implement suicide postvention procedures after the first death.

28. State of Montana v Justine Winter 20/20 Season 31 Episode #50
Nighttime car accident resulted in two deaths
Justine survived but has extensive medical injuries including brain damage and has no memory of the accident
Justine was 16 years, one month at the time of the accident and had texted her boy friend about crashing her car 6 minutes before the accident
She was tried in adult court on two counts of deliberate homicide
How might you defend her and does this case fit the pattern of youth suicide?
What do you want to know about Justine?

29. Joiner’s Model of Suicide Risk, 2006

30. Lawsuit over Self Injury Notification
Coulter Vs. Washington Township, N.J.
Issues
Student deposition/insight into factors
Parent deposition
Counselor deposition

31. Snohomish, WA Case
9th grade female student M (late April) told her friend K who was angry at her boyfriend that she would stab K’s boyfriend for her
Her friend reported threat to the school counselor
School emergency expelled her and told M and her mother that M would need to get psychiatric care before she would be readmitted

32. School Records and Knowledge
M seen as quiet, good student but grades declined 2nd semester 9th grade year and no history of any discipline incidents
8th grade counselor’s notes say M talked about cutting, sexting and wanting to be raped
9th grade counselor heard M might be cutting in Dec. that year and met with her
Checked with her mom in Jan. and found out M was in private counseling

33. Continued
School counselor on date of threat in April without a release called the private psychologist to share M had thoughts of suicide and killing family members
M was evaluated by a psychiatrist for homicidal and suicidal thoughts and hospitalized for 5 days in a partial program
Diagnosis was Major Depression and Generalized Anxiety, M was already on an anti-depressant that was working but was guarded in treatment, not homicidal or suicidal at discharge

34. Continued
Psychiatrist stated in writing that M was safe to return to school and was continuing in out patient treatment (only records school received)
School held re-entry meeting on 5/5 with school staff, M and her mother and alternative school was mentioned but declined by M and mom
Focus was largely academic and how to support M and behaviors to watch for
No behavioral concerns reported before end of school except PE teacher noted cuts legs

35. Continued Fall Next Year
Meeting 9/22 with counselor, teachers, M and her mom
Mom reported M still in therapy and using skills learned and had a future orientation
Teachers shared largely academic concerns but M had talked of drugs, made at least one student uncomfortable and patted one student too hard, had done a paper on a serial killer and one on managing stress

36. Stabbing Incident
Oct. 25th M who still continued in twice a month counseling and medication, hid in the restroom listening to violent music, with knives she had taken from her step-father
She waited for RR to clear then stabbed the last two girls in the RR, one of which nearly died, M did not know either girl
Plaintiff’s sued the treatment clinic that provided outpatient treatment , the hospital and the school

37. Plaintiff’s Criticism of School
M should have been placed in alternative school or not allowed to return, should have been evaluated for Special education, there was no wraparound program on return from hospital, school should have insisted on more information from the hospital and clinic
School threat assessment in April was inadequate, M should have been searched every morning or escorted everywhere including to the RR or M should have been seen by school counselor every morning,

38. More Questions
What else do you want to know about the treatment that M received at the clinic and hospital?
Is the law suit warranted against the school, clinic and hospital?
When a psychiatrist does a safety assessment what does that really mean?
Did the psychiatrist miss psychotic features to M’s illness?
Can schools force records to be released to them?

39. Case Discussion Questions
What do you think of the case against the school? Can schools force the release of records?
Are school personnel in a position to question a safety letter from a psychiatrist?
What constitutes a thorough threat assessment and how good are we at predicting violence? How often do female adolescents attempt homicide and what is the relationship between homicide and suicide?

40. Structured Assessment of Violent Risk Youth (SAVRY)
Risk viewed as “dynamic” subject to change not just as “static”
Improvement noted in clinicians’ ability to distinguish violent individuals, now better than chance accuracy
Previous assessment has been unstructured purely “clinical”

41. SAVRY
Systematic risk assessment with checklist of risk factors related to violence for 12 to 18 year olds
Systematic risk assessments perform better than unstructured ones
Dynamic risk factors especially significant for adolescents
SAVRY has 4 domains and 30 items all items rated low medium or high

42. SAVRY Domains
Historical risk factors such as history of violence, early initiation of violence, past supervision failure, history of NSSI or suicide attempts, exposure to violence in home, childhood maltreatment, parental criminality, early caregiver disruption, and poor school achievement

43. SAVRY Domains
Social/Contextual risk factors such as peer delinquency, peer rejection, stress and poor coping, poor parental management, lack of personal/social support and community disorganization

44. SAVRY Domains
Individual/Clinical Risk factors such as negative attitudes, risk taking/impulsivity, substance abuse, anger problems, low empathy/remorse, ADHD, poor compliance and low interest/commitment to school

45. SAVRY Domains
Protective factors such as pro-social involvement, strong social support, strong attachment bonds, positive attitude towards intervention and authority, strong commitment to school and resilient personality traits
Available from Psychological Assessment Resources

46. How Can School Personnel Protect Themselves from Liability?
Maintain Liability Insurance
Seek supervision and consultation
Keep good records
Document training on crisis intervention
Provide Best Practices responses

47. How Can School Psychologists Make A Difference?
Advocate for prevention programs in schools and communities
Collaborate with school administrators and relevant agencies
Increase the circle of care when students are known to be at risk
Keep up with best practices in crisis intervention

48. More Information spoland@nova.edu www.nova.edu/suicideprevention
New book, Suicide in schools by Erbacher, Singer and Poland, Routledge Dec. 2014