1. + Some Secrets SHOULD be Shared… It Takes a Village: Involving School Staff and Parents in Suicide Prevention Candice Porter, MSW, LICSW Executive Director Screening for Mental Health, Inc.

2. What is Screening for Mental Health, Inc. SMH is… a national non-profit organization whose mission is to provide innovative mental health and substance abuse resources, linking those in need to quality treatment options. The SOS Signs of Suicide ® Prevention Program is… an award-winning, evidence-based educational and screening tool used in middle and high schools across the country.

3. Youth Programs at SMH SOS Signs of Suicide Prevention Program  High School Program  Middle School Program SOS Signs of Suicide Booster Program Signs of Self-Injury Prevention Program

4. What we will cover today: 1. Youth suicide a. Signs & symptoms b. Risk factors & other definitions 2. What can schools do? Implementing an evidence- based, universal prevention program 3. Reaching out to trusted adults in your community 4. Suicide prevention and risk management 5. Talking points 6. Question and answer

5. 3 rd leading cause of death among youth ages 15-24 (CDC, 2011) In 2011, 4,630 people between the ages of 15 and 24 completed suicide. 12.5% of total suicides that year. But STILL….adolescent suicidal behavior is deemed underreported Prevalence of Suicide Among Youth

6. By the Numbers… 2013 Youth Risk Behavior Survey found that: 29.9% felt so sad or hopeless for 2+ weeks that they stopped doing some usual activity. 17.0% seriously considered attempting suicide. 13.6% made a suicide plan. 8.0% attempted suicide. 2.7% of those who made an attempt required medical attention Find the data for your city/state: http://www.cdc.gov/HealthyYouth/yrbs/index.htm

7. Behaviors that Contribute to Unintentional Injuries and Violence WI Students % US Students % MA Students Are At: Seriously considered attempting suicide (During the 12 months before the survey.) 13.215.8Less Risk Attempted suicide (One or more times during the 12 months before the survey.) 6.07.8Equal Risk Wisconsin Student Health Survey

8. Risk Factors A risk factor is any personal trait or environmental quality that is associated with suicide. Risk factors ≠ causes. Examples: o Behavioral Health (depressive disorders, NSSI, substance abuse) o Personal Characteristics (hopelessness, ↓ self-esteem, social isolation, poor problem-solving) o Adverse Life Circumstances (interpersonal difficulties, bullying, hx abuse, exposure to peer suicide) o Family Characteristics (family hx suicide, parental divorce, family hx mental health disorders) o Environmental (exposure to stigma (including discrimination based on sexual orientation), access to lethal means, limited access to mental health care, lack of acceptance)

9. Risk Factors for Suicide Mental illness The strongest risk factors for suicide in youth depression substance abuse previous attempts (NAMI, 2003) Over 90%... of people who die by suicide have a least one major psychiatric disorder (Gould et al., 2003) Alarmingly, 80%... of youth with mental illness are not receiving services (Kataoka, et al 2002).

10. Alcohol and Suicidal Behavior in Teens Alcohol use, drinking while down, and heavy episodic drinking are strongly associated with suicide among adolescents. Relationship of drinking to unplanned suicides:  ↑ disinhibition and impulsivity  ↑ aggression and negative affectivity  ↑ cognitive constriction → restricted production of alternative coping strategies Drinking alcohol while down: more than a 75% increase in risk Alternative avenue for identification and early intervention. (Schilling, et al. 2009)

11. Suicide Warning Signs A warning sign is an indication that an individual may be experiencing depression or thoughts of suicide. Most individuals give warning signs or signals of their intentions. Seek Immediate Help Threat to kill themselves, actively seeking means, talking/writing about death Other Warning Signs to Take Seriously  Risky behavior, recklessness  ↑ substance use  ↓ interest in usual activities  Withdrawal ***Stay aware of changes in your students – in their affect, behavior, appearance, attendance, etc.***

12. Protective Factors Protective factors are personal traits or environmental qualities that can reduce the risk of suicidal behavior. Protective factors don’t provide immunity, but help reduce risk. Examples:  Individual Characteristics (adaptable temperament, coping skills, self-esteem, spiritual faith)  Family/Other Support (connectedness, social support)  School (positive experience, connectedness, sense of respect)  Mental Health and Healthcare (access to care, support through medical and mental health relationships)  Access to Means (restricted access to firearms/medications/alcohol, safety barriers for bridges)

13. Precipitating Event A precipitating event is a recent life event that serves as a trigger, moving an individual from thinking about suicide to attempting to take his or her own life. NOT causes  No single event causes suicidality; other risk factors are typically present. Examples:  breakup  bullying incident  sudden death of a loved one  trouble at school

14. Suicide: A Multi-Factorial Event

15. What Can Schools Do? “School systems are not responsible for meeting every need of their students. But when the need directly affects learning, the school must meet the challenge.” (Carnegie Task Force on Education ) Barriers to the mission of education Take responsibility: minimize student alienation & despair Promote healthy development & protective buffers Center for Mental Health in Schools at UCLA (http://smhp.psych.ucla.edu)

16. SOS Signs of Suicide Program Goals Decrease suicide and attempts by increasing knowledge and adaptive attitudes about depression Encourage individual help-seeking and help-seeking on behalf of a friend Reduce stigma: mental illness, like physical illness, requires treatment Engage parents and school staff as partners in prevention through education Encourage schools to develop community-based partnerships

17. SOS Signs of Suicide Student Goals Help youth understand that depression is a treatable illness Educate youth that suicide is not a normal response to stress, but a preventable tragedy that is often a result of untreated depression Inform youth of the risk associated with alcohol use to cope with feelings Increase help-seeking by providing students with specific action steps: ACT Encourage students and their parents to engage in discussion about these issues

18. Universal Prevention Universal prevention strategies are designed to reach the entire population, without regard to individual risk factors and are intended to reach a very large audience. The program is provided to everyone in the population, such as a school or grade, with a focus on risk reduction and health promotion.  Reach a broad range of adolescents  At-risk/sub-clinical/clinical symptoms  Reduces stigmatization  Promotes learning and resiliency in all students  Overrides implementer assumptions

19. ACT

20. SOS Program Components What comes in the program?  Implementation Guide  Educational DVD & Discussion Guide  Screening Tools and Student Response Cards  High School Student Newsletter / Middle School Student & Parent Newsletters  Customizable Wallet Cards/ ACT stickers / Posters  Educational Materials for Staff, Students, and Parents  Postvention Guide  Gatekeeper Training Tools: Training Trusted Adults DVD and Plan, Prepare, Prevent online training module  “Life Teammates” Packet for Coaches

21. Youth Programs at SMH SOS Signs of Suicide Prevention Program  High School Program $395  Middle School Program $395  Combination Program $655 SOS Signs of Suicide Second Act Program $200 Signs of Self-Injury Prevention Program $175

22. Gatekeeper Training Gatekeeper training involves educating adults who regularly interact with youth to recognize warning signs for suicide and know how to respond appropriately to at-risk youth. A gatekeeper should ultimately be able to provide a link, or open the gate, between a young person and a mental health professional.

23. Why Gatekeeper Training? Teaches additional skills, including how to:  reduce a person’s suicide risk by talking with them  keep someone safe until additional help can be found  facilitate referrals Creates more community members prepared to help Trains adults to effectively respond if approached for help by a youth Increases participation and investment of community in youth suicide prevention Clarifies myths and facts about youth mental health and suicide

24. To launch the SOS online gatekeeper module, visit: www.MentalHealthScreening.org/Gatekeeper 1.5 free contact hours for school social workers, counselors, psychologists, and nurses (Certificate of Completion available for all learners) ** CEU’s for social workers sponsored by ACSSW ** Gatekeeper Module

25. Training Trusted Adults SOS Gatekeeper Video

26. Sample Q’s from the Discussion Guide What are some of the risk factors and warning signs in the video that stuck out for you? What are some protective factors you might find in your students? The professionals discussed confidentiality and Melissa in Elyssa’s story said, “It’s ok to tell.” What are some steps to take if a student discloses the need for help? What qualities do you think make you a trusted adult?

27. Preparing for Your Staff Meeting/Parent Night 1. Review your school’s crisis response protocol 2. Take SOS online gatekeeper training module  Familiarize yourself with youth depression and suicidality  Plan for specific program implementation 3. Work with your administration  Establish whether your school will be implementing the program  If so, establish date and time so that you may communicate the information to your staff during the training

28. Preparing for Your Staff Meeting/Parent Night 4. Preview the Training Trusted Adults DVD  Make sure the DVD is in working order  Think about your own reactions to this video 5. Consult the discussion guide, plan your talkback  Personalize the discussion to your audience 6. Review definitions (risk factors, etc.)  Be prepared to communicate these terms to your staff 7. Understand myths/facts about depression and suicide  Refer to examples in your Implementation Guide

29. Staff Meeting: Step by Step 1. Distribute disclosure guidelines for staff.  Review your district’s crisis response protocol.  Review how staff should proceed if approached by a student for help. 2. Show the Training Trusted Adults DVD. 3. Facilitate a follow-up conversation using the discussion guide (including definitions, myths/facts). 4. Allow extra time for q & a with your staff.

30. Parent/Community Night: Step by Step 1. Review your district’s crisis response protocol. 2. Show the Training Trusted Adults DVD. 3. Facilitate a follow-up conversation using the discussion guide (including definitions, myths/facts). 4. Review school policy for following up with at-risk students, including how and when parents/guardians will be contacted if their child needs further help. 5. Encourage parents to talk to their children about depression, suicide, and mental health! 6. Provide parents/guardians with school and community-based mental health resources in your area.

31. Identify & train your team Decide on format Engage your gatekeepers Prepare for follow-up Start small and pilot-test Gatekeeper Training is a Crucial Part of Program Design

32. For more information contact: Screening for Mental Health Meghan Diamon, LCSW mdiamon@mentalhealthscreening.org 781-591-5230 Or visit: www.MentalHealthScreening.org Screening for Mental Health, Inc. One Washington Street, Suite 304 Wellesley Hills, MA 02481 P: 781.239.0071 F: 781.431.7447 www.MentalHealthScreening.org

33. References American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC. Aseltine, R., et al. (2007). Evaluating the SOS suicide prevention program: A replication and extension. BMC Public Health 7(161). Aseltine Jr., R.H. & DeMartino, R. (2004). An Outcome Evaluation of the SOS Suicide Prevention Program. American Journal of Public Health, 94 (03), 446- 451. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS) [online]. (2005) [cited 2011 Feb.16]. Available from URL: www.cdc.gov/ncipc/wisqars www.cdc.gov/ncipc/wisqars

34. References Gould, M., et al. (2003). Youth suicide risk and preventive interventions: A review of the past 10 years. Journal of the American Academy of Child and Adolescent Psychiatry, 42 (4), 386-405. Gould, et al. (2007). Evaluating Iatrogenic Risk of Youth Suicide Screening Programs. American Medical Association, 293(13), 1635-1643. Kataoka, S.; Zhang, L.; & Wells, K. (2002). Unmet need for mental health care among U.S. children: Variation by ethnicity and insurance status. American Journal of Psychiatry, 159 (9), pp. 1548-1555. National Alliance of Mental Illness (NAMI). (2003). Depression in Children and Adolescents. Retrieved on June 16, 2009 from http://www.nami.org/Template.cfm?Section=By_Illness&template=/Content Management/ContentDisplay. cfm&ContentID=17623 http://www.nami.org/Template.cfm?Section=By_Illness&template=/Content Management/ContentDisplay. cfm&ContentID=17623

35. References Schilling, E. A., Aseltine, R. H., Glanovsky, J. K., James, A., & Jacobs, D. (2009). Adolescent alcohol use, suicidal ideation, and suicide attempts. Journal of Adolescent Health, 44,335-341. Substance Abuse and Mental Health Services Administration. (2012). Results from the 2010 National Survey on Drug Use and Health: Mental Health Findings, NSDUH Series H-42, HHS Publication No. (SMA) 11-4667. Rockville, MD: Substance Abuse and Mental Health Services Administration. UCLA Center for Mental Health in Schools. School community partnerships: a guide. Retrieved from http://smhp.psych.ucla.edu/pdfdocs/guides/schoolcomm.pdf http://smhp.psych.ucla.edu/pdfdocs/guides/schoolcomm.pdf World Health Organization. (2006). WMO Statement on Adolescent Suicide. http://www.wma.net/en/30publications/10policies/a9/index.html.pdf?print- media-type&footer-right=[page]/[toPage] http://www.wma.net/en/30publications/10policies/a9/index.html.pdf?print- media-type&footer-right=[page]/[toPage