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October 2013 CSSW Conference Ellen Kelty, MA, NCSP Nationally Accredited School Suicide Prevention Specialist Mental Health and Assessment Services Denver.

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Presentation on theme: "October 2013 CSSW Conference Ellen Kelty, MA, NCSP Nationally Accredited School Suicide Prevention Specialist Mental Health and Assessment Services Denver."— Presentation transcript:

1 October 2013 CSSW Conference Ellen Kelty, MA, NCSP Nationally Accredited School Suicide Prevention Specialist Mental Health and Assessment Services Denver Public Schools Ellen_kelty@dpsk12.orgEllen_kelty@dpsk12.org 720-423-8164

2 In 2011, there were: 195 Homicides 482 Motor vehicle deaths 610 Influenza and pneumonia deaths 790 Diabetes deaths 910 deaths by Suicide According to Colorado Health Info Dataset (COHID) http://www.cdphe.state.co.us/cohid

3 22 percent reported feeling so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities during the past 12 months 11.4% percent reported making a plan during the past 12 months 6 % reported an actual suicide attempt in the past 12 months http://www.cdphe.state.co.us/hs/yrbs/yrbs.html

4 17.4 percent reported feeling so sad or hopeless almost every day for two weeks or more in a row that they stopped doing some usual activities during the past 12 months 10.4% percent reported making a plan during the past 12 months 5.7 % reported an actual suicide attempt in the past 12 months http://www.cdphe.state.co.us/hs/yrbs/yrbs.html

5 Statewide, suicide is the 2 nd leading cause of death for people 10 - 24 years old In 2008 Colorado had the seventh highest rate of suicide in the country http://webappa.cdc.gov/sasweb/ncipc/mortrate. html Ellen Kelty, MA, NCSP October 2013

6 Given the strong correlation between suicidal and violent behavior, addressing suicidal behaviors may help address other violent behaviors. 78% of school attackers exhibited a history of suicide attempts or suicidal thoughts at some point prior to their attack. `(US Secret Service Report Safe School Initiative) Ellen Kelty, MA, NCSP October 2013

7 Any youth can become suicidal Suicide deaths in Colorado 76% are male 84% are white Non-Hispanic (2006) Hospitalizations 59% of hospitalizations for suicide attempts are female 75% are white Non-Hispanic (2004) Psychological autopsy studies have found that 90% of teen suicides could be retrospectively diagnosed with one or more mental disorders (American Association of Suicidology Resource Guide 2008) Ellen Kelty, MA, NCSP October 2013

8 LGBTQQ students Students involved with juvenile justice system and foster care Latino students Students with disabilities Ellen Kelty, MA, NCSP October 2013

9 LGBTQQ youth have a significantly higher rate of attempting suicide Most attempts among LGBTQ populations occur during adolescence and young adulthood 2005 MA YRBS – Students who self-reported as LGB were 4x as likely to report attempting suicide in the last year as compared to non-LGB counterparts LGBTQQ youth are more likely to be bullied, homeless, and ostracized by family because of their sexual preference or gender identity Suicide Risk and Prevention for Lesbian, Gay, Bisexual, and Transgender Youth, Suicide Prevention Resource Center

10 Operates the nation’s only 24-hour toll-free suicide prevention helpline for LGBTQQ youth 1.866.4.U.TREVOR www.thetrevorproject.org Ellen Kelty, MA, NCSP October 2013

11 10% of CO youth are involved in either or both the juvenile justice and child welfare systems Risk of suicide among adolescents involved with either the juvenile justice or child welfare systems was 5 x as high as those in the general adolescent population (Farand, Chagnon, Renaud, Rivard, 2004) Ellen Kelty, MA, NCSP October 2013

12 Chicago research project of 1829 youth More than 1/3 of the youth and nearly 50% of females had felt hopeless or thought about death in the 6 months prior to detention 10% had thoughts about committing suicide in the past 6 months 10% had ever attempted suicide Recent suicide attempts were most prevalent in females and youth with major depression and generalized anxiety disorder Fewer than 50% with recent thoughts of suicide had told anyone about their ideation Abram, Choe, Washburn, Teplin, King, and Dulcan(2008) Ellen Kelty, MA, NCSP October 2013

13 Probation offenders with 8+ offenses are 5 x at risk 90% of probation officers stated they are completely or somewhat responsible for mental health information about youth they supervise 40% of probation officers indicated that it is acceptable for youth to pass through intake, adjudication & disposition without receiving a full assessment 75% of probation officers indicated no one in their setting is responsible for mental health assessment Wasserman, McReynolds, 2002 Ellen Kelty, MA, NCSP October 2013

14 2 ½ x more likely to seriously consider suicide 4x more likely to have attempted suicide (Pilowsky & Wu, 2006). 8-year-olds who were maltreated or at risk for maltreatment, nearly 10% reported wanting to kill themselves (Thompson, 2005). Experiencing childhood abuse or trauma increased the risk of attempted suicide 2 to 5x (Dube et al., 2001) 2/3 of suicide attempts may be attributable to abusive or traumatic childhood experiences (Dube et al., 2001) Ellen Kelty, MA, NCSP October 2013

15 School Reporting depression Reporting they have a plan Reporting they have attempted DPS (6 to 12 th graders)25%13%8% Alternative School#1 MS 30%16%18% Alternative School #1 HS 30%16%18% Alternative school # 2 HS 30%11%6% Alternative to Expulsion School MS 38%40%31% Alternative to Expulsion School HS 29%27%25% Ellen Kelty, MA, NCSP October 2013

16 Students in special education have higher rates of suicidal ideation and suicide attempts These students have higher depression scores A relationship exists between students having SIED and suicidal ideation and attempts Adolescent females in special education think more about suicide and attempt more often than adolescent females in general education (Wachter and Bouck, Teaching Exceptional Children, 2008) Ellen Kelty, MA, NCSP October 2013

17 Hispanic students considered suicide 2x more often than white students Among females, over 32% of Hispanic girls considered suicide. This number is more than 2x the percentage of white girls (15%) (Center for Disease Control and Prevention National Study, 2007) Ellen Kelty, MA, NCSP October 2013

18 What factors might be protective and help student to avoid suicide? Ellen Kelty, MA, NCSP October 2013

19 Self-esteem Involvement in community Religious belief system Coping strategies good problem solving skills Strong support system Optimism Ellen Kelty, MA, NCSP October 2013

20 Increase when these factors occur at same time Biological Factors Risk Factors Warning Signs Immediate Trigger or Crisis Model from American Association of Suicidology Ellen Kelty, MA, NCSP October 2013

21 Psychopathology Prior attempts People who have attempted suicide are more likely to succeed in the future Family Problems Poor Coping Skills Cognitive Inflexibility Having alcohol or drug problem 50% of teens who die by suicide have a high blood alcohol content at time of death Ellen Kelty, MA, NCSP October 2013

22 Suicidal behavior runs in families Identical twins higher rates then fraternal twins Biological parents of teen suicides are more likely to have suicidal histories then do adoptive parents Ellen Kelty, MA, NCSP October 2013

23 Acute Risk Factor Red Flag Suicidal ideation Looking for ways to kill self, practice Increasing alcohol, drug use Withdrawing from friends, family Dramatic mood changes Anxiety, agitation, sleep disturbance Rage, uncontrolled anger Hopelessness Ellen Kelty, MA, NCSP October 2013

24 Legal or disciplinary crisis most common Break up with girlfriend/boyfriend Public Humiliation/Shame Major Loss Sense of Failure Ellen Kelty, MA, NCSP October 2013

25 Think their problems are unsolvable Thinking narrows until they can’t see other solutions Are dangerous to themselves for 24 - 78 hours (Nelson and Galas) Ellen Kelty, MA, NCSP October 2013

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28 Among females may be related to the stress caused by the expectation of obligation to the family May experience stress with the conflict between placing family needs above individuals needs and what is taught in the mainstream culture about the importance of individuality Recently immigrated families may not understand the health care system and may be reluctant to seek help in the fear of being reported as undocumented Families may avoid seeking mental health help because they feel that suicide should be dealt with by the family or faith community First Language differences are a barrier to seeking help Family closeness and good relations with parents are resiliency factor Ellen Kelty, MA, NCSP October 2013

29 Girls struggle to reconcile two cultures The greater the level of emotional attunement and understanding between the daughter and her parents, the less likelihood of a suicide attempt Typical Latina teen who attempts suicide 14 or 15 the daughter of immigrant parents lives in a low-income setting is caught in an intense battle with her mother over Latino and American cultures. Zayas, Latinas Attempting Suicide: When Cultures, Families and Daughters Collide Ellen Kelty, MA, NCSP October 2013

30 Values Family has a governing role Family cohesion, obligation Intense attachment to relatives Deference to parents’ and the family’s needs Interdependence Cultural traditions socialize women to be passive, demure, and responsible for family obligations, unity, and harmony A girl’s perception of causing a breach in family integrity may be a precondition for her suicide attempt (Zayas, et all 2005, retrieved on 4-7-2012 at http://www.cathexa.com/uploads/Latina_Suicide.pdf) Ellen Kelty, MA, NCSP October 2013

31 African Americans don’t die by suicide Myth within the culture and in dominate culture Women are strong, resilient and never take their own lives Men are macho and never take their lives African Americans don’t have depression Faith based culture therefore suicide does not occur Every 4.5 hr, one African American dies by suicide Suicide in this population is responsible for 73,065 years of potential life lost (Crosby & Molock, 2006). Ellen Kelty, MA, NCSP October 2013

32 Rates were low until the beginning of the 1980’s when rates started to increase radically Between 1981 and 1994, the rate increased 78% Since then, the rate has decreased significantly White youth are almost 2x as likely to die by suicide Firearms are the predominant method of suicide regardless of gender and age, accounting for roughly 50.4% of all suicides National Center for Injury Prevention and Control www.cdc.gov/ncipc/wisqars, 2009 www.cdc.gov/ncipc/wisqars Ellen Kelty, MA, NCSP October 2013

33 Adolescents have both the highest number and the highest percentage of suicides in all of the African American population, and cohort studies have shown them to be more at risk than older generations (Crosby & Molock, 2006; Joe, 2006) Resource: http://www.nopcas.com/index.htmlhttp://www.nopcas.com/index.html Ellen Kelty, MA, NCSP October 2013

34 Asian-American women ages 15-24 have the highest suicide rate of women in any race or ethnic group in that age group Suicide is the second-leading cause of death for Asian-American women in that age range Ellen Kelty, MA, NCSP October 2013

35 Higher rates among teens with lower acculturation parent-child conflict collectivist/family-harmony values 72. Lau AS, Jernewall NM, Zane N, Myers, 2008 Protective factors Religiosity Family cohesion are protective against suicidal thoughts Zang 1996 Ellen Kelty, MA, NCSP October 2013

36 Stress related to being model minority Expected to excel academically Problems should be dealt with in the family Value of privacy regarding family matters Females The cultural expectations may conflict with expectations of dominate culture May not have freedom to socialize outside of school as much as white students Ellen Kelty, MA, NCSP October 2013

37 Native youth have an average suicide rate 2.2x higher than the national average (CDC, 2005) On certain reservations, the incidence of youth suicide has been documented at 10 times the national average North Dakota 2004 there was an average of 6 suicide attempts and 1 completion for every 5 days Senator Byron L. 2010 Dorganhttp://www.apa.org/pubs/journals/features/ser-7-3-213.pdf Significantly fewer (21%) urban-reared AI/AN youth were found to have suicide ideation versus 33% among reservation-reared youth Cultural spiritual orientation is a protective factor Freedenthal, S. & Stiffman, A. R. (2004) Ellen Kelty, MA, NCSP October 2013

38 Jose is a Latino boy in fostercare. He attends a small school and is involved in art at the school He recently was taken to the detention center for stealing a car. On the way there he kept saying he was suicidal. Table top Discussion What are Jose’s risk factors? What are resiliency factors for Jose? How will his cultural background impact his situation and need for treatment Ellen Kelty, MA, NCSP October 2013

39 Cultural views of mental illness Cultural views about mental health treatment Mistrust of mental health system Lack of culturally responsive treatment Access to treatment Concern about undocumented status Stigma regarding seeking help Language differences Disconnect between faith and counseling services Ellen Kelty, MA, NCSP October 2013

40 Include parents and extended family Value and incorporate religious belief system Be aware that depression or suicidal ideation maybe expressed differently than in white culture Ellen Kelty, MA, NCSP October 2013

41 Spiritual beliefs may be extremely relevant There are many religions which denounce suicide Child’s understanding of death may not be developed, may not understand death is permanent Younger youth may want to die to be with family member A fantasy may be that post suicide, a person is able to witness the impact on others, gaining revenge for a hurt. Lack of spiritual belief or naïve concepts of death may predict lethality (Zadah and Sandoval 2008) Ellen Kelty, MA, NCSP October 2013

42 Individual- Think of the most difficult case that you have had with a suicidal youth What was the situation? Who was involved- what were the cultural differences between yourself and youth involved? Was the treatment successful? What if anything could have been done differently? Ellen Kelty, MA, NCSP October 2013

43 Talking about suicide will not give students the idea to complete suicide Discussing the subject openly and showing that you care is one of the most helpful things that you can do Ask directly, “Are you thinking of killing yourself?” Ask even when they do not bring it up Always ask about prior attempts Ellen Kelty, MA, NCSP October 2013

44 ASK— “Are you having thoughts of suicide?” Have you tried to kill yourself before? How did you try/would you do it? LISTEN— “Tell me what’s been going on for you.” TAKE ACTION. DO a suicide risk assessment- Connect to supportive services Ellen Kelty, MA, NCSP October 2013

45 Research has shown that suicide risk assessments are effective in preventing suicide in middle and high school students Identifying and assessing students who are considering suicide are clearly effective means of preventing it (Crepeau-hobson 2011) To date, DPS has not lost a student to suicide when an SRR was completed. Ellen Kelty, MA, NCSP October 2013

46 3 School Districts Research- Based Suicide Prevention and district wide Suicide Risk Assessment Of 3443 students assessed over a three year period, none went on to commit suicide Conversely the small number of students who committed suicide during that time were not previously assessed by school personnel – Crepeau-Hobson, UCD 2012 Assessment + Prevention = Saving Lives – Slide used with permission from Ron Lee, CCSD Ellen Kelty, MA, NCSP October 2013

47 Should occur whenever a student conveys an intent to harm themselves Intent can be conveyed a numbers of ways – verbal and written statements, drawings, song lyrics etc. Intent is appearing on Facebook, Ims, and text messages Need to consult? Contact: Mental Health & Assessment at 720-423-8034 Ellen Kelty, MA, NCSP October 2013

48 Make sure the student is safe Do not leave them alone Notify the building leader immediately that you have a suicidal student and are doing an assessment Document the incident in detailIt is recommended that this process include two staff members with mental health training Ellen Kelty, MA, NCSP October 2013

49 Emergency Contract for Parents is completed Available in English and Spanish Needs to be signed by the parent or guardian Parents receives a copy If unable to reach parent or guardian Document attempts May need to do home visit Can request police to do welfare check Ellen Kelty, MA, NCSP October 2013

50 Talk to others involved with the student to get more background information Ellen Kelty, MA, NCSP October 2013

51 Interview and Assess the Student Complete all sections thoroughly Document why the SRR is being completed What happened When did it occur What was the trigger Check the warning signs Medication and Psychiatric Diagnosis Special Education/Section 504 status Look at strengths and coping skills Ask, in detail, questions to assess suicidal thinking and behavior Ellen Kelty, MA, NCSP October 2013

52 With colleague, determine level of risk Consider: Specificity of plan Lethality of means Availability of resources to do the plan Proximity of supportive person Ellen Kelty, MA, NCSP October 2013

53 Usually need to go directly to the hospital or have just gotten out of the hospital Plan is concrete and student has access to the means If requesting a police transport or a 72 hour mental health hold, call 911. Ellen Kelty, MA, NCSP October 2013

54 List referrals given to the family (be sure they are current) Make sure referrals are appropriate for the student Consider his or her culture, language, and religion Ellen Kelty, MA, NCSP October 2013

55 Great referral for depressed and suicidal students Pays for licensed counseling for students at-risk for suicide The mental health staff member at the school must contact the Second Wind Fund www.swfmd.org They receive a referral number needed to begin counseling Ellen Kelty, MA, NCSP October 2013

56 What can the school do to ensure safety? Increase supervision Daily or weekly check-in/check-outs Referral to SIT, 504 or IEP Team, as appropriate Address the problem identified as the trigger Ask the student and parent what would help  Obtain signatures at bottom of page Ellen Kelty, MA, NCSP October 2013

57 Available in English and Spanish If the student won’t sign.. it might be a high risk case Help the student identify support people Ensure they have someone to talk to outside of school Give the student a copy of the form Program emergency numbers in their cell phone Give the Trevor Project and the National Lifeline Number Meet with the staff people that are listed on the SRR to discuss the student’s needs Ellen Kelty, MA, NCSP October 2013

58 Be aware of possible contagion issues Check for depression in referring student Release them from responsibility Thank them for the courage they demonstrated Answer questions they may have, while Ellen Kelty, MA, NCSP October 2013

59 Need to develop awareness of how our own behaviors and background impact our interactions with youth Our cultural background influences our views of suicide, mental illness and counseling Students and parents will perceive us a certain way based on dimensions of our culture We will perceive the student and parent a certain way based on dimensions of our culture We have to be aware of this and adapt our work to meet the needs of the student Ellen Kelty, MA, NCSP October 2013

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61 The Three-Tiered Instruction Model Tier 3 1-7% Tier 2 5-15% Tier 1 80-90% Academics Behavior UNIVERSAL Tier One High quality instruction in both academics and behavior and social- emotional support for all students TARGETED Tier Two Targeted, specific prevention or remediation instruction and interventions for students whose academic performance or behavior lags behind the norm for their grade and educational setting INTENSIVE Tier Three Intensive, individualized instruction for students who have an insufficient response to evidence-based interventions in the first two tiers Ellen Kelty, MA, NCSP October 2013

62 School wide suicide prevention curriculum Signs of Suicide (SOS) FIRE Within Sources of Strength Yearly school wide parent and staff training English and Spanish School wide social-emotional programs Increase student engagement at school Increase On increasing student self-esteem Increase student feeling of safety at school Examples PBIS, school wide bully-prevention Ellen Kelty, MA, NCSP October 2013

63 Should be evidence based Increase adult and student awareness of suicidal behavior and warning signs Teach students how to respond Identify students at risk Often screen for risk Ellen Kelty, MA, NCSP October 2013

64 Students three months after receiving the training were 40% less likely to report a suicide attempt in the three months after the program (Aseltine & DeMartino, 2004) The beneficial effects of SOS were observed among high school-aged youth from diverse racial/ethnic backgrounds, highlighting the program's utility as a universal prevention program (Aseltine, James, Schhilling, and Glanovsky 2007) Used in Cherry Creek, Douglas County and DPS Ellen Kelty, MA, NCSP October 2013

65 Recommended by NASP, Safe and Drug Free Schools Middle school curriculum recognized by the Suicide Prevention Resource Center and the American Foundation for Suicide Prevention as a best practice Research based Diverse students on DVD Tier One Program Inexpensive $395 a kit Easily implemented Students really enjoy it Recommended as postvention program by NASP Ellen Kelty, MA, NCSP October 2013

66 Identify symptoms of depression and suicidality in themselves or their friends Respond effectively by seeking help from a trusted adult Suicide is directly related to mental illness, typically depression Suicide is not a normal reaction to stress or emotional upset Ellen Kelty, MA, NCSP October 2013

67 “My friend would have been alive if we had received the SOS program last year!” seventh grader Ellen Kelty, MA, NCSP October 2013

68 Free, high-touch, transformational suicide prevention program provided by the Carson J Spencer Foundation in partnership with Junior Achievement and the Second Wind Fund Address this problem by giving the students the skills they need to start a profitable business that raises awareness about and prevents suicide A classroom of 20 students will impact 2,000 or more community members! By the end of the year: 91% of student body can demonstrate knowledge/awareness about suicide 74% demonstrate positive behavior around mental health advocacy 88% believes the business was successful in making money AND preventing suicide Ellen Kelty, MA, NCSP October 2013

69 Focus on high risk populations Focus on students with risk factors Staff development and direct consultation/coaching on programs that decrease suicide risk by increasing self-esteem, and involvement in schools Specific programing for students Examples: Gay/Straight Alliance (GSA) Grief support Restorative Approaches (RA) Whytry groups Denver Kids mentors Ellen Kelty, MA, NCSP October 2013

70 Approximately 24,000 children ages 18 and under suffer from the death of a parent to suicide each year in the USA Crossing 13, Memoir of a Father’s Suicide by Carrie Stark Hughes for teens SOS, A Handbook for Survivors of Suicide. Washington DC: American Association of Suicidology. http://www.suicidology.org. http://www.suicidology.org Bart Speaks Out: Breaking the Silence on Suicide by Linda E. Goldman, and Jonathan P Goldman Ellen Kelty, MA, NCSP October 2013

71 Work to end bias and harassment Gay/Straight Alliance Day of Silence Ally Week Tools for Developing and Implementing a Safe Schools Campaign” at www.glsen.orgwww.glsen.org Ellen Kelty, MA, NCSP October 2013

72 Suicide Risk Assessment Suicide Risk Assessments…. completed whenever there is a credible threat of significant self-injury Emergency consultation for students in crisis Re-entry process for students returning after an attempt Consultation regarding supporting students who have lost a family member or friend to suicide Postvention Support District Crisis Response Team (DCRT) to provided support following a student death by suicide Consultation on best practice postvention interventions to avoid risk of further deaths Ellen Kelty, MA, NCSP October 2013

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74 Suicide contagion is exposure to the suicide of others that causes an increase in or outbreak of suicidal behavior The teens do not need to have known the person who died to be vulnerable to this risk Teens and young adults appear to be especially susceptible to contagion Schools must be careful around poetry, artwork etc. that highlights suicide or cutting behavior Ellen Kelty, MA, NCSP October 2013

75 Write your pledge and share with a neighbor Pledge: To do this I need to: I will do this by (date) What is your first step? Challenges I might face: I will handle the challenges by: Ellen Kelty, MA, NCSP October 2013

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