1. Resources for Strengthening Suicide Crisis Response and Prevention Systems in Schools
April 6, 2018
Intro, thank you, workshop title. Has to do with state policy AB2246, requiring public schools grades 7-12 to have policies around suicide crisis response and prevention
County working with Stanford and HEARD Alliance team to provide support on this policy
In addition to today’s team: Dr. Shashank Joshi, Jasmine Lopez
Also Linda Lenoir, District Nurse for Palo Alto Unified for 26 years, helped to found HEARD Alliance in Palo Alto, and one of the creators of the K-12 Toolkit for Mental Health Promotion and Suicide Prevention
Linda - family emergency; Jonathan Frecceri
Introductions: Jonathan, Christine, Mary, Zinat, Nadia

2. Needs assessment findings
AGENDA
Introductions
Needs assessment findings
What are your top three concerns/issues/ questions?
Panel discussion
Promotion: Staff suicide prevention trainings
Promotion: Student mental health education
Intervention
Postvention
Debrief/wrap-up
Issued needs assessment survey to all school districts in SCC, looking to get an idea of where schools are at and what their primary concerns are
Will share findings of survey to set stage for panel and conversation
While listening please think about your top three concerns, issues, questions around suicide crisis response and prevention at your school
After findings will ask you to write these down so that panelists can address those questions in their sections
Panel discussion - about 40 min; each panelist will present a different topic
5 minutes at end for wrap-up and evaluations

3. Needs Assessment Findings
Please consider your own top issues/concerns/questions - will ask you afterwards - write on Post-Its
2 additional surveys received this week, so numbers have been updated and slightly different from printed slides

4. Approx. 56,344 students represented 11 high schools 13 middle schools
RESPONSE OVERVIEW
Total: 25 (22 usable)
14 school districts
Approx. 56,344 students represented
11 high schools
13 middle schools
2 elementary
Respondents: Principals, Student Services Coordinators, Associate Superintendents, School Counselors
32 SCC school districts
Responses geographically spread across County, from North (Palo Alto) to South (Gilroy)

5. Psychologists: 1.4 per 1,000 students LMFTs: 1.9 per 1,000
MENTAL HEALTH CLIMATE
Staffing (averages)
Psychologists: 1.4 per 1,000 students
LMFTs: 1.9 per 1,000
Licensed Social Workers: 0.1 per 1,000
Others: guidance counselors, behaviorists, interns
Mental health clubs/support groups: 16 of 23 (70%)
On average, limited mental health staffing
Some schools supplementing with interns or part-time staff, partnerships
Speaks to importance of creating climate of MH on campus - good to see a majority of schools with MH clubs or support groups

6. Recent suicide(s) experienced by school community (2015-2018) % Count
MENTAL HEALTH CLIMATE
Recent suicide(s) experienced by school community ( ) %
Count
Yes
21.7% 5 No
78.3% 18
Total
100% 23
Comfort level with addressing topics of youth mental health and suicide prevention (1-10): Mean 6.5

7. DOES YOUR SCHOOL CURRENTLY HAVE A SUICIDE PREVENTION AND INTERVENTION POLICY IN PLACE?
YES
YES, and we are in the process of updating it
NO, we are in the process of developing it
All respondents either have a policy or are in the process of developing one NO

8. DOES YOUR SCHOOL HAVE A TEAM IN PLACE FOR MENTAL HEALTH CRISIS INTERVENTION/RESPONSE?
YES NO
In progress
Almost every responding school has an intervention team in place
1 in progress

9. WHAT ASPECT(S) OF SUICIDE PREVENTION IS YOUR SCHOOL MOST INTERESTED IN RIGHT NOW?
POSTVENTION
INTERVENTION
Most interest in Promotion/Prevention
Indicates strong interest in being prepared to respond in Intervention and Postvention (following a suicide)
PROMOTION

10. INTERVENTION AND POSTVENTION
Low risk Moderate risk Attempts Postvention
Support for low-risk students
Support for students with moderate risk
In-school suicide attempts
Out-of- school suicide attempts
Re-entry after suicidal crisis
Response to suicide deaths
Yes
77%
14%
50%
23%
In Progress 9%
41%
36%
27% No 0%
45%
Summary of responses about schools having action plans/processes in place for different levels of intervention
Organized from plans for low-risk students, to higher risk, to attempts, re-entry, and response to deaths/postvention
Majority answers are highlighted

11. Trainings Received in Past School Year
PROMOTION
Awareness of administration and staff about safe messaging best practices: 6.7 out of 10
Trainings Received in Past School Year
School mental health professionals (1)
Teachers (2)
Other school staff (3)
Students (4)
Yes
64%
36%
32% No
68%
(1) QPR, YMHFA, SafeTALK, ASIST, Kognito, AMSR, Suicide to Hope, on-site
(2) QPR, SafeTALK, ASIST, Kognito, Keenan Safe Schools online module, on-site
(3) QPR, other training by school counselors
(4) More than Sad, Kognito, Sources of Strength, Other (Second Step/Step Up to Thrive, Life Skills, ACT)

12. IS SOCIAL EMOTIONAL LEARNING TAKING PLACE AT YOUR SCHOOL?
YES NO
More on broader mental health climate at schools - almost all had some form of SEL taking place
Examples in chart below
Christine to talk more about integrating suicide prevention/promotion into what’s already going on at school
PBIS
AcaPrep (AVID-like curriculum)
Project Cornerstone, Club 47
Life Skills, Olweus Bullying Prevention, Be Seen and Heard
Mission Be
Why Try
The Character in Focus Collection
Restorative justice practices
School Connect
Second Step, Step Up to Thrive
Mindfulness curriculum

13. TOP THREE ISSUES OR QUESTIONS
Promotion (22)
-**Trainings (parents, staff, admin, counselors, students)
-*Systemic, sustained education and awareness
-*Promoting SEL, mindfulness, comprehensive wellness
-Fighting stigma
-Negative impacts of social media on mental health
-Cross-cultural connections
Crisis intervention and response (11)
-*Intervention/response protocols, developing plans
-*Re-entry/safety plans, after-care
-Confidentiality
-CPS response
General mental health services for students (8)
-Staffing, increasing/maintaining support during fiscal uncertainty
-Improving counseling for students on- site/ continuous improvement
-Wrap-around services, linkages to outside agencies, long-term therapy
Postvention (3)
-Protocol for postvention
-Handling social contagion of suicide
** or * high frequency response
How we have generally structured panel

14. WHAT ARE YOUR TOP THREE CONCERNS/ISSUES/QUESTIONS?
Consider/discuss
Write down (one issue per Post-it)
Post under Promotion, Intervention, Postvention, Other

15. Promotion: Staff Suicide Prevention Trainings

16. INCREASING ACCESS: GATEKEEPER TRAININGS
Tier 3: ASIST, Suicide to Hope
Suicide to Hope/ASIST: Clinicians
Tier 2: ASIST
ASIST: Mental health professionals, first responders
A trainings model
Youth Mental Health First Aid: Parents
More than Sad/Youth QPR/Break Free From Depression: Students
QPR: school staff, teachers
Tier 1: QPR, More than Sad, Youth Mental Health First Aid, Break Free From Depression

17. Mental Health/Suicide Prevention Training Sequence1
School staff/MH Professionals 2
Administrators/ Teachers/Parents 3
Students
Staff and teachers must have adequate training before student trainings take place. Once you train students, you will get an increase in referrals.

18. Provide an overview of the trainings and how they differ
Provide an overview of the trainings and how they differ. Provide training materials.

19. Promotion: Student Mental Health Education

20. Assessment and Referral Forms
Education/Training
Depression Awareness
Suicidal Ideation
Sleep
Self-Care
Mental Health Resources
Community
Online/Crisis Lines
Grief Support
Safe & Caring School Environment
SEL
Mindfulness
PROMOTION
Protocols
Red Folder
Crisis Response Team
Assessment and Referral Forms
At-Risk Students
Identification
Monitoring
These are recommendations for what we are finding that works.
Safe and Caring School Climate and Education/Training - how do you increase student connectedness? Is there someone you can connect with on campus? Just by starting the conversation, you are creating a pathway for students to come forward when they need the support or help
At-Risk Students and Protocols: you will never get to this piece if you don’t have a relationship with the students and start the conversation

21. Safe and Caring School Climate
· Safety & Discipline
· Teacher Connectedness
A teacher or some other adult who: really cares about me; tells me when I do a good job; would notice when I’m not there; always wants me to do my best; listens to me when I have something to say; believes that I will be successful
· School Connectedness or Sense of Belonging
I feel close to people at school; I feel like I am part of this school; I am happy to be at school; the teachers treat students fairly
· Peer Support
How often would students: tell you you’re good at things; explain something if you didn’t understand; invite you to do things with them; help you if you are hurt; miss you if you weren’t at school; help you if something is bothering you; ask to work with you; help you if other students treat you badly; share things with you

22. MENTAL HEALTH EDUCATION IN SCHOOLS
Mental health in youth programs means integrating mental health education in clubs and after-school programs

23. Student Referral Process
What is the process for referring a friend or making a self- referral?
Procedures for how student referrals are managed and addressed must be explicitly shared with students.
List the names and role of each staff member in the Front Office/Counseling Office
Map and list the school and community-based mental health resources
Explain how mental health referrals are tracked and monitored
Provide an anonymous reporting box (Refer-a-friend box)
Establish a problem-solving process
Be clear about what the school is able to offer and when a student is referred to mental health providers outside of school

25. SEL Skills Important for Mental Health Promotion
Problem Solving
achieve goals, positive decision-making, managing social scenarios
Self- Control or Self-Regulation
being able to direct attention, thoughts, impulses, and emotional control
Trust and Help Seeking
increases prosocial behaviors
Decreasing Self-Destructive Behaviors
SEL skills gained leads to decreased self-destructive behaviors

26. Skill-building programs (e.g. youth QPR, Kognito “Friend2Friend”
STUDENT EDUCATION
Mental health curricula (e.g. More than Sad, Break Free from Depression)
Skill-building programs (e.g. youth QPR, Kognito “Friend2Friend”
Peer leader programs (e.g. Sources of Strength)
Mental health information and resource information (Appendix B3)
FAQs (Appendix B1)
What is the process for referring a friend or self-referral? Each site should identify site protocols or create a template

27. Student Education All are evidence-based and
Some of you have heard of some of these and some of you have not
More Than Sad: we do not recommend this for high school students; kids want the situations to look and feel real; would be better for middle school and adults

28. Student Education
Kognito: excellent training tool; interactive; biggest challenge is the cost; now have 5 evidence-based training modules; monthly updates on usage, completion rates,
Sources of Strength: students are trained and running it; peer-led conversation to reduce stigma and prevent suicide; refer to the wheel when every month refers to something else; Gunn, Paly, SHS, SI; students are recommended by teachers and the founder comes to train students; some schools integrate spirituality; advisors and teachers are hands-off; requires 3 years of data collection
BFD: all grades receive the education; universal education; question lately has been if the students should receive a refresher class; comes with activities; menu of 10 activities that breaks down into 60% activity and 40% conversation; students are not comfortable talking to a complete stranger; format: ppt-ppt-video-discussion; just release SEL training; very authentic in their presentation; mental health team on-site offers the training on site; you train yourself at your own pace

29. MENTAL HEALTH INVENTORY
the inventory is a helpful guiding tool to use as they are implementing social, emotional, and mental health promotion in their school

30. Intervention

32. INTERVENING IN A MENTAL HEALTH CRISIS

33. IDENTIFYING AND MONITORING AT-RISK STUDENTS

38. NOTIFYING FAMILIES, SAFETY PLANNING, REFERRALS

39. Postvention (= Prevention)

40. Goals of Postvention
Treat a loss to suicide like any other sudden loss such as a heart attack or car accident death
Support all members of the school community
Prevent a contagion or cluster
Identify, monitor and support vulnerable students who are now at increased risk of suicide
Return school to regular routine as soon as possible - usually within a week.
Note: All members of the school community are initially in crisis. The Toolkit is designed to support all individuals through simple and clear protocols

41. Sample Scripts, Letters & Announcements
Day by Day Guide
Notifications, supports, talking points about suicide, addressing grief
Sample Scripts, Letters & Announcements
Minimizing Risk of Contagion
Working with Media
Identify & Support vulnerable students
POSTVENTION
Actions After a Suicide
Memorialization Recommendations
Meaningful & safe
Short term & long term Preparing for anniversaries & special events
Student, Staff & Family Supports
Initial staff meeting agenda, grief support, assess students, assist staff

42. Additional Issues of Concern
Contagion and Clusters (Attachment 2.19)
Teens vulnerable to adverse effects of exposure to the suicide of a peer
A Cluster is an excessive number of suicides occurring in close temporal &/or geographical proximity
Teens who die within localized communities are more likely to have pre-existing vulnerabilities
Prevent contagion by identifying vulnerable students
More likely to have these risk factors: previous suicidal thoughts or behaviors, having been hospitalized for a mental health or substance abuse problem, recent or anticipated relationship break-up, physical self injury or physical violence towards others
Media coverage can contribute to contagion or prevent contagion depending on how suicide is presented (see Media Guidelines attachments 3.18i, 3.18ii & 3.22)

43. Additional Issues of Concern con’t
Transitioning - Primary school through life after school (Attachment 1.2)
Can be stressful experiences for students particularly after a suicide
Additional support needed at these times
What to do when a student expresses suicidal thoughts or behaviors
QPR as a Universal Intervention (Attachment 1.13a)
QPR Guidelines for Students - Safe Delivery of Suicide Prevention for Youth (Attachment 1.13b)
For Parents: “When Your Child Expresses Suicidal Thoughts” trifold (Attachment B4)

44. FAQs http://www.heardalliance.org/help-toolkit/
What is expected development during adolescence?
What is normal/abnormal teenage behavior?
What is depression?
How does grief differ from depression?
What is the role of genetics and family history in the development of depression?
What are the risk factors/causes of depression?
What are symptoms of depression?
What is the treatment for depression?

45. Comments & Questions