1. 1 A Closer Look at Suicidal Behavior and Sexual Assault/Misconduct in Job Corps Valerie Cherry, Ph.D. Principal Mental Health Consultant April 26, 2001

2. 2 Briefing Outline Suicide –Suicide in the United States –Suicide Among Youth Aged 16-24 –Job Corps Data on Suicidal Behavior –Comparison of Job Corps Data to National Data –Information on Suicidal Behaviors and Characteristics –Recommendations for Job Corps Sexual Assault –Sexual Assault in the United States –Job Corps Data on Sexual Assault and Misconduct –Comparison of Job Corps Data to National Data –Recommendations for Job Corps

3. 3 Suicidal Behavior

4. 4 Suicide in the United States--A National Crisis Surgeon General’s Call To Action To Prevent Suicide, 1999 Suicide is the 8th leading cause of death for all Americans (up from 9th in 1996) There are an estimated 16 attempted suicides for each completed suicide Research shows that almost all people who kill themselves have a diagnosable mental or substance abuse disorder or both, and the majority have a depressive illness

5. 5 Suicide Among Youth Aged 15-24 Third leading cause of death for young people aged 15-24, behind unintentional injury and homicide From 1980-1997, the rate of suicide among persons aged 15-19 years increased by 14%. For African-American males aged 15-19, the rate increased 105% (National Center for Health Statistics, 1998, and CDC,1998)

6. 6 Suicide risk among young people is greatest among young white males; however, from 1980 through 1997, suicide rates increased most rapidly among young black males Males under the age of 25 are much more likely to commit suicide than females Suicide Among Youth Aged 15-24

7. 7 Important risk factors for attempted suicide in youth are depression, alcohol or other drug use disorder, and aggressive or disruptive behaviors Depressed adolescents are five times more likely to attempt suicide when compared with a control group of peers who are the same age without depression (Weissman, et. al., 1999) Special populations Suicide Among Youth Aged 15-24

8. 8 Suicide Threats, Attempts, and Suicides in Job Corps* PY97-99 *Job Corps population is 16 to 24 years of age, however, there is a fractional percentage of students older than 24 years. Job Corps averaged 78 suicide threats, 91 suicide attempts, and 1 suicide per year over the past 3 years

9. 9 Job Corps Suicide Threats and Attempts by Region PY97-99 Percentages were calculated based on the average number of students in each region per OBS reports

10. 10 Location of Suicide-related Behavior (i.e., on or off center) PY97-99

11. 11 Age of Job Corps Student at Time of Suicide Attempt PY97-99

12. 12 Length of Time (months) in Job Corps at Time of Suicide Attempt PY97 - PY99

13. 13 Job Corps Suicide Data PY97 to present * *Through September 10, 2000 **Suicide #4 was from PY2000 Of the 4 Job Corps students who have committed suicide from PY97 to present, 3 were male, the average age was 19, and the average length in the program was 4.75 months.

14. 14 Methods of Suicide Attempts (Job Corps) The majority of suicide attempts among Job Corps students were from poisoning (e.g., drug overdoses), 62%; followed by cutting wrists, 27%. PY 97-99

15. 15 Methods of Suicide (National) National Suicides 1997 and 1998* The majority of suicides nationally for this age group (non-Job Corps) are from firearms, 61%; followed by suffocation (includes hangings), 23%. *National suicide data for 1999 is unavailable; there is no national data on method of suicide attempts available for this age group.

16. 16 Suicides for Ages 16-24 National versus Job Corps Suicides per 100,000 1997-1999* Job Corps Suicide Data PY97--0 (Total Pop. 65,705) PY98--2 (Total Pop. 67,524) PY99--1 (Total Pop. 70,839) National Suicide Data 1997--3,963 (Total Pop. 32,735,991) 1998--3,913 (Total Pop. 33,320,356)

17. 17 Conclusions Our Job Corps students are among the groups at risk for suicidal behavior. Job Corps is well below the national averages for suicides and suicide attempts among youth 16-24 Most completed suicides occur early during a trainee’s tenure at the Job Corps site and are male students Drug overdose (both illegal drugs and over the counter) is the most frequently used method of suicide attempt in Job Corps; OTC drugs make up the majority of the drug overdoses Regional percentages of suicide threats and attempts average 1.33% of students; there is no regional pattern of variation in suicidal behavior

18. 18 PY 2000 Review Too early to trend Possible Reasons for Suicide Behavior –Overall increase nationally for the Job Corps student age group –Inherent issues with Job Corps students –Staff training needs –Lack of case management on center –Specific center issues (San Diego Example)

19. 19 What is Behind Suicidal Behavior ? Stressful life events often precede a suicide or suicide attempt: –Trouble at school or with a law enforcement agency –A broken relationship with a boyfriend or a girlfriend –A fight among friends The events are rarely a sufficient cause of suicide, but they can be precipitating factors in young people

20. 20 Risk factors among females include: –Presence of major depression (most significant factor) –Previous suicide attempt (increases the risk approximately threefold) Risk factors among males include: –Previous suicide attempt (most potent predictor) –Depression –Disruptive behavior –Substance abuse (Shaffer et. al., 1998) What is Behind Suicidal Behavior ?

21. 21 Recommendations for Job Corps National Level Continued national recognition that suicidal behavior is a significant public health issue among youth –Allocation of resources –National suicide prevention/response guide –Information sharing forum (conferences, meetings, workgroups) for center staff and Job Corps mental health professionals

22. 22 Institutionalizing Suicide Risk Reduction –Screening on center –“Gatekeeper” training for all center staff in recognizing the risk factors associated with suicide and dealing with trainees at risk Recommendations for Job Corps National Level

23. 23 Recommendations for Job Corps National Level Increase the use of community care resources for mental health services including support programs for persons who survive the suicide of a trainee Regional tracking of suicidal behaviors by centers Additional center mental health consultant/staff hours

24. 24 Recommendations for Job Corps Center Level General Suicide Education –Incorporate some of the social skills topics that focus on self- esteem, social competency, and relationships Crisis Management –Reduce the intensity level of the crisis

25. 25 Recommendations for Job Corps Center Level Means Restriction –Centers should continue to maintain firm rules that restrict access to handguns, drugs, medicines, and other means of suicide. Intervention After a Suicide –Each center should have an intervention plan to cope with the crisis caused by suicides or attempted suicides. This is called “Critical Incident Debriefing” and can be included in the center’s operating procedure document.

26. 26 References and Resources Centers for Disease Control and Prevention (1998). Youth risk behavior surveillance—United States, 1997. CDC Surveillance Summaries, August 14, 1998. MMWR, 47 (No. SS-3). Centers for Disease Control and Prevention (1999). Suicide deaths and rates per 100,000 [On-line]. Available: http://www.cdc.gov/ncipc/ data/us9794/suic.htm. National Center for Health Statistics. (1998). Leading causes of death by race and sex for selected age groups: United States 1979- 96. Rockville, MD. Shaffer, D., Garland, A., Gould, M., Fisher, P., and Trautman, P. Preventing Teenage Suicide: A Critical Review. Journal of the American Academy of Child and Adolescent Psychiatry, 1988; 27:675-687.

27. 27 U.S. Public Health Service, The Surgeon General's Call to Action To Prevent Suicide. Washington, DC: 1999. U.S. Public Health Service, Mental Health: A Report of the Surgeon General. Washington, DC: 1999. Weissman, M. M., Wolk, S., Goldstein, R. B., Moreau, D., Adams, P., Greenwald, S., Klier, C. M., Ryan, M. D., Dahl, R. E., and Wickramaratne, P. (1999 ). Depressed Adolescents Grown Up. Journal of the American Medical Association, 281, 1707– 1713. References and Resources

28. 28 Centers for Disease Control and Prevention, National Center for Injury Prevention and Control www.cdc.gov/ncipc 404-639-3286 www.cdc.gov/ncipc Health Resources and Services Administration www.hrsa.dhhs.gov 301-443-1989 www.hrsa.dhhs.gov National Institute of Mental Health (NIMH) Suicide Research Consortium www.nimh.nih.gov/research/suicide.htm 301-443-4536 www.nimh.nih.gov/research/suicide.htm Substance Abuse and Mental Health Services Administration www.samhsa.gov 301-443-8956 www.samhsa.gov Office of the Assistant Secretary for Health/Surgeon General www.surgeongeneral.gov 202-690-7694 www.surgeongeneral.gov References and Resources

29. 29 Sexual Assault and Misconduct

30. 30 Facts About Sexual Assault Sexual assault continues to be the most rapidly growing violent crime in America Over 700,000 women are sexually assaulted each year Fewer than 50% of rapes are reported The incidence of date rape is greatest for young people ages 16-24 Male victims represent 5% of reported sexual assaults Among female rape victims, 61% are under age 18

31. 31 Sexual Assault Among U.S. College Students A survey of 6,159 college students enrolled at 32 institutions in the U.S. found: 57% of the assaults occurred on dates 73% of the assailants and 55% of the victims had used alcohol or other drugs prior to the assault 25% of the men surveyed admitted some degree of sexually aggressive behavior 42% of the victims told no one about the assault

32. 32 Facts About Sexual Assault Rapes occur at the highest rates among the ages of the Job Corps population National Institute of Justice/Centers for Disease Control and Prevention, Research in Brief, November 1998

33. 33 Facts About Sexual Assault National Institute of Justice/Centers for Disease Control and Prevention, Research in Brief, November 1998

34. 34 Facts About Sexual Assault Bureau of Justice Statistics, Sexes and Offenders, February 1997

35. 35 Facts About Sexual Assault Bureau of Justice Statistics, Sexes and Offenders, February 1997

36. 36 Sexual Assault and Misconduct Significant Incident Reporting (SIR) System definitions: –Sexual Assault Any alleged nonconsenting sexual act involving forceful physical contact including rape, attempted rape, rape by a foreign object, and sodomy –Sexual Misconduct/Battery The intentional touching, mauling, or feeling of the body or private parts of any person without the consent of that person; sexual misconduct also includes sexual harassment or unsolicited offensive behavior such as unwelcome sexual advances, requests for sexual favors, and other verbal or physical contact of a sexual nature

37. 37 Sexual Assault and Misconduct SIR Data –Data is recorded for sexual assaults and sexual misconduct incidents by students, staff, and other (non-Job Corps) person(s) –The vast majority of the SIRs received report the student as the victim of the assault or misconduct (there are a few incidents in which a staff member is the victim)

38. 38 Job Corps Sexual Assaults and Misconduct PY99

39. 39 Location of Job Corps Sexual Assaults and Misconduct PY99

40. 40 Perpetrators of Job Corps Sexual Assaults and Misconduct PY99

41. 41 Job Corps Sexual Assaults and Misconduct by Region PY99 Data from PY99 OBS reports

42. 42 Sexual Assault (Rape) Data: National vs. Job Corps National data from 1998 Criminal Justice Sourcebook published by the Bureau of Justice Statistics (for ages 16-24) Job Corps data from SIR reports and SPAMIS

43. 43 Conclusions Job Corps statistics are below the national rates for sexual assaults (rapes) Sexual misconduct continues to be an area of concern Sexual assault is a silent violent crime that could lead to under-reporting by students

44. 44 Recommendations for Job Corps Resources for Centers –Train staff identified for the sexual assault response team as well as residential advisors Providing and responding to incident Meeting the needs of the victim Recognizing the silent reaction to sexual violence

45. 45 Recommendations for Job Corps Prevention Strategies – Groups on Center –Provide general sexual assault information to all students –Focus on developing skills that reduce student’s vulnerability to sexual violence Recognize and become sensitive to potentially abusive situations Learn the difference between passive and assertive responses and practice them Identify mixed signals and the role of alcohol and drugs Understand what “Healthy Dating” means

46. 46 1.National Crime Center and Crime Victims Research and Treatment Center. Rape in America: A Report to the Nation. Arlington, VA; 1992:1-16 2.Koss M.P., Hidden rape: sexual aggression and victimization in a national sample of students in higher education. In: Burgess A.W. (ed.), Rape and Sexual Assault. New York, NY: Garland Publishing: 1998;2:3-25. 3.Prevalence, Incidence, and Consequences of Violence Against Women: Findings from the National Violence Against Women Survey 1998. National Institute of Justice and the Centers for Disease Control and Prevention NCJ 172837 References and Resources

47. 47 Videotape Resources:“Date Rape,” AIMS Multimedia - 40 minutes 1-800-367-2467 “No Means No: Avoiding Date Abuse” Phoenix Learning 19 minutes 1-800-221-1274 Curriculum Resources:“Adolescent Sexual Assault and Harrassment Prevention Curriculum.” Marjorie Fink. Learning Publications, Inc. 1-800-222-1525 “Acquaintance Rape and Sexual Assault - A Prevention Manual.” Andrea Parro Learning Publications, Inc. 1-800-222-1525 Internet Resource: National Coalition Against Sexual Assault - www.ncasa.org References and Resources