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Expanding Suicide Prevention to Include Upstream Approaches

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SPRC Research to Practice Webinar

If you are experiencing technical difficulties, please call 307-GET-WEB1 (307-438-9321)

Expanding Suicide Prevention to Include Upstream Approaches

September 25, 2012

Opening Remarks

Gail F. Ritchie

SAMHSA’S MISSION

To reduce the impact of substance abuse and mental illness on

America’s communities

National Research Council and Institute of Medicine, 2009

SAMHSA and the Institute of Medicine

Preventing Mental, Emotional, and Behavioral Disorders, Among Young People, Progress and Possibilities

Contact Information

Gail F. Ritchie, M.S.W., LCSW-C

Coordinator, Prevention Practices in Schools Grant Program

Mental Health Promotion Branch

Substance Abuse and Mental Health Services Administration

gail.ritchie@samhsa.hhs.gov

Today’s Presenter

Philip Rodgers, PhD

Organizing Committee

•Scott Fritz, SPTS

•Effie Malley, formerly of AAS

•Maureen Underwood, SPTS

•Peter Wyman, U. of Rochester Medical Center

•Phil Rodgers, AFSP

Expanding the Youth Suicide Prevention Paradigm: Establishing and Promoting the Importance of Upstream Suicide Prevention Approaches

Expert meeting held at the 45th Annual Conference of the American Association of Suicidology, April 18, 2012, Baltimore, MD.

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U.S. Suicide Rate for 1999-2009 by Age Ra

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Can a suicide that occurs here

Have been prevented here?

Age

Rate

per

100

,000

U.S. Suicide Rate for Years 1999-2009 by Age Group

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1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Age 5-9 Age 10-14 Age 15-19 Age 20-24

The IOM report supports a Mental Health Intervention Spectrum

O’Connell, Boat, & Warner (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People. Washington, D.C.: The National Academies Press.

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U.S. Suicide Rate for 1999-2009 by Age Ra

te p

er 1

00,0

00 Can a suicide that

could occur here

Be prevented here?

Age

Today’s Presenter

Dennis D. Embry, PhD

Acting for Early, Upstream Suicide Prevention

Dennis D. Embry, Ph.D. President/Senior Scientist

PAXIS Institute

Research to Practice Webinar

A recent webinar experience on the topic

Is this early prevention?

Is this early prevention?

Is this early prevention?

Is this early prevention?

Thinking way upstream Really?

What if we started here with early

suicide prevention?

Thinking way upstream What might be the early malleable predictors? Could we actually change those predictors easily and reliably? And what else might change as a consequence of the prevention or protection strategies.

risk factors during development from early childhood to adolescence

Psychiatric problems in childhood and/or adolescence, including depression

Child and/or adolescent externalizing disorders

Childhood adversity (especially with the above)

Low self-esteem (self-efficacy)

Aggressive or delinquent behavior

Prax Kinderpsychol Kinderpsychiatr. 2012;61(1):32-49.

First Grade

When are these risk factors most universally detectable?

Psychiatric problems in childhood and/or adolescence, including depression

Child and/or adolescent externalizing disorders

Childhood adversity (especially with the above)

Low self-esteem (self-efficacy)

Aggressive or delinquent behavior

Thinking midstream What might be the midstream malleable predictors? • Early and current smoking • Dose response, MORE smoking =

MORE suicide risk, controlling for other variables

• Smoking affects monoamine oxidase (MAO), which increases suicide risk

Breslau et al. Arch Gen Psychiatry 2012;():1-8

Adolescence

Hypothesis #1 If we can reduce early aggressive or ADHD-like behavior and victimization by peers in First Grade, that might be the first step toward the long-term prevention of suicide.

Golly, almost every teacher would like it if there was more time to teach and for kids to learn.

Hypothesis #1 If we can reduce early aggressive or ADHD-like behavior and victimization by peers in First Grade, that might be the first step toward the long-term prevention of suicide.

Let’s see if we can reduce disturbing,

distracting, and inattentive

behaviors in classrooms — as

our first test.

Montrose Wolf Harriet Barrish

Muriel Saunders invented the Game in 1967 as a first-year, 4th grade teacher.

Published as a study in 1969.

www.pubmed.gov

Longitudinal Johns Hopkins Studies of GBG

Every child

rated by teachers

Kindergarden First Grade

GBG

NO GBG

Tested in 41 first- and second-grade classrooms within

19 elementary schools with two

consecutive groups of first

graders.

Young Adulthood Follow Up

Age 19-21

Age 26

Age 30

Age 19-21

Age 26

Age 30

Purpose: To find out if GBG

affected their adult lives.

No More GBG

No GBG

Grades 2 thru 12 Follow Up

Purpose: To find out if GBG affected their

adolescent lives.

By the early 1990s, multiple

studies including this

randomized one proved that

GBG reduced the early predictive behaviors.

Wow! In 1998, Drs. Kellam and Anthony showed that GBG reduced tobacco initiation—one of the middle predictors.

Tobacco Initiation (Age of First Use)

So now, let’s see if GBG affects suicide indicators among youth and young adults.

Wilcox, H. C., Kellam, S., Brown, C. H., Poduska, J., Ialongo, N., Wang, W., & Anthony, J. (2008). The impact of two universal randomized first- and second-grade classroom interventions on young

adult suicide ideation and attempts. Drug & Alcohol Dependence, 95(Suppl 1), 60-73.

So now, let’s see if GBG affects suicide indicators among youth and young adults.

Wilcox, H. C., Kellam, S., Brown, C. H., Poduska, J., Ialongo, N., Wang, W., & Anthony, J. (2008). The impact of two universal randomized first- and second-grade classroom interventions on young

adult suicide ideation and attempts. Drug & Alcohol Dependence, 95(Suppl 1), 60-73.

Timeline of Benefits…

More time for teaching and learning

First Month

Less stress for Staff & Students

Better Attendance

Better Academics

Less Illness

Fewer Service Needs

Fewer Referrals

First Year

Happier Families

Less Vandalism

2nd & 3rd Years ADHD

Averted Oppositional

Defiance Averted Special Education

Averted

5-15 Years No

Tobacco Less

Alcohol Less Conduct

Disorders Less

Depression Less Crime,

Violence, Suicide High School Grad &

University

How is this accomplished?

By teams with group based reward— during any regular teaching & learning activity

The Blue Team The Red Team The Yellow Team

The Team Aim: to Win

Ms. Dion Jan 23

Blue Red

Yellow 20 40

20 60

Spleems are counted and marked with neutral tone for the team, not the individual child.

Teams who have 3 or fewer Spleems win.

Winning teams earn a “Granny’s Wacky Prize”. Team having 4 or more Spleems lose that game.

PAX Minutes = winning teams x minutes played.

e.g., disturbing behaviors

Thank you, Dennis D. Embry, Ph.D

dde@paxis.org 1-520-299-6770

Today’s Discussants

Morton M. Silverman, MD Sheppard G. Kellam, MD

Today’s Discussants

Morton M. Silverman, MD Sheppard G. Kellam, MD

Thank you!

www.sprc.org

Xan Young, MPH SPRC Training Institute, Project Director xyoung@edc.org 202-572-3728

Dominique Lieu SPRC Training Institute, Training Specialist dlieu@edc.org 617-618-2984