A L I S S A B R I G G S , P H D ; C O L L E E N C O R N E L I U S , M S ;

C H E L S E A S H E E H A N , M S

A D O L E S C E N T M E D I C I N E A N D Y O U N G P A R E N T S P R O G R A M

U N I V E R S I T Y O F K E N T U C K Y

Preventing Suicide: What can Schools Do?

Objectives

Participants will be able to describe:

The Multi-Tiered Systems of Support (MTSS) framework

Evidence-based suicide prevention activities in

schools that align with the MTSS model The implementation of post intervention in schools

after a suicide

Why Schools?

Suicide is the 2nd leading cause of death for 10-24 year-olds

School is where people in this age group

spend most of their day In 2008, 33% of school psychologists

reported that a student in their school died by suicide

(1 8)

MTSS

MTSS with Suicide Prevention

Tier 1: School-wide prevention activities

Tier 2: Targeted interventions for students at higher risk for suicide

Tier 3: Intensive interventions for students at the greatest of suicide

(10, 11)

Suicide Prevention

Tier 1

Target: All students (and possibly everyone in the school community)

Educate Reduce risk factors Promote protective factors SOS Signs of Suicide High School Program Good Behavior Game (2, 16, 15)

Protective Factors

Connectedness Contact with caregivers Availability of care

Easy access to physical and mental health care

Coping ability Problem-solving and conflict-resolution skills See: http://www.sprc.org/sites/default/files/migrate/library/RiskProtectiveFactorsPrimer.pdf, http://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html

Risk Factors

Oppression and victimization At-risk groups

Students with mental health disorders Students who are using substances Hispanic females Native American males LGBTQ Victims of bullying Children with a trauma history Runaway/homelessness “Frequent fliers”

(2, 8, 3)

Risk Factors

Family history of suicide Feelings of hopelessness Impulsive or aggressive behavior Local epidemics of suicide Barriers to accessing mental health treatment Loss Physical illness Easy access to lethal means Unwillingness to seek help

See: http://www.sprc.org/sites/default/files/migrate/library/RiskProtectiveFactorsPrimer.pdf, http://www.cdc.gov/violenceprevention/suicide/riskprotectivefactors.html

(3)

Tier 2

Target: At-risk students

Possible Activities: Teaching tolerance Group counseling Gay/Straight Alliance Reduce barriers through a Family Resource and

Youth Service Center Check and Connect

Tier 3

Target: Individual students who have engaged in suicidal behavior

Resolve any immediate crises and address risk for future suicidal behavior

Possible Activities:

Risk assessments Linking students with appropriate care Evidence-based mental health interventions Planning for re-entry to school (if hospitalized)

(2, 17, 18)

Tier 3

Respect and empower the student throughout the process by: Clearly explaining the limits of confidentiality Empowering the student to communicate with

caretakers Creating a clear picture of future steps Involving the student in planning future

treatment

Suicide Post-Intervention

Tier 1

Support the school community Prevent contagion

(19)

Tier 2

Provide mental health interventions: Groups at increased risk

Those close to the person who committed suicide

(19)

Tier 3

Identify and respond to individuals:

Who are having particular difficulty coping Who are at high risk for suicide

(19)

Resource

After Suicide: A Toolkit for Schools

(19)

Resources

Model School District

Miami-Dade County Public schools implemented systematic suicide prevention and suicides attempts

went from 45.5 per 100,000 to 9 per 100,000 (over 18 years).

(17)

Toolkit

Preventing Suicide: A Toolkit for High Schools

(19)

Websites

National Suicide Prevention Lifeline American Foundation for Suicide Prevention National Institute of Mental Health Suicide Prevention Resource Center Substance Abuse and Mental Health Services

Administration (SAMHSA) Erika’s Lighthouse

Next Steps

Ahhhh, Where Do We Start?

Gather a team Review existing activities and protocols Be prepared to respond to a crisis Develop a screening procedure Design and implement prevention efforts at

Tier 1 and Tier 2

References

1. Sullivan EM, Annest JL, Simon TR, Luo F, Dahlberg LL, Centers for Disease C, et al. Suicide trends among persons aged 10-24 years--United States, 1994-2012. MMWR Morb Mortal Wkly Rep. 2015;64(8):201-5.

2. Miller DN, Eckert TL, Mazza JJ. Suicide Prevention Programs in the Schools: A Review and Public Health Perspective. School Psychology Review. 2009;38(2):168-88.

3. Lieberman R, Poland S, Korfield C. Best Practices in Suicide Prevention and Intervention. In: Harrison PL, Thomas A, editors. Best Practices in School Psychology: Systems-Level Services. Bethesda, MD: National Association of School Psychologists; 2014. p. 273-88.

8. Berman AL. School-Based Suicide Prevention: Research Advances and Practice Implications. School Psychology Review. 2009;38(2):233-8.

10. Sugai G. Promoting behavioral competence in schools: A commentary on exemplary practices. Psychology in the Schools. 2007;44(1):113-8.

11. Walker HM, Horner RH, Sugai G, Bullis M, Sprague JR, Bricker D, et al. Integrated approaches to preventing antisocial behavior patterns among school-age children and youth. J Emot Behav Disord. 1996;4(4):194-209.

References

15. Wei Y, Kutcher S, LeBlanc JC. Hot Idea or Hot Air: A Systematic Review of Evidence for Two Widely marketed Youth Suicide Prevention Programs and Recommendations for Implementation. Journal of the Canadian Academy of Child and Adolescent Psychiatry. 2015;21(1):5-16.

16. Katz C, Bolton SL, Katz LY, Isaak C, Tilston-Jones T, Sareen J, et al. A systematic review of school-based suicide prevention programs. Depress Anxiety. 2013;30(10):1030-45.

17. Zenere FJ. The Sustained Reduction of Youth Suicidal Behavior in an Urban, Multicultural School District. School Psychology Review. 2009;38(2):189-99.

18. Qin P, Nordentoft M. Suicide risk in relation to psychiatric hospitalization: evidence based on longitudinal registers. Arch Gen Psychiatry. 2005;62(4):427-32.

19. Center AFfSPaSPR. After a Suicide: A Toolkit for Schools. Newton, MA: Education Development Center, Inc.; 2011.

Questions?