Heather Applegate, Ph.D. Beth Doyle

Transcription

1 Heather Applegate, Ph.D. Beth Doyle

2 Background on Youth Suicide Rationale for Schools Our Approach to Suicide Prevention Depression Awareness Suicide Screening & After Care Procedures Completed Suicide Postvention LCPS Outcomes

3 Heather Applegate

4 Suicide is the 3rd leading cause of death among persons aged years old (CDC, National Center for Injury Prevention and Control, 2010), accounting for 20% of all deaths annually 2009: 101 per day Results from the 2011 Youth Risk Behavior Survey, during the past 12 months, students reported: 15.8% seriously considered attempting suicide (up from of 13.8%) 12.8% made a plan about how they would attempt suicide (up from 10.9%) 7.8 % actually attempted suicide one or more times (up from 6.3%) 2.4% made an attempt that resulted in medical treatment (up from 1.9%) 4

5 2010: 11 th leading cause of death in Virginia, 3 rd among 10- to 24-year olds

6 2010: 19.8 per 100,000 in Eastern region 9.7 per 100,000 in Northern region

7 Suicide rates increase as a function of age Conversely, suicide attempts are highest among adolescents and young adults Females are more likely to report having had suicidal ideation and are twice as likely to attempt suicide Males are 5 times more likely as females to die by suicide Highest among Native American and Asian American groups 7

8 90% of suicide is associated with a psychological disorder, typically depression (substance abuse, anxiety) Prior suicide attempts (12% reattempt within 3 months) Exposure to suicide or suicide attempts by family and peers History of or currently being abused. Easy access to lethal methods, especially guns (60% of all completed suicides in Virginia were by firearm.) Major life stressors/crises, such as relationship problems, death of loved one, or legal or discipline problems. 8

9 Liability is not in the outcome but in the process. Dewey Cornell, University of Virginia Suicide prevention is everyone s responsibility. - Scott Poland

10 Virginia Code and adjoining regulations on suicide prevention (1999) From a liability perspective, schools should have 1) clear policies that meeting the prevailing standards for safety and security, 2) follow these standards in their practice, and 3) maintain adequate documentation of their decisions and actions in adherence to their policies. 10

11 Surgeon General issued a national Call to Action to Prevent Suicide (U.S. Public Health Service, 1999) VA Health/Physical Education SOL The student will implement personal-injuryprevention and self-management strategies that promote personal, family, and community health throughout life. d) Recognition of tendencies toward self-harm f) Crisis-management strategies h) Recognition of when to seek support for self and others Case law 11

12 Suicide prevention is an on-going process Prior risk is strongly indicative of future risk Expressed intent and objective markers of intent can be in conflict Suicide prevention training for professionals must be on-going Many preventable suicides are the result of failure to communicate among relevant parties One size does not fit all Miller, D.N. (2011). Child and Adolescent Suicidal Behavior: School-Based Prevention, Assessment and Intervention. New York: Guilford Press.

13 Suicide Screenings, After Care & Suicide Postvention Targeted Boosters of Depression Awareness Depression Awareness

14 Depression Awareness/Suicide Prevention Program Implemented in Ninth Grade Health and Physical Education class presentations. Opt out program Booster program for upper grades (Tier 2) for selected schools Implemented by School Psychologists, Social Workers, and School Counselors Based on the Signs of Suicide program, the only evidence-based program demonstrating a reduction (40%) in suicide attempts Delivered through a planned lesson, educational video, and guided classroom discussion 14

15 LCPS Suicide Prevention Guidelines for responding to the presence of a suicidal ideation and behavior Goals are to: Ensure student safety Assess suicide risk using rubric and need for services Facilitate through parental contact appropriate care 15

16 Based on the Code of Virginia and VDOE s Suicide Prevention Guidelines Revision of LCPS Suicide Prevention Guidelines to reflect an organized, step-wise process

17 1. Identify and report an at-risk student 2. Supervise the student 3. Conduct a suicide risk screening 4. Make the appropriate contact a. Parents; or b. Child Protective Services 5. Meet with the parent 6. Hold a follow up meeting 7. Maintain documentation

18 All licensed staff are required to report students who are at-risk of suicide Any direct communication from a student that indicates suicidal intent Identified students must be reported to licensed school professionals, who by training and job responsibility, possess the skills to professionally assess imminent danger. school counselor In the school counselor s absence, psychologists, social workers, or substance abuse prevention specialists The counselor informs the building principal at the earliest convenience.

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20 Urgency in timely notification and location of the student is key. (Drop everything moment) Child must be supervised at all times until a screening is conducted and a determination of risk is made. If the referral is made at the end of the day, the child is not allowed to leave until a screening has occurred. The child s parent is immediately notified.

21 WHO First Responder: School counselor Second Responders: School psychologist, social workers, or substance abuse prevention specialist Colleague Consultation is encouraged The school nurse is not included among staff who conduct a suicide risk screening WHY Assessment drives response Standard of care Documentation helps avoid liability and legal pitfalls How Suicide Risk Screening Documentation Form

22 Page 1 of the Suicide Risk Screening Documentation Form

23 Areas to Assess Low Risk Moderate Risk High Risk Suicidal Ideation - Frequency - Intensity - Duration Thoughts of death or suicidal ideation of limited frequency, intensity, and duration Frequent suicidal ideation with limited intensity and duration Specificity No plan Some specificity of plan Persistent suicidal ideation that is intense and lasting Strong specificity of plan Intent No intent No intent Strong intent, both subjective and objective Suicidal Behaviors No behaviors No behaviors Possible behaviors Risk Factors Modifiable risk factors Multiple risk factors Protective Factors Strong protective factors Few protective factors Strong risk factors Irrelevant

24 If the screening does NOT reveal that the reason for contemplating suicide is related to parental abuse or neglect, then the school counselor contacts the parents The counselor documents the following: a. Time and date of call b. Name of the person contacted c. Parent s or guardian s response In the course of contact with the parent, if abuse or neglect is suspected (e.g., a parent acknowledges the child s suicidal intent but indicates no intent to act for the well-being of the child), LCPS protocol for contacting CPS is followed. d. Any required follow-up If the counselor is unable to contact the parent or guardian by the end of the school day, then the school s crisis management plan is followed for seeking emergency treatment for a student without the parent s authorization.

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26 If the screening reveals that the reason for contemplating suicide is related to parental abuse or neglect, the school counselor reports this to the principal. The principal contacts CPS (under 8-55) with the following: a. Name and LCPS position b. the name and identifying information of the child c. the legal requirements for the call, citing of the Code of Virginia Stress the need to take immediate action to protect the child from harm d. specifics as to reported abusive behavior or incidents e. significant recent changes in school attendance, performance or behavior f. when such changes were noted and their duration g. an offer to facilitate an appropriate mental health referral The principal documents the following: a. Time and date of call b. Name of the person contacted c. Response plan agreed upon d. Any required follow-up

27 When screening data indicates that a student exhibits moderate or high risk of suicide, the student must remain under adult supervision until a parent or authorized person accepts responsibility for the student Parents of children who are at low risk may elect to pick up their child but would not be required. Have the parent read and sign the Parental Acknowledgement of Notification of Suicidal Thoughts or Feelings and Release of Information form before the student is released.

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30 For determinations of moderate or high risk, the school counselor schedules and invites the parent (unless it is related to parental abuse/neglect) to a follow up meeting after the suicide risk assessment is completed Purpose is the following: a. to create a safety plan b. determine child s current status c. exchange information For low risk determinations, the school counselor should check-in with the child, teacher, and/or parents as appropriate.

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32 All documentation completed during this process should be maintained by the professional(s) providing these services in a file separate from the student s scholastic record for a period to include the balance of the current year as well as the entire following school year. Retention of documentation is in accordance with Library of Virginia, General Schedule No. 21, Series

33 Crisis Intervention Teams 6 rotating teams on-call on a monthly basis throughout the calendar year Provide school-based support Establish and reaffirm psychological security and safety Assess psychological impact and triage support needs/referral Establish or re-establish social support systems Provide psycho-education or caregiver trainings to teachers/parents Facilitate intervention and support groups 33

34 The Depression Awareness Suicide Prevention program and refresher sessions were presented to approximately 4,435 ninth and tenth grade students during the school year Program results indicated strong student endorsement of the program (over 90% of students recommended the program) and significant * knowledge gain in recognizing and responding to serious depression and potential suicidality in themselves or a friend. The youth suicide rate in Loudoun County remains the fourth lowest among the 35 Virginia health districts. The LCPS Depression Awareness Suicide Prevention program was selected as a mini-workshop at a past Governor s Conference on Education * p<.05 34

35 School Counselors, Psychologists and Social Workers provided feedback on a 2011 End-of- Year survey (N=141). On average, 7.86 of screenings resulted in low risk, 2.1 resulted in moderate risk, and 1.21 resulted in high risk

36 School Counselors, Psychologists and Social Workers provided feedback on a 2011 End-of-Year survey. The majority of respondents indicated they strongly agreed or agreed regarding the following items: Having three (3) categories for suicide risk classification is useful (75% of respondents) The new screening and criteria results in better accuracy in identifying suicidal risk (63%) The training prepared me to implement the new suicide prevention guidelines (84% of respondents)

37 I appreciate that we have standardized how we approach suicide threats and that we are using current information about suicide, risk factors and protective factors. The new guidelines provide me with documentation of protocol that I did not have before and would be necessary in any legal proceedings. I think that these documentation forms provide a very comprehensive framework from which to proceed.