Tell Me More A YOUTH BASED MODEL FOR ASSESSING SUICIDE RISK

Transcription

1 Tell Me More A YOUTH BASED MODEL FOR ASSESSING SUICIDE RISK 1

2 DIANNE THOMPSON, ED.S DIRECTOR, ADVISEMENT & COUNSELING GWINNETT CO. PUBLIC SCHOOLS MAUREEN UNDERWOOD LCSW YOUTH SUICIDE PREVENTION SPECIALIST DALLAS, TEXAS Your Presenters 2

3 3 OUR OBJECTIVES Describe the Tell Me More structured intervention model Demonstrate developmentally appropriate methods for communicating with students Demonstrate strategies for engaging challenging students and parents

4 Stephanie s Story

5 Our Starting Points Youth suicide prevention is a young field Began in 1980 s with universal school based prevention programs As knowledge base expanded, program directions have grown Current state of the field 2 nd & 3 rd generation universal school programs Research on identification of risk factors & warning signs Case identification through screening, gatekeeper awareness Crisis intervention/postvention services Development of evidence based treatment 5

6 The CONTINUING Challenges Despite current efforts, rates going up Suicide now 2 nd leading cause of death Incidents of mass shootings 30% since 2011 Clusters of suicide 1% in 1991 to 5 10% in 2013 More data on risk in youth involved in bullying, LGBTQ youth Cultural context is rapidly shifting 6

7 Challenges for Counselors Lack of graduate school/continuing education training in suicide assessment & management Limited experience with suicidal youth Fear of liability Lack professional competence

8 Violence & Terrorism Family Structure Changed Competitive climate Cyberspace is Fantasy Land Age of Sexual Maturity 8

9 Generation Like 9

10 The Adolescent Brain A COMPLICATING FACTOR 10

11 11

12 The Impact on Developmental Issues Search for identity Why bother? Relationships What s monogamy? Increased ability for delayed gratification Look it up on Google Individuation Helicopter parents Social skills development Who needs them when you can text? Morals & values If I can do it online, it must be okay 12

13 The Impact on Behavior Use of street drugs/prescription medication abuse Alcohol use/abuse 34% of teens reported currently drinking alcohol Wall Street Syndrome Self injury increasing 17% of people reported having started self injury before the age of 12 13

14 What we bring to the table STORIES WITH HOLES 14

15 WHAT DID YOU SAY ABOUT What I understand about suicide is What I don t understand is What would help me understand better What would make me better at what I do

16 What Most Clinicians Say Understand hopelessness, level of pain, ambivalence, pain of survivors Don t understand suicide as problem solving alternative, impulsivity, irrationality, perceived selfishness What would help them understand better is talking with attempters, going to training, learning more

17 The Context for Prevention: A Competent Suicide Prevention Community Concern for youth suicide prevention is shared by all community members All members can recognize signs of risk The community has a coordinated fabric of prevention activities that are integrated into established community services 17

18 Role of the School in Suicide Prevention Critical Limited Falls under the mandate to provide students with safe environment where the primary focus is on learning 18

19 Discipline Issues: INTERSECTION WITH MENTAL HEALTH CONCERNS 19

20 20 Youth Risk Behavior Survey 30% 40% 20% Total Female Male Felt sad or hopeless (almost every day for 2 or more weeks in a row so that they stopped doing some usual activities during the 12 months before the survey)

21 21 Youth Risk Behavior Survey 18% 23% 12% Total Female Male Seriously considered attempting suicide (during the 12 months before the survey)

22 22 Youth Risk Behavior Survey 15% 19% 10% Total Female Male Made a plan about how they would attempt suicide (during the 12 months before the survey)

23 23 Youth Risk Behavior Survey 9% 12% 6% Total Female Male Attempted suicide (one or more times during the 12 months before the survey)

24 24 Youth Risk Behavior Survey 3% 4% 2% Total Female Male Attempted suicide that resulted in an injury, poisoning, or overdose that had to be treated by a doctor or nurse (during the 12 months before the survey)

25 What about Confidentiality? 25 Educator s decisions about the needs of the student are based on the quality of the information available to them. Bernard James, J.D., National School Safety Center

26 26 What about Confidentiality? HIPAA Health Insurance Portability & Accountability Act Covered entities are providers who bill insurance health plans HIPAA Privacy Rule authorizes disclosure of danger to self or others to another health care provider in these instances CONFIDENTIALITY DOES NOT APPY!!

27 27 What about Confidentiality? FERPA Family Educational Rights and Privacy Act Goals: 1) to give parents access to the educational records of their children; 2) to limit the transferability of records without consent Nonconsensual disclosures of educational record information in response to an emergency are exempt from the consent requirement FERPA does not apply to shared VERBAL communication

28 Sample confidentiality office tools 28

29 MS ES HS 29

30 Tell Me More: Using a Cognitive Behavioral Approach to Understand Suicide SHIFTING THE PARADIGM

31 What is Tell Me More? Reflects the 3 hardest but most important things to say to someone who is suicidal Opens the door to talking about suicide in a conversational way Frames suicide as the solution to that seemingly unsolvable problem Avoids clichés

32 32 A problem welldefined is a problem halfsolved WHAT IS SUICIDE??

33 33 Definitions of Suicide 1)Self initiated injury completed with the intention of dying 2) An attempt to solve a problem of intense emotional pain with impaired problemsolving skills

34 34 The Five Characteristics of Suicide 1. Suicide is viewed as an alternative to a seemingly unsolvable problem. 2. Crisis thinking impairs problem solving. 3. A suicidal person is often ambivalent. 4. The choice of suicide has an irrational component. 5. Suicide is a form of communication.

35 35 1.Problem-solving alternative For youth, usually follows: Disciplinary crisis Humiliation Break up May precede a feared event: Test Moving YOUR INTERVENTIONS? VENTILATE & VALIDATE

36 36 2. Presence of Crisis Thinking Tunnel vision High emotionality Impaired judgment Impulsiveness desperation to solve the problem combined with a feeling of hopelessness Your Interventions? Empathically engage

37 37 Tunnel Vision of Suicidal Crisis Thinking Healthy problem solving Triggering event Unhealthy problem solving Suicide as only option

38 38 3. Presence of Ambivalence Feeling two opposite things at the same time Lacking the perspective to have hope that things can get better YOUR INTERVENTIONS? LEND HOPE

39 39 4. Thinking Has Irrational Quality Often hardest characteristic to understand because it defies logic Reflects disconnect of survival instinct YOUR INTERVENTIONS? REALITY TESTING

40 40 5. Attempt at Communication Message usually relates back to that unsolvable problem With youth, may be directed at parents May be on social networking sites YOUR INTERVENTIONS? ASKING THE QUESTION

41 What does this look like in real life? CHARACTERISTICS ACTIVITY 41

42 Overlap Theory of Suicide Risk Factors Biopsychosocial Access to means Previous attempt Page 42

43 Risk Factors / Warning Signs 43 Red - Warning Signs Yellow - Risk Factors Green - Protective Factors

44 How the Crisis of Suicide Develops Perception of unsolvable problem 2. Usually one in a series of problems 3. Problem viewed as only solvable by suicide 4. Suicide becomes consistent with view of self 5. Other alternatives are disregarded 6. Death seems like the only answer

45 45 THE PERFECT STORM 45

46 46 Warning Signs Feelings Actions Changes Threats Situations

47 47 Tell Me More THE INTERVENTION PROCESS

48 48 What is the Tell Me More Model? Reflects the 3 hardest but most important words to say to a suicidal student Opens the door to talking about suicide in a conversational way Addresses questions about suicide risk from a developmental perspective Frames suicide as the solution to that seemingly unsolvable problem Avoids clichés

49 49 Components of the Intervention Process Assessment Evaluation of assessment results Parental contact Referral

50 50 Key Components of the Assessment Interview You The student Collaborative partners Parents/guardians

51 51 The Student Things to consider: Attitude/previous experience with seeking help Cultural background Developmental level Previous contact with the counselor

52 52 Elementary Students Eager to please Puberty may be starting Concrete/ literal thinkers Need simple words Worry about parental reaction Need support familiar teacher can help

53 53 Middle School Students 1)Experience strong often conflicting emotions 2) Prone to dramatic, emotional outbursts 3) Self esteem is generally fragile 4) Growing peer allegiance combined with budding independence 5) Despite testing, need for adults to remain in control

54 54 High School Students 1) Dealing with separation/individuation 2) May see all adults in parental role 3) Constructing self identify 4) Experimenting with intimacy 5) Possessing a sense of personal uniqueness

55 55 Tell Me More Assessment Interview Outline

56 56

57 57 The First Step in Assessment Get collateral information! Observations of teachers Attendance, tardiness & disciplinary records School nurse contacts List of prescribed medications

58 58 Questions to Answer Why is the student having these thoughts now? How long has s/he been having them? How often does s/he have them? Has s/he made specific plans to carry them out? Does s/he have access to means? What does the student perceive as deterrents to suicide? Has student ever attempted suicide in the past?

59 59 How to Address These Issues 1. Be prepared with a sequence of opening questions 2. Ask questions in a logical and direct way. 3. Check out your understanding 4. Ask for details about anything that concerns you 5. Take ideation as seriously as behavior 6. Always consult with a supervisor 7. Document your observations

60 60 Develop a Safety Plan with the Student Collaborative process that helps student identify triggers to suicidal thinking and proactively develop strategies to deal with them

61 All forms & procedures were vetted by our Board attorney 61

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63 63 Interviews with Challenging Students INTEGRATING THEORY INTO REAL LIFE

64 Engaging Parents THE MOST OVER-LOOKED PART OF THE INTERVENTION STRATEGY 64

65 65 Parents: Setting the Stage Engage students in the process. Assume parents want to act in their child's best interests. Remain nonjudgmental and calm. Be prepared for shock and denial. Anticipate previous parental contact with mental health. Avoid power struggles!

66 66 Seeing the Situation From the Parents Perspective Denial Shock/defensiveness Self blame Feeling overwhelmed Anger Fear Gratitude

67 67 What Not To Do in a Parent Meeting Call parents by first names Be too casual Self disclose Ignore resistance Rush Answer the phone

68 Document... Document. Document.. 68

69 69 Interventions with Challenging Parents INTEGRATING THEORY INTO REAL LIFE

70 70 Making Effective Referrals Key points to keep in mind: Involve the student. Address the reluctance. Consider the impact of peers. Involve the parents. Make sure your referral recommendation is appropriate.

71 71

72 Taking care of yourself THE STORY OF THE OLYMPIC 72

73 CONTACT INFORMATION 73

74 Resources for Teens, 74 Parents & Educators