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1 Thumbs up

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3 The Challenge of Teen Suicide OPTIONS FOR HOPE

4 Ginny Rusy, MPH, MS, RD, LPC Integrated Behavioral Health Foresight Family Physicians

5 Objectives Recognize appropriate primary care screening tools for this population. Know the appropriate questions to ask based on the screening results. Identify risk factors and protective factors in a teen s life. Begin to be comfortable talking about suicide and asking hard questions.

6 A suicide note if you haven t noticed the scars on my hips or the fake smile on my lips or the forced laugh that i ve adopted or the way i don t care about the things i used to love, then don t you dare stand at my grave and cry How can you cry for someone That you don t even know?

7 i think i hit the point in life where, i cried, i fought, i tried, but everything is crashing down. my demons are screaming louder, trying to eat the rest of me. and this time, i m not going to fight back. (d.j.k.)

8 Statistics Colorado ranks 10 out of the 50 states in suicide death. suicide is the 2 nd leading cause of death in ages Males continue to use more lethal means and die more often.

9 Females account for more attempts. Young women are beginning to use more lethal means such as guns and suffocation. Additionally females also react more strongly to friends, family members and relatives who die by suicide.

10 Characteristics of Teens

11 Inability to see the big picture. Impulsive. Brain is not fully developed. Trying to fit in, be accepted. Gender challenges. Influenced by peers easily. Difficulty putting feelings into words. Overwhelmed by feelings.

12 Risk factors

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14 Characteristics that precede or increase the likelihood of suicidal behavior or suicide.

15 Types of Risk Factors Demographic Characteristics. Clinical Features. Family and Interpersonal Factors. Contextual Factors. Life Stressors.

16 What are protective factors

17 Protective factors are variable that decrease suicidal behaviors and help prevent and decrease the likehood of suicide.

18 This Photo by Unknown Author is licensed under CC BY-NC-

19 Types of protective factors Stable housing. Trusted and supportive parents or other adult. Sense of well being. Coping skills. Engagement with life. Sense of purpose. Positive interests. Others..

20 So what is the role of primary care? Prevention. Screening. Assessment. Referral. Treatment.

21 Screening Where do you see the Challenge in Primary Care Knowledge Time Comfort Personnel

22 Primary Care Physicans are in a unique position to identify early signs of depression.

23 Primary Care Physicians may evaluate 70% of adolescents annually, including 45% of them in the month before they die by suicide. Most Primary Care Physicians have reported they lack adequate training in depression assessment and management. (Fallucco, et.al, 2015:15: , Academic Pediatrics)

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25 Office Initiative. In Primary Care Office Protocol. Trainings for all staff. Develop referral network. Order and keep on hand patient education tools.

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27 Screenings A screening is brief and easy to implement. Is reliable and valid. Creates a plan for communication, documentation and followup.

28 Recommended screenings PHQ9-Question 9. PHQ9-Adolescent Version. Columbia Suicide Rating Scale. Suicidal Ideation Questionnaire Junior. Beck Scale for Suicidal Ideation. Youth Risk Behavior Survey.

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30 Assessments Principles Risk is understandable ; involves multiple factors. Risk is not static, assessment must be ongoing. Risk does not shout out ; must be specific and focused. Multiple informants are ideal.

31 Steps in assessment Review your comfort level. Assess your own attitudes regarding suicide. Review the screening tool early in the exam; not as they go out the door.

32 Steps in assessment (cont.) Get additional training and supervision. Be familiar with your community s crisis numbers, hotlines and other aids. Have these numbers in every exam room and in your phone and laptop if necessary.

33 Assessment in the exam room/office Review the screening with the teen. Take time to listen to their story. Validate their emotional pain and concerns.

34 Assessment in the exam room/office Share the message that you are interested in helping. Caring attitude. Respectful. If you need assistance call a trusted colleague, don t leave the teen alone and maintain continuity of care whenever possible. Don t give the teen the impression that you are passing them off to someone else.

35 Practice, practice, practice.. Normal for providers to feel anxious ; they want to build rapport as quickly as possible. Struggle with what to say and what not to say. Often not prepared for this to happen in a busy day s schedule. May believe in several of the myths regarding suicide. May be burned out and have other worries.

36 Do s and don ts Do s Screen early in the appointment. Main a calm and collaborative attitude. Ask directly about suicide. Use multiple questions. Don ts Screen patient s they are waling out the door. Overreact to the mention of suicide. Avoid all references to suicide. Ask only one question.

37 Your Turn to practice

38 Asking the question..

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40 Survivors More at risk in the days, weeks, months and years following. Self blame. Guilt. Copy cat suicides. Support for all involved.

41 Resources The Western Colorado Suicide Prevention Foundation provides training and has a local Mind Springs Health Crisis Hotline open 24/7: They also have a 24/7 text line, text TALK to There s the Crisis Text Line too, all you have to do is text HOME to and there are real people to talk to 24/7. The Nation Suicide Prevention Lifeline and they re available on the phone and chat 24/7.

42 Questions?