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Suicide Prevention Gatekeeper Agenda

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Title: Suicide Prevention Gatekeeper Agenda


1
Suicide Prevention Gatekeeper Agenda
  • Welcome Introductions
  • The School Setting A Healthy Climate
  • Emotions, Stigma and Suicide
  • Myths Facts About Suicide
  • Suicide Trends Statistics
  • Suicide Risk Protective Factors
  • Gatekeeper Training
  • District/Campus Level Teams
  • Clara Cáceres Contreras
  • ccontreras_at_esc1.net
  • 956-984-6125
  • www.esc1.net

2
Suicide
  • When you hear the word Suicide what comes to
    mind?
  • What emotions do you feel?
  • Who do you think of and how old were you when It
    (suicide) happened?
  • Our thoughts and emotions can impact how we
    interact with people at risk. (confusion, fear,
    denial, shock, anger)
  • Understanding suicide awareness sessions makes
    a difference!

2
3
Stigma Suicide
  • Psychological autopsies has shown that 90 of
    people who died by suicide had a diagnosable
    mental illness and/or a substance use disorder.
  • Suicidal individuals are usually dealing with
    multiple layers of stigma.
  • What impact could this have on the person? (not
    getting help, suicide, etc)

3
4
School Climate (Issue Brief 2- School Climate)
  • School Connectedness
  • Meaningful Participation
  • Academic Achievement
  • School Safety Security
  • Training
  • Respectful Discipline
  • Aesthetically Pleasing-Physical Environment

5
School Climate
  • Help ensure that the school climate is one that
    is supportive of the at risk student.
  • Fostering a feeling of connectedness between the
    students and the school,
  • Proving an opportunity for students to become
    involved in school activities,
  • Ensuring a safe and positive environment creates
    a climate that has potential to have a profound
    impact on adolescent suicide.

5
6
Why the School Setting?
  • Schools are in a key position to identify mental
    health problems early and to provide a link to
    appropriate services.
  • More than 52 million youth attend 114,000 schools
    in the US.
  • When combined with the 6 million adults who work
    a the schools, almost 1/5th of the population
    passes through schools everyday.

6
7
Why the School Setting?
  • Adolescents spend one third of their day in
    school.
  • The average classroom has 3 students who have
    attempted suicide.
  • School education codes mandate not only to
    educate but also to protect students.
  • 5.2.2 District Improvement -Plans Strategies for
    improving student performance, including
    instructional methods, methods for addressing
    the needs (of students) for special programs
    (e.g., suicide prevention, conflict resolution,
    violence prevention, dyslexia treatment
    programs) drop out reduction discipline
    management staff development career education
    for students and accelerated education

7
8
Why the School Setting?
  • Schools have been held liable for not taking
    action to protect at-risk students.
  • At school students have the greatest exposure to
    multiple helpers.
  • Research has found that the schools provide an
    ideal and strategic setting for preventing
    adolescent suicide.

8
9
The Schools Role Prevention
  • Incorporate suicide prevention and intervention
    as an integral part of school-based mental health
    services
  • Raise awareness of risk factors
  • Bolster protective factors
  • Identify students at risk
  • Intervene with at risk students
  • Create a culture of connectedness

9
10
The Schools Role Prevention Planning
  • Develop clear intervention and post-intervention
    protocols
  • Establish a Suicide Task Force
  • Develop policies and procedures
  • Asses potential risk factors in school
    environment
  • Identify and implement suicide prevention programs

10
11
The Role of School StaffPrevention/Gatekeeper
  • Research has found that 25 of all teachers
    sampled in a study reported that they had been
    approached by a suicidal teen.
  • Research also suggests that school staff believe
    that they have a larger role in identifying
    students at risk for suicide.
  • School staff can be a lifeline to a student who
    is in crisis.

11
12
Suicide Nomenclature Activity(definitions)
  • Completed Suicide/ Death by Suicide
  • Gatekeeper
  • Suicide Attempt
  • Suicide Threat
  • Suicide Ideation
  • Deliberate Self-Harm
  • Unintentional Injury or Accident
  • Suicide Attempt Survivors
  • Suicide Survivors
  • Suicidology
  • Prevention
  • Intervention/Treatment
  • Postvention

13
Suicide in the US
  • 13.7 million children in the US have a mental
    health disorder
  • 2/3 of them are not getting help they need
  • Neglecting mental health can lead to serious life
    threatening consequences such as school failure,
    family conflicts, drug abuse, violence and suicide

13
14
Suicide in the US
  • Suicide is the third leading cause of death for
    youth ages 15-24
  • Suicide rates for ages 10-14 have increased by
    51 between 1981 and 2004
  • Approximately 1 in 5 teenagers seriously consider
    suicide
  • 1 in 12 attempt suicide yearly in the US with
    700,000 requiring medical attention

14
15
Methods of SuicideTexas Children Ages 10-14
15
16
Texas YRBS
  • Made a plan about how they would attempt suicide
    in the last 12 months.
  • Total-12.2
  • Females-15.1
  • Males-9.4

16
17
Texas YRBS
  • Attempted suicide one or more times in the last
    12 months.
  • Total-9.4
  • Females-12.5
  • Males-6.1
  • Highest overall rate was in Hispanic females
    (15.8)

17
18
18
19
19
20
True / False
  • Adolescent suicide is an increasing problem in
    the United States.

(True) While the suicide rate for the general
population has remained relatively stable since
the 1950s, the suicide rate for adolescents has
more than tripled.
21
True / False Answers
  • Most teenagers will reveal that they are suicidal
    or have emotional problems for which they would
    like emotional help.(True) Most teens will
    reveal that they are suicidal and although
    studies have shown that they are more willing to
    discuss suicidal thoughts with a peer than a
    school staff member, this disposition that most
    teens have towards expressing suicidal ideations
    could be used for screening adolescents through
    questionnaires and/or interviews.

22
True / False Answers
  • Adolescents who talk about suicide do not attempt
    or commit suicide.(False) One of the most
    ominous warning signs of adolescent suicide is
    talking repeatedly about ones own death.
    Adolescents who make threats of suicide should be
    taken seriously and provided the help they need.
    In this manner, suicide attempts can be averted
    and lives can be saved.

23
True / False Answers
  • Educating teens about suicide leads to increased
    suicide attempts, since it provides them with
    ideas and methods about killing themselves.
    (False) When issues concerning suicide are
    taught in a sensitive, educational context they
    do not lead to, or cause, further suicidal
    behaviors.

24
True / False Answers
  • Talking about suicide in the classroom will
    promote suicidal ideas and suicidal behavior.
    (False) Talking about suicide in the classroom
    provides adolescents with an avenue to talk about
    their feelings, thereby enabling them to be more
    comfortable with expressing suicidal thoughts and
    increasing their chances of asking help from a
    friend or school staff member.

25
True / False Answers
  • Parents are often unaware of their childs
    suicidal behavior. (True) Studies have shown
    that as much as 86 of parents were unaware of
    their childs suicidal behavior.

26
True / False Answers
  • The majority of adolescent suicides occur
    unexpectedly without warning signs. (False)
    Nine out of ten adolescents who commit suicide
    give clues to others before their suicide
    attempt. Warning signs for adolescent suicide
    include depressed mood, substance abuse, loss of
    interest in once pleasurable activities,
    decreased activity levels, decreased attention,
    distractibility, isolation, withdrawing from
    others, sleep changes, appetite changes, morbid
    ideation, offering verbal cues, offering written
    cues, and giving possessions away.

27
True / False Answers
  • Most adolescents who attempt suicide fully intend
    to die.(False) Most suicidal adolescents do not
    want suicide to happen. Rather, they are torn
    between wanting to end their psychological pain
    through death and wanting to continue living,
    though only in a more hopeful environment. Such
    ambivalence is communicated to others through
    verbal statements and behavior changes in 80 of
    suicidal youths.

28
True / False Answers
  • There is a significant difference between male
    and female adolescents regarding suicidal
    behavior. (True) Adolescent females are
    significantly more likely than adolescent males
    to have thought about suicide and to have
    attempted suicide.

29
True / False Answers
  • The most common method for adolescent suicide
    deaths is drug overdose. (False) Guns are the
    most frequently used method for deaths by suicide
    among adolescents. In 1994, guns accounted for
    67 of all adolescent deaths by suicide while
    strangulation (via hanging), the second most
    frequently used method for adolescent suicide
    deaths, accounted for 18 of all adolescent
    deaths by suicide.

30
True / False Answers
  • Because female adolescents die by suicide at a
    lower rate than male adolescents, their attempts
    should not be taken seriously.(False) One of
    the most powerful predictors of death by suicide
    is a prior suicide attempt. Adolescents who have
    attempted suicide are 8 times more likely than
    adolescents who have not attempted suicide to
    attempt again.

31
True / False Answers
  • Not all adolescents who engage in suicidal
    behavior are mentally ill.(True) Studies
    involving psychological autopsies of adolescents
    who completed suicide suggest that most
    adolescents are relatively rational and coherent
    at the time of their death. However, other
    research does suggest that identifying at-risk
    youth, by utilizing depression scales and
    psychopathology inventories, through screening
    and treating those individual who test positive
    for mental illness can benefit from counseling.

32
True / False Answers
  • Suicidal behavior is inherited.(False) There is
    no specific suicide gene that has ever been
    identified.

33
True / False Answers
  • Adolescent suicide occurs only among poor
    adolescents.(False) Adolescent suicide occurs
    in all socioeconomic groups. Socioeconomic
    variables have not been found to be reliable
    predictors of adolescent suicidal behavior.
    Instead of assessing adolescents socioeconomic
    backgrounds, school professionals should assess
    their social and emotional characteristics (i.e.,
    affect, mood, social involvement, etc.) to
    determine if they are at increased risk.

34
True / False Answers
  • The only one who can help a suicidal adolescent
    is a counselor or a mental health
    professional.(False) Most adolescents who are
    contemplating suicide are not presently seeing a
    mental health professional. Rather, most are
    likely to approach a family member, peer, or
    school professional for help. Displaying concern
    and care as well as ensuring that the adolescent
    is referred to a mental health professional are
    ways paraprofessionals can help.

35
True / False Answers
  • Adolescents cannot relate to a person who has
    experienced suicidal thoughts.(False) Data from
    the 1997 Youth Risk Behavior Surveillance Survey
    (YRBS), which surveyed 16,262 high school
    students, found that one in five students (24.1)
    had seriously considered attempting suicide in
    the previous year.

36
True / False Answers
  • If an adolescent wants to commit suicide, there
    is nothing anyone can do to prevent its
    occurrence.(False) One of the most important
    things an individual can do to prevent suicide is
    to identify the warning signs of suicide and
    recognize an adolescent at increased risk for
    suicide. School professionals should, therefore,
    be aware of these risk factors and know how to
    respond when a student threatens or attempts
    suicide. The existence of a school crisis
    intervention team may assist with this process.

37
Self-Mutilation Versus Suicide
  • The intent of self-mutilation is different than
    suicide-some use it as a form of
  • Emotion regulation
  • It calms me down.
  • Releases endorphins and changes the serotonin
    levels in the brain
  • The relief is within seconds

37
38
Self-Mutilation Versus Suicide
  • Self mutilation is not done with the intent to
    die.
  • The suicidal person usually views death as the
    only way to stop the internal psychic pain. So
    death is usually the intent of their behavior.
  • However, those who self-mutilate are at an
    increased risk for suicide. They need to be
    monitored and assessed for suicidality.

38
39
Risk Factors(Issue Brief 3b- How Can a School
Identify a student At-Risk for Suicide)
Suicide Awareness Curriculum Importance of
curriculum length Exemplary programs Mental
health approach Gatekeeper Training Screening
40
Lunch
41
Gatekeeping Three Easy Steps You Take Every Day
  • QuestionNotice signs ask
  • PersuadeAsk facts permission to get them help
  • Refer Identify needs-reach out for help

Remember to keep it simple like CPRwill provide
assistance until you hand them over to qualified
staff!
41
42
Gatekeeping
  • Is not intended to be a form of counseling or
    treatment
  • Is intended to offer hope through positive action
  • Is intended to teach those who are in a position
    to recognize warning signs, clues suicidal
    communications of people in trouble to ACT
    vigorously to prevent a possible tragedy.

43
Risk Factors(Issue Brief 3a-Risk Protective
Factors and Warning Signs)Multifactorial
Causation-9 out of 10 youth that engage in
suicidal behavior give clues
  • Risks
  • Previous suicide attempt
  • Substance abuse disorder
  • Feeling hopelessness, isolation, living alone, or
    runaways
  • Parental Psychopathology (depressive
    disorder/mood disorder)
  • Access to firearms
  • Physical/sexual abuse
  • School difficulties (grades, attendance, conduct
    disorder or disruptive, aggressive, impulsive
    behaviors, juvenile delinquency)
  • Life stressors/interpersonal losses,
    relationships, legal disciplinary problems
  • Sexual orientation (homosexual, bisexual,
    trans-gender youth, identity issues)
  • Chronic physical illness
  • Contagion or imitation (exposure to media,
    friends, or acquaintances)

44
Protective Factors(Issue Brief 3a-Risk
Protective Factors and Warning Signs)Multifactor
ial Causation-9 out of 10 youth that engage in
suicidal behavior give clues
  • Protective
  • Family cohesion
  • Good coping skills
  • Good academics
  • Impulse control
  • Feeling connected to school
  • Good peer relationships
  • Lack of access to means suicidal behavior
  • Advise seeking/help seeking behaviors
  • Problem solving/conflict resolution
    skills/abilities
  • Opportunities for meaningful participation/social
    integration
  • Sense of worth/confidence
  • Stable environment
  • Access to care, mental, physical, substance
    disorders
  • Responsibility/accountability for others/pets
  • Religiosity

45
  • Early Warning Signs
  • (Issue Brief 3a-Risk Protective Factors and
    Warning Signs)
  • Withdraw from friends and family
  • Preoccupation with death
  • Marked personality change serious mood changes
  • Difficulty concentrating
  • Difficulties in school (decline in quality of
    work)
  • Change in eating sleeping habits
  • Loss of interest in once pleasurable things
  • Frequent complaints about physical symptoms,
    often related to emotions, such as stomachaches,
    headaches, fatigue, etc.
  • Persistent boredom
  • Loss of interest in things one care about

46
Late Warning SignsIssue Brief 3a-Risk
Protective Factors and Warning Signs)
  • Openly talking about suicide or a plan
  • Exhibiting impulsivity such as violent actions,
    rebellious behavior, or running away
  • Refusing help, feeling beyond help
  • Statements of hopelessness, helplessness or
    worthlessness
  • Giving away favorite possessions,
  • Complaining of being a bad or rotten person
  • Inability to tolerate praise or rewards
  • Verbal statements, hints, such as, you will not
    need to worry about me much longer or I wish I
    were dead
  • Suddenly cheerful after a period of depression
    may mean student has already made up his mind to
    his problems by ending his life

47
Direct Verbal Clues
  • I am going to end it all.
  • I have decided to kill myself.
  • If_______happens or doesnt happen,
  • I am going to kill myself.
  • I wish I were dead

47
48
In-Direct Verbal Clues
  • They/she/he would be better off without me.
  • I want to go to sleep and never wake up.
  • I cant take it anymore!
  • You wont have to worry about me anymore.
  • Nobody cares if I am dead or alive.
  • I am going to put an end to all of this soon.
  • If this is how life is, I want out.
  • I am tired of life. Whats the point of going on?
  • I am calling it quits, living is useless.
  • You are going to regret how you have treated me.

48
49
Behavioral Clues
  • Purchasing a gun
  • Relapse into drug or alcohol use after recovery
  • Giving away prized possession
  • Changes in behavior

50
Situational Clues
  • Flare up/rejection by loved ones
  • Recent unwanted move
  • Death/loss of friend/loved one
  • Loss of freedom
  • In trouble with the law or authorities

51
Intervention StrategiesResponding to a Student
Crisis(Issue Brief 6c-Responding to a Student
Crisis)
  • What NOT to do
  • Promise confidentiality
  • Debate the issue of suicide (right or wrong?)
  • Panic, rush or act shocked
  • Judge or dare
  • Minimize the situation (we all go through this)
  • Leave the student alone!!
  • Preach or manipulate
  • If a student does have a weapon do not attempt to
    take the weapon by force
  • What to DO
  • Assess situation
  • Ensure student safety
  • Stay with youth
  • Send someone for help
  • Listen, listen, listen
  • Be empathic
  • Be direct (dont be afraid to say suicide)
  • Inform parents
  • Take the student seriously

52
Preparing for the question
  • Plan a time and place to ask the question
  • Try to secure a private setting
  • Give yourself plenty of time
  • Be prepared to listen

52
53
How to Ask the Question
  • Less Direct Approach
  • Sometimes people that feel the way you do want
    to kill themselves are you thinking of doing
    that or are you feeling that way
  • Do you feel so unhappy you wished you were dead
  • More Direct Approach
  • Are you thinking about suicide/killing yourself
  • (Practice, Practice, Practicemake it you)

54
What to Say Persuade they get Help
  • Listen
  • Give your full attention
  • Speak only when the person has finished
  • Dont judge, condemn or rush
  • Be calm, watch your fears
  • Sample
  • Will you let me help you make an appointment
    with?
  • Will you go with me to the counselor/nurse?
  • Will you promise not to harm yourself ?

55
What to do-Referral
  • Personally take the child to the appropriate
    person, counselor, social worker, or nurse.
  • Reach out for help, dont wait, do something
  • Hope begins with you!

56
Practice Session Role Play
  • The Gatekeeper could the following steps to
    briefly intervene
  • Greet student, state the facts ( _____________ I
    noticed that you (fact, fact)).
  • Make a statement about the students mood (You
    seem _______________).
  • Ask the question (___________, are you thinking
    about killing yourself?).
  • Thank the student for being truthful
    (__________I really appreciate your telling me
    the truth about this.).
  • Start the student toward help (Lets get you
    some help.).
  • Start moving slowly, (walk with me..).

57
Practice SessionRole Play
  • Scenario 1--Aimee, 15, has started being late to
    class.--She is not turning in work, and you
    notice cuts on her wrist.--She has poor eye
    contact, and she is suddenly not social. --A
    friend of Aimees comes to you worriedshe got an
    email in which Aimee refers to just
    Disappearing forever.
  • Scenario 2--Prakash, 10, is normally quiet and
    studious. -- He gets in trouble for bringing a
    knife to school and gets into a fight.--You are
    his math teacher and math is his favorite
    subject. He likes you. Today, he sits at the
    back of the classroom and is the last to leave,
    as if he wants to talk.
  • Scenario 3--Marta,13 is a student who talks often
    in class, and gets into trouble for clowning
    around and laughing. --Today she has a bruise on
    her face that she is trying to hide. --She is
    sullen and withdrawn and makes no eye contact.
  • (One person plays the Gatekeeper, the other the
    student, than switch roles with next scenario of
    their choice or make up your own scenario)

57
58
Practice SessionRole Play
  • Scenario 1--Robert, 16, is the class clown, but a
    wizard on the football field. His personality
    has been shifting.--You are the coach. You
    notice he is losing weight. You know his parents
    recently divorced.--He is normally on time to
    practice. He comes late, doesnt make eye
    contact, and says he cannot stay to play today.
    Football has been his life.
  • Scenario 2--Nakeeta,17, is captain of her debate
    team. You are her English teacher. She has been
    making plans to attend a competitive all-girls
    college. You are recommending her. She fails
    to turn in a key assignment. --She starts
    keeping to herself and is avoiding her
    friends--When you talk to her about it, she tells
    you with tears in her eyes not to bother with the
    recommendationshe has no future.
  • Scenario 3--Mien Tsu, 6, is one of 8 children.
    He is painfully quiet, but loves your music
    classroom. --Every class he volunteers to help
    you pass out rhythm instruments. --Today he is
    crying and sits in a ball on the floor. --His
    father has been in and out of the hospital for
    weeks. --When class is over, he doesnt leave,
    but sits silently crying and hits his fists
    repeatedly on his legs.
  • (One person plays the Gatekeeper, the other the
    student, than switch roles with next scenario of
    their choice or make up your own scenario)

59
General Gatekeeping Team Roles and Tasks
60
Suicide Prevention Sample Level 1 Gatekeeping
Documentation Form (Remember to edit this to meet
your district/campus needs) Staff
Name_____________________________Date______Time___
__ Student Name__________________________________
_Grade_____ What I noticed What I asked the
student What the student said What I did
  • Note If he/she is thinking about killing
    himself/herself
  • Ask if they have a plan
  • Ask them to describe their plan
  • Ask if they have initiated their plan
  • If yes, take appropriate action immediately,
    including calling 911 if necessary
  • Be aware that the student may not be truthful.
    If your intuition is that they are not truthful,
    refer the student to the next level.

61
Suicide Prevention Sample Level 2 Campus
Screening Form Student Name______________________
______________Date ________Time____ Student
stated (in the students words) As reported by
_________________________________________ Frequenc
y of thoughts ____________________________________
______________ (months, weeks, days, hours,
minuteshow often) (ask how often are you
thinking about killing yourself? Once a week??
Etc.) Intensity of thoughts
1 2 3 4 5 6 7 8 9
10 (ask on a scale of 1 to 10, ten being ready
to kill yourself, how intense are your
thoughts?) Duration of thoughts (write an
amount) (ask when you think about it, how long
do you think about it each time?) History of
Attempts (ask have you ever tried to kill
yourself in the past? When? Where? What
triggered it? What happened?) History of
Methods (ask what methods did you
use?) Drug/Alc. Use (ask about this past and
present, related to the attempts) Current
Medications/Counseling (ask are you currently
taking medication? Are you seeing a counselor?
Have you in the past?) Plan (ask what is your
plan, when/where do you plan to do
this?) Method (ask how are you going to do
thiswhat method?) Other statements
Check when completed
Parent/Guardian notified
Administrator notified
SPED counselor/LSSP notified MHMR
Called
62
Suicide Prevention Sample Level 2 Campus
Screening Form Parent Statement I have had
explained to me the seriousness of the situation
and agree to accept responsibility to keep my
child safe. I agree to take my child for further
evaluation today. Further, I understand to make
our home safe I must remove any guns, knives,
other weapons, medication and other possible
means from my home. In the event of an
emergency, we will call (the local suicide
hotline phone number) immediately. Local
Hotline ______________________ Contact Name
_____________________ Parent Signature____________
_____________Date/time________________ Student
statement I agree to keep myself safe today and
go to get help, and tell my parent if I feel like
killing myself Student Signature_______________
________Date/time_________________ School
Screener signature______________________
63
Possible Actions for your District/Campus
  • ? 1. Choose a district leader for the
    gate-keeper team.
  • ? 2. Develop a team of key team members that
    might include counselors, administrators,
    nurses, school board member, a SHAC team member,
    school safety officers, SDFS federal program
    director, and other members that you want
    represented on the team.
  • ? 3. Review the gate-keeping training
    objectives and concepts.
  • ? 4. Decide who on each campus will be the
    lead go to personthe campus team leader.
  • ? 5. Establish a district-wide campus
    training plan.
  • ? 6. Break into subcommittees to do the
    following
  • The campus go to team leaders will develop a
    list of team members on each campus.
  • Counselors will revise the screening forms to
    meet the districts needs/approval.
  • SHAC representative/safety officer/board
    member/SDFS director/administrators will review
    the laws, student handbook, school safety
    policies and legal matters and update as needed.

64
Possible Actions for your District/Campus
  • ? 7. Have gate-keeper team discuss district
    policies and procedures related to
  • a. Students running off campus
  • b. Students with a weapon on campus
  • c. Students over-dosing on campus and the
    reporting process of such occurrences.
  • d. Any other issues that might be of
    importance to discuss before training
  • ? 8. Assign break-out groups any follow-up to
    include
  • a. Typing, editing and compiling any
    district-wide procedures.
  • b. Typing and editing the screening forms and
    training materials to reflect district
    needs/campus needs.
  • c. Campus teams review new training
    documentation and finalize for training
  • ? 9. Make adjustments to the district plan
    based on input received from
  • the gate-keeping team.
  • ? 10. District team designee (contact local MHMR
    to share information and the district plan.
    Develop the local notification process with MHMR
    when students need emergency assessment.
  • ? 11. SHAC team member informs parents about the
    district plan to help inform parents and gain
    parental support.
  • ? 12. Determine if your school district has a
    suicide postvention protocol. If not, raise this
    issue with appropriate personnel.
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