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Background on Youth Suicide Rationale for Schools Our Approach to Suicide Prevention
Depression Awareness
Suicide Screening & After Care Procedures
Completed Suicide Postvention
LCPS Outcomes
Heather Applegate
Suicide is the 3rd leading cause of death among persons aged 15-24 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%)
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2010: 11th leading cause of death in Virginia, 3rd among 10- to 24-year olds
2010: 19.8 per 100,000 in Eastern region 9.7 per 100,000 in Northern region
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
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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.
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Liability is not in the outcome but in the process. – Dewey Cornell, University of Virginia
Suicide prevention is everyone’s responsibility.
- Scott Poland
Virginia Code
22.1-272.1 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.”
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Surgeon General issued a national Call to Action to Prevent Suicide (U.S. Public Health Service, 1999)
VA Health/Physical Education SOL 10.3. The student will implement personal-injury-prevention 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
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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.
Suicide Screenings,
After Care & Suicide
Postvention
Depression
Awareness
Targeted Boosters of
Depression Awareness
Depression Awareness/Suicide Prevention Program Implemented in 2001-2002 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
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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
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Based on the Code of Virginia §22.1-272.1 and VDOE’s Suicide Prevention Guidelines Revision of LCPS Suicide Prevention Guidelines to reflect an organized, step-wise process
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
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.
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.
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
Page 1 of the Suicide Risk Screening Documentation Form
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
Persistent suicidal ideation that is intense and lasting
Specificity No plan Some specificity of plan
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
Strong risk factors
Protective Factors Strong protective factors
Few protective factors
Irrelevant
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.
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 §22.1-272.1 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
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.
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.
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 007109
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
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The Depression Awareness Suicide Prevention program and refresher sessions were presented to approximately 4,435 ninth and tenth grade students during the 2010-2011 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
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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
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)
“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.”
