Preventing Adolescent Suicide by Joining Forces in the Community

Transcription

1 Preventing Adolescent Suicide by Joining Forces in the Community The Screening for Mental Health SOS program Moderator: Alan Holmlund, MSW, Director, Suicide Prevention Program, Massachusetts Department of Public Health Panelists: Joanna Bridger, LICSW, Clinical Services Director, Riverside Trauma Center Tricia Buonacore, Health Educator, Littleton Middle School Meghan Diamon, MSW, LCSW, Youth Programs Manager, Screening for Mental Health Sarah Dorfman, Adjustment Counselor, Littleton Public Schools Stuart Jacoby, EdD, School Psychologist, Boston Public Schools 1

2 Suicide Prevention and Integrated Care In the year they died by suicide: 32% saw a mental health professional (Luoma et al, 2002) 39% visited an emergency room (Gairin et al, 2003) 77% saw a PCP (Luoma et al, 2002) In the month they died by suicide: 20% saw a mental health professional (Luoma et al, 2002) 10% visited an emergency room (Gairin et al, 2003) 45% saw a PCP (Luoma et al, 2002) 2

3 Youth Suicide 90% of youth who die by suicide suffer from a diagnosable mental health disorder 1 in 5 adolescents will experience depression before the age of 18 Over 50% of adolescents with mental illness never receive treatment Approximately 1 in 50 American adolescents will make a suicide attempt that requires medical attention Suicide is the 2nd leading cause of death among year olds (CDC, 2013) 3

4 Youth Risk Behavior Survey Of US High School Students: 29.9% felt so sad or hopeless for 2+ weeks that they stopped doing some usual activity (up from 28.5%) 17.0% seriously considered attempting suicide (up from 15.8%) 13.6% made a suicide plan (up from 12.8%) 8.0% attempted suicide (up from 7.8%) 2.7% of those who made an attempt required medical attention (up from 2.4%) Find the data for your city/state: 4

5 Massachusetts Youth 5

6 SOS Signs of Suicide Prevention Program Developed in 2001 by Screening for Mental Health, Wellesley, MA Used by over 10,000 schools nationwide Implemented in almost 300 Massachusetts schools Universal prevention through education and screening Encourages schools to develop community-based partnerships 6

7 SOS Signs of Suicide Prevention Program Goals Decrease suicide and attempts by increasing knowledge and adaptive attitudes about depression Encourage individual help-seeking and help-seeking on behalf of a friend Reduce stigma: mental illness, like physical illness, requires treatment Engage parents, school staff and community as partners in prevention through education 7

8 SOS Signs of Suicide Student Message - ACT Acknowledge Acknowledge that you are seeing signs of depression or suicide in a friend and that it is serious Care Let you friend know you care about them and that you are concerned that he or she needs help you cannot provide Tell Tell a trusted adult that you are worried about your friend 8

9 SOS Signs of Suicide Prevention Program Evaluation SOS is the only universal school-based suicide prevention program for which a reduction in self-reported suicide attempts has been documented. In a randomized controlled study, the SOS Program showed a reduction in selfreported suicide attempts by 40%. Study published in BMC Public Health, 2007 found SOS to be associated with: significantly greater knowledge more adaptive attitudes about depression and suicide significantly fewer suicide attempts among intervention youths relative to untreated controls (Aseltine, 2007) Included in SAMHSA s National Registry of Evidence-Based Programs and Practices (NREPP) 9

10 The Power of Screening 10

11 SOS Implementation in Littleton, MA Littleton Middle School (educating 365 students) Approach to learning incorporates the whole child emphasizing social and emotional well being SOS Middle School Prevention Program and Screening takes place in all 7 th grade health classes Students also receive SOS programming in 10 th and 12 th grades at Littleton High School 11

12 History of SOS at Littleton See a New Sun Foundation (SANS) provided the first SOS program in 2007 Training provided by Screening for Mental Health Team approach Health teacher, Adjustment counselor, 7 th grade teachers, Nurse, PE, secretaries, high school counselors, school psychologist, resource officer, partner agency 12

13 Nuts and Bolts Parent/Student Outreach Passive consent (parents can opt out) Program explanation in school newsletter Community Outreach MSPP contacted How should we engage other providers? SOS Education and Screening Counselors follow up with students who are flagged- parents called Counselors talk with students in same vicinity Students encouraged to come forward about themselves or a friend 13

14 Follow Up Health lessons Adjustment counselor follows up with parents, students, hospitals Release forms ER/Hospitalization MSPP INTERFACE Referral Service 14

15 Best Practices Developed Screening form has changed over the years based on feedback from schools New validated screen much easier to score Video has been updated Students find it more realistic now Process for calling students out of class for follow up is more focused on student privacy Time of year has changed Each year, we review and plan improvements for the next year 15

16 BPS-Need for Integration Recognition that Boston Public Schools are unique And each school within the district is unique This model was created to address the unique needs of the students in the City of Boston in relation to state and national initiatives. Of the 135 schools in BPS, 90 have partnerships with community mental health agencies. The composition of services varies by school and agency. Leads to vast inequities in services across the district 16

17 Comprehensive Behavioral Health Model Benefits for our students Benefits for our schools Benefits for our district Instruction in prosocial skills Access to targeted supports and services Improved academic performance Increased positive behaviors Integrated academic and socioemotional learning Professional development on evidencebased interventions Improved school climate and student engagement Increased skills to address students needs Data management and accountability Partnerships with families and community agencies Increased capacity to provide access to services Improved coordination of services 17

18 Comprehensive Behavioral Health Model SOS is a tier one/primary intervention 18

19 Value of Integration in the CBHM Model Strong partnerships with providers allow for universal screening and referral Screenings are performed in a variety of classes including Advisories and Health classes Students who are screened as part of the SOS program and require followup are seen by either Student Support Staff or School Psychology Staff immediately Referrals for care are made to the appropriate school partner SOS is being implemented in both CBHM and Non-CBHM schools CBHM Schools better equipped to implement primary prevention programs 19

20 Why Grief Following Suicide Can Be More Complicated Shock at the sudden/unexpected death Social stigma/shame Intense search for the reasons why Police investigation/media involvement Could this death have been prevented? Ambiguity about volition of deceased Feelings of abandonment and rejection Fear of own self destructive impulses Fear of possible suicidality of others Violence/trauma of the death Lengthy court action precludes closure Anger at perpetrator (scapegoating/blaming) Increased risk of suicide Adapted from Underwood (1997) & Cerel et al. (2015) 20

21 Six Months after the Suicide Death of a Peer 4x more likely to develop a psychiatric disorder 6x more likely to develop major depression More likely to develop Post Traumatic Stress Disorder 5X higher rate of suicidal ideation Brent (2010) 21

22 Postvention Tasks and the Role of Integration 1) Verify death and facts surrounding the death Confirm with family, police or medical examiner 2) Coordinate internal and external resources Behavioral and Medical Health Providers, Faith Community, School Resource officer, etc. 3) Disseminate accurate information 4) Support for those most impacted by the death Considering those outside of the school 5) Identify those most at risk 6) Provide opportunities for commemoration Involve community providers, parents, etc. 7) Provide psycho-education on grief and suicide Riverside Trauma Center (2011) 22

23 Postvention Tasks and the Role of Integration 8) Casefind/Screen for depression 9) Implement trauma response for second/ subsequent suicide 10) Develop linkages to resources Clinical follow-up, funding opportunities, clubs/groups 11) Evaluate postvention response 12) Develop community/system wide prevention plan Community coalition/task force Resource map of community leaders/ programs/people interested in helping Address risk and protective factors Resilience curriculum Means reduction Sustainability Proactive use of media and advocacy Riverside Trauma Center (2011) 23