TEXAS&SUICIDE&SAFER&SCHOOLS&

Transcription

1 TEXAS&SUICIDE&SAFER&SCHOOLS& 2015 Authored)by:)Dr.)Scott)Poland)and)Dr.)Donna)Poland )Produced)in)collaboration)with)) Texas)Department)of)State)Health)Services)and)Mental)Health)America)of)Texas)

2 2 TableofContents IntroductionandIncidence...4 PurposeoftheReport...5 TexasSuicidePreventionOverview GeneralFactsaboutSuicide WarningSignsforSuicide RiskFactorsthatcanIncreaseSuicidalIdeation ProtectiveFactorsthatDecreaseSuicidalBehavior...23 MostCommonMythsaboutYouthSuicide..24 UnderstandingSuicide:InterpersonalTheoryofSuicide.. 27 OverviewoftheMostCurrentSuicidePrevention/InterventionRequirementsinTexas Schools.. 27 Blueprint:ImplementingTexasLegislationforSuicidePreventioninSchool AdditionalRecommendations:AfteraReviewofTexasLegislationandEducation Code ScreeningPrograms SuicideIntervention AssessmentandIntervention Confidentiality/ConfidentialityExceptions SuicidePostvention Postvention:CommonlyAskedQuestionsandResponses.. 48 SuicidePostventionChecklist SuicideandSchools:LiabilityIssues...54 ProfessionalEthicalStandardsforKeySchoolPersonnel..60 AdditionalSummativeRecommendationsforSuicidePreventioninTexasSchools.. 63

3 3 AppendixContents A\ DeathbySuicideStatistics 68 B\ TexasSuicideSafeSchoolsSurveyforEducators. 72 C\ TexasSuicideSafeSchoolsSurveyforLeaders..74 D\ TexasStateAgencies,National/FederalAgenciesandOrganizations..76 E\ SPRCResourcesSpecifictoYouthSuicidePrevention/Intervention/Postvention 83 F\ SuicidePreventionTrainingResourcesListedinTexasToolkit.. 84 G\ InformationaboutSPRC snationalregistryofevidencebasedprogramsandpractices..87 H\ TexasE\ResourcesforSuicidePreventionAvailablefromMentalHealthAmericaofTexas...91 I\ AdditionalSuggestedResources AbouttheAuthors AbouttheCollaboratingOrganizations 96 References...98 AdditionalAnnotatedBibliography

4 4 SuicideSaferSchoolsinTexas Produced)in)collaboration)with)the)Texas)Department)of)State)Health)Services)and)Mental)Health)America)of) Texas)) Authored)by)Dr.)Scott)Poland)and)Dr.)Donna)Poland) IntroductionandIncidence Suicidehasbeenidentified(dependingonageanddatacollectiondate)asthesecondorthird leadingcauseofdeathforyouthsages10\24nationwide.thoughitislikelyunderreporteddueto socialstigma,reportedsuicidesaccountforapproximately4,600deathsayearamongyouthintheu.s. Ina2013survey,1in13U.S.9th\12thgradersreportedhavingattemptedsuicideoneormoretimesin thepastyear,andmorethan1in7reportedseriouslyconsideringattemptingsuicide.youthsuicideis aseriouspublichealthissueandithasincreasedinrecentyears.itisnotedthatmosteducatorsare notfamiliarwiththeincidenceofsuicideandareverysurprisedtolearnhowoftenahighschool studenthasthoughtsaboutsuicide,makesaplanandevenattemptssuicide.thereisagreatdealof misinformationaboutsuicideandmanyheldmythsthathaveresultedinalackofawarenessand hesitancytotalkdirectlyaboutaleadingcauseofdeathforouryouth.thisreportemphasizes dispellingthemanymythsthathavebeenperpetuatedaboutsuicidewiththegoalofempowering Texaseducatorsthattheycanmakeadifferenceincreatingsuicidesaferschools Itisimportanttoknowthatsomegroupsareatahigherriskforsuicidethanothers.Malesare morelikelytodiebysuicidethanfemales,butfemalesaremorelikelytoattemptsuicide.among racial/ethnicgroupsnationwide,americanindian/alaskanativeyouthhavethehighestsuiciderates. Inaddition,researchhasshownthatlesbian,gay,bisexual,andtransgenderyouthreportsuicide attemptsatsignificantlyhigherratesthantheirheterosexualcounterparts.severalotherfactorsput teensatriskforsuicide,includingafamilyhistoryofsuicideorpastsuicideattempts,mentalor physicalillness,substanceabuse,stressfullifeevents,easyaccesstolethalmethods,exposureto suicidalbehaviorofothers,andincarceration.

5 5 Approximately157,000youngpeopleages10\24aretreatedforsuicideattemptsatU.S. emergencydepartmentseveryyear.accordingto2012datacollectedbythenationalcenterforinjury PreventionandControl,poisoningisthemostcommonformofintentional,self\inflicted,non\fatal injuryresultinginhospitalizationsfor10\to24\year\olds.whileourinterestinthisstudyisforschool agedchildren,itisimportanttorecognizethedatatheyhavecollectedthroughtheageof24.manyof ourschoolcommunitiesareimpactedbysuicidesofolderformerstudentsastheyhaveyounger siblingsorfriendsstillattendingschool. This information was compiled from the following sources: Centers for Disease Control and Prevention. (2014). Suicide prevention. Retrieved from: U.S. Surgeon General and the National Action Alliance for Suicide Prevention. (2012) national strategy for suicide prevention. Retrieved from: Child Trends. (2014). Teen homicide, suicide, and firearm deaths. Retrieved from: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention. (2014). WISQARS leading causes of nonfatal injury reports. Retrieved from: AppendixAprovidesinformationaboutoverallsuicideratesinthenationandinTexasinrelationtoour youth. PurposeoftheReport ThisreportisdesignedtoassistTexaseducatorstoknowtheincidenceofyouthsuicideandto recognizeschoolshavetheabilitytoincreasesuicideawareness,increaseprotectivefactors,build resiliencyinstudentsandveryimportantlytointerveneandgethelpforasuicidalstudent.itis essentialthateducatorsbeabletodistinguishthefactsaboutyouthsuicidefromthemanymythsand misperceptions.suicideispreventableandasystemwideapproachisneededthatincludestheschools andallstakeholders.thereisanationalfocusonsuicidepreventionandthe2012strategyforsuicide Preventionstressedthatsuicidepreventionneedstobeacorecomponentofhealthservicesandthe ZeroSuicideModelhasthegoalofimprovingoutcomesforsuicidalindividuals.Texashassetgoalsto improveidentification,treatmentandsupportforsuicidalyouthandtoestablishsuicidecare CommunitieswithinthepublicmentalhealthsystemaspartofaZeroSuicidestatewideemphasisfor

6 6 healthcareandbehavioralhealthcare.texashasmadegreatprogressinincreasingsuicideprevention effortsinschoolsandimprovingpartnershipswithlocalandstateagencies.thisreportisdesignedto clarifytheroleoftheschoolsandincreasenotonlyawarenessofyouthsuicidebuttohelpschools increasetheircollaborativeeffortsforpreventionandknowledgeofavailableresources.suicide interventioninschoolshasthreemajorcomponentsthatwillbeaddressedinthisreport:prevention, interventionandpostvention.texashaslegislativerequirementsforschoolsandsuicideprevention. Thisreportwillreviewthelegislationandmakepracticalrecommendationsintheformofaplanfor howschoolscanbestimplementthelegislation.extensiveinformationaboutsuicideprevention requirementsintexasschoolsappearsinthelegislationsectionofthisreport. BothauthorsworkedintheTexasschoolsformanyyearsandsuicideinterventionwasthe highestpriority,butwefeltitwasessentialtosurveytexaseducatorsandleadersoutsideofthe schoolsinstateagenciestogetanaccuratepictureoftheaccomplishmentsandchallengesforsuicide saferschoolsintexasbeforewritingthisreport.weareveryfamiliarwithoneofthemostimportant suicidepreventionstrategiesrecommendedbythecenterfordiseasecontrol(cdc)whichisto increaseconnectionsasawaytopreventsuicide.webelievethateverystudentneedstofeelasense ofbelongingandconnectednesswiththeirschool,classmatesandschoolstaff.schoolshavealways impresseduponparentsandguardiansthatweneedtheirpartnershipinhelpingtheirchildrentobe successful.webecameprofessionaleducatorsandstateleadersineducatingouryouthbecausewe careabouttheirlearning,socialgrowth,mentalandphysicalwellbeing.childrenareinschooland underdirectsupervisionofteachersandschoolstaffforaminimumofsevenhoursaday.forstudents whoparticipateinafter\care,sports,ortheartsandclubs,thetimecanextendmanymorehours.itis notuncommonforparentstocommentthattheirchildrenspendmostoftheirwakinghoursatschool. Thismakeseducatorsdevotionoffocusedandundistractedtimetoeachstudentintheclassroom, lunchroom,hallways,socialplay,andorganizedafter\schoolactivitiesacriticalopportunitytoobserve, report,andintervenewhenweseeachildinemotionaldistress.itisveryimportantthatalltexas educatorsknowthewarningsignsofsuicideandnotedramaticchangesinastudent sbehaviorand workasamemberofaschoolteamtoobtainassistanceandsupportforthestudent.moredataabout suicidalthoughts,behaviorandactionsaregatheredonthehighschoolstudentpopulationthatany otherschoolagedgroup.themostcurrentdataforhighschoolstudentsnationallyandintexas appearsbelow.

7 7 2013NationalandTexasYRBSResultsforHighSchoolStudents: Dataretrievedfrom: NationwideYouthRiskBehaviorSurveillance Surveyed15,000H.Sstudentsandinthelastyear 17.0%consideredsuicide(increasefrom2011) 13.6%madeasuicideplan(increasefrom2011)) 8.0%madeanattempt(increasefrom2011) TexasYouthRiskBehaviorSurveillance2013 Surveyed3181H.S.studentsandinthelastyear 16.7%consideredsuicide 15.6%madeasuicideplan(increasefrom2011) 10.1%madeanattempt(unchangedfrom 2011) ItisveryimportanttonotethatthenumberofTexashighschoolstudentswhomadeasuicide planandattemptedsuicideinthelastyearisabovethenationalaverage.studentswithaprevious historyofsuicideareverymuchconsideredatriskforfuturesuicidalbehavior.yrbsdatahasbeen gatherednationallyeverytwoyearssince1991bythecenterfordiseasecontrolandprovidesvery importantinformationaboutmanyatriskbehaviorsforhighschoolstudents.allhighschoolpersonnel arestronglyencouragedtoreviewyrbsdatafortexasstudentsinallatriskcategories. Therehasbeenanationalmovementtoincreasesuicidepreventioninschoolsandmanystates currentlyarerequiringannualin\servicetrainingforschoolpersonnel.mostnotablythejasonflatt Act,andsimilarlegislationwhichaddressesyouthsuicideawarenessandpreventionpertainingto annualteacherin\servicetraininghaspassedin15statestexasisamongthethirtypercentofour

8 8 stateswhohavepassedlegislationtorequireteachersuicidepreventiontraining.inall15states,this legislationhasbeensupportedbythestate sdepartmentofeducationandthestate steacher s Associationwhichpointstothevalueseeninsuchpreventativetraining.Therequirementsforteachers trainingdifferamongthevariousstates.theamericanfoundationforsuicideprevention(afsp) summarizesstatelegislationandprovidedawealthofinformationforsuicidepreventioninschools. AFSPnotedonlyafewstatesarerequiringsuicidepreventionpresentationstostudents. AsurveyofTexaseducatorswasconductedbyPolandandPolandin2015priortowritingthis report(acopyofsurveycanbefoundinappendixc)indicatedresoundingly,educatorsatpre\k through12 th gradecampusesanddistrictsintexashaveaskedfortrainingandincreasedresourcesto aidtheminrespondingtoyouthsuicidethoughts,attempts,andcompletions. 96%oftherespondentshavereceivedsuicidepreventiontraining.Anecdotalcommentswrittenby counselorsandotherschoolpersonnelindicatedthattheyrecognizedandunderstoodthesignsof suicideideationandhadaplaninplaceforaddressingtheneedsofthedistressedstudent(s).however, afollow\upquestionregardingtheirconfidenceinknowledgeandskillsforinterveningwithasuicidal studentreflectedthat100%insuburbandistrictsexpressedtheywereconfidenttosomewhat confidentwiththeirskillsbutonly50%inruraldistricts,and40%inurbandistricts,expressedthey wereconfidenttosomewhatconfidentwiththeirskills. 50%oftheoverallrespondentswerefamiliarwiththeBestPracticesresourcesthatare advocatedinthisdocumentandprescribedbynationalandstatesuicideprevention organization. 89%oftheoveralleducatorrespondentsindicatedtheyhavepersonallyrespondedtoayouth suicide. 56%ofoverallrespondents schoolshaveprovidedsuicidepreventiontrainingtostudentsand parents.manycommentingthattrainingisdonewhenan atrisk youthisidentifiedand interventionsaredoneonlyforthespecificyouthandtheirparent.most yes responses indicatedguidancelessons,orgroupcounselingofabroadernaturethatdoesnotspecifically mentionsuicideprevention.

9 9 48%ofoverallrespondentsindicatedthattheirschoolhasaprocedureforscreening depression/suicidewithstudents.thequestionaskedifscreeningwasprovidedfor all students,butresponsesindicatedscreeningisnotdoneforentirestudentbody.someschools doa generalneedsassessment atthebeginningoftheschoolyeartodeterminewhich studentsmayneedattention.teenscreenwasindicatedby2schoolsasatoolusedfortheir entire5 th and6 th gradestudents.(currently,theteenscreenprogramisnolongeravailablefor purchase.) 67%ofoverallrespondentsdidnotknoworwereunsureofanydistrictinformationorcampus improvementplansthatincludedsuicideprevention. ASurveyofTexasleadersinSuicidePreventionwhoworkinstateagencieswasalsoconductedby PolandandPolandin2015priortowritingthisreport(copyofsurveycanbefoundinAppendixD)that indicatedthattheyareveryfamiliarwithbestpracticesandverydedicatedtoassistingtexasschoolsin allaspectsofsuicideintervention.theseleaderswereaskedaboutthetopsuccessesforsuicide preventioninthetexasschoolsandcitedthefollowing:legislationsisinplace,schooldistrictshave reachedoutforguidance,freeonlinetrainingisavailableforeducatorsandmanystatewideefforts areinplacetopromoteawarenessincludingelectronicresources,appsandwebsites.inaddition,the DepartmentofStateHealthServices(DSHS)hasasuicidepreventioncoordinatorandtherearemany (30)coalitionsforsuicidepreventionaroundthestateandeverylocalmentalhealthcenterhasa designatedsuicidepreventioncoordinator.thestatehasalsoprovidedfundingformentalhealthfirst Aidtrainingthatanumberofschoolshavetakenadvantageof.Mentalhealthandsuicideprevention havealsobeenaddedtolocalschoolhealthadvisorycouncilrequirements.thefactthatasksuicide preventiontrainingshavebeenprovidedinmanylocationsaroundthestatewasalsocitedasa strength.thetexaseducationagency(tea)alsohasfacilitatedbi\monthlymeetingsofstateagency staffthatfocusonmentalhealthandsuicidepreventionformorethanayear.muchprogressinsuicide preventionintexashastakenplaceinthelastdecade 50%oftheoverallrespondentssomewhatbelievedTexasschoolswerefamiliarwiththeBest Practicesresourcesthatareadvocatedinthisdocumentandprescribedbynationalandstate suicidepreventionorganization.

10 10 75%oftheoverallrespondentssomewhatbelievedTexasschoolshadagoodunderstandingof howtoimplementtexaslawsregardingsuicidepreventioninschools 75%oftheoverallrespondentswerenotconfidentthatTexasschoolshadtheknowledgeand skillsforinterveningwithasuicidalstudent 75%oftheoverallrespondentssomewhatagreedthatTexasschoolswereawareandutilized communityandstateresourcesforprevention/intervention 50%oftheoverallrespondentssomewhatbelievedTexasschoolshavethetrainingnecessary toworkwithstudentsandparentsintheaftermathofayouthsuicide 50%oftheoverallrespondentsdidnotbelieveTexasschoolshadacomprehensiveplanfor addressingsuicidepreventionandpostvention 100%oftheoverallrespondentsbelievethatyouthsuicideisaprobleminTexas 75%oftheoverallrespondentsbelievethatschoolsplayasignificantroleineducatingstaff, parentsandstudentsonsuicidepreventionintexas 100%oftheoverallrespondentsbelievethatschoolsneedmoreinformationandguidanceon suicideprevention/interventionstrategies TheLeaderswerealsoaskedwhattheybelievedtobethebiggestchallengesforsafersuicide preventionschoolsintexasandindicatedthefollowing:needformorecounselor/socialworkerstime tofocusonstudentmentalhealth,mentalhealthisimportantbutstatemandatesfocusonclassroom academics,limitedtimeexistsforprofessionaldevelopmentforeducatorsanditisdifficulttoprovide suicidepreventiontrainingtoeveryonewhoneedsit.additionallyitwasnotedthatsomeschoolsdo notknowhowtoaddresssuicideanditisadifficultsubjectandmanyofthebestpreventioneffortsin Texasschoolsthatareinplacewereimplementedonlyaftersuicidedeaths.Respondentsalsostressed theneedforstandardizedimplementationandmonitoringofsuicideprevention.itwasalsonotedthat thereisalackofdevelopmentallyappropriateprogramsonmentalhealthandpreventionfor elementaryagestudents.itisalsochallengingthatmuchofthefundingforsuicidepreventionis dependentonobtaininggrants.

11 11 LeaderswerealsoaskedwhatwouldhelptheTexasschoolsimplementrequiredlegislationand improvesuicidepreventionefforts.respondentscitedtheneedformoreguidancetobeprovidedto districtsandincreasedawarenessoflegislativerequirementsandthebestpracticesprogramlistthatis providedbydshs.itwasalsoemphasizedthatkeypersonnelsuchascounselorsneedtoreceive additionaltrainingonsuicideassessmentandintervention.aunifiedmissionforsuicideprevention needstobeestablishedthatincreasescollaborativeeffortbetweenallstakeholderswitha recommendedfocusonhowlocalandstateagenciescanassistschoolswithsuicideprevention.itwas alsosuggestedthatsuicidepreventionbealignedwithothermajorschoolinitiativessuchasbullying prevention,dropoutpreventionandsubstanceabuseprevention.additionalstatefundingfor preventionwasdescribedasessential. TexasSuicidePreventionOverview AnexcellentresourcethatallschoolpersonnelneedtobefamiliarwithistheSuicidePrevention ResourceCenter(SPRC)whichprovidesextensiveresourcesforschoolandcommunityeffortsin preventingsuicidedeaths.theirmissionistoassistinsuicidepreventionefforts.thesprcbelieves thatsuicideismosteffectivelypreventedbyacomprehensiveapproachthatemployssevenstrategies: (1)identifypeopleatrisk,(2)increasehelp\seeking,(3)provideaccesstomentalhealthservices,(4) establishcrisismanagementandpostventionprocedures,(5)restrictaccesstolethalmeans,(6) enhancelifeskills,and(7)promotesocialnetworksandconnectedness.theirnewsletter,theweekly Spark,containsannouncementsandinformationaboutsuicide,suicidepreventionandmentalhealth issues.theyprovidebriefsummariesofnational,stateandtribalandinternationalnews;analysesof relevantresearchfindings;descriptionsoffundingopportunities,andlinkstoadditionalresources. TheBestPracticesRegistry(BPR)isfundedbytheSubstanceAbuseandMentalHealthServices Administration(SAMHSA)andisdesignedtosupportprogramplannersincreatingeffectivesuicide preventionprograms.thebprhastwosections.sectionilists evidence\based programsthathave undergonearigorousevaluationandhaveachievedpositiveoutcomesforeffectiveprevention,and incorporatethebestavailableresearch. SectionIIlistsstatementsthatsummarizethebestknowledge insuicidepreventionintheformofguidelines,protocols,orconsensusstatements.thesestatements

12 12 typicallyresultfromacollaborativeprocessinvolvingkeyexpertsandstakeholdersand/orathorough reviewoftheliteraturebyapreeminentexpertinthattopicarea. MoreinformationveryrelevantforTexasschoolsabouteffectiveplanningandevaluationis availablefromthesprcatwww.sprc.organdalsoattexassuicideprevention.org. AboutSuicidePrevention AStrategicPlanningApproachtoSuicidePrevention(freeonlineworkshop) LocatingandUnderstandingDataforSuicidePrevention(freeonlineworkshop) AmericanIndian/AlaskaNativeSuicidePrevention:BasicsofGettingStarted EvaluationResourcesintheSPRCLibrary PlanningResourcesintheSPRCLibrary SeeAppendixEforcontactinformationforTexasStateagencies,National/FederalAgenciesand organizationsdedicatedtosuicidepreventionandappendixgforalistoftrainingprogramsthatare listedinthetexascomingtogethertocaretoolkit. GeneralFactsaboutSuicide Between2000and2013,thesuiciderateforallagesintheUnitedStatesrosefrom10.43(per 100,000)to13.02.Overthesametimeperiod,thesuiciderateformaleswentfrom17.11to Amongfemales,theraterosefrom4.00to5.67.Overall,mendiebysuicideatfourtimestherateof women.althoughsuicideratesarelowerforyoungeragegroupsthanforolderadults,suicideisthe secondandthirdleadingcauseofdeath(dependinguponage)foryoungpeopleintheunitedstates. 10\14;3 rd leadingcauseofdeathafterunintentionalcausesandmalignantneoplasms 15\24;2 nd leadingcauseofdeathafterunintentionalcauses Ratesofideation(i.e.,consideringandplanningsuicide)amongfemalehighschoolstudentsare nearlydoublethatofmalehighschoolstudents.thoughtsandattemptsamonghighschool

13 13 studentsarehigherthanamongadultsingeneral,althoughdeathsamongadolescentsare lower. Youngpeopleage15\19completesuicidenationallyatarateof7.53%andata7.49%inTexas. Children11\14yearsofagecompletesuicidenationallyatarateof1.5%andat1.41%inTexas. Suicideisthethirdleadingcauseofdeathamongpersonsaged15\24yearsandaccountsfor 20%ofannualdeathsinthisagerange. Alaskayouthsuiciderankedhighestinthenationwith38.2annualdeathsper100,000youth betweentheagesof15\19.texasranked33 rd with11annualdeathsper100,000youth,and thelowestyouthdeathbysuicidewasfoundinthedistrictofcolumbiaandrhodeislandwith.1per100,000youth. ChartsandgraphsonoverallUSandteensuicideratescanbefoundinAppendixAandat; o CDC'sWISQARSwebsite"FatalInjuryReports," January2015 o suicide. WarningSignsofSuicide Include,)but)are)not)limited)to)the)following,)(Erbacher,)Singer)&)Poland,)2015,)and) o o o o o o o Talkingaboutsuicide Makingstatementsaboutfeelinghopeless,helpless,orworthless Adeepeningdepression Historyofmentalillness Preoccupationwithdeath Takingunnecessaryrisksorexhibitingself\destructivebehavior Engaginginnon\suicidalself\injury

14 14 o o o o o o o Beingvictimizedbybullying Outofcharacterbehavior,dramaticchangesinbehavior Alossofinterestinthethingsonecaresabout Visitingorcallingpeopleonecaresaboutinawaythathintsatsayinggoodbye Makingarrangements;settingone saffairsinorder Givingprizedpossessionsaway Exposuretosuicide LeadingMethodsofSuicideinYouthBetweenAgesof10S19 Themostcommonmethodofsuicideinthisagegroupwasbyfirearm(49%),followedby suffocation\mostlyhanging(38%)andpoisoning(7%)accordingtowisqarsdata. simportanttonotethatwhilethismostlyreflectsthemethods usedbyourmaleyouth,ourfemaleyouth smostcommonmethodissuffocationfollowedcloselyby poisoning.inyouthbetweentheagesof15\24,estimatesindicatethereare100\200suicideattempts foreachsuicidedeath. RiskFactorsThatCanIncreaseSuicidalIdeation DemographicInformationandCommonPredictorsacrossAllAges: AgeSSuicideriseswithage.Forwhitemales,theolderheis,themoreatriskheis.Whitemalesover65 haveasuiciderate4timesthatofthenationalaverage. GenderSMoremalescompletesuicide.Morefemalesattemptsuicide.Maleschoosemorelethal means. EthnicitySMorewhitescommitsuicidethanpersonsofcolor.Statisticsshowanincreaseinyoung African\Americanmales,ages15\24. LossSThemoreirrevocabletheloss,thegreatertherisk.Suicideisassociatedwithanaccumulationof lossesthroughoutlife.

15 15 SubstanceAbuseSAlcoholincreasestheriskofcompletedsuicide.Drugabuseiscorrelatedwithmore attempts. MentalillnessSPriorpsychiatrichospitalizationincreaseslevelofrisk.Itisestimatedthat1/3ofall completedsuicideshaveadiagnosabledepressiveillness. PhysicalillnessSSuddenonsetofaseriousillnessorchronicconditionswithpoorprognosisand/or intensepainindicatesgreatlyincreasedrisk.illnessgenerallyplacesastrainondefensesandcoping skills,thusincreasingrisk. DownwardeconomicmobilitySUnemployment,frequentjobchanges,directionofreducedstatusor reducedearningsincreasesrisk.considerhowone sidentityisimpactedbythesesetbacks. LivinginthecitycenterSAreasofhighcrime,alcoholism,mentalillness,poverty,orfamily disorganization. Urbanconditionsincreasesocialisolationandalienation. RelationshipdisruptionSThemorefinalthechange,thegreatertherisk.Marriageisprotectionfor males.womensurvivebetterwithoutamatethandomen. PreviousattemptsSPriorattemptersareconsideredhighrisk.Themorelethaltheearlierattempts,the greatertherateofsubsequentcompletedsuicide. FamilyorclosefriendsattemptedorcompletedSPresenceoflovedoneswithattemptsorcompletions increasesrisk. Modeling ofbehaviorplantstheseedthatsuicideisanacceptedwayofcoping. HistoryofphysicalorsexualabuseSThemesofvulnerability,posttraumaticstress,etc.,complicate coping.historyofabusereduceschancesforself\empathy. AbsenceofasupportsystemSLackofresourcesandsocialsupportiscorrelatedwithcompleted suicide.considerhowcapablehe/sheisofdevelopingnewresources. RiskFactorsSpecifictoSchoolAgedYouth Berman,JobesandSilverman(2006)identifiedthefollowingtypesofyouthwhowouldlikelybethe mostatriskforsuicidalbehavior: Depressed:experiencesoverwhelminghopelessness,irritabilityand/orsadnessevenwhen thingsare goingwell. SubstanceAbuse:self\medicateswithsubstances,orengagesinincreasinglyriskybehavior whileundertheinfluence.

16 16 Borderlineorschizotypal:hasdifficultiesmaintaininghealthyinterpersonalrelationshipsand expressingemotionsinhealthyways. Antisocial,actingout,orconduct\disorderedadolescent:rejectssocialsanctionednotionsof health,well\being,andpro\socialactivities. Marginal,isolatedloner:disconnectedfrompeers,parents,orassociatesmostlywithother marginalizedyouth(e.g.homelessyouth). Rigidperfectionist:experiencesanytypeoffailurewhetheritisdefinedbyselforothers. Psychotic:experiencesdelusionsorhallucinations,orlivesinfearofdecompensation. In\crisis:livesinastateofperpetualstress\relatedoverwhelm;respondsinimpulsiveand irrationalways;unabletoengageincreativeproductiveproblemsolving. AdditionalPopulationsAtSRiskandRiskFactors LGBTQ Therearehigherratesofsuicidefortheseyouthduetheuniquecomplicationsratherthantheir sexualidentity.externalfactorsthatincludeconflict,harassment,abuserejection,andlackof supportcontributetotheirsuicidalbehavior.psychologicaldistressisveryacuteforstudents whoareamongthelesbian,gay,bisexual,transgender,orquestioningpopulationandstudies havefound2to3timesmoresuicideattemptsthantheirheterosexualpeers. AdvocacyforGLBTpopulationinschoolisoftenmetwithresistanceandthestrongest protectivefactorisparentalacceptance(lieberman,poland,kornfeld,2014).bullying,isolation, feelingsofbeingdifferentandunaccepted,insomecasesleadstohopelessness,loneliness, depression,andsuicidalideation.eventhoughthesepopulationshavebecomemore acknowledgedandacceptednationally,dependingontheschool scommunity,theseyouth maybeatrisk. MoreinformationandprogramsaboutandsupportforLGBTQstudentscanbefoundat; GLBTNationalHotline1\888\THE\GLNH(843\4564) RainbowYouthHotline1\877\LGBT\YTH(1\877\542\8984) LGBTSuicidePreventionHotlinewww.TheTrevorProject.orgor1\800\850\8078

17 17 GayLesbianStraightEducationNetworkwww.glsen.org NAMIwww.nami.org1\800\950\NAMI(6264) Parents,FamiliesandFriendsofLesbiansandGayswww.pflag.org AmericanPsychologicalAssociationwww.apa.org/pi/lgbc/ LearningDisabilities Studentswithlearningdisabilities(LD)arewellacquaintedwithacademicdifficultyand maladaptiveacademicbehavior.incomparisontostudentswithoutld,theyexhibithighlevelsof learnedhelplessness,includingdiminishedpersistence,loweracademicexpectations,andnegative affect,(idanandmargalit,2014).socialbehavioralresearchhasindicatedthereisanincreasedriskfor suicideamongstudentswithldthatislinkedtodepression,feelingsofhopelessness,and isolation/rejectionfromthemainstream(bender,rosenkrans,andcrane,1999). SleepDeprivationinAdolescents Thereisagrowingbodyofresearchthatwelldocumentsthatmanyadolescentsaresleep deprived.eventhoughadolescentsrequireasmuchas8to10hoursofsleepatnight,accordingtothe NationalSleepFoundationtheysimplyarenotwiredtoretireearlytobedandhavedifficultyfalling asleepbefore11pmandcellphonescallsandmessagesmayawakenthemduringthenight.the majorityofsecondaryschoolsinamericanbeginasearlyas7:30am.numerousstudieshave addressedtheharmfuleffectsofsleepdeprivationonadolescentsandoneinparticularbygoldstein, Bridge,&Brent(2008)foundasignificantrelationshipbetweensleepdeprivationandsuicide completionforadolescents.oneauthorofthisreportrespondedtosuicideclustersinboththefairfax CountyandthePaloAltoSchoolsduringthe2014\15schoolyearsandmanycommunityconcernswere voicedaboutthelackofsleepforadolescentsasacontributingfactorfordepression,hopelessnessand suicide.thefairfaxcountyschoolsbeginningwiththefallof2015willnotstartthehighschoolday before8:00am.

18 18 NonSuicidalSelfInjury(NSSI) ThemostcommonformsofNSSIarecutting;burning,scratchingtheskinandnotletting woundsheal.theincidenceofnssihasincreasedforyouthandtheprimarytheoriestoexplainwhy theyengageinthisbehavioraretoreleaseendorphinsortoregulateemotions.nssiisacomplex copingbehaviorthatfulfillsamultitudeofneedsforthosethatengageinit.nssiisastrongpredictor ofsuicideasstudentsareessentiallypracticingharmingthemselvesandschoolsneedtodevelop trainingandprotocolsforstafftohelpthembetterunderstandandrespondtonssiandkeypersonnel suchasschoolcounselorsneedtobefamiliarwiththemosteffectivetreatments(erbacher,singerand Poland,2015). Depression Researchhasfoundthatapproximately20%ofallteenagerssufferfromdepressionatsome pointduringtheiradolescenceandmostdonotreceivetreatment.whiledepressiondoesn tmean suicidalideationisimminentforeverystudentthatexperiencesdepression,itisthemostcommon indicatorinsuicidalyouth.studentsmayappearirritable,tearful,down,orsullen,andnotfind pleasureintheactivitiestheypreviouslyenjoyed.thekeytodistinguishingdepressionfromnormal teenagebehavioriswhetheritispersistentoveraseveralweekperiodandperseverantmeaningthat itaffectsallaspectsoftheirlife(academic,socialandfamily).youngerchildrenmayexpressdepression throughsomaticcomplaints;headaches,badfeelingsinstomach,etc.schoolpersonnelshouldknow theincidenceofdepression,bealerttostudents shiftingmoods,andaccesscommunitymentalhealth resources(erbacher,singer,&poland,2015).itisparticularlyimportanttopayattentiontothemesof hopelessnessanddepressioninthewritingandartworkofstudentsandtoalertkeypersonnelsuchas counselorsandadministratorswhensuchthemesarenoted. PrecipitatingEvent Thishasbeenreferredtoasthe, strawthatbrokethecamel sback meaningthatthestudentwas previouslysuicidalandonemorethingtheycannotcopewithontopofeverythingelsehascaused

19 19 themtoactontheirpreviouslythoughtoutsuicidalplans.polandandlieberman(2002)identifiedthe followingstressfuleventsthatschoolpersonnelshouldbealertforthatmighttriggerasuicide attempt:romanticbreakup,severeargumentwithfamilyorfriends,recentlossoflovedone,victimof bullyingorseverehumiliation,schoolfailure,lossofadreamsuchasnotmakingaschoolteamor rejectionfromcollegeofchoice,severeschooldisciplineorarrest/incarceration.itisimportantthat schoolpersonnelbealertforalloftheseprecipitatingeventsbutespeciallystudentsinserious disciplinarytroubleassomeparentswhosechildrendiedbysuicideandwhoreceivedpunishmentby schooladministrationforseriousinfractionshaveclaimedthepunishmenttobeacontributingfactor totheirchild ssuicide.parentsclaimedthatexclusionfromschoolrobbedthechildofasupport system,identityandfriends,causingtheirchildtosinkintoadeepdepressionanddiebysuicideand therearemanythousandout\of\schoolsuspensionsintexasannually(fuentes,2011). HistoryofTraumaandAbuse AccordingtoarecentstudybyFuller-Thomson, E., Rotman, S. (April, 2012)approximatelyone\ thirdofadultswhowerephysicallyabusedinchildhoodhaveseriouslyconsideredtakingtheirown life aratethatisfivetimeshigherthanadultswhowerenotphysicallyabusedinchildhood.the researchsuggestssuicidemayhavedevelopmentaloriginsrelatingtoabuse thatphysicalorsexual abusemayleadtochangesinthestressresponseinthebrainwhichincreasetheriskofsuicidal thoughtsandbehavior. SpecificEthnicGroupsandGenders(datatakenfrom2013YRBSHighSchoolstudy): SeriouslyConsideredAttemptingSuicide Nationwide,17.0%ofstudentshadseriouslyconsideredattemptingsuicideduringthe12 monthsbeforethesurvey.theprevalenceofhavingseriouslyconsideredattemptingsuicidewas higheramongfemale(22.4%)thanmale(11.6%)students;higheramongwhitefemale(21.1%),black female(18.6%),andhispanicfemale(26.0%)thanwhitemale(11.4%),blackmale(10.2%),and Hispanicmale(11.5%)students,respectively. MadeaSuicidePlan

20 20 Duringthe12monthsbeforethe2013YRBSsurvey,13.6%ofstudentsnationwidereported theyhadmadeaplanabouthowtheywouldattemptsuicide.theprevalenceofhavingmadeasuicide planwashigheramongfemale(16.9%)thanmale(10.3%)students;higheramongwhitefemale (15.6%),blackfemale(13.1%),andHispanicfemale(20.1%)thanwhitemale(10.1%),blackmale (7.7%),andHispanicmale(11.2%)students,respectively. AttemptedSuicide Nationwide,8.0%ofhighschoolstudentshadattemptedsuicideoneormoretimesduringthe 12monthsbeforethesurvey.Theprevalenceofhavingattemptedsuicidewashigheramongfemale (10.6%)thanmale(5.4%)students;higheramongwhitefemale(8.5%),blackfemale(10.7%),and Hispanicfemale(15.6%)thanwhitemale(4.2%),blackmale(6.8%),andHispanicmale(6.9%)students, respectively. Whilewhitemalesaccountedfor80%ofallsuicides(allagegroups)in2013,thehighestU.S. suiciderate(14.2)wasamongwhitesandthesecondhighestrate(11.7)wasamongamericanindians andalaskanatives.muchlowerandroughlysimilarrateswerefoundamongasiansandpacific Islanders(5.8),Blacks(5.4)andHispanics(5.7). MoredetailedinformationisavailableinMMWR/June13,2014/Vol.63/No.4andat GeneticPredisposition Thiscategoryreferstoyouthwhohaveafamilyhistoryofmentalillnessorsuicide.Scientific andsocio\behavioralresearchthroughtheyearshashadmixedfindingsregardingthegenetic predispositiontosuicidalideationandcompletionamongfamilymembers.arecentexhaustivereview oftheliteraturebyzai,luca,strauss,tong,sakinowskyandkennedy(2012),foundthroughfamily, twin,andadoptionstudiesthat,althoughlimited,thereisageneticbasistosuicidalbehavior.high suicideratesinsomefamiliesmaybeinfluencedbygenetics,butcanalsobecloselycorrelatedwith environmentalfactorswithinthefamilies(joiner,2011).

21 21 ParentalHistoryofViolence,SubstanceAbuse,orDivorce Theoverarchingthemeforthiscategoryistheinstabilitythatchildrenexperienceinthehome. Studieshavefoundthatfamilydisruptioncanleadtosuicidalideation.Whetheritisdivorce,which oftencreatesachangeinfinancesandlivingarrangements,orthephysicalaggressionchildrenwitness orexperience,theimpactonchildrenissignificant.inanotherstudy,reportedbythompson,litrownik, Isbell,Everson,EnglishandDubowitz,2012.Theystudied340adultoffspringwhoseparentshad depressioninthepastandfoundthat7%oftheoffspringhadsuicidalideationinthepreviousmonth alone. RelationshipbetweenBullyingandSuicide Themediacoinedtheterm bullycide asameanstostronglyimplythatthebullyingthatthe victimreceivedwasthecausationforhis/hersuicide.studentsinvolvedinbullying,asavictimorbully, areatasignificantlyhigherriskfordepressionandsuicide.furthermore,themorefrequentlyan adolescentwasinvolvedinbullying,themorelikelythatheorshewasdepressed,hadfeelingsof hopelessness,hadserioussuicidalideation,orhadattemptedsuicide(gould&kramer,2011). Internalizingproblems(includingwithdrawal,anxiety,anddepression),lowself\esteem,low assertiveness,andaggressivenessearlyinchildhood(possiblerejectionbypeers/socialisolation)are personalcharacteristicsthatincreaseayouth slikelihoodofbeingbulliedaswellasriskfactorsfor suicidality(arseneault,bowes,&shakoor,2010).further,studentswhoareamongthelesbian,gay, bisexual,transgender,orquestioning(lgbtq)populationareoftenstigmatizedandbulliedinschool, andaremorelikelytoattemptsuicideaswell.knowingthefrequencyofbullyingthatoccursinschools andthesestatisticsthatillustratetheconnectionbetweenbullyingandsuicide,itonlymakessensefor schoolstothoroughlyscreenforsuicidalthoughts/behaviorswhenaddressingbullyingincidents and/orthroughbullyingpreventionprograms(suicidepreventionresourcecenter,briefonsuicide andbullying[sprc],2011). Thepreviousschoolyardbullyinghasnowexpandedtothepotentialfor24/7bullyingthrough theinternet.whilebullyinglikelywillnotleadtoahealthychildfeelingsuicidal,itcanexacerbatethe instabilityandhopelessnessinvulnerableyouthalreadydealingwithstressandmentalhealthissues (Hinduja&Patchin,2010).Cyberbullyingvictimsreportmoredepressivesymptoms,suicidalideation, self\injury,andsuicideattemptsthanvictimsoftraditionalschoolbullying(schneider,o Donnell,

22 22 Stueve,&Coulter,2012).ItisveryimportanttonotethatTexaslegislationemphasizedthatboththe bulliesandthevictimsofbullyingmaybeatriskforsuicide. ImpactofAgeonSuicidalBehavior:Elementary,MiddleSchool,HighSchool o Elementaryschool\agedchildrenrarelydiebysuicide.But,arecentstudybyRibeiro, Bodell,Hames,Hagan,andJoiner(2013)found75%ofthesocialworkersinschool settingsreportedworkingwithatleastonestudentwhoreportedserioussuicidal ideation,and40%reportedworkingwithatleastonewhohadbeenhospitalized.many elementarypersonnelhavecommentedthattheyareincreasinglyworkingwithsuicidal students.thisreportcitestwosuicidesofelementaryagestudentsthatresultedina lawsuitfiledagainstschoolsbutthereislittleguidanceintheliteratureaswhata comprehensivesuicideprogramshouldconsistofinelementaryschools. o Middleschool\agedyouthreportthehighestratesofsuicidalideation,plan,and attemptofanyagegroup,althoughthedeathrateislowerthanolderadolescentsand youngadults.singer&slovak(2011)researchstatesthatthisisatimewhentraditional bullyingpeaks,cyberbullyingcontinuestoescalate,andchildrenhavemovedawayfrom theirparentsandschoolpersonnelasconfidantsandsoundingboards. o Highschool\agedyouthhavethegreatestaccesstomeansandreportthattheyhave hadlongertermsuicidalideationandaremorelikelythanyoungerstudentstoreporta priorattempt(erbacher,singer&poland,2015). CulturalFactors Cultureplaysanimportantdynamicinthethoughtsofasuicidalstudent,theapproachused withtheirfamily,andanyresourcesthatmightberecommended.especiallyintheaftermathofa deathbysuicide,schoolpersonnelshouldbesensitivetotheculturalbeliefsofthefamilyandthe studentpopulationandgreatcareshouldbetakentoseekoutpersonnelandresourcesthatarea goodmatchfortheneedsofthefamilyduringinterventionand/orpostvention(hamilton,2013).itis especiallynotedthatnativeamericansyouthhaveahighsuiciderateandtexaseducatorsneedtobe veryfamiliarwithtribalcustomsandpractices.

23 23 ImpactofExperiencesandPersonalResiliency Ayoungpersondevelopsthefeelingofself\worth,control,andpositivitybyasumtotalofthe eventsandexperiencesinhis/herlife.covey(2008)emphasizedthatstudentshaveanemotionalbank account.whengoodthingshappenforstudents,chipsareplacedintheemotionalbankaccount;good grades,friendships,engagingactivities.whenbadthingshappen:badgrades,breakupswithfriends, isolation,deathoffriendorfamilymember,chipsarewithdrawn.researchreflectsthatayoung person sabilitytobouncebackfromtraumaorstress,toadapttochangingcircumstancesandrespond positivelytodifficultsituationsisproportionaltotheirresilience.researchhasfoundthatthekeysto residencyforyoutharebeingsurroundedbycaringandsupportivefamilyandfriends,remaining optimisticaboutthefuture,utilizingproblemsolvingskillsandhavingtheopportunitytoventstrong emotions.ontheoppositeendofthespectrumisthestudentwhohasadiminishedsenseofself\ worth,inabilitytocope,sociallywithdrawn,and/orunabletohandlelifestressorsandlacksasupport network.familyandschoolenvironmentsthataresupportiveandcaringwillenhanceresilience,while lackoffamilysupportorexposuretoabuseortraumamaymakeastudentvulnerable.aseducators, it simportanttobeawareoftheeventsandexperiences;multipleevents,severityofevent,personal associationoridentificationthatthestudentmayhavewiththecircumstancesoftheevent(beautrais, Joyce&Mulder,1996).NotethatMentalHealthAmericaofTexasprovidesshortvideosofHelpand Hopeofrealstudentsdescribingtheirresiliencyandhowtheygothelpforthemselvesorsomeone else.seevideoslistedintexase\resourcesinappendiceswhichcanbedownloadedtouseaspartofa morecomprehensivesuicidepreventionawarenessortrainingprogram. ProtectiveFactorsthatDecreaseSuicidalBehaviorfromtheWorldHealthOrganization Familycohesionandstability Copingandproblemsolvingskills Positiveself\worthandimpulsecontrol

24 24 Positiveconnectionstoschoolandextracurricularparticipation Successfulacademically Goodrelationshipswithotheryouth Seeksadulthelpwhenneeded Lackofaccesstosuicidalmeans Accesstomentalhealthcare Religiosity Schoolenvironmentthatencourageshelpseekingandpromoteshealth Earlydetectionandintervention MostCommonMythsaboutYouthSuicide Texaseducatorsmustaddressthemanymythsofsuicideinordertoincreaseprevention efforts.amoredetailedlistwithdeeperexplanationsofthecorrespondingfactsisavailableinthe onlineeresourcesforsuicideinschools:apractitioner sguidetomulti\levelprevention,assessment, Intervention,andPostvention: Myth:IfIaskastudentaboutsuicidalideation,Iwillputtheideainhisorherhead. Fact:Askingsomeoneaboutsuicidewillnotmakehimorhersuicidal.Iftheyarenothavingsuicidal thoughtsthentheconversationprovidesanopportunitytotalkwiththemaboutwhattodoiftheyora friendeverdohavesuicidalthoughts. Myth:Ifastudentreallywantstodiebysuicide,thereisnothingIcandoaboutit. Fact:Suicideispreventable.Evenstudentsatthehighestriskforsuicidearestillambivalentabout desiringdeathanddesiringlife.mostofalltheywantthingstochange. Myth:Studentswhotalksaboutsuicideallofthetimeisnotactuallysuicidal,thereforeyoudon tneed totakethestatementsseriously.

25 25 Fact:Youthwhomakesuicidalstatementstypicallyhavesomeriskforsuicide.About80%to90%of personswhodiedbysuicideexpressedtheirintentionstooneandoftenmorethanoneperson.all suicidalstatementsshouldbetakenseriously. Myth:Suicideusuallyoccurswithoutwarning. Fact:Apersonplanningsuicideusuallygivescluesabouthisorherintentions,althoughinsomecases thecluesmayhavebeensubtle. Myth:Asuicidalpersonfullyintendstodie. Fact:Mostsuicidalpeoplefeelambivalenttowarddeathandarrangeanattemptedsuicideataplace andtimeinthehopethatsomeonewillintervene. Myth:Suicidalindividualsdonotmakefutureplans. Fact:Manyindividualswhodiedbysuicidehadfutureplans,forexampletheyhadbookedandpaidin advanceforvacations Myth:Thosewhodiedbysuicidealmostalwaysleftanote. Fact:About75%ofsuicidevictimsdidnotleaveanote. Myth:Youngpeopleengaginginself\injurysuchasmoderatesuperficialcuttingorburningtheirbody willnotattemptsuicide. Fact:Youngpeopleengaginginself\injurymayacquiretheabilityforasuicideattemptastheybecome comfortableandhabituatedtoharmingthemselves. Myth:Ifapersonattemptssuicideonce,heorsheremainsatconstantriskforsuicidethroughoutlife. Fact:Suicidalintentionsareoftenlimitedtoaspecificperiodoftime,especiallyifhelpissoughtand received. Myth:Ifapersonshowsimprovementafterasuicidalcrisis,theriskhaspassed. Fact:Mostsuicidesoccurwithinthreemonthsorsoaftertheonsetofimprovement,whentheperson hastheenergytoactonintentions,saygoodbyesandputtheiraffairsinorder. Myth:Suicideoccursmostoftenamongtheveryrichandtheverypoor. Fact:Suicideoccursinequalproportionsamongpersonsofallsocioeconomiclevels. Myth:Familiescanpassonapredispositiontosuicidalbehavior. Fact:Suicideisnotaninheritedtrait,butanindividualcharacteristicresultingfromacombinationof manyvariables.onevariablemaybethatanotherfamilymemberhasdiedbysuicidecreating exposuretosuicideandtheremaybehistoryofdepressioninthefamily. Myth:Allsuicidalpersonsarementallyill,andonlyapsychoticpersonwillcommitsuicide.

26 26 Fact:Studiesofhundredsofsuicidenotesindicatethatsuicidalpersonsarenotnecessarilymentallyill. Myth:Ifasuicidalindividualisstoppedfromusingonemethodtheywillfindanotherwaytodieby suicide. Fact:Researchhasdocumentedthatifaspecificmethodisremovedandnotavailablethatsuicidal individualsareveryunlikelytoseekanothermethod.themeansmatterwebsiteatharvardprovides extensiveresearchthatremovingthelethalmeanssuchasagunandraisingthebarrieronbridgeshas decreasedsuicides.moreinformationisavailableathttp:// Mythsaremostoftenbasedonstaticmisunderstandingsorknowledgefrommanyyearsago andcanonlychangewhennewconceptsarisewhichareresearch\based.reflectedinthechartbelow arenewinsightstoguideeducatorsinhowweviewsuicidalstudents. OldBeliefvs. NewBelief Suicide\Killingofoneself Penacide\Killingthepain Goal\Endlife Goal\Endpain/suffering Eventorbehavior Processofdebilitation Decisionandapersonalchoice Diseaseoutcome\nochoice involvedbeyondcrisispoint Ameansofcontroland Theresultofseverestressand manipulation psychologicalpain Voluntaryaction Involuntaryresponse Individualisadecision\maker Individualisavictim Apsychologicalphenomenon Aphysiologicalorneurobiological involvingthemind phenomenoninvolvingthebrain

27 27 UnderstandingSuicide:InterpersonalTheoryofSuicide ThemostwidelyacceptedtheoryofsuicidewasdevelopedbyJoiner(2005)whichidentified twomaincomponentstodesireforsuicide.thefirstislowbelongingness.thetheorystressedthat lackofconnectionstoothersisamajorfactorinsuicide.texaseducatorsareencouragedtobealert forstudentswhoarenotconnectedtoschoolstaff,classmatesandschoolactivitiesastheyarelikelyto havefewifanyfriends,beonthefringesofstudentlife,rarelyvolunteerintheclassroom,andseek isolationduringsocialtime.schoolsshouldhaveanenvironmentandacademic/socialstructurethat providesavenuesforeverystudenttodevelopasenseofbelongingandvaluewithintheschool community.thesecondfactorperceivedburdensomenessiswhensomeoneviewsthemselvesasa burdentoothersandbelievestheirfamilywouldbebetteroffwithoutthem.joiner(2005)stressed thatmanypeoplehavethesetwofactorspresentbutthankfullymostdonotattemptordiebysuicide. Theadditionalandcriticalvariableidentifiedinthistheoryisacquiringthecapabilityforsuicide throughexposuretopainandsuffering.joinercoinedthetermlearnedfearlessnessastheynolonger feardeathastheyhavehabituatedorworkeduptosuicidethroughaseriesofprovocativebehaviors. Texaseducatorsareencouragedtobealertforstudentswhoareengaginginrecklessbehavior,or sufferunexplainedinjuriesandforthoseengaginginnssi. OverviewoftheMostCurrentSuicidePrevention/InterventionRequirementsinTexas Schools ThefollowinginformationsummarizesthesuicidepreventionlegislationrelatedtoK\12schools fromthe84 th Legislativesessioncompletedinthespringof2015whichaddedSenateBills674andHB 2186.ThelegislationrelatedtosuicideandK\12schoolsfromthe83 rd Legislativesessionin2013isalso reviewed.agreatdealofcollaborationbetweentexaseducationagency(tea)andthedepartmentof StateHealthServices(DSHS)andtheMentalHealthAmericaofTexas(MHAT)keepsschoolpersonnel

28 28 informedofsuicidepreventionrequirementsfork\12schoolsettings.clarificationandmore informationanddetailedanalysisofthelegislationareavailablefromthedshs,teaandmhat. SenateBill674makesthetrainingforteachersintraining(universitypreparationprograms)the sameasforexistingteachersandthetrainingmustuseabestpracticesprogramrecommendedby DHSHincoordinationwithTEAandtheagencieswillcollaborateandprovideschoolswithanupdated listofbestpracticessuicidepreventionprogramseachyear. HouseBill2186requiresallschooldistrictstaffdevelopmentorientationfornewemployeesin districtandopenenrollmentcharterschoolstoincludesuicideprevention.thetrainingschedule (frequencywhetherannualoreveryfewyears)willbedeterminedbyteaforexistingteachers.all trainingsmustuseabestpracticesprogramrecommendedbydhshincoordinationwithtea,andthe agencieswillcollaborateandprovideschoolswithanupdatedlistofbestpracticessuicideprevention programseachyear. HouseBill2684requiresTexasschooldistrictswithmorethan30,000studentsthat commissionsaschooldistrictpoliceofficeroratwhichaschoolresourceofficerprovideslaw enforcementtohaveapolicythatrequirestheofficertocompleteatrainingprogramof16hoursina varietyofmentalhealth,positivedisciplineandde\escalationtechniquesthatarespelledoutinthe law.suicidepreventionadvocatesareexpectedtoprovideinputintothistrainingthatwillbecreated bythetexascommissiononlawenforcement(tcole).thetcolemustcreatethismodeltraining programby12/1/15anditistobeavailabletoofficersby2/1/16. These2015Billsaddedtolegislationpassedpreviouslyinthe83rdLegislativeRegularSessionin 2013requiringtrainingforpublicschoolteachersandteachersintraining,counselors,principals,and allotherappropriatestaffinthedetectionandeducationofstudentsatriskforsuicideorwithother mentaloremotionaldisorders.senatebill831ofthe83rdregularlegislativesession,amended Section oftheHealthandSafetyCodetoincludealistofbestpracticebasedprogramstobe reviewedandpostedannuallyonthewebsitesofdshs,thetexaseducationagency(tea),andeach RegionalEducationServiceCenter(ESC).

29 29 HouseBill1386from2013requiredindependentschooldistrictstohaveaDistrict ImprovementPlanthatincludessuicideprevention.Advocatesofsuicidepreventionshouldworkwith theirschooldistrict slocalcommitteeandstakeholderstoensurethedistrict splanandtraining includesmethodsforaddressingsuicideprevention(tex.educationcode11.252).schoolcounselors havebeenspecificallymentionedintexaslegislationashavingtheroleofensuringthattheschool s counselingprogramandservicesintegratebestpracticesinsuicideprevention(tex.educationcode ).Texaslegislationhasalsoclarifiedthatparentalpermissionisnotneededforcounselinga childbyalicensedorcertifiedphysician,psychologistorcounselororsocialworkerhavingreasonable groundsthatachildiscontemplatingsuicide(tex.familycode32.004). ItisrecommendedthatschoolpersonnelreviewtheprogramlistprovidedbyDSHSandTEA programsthoughtfullyinconsideringthespecificneedsofyourschooldistrictandthepersonnel neededtoprovidethetraining.programsonthelistmustataminimumcoverthefollowing: recognitionofthewarningsignsofsuicideandhowtointerveneeffectivelybyprovidingnoticeand referraltotheparentorguardiansothatappropriateactioncanbetakenbyaparentorguardian. Schoolpersonnelwhohavequestionsabouttheimplementationofthelegislation,howtoutilizelocal andstateresourcesoraboutanyoftheprogramsonthebestpracticeslistshouldcontactdshsortea. Programsonthelistmusthelpschoolpersonnelidentifystudentsatriskforsuicideincludingstudents whoareormaybethevictimsorwhoengageinbullying,recognizethewarningsignsofsuicideandto knowhowtointerveneeffectivelybyprovidingnoticeandreferraltotheparentorguardiansothat appropriateactionsuchasseekingmentalhealthorsubstanceabuseservicesmaybetakenbythe parentortheguardian(tex.health&safetycode BluePrint:ImplementingTexasLegislationforSuicidePreventioninSchools TheTexasrequiressuicidepreventioninTexasschooldistrictimprovementplans: 1. Goal:provideallnewemployeeswithsuicidepreventiontrainingandkeeparecordof whocompletedthetraining.accomplishedbyconductingsuicidepreventiontrainingfor allnewemployeesthatusesabestpracticesprogramrecommendedbydhshin coordinationwithteaandkeepingawrittenrecordofthenameofeachemployeewho attendedthetraining.thisgoalmayalsobemetthroughindependentreviewofsuicide

30 30 preventionmaterialthatcomplieswiththeguidelinesdevelopedbyteaandoffered online. 2. Goal:provideallexistingemployeeswithsuicidepreventiontrainingontheschedule requiredbytea.accomplishedbycontactingteatoobtainthespecificscheduleand conductingsuicidepreventiontrainingforexistingemployeesthatusesabestpractices programrecommendedbydhshincoordinationwithteaandkeepingawrittenrecord ofthenameofeachemployeewhoattendedthetraining.thisgoalmayalsobemet throughindependentreviewofsuicidepreventionmaterialthatcomplieswiththe guidelinesdevelopedbyteaandofferedonline. 3. Goal:thatallTexasschooldistrictswithmorethan30,000studentsthatcommissionsa schooldistrictpoliceofficeroratwhichaschoolresourceofficerprovideslaw enforcementtohaveapolicythatrequirestheofficertocompleteatrainingprogramof 16hoursinavarietyofmentalhealth,positivedisciplineandde\escalationtechniques thatarespelledoutinthelaw.accomplishedbyworkingwiththetexascommissionon LawEnforcementtoschedulethetrainingandkeepingawrittenrecordofthenameof eachofficerwhoattendedthetraining. AdditionalRecommendations:AfteraReviewofTexasLegislationandEducation Codes: 1. ItisveryclearthatTexascodesplaceagreatdealofresponsibilityonschoolcounselors(Tex. EducationCode33.006)forsuicidepreventionasitisspecificallymentionedundertheirduties indevelopingacomprehensiveguidanceprogram.schoolcounselorshavebeenandcontinue tobeveryinstrumentalinsuicideprevention,butitisveryimportanttoprovidethemwith trainingbeyondthebasicawarenesstrainingthatwillbeprovidedtootheremployeesasthe schoolcounselorwillmostlikelybethestaffmemberthatsuicidalstudentswillbereferredto forintervention.theassessmentandinterventionsectionofthisreportoutlinedspecificssteps forcounselorstofollow.schoolcounselorsneedtrainingonallaspectsofsuicideassessment andinterventionanditisrecommendedthattrainingbeprovidedforallschoolcounselorsby