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

31 31 DSHS,MHAT,TEAandtheRegionalEducationServiceCentersandawrittenrecordbekeptof thenameofthecounselorwhoattendedthetraining. 2. TheTexasHealthSafetyCode( )allowsTexasschoolstodesignateatleastonepersonin thedistricttoactasaliaisonofficerinthedistrictforthepurposeofidentifyingstudentsin needofmentalhealthinterventionincludingsuicideprevention.itisstronglyrecommended thatadistrictdesignatethisliaisonandthattrainingbeprovidedtothembydshs,mhat,tea andtheregionaleducationservicecentersandawrittenrecordbekeptofthenameofthe employeewhoattendedthetraining.itisalsorecommendedthatthedesignationoftheliaison beincludedinthedistrictimprovementplan.itwouldseemhighlylikelythatthedesignated individualwouldbeasecondaryschoolcounselororthedirectorofcounselingservicesforthe district.itisalsohighlyrecommendedthatlargeschooldistrictswouldneedtodesignate severalliaisonsandthatthelargehighschoolinthestatewouldhaveanindividualcampus designee.itisexpectedthattheliaison(s)wouldbeveryhelpfulindevelopingpoliciesand proceduresforthedistrictforsuicidepreventionandthattheywouldbefamiliarwithlocaland stateresources. 3. ThereisnomentionofpostventionintheTexaslegislationorinanyofthecodesthatwere reviewed,howevertheaftermathofasuicideisaverychallengingtimeforschoolsand unfortunatelywhenoneyouthsuicidehappensthechancesincreasedramaticallythat additionalsuicideswilloccur.itisstronglyrecommendedthatthedistrictliaisonorliaisonsfor suicidebeveryfamiliarwithbestpracticesinsuicidepostvention(seesectioninthisreport) andthattrainingbeprovidedbydshs,mhat,teaandtheregionaleducationservicecenters andawrittenrecordbekeptofthenameoftheliaisonwhoattendedthetraining.itis expectedthattheliaisonorliaisonswouldbeveryhelpfulindevelopingpoliciesandprocedures forthedistrictforsuicidepostvention.theliabilitysectioncitesthemaresvshawneemission Schoolslawsuitthatwasaboutfailuretoimplementbestpracticespostventionprocedures. ScreeningPrograms Oneoftheauthorshasbeenworkingonsuicidepreventionintheschoolsince1982and believesstronglythatthemostpromisingadditiontosuicidepreventionisdepressionscreening. Beforethedevelopmentofdepressionscreeningprograms,youthsuicidepreventionprogramsonly

32 32 focusedontrainingtheadultstorecognizewarningsignsofsuicidalbehaviorinyouthandthiswas mostoftenreferredtoas, gatekeepertraining accordingtopoland,(1995).theproblemwithonly providingsuicidepreventioninformationforschoolpersonnelandtheotheradultsinthelivesof studentsisthatstudentsarebyfarthemostlikelytosharethoughtsofsuicidewiththeirfriends insteadoftheadultsintheirlives.itiscuriousthatdepressionscreeningwasreferredtointexas legislationasmedicalscreeningasitissimplyaquestionnairethatstudentsfilloutthataskquestions aboutenergylevel,joyoflifeandthoughtsofsuicide.studentsscoretheirownquestionnaireandcan determineiftheyarelikelysufferingfromdepressionandneedmentalhealthservices.signsofsuicide (SOS)whichisevidencedbased,BPRI(whichisthemostrigorousevaluationcategory)providesa screeningandeducationalpackageandisusedinalargenumberofschoolsaroundthecountryand extensiveinformationaboutsosappearsbelow.sosisinexpensiveandmanytimesthematerialhas beenprovidedbysosfreebutthecostforthequestionnairesandtheactvideoisapproximately $200. o SOSSignsofSuicideisasecondaryschool\basedsuicidepreventionprogramthatis listedasevidencedbasedonbestpracticesregistryi.theprogramincludesscreening andeducation.studentsarescreenedfordepressionandsuicideriskandreferredfor professionalhelpasindicated.studentsalsoviewavideothatteachesthemto recognizesignsofdepressionandsuicideinthemselvesandothers.theyaretaughtthat theappropriateresponsetothesesignsistousetheacttechnique:acknowledgethat thereisaproblem,letthepersonknowyoucare,andtellatrustedadult.studentsalso participateinguidedclassroomdiscussionsaboutsuicideanddepression.theprogram attemptstopreventsuicideattempts,increaseknowledgeaboutsuicideanddepression andincreasehelp\seekingbehavioramongmiddleandhighschoolstudents.sossigns ofsuicidehasbeenimplementedinmorethan7,000schoolsintheunitedstates, Canada,andIreland.In2012,twogatekeepertoolsweremadeavailableforusein programimplementation:trainingtrustedadults,a22\minutedvdforuseinstaff meetingsorparentnights,andplan,prepare,prevent:thesosonlinegatekeeper Training,a90\minuteonlinecourseprovideArandomizedcontrolstudyfoundthat therewasa40%dropinsuicideattemptsinschoolsthatimplementedthesignsof SuicidePreventionProgram(SOS).Aconcernexpressedbymanyeducatorsisthatif theyimplementthesosprogramthatmanystudentswillbeidentifiedassuicidaland

33 33 theschoolwillnotbeabletofollowupasneededwitheachstudent.thesoswebsite resistancetoscreeningandforimplementationandrecommendsthatonlya manageableportionofthestudentbodybescreenedatatimesothatfollowupand interventioncanbeprovided.texasrequiresthatparentalpermissionisobtainedprior tostudentsparticipatinginsosandscreeningprogramswerereferredtoasamedical screening(tex.health&safetycode ).theauthorsexperiencehasbeenthat oftenmultiplesuicideshavehadtooccurinaschoolbeforeresistancetoscreeningis overcome.erbacher,singerandpoland(2015)stressedmanybenefitsofsosandmost notablythatstudentlearnedtheimportanceofgettingadulthelpforthemselvesor theirfriendinatimeofsuicidalcrisis. o TheColumbiaUniversityTeenScreen ProgramwasmentionedbyafewTexasdistricts, intheeducatorsurveybutitdoesnotappearonthecurrentbestpracticesregistry. TeenScreenwasdesignedtoensurethatallyouthareofferedamentalhealthcheck\up beforegraduatingfromhighschool.teenscreen Programidentifiedandreferredfor treatmentthosewhowereatriskforsuicideorwhosufferedfromanuntreatedmental illness.allstudentsinaschool,withparentalconsent,weregivenacomputer\based questionnairethatscreenedthemformentalillnessesandsuiciderisk.thetexassurvey indicatedthatitwasgivenmostlyto5 th and6 th graders.on15november,2012. TeenScreenannouncedonitswebsite: TheNationalCenterwillbewindingdownits programattheendofthisyear. TherehavebeenrumorsthatTeenScreenhasobtained fundingandwillberestarted. o TheColumbia\SuicideSeverityRatingScale(C\SSRS)isabestpracticescreeningtool thatcanbeusedbyavarietyofagencies.thisbriefsurveyhasbeenshowntoidentify accuratelyindividualsatriskofsuicide.ithasuseintheschoolsystemasanearly warningtooltoscreenforsuicidality.thec\ssrshasbeenimplementedincountless schoolsaroundthecountry.implementationofthescalehasoccurredbothwhen individualschoolsseekoutatooltohelpthemaddresssucideintheirstudent populationandwhendepartmentsofeducationadoptthec\ssrsasthetoolofchoice

34 34 forazerosuicideapproach..atleastoneschooldistrictintexas(tarrant)isusingthe C\SSRSdistrict\widetoscreenyouthinschoolforsuiciderisk. o MoreinformationisavailableabouttheC\SSRSanditsapplicationinschoolsettings alongwitha30minutetrainingvideoathttp:// offeredfree.thereismoreinformationinthezerosuicidetexastoolkitchapterfive aboutscreeningforsuiciderisklocatedathttp://sites.utexas.edu/zest SuicideIntervention AssessmentandIntervention Theimportanceofallschoolstaffreceivingtraining(whichisrequiredinTexas)onthewarning signsofsuicideandtheimportanceofreferringatriskstudentstotheadministrationandcounseling staffhasalreadybeenemphasizedasthecornerstoneofsuicidepreventioninschools.avery importantcomponentofsuicidepreventionisdepressionscreening.studentslearnthewarningsigns ofsuicide,theimportanceofseekinghelpfromadultswhentheyrealizethattheyorafriendare depressed.depressionscreeningwillresultinmoresuicidalstudentsbeingidentifiedandreferredfora suicideassessment.poland(1989)stressedthateachschoolneedskeypersonneltrainedinsuicide assessmentandthatschoolcounselorsarethelogicalpersonnelastheyaretypicallybasedonlyonone campus.erbacher,singerandpoland(2015)clarifiedthatasuicideriskassessmentisdoneto determineifsuicidalideation,intentandplanarepresentandtoidentifywhatstepsneedtobetaken tosafeguardthestudent.akeypartoftheprocessistodetermineifthestudentisinimminentrisk (forexample,inthenext48hours).miller(2011)stressedthatnoproblemfacingschoolmentalhealth professionalsismoreurgentthantheneedfortraininginsuicideassessmentandthatagood assessmentresultsinaneffectiveintervention.schoolpersonnelunderstandablyexperienceanxiety whenfacedwithastudentwhomaybesuicidalanditisvitalthattheyreceivetraininginassessment. Thistrainingcanbeprovidedbybringingexpertstotheschoolsystemtoprovidetrainingin assessmentandinterventionorbysendingkeypersonneltoconferencesandtrainingsconductedby stateandnationalassociationsthatfocusonsuicideprevention(exampletheannualtexassymposium onsuicide).keypersonnelsuchasschoolcounselorsmustalsoknowthefactsaboutyouthsuicide,and itisimportantthattheynotbelieveanyofthemythsaboutsuicide.recentlyaschoolpsychologist

35 35 askedthequestion Isittruethatsomestudentswilldiebysuicidenomatterwhatwedoasisn ttheir destiny.thisisanexampleofwhytherequiredtrainingintexasissoimportant. Schoolpersonnelhavealsofrequentlyaskedifallstudentthreatsofsuicideneedtobetaken seriouslyandhavecommentedthatmanytimesastudentisperhapsjustseekingattentionoristrying tomanipulateasituation.theansweristhatallstudentthreatsofsuicidemustbetakenseriouslyand thestepsoutlinedbelowfollowed.itiscertainlyacknowledgedthatthiswilltakealotoftimeforkey personnelsuchasschoolcounselors,buttakingallthreatsseriouslywillsavelivesandwillalsoprotect schoolpersonnelfromliabilityshouldasuicideoccur. TwokeyconceptsforassessmentoutlinedbyPoland(1989)werethatinquiryaboutsuicide mustbedirectandclarifieditwillnotplanttheideainthemindofastudent.studentsareoften ambivalentaboutsuicideandoneminutewanttodieandendwhattheybelievetobeunendurable painbutthenextminutethereisaglimmerofhopeandsomethingpositivehashappenedandthey wanttolive.theinterventionofanyonepersoncanmakeallthedifference.manystudentsafter beingquestionedaboutsuicidalthoughtsandplanshavefeltrelievedthatsomeoneistheretohelp them. Itisessentialtorespondimmediatelywhenastudentisbelievedtobesuicidal.Abuildingprincipal recentlysharedtwoexamples. 1. Astudentwasrumoredtobesuicidalandtheprincipalaskedthecounselortocheckintoit, assumingthecounselorwoulddosoimmediately.theprincipalsoughtthecounselorouttwo hourslaterandwasdismayedtobetoldthatthecounselorhadnotfoundtimetotalkwiththe studentasyet. 2. Anotherstudentwasreportedtobesuicidalandthecounselorwasaskedtoseethestudent immediatelytomakeanassessment.theprincipalaskedlaterwhattheycounselorhadfound outandthecounselorreportedthatthestudentseemedtobefine.theprincipalasked, What didthestudentsayaboutsuicidalthoughtsandactions?thecounselorrepliedthattheydid notdirectlyinquireaboutsuicide.

36 36 Confidentiality/ConfidentialityExceptions Oneissuethatschoolpersonnelstrugglewithiswhenandiftheymustnotifyparentsin theeventtheybelieveastudenttobesuicidal?itisimportanttonotethatwhilementalhealth personnelaretoalwaysupholdconfidentiality,thereareexceptionstothisrule.suicidal ideationorbehaviorisoneofthoseexceptions.allstudentsshouldbeawareofthelimitsof confidentialityandthattheschoolstaffmustnotifytheparentsofasuicidalstudent.whileit mayupsetthestudentthatyouaredivulgingtheirprivateinformationtotheirparentsorother necessaryschoolstaff,itwillbelessdifficulttorepairrapportwithastudentwhoisalivethan todealwiththepotentialoutcomesifhe/shedoesattemptand/ordiebysuicidewithout parentnotification.aspreviouslydiscussedinthisreportmostoftheliabilitycasesagainst schoolsfollowingthesuicideofastudenthavebeenbecausetheparentsofastudentknownto besuicidalwerenotnotified.theonlyexceptiontoparentnotificationiswhenyouhavereason tobelievethesuicidalstudentisbeingabusedbytheirparentsandthenthecallmustbemade immediatelytochildprotectiveservices. Theimportanceofdevelopingrapportwithasuicidalstudentcannotbeoverstated.School personnelneedtodrawonalloftheirskillsforinteractingwithstudentsandthefactistheymight actuallybemeetingastudentforthefirsttimewhenthestudentisinthemidstofacrisis.school personnelareencouragedtoinitiallyconcentrateonlisteningtothestudentandlettingthestudent knowtheyarenotthefirststudenttohavesuicidalthoughts.itisimportantthatyoucareandhave helpedotherstudentsincrisisbefore.thefollowingareastoaddressinsuicideassessmentwhich coverriskfactors,warningsignsandprotectivefactorsforsuicidalstudentswereoutlinedby Lieberman,PolandandKornfeld(2014) Whatarethecurrentfeelingsofthestudent? Whatwerethewarningsignsthatinitiatedthereferral? Whatistheindividual scurrentandpastlevelofdepression? Whatisthestudent scurrentandpastlevelofhopelessness? Hasthestudentcurrently,orinthepast,thoughtaboutsuicide(eitherdirectlyor passively)? Whatisthemethodofanyprevioussuicideattempt(s)?

37 37 Doesthestudenthaveacurrentsuicideplanorplantoharmhim/herself(themorespecific ofaplan,ifapplicable,thehighertherisk)? Whatmethoddoeshe/sheplantouseanddoestheindividualhaveaccesstothemeans (higherriskwheneitherorbothofthoseareaffirmed)? Whatarethestudent sperceptionsonburdensomenessandbelongingness? Havetheybeenexposedtoasuicide? DotheyhavehistoryofengaginginNSSI? Istherearehistoryofalcoholordruguse? Whatarehis/hercurrentproblemsandstressorsathomeandatschool? Hasthestudentdemonstratedanyabruptchangesinbehaviors? Whatisthestudent scurrentsupportsystemandwhatprotectivefactorsareinplace (higherisolationmightindicatehigherrisk)? Whatisthestudent scurrentmentalhealthstatus?isthereahistoryofmentalillness? Isthereahistoryofbullying,victimization,loss,and/ortrauma(anyaffirmativeresponse mightindicateahigherrisk)? Whatarethestudent sreasonstolive(more,healthyanswerstothisquestionmight indicatelowerrisk)? Muchhasbeenwrittenasaguidetodeterminewhetherastudentisatlow,mediumorhigh riskforsuicidebymiller(2011),lieberman,poland&kornfeld(2014),erbacher,singerandpoland (2015)thatissummarizedbelowwithrecommendations. LowRisk(ideationonly) Actions:Developasafetyplancollaborativelywiththestudent. Notifytheparentsoftheirchild ssuicidalideation Persuasivelyrequestthatparentssignareleaseofinformationformsothatdesignatedschool personnelcandirectlycommunicatewithcommunitymentalhealthprofessionals Documentallactionsthatincludehavingparentssignanemergencynotificationform

38 38 MediumRisk(currentideationandprevioussuicidalbehavior) Actions:Supervisestudentatalltimes(includingrestrooms) Developsafetyplanwiththestudent NotifyandreleasestudentONLYto: Parentorguardianwhocommitstoincreasesupervisionandseekanimmediate mentalhealthassessment Lawenforcement Psychiatricmobileresponder Persuasivelyrequestthatparentssignareleaseofinformationformsothatdesignatedschool personnelcanspeakdirectlywithcommunitymentalhealthprofessionals Documentallactionsthatincludehavingparentssignanemergencynotificationform Developfollowupplanatschoolthatincludesare\entryplanifthestudentishospitalized.All studentsreturningfrommentalhealthhospitalizationshouldhaveare\entrymeetingwhere parents,schoolandcommunitymentalhealthpersonnelmakeappropriatefollowupplansto supportthestudent HighRisk(currentplanandaccesstomethod) Actions:Supervisestudentatalltimes(includingrestrooms). Developsafetyplanwiththestudent. NotifyandreleasestudentONLYto: Parentorguardianwhocommitstoincreasesupervisionandseekanimmediate mentalhealthassessment Lawenforcement Psychiatricmobileresponder Persuasivelyrequestthatparentsignareleaseofinformationformsothatdesignatedschool personnelcanspeakdirectlywithcommunitymentalhealthprofessionals. Documentallactionsthatincludehavingparentssignanemergencynotificationform. Developfollowupplanatschoolthatincludesare\entryplanifthestudentishospitalized.All studentsreturningfrommentalhealthhospitalizationshouldhaveare\entrymeetingwhere parents,schoolandcommunitymentalhealthpersonnelmakeappropriatefollowupplansto supportthestudent.

39 39 AuthorsasearlyasPoland(1989)andasrecentlyasErbacher,SingerandPoland(2015) emphasizedthatfewthingchangeinachild slifewithoutthesupportoftheirparentsandthe challengeforkeyschoolpersonnelsuchascounselorsistoobtainasupportivereactionfromthe parentsofasuicidalstudent.thefollowingsuggestionsareofferedforengagingandsupporting parentsofasuicidalstudent.itisstronglysuggestedthataconferencewithparentsbeheldinperson ratherthanviathetelephoneandthatasuicidalstudentnotbeallowedtoleaveschoolontheirown evenifthatiswhathis/herparentshaverequested. 1) Beginwithaskingparentshowtheirchildhasbeendoingandiftheyhavenotedany changesintheirchild sbehavior. 2) Statewhatyouhavenoticedintheirchild sbehaviorandaskhowthatfitswithwhatthey haveseenintheirchild. 3) Adviseparentstoremovelethalmeansfromthehomeastheirchildispossiblysuicidal.You canequatethistohowyouwouldadvisetakingcarkeysfromayouthwhohadbeen drinking.pleaseclarifythattexaslawrequiresgunsbelockedawayfromminorsunderthe ageof17(tex.penalcode46.13). 4) Provideempathyforthissituationandcommentonitsscarynatureforparents. 5) Acknowledgetheemotionalstateoftheparents. 6) Acknowledgethatitisessentialforschools,parentsandcommunityservicestocollaborate tohelpasuicidalchild,asnoonecandothisalone.iftheparentisangrythatyouhave providedcounselingtotheirchildwithouttheirconsentthenadvisetheparentsoftexas legislationthathasalsoclarifiedthatparentalpermissionisnotneededforcounselinga childbyalicensedorcertifiedphysician,psychologist,counselororsocialworkerhaving reasonablegroundsthatachildiscontemplatingsuicide(tex.familycode32.004). 7) Iftheparentappearstobeuncooperativeorunwillingtotakecertainactions,findouttheir beliefsaboutyouthsuiciderisk/behaviorandseeiftherearemythstheybelievethatare blockingthemfromtakingproperaction. 8) Acknowledgeandexploreanyculturalorreligiousconcerns,oranyotherconcerns,that mightreducetheparent sacceptanceofmentalhealthtreatment.

40 40 9) Whenpossible,alignyourselfwiththeparent.Itisimportantforthemtounderstand wheretheyouthhasgottenthisideawithoutminimizingbehaviors. 10) Referparentstolocalcommunitymentalhealthtreatmentthattheschoolhaspreviously workedwellwithandexplainwhatitistheycanexpectfortreatmentoftheirchild. 11) Clarifytheroleoftheschoolsandthefollowupthatwillbedoneatschool 12) Persuasivelyrequestthatparentssignareleaseofinformationformsothatdesignated schoolpersonnelcanspeakdirectlywithcommunitymentalhealthprofessionals 13) Documentallactionsthatincludehavingparentssignanemergencynotificationform SuicideAssessmentScales Therearenostandardizedscalesthatcanreplaceathroughinterviewwithastudent afterrapporthasbeenestablished,(erbacher,singerandpoland,2015)howeverstandardized assessmentscalescanabeavaluableadditiontotheinterviewastheyhavebeenpublished, validatedbyresearch,andtakeabouttenminutestocompleteandthebeckscalehasa Spanishversion.ThefollowingscalesarelistedintheSAMHSAToolkitforSchoolswhich canbe foundathttp://pathprogram.samhsa.gov/channel/samhsa\toolkits\494.aspx BeckScaleforSuicideIdeation SuicideIdeationQuestionnaire SuicideProbabilityScale InventoryofSuicideQuestionnaire ColumbiaSuicideSeverityRatingScale SafetyPlans Manygenerationsofmentalhealthprofessionalswerepreviouslytaughttohavesuicidal clients/studentssignacontractthattheywouldnotharmthemselves.thesecontractsreferredtoas nosuicideornoharmcontractswereoftenpreprintedonschoolstationery.criticismsofthese contractswerethatmentalhealthprofessionalsmightrushorevencoerceastudentintosigningone.

41 41 Miller(2011)emphasizedthatalthoughtheuseofcontractsisverywidespread,thereisnoempirical researchtosupportthatcontractswereeffectiveinpreventingsuicide.contractsalsodidnotprotect theprofessionalfromliabilityandcontractswerecriticizedforfocusingonwhatthestudentwouldnot doasopposedtowhatthestudentwoulddoinatimeofsuicidalcrisis. Safetyplansdifferfromnosuicidecontractsinthattheyarenotdevelopedaheadoftimebut insteadareatooldevelopedjointlywiththestudentincrisis.thesafetyplanfocusesonidentifying copingstrategies,peerandadultsupportforthestudentandincludeslocalandnationalsuicide preventionresourcesandhotlinenumbers.studentsaregivenacopyoftheplantheyhelpeddevelop andareencouragedtoreviewitwhentheyhavesuicidalthoughts.texasschoolpersonnelarestrongly encouragedfollowbestpracticesandshiftfromtheutilizationofnosuicidecontractstothecreationof safetyplanswithsuicidalstudents.asamplesafetyplanisavailablefromthesuicideprevention ResourceCenteratthefollowinglink: AnexampleofsafetyplanninginterventioncanbefoundattheTexasZeroToolkit: Theresearcherswhooriginallydevelopedsafetyplanshaveextensiveinformationonthiswebsite: Confidentiality/ConfidentialityExceptions Itisimportanttonotethatwhilementalhealthpersonnelaretoalwaysupholdconfidentiality, thereareexceptionstothisrule.thesuspectofsuicidalideationorbehaviorisoneofthose exceptions.allstudentsshouldbeawareofthelimitsofconfidentiality.whileitmayupsetthestudent thatyouarenotifyingeithertheirparentsor(cps)childprotectiveservices(ifparentsarebelievedto beabusive)oftheirsuicidalbehavior,itwillbelessdifficulttorepairrapportwithastudentwhois alivethantodealwiththepotentialoutcomesifhe/shedoesattemptand/ordiebysuicide. NotifyingParents TransferofResponsibilitiestoParents:NotificationandMakingtheCall

42 42 Thefailureoftheschooltonotifyparents/guardianswhenthereisreasontosuspectthatthe studentissuicidalisthemostcommonsourceforlawsuitsasevidencedbythediscussionofwykev PolkCounty(liabilitysection).Asnotedprior,whenthereisreasontobelievethatastudentis contemplatingsuicide,theconfidentialitymustbebrokenandtheparentsshouldthenbenotified. Schoolpersonnelhaveanobligationtoreportanychildwhoissuspectedtobeat\riskforsuicidebased onforeseeabilityandthechallengeforschoolpersonnelistogetasupportivereactionfromparents, increasesupervisionofthestudentandobtainneededmentalhealthservicesforthestudent.evenif astudentdeniessuicidalideation/intent,asintheeiselvmontgomerycountycasediscussedinthe liabilitysection,itisthedutyoftheschooltonotifytheparentsofsuicidalconcernsreportedbyothers butdeniedbytheirchild. Whenitcomestimetowarnparentsthattheirchildmightbesuicidal,someissuesmayarise.First, ifitisbelievedthatthestudent sparentsareabusivethenschoolstaffneedstocallchildprotective ServicesandcoordinatesupervisionofthestudentandparentnotificationwithCPS.Secondly,afew parentsmaybeuncooperativeandmayrefusetocometotheschooltotalkand/orpersonallypickup theirchild.toavoidanegligencelawsuit,schoolstaffshouldnotallowsuicidalstudentstowalkor takethebushome,nomatterwhattheparentshaverequested.ifaparent/guardianrefusestoseek outadditionalmentalhealthservicesfortheirchild,and/ordoesnottakethesuicideriskseriously,itis recommendedthattheschoolpersonnelnotifycps. Whenastudent ssuicidalityisinquestion,aschoolcounselor/staffmember,asclarifiedabove, hastheresponsibilitytonotifyaparent/guardianandmakeappropriaterecommendations/referrals. Oncethisisaccomplishedanditisproperlydocumented,theschoolstaffhasfulfilledtheirlegalduty astheresponsibilityforthestudentistransferredbacktotheparentsthroughnotification.duringthis process,schoolstaffisencouragedtoutilizeemergencynotificationformsfordocumentationthat parentswerenotifiedandtokeepacopyoftheformstodocumentthattheydid,infact,notifythe parentsandmakeappropriaterecommendations.thesedocumentswillbenecessaryand advantageousifanylegalactionistakenagainsttheschoolregardingthatstudent. Furthermore,theauthorsrecommendschoolpersonneldevelopasafetyplanwiththestudentas discussedinthisdocumentandcontinuetomonitorthestudentcloselyandensurehe/sheisreceiving thesupportneeded.schoolcounselorswouldlikelybetheappropriatepersonneltofollowupwiththe familyandstudenttoinquireifoutsideservicesarebeingrendered.itisalsostronglyrecommended

43 43 thatareleaseofinformationformbesignedbytheparentstoallowtheschoolcounselorto communicatewithoutsidepractitionerssuchastherapistsandmedicalpersonnel.parentsmaybe reluctanttosignareleaseofinformationformandschoolcounselorsareencouragedtoexplain thoroughlyandpersuasivelywhyitisinthebestinterestofthestudentforthereleasetobesignedso thatinformationmaybesharedandsafetyensured. Oneofthechallengesforschoolpersonnelandespeciallyschoolcounselorsistorefersuicidalstudents toprivatepractitioners,agenciesandhospitalswheretheprofessionalsarewelltrainedinsuicide assessment.aparentoncecommentedtooneoftheauthorsofthisreport, Itookmysontoa psychologistastheschoolrecommendedbutwastoldbythepsychologistnottoworryasmysonwas exhibitingtypicalteenagebehaviorandtwoweekslaterhediedbysuicide Ataskforceofthe AmericanAssociationofSuicidologyaddressedseriousgapsinthetrainingofmentalhealthproviders concerningsuicideassessment(schmitz,allen,feldman,gutin,jahn,kleespies,quinett&simpson, 2012).Thetaskforcecalledforaccreditingbodies,trainingprogramsandlicensingorganizationsto improvetrainingthroughcoursework,requiredcontinuingeducationandincludeexamination questionsforlicensuretoimprovecompetencyinsuicideassessment.fewchangesareexpectedinthe nearfuturetoaddressthelackoftrainingthatmostmentalhealthprofessionalshaveinsuicide assessmentalthough5stateshavenowmandatedsuicidepreventiontrainingformentalhealth professionals. Schoolsareurgedtoworkwiththeirlocalcommunitymentalhealthorbehavioralhealth center.eachofthe37localmentalhealthauthoritiesintexashasdesignatedsuicideprevention coordinatorswhocanassistschoolswithsuicidepreventionandpostvention.theyarelistedatthe TexasCouncilofCommunityCenter swebsite: MobileCrisisOutreachTeamswhocancometoaschoolwhencalledforassistance.Manyofthe centersconductasistsuicideinterventiontrainings,safetalk,mentalhealthfirstaidandaskabout SuicideToSaveALifegatekeepertrainingswiththeirstaffandcommunity,andhaveimplemented zerosuicideprograms.texasalsohasmorethan30localsuicidepreventioncoalitionswhichmaybe abletoprovidesomereferralinformationtoschoolsorparentsandassistinbestpracticebased suicidepreventiontraining.(seelistofcommunitymentalhealthcentersandlocalsuicideprevention coalitionsattexassuicideprevention.org).

44 44 SuicidePostvention Theaftermathofayouthsuicideisasadandchallengingtimeforaschool.Postventionisa termthatwascoinedbyshniedman(1985)todescribehelpfulandappropriateactsafteradireevent. Thetermhasbecomesynonymouswiththechallengingaftermathofsuicide,andfeweventsare scarierforaschoolthanthesuicideofastudent.schoolstypicallyunderestimatetheimpactofa suicideandprovideassistancetoonlyafewstudentsfortooshortaperiodoftime(erbacher,singer& Poland,2015).Itisessentialtosupportschoolstafffirstafterasuicideandhopefullytheywillbebetter abletoassisttheirstudents.manyofthetexasschoolpersonnelsurveyedrecentlyindicatedthattheir schoolordistricthadexperiencedasuicide.fewschoolpersonnelhaveeverreceivedtrainingonbest practicesinsuicidepostvention.manyschoolpersonnelhavetheideathatthemainpostvention recommendationistodonothingasitmightglorifythevictim.thepostventionliteratureneversaiddo nothingasrecommendationsalwaysfocusedonthelivingandthekeytaskforschoolsofdealingwith grief,shockandconfusion.previousliteraturesummarizedbypoland(1989)didcautionagainstany typeofpermanentmarkeratschooloranytypeofamemorial(suchasplantingatree)oraceremony nomatterhowsmallasforexamplelightingcandlesinmemoryofthedeceased.itisimportanttonote thatanexcellentguideforschoolswasdevelopedbytheamericanfoundationforsuicideprevention entitled,afterasuicide:atoolkitforschools,thatisavailableonbothoftheirwebsites.theguide providesspecificguidelinestobalancetheoftenfeltneedsthatstudentshavetodosomethingaftera suicidewithoutglorifyingthesuicidevictimwhichmightcontributetootherteenagersconsidering suicide.schoolsareencouragedtodownloadthisguideandhaveitavailableifasuicidedoesoccurand followtheexcellentrecommendationsprovidedthatweredevelopedafterextensivedialoguewith numerousexpertsinsuicidepreventionincludingoneoftheauthorsofthisreport.itisimportantthat Texasschoolpersonnelbeveryfamiliarwiththisguideandtorecognizetheycouldbecriticizedand evensuedforfailingtoimplementrecommendationsfromtheguide(seemaresvshawneemissionin liabilitysection). Themajortasksforsuicidepostventionaretohelpstudentsandfacultytomanagethe understandablefeelingsofshock,griefandconfusion.themajorfocusatthistimeshouldbegrief resolutionandpreventionoffurthersuicides.itisessentialafterasuicideoccurstopartnerwith communityresourcessuchasmental,health,lawenforcement,clergy,survivorgroupsandmedical personnel.wemustacknowledgethatnoteveryyouthsuicidecanbepreventedbutthemajoritycan

45 45 be.itisveryimportantforschoolstoacceptassistancefromlocal,stateandnationalresourcesaftera suicide.schoolpersonnelarestronglyencouragedtoavoidtheword committed andinsteadtouse usthephrase, diedbysuicide asitismuchmoreacceptabletosuicidesurvivors.exposuretosuicide isariskfactor,andsuicideisalwaysonthemindsofsomestudentsandthoughtsofsuicideand attemptsincreaseafteradeathbysuicidehasoccurred.itisveryimportantthatschoolcounselorsin particularreachouttostudentswhoarethemostaffectedandprovidethemanopportunitytotalk aboutwhathashappened.counselorshaveoftenaskedafterastudentsuicideiftheyneedtoseeall theotherstudentsintheschoolthatwereknownpreviouslytobesuicidalandtheanswerisyes,see thosestudentassoonaspossibleastheyarelikelytohaveincreasedthoughtsofsuicidenowthatit hashappened.postventionisalsoanoptimaltimeforschoolstoreviewthetrainingthatisprovidedto staffandstudentsaboutsuicidepreventionandtoreviewprotocolsandguidelinesinplaceforsuicide prevention. Schoolpersonnelalsoneedtobefamiliarwiththeconceptofsuicideclusterswheresuicides areclosetogetherinspaceortime.thetermcontagionisapossibleexplanationforaclusterand adolescentsarethemostsusceptibletocontagion.clustersareestimatedtoaccountforasmanyas 200youthsuicidesannually(Joiner,2011).Clustersareoftwotypesasamassclusterismediarelated andisinresponsetonationalmediaorsocialmediacoverageofanactualorfictionalsuicide.there was,forexample,muchconcernofamassclusterrecentlyafterthesuicideofrobinwilliams,thewell\ knowncomedian.pointclustersoccurinadefinedgeographicalregionandmayinvolvenumerous deaths(orattempts)inashortperiodoftime.unfortunatelyanumberofschoolshaveexperienced pointclusterswhereanorganizedresponseinvolvingschoolandcommunityandstateresourcesis necessary.joiner(2011)stressedthatthereismoreempiricalsupportforpointclustersthanmass ones.ifacommunityisexperiencingapointclusterisveryimportanttoinvolvethemedical communityasmanysuicidalindividualsincludingteenagerssawthefamilyphysicianbeforetheir death,andphysiciansareinauniqueroletointervenewithasuicidalyouth.national recommendationshavestressedthatallteenagersseeingaphysicianforanyreasonshouldbe screenedfordepressionandsuicide. Theresearchliteratureestimatesthatonceasuicidehappensthechancesofanotherdeathby suicideincreasesdramatically.thefollowingsuggestionsareintendedtoguidestaffduring postvention:

46 46 * Itisimportanttobehonestwithstudentsaboutthescopeoftheproblemofyouthsuicideand thekeyrolethateveryone(includingthestudents)playsinprevention. * Itisimportanttobalancebeingtruthfulandhonestwithoutviolatingtheprivacyofthesuicide victimandhis/herfamilyandtotakegreatcarenottoglorifytheiractions. * Itisimportanttohavethefactsoftheincident,bealerttospeculationanderroneous informationthatmaybecirculatingandassertively,yetkindly,redirectstudentstoward productive,healthyconversation. * Schoolpersonnelneedtoreachouttothefamilyofastudentwhohasdiedbysuicideas quicklyaspossibleandoffercondolenceandsupportespeciallytosurvivingsiblingswholikely alsoattendyourdistrictschools. * Itisrecommendedthatthefuneralforastudentwhodiedbysuicidebeheldatalocationother thantheschoolashasbeenpreviouslydoneinveryruralcommunities.thefuneralneedstobe scheduledafterschoolsothatlargenumbersofstudentsarenotabsentfromschoolandmost importantlytheirparentsaremorelikelytobeabletoattendthefuneralwiththeirchildren. Schoolpersonnelarealsostronglyencouragedtoattendthefuneralandbeavailabletoassist grievingchildren. * Schoolsareencouragedtobetruthfulandfactualafterverificationthatthedeathwasby suicideincommunicationwithstudentsandinformationisbestsharedeitherindividually,in smallgroupsorinclassrooms.publicaddressannouncementsaretobeavoided. * CenterforDiseaseControlresearchcitedbyLieberman,PolandandKornfeld(2014)foundthat teenagersmostsusceptibletosuicidecontagionarethefollowing:studentswhobackedoutof asuicidepact,studentswhohadalastverynegativeinteractionwiththevictim,studentswho nowrealizetheymissedwarningsignsandstudentswiththeirownsetofadversities/previous suicidalbehaviorwhomaynotevenhaveknownthevictim. * Studentsatriskduetotheirownhistoryofadversitiesandprevioussuicideattemptsmay considerutilizingthesamemethodusedbytherecentsuicidevictim * Ifthesuicidewasbygunshotitisrecommendedthatalllocalfamiliessafeguardgunsfrom theirchildren(whichisrequiredbylawintexas.) * Itisimportantthatstudentsnotfeelthatthesuicidevictimhasbeenerasedandthatstudents beprovidedanopportunitytotalkaboutthedeceased.

47 47 * Numerousprofessionalassociationscautionthatmemorialsnotbedramaticandpermanent andsuggestinsteadactivitiesthatfocusonlivingmemorialssuchasfundingsuicideprevention. * Schoolpersonnelareencouragedtomonitorsocialmediaafterasuicideoccursasvulnerable youthoftenconnectwitheachotheronline. * Schoolpersonneloftenconsiderpostponingpreviouslyscheduledsuicidepreventionprograms ifasuicidehasoccurredbutpreventioninformationisneededmorethaneverassuicideis moreonthemindsofstudentsthaneverbefore.thepresentationshouldemphasizethatnot allsuicidescanbepreventedbutmostcanandweallhavetoworktogethertopreventfurther suicides. * Schoolsareencouragedtoconductacarefullyplannedmeetingforparentsintheaftermathof suicidethatfocusesonthelivingandclarifiesthewarningsignsofsuicideandhowto distinguishtypicaladolescentbehaviorfromdepressionandwhereparentscangoforhelpfor theirchild.thismeetingacknowledgesthesuicidedeathandfollowstheguidelinesbelowfor talkingwithstudents.localcommunitymentalhealthcentersandlocalsuicideprevention coalitionscanhelpwiththesemeetings. * Suicidepreventioninformationandthewarningsignsofsuicideneedtobeavailableonthe districtwebsitethatcanbefoundwithasimplesearchwiththetermsdepressionorsuicide. Thedistrictwebsiteinformationneedstoincludeguidanceforparentsandhowtheschool districtpartnerswithcommunityresourcestopreventoneoftheleadingcausesofdeathfor childrenandhowtheycanassisttheirchildiftheyareexposedtosuicide. * IfasuicideclusterdoesoccurtheCenterforDiseaseControlrecommendsconveningaplanning teamthatinvolvesallsectorsofthecommunityincluding(medicalpersonnel,lawenforcement, mentalhealthpersonnel,clergy,survivorgroups,media,stateandcommunityagenciesand crisishotlinepersonnel)identifyingandcounselingatriskstudentsanddeliveringapublic responsethatavoidsglorificationandsensationalism. * MajorprotectivefactorsagainstyouthsuicideidentifiedbytheWorldHealthOrganizationare thefollowing:stablefamilies,positiveconnectionsatschool,goodconnectionswithother youth,religiousinvolvement,lackofaccesstolethalweapons,accesstomentalhealthcareand awarenessofcrisishotlineresources.

48 48 Postvention:CommonlyAskedQuestionsandResponses Whydidhe/shediebysuicide?Wearenevergoingtoknowtheanswertothatquestionasthe answerhasdiedwithhim/her.thefocusneedstobeonhelpingstudentswiththeirthoughtsand feelingsandeveryoneintheschoolcommunityworkingtogethertopreventfuturesuicides. Whatmethoddidtheyusetoendtheirlife?Answerspecificallywithinformationastothemethod suchashe/sheshotherselfordiedbyhangingbutdonotgointoexplicitdetailssuchaswhatwasthe typeofgunorropeusedortheconditionofthebodyetc. Whydidn tgodstophim/her?therearevaryingreligiousbeliefsaboutsuicideandyouareallfreeto haveyourownbeliefs.however,manyreligiousleadershaveusedtheexpression Godsoundedthe alarmbutcouldnotstophim/her.godhasembracedthemyes,andhe/sheisinwhateverafterlifeyou believein,butgodisactuallysaddenedthathe/shedidnotstayonthisearthanddogod sworkover theirnaturallifetime. WhatshouldIsayabouthim/hernowthattheyhavemadethechoicetodiebysuicide?Itis importantthatwerememberthepositivethingsaboutthemandtorespecttheirprivacyandthatof theirfamily.pleasebesensitivetotheneedsoftheirclosefriendsandfamilymembers. Didn the/shemakeapoorchoiceandisitokaytobeangrywiththem?theydidmakeaverypoor choiceandresearchhasfoundthatmanyyoungpeoplewhosurvivedasuicideattemptareverygladto bealiveandneverattemptedsuicideagain.youhavepermissionforanyandallyourfeelingsinthe aftermathofsuicide,anditisokaytobeangrywiththem.thesuicideofayoungpersonhasbeen comparedtothrowingarockintoapondwithrippleeffectsintheschool,churchandthecommunity andthereisoftenasearchforasimpleexplanation.theserippleeffectshaveneverbeengreaterwith theexistenceofsocialnetworks(e.g.facebook).itisrecommendedthatschoolstaffandparents monitorwhatisbeingpostedonsocialnetworkssitesintheaftermathofasuicide.suicideisa multifacetedeventandsociological,psychological,biological,andphysiologicalelementswereall presenttosomedegree.thesuicideisnoone sfaultbutyetiseveryone sfaultandsuicideprevention iseveryone sresponsibility.manyindividualswhodiedbysuicidehaduntreatedmentalillnesses,most likelydepression,anditisimportantthateveryoneisawareofresourcesthatareavailableintheir schoolandcommunitysothatneededtreatmentcanbeobtained.itisalwaysimportantthateveryone

49 49 knowsthewarningsignsofsuicideandtheyareoutlinedingreatdetailonwebsitesreferencesinthis handout. Isn tsomeoneorsomethingtoblameforthissuicide?thesuicidevictimmadeaverypoorchoiceand thereisnoonetoblame.thedecisiontodiebysuicideinvolvedeveryinteractionandexperience throughouttheyoungperson sentirelifeupuntilthemomenttheydiedandyetitdidnothaveto happen.itisthefaultofnoone. HowcanIcopewiththissuicide?Itisimportanttorememberwhatorwhohashelpedyoucopewhen youhavehadtodealwithsadthingsinyourlifebefore.pleaseturntotheimportantadultsinyourlife forhelpandshareyourfeelingswiththem.itisimportanttomaintainnormalroutines,proper sleepingandeatinghabitsandtoengageinregularexercise.pleaseavoiddrugsandalcohol.resiliency whichistheabilitytobouncebackfromadversityisalearnedbehavior.everyonedoesthebestwhen surroundedbyfriendsandfamilywhocareaboutusandbyviewingthefutureinapositivemanner. Whatisanappropriatememorialtoasuicidevictim?Themostappropriatememorialisalivingone suchasascholarshipfundorcontributionstosupportsuicideprevention.theamericanfoundationfor SuicidePreventionwww.asfsp.organdtheSuicidePreventionResourceCenterwww.sprc.org publishedin2011,anexcellentguideforpostventionentitled,afterasuicide:atoolkitforschools, thatisavailableonbothoftheirwebsites.theguideprovidesspecificguidelinestobalancetheoften feltneedsthatstudentshavetodosomethingafterasuicidewithoutglorifyingthesuicidevictim whichmightcontributetootherteenagersconsideringsuicide.schoolsareencouragedtodownload thisguideandhaveitavailableifasuicidedoesoccurandfollowtheexcellentrecommendations providedthatweredevelopedafterextensivedialoguewithnumerousexpertsinsuicideprevention.it isimportantthattexasschoolpersonnelbeveryfamiliarwiththisguideandtorecognizetheycouldbe criticizedandevensuedforfailingtoimplementabestpracticespostventionresponse.thereisalsoa postventionchapterinthetexascomingtogethertocaretoolkitavailableat TexasSuicidePrevention.org. Howseriousistheproblemofyouthsuicide?Itisthesecondleadingcauseofdeathforteenagersand theeleventhleadingcauseofdeathforallamericans,andmorethan38,000americansdiebysuicide eachyear.

50 50 Whatarethewarningsignsofsuicide?Themostcommonsignsarethefollowing:makingasuicide attempt,verbalandwrittenstatementsaboutdeathandsuicide,fascinationandpreoccupationwith death,givingawayofprizedpossessions,sayinggoodbyetofriendsandfamily,makingoutwills,and dramaticchangesinbehaviorandpersonality. WhatshouldIdoifIbelievesomeonetobesuicidal?Listentothem,supportthemandletthemknow thattheyarenotthefirstpersontofeelthisway.thereishelpavailableandmentalhealth professionalssuchascounselorsandpsychologistshavespecialtrainingtohelpyoungpeoplewhoare suicidal.donotkeepasecretaboutsuicidalbehaviorandsavealifebygettingadulthelpasthatis whatagoodfrienddoesandsomedayyourfriendwillthankyou. Howdoesthecrisishotlinework?Weareveryfortunatetohavenationallycertifiedcrisishotlinesin manycitiesthatareavailable24hoursadayandmannedbytrainedvolunteers.thereisalsoa24hour nationalsuicidehotlineandthatcanbereachedvia1s800ssuicideor1s800s273s8255.allofthetexas localmentalhealthauthoritiesandcommunitymentalhealthcentersalsoarerequiredbylawtohave acrisisline.itisimportanttosaveboththenationalsuicidepreventionlifelinenumberandthelocal crisislinenumberinyourcellphonesothattheyareeasilyavailablewhenneeded.note:sometexas schooldistrictshavepromotedtheselinewitha SaveANumbertoSaveALife campaignannounced atsportingeventsduringtheannualsuicidepreventionweek. HowcanImakeadifferenceinsuicideprevention?Knowthewarningssigns,listentoyourfriends carefully,donothesitatetogetadulthelpand,rememberthatmostyouthsuicidescanbeprevented andbecomeawareofwaystogetinvolvedwithsuicideprevention.highschoolstudentscanvolunteer insomecitiesandbetrainedtoanswertheteenline.please,contactthelocalcrisishotlineformore information.onepersoncanmakethedifferenceandpreventasuicide WherecanIgoformoreinformationaboutpreventingsuicide?ContacttheAmericanAssociationof Suicidology(AAS)atwww.suicidology.orgorTexasSuicidePreventionresourcesat OrYellowRibbonSuicidePreventionProgramatwww.yellowribbon.orgortheAmericanFoundation forsuicidepreventionwww.afsp.orgorthesuicidepreventionresourcecenteratwww.sprc.orgor NovaSoutheasternUniversityatwww.nova.edu/suicidepreventionasfourtrainingvideosfocuson suicideawareness,suicideassessment,suicidepostventionandself\injuryinschoolsordownloadthe

51 51 appsandvideosofhelpandhopelistedinappendixiase\resourcesfrommentalhealthamericaof Texas. Howwelldofamilieswholostachildtosuicidecopewiththeloss?Theliteraturewelldocumentsthe devastatingeffectofsuicideonthefamilyandthatfamilymembersoftenfeelisolated.research studiesconducted15monthsafterthesuicideindicatethatthefamilieshaveresumednormal functioning,howevertheyareprofoundlyaffectedespeciallywhenthereislittleexplanationforthe suicideoftheirlovedone(erbacher,singer&poland2015).familymembersmayexperienceanger towardsthosetheybelievearesomehowresponsible,lossofinterestintheiremploymentorschool work,increasedabsences,disruptedsleepingandeatingpatterns,grief,helplessness,abandonment, isolation,loneliness,shameandguilt.suicidesurvivorshavemoredifficultywiththegrievingprocess thansurvivorsoflossesfromothercausesthansuicide.survivorsoftenreportedfeelinguncomfortable withthenaturallyoccurringsupportsystemsandschoolandcommunitymembersoftenareunsureof whattosayandhowtoreachouttothosewholostafamilymembertosuicide. Ifafamilymemberhasapre\existingmentalhealthconditionitwilllikelybeexacerbatedand previoussubstanceabusewilllikelyincrease.familiesreportedreceivinglesssupportthatthey deemednecessaryafterasuicideandwhatsupporttheydidreceivewasoftenpoorlytimedand especiallyineffectiveforyoungersiblings.researchstudieshavealsofoundthatapproximately50%of thetimethatchildrenwerenottoldthetruth,thatthecauseofdeathwassuicide.childrenoftenfind outthetruthatalaterdateandareupsetthattheywerenottoldthetruth(joiner,2011). Bereavementwasespeciallycomplicatedwhenfamilymembershelddeeplyreligiousbeliefsandmoral convictionsagainstsuicide.familyphysiciansandschoolpersonnelwhoareknowledgeableabout helpingsurvivorscopeandavailablecommunityresourcescanplayasignificantroleinsupportingthe grievingfamily.familymembersoftenreceivecomfortandfindmeaninginbecominginvolvedin suicideprevention.

52 52 SuicidePostventionChecklist (KeypointsfromErbacher,Singer&Poland2015,Lieberman,Poland&Kornfeld2014andAfter asuicide:toolkitforschoolsfromwww.afsp.organdwww.sprc.org.) 1.Verifythatadeathhasoccurredandconfirmcause. 2.MobilizetheSchoolCrisisResponseTeamandnotifyyourlocalcommunitymentalhealthcenter. 3.Assessthesuicide simpactontheschoolandestimatethelevelofneededpostventionresponse. 4.Notifyandsupportschoolstaff. 5.Contactthefamilyofthesuicidevictim. Contactshouldbemadeinpersonwithin24hoursofthedeath.Purposesinclude... o expresssympathy, o offersupport, o identifythevictim sfriendswhomayneedassistance, o discusstheschool spostventionresponse, o identifydetailsaboutthedeaththatcouldbesharedwithoutsiders, o discussfuneralarrangementsandwhetherthefamilywantsschoolpersonneland/or studentstoattend 6.Determinewhatinformationtoshareaboutthesuicide. SampleLettersshouldbeavailabletouseatemplatesdependingonthemessaging; o Deathhasbeenruledasuicide o Causeisunconfirmed(askthatrumorsnotbespread) o Familyhasrequestedcauseofdeathnotbedisclosed(rumorsofsuicideandsincethat subjecthasbeenraised).(suicideisaleadingcauseofdeathforyouthandwemustall knowthewarningsignsofsuicideandwheretogethelpforourselvesorourfriends. Suicideisverycomplex,butmentalillnessessuchasdepressionareusuallythecause.) 7.Determinehowtoshareinformationaboutthedeath 8.Identifystudentssignificantlyaffectedbythesuicideandinitiateareferralmechanism RiskFactorsforImitativeBehavior o Facilitatedthesuicide o Failedtorecognizethesuicidalintent o Believetheymayhavecausedthesuicide

53 53 o Hadarelationshipwiththesuicidevictim o Identifywiththesuicidevictim o Haveahistoryofpriorsuicidalbehavior o Haveahistoryofpsychopathology o Showsymptomsofhelplessnessand/orhopelessness o Havesufferedsignificantlifestressorsorlosses o Lackinternalandexternalresources 9.Conductafacultyplanningsession 10.Initiatecrisisinterventionservices 11.Memorials Strivetotreatallstudentdeathsthesameway o Encourageandallowstudents,withparentalpermission,toattendthefuneral o Reachouttothefamilyofthevictim o Contributetoasuicidepreventioneffortinthecommunity o Developlivingmemorials,suchasstudentassistanceprograms,thataddressriskfactors inlocalyouth o Addressspontaneousmemorialsonschoolgrounds Prohibitingallmemorialsisproblematic o Recognizethechallengetostrikeabalancebetweenneedsofdistraughtstudentsand fulfillingtheprimarypurposeofeducation o Meetwithstudentsandbecreativeandcompassionate o Spontaneousmemorialsshouldbeleftinplaceuntilafterthefuneral Avoidholdingfuneralservicesonschoolgrounds Withcarefulplanning,schoolsmayparticipateingatheringssuchascandlelightmemorials. Schoolcounselorsshouldbepresenttosupportgrievingstudents. Monitoroffcampusgatherings Studentnewspapercoverageshouldfollowmediareportingguidelinesavailableat Yearbookandgraduationdedicationortributesshouldallbetreatedthesameregardlessofthe causeofdeathforthestudent

54 54 Grievingfriendsandfamilyshouldbediscouragedfromdedicatingaschooleventandguided towardspromotingsuicideprevention Permanentmemorialsoncampusarediscouraged 12.SocialMedia CreateaSocialMediaManagertoassistthePublicInformationOfficer Utilizestudentsas"culturalbrokers"tohelpfacultyandstaffunderstandthesocialmediathat iscurrentlymostusedbystudents Trainstudentsingatekeeperrole,andspecificallyidentifywhatsuiciderisklookslikewhen communicatedviasocialmedia. Havestaffmonitorsocialnetworksandprovidesafemessagingwhenimportant(thiswill requirethatdistrictsnotcompletelyblockthesenetworks) Haveparentsgetinvolvedintheirchild'ssocialmedia Monitorforhighriskstudents Psycho\education:Makeuseofsocialmediatopostpreventionmessages,hotlinesand communitymentalhealthresources. Givestudentsspecifichelpfullanguagetoincludewhenmakinguseofsocialmediasuchas bannersandinfofromthenationalsuicidepreventionlifelinewebsite ( WorkwithYouTubeandFacebooktotakedownmessages,disturbingimagesorlanguage UtilizetheFacebookapplicationforconcernsorissueswithcontent. 14.Debriefthepostventionresponsewithschoolcrisisteammembersandidentifyneededadditional actions SuicideandSchools:LiabilityIssues Fewprecedentshavebeensetregardingaschool sliabilityincasesofthesuicideofastudent andwithonlyafewexceptionsschoolpersonnelhavebeengrantedsovereignimmunity.ifonecourt upheldanactionagainstpublicschoolpersonnelbasedonadutytopreventsuicidewhentheywere awareofsuchintent,countlessothercourtshavenottakensuchaction.thecourtslookatwhetheror

55 55 notthestudent sdeathwasaresultfrominadequatetrainingand/orinadequateresponsesfrom schoolpersonnel.itisextremelyhardtoprovethataschool sbreachofdutycausedthesuicidewhile weighinginallotherfactor sinthestudent slife.whileitisdifficulttofindschoolpersonnel accountableforthesuicideofastudent,alawsuitcancostaschooldistricthundredsofthousandsof dollarsinlegalcosts,tremendousstress,time,andtheplacementofastigmaonthedistrict.itis importanttonotethatoneoftheauthorsofthisreporthasservedasanexpertwitnessinanumberof liabilitycasesinvolvingschoolsandsuicide PriortothecaseofEisel)v.)Montgomery)County)Board)of)Education(1991),courtsconsistently concludedthatschoolsdidnothavealegalobligationtopreventsuicide.thiscaseraisedtheissuethat schoolcounselorsmighthavealegaldutytopreventsuicideduetothespecialrelationshipthat counselorshavewithstudents.twoschoolcounselorsweretoldbyclassmatesofnicoleeiselthatshe plannedtodiebysuicide.eiselwhenquestionedbythecounselorsdeniedsuicidalthoughtsorplans andthecounselorschoosenottonotifyherparents.eisellaterdiedbysuicide.aninitialmaryland courtfoundthatthecounselorsdidhaveadutytowarnherparents,butultimatelyaftermanyofyears oflitigation,ahighercourtfoundinfavorofthecounselorsandtheschooldistrict.itisimperativefor administratorsandkeyschoolsupportpersonnelsuchasschoolcounselorstoknowthestatusof previouslitigationinvolvingschoolsandsuicideandbefamiliarwithkeylegaltermssuchasthe following: Negligence Negligenceisabreachofdutyowedtoanindividualinvolvinginjuryordamage(suicide)that findsacausalconnectionbetweenalackoforabsenceofdutytocareforthestudentandhis/her subsequentsuicide.inafewcasescourtshaveaskedschoolstoproducerecordsofwhentheytrained staffonsuicideprevention.itisimperativethatschoolsnotonlyholdannualtrainings,butalso documentwhenthesetrainingswereheldandwhowasinattendance.onecasethatraisedquestions ofnegligenceandtraininginsuicidepreventionwaswitsell)et)al)v.)the)school)board)of)hillsborough) County(2011). HopeWitsell,amiddleschoolstudent,wasreferredtotheschoolsocialworkerafterher teachernoticedshallowcutsonherthigh.itwaswellknownbyschoolpersonnelthatshewas

56 56 experiencingbullying,andharassmentfollowinghersendingasextingimageviatexttoanother studentthepreviousschoolyear.thesocialworkerhadthestudentsignano\harmcontractbutfailed tonotifyherparentsoftheconcernsaboutsuicide.witselldiedbysuicidethenextday.herparents foundacopyoftheno\harmcontractsignedbyhopeandthesocialworkerafterhersuicide.as mentionedinthisreport,thereisasignificantconnectionbetweenbullyingandsuicidethatmustbe addressedinschools.herparentssuedtheschoolboardofhillsboroughcounty,floridaunder allegationsofnegligence.theschoolboardwasnotfoundlegallyresponsible;howeveroneimportant issueinthecasewaswhetherornotthesocialworker sfailuretofollowthedistrictpolicyofparent notificationwasduetolackoftrainingonthedistrictpolicythatrequiredparentnotification. Foreseeability Schoolpersonnelcanbeheldliableifitisfoundthatareasonablepersonwouldhavebeenable torecognizethatthestudentwassuicidal.courtshaveallowedactionsagainstschoolofficialsforsuch acause,relatingtotheabsenceofappropriatesupervisionorthelackofappropriate policies/proceduresusedwhenastudent ssuicideisdeemedforeseeable(alikelyandimminent danger).onecasethatraisedthequestionofforeseeabilitywaswyke)v.)polk)county)school)board (1997)assadly,13\year\oldShawnWykekilledhimselfinhisownhomeaftertwopriorattemptson schoolpropertythepreviousdaythattheschoolassistantprincipalwasawareof.theassistant principaltalkedtoshawnabouthissuicideattemptsbutdidnotnotifyhisparents,increase supervisionorobtainanycounselinghelpforhim.thiscasewenttoatrialandthejuryfelthis attemptsontheschool scampuswouldcauseanysensiblepersontoreasonablyassumethathe neededhelp/careorhewouldbeinimminentdangertohimselfandtoattemptsuicideagain.his suicidewasdeemedforeseeable.theschooldistrictarguedthatsuicideisaninterveningforce,butthe juryfoundthatthedefendantshadstrongreasontoanticipatehissuicide.theschooldistrictwas foundliablefornotofferingsuicidepreventionprograms,fornotprovidingadequatesupervisionof thestudent,andforfailingtonotifyhisparentsthathewassuicidal.

57 57 StateSCreatedDanger Aschoolcanbefoundtohavebeeninviolationoflegalresponsibilitybasedontheconstitution rightsofthevictims.theargumentstatesthatthroughenactingorfailingtoenact/followthroughwith certainpoliciesandprocedures,theschooliscausingdangertothestudentwhohasdiedbysuicide. Overall,tohaveaconvincingargument,theplaintiffmustestablish:therewasforeseeableanddirect harm,astateactor(schoolemployee)actedwithalackofresponsibilitythat, shockstheconscience, andarelationshipexistedbetweenthestateandplaintiffsuchthattheplaintiffwasaforeseeable victimofthedefendant sacts.onesuchcase,armijo)v.)wagon)mound)public)schools(1998),involved aspecialeducationstudentthatwassuspended,drivenhomebyaschoolemployee,andleft unattendedatthehomewherehekilledhimselfwithagun.priortodrivinghimhomeandleavinghim unattendedwithoutparentalconsent,schoolemployeeswereawareofthestudent ssuicidalthreats andaccesstofirearmsinhishome.theschoolwasnotultimatelyfoundlegallyresponsible,butthe factthatthelowercourtallowedthecasetogototrialallowedforthepossibilityoffindingtheschool liableforthesuicideofastudentunderstate\createddanger. Immunity Governmententitiesincludingschoolsandschoolpersonnelaregrantedimmunityiftheir conductdoesnotclearlyviolateconstitutionalrightsofwhichareasonablepersonwouldhaveknown. Thereisaconstitutionalrightofa dutytoprotect; however,statelawsbasedonchildattendanceat schoolshavefailedtoconvincecourtsthatachild sattendanceatschoolcreatestherelationshipthat wouldmandateaschool sdutytoprotectstudents.itisverydifficulttosuccessfullysueaschoolor schooldistrictfortheactionsofitsemployees,unlesstheschoolboardoradministrationfailedto enactpoliciesandproceduresthatviolatetheirdutytoprotectstudentsfromstate\createddangeror aspecialrelationshipexisted.often,courtsgrantsummaryjudgmentinfavorofthedefendants (schoolsandschoolboards)ordismisscasesduetothefactthattheactionsorlackofactions,takenby theschoolemployeefailstobefoundto shocktheconscience.

58 58 SpecialRelationship Aspecialrelationshipargumentfollowsthelogicthatifastateentityholdsa special relationship withastudent,thatitistheirresponsibilitytoprotectthechildfromharm.ithasbeen arguedthatpublicschools(stateentities)doholdaspecialrelationshipwiththeirstudents,butitis verydifficulttoconcludeunlessthechildisinthestate scustodythroughprison,involuntary commitmentintoaninstitution,orplacedinfostercare.inthecaseofdoe)v.)covington)county)school) District(2012),nine\year\oldJaneDoeandherfamilybroughtlitigationagainstthegirl sschooldistrict fortheirdeliberateindifferencetohersecurity.janedoewasrepeatedlycheckedoutoftheschool andsexuallymolestedeachtimebyamanwhowasnotauthorizedtodoso.theplaintiff sargument statedthataspecialrelationshipexistedduetojane syoungage(nineyearsold),andmandated schoolattendance.thiscasewasultimatelydecidedbythe5thcircuitfederalcourtthatfoundthat therewasnospecialrelationshipbetweentheschoolandjanedoeanddismissedthecase.thiscase doesnotinvolveastudent ssuicide,howeveritdoesdemonstratehowcomplicatedthe special relationship argumentcanbecome. InLocoParentisDoctrine Thisdoctrinereferstothelegalresponsibilityofaschooltofunctionandperformthe responsibilitiesofaparentforastudentwhileatschool.inotherwords,schoolsmaybemandatedby thisdoctrinetolookoutforthestudent sbestinterest.schoolsassumethecontrolandsupervisionof thechildrenasstand\inparentswhiletheyareattending. InterveningForce Manyschooldistrictattorneyswhendefendingschoolsusethe interveningforce argument afterthesuicideofastudentemphasizingthatsuicideisasupersedingandinterveningforcethat breaksanychainofcausationbetweenevents.thisargumentstatesthattherewouldbenowayto placecauseonaschool snegligence/causeandeffect,assuicideisanactionthatonlytheindividual him/herselfcanprevent.thisargumentwasusedbythecypressfairbanksisd(fowlerv.szostek, 1995)intheschooldistrict sdefensefollowingthesuicideofamiddleschoolstudentnamedbrandi

59 59 Nelsonwhowasremovedfromschoolandrecommendedforexpulsionbasedonstatementsfrom otherstudentthatshewassellingdrugsatschool.followingherremovalherparentstookherhome andleftheraloneandsheshotherself. Theprimaryargumentfromtheplaintiff sattorneywasthattheschoolshouldhaverealized thatbecauseshewasinaseveredisciplinesequenceshemightbesuicidal.thisargumentwasbased onthefactthatsuicideisaleadingcauseofdeathforteenagersandthatschooldisciplinecanbea precipitatingeventtosuicide.theplaintiffsintheirwrongfuldeathsuitbelievedthattheschoolhada dutytoexplorethepossibilitythatnelsonmighthavesuicidalideation. Thedefendants motionforsummaryjudgmentwasultimatelygrantedafterbeingdenied initially,demonstratingthatthedoctrineofsovereignimmunityandtheconceptofinterveningforce impedealmostallclaimsmadebyplaintiffs.althoughitisunknownwhetherornotthediscipline situationwasadirectcauseofhersuicide,itlikelyplayedakeyroleinheractions.itishighly recommendedthatschoolofficialshandledisciplinarymeasureswithcompassionandcare,asitisnot uncommonforschooldisciplinesuchassuspensionorexpulsiontoprovokestudentstofollowthrough onearlierthoughtoutsuicidalplans.itisrecommendedthattheschoolofficialstakeextratimewith anystudentinvolvedinaseriousdisciplinarysituation.someexamplesandrecommendationsofwhat tosay/dotoprovidecareforthedisciplinedstudentareasfollows: 1. Askthestudent: Areyougoingtobeokay? and Doyouneedtoseethecounselor beforeyouleaveschool? 2. Tellthestudent: Westillcareaboutyou. 3. Totheparent/guardian: Doyouthinkyoucouldstayhomewithyourchildtodayasthis mustbeaverydifficulttimeforthem? 4. Discusswiththeschoolcounselorifhe/shemayknowaboutanyadditionalwarning signsforthatstudent.alsoaskthecounselortoquestionthestudentabout hopelessnessandthoughtsofsuicide.

60 60 ProfessionalEthicalStandardsforKeySchoolPersonnel NoMaleficence/DoNoHarm Foracounselor/psychologistinparticulartoupholdhis/herethicalstandards,he/shemustdo noharm.notingthegravestatisticsofsuicidalityinyouth,suicidepreventioneffortsonlyseemtobe commonsensetothosewhowishtodonoharmtothestudentpopulation.althoughthereisan inconsistencyintheoutcomesofpreviouscourthearingsontheextentofaschooladministrator, socialworker,psychologistorcounselor slegalobligationtopreventastudent ssuicide,theirethical obligationisnotupforquestionastheyareethicallyboundtomakeeveryattempttopreventharm andprotectstudentsfrompotentialdanger. Competence Schoolmentalhealthprofessionalsinparticularmustbecompetentanduptodateontherisk factorsandwarningsignsofsuicide.thiscanbeensuredthroughmandatingtrainingsonsuicide prevention,assessment,andintervention.thereisanationalmovementtomandatetrainingfor schoolpersonnelonsuicidepreventionandsomestateshavemandatedmorethantrainingonthe warningsignsofsuicide.forexample,thestateofwashingtonrecentlypassednewlegislationentitled K\12 TroubledYouthAct Thislawmandatesthatschoolnurses,schoolsocialworkers,schoolpsychologists,andschool counselorsattendatraining(atleastthreehoursinlength)onyouthsuicidescreeningandreferralasa requirementforbothinitialandcontinuingcertification.asnotedearlierinthisreport,texashas recentlymandatedtrainingforteachersandschoolpersonnel.

61 61 SuicidePostventionandLiability Theterm postvention referstoeventsandactivitiesthatareplannedforschoolstoputinto actionfollowingasuicideasameanstoassesstheoverallimpact,identifyat\riskindividuals,preventa contagioneffectfromoccurring,andsupportsurvivorswhoareemotionallyaffectedbythedeathand arelikelyhavingincreasedthoughtsofsuicide.schoolsasdiscussedinthisreportareoftenunprepared tohandletheaftermathofasuicideandmaynotrealizethatpostventioneffortsthatarecarefully plannedandimplementbestpracticesareessentialtopreventfurthersuicides. Theauthorsareonlyawareofonelegalcasethatinvolvedhowaschool shandlingthesuicide ofastudentmighthavecontributedtoanothersuicide,whichisthecaseofmares)v.)shawnee)mission) School)District(2007).Inthissuit,Mrs.Maressuedtheschoolfornegligenceintheirdutytoprotect hersecondsonjustin,whodiedbysuicide(poland&chartrand,2008).theplaintiffarguedthatthe districtfailedtoimplementpostventionproceduresatthehighschoolfollowingheryoungerson Jason ssuicide,claimingthatthatsuchanimplementationcouldhavepreventedheroldersonjustin whoattendedthesamehighschoolfromdyingbysuicidejustsixmonthsafterthesuicideofhis youngerbrother.theplaintiff,mrs.mares,arguedthatshewasnaïveastohowsheandherfamily shouldappropriatelycopewiththedeathofherfirstsonjasonandthattheschoolstaffalsorefrained fromreachingouttojustinmares,excepttotellhimthathecouldnotgraduate.theschooldidnot presentanysortofpostventionresponseoroffercounselingtojustinnordidtheschoolreachoutto Mrs.MarestomakesuggestionsastohowsheshouldsheshouldhandletheaftermathofJason s suicidewithherotherchildren.oneaspectinquestionwasifasensiblepersonwouldhavehadreason toanticipatejustin sdepressiveandsuicidalthoughtsafterthedeathofhisyoungerbrother?further, shouldschoolprofessionalshaveanticipatedhisdepressionandwasitnegligencenottointervene? Thequestionofinlocoparentiscontrolwasalsocentraltothelawsuithoweverdefendants maintainedtheargumentthatbecausejustin ssuicideoccurredoffcampus,theynolongerhadinloco parentiscontrol.theschooldistrictfiledforasummarydismissal;however,thismotionwasdenied andtheshawneemissionschooldistrictdidsettlewithmrs.maresoutofcourt,butthespecificsof thesettlementaresealed(poland&chartrand,2008).thereisastrongchancethatjustin ssuicide couldhavebeenpreventedmostimportantlyandtheamountoftime,energy,andmoneythatthe ShawneeMissionSchoolDistrictspentonthiscase(aswellasthestigmaplacedonthedistrict)could havealsopossiblybeenpreventedbyimplementingbestpracticespostventionprocedures.

62 62 BullyingandSuicideLiability Therehavebeenanumberoflawsuitsfiledbyparentsagainstschoolpersonnel,citingthe school sfailuretostopbullyingasaproximalcauseoftheirchild ssuicide.anumberofparentshave beenveryvocalinattributingthesuicideoftheirchildtobullying.thedistrictofbluesprings,missouri investedconsiderabletimeandeffortrespondingtoalawsuitfollowingthesuicideofbrandonmyers (Evenson,2012),a12\year\oldstudentwhoreportedlyhadbeenavictimofcontinuousbullyingat school.thedistrictsettledwiththeparentsoutofcourtfor$500,000.00shortlybeforeatrialwasto begin. Inanothercaselinkingbullyingtosuicide,The)Estate)of)Montana)Lance)et)al)v.)Kyer)et)al (2011)wasfiledagainsttheLewisvilleIndependentSchoolDistrictfollowingthesuicideofMontana Lance,afourthgradestudentwhohunghimselfatschool.Hisparents,Mr.andMrs.Lance,claimed thattheschoolfailedinprovidingsafetyformontana,asuicidalspecialeducationstudentwhowas knowntobesuicidal,throughtheirabsenceofpolicies,procedures,andtrainingsforhowschoolstaff shouldhaveworkedwithmontanaandprotectedhimfromthebullying.mr.andmrs.lancefurther arguedthattheschoolhadaspecialrelationshipwiththeirson,ashewasayoungstudentwitha disability.furthermore,thedayhediedhewasinadisciplinesetting(inschoolsuspension)inwhichhe wasbeingheldinvoluntarily.theplaintiffsalsomadetheclaimofstate\createddanger(knowingly allowingasuicidalmontanatousearestroomthatschoolpersonneldidnothaveakeytoopenthe dooronceitwaslocked).accordingtotheplaintiffs,montanawasdiscriminatedagainstasevidenced bytheschool snegligencetoaddressmontanaandhisfamily scomplaintsofthebullyingand harassmentwhichtheybelieveledtomontana ssuicide.ajudgefortheeasterndistrictcourtof Texasdismissedthecase,claimingthattheplaintiff sdidnotprovidesufficientevidenceto demonstratethatmontanalancewasdiscriminatedagainstandthatnospecialrelationshipexistedas MontanaLancewasnotimprisoned,involuntarycommittedinaninstitution,orinfostercare.Thecase wasappealedtothe5thcircuitfederalcourtwhichalsosidedwiththeschooldistrict. Whilethecasewasdismissed,theimplicationsfromthistragedyarewidespread.Asnumerous youthsuicideshavebeenlinkedtobullying,itisimperativeforschooldistrictstoimplementboth bullyingandsuicidepreventionprogramsandtorecognizethestrongassociationbetweenbullyingand suicide.texaslegislationidentifiedthatstudentatriskforsuicideincludesstudentswhoareormaybe thevictimsorwhoengageinbullying(tex.health&safetycode ).

63 63 SummativeRecommendationsforSuicideSaferSchoolsinTexas SchoolDistrictActionSteps BackgroundandPolicy 1. Ensurethatyourschooldistricthasacomprehensivesuicidepreventionpolicyincludedinthe DistrictImprovementPlanasrequiredbyTexasstatutethatspecifiesannualtrainingforallstaff onthewarningsignsofsuicideandtheimportanceofworkingasateamandnotkeepinga secretaboutsuicidalbehavior.theplanshouldalsoprovidetrainingonsuicideassessmentfor keyschoolsupportpersonnelincludingcounselors,socialworkersandschoolpsychologists. Policiesshouldbedevelopedtoensurethatsuicidalstudentsareproperlysupervisedandthat theirparentsarenotifiedwhentheirchildissuicidal.districtsalsoneedtobefamiliarwith local,communityandstateresourcesandanyspecificinterventionsavailableintexasincluding proceduresforinvoluntaryhospitalization. 2. BeveryfamiliarwithTexaslegislativeinitiativesforsuicidepreventionandtheexcellent resourcesavailableatdshs,teaandmhat/texassuicideprevention.org. 3. Recognizethatlackofinformationandmisinformationandmythsaboutsuicidehasresultedin youthsuicidepreventionnotreceivingtheattentionthatisneeded. 4. Reviewthesuicidepreventionrequirementsfromthe84 th legislativesessionandsharethem withallbuildingprincipals 5. ReviewthebestpracticeslistsentoutannuallybyDSHSandTEAandavailableontheir websites. 6. BefamiliarwiththeBestPracticesRegistryprovidedbytheSPRC. 7. Developdistrictproceduresandguidelinesforprevention,interventionandpostventionwithat riskandsuicidalstudents,parentnotification,andreferralandfollowupservicesatschoolfor suicidalstudents(note:extensiveguidelines,forms,lettersandproceduresavailablefrom PreventingSuicide:AToolkitforHighSchoolsfromSPRCandAfterasuicide:Toolkitforschools fromafspandsprc) 8. Developspecificschoolpoliciesforsecuringsupervisionandsupportforstudentswhoare identifiedasdepressedand/orsuicidal.

64 64 9. Becomefamiliarwiththeresearchaboutsleepdeprivation,earlyschoolstarttimesandthe adverseeffectonsecondaryagestudentstodeveloppolicyregardingoptimumstarttimes. Infrastructure 10. Formadistricttaskforceonsuicidepreventionthatincludesrepresentativesfromelementary andsecondaryschoolsandensurethatitmeetsataminimumtwiceayear 11. EnsurethatyourDistrictSchoolHealthAdvisoryCouncils(SHAC)includesadvisorsfamiliarwith mentalhealthandsuicideprevention. 12. Identifylocalandstateresourcesforsuicidepreventionandmeetwiththeirrepresentativesin personorviaconferencecalltoimprovecollaboration(dshs,localcommunityorbehavioral healthcentersandlocalsuicidepreventioncoalitions) 13. Designationasuicidepreventionliaisonorliaisonsandconsidergettingthemcredentialedin schoolsuicidepreventionfromtheamericanassociationofsuicidologywww.suicidology.org 14. Ensurethatschoolcounselorschedulesandratiotostudentsmeetsnationalrecommendations fromtheamericaschoolcounselorassociation(asca) TrainingandTools 15. Obtainextensive,bestpracticebasedsuicideassessment/prevention/intervention/postvention trainingforkeypersonnelsuchasschoolcounselorsandschoolpsychologists 16. InvestigatedepressionscreeningsuchasSignsofSuicide,(SOS),C\SSRSorothersbasedonbest practices 17. ImplementprogramstosafeguardandsupportLGBTQstudents.Recognizethatlesbian,gay, bisexualandtransgenderyouthareoftenthetargetofbullyingandincreasesupportforthose studentsandthattheyhavehigherratesofsuicidethantheirheterosexualpeers.excellent resourcestoprovidesupportareavailablefromthegaylesbianstraighteducationnetworkat ReviewandimplementtrainingfromthebestpracticeslistfromDSHSandTEAforallschool personnel 19. Planandconductannualtrainingsforallstaffonbullyingpreventionandrecognizethereisan associationbetweenbullyingandsuicide 20. Implementprogramstoincreasestudentresiliency.

65 IncreaseeffortstoensurethateveryTexasstudentfeelsconnectedtotheirschoolandprovide activitieswherestudentsareaskedtolistthesignificantadultsintheirlifethattheycouldgoto forhelp. 22. TeachstudentstheNationalCrisisHotlineNumbers(800\273\TALKor800\273\8255)Students willalsobeinterestedtoknowthatontheiphoneifsuicideismentionedtosirithattheyare providedwiththenationalcrisishotlinenumbersandsiriofferstoconnectthem. 23. Providelocal,stateandnationalcrisishotlinenumbersthatcanbeaccessedbyeitherparents orstudentsonthedistrictwebsite. 24. Providementalhealthpresentationsannuallyforparentsthatincludesuicideprevention information. 25. Provideinformationonthedistrictwebsiteaboutdepressionandsuicidethatincludes informationaboutwhoparentsshouldcontactiftheyareconcernedabouttheirchild. 26. Reviewpreventionandpostventionproceduresinthisreportandfrom:PreventingSuicide:A ToolkitforHighSchoolsfromSPRCandAfterasuicide:ToolkitforschoolsfromAFSPandSPRC, andpostventionchapterintexas ComingTogethertoCaretoolkit. 27. Trainstaffto AsktheQuestion aboutsuicideandnotbeafraidtoinquiredirectlyabout thoughtsofsuicidesinceresearchhasshownthatdirectinquiryisexactlywhatisneededandis infactlikelytosavealife. StateofTexasActionSteps EducationPolicy,OutreachandSustainability 1. Indevelopingstatewidepolicy,itisnotedontheTexasEducatorSurveythatruralandurban districtpersonnelreportedtheleastconfidenceinrespondingtosuicidalstudentsandall personnelrespondingsupportedtheneedformorefamiliaritywithbestpracticesfor prevention. 2. SendaletterattoallTexassuperintendentsclarifyingthesuicidepreventionrequirements fromthe84 th legislativesessionfromdshsand/orteaandpostletteroneducationservice Centerwebsites. 3. Schedulepresentationatstateschooladministrativeconferencesforprincipals, superintendentsandschoolboardmembersonthelegislativerequirements,howtomeetthem

66 66 andtoclarifylocalandstateresourcesforsuicidepreventionandpostontheirorganizational websites. 4. Conductbiannual,representativestatewidesurveyofTexaseducatorsonsuicideprevention thatbuildsonthesmallsurveycompletedforthisreport. 5. SendanannualletteratthebeginningofeachschoolyeartoallTexasprincipalsfromDSHS and/ortea,listingorgivinglinkstotexasresourcesforsuicidepreventionandincludingthe updatedbestpracticeslist. 6. Thediscussionoflitigationonsuicideandschoolsshouldbesharedwithschooladministrators inleadershipconferencesaroundthestate. 7. TheTexasEducatorSurveyalsonotedevenelementarystudentshavesuicidalbehavioranda needexistsformorepreventionprogramsattheelementarylevel.thereisnationalneedfor moreprogramsatthislevelandtexascouldtaketheleadincreatingsuicideprevention programsforelementaryschools. Training,ToolsandPrograms 1. Providestatefundedregionaltrainingsforschoolcounselorsonsuicide assessment/intervention(dshs,mhatandregionaleducationservicecenters(esc s). 2. Increasecollaborationofstateandlocalresourcesofferedtoschoolsandyouth. 3. IncreaseusabilityandvisibilityofbestpracticeslistonlineforDepartmentofStateHealth Services,MentalHealthAmericaofTexasandit stexassuicideprevention.orgwebsite,regional EducationServiceCentersandkeyeducationandschoolprofessionalorganizations. 4. Adoptastatewideprogramtoenlistschoolsandschooldistrictsinaformal SuicideSafer School comprehensiveprogramandrecognizeoutstandingschooleffortsinimplementing suicidepreventionprogramsandutilizinglocalandstateresources. 5. Investigateimplementingdepressionscreening(SOS)orotherbestpracticescreening statewide. 6. Ensurestatefundingforyouthandschoolsuicidepreventiontoensuresustainabilityof programs.

67 67 Appendix AS DeathbySuicideStatistics BS TexasSuicideSafeSchoolsSurveyforEducators CS TexasSuicideSafeSchoolsSurveyforLeaders DS TexasStateAgencies,National/FederalAgenciesandOrganizations ES SPRCResourcesSpecifictoYouthSuicidePrevention/Intervention/Postvention FS SuicidePreventionTrainingResourcesListedinTexasToolkit GS InformationaboutSPRC snationalregistryofevidencesbasedprogramsand Practices. HS TexasESResourcesforSuicidePreventionAvailablefromMentalHealthAmericaof Texas IS AdditionalSuggestedResources

68 68 AppendixA DeathbySuicideStatistics

69 69 Itisimportanttorecognizethesuicidepreventionchallengesinrelationtotheuniquedevelopmental characteristicsofpre\kthrough12studentswithinthecontextoftheeducationalsettingandits respectivecommunity. Theabovemapprovidesanoverviewofannualdeathsbysuicideforallages.Asindicated,thewestern partoftheu.s.experiencesmoresuicidesthandotheeasternstates.afewofthecorrelatingfactors inspecificregions/citiesinclude;isolationand/remoteness,densepopulations,andseniorpopulations. FactorsinfluencingyouthsuicidecanbefoundinthesectionofthisdocumentidentifiedasRiskFactors theincreasesuicidalideation.

70 70 SuicideDeathStatisticsfortheStateofTexasbyGenderfor2008S2012byAgeGroup Male Female BothSexes 0 Age 5to 14 15to 24 25to 35to 45to 55to 65to 75to 85 All and Ages over TexasSuicideDeathRatesbyAgeGroup2008S2012Rate=Deathsper100,000population AgeDistributionofSuicideDeathsinTexas Deathbysuicideaffectsallages,asthischartindicateswithmaleshavingahigherratethanfemalesforallages.Theratesforsuicide begintoriseintheteenandyoungadultyearsandthehighestratesofsuicideintexasareoccurringintheelderlypopulationoverage 85andinthe45\54agegroup. SuicideDeathRatesforTexas, 2008S2012byAgeGroup AllAges 85andover 75to84 65to74 55to64 45to54 35to44 25to34 15to24 5to14 SuicideDeathRatesfor Texas,2008\2012byAge GroupRate

71 TexasSuicideDeathRatesforLast3YearsForWhichWe HaveData(2011,2012,2013) BexarCounty 20 DallasCounty 15 HarrisCounty 10 TarrantCounty 5 TravisCounty Texas 0 Age 5to 15to 25to 35to 45to 55to 65to 75to 85 All and Ages over 12leadingcausesofdeathinTX,2013 Diseasesofheart Malignantneoplasms Chroniclowerrespiratorydiseases Cerebrovasculardiseases Uninten{onalinjuries Alzheimer'sdisease Diabetesmellitus Sep{cemia Nephri{s,neprho{csyndromeand Influenzaandpneumonia Chronicliverdiseaseandcirrhosis Suicide USrate* TXrate* AgeSadjustedrateper100,000 *Rates are age adjusted to the 2000 US Standard Population (per 100,000). Centers for Disease Control and Prevention, National Center for Health Statistics. Multiple Cause of Death on CDC WONDER Online Database, released Data are from the Multiple Cause of Death Files, , as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. Accessed at on Jun 18, :05:47 PM Website sources: &

72 72 AppendixB Texas Suicide Safe Schools Survey for Educators Current Position: Years in Education: Please circle one of the descriptors. My district/school is RURAL, URBAN, SUBURBAN. The purpose of this survey is to collect information regarding: - suicide prevention and intervention information/training previously provided. - active measures that have been taken by school/district in youth suicide prevention/intervention. - perceived needs or gaps in training that can ensure you are better prepared to have a suicide safe school. Please check the descriptor that most reflects your opinion and/or understanding based on your educational experiences in Texas schools. A comment space has been provided for additional information should you wish to elaborate on your response. YES NO Suicide Awareness/Prevention Training Additional Thoughts? Have you received suicide prevention training? Are you familiar with the Best Practices resource recommended for school administrators in the aftermath of a youth suicide? Does your school have a plan to prevent youth suicide? Do you have a youth suicide prevention plan that is in writing? Have your staff/colleagues rehearsed the actions needed in the aftermath of an attempted or a completed youth suicide? Have any of the schools you ve worked in experienced a youth suicide? Have you personally been involved in prevention or intervention actions for a suicidal youth? Does Texas legislation require youth suicide prevention efforts in schools? Does the district website provide information about youth suicide prevention? Does the district/school have youth suicide prevention included in the District or Campus Improvement Plan? Have you or staff members provided suicide prevention training to students and parents?

73 73 Do you have a depression/suicide screening procedure that you use with all students? Agree=1, Somewhat Agree=2, Disagree=3 Additional Thoughts? I am confident in my knowledge and skills for intervening with a suicidal student I am aware of the significant warning signs for youth suicide I have the training necessary to work with parents and students in the aftermath of a youth suicide within my school community I believe my school and/or district has a comprehensive plan for addressing suicide prevention and postvention I believe that youth suicide is a problem in Texas that should be addressed I believe that schools play a significant role in educating staff, students, and parents on suicide prevention I feel my staff/colleagues are well trained in responding to youth who attempt and/or complete death by suicide I feel I, my staff/colleagues need more information and/or guidance on suicide prevention/intervention strategies. If you have been trained in suicide prevention, select the training from the following list: ASK about Suicide to Save a Life ASIST Applied Suicide Intervention Skills Training QPR Question Persuade Respond Mental Health First Aid At-Risk for Texas Educators, Elementary, Middle School or High School version Other: How frequently does your school/district provide youth suicide prevention information to staff? Who was required to receive training and what was the focus? What resources inside and outside the district are available to you for suicide prevention? Is there anything else you would like to add?

74 74 AppendixC Texas Suicide Safe Schools Survey for Leaders Current Position: Organization: Years in Position: The purpose of this survey is to collect information regarding: - active measures that have been taken toward youth suicide prevention/intervention in Texas schools. - perceived needs or gaps in training in Texas schools. -organization/agency collaboration with Texas schools specific to youth suicide prevention/intervention/postvention. What do you believe are the top 3-5 successes for suicide prevention in Texas Schools? What do you believe are the top 3-5 challenges for suicide prevention in Texas schools? I believe the following would help our Texas schools understand and implement Texas laws regarding suicide prevention:

75 75 Please check the descriptor that most reflects your opinion and/or understanding based on your experiences. A comment space has been provided for additional information should you wish to elaborate on your response. Agree=1, Somewhat Agree=2, Disagree=3 Additional Thoughts? I believe that Texas schools are aware of suicide prevention and postvention Best Practices I believe that Texas schools have a good understanding on how to implement Texas laws regarding suicide prevention in schools I am confident Texas schools/districts have the knowledge and skills for intervening with a suicidal student I believe our schools are aware of and utilize community and state resources for youth suicide prevention/intervention Our schools have the training necessary to work with parents and students in the aftermath of a youth suicide in the school community I believe our schools have comprehensive plans for addressing suicide prevention and postvention I believe that youth suicide is a problem in Texas that should be addressed I believe that schools play a significant role in educating staff, students, and parents on suicide prevention I feel our schools need more information and/or guidance on suicide prevention/intervention strategies. If you have been trained in suicide prevention, select the training from the following list: ASK about Suicide to Save a Life ASIST Applied Suicide Intervention Skills Training QPR Question Persuade Respond Mental Health First Aid At-Risk for Texas Educators, Elementary, Middle School or High School version Other: How frequently does your organization/agency provide suicide prevention information to schools? Which school personnel should receive training and what should be the focus? What resources or programs outside the school district do you recommend schools take more advantage of? Is there anything else you would like to add?

76 76 AppendixD TexasStateAgenciesandNational/FederalAgenciesandOrganizations MentalHealthandSubstanceAbuseServices 909West45thStreetand 1100W.49thStreet Austin,TX78756 DSHSHealthServiceRegions\AlistingoftheDSHSPublicHealthServiceRegionsthatincludesheadquarter locations,regionalmedicaldirectorsanddeputydirectors,andlinkstotheirwebpages. HealthandSubstanceAbusedivisionmaintainsaneasytouselistingoflocalmentalhealthauthoritiesandtheir 24/7crisislines.Youareabletosearchbycounty,cityorzipcodetofindtheonenearestyou.Youcanreachthe TexasSuicidePreventionoffersanumberofvideos,onlineandin\persontrainingoptionsrelatedtosuicide prevention,includingthe ASK trainingprogram.inaddition,thewebsitehighlightsanumberofbestpractice designatedtrainingoptionsavailableintexasandnationally.thiswebsiteismaintainedbymentalhealth AmericaofTexaswithinputfromtheTexasSuicidePreventionCouncilandtheTexasDepartmentofState HealthServices.YoucangetmoreresourcesonsuicidepreventionandsubscribetoaTexasSuicidePrevention PreventionandPostventiontoolkitavailableatthiswebsitealsogivesbackgroundontheTexasSuicide PreventionCouncilandlettersofagreementforlocal,college,military/veterancoalitionsorofficial representativesofstatewideorganizationstojoin.

77 77 Foundedin1935,MentalHealthAmericaofTexasisthestate slargestandlongest\servingmentalhealth educationandadvocacygroup.today,theirreachextendsbeyondtheiroriginalintentbyservingtopromote mentalhealth,workingtopreventmentalillnessandsubstanceabuse,andensuringalltexanshaveaccessto effective,culturallycompetentmentalhealthcare.inaddition,mentalhealthamericaoftexashasservedas thefacilitatorandfiscalagentforthetexassuicidepreventioncouncilandhashelpedthetexassuicide PreventionCouncilcreateandupdatetheTexasStatePlanforSuicidePrevention. Throughawiderangeofcollaborativeefforts,MentalHealthAmericaofTexasstrivestoprovideconsumers, mentalhealthprofessionals,firstrespondersandpublicpolicyleaderswiththemostcomprehensive,evidence\ basedsourcesofinformationrelatedtomentalhealth,substanceabuse,mentalillnessandsuicideprevention. TheTexasSchoolSafetyCenter(TxSSC)isanofficialuniversity\levelresearchcenteratTexasStateUniversity,a memberofthetexasstateuniversitysystem.thetxsscistaskedinchapter37ofthetexaseducationcode withkeyschoolsafetyinitiativesandmandatesthatincludeplanning,training,anddrilling,andinthe Governor shomelandsecuritystrategicplan.towardthisaim,thetxsscservesasthecentrallocationforthe disseminationofsafetyandsecurityinformation,includingresearch,training,andtechnicalassistancefork\12 schoolsandjuniorcollegesthroughoutthestateoftexas.specifically,thecenterprovidesuniversaland regionalservicestostudents,educators,administrators,campus\basedlawenforcement,community

78 78 organizations,stateagencies,andcolleges/universitiesinanefforttoincreasesafetyandsecurityintexas schools.inaddition,thetxsscalsobuildspartnershipsamongyouth,adults,schools,lawenforcementofficers, andcommunitystakeholderstoreducetheimpactoftobaccoonalltexansthroughprevention,trainingand enforcementinitiatives. NationalOrganizationsandFederalAgencies Manynationalorganizationsandfederalagenciesareinvolvedinsuicideprevention.Theyarevaluablesources ofinformation,andsomeofferfundingopportunities,technicalassistance,andtrainingsaswellasresourcesfor professionalsandthegeneralpublic. SuicidePreventionResourceCenter(SPRC) ThisSAMHSA\funded,nationalcenterhelpsstrengthenthesuicidepreventioneffortsofstates,tribes, communities,andcollegecampuses,aswellasorganizationsthatservepopulationswithhighsuiciderates.it providestechnicalassistance,training,resourcematerials,aweeklynewsletter,thesprconlinelibrary,and customizedinformationthatoutlinestherolesofvariousprofessionalsinpreventingsuicide.sprcproducesthe BestPracticesRegistry(BPR)forSuicidePrevention.SPRCalsohelpsbuildpartnershipsbetweenhealthand mentalhealthprovidersandprovidesorganizationalsupportforthenationalactionallianceforsuicide Prevention. AmericanAssociationofSuicidology(AAS)

79 79 AASisanon\profitorganizationthatpromotesresearch,publicawarenessprograms,publiceducation,and trainingforprofessionalsandvolunteers.itservesasanationalclearinghouseforinformationonsuicide, publishinganddisseminatingstatisticsandsuicidepreventionresources.aasalsohostsnationalannual conferencesforprofessionalsandsurvivors. AmericanFoundationforSuicidePrevention(AFSP) AFSPisanon\profitorganizationthatfundsresearchtoadvanceunderstandingofsuicideandsuicide prevention.italsoofferseducationalprogramsandresourcesforprofessionals,survivorsofsuicideloss,andthe publicaboutsuicideprevention.afsp spublicpolicydivision,spanusa,promotesandkeepstrackofpolicies andlegislationrelatedtosuicideprevention.afsp schaptersorganizesuicideawarenesseventsandbuild connectionsamonglocalresourcesandservicesaddressingsuicideprevention. NationalSuicidePreventionLifeline TheLifelineprovidesimmediateassistance24hoursaday,7daysaweektoindividualsinsuicidalcrisisby connectingthemtothenearestavailablesuicidepreventionandmentalhealthserviceproviderthroughatoll\ freetelephonenumber:1\800\273\talk(8255).thelifelinealsoprovidesinformationalmaterials,suchas brochures,walletcards,posters,andbookletsfeaturingthelifelinenumber.

80 80 U.S.SubstanceAbuseandMentalHealthServicesAdministration(SAMHSA) SAMHSAfundsandsupportstheNationalLifelineandSPRC,andmanagestheGarrettLeeSmithgrantprogram, whichfundsstate,territorial,andtribalprogramstopreventsuicideamongyouth.ithasdevelopedthenational RegistryofEvidence\basedProgramsandPractices(NREPP),whichreviewsevidenceofeffectivenessfor preventionprogramsontopicsrelatedtobehavioralhealth,includingsuicide.samhsaalsosponsorsseveral preventioncampaigns. NationalInstituteofMentalHealth(NIMH) TheNIMHwebsitehasasectiononsuicidepreventionthatincludesinformationandresourcesusefulfora varietyofaudiences,includingresearchers,healthcareprofessionals,andconsumers.nimhalsoconducts researchonsuicideandsuicideprevention. NationalCenterforInjuryPreventionandControl(NCIPC) NCIPC,locatedattheU.S.CentersforDiseaseControlandPrevention,isavaluablesourceofinformation, resources,andstatisticsaboutsuicide,suiciderisk,andsuicideprevention.itincludeslinkstoanumberof statisticaldatabases,includingwisqars(web\basedinjurystatisticsqueryandreportingsystem),yrbss (YouthRiskBehaviorSurveillanceSystem),NationalViolentDeathReportingSystem,andNationalVitalStatistics System.

81 81 IndianHealthService(IHS) IHS CommunitySuicidePreventionwebsiteprovidesAmericanIndianandAlaskaNativecommunitieswith culturallyappropriateinformationaboutbestandpromisingpractices,trainingopportunities,ongoingactivities, potentialpartnerships,andotherinformationregardingsuicidepreventionandintervention.thisinformation canhelpcommunitiesandschoolscreateoradaptsuicidepreventionprogramsthataretailoredtotheirneeds. SuicideAwarenessVoicesofEducation(SAVE) SAVEisanon\profitorganizationwhosemissionistopreventsuicidethroughpublicawarenessandeducation, reducestigma,andserveasaresourcetopeopleaffectedbysuicide.itspreventionandeducationprogramsare designedtoincreaseknowledgeaboutdepression,suicide,andaccessingcommunityresources,andtoincrease understandinganduseofinterventionskillstohelppreventsuicide. Children ssafetynetwork(csn) CSNisanationalresourcecenterforinjuryandviolenceprevention,includingsuicideprevention.CSNprovides technicalassistanceoninjurypreventionplanning,programs,andbestpractices;analyzesandinterpretsinjury data;partnerswithnationalorganizationsandfederalagenciestopromotechildandadolescenthealthand

82 82 safety;disseminatesinjurypreventionresearch;conductstrainingsandpresentations;andproduces publications. InjuryControlResearchCenterforSuicidePrevention(ICRCSS) ThisCDC\fundedinjurycontrolresearchcenterpromotesapublichealthapproachtosuicidepreventionthrough acollaborativeprocessofresearch,outreach,andeducation.itsgoalistodrawsuicidepreventiondirectlyinto thedomainofpublichealthandinjuryprevention,andlinkittocomplementaryapproachesinmentalhealth. Thecenterconductsresearchprojects,providestechnicalassistance,andorganizesconferencecalls,webinars, andanannualresearchtraininginstituteforthoseworkinginthesuicidepreventionfieldorengagedinsuicide\ relatedresearch. TheJasonFoundation,Inc.(JFI),anon\profit501c3,isdedicatedtothepreventionofthe SilentEpidemic of youthsuicidethrougheducationalandawarenessprogramsthatequipyoungpeople,educators/youthworkers andparentswiththetoolsandresourcestohelpidentifyandassistat\riskyouth.theyprovideacurriculumunit forstudentsandinformationalseminarsforteachersandparents.

83 83 AppendixE SPRCresourcesspecifictoyouthsuicideprevention/intervention/postvention SPRC(SuicidePreventionResourceCenter)providescustomizedinformationsheetsonsuicidepreventiontasks thatcanhelpprofessionalsinavarietyofrolestakeactiontopreventsuicide.herearesomeoftheresources thatspecificallyaddresstheschoolcommunityandareavailablefreeofchargeforyoutoreproduceand distribute;theroleofhighschoolteachersinpreventingsuicide TheRoleofHighSchoolMentalHealthProvidersinPreventingSuicide TheRoleofManagersinPreventingSuicide TheRoleofCo\WorkersinPreventingSuicide TheRoleofFaithCommunityLeadersinPreventingSuicide TheRoleofEmergencyMedicalServicesProvidersinPreventingSuicide TheRoleofLawEnforcementOfficersinPreventingSuicide Additionally,SPRChasayouthsuicidepreventiontrainingprogramthatincludesthefollowing; PreventingSuicide:AToolkitforHighSchools AfteraSuicide:AToolkitforSchools TheRoleofHighSchoolTeachersinPreventingSuicide TheRoleofHighSchoolMentalHealthProvidersinPreventingSuicide SuicidePreventionamongLesbian,Gay,Bisexual,andTransgenderYouth:ExpandingtheFrameand BroadeningOurApproaches:AResearchtoPracticeWebinar SuicidePreventionamongLGBTYouth:AWorkshopforProfessionalsWhoServeYouth OtherKeyResourcesfromOurLibrary

84 84 AppendixF InformationaboutSPRC snationalregistryofevidencesbasedprogramsandpractices. HowdoestheBPRincorporatethebestavailableresearchevidence? 1. BylistingevidenceSbasedsuicideinterventionsinSectionI.Thesourcefortheseinterventionsis SAMHSA'sNationalRegistryofEvidence\BasedProgramsandPractices(NREPP).Atminimum,allSection Iprogramsmustdemonstrateoneormorepositiveoutcomesrelevanttosuicidepreventiontoqualify fornreppreview.formoreinformation,seesectioni. 2. BybasingSectionIIandIIIreviewcriteriaoncurrentresearchandexpertise.ThedesignoftheBPR recognizesthatthesuicidepreventionfieldcanbenefitfromdisseminationofotherinformationin additiontoevaluatedprograms.theseincludeguidanceandrecommendationscreatedbyexpertsor consensusprocesses;andprograms,practices,andpoliciesthathaveundergonereviewtoassess whetherthecontentisaccurate,safe,likelytomeetspecifiedobjectives,andconsistentwithstandards ofprogramdesign. WhiletheBPRisausefulresourceforidentifyingprogramsandmaterials,selectingprogramsfromthe BPRisnotasubstituteforengagingineffectiveplanningprocesses)and)adhering)to)principles)of) effective)prevention.inotherwords,plannersshouldnotsimply"pickfromthelist,"butrathershould engageinasystematicplanningeffortandusethebprtohelpidentifyprogramsormaterialsthat addresslocalneedsandcircumstances.thenextsectionprovidesrecommendationsforusingthebpr withinthecontextofaneffectiveplanningprocess. HowcanIusetheBPRasaresourcefordevelopingeffectivesuicidepreventionprograms? (1)Engageinasystematicplanningprocess.ProgramplannersareencouragedtousetheBPRinthecontextof asystematicstrategicplanningprocess(thisexampleisbroadlyapplicabletocommunityplanning,althoughthe surroundingtextdescribesitsuseinacampuscontext).inthistypeofplanningprocess,multiplestakeholders typicallyworktogethertoassesslocalneeds,assets,andreadiness,setgoals,chooseorcreateinterventions thatmatchlocalproblemsandcircumstances,andevaluateeffortsandusetheresultsforimprovement. BPRlistingscanbeusedinseveralwaysduringthisplanningprocess.Forexample,plannerscansearchSectionI forevidence\basedsuicidepreventionprogramsthatmatchtheiridentifiedneeds,resources,andaudiences. SincetheBPRisnotacomprehensivelistofallevaluatedprograms,plannersareencouragedtoconducta literaturesearchaswell.ifnoevidence\basedprogramsexistthatmatchlocalneeds,plannersmayconsider adaptingoneoftheprogramslistedinsectioniorfoundintheliterature,makingrevisionsbasedontheory,

85 85 localassessment,andanunderstandingoftheaudience,whileretainingkeyinterventioningredients.resources about programfidelityandadaptation canbehelpfulinguidingthesetypesofprogramrevisions.adetailed synthesisoftheliteratureonfactorsthatinfluenceprogramimplementationcanalsoinformdecisionsabout localimplementationofevidence\basedprograms. Whethercreatinganewprogramorusinganexistingone,plannersshouldconsultSectionIIoftheBPRto determinewhetherthereareexpertorconsensusguidelinesrelevanttotheirplanningefforts. ProgramplannerscanconsultSectionIIItofindexamplesofresourcematerials,trainings,protocolsandpolicies forsuicidepreventionthatincludeaccurateinformation,arelikelytomeetprogramobjectives,followsafe messagingguidelines,andadheretorecommendationsforsuicidepreventionprogramdesign.whilethe programsandmaterialsinsectioniiihavenotbeenreviewedforeffectiveness,theyareexamplesofprogram contentthatmeetspecifiedstandardsandmaybesuitableforaddressingidentifiedprogramneeds.finally,by applyingthesectioniiicontentstandardstoprogramstheycreateorimplementpreventionprofessionalscan increasethelikelihoodthattheirprogramsandpracticeswillbeeffective. (2)Followprinciplesofeffectivepreventionpractice.Suicidepreventionpractitionerscanbenefitfromthe largebodyofresearchaboutwhatworksinthepreventionofotherhealthandsafetyproblemssuchasinjury andsubstanceabuse.forexample, Onereviewofpreventioneffortsacrossfourareas(substanceabuse,riskysexualbehavior,school failure,andjuveniledelinquencyandviolence)identifiedninecharacteristicsthatwereconsistently associatedwitheffectivepreventionprograms:programswerecomprehensive,includedvaried teachingmethods,providedsufficientdosage,weretheorydriven,providedopportunitiesfor positiverelationships,wereappropriatelytimed,weresocioculturalrelevant,includedoutcome evaluation,andinvolvedwell\trainedstaff. Recognizingthatbestpracticeprinciplesexistforspecifickindsofefforts,thissummaryprovides principlesofeffectivesubstanceabusepreventiondividedintosixdomains:individual,family,peer, School,Community,andSociety/Environmental. Thebroaderpublichealthliteraturealsoemphasizestheneedtoundertakeenvironmentaland systemschangeeffortsthatcomplementandworkinsyncwithindividually\focusedinterventions. InjurypreventionexpressesthisconceptthroughtheThreeEsofPrevention:Education, Enforcement,andEnvironment.

86 86 Onceinterventionsareselectedtomeetlocalneeds,plannersareencouragedtovisitSectionIIoftheBPRand toconductatargetedsearchofthebroaderliteraturetodeterminewhethertherearescience\basedorbest practiceprinciplesdocumentedforthattypeofprogram,policy,orservice(e.g.,gatekeepertraining,media campaigns,professionaltrainingprograms,policydevelopment.) (3)Conductprogramevaluationanddisseminatethefindings.Plannersareencouragedtobuildevaluationinto theireffortstoassesstheeffectivenessoftheirprogramsandbuildtheknowledgebaseinthefield. Formoreinformationabouteffectiveplanningandevaluation,see AboutSuicidePrevention AStrategicPlanningApproachtoSuicidePrevention(freeonlineworkshop) LocatingandUnderstandingDataforSuicidePrevention(freeonlineworkshop) Colleges&Universities:DevelopingaCampusProgram AmericanIndian/AlaskaNativeSuicidePrevention:BasicsofGettingStarted EvaluationResourcesintheSPRCLibrary PlanningResourcesintheSPRCLibrary

87 87 AppendixG SuicidePreventionTrainingResourcesListedinTexasToolkit ListedinComingTogethertoCare:ASuicidePreventionandPostventionToolkitforTexasCommunities (availableonlineattexassuicideprevention.org) Schoolsshouldchecktomakesuretrainingprogramisbasedonbestpractices.Note:notallofthe programslistedbelowareinthesprcbestpracticeslistalthoughtheyarebasedonbestpractices. TheSuicidePreventionBestPracticesRegistrycanbefoundathttp:// TheTexasSuicidePreventionCouncilurgesschoolstoutilizebestpracticebasedprogramslistedintheSPRC BestPracticesRegistrywhichcanbefoundatwebsiteabove.Inaddition,recentlypassedTexasLegislation requiresschooldistrictstaffdevelopmentforallnewdistrictandopenenrollmentcharterschooleducators mustincludesuicidepreventiontrainingannuallyaspartofthedistrictorcharterschool snewemployee orientation, and must also be provided to existing school district and open\enrollment charter school educatorsonascheduleadoptedinrulesbythetexaseducationagency(tea).thetrainingmustuseabest practice\basedprogram(s)recommendedbythedepartmentofstatehealthservicesincoordinationwith TEA. AdolescentWellness ASK(AboutSuicidetosaveaLife) AtSRiskForElementaryEducators (TexasStateVersion) Schooltrainingmanualandtoolkittopromoteawarenessandearlyrecognition ofadolescentdepression,writtenbymcleanhospitalandchildren shospitalof Boston.Theyofferprintmaterials,curriculum,workshopsandparentresources. MentalHealthAmericaofTexascoordinatesa2\hoursuicideprevention gatekeeperworkshopinselectedcommunitiesandschools.somecommunities havetrainersavailable. Ifyouwouldlikeapresentationforyourorganizationorschool, areavailableinyourarea.ifyouwouldliketolearnhowtoidentifyand appropriatelyrespondtosomeonewhoisfeelingsuicidala60\minutevideois availableathttp:// Freeone\hour,interactiveonlinesuicide\preventiontrainingforelementary educatorsandteachers\in\trainingintexas.

88 88 AtSRiskForTexasPublicMiddle SchoolEducators (TexasStateVersion) Freeone\hour,interactiveonlinesuicide\preventiontrainingforpublicmiddle\ schooleducatorsandteachers\in\trainingintexas. AtSRiskForHighSchoolEducators (TexasStateVersion) Freeone\hour,interactiveonlinesuicide\preventiontrainingforpublichigh schooleducatorsandteachers\in\trainingintexas AtSRiskForCollegeStudents (TexasStateVersion) Freeone\hour,interactiveonlinesuicide\preventiontrainingforcollege studentsintexas. AtSRiskForCollegeFaculty (TexasStateVersion) Freeone\hour,interactiveonlinesuicide\preventiontrainingforcollegefaculty intexas. CALM(CounselingonAccessto LethalMeans) ns\matter/ Trainingtoconductfirearmsafetycounselingandtoreduceaccesstofirearms, medicationsandotherlethalmeans. Empathos Empathos missionistoenableprofessionalstobemoreeffective,sothat peopleatriskforsuicidehavebettersolutions.newvideotraining Managing SuicideRiskCollaboratively:TheCAMSFramework. GlendonAssociates TheGlendonstaffconductseducationalandtrainingseminarsandworkshops. Theseworkshopsarepresentedinaninteractivestyle,intermixinglecture, discussion,andvideodemonstrations.theyaredesignedtogiveparticipants theopportunitytodiscussthetheoryandmethodspresentedandtheir applicationtoclinicalpractice.glendonworkshopshavebeenconductedat universities,mentalhealthfacilitiesandhospitalsthroughoutthecountry. JasonFoundation Aresourceforstudents,parents,educators,andcommunityworkers.Program createdanddevelopedbyaparentofchildwhodiedbysuicide. Kognito Developerofonlinerole\playingsimulations,whereusersbuildinterpersonal skillstomanagechallengingconversationsintheareaofhealthandmental health,includingsuicideprevention.

89 89 LivingWorks DevelopedtheAppliedSuicideInterventionSkillsTraining(ASIST)workshop (formerlythesuicideinterventionworkshop),aworkshopforcaregiverswho wanttofeelmorecomfortable,confidentandcompetentinhelpingtoprevent theimmediateriskofsuicide.othertrainingsarealsoavailable. NationalSuicidePrevention ResourceCenter Provideseducationalresourcestohelppublicofficials,serviceproviders,and community\basedcoalitionsdevelopeffectivesuicidepreventionprogramsand policies.alsoprovidesaresourcedatabasecomposedofsuicideprevention articlesandinformation. QPRInstitute Over1,000trainersofsuicidepreventionthroughouttheUnitedStates.Offersa varietyoftrainingopportunitiesandmaterials(includingself\studycourses)to improvesuicideriskdetection,assessmentandmanagementskills.alsooffers suicideriskmanagementinventoriesandprotocolsavailableforthoseworking withadultsofallages,thoseworkingwithchildrenandadolescentsandthose treatingsuicidalpeopleininpatientandresidentialsettings.trainingprograms arealsoavailableforthosewhoworkwithsurvivorsofsuicideandother trauma. SuicideInformationandEducation Center Containssuicideinformationandeducationalresourcesaswellassuicide preventiontrainingprograms.supportsdownloadablepamphlets,cardsand informationkitsonavarietyofsubjects(someresourcesincludeacost). TrainingInstituteforSuicide AssessmentandClinical Interviewing m Offerstrainingsandcoursesonsuicideassessment,suicideprevention,violence assessment,riskassessment,crisisintervention,clinicalinterviewing,diagnostic interviewing,andmethodsforengagingclientsandtransformingresistance. YellowRibbonYouthSuicide PreventionProgram TheYellowRibbonYouthSuicidePreventionProgramisdedicatedtoincreasing youthawareness,reducingstigmaassociatedwithaskingforhelp,and preventingyouthsuicidethroughpeergroupawareness. SuicideInformationandEducation Center Containssuicideinformationandeducationalresourcesaswellassuicide preventiontrainingprograms.supportsdownloadablepamphlets,cardsand informationkitsonavarietyofsubjects(someresourcesincludeacost).

90 90 YouthSuicidePrevention EducationProgram WashingtonState sprogramofawareness,education,prevention,intervention, postvention,communitybuilding,collaboration,replication&sustainability.be\ A\LinkGatekeeperPresentationsandTrainingsareavailabletoyouthand adults,separatelyandjointly.curriculumsaredesignedforprofessionalandlay people,ems/fireandlawenforcement.

91 91 APPENDIXH TRAINING VIDEOS & LESSON GUIDES: ASK About Suicide to Save A Life (1 hour) Suicide Prevention Resources in Texas (11 mins.) Find Additional Info on Apps itunes or Google Play Texas Suicide Safer Home App The Suicide Safer Home App offers practical tips for parents and caregivers by securing access to lethal means of death by suicide. First responders, health, and mental health professionals can use this app for educational and reference materials. To download app, search suicide safer home. Virtual Hope Box App Enjoy puzzles? Then, download this Hope Box and find compartments for fun and inspirational mental health messages and activities that promote hope. The Hope Box, available on iphone and Android phones, is not a substitute for professional help. ASK About Suicide App ASK about Suicide to Save a Life app for mobile devices can help save a life by providing information about suicide warning signs and how to ask about suicide. Crisis hotlines include National Lifeline, To download app search suicide prevention. Free At-Risk True Stories of Online Training Hope and Help Public Schools (Videos) Duis Sed Sapien & Colleges Nunc Et Orci A series of short and inspirational Morbi Posuere Mental Health America of Texas Mhatexas.org Sign Up for Our Newsletter: TexasSuicidePrevention.org At-Risk interactive training simulations for educators in elementary, middle, high school, colleges, and college students. Texas educators can access training at: videos featuring true stories of Texas high school and college students sharing personal messages of hope and help. Videos can be accessed at texassuicideprevention.org (Training tab) or Share Info & Get

92 92 AppendixI AdditionalSuggestedResourcesofotherresourcesthatmaybehelpful. AmericanAssociationofSuicidology(AAS); AAShasdevelopedacredentialingprogramonsuicidepreventionforschoolpersonnelandaGuide forschool\basedsuicidepreventionprogramarelistedonbpriiatsprcandprovidepractical recommendationsforthesafeandeffectiveimplementationofschool\basedsuicideprevention programs.topicsinmuchgreaterdetailthatareaddressedbytheguidelinesincludethefollowing: RequirementsforEffectivePreventionPrograms RequirementsforEffectiveImplementation RequirementsforInstitutionalization(RetentionOverTime)OfPrograms RequirementsforComprehensiveSchoolBasedSuicidePreventionProgram(s) Formoredetailsaccesshttp:// AmericanFoundationforSuicidePrevention: AFSP(AmericanFoundationforSuicidePrevention)hasprovidedseverallinksthatshareAFSP s federallegislativeandregulatorypriorities,whichtheafspboardofdirectorsupdateseach yearbasedonrecommendationsfromourpublicpolicycouncil programs priorities/american\indian\alaska\native\youth\suicide\prevention TheJedFoundation: KidCentralTN:

93 93 NAMI(NationalAllianceonMentalIllness); NationalAssociationofSchoolPsychologists: NationalCouncilforSuicidePrevention: NationalStrategyforSuicidePrevention(PDF): NovaSoutheasternUniversitySuicideandViolencePreventionOffice: SamaritansUSA: SuicideAwarenessVoicesofEducation(SAVE): TennesseeSuicidePreventionNetwork: TheTrevorProject: YellowRibbonSuicidePreventionProgram:

94 94 AbouttheAuthors ScottPoland,Ed.D. ScottPolandiscurrentlyaProfessoratCPSandtheCo\DirectoroftheSuicideandViolence PreventionOfficeatNovaSoutheasternUniversityinFortLauderdale. Iworkedintheschoolsasapsychologistoradirectorfor26yearsandamstillveryinvolvedin schoolcrisisresponseandconsultationandprovidedonsiteassistanceinaseveraltexasschool districtsrecently.iamasurvivorofthesuicideofmyfather,andourfamilyisanexampleofonethat neverbelievedasuicidecouldhappen.ibecamededicatedtosuicidepreventionafterbeingpromoted tothedirectorofpsychologicalservicesincypress\fairbanksisdandbeingfacedwiththesuicidesof severalstudents.thesuperintendentaskedmein1982whatiwasgoingtodoaboutthesesuicides.i answeredthatididnotknowbutfiguringouthowtopreventyouthsuicidehasbeenmyhighest professionalpriorityeversince,andihavepresentedmorethan1000timesonthetopicofschool crisisandsuicideintervention.iamalicensedpsychologistandaninternationallyrecognizedexperton youthsuicide,andschoolcrisisandhaveauthoredorco\authoredfivebooksonthesubject.iama pastpresidentofthenationalassociationofschoolpsychologistsandapastpreventiondivision DirectoroftheAmericanAssociationofSuicidology.Ihavetestifiedaboutthementalhealthneedsof childrenbeforetheu.s.congressonfouroccasionsandhavepersonallyassistedschoolcommunities after16schoolshootings,actsofterrorism,naturaldisastersandnumeroussuicideclusters. DonnaPoland,Ph.D. Ihavebeenaprofessionaleducatorfor37yearsofwhich27yearswereinpublicschoolsinthe stateoftexaswhereeverythingisbigimaginemysurprise,asafirstyearteacher,whenidiscovered thatmymiddleschoolclassesaveraged30+studentsandihadsixclasseseachdayiveryquickly discoveredthatineededtogettoknowmystudentsandbuildarespectfulandnurturingenvironment beforeicouldevenconsiderteachingthecurriculum.havingthatvitalconnectionwitheachstudent wasthereasoniwalkedjoyfullyintothebuildingeveryday.after17yearsintheclassroom,ibegan myadministrativejourneyasadirectorofinstruction,anat\riskcoordinator,anassociateprincipal, andfinallyaprincipal.immediatelyupontakingaleadershiprole,iwasfacedwiththetragedyofa scholarathletetakinghislifebysuicidejustdaysbeforehewasduetoenter9 th grade.iwouldliketo sayitwastheonlyoneiexperienced.unfortunately,everyyearresultedinworkingwithparents,staff,

95 95 andchildrenintheaftermathofadeathbysuicideoranaccidentaldeath.thenexttenyears(ata smallprivateschoolthatiscollegepreparatoryinflorida)ihavecontinuedtoneedtheskillsfor developingprograms,educatingstaff,andworkingwithparentsregardingthesignsofdepressionand suicide.afterexperiencingadeathbysuicide,especiallyofayoungperson,oneneverforgetsthe detailsofalifeendedtoosoonandthehauntingquestionsof;whatdidinotsee,whatcouldihave done?ihopetheinformationcontainedinthisreportwillhelpyouinyourworkwithouryoung people.

96 96 AbouttheCollaboratingOrganizations TexasDepartmentofStateHealthServices Followingthemergerofmultiplestateagencies,theTexasDepartmentofStateHealthServices(DSHS)was formedin2003andtooktheleadforsuicidepreventionintexasbyrecognizingsuicidepreventionasapublic healthproblem.currently,texasiscommittedtoadvancingthemissionandworkofthenationalactionalliance forsuicidepreventionanditsstrategytoattainazerosuicideoutcomeforthestate.tothatend,thetexas DepartmentofStateHealthServicesisworkingtobringacaresystemthatembracesagoalofzerosuicidesto Texas.DSHSisbuildinganinfrastructurethroughoutthecommunitymentalhealthsystemwherethereisa trainedandskilledworkforcethathasthecapacityandconfidencetointerveneinasuicidalsituation. Furthermore,DSHSisworkingtoensurethattheskillsandtoolsnecessarytoassesssuicideriskandtheability tousebestpracticesandevidence\basedstrategiesforsuicidecareareinplacethroughouttexas.by collaboratingatthelocal,state,andnationallevels,dshsisworkingtomakesurethatthecorecapabilitiesare inplacetosetuptreatmentplansthatsupporteachpersonfortheeliminationofsuicidality.inatrulysuicide safecaresite,suchagencieswillalsobesupportedbyqualitypoliciesandproceduresaboutsuicidecarewitha systemforcontinuousimprovement. Texashascreatedastatewidecomprehensivesuicidesafecaresystem,Texas SuicideSafeCare:ZeroSuicidesin Texas(ZEST).Theinitiative,fundedbyathree\yearSAMHSAcooperativeagreementawardedtotheTexas DepartmentofStateHealthServices(DSHS),isaimedatimprovingaccesstomentalhealthservicesandreducing suicidesamongyouth,ages10to24,atriskofsuicide.inpartnershipwiththeuniversityoftexasandmental HealthAmericaofTexas,theprojectwillfocusonenhancementstotheTexaspublicmentalhealthsystemto improveservicedeliveryforchildren,youth,andyoungadultswithseriousemotionaldisturbancesorsevereor persistentmentalillness.thissuicidesaferschoolsreportisafirststepatlookingathowsomeofthesuicide SafeCareconceptscanbeexpandedandimplementedinTexasschools.JennaHeise,SuicidePrevention CoordinatorforthestateistheprimaryDSHScontributortothisreport. Additionalinformationandresourcescanbefoundat:

97 97 MentalHealthAmericaofTexas MentalHealthAmericaofTexashaspartneredwiththeTexasDepartmentofStateHealthServicesandit s predecessorstateagenciesonyouthsuicidepreventionstatewideprogramssince2005whentexaswasfirst awardedagarrettleesmithyouthsuicidepreventiongrant.itcontinuesasapartnerinthetexasyouth SuicidePreventionProjectandtheZeroSuicideTexasProgramwhichprovidespublicawareness,outreachand traininginsuicideprevention.mentalhealthamericaoftexasalsoservesasthefacilitatorandfiscalagentfor thetexassuicidepreventioncouncilwhichischargedwiththedevelopmentandupdatingofthetexasstate PlanforSuicidePrevention.Asthestate slargestandlongest\servingmentalhealtheducationandadvocacy group,mentalhealthamericaoftexashasalsobeenaleadingforceforeffectiveadvocacyandpublicpolicyfor mentalhealthandsuicideprevention.merilykelleristhesuicidepreventionandpostventionconsultant/ contributortothisreportwithassistancefromconsultantmaryellennudd,andkimberlywilliams,suicide PreventionProgramManagerforMentalHealthAmericaofTexas.

98 98 References 2013NationalYRBSResultsforHighSchoolStudents;Dataretrievedfrom: AmericanAssociationofSuicidology.(2015). AmericanFoundationforSuicidePrevention.(2015). AmericanIndian/AlaskaNativeYouthSuicidePrevention\AmericanFoundationforSuicide Prevention.(2014)Retrievedfrom: policy/other\legislative\priorities/american\indian\alaska\native\youth\suicide\prevention AnnualDeaths/Aged15\24\CenterforDiseaseControl.(2015).Retrievedfrom: Armijov.WagonMoundSchoolDistrict,159F.3d1253(10 th Cir.1998). Arseneault,L.,Bowes,L.,&Shakoors.(2010)Bullyingvictimizationinyouthsandmentalproblems. PsychologicalMedicine,40,(pp717\729). Beautrais,A.,Joyce,P.,&Mulder,R.(1996)RiskFactorsforSeriousSuicideAttemptsAmongYouths Aged13through24Years.TheAmericanAcademyofChildandAdolescentPsychiatry,35,(pp1174\ 1182). Bender,A.,Rosenkrans,G.&andCraneC.(1999)LearningDisabilityQuarterly,vol.;/22,2:((pp143\ 156) Berman,A.L.,Jobes,D.A.,&Silverman,M.M.(2006).AdolescentSuicide:AssessmentandIntervention (2 nd ed.)washington,d.c.:americanpsychologicalassociation. CentersforDiseaseControlandPrevention.(2014).Suicideprevention.Retrievedfrom: ChildTrends.(2014).Teenhomicide,suicide,andfirearmdeaths.Retrievedfrom: ChildhoodInjuriesandViolence.(2014).Retrievedfrom: CommonMythsaboutYouthSuicide.(2014).Retrievedfrom: CopingwithSuicideLoss.(2013).Retrievedfrom: loss/education\training Covey,S.(2008).TheLeaderinMe:HowSchoolsandParentsAroundtheWorldareInspiring Greatness,OneChildataTime.SaltLakeCity:Franklin\Covey. Doev.CovingtonCountySchoolDistrict,675F.3d849(5 th Cir.2012). Erbacher,T.,Singer,J.,Poland,S.(2015)SuicideinSchools:APractitioner sguidetomulti\level Prevention,Assessment,Intervention,andPostvention.NewYork:Routledge. Eiselv.BoardofEducationofMontgomeryCounty.324Md.376,597A.2d447(MdCt.App. 1991). Evans\Campbell,T.(2008).HistoricalTraumainAmericanIndian/NativeAmericanCommunities:A

99 99 multi\levelframeworkforexploringimpactsonindividuals,families,andcommunities.journalof InterpersonalViolence.23(2),316\338. Evenson,K.(2012,October3).Bullyingsuicidelawsuitsettled.TheExaminer.Retrievedfrom: FactSheetsRelatedtoSuicide\TexasSuicidePrevention.(2015).Retrievedfrom: FatalInjuryReports\CenterforDiseaseControl.(2015).Retrievedfrom: Fowlerv.Szostek,905S.W.2d336(Tex.App. Houston[1 st Dist.]1995. Fuentes,F.(2011).LockdownHigh:WhentheSchoolhouseBecomesaJailhouse.NewYork:Verso. Fuller\Thomson,E.,Rotman,S.(April,2012).PhysicalAbuseMayRaiseRiskofSuicidalThoughts, JournalofSuicideandLife\ThreateningBehavior,Retrievedfrom: GarrettLeeSmithMemorialActPrograms:AmericanFoundationforSuicidePrevention.(2015). Retrievedfrom: Goldstein,T.,Bridge,J.&Brent,D.(2008).Sleepdisturbancesprecedingcompletedsuicidesin adolescents.journalofconsultingandclinicalpsychology,76,(1)84\91. Gould,M.&Kramer,R.A.(2011).Youthsuicideprevention.Suicide&Life ThreateningBehavior,31. 6\31. Hamilton,E.,(2013).AReviewofCulturalDisparitiesRegardingSuicidalBehaviorinAtRisk Populations.UndergraduateJournalofPsychologyBerkeley,6,(pp25\43). Hinduja,S.&Patchin,J.W.(2013).SocialInfluencesonCyberbullyingBehaviorsAmongMiddleand HighSchoolStudents.JournalofYouthandAdolescence,42(5),(pp711\722). HowtoHelpSomeoneWhoisThinkingAboutSuicide\AmericanFoundationforSuicidePrevention. (2015).Retrievedfrom: priorities/american\indian\alaska\native\youth\suicide\prevention Idan,O.,Margalit,M.Socio\emotionalSelf\Perceptions,FamilyClimate,andHopefulThinkingAmong StudentsWithLearningDisabilitiesandTypicallyAchievingStudentsFromtheSameClassesJournalof LearningDisabilities,March/April201447:136\152,firstpublishedonMarch21,2012 doi: / InjuryControlResearchCenterforSuicidePrevention.(2014).Retrievedfrom: Joiner,T.,(2005).WhyPeopleDiebySuicide.Cambridge:HarvardUniversityPress. Joiner,T.,(2011).MythsaboutSuicide.Cambridge:HarvardUniversityPress. Kessel,S.,SchneiderS,O'DonnellL.,StueveA,&CoulterR.(2012)AmericanJournalofPublicHealth, 102(1):(pp171\177). Lieberman,R.,Poland,S.,&Cassel,R.(2008).SuicideInterventioninSchools.InA.Thomas&P. Harrison(Eds.),BestPracticesinSchoolPsychologyV(pp.1457\1473).Bethesda,MD:National

100 100 AssociationofSchoolPsychologists. Lieberman,R.,Poland,S.,Kornfeld,C.(2014).SuicideInterventioninSchools:InA.Thomas&P. Harrison(Eds.),BestPracticesinSchoolPsychologyVI(pp.273\288).Bethesda,MD:National AssociationofSchoolPsychologists. Maresv.ShawneeMissionSchoolDistrict,No.06CV00160(2007). MentalHealthParity\AmericanFoundationforSuicidePrevention.(2014).Retrievedfrom: Miller,D.(2011).ChildandAdolescentSuicidalBehavior:School\BasedPrevention,Assessmentand Intervention.NewYork:GuilfordPress. MythsandFactsaboutSuicide.(2014)Retrievedfrom: NationalCenterforInjuryPreventionandControl,CentersforDiseaseControlandPrevention.(2014). WISQARSleadingcausesofnonfatalinjuryreports.Retrievedfrom: NativeAlaskacommunities:Amultilevelframeworkforexploringimpactsonindividuals,families,and communities.journalofinterpersonalviolence,23(3),316\338. Poland,S.&Chartrand,D.(2008).Suicidepreventionandschools.DistrictAdministration Retrievedfrom: Poland,S.&Lieberman,R.(2002).SuicideInterventioninSchools:InA.Thomas&J.Grimes(Eds.), BestPracticesinSchoolPsychologyIV(pp.1151\1167).Bethesda,MD:NationalAssociationofSchool Psychologists. Poland,S.(1989).SuicideInterventioninSchools.NewYork:GuilfordPress. Poland,S.(1995).BestPracticesinSuicideIntervention.InA.Thomas&J.Grimes(Eds.),BestPractices inschoolpsychologyiii(pp.155\166).bethesda,md:nationalassociationofschoolpsychologists. PolicyWebinarSeries\AmericanFoundationforSuicidePrevention.(2014).Retrievedfrom: Ribeiro,J.D.,Bodell,L.P.,Hames,J.L.,Hagan,C.R.,&Joiner,T.E.(2013).Anempiricallybasedapproach totheassessmentandmanagementofsuicidalbehaviorjournalofpsychotherapyintegration,23(3), doi: /a RolesinSuicidePrevention\SuicidePreventionResourceCenter.(2014).Retrievedfrom: Schmitz,W.,Allen,M.,Feldman,B.,Gutin,N.,Jahn,M.,Kleepsies,P.,Quinett,P.,&Simpson,S. (2012,).Preventingsuicidethroughimprovedtraininginsuicideriskassessmentandcare.Suicideand LifeThreateningBehavior42(3).pp.292\304. Shneidman,E.(1985).DefinitionofSuicide.NewYork:Wiley. Singer,J.,Slovak,K.(2011).SchoolSocialWorkers PerceptionofSuicidalBehavior.Childrenand Schools,33,(pp215\225).

101 101 SubstanceAbuseandMentalHealthServicesAdministration.(2014).Retrievedfrom: SuicidePreventionLifeline.(2015).Retrievedfrom: SuicidePrevention\NationalInstituteofMentalHealth.(2015).Retrievedfrom: SuicidePreventionResourceCenter.(2015).Retrievedfrom: SuicidePreventionVoicesinEducation.(2015).Retrievedfrom: SuicidePrevention/.(2015)IndianHealthService.(2014).Retrievedfrom: TheEstateofMontanaLanceetalv.Kyeretal,No.4:2011cv00032(E.D.Texas2011). Thompson,R.,Litrownik,A.J.,Isbell,P.,Everson,M.,English,D.,Dubowitz,H.etal(2012). Adverse experiencesandsuicidalideationinadolescence:exploringthelinkusingthelongscansamples. PsychologyofViolence(2):(pp211\225). U.S.SurgeonGeneralandtheNationalActionAllianceforSuicidePrevention.(2012).2012National StrategyforSuicidePrevention.Retrievedfrom: WorldWideHealthOrganizationResourceCenter.(2015).Retrievedfrom:, Witselletalv.TheSchoolBoardofHillsboroughCounty,No.8:11\cv\\00781(M.D.Florida 2011). Wykev.PolkCountySchoolBoard,137F.3d1292(11 th Cir.1997). YouthSuicideRates\CenterforDiseaseControl.(2015).Retrievedfrom: Zai,T.,Luca,B.,Strauss,G.,Tong,M.,Sakinofsky,K.,&KennedyM.(2012).TheNeurobiologicalBasis ofsuicide,crcpress.newyork:taylor\francis.

102 102 ANNOTATEDBIBLIOGRAPHY AfteraSuicide:AToolkitforSchools Thishandbookprovidesabroadconsensusregardingthebestwaystodealwithatragiclossinaschool communityandtopromoteacoordinatedcrisisresponseinordertoeffectivelymanagethesituation, provideopportunitiesforgriefsupport,maintainanenvironmentfocusedonnormaleducational activities,helpstudentscopewiththeirfeelings,andminimizetheriskofsuicidecontagion.stepby stepguidelinesareprovidedandtheoverallstrategythatalldeathsneedstobetreatedthesameas muchasispossible.sampleletterstosendtoparentsarealsoprovided. PreventingSuicide:AToolkitforSchools " ThisdocumentfromSAMHSAassistshighschoolsandschooldistrictsindesigningandimplementing strategiestopreventsuicideandpromotementalhealth.includedaretoolstoimplementamulti\ facetedsuicidepreventionprogramthatrespondstotheneedsandculturesofstudents. SuicideinSchools:APractitioner sguidetomultislevelprevention,assessment,interventionand PostventionbyTerriErbacher,JonathanSingerandScottPoland:NewYork:Routledge& Thisbookdistillsthebestcurrentknowledgeonchildandadolescentsuicidepreventioninto comprehensiveguidelinesforschool\basedpractitioners.theauthorsbasedonawealthofexperience providebest\practicerecommendationsfordevelopingschoolwidepreventionprograms,conducting riskassessments,andinterveningatdifferentlevelsofintensitywithstudentsatrisk.alsopresented arepostventionproceduresforrespondingeffectivelyifasuicidedoesoccur.legalandethicalissues arealsoaddressedindetail. LosAngelesCountyYouthSuicidePreventionProject

103 103 TheLosAngelesCountyYouthSuicidePreventionProject(YSPP)isajointeffortbetweentheLos AngelesCountyDepartmentofMentalHealth(LACDMH),theLosAngelesCountyOfficeofEducation (LACOE)CenterforDistanceandOnlineLearning(CDOL),andtheLosAngelesUnifiedSchoolDistrict (LAUSD).TheYSPPwebsitehasbeenexpresslydevelopedforthe80schooldistrictswithinLos AngelesCounty,toprovideadministrators,staff,parents,andstudentswiththemostup\to\date information,protocols,materialsandresourcesonthepreventionofyouthsuicide. NovaSoutheasternUniversity,SuicideandViolencePreventionOffice(SVP) TheSuicideandViolencePreventionofficereceivedaGLSgrantanddevelopedtrainingvideosonthe followingtopics:suicideawareness,suicideassessment,andsuicideprevention/postventionin SchoolsandCriticalIssuesinSelf\Injury.Thevideosareavailableatnocharge.SVPalsopublishesa quarterlynewsletterwithinterviewsfromexpertsinthefield.allvideosandthenewslettersare availableatwww.nova.edu/suicideprevention ========================================================================================= 2015MentalHealthAmericaofTexas PermissiontouseandreproducethisdocumentisgrantedbyMentalHealthAmericaofTexas.Werequestthat youletusknowifyouareplanningtouseordistributethisinformationandincludethecopyrightinformationif Thisreportwasdeveloped[inpart]underagrantnumberSM61468fromtheSubstanceAbuseandMental HealthServicesAdministration(SAMHSA),U.S.DepartmentofHealthandHumanServices(HHS)andtheTexas DepartmentofStateHealthServices(DSHS).Theviews,policies,andopinionsexpressedarethoseoftheauthors anddonotnecessarilyreflectthoseofsamhsa,hhsordshs.

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