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Suicide Prevention Policy Training

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Title: Suicide Prevention Policy Training


1
Suicide Prevention Policy Training
  • DJJDP 18 Identifying, Communicating, and
    Providing Prevention Services for Juveniles
    At-Risk of Committing Suicide
  • DJJDP 18.1 Suicide Attempts

2
7 Components of Suicide Prevention Program
  • Lindsay M. Hayes, National Center on Institutions
    and Alternatives, recommends 7 components for an
    effective suicide prevention program
  • Written policy,
  • Observation,
  • Safe housing,
  • Intake screening,
  • Training,
  • Mortality review, and
  • CPR certification.

3
COMPONENT 1WRITTEN POLICY
4
POLICY Identify Juveniles At-Risk of Committing
Suicide
  • Staff members shall utilize the following to
    identify juveniles at-risk of suicide
  • What they hear (a juveniles self report or
    report by other),
  • What they see (juveniles actions or behaviors),
    and
  • Screening and assessment tools.
  • REPORT IMMEDIATELY!!!

5
ACTIVITY
  • Myth or Reality???

6
Most suicidal youth want help.
  • REALITY
  • Most suicidal youth ask for help directly or
    indirectly. Formerly suicidal youth express
    gratitude for the help and support they received
    during their crisis.

7
Most suicide attempts happen without warning.
  • MYTH
  • Suicidal youths often give both verbal and
    non-verbal warning signs that may go unnoticed or
    unheeded by those around them. As caretakers for
    at risk youths, it is imperative that we have a
    ready understanding of suicidal warning signs.

8
Asking a youth about suicide may cause him/her
to attempt suicide.
  • MYTH
  • Not talking about suicide may prove deadly if the
    juvenile is already thinking about doing so.
    Most people considering suicide want to talk
    about how they feel and are relieved when someone
    recognizes their pain.

9
Suicide secrets or notes must be shared.
  • REALITY
  • Confidentiality cannot be maintained in the face
    of potential suicide or self-harm.

10
People who talk about suicide may commit
suicide.
  • REALITY
  • Seven out of ten suicide attempts or deaths are
    preceded by talk of suicide. This is often a
    plea for help.

11
Suicidal behavior is not just a way to get
attention.
  • REALITY
  • All suicidal threats must be taken seriously.
    Remember Suicidal gestures, self-harm or
    attempts that begin as manipulative behavior can
    just as well end in death.

12
Mental illness increases the chances of dying by
suicide.
  • REALITY
  • Although the majority of people with mental
    illness do not attempt suicide, mental illness
    does increase the chances of dying by suicide.
    Most at risk suffer from Depression, Substance
    Abuse Disorders, and other disorders that include
    an impulsive element.

13
Suicide is hereditary.
  • MYTH
  • There is no suicide gene. However, suicide may
    be seen as a model for coping in some families.
    Thus, juveniles who witness or survive the
    suicide of a family member may be at higher risk
    for suicide themselves.

14
Gay, Lesbian and Bi-sexual youths are no more
likely to attempt suicide than heterosexual
youths.
  • MYTH
  • Youths with same-sex romantic partnerships are
    twice as likely to attempt suicide than other
    youths. The stress of coming to terms with ones
    sexual identity in a culture that shuns minority
    preferences may contribute to this. These youths
    may also have less family support.

15
People at high risk for suicide may appear to be
happy, while extremely depressed people may not
be contemplating suicide.
  • REALITY
  • Some suicidal people may appear happier as they
    get closer to committing suicide as they believe
    they have found the solution to their problems.
    Very depressed people may be too apathetic to
    commit suicide.

16
People who show sudden and marked improvement
after a suicide attempt are generally in the
clear.
  • MYTH
  • The 3 months following a suicide attempt are
    critical, especially if a person shows sudden
    improvement. The person may have resolved to
    kill himself and may be happier having made a
    decision. Also, when the initial attention and
    support begin to wane, the persons life may
    return to normal and the same problems as
    before may return.

17
Suicide is preventable.
  • REALITY
  • Absolutely! Why else would we be here? Most
    people consider suicide for only a short time.
    Given assistance and support, there is a strong
    possibility that there will not be another
    attempt. The more effort that is made to help
    the juvenile develop coping skills during the
    post suicide crisis and the more time that
    passes, the better the prognosis.

18
Our Reality
  • Of all children and adolescents, those
    incarcerated in the juvenile or criminal justice
    systems are at the highest risk of serious
    suicide attempts (Gray et al., 2002 Penn et al,
    2003). Despite around-the-clock supervision and
    a lack of access to firearms, the methods for
    suicides and attempts used in this population
    tend to be more violent and more successful than
    those of young people in the general population
    (Penn et al, 2003).

19
Who is at-risk?
  • Risk Factors for General Population
  • Mental disorders and substance abuse
  • Physical, sexual, and emotional abuse
  • Self-injurious behavior
  • Factors for Institutional Environments Conducive
    to Suicidal Behavior
  • Authoritative environment
  • Shame of incarceration for those not detained
    previously
  • Lack of privacy, lack of choices, and being
    locked in a room
  • No apparent control of the future
  • Fears of the unknown
  • Isolation from family friends

20
Statistics Reported in National Survey
  • RISKS IDENTIFIED?
  • 88 of victims had a substance abuse history
  • 23 of victims had a history of medical problems
  • 58 of victims had emotional abuse history
  • 44 had physical abuse history
  • 39 had sexual abuse history

21
Court Services Requirements
  • If a juvenile (or if someone reports that a
    juvenile)
  • Presents risk factors
  • Indicates suicidal ideation/threats
  • Exhibits suicidal behavior tendencies
  • During
  • Social History
  • Risk or Needs Assessment
  • Probationary Services
  • General conversation (or message receipt)
  • Enrollment in a CIP (Community Intervention
    Program), such as Camp Woodson.

22
Court Services Requirements (contd)
  • THEN, the CC shall
  • Make service referral (record in NC-JOIN referral
    section Case Notes)
  • Communicate suicide risk to service referral
  • Notify juveniles parent/legal guardian (record
    in NC-JOIN Case Notes)
  • Create NC-JOIN suicide risk

23
ALL STAFF COMMUNICATE DOCUMENT
  • Communicate document what you hear, see, and
    assess/screen
  • Record in NC-JOIN AND
  • When juvenile is going to YDC, Camp Woodson, or
    DC
  • Notify staff receiving the juvenile through a
    conversation over the phone or in person AND
  • Notify staff receiving the juvenile via e-mail
  • Send juvenile info. in purple folder

24
COMPONENT 2
  • Observation

25
2 types of suicide prevention supervision in
DJJDP facilities
  • Suicide Watch (Constant)
  • Suicide Alert
  • (Close)

26
SUICIDE WATCH
  • Constant Supervision
  • Continuous, uninterrupted
  • While the juvenile is in his room, constant
    one-on-one supervision
  • During regular activities, constant supervision
    while amongst many juveniles unless more
    stringent supervision requirements are
    recommended by LMHC
  • At least one (1) staff member is dedicated to the
    sole duty of providing constant supervision for
    the juvenile on suicide watch

27
SUICIDE WATCH REQUIREMENTS
  • Anyone can place a juvenile on watch
  • Constant Supervision
  • Document observations at intervals not to exceed
    10 minutes on p. 3 of Self Harm Prevention Orders
  • LMHC assesses juvenile within 24 hours

28
SUICIDE ALERT
  • Close Supervision
  • Supervision at intervals not to exceed 10
    minutes.
  • While the juvenile is in his room, supervision at
    intervals not to exceed 10 minutes.
  • During regular activities, close supervision
    while amongst many juveniles unless more
    stringent supervision requirements are
    recommended by the LMHC.

29
SUICIDE ALERT REQUIREMENTS
  • Only LMHC can use this supervision tool for a
    juvenile at-risk of committing suicide (at a
    lesser threat level than suicide watch)
  • Close Supervision
  • Document observations at intervals not to exceed
    10 minutes on p. 3 of Self Harm Prevention Orders
  • LMHC assesses juvenile every 24 hours

30
Trainer Presents LMHC Action Flowchart
  • Please reference your Flow Securing Juvenile
    Suicide Prevention Services handout

31
Statistics Reported in National Survey
  • 41 of victims were found in less than 15 minutes
    following the last observation of the youth
  • 15 of victims were found after more than one
    hour of last being seen alive
  • 17 of victims were on suicide precautions at the
    time of their deaths (most of whom were required
    to be observed at 15-minute intervals)

32
Component 3
  • Safe Housing

33
Avoid isolation
  • LMHCs are encouraged to find alternatives to
    confining a juvenile at-risk for committing
    suicide to a room
  • 75 of victims were assigned to single-occupancy
    rooms

34
Juveniles placed on suicide watch and suicide
alert shall receive
  • Daily counseling AND
  • Daily suicide assessments

35
Juveniles Placed on Suicide Watch and Suicide
Alert
  • Participate in the regular program at the
    facility
  • Are required to attend and encouraged to
    participate in individual and group counseling.

36
Component 4
  • INTAKE SCREENING
  • Initial and Continual Screening

37
Initial Admission to YDC, DC, or Camp Woodson
  • Place juvenile on SUICIDE WATCH if
  • Juveniles self-reports, behaviors indicate, or
    you receive report from others
  • NC-JOIN Case Notes or NC-JOIN suicide risk,
  • e-mails,
  • all documentation arriving
  • w/juvenile, and
  • any telephone calls received.

38
Initial Admission to YDC, DC, or Camp Woodson
(contd)
  • Place juvenile on SUICIDE WATCH if
  • Juvenile answers yes to any question on the
    Suicide Risk Screening (administered at
    admission)
  • MAYSI-2 (administered within 24 hrs. of
    admission) indicates at-risk of committing suicide

39
Re-Administer MAYSI
  • The MAYSI must be administered within 24 hrs. of
    admission
  • Re-administer
  • Every 6 months
  • Within 24 hours of returning a juvenile from
    Court to the facility (when committed to a YDC)
  • When staff or LMHC indicates need (such as
    following stressful situations)
  • Place juvenile on suicide watch as MAYSI
    indicates risk.

40
Statistics Reported in National Survey
  • Precipitating Events?
  • Recent death of a family member
  • Failure in the program
  • Contagion (from another suicide in the facility)
  • Parent(s) threat of/failure to visit
  • Other (loss of relationship, close proximity to
    birthday, suicide pact with peer, ridicule from
    peers)

41
COMPONENT 5
  • TRAINING

42
Suicide Prevention Policy Training
  • Pre-service and annual instruction in suicide
    prevention is required.

43
Suicide Prevention Training
  • Objective To provide a tiered training approach
    in order to ensure that DJJDP staff
  • understand their role as it pertains to the
    policy, AND
  • receive meaningful suicide prevention and
    awareness training.
  • The first tier is Suicide Prevention Policy
    (DJJDP 18 18.1). The other tiers are specific
    to job functions within the Department will be
    carried out via in-service training and/or
    district workshops.

44
Suicide Attempts
  • DJJDP 18.1

45
Arriving at the Scene of a Suicide Attempt
  • Safeguard the juvenile,
  • Secure immediate medical
  • attention for the juvenile, and
  • Provide constant one-on-one supervision (suicide
    watch) until medical services (on-site or
    off-site) arrive.

46
When a Juvenile Needs Life Saving Efforts
  • Staff shall
  • provide life saving efforts,
  • communicate the emergency,
  • preserve the scene, and
  • document the event.
  • If the juvenile remains at the facility, staff
    shall immediately place the juvenile on suicide
    watch.

47
Response to Juvenile in Need of Emergency
Services
  • Designate another staff member within earshot to
    call 911 for emergency services and apply life
    saving efforts as taught in CPR/First Aid until
  • Juvenile recovers,
  • emergency medical services arrive, or
  • death has occurred (as pronounced by medical
    personnel/nurse).

48
HOSPITALIZATION
  • A staff member must accompany and remain present
    with the juvenile during the entire
    hospitalization.
  • The Facility Director and LMHC shall receive the
    available details of the medical emergency,
    actions taken, results of all evaluations and
    final disposition in a written summary provided
    by the staff member accompanying the juvenile to
    the hospital.

49
Direct care staff cannot conclude death.
  • Who can?
  • licensed physician,
  • nurse, or
  • emergency medical technician
  • (required by N.C. Gen. Stat. 130A-383)

50
If a Juvenile is Pronounced Dead
  • Leave juveniles body uncovered and unmoved
  • Follow scene preservation procedures
  • Ensure the Facility Director is notified

CAUTION!
51
Scene Preservation
  • In the event of an incident, staff shall
  • Ask all staff and juveniles
  • to exit the area.
  • Restrict Area Ensure that no person enters the
    area prior to law enforcement arrival. (A staff
    member should be present at each entryway to the
    area until law enforcement arrives.)

52
Scene Preservation
  • Staff shall
  • Assign a staff member to meet law enforcement at
    the entryway and escort them to the secured area.

53
Scene Preservation
  • Do not allow smoking or drinking in or around the
    secured area.
  • Do not clean the area or touch any item in the
    area until the Facility Director authorizes you
    to.

NO SMOKING NO DRINKING NO CLEANING
54
Scene Preservation
  • Supervisors should have a contingency call plan
    to allow staff on-duty to secure the area or be
    interviewed by the police.

55
  • Remember to complete a Serious Incident Report

56
COMPONENT 6
  • MORTALITY REVIEW

57
DEBRIEF
  • Debriefing and an analysis of the event is
    required
  • Chief Court Counselor and Facility Director
    monthly reports must include aggregate data in
    their Monthly Reports such as
  • of juveniles on suicide watch (facilities),
  • of juveniles on suicide alert (facilities),
  • of suicide risk entries,
  • Number and type of referrals made,
  • Number of juveniles displaying suicidal behavior

58
MD 4, Serious Incident Reports
  • The Facility Director/Chief Court Counselor is
    responsible for
  • Tracking all incidents that are not defined as
    serious, and
  • Providing a monthly report to his supervisor of
    any trends identified (i.e. One (1) juvenile
    involved in numerous use of force incidents or,
    one (1) location identified as the site for
    numerous altercations).

59
MD 4, Serious Incident Reports (contd)
  • The Facility Director/Chief Court Counselors
    supervisor is responsible for forwarding any
    trend concerns through the chain of command.

60
Counseling Available
  • The Facility Director or his designee shall
    arrange counseling availability for staff and
    juveniles as needed.

61
Where can I find more information?
  • Suicide Prevention policies can be found at
    http//www.juvjus.state.nc.us/about/policy/dept/su
    icide_prevention.html or by going to the Depts
    homepage Click on About Us, Policy Manual,
    Departmental Policy, DJJDP 18.
  • Best practice literature and training
    presentations will be there, too.
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