Suicide Prevention Policy Training

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Suicide Prevention Policy Training

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

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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.

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COMPONENT 1WRITTEN POLICY
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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!!!

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ACTIVITY

• Myth or Reality???

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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).

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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

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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

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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.

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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

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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

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COMPONENT 2

• Observation

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2 types of suicide prevention supervision in
DJJDP facilities

• Suicide Watch (Constant)
• Suicide Alert
• (Close)

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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

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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

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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.

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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

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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)

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Component 3

• Safe Housing

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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

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Juveniles placed on suicide watch and suicide
alert shall receive

• Daily counseling AND
• Daily suicide assessments

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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.

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Component 4

• INTAKE SCREENING
• Initial and Continual Screening

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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.

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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

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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.

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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)

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COMPONENT 5

• TRAINING

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Suicide Prevention Policy Training

• Pre-service and annual instruction in suicide
  prevention is required.

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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.

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Suicide Attempts

• DJJDP 18.1

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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.

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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.

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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).

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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.

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Direct care staff cannot conclude death.

• Who can?
• licensed physician,
• nurse, or
• emergency medical technician
• (required by N.C. Gen. Stat. 130A-383)

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If a Juvenile is Pronounced Dead

• Leave juveniles body uncovered and unmoved
• Follow scene preservation procedures
• Ensure the Facility Director is notified

CAUTION!
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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.)

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Scene Preservation

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

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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
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Scene Preservation

• Supervisors should have a contingency call plan
  to allow staff on-duty to secure the area or be
  interviewed by the police.

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• Remember to complete a Serious Incident Report

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COMPONENT 6

• MORTALITY REVIEW

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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

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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).

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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.

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Counseling Available

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

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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.