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Some Secrets SHOULD be Shared


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Title: Some Secrets SHOULD be Shared


Some Secrets SHOULD be Shared
It Takes a Village Involving School Staff and
Parents in Suicide Prevention Candice Porter,
MSW, LICSW Executive Director Screening for
Mental Health, Inc.
What is Screening for Mental Health, Inc.
  • SMH is
  • a national non-profit organization whose mission
    is to provide innovative mental health and
    substance abuse resources, linking those in need
    to quality treatment options.
  • The SOS Signs of Suicide Prevention Program is
  • an award-winning, evidence-based educational and
    screening tool used in middle and high schools
    across the country.

Youth Programs at SMH
  • SOS Signs of Suicide Prevention Program
  • High School Program
  • Middle School Program
  • SOS Signs of Suicide Booster Program
  • Signs of Self-Injury Prevention Program

What we will cover today
  • Youth suicide
  • Signs symptoms
  • Risk factors other definitions
  • What can schools do? Implementing an
    evidence-based, universal prevention program
  • Reaching out to trusted adults in your community
  • Suicide prevention and risk management
  • Talking points
  • Question and answer

Prevalence of Suicide Among Youth
  • 3rd leading cause of death among youth ages 15-24
    (CDC, 2011)
  • In 2011, 4,630 people between the ages of 15 and
    24 completed suicide.
  • 12.5 of total suicides that year.
  • But STILL.adolescent suicidal behavior is deemed

By the Numbers
  • 2013 Youth Risk Behavior Survey found that
  • 29.9 felt so sad or hopeless for 2 weeks that
    they stopped doing some usual activity.
  • 17.0 seriously considered attempting suicide.
  • 13.6 made a suicide plan.
  • 8.0 attempted suicide.
  • 2.7 of those who made an attempt required
    medical attention
  • Find the data for your city/state
  • http//

Wisconsin Student Health Survey
Behaviors that Contribute to Unintentional Injuries and Violence WI Students US Students MA Students Are At
Seriously considered attempting suicide (During the 12 months before the survey.) 13.2 15.8 Less Risk
Attempted suicide (One or more times during the 12 months before the survey.) 6.0 7.8 Equal Risk
Risk Factors
  • A risk factor is any personal trait or
    environmental quality that is associated with
  • Risk factors ? causes.
  • Examples
  • Behavioral Health (depressive disorders, NSSI,
    substance abuse)
  • Personal Characteristics (hopelessness, ?
    self-esteem, social isolation, poor
  • Adverse Life Circumstances (interpersonal
    difficulties, bullying, hx abuse, exposure to
    peer suicide)
  • Family Characteristics (family hx suicide,
    parental divorce, family hx mental health
  • Environmental (exposure to stigma (including
    discrimination based on sexual orientation),
    access to lethal means, limited access to mental
    health care, lack of acceptance)

Risk Factors for Suicide
  • Mental illness
  • The strongest risk factors for suicide in youth
  • depression
  • substance abuse
  • previous attempts (NAMI, 2003)
  • Over 90...
  • of people who die by suicide have a least one
    major psychiatric disorder (Gould et al., 2003)
  • Alarmingly, 80...
  • of youth with mental illness are not receiving
    services (Kataoka, et al 2002).

Alcohol and Suicidal Behavior in Teens
  • Alcohol use, drinking while down, and heavy
    episodic drinking are strongly associated with
    suicide among adolescents.
  • Relationship of drinking to unplanned suicides
  • ? disinhibition and impulsivity
  • ? aggression and negative affectivity
  • ? cognitive constriction ? restricted production
    of alternative coping strategies
  • Drinking alcohol while down more than a 75
    increase in risk
  • Alternative avenue for identification and early
  • (Schilling, et al. 2009)

Suicide Warning Signs
  • A warning sign is an indication that an
    individual may be experiencing depression or
    thoughts of suicide.
  • Most individuals give warning signs or signals of
    their intentions.
  • Seek Immediate Help
  • Threat to kill themselves, actively seeking
    means, talking/writing about death
  • Other Warning Signs to Take Seriously
  • Risky behavior, recklessness
  • ? substance use
  • ? interest in usual activities
  • Withdrawal
  • Stay aware of changes in your students
  • in their affect, behavior, appearance,
    attendance, etc.

Protective Factors
  • Protective factors are personal traits or
    environmental qualities that can reduce the risk
    of suicidal behavior.
  • Protective factors dont provide immunity,
  • but help reduce risk.
  • Examples
  • Individual Characteristics (adaptable
  • coping skills, self-esteem, spiritual faith)
  • Family/Other Support (connectedness, social
  • School (positive experience, connectedness, sense
    of respect)
  • Mental Health and Healthcare (access to care,
    support through medical and mental health
  • Access to Means (restricted access to
    firearms/medications/alcohol, safety barriers for

Precipitating Event
  • A precipitating event is a recent life event that
    serves as a trigger, moving an individual from
    thinking about suicide to attempting to take his
    or her own life.
  • NOT causes
  • No single event causes suicidality other risk
    factors are typically present.
  • Examples
  • breakup
  • bullying incident
  • sudden death of a loved one
  • trouble at school

Suicide A Multi-Factorial Event
What Can Schools Do?
  • School systems are not responsible for meeting
    every need of their students. But when the need
    directly affects learning, the school must meet
    the challenge.
  • (Carnegie Task Force on Education)
  • Barriers to the mission of education
  • Take responsibility
  • minimize student alienation despair
  • Promote healthy development protective buffers
  • Center for Mental Health in Schools at UCLA

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

SOS Signs of Suicide Student Goals
  • Help youth understand that depression is a
    treatable illness
  • Educate youth that suicide is not a normal
    response to stress, but a preventable tragedy
    that is often a result of untreated depression
  • Inform youth of the risk associated with alcohol
    use to cope with feelings
  • Increase help-seeking by providing students with
    specific action steps ACT
  • Encourage students and their parents to engage in
    discussion about these issues

Universal Prevention
  • Universal prevention strategies are designed to
    reach the entire population, without regard to
    individual risk factors and are intended to reach
    a very large audience. The program is provided to
    everyone in the population, such as a school or
    grade, with a focus on risk reduction and health
  • Reach a broad range of adolescents
  • At-risk/sub-clinical/clinical symptoms
  • Reduces stigmatization
  • Promotes learning and resiliency in all students
  • Overrides implementer assumptions

SOS Program Components
  • What comes in the program?
  • Implementation Guide
  • Educational DVD Discussion Guide
  • Screening Tools and Student Response Cards
  • High School Student Newsletter / Middle School
    Student Parent Newsletters
  • Customizable Wallet Cards/ ACT stickers / Posters
  • Educational Materials for Staff, Students, and
  • Postvention Guide
  • Gatekeeper Training Tools Training Trusted
    Adults DVD and Plan, Prepare, Prevent online
    training module
  • Life Teammates Packet for Coaches

Youth Programs at SMH
  • SOS Signs of Suicide Prevention Program
  • High School Program 395
  • Middle School Program 395
  • Combination Program 655
  • SOS Signs of Suicide Second Act Program 200
  • Signs of Self-Injury Prevention Program 175

Gatekeeper Training
  • Gatekeeper training involves educating adults who
    regularly interact with youth to recognize
    warning signs for suicide and know how to respond
    appropriately to at-risk youth.
  • A gatekeeper should ultimately be able to provide
    a link, or open the gate, between a young person
    and a mental health professional.

Why Gatekeeper Training?
  • Teaches additional skills, including how to
  • reduce a persons suicide risk by talking with
  • keep someone safe until additional help can be
  • facilitate referrals
  • Creates more community members prepared to help
  • Trains adults to effectively respond if
    approached for help by a youth
  • Increases participation and investment of
    community in youth suicide prevention
  • Clarifies myths and facts about youth mental
    health and suicide

Gatekeeper Module
To launch the SOS online gatekeeper module,
1.5 free contact hours for school social workers,
counselors, psychologists, and nurses
(Certificate of Completion available for all
learners) CEUs for social workers sponsored
Training Trusted Adults SOS Gatekeeper Video
Sample Qs from the Discussion Guide
  • What are some of the risk factors and warning
    signs in the video that stuck out for you?
  • What are some protective factors you might find
    in your students?
  • The professionals discussed confidentiality and
    Melissa in Elyssas story said, Its ok to
    tell. What are some steps to take if a student
    discloses the need for help?
  • What qualities do you think make you a trusted

Preparing for Your Staff Meeting/Parent Night
  • Review your schools crisis response protocol
  • Take SOS online gatekeeper training module
  • Familiarize yourself with youth depression and
  • Plan for specific program implementation
  • Work with your administration
  • Establish whether your school will be
    implementing the program
  • If so, establish date and time so that you may
    communicate the information to your staff during
    the training

Preparing for Your Staff Meeting/Parent Night
  • Preview the Training Trusted Adults DVD
  • Make sure the DVD is in working order
  • Think about your own reactions to this video
  • Consult the discussion guide, plan your talkback
  • Personalize the discussion to your audience
  • Review definitions (risk factors, etc.)
  • Be prepared to communicate these terms to your
  • Understand myths/facts about depression and
  • Refer to examples in your Implementation Guide

Staff Meeting Step by Step
  • Distribute disclosure guidelines for staff.
  • Review your districts crisis response protocol.
  • Review how staff should proceed if approached by
    a student for help.
  • Show the Training Trusted Adults DVD.
  • Facilitate a follow-up conversation using the
    discussion guide (including definitions,
  • Allow extra time for q a with your staff.

Parent/Community Night Step by Step
  • Review your districts crisis response protocol.
  • Show the Training Trusted Adults DVD.
  • Facilitate a follow-up conversation using the
    discussion guide (including definitions,
  • Review school policy for following up with
    at-risk students, including how and when
    parents/guardians will be contacted if their
    child needs further help.
  • Encourage parents to talk to their children about
    depression, suicide, and mental health!
  • Provide parents/guardians with school and
    community-based mental health resources in your

Gatekeeper Training is a Crucial Part of Program
For more information contact
  • Screening for Mental Health
  • Meghan Diamon, LCSW
  • 781-591-5230
  • Or visit

Screening for Mental Health, Inc. One Washington
Street, Suite 304 Wellesley Hills, MA 02481 P
781.239.0071 F 781.431.7447 www.MentalHealthS
  • American Psychiatric Association. (2000).
    Diagnostic and statistical manual of mental
    disorders (4th ed., text rev.). Washington, DC.
  • Aseltine, R., et al. (2007). Evaluating the SOS
    suicide prevention program A replication and
    extension. BMC Public Health 7(161).
  • Aseltine Jr., R.H. DeMartino, R. (2004). An
    Outcome Evaluation of the SOS Suicide Prevention
    Program. American Journal of Public Health, 94
    (03), 446-451.
  • Centers for Disease Control and Prevention,
    National Center for Injury Prevention and
    Control. Web-based Injury Statistics Query and
    Reporting System (WISQARS) online. (2005)
    cited 2011 Feb.16.  Available from URL

  • Gould, M., et al. (2003). Youth suicide risk and
    preventive interventions A review of the past 10
    years. Journal of the American Academy of Child
    and Adolescent Psychiatry, 42 (4), 386-405. 
  • Gould, et al. (2007). Evaluating Iatrogenic Risk
    of Youth Suicide Screening Programs. American
    Medical   Association, 293(13), 1635-1643.
  • Kataoka, S. Zhang, L. Wells, K. (2002). Unmet
    need for mental health care among U.S. children
    Variation by ethnicity and insurance status.
    American Journal of Psychiatry, 159 (9), pp.
  • National Alliance of Mental Illness (NAMI).
    (2003). Depression in Children and Adolescents.
    Retrieved on June 16, 2009 from

  • Schilling, E. A., Aseltine, R. H., Glanovsky, J.
    K., James, A., Jacobs, D. (2009). Adolescent
    alcohol use, suicidal ideation, and suicide
    attempts. Journal of Adolescent Health,
  • Substance Abuse and Mental Health Services
    Administration. (2012). Results from the 2010
    National Survey on Drug Use and Health Mental
    Health Findings, NSDUH Series H-42, HHS
    Publication No. (SMA) 11-4667. Rockville, MD
    Substance Abuse and Mental Health Services
  • UCLA Center for Mental Health in Schools. School
    community partnerships a guide. Retrieved from
  • World Health Organization. (2006). WMO Statement
    on Adolescent Suicide. http//