Suicidal Ideation and Behaviors

1. Suicidal Ideation and Behaviors Excerpts adapted from: Stephen E. Brock, Ph.D., NCSP, LEP & Shelley Hart California State University, Sacramento Ridgway Presentation Spring: 2007 John Lestino

2. Suicide Risk Factors • Psychopathology • Associated with 90% of suicides • Prior suicidal behavior the best predictor • Substance abuse increases vulnerability and can also act as a trigger • Familial • History • Stressor • Functioning

3. Suicide Risk Factors • Biological • Reduced serotongenic activity • Situational • 40% have identifiable precipitants • A firearm in the home • By themselves are insufficient • Disciplinary crisis most common

4. Suicide Warning Signs • Suicide notes • Direct & indirect suicide threats • Making final arrangements • Giving away prized possessions • Talking about death • Reading, writing, and/or art about death • Hopelessness or helplessness • Social Withdrawal and isolation • Lost involvement in interests & activities • Increased risk-taking • Heavy use of alcohol or drugs

5. Suicide Warning Signs • Abrupt changes in appearance • Sudden weight or appetite change • Sudden changes in personality or attitude • Inability to concentrate/think rationally • Sudden unexpected happiness • Sleeplessness or sleepiness • Increased irritability or crying easily • Low self esteem

6. Suicide Warning Signs • Dwindling academic performance • Abrupt changes in attendance • Failure to complete assignments • Lack of interest and withdrawal • Changed relationships • Despairing attitude

7. Predicting Suicidal Behavior (CPR++)(Ramsay, Tanney, Lang, & Kinzel, 2004) • Current plan (greater planning = greater risk). • How (method of attempt)? • How soon (timing of attempt)? • How prepared (access to means of attempt)? • Pain (unbearable pain = greater risk) • How desperate to ease the pain? • Person-at-risk’s perceptions are key • Resources (more alone = greater risk) • Reasons for living/dying? • Can be very idiosyncratic • Person-at-risk’s perceptions are key

8. Predicting Suicidal Behavior (CPR++)(Ramsay, Tanney, Lang, & Kinzel, 2004) • (+) Prior Suicidal Behavior? • of self (40 times greater risk) • of significant others • (+) Mental Health Status? • history mental illness (especially mood disorders) • linkage to mental health care provider

9. Suicide Intervention Risk Assessment & Referral Procedures 1. Conduct a Risk Assessment. 2. Consult with fellow school staff members regarding the Risk Assessment. 3. Consult with County Mental Health.

10. Suicide Intervention Risk Assessment & Referral Procedures • Use risk assessment information and consultation guidance to develop an action plan. Action plan options are as follows: • Extreme Risk • If the student has the means of his or her threatened suicide at hand, and refuses to relinquish such then follow the Extreme Risk Procedures. B. Crisis Intervention Referral • If the student's risk of harming him or herself is judged to be moderate to high then follow the Crisis Intervention Referral Procedures. C. Contracting • If the student's risk of harming him or herself is judged to be low then follow the Contracting Procedures.

11. Suicide Intervention Risk Assessment & Referral Procedures • Extreme Risk • Call the police. • Calm the student by talking and reassuring until the police arrive. • Continue to request that the student relinquish the means of the threatened suicide and try to prevent the student from harming him-or herself. • Call the parents and inform them of the actions taken.

12. Suicide Intervention Risk Assessment & Referral Procedures B. Crisis Intervention Referral • Determine if the student's distress is the result of parent or caretaker abuse, neglect, or exploitation. • Meet with the student's parents. • Determine what to do if the parents are unable or unwilling to assist with the suicidal crisis. • Make appropriate referrals.

13. Suicide Intervention Risk Assessment & Referral Procedures C. Contracting • Determine if the student's distress is the result of parent or caretaker abuse, neglect, or exploitation. • Meet with the student's parents. • Make appropriate referrals. • Write a no-suicide contract. • 5. Protect the privacy of the student and family. • 6. Follow up with the hospital or clinic.

14. Positive Psychology:Where Existentialism meets CBT Presented by: Terry Molony, Ed.S. Cherry Hill Schools Philadelphia College of Osteopathic Medicine John C. Lestino, MA, LPC Edgewater Park Schools

15. Pessimists view Bad events Permanent Pervasive Internal Good events Temporary Specific External Optimists view Bad events Temporary Specific External Good events Permanent Pervasive Internal Attributional Styles

17. Components of Flow • Task that we have a chance to complete • Able to concentrate • Task has clear goals • Immediate feedback is provided • Sense of control over actins • Sense of self disappears • Sense of duration of time is altered

18. Functional Factors Behavior and It’s Purposes

19. Components of Functional Assessment • Access to social attention • Access to tangibles or preferred activities • Escape, delay, reduction, or avoidance of tasks • Internal stimulation (automatic reinforcement)

20. Five Primary Components of a Functional Assessment • A clear description of the problem behavior. • Identification of the events, times, and situations when behavior will and will not occur. • Identification of the consequences that maintain problem behavior. • Development of hypotheses that describe the behavior, the type of situation in which it occurs and the reinforcers maintaining it. • The collection of direct observation data to support the hypotheses.

21. Understanding social rules and what is expected …….How do people teach it? Social StoriesRule cards Feedback on performanceRole playsVideo instruction

22. Social Stories • Can be used with modifications such as pictures to assist with comprehension • Developed by Carol Gray • Can be used for multiple purposes • multi-element tasks • addressing fears • addressing challenging behaviors

23. What does not destroy me…makes me stronger. • Studies have shown that people who overcome difficult events often express positive psychological changes. • The creation of meaning • A cognitive theory is that the traumatic event provides new information about oneself or the world which is worked through until the schemas match reality.