Crisis Management

1. Crisis Management

2. Checking In Suicide is Personal Many of us are survivors, who miss our friends and relatives Some may be attempt survivors Please take care of yourself during this training! Give us the Thumbs up!

3. Definitions • Suicide-Self-injury with the intent to cause death World Health Organization • Survivor-Those left behind (families, friends, etc.) • Contagion- suicidal behavior is imitated by one or more individuals following the awareness of a recent threat, attempt, or completion

4. Oklahoma • 2010 - 618 suicide deaths – 13th highest • Oklahoma’s =16.5 U.S. = 12.4 (1) • Suicide and Homicide Statistics (2004-2009) (2) • 3,203 deaths by suicide were reported • 1,322 homicides • On average 534 die by suicide annually • On average 220 deaths by homicide annually • 1.) American Foundation for Suicide Prevention http://www.afsp.org/index.cfm?fuseaction=home.viewPage&page_id=05114FBE-E445-7831-F0C1494E2FADB8EA • 2.) Summary of Violent Deaths in Oklahoma; Oklahoma Violent Death Reporting System, 2004-2009

5. Oklahoma • Suicide rates highest in the 25-64 age group • 79% of suicide victims are male, 21% are female • The rate of suicide completion is higher for males than females across all categories of race and age. • Overall rate for males increased 12% from 22.3 in 2004 to 25 in 2009 (2% annual increase) • Male suicide rates increased 27% among persons 45-64 and 22% among persons 25-44 (5% and 4% average annual increases respectively) • Summary of Violent Deaths in Oklahoma; • Oklahoma Violent Death Reporting System, 2004-2009

6. Oklahoma • Of those that lost their lives to suicide, 23% served in the US Armed Forces. • Suicide rate among veterans 65 years and older decreased 27%, while the suicide rate among veterans 35-44 increased 67%. • Firearms (60%), hanging/strangulation (19%), poisoning (18%). Summary of Violent Deaths in Oklahoma; Oklahoma Violent Death Reporting System, 2004-2009

7. Proving the Case for Prevention • Second leading cause of death among youth in Oklahoma. • One out of 53 high school students (1.9 percent) reported having made a suicide attempt that was serious enough to be treated by a doctor (Nationally). • For each suicide death -100–200 suicide attempts. • 1 out of every 15 high school students attempts suicide each year. CDC, 2010a

8. Proving the Case in our Schools • Second leading cause of death among youth in Oklahoma. • One out of 53 high school students (1.9 percent) reported having made a suicide attempt that was serious enough to be treated by a doctor (Nationally) • For each suicide death -100–200 suicide attempts • 1 out of every 15 high school students attempts suicide each year CDC, 2010a

9. Power of Words

10. Consideration • Adult Attitudes • Youth Attitudes • It is all about getting those to help

11. Suggested Dialogue Always be mindful those around you may have lost someone to suicide and may have attempted.

12. Connections • Perceptions of friendships • Church • Neighborhoods • Organizations • Clubs • Sports

13. Adolescent “Triggers” • Loss • Change • Trouble

14. After An Event • Gatekeeper trainings for adults • National Suicide Prevention Lifeline placement • Office box • Debriefing • Community small trainings • Support groups • Extra mental health supports

15. Crisis Management Preparation to • Deal effectively with multiple pressures from various sources • Specific detailed plan • Uniqueness of each event • Provide management of information to the community • Avert contagions

16. Team Preparation • All members trained in a gatekeeper training • Members trauma trained • Schedule initial meeting to develop plan • Schedule quarterly meetings • Revisit policies • Update resources • Revise/develop referral protocols • Commitment of team • Ensure annual gatekeeper trainings for key staff including staff resources how to talk with youth about suicide

17. Role Possibilities • Administration • Team leader • Information coordinator • Parent Liaison • Administrative Liaison • Student Wellness Coordinator • Operations Coordinator • Faculty Support Coordinator • Community Liaison • Student Crisis Assessment Team for those at risk (referrals, parent meetings, etc.) • Back ups for each position

18. Crisis Response The Crisis Response Team • Ten to 15 people chosen for their skills, credentials, and ability to work compassionately and effectively under pressure— • Administrators • Counselors • Social workers • Psychologists • Nurses • School resource officers • Faith community • Local law enforcement

19. Crisis Response Checklist • Confirm death/Inform the school superintendent • Contact the deceased’s family to offer condolences, inquire what the school can do • Call an immediate meeting of the Crisis Response Team • Immediately notify faculty and staff of the death (usually phone or e-mail). • Schedule all-staff meeting ASAP • Notify students in first hour class • Prepare script to be delivered by first hour teacher (get replacement for teachers not able to make announcement) • Decide who will follow the deceased person’s schedule

20. Crisis Response Checklist Operations • Assign a staff to follow the deceased student’s schedule • Arrange for several substitute teachers or “floaters” from other schools • Arrange for care stations, for staff and students. • Provide tissues and water throughout the building • Watch the school environment • Prepare to track and respond to student and/or family requests for memorialization. Community Partners Coroner/medical examiner Police Mayor’s office/local government Mental health and medical communities Grief support organizations, to plan for service needs Arranging for outside trauma responders

21. Crisis Response Checklist Funeral • Communicate logistics, including the need for crisis counselors and/or security to be present at the funeral. • Importance of communicating with clergy, contagion, etc. • Keep school open if the funeral is during school hours • Back up staff at school • Arrange for counselors/school staff to attend the funeral. • Encourage parents to accompany their child to the funeral. • Team staff to be present at funeral home during visitation.

22. Crisis Response Checklist Media Relations • Prepare a media statement. • Designate a sole media spokesperson • Advise students to avoid interviews with the media. • Refer media outlets to Reporting on Suicide: Recommendations for the Media. Social Media • Oversee school’s use of social media as part of the crisis response. • Convene a small group of students to work with school administration to monitor social networking sites and other social media.

23. Crisis Response Checklist • Draft death notification statement for parents, including resources. • Provide handouts on Facts About Suicide and Mental Disorders in Adolescents and Talking About Suicide to faculty. • Crisis team debrief every day • Care stations for students (time period) • Announce care stations hours and locations • Ask for outside help • Send letter to parents • Ensure letter is also placed on the webpage • Monitor social media

24. Crisis Response Checklist Safety • Keep to regular school hours. • Ensure that students follow established dismissal procedures. • Call on school resource officers to assist parents and others. • Pay attention to students who are having particular difficulty

25. First day(called special faculty meeting) Allow at least one hour to address the following goals: • Introduce Team • Share accurate information • Allow staff to express their own reactions and grief. • Provide scripted death notification • Prepare for student reactions and questions by providing handouts to staff on Talking About Suicide and Facts About Suicide and Mental Disorders in Adolescents. • Explain plans for the day, including locations of care rooms. • School climate-changes in behavior among the students • Brief staff on referral process • Apprise staff of any outside responders. • Remind staff to allow students to go to the care stations • Remind staff of student dismissal protocol for funeral.

26. End of first day • Hold all staff debrief • Offer verbal appreciation of the staff. • Review the day’s challenges and successes. • Debrief, share experiences, express concerns, and ask questions. • Disseminate information regarding the death and/or funeral arrangements. • Discuss plans for the next day. • Self-care. • Avoid tests

27. Get the Facts First Confirm the death. (Principal or ?) If the Cause of Death Is Unconfirmed Rumors-harmful for everyone Family may not want it labeled a suicide Students may already be talking Administration to talk/consult with the family Team Leader

28. Team Leader • Makes team assignments • Coordinate with administration • Schedules debriefings • Schedules breaks • Maintains documents and protocols • Leads faculty meetings/debrieings

29. Information • Provides media statements or coordinates with district assigned media spokesperson • Provides media with best practices for reporting • Checks with families about facts and their wishes • Provides information about funerals, etc. • Determines level of information and message youth receive • Provides script to be given to youth via their first hour teacher • Maintains media files • Provides best practices for social media messages, youth discussions, parent prevention strategies for media • Ensures the 800-273-Talk number is posted in schools, scrolling messages, etc.

30. “The family has requested that information about the cause of death not be shared at this time” • “We know there has been a lot of talk about whether this was a suicide death. Since the subject of suicide has been raised, we want to take this opportunity to give you accurate information about suicide in general, ways to prevent it, and how to get help if you or someone you know is feeling depressed or may be suicidal.”

31. Emergency Faculty Meeting • First thing after the death • Relay family wishes • Introduce people who will be in the building • Explain front office staff roles for the next few days • Provide staff with referral procedures • Introduce locations of Care Stations • Provide staff with script • Provide them with agenda for the first day after the suicide(traumatic death) • Ensure all missing school staff receive information • SELF CARE…. • Provide end of school debrief

32. Parent Liaison • Provides resources, materials for parents • Answers inquiries from parents • Host parent meetings • Provides resources for parents on the school web page (access number, materials discussing grief and how to help your child) • Providing take home letters

33. Coordinator of student care stations • manages logistics of locations, staffing, and protocol for • dismissing students to care stations

34. Community Liaison • informs relevant community agencies of the school’s plans; • arranges for community volunteers to augment school team if necessary • contacts off-campus referral resources to alert them to potential referrals • Reaches out to clergy

35. Physical Logistics Coordinator • Addresses all issues that affect the physical school building • Arranges facility setups for meetings • Deals with extended school hours, evening meetings

36. Faculty Support Coordinator • at least two members follow the daily schedule of the • deceased and siblings; are available to answer faculty • questions; provide support to the faculty if not done by • community team member

37. Community Events • Smaller groups more favorable • Recent unseen wounds • Freedom to disclose

38. Critical Climate Oversight • two or more members of the team coordinate crisis • contacts with vulnerable students

39. Administrative Liaison • Distributes scripts for phone responses and directs staff • Who answer phones; distributes information to faculty • Coordinates meeting room and faculty support room assignments • manages rumors

40. Helping Students Cope KEY CONSIDERATIONS • Emotional regulation - a person’s ability to express intense emotions such as grief and fear. Adolescents have mastered basic skills encountered daily Challenged in the face of a suicide Complex feelings - physical indicators (stomach upset, restlessness, or insomnia) Increased risk for difficulties with emotional regulation • Opportunities to express their emotions • Meetings with Students in Small Groups • Adjust the regular academic schedule. • Have counselors go into the classrooms to give students accurate information about suicide • Provide safe reporting

41. Helping Students Cope Help Students Identify and Express Their Emotions • Emotional expression-anger, humor, silence, etc. What is your biggest concern about the I immediate future? What would help you feel safer right now? Practical Coping Strategies • simple relaxation, such as taking three deep slow breaths • engaging in favorite activities or hobbies • exercising • reminding themselves that they can use coping skills • list people they can turn to • list things they’re looking forward to • focusing on individual goals • Students should also be encouraged to think about how they want to remember their friend.

42. Working with the Community • Suicide happens in communities, not just in schools • Engage mental health providers • Coroner/Medical Examiner • Faith community • Media-Educate the community about the causes and complexity of suicide and to identify available mental health resources. • Law Enforcement • First Responders-EMT • Funeral directors • SOS groups

43. Memorialization • All deaths the same way-alleviate stigma • Contagion • Funerals • School newspapers • Desks/ lockers/uniforms • Events • Permanent memorials/scholarships (for everyone, forever?) • Graduation • Memorials t-shirts yearbook ads candle light vigils (ongoing) Creative ideas Out of Darkness Walks a day of community service Volunteering on crisis line Suicide awareness campaign

44. Social Media • Involve Students • Disseminate Information • Schools website and/or an online presence • The funeral or memorial service • Where students can go for help or meet with counselors • Resource numbers 800-273-TALK

45. Suicide Contagion • What is it? • How do you prevent it? • Identifying Other Students at Possible Risk for Suicide • Of special concern are those students who: -have a history of suicide attempts -are dealing with stressful life events such as a death or divorce in the family -were eyewitnesses to the death -are family members or close friends of the deceased -received a phone call, text, or other communication from the deceased foretelling the suicide -may have fought with or bullied the deceased • Encourage screenings for those at heightened risk by using a mental health screening • Connect with Mental Health providers • Monitor media coverage

46. Bringing in Outside Help • Build a local coalition-toolkit • National Emergency Assistance Team of the National Association of School Psychologists http://www.nasponline.org/resources/crisis_safety/neat.aspx • The Dougy Center: National Center for Grieving Children & Families http://www.dougy.org • Riverside Trauma Center http://www.riversidetraumacenter.org • Boston Children’s Foundation http://www.bostoncf.org

47. Going Forward • Lifeline’s programs • Suicide awareness programs to educate teachers and other school personnel • Programs to educate students themselves about depression, anxiety, substance abuse, and conduct disorder • Gatekeeper training programs, which teach practical skills • Best Practices Registry for Suicide Prevention (BPR), maintained by SPRC and AFSP and available at http://www.sprc.org. • Another source is the National Registry of Evidence-Based Programs at http://www.nrepp.samhsa.gov. • Creating school strategies

48. General Considerations • Treat Allstudent deaths in the same way. Why? Stigma, family, friends • Schools should be aware that adolescents are vulnerable to the risk of suicide contagion. Why? Glamorization, Copy cat • The student who died by suicide was likely struggling with a mental anguish. ? You cannot always see what may be happening-substance abuse, anxiety, etc. • Help is available for any student Why? Although we may think everyone is ok, we never know what the event may have triggered.

49. Resources National Suicide Prevention Lifeline 800-273-TALK ODMHSAS 405-522-3835 www.odmhsas.org Resource Center http://ok.gov/odmhsas/Prevention_/E-Prevention_Resource_Center/index.html After a School Suicide http://ok.gov/odmhsas/Prevention_/Prevention_Initiatives/Youth_Suicide_Prevention_and_Early_Intervention_Initiative/index.html Tom Thomson 405-522-3908 tthomson@odmhsas.org Access Specialist

50. For additional questions Tracy McKeown MPH 405-419-4142 Tracy_mckeown@occhd.org Julie Geddes 405-522-3835 jgeddes@odmhsas.org