Brooke Anderson, LCSW / AISD School to Community Liaison

1. Remaining calm in a crisis: Effective ways to intervene when a child or adolescent presents in psychiatric crisis. Brooke Anderson, LCSW / AISD School to Community Liaison Laura Slocum, LPC / ATCIC MCOT Mobil Crisis Team Manager Dianna Groves, LPC AISD Learning Support Services Crisis Coordinator

2. What you will walk away with today: • Understand the principles behind crisis intervention theory and how to apply them to realistic situations • Feel confident and comfortable asking the “tough questions when it comes to children or adolescents in crisis • Conduct a thorough suicide risk assessment including next steps and problem solving for safety. • Be knowledgeable of community resources that help children in psychiatric crisis.

3. Overview of Crisis Intervention Theory • Developed November 28, 1942 after the fire at the Coconut Grove night club by Dr. Eric Lindemann • Continued to be developed in the social work profession and was discovered to be a highly effective time to intervene and make change in clients’ lives • Crisis intervention theory believes that a crisis can either result in a highly positive or a highly negative change. The goal of crisis intervention theory is to remove vulnerabilities from the person’s past and bolster them with new coping skills to serve as a buffer to stressful situations in the future. • “A little help, rationally directed and purposefully focused at a strategic time is more effective than more extensive help given at a period of less emotional accessibility.” Lydia Raporport

4. Definition of Crisis (simplified in a children’s dictionary) • 1 : the turning point for better or worse in a disease • 2 : a turning point (as in a person's life or in the plot of a story) • 3 a : an unstable or difficult time or state of affairs <a financial crisis> b : a situation that has become very serious <the energy crisis> • Danger and Opportunity- Pictogram in Chinese for Crisis

5. Stages of a Crisis • Hazardous event – something happened • Vulnerable state – how the client feels • Precipitating factors – stress, etc. • Active crisis – outcry of suicide • Phases of Crisis Intervention: • Goals • Relief of symptoms – How can we get you feeling better • Restoration of pre-crisis level functioning • Understanding precipitating events and their contributions to disequilibrium • Remedial measures to address results of crisis and prevent future ones.

6. What do I do now? • Establish contact • Assess, Assess, Assess: • Actual Crisis Event (What happened) • Student’s subjective responses • Historical and current coping skills, resources and strengths • Student’s functional skills and abilities • Triage the most critical concerns • Spell out specific next steps : Take Action

7. The Big Three • Suicidal Ideation and current self harm • Homicidal Ideation • Psychosis

8. Some Sobering Statistics • Suicide is the 3rd leading cause of death for youth ages 10-24 • One in 11 high school students made a suicide attempt in the past 12 months • 86% of school counselors surveyed reported that they had counseled a student who had threatened or attempted suicide • 62% of school counselors surveyed reported that they have had a student make a nonfatal suicide attempt at school From the American Association of Suicidology

9. From SAMHSA • A nationwide survey of youth in grades 9-12 across the US found that 15% of students reported seriously considering suicide. • 11% reported creating a plan • 7% reported trying to take their own life in the 12 months preceding the survey. • Over 40% of surveyed gay or lesbian youth seriously considered attempting suicide.

10. Assumption makes an … out of you and me. Assessment does not. Most important step • Never underestimate the importance of assessment

11. Assessing Suicide Risk • According to the Harvard Medical School Guide to Suicide Assessment and Intervention, "There is no psychological test, clinical technique, or biological marker sufficiently sensitive and specific to support accurate short-term prediction of suicide in an individual person" (Jacobs et al., 1999, p. 4). However, the guide also suggests that the use of a suicide assessment can "allow for a more informed intervention" (p. 6). These interventions can include decisions about whether additional expertise, medication, or hospitalization is warranted.

12. IS PATH WARM? • I = Ideation • S = Substance Abuse • P = Purposelessness • A = Anxiety • T = Trapped • H = Hopelessness • W = Withdrawal • A = Anger • R = Recklessness • M = Mood Change

13. SAFE - T • Suicide Assessment Five Step Evaluation and Triage • 1) Identify Risk Factors • 2) Identify Protective Factors • 3) Conduct suicide inquiry • 4) Determine Risk Level/Intervention • 5) Document

14. Is the student a member of an at-risk, vulnerable or socially marginalized group? (e.g. male, older adolescent, history of mental illness, GLBT)

15. What historical or predisposing factors may elevate suicide risk? (e.g. previous history of suicidal behavior, family history of suicide, history of child abuse)

16. What are the presenting problems or current risk factors? (e.g. mental health status, impulsivity, aggression, stressful life events, relationship break-up, conflict with a family member, failure, disciplinary problems)

17. What is the level of current suicidal thinking and planning? (e.g. duration, specificity and intensity of ideation, level of planning, access to plan)

18. What are some specific protective factors (e.g. coping and problem-solving skills, supportive family, relational connections and social support, plans for the future, willingness to ask for help)

19. Documentation SOAP Method Subjective: What the client tells you Objective: Factual, quantifiable Assessment: Summary of client’s clinical thinking Plan: Parameters of treatment, action plan and prognosis

20. Break into Small Groups • Please select a “recorder” to document • Decide on the person at risk for suicide to give the details for assessment • Chose the individual who is going to ask the questions (everyone can participate, but one person leads) • Decide how to ASK the questions and what ACTION to take • Document your assessment and plan

21. AISD Guide for Counseling Support Following a School Crisis • AISD Crisis Counseling Support Team is the 12 District’s SSS Social Service Specialist Coordinator by Dianna Groves • Team assist campus counselors in monitoring & counseling students following campus crisis • SSS will work directly with Principal/Counselor to determine the LEVEL of crisis and support needed • Campus Level Crisis / Handled by Campus Staff • District Level Crisis / Need additional support from district • Community Level Crisis / Community Involvement

22. AISD Suicide Intervention Protocol • AISD Protocol provides specific steps for counselors and school staff • If student has specific plan /previous attempt/ or presenting imminnent danger, contact the SRO immediately • Contact Parents & Campus Administrator Immediately