Understanding Grief, Loss, and Suicide Prevention in Youth: A Comprehensive Guide

1. Overview • Grief & Loss • What grief looks like • What is normal • Dos and Don'ts • Activities • In class demo

2. Overview • Suicide • Rates & patterns • Protective & risk factors • Working with suicidal students • Risk Assessment • Crisis management • Prevention • Resources

3. Grief and loss

4. What grief looks like • Varies from child to child and across dev stages • Preschool • Tend to see death as temporary and reversible • Cartoons portrayal of death • Primary/intermediate aged • More advanced view of death, though still do not think it could happen to them or anyone they know

5. Normal Responses • Sadness immediately following death, as well as on and off over long period of time • Unexpected moments of sadness are typical • Anger • In the form of boisterous play, nightmares, irritability • Often directed towards surviving family members • Regressing • Typical with death of a parent • Infantile behavior, demand food, attention and cuddling, baby talk • Guilt • Younger children especially feel like they were the cause of death, due to their egocentric world view

6. DOs and DON’Ts with Grieving Students • DOlisten. • DO follow routines. • Routines provide a sense of safety which is very comforting to the grieving student. • DO set limits. • Just because students are grieving, doesn’t mean that the rules do not apply. DO NOT suggest that the student has grieved long enough.

7. Dos and Don’ts • DO NOT indicate that the student should get over it and move on. • DO NOT act as if nothing has happened. • DO NOT say things like:  - “It could be worse. You still have one brother.”  - “I know how you feel.”  - “You’ll be stronger because of this.” • DO NOT expect the student to complete all assignments on a timely basis.

8. Activities for children • Drawing • Family before/after loss • Small groups • Letter writing • Puppet shows • Balloon activity • All ages • TR Grief DVD • http://trevorromain.com/products-page/dvd/death-dvd/

9. Activities for adolescents • Journaling/letter writing • Prompts: • The thing that makes me feel the saddest is ..... • If I could talk to the person who died I would ask…. • Since the death my family doesn’t…. • Coping/relaxation techniques • Sailboat breathing • Role plays • Small groups • Drawing/memory books • TR DVD

10. Activities for teens • Journaling • Letter writing • Reading • Memory book/collage • Teaching relaxation/coping strategies • Small groups

11. Discussion • For what populations to do foresee traditional responses to grief being inappropriate or ineffective? • What would you do instead?

12. Balloon Activity • Think of a significant person in your life that has passed away • If you could send them a message today, what would it say?

13. Youth Suicide

14. Rates & Patterns • Many youth suicides occur between ages 12-14 • Incidence increases again in late teens • Girls are more likely to have suicidal ideation • Boys ideation more often results in completed suicide • Highest rates among Native American youth

15. Risk Factors • Personal characteristics • Psychopathology, namely depression • 90% of youth suicide victims have at least one major psychiatric disorder • Prior attempts • Strong predictor of completed suicide • LGBTQ • Personality factors • Poor interpersonal problem solving linked with risk of suicidal behavior

16. Risk Factors cont. • Family characteristics • History of suicidal behavior • Parental psychopathology • Adverse life circumstances • Stressful life events • Physical abuse • Socioenvirnomental Factors • School and work problems • Access to firearms • Suicide contagion

17. Protective Factors • Family cohesion • Religiosity • Restricting access to means • Peer support • Pets • Sound emotional regulation

18. What to do when faced with a suicidal student.. • Try to stay calm and be supportive • Student is feeling hopeless and stressed, your reaction is pivotal • Take a nonjudgmental stance • Moral reasoning is not appropriate • Encouraging self-disclosure • Painful for student to share • Helps with lethality assessment • Empowering students, emphasizing their worth, and making them feeling heard and respected are key elements • Share with the student your responsibility to keep them safe and your next steps to do so

19. Things to consider when assessing risk • Has the student imagined the reaction of others to his/her death? • Has the student made any final arrangements? • What is the method of planned use? • Does he/she have access to the means? • Support system? • Any reasons inhibiting suicide?

20. Risk Assessment • Be direct and unambiguous in asking questions • i.e. Are you considering harming yourself? If so, how? • Assess lethality of method and identify a course of action • Determine if student has a thorough understanding of the finality of death

21. Risk Assessment cont. • Outline the steps that will be taken to help the student • Keep detailed notes • Gather information from parents and teachers • Take necessary action • Call parents • Law enforcement • Social worker • No Harm contract

22. No harm/safety contracts • Some debate regarding their use • Counselors choice to implement • Tend to emphasize what students won’t do, rather than what they will do • False sense of security • Alternatives might look like encouraging student to agree to meet weekly with you from now on

23. Discussion • Thoughts on no harm contracts? • Given that they are neither contractual nor ensure student safety

24. What to NOT do… • Do not attempt to provide in-depth counseling regarding their issues • This cannot take place during height of suicidal crisis • Do not normalize suicide • It is one option, but there are stressing that others exist as well • Do not do the assessment alone • Observations made by multiple professionals are more comprehensive • Consultation is key!

25. Discussion • How will consultation look differently at each our your internship sites? • What barriers exist at these levels?

26. Crisis Management/Postvention • Telephone network should be in place to notify staff and arrange staff meeting prior to following school day • Statement given to staff • Esp important for contact with media • Upset students have a place to go outside of class • MH resources/referrals in place for students and families • Memorial service held off school grounds • Suggested for deaths of any kind • Contacting family and offer support

27. Prevention • Coping and Support Training (CAST) • Empirically supported 12 session peer group intervention for HS students • Effective with students at-risk for drop out and screened as suicide vulnerable • Over $400 for curriculum package  • Communication with admin • Ideally, district wide procedures • Participation in crisis teams

28. Prevention cont. • Faculty training • Teachers are often the first to know/suspect • Parent education • Protective factors • Warning signs • Classroom presentations re: your role as school counselor

29. Resources For information/resources on grief & loss: • Dougy Center • http://www.dougy.org/ • Hospice of the Valley • http://www.hov.org/teen_grief_program.aspx • American Hospice • http://www.americanhospice.org/articles-mainmenu-8/grieving-children- mainmenu-12 • American Academy of Child and Adolescent Psychiatry • http://www.aacap.org/cs/root/facts_for_families/children_and_grief • Camp Willie • http://www.campfireusasnohomish.org/campwillie.htm • Trevor Romain DVD – Grades 2-8 • http://trevorromain.com/products-page/dvd/death-dvd/

30. Resources cont. Suicide Prevention Efforts • Youth Suicide Prevention Program • http://www.yspp.org/ • High school based prevention: CAST • http://www.reconnectingyouth.com/cast/ Responding to school crisis • National Child Traumatic Stress Network • http://www.nctsn.org/resources/audiences/school-personnel/crisis-situation • UCLA Center for Mental Health in Schools • http://smhp.psych.ucla.edu/ • National Institute for Trauma and Loss in Children • http://www.tlcinstitute.org/crisisint.html