Suicide Prevention, Intervention & Postvention Protocol

Capistrano Unified School District Board of Trustees Martha McNicholas, President Gila Jones, Vice President Patricia Holloway, Clerk Amy Hanacek, Member Judy Bullockus, Member Dr. Gary Pritchard, Member Jim Reardon, Member Superintendent Kirsten Vital Associate Superintendents Dr. Susan Holiday, Associate Superintendent of Education Services Dr. Greg Merwin, Associate Superintendent of Student Support Services Executive Directors Mike Beekman, Executive Director Safety and Student Services Dr. Wendy Pospichal, Executive Director Intergraded Support Services Suicide Prevention, Intervention & Postvention Project Lead Rebecca Pianta, District Lead School Counselor Suicide Prevention & Intervention Project Staff Beth Chapman, Intervention Specialist Sonia Eatmon, School Psychologist Steven Gelsigner, Director of Related Services Joan Kaufman, Intervention Specialist Erin Masters, School Psychologist Dr. Loren Thurston, School Psychologist Suicide Postvention Project Staff Ryan Burris, Chief Communications Tom Bogiatzis, School Counselor Dr. George Duarte, Principal Marnie Feely, School Psychologist Josue Garcia, Intervention Specialist Steven Gelsigner, Director of Related Services Nereida Guillen, Intervention Specialist Kendall Hayward, School Counselor Joan Kaufman, Intervention Specialist Kasey Kessler, School Counselor Kristin Orloff, Assistant Principal Erin Pegan, School Psychologist Stephanie Pettey, Coordinator of Mental Health Hanh Marrocco, OCDE Crisis Response Network Coordinator Holly Ta, Intervention Specialist Joyce Toledo, School Counselor Cassie Walde, Communications & Public Relations Specialist 1

Capistrano Unified School District Suicide Prevention Protocol

Table of Contents

Suicide Prevention Protocol Abstract ........................................................................................................ 3 Protocol for Responding to Students at Risk for Suicide ....................................................................... 4-5 Suicide Risk Assessment Guide................................................................................................................. 6 Suicide Risk Level Action Plan ................................................................................................................ 7 Suicide Risk Level Reference Guide ........................................................................................................ 8 Suicide Assessment Risk Form (SARF) ................................................................................................... 9 Personal Strategies Plan ........................................................................................................................... 10 Suicide Prevention Guideline for Parents (Elementary) .................................................................... 11-12 Suicide Prevention Guideline for Parents (Secondary) ..................................................................... 13-14 Spanish Suicide Prevention Guideline for Parents (Elementary) ...................................................... 15-16 Spanish Suicide Prevention Guideline for Parents (Secondary) ........................................................ 17-18 Emergency Resources ............................................................................................................................. 19 Community Counseling Resources ......................................................................................................... 20

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SUICIDE PREVENTION & INTERVENTION PROTOCOL The Capistrano Unified School District is committed to providing a safe, civil and secure school environment. Suicide is the third leading cause of death in youth between the ages of 10-19. Eleven percent of high school students have made at least one suicide attempt, while 40 percent have indicated serious suicidal thoughts. Schools are in a unique position to teach/reinforce resiliency skills, identify atrisk students, and provide appropriate intervention strategies. It is the District’s charge to respond appropriately to a student expressing or exhibiting suicidal ideation or behaviors. A program that implements a systematic approach has the potential to increase both emotional and academic performance stability. After careful review of current suicide prevention protocols available from statewide districts, an adaptation of the LAUSD suicide protocol was developed to meet the needs of Capistrano Unified School District’s population. This protocol will serve as a uniform tool for crisis team members and administrators/designees when assessing a student for suicidal risk. The goals of this suicide prevention protocol are to:  Increase the knowledge of at-risk indicators.  Provide strategies to increase and reinforce resiliency factors.  Provide a user friendly and standardized concerned persons/referral protocol.  Provide a standardized intervention protocol that includes cooperation and collaboration with outside agencies and a more overall, protective environment for potential existing, returning and reoccurring suicidal students.

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PROTOCOL FOR RESPONDING TO STUDENTS AT RISK FOR SUICIDE

The following is a summary checklist of general procedures for the crisis team member or administrator/designee to respond to any reports of students exhibiting suicidal behavior/ideation. The urgency of the situation will dictate the order in which the subsequent steps are followed. A. RESPOND IMMEDIATELY • Once a student is identified to be at risk for suicide the referral should be directly sent to any crisis team member. If the crisis team member is unavailable, the referral should be given to an available administrator/designee. • Ensure that any student sent to the office for suicide risk assessment is accompanied by a staff member. B. SECURE THE SAFETY OF THE STUDENT • Ensure that the student is supervised at all times. • If the student is agitated, unable to be contained or for immediate assistance, contact the SRO/Patrol Deputy. C. ASSESS FOR SUICIDE RISK (See Suicide Risk Assessment Guide) • Designated crisis team member or administrator/designee gathers essential background information that will help with assessing the student’s risk for suicide (e.g., what the student said or did, information that prompted concern or suspicion, copies of any concerning writings or drawings). • The crisis team member meets with the student to complete a risk assessment using the Suicide Risk Assessment Guide. • The designated crisis team member collaborates with another crisis team member to determine level of risk. D. DETERMINE APPROPRIATE ACTION PLAN (See Risk Level Action Plan) • Determine action plan based on level of risk. • Notify an administrator/designee of the student’s risk level. • If the SRO/Patrol Deputy/SMART/CAT determines that he/she will transport the student to an emergency hospital, notify an administrator/designee beforehand. • Contact the parent/guardian or consult the emergency card for an appropriate third party. Communication with parent/guardian may include:  Communicating concerns and making recommendations for safety in the home (e.g., securing firearms, medications, cleaning supplies, cutlery, razor blades, etc.).  Providing school and/or local community mental health resources. Students with private health insurance should be referred to their provider.  Facilitating contact with community agencies and following-up to ensure access to services.  Providing a copy of Guidelines for Parents (Elementary) or Guidelines for Parents (Secondary).

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PROTOCOL FOR RESPONDING TO STUDENTS AT RISK FOR SUICIDE

 Obtain parent/guardian permission to release and exchange information with community agency staff using the Parent Authorization for Release/Exchange of Medical Information form. E. DETERMINE APPROPRIATE FOLLOW-UP PLAN • Develop a personal strategies plan.  Identify caring adults in the school, home and community environment.  Discuss and identify helpful coping skills.  Provide after-hours resource numbers such as the Suicide Prevention Crisis Line (877) 7274747. • Mobilize a support system and provide resources.  Connect student and family with social, school and community supports.  For mental/physical health services, refer the student to a community resource provider, or their health care provider. • Follow up with student and monitor, if needed. • Consider scheduling a SST/504/IEP meeting to review concerns & on campus action plan, if warranted. F. STUDENT RE-ENTRY GUIDELINES • If student is held for a 5150 hold, establish a retry plan by conducting a SST/504/IEP meeting before or soon after the student’s return back to school. • The team will determine appropriate course of action that may include additional support, services and/or assessment. • If student transfers to new school, coordinate re-entry with that school. G. DOCUMENT ALL ACTIONS • Document in Aeries that a risk assessment was conducted and indicated follow actions (i.e.: Risk assessment conducted, referred to SRO, parent notified & outside referral made) • Complete the Suicide Assessment Risk Form (SARF). The SARF should be kept in a confidential file, separate from the student’s records and should not be shared with anyone. The SARF is considered confidential information. *** SUSPECTED CHILD ABUSE *** • If child abuse by a parent/guardian is suspected or there is reasonable suspicion that contacting the parent may escalate the student’s current level of risk, and/or the parents/guardians are contacted and unwilling to respond, report the incident to child protective services by calling (800)207-4464. • The report should include information about the student’s suicide risk level and any concerning ideations or behaviors. The reporting party must follow directives, as indicated by the child protective services agency personnel.

The privacy of all students should be protected at ALL times. Disclose information only on a need to know basis.

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SUICIDE RISK ASSESSMENT GUIDE Confidential

The suicide assessment checklist should be used as a guide while assessing the student. LOW

MODERATE

HIGH

1. Suicide Plan __ Method __ Time __ Location __ Details __ Means

__ unclear __ in the future __ unplanned __ vague __ doesn't have means

__ some plans __ within a few hours __ may be in place __ some specifics __ means close by

__ detailed plan __ immediately __ at the location __ well thought out __ has means at hand

2. Final Arrangements

__ vague

__ made some plans

__ has given away possessions __ note left/will made out

3. Previous Attempts

__ none

__ moderate lethality

__ 2 or more attempts __ one high lethality

4. Alcohol/Drug Use

__ none __ infrequent __ has in the past

__ frequently to excess

__ continual abuse

5. Can Only See Death

__ none __ little; can see options

__ some

__ markedly

6. Hostility

__ none __ little

__ some

__ markedly

7. Disoriented

__ none __ little

__ some

__ markedly

8. Past Psychiatric Help

__ none

__ one or two

__ three or more

9. Recent Loss/Loss of a Loved One by Suicide/ Trauma

__ none

__ one or more

__ multiple

10. Isolation/Withdrawal

__ vague feeling of isolation

__ some feelings of being helpless and hopeless __ withdrawn

__ hopeless __ helpless withdrawn __ continually tearing

11. Anxiety

__ mild

__ moderate

__ high __panic phase __ extremely calm if decision is made

12. Depression

__ mild

__ moderate

__ severe __ happy if decision is made

13. Significant Others

__ several people available

__ few __ only one person available

__ no one available

Place this form in your CONFIDENTIAL file- DO NOT place in student’s CUM file

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SUCIDE RISK LEVEL ACTION PLAN

DO NOT LEAVE THE STUDENT UNSUPERVISED  Low Risk:  Best practices indicate to collaborate with another crisis team member to determine the risk level.  Develop a personal strategies plan that identifies caring adults, appropriate communication and coping skills.  Assist in connecting with school and community resources, including crisis lines.  Communicate concerns with parent/guardian and provide resources.  Notify an administrator/designee that risk assessment was conducted.  Complete the SARF and place in your confidential file.  Follow up with student and monitor as needed.

 Moderate and High Risk:  Best practices indicate to collaborate with another crisis team member to determine the risk level.  Develop a personal strategies plan that identifies caring adults, appropriate communication and coping skills.  Contact the SRO/Patrol Deputy/CAT. The SRO/Patrol Deputy/CAT will conduct their assessment to determine if a 5150 hold is appropriate.  Notify an administrator/designee that risk assessment was conducted.  If the SRO/Patrol Deputy/SMART/CAT determines that the student will be transported to an emergency hospital, notify an administrator/designee beforehand.  Communicate concerns with parent/guardian and provide resources.  Complete the SARF and place in your confidential file.  If student is held for a 5150 hold, establish a retry plan by conducting a SST/504/IEP meeting before or soon after the student’s return back to school.  Follow up with student and monitor, as needed.

*** If child abuse is suspected, contact CPS**** 7

SUICIDE RISK LEVEL QUICK REFERENCE GUIDE

RISK LEVEL

Low Risk

DEFINITION  

Does not pose imminent danger to self Insufficient evidence for suicide potential

INDICATORS        

Passing thoughts of suicide No plan No previous attempts No access to weapons or means no recent losses Support system in place No alcohol/substance abuse depressed mood/affect Evidence of thoughts in notebooks, internet postings, drawings Sudden changes in personality/behavior (e.g., distracted, hopeless, academically disengaged)

ACTIONS 





   

Moderate Risk



May pose imminent danger to self, but there is insufficient evidence to demonstrate a viable plan of action to do harm

       

High Risk





 

Poses imminent danger to self with a viable plan to do harm Exhibits extreme and/or persistent inappropriate behaviors Sufficient evidence for violence potential Qualifies for immediate arrest or hospitalization

   

     

Best practices indicate to collaborate with another crisis team member to determine the risk level. Develop a personal strategies plan that identifies caring adults, appropriate communication and coping skills. Assist in connecting with school and community resources, including crisis lines. Communicate concerns with parent/guardian and provide resources. Notify an administrator/designee that risk assessment was conducted. Complete the SARF and place in your confidential file. Follow up with student and monitor as needed.

Thoughts of suicide Plan with some specifics Unsure of intent Previous attempts and/or hospitalization Difficulty naming future plans Past history of substance use, with possible current intoxication Self-injurious behavior Recent trauma (e.g., loss, victimization)



SEE HIGH RISK

Current thoughts of suicide Plan with specifics, indicating when, where and how Access to weapons or means in hand Finalizing arrangements (e.g. giving away prized possessions, good-bye messages in writing, text, on social networking sites Isolated and withdrawn Current sense of hopelessness Previous attempts No support system Currently abusing alcohol/substances Mental health history Precipitating events, such as loss of loved one, traumatic event, or bullying



Best practices indicate to collaborate with another crisis team member to determine the risk level. Develop a personal strategies plan that identifies caring adults, appropriate communication and coping skills. Contact the SRO/Patrol Deputy/CAT. The SRO/Patrol Deputy/CAT will conduct their assessment to determine if a 5150 hold is appropriate Notify an administrator/designee that a risk assessment was conducted If the SRO/Patrol Deputy/SMART determines that the student will be transported to an emergency hospital, notify an administrator/designee beforehand Communicate concerns with parent/guardian and provide resources Complete the SARF and place in your confidential file If student is held for a 5150 hold, establish a retry plan by conducting a SST/504/IEP meeting before or soon after the student’s return back to school





 

  



Follow up with student and monitor as needed

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SUICIDE ASSESSMENT RISK FORM (SARF) Confidential

SUICIDE ASSESSMENT RISK REPORT Student Name ________________________________

Date: _____________________________________

Crisis Team Member ___________________________

School ____________________________________

Student Referred By: (Check all that apply) ____ Self

____ Administrator

____ Counselor

____ Parent

____ Teacher

____ Psychologist

____ Peer

____ Nurse/Health Assistant

____ Other (specify): _________________

Reason for Referral: (Check all that apply) ____ Current attempt

____ Sudden changes in behavior

____ frequent complaints of illness

____ Direct threat

____ Drug or alcohol abuse

____ Psycho-social stressors

____ Indirect threat

____ Self-injury

____ Previous attempt(s)

____ Giving away possessions

____ Mood swings

____ Other (specify): _______________

____ Signs of depression

____ Truancy or running away

Suicidal Behavior: (Check all that apply) ____ Ideation

____ Suicide Plan

____ Suicidal Attempt

____ 5150 Hospitalization

Previous SARF ____ Yes

____ Self-Injury

____ No

Interventions: (Check all that apply) _____ Parent/Guardian Contact: Name _____________________________ Date/Time: ___________________ _____ Suicide Prevention Guidelines Provided to Parent/Guardian _____ Outside Referral Made: Community Resources/Health Care Provider _____ Child Abuse Report Made (endangerment) _____ Referred to SRO/Patrol Deputy/SMART Transported by: _________________________ _____ 5150 Hospitalization _____ SST Meeting Planned _____ Other (specify) _____________________________ Place this form in your CONFIDENTIAL file-DO NOT place in the student’s CUM file

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PERSONAL STRATEGIES PLAN STEP 1: I should use my safety plan when I notice these warning signs (thoughts, images, moods, situations, behaviors): 1. _____________________________________ 2. _____________________________________ 3. _____________________________________ STEP 2: Internal coping strategies – Things I can do by myself to help myself not act on how I’m feeling (e.g. favorite activities, hobbies, relaxation techniques, distractions): 1. _____________________________________ 2. _____________________________________ 3. _____________________________________ What might make it difficult for me to use these strategies? _______________________________________________________________________________________ Solution: _______________________________________________________________________________________ STEP 3: People and places that improve my mood and make me feel safe: 1. Name: _____________________________________ 2. Name: _____________________________________ 3. Place: ______________________________________ What might get in the way of me contacting these people or going to these places? _______________________________________________________________________________________ Solution: _______________________________________________________________________________________ STEP 4: People I trust who can help me during a crisis: 1. Name:______________________________________ 2. Name: ______________________________________ 3. Name: ______________________________________ Why might I hesitate to contact these people when I need help? _______________________________________________________________________________________ Solution: How will I let them know that I need their help? _______________________________________________________________________________________ STEP 5: Professional resources and referrals I should contact during a crisis (available 24/7):  Orange County Suicide Center: 877-727-4747  National Suicide Prevention Lifelines: 800-273-8255  Call 911 if you need immediate help in order to remain safe. STEP 6: Steps I can take to keep myself safe by reducing access to means I would consider using during a suicidal crisis: 1. _____________________________________ 2. _____________________________________

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SUICIDE PREVENTION GUIDELINES FOR PARENTS PART ONE (ELEMENTARY)

Youth Suicide in the United States* • Suicide is the third leading cause of death for youth aged 10-24 in the United States. • In recent years more young people have died from suicide than from cancer, heart disease, HIV/AIDS, congenital birth defects, and diabetes combined. • For every young person who dies by suicide, between 100-200 attempt suicide. • Males are four times as likely to die by suicide as females - although females attempt suicide three times as often as males. SUICIDE IS PREVENTABLE: Here’s what you can do: • Talk to your child about suicide. Don’t be afraid; you will not be “putting ideas into their heads.” Asking for help is the single skill that will protect your student. Help your child to identify and connect to caring adults to talk to when they need guidance and support. • Know the risk factors and warning signs of suicide. • Remain calm. Establish a safe environment to talk about suicide. • Listen to your child’s feelings. Don’t minimize what your child says about what is upsetting him or her. Put yourself in your child’s place; don’t attempt to provide simple solutions. • Be honest. If you are concerned, do not pretend that the problem is minor. Tell the child that there are people who can help. State that you will be with him or her to provide comfort and love. • Be supportive. Children look for help and support from parents, older brothers and sisters. Talk about ways of dealing with problems and reassure your child that you care. Let children know that their bad feelings will not last forever. • Remove means to potentially dangerous items (i.e. firearm, knife, pills, etc…) in the home, as long as it does not put the caregiver in danger. • Take action. It is crucial to get professional help for your child. When you are close to a situation it is often hard to see it clearly. You may not be able to solve the problem yourself. Many students, no many how safe and healthy a family is, can benefit from talking to a trained, objective and safe professional.  Help may be found at a local mental health agency, family service agency or through your clergy. 

Become familiar with the support services at your child’s school. Contact the appropriate person(s) at the school, for example, the school social worker, school psychologist, school counselor, or school nurse.

*M. Heron, D. L. Hoyert, S. L. Murphy, J. Xu, K. D. Kochanek, & B. Tejada-Vera. (2009, April). Deaths: Final Data for 2006. National Vital Statistics Reports, 57(14).

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SUICIDE PREVENTION GUIDELINES FOR PARENTS PART TWO (ELEMENTARY)

Youth Suicide Risk Factors While the path that leads to suicidal behavior is long and complex and there is no “profile” that predicts suicidal behavior with certainty, there are certain risk factors associated with increased suicide risk. In isolation, these factors are not signs of suicidal thinking. However, when present they signal the need to be vigilant for the warning signs of suicide. The behaviors listed below may indicate that a child is emotionally distressed and may begin to think and act in self-destructive ways. If you are concerned about one or more of the following behaviors, please seek assistance at your child’s school or at your local mental health service agency. Home Problems

Physical Problems

• Running away from home

• Frequent stomachaches or headaches for no

• Arguments with parents / caregivers

apparent reason • Changes in eating and/or sleeping habits

Behavior Problems

• Nightmares or night terrors

• Temper tantrums • Thumb sucking or bed wetting/soiling

School Problems

• Acting out, violent, impulsive behavior

• Chronic truancy or tardiness

• Bullying

• Decline in academic performance

• Accident proneness

• Fears associated with school

• Sudden change in activity level or behavior • Hyperactivity or withdrawal Serious Warning Signs • Severe cruelty towards people or pets

• Risk taking, such as intentional running in front

• Scratching, cutting or marking the body

of cars or jumping from high places

• Thinking, talking, drawing about suicide

• Intense/excessive preoccupation with death

• Previous suicide attempts

OC COUNTY RESOURCE Suicide Prevention Hotline 877-7-CRISIS or 877-27-4747

NATIONAL RESOURCE Suicide Prevention Lifeline 800-273-TALK or 800-273-8255 12

SUICIDE PREVENTION GUIDELINES FOR PARENTS PART ONE (SECONDARY)

Youth Suicide in the United States* • Suicide is the third leading cause of death for youth aged 10-24 in the United States. • In recent years more young people have died from suicide than from cancer, heart disease, HIV/AIDS, congenital birth defects, and diabetes combined. • For every young person who dies by suicide, between 100-200 attempt suicide. • Males are four times as likely to die by suicide as females - although females attempt suicide three times as often as males. SUICIDE IS PREVENTABLE. Here’s what you can do: • Talk to your child about suicide. Don’t be afraid; you will not be “putting ideas into their heads.” Asking for help is the single skill that will protect your student. Help your child to identify and connect to caring adults to talk to when they need guidance and support. • Know the risk factors and warning signs of suicide. • Remain calm. Establish a safe environment to talk about suicide. • Listen without judging. Allow for the discussion of experiences, thoughts, and feelings. Be prepared for expression of intense feelings. Try to understand the reasons for considering suicide without taking a position about whether or not such behavior is justified. Ask open-ended questions. • Adult supervision as needed. • Remove means to potentially dangerous items (i.e. firearm, knife, pills, etc…) in the home, as long as it does not put the caregiver in danger. • Take action. It is crucial to get professional help for your child. When you are close to a situation it is often hard to see it clearly. You may not be able to solve the problem yourself. Many students, no many how safe and healthy a family is, can benefit from talking to a trained, objective and safe professional.  Help may be found at a suicide prevention center, local mental health agency, family service agency or through your clergy.  Become familiar with the support services at your child’s school. Contact the appropriate person(s) at the school, for example, the school social worker, school psychologist or school counselor. *M. Heron, D. L. Hoyert, S. L. Murphy, J. Xu, K. D. Kochanek, & B. Tejada-Vera. (2009, April). Deaths: Final Data for 2006. National Vital Statistics Reports, 57(14). 13

SUICIDE PREVENTION GUIDELINES FOR PARENTS PART TWO (SECONDARY)

Youth Suicide Risk Factors: While the path that leads to suicidal behavior is long and complex and there is no “profile” that predicts suicidal behavior with certainty, there are certain risk factors associated with increased suicide risk. In isolation, these factors are not signs of suicidal thinking. However, when present they signal the need to be vigilant for the warning signs of suicide. Specifically, these risk factors include the following: • History of depression, mental illness or

• Isolation or lack of social support

substance/alcohol abuse disorders

• Impulsivity

• Family history of suicide/suicide in community

• Situational crises

• Presence of a firearm or rope

• Incarceration

• Hopelessness Suicide Warning Signs: Warning signs are observable behaviors that may signal the presence of suicidal thinking. They might be considered “cries for help” or “invitations to intervene.” These warning signs signal the need to inquire directly about whether the individual has thoughts of suicide. If such thinking is acknowledged, then suicide interventions will be required. Warning signs include the following:  Suicide threats. It has been estimated that up to 80% of all suicide victims have given some clues regarding their intentions. Both direct (“I want to kill myself”) and indirect (“I wish I could fall asleep and never wake up”) threats need to be taken seriously.  Suicide notes and plans. The presence of a suicide note is a very significant sign of danger. The greater the planning revealed by the youth, the greater the risk of suicidal behavior.  Prior suicidal behavior. Prior behavior is a powerful predictor of future behavior. Thus anyone with a history of suicidal behavior should be carefully observed for future suicidal behavior.  Making final arrangements. Giving away prized possessions, writing a will, and/or making funeral arrangements may be warning signs of impending suicidal behavior.  Preoccupation with death. Excessive talking, drawing, reading, and/or writing about death may suggest suicidal thinking.  Changes in behavior, appearance, thoughts, and/or feelings. Depression (especially when combined with hopelessness), sudden happiness (especially when preceded by significant depression), a move toward social isolation, giving away personal possessions, and reduced interest in previously important activities are among the changes considered to be suicide warning signs. Orange County Suicide Prevention Hotline ~ 877-7-CRISIS OR 877-727-4747

National Suicide Prevention Lifeline ~ 800-273-TALK or 800-273-8255

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GUÍAS DE PREVENCIÓN DEL SUICIDIO PARA PADRES PARTE UNA (PRIMARIA)

Suicidio de los adolescentes en los Estados Unidos* • El suicidio es la tercera causa principal de muerte entre los jóvenes entre las edades de 10 a 24 años en los Estados Unidos. • En años recientes más personas jóvenes han muerto por suicidio que todas las enfermedades combinadas de cáncer, enfermedad del corazón, VIH / SID y defectos congénitos. • Por cada joven que muere por suicidio, entre 100-200 intentan el suicidio. • Los varones tienen cuatro veces más probabilidades de morir por suicidio que las mujeres - aunque las mujeres intentan suicidarse tres veces más frecuentemente que los hombres. EL SUICIDIO SE PUEDE PREVENIR: Esto es lo que puede hacer: • Hable con su hijo sobre el suicidio. No tenga miedo; usted no va a "poner las ideas en su cabeza". • Pedir ayuda es la única posibilidad que protegerá a su hijo/a. Ayude a su hijo/a a identificar y conectarse con adultos de confianza con quien puedan hablar cuando necesiten orientación y apoyo. • Conozca los factores de riesgo y señales de advertencia de suicidio. • Mantenga la calma. Establezca un ambiente seguro para hablar sobre el suicidio. • Escuche los sentimientos de su hijo/a. No minimice lo que su hijo/a dice acerca de lo que lo/la está alterando. Póngase en el lugar de su hijo/a; no intente dar soluciones simples. • Sea honesto. Si está preocupado, no pretenda que el problema es mínimo. Dígale a su hijo/a que hay personas que pueden ayudarle. Dígale que va a estar con él/ella para ofrecerle consuelo y amor. • Bríndele apoyo. Los hijos/as buscan ayuda y apoyo de los padres, hermanos y hermanas mayores. Hable sobre las maneras de enfrentar los problemas y asegúrele que a usted le importa. Haga saber a su niño/a que sus sentimientos negativos no van a durar para siempre. • Elimine los artículos que puedan ser potencialmente peligrosos (p. ej., arma de fuego, cuchillo, pastillas, etc...) del hogar, con tal de que no ponga en peligro al proveedor de cuidado. • Tome acción. Es crucial que obtenga ayuda profesional para su hijo/a. A menudo es difícil ver con claridad cuando estamos cerca de una situación así. Tal vez no pueda resolver el problema por sí mismo. Muchos de los estudiantes, no importa que tan segura y saludable sea una familia, pueden beneficiarse al hablar con un profesional capacitado, que sea objetivo y seguro.  Puede encontrar ayuda en una agencia local de salud mental, la agencia de servicios familiares o por medio de su consejero espiritual.  Familiarícese con los servicios de apoyo en la escuela de su hijo/a. Póngase en contacto con la persona (s) apropiada en la escuela, por ejemplo, el trabajador social, psicólogo, consejero escolar o enfermera. *M. Heron, D. L. Hoyert, S. L. Murphy, J. Xu, K. D. Kochanek, & B. Tejada-Vera. (Abril, 2009). Muertes: Estad. Final del 2006. Informes de estadísticas vitales nacionales, 57(14).

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GUÍAS DE PREVENCIÓN DEL SUICIDIO PARA PADRES PARTE DOS (PRIMARIA)

FACTORES DE RIESGO DE SUICIDIO EN LOS JÓVENES Mientras que el camino que conduce a un comportamiento suicida es largo y complejo y no hay un "perfil" que predice el comportamiento suicida con certeza, hay ciertos factores de riesgo asociados que aumentan el riesgo de suicidio. Aisladamente, estos factores no son signos de pensamientos suicidas. Sin embargo, cuando están presentes indican la necesidad de estar alerta a las señales de advertencia del suicidio. Las conductas enumeradas a continuación pueden indicar que un niño/a está emocionalmente afligido y puede comenzar a pensar y actuar de maneras autodestructivas. Si usted está preocupado por uno o más de los siguientes comportamientos, por favor busque ayuda en la escuela de su hijo/a o en la agencia de servicios de salud mental de su localidad. Problemas en casa

Problemas físicos

• Fugarse de la casa

• Dolores de estómago o de cabeza sin una razón

• Discusiones con los padres/encargado

aparente

Problemas de comportamiento

• Cambios en la alimentación y/o hábitos de sueño

• Berrinches

• Pesadillas o terrores nocturnos

• Chuparse el dedo, orinarse o defecarse en la cama

Problemas escolares

• Comportamiento rebelde, violento, o impulsivo

• Ausentismo crónico o tardanza

• Intimidación

• Declive del rendimiento académico

• Propensión a los accidentes

• Temores asociados con la escuela

• Cambio repentino en el nivel de actividad o comportamiento • Hiperactividad o alejamiento Señales graves de advertencia • Crueldad severa hacia humanos o mascotas

• Tomar riesgos, tales como correr

• Rascarse, cortarse o marcarse el cuerpo

intencionalmente delante de autos o saltar

• Pensar, hablar, dibujar sobre el suicidio

desde lugares altos

• Intentos previos de suicidio

• Preocupación intensa o excesiva con la muerte

RECURSOS EN EL CONDADO DE ORANGE

RECURSOS NATIONALES

Línea directa de prevención del suicidio

Línea de vida para prevención del Suicidio

877-7-CRISIS o 877-27-4747

800-273-TALK o 800-273-8255 16

GUÍAS DE PREVENCIÓN DEL SUICIDIO PARA PADRES PARTE UNO (SECUNDARIA)

El suicidio de los jóvenes en los Estados Unidos* • El suicidio es la tercera causa principal de muerte entre los jóvenes entre las edades de 10 a 24 años en los Estados Unidos. • En años recientes más personas jóvenes han muerto por suicidio que todas las enfermedades combinadas de cáncer, enfermedad del corazón, VIH / SID y defectos congénitos al nacer. • Por cada joven que muere por suicidio, entre 100-200 intentan el suicidio. • Los varones tienen cuatro veces más probabilidades de morir por suicidio que las mujeres - aunque las mujeres intentan suicidarse tres veces más frecuentemente que los hombres. EL SUICIDIO SE PUEDE PREVENIR: Esto es lo que puede hacer: • Hable con su hijo sobre el suicidio. No tenga miedo; usted no va a "poner las ideas en su cabeza". Pedir ayuda es la única posibilidad que protegerá a su hijo/a. Ayude a su hijo/a a identificar y conectarse con adultos de confianza con quien pueden hablar cuando necesitan orientación y apoyo. • Conozca los factores de riesgo y señales de advertencia de suicidio. • Mantenga la calma. Establezca un ambiente seguro para hablar sobre el suicidio. • Escuche sin juzgar. Permita la discusión de experiencias, pensamientos y sentimientos. Esté preparado para la expresión de sentimientos intensos. Trate de entender las razones por las cuales el suicidio es considerado sin tener una postura acerca de si ese tipo de comportamiento se justifica o no. Haga preguntas abiertas. • Supervisión de un adulto cuando sea necesario. • Elimine los artículos que puedan ser potencialmente peligrosos (p. ej., arma de fuego, cuchillo, pastillas, etc...) del hogar, con tal de que no ponga en peligro al proveedor de cuidado. • Tome acción. Es crucial que obtenga ayuda profesional para su hijo/a. A menudo es difícil ver con claridad cuando estamos cerca de una situación así. Tal vez no pueda resolver el problema por sí mismo. Muchos de los estudiantes, no importa que tan segura y saludable sea una familia, pueden beneficiarse al hablar con un profesional capacitado, que sea objetivo y seguro.  Puede encontrar ayuda en una agencia local de salud mental, una agencia de servicios familiares o por medio de su consejero espiritual.

 Familiarícese con los servicios de apoyo en la escuela de su hijo/a. Póngase en contacto con la persona (s) apropiada en la escuela, por ejemplo, el trabajador social, psicólogo o consejero escolar. *M. Heron, D. L. Hoyert, S. L. Murphy, J. Xu, K. D. Kochanek, & B. Tejada-Vera. (Abril, 2009). Muertes: Estad. Final del 2006. Informes de estadísticas vitales nacionales, 57(14).

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GUÍAS DE PREVENCIÓN DEL SUICIDIO PARA PADRES PARTE DOS (SECUNDARIA)

FACTORES DE RIESGO DE SUICIDIO EN LOS JÓVENES: Mientras que el camino que conduce a un comportamiento suicida es largo y complejo y no hay un "perfil" que predice el comportamiento suicida con certeza, hay ciertos factores de riesgo asociados que aumentan el riesgo de suicidio. Aisladamente, estos factores no son signos de pensamientos suicidas. Sin embargo, cuando están presentes indican la necesidad de estar alerta a las señales de advertencia de suicidio. Específicamente, estos factores de riesgo incluyen lo siguiente:

• Historial de depresión, enfermedad mental, problemas de abuso de sustancias o alcohol • Antecedentes de suicidio en la familia o en la comunidad • La presencia de un arma de fuego o una cuerda

• Desesperación • El aislamiento o la falta de apoyo social • La impulsividad • Crisis situacional • Encarcelamiento

Los signos de advertencia de suicidio: Los signos de advertencia son conductas observables que pueden indicar la presencia de pensamientos suicidas. Ellos podrían ser considerados como "gritos de auxilio" o "invitaciones para intervenir". Estos signos de advertencia señalan la necesidad de preguntar directamente acerca de si el individuo tiene pensamientos de suicidio. Si este tipo de pensamiento es admitido, entonces se requerirán intervenciones de suicidio. Las señales de advertencia incluyen lo siguiente: 

Amenazas de suicidio. Se ha estimado que hasta el 80% de todas las víctimas de suicidio han dado algunas pistas sobre sus intenciones. Tanto directa ("Quiero matarme") e indirecta ("Me gustaría poder conciliar el sueño y nunca despertar") las amenazas deben tomarse en serio.

 Notas y planes de suicidio. La presencia de una nota de suicidio es una señal muy importante de peligro. Entre más revele el joven de sus planes, el riesgo de comportamiento suicida es mayor.  Comportamiento suicida previo. El comportamiento previo es un potente pronóstico del comportamiento futuro. Por lo tanto cualquier persona con un historial de comportamiento suicida debe ser observado cuidadosamente ya que dicho comportamiento suicida puede presentarse en el futuro.  Hacer los arreglos finales. Regalar pertenencias de valor, escribir un testamento y/o hacer los arreglos para el funeral pueden ser señales de advertencia del inminente comportamiento suicida.  Preocupación por la muerte. Hablar excesivamente, dibujar, leer y/o escribir sobre la muerte puede sugerir pensamientos suicidas.  Cambios de comportamiento, apariencia, pensamientos y/o sentimientos. Depresión (especialmente cuando se combina con la desesperación), felicidad repentina (especialmente cuando es precedida por una depresión significativa), un movimiento hacia el aislamiento social, regalar pertenencias personales y el reducido interés en actividades que antes eran importantes; están entre los cambio considerados como señales de advertencia de suicidio. Línea directa de prevención de suicidio del condado de Orange ~ 877-7-CRISIS OR 877-727-4747 Línea de vida para prevención del Suicidio~ 800-273-TALK o 800-273-8255

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EMERGENCY RESOURCES Orange County Child Abuse Registry

(800) 207-4464

Patrol Deputy

(949) 770-6011

CAT (866) 830-6011 The Centralized Assessment Team (CAT) is for assessment and evaluation of individuals experiencing psychiatric emergencies including threats to harm self, others, or gravely disabled SMART (949) 283-0536 or (949) 283-2714 The School Mobil Assessment & Resource Team (SMART) typically responds to direct or indirect threats to schools, threats to children on campus and school staff members, the possession of weapons on campus or the threat to bring weapons to school, suicide threats if the threats involve weapons or the act is believed to effect campus security, and assaults on staff members. SMART may also respond to other issues once the SRO has contact them and SMART determines a need for safety reasons. If, like in this case, the SRO is not available and you believe there is a threat at the school as a result of the suicide threat, you may call SMART for their recommendation. However, normal mental health evaluations absent threats involving the schools should be performed by an SRO, patrol deputy or CAT. Mission Hospital - Mission Viejo 27700 Medical Center Road Mission Viejo, CA 92691

(949) 364-1400 www.mission4health.com

Emergency Suicide Evaluations Mission Hospital - Laguna Beach 31872 Coast Highway Laguna Beach, CA 92651

(949) 499-1311 www.mission4health.com

Emergency Suicide Evaluations Suicide Prevention Crisis Line (877) 727-4747 www.didihirsch.org Crisis chat available online Speak with a highly trained member of Didi Hirsch's suicide prevention crisis line, which provides direct, confidential 24-hour telephone counseling to individuals contemplating, threatening or attempting suicide.

National Suicide Prevention Hotline www.suicidepreventionlifeline.org

(800) 273-8255 Crisis chat available online

24 hours a day, 7 days a week - by calling you will be connected to a skilled, trained crisis counselor

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COMMUNITY COUNSELING RESOURCES Counseling Centers

Drug & Alcohol Abuse

BBK Results Oriented Therapy

(714) 543-0483

California Youth Services

(949) 303-9016

CARE Counseling Center Casa de la Familia Catholic Charities of Orange County, Inc. CHEC Family Resource Center Child Guidance Center The Chicago School's Irvine Counseling Center The Community Resource Center of San Clemente Western Youth Services Family Assessment Counseling & Education Services

(714) 836-9900 (714) 667-5220 (714) 347-9674

The Bridge

(949) 716-4653

The Community Resource Center of San Clemente DECISIONS Hope By The Sea

(949) 303-0353 (949) 303-9016 (949) 218-2690

(949) 489-7742 (714) 953-4455

JADE (Juvenile Alcohol & Drug Education) Touchstones Turning Point for Families

(949) 303-9016 (877) 507-6242 (714) 547-811

(949) 769-7747

Twin Town Treatment Centers

(866) 594-8844

(949) 595- 8610

Safe Rides for Teens Pacific Hills Treatment Center

1-800-273-RIDE (888) 758-9677

(714) 447-9024

US NO Drugs

(888) 852-5869

Families Forward

(949) 552-2727

Laguna Behavioral Pepperdine Resource, Youth, Diversion, and Education Pepperdine University Community Counseling Center Pilgrimage Family Therapy Center South Orange County Family Resource Center Turning Point for Families

(949) 367- 1200

Grief & Loss Arts & Creativity for Healing, Inc.

(949) 367-1902

(949) 425-1911

Camp Erin - Orange County

(714) 884-8714

(714) 547-811

The Compassionate Friends - Irvine (Spanish) Gary's Place for Kids

(949) 228-6402 (949) 348-0548

Western Family Services

(949) 900-3242

Kids Konnected

(949) 582-5443

New Hope Grief Support

(562) 429-0075

Loved Ones Healing Center (LOVS)

(310) 337-7006

[email protected]

(949) 233-2570 (949) 460-5320 (949) 364-0500

Cancer Support Services Kids Konnected

(949) 582-5443

Walk with Sally

(310) 378-5843 Domestic & Dating Violence

Comfort Zone Camp The Compassionate Friends - Irvine Chapter

(310) 781-1032 (714) 504-7042

LGBTQ Support The Center OC

714-953-5428 X 206

Rainbow Youth Group

714-953-5428 X 206

Colette's Children's Home

(714) 596-1380

Youth Empowered to Act (YETA)

714-953-5428 X 206 -

Human Options - 24 hour hotline

(877) 854-3594

OC Accept

(714) 517-6100

Kathy's House

(949) 248-8300

PFLAG - South Orange County

(949) 677-7840

Laura's House

(866) 498-1511

Trans*Fusion

714-953-5428 X 206

Mariposa Women & Family Center

(714) 597-6494

OC Domestic Violence Hotline

(714) 992-1931

Military One Source

800-342-9647

Temporary Restraining Order Info. South Orange County FRC Human Options

(714) 935-7956

FOCUS

(760) 859-6079

Military Support

(949) 757-3635

COMMUNITY RESOURCES: The referrals listed are not sponsored, endorsed, supported or specifically recommended by the Capistrano Unified School District or any of its employees. The referrals are provided as a community service based on information gathered from the providers or other sources. The District has not done any independent investigation or evaluation of any resource and does not take any responsibility for the quality or competency of the services provided.

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Capistrano Unified School District Suicide Postvention Protocol Table of Contents

Suicide Postvention Protocol Abstract ........................................................................................................22 Verify the Death ..........................................................................................................................................23 Contact the Family ......................................................................................................................................23 Notify Key Contacts .............................................................................................................................. 23-24 Notify the School Community. ...................................................................................................................25 Notify and Support Staff. ...................................................................................................................... 24-25 Notify and Support Students. ................................................................................................................ 25-26 Key Considerations ............................................................................................................................... 26-27

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SUICIDE POSTEVENTION RESPONSE ABSTRACT

Postvention (interventions that are conducted after a suicide) assists students in ways that promote the mental health of the entire school community and supports students experiencing a mental or suicidal crisis after the suicidal death of a school community member. These interventions are meant to help manage the various aspects of the crisis and prevent contagion. Support and resources are provided for students, staff, parents and the entire community. All aspects of postvention strive to treat the loss in similar ways to that of other deaths within the school community and to return the school environment to its normal routine as soon as is possible. In this way, postvention is inextricably linked to prevention.

22

SUICIDE POSTEVENTION RESPONSE

STEPS TO TAKE IN THE IMMEDIATE AFTERMATH A. VERIFY THE DEATH • Principal or Designee verifies death with Coroner Office 714-647-7400 or if necessary, local law enforcement • Executive Director of Safety and Student Services and/or Chief Communications Officer can assist with death verification if needed • The Orange County Sheriff-Coroner’s website can be utilized to confirm a death if needed: http://ws.ocsd.org/EServices/Mortuary_Release.aspx B. CONTACT THE FAMILY • Principal or Designee contacts family to express sympathy as you would for any sudden death • Inquire about what the school can share about their loss. If family is unwilling or not ready to share, help the family craft a message that they do want released in order to minimize rumors, misinformation, and speculation. Acknowledge that this is a great tragedy and assist them in understanding that crafting a message about the cause of death will help their child’s friends who are suffering. • Information about the cause of death should not be disclosed to the school community until the family has consented to disclosure • If the siblings have not been informed, ask family how they would like them to be informed • Ask what the school can do to support siblings • Ask what school can do to support them (e.g., PTA to assist providing meals, inform family about Didi Hirsch’s Bereavement Support Services: 714-547-0885, etc.) • Ask family if there are any friends that may need additional support • Let them know the school will be checking in with them in the coming days and weeks to determine what support the school can provide • Ask family to provide service/memorial information if they wish to share it with the school community C. NOTIFY KEY CONTACTS • Principal or Designee notifies Assistant Superintendent of Elementary or Secondary Education who will arrange for teacher substitutes if needed • Principal or Designee notifies Executive Director of Safety and Student Services and Chief Communications Officer • Principal or Designee notifies Executive Director of Integrated Support Services who will notify Crisis Response Coordinators and schools where siblings and close relatives attend • Crisis Response Coordinators will work in conjunction with Principal or Designee to assess the level of impact to the school community • Crisis Response Coordinators will notify and activate the Crisis Response Team • Principal or Designee will ensure office staff knows how to respond to inquiries • In Aeries, mark absences as “excused” for the first three days so that automated phone calls are not triggered. • After three days, in Aeries, under demographics status and attendance enrollment, mark student as “deceased” so no automated messages regarding absence are sent home 23

SUICIDE POSTEVENTION RESPONSE

D. NOTIFY THE SCHOOL COMMUNITY • Concerns and wishes of family members regarding disclosure of the death and cause of death should be taken into consideration when providing facts to parents/guardians. • Principal or Designee notifies the school community about the student’s death and the school’s response • Communicate letter to families in the most expedient way so they will know what their student will be facing at school when the death is announced. • Letter should include a list of local resources • Designate location for parents who come to campus to ask questions and express concerns. • Include information on the signs of suicide (if the family allows the disclosure of suicide). • Include information for Families to support their children through the grieving process E. NOTIFY AND SUPPORT STAFF • The Principal or Designee will work in conjunction with the family and district personnel to determine the appropriate information to share with staff members. The concerns of family members regarding disclosure of the death and cause of death will be taken into account • Principal or Designee conducts the initial all-‐staff meeting to notify staff. • Goals for this meeting include:  Convey what information can be relayed to staff  Prepare a plan for staff to inform and respond to students. In order deal with student reactions • Identify staff uncomfortable with notifying students of the death. Designate Crisis team members to support those staff members in their classrooms. A counseling support team members will provide support to staff as needed throughout the day (i.e. following the student’s schedule) • Remind staff who the designated media spokesperson is and that they should refer any outside requests for comments or information to this individual. Staff should communicate with students that they are not required to speak to the media and if they do, they should do so with an adult present • Control rumors by stating only facts as allowed by the family. Principal or Designee will update staff as more recent information comes in and is deemed appropriate to share • Principal or Designee will communicate with staff where and how to seek support on campus as needed • Provide staff with resources for themselves and the community • Inform staff on how to refer students who may be exhibiting signs of distress in the following days after a completed suicide. • Inform staff where to send at-risk students and that they must be sent with another student or escorted by adult -‐ never alone • Notify staff about designated locations on campus for students who would are in need of counseling • Follow protocol for removing personal items from locker or desk • A counseling team should work with the specific teachers who will be directly affected by the “empty desk”. A plan should be in place which is age-appropriate and comforting. The plan 24

SUICIDE POSTEVENTION RESPONSE

• • • • • • •

should be both short (the first couple of days) and long term (when is it appropriate to change the classroom configuration, reassign the locker, etc) Send follow up email after the staff meeting with information discussed in the first meeting and any additional details, such as list of local resources. At the end of the day, conduct a follow up staff meeting if needed to acknowledge that it’s been a difficult day for everyone and that the meeting is an opportunity to share experiences from the day and what their needs for support will be for the next. Inform staff as to the continued availability of roving substitute teachers. Determine this based upon expressed need and day one experiences in the classroom. Allow staff to express concerns and ask questions. Emphasize self-‐care for teachers/staff since they have been primarily focused on taking care of students. Reminder to continue to identify, monitor, and support students who may be at risk. Crisis Coordinators or Designee from the Orange County Department of Education Crisis Response Network will assess the impact on Crisis Responders and Staff and provide support if needed

F. NOTIFY AND SUPPORT STUDENTS • The Principal or Designee will work in conjunction with the family and district personnel to determine the appropriate information to share with students • Inform Crisis Response Team of the exact story that the team is allowed to share based on family wishes • Designated locations on campus for students who would are in need of counseling. Provide snacks if possible along with art and writing supplies for creative expression that may later be preserved for the student’s family. • Have two Crisis Responders follow the deceased student’s schedule to debrief with the class and make students aware of the services that are available. In addition, the Crisis Responders will:  Disclose what the information that can be shared with students and watch for students who may be upset/ need immediate assistance  Take down names of students who would like students to check in. Encourage students to inform staff privately about peers that may be in distress.  Provide students with examples of signs of distress (e.g. nightmares, crying spells, loss/increase of appetite, etc.) and address coping skills (writing feelings out, reach out to family members, texting friend)  Normalize these symptoms and inform them that this might occur immediately or even later on.  Inform students about the designated location(s) on campus for students who would are in need of counseling  Crisis Response Team will identify, monitor, and support students who may be at risk. Indicators of students in need of additional support or referral may include the following: 1. Close connections to the deceased (e.g., close friends, siblings, relatives, teacher) 2. Experienced a loss over the past six months to a year, experienced a traumatic event, witnessed acts of violence, or have a loved one who has died by suicide 25

SUICIDE POSTEVENTION RESPONSE

• • •

3. Appear emotionally over-controlled (e.g., a student who was very close to the deceased but who is exhibiting no emotional reaction to the loss) or those who are angry when majority are expressing sadness 4. Unable to control crying Designate someone to circulate on campus to determine who might be in need and to monitor for rumors (e.g. campus supervisor) and refer to Crisis Response Team if needed Crisis Team members meets with students in need of counseling individually or via small group to provide emotional support Crisis Response Coordinators will schedule debrief with Crisis Response Team to discuss at risk students who need follow-‐up, what went well and what could be improved, create a plan for the following day and assign jobs, and self-care for team members

G. KEY CONSIDERATIONS • Funerals/Memorials: Depending on family wishes, the Principal or Designee will disseminate information about the funeral to students, parents, and staff as soon as it becomes available. Information may include:  Location of the funeral  Time of the funeral  Guidance regarding how to express condolences to the family (e.g. treat like any other sudden death, family wishes for charitable donations vs. flowers, etc.).  School policy for releasing students during school hours to attend (i.e., students will be released only with permission of parent, guardian, or designated adult). • Memorialization: In the interest of identifying a meaningful, safe approach to acknowledging the loss, schools should both meet with the student’s friends and coordinate with the family. The school’s goal should be to balance the students’ need to grieve with the goal of limiting the risk of inadvertently glamorizing the death. In all cases, schools should have a consistent policy so that suicide deaths are handled in the same manner as any other deaths. • Suicide Contagion is the process by which one suicide death may contribute to another. In fact, suicide(s) can even follow the death of a student from other causes, such as an accident. Although contagion is comparatively rare (accounting for between 1 percent and 5 percent of all suicide deaths annually), adolescents and teenagers appear to be more susceptible to imitative suicide than adults, largely because they may identify more readily with the behavior and qualities of their peers. Reminding staff regarding suicide contagion and how to identify students warning signs. • If there appears to be contagion, schools should consider taking additional steps to identify other students who may be at heightened risk of suicide and coordinate suicide prevention effort  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 (including siblings at other schools as well as teammates, classmates, and acquaintances 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 26

SUICIDE POSTEVENTION RESPONSE

•

Prepare for graduation ceremonies, anniversaries and special events  Prior to graduation ceremonies for the deceased student’s class, check with family about any requests. Acknowledgment of a student who has died by suicide should be consistent with acknowledgement of a student who has died by any other means  Be aware of special events (e.g. proms, birthday etc.), holidays, and anniversaries, as these may activate possible stress/grief responses (physical, emotional, social, cognitive) in students or staff.  The probability of contagion is heightened on the anniversary of the death as well as on other meaningful days.  Consult with the family about memorials. The person designated as the liaison with the family needs to be prepared to explain the memorialization policy to the family while respecting their wishes as well as the grieving traditions associated with the culture and religion.  Inform and remind staff: Remind staff to be aware that students may experience emotional reactions; educate staff about the warning signs of suicide and how to recognize and respond to students who may be at risk or experience severe emotions; remind staff they may also experience an emotional reaction to date; have grief counselors on call if needed

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TOOLS FOR CRISIS RESPONSE (Beginning on the following page)

      

Sample Death Notification Statement for Parents Sample Death Notification Statement for Students Sample Agenda for Initial All-Staff Meeting Talking About Suicide Facts About Suicide and Mental Disorders in Adolescents Helping Students Cope Suicide Prevention Parent Handout

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Sample Death Notification Statement for Parents

Option 1 – When the death has been ruled suicide I am writing with great sadness to inform you that one of our students, ________, has died. Our thoughts and sympathies are with [his/her] family and friends. All of the students were given the news of the death by their teacher in [advisory/homeroom] this morning. I have included a copy of the announcement that was read to them. The cause of death was suicide. We want to take this opportunity to remind our community that suicide is a very complicated act. It is usually caused by a mental disorder such as depression, which can prevent a person from thinking clearly about his or her problems and how to solve them. Sometimes these disorders are not identified or noticed; other times, a person with a disorder will show obvious symptoms or signs. I am including some information that may be helpful to you in discussing suicide with your child. Members of our Crisis Response Team are available to meet with students individually and in groups today as well as over the coming days and weeks. Please contact the school office if you feel your child is in need of additional assistance; we have a list of school and community mental health resources. Please do not hesitate to contact me or one of the school counselors with any questions or concerns. Sincerely, [Principal] Option 2 – When the family has requested that the cause of death not be disclosed I am writing with great sadness to inform you that one of our students, ________, has died. Our thoughts and sympathies are with [his/her] family and friends. All of the students were given the news of the death by their teacher in [advisory/homeroom] this morning. I have included a copy of the announcement that was read to them. The family has requested that information about the cause of death not be shared at this time. Members of our Crisis Response Team are available to meet with students individually and in groups today as well as over the coming days and weeks. Please contact the school office if you feel your child is in need of additional assistance; we have a list of additional school and community mental health resources. Please do not hesitate to contact me or the school counselors with any questions or concerns. Sincerely, Principal]

From “After a Suicide: A Toolkit for School”

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Sample Death Notification Statement for Students

Option 1 – When the death has been ruled a suicide It is with great sadness that I have to tell you that one of our students, _________, has taken [his/her] own life. All of us want you to know that we are here to help you in any way we can. A suicide death presents us with many questions that we may not be able to answer right away. Rumors may begin to circulate, and we ask that you not spread rumors you may hear. We’ll do our best to give you accurate information as it becomes known to us. Suicide is a very complicated act. It is usually caused by a mental disorder such as depression, which can prevent a person from thinking clearly about his or her problems and how to solve them. Sometimes these disorders are not identified or noticed; in other cases, a person with a disorder will show obvious symptoms or signs. One thing is certain: there are treatments that can help. Suicide should never, ever be an option. Each of us will react to _____’s death in our own way, and we need to be respectful of each other. Feeling sad is a normal response to any loss. Some of you may not have known ______very well and may not be as affected, while others may experience a great deal of sadness. Some of you may find you’re having difficulty concentrating on your schoolwork, and others may find that diving into your work is a good distraction. We have counselors available to help our school community deal with this sad loss and to enable us to understand more about suicide. If you’d like to talk to a counselor, just let your teachers know. Please remember that we are all here for you. Option 3 – When the family has requested that the cause of death not be disclosed It is with great sadness that I have to tell you that one of our students, _________, has died. All of us want you to know that we are here to help you in any way we can. The family has requested that information about the cause of death not be shared at this time. We are aware that there has been some talk about the possibility that this was a suicide death. Rumors may begin to circulate, and we ask that you not spread rumors since they may turn out to be inaccurate and can be deeply hurtful and unfair to ______ as well as [his/her] family and friends. We’ll do our best to give you accurate information as it becomes known to us. Since the subject has been raised, we do want to take this opportunity to remind you that suicide, when it does occur, is a very complicated act. It is usually caused by a mental disorder such as depression, which can prevent a person from thinking clearly about his or her problems and how to solve them. Sometimes these disorders are not identified or noticed; in other cases a person with a disorder will show obvious symptoms or signs. One thing is certain: there are treatments that can help. Suicide should never, ever be an option. Each of us will react to _____’s death in our own way, and we need to be respectful of each other. Feeling sad is a normal response to any loss. Some of you may not have known ______very well and may not be as affected, while others may experience a great deal of sadness. Some of you may find you’re having difficulty concentrating on your schoolwork, and others may find that diving into your work is a good distraction. We have counselors available to help our school community deal with this sad loss. If you’d like to talk to a counselor, just let your teachers know. Please remember that we are all here for you. From “After a Suicide: A Toolkit for School”

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➲

Sample Agenda for Initial All-Staff Meeting This meeting is typically conducted by the Crisis Response Team Leader and should be held as soon as possible, ideally before school starts in the morning. Depending on when the death occurs, there may not be enough time to hold the meeting before students have begun to hear the news through word of mouth, text messaging, or other means. If this happens, the Crisis Response Team Leader should first verify the accuracy of the reports and then notify staff of the death through the school’s predetermined crisis alert system, such as e-mail or calls to classroom phones. Remember that information about the cause of death should be withheld until the family has been consulted.

Goals of Initial Meeting Allow at least one hour to address the following goals: • Introduce the Crisis Response Team members. • Share accurate information about the death. • Allow staff an opportunity to express their own reactions and grief. Identify anyone who may need additional support and refer them to appropriate resources. • Provide appropriate faculty (e.g., homeroom teachers or advisors) with a scripted death notification statement for students. Arrange coverage for any staff who are unable to manage reading the statement. • 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 crisis counseling rooms. • Remind all staff of the important role they may play in identifying changes in behavior among the students they know and see every day, and discuss plan for handling students who are having difficulty. • Brief staff about identifying and referring at-risk students as well as the need to keep records of those efforts. • Apprise staff of any outside crisis responders or others who will be assisting. • Remind staff of student dismissal protocol for funeral. • Identify which Crisis Response Team member has been designated as the media spokesperson and instruct staff to refer all media inquiries to him or her.

End of the First Day It can also be helpful for the Crisis Response Team Leader and/or the Team Coordinator to have an allstaff meeting at the end of the first day. This meeting provides an opportunity to take the following steps: • Offer verbal appreciation of the staff. • Review the day’s challenges and successes. • Debrief, share experiences, express concerns, and ask questions. • Check in with staff to assess whether any of them need additional support, and refer accordingly. • Disseminate information regarding the death and/or funeral arrangements. • Discuss plans for the next day. • Remind staff of the importance of self-care. • Remind staff of the importance of documenting crisis response efforts for future planning and understanding. AFSP & SPRC:

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Talking About Suicide from After a Suicide: A Toolkit for Schools Give accurate information about suicide.

by saying . . .

Suicide is a complicated behavior. It is not caused by a single event such as a bad grade, an argument with parents, or the breakup of a relationship.

“The cause of _____’s death was suicide. Suicide is most often caused by serious mental disorders like depression, combined with other complications.”

In most cases, suicide is caused by an underlying mental disorder like depression or substance abuse. Mental disorders affect the way people feel and prevent them from thinking clearly and rationally. Having a mental disorder is nothing to be ashamed of, and help is available.

“_____ was likely struggling with a mental health issue like depression or anxiety, even though it may not have been obvious to other people.” “There are treatments to help people who are having suicidal thoughts.” “Since 90 percent of people who die by suicide have a mental disorder at the time of their death, it is likely that ______ suffered from a mental disorder that affected [his/her] feelings, thoughts, and ability to think clearly and solve problems in a better way.”

Talking about suicide in a calm, straightforward manner does not put ideas into kids’ minds.

“Mental disorders are not something to be ashamed of, and there are very good treatments to help the symptoms go away.”

Address blaming and scapegoating.

by saying . . .

It is common to try to answer the question “why?” after a suicide death. Sometimes this turns into blaming others for the death.

“The reasons that someone dies by suicide are not simple, and are related to mental disorders that get in the way of the person thinking clearly. Blaming others—or blaming the person who died—does not acknowledge the reality that the person was battling a mental disorder.”

Do not focus on the method or graphic details.

by saying . . .

Talking in graphic detail about the method can create images that are upsetting and can increase the risk of imitative behavior by vulnerable youth.

“It is tragic that he died by hanging. Let’s talk about how _____’s death has affected you and ways for you to handle it.” “How can we figure out the best ways to deal with our loss and grief?”

If asked, it is okay to give basic facts about the method, but don’t give graphic details or talk at length about it. The focus should be not on how someone killed themselves but rather on how to cope with feelings of sadness, loss, anger, etc.

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Talking About Suicide (continued from previous page) Address anger.

by saying . . .

Accept expressions of anger at the deceased and explain that these feelings are normal.

“It is okay to feel angry. These feelings are normal and it doesn’t mean that you didn’t care about____. You can be angry at someone’s behavior and still care deeply about that person.”

Address feelings of responsibility.

by saying . . .

Reassure those who feel responsible or think they could have done something to save the deceased.

“This death is not your fault.” “We can’t always predict someone else’s behavior.” “We can’t control someone else’s behavior.”

Encourage help-seeking.

by saying . . .

Encourage students to seek help from a trusted adult if they or a friend are feeling depressed or suicidal.

“We are always here to help you through any problem, no matter what. Who are the people you would go to if you or a friend were feeling worried or depressed or had thoughts of suicide?” “There are effective treatments to help people who have mental disorders or substance abuse problems. Suicide is never an answer.” “This is an important time for all in our [school, team, etc.] community to support and look out for one another. If you are concerned about a friend, you need to be sure to tell a trusted adult.”

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Facts About Suicide and Mental Disorders in Adolescents from After a Suicide: A Toolkit for Schools Suicide is not inexplicable and is not simply the result of stress or difficult life circumstances. The key suicide risk factor is an undiagnosed, untreated, or ineffectively treated mental disorder. Research shows that over 90 percent of people who die by suicide have a mental disorder at the time of their death. In teens, the mental disorders most closely linked to suicide risk are major depressive disorder, bipolar disorder, generalized anxiety disorder, conduct disorder, substance use disorder, and eating disorders. While in some cases these disorders may be precipitated by environmental stressors, they can also occur as a result of changes in brain chemistry, even in the absence of an identifiable or obvious “reason.” Suicide is almost always complicated. In addition to the underlying disorders listed above, suicide risk can be affected by personality factors such as impulsivity, aggression, and hopelessness. Moreover, suicide risk can also be exacerbated by stressful life circumstances such as a history of childhood physical and/or sexual abuse; death, divorce, or other trauma in the family; persistent serious family conflict; traumatic breakups of romantic relationships; trouble with the law; school failures and other major disappointments; and bullying, harassment, or victimization by peers. It is important to remember that the vast majority of teens who experience even very stressful life events do not become suicidal. In some cases, such experiences can be a catalyst for suicidal behavior in teens who are already struggling with depression or other mental health problems. In others, traumatic experiences (such as prolonged bullying) can precipitate depression, anxiety, abuse of alcohol or drugs, or another mental disorder, which can increase suicide risk. Conversely, existing mental disorders may also lead to stressful life experiences such as family conflict, social isolation, relationship breakups, or school failures, which may exacerbate the underlying illness and in turn increase suicide risk.

Warning Signs of Suicide These signs may mean someone is at risk for suicide. Risk is greater if a behavior is new or has recently increased in frequency or intensity, and if it seems related to a painful event, loss, or change. • Talking about wanting to die or kill oneself • Looking for ways to kill oneself, such as searching online or buying a gun • Talking about feeling hopeless or having no reason to live • Talking about feeling trapped or in unbearable pain • Talking about being a burden to others • Increasing the use of alcohol or drugs • Acting anxious or agitated, or behaving recklessly • Sleeping too little or too much • Withdrawing or feeling isolated • Showing rage or talking about seeking revenge • Displaying extreme mood swings

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What to Do in a Crisis Take any threat or talk about suicide seriously. Start by telling the person that you are concerned. Don’t be afraid to ask whether she or he is considering suicide or has a plan or method in mind. Resist the temptation to argue the person out of suicide by saying, “You have so much to live for” or “Your suicide will hurt your family and friends.” Instead, seek professional help. In an acute crisis: • Call 911. • Do not leave the person alone. • If safe to do so, remove any firearms, alcohol, drugs, or sharp objects that could be used. • Call the National Suicide Prevention Lifeline: 1-800-273-TALK (8255). • Take the person to an emergency room or walk-in clinic at a psychiatric hospital.

Symptoms of Mental Disorders Associated with Suicide Risk Most adults are not trained to recognize signs of serious mental disorders in teens, and symptoms are therefore often misinterpreted or attributed to normal adolescent mood swings, laziness, poor attitude, or immaturity. Diagnosis of a mental disorder should always be made by a qualified mental health professional. The key symptoms of major depressive disorder in teens are sad, depressed, angry, or irritable mood and lack of interest or pleasure in activities the teen used to enjoy, lasting at least two weeks. Symptoms represent a clear change from the person’s normal behavior and may include changes in appetite or sleep, feelings of worthlessness/guilt, inability to concentrate, slowed or agitated movement, recurrent thoughts of death or suicide, fatigue/loss of energy, and self-harm behavior. Sometimes referred to as manic depression, bipolar disorder includes alternating episodes of depression and mania. Symptoms of mania last at least one week, cause clear social or academic problems, and include extreme distractibility, lack of need for sleep, unusually rapid speech or motor activity, excessive talking, and involvement in risky activities such as gambling or irresponsible sexual behavior. The key characteristic of generalized anxiety disorder is excessive, uncontrolled worry (for example, persistent worry about tests or speaking in class) occurring on most days for a period of six months. Symptoms may include restlessness or feeling keyed up, irritability, being easily fatigued, muscle tension, difficulty concentrating, and sleep disturbances. Teens with substance use disorder show a problematic pattern of drug or alcohol use over 12 months or more, leading to significant impairment or distress. Symptoms include taking larger amounts, over a longer period, than intended; continued use despite knowing that it is causing problems; increased irritability and anger; sleep disturbances; and family conflict over substance use. Conduct disorder is a repetitive, persistent pattern in children or adolescents of violating the rights of others, rules, or social norms, occurring over 12 months. Symptoms include bullying or threatening others, physical fights, fire-setting, destroying property, breaking into houses/cars, physical cruelty to people or animals, lying, shoplifting, running away from home, and frequent truancy. Anorexia nervosa and bulimia are eating disorders that are strongly linked to other mental disorders, especially depression and anxiety. Symptoms of anorexia nervosa include refusal to maintain body AFSP & SPRC:

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weight at a minimally normal level for age and height, intense fear of gaining weight, and a denial of low body weight. Symptoms of bulimia include repeated episodes of binge eating (at least twice a week for three months) combined with recurrent inappropriate behaviors to avoid gaining weight such as vomiting, misuse of laxatives, or excessive exercise.

Help Is Available If there are concerns about a student’s emotional or mental health, a referral should be made to an appropriate mental health professional for assessment, diagnosis, and possible treatment. Mental health resources that may be available include school counselors, community mental health agencies, emergency psychiatric screening centers, and children’s mobile response programs. Pediatricians and primary care providers can also be a source of mental health referrals. Some depressed teens show improvement in just four to six weeks with talk therapy alone. Most others experience a significant reduction of depressive symptoms with antidepressant medication. Medication is usually essential in treating severe depression and other serious mental disorders, such as bipolar disorder and schizophrenia. Since 2004, an FDA warning has recommended close monitoring of youth taking antidepressants for worsening of symptoms, suicidal thoughts or behavior, and other changes. Risks of medication must be weighed against the risks of not effectively treating depression or other serious mental disorders. (Adapted with permission from More Than Sad: Preventing Teen Suicide, American Foundation for Suicide Prevention, http://www.morethansad.org.)

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Additional Information Center for School Mental Health Assistance. Crisis intervention: A guide for school-based clinicians. (2002). http://csmh.umaryland.edu/resources/CSMH/resourcepackets/files/crisis_intervention_2002.pdf Maine Department of Health and Human Services. Media guidelines for school administrators who may interact with reporters about youth suicide. (2006). http://www.maine.gov/suicide/professionals/program/mediaschool.htm National Association of School Psychologists. Culturally competent crisis response: Information for school psychologists and crisis teams. (2004). http://www.schoolcounselor.org/files/cc_crisis.pdf National Suicide Prevention Lifeline. http://www.suicidepreventionlifeline.org 800-273-TALK (8255) Reeves, M. A., Brock, S. E., and Cowan, K. C. Managing school crises: More than just response. (2008). http://www.nasponline.org/resources/principals/School%20Crisis%20NASSP%20May%202008.pdf Suicide Prevention Resource Center (SPRC). Customized information for school health and mental health care providers. (2008). http://www.sprc.org/featured_resources/customized/school_mentalhealth.asp U.S. Department of Education, Office of Safe and Drug-Free Schools. Practical information on crisis planning: A guide for schools and communities (2007). http://www2.ed.gov/admins/lead/safety/emergencyplan/crisisplanning.pdf Weekley, N., and Brock, S. E. Suicide: Postvention strategies for school personnel. (2004). http://www.nasponline.org/resources/intonline/HCHS2_weekley.pdf

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Helping Students Cope In the aftermath of a suicide, students and others in the school community may—not surprisingly—feel emotionally overwhelmed, which can disrupt the school’s ability to return to its primary function of educating students, and can increase the risk of prolonged stress responses and even suicide contagion. The following are strategies that schools can use to help students balance the timing and intensity of their emotional expression and restore the school’s ability to function effectively.

KEY CONSIDERATIONS The term emotional regulation refers to a person’s ability to appropriately experience and express intense emotions such as grief and fear. Most adolescents have mastered basic skills that allow them to handle strong emotions encountered day to day. But these skills may be challenged in the face of a suicide. In addition, young people may not yet have learned how to recognize complex feelings or physical indicators of distress, such as stomach upset, restlessness, or insomnia. Moreover, adolescence marks a time of increased risk for difficulties with emotional regulation, given the intensification of emotional responses that come with puberty and the structural changes in the brain that occur during this developmental period. It is therefore important for schools to provide students with appropriate opportunities to express their emotions and identify strategies for managing them, so the school can continue its primary focus of education. It may also be useful for school staff to identify and reach out to families of students who are not coming to school. When implementing these strategies, leadership will most likely be provided by the school counselor, school nurse, and/or community mental health partner, all of whom should be members of the school’s Crisis Response Team. However, all adults in the school community can help by modeling calm, caring, and thoughtful behavior.

Schedule Meetings with Students in Small Groups It will likely be necessary to adjust the regular academic schedule in order to spend time with students to help address their emotional needs. It is preferable to reach out to students in a deliberate and timely way rather than to allow the emotional environment to escalate. It is also preferable to meet with students in small groups, which enables adults to identify those youth who appear in need of additional attention. If possible, have counselors go into the classrooms to give students accurate information about suicide, the kinds of reactions that can be expected after hearing about a peer’s suicide death, and safe coping strategies to help them in the coming days and weeks. Wherever possible, group meetings should follow a structured outline, keep to a time limit, and provide each student with an opportunity to speak. The meetings should focus on helping students identify and express their feelings and discuss practical coping strategies (including appropriate ways to memorialize the loss) so they may return their focus to their regular routines and activities.

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If the deceased student participated in sports, clubs, or other school activities, the first practice, game, rehearsal, or meeting after the death may be difficult for the other students. These events can provide further opportunities for the adults in the school community to help the students appropriately acknowledge the loss.

Help Students Identify and Express Their Emotions Youth will vary widely in terms of emotional expression. Some may become openly emotional, others may be reluctant to talk at all, and still others may use humor. Acknowledge the breadth of feelings and diversity of experiences and emphasize the importance of being respectful of others. Some students may need help to identify emotions beyond simply sad, angry, or happy, and may need reassurance that a wide range of feelings and experiences are to be expected. They may also need to be reminded that emotions may be experienced as physical symptoms, including butterflies in the stomach, shortness of breath, insomnia, fatigue, or irritability. To facilitate this discussion, students may be asked: What is your biggest concern about the immediate future? What would help you feel safer right now?

Practical Coping Strategies Encourage students to think about specific things they can do when intense emotions such as worry or sadness begin to well up, including: • simple relaxation and distraction skills, such as taking three deep slow breaths, counting to 10, or picturing themselves in a favorite calm and relaxing place • engaging in favorite activities or hobbies such as music, talking with a friend, reading, or going to a movie • exercising • thinking about how they’ve coped with difficulties in the past and reminding themselves that they can use those same coping skills now • writing a list of people they can turn to for support • writing a list of things they’re looking forward to • focusing on individual goals, such as returning to a shared class or spending time with mutual friends Often, youth will express guilt about having fun or thinking about other things. They may feel that they somehow need permission to engage in activities that will help them feel better and take their mind off the stressful situation. Students should also be encouraged to think about how they want to remember their friend. Ideas range from writing a personal note to the family, to attending the memorial service, to doing something kind for another person in honor of their friend. Be sure to educate students about the school’s guidelines regarding memorialization. Acknowledging their need to express their feelings while helping them identify appropriate ways to do so can begin the process of returning their focus to their daily lives and responsibilities.

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Reach Out to Parents Parents may need guidance on Talking About Suicide with their children and how best to support them at this difficult time. They may also need reliable information relating to the document Facts About Mental Disorders and Suicide in Adolescents.

Anniversary of the Death The anniversary of the death (and other significant dates, such as the deceased’s birthday) may stir up emotions and can be an upsetting time for some students and staff. It is helpful to anticipate this and provide an opportunity to acknowledge the date, particularly with those students who were especially close to the student who died.

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Additional Information Bonner, C. Emotion regulation, interpersonal effectiveness, and distress tolerance skills for adolescents: A treatment manual. Services for Teens at Risk, Western Psychiatric Institute and Clinic, University of Pittsburgh Medical Center. (2002). www.starcenter.pitt.edu/files/document/Emotional_Regulation.pdf National Association of Independent Schools. Helping students cope with suicide. (2004). http://www.nais.org/articlePrint.cfm?print=Y&ItemNumber=145734 National Association of School Psychologists. Dealing with death at school. (2004). http://www.nasponline. org/resources/principals/Dealing%20with%20Death%20at%20School%20April%2004.pdf Poland, S. Practical suggestions for crisis debriefing in schools. (2002). http://www.schoolsecurity.org/ resources/Practical%20Suggestions%20for%20Crisis%20Debriefing%20for%20Schools.pdf Poland, S., and J. McCormick. Coping with crisis: A quick reference. (2000). Sopris West. http://www.sopriswest.com Steinberg, L., Dahl, R., Keating, D., Kupfer, D. J., Masten, A. S., & Pine, D. The study of developmental psychopathology in adolescence: Integrating affective neuroscience with the study of context. In D. Cicchetti (Ed.), Handbook of Developmental Psychopathology. (2006). New York: John Wiley & Sons. U.S. Department of Education, Emergency Response and Crisis Management (ERCM) Technical Assistance Center. Coping with the death of a student or staff member. (2007). http://rems.ed.gov/docs/CopingW_Death_StudentOrStaff.pdf

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GUÍAS DE PREVENCIÓN DEL SUICIDIO PARA PADRES

Servicios de Apoyo Estudiantil 33122 Valle Road, San Juan Capistrano, CA 92675 (949) 234-9200

El suicidio es un problema grave de salud pública que tiene un impacto enorme en las familias, los amigos, los compañeros de escuela, los compañeros de trabajo y las comunidades,  así como en nuestro personal militar y veteranos. La prevención del suicidio es un esfuerzo colectivo por parte de las organizaciones comunitarias, los profesionales de la salud mental y los expertos para reducir la incidencia del suicidio a través de la educación, el conocimiento y los servicios.

EL SUICIDIO SE PUEDE PREVENIR

FACTORES DE RIESGO DE SUICIDIO EN LOS JÓVENES

Los signos de advertencia de suicidio: Los signos de advertencia son conductas observables  que pueden indicar la   presencia de pensamientos suicidas. Estos podrían ser considerados como «gritos de auxilio» o  «invitaciones para  intervenir». Estos signos de advertencia señalan la necesidad de preguntarle directamente al individuo si tiene pensamientos de suicidio. Si este tipo de pensamiento es admitido, entonces se requerirán intervenciones de suicidio. Las señales de advertencia incluyen lo siguiente:   

Aunque el camino que conduce a un comportamiento suicida es largo y complejo y no existe una «característica» que predice el comportamiento suicida con certeza, hay ciertos factores de riesgo asociados que aumentan el riesgo de suicidio. De forma aislada, estos factores no son signos de pensamientos suicidas. Sin embargo, cuando están presentes indican la necesidad de estar alerta a las señales de advertencia de suicidio. Específicamente, estos factores de riesgo incluyen lo siguiente: * Acceso a los medios (p.ej.: armas de fuego, cuchillos,  medicamentos)

Conéctese

*Comuníquese y colabore con el personal administrativo, el personal de salud mental y el concejero de la escuela de su hijo para buscar apoyo. *Póngase en contacto con el Departamento de Salud Mental, la policía o los servicios de protección, según sea necesario.   *Ayude a su hijo a identificar un adulto o varios adultos, en quienes pueda confíar tanto en la casa como en la escuela. 

Sea un Modelo 

*Permanezca calmado. Establezca un * Factores de estrés (p.ej.: pérdida (de un medio ambiente seguro para hablar del suicidio. familiar cercano), relaciones de compañeros, escuela, género, cuestiones *Esté consciente de sus pensamientos, de identidad.  emociones y reacciones a medida que escucha sin juzgar.  * Historial de depresión, enfermedad mental, problemas de abuso de sustancias Enseñe o alcohol. *Aprenda cuales son las señales de *Sentimientos de tristeza, impotencia y advertencia y los factores de riesgo del * Antecedentes de suicidio en la familia o desesperación.  suicidio así puede proporcionar de un amigo cercano. información y educación sobre el suicidio *Cambios significantes de comportamiento, y la autolesión. *Historia de enfermedad mental en la  apariencia, pensamientos y sentimientos familia. *Recomiende comportamientos de buscar *Retraimiento y distanciamiento social  ¡Esto es lo que puede hacer! ayuda. Ayude a su hijo a identificar un adulto o varios adultos, en quienes Escuche *Amenazas de suicidio (directas e confíen tanto en la casa como en la indirectas) escuela.   * Evalué el riesgo suicida.  *Notas y planes de suicidio.   *Busque opciones en la escuela y   * Escuche sin juzgar. recursos comunitarios incluyendo *Historia de ideacicón y comportamiento   referencias de servicios profesionales de suicida   * Haga preguntas abiertas. salud mental, según sea necesario.   *Conducta autolesiva Proteja  *Preocupación por la muerte.  *Hacer arreglos finales (p.ej., regalar posesiones preciadas, publicar los planes en los medios sociales, enviar mensajes de texto a los amigos)  

Lista de Recursos Comunitarios

    * Tome acción inmediatamente.       * Supervise y no deje solo a su hijo.       *Considere en desarrollar un plan seguro en         la escuela y en la casa, según sea           necesario.   

Entendiendo el Suicidio: Mitos y Realidades Para entender por qué las personas mueren por suicidio y por qué tantos otros intentan quitarse la vida, es importante saber la realidad. A continuación, lea la  verdad acerca del suicidio y compártala con los demás.

Mito: El suicidio no puede ser prevenido.    Mito: Una persona que amenaza con Si alguien tiene pensado quitarse la   suicidarse realmente no lo hace, vida, no hay  nada que hacer para únicamente busca atención. detenerlo. Realidad: El suicidio es prevenible. La gran Realidad: Aquellos que hablan de mayoría de personas que    suicidio o expresan contemplan suicidarse en realidad pensamientos de querer morir, no quieren morir. Buscan acabar están en riesgo de suicidio y con el intenso dolor mental o físico necesitan de su atención. La que sienten. La mayoría padece de mayoría de las personas que enfermedad mental. Las mueren por suicidio dan algún intervenciones pueden salvar vidas. indició o advertencia. Tome en Western Youth Services serio todas las amenazas de 26137 La Paz Road, Suite 230 Mito: Preguntarle a alguien si tiene suicidio. Aunque crea que sólo Mission Viejo, CA 92691 pensamientos suicidas pondrá la son «gritos de ayuda», ¡ayude! Tel.: (949) 595-8610 idea en su cabeza y causará que actué en ellos. Mito: Es fácil para los padres y Realidad:  Si teme que alguien que conoce proveedores de cuidado saber está en crisis o deprimido, cuando su hijo está mostrando preguntarle si está pensando en signos de comportamiento suicida. South County Family Resource suicidarse puede ayudarlo. Al dar Center a la persona la oportunidad de Realidad: Lamentablemente, los estudios 23832 Rockfield Blvd., Suite 270 compartir sus problemas, puede    muestran que este no es el caso en Lake Forest, CA 92630 aliviar su dolor y encontrar un porcentaje sorprendentemente Tel.: (949) 364-0500   soluciones. grande de familias. Esto ilustra la importancia de que los padres y los Mito: El suicidio es hereditario proveedores de cuidado deben estar atentos a las señales de Realidad: Aunque el suicidio puede estar advertencia, los factores de riesgo, presente en ciertas familias, los a hacer preguntas directas y a estar CHEC Family Resource Center intentos no son genéticamente disponibles a conversaciones.   heredados. Los miembros de las 27142 Calle Arroyo familias comparten el mismo Mito: Sólo ciertas personas tienen San Juan Capistrano, CA 92675 ambiente emocional y el suicidio tendencias suicidas. Tel.: (949) 489-7742 culminado por un miembro de la familia bien puede elevar los Realidad: Todos tenemos el potencial para el pensamientos suicida como una suicidio. Las evidencias muestran opción para otros miembros de la que la predisposición de familia.   condiciones pueden llevar a un suicidio o intento de suicidio Mariposa Women & Family

Center

29222 Rancho Viejo Road San Juan Capistrano, CA 92675 Tel.: (949) 429-6888 812 West Town and Country Road Orange, CA 92868 Tel.: (714) 597-6494

OC Links   OCLinks es un servicio teléfonico donde las personas pueden llamar para recibir información, referencias y tambien pueden chatear en línea con un representante para navegar el sistema de Servicios de Salud Mental y Comportamiento (BHS) dentro de la Agencia del Cuidado y Salud del Condado de Orange. Las personas que llaman son conectados/as con navegadores clínicos que son expertos y tienen conocimiento en todos los programas dentro del sistema de BHS. Esto incluye, Salud mental para niños y adultos, programas internos y externos para las personas que sufren de consumo de alcohol y drogas, servicios de crisis, y programas de prevención/intervención a temprana edad. Tel.: (855) 625-4657 http://ochealthinfo.com/bhs/about/pi/oclin ks/  

¿Qué debo hacer si estoy preocupado por mi hijo? Si usted cree que su hijo está pensando en suicidarse, enfrente la situación preguntándole. Preguntar es el primer paso para salvar una vida y puede hacerle saber que está disponible para escucharlo. Estos son algunos ejemplos de cómo usted puede preguntar: « ¿has pensado en el suicidio?» «A veces cuando las personas están tristes, como tú, piensan en el suicidio. ¿Has pensado en ello?»

Información de emergencia/después de horas de servicios Si usted necesita ayuda INMEDIATA, llame al 911.  Para una emergencia psiquiátrica, póngase en contacto con el  Departamento de Salud Mental al centro de acceso las 24 horas al (800)  845-7771.

  Recursos para Padres y Proveedores de Cuidado, Niños y Adolescentes LÍNEAS DIRECTAS DE LA COMUNIDAD National Suicide Prevention Lifeline   (800) 273-TALK (8255) (24 Hours) Trevor Lifeline (866)488-7386) (24   Hours) Teen Line (800) 852-8336 (6pm  10pm) SMARTPHONE APPS MY3 Teen Line Youth Yellow Pages

TEXT AND CHAT RESOURCES Crisis Chat (11am-11pm, daily) Teen Line - text "TEEN" to 839863

ONLINE RESOURCES http://www.trevorproject.org http://teenline.org http://www.afsp.org/understandingsuicide