Youth in Crisis: Suicide Prevention & Intervention

The Hard Reality 

In today’s world our youth face tremendous life pressures that put them at risk for a myriad of self-destructive behaviors.  Many of our youth lack coping skills or healthy coping skills that can prevent devastating consequences like suicide. Although youth suicide rates have dropped since 1992, it still remains as the third leading cause of death among 10-19 year olds.  

Completed suicides are only part of the picture. Other forms of suicidal ideation and behaviors are much more common and typically are exactly the kind of behaviors to watch for. Prevention and intervention in this area should not be taken lightly. It is estimated that for every youth who dies by suicide, 100-200 youth attempt it. Within a typical high school classroom it is likely that at least three students have attempted suicide in the past year. (Poland & Lieberman, 2002) 

There are many risk factors that indicate red flags as long as people are educated about them and how to respond. Youth who are contemplating suicide frequently show warning signs of their distress. Parents, teachers, and friends are in a key position to pick up on these signs and get help. Most importantly never take these warning signs lightly or promise to keep them secret. It is better to err on the side of caution. There are some cases where one might just think a student is just asking for attention. Give it to them. I cannot stress this enough. All behaviors have a purpose. The key is to find ways to give them the right kind of attention. In most cases the individual is looking for signs that someone cares or is reaching out for help. Always take it seriously. However, don't overreact either. There is a fine balance here for the helping professionals. If in doubt, refer to whomever in your school is the most trained in mental health supports for students. This is typically your school psychologist, but could also be your school counselor or social worker. 

Suicide Warning Signs 

Many suicidal youth demonstrate observable behaviors that signal their suicidal thinking.  These include: 

·  Suicide notes.  These are a very real sign of danger and should be taken seriously. 

·  Threats. Threats may be direct statements (“I want to die.” “I am going to kill myself”) or indirect comments (“The world would be better without me”, “Nobody will miss me anyway”). Indirect clues could be offered through joking or through comments in school assignments, particularly creative writing or artwork.  Younger children and those who may have some delays in their development may not be able to express their feelings in words, but may provide indirect clues in the form of acting-out, violent behavior, often with threatening or suicidal comments. 

·  Previous attempts. If a child or teenager has attempted suicide in the past, there is a greater likelihood that he or she will try again.  

·  Depression (helplessness/hopelessness). When symptoms of depression include strong thoughts of helplessness and hopelessness, a child or adolescent is possibly at greater risk for suicide.  

·  “Masked” depression. Sometimes risk-taking behaviors can include acts of aggression, gunplay, and alcohol/substance abuse. While some youth may not act “depressed,” their behavior suggests that they are not concerned about their own safety. 

·  Final arrangements. This behavior may take many forms. In adolescents, it might be giving away prized possessions such as jewelry, clothing, journals or pictures. 

·  Efforts to hurt oneself.  Self-injury behaviors are warning signs for young children as well as teenagers. Common self-destructive behaviors include running into traffic, jumping from heights, and scratching/cutting/marking the body. 

·  Inability to concentrate or think clearly.  Such problems may be reflected in classroom behavior, homework habits, academic performance, household chores, even conversation. If a student starts skipping classes, getting poor grades, acting up in class, forgetting or poorly performing chores around the house or talking in a way that suggests they are having trouble concentrating, these might be signs of stress and risk for suicide. 

·  Changes in physical habits and appearance.  Changes include inability to sleep or sleeping all the time, sudden weight gain or loss, disinterest in appearance or hygiene. 

·  Sudden changes in personality, friends, behaviors. Parents, teachers and friends are often the best observers of sudden changes in suicidal students.  Changes can include withdrawing from friends and family, skipping school or classes, loss of involvement in activities that were once important, and avoiding friends. 

·  Death and suicidal themes. These might appear in classroom drawings, work samples, journals or homework. 

·  Plan/method/access. A suicidal child or adolescent may show an increased interest in guns and other weapons, may seem to have increased access to guns, pills, etc., and/or may talk about or hint at a suicide plan. The greater the planning, the greater the potential for suicide. 

What to Do 

Youth who feel suicidal are not always likely to seek help directly. This is why it is important for parents, school personnel, and peers to be able to recognize the warning signs and take immediate action. When a youth shows signs they may be considering suicide, the following actions should be taken: 

• Remain calm. 
• Ask the youth directly if he or she is thinking about suicide. 
• Focus on your concern for their wellbeing and avoid being accusatory. 
• Listen. – This cannot be stressed enough. 
• Reassure them that there is help and they will not feel like this forever. 
• Do not judge. 
• Provide constant supervision. Do not leave the youth alone. 
• Remove means for self-harm. 
• Get help: School staff should take the student to the designated school mental health professional or administrator. Peers should not agree to keep the suicidal thoughts a secret and instead should tell an adult. Parents should seek help from school or community mental health resources as soon as possible. 

It's been far too long

The title of this entry eludes to a number of things. The first of which is it has been a very long time since I have posted anything here. Trying to make a difference in the world can be very time consuming. Not to mention the fact that I don't always feel that it's safe to post every one of my qualms about my career out in public. You just never know who might be reading this.

But I am going to try to add a few points of discussion this year. The first is RtI. This is also the other reference to the title. In my three years as a practicing school psychologist I have not had the luxury of working in a school that has an established RtI process (or MTSS as it is referred to in the state of Kansas). This can be quite frustrating because I know how beneficial it can be to both the students and the teachers. Yet the resistance to establishing such a process is strong. I have found that most teachers hate change. They want to keep doing the same thing they have been doing for years regardless of its lack of effectiveness. Now not all teachers are this way, but a good majority. At least in my short experience.

Last year I worked in one school that was starting the process. It was imperfect, but fabulous to see them embracing it! They were able to see how useful it can be to both helping the students and defining a clearer path to identification. I was very proud of them and eager to help.

The other school I work in went through the MTSS training (the leadership team did anyway), but nothing really changed. In fact, it seemed to become much more convoluted. It also seemed to just make the process essentially disappear. Inconsistency in identifying students at-risk properly became the norm. And now it seems we are standing on the fence between the old ways and the new ways, neither of which are being implemented effectively to make appropriate changes.

So one of my goals this year is to shake it up. I want to see this school be as good as I know it can be. This means that some people are going to have to change their way of doing things whether they like it or not. In order for me to get this to happen I need administrative support. I'm hoping I can get that. I won't be here at this school forever and I want to leave it knowing that they are on the right track to helping kids.

So here we go! A new school year! Let's get to it!

504 Plans: What's the point?

I have not had the experience of developing 504 Plans. Generally, this is not something that is drawn up by the school psychologist...or so I'm told. I have a general idea what they are and their purpose, but very little understanding of the 'process behind the document'. For IEPs there is a very extensive process, which is legally defined for us by state and federal law. We have guidelines for each step and explicit expectations to meet. Schools (well, most schools, there are definitely exceptions to this out there) don't have a problem with meeting the needs of students who are eligible for Special Education Supports. (Now, is this solely because IEPs are backed by government funding? I don't know. I'm certain that has a lot to do with it, but we'll get to that later.)

The school I work in now does an amazing job at providing supports for students in need. When I refer to students in need, I'm not just talking students with an IEP. I'm also talking about students in the tier two intervention process (ours intervention team is referred to as the Student Intervention Team (SIT), but everyone has their own special term for them.) These are teams that consist of several school staff professionals gathering to problem solve ways to help students who are struggling, but not struggling to a significant degree.

When considering my own education teams and the excellent support resources our school provides for all students I have to ask myself...what is the point of a 504 Plan?  I've asked this of some colleagues as well who work in school that actually do 504 plans. The typical answer is "They are mandated by law." But what good is a law if it's not enforced? I don't see anyone checking into schools to see why there are no 504 plans done. If fact even the "auditing" done through special education might be considered kind of a joke. I mean, all they do is check the paperwork (at least from what I've seen so far in my experience). So essentially schools can do as much or as little as they want for kids as long as the paperwork says all the right things, is up to date, has signatures, and parents aren't making a fuss about any of it. But I digress... Another reason I've heard is that some schools will use 504 plans to decrease their special education ratio. In some cases it does seem appropriate to do a 504 Plan. Let me give you a scenario. You have a student whose expense and liability is great due to the severity of their disability. Their disability doesn't impact their ability to learn or put them significantly behind their peers academically. However, their disability forces the need for ramps to be put in, a staff member trained to work with the medical conditions the student has to deal with on a daily basis such as toileting, and maybe the school has to put in new doors too. These necessary supports will likely be very costly. The student generally gets by throughout the day without the need for an intense amount of help. There are times when they may have some kind of emergency situation that needs tended to and they might need help with toileting. So the student has a disability, but they don't show a need for intensive support services beyond what be provided through general education. This would be one case where a 504 Plan might be more appropriate. Another situation would be if you have a student with a vision or hearing disability, but the disability itself does not significantly impact their ability to learn. Or perhaps you have a student with a vision disorder that makes some activities difficult to do such as transfer information from the board to paper or see things on a computer screen. Academically they do fine and with a little bit of intervention could probably do a little better. The parents are also wanting a document such as an IEP or 504 Plan that can follow them after high school. Seems reasonable since the disability is one the child will have to deal with for the rest of their life. Technically, both of these situations warrant 504 Plans, but when the school psych mentions that dirty dirty word administrators about have a stroke.

There are good reasons for administration to be fearful of 504 Plans though. Now that I've done the research I completely understand why it freaks them out! It's not just that there's no federally funded monies that the school can access to support them (i.e. purchasing specialized curriculum/supplies, etc, which contrasts from special education since the school is allotted financial aid to help fund supplies needed for identified students). I used to think this was the only reason. I wasn't entirely wrong, but there's much more to it than I realized before. 504 plans can also be super scary because if your school were to be audited by the government to check on the fidelity and implementation of your plans and they had not been updated (similar to an IEP), and/or were not being followed to the extent of the plan that was devised, the government can essentially remove ALL of your school's funding (i.e. any state aided funds for ANY/ALL programs that are being supported within your school system...not just special education funds)! This would be a HUGE loss to the school system and community! Parental litigation is also a concern – it's not like IEPs/MDTs aren't prone to legal litigation – it's the concern that if the parent has a legitimate argument and the school is found "guilty" of not providing the identified services, the school is vulnerable to more "loss" than the average special education legal case. This makes principals and superintendents uncomfortable (to say the least) and rightly so!

So, what's the right thing to do? Personally, I feel that we should do whatever we can that is in the best interest of the child. Then again when the government gets involved it can get quite sticky. So, I'm not sure I can say with any conviction (yet) what I think the right thing to do is. I'm still working on that. In the meantime, I hope to find minimal reasons to have 504 Plans drawn up. They seem great and may have been initially developed with good intentions, but seem to be more trouble than they're worth. If you have the staff to support them and ensure that they are followed through and managed then go for it, but if you don't you might just be asking for trouble.

Searching For Hope

Sometimes I find myself riddled with sadness and frustration. I hate feeling like I'm unable to help others in a meaningful and lasting way. So many of my students live in terrible homes with parents or guardians who neglect them or abuse them. Many of the students come to school in filthy clothes, clothes that don't fit or have holes in them, and without having been fed properly. Some of them come to school exhausted because their parents don't have a bed for them to sleep in so they sleep on the floor. I make a lot of calls to social services and they are mostly just a waste of time. They rarely do anything to help if they do anything at all.

How can we expect children to be ready to learn when their basic needs are not met? We can't. That's the truth of it. So what, as educators, can we do? I have yet to find an answer to this question.

I want to help these kids, give them clothes, care, food, and all the things that little children should be getting from their parents, but I just don't make enough money to support multiple children. I've been considering creating a charity drive for children in need that attend our school. It would be so nice to just go and grab whatever a student needs...clean clothes, clothes that fit, a book bag, school supplies, or whatever. I haven't really figured out how to do this yet or if it would even be appropriate for me to do so.