Center and Crisis Services & An Introduction to Youth Suicide Prevention/Intervention/ Postvention
by user
Comments
Transcript
Center and Crisis Services & An Introduction to Youth Suicide Prevention/Intervention/ Postvention
Center and Crisis Services & An Introduction to Youth Suicide Prevention/Intervention/ Postvention o o o o o o o o o o o o Overview of DCMHMR and regular services Overview of Crisis Services Suicide Myths and Truths Legal Implications for Schools Best Practices for School Suicide Prevention/Intervention / Postvention Statistics for Youth Suicide Crisis Model and How to Identify a High Risk Student Do’s and Don'ts for Suicide Intervention and Postvention Social Networking Peer Support Suicide Contagion/Clusters/Copy Cat Role Play and Case Studies 2 3 The local mental health and mental retardation authority for all of Denton County Non – profit organization (501 C-3) Unit of local government administered by a nine member board of trustees which are appointed by the Denton County Commissioners Court Contract provider for the Texas Department of State Health Services and Texas Department of Aging and Disability Services 4 Denton County MHMR Serves Children and Adolescents from the ages of 3-17 that have severe emotional, behavioral or mental disorders. All potential clients must receive an intake which can be scheduled through the hotline. We accept Children and Adolescents with Medicaid or those that are uninsured. Fees are determined according to a sliding scale. 5 Psychiatry: Includes assessment of symptoms and prescription/ monitoring of medications. Assessment Services Case Management and Rehabilitative Services. Counseling: Time Limited individual and family counseling. 6 Crisis Hotline and Resolution Services Skills Training: Facilitates the client’s community integration and provides opportunities for improved functioning. Family Partner: Provides wraparound team process. Parent Support Group: Tuesdays in Lewisville and Denton once a month at 6:00 pm. 7 Home and Community-Based Services (HCS): o o o o o o o o Care Coordination Service Coordination Adaptive aids Minor home modifications Counseling and therapies (includes audiology; speech/language pathology, occupational or physical therapy; dietary services; social work; and psychology) Dental treatment Nursing Residential assistance o o o o o o o Supported home living Foster/companion care Supervised living Residential support Respite Day habilitation Supported employment 8 General Revenue (GR) Services: o Service Coordination o Community Support o Respite o Employment Assistance o Supported Employment o Nursing o Behavioral Support o Specialized Therapies o Vocational Training o Day Habilitation 9 Texas Home Living Waiver Program Services: o Adaptive aids o Minor home modifications o Specialized therapies o Behavioral support o Dental treatment o Nursing o Community support o Respite o Day habilitation o Employment assistance o Supported employment 10 Denton County MHMR was granted additional funding by the state to expand and improve mental health crisis services within Denton County. Crisis Redesign was implemented December 1, 2007 11 Two clinicians to assess individuals during business hours and one after hours. Response/wait time was long. Averaged 80 emergency screenings per month. No immediate crisis services available. 12 Since December 1, 2007: -Average 180-200 emergency screenings per month. - Response time has decreased. - Case management - Psychiatric services if appropriate. - Counseling services if appropriate. - Mobile Crisis Outreach Teams increased – over 25 day staff! Does not count after hours teams! - Substance abuse counseling. - Additional availability of short term hospital contract bed days. 13 Screening Location and Time Dec.1, 2007 Dec. 1, 2008 Dec. 1, 2008 Dec. 1, 2009 Dec.1, 2009 Dec. 1, 2010 Community 902 1,155 1,192 Office 319 560 833 Total 1,221 1,715 2,025 8a-5p 756 1,085 1,368 Nights/ Weekends/ Holidays 465 630 657 14 From December 1, 2010 – May 31, 2011 The Crisis Team has completed 928 Screenings so far! 15 2008 Jan.-Dec. 2009 Jan.-Dec. 2010 Jan.-Dec. 2011 Jan.-July 72 214 239 155 16 A crisis is a stressful situation or set of events that are perceived or experienced as intolerable and unsolvable because the individual’s customary coping strategies and problem solving skills are exceeded In a crisis an appropriate coping response is unknown, but in an emergency it can readily be implemented. DCMHMR defines a crisis as someone who has thoughts of suicide, homicide and/or has deteriorated to the point to where they are a risk of harm to themselves or others. 17 Denton County MHMR provides a crisis hotline service accredited by the American Association of Suicidology (AAS) Hotline staff will provide information, support, intake appointments, intervention, and referrals to callers 24 hours a day, 7 days a week. Hotline is available to anyone Hotline Number:1-800-762-0157 TTY Hotline Number:1-800-269-6233 18 ◦ To determine the risk of harm to self or others. ◦ To assess Acute and Chronic risk factors of suicide. ◦ To check the individual’s mental status for impaired or disturbed thought patterns. ◦ To assess the individual’s social environment for distress or support. ◦ To assess substance abuse. ◦ To determine what is the least restrictive environment in which an individual can safely function and receive treatment. ◦ To facilitate inpatient treatment for the individual if the clinician determines that to be the least restrictive environment. 19 › All Screenings undergo the following assessment process: Emergency criteria met Drug/alcohol levels acceptable for mental health treatment. BAC must be at below .08 or 80 and be Narcan free for 24 hours for team to screen. Client must be medically stable for team to screen. Physical problems - See Hospital Exclusionary Criteria for considerations Intellectual and Developmental Disabilities considerations 20 Secure locations include jail, DCMHMR office and Hospitals (medical and psychiatric). In the Hospital ~ has the psychiatric consult recommended inpatient treatment? If so, is the patient insured and will they go voluntarily? Police to stay for entire assessment if environment is an unsecure location or client is combative. If it is a child, we attempt to locate the parent/guardian. CPS will be contacted for any unaccompanied minors. Response time goal is within one hour. 21 Mobile Crisis Outreach Teams (MCOTs) provide face-to-face clinical assessments to individuals in crisis 24 hours a day, 7 days a week in Denton County. A MCOT consists of 2 individuals, a Qualified Mental Health Professional, and a licensed professional. The licensed professional can either be a Licensed Professional of the Healing Arts (LPC, SW, etc.) or a Registered Nurse. All MCOT Team Members are AAS Certified Crisis Workers. Teams will respond to appropriate crisis calls from hotline or walk-ins during business hours at our Denton and Lewisville outpatient clinics. 22 Crisis outpatient services consist of psychiatric services, medication, cognitive behavioral counseling, chemical dependency counseling, case management and referrals to outside organizations. All individuals seen for a crisis assessment meet face to face with a crisis staff member within 24 hours for a follow-up if outpatient services are recommended. Individuals are then seen by the team at least weekly. Crisis Services are time limited. 23 If there is a student that has been identified as high risk, do the following: 1. DO NOT LEAVE THE CHILD ALONE. 2. Notify the parents and make every attempt to have them come in. 3. Have campus security or police secure the scene. 4. Call the Crisis Line who will in turn contact MCOT. Please make sure the number of the person most familiar with the situation is left with the hotline 5. MCOT will determine the student’s least restrictive options. 24 25 Myth: Adolescents who talk about suicide do not attempt or complete suicide. Truth: One of the most dire warning signs of adolescent suicide is talking repeatedly about one’s own death. Adolescents who make threats should be taken seriously and provided the help they need (25,16). Myth: Educating teens about suicide leads to increased suicide attempts, since it provides them with ideas and methods about killing themselves. Truth: When issues concerning suicide are taught in a sensitive and educational context they do not lead to, or cause further suicidal behaviors (23). 26 Myth: Suicidal behavior is inherited. Truth: There is no specific suicide gene that has ever been identified in determining or contributing to the expression of suicide (15,20,17,5). Myth: Most teenagers will not reveal that they are suicidal or have emotional problems for which they would like emotional help. Truth: Most teens will reveal that they are suicidal. Although studies have shown that they are more willing to discuss suicidal thoughts with a peer than a school staff member (25). 27 Myth: Adolescent suicide occurs only among poor adolescents. Truth: It occurs in all socioeconomic groups (5,4,19) and socioeconomic variables have not been found to be reliable predictors of adolescent suicidal behavior. Assessing social and emotional characteristics are more helpful to determine if a youth is at increased risk (25,15,5,4,19). Myth: Suicide occurs in great numbers around holidays in November and December. Truth: Highest rates are in May and June and lowest rates are in December. (3) 28 Myth: Elementary school children are not at risk for suicide. Truth: While rates of completed suicide are considerably lower in this population, statistics show that it does happen (22). 29 Landmark Case: Wyke vs. Polk County School Board 11th Federal Circuit Court 1997: Found the district liable for not offering a suicide prevention program, providing inadequate supervision of a suicidal student and failing to notify parents when their child was suicidal. 30 Landmark Case: Mares vs. Shawnee Mission Schools Johnson County District Court 2007: The school system settled out of court after being sued following the suicides of two brothers. The key issue in the case was failure to implement suicide postvention procedures after the first death. 31 Structure Control Support 32 Have a strong Crisis Management Plan and Policies as well! The plan should include the most current information about suicidal behavior, risk factors, protective factors, contagion and prevention guidelines. The Crisis Response team should be identified and provided additional training to fulfill individual roles (11). The plan should include detailed instructions identifying each person’s role in response to suicide threats, attempts or completed suicide (11). This should include staff that are identified and not identified as Crisis Response Team Members. 33 This plan should be practiced and reviewed regularly (11). Each teacher and counselor should keep a copy of the plan in the classroom as well as offices so it is easily accessible (11). Encourage all staff to collaborate in recognizing at risk/high risk students (11). Provide parents and students with opportunities to become involved in suicide prevention strategies offered by the school (11). 34 Identify who your front line staff will be for children at higher risk. Front line staff should screen high risk youth using an approved tool (11). Consider having front line staff accredited through AAS Program. Conduct repeated screenings on high risk students once or twice every school year (11). Consider providing peer assistance programs. Evaluate the current plan/policies for effectiveness regularly (11). Who will address media, notify parents and begin to bring in community resources? 35 Establish collaborative relationships with community agencies such as police, clergy and mental health centers (11). Provide staff with contact information on these resources so appropriate referrals are made. If you identify a student as being a moderate or high risk of suicide, call the Denton County MHMR Hotline. 36 Statistics for Youth Suicide 37 o o o o Suicide is the third leading cause of death for youth ages 1024 behind accidents and homicides (7). In 2007, there were 4,320 completed suicides for youth ages 10-24. For those aged 20-24 the rate was 12.5 per 100,000. For those aged 15-19 the rate was 6.9 per 100,000. For those aged 10-14, less than 1 per 100,000 (7). Male youth die by suicide five times more frequently than female youth (7). Females attempt three times more frequently than males (7). The majority of youth who died by suicide used firearms (45%) and suffocation was the second most commonly used method (38%) (7). 38 A Survey Conducted by the CDC among High School Students in 2009 revealed the following: 13.8% of students in grades 9-12 seriously considered suicide in the previous 12 months (17.4% of females and 10.5% of males)(6). 6.3% of students reported making at least one suicide attempt in the previous 12 months (8.1% of females and 4.6% of males)(6). 39 Findings from a study conducted by scientists at the Centers for Disease Control and Prevention indicate that youth threatened or injured by a peer were 2.4 times more likely to report suicidal thoughts, and 3.3 times more likely to report suicidal behavior than non-victimized peers (14). 40 Native American/Alaska Native Youth have the highest rate of suicide with 14.8 per 100,000. White youth are next highest with 7.3 deaths per 100,000 (7). While the rate of completed suicide for Hispanic youth is lower than that for NonHispanics (5.4 per 100,000)(6), school aged Hispanic youth self-report higher rates of feeling sad or hopeless, of thinking about suicide, and of attempting suicide (7). 41 Lesbian, gay, and bisexual youth are up to four times more likely to attempt suicide than their heterosexual peers (18). More than 1/3 of LGB youth report having made a suicide attempt (10). Nearly half of young transgender people have seriously thought about taking their lives and one quarter report having made a suicide attempt (13). LGB youth who come from highly rejecting families are more than 8 times as likely to have attempted suicide than LGB peers who reported no or low levels of family rejection (21). 42 All Races/Both Genders/Exact Numbers 10 1999 2000 2001 8 2002 6 2003 2004 4 2005 2 2006 2007 0 Ages 5-14 Ages 15-24 2008 43 Trigger Growth/Healing Accumulation of Losses Pre-Crisis Cycle of Escape Passage of Time Crisis 44 Withdrawal from family and friends (11) Preoccupation with death (11) Marked personality change and serious mood change(11) Difficulty concentrating (11) Difficulties in school (decline in quality of work) (11) Change in eating and sleeping habits (11) Loss of interest in pleasurable activities & things one cares about (11). Frequent complaints about physical symptoms, often related to emotions such as stomach aches, headaches, fatigue, etc (11). Persistent boredom (11). 45 Actually talking about suicide or a plan (11) Exhibiting impulsivity such as violent actions, rebellious behavior or running away (11). Refusing help, feeling “beyond help”(11) Complaining of being a bad person or feeling “rotten inside” (11). Making statements about hopelessness, helplessness, or worthlessness (11). Not tolerating praise or rewards (11) Giving verbal hints such as: “ I won’t be a problem for you much longer,” “Nothing matters,” “It’s no use,” and “I won’t see you again” (11). 46 Becoming suddenly cheerful after a period of depression-this may mean that the student has already made the decision to escape all problems by ending his/her life (11) Giving away favorite possessions (11) Making a last will and testament (11) Saying other things like: “I’m going to kill myself,” “I wish I were dead,” or “I shouldn’t have been born.” (11) Using social media to convey these messages. 47 Acute Risk Factors: I – Ideations of Suicide S -Substance Use Increase P - Purposeless A – Anxiety/Insomnia T - Trapped H – Hopeless W - Withdrawn A – Angry R – Reckless/Self-Injury M – Mood Swings Are there Firearms in the household? Contagion or Imitation a possibility? 48 Previous Suicide Attempts (2) Diagnosable Mental Illness (2) Previous Mental Health Hospitalizations (2) Chronic Isolation (2) Family History or exposure to suicide (2) Mental Health Issues (2) Childhood Abuse (2) Significant Medical Illness (2) Low Self-Esteem (2) Poor Coping Skills (2) Life Stressors/Losses/School problems/Living Alone(11) Being Bullied(11) Sexual Orientation(11) Juvenile Delinquency (11) 49 Acute Risk Factor Low Risk Moderate Risk High Risk Ideations of Suicide None or Passive thoughts of death Active, no plan or preparations, may threaten Constant, planned, preparations, intent, means available Substance Use None As usual Excessive, increased Purposeless Has Reasons for Living Ambivalent; reasons for dying>for living Sees no reasons for living, no purpose in life; Feels burdensome. Anxiety No significant signs or mild anxiety Moderate anxiety, restlessness, agitation or slight insomnia Agitated, restless, difficulty sleeping or panicky 50 Acute Risk Factor Low Risk Moderate Risk High Risk Trapped Able to see choices, does not feel hopeless Some constricted thinking Hopeless Looking forward, reasonably positive regarding self, others and the future Some pessimism, Negative feelings some negative about self, others feelings regarding and the future self, others and the future Withdrawal None evident Less active, less pleasure (and interest) in usual activities, some decline in performance (school, work) Sees choices as continued pain versus death, sees no way out Socially Isolated, closed off, acutely and unhappily alone. May have stopped engaging in previous activities completely. 51 Acute Risk Factor Low Risk Moderate Risk High Risk Anger Slight irritations at worst Angry outbursts, Irritable, Sees others as not supportive Marked anger or rage, harboring fantasies of revenge, paranoid Recklessness Nothing unusual Minor risk taking Acting without thinking, risking dangerous consequences in behavior Mood Change No change Slight downturn in mood Dramatic Shift in Mood 52 Family connectedness and school connectedness(2) Reduced access to firearms(2) Safe Schools(2) Academic achievement(2) Self-Esteem (2) Positive Relationships with other school youth(11) Lack of access to means (11) Help-seeking behavior (11) 53 Impulse control (11) Problem solving/conflict resolution abilities (11) Stable Environment (11) Access to care for mental/physical and Substance Use Disorders (11) Responsibilities for others/pets (11) Spiritual Connectedness/Religion (11) Anything the youth states that is a reason for living!!! 54 When having a conversation with a youth that you think is at risk, find out about thoughts of suicide quickly after establishing a rapport. Ask what you need to know directly! Younger children tend to be very concrete thinkers. Avoid abstraction. Asking a youth if they want to “hurt themselves” may mean cutting in their mind. 55 Don’t ask leading questions like, “You’re not thinking of suicide are you”? Chances are you will not get a truthful response (24). Sample questions to uncover suicidal thinking (24): • Sometimes, people in your situation (describe the situation) lose hope; I’m wondering if you may have lost hope, too? • Have you ever thought things would be better if you were dead? • With this much stress (or hopelessness) in your life, have you thought of hurting yourself? • Have you ever thought about killing yourself? 56 If there are thoughts of suicide, ask specifically about frequency, duration and intensity (24). Sample questions to assess suicidal ideation (24): • When did you begin having suicidal thoughts? • Did any event (stressor) happen before the suicidal thoughts? • How often do you have thoughts of suicide? How long do they last? How strong are they? • What is the worst they have ever been? • What do you do when you have suicidal thoughts? • What did you do when they were the strongest ever? 57 After discussing suicidal thoughts, inquire about plan and the means (24). Sample questions to assess suicidal planning (24): • Do you have a plan or have you been planning to end your life? If so, how would you do it? Where would you do it? When would you do it? • Do you have the (drugs, gun, rope) that you would use? Where is it right now? 58 Determine the extent to which the patient expects to carry out the plan and believes the plan or act to be lethal vs. selfinjurious (24). Sample questions to assess intent (24): • What would it accomplish if you were to end your life? • Do you feel as if you’re a burden to others? • How confident are you that this plan would actually end your life? • What have you done to begin to carry out the plan? For instance, have you rehearsed what you would do (e.g., held the pills or gun, tied the rope)? 59 Sample questions to assess intent (cont.)(24): •How likely do you think you are to carry out your plan? • What stops you from killing yourself? • Have you made other preparations (e.g., given away prized possessions) • What makes you feel better (e.g., contact with family, use of substances)? • What makes you feel worse (e.g., being alone, thinking about a situation)? 60 Anyone with training can ask the questions noted in slides 53-58, however, determination of risk should be assessed by a counselor, MCOT or other Mental Health or Medical Professional. Practice asking these questions prior to a real encounter (24). If you suspect the child is not being honest, ask questions in different ways until there is reconciliation between what the child says and what you are seeing (24). Ask any collaterals for clarification. This may include parents, friends and police (24). 61 Youth will often talk to each other about topics that they are uncomfortable discussing with adults Arm children with appropriate information on suicide. This should include information on when to tell an adult. Help them understand what should be a cause for concern. Consider a peer mediation program and train frontline youth. 62 Avoid using a brief (2-4 hour), one-shot approach in assembly presentations or classes. A prolonged approach is better (11). Curriculum should include myths, facts, risk factors, warning signs, what they can do to help and resources (11). Curriculum approaches that attempt to increase students’ self esteem, coping and problem solving skills may in turn increase the likelihood that they may seek help if they are in need (11). 63 Avoid approaches such as suicide as a reaction to stress, media depictions of suicidal behavior or having a youth that attempted suicide give testimonials. Curriculum could be implemented in already established health or life-skills classes (11). Research has shown that curriculum length of anywhere from three classes (40-45 minutes each) to a semester long class are effective at significantly reducing suicidal ideations, hopelessness and depression in adolescents (11). There are established toolkits on the resource list provided that could be helpful in curriculum development. 64 A suicide death will be discussed using this medium and there will often be a spontaneous memorial posted. Someone should monitor discussions on social media. Look for rumors, information on gatherings, derogatory messages and indications that a youth may need assistance (1). Be a part of the memorial by posting positive and accurate help related information and hotline numbers (1). Find a student leader to help in these efforts and assure them that you are interested in supporting a healthy response to their peer’s death and not trying to thwart communication (1). 65 WHAT TO DO WHAT NOT TO DO Ensure a student’s safety (11). Debate whether suicide is right or wrong or promise secrecy or confidentiality. NEVER leave them alone or send them away if they have expressed suicidal ideations (11). Listen, be direct, remain calm and know your limits (11). If situation is beyond your scope, find someone to take over. Panic or act shocked (11). Be empathetic, honest and take it seriously (11). Rush, lose patience, give advice, be judgmental, preach, or minimize (11). Make sure the student knows what is going on during the intervention process (11). Surprise the youth by escorting then to a large room with several members of the crisis intervention team (11). Get additional assistance if needed (11). Physically remove a weapon (11). Inform Parents/Caretakers (11). Keep the situation to yourself (11). 66 WHAT TO DO WHAT NOT TO DO Have an established plan to deal with the media which will include one identified spokesperson. Provide factual information and concern for the family. Encourage reporters to provide information that increases public awareness of risk factors, warning signs, hotlines and resources (11). Avoid sensationalizing, glorification or over simplifications of the suicide. Avoid graphic descriptions/details and front page headlines. Displays in the media of memorializing can increase the likelihood of imitation/contagion/copycat suicides. Staff should not talk to the media or spread rumors (11). Follow the established Crisis Management plan. This should include activation of the Crisis Response Team, securing facts about the death (ME Report), informing the Superintendent, calling the Family of the deceased, scheduling a time and place to meet with faculty and other school staff, contacting community support services, arranging a meeting for parents, meeting with students in small groups, offering support services and debriefing with staff each day for at least 5 days (11). Avoid being unprepared. 67 WHAT TO DO WHAT NOT TO DO Assure staff have an updated list of referral resources, compile a list of all students close to the deceased, find out if there are siblings and notify the principals of those schools, compile a list of all staff members that had contact with the deceased, update and compile a list of students who may be at risk for suicide (11). Avoid being unprepared. Provide counseling and supportive Avoid having a large assembly with services to staff and students. students to discuss the suicide (9). Resources should be available at school and off campus. Inform local mental health agencies and crisis lines so they can prepare to meet needs (11). 68 WHAT TO DO WHAT NOT TO DO Provide information about funeral and family visitation arrangements to staff, students, parents and community members. Encourage the family to schedule the funeral after school hours to facilitate student attendance or arrange for students and staff to be excused from school to attend the funeral (11). Have a memorial or funeral at the school or fly flags at half mast. Avoid permanent memorials on school property. Follow-up with students identified as at risk and provide ongoing assessment and monitoring (11). Stop intervention efforts after first week. Keep to regular school hours and ensure students follow established dismissal procedures (1). Cancel school or school activities. Treat this death as you would any other. Must find a balance between respectfully acknowledging the death and not promoting contagion with memorial efforts (1) Treat it differently. This can increase stigma. 69 Suicide Contagion: process by which one suicide death may contribute to another (1). Suicide Cluster: A group of suicides or suicide attempt, or both, that occurs closer in time and space than would normally be expected in a given community (22) Copy Cat Suicide: When a person copies the manner of death of another person (22). 70 Youth are more vulnerable than adults because they may identify more readily with the behavior and qualities of their peers (1). Contagion is rare – only accounting for 15% of all suicide deaths annually (1). Media coverage can contribute to contagion. Front page stories, simplistic explanations of suicide, graphic depictions and printing photos of the victim can be contributing factors (22). 71 Avoiding any sensationalizing, romanticizing or glorification of the suicide or the victim (22). Remember anniversary dates can also be a time of increased risk (22). Encourage students to get involved with living memorials which may help prevent other suicide deaths (22). Refer to lists that should be made (noted on postvention steps-slide 56) and follow up with these students. 72 Opportunities for staff to talk to someone they trust in the event of a school crisis is essential. Resources should be given to staff for counseling. Find self-care opportunities to manage stress and restore balance. 73 Role Play & Case Studies 74 American Association of Suicideology – www.suicideology.org American Foundation for Suicide Prevention – www.afsp.org Centers for Disease Control – www.cdc.gov Mental Health America of Texas – www.mhatexas.org National Institute for Mental Health – www.nimh.nih.gov Substance Abuse and Mental Health Services Administration – www.samhsa.gov Suicide Prevention Resource Center – www.sprc.org Texas Department of State Health Services – www.dshs.state.tx.us 75 Free Toolkits for Schools: 1.Youth Suicide Prevention School-Based Guide. http://theguide.fmhi.usf.edu/ 2. Suicide Prevention and Postvention: Toolkit for Texas Communities. www.texassuicideprevention.org 3. After a Suicide: A Toolkit for Schools 2011. www.afsp.org and www.sprc.org. 4. The Trevor Survival Kit. http://www.thetrevorproject.org/survivalkit 76 Hotlines: 1. Denton County MHMR - 24 Hour Crisis Hotline – 1-800- 762-0157 or TTY – 1800-269-6233 2. National Suicide Prevention Lifeline – 1800-273-TALK (8255) or TTY 1-800-7994889 3. Girls and Boys Town National Hotline – 1800-448-3000 or TTY 1-800-448-1833 4. The Trevor Lifeline – 1-866-488-7386 77 1. After a Suicide Toolkit 2011: American Foundation for Suicide Prevention 2. 3. 4. 5. 6. 7. and Suicide Prevention Resource Center: p.11, 35, 40-41, 43 American Association of Suicideology – www.suicideology.org American Foundation for Suicide Prevention – www.afsp.org Borowsky, I.W., Ireland, M., Resnick, M.D. (2001) Adolescent suicide attempts: Risks and protectors. Pediatrics, 107(3), 485–493. Brent, D.A. (1995). Risk factors for adolescent suicide and suicidal behavior: Mental and substance abuse disorders, family environmental factors and life stress. Suicide and Life-Threatening Behavior, 25, 52–63. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance—United States, 2009. Surveillance Summaries, June 4. MMWR 2010; 59 (No. SS-5). Centers for Disease Control and Prevention, National Center For Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS)[online]. Available from www.cdc.gov/ncipc/wisqars. 78 8. Centers for Disease Control and Prevention, 2007. http//webappa.cdc.gov/sasweb/ncipc/mortrate10_sy.html. 9. Centers for Disease Control and Prevention. Youth Risk Behavior Surveillance—United States, 2005. 10. D’Augelli AR - Clinical Child Psychiatry and Psychology , 2002. 11. Doan, J., Roggenbaum, S., & Lazear, K. (2003). Youth Suicide prevention school based guide – Issue Brief 3a: Risk Factors: Risk and Protective Factors, and Warning Signs. Tampa, FL: Department of Child and Family Studies, Division of State and Local Support Louis de la Parte Florida Mental Health Institute, University of South Florida. (FMHI Series Publication ( #2183a,4, 6c) 12. Gould, M.S., Kramer, R.A. (2001). Youth suicide prevention. Suicide and Life Threatening Behavior, 31, 6–31. 13. Grossman AH, D’Augelli AR - Suicide and Life Threatening Behavior , 2007. 79 14. Jennifer Wyatt Kaminski, Xiangming Fang, Victimization by Peers and Adolescent Suicide in Three US Samples, The Journal of Pediatrics, In Press, Corrected Proof, Available online 19 July 2009, ISSN 0022-3476, DOI: 10.1016/j.jpeds.2009.04.061 15. King, K.A. (1999). Fifteen prevalent myths about adolescent suicide. Journal of School Health, 69 (4), 159–161. 16. Kirk, W.G. (1993). Adolescent suicide: A school based approach to assessment and intervention. Champain, IL: Research Press. 17. Lester, D. (2000). Suicide prevention: Resources for the millennium. Ann Arbor, MI: Sheridan Books. 18. Massachusetts Youth Risk Survey, 2007. 19. Moscicki, E. (1999). Epidemiology of Suicide. In D.G. Jacobs (ed), The Harvard Medical School Guide to Suicide Assessment and Intervention. San Francisco: Jossey-Bass Publishing 1999:40–51. 80 20. O’Carroll, P.W., Potter, L.B., Mercy, J.A. (1994). Programs for the prevention of suicide among adolescents and young adults. MMWR CDC Surveillance Summary 43 (RR-6)1–7. 21. Ryan C, Huebner D, et al – Peds, 2009;123(1):346-352) 22. Suicide Prevention and Postvention Toolkit for Texas Communities: p.71&78 23. Tierney, R., Ramsay, R., Tanney, B., Lang, W. (1991). Comprehensive school suicide prevention programs. In Leenaars, A.A., Wenkstern, S. (Eds.) Suicide Prevention in Schools. New York:Hemishere Publishing Corporation 24. Western Interstate Commission for Higher Education (WICHE) and Suicide Prevention Resource Center (SPRC). (2009) Suicide Prevention Toolkit for Rural Primary Care. A Primer for Primary Care Providers. Boulder, Colorado: Western Interstate Commission for Higher Education. 25. Zenere, F.J. & Lazarus, P. J. (1997). The decline of youth suicidal behavior in an urban, multicultural public school system following the introduction of a suicide prevention and intervention program. Suicide and Life-Threatening Behavior, 27(4), 387–403. 81 Phyllis Finley, B.A., QMHP, QMRP MCOT Community Liaison (940) 565-5295 [email protected] Denton Outpatient Clinic 2519 Scripture P.O. Box 2346 Denton, TX 76202 Main – (940) 381-5000 dentonmhmr.org Our Mission: To enhance the quality of life for the persons we serve and their families 82