Youth Suicide - Information For Schools - Intervention
IDAHO GUIDELINES FOR SCHOOL-BASED SUICIDE INTERVENTION
Schools can convey that they value and care for their students and staff by implementing best practices’ suicide prevention, intervention, and postvention plans.
The best intervention programs are successful because good training precedes them, allowing school communities to identify students at risk quickly and safely, and to follow-up regularly and monitor these students. Thankfully, good prevention and intervention lessen the need for postvention programs.
IDAPA 08.02.03.160(3a) states “Each public school district shall adopt a policy on student suicide prevention. Such policy shall, at a minimum, address procedures relating to suicide prevention, intervention and postvention. As used in this paragraph, "postvention" means counseling or other social care given to students after another student’s suicide or attempted suicide.”
The following guidelines are largely excerpted from Preventing Suicide: A Toolkit for High Schools published by SAMSHA.
Intervention Program Goals
- To identify and respond to students at risk for suicide in a prescribed manner while keeping both the student and classmates safe
- To utilize Regional Case Managers to connect home, student, and school for continuity of care
- To set up pre-arranged building contact(s) for the preliminary assessment and subsequent follow up of the student
- To refer students at risk to recognized mental health programs which may include emergency personnel (ambulance or police) and designate people who make calls to these agencies and to parent/guardians
- To have a pre-determined documentation plan, which must include dates and times of parent/guardian contacts and their responses
- To help students integrate safely back into the school setting when appropriate
- To monitor the student and adjust activities as needed after integration
- To provide school or staff support if needed
- To reach out for support from Idaho Lives Project or the SDE as needed
- The entire school community must be trained in prevention and intervention and then act accordingly. The school community includes administration, custodians, bus drivers, teachers, students, aides, lunchroom workers, regular volunteers, etc., so that they are ready to respond at the initial identification of students at risk. Protocols should be regularly discussed at staff or professional development meetings, and new staff and substitutes should be provided an opportunity to learn these protocols. If the district/school has a handbook for staff and substitutes, these protocols should be included.
- Schools should access Regional Case Managers (RCMs) for support. RCMs provide free services both to the school and family to:
- Advocate for the youth throughout the transition process
- Act as liaisons among the family, behavioral health or emergency department, the school, and the student
- Participate in school re-entry teams, if applicable, to support implementation of behavioral health goals
- Provide youth suicide assessment services when the family has no other access to assessment resources
- Pre-screening of agencies that can offer mental health help to the student and family, including those who take sliding-scale fees, and that are willing to work with the school to re-integrate the student when appropriate, is important so the intervention is smooth. Consider agencies that have training in assessing and managing suicide risk and experience working with youth.
- Emergency personnel and police, including school resource officers and security, should be involved in planning so all parties understand procedures and their roles in managing the situation.
- Protocols should be available for times when parents are unavailable or when they refuse to take their child (deemed critical) to receive mental health services.
- Confidentiality rights must be explained and understood by anyone involved.
- A crisis that affects a classroom or a group of students may require postvention work, including a letter/email sent to parents/guardians of students affected by the attempt. (Confidentiality issues apply here. Know your district’s confidentiality policies.) Classroom discussions about the incident, other than to debrief students involved, should be avoided. Staff involved with the student should receive appropriate information within the confines of confidentiality.
- Cultural issues and language barriers must be addressed, and protocols set up to accommodate these students and their families’ needs in a crisis.
See Questions for Guiding Intervention Set Up
After a student is identified and is in the custody of the identified mental health screener, then the mental health screener should follow specific guidelines.
- Never leave the student alone until they are in custody of the parent/guardian, mental health authority, or emergency personnel.
- Use screening devices carefully to assess the extent of the threat to self or others.
- Follow through with parent/guardian regardless of the screening outcome. If a student is deemed likely to make a suicide attempt or harm others, also contact the agency where the parent and student are to go and ask that the agency to call you if they fail to show up in a timely fashion. If parents seem reluctant or embarrassed, use some ideas from Engaging the Parent to alleviate their discomfort. Confirm parent/guardian contact (See Confirmation of Parental Contact Form).
- Follow up with the parent and the mental health agency and ask parents to sign release of confidentiality with that agency. (Use your district’s confidentiality release form or use the Exchange of Information Form. Best practice suggests obtaining the parent signature during the initial visit in your presence when possible.
- Debrief those involved—student, teacher, school personnel who brought the student to the mental health screener. Confidentiality issues apply here. Know your district’s confidentiality policies (See Self-Care for Adults).
- Decide with the parent/guardian and the mental health agency how and when the student is to return (See Sample Student Re-Entry Plan).
- Document all the preceding steps (See Document Actions List).
- NO STUDENT WITH ASCERTAINED RISK SHOULD BE SENT HOME ALONE. The student should be accompanied by an adult who is informed of the situation and to whom you have provided a list of resources, including those related to means restriction. The adult cannot leave the child until they are in custody of a parent or guardian.
For a specific and comprehensive list of intervention actions for school counselors please see Helping Suicidal Youth: Detailed steps for Counselors.
Other Intervention Considerations
Assessment Tool: Each school must find an evidence-based screening tool fit its needs, such as the Columbia Suicide Severity Rating Scale for Youth.
The screening should involve:
- Determining whether the student has a suicide plan and what it is.
- Asking whether the student has lethal means - on person or accessible elsewhere.
Also, be sure to:
- Consult with other student services personnel and find out any other related information from teachers or peers, even if this is done after the original screening. Collect any current information about the student, such as, attendance, behavioral records, and previous evaluations from appropriate staff.
- Inform administration/crisis team of results of risk screening and determining next steps.
Avoid No-Suicide Contracts: No-suicide contracts should not be used. Such contracts normally consist of a written agreement between a person deemed at risk and their counselor/therapist in which the person at risk agrees not to attempt suicide. No-suicide contracts tend to be worded to instruct the person at risk what NOT to do rather than what To Do. Research also demonstrates that these contracts may increase hopelessness and may increase liability for the school.
Safety Plans Recommended: Instead of No Suicide Contracts use a safety plan. A safety plan is a concise, user-friendly crisis plan with a few simple statements. The development of the card itself can help dilute the intense distress often experienced during intervention. Safety plan statements can be written on an index card, piece of paper, typed and printed on card stock, or anything else that can be easily kept on one’s person or on their phone. Plans should focus on increasing feelings of belongingness and decreasing feelings of burdensomeness/ineffectiveness. (Joiner, 2005) Anyone can help a youth develop a safety plan, and the mental health clinician usually incorporates one as part of the treatment plan. The school crisis team member or counselor should be informed of this safety plan to better support the student upon return (See Safety Plan). In addition to the written safety plan, several phone apps are available for youth to use, both for suicide prevention and for other mental health issues:
Report Suspected Abuse or Neglect: When anyone has reasonable cause to suspect that a student has been, or is likely to be abused or neglected, they must make a report of suspected abuse or neglect to the proper authorities. In Idaho, school staff, as well as all adults, are mandated reporters. In Idaho, call 855-552-5437 to report child abuse or call your local police or SROs. If a school staff member determines that a student under age 18 appears to be at risk of attempting suicide, and the parent/guardian refuses to obtain services for them, a report should be made to the Idaho Department of Health and Welfare (IDHW) for negligence (failure to seek necessary mental health treatment), which may place the child at risk of serious harm or death. IDHW will conduct an assessment to determine if abuse or neglect exists and will engage the family to voluntarily meet the treatment needs of the child.
Lethal Means: Separate a suicidal student from lethal means if the means are on or near the student and if safe to do so. For example, if a weapon is near the student, such as in a backpack, leave the backpack and take the student to another room. If the student has pills on them, ask if you can hold the pills for them while you are talking.
Call the police when the student is in possession of a weapon, such as a gun, knife, or other dangerous item. Secure the area by either removing students to another classroom or area, or by preventing them from entering the room or area. Since lethal means must be removed without putting anyone in danger, immediately notify your school resource officers or local law enforcement agency. Law enforcement officers have special training to de-escalate a situation that can very quickly become dangerous. If a student requires evacuation by ambulance, the police need to be notified.
Guidelines for a Student Suicide Attempt on School Premises
- In classrooms or other small groups where the student was present during the crisis, offer a brief statement assuring others that the student who made the suicide attempt is receiving help (ask parents how they would like the situation to be addressed). Keep the details of the attempt confidential, while addressing the facts of the situation in a respectful, non-glorifying way. Keep in mind that each situation is different. Remind students that this student has a mental health issue that will be addressed, just as if he or she had a broken leg or in a way that any other physical health problem would be addressed. Ask students to please honor the privacy of this student. An at-school attempt warrants a letter/email sent to parents of students, especially those directly affected by the attempt, while maintaining the attempter’s privacy as much as possible.
- Describe and promote resources for where students can get help.
- Monitor close friends and other students known to be vulnerable and offer support as needed.
- Conduct a mandatory informational debriefing for staff, administrators, and crisis response team members who directly dealt with the student in crisis and take notes for staff who are not available to attend. Help other school staff by providing an opportunity to address feelings and concerns and conduct any necessary planning.
- Document actions taken as required by school protocol.
Guidelines for a Student Suicide Attempt off School Premises
A severe, life-threatening suicide attempt off school premises can have a significant impact on the student body. To prevent a crisis from escalating among students, it is important that school personnel follow these steps, or implement your school district’s crisis plan.
- Notify the school administrator or designee who will verify the crisis with police/parents. Then immediately communicate with designated individuals, as needed, such as crisis or student assistance team members, the school nurse, social worker, counselor or psychologist, emergency medical professionals, community crisis service providers, law enforcement and the superintendent of schools.
- The superintendent or designee alerts principals at schools attended by siblings, who in turn will notify counselors, nurses, and others in a position to help siblings and other students who might be affected if the student’s parents agree.
- Mobilize the school-based crisis team, with support from community crisis service providers, to help staff address the reactions of other students. When other students know about a suicide attempt, steps must be taken to avoid copycat behavior among vulnerable at-risk students. (*Note: At-risk students may be friends and relatives of the student or other students who may not know the individual, but who themselves are at risk for other reasons.)
- Establish communication with the parent/guardian to determine intervention steps and how the school might be helpful and supportive to the student and family. Also address how the family would like the situation announced at school. Ask parents if you may alert other schools that may have students impacted by the attempt, including the attempter’s siblings.
When a suicide attempt is severe and affects many of the students/staff, e.g., on social media, convene a staff meeting and address the issue of the crisis with the facts and how to proceed. Ask staff to monitor students for any signs of distress. If the suicide attempt is high profile or likely to result in death, an email message should be sent to all students’ parents alerting them of the attempt and providing them with resources (See All Parent Letter/Email). Alert the attempter’s parents that you will be sending this letter/email; that you will not identify the student, but that it is important to keep other vulnerable youth safe.
- Establish a plan for periodic contact with the student while away from school.
- If necessary, plan for class work assignments to be completed at home. If the student is unable to attend school for an extended period, determine how to help the student complete their requirements, e.g., homebound instruction (See Sample Student Re-Entry Plan).