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Impact of Suicide on Youth and Families. The O nes We Miss. Video . Who would have thought this could happen?. What do we know?. Wisconsin – 5 th highest in nation 10-14 year olds Second leading cause of death – 15-24 yr. olds National Rate = 8.76 Wisconsin Rate = 10.78

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Who would have thought this could happen?

What do we know
What do we know?

  • Wisconsin – 5th highest in nation 10-14 year olds

  • Second leading cause of death – 15-24 yr. olds

  • National Rate = 8.76

  • Wisconsin Rate = 10.78

  • People who die in Wisconsin due to suicide are younger…

What else do we know
What else do we know?

  • Inpatient hospitalization for youth (15-24) is more than double than the nation.

  • E.R. visits are slightly lower than national rates

    What would this mean to you?

Why are you here today
Why are YOU here today?

Small group discussion:

Introduce yourself

What is your compelling story?

Share story with larger group if willing

Learning objectives
Learning Objectives

  • Gain understanding of the phenomenology of suicide and its impact on children and adolescents.

  • Understand the warning signs, risk factors, and protective factors of suicide when assessing children and families.

  • Gain understanding of the scope of the problem facing Wisconsin, and thus Child Welfare and Juvenile Justice Professionals.

Learning objectives cont
Learning Objectives Cont…

  • Develop an awareness and understanding of who are the “Ones We Miss”, including children in out-of-home care and youth who are bullied.

  • Have an opportunity to discuss several strategies currently utilized in Wisconsin to address the problem of child/adolescent suicide to use in case planning.

    6. Develop a system of care and crisis plan for a child in the child/adolescent in the system to use in case planning

The burden of suicide in wisconsin
The Burden of Suicide in Wisconsin

“Suicide affects an entire community and, because it is a complex issue, it will take a community to work on it.”

Pat Derer, President, HOPES

(Helping Others Prevent and Educate about Suicide)

  • Rates remain constant (2000 to 2006)

  • Greatest number – ages 35-54

  • Greatest ER/hosp. – ages 15-24

  • Native American have highest rate

The burden of suicide in wisconsin1
The Burden of Suicide in Wisconsin

  • Firearms most frequently used method

  • 1 of 4 have history of previous attempts

  • Over 33% had alcohol present in their system

  • Mental health – especially depression

  • 4:1 male to female suicide deaths

  • Cost – years lost to society (20,000 years/year)

  • Method

  • Location

  • Circumstances

  • Interpersonal circumstances

  • Life Stressor Circumstances

Interesting data on wi
Interesting Data on WI

  • US rate declined 24% during 1995-2005

  • Wisconsin only 8% decline

  • Firearms = 60% of completed youth suicides

  • But….88% hospitalizations for O.D. & cutting

  • So….most lethal methods = no hospitalization

    Rates of attempts, mortality, and self-reported risk among youth is unacceptably high

Who are we missing
Who are we missing?

Male deaths outnumber female deaths

  • use more lethal methods

  • are not hospitalized

    What else do we know about male adolescents?

    More to come…

Risk factors and warning signs
Risk Factors and Warning Signs

Small group discussion:

What do you know about suicide?

Risk factors?

Warning signs?

List on flip chart and post on wall when finished

Suicidal behaviors
Suicidal Behaviors

  • Suicide

  • Suicide Attempt

  • Suicide Ideation

  • Suicide Plans

Ones we miss
Ones we miss…..

  • 55% talked about suicide within a month of their suicide

  • 45% did not

  • 73% who died DID NOT mention intent or ideation during last contact w/ a professional

  • Those who did:

    60% - spouses

    50% relatives

    18% caregivers

Specific risk for males
Specific Risk for Males

  • Relationships

  • Access and ability to use lethal means

  • Murder – Suicide

  • Socially isolated

  • Family history

  • Mental illness or substance abuse

  • Divorce

  • Homosexuality

Self injurious behavior sib
Self-Injurious Behavior (SIB)

  • Severe

  • Stereotype

  • Socially Acceptable/ Emblematic

  • Superficial/Moderate


  • Attempt suicide much younger than previously thought

  • Hanging is the most common method

  • Don’t express suicidal intent or signs of depression

  • Have conflicts with parents


Warning signs:

  • Past attempts/threats

  • Past violent aggressive behavior

  • Cognitive immaturity/impulsivity

  • Little to no supervision

  • Bringing weapons to school

  • Recent experience of humiliation/shame

  • Bullying

  • Victim of abuse/neglect

  • Witnessing violence in the home

  • Themes of death/preoccupation with violence

  • Poor peer relationships

  • Vandalism, cruelty to animals, fire setting


What separates those who attempt from those that think about it?

  • Substance abuse (12.8 times)

  • Enduring hopelessness

  • Isolation

  • Reluctance to discuss suicidal thoughts

  • Psychopathology

General risk factors for adolescents
General Risk Factors for Adolescents

  • Previous suicide attempt

  • Mental Illness

  • Imitation

  • Family history of suicide

  • Sexual orientation

  • Sexual abuse

  • Other stressors

  • Incarceration

Protective factors
Protective Factors

  • Friends - most important protective factor

  • Supportive parent

  • School relationships

Are these ones we miss
Are these… “Ones We Miss”?

African American

The System


Native American






  • Ratio of attempts to completions: 4,000:1

  • Suicide attempt is NOT a statistical risk factor

  • Depressive episode IS a risk factor

  • Do not always have a precipitating event

  • May attempt while recovering from depression

  • Panic attacks ARE a risk factor


  • Ratio of attempts to completions: 500:1

  • Attempts ARE statistical risk factor

  • Often kill themselves within a few hours of a precipitating event:

    • Anxiety

    • Legal problems, relationships, humiliating experience, etc.

  • Aggressiveness IS a risk factor

Are these some of the ones we miss
Are these some of the “Ones We Miss”?

African American

The System


Native American

Native American




Possible reasons for increase
Possible Reasons for Increase

  • Stigma around mental health

  • Non-native workers

  • Removed from “community”

  • Historical oppression

  • Intergenerational trauma

Protective factors1
Protective Factors

  • Culture

  • Tradition

  • Community

  • Family

Richard cardinal1
Richard Cardinal

  • Risk Factors?

  • Protective Factors?

  • Commonalities to youth in the system today?

Are these some of the ones we miss1
Are these some of the “Ones We Miss”?

African American

African American

The System


Native American




African american youth
African American Youth

  • Historically lower rates than whites

  • This is changing – 10-14 year olds greatest increase

  • Why?

    • Better knowledge, attention, reporting

    • Same as white counterparts

    • Structural barriers to health care

    • Attitudinal barriers

    • Economics/employment

African american youth1
African American Youth

  • Access to firearms

  • Isolation from social institutions

  • Protective factors: family, church, school, community

Are these some of the ones we miss2
Are these some of the “Ones We Miss”?

African American

The System



Native American




Lgbtq youth

  • Extremely high rate of depression, suicidal thoughts, and suicide attempts

  • 30% of all adolescent suicides

  • Primary cause (reported by LGBT teens) is negative family interactions

  • “One’s We Miss”…………….

Are these some of the ones we miss3
Are these some of the “Ones We Miss”?

African American

The System


Native American






The bullied and the bullies
The Bullied and the Bullies

Definition of Bullying:

Unwantedaggressive behavior that is intentional and that involves an imbalance of power or strength. Typically repeated over time.

Physical: hitting, tripping, breaking possessions

Verbal: name calling, threatening, taunting

Social/Relational: shunning, gossip/rumors, cyber bullying

Profile of a bullied child adolescent
Profile of a Bullied Child/Adolescent

Two main groups: The Passive Victim

The Provocative Victim

LGBTQ Youth:

Teens bullied 26 times/day

31% threatened or injured last year

Impairs their education

2-4 times as likely to attempt suicide

28% drop out of school

4 of 5 say they don’t know ONE supportive person at school


  • Bullies are usually “loners”

  • They have low self-esteem

  • Bullying is the same as conflict

  • Most bullying is physical

  • It isn’t serious

  • Most likely to happen in urban school

  • Most likely to happen on the bus

  • Most kids who are bullied tell an adult.

  • Bullied kids learn to deal with it on their own.

Small group discussion
Small Group Discussion

On your current caseload…

  • Which youth are “at risk”?

  • Identify specific risk factors

  • Identify protective factors

Familial pathways to early onset suicidal behavior

Parent’s suicide attempt

Parent’s impulsive aggression or neurocognitive deficits

Parent’s mood disorder

Suboptimal family environment

Abuse and neglect of child

Child’s impulsive aggression or neurocognitive deficits

Child’s mood disorder

Child’s suicide attempt

Life stressors

Familial Pathways to Early-Onset Suicidal Behavior

Brent, D.A., and Mann, J.J. (2006). Familial pathways to suicidal behavior – Understanding and preventing suicide amount adolescents. Perspective. Retrieved from

The question model
The Question Model

  • Ask the question(s)

  • Listen and respond

  • Act or refer

Let s practice
Let’s Practice!

  • Dyads

  • Each person has a brief scenario

  • You will have 5 minutes to interview and practice asking the difficult questions

  • Feedback

Now what do you do with w hat you know
Now, what do you do with what you know?

Small group discussion

  • How will you refer to in your community?

  • Who will you have on your team?

  • Who makes the decision regarding the “act/refer”?

    Put on flip chart and share with the group

Additional approaches
Additional Approaches

Department of Education

  • Health Classes

  • SOS (Signs of Suicide)

  • ACT (Acknowledge, Care and Tell)

  • Teen Screen

  • Addressing Bullying

What about you
What about YOU?

12 areas of impact for the Social Worker

  • Denial and Disbelief

  • Grief and Loss

  • Anger

  • Self-Blame and Guilt

  • Professional Failure and Incompetence

  • Responsibility

What about you1
What about YOU?

  • Isolation

  • Avoidant Behaviors

  • Intrusion

  • Changes in Professional Behavior

  • Justification

  • Acceptance

Small group discussion1
Small Group Discussion

  • Discuss your reaction to these themes.

  • Talk about your experience with a completed or attempted suicide client situation.

    What was helpful?

    What was not helpful?

    Be ready to share what was helpful/not helpful

    with larger group.

Whew that is a lot of information
Whew! That is a lot of information!

  • Suicide in WI

  • Risk factors

  • Warning signs

  • Protective factors

  • The “ones we miss”

  • Special risks for children and youth in care

  • How to ask the questions

System of care application
System of Care Application

  • Use Jared case scenarios

  • Choose JJ or CPS perspective

  • Read the scenario

  • Develop a System of Care

  • Document on System of Care handout

Support plan crisis plan application
Support Plan (Crisis Plan) Application

  • Use same CPS or JJ perspective - read corresponding handout

  • Create a Crisis Plan for when Jared returns to home (JJ) or foster home (CPS)

  • Discuss: How would you know if Jared is in crisis? What strategies would you implement?

  • Use Support Plan handout-Question 6 for documentation

Resources (American Foundation for Suicide Prev.) (Suicide Prev. Resource Center) (Mental Health of WI) (Helping Others Prev. & Educate) (Suicide Prev. ActionNetwork USA)