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Screening for Mental Health Needs. Hope M. Siler, MSW, LSW ASPEN Project Regional Director. www.wvaspen.com. OBJECTIVES. Participants will be introduced to SAMHSA’s “Preventing Suicide: A High School Toolkit” Participants will learn the significance of suicide as a public health concern

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screening for mental health needs

Screening for Mental Health Needs

Hope M. Siler, MSW, LSW

ASPEN Project Regional Director

www.wvaspen.com

objectives
OBJECTIVES
  • Participants will be introduced to SAMHSA’s “Preventing Suicide: A High School Toolkit”
  • Participants will learn the significance of suicide as a public health concern
  • Participants will learn to utilize tools for screening for mental health (PHQ-9, ASAP-20)

www.wvaspen.com

www.wvaspen.com

preventing suicide a toolkit for high schools
Preventing Suicide:A Toolkit for High Schools

This tool will help schools and communities:

  • Assess their ability to prevent suicide among students and respond to suicides that may occur
  • Understand strategies that can help students who are at risk for suicide
  • Understand how to respond to the suicide of a student or other member of the school community

www.wvaspen.com

www.wvaspen.com

preventing suicide a toolkit for high schools1
Preventing Suicide:A Toolkit for High Schools
  • Identify suicide prevention programs and activities that are effective for individual schools and respond to the needs and cultures of each school’s students
  • Integrate suicide prevention into activities that fulfill other aspects of the school’s mission, such as preventing the abuse of alcohol and other drugs.

www.wvaspen.com

www.wvaspen.com

why suicide prevention in schools
Why Suicide Prevention in Schools?

Many high school students reported that they had seriously considered suicide in the past year

CDC, 2010a

www.wvaspen.com

www.wvaspen.com

why suicide prevention in schools1
Why Suicide Prevention in Schools?

Suicide is the third leading cause of death among teenagers in the United States

CDC, 2009

www.wvaspen.com

www.wvaspen.com

why suicide prevention in schools2
Why Suicide Prevention in Schools?

One out of every 53 high school students (1.9 percent) reported having made a suicide attempt that was serious enough to be treated by a doctor or a nurse

CDC, 2010a

www.wvaspen.com

www.wvaspen.com

why suicide prevention in schools3
Why Suicide Prevention in Schools?
  • Maintaining a safe school environment is part of a school’s overall mission.
    • Many activities designed to prevent violence, bullying, and the abuse of alcohol and other drugs can also reduce suicide risk among students (Epstein & Spirito, 2009).
    • Programs that improve school climate and promote connectedness help reduce risk of suicide, violence, bullying, and substance abuse (Resnick et al., 1997; Blum, McNeely, & Rinehart, 2002).

www.wvaspen.com

www.wvaspen.com

why suicide prevention in schools4
Why Suicide Prevention in Schools?
  • Maintaining a safe school environment is part of a school’s overall mission.
    • Efforts to promote safe schools and adult caring also help protect against suicidal ideation and suicide attempts among LGB youth (Eisenberg & Resnick, 2006).
    • Some activities designed to prevent suicide and promote student mental health can reinforce the benefits of other student wellness programs.

www.wvaspen.com

www.wvaspen.com

why suicide prevention in schools5
Why Suicide Prevention in Schools?

1. Maintaining a safe school environment is part of a school’s overall mission.

2. Students’ mental health can affect their academic performance.

  • 1 out of 5 high school students receiving grades of mostly D’s and F’s attempted

www.wvaspen.com

www.wvaspen.com

why suicide prevention in schools6
Why Suicide Prevention in Schools?

1. Maintaining a safe school environment is part of a school’s overall mission.

2. Students’ mental health can affect their academic performance.

3. A student suicide can significantly impact other students and the entire school community.

  • Knowing what to do following a suicide is critical to helping students cope with the loss and prevent additional tragedies that may occur.
  • Adolescents can be susceptible to suicide contagion

www.wvaspen.com

www.wvaspen.com

why suicide prevention in schools7
Why Suicide Prevention in Schools?

1. Maintaining a safe school environment is part of a school’s overall mission.

2. Students’ mental health can affect their academic performance.

3. A student suicide can significantly impact other students and the entire school community.

4. Schools have been sued for negligence for the following reasons

  • Failure to notify parents if their child appears to be suicidal
  • Failure to get assistance for a student at risk of suicide
  • Failure to adequately supervise a student at risk

www.wvaspen.com

(Doan, Roggenbaum, & Lazear, 2003; Juhnke, Granello, & Granello, 2011; Lieberman, 2008–2009; Lieberman, Poland, & Cowan, 2006)

www.wvaspen.com

how schools can prevent suicides
How Schools Can Prevent Suicides
  • Protocols for helping students at risk of suicide

www.wvaspen.com

www.wvaspen.com

how schools can prevent suicides1
How Schools Can Prevent Suicides
  • Protocols for helping students at risk of suicide
  • Protocols for responding to suicide death

www.wvaspen.com

www.wvaspen.com

how schools can prevent suicides2
How Schools Can Prevent Suicides
  • Protocols for helping students at risk of suicide
  • Protocols for responding to suicide death
  • Staff education training

www.wvaspen.com

www.wvaspen.com

how schools can prevent suicides3
How Schools Can Prevent Suicides
  • Protocols for helping students at risk of suicide
  • Protocols for responding to suicide death
  • Staff education training
  • Parent education

www.wvaspen.com

www.wvaspen.com

how schools can prevent suicides4
How Schools Can Prevent Suicides
  • Protocols for helping students at risk of suicide
  • Protocols for responding to suicide death
  • Staff education training
  • Parent education
  • Student education

www.wvaspen.com

www.wvaspen.com

how schools can prevent suicides5
How Schools Can Prevent Suicides
  • Protocols for helping students at risk of suicide
  • Protocols for responding to suicide death
  • Staff education training
  • Parent education
  • Student education
  • Screening

www.wvaspen.com

www.wvaspen.com

chapter 1 getting started
Chapter 1GETTING STARTED

The two essential components that every school should have in place are:

  • Protocols for helping students at possible risk of suicide (PREVENTION)
  • Protocols for responding to a suicide death (POSTVENTION)

www.wvaspen.com

www.wvaspen.com

chapter 1 getting started1
Chapter 1GETTING STARTED

Step 1. Engage administrators, school boards, and other key players.

  • Explain why it is important to address suicide risk among students.
  • Highlight data and information specific to your district, State, or tribe.
  • Share your plans.

www.wvaspen.com

www.wvaspen.com

school staff responsibilities
SCHOOL STAFF RESPONSIBILITIES

Superintendent *Curriculum director *Principal

Assistant principal* Teachers *Technology staffHealth educator*Athletic staff *School nurse

School health coordinator*school counselor

Guidance counselor*School social worker

Student assistance program staff*pupil services

School psychologist*Special education staff

Members of the Crisis Response *school resource officer

School-based health centerand/ormental health center staff

www.wvaspen.com

www.wvaspen.com

chapter 1 getting started2
Chapter 1GETTING STARTED

Step 2. Bring people together to start the planning process.

  • Engage school staff.
  • Engage community partners

www.wvaspen.com

www.wvaspen.com

chapter 1 getting started3
Chapter 1GETTING STARTED

COMMUNITY PARTNERS

Community Youth Center * Cultural Communities Leaders

Mental health providers * Community mental health agencies

Substance abuse counselors * Crisis center workers

Healthcare providers * Community health department staff

Hospital, ER staff * EMT’s * Fire & Rescue personnel

First responders * Coroner

Police * Clergy * County social services staff

Child welfare providers * Juvenile justice professionals

Media representatives * Immigrant & Refugee organization staff

LGBT youth–serving program staff * YMCA * Boys & Girls Club

www.wvaspen.com

www.wvaspen.com

chapter 1 getting started4
Chapter 1GETTING STARTED

Step 3. Provide key players with basic information about youth suicide and suicide prevention.

www.wvaspen.com

www.wvaspen.com

risk factors
RISK FACTORS
  • Behavioral Health Issues/Disorders
  • Personal Characteristics
  • Adverse/Stressful Life Circumstances
  • Risky Behaviors
  • Family Characteristics
  • Environmental Factors

www.wvaspen.com

www.wvaspen.com

risk factors1
RISK FACTORS
  • Behavioral Health Issues/Disorders
    • Depressive disorders
    • Substance abuse or dependence
    • Conduct/disruptive behavior disorders
    • Other disorders (anxiety, personality, etc.)
    • Previous suicide attempts
    • Self-injury (without intent to die)
    • Genetic/biological vulnerability

www.wvaspen.com

www.wvaspen.com

risk factors2
RISK FACTORS
  • Personal Characteristics
    • Hopelessness
    • Low self-esteem
    • Loneliness
    • Social alienation and isolation, lack of belonging
    • Low stress and frustration tolerance
    • Impulsivity
    • Risk-taking, recklessness
    • Poor problem-solving or coping skills
    • Perception of self as very underweight or very overweight
    • Capacity to self-injure
    • Perception of being a burden

www.wvaspen.com

www.wvaspen.com

risk factors3
RISK FACTORS
  • Adverse/Stressful Life Circumstances
    • Interpersonal difficulties or losses
    • Disciplinary or legal problems
    • Bullying, either as victim or perpetrator
    • School problems
    • Physical, sexual, and/or psychological abuse
    • Chronic physical illness or disability
    • Exposure to suicide of peer

www.wvaspen.com

www.wvaspen.com

risk factors4
RISK FACTORS
  • Risky Behaviors
    • Alcohol or drug use
    • Delinquency
    • Aggressive/violent behavior
    • Risky sexual behavior

www.wvaspen.com

www.wvaspen.com

risk factors5
RISK FACTORS
  • Family Characteristics
    • Family history of suicide or suicidal behavior
    • Parental mental health problems
    • Parental divorce
    • Death of parent or other relative
    • Problems in parent-child relationship

www.wvaspen.com

www.wvaspen.com

risk factors6
RISK FACTORS
  • Environmental Factors
    • Negative social and emotional environment
    • Lack of acceptance of differences
    • Expression and acts of hostility
    • Lack of respect for the cultures of all students
    • Limitations in school physical environment
    • Weapons on campus
    • Poorly lit areas conducive to bullying and violence
    • Limited access to mental health care
    • Access to lethal means, particularly at home
    • Exposure to other suicides, leading to suicide contagion
    • Exposure to stigma and discrimination

www.wvaspen.com

www.wvaspen.com

protective factors
PROTECTIVE FACTORS
  • Individual Characteristics and Behaviors
  • Family and Other Social Support
  • School
  • Mental Health and Healthcare Providers and Caregivers
  • Access to Means

www.wvaspen.com

www.wvaspen.com

wall of resistance
WALL OF RESISTANCE

www.wvaspen.com There is HOPE. Ask for HELP. Choose LIFE. Suicide Prevention Lifeline 1-800-273-TALK (8255)

warning signs is path warm
WARNING SIGNS“IS PATH WARM”
  • I…ideation
  • S…substance abuse
  • P…purposelessness
  • A…anxiety
  • T…trapped
  • H…hopelessness
  • W…withdrawal
  • A…anger
  • R…recklessness
  • M…mood changes (sudden, positive or negative)

www.wvaspen.com

www.wvaspen.com

suicide crisis episode
Suicide Crisis Episode

Years Days Hours Days Years

Risk Imminent

Crisis Peaks

www.wvaspen.com There is HOPE. Ask for HELP. Choose LIFE. Suicide Prevention Lifeline 1-800-273-TALK (8255)

Crisis Begins

Risk Level

Crisis Diminishes

Hazard Encountered

Stable

Stable

Plus or minus three weeks

the many paths to suicide
The Many Paths to Suicide

Cause of Death

Fundamental Risk

Acute Risk

Poison

Biological

www.wvaspen.com There is HOPE. Ask for HELP. Choose LIFE. Suicide Prevention Lifeline 1-800-273-TALK (8255)

Firearm

Increased hopelessness serious contemplation

Personal/Psychological

WALL OF RESISTANCE

Hanging

Jumping

Environmental

Autocide

national data ages 13 19
NATIONAL DATAAges 13-19
  • 2009, 1,852 young people died by suicide
  • Suicide is the 3rd leading cause of death
  • For every completed suicide death, there is 100-200 attempts (1 every 60 seconds)
  • For every suicide death, there is at least 6 survivors left behind

www.wvaspen.com

www.wvaspen.com

national data yrbs report
NATIONAL DATAYRBS Report
  • 1/53 high school students reported having made a suicide attempt that was serious enough to be treated by a doctor or nurse
  • 1/16 high school students reported having attempted suicide at lease once.
  • 1/9 had made a plan about how to attempt suicide
  • 1/7 reported having seriously considered attempting suicide during the preceding 12 months

www.wvaspen.com

www.wvaspen.com

west virginia data 15 24 years

There is HOPE.

Ask for HELP.

Choose LIFE.

West Virginia Data15-24 Years

2000-2009

www.wvaspen.com Suicide Prevention Lifeline 1-800-273-TALK (8255)

slide41

Suicide:

A PREVENTABLE DEATH IN OUR STATE

West Virginia Suicides by county

Ages 15-24

2000-2009

Rate per 100,000 Population

Hancock

4 (12.26)

Brooke

4 (12.56)

Ohio

WV Average Rate 13.2/100,000

320 Deaths by Suicide

7 (10.81))

Marshall

12 (29.79)

Morgan

Monongalia

Wetzel

3 (15.30)

www.wvaspen.com There is HOPE. Ask for HELP. Choose LIFE. Suicide Prevention Lifeline 1-800-273-TALK (8255)

10 (3.97)

3 (18.15)

Tyler

Marion

Preston

Berkeley

5 (46.92)

11 (12.38)

6 (16.39)

11 (9.89)

Pleasants

Mineral

Jefferson

0 (0.00)

Harrison

Taylor

Hampshire

Dodd-

13 (15.36)

7 (20.00))

6 (9.75)

ridge

5 (26.13)

2 (7.78)

Wood

Ritchie

1 (9.88)

10 (9.68)

Grant

4 (34.13))

Barbour

Tucker

1 (13.19)

2 (16.07)

Hardy

4 (19.02)

Wirt

Lewis

3 (20.28)

1 (13.66)

Gilmer

Cal-

2 (10.22)

houn

2 (12.97)

Upshur

Randolph

Jackson

2 (22.25)

4 (10.52)

3 (8.30)

Mason

3 (9.01)

3 (10.07)

Roane

Braxton

Pendleton

1 (5.34)

2 (11.34)

0 (0.00)

18.15 – 46.92

Putnam

Webster

10 (16.14)

Clay

Cabell

3 (26.51)

4 (30.34)

12.26 – 16.39

18 (10.32)

Kanawha

Nicholas

Pocahontas

47 (20.96))

Lincoln

5 (15.89)

2 (20.60)

10.07 – 11.34

Wayne

4 (14.53)

5 (9.63)

Boone

Fayette

2 (6.79)

0.00 – 9.89

Greenbrier

16 (27.19)

Logan

8 (20.23))

9 (20.92)

Raleigh

Mingo

10 (10.55)

Wyoming

Summers

Monroe

3 (8.81)

1 (3.47)

2 (13.69)

0 (0.00)

Mercer

McDowell

12 (160.5)

2 (6.68)

chapter 1 getting started5
Chapter 1 GETTING STARTED

Step 4: Develop your overall strategy.

  • Assess your current policies, programs and school culture

www.wvaspen.com

www.wvaspen.com

slide43
No one is safe from the risk of suicide –

wealth,

education,

intact family, or

popularity

cannot protect us from this risk

www.wvaspen.com

www.wvaspen.com

chapter 2 protocols for helping students at risk for suicide
Chapter 2PROTOCOLS FOR HELPING STUDENTS AT RISK FOR SUICIDE

WHY IS IT IMPORTANT TO BE PREPARED TO HELP STUDENTS AT RISK OF SUICIDE?

www.wvaspen.com

www.wvaspen.com

chapter 2 protocols for helping students at risk for suicide1
Chapter 2PROTOCOLS FOR HELPING STUDENTS AT RISK FOR SUICIDE

Why is it important to be prepared…?

  • Maintain a safe and secure school environment
  • Promote the behavioral health of students, which enhances their academic performance
  • Avoid liability related to suicides or suicide attempts by students

www.wvaspen.com

www.wvaspen.com

chapter 2 protocols for helping students at risk for suicide2
Chapter 2PROTOCOLS FOR HELPING STUDENTS AT RISK FOR SUICIDE
  • Suicide risk resources
  • Self-injury and suicide risk information
  • Guidelines for notifying parents
  • Parent contact acknowledgement form
  • Guidelines for student referrals
  • Student suicide risk documentation form
  • Protocol for responding to a student suicide attempt
  • Guidelines for facilitating a student’s return to school

www.wvaspen.com

www.wvaspen.com

chapter 3 after a suicide
Chapter 3AFTER A SUICIDE
  • Immediate response protocol
  • Sample script for office staff
  • Sources of postvention consultation
  • Guidelines for working with the family
  • Guidelines for notifying staff
  • Sample announcements
  • Sample letter to families
  • Talking points for students and staff after a suicide
  • Guidelines for Memorialization
  • Guidelines for working with the media
  • Long-term response protocol
  • Guidelines for anniversaries of a death

www.wvaspen.com

www.wvaspen.com

chapter 3 after a sucide
Chapter 3AFTER A SUCIDE
  • Key Terms:
    • Survivor: a person who has experienced the suicide of a family member, friend, or colleague
    • Attempt survivor: a person who attempts suicide but does not die
    • Postvention: refers to programs and interventions for survivors following a death by suicide
    • Suicide contagion: is “a process by which the suicide or suicidal behavior of one or more persons influences others to commit or attempt suicide” (Davidson and Gould, 1989)

www.wvaspen.com

www.wvaspen.com

chapter 4 staff education training
Chapter 4STAFF EDUCATION & TRAINING
  • All staff should be…
    • Aware of risk of suicide
    • Aware that the school is taking steps to reduce suicide risks
    • Trained to recognize the warning signs
    • Able to take action if they become aware of a student who displays suicide warning signs

www.wvaspen.com

www.wvaspen.com

chapter 4 staff education training1
Chapter 4STAFF EDUCATION & TRAINING
  • NREPP (National Registry for Evidenced-Based Prevention Practices) Gatekeeper Trainings:
    • Lifelines
  • BPR (Best Practice Registry) Gatekeeper Trainings:
    • QPR (Question, Persuade, Refer)
    • More Thank Sad
    • safeTALK
    • ASIST

www.wvaspen.com

www.wvaspen.com

chapter 5 parent guardian education outreach
Chapter 5PARENT/GUARDIAN EDUCATION & OUTREACH
  • Education and outreach programs
    • NREPP (National Registry for Evidenced-Based Prevention Practices)
      • Lifelines
    • BPR (Best Practice Registry)
      • Not My Kid (17-minute video online)
  • Facts For Parents (handout)
    • Designed to educate and gain support for implementation of initiatives

www.wvaspen.com

www.wvaspen.com

chapter 5 parent guardian education outreach1
Chapter 5PARENT/GUARDIAN EDUCATION & OUTREACH
  • Effective programs should include…
    • Identifying students at possible risk and referring them to appropriate services
    • Responding appropriately to a suicide death
    • Providing training and suicide awareness education for staff
    • Educating parents regarding suicide risk and mental health promotion
    • Educating and involving students in mental health promotion and suicide prevention efforts
    • Screening students for suicide risk

www.wvaspen.com

www.wvaspen.com

chapter 6 student programs
Chapter 6STUDENT PROGRAMS
  • Types of programs (3):
    • Curricula for all students
      • Provide information about suicide prevention
      • Promote positive attitudes
      • Increase student’ ability to recognize if they or their peers are at risk for suicide
      • Encourage students to seek help for themselves and their peers

www.wvaspen.com

www.wvaspen.com

chapter 6 student programs1
Chapter 6STUDENT PROGRAMS
  • Types of programs:
    • Skill-building programs for at-risk students
      • Help protect at-risk students from suicide by
        • Building their coping, problem-solving, and cognitive skills
        • Addressing related problems such as depression and other mental health issues, anger, and substance abuse

www.wvaspen.com

www.wvaspen.com

chapter 6 student programs2
Chapter 6STUDENT PROGRAMS
  • Types of programs:
    • Peer leader programs
      • Teach selected students skills to identify and help peers who may be at risk.
      • Some teach connectedness among students and also between students and staff

www.wvaspen.com

www.wvaspen.com

chapter 7 screening
Chapter 7SCREENING
  • Ideas for maximizing parental response rate
  • Screening programs
    • NREPP (National Registry of Evidenced-Based Prevention Practices)
      • www.sprc.org/bpr/section-i-evidence-based-programs
      • SOS Signs of Suicide
    • BPR (Best Practice Registry)
      • www.sprc.org/bpr/section-iii-adherence-standards
      • More Than Sad

www.wvaspen.com

www.wvaspen.com

chapter 7 screening1
Chapter 7SCREENING
  • Identifying Students at Risk, Alternatives:
    • Academic achievement
    • Effort
    • Conduct
    • Attendance
    • Negative report card comments
    • Code of student violations
    • Involvement with school police

www.wvaspen.com

www.wvaspen.com

chapter 7 screening2
Chapter 7SCREENING
  • Active Parental Consent
    • Definition: a student can participate only if the parent gives explicit permission, in writing
    • Pros: ensures parents are informed and their approval is obtained. This engagement increases the likelihood that parents will help their child obtain treatment, if it is needed.
    • Cons: often difficult to get responses from parents and takes more staff time; fewer students likely to be screened.

www.wvaspen.com

www.wvaspen.com

phq 9 screening questionnaire
PHQ-9 Screening Questionnaire
  • The Patient Health Questionnaire Modified for Teens (PHQ-9 Modified) can be used with patients between the ages of 12 and 18 and takes less than five minutes to complete and score.
  • Patients should be informed of their confidentiality rights before the PHQ-9 Modified is administered.

www.wvaspen.com

www.wvaspen.com

phq 9 screening questionnaire1
PHQ-9 Screening Questionnaire

SCORING…

  • For every “X”
    • Not at all = 0
    • Several days = 1
    • More than half the days = 2
    • Nearly every day = 3
  • Add up all the “X”ed boxes = total score
  • Total score > 11 are POSITIVE

www.wvaspen.com

www.wvaspen.com

phq 9 screening questionnaire2
PHQ-9 Screening Questionnaire
  • Regardless of the PHQ-9 Modified total score, endorsement of serious suicidal ideation OR past suicide attempt (questions 12 and 13 on the screen) should be considered a positive screen.

www.wvaspen.com

www.wvaspen.com

phq 9 screening questionnaire3
PHQ-9 Screening Questionnaire

INTERPRETATION…

  • The questionnaire indicates only the likelihood that a youth is at risk for depression or suicide; its results are not a diagnosis or a substitute for a clinical evaluation.

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www.wvaspen.com

phq 9 screening questionnaire4
PHQ-9 Screening Questionnaire

DEPRESSION…

  • The overall score on the PHQ-9 Modified provides information about the severity of depression, from minimal depression to severe depression.

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phq 9 screening questionnaire5
PHQ-9 Screening Questionnaire
  • Total Score: Depression Severity
      • 1–4: Minimal depression
      • 5–9: Mild depression
      • 10–14: Moderate depression (≥ 11 = Positive Score)
      • 15–19: Moderately severe depression
      • 20–27: Severe depression

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www.wvaspen.com

asap 20 adolescent suicide assessment protocol
ASAP-20Adolescent Suicide Assessment Protocol
  • 20 items divided into 5 subgroups
    • Historical items (#1-4)
    • Clinical items (#5-9)
    • Specific suicidality items (#10-12)
    • Context items (#13-18)
    • Protective factor items (#19-20)
  • Other considerations

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www.wvaspen.com

asap 20 adolescent suicide assessment protocol1
ASAP-20Adolescent Suicide Assessment Protocol

Actions Taken

1. Continue monitoring risk factors

2. Notify family

3. Notify/consult with supervisor

4. Recommend/refer to outpatient treatment

5. Recommend/refer to psychiatric consult/med evaluation

6. Contract for NO SUICIDAL behaviors

7. Recommend elimination of access to firearms/poisons

8. Notify legal authorities &/or CPS of risk to self/or others

9. Recommend/refer to day treatment

10. Recommend/refer to crisis unit/voluntary hospitalization

11. Initiate involuntary hospitalization

12. Other:

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asap 20 adolescent suicide assessment protocol2
ASAP-20Adolescent Suicide Assessment Protocol
  • SCORING…
    • No = 0
    • Mild = 1
    • Moderate = 2
    • Severe = 3
    • Risk level (total score of all 20 items)
      • Low = 0-15
      • Medium = 16-19
      • High = 20+

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www.wvaspen.com

resources
RESOURCES

wvsuicidecouncil.org

wvaspen.com

sprc.org

afsp.org

spanusa.org

suicidology.org

jasonfoundation.org

thetrevorproject.org

jedfoundation.org

Suicide Prevention Lifeline

1-800-273-TALK (8255)

www.wvaspen.com

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