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1. **Title**: Addressing Suicide Risk in Individuals with Disabilities and Chronic Health Conditions 2. **Summary**: In

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1. **Title**: Addressing Suicide Risk in Individuals with Disabilities and Chronic Health Conditions 2. **Summary**: In

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  1. Addressing suicide risk among individuals with disabilities and chronic health conditions Kanbi Knippling, M.S., PCLC, NCC John Sommers-Flanagan, Ph.D.

  2. Getting to know us, getting to know you What brings you here today?

  3. Defining disability "...a person who has a physical or mental impairment that substantially limits one or more major life activities, a person who has a history or record of such an impairment, or a person who is perceived by others as having such

  4. Recognizing the nuance •The disability community is incredibly intersectional and diverse •A note on language •Social model of disability •The relationship between chronic health conditions and

  5. Disability & suicide risk • We know that there is an increased risk of suicide among adolescents and adults with disabilities • Differences in type of disability and risk

  6. Historical perspectives of disability & suicide •A moral lens •Acknowledging the impact

  7. • Locus of control • Socioeconomic status • Social support (including family of origin) • Severity of disability • Societal attitudes • Experiences of self-blame, depression, lack of positive coping skills, and other signs of emotional distress • Spirituality Factors influencing adjustment to disability

  8. Emphasizing relationship •Disabled clients may be seen as less capable of employing personal choice and autonomy within therapeutic relationships •Exploring our own biases and assumptions related to the topics of disability and suicide is imperative •Speak with, not for

  9. Adopting a Strengths- Based Approach • Embrace Shneidman’s position: suicidal thoughts and behaviors are neither an illness nor a sin. • SI is a signal of distress • Relationship, empathy, joining = More important than risk assessment

  10. Adopting a Strengths- Based Approach • Recognize the limits of risk/protective factor assessment (50 year meta-analysis; cutting; previous attempt). • We are transparent (e.g., hosp), build trust and collaborate to develop individualized safety plans and decrease personal distress. [This is our North star]

  11. Seven Organizing Life Dimensions 1.Emotional [Core: Excruciating distress] 2.Cognitive or Mental [Mental constriction, “nothing helps”] 3.Interpersonal [Social disconnection or perceived burden] 4.Physical/Biomedical [Agitated, impulsive, ill, and drugs] 5.Spiritual/Cultural [Meaninglessness or disconnection] 6.Behavioral [Suicide plan/intent, lethal means available] 7.Contextual [Sociological, political, and environmental stressors]

  12. Cramer's suicide competencies – A Resource https://www.counseling.org/publications/counseling-today- magazine/article-archive/article/legacy/taking-a-strengths-based- approach-to-suicide-assessment-and-treatment 5) Determine the level of risk.* Obtain information about self-perceived risk and collaborate. 1) Be aware of and manage your attitude and . . . Develop self-awareness. 6) Develop and enact a collaborative evidence-based treatment plan. 2) Develop and maintain a collaborative, empathic stance with clients. 7) Notify and involve other people. 3) Know and elicit evidence-based risk and protective factors. 8) Document risk assessment, the treatment plan and the rationale for clinical decisions. 4) Focus on the current plan and intent of suicidal ideation. 9) Know the law concerning suicide. 10) Engage in debriefing and self-care.

  13. Bringing it all together Laura (she/her) is a 23-year-old, cisgender, bisexual young adult living in rural Montana. Laura recently became physically disabled after enduring a spinal cord injury in a vehicle accident 5 months ago, resulting in a loss of functioning in both of her legs and significant hearing loss in her right ear. Following the accident, Laura was in an inpatient rehabilitation facility for six weeks, and she has since had to withdraw from her graduate studies in creative writing to further focus on healing. Since this time, Laura has become increasingly withdrawn from her friends and family, often expressing that she "just wants to be alone" and "doesn't see 'the point' anymore." A few days ago, Laura expressed to her primary care physician

  14. Reflections from practice activity

  15. Implications for teaching & supervisory practice • Kanbi • Address personal biases and assumptions related to disability and suicide oAssist students and supervisees in addressing their own biases and assumptions • Incorporate disability topics and awareness across all coursework and areas of supervision oHow are we supporting students and supervisees in developing these skills? • Increase awareness of community supports

  16. Questions?

  17. References

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