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STOP Suicide DC Department of Mental Health

STOP Suicide DC Department of Mental Health. Julie Goldstein Grumet, PhD Project Director. SAMHSA Grants. Linking Adolescents at Risk of Suicide to Mental Health Services: 2005-2009 State/Tribal Youth Suicide Prevention Grant: 2009-2012. Facts and Statistics.

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STOP Suicide DC Department of Mental Health

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  1. STOP Suicide DC Department of Mental Health Julie Goldstein Grumet, PhD Project Director

  2. SAMHSA Grants Linking Adolescents at Risk of Suicide to Mental Health Services: 2005-2009 State/Tribal Youth Suicide Prevention Grant: 2009-2012

  3. Facts and Statistics • Suicide accounts for 13% of all adolescent deaths • Most suicides result from untreated depression • 3rd leading cause of death for youth (15-24 years) • 1 in 5 teens seriously consider suicide • For every suicide, 6-8 peoples’ lives impacted • GLBT individuals 3x more likely to attempt

  4. Risk Factors for Youth Suicide Strongest Predictors • Previous suicide attempt • Current talk of suicide/making a plan • Strong wish to die/preoccupied with death(i.e., thoughts, music, reading) • Depression (hopelessness, withdrawal) • Substance use • Recent attempt by friend or family member

  5. Other Risk Factors • Being expelled from school /fired from job • Family problems/alienation • Loss of any major relationship • Death of a friend or family member, especially if by suicide • Diagnosis of a serious or terminal illness • Financial problems (either their own or within the family) • Sudden loss of freedom/fear of punishment • Feeling embarrassed or humiliated in front of peers • Victim of assault or bullying

  6. Warning Signs • Threatening suicide • Getting a gun or stockpiling pills – accessing means • Purposeless – no reasons for living • Anxiety or agitation • Impulsivity/increased risk taking • Insomnia • Unexplained anger, aggression, irritability • Substance abuse – excessive or increased • Hopelessness • Withdrawal from friends/family/society • Recklessness – risky acts/unthinking • Mood changes

  7. “STOP” (School-Based Teen Outreach Program) for Suicide: Goals • Increase number of adolescents identified as at risk and assessed for suicide • Enhance ability of mental health providers to identify and assess for risk of suicide • Improve coordination of care provided to students at risk for suicide and families • Improve family/caregiver education and access to MH services

  8. STOP Suicide Project: Components • Screening for students Columbia University TeenScreen • Teacher/Staff/Parent Gatekeeper Training Question, Persuade, Refer (QPR) Gatekeeper Training • Classroom based prevention program Signs of Suicide (SOS)

  9. DC Public Schools • Approximately 70,000 youth under age 18 in DC • Approximately 20,000 youth enrolled in public middle schools and high schools (does not include charter) • 79% African American; 12% Hispanic; 7% Caucasian • 68% graduation rate • 19% truancy rate • 70% free and reduced lunch • 49% passed DC CAS for elementary reading and math (DC CAS); 40% passed secondary math; 41% passed secondary reading (taken in Grades 3-8 and 10)

  10. D.C. Suicide Statistics • 16th leading cause of death for residents • 18 youth suicides between 2000-2008 (age 11-24) (OCME) • Lowest suicide rate in country But so many risk factors!

  11. Risk Factors D.C. exceeds national average for: • Childhood death rate • Youth under 18 whose parents do not have full time jobs • Youth living in a single parent household • Youth who live in poverty • Youth dropout • Violent crime is three times national average • 3% residents have HIV • 3rd highest jurisdiction for abuse/neglect • High gang involvement (Sources: Annie E. Casey Foundation, 2008; Children’s Bureau of the Administration on Child, Youth, and Families, 2004; FBI, 2003; HIV Office of the Department of Health, 2009)

  12. The Youth Risk Behavior Survey (High School Youth) (CDC, 2007) In the past 12 months (In D.C.) • 29% felt sad or hopeless for 2 weeks(27%) • 15% have seriously considered suicide(15%) • 11% have made a plan (12%) • 7% have made an attempt(12%)* • 2% required emergency room care(4%)

  13. Youth Risk Behavior Survey (Middle School Youth) (DCPS, 2007) • 24% report suicidal ideation • 13% made a plan • 13% tried to kill themselves

  14. DMH TeenScreen Program • 2005-2008 • Public and public charter schools • Primarily screened in schools with DMH School Mental Health Clinician (we are in approx. 58 schools) • Staff included Project Director/PI; Evaluator; Case Manager (for one year) • 6th – 12th graders • Active consent

  15. DC DMH TeenScreen • 22 screening days (2005-2008) • 13 middle schools; 9 high schools • Approximately 5700 consent forms distributed • 1021 returned (18%) (range of 4% to 95%) • 96 (9%) parents refused consent • 34 (3%) youth refused assent on day of screen • 126 (12%) absent or sick on screening days • 786 youth screened total

  16. A Word About Consent • Handed out at Back-to-School Night, in class multiple times • Youth distributed consents • Teachers called homes • $5 gift cards to Target; movie passes, $5 gift card to McDonald’s, Washington Wizards tickets, extra credit • Received greater percentage of consents when targeted smaller groups (one class, one teacher, one grade) • Consent was opt in or opt out • Youth who were absent were not screened – letter sent home • 23% youth report never receiving the consent form (though this isn’t possible) • Town Hall Forums

  17. Demographics • 2/3 High School; 1/3 Middle School • 60% Female; 40% Male • 66% African American; 27% Latino; 7% Other • More 9th and 12th graders

  18. Results • 37% youth screened positive overall • 13% report thoughts of killing themselves in past three months • 10% report making a suicide attempt • 6% unhappy or sad in last three months • 10% irritable or in bad mood • 1-2% anxious, withdrawn, substance abuse issues

  19. Results for High School Youth(N=503) • 35% HS youth screened positive All HS youth: • 10% reported suicidal ideation • 11% reported a previous attempt • 19% bad or very bad problem with anger • 12% reported feeling unhappy or sad • Less than 1% reported problems with drugs or alcohol Of those who screened positive for anything: • Anger and depression two biggest issues (41% and 30%, respectively)

  20. Results for Middle School Youth(N=283) • 41% of MS youth screened positive All MS youth: • 17% reported suicidal ideation • 8% reported making a suicide attempt • 14% reported feeling unhappy or sad • 25% reported anger/irritability • 1% problems with substances Of those who screened positive for anything: • Anger and depression also biggest issues (48% and 31%) • 17% reported anxiety • 14% reported problems with friends

  21. HS Youth with Suicidal Ideation 47% made a previous attempt 47% problems with depression or anger 24% problems with anxiety 12% troubles with friendship 8% withdrawing from others 6% substance abuse MS Youth with Suicidal Ideation 34% made a previous attempt 51% feel depressed 72% report problems with anger 32% problems with anxiety 24% have difficulties with friends 28% withdrawing from others 7% drug or alcohol problems *small N Risk Factors for Current Suicidal Ideation in an Urban Population*

  22. So Who is at Risk? • Anger is a huge risk factor followed by depression • Substance abuse is not endorsed by this population • Previous attempt is a risk factor for current suicidality • MS youth with current ideation seem to be more socially isolated • HS girls 136% more likely than HS boys to report suicidality (OR=2.36, CI=1.35; 4.13, p<.05) • Girls more likely than boys to endorse any suicidal behaviors • Greater percentage of MS youth report suicidal thoughts • Greater percentage of HS youth report attempts

  23. A Word About Attempts • Most were not objectively “lethal” • Impulsive • Issues with self-report: Youth reported more than just past three months • Most had never told anyone before

  24. Suicide Among Urban Youth • Lack of appropriate coping skills • Depression likely exhibited as a behavioral issue • Lack of access to treatment • No diagnosis • Long waiting lists • Inability of caregivers/pediatricians/teachers to recognize • Minimization/Stigma

  25. Referrals 33% needed a referral; 5% needed no referral 2% immediate evaluation to hospital/private provider Where did they go? • 47% to SMHP • 23% to other school personnel • 20% to outpatient providers • 2% to other services Did they go? • 52% kept one appointment after one month post-screen • 68% kept one appointment by six months post-screen

  26. Parent Satisfaction Surveys • Attempted to contact all parents of positively screened youth • 17% (N=43) took survey; received gift card • 81% felt consent form was easy to understand • 79% would recommend screening to others • On average, youth met with counselor 3 times (range 1-15; mode=2)

  27. Parent Identified Components that Assisted with the Linkage

  28. Benefits to providing school-based suicide prevention screening and treatment • Emotional issues greatly interfere with academic success • Prevention programs – find them early! • Youth have often never told anyone before • Helps to raise awareness/reduce stigma • Parents more likely to follow through – youth get the services

  29. Challenges to Implementing School-based Suicide Prevention Program • Lack of parental consent • School activities/access to youth can change quickly – field trips, class or school wide tests, fire drills, absent youth, substitute teachers, hall walkers • Hard to get in touch with some parents post-screening • Parents minimize the results • Youth minimize the results • Lack of appropriate staff to administer, follow up • Lack of good local referral sites – school personnel inundated • Long waiting periods screening to treatment • Language barriers • Principals don’t want to endorse screening; prevention more palatable

  30. Recent Publications • Brown, M. and Goldstein Grumet, J. (April 2009). School based suicide prevention with African American youth in an urban setting. Professional Psychology: Research and Practice, (40) 2, 111-117.

  31. Helpful websites • www.suicidology.org (American Association of Suicidology) • www.mentalhealth.org/suicideprevention (National Strategy on Suicide Prevention) • www.sprc.org (Suicide Prevention Resource Center) • www.QPRinstitute.org (QPR Gatekeeper Training) • www.teenscreen.org (Columbia University TeenScreen Project)

  32. Contact information Julie Goldstein Grumet (202) 698-2470 Julie.goldstein@dc.gov

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