Webinar Recap: Effective Suicide Policy & Procedures for District Administrators

Jeremy Glauser (00:04):
A little about this webinar series. This is one of several webinars that will be in this, this what we’re calling Special Education series. We kicked it off not too long ago with Phyllis. Wolfram the executive director for the Council of Administrators of Special Education today. We’re pleased to have Dr. Mitchell Samet, and then we’ll also have Jenny Miller Millward, excuse me, and Steve Ireland next week. And then I’ll be presenting in December. There are lots of really good topics. We encourage you to come and register, even if you can’t attend. We really hope that you’ll be able to get the register and get the recordings and the resources that are offered afterward today. It’s my pleasure to introduce Dr. Samet, if you can turn on your webcam, we’d love to see your face as we get this webinar underway.

Jeremy Glauser (01:07):
As I mentioned early on, Dr. Samet is a New York licensed psychologist and has served as an adjunct professor and on the N A P board. He is currently the chair. He currently chairs the school and youth work group for the OMH suicide prevention council and trains extensively in suicide prevention and intervention. As a matter of fact, we were just talking before we got started today about his day-long training session. And, and now I want to sign up and be part of that because it sounds like such great content. He consults with numerous numerous school districts and organizations on this topic of suicide prevention. He also, co-authored a book, a guide for suicide prevention in New York schools and has some wonderful news about that. And and how that’s being adopted has also developed in trains on this, helping students at risk in suicide. That’s an evidence based intervention and prevention program, which was recently published in NASP school psychology review. I think it’s safe to say that we’re, we’re graced with Dr. Sam’s time and attention and knowledge today. I invite you to buckle up and, and ask your questions and participate as much as you like in the chat with that. I’m going to stop sharing my screen and let Dr. Sam take the wheel.

Dr. Mitchell Samet (02:38):
Okay

Jeremy Glauser (02:38):
While’re doing that, I, I will just say that the 988 suicide prevention hotline, we should mention that. And George will put in some details on that in the chat, but Dr. Samet, please take it away.

Dr. Mitchell Samet (02:54):
All right. Thank you. I don’t know what to do with that tremendous introduction. I hope I can live up to half of what you said. Oh, we believe in you <laugh>, but I do appreciate that. I also wanna thank John Kelly. John was the one who connected me to eLuma. This is my second presentation for eLuma. I also wanna mention just briefly that recently our 988 talk and text line is up and running nationally. And we strongly believe that talk helps save lives. So pass the word that, that that’s kind of a shortcut on your phone or on your text to get people to help. So let’s get going with some relevant statistics. If we look at the big picture, suicide has grown tremendously and it’s become the 10th leading cause of death in the United States. I’m just gonna get rid of my picture so I can see the screen better. And it’s surpassed the death rate for things: motor vehicle accidents, homicides, breast cancer, and a New York state where I primarily practiced. There were over 1700 deaths you know in, during the span related to, to suicide. Now, since we’re turning our one

Dr. Mitchell Samet (04:25):
If we turn our attention to youth, I’m very sorry. Okay. Suicide is the second leading cause of death among children and teens for youth, believe it or not. I think this is staggering. There’s an 18.8% chance that youth have considered suicide within the past year. Over 15% of school age kids have made a plan and almost 9% have actually made attempts. So if you think about those kids sitting in your classroom, almost 9% of the kids in your classroom have actually made attempts within the year. And this all comes from the youth risk behavior survey recently. The trend has gotten worse. And when, when I was talking to to George a little bit earlier, we talked about the fact that since 2007, with the advent of smartphones and social media suicide deaths have kind of spiked and have now surpassed homicide deaths for young people.

Dr. Mitchell Samet (05:30):
And if we look at the trend from 2007 to current suicide is almost three times more likely to occur in younger adolescents. And unfortunately that’s trending younger. Younger kids are more and more at risk as the pressures of adulthood kind of drift into that middle school age, where before it was more isolated to high school age, the trend is consistent across varied ethnic groups. And there are some groups in particular that we’ll talk about later that are even at greater risk than the general population. Now, this slide’s a couple of years old, and I’m not gonna bore you too many statistics, but I think this one’s particularly important because if we look in New York state a few years back, 2018, we can see that there were more than 4,500 emergency department, ER visits because of self-harm, it’s broken down by age and, and you can see there are more females than males, but if you look to the right, you can see that only 1700 –

Dr. Mitchell Samet (06:30):
So about a third of them ended up being hospitalized. So if our old notion of, you know when a student mentions the S word in school, we quickly went further out to community mental health to keep them safe. That notion really doesn’t work. And I would suggest that I think school based mental health professionals and administration are perhaps in a better position to intervene with kids who may be at risk, assess their level of risk and and, and, and, and really make the appropriate referral and keep themselves while they’re in the school. So while the school is never gonna be asked to replace what happens in a psychiatric hospital, that old notion of referring out and not taking, you know, some onus on this is, is, is false.

Dr. Mitchell Samet (07:25):
And here are some conclusions. Our traditional pathway to care is lacking. And school based professionals may be in the best position to assess and provide short term therapeutic support for kids. Let’s look at some of the more recent post COVID statistics. This was released just in January from the Surgeon General. And it was and before the pandemic mental health was already a leading cause of poor life outcomes for children. But since the pandemic over 140,000 children have lost a parent or a grandparent, a caregiver to COVID and psychological distress among children has doubled. And the CDC and the Surgeon General’s office have noticed a 51% increase in suicide attempts and suicidal ideation among adolescent girls in particular. Now that’s not the case for everyone. There are some kids who tended to thrive during the pandemic. They got more sleep, they had more family connectedness.

Dr. Mitchell Samet (08:28):
There was less academic pressure. There was less bullying. Their schedules were more flexible and they were able to establish some better coping skills. So some kids actually thrived during the pandemic, but there were some that did not. And in particular, there are some groups that were at greater risk. Those with intellectual and developmental disabilities were more at risk because of disruption to their school services. It was very tough for schools to deliver the same level of service for these kids who had needs. Certain racial and ethnic minority groups like American, Indian, and Alaskan natives partly because of limited access. So they couldn’t stay connected to school. Black youth were more likely to lose a parent than the general population due to COVID for Latina youth. Latinx. There were higher rates of loneliness reported Asian Americans suffered from increased stress due to hate and harassment.

Dr. Mitchell Samet (09:29):
LGBTQ plus individuals sometimes were confined to homes where their families were not as supportive and accepting of their identities. Low income families had economic, educational and social disruption. Rural areas have limited access to mental health more limited internet access. And finally, immigrant households suffered because of language and technical barriers. So those things definitely tended to complicate things. And then in addition, there were other factors going on unrelated to COVID, but was happening during this time, there was a national reckoning over deaths in the black community and the whole BLM movement COVID related hate and violence was prevalent among Asian Americans. There was an increase in gun violence, increased political polarization and increased concerns about climate change were coming out at that point. And there were increases in emotionally charged disinformation.

Dr. Mitchell Samet (10:32):
So that combination of stuff happening during the COVID age, definitely added to, to some of this. So now what do we do about this? Well, we can think about suicide school-based suicide prevention through a multi-tiered system supports MTSS lens. And we break that down into Tier One, which are more universal supports, things like awareness, training, mental wellness, education, school, climate connectedness, tier two, which have to do with targeted supports for those who are more at risk. And we’ll talk about some individual risk factors. We’ll talk about groups that are at greater risk. And then we’ll also talk briefly about individual interventions in including things like understanding risk factors, doing suicide risk awareness, and then doing safety planning in the schools. So it’s a lot to cover in just about 30 or 40 minutes, but we’re gonna we’re gonna push through. Okay. So if we look at one, a, the first question is, does your frontline staff receive ongoing recognition training training?

Dr. Mitchell Samet (11:38):
Do they know the procedure for referral, and then a warm handoff and a warm handoff essentially? I had one yesterday. I was working in a school where there was a young girl who was talking about shooting herself, and the teacher brought her to my office. We sat there and talked about it, and then they left me to do an assessment. So that’s what the long handoff and the warm handoff is all about. So if we look at stamp awareness training the key here is to know the warning science and the acronym facts works here. F stands for feelings, hopelessness, worthlessness, despair, worry. Actions include trying to gain access to lethal means like a weapon showing more aggressive behaviors that are inconsistent from their past behavior doing self-harm. And then you look for changes in the student’s previous attitude or changes in their behavior or their mood, either direct or indirect threats. And in addition, situations related to that. So my colleague Peter does a far better job of going through this. So let’s take a moment to listen here.

Dr. Peter Faustino on video (12:55):
Hi, I’m Peter Faustino. We’ve just talked about a variety of risk factors for suicide. It’s important to remember that although risk factors are common, all they tell us is that someone may be at risk for suicide, just like risk factors for heart disease. Don’t mean that someone will have a heart attack. Suicide risk factors are simply indicators of potential risk, but a percentage of your students with risk factors may start to exhibit what we call warning sites. These are the things that tell us to stop and pay immediate attention because a student may be at risk for engaging in suicidal behavior. In the near future. The word facts provides a helpful tic for identifying the most commonly recognized warning signs F stands for feelings, hopelessness, worthlessness, despair about the future or excessive worry. We should be concerned about students who are exhibiting these types of feelings.

Dr. Peter Faustino on video (13:59):
A denotes actions, actions include things like trying to get access to a gun or pills, behaving recklessly, or increasing alcohol or drug use. It can also include showing aggressive behavior. That’s inconsistent with the student’s previous demeanor, self-harming behaviors, or being involved in bullying actions. Something new that’s been added to this category is looking online for ways to die. C indicates changes. This is a very important category because it means we’re looking for changes from the students, previous attitude, moods, or behaviors, which have been noticeable for at least a couple of weeks. For example, students who were active may become withdrawn, quit athletic teams, stop paying attention to personal appearance, daydream, or even fall asleep in the classroom. It would be impossible to list all of the potential behaviors that you might see. So simply concentrating on recognizing changes from previous behaviors is the real key to making assessments in this category T represents the threats that some students make or hint at.

Dr. Peter Faustino on video (15:15):
These can be specific statements of intent like I’m done with living, or I’m thinking of killing myself or Roy. Some innuendos in writing or other class assignments threats may also be posted on social media sites, whether specific or vague threats tell us that the student is thinking about death or suicide. And that is what escalates our level of concern S refers to situations that may serve as triggers for the suicide. These include getting into trouble at home in school, or with legal authorities, personal losses in relationships, opportunities, or even losses of less tangible things like self-esteem or hopes for the future life changes for which the students feel overwhelmed or unprepared such as moving or the transition after high school graduation can also serve as triggers. The most worrisome time is between the occurrence of the triggering situation and its resolution in that period of uncertainty before the outcome is known.

Dr. Peter Faustino on video (16:21):
So what do you do if you observe several of these warning signs in one of your students, first of all, you don’t have to be certain that suicide is part of the problem at all. If you notice warning signs, especially if you see something that fits into the threat, seriously, you want to respond, treat your concerns the same way you would deal with concerns about any student. Your attention should be one the changes in the student’s academic engagement, focus on specific things you’ve observed and not try to figure out what’s causing them. And remember, while students can disagree with your feelings about them, they can’t disagree when you’ve given them specific and observable examples for your worries, organize your concerns so that you can talk with the student about them in a structured way. Follow this up with a warm handoff to your designated resource staff. What’s a warm handoff? We’ll tell you in a couple minutes.

Dr. Mitchell Samet (17:23):
Okay. And we’re lying. We’re not gonna tell you I mentioned it briefly and that’s part of our full day training. So if you feel that you would like to do something like this, basic awareness training is one of the things that I feel would be critical. So for all of your forward facing school staff, your teachers, teacher, assistant coaches people who work in the offices this SST training, suicide safety for teachers and school staff is available through the suicide prevention center of New York state. You can find it by looking up SBCY and I’ll have their email information at the end and their website. And it could be done either in your building or if you’re out of New York, it could be done virtually and they also do training so that you can get someone in your district to learn this and then do the training for your forward facing staff. All right. So let’s go on to one B the second question universally is, do you have a suicide policy or at least a practice ate place in your district? And is it inclusive to include marginalized groups? Does your administration and clinical staff get regular training? The book on the right a guide for suicide prevention in New York schools is something I co-authored it’s available through the SC Y website. It could also be available. Let me see if, can we get rid of that?

Speaker 3 (19:00):
Okay.

Dr. Mitchell Samet (19:07):
All right. So at this point the New York State Ed Department has recognized our document and has now taken it. They, and they’ve included that in, in their own guide that came out in 2022 was called a companion guide for the, from the New York State Office of Mental Health. And it’s chock full of great materials. I’m gonna show you some of them. It’s meant to establish a school crisis team and the crisis team was responsible for, let’s see if I can get rid of this. Thank you. Okay. I had something blocking me, establishing a school crisis team. The crisis team should be responsible to develop and implement suicide and intervention and post function procedures. Each member of the crisis team should have distinct roles and together they should be trained and retrained every year and that’s gonna be critical. And it’s something that we strongly recommend.

Dr. Mitchell Samet (20:26):
Okay. This guide talks about questions like should a school administrator should be designated as kind of like the point person around those issues. So every school district should have one, typically that’s a, a, either a school psychologist or could be an administrator. There should be development written procedures to clearly delineate how to refer a student when there was a concern about suicide. It should be reviewed with staff annually during those early kinds of superintendent’s conference days. And what I love about the New York State Ed Department’s guide is, there are a lot of grab and go appendices where you could take it, modify it as you need, put your district letter ahead on top and start using that. Here are a couple of them. This has to do with knowing the warning signs. There’s one on warm handoffs.

Dr. Mitchell Samet (21:19):
There’s one about parent guardian communication that offers a great checklist to make sure that you’ve done everything right. Here’s a few others here’s a protocol for responding to a SU, a student suicide attempt and it includes so the first person to reach a student should stay with the student, call 911 and call the school health services personnel. The school suicide liaison should do X, Y, and Z. And it’s a way to document your efforts. So this way, everyone knows what to do. And we’ve had a record of that. This is something that we developed as part of our HSR helping students at risk training. And it’s a sample risk assessment, safety planning guide, where you put everything from who prompted the referral. What were some of the things that you were concerned about? Do you know what you have done?

Dr. Mitchell Samet (22:12):
Were you supervising the student? Did you notify the parents? Did you help the student develop a safety plan? And again, this is in the append of that nine document it’s available free and you can grab and, and use it as you wish. Here’s a sample parent notification guide something that shows I, what you should do when you contact parents and includes their signature. And this is a HIPAA/FERPA release form. One of the things we strongly recommend is that we ask the parents if they come in to get their students, and they’re going, let’s say to a psychiatric ER we asked them to sign a release so that we could talk to the folks who were doing the assessment, give them some background and, and, and that piece is particularly important. So those are all wonderful forms and grab and go documents that you could utilize.

Dr. Mitchell Samet (23:07):
And those are all available in that New York State Ed Department guide that we talked about. Okay. Tier One, does your school district or your school based clinic have a mental health, wellness curriculum? Is it K12 and are these research based tools, and do you have anything for parents? One that I think is particularly good in that we have in our Westchester schools where I have my office is DBT steps. A it’s an evidence-based practice for school based clinicians. And you can do the training with Jim Maza and his team. Pause of comfort is nice. It’s one for younger kids, and the New York State Department of Ed has an entire guide, which is available on mental health education, literacy in schools. And it kind of links to a continuum of wellbeing. And that’s done through the school mental health resource and training center, and that’s also filled with great materials.

Dr. Mitchell Samet (24:10):
And then the last one is the New York State Guide, and this is essential for learning. And it basically presents a mental health and wellness curriculum that you can grab, and go for your district. Okay. If we had time, I would love to play this, but we really don’t. This is a great, great piece. It was created by the Mayo clinic. And it’s a video where kids are talking to their parents. So one of the questions we said before is, do you have anything for parents? And are you doing anything? And, we’ve used this before to kick off the discussion with parents on what they can do to keep their kids safe and give them some of those risk factors and warning signs. So it’s something I strongly recommend as well.

Dr. Mitchell Samet (24:58):
We’re, we’re gonna move on though. We’re not gonna watch that. And then if we go to one D what effort is your school engaged in to foster a culture of inclusion, acceptance, and connectedness. And we might ask why is that important while students who do feel connected in school are one more likely to attend school regularly, stay in school longer and have higher grades. They’re less likely to smoke drink alcohol, use drugs, or have unwanted sexual intercourse. They’re less likely to carry weapons or bring weapons to school. They are less likely to become involved in violence. Students who feel connected to their school also are less likely to become injured from dangerous material dangerous activities, such as drinking and driving, driving recklessly, not wearing your seatbelt. And students who are connected to their schools are also far less likely to have emotional problems suffer from eating disorders or experience suicidal thoughts or attempts.

Dr. Mitchell Samet (26:00):
And if we kind of connect that to having an affirming and welcoming school climate, think about some of your kids who might be on the fringes of the mainstream. And so a question is, does your school do a good job of making those students feel welcome as well, doing that improves learning improves attendance improves the disciplinary actions. So there are fewer referrals to your administrators because discipline reduces drug and alcohol use among youth. It reduces bullying and violent victimization in your building, and it reduces suicidal thoughts and feelings among those kids.

Dr. Mitchell Samet (26:43):
Okay. So that’s Tier One. So we’ve been looking at the big picture and we’ve thought a little bit about what we could do district-wide as a large group to kind of make things better. Now let’s start to think in terms of some targeted interventions. And one of the things I would say is know your students and know your student population. So we can think of them in terms of a few different modules. One is the student struggling with individual risk factors, which may put them at greater harm. And what, one of the things we know is that if someone suffers from depression or anxiety, someone is using substances, someone has already engaged in self-harm. If they’ve had prior suicidal behaviors, those individual factors certainly make them at greater risk. So it’s important that we know our students well, and know if they have that kind of history.

Dr. Mitchell Samet (27:37):
In addition, is the students struggling with family concerns, which may put them at greater risk students who, who whose home life is not secure, who may be suffering from homelessness, from poverty, if there’s violence in the home, if there’s physical or sexual abuse, if they’ve lost a parent or, or a caregiver, those family concerns also increased risk. It is something for all, all of our school based clinicians and administrators to think about. So knowing those factors among your kids will help keep them safe. Third is, has the student been exposed to events that have increased risk? You might be surprised, but problems with discipline students who are failing students who are suffering from relationship problems and believe it or not, it’s less breakups and more loss of friends, students who are impacted by, by bullying, who are rejected by peers.

Dr. Mitchell Samet (28:36):
And I know that we were talking earlier before this, but if there are other peers who have made attempts, or if there’s a completed suicide, that certainly increases risk among the, the student population. So again, tier two targeted interventions have to do with individual risk factors. They have to do with family concerns that may increase risk. They may, it may have to do with things that they’ve been exposed to, events that may have increased, that may increase their risk. And it also has to do with you know, do they identify with a group outside of the mainstream? So we know that students who are in the minority tend to be more at risk than the general population kids who identify as LGBQ+ are also at much higher risk than the general population students who come from poverty or homeless situation students who who have questionable immigration status where their parents or they are insecure, and whether they’re gonna be able to stay students who struggle with language or or learning disabilities, those individual factors and group factors make a difference as well.

Dr. Mitchell Samet (29:50):
So here are a few brief things that I could offer to you for Tier One. One is called inspiring comfort, and it has to do with kids who are grieving and suffer from violence and trauma. One that I was involved with a while back was something called honest, open, proud up to me that has to do with strategic disclosure. And so that kids with previous mental illness, so hospitalizations you know, they’re given advice on if, and when they should be sharing this information and how sources of strength is a wonderful program that comes out of the university of Rochester. And one of their creators is on my council and they include both trusted adult mentors, and also they train peer mentors to work with kids. And that’s perfect for invisible and marginalized kids who may not, who, who may not be accessing guidance services.

Dr. Mitchell Samet (30:52):
There’s a ton of school climate initiatives for those who are invisible, bullied or marginalized. We talked about DBT steps, a DBT in the schools for kids with emotional dysregulation. The got five challenge has to do with a recent program that we put together in New York. And it had to do with using the text line. And then last but not least, the Trevor hotline is a LGBTQ+. It’s actually the largest LGBTQ+ organization in the country. They have the Trevor hotline and they also recommend things like having a Gay-Straight Alliance and working on climate effort to make sure that LGBTQ+ kids feel welcome that there are staff members who can relate to them moving along. So there are also some life events that can increase risk.

Dr. Mitchell Samet (31:51):
I think certainly death of a parent or an illness could certainly increase risk kids who are exposed to suicide. Particularly if it’s a completed suicide attempt are at greater risk kids who are getting into some trouble difficulty that could be problematic particularly if they’re in legal trouble or if they’re in disciplinary trouble. And one of the things to think about is, should your administration be thinking in terms of those kids who are constantly getting into disciplinary trouble, are they at risk of rejection? Loss of a peer group is certainly a life event event that increases risk kids who suffer from bullying and the relationship between bullying and suicide is far more complex than one, you know, than one believes it’s not quite that simple, but we do know that kids who tend to be bullied also tend to become depressed, feel marginalized and tend to be more at risk kids who transfer from a new school and haven’t established a peer group unwanted pregnancies being outed, or coming out.

Dr. Mitchell Samet (32:55):
Those are all life events that certainly could increase risk. And then if we think about it, there are also events that should be triggering the screening questions that we’ll talk about in a moment. If a student has gone through a serious disciplinary reaction, if the psychologist is doing testing for emotional disability, emotional disturbance if a student returns to school after a psychiatric hospitalization, perhaps screening questions should be part of your screening for kids who are during a sport postvention activities. And again, we have to consider the timing of it, but postvention is, is after a suicide happens in your community, should you be, should that trigger screenings down the line, school refusal witnessing a violent incident. Those are all things that might want us to think about using the screening question. They could be this simple.

Dr. Mitchell Samet (33:52):
Have you ever felt so bad that you considered suicide wish you were dead, wanted to take your life thought about killing yourself? And the second screening question is something like this. Have you ever done anything or prepared to do anything that you thought could kill you? It’s important to both get at suicidal thoughts and ideation and also behavior. And as we go through and we learn a little bit more about individual interventions and risk assessment tools, we’ll get into that in a little bit more detail. So Tier Three, which we’re coming around the bend here talks about individual interventions to use when a student may be at risk. So here are some important questions. Does your clinical staff at school receive training in risk assessment tools like the Columbia suicide severity rating scale? And is this part of your team’s regular practice?

Dr. Mitchell Samet (34:47):
If they’re using just a clinical interview alone, I would suggest that you add that to their toolbox. Do you have your staff available to use a collaborative model in our training? We feel it’s important to try to get when possible to get two people in the room, whether it’s two clinical staff or administrators with one of the clinical staff to help intervene with a student who may be at risk. So think about whether that’s possible, where you work. Do you have the personnel at the time to do it? Does your building have a crisis intervention team? Remember, the State Ed Department talked about the fact that’s really critical that every building should have a team with a coordinator. So are you using a collaborative approach? Do you have shared decision making and shared responsibilities? And are you using some of the documentation templates that I showed you before?

Dr. Mitchell Samet (35:40):
Do you have procedures for follow up with kids who may be at risk and are you prepared to help guide parents through the process and last, do you do safety planning with students as well? It’s a lot to talk about. I’m particularly proud of this program. It’s called helping students at risk for suicide. I helped develop this along with the New York Association of School Psychologists. One of our colleagues was from the University of Buffalo Alberta Center for Bullying Abuse, the Suicide Prevention Center of New York, which is part of the office of mental health. We developed this about four or five years ago. We do monthly training, it’s trauma informed prevention and intervention. That’s done in the schools and we’ve been doing it online. So we can come to you for school, mental health professionals.

Dr. Mitchell Samet (36:33):
So school psychologists, school counselors, school nurses, social workers, and those administrators who are hands on with, with the kids. And it incorporates the Columbia Suicides Severity Ratings Scale as an assessment tool. It includes triaging. It includes intervention and referral based on the severity of the risk. We’ll talk about that more in just a moment. It includes things like safety planning, which is an evidence-based practice that all of your school-based professionals can learn quickly and use to help save lives. It also includes things like making sure that we have planned for a safe return to school, and whether that’s the next day or after they come out of hospitalization and it is offered live and virtually every month or so. And it can be done through the suicides prevention center of New York or through NAAS. Okay.

Dr. Mitchell Samet (37:33):
This is the Columbia Suicides Severity Ratings Scale. I’m not gonna spend a lot of time on it, but it includes six questions. You always ask questions one, two and six. The first has to do with ideation, a wish to be dead. A second has to do with having thoughts of suicide. If you answer yes to one and two, you go through, you ask 3, 4, 5, and you always ask six as well, which has to do with suicidal behavior. Based on the student’s response to those questions, you determine a level of risk, whether it’s low, medium, or high. And then there are specific interventions that you could do based on their level of risk. So low risk, you you might take X steps, moderate risk. You might take more drastic steps or, you know, more interventions at higher risk.

Dr. Mitchell Samet (38:26):
You, you’re gonna probably want the student to be seen immediately in community mental health or or a psychiatric hospital. And this is a little bit better picture of the Columbia and the colors denote level of risk, yellow denotes low risk, orange denotes moderate risk, and red high risk. And what you could do is you could adopt a set of procedures in your district for kids who might be low, moderate, or high, and specifically what you might wanna do in order to intervene with those kids. So while your team may be utilizing interviewing and background with these kids I think it’s particularly important to add an evidence based scale like the Columbia to determine risk and guide your interventions. So the next slide is particularly important because it really talks about some key factors.

Dr. Mitchell Samet (39:27):
After this, I will open up for some questions. We’ll have a little bit of time, but some important keys to effective practice include number one, does your district have a policy or practice document in place? And that could be a board policy on suicide. That’s specific as to what you’re gonna do, or it could literally just be a practice document that talks about how to, here’s, how we do things in our district and having that in place and making sure that all of your clinical and administrative staff are trained in this will help save lives. So it’s that that’s a critical piece that you should bring back, and think about. And if you, if you have something that’s somewhat nebulous, then it’s really important for you to be thinking in, in terms of putting something more specific in place.

Dr. Mitchell Samet (40:19):
The second key is a focus on school climate. So think about whether you are doing enough in your district to foster a climate of connectedness and inclusion. And are you doing enough K12 around mental health education? I know in New York state there is a K12 curriculum, but how is that being delivered? Is it getting to all of the kids? And, is it enough? And in addition, are you doing enough to make sure that your school has a climate where people feel included, remember kids who feel connected are less likely to get into difficulty or less likely to suicide and are, and are more likely to to come to school and, and do well in your building. And in particular, think about those groups of kids who are on the fringe who are minority groups, LGBTQ+ youth, kids who might be more transient.

Dr. Mitchell Samet (41:17):
Are you doing the same for them? The third question is, and this is a particularly important one. This was from the beginning when my friend Peter was talking, are all of your frontline staff receiving the gatekeeper training? That’s the ability to rec to know risk factors and warning signs, and to know what to do. If you have a concern about one of your kids, who do you go to, how do you go to them? Does your staff know what to look for and do they know what to do and who to go to? And that’s particularly important next: has your district developed a crisis or an intervention team? If you remember, New York State Ed talked about, every district should have a team with a leader and that team should get training every year and make sure that all of their staff are getting awareness training every year as well.

Dr. Mitchell Samet (42:09):
In addition if we look at number five, the other critical question is, are you using an evidence based assessment tool to further your assessment of kids who are at risk? So just because the student says that they may be feeling suicidal you know, then is your staff pulling out the Columbia or something like it, there are others and assessing kids determining level of risk, because that will help determine the most effective practice. Has your staff developed a reliable community mental health network? So one question is, if you have someone who may be at risk, do you have a place to send them in some of the more far reaching rural areas? It’s hard to find psychologists who work with kids. The nearest psychiatric hospital or community clinic may be miles away. So it’s particularly important for you to develop a reliable network of people that, you know, work well with your kids and, and are available to refer to if your kids may be at risk.

Dr. Mitchell Samet (43:12):
We didn’t talk much about safety planning but in some of our trainings, we, we talk about safety planning and that has to do with helping kids who may be at risk to understand what their triggers are, develop ways that they could keep themselves safe through distraction, through help seeking and as particularly important and last think about D does your district have a postvention training plan? That’s a plan that you have in place in the event that someone in your, in your community, in your school community does complete suicide. And, you know, while you know, everyone should have that plan, you hope that it stays in the drawer and just yellows with aids, and you never have to use it. But if you’re faced with that situation, it is particularly important for your staff to be prepared to know what to do to have procedures in place, to figure out who’s gonna do what and all of that is particularly critical.

Dr. Mitchell Samet (44:10):
All right. So before we go to questions, I just wanna recognize some of the folks who help the New York Association of School Psychologists. Their website is listed here. You can get my school guide on the IAS website, the State Ed Department, their website is here, and you can go there and grab for free that New York state guide that I showed you. And like I said, it works even better as a kind of ebook because it’s chock full of materials that you can literally grab and go paste, you know, modify it as you wish, paste your district letterhead on top and start using them. And then SBC and Y prevent suicide. New york.org has tons of materials. And they could do both the recognition training and the HSR training. Okay. So I want to give you my name and my contact information, if you want, I’m gonna stop sharing my screen now. And I’m gonna ask Jeremy to come on and I apologize for the technical difficulty here and there. But I’m happy that we got through all of this, Jeremy.

Jeremy Glauser (45:21):
Yeah, this was fabulous. Lots of really good tips that we can go back and we can implement and want to say, thank you for sharing so much detailed information through your experience. We’ve got two questions that we want to tackle. The first one comes from Justin Dove. Are there any parental consent concerns we should keep in mind before proceeding with suicide risk assessments when a student is in crisis?

Dr. Mitchell Samet (45:52):
That’s a great question. And it does get a little bit tricky. I would say that if you’re gonna adopt a policy, you should probably show it to your district lawyers to make sure that they’re in agreement. But what I would say is this you know, one, when we have a student in our building and we identify as someone who may be at risk and we want them and we’ve, we’ve done an assessment. One of the things we do almost immediately is we reach out to parents and we try our very best to get them in. And one of the things we like about that collaborative approach is, well, one person stays with the student, tends to their needs, makes sure that they have their code, gets their lunch, gets their stuff out of their locker.

Dr. Mitchell Samet (46:35):
The second person can, can leave to notify the administration that we have a crisis for someone. And then, then also get on the phone with the parent and let them know what’s going on. And, and, you know, parents are not well trained in this. So it’s important to really be a resource to parents, let them know exactly what they could do. And then ideally if you get the parents to the district, the parents could be there to to, to be there, to do an intervention and to help transport in the rare case, when you cannot get parents on the line. I think districts, and I’m not a lawyer, but in local parentis suggests that that administration then has a responsibility to do whatever they need to, to keep kids safe. And in that case, again, talk to your district lawyers. But in that case, I think whether it means calling an ambulance or transporting yourself depending on your district policy, or just hanging on to kids until the parents are able to get there. You know, but and, and one of the thing, and I think one way around that is we have that sample HIPAA/FERPA form and that, you know, and we also have that form for parents that we ask them to sign, which basically says, here’s what we’ve shared. Here’s our recommendation, please sign here. So that kind of covers you in that you’ve, you’ve, you know, and, and documents that you’ve given the parents the information that they need to move forward effectively.

Jeremy Glauser (48:01):
Yeah that answers the question. Yeah. II really appreciate that. And I think the key takeaway from what you’re saying is definitely consult with your district attorney to make sure that your policy and decision is within those parameters. R Right. But also make sure that you have adequately communicated and adopted a policy around this. II’m in the same campus as you, it’s really our responsibility to keep students safe. And so sometimes we just have to go into action.

Dr. Mitchell Samet (48:35):
And Jeremy, and one of our trainees, we talk about the fact that listen, when, when kids are in kindergarten fire and Fred comes into the kindergarten class and talks about stop drop roll, right. And everyone gets that training, but we know from statistically that kids are much more at risk for suicide. And yet that kind of training really doesn’t happen. And we don’t do that training with parents either. So a part of our responsibility as school based professionals is to understand that and to really, you know, you know, number one, make sure that kids know what to do, what the warning signs are, who to go to and also to be a resource for parents. That’s why that Mayo clinic piece is really important because you know, I, I think a great activity is to, is to talk about suicide to parents and to give them that stop drop and role training that, that they probably have never seen before.

Jeremy Glauser (49:32):
I really like that analogy that is very applicable to us. And just as a reminder, for everyone who’s listening, we are sharing the recording and the resources that we’ve referenced with you after the webinar. So you will get quite a few references and, and even some actual materials in your inbox, let’s go to Chris’s question. And this is from Chris. Keep in mind that many districts are very rural and very poor staffing is low. Money is tight, but the problems are the same as many large districts there. Aren’t the luxury of having many of the tools and training you are talking about. There aren’t even enough mental health people near the districts, your thoughts on how to address this in a more rural setting.

Dr. Mitchell Samet (50:20):
Yeah. And, and that, and that’s, that’s not outside of New York as well. When we do trainings in central New York there are some counties in central New York that have maybe three psychologists in the entire county, and none of them work with kids. So it’s not, so that’s a common problem. That’s, that’s not just in rural Appalachia or the mountain states. It’s a New York problem as well. And I think in that case, you have to be fairly creative. Most school buildings have a school nurse and the school nurse can get this training. If you know, most buildings have at least one administrator and the administrators can do this training. And in addition if, you know you need more find a trusted kind of experienced teacher who, who is great with the kids and get them the training, ideally if you could have someone who’s trained in psychology or social work, that might be preferable, but in the rural areas, you have to get a little creative. And, and, you know, on top of that, one of the things that Jeremy and I were talking about is that some of this stuff could even be done remotely. I know that we’ve been doing remote trainings all over the place. So I wonder if we could use technology to connect kids to those who might be more available if you’re a hundred miles from the nearest mental health clinic.

Jeremy Glauser (51:45):
Yeah. And I really love what you’re saying. I think innovation is part of this. We also need to work as partners in the community, and there are, there are options. There are I’ll resources that are out there, but yeah, you’re right. It does require us to innovate and adapt. I can’t help, but laugh a little bit at Chris’s comment here. And, Chris, you may very well be, well, you, you may very well be right, but you know, reach out to me, let’s have a phone conversation. I would love to hear how you pronounce your last name so that I can get it right. Let’s take this last question from Melanie and I, I don’t have Melanie’s last name in front of me either. It’s probably a challenging last name. <Laugh> Viro. I like that. So I am a school psychologist in a large district. What resources can I offer teachers as a quick screening slash check in identifying students that are struggling? Is there just a quick resource that you would point our group to today?

Dr. Mitchell Samet (52:58):
Yeah, I think the best one is, is that gatekeeper training, that suicide safety for teachers and school staff, it’s one hour long, it’s perfect for a faculty meeting. And that’s, that’s a quick you know, and, and it could be done online and it, it, and if you do it online, it could be free. And, and that could be an easy way to get your teachers the information they need. And then, and then to know that if they have concerns about a kid, if an English teacher is concerned about a student’s writing, or a PE teacher notices a change in a student during class, that they know who to go to and what to do, mm-hmm <affirmative> and you don’t have to be right about, about the problem. You, you just have to show concern, bring the kid down to the school psychologist, the, the school counselor, and say, I’m worried about Jimmy. You know, I’ve seen some changes. Could, could you, you know, Jimmy, could you talk to this person?

Jeremy Glauser (53:52):
Yeah. We will make sure to point that out. So George, in our follow up, let’s call out that reference. And that resource specifically for this group, I wish we had more time. Unfortunately time is not on our side, and it is the point where we will wrap up. If you do have more questions,, we invite you to engage with us. Dr. Sam here has shared his contact information. We encourage collaboration, we encourage connection because we really do want to spread good information for all. So as we close up, I want to remind you about some upcoming webinars. The next webinar that we have in the mental health or the MTSS and Mental Health Series is the Suicide 101: What We Know About Youth Suicide and What We Don’t, that’s with Dr. Greg Hudnall next Wednesday, September 28th at 1:00 PM Eastern time.

Jeremy Glauser (54:56):
I have personally witnessed the program that Dr. Hudnall has rolled out across multiple states called the suicide squad and the life saving work that they’re doing. It will be tremendous to hear what they’re doing, how they’re doing it. And hopefully that will benefit many of us. We have another webinar next week. Just the day after on Thursday, that is part of this special education track. And that is with Dr. Jenny Millward and Steve Ireland, please come join us. As we talk about Medicaid and the work that the National Alliance for Medicaid and Education is doing, you might recall that the recent Safer Communities Act had a directive to the CMS to revisit the Medicaid rules and regs. And we’re all hoping that that means much simpler rules and regs, and how to access such a critical source of revenue for schools in Medicaid.

Jeremy Glauser (55:55):
We also wanna remind you that you can get $50 donated to the National Alliance on Mental Illness by simply scheduling and attending a consultation with our team here at eLuma, we want to engage with you. We want to talk shop so to speak. We want to help where we can help and, and be a resource and a partner in this community. We encourage you to do that by visiting the link or scanning that QR code with your phone. Thank you so much for coming today. We really appreciate your attentiveness and your questions, and Dr. Samet, we especially appreciate your time in preparing and delivering this important message. We will distribute this after the webinar. And thank you very much for being here. We look forward to being with you in future webinars. Have a good day. Everybody take care.