will attend all scheduled therapy sessions.” Consistent with the safety plan intervention, a commitment to treatment helps suicidal individuals understand the strategies necessary to improve clinical outcomes. One of those strategies includes participating in their own treatment. Treatment goals may also include consultation with clinicians with prescription privileges if anxiety, depressed mood, or other psychiatric problems may interfere with the patient’s ability to engage in treatment fully. Additional goals may be based on the specific treatment model being utilized (Cha et al., 2018). Some treatment goals should be avoided. For example, it is important to recognize that suicidal individuals may, in fact, make suicide attempts (and have suicidal thoughts) while in treatment. To make complete remission of suicidal thoughts and attempts a treatment goal is unrealistic; goals that do Youth suicide intervention programs and treatments Skills training Skills training programs use a risk-reduction approach for suicide prevention. They are designed to increase protective factors. In general, the programs teach life skills such as coping, problem solving and decision making, along with cognitive skills. Their goal is to indirectly prevent the development of suicide by targeting risk factors and giving youth important skills to aid in reducing suicidal ideation. Helping people build life skills such as critical thinking, stress management, conflict resolution, problem solving and coping, can prepare them to safely address challenges such as economic stress, divorce, physical illness, and aging (SPRC, 2018). Resilience, the ability to cope with adversity and adapt to change, is a protective factor against suicide risk. While it has some overlap with life skills, resilience also encompasses other attributes such as optimism, positive self-concept, and the ability to remain hopeful. Skills training, mobile apps, and self-help materials are examples of ways to increase life skills and build resilience (SPRC, 2018a). The Suicide Prevention Resources Center (2018a) provides the following steps to develop a skills training program: ● Sponsor workshops that teach mindfulness and stress reduction skills. ● Provide information about self-help tools and apps that promote coping. ● Identify common stressors affecting the target population (e.g., financial problems, relationship issues) and offer skill- building workshops designed to prevent or minimize their occurrence. ● Create an institutional culture that promotes and encourages qualities such as empathy, optimism, and forgiveness. ● Implement life skills and classroom behavior management curricula. ● Provide resources and information to help people cope with life transitions. The Reconnecting Youth Program The Board of Cooperative Educational Services of New York State (BOCES) describes the Reconnecting Youth Program (RY) as a school-based suicide prevention program focused on students who have poor academic achievement and are at increased risk of dropping out of school (Breux et al., 2017). RY is a school-based prevention program for students ages 14 to 19 years that teaches skills to build resiliency against risk factors and control early signs of substance abuse and emotional distress. These students are more likely to show symptoms related to suicidal behaviors, including substance abuse, depression, aggression, and suicidal ideation. The program provides a framework for appropriate social support-system building through bonding activities and parental involvement while minimizing deleterious peer relationships. The program also focuses on strengthening connections to the school.
not include the management of such behaviors fail to provide patients with steps they may take to improve outcomes. Finally, while it is certainly useful and appropriate to use standardized instruments to measure clinical outcomes, caution should be taken when specific scores on these measures are indicated in the treatment plan. While this creates an observable treatment goal (e.g., score on Beck Depression Inventory-II <14), these symptoms may wax and wane in suicidal individuals. It is more important to consider consistency of measurable outcomes over a period of time (e.g., score on Beck Depression Inventory-II <14 for 6 consecutive weeks). Also, clinicians should regularly monitor standardized measure outcomes and compare them to stated treatment goals. Some managed-care organizations will refuse to pay for treatment once goals have been met if they are not subsequently reviewed and revised. Engaging in a systematic strategic planning process, including an assessment of needs related to life skills and resilience, is important to help focus and tailor the plan; SPRC’s strategic planning approach to suicide prevention includes the following six steps: 1. Describe the problem and its context. Use data and other sources to understand how suicide affects your community and describe the problem and its context. 2. Choose long-term goals. Identify a small set of long-term goals (e.g., reduce the suicide rate among a particular group). 3. Identify key risk and protective factors. Prioritize the key risk and protective factors on which to focus your prevention efforts. 4. Select or develop interventions. Decide which combination of strategies (e.g. increase connectedness, increase access to evidence-based treatments) best address the key risk and protective factors and will be a part of the comprehensive approach to suicide prevention. Then find and review existing programs and practices to select approaches that have evidence of effectiveness and are a good fit for the settings, populations, needs, and resources. If there are no programs to meet the population’s needs, one can be adapted or created. 5. Plan the evaluation. Use the evaluation plan to track progress toward long-term goals, show the value of the suicide prevention efforts, and decide how to expand them. 6. Implement, evaluate and improve. Implement and evaluate activities, using evaluation data to monitor implementation, solve problems and enhance prevention efforts. (SPRC, 2018a) For more information on each of these steps, visit the SPRC website, found in the Resource section of this course. Eligible students must have either: (1) fewer than the average number of credits earned for all students in their grade level at their school, high absenteeism, and a significant drop in grades during the prior semester or (2) a record of dropping out of school. Potential participants are identified using a school’s computer records or are referred by school personnel if they show signs of any of the above risk factors. Eligible students may show signs of multiple problem behaviors, such as substance abuse, aggression, depression, or suicidal ideation. RY also incorporates several social-support mechanisms for participating youth, such as social and school bonding activities to improve teens’ relationships and increase their repertoire of safe, healthy activities; development of a crisis-response plan detailing the school system’s suicide- prevention approaches; and parent involvement, including active parental consent for their teen’s participation and ongoing support of their teen’s RY goals.
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