to a county office of education to acquire and disseminate the identified training program to local educational agencies at no cost. By requiring county offices of education to acquire and disseminate those training programs, the bill imposes a state- mandated local program. The bill makes these requirements contingent on funds being appropriated in the annual Budget Act or another statute for these purposes (California State Legislature, 2018). The California Department of Education (2020) created a Model Youth Suicide Prevention Policy for local education agencies, in order to create a framework for the state’s mandated suicide prevention, intervention, and postvention. The HEARD (Healthcare Alliance for Response to Adolescent Depression) Alliance, centered on the Peninsula of the San Francisco Bay area, has produced toolkits (see Resources section at the end of the course) for mental health promotion and suicide prevention in California schools (Joshi et al., 2017), addressing all aspects of the problem, from the need for promoting mental health and wellness, through intervention, to postvention following a suicide. Peer leadership training A number of studies have found that young people are more likely to talk to peers than adults about suicidal ideation (Pickering et al., 2018). Peer leadership programs put students in a position to help suicidal peers by training them to respond appropriately and referring them to a trusted adult. Peer leadership has been shown to establish positive coping norms within the school environment and may be helpful in reducing suicidal behavior (Wulandari, Keliat, & Mustikasari, 2019). Sources of Strength was one of the first peer leadership training programs established (Surgenor, Quinn, & Hughes, 2016), and is discussed in more detail below. Petrova et al. (2015) conducted a study on the effectiveness of peer leadership programs for enhancing protective factors for suicide prevention. Their results provided evidence that immediately following the presentations, healthy coping practices modeled by peer leaders enhanced classroom-wide help-seeking acceptance and intentions, attitudes about overcoming barriers to helping suicidal peers, perceptions that their school has capable adults to help suicidal peers, and naming trusted adults. Linked to lower risk for suicidal behavior and increased help seeking among suicidal youth, these attitudes and perceptions are potentially important targets for suicide- prevention communications. Sources of strength program Sources of Strength is a suicide-prevention program designed to increase eight protective factors in the student population and decrease risk factors associated with suicide, including social isolation and ineffective coping skills (Petrova et al., 2015). The program promotes seeking help for suicide by changing perceptions about help-seeking behavior, which traditionally has not seen young people seeking help from adults due to negative beliefs about professional help, “codes of silence” (shame and self-stigma, fears about disclosure, and a lack of trust that others will understand), and attitudes promoting self-reliance (Calear et al., 2016). Peer leaders recruited to the program work to change these norms by promoting and modeling help-seeking behavior and positive communication with “trusted adults,” as well as the utilization of multiple sources of strength in times of distress, discouraging self-reliance. These actions work to normalize Conclusion This represents the end of this course; it does not, however, represent the end of training and preparation necessary for clinicians to appropriately manage suicide risk and behavior. Additional supervised clinical experience is an excellent next step in honing the skills learned in this course, and exposure to a large number of different suicide risk cases is necessary to develop mastery in this area. However, in completion of this course, clinicians, medical staff, educators, and community leaders now have a strong foundation for identifying, assessing, and intervening with youth and adults who present with
help-seeking behavior and increase its acceptability. It also creates positive coping norms and builds protective influences within the school. This model fosters positive peer support within the school environment. Peer leaders are usually selected by school staff and are trained to encourage their schoolmates and friends to identify and connect with trusted adults and to use all available coping resources, both formal and informal. A fundamental goal of the program is to increase the likelihood that students with suicidal ideation and suicide-associated risk factors will receive help with mental health services and, consequently, reduce the incidence of suicidal ideation and suicide attempts. A randomized control trial was used to evaluate the Sources of Strength program. Eighteen schools were randomized to receive training immediately after the program’s initiation or after being waitlisted. Surveys were administered to 453 peer leaders and 2,675 students at baseline and after four months. The results showed that trained peer leaders had an increase in adaptive standards regarding suicide and a willingness to engage an adult in cases of suicidal friends despite their friends’ requests for secrecy. Overall, the changes observed in the intervention schools were congruent with the immediate goals of the Sources of Strength program, which were to enhance norms pertaining to suicide help-seeking, increase knowledge of capable adults, and increase acceptability of engaging adults for help within student peer groups (Calear et al., 2016). Trained peer leaders were four times more likely to involve an adult in cases of suicidal friends compared to the control group. This is likely because of their perception of increased adult support and acceptability of help- seeking behaviors. To date, there have been few trials evaluating suicidal ideation or suicidal attempts as outcomes. Further evaluation on the randomized control trial is needed and a two-year national trial in Australia will culminate in 2019. Overall, the program provided an opportunity for student peers to positively influence schoolmates at risk for suicide and increased the perception among students that adults can be helpful (Calear et al., 2016). Postvention When a student dies by suicide, or engages in suicide-related behavior, professional school counselors are responsible for providing supportive services to the community, actions that then become part of the suicide prevention efforts. The American Foundation for Suicide Prevention and SPRC offer a free resource called “After a Suicide: A Toolkit for Schools,” which outlines step-by-step resources for responding to student suicide in ways that align with best practice (Minton & Bruner, 2016). Systematic evaluation of school-based postvention programs has yielded limited evidence of effectiveness. One strategy demonstrated to be helpful is immediate and appropriate response by authority figures in the school. Crisis intervention training of gatekeepers within the school setting may help decrease depression and suicide rates following a suicide death by equipping teachers and administrators to appropriately respond to a crisis. A classroom teacher quickly and accurately informing students and subsequently informing parents can help to decrease confusion and potential contagion (O’Neil et al., 2020). suicidal ideation and behavior. Further learning opportunities are also presented in the Resources section below, which will further develop these skills. There is now no reason to fear the occurrence of suicide risk in your setting, and indeed, one of the worst things a clinician can do let anxiety or fear of asking about suicide stop them from taking the necessary steps to ensure a patient’s safety. Careful assessment, monitoring, and intervention with those at elevated suicide risk literally saves lives; there is nothing to fear about that!
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Book Code: PYCA1423
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