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Suicide intervention procedure

SUICIDE INTERVENTION PROCEDURE
The following suicide intervention procedures are designed to be a guide for School Counselors, School Social Workers, and School Psychologist to use when addressing concerns with a student who may be possibly suicidal. How the procedures are implemented and staff involved will be directly dependent on the availability of schools resources. Additional measures to assure the safety of the student may be utilized if felt appropriate and the school administrator deems them necessary. The counselor, social worker, and psychologist may modify the procedure in emergency situations if in their professional judgment modifications are necessary to ensure the safety and welfare of the student. Any staff member who becomes aware that a student may be possibly suicidal is to immediately notify the Student Support Services Department or an Administrator and will not leave the child alone. A School Counselor, School Social Worker, School Psychologist, or School Administrator will see the student as soon as possible and not leave the student alone. If the student is violent or has a weapon the School Administrator and/or School Resource Officer need to be notified. A call can be made to 911 if those resources are not available. The School Counselor, School Social Worker, School Psychologist or School Administrator will attempt to conduct an interview. The interview is not and should not be considered an evaluation or screening. The interview’s purpose is to provide school staff additional information so a decision can be made that will help assure the safety of the student. The staff conducting the interview needs to explain the importance of breaking confidentially in the case of suicidal risk and explore whether the student would prefer taking the lead during the process of informing parents. Based on the interview one of the following two procedures is initiated: A. If the student’s responses indicate that he/she may not be at immediate risk. 1. Parents are notified of the possible concern while the student is still with the staff member making the notification. They should be advised regarding supervision and support for their child as well as possible referral resources. 2. The building or grade level principal is notified. B. If the student admits to being suicidal or his/her responses indicate immediate risk, the following steps are suggested to assure the student’s safety. 1. The parents are notified immediately of the seriousness of our concern and told 2. The building or grade level principal is notified. 3. The school social worker and/or school resources officer, if available, is notified 4. The student is not to be left alone and should remain with staff (preferably a student service staff) until a parent/guardian or identified emergency person can arrive at the school. The parents will be advised to take the student to where an evaluation/intervention can be provided by a professional licensed mental health provider. The student will not be allowed to leave the school unless accompanied by a parent/guardian or the parent provides approval for the student to be discharged to someone else such as another relative or an emergency contact person. Documentation of parent approval should be made. 5. Before the student is discharged school staff needs to advise the person picking the student up regarding needed supervision and support for the student as well as possible referral sources. 6. Documentation needs to be made if the parent is resistant. A resistant parent may be asked to sign a Parent Information Form acknowledging that they have been notified of their child’s suicidal state, advised regarding supervision, support, and possible referral source, informed that it is neglectful not to get treatment for suicidal child, and the school may call Social Services if needed. Another option would be to give the resistant parent the Parent Information Form before a witness. A copy should be made for documentation. 7. The student can safely return to school after being evaluated, by a licensed professional mental health provider. If the student is returned to school without an evaluation completed or intervention provided the Department of Social Services will be contacted. Re-entry could be an administrative decision based on the safety of the student and the Re-Entry Plan. 8. A Re-Entry Plan with the school counselor, parent, and the student needs to be made before the student returns to his/her classes. The school administrator should be informed when the student has return to school and inform of the re-entry plan. SUGGESTED TOOLS
The suicide intervention procedure is the suggested minimal level of intervention. It is a guide for school counselors/school staff to use when addressing concerns with a student who may be possibly suicidal. How the procedures are implemented and staff involved will be directly dependent on the availability of school resources. Additional measures to assure the safety of the student may be utilized if felt appropriate. The following are examples of tools that may be found useful during the process particularly the interviews with the student and parents and the Re-Entry Plan Meeting. The counselor/school staff may use but is not limited to only these devices and suggested techniques. GUIDE FOR RESISTANT OR UNAVAILABLE PARENT SUICIDE INTERVENTION INTERVIEW

CONSIDERATIONS:

Demonstrate a willingness to listen. Keep calm. Demonstrate empathy, warmth and respect.
Demonstrate that you are nonjudgmental keeping in mind how devalued a suicidal person feels.
Demonstrate that you take the situation seriously. Never use teasing, challenges, satire or sarcasm
to try to shock them out of the decision.
Verbalize your concern for the student’s well-being. Discuss concerns openly and ask direct
questions.
Explain the importance of and your responsibility for breaking confidentiality in the case of
suicidal risk.
Be certain the student is in a supervised and supportive environment while you start informing
others and arranging help.
Talk to the parents about removing any tools to destructive behaviors removed from the home.
Document all steps.
INTERVIEW QUESTIONS:

“It seems you may have had some bad times lately when things haven’t been going to well. What kinds of things have been happening?” Note: Depending on the student and the prior information you have, you may need to inquire directly about illness or death of family members or friends, loss of friends or love interests, disciplinary or legal difficulties, problems with academics, abuse, risk taking behaviors, etc. Acknowledge the feelings of sadness, anger, etc. and how normal they would be in such a situation. “Have you had feelings of (see above) that you have had trouble talking about or letting people know about? Tell me about some of them now if you can.” “Is there anyone you feel comfortable talking with? Family? Friends? School staff? Community contacts?” “Do you feel like things are going to get better? What needs to happen to make things better? How long do you think it will be before things are better?” “Have you done any other things that are really out of the ordinary for you to do? Things that surprise you or your friends?” A. Eating less or more than usual? B. Sleeping more than usual or having trouble going to sleep or staying asleep? C. Lost your temper? If so, did you hurt yourself or anyone else? D. Run away from home or thoughts about doing so? E. Skipped school? Is this unusual for you? F. Given away any prized possessions? G. Apologized to others for past transgressions? H. Used drugs or alcohol recently? How much? How often? What is normal for you? I. Changed activities or habits? Including finding less enjoyment in activities that J. Having difficulty concentrating in school or while driving? K. Feeling bored? L. Suffering from headaches, stomachaches or fatigue more than usual? M. Feeling more cheerful right now than has been typical for you recently? N. Increased risk taking or impulsive behaviors? “Sometimes people start to feel so sad or down they think that they would just be better off dead. Have you ever thought anything like that?” If yes, ask, “What do you think it would be like to be dead?” Note: This may be an opportune time to ask about belief systems about life, death, a higher power as such belief systems can be negative or protective factors. “What has happened to make you want to do this now?” “How long have you been having these thoughts?” “Does anyone else know you are having these thoughts? If so, What did they say or do about it?” “Who will miss you? What do you think would happen with your parent(s) and other family members? What do you think would happen with your friends?” “Has anyone in your family or any friend(s) attempted or committed suicide?” If so, what happened? Have you ever attempted suicide before?” Note: Try to determine the method as well as intervening factors in the event of an unsuccessful attempt. “Have you thought about how you would do it? If so, what is your plan? Do you have the (tools)?” “Has anyone tried to stop you? If so, who and how?” “On a scale of 1-10 how much do you want to die?” “On a scale of 1-10 how much do you want to live?” “On a scale of 1-10 what is the probability that you will kill yourself? Is there anyone or anything that would stop you?” Italicized questions may be supplemental if you have questions about the students being forthcoming about suicidal thoughts and plans. They are most likely to be questions addressed to family or staff who know the student well. STAY ALIVE CONTRACT
A “no suicide contract” is considered to be part of and not a substitute for a comprehensive suicide management system. Although it may not prevent suicide it can, if implemented properly be a helpful tool. The school counselor/school staff asking for a contract can be a genuine statement of caring and concern for the student. If a relationship can be established and the contract presented as a genuine statement of concern a therapeutic alliance may be forged. It also gives the student someone to turn to in a suicidal crisis. The contract is a suggested option if the counselor feels a relationship has been established and comfortable with presenting the contract in a caring manner. Example: STAY ALIVE CONTRACT
I, ___________________________________________________ (STUDENT), WILL NOT TAKE ANY ACTIONS TO END MY LIFE UNTIL I TALK WITH YOU, (SCHOOL PERSONNEL) __________________________________________. IF I FEEL SUICIDAL, I WILL CONTACT YOU AS SOON AS POSSIBLE. IF YOU ARE NOT AVAILABLE, I WILL ALSO CALL: 392-6936 or 251-6587 (24 HOUR HOT LINE) FOR ASSISTANCE. PARENT INFORMATION FORM
We are very concerned with the welfare and safety of your child. We have been made aware that your child may be possibly suicidal. All suicide concerns should be taken seriously. To assure the safety of your child we want to advise you in several areas. 1. Your child needs to be closely supervised, if possible until seen by a professional licensed mental health worker. We suggest guns, weapons, potentially lethal medications and alcohol be removed from the home. Do not leave your child alone. 2. Your child needs to be taken to a licensed professional mental health worker who can complete an evaluation to help determine the severity or seriousness of our concerns. They can advise you on what type of interventions might be needed. They can explain the possible need to counseling, what type of counseling would be of most benefit, and how much counseling will cost. In a crisis cost is usually not an issue. Many agencies have what is called a sliding fee which basis their fee on your income. 3. Your child will need support during this possible crisis. Your child may need reassured that you love them and you will help them get the help they need. Be patient and try not to deny their concern. Try to remain calm but concerned. Show love, and seek out the help your child may need with no strings attached. Take threats and gestures seriously. Don’t tease, challenge or use satire. Keep communication open and nonjudgmental. Avoid saying anything demeaning or devaluing while conveying empathy, warmth and respect. Be careful not to get angry with your child for bringing this concern up or show resentment because it made you leave work or other inconveniences that may occur to assure your child’s safety. 4. It might be considered neglect if you do not get treatment for a child who is suicidal and we may contact the Department of Social Services if needed. 5. We will need to develop a Re-Entry Plan with you when your child returns to school. The day your child re-enters school and before he or she goes to classes a meeting needs to be held with you, your child, and the school counselor. Counselor _____________________________ Parent _____________________________ GUIDE FOR RESISTANT OR UNAVAILABLE PARENT
School counselor/school staff may find the following information and suggestions helpful when trying to address two difficult situations that, although occurring infrequently, will require team cooperation and administrative support, decision-making and direction. The school counselor/school staff and school administrator are not limited to only these suggestions. 1. If the parent refuses to come to school and refuses to permit an emergency person to pick up The student will be referred to the Department of Social Services. Depending on DDS’s response a meeting with the school administrator will need to be held to discuss options and transportation needs. Several options are available that will require an administrative decision. Keep the student at school till parent comes in. Have school social worker and counselor take student to the parent. If the student volunteers to go, and it is before 5:00, the student can be taken directly to Southeastern’s main center at 2023 South 17th Street. An attempt to contact the parent and communicate this decision is made. If unable to contact parents or if parents continue to refuse to come to school the school resource officer and/or school social worker might be used to provide transportation and the person who conducted the interview ride along with the student. This would be an administrative decision. If the student is not volunteering to go a decision may be made to complete commitment papers to assure the safety of the student. a. If a decision is made to proceed with commitment papers an attempt is made to contact the parents and communicate that decision to the parents. The parents are also requested/advised it may be better for the student that they become part of the process, to come to school, pick up their child and proceed with the commitment papers themselves. Documentation needs to be made if the parent is resistant. b. If before 4:30 p.m. the commitment papers can be obtained by contacting the Estates and Special Proceedings Office at the New Hanover County Court House (910) 341-4451 or (910) 341-4470. They report if we, ask for the clerk and inform them that we are bring in a student they will arrange a private room, have staff available, and complete paper work as fast as possible. The school resource officer may be able to help transport the student and the person who conducted the interview to the courthouse and then transport them to Southeastern after the papers are completed. The person who conducted the interview will be required to provide information and swear to its truthfulness. The courthouse is located on 3rd and Princess Street. c. If after 4:30 p.m. the commitment papers have to be completed at the Magistrates Office, which is, located on the first floor of the Sheriffs office located at 4th and Princess Street. The school resource officer can transport the student and person who conducted the interview to the Magistrates Office. The person who conducted the interview will need to provide information and swear to its truthfulness. After the papers are completed the schools resources officer can transport the student and staff to the Crisis Station at Southeastern. 2. If parent cannot be located and an identified emergency person cannot be located. DDS should be notified. If they are not able to intervene a meeting with an administrator will need to occur to discuss options and transportation needs. The same options and processes as listed above may need to be implemented. This again will require an administrative decision. RE-ENTRY PLAN
1. Reviewed with parent’s recommendations made by agency/person that conducted the 3. Receiving weekly individual and family counseling sessions with social worker. 4. Scheduled appointment with a psychiatrist. 5. Agree to contact school counselor if re-entry plan does not seem to be working or need to 6. Agree to inform school counselor if they feel suicidal. 7. Parent gave permission for school counselor to share information with therapist and doctors. Student Signature:______________________ Parent Signature: ______________________ NEW HANOVER COUNTY INTERAGENCY
AUTHORIZATION FOR MUTUAL EXCHANGE OF INFORMATION
I, the parent or guardian, do hereby authorize the mutual exchange of medical, psychiatric, social work, psychological, educational, and developmental history information regarding the above named child among the following agencies: New Hanover County Schools Department of Social Services Southeastern Center for Mental Health, Developmental Disabilities, and Substance Abuse Services Fifth Judicial District Office of Juvenile Justice Other: Other: The purpose of this exchange of information is to ensure that the comprehensive program offered to your child is of the best possible quality. It may be used in making service recommendations. I understand that I may revoke this consent at any time except to the extent that action on this consent has been taken. This authorization is fully understand and is made voluntarily on my part. Signature (Parent/Legal Guardian)

Source: http://www.nhcs.k12.nc.us/support/Counselors-Social%20Wkrs/SUICIDE%20INTERVENTION%20PROCEDURES.pdf

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