May 27, 1997



Notes from the President: Outreaching Schools for Suicide Prevention

By Kristie Ladegard, MD

2016 CCAPS President, working for Denver Health, providing psychiatric services and consultation for local schools and for the Family Crisis Center.

According to the National Center for Health Statistics, a part of the Center Disease Control and Prevention; between 1999 and 2014 the suicide rate for all ages under age 75 rose by 25% from 10.5 per 100,000 to 13 per 100,000.1 While other causes of death are on the decline, suicide just keeps climbing.1 Suicide in youth remains a critical topic, and continues to make headlines in the news and in medical journals that rates are rising. There is one age group that really stands out — girls between the ages of 10 and 14. Though they make up a very small portion of the total suicides, the rate in that group jumped the most — it experienced the largest percent increase, tripling over 15 years from 0.5 to 1.7 per 100,000 people.1 In Colorado an article in the Denver Post pointed out that a rise of more than 700 percent in suicide risk reports occurred among students in Jefferson County schools in the past three years, coupled with a doubling in the number of reported threats over the past year.2

So what is the reason for this rise? Currently we do not have any evidence for the exact cause for the rise in rates in youth. Could it be the increase in social media, younger onset of puberty, a decrease in prescribing antidepressants due to the black box warning, the use of more lethal methods to attempt suicide, lack of health care coverage (especially mental health care), or the economic downturn in the late 2000s? These are just some of the ideas researchers are investigating to find out what is causing an increase in suicide rates. These statistics can be heartbreaking especially when thinking about the work we do on a daily basis. In addition to seeing individual patients in our profession, what else can we do to make a

difference regarding this serious health concern? It turns out there is a lot we can do. By working with community partners such as schools and our medical colleagues, we can develop comprehensive and collaborative programs to help prevent youth suicide.

CCAPS was grateful to receive a grant from the American Academy of Child and Adolescent Psychiatry to provide suicide prevention training in elementary schools. Since 95% of American youth are enrolled in schools, they provide an optimal environment for identifying, and reaching out to youth at risk for suicide. Research has found that schools provide an ideal and strategic setting for preventing adolescent suicide.3 Mental health interventions in schools are much more effective when mental health providers collaborate with teachers, since teachers have substantially more access to students than mental health professionals do. In the school-based model, in addition to treating students on an individual basis, child psychiatrists are part of the school community. Training in schools has been found to increase teacher’s confidence that they have the ability to recognize a student potentially at risk for suicide by more than four times that of teachers who don’t receive training.4 Training faculty and various staff members in schools is universally advocated and supported by research as an essential and effective component to a suicide prevention program.5

As a part of the grant CCAPS collaborated with Denver Public Schools (DPS) by working with Ellen Kelty, program manager for the Department of Social Work and Psychological Services in the Office of Social and Emotional Learning in DPS. Ms. Kelty is a Nationally Accredited School Suicide Prevention Expert and coordinates the district’s suicide prevention and assessment efforts. Her role includes training teachers, administrators, other school staff, parents, and youth about suicide prevention in DPS. She connected CCAPS with

Notes from the President continued

DPS elementary schools that requested suicide prevention training for their staff. Dr. Scot McKay and I presented at 2 elementary schools before school ended for the summer. The first was Cheltenham Elementary School located in the West Colfax neighborhood of Denver. There are 506 students enrolled in Cheltenham, with 98% of their students meeting criteria for a free or reduced lunch program. 81.8% of Cheltenham’s students are Hispanic, 7.8% Black, 5.5% White, 2.7% are two races, 1.7% American Indian, and 0.6% Asian.6 There is a student/teacher ratio of 17/1 (the national average for elementary schools is 15/1) and Cheltenham’s teachers have an average of 6 years of teaching experience.6 Approximately 34 staff members attended the meeting, including a few administrators. Our presentation covered 3 major objectives: identifying protective and risk factors in youth suicide, describing warning signs of suicide in both teens and in younger youth, and explaining steps to take when approaching suicidal youth. We also discussed several resources available to youth and families such as the Colorado Crisis Hotline. You can access the full powerpoint presentation at aacap/Regional_Organizati ons/CCAPS/ Links.aspx.

The second school we presented at was Gilpin Elementary School, located in the Five Points neighborhood of Denver. There are 287 students enrolled in Gilpin with 78% of their students meeting criteria for a free or reduced lunch program. 46.3% of Gilpin’s students are Hispanic, 23.3% are Black, 22.6% are White, 7.0% are two races, and 0.7% are American Indian.7 There is a student/teacher ratio of 17/1 and Gilpin’s teachers have an average of 9 years teaching experience.7 Close to 10 staff

members attended our presentation, including the school Principal, Kimberly Riggins. This presentation was very interactive; staff asked important questions including how to manage challenging students who have voiced suicidal statements in their classrooms.

We administered Pre-Tests and Post-Tests prior to and after our presentations and then compared the scores of the two. Based on these scores, 88% of school staff showed an increase in their ability to recognize basic risk factors and warning signs and in their ability to identify what actions to take when concerned about a suicidal student. We handed out wallet cards that listed our website and a link that contained countless resources for teachers, school staff, students, parents, families, and providers regarding suicide prevention in schools. Also on the wallet cards were steps that teachers/school staff can take when interacting with a student who may be suicidal.

There are several more elementary schools in the Denver area that are requesting similar suicide prevention training, and CCAPS is hopeful to have the opportunity to continue our mission of providing education on this topic in the fall.

This experience was extremely rewarding as it provided an opportunity for us to step out of our offices and engage with a community that not only cares deeply for our youth but also has direct contact with them on a regular basis. As Child Psychiatrists we are being called on more and more to step out of our clinics to meet youth where they are and to develop solutions that help create a healthy and positive community for them. Working with schools is one way Child Psychiatrists can accomplish this mission.

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References

1 Curtin SC, Warner M, Hedegaard H. Suicide rates for females and males by race and ethnicity: United States, 1999 and 2014. NCHS Health E-Stat. National Center for Health Statistics. April 2016.

2 Aguilar J, Klemaier J. (2015, November 13). Suicide risk report rate soars in Jeffco schools. The Denver Post Retrieved from

3 King, C.A. (1997) Suicidal behavior in adolescence. Maris, R.W., Silverman, M.M., and Canetto, S.S. (Eds.), Review of Suicidology (61-95). New York, NY:Guilford Press.

4 King, K.A. (2001) Developing a comprehensive school suicide prevention program. The Journal of School Health 71(4), 132-137

5 Zenere, F.J., & Lazarus, P. J. (1997). The decline of youth suicidal behavior in an urban, multicultural public school system following the introduction of a suicide prevention and intervention program. Suicide and Life-Threatening Behavior, 27(4), 387–403.

6 Cheltenham Elementary School. Demographics Retrieved from

schools.l/16001/Cheltenham-Elementary-School

7 Gilpin Elementary School. Demographics Retrieved from

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Drs. Scot McKay and Kristie Ladegard provide information and opportunities to share experiences and strategies at Cheltenham (above) and Gilpin (below) Elementary Schools in Denver as part of the AACAP Advocacy and Collaboration Grant activities.

YOUTH SUICIDE PREVENTION RESOURCES

For a list of Colorado resources, guides for teachers, school staff, parents, families and providers, please visit our website:

aacap/Regional_Organizations/CCAPS/ Links.aspx

Resources include:

Elementary School Suicide Prevention Training PowerPoint used in Denver Public school presentations, currently available for continued use by school staff.

A Suicide Prevention Reference List that includes power point presentations from the 2016 CCAPS Spring Meeting keynote speaker and local panelists, a suggested reading list, websites for further research, academic and research references and links to suicide prevention programs that were mentioned at the meeting.

A Suicide Prevention Resource Guide with sections for teachers and school staff, Colorado specific resources and programs, resources for families and concerned others and treatment options in our state.

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