Crisis MANAGEMENT AND SUICIDE PREVENTION FOR CLINICIANS WORKING WITH EB/D STUDENTS

(c) Dr. Sharron M. Singleton 2010

Identify the need for crisis management and suicide prevention services for public school systems

Provide a basic overview of crisis development and how it may manifest in the school setting

Provide basic attending and active listening skills that can be utilized in crisis management

Discuss suicide prevention and assessment strategies appropriate for public school use





Crisis refers to a sustained period of acute emotional upset arising from a person’s perception of events resulting in a temporary inability to cope by means of one’s usual problem solving devices

Academic problems Altered states of consciousness Anger/low frustration tolerance Bully or bullied Chemical and substance abuse Criminal behavior Delayed cognitive and affective

development Emotional lability/depression External locus of control History and threats of violence Hypersensitivity Impulsivity Mental illness Preoccupation with violent themes Suicidal ideation


Creates: Stress Distractions Hostile learning

environment Interferes

with: Ability to

concentrate Rhythm of

teaching Rhythm of

learning

Precipitating event Underlying factors or

circumstances Strong emotional reaction Inability to cope Defined by the person involved



SameBetterWorse


The immediate and timely intrusion into a person’s life at a time when the stress he or she is experiencing is too great to be handled and managed through the use of usual coping mechanisms


Diffuse the emotional level of the child

Guide the child through resolving the problem


Present oriented Problem specific Worker is a direct,

active participant Focus is on the return of

the child to pre-crisis level of functioning




cquire rapport and information

•Provide support

•Build trust

•Build a relationship

•Collect information

•Conduct Triage Assessment

Assumes that it is necessary to assess crisis in three domains: affective, cognitive, and behavioral

Assessment in the three domains helps to capture the complexity of the crisis and suggests how directive the intervention should be

Triage Assessment System for Students in Learning Environments (TASSLE)


Anger/hostility Anxiety/fear Sadness/

melancholy


Perception of the eventThreatLossTransgression



Approach

Avoidance

Immobility


oil down the emotions and problem or event

•Make the time relationship connection

•Identify the significance of the current appearance

•Identify the precipitating event

•Clarify the meaning of the event

•Establish a working goal


oping skill development

•Switch to a problem-solving focus

•Utilize triage assessment score to guide work

•Create options

•Refer for service follow-up


Eye contact Posture Physical distance Facial expressions Gestures Setting Position Voice tone Rate of speech Movement Level of energy



Purpose is to establish trust & rapport and clarify the emotional status of the individual

Task is to respond to the emotions revealed, not the content


I hear sadness in your voice

Purpose is to clarify content, check perceptions, and provide feedback

Summarize in a concise form, the important content and emotions connected to the situation


So, what I hear you saying is that you are more ill than you first thought and that’s really scary…

Purpose is to clarify and obtain information when the person is only giving vague clues

Repeat, word-for-word, what the person just said, with a questioning inflection in your voice


Things will never be the same?

Purpose is to collect information while reducing the feeling of being interrogated

Begin all questions with what, when who, where, or how; never why


What will never be the same?

Purpose is to build trust and rapport and validate the person’s right to have emotions

Task is to focus on feelings without justifying negative behavior


It’s okay to feel frightened.

Purpose is to provide time for thinking and to set limits

Task is to remain silent for an effective period of time


Purpose is to encourage the person to continue talking without interrupting them

Task is to let them know you are listening


So, I said to her, I said, you don’t

really love me; …Umm…

Purpose is to redirect an unproductive interaction

Task is to set limits in a non-threatening manner


I feel very uncomfortable when you talk this way because I know you really do want things to be better.

Adolescent suicide is generally unexpected

Among 10 – 24 year olds Homicide is the 2nd leading

cause of death Suicide is the 3rd leading cause

of death The survivors are left with

guilt, anger, and a sense of unfinished business with the deceased


(c) Dr. S. M. Singleton, 2010

A situation in which an individual engages in behaviors for the intended purpose of ending his or her life


Feelings of hopelessness and helplessness

Magical thinking Psychache Certain situations

1. Sudden loss2. Lack of social supports3. Sudden changes in life

patterns4. Chronic physical or mental

illness5. Unfulfilled expectations

(self/others)6. Unexpressed anger



Direct expression of deep feelings of hopelessness and helplessness

Provision of clues1. Indirect verbal clues are expressions that

contain hints about suicidal plans2. Behavioral clues are hints that we get through

discussions of recent behavior 3. Situational clues are clues inherent in the

person’s situation that they reveal in discussion.

4. Syndromatic clues are a constellation of psychological factors that, in combination may indicate a risk for suicide.


If n o , c on tin u e w ith th e c ris is in te rven t ion p roce ss

In itia te h e lp o r in it ia te a trace

O ffe r to p rovid e m ed ica l h e lp if n eed ed

If yes , fin d ou t w h at th ey h ave d on e

C on trac t fo r h e lp

D iffu se am b iva len ce an d an g er

F in d a h ook fo r th e p e rson to w an t to live

A sc erta in p lan o f ac tion

D iffu se em otion s

If n o , red u c e le th a lity if n ecess ary

If yes , fin d ou t if th ey h ave a lread y d on e an yth in g

A sk th e q u es tion : A re yo u com m ittin g s u ic id e?

R ec og n ize c lu es

E s tab lish ra p p ort an d lis ten fo r em otion s

Trust your suspicions that the young person may be self destructive

Tell the child that you are worried about him/her; then listen with a nonjudgmental and supportive attitude

Ask direct questions Don’t act shocked or debate whether suicide is right

or wrong Don’t promise to keep the intentions a secret Don’t’ leave the child alone if you think the suicide is

immediate Don’t be embarrassed or reticent about getting help Ensure that the child is safe and that the appropriate

adults responsible for the child are notified Assure the child that something is being done and

that their feelings are not being discounted Assume an active and authoritarian role as needed to

protect the child at risk Actively acknowledge the reality of suicide as a

choice but do not “normalize” suicide as a good choice


Allen, M., Burk, K., Bryan, E., Carter, D., Orsi, R., & Durkan, L. (2002). School counselors’ preparation for and participation in crisis intervention. Professional School Counseling, 6(2), 96-102.

Bridge, S., Hanssens, L., & Santhanam, R. (2007). Dealing with suicidal thoughts in schools: Information and education directed at secondary schools. Australasian Psychiatry, 15(supplement), s58-s62.

Brock, S. E., Sandoval, J., & Lewis, S. (2001). Preparing for crises in the schools: A manual for building school crisis response teams. New York: John Whiley & Sons.

Couvillon, M., Peterson, R. L., Ryan, J. B., Scheuermann, B., & Stegall, J. (2010). Teaching Exceptional Children, 42(5), 6-17

Klicker, R. L. (2000). A student dies, a school mourns: Dealing with death and loss in the school community. Philadelphia: Accelerated Development.

Suicide assessment and treatment. Knox, K. S. & Roberts, A. R. (2005). Crisis intervention and crisis

team models in schools. Social Work, 27(2), 93-100. Sandoval, J. (Ed.). (2002). Handbook of crisis counseling,

intervention, and prevention in the schools. Mahwah, NJ: Lawrence Erlbaum.


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Crisis MANAGEMENT AND SUICIDE PREVENTION FOR CLINICIANS WORKING WITH EB/D STUDENTS

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