Results for Kids: Youth Suicide Prevention

1. Results for Kids:Youth Suicide Prevention A Project of the San Diego Children’s Initiative Funded by the California Endowment

2. Achieving better RESULTS FOR KIDS • Achieve Results for KidsProject • Convened by the San Diego Children’s Initiative • Funded by the California Endowment • Aims to improve selected child health indicators. • Community stakeholders are “turning the curve” to reverse a negative trend in youth suicide rates. • We know what kids need to be healthy, where the indicators stand, and what works. • Through community-wide action we can achieve optimal results in the health and well-being of children.

3. Results Based Decision Making and Budgeting Community-wide work on whole population well-being

4. Results Based Accountability inDecision Making and Budgeting Work on population well-being • Results/indicator driven • Ongoing community-wide process • Evidence-based • Both technical and political • Not program planning and evaluation

5. ? Fixed Leaking Roof: Results thinking in everyday life Source: Friedman, Results-Based Accountability RBA-101 Experience: Measure: Inches of Water Story behind the baseline (causes): Collect data. Partners: Who else cares about this problem? Who can help me fix this problem? What Works: New roof? Tar? Tin? Action Plan: How can I implement what works?

6. Source: Friedman, Results-Based Accountability RBA-101 San Diego Results for Kids Project begins here, At the point where the Report Card & Children’s Budget stop Report Card Stopping Point ? Taking action to get better results!

7. Youth Suicide Statistics For more information: www.cdc.gov www.sdchip.org www.yellowribbonsd.org www.thechildrensinitiative.org

8. Sobering Statistics • 11 young people between ages 15-24 die by suicide everyday in U.S. • 1/10 U. S. high school students report having attempted suicide • U.S. rates for ages 10-14 have risen dramatically (120%) since 1990 • A majority of adolescents who die by suicide use a firearm

9. San Diego County Youth Suicide Statistics (1996-2001) • San Diego County is above national average. • About one teen dies by suicide each month. • Youth suicide rates highest in North County East. • In San Diego among those youth ages 15-24 • Young black men had the highest suicide rates. • White young men had rates almost as high as blacks. • Asian and Hispanic young men’s rates followed. • Female youth had much higher rates of suicide attempts.

10. Suicide Attempts and Rates Among San Diego Youth Source: CHIP Report on Suicide in San Diego County: 1996-2001

12. Suicide and Lethal Means • 60% of all people who died by suicide, killed themselves with a firearm. • Lethal Means • Describes a way people attempt suicide with high likelihood of death. • Limiting a suicidal person’s access to lethal means is critical. Suicidal Thinking + Access to Lethal Means = Tragedy

13. Youth Suicide Attempts For each completed suicide 8-25 attempts • Suicide attempt rates are increasing among San Diego County youth. • Scores of San Diego youth are hospitalized each year for self-inflicted non-fatal injuries (indicating suicide attempts). • Among those high school students considering suicide, there were: • 29% Whites, 24% African-Americans • 21% Hispanics, 16% Asians

14. Suicide Attempts and Rates Among San Diego Youth Suicide Attempts by Gender, Students Grades 9-12, San Diego City Schools, 2001 Source: CHIP Report on Suicide in San Diego County: 1996-2001

15. Warning Signs • Previous suicide attempt • Abrupt changes in personality • Giving away possessions • Withdrawal from friends, activities • Changes in eating or sleeping patterns • Irritability, can’t concentrate • Use/abuse of drugs or alcohol

16. Percent of all students who attempted suicide at least once during the prior 12 months From US total sample Source: Student reports from San Diego City Schools - YRBS

17. Percent of all students who attempted suicide at least once during the prior 12 months From US total sample Source: Student reports from San Diego City Schools - YRBS

18. Percent of 9th grade students who attempted suicide at least once during prior 12 months From US total sample Source: Student reports from San Diego City Schools - YRBS.

19. DEPRESSION* Percent of students who ever felt so sad or helpless almost every day for at least 2 weeks in a row that they stopped doing some usual activities during the prior 12 months (2001) Source: Student reports from San Diego City Schools -YRBS.

20. Checklist on Risks for Youth Suicide • Access to firearms • Problems with school, work, or the law • Depression or stress • Frequent alcohol or drug use • Ridicule or discrimination • Sexual orientation and/or identity • Frequent moves or school change • Unintended pregnancy • Breakup of a romance

21. Suicide is preventable

22. What Works? What prevention strategies are recommended? To find out more: www.safeyouth.org/scripts/facts/suicide.asp www.cdc.gov www.mentalhealth.org/suicideprevention www.nmha.org www.afsp.org www.sprc.org www.suicidology.org www.youthsuicide.ca

23. Three General Approaches - USI • Universal • Strategies to promote awareness and responsibilityin the whole population. • Selective • Strategies to address known or suspected risk factors for suicide among at-risk groups. • Indicated • Strategies to identify and refer individual suicidal youth for intervention services.

24. Communities should… • Use a multi-faceted approach. • Don’t just focus on one risk factor • Address multiple risk factors • Develop community-wide plan. • Link suicide prevention programs with mental health resources. • Aim to reduce youth violence overall.

25. Recommended Strategies – Use ALL • General suicide education. • Adult “gatekeeper” training. • Peer support programs. • Restricted access to firearms and other lethal means. • Crisis centers and hotlines. • Risk screening and surveys. • Intervention after a suicide.

26. What Works? Strategies for San Diego

27. STRATEGY: General suicide education Why universal education/awareness? • The general public needs to know: • Suicide is preventable • What to do or say to someone at risk • People in contact with youth need to know: • The signs of / risks for youth suicide. • How to assist or intervene. • All youth need to know: • The signs and risks of youth suicide, and • When to ask for help.

28. General suicide education • San Diego Community Health Improvement Project (SD-CHIP) • Information and statistics dissemination • Public education activities • Occasional suicide prevention campaigns

29. Strategy: Adult gatekeeper training • Who is a “gatekeeper”? • Any adult who works directly with youth • Education program staff training • Teachers at school and after-school • Coaches, custodians, bus drivers, etc. • Community adult training • Parents, neighbors, and mentors • Law enforcement, clergy, doctors, nurses, etc.

30. Training “Gatekeepers” • Evaluations of “gate-keeper training” show: • All staff and faculty need training, including bus drivers, cafeteria workers, and coaches who often have friendships with students. • Peers are often the first to be aware of other students having problems and need training. • Too few professionals are trained on youth suicide prevention. • Follow-up on referrals to treatment needed.

31. Yellow Ribbon Suicide Prevention Program • Since 1994, Yellow Ribbon has been training adults and youth on opportunities and strategies for prevention • Universal prevention strategy: • Everyone can be a link that saves a life • Connects with every middle and high school in San Diego County

33. STRATEGY: Peer Support Programs • Peer support programs • 78% of adolescents go to peers for help before they go to an adult • Source: American Association of Suicidology • “It’s youth who started this project and youth who continue to make it grow!” • YRSPP is educating peers

34. Cal State San Marcos Magnet Project • Collaboration of Yellow Ribbon & CHIP • Training for RAs in new dorms • Training for Peer Education and Support (PEAS) volunteers • Distributing magnets and cards in dorms, health fairs and orientation

35. Cal State San Marcos Magnet Project

36. The Ramona Project • Ramona High School students formed a Yellow Ribbon Team • Team initiated, designed and implemented a peer mentored project • Prevention message is sustained from middle school  high school

37. Critical Hours / After-School Programs • Opportunity: Provide youth education about suicide and mental health • 25,000 young people ages 10 – 15 served each school year • More than 400 San Diego County sites • Prevention and safety are program goals – suicide prevention education should be added at every site.

38. STRATEGY: Restrict Access to Firearms • Reducing youth access to firearms is an underutilized strategy. • Adults can do more. • Gun locks are essential but not enough. • Gun safety is the job of every gun owner. • Suicide risk increases five-fold when there is a firearm in the home.

39. Restrict Access to Firearms • Opportunity: More efforts to reduce youth access to firearms in San Diego. • Enforce city and county codes in relation to firearm safety. • Educate schools, parents, and community about safe gun storage. • Provide gun safety devices and education to parents. • Develop and implement a county-wide media campaign to reduce access to and use of firearms by youth.

40. STRATEGY: Crisis Lines • Suicide / Crisis Intervention Hotlines • San Diego 1-800-479-3339 • California 1-800-843-5200 • National Hopeline 1-800-SUICIDE 1-800-784-2433

41. School Resources/Referral Line • San Diego County Office of Education, Safe Schools • 858-292-3666 www.sdcoe.k12.ca.us/student/ss/welcome.html

42. STRATEGY: Screening for Youth Risk& Assessing Youth At-risk • Opportunity: Screen, assess, and refer San Diego youth • Screening youth for warning signs associated with suicide • Assessment of youth with clear risk factors and referring for treatment

43. Youth Risk Surveys • Opportunity: Ask questions in each high school in San Diego County • Youth Risk Behavior Survey (YRBS) • Nationwide, San Diego City Schools • Standardized questions on suicide • California Healthy Kids Survey • California and SD County Schools • Optional questions on suicide

44. Did you make a plan about how you would attempt suicide? Did you ever seriously consider attempting suicide? How many times did you actually attempt suicide? If you attempted suicide, did any attempt result in an injury, poisoning, or overdose that had to be treated by a doctor or nurse? Questions from Youth Risk Behavior Surveyand California Healthy Kids Survey During the past 12 months -

45. Monitoring Outcomes • Community Health Improvement Partners (CHIP) • www.sdchip.org • Analyses of suicide data • Statistics available to the public • San Diego County Report Card • Youth suicide as one indicator

46. Summary – San Diego Action • Suicide Prevention Education Programs • Hotlines and crisis centers • Suicide intervention services • Gun safety & violence prevention • YRBS/California Healthy Kids Survey • Monitoring suicide outcome data

47. Matrix on What Works

48. Ten Priorities for Prevention • Universal, selected, and indicated approaches together. • Decreased access to lethal means. • Training in assessment and intervention for professionals. • More identification and referrals by peers & gatekeepers. • Improved accessibility and delivery of services. • Greater continuity from hospital to outpatient treatment. • Improved media practices. • Promotion of protective factors. • Studies of individual treatment efficacy. • Studies of program effectiveness. Source: Kalafat, Suicide Prevention and Intervention, Institute of Medicine, 2001.

49. California Suicide Prevention Plan CA Plan Goals = San Diego Challenges • Promote awareness that suicide is preventable. • Develop broad-based support • Implement strategies to reduce stigma of mental health, substance abuse, and suicide prevention services • Implement suicide prevention programs. • Reduce access to lethal means • Train for recognition of risks • Promote effective professional practices • Increase access to behavioral health services • Improve media portrayals and reports • Support research • Improve surveillance of this public health problem.

50. San Diego Priorities for Action • Limiting access to firearms • Training adult gatekeepers • Educating youth • Measuring progress with youth risk surveys