INTERVENTION SCOPE & SEQUENCE
“I was in my second year as a school counsellor when I got my first referral for assessment of a student a teacher thought might be suicidal. I remembered what I had learned in graduate school about depression in adolescence but I didn’t remember any specifics about suicide risk assessment. I knew some questions to ask but I’m sure there were others I missed. I don’t know who was more anxious about the interview- the student or me!” -Mississippi school counsellor
What is the purpose of Lifelines Intervention?
There’s been a trend in recent years to provide more education in schools about mental health, especially as it relates to suicide prevention. Many health curricula teach students about signs and symptoms of depression and other mental disorders. Faculty and staff may get the same type of training at presentations or in-service workshops. The Lifelines approach utilizes a different tactic. While the authors recognize the importance of mental health education, their slant on youth suicide prevention is broader and focuses on mental wellness rather than on mental illness.
The signature of Lifelines has been the establishment of a “competent school community,” where all members can identify the signs of suicide risk and know what to do in response. This book is written for school resource staff who are often called upon to intervene when there is concern about a student’s potential suicide risk. While the authors recognize that assessment by a community mental health professional is ultimately required with at-risk students, they also know that school staff may find themselves in a position of having to provide targeted interventions to facilitate those subsequent referrals. This manual reflects this unique role in the intervention process. The goal is to provide staff with helpful tips and resources to improve their comfort level in asking the questions that they need to ask in order to help save a life.
Lifelines also highlights the promotion of resilience or “protective” factors for youth—including assisting students in identifying trusted adults in their support network and teaching them that it’s okay to ask for help.
There is, however, a paradox in school-based suicide prevention: when it’s effective, more students are identified as being at potential risk. When the competent suicide prevention community is in action, this identification can come from a variety of sources: peers, faculty and staff, parents, or the at-risk students themselves. Whatever the source, however, a chain of events should be set in motion to create a safety net for the student. This safety net includes not just the resources of the school but also those of the community at large.
What is Intervention?
The authors believe that school-based intervention for suicide risk is three-tiered: one tier addresses early identification and assessment of at-risk students, the second makes referral to community resources for additional services, and the final tier enhances the protective factors that increase resilience and provide buffers from stress.
What is the School’s Role in Intervention?
There are three aspects to the school’s role in intervention:
- Identify and assess
- Create a school-based safety net
- Enhance protective factors
The safety net for at-risk students created in the school does include assessment and intervention grounded in sound mental health theory: identify the problem, gather relevant information, and make a referral (Granello and Granello 2007). And while this initial intervention is critical, its scope is limited. Lifelines firmly believes that schools are not mental health centres; they simply take the first step in getting students the mental health care they need from community resources. The guidelines Lifelines presents for school-based interventions reflect that bias.
Referral to community-based resources for assessment and/or treatment is the second tier of intervention. Effective referrals involve both the student and the student’s parents, and require knowledge about community resources so that the resource is matched to the student’s needs.
In regard to the final aspect of intervention in the school—the creation and support of “protective factors” for students—if a school is a competent and compassionate community for its students, protective factors will be inherent in the school’s culture. These factors will include teaching students that it’s okay to ask for help, engaging them in school and community activities, recognizing student accomplishments, and encouraging pro-social behaviour by all school community members, including faculty and staff.
There’s another reason schools should consider intervention as a part of a comprehensive suicide prevention protocol. Research has demonstrated that when schools implement student awareness curricula for suicide prevention, self- and peer-generated referrals tend to increase. However, while school resource staff can perform the “gatekeeper” function of making initial assessments and subsequent referrals to local mental health resources for further evaluation and follow-up, they are generally without specific protocols to guide them in these critical tasks. There are, for example, no clinical tools on the National Registry of Evidence-based Programs and Practices (NREPP) or the Best Practices Registry (BPR) of the Suicide Prevention Resource Centre (SPRC) that detail procedures to be utilized in schools. A standardized clinical framework that asks explicit questions about suicide risk is, of course, indicated, but what are the parameters for questioning in a school setting? What format should schools use to communicate information obtained in the school setting to local mental health treatment resources? And how can parents or guardians, who may misunderstand or distrust mental health services, be engaged as collaborators in the process?
The interventions in this manual build on the foundation of the competent and compassionate school community described in the Lifelines prevention model, as listed on NREPP. The manual adapts the training format for the assessment and management of suicide risk created by the Suicide Prevention Resource Centre to the resources and limitations of school settings. The manual begins with a discussion of the historical context of suicide and an exploration of personal values and attitudes toward suicide. It then takes school resource staff through a process that includes preparing for the interview with the potentially at-risk student, gathering collateral information, and addressing specific topics in an interview format called “Tell Me More”.
The manual reviews techniques that can be useful with students who are challenging to interview, and it provides clear guidance in involving parents and guardians as partners in suicide prevention. It addresses specific needs presented by students who are bullied, members of sexual minorities, gifted, or in special education classes. Finally, this manual describes ways in which schools can increase protective factors that promote resiliency.
What are the Objectives of this Manual?
The Lifelines Intervention manual begins by creating a foundation of knowledge that grounds the school’s role in assessment and intervention. It continues by addressing the following objectives:
- To highlight the role of personal values and experiences in the assessment/intervention process
- To present epidemiological information about suicide risk to facilitate early identification of at-risk students.
- To review a protocol for an assessment interview.
- To outline strategies for engaging students and parents in the assessment/referral process.
- To call attention to special categories of students who may be at elevated suicide risk, especially students returning to school after a suicide-related absence.
How is the Manual Organised?
The Lifelines Intervention manual reflects what the authors have learned about the role of school-based resources from their sixty-plus years of collective experience in school settings. The chapters are structured around typical questions educators and school resource staff ask about intervention with potentially suicidal students. In addition to reviewing basic information about suicide to create a solid foundation for an intervention, the manual provides a template for the initial assessment in the school setting. We review the reasoning behind including particular questions in the assessment interview. The challenge of involving the student’s parents in the referral process is discussed in detail. Sample interviews with both students and parents/guardians are included on the DVD.