Suicide Intervention and Prevention Foster Parent Training
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This document provides guidance for caregivers on suicide prevention, intervention, and postvention. It outlines that youth in foster care are at high risk for suicide and emphasizes the importance of a standardized approach. Key steps include conducting regular suicide screenings, assessing risk level, creating safety plans, seeking emergency help if needed, and providing postvention support. The goal is to help caregivers identify at-risk youth, take appropriate action, and prevent suicide among vulnerable children in their care.
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Suicide Intervention and Prevention Foster Parent Training
- 1. Suicide Prevention, Intervention, and Postvention Actions for Caregivers
- 2. Importance of a Standardized Approach to Suicide Awareness and Prevention Suicide is the 2nd leading cause of death for youth ages 10-14. Children in foster care are 4 times more likely to have considered and 4 times more likely to have attempted suicide. 90+% of all youth who died by suicide had a mental health condition. 22% of special education students report having seriously considered attempting suicide.
- 3. The kids you care for are incredibly vulnerable and at risk of taking their own lives. We want to be sure we are doing our best to prevent suicide. Importance of a Standardized Approach to Suicide Awareness and Prevention
- 4. Important Words to know: Acute – emergency or crisis –immediate danger Non-Acute – not emergent, intervention needed Suicide Attempt- any act a child commits intending to cause death Suicide Screening -a standardized instrument is used to identify children who may be at risk of suicide Suicide Assessment -A comprehensive evaluation of a child by a licensed professional to confirm suspected suicide risk
- 5. Gatekeeper training -teaches people to identify individuals who are showing warning signs of suicide risk ASQ – Ask Suicide-Screening Questions is the screening tool used by Arrow Safety Plan -a written list of coping strategies, sources of support and supervision plan for children at high risk for suicide Postvention -Activities that reduce the risk of suicide by a person affected by the suicide of another Important Words to Know: This Photo by Unknown Author is licensed under CC BY-NC-ND
- 6. WHY ASK? Warning Signs Click the Link Below to watch an educational video from Mayo Clinic Teen Suicide Prevention
- 7. Arrow case managers will complete a ASQ Suicide Screening routinely: • Upon admission for children ages 10 and older and upon admission for children less than 10 when they have a history of suicide attempts or thoughts OR the caregiver requests a screening because of risk factors or warning signs of suicide • Every 90 days after admission for all children 10 years of age and older • Immediately for a child of any age whenever the child exhibits warning signs of suicide that necessitate a suicide screening be conducted, including whenever requested by a foster parent • Upon returning from a mental health crisis (weekly for 30 days or until child is no longer suicidal)
- 8. ASQ consists of the following questions: 1. In the past few weeks, have you wished you were dead? 2. In the past few weeks, have you felt that you or your family would be better off if you were dead? 3. In the past week, have you been having thoughts about killing yourself? 4. Have you ever tried to kill yourself? If yes, how? When? If the patient answers Yes to any of the above, ask the following acuity question: 5. Are you having thoughts of killing yourself right now? If yes, please describe:
- 9. Risk Factors Review: Characteristicsor conditionsthat increasethe chance that someone may attemptsuicide: o symptoms of or being treated for depression, o use of substances, o being bullied, o access to lethal means, o parent’s divorce or separation from family, o exposure to suicide, o having a history of experiencing abuse/neglect, o lack of friends, o previous suicide attempt/s, o chronic physical pain, o family history of suicide, o recent relationship break up, o exposure to domestic violence, o exposure to a traumatic event, o history of sexual abuse or assault, and severe, prolonged stress o Sexual Identity struggles, LGBTQ youth This Photo by Unknown Author is licensed under CC BY-NC-ND
- 10. Why use an Evidence-Base Programs or Practices (EBPs)? Talking about wanting to die or to hurt or kill oneself; Looking for a way to kill oneself; Being preoccupied with death in conversation, writing, or drawing Talking about feeling hopeless or having no reason to live; A change in personality; Giving away belongings; Withdrawing from friends and family; Having aggressive or hostile behavior; Neglecting personal appearance; Running away from home or a residential placement; or Risk-taking behavior, such as reckless driving or being sexually promiscuous. A Suicide Screening is needed anytime a youth:
- 11. Action to Take: Request a Suicide Screening When youth show Warning Signs: STAY WITH THE YOUTH until a screening has been completed! NEVER LEAVE THEM ALONE! 1 Contact your case manager for suicide risk screener. 2 If after hours, contact the Arrow On-Call number. 3 Follow next steps based on screener outcome 4
- 12. Ifthesuicideriskscreeningfindsthechildtohaveapotentialforrisk ofsuicide,theagency,caregiver,oradoptiveparentmust: 12 Action: From Screening to Assessment o Ensure child has a suicide risk assessment by a licensed mental health provider within 24 hours o Do not leave child alone until an assessment is complete o Remove means of harm o Notify all persons responsible for the child’s care of suicide risk and safety plan o Follow through on recommendations by the mental health professional o Update/create the child’s safety plan with Arrow staff member
- 13. Action to Take: Emergency Suicide Assessment If the child in your care seriously harms themselves, makes a suicidal gesture or attempt: o Contact emergency services, render first aid or go to ER (as appropriate) o DO NOT leave child alone o Remove other children from the area o Remove any means that could be used to harm themselves o CALL your case manager or on-call coverage o Get an immediate assessment by licensed provider for suicide o Alert each person responsible for the child’s care of the risk of suicide and the safety plan
- 14. Once a child either returns home or is placed following a suicide attempt or psychiatric hospitalization: Notify your Arrow Case Manager when a youth is being discharged from a psychiatric hospital. Child Placement Management Staff or licensed clinician will meet with the child within 24 hours of the child’s arrival to your home, implement or update the safety plan and conduct the ASQ suicide screener. During this transition time, the child will: Have weekly suicide risk screenings for the first 30 days or no risk is present (whichever is longer). Review and update child’s safety plan weekly for the first 30 days or no risk is present. Removal of any means child could use for self-harm for no less than 30 days. Alert any persons responsible for the child’s care or supervision protocols and safety plans. When the Crisis Is Over:
- 15. If Safety Planning is Needed: It will be created by the Arrow team, you and the youth in crisis. It will be updated on an ongoing basis until the crisis has passed or 30 days has elapsed (whichever is longer). The safety plan will: outline all steps required of caregiver and at- risk child be signed by caregivers and the child (or document refusal) to show understanding of the plan. • All those responsible for the supervision of the child should be made aware of the safety plan. • Caregivers and child will receive a copy of the safety plan.
- 16. Postvention Arrow has a protocol for managing deaths by suicide with the goal of supporting employees, children, caregivers, and parents. We recognize that this type of loss is traumatic, and our goal is to provide a healing support approach to decrease further risk to other youth and adults impacted. Arrow’s leadership team will walk families and team members through this postvention process including creating an action plan, communication strategies, and ensuring access to mental health resources. While we pray that your family never experiences such a tragedy, please know that if one should arise, we are here to support you. 16
- 17. NEVER leave a child/youth alone if there is a concern of suicidal risks. Remember to always contact your Arrow case manager or on-call staff when any concern of suicide arises. Connect with your child and ASK questions if you notice warning signs such as them giving away items. When your child has risk factors, such as a history of suicidal thoughts or actions, be on the lookout for warning signs. If warning signs are present have your child screened for suicide risk. When your child is suicidal seek emergency mental health and/or medical care immediately. Never be afraid to Ask about suicide, it could save a life! Just to Review:
Editor's Notes
- Acute – Non-acute – Suicide attempt – any act a child commits intending to cause his death, excludes suicidal gestures where it is clear that the act was unlikely to cause death Suicide screening- is a standardized instrument used to identify children who may be at risk of suicide, it is usually done orally with the screener asking the questions. Typically, the caregiver will be asked to leave the room during a screener. Suicide Assessment – is a comprehensive evaluation completed by a mental health or medical profession to CONFIRM suspected suicide risk, ESTIMATE the level of danger to the child and GUIDE in creating an intervention plan to ensure the child’s safety
- ASQ- ASK SUICIDE SCREENING QUESTIONS – this it the evidenced based approved screening tool used by Arrow designed to screen children for RISK of suicide Safety Plan – is a prioritized written list of coping strategies and sources of support for children to use who have been deemed at high risk for suicide. Children can use the strategies before or during a suicidal crisis – the plan is brief, in the childs own words, created with child and caregiver and signed by child and caregiver – a copy will usually be given to child and caregiver Postvention – activities that promote health and reduce the risk of suicide by a person affected by the suicide of another Gatekeeper training – a training that teaches anyone to be able to identify the warning signs of suicide risk and help those at risk get the help they need
- The key is to be on the lookout for the warning signs that can be in combination with the risk facctors * these risk factors alone do not necessarily mean a child is currently suicidal
- The key is to be on the lookout for the warning signs that can be in combination with the risk facctors * these risk factors alone do not necessarily mean a child is currently suicidal
- The key is to be on the lookout for the warning signs that can be in combination with the risk facctors * these risk factors alone do not necessarily mean a child is currently suicidal
- Suicide warning sides are indicators that either a child may be in danger of suicide or need help. If you notice one warning sign, be on the look out for additional warning signs and don’t be afraid to ask questions
- When the children in your care show warning signs it is time to take action and they need a suicide screeningYour casemanager or On Call arrow team member will assist in completing the ASQ screening and advise you of next steps
- - Refer the child to a mental health professional for a suicide risk assessment within 24 hours; - Closely monitor the child to ensure the child’s safety until a mental health professional assesses the child; - Remove any harmful objects, chemicals, or substances that a child could use to carry out a suicide attempt - Alert each person responsible for the child’s care or supervision of the potential risk of suicide and any new or updated safety plan; and -Upon conclusion of the risk assessment, follow through on recommendations by the mental health professional and update the child’s safety plan and service plan accordingly.
- Contact EMS or go to ER and render First Aid as appropriate to the situation Serious harm would be Injuries that are bleeding significantly , broken bones. sprains, deep bruising, ingesting dangerous substances, passing out from the harm attempt or bodily marks from item used to attempt harm with DO NOT LEAVE THE CHILD ALONE (keep eyes on them at all times) Call your case manager or after hours on call to request a suicide screening and to get instructions on next steps Remove any means they could use to harm themselves (weapons, sharps, medications, caustic chemicals, belts, glass items etc…) Immediately have the child assessed by a licensed mental health provider for suicide risk and follow recommendations Alert all those responsible for the child’s care of the current risk, safety plan and recommendations
- We want to ensure a child’s readiness to return to care and remain safe following a mental health crisis (for example, from a suicide attempt or psychiatric hospitalization) As we know suicide risk is higher following discharge from the hospital In these instances Arrow Child placement management staff (TX) or Licensed mental health clinicians (MS) will meet with the child within 24 hours of the child’s arrival to your home to discuss protocols that would help to ease the child’s transition into the home post hospitalization, ensure the child’s safety, and reduce any risk of suicide. A screening (ASQ) and a safety plan is completed at this time (and/or updated if one was made previously) The protocols must include: - Weekly suicide risk screenings for the first 30 days or until the child is no longer reporting suicidal thoughts, whichever is longer. -Creating or reviewing and updating the child’s safety plan weekly for the first 30 days until the child is no longer suicidal or whichever is longer -Removal of any harmful objects, chemicals, or substances that a child could use to carry out a suicide attempt or self-harm for a period to be determined by the treatment team, but not less than 30 days. -The agency must alert any persons responsible for the child’s care or supervision of the new protocols and new or updated safety plan.
- Safety Plans are a document that outlines ways that a child can keep themselves safe and whom to seek assistance from. They will be implemented any time there is a risk of suicide, initially at placement due to history or after return from a mental health crisis or suicide attempt. A safety plan will be created by agency staff and or emergency mental health professionals and then updated by agency staff with the child and the caregiver on an ongoing basis until the crisis has passed or 30 days has elapsed (whichever is longer). The safety plan will be documented on a standardized form The safety plan will outline all steps required of caregiver and at-risk child – such as what coping skills to employ and when, identified triggers and who to contact when issues arise be signed by caregivers and the child (or document refusal) to show understanding of the plan. Those responsible for care of the child should be made aware of the safety plan Caregivers and child will receive a copy of the safety plan; the other copy will be uploaded to the child’s records
- When in doubt always contact your Arrow case manager or on-call staff, but in instances of an emergency please call 911 first. It is always better to err on the side of caution to ensure the safety of the child in your care. Remember you are now a Gatekeeper and are able to identify suicide risk and talk to a child at risk for suicide to ensure they get the help they need!