Schools Role in Helping Teenagers to Stop Suicide - Essay Example

Schools’ role in helping teenagers to stop suicide Abstract Suicide is the third-leading reason of death among young people aged 15-19 in the United States, having tripled since the 1950s and reaching 4,234 youth in 2001. Due to a particularly important role of schools in youth suicide prevention, it is necessary to promote school-based suicide prevention programs and educate school staff to identify and help students who may be at risk for committing suicide. My research is going to evaluate school-based suicide prevention programs used with young people in Portland in the state of Maine, which has historically placed a high priority on suicide prevention. I am going to evaluate both the process of ongoing programs, and the outcomes of finished programs for young people. I hope that this research will enable teachers and school workers to see the benefits of their programs on young people, to improve eventual drawbacks and, thus, to be able to provide all teenagers at risk for committing suicide. Schools’ role in helping teenagers to stop suicide Statistics reveal that suicide is the third-leading reason of death among young people aged 15-19 in the United States, thus becoming a major public health problem (National Conference of State Legislatures; Peacock 2000, p. 6). The number of teen suicides has tripled since the 1950s, reaching 4,234 youth in 2001. In case of younger children, between the ages 10 and rate, this rate has increased by more than 100 percent. Furthermore, according to the Youth Risk Behavior Survey published by the Centers for Disease Control and Prevention (CDC) in 2003, during the previous year, 17 percent of high school students had considered attempting suicide, 16.5 percent had had a suicide plan, and 8.5 percent had actually tried to kill themselves (Goldrick, 2005, p. 2). The annual medical cost of suicide for Americans aged under 20 is estimated at $1 billion, with additional costs including lost future earnings and impacts on quality of life, thus increasing the overall suicide-related costs to over $15 billion a year. Suicide can be associated with complex interactions among genetic, neurobiological, psychological, social, cultural, and environmental risk and protective factors. Thus, when designing a suicide prevention strategy it is necessary to involve multiple disciplines in order to create an integrated system of interventions across such levels as schools, the community, the health care system, the family, and finally the individual (U.S. Department of Health and Human Services, Public Health Service, 2001, p. 22). In case of teenagers, school may play a very important role in suicide prevention (National Center for Mental Health Promotion and Youth Violence Prevention, 2006). There are many different approaches and methods that can be implemented at schools to prevent teenage suicide. School-based screening may be a very useful tool to identify youth at risk. While one approach used at school identifies teenagers at risk through low academic performance and poor attendance, another uses brief screening instruments to find young people with depressive symptoms or suicidal thoughts, provide them with more thorough evaluation and appropriate treatment (U.S. Department of Health and Human Services, Public Health Service, 2001, p. 176). Another common approach is school gatekeeper training, aimed to enable school workers to recognize young people at risk of suicide and to refer them for help (Centers for Disease Control, 1992). Participation in gatekeeper training programs allows school staff to recognize and reduce sources of stress in the social environment of the school as well as to help students who may have suicidal thoughts. Furthermore, schools can implement a school crisis preparation and response plan, which can help a school to respond to students’ violent or suicidal behavior. Finally, the rates of suicide among young people may be reduced with the implementation of school-based mental health programs, which aim to provide children and young people with diagnosis of and treatment for the mental health programs (National Center for Mental Health Promotion and Youth Violence Prevention, 2006, p. 2-3). However, many schools still lack resources and capacities to provide teenagers with suicide prevention programs. The study in the field reveals that only one-third of high school workers found their schools appropriately prepared to recognize and help students with a mental-health condition. The programs currently used at schools are often poorly designed, they lack theoretical base and empirical research (Thompson, et al., 2001, p. 742). Furthermore, the majority of school officials and educators do not have the skills necessary to identify teenagers at risk of suicide and less than half of the states include suicide prevention in school curriculum (Goldrick, 2005, p. 3). Given great numbers of young suicide attempters every year, it is necessary to promote school-based suicide prevention programs, supported with theoretical base and empirical research. It is also essential to train school workers so that they could recognize youth at risk and provide them with help and appropriate treatment. Finally, schools need to cooperate with mental services in order to provide all children and adolescents with appropriate diagnosis and treatment. In this research I am going to investigate the role of different suicide prevention programs, used with young people in Portland, Maine. Due to a great number of youth suicides in this state (101 deaths from 2001-2005 for young people aged 15-24; Maine Youth Suicide Prevention Program, 2006), Maine places a high priority on youth suicide prevention interventions. I am going to discuss the influence of these programs on young people, the project limitations and ethical considerations. I hope that this research will be of use to teachers, school workers, and, finally, all young people at risk for committing suicide. Literature review There are two basic kinds of school-based suicide prevention programs. One approach, proposed by Thompson and Eggert (1999, p. 15-20) recognizes young people at risk for school droop out through poor academic performance and attendance. After a thorough evaluation, they can be provided with different kinds of interventions aimed to reduce the potential for substance use and suicide. While there is no empirical evidence that this approach reduces suicidality among young people, it enables teenagers to develop their sense of personal control, which may have further long-term beneficial effects, such as a decrease in juvenile delinquency or teen pregnancy rates. Thompson, et al., (2001, p.742) investigated two preventive interventions aimed at potential high school dropouts, Counselors Care (C-Care) and Coping and Support Training (CAST). Counselors. C-Care involves a comprehensive assessment of a youth’s risk and protective factors, followed with a brief intervention aimed to provide young people with extensive social network connections, including parents and school personnel, and, thus to develop their personal resources. The CAST intervention is a 12-session peer- group training program, aimed to teach young people life skills. The combined C-Care/CAST approach resulted in such benefits for young people as increased sense of personal control, problem-solving skills, and family support (Thompson, et al., p. 742-743). Both used alone and in a combined approach, these interventions resulted in decreased suicide risk behaviors. When evaluated immediately after the intervention and at the 9-month follow-up, young people examined revealed significant reduction in suicidal ideation, depression, anxiety, anger, and hopelessness. Thus, these approaches resulted to be very promising for preventing suicide among potential high school dropouts. The approach investigated by Shaffer and Craft proposes the use of brief screening instruments to recognize potentially suicidal youth and provide them with a more complex evaluation and appropriate treatment (U.S. Department of Health and Human Services, Public Health Service, 2001, p. 176). While this approach is a useful tool to recognize youth at risk, it is not precise to recognize only those at risk for suicide and, thus, may burden a limited referral or service system. Furthermore, this approach is likely to label teenagers instead of providing each individual with necessary treatment, adjusted to his or her needs. Gatekeeping programs, advocated by Campbell (2004, p. 9), aim to provide individuals working with young people with basic suicide prevention and intervention skills. Participation in gatekeeping programs enables teachers and school workers to gain knowledge about suicidal behavior, learn specific skills necessary to identify, respond and refer potential suicidal teenagers for help, and help their family and friends in the aftermath of a suicidal event. Another advocate of gatekeeping programs, Quinett stated that training many members of a community as gatekeepers would result in a significantly reduced number of suicide attempts. The QPR gatekeeper training intervention is taught by qualified instructors in 1-2 hour programs, including role-play and practice. Gatekeepers use Signal Detection Theory to recognize suicide warning signs, such as verbal, behavioral and situational clues, and respond to them. This training also involves such skills as decoding information conveyed in indirect, coded or oblique suicidal communications and dealing with fear, sadness and other overwhelming emotions, which accompany the process of dealing with potentially suicidal teenagers (Campbell, 2004, p. 18). The studies in the field reveal positive impacts of gatekeeper training programs on knowledge and attitudes about suicide and on referral skills. Furthermore, a research conducted in one high school showed positive impacts three years after the introduction of a gatekeeper curriculum for school counselors. However, far more research is needed in the field to measure the role of gatekeeping programs in the reduction of suicide rates among young people. Approach and methods My research is going to investigate the impact of different school-based suicide prevention programs on decrease in suicide rates among young people in my city. I am going to evaluate different programs implemented in high schools in Portland in the last years, following the evaluation design for suicide prevention programs proposed by Patton (U.S. Department of Health and Human Services, Public Health Service, 2001, p. 166-171). The programs I am going to evaluate include a gatekeeper training program, SOS (Signs of Suicide), and the combined CAST/C-CARE approach. All these programs are registered in NREPP (National Registry of Evidence-Based and Practices) and have been reviewed and rated by several independent investigators (The Suicide Prevention Resource Center, n. d). My evaluation involves both the process and the outcome of the program. The process evaluation addresses the extension to which the programs are implemented, eventual drawbacks that need to be improved, the program description, and the influence of the program context. It is also going to involve ongoing dialogue and frequent communication with the teachers and school workers who are implementing the programs. When evaluating the outcome of the programs, I am going to work with the staff and the students who have finished the projects, using such materials as survey questionnaires and interview protocols. My evaluation will measure the relationship between the intervention and its outcomes, the effectiveness of the program, and, finally, the connection between social and community indicators and the program outcomes. Work plan and tasks My research is going to follow the three crucial steps: contacting school workers engaged in the projects and establishing the cooperation with them, designing the focus of the evaluation, and gathering evidence. I am going to conduct my research within six months’ time. My target group includes young people at risk for attempting suicide from three high schools in Portland (Maine) that implement different suicide prevention strategies. When establishing the communication with the school workers, it is necessary to acquaint them with the project objectives, to establish the time, the place, and the frequency of the meeting, and any additional forms of communication, such as written reports, e-mails and surveys. Once the communication has been established, I am going to design the focus of the evaluation, aimed to measure the impact of suicide prevention programs. Finally, I am going to gather the evidence, meeting the school workers every week, preparing reports on their activities, and collecting the data concerning the outcomes of finished programs for the students. Funding The programs I am going to evaluate have different sources of funding, provided by several different entities. Since 1985, a bill has been introduced to the House of Representatives to provide all the States with funding for suicide prevention programs (U.S. Department of Health and Human Services, Public Health Service, 2001). The Federal government is responsible for the provision of funding to all programs and research that protect the health and well-being of all citizens. The costs of the SOS program are estimated at $200, which includes the program materials provided by the supplier: procedure manual, teacher training video, student video, and other support materials. When it comes to the C-CARE/COST program, they vary, including C-CARE protocols, CAST protocols, Counselor training and CAST leader training. Both programs are supported by a grant from the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (Suicide Prevention Resource Center, 2005). The cost of participation in a full-day gatekeeper training, organized by the Maine Center Disease Control in several cities in the state, is $50 (Maine Center for Disease Control, 2009). These programs are funded by a collaborative initiative among the agencies of the Maine Children’s Cabinet, involving the Departments of Health and Human Services, Educations, Corrections, Labor and Public Safety (Department of Health & Human Services, State of Maine, 2006). Project impact, project limitations and ethical considerations My project is going to evaluate the impact of different suicide prevention programs on young people in Portland. Given the outcomes of the program evaluation, the teachers and the school workers will be able to see how their work influences young people and to improve eventual faults. The project outcomes may also provide useful information to other schools that are going to implement suicide prevention programs. However, there are some project limitations that may severely limit potential use of the program outcomes. First, as my project concerns only a few schools in a medium class background with relatively low dropout rates, the results may vary in another social environment. Furthermore, as the data concerning finished programs are restricted to surveys conducted with the program participants and the teachers, they may not cover all aspects of the program impact on young people. When it comes to ethical considerations, it is very important to avoid bias and prejudice against people with mental health problems (U.S. Department of Health and Human Services, Public Health Service, 2001). Thus, when working on my research, I will use the approach “people first”, always referring to “young people at risk for committing suicide” rather than “suicidal young people”. Mental illness should be viewed with the same understanding and concern as all other illnesses and all people affected with it should be provided with care, understanding and help they need. Relevant testing of hypothesis I hope that the collection of the relevant data, involving written reports, surveys, and other information provided by the teachers and school workers engaged in the program will allow me to evaluate accurately both the process and the outcomes of school-based suicide prevention programs. I consider these evaluation instruments valid and reliable for the purposes of my research. References: Campbell, D., 2004. Preventing youth suicide through gatekeeper training. A resource book for gatekeepers. Augusta: Medical Care Development, Inc. Available at: http://www.maine.gov/suicide/docs/gkeepbook.pdf [Accessed 30 December 2009] Centers for Disease Control, 1992. Youth suicide prevention programs: a resource guide. [Online] Atlanta: Centers for Disease Control. Available at: http://www.cdc.gov/ncipc/dvp/Chapter%201.PDF [Accessed 28 December 2009]. Department of Health and Human Services, State of Maine, 2006. Maine Youth Suicide Prevention Program. [Online] Augusta: Department of Health and Human Services, State of Maine. Available at: http://www.maine.gov/suicide/myspp/contact.htm [Accessed 30 December 2009] Goldrick, L. , 2005. Youth suicide prevention: strengthening state policies and school-based strategies. [Online]. NGA Center for Best Practices. Available at: http://www.nga.org/cda/files/0504SUICIDEPREVENTION.pdf [Accessed 28 December 2009]. Maine Center for Disease Control, 2009. Maine youth suicide prevention program. Educational programs at a glance. [Online]. Augusta: Maine Center for Disease Control. Available at: http://www.maine.gov/suicide/docs/Training%20Flyer%2009-10.pdf [Accessed 30 December 2009]. Peacock, J., 2000. Teen Suicide. Minnesota, Capstone Press Quinnett, P., 2007. QPR gate keeper training for suicide prevention. The model, rationale and theory. Spokane: QPR Institute. Available at: http://www.qprinstitute.com [Accessed 30 December 2009]. Suicide Prevention Resource Center (SPRC), 2005. SOS: Signs of Suicide. Newton: Suicide Prevention Resource Center Thompson, E.A., and Eggert, L.L., 1999. Using the suicide risk screen to identify suicidal adolescents among potential high school dropouts. Journal of the American Academy of Child Adolescent Psychiatry, 38, 1506-1514. Thompson, E.A., Eggert, L.L., Randel, B. & Pike, K., 2001. Evaluation of indicated suicide risk prevention approaches for potential high school dropouts. American Journal of Public Health, 91(5), 742-752. U.S. Department of Health and Human Services, Public Health Service, 2001. National strategy for suicide prevention: goals and objectives for action. [Online] Rockville, MD: U.S. Department of Health and Human Services, Public Health Service. Available at: http://download.ncadi.samhsa.gov/ken/pdf/SMA01-3517/SMA01-3517.pdf [Accessed 28 December 2009]. Read More