Tier I: Universal Interventions – Guide for NY Schools

Universal Interventions - Tier I

School districts should develop policies and programs which include Tier I universal suicide prevention. One way to envision suicide prevention in school is through the lens of a Competent and Caring School Community(Underwood, 2010). This setting is one in which all members of the school community play a role in prevention, from the school board to parents, staff, and to students. Everyone is responsible for the safety and well-being of each other and have the competency to recognize when to ask for help and know how and where to access assistance if there is a concern about suicide.

Faculty and Staff Awareness Training

It is critical that the district develop written procedures for the staff to follow, when warning signs of suicide are observed or suspected. Staff awareness training should include how to identify warning signs and the procedures to follow when referring a student thought to be at risk for suicide. Faculty education must also include guidelines about what educators can do to promote protection from suicide including the promotion of positive mental health, how to handle suicide related topics in the classroom, and how to identify developmentally appropriate materials for classroom use and school/community resources.

High quality resources for staff awareness training are readily available. The Society for the Prevention of Teen Suicide provides a free online two-hour course, Making Educators Partners in Youth Suicide Prevention: Act on FACTS. A three-minute trailer is available and the training modules can be accessed by registering at SPTS University. Suicide Safety for School Staff is a brief training (60 to 90 minutes) designed by the Suicide Prevention Center of New York (SPC-NY) to meet the basic awareness needs of faculty and school staff. A network of over 200 trainers are available and connected to 10 regional training centers across New York. To find a trainer or to learn more about this initiative, contact SPC-NY. New York City educators also have the option of accessing free online modules of Kognito’s At Risk.

Focus on Social Emotional Competency Development (SEL)

Extensive research indicates that effective mastery of social emotional competencies is associated with greater well-being and better school performance. On the other hand, the lack of competency in these areas can lead to a variety of personal, social, and academic difficulties. In fact, a study of young students found a significant relationship between students’ social emotional competencies in first grade and their outcomes 13 years later (Bradshaw, 2013). Those students with early pro-social skills were more likely to graduate from high school on time, complete a college degree, and achieve and maintain full-time employment. Further, during high school they were less likely to be involved with police, use alcohol or misuse opioids, or require medication for emotional or behavioral issues. In addition to the many other benefits of SEL, lifetime suicide risk is diminished when students learn social problem-solving skills and learn to cope with emotional challenges and life stressors. Effective SEL programs have demonstrated an increase in social connectedness, which is an additional protective factor against suicide risk.

In 2018 and 2019, the New York State Education Department (NYSED) published new resources to assist schools and districts in implementing SEL strategies through explicit instruction, integration with academic curricula, general teaching practices, integration of SEL in school and district policy and practice, and professional development and SEL support for adults in the school community. These resources can be found on NYSED’s SEL website, and include: (1) SEL benchmarks for voluntary implementation, (2) a framework document explaining SEL concepts and the need for and benefit of SEL, (3) a guidance document to provide implementation strategies and resources for districts and schools; and (4) district-developed crosswalks aligning SEL competencies, academic standards, classroom activities, and general teaching practices. Social Emotional Learning: Essential for Learning, Essential for Life provides a framework explaining SEL concepts, and the need for and benefit of SEL to assist schools with implementation of the NYSED recommended SEL benchmarks. The Collaborative for Academic, Social, and Emotional Learning (CASEL) provides an extensive collection of resources, including a Guide to Schoolwide Social and Emotional Learning, to assist schools and districts in the implementation of Social Emotional Learning strategies.

School Connectedness and School Climate

School connectedness is best defined as a belief held by students that adults and peers at school care about them and about their learning. School connectedness leads to both positive educational and health outcomes which includes a sense of student belonging and contribution, believed to be important protective factors against suicide risk. CDC developed School Connectedness: Strategies for Increasing Protective Factors Among Youth, a resource document for schools.

School climate is defined as the way school culture affects a child’s sense of safety and acceptance, and consequently is a critical determinant of their ability to focus on the task of learning. Measuring school climate is a crucial step in creating a safe and caring environment. Collecting data through surveys of students, parents, and staff is an important component of a school climate assessment. The NYSED promotes efforts to build and maintain positive and healthy school climates, and has engaged in a School Climate Pilot Project using United States Department of Education School Climate Surveys.

Upstream Prevention Programs

Research suggests that universal prevention programs for children may effectively reduce adolescent emotional and behavioral problems that are risk factors for future suicidal behavior. While many upstream prevention programs, such as Positive Behavioral Interventions and Supports (PBIS) framework, Second Step program and mindfulness training, may enhance protection against suicide for students, few programs have actually been studied for this outcome. Two programs, the PAX Good Behavior Game, and Youth Awarenessof Mental Health are universal interventions that have shown to reduce suicide attempts over time. Sources of Strength is a program that utilizes trained student peer leaders and adults and has been shown to improve school- wide help-seeking and engagement of adult help for suicidal peers, with the greatest benefits for suicidal youth (Wyman, 2010).

Mental Health Literacy Education

Mental health literacy is defined  as  “knowledge and beliefs about mental disorders which aid their recognition, management, or prevention.” A growing body of research in mental health literacy suggests that an increased understanding of mental health will improve help-seeking behaviors, reduce stigma, and promote better health outcomes (Kutcher, 2016). This is true for both young people and their supporters such as families, teachers, and peers.

Health education that respects the importance of mental health, as well as the challenges of mental illness, will help young people and their families and communities feel more comfortable seeking help, improve academic performance and, most importantly, save lives. According to the CDC, “focusing on establishing healthy behaviors during childhood is more effective than trying to change unhealthy behaviors during adulthood.” An equally important part of this conversation is to help students identify risk and protective factors, as learning and resiliency can result in positive decision-making and life-long success, which are the primary goals of health and education.

In June, 2018, NYSED published a comprehensive guide Mental Health Education Literacy in School: Linking to a Continuum of Well-being to provide guidance for developing effective mental health education instruction in the classroom. The guidelines comply with the recent amendments to Education Law 804, while also looking at embedding mental health well-being within the broader context of the school environment to promote a positive culture and climate.

The School Mental Health Resource and Training Center, was established by the Mental Health Association in New York State, Inc. (MHANYS) to help schools comply with the new law. The Center provides free online mental health training (CTLE- Eligible) and instructional resources for educators, as well as mental health resources for parents and guardians, students and community-based mental health providers. Statewide, Resource Center staff can provide professional development for school staff, including MHANYS Mental Health and Wellness 101, mental health instruction for students, and technical assistance for developing mental health curriculum and school wide mental health promotion strategies.

Finally, the Resource Center can provide support in establishing school-community partnerships. MHANYS addresses suicide prevention in their white paper Mental Health Education in New York Schools: A Review of Legislative History, Intent, and Vision for Implementation. This document offers core elements that should be included in school mental health curricula and acknowledges that unrecognized, untreated and late treated mental illness elevates the risk of mental health disabilities, suicide, and self-injury (Richter, 2017).

In addition, teenmentalhealth.org is an evidence-based, comprehensive mental health curriculum for grades 8-10 that is implemented through a train-the-trainer model. The training has been shown to significantly increase educators’ knowledge about mental health and significantly decrease stigma. National Alliance on Mental Illness NYS (NAMI NYS) offers Ending the Silence presentations for students, educators and families, a stigma reducing program. The American Foundation for Suicide Prevention (AFSP), which has chapters across NYS, offers More than Sad for students, educators and families, a video- based educational presentation on teen depression.

Student Suicide Prevention Education

Suicide prevention education can begin in middle school or high school. It should include common warning signs and how and when to seek help. However, it should be noted that not all suicide prevention education efforts are helpful. Presentations can inadvertently stigmatize a student who may need help. In some cases, sensational presentations by persons with a compelling story have raised concerns about suicide contagion and about students learning how to kill themselves from such presentations. Yet, suicide prevention education can improve student knowledge of how, when, and where to seek help.

When implementing suicide prevention education, it is important that the educator be well trained in evidence-based suicide prevention that is developmentally appropriate, that  the  presentation be integrated with other similar content rather than standing alone, and that it be done in a classroom or small group, rather than in an auditorium presentation. Classroom teachers are wise to collaborate with student support service providers in the development of the presentation. When student support service providers co-teach or support classroom teachers, they can assure that students know how to access help. Since the best outcome of any such education would be that students would recognize signs of distress in themselves and their classmates and  reach out for help, it is best that parents and adults in school have also had suicide prevention awareness education.

The SPC-NY offers a tip sheet for classroom presentations. Several programs and curriculum exist for student suicide prevention awareness. As an example, Lifelines Prevention is a manualized curriculum from Hazelden Publishing that has lessons plans for middle and high school students. Another program, Sources of Strength (SOS) engages peer leaders to enhance protective factors across a high school population. SOS has been shown to improve social norms associated with suicide prevention with the greatest changes being among students with suicidal ideation. Major findings include improved perceptions of support from adults and increased likelihood that they would tell an adult if they were concerned about suicide (Wyman, 2010).

Parent Education

Parents need information about the prevalence of youth suicide, its warning signs, how to respond if their child or another child is at risk, and where to turn in their community for help. Some parents do not relate well to written materials or videos, especially on difficult topics like suicide and may respond better to verbal or personal communication.

The Society for the Prevention of Teen Suicide offers several resources that can be helpful for designing parent awareness or education activities. Among their resources is a free 17-minute video titled Not My Kid designed to answer the questions most frequently asked by parents about suicide. The Mayo Clinic offers a 5 minute video that focuses on the warning signs and how to respond. The Suicide Prevention Center of New York offers a parent brochure that can be downloaded or linked.  The Jed Foundation offers a conversation guide for concerned parents of teens.