Fluent Essays

Many survivors of childhood trauma do not seek treatment until they are well into adulthood. Often, their presenting complaints may not directly reflect a childhood trauma, but rather the outcome of a lifelong psychological reaction to the trauma. For instance, a survivor of childhood sexual abuse may seek treatment as an adult for a variety of issues, such as depression, alcohol or drug abuse, or insomnia, which may appear unrelated to the abuse.In this Discussion, you will analyze the long-term effects of childhood trauma on survivors mental and physical well-being.To prepare for this Discussion:Review this week’s resources related to Childhood Trauma, focusing on topics such as child physical and sexual abuse, the importance of trauma diagnosis, and prevention/treatment programs.Pay particular attention to how exposure to a childhood trauma might result in a transcrisis state.Consider the destructive behaviors that survivors of childhood sexual abuse might exhibit in the absence of appropriate aftercare.Reflect on psychological and physical characteristics associated with neglected children. Think about how such characteristics might be indicative of a transcrisis state.Think about survivors cognitive impairments, emotional reactions, and behaviors associated with exposure to family violence. Also, consider how survivors relationships are affected by exposure to family violence in childhood.Consider the long-term psychological and physical effects of child abuse on adult survivors.Identify a specific type of childhood trauma (e.g., child physical abuse, sexual abuse, neglect, or exposure to family violence). Think about how exposure to this type of trauma might result in a transcrisis state. Also, reflect on various behavioral, cognitive, emotional, and psychosomatic characteristics of survivors that might be indicative of a transcrisis state.With these thoughts in mind:By Day 4Post an explanation of how a specific type of childhood trauma might lead to a transcrisis state among survivors. Then, provide at least two specific examples of how survivors psychological and/or physical health might be affected by being in a transcrisis state. the_school_psychologist_s_role_in_suicide_prevention.pdf posttraumatic_stress_among_students_after_the_shootings_at.pdf cultural_considerations_in_adolescent_suicide.pdf understanding_interpersonal_trauma_in_children.pdf child_sexual_abuse__links_to_later_sexual_exploitation_high_risk_sexual_behavior.pdf child_physical_abuse.pdf Unformatted Attachment Preview This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. School Psychology Quarterly, Vol. 11, No. 2,1996, pp. 169-185 The School Psychologists Role in Suicide Prevention Jonathan Sandoval and Stephen E. Brock University of California, Davis Youth suicide is a leading cause of death among adolescents and represents a major health problem for this population. The school psychologists involvement in this health issue spans primary, secondary, and tertiary prevention and working with the aftermath of a suicide or suicide attempt. Primary prevention activities involve supporting and delivering curricula educating youth about suicide in general and promoting social problem solving in the school milieu. Other primary prevention activities include: Screening all students for suicidal ideation, creating networks of peer helpers, working to reduce the availability of suicidal means (e.g. gun control), training school personnel to identify and refer potentially suicidal individuals, and establishing interdisciplinary crisis response teams. Secondary prevention involves working with individuals and groups at risk for engaging in suicidal behavior. Special education, alternative education students, gay and lesbian youth, certain ethnic minority youth, and individuals with psychopathology need to receive differential services and attention. Tertiary prevention requires swift treatment and referral. Services delivered following a suicide are termed postvention. Suicide survivors obviously must receive services as part of tertiary prevention, but school psychologists must be prepared to advise school personnel on such issues as memorializing a death, communicating information, and squelching rumors. This article will outline the school psychologists role in preventing youth suicide. The school psychologists involvement spans primary, secondary, and tertiary prevention. Youth suicide, along with accidents and homicide, is a leading cause of death among adolescents and represents a major health problem for this population (Centers for Disease Control, 1991). For the young adult population, AIDS is increasing fatal. All of these threats to life, such as violence to self or others, and engaging in risky drug, sexual, and other behavior, may be countered in similar ways by school psychologists. Although this article will focus on suicide, we hope it will serve as a template for thinking about and addressing these other serious health problems. Address correspondence to Jonathan Sandoval, Division of Education, 2075 Academic Surge, University of California, Davis, CA 95616-8579. 169 170 SANDOVAL AND BROCK This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. PRIMARY SUICIDE PREVENTION Because academic and social competence are basic to creating resilient and effective adults, primary prevention begins with schooling. The more that can be done to promote normal development through an educational program which accommodates to individual differences, the less likely will be the development of mental health problems that produce youth suicide. Accordingly, to the extent the school psychologist contributes to making the school more effective as a system, through performing the routine duties assigned, he or she is a part of the process of preventing youth suicide. However, there are more explicit activities where the school psychologist may be involved. Awareness Programs for Students Possible primary prevention activities start with supporting and delivering curricula designed to educate all youth about suicide in general. These are usually referred to as awareness programs. A number of curricula have been developed, implemented, and evaluated (Ryerson, 1990; Sandoval, London, & Rey, 1994; Wass, Miller, & Thornton, 1990). The California curriculum package is typical (California State Department of Education School Climate Unit, 1986). It is based on a five-day set of one-hour lesson plans designed to teach students to recognize suicidal behavior in peers and to refer a troubled peer to an appropriate adult. The first unit consists of an introduction, providing facts and exposing common misconceptions of suicide and its causes. The second unit focuses on the transient nature and symptoms of depression and the warning signs of suicide. The third unit is intended to help students recognize the roles of substance abuse and stress in the development of suicidal feelings and to teach them some skills for coping with stress and depression. The fourth lesson is directed specifically at giving students the skills necessary to be helpful to adolescents who are suicidal. The final lesson has the goal of increasing understanding of appropriate and available school and community resources. These suicide awareness programs are usually added to the health or social studies curriculum. Rigorous evaluations of these programs have indicated that they can change attitudes and knowledge about suicide, but that they do not always do so (Ciffone, 1993; Kalafat & Elias, 1994; Overholser, Hemstreet, Spirito, & Vyse, 1989; Shaffer, Garland, Vieland, Underwood, & Busner, 1991; Spirito, Overholser, Ashworth, Morgan, & Benedict-Drew, 1988). In general these programs have been shown to produce benefits. In spite of these generally positive findings, it must be pointed out that a number or controversies surround this form of primary prevention, including the adequacy of program evaluation. Shaffer and his colleagues warn that there are dangers in awareness programs if suicide is portrayed as a tragic, heroic, or romantic response to stress and pressure imposed by an uncaring adult world (Shaffer, Garland, & Bacon, 1987). Such a characterization may contribute to contagion. Instead, they THE SCHOOL PSYCHOLOGISTS ROLE IN SUICIDE PREVENTION 171 This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. argue that programs should emphasize suicide as a deviant act by someone with a mental disturbance. In addition there is some concern than not all students are equally influenced by the program. Many students already have sound knowledge in this area, and those at risk of suicide may be negatively effected by program participation (Shaffer, Garland, & Whittle, 1988). There also may be gender differences; often males do not respond helpfully or empathically to suicidal peers, although this finding is not robust (Kalafat & Elias, 1994). Competence Enhancement Curriculum Another curriculum-based approach is to teach general coping skills, social skills and stress-reduction procedures. A number of these programs exist and have been positively evaluated. Examples include Spivack and Shures (1974) Interpersonal Cognitive Problem Solving, Eliass Improving Social Awareness-Social Problem Solving (Elias & Clabby, 1992) and Gesten and Weissbergs Social Problem-Solving (Gesten, Weissberg, Amish, & Smith, 1987) The skills developed through this type of program enable children to cope more effectively with the social problems and stresses which may contribute to youth suicide. Skills taught are problem recognition, goal setting, the generation of possible solutions, anticipating outcomes of solutions, evaluating trial strategies, and so on. Included is the practice of social problem solving in the school milieu. Although these programs are often used with young children and usually do not explicitly bring up the topic of suicide, they nevertheless have preventive power. The school psychologists role in both awareness programs and competence development programs may be to implement the program, serve as resource to those implementing the program, or simply to advocate for the inclusion of such programs in the curriculum. Peer Programs Increasingly school people are turning to peer programs to address the problems of suicide as well as problems centered around conflict and violence. School psychologists should know about these programs and participate in their formation and the training of peer helpers. One strong rationale for a peer program is that adolescents are more likely to confide suicidal thoughts and intentions to a friend than to a parent, teacher, or other adult (Ross, 1985; Shaffer, Garland, & Bacon, 1987). Peers know about students in trouble and peer helpers or leaders become important bridges to help. As a result, training in suicide awareness and how to make referrals targeted at peer counselors or student leaders are another option for prevention. These programs cover the same topics as general programs, although there may be a greater emphasis on how to expedite a referral, and why it is important not to hold dangerous information in confidence and attempt to counsel suicidal peers. Having a network of watchful students on the lookout for potentially suicidal individuals increases the likelihood of early intervention. 172 SANDOVAL AND BROCK This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Staff Awareness Programs It is also important to educate the school community about youth suicide. School psychologists are logical school personnel to coordinate and present programs for teachers, administrators, and staff. Community resources may also be brought in to assist, and there are good audio-visual resources to supplement lecture and discussion (Davis & Sandoval, 1991). As in other awareness education, the stress should be on the warning signs of suicide (e.g. a suicide threat, a previous suicide attempt, depression, marked changes in behavior, making final arrangements) and what to do if they are encountered. Some topics emphasized with staff are legal issues, school policy issues, crisis management procedures, causes of suicide, and suicide intervention (Garland & Shaffer, 1988). Parent Awareness Programs Ryerson (1990) believes that parent involvement is critical and has developed a parent education model. Nevertheless, it is difficult to get parents involved in school programs at the secondary level. Informational programs for parents can cover the same topics as with staff and students. Awareness can be facilitated through programs open to the public such as those sponsored by a school Parent Teacher Association, through contributions to local newspapers, or through programs presented to community groups, such as service clubs. School psychologist should be prepared to speak at such programs as part of their outreach obligations. Referrals and Screening Programs There are four ways that school psychologists might initiate contact with suicidal youth: self-referral, psychoeducational evaluation, informal referral, and screening. The first three forms of contact would lead to secondary or tertiary intervention, but screening is a primary prevention activity. Psychometric screening for suicidal behavior is a two-stage process. First comes the administration of a psychological questionnaire designed expressly for this purpose. Second comes a thorough clinical evaluation of students identified by the screening instrument. William Reynolds (1988) has produced some excellent tools for use in schools by school psychologists. Sophisticated school psychologists may be interested in implementing screening programs. School Crisis Response Teams Another important activity for school psychologists to help with the establishment of an interdisciplinary crisis response team (Brock, Sandoval, & Lewis, 1996). If a crisis response team is in place, a much more rapid reaction to a suicidal emergency will be possible. In addition, through the creation of such a team, other crisis events will be prepared for and more individuals may receive more training in managing suicidal behavior. We will provide more detail on how a crisis THE SCHOOL PSYCHOLOGISTS ROLE IN SUICIDE PREVENTION 173 TABLE 1. Crisis Response Team Roles This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Crisis Response Team Coordinator. The Crisis Intervention Team Coordinator oversees initial and follow-up interventions. This is the individual to whom all completed suicides are reported, who is responsible for verifying that a death has occurred and who then notifies the other crisis response team members. Media Liaison. This individual is responsible for ensuring that staff knows how to deal with the media (i.e., what to say or to whom to refer them), for creating an environment that would facilitate media cooperation with school requests, and for arranging interviews. Additionally, this individual plays a major role in determining what and how information will be shared with the press and community. Referral Coordinator. The Referral Coordinator is typically a school psychologist or counselor. This individuals responsibilities include making referral forms available to staff, maintaining a referral list, distributing a referral summary to support staff, establishing a procedure for self referral, identifying high risk students, and helping to plan and implement intervention procedures. At the conclusion of the intervention this individual would be responsible for writing a detailed summary of the crisis and the crisis interventions. Following a suicide it may be appropriate for community resources Security/Police Liaison. The Security/Police Liaisons responsibilities include implementing plans designed to ensure student safety following a crisis, and acting as a liaison with local law enforcement officials. For example, although not typically an issue, crowd control can become a problem (Davis & Sandoval, 1991). If a student suicide took place at a particularly public school site, and students are aware of this fact, it may be that large numbers of students will congregate at this location. In this situation the Security/Police Liaison would be responsible for the appropriate crowd control procedures. This Liaison would also be the person from the school who would have access to the local police department. Garfinkel et al. (1988) recommend that the school let the police know that this Liaison is the person whom they can contact day or night with any reported suicide. Also, it might be appropriate to have someone, such as the Security/Police Liaison walk the halls to monitor common areas such as bathrooms, parking lots, and cafeterias. In this way the Liaison would be able to observe and connect with students in need or at risk who are not in their classrooms (Berman & Jobes, 1991). Note. Adapted from Brock, Sandoval, and Lewis (1996). response team might operate in the section on postvention. A major prevention activity for school psychologists is setting up, organizing, and training team personnel. A typical crisis response team might include the Crisis Response Team Coordinator, Media Liaison, Referral Coordinator, and Security/Police Liaison. A brief description of the duties of these crisis response team members in responding to suicide is provided in Table 1. Comprehensive Services Planning Recently, a number of model programs have been developed with the aim of establishing collaborative partnership between a constellation of community agencies and the public school. These partnerships pool resources and locate them as school sites so that services may be delivered to children and families in an integrated and holistic manner (Dryfoos, 1994). School psychologists have a role in creating and staffing these collaborative efforts (Romualdi & Sandoval, 1995). With coordinated 174 SANDOVAL AND BROCK resources, more and better services may be delivered to adolescents which will reduce the likelihood of suicidal behavior going unnoticed and untreated. This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. Community Development A final indirect form of primary prevention is working as a citizen and as a psychologist for an improved community. As communities develop and begin to provide opportunities for youth for meaningful work and recreation, some of the factors working to stimulate suicidal behavior can be lessened. Helping neighborhoods become more involved in the decisions that affect them often involves political action. As a citizen it is also possible to work to reduce the availability of suicidal means. School psychologists may wish to advocate on issues such as gun control, driver safety, and drug education or enforcement as a means of reducing the probability of impulsive suicide. SECONDARY SUICIDE PREVENTION Secondary prevention involves working with individuals and populations at risk of suicidal behavior. Individuals at risk are often those who have begun to exhibit suicidal symptoms, such as suicidal ideation or even a suicide attempt. If a student brings up the topic of suicide during an evaluation or during a counseling interview, it is vitally important to remember that because the student is aware of and talks about suicide does not mean that he or she will not do it. The school psychologist must be sensitive to direct and indirect messages about suicidal ideation and behavior and be prepared to inquire directly about the topic. Most experts agree that children and adolescents are most interested in talking openly about suicidal thoughts and feelings with adults who can talk about it openly with them (e.g., Hawton, 1986; Orbach, 1988). Davis and Sandoval (1991) review a number of models of suicide assessment approaches suitable for school psychologists. Programs for Youth with Suicidal Ideation Special interventions for teenagers with suicidal ideation could be created within the school setting, but more likely they will be established in community mental health settings, where there is more time and trained personnel for group and individual counseling and psychotherapy. Establishing good coordinate relationships with agencies delivering these specialized services may fall to the school psychologist. Programs for Populations at Risk Some individuals, because of the social contexts in which they live, may also be considered at risk because the group to which they belong has a greater than average This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly. THE SCHOOL PSYCHOLOGISTS ROLE IN SUICIDE PREVENTION 175 incidence of suicide. Although we are aware that a number of groups have high suicide rates, few programs have been documented that are specifically designed for special populations, such as gay and lesbian youth or students in special education. Creating such programs is a special challenge to school psychologists. Evidence increasingly suggests that adolescents with learning disabilities (JanTausch, 1964), victims of physical (Green, 1978) and sexual (Briere & Zaidi, 1989) abuse, substance abusers (Robins, 1982), and runaways (Robins, 1989) are at high risk of suicide. These groups are often concentrated in continuation and alternative secondary education schools. School psychologists assigned to these schools must be ... Purchase answer to see full attachment