Critical Event Support with County of San Diego

Guidelines for Student or Staff Sudden Death (Part 2)

Guidelines for Developing Policies and Procedures

Youth suicide will not decrease without community prevention and intervention efforts. School districts are positioned to provide leadership for prevention programs. The following guidelines for creating policies and procedures to address suicide are offered to school districts in the hope that they will lead to the development of operational procedures that can be followed by school district personnel.

In developing policies and procedures, several important principles should be remembered:

1. Parent contact—Parents should be contacted whenever their child is presenting a danger to him or herself or to others.
2. Screening—School personnel should be available and accessible to students needing to communicate personal concerns. School personnel should be trained to screen for suicidal ideation. Substance abuse, psychiatric illness, chronic running away, and physical or sexual abuse can place children at risk for suicide.
3. Home-–school–community communication system—A contact person at the school should set up a home–school–community system to monitor the activities of students identified as potentially suicidal.
4. Referral—Students who have serious problems or make suicidal threats or attempts should be referred to psychiatrists, psychologists, or counselors who are trained and licensed to treat suicidal youth.

While it is not the responsibility of either the special education staff or the school officials to provide treatment, it is the responsibility of schools to protect children when they are at school. The procedures described below may help to prevent suicides and to protect schools from liability if a suicide does occur.

Steps to Follow

To establish policies and procedures that prepare school districts for crises such as suicide, there are three general steps to follow.

Step 1: Community Involvement

Suicide is a social problem. Consequently, it requires cooperative social solutions. For schools to intervene effectively with suicidal students, a concerted effort must be organized among teachers and others in the caring professions, both inside and outside the school system. The community group should develop suicide prevention policies and procedures. Involvement of a broad cross section of the community will increase commitment and create a network of professionals seeking a solution to the suicide problem.

Before writing policies and procedures, the school district should gather information about available community resources, including the names and addresses of contacts to whom schools can refer students and families in times of crisis. The referral network might include mental health centers, private hospitals, psychiatrists or psychologists in private practice, religious or spiritual communities (e.g., churches), and local law enforcement agencies.

Having many agencies involved in the suicide-prevention program will expedite training of suicide-prevention staff and will guarantee the availability of a range of support services in the event of a suicide threat, attempt, or completion. Various agencies working together should be better able to identify and solve community problems that may increase the risk of youth suicide than any one agency working alone.

The school district should develop a network among the schools and other public agencies to exchange information about suicidal students who need support services. The challenge in establishing such a network will be to exchange significant information while protecting the student's right to confidentiality.

Step 2: Develop written policies.

The school district should write suicide-prevention policy based on an analysis of community needs and careful study of the role of the schools in the community. The policy should be evaluated on a regular basis to ensure continuing responsiveness to community need. The following is an example of a possible board policy:

The board has committed itself to providing the leadership within the community to act in concert with other organizations and agencies to develop a community-wide approach to dealing with the problems of youth stress, depression, and suicide. The board feels it is imperative that cooperative planning and action be taken among all agencies and persons involved with youth in identifying, preventing, and intervening in stress, depression, and suicide among our youth.

The board's concern is reflected in the district's stated goal "to increase community awareness of the needs of at-risk youth and to improve the district's ability to educate and assist those students." The board supports the cooperative community-wide development of specific administrative procedures and training strategies to assist youth in crisis and their families.

Step 3: Develop written procedures.

Policy statements should be refined into specific procedural guidelines that prescribe specific action to be taken in the event of a suicide threat, attempt, or completion. The procedures outlined below are applicable to four kinds of situations that may arise:

1. Suspected suicidal ideation
2. Suicide threat
3. Suicide attempt
4. Suicide completion

The sequence of actions described in the four situations below should be adapted to the existing circumstances and/or procedures in individual school districts.

1. Suspected Suicidal Ideation

Staff must be trained to recognize a suicidal ideation, understand what their responsibilities are when an ideation occurs, and know what action to take.

2. Suicide Threat

In the event of a suicide threat, the following actions should be taken:

• Have an appropriately trained staff member, such as a school psychologist or counselor trained in suicide assessment, evaluate the risk and provide immediate crisis-intervention services to the student. Threats of suicide should never be taken lightly.
• Remove the student from any area containing any dangerous substances and/or implements, and remove any dangerous substances or implements from the student.
• Do not leave the student alone until either it is determined that the student is no longer in danger, or until that student has been referred to appropriate treatment.
• Notify the parents.
• Have the contact person at the school set up a home–school–community communication system, and notify other school personnel about the need to monitor the student.

3. Suicide Attempt

In the event of a suicide attempt (defined as any behavior or gesture that indicates an intent to take one's life) the following actions should be taken:

• Treat it as a medical emergency. Call emergency medical services (911), if necessary.
• Have a staff member stay with the student at all times.
• Remove all dangerous substances and/or implements from the student and from the area.
• Notify the parents immediately.
• Have an appropriately trained staff member assess the situation and provide crisis-intervention services.
• Involve psychological or consultation services through the community-referral system. The employee assistance program (EAP) may also be of assistance here.
• Have the contact person set up a home–school–community communication system and notify other school personnel (school administrators, counselors, nurses, and teachers) about the need to monitor the student. If appropriate, the school could develop and implement an individual assistance plan with the student, school, family, and other involved agencies.
• Urge parents to seek immediate treatment for the student. The district should document any such encouragement and the parents' response. If the parents do not respond, the student should be referred to Child Protective Services.

4. Suicide Completion

If a suicide is completed, the following actions also appropriate to a suicide attempt should be taken:

1. Treat it as a medical emergency and call emergency medical services.
2. Have a staff member stay with the student.
3. Notify the parents immediately.
4. Notify staff members.

In addition, the following actions should be taken:

• A school crisis team meeting should be called. The crisis team should be organized prior to a crisis and should include school and/or district administrative, counseling, and psychological services staff, teachers, and nurses. Professionals from outside the schools also may be included, such as psychiatrists or psychologists, community mental health professionals, or emergency response mental health personnel. After a suicide completion, the crisis team should identify students who are at the highest risk for suicide, including students who were close friends of the victim, students who seem particularly troubled by the suicide, students who have themselves made suicide attempts, or other high-risk students with poor coping skills.
• The superintendent's office should be notified about the suicide, and the post-suicide plan should be implemented.
• All building personnel should be notified about the suicide, and the post-suicide plan should be implemented.
• Factual information about the suicide should be communicated to school staff and to the students. Rumors should be dispelled. General announcements of the suicide are not recommended, unless accompanied by counseling and educational support in all classes.
• Parents of any students expressing strong emotional reactions or suicidal ideation should be notified. Those parents should be urged to seek treatment for their children.
• Members of the crisis team should make presentations to each class in which the student was enrolled, and discuss the facts of the student's suicide and the futility of suicide. All students who want to discuss the subject further should be urged to see the school counselor or other specially trained staff. If any students are experiencing strong emotional reactions, their parents should be notified, and the students should be referred for treatment.
• All teachers should set aside time for students to discuss their reactions to the tragedy, and students who seem very upset should be referred to the counseling team.
• Counseling services should be made available to those students who have been identified as at risk for the length of time that the crisis team deems necessary. Referral for treatment to community agencies or hospitals should be made, if appropriate.
• School in-service sessions and counseling time should be made available to all school personnel to help them deal with their own reactions to the suicide.
• Neither the student nor the suicidal act should be glorified or memorialized in any way.

While the procedure should clearly state that the special education assessment process should not be used in lieu of immediate parental notification or as the initial resource in assessing risk when more immediate steps are obviously indicated, provisions should be made for the referral of a suicidal student for special education assessment.

The teaming process used for determining eligibility for the seriously emotionally handicapped area can be helpful in determining which staff and resources are available to intervene with a student, who, while not determined to be immediately at risk, may evidence behaviors that suggest a high-risk profile for suicide. The procedures also should suggest that during the assessment process, interventions should be implemented that diminish suicidal risk, for example, parental contact or involvement, use of school staff who offer a safe and supportive environment, and disciplinary approaches that do not increase the student's sense of failure. It is extremely important to secure the cooperation of family, friends, school personnel, neighbors, and others who will assist in providing support and supervision for the student. Parents must be warned that a suicidal student should not be left alone.

Another important suggestion is (and should be standard practice for any special education program) to secure written parental permission for the school to communicate directly with treatment providers. The treatment plan and the school intervention plan must work closely together, not at cross purposes.