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Welcome to SPRC’s Research to Practice Webinar
Expanding Suicide Prevention to Include Upstream Approaches
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SPRC Research to Practice Webinar
If you are experiencing technical difficulties, please call 307-GET-WEB1 (307-438-9321)
Expanding Suicide Prevention to Include Upstream Approaches
September 25, 2012
Opening Remarks
Gail F. Ritchie
SAMHSA’S MISSION
To reduce the impact of substance abuse and mental illness on
America’s communities
National Research Council and Institute of Medicine, 2009
SAMHSA and the Institute of Medicine
Preventing Mental, Emotional, and Behavioral Disorders, Among Young People, Progress and Possibilities
Contact Information
Gail F. Ritchie, M.S.W., LCSW-C
Coordinator, Prevention Practices in Schools Grant Program
Mental Health Promotion Branch
Substance Abuse and Mental Health Services Administration
gail.ritchie@samhsa.hhs.gov
Today’s Presenter
Philip Rodgers, PhD
Organizing Committee
•Scott Fritz, SPTS
•Effie Malley, formerly of AAS
•Maureen Underwood, SPTS
•Peter Wyman, U. of Rochester Medical Center
•Phil Rodgers, AFSP
Expanding the Youth Suicide Prevention Paradigm: Establishing and Promoting the Importance of Upstream Suicide Prevention Approaches
Expert meeting held at the 45th Annual Conference of the American Association of Suicidology, April 18, 2012, Baltimore, MD.
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U.S. Suicide Rate for 1999-2009 by Age Ra
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Can a suicide that occurs here
Have been prevented here?
Age
Rate
per
100
,000
U.S. Suicide Rate for Years 1999-2009 by Age Group
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1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Age 5-9 Age 10-14 Age 15-19 Age 20-24
The IOM report supports a Mental Health Intervention Spectrum
O’Connell, Boat, & Warner (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People. Washington, D.C.: The National Academies Press.
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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24
U.S. Suicide Rate for 1999-2009 by Age Ra
te p
er 1
00,0
00 Can a suicide that
could occur here
Be prevented here?
Age
Today’s Presenter
Dennis D. Embry, PhD
Acting for Early, Upstream Suicide Prevention
Dennis D. Embry, Ph.D. President/Senior Scientist
PAXIS Institute
Research to Practice Webinar
A recent webinar experience on the topic
Is this early prevention?
Is this early prevention?
Is this early prevention?
Is this early prevention?
Thinking way upstream Really?
What if we started here with early
suicide prevention?
Thinking way upstream What might be the early malleable predictors? Could we actually change those predictors easily and reliably? And what else might change as a consequence of the prevention or protection strategies.
risk factors during development from early childhood to adolescence
Psychiatric problems in childhood and/or adolescence, including depression
Child and/or adolescent externalizing disorders
Childhood adversity (especially with the above)
Low self-esteem (self-efficacy)
Aggressive or delinquent behavior
Prax Kinderpsychol Kinderpsychiatr. 2012;61(1):32-49.
First Grade
When are these risk factors most universally detectable?
Psychiatric problems in childhood and/or adolescence, including depression
Child and/or adolescent externalizing disorders
Childhood adversity (especially with the above)
Low self-esteem (self-efficacy)
Aggressive or delinquent behavior
Thinking midstream What might be the midstream malleable predictors? • Early and current smoking • Dose response, MORE smoking =
MORE suicide risk, controlling for other variables
• Smoking affects monoamine oxidase (MAO), which increases suicide risk
Breslau et al. Arch Gen Psychiatry 2012;():1-8
Adolescence
Hypothesis #1 If we can reduce early aggressive or ADHD-like behavior and victimization by peers in First Grade, that might be the first step toward the long-term prevention of suicide.
Golly, almost every teacher would like it if there was more time to teach and for kids to learn.
Hypothesis #1 If we can reduce early aggressive or ADHD-like behavior and victimization by peers in First Grade, that might be the first step toward the long-term prevention of suicide.
Let’s see if we can reduce disturbing,
distracting, and inattentive
behaviors in classrooms — as
our first test.
Montrose Wolf Harriet Barrish
Muriel Saunders invented the Game in 1967 as a first-year, 4th grade teacher.
Published as a study in 1969.
Longitudinal Johns Hopkins Studies of GBG
Every child
rated by teachers
Kindergarden First Grade
GBG
NO GBG
Tested in 41 first- and second-grade classrooms within
19 elementary schools with two
consecutive groups of first
graders.
Young Adulthood Follow Up
Age 19-21
Age 26
Age 30
Age 19-21
Age 26
Age 30
Purpose: To find out if GBG
affected their adult lives.
No More GBG
No GBG
Grades 2 thru 12 Follow Up
Purpose: To find out if GBG affected their
adolescent lives.
By the early 1990s, multiple
studies including this
randomized one proved that
GBG reduced the early predictive behaviors.
Wow! In 1998, Drs. Kellam and Anthony showed that GBG reduced tobacco initiation—one of the middle predictors.
Tobacco Initiation (Age of First Use)
So now, let’s see if GBG affects suicide indicators among youth and young adults.
Wilcox, H. C., Kellam, S., Brown, C. H., Poduska, J., Ialongo, N., Wang, W., & Anthony, J. (2008). The impact of two universal randomized first- and second-grade classroom interventions on young
adult suicide ideation and attempts. Drug & Alcohol Dependence, 95(Suppl 1), 60-73.
So now, let’s see if GBG affects suicide indicators among youth and young adults.
Wilcox, H. C., Kellam, S., Brown, C. H., Poduska, J., Ialongo, N., Wang, W., & Anthony, J. (2008). The impact of two universal randomized first- and second-grade classroom interventions on young
adult suicide ideation and attempts. Drug & Alcohol Dependence, 95(Suppl 1), 60-73.
Timeline of Benefits…
More time for teaching and learning
First Month
Less stress for Staff & Students
Better Attendance
Better Academics
Less Illness
Fewer Service Needs
Fewer Referrals
First Year
Happier Families
Less Vandalism
2nd & 3rd Years ADHD
Averted Oppositional
Defiance Averted Special Education
Averted
5-15 Years No
Tobacco Less
Alcohol Less Conduct
Disorders Less
Depression Less Crime,
Violence, Suicide High School Grad &
University
How is this accomplished?
By teams with group based reward— during any regular teaching & learning activity
The Blue Team The Red Team The Yellow Team
The Team Aim: to Win
Ms. Dion Jan 23
Blue Red
Yellow 20 40
20 60
Spleems are counted and marked with neutral tone for the team, not the individual child.
Teams who have 3 or fewer Spleems win.
Winning teams earn a “Granny’s Wacky Prize”. Team having 4 or more Spleems lose that game.
PAX Minutes = winning teams x minutes played.
e.g., disturbing behaviors
Today’s Discussants
Morton M. Silverman, MD Sheppard G. Kellam, MD
Today’s Discussants
Morton M. Silverman, MD Sheppard G. Kellam, MD
Thank you!
www.sprc.org
Xan Young, MPH SPRC Training Institute, Project Director xyoung@edc.org 202-572-3728
Dominique Lieu SPRC Training Institute, Training Specialist dlieu@edc.org 617-618-2984