Overview
Grief & LossWhat grief looks likeWhat is normalDos and Don'ts Activities
○ In class demo
Overview
SuicideRates & patternsProtective & risk factorsWorking with suicidal studentsRisk AssessmentCrisis managementPrevention
Resources
GRIEF AND LOSS
What grief looks like
Varies from child to child and across dev stages
PreschoolTend to see death as temporary and
reversibleCartoons portrayal of death
Primary/intermediate agedMore advanced view of death, though still
do not think it could happen to them or anyone they know
Normal Responses Sadness immediately following death, as well as on
and off over long period of timeUnexpected moments of sadness are typical
Anger In the form of boisterous play, nightmares, irritability Often directed towards surviving family members
RegressingTypical with death of a parent Infantile behavior, demand food, attention and cuddling, baby
talk Guilt
Younger children especially feel like they were the cause of death, due to their egocentric world view
DOs and DON’Ts with Grieving Students
DO listen. DO follow routines.
Routines provide a sense of safety which is very comforting to the grieving student.
DO set limits. Just because students are grieving, doesn’t
mean that the rules do not apply. DO NOT suggest that the student has grieved long enough.
Dos and Don’ts DO NOT indicate that the student should
get over it and move on. DO NOT act as if nothing has happened. DO NOT say things like:
- “It could be worse. You still have one brother.” - “I know how you feel.” - “You’ll be stronger because of this.”
DO NOT expect the student to complete all assignments on a timely basis.
Activities for children Drawing
Family before/after loss Small groups Letter writing Puppet shows Balloon activity
All ages TR Grief DVD
http://trevorromain.com/products-page/dvd/death-dvd/
Activities for adolescents Journaling/letter writing
Prompts: ○ The thing that makes me feel the saddest is .....○ If I could talk to the person who died I would ask….○ Since the death my family doesn’t….
Coping/relaxation techniquesSailboat breathing
Role plays Small groups Drawing/memory books TR DVD
Activities for teens
Journaling Letter writing Reading Memory book/collage Teaching relaxation/coping strategies Small groups
Discussion
For what populations to do foresee traditional responses to grief being inappropriate or ineffective?What would you do instead?
Balloon Activity
Think of a significant person in your life that has passed away
If you could send them a message today, what would it say?
Youth Suicide
Rates & Patterns
Many youth suicides occur between ages 12-14
Incidence increases again in late teens Girls are more likely to have suicidal
ideation Boys ideation more often results in
completed suicide Highest rates among Native American
youth
Risk Factors Personal characteristics
Psychopathology, namely depression○ 90% of youth suicide victims have at least one
major psychiatric disorder
Prior attempts○ Strong predictor of completed suicide
LGBTQ Personality factors
○ Poor interpersonal problem solving linked with risk of suicidal behavior
Risk Factors cont.
Family characteristicsHistory of suicidal behaviorParental psychopathology
Adverse life circumstancesStressful life eventsPhysical abuse
Socioenvirnomental FactorsSchool and work problemsAccess to firearmsSuicide contagion
Protective Factors
Family cohesion Religiosity Restricting access to means Peer support Pets Sound emotional regulation
What to do when faced with a suicidal student.. Try to stay calm and be supportive
Student is feeling hopeless and stressed, your reaction is pivotal
Take a nonjudgmental stanceMoral reasoning is not appropriate
Encouraging self-disclosurePainful for student to share Helps with lethality assessment Empowering students, emphasizing their worth, and
making them feeling heard and respected are key elements Share with the student your responsibility to keep
them safe and your next steps to do so
Things to consider when assessing risk Has the student imagined the reaction of
others to his/her death? Has the student made any final
arrangements? What is the method of planned use?
Does he/she have access to the means? Support system? Any reasons inhibiting suicide?
Risk Assessment
Be direct and unambiguous in asking questions i.e. Are you considering harming yourself? If
so, how? Assess lethality of method and identify a
course of action Determine if student has a thorough
understanding of the finality of death
Risk Assessment cont. Outline the steps that will be taken to help
the student Keep detailed notes Gather information from parents and
teachers Take necessary action
Call parentsLaw enforcementSocial workerNo Harm contract
No harm/safety contracts Some debate regarding their use
Counselors choice to implementTend to emphasize what students won’t do,
rather than what they will doFalse sense of security
Alternatives might look like encouraging student to agree to meet weekly with you from now on
Discussion
Thoughts on no harm contracts?Given that they are neither contractual nor
ensure student safety
What to NOT do… Do not attempt to provide in-depth
counseling regarding their issuesThis cannot take place during height of suicidal
crisis Do not normalize suicide
It is one option, but there are stressing that others exist as well
Do not do the assessment aloneObservations made by multiple professionals are
more comprehensiveConsultation is key!
Discussion
How will consultation look differently at each our your internship sites?
What barriers exist at these levels?
Crisis Management/Postvention
Telephone network should be in place to notify staff and arrange staff meeting prior to following school day
Statement given to staff Esp important for contact with media
Upset students have a place to go outside of class MH resources/referrals in place for students and
families Memorial service held off school grounds
Suggested for deaths of any kind Contacting family and offer support
Prevention
Coping and Support Training (CAST)Empirically supported 12 session peer group
intervention for HS students Effective with students at-risk for drop
out and screened as suicide vulnerableOver $400 for curriculum package
Communication with adminIdeally, district wide procedures
Participation in crisis teams
Prevention cont.
Faculty trainingTeachers are often the first to know/suspect
Parent educationProtective factorsWarning signs
Classroom presentations re: your role as school counselor
Resources
For information/resources on grief & loss: Dougy Center
http://www.dougy.org/ Hospice of the Valley
http://www.hov.org/teen_grief_program.aspx American Hospice
http://www.americanhospice.org/articles-mainmenu-8/grieving-children-
mainmenu-12
American Academy of Child and Adolescent Psychiatry http://www.aacap.org/cs/root/facts_for_families/children_and_grief
Camp Willie http://www.campfireusasnohomish.org/campwillie.htm
Trevor Romain DVD – Grades 2-8 http://trevorromain.com/products-page/dvd/death-dvd/
Resources cont.
Suicide Prevention Efforts Youth Suicide Prevention Program
http://www.yspp.org/ High school based prevention: CAST
http://www.reconnectingyouth.com/cast/
Responding to school crisis National Child Traumatic Stress Network
http://www.nctsn.org/resources/audiences/school-personnel/crisis-situation
UCLA Center for Mental Health in Schools http://smhp.psych.ucla.edu/
National Institute for Trauma and Loss in Children http://www.tlcinstitute.org/crisisint.html
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