Suicidal Ideation, Attempts,

and Completion in
Elementary Aged Children:
What can you do to intervene?
BY REBECCAANNE EDELMAN
WAKE FOREST UNIVERSITY
CNS 760
Part 1: Define the problem

 Currently, there is a lack of

knowledge, conversation, and ability
to identify, treat, and prevent suicidal
ideation in elementary school aged
students.
 Part 1
cont.

Prevalence
 Study 1: Suicide in Elementary School-Aged Children and
Early Adolescents - Klingenbjerg
 What this study tells us:
 Suicide is a leading cause of death in US elementary school-aged
children.
 The highest affected group is African American males.
 This study supports a need for suicide prevention strategies to be
more prevalent in school settings at younger ages.
 There were 699 suicides between ages 5-14 from 2003-2012. 1/3 of
these students had a diagnosed mental illness; 59% had ADD/ADHD,
29% had depression.

(Klingenbjerg, 2017)
 Part 1
cont.

“ “This study draws attention to a group of

youth who may be at higher risk for suicide
and may benefit from targeted prevention
strategies. Healthcare providers who care for
elementary school students with ADD/ADHD
as well as black youth need to be aware of
the rise in suicide rates and careful screening
of these at-risk patients is indicated.”
”
(KLINGENBJERG, 2017)
 Part 1
cont.

Prevalence
 Study 2: Suicide Trends Among Elementary School–Aged Children in
the United States From 1993 to 2012 – Bridge 2015
 What this study tells us:
 Between 1993 and 2012, a total of 657 children aged 5 to 11 years died by
suicide in the United States, a mean of nearly 33 children per year, with 553
(84%) who were boys and 104 (16%) who were girls. African American Males
experiencing the highest rate.
 What factors might influence increase in suicide rates among African
American children:
 Exposure to violence.
 Less likely to seek help for depression, suicidal ideation, and suicide
attempts.
 Reaching puberty at a younger age.

(Bridge, 2015)
 Part 1
cont.

“ Black children may experience disproportionate

exposure to violence and traumatic stress and
aggressive school discipline. Black children are also
more likely to experience an early onset of puberty,

”
which increases the risk of suicide, most likely owing
to the greater liability to depression and impulsive
aggression. Black youth are also less likely to seek
help for depression, suicidal ideation, and suicide
attempts.”
(BRIDGE, 2015)
Part 1
cont.
 Part 1
cont.

Prevalence
 Study 3: The Effectiveness of School-Based Mental Health Services for
Elementary-Aged Children: A Metanalysis – Sanchez 2018
 What this study tells us:
 School personnel, teachers, volunteers, etc. are the front line of mental health care
and implementation for our youth.
 Teachers provide a majority of MH services where school counselors and other
mental health school based workers only provide 2% of care.
 “Curriculum-driven social emotional learning services and pullout mental health
programs go beyond the primary role of teachers and accordingly might be more
difficult to implement. Indeed, teachers might need additional support and
resources when mental health services extend them beyond their primary roles and
require task shifting.

(Sanchez, 2018)
 Part 1
cont.

“ “…integration of mental health

services into the normal academic
curriculum significantly improved
the effectiveness of school-based
services.
(SANCHEZ, 2018)
”
 Part 1

Risk Factors
cont.

At Risk
Demographics
African American students
“experience disproportionate
exposure to violence and
traumatic stress and aggressive
school discipline. Black children
are also more likely to
experience an early onset of
puberty, which increases the
risk of suicide, most likely owing
to the greater liability to
depression and impulsive
aggression. Black youth are
also less likely to seek help for
depression, suicidal ideation,
and suicide attempts.”
Preparing Parents
and School Staff
Properly training teachers to
assess Mental Health needs in
the classroom: While data
supports in classroom strategies
and care it is imperative that
teachers who assess these
needs have proper training in
doing such. I.e. SOS or Mental
Health First Aid training.
Being Aware of
the Child’s
Experiences
A high percentage of students
in these numbers were
diagnosed with mental illness or
exposed to traumatic events
before their death by suicide.

(Mcwhirter, 2016)
 Part 1

Signs of Suicidal Thoughts

cont.

 Loneliness
 Depression
 Exposure to violence
 Anger Control
 Negative Self-image
 Children and adolescents may say any of the following or similar statements:
 “I don’t see how I can go on.”
 “I wish I were dead.”
 “There’s only one way out of my problems.”
 “I won’t be around much longer.”
 “I’m tired of living.”
 “You’ll be sorry you treated me this way.”
 “Pretty soon my troubles will be over.
(Mcwhirter, 2016, pg. 255)
 Part 1

Could Suicidal Ideations Really Happen cont.

so Young? YES.
News Stories from Around the Country

Third-grader 9-year-old Sixth Grader

Gabriel Taye
Two days after being attacked and
bullied in the bathroom Gabriel Taye
hung himself with a necktie in his
bedroom.
(Ali ,2017)
A’Layah
Her parents stated she experienced
bullying so intense that they believe
it contributed to her suicide.
(Broda, 2018)
Ronin
Ronin died by suicide after
schoolmates had bullied him for
being a cheerleader.
(ABC7, 2014)
Part 2: What Can YOU Do?

 Identifyingand learning best practices in

preventing and intervening with childhood
suicide at home and school.
 Part 2
cont.

Intervention 1: School Based Suicide Prevention

Program
 Goals: Incorporate parents/guardians, school officials, students, and
the community into the conversation to prevent and identify
suicidal ideation in students at school.
 Why his program: These programs; include group, psychoeducation,
and trainings. They target members of the school community and
encourage them to be more familiar with “signs and symptoms of
suicide so they can recognize them in themselves and in others.”
(Katz, 2013).
 Part 2
cont.

“ These programs are

designed to facilitate

”
self‐disclosure, especially to
other peers.
(KATZ, 2013)
 Part 2
cont.

Intervention 2: SOS Program/Peer Guidance

 Goals: Incorporate students into the conversation to prevent and

identify suicidal ideation, risk factors, and signs in peers.
 Why his program: SOS is a peer intervention-based program that
promotes a better understanding of suicidal intent and associated
behaviors. Through this training program, students are taught to
identify overt and covert signs of suicide risk. They are subsequently
trained to seek adult assistance from a teacher, administrator,
parental, or community member for assistance and help. This
program is well researched and in two separate random control
studies has statistically significant decrease in suicide attempts in
those completing the program.

(Schilling, 2015)
 Part 2
cont.

“ This program promotes the idea that it

is okay to seek help when experiencing
mental and emotional distress. The SOS

”
program incorporates education,
awareness, and screening tools and
strategies.
(KATZ, 2013)
 Part 2
cont.

Intervention 3: Screening

 Goals: Encouraging those who you may believe to be

experiencing suicidal ideations to open up and seek aid.
 Why his program: The method of screening involves
question used to ask about and aid those who may be
showing signs of suicidal ideations these tools and
question show significant success with older elementary
students.

(Katz, 2015)
 Part 2
cont.

“ An example of a few screening questions would be:

1) In the past few weeks, have you felt that you or
your family would be better off if you were dead?
2) In the past few weeks, have you wished you were

”
dead?
3) In the past week, have you been having thoughts
about killing yourself?
4) Have you ever tried to kill yourself?
(HOROWITZ, 2014)
 Part 2
cont.

Intervention 4: Gate Keeper Training/ QPR

 Goals: Provide psychoeducation and training to

empower all people to play a more active role in their
communities mental health.
 Why his program: A Gatekeeper is defined as anyone who could
help someone who is suicidal. (Katz, 2013) Question, Persuade, Refer
(QPR) is an easily accessible gatekeeping method that can be used
on all age groups. QPR is an hour-long training session that attempts
to “increase knowledge and dispel myths about suicide and suicidal
behaviors, including warning signs and available resources.” (Horowitz,
2014)
 Part 2
cont.

“ The basic four steps of QPR are to “(1) to recognize

suicide warning signs, (2) training all school staff in QPR,
(3) training school counselors to properly assess at‐risk
students, and (4) organizing access to professional

”
assessment and treatment” (Katz, 2013). These four
steps and hour session allow for increased awareness
among school staff, students, and members off the
community to better recognize signs of suicide.

(KATZ, 2014)
 Part 2
cont.

QPR Training
can be found
at the below
like and
completed in
only one hour.
HTTPS://QPRINSTITUTE.COM/I
NDIVIDUAL-TRAINING
 Part 2
cont.

“
Early detection can be managed conveniently and
inexpensively through group screening devices and suicide
threat can also be detected through gatekeeper training
programs. In these programs, adults who come into contact
with youth in school on a daily basis are trained to identify

”
suicidal youth because suicidal children and adolescents are
often not identified.
(MCWHIRTER, 2016, PG, 255)
Part 3: The Plan
A PLAN FOR YOUTH AT RISK WITH SUICIDAL IDEATIONS.
 Part 3
cont.

Education for Adults: Parent/Guardian

Awareness Event
 Host a night at start of school year dictated to the emotional development of
elementary students led by the School Counselors and administration.
 The school will incorporate different warning signs, emotions, and risk factors for
suicidal thoughts, actions, or emotions into the radar of adults involved in the
students lives.
 During the suicide awareness portion of the parent awareness evening, parents will be
given a questionnaire that will measure their current knowledge of signs, responses to
child showing suicide signs, attitudes towards the topic of suicide, and steps they can
take to help students in crisis.
 After this assessment, they will watch the movie Youth Suicide: Recognizing the Signs.
 Following the movie, they will partake in a group discussion lead by the school
counselor. In this talk the counselor will provide honest discussion about suicide
statistics in elementary students, open conversation with question and answer, and
provide resources and reading materials pertinent for the school’s environment.

(Mental Health Screening, "SOS: Signs of Suicide")

 Part 3
cont.

Classroom Prevention Activity: SAFE HAVEN

 Objective: Students will be able to identify risk factors and suicide warning signs
in their peers. They will be able to help their peers when they might feel
overwhelmed, sad, or hopeless.
 Age: 5th and 6th grade students
 Time: 1 hours
 Process:
 Students should be separated into small groups with access to the internet. They are
instructed that their goal is to “help classmates who might be feeling overwhelmed,
depressed, or hopeless, we’re going to lay some of the groundwork needed to create
a peer counseling group that would provide a safe and supportive place for youth to
get help.
 First, think of a name for your group.
 Students will begin research to gather information about suicide that will help create
educational materials for a poster that could be used to get the message out about
your new support group. Topics should include: Statistics on elementary suicide, Who is
at risk, List of warning signs, What to do if you suspect someone is considering suicide,
Where to get help.”
 These projects will then be shared with the class and displayed throughout the school
for others to see.

(American School Counselor Association, National Association of School Psychologists, & The Trevor Project)
Part 3
cont.
 Part 3
cont.

School Counselor Created Groups

 Peer Counseling Group: SC will develop a group that meets biweekly
and is open to all students. This group will address the needs of students
who feel overwhelmed, depressed, or hopeless. This group will also
connect students with similar experiences and feelings to show they are
not isolated and alone.
 Large Group Guidance: For SC’s who are in the rotation create a large
group guidance lesson surrounding hopelessness and suicidal ideation.
Students will be able to address and learn about how they can
intervene with a peer that is experiencing these thoughts and feelings.
Also, what they can do if they are feeling this way.
(American School Counselor Association, National Association of School Psychologists, & The Trevor Project)
 Part 3
cont.
Intervention Plan

 What is it?

 An intervention is a reality-based process that is intended to protect

an individual from harm. In this case, an elementary student.

 What types?

 The main form of intervention is Gate Keeper Training for Staff, Class
Parents, an PTA. SC will lead Gate Keeper Training for members of
the school community that are in regular contact with school
students and staff. They will also have the below strategies to follow
as implemented by the county policy.

("Suicide Prevention and Intervention Resources", 2016)

 Part 3

Intervention Plan
cont.

Immediate Steps Follow Up

 Student will not be left alone. This  SC will confirm students mental
means freeing a staff member who is health assessment including
properly trained in this crisis response obtaining appropriate verification.
situation to insure safety of a student.
 Trained staff will have to identify
Staff members will provide the
what types of accommodations this
student with needed supports.
student may need to attend school
 A parent or guardian MUST be in a safe and supported manner. This
notified ASAP. includes building a support team
with the student made up of people
 IF suicidal ideation is present, as
in the school they trust.
assessed by the school counselor or
other trained school staff, the
parents will be referred to a mental
health assessment.
("Suicide Prevention and Intervention Resources", 2016)
 Part 3
cont.
Intervention Plan: Is it working?

 The most effective way to assess if this plan is effective is to address the
population it is geared for: the students.
 By administering a beginning of year, mid-year, and end of year survey
that addresses topics of suicide, ideation, support systems, crisis
intervention and comfortableness helping themselves and those
experiencing these situations, school administrators will be able to fully
assess the students need in this area.
 A similar survey will be given to parents, teachers, staff, and frequent
volunteers asking if they feel comfortable addressing the symptoms of
suicidal thought in their students or other children. They will also attest
to access to resources and knowledge on what to do in these
situations.
 Works Cited
 ABC 7. (2014, December 05). 12-year-old boy kills himself after being bullied for being a cheerleader. Retrieved from http://abc7chicago.com/society/12-year-old-
boy-kills-himself-after-being-bullied-for-being-a-cheerleader/424020/
 Ali, S. (2017, May 12). School releases video showing bullying of 8-year-old who killed himself. Retrieved from https://www.nbcnews.com/news/us-news/8-year-old-s-
suicide-leads-cincinnati-school-release-video-n758896
 American School Counselor Association, National Association of School Psychologists, & The Trevor Project. Model School District Policy on Suicide Prevention: Model
Language, Commentary, and Resources. American Foundation for Suicide Prevention. Retrieved from https://afsp.org/wp-content/uploads/2016/01/Model-
Policy_FINAL.pdf.
 Bridge, J. A., Asti, L., Horowitz, L. M., Greenhouse, J. B., Fontanella, C. A., Sheftall, A. H., . . . Campo, J. V. (2015). Suicide Trends Among Elementary School–Aged
Children in the United States From 1993 to 2012. JAMA Pediatrics, 169(7), 673. doi:10.1001/jamapediatrics.2015.0465
 Broda, N. (2018, March 17). In wake of 9-year-old's suicide, Waterford father urges other parents to talk with children about how they are feeling and what they are
thinking. Retrieved from http://www.theoaklandpress.com/general-news/20180317/in-wake-of-9-year-olds-suicide-waterford-father-urges-other-parents-to-talk-with-
children-about-how-they-are-feeling-and-what-they-are-thinking
 Horowitz, L. M. (2014). Ask suicide-screening questions: Feasibility and perspectives on ED screening. PsycEXTRA Dataset. doi:10.1037/e530122014-001
 Katz, C. , Bolton, S. , Katz, L. Y., Isaak, C. , Tilston‐Jones, T. , Sareen, J. and , (2013), A Systematic Review of School-Based Suicide Prevention Programs. Depress Anxiety,
30: 1030-1045. doi:10.1002/da.22114
 Klingenbjerg, P. M. (2017). Suicide in Elementary School-Aged Children and Early Adolescents. The Journal of Emergency Medicine, 52(1), 125.
doi:10.1016/j.jemermed.2016.11.037
 Mcwhirter, R. (2016). At risk youth. Cengage Learning.
 Mental Health Screening. SOS: Signs of Suicide. Mentalhealthscreening.org. doi:10.3897/bdj.4.e7720.figure2f
 Sanchez, A. L., Cornacchio, D., Poznanski, B., Golik, A. M., Chou, T., & Comer, J. S. (2018, March). The Effectiveness of School-Based Mental Health Services for
Elementary-Aged Children: A Meta-Analysis. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/29496124
 Schilling, E. A., Aseltine, R. H., & James, A. (2015). The SOS Suicide Prevention Program: Further Evidence of Efficacy and Effectiveness. Prevention Science,17(2), 157-
166. doi:10.1007/s11121-015-0594-3
 Suicide Prevention and Intervention Resources. (2016). : PA Youth Suicide Prevention Initiative. Retrieved from http://www.oleyvalleysd.org/wp-
content/uploads/2011/07/Suicide-Prevention-Resources.pdf