PRELIMINARY

(Published July 2018)

Interim Recommendations from the Northeast

Ohio Youth Health Survey, Spring 2018

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Contents
Preliminary Recommended Suicide Prevention Strategies ................................................................ 2
Strategy 1: Develop a protocol to help students at risk of suicide ................................................ 2
Strategy 2: Develop a protocol to respond safely to a suicide death ............................................ 3
Strategy 3: Identify students who are at risk of suicide .................................................................. 4
Strategy 4: Integrate suicide awareness & prevention into curriculum for staff, students, and
families .............................................................................................................................................. 6
Strategy 5: Enhance protective factors ........................................................................................... 7
Supplemental Information on Screening ...........................................................................................10
Definitions ...........................................................................................................................................13
Abbreviations ......................................................................................................................................14
Additional Resources ..........................................................................................................................15
References ...........................................................................................................................................17

This document contains preliminary recommendations and has been

prepared using initial analyses of data gathered through the Northeast
Ohio Youth Health Survey. Some of the recommendations may evolve as
further analyses are completed.

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Preliminary Recommended Suicide Prevention Strategies
The most effective way to prevent suicide is to use a number of complementary strategies.1,2
Rather than trying to implement all initiatives at the same time, school-based suicide prevention
programs can be built on a foundation that responds to the most serious issues faced by
students and schools: a student at high risk of suicide and a death by suicide of a student (which
may put other students at risk). The five strategies outlined in this document include: 1)
developing a strategy to help students at risk of suicide, 2) developing a protocol to respond
safely to a suicide death, 3) identifying students who are at risk of suicide, 4) integrating suicide
awareness & prevention into curriculum for staff, students, and families, and 5) enhancing
protective factors.
It is important to remember that the field of suicide prevention is evolving as ongoing research
reveals best practices. The following recommendations are based on the best available evidence,
particularly CDC’s Preventing Suicide: A Technical Package of Policy, Program, and Practices and
Substance Abuse and Mental Health Services Administration’s (SAMHSA) Preventing Suicide: A
Toolkit for High Schools. Both packages provide a core set of strategies to achieve and sustain
substantial reduction in suicide, helping communities sharpen their focus on prevention activities
with the greatest potential to prevent suicide.1,2

Ideally, two suicide prevention strategies that every school will put into place are: 1)
protocols for helping students at risk of suicide, and 2) protocols for responding to a
suicide death to help prevent additional suicides.
Strategy 1: Develop a protocol to help students at risk of suicide
It is critical to implement protocols for responding to students at risk of suicide before carrying
out strategies to help identify students at risk of suicide. Identification of students who are at risk
of suicide is more likely to prevent suicide when procedures are in place to ensure these
students receive appropriate services. Only after creating these response procedures is a school
ready to employ other strategies to prevent suicide.

By developing a protocol to help students at risk of suicide, school communities protect student
safety and improve students’ access to behavioral health services. For detailed guidance in
creating this protocol, please see Chapter 2 of the SAMHSA Suicide Prevention Toolkit. The
toolkit includes practical instruments for school leaders including: questions for mental health
providers, suicide risk assessment resources, information sheets for staff and families, guidelines
for student referrals, and more.

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Steps to develop protocols to help students at risk of suicide include:
1. Convene a group to create protocols for helping students at risk of suicide
2. Identify the suicide risk response coordinator
3. Identify and involve mental health service providers to whom students can be referred
4. Develop a protocol to help students at risk for suicide
5. Develop a protocol for responding to a suicide attempt in the school or on the school campus
6. Plan for managing a student’s return to school
7. Train staff on protocols
8. Review and update protocols periodically

Strategy 2: Develop a protocol to respond safely to a suicide death

The death of any young person is a tragic event. Suicide can have a profound effect on a school
community, leaving students and staff vulnerable to depression and suicide contagion. By
organizing a protocol to respond to the suicide death of a student, schools are better prepared
to help students and staff cope—both short- and long-term—with the emotional repercussions
of a suicide. In the average Ohio high school classroom, three students have attempted suicide in
the past year.3 Developing a plan for how to respond to a student’s suicide is an unfortunate
necessity for modern American schools. Ideally, this planning takes place before tragedy strikes.
Effective response to a student’s suicide can also avoid the rare but real phenomenon of suicide
contagion. Teens are more susceptible to suicide contagion than other age groups.4 Groups of
related suicides, called suicide clusters, represent approximately 1–2 percent of all adolescent
suicides in the United States.5 While some clusters include students from the same school, it is
not necessary for young people to have direct contact with one another to become part of a
suicide cluster. A suicide by a celebrity or role model can raise vulnerable adolescents’ risk for
suicide, as can widely publicized suicides by other adolescents.2
How a school responds to a suicide, as well as the way in which the media reports on a suicide,
can help prevent—or promote—suicide contagion. Unintentionally glamorizing a youth who died
by suicide, suggesting the death was caused by a single problem (such as bullying or breaking up
with a significant other), or providing detailed descriptions of how a youth died can raise suicide
risk among other vulnerable young people. It is important to work with media to ensure that the
public’s right to know is balanced with the damage that inappropriate reporting can cause.
School campuses need to be managed for safety. Press and other outsiders should not be
allowed open access to school campuses or students.
In the wake of a suicide, active monitoring of types of information (and misinformation) being
shared by students on social media can help identify students in need of emotional support and
mitigate the harmful effects of suicide. Active monitoring involves visiting online condolence
pages, newspaper and media sites (particularly those allowing readers’ comments), and social
networking pages regularly to watch for suicide-related content, messages of distress, and

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misinformation. Potential responses to online content include posting comments that dispel
rumors, reinforcing important information such as the connection between mental illness and
suicide, and offering links to suicide prevention and mental health resources.
School districts may consider taking steps to develop a protocol for how they will respond to a
student’s suicide. For detailed guidance in creating this protocol, please see Chapter 3 of the
SAMHSA Suicide Prevention Toolkit. The toolkit includes practical instruments for school leaders
including sample announcements, letters to families, and scripts for office staff; guidelines for
working with decedent’s family, notifying staff, memorialization, and working with the media;
resources for postvention consultation; and checklists to facilitate development of immediate
and long-term response protocols. For additional information about initiating a coordinated
response in response to a suicide, please see the recently released After a Suicide: A Toolkit for
Schools, Second Edition.

Steps to develop a protocol for responding to a suicide:

1. Convene a group to create the protocol
2. Identify community partners who can help
3. Create a protocol for your school’s immediate response to a suicide
4. Include the Immediate Response Protocol in your school’s crisis response plan
5. Create a protocol for the long-term response to a suicide
6. Train staff on protocols
7. Review and update protocols periodically

Strategy 3: Identify students who are at risk of suicide

Suicide is a multifactorial problem—supporting students at risk of suicide requires a
multifactorial approach. No single strategy will identify all students at risk of suicide. Schools may
consider incorporating multiple tactics to identify and support people at increased risk of suicide.
Key decision makers can review potential approaches and implement strategies that make sense
for their community. To learn from other organizations’ experiences of evidence-based
programs, please see CDC’s Suicide Prevention Technical Package.
Identify Early Warning Signs
Staff, students, and families may be educated on the recognition and response to warning signs
of suicide. Warning signs are signals that someone may be in danger of suicide, either
immediately or in the near future.
Warning Signs and How to Help
When to seek immediate help
School staff, families, and students should seek immediate help from a mental health provider,
911 or emergency response, or the National Suicide Prevention Lifeline (1-800-273-8255) if they
hear or see any of these critical behaviors:

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 > Student threatening to hurt or kill him or herself
> Student talks of wanting to hurt or kill him or herself
> Student looking for ways to kill themselves (e.g. seeking access to pills, weapons, other
means)
> Student talking or writing about death, dying, or suicide, when these actions are out of
the ordinary for the person
When to make a referral
School staff, students, and families should seek help from a mental health provider or the
National Suicide Prevention Lifeline (1-800-273-8255) for a referral if they hear or see anyone
exhibiting one or more of the following warning signs of suicide6:

> Feelings of hopelessness > Rage, uncontrolled anger, expressions

> Anxiety, agitation, trouble sleeping, or
sleeping all of the time
> Feelings of being trapped – like there’s
no way out
> Increased alcohol and/or drug use
> Dramatic mood changes
of wanting or seeking revenge
> Reckless behavior or more risky
activities, seemingly without thinking
> Giving away prized possessions
> Withdrawal from friends, family, and
community

Formal training on identification of and response to warning signs of suicide often occurs
through prevention initiatives like gatekeeper training programs.
Gatekeeper training programs
Gatekeeper training programs are designed to help adults who work with adolescents identify
when other students are at-risk, understand how to facilitate help, and take action to support
students so that there is a reduced opportunity—and perceived need—for suicidal behavior.7-10
Two of the most utilized gatekeeper training programs are Mental Health First Aid and Question,
Persuade, Refer (QPR). Peer support programs work in the same way as gatekeeper training
programs, using peers as gatekeepers, rather than school staff.

Steps to develop protocols to identify students at risk of suicide include:

1. Convene a group to plan incorporation of a gatekeeper training program into prevention
activities
2. Secure support from administrators and staff for gatekeeper training program to teach early
warning signs
3. Select a gatekeeper program to use for students and staff in your school
4. Identify and involve mental health service providers to whom students can be referred
5. Engage parents in gatekeeper training and recognizing early warning signs
6. Implement gatekeeper training into curriculum and repeat annually
7. Train staff, students, and families to identify suicide risk factors and warning signs among
students and to take appropriate action

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Strategy 4: Integrate suicide awareness & prevention into curriculum for staff,
students, and families
Suicide awareness and prevention may be incorporated into curricula for students and
educational opportunities for school staff and families in all school districts.
Staff
Schools may consider making staff aware that suicide poses a risk to their students and that the
school and school district are taking steps to reduce this risk. All staff may be trained to
recognize and respond to the warning signs of suicide in young people. Many schools choose to
train staff through “gatekeeper training”, which teaches and empowers staff to identify
individuals who may be at risk for suicide, verify this risk by talking with the individual, and refer
the individual to mental health services that will help reduce their risk.3 In addition to trainings
provided to all staff, appropriate mental health professionals should be qualified to assess, refer,
and follow-up with students identified as at risk of suicide.3

Students
Studies show that most youth who are suicidal talk with peers about their concerns (rather than
adults) but as few as 25% of peer confidants tell an adult about their suicidal peer.8 Student
programs that address suicide can play a significant role in reducing risk for suicide when used in
conjunction with other strategies, such as creation of response protocols and staff training. Key
stakeholders among your school community’s leaders and behavioral health staff may consider
reviewing the types of student suicide prevention programs to determine what type(s) of
student program(s) best fit the needs of your school district.
Types of Student Suicide Prevention Programs:
1. Curricula for all students
> Provide information about suicide prevention
> Promote positive attitudes
> Increase students’ ability to recognize if they or their peers are at risk for suicide
> Encourage students to seek help for themselves or their peers
2. Skill building programs for at-risk students
> Help protect at-risk students from suicide by building their coping, problem-solving, and
cognitive skills
> Address problems that can lead to suicide, such as depression and other mental health
issues, anger, and drug use
3. Peer leader programs
> Teach selected students skills needed to help students at risk
> Empower selected students so that they can take action to improve the school
environment
Families
Providing parents and families with specific suicide prevention education is important for helping
parents identify and get help for children at risk, reinforcing messages learned at school, and
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ensuring that school-based suicide prevention efforts appropriately target the needs of the
community and engage families as stakeholders.
Parents & families specifically need information about:
> The prevalence of suicide and suicide attempts among youth
> The warning signs of suicide
> How to respond when they recognize their child or another youth is at risk
> Where to turn for help in the community
There are a number of free and low-cost, evidence-based suicide prevention programs available
to schools and communities. Your decision-makers and stakeholders may consult CDC’s Suicide
Prevention Technical Package and SAMHSA’s National Registry of Evidence-based Programs and
Practices (NREPP) to find a program that meets your school community’s needs and priorities.
Please note that NREPP may not include all evidence-based programs. Programs are included in
the NREPP database in one of two ways – some intervention developers may self-nominate to
participate in the NREPP or an intervention may be identified through a literature search by
SAMHSA staff. Therefore, there may be some interventions that are not submitted to or
reviewed to be included in the NREPP.
For guidance on implementing staff-, student-, and family-level strategies, please see Chapters 4-
6 of the SAMHSA Suicide Prevention Toolkit.

Steps to integrate suicide awareness & prevention into curriculum for staff, students, and
families:
1. Convene a group to assess staff’s, students’, and families’ education, training, and outreach
needs
2. Select or develop education and outreach programs that fit the needs of your school
3. Provide all staff, students, and families with information and awareness about suicide and
the school’s role in suicide prevention
4. Integrate suicide prevention programs into other initiatives to improve behavioral health

Strategy 5: Enhance protective factors

Building positive assets in adolescents not only enhances their potential achievement, but also
protects against suicide. Teaching coping and problem-solving skills, to both students and
parents/families, is a critical component of suicide prevention. Many programs focused on social-
emotional learning and parenting/family relationships build resilience and reduce risk factors for
many behaviors related to suicide.1 To learn from other organizations’ experiences of evidence-
based programs, please see CDC’s Suicide Prevention Technical Package.

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Promote Connectedness
School leaders may consider instituting programs and initiatives into Northwest’s curricula that
promote school connectedness. School connectedness is, “the belief by students that adults and
peers in the school care about their learning as well as about them as individuals.”11 By
increasing students’ sense of connectedness to their school, positive changes to the school
climate can result in improved academic achievement and healthy behaviors among students.
Strategies for building connectedness include:11
• Providing students with the academic, emotional, and social skills necessary to be actively
engaged in school
• Using effective classroom management and teaching methods to foster a positive
learning environment
• Creating decision-making processes that facilitate student, family, and community
engagement; academic achievement; and staff empowerment
• Providing education and opportunities to enable families to be actively involved in their
children’s academic and school life
• Creating trusting and caring relationships that promote open communication among
administrators, teachers, staff, students, families, and communities
• Providing professional development and support for teachers and other school staff to
enable them to meet the diverse cognitive, emotional, and social needs of students
Systems to increase connectedness, when implemented in concert with other suicide prevention
strategies, help reduce risk of suicide, violence, bullying and substance abuse.12 Efforts to
promote safe schools and adult caring also help protect against suicidal ideation and attempts
among lesbian, gay, bisexual, and transgender youth.
Build Resilience
Resilience is a person’s ability to succeed in the face of adversity or stress. Resilient adolescents
are likely to enter adulthood with a good chance of coping well, even if they have experienced
difficult circumstances in life. A resilient adolescent has the ability to handle stress positively.

Factors associated with resilience include:

> A caring, supportive adult in one’s life
> Appealing, sociable, easygoing personality traits
> Intelligence
> Good judgment & social skills
> One or more things a person does well (talents)
> Belief in oneself and one’s ability to make decisions
> Religiosity or spirituality

There are a number of ways that adolescents can reduce stress and promote positive mental
health and resiliency. These include regular exercise and meals; avoidance of use of illegal drugs,
alcohol, tobacco, or excess caffeine; relaxation techniques such as deep breathing and
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meditation; development of assertiveness skills; rehearsal and practice of responses to stressful
situations; division of large tasks into smaller, more manageable tasks; recognition and reduction
of negative self-talk; avoidance of perfectionism in self and others; breaks from stressful
activities or situations; and establishment of a friend network to help cope in positive ways.13
In recognition of the protection provided by resilience, a number of formal programs such as
Sources of Strength and the Youth Aware of Mental Health Program (YAM), have been
established to help adolescents develop positive coping skills.1 The Ohio Department of Mental
Health and Addiction Services (OhioMHAS) also sponsors a campaign called Be Present that is
aimed at building resilience among youth, teens and young adults across the state.
Some of these programs target specific high-risk adolescents (such as those exposed to previous
trauma or those with a history of mental illness) and others can be used with entire school
populations. The most successful school-based and community-based approaches to building
resilience involve peers as leaders or partners in learning. Additionally, community-level
characteristics also play a large role in fostering and maintaining youth resilience. These
characteristics include both formal and informal neighborhood supports, services for families,
safety and economic vitality of communities, and a community culture of looking out for others
and valuing young people.

Steps to enhance protective factors include:

1. Convene a group to plan incorporation of protective factor enhancement into suicide
prevention activities
2. Evaluate positive coping skills and resiliency building programs and select the program(s) that
best fit the needs of your school
3. Secure support from administrators and staff for protective factor programming
4. Engage parents in protective factor training
5. Implement programs to build positive coping skills
6. Evaluate efficacy of programs and improve as appropriate

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Supplemental Information on Screening
Best practices related to school-based suicide screening are unclear.14 There is evidence to show
that, with appropriate resources to handle individuals who screen positively, suicide screening
can help identify students at risk of suicide.15 However, there is also evidence that screening for
suicide does not adequately identify individuals at highest risk of suicide and, if not implemented
with adequate resources, can cause harm.16,17 Below, we provide an overview of the advantages
and disadvantages of different screening approaches to help Northwest leadership decide if
screening is right for their schools.

Targeted Suicide Screening

Targeted screening is performed among a sub-population of students, often based on the
presence of risk factors. One potential approach to targeted screening in schools might include:
administration of a brief, identifiable (non-anonymous), self-reported suicide questionnaire to
students referred to school counselor for a drop in grades, changes in behavior, or concern from
a classmate or teacher. Students identified as at-risk on this targeted screen could then be
interviewed by trained school staff or mental health personnel to assess safety and referred to
mental health treatment or prevention programs.
Benefits of targeted screening include:
• Ability to identify students at highest risk of suicide. Targeted suicide screening of high-
risk populations, as identified through the NOYHS survey, indicates which individual
students need further evaluation and potential treatment.
• In settings where access to immediate mental health resources is limited, targeted
screens balance the need to identify students at highest risk with the responsibility to
connect all identified students with resources.
• Targeted screens are performed in close collaboration with mental health professionals
to ensure that staff administering or scoring the assessment know what to do with
positive results.
• Connection of at-risk students with treatment prevents suicide, and improves students’
behavioral health, school performance, social development, and future productivity.
• Self-administered scales can be useful for screening, because adolescents may disclose
information about suicidality in self-report that they deny in person.
• Effective safeguards can be put in place for privacy and confidentiality.
Disadvantages of targeted screening include:
• By not screening every student, there is a possibility that an at-risk student may be
missed by a targeted screen. As such, it is important to train staff and students to identify
at-risk behaviors, understand how to facilitate help, and take action to support students
to create multiple pathways to detect and help at-risk students.

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 • Schools are places of learning, not mental health facilities. Targeted screens require close
collaboration with mental health professionals to ensure that staff administering or
scoring the assessment know what to do with positive results.
• Screens need to be repeated because suicide risk changes over time. In addition to
periodic screening, school staff, students, and families can be trained in identification of
suicide ‘warning signs’ to monitor for changes in individual’s risk of suicidality.
• Screens are not diagnostic and do not allow for definitive statements about a student’s
problems or needs. At best, screening procedures provide a preliminary indication that
something may be wrong. All students who screen positively for suicide risk should be
evaluated by a mental health professional to avoid misdiagnosing or stigmatizing a young
person.

Universal Suicide Screening

Universal screening involves screening all students at a school without regard to risk status of
individuals. One potential approach to universal screening might include: administration of a
brief, identifiable (non-anonymous), self-reported suicide questionnaire to all students. Students
identified as at-risk (e.g. students endorsing suicidal behavior) could then be interviewed by
trained school staff or mental health personnel to assess safety and referred to mental health
treatment or prevention programs.
Benefits of universal screening include:
• Ability to identify all students at risk of suicide. Parents and teachers may not be able to
tell that a youth is suicidal and youth may not step forward on their own to get help. The
results of universal screening indicate which students need further evaluation and
potential treatment.
• Universal screens are performed in close collaboration with mental health professionals
to ensure that staff administering or scoring the assessment know what to do with
positive results.
• Connection of at-risk students with treatment prevents suicide, and improves students’
behavioral health, school performance, social development, and future productivity.
• Self-administered scales can be useful for screening, because adolescents may disclose
information about suicidality in self-report that they deny in person.
• Effective safeguards can be put in place for privacy and confidentiality.
Disadvantages of universal screening include:
• Universal suicide screens are designed to pick up every potential case of suicidality. As
such, universal screening of students may over-identify suicidality. This is known as a
“false positive.” False positives occur when students who do not really have suicidality
turn up positive on a suicide screen. In order to identify “true positives” from “false
positives,” students identified to be at-risk of suicide through universal screening should
receive secondary assessment by a mental health professional or trained counselor.

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 Additionally, schools may consider increasing mental health staff available to conduct
secondary assessments.
• Screens need to be repeated because suicide risk changes over time. In addition to
periodic universal screening, school staff, students, and families can be trained in
identification of suicide ‘warning signs’ to monitor for changes in individual’s risk of
suicidality.
• Screens are not diagnostic and do not allow for definitive statements about a student’s
problems or needs. At best, screening procedures provide a preliminary indication that
something may be wrong. All students who screen positively for suicide risk should be
evaluated by a mental health professional to avoid misdiagnosing or stigmatizing a young
person.

Any screening, whether targeted or universal, should be conducted in accordance with

recommendations from the Substance Abuse and Mental Health Services Administration
(SAMHSA)12:
• Screening efforts ideally include related training, education or outreach before or
concurrently with screening campaigns in order to improve screening participation rates
and to establish a more robust network of support for youths at elevated risk for suicide.
• School leaders may consider engaging parents, school personnel, and other key
stakeholders from the earliest stages of planning for screening, including the planning
process and the schedule and protocol for screening and referral.
• Schools or implementing partners may consult with the screening tool developer or the
distributer to assist in estimating the service needs for the anticipated number of positive
identifications.
• Screening should be implemented after the process of referral and follow-up care are
clearly established and where available resources—including appropriately trained
service providers—have been identified and aligned to address the needs of youths
identified at risk for suicide. Behavioral health providers can be notified prior to the
screening to facilitate referral procedures.
• Active parental consent prior to screening is required by the Protection of Pupil Rights
Amendment (PPRA) of 1978. When soliciting parental consent, schools may consider how
they can help families understand the value of screening, as well as increase the number
who return consent forms, including using culturally and linguistically appropriate
language and incentives.
• Schools may consider obtaining student assent prior to any school-based screening
effort.
• Staff administering the screening will be more successful if thoroughly trained in the use
of the screening tool and administering the overall screening process.

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 • Qualified behavioral health professionals can oversee the screening process and
administer interviews to all youth that screen positive on the initial screen to determine
level of risk and avoid false positives.
• Protocols may be established to carefully protect the identities of all students screened,
including those who initially screen positive and are subsequently determined to not be
at risk.
• Modified protocols may be required when screening special needs youth or to address
the needs of diverse cultural populations.
• Scoring or other review of screening results can take place immediately to identify those
youth at risk for self-harm, and protocols may include guidance for how to address the
needs of those youth who screen positive for depression or some other disorder even if
they are not actively suicidal.
• Response protocols can be developed prior to screening so youth suspected of being at
imminent risk for suicide and their caregivers receive immediate guidance and referral.
• Schools implementing a suicide prevention screening program may consider creating a
complete directory of community resources for behavioral health that can be shared with
parents and used for student referral.

Definitions
Postvention: programs or interventions for survivors following a death by suicide. These
strategies can help alleviate suffering, decrease emotional distress of suicide survivors, and
prevent suicide contagion.
Protective factors: personal or environmental characteristics that reduce the probability of
suicide. Protective factors can buffer the effects of risk factors.
Resilience: the capacity to resist the effects of risk factors.
Risk factors: personal or environmental characteristics that are associated with suicide.
People affected by one or more of these risk factors have a greater probability of suicidal
behavior.
Suicide attempt: A non-fatal self-directed potentially injurious behavior with any intent to die as
a result of the behavior. A suicide attempt may or may not result in injury.
Suicidal behavior: term to encompass all suicide-related behaviors or actions, including suicide
attempts and suicides.
Suicide: Death caused by self-directed injurious behavior with any intent to die as a result of the
behavior.
Suicide contagion: process by which the suicide or suicidal behavior of one or more persons
influences others to complete or attempt suicide.
Suicidal ideation: thoughts of engaging in behavior intended to end one’s life.
Suicidal ideation with plan: thoughts of ending one’s life, with specific formulation regarding
method through which one intends to end one’s life.

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Survivor: a person who has experienced the suicide of a family member or loved one. A person
who attempts suicide but does not die is an attempt survivor.
Warning signs: indications that someone may be in danger of suicide, either immediately or in
the near future.2,18

Abbreviations
CDC – Centers for Disease Control and Prevention
MHAR – Mental Health and Addiction Recovery
NREPP – National Registry of Evidence-based Programs and Practices
NOYHS – Northeast Ohio Youth Health Survey
ODH – Ohio Department of Health
OhioMHAS – Ohio Department of Mental Health & Addiction Services
SCESC – Stark County Educational Service Center
SCHD – Stark County Health Department
SAMHSA – Substance Abuse and Mental Health Services Administration

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Additional Resources
Crisis Planning
Evidence-Based Prevention
Search tool from Suicide Prevention Resource Center to help partners make decisions about the
programs and practices that will be a part of your comprehensive approach to suicide
prevention.
http://www.sprc.org/keys-success/evidence-based-prevention

Practical Information on Crisis Planning

Guide for schools and communities to navigate crisis planning. Provides overview of critical
concepts and components of crisis planning with examples of promising practices.
https://rems.ed.gov/docs/PracticalInformationonCrisisPlanning.pdf

Crisis Response
Crisis Response Protocol – Example from Madison, WI
Madison Metropolitan School District’s crisis response plan for sudden deaths, suicides, or
critical incidents. Concrete example of how one school district incorporated suicide into their
crisis response procedure.
http://www.mhawisconsin.org/Data/Sites/1/media/gls/gls_madisoncrisisplan.pdf

Manual for Schools: Managing Traumatic Events

Crisis planning guide from educational psychologists based in UK.
https://search3.openobjects.com/mediamanager/hackney/fsd/files/manual_for_managing_trau
matic_incidents.pdf

Postvention Guidelines
Practical guide from Australia, designed to assist schools in responding to the tragic occurrence
of suicide or attempted suicide within their student community. Includes actionable items and
suggested timeline for schools in the process of responding to a suicide.
https://www.education.sa.gov.au/doc/suicide-postvention-guidelines
Postvention Manual
Guide for schools and communities to develop their own postvention procedures.
https://www.starcenter.pitt.edu/Files/PDF/Manuals/Postvention.pdf

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Gatekeep Training
Mental Health First Aid
https://www.mentalhealthfirstaid.org/
Question, Persuade, Refer (QPR)
https://qprinstitute.com/

Resources for Parents & Families

Children, Teens, and Suicide Loss
Plain language guide for parents & families on how to support youth through loss of a loved one
to suicide.
https://afsp.org/find-support/ive-lost-someone/resources-loss-survivors/children-teens-suicide-
loss/

Social Media
Tips on Social Media from Riverside Trauma Center
Numerous resources from Riverside Trauma Center, including: talking to children about 13
Reasons Why; responding to traumatic event; and tips on social media after a suicide loss for
students, school administrators, and parents.
http://riversidetraumacenter.org/trauma-center-resources/
How to Use Social Media for Suicide Prevention
Resource from California Mental Health Services Authority to help organizations or communities
evaluate if use of social media for suicide prevention is right for them, and if so, tips for how to
implement safe, effective messages into organizations’ social messaging.
http://eiconline.org/teamup/wp-content/files/13-CALM-0106-Socialmedia_Guide_FNL.pdf

Suicide Contagion
Suicide Clusters and Contagion
Journal article from Principal Leadership providing an overview of the concept of suicide
contagion, factors driving suicide contagion, and how school leadership may prevent or disrupt
contagion.
http://cdpsdocs.state.co.us/safeschools/Resources/Suicide%20Clusters/Suicide_Clusters_NASSP
_Sept_%2009.pdf

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References

1. Stone D, Holland K, Bartholow B, Crosby AE, Davis S, Wilkins N. Preventing suicide:

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