Youth Suicide Prevention with Kiwanis

Introduction

On October 31st I had the opportunity to deliver a presentation on youth suicide to the Sigourney Kiwanis. Kiwanis is a service organization that works with youth. This was a wonderful, active group that I enjoyed having the opportunity to speak with.

I’ve expanded on the point-form presentation that I left participants with, if you’re interested in reading more.

Suicide in Iowa

According to the Iowa Department of Public Health (Fleig, 2018) there were 478 suicide deaths in Iowa in 2018 including 39 teenagers. This is a large increase over the 2016 data kept by the CDC. 478 deaths means someone dies every 18 hours.

Suicide in General

For every suicide death, we know there are as many as 50 suicide attempts. (Schwartz-Lifshitz, et. al., 2012) This is partly because of the method that is used. The survival rate for firearm suicide is about 2%, for hanging it is about 30% and for overdose it is 98%. (Elnour & Harrison, 2008; Spicer & Miller, 2000)

Suicide Risk Factors

Anything that overwhelms someone’s coping and makes them feel hopeless may lead to suicidal behavior. Examples include:

  • Struggling in school
  • Anxiety or depression
  • Bullying
  • Substance abuse
  • Being a victim or survivor of abuse (physical, emotional, sexual)
  • Being a child of a parent who is struggling with substance abuse

Suicide Warning Signs

Warning signs are signs that a suicide attempt may be imminent. They include:

  • Giving away prized possessions
  • Talking about death
  • An unexpected peace or calm after a significant struggle (because the person has made the decision to attempt suicide)

Protective Factors Against Suicide

Protective factors are those things that help keep us safe from suicide or buffer us from suicide.

  • Academic Achievement
  • Parental and Non-Parental Connectedness (trusted adults)
  • Supportive Friendships
  • Involvement in Sports
  • Strong mental health / wellness

How You Can Help

Recognize Statements of Lethality

Also called statements of finality or invitations – invitations to ask about suicide – statements of lethality let us know that someone might be struggling with suicide. Statements of lethality include:

  • I can’t go on
  • I can’t do it anymore
  • I wish I was dead
  • I’m at the end of my rope

Ask Clearly About Suicide

You will not put the idea in the person’s head if you ask them about suicide. What you will do is help reduce the isolation and loneliness that person is feeling and reduce the intensity of those suicidal thoughts.

Limit Access to Lethal Means

Limiting access to lethal means, by securing firearms or locking up pills is an important part of safety planning with a vulnerable youth.

Take Intent Seriously

Additionally, take suicidal intent seriously. If a teenager overdoses on a harmless product like melatonin that they believe will hurt them, treat that like a serious suicide attempt.

Recognize Self-Injury is Different from Suicide

Recognize that non-suicidal self-injury (cutting) is separate from suicidal behavior and is usually a coping strategy rather than a means to an end.

Suicide Risk Assessment (CPR Model)

If someone has indicated that they are struggling with suicide, I want to know their current plan, their previous exposure to suicide and their resources/lack of resources.

Current Plan of Suicide

The more detailed their plan, the higher the risk level. Do they have access to the plan? Do they know when or where they want to carry out the plan? We know that taking away those means (e.g. securing the pills), in most cases does not cause an individual to try a different method. Instead, they step back and reconsider their suicide plan.

Previous Exposure to Suicide

Have they attempted before? If so, what’s different now? What’s changed? And have they ever lost someone close to them to suicide? If they have this increases their own risk for suicide.

Lack of Resources or Supports

A lack of resources like friends, family or counselling is one of the most significant risk factors for suicide.

Really Simple Suicide Intervention

If the youth can keep themselves safe today, tonight, tomorrow – then I’m okay with that. I can make an appointment for a counsellor or put other supports in place. If that youth can’t, then I’m going to call 911 or get them to the hospital for some emergency supports.

How Communities Can Help

Communities can form a Youth Suicide Prevention Action Group (YSP), this is a group that brings together members from different sectors like education, mental health, faith and law enforcement to work on resources to help reduce youth suicide.

Implementing an evidence-based program like Yellow Ribbon can help.

Hope for the Future

Senate File 2113 signed in March, requires teachers to get suicide awareness trained
(1 hour of Gatekeeper Training)

70% of those who attempt suicide and live will never make a second attempt because they get the help that they need. (Owens, Horrocks & House, 2002)

References

Elnour, A.A. & Harrison, J. (2008) Lethality of suicide methods. Journal of Injury Prevention. 14(1). 39-45. doi: 10.1136/ip.2007.016246.

Fleig, S. (2018, Oct 29) Following historically high suicide rates, Iowa schools become mental health ‘gatekeepers’. The Des Moines Register.

Owens, D., Horrocks, J. & House, A. (2002) Fatal and non-fatal repetition of self-harm: systematic review. British Journal of Psychiatry. 181. 193-199.

Schwartz-Lifshitz, M., Zalsman, G., Giner, L., & Oquendo, M. A. (2012). Can we really prevent suicide?. Current psychiatry reports14(6), 624-33.

Spicer, R. S., & Miller, T. R. (2000). Suicide acts in 8 states: incidence and case fatality rates by demographics and method. American journal of public health90(12), 1885-91.

Cite this article as: MacDonald, D.K., (2018), "Youth Suicide Prevention with Kiwanis," retrieved on June 26, 2019 from http://dustinkmacdonald.com/youth-suicide-prevention-kiwanis/.
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Golan Model of Crisis Intervention

Introduction

Naomi Golan is the creator of the Golan Model of Crisis Intervention, and a pioneer of crisis theory and crisis intervention. She is Professor Emeritus at the University of Haifa in Israel, where she retired in 1984. (Dorfman, 2013)

Golan’s 1978 book Treatment in Crisis Situations provided a review of her three phase model of crisis intervention. While this work has been integrated into the work of modern day crisis intervention and even regular social work practice it was quite innovative in its day.

Golan Model of Crisis

The model that Golan proposes involves three stages or phases, and is designed to be completed in 5-6 sessions. The three phases are Assessment, Implementation and Termination. These are reviewed in more detail below.

Assessment

The assessment stage happens in the first session. The goals of the assessment stage are very similar to Boiling Down the Problem in the ABC Model and the Step 1 (Defining the Problem) in the Six Step Model of Crisis Intervention.

First, you must identify what the traumatic event or precipitating event that caused the crisis. Second, you must understand the client’s reaction or response to crisis. Third, what context did the crisis event happen in – what else is going on in the client’s life? The term “hazardous event” is sometimes used to describe the nature of the stressor. Fourth, you must identify how the client has been affected by the crisis, and finally what is the client’s primary concern as a result of the crisis?

Golan (1969) identifies four elements that can be used to determine if a client is in crisis:

  • a hazardous event
  • a vulnerable state
  • a precipitating factor
  • a state of active crisis or disequilibrium

A comprehensive assessment will be the road-map you rely on to ensure you have accurately understood the nature of the client’s crisis.

Implementation

Once you have identified the goals for treatment (collaboratively with the client), you will proceed to the Implementation phase. During implementation, you will collect information on the client’s pre-crisis functioning, coping strategies, strengths and weaknesses, and support systems available to them.

Once you have this information, you can begin to set some concrete goals with the client. For example, a recently divorced client who is completely overwhelmed with what to do next might set a goal to make an appointment with a career counsellor or resume writing service – or even something as simple as a checklist to ensure they shower and brush their teeth each morning.

The Implementation stage will run from the first session to approximately the fourth session.

Termination

Termination is the final sessions, which might be the 5th or 6th session. Now that the client has made some steps towards regaining pre-crisis functioning, the client and therapist make a plan to wrap up services and make plans for the future.

Similarities and Differences with Other Crisis Intervention Models

ABC Model

The ABC Model includes three stages:

  1. Achieving Rapport
  2. Boiling Down the Problem
  3. Contracting for Action

Similarities

Boiling Down the Problem most of the elements in the Implementation Phase, including understanding the elements that are leading the client to their crisis, and getting a detailed understanding of their coping strategies. The focus in the Termination model is very similar to the Contracting for Action part of the ABC Model.

Differences

The ABC Model includes achieving rapport as an explicit element, while the Golan Model does not, this is just expected. Additionally, the Termination phase in the Golan Model covers next steps after the client wraps up therapy, while the ABC Model may lead into regular counselling or therapy, without necessarily stopping therapy.

Six Step Model of Crisis Intervention

The Six Step Model of Crisis Intervention includes six steps:

  1. Defining the Problem
  2. Ensuring Client Safety
  3. Providing Support
  4. Examining Alternatives
  5. Making Plans
  6. Obtaining Commitment

Similarities

Both the Six Step Model and the Golan Model of Crisis Intervention include defining the nature of the problem, understanding their supports and existing resources, making goals or plans, and a termination or wrap up phase.

Differences

The Six Step Model includes more specific phases than the Golan Model. For example, Ensuring Client Safety (meeting their basic needs like shelter and food) and Providing Support (accepting the client as a person of value and worth) are absent from the Golan Model. On the other hand, the Golan Model includes assessing pre-crisis functioning in a way that the Six Step Model does not.

Finally, the Golan Model includes a more thorough Termination phase, while the Six Step Model’s Termination phase (“Obtaining Commitment”) is more about obtaining verbal agreement about next steps.

LAPC Model

The LAPC Model includes four steps:

  1. Listen
  2. Assess
  3. Plan
  4. Commit

Similarities

The LAPC Model’s Assess Phase is very similar to the Assessment Phase in the Golan Model, while the Plan Phase is very similar to the Implementation Phase. Finally, the Commit phase includes elements similar to those in the Termination phase of the Golan Model.

Differences

The main difference is that the LAPC Model includes a step involving Listening, while the Golan Model does not. Additionally, the LAPC Model includes safety planning and taking care of basic needs, things that were less of a concern to Golan – who was frequently taking care of clients in a hospital setting where this was already assumed.

Conclusion

As you can see, many crisis intervention models are overlapping and interrelated. The Golan Model of Crisis Intervention is a useful model of crisis intervention, and has several important similarities and differences when compared with other models like the Six Step Model, the ABC Model, and the LAPC Model.

References

Golan, N. (1969) When is a client in crisis?. Social Case Work. 50(7). pp. 389-394.

Golan, N. (1978) Treatment in Crisis Situations. New York, NY: Free Press.

Dorfman, R.A. (2013) Clinical Social WorkDefinition, Practice And Vision. London, England: Routledge.

Cite this article as: MacDonald, D.K., (2018), "Golan Model of Crisis Intervention," retrieved on June 26, 2019 from http://dustinkmacdonald.com/golan-model-crisis-intervention/.
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Develop a Fee-for-Service Program to Diversify Revenue

Introduction

Does your organization have a fee-for-service program? I recently had the opportunity to sit down with a local United Way chapter that was looking to hire a new executive. Some of the things that we discussed included:

  • A review of their financial statements
  • Importance of development of a planned giving/endowment program
  • Improving the organization’s messaging

Additionally – and the purpose of this post – I made sure to discuss the importance of fee-for-service programs in an effort to diversify fundraising. Since its founding, the United Way’s primary fundraising strategy has been workplace campaigns, but in the era of direct donations online right to funded agencies, donations from youth and other tech-savvy individuals to the United Way have been falling.

This is where fee-for-service programs can come in handy. These training sessions and services provide value to the nonprofits while also diversifying the United Way’s fundraising.

Types of Training

As the Director of Online Support at Distress Centre Durham, I led training sessions in topics including:

  • Creating an Online Text and Chat Program
  • Providing Crisis Intervention via Text and Chat
  • DCIB/CPR Suicide Risk Assessment
  • Using the Spousal Assault Risk Assessment
  • Youth Suicide Prevention

These sessions ranged in length from 45 minute “Lunch and Learns” up to full day training sessions designed to Train the Trainer who would go back to their own organization and train volunteers or other staff. Your organization will obviously tailor the types of training that you provide depending on your service.

For example, an organization that works with women fleeing intimate partner violence might offer training sessions like:

  • Working with Abused Women
  • Running a Shelter
  • Providing Intimate Partner/Domestic Violence (IPV/DV) Services via the Phone
  • Intimate Partner Violence Assessment

These trainings may be prepared for other service providers, for individuals in the community like therapists and counsellors, or even over the internet via e-learning. E-learning is an under-utilized form of training in the nonprofit world, and once the course is developed the majority of your organization’s time is spent updating and revising the material yearly.

Board Training

If your organization is a cornerstone in the community like the United Way is, developing a comprehensive Board of Directors Training can be a lucrative revenue source. Even small communities have several organizations, while larger ones will have dozens of Boards. Board Training improves those organization’s capacity to govern their organization while generating revenue for your organization. As Boards naturally have turnover, this can represent a recurring revenue source.

Providing Services to Other Nonprofits

Services are also an option for a nonprofit to expand. For example, I’ve prepared Social Return on Investment (SROI) Reports that demonstrate the value your organization gives over and above the mere dollar donated can be significant in demonstrating your value proposition. A dollar donated to the United Way or another organization that is at the center of the nonprofit ecosystem can go much further than if it is donated directly to the partner agencies.

Here is a one slide from the SROI Analysis that I conducted for Distress Centre Durham’s helpline program:

Other opportunities abound depending on your specific skills and training.

For example, I directed the Evaluation Program for our Basic Helpline Training at Distress Centre Durham. This involved pre-and-post knowledge and attitude surveys that were examined. I built automated tools in Excel to sharply reduce the labor required (so that any student or intern could plug in the numbers and it would spit out the evaluation.) When certain questions were not being answered correctly, the training was adjusted.

You can help organizations develop these kind of tools and to build their own evaluation programs to give them the data that they need.

Train-the-Trainer

Some organizations specifically provide T4T (Train the Trainer) programs. Completing these programs entitle you to lead the training programs. Leaning on my work in suicide prevention, there are several options that you can use to bring Suicide Awareness or Assessment/Intervention Training to your community.

The QPR Institute provides QPR Suicide Gatekeeper Instructor Training for $500. QPR Certified Instructors (who can take an e-learning course in order to get certified) may charge $20 per participant for 2 hours of suicide awareness training.

A similar program is offered by LivingWorks and called safeTALK. safeTALK costs $1000 for the 1-day training program, and the instructors may charge $50-100 per participant for the 3-hour training program.

Finally, Applied Suicide Intervention Skills Training (ASIST) is a 2-day suicide risk assessment and intervention program. The LivingWorks ASIST Instructor program costs $2500 for the 5 days of training, and participants are charged $100-300.

Case Study: The United Way

The United Way has opportunities to reinvent themselves as a critical source of support – and not just financially – for all nonprofits in their community. Going beyond the traditional workplace campaign and volunteer resource center, United Way can become essential. For example, a nonprofit decides they need to improve their fundraising and strategic direction and they contact their local United Way.

The United Way provides them with free Board of Directors e-learning, which helps the Directors learn the importance of a strong outcome and evaluation program. They decide to pay for an SROI Analysis to be conducted on their most valuable program; that evaluation indicates that for every $1 invested in their program, $4 is generated in social value to the community.

Armed with that knowledge, they approach a new funder and get funding for a youth mentoring program. In order to make sure that all their Mentors are equipped the best they can, the nonprofit notes in their application that all staff and volunteers working with youth will receive QPR Suicide Awareness Training.

The United Way generates revenue from the SROI Analysis and the QPR Training, while the nonprofit improves their fundraising by better telling their story. As the Board of Directors naturally changes in composition, those individuals may take their knowledge of Board training to their new organization – increasing your reach.

Conclusion

Does your nonprofit generate revenue with fee-for-service programs? Would you like to? Share below. As well, if you’re looking for information on outcomes or evaluations feel free to contact me.

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Sending Anonymous Emails

Introduction

Sometimes it can be useful to send emails that are anonymous. This can be because you need to communicate information in an emergency without it being traced back to you, or for a variety of other reasons.

It is important to ensure that anonymous emails are sent for good reasons only – and not to spread hatred or dissent. Stand behind your writing.

Sending encrypted emails is a different subject. Those emails are prevented from being opened by anyone without the right access but your identity is shared. In the case of anonymous emails there is no identifying information transmitted with them.

Tails

Tails is an operating system that is designed for privacy purposes. It can be run from a CD/DVD drive, or booted from a USB stick.  The web browser uses the encrypted technology Tor. Once you have Tails downloaded and run, you can create a free email account such as one at Hotmail or Gmail with made-up details and there would be no way to trace your anonymity.

Instant Messaging

If, like Bradley (now Chelsea) Manning you are communicating with individuals through an instant messaging platform like AIM, Google Talk, or IRC – then the Pidgin app included in the Tails installation will allow you to do so.

Pidgin is described as “a chat program which lets you log in to accounts on multiple chat networks simultaneously. This means that you can be chatting with friends on MSN, talking to a friend on Google Talk, and sitting in a Yahoo chat room all at the same time.”

Because Tails encrypts your internet communication you can create an account on say, Google Talk and use it for encrypted Google Talk chatting with an important source

Other Anonymous Email Servers

Websites like SendAnonymousEmail.net allow you to send a simple anonymous email via a web interface. That combined with Tails will allow you to send a simple communication without attachment to the address that you specify.

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Values Worksheet

Introduction

Below is a set of values. You can use these to help your organization choose the values that are most important to them as you begin your organizational planning.

Values

Accountability Achievement Adventure
Assertiveness Authority Autonomy
Bearing Boldness Bravery
Charity Commitment Community
Compassion Competence Confidence
Coolness Courage Creativity
Decisiveness Determination Discipline
Duty Empathy Endurance
Fairness Faith Flexibility
Happiness Health Honor
Humility Improvement Initiative
Integrity Intelligence Justice
Knowledge Leadership Liberty
Logic Loyalty Maturity
Order Peace Persistence
Personal Courage Pride Professionalism
Respect Responsibility Restraint
Security Selfless Service Service
Stability Status Strength
Support Tact Teamwork
Tolerance Toughness Traditional
Trust Understanding Valor

 

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