powerpoint presentationriversidetraumacenter.org/wp-content/uploads/2019/09/postvention-i… ·...
TRANSCRIPT
![Page 1: PowerPoint Presentationriversidetraumacenter.org/wp-content/uploads/2019/09/Postvention-I… · Barriers to health care Unsafe media portrayals of suicide Safe and supportive school](https://reader036.vdocuments.mx/reader036/viewer/2022070707/5ea128cf6c78384f3802a5b6/html5/thumbnails/1.jpg)
9/13/2019
1
Responding to Sudden, Unexpected
Loss: Strategies for Supporting Schools,
Organizations, and Communities
International Association of Suicide Prevention Derry, Northern Ireland
September 2019
Presented by:
Larry Berkowitz EdD Jim McCauley, LICSW
Riverside Trauma Center
Help communities recover from the overwhelming stress caused by traumatic events by providing community outreach and counseling.
Educate communities and organizations about suicide prevention, psychological trauma, and the emotional needs of returning veterans.
We serve communities, schools, health and human services providers, organizations, government agencies, workplaces, and individuals.
We have provided trauma-related services since 1990
www.riversidetraumacenter.org
Riverside Trauma Center
Riverside Trauma Center
Critical Incident Responses
• Sudden/ Unexpected Deaths –Fatal Car Accidents
• Tragic Deaths of Children
• Homicides
• School Shootings *
• primarily suicide deaths • Local Disasters – Tornados, Floods
• Teacher arrested for child pornography/ sexual abuse
• Islamophobia
Riverside Trauma Center
A world where communities and organizations provide everyone who is exposed to suicide access to effective services and support immediately- and for long as necessary- to decrease their risk of suicide, to strengthen their mental health, and to help them cope with grief.
(National Action Alliance for Suicide Prevention, 2015)
A New Vision for Postvention
![Page 2: PowerPoint Presentationriversidetraumacenter.org/wp-content/uploads/2019/09/Postvention-I… · Barriers to health care Unsafe media portrayals of suicide Safe and supportive school](https://reader036.vdocuments.mx/reader036/viewer/2022070707/5ea128cf6c78384f3802a5b6/html5/thumbnails/2.jpg)
9/13/2019
2
Riverside Trauma Center
Is There a Need for Postvention?
Adolescent suicide loss survivors experience increased depression, complicated grief, PTSD. (Brent, et. al.1996)
In some settings workers exposed to suicide are 3.5 times more likely to subsequently die of suicide
(Hedstrom, et. al. 2008)
Summary of research showing 54% of attempters know at least one person who attempted or died of suicide (86% - attempt occurred more than 12 months after the suicidal behavior of the model) (DeLeo & Heller, 2008)
Exposure to suicide is a significant risk factor for suicide Contagion (Gould, 2010)
Riverside Trauma Center
Suicide Contagion vs Suicide Cluster
Contagion:
Process by which knowledge of one suicide facilitates/influences the occurrence of a subsequent suicide.
Viewed within the larger context of behavioral contagion or social learning theory.
Also termed “modeling”
Cluster:
Excessive number of suicides occurring in close temporal and/or geographical proximity.
Gould (2010)
Riverside Trauma Center
A study was conducted by Cerel and colleagues found: An average of 115 people are exposed when each suicide occurs. On a 5-point scale rating closeness of their relationship to the person
who died by suicide whom they knew the best, of the 115 people exposed, 71 felt some degree of closeness, 42 of those 71 felt a higher degree of closeness, and 21 of those 42 people felt a very high degree of closeness.
Perceived impact respondents felt that the suicide had on their life, of the 115 people exposed,
53 said their lives were disrupted for a short time, 25 of those 53 people said their lives were disrupted in a major way 11 of those 25 people said the suicide had a devastating effect on
their lives.
Impact for the Survivors
Cerel et al. (2017) Riverside Trauma Center
Individuals at Risk
X
Girlfriend X X Siblings
X Team-mates
Co-workers
X Ex-girlfriend Neighbors X
X “Vulnerable”
students/ adults
X Individuals with
recent losses
X Friends X
Friends on X
Social Media
Adapted from Underwood and Dunne-Maxim (1997)
X All students in
same grade
X Those who identify
in some way with the
deceased
![Page 3: PowerPoint Presentationriversidetraumacenter.org/wp-content/uploads/2019/09/Postvention-I… · Barriers to health care Unsafe media portrayals of suicide Safe and supportive school](https://reader036.vdocuments.mx/reader036/viewer/2022070707/5ea128cf6c78384f3802a5b6/html5/thumbnails/3.jpg)
9/13/2019
3
Riverside Trauma Center
Domains Affected by Trauma and Acute Grief
Domain Symptoms
Emotional Shock, sorrow, anger, guilt, irritability
Cognitive/
Thinking
Confusion, intrusive thoughts, concentration
Social/Behavioral
Withdrawal, crying, fighting
Physical/Somatic
Fatigue, stomachache, startle response, sleep
Relational Withdrawal; fighting, fear of being alone; feeling
obligated to interact with people
Spiritual/
Meaning-Making
“Nothing matters.” “Why would God do this?”
“Why do I bother to do this kind of work?”
Riverside Trauma Center
Why Grief Following Suicide Can Be
More Complicated
Shock at the sudden/unexpected death
Social stigma/shame Intense search for the
reasons “why” Police investigation/media
involvement “Could this death have been
prevented?” Ambiguity about volition of
deceased (did he/she really mean to die?)
Violence/trauma of the death
Feelings of abandonment or rejection
Fear of own self destructive impulses
Fear of possible suicidal thoughts/behaviors of others
Long delays in receiving autopsy/medical reports precludes “closure”
Anger at the deceased and/or others - Scapegoating/blaming
Adapted from Underwood (1997) & Cerel et al. (2015)
Riverside Trauma Center
Grief Trauma
Sadness is the most common emotion. Terror/Fear is the most common emotion.
Acute grief generally runs its course over time.
With Post-Traumatic Stress lack of treatment can worsen the condition.
Pain is an acknowledgement of the loss. Pain can trigger terror and powerlessness
Generally does not attack nor “disfigure” the self-image of the bereaved.
Generally attacks, distorts and “disfigures” the self-image of the bereaved.
Generally does not involve trauma reactions like flashbacks, startle reactions, hypervigilance, numbing, etc.
Involves grief reactions in addition to trauma specific reactions like flashbacks, startle reactions, hypervigilance, numbing, etc.
Trauma vs. Grief
Riverside Trauma Center
“What About OUR pain?”
Who else is impacted throughout a community?
Building a competent community (Kalafat)
![Page 4: PowerPoint Presentationriversidetraumacenter.org/wp-content/uploads/2019/09/Postvention-I… · Barriers to health care Unsafe media portrayals of suicide Safe and supportive school](https://reader036.vdocuments.mx/reader036/viewer/2022070707/5ea128cf6c78384f3802a5b6/html5/thumbnails/4.jpg)
9/13/2019
4
Riverside Trauma Center
Think through the timeframe of the response:
Today
Rest of this week
Weekend
Services
After the funeral
One week out
Two weeks out
Timeframe of the Response
Mixed State – B. Matros
Riverside Trauma Center
Reactions and distress may resurface during milestone moments and anniversaries.
It is often helpful to prepare the bereaved to anticipate these reactions.
Anniversaries (of birth, death, “monthaversaries”)
Milestone moments: prom, graduation, buying a new house, wedding, etc.
Anniversaries and Milestones
Riverside Trauma Center
Promote healthy grieving Restore equilibrium and functioning/Stabilize the
environment Commemorate the deceased Provide comfort to those distressed Reduce the risk of contagion Minimize adverse personal outcomes (Depression,
PTSD, complicated grief) Use the experience/tragedy as a “teachable” moment Increase empowerment and mutual support for
organizational members
Postvention Goals
Riverside Trauma Center
Postvention Guiding Principles
Avoid oversimplifying the causes of suicide
Emphasize the correlation with depression and mental illness
Avoid romanticizing/glorifying
Discourage focus on method
Provide structure for on-going suicide prevention efforts
![Page 5: PowerPoint Presentationriversidetraumacenter.org/wp-content/uploads/2019/09/Postvention-I… · Barriers to health care Unsafe media portrayals of suicide Safe and supportive school](https://reader036.vdocuments.mx/reader036/viewer/2022070707/5ea128cf6c78384f3802a5b6/html5/thumbnails/5.jpg)
9/13/2019
5
Riverside Trauma Center
Shame – embarrassment – reduced cohesion
“This place is cursed”
“That town needs to stop killing kids”
“I go out of my way to avoid telling people where I am from.”
“The minute I can afford to move I’m leaving this hell hole.”
Impact on School/Business/
Community
Riverside Trauma Center
Postvention Tasks
1) Verify deaths and facts surrounding the death
Superintendent/CEO/HR/ League Director
Who? When?
Confirm with family, police or medical examiner
Assume widespread rumors
Riverside Trauma Center
“If you’re about to open your mouth to say something to make the family feel better – don’t.”
Be a “compassionate presence” – sometimes this is enough.
Representative from the school should visit with the family ASAP.
Ask the family what their understanding is of the death.
Gently encourage the family to acknowledge it as a suicide. Enlist the family in your postvention efforts
Talking with the Grieving Family
Riverside Trauma Center
2) Coordinate internal and external resources
Crisis team (frequent mtgs)
Early Responders – police, fire, EMS, clergy
Local mental health partners/HR/ EAP’s
Other school districts
Trained clergy/ funeral home directors
External resources support those implementing the postvention plan
Postvention Tasks
![Page 6: PowerPoint Presentationriversidetraumacenter.org/wp-content/uploads/2019/09/Postvention-I… · Barriers to health care Unsafe media portrayals of suicide Safe and supportive school](https://reader036.vdocuments.mx/reader036/viewer/2022070707/5ea128cf6c78384f3802a5b6/html5/thumbnails/6.jpg)
9/13/2019
6
Riverside Trauma Center
3) Disseminate accurate information
Factual, written information acknowledging suicide
Condolences to family and friends
Plans for support
Funeral plans
Changes in schedule
Announce in small groups (no public address)
Postvention Tasks
Riverside Trauma Center
4) Support for those most impacted by the death
Follow schedule of the deceased/ work groups
Friends, family, conflicted relationships
Less obvious – administrative staff, clients, others in the community (activities, neighbors), those in remote offices who have frequent phone contact
Emphasis is on mourning the loss
Postvention Tasks
Riverside Trauma Center
Encourage atmosphere of open expression to all reactions
Communicate facts clearly (then repeat) Initiate conversations about the deceased: facilitate
through artwork, collages, tape recording, journals Physical activity/encourage peer activities Flexibility (eg. around physical complaints) Resume routines Support rituals for the deceased Relief staff/Tutoring and temporary reduction in
work/academic load
School Response to Childhood Bereavement
Riverside Trauma Center
Why? - making sense of the death Responsibility- guilt and blame (“tyranny of
hindsight”) Social disruption- isolation Shame- stigma, silence Anger- rejection and abandonment Trauma- shock and horror Relief- end of suffering Suicidality- why go on? Sorrow- grief and yearning
Prominent Themes for Survivors
Adapted from Jordan (2014)
![Page 7: PowerPoint Presentationriversidetraumacenter.org/wp-content/uploads/2019/09/Postvention-I… · Barriers to health care Unsafe media portrayals of suicide Safe and supportive school](https://reader036.vdocuments.mx/reader036/viewer/2022070707/5ea128cf6c78384f3802a5b6/html5/thumbnails/7.jpg)
9/13/2019
7
Riverside Trauma Center
Information management – who to tell and when
Communication shutdown-trying not to upset others or manage conflict
Disruption of family rituals/ routines
Loss of cohesion
Coping Asynchrony – Differences in grieving styles/ change in availability/ different timelines
The Burden of taking care of others
The “Supermarket Aisle”
Prominent Themes for Survivors: Family
Adapted from Jordan (2014) Riverside Trauma Center
• Self Care
• Educate yourself
• Lower your expectations
• Be with people who “get it” and “get you.”
• Experiment with healing
• “Don’t waste your grief” – engage in activities that honor your loved one
• Be patient with yourself
• Have faith in your resilience • Adapted from John Jordan PhD
How to Survive
Riverside Trauma Center
Postvention Tasks
5) Identify those most at risk
Identify with deceased (even if remote)
Feeling responsible
Recent loses
“Impressionable” students
Hx of suicidal behavior/ suicide survivor
Bracing Ourselves – B. Matros
Riverside Trauma Center
Postvention Tasks
6) Provide opportunities for commemoration
Policy for all deaths Outside of school activities Encourage family to participate Discourage permanent memorials Encourage prevention activities and simple
activities (meals, transportation) Emphasize deceased’s life (vs. method of
dying)
![Page 8: PowerPoint Presentationriversidetraumacenter.org/wp-content/uploads/2019/09/Postvention-I… · Barriers to health care Unsafe media portrayals of suicide Safe and supportive school](https://reader036.vdocuments.mx/reader036/viewer/2022070707/5ea128cf6c78384f3802a5b6/html5/thumbnails/8.jpg)
9/13/2019
8
Riverside Trauma Center
Postvention Tasks
7) Provide psycho-education on grief and suicide
Educate on depression/ grief process/ mental illness/ “perfect storm”
Encourage adaptive coping strategies
Encourage questions
Consider curricula – SOS, Lifelines, Break Free From Depression (Schools); Working Minds (workplace)
Role of Community Forums
Riverside Trauma Center
How do we change the narrative?
Messages of hope
Encourage help-seeking
Encourage improved social support
Fight stigma about mental health challenges and asking for help
National Action Alliance: Framework for Successful Messaging: (actionallianceforsuicideprevention.org)
Messaging
Riverside Trauma Center
Postvention Tasks
8) Casefind/Screen for depression or suicide
Consistent with public health approach Brief Screening for Adolescent Depression in
conjunction with SOS Signs of Suicide Program Mindwise.org Screening for adults “Exposed” vs. “unexposed” Prepare teachers, parents, and students for
screening event Workplace screenings more challenging Enhanced mental health resources in place
![Page 9: PowerPoint Presentationriversidetraumacenter.org/wp-content/uploads/2019/09/Postvention-I… · Barriers to health care Unsafe media portrayals of suicide Safe and supportive school](https://reader036.vdocuments.mx/reader036/viewer/2022070707/5ea128cf6c78384f3802a5b6/html5/thumbnails/9.jpg)
9/13/2019
9
Riverside Trauma Center
Riverside Trauma Center
Adult Screening
Riverside Trauma Center
Postvention Tasks
9) Implement trauma response for second/ subsequent suicide
Increased risk of a cluster
Trauma focus ( more than one death, witness, homicide-suicide, extended publicity/ blame)
Psycho-ed around self care
Coping groups
Riverside Trauma Center
Postvention Tasks
10) Develop linkages to resources:
Need for clinical follow-up/ on-going support
List of local resources/ publicized lists
Funding opportunities
Designated counselor in school
Project SERV
AFSP, Samaritans, The Loss Project
![Page 10: PowerPoint Presentationriversidetraumacenter.org/wp-content/uploads/2019/09/Postvention-I… · Barriers to health care Unsafe media portrayals of suicide Safe and supportive school](https://reader036.vdocuments.mx/reader036/viewer/2022070707/5ea128cf6c78384f3802a5b6/html5/thumbnails/10.jpg)
9/13/2019
10
Riverside Trauma Center
Postvention Tasks
11) Evaluate postvention response
Lessons learned
Review/revise crisis plan/ protocols
Address “unfinished” business
Plan for milestones anniversary, graduation, workplace holiday party, etc.
Climbing – B. Matros
Riverside Trauma Center
Postvention Tasks
12) Develop community/ system wide prevention plan
Community coalition/task force Resource map of community leaders/
programs/people interested in helping Proactive use of media Address risk and protective factors Resilience curriculum Means reduction Sustainability Advocacy
Riverside Trauma Center
Examples of Risk & Protective Factors in a Social Ecological Model
Individual Societal
Community Relationship
Protective Factors
Risk Factors
Availability of Physical and mental health care
Restrictions on lethal means of suicide
Availability of lethal means of suicide
Unsafe media portrayals of suicide
Safe and supportive school and community environments
Sources of continued care after psychiatric hospitalization
Few available sources of supportive relationships
Barriers to health care (e.g. lack of access to providers or medications, prejudice
High Conflict or violent relationships
Family History of suicide
Connectedness to individuals, family , community, and social institutions
Supportive relationships with health care providers
Coping and problem solving skills
Reasons for living (e.g. children in the home)
Moral objections to suicide
Mental Illness
Substance abuse
Previous suicide attempt
Impulsivity/aggression
2012 National Strategy for Suicide Prevention Riverside Trauma Center
Dilemmas in Postvention
“We don’t think it was a suicide.” Large staff Meetings/Assemblies Notifications The “empty chair/desk” Memorials Services Rumors The Media The Diploma When the Family Shows Up
![Page 11: PowerPoint Presentationriversidetraumacenter.org/wp-content/uploads/2019/09/Postvention-I… · Barriers to health care Unsafe media portrayals of suicide Safe and supportive school](https://reader036.vdocuments.mx/reader036/viewer/2022070707/5ea128cf6c78384f3802a5b6/html5/thumbnails/11.jpg)
9/13/2019
11
Riverside Trauma Center
Lessons Learned
“Exposure” to suicide is more important (and complicated) (and confusing) than “Contagion”
Think about/plan for “cohorts” “Don’t take it personally but there is no way these guys are
going to talk to you…” The use of outside resources after a suicide death is essential:
Who is taking care of the “caretakers?” (The kids are watching) Expertise Reducing the stigma with an open response
Suicide is political and often engenders blame, guilt, & anger Social Media will greatly complicate your postvention response:
Immediacy Rumors Geography
Riverside Trauma Center
• Social Media has changed postvention
• Facebook Memorials
• Who is monitoring?
• “Worrisome” Posts
• Tips for Adolescents – Parents – Administrators
Role of Social Media in Postvention
![Page 12: PowerPoint Presentationriversidetraumacenter.org/wp-content/uploads/2019/09/Postvention-I… · Barriers to health care Unsafe media portrayals of suicide Safe and supportive school](https://reader036.vdocuments.mx/reader036/viewer/2022070707/5ea128cf6c78384f3802a5b6/html5/thumbnails/12.jpg)
9/13/2019
12
Riverside Trauma Center
Postvention Models and Resources
Excellent models exist:
Underwood and Dunne-Maxim, 1997
“Connect”NAMI, NH, 2010
Brock, 2003
Kerr, Brent et al., 2003
“After a Suicide: A Toolkit for Schools,” SPRC.org
“Postvention: A Guide for Response to Suicide on College Campuses” HEMHA.org
“A Manager’s guide for Suicide Postvention in the Workplace” Suicidology.org
Riverside Trauma Center
Riverside Trauma Center’s Postvention Guidelines
Connect
Carson Spencer Foundation
Crisis Care Network
The Loss Project
National Strategy for Suicide Prevention
Postvention Models for Agencies/
Businesses/ Communities
Riverside Trauma Center
Responding to Sudden, Unexpected Loss: Strategies for Supporting Schools, Organizations,
and Communities
Larry Berkowitz, EdD [email protected]
Jim McCauley, LICSW [email protected]