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SPRC Research to Practice Webinar Expanding Suicide Prevention to Include Upstream Approaches September 25, 2012 If you are experiencing technical difficulties, please call 307-GET-WEB1 (307-438-9321)
Opening Remarks Gail F. Ritchie
SAMHSA’S MISSION To reduce the impact of substance abuse and mental illness on America’s communities
SAMHSA and the Institute of Medicine Preventing Mental, Emotional, and Behavioral Disorders, Among Young People, Progress and Possibilities National Research Council and Institute of Medicine, 2009
Contact Information Gail F. Ritchie, M.S.W., LCSW-C Coordinator, Prevention Practices in Schools Grant Program Mental Health Promotion Branch Substance Abuse and Mental Health Services Administration gail.ritchie@samhsa.hhs.gov
Today’s Presenter Philip Rodgers, PhD
Expanding the Youth Suicide Prevention Paradigm: Establishing and Promoting the Importance of Upstream Suicide Prevention Approaches Expert meeting held at the 45th Annual Conference of the American Association of Suicidology, April 18, 2012, Baltimore, MD. Organizing Committee • Scott Fritz, SPTS • Effie Malley, formerly of AAS • Maureen Underwood, SPTS • Peter Wyman, U. of Rochester Medical Center • Phil Rodgers, AFSP
U.S. Suicide Rate for 1999-2009 by Age 14 12 10 Rate per 100,000 Can a suicide 8 that occurs here 6 Have been 4 prevented here? 2 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age
U.S. Suicide Rate for Years 1999-2009 by Age Group 16 14 12 Rate per 100,000 10 8 6 4 2 0 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 Age 5-9 Age 10-14 Age 15-19 Age 20-24
The IOM report supports a Mental Health Intervention Spectrum O’Connell, Boat, & Warner (2009). Preventing Mental, Emotional, and Behavioral Disorders Among Young People . Washington, D.C.: The National Academies Press.
U.S. Suicide Rate for 1999-2009 by Age 14 12 10 Can a suicide that Rate per 100,000 could occur here 8 6 Be prevented here? 4 2 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age
Today’s Presenter Dennis D. Embry, PhD
Acting for Early, Upstream Suicide Prevention Dennis D. Embry, Ph.D. Research to Practice President/Senior Scientist Webinar PAXIS Institute
A recent webinar experience on the topic
Is this early prevention?
Is this early prevention?
Is this early prevention?
Is this early prevention?
Thinking way upstream Really? What if we started here with early suicide prevention?
Thinking way upstream What might be the early malleable predictors? Could we actually change those predictors easily and reliably? And what else might change as a consequence of the prevention or protection strategies.
risk factors during development from early childhood to adolescence Psychiatric problems in childhood and/or adolescence, including depression Child and/or adolescent externalizing disorders Childhood adversity (especially with the above) Low self-esteem (self-efficacy) Aggressive or delinquent behavior Prax Kinderpsychol Kinderpsychiatr. 2012;61(1):32-49.
When are these risk factors most universally detectable? First Grade Psychiatric problems in childhood and/or adolescence, including depression Child and/or adolescent externalizing disorders Childhood adversity (especially with the above) Low self-esteem (self-efficacy) Aggressive or delinquent behavior
Adolescence Thinking midstream What might be the midstream malleable predictors? • Early and current smoking • Dose response, MORE smoking = MORE suicide risk, controlling for other variables • Smoking affects monoamine oxidase (MAO), which increases suicide risk Breslau et al. Arch Gen Psychiatry 2012;():1-8
Hypothesis #1 If we can reduce early aggressive or ADHD-like behavior and victimization by peers in First Grade, that might be the first step toward the long-term prevention of suicide. Golly, almost every teacher would like it if there was more time to teach and for kids to learn.
Hypothesis #1 If we can reduce early aggressive or ADHD-like behavior and victimization by peers in First Grade, that might be the first step toward the long-term prevention of suicide. Let ’ s see if we can reduce disturbing, distracting, and inattentive behaviors in classrooms — as our first test.
Muriel Saunders invented the Game in 1967 as a first-year, 4th grade teacher. Published as a study in 1969. Harriet Barrish Montrose Wolf
www.pubmed.gov
Longitudinal Johns Hopkins Studies of GBG Kindergarden First Grade Grades 2 thru 12 Young Adulthood Follow Up Follow Up Age Age Age No More GBG GBG Every 26 30 19-21 child rated by NO Age Age Age No GBG teachers GBG 26 30 19-21 Tested in 41 first- Purpose: To find out Purpose: To find and second-grade if GBG affected their out if GBG classrooms within adolescent lives. affected their 19 elementary adult lives. schools with two consecutive groups of first graders.
By the early 1990s, multiple studies including this randomized one proved that GBG reduced the early predictive behaviors.
Wow! In 1998, Drs. Kellam and Anthony showed that GBG reduced tobacco initiation—one of the middle predictors. Tobacco Initiation (Age of First Use)
So now, let ’ s see if GBG affects suicide indicators among youth and young adults. Wilcox, H. C., Kellam, S., Brown, C. H., Poduska, J., Ialongo, N., Wang, W., & Anthony, J. (2008). The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts. Drug & Alcohol Dependence, 95(Suppl 1), 60-73.
So now, let ’ s see if GBG affects suicide indicators among youth and young adults. Wilcox, H. C., Kellam, S., Brown, C. H., Poduska, J., Ialongo, N., Wang, W., & Anthony, J. (2008). The impact of two universal randomized first- and second-grade classroom interventions on young adult suicide ideation and attempts. Drug & Alcohol Dependence, 95(Suppl 1), 60-73.
Timeline of Benefits… First Month More time for teaching Less stress for Staff and learning & Students First Year Fewer Better Fewer Less Happier Better Less Service Attendance Referrals Illness Families Vandalism Academics Needs 2nd & 3rd Years ADHD Oppositional Special Education Averted Defiance Averted Averted 5-15 Years No Less Less Crime, High School Grad & Less Less Conduct University Tobacco Alcohol Depression Violence, Suicide Disorders
How is this accomplished?
By teams with group based reward— during any regular teaching & learning activity The Blue Team The Red Team The Yellow Team
e.g., disturbing The Team Aim: behaviors to Win Spleems are counted and marked with neutral tone for the team, not the individual child. Jan 23 Ms. Dion Teams who have 3 or fewer Spleems win. Winning teams earn a “ Granny ’ s Blue Wacky Prize ” . Red Yellow Team having 4 or more Spleems 20 20 lose that game. 60 40 PAX Minutes = winning teams x minutes played.
Thank you, Dennis D. Embry, Ph.D dde@paxis.org 1-520-299-6770
Today’s Discussants Sheppard G. Kellam, MD Morton M. Silverman, MD
Today’s Discussants Sheppard G. Kellam, MD Morton M. Silverman, MD
Thank you!
www.sprc.org Xan Young, MPH SPRC Training Institute, Project Director xyoung@edc.org 202-572-3728 Dominique Lieu SPRC Training Institute, Training Specialist dlieu@edc.org 617-618-2984
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