Children's Hospitals Today - Spring 2017 - 26

FEATURE / SUICIDE

Prevention strategies
When adolescent suicides occur, behavioral health providers must be
prepared to act. But as community
stewards, it's important to implement
preemptive measures as well. In the
years before the two suicide clusters,
UF Health developed The Partners in
Adolescent Lifestyle Support (PALS)
program as a community health initiative. Since 2001, PALS has been a UF
Health-sponsored, school-based initiative where licensed therapists from
UF Health Shands Psychiatric Hospital
supervise advanced Ph.D. or masterslevel psychology students. This group
provides peer support and therapeutic
intervention to students and enhances
leadership skills for teens. Services
include crisis intervention, individual
psychotherapy and group psychotherapy. PALS has programming available to schools and counseling services
for at-risk students who are identified
through self-referrals or referrals from
other students, parents or teachers.
PALS administrators work with
schools to hold scheduled events to
raise awareness about mental health.
For example, twice a year, a local high
school hosts a large seminar on suicide
and bullying prevention and conducts
events in each class. In addition, PALS
facilitates ad hoc events at the request
of school administrators. In one instance, University of Florida College of
Pharmacy professionals presented at a
high school to educate students about
prescription drug abuse and awareness.

Common language

EXECUTIVE FUNCTIONING
Set of processes that have to
do with managing oneself and
one's resources to achieve a
goal; umbrella term for skills
involving mental control
and self-regulation

SOCIAL LEARNING
THEORY
The idea that people learn from
one another, via observation,
imitation and modeling

SUICIDE CLUSTER
A group of suicides, attempts or
both that occur close together
in time and space than what
would be normally expected in a
given community

When prevention
doesn't work
Despite best efforts to prevent adolescent suicides with programs like PALS
in place, negative outcomes can occur.
Admission data to the psychiatric hospital demonstrates the phenomenon of
suicide clusters. In the year before the
suicide cluster, the hospital averaged 0.5
admissions per month for students from

CHILDREN'S HOSPITAL S TODAY Spring 2017

SUICIDE CONTAGION
Exposure to suicide or suicidal
behaviors within one's family,
peer group or through media
reports of suicide; can result
in an increase in suicide or
suicidal behaviors

School A. In the two months after the
suicide cluster at School A, the hospital
admitted 14 students-drastically higher than the annual age-adjusted suicide
death rate per 100,000 in Florida.
Admissions from School B's suicide
cluster displayed a similar narrative
in the months after the event. Before
the suicide cluster, the hospital admitted, on average, 3.04 students per
month from this school. After the first
identified suicide, admissions reached
13 the next month, and averaged 7.25
admissions for eight months. As the
numbers indicate, appropriate reactive
measures are necessary when a suicide
cluster is active. So how can a hospital
prevent further negative outcomes and
respond in times of community crisis?
PALS administrators offered special
programming and extended hours of
service within each school. As a community benefit program, PALS services
were available when schools needed
them, and leaders at each school decided what best fit the students' needs.
For example, School A increased its
law enforcement and mental health
counseling presence on campus, and
through a grant, hired a full-time
social worker for care coordination.
Additionally, parents organized an
education night focused on suicide prevention, and a UF Child and Adolescent
Psychiatry trainee presented on how
to differentiate normal and depressed
behaviors in children.
School B decided additional programming would increase the potential for
copycat actions and declined additional ad hoc PALS services. Without future
controlled studies, it's difficult to define
the most appropriate follow-up measures for mitigating suicide clusters.
For hospitals, it's important that all
intake counselors are up-to-date on
news related to suicide clusters and resulting protocols or protocol changes.
At UF Shands, the team disseminates
pertinent information or processes and
ensures redundancy of communication

Table of Contents for the Digital Edition of Children's Hospitals Today - Spring 2017