Tulare-Kings Counties SOS Signs of Suicide Project Proposal
Region VII Student Mental Health Initiative
TCOE Choices Prevention Programs
I. Overview
The Region VII Student Mental Health Initiative (which includes Tulare and Kings Counties) via the Tulare County Office of Education’s Choices Prevention Programs unit (TCOE Choices) will implement the SOS Signs of Suicide (SOS) program along with the Kings County Office of Education (KCOE). SOS as well as an additional educational component will be provided to all seventh graders in a minimum of six middle/junior high schools and all ninth graders in a minimum of six high schools in Tulare and Kings Counties, in the spring semester of 2013 and the 2013-2014 school year. Participating students will also be able to participate in a related service-learning project. An external evaluation is included to measure the impacts of the program in Kings and Tulare County schools and to suggest improvements, as needed, in its implementation.
II. The Applicant
The TCOE supports all of Tulare County’s school districts, operates schools for students with a variety of needs, and is responsible for many countywide programs for K-12 students. The KCOE plays the same role in Kings County. Among TCOE’s units is Choices Prevention Programs, its prevention arm, which helps students avoid the pitfalls of alcohol, tobacco, and other drugs and instead build positive life skills and develop and maintain a healthy lifestyle. TCOE Choices serves as the regional lead (for the region that includes Kings and Tulare Counties) for After-School Programs, Safe Schools in Crisis, and the Student Mental Health Initiative. TCOE Choices has a long history of successfully implementing effective research-validated curricula in schools throughout the County, including some that address mental health-related problems. TCOE Choices enjoys a positive working relationship with its counterpart unit in the KCOE. TCOE Choices has extensive experience administering a multitude of grant programs funded by the federal government, the State of California, and local governments.
III. The Curriculum
SOS Signs of Suicide Prevention Program is an award-winning, nationally recognized program designed for middle and high school-age students. The program teaches students how to identify the symptoms of depression and suicidality in themselves or their friends, and encourages help seeking through the use of the ACT® technique (Acknowledge, Care, Tell).
The SOS High School Program is the only school-based suicide prevention program listed on the Substance Abuse and Mental Health Services Administration’s National Registry of Evidence-based Programs and Practices that addresses suicide risk and depression, while reducing suicide attempts. In a randomized control study, the SOS program showed a reduction in self-reported suicide attempts by 40% (BMC Public Health, July 2007).
SOS Signs of Suicide is a secondary school-based intervention that includes screening and education. The basic program can be completed in roughly one hour at a bare minimum, but we believe and local experience in Woodlake indicates that it works well as a two class period program. (In our program we also propose adding an educational component to SOS in order to reinforce the content and develop student skills). Students are screened for depression and suicide risk and referred for professional help as indicated. Students view a 25-minute video that teaches them to recognize signs of depression and suicide in others. They are taught that suicide is not a normal response to stress, but rather a preventable tragedy that often occurs as a result of untreated depression. Students are given specific action steps, encouraged to engage in a discussion about these issues with their parents as well as utilize the peer-to-peer help-seeking model known as ACT® (Acknowledge-Care-Tell), that the appropriate response to these signs is to acknowledge them, let the person know you care, and tell a responsible adult (either with the person or on that person's behalf). The intervention attempts to prevent suicide attempts, increase knowledge about suicide and depression, develop desirable attitudes toward suicide and depression, and increase help-seeking behavior.
The SOS kit is designed to provide the tools needed to implement the program successfully utilizing existing school staff. The kit includes a procedure manual, step-by-step instructions including training materials, best practice guidelines, educational resources, lesson plans, templates (in English and Spanish), and a training DVD, so no formal training is necessary. There is also a 90-minute online self-paced interactive training course available free of charge. Continuing education credits (CEUs) are available for free for those who complete the course.
As noted above, the SOS Signs of Suicide® High School program incorporates peer intervention as part of its implementation strategy. Research indicates that adolescents are more likely to turn to peers than adults when facing a suicidal crisis. By training students to recognize the signs of depression, self-injury, and suicidality and empowering them to intervene when confronted with a friend who is exhibiting these symptoms, SOS capitalizes on an important social/emotional aspect of this developmental period.
The DVD features the true stories of three teenagers who all struggled with mental health issues. The video, which is the 2011 recipient of the Aster Award honoring excellence in medical marketing, also showcases vignettes that provide students with simple and specific instructions for how to recognize the signs of distress, in either themselves or a friend, and to respond effectively.
The High School Program includes a seven-question Brief Screen for Depression (BSAD) for both parents and students with scoring instructions. The parent version is an optional tool that schools can distribute to parents of students participating in the SOS Signs of Suicide Prevention program. It engages parents to be partners in prevention by assessing their son or daughter for possible suicide/depression risk factors.
Results from the Brief Screen for Adolescent Depression are not diagnostic, but merely indicate the presence, or absence, of symptoms that are consistent or inconsistent with depression or suicide. Negative responses to the questionnaire do not rule out depression/suicidality and positive responses do not conclusively establish depression/suicidality. A thorough diagnostic evaluation by a healthcare professional is always necessary to determine whether or not there is the presence/absence of depression/suicidality. Parents should be contacted immediately by phone if a student is deemed at-risk for suicide.
The High School Program also includes a student newsletter with helpful articles, facts, tips, and resources. The kit also includes wallet cards, posters, stickers with the ACT message, and postvention guidelines.
The content of the SOS Signs of Suicide® Middle School Program is the same as that of the High School Program, however it is designed to be appropriate for its target age group (grades 5-8). The accompanying video is also shorter (18 minutes long compared to 25 minutes for the High School Program). The Middle School Program also includes a newsletter for both parents and students, the BSAD depression screener for students only, educational materials for parents and staff, and stickers with the ACT message.
For counselors, educators, administrators and concerned parents, the goals of the program are to decrease suicide, suicide attempts, and self-injury through awareness and knowledge of the signs of depression, self-injury and suicidality in youth, and to provide information about available referral resources. By treating mental illness like any other physical illness, the program helps fight stigma surrounding depression and suicide. The SOS program is designed to incorporate discussion of mental health issues into existing health and wellness curricula. The program also increases self-efficacy and access to mental health services for at-risk youth and their families by getting schools to partner with community-based organizations that share the mission of reducing youth suicide.
IV. Alignment with Education
We plan not only to provide the SOS program to middle and high school students but, if desired by the school administrators at each school, to augment SOS with an educational component that both reinforces the information and themes of SOS and aligns SOS to current and future educational standards. We anticipate the educational component generally lasting one class period, for a total of three class periods for the program. This component will pertain to student mental health in general rather than focusing specifically on suicide.
The Common Core State Standards (CCSS), which are mandated to be followed by all California public schools by fall 2013, define the knowledge and skills students should have within their K-12 education careers so that they will graduate high school able to succeed in entry-level, credit-bearing academic college courses and in workforce training programs.
As stated in the CCSS Initiative Mission Statement, “The standards are designed to be robust and relevant to the real world, reflecting the knowledge and skills that our young people need for success in college and careers.”
We aim to add an educational component to SOS to align the program to educational standards, integrating what students learn about mental health and reinforcing it while also continuing students’ development of a variety of skills emphasized in the educational standards.
There is a wide range of possible activities that would help reinforce what students learn in SOS while they continue to develop skills that will help them in school and in life. For example, participating students might be asked to write a short essay about how they might respond to a hypothetical situation shown in the SOS video and why. Students could develop their analytical and speaking skills, alone or in teams, by participating in a debate and taking opposing sides of a situation or issue presented in the video. Students could also be asked to present information to the class about, say, the prevalence of mental health problems in their community or in Kings or Tulare Counties. This would require the students to do research (preferably using multiple sources), analyze the information, and make a coherent presentation based on what they learned.
Our program staff will have an variety of activities for students that will align SOS to CCSS. School administrators and teachers will be free to choose which ones will be used (depending on the educational needs of their students) and even, collaborating with us, to develop their own student activities to accompany SOS. Depending on the length of the desired educational component and program staff availability, staff may be limited to providing guidance to teachers at the participating schools, who would themselves implement the educational component.
We will also offer schools the opportunity to have students who participate in SOS create and implement a service-learning project related to the topic of suicide awareness and prevention. Students could, for example, help to educate members of their community at a local festival or resource fair or speak on the topic of suicide at venues in their communities, such as community centers, nursing homes, service clubs, and even elementary schools. Alternatively, they could develop skits to perform or create brochures or flyers with helpful information such as the national suicide hotline telephone number. The possible projects are limited only by the students’ imagination. The students would, of course, need to be given permission by their school administration and other organizations that would be involved or impacted. Program staff will guide the process of project development and implementation alongside school staff.
V. Implementation of the Program
Our program will provide SOS to all seventh graders in a minimum of six middle/junior high schools and all ninth graders in a minimum of six high schools in Tulare and Kings Counties over the time period of the grant: the spring semester of the 2012-2013 school year and the entire 2013-2014 school year. Schools will be given the choice of which classes SOS will be integrated into. While SOS can certainly be integrated into Health classes, it would work equally well in an English/Language Arts class or a variety of Social Studies classes. These subjects would allow for relatively easy alignment with the Common Core State Standards.
Program staff will teach SOS initially at all program schools that choose to participate, spread throughout the semester. We will ask school administrators their preferences of instruction dates and then set a schedule for the semester or school year. A permission slip will need to be signed by students’ parents or guardians in order for them to participate. It will include permission to collect screening and evaluation data.
While program staff will teach SOS initially at all schools, the goal is to transition instruction to school staff. We will ask that each participating school have two staff members available, preferably one of them a counselor, to serve as Mental Health Advisors. These individuals will initially serve as an SOS co-instructor and complete ASIST training, but after about a semester they will transition to become the sole instructor of most if not all SOS classes at each school, including the educational component. The Mental Health Advisors will also serve as the on-site point of contact for students who have suicidal thoughts or concerns about their mental health or that of their fellow students. The Mental Health Advisors will be able to refer students at risk of suicide to mental health professionals for screening, diagnosis, case management, and other help. Program staff will remain available to support the on-site Mental Health Advisor as needed by, for example, helping to organize service-learning projects and parent nights and helping iron out any kinks in the referral process.
We believe it is a good idea to have a therapist from a mental health partner organization in each school’s area (such as Kings View, TCOE Behavioral Services, Tulare Youth Service Bureau, Visalia Youth Services, or qualified staff members of Family Resource Centers) to be present in at least several SOS sessions in each SOS course, in order to help answer any questions the students may have, to serve as a friendly face of the mental health profession, and to talk briefly about the help these organizations can offer students in need of help. We believe that having a therapist speak directly to students and emphasize his or her organization’s availability will make it more likely that students will ask for help for themselves or their peers. A small stipend of $100 per SOS class will be provided to the visiting therapists.
Our program staff from TCOE Choices and the KCOE will quickly become experts in SOS, adept at teaching the program, and will know how to connect students who score high on the BSAD to help. They will convey this knowledge to the Mental Health Advisors at each school. Program staff will also become highly skilled in integrating the educational component into SOS in a variety of ways, giving school administrators and teachers a menu of options to choose from. This list of options will include a service-learning project.