School Counseling

Suicide is the second leading cause of death among school age youth. However, suicide is preventable. Youth who are contemplating suicide frequently give warning signs of their distress. Parents, teachers, and friends are in a key position to pick up on these signs and get help. Most important is to never take these warning signs lightly or promise to keep them secret. When all adults and students in the school community are committed to making suicide prevention a priority-and are empowered to take the correct actions-we can help youth before they engage in behavior with irreversible consequences

Suicide Risk Factors

Although far from perfect predictors, certain characteristics are associated with increased odd of having suicidal thoughts. These include:

• Mental illness including depression, conduct disorders, and substance abuse.
• Family stress/dysfunction.
• Environmental risks, including presence of a firearm in the home.
• Situational crises (e.g., traumatic death of a loved one, physical or sexual abuse, family violence).

Suicide Warning Signs

Most suicidal youth demonstrate observable behaviors that signal their suicidal thinking. These include:

• Suicidal threats in the form of direct ("I am going to kill myself") and indirect ("I wish I could fall asleep and never wake up again") statements.
• Suicide notes and plans (including online postings).
• Prior suicidal behavior.
• Making final arrangements (e.g., making funeral arrangements, writing a will, giving away prized possessions).
• Preoccupation with death.
• Changes in behavior, appearance, thoughts and/or feelings.

What to Do

Youth who feel suicidal are not likely to seek help directly; however, parents, school personnel, and peers can recognize the warning signs and take immediate action to keep the youth safe. When a youth gives signs that they may be considering suicide, the following actions should be taken:

• Remain calm.
• Ask the youth directly if he or she is thinking about suicide (e.g., "Are you thinking of suicide?").
• Focus on your concern for their well-being and avoid being accusatory.
• Listen.
• Reassure them that there is help and they will not feel like this forever.
• Do not judge.
• Provide constant supervision. Do not leave the youth alone.
• Remove means for self-harm.
• Get help: No one should ever agree to keep a youth's suicidal thoughts a secret and instead should tell an appropriate caregiving adult, such as a parent, teacher, or school psychologist. Parents should seek help from school or community mental health resources as soon as possible. School staff should take the student to a school-employed mental health professional or administrator.

The Role of the School in Suicide Prevention

Children and adolescents spend a substantial part of their day in school under the supervision of school personnel. Effective suicide and violence prevention is integrated with supportive mental health services, engages the entire school community, and is imbedded in a positive school climate through student behavioral expectations and a caring and trusting student/adult relationship. Therefore, it is crucial for all school staff members to be familiar with, and watchful for, risk factors and warning signs of suicidal behavior. The entire school staff should work to create an environment where students feel safe sharing such information. School psychologists and other crisis response team personnel, including the school counselor and school administrator, are trained to intervene when a student is identified at risk for suicide. These individuals conduct suicide risk assessment, warn/inform parents, provide recommendations and referrals to community services, and often provide follow up counseling and support at school.

Parental Notification and Participation

Even if a youth is judged to be at low risk for suicidal behavior, schools may ask parents to sign a documentation form to indicate that relevant information has been provided. Parental notifications must be documented. Additionally, parents are crucial members of a suicide risk assessment as they often have information critical to making an appropriate assessment of risk, including mental health history, family dynamics, recent traumatic events, and previous suicidal behaviors. After a school notifies a parent of their child's risk for suicide and provides referral information, the responsibility falls upon the parent to seek mental health assistance for their child. Parents must:

• Continue to take threats seriously: Follow through is important even after the child calms down or informs the parent "they didn't mean it." Avoid assuming behavior is simply attention seeking (but at the same time avoid reinforcing suicide threats; e.g., by allowing the student who has threatened suicide to drive because they were denied access to the car).
• Access school supports: If parents are uncomfortable with following through on referrals, they can give the school psychologist permission to contact the referral agency, provide referral information, and follow up on the visit.
• Maintain communication with the school: After such an intervention, the school will also provide follow-up supports. Your communication will be crucial to ensuring that the school is the safest, most comfortable place for your child.

Resiliency Factors

The presence of resiliency factors can lessen the potential of risk factors to lead to suicidal ideation and behaviors. Once a child or adolescent is considered at risk, schools, families, and friends should work to build these factors in and around the youth. These include:

• Family support and cohesion, including good communication.
• Peer support and close social networks.
• School and community connectedness.
• Cultural or religious beliefs that discourage suicide and promote healthy living.
• Adaptive coping and problem-solving skills, including conflict-resolution.
• General life satisfaction, good self-esteem, sense of purpose.
• Easy access to effective medical and mental health resources.

© 2015, National Association of School Psychologists, 4340 East West Highway, Suite 402, Bethesda, MD 20814; (301) 657-0270, Fax (301) 657-0275; www.nasponline.org

Additional Information

Schools and communities around the country will be impacted by the loss of life associated with the war in Iraq. The effects may be significant for some people because of their emotional closeness to the war and/or their concern over terrorism. How school personnel handle the resulting distress can help shape the immediate and longer-term grieving process for students, staff, and families. Children, in particular, will need the love and support of their teachers and parents to cope with their loss and reach constructive grief resolution.

Expressions of Grief

Talking to children about death must be geared to their developmental level, respectful of their cultural norms, and sensitive to their capacity to understand the situation. Children will be aware of the reactions of significant adults as they interpret and react to information about death and tragedy. In fact, for primary grade children adult reactions will play an especially important role in shaping their perceptions of the situation. The range of reactions that children display in response to the death of significant others may include:

• Emotional shock and at times an apparent lack of feelings, which serve to help the child detach from the pain of the moment;
• Regressive (immature) behaviors, such as needing to be rocked or held, difficulty separating from parents or significant others, needing to sleep in parent’s bed or an apparent difficulty completing tasks well within the child’s ability level;
• Explosive emotions and acting out behavior that reflect the child’s internal feelings of anger, terror, frustration and helplessness. Acting out may reflect insecurity and a way to seek control over a situation for which they have little or no control;
• Asking the same questions over and over, not because they do not understand the facts, but rather because the information is so hard to believe or accept. Repeated questions can help listeners determine if the child is responding to misinformation or the real trauma of the event.

Helping Children Cope

The following tips will help teachers, parents, and other caregivers support children who have experienced the loss of parents, friends, or loved ones. Some of these recommendations come from Dr. Alan Wolfelt, Director of the Center for Loss and Life Transition in Fort Collins, Colorado.

• Allow children to be the teachers about their grief experiences: Give children the opportunity to tell their story and be a good listener.
• Don’t assume that every child in a certain age group understands death in the same way or with the same feelings: All children are different and their view of the world is unique and shaped by different experiences. (Developmental information is provided below.)
• Grieving is a process, not an event: Parents and schools need to allow adequate time for each child to grieve in the manner that works for that child. Pressing children to resume “normal” activities without the chance to deal with their emotional pain may prompt additional problems or negative reactions.
• Don’t lie or tell half-truths to children about the tragic event: Children are often bright and sensitive. They will see through false information and wonder why you do not trust them with the truth. Lies do not help the child through the healing process or help develop effective coping strategies for life’s future tragedies or losses.
• Help all children, regardless of age, to understand loss and death: Give the child information at the level that he/she can understand. Allow the child to guide adults as to the need for more information or clarification of the information presented. Loss and death are both part of the cycle of life that children need to understand.
• Encourage children to ask questions about loss and death: Adults need to be less anxious about not knowing all the answers. Treat questions with respect and a willingness to help the child find his or her own answers.
• Don’t assume that children always grieve in an orderly or predictable way: We all grieve in different ways and there is no one “correct” way for people to move through the grieving process.
• Let children know that you really want to understand what they are feeling or what they need: Sometimes children are upset but they cannot tell you what will be helpful. Giving them the time and encouragement to share their feelings with you may enable them to sort out their feelings.
• Children will need long-lasting support: The more losses the child or adolescent suffers, the more difficult it will be to recover. This is especially true if they have lost a parent who was their major source of support. Try to develop multiple supports for children who suffer significant losses.
• Keep in mind that grief work is hard: It is hard work for adults and hard for children as well.
• Understand that grief work is complicated: Deaths that result from a terrorist act or war can brings forth many issues that are difficult, if not impossible, to comprehend. Grieving may also be complicated by a need for vengeance or justice and by the lack of resolution of the current situation: the conflict may continue and the nation may still feel at risk. The sudden or violent nature of the death or the fact that some individuals may be considered missing rather than dead can further complicate the grieving process.
• Be aware of your own need to grieve: Focusing on the children in your care is important, but not at the expense of your emotional needs. Adults who have lost a loved one will be far more able to help children work through their grief if they get help themselves. For some families, it may be important to seek family grief counseling, as well as individual sources of support.

Developmental Phases in Understanding Death

It is important to recognize that all children are unique in their understanding of death and dying. This understanding depends on their developmental level, cognitive skills, personality characteristics, religious or spiritual beliefs, teachings by parents and significant others, input from the media, and previous experiences with death. Nonetheless, there are some general considerations that will be helpful in understanding how children and adolescents experience and deal with death.

• Infants and Toddlers: The youngest children may perceive that adults are sad, but have no real understanding of the meaning or significance of death.
• Preschoolers: Young children may deny death as a formal event and may see death as reversible. They may interpret death as a separation, not a permanent condition. Preschool and even early elementary children may link certain events and magical thinking with the causes of death. For instance, as a result of the World Trade Center disaster, some children may imagine that going into tall buildings may cause someone’s death.
• Early Elementary School: Children at this age (approximately 5-9) start to comprehend the finality of death. They begin to understand that certain circumstances may result in death. They can see that, if large planes crash into buildings, people in the planes and buildings will be killed. In case of war images, young children may not be able to differentiate between what they see on television, and what might happen in their own neighborhood. However, they may over-generalize, particularly at ages 5-6—if jet planes don’t fly, then people don’t die. At this age, death is perceived as something that happens to others, not to oneself or one’s family.
• Middle School: Children at this level have the cognitive understanding to comprehend death as a final event that results in the cessation of all bodily functions. They may not fully grasp the abstract concepts discussed by adults or on the TV news but are likely to be guided in their thinking by a concrete understanding of justice. They may experience a variety of feelings and emotions, and their expressions may include acting out or self-injurious behaviors as a means of coping with their anger, vengeance and despair.
• High School: Most teens will fully grasp the meaning of death in circumstances such as an automobile accident, illness and even the World Trade Center or Pentagon disasters. They may seek out friends and family for comfort or they may withdraw to deal with their grief. Teens (as well as some younger children) with a history of depression, suicidal behavior and chemical dependency are at particular risk for prolonged and serious grief reactions and may need more careful attention from home and school during these difficult times.

Tips for Children and Teens with Grieving Friends and Classmates

Seeing a friend try to cope with a loss may scare or upset children who have had little or no experience with death and grieving. Following are some suggestions teachers and parents can provide to children and youth to deal with this “secondary” loss.

• Particularly with younger children, it will be important to help clarify their understanding of death. See tips above under “helping children cope.”
• Seeing their classmates’ reactions to loss may bring about some fears of losing their own parents or siblings, particularly for students who have family in the military or other risk related professions. Children need reassurance from caregivers and teachers that their own families are safe. For children who have experienced their own loss (previous death of a parent, grandparent, sibling), observing the grief of a friend can bring back painful memories. These children are at greater risk for developing more serious stress reactions and should be given extra support as needed.
• Children (and many adults) need help in communicating condolence or comfort messages. Provide children with age-appropriate guidance for supporting their peers. Help them decide what to say (e.g., “Steve, I am so sorry about your father. I know you will miss him very much. Let me know if I can help you with your paper route….”) and what to expect (see “expressions of grief” above).
• Help children anticipate some changes in friends’ behavior. It is important that children understand that their grieving friends may act differently, may withdraw from their friends for a while, might seem angry or very sad, etc., but that this does not mean a lasting change in their relationship.
• Explain to children that their “regular” friendship may be an important source of support for friends and classmates. Even normal social activities such as inviting a friend over to play, going to the park, playing sports, watching a movie, or a trip to the mall may offer a much needed distraction and sense of connection and normalcy.
• Children need to have some options for providing support—it will help them deal with their fears and concerns if they have some concrete actions that they can take to help. Suggest making cards, drawings, helping with chores or homework, etc. Older teens might offer to help the family with some shopping, cleaning, errands, etc., or with babysitting for younger children.
• Encourage children who are worried about a friend to talk to a caring adult. This can help alleviate their own concern or potential sense of responsibility for making their friend feel better. Children may also share important information about a friend who is at risk of more serious grief reactions.
• Parents and teachers need to be alert to children in their care who may be reacting to a friend’s loss of a loved one. These children will need some extra support to help them deal with the sense of frustration and helplessness that many people are feeling at this time.

Resources for Grieving and Traumatized Children

At times of severe stress, such as the trauma of war or terrorist attacks, both children and adults need extra support. Children who are physically and emotionally closest to this tragedy may very well experience the most dramatic feelings of fear, anxiety and loss. They may have personally lost a loved one or know of friends and schoolmates who have been devastated by these treacherous acts. Adults need to carefully observe these children for signs of traumatic stress, depression or even suicidal thinking, and seek professional help when necessary.

Resources to help you identify symptoms of severe stress and grief reactions are available at the National Association of School Psychologist’s website— www.nasponline.org. See also:

• For Caregivers
  Deaton, R.L. & Berkan, W.A. (1995). Planning and managing death issues in the schools: A handbook. Westport, CT: Greenwood Publishing  Group.
• Mister Rogers Website: www.misterrogers.org (see booklet on Grieving for children 4-10 years)
• Webb, N.B. (1993). Helping bereaved children: A handbook for practitioners. New York: Guilford Press.
• Wolfelt, A. (1983). Helping children cope with grief. Bristol, PA: Accelerated Development.
• Wolfelt, A (1997). Healing the bereaved child: Grief gardening, growth through grief and other touchstones for caregivers. Ft. Collins, CO: Companion.
• Worden, J.W. (1996). Children and grief: When a parent dies. New York: Guilford Press
• Helping Children Cope With Death, The Dougy Center for Grieving Children, www.dougy.org.
  For Children
• Gootman, M.E. (1994). When a friend dies: A book for teens about grieving and healing. Minneapolis: Free Spirit Publishing.
• Greenlee, S. (1992). When someone dies. Atlanta: Peachtree Publishing. (Ages 9-12).
• Wolfelt, A. (2001). Healing your grieving heart for kids. Ft. Collins, CO: Companion. (See also similar titles for teens and adults)

Adapted from material first posted on the NASP website after September 11, 2001. NASP has made these materials available free of charge to the public in order to promote the ability of children and youth to cope with traumatic or unsettling times. The materials may be adapted, reproduced, reprinted, or linked to websites without specific permission. However, the integrity of the content must be maintained and NASP must be given proper credit.

© 2003, National Association of School Psychologists, 4340 East West Highway, Suite 402, Bethesda, MD 20814, 301-657-0270, www.nasponline.org